Professor Annemarie Jutel of Victoria University of Wellington’s Graduate School of Nursing, Midwifery and Health applauds the shift in thinking provided by the Wellbeing Budget, but stresses the need to address the social determinants of health, alongside improvement in service delivery, if all New Zealanders are to benefit.

The Wellbeing Budget represents an important shift in rethinking how and what governments focus on in improving the lives of New Zealanders. This shift away from the narrowly economic focus of previous governments must be applauded.

With a record $1.9billion allocated over five years to transform our approach to mental health and addiction, and targeted and tailored initiatives to improve Māori and Pacific peoples’ health and wellbeing, there are positive signs this government intends on embracing a more holistic vision of health and wellbeing.

Nevertheless, in order for the government to make real strides in increasing the health and wellbeing of New Zealanders, it needs to be considering the various social determinants responsible for the many inequities we see in health.

The social determinants of health are the conditions in which people are born, grow, live, work and age, and are shaped by the distribution of money, power and resources at all levels. To think that we can look at mental health and suggest that it is a problem of medicine and counselling, is to overlook that poverty, inequity and the structure of society contributes to the pressures experienced by young and old alike in society today.

It is these pressures, coupled with years of underfunding that have led to the issues the Mental Health Package seeks to address.

Aside from the very real issue of staffing the initiatives within the Mental Health Package, many will also question whether there is enough space within the Budget to address the various social determinants of health and for promoting and allowing for mental, physical and social wellbeing, rather than simply ‘fixing mental health’.

Whanau-centred approaches to primary health care, community-led interventions and increasing the numbers of Māori and Pacific Peoples in health care can provide effective service delivery, while also addressing inequities. It’s important that this Budget recognises the role of culture in health policy and service delivery.

However, if we want our people to eat healthy, to be healthy and to seek early medical attention, then our people must be able to afford to do so. It’s not just a matter of making a choice, it’s about having a choice.

When people live in inadequate settings or contexts, they do not have the control of those things many of us take for granted: good food, good air, warm dwellings, and the knowledge of where tomorrow’s breakfast will come from. They do not have control of those things which are vital to our health and wellbeing, both mental and physical.

The indexing of main benefits to wage growth will relieve some of the pressures experienced by some low income families and will begin to address a key economic factor determining health. My hope is that we continue to address these key social and economic determinants as we fund and make decisions on improving the health and wellbeing of New Zealanders. The Wellbeing Budget is a start, but there needs to be more.