Sir Collin Tukuitonga has been a leading figure in health policy for nearly three decades, including as the country’s Director of Public Health.

He resigned from all his government roles at the end of 2023. He’s since been followed by another top three public health servants, who’ve departed in recent months over ongoing restructures and government decision-making. 

In this conversation with Teuila Fuatai, Sir Collin reflects on his public health career and explains why he made the call to quit.

I went into public health policymaking because I thought I could change the world.

I’d been in general practice for about 10 years, and I’d come to resent the pattern of healthcare I was part of.

Most of my patients were Pacific. Each week, they’d come in with similar illnesses, which were almost always linked to poor housing conditions and poverty.

The children’s issues were particularly heartbreaking — they suffered from a treat-and-repeat cycle of problems like coughs and ear infections. Symptoms that I knew were attributable to overcrowding and cold homes.

Eventually, I started thinking more broadly about my practice and role as a Pacific doctor.

If I could just get involved in housing policy, I thought, then maybe I could convince the government to improve the warmth of houses, and to create more space in the houses they were building. That would, in turn, stem the pipeline of illnesses we were seeing in our community clinics.

I believed that was the way forward. I wanted to shape public policy in a direction that benefited more people, especially those who needed it most. Just like today, the greatest need was in Pacific and Māori communities, where poorer health outcomes reflected inequities in care and their wider social-economic circumstances.

Of course, this was easier said than done. But for 30 years, I stuck at it. I held my years as a GP and my dreams of a better health baseline for communities in the front of my mind. When I started in policy work, that was my general focus. Then, in later years, I worked specifically on Pacific health and related issues.

Eventually, I became Director of Public Health at the Ministry of Health. I’ve also been chief executive of the old Ministry of Pacific Island Affairs. Over the years, my advisory roles have spanned various working groups, mostly focused on health, but also with the Pacific ministry and ACC.

Like any career, there have been big moments, and wins and losses.

The meningitis epidemic in the 1990s is something I’ll never forget. We had a lot of people, particularly teenagers, dying. Just like Covid, Māori and Pacific were among the worst affected, and that resulted in the deaths of young people.

I was involved in getting a vaccine from Europe for the meningococcal B strain that caused the epidemic. The vaccine rollout, alongside a programme of information and education for families, led to a marked decline in cases of kids with meningococcal disease.

I’m also proud of my involvement in programmes to support clinics that are owned and run by Pacific communities. Contributing to the establishment of the Pacific healthcare provider The Fono, in the late 1980s in West Auckland, remains a career highlight.

Of course, the problem with public health is that it’s never that clear-cut. You can’t say that I did this or I did that because it takes a number of years to see change, and it inevitably involves a whole lot of people and policy areas. On top of that, when you’re focused on Pacific, and Māori health, the politics around policymaking become critical. Even though that shouldn’t be the case.

In my experience, whoever was the Minister of Health — and how well they understood inequity — was particularly important.

Essentially, the minister needed to be on-side for anything that required money and was outside standard, conventional policymaking. “Conventional”, back then, referred to the Pākehā population, the so-called “mainstream”. In that sense, without the minister’s support, policies that targeted Pacific never saw the light of day.

Today, “universal” has replaced “conventional” or “mainstream” in the policy rhetoric.

With all the current political noise, it’s worth spelling out what that means.

In health, universalism is the idea that everyone should get exactly the same care, regardless of background or circumstance. It works if you’re middle class and Pākehā because your health needs almost always fall into the majority.

It doesn’t work for population groups outside these parameters — which are disproportionately Pacific and Māori — because those groups have a different baseline. And there’s ample evidence for that. For example, diabetes is six times more prevalent in Pacific people than in Pālagi. For Māori, diabetes is four times more common than for Pākehā.

The public health perspective will always say that, to address inequities, like those we see in diabetes rates, we should target resources to those who need it most.

Unfortunately, despite our success when we do exactly that, and all the research and evidence that validates the approach, targeted health policies remain a tough sell at the decision-making level. We see that even more in today’s political climate.

I’ve faced open racism when advocating for Pacific health in the policy space.

I’ve also navigated less blatant racist views and bias among colleagues. Often, this comes in the form of comments like:

“Why are you guys special?”

“Your poor health is your own fault. Eat healthy. It’s simple.”

“Everyone needs this, there’s no particular reason why we should be targeting Pacific people.”

Right now, that perspective is being spearheaded by the ACT Party. Over and over again, we’re being told that everyone should be treated the same.

That’s flawed and driven by ideology rather than evidence.

But ideology-driven decision-making is common practice among our officials and policymakers. In 2013, Sir Peter Gluckman, the prime minister’s chief science adviser at the time, did a comprehensive review of policymaking in Wellington. He found that despite all the talk about evidence-based and data-driven decisions, a lot of policy was based on personal values and individual experience.

It’s an area this government has excelled in.

Generally, when a new government takes office,  programmes targeting Pacific and Māori that work well are allowed to continue. I’ve seen that happen when we’ve swung from National to Labour and vice versa. Governments tend to be wary of the  political fallout from cutting programmes that deliver results.

For example, the Pacific Provider Development Programme was established in 1998 when Bill English was the Minister of Health. The initiative provided funding for Pacific community health providers after research showed patients who saw health practitioners from a similar cultural background were more likely to experience better health outcomes. When Labour came into power, they kept it going. That programme still exists today — and has so far survived the assault on targeted policy initiatives.

But then, at the end of 2023, our smokefree legislation was repealed by the coalition government. That changed everything for me.

The legislation was designed to move us toward a smokefree Aotearoa by the end of this year. Planned changes included curtailing the sale of cigarettes to young people born after 2009, reducing the number of outlets selling tobacco products from 700 to 70, and making de-nicotised cigarettes — that is, cigarettes without nicotine — available.

I saw it as a gamechanger, particularly for Māori and Pacific.

Despite the steady decline in the overall smoking rate in the past 20 years, rates among Māori and Pacific people have remained twice as high as those for Pākehā.

Ease of access is a significant factor. We know that where our people live, suburbs like Ōtara and Māngere, there are more fast food outlets, alcohol outlets and places that sell cigarettes. They cluster in these areas rather than in suburbs like Remuera and Mission Bay. Drastically reducing the number of outlets selling cigarettes simply makes them less available.

We also know from international research that nicotine is the most addictive component in cigarettes. Through the legislation, we’d laid the foundations for an Aotearoa where nicotine-free, and thus non-addictive, cigarettes were the norm. We were setting up the young people of today for a much healthier future.

I was so proud of the plan, and totally devastated when it was scrapped only a year into implementation.

I thought it was completely immoral behaviour from our policymakers. Even worse was that the repeal was linked to the need for the government to find money for its tax cuts.

That meant Pacific, and Māori, would not only lose out in terms of anti-smoking initiatives, we’d also end up paying more toward the tax cuts. Cigarettes have a significant tax, so the more you smoke, the more you pay for that policy.

Not long after, the government also disestablished the work of the Māori Health Authority. Again, I thought that was incredibly shortsighted and ill-advised.

I couldn’t, in all honesty, remain in my roles. The government didn’t seem interested in listening to genuine public health advice. So I left the board of the New Zealand Quality and Safety Commission as well as the Public Health Advisory Committee.

Now, I advocate for Pacific health and genuine public health policy approaches from outside the machinery of government.

At the University of Auckland, I’m one of the co-directors of the Centre for Pacific and Global Health. We focus on Pacific-specific research. For example, we’ve just done a study of mental health issues in Sāmoa, Tonga, the Cook Islands, Niue and Tokelau. We also run workshops with health workers in the wider region through that centre.

My other big focus is getting more of our students into the health science pathways like medicine, pharmacy and nursing. One of the things David Seymour has pushed for is a review of MAPAS, the Māori and Pacific Admission Scheme at Auckland’s medical school. We’ve yet to see the terms of reference for the review. But there’s so much material showing how effective MAPAS is, and we’re ready to fight hard for it.

More than ever, I’m determined to be ready for whatever is thrown at us.

From a public health perspective, this government is making totally irresponsible and dangerous decisions, and Pacific and Māori are in the firing line.

There’s so much evidence that shows the health needs of different populations vary — and that if you apply the same formula to everyone, you’re not going to make the necessary impact.

More than that, in this country, Māori are tangata whenua. As Indigenous people, and under Te Tiriti, they have unique rights that must be honoured.

Sadly, we’re in a political environment where a lot of progress that’s been made towards recognising those rights, as well as achieving equitable outcomes for Pacific, is being dismantled.

The political action stems from ideology grounded in ignorance, racism and fear. It has nothing to do with evidence, or public health priorities, or quality of life for people.

At least, outside the tent, I’m now free to stand openly against it.

Sir Collin Tukuitonga is a leading public health figure who has held high-level roles in local, regional and international organisations, including the World Health Organisation. He was born and raised in Niue, and was appointed as a professor at the University of Auckland in early 2025.

As told to Teuila Fuatai and made possible by the Public Interest Journalism Fund.

E-Tangata, 2025