Each decade, more chronic illness. Each election, more medicine

Why have RNZ and Stuff journalists broadly dismissed and/or criticised Make New Zealand Healthy without evaluating the merits of its policy proposals? They, their families and friends are more likely to be diagnosed with multiple conditions and take multiple medications at a younger age than your grandparents.

One diagnosis is often just the beginning. Chronic illnesses tend to cluster. This is multimorbidity: multiple chronic conditions affecting the same person, often interacting and compounding the burden of illness.

The cost of multimorbidity is super-additive and deprived communities get sick a decade earlier. A diagnosis of type 2 diabetes, cardiovascular disease or depression carries a higher probability of living with, or developing, a range of metabolic, neurological and/or physical conditions.

The Health and Independence Report 2025 documents that non-communicable disease accounts for 83.3% of all health loss, and that there has been an 8% increase in adult multimorbidity between 2021 and 2025, with approximately 1.5 million adults now living with two or more chronic conditions.

Yet every election debate focuses on the bottom of the cliff, where the ambulance sits. At most it glances part way up to screening, then returns to the bottom.

Since 2014 the pharmaceutical budget has grown more than six times as fast as the population in percentage terms, and budgeted expenditure per resident increased by approximately 80% in nominal terms (Pharmac 2014; 2024/25).

But this is not discussed in 2026 election debates.

It gets worse. Annual antidepressant prescribing more than tripled among 5–14-year-olds and more than doubled among 15–24-year-olds between 2011 and 2021 (Pharmac 2022). The problem here is bigger than depression, anxiety or psychosis; the treatments can have life-changing side-effects.

We are getting sicker. The language of more doctors, nurses and more medicines is a direct effect of the escalation of multimorbidity, but no-one is talking about the manmade drivers.

In late September Winston Peters announced New Zealand First’s health policy – a 15-Point Plan. NZ First called it a ‘bold shift’. New Zealand Herald, RNZ and Stuff covered the story.

Within a couple of days Lauren Crimp (RNZ republished by NZ Herald) and Emma Ricketts (Stuff) with evident alarm, highlighted that NZ First’s policies had been drawn from the Make New Zealand Healthy (MNZH) charity’s suite of policies.

Crimp and Ricketts did not start an investigation to consider the context of the so-called controversial NZ First and MNZH policies in a country with distressing increases in mental and metabolic ill health, particularly among younger age groups.

An opportunity to hold New Zealand First to account

New Zealand First’s 15-Point Health Plan currently lacks substance, containing only simple statements. Many of the very big opportunities that were highlighted by MNZH were not there. However, these statements nevertheless amount to a set of promises that the New Zealand public can use to hold NZ First to account.

A large opportunity has presented itself – we can demand to see how the points would be translated into policy.  Instead, we’ve witnessed dismissive posturing on the MNZH policies, but no deep evaluation. The journalists simply finished their pieces and moved on.

Yet the MNZH policies are directly designed ‘up at the cliff top’ and stop the multimorbidity onboarding process.

A huge body of evidence suggests that two interconnected factors drive risk for these increasingly common conditions: 1. Diets high in refined carbohydrates and ultra-processed food, which directly elevate blood glucose and lipid levels; and 2. Insufficient levels of dietary micronutrients that are key cofactors in metabolic and mental processes – and that a shift to lower refined carbohydrate intakes is practical and affordable for the majority of New Zealanders (Reclaiming Health, chapter 10) – particularly with GST removed (MNZH Chapter 6).

Starchy carbohydrates and ultra-processed foods can comprise at least half the daily diet and doctors tear their hair out wondering why patients don’t ‘just’ reduce calorie intake. But, as the Physicians and Scientists for Global Responsibility’s (PSGRNZ) Reclaiming Health paper found, we can’t ‘just’ reduce calories if we don’t understand the role of addictively formulated foods that fail to sustain satiety (keep you full), glucose spikes, dopamine-driven reward pathways and the difference between craving and hunger that keep people trapped in addictive food-cycles.

The doctors and scientists who have worked this out, are transforming patients’ lives.

Reclaiming Health was sent to all members of Parliament in January, and the MNZH policies were sent to the major political parties some five months ago.

Addressing surging illness in the under 50s group

New Zealand has a non-communicable disease crisis and the people of New Zealand are hammered by multimorbidity. It is much more common to have multiple diagnoses, and be prescribed multiple medications – the cost of multimorbidity – is super-additive.

The Ministry of Health’s (MoH) Health and Independence Report 2025 documents the changing health landscape. The greatest increase in multimorbidity (above 11%) occurred among adults aged 25–54 years. Our young people are getting sicker at younger ages than their ancestors. The burden includes (and these are often overlapping conditions): metabolic, cardiovascular, renal, neurological, mental health, musculoskeletal, respiratory and other chronic conditions (MoH 2024; 2025). Between 2014 and 2024, diagnosed diabetes prevalence increased by 68% among 25-34-year-olds and 55% among 35-44-year-olds.

High or very high psychological distress more than tripled between 2011/12 and 2024/25, reaching 29.2% among young women aged 15–24. Multimorbidity also develops substantially earlier among Māori and Pacific peoples, affecting 51.2% of Māori and 62.9% of Pacific peoples by age 55–64.

PwC estimated in 2021 that the lifetime cost of T2D diagnosed at age 25 would result in $565,000 in costs to the health system. Compellingly, remission from T2D is possible in the first 6 years after diagnosis and beyond, and ketogenic or low-carbohydrate diets can support remission, or significantly reduce medication requirements and avoid the hunger and cravings associated with low-calorie diets.

But the personal costs are greater: children born to diabetic mums are more likely to be diagnosed with a psychiatric disorder, and multimorbidity is common, with younger people with T2D at elevated risk of heart disease.

How do we tie it all back to an over-abundance of starchy carbs? Insulin resistance is a hallmark of type 2 diabetes and several other metabolic diseases and is associated with altered brain function. Elevated triglycerides are both a marker of insulin resistance and an indicator of increased cardiovascular risk, with triglyceride-rich lipoproteins and their remnants contributing to atherosclerosis. Insulin resistance also promotes fat accumulation in the liver, contributing to metabolic dysfunction-associated steatotic liver disease (MASLD), which can further exacerbate insulin resistance and is associated with increased risks of type 2 diabetes and cardiovascular disease.

A major global review found that 83% of people with T2D had multiple chronic conditions, including conditions traditionally associated with T2D and others not directly related to it (Ferede et al., 2025). A large, ethnically diverse U.K. study found that the age-standardised proportion of people with T2D who had three or more additional chronic conditions was approximately 30% among those at diagnosis and 60% among those ten years after diagnosis. Hypertension, back pain, depression and osteoarthritis were prominent, illustrating a burden extending well beyond conventional diabetic complications (Pearson-Stuttard et al., 2022).

Pearson-Stuttard J, Holloway S, Polya R et al. Variations in comorbidity burden in people with type 2 diabetes over disease duration: A population-based analysis of real world evidence, eClinicalMedicine 2022;52: 101584, August 2022.

Such multimorbidity complicates diagnosis, treatment decisions, medication management and coordination of care. These data show how diseases rarely occur in isolation, and should help explain why multimorbidity is terribly common in older populations. Nearly half (46%) of New Zealand adults over 65 take 5 or more medications.

But you may have prediabetes for years before you receive a formal T2D diagnosis. Unfortunately, people who are diagnosed with prediabetes may be at elevated risk for a broad spectrum of health conditions, some extending well beyond conventional metabolic disorders, as the data from a U.K. study below shows (Wu et al. 2025).

Wu Y, Fan X, Shi Y, et al. Association of pre-diabetes with the risks of adverse health outcomes and complex multimorbidity: evidence from population- based studies in the NIS and UK Biobank. BMJ Public Health 2025;3:e001539. doi:10.1136/ bmjph-2024-001539. Figure 2 (adapted).

Professor Caryn Zinn has subsequently argued that prediabetes should instead be recognised as early diabetes.

As New Zealand data show, diabetes is growing at the fastest rate in younger populations.

However, when younger people are diagnosed with T2D, a similar spectrum of associated comorbidities arise – just at earlier ages.

These diseases often operate in a vicious, interconnected cycle. As people gain excess weight (from food, fatigue and medication), the body must compensate for increasing metabolic demands. The risks of cardiovascular disease, certain cancers and joint conditions rise, while hormonal regulation, inflammation and metabolic function may become increasingly disrupted.

Patel D, Shah AS, Magella B, Bahrainian M, Brown EA, Liu TYA, Shah V, Channa R, Wolf RM. High rate of complications in a real-world cohort of youth with T2D: a multicenter analysis. J Diabetes Complications. 2025 Sep;39(9):109091. doi: 10.1016/j.jdiacomp.2025.109091

Attacking the messenger not the message

Wow. The lifetime cost of T2D diagnosed at age 25 results in $565,000 in health system costs – not to mention the higher risk of suffering from all the likely comorbid conditions.

Instead, Emma Ricketts spent valuable time sleuthing to prove that NZ First had drawn policy ideas from MNZH. She didn’t evaluate the key MNZH policies to assess their merit, or link to them for the benefit of the public. Ricketts then discussed point nine ‘find better ways to acknowledge our nurses’, in detail. This was one of the ‘lightest’ policies in the MNZH portfolio.

Ricketts then spent a good portion of the article using language about the founders and some members of the panel that, from my reading, suggested these were not the kind of people one would want to be involved with. It was not defamatory, but it certainly amounted to a form of shaming, or a subtly discrediting portrayal.

Ricketts could have linked to the About Us page to highlight the professors involved and their extensive research and publication records in metabolic and mental health; or discussed how some of the doctors have recognised the prevalence of disease in their communities, including Māori and/or low-income communities, and are adopting novel treatment strategies to reverse T2D and improve quality of life. Because they’ve seen the impact of multimorbidity in real time. But she didn’t.

Days later, Boyd Swinburn wrote a disparaging article on NZ First’s policies. For decades, Swinburn, an academic I have long admired, has condemned the rise of addictive ultra-processed food and sugar-sweetened beverages, the power of the corporate marketing machine behind them, and he is well aware that ultra-processed foods now comprise half of New Zealand diets.

As Swinburn acknowledged, the policies came from MNZH. He knows some of the academics on the advisory panel. MNZH cited his work – like Swinburn, recommending the Ka Ora Ka Ako programme, better food marketing rules and a policy shift to remove GST from healthy food and implement SSB taxes, leaving people with more money in their pocket (than the 3.5% that might occur from breaking up the supermarkets).

Confusingly, Swinburn opened with ‘alarm bells’, invoked Robert F. Kennedy Jr. and his vaccine controversies, and characterised the proposals as ‘vibes and vitamins’ and the product of a whiteboard brainstorm followed by a little Googling. These are effective rhetorical devices, but they are not substitutes for examining the evidence.

He raised legitimate concerns about placing too much faith in education and individual choice. Yet he did not examine how MNZH’s wider policy proposals address the institutional, scientific and structural conditions shaping those choices – including policies to support people to manage ultra-processed food addiction. Nor did he consider how the nutrition proposals were designed to work together: reforming how we research nutrition, how we teach it, how health professionals diagnose under-nutrition, evaluate nutrient and medicines risks and apply emerging evidence, and how we make nutritious whole foods more affordable.

When discussing dietary guidelines, Swinburn directed readers towards Scandinavian and Latin American countries while dismissing the recent U.S. shift as controversial. But controversy is not a scientific assessment. Surely an expert interested in evidence-based policy should be willing to examine the underlying U.S. scientific evidence, identify its strengths and weaknesses, and explain which findings should or should not inform New Zealand’s approach.

There are many reasons the Health Star Rating system did not make MNZH’s priority list. A growing research field challenges the assumption that conventional macronutrient recommendations are equally appropriate for all population groups. Individuals differ in their metabolic responses to dietary carbohydrates, and people with insulin resistance or metabolic syndrome may benefit from dietary approaches that depart substantially from conventional recommendations.

These are not arguments for replacing one dietary orthodoxy with another but, rather, arguments for independent scientific scrutiny, including of the assumptions embedded in existing guidelines and food-rating systems. Why then, did Swinburn not examine the underlying policies which include recommendations he is passionate about, assess their scientific and policy merit, and consider how we might hold NZ First accountable for delivering them?

TVNZ and Jack Tame: A lack of imagination?

For decades National and Labour have controlled the health portfolio. The health section of the October 6 TVNZ leaders’ debate was an exercise in talking about more doctors, more nurses and more drugs for an increasingly sick population. The October 13 Multi-Party TVNZ leaders’ debate  and the October 14^th NZME Chris and Chris edition didn’t seem to fare any better.

Labour and National, who have dominated the Health portfolio since 1940, have corkscrewed themselves into more doctors, more nurses and more medications. Jack Tame’s questions reflected long-held corporate media framing. Tame focussed on nurse and doctor numbers and the 169 pharmaceutical medicines applications waiting for public subsidy approvals, including cancer and Wegovy GLP-1 weight-loss drugs (which require much deeper evaluation than we see in mainstream media).

Tame could have asked more searching, incisive and challenging questions. He could have asked about the cost of multimorbidity, why our mental illness is growing and why metabolic syndrome is out of control, why multimorbidity rates are surging in young adults and asked why the Ministry of Health keeps ignoring recommendations by respected, highly cited academics: Professor Grant Schofield, Professor Julia Rucklidge, Professor Caryn Zinn and Professor Boyd Swinburn that would help reduce these rates.

He could then ask why their findings aren’t being incorporated into policy.

Parties liked by younger voters don’t address the drivers

A couple of months ago, I wrote about the terrible state of health policies this election year. I found that the minor parties that the media never tend to refer to, had the best policies. The parties I expected to address metabolic and mental health – the Greens and Opportunity Party that attract younger voters – yet neither adequately addresses the drivers of metabolic and mental ill health affecting these same age groups.

I was once a long-term Green Party member. The Green Party’s health plan promises better access to screening, diagnosis, treatment, medicines and healthcare services, but offers little commitment to investigating why chronic diseases are developing at younger ages, why multiple conditions cluster, or how these trajectories might be prevented. Prevention gets a mention, but the scientific research and institutional reforms needed to tackle the underlying drivers of multimorbidity are conspicuously absent.

The Opportunity Party goes slightly further, proposing long-term health funding, a national nutrition survey, food standards and restored school lunches. But its proposals appear to take existing dietary guidelines and nutritional assumptions for granted. There is no commitment to building the independent scientific capability needed to critically reassess those assumptions, investigate why chronic metabolic illness is developing at younger ages, or determine whether current health advice is itself part of the problem.

As I noted previously, the most comprehensive health policy for addressing our non-communicable disease pandemic, continues to be the Outdoors and Freedom party, which I don’t believe were invited to the TVNZ multi-party debate.

However, if New Zealand First takes its 15-point Health Plan seriously and develops those proposals into substantive, evidence-based policies, it could lead transformative health reform in New Zealand. But there’s no glory without guts.

Two interconnected factors: Elevated insulin & under-nutrition

As humans we’ve always had trauma, sadness, and suffering. But there is now strong evidence that inadequate diets directly reduce our resilience in dealing with those ups and downs, and increase the likelihood of being diagnosed with a spectrum of metabolic diseases.

Let’s return to those two interconnected factors: 1. Diets high in refined carbohydrates and ultra-processed food; and 2. Insufficient levels of dietary micronutrients.

Diets dominated by refined cereals, starchy carbohydrates and ultra-processed foods, many of which stimulate dopamine-mediated reward pathways, can further compound these problems, particularly when they displace nutrient-dense whole foods. Even when ultra-processed foods are matched for nutrient quality, they frequently still spike blood sugar. Poor dietary quality can alter the gut microbiome and contribute to inadequate intake of essential vitamins and minerals.

The diagrams above show the pattern of multimorbidity that is being observed globally. Metabolic syndrome is a cluster of interrelated risk factors, including elevated blood glucose, hypertension and dyslipidaemia, which can precede or accompany type 2 diabetes, cardiovascular disease and chronic kidney disease. The emerging cardiovascular–kidney–metabolic (CKM) framework recognises that these conditions share overlapping biological pathways and often develop together. Importantly, neither obesity nor excess body weight is necessary for metabolic dysfunction to develop.

Elevated blood glucose is one part of the story, another part is insufficient nutrients and poor gut function from refined, high carbohydrate diets.

Inadequate diets dominated by ultra-processed foods and processed cereals are closely tied to increased rates of anxiety, depression, ADHD and a spectrum of other mental illnesses. Clinical trials and systematic reviews increasingly demonstrate that low-carbohydrate and ketogenic dietary interventions can improve depressive symptoms (including treatment-resistant depression), with additional evidence of benefits in people with serious psychiatric disorders. These findings strengthen the case for integrating metabolic and nutritional interventions into mental healthcare, particularly given the well-documented adverse effects of commonly prescribed psychiatric medicines. Further research should evaluate comparative effectiveness, safety and long-term outcomes.

Dietary nutrients are needed for countless biological processes, including the production and regulation of neurotransmitters, energy metabolism and normal brain function. Where nutritional deficiencies, metabolic dysfunction and impaired nutrient absorption coexist, they may contribute to fatigue, cognitive difficulties, poor mental health and a declining quality of life.

Unfortunately, our current nutrient reference levels are designed to prevent recognised deficiencies, but do not evaluate what optimum levels are necessary to protect brain health in infants, teenagers, adults and the elderly. Doctors are perplexed when the Medicines Act classifies nutrients as medicines, even when many nutrients have well understood and relatively low-risk profiles at appropriate doses.

A not-so-free-market where global multinationals dominate the food supply

We apparently live in a ‘free market’, yet our food system is dominated, and distorted, by cheap ultra-processed foods produced and marketed by a relatively small number of powerful multinational corporations and where the drugs that are claimed to solve the crisis are also predominantly owned by a relatively small number of powerful multinational corporations.

Meanwhile, our media rarely questions why meat and dairy, two of New Zealand’s major export products, are increasingly unaffordable for many New Zealanders. Nor does it ask how we might make these nutritious foods more accessible, for example, by removing GST on whole foods, as Australia, Canada, the U.K. and Ireland do (and note, Australia and the U.K. don’t apply GST to household water).

Why are red meat and dairy not a priority? Current guidelines focus on greater consumption of fruit and vegetables and give insufficient consideration to individual differences in carbohydrate tolerance, insulin resistance and metabolic health, including the greater nutritional value of meat and full-fat dairy. The current guidelines deflect conversation away from the affordability and benefits of animal agriculture, where farmers are often price receivers. Yet these are precisely the questions that warrant open scientific debate.

Funding drugs but not funding research into side-effects

Our doctors are presented with medicines data that rarely identifies numbers needed to treat by age and sex, or identifies adverse effects by age and sex. It certainly doesn’t provide a system of understanding why nutrient interventions might be more appropriate, particularly for growing bodies. Young people are not offered well researched multinutrient supplements that are explicitly designed for brain health in growing bodies. This is a failure of equity and choice.

In order to consider the merits and veracity of controversial knowledge that might challenge the status quo, scientists need secure long-term funding to research nutritional and dietary health. This isn’t the case now.

As multimorbidity and polypharmacy increase, medication-related effects can add another layer of complexity to nutritional health, digestive function and quality of life. Even claimed low-level side-effects can impact quality of life. Many commonly prescribed medicines, including treatments for diabetes, mental illness, cardiovascular conditions and chronic pain, can themselves cause constipation, diarrhoea or other gastrointestinal disturbances.

Withdrawal from commonly prescribed antidepressants, particularly SSRIs, can be far more difficult than previously acknowledged. People who expect to take these medicines for only three to six months may experience side-effects and severe withdrawal symptoms, including sexual dysfunction, akathisia (intense inner restlessness), anxiety, insomnia, dizziness and suicidality. For some, these symptoms can persist for months or longer, making discontinuation extraordinarily difficult and potentially leaving people taking medication for years longer than they expected.

Antidepressant prescriptions as a response to deteriorating mental health are growing among young New Zealanders. The annual number of antidepressant prescription items dispensed to people under 25 has surged. Earlier peer-reviewed research found that SSRI dispensing rates among adolescents aged 13–17 doubled between 2007/08 and 2015/16 alone. These trends warrant serious investigation into the underlying drivers of psychological distress, alongside access to appropriate treatment.

Hey Crimp, Ricketts, Tame & Swinburn, can you have a Confab?

I wrote the Reclaiming Health (2026) paper for Physicians and Scientists for Global Responsibility, and a large number of scientific experts provided statements of support. It was sent to every member of Parliament and distributed to mainstream media in January.

The press release was not picked up by Stuff, New Zealand Herald or RNZ.

After completing Reclaiming Health, I was then invited to draft the MNZH papers. I did this over several months, without direction from the board, with the full consent of the advisory panel, and at no cost.

The very reason for the lacklustre media response may be the ‘controversial’ central claim, which places pro-inflammatory starchy refined carbohydrates as the upstream disease driver – sitting at the top of the cliff (to mix metaphors) – and that by substantially reducing this food group (affordably, for most people) risk is lowered for cancer, diabetes, mental illness, dementia, fatigue and a large range of associated conditions.

However, PSGRNZ’s Reclaiming Health paper (published here in chapter form) shows that we will not reverse metabolic illness or the crisis in brain health unless we take a much deeper dive into the global science than is currently permitted (due to limited funding). We cannot continue to simply draw from a narrow selection of defined epidemiological data and claim that randomised control trials are necessary for dietary changes demonstrably do not hold the side effect risk of pharmaceutical medication.

We must examine emerging evidence on the mechanisms of cellular function and biological systems, including insulin signalling and inflammation, and consider this alongside case studies, cohort data and broader epidemiological evidence.

If we are serious about evidence-based prevention, why should existing dietary policy be protected from the very scientific scrutiny we demand of proposed alternatives?

Transformative change requires a government willing to recognise the role of ultra-processed foods, addictive eating behaviours and individual carbohydrate tolerance in metabolic and mental health.

Wealthier New Zealanders can afford health coaches who help them navigate food addiction, understand their metabolic responses and learn how to prepare nourishing meals. Yet when government and our political parties fail to recognise the relationship between food addiction, nutrition education and individual metabolic differences, those without the means to obtain personalised support are left behind. That is a fundamental failure of health equity.

This presents a huge and exciting opportunity for paradigm-changing debate, which could be prompted by the MNZH suite of policies and the work undertaken by health researchers across our university system. Is obesity explained solely through a ‘calories in, calories out’ model of energy balance? Or does excessive consumption of starchy carbohydrates, insulin resistance and the complex metabolic responses that follow play significant roles? Do current macronutrient and micronutrient recommendations stack up in 2026?

The policies are sitting there waiting to be discussed and debated.

What a waste.

NZ First’s decision to step into this political mosh pit is an invitation to look more broadly at why our young people are getting sicker, and to ask frank, honest, controversial and even contradictory questions.

The familiar political refrain of more funding for more medicines is an old one. But who does the refrain ultimately serve?

Patients undoubtedly need access to effective treatments, yet pharmaceutical manufacturers directly benefit from an expanding market for chronic disease medicines.

We can increase the number of doctors and prescription rates – but where is the equally determined political commitment to understanding and recognising why so many New Zealanders are becoming chronically ill at younger and younger ages, and preventing the descent into illness in the first place?

Labour and National have controlled the Health Ministry portfolio for 90 years. Perhaps we all deserve a change.