Comment: The release of the Window on Disability report by Te Tāhū Hauora, the Health Quality and Safety Commission, should be a watershed moment for health care in Aotearoa New Zealand.
Instead, it risks becoming yet another document that clearly identifies inequity but stops short of demanding the level of action required to address it.
The findings are stark and confronting. Disabled people in Aotearoa are dying at five times the rate of non-disabled people. Disabled Māori are 10 times more likely to die from treatable conditions.
These are not marginal differences; they are indicators of systemic failure. This is not a problem of isolated incidents or individual bias alone. It is a pattern of structural inequity embedded across the health system.
The report names this clearly as “structural invisibility”, a system that does not adequately see, understand, or respond to disabled people. When people are invisible in policy, in data, and in service design, poor outcomes are inevitable.
The consequences of this invisibility are lifelong and compounding. Disabled people experience poorer access to care, lower quality treatment, and worse health outcomes across their lives. For disabled Māori, these inequities are intensified by the ongoing impacts of colonisation and systemic racism, creating a dual burden that the health system has yet to meaningfully address.
Alongside these structural problems are the everyday realities disabled people face in health care settings. Micro-aggressions – subtle but persistent forms of discrimination that erode trust – create barriers to access, and contribute to unsafe care.
They send a clear message that disabled people are not valued equally within the system. This combination of structural failure and daily discrimination creates a health environment where neglect and harm are predictable.
Given the scale of the problem, the response outlined in the Window on Disability report is deeply inadequate.
Its recommendations focus largely on incremental, process-driven actions: improving data collection, establishing working groups, reviewing frameworks. These are not unimportant steps, but they are fundamentally misaligned with the urgency of the matter.
We are not dealing with a system that needs fine tuning. We are dealing with one that is producing preventable deaths at significantly higher rates for a specific population. The response to that reality cannot be incremental.
There is a clear risk that the proposed approach will result in what can only be described as administrative progress without substantive change. Better data may lead to better measuring, but without accountability mechanisms, it will not lead to better outcomes.
It may simply document inequity in greater detail while people continue to die. What is missing is a commitment to measurable, enforceable change. At a minimum, this must include mandatory reporting of health inequities, public transparency through accessible dashboards, and direct links between funding and equity performance. Without these mechanisms, there is little incentive for the system to shift in the ways required.
Equally concerning is the ongoing exclusion of disabled people from decision-making processes. Policies and services continue to be developed without meaningful involvement from those most affected.
This is not only unjust, but solutions designed without the expertise of lived experience are unlikely to succeed. Disabled people are not passive recipients of care, they are experts in their own lives, with critical knowledge about what works, what fails, and what needs to change.
As a researcher with lived experience of disability and co-director of the Taunakitanga Takitini research programme, I can affirm our current research highlights plenty of opportunities for government agencies to step up immediately and make changes to health policies and services that can save the lives of disabled people.
These agencies have a responsibility to provide safe, high-quality health care and save the lives of disabled people. They cannot do this without us.
This is not a call for consultation as a formality. It is a call for genuine partnership, where disabled people are actively involved in shaping the systems that affect them.
The voices of disabled people themselves reinforce this message. Waata Houia, a 41-year-old Māori man with a learning disability, stated in the report: “We’re the same as everyone else, but we’ve got a learning disability. We know what we can do, we know what we want to talk about, and we know what they need to learn so they can be accessible to us as who we are. Treat us as equal.”
As the agency responsible for monitoring and improving quality and safety, Te Tāhū Hauora has a critical role to play. The report represents an important step in acknowledging the scale of inequity, but acknowledgement alone is not enough.
Strong leadership is required and that means setting expectations that match the severity of the problem. It means moving beyond the cautious, ineffective recommendations and calling for decisive, system level change.
Te Tāhū Hauora has a mandate to hold the government agencies and health providers accountable for delivering measurable improvements in outcomes for disabled people.
The Government, the Ministry of Health, and Health NZ also have an unequivocal responsibility. A health system that allows such stark disparities to persist is not safe, not equitable, and not fit for purpose. Addressing this is not optional, it is a fundamental obligation.
There are immediate actions that should be taken. These include embedding equity targets into funding agreements, requiring regular public reporting on outcomes, investing in culturally safe and accessible services, and ensuring disabled people are resourced and supported to participate in decision making at all levels. None of these actions are beyond reach. What is required is the political will to prioritise them.
The Window on Disability report opens a clear and urgent window into the realities faced by disabled people in Aotearoa. The evidence is unequivocal. The question now is whether those in positions of power are willing to respond with the level of urgency and courage that this moment demands.
We cannot afford to respond to a crisis of this magnitude with incremental change. We cannot continue to accept preventable harm and loss of life as an unfortunate but inevitable outcome. The path forward is clear. Listen to disabled people and act decisively. Anything less is a continuation of the failure this report so clearly exposes.
