This year’s budget allocation for health echoes most past budgets. It implies there is significant investment and earmarks some specific areas that will receive additional support. But in reality, this is a cutback budget signalling continued austerity.

The government is right that health receives the largest share of investment among categories, some NZ$34.2 billion, up from $31 billion in 2025. This represents an increase of about 10% and makes a good sales pitch.

Yet much of this expenditure, as always, is spread over several years. This means the compound annual growth rate of budget funding for health through to 2029–30 is 3.49% per year, basically matching the inflation rate.

In healthcare, the inflation rate tends to exceed what is happening in the general economy. As noted in the budget document itself, the funding will simply “maintain current health settings”.

This is not good enough. New Zealand’s health system is in dire need of help and already comparatively underfunded.

The argument that health is a backbone of a strong economy and good society is supported by multiple studies.

In this context, building a highly productive, high-quality and accessible health system is fundamental. But this requires significant investment as well as long-term planning.

In an adversarial political system such as New Zealand, focused largely on the short term, it also requires politicians to work across party lines in the best interest of the public – for the current population needing to access high-quality services regardless of income or ability to pay as well as for future generations.

Health requires a growth mindset

Health is unlike any other area of public service in that it requires strong government intervention and support for public services to deliver for people. It requires a development and growth mindset as well as understanding that underinvestment is a losing strategy.

Budget allocations could have been made in key areas, and the health workforce should have been front and centre.

Staff shortages, along with the general working environment, are increasingly challenging in the public hospital system. This includes facilities and a generally negative ethos, driven by successive governments failing to grasp the fundamental need for long-range workforce planning.

Unmet need for specialist assessments in the public hospital system is worsening, highlighted again recently. The budget makes no mention of how maintaining current settings would do anything other than worsen the workforce and service access crises.

Primary care is another area requiring investment and attention. Growing unmet need places mounting pressure on already busy general practitioners (GPs).

For patients referred back to their GP, unable to access a public hospital specialist, this is stressful and unproductive. Improving the ability of GPs to manage unmet need – including through covering patient fees – would have been an important signal.

The budget allocates $80 million for the building of a third medical school, but this will not help, at least not until 2035.

New investments

Some of the earmarked “new spending” initiatives are important and should add value.

Digital and cyber security gets $152 million over five years ($35 million to $39 million per year). This is a small investment in an area where New Zealand once led the world. The recent high-profile data breaches have been an indictment on lazy government policy and poor private provider attention to security basics.

Investments in ambulance services ($35 million over five years), paediatric palliative care (a new site in the South Island in addition to the existing Auckland Starship hospital; $15.5 million over five years) and the national bowel screening program ($12.4 million over five years) to lower eligibility from 58 to 56 years are all important and welcome.

There are also investments in hospitals including additions to Whangārei Hospital and some additional funding for the new Dunedin Hospital construction.

In an election year, a bold government could have laid down a pathway for long-term planning. It could have stated an intention to build genuine all-party consensus on healthcare and acknowledge that an adversarial system is not serving people.

It is also important to consider the cost of ongoing health sector reform. The previous government initiated reforms in 2022 but the coalition government disestablished new agencies (such as the Māori Health Authority) and repealed new policies and laws (such as legislation that would have created a smoke-free generation). The cost of these repeated reforms, as well as ongoing structural changes, is likely to be in the hundreds of millions.

The public deserves better. Rather than restructuring, this money should have been invested by all politicians in services and future generations.

The government could also have announced a commission to review healthcare funding as New Zealand’s public health system is weakening, with increasing provision by the private sector. In summary, budget 2026 is a short-term plan for continued austerity for the health sector.

Robin Gauld has received funding from the NZ Health Research Council, NZ Ministry of Health, Health Quality and Safety Commission and General Practice NZ.

I was a junior doctor on the front lines when journalist Eric Schlosser published Fast Food Nation 25 years ago. Back then, my days (and far too many nights) were spent picking up the pieces of a healthcare system that already felt like it was bursting at the seams.

Fast Food Nation pulled back the curtain on the fast-food industry, showing how a system built for speed, efficiency and profit reshaped what Americans eat, how food is produced and the conditions under which many people worked. More broadly, it revealed the harms of the industrial food system as a whole. The New York Times called it “a fine piece of muckraking, alarming without being alarmist”.

We are no longer looking at a warning of what might happen. We are living through the reality Schlosser predicted: that allowing this hyper-processed, factory-style fast-food model to creep into our daily lives would drive a heartbreaking global epidemic of obesity and preventable chronic illness. Today, we know ultra-processed foods are linked to over 30 serious health problems, including cardiovascular disease (heart attacks and strokes), type 2 diabetes and mood disorders (anxiety and depression).

In an afterword to the 25th-anniversary edition, Schlosser shares angry responses to the book from McDonald’s, the National Restaurant Association and the National Meat Institute. He also describes being heckled at events, including by a man who put him in a headlock in a carpark and shouted, “Why do you hate America, why do you hate America so much?”

Today, United States health secretary Robert F. Kennedy Jr and his MAHA (Make America Healthy Again) movement echo the messages of Scholsser’s book, declaring ultra-processed foods “poison” and the main culprit of the nation’s “chronic disease epidemic”. (At the same time, president Donald Trump worked the McDonald’s drive-thru counter on the 2024 campaign trail and has even made a habit of serving McDonald’s to athletes at the White House.)

A broken food environment

In those early clinical years in 2001, I was treating what I now recognise as the end-stage symptoms of a broken food environment: Type 2 diabetes, heart disease, and the early wave of the obesity epidemic. But at the time, I lacked the perspective of a long career – and the personal stake of being a parent.

I saw the patients, but I hadn’t yet fully grasped what Schlosser calls the “operating system” driving them into my clinic. Reading the book in 2026, the stakes feel vastly different. With two decades of general practice behind me and my own children now navigating their way around a kitchen, the clinical has become deeply personal.

In 2001, fast food was still draped in a cloak of mid-century optimism. The Golden Arches of McDonald’s, for example, weren’t just a logo. They represented consistency, safety and an image of suburban success.

Schlosser didn’t just critique the menus of the fast-food industry. He deconstructed the entire machine, revealing that a “cheap” burger was a financial illusion. The true costs were being paid by the whole of society: the exploited workforce, the polluted environment and eventually, the unsuspecting taxpayer through soaring healthcare bills.

As a GP, I see this as an important shift in blame. It moves the conversation away from “bad individual choices” and toward an understanding that industrial forces have tipped the scales against our biology.

1. The chemical hijack of our tastebuds

One of the most unsettling parts of the book is the look inside the secret flavour labs of New Jersey: the origin story of our current ultra-processed food crisis. Scientists didn’t just make food taste good, Schlosser revealed – they engineered “mouthfeel” and “aroma” to replace the nutrition lost in processing.

In medical terms, these are neurological hacks. They are designed to hit a bliss point that bypasses the body’s natural satiety signals. (The “I’m full” feeling.)

When we consume these foods, we’re not just eating; we are ingesting an engineered experience that creates a cycle of addiction – one many of our children are trapped in before they even reach high school.

2. The ‘Shadow Workforce’ and human dignity

Schlosser highlighted how the industry relies on treating humans as interchangeable parts within a system. His depiction of fast food is less a collection of convenient eateries and more a meticulously engineered extraction machine that sustains itself by consuming a steady diet of vulnerable human “inputs”.

He describes various people used to keep the system running. Children targeted by “cradle-to-grave” marketing and hazardous night-shift labour. Service workers and immigrants facing injuries on slaughterhouse floors. Independent ranchers (farmers), now functioning as quasi-indentured labour under monopoly power. And the low-income families trapped in areas with a high concentration of unhealthy food outlets.

Ultimately, the industry thrives by externalising its “true cost”, he writes. The silent taxpayer is left to pick up the multi-billion-dollar bill for both the welfare subsidies of underpaid workers and the chronic disease epidemics.

From a public health perspective, when you prioritise “throughput” over human dignity, the trauma and physical toll on workers eventually lands right back in the lap of the public health system.

3. The monopoly on our health

By 2026, the “captive supply” Schlosser warned about has become a reality. “It’s just another way of controlling prices through captive supply,” he wrote. “The packers now own some of these big feeders lock, stock, and barrel, and tell them exactly what to do.”

A handful of companies now control everything from infant formula to meatpacking. This lack of competition isn’t just an economic issue; it’s a national security and health risk. When a system is this brittle, a single failure can threaten our access to basic nutrition.

Monopoly power has effectively diminished our “food sovereignty”, or community control over our own food – the freedom to choose health over convenience.

2026: from debate to rebellion

The most striking change since the book’s first edition is the shift in the political weather. For decades, critics of the food industry were dismissed as “nanny state” enthusiasts.

But in 2026, something has changed. We’ve seen an 83% consensus among voters for clearer warning labels on processed foods. Regardless of your personal politics, the emergence of the MAHA movement, and the unlikely alliance between traditional disrupters and health advocates, show that the old guard’s influence is being substantially challenged.

The movement echoes Schlosser’s core arguments.

The true cost must be paid, he argues. We can’t let corporations privatise profits while the public pays for expensive heart surgeries. Corporations aren’t people: the legal fictions that allow the manipulation and exploitation of children’s diets must be challenged. And agency is essential; we are not victims of an inevitable system.

A GP’s final word

Fast Food Nation shifted the public conversation about food and health away from individual “willpower” and onto systemic corporate accountability. It catalysed the modern food activism movement, forever changing how society calculates the “true cost” of a cheap meal. And it directly paved the way for today’s historic, cross-partisan demands for health reform and food sovereignty that we see today.

As a doctor who has spent 20 years treating damage done by the industrial food complex, I see this book as a necessary health check on the world we’ve built. The true cost of a fast-food burger is never just a few dollars; it’s the quiet, chronic toll it takes on our bodies, our families and our communities.

However, Schlosser’s 2026 update isn’t a “told you so”. It’s a call to take back our agency. The Golden Arches are no longer seen as a “trusted friend,” but as a monument to a model we have finally outgrown. We have the collective power to un-rig the system and choose real food again.

The question is: will we?

Natasha Yates is affiliated with the RACGP.

The Sex Discrimination Act is currently in the news following the outcome of a high-profile court case reaffirming transgender rights in Australia.

The controversy concerns the meaning of “sex” in the act and its interaction with gender identity discrimination. The Coalition wants to amend the act to include a definition of biological sex, arguing “the law does not properly protect single sex spaces for women and girls”.

But what’s missing from the conversation is how the Sex Discrimination Act works and what it was designed to achieve.

What is the Sex Discrimination Act?

The Sex Discrimination Act is a federal law. It originally became law in 1984 and protected people from sex, pregnancy and marital status discrimination.

Currently, the act protects people from discrimination based on a wider range of attributes, called “protected attributes”. These include their sex, sexual orientation, gender identity, intersex status, marital or relationship status, pregnancy or potential pregnancy status, breastfeeding or family responsibilities.

Discrimination is prohibited in employment, the provision of goods, services and facilities, education, accommodation, land, clubs, and federal programs and laws. A purpose of the act is to eliminate “so far as possible” discrimination based on the protected attributes.

Unlawful discrimination is either “direct” or “indirect”. Direct discrimination occurs when a person with an attribute is treated less favourably than a person without that attribute in the same situation. Classic examples of direct sex discrimination are where a woman is paid less than a man while completing the same work.

Indirect discrimination addresses more subtle forms of inequality. For example, a rule may seem to treat everyone equally, but, in practice, it disadvantages one group that shares an attribute.

Let’s say a firm requires all partners to work a 60-hour week. People with family responsibilities could be less able to comply with this rule.

Rules that cause disadvantage based on an attribute can be legal if they are reasonable, but direct discrimination cannot be defended on the basis it is reasonable.

Read more: Politics with Michelle Grattan: Margaret Thornton on the landmark Tickle v Giggle transgender case

What are the exceptions?

There are limits to protection against discrimination under the Sex Discrimination Act.

The act contains many exceptions allowing conduct that would otherwise be discriminatory. For example, there are general exceptions for services where they can only be provided to members of one sex.

Exceptions also apply to staff and students in religious educational institutions.

There are exceptions for participation in sports where strength, stamina or physique is relevant.

It is also not discrimination to provide affirmative action or equal opportunity measures. But these exceptions, called “special measures”, cannot discriminate on the basis of other protected attributes.

Very few court tests

Despite the act being in force for more than 40 years, it has received little attention from higher courts.

The recent decision of Giggle For Girls v Tickle was the first case of gender identity discrimination heard by the Federal Court. The full bench found a transgender woman had been directly discriminated against on the basis of gender by being refused access to a women-only social media app.

The High Court of Australia has considered only three sex discrimination claims in its history. None of these was made under the Sex Discrimination Act. Two of those were decided in the 1980s, and one was considered in 2006. That means the High Court has not heard a sex discrimination claim in 20 years.

It has never considered the act and its prohibitions on discrimination. This means there is little higher court authority on how its provisions operate.

Read more: A historic court victory has upheld transgender rights in Australia. A legal academic explains why

The 2013 changes

Until 2013, federal law did not protect people from discrimination because of gender identity, sexual orientation or intersex status. While there were protections in state and territory acts for these attributes, they varied greatly. This led to inconsistent protection from discrimination across Australia.

In 2013, the federal Sex Discrimination Act was amended to include the attributes of gender identity, sexual orientation, intersex status and relationship status.

This made it unlawful to discriminate, directly or indirectly, against people based on their sexual orientation, gender identity, intersex status or relationship status. This protection from discrimination applies in all areas of life captured by the act.

The amendments created definitions of these newly protected attributes. The definition of gender identity was designed to achieve “maximum protection” for gender-diverse people.

It was also designed to recognise that “gender” and “sex” are distinct concepts. The definition indicates both are changeable.

Further, the definition of “intersex status” was designed to recognise that sex is not binary.

The definitions of “man” and “woman” were also removed and are instead understood by their “normal meaning”. This means the words aren’t narrowly interpreted to exclude transgender people. Women and men (of all ages) would also continue to be protected from discrimination based on their sex.

In 2013, the amendments made to the Sex Discrimination Act were not particularly controversial. As then-Attorney-General Mark Dreyfus noted in respect of a Senate Committee Report on human rights and discrimination legislation:

all parties agree on one issue – the pressing need for protection from discrimination for the lesbian, gay, bisexual, transgender and intersex community at the federal level.

It was recognised that there was substantial evidence of discrimination due to sexual orientation, gender identity and intersex status. This discrimination was harmful and created barriers in how people could live their lives.

While controversies have sprung up since, the 2013 changes to the Sex Discrimination Act remain a milestone. For many Australians, the changes marked the first time that federal law protected their right to live free from discrimination.

Alice Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.