The New Zealand health care environment has changed greatly over the last decade, with shorter lengths of hospital stays, ongoing technological advances, and prioritising health funds because there isn't enough money to do everything.
It is likely that the emphasis on improving quality, policy and practice based on evidence will strengthen in the future, with a greater focus on research and development on which to base decisions.
This is a time of rising demand for safe and effective services, and rising costs and rising expectations of what can be supplied in health care.
In addition, there is an awareness of the need to respond effectively to the poorer health status of Māori, Pacific peoples and those on low incomes.
The New Zealand Public Health and Disability Act 2000 governs the structure of the health care system.
This legislation defines how each part of the system works, including the establishment of District Health Boards. Services are guided by the New Zealand Health Strategy and the New Zealand Disability Strategy and the Maori Health Strategy, He Korowai Oranga.
Public health is a key component of the New Zealand health sector. Public health activities aim to influence what has a major impact upon the health status of New Zealanders. For example, a screening programme may reduce illness and death for a number of New Zealanders.
An emphasis on primary health care and the adoption of a population health focus aim to maintain and improve the overall health of entire populations and reduce inequalities in health between different groups.
While some aspects of screening are best managed at a local or regional level, some high-level screening functions are best delivered nationally to ensure screening is the same throughout the country.
The New Zealand Health Strategy (2000) sets out the direction for all health services. There is a strong focus on population health and on tackling health inequalities, particularly for Māori, Pacific peoples and those on low incomes. The Government's priorities are identified, based on seven principles.
Screening programmes worldwide tend to have poorer participation by minority ethnic groups and low-income people. This situation presents a particular challenge for those who manage screening programmes. The National Screening Unit is focused on ensuring screening programmes do not continue or worsen health inequalities.
The National Screening Unit's vision fits with the New Zealand Health Strategy in its aim of reducing inequalities, particularly for Māori and Pacific peoples and building the health of New Zealanders.