The canary in the coal mine: inequitable healthcare for those living with multimorbidity in Aotearoa New Zealand.

New Zealand's 2001 Primary Health Care Strategy set a bold goal of reducing health inequities through a population health approach with innovative models of care and a revised funding framework. Twenty-five years later, significant disparities persist. This paper utilises recent literature alongside a case study derived from a recent evaluation of a long-term conditions programme in primary care. The evaluation found significant barriers to a successful model of care. These included a generic user-pays model that did not accommodate low health literacy, poverty-related constraints, geographic isolation, disability or the need for culturally safe care. System-level obstacles such as complex referral pathways, inadequate training, insufficient resourcing and static funding mechanisms further entrenched inequity. The article concludes that persistent inequities for some groups in Aotearoa New Zealand demonstrate that innovative programmes alone cannot overcome structural, resourcing and policy deficits. A fundamental reorientation of primary healthcare funding and design that integrates socio-economic, cultural, environmental, commercial, digital and geographical determinants is required. Embedding cultural safety to honour the diversity in our communities, along with an appropriate allocation of resources for primary healthcare in both rural and urban settings, is necessary to work towards equitable health outcomes in Aotearoa New Zealand.