New Zealand set a target of 1.4 rheumatic fever hospitalisations per 100,000 for June 2017 and recorded 2.9 in 2016, and none of the five national health targets in force since July 2024 measures rheumatic fever

What is happening?

In 2012 New Zealand gave acute rheumatic fever a national number. As one of the Better Public Services targets, the Government set out to cut first hospitalisations for the disease by two-thirds, from a 2009 to 2011 baseline of 4.0 per 100,000 to 1.4 per 100,000 by 2017-06. The Rheumatic Fever Prevention Programme that carried the target ran from 2012-07 to 2017-06 at a reported cost of NZD 65 million, working through eleven high-risk district health boards.

A national evaluation of the programme published in the International Journal of Epidemiology records the rate at 2.9 per 100,000 in 2016. In 2016 the Ministry of Health acknowledged, as reported at the time, that the target was unlikely to be met by its deadline. A ministry official pointed to community sore throat clinics outside schools that had not been as quick or as convenient as hoped, and two Auckland district health boards reported rates that had risen rather than fallen. The same coverage said the ministry would keep funding the eleven boards at NZD 5 million a year until 2022.

In 2022 the health system itself was rebuilt. The Pae Ora (Healthy Futures) Act 2022, which received royal assent on 2022-06-14, replaced all twenty district health boards with a single national body, Health New Zealand, Te Whatu Ora.

In 2023-06 a Rheumatic Fever Roadmap 2023–2028 was published as a five-year national plan. Its official summary page at Health New Zealand gives no numeric target and no date, either for the hospitalisation rate or for the gap between population groups. Separately, the Government now reports against five national health targets in force since 2024-07 — emergency department stays within six hours, first specialist assessment within four months, elective treatment within four months, cancer treatment within 31 days, and immunisation at 24 months. None of the five measures rheumatic fever.

The rate is still counted. Health New Zealand publishes a first hospitalisation rate of 3.8 per 100,000 for 2024 and 3.2 per 100,000 for 2025. In 2025 the rate was 7.8 for Māori, 23.0 for Pacific peoples and 0.3 for everyone else, which Health New Zealand describes as 26 times and more than 75 times the rate of the comparison group — figures published with no national numeric target now in force for any of them to be measured against.

Whose problem is this?

The body that counts the rate every year and the body that chooses which rates carry a target are both inside government. Nothing outside government obliges either of them to put the two together again after the 2017 deadline passed.

Where does this problem end?

Cold, damp and crowded housing is often discussed alongside this disease, and the enforcement of rental housing standards is treated in a separate dossier rather than here. The boundary of this one is the yardstick and not the disease, because a rate that is still counted every year now has no number in force to be counted against.

What is the state now, and what should it be?

Now

Needs a new measurementthe target state: the 2012 figure of 1.4 per 100,000 by 2017-06 is the last numeric statement of the intended state found in any source opened here, and its date has passed. The Health New Zealand summary page for the 2023–2028 roadmap names no successor figure and no date, and none of the five national health targets in force since 2024-07 names one. No source opened here gives a target for the gap between Pacific peoples, Māori and the rest of the population. This dossier does not supply a target of its own in that empty place.

How big is it?

The published measure is a rate, not a count of people. The national first hospitalisation rate was 3.2 per 100,000 in 2025 and 3.8 per 100,000 in 2024, and in 2025 it was 23.0 for Pacific peoples, 7.8 for Māori and 0.3 for non-Māori non-Pacific people.

The counts that are published are for children. In 2024 there were 51 new cases among Pacific children aged 5 to 14, a rate of 76.7 per 100,000, and 46 among Māori children aged 5 to 14, a rate of 25.5 per 100,000.

The pattern is long. A peer-reviewed study covering 2000 to 2020 gives rates among children of 50.9 per 100,000 for Pacific children against 1.0 for European or Other children, 22.4 for Māori children, and 31.4 in the most deprived fifth of areas.

A count of affected people is not derived here. The sources opened give rates per 100,000 but not the population counts by age and ethnic group that would turn those rates into people, and none gives the share of first episodes that go on to long-term rheumatic heart disease. The annual count of children admitted is therefore the only size this dossier can state, and it says nothing about the heart damage carried forward from earlier years.

Under what conditions does it arise?

1. The target lived inside a fixed-term programme. The 2017-06 target date and the end of the Rheumatic Fever Prevention Programme were the same month. When the programme ended, the date passed with it, and no source opened here records a successor date being set at that point.

2. The follow-on money was time-limited too. The funding described in 2016 ran to eleven district health boards until 2022, and in 2022 the Pae Ora (Healthy Futures) Act 2022 replaced all twenty boards with Health New Zealand. The bodies named as recipients of that funding no longer exist in the same form.

3. The rate is measured but not compared with anything. Health New Zealand publishes a first hospitalisation rate every year. Without a target, a year in which the rate rises produces no missed target and no required report.

4. The national target set does not include it. The five national health targets in force since 2024-07 cover emergency department stays, specialist assessment, elective treatment, cancer treatment timing and childhood immunisation. A condition outside that set is not reported against any of them.

5. The burden falls where the rates are highest, not where the targets are. Across 2000 to 2020 the highest rates were among Pacific and Māori children and in the most deprived fifth of areas. Those are the places a population-wide target of 1.4 per 100,000 was meant to reach, and no target now names them.

What has been tried?

The country has tried a funded programme with a number, then funding without a number, then a plan without a number, and alongside those a vaccine research grant and a housing initiative. The only attempt on the record that carried a numeric target with a date was the first one, and that date passed in 2017.

What was found?

Why is it still unsolved?

Measurement absent — the rate is still counted every year, but since 2017-06 there has been no national number in force for it to be measured against.

A target turns a statistic into a test. In 2012 the first hospitalisation rate had one: 1.4 per 100,000 by 2017-06. The 2016 figure of 2.9 could be read against it, and in 2016 the Ministry of Health did read it that way and said the target was unlikely to be met. That reading was only possible because a number and a date existed. The number was attached to a programme with a fixed end, and when the programme ended the date passed without a successor on the record.

The second part is that each later step left the yardstick where it was. Follow-on funding was described in 2016 as running to 2022. In 2022 the district health boards that received it were replaced by a single national body. In 2023 a five-year roadmap was published, and its official summary names no target figure and no date. From 2024-07 the Government reported against five national health targets, and rheumatic fever is not one of them. None of these steps removed the measurement, and none of them put a number back beside it.

The third part, which keeps the pattern stable, is that the absence produces no event. Health New Zealand publishes 3.8 per 100,000 for 2024 and 3.2 for 2025, with rates of 23.0 for Pacific peoples and 7.8 for Māori in 2025, and nothing in the national target set turns those figures into a missed target, a report to Parliament or a revised plan. A rate with no target can rise or fall without anyone being required to say whether that was the intended direction.

What observation would mean it is solved?

Candidates — (a) a numeric national target with a date is set for rheumatic fever, published in the roadmap or in the national target set (b) the first hospitalisation rate falls over several consecutive years on a stated counting basis (c) the gap in rates between Pacific peoples, Māori and the rest of the population narrows over several consecutive years.

(a) alone is paper. A target restores the test but not the result. The 2012 target existed for five years and the rate recorded in 2016 was 2.9 against 1.4. A new number would make the next shortfall visible, and it would change nothing for the children admitted in the meantime.

(b) alone can mislead. The public health science institute describes 2024 case rates as a return to pre-pandemic levels, which means the series has already moved for reasons outside any programme. A fall over a few years could reflect a disruption rather than prevention, and a series without a stated counting basis cannot be compared across the 2016 evaluation and the current data set.

(c) alone can move in the wrong way. A gap can narrow because rates in the comparison group rise. In 2025 that group was at 0.3 per 100,000, so the difference between groups is almost entirely the level among Pacific peoples and Māori. The three have to be read together, and (a) is the one that would let (b) and (c) be read against something.

What is it connected to?

Fills with researchrental housing quality and its enforcement, household crowding, access to primary care for sore throat, rheumatic heart disease in adults, the 2022 health system restructuring more generally, and rheumatic fever programmes in Australia and other comparable jurisdictions. Relation type and evidence grade were not confirmed in this round.

What these sources do not say

• Why no numeric target followed the 2012 one. No source opened here carries a Government, Ministry of Health or Health New Zealand explanation of why the 2023–2028 roadmap summary names no target figure, or why rheumatic fever is not among the five national health targets. The Government release announcing the roadmap did not return its text to the automated reader, so whatever it says is not reflected here.
• Whether the full roadmap contains a number. Only the official summary page was read. The full document did not load on two attempts, so whether a target figure appears somewhere inside it is not established.
• The rate at the deadline. No source opened here gives the first hospitalisation rate for the period ending 2017-06. The latest figure tied to the programme evaluation is the 2016 rate of 2.9.
• Whether the 2016 figure and the current data set count on the same basis. The 2016 rate comes from the programme evaluation and the 2024 and 2025 rates from the Health New Zealand data set. No source opened here states that the two use the same case definition, so the direction of change between 2016 and 2025 is not stated here.
• Whether the follow-on funding ran to 2022 and what replaced it. The NZD 5 million a year was described in 2016. No source opened here confirms that it was paid through to 2022, ended then, or continued under Health New Zealand.
• When the district health boards stopped operating. The royal assent date of 2022-06-14 was confirmed. The date on which the boards were actually replaced was not.
• The Pacific population count. No source opened here gives the 2023 census count for Pacific peoples. The census figure that was opened is reported as people of Māori descent, and no source opened here says whether that matches the group definition used in the rate series.
• How many first episodes lead to rheumatic heart disease. No source opened here gives that progression rate, so no estimate of long-term heart disease is made.
• What the ratios in the twenty-year study rest on. The stated ratios of 53, 23 and 22 differ from the quotient of the rounded rates shown beside them, and the material opened does not state whether they are adjusted.
• What the Pacific Healthy Homes initiative achieved. No source opened here reports a measured outcome for the 600 homes.
• Where the vaccine research stands. The 2021 funding announcement gives no completion date, and no source opened here reports a vaccine entering the national immunisation schedule.

See the evidence

No full primary planning document was read. The Health New Zealand data set page and the roadmap publication page were opened directly, as were the programme evaluation article, the twenty-year child health study and the public health science institute release; together they carry the 2012 target, the 2016 rate, the 2024 and 2025 rates by group and the absence of a numeric target on the roadmap summary. The full roadmap document, the Government release on the roadmap and the census page for Pacific peoples did not return their content and are left as unconfirmed rows rather than removed. The Ministry acknowledgement of 2016, the programme cost, the follow-on funding and the vaccine and housing initiatives come from press reports, and the list of five national health targets comes from a public broadcaster report rather than from the target documents. Where the opened sources disagree the disagreement is left visible: the rate ratios in the twenty-year study do not match the quotient of the rounded rates shown beside them, and the 2016 evaluation and the current Health New Zealand data set are not stated by any opened source to count on the same basis. This is a Path A output (research-based definition), so observation_refs is empty and provenance_mode: press-derived.

People affected

Estimated range Not derivable

The reason and what is missing are listed under “What is missing” below