The National Party recently announced a proposal to cut foreign aid budget by 10% in order to increase funding for Pharmac and expand access to medicines.
National’s health spokesman, Simeon Brown, argued that New Zealander’s “hard earned money” should be spent “here at home” rather than sent overseas.
The proposal has obvious appeal. For many New Zealand families, access to medicine may determine years or quality of life with a loved one.
As many New Zealanders face barriers to accessing medicines and healthcare, alongside increased costs of living, it may be understandable that politicians would argue that public money should be directed towards domestic healthcare.
But while increasing medicine funding may be a legitimate policy goal, does that say anything about where that money should come from? Or why foreign aid is singled out as the spending category that should be reduced?
At the heart of this proposal is an implicit assumption that New Zealand faces a choice between helping people domestically and helping people abroad.
This tension is called a zero-sum trade off: either medicines are funded for New Zealanders or assistance is provided overseas.
But the zero-sum trade-off is not inevitable. Government budgets involve countless competing priorities, and every funding decision reflects a political judgment about what commitments are to be protected, and what commitments are to be sacrificed.
It is not a matter of whether New Zealanders deserve access to medicines or cancer screening: of course they do.
Most people would accept that governments have special responsibilities towards their own citizens. Few, for example, would argue that New Zealand should spend more on foreign assistance than it spends on domestic healthcare, education, or social welfare.
Governments have obligations towards the people they are elected to govern.
This tension is not new and is the centre of long-standing debates about what affluent countries owe to people beyond their borders.
But it becomes acutely visible when funding for international assistance is presented as competing with domestic needs.
The problem with this framing is that it treats domestic and international responsibilities differently. Domestic responsibilities are necessities while international responsibilities are optional extras that become relevant only when domestic needs are satisfied.
But this standard is extraordinarily demanding. No society ever fully satisfies domestic needs. There will always be pressures on healthcare, housing, education, infrastructure, and social services. There will always be additional medicines to be funded.
Of course, governments should always aim to address these needs, particularly in addressing unfair differences and inequities between people.
But if responsibilities beyond borders only become relevant once all domestic needs are met, they may never become relevant at all.
New Zealand has historically considered itself a principled international actorand has good international diplomatic relationships.
Yet when measured by what New Zealand financially contributes, this image becomes distorted. In 2025, New Zealand devoted just 0.27% of Gross National Income to Official Development Assistance.
This is well below the United Nations target of 0.7% and is 23rd out of 29 OECD donor countries.
Before further limiting aid to an already limited aid budget, one should consider whether New Zealand is contributing as much as a country of its wealth reasonably could.
The debate also raises a more fundamental question of fairness.
No one chooses where they are born. Yet birthplace remains one of the strongest indicators of health, opportunity and life expectancy.
In New Zealand, fewer than five children die before reaching their fifth birthday for every 1000 births. In some countries, that figure is more than twelve times higher.
Around five million children worldwide die before their fifth birthday every year from largely preventable causes such as pneumonia, diarrhoeal disease, and malaria. This figure is roughly equivalent to the entire population of New Zealand.
These differences are not reflections of effort, merit, or personal virtue. They are largely consequences of circumstances of which neither person had any control.
These statistics do not mean that New Zealanders need to feel guilty for their advantages, nor does it imply that governments owe the same duties to everyone everywhere.
But it is an uncomfortable question- why should geographic distance make an illness, and a person, less relevant?
The assumption that aid and domestic wellbeing are competing priorities is also increasingly difficult to sustain in an interconnected world. Foreign aid is often portrayed as money that leaves New Zealand and produces benefits elsewhere.
The Covid-19 pandemic demonstrated how health, economic, and social outcomes are shaped by events beyond national borders. Emerging infectious diseases, antimicrobial resistance, climate related health threats, fragile health systems, as well as wider geopolitical events, do not remain neatly contained within state borders.
Research suggests that investments in global health preparedness, for example, cost only a fraction of the economic losses associated with major pandemics.
Rather than representing a diversion of resources away from New Zealanders, some forms of development assistance, such as those focused on health security, vaccination, and disease preparedness, are better understood as investments in collective wellbeing.
Foreign aid, therefore, cannot be reduced solely to matters of generosity, but is part of the infrastructure of international cooperation on which countries increasingly depend.
None of these arguments means that foreign aid budgets are exempt from evaluation and scrutiny. People can disagree about how much assistance New Zealand should provide, how effective aid programmes are, or how funding could be used.
Nor does it mean that expanding access to medicines for New Zealanders is not a worthy objective.
However, framing the issue as a choice between helping New Zealanders or helping others obscures the wider ethical question.
The question is not whether New Zealand should care for its own citizens, but whether concern for citizens eliminates concern for everyone else.
How that question is answered says as much about the values of New Zealand as it does about budget priorities. In an increasingly interconnected world, looking after New Zealanders and recognising responsibilities beyond borders need not be competing ambitions.
The real challenge is deciding whether, and how, the government can make room for both.
- Dr Emma Anderson is a former University of Otago student and researcher in global health ethics.