In the early 2000s, Dr Shane Reti spent three years walking across Northland. He was 40, and he’d been a practising GP for about a decade. He’d just been appointed to the local district health board, which was dragging its feet on its health-needs assessment: a statistical sampling of the population to figure out what the region’s most pressing problems were.
So, Reti designed his own study. He took it to the ethics committee at the University of Auckland, who raised eyebrows at his proposed method: he would personally conduct the sample on foot over a number of years during his evenings and weekends. Eventually, they told him to fill his boots; approval was granted.
“I’d call Stats NZ for a meshblock,” Reti recalls, referring to the small geographic areas preferred by government agencies for their analytics, “which could be anywhere in all of Northland. I’d drive there and do 10 houses to the left in that meshblock. Streets and roads I never knew.”
He knocked on doors and asked residents to answer his survey questions. And because he wanted his study to be true to its design, he went to properties that were inaccessible and sometimes downright dangerous. He got lost; bitten by a dog. “I nearly drove into a flooded stream trying to get to the house across it. Didn’t see it in the dark. Wasn’t until I heard a noise and it was boulders rolling down the flooded water. I thought, what the heck’s that? I stopped the car in time.”
Then there was the gang house: a fortified building in Moerewa with boards over the windows. “It was 10 o’clock on a Sunday morning,” Reti recalls. “I knock on the door. Patched member comes out. ‘What do you want?’ I say, “Tēnā koe, kō Dr Shane Reti tōku ingoa, and I’m doing a health survey. May I speak with the owner of the home? He says, ‘Inside.’ So I walk in. There’s one dim light showing. I couldn’t see the roof because of all the smoke. There’s six gang members sitting on crates. And they’re scrutinising me.
“So I start asking my questions. And I had 16 questions, but the question I’m thinking of in advance is question 14: ‘Have you used any narcotics in the past year?’ I wasn’t sure how that’d go down in this audience – I could have dodged it. But then I thought, ‘Nope. You want to stay tight to your study design.’ I asked the question and they fell about the floor laughing. One of them fell off a crate. They’re all shouting, ‘He sniffs.’ ‘He snorts.’ ‘He injects.’ They thought it was hilarious. So, I extracted the information. Completed the survey. They were gracious.”
Into the Weeds
Reti shares this story in the National Party caucus room, a brightly lit wood-panelled space on the third floor of Parliament. Portraits of previous National leaders look down on us; Don Brash keeps catching my eye. Reti looks 50 but turned 60 this year. He’s softly spoken, neatly dressed; his shirt has a discreet SRR monogram sewn into the French cuffs (Shane Raymond Reti). He tells his stories in the polished, anecdotal style that professional politicians offer the media and the public, but he frequently veers off into the weeds of dermatology, emergency medicine, health informatics and non-linear equations.
It’s a long way from the Moerewa gang house, but it was Reti’s journey through Northland that eventually brought him to politics, where he now sits on National’s front bench as spokesperson for health, Covid-19 response, Māori-Crown relations and Pacific peoples. In recognition of the study and his other community work, he was awarded a Queen’s Service Medal. In 2007, he won a Harkness Fellowship to study at Harvard. He spent six years there, became an associate professor at Harvard Medical, chief operating officer for a division at one of the university’s teaching hospitals, and took on a role delivering health-information technology into the Middle East.
On the front lines
What drew him back to New Zealand and a political career? “My values had always aligned with National,” he says. During his time at Harvard, he built relationships with the party’s leadership, and when the Whangārei electorate seat became available, he was encouraged to return home and stand. He came into parliament in 2014, but still practises as a physician.
A few nights before our interview, he headed out with the Wellington Free Ambulance, riding along on their late shift. He was there to observe, but jumped in when needed, taking blood and dressing wounds. He does this all over the country as often as he can. That night, he rode with the paramedics until 2am.
Reti affiliates to Ngāti Wai and Ngāti Maniapoto. He was born in Hamilton to a Mormon family, the oldest of five kids. “Dad was a carpenter, but he worked two jobs. He did commercial cleaning around Hamilton. So, some of my early childhood memories are on a vacuum cleaner with Dad or with a toilet brush, whatever my task was at whatever building we were cleaning.” Both parents left school early, but put an emphasis on the importance of tertiary education for their children. A political career didn’t resonate for Reti, but medicine did. When he was six, he made a makeshift first-aid kit and took it to school.
At 17, he was awarded a Rotary exchange scholarship for a year in the US. He still seems a little mystified by this. “I didn’t know what Rotary was. Why would I? And yet for some reason, they selected a blue-collar family and a young Māori lad to represent them over in the US. None of my family had ever been on a plane before, and off I flew to rural Idaho.”
His host families were extremely wealthy – one of them owned a ski resort and played golf with actor Clint Eastwood. Reti travelled around the US in a private jet. When he returned to New Zealand, he went to medical school in Auckland and joined the Territorials. Didn’t he want to have fun in his student years? He shakes his head. “I’m a non-drinking Mormon boy. You really think I’m going to party?”
Instead, he went on manoeuvres. His basic training was at Burnham, the army base on the Canterbury Plains. “It was so cold they sent the regular force back, but they thought they’d keep the university folk out there just to prove a point. So, we’re freezing. The water bottles burst. We took the tent poles out of the tents and the tents stayed up – it was that cold.
“I remember this Vietnam vet sergeant major: ‘Character building, boys. Character building.’ I was 17 and I thought, ‘Nah, it’s just cold.’ But there have been other times in my life when I’ve been cold and I thought, ‘You’ve been colder than this, Shane. You’ll be fine.’ He was right. I’ve had a sequence of experiences that stood me in good stead for later life.”
Individualised Care
Reti’s research papers from his time at Harvard are all online. His field was clinical informatics, an interdisciplinary study combining health, information technology and data science, and the titles hint at the kind of health minister he’d like to be: Data mining using clinical physiology at discharge to predict ICU readmissions; Mortality prediction of septic shock patients using probabilistic fuzzy systems; Reducing unnecessary lab testing in the ICU with artificial intelligence. There’s a combination of systems thinking: high technology, big data, and machine learning, but from a patient-centric viewpoint.
Much of 20th-century medicine was focused on specific diseases and conditions. Individual patients were seen as interchangeable, almost peripheral to diagnosis and treatment. Reti’s former lab at Harvard drove the shift away from that approach towards patient autonomy, and individualised care. “It’s like my whakapapa,” he says. “Whenever I go back to the States and people ask me what lab I’m from, I say the lab of Charles Safran and Warner Slack and straight away they know everything about me. They know, ‘He’s gonna be very patient-centric. He’s gonna speak the patient voice all day.’”
Labour holds a litany of charges against Reti, pointing to his socially conservative voting record. He opposed the euthanasia bill and abortion reform, and was one of only eight MPs to oppose the conversion therapy ban. He’s compared Māori mortality rates today with those of the 1840s.
Reti, or “Dr Shane” as she referred to him, was National’s deputy during Judith Collins’ leadership – described by some within his own party as a reign of terror, only partly as a joke – which resulted in a dire election loss.
Health Minister Dr Ayesha Verrall recently accused him of releasing misleading data about the number of nurses leaving the health system. In 2022, the NZ Herald removed an opinion piece he’d written about mental health statistics during the Covid pandemic because the graphs were inaccurate.
But canvass other politicians and journalists, and there’s agreement he’s a very “thoughtful” fellow. Which sounds like a compliment, but isn’t, quite. Politics is often about acting on instinct, seizing opportunity, going on the attack. Reti’s compulsion to dive into the weeds on every issue, to meticulously diagram everything out on his office’s many whiteboards, is not always regarded as an asset.
“He’ll be a better minister than opposition MP,” one National insider observes. Another remarks: “He’s not a retail politician.”
Labour is extremely vulnerable on health – a system in chaos, chronic staff shortages, an inexperienced minister, endless negative media – but when health is compared with National’s sustained campaigns on crime, inflation, housing and education, some in his party feel he isn’t drawing enough blood – that Reti lacks the appetite for attack politics. “I take that as a badge of honour,” he says when asked about some of these critiques.
“I would submit that if I can’t win an argument with persuasive reasoning and evidence, then I’m in the wrong job.”
Scarce Resources
Although still a non-drinker, Reti has convinced National to support medicinal cannabis and he is quick to draw the distinction. “It’s on the basis of the evidence.”
He doesn’t believe there’s a philosophical difference between politics and medicine. “I submit to you that anyone who starts a health course is in politics because you’re making decisions about scarce resources, and that is political.”
When he was on the Northland DHB, Reti became an advocate for water fluoridation. The region had the worst state of dental health in the country and fluoridation was the easiest, cheapest fix. The board wanted to survey the region and seek a mandate for the policy. But that would have cost about $70,000 – money it didn’t have.
Reti’s solution was to take out his chequebook and write the local council a blank cheque. He didn’t have the money, either, so he took on locum shifts to fund it. The survey was done. The region’s water was fluoridated. It’s a story that speaks not only to Reti’s conception of healthcare as politics, but also his inclination to bypass political or bureaucratic problems by solving them himself. He says it’s been pointed out to him, “Shane, you’re the orchard owner, not the guy picking the apples.”
If the coming general election puts him in charge of the health system, his DIY approach will never be an option. The sector employs about 220,000 people and costs about $24 billion a year. He’ll inherit a vast and dysfunctional bureaucracy. He’s already announced he’ll get rid of Te Aka Whai Ora/Māori Health Authority, replacing it with a Māori health directorate within the Manatū Hauora/Ministry of Health, and that he’ll prune back the hundreds of communications staff within the sector.
But health is a famously difficult portfolio to navigate. Reti’s dedication to reason and persuasion may have guided him through the streams of Northland to the labs and lecture theatres of Harvard, but they have far less purchase in parliamentary politics or central government. His reception back in the gang house may have been gracious, but his experiences in the boardrooms and executive suites of the health bureaucracy could be far more brutal.
