CONFERENCE PRESENTATION

Building in policy for ‘fantastically cheerful medicine’. Why the Ministry of Health may choose to ignore a key UK Case study.

New Zealand Sociology (SAANZ) conference 2025 presentation on health reform.

Sociological Association of Aotearoa New Zealand (SAANZ).

A Sociology of Beauty and Joy

Critical Health Studies stream: 3 keywords: metabolic, mental, remission. Session 8.5: Food and Health, Friday December 5, 2025. J.R.Bruning.

Legacy policies and guidelines have not been able to mitigate New Zealand’s metabolic and mental health epidemic – the uncomfortable fact is that the status quo is not preventing chronic illness in the New Zealand population. When blood sugar is elevated and unstable, triglyceride levels rise and insulin comes to the rescue. It is not just sugar that elevates blood sugar. White rice, potatoes and cereal products elevate blood sugar with sugar sweetened beverages, juice and ultraprocessed foods – together forming a cumulative daily carbohydrate burden.

Unwin D, Haslam D, Livesey G (2016) **It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited.** *Journal of Insulin Resistance*.

The prediabetes and diabetes crisis continues to surge as prevalence rises in younger age groups. Amid this crisis, the Ministry of Health recommends some 5-9 serves of cereals a day. Ministry of Health white papers do not draw attention to the health risks from diets high in refined carbohydrates (also known as starches). These diets cumulatively increase blood sugar across the day.

The uncomfortable fact is that the cumulative burden of refined carbohydrates drives risk for a cascade of multiple health conditions: multimorbidity. This includes both metabolic conditions such as diabetes, heart risk and cancer but also, confrontingly, mental health conditions that normative positions relegate to being exclusively psychosomatic. The evidence of benefit from a change in diet is demonstrated at the cellular and mitochondrial level, and includes a rapidly expanding body of case and cohort studies.

When Ministry of Health policy papers and guidelines are systematically analysed, as we have done at the Physicians and Scientists for Global Responsibility (PSGR), a New Zealand-based charitable trust, we can see that diet is not in the intervention toolbox across the policy landscape. Interventions focus on screening and immunisation. PSGRNZ’s forthcoming paper reveals how New Zealand’s health system lacks policies or resources that would require officials to review this evidence in a scientifically methodological and robust manner. Official documents fail to wrangle with the common problem of comorbidity (or multimorbidity) that commonly follows a diabetes diagnosis. Official documents are silent on the pervasive problem of polypharmacy that is associated with the cascade of biological conditions that follow a diabetes diagnosis.

PSGR’s forthcoming paper not only reviews policy to assess how diet and nutrition is prioritised across the policy landscape, it lays out the carbohydrate cascade, the insulin pathway that precedes and accompanies most of our pervasive health challenges, providing some 500 references for support. The wicked problem – multimorbidity – may have – upstream – a dominant underlying driver: excessive carbohydrate exposure.

Essentially, the culture, structure, policies, guidelines and habits of the Ministry of Health and its associated agencies effectively negate any obligation or requirement for officials to consider this contradictory and uncomfortable knowledge, even though it holds potential to mitigate the metabolic and mental health epidemic.

The issues raised above are well known by certain groups in New Zealand that struggle to get the complex issues at play addressed by the mainstream media and who consistently receive brush-offs by the Ministry of Health. Non-knowledge includes an absence of knowledge and information in policymaking and regulation. Matthias Gross (2016) provides insight here. While ignorance denotes the limits of knowing, non-knowledge itself is a specific kind of knowledge about what is not known. Certain actors benefit by government officials, social scientists and the general public not knowing, because the underlying facts are simply not known. The absence of knowledge effectively defuses any contestation and creates barriers to the production of knowledge. The structural arrangements prevent contestation of the prevailing perspective.

Who benefits from the not-knowing? When equity is conflated with equal access to medical treatment and pharmaceutical drugs, no matter how sick, no matter how many preventable chronic health conditions that are diagnosed – it is the medical industrial complex that benefits.

Knudsen at al aptly describe: Knowledge is power, but so is the control of ignorance and to control the line between knowledge and ignorance is clearly a form of power.’

Power quietly entrenches itself in the repetitive equity and wellbeing rhetoric across government health policy which consistently conflates health with access to medicine. No government document highlights the epistemic injustice that is submerged - equity of access to medicine – which manifests as polypharmacy will be overrepresented in poorer populations.

It is the norm in New Zealand to have multiple health conditions. Sharon Leitch et al reviewed 2011-2013 medical records, finding that 7308 of 9076 (80.5%) patients received 175 657 prescriptions for 846 different medications from their general practices. James Stanley’ et als 2018 chart highlights the earlier presence of multimorbidity and drug dispensing in Māori populations. Tony Blakely and colleagues have pointed out that two or more health conditions do not amount to a simple additive cost. Multimorbidity is superadditive. As polypharmacy increases so do adverse effects of drugs, and the drugs that are required to stem the suffering from the adverse drug effects. Yet the institutional silence weighs heavy. This massive moral and ethical disconnect remains unrecognised.

Stanley J, Semper K, Millar E, Sarfati D. (2018). **Epidemiology of multimorbidity in New Zealand: a cross-sectional study using national-level hospital and pharmaceutical data**. BMJ Open.

New Zealand sociological work which tackles the sticky problem of multimorbidity and the related spectre of polypharmacy to highlight the ethical contradictions presented by the dominant representation of ‘health equity’ could not be identified. Health equity should not be defined as a function of equal access to drugs at onset of disease. This is medical equity. Equity principles that conflate equity of access to treatment as the predicator of health equity are misleading and incorrect. These normative positions are entrenched across government and academia and they perpetuate a medical mindset that masquerades as a health mindset.

The issues I raise here may sound unfamiliar and perplexing. New Zealand academia retain a focus on junk food, saturated fat, sugar and obesity as the key causal driver of diabetes and other related health conditions. Crucially and connectedly, while public health actors lament poor adherence to diets and the power of big junk food, they are yet to integrate new knowledge that addiction to ultraprocessed food constitutes a substance use disorder. An international consensus group has recently formalised a language around food addiction, which includes acknowledgement of the dopaminergic action of industrially formulated high glycemic index carbohydrates and fats.

The absence of sociological introspection is reflective of the prevailing relations of power. There are legitimate established issues that can be problematised: sugar, junk food marketing, foodways, equity of medical treatment and access to healthy food. But the greater elephant of a health system that equates high carbohydrate, low fat intakes with ‘health’, would require an interdisciplinary team with a large research budget, and the funding would have to be approved.

My master’s thesis provides some insight on why this latter scenario is unlikely. New Zealand policy for research and science drives the approvals for long-term research. Interdisciplinary research that will never conform to excellence norms and that will not guarantee an innovation, falls outside funding scopes. The scientists – including social scientists - that might flag these complex and complicated issues simply don’t exist, because they fall outside of funding scopes. No pressure can then be exerted on officials who, in the knowledge gap, default to favour engagement in non-learning activities that are supported by current beliefs. Jalonen has described how ‘organisations alienate themselves from issues that must be attended to in the future’.

You are at this talk as your interest was likely piqued by the case study of the UK based Unwin clinic. The intervention combines medical diagnosis of prediabetes or diabetes and the prescription of a dual treatment pathway. Clinical care is delivered through doctor–patient counselling and reinforced by a community-led, networked system of support. This integration of medical, psychological and sociological perspectives weaves a change-framework, with a core focus on reducing daily carbohydrate intake to improve glycaemic control. GP David Unwin tracks patient blood test results to ensure that medication changes to reflect changes in blood pressure and HbA1C. This includes deprescribing medications if conditions are reversed.

Unwin D, Delon C, Unwin J, et al. (2023). **What predicts drug-free type 2 diabetes remission? Insights from an 8- year general practice service evaluation of a lower carbohydrate diet with weight loss.** BMJ Nutrition, Prevention & Health.

The clinicians involved with this pioneering work have subsequently released a cascade of papers documenting the success of the programme. The papers not only demonstrate reductions in key markers of metabolic syndrome, including body weight, blood-glucose, and systolic blood pressure, they document marked improvements in patient mental wellbeing. In addition, the programmes success has revolved around a health-coach model. This has been replicated in further trials and the Unwin practice’s model has been adopted across the world including in New Zealand.

A distinctive feature of the programme is its explicit recognition of food addiction within prediabetic and diabetic cohorts. Individual-led outcome parameters include clinical psychological support which recognises and integrates the role of hope as a change agent. Patients are provided with practical tools, tips, and support networks to help overcome addictive eating patterns while building food preparation and cooking skills.

As the Unwin Clinic results showed success, Dr Jen Unwin published papers on other trial outcomes, and in this year, Unwin and a group of colleagues published a consensus paper on food addiction which was presented at the food addiction conference. Dr Jen Unwin described the cycle, the ultraprocessed food addiction trap that was perpetuated by exposure to hyperpalatable ultraprocessed foods, suppression of frontal lobe activity, the observation that Neurons that fire together, wire together, the damaging impact to the mitochondria, leading to energy deficits; the problem of Negative reinforcement: a bad feeling state is temporarily relieved with a low mood being temporarily relieved by the re-exposure to the industrially formulated substances that are high in carbohydrates and industrially refined fats.

The measurable improvements in glycaemic control, significant prescribing savings, and marked improvements in mental health produces happier people with more energy and purpose. Clinician Jen Unwin has described the approach as ‘fantastically cheerful medicine’.

What is the bad news? The underlying evidence that supports the Unwin clinic case study – the case for refocusing upstream – conflicts with New Zealand’s normative perspective, and is out of scope of Ministry work programmes. Unfortunately, New Zealand health agencies predominantly rely on ‘international evidence reviews’ that adhere to current guideline beliefs that reduce saturated fats, place no limit on carbohydrate consumption and limit meat proteins. These same reviews are largely silent on the biochemical impact of nutrition on biological health, including mental health, and the particular importance of the fat and protein macronutrients.

Therefore, it is unlikely that the Unwin clinic case study would gain political traction within the Ministry of Health due to the uncomfortable knowledge that is produced. The case study is in essence a challenge to normative representations of a healthy diet and therefore challenges the dietary guidelines. Risk is an outcome of a daily carbohydrate burden and the requirement for tailoring of a diet to keep blood glucose low. The Unwin’s have fluency on metabolic syndrome as a cascade of effects associated with poor blood glucose, and food addiction critical factor that prevents dietary change and improvements in health. The Unwin’s case study adds to a substantial literature providing evidence for the insulin pathway as a key factor – if not driver - of not only prediabetes and diabetes, but of high blood pressure, cardiovascular disease i.e. – metabolic syndrome, of which a broad spectrum of common so-called brain related conditions including anxiety and depression.

These emergent knowledges and the questions they raise are not recognised by the Ministry of Health. The issues are outside the work programme.

Justesen and Plesner have advanced the concept of pluralistic collective ignorance, a term developed to account for diversity in how organizational members contribute to ignoring a phenomenon and the diversity of actors who contribute to ignoring it. Ignorance can be produced and reproduced via the daily interactions between multiple actors, ignoring and repressing what is known, a practice of ‘unseeing’ that as Otto et al have alluded to, allow organisational actors to know what not to know.

The medical and pharmaceutical complex do not have to engage in Gieryn’s boundary work. New Zealand’s Ministry of Health does this for them simply by ruling out emergent science which would contradict taken-for-assumptions through an absence of policies directing them to do such work, and the non-existence of research freedom. The Ministry of Health’s cognitive bias is firmly locked onto safeguarded rails that only go in one direction.

I conclude with Paul, Vanderslott and Gross’s (2022) observation that:

‘while knowledge is presented as a compelling reason for action, inaction too can be pursued through ignorance, and ignorance a strategy for inaction and the avoidance of accountability.’

Cheerfulness of patient outcomes be damned.