a black and white image of Casey Costello wearing a shirt and blazer, with pink words like "women" "females" and "people???" overlaid

Casey Costello, confused

OPINIONPoliticsApril 15, 2025

A deeply frustrating line-by-line reading of Casey Costello’s letter to Health NZ

Editor

Casey Costello, confused

Does the associate minister of health know that sex and gender are two different things? Her letter suggests no.

On March 27, associate minister of health Casey Costello sent the interim CEO of Health NZ a letter (via email) raising a serious health concern. The concern required four paragraphs of text that, on the surface, read like a fairly boring update from Costello but on a closer read, reveal a woman of the female sex deeply confused by basic medical concepts.

Let’s take it slowly.

Addressed to Dr Dale Bramley, interim chief executive, Health New Zealand.

This is a great start. Bramley’s name is spelled correctly and his job title is correct. Interestingly, the letter was sent to Bramley’s email which includes an “@TeWhatuOra” as the agency name. The government’s earlier insistence on changing Māori agency names to English to make it easier for everyone to understand has instead resulted in a much more confusing situation where people’s work email addresses don’t match their workplace name right above it.

I wonder if this will become increasingly ironic as the letter goes on.

Dear Dale

Lovely opening.

As the associate minister of health responsible for women’s health, I write to you to express concerns when referring to women in internal and public documents and communications.

Ominous first line that grabs your attention and is straight to the point. Good writing here from Costello. My immediate thought when reading this was “oh no, did someone refer to women as bitches in an email?”

As we know from the Women’s Health Strategy, we see inequity in women’s health in New Zealand for a variety of reason. These inequities are larger for many groups of women, including wāhine Māori, Pacific women, rural women and disabled women.

This is also true and it’s heartening to know that the associate minister of health is aware that different demographics have different health needs and when inequities are not addressed, it creates health outcome disparities. Confusing, then, for her government to be operating on a “need, not race” directive, particularly in the health sector, which downplays the existence of race-based inequities. Am sure Costello is looking into this and drafting up some internal letters.

It is widely accepted that there is a sex bias in the health system, meaning women often have their symptoms overlooked or minimised, resulting in delays in diagnosis.

Ah, our first basic concept, misunderstood. A sex bias suggests a bias based on, well, sex. Women having their symptoms overlooked or minimised (which does happen) is a gender bias. These are two different things. One is biological, the other social. But we still don’t fully know what this letter is about so maybe Costello will clear it up later.

Women also have sex-specific medical conditions such as endometriosis, gynaecological cancers and pregnancy are only experienced by those of the female sex.

Hmmm she’s done it again with the conflating of gender and sex. Women are certainly more likely to experience endometriosis, gynaecological cancers and pregnancy but “women” and “sex-specific” don’t really work in the same sentence. Plenty of women don’t have “female sex-specific” organs, whether through illness, congenital anomaly or – and this is what I’m assuming Costello is railing against – gender expression and dysphoria.

Costello would have gone through New Zealand’s education system back when differentiating between sex and gender was not a thing. Thankfully it is now, so young people can learn about the difference between sex and gender, including the existence of intersex and trans peo- wait, no, news just in this week: after scrapping the RSE (relationships and sexuality education) guidelines last June, the government has opened consultation on a new draft framework that includes mention of consent and sexuality but little mention of gender identities and no mention of intersex people.

As women age, they experience sex-specific issues like menopause and greater loss of bone density and higher rates of dementia than males. It is therefore important that we have clarity about the people we are referring to when talking about women’s health.

Again, concern for gender inequities in health is a good thing for the associate minister of health to raise. It is unclear which example of “unclear” language Costello is responding to here, given it’s not common to see gender-inclusive language when referring to dementia rates. What’s concerning me, however, is Costello starting a sentence with “as women age” and ending with “higher rates of dementia than males”. Women and males, the two sexgenders. Very clear, thank you.

Sex-specific language ensures that women know what health services they are entitled to and can access these easily, especially for those women with English as a second language.

“Sex-specific language” would mean only referring to patients as males or females, which I’m not sure has ever been done? Costello’s concern for women with English as a second language is nice and as someone who has “translated” more than one doctor’s appointment for my mum (who speaks fluent English as a second language), I agree that health officials could be a lot better at communicating with patients, particularly when there are different cultural and societal norms regarding pain and seeking help. I’m not sure “pregnant people” is the most pressing language to address.

Recent documents that have reached my office from the Ministry of Health have referred to women as ‘pregnant people’, ‘people with a cervix’ or ‘individuals capable of childbearing’.

Actually, they haven’t referred to women as anything. They have referred to pregnant people as “pregnant people”, people with a cervix as “people with a cervix” and individuals capable of childbearing as “individuals capable of childbearing”. This may seem semantic because it is, but if one were to expect specificity in language from anywhere, it would be from the medical sector.

Those terms above are specific. They may not be how most people talk in everyday language but they’re more medically accurate, as they should be. Lots of people, maybe even Costello, refer to “down there” as being the vagina. It’s somewhat true but if you went to a doctor, they’d (correctly) refer to the outside part as the vulva and the inside part as the vagina. And yes, I am using “outside part” and “inside part” to demonstrate accessible language.

Or, to put it another way, when I go to the doctor because I have the shits, I am broadly correct in my assessment but I would expect them to refer to it as something a bit more medically appropriate (persistent diarrhoea).

Only women and people of the female sex can get pregnant and birth a child no matter how they identify.

Unfortunately this is not true. If Costello wants to get technical about a social construct like “women” then she should also note that girls can get pregnant too. She’s also asked for clearer language but frankly “pregnant women and people of the female sex” is a lot more confusing and clunky than “pregnant people”.

My priority as the minister responsible for women’s health is to support women to live longer in better health.

Noble cause. Might I suggest not repealing smokefree laws or giving tax breaks to tobacco companies?

It is therefore reasonable to expect that women are fully aware of the services and support available to them. As such, I consider that clear language should be used in all documents and communications that refer to health issues specific to females.

Fitting to end this letter by once again conflating women and females, gender and sex. But evidently, despite not knowing this basic difference, Costello feels strongly about this language being used enough to demand that language policies be changed. And what was the policy exactly? When asked by RNZ this week, “a Health New Zealand spokesperson said the agency did not have a policy relating to the use of gender-inclusive language”.

Costello doubled down when asked to clarify her letter but added: “This does not stop Health NZ and the Ministry of Health developing communications and resources for trans and non-binary people.”

So Costello’s suggestion for “clearer” language is for Health NZ staff (with Te Whatu Ora email addresses) to instead create two separate communication strategies when referring to the same specific health needs, one which uses the very-much-not-sex-specific “women” and another that uses the more medically accurate phrasing.

In all of this, Costello never mentioned a single woman complaining about the communications or finding it hard to understand. In fact, her only reference to it was the documents she herself had received and taken issue with. Perhaps the easiest solution to this non-existent problem would be to create special communications just for Costello, so she doesn’t get further confused by the separate concepts of sex and gender.

Very clear, very efficient.

Keep going!

Audience watching a colorful, glitch-effect presentation in a dimly lit room. A group of people is seated at desks on stage, with a large screen displaying text, including the name "Richard Taylor.

Richard Taylor addressing the crowd at Vision for Wellington’s second event. Image: Joel MacManus

OPINIONPoliticsApril 15, 2025

Windbag: Vision for Wellington shows its blind spots

Joel MacManus

Wellington editor

Richard Taylor addressing the crowd at Vision for Wellington’s second event. Image: Joel MacManus

The political supergroup’s event about Wellington’s art scene involved lots of CEOs and very few artists.

Windbag is The Spinoff’s Wellington issues column, written by Wellington editor Joel MacManus. Subscribe to the Windbag newsletter to receive columns early.

I’ve been pretty sceptical about Vision for Wellington, the supergroup of wealthy and powerful Wellingtonians, ever since it launched with a glowing front page story in The Post. They’ve made absurd claims that their inherently political project is “non-political”. Sinead Boucher seems to have used Stuff as the group’s internal marketing department. Their star-studded debut event was devoid of vision and consisted mostly of angry retirees complaining about bike lanes.

Credit where credit’s due: the group’s second event was more interesting and constructive than the first (though that’s not saying much). “A Creative Conversation”, focused on Wellington’s art scene, was held on Thursday last week at Toi Whakaari in Newtown. It ran for nearly two-and-a-half hours, starting with a panel discussion followed by an audience brainstorming exercise. Throughout the evening, two people frantically jotted notes on whiteboards; Vision for Wellington has hired consulting firm PwC to collate its ideas and write its final “vision”.

The three panellists were impressive. Muralist and sculptor Ariki Whakataka Brightwell presented some of her pieces and discussed the challenges of finding workshop spaces. NZ Art Show director Carla Russell highlighted the importance of finding profitable models and working with the business sector. Wētā Workshop founder Richard Taylor brought out the Wētābot005, a Terminator-esque robot that was both awe-inspiring and terrifying. It remained on stage for most of the event, subtly lifting its arms and chest every few seconds as if it were breathing.

The audience was considerably smaller than the 1,000-strong crowd at the first event, with the 200-seat theatre about three-quarters full. Most of the audience members were individually invited because the group deemed them “important members of Wellington’s arts and creative community”.

When MC Simon Bowden asked how many of the audience were artists, about 10% raised their hands. When he asked how many had a second job to support their art, the number halved. There were plenty of chief executives and board directors who run arts organisations, but very few people who make art.

At the start of the brainstorming session, Bowden invited six early-career artists (the youngest people in the room by far) on stage to ask “provocations” for the crowd to discuss. The results were a mixed bag. The crowd suggested a council-funded role to help artists with administrative tasks, a city arts hub, and an artists-in-residency programme within government ministries.

One person raved about their recent visit to the British Museum and suggested, “What we really need is a museum that incorporates our music and our art” (a fascinating idea for the city Te Papa is in). Carolyn Henwood, a founding member of Circa Theatre, wanted to create a unified arts industry group in the vein of Beef + Lamb New Zealand or New Zealand Winegrowers. Richard Taylor suggested forming a commercial board to be “the Fonterra or Zespri of the arts world”.

When you put a bunch of board directors in a room to solve a problem, it’s not surprising that their idea is to create another corporate board. When all you have is a hammer, everything looks like a nail. This is the fundamental problem with the Vision for Wellington project so far. They’re the upper class, talking to the upper class. The people who will take Wellington’s art scene forward aren’t sitting in board meetings. They’re putting on grimy gigs at Valhalla and unhinged shows at BATS. They’re 21-year-old buskers, not 65-year-old CEOs.

Let’s ask the question no one at the Vision for Wellington event asked: what makes a city’s art scene great?

In 2022, researchers at Columbia University tried to answer that question with a study titled Towards quantifying the strength of music scenes using live event data. They used the number of live music shows per 100,000 people as a rough indicator to measure the strength of a local music scene. Then, they explored how it correlated with 28 socio-economic indicators.

The factors most strongly correlated with thriving music scenes included the number of performance spaces available, affordable rents, high population density of people aged 18-29, and high rates of public transit use, cycling and walking.

If up-and-coming artists are surrounded by their peers, have plenty of opportunities to perform, and can afford to survive with a part-time job, they have the best chance to develop their talent.

In the late 90s and early 2000s, Wellington produced an enormous number of breakthrough artists (Taika Waititi, Jemaine Clement, Bret McKenzie, The Phoenix Foundation, Fat Freddy’s Drop, The Black Seeds, Fly My Pretties, Fur Patrol, Dai Henwood and Jo Randerson, to name a few). That’s because the growth conditions were ideal. There were twice as many performance venues operating, and rent was a hell of a lot cheaper.

In 2025, there are still plenty of cool people making interesting art (shoutout Dartz, Dateline and Maria Williams) but they’re doing it in an environment that makes it much harder to succeed.

Notes on the whiteboard that will be collated by PwC (Photo: Steve Cosgrove)

Richard Taylor spoke about live music as the nucleus of the art scene. “Youth culture gathers around the brightest lights,” he said. Young artists “deserve a home”, but Taylor said he was worried about the financial pressures they faced. He gets it. I’m not sure anyone else from Vision for Wellington does.

When an audience member made an impassioned plea for affordable housing – “If people can’t afford to live in the city, that’s the issue” – there was an awkward silence. Then, a couple of people started clapping (I joined in). Bowden hurriedly cut off the applause and moved on, insisting they were behind schedule and didn’t have time to dwell on housing. The event ran for another 75 minutes after that.

Maybe Bowden was worried that housing was too political. But these are political problems. Successive councils have created a housing shortage by introducing zoning changes that restricted the construction of new homes. They’ve made it more difficult for venues to operate by limiting opening hours and liquor licensing and cracking down on noise complaints.

Vision for Wellington, so far, has been unwilling or unable to grapple with the role the cost of living crisis plays in Wellington’s malaise. I suspect that’s because they don’t feel it.

Here’s my practical suggestion for Vision for Wellington: go talk to the E tū Musicians’ Union about its successful efforts to change the council’s noise control rules for venues. Find out what else they need and use your power to amplify their voices.

Then, go talk to A City for People, the young-people-led Yimby group that spearheaded the fight for zoning reform to allow more housing. Use your considerable wealth and influence to support property developers who want to build homes and oppose those who try to stop them. It would do a lot more good than another two-and-a-half-hour talkfest in a room full of CEOs.