From 0.1% of the total population in 1945 to 6.9% in 2006, Pacific peoples now resident in New Zealand highlight significant health policy and service delivery issues within an increasingly diverse society. Over the last decade, marked differences in the health status of Pacific New Zealanders and Palagi New Zealanders have been well documented, showing high levels of disparity and continuing negative trends. This paper provides a broad overview of the history of Pacific health and health initiatives in New Zealand from the 1940s through to the mid 2000s, highlighting the interface between Pacific peoples and the New Zealand health sector. While the New Zealand Government has become increasingly responsive to Pacific health needs, significant disparities remain between Pacific and Palagi populations. Furthermore, many of the encouraging health initiatives introduced in the past decade remain at risk due to a variety of factors, including a need to strengthen the Pacific health workforce and management expertise.