Nelson would be left without a fully functioning hospital in a major earthquake, the city's mayor says.
A report from the health agency Te Whatu Ora showed more than 100 hospital buildings around the country were below 34 percent of the national building standard, despite many of them being critical for any disaster response.
Two of those are at Nelson Hospital, which sits in a medium-risk area for a major quake.
Mayor Nick Smith said the report emphasised the importance of the hospital's rebuild, which was under way, and on schedule.
"But it is true that if we had a major seismic event in Nelson we would not have a fully functioning hospital, and that is why it is so important that progress is made as quickly as possible on getting the our hospital upgrade done."
Smith said there was no immediate safety risk, but the hospital's current state left the region ill-equipped for a large earthquake.
In Taranaki four hospital buildings would be at medium risk in a major earthquake. It was another region where work had begun to strengthen hospital buildings to withstand major shakes.
Taranaki Mayor Neil Holdom said the data underscored the need for ongoing investment.
A new hospital east wing is due to be completed three years from now, at a cost of about $400 million.
"The key thing is that we see the right level of investment to not just replace, but reflect the fact that our population's growing. So we want modern facilities for our people and the people that work in there, that are safe and fit for purpose for the next 40 or 50 years."
Holdom said all good employers should ensure their buildings were safe.
The report found seismic assessments had not been published for more than a third of hospital buildings nation-wide, including 40 categorised as importance level 4. While "shortcomings" were also being found in some recently built hospital buildings.