My good friend Dr Ayesha Verrall has written a really interesting post over at Policy Progress on the appropriate role for the public health system. Ayesha argues that the public health system exists not just to care for the sick, we should also view health as an investment and as a social determinant.
In terms of investment we need to see the value of a healthy population and workforce. Health is a public good and we should see the benefits of health care to our wider society that are far wider than simply ameliorating suffering. Health as a social determinant looks at the linkages between health and other factors such as socio-economc status, social isolation and so forth.
Ayesha advocates a greater focus on preventative health care, but also points out how this can challenge the agreed role of the state:
“…different approaches to health care may prioritise treatment on the basis of need (the most sick), or treatment based on ability to benefit (often less sick) through to prevention (not sick at all). In extending the scope of the health system to prevention, one intervenes in the lives of the healthy. Those the subject of preventive medicine aren’t sick, don’t feel sick and may not agree with authorities that it is worth their while participating. As progressives seek to do more through preventive medicine, we test the boundaries of the agreed role of the state. The benefits of intervention may take generations to materialise and – when they do they appear as statistical phenomena – represent decreasing rates of disease, rather than individuals who can point to concrete services creating improvement in their lives.”
The last Labour government increased the focus on preventative health care, but many of the steps we took have been reversed by the new National-led administration. I strongly believe that we’re far better off investing in programmes that keep us healthy rather than focusing on putting more ambulances at the bottom of the cliff. But as Ayesha points out, we have to carefully consider where the appropriate role of the state starts and ends.
one of the more important aspects of developing acceptance of the need for, and the benefits of preventative medicine would be education. as in how to live and eat in a way that won’t make you ill further down the track.
how much work, or progress has been made in incorporating things like healthy life skills into secondary school curriculums? cooking skills would be my first choice as an obvious place to start.
sponsering night classes might be a relatively inexpensive method of spreading the good word without giving the reactionary conservatives too much ammunition in the battle to maintain profit margins for the drug cartels.
Big ups for public health!
And perhaps we do not always have to be in a hurry to jump and spend $100M on some corporate’s bottom line. This seems to happen under the pretence of combating the next fad disease which becomes all important just as big pharma comes up with a new whizzbang product to market to our health officials.
but many of the steps we took have been reversed by the new National-led administration.
While I have a great deal of enthusiasm for well-thought-out public health initiatives, one has to ask the question as to whether any of the initiatives cancelled by the National party had any demonstrable value.
One has also to ask where the real priorities in health spending are according to the taxpayer, who is, after all, the person footing the bill.
Just wondering – how would one ask ‘the taxpayer’ exactly? I mean, which tax payers in particular would you ask?
And even given that, how would said tax payer(s) be able to tell you whether or not the priority should be a centralised neurosurgery unit in Christchurch, a new MRI unit in the Auckland region, or additional public health nurses for each DHB?
Ah well lets just try your idea out and see what happens. Perhaps we could use an STV type system to rank a list of 10 or 20 different priorities and go with that.