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Posts Tagged ‘public health’

There is more to health than a league table

Posted by Grant Robertson on August 29th, 2011

The conventional wisdom is that Tony Ryall is making a good fist of the Health portfolio. Now that I am up close in the area I can say that he keeps a tight rein on matters health, and is managing the portfolio effectively. But there is a big difference between managing the politics of health and actually doing what is right for the long term health outcomes of New Zealanders.

The best evidence of that is the release today of the Child Health Monitor Report. It shows, among other things, that in the last two years there have been an additional 5 000 avoidable hospital admissions for things like respiratory illness and skin infections. The authors of the report note that the cost of going to the doctor, especially after hours is a factor in whether children are getting the healthcare they need, along with a range factors associated with child poverty.

I am not saying all of this is down to the Health policy of the current government. But the focus on the narrow range of health targets set by the Minister means that child health is not the priority it should be. The Minister has narrowed the health targets in such a way as to scratch the itches of waiting lists and time spent in ED, but it is at the expense of early intervention and public health programmes. District Health Boards have responded by pursuing the Minister’s targets, spending on public health has been slashed ($124 million in the last Budget) and funding for primary care has failed to keep up with inflation.

Just managing the Health portfolio is not enough. I actually think it is irresponsible to avoid the long term investments that will lead to long term health benefits in favour of things that are designed to fit on a coloured chart and make the Minister look good.

Labour, through Annette King, has already outlined our Agenda for Children that will put children’s well being at the centre of our social policy. More details will be announced in the election, but from a health policy point of view public health and affordable and accessible primary care must be a priority.

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Filed under: children, health, inequality
24 Comments

Smokefree 2025

Posted by Iain Lees-Galloway on November 3rd, 2010

The Maori Affairs Select Committee tobacco inquiry report is finally out. I’m proud to have been part of putting such a bold set of recommendations to the Government.

The mood on the committee was to direct as much of the attention as possible towards making the industry itself more accountable and supporting smokers who want to quit. That’s why we favoured recommendations like removing tobacco displays, plain packaging and funding for nicotine replacement therapy.

We tried as much as possible to steer away from further impacting individual smokers. So we didn’t come out so strong on proposals like banning smoking in cars or in private homes. Personally I’m opposed to both. The only initiative that directly affects smokers is increasing excise tax.

I see the tobacco industry is upset as is their front organisation the Association of Community Retailers (sounds so friendly, doesn’t it).

Good. If they’re squealing it probably means we are on the right track. The question now is: Will the Government show the same ambition as the committee?

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Filed under: health
75 Comments

The role of public health

Posted by Chris Hipkins on August 19th, 2010

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.

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Filed under: health, public services
5 Comments

What Motivates You to Stay Healthy?

Posted by Iain Lees-Galloway on August 14th, 2010

It’s a slightly tired old saying but nevertheless true that prevention is better than cure.

Fittingly, it’s a mantra that resonates particularly in the Health system. Appropriate investment in the prevention (and management) of disease and injury is far more cost effective and socially constructive than waiting for you to get sick and only then trying to fix you.

Gareth Morgan recently wrote a column in which he notes that every dollar invested in prevention produces four times the results gained by a dollar spent in treatment.

It’s not a new concept by any stretch of the imagination. Some responses to the challenge of preventing illness have been successful, others haven’t. Some have been politically palatable, others have been labeled ‘Nanny State’.

So here are some questions:

  • What motivates you to be healthy?
  • Are you motivated to be healthy?
  • Can the Government motivate you to be healthier, if so how?

I’m keen to hear what you think because if we are really going to crack this one, we need to get alongside people and not just be telling them what’s best.

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Filed under: health
31 Comments

Where to in Health?

Posted by Grant Robertson on August 8th, 2010

In Wellington we woke to the news on Friday that Ken Whelan, the Chief Executive of the Capital and Coast District Health Board had resigned. In his farewell email to staff Whelan said

there was no more room to cut the district health board’s costs, despite Government pressure to do so. “I cannot see where any more major efficiency can come from without negatively impacting on services.”

Even Sir John Anderson, the government’s appointment to Chair the Board has said that any further savings “would cut into muscle”.

I have had a bit to do with Ken over the last 18 months or so that I have been an MP, and I regard him very highly. He listened, he was honest, and had a very good grasp on what was happening within the DHB. When he sounds the warning he has made on his departure, the government should listen. The two areas where I have the biggest concerns in Wellington are mental health and public health where cuts are starting to have an impact. In Mental Health this will get worse with the closing of the two community clinics in the city and Kilbirnie set to cause significant disruption to service, despite the best efforts of the staff involved.

When we combine what is happening in Wellington, the public uprising over neurosurgery in Dunedin, the at least 80 cuts to frontline services elsewhere across the country, as highlighted by my colleague Ruth Dyson, and the fact we still do not have a Director-General of Health in place, questions have got to be asked about where Tony Ryall is taking Health. It is never going to be easy. Maintaining and developing health services with an ageing population, increased costs and understandable public desire for locally accessible services is a tough ask. But it needs leadership and it needs to get beyond glib answers in Parliament.

A place to start? Of Capital and Coast’s $47 million deficit, $37 million of it relates to the building of the regional hospital. A senior health professional I spoke to on Friday noted that other DHBs with financial issues are also in this state because of costs related to the buildings. A chunk of this is due to the capital charging regime. I think we need to re-look at the capital charging regime. Of course we want DHBs and other government entities to be efficient in their use of buildings and capital, but if it starts to mean cuts into core medical services, we have to question if the priorities are right?

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Filed under: health, public services, wellington
8 Comments

Nats: Poor people should just die

Posted by Chris Hipkins on August 17th, 2009

I find the idea that we should prioritise healthcare to those who are in the workforce totally disgusting. Mothers, grandparents, children and others who are not in the workforce will rightly be worried that these ideas are even under discussion by the National/ACT/Maori Party government. Even more so because Tony Ryall doesn’t seem to have ruled them out.

I was disappointed that Ryall wasn’t challenged on this aspect of his health reforms when he appeared on TVNZ’s Q+A over the weekend. But he shouldn’t have waited for the question that never came. He should have made it clear that quality public healthcare will continue to be available for all New Zealanders. Failure to do so suggests a chronic lack of leadership and a questionable set of values on the part of our current administration.

I firmly believe that the highest possible standard of healthcare should be available to all New Zealanders, whatever their position in our society. The utilitarian notion that we should only provide healthcare to those who contribute to economic activity is appalling. It would save a lot of money if we left the old and the sick to die, but we’d be a morally bankrupt society if we did so.

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Filed under: health, inequality, public services
35 Comments