How healthy are New Zealanders?

New Zealand’s health system has been the subject of a run of bad press articles in the past few years, but how does the latest OECD report rate us?

A lack of funding for DHBs. A mental health system in crisis. People getting fatter, and long waiting times for operations.

The narrative on our failing health system has been a beating drum for Labour while in opposition - a narrative that they used to repeatedly attack the National  Government and one that gained them significant traction.

Now that they are in power, new Health Minister David Clark faces the daunting prospect of making good on his promises.

Significant additional investment in the health system has been indicated.

New Zealand faces a shortage of locally-trained doctors and an obesity epidemic that is one of the world’s worst

A new hospital in Dunedin will be fast-tracked and an inquiry into mental health started.

Clark has been a vocal critic of an underfunded system, pointing repeatedly to billions having being stripped from the budget.

But as many politicians have learned over the years, there is never enough money in the health system to keep everyone happy and fixing every problem may prove impossible.

A new OECD report into the state of healthcare in the developed world, Health at a Glance, highlights some of those challenges.

While New Zealand has done well in areas such as lowering its smoking rate and wait times for hip and knee replacements, it faces a shortage of locally-trained doctors and an obesity epidemic that is one of the world’s worst.

We have clean air but bad asthma rates, while the number of hospital beds per capita is well under the OECD average.

We also have high rates of suicide following hospitalisation for psychiatric disorders such as schizophrenia and bipolar disorder.

Newsroom wanted to talk to Clark about the report and how he planned to tackle some of the challenges illustrated.

Unfortunately he was too busy for an interview.

Obesity

One of New Zealand’s greatest shames is how overweight we have become.

There are only two nations with a greater average body mass index (BMI) than us – Mexico and the United States.

Almost a third of the country is considered obese, against the OECD average of 19.2 percent. Things are even worse for our children, with 36.2 percent obese.

The Ministry of Health’s own statistics are similar for adults, but put the percentage of obese children at just 11, with another 21 percent classed as merely overweight. A 22-initiative childhood obesity plan was launched by the Ministry in 2015.

Funnily enough, the report also mentions that New Zealand eats the most fruit in the OECD behind Australia, and the third-most vegetables behind Australia and Korea (it’s unknown if our love of starchy potatoes, kumara and taro are factors here).

So, why are we so fat?

Tony Blakely, a public health professor at Otago University, said there was no simple way to answer that question.

The obesity epidemic is affecting almost every country as people consume more energy than they expend and high-density foods become more readily available.

“In terms of obesity, it's certainly washed through the United States and Mexico earlier and with more fury than other countries, but New Zealand is not far behind,” Blakely said.

Maori and Pasifika people had a high average BMI because of their physiology which bumped up New Zealand’s rating, but price also contributed as did the marketing of certain types of foods, he said.

“You only need to walk into the dairy and, rather than buy whatever you went in for, just stand there and look around at the amount of marketing in your face, it’s pervasive.”

The introduction of a tax on sugary drinks was ruled out by the previous Government, but Clark has said it is still on the table.

It’s an idea that is always of media interest, and Blakely said it would be an excellent first step to show both the industry, and the public, that the problem was being taken seriously.

More work was needed to create a framework around other nutritional areas such as junk food and healthy food items, but if the right mix of taxes and subsidies was created it could greatly improve the country’s diet, he said.

What the MoH says: Chief strategy and policy officer Hamiora Bowkett agreed obesity was a critical health challenge for New Zealand. A 22-initiative Childhood Obesity Plan went live in 2015, bringing together the private sector, schools, and families. At its centre is the 'raising healthy kids' target that aims to identify 95 percent of obese children and refer them to intervention services, making New Zealand one of the few countries in the OECD to have a plan and target.

Asthma

Our air is the cleanest in the world, so why are so many of us struggling to breathe?

The report puts New Zealand at number one for the lowest air pollution levels, ahead of Scandinavia, Australia, and Canada.

But despite this, our lungs are struggling.

For every 100,000 Kiwis, 363 will be admitted to hospital for asthma. The rate gets a big red X from the report, with only Turkey, Ireland, Hungary and Australia worse off.

To understand this problem, we need to turn our eyes to the quality of our housing stock.

Many, especially rentals, are cold and damp, lacking insulation and adequate heating.

Letitia O’Dwyer, chief executive of the Asthma Foundation, said the condition was much harder to control when people lived in crowded, damp, mouldy, cold houses.

Poverty was a main driver of asthma, especially among children where it was the most common diagnosis in those aged 0-14 years who were admitted to hospital for a poverty-related condition.

Those who did not have enough income to visit a GP would often put off picking up a needed prescription, she said.

For the problem to be taken seriously, a national health target was the only solution.

“We are calling on the Government to take action and support a national health target that focuses on reducing emergency visits for acute respiratory illnesses by 20 percent within the next five years.

“Put quite simply, a national health target with dedicated funding from the Government is crucial to reduce emergency visits for acute respiratory illness. Only then will reducing respiratory illness become part of the DHB annual planning process.

What the MoH says: Asthma is part of the new Better Public Service targets that aims to reduce avoidable hospital admissions in children by 25 percent by 2021.

Doctor training

In short, we don’t train enough of our own doctors but instead bring them in from overseas.

For the year 2015, the number of medical graduates was just 8.7 per 100,000 – well below the OECD average of 12.1.

But scrolling down the report reveals that New Zealand sits second-highest for foreign-trained doctors and number one for foreign-trained nurses.

Overall, doctor numbers are slightly below average but the number of nurses is above average.

Ian Powell, executive director of the Association of Salaried Medical Specialists, said the report highlighted a serious problem.

Employing foreign doctors was not an issue, but the huge dependency on them to fill positions was.

New Zealand-trained doctors tended to stay in the job for longer, while those from overseas would often return home after a few years leaving another gap to fill.

Some local doctors also left for overseas because of better pay and conditions, with burnout an issue in New Zealand hospitals.

Powell said the first step to address the issue was to get a more realistic grip on the level of specialist shortages in New Zealand, which was usually about 3.5 to four times higher than the advertised vacancy rate and would be a problem that continued to grow as senior doctors retired.

What the MoH says: Definitions of health practitioners vary across different countries so it was misleading to compare statistics, Bowkett said. The first commitment was to grow the New Zealand workforce, particularly Maori and Pasifika staff. Half of international specialists have undertaken training in New Zealand, while the number of New Zealand trained medical graduates has doubled since 2008.

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