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NZ’s deadly public health battle
There’s nothing sexy about public health.
It’s not likely to form the setting of a television drama like Grey’s Anatomy. Unlike personal health, public health success doesn’t look like a child bravely smiling from a hospital bed, it looks like a line on a graph trending downward, or upward depending on the measure.
Public health is prevention. It’s sewers, clean drinking water, legislation to stop the import of asbestos-laden building materials and government action to lower smoking rates.
It’s doctors wielding not stethoscopes, but documents heavy with policy recommendations to get the statistics feeding those graph lines moving in the right direction.
As one public health researcher famous for his work on asbestos put it, those dry statistics are people “with the tears wiped away”.
Public health is a topic University of Otago’s Sir David Skegg is passionate about and has spent decades trying to champion. Twenty-five years ago he chaired the now disbanded Public Health Commission.
His recently published book, The Health of the People, points out New Zealand’s vacuum of public health leadership, the appalling state of some aspects of public health, and the influence of lobby groups on elected officials.
Who looks after the collective health of our nation?
The leadership position for public health in New Zealand, is held by the Director of Public Health, a position now held - after being vacant for some years - by Dr Caroline McElnay.
It’s a position required by legislation.
Skegg describes McElnay as very good but points out despite the title, she is not part of the Ministry of Health executive leadership team.
“They [the Ministry of Health] have an executive leadership team which has got about 10 people on. It's quite big, but the director of public health is not there. So, you can see the amount of priority, the Ministry is giving to public health.”
The executive leadership team has 16 members. There is deputy director-general population health and prevention on the team, but the director of public health is not included.
Also required by legislation is a division within the Ministry of Health call the Public Health Group.
“The public health group in recent years has just been just a remnant actually. Just a very small number of people. You can't even find them on the Ministry of Health website,” said Skegg.
He believes the Ministry is “totally overwhelmed” administering personal health services.
“There just aren't the experts in the Ministry of Health that a country like New Zealand needs to plan and oversee public health programs and to respond to emergencies.”
How do we score?
Once New Zealand was referred to as the campylobacter capital of the world by food safety experts.
It’s estimated there are 30,000 cases per year, most caught from fresh chicken. A report released in 2018 shows 60 to 90 percent of fresh chicken has high levels of the bacteria which can cause stomach illness and lead to complications such as arthritis and the paralysing Guillain-Barre syndrome.
Skegg said the Ministry for Primary Industries has declined to lower the allowable contamination levels for fresh chicken any further.
“The Ministry for Primary Industries won't even agree to put a warning label on the packages to tell people.”
Campylobacter was also the culprit in the Havelock North water disaster which killed at least three people and affected 5500 people, around 40 percent of the town’s population.
It’s thought sheep faeces contaminated the drinking water, and it was not the first time the same bores had been contaminated.
A Government inquiry into the outbreak was damning:
“These findings point to a widespread systemic failure among water suppliers to meet the high standards required for the supply of safe drinking water to the public. The industry has demonstrated that it is not capable of itself improving when standards are not met.
“Neither has the Ministry of Health, the government body charged with administering the provisions of the Health Act governing drinking water, shown an ability to call the industry to account.”
Skegg also points at New Zealand’s obesity rate and the sluggishness in implementing bowel screening as other areas of concern.
“I have not been able to identify one other developed country that is as lacking as New Zealand in that [leadership in public health] regard. Indeed, many developing countries have much stronger public health agencies.”
His biggest fear is nothing will be done to avert a slow-moving train wreck.
Where did it all go wrong?
There was a time when New Zealand had a well-resourced public health advocacy body, the Public Health Commission (PHC), which Skegg chaired.
His book provides an eye-opening view into the power of lobby groups and details a meeting from hell.
During his time, several draft papers were written by the PHC and circulated on topics such as alcohol, nutrition, food safety and smoking.
Skegg was summoned to a meeting with then Minister of Health Bill Birch. In his book he recounts the meeting.
“Mr Birch intimated that the draft papers from the PHC had ‘upset’ the Dairy Board, the Beer, Wine and Spirits Council and the Wine Institute … The Minister made it very clear he did not accept that the PHC would take a different view from the Dairy Board and Wine Institute.”
The following day Skegg met with the Associate Health Minister Maurice Williamson who opened the meeting with the statement: "Let's get straight down to battle."
He describes what followed as a “torrent of words laced with expletives” from Williamson. Skegg was told he was supposed to only investigate smoking during pregnancy, rather than smoking in general.
Sixteen months later Cabinet disestablished the Public Health Commission.
A tobacco company corporate affairs manager wrote: “Clearly we can’t take the full credit for its demise … but the death of the PHC is a damn fine Christmas present.”
What needs to happen?
“My biggest fear is that nothing will happen. We'll just bumble along, even where there is clear evidence that things need to be done,” said Skegg.
His biggest hope is that a report from a Health and Disability Panel due next will recommend changes to strengthen public health. His book suggests options such as a Crown entity could be formed dedicated to public health, or a model similar to the office of the Parliamentary Commissioner for the Environment adopted.
When asked about what the graph trend lines in a successful public health system would look like, Skegg responds it’s about reducing mortality rates in younger age groups.
“It’s also the burden of different diseases that we know to be preventable. Waterborne illnesses like campylobacter shouldn't be happening in a developed country like New Zealand.”
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