By urging New Zealanders to do their bit to take pressure off an ailing health system, the Ministry of Health risks adding another barrier to seeking care for people who need it the most.
I always feel slightly uncomfortable responding with “look after yourself” to someone who’s told me they’re unwell. The taken-for-granted phrase has become ubiquitous in email correspondence within pandemic times. While it’s not quite as blunt as urging your mate to fend for themselves or cope alone, imploring someone to look after themselves doesn’t really offer much comfort if they’re stuck in bed feeling absolutely lousy.
So I was especially unnerved to see that sentiment – in near-verbatim wording – being expressed by the ministry responsible for overseeing New Zealanders’ health.
A piece of peculiar Ministry of Health comms shared to social media last week, headlined “Kiwis urged to look after themselves and alleviate pressure on health system this winter”, encouraged people across the country to “look after their health” and to “do their bit to reduce pressure on the health system through what will be a challenging winter”.
It went on to underscore the additional pressure being put on the health system across the board: GPs, pharmacies, community health clinics, ambulances and hospitals.
What can be done to take the pressure off? The ministry made a plethora of suggestions that included getting vaccinated, self-care like eating well and getting plenty of sleep, stocking up on honey and boxes of tissues in case you do get sick, as well as hinting that medical care that isn’t urgent should be avoided. “There are many minor ailments that can be treated with over-the-counter medicines,” the press release said. “So people who are not seriously ill are encouraged to seek advice from their local pharmacist.”
Fraying threads have appeared across the country’s health system recently. On May 23, Dunedin Hospital’s Covid-19 ward was at capacity, and the hospital has since closed all wards across the hospital to visitors because of these pressures. Christchurch Hospital is running at more than 110% capacity – with surgeries and cancer treatments being delayed daily. Community health providers and GPs have reported they are struggling to meet demands. Over the weekend, the Otago Daily Times reported that pressure on nurses has left some so stressed they’ve been reduced to tears in hospital corridors.
This is all to say that the Ministry of Health isn’t crying wolf: our health system and the workers who keep it running are under massive pressure from widespread Covid-19 circulation and newly opened borders, which will not only let further Covid-19 variants into the country, but also flu and other infectious diseases. The potential for large numbers of cases of long Covid, which is thought to affect more than 30% of people who have had Covid-19, only adds another layer of complication.
But this message from the Ministry of Health is more than just a clunky admission of our current reality.
There’s something deeply unsettling about our national health body urging us to second-guess whether we really need primary healthcare and hinting that we should perhaps rethink our planned GP visit. Asking people to alleviate pressure on the healthcare system will lead to people not seeking care when they need it.
For Māori and Pasifika, those barriers are especially concerning. Tangata whenua have the poorest health outcomes and highest mortality rate of any ethnic group in New Zealand. Although Māori experience a high level of healthcare need, they in turn receive less access to appropriate healthcare services.
According to the 2021 New Zealand Health Survey, 15.7% of Māori adults and 15.2% of Pacific adults had not visited a GP due to cost in the past year, compared with 10.2% of the rest of the population. Māori and Pacific adults were respectively 2.8 and two times as likely as non-Māori and non-Pacific adults to not have collected a prescription because of the cost. It’s barriers like cost, transport or the inability to take time off work that often lead people to turn up in hospital emergency rooms with compounded and preventable health problems.
It might not be the intention, but ham-fisted messaging like this discourages those of us who are already likely to dismiss health niggles and necessary screenings or who already have barriers to access – especially in Māori, Pasifika, disability, rural and low-income communities. The Ministry of Health’s message isn’t far removed from the “toughen up” approach to health that you’d hope we were shifting away from.
Knowing the impacts of inequity around healthcare, it seems beyond belief that health communication would add another barrier to put people off seeking it. Messaging like this reinforces low trust in the health system. We’ve seen the impacts of that distrust crystallised throughout the pandemic – it’s a vicious cycle that leaves us all worse off.
The crux of the problem here, though, is that while our system is inarguably under immense and immediate pressure, the Ministry of Health and central government have access to meaningful tools that would relieve some of this. The situation demands genuine solutions, rather than offloading responsibility onto individuals as their notice seems to suggest: “We can boost our immunity against illness by eating healthy foods, staying active, and getting plenty of sleep. It’s important to look after our mental health too.”
It is of course very sensible to do all of these things (even if this kind of self-care is easier said than done for many of us). But we can’t load a crumbling public health system onto the backs of five-plus a day and a good night’s shut eye. Abdicating responsibility to individuals to manage a public health crisis isn’t a solution.
I find it immensely difficult to reconcile this kind of messaging with the loosening of restrictions around Covid-19 and the government’s shoulder shrug of disinterest in reinstating or creating new public health measures to slow the spread and reduce the strain on services.
At the moment, beyond vaccines, our public health response to Covid-19 has been reduced to one remaining protection: masks. If that’s all we have, why not reinstate mask wearing in schools and hospitality venues? Should free respirator masks be funded? Perhaps we need campaigns and information around better-quality masks? There are immediate options beyond that too: indoor air quality standards, universal free flu vaccines, empowering Māori health providers, robust support for people who are isolating, campaigns around how Covid-19 spreads through aerosols or how to do a nasal swab properly. Or, I hate to be a killjoy, but perhaps areas with high transmission need to be upgraded to the red setting. The point is that we shouldn’t have let it get to a point where the ministry felt the need to ask us to back off.
There were and are alternatives to the road we’re heading down. Responding to a pandemic cannot rely on individual responsibility – only a collective public health response will work. In this case it demands a recommitment by the government to public health measures and to the health and welfare of New Zealanders. We know this all too well from our earlier responses to the pandemic.
As we’ve seen before, a health system crumbling under the weight of Covid-19 isn’t inevitable. And rather than looking after ourselves, we’ll need to look after each other.