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PoliticsNovember 7, 2018

NZ faces a daunting health gap. Damned if we’re going to sit and watch it grow


There is an enormous mismatch between the size of the damage caused by tobacco, alcohol and unhealthy food and the amount invested in preventing that damage. Dozens of professionals have formed the Health Coalition Aotearoa, which launches today, to tackle the issue, explains Dr David Galler.

In 2014 the Office of the Children’s Commissioner and the Paediatric Society released their report Solutions to Child Poverty. It was an excellent document and a gift to a nation embarrassed by the alarming rate and extent of the deprivation that so many New Zealand children suffered. The report outlined the evidence and an approach to its implementation to reduce child poverty rates by between 30% and 50% by 2020. On beThalf of the previous government the prime minister of the day, John Key, in effect dismissed this gift to the nation on the basis of one of its many recommendations, the call for a universal child benefit.

Not long after, another expert group approached the then health minister with a plan to reduce the harm from unhealthy food, the major driver of our epidemic of obesity related diabetes. That too was rejected. Thankfully much has changed since then.

During the last election Campaign, the NZ Labour Party emphasized its pledge to reduce child poverty and now that they are in government, they have adopted many of the recommendations and the approach to their implementation suggested in the original 2014 Solutions to Child Poverty report.

In a similar light, a new expert group, The Health Coalition Aotearoa, has been meeting regularly to reformulate an evidence based plan to reduce the harm done to individuals, whaanau, communities and the nation by unhealthy food, alcohol and tobacco. This, too, is a gift to the nation and one we hope the current government will consider seriously.

Today, the hospital where I work is full. In fact, according to an email just circulated, 107% full. Over the last 24 hours, 298 people presented to our emergency department and right now, 100 are still there and 50 of them need beds on our wards.

There are patients all of over the place; in the clinics, staying longer in the short stay wards and backed up waiting for surgery. It’s like this everyday and it’s the same for other hospitals under similar pressure, struggling to cope with what seems like an ever-escalating need for services.

What we do in our hospitals, resuscitating the ill, making diagnoses and providing definitive treatment is good, but for many it’s already too late: so much damage has been done, the suffering and loss is already evident – it’s all too obvious that their lives will be prematurely shortened.

This is how it is today, how it was yesterday and the day before and the day before that; and it will be like this tomorrow, the next day and forever after if we carry on as we do now.

A major cause of that suffering and loss is from preventable complications of preventable disease. Much of this is related to the toll associated with things that general practitioners, community clinics and medicine as a whole cannot fix but only society can. I am talking about the impact of unhealthy food, tobacco, and alcohol, which together contribute to at least one third of the total preventable health loss in New Zealand.

Of course that preventable health loss is not evenly distributed across the country. By way of example, the numbers of people with diabetes is highest within the area covered by my own District Health Board, followed by Waitemata, Auckland and Canterbury; and in each case those affected are four times more likely to live in the lowest socioeconomic neighbourhoods compared to those that live in the least deprived areas.

At home it is cardiovascular disease and diabetes, so often related to obesity, that are two of the leading causes of morbidity and mortality in NZ and a massive cause of accelerating healthcare costs, much of which is spent in the hospital setting, and a lot of that in the last years of peoples’ lives.

Most affected are Māori and Pacific peoples and this goes a long way to explain persistent gaps in life expectancy between them and others living in Counties Manukau and elsewhere.

Although New Zealand has the third highest rate of overweight and obesity for adults and children within OECD countries, despite the rising cost, many are still able to access some form of treatment to help manage their worsening symptoms. That is not the case for many in the Pacific, where obesity related diabetes is at plague levels and decimating whole populations as a result of its complications, notably advanced cardiovascular disease, recurrent infection and kidney failure.

The prospect of carrying on as we are is both depressing and unsustainable. The toll on all of us is too great: individuals suffer, so too do their families; great swathes of people are lost from their communities and from the productive workforce; the state spends more and more on treating the complications of preventable disease and still the people come; and when they are not in hospital being treated, many have little option but to take a benefit. It breaks my heart to see this day in and day out: younger and younger people now with so much potential, left with little prospect of being happy, well, self reliant and productive.

This cycle of misery and the endless work it creates takes its toll on healthcare professionals too, forced to push back against a tide they have little control over but at the same time increasingly aware that the overall system of care is letting them down by not more strategically and effectively dealing with the causes of illness that lie outside of health’s immediate purview. The negative impact plays its part in the appalling rates of burnout amongst healthcare staff in NZ.

The evidence is clear, in NZ there is an enormous mismatch between the size of the damage caused by tobacco, alcohol and unhealthy food and the amount invested in preventing that damage – less than one half of one percent of the health budget. That is the gap that the newly formed Health Coalition Aotearoa wants to help to close with the implementation of evidence based policies recommended by the World Health Organisation, to achieve WHO and government targets for reducing smoking, heavy drinking and obesity levels.

The Coalition, led by Professor Boyd Swinburn, is an umbrella organisation comprising over 30 health groups, 55 health professors and clinicians committed to reducing harm from tobacco, alcohol and unhealthy food, and it will be officially launched at parliament by the health minister, David Clark, today. We hope it will make a difference.

Dr David Galler is an Intensive Care Specialist at Middlemore Hospital and a member of the Steering Group of The Health Coalition Aotearoa

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