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Our public health system is world class, and desperately needs to be better, in mental health especially

A range of globally recognised public health concepts could improve our current system, many of which go beyond simply chucking money at the problem, writes Haimona Gray. 

In my relatively brief 28 years of life I have been a paid defender of the public health system, a paid apologist for the public health system, a paid vocal critic of the public health system, and a patient of the public health system (no payment required).

Throughout all this I have discovered two things to be true: we have a world-class health system, and we desperately need to improve it.

The purpose of the public health system is both ethical and practical. We need our population to be supported into good health as part of the unspoken social contract we as a populace have agreed to with our government. More cynically, but no less true, we also need a working public health system so our population can continue to work, purchase things and progress through our economic system.

Burwood Hospital, Christchurch. Photo: Health.govt.nz

But merely having a health system is not enough. It also needs to deliver.

Below, some globally recognised public health concepts that could improve our current system, most of which go beyond the simplistic throw money at it! Most.

A good health service is accessible

Public healthcare being accessible is kind of the whole point, and as a nation our record is patchy.

According to Ministry of Health statistics, 94.9% of New Zealanders are enrolled with a Primary Healthcare Organisation (a GP, to you and me). An impressive statistic, but it doesn’t tell the whole story.

Inequality of access is not simply a concern around Emergency Department waiting times, though that matters. Nor is it about GP patient lists being full, though that matters, too. Often the biggest barriers to accessing health care are geographic and financial.

The issues are not having time, transport, or money to put towards attending distant health services, missing work to seek medical advice for themselves or loved ones, are a reality in so many of our communities.

These are not anecdotes but examples from Patient Experience research undertaken in New Zealand hospitals by internal DHB services and supported the Health Quality and Safety Commission, who do great work in this field.


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Our hospitals are filled with repeat customers, while this isn’t surprising if someone has a long term medical condition, there’s a large contingent who don’t and would be better supported outside a hospital setting.

Exact figures around what percentage of Emergency Department admissions this group makes up aren’t readily available but in my experience it is significant.

A misunderstood but important innovation our system and public psyche needs to accept is distance health services.

Telehealth and remote triaging of low-risk medical issues has been discussed widely by community health groups, and even implemented by the Ministry of Health and health service providers to positive results.

To evolve from its current state to a vital part of our public health system will require both connection to community services to really create large scale change, but it’s a positive step.

Pop culture has acclimatised us to a world of robot doctors magically fixing us with lasers and nano-robots but for many a world without a doctor in front of them is daunting. This is understandable, but once we learn how to deal with it better outcomes will follow.

A good health service communicates meaningfully with its patients

If the idea of the public health system is to achieve positive health outcomes with its patients, it should be vital to engage with patients in a way which helps them continue to get better once they are discharged.

Sadly, fear of effectively communicating with non-Anglo Saxon patients has been a cornerstone of most medical education in this country’s history.

Arguments from such notable former health ministers as Helen Clark against “Cultural Safety” practices have stifled our health education system from teaching how to treat all of its patients to achieve the same level of health.

While indigenous health academics and groups such as the New Zealand’s Nurses Organisation have been national leaders of this debate, concern around identity politics has held us back from putting patients’ needs ahead of concerns around treating people differently.

It is not too much to expect medical professionals to communicate with patients in the most effective manner: being mindful of cultural practices or beliefs, or bringing in whānau to create a support structure around medication or follow-up visits, or things as simple as not asking if they have a nickname because the doctor is too lazy and apathetic to try to learn how to say the patient’s name.

Putting patients and their families off visiting public health services for things like vaccinations risks the health of us all. The goal of public health services is to put positive patient outcomes first, regardless of distractions like anti-Political Correctness whingers without medical degrees or obligations to “do no harm”.

A good health system is interconnected

Anyone who has gone to a public health service only to be referred to another service in another building (or city, or island), will understand the time and goodwill wasting that can come with our public health system.

This is an unfortunate quirk of complex systems, but it also represents a failure by the Ministry of Health to progress secure patient data sharing and appointment booking IT systems.

In a speech to Whānau Ora services late last year, then deputy PM Bill English singled out and applauded Māori health IT company Whānau Tahi for their work in this field – specifically connecting disparate, community based health services to each other to allow one point-of-contact for their clients and making it fully auditable.

IBM, Orion Health, and others have dedicated substantial money to building similar systems. It is the future, and one with many added perks such as greater and richer data for research, and eventual cost savings.

A good health system takes mental health seriously

We have one of the worst rates of suicide in the OECD, we have jails full of people with mental health and addiction problems. We are in a serious predicament.

It is time we treat mental health support services as not just vital services on their own, but also as vital preventative measures to greater health and societal issues.

There is no revolutionary technology, policy directive, or whole-of-system approach to solve this. Only adequate funding and greater support for frontline staff will make a dent in our shameful history of negligence and underfunding.

Of all the great challenges our health system faces, including the many I didn’t have the time or knowledge to properly articulate, mental health services represent the greatest opportunity and the greatest risk if we continue to underfund it.

Television personalities raising awareness matters. Talking with our whanau about what we all can do support each other matters. Words matter, but unless our frontline services are funded to deal with the scale of mental health issues in our communities we will be applauding ourselves for doing nothing, for inaction.


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