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(Image: Archi Banal)
(Image: Archi Banal)

SocietyJuly 29, 2022

Ashley Bloomfield on his 3am ‘butterflies’, dodging burnout and saying goodbye

(Image: Archi Banal)
(Image: Archi Banal)

On the director general of health’s last day in the job, he speaks to Stewart Sowman-Lund about his emotions leaving the role – and why he never felt comfortable fronting the media.

Ashley Bloomfield became one of the most familiar faces of New Zealand’s Covid-19 pandemic by fronting no fewer than 307 media briefings between January 2020 and this Wednesday. For many his presence at the daily 1pm updates provided a sense of comfort and reassurance. But if he appeared calm and collected behind the lectern, on the inside he was feeling anything but.

“I was very nervous at number one and still nervous at number 307,” he tells The Spinoff. “I know when I have a day with a stand-up or a media round because I wake up at 3 in the morning and start rehearsing it in my mind, even now. I still get butterflies, I still get stressed.”

Today is Bloomfield’s last day in the role of director general of health, a post he has held since mid-2018. He won’t need to front another 1pm presser or stand alongside the prime minister in the Beehive theatrette ever again. Bloomfield’s leaving a year earlier than expected, in the same month New Zealand transfers to a new health system, but ostensibly to spend time with his family. He’s planning a lengthy holiday and isn’t prepared to announce anything more just yet – though confirms he’s had work offers come in already.

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On the day I chat to Bloomfield, he’s been up since the early hours doing back-to-back media interviews. He probably has nothing new to say to me, and as I attempt to weasel out some sort of “exclusive angle” during this decidedly non-exclusive interview opportunity, I learn just how diplomatic Bloomfield can be. For someone who has “ruled out” a run at political office, his ability to say “what I would say” rather than simply answer the question is nothing short of impressive. 

Was he sad to be leaving the director general role? Neither yes or no, he tells me. “My overwhelming emotion is probably bittersweetness,” he says. “I’m looking forward to the break, but I’m not looking forward to leaving the building and the people here.” What books did he read during the first lockdown to help take his mind off things? “I’m a pretty keen reader of both fiction and non-fiction,” he says. “I often like to get immersed in a good novel.”

But despite Bloomfield’s incredible ability to avoid taking a side even on his reading preferences, our chat reveals some intriguing details of his time as New Zealand’s most prominent Covid communicator. Getting nervous before all 307 of his media press conferences is one example. “I guess it was just part of my mental preparation, I’d start while I was supposed to be sleeping,” he says. “The 3am ‘conversations with yourself’ is by far the worst time of the day to do that… but knowing I had a stand-up or an interview, you’ve got to be on the top of your game and make sure the way you’re communicating is always on point.”

That ability to communicate “on point” is part of the reason Bloomfield developed such a devoted fanbase. His face ended up on merchandise, a remixed video of him explaining Covid rules played to thousands of revellers at summer festivals up and down the country, and the 1pm press conferences were immortalised on IMDB. He was, though he cringes at the term, a celebrity. “I didn’t have any control over that,” says Bloomfield. “Especially through that first lockdown, those daily stand-ups were such an important part of people’s lives. Many people felt that I became a part of their family from being in their living room on the TV at 1pm every day. People recognised me and felt I was someone that they knew.”

As an alumnus of Wellington’s Scots College, Bloomfield is now up against Steven Adams for the title of the school’s most famous ex-pupil. The pair haven’t crossed paths, though Bloomfield says he’d love for that to happen. “I’d need to take a ladder with me,” he jokes, letting slip that he recently watched – and loved – the Adam Sandler basketball movie Hustle on Netflix.

The many faces of Ashley Bloomfield (Photos: Getty Images / Additional design: Archi Banal)

Though Bloomfield’s profile faded slightly as last year’s delta outbreak dragged on and the simple alert level system devolved into the confusing assortment of rules we have now, as director general he remained largely untouchable. Take last year, when ex-National leader Judith Collins called Bloomfield a “one-trick pony”, almost causing a political crisis. Or when the former health minister David Clark threw Bloomfield under the bus for a quarantine bungle. Bloomfield says he couldn’t let these things get him down. “I’m a senior public servant and even when there’s not a pandemic you have some really challenging moments. I tried not to take those ups and downs too personally but keep things in perspective and stay grounded,” he says.

Bloomfield may have avoided letting personal remarks get in the way of his job, but he admits it wasn’t always easy to separate his work and private life. At one point, he very nearly burnt out. “I had moments where I realised I was at the limits of my resilience and needed to take some time out and spend time with family… ripping down a hill on a mountain bike or reading a book,” he says. 

Not letting work get in the way of everything was a “big lesson” that Bloomfield quickly learnt in the early days of the pandemic. “Resilient people aren’t the people that keep going, they’re the ones that know their boundaries and stay within them,” he says. “Quite early on after I’d done a number of days in a row, I felt myself under a lot of stress and thought now was the time to step back. It was a real wake-up call for me, it was deliberate after that to make sure I didn’t reach the point where I burnt out.” 

Whatever Bloomfield does next, it’s unlikely he’ll face the same intense scrutiny he did as director general of health during a global pandemic. A number of job offers are already on the table, but he won’t divulge anything just yet. And despite his masterful ability to avoid giving a straight answer, Bloomfield remains sure of one thing: now is the right time to say goodbye.

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Image: Getty Images
Image: Getty Images

SocietyJuly 28, 2022

What is medical bias, anyway?

Image: Getty Images
Image: Getty Images

Medical bias and systemic racism are terms often used to characterise health inequity in Aotearoa. But what does that mean, exactly? Naomii Seah explains.

“If you don’t take a temperature, you won’t find a fever,” says Kai Tahu researcher and physician Sue Crengle.

Crengle is speaking on the state of inequity in the medical system of Aotearoa. In other words: if you don’t look, you won’t find it, and minority populations will continue to suffer worse health outcomes.

Her colleague Gillian Whalley agrees: “When I started I knew there were problems [with medical inequity]. 20 years ago I wouldn’t have called it systemic racism. But as… I’ve looked for it, I can see it everywhere now.” 

Last week, Crengle and Whalley released a new research paper in the New Zealand Medical Journal, which found that using international medical standards may lead to the under-recognition of cardiac enlargement in Māori and Pacific populations.

Currently, the international reference ranges for heart size are based largely on studies done on Pākehā. In other words, what’s “normal” in medicine is often defined by whiteness and maleness, as it is in other aspects of society. Sound familiar? Just as speaking English is “normal” and other languages aren’t, so are NZ European bodies “normal”, which dismisses the population specific needs of other groups.

Here, it’s important to note that “population specific needs” is not a term that supports biological determinism, which is the concept that biology is the defining factor in health risks and outcomes – a concept that leads straight to eugenics. Biologically, ethnic groups are not fundamentally different from one another. Research shows that the use of ethnicity as a determinant of health is actually a stand-in for many other complex issues. Rather than being a purely biological difference, ethnicity often dictates how we are perceived by others, and therefore how we are treated.

It’s mostly through social bias, then, that ethnicity can have a measurable impact on health outcomes. However, some general differences between ethnic populations may exist; for example, East Asians tend to be shorter than other populations. These differences could themselves be a result of complex social factors and are often understudied, and it’s difficult to point to specific causes. But whatever the truth is, ignoring these differences can also result in medical inequity.

Crengle and Whalley’s paper shows what medical bias can look like in a New Zealand context. Here’s a brief run-down: heart size is correlated with body size and composition, so it usually follows that a taller individual will have a larger heart. The assumption is therefore that Māori and Pacific people may have heart sizes on the upper range of “normal” as they may be taller and larger than NZ Europeans – that was the hypothesis the researchers began with. To test this assumption, Crengle and Whalley measured the heart size of 263 healthy self-identified Māori or Pasifika adults.

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What they found was in fact the opposite – heart sizes of healthy Māori and Pasifika adults (with no significant medical conditions such as renal failure, heart disease, pregnancy) were significantly smaller than the upper limit of “normal”. That means Māori and Pacific populations may need a lower reference range for heart size than what’s currently in use in the cardiovascular field. In simple terms: enlarged hearts may be going undiagnosed in Māori and Pasifika patients. Heart enlargement is a risk factor for coronary disease, and this under-diagnosis could explain some of the statistically poor health outcomes for Māori and Pasifika in New Zealand.

The leading rhetoric in these health inequities is that Māori and Pacific populations have increased risk factors, or may present late to medical services. But medical inequity also lies in who the system is built for, and who it caters to.

“I had never really liked the way we decide on simple numbers [to define what] is the norm or not,” says Whalley. She gives the example of body mass index (BMI), which is a simple number based on height and weight. It’s often used as a proxy for overall health, and it’s an important number in deciding access for many medical treatments.

“It doesn’t take into account body composition,” notes Whalley, which is only one of the myriad issues with the measure. This means BMI doesn’t factor in whether your weight is concentrated in muscle mass or fat. And surprise, surprise, “normal” BMI ranges are based mostly on NZ European bodies. (The reference ranges are also very outdated and stigmatising, but that’s a whole other conversation). This has impacts on Māori and Pacific health. Whalley notes that “it’s quite hard for Māori and Pacific people to get kidney transplants because they’re considered too overweight.” But BMI is “crude”, as Whalley puts it, and it’s one of the many measures that can prevent equitable access to healthcare. “Medicine is super complex… there’s a massive risk of oversimplification.”

And that oversimplification is why until recently, medical research didn’t see the issue with generalising studies based largely on cisgender Pākehā male bodies to all populations.

Another example you may have heard of is heart attacks in women. Clinical trials studying heart attacks often excluded women, which meant that the gender specific symptoms of heart attacks in women went largely unrecognised. Public health announcements and media portrayals of coronary events tend to show a man having chest pain. But women are more likely to experience shortness of breath, back pain and nausea; they’re also more likely to suffer heart attacks without chest pain at all. The gap in medical research has been linked to worse health outcomes for women. Women are more likely to die from a heart attack than men, and are more likely to have recurring coronary events as well as more likely to develop disabilities from heart failure.

It’s these gaps in knowledge and research that contribute to inequitable health outcomes. It’s telling that wahine Māori and Pasifika women tend to have even worse outcomes than Māori and Pacific populations generally. Medical bias exists where any social bias exists. But how do we address it?

Crengle, who’s recently been appointed to the new Māori Health Authority, believes that New Zealand specific reference ranges are needed for more healthcare fields, and that we shouldn’t rely on international standards. Whalley agrees, noting that the Māori Health authority is an important first step to achieving more equitable healthcare in New Zealand. Whalley and Crengle both want more attention directed at population specific medical research, and targeted interventions.

“It’s about asking communities what is important to them,” adds Whalley.

“I think the old concept of equality, treating everybody the same, will not raise Māori and Pacific health onto an equal level with Pākehā health. Treating everybody equally has 100% led to unequal outcomes. Something’s wrong. We’ve got to fix it.”

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