Public health priorities

Barbara Brookes

How can it be that a public body appointed to set priorities for public health in New Zealand became described by a member of the same government that appointed it as “a bunch of cretins”?

The answer, epidemiologist and public health physician Sir David Skegg suggests in his compelling book The Health of the People (BWB Texts, 2019), is that politicians focused on personal health services take a short-term view, and ignore the longer-term factors that impact on the health status of the community. That preference for the short-term may be influenced by particular lobby groups – promoting food and alcohol, for example – industries whose interests would be endangered by regulation in the interests of health.

The Health of the People is motivated by concern that a focus on short-term medical services has left New Zealanders with almost no centralised planning and oversight of the kind that would have prevented what occurred in Havelock North in August 2016. In that disaster, 40 percent of residents became seriously ill because of unsafe drinking water, 45 people were hospitalised and at least three people died. While the issue hit the headlines when it occurred, the public learned little about the subsequent Inquiry, which found that the Ministry of Health failed in its duty of enforcing standards to ensure safe drinking water. The findings of the Inquiry were as invisible to the public as the bugs in the water.

Skegg points out that other countries, with significantly larger populations, do much better. One of the tables included in his book compares infant mortality rates in Singapore and New Zealand. In the 1950s Singapore had over twice New Zealand’s infant mortality rate. Yet from 2010 to 2014, Singapore had only 1.8 infant deaths per 1000 live births. In this same period, New Zealand had 4.3 per 1000. Colorectal cancer provides another example. New Zealand women have the highest incidence of colorectal cancer in the world. Yet while England established a national programme using a faecal occult blood test in 2006, it took until 2017 for New Zealand to start to roll out a screening programme.

In a lively text that charts the real possibilities for future population health planning formulated by the short-lived Public Health Commission (which Skegg chaired), we see the ways in which short-term governments have difficulty committing to long-term public health strategies. Economic imperatives loom large for governments. A policy, for example, to prevent the harms caused by excessive drinking will inevitably clash with the interests of the Beer, Wine and Spirits Council. The question then becomes, to whom is the government more beholden? Is it those public health experts serving on the Public Health Commission (who were called by politician Murray McCully in 1993 “a bunch of cretins and pointy-headed wasters“), or is the liquor industry? The Public Health Commission was disestablished in 1995. By May 2018, annual alcohol sales in New Zealand totalled $1.6 billion. Industry interests have clearly prevailed. Beer, spirits and liqueurs are now ten percent more affordable than they were in 2012. If this is not good for public health, as suggested by fetal-alcohol syndrome, some cancers, domestic violence and driving accidents, it does line the pockets of those in the business.

The sheer number of confusing acronyms for various government bodies to do with health suggests how vulnerable long-term planning is in a country with a three-year election cycle. But the consequences of the obesity epidemic, for example, will involve massive health care expenditure in the future, so (as with climate change) to do nothing now is to hide our heads in the sand. Skegg suggests various ways where expertise might be employed in a central agency to promote public health. It should be possible in a country of only 5 million people to have a blueprint for preventive strategies to improve health. This little book makes a big plea: that New Zealand’s future should be guided by population health policies that look to the well-being of all. It is a reminder that well-organised, expert and independent government agencies are as important as the revolving door of political careers.

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Barbara Brookes is co-editor of Corpus.