If an ounce of prevention is worth a pound of cure, New Zealand has its health priorities skewed, an eminent epidemiologist says.
He says since the Public Health Commission (PHC) was axed by the National government under Jenny Shipley in 1996 there has been a critical lack leadership in the sphere of public health.
Preventative public health programmes save governments money in the longer term, but politicians, who are continually lobbied by groups with vested interests such as the tobacco and alcohol sectors, often overlook this, Sir David Skegg says.
Sir David, a former government and WHO adviser and former chair of the Public Health Commission, has just published a book The Health of the People on the shift from public health to personal health services.
“Over time public health has probably done more to extend our life and improve the quality of life than personal health care, but they are both indispensable,” he says.
The Havelock North water contamination was a dramatic example of New Zealand’s weakness in this area, he says.
“I once heard an Australian say ‘the great thing about New Zealand is it’s the only third world country where you don’t need to boil the water’.”
The Havelock North campylobacter outbreak was unprecedented in a developed country, he says
“Forty percent of the population was struck down by this potentially serious bacterial infection, 45 people were hospitalised and at least 3 died.
“There are many people in Havelock North now with arthritis that was caused by that epidemic and it should never have occurred.”
A government enquiry into the contamination was scathing, Sir David says.
“There was a complete failure of leadership and stewardship by the Ministry of Health, they [the report] said the ministry was inept and they talked about an enormous vacuum of leadership.”
That lack of central government leadership is not confined to the provision of safe water, Sir David tells Kathryn Ryan.
“The bodies responsible for providing safe water were not doing their job properly and the Ministry, which has the legal responsibility under the Health Act, was not taking steps to ensure that they did.
“In fact, and this is not confined to water, the Ministry’s had a long-standing policy of really hardly ever using their legal powers and just turning a blind eye to groups that flout the regulations.”
Asbestos regulation is another area where New Zealand lags the world in terms of its public health regulations, he says.
“Twice as many people die from mesothelioma in New Zealand as from cervical cancer now.
“The UK introduced its first asbestos regulations in 1931, they strengthened them over subsequent decades, we didn’t bring in any regulations until 1978.”
The World health Organisation (WHO) recommended countries ban importing building materials containing asbestos in the 1990s, he says.
“The UK did that in the late 1990s, Australia in 2003 New Zealand didn’t do that until 2016, we kept on bringing in asbestos building materials from China and elsewhere and we’re going to be suffering from that for decades to come.”
New Zealand’s personal healthcare system is pretty good, Sir David says.
“I think that our system for personal healthcare works reasonably well, I’d probably give it a B minus pass, it’s an A minus if you’ve got lots of money because it is unfortunately a two-tier system.
“But for public health I’d be giving it a D or an E fail, because we’re just not doing the things that other countries do.”
The Ministry of Health is too concerned with the provision of personal health services to the detriment of public health, he says.
“The Ministry of Health over a long period, long before the Public Health Commission, has really been overwhelmed by the challenge of overseeing personal health services with tightly restricted budgets and public health has been neglected,” he says.
A similar body to the PHC is needed, which Sir David says is a “brilliant idea”.
"The Ministry of Health is clearly the key central body that needs to greatly strengthen its expertise and resources in public health but also I believe we need a separate agency for public health.
“Around the country the DHBs and local authorities and so on, there are some excellent people, public health professional, dedicated and skilled but unfortunately in Wellington there’s what seems like a black hole.”
Complacency is a curse in New Zealand, Sir David says.
“New Zealand is a famously complacent country and people just tend to accept our mediocre performance, it’s funny we don’t accept it in sport but we do in health.”
He says the Ministry of Health has become “more and more an organisation that sings the song of whichever government is in power.”
“One of our problems in New Zealand, when we’re thinking about public health, is the three-year electoral cycle they’re always thinking about the next election and they’re always terribly close.”
But money spent on public health is money well spent, he says. Bowel screening is an example according to Sir David.
“The Australians introduced their national bowel screening programme in 2006, we’re hoping to have one rolled out by 2021, they’ve been able to calculate that programme is going to save billions of dollars of expenditure in treating bowel cancer.
“We’ve made a poor economic decision as well as a heartless one. New Zealand woman have the highest bowel cancer rate in the world, men have the third highest but we are just lagging more than a decade behind most European countries and Australia.”
A strong impartial voice advocating for public health is needed, Sir David says especially in the sphere of harm prevention from products such as tobacco, alcohol and some foods.
“There is an inevitable contest between people who are trying to improve health and the commercial interests that are damaging health and at the moment there is not an effective public health voice to counteract the highly effective lobbying that goes on from vested interests.”