THE PRESS THURSDAY, DECEMBER 28, 1989. A sound approach to health

Press, 28 December 1989, Page 16

THE PRESS THURSDAY, DECEMBER 28, 1989. A sound approach to health

The health plans announced by the Minister of Health, Ms Helen Clark, have a sound approach in theory; whether they can be carried out in practice remains to be seen. The. thrust is. towards the prevention of illnesses and accidents. It is not the first time in New Zealand that the value of prevention has been urged. What is different in the approach now taken is that it is meant to be better co-ordinated, and emphasis is being given to obtaining particular results within a given times The goals and targets set are specific. For instance in tobacco smoking, identified as the most preventable cause of death in New Zealand, one target is to reduce tobacco consumption from 2068 grams a person 15 years and over each year, to 1500 grams by 1995, and to 1000 grams by the year 2000. Another target is to reduce the difference in Maori as compared with European smoking rates from a 75 per cent disparity in 1981 to 50 per cent disparity, or less, by 1995, and to 10 per cent by the year 2000. Strategies to achieve such targets include health education, legislative requirements for smoke-free zones, the enforcement of restrictions on the sale of cigarettes to children, and an increased price for tobacco. Some of these policies will require Government measures. Presumably, if the Government expects area health boards to reach certain targets, it will itself be prepared to pass legislation or take other measures. Nine other health areas have been identified. All of these have been selected because they are seen as related to the msst important causes of death, diseases, • and disability in New Zealand. The selection of the health problems has been done with care. Many of the illnesses most prevalent in New Zealand have multiple causes, often associated with lifestyles. Coronary heart disease is the leading cause of death in New Zealand, and nutrition, smoking, and high blood pressure — all areas targeted for attention — may be causes singly or together. Selecting one or two areas and ignoring the others would have been inadequate. A more political or propagandist document would have been less comprehensive. The health plans proposed by the Government largely follow guidelines' proposed by two World Health Organisation meetings: the 1981 World Health Organisation Global Strategy for Health for All by the Year 2000, and the Ottawa Charter for Health Promotion, which derived from a conference in Ottawa in 1986. The Ottawa Charter set out the aims of building public policy on health, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services. New Zealand took part in both conferences. The health plans just announced would seem to be a comprehensive response to the suggestions in the Ottawa Charter. Some of the plans may not be fulfilled, either because disorders are not reported, or perhaps because of a lack of co-ordination between general practitioners and the

hospitals. A visit to p doctor is now expensive arid many people low incomes may be reluctant to visit a doctor’s surgery. Death rates from coronary heart disease and stroke are higher among low-income groups and among Maoris. If the initial cost of medical diagnosis and treatment is a disincentive, it will be difficult to get at some of the groups most at risk. If the general practitioner wants to refer a case on, either for a second opinion or for further treatment, the hospitals will have to be able to cope with this. The Government is not simply offering helpful suggestions to area health boards; it is tying area health boards down in contracts to provide the services the Government requires. Many of the preventive measures entail extensive education programmes, probably in schools, and, in some cases, extensive screening programmes. The Canterbury Area Health Board already has a health education unit, but what is envisaged is something more far-reaching. By stipulating the targets in contracts, the Government has effectively removed one area of discretionary spending by the area health boaards. More money from the Government is not expected; therefore the money for the extra spending on health promotion will come at the expense* of existing services, possibly before they can be spared and before the results that are sought come from the preventive effort. Hopes have been expressed that costs will be cut. That is likely to take the form of having fewer patients in hospitals and more people being treated in day surgeries instead. Another way would be to treat more patients in the same time. Whether these efficiencies will be enough remains to be seen. It seems probable that the emphasis given to preventive medicine may also result in a decrease in some of the high-technology treatments.

The Government will need to bear in mind that the higher level of diseases and disabilities associated with lifestyles followed by New Zealanders will for many years continue to make demands on the country’s health system and proper provision will have to be made for that. In time, the measures should have an effect on the demand on health services, but some of the thoroughly laudable aims may not show up for 25 years to 30 years.

The Government cannot avoid a continuing outlay of a great deal of money for health services in the short term. But in the longer term, if the targets are reached, New Zealanders will be a healthier people because of the approach taken.

This philosophy on health is very similar to the Roger Douglas philosophy on economics and business. Economic restructuring is painful and recovery is slow; but a drastic overhaul of attitudes is deemed necessary for greater welfare in the end. If the Government pushes its health doctrine too far and too fast at the expense of medical services, citizens will not be as tolerant as they were with economic adjustments.