PUBLIC HEALTH

Evening Post, Volume XCVII, Issue 65, 19 March 1919, Page 3

PUBLIC HEALTH

WORK OF DEPARTMENT MINISTER RESENTS CRITICISM REPLY TO BE. MAKGILL'S VIEWS. At yesterday afternoon's sitting of the Influenza Epidemic Commission, the Hon. G. W. Bussell, Minister for Public Health, attended and made a statement ■■concerning the criticisms of the Department made by Dr. E. H. Makgill before the Commission on the previous afternoon. The Minister said the matter had been considered by Cabinet that day, and he had been instructed to make a statement which, however, was not a statement of Cabinet, but of the Minister. "My attention," said Mr. Russell, "has Wn directed to the evidence given before the Commission yesterday by Dr. MakgiU, an officer of the Public Health Department, who informed the Commission that the evidence had been prepared in consultation with his colleagues, and that it did not express merely his own opinion. " I have to express regret that this evidence was not given prior to that given by me. The statement in question generally traverses the political side of the control of the Public Health Department, and the question was asked: ' Was the Public Health Department to bo merely an advisory body? If so, it should have no mandatory powers and no responsibilities in local government.'

EARLIER PRECEDENTS. " With reference to this aspect, it is necessary to understand that the policy upon which the legislation of New Zealand has been built in a.ll is that of government by the people themselves, and the State assumes control in such matters as it is necessary, for the interests of the State. For example, the Railways Department ia a purely State function. The Education -Department, while financed by the Government, is, on the other hand, broken up into education hoards, secondary school boards, and school committees for primary, hoards of governors for secondary schools and colleges, and the Senate as the over-ruling body I for university education.

" In exactly the same way the object in public health has been as far as possible to throw the responsibilities upon t>ie people themselves through the local authorities. It is not the policy of this or any Government to take away from the functions of city councils and other local bodies, but rather to enlarge those functions and to employ the Public Health Department, as far as possible, as an advisory and supervising authority.

STATUS OF THE DEPARTMENT. " The statement is further mad© ' that the status of the Deuartment is therefore most unsatisfactory. It lacks powers where powers are most needed. It possesses powers in theory which cannot be exercised in practice, and its functions are directly controlled by a Ministry devoid of expert knowledge.' It is difficult to know exactly what is meant by the remarks that are made. If they suggest that the entire Public Sarvice of the country, including sanitation of the cities and work which now properly devolves upon the local authorities, should be assumed by the State, the answer is that such a proposal could only be made by men who are totally unacquainted with the genius of our race, which properly and legitimately insists upon control by properly constituted governing authorities of all functions and powers which can lentimately be placed in their hands. The idea of the Public Health Department assuming anything more than supervising authority and powers of direction re"garding sanitation, drainage, etc., would be too ridiculous for words. SIMPLE FACTS AND LUEID COLOURS.

In some respects the Department has very real control. For example, under the Public Health Amendment Act the Minister has power to order a local authority to instal a system of drainage, or, if necessary, to give authority to the local body for the .installation of a system of drainage, without the necessity of taking a poll from the ratepayers. This is a very real safeguard, and, of course, is always exercised only upon the advice of the Chief Health' Officer. "The statement is made :—'At times a political aspirant finds it useful to arouse a passing interest in some branch of public health, and to this end some simple facts will be decked in lurid colours to attract attention. But his interest in the subject soon ceases, and the public, pacified by the discovery of the deception, sinks back into peaceful indifference. Sanitary progress can . only be secured by taking public health out of the sphere of politics, and by establishing a continuity of policy of which one item should be the education of the public to seek after sanitary righteousness. To this end it is necessary to establish a strong controlling body representing various grades of public opinion, and seasoned by a liberal admixture of expert knowledge in the sciences and trades with which sanitary work is most directly concerned. In the Public Health Amendment Act of 1918, clause 2, an attempt has been made to establish such a body by the creation of a Board of Public Health. Unfortunately, when we examine into the powers of this board we find that they are merely an advisory board reporting to the Minister their opinions on public health questions. The board cannot direct the. enforcement of any sanitary works, cannot initiate precautions, cannot bring pressure to bear on local bodies, or give directions to the departmental officers. Their recommendations go to the Minister, and thus are subject to those political considerations inseparable from Cabinet control. In the same Act, district advisory boards may he constituted by the Minister. Their function is to report on matters which he may refer to them, a variety of sanitary debating club, in fact, to whom subjects for discussion will be allotted, and whose resolutions may be duly. pigiaon-liolcd if they run contrary to popular prejudice, or are otherwise' inconvenient. Little of value need be anticipated from the creation of these bodies at present constituted. "AN UNLUCKY FORTUITY." "Passing over the political references herein," added Mr.- Riusel, "I wish to take the strongest exception to the statements herein made with regard to the Board of Health, established by the Public Health Amendment Act. 1918, and which by a most unlucky fortuity of circumstances holds its first meeting today, for the purpose of completing what measures are necessary in view of a possible recrudescence of the epidemic. 1 may say that this board has been appointed exactly on the lines of the Council of Education, as provided in sections 8-10 of the Education Act, 1914, and a further precedent is the Board of Agriculture, appointed under the Board of Agriculture Act, 1913. If the members of the Commission will compare the Council of Education- and its powers with those placed upon the Public Health Board in clause 2 of the Public Health ..Amendment Act, 1919, they will see how

closely tbe legislation in connection with education has been followed NOT A USELESS BODY. "I -will now mention the personnel of the board : The Minister for Public Health, k chairman; the Chief Health Officer, president of the British Medical Association for New Zealand, Dean of the Faculty of Medicine in the Otago University, and officer in charge of local government in the Internal Affairs Department. The other five members comprise Dr. Gordon, a leading medical practitioner in Auckland; Mr. William Ferguson, chairman of the National Efficiency. Board; Hon. W. H. Triggs, M.L.C., of Christchurch; Ilori. . John Barr. M.L.C., to represent Labour; and Mr. Hurst Seager, the leading authority in New Zealand upon town-planning. Mr. Hurst Seager and the officer in charge of local government in the Department of Internal Affairs, have been brought in, in connection with the townplanning responsibilities which are laid upon the Department.

"If the Commission will look at clause 11 of the Amendment Act, 1918, they will see that in connection with insanitary areas very large responsibilities are laid upon the Board of Health. Under certain circumstances they are required to \hold a public inquiry and transmit their report, to the Minister for Health, forwarding a copy to the local authority. Thus are very important responsibilities' laid upon the Board of Health in connection with the insanitary areas in our cities. I think the personnel of the Board of Health completely justifies my assertion that that board will not be a use-less body. On the contrai-y, tho ability and experience of the gentlemen who form it will, in my opinion, be of the greatest value to tho Government in connection with matters relating to the general health of the Dominion. SANITARY DEBATING CLUBS.

"In exactly the same way, tho District Advisory Committees which are provided for, and which are contemptuously referred to by the departmental officers as 'a variety of sanitary debating club'—an expression which I think is most offensive—are to consist of five members, with a District Health Officer, who shall be chairman, and the president of the B.M.A. for the district, as ex-offi-cio members, while I trust the other three will be comprised of the Mayor, the chairman of the Hospital Board, and president of the Trades and Labour Council, or a direct representative of Labour. These gentlemen, when constituted an advisory board with regard to matters of local health arising out of sanitation, housing, food conditions, and similar matters, will be of the greatest assistance to the Government. To describe such a body, when constituted, as 'a variety of sanitary debating club,' is, in my opinion, not worthy of the departmental officers who prepared the brief Dr. Makgill placed before the Commission. Throughout the whole of the evidence there are improper allusions to the political side of the Department's work, which I exceedingly regret to observe. "The idea, according to the departmental officers, is that 'the controlling body should be a non-political Board of Health, composed of persons with experience and expert knowledge, whose actions and decisions will be founded on scientific laws and actuated by the practical needs of the community.'

I "UNTHINKABLE." "In so fax- as these suggestions reflect upon myself and previous Ministers for j Health, they are unworthy of serious notice. If the idea of the departmental officers is to establish a Public Health authority of a bureaucratic character, in which they will be able to act without the control of the people as represented by Parliament, and without the control of Parliament as represented by Cabinet and the Ministerial head, they have still a great deal to learn about the country in which they live. The people of New Zealand would never for one moment tolerate the establishment of a bureaucratic system as regards health or any other j subject. On a previous occasion there | was a Railway Commission which controlled the railways. They were displaced, and it is unthinkable that the Government should hand over to departmental officers the huge responsibilities, financial and otherwise, that would be entailed in the proposal submitted to the Commission.

"It is suggested that 'doubtless a Minister for Health is needed to report the claims of sanitation to Cabinet and to Parliament. The general expenditure must be thus controlled as also the amendments and additions to sanitary legislation. But here his functions should end, and the real controlling authority should be a non-political board of health composed of persons with experience and expert knowledge, whose actions and decisions will be founded on scientific laws and actuated by the practical needs of the community.' The answer to .that is that such a body has been established in the Public Health Board.

WHEN OPINIONS DIFFER. "It is not necessary for me to point out the importance of the Minister for Public Health being associated with a board whose proposals may require that he should have a thorough knowledge of them in order to carry them through Cabinet. Now, what is the present position? It is an unwritten law that,no new expenditure involving a sum of over £250 can be made by a Minister unless it is first approved by Cabinet. That is ■the sheet-anchor against incompetent control, and invariably it is on the advice of his expert officers that the Minister acts in these matters. Sometimes there may be a difference of opinion between the Minister and his chief adviser. In that case, of course, the Ministerial j decision stands. It is impossible for me not to regard the attack upon Ministerial control which is being made by the | Department as aimed at myself. I have now been Minister for Public Health on j , two occasions, first in the Government i of 1912 and secondly in the present Government for nearly four years. No proposal has ever been submitted to me by | the Department that would go in the direction of improving the public health service of the country, and been turned down. The salaries have been referred to. In this connection. I have to say that several of the salaries of the higher officers have been raised ■while I have been Minister. There may have been more Ministerial initiative than the Department cared about. Amongst those matters which have depended upon i Ministerial initiative are the following : (1) Extension of the St. Helens Homo system at G-isborne and Inver- ] j cargill, and creation of maternity hos- j pitals and wards at Napier, Blenheim, and other places. The policy of urging the hospital boards to create maternity wards has been a Ministerial policy, not a departmental one. (2) The establishment of medical bursaries at the Otago University for the purpose of providing assistant house surgeons for our hospitals. (3) The establishment of dental bursaries. (4) The encouragement and extension of the Plunkct nurses. (5) The extension of the Public Health service by the Public Health Amendment Act, 1918, to country districts as well as our cities. (6) The establishment of a Board of Health. RESPONSIBILITY AND CONSCIENCE "There has never been any desire or intention on the part of the Mmistßi1 to interfere with the scientific, experimental, or technical sides of the Department, except us I stated in my evidence a few days ago, Uio wish to make a line of demarcation as regards the heads of the Denartment and District Health

Officers between the purely scientific and lay work. If the Department is, therefore, in a backward state as regards organisation, efficiency, and ability to meet the public health conditions arising out of epidemics and such untoward events, the responsibility rests upon tile heads 'iof that Department to show to the Commission and to the people of the country that they have made recommendations which would have stopped the leaks, that they have asked for money which has been Tefused, and, in fact, that they are not themselves responsible for the condition .against which they complain. To sneer at Ministers as politicians, and to say that 'politicians reflect the popular wishes rather than scientific needs' is a very cheap and easy way for the men whom the Government have paid to advise with regard to public health to escape the responsibility that rests upon them.

"I repeat without any hesitation that if. at any time during the years I have held office, the Department heads had made and forwarded to me recommendations with regard to the improvement of the service, the alteration of the law, the raising of salaries, their suggestions would have been brought before Cabinet, upon which would have rested the responsibility of inaction. No such recommendations have been made, and for the condition, therefore, of the Department to-day, the responsibility rests, not unpn the Government, but upon the Departmental, officers, who have apparently salved their consciencies by preparing the statement which has been laid before the Commission.

The Chairman (Sir John Denniston) said that in regard to the question of the time at which Dr. Makgill's evidence had been, given, that had been fixed by the Commission and not by the witness. The Commission had sought a full and frank expression of opinion from the officers of the Department, and what had been given had no reference to persons. Dr. Makgill's statement was a general statement of tho views of the officers of the Department, a general expression of opinion in the abstract, on the activities of the Department without regard to the existing Minister or the board. Mr. Russell replied that Cabinet consisted of thirteen gentlemen, all of whom were politicians, and whether the references were personal or not, the Government could not accept a statement which, although given in the abstract, was a general criticism of the Government.