Give priority to public health
Heather Simpson’s health review should learn from Covid-19 the importance of spending money at the top of the cliff, write Debbie Edwards, David Galler, Todd Krieble and Colin Tukuitonga.
The long-awaited review of the health system, led by Heather Simpson, will be published today. We expect and hope that it will be bold and challenging. We hope, too, that it will provoke a wideranging and open discussion about what the future might hold, and how we can work together to create a better, higher-quality health system that actively prevents disease, promotes wellness, and addresses the gross inequities that currently exist. We hope it will lay the foundations for improving health outcomes and quality of life for all, to give us the best chance to reach our potential.
What our prime minister, the state services commissioner and the director-general of health decide to do with this report will hugely affect all of us, and all those that follow.
The Simpson Report was written before Covid-19 arrived, and a lot has changed since then. For the best part of three months, we’ve had a team of five million who together have been part of a highly successful public health response – quarantining, isolating, physical distancing, getting tested and traced, despairing and celebrating as new cases came and went.
People who had never heard of Dr Ashley Bloomfield tuned in for daily updates and debriefed later in evening Zoom meetings. We debated R-values, crushing the curve, strategies for elimination v suppression v mitigation, the Swedish approach, trade-offs between health and the economy, the supply and demand for PPE and nasal swabs. We bought T-shirts and wrote songs, and gradually we all became amateur epidemiologists.
Many of us know only now how close we came to catastrophe. We were saved by that brave and timely decision to go hard and to go early. Just as importantly, behind the scenes, resources were rapidly poured into our very under-resourced public health units.
Despite a pandemic being the most likely and significant global security threat our public health and hospital sectors might face, for many, this was the first time they had heard of this incredibly important specialty area. Public health has had a low profile in New Zealand, only visible when something goes horribly wrong – contaminated water in Hawke’s Bay, or the arrival of highly contagious and lethal viruses like measles or Covid-19.
For too long public health has been on the wrong end of funding decisions, while most resources were diverted to treat complications of preventable diseases – funding the ambulance at the bottom of the cliff, rather than the fence at the top. Whilst we squashed Covid-19, during our lockdown preventable diseases like cancers and diabetes will have gone unscreened and undiagnosed, showing just how thinly resourced we actually are.
As good and important as our treatment services are here in Aotearoa, our health and how we recover from illness and injury are shaped by other things: genetics and luck, the environment and communities we live in, our behaviours and the choices we end up making.
Public health pays a critical role in these areas by preventing illness, promoting wellbeing and protecting whole populations through collective action. It is the foundation of the health and wellbeing of all of us.
Its influence should underpin public policy well beyond health – addressing poverty and improving income, employment, education, housing, transport, inequality, structural racism, violence, social cohesion, and dealing with pollution and climate change. Effective public health policy should make it easy to make healthy choices about what we eat, not to smoke, and how active we are.
There is no doubt that investment in public health realises the greatest return on investment. But it’s been neglected and underresourced for so long that one prominent public health leader recently described it as no longer fit for purpose, ‘‘an old dunger’’.
In this era of climate change, with a government focused on wellbeing and in the aftermath of our extraordinary success in managing the coronavirus pandemic, this is the time to structure and resource public health properly.
This shouldn’t be left to the health sector alone. The process you use to get to the future determines the future you get – so let’s make the most of this once-in-a-lifetime opportunity to have the conversation across government, and with our team of five million, about our aspirations and what really matters for the health and wellbeing of New Zealanders.
Debbie Edwards is senior policy manager at Auckland Council; Dr David Galler is an intensive care specialist at Middlemore Hospital; Todd Krieble is deputy chief executive of the NZ Institute of Economic Research; and Dr Colin Tukuitonga is associate dean Pacific at Auckland University. These are their personal views.