Overcrowding puts vulnerable babies at risk
The revenue from a sugar tax supports healthy living programmes in a United States city. Rachel Thomas reports. Newborn intensive care units rely on the ‘goodwill’ of worn-out staff to operate. and report.
In Berkeley, California, students are cooking kale and washing asparagus at schools named after Malcolm X and Martin Luther King Jr. Teenagers are going to ‘‘health parties’’ and drinking smoothies they’ve made on pedal-powered bikes.
And, it’s all thanks to a sugar tax.
It may sound so hipster it hurts, but the public school district’s decade-old cooking and gardening programme is among the city’s most valued health initiatives, and it almost lost it in 2013, when the Berkeley Unified Schools District faced a $1.9 million loss in grant money.
The city’s residents were richer, meaning – much like New Zealand – the schools no longer qualified for the same level of funding.
Enter ‘‘Berkeley v Big Soda’’ and a resoundingly successful campaign for a city-wide tax on fizzy drinks.
Since it took effect in March 2015 and through until 2019, the sugar tax will pour US$5m into supporting health programmes in Berkeley.
The biggest chunk, US$2.16m, has gone to Berkeley Unified Schools District, rescuing its gardening and nutrition programmes – designed to teach students of all ages how to grow and harvest food, especially targeted to AfricanAmerican and Latino students.
‘‘We’re a very affluent city but there are major disparities on the basis of race and health outcomes. Not surprisingly, it’s black and brown kids that are the ones most impacted,’’
Berkeley
Hospitals do not have room for the most vulnerable newborns, and desperate doctors are pleading for the Ministry of Health to step in before more babies are put at risk.
Stuff has found neonatal intensive care units (Nicu) are struggling with overcrowding, with at least three units dealing with more babies than their capacity allowed for most of last year.
The shortage means newborns and their mothers are being ferried on expensive transfers between main centres because there is no room to care for their babies in the hospital closest to home.
Clinicians say neonatal care needs to be organised and funded nationally, and have urged the ministry to take action since at least February last year.
In Christchurch, the unit operated near or above 100 per cent occupancy for all of last year. Because of this, the Canterbury District Health Board sent 31 women with high-risk pregnancies to give birth in other cities, twice as many as in 2016.
Waikato’s unit has been overcrowded for the past six months, at 105 to 110 per cent. In Wellington, the unit was over capacity for 190 days last year.
Temporary cots are wheeled in Mayor Jesse Arreguin says. Revenue from the tax goes into the city’s general fund but the money is allocated by a panel of health experts and community representatives to where they see a need.
Another key recipient was the nonprofit group Healthy Black Families, founded four years ago by former obstetrician-gynaecologist and single mother Dr Vicki Alexander.
The group has successfully applied for US$760,000 in funding since the tax took effect, which will carry it through to 2019. With that money, the group has trained educators and ‘‘water ambassadors’’ to teach the city’s marginalised black community healthy eating habits and cooking, such as how to feed a family of four for $10 or less.
‘‘It’s a major cultural shift that we have to make happen. We have been so sold on sugary-sweetened beverages, it’s a damn shame. We have to really hit hard,’’ Alexander says. ‘‘It’s reeducation and it’s re-training your tongue.’’
The non-profit runs ‘‘health parties’’ where there’s dancing, acupuncture, massages and pedal-powered juicers in an to house more infants, and twins have to share incubator power sockets.
‘‘We can double up bed spaces where there’s room, but you can’t run a unit like that because it’s only a short-term fix when you’re in a crisis,’’ said Wellington Nicu’s clinical manager, Dr Vaughan Richardson.
‘‘We’ve made it so it’s possible, but it’s not what it was designed to do.’’
Starship children’s hospital has not had the same issues because Middlemore Hospital also has a Nicu so demand in Auckland is typically shared.
However, an Auckland regional neonatal cot demand and capacity review is under way. While clinicians say babies in their care are still safe, New Zealand guidelines put safe levels at 85 per cent occupancy.
International studies have found babies admitted to a unit at full capacity were 50 per cent more likely to die than in those that were half-full.
‘‘It’s mainly working because of goodwill, rather than something that’s set up long-term as a good idea,’’ Richardson said.
‘‘I believe it’s safe, it’s just sometimes the staff have to work really hard to look after babies.
‘‘It’s a pretty high-pressure job at the best of times, and staff are worn out under those attempt to get the community interacting in a healthier lifestyle.
‘‘People can see that change in your environment can be fun and it doesn’t have to be onerous.’’
The group will also run the programme in the neighbouring city of Oakland, where a sugar tax was adopted in Berkeley’s wake.
‘‘Some areas of Oakland are really depressed, extremely depressed. There’s much more food banks and food distribution going on.
‘‘We want to get people to a point where they change their unhealthy behaviour and help to change other people’s behaviour. This idea of health parties is really catching on.’’
Funding has also been dished out to projects designed to improve diabetes awareness and reduce dental cavities by improving access to dental care.
Despite the city’s high income brackets, poverty is rife in Berkeley – home to ‘‘tent cities’’ where the homeless literally set up camp on the streets.
There’s a housing shortage in the southern suburbs, where families of four share two-room homes.
‘‘They’re all social determinants of bad health,’’ Alexander says.
Arreguin says the city knows that sugary drink consumption is likely to drop, and acknowledges they will need to eventually think of other sources of revenue.
‘‘We’ll have to think about how we’re going to fund that. That’s a conversation for the city and the school district.’’
But the programmes the tax is funding aim to break the cycle of health problems. If consumption of these drinks stops, some of the health problems the tax is addressing won’t demand as many resources, he says.
‘‘We want fewer people to drink sugarsweetened beverages and that is one of the things we’re trying to achieve through funding these different organisations.’’
❚ Part of the problem, Opinion A11 circumstances. They won’t stop doing their work, but something needs to be fixed.’’
When Stuff first approached the ministry, it said concerns had not been raised with it by health boards.
‘‘We are not aware of any DHB which has raised the issue [of neonatal overcrowding] formally with the Ministry of Health,’’ ministry child and youth chief adviser Dr Pat Tuohy said.
‘‘If a DHB believes its neonatal unit is under pressure, the ministry expects the DHB to raise this formally and is happy to discuss such issues with DHBs.’’
But the Canterbury board said it warned the ministry in February last year that its Nicu was at risk of acute service failure. In Wellington, clinicians have also raised problems with ministry staff.
Overcrowding issues were first identified in a 2008 review of neonatal services. As a result, the New Zealand Newborn Clinical Network was formed, to allow more collaboration.
The network’s clinical leader, Nicola Austin, said it had repeatedly asked the ministry to provide more support during the past two years. It had asked for the units to be managed nationally, instead of each health board resourcing its own units. This would increase consistency and equity across the country and address safe staff levels, she said. ‘‘The action is lacking.’’
When Stuff asked the ministry again, Tuohy said he had frequent meetings with health officials and neonatal clinicians.
‘‘Many units are currently under pressure due to staffing issues, changes in admission rates and the increasing demands made as we save even more very premature babies . . . I am aware Canterbury are under pressure in their neonatal unit, with high occupancy rates.’’
Despite the birth rate declining, neonatal care is in higher demand.
Richardson said this was because of developments in medicine, as younger babies were now more likely to be kept alive, and increasing complexities in the mother, including age and obesity.
Queenstown mother Leah White stayed at Christchurch’s Nicu for 44 days after she gave birth to premature twins in June.
Her babies received ‘‘wonderful care’’ but the busy unit made it hard for her and her husband to bond with the twins, who were frequently kept in different rooms for space reasons.
‘‘Babies would come out sooner if parents could spend more time with them.’’
Frequent visitor bans meant White’s older son and parents could not spend time with the babies.
It was upsetting to see other mothers being uncomfortable and struggling to establish breastfeeding with their newborns, she said.
‘‘You try and get there before 7am because you know you’ll get a chair and you don’t want to leave for lunch because you’re going to lose your chair,’’ she said.
The December 2016 external review of the Christchurch service, obtained under the Official Information Act, found its neonatal intensive care unit had been ‘‘well over capacity’’ since 2013.
While it was still performing well, this was put down to a resilient and hard-working team, and it was ‘‘neither sustainable nor prudent to continue’’.