Outlook unhealthy

T he rise in the rate of admissions to hospital for infectious diseases during the 20 years to 2008, as shown by a just-published University of Otago study, is worrying. It should not, however, be a great surprise. The rate of meningococcal disease, for instance, a typically Third World disease associated with poor hygiene, is much higher in New Zealand than in other developed countries. Other factors, such as an aversion to immunisation and continued high rates of smoking among some groups, are also obvious pointers to poor health outcomes. Nonetheless, the statistics are, as one of the authors of the study noted, a national embarrassment.

The study was the first ever done of serious infectious diseases across the whole country. It analysed 5 million overnight admissions to hospitals between 1989 and 2008. The authors say they were surprised by their findings. This is because as a country becomes wealthier, as New Zealand did in that period, the rate of non-infectious diseases, such as cancer and diabetes, usually rises and the infectious-disease rate falls. However, as the study found, while admissions to hospital for non-infectious diseases did rise, by a modest 7 per cent, admissions for infectious diseases, far from falling, went up by more than 50 per cent over the period.

This is not only a dreadful result for those suffering from the diseases, it also imposes a huge burden on hospitals and district health boards. They are already having to plan to cope for an ageing population, with all the increased health costs that is likely to bring, and the ever-rising cost of more sophisticated drugs and equipment.

An additional load brought about by this kind of largely preventable cause is not something they will welcome. Hos- pital budgets throughout the 20 years in the survey, and indeed since, even at a time of supposed financial stringency, have consistently risen by more than the rate of inflation.

But as was noted as long ago as when Helen Clark was health minister, budgets cannot continue to rise forever.

The main contributions to the rise in the rate of hospitalisation come from increases in respiratory, skin and gastrointestinal infections. Many of these are, of course, diseases associated with poverty and the conditions that come with it of poor housing, overcrowding, poor nutrition and the like. The study’s authors suggest that a widening of the income gap between the poor and the better off may be to blame. That may need further study because, while the gap between the poorest and the better off may have increased, it is highly unlikely there has been a decline in the income of the poorest of a degree sufficient to explain a rise of the magnitude that has occurred.

The idea of dealing with the problem before it gets to the acute stage of requiring hospitalisation is, however, undoubtedly sound. Eliminating poverty is a large and complex matter, and obviously has to be addressed, but simpler measures at the personal level – inculcating better hygiene habits, getting rid of smoking, reducing the intake of junk food so often found in poor households – would also be effective.

Since Maori are disproportionately represented in the statistics, iwi institutions also have a role to play, particularly in the provision of primary healthcare. Some, using money from Treaty of Waitangi settlements, are already doing this. More obviously needs to be done.