The need to address both health and economic issues and also for stability

Some of the Covid debate has tended towards health versus economy, but it can’t be an either/or argument. Good health of the population is important for the economy, and a good economy is important for health and wellbeing – “there are many dimensions to health and well-being, many of which build fundamentally on economic stability”.

We had to go into some degree of lockdown, and we have to come out of lockdown. The big challenge is to do this as safely as possible as far as Covid health is concerned, but taking into account the importance of the economy in general, but also specifically in relation to individual and community health.

Many of us have kept a close eye on Covid data, numbers and rates of cases, deaths, tests and more.

Economic signals have been much more mixed, for example share markets plummeted, but have since recovered a lot of the lost ground.

But there’s a key difference – Covid proved to be able to spread fast, and deaths started to surge within a month of an outbreak. Containment has been observable. In contrast a lot of the economic effects are spread over many things, and are likely to lag somewhat. Some companies and jobs will survive, and while some have already been lost the economic impact will take months (at least) to play out.

One of the go to websites for data has been the Johns Hopkins University Covid map.  Caitlin Rivers is an assistant professor in Outbreak science + epidemiology + health security, but she acknowledges the importance of considering both health and the economy,

I’ve been noticing a dangerous polarization in our discussions around navigating our way through the pandemic.

She’s in the US were polarisation has been a growing problem since well before Covid struck.

Reopening is said to be playing games with people’s lives. Continuing stay at home measures is said to be without regard for the economy. This is a false choice.

We were the first group to put out detailed reopening guidance back in March, the same week that many states were issuing stay at home orders. The goal is and has always been to reopen – the question is how to do it safely

Staying home was always meant to be temporary, to prevent the healthcare system from being overwhelmed and to put in place capacities to enable a transition to case-based management. The question is how and when we will reopen. It was never about if we will reopen.

I’ve written about the answers to these questions extensively. The ‘how’ is through test-trace-isolate. The ‘when’ is as soon as we have that in place. The ‘then what’ is by re-introducing low risk activities, waiting to see what happens, and moving up from there. 

As I’ve said many times, what we want to avoid in the reopening process is creating the conditions that led to us having to stay home in the first place. The conditions of NYC, Lombardy, Wuhan. And yes, those places are all urban centers, but rural areas are vulnerable, too.

In April an average of ~2,000 people died of coronavirus in the US each day. That is more than daily average from cancer or heart disease. I fear there is growing complacency that this level of loss is a new normal. Are we really ready to add a new leading cause of death?

My answer to Q’s about whether x, y, z place is ready to reopen is to ask whether those places have the capacities, and if not, how do we build them. Yes, it’s a big lift, but (my current fav phrase) we have done hard things before. We can do this too.

But – and I’ve said this before too – there are many dimensions to health and well-being, many of which build fundamentally on economic stability. I worry as much as anyone about secondary consequences of e.g. poverty and other gaps in care of chronic conditions.

My job is to provide public health counsel, and so that’s what I do. It’s a missed opportunity to have a deeper discussion when I or other experts are set up in an either-or, economy-public health discussion. It’s about how we do both, safely

Again I’ll quote “ there are many dimensions to health and well-being, many of which build fundamentally on economic stability” – this suggests that now is not the time to launch into radical economic or social change, which would be certain to result in instability.

Hospitals told to consider delaying surgery for older and overweight people

Health care investigations, treatment and surgery have always had to be prioritised and limited do to demand outstripping resources, but this will raise a few eyebrows: Hospitals urged to consider putting off some surgery

Hospitals are being told to consider putting off surgery for seriously overweight people and those over 70 unless it is urgent.

A memo from the Ministry of Health to district health boards has outlined how they should manage getting normal services up and running again with the risk of Covid-19 still looming.

It said deferring treatment should be considered for people over 70, those with a body mass index over 40, or those with other conditions including heart, lung or kidney disease.

That is because if they contracted Covid-19 they had a higher risk of death.

But if they urgently need treatment, they should get it, the memo said.

I don’t know why people who are at higher risk from Covid are being put on a lower priority. At this stage the risks of anyone getting Covid look very low.

There has to be prioritising as they crank up normal health care again, there always is, but putting people down the list due to the (low) possibility of catching a specific virus looks dicey to me.

Why not include influenza as well? Anyone with a greater chance than normal of having any sort of lung or heart problems?

Certain and uncertain consequences of Covid lockdown

The lockdown of New Zealand will have some obvious consequences, but other consequences are less certain.

The near isolation of most people in their homes with some exceptions and exemptions will reduce the spread of the virus in the short term at least, and should keep the death toll lower than it would otherwise have been. The longer term health outcomes are less certain, it is dependent on short term success, improvements in treatment and the time taken to develop an effective vaccine.

It is certain there will be a substantial impact on the economy and an increase in unemployment. It is unknown how bad, and for how long – we don’t know if the economy will bounce back or if we will be in for a protracted recession, or whether it will deteriorate into a depression.

Sport was a prominent early casualty of the virus, and the flow on effect will be substantial for a year or two at least. Many sports have shut down for the short term at least. The Olympic Games have been delayed by a year.

There are other certainties and uncertainties. One significant uncertainty is how long the lockdown will be in place, and if it is relaxed by how much and for how long. For example we may be allowed to go back to work but still need to limit travel around the country.

Road toll

The lockdown means far fewer vehicles on the streets and roads, and shorter trips, so the road toll will come down for a while at least. There are already signs of this – the number of deaths from 1 January to 1 April 2020 are already down slightly, being 84 (for the same period in the four previous years the toll was 90, 92, 105, 100).

Drownings

There is likely to be reduction in the number of deaths by drowning at least for the duration of the lockdown. Over the last three years total deaths have been 92, 78, 82.

Accidental and workplace deaths

Deaths in the workplace will reduce significantly while the lockdown is in place.In the year to January 2020 there were an average of 9.4 deaths per month, with 10 bin both last March and April.

Accidental deaths will probably also reduce, but they could still occur at home as people do more work on houses and rooves without being able to get scaffolding.

Suicides

It’s uncertain what the overall effect of the lockdown will have on our suicide rate.Some people will be more stressed, some will be less stressed. Being confined to home won’t stop some going out and at least trying, but the lockdown will reduce opportunities and increase contact and surveilance of at risk people.

There were a record 685 recorded suicides in the year to June 2019.

Relationships

The lockdown effect on relationships will be uneven and uncertain. Some relationships will be more stressed, some may benefit from more time together. Being confined to home during the lockdown their may be a lag in relationship breakups.

There will be less temptation and opportunity for infidelity and jealousy.

Family Time

Some parents and children will benefit from having enforced time together

Infectious and Communicable Diseases

Following on from the effect on relationships, there is likely to be less promiscuity and fewer sexually transmitted diseases.

It won’t just be the spread of Covid-19  that is limited, the lockdown will also reduce the cold, flu, hepatitis, measles and all other communicable diseases.

Schools being closed will improve the health of kids, and nits should be contained more than usual.

Other Health Issues

Along with the lockdown hospitals have geared up for treating Covid-19 patients by reducing operations and treatments. There could be a negative impact on health, which could result in more deaths from delayed or unavailable treatment and delayed diagnosis and detection of diseases.

Media

Traditional commercial media – newspapers, magazines, radio and television – were already struggling and in decline. They will be severely impacted by the hit to business activity, which has taken most of their revenue away (ironically while getting a big boost in readership and audience).


This is just some of the things that will be impacted by the Covid lockdown. It will take a year or two to quantify some of the impacts, and some impacts may never be quantified.

There are some certainties but many uncertainties, and there will be both positive and negative outcomes.

We are stuck with what we have got for now, we should be doing what we can to make something out of the change in opportunities – including not grumping and grizzling too much about things we can’t change..

Daily health update – +61, total 708

Director of Public Health Dr Caroline McElnay today.

47 new confirmed, 14 new probable (+61) – total now 708

The increase is similar to yesterday (58) so even with more testing the case numbers are not growing faster.

2 of 14 in hospital are in intensive care, condition stable

Still just 1 death

82 recovered

Summary

As at 9.00 am, 1 April 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 647 47
Number of probable cases 61 14
Number of confirmed and probable cases 708 61
Number of cases in hospital
Number of recovered cases 82 8
Number of deaths 1

New case definition for diagnosis and testing will be issued today, still relying on clinical judgment

Anyone with respiratory symptoms regardless of travel history

Capacity 3,700 tests per day, but will increase from 8 to 10 labs by the beginning of next week.

 

Trump wants UK National Health Service included in trade negotiations

Donald Trump’s visit to the UK was always going to be controversial. He has strongly supported Brexit, something that is dividing the UK. But Trump has upped the ante – he says that when US-UK trade takes start after Brexit (if it ever happens) he wants the UK National Health Service to be opened up to US companies.

Fortune: There’s One Subject in the U.K. That’s as Toxic as Brexit. Trump Just Waded Into It

Once, advocates of the U.K.’s departure from the European Union argued that Brexit would mean more government funding for the country’s National Health Service, or NHS.

Now, President Donald Trump has confirmed the opposite: in trade talks between the U.S. and U.K., which will take place once Brexit has gone into effect, the U.S. wants the U.K. to open up the cherished British public health system to American companies.

“I think everything with a trade deal is on the table… NHS and anything else, a lot more than that,” Trump said at a joint press conference with Prime Minister Theresa May on Tuesday, on the second day of his state visit.

The president was responding to a question about whether he agreed with the U.S ambassador to the U.K., Woody Johnson, who said Sunday that he assumed the NHS “would be on the table” in the imminent trade talks, as the negotiations would account for the entire British economy. And his response has already elicited fury among leading politicians from across the British political spectrum.

The public nature of the NHS, which has been free to use for seven decades, is practically seen as sacred in the U.K., and attempts to change that status are politically toxic. A degree of privatization has been taking place in recent years, but NHS bosses want to reverse the process by squeezing out local for-profit contractors such as Virgin Care and Care U.K.

Further opening up the NHS to American contractors would therefore be an explosive political development. The U.S. ambassador’s comment prompted British Health Secretary Matt Hancock—one of the contenders for May’s job, as she is about to step down—to defend the health service in unequivocal terms.

However it’s hard to see much progress being made on US-UK trade talks at this stage. Brexit looks to be far from resolved, and the Prime Minister who Trump is meeting with, Theresa May, is soon stepping down. The NHS is likely to now feature in the contest for leadership of the Conservative party and the country.

RNZ: Trump praises ‘extraordinary’ US-UK alliance on state visit

US President Donald Trump has said the US and UK have the “greatest alliance the world has ever known”.

That’s what you would expect when the current leaders of the US and UK are the greatest the world has ever known.

The US president met Brexit Party leader Nigel Farage at the US ambassador’s residence, Winfield House. Mr Farage tweeted that it was a “good meeting” and Mr Trump “really believes in Brexit”.

Mr Trump also said he turned down a meeting with Jeremy Corbyn, who addressed protesters in Westminster. Mr Trump said Mr Corbyn was a “negative force”. “I really don’t like critics as much as I like and respect people who get things done,” he said.

Mrs May said the scope of trade talks had to be agreed by both countries.

Asked if the NHS would be included in post-Brexit trade talks, Mr Trump said “everything is on the table”.

Health Secretary Matt Hancock was among several Conservative leadership candidates hoping to replace Theresa May who said they would not allow the NHS to become part of any trade talks. “Not on my watch,” he tweeted.

Perhaps the US will play a Trump card – impose tariffs on the UK unless they hand their health system over to US companies.

An experience with the health system

As others have noted Gezza has some health challenges at present. And like others I wish him the best outcome and a speedy recovery. His absence here is noticed.

I don’t want to detract from that, but this post is about someone else’s experience with the health system – mine.

Our health system cops a lot of criticism, especially related to finances and costs, and it’s struggle to provide all the health care that everyone wants and needs.  But recent experience of mine is mostly positive.

I was last in hospital as a patient in the 1960s – until last night.

Yesterday afternoon I started to get lower abdominal pains, which got worse as the day wore on. By early evening they were quite bad. I couldn’t lie, sit or stand with any degree of comfort. So I had a trip to the Dunedin Emergency Department.

It was busy, with the waiting room fairly full. I was seen quickly by the triage nurse, who took details and gave me some painkillers, and then asked me to wait in the waiting room. This was the bad part of my experience, trying to stop being too uncomfortable in a basic sort of chair in a crowded room for two hours, with the only break being a trip to the toilet to vomit.

When at last I was called I got a cubicle bed, and from there the care I received was all good, very thorough. I was quickly given a diagnosis, kidney stones, which was a surprise because I hadn’t thought of that and Google didn’t suggest it when I searched lower abdominal pain. While it was very painful and uncomfortable it didn’t seem like too big a deal.

I had a bunch of tests, blood, urine, blood pressure etc, plus an ECT thrown in (standard if you’re over 50). Then an xray, which confirmed the likelihood of kidney stones. By now it was getting late, and they gave me a bed in a quiet corner so that I would be on hand for a CT scan in the morning.

Breakfast was fairly bland and standard but adequate – fruit and cereal, and toast that is never great when it’s been cooked an hour ago, but that’s what you get.

Then the CT scan, followed by normal sort of waiting for results – long enough to get lunch, which was edible but bland soup and a quite nice sandwich.

The scan confirmed there were a couple of kidney stones.

According to online searches 10-20% of men get kidney stones at some stage of their life, and half the rate for women. About half of those who get them don’t get them again.

I was given a prescription and was able to go home and let nature take it’s course, hopefully. It could take a few days, possible weeks depending on what you find online.

We have a very multicultural health system, with doctors and nurses of at least seven obvious ethnic origins. All were professional, helpful and friendly, I could quibble about a couple of things but overall the care was very good, better than expected – having a not too bad diagnosis helped of course.

This is why there wasn’t much posting this morning, I did a bit when awake after a 3 am observation. But regulars kept things ticking away via comments, thanks for that as per usual.

Apart from complimenting this part of our health system, this makes one ponder how quickly your life can change. I have been inconvenienced but otherwise got off quite lightly – this time.

I’m grateful for what I’ve got, still, including a fairly decent health system.

And I will adjust my lifestyle. There are plenty of hints online.

Not smart (or healthy) to use smartphone too much

Research indicates that using a smartphone too much is increasing stress, is a threat to health, and could result in earlier death.

This could mean that too much raging online increases rage levels, causing more social strife.

I wonder if how you use your smartphone may matter more than how much you use it.

NY Times: Putting Down Your Phone May Help You Live Longer

By raising levels of the stress-related hormone cortisol, our phone time may also be threatening our long-term health.

An increasing body of evidence suggests that the time we spend on our smartphones is interfering with our sleep, self-esteem, relationships, memory, attention spans, creativity, productivity and problem-solving and decision-making skills.

But there is another reason for us to rethink our relationships with our devices. By chronically raising levels of cortisol, the body’s main stress hormone, our phones may be threatening our health and shortening our lives.

Until now, most discussions of phones’ biochemical effects have focused on dopamine, a brain chemical that helps us form habits — and addictions. Like slot machines, smartphones and apps are explicitly designed to trigger dopamine’s release, with the goal of making our devices difficult to put down.

This is mostly about marketing – selling products and selling online services. Too much inane advertising watching passive media could also raise stress levels.

This manipulation of our dopamine systems is why many experts believe that we are developing behavioral addictions to our phones. But our phones’ effects on cortisol are potentially even more alarming.

Cortisol is our primary fight-or-flight hormone. Its release triggers physiological changes, such as spikes in blood pressure, heart rate and blood sugar, that help us react to and survive acute physical threats.

These effects can be lifesaving if you are actually in physical danger — like, say, you’re being charged by a bull. But our bodies also release cortisol in response to emotional stressors where an increased heart rate isn’t going to do much good, such as checking your phone to find an angry email from your boss.

Not taking your work home with you is important in reducing work related stress. I’m not set up to get work emails on my phone, so I’m not effectively on call.

If they happened only occasionally, phone-induced cortisol spikes might not matter. But the average American spends four hours a day staring at their smartphone and keeps it within arm’s reach nearly all the time, according to a tracking app called Moment. The result, as Google has noted in a report, is that “mobile devices loaded with social media, email and news apps” create “a constant sense of obligation, generating unintended personal stress.”

“Your cortisol levels are elevated when your phone is in sight or nearby, or when you hear it or even think you hear it,” says David Greenfield, professor of clinical psychiatry at the University of Connecticut School of Medicine and founder of the Center for Internet and Technology Addiction. “It’s a stress response, and it feels unpleasant, and the body’s natural response is to want to check the phone to make the stress go away.”

So an addiction to being connected is a large part of the problem.

Any time you check your phone, you’re likely to find something else stressful waiting for you, leading to another spike in cortisol and another craving to check your phone to make your anxiety go away. This cycle, when continuously reinforced, leads to chronically elevated cortisol levels.

And chronically elevated cortisol levels have been tied to an increased risk of serious health problems, including depression, obesity, metabolic syndrome, Type 2 diabetes, fertility issues, high blood pressure, heart attack, dementia and stroke.

Making it likely people are getting crankier, more easily offended and upset, more intolerant.

Elevated cortisol levels impair the prefrontal cortex, an area of the brain critical for decision-making and rational thought. “The prefrontal cortex is the brain’s Jiminy Cricket,” says Dr. Lustig. “It keeps us from doing stupid things.”

Impairment of the prefrontal cortex decreases self-control. When coupled with a powerful desire to allay our anxiety, this can lead us to do things that may be stress-relieving in the moment but are potentially fatal, such as texting while driving.

The effects of stress can be amplified even further if we are constantly worrying that something bad is about to happen, whether it’s a physical attack or an infuriating comment on social media.

Some people seem to be constantly worried about potential wars, perceived injustices and threats (justified or not) of reduced rights – and more susceptible to believing conspiracies?

To make your phone less stressful, start by turning off all notifications except for the ones you actually want to receive.

Next, pay attention to how individual apps make you feel when you use them. Which do you check out of anxiety? Which leave you feeling stressed? Hide these apps in a folder off your home screen. Or, better yet, delete them for a few days and see how it feels.

Unfortunately, it isn’t easy to create healthy boundaries with devices that are deliberately designed to discourage them. But by reducing our stress levels, doing so won’t just make us feel better day-to-day. It might actually lengthen our lives.

If you have a smartphone addiction try to use it less, stress less, and what you do may end up being better quality engagement.

 

More talk on ‘drug use is a health issue’ but where’s the action?

More talk but still a lack of action on drug abuse issues.

Minister of Police Stuart Nash talks some talk on addressing drug problems, but his Government is still failing to walk any meaningful walk on addressing urgent drug abuse issues.

RadioLive: Drug use should be treated ‘as a health issue’ – Stuart Nash

So why the fuck doesn’t the Government take urgent action to do that?

Police Minister Stuart Nash is refusing to say whether he’s for or against ending marijuana prohibition, but appears to be leaning in favour.

“I’m not going to give you a yes or no, because I want to see what this looks like,” he told host Duncan Garner.

“I’ll weigh up the benefits and I’ll vote accordingly.”

But as long as there are sufficient social services in place to deal with the harmful effects of marijuana, Mr Nash appears to be in favour of legalisation.

But the Government seems to be dragging the chain on this – they opposed Chloe Swarbrick’s bill, their own bill is limited to medicinal use of cannabis and they are not exactly rushing on that, and while greens got a promise of a referendum on cannabis law before or at the next election there is no sign of action there.

Drug abuse is already a major health and crime and prison issue. people continue to die, lives continue to be ruined, and all Nash does is parrot ‘drugs should be treated as a health issue’.

“I was incredibly proud of Jacinda Ardern not to sign up to Donald Trump’s new war on drugs,” he added. “We need to treat this as a health issue – the police are doing this, we’re doing this as a society.”

But nowhere enough, and nowhere near urgently enough.

He said the police are already using discretion not to criminalise drug users – even those consuming hard drugs.

“We refuse to treat every single addict out there as a criminal. This is a health issue. An example – Operation Daydream, this is going after the meth dealers and suppliers. Police did that, they rounded them up.

“After that they went to all the addicts and instead of putting them in front of a judge, as they have done in the past, they put them in front of social services to help these people. That’s the sort of society we need to create.”

One approach has had some success. Newsroom: Addiction courts save millions in prison costs

With more than 10,000 people behind bars and total prison costs expected to top $1 billion next year, politicians are desperate for ways to rein in the corrections system.

The problems sometimes seem intractable, the financial and human costs ever-increasing.

But far from the halls of power and policy summits, one approach being employed to stop people offending and going back to prison has had some real success.

Grounded in evidence and criminal justice research, the country’s two Alcohol and Other Drug Treatment (AODT) courts are tasked with handling one of the toughest, and most costly, cohort of offenders: recidivist criminals.

There is a clear pattern in the lives of this cohort. They commit crimes, go to prison, get released, and then start the cycle again.

In the AODT courts, the offenders also have an added layer of complexity – their offending has been clinically assessed as driven by their alcohol and/or drug addiction.

The two Auckland-based pilot courts, set up nearly seven years ago, have shown interesting results.

Great. So why not have more of this?

In an interview with Newsroom, Justice Minister Andrew Little is positive about the AODT courts, but says any expansion will not occur before a final impact evaluation. This is due to be completed next year.

An interim-evaluation took place four years ago, and showed positive progress.

“I have a personal and principled commitment to seeing more of this, but there is a commitment to doing a more formal evaluation of the court,” he says.

“That is underway. Following that, [will be] the basis for making my bid for more resourcing to see more of them.”

Little also alludes to the challenges of pushing for long-term change.

“This is the whole question in the broader criminal justice system. Treasury kind of weighs it every time. There might be greater resources needed at the front-end, but if that means that is resulting in fewer people going to prison, and we are still reducing the reoffending rate significantly and materially, then … that is the right place to put the resources rather than at the far end when it is kind of too late.”

However, for those who understand the improved outcomes achieved through AODT courts, waiting for another evaluation is a tough ask. Feedback from the recent Justice Summit in Wellington included queries around when other parts of New Zealand would have access to AODT courts.

As drink driving researcher Gerald Waters puts it: “I’ve also looked at all offending in New Zealand – 80 percent of crime is alcohol and drug related. It’s obvious that you shouldn’t be having drug court once a week – you should be having it six days a week with one day for normal crime”.

Like may things under the current Government, after making a big deal with what the achieved in their first 100 days – mostly initiating things that would take more time – Andrew Little ‘says any expansion will not occur before a final impact evaluation. This is due to be completed next year.’

In the meantime, drug use will be in part treated as a health issue, but will remain a large criminal and prison issue until they get off their inquiry laden arses and take urgent and comprehensive action.

Jacinda Ardern has promoted her Government as progressive – it may be, but it seems to be snail’s pace progress on things she and he ministers have claimed to be in need of urgent attention. This is very disappointing.

Cannabis poll: high support for use, not for supply

The NZ Drug Foundation has just released the results of a cannabis poll, carried out from 2 July 2018 until 17 July 2018

Participants stated whether an activity should be illegal, decriminalised, or legal.

Growing and/or using cannabis for medical reasons if you have a terminal illness

  • 10% – illegal
  • 17%  – decriminalised.
  • 72%- legal

Growing and/or using cannabis for any medical reasons such as to alleviate pain

  • 13% – illegal
  • 17%  – decriminalised.
  • 70%- legal

So high support for use of cannabis for medical reasons.

Growing a small amount of cannabis for personal use

  • 38% – illegal
  • 29%  – decriminalised
  • 32%- legal

Possessing a small amount of cannabis for personal use

  • 31% – illegal
  • 32%  – decriminalised
  • 35%- legal

More wanting to keep it illegal for personal (recreational) use but still about two thirds in support for legal change.

Growing a small amount of cannabis for giving or selling to your friends

  • 69% – illegal
  • 18%  – decriminalised
  • 12%- legal

Selling cannabis from a store

  • 60% – illegal
  • 9%  – decriminalised.
  • 29%- legal

Here there is much higher support for staying illegal for ways of getting cannabis apart from growing your own.

Source: NZ Herald Cannabis issues poll

The poll was conducted by Curia Market Research

943 respondents agreed to participate out of a random selection of 15,000 phone numbers nationwide

Major review of health system

This one is called a Review but it seems to be similar to the scores of working groups and committees and inquiries set up by the Government.

A major health Review, to be chaired by Heather Simpson, senior staffer for Helen Clark when she was Prime minister and also in when working for the UN, and I think also assisting the current prime Minister’s office, will report back by January 2020.

That is unlikely to leave enough time to make any major changes prior to the election, but will likely provide for a  basis for Labour-Green campaign policy.


Major review of health system launched

Health Minister Dr David Clark has announced a wide-ranging review designed to future-proof our health and disability services.

“New Zealanders are generally well served by our health services, particularly when they are seriously unwell or injured. Overall we are living longer and healthier lives – but we also face major challenges,” says David Clark.

“The Review of the New Zealand Health and Disability Sector will be wide-ranging and firmly focused on a fairer future. It will look at the way we structure, resource and deliver health services – not just for the next few years but for decades to come.

“We need to face up to the fact that our health system does not deliver equally well for all. We know our Māori and Pacific peoples have worse health outcomes and shorter lives. That is something we simply cannot accept.

“We also need to get real about the impact of a growing and aging population, and the increase in chronic diseases like cancer and diabetes. Those issues in turn create pressure on services and the health workforce that need to be addressed for the long term sustainability of our public health service.

“The Review will include a strong focus on primary and community based care. We want to make sure people get the health care they need to stay well. Early intervention and prevention work can also help take pressure off our hospitals and specialist services.

“People rightly have high expectations of our public health service. As Health Minister I want to ensure we can meet those expectations now and into the future,” says David Clark.

The Review will be chaired by Heather Simpson, who is perhaps best known as Chief of Staff to Helen Clark from 1999-2008 but also has a background in health economics. The Review will provide an interim report by the end of July 2019 and a final report by 31 January 2020.

 

The review would culminate in a report to Government, including recommendations, on:

  • How the health system can improve accessibility and outcomes for all populations
  • Whether the health system promotes the right balance between availability of services,
    (particularly tertiary services) population density and proximity
  • Whether the current system is well-placed to deal with environmental challenges such as climate
    change, antibiotic resistance and technological advances
  • Whether there are changes that can be made to the health system that would make it fairer,
    more equitable and effective
  • How the technological and global healthcare context is evolving, what opportunities and risks
    this rapidly-evolving context presents, and whether there are changes that would support the
    health system to adapt effectively given the rapid changes underway.

In examining the points above, the review would consider the following:

  • Demographic impacts – what the predicted population changes are, their potential impacts
    upon service demand, workforce availability and risks that may need to be managed
  • The international landscape – what New Zealand might learn from examining where health
    systems are heading internationally and what the impacts are, including input from relevant
    international organisations such as the OECD, World Health Organisation and the
    Commonwealth Fund
  • Decisions around distribution of healthcare resources, capacity of the health system to deliver
    care and clinical effectiveness (quality and safety) – e.g. how does the current geographic
    distribution of services help or hinder the system as a whole
  • Funding – how financial resources applied to health funding could be altered to provide
    greater flexibility in allocation, better transparency of return on investment, better support
    innovation in service mix/design and investment in key enablers, and reduce inequities
    through targeting those in need
  • Investment practices – providing a nation-wide view of how much infrastructure will be
    needed, over what timeframe and the balance to be struck across service provision and
    delivery
  • Ways to support the increasing priority of the role primary care and prevention has within the
    wider heath service
  • Potential opportunities and risks associated with rapidly emerging technological advances and
    the implications for, including but not limited to, clinical tools and settings, communication and
    transport
  • Institutional arrangements – roles and responsibilities, funding, accountability and delivery
    arrangements.

[DRAFT] Health and Disability Review Terms of Reference.pdf