Health Cuts?

If you were wondering why Labour spent so much extra money on Health without actually improving the health of New Zealanders, nor their access to services, puzzle no longer. Ruth Dyson reveals all. She is complaining that some of the health promotions that were dear to Labour’s heart have been cut or seriously curtained. Things like cancer “control”, heart promotions and the diabetes “get checked” programme. Nothing wrong with complaining about that, of course. She is entitled to her opinion on their usefulness. But she opens her mouth and reveals Labour’s blind spot:

“Labour health spokeswoman Ruth Dyson said the Government had broken its promise to cut backroom services in favour of the front line.

““These are all frontline services. Preventing patients from being ravaged by these diseases should be a priority.””

No, Ruth, these are NOT frontline services. They never were and they never will be. These are all Labour’s attempts at preventative health promotion and, as such, provide no health service at all. This is not to say that preventative health is necessarily useless, just that they are not frontline services. They are not delivering medicine, they are delivering social change. At least, they might be delivering this.

The biggest problem with all of these preventative health schemes is that no one appears to have bothered to examine whether they are making any difference. Labour’s attempt to monitor results of these campaigns (now removed from the health reporting list by National) were so wishy-washy and soft, that it was impossible to tell from the data whether they were successful. That does not seem like a good use of taxpayer dollars to me.

Take the diabetes programme “get checked”, for example. This programme, unlike most, actually has links to hard data like blood results, blood pressure readings and hospital admission rates for diabetes and diabetic complications. All the hard evidence shows that the programme has made virtually no difference to the quality of diabetic control.

Here’s why:

Diabetics who normally don’t attend their regular check-ups don’t abscond because they can’t afford it, they don’t come in because they can’t be bothered. Diabetes is one of those diseases that kill you slowly, like high blood pressure (only worse). People don’t like to see the doctor unless they are sick. So they don’t. All that “get checked” does is make it cheaper for the people who would have regularly attended their doctors for diabetic monitoring. It is a subsidy for diabetics. Nothing more, nothing less.

There is nothing wrong with this. It is just not something you want to fund at the expense of real frontline services like outpatient visits and elective surgery.

Labour’s singular failure in health is their constant focus on what would be nice at the expense of focussing on what is truly needed. Nobody is saying that heart prevention programmes are invariably a waste of time. We may demonstrate that they may be very useful indeed at reducing long-term heart disease. But it is not right that a dozen people should die because they can’t get heart surgery in time in order to fund a social intervention. Particularly one that does not have demonstrable benefits.

There is a school of thought (to which I subscribe) that says that changes in the health status of population groups are nothing to do with health services or even preventative programmes (with the possible exception of some vaccination programmes). The health status of a population is determined almost entirely by it’s economic well-being and by the current mores and habits of society. The latter appears to be highly resistant to social change programmes and responds only with generational change. For instance, if you want to stop smoking, target only the young and, to ensure smoking is not perceived as “cool”, do it subtly with negative characters in books and children’s shows, not by banning or “shock” adverts (what little boy is not fascinated by revolting pictures of lungs in smoking adverts?). Targeting teenagers is way too late. Targeting adults is a total waste of time.

Health services are vital for individual health but are very poor at health in population groups. The focus of health services should therefore be on individual health, rather than on “prevention”. This is not to say that doctors and nurses cannot have a health prevention message, but that the health services main priority should always be illness. That is what we are trained for. If you want to keep people well, talk to the gymnasiums and the sports people, chat to the food industries. Ban television.

Just don’t waste health dollars.

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