Thanks, Tapu

I confess that the MacDoctor was seriously thinking about chucking in this blogging lark. For the past week or so the news has been deeply uninspiring, with lackluster lists from Labour, gaggles of gays and a gormless Goff.

Nothing new there, then.

National found itself essentially nationalising another company.

Nothing new there, either.

For a party that is constant berated by Labour for its privatisation agenda, National do appear to be accumulating rather than disinvesting.

The only vaguely amusing thing is the irony of the left complaining about the right nationalising things.

The MacDoctor was about to succumb to ennui and write some sort of self-immolating epitaph for his blog when the redoubtable Ms Tapu Misa came to the rescue.

Starting with a jab at the short-sightedness of politicians bound to electoral cycles (No argument from me there, by the way) she asks the question:

“How else to explain our poor performance on child health and wellbeing?”

Unfortunately, she utterly fails to answer her otherwise excellent question. As near as I can make out, she seems to think that more school nurses will do the trick here. This would be funny, if it was not so painful. She also places the hoary old chestnut of blame on the “child poverty rate” on which she says:

“All are preventable, and all can be linked to rising rates of child poverty, which went from around 11-15 per cent in the 1980s to around double that in 1990-92. The tipping point was in 1994, three years after National slashed benefits by 21 per cent.”

I have no idea what she means by the “tipping point” in terms of child poverty. The child poverty rate was still 15% in 2010. It has fluctuated over the past 30 years, but has stayed between 10 and 20% while child health statistics have slowly deteriorated.

There is no doubt that New Zealand’s statistics on child health are very poor. In the OECD rankings we are 21/30 for infant mortality and 26/30 for injury deaths in 1-4 year olds. Of course, some of this is triggered by our high child abuse rates, rather than our health status per se. But even on the poor health front we are doing badly. We have 14 times the OECD rate of rheumatic fever, 5-10 times the rate of whooping cough and one of the lowest measles vaccination rates (82%; placing us 29/30). All of these statistic are worse than they were a decade ago. And the child poverty rate is the same. And the number of school nurses has doubled.

Clearly reducing child poverty and increasing school nurses is not likely to be a winning policy for improving child health. The MacDoctor notes in passing that the large amounts of money lavished by the previous government on welfare issues, including the provision of Working for Families, Early Start and free Childcare, have made little inroad on child health.

Of course the most glaringly obvious thing about our terrible child health statistics is that they are comprised almost entirely of Maori and Pacific Island children. Maori children, for instance, are 23 times more likely than Pakeha children to be hospitalised for rheumatic fever. Pacific Island children are a stunning 48.6 times more likely to be hospitalised for rheumatic fever. Bronchiectasis rates for hospitalisation are 4 times and 10.6 times greater, respectively.

While there is some truth to the fact that poor Maori and Pacific Island statistics are driven by the over-representation of these groups in the lower income bands, it is also obvious that there is more going on here than socio-economics. Our practice runs a comprehensive recall system to ensure that patients are reminded about vaccinations, cervical smears, diabetic checkups and routine blood tests amongst others. Maori and Pacific Islanders are vastly over-represented in our lists of non-responders, this despite our practice having fewer Maori and Pacific Islanders than most.

Almost all these services are free, so money is not a problem. There are some work and transport issues, but we are open until late and are reasonably accommodating about routine services late at night. There are no real socio-economic issues that stand as a barrier to access. One must therefore conclude that there is a distinct cultural issue here. My observation would be that both Maori and Pacific Islanders see little or no value in preventative medicine. They delay medical care unnecessarily, even when there are no barriers to care. Children under six have been seen for free for a decade and yet they are still brought in late in their illnesses. No matter how carefully you explain the importance of maintenance treatments for diabetes and asthma and the like, many will default from their medication as soon as they feel better.

It was for this reason that I was initially a supporter of Turia’s Whanau Ora, on the strength that it may address this cultural barrier to preventative healthcare. Unfortunately, the initial possibilities of the idea seem to have been swallowed up by political correctness and bureaucracy and I expect little more than another band-aid over the festering sore that is Maori health.

This is not to say that nothing can be done to improve the health of Maori and Pacific Island children. There is one particular intervention that has been demonstrated to improve children’s health unequivocally.

Parents that have jobs.

Getting people into employment and people in low-wage employment into better jobs is the best way to ensure that children are healthy. All the welfare in the world has not been shown to have the benefit of just one parent in a full-time job. That includes getting the disabled into employment suitable for them. It includes getting solo mums and dads into some form of work. Relying on government handouts does not bring life, only sickness and death.

Additional:

Professor Innes Asher, head of Auckland University’s Department of Paediatrics, has a go at youth on sickness benefits:

“There was a large increase in the number of young people receiving the sickness and invalid benefit between 2002 and 2007 (the largest increase was in the 18-19 age group). “Why was there such an increase in young people on invalid and sickness benefits? How much is due to mental and physical disease as a result of the increase in child poverty?””

To answer the second question – there was little or no increase in child poverty over the time in question so it is questionable whether any increase in sickness can be attributed to this. There was, of course a substantial increase in the amount of welfare and a marked decrease in the strictness of sickness benefit criteria over this period. This is far more likely to have been the cause of the rise in young people claiming sickness benefits, rather than a sudden massive increase in illness.

But, hey, Child Poverty sounds much better than stupid government incentives, doesn’t it?

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