The Treaty is No 1 healthgiver

Random Thought Dec 11 2000

The Health Strategy released at 3.30pm 11 December is a slender document, unburdened by hard-edged thinking but burdened with some politically soggy tendencies that may well lead to some telling attacks from ACT and National.

Nowhere is there any suggestion people might take some individual responsibility for seeing to their own good health and for the consequences of good and bad decision-making. The burden for seeing individuals’ health is squarely on the state’s shoulders. Prevention is very much the junior arm of this government’s health policy though it does make interpersonal, family, school and community violence one of its 13 “priority population health objectives”.

The strategy is heavily infused with woofterish thinking on the Treaty of Waitangi and Maori health. For example:

  • Top among the “seven fundamental principles” is not “good health and wellbeing” (No 2), nor health promotion and disease and injury prevention (No 4) but “acknowledging the special relationship between Maori and the Crown under the Treaty of Waitangi”. Apparently, under the new regime this acknowledgement is the item that will do most to improve health and health care.
  • The Treaty is defined (and this is presumably an official definition by the cabinet) as “New Zealand’s founding document. It establishes the relationship between the Crown and Maori as tangata whenua (first peoples) and requires both the Crown and Maori to act reasonably towards each other and with utmost good faith”. You will search the Treaty in vain for any clause saying this. It is made up by the same health bureaucrats who gave you article 4 (of a three-article Treaty) earlier this year.
  • On p21 you will find the “Maori priority first” item scrubbed from the just-passed Health and Disability Bill coming in through the back door. It gives as the first of “three key initiatives” for district health boards: “Ensuring the patients with the greatest need and ability to benefit are offered treatment first. This needs-based approach helps to reduce health inequalities as people from populations with the poorest health status, such as Maori, stand to gain improved access to elective services.” That sounds awfully like an instruction to give Maori first priority.
  • And on p5 you will find what looks like a purely racist statement: that “ethnicity” is one of 10 “factors that most influential health. Since “income”, “education”, “employment”, “housing” and “a sense of control over life circumstances” are also listed, “ethnicity” in this context can only mean the racial genes you inherit. ACT, if it is half-alive this week, should have real fun in Parliament with this one.

This strategy is the first in what promises to be a flood of “strategies”: on disability, primary health care (accent on “not-for-profit” primary health care organisations”), palliative care, Maori health, Pacific health and disability, health of older people, youth health, health knowledge, oral health and sexual and reproductive health. At least this will keep the bureaucrats in business, even if health status doesn’t improve and funding is slender because Michael Cullen is wrapping it up in his superannuation plan. Repeatedly, the strategy emphasises the phrase “within the money available”.

Summary of the key elements:

Seven fundamental principles must be reflected across the health sector. Any new strategies or developments must relate to them.

  • acknowledging the special relationship between Maori and the Crown under the Treaty of Waitangi
  • good health and wellbeing for all New Zealanders throughout their lives
  • an improvement in health status of those currently disadvantaged
  • timely and equitable access for all New Zealanders to a comprehensive range of health and disability services, regardless of ability to pay
  • a high-performing system in which people have confidence
  • active involvement of consumers and communities at all levels.

There are 10 goals and 61 objectives, “chosen according to a variety of criteria including, crucially, the degree to which they can improve the health status of the population and their potential for reducing health initiatives”. [Rocket science, that].

Of these, the government has highlighted 13 population health objectives for the Ministry of Health and district health boards to focus on:

  • reduce smoking
  • improve nutrition
  • reduce obesity
  • increase the level of physical activity
  • minimise harm caused by alcohol and illicit drug use to both individuals and the community
  • reduce the incidence and impact of cancer
  • reduce the incidence and impact of cardiovascular disease
  • reduce the incidence and impact of diabetes
  • improve oral health
  • reduce violence in interpersonal relationships, families, schools and communities
  • improve the health status of people with severe mental illness
  • ensure access to appropriate child health care services, including well child and family health care and immunisation.

The strategy aims to reduce inequalities by ensuring “accessible and appropriate services” for “people from lower socioeconomic groups”, Maori and Pacific peoples.

Five service delivery areas are highlighted:

  • public health
  • primary health care
  • reducing waiting times for public hospital elective services
  • improving the responsiveness of mental health services
  • accessible and appropriate services for people living in rural areas.

There are “key” quality issues:

  • “sector-wide continuous quality improvement mechanisms and initiatives”
  • individual rights
  • consultation
  • coordination
  • information management and technology
  • workforce development and technology
  • evaluation of the New Zealand health strategy.

To implement the strategy, the strategy proposes:

  • “toolkits to identify the action that different types of organisations or providers can take to address priority objectives”
  • “detailed action-oriented strategies for specific health issues, services or population groups” [code for Maori and Pacific islanders]
  • performance and funding agreements.

And they are not finished. “There will be an ongoing process to add new components”, including “further guidance to district health boards” which will “allow them more flexibility to respond to their local populations’ needs”.

In a word, this whole document reads like a palliative.