The health pillar of good government

Whatever the result on September 20, John Key will start the next term with diminished personal authority. Our democracy’s health is also diminished.

Key’s inch-by-inch retreat to the point where his imagined leftwing conspiracy turned into a rightwing one and he had to sack — sorry, accept the resignation of — Judith Collins has reflected a trading-floor culture, not the disciplined executive management required of a modern prime minister.

Add to that his crass judgment — confirmed (to my astonishment at the time) at a press conference in February — in choosing to chat with the scurrilous blogger whose emails have stirred the furore.

The damage, as argued here last week, is deeper than to Key’s image or authority as Prime Minister. It is to our generally well-functioning democracy, which is what elections underpin. Some journalists’ misjudgements are also part of that democratic damage.

Our democracy is still in far better shape than that of the United States, a country Key fawns over. And Key is generally a man of goodwill and decency. If he gets a third term, he could, with guidance from his Deputy Prime Minister, retrieve his democratic authority.

But the refocusing of the election campaign on to proper ministerial process — the foundation of good government, usually taken for granted — has crowded out attention to the pillars of good government.

One pillar is science, as noted last week. Another is health.

Politicians mostly think of “health” as fixing up sickness. That was departing Health Minister Tony Ryall’s dominant focus. He heavied hospitals into doing more operations and periodically totted up and crowed about the numbers. That is fine as far as it goes. But there is growing evidence that hospitals are under serious financial and operating strain, which can’t be contained much past the election.

Ryall did also focus on getting more children immunised, which is aimed at preventing sickness, and did expand free GP visits, which helps keep sick people out of expensive hospitals.

But he removed the ban on school tuck shops selling junk and sugared food and similar drinks, which contribute to later chronic diseases, including diabetes and heart failure. He was unenthusiastic about last November’s wide-ranging unanimous select committee report on ensuring children are truly well in their first years of life. Last week’s “health” policy announcements by National aimed to speed up cancer diagnosis and fund more operations to reduce pain, plus a tiny amount for primary care.

Health is far more than fixing up sickness and crude preventions. It is wellbeing. Its ingredients reach across the whole of life. The Maori word “ora” gets closer.

National has yet to generate a ministerial prospect who has demonstrated a determination to pursue that wider perspective.

Labour gets it, mostly: Annette King’s abundant policy talks of the need to fix child poverty and to deliver “warm, dry housing, equitable and fair fiscal and social welfare policy, equitable and affordable access to health services” and “employment and safe workplaces”. King also emphasises “preventing and managing non-communicable diseases”, which experts say are the big sicknesses of the future.

The Greens’ Kevin Hague, a former hospital manager who would most likely be health minister if the government changes (King would be nominated for Speaker), has the wide perspective you would expect of a Green.

Health actually is wellbeing.

That starts, as the health select committee found, when a child is in the womb (arguably, with better behaviour by the mother before the child is conceived). Labour, through its puzzlingly undersold children policy, and the Greens get that. New Zealand First also signed up to the committee report.

Health depends on enough and nutritious food, adequate living quarters, including space to allow a degree of individuality, reasonable access to other necessities, companionship and a sense of belonging and genuine ability to participate in society. And for that there needs to be good education and an adequate income. Aspects of “justice” come in, too.

In “health” terms the economy is the servant of wellbeing.

Of course, a richer economy generates a wider and better range of supports for services that fix up or maintain physical and mental health.

But the cost of that approach to health will make its provision increasingly problematic in the next 20 years. And if the present economic structure remains, embedding very wide disparities in income and wealth, our society is likely to be more fractious and food, housing, companionship, community belonging and the ability of many to fully participate in society will remain expensively compromised.

That would keep the expensive fixit industry busy. But that is not the equivalent of wellbeing.

At his best Key does, sort of, get that when he says he wants his legacy to be what he has done for disadvantaged children. He has yet to deliver. And right now he is off-key.