Tapu Misa on current affairs

Tapu Misa is a Herald columnist focussing on Pacific affairs

Tapu Misa: Govt foolish to sniff around school nursing for savings

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Tapu Misa writes that if healthy children turn into productive adults, where's the logic in reviewing so vital a service?

Photo / Paul Estcourt
Photo / Paul Estcourt

Think of preventive health care as the condom that most governments don't want to wear.

Prevention isn't, let's face it, sexy. It doesn't tug at the heart-strings. It lacks the drama and immediacy of, say, John Key riding in to save the day on Herceptin. And it requires the kind of farsightedness not given to many politicians.

You might say governments who can't see beyond election cycles are a lot like teenagers who can't see beyond the weekend. They live in the here and now. They want instant gratification.

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

At McAuley High School, a decile 1 Catholic girls' school in Otahuhu, the school nurse Phillipa Bennetts is an expert on teenagers and the kinds of stresses they go through. She thinks we're too quick to write them off; that we're not doing enough to support them through the rough few years that will decide how the rest of their lives will play out.

If she had her way, no one would ever get expelled or excluded. She's exactly the kind of person you'd want in your corner - caring, understanding, a bit stroppy.

Bennetts' job is nine parts prevention. Along with the Panadol and the bandages for grazed knees, she educates and counsels. For the past 10 years, she's dispensed healthcare and advice to hundreds of teenaged girls who wouldn't otherwise have access to a health service, or a non-judgmental ear. Many of them come from busy households where transport is non-existent, and their health needs come a long way behind everyone else's.

Bennetts was hired under a community-driven initiative to raise achievement levels in what came to be known as the AIMHI schools - one Wellington (Porirua) and eight predominantly brown South Auckland decile 1 high schools.

With funding from the Ministry of Education and later the district health boards, the schools were able to employ nurses, social workers and counsellors.

Last week, Health Minister Tony Ryall's office confirmed that he had commissioned a review of the $5.6 million a year spent on health services in Decile 1 and 2 schools, teen parent units and alternative schools.

This seems like a gigantic waste of money, given that much money has already been spent reviewing the school health services, and the latest evaluation, by PricewaterhouseCoopers, is only two years old. That confirmed that the services were improving health access for teenagers, and probably also improving achievement in schools. I say probably because, while achievement went up in the AIMHI schools, it's difficult to isolate exactly what contributes to a student's success.

As one teacher said, "If the students are healthier, their problems are dealt with and they are safe, they do better. It's not rocket science."

What Bennetts and her colleagues do isn't easily quantified. According to one ex-student, Bennetts is "an awesome mentor and supporter" who saw her through a difficult time in her life.

But it's clear that the need which communities in South Auckland identified 10 years ago hasn't gone away. If anything, it's become even more critical. Children do worse here than in most other OECD countries, and they do worse than other New Zealanders, particularly the elderly.

As Professor Innes Asher, head of Auckland University's Department of Paediatrics, has said, she's seeing worse disease among children and more of it than she saw 20 years ago.

Asher cites high rates of hospitalisation for pneumonia, bronchiectasis (lung damage caused by severe or repeated pneumonia), whooping cough, and rheumatic fever (which can damage heart valves).

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.

Asher notes too that 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?"

We shouldn't be penny-pinching on health spending for young people, says Bennetts.

"I and hundreds of other nurses believe in this service.

"We know it makes a difference. This is part of primary health care and it needs to be embedded in every school. The Government is talking about 'better, sooner, and more convenient healthcare'. What could be better, sooner and more convenient than school nurses?

"We need to invest in the future. If we're going to change the trajectory of health we need to do it at an early age. We need to invest in producing healthy, well functioning young people so they can leave school, get a job and function out in the world. We can lead the world in this."

Tapu.Misa@gmail.com

- NZ Herald

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