Isaac Davison is a NZ Herald political reporter.

Study points to diabetes as a looming health disaster

Opposition MPs argue that research indicating one New Zealander in five suffers from pre-diabetic conditions is a symptom of deeper rot in the system, and a sign that the Government's health targets are misdirected.

Labour health spokeswoman Annette King described diabetes as "a looming crisis [that] Health Minister Tony Ryall can't hide from". Photo / Supplied
Labour health spokeswoman Annette King described diabetes as "a looming crisis [that] Health Minister Tony Ryall can't hide from". Photo / Supplied

University of Otago researchers poring over blood samples uncovered a trend in adult New Zealanders that rattled health officials.

The research team, part of a special unit at the university which focused on diabetes and obesity, was investigating the prevalence of a blood disorder that preceded Type 2 diabetes. It was the first time this had been measured at a national level.

Out of 4800 New Zealanders aged over 15, nearly one in five had pre-diabetic conditions.

"I guess we thought they'd be high, but the question was how high?" said lead researcher Dr Kirsten Coppell when the findings were released in March.

She added: "It's hard to ignore the fact that we've become increasingly overweight and obese and that is definitely a risk factor for developing diabetes."

Opposition MPs went further.

"It should be an absolute flashing warning light with all of the klaxons going off that we are going to be engulfed by this wave of diabetes," said Green Party health spokesman Kevin Hague.

Labour health spokeswoman Annette King described it as "a looming crisis [that] Health Minister Tony Ryall can't hide from".

These MPs argued that the alarming findings were a symptom of deeper rot in the health system, and a sign that the National-led Government's national health targets were misdirected. They said there was too much emphasis on politically popular goals, such as elective surgery, at the expense of big-picture health problems such as obesity.

The Health Minister rejects these claims, saying that the previous Government's targets were messy and unachievable.

When National entered Government in 2008, Mr Ryall cut the national health targets from 10 to six, dropping goals for mental health, oral health, and nutrition and physical exercise.

Mr Ryall told the Herald: "Ten was too many and some of them weren't particularly relevant to what you could hold anyone accountable for. One of the health targets they had was that 70 per cent of adults would eat three vegetables a day. Well, look, how do you measure that on an ongoing basis?"

The minister said reducing obesity was too complex to fit into a neat, achievable target: "There is very little evidence on exactly what works."

At present, the ministry focuses on maternal and newborn nutrition to reduce obesity rates. Mr Ryall also boosted diabetes prevention and care funding by $8.9 million a year in this year's Budget.

But after two damning studies published this year, experts have called for healthy eating programmes to be reintroduced. One paper showed the adult obesity rate had jumped three percentage points to 29 per cent since 2005, and another indicated that the average blood pressure of New Zealanders had risen since 2002.

National kept five of Labour's targets - improved access to elective surgery, shorter waits for cancer treatment, increased immunisation, better help for smokers to quit, and more heart and diabetes checks - and added a new target of cutting emergency department waiting times.

All of the targets are being met except for the heart and diabetes checks, which the ministry is struggling to reach.

Mr Ryall said that the health service was about much more than six targets - these were just the priority areas that were of concern to the public.

He felt critics singled out elective surgery increases for criticism while ignoring other targets that focused on cancer and heart disease.

"I say to the Opposition, which one of these targets do you not think is important to patients? And they never answer that question."

He argued that other government schemes that were not covered by the targets also had important health benefits, such as the home insulation programme and KiwiSport.

But Mr Hague said that singling out targets guaranteed investment and energy flowed into them and away from other sectors. "I would maintain that this focus on elective surgery is at the expense of virtually everything else in the health sector."

A report published in February echoed Mr Hague's concern.

Health systems expert Don Matheson, from Massey University, conducted a review of Capital and Coast District Health Board. He found that the single-minded focus on reducing emergency department waiting times and meeting surgery targets had come at the expense of reducing inequalities in the health system. It had forced the DHB to spend more on hospital activity, prompting cuts to primary care.

Mr Ryall dismissed the report as "ideological" and said that if a hospital's emergency department was doing well, the whole hospital was doing well.

Critics of his targets were concerned not only about the priorities that he had chosen, but about the potential for a "tick-box" culture which put pressure on DHBs to meet the targets at all costs.

The ministry champion of the emergency department target, Mike Ardagh, said DHBs were explicitly told that compliance with the targets should not be achieved at the expense of quality of care.

He told a select committee that the ministry did not use financial sanctions such as bonuses or penalties - as employed in parts of Australia - because it could put too much pressure on DHBs and lead to "gaming" of the system.

But he noted that DHBs were placed under pressure to reach the targets in other ways, such as in the regular publication of their performance.

"There is a degree of naming and shaming with the publication of the league tables and the competitive element of that. And there's no question that the ministry and the National Health Board will interact with DHBs who they feel need to pull their socks up.

"There is that pressure to perform and that, in my view, is a two-edged sword. We need enough of it to make sure the DHBs do perform, but we don't want to push them into any encouragement to 'game' the target or comply at all costs."

So how would Labour or the Greens change the targets?

Mr Hague said he would shift investment into public health, and measure the amount of people who were appearing in hospital with conditions that shouldhave been prevented or treated in primary care.

He said his party would also emphasise cross-agency work between schooling, housing, local government and social development, ensuring that all these agencies had health goals.

Ms King said Labour would not cut the number of people getting elective surgery. The new health spokeswoman said she was still developing policy, but insisted that greater emphasis needed to be placed on mental health.

- NZ Herald

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