New Zealand must change its health-care priorities from the last two years of life to the womb if it is to improve its record on child health and child abuse, an inquiry has found.
More than half the Government's $14 billion health budget goes towards caring for people late in life.
The parliamentary health committee says this is contrary to widely accepted research which shows that it would make more economic and social sense to do the exact reverse by focusing on the period between pre-conception and 3 years of age.
This is one of the main findings from the committee's report, published yesterday, following an 18-month inquiry into improving child health and cutting child abuse.
Read the full report online here.
The far-reaching report sent a strong cross-party message to the Government to make changes in several areas including sexual health, maternal health, nutrition, alcohol abuse and early childhood education.
MPs on the health committee were particularly concerned about New Zealand's record on early pregnancy checks in South Auckland, and urged the Ministry of Health to introduce a new national health target of getting every woman checked within 10 weeks of conception.
They highlighted the need for mandatory sex education in schools to reduce the teenage pregnancy rate and suggested putting stark warning labels on beer and wine to discourage pregnant mothers from drinking.
Committee chairman Paul Hutchison said there was substantial debate among the group of 10 MPs - which included five National MPs - on many of the issues, but they found a consensus on all the main recommendations.
He said at the heart of the report was the need to rigorously analyse how early intervention programmes could save money and give New Zealanders longer, healthier lives.
"Everywhere health systems are under stress and strain because of increased demand, finite resources. We're saying this is indeed an area where money can be saved in the long term."
He said that changing funding priority to the first years of life would not be at the expense of care for the elderly or critically ill.
"What we're saying is, 'Do this stuff up front and people will live more quality years for longer.' We make sure we do the very best from the beginning and we will avoid a huge burden of disease."
The inquiry's first recommendation was to investigate within 12 months whether research by Nobel Prize-winning American economist James Heckman could be applied to New Zealand.
The report said: "The work of Heckman ... has built up compelling economic evidence that investment in the very early years, probably from pre-conception, will yield a significantly higher return for every dollar than delayed investment, provided the intervention is of high quality and is evidence based."
The committee said that once a New Zealand evidence base was established, the Government should move quickly to reprioritise its focus and investment towards the period between pre-conception and 3 years old.
"Intervening in the first three years, when children are at their most receptive stage of development, has been shown to have the potential to permanently alter their development trajectory and protect them against risk factors present in their daily environment."
The Government has already put some energy and money into pre-natal nutrition and care on the basis of research by the Sir Peter Gluckman-led Liggins Institute.
The health committee recommended this focus on early intervention should be extended to other sectors such as early childhood education and sexual health.
New Zealand's rates of unplanned and teen pregnancy came under special scrutiny during the inquiry.
MPs on the committee said New Zealand stood out among developed countries for its high rates of unplanned pregnancy - between 40 and 60 per cent of all pregnancies.
Mr Hutchison stressed that not all unplanned pregnancies were unwanted, but he said it did raise the question of whether parents were in good health when they conceived.
The MPs decided the record on teenage pregnancies was the result of fragmented and uneven sexual and reproductive health care and education, which required an overhaul.
"We are alarmed by New Zealand's high rate of teenage parenthood, because it is often, although not always, associated with adverse outcomes for parents and by extension their children. While we are pleased that some positive initiatives are under way, they appear to be inconsistent across the country and essentially unco-ordinated."
The committee noted that parents could choose to exclude their children from sexual education, and also found rural access to emergency contraception was limited.
Among its changes, it recommended all schools offer sex education within two years, monitored by the Education Review Office. A wider range of long-acting contraceptives should be offered free or at low cost to women in lower-income families.
The Government must respond to the inquiry within 90 days.
*Research the cost-effectiveness of early intervention programmes from pre-conception to three years within 12 months.
*Set a national health target for all women to have an antenatal assessment within the first 10 weeks of pregnancy.
*Make sexual education mandatory in all schools and increase access to long-acting contraceptives.
*Develop an action plan with NGOs and private sector for evidence-based nutrition programmes.
*Develop an action plan to combat fetal alcohol syndrome, introduce warning labels on alcohol products, and consider higher taxes on alcohol.
*Consider expansion of early childhood education services in poor areas.
*Prime Minister to take on a formal leadership role in developing a cross-agency plan for children's health.
*Invest in a nationwide oral health campaign and transfer responsibility for fluoride additives to Ministry of Health and DHBs.
*Give support to funding for research on children's health, and match it to international benchmarks.