Health services in cloud cuckoo land
Did you notice in the summaries this newspaper ran last week of the latest report on the state of the nation's health that almost everything and everybody was blamed for it - except the health services themselves?
The 444-page quinquennial report carries the impressive title Our Health, Our Future - Hauora Pakari, Koiora Roa: The Health of New Zealanders 1999 and is put out by the Ministry of Health.
And guess what it tells us? That 70 per cent of deaths in this country in a year are "avoidable." Which, if I understand English rightly, means that thousands of New Zealanders die each year who should not have.
The section of the report that fascinates me is the one that tells us how we (not the health services, but us) can save thousands of our own lives a year.
It assumes that major health gains (whatever they might be) are possible if people will change their lifestyles. Many thousands of lives, it says, could be saved each year if people gave up bad habits.
Naturally, since the health professions have been obsessed with it for decades, smoking comes top of the list and it is suggested that if no one smoked, 4300 lives a year would be saved. What the report doesn't tell us is the extent to which anti-smoking campaigns have lowered the death rate from so-called smoking-related diseases.
Surely in recent decades, in which thousands of us have quit smoking, there should have been a huge reduction in deaths from that cause. Has there been? If so, why has it not been trumpeted? If not, why have we not been told that the campaign has been a fizzer?
Surprisingly, alcohol gets a mention, although, unsurprisingly, the reference is preceded by the comment that it has some protective effects against heart disease. Its overall effects are, however, seen as negative, costing the population about 4000 years of life in 1996-97. Just what that means I'm not sure, but it certainly sounds impressive.
What I do know is that a noted physician once told me that one in every five beds in hospitals in New Zealand was occupied at any given time by a person whose main reason for being there was drinking too much booze.
I reckon that alcohol causes at least as many deaths as smoking is said to, and wonder why we don't have a concerted campaign to get people to give up drinking (not drink in moderation, but give up altogether) and why we haven't got great big warnings plastered on booze bottles saying: "Alcohol Kills."
The report tells us that diet is a big problem and if all of us ate at least five helpings of fruit and vegetables each day, 800 lives a year would be saved; and that if everyone took a minimum of 2.5 hours a week of moderate exercise, another 2000 a year would live.
Well, I've got news for Dr Karen Poutasi and her Ministry of Health. If they intend to predicate health policy on people changing their lifestyles, they're wasting their time and the Government's money.
Because we are all afflicted by two fundamental human beliefs - "I'm different" and "It can't happen to me" - we will not change our habits simply because someone says we should.
I, for instance, will continue to smoke because my father smoked unfiltered cigarettes all his life and died at 93; I will not under any circumstances eat five helpings of fruit a vegetables a day; and you won't find me doing two and a half hours of even moderate exercise a week unless I have to mow the lawns and vacuum the pool in the same week, as well as spend an hour fast-walking.
What I, and I suspect most New Zealanders, want from our health service is for it to be there if and when we need it, irrespective of whether our need arises from our bad habits. And in that regard I consider those doctors who refuse to admit patients who smoke to certain hospitals as being in breach of the Hippocratic Oath.
I have no argument with preventive medicine. ("Preventative," incidentally, is a noun, a synonym for a prophylactic device, usually a condom.) But if health planning is to be based on the assumption that the populace at large will respond favourably, health professionals are living in cloud cuckoo land.
* garth_george@herald.co.nz
<i>Dialogue:</i>Garth George
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