Five ideas for the new Health Minister

As the rate of diabetes and other chronic diseases continues to rise, caring for one's own health is vital. Picture / Warren Buckland.

Our new Minister of Health, Dr Jonathan Coleman, has inherited a portfolio which has averaged expenditure increases of 4.2 per cent per year for the past decade. There will be pressure to continue increasing funding, offset by reductions in education, social programmes, culture, environmental protection, and public housing. This would be a mistake.

Over the next few years more Kiwis will develop chronic diseases such as diabetes, dementia and respiratory disease. The cost of caring for individuals in their last few months of life will continue to grow as long as we focus on adding years to life instead of adding life and dignity to years. It's financially unsustainable.

Left unchanged, spending increases will be driven by greater use of pharmaceuticals, diagnostic, and information technology. Technology companies will make fortunes selling computer apps to monitor behaviour in the mistaken belief that information and feedback are enough to alter complex conditions.

Pharmaceutical companies will push drugs for more people at an earlier age by inferring they reduce the risk of chronic conditions. They will point to studies showing their drugs are more effective and cost efficient than doing nothing or using another medical treatment. But they will fail to compare themselves with public health interventions.

Big Pharma, and the nations that host them, will use international trade agreements, like the Trans-Pacific Partnership, to increase their profits by dismantling Pharmac (which protects New Zealand consumers and taxpayers from even higher pharmaceutical costs). Trade agreements will be used to block public health efforts to reduce the consumption of tobacco, alcohol and unhealthy food.

Minister Coleman's former colleagues in family medicine will lobby for more primary and acute care. The National Party has already announced an intention to extend free GP visits to children under the age of 13, and extend elective surgeries. But, is this the best investment? Here are five pragmatic alternatives for dealing with future health challenges at a sustainable cost.

15 per cent of Kiwis and one in five 15-to-17-year-olds put their health at risk because of their alcohol consumption. Photo / Mark McKeown.

1. Combat poverty

Get serious about reducing poverty and increasing social connectivity. A 2013 study from Toronto, Canada found that reducing poverty and improving social cohesion were twice as likely to reduce disability and chronic disease as increasing access to health care. Making investments in low-income families by increasing after tax incomes and increasing access to affordable education, child care, housing, food and transportation will produce more health at less cost than increasing access to medical treatment, drugs, or technology.

2. Invest in public health interventions

Put more emphasis on disease prevention and health promotion. However, be aware that many preventive and screening activities delivered through primary and acute care will actually cost us more money. In contrast, public health interventions such as price regulation, advertising restrictions, and health labelling improve health while reducing health care costs.

For example, 15 per cent of Kiwis and one in five 15-to-17-year-olds put their health at risk because of their alcohol consumption. Nearly 30 per cent of women drink alcohol during pregnancy, potentially harming their growing babies. As indicated by the New Zealand Law Commission's report on alcohol, excise taxes, restrictions on advertising and health warnings are highly effective and cost efficient ways to reduce alcohol-related hazards.

3. Support healthy ageing

Let's ensure our seniors remain healthy and independent for as long as possible by increasing funding for healthy ageing.

This means rethinking the design of houses, transportation, food and recreation. It means increasing funding for assisted and long-term care to eliminate chemical restraint, boredom, and isolation. Money spent on professionally-qualified staff, nutrition, and recreation will be offset by lower drug costs and unintended medical complications.

4. Reframe end-of-life care

Let's also get serious about dignified end-of-life care. We need to make it easy and affordable for everyone to have a living will and end of life care plan. This isn't about euthanasia or assisted suicide - it's about ensuring people have a voice in the type and extent of care they receive in their last days, often when they cannot speak for themselves. We also need to do more to promote and fund hospices.

These remarkable resources help people and their loved ones to face death with dignity. Most people die in expensive hospital settings while less than 10 per cent use the community or residential resources at a hospice - and this needs to change.

5. Fund better research and training

Better-trained, innovative and competent nurses, social workers, programme evaluators and specialists in public health, environmental health, occupational health, health analytics and more will not only help manage costs, but increase our society's resilience, adaptability and productivity. Medicine isn't the only profession that can, and must, improve practice through evidence and evaluation. Research funding must come from both industry and government to ensure we put health and public interest before wealthy shareholder profits.

• Paul McDonald, Professor and Pro Vice-Chancellor of Massey University's College of Health.