Future NZ: In pursuit of healthiness

New Zealand's future health needs mean less care and more costs to individuals.

Health care - who gets it and who pays for it - will be one of the most pressing issues of the next few decades. Professor Paul McDonald says our environment - natural and built - will play a part

Today, one in eight Kiwis is over the age of 65. By 2030, that number will grow to one in four. Add to that Kiwis migrating from the country to the city at the rate of one per cent per year and it all adds up to profound effects on our future health.

As our population ages, we'll see more chronic conditions like cancer, asthma and chronic obstructive pulmonary disease, diabetes, heart disease, depression, and dementia. Population growth, the destruction of natural bush and wetlands, and climate change will mean greater contact with animals. That increases the threat of zoonotic diseases like "bird flu" (conditions that pass from animal to humans).

At the same time, humans will continue to develop conditions more resistant to treatment by antibiotics. As we've seen recently with SARS and H1N1, there will be no sanctuary as infectious threats are rapidly transported around the world and across national borders.

Let's talk money, too. The deadly combination of rapid rises in chronic, zoonotic, and antibiotic resistant diseases will cause health care costs to continue their upward spiral. History suggests that increased reliance on technology, medications, individualised clinical treatment, and narrow definitions of evidence-based health care will not be enough to stem the tide.

These are the very factors driving health care costs in the United States, Canada, Germany and the UK to unprecedented levels. As these countries' recent experiences have shown, the net effect is that health care gobbles up the money and resources needed elsewhere to keep your population educated and housed, the enviroment protected and the economy booming.

In summary, less care and more costs to individuals, at the very time many of us will be developing chronically disabling conditions, particularly among those already poor, unemployed, socially marginalised or unable to access education.

How can New Zealand ensure its future is one where more people live happy, healthy and prosperous lives; where environments are valued, and resources and opportunities are more equitably shared? It will require considerable creativity, political determination, and public support to move away from unsustainable and expensive medically-driven paradigms.

Professor Paul McDonald.

Health doesn't have to be defined as a set of medical conditions that occasionally have social consequences. Rather, it should be framed as a set of social, economic, political, cultural and environmental choices that have profound consequences for our health and health care.

Professor Paul McDonald is the Pro Vice-Chancellor of Massey University's College of Health.