Editorial: Third World rank for health quality

New Zealanders recoil at a report from the World Health Organisation that ranks this country 41st - behind Morocco for heaven's sake - for the quality of national health systems in the organisation's 191 member states. Every year for a long while now additional hundreds of millions of dollars have been pumped into the public health system and there has not been much to show for it. But 41st?

Waiting lists have grown as fast as extra funds have been found for them, and professionals in every branch of the service say they are chronically under-resourced. But those pressures are felt in the best public health systems. Demand for healthcare is growing rapidly as populations age. Human beings can always be healthier. We demand every advance in diagnostics and drugs, and we want them "free." Finance, unfortunately, is not infinite and health authorities are obliged to ration their services. But 41st?

That's far lower than we rank now on international comparisons of per capita wealth, so we haven't an economic excuse. In any case, WHO rankings bear no relation to the proportion of national wealth spent on health. Britain, which spent 5.8 per cent of GDP, was well ahead of New Zealand at 8.2 per cent. The WHO measures services by their ability to improve the health of the population, their responsiveness to public expectations and the fairness of financial contribution.

"Fair" to the WHO means collective funding through taxes or insurance. New Zealand ranks 25th on the proportion of its health bill financed by those means, so fairness is not our major problem. Unsatisfied public expectations may count more heavily against us. The public system may be more responsive than public opinion perceives, but perceptions may be what the WHO is counting.

More likely, though, it is on the health of some sections of the population that this country is falling down the chart. We are warned often enough. Recurring illness rates in poorer areas such as South Auckland are reported with distressing frequency, and very little seems to be done. This winter, Middlemore Hospital is braced for one of its worst outbreaks of flu and respiratory diseases that tell their own tale of substandard housing, lack of heating, overcrowding and other symptoms of poverty.

Not long ago the hospital appealed for donations of warm clothing for babies and infants. The South Auckland Health Foundation finds thousands of children falling ill simply because they are too cold. Researchers repeatedly find rates of childhood diseases at Third World levels in South Auckland.

Communicable diseases such as whooping cough and bronchitis have been steadily increasing for five years, particularly in the Polynesian population. Meningitis, a deadly illness that should strike rarely and quickly abate in a country like this, has been around for nearly 10 years now and shows no sign of waning.

Poverty and, sometimes, poor parenting may be the problem. But immunisation rates in South Auckland are also well below the national average. Campaigns through hospitals and schools do not seem to reach the homes where the message is most needed. Health workers wonder whether promotion would be more effective through McDonald's. Well why not? Something different has to be done. The incidence of preventable diseases in places such as South Auckland is a national disgrace. A ranking with the Third World should bring that message home.