Final report on Paritutu health support service
29 April 2008
Final report on Paritutu health support service released
Today, Allen and Clarke Policy and Regulatory Specialists Limited (Allen & Clarke) released its final recommendations report on a proposed health support service for residents and workers in Paritutu, New Plymouth, who were exposed to dioxin from the former Ivon Watkins-Dow agrichemical plant.
Allen & Clarke Director, Matthew Allen, thanked the many people who contributed to the report.
“Our proposal has to be based on the best evidence available” he said, “and it also has to be acceptable to those people who have been exposed. We have done our best to marry up available evidence with the needs of those people who have been exposed to dioxin.”
“Among others, we sought the views of people who may have been exposed to dioxin in Paritutu, potential health service providers, and a technical group consisting of epidemiologists, toxicologists, and public health specialists. The advice and feedback we received has helped us to strengthen the proposals for the health support service.”
Mr Allen announced that the main features of
the health service proposed by Allen & Clarke are as
*The service would have a preventive focus, aiming to promote healthy lifestyles, reduce the impact of modifiable risk factors like smoking, and support the early detection of diseases;
*The “hub” of the service would be an annual free wellness check delivered by a primary care team in a general practice setting, and supported by information and advice for service providers such as GPs and practice nurses and for service users;
*The health practitioner conducting the wellness check would have the option of referring the patient on to other services. The proposed optional services are:
o health promoting services such as advice on nutrition, physical activity and counselling and support programmes for quitting smoking and reducing alcohol use;
o enhanced access to mental health services such as counselling for stress, anxiety, depression and other mild to moderate mental health needs;
o genetic counselling; and
o serum dioxin testing under limited conditions
*A database would be established for those exposed to dioxin for the purposes of communication, administration, and service monitoring.
Recommended information approaches include detailed online information, the establishment of a technical focal point to provide advice to health practitioners on recent research on dioxin health effects, and the holding of community seminars in New Plymouth on dioxin and health-related topics.
Mr Allen said that there was limited evidence suggesting effects on the descendants of those individuals who were exposed to dioxin. Accordingly, Allen & Clarke has recommended that descendants be encouraged to access existing health services, but also that descendants be offered the opportunity to be added to a database for future contact on dioxin-related research of interest to them. Allen & Clarke has also recommended that the Ministry of Health support the provision of full antenatal screening for more subtle forms of spina bifida, as well as actively promote folate supplementation during pregnancy.
Mr Allen said that the criteria for eligibility to access the health support service were very similar to those proposed in the Allen & Clarke Preliminary Thinking document shared with the community in November 2007, with a notable exception being that the proposed “zone of eligibility” was larger.
“The evidence tells us that the spread of dioxin emissions from the then Ivon Watkins-Dow agrichemicals plant in Paritutu was concentrated in an area approximately 1,000 metres to the east and 400 metres to the south of the plant,” he said. “Having recognised that, we have however recommended that the proposed geographical area of eligibility be extended to 1,200 metres to the east and 1,200 metres to the south to build in a precautionary “buffer zone.” We did this so that the eligibility criteria were, within reason, over-inclusive rather than the opposite.”
“Those who lived or worked in the identified area for at least one year between 1962 and 1969 or at least five years between 1970 and 1987 would be eligible to access the service provided that they are also eligible for publicly funded services in New Zealand.”
“Our proposal envisages that people would access the service by first applying to an independent panel to establish their eligibility,” Mr Allen said. “After the panel confirms that the applicant is eligible, the next step would be for that person to book in for the first free wellness check.
“We have also recommended that community representation be included on a steering group charged with overseeing the implementation and evaluation of the health support service.”
Mr Allen acknowledged that some parts of Allen & Clarke’s proposals for the health support service would not necessarily please everyone.
“We looked carefully at all of the proposals put forward by the community. At the end of the day, however, some ideas, for example, the complementary therapies advanced, just weren’t supportable on the available evidence.”
“We have recommended that a watching brief be maintained on various areas of research so that the service is as responsive as possible to people’s needs and to new evidence as it becomes available.”
Allen & Clarke understands that the Ministry of Health has accepted Allen & Clarke’s recommendations and that it intends to roll the health support service out from 1 July 2008.
* People living in Paritutu have been concerned for a long time about dioxin exposure from the former Ivon Watkins Dow plant. A serum dioxin study showed that some residents have the dioxin TCDD at levels significantly above those of the general New Zealand population.
* The Ministry of Health has concluded that the dioxin levels found amongst a group of Paritutu residents may have health consequences for individuals and may cause increased rates of disease, in particular cancer, on a population basis. This means that there could be a small additional increase in cancers as a result of exposure for the most highly exposed group, but because of the nature of cancer, the exposure, and dioxin’ action as a promoter rather than an initiator of cancer, it would be impossible to determine which individual cases of cancer were actually caused by the exposure. The extent of the increased cancer mortality risk is difficult to precisely determine, but is estimated that it may be up to ten percent above the national cancer mortality rate for highly exposed Paritutu residents.
* The health support service project has involved developing and consulting on options for a health support service for residents and workers who may have been exposed to dioxin from the Ivon Watkins Dow plant in New Plymouth between 1962 and 1987, and on the provision of health information and advice to medical practitioners and other health professionals supporting exposed persons.
Allen & Clarke’s terms of reference were to research,
scope and consult on options for such a programme, including
* review existing research on health services for chemically-exposed populations
* define the criteria for accessing the proposed services
* develop and analyse options for an early intervention health support programme
* develop guidelines, recommendations and specifications for a health support programme
* develop a programme for ongoing health information and advice for health professionals
* consult with the community, Government agencies, and other stakeholders on the proposed programme
* identify resource and implementation implications
* develop a monitoring and evaluation framework
* complete a final report and implementation plan, and
* report findings to the Ministry of Health and the community.
* As part of the extensive consultation process
followed by Allen & Clarke, the following documents were
released for public consideration:
* Health support services for groups exposed to dioxin: Phase 1: Assessment of evidence and options (July 2007)
* Health support services for groups exposed to dioxin: Discussion document (July 2007)
* Health Support Services for People Exposed to Dioxin: Analysis of Submissions and preliminary thinking about the next steps (October 2007)
* For the terms of reference and questions and answers on the health support service project see www.moh.govt.nz/moh.nsf/indexmh/dioxins-healthsupportprogramme.
* For more information on Allen & Clarke see www.allenandclarke.co.nz