New Zealand Health Strategy Launch

Porirua

Thursday, June 1, 2000

Historic Day For Health

SPEECH BY THE HON. ANNETTE KING

MINISTER FOR HEALTH

I am delighted to be in Porirua today on what is an historic day for health in New Zealand. The discussion document I am releasing today on the New Zealand Health Strategy marks the first time in a decade a New Zealand government has taken a genuinely strategic approach to developing a public health system for this country.

The Government's broad proposals for changes to the health system were well understood before the last election. Even so, I know some health professionals have been dismayed at the prospect of yet another round of change in a sector that has seen more than its fair share in the past two decades.

Most health professionals I have spoken to do not share such misgivings. They know New Zealanders need a system they can trust, a system that is publicly accountable, not accountable to a so-called market model, and a system that is designed to tackle some of the alarming health disparities that exist in New Zealand.

It is important New Zealand has a nationwide Health Strategy in place. The changes in the last decade under the previous Government were dramatic in nature, but they led to fragmentation, and were carried out with no long-term strategy in mind to bring about an improvement in the state of health of New Zealanders.

The New Zealand Health Strategy has been brought together by a wide-ranging and experienced group of people in the health sector, people who are at the grass roots of health provision, who know what's going on, and who have a good feel for the direction we need to take. Their names are included in the strategy document, and I want to take this opportunity to thank them publicly for all the hard work they have done.

To my mind, every health initiative this Government is taking or plans to take will stand a far better chance of achieving optimum results if it occurs within an overall framework for health.

The New Zealand Health Strategy can be called the overarching document for the new public health service.

The NZHS will sit alongside a companion document, the New Zealand Disability Strategy, which is currently being developed, but it won't replace other existing specific health strategies, such as the Child Health Strategy, the National Mental Health Strategy and the recently-released Primary Health Care Strategy. These strategies will fall under the umbrella of the NZHS, which sets priorities, provides an overall focus for existing strategies and creates a framework for developing future strategies.

The NZHS could also be called the overarching vision, in fact, because it is not only about overall principles, goals and objectives, but it is about what we want to achieve in terms of the health of our society.

It is about what New Zealanders deserve from a public health system in terms of access, quality, and fairness across all cultural and socio-economic groups. And it is about what I am determined a public health system in New Zealand WILL deliver.

When you read the document, I hope one thing you notice about it is that it is all about health. That might seem a strange thing to say, but in the last 10 years health has too often not actually been discussed in terms of health. Hospitals have become companies, patients have become clients. There will be no more of that.

Of course, there will always be discussion about resources and money. But in future the health debate will concentrate on the best ways to use our limited resources to deliver good health to New Zealanders, regardless of where they live, regardless of their culture, regardless of their socio-economic status.

Before I talk in more detail about the NZHS, and the role you have to play in it, I want to talk briefly about why there needs to be change in philosophy in the New Zealand health system.
 We have to improve the overall health status of New Zealanders.
 We have to address the key determinants of health, such as age, gender, ethnicity, income, education and employment, housing, access to health services, and a sense of control over one's own life.
 We need to develop a comprehensive, holistic and robust approach that involves other sectors.
 We need to address disparities in health, particularly among Maori and Pacific people. Many people with higher health needs simply do not access the care they need. We have to close the gaps.
 We need to make a real and healthy difference to our society.

I mentioned earlier that the New Zealand Health Strategy discusses fundamental principles, key goals and objectives and the areas of health service delivery which demand priority action. I now want to discuss these in more detail because they form the basis of stage one of the New Zealand Health Strategy.

The NZHS identifies seven fundamental principles that should be reflected across the whole health sector, and which should influence the development of specific new strategies in the future.
The seven principles are:
1. Very good health and wellbeing for New Zealanders throughout their lives.
2. Improvement in health status for those now disadvantaged.
3. Collaborative health promotion and disease and injury prevention by all sectors.
4. Timely and equitable access for all New Zealanders to a comprehensive range of health and disability services, regardless of their ability to pay.
5. Acknowledgement of the special relationship between tangata whenua and the Crown under the Treaty of Waitangi.
6. A high-performing system in which people have confidence.
7. Active involvement of consumers and communities at all levels.

I do not believe that anyone who has the real interest of the health of New Zealanders at heart will find any difficulty with any of those principles. Of course, those who espoused the market model of the past decade may well purse their lips at the heresy of allowing communities to have a say in their own health system, but that's one heresy I'm proud to promote.

The seven principles I have mentioned underpin the NZHS, but principles count for little if no clear way is found to implement them. That is why much of the work in developing the NZHS has concentrated on key goals and objectives. From this work the Government is highlighting 12 objectives which the Ministry of Health and District Health Boards, when they are established, should focus on for most immediate action.

Many of these 12 objectives are matters I have already highlighted frequently this year, but the NZHS brings them all together to provide a clear focus for the future. The objectives, which the public can still have a say on and influence, are:

 To address the health disparities between Maori, Pacific people and other New Zealanders
 To reduce smoking
 To improve nutrition and reduce obesity
 To increase the level of physical activity
 To reduce the rate of suicides and suicide attempts
 To minimise the harm caused by alcohol, illicit and other drug use to both individuals and the community
 To reduce the incidence and impact of cancer
 To reduce the incidence and impact of cardiovascular disease
 To improve oral health
 To reduce violence in interpersonal relationships, families, schools and communities
 To ensure appropriate child health care and immunisation services.

Developing the key goals and objectives was no easy matter. The process began by addressing society-wide issues, such as employment, housing and income status. The next step was to assess the immediate environment in which people live and the potential for effecting health improvement within this environment. It was also necessary to consider lifestyle behaviours and specific diseases.

The 12 objectives highlighted for immediate attention will be adopted across the whole country, and they will all be reflected in the accountability arrangements I have with District Health Boards.

There will be other local objectives as well, and DHBs will be expected to determine which other objectives or targets are most appropriate to the needs of their own populations, and will do this in consultation with their local communities.

The New Zealand Health Strategy also defines the six service priority areas the Government wishes the health sector to concentrate upon in the short to medium term. Given the Government's policy, these six service areas should come as no surprise. They are:

1. Public health
2. Primary health care
3. Reducing waiting times for public hospital elective services
4. Improving the responsiveness of mental health services
5. Maori advancement in health
6. Improving the health of Pacific people

All six areas are vital in terms of improving the health of New Zealanders, but today I just want to address the last two in a little more detail.

Improvements in Maori health status are critical, given that Maori on average have the poorest health status of any group in New Zealand. Health inequalities that impact negatively on Maori must be reduced and eventually eliminated.

Working toward closing the gaps will involve government departments and agencies working co-operatively across sectors, and it will heavily involve communities working together.

I can say now, however, that short to medium-term objectives for closing the gaps for Maori will include: Rangatahi health, disability support services and alcohol and drug services, improving the quality and effectiveness of health promotion and education programmes targeted at Maori, forming effective partnerships at all levels under the Treaty, increasing Maori participation at all levels of the public health sector, improved mental health services and increasing the number of Maori in the health workforce.

Maori health gain priority areas will remain immunisation, hearing, smoking cessation, diabetes, asthma, mental health, oral health and injury prevention.

The specific aims for Pacific peoples are to strengthen Pacific primary health initiatives, improve the health of Pacific children, improve mental health services for Pacific people, enhance screening programmes to improve their health, and also to increase the number of Pacific people in the health workforce.

This discussion document being released today reflects Stage 1 of the New Zealand Health Strategy. Stage 2 will reflect the more established nature of District Health Boards which will have developed close community links and links across the sectors affecting health and the need to Close the Gaps. Stage 2 will add new components to the NZHS, and will allow DHBs to respond more flexibly to the needs of their local populations.

I want to emphasise that this document is a discussion document. Much careful work has gone into its preparation, and I am pleased it reflects the way this Government wants the public health system to develop. The document can be made even better with your participation, however. A large number of public meetings, hui and fono have been organised to explain the document around the country and to obtain feedback. The first one is actually being held today. Formal feedback can also be sent to the Ministry, and I expect I will also receive much feedback, formal and informal.

That is the way it should be. The New Zealand Health Strategy is too important for our future not to encourage the widest debate. Thank you very much for coming here today.

ENDS

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