Working Together to Improve the Health of NZers
Hon. Steve Maharey
24 July 2000 Speech Notes
Making the Links – Working Together to Improve the Health of New Zealanders
Address to the Public Health Association 2000 conference, People in Public Health. Centennial Convention Centre, Palmerston North.
Thank you for the invitation to address the conference this evening. As a local MP can I also take this opportunity to welcome you to the Knowledge City of Palmerston North and the sunny Manawatu.
I was pleased to be asked to speak to your conference because I see my role as Social Services and Employment Minister, and indeed as an associate minister of education, as working on the underlying factors that shape the health status of New Zealanders.
I know that you will be hearing from my colleague Health Minister Annette King later in the week – so I won't attempt to steal her thunder by focusing my comments within the health services.
Instead I would like to speak on how the new Government sees the interconnections between my portfolios – the social services, skills development and the labour market – and health status.
Social and economic determinants of health
After ten years in the wilderness we finally have a Government which recognises that health status cannot be separated from the other realities of people's lives.
Poverty, unemployment, poor housing, educational failure and poor health are inextricably linked.
I know that this was a difficult message to sell to the last Government. Of course they had reason not to want to hear it.
But almost every health professional knows families who crowded together to cope with high State house rentals; whose children were always sick and missing school because of the damp conditions and lack of heating; while chronically unemployed parents became more and more depressed and despondent.
And children who witness deprivation during childhood, with attendant shifts to avoid landlords and bailiffs, are less likely to do well in school, locking them into a cycle of low income and poor health. It is no wonder that children loose hope while our youth suicide statistics climb.
A narrow focus on treating the manifestations of poor living standards and unequal income distribution, without addressing the underlying causes, is futile.
The new Government was elected because New Zealanders wanted a rebalancing in our society.
In essence I am saying that times have changed.
The new Government accepts unreservedly that an effective health policy is one that addresses the causes of ill health.
We understand that decent housing, a job and a future will often do more for a persons health and wellbeing than anything else. And wellbeing must be our focus.
In Labour's pre-election health policy, Focus on Patients, this was expressed clearly in our health vision:
Labour’s vision is to see all New
Zealanders enabled to live the full course of their natural
lives as free from illness and disability as possible. To
achieve that Labour in government will be committed to
tackling the causes of ill health; like poverty, poor
housing, unemployment, low levels of education and unhealthy
environments. We will approach health holistically and not
just as a matter of treating sickness.
Focus on Patients – Labour on Health, October 1999, p. 5.
Our vision was informed by many public health experts, many of whom I'm sure are in the audience today so I won’t embarrass them by naming names. I would like to refer to a couple of recent documents however.
The first is the excellent 1998 Social, Economic and Cultural Determinants of Health background paper prepared for the National Health Committee. It makes the key observation that 'good health is one of the factors which enables people to participate fully in society, so it is vital for the functioning of a democratic state to minimise ill health' (p. 4).
The second document is the briefing paper prepared for me as an incoming Minister by the Ministry of Social Policy. It paints an unhappy picture of the society we live in and clearly articulates the case for a coordinated programme of investment in the future of all New Zealanders.
As a new Government we have heard the call and we are responding.
The government made a commitment in the Speech from the Throne to promote policies to improve the economic and social wellbeing of all New Zealanders, which reduce inequality and which are environmentally sustainable.
Annette King has recently published a discussion document towards the development of a New Zealand Health Strategy on which public submissions close at the end of the week.
We want the New Zealand Health Strategy to provide a comprehensive framework to deal with New Zealand's health problems.
That means it will have to connect with all aspects relating to health, including housing, social services, education, poverty, unemployment, the environment and a more strategically planned and integrated economic policy.
The broad scope of these interlinking strategies recognises the broad range of factors which have an influence on health. We cannot allow policy in areas such as housing, social services, employment and the economy to continue to be developed without due consideration to how the policy might impact on health.
We aim to put that right by developing more cohesive policies across the relevant sectors, and considering the impact of social policy proposals on public health.
In June the Government delivered its first Budget.
You will recognise in the goals we set for the Budget a desire to tackle social exclusion.
The goals were
develop an innovative economy which creates jobs and provides opportunities for all New Zealanders;
foster education and skills;
close the gaps that now divide our society;
restore trust in government and to promote a strong public service;
treasure and nurture our environment; and,
celebrate our identity as a people who defend freedom and fairness, enjoy arts, music, movement and sport, value our cultural heritage and who are committed to the Treaty of Waitangi.
So did we deliver on our goals and will health outcomes be improved by the package. The answer has to be yes to both questions.
Let's take a quick gallop through some of initiatives:
Income related rents will be introduced from 1 December 2000. More than 40,000 of our poorest households will get increased assistance averaging around $40 a week.
The Government restored the 65 percent wage relativity for New Zealand Superannuation from 1 July 2000.
Education and skills
New funding has been invested in our education system from pre-school all the way through to post-school vocational and tertiary education.
Opportunities for jobs have been created with the funding of three major employment programmes and a refocussing of the Department of Work and Income to give greater attention to its employment role.
Closing the gaps
It is in all our that we move to close the gaps that have opened up between Maori and Pacific peoples, and other New Zealanders. Significant new funding was provided in the Budget to give Maori and Pacific communities the capability to devise their own economic and social programmes.
Improving the evaluation capacity of Government
I want to talk briefly about the ability of Government to evaluate the success of its own programmes.
I don't think that programme evaluation is as central to the policy process as it should be.
My sense is that we have a capacity and a capability problem, but I also sense that the professional culture and the political culture have not been conducive to the development and sustenance of an evaluation culture.
This is especially concerning when you consider that as a Government we have indicated a strong desire to shift the focus of public policy from outputs to outcomes.
There are implications for the accountability regime within the public sector. It is relatively straight-forward to design a contract for the delivery of outputs. It is altogether different when one is contracting for outcomes, particularly given lags between outputs and outcomes.
It is easy enough to purchase places on a vocational education and training programme for at risk youth. One training place = one output.
But what is the preferred outcome - further education and training, a job?
Over what time-period should we be measuring outcomes - 3 weeks or 12 months?
Recently the Department of Work and Income, the Department of Labour through the Labour Market Policy Group and the Ministry of Social Policy sponsored a forum on assessing the impact of government-funded employment and welfare interventions which I opened.
Increasing interest and emphasis in New Zealand on determining the outcomes of government programmes has begun to generate considerable debate both within and between government agencies on the most appropriate methodologies to determine the impact of Government programmes.
As professionals working in the broader health sector I know that you will appreciate the importance of evaluation. Both for determining the success of particular programmes and also for building constituencies of support for tackling social exclusion.
Public involvement in the public policy process
Can I conclude by acknowledging the work of all those associated with the Public Heath Association.
Yours is an Association which works in a critical area of Government policy and I commend you for the way in which you seek to engage in the public policy process.
This Government wants to see a much greater involvement by all New Zealanders in our political life – and that's political with a capital and a little 'p'.
We hold strongly to the principle of subsidiarity. That is we recognises that society consists of a range of groups, communities, organisations and spheres, and that each of these has a valid and important role to play in the society as a whole and in fulfilling its members needs and interests.
The Government is committed to greater devolution and decentralisation. We want to foster active partnerships with the community and voluntary sector, with local government and with the business community.
In opposition we noted with concern the steady decline of the relationship between Government and civil society.
Unthinking adherence to a rigid contracting model, centralised needs identification and programme specification, and an unwillingness to acknowledge the independence of sector groups over the last decade–led to an almost complete breakdown of the relationship.
Fundamentally, the last government failed to recognise the character of the community and voluntary sector.
I am the first Minister in New Zealand to hold the portfolio responsibility for the Community and Voluntary Sector and it is very challenging and enjoyable role.
Soon I will be announcing the membership of a joint government / community sector working group to develop proposals to strengthen the relationship.
I have already appointed former Waitakere City Deputy Mayor Dorothy Wilson to chair the group.
The desire of the community and voluntary sector to take an active role in rebuilding the relationship is witnessed by the fact that over 300 people have applied to take up the seven community voluntary sector places on the group.
There are of course many health organisations within the community and voluntary sector and I expect that the process of developing the agreement is one that you will want to keep abreast of.
In the meantime can I simply thank you for being in on the ground and taking the time to make your views known to the new Government.
I met with representatives from your organisation several months ago and I was impressed by the cogency of your arguments and the degree to which they accorded with our own. This Government will continue to listen to you and invites you to join with us in partnership to fulfil your manifesto, while we fulfil our own.
Thank you for listening.