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New Zealand’s ‘National Disgrace’: ‘One Of The Worst Places To Bring Up A Child’

David McCormack is a cardiothoracic surgeon employed at Waikato Hospital by Te Whatu Ora (Health New Zealand). He is also an Associate Chief Medical Officer and an Honorary Associate Professor of Surgery.

Surgical precision

He knows his clinical stuff. But he knows much more: He is socially aware, insightful and has a compassionate heart. This is evident from his recent post in LinkedIn (3 October):

As a cardiac surgeon – I had never treated rheumatic heart disease before coming to Aotearoa New Zealand. The grievous impact it has on young lives and whanau cannot be overstated.

It is a disease divided down racial lines in New Zealand – 93% of cases present in Pasifika and Māori children. Pasifika children are admitted to hospital for rheumatic fever 140 times more often than children of “European or other” ethnicities, while Māori children were admitted 50 times more often. On average 140 people die from rheumatic heart disease each year. Roughly 160 new cases are diagnosed a year but many cases go unreported.

Anything that can be done to remove the inequitable burden of this disease on the population is of the greatest priority.

I look forward to the day that rheumatic heart disease becomes a historic rarity on these shores.

With surgical precision McCormack has hit the nail on the head. In summary, he had to migrate to Aotearoa New Zealand to come across this extremely rare disease (in developed economies), overwhelmingly this disease disproportionately and unjustly affectsMāori and Pasifika children, many cases are unreported (unmet need), and it must become a “historic rarity”.

McCormack’s catalyst

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The catalyst for his post was a Guardian article by Eva Colette (7 August): New Zealand’s most iniquitous disease. The article describes rheumatic fever as a “deadly autoimmune disease” for which there is no cure.

“It can be painful, cause neurological effects, and can develop into irreversible rheumatic heart disease, requiring long-term drug treatment and, on occasion, heart valve surgery.”

Corlette discusses in depth the impact of the disease on “racial lines” (Māori and Pasifika) and concludes that “On many measures, New Zealand is currently one of the worst places in the developed world to be a child.”

Homegrown breakthrough research: skin infections

The Guardian article also draws upon some very interesting New Zealand breakthrough research. Rheumatic fever can be triggered by untreated strep-throat (a bacterial infection that may cause a sore, scratchy throat). But this home-grown research has discovered that it can also be triggered by untreated skin infections.

The research is reported in the highly respected international medical journal The Lancet (4 July):    Risk factors for acute rheumatic fever. The lead author for this article is prominent epidemiologist Professor Michael Baker.

Baker and his colleagues’ work is even more important because of the lack of previous published research on the risk factors behind acute rheumatic fever; an absence that has alarmed paediatricians and epidemiologists for years.

Those most likely to develop skin infections are those who live in overcrowded housing. They comprise more than 10% of Aotearoa’s population. While highly disproportionally Māori and Pasifika, many of these 10%+ also come within the European/Pakeha census classification living in similar circumstances.

Compound this impact of overcrowding with the fact that those who lack access to primary healthcare largely provided in New Zealand by general practitioners, are more likely to develop acute rheumatic fever. What a deadly combination!  

No wonder Baker describes this fever as “…most iniquitous disease probably in New Zealand.” One lesson to be taken is the need for health professionals to go all out on treating skin infections.

A ‘national disgrace’

Among many comments on David Cormack’s LinkedIn post was the following from Rob Campbell, Chair of Te Whatu Ora:

You are right David. A national disgrace. Needs all agencies and communities working together.
And remember this, people who are well off and the businesses that employ the parents on low wages, you bear responsibility too.

Like McCormack, Campbell’s post in response is very good. He’s right to describe it as a “national disgrace”. Michael Baker’s call for health professionals “…to go all out on treating skin infections” is the right call to make. Like McCormack, he is doing the responsible thing.

Where responsibilities reside

But the challenge to ending this “national disgrace” is first, addressing the severe health professional shortages in both community and hospital care. These shortages are the biggest obstacles to treating skin infections at the level required. Campbell’s responsibility is to ensure that Te Whatu Ora immediately takes the necessary steps to address these shortages.

However, as Rob Campbell correctly observes, addressing this “national disgrace” goes beyond the health system. Acute rheumatic fever is driven by social determinants of health which are external to the health system. These determinants are by far responsible for the greatest demands on the health system as well as being its biggest cost driver.

There are several social determinants of health with the most significant being low incomes. But housing is also a big factor. Recent data suggests that the Government’s heathy homes initiative has had a positive influence in reducing hospital admissions for some conditions within a relatively short period of time.

But much more has to be done in housing. Even more has to be done with incomes, including benefit levels and extending the ‘living wage’ (itself only a little over a mere $23 per hour). This is a government rather than health system responsibility. No-one else can fix it.

Ensuring that the health system has the right workforce capacity and capability to treat skin infections is the responsibility of Te Whatu Ora. It is also its responsibility for it to forcefully and persistently advocate government action on addressing social determinants of health, beginning with income and overcrowding housing.

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