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This month’s edition of Healthcare Review – OnlineTM is the first in a two-part series examining public health in New Zealand and Australia.
Public health in its fullest sense incorporates the range of activities related to health promotion, health protection and disease prevention.
Internationally, the emphasis has been on disease prevention, which aims to eliminate health problems and to optimise the well-being of individuals and the community, rather than on health promotion.
Disease prevention serves a community well when morbidity is high across society and interventions at the community level achieve significant reductions in mortality and morbidity. It is less effective when the major controllable determinants of disease have been addressed. Such a situation requires changes in individual health-related behaviour and individual clinical interventions to achieve comparable progress. These aims apply in health promotion.
Health promotion has been described as offering ’the promise of a quantum leap in improving the health status of the community by participating in behaviour perceived as not only responsible but appropriate and desirable, providing positive reinforcement rather than anxiety-provoking caution’. 1
In the 1990s, successive ministers of health in New Zealand have emphasised the importance of public health, improved health status, action on health and independence and an increased emphasis on population health approaches.
Dr Gillian Durham, Director of Public Health and Deputy Director-General, Safety and Regulation, New Zealand Ministry of Health, considers how this political commitment has been translated into a policy framework for public health in New Zealand.
Durham outlines factors affecting the effective implementation of this framework, such as co-operative working relationships and workforce development issues.
In a comparison of the New Zealand public health policy framework with that of Australia, Durham notes the broadly similar strategic approach to public health and emphasis on development of the infrastructure in both countries. However, she highlights a more rigorous application of priorities at a national level and a more systematic approach to public health workforce development in Australia, and a greater emphasis on intersectoral co-ordination in New Zealand, which is required to facilitate comprehensive approaches to public health.
Paul Stephenson, Manager Public Health Protection, Auckland Healthcare, summarises what he sees as the challenges for public health providers in New Zealand. He proposes that the core competencies in public health are health surveillance, applied epidemiology, applied health risk analysis and management, public communication and programme management.
In his paper he defines each of these core competencies and outlines their contribution to public health. In his view, these public health competencies must be first nurtured and grown within public health and then transplanted into the wider health sector where they will have broad ranging positive effects on the ability of the sector to contribute to health gain. However, he highlights the issue that New Zealand has with lack of critical mass in relation to issues of technical expertise and notes that this issue firmly applies in public health.
A process of consolidation or the development of virtual teams would support expansion of the required unique skill sets, as would support from Ministry of Health, allowing the public health competencies to become the new common language and base note for sector development.
Dr Sven Hansen, Director of E-Health Ltd, an organisation promoting corporate health and wellness programmes, and a Director of Auckland Healthcare, focusses on preventive medicine in his paper.
Despite widespread talk among medical opinion leaders in New Zealand about preventive medicine as a solution in health, its implementation has failed according to Hansen. He notes barriers to an increased focus on preventive medicine, in particular funding issues. Current funding streams recognise and reward acute care, and clinical skills, technology and facilities will gravitate to activities and procedures that are funded. In Hansen’s view, Government and insurers need to align and focus funding mechanisms such that they enable the development of effective preventive efforts.
Hansen describes prevention as a central discipline within medicine. Preventive medicine should inform all branches of medical practice and all streams of funding. On a positive note, the marked growth of research and high quality evidence for prevention means that evidence for preventive medicine is beginning to reach the educated public and to be applied.
Hansen highlights the fragmented nature of efforts toward disease prevention in New Zealand. He sees a healthy dialogue between providers and funders of health services that crystallises definitions, philosophy, principles and processes in preventive medicine as an essential first step towards preventive medicine and, within his paper, begins this dialogue.
A subsequent edition on public health and disease prevention will expand on the coverage in the current edition with respect to public health policy outside New Zealand.
Complementing the paper in this edition from Dr Gillian Durham, which considers public health policy in New Zealand, Professor Don Nutbeam, Professor of Public Health, and Director, Australian Centre for Health Promotion, will provide an Australian perspective on the role of policy in health promotion.
A paper from Professor Alaistair Woodward, Professor of Public Health and Dr Tony Blakeley, Registrar Public Health at Wellington Medical School, will focus on areas of differences in regulation between New Zealand and other countries and will also consider regulation in other areas that impact on health including occupational health, environmental health, housing policy, etc.
Val Orchard, Science and Research Manager at the Institute of Environmental Science and Research Limited (ESR), will expand the discussion begun by Woodward and Blakeley, considering in more detail the role of environmental health issues in disease prevention and health promotion.
Finally, Dr Nick Jones Medical Director, Public Health Protection, Auckland Healthcare, will offer a slightly different focus, considering the role of public health surveillance in disease management and health promotion.
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