Saturday, 27 April 2013

Where to from here?

This blog is where I get talk about what I would like to see happen in the public health system and how I think we could get everyone using doctors, hospitals and other health services provided by the government.

I acknowledge that the current system is not working, mainly because those that need health care the most are not in a position to get it.  However, in saying that, here in New Zealand we are in a better position than some other countries, like the USA.  In New Zealand we have a public health system that tax payer’s pay for, that everyone has access to.  In New Zealand we have the choice about using a private health system, which may or may not be a better system. I personally, am happy to use the public health system and to not pay for my health care, because I feel that I would be wasting my money.

The New Zealand system is still not ideal and there is a long way to go before everyone gets the health care they need and deserve.  Why are there people who are not able to access the health system our government provides for us? There are many reasons, some are:
  •  Access, physical accessibility, transport for example, or lack thereof.
  • Cost, being unable to afford to go to the doctors, even if you are enrolled in a PHO (primary health organisation) there is still a charge to see the GP.
  •   Ethnicity, people of certain ethnic backgrounds are over represented in the statistics for not accessing public health, I cannot say why in this blog, as it is a very complex issue in itself.
  •  Age, statics show that the elderly are, again, over represented in not accessing public health.

(Carroll, Casswell, Huakau, Howden-Chapman & Perry, 2011, Expert Advisory Group, 2012, Woodward & Kawachi, 2000)

I am putting this link to the TED talk by Rebecca Onie (2012), because I feel what she suggests in her talk about how to improve the health care system are ideas that are achievable and would work in a country like New Zealand, due to the Maori holistic theory and perceptions of health care (Ministry of Health, 2012).

One thing I would like to see in the future is partnerships between primary health care services and early childhood centres.  At the moment there are very little in the way of this kind of partnership.  Currently, the public health nurse come to centres to test children’s hearing and vision and some centres have Plunket come in to do the Well Child checks on children who attend the centre.  I feel that this is not enough and teachers and health care providers need to work together more. However, in discussions with peers there are many ethical issues around these possible partnerships which may be holding back this theory.  

The children’s commissioner (2012) has a vision, ensuring that children are at the centre of policies that affect them the most, for example ensuing that all children have “equitable access to health care” (Expert Advisory Group, 2012, p. 29).  The Expert Advisory Group on Solutions to Child Poverty paper (2012) has eight recommendations that I agree with, including making GP visits free 24/7 to all children under the age of 6 (Expert Advisory Group, 2012) and ensuring that all health providers communicate with each other to ensure children do not fall through the gaps in the system. I feel that if the New Zealand government is serious about child health and access to public health they will take seriously the recommendations made by the Advisory Group and will implement policies to ensure that our children’s health is a priority. 

A final thought, I have not had the scope in this blog to write about everything I would like to write about.  I therefore, acknowledge that they may be gaps in my blog.  I am aware of these gaps, but I am unable to cover all I wanted to cover due to word count constrictions.

References:

Carroll, P., Casswell, S., Huakua, J., Howden-Chapman, P., & Perry, P. (2011). The widening
            gap: Perceptions of poverty and income inequalities and implications for health and
social outcomes. Social Policy Journal of New Zealand: Te Puna Whakaaro.
Retrieved from
Children’s Commission (2012). Solutions to child poverty in New Zealand evidence for
action. Retrieved From
Woodward, A., & Kawachi, I. (2000) Why reduce health inequalities? Journal of
            Epidemiology and Community Health. 54(12) 923-929. Retrieved from
http://www.scopus.com/record/display.url?eid=2-s2.0-0033738620&origin=resultslist&sort=plf-f&src=s&st1=%28why+do+populations+not+access+public+health%29&nlo=&nlr=&nls=&sid=56D66B52518098B704185098AD7D8499.Vdktg6RVtMfaQJ4pNTCQ%3a110&sot=b&sdt=cl&cluster=scoaffilctry%2c%22New+Zealand%22%2ct&sl=60&s=TITLE-ABS-KEY%28%28why+do+populations+not+access+public+health%29%29&relpos=0&relpos=0&searchTerm=TITLE-ABS-KEY%28%28why+do+populations+not+access+public+health%29%29+AND+%28+LIMIT-TO%28AFFILCOUNTRY%2C%5C%26quot%3BNew+Zealand%5C%26quot%3B+%29+%29+#

Wednesday, 17 April 2013

Current Child Health Policies and Services in New Zealand

This blog will focus on what child health policies governments have put in place to encourage families of all incomes to use the public health system for the benefit of their children.

Current child health policies and services available to all families and children in New Zealand:
Plunket checks, once your baby is six weeks old a Plunket nurse will take over health visits from your midwife or lead maternity carer (LMC) (Ministry of Health, 2013; Pollock, 2012). This means that a Plunket nurse will come to your home and provide you with general health advice and support while doing general health checks on your baby, encompassing the Well Child checks and book (kidshealth.org.nz, 2012; Ministry of Health, 2013; Plunket, n.d.; wellchild.org.nz, 2011). The Well Child books used to be called “Plunket” books, before 1996 (Ministry of Health, 1996; Patterson, n.d.).



Well Child checks were introduced in 1996, as a way to improve and centralise child health (Ministry of Health, 1996). These Well Child checks can be done by a health provider of your choice, many people use the local Plunket nurse, but you are able to use any health provider you feel comfortable with, a GP, Māori or Pacific health provider or Public Health Nurse.  The Well Child checks are for children up to the age of 5 (kidshealth.org.nz, 2012; Ministry of Health, 2013; wellchild.org.nz, 2011).




B4 school checks, introduced in 2008, as a part of the Well Child checks, are assessments that are undertaken by early childhood centres, nurses and parents to help assess how ready a four year old child is for school and if there are any developmental issues that may need to be looked at in greater depth before the child starts school. The B4 school check is not compulsory however, getting a B4 school check done before increases the likelihood of any physical, social, behavioural and health issues being picked up (kidshealth.org.nz, 2012; Ministry of Health, 2013; Neale, 2012; wellchild.org.nz, 2011). If there are any issues you are able to deal with them before they impact on your child’s learning at school. 


All of the above services are free to all New Zealand children.


Free Doctors’ visit for under 6’s is a policy brought in by Labour in 2008, however there was a $32.50 subsidy introduced in 1997 that was widely known as “free under sixes policy” (Hodgson, 2007, para. 13).  Nevertheless, doctors were still able to charge patients for consultations so, visits to the doctor may not have been free for all.   The Labour government wanted all children to be able to access their GP’s readily. Hodgson (2007) stated “we don’t want parents thinking twice about taking their young children to the doctors because of how much it costs” (para. 3).  This policy has not been entirely successful though, in 2010 only 78% of doctors were providing free visits to under 6’s (Fancourt, Turner, Asher, & Dowell, 2010).   Also, even though doctors’ visits are free for under 6’s this applies, mostly, during business hours. Unfortunately, children do not only get sick between 9 and 5 and the cost of after-hours medical care is too expensive for many families (Fancourt, Turner, Asher, & Dowell, 2010; Hill, 2013).   “The goal of universal free care remains unmet, particularly for after-hours care, and maybe contributing to poor child health statistics in New Zealand” (Fancourt, Turner, Asher, & Dowell, 2010, p. 339 ). The National Party’s 2011 policy states that “National will extend free afterhours care for children under six, roll out a comprehensive afterhours telephone health advice service with access to nurses, GPs, and pharmacists”, however, I am yet to find any evidence to confirm that this policy has been implemented.   

My next blog will look at where to from here and possible partnerships between early childhood settings and health providers.

References:
Fancourt, N., Turner, N., Asher, M. I., & Dowell, T. (2010). Primary health care funding for
            children under six years of age in New Zealand: Why is this so hard? Journal of
            Primary Health Care, 2(4), 338-342. Retrieved from
Hill, M. (2013, February 17). Free healthcare? Yeah right. The Press. Retrieved from
Hodgson, P. (2007). More support for free doc visits for under-6’s. Retrieved from
            http://www.beehive.govt.nz/node/30431.
Kidshealth.org.nz. (2012). Well child/tamariki ora services for under fives. Retrieved from
Ministry of Health. (1997). Well child/Tamariki ora. National schedule. Wellington, New
            Zealand: Author.
Ministry of Health. (2013). Well Child/Tamariki Ora. Retrieved from
Neal, I. (2012, June 24). Ministry ‘hides test’s real purpose’. Retrieved from
New Zealand National Party. (2011). Policy 2011. Health: Primary Care. Retrieved from
Patterson, K. (n.d.). Plunket nurse. Retrieved from
Plunket. (n.d.). Plunket. Retrieved from http://www.plunket.org.nz/.
Pollock, K. (2012). Story: Child and youth health: Page 6 – Primary health initiatives. Te
            Ara: The encyclopaedia of New Zealand. Retrieved from
Wellchild.org.nz. (2011). Well child/tamariki ora. Retrieved from
            http://www.wellchild.org.nz/2/.

Wednesday, 10 April 2013

Inequalities in incomes and health

This blog is going to focus on the second question I asked in my first blog, how does the payment of health affect access to health services for people on low incomes?

In my research about the public health system I have come across some interesting statistics that I want to share with you and these statistics will help answer my question.

OECD and WHO statistics show us that the bigger the income differences in a society the bigger the difference between society’s health (Denton, 2003; OECD, 2011; Peacock, Devlin, McGee, 1999; Wilkinson, 2011). For example, in New Zealand the gap between rich and poor is large and the corresponding statistics on the health of the population is similarly large.



On the flip side of these statistics are countries, such as Sweden and Japan, who have smaller gaps between the rich and poor and as a result the differences in the health of the population are a lot less noticeable (OECD, 2011; Wilkinson, 2011).

When I first saw this graph on a TED talk by Richard Wilkinson (2011) I was stunned, New Zealand is fifth on the graph of countries whose health is worse because of the income inequities.  This was a real surprise for me.  Considering that we have a public health system that is, in theory, available to all, how can we possibly be in such a negative position in the statistics.

Why are there links between the differences in incomes and the differences in the health of the population? What causes health inequalities?

These are not simple questions to answer; it is as complex as the private versus public funding of health.  Have I got the scope to answer this question in this blog? Probably not, but I will try.  
One belief about why there are health inequalities is because “health is generally not high on the political agenda. Policy and planning are heavily influenced by a few elite groups who are least affected by health inequalities” (Prinja & Kumar, 2009, para. 2).

A report written for the Ministry of Social Development tells us that in New Zealand the links between low incomes and poor health are because of

  •  lack of money for medicines, 
  • lack of good and healthy food, 
  • lack of education, 
  • the neighbourhood you live in,  
  • poor household conditions – cold and damp houses and 
  • overcrowding

(Baker et al. 2000; Cheer et al. 2002; Crampton et al. 1997; Ellaway et al. 2001; Howden-Chapman et al. 2007; Lochner et al. 2003; McCulloch 2001; McNicholas et al.2000; Waldegrave et al. 2004; as cited in Carroll, Casswell, Huakau, Howden-Chapman & Perry, 2011).

How does the payment of the health affect lower income families and their children? In New Zealand, I feel that we measure up pretty well, compared to some countries, however, I think we have a long way to go before we measure up to countries like Sweden or Japan.  The public health system is accessible to all New Zealanders, no matter their income, but they must first have the ability to access the services the government has put in place for them.  

My next blog is going to look at current New Zealand child health policies and what governments have done in the past to ensure that children are benefiting from the public health system.  

References:
Carroll, P., Casswell, S., Huakua, J., Howden-Chapman, P., & Perry, P. (2011). The widening
            gap: Perceptions of poverty and income inequalities and implications for health and
            social outcomes. Social Policy Journal of New Zealand: Te Puna WhakaaroRetrieved from
Deaton, A. (2003). Health, Income and Inequalities. Retrieved from
OECD (2011). An overview of growing income inequalities in OECD countries: Main
            Findings. Retrieved from http://www.oecd.org/els/soc/49499779.pdf.
Peacock, D., Devlin, N., & McGee, R. (1999). The horizontal equity of health care
          in New Zealand. Australian and New Zealand Journal of Public
          Health.23.(2).:126-130. Retrieved from 
Prinja, S & Kumar, R. (2009). Reducing health inequalities in a generation: A dream or a
            reality? Retrieved from http://www.who.int/bulletin/volumes/87/2/08-062695/en/.
Wilkinson, R. (2011, July). How economic inequalities harm society. [Video
            file].  Retrieved from http://www.ted.com/talks/richard_wilkinson.html.