Speech notes from health minister Tony Ryall

Good afternoon and thank you for inviting me to join you in launching the Massey University School of Public Health.

This opening is a milestone in the development of health teaching, research and practical application for Massey.

The School's funding and focus is clearly based on a partnership approach - both nationally and internationally.

It also has a commitment to workforce development, and will be able to contribute to some key health sector initiatives that will make Kiwis healthier.

A core emphasis of the Massey School of Public Health will be teaching and developing our health workforce through building research capacity and increasing our understanding of issues that have a significant impact on health.

The public health workforce needs to be strengthened as it will be of critical importance in meeting present challenges and in the near future.  

Critical to that future is also living within the much tighter financial environment we all find ourselves in.

The new government came to office with New Zealand well and truly in the grip of one of the worst recessions since the 1930s.

While signs of improvement are visible, New Zealand still faces six years of considerable financial deficits. And even then we will owe a massive $65 billion in public debt. In fact, within six years or so New Zealand will be paying close to $6 billion a year in interest...which is almost half the current health budget.

But this is not unique to New Zealand. In Ireland, public service salaries including in the health service and academia have been cut by around 13%. The British Government announced thousands of top-earning public sector workers, including judges, GPs, NHS managers and senior civil servants, are to have their pay frozen in 2010/11 for the foreseeable future. Canada is also freezing public service salaries.

Last year's Budget saw Health secure $750 million - half of all new spending.  This year's Budget has a limit of $1.1 billion of new spending across the entire public sector.

Health will get a good share of that smaller allocation. But the budget increase will not be as large as in previous years.

The Ministry of Health is reviewing its spending to identify programmes that can be stopped, scaled or slowed and it would be unfair for hospitals alone to carry the burden.  I want to be clear public health is important to this government but these reviews will affect a number of public health programmes including in areas where there has been very significant funding growth in recent years.

Change is needed.

In Wellington, the Government scrapped 200 vacant positions in the Ministry of Health, and that freed up $20 million of funding for frontline services.

Further changes are expected as we reduce back-office duplication and improve regional co-operation across DHBs........

Coming to speak to you today has provided me with an opportunity to learn about the areas where Massey has already contributed well to public health advancement for New Zealand.

One example is occupational health - Massey has contributed much in both epidemiology and clinical research, with the work being capable of practical and immediate application.

The School already receives funding from a range of diverse sources. Its work is not only funded by the Health Research Council but also by a variety of industry groups. These are particularly important in environmental and occupational health areas.

I'm told that Phillipa Gander has studied sleep, fatigue and wakefulness issues in many occupations - anaesthetists, junior doctors, drivers, fishermen, taxi drivers, pilots. It's vital we reduce risk of fatigue in all these areas for safety reasons. In addition I am looking for a few tips to pass on to some of my colleagues to help manage their sleep and wakefulness issues that seem to crop up in the Parliamentary debating chamber at times!!

Dr. Casswell has led the way, in a huge body of research, in publishing on drugs  -  including methamphetamines, alcohol, and cannabis. In turn these drugs have huge relevance for prisons, for crime and police work, for education, and of course for the public health service. Policy makers in all these fields need Dr Casswell's school's data  and analysis as an essential ingredient in the way we manage and confront these difficult issues. Her work has informed the Government Methamphetamine Action Plan.

This government has put a number of key public health issues at the centre of our expectations of District Health Boards and the Ministry of Health in our Health Targets and we are strongly committed to them. They are:

• increasing immunisation,

• extending smoking cessation programmes, and

• improving risk assessment of the eligible population for cardiovascular disease and diabetes.

Immunisation coverage is a basic public health measure. So many other countries do so much better than us. That's why we have put so much store on improving this vital measure.

I can announce today that New Zealand has reached for the very first time the national immunization target for 2009/10 of 85% of two year olds fully immunized. That is the highest coverage we've ever reported in this country - and we've got there three months earlier than planned.

A real tribute to our frontline primary health care workers for achieving this very good result.

Five years ago - in 2005 - the total immunization coverage for two year old children was 77.4% five years ago (2005).

However coverage is reported to be low -  predominantly from some DHBs with large Maori populations: Tairawhiti, Bay of Plenty, Northland, Lakes.   

Despite additional investment in providers and publicity in these areas, these DHBs are still failing to reach many of their local people.

Understanding what motivates parents to immunize their children or not requires much more investigation. Some research indicates that parents don't want to immunize their kids or for their community because they don't appreciate the benefit for the kids, their midwife tells them not to, or they think doctors and nurses are only recommending it because these health professionals are being paid financial incentives. Other parents become suspicious that "the system" only tells them the good side and fails to mention the down sides.

To reach the next child immunization target of 95% by 2012, we will need a more sophisticated way of finding out why parents make the decisions they do - and more approaches to ensure parents are able to make well informed decisions for themselves and to recognize the benefit for the community. The basic public health approach could work better than it is.

Over the next few years we will need public health leadership to work more effectively alongside primary care to resolve this challenge.

The Parliamentary Health Select Committee's inquiry into child immunization will be useful in engendering debate about what can help further improve and sustain higher rates.

This government recognizes and acknowledges the importance of public health in many ways, both at the practical and policy levels.

The 'Warm Up New Zealand: Heat Smart' initiative is an insulation and clean heat programme initiated by this government that gives New Zealanders the opportunity to make their homes warmer and drier.  Over the next four years the scheme aims to retrofit  about 190,000 New Zealand homes.

This will I think come to be seen as the most significant new public health initiative of the decade. History will show that this programme made an enormous impact on improving the public health, and the futures of thousands of kiwi families.

We know that warmer, drier homes bring health benefits, especially for those with respiratory illness or other conditions and the huge investment the Government is making is a recognition of this.

However New Zealand homes are on average 6 degrees centigrade below World Health Organization recommended minimum levels, nearly half of them are damp, mouldy and many are full of fungi and dust mites.

The Energy Efficiency Conservation Authority (who administers the Warm-up New Zealand: Heat Smart programme) estimates that the impact of the home insulation scheme over the three year period (2009/10-2011/12) will result in $240 million in health benefits and a further $256 million in energy savings.

A considerable amount of that health saving will come from fewer hospitalizations of people living in poorly insulated houses. We are hearing all the time of families whose lives have been turned around by this scheme.

With the new school of public health, Massey University will now be even better placed to ensure that politicians and policy makers know how to make scarce health dollar goes further. When investing in public health initiatives, it is critical that they are based on sound evidence produced by reputable researchers.  And that is no doubt what you are offering.