Media release from the APAC forum

The vast majority of ill health in childhood is driven by poverty and overcrowded housing, two leading paediatricians have told the APAC Forum on Quality Improvement in Health Care in Auckland.

In a joint presentation titled 'Future-proofing child health', Hawke's Bay paediatrician and Children's Commissioner Dr Russell Wills says children's health is a very good barometer of the social wellbeing of a society.
"The fact that we're so busy reflects that things aren't going so well."

But he says there are local initiatives that have made an impact on some areas of child health.

"These combine evidence-based solutions with a well-trained workforce that's comfortable with and works well with socially complex families - families who experience issues such as domestic violence, mental illness and addiction.

"The common feature of those solutions tends to be several agencies working together collaboratively, whether it's in a large urban or a provincial setting. We use data and databases to make sure that kids who most need care receive it, and we monitor the performance of our services to help them improve."

Dr Wills says the immunisation rate for two-year-olds is 96 percent in Hawke's Bay, which has the fifth poorest child population in the country.

"It's a perfect example of collaboration between public health, GPs and practice nurses, early childhood education and government and non-governmental social services, who have a clear objective, make good use of data, and are doing the right things well with proper evaluation."

Co presenter, Counties Manukau DHB paediatrician Dr Adrian Trenholme stressed factors outside the health system need to be addressed if population health, particularly child health, is to be improved.

"Giving people high quality medical care is good for individuals, but doesn't change the health of the whole population."
He agrees with Dr Wills that recent initiatives where primary, secondary and tertiary health agencies work with other government and non-government agencies at a local level are making a difference.

These include the Healthy Housing Programme, where Housing New Zealand and district health boards work together to reduced overcrowding and the risk of health-related problems, improve access to health and social services and increase awareness of healthy living in three disadvantaged areas of the country.

"Housing is a huge one for us and there's evidence the programme has reduced hospital admissions for children in South Auckland.
In July, the first of 18 planned school-based clinics in South Auckland to tackle rheumatic fever in five to 14-year-olds was launched. There were 51 cases of acute rheumatic fever last year in the Counties Manukau DHB region, with Māori and Pacific children disproportionately affected.

"In addition to the current public health nurse services, nurse-led teams in each school will provide a programme of throat swabbing and skin infection diagnosis and treatment with optional home assessment."

Dr Trenholme says another study is looking at preventing chronic lung disease in children who have been admitted to hospital. "This is a collaborative between primary, tertiary and secondary care, involving all agencies for these families, so as a model of health care it might make a difference."