Cameron Schauer and Jason Robertson describe the symptoms, aetiology, subtypes and consequences of reflux. They also discuss the investigations used for diagnosis, investigating those with alarm features and evaluating success of treatment. Finally, they examine multimodal treatment, including lifestyle, pharmacological and surgical interventions
Rust never sleeps: Neither does a health system’s needs and wants
Rust never sleeps: Neither does a health system’s needs and wants
Editor Barbara Fountain finds a thread through recent events in the health sector
As if someone has seen fit to bury some recalcitrant university students up to their necks in the noon-day sun
I have been sitting here staring at a photo of the vacant lot that was to be home to Dunedin’s new hospital, looking for inspiration. Like the health system, my mind is swimming with possibilities but none that will be pinned down. The lot, where once stood the Cadbury chocolate factory, is not quite vacant; there is an arrangement of rust-coloured structures low to the ground identified by an architecturally knowledgeable photographer as “pile heads”.
When I switch to Google Earth for a different view of ground zero of the latest fracas in health, I see that, snapped by satellite cameras, the piles cast long shadows, so they almost look like a small platoon absconded from China’s buried army of terracotta soldiers.
Closer up, their black toppings look like mortar boards, as if someone has seen fit to bury some recalcitrant university students up to their necks in the noon-day sun.
It is a scene adequately described as “forlorn”.
And that about sums up the general tenor of the health system at the moment.
I returned from a short break recently to learn the Government is on a crusade to stamp out prioritisation based on ethnicity in favour of need, as if the country is a Rolling Stones’ track stuck on replay: “You can’t always get what you want, but sometimes, you just might find you get what you need.”
Apparently, the people of Dunedin only “wanted” a fit-for-purpose hospital. It’s not what they “needed”. What they need has a lower price tag.
I anticipated it wasn’t going to be good news for Dunedin when the media advisory said both health minister Shane Reti and infrastructure minister Chris Bishop were going to be in town for an announcement on the hospital. Dr Reti needs some wins on the board – you don’t share the podium when it is good news. By contrast, prime minister Christopher Luxon was last week due to attend the extension of an Auckland private hospital.
Nevertheless, I’m not convinced the Dunedin decision is set in concrete – so to speak. The people of the south have fought long and bitter battles over health services. This is just another. Many looking through the wire at the deserted building site will share in the irony that the report consigning the hopes of Dunedin residents and beyond, to the rubble pile of broken election promises, is the Rust Report. A further three reports remain unreleased.
That continues a theme for this government.
Dr Reti has had to sit back and watch the continuing circus that is the “smokefree” associate health minister Casey Costello defending her shrouded-in-mystery independent advice which sees removing excise tax on heated-tobacco products create a potential windfall of millions for tobacco company Philip Morris. But will it? Who actually knows what heated tobacco is? Is anyone out there microwaving their cigarettes? (Almost the moment I wrote that line, I discovered it might just be the case as the delivery devices for heated tobacco are not currently approved in New Zealand.)
On RNZ, Mr Luxon stepped up to the plate on behalf of Ms Costello, defending her unreleased, mystery advice and touting heated-tobacco products as a one-year trial indicative of the Government’s desperation to reduce smoking rates; paying no heed to Treasury advice that heated-tobacco products are more harmful than vaping.
“We will try anything to get Kiwis off smoking,” says Mr Luxon.
Might I suggest reversing your government’s decision to ditch legislation that would gradually cut access to tobacco, creating a smokefree generation.
It’s never easy being a health minister and people carry the mantle with a broad spectrum of enthusiasm. I have no doubt of Dr Reti’s dedication to the task at hand, but I think it is unfortunate he finds himself in the Cabinet of an ideologically driven Coalition Government, rather than that of a traditional pragmatic National Government.
A younger Dr Reti, in 2004, carried out research assessing the New Zealand Health Strategy in Northland. In his findings he wrote: “Current interventions and new strategies need to press forward with the evidence that the majority of smokers actually want to stop smoking…As a key high-risk group, Māori continue to warrant prioritisation in the area of smoking reduction.”
Though the current coalition agreements include a dedication to evidence-driven policy, that is a smokescreen. Needs must, in politics. And for this government that means ditching ethnicity as a factor in delivering services. That means ditching evidence.
In a tiny cosmic twist, the correspondence address for Dr Reti’s paper 20 years ago, is Rust Ave.
We're publishing this article as a FREE READ so it is FREE to read and EASY to share more widely. Please support us and our journalism – subscribe here
One of the benefits of subscribing is you will also be able to share your thoughts about what you read with others in our Comment Stream. You can also take notes on what you read with Capture