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Children’s Health: not a high priority for Health Minister Tony Ryall

11 January 2013 30 comments

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hodgson-cartoon-12-sept

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There was a time in New Zealand when health professionals like the legendary Doctor Smith created the first health system in the Hokianga without a single bureaucrat in sight. Until health management was corporatised under National 20 years ago the Coast had some outstanding no-nonsense characters in the public system but the intervening period has seen such people increasingly undermined by irrelevant bureaucracy and absurd political agendas.” – David Tranter, 9 January 2013

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After the spectacular cock-ups by Education Minister, Hekia Parata, it seems that the Health sector is next in line for the “National Treatment”.

Tony Ryall has demanded that the Health Budget be cut by $30 million this financial year (see:  Govt eyes cuts to elective surgery) Cuts to elective procedures that National’s spin-meisters “deemed to be of little benefit” are being planned – and details released to the media during the new season/holiday period when the public’s attention is focused on relaxation, barbecues, beaches, and “sinking a few coldies“.

Most of the mainstream media is also still “on holiday”, with minimal current affairs and investigative reporting being carried out by Radio NZ, TV3, and TV1. Only print media is reporting National’s covert cost-cutting programme – and even then, the Herald seems to be printing comments such as,

The National Health Committee has to find savings of $30 million this financial year from elective procedures deemed to be of little benefit.

The money would be used for smarter investment in other parts of the health system.

See: Govt eyes cuts to elective surgery

Note no quotation marks anywhere through those two paragraphs. The statements are presented as reported fact – not as government media  statement reflecting National Party policy.

This appears to be a re-run of National’s disastrous  “health reforms”  of the late 1990s,

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[National] Govt refuses extra ENT funding - ODT - 27 March 1997

Govt refuses extra ENT funding – ODT – 27 March 1997

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Call for funds  - ODT - 1 April 1997

Call for funds – ODT – 1 April 1997

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Wait for grommets a worry - ODT - 16 April 1997

Wait for grommets a worry – ODT – 16 April 1997

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Child health-care 'neglected' - ODT - 22 May 1997

Child health-care ‘neglected’ – ODT – 22 May 1997

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Sick children wait 2 years for surgery - ODT - 28 July 1997

Sick children wait 2 years for surgery – ODT – 28 July 1997

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Grommet 'blitz' clears backlog - ODT 19 November 1998

Grommet ‘blitz’ clears backlog – ODT 19 November 1998

Grommet 'blitz' clears backlog - ODT 19 November 1998

Grommet ‘blitz’ clears backlog – ODT 19 November 1998

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By the time Labour came to power in late 1999, the public Health system was a mess. National had gutted healthcare through funding cuts; increased management-bureacracy; closures; low salaries for front-line staff; and a slavish adherence to right wing dogma over the needs of communities and people.

The new incoming Labour-led government had much to re-build,

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$1.5b injection for health - 9 December 2001

$1.5b injection for health – 9 December 2001

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(When National supporters talk of Labour “wasting money” during their nine years in government – this is what they are actually referring to: the re-building of our public services.)

Note the weasel-words from Roger Sowry, National’s health spokesperson, in the above article,

Roger Sowry dismissed the announcement as a cynical, political move to hose down hotspots in health, including angst over waiting lists, DHB debts and health workers striking for higher  pay.

[…]

“It’s about politics. It’s not about the patient. It’s about saying we’ve got a problem with health, we can get a story out that there’s   a big lot of money coming down the barrel – it’s  about buying a comfort level for the next election.”

Roger Sowry should know about “hosing down hotspots in health, including angst over waiting lists, DHB debts and health workers striking for higher  pay” –  that is precisely the mess that National  left this country up until they were booted out in 1999.

The above stories are just a tiny few of the headlines from the 1990s.

Here are a few more that Mr Sowry might recognise – or should recognise. They all happened on his watch,

Claim many burned out by health sector reforms – 21 December 1996

Minister asked to halt job cuts  – 24 December 1996

Retiring GP pleased to escape growing bureacracy – 3 January 1997

$1m of health funds spent to date on rent for empty office space – 25 January 1997

More health changes tipped – 8 March 1997

Health reforms ‘harebrained’ – 15 March 1997

Rural abdication mockery of health system –  22 May 1997

Must pay for ‘wants’  – 19 July 1997

Cuts to hospital services expected – 8 August  1997

Move for sick to pay more  – 12 October 1997

English gives surgery pledge –  12 October 1997

Death The Northland Way – The Star – 15 October 1997

CHE announces cuts to public nursing hours – 15 October 1997

The Nation’s Health – 1 November 1997

‘Serious flaws’ in Govt’s health funding formula  – 31 January 1998

Privatising the public health system  – 2 February 1998

GP hits out at health reforms – 3 February 1998

Acute heart surgery list nearly 400  – 5 February 1998

Funding for Dunedin eye clinic slashed –  26 February 1998

Anger on heart op delay – 12 April 1998

Poorer patients put off doctors’ visits –  29 March 1998

Shipley, Bolger sorry for deaths of patients – 3 April 1998

Booking systems risky process, surgeon says  – 8 April 1998

Deaths hangs over boost in health funds – 9 April – 1998

Life on the waiting list uncertain – 9 April 1998

English may review waiting list funding –  11 April 1998

Health cuts spell doom for services – 30 April 1998

English agrees system flawed – 19 May 1998

Hospitals now owe $1.3 billion – 4 June 1998

100 drop off surgery lists  – 10 October 1998

Health sector needs stability, minister says – 28 January 1999

Four forced off waiting list die  – 15 March 1999

Patients ‘no better off’ – 29 March 1999

Widow says little improvement seem – 3 April 1999

Hospital waiting lists nudge 200,000 – 4 April 1999

Staff shortages could hit patient care, say nurses  – 4 May 1999

NZ heart attack victims likelier to die – 7 August 1999

Public hospital ills blamed on funding – 20 August 1999

Health spending rates poorly – 24 August 1999

Home Invasion – 24 June 2000

etc, etc…

That was the way we were in the 1990s; hospital budgets slashed resulting in chronic under-funding; growing privatisation of  healthcare; medical staff leaving New Zealand; bureacratic management growing; and people like Rau Williams, Colin Morrison, and others dying on waiting lists… all while a National-led government blundered on.

Things became so bad that even medical professions like the Royal Australasian College of Opthalmologists took to placing advertisements in newspapers, absolving  themselves of all blame and responsibility for the country’s chaotic and collapsing health system,

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Cataract surgery fact & fiction - advertisement - 6 October 1998

Cataract surgery fact & fiction – advertisement – 6 October 1998

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And while medical professions around the country distanced themselves from National’s non-stop bungling, others were jumping in, keen to exploit people’s fears and uncertainties for profit,

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Heartwatch Insurance Cover - advertisement - Otago Daily Times - 21 February 1998

Heartwatch Insurance Cover – advertisement – Otago Daily Times – 21 February 1998

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If you feel uncertain about the future…”

Talk about manipulating people’s fears.

What sort of society were we becoming that the callous exploitation of people’s   misery was somehow acceptable behaviour?! Was this the path that New Zealand had taken?

Or was our collective disgust finally being voiced with this statement,

I get a sense that the public is saying in quite a specific way, enough’s enough, we can’t take any more, you’ve got to stop, you’ve gone to far.” – Ian Powell,  Association for Salaried Medical Specialists, on Health cuts by the National-led government, 1 November 1997

The Minister of Health at the time, Bill English, and his colleagues – many of whom are still in Parliament (like Tony Ryall) – have much  to answer for.  For this was their legacy.

It now appears that they have not learned the lessons of that dark decade.

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Govt eyes cuts to elective surgery

Full story

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Govt's proposed health cuts could affect children - Labour

Full story

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Doubt over savings from restricting ear treatment

Full story

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Oh dear lord, not again!!

It appears that National may be hell-bent of repeating it’s ghastly performance of the 1990s – especially the late ’90s, where people died as a result of the then-National-government’s ineptitude.

And didn’t we go through a similar exercise in reducing grommet operations for our children in 1997 and 1998?!?! Oh yes, we did.

The three Herald articles above repeat the same mantra over and over again,

The National Health Committee, which is responsible to Health Minister Tony Ryall, is trying to find $30 million of savings in the public health system for reinvestment in more effective or better-targeted treatments.

See: IBID

What  investment could possibly be “more effective or better-targeted “ than  treating glue ear in children???

What “investment” could be better than removing a potential barrier for children to learn at school – a barrier called deafness, caused by glue-ear?!

The so-called “National Health Committee” are not new to this kind of narrow, anti-social thinking. They’ve been around for quite a few years and were involved in National’s blundering healthcare “reforms” – policies which led to the needless deaths of Colin Morrison, Rau Williams, and others.

This media report in the “Sunday Star Times”, on 12 October 1997, illustrates the sort of repulsive “philosophy” which this nasty little ‘Quango’ comes up with, from time to time.

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Move for sick to pay more - Sunday Star Times - 12 October 1997

Source: Sunday Star Times

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Note the comments high-lighted in red,

Patient charges could be increased to pay for more health care, according to a draft report by the high-powered Government adviser the National Health Committee.

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If user part-charges were high enough, the report said people’s ability and willingness to pay them would be a way of deciding which demands for publicly-funded services should be met.

Make no mistake. What these invisible, faceless, nameless bureacrats were suggesting to the then-National government was that raising “user part-charges” would deter certain classes of people from accessing the health service.

For example, if you were poor.  Or unemployed. Or a solo-parent. Or a pensioner. Perhaps Samoan or Maori. This was the power of the State being used to determine who lives and who dies – not on clinical grounds – but on your ability to pay.

The article goes on to state,

The report said funding for health and disability services should be directed at services which:

  • Showed good effectiveness or benefit with those standing to gain the most receiving services first.
  • Are the best value for public money.
  • Are a fair use of resources

[…]

It said people must be prepared to made trade-offs to achieve  a sensible mix of proven, cost-effective services.

I don’t know about the reader, but these remarks chill me to the bone. These are bean-counters giving advice to the Minister of Health; advice which measures outcomes according to “ the best value for public money” and if  “user part-charges were high enough…  people’s ability and willingness to pay them would be a way of deciding” who has access to life-giving medical care.

The only thing missing here is what do they advise we do with the corpses of people who did not have the  “ability and willingness to pay”  for “ high enough user part-charges“.

Perhaps ovens…? User-pays of course. With the bill for incineration being forwarded to next-of-kin…

Which leads us to the next question;

The “National Health Committee” – Who Are They?

Who are the so-called “National Health Committee” and what are their qualifications to be making recommendations on our healthcare system?

The Committee comprises of these kindly-looking folk,

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NHC members

Source

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Mrs Anne Kolbe

Chair

– specialist paediatric surgeon and an Associate Professor at the University of Auckland’s School of Medicine.

Dr Mark O’Carroll

– is a Respiratory Physician at Auckland City Hospital with subspecialty interests in Cystic Fibrosis, Lung Transplantation and Interventional Pulmonology.

Mr Craig Climo

– management.

Mr Ross Laidlaw

– retired corporate lawyer.

Ms Sharon Mariu

–  consultancy  in strategic and business development.

Mr Alex Price

– Chief Executive of Fertility Associates […] He holds a chemical engineering degree, an MBA from IMD, Switzerland and a graduate certificate in reproductive medicine from the University of New South Wales.

Source

Of the six committee members, only two have medical qualifications  as practititioners. The rest are ex-lawyers, bean-counters, pricey consultants, and business-types.

These are the bean-counters – faceless and nameless no more – who are now suggesting that savings in the country’s Health budget could be made by effectively stealing $30 million away from our children who need grommets for their ears.

The committee members – with their usual euphemisms – called the cost-cutting, “disinvestment“. I kid you not. See: Govt eyes cuts to elective surgery

So taking away a surgical procedure which gives our children a better chance at school – because they can actually hear what is being said in the classroom – is “disinvestment“?!

I call it naked selfishness and thieving from the vulnerable. So this is what the term “stealing candy from a baby” means.

I think every one of these “kindly-looking folk” should hang their heads in shame and resign their arses from this odious little quango. We have enough child poverty and poverty-related disease in this country without people like this lot, funded by us the taxpayer, adding to it with revolting policy-advice.

The New Year is just barely over a week old, and already we are reading stories of National’s intentions toward us and our children.

How many will suffer and/or die this time?

Addendum

Date:   Fri, 11 Jan 2013 at 1:45
From: Frank Macskasy <fmacskasy@yahoo.com>
Subject:Children’s Health: not a high priority for Health Minister Tony Ryall?
To: “Tony.Ryall@parliament.govt.nz” <Tony.Ryall@parliament.govt.nz>
Bcc: Chris Laidlaw RNZ <sunday@radionz.co.nz>,
“campbelllive@tv3.co.nz” <campbelllive@tv3.co.nz>,
Dominion Post <editor@dompost.co.nz>,
Daily News <editor@dailynews.co.nz>, Daily Post <editor@dailypost.co.nz>,
Hutt News <editor@huttnews.co.nz>, Jim Mora <afternoons@radionz.co.nz>,
“joanna.norris@dompost.co.nz” <joanna.norris@dompost.co.nz>,
Kim Hill <saturday@radionz.co.nz>,
“kate.chapman@fairfaxmedia.co.nz” <kate.chapman@fairfaxmedia.co.nz>,
Listener <editor@listener.co.nz>,
Morning Report <morningreport@radionz.co.nz>,
NZ Herald <editor@herald.co.nz>,
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“news@dompost.co.nz” <news@dompost.co.nz>,
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Otago Daily Times <odt.editor@alliedpress.co.nz>,
“primenews@skytv.co.nz” <primenews@skytv.co.nz>, Q+A <Q+A@tvnz.co.nz>,
Southland Times <editor@stl.co.nz>, TVNZ News <news@tvnz.co.nz>,
The Press <letters@press.co.nz>,
The Wellingtonian <editor@thewellingtonian.co.nz>,
“tracy.watkins@fairfaxmedia.co.nz” <tracy.watkins@fairfaxmedia.co.nz>,
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Wairarapa Times-Age <editor@age.co.nz>,
“wellington.news@tv3.co.nz” <wellington.news@tv3.co.nz>

For the Health Reporter:

Children’s Health: not a high priority for Health Minister Tony Ryall?

https://fmacskasy.wordpress.com/2013/01/10/childrens-health-not-a-high-priority-for-health-minister-tony-ryall/

The “National Health Committee” recently recommended stripping $30 million from the Health budget by cutting back on grommet operations for our children. According to the NHC,  the insertion of grommets is the only elective procedure specifically targeted for “disinvestment”.

Question: Who are the “National Health Committee” ?

Question: What advice did they give to the National government in the late 1990s, which effectively would have meant high “part charges” for medical care, and more people dying needlessly?

Question: Did National try cutting back on grommet operations in the 1990s? What were the consequences?

Question: Why is the “National Health Committee” – an unelected quango that comprises of four business/consultant/lawyer-types and two actual medicos – giving advice to a government that might result in suffering and poor education outcomes for our children?

Question: why has a blogger demanded that the entire “National Health Committee” resign their arses out of that quango?

It’s surprising what one can uncover with a bit of digging around.

-Frank

Blogger

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Cartoonconsult

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References

Scoop: Tony Ryall – Reduction in State agencies confirmed

NZ Herald: Govt eyes cuts to elective surgery

NZ Herald: Doubt over savings from restricting ear treatment

NZ Herald: Govt’s proposed health cuts could affect children – Labour

NZ Herald: The Hobbit: should we have paid?

Dominion Post:  Children need changes now – commissioner

National Health Committee

Previous related blogposts

Priorities?

Terminal disease sufferer appeals to John Key

Health Minister circumvents law to fulfill 2008 election bribe?

Johnny’s Report Card – National Standards Assessment – Compassion

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Back to the Future?

6 October 2011 2 comments

This piece in the media reminded me of issues in the late 1990s…

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Full Story

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Some things never change, it seems. Tides. The rise and setting of the sun and moon. Human nature. And politicians who cut social services,  because they harbour the naive notion that money is more important than the health and well-being of our young and elderly.

As the following media articles, from 1997 and 1998 show, National has not changes any of it’s stripes or spots,

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Otago Daily Times

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Otago Daily Times

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The Dominion

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Thirteen years later, and nothing has changed.

What is surprising is that people seem to forget National’s policies of cutting social services. Really – what were voters expecting, in 2008?

And what services will National cut, if they are voted back in, in November?

Finally: note who the Minister of Health was, in 1997 – Bill English.

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Why did the fat kiwi cross the road?

30 September 2011 6 comments

First, let me bore you all with some stats, facts, and figures,

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This page provides introductory facts and statistics about obesity in New Zealand. For more information, refer to A Portrait of Health: Key Results from the 2006/2007 New Zealand Health Survey.

Obesity statistics for New Zealand adults

The 2006/07 New Zealand Health Survey found that:

  • One in four adults were obese (26.5%)
  • 41.7% of Māori adults were obese
  • 63.7% of Pacific adults were obese
  • 11% of Asian adults were obese
  • Pacific men and women were two and a half times more likely to be obese than men and women in the total population.
  • Māori men and women were one and a half times more likely to be obese than men and women in the total population.
  • There has been an increase in the prevalence of obesity for men and women from 1997 to 2006/07, adjusted for age, but the rate of increase appears to be slowing.

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Obesity statistics for New Zealand children

The 2006/07 New Zealand Health Survey found that:

  • One in twelve children (aged 2 to 14 years) were obese (8.3%).
  • One in five children were overweight (20.9%).
  • There has been no change in the average (mean) BMI for children aged 5-14 years since 2002.
  • There has been a decrease in average BMI for Māori children.
  • Adjusted for age, Pacific boys and girls were at least 2.5 times more likely to be obese than boys and girls in the total population.
  • Māori boys and girls were 1.5 times more likely to be obese than boys and girls in the total population.

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Other statistics

  • Nine out of ten (87.8%) children aged from birth to 14 years have ever been breastfed.
  • Nine out of ten (87.8%) children aged 2-14 years ate breakfast at home every day in the past 7 days.
  • Two out of three (63.6%) children had fizzy drink in the past 7 days. One in five (19.6%) children had three or more fizzy drinks in the past seven days.
  • Seven out of ten (70.9%) children ate fast food in past seven days. One in seven (13.6%) ate fast food twice in past seven days and one in 14 (7.2%) had eaten fast food three or more times in past seven days.
  • Two out of three (64.1%) children aged 5-14 years usually watched two or more hours of television a day. This equates to 368,700 children.
  • Two out of every three adults (64.1%) ate the recommended three or more servings of vegetables each day, and two out of three adults (60.0%) ate the recommended two or more servings of fruit a day.
  • One in seven adults (13.6%) reported that they were currently taking medication for high blood pressure. This equates to 425,500 adults.
  • One in 12 adults (8.4%) were currently taking medication for high blood cholesterol.
  • One in 20 adults (5.2%) had been diagnosed with ischaemic heart disease.
  • The prevalence of diabetes in children was 0.2% which means that approximately 1700 children had been diagnosed with diabetes by a doctor (most probably type 1).
  • One in 20 adults (5.0%) had doctor-diagnosed diabetes (excluding diabetes during pregnancy). This equates to 157,100 adults. Nine out of every ten adults with diabetes were diagnosed when they were 25 years or older, and almost all will have type 2 diabetes.
  • After adjusting for age, Pacific men and women had three times the prevalence of diagnosed diabetes than men and women in the total population.
  • Just under half of children (47.0%) aged 5-14 years usually use active transport to get to and from school (walking, biking, skating or using other forms of physical activity). Common reasons given by parents for what stops their children walking, biking or skating to school – live too far from school, busy traffic/main road, too dangerous for reasons other than traffic, takes too long.
  • Half of all adults (50.5%) met the definition of being regularly physically active. Overall one in seven (15.0%) adults were sedentary, reporting less than 30 minutes of physical activity in the previous week.

Source

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Like nearly every other Western (and non-Western) society, New Zealanders are putting on the kilos. The problem of obesity starts young in our lives, as we consume sugary, fatty, highly-processed foods – and usually ends in heart disease, diabetes, and early death. The last bit – early death – is usually the worst.

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Source

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In fact, obesity has become an epidemic in the West. This is not helped by the fact that over-eating can be as addictive as alcohol, tobacco, gambling, drugs, etc. A ‘Time‘ article, last year stated,

But what shocked the researchers was that extended-access rats also showed deficits in their “reward threshold.” That is, unrestricted exposure to large quantities of high-sugar, high-fat foods changed the functioning of the rats’ brain circuitry, making it harder and harder for them to register pleasure — in other words, they developed a type of tolerance often seen in addiction — an effect that got progressively worse as the rats gained more weight. “It was quite profound,” says study author Paul Kenny, an associate professor of neuroscience at the Scripps Research Institute. The reward-response effects seen in the fatty-food-eating mice were “very similar to what we see with animals that use cocaine and heroin,” he says.” Source

Science is confirming what many of us had already intuited; that obesity was not simply a matter of “will power” or exercise – any more than “self-discipline” is for alcoholics or gamblers. There is much more going on, in the depths of our brains, that is affected by what we are eating – and vice versa.

By June, 2008, the previous Clark-led government courageously attempted to halt the obesity epidemic. Despite being sensitive to criticisms of “nanny statism”, their policy was not to ban junk food throughout the country. Nor to force feed us with vegetables and fruit. And not to frog-march us up and down our streets with battalions of Exercise Police.

Their plan was simply to cut crappy food out of our school ‘tuck’ shops.

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Full story

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You would think that this modest proposal would have been welcomed by sensible people who understood the problem, and realised that what we fed our children early in their lives would have an impact on their later years? Sensible, right?

Oh hell no. That would require common sense; foresight; and a strong sense of community responsibility.

In the above article, Secondary Principals’ Association president, Peter Gall said “ secondary school principals would generally have preferred an educational approach to improving nutrition, rather than Government rules which “can seem a bit heavy-handed“. ”

I wonder if Mr Gall considers it “heavy handed” when we deny our children access to cigarettes and alcohol? After all, if it’s “heavy handed” to try to provide healthier food options for our children, then let’s go hell-for-leather and give 10 year olds a six-pack of  DB Bitter for breakfast. We can always try an “educational approach” later?

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Unfortunately for us – but more unfortunate for our children – this bizarre attitude of Individual Responsibility won out over Community Proactivity. The National Party was perhaps chief amongst culprits, as it began a smear campaign of “nanny statism” against the then-Labour Government.

Headlines such as “National slams ‘nanny-state’ health bill“; “National Party: Public health bill in ‘nanny state’ realm“; and ” ‘Nanny state’ fears on health bill” filled our media. Irrational comments like this, became the mainstream ‘narrative’ of the debate, “”National said the codes were regulations by stealth as they could be converted into law if the Health Ministry did not think the voluntary codes were working.  Codes could cover a range of things from what could be in a school lunchbox, to physical activity and food advertising.”Source

Gosh,  and just think; if Labour has it’s wicked way,  our kids might not become obese!! Shock! Horror!

In November 2008, National was elected into power, and John Key became our Prime Minister.

Even as the world was facing a global banking crisis, and recession was impacting on nearly every nation on Earth, the new National government still found time to reverse Labour’s evil plan to reduce obesity amongst our children.  In March 2009, National scrapped the healthy foods in schools policy,

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Full Story

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You have to read that article in it’s entirety to grasp the full flavour of lunacy involved in the ‘rational’ behind National’s decision.

There was simply no coherent, logical reason offered except, as Education Minister Anne Tolley said, “It’s not teachers’ responsibility to act as food police. If we want to start changing behaviour, that’s got to start happening at home.

Riiiight. The same goes to allowing our children to have access to a couple of shots of bacardi as well?

Never mind that Wellington nutritionist, Sarah Burkhart, said that,  “[A pie] isn’t a high carbohydrate food source. That’s actually one of the worst things you could [eat].” Source

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Oh no, because neo-liberal politicians know better than nutritionists. We are going to have Freedom of Choice Even If It Damn Well Kills Us (and our children). Essentially, that is precisely the message that National gave New Zealanders two years ago.

Thankfully, some school’s exhibited far more maturity on this issue than our brain-dead politicians and Wellington College deputy principal Dave Ashby said the college would probably keep its new healthy menu,

“Schools have got a responsibility to young people. I don’t think we’re going to chuck it all in now.” Source

Thank you, Dave “Common Sense” Ashby.

However, leaving these matters to the whims of individual schools is not a solution. It means that some schools  simply won’t bother; they will defer decision making further “down the food chain”,  to our children.

It certainly  sends conflicting messages to the community.

And National’s over-turning of Labour’s policy also shows a total lack of any measure of leadership on this problem (I refuse to call it an “issue” – it is a problem).

On 27 February, the New Zealand Medical Association released a statement, condemning the National Government’s Do Nothing approach. They described Anne Tolley’s actions as “incomprehensible”. Despite it’s length, I will re-print their statement in full. It is worthwhile spending ten minutes to read it,

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Our reasons for opposing removal of the clause follow.
  • The Minister, Hon Anne Tolley, states that the core business of schools is to provide students with a “quality…learning environment”.1 Students cannot be expected to benefit fully from such an environment if they are inadequately nourished or experiencing poor health because of poor nutrition. Research suggests that good nutrition is associated with better overall school and academic performance, intelligence, and psychosocial functioning.2–4 Thus, a healthy school food environment seems imperative for a quality learning environment.
  • The Minister states that boards of trustees can “make their own decisions about appropriate food and drink options”.1 However, the reason the clause was introduced was that school food under boards of trustees was not sufficiently nutritious. A study in 2007 by Utter et al showed an association between use of school canteens in New Zealand and more frequent consumption of high fat and high sugar foods. 5 An earlier study by Carter et al found that the most commonly available foods in primary schools were pies (79%), juice (57%), and sausage rolls (55%).6 There were over five times more unhealthy meals on offer than healthy meals, and filled rolls (a healthy option) were the most expensive item.
  • It is unrealistic to expect boards to have the detailed nutrition knowledge necessary to ensure an appropriate and healthy food service, especially with their already heavy workload. The Minister’s decision means that whilst schools are still required to promote healthy foods, they must determine what foods are healthy and, of greatest concern, can continue to sell unhealthy food. This is contradictory and suggests ‘do as I say, not as I do’ to children.
  • Relying on education alone has not worked for other public health issues such as smoking, seat belts, cycle helmets, and drink driving, which ultimately required regulation to bring about positive changes in behaviour.7 There is no reason to think education will work any better for tackling our obesity problem. If we expect people to eat healthily, the environment must be changed to “make healthy choices the easy choices”.8
  • Relying on nutrition education alone also assumes there is free choice in school canteens. However, food choices are constrained by the environment. If all that is available is food that is unhealthy and heavily promoted in the media, or if healthy foods are more expensive, then students don’t have a true choice. Furthermore, younger children can not be expected to make rational choices about food based on health.
  • Development and implementation of the Ministry of Education’s guidelines on ‘Food and Nutrition for Healthy, Confident Kids’9 was the result of a prolonged and extensive amount of work on the part of government, schools, health sector, and the food industry. That expense and resource was well justified given the potential long-term gains, but has now been completely wasted, without even evaluating its potential success.
  • The Minister has also stated that there is confusion about the guidelines amongst schools.1 However, this could be resolved given sufficient time to work with schools. ERO report that since the clause came into effect in June 2008, 95% of schools had already implemented the guidelines.10
  • The fact that children bring unhealthy food into school or buy it out of school is not, as has been proposed, a reason to allow unhealthy food to be sold at school.1 The same rationale is not accepted in other circumstances. For example, it could never be acceptable to allow cigarettes to be sold at school because students could buy them at a local dairy.
  • Whereas at one time New Zealand was seen as a global leader in our efforts to tackle obesity,11 this latest move by the National government puts New Zealand seriously out of step with other countries. The UK Government, for example, is making laudable efforts to tackle childhood obesity, including implementing regulations around school food, and embarking on plans to broaden the reach of such regulations to include other key environments such as restaurants and workplaces.
The future cost to the country of obesity and nutrition-related disease is immense.12–14 It is of the utmost importance that we support young people to develop healthy eating habits as they grow. This requires environments that support healthy food choices.
The current rates of childhood overweight (21%) and obesity (8%) show that existing environments are not conducive to healthier choices.15 Government intervention is justified to protect children and to prevent the high societal costs of nutrition-related disease. This does not make New Zealand a ‘nanny state’, but simply a caring state.
Delvina Gorton
Dietitian / Research Fellow
Clinical Trials Research Unit, University of Auckland
Helen Eyles
Nutritionist / Research Fellow
Clinical Trials Research Unit, University of Auckland
Cliona Ni Mhurchu
Public Health Nutritionist / Programme Leader (Nutrition & Physical Activity)
Clinical Trials Research Unit, University of Auckland
Chris Bullen
Public Health Medicine Specialist / Acting Director
Clinical Trials Research Unit, University of Auckland

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Now, you’re probably wondering; why should I accept the statement of the people above, rather than my democratically elected representatives?

It’s very simple. The people above are trained in matters relating to health. Their #1 concern is mine and your well-being. That is why they went to University; spent years and thousands of dollars being educated; and why they took time to make their views known to you. In short, they care.

The people who over-turned Labour’s National Administration Guidelines for healthy foods are politicians. They care only to be re-elected.

Or put another way, who would you trust to look after your health; your GP? Or the Minister of Health, Tony Ryall? Your call.

In March 2010, more Health professionals joined the nutritionists above, calling on the Government to reinstate legislation for all schools to provide healthy canteen food,

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Christchurch public health nutritionist Bronwen King, said,  “What we need is strong leadership and tough measures, not the soft options they are dishing out now. Unless we get this, we will all pay the price.”  Source

The response of the Minister of Health, Tony Ryall, was thus,

The new Government has a more balanced approach than the finger-pointing, nanny state attitude of the previous administration,” he said.

“We trust school boards of trustees and parents to decide what they sell in their own tuck shops.”  Ibid

“Nanny state attitude”, remarked Mr Ryall. More politicking.  What was it I said about who to trust; health professionals or politicians?

However, the government has taken “action”. If you can call it that,

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By now you are probably wondering why on Earth our political representatives in Parliament would ‘can’ Labour’s healthy foods policy for schools – which costs very little for the taxpayer to impliment – whilst committing $8 million dollars for 300 bariatric procedures (weight loss surgery) in the next four years? What possible sense is there to such a bizarre situation?

In terms of health outcomes and sensible use of tax-dollars – very little sense.

In terms of political appearances to be Doing Something – it makes perfect sense.

By scrapping Labour’s healthy foods policy, National gives the appearance of rejecting “nanny statism” (though National has passed, or assisted, similar legislation in the past – such as the so-called “anti-smacking Bill), and reinforcing the Rights of Individuals to “make their own decisions”.

By funding 300 bariatric procedures, National is seen to be Doing Something to address this nation’s obesity problem. Above all, politicians understand that the public’s perception must be influenced: politicians need to be seen to be Doing Something to address a problem.

It is precisely the reason why “boy racer” legislation was passed by National – despite police already having considerable powers to seize cars and arrest drivers. The point was not that new laws were needed – but politicians had to be seen to be Doing Something.

The reason why National could not rely on Labour’s healthy foods in schools programme? It would not have offered the immediate results that politicians require. Such a programme takes years – decades! – to show results. Politicians face re-election every three years.

Unfortunately, as usual, it is the public and our children, who will suffer the results of this political expediency. We will also pay for it, in monetary terms,

“About 150,000 New Zealanders could potentially benefit from bariatric surgery. One in five New Zealanders are obese, leading to direct health costs of almost half a billion dollars each year. “ Source

And it’s getting worse,

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Note the statement in that article, under-lined in red,

“Christchurch obesity surgeon Richard Flint said patients selected for the pilot programme would be younger and with a body mass index (BMI) of 35 to 45. “

That’s right, folks. Not only are we  spending more money for weight-reducing operations – but the patients are becoming younger, as obesity increases in our society.

National is also supporting a policy of “outsourcing” these procedures to private clinics,

Christchurch obesity surgeon Richard Flint said… ” Christchurch Hospital did not have the resources to do the operations so they would be outsourced to private clinics.” Ibid

So now companies are making a profit out of the growing obesity epidemic. This, no doubt, fits in very well with National’s core ideology of  encouraging private “providers” for our health needs.  Someone will be making a lot of money out of  peoples’ misery.

But it’s going to cost us taxpayers even more,

“There were plans for the multimillion-dollar Christchurch Hospital redevelopment to include a bariatric surgery unit. “ Ibid

This is how obesity impacts on us, as a society, and as individuals. As obesity gets worse, we will end up paying more for hospitals, surgical procedures, medicines, post-surgical care, etc.

And to make it worse, the Government is actually proud of it’s “accomplishments” in this area,

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Remarkable. We have a government that is willing to spend half a billion tax-dollars on new hospital facilities and operations…

… but balks at removing unhealthy food from school cafetarias. Obviously, National has forgotten what their grandmothers and grandfathers knew instinctively; a gram of prevention, is worth a kilo of cure. I guess their imperative for re-election outweighs simple common sense? Little wonder that we distrust politicians.

There are those in society who are vocal in their  insistance that obesity is an “issue of personal responsibility”, and not something for the State to be concerned with. I reject that philosophy utterly.

We are a community, who rely on each other for everything that we have. None of us achieved or gained anything on our own – someone, at some point in time, helped us to get to where we are today.

When it comes to the obesity epidemic, this is a problem that affects us all; whether in the taxes we pay, or a family member directly affected. Or ourselves.

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We need to remember this, the next time a Minister tells us that it is a matter of “choice”. If it is “choice”, then we should be choosing to have sensible, proactive policies when it comes to food for our children – and not just leave it up to individuals. For children, that does not always work. And eventually, that “choice” will lead to a “choice” whether to have an expensive operation or not.

(Please note, I am not opposed to people requiring such operations. Such medical interventions are life-saving.  My call is for programmes that offer children better outcomes than what is currently “on the menu” for them.)

And yet, with a bit of common sense and prevention, we ultimately wouldn’t be needing those expensive new hospital wings, and surgical weight-loss procedures.

Q: Why did the fat kiwi cross the road?

A: To get to his appointment at the new bariatric-wing of his local hospital. (Yeah, I know, not funny. It wasn’t meant to be.)

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Hey, People! Leave our kids alone!

Additional

Tumeke blog:  Ronald McDonald becomes guest editor at the NZ Herald

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