Events like the one in NY below facilitate public health and activity levels, raise awareness of alternative, more socially equitable and environmentally friendly tranposrt options, nurture community cohesion and trust in others, break down social barriers… The city streets as a place where people can meet as equals and have a good time is a pretty basic, yet revolutionary concept. Bogota, where this event started, now has it every week, where over 100 km of the city’s streets are closed to traffic (video here).

This is the kind of stuff we need. Heaps of social action is reactive, rather than proactive, and while for some issues this is really crucial, we sometimes need to be more visionary. We need to get creative, and imagine the world how we want it to be, rather than battling against a world we want to avoid. If we want to move beyond endless consumption, materialism and accumulation of power and wealth, and their attendant environmental impacts and social injustices, we need to get into alternative ways of finding  joy and fun!

Take a look at the video below (sorry, the alignment for the embedded video is all out of whack, and for some reason the video is showing up twice… I’m really crap at this IT stuff!!)

” mce_src=”” alt=”" border=”" hspace=”" vspace=”" width=”" height=”" align=”" />

Unlike countries like Australia, the United States and the UK, New Zealand is unusual in not requiring its GPs to undertake separate training as General Practitioners.

Furthermore, about another 700 GPs are currently in training, under various levels of supervision, and provide primary health care to local communities.

Therefore, of the approximately 4100 GPs in New Zealand, 1400 (about one third) of them are not trained to be so.

This is somewhat disturbing news, particularly at a time when there is a national shortage of doctors in general, and GPs in particular.

The governments answer would seem to be to encourage the use of nurses to relieve doctors of some of their workload, but international studies show this is a problematic practice, and it is doubtful it will have the desired effect.

New Zealand should take a leaf out of the global health care book, and insist upon doctors who wish to be GPs being trained specifically as GPs.

General practice is a specialism. It is reasonable to assume that people engaged in specialist pursuits - such as a oncology, pediatrics, or neurosurgery - would have had specific additional training to ensure they understand their field and are able to provide the best possible care.

Shouldn’t we expect the same from General Practice - doctors from whom, in the Government’s primary health care strategy, a great deal is expected?

“Widening geographic inequalities in death rates from ischaemic heart disease, diabetes, and chronic obstructive pulmonary disease have marked differences between District Health Board regions, the journal said in an editorial.

”It based the warning on research published in the journal arguing that higher rates of ill health among poor people are leading to differences in a mortality rates between regions.

“The changing social and political environment disadvantaged poor people and areas, as well as Maori and Pacific people. Healthcare reforms which required people to pay more for their treatment led to poorer people making less use of health services, and unequal rationing of primary healthcare had affected some regions more than others”

Full story: http://www.stuff.co.nz/4681227a11.html

In July the New Zealand Council of Christian Social Services (NZCCSS) continues its election year call for greater awareness of key issues facing New Zealand by promoting the message that more action is needed to provide a valued place in our society for older people.

The fact that more people are living longer than ever before is something we should be celebrating as an outstanding achievement. Older New Zealanders make huge contributions to maintaining our social fabric through their life skills and life experience; as workers, as parents or grandparents, as caregivers and as active members of the community. Yet too often older people are portrayed as a burden on society, suffer from ageism, are exploited or even abused. Genuine issues of poverty, loneliness and sickness are too easily ignored.

NZCCSS argues that the realities of an ageing population put some fundamental challenges before all of us: Where and how shall we live? Who will be there to help us when it is needed? What choices will we be able to provide older people with? 

The second in the series of brochures published by NZCCSS for its member organisations, Church-based audiences and wider public, looks at the massive social change that our ageing population is bringing with it. This second part of a call for more action asks the question about how we value older people in our society? A central measure of value is the range of choices that will be available for older people who have few assets, low incomes and/ or high needs. A copy of the brochure is available to download here.

NZCCSS has summarised some of the key issues in a briefing given to Church Leaders [Read more]

“”The ACC system is one of the simplest in the world for patients to navigate“…Straightforward claims are processed in weeks, with all decisions made within nine months, and a fixed award structure ensuring that similar injuries receive similar compensation…The system, funded through general taxation and an employer levy, is remarkably affordable. To date, compensation for medical injuries has cost just $29 million—for a population of about 4 million. Reforms enacted in 2005 are expected to incur additional costs of $5 million per year.” (ref and ref)

Marie Bismark and Ron Paterson’s article “No-Fault Compensation in New Zealand: Harmonizing Injury Compensation, Provider Accountability, and Patient Safety” is well worth a read.Given that Australia use a mix of private and state sector mechanisms to provide similar accident compensation systems, isn’t it a bit ironic that many in Australia call them to follow us - but here’s National with a fairly uninspired co-option of Australian broken systems? Would it provide greater flexibility to the public and employers?ACC isn’t admired by everyone. Roger Kerr, Executive Director of the New Zealand Business Roundtable had a thing or two to say.Yest according to the government:

“Research shows private insurers are often less concerned about the vocational rehabilitation of injured clients – and that a significant group of people can miss out on injury cover altogether under privatised schemes.”

I’m not sure how true the first part of that is, though, and which research they are drawing upon. many insurers already offer income protection insurance that covers people for rehabilitation. But of course, you have to pay quite a bit for that privilege.So why do National want to do this? I just don’t understand their rationale.I get that there might be benefit to business owners in so far as they can reduce costs.But Is there a real benefit here to the public which I’m blind to, particularly when we are entering one of the most economically challenging times since the 1990s (when National were last in power)?I can only see it leading to possible job losses and increased costs relating to ACC due to loss of scale of cover - so we end up with a two tier system. It seems I’m not alone. And will competition assist businesses in creating, nurturing and maintaining a healthy and capable workforce?I don’t think any of us should be a slave to dogma, left or right. But we need to ask some serious questions, and get answers, about who benefits from policies like these, and whether that’s consistent with a just society.

If you do, you’ll get the treat of listening to Jo Randerson, astonishingly talented writer and performing artist, who will be reflecting with Kim about art and mental health at that time.

“Award-winning writer and performer Jo Randerson is curating the exhibition My House Surrounded by a Thousand Suns at The New Dowse in Lower Hutt (5 July to 26 October). The recipient of a New Zealand Mental Health Media Grant, Randerson’s show includes work from individuals formerly known as ‘outsider artists’, including those with experiences of mental illness and intellectual disability, inspired by her recent trip to Belgium’s Guislain Museum.

We believe a just and compassionate society can be achieved by more action to:

• Support families and communities in nurturing and protecting our children as taonga.
• Provide older people with a range of choices for their homes, support and lifestyle.
• Utilise our nation’s prosperity responsibly to eliminate poverty.
• Enable access to good, affordable housing for everyone.
• Support community-based organisations to grow the spirit of aroha tetahi ki tetahi - looking after each other.

During the year a series of five discussion leaflets and posters is being produced to support the Call for More Action, the first of which was released in June.

“Are we looking after our children?” - when one in five of them are living in poverty. This is the central question behind the first part of the call for action - let us begin to really nurture and protect our children. Suggested actions for communities and individuals are included in the information that can be downloaded from  http://www.justiceandcompassion.org.nz/site/home.php  

We’ll keep you posted as new information comes to hand.

Problem gambling heavily impacts the most vulnerable people in our society. It can result in dire financial problems, insurmountable debt and impacts hugely on individuals, families and children. Pokie machines, which make up the bulk of the problem gambling, are concentrated in low socio-economic areas. The fact that the problem gambling helpline is unable to continue to provide its essential services is a deep betrayal of those Kiwis bearing the heavy costs of gambling problems.

Read full press release

The Hikoi of Hope is calling for a public health system that New Zealanders can trust. Many New Zealanders consider health services that are safe, reliable and accessible to be a prerequisite for a caring society. Anything less compromises, in particular, the well being of the most vulnerable members of our society – our children, the elderly and those on low-incomes.

Ten reasons why New Zealanders have lost their trust in the health system:

1. Waiting lists – how does New Zealand compare with other countries?
New Zealand’s hospital waiting lists and waiting times are among the longest for developed countries. Latest official figures estimate 2500 in every 100,000 New Zealanders are on surgical waiting lists – nearly five times the rate of Australia’s and about three times the rate of Holland’s and Canada’s. England also has long waiting lists, though New Zealand’s rates per population are about 8% higher. In 1997 there were more than 38,600 people (42% of the official waiting lists) waiting longer than a year, and more than 20,000 (22%) waiting longer than two years. In Holland a six month wait for an operation is considered unacceptable.

2. Poor accountability to the public
A decade ago the public was represented on elected area health boards. Community Health Committees were established and there was a requirement to involve the public in areas such as mental health and maternity care. Today there is no elected public representation on any health organisation apart from a few individuals nominated by local body councils to sit on CHE boards. In June 1998, the few surviving community health groups had their small state funding allowance abolished.

3. Rural hospitals doing less
Rural hospital procedures have been reduced by about a fifth since 1993. In 1992 there were 1000 surgical discharges from Dargaville Hospital, last year there were 45. Balclutha Hospital’s discharge rate fell from 1716 to 71. Rural general practitioners are leaving their practices because of overwork. Provincial New Zealanders are having to travel to main centres for basic health treatment. International research into safety and cost effectiveness of small hospitals suggests centralisation of services may not achieve the benefits that are often claimed.

4. Larger hospitals are struggling to cope
Total public hospital discharges per 10,000 population increased by only 1.3% between 1994 and 1997, despite advances in technology which enables patients to recover more rapidly and more surgery to be performed on a day-treatment basis. Between 1990 and 1993, under the previous area health board system, hospital discharges per 10,000 population increased by 19.6%.

5. More health dollars spent on bureaucracy
In 1991/92 the cost of administering the public health system through the Department of Health totalled $52 million. The administration budget for this financial year is more than $120 million, shared between the Ministry of Health and the Health Funding Authority. (A relatively small portion of this increase would be due to the administration of disability support services which were previously administered by Social Welfare.) Our public hospital companies employ one manager for every five medical staff (compared with one manager for every 14 medical staff under the previous Area Health Board system). Hospital companies are now spending an estimated $330 million on managers and administration, due largely to the work involved in contracting.

6. Hospitals lack funds to operate effectively
While total government health funding has increased in real terms in recent years, the extra money is not going to hospital services. Total government health spending increased by 3.6% between 1988/89 and 1996/97 in real per capital terms, but hospital funding decreased by 6.3%, even when taking into account CHE deficit financing and adjustments for different funding arrangements when area health boards changed to CHEs. CHE/public hospitals are $1.3 billion in debt; they pay about $60 million in interest payments annually.

7. Mediocre funding levels by international standards
In 1980 New Zealand government spending on health was 6.2% of gross domestic product (GDP), which placed us 4th among OECD countries. Since then we have been one of only five countries to reduce health spending per GDP. By 1996, New Zealand government spending (including GST and CHE deficit financing) totalled 5.8% of GDP, placing us 14th among OECD countries. Over that same period, private health spending increased from 12% to 23.3% of GDP.

8. User charges prevent access to treatment
About 200,000 New Zealanders had not seen a doctor when they needed to during 1996/97 because of user charges, according to a Statistics New Zealand survey. A survey of GPs published in November 1995 showed 71% of respondents believed their patients were delayed seeing their GP because of the cost.

9. Crisis in mental health services continues
The Mental Health Commission estimates staff numbers for children’s mental health services must increase eight-fold to meet the country’s needs, and the number of staff working in adult services needs to double. Despite these signals, Wellington mental health services are facing cuts of up to 20 staff, and the general manager of mental health services at Waitemata Health said severely disturbed mental health patients are dangerously overcrowded and people are being discharged too early because of the demand for beds.

10. Declining health status
Compared to other OECD countries, New Zealand has high rates of cardiovascular disease, respiratory disease, breast and bowel cancer, motor vehicle injuries and suicide. Many cases are preventable. In 1960, New Zealand’s infant mortality rate ranked 6th out of 21 OECD countries; by 1995 we were in 5th place. Life expectancy has not increased as fast as in many other OECD countries. Since 1990, Maori life expectancy has not increased. Generally, Maori experience a higher infant death mortality rate (mainly due to sudden infant death syndrome), high death and hospitalisation rates in infant, childhood, youth (predominantly from injuries, asthma and respiratory infections) and higher mortality and hospitalisation rates in adulthood and older age (especially from injuries, cardiovascular and respiratory disease, diabetes and most cancers). Maori are more than twice as likely to be admitted to hospital than non-Maori.

More

Sources:
Purchasing for Your Health, Ministry of Health, NZ, 1998
Federal Minister of Health, Australia, media release, 17 March 1998
British Medical Journal, 11 January 1997; 21 March 1998
Department of Health, England, media release, 16 June 1998; 30 June 1998
Minister of Health media statement, 28 May 1998
Otaki Community Health Group, media release, 8 June 1998
Opposition spokesperson on Health, media release 15 June 1998; 9 July 1998
Concentration and Choice in the Provision of Hospital Services, NHS Centre for reviews & Dissemination, report 8, 1997
Morning Report, 22 June 1998
Health Expenditure Trends in New Zealand, Ministry of Health, 1998
1996/97 New Zealand Health Survey, Statistics New Zealand, July 1998

I would agree that nursing and teaching, among the civil service professions, should merit increases in their salaries. This is because of their direct service to human life; one deals with the health of our people and the other with the education of our children. These are fundamental to the kind of society that we wish to build and nurture; a compassionate, just and inclusive society. The nurses and the teachers may have genuine and legitimate concerns and, in this regard, I urge the interim government to listen carefully to the concerns of the nurses and teachers, and find a way to negotiate and mitigate them. Mediation is one that is not often tried. I urge the leaders in this dispute to go into mediation and negotiate their respective concerns and agree on what they can compromise upon, given our current situation.

However, because their professions deal directly with human life and the nurture of knowledge of our children, the strike actions by nurses and teachers are not justified. The greater claim on our moral responsibility lies with the preservation of human life, i.e., the care of the sick and the elderly, and the education of our children, and not with the demands of the interim government or the nurses or the teachers. Their concerns, whatever they are, must be dealt with through another formal mechanism and not through strike actions. In this regard, the strike actions by the nurses and the teachers cannot simply be morally justified.

Furthermore, health and education are not private goods where we can simply walk off our jobs without due consideration to the consequences of our actions to ourselves and to those whom we take an oath to serve, through thick and thin. These are first and foremost, public goods and as such, any action that will endanger the provision of these services cannot be justified action, even on ethical grounds. What seems to have been forgotten by the interim government, teachers and the nurses is the whole area of compassion and empathy to the very people they have pledged to serve. We must not forget that when we demand our rights, we must also hold out our responsibilities, in this case, to the sick, the elderly and the children.

Another reason why health and education are regarded as public goods is because of our society’s fundamental responsibility to the needy and the poor among us. We exercise this responsibility by making public health care and education affordable and accessible to them. Without this fundamental entitlement, the poor will have no recourse for their need for proper health care for themselves and education for their children. We should not ever subject our people to make a choice on whether they live or die, mainly because a few among us decided to hold what belongs to the public – health and education - ransom. We must also remember that many of our people are living below the poverty line and are worst off than most of us.

Where public goods such as health and education are put at risk, our first priority is to ensure that normal services in our hospitals, health centres and schools are not interrupted. This is because these are not only public goods to which all citizens are entitled to, but, as mentioned, they directly concern human life and our people’s right to life and our children’s right to education. These are basic values from a Christian point of view, and even from a humanistic one. Human life and the right to life are absolutes and must never be made relative.

We have all being called by God during this time of need to be servants to our “brothers and sisters”. In this regard, I wish to call upon all Anglican Church parishioners in the Episcopal Unit of Vanua Levu and Taveuni, especially those who have some medical knowledge, to help out, wherever you can and at a time that is most suitable to you and your families, in the hospitals in Labasa and Taveuni or in the other health centres around Vanua Levu. I would also like to request that we organise ourselves to visit the working nurses, doctors and the sick, and to volunteer our services in helping out in other areas of need in the hospitals and health centres around Vanua Levu.

In the Love and Peace of God
+ Bishop Apimeleki Qiliho

Bishop of the Episcopal Unit of the Anglican Church in Vanua Levu and Taveuni
2/8/2007
Contact Nos.: 9467048 (m) or 8811420 (ph)

[MEDIA RELEASE ENDS]

You might also be interested in his biblical reflection on forgiveness in a Fijian context.