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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 03-June-2005, Vol 118 No 1216

The New Zealand Government’s 2005 Budget: missed opportunities for significant public health progress
The Government’s 2005 Budget of May 20051 has increased the level of funding for health services, for primary care, and for health research. However, it is a weak budget in overall public health terms, omitting basic steps necessary to improve the overall health status of New Zealanders.
Key issues on which progress could have been made from a public health perspective include the following:
  • Improved progressivity—Deprivation and income inequalities have a major impact on health in New Zealand.2 Identifying the potential health benefits of wealth redistribution policies is complex, but preliminary modelling work based on New Zealand census mortality data is suggestive of overall reductions in the inequalities in mortality and in overall mortality rates if income is more equally distributed (Personal Communication, T Blakely, University of Otago). These potential equity benefits are particularly necessary, due to the marked increase in inequalities in this country as a result of various government policies since the early 1980s.3
While the 2004 Working for Families budget package was a valuable initiative to address inequalities, the 2005 Budget did not substantively advance government policy on deprivation and income inequalities by making the overall tax and benefit system more progressive. It also lacked specific reforms that could potentially benefit low-income New Zealanders, such as making childcare a tax-deductible expense.
  • Focus on prevention—The Budget included commendable funding for primary prevention in some components of the cancer control package and for immunisation. Nevertheless, this will have a relatively minor impact on prevention in comparison to what is achievable. Recent work by the Ministry of Health, identifying the major upstream causes of preventable death by risk factor in New Zealand,4 shows the major scope for primary prevention (e.g. diet for 29% of deaths, tobacco [18%], and deprivation [17%]). Furthermore, the scientific evidence-base for cost-effective interventions in some of these areas of primary prevention is strong, particularly with regard to tobacco control.5
  • Support for Maori—Substantive progress with improving Maori health is critical to reducing health inequalities,6 enhancing social justice, meeting the Government’s Treaty of Waitangi obligations, and meeting key Government goals.7 Some of the Budget items relating to healthcare and housing for lower income population groups may provide minor health benefits to Maori. Nevertheless, there was no specific funding for Maori health programmes8–10 and indeed the word “Maori” was not mentioned once in the Budget speech; despite the evidence favouring culturally appropriate prevention programmes and healthcare services designed to address Maori health needs.11–13
  • Action on health protecting taxes—This Budget further elaborated aspects of a proposed carbon charge (a desirable intervention from a global public health perspective), but it failed to introduce other health protecting taxes. It failed to raise tobacco tax despite the lack of a non-indexation rise since 2000, and strong New Zealand14 and international evidence for public health benefits from increasing this tax. There is also an ethical justification of tobacco taxes when the revenue is used appropriately for tobacco control.15 Similarly, there is also strong international evidence for the health benefits from alcohol taxes.16,17
An increase in alcohol taxes is particularly relevant in New Zealand, given the high prevalence of self-reported hazardous drinking patterns (eg, 27% of males18) and the high net annual years of life lost from alcohol use.19 Other potential targets for health protecting taxes were also ignored (e.g. on foods high in saturated fat,20 salt in processed foods, and the advertising of high sugar and/or fat foods).
Central government fiscal policies can only address some of the multiple social and economic determinants of health status. Nevertheless, it creates an important fiscal framework and the Government missed obvious opportunities in this Budget to significantly improve public health and reduce health inequalities in New Zealand. We will now have to wait for the next budget for an opportunity for further progress in these areas.
Nick Wilson, George Thomson, Peter Crampton, Tim Rochford
Department of Public Health
Wellington School of Medicine and Health Sciences

References:
  1. New Zealand Herald. Full text: Budget speech. 19 May 2005. Available online. URL: http://www.nzherald.co.nz/index.cfm?ObjectID=10126351 Accessed May 2005.
  2. Blakely T, Kawachi I, Atkinson J, Fawcett J. Income and mortality: the shape of the association and confounding New Zealand Census-Mortality Study, 1981-1999. Int J Epidemiol. 2004;33:874–83.
  3. Blakely A, Fawcett J, Atkinson J, et al. Decades of disparity II: Socioeconomic mortality trends in New Zealand, 1981-1999. Wellington: Ministry of Health & University of Otago; 2005.
  4. Ministry of Health. Looking upstream: Causes of death cross-classified by risk and condition, New Zealand 1997. Wellington: Ministry of Health; 2004. Available online. URL: http://www.moh.govt.nz/moh.nsf/wpg_Index/Publications-Looking+Upstream Accessed May 2005.
  5. Hopkins DP, Briss PA, Ricard CJ, et al. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med. 2001;20(2S):16–66.
  6. Ajwani S, Blakely T, Robson B, et al. Decades of Disparity: Ethnic mortality trends in New Zealand 1980-1999. Wellington: Ministry of Health and University of Otago, 2003. Available online. URL: http://www.wnmeds.ac.nz/academic/dph/research/nzcms/Ethnic_Mortality_Trends070703.pdf Accessed May 2005.
  7. Ministry of Health. Annual report for the year ended 30 June 2004. Wellington: Ministry of Health; 2004, p19.
  8. BRC. Evaluation of Culturally Appropriate Smoking Cessation Programme for Maori Women and their Whanau: Aukati Kai Paipa 2000. Wellington: Ministry of Health, 2003. Available online. URL: http://www.moh.govt.nz/moh.nsf/7004be0c19a98f8a4c25692e007bf833/50be7bea182bcb5bcc256d6c000c5408?OpenDocument Accessed May 2005.
  9. Barnes HM, McPherson M. Maori Smoker and Whanau Response to “It’s about whanau” Television Commercials. Auckland: Whariki Research Group, SHORE Research Centre, Massey University; 2003.
  10. Wilson N, Grigg M, Graham L, Cameron G. The effectiveness of television advertising campaigns on generating calls to a national quitline by Maori. Tob Control. 2005 (in press).
  11. Ratima MM, Fox C, Fox B, et al. Long-term benefits for Maori of an asthma self-management program in a Maori community which takes a partnership approach. Aust N Z J Public Health. 1999;23:601–5.
  12. Huriwai T, Sellman JD, Sullivan P, Potiki TL. Optimal treatment for Maori with alcohol and drug-use-related problems: an investigation of cultural factors in treatment. Subst Use Misuse. 2000;35:281–300.
  13. Maniapoto T, Gribben B. Establishing a Maori case management clinic. N Z Med J. 2003;116(1169). URL: http://www.nzma.org.nz/journal/116-1169/328
  14. Wilson N, Thomson G. Tobacco tax as a Health Protecting Policy: A brief review of the New Zealand evidence. N Z Med J. 2005;118(1213). URL: http://www.nzma.org.nz/journal/118-1213/1403
  15. Wilson N, Thomson G. Tobacco taxation and public health: ethical problems, policy responses. Soc Sci Med. 2005;61:649–59.
  16. Chaloupka FJ, Grossman M, Saffer H. The effects of price on alcohol consumption and alcohol-related problems. Alcohol Res Health. 2002;26:22–34.
  17. Cook PJ, Moore MJ. The economics of alcohol abuse and alcohol-control policies. Price levels, including excise taxes, are effective at controlling alcohol consumption. Raising excise taxes would be in the public interest. Health Aff (Millwood). 2002;21:120–33. Available online. URL: http://www.niaaa.nih.gov/publications/arh26-1/22-34.htm Accessed May 2005.
  18. Ministry of Health. A Portrait of Health: Key results of the 2002/03 New Zealand Health Survey. Wellington: Ministry of Health, 2004. Available online. URL: http://www.moh.govt.nz/moh.nsf/0/3d15e13bfe803073cc256eeb0073cfe6?OpenDocument Accessed May 2005.
  19. Ministry of Health. Our Health, Our Future: The Health of New Zealanders 1999. Wellington: Ministry of Health, 1999. Available online. URL: http://www.moh.govt.nz/moh.nsf/0/6910156be95e706e4c2568800002e403?OpenDocument Accessed May 2005.
  20. Wilson N, Mansoor O. Food pricing favours saturated fat consumption: supermarket data. N Z Med J. 2005;118(1210). URL: http://www.nzma.org.nz/journal/118-1210/1338


     
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