End-of-term brief review of the New Zealand
Government’s actions on five major health risk factors
Near the end of each electoral term is an appropriate point
to review New Zealand (NZ) Government performance in implementing primary
prevention initiatives aimed at preventing poor health outcomes. To structure
such a review, we selected five risk factors for lost disability-adjusted life
years (DALYs). These are the top five risk factors for high-income countries in
the World Health Organization region which includes New Zealand (Western Pacific
These risk factors are listed in descending order of
importance in Table 1 and this list reasonably equates with the top risk factors
for causes of death from previous NZ-specific
work.2 We then searched for new government
actions relating to primary prevention of these risk factors. This was via
Medline searches, searches of the Ministry of Health website, and the media
releases by the Minister of Health covering the November 2008 to September 2011
Results in the form of new policies implemented and areas of
relative inaction are presented in Table 1.
Note: * Ranked by lost DALYs for high-income countries in the region which includes New Zealand (Western Pacific Region).1
primary prevention policies and apparent areas of inactivity
was involved in a landmark inquiry by the Maori Affairs Select
Committee3 and followed this up in its response
to the inquiry’s recommendations by adopting the goal of “reducing
smoking prevalence and tobacco availability to minimal levels, thereby making
New Zealand essentially a smoke-free nation by
2025”.4 It instituted a series of three
above-inflation tobacco tax increases and enacted legislation to ban
point-of-sale tobacco displays (along with other minor refinements to the law),
to be implemented in 2012. There were ongoing tobacco-related social marketing
interventions by the Health Sponsorship Council (albeit with declining
funding5), the national Quitline Service
continued to support quitting, and there were improvements in access to
pharmacotherapies for smoking cessation, and the delivery of smoking cessation
interventions in primary and secondary care settings. Smoke-free prisons were
also successfully introduced in 2011. Ministers have made public commitments to
introduce plain packaging of tobacco products in line with the forthcoming
Australian policy. However, there was no other action to further advance
smoke-free environments legislation (despite the
gaps6). Also, many other areas of tobacco
control were not substantively advanced,7 and
there are unresolved issues around achieving the smoke-free nation 2025 goal,
notably the lack of any coherent strategy or milestones for achieving this
Some progress, but gaps remain which need to be addressed if substantive progress towards the smoke-free nation goal is to be achieved
(heavy and binge drinking)
A major Law Commission Report10 (initiated by the preceding Government) was considered by the current Government. This Report and ensuing debate have increased awareness of the public health threat that excessive alcohol use presents in NZ. A Select Committee process has considered draft legislation and produced a Report (but no legislation was passed prior to the 2011 election). Nevertheless, key components of the Law Commission’s recommendations were missing from the Select Committee’s Report (e.g., higher alcohol taxes, lower drink driving levels, major restrictions on marketing, and substantive limitations on access). Various criticisms of the limited response by the Government have been published.11 12 Also, the lack of action contrasts with high NZ public support for improved policies around access to alcohol and enforcement of alcohol-related laws13 and very extensive public involvement in the Select Committee process. Furthermore, the lack of action on alcohol pricing is not consistent with the evidence for price increases being the most effective14 and cost-effective intervention to reduce alcohol-related harm.15 16
Some limited plans for legislative reforms that do not adequately utilise major interventions such as alcohol tax
The Government has made no moves to consider regulations to reduce dietary salt intake or improved food labelling to indicate “high salt” foods (despite the importance of excess salt in terms of cardiovascular disease in NZ17). This inaction is problematic given the many international studies suggesting how cost-effective interventions to reduce salt intake would be (e.g., various studies18-21). (See also elsewhere in this Table concerning nutrition-related and alcohol-related interventions that may impact on the risk of high blood pressure.)
No progress on reducing salt intake by Government.
Nutrition: The Government reversed an existing policy limiting the availability of unhealthy food at school tuck-shops.22 Consideration of a Bill to remove GST from healthy food ("Goods and Services Tax (Exemption of Healthy Food) Amendment Bill") was rejected with no opportunity for further consideration by a Select Committee. There was no substantive progress on: (i) limiting the marketing of unhealthy food; (ii) improving the provision of healthy food to school children; and (iii) considering taxes on soft drinks (as per various US jurisdictions) or taxes on high sugar/fat foods such as in several European countries.23 Others have reported on the lack of a national strategy to address obesity and that in NZ “population approaches to reduce the burden of obesity have been systematically cut in the last 3 years; for example, the National Healthy Eating Health Action Strategy is no more, Mission On has disappeared [a physical activity programme], and the requirement for schools to provide healthy food has been abolished.”24
Physical activity: The
Government has enhanced support for sport in schools
(Kiwisport25), has provided modest support for
parts of a national cycleway, and has funded some innovative local initiatives
to improve cycling and walking.26 Nevertheless,
the focus and budget for public transport (and cycling and walking) remains tiny
compared to established roading in recent government agency
No progress on improving nutrition and mixed progress on supporting enhanced physical activity
As above for “high blood glucose” – particularly the issues around nutrition.
In summary, there has been some progress by the current
Government on tobacco control in this last electoral term. However, the impact
of the measures implemented is difficult to assess as there are no recent data
on the key indicator of progress (reductions in smoking prevalence) since
There has been very limited progress in each of the other
four risk factor areas in Table 1. This lack of attention to prevention may be
considered wasteful, given the growing evidence that many preventive
interventions are cost-effective and will ultimately save funds for the
taxpayer-funded health sector.29 Indeed,
improved prevention of heavy alcohol use and misuse would probably generate a
rapid return on investment (e.g., with short-term reductions in hospitalisations
for injury and in crime prevention). Improved alcohol control would also protect
front-line health workers from abuse and assault, and improve the efficiency of
delivering acute health services (especially in emergency
A more detailed review of the NZ Government’s
performance in the area of primary prevention would encompass other important
risk factors (e.g., high cholesterol and fruit and vegetable
consumption31), the acute crisis of the 2009
influenza pandemic, and the critical need to both mitigate and start to adapt to
global climate change. A more comprehensive review would also assess the degree
to which primary preventive measures have been implemented, or have impacted
upon, the marked disparities in levels of these five risk factors by ethnicity
and socio-economic status.31 Similarly, such a
review could also make comparisons with the previous Government. On this point
we briefly note that the previous Government made some progress in reducing
smoking prevalence and reducing exposure to second-hand smoke (over a nine-year
period for the Labour-led Government).28
Nevertheless, that previous Government also generally made very limited progress
on the other risk factors in Table 1.
Reasons for the lack of progress by NZ Governments in
addressing these risk factors may reflect ideology (tending towards a minimal
role of the state), the role of vested commercial interests in influencing
policy in NZ,32 and a focus by politicians on
crises (e.g., the global financial crisis and events such as the Christchurch
earthquake). Nevertheless, addressing primary prevention should not be
sidelined, if politicians wish to protect health, reduce inequalities, and at
the same time make the best use of limited health dollars.
Nick Wilson, George Thomson, Richard Edwards
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K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions on
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