NZMA Home

Table of contents
Current issue
Search journal
Archived issues
NZMJ Obituaries
Classifieds
Hotline (free ads)
How to subscribe
How to contribute
How to advertise
Contact Us
Copyright
Other journals
The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 14-October-2011, Vol 124 No 1344

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 Region).1
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 period.
Results in the form of new policies implemented and areas of relative inaction are presented in Table 1.

Table 1: New primary prevention policies and areas of apparent inaction by the NZ Government in the last electoral term (November 2008 to September 2011) that relate to primary prevention of the top five health risk factors

Key risk factor (ranked)*
New primary prevention policies and apparent areas of inactivity
Summary around progress
Tobacco use
The Government 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 goal.3 8 9
 Some progress, but gaps remain which need to be addressed if substantive progress towards the smoke-free nation goal is to be achieved
Alcohol use (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
High blood pressure
 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.
High blood glucose
 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 plans.27
No progress on improving nutrition and mixed progress on supporting enhanced physical activity
Overweight and obesity
 As above for “high blood glucose” – particularly the issues around nutrition. As above.
Note: * Ranked by lost DALYs for high-income countries in the region which includes New Zealand (Western Pacific Region).1
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 2009.28
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 departments).30
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
Department of Public Health, University of Otago, Wellington, New Zealand
nick.wilson@otago.ac.nz

References:
  1. World Health Organization. Global Health Risks: Mortality and burden of disease attributable to selected major risks. Geneva: The World Health Organization, 2009.
  2. Ministry of Health. Looking upstream: Causes of death cross-classified by risk and condition, New Zealand 1997. Wellington: Ministry of Health, 2004.
  3. Blakely T, Thomson G, Wilson N, et al. The Māori Affairs Select Committee Inquiry and the road to a smokefree Aotearoa. N Z Med J. 2010;123(1326):7-18.
  4. New Zealand Government. Government Response to the Report of the Māori Affairs Committee on its Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori (Final Response). Wellington: New Zealand Parliament, 2011.
  5. Health Sponsorship Council (HSC). Health Sponsorship Council Annual Report for the year ended 30 June 2010. Wellington: HSC, 2010. http://www.hsc.org.nz/sites/default/files/HSC-Annual-Report-100630.pdf
  6. Wilson N, Edwards R, Parry R. A persisting second-hand smoke hazard in urban public places: Results from fine particulate (PM2.5) air sampling. N Z Med J. 2011;24(1330):34-37.
  7. Wilson N, Thomson G, Blakely T, et al. A new opportunity to eliminate policy incoherence in tobacco control in New Zealand. N Z Med J. 2010;123(1311):89-92.
  8. Wilson N, Blakely T, Hoek J, et al. The Government's goal for a Smokefree New Zealand by 2025: more decisions, and more detail, are urgently needed. N Z Med J. 2011;124(1331):111-3.
  9. Thomson G, Wilson N. New Zealand: Smoke-free by 2025? Tob Control. 2011;20:255.
  10. New Zealand Law Commission. Alcohol in Our Lives: Curbing the Harm (NZLC R114). Wellington: New Zealand Law Commission. http://www.lawcom.govt.nz/project/review-regulatory-framework-sale-and-supply-liquor/publication/report/2010/alcohol-our-lives, 2010.
  11. Kypri K, Maclennan B, Langley JD, et al. The Alcohol Reform Bill: more tinkering than reform in response to the New Zealand public's demand for better liquor laws. Drug Alcohol Rev. 2011;30:428-33.
  12. Wilson N, Imlach Gunasekara F. National alcohol plans. New Zealand's alcohol plan is less than "half hearted". BMJ. 2011;342:d2147.
  13. Maclennan B, Kypri K, Langley J, et al. Public sentiment towards alcohol and local government alcohol policies in New Zealand. Int J Drug Policy. 2011;[E-publication 8 July].
  14. Wagenaar AC, Tobler AL, Komro KA. Effects of alcohol tax and price policies on morbidity and mortality: a systematic review. Am J Public Health. 2010;100:2270-8.
  15. Cobiac L, Vos T, Doran C, et al. Cost-effectiveness of interventions to prevent alcohol-related disease and injury in Australia. Addiction. 2009;104:1646-1655.
  16. NICE (National Institute for Health and Clinical Excellence). Alcohol-use disorders: preventing the development of hazardous and harmful drinking (NICE public health guidance 24) London: NICE. http://www.nice.org.uk/nicemedia/live/13001/48984/48984.pdf , 2010.
  17. McLean RM, Mann JI, Hoek J. World Salt Awareness Week: more action needed in New Zealand. N Z Med J. 2011;124:68-76.
  18. Bibbins-Domingo K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010;362:590-9.
  19. Joffres MR, Campbell NR, Manns B, et al. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Can J Cardiol. 2007;23:437-43.
  20. Asaria P, Chisholm D, Mathers C, et al. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007;370:2044-53.
  21. Cobiac LJ, Vos T, Veerman JL. Cost-effectiveness of interventions to reduce dietary salt intake. Heart. 2010;96:1920-5.
  22. Gorton D, Eyles H, Ni Mhurchu C, et al. Removal of the requirement for schools to only sell healthy food a giant leap backwards. N Z Med J. 2009;122:130-2.
  23. Holt E. Hungary to introduce broad range of fat taxes. Lancet. 2011;378:755.
  24. Signal S, Firestone R, Mann J, et al. New Zealand’s shocking diabetes rates can be reduced—9 urgently needed actions. N Z Med J. 2011;124(1340):89-92.
  25. Key J. Kiwisport initiative good for young people (media release, 11 August): NZ Government. http://www.beehive.govt.nz/release/kiwisport+initiative+good+young+people, 2009.
  26. NZ Transport Agency (NZTA). Walking and cycling model communities announced. Wellington: NZTA, 2010. http://www.nzta.govt.nz/about/media/releases/725/news.html
  27. NZ Transport Agency (NZTA). NZ Transport Agency Statement of intent 2011–2014. Wellington: NZTA, 2011. http://www.nzta.govt.nz/resources/statement-of-intent/docs/soi-2011-2014.pdf
  28. Ministry of Health. Tobacco Use in New Zealand: Key findings from the 2009 New Zealand Tobacco Use Survey. Wellington: Ministry of Health, 2010.
  29. Vos T, Carter R, Barendregt J, et al. Assessing Cost-Effectiveness in Prevention (ACE–Prevention): Final Report: University of Queensland, Brisbane; and Deakin University, Melbourne. www.sph.uq.edu.au/bodce-ace-prevention, 2010.
  30. Imlach Gunasekara F, Butler S, Cech T, et al. How do intoxicated patients impact staff in the emergency department? An exploratory study. N Z Med J. 2011;124(1336):14-23.
  31. Wilson N, Blakely T, Foster R, et al. What are the priority health risk factors for researching preventive interventions as part of NZACE-Prevention? [Technical Report 1]. Wellington: University of Otago. http://www.otago.ac.nz/wellington/research/bode3/publications/otago018729.html, 2010.
  32. Jenkin GL, Signal L, Thomson G. Framing obesity: the framing contest between industry and public health at the New Zealand inquiry into obesity. Obes Rev. 2011;[E-publication 13 August].
     
Current issue | Search journal | Archived issues | Classifieds | Hotline (free ads)
Subscribe | Contribute | Advertise | Contact Us | Copyright | Other Journals