Tony Ryall
21 February, 2013
Massey University College of Health Opening
Thank you for the introduction Vice Chancellor Steve Maharey.
It is a pleasure to be here to open Massey University’s new College of Health.
Three Campuses – Albany, Manawatu and Wellington, 2,000 students and 300 staff all focussed on preventing disease and
promoting well-being using leading edge research and teaching.
There are a great many esteemed members from Health here today.
I’d like to acknowledge Professor Sir Peter Gluckman, Chief Science Advisor to the Prime Minister – and Emeritus
Professor Sir Mason Durie, who led the establishment of the College. He’ll be sharing his vision of the College next.
I am happy to report that New Zealand is making very good progress in patient care.
Across the country throughout general practices and hospitals–patients are waiting shorter times for treatment, and
record numbers of them are now getting the operations they need.
But we all must continue working to future proof the country’s health services against the challenges thrown up by an
ageing population.
I am expecting the new Massey University College of Health to come up with affordable solutions to keeping New
Zealanders out of the doctor’s waiting room and out of hospital!
Massey has always demonstrated a strong entrepreneurial approach to meeting the challenges of the day.
It was formed to in response to New Zealand’s needs for higher education in agriculture.
Then it successfully adapted to a very different landscape in subsequent years expanding over the last decade into three
different regions.
It is this mix of practicality and innovation –- that will be in increasing demand across New Zealand’s health service.
Financial and Demographic Challenges
Our country faces a significant fiscal deficit and growing public debt.
Only four years ago the government owed $8 billion. Taking the sharp edges off the recession has seen that debt grow to
$60 billion today. In four years’ time, we expect that will peak at $73 billion.
To control that growing debt, the government is working towards a balanced budget in 2014/15.
That means a strong focus on public spending, and getting the most out of every dollar.
Health is a fifth of all government spending so we in the public health service have an important role to play in that.
Overseas Health Budgets
You’ll all be aware of the significant pressure on health budgets around the world. In Greece, there’ve been reports of
maternity hospitals refusing to release new born babies to parents if the bill hasn’t been paid!
Ireland has cut what it pays health professionals, frozen recruitment, closed hospital beds and restricted medical
subsidies for older people.
Australia’s Federal Budget has stopped $1 billion of health spending to redirect to other priorities. There are signs of
workforce over-supply, as the Australian States scramble to find places for several hundred medical graduates.
New Zealand’s health services are coming through the global financial crisis in much better shape than many other
countries. We’ve increased Vote Health by around $2 billion in four years.
In 2009/10, while other OECD countries were reducing health spending, New Zealand had a 3.4 per cent increase in real
health spend, the third highest of 27 nations. As a result, New Zealand has risen to having the fifth equal highest
spend on health as a proportion of its GDP.
The latest OECD report shows New Zealand fourth for prevention and public health spending – behind the United States,
Hungary and Estonia!
But the money is still tight, increases in health spending have slowed, and it is likely to remain that way for the
foreseeable future.
Our sector has greatly benefited from a low inflation environment. For the past year CPI,(after adjusting for the
tobacco price increase) was 0.61 per cent.
Health funding has to be put into the most effective areas that we can.
That means definable, measurable initiatives that achieve results – that make a real difference to New Zealanders’
health.
Priorities for Prevention
In prevention, this government has selected a discrete number of high impact, high return preventive health targets;
immunisation, smoking and heart disease/diabetes.
This was intentional as public health dollars had been spread too thinly, on too many projects over ten years with very
little health gain to show for it.
The results in our target areas have been immediate and successful, even internationally significant. Focus and
accountability achieve results.
For example, our national Immunisation rates are now at all time high
One of the most effective ways of preventing a lot of infectious diseases is to immunise young children.
This government set a national child health target of fully immunising 95% of two-year olds –and turned the heat on DHBs
and primary care to perform. And they have. Rates have shot up.
They’ve risen from around 70% only four years ago, to 95% of two year olds now fully immunised –– across all socio
economic and ethnic groups.
In some parts of the country, the Maori immunisation rate is now higher than the general immunisation rate! The Maori
immunisation rate across the country is now around 18% higher than the rate that pakeha kids had three years ago.
Younger babies are the most vulnerable of all.
I don’t need to remind anyone of how whooping cough can affect an infant. Or of the epidemic we’re currently
experiencing. That has prompted us to offer all pregnant women free whooping cough vaccine.
As part of the Prime Minister’s drive for Better Public Services results for New Zealanders, we’re now aiming to have
eight month olds immunised.
We’ve now reset the immunisation health target to 95% of all eight month olds fully immunised with the three primary
series of immunisations by 2014
We’re already ahead.
As at the second quarter of this financial year, we have immunised 89% of all 8 month olds.
That’s a 2% increase from the previous quarter and 4% above the national target.
Smoking at a turning point
On tobacco, our Government has created a turning point in the campaign against smoking…with more actions than ever
before on a scale never seen before.
The Government has passed an unprecedented 40% increase in tobacco tax…the most effective way to prevent and deter
smoking.
Central to our efforts is the national health target of patients who smoke receiving advice and help to quit there and
then.
There’s plenty of evidence which shows that a doctor or a nurse having a conversation with a patient about their smoking
and what they can do to stop is highly effective in reducing smoking.
This is engaging our hospitals like never before. From zero to 95 per cent in four years.
We’ve brought General Practice into the target now. And that’s at 43 per cent.
We’ve legislated to phase out tobacco displays will soon pass. And plain packaging is inevitable.
When it comes to non-communicable diseases, dealing with tobacco offers the best impact for dollars spent.
Heart Disease and Diabetes Prevention
The Government is putting significant effort in heart and diabetes checks – the third of our national preventive health
targets.
Heart Disease is the leading cause of death in New Zealand.
About 16,000 people are admitted to hospital with a heart attack every year, and about 6,000 will have a stroke.
Diabetes is a major and increasing cause of disability and premature death. Its prevalence is growing at a rate faster
than population growth.
Diabetes is also a good indicator of just how responsive a health system is to people who need it most – eg detecting
and diagnosing. About 200,000 people have been diagnosed with diabetes – mostly type 2 – but there are many thousands
who have diabetes who have not yet been diagnosed.
We’re targeting improvements to the detection, risk assessment and management of these diseases. Not only have we
increased the number of cardio-vascular risk assessments, there are good improvements in the level of diabetes
management.
And, for the first time, a group of registered nurses – specialised in diabetes health care – are now authorised to
independently prescribe medication for their patients – under the guidance of a medical practitioner.
This will make life easier for patients, and make better use of nursing skills, leaving medical practitioners with more
time to spend on more complex cases.
This year we’ve set a target of 90% of eligible patients having their heart disease risk assessed. And we’re expecting
even better performance in this area.
A heart and diabetes check is really an entry point for a lot of people – and it is a great opportunity for encouraging
people to make the lifestyle changes they need to make to have healthier lives.
We need to see a significant step up in the emphasis that primary care networks are putting into more heart and diabetes
checks.
We’re trying to get 75 per cent by the end of the next financial year. We’re at around 55% now - that’s about 680,000
people - and it’s rising. But we need to go faster – we need better performance.
To that end we’ve engaged the New Zealand heart foundation to take a far more active role in working with primary care
networks to encourage much greater focus on that target
Healthy Weights
Newspaper reports say that according to a twenty year- long Auckland University obesity study, the battle against the
bulge should start while you're still a toddler.
In the reports, researchers have found if obesity can't be curbed before a child turns 4, attempts to shed the fat could
prove relatively ineffective later in life.
The University of Auckland study, funded by Cure Kids, has tracked the health of 871 Pakeha from birth to their teens,
measuring the impact on obesity of everything from TV, diet, stress and exercise to genetic factors.
The study has so far found that higher body-fat percentages in children at 7 and 11 years are associated with their
mother's weight and age at time of birth.
Maternal and newborn nutrition
This fits with advice from the Prime Minister’s Chief Science Advisor Professor Sir Peter Gluckman on the best point of
intervention for obesity.
Professor Gluckman suggests that pre-conditions for obesity are set very early and the best intervention point is
maternal and new-born nutrition.
Maternal and new-born nutrition is internationally recognised as a key area to tackle obesity.
In a recent BBC article, Prof Philippe Froguel from Imperial College London, said once obese, a child can find it
difficult to lose weight and teaching parents about the dangers of overfeeding and bad nutritional habits at a young age
would be a much more effective obesity prevention campaign.
Funding previously allocated under the Healthy Eating Healthy Action strategy is now being shifted to this new priority
area to improve maternal and child nutrition and physical activity.
The Government is also using a range of approaches to both prevent and treat obesity and to encourage New Zealanders to
eat healthy and exercise.
These include early identification of children with weight issues through the B4 School Check programme, Green
Prescriptions, Diabetes Care Improvement Package, KiwiSport, and the Fruit in Schools programme for low decile schools.
The Government also works with other organisations to improve the health of New Zealanders. For example, the total
number of hours of food advertising restrictions during children’s television time per week across the three major free
to air TV channels has more than doubled under this Government to 101 hours and 30 minutes a week.
But, as you are aware, Health cannot do it alone.
Keeping kiwis healthy goes beyond the health service.
For instance, warmer homes equal healthier families
National and the Green Party worked together to introduce a significant public subsidy for insulating homes of tens of
thousands of New Zealand families: Warm Up New Zealand: Heat Smart is spending $347 million for 230,000 homes.
We know that warmer, drier homes bring health benefits, especially for those with respiratory illness or other
conditions.
To date we’ve insulated over 200,000. I am confident that this will come to be seen as the single most significant new
public health initiative of the decade.
Warm, healthy homes are also a key factor in reducing the incidence of rheumatic fever.
I would like to take the opportunity to report some early signs of progress with another of our specific, high impact,
prevention programmes.
Action on Rheumatic Fever
Rheumatic fever is a third world disease that was allowed to linger in this country for far too long.
Now we’re spending $24 million over four years to run throat swabbing programmes with antibiotic follow-up treatment for
around 50,000 school children across high prevalence communities.
Provisional rheumatic fever hospitalisation data for 2012 shows a lower incidence rate than 2011.
In 2012 there were 169 initial hospitalisations of acute rheumatic fever (3.8 per 100,000) compared with 187 (4.2 per
100,000) in 2011.
Our goal is to reduce the incidence of this third world disease by two thirds to 1.4 cases per 100,000 people by June
2017.
While it is still too early to confirm a decreasing trend, these early signs of progress are encouraging.
As well as sore throat swabbing and follow-up antibiotic treatment if needed, programmes are also working with local
services to address other common health issues such as skin infections, healthy housing and insulation.
Another welcome development in this area, is the recent announcement of a combined Australian/New Zealand project to
find a vaccine for rheumatic fever
I’d like to take this opportunity to acknowledge the lead role our Chief Science Advisor to the Prime Minister has
played in this. Thank you Professor Peter Gluckman.
This agreement between the two Prime Ministers shows just how seriously the National-led Government is taking the fight
against rheumatic fever.
There is considerable work yet to be done but an effective vaccine against Group A Streptococcus would be a major step
forward in the long-term control of the disease.
Conclusion
This government is interested in what works.
We want to continue to put taxpayers’ money into the most effective areas that we can.
Health faces major ongoing financial challenges – irrespective of the global crisis.
And we all have to learn to adapt and do things smarter.
I look forward to the research that Massey College of Public Health will undertake making a real, practical difference
to improve the health of individuals, communities, and populations.
I commend you for your specific focus on prevention as a way of addressing issues upstream from both the health
challenges that we already face, and those that are yet to come.
It is my pleasure to officially open Massey University’s College of Health.
And I will look forward to celebrating not only the achievement of your future graduates, but also the hard work and
dedication of the staff members themselves who assist those students to succeed.
Thank you for the opportunity to be here today. I wish you every success.
ENDS