Public Health Expert

Professor Tony Blakely is an epidemiologist at the University of Otago, Wellington. He has an extensive portfolio of research. Tony initiated and implemented the New Zealand Census-Mortality Study (NZCMS) in the late 1990s, a pioneering study linking the national censuses with mortality data to allow monitoring and research on ethnic and socio-economic inequalities and the contribution of smoking to mortality (the NZ census periodically includes smoking). He has also led the parallel study, CancerTrends, that links census and cancer registration data to allow cancer incidence and survival studies.

Screening for lung cancer in NZ is highly unlikely to be cost-effective: New NZ study - Public Health Expert

Sep 03, 2018

Dr Richard Jaine, Dr Giorgi Kvizhinadze, Prof Nick Wilson, Prof Tony Blakely There is reasonably strong evidence screening for lung cancer with low-dose computed tomography (LDCT) scans is effective at reducing lung cancer mortality. However, new research suggests it is highly unlikely to be cost-effective in NZ. We have just published the first NZ study to examine the cost-effectiveness of lung cancer screening in the journal Lung Cancer, and we estimate that it would cost NZ$154,000 per quality-adjusted life-year (QALY) gained – even among heavy smokers [1]. This means that gaining the equivalent of one year of life in perfect health from lung cancer screening comes with a price tag of about $150,000. This suggests that if we want to reduce the burden of lung cancer in NZ but still have to work within a finite health budget, we should … Read More

A 100 years ago today – the likely first NZ death from the 1918 influenza pandemic - Public Health Expert

Aug 28, 2018

Prof Nick Wilson, Dr Jennifer Summers, Prof Michael Baker The 1918 influenza pandemic began to kill New Zealanders 100 years ago today. Ultimately it killed 9000 NZ citizens and so is by far the largest natural disaster to hit this country. In this blog we reflect on this event and draw links with the present day pandemic risks (including from synthetic bioweapons). We highlight the importance of continuing to invest in public health infrastructure and pandemic preparedness and planning. The start of this pandemic was the beginning of the worst single natural disaster to kill New Zealanders in recorded history. Around 9000 NZ citizens died – as per the updated estimate in the recent book by historian Prof Geoffrey Rice [1]. In comparison, an estimated 258 people died in the Hawkes Bay earthquake of 1931 (the next biggest natural hazard … Read More

The case for lowering salt levels in processed foods is now even stronger – new research - Public Health Expert

Jun 26, 2018

Prof Nick Wilson, Dr Cristina Cleghorn, Dr Nhung Nghiem, Prof Tony Blakely The scientific case for lowering dietary salt intakes became a bit confused in recent years by studies which suggested that both low sodium (salt) intake and high sodium intake were associated with higher risk of death. But new research suggests that low sodium intakes are not associated with a higher risk of death and the results for low sodium intake in these other studies may be largely due to inaccurate measurement of sodium intake. So the scientific community can now more confidently recommend that governments progress interventions to reduce sodium levels in processed foods. This could substantially benefit health, reduce health inequalities and save health sector costs. What does the new study show? The newly published research compared the association between salt (sodium) intake and death, based on … Read More

Capitalising on NZ’s linked data by increasing IT and researcher capacity: Opportunity is knocking - Public Health Expert

Jun 19, 2018

Tony Blakely, Andrea Teng, Sheree Gibb, Nhung Nghiem, Barry Milne, Andrew Sporle, Gabrielle Davies, Nevil Pierce, Ruth Cunningham, and on behalf of the Virtual Health Information Network A key strategic advantage for NZ and research is our national routinely-collected datasets.  This can generate new knowledge in academia, service delivery and policy.  Conversely, NZ has some key barriers to overcome to make the best use of that data – most importantly, data systems infrastructure and research capacity.  In this blog, we consider these opportunities and barriers.  We believe we are at a moment in time when a major centralized investment is required that will return dividends to NZ citizens and academics through better policy making and new knowledge discovery. NZ has a key natural advantage in research: our national datasets. NZ is also a small country with strong links … Read More

How much of Māori:European mortality inequalities are due to socioeconomic position and tobacco? - Public Health Expert

Jun 15, 2018

Prof Tony Blakely, Dr Andrea Teng, Prof Nick Wilson Policy-makers need to know how much of ethnic inequalities in health are due to socioeconomic position and tobacco smoking, but quantifying this is surprisingly difficult. In this Blog, and accompanying video, we summarize new research using NZ’s linked census-mortality data, blended with innovative new ‘counterfactual’ methods to determine causal relationships that can shed light on policy-relevant questions.  A half or more of Māori:European/Other inequalities in mortality are due to four socioeconomic factors (education, labour force status, income and deprivation), and this percentage is stable over time for males but increasing for females.  Eradicating tobacco will not only improve mortality for all sociodemographic groups, but reduce absolute inequalities in mortality between Māori and European/Other by a quarter. It is hard to think of another intervention that will reduce inequalities by … Read More

Smoke, heat or vapour? Ideas for risk-proportionate regulation to make World Smokefree Day irrelevant by 2025 - Unsorted

May 31, 2018

Richard Edwards, Anaru Waa, Janet Hoek, Louise Thornley, Nick Wilson. ASPIRE 2025, Department of Public Health, University of Otago, Wellington World Smokefree Day is an apt day on which to propose some ideas that may greatly increase momentum for the achieving Smokefree Aotearoa 2025. Tobacco and vaping products such as e-cigarettes vary greatly in their likely adverse health effects and overall impact on population health. Reflecting this, the Ministry of Health announced in May that it will investigate ‘risk-proportionate’ regulation for tobacco and vaping products. This blog discusses public health considerations in developing the new regulatory framework, and proposes key features of a risk-proportionate approach. We argue the framework should aim to minimise harm and maximise benefits to population health by accelerating progress towards New Zealand’s Smokefree 2025 goal. As well as clarifying the appropriate regulatory approaches to … Read More

A public health perspective on taxing harmful products - Public Health Expert

Apr 17, 2018

Prof Nick Wilson, Prof Tony Blakely, Dr Amanda Jones, Dr Linda Cobiac, Dr Nhung Nghiem, Dr Anja Mizdrak, Dr Cristina Cleghorn The New Zealand Government has set up a Tax Working Group to consider reforms of the tax system. In this blog we briefly discuss some of the opportunities for tax reform that will potentially improve health and lower health costs, reduce health inequalities and enhance environmental sustainability. Regular reviews of the tax system are important given that taxation has a large impact on human well-being, the economy and the environment. In the past, NZ has been smart from a health perspective in using taxes to ensure relatively high tobacco prices to reduce this important risk factor (NZ is one of the world leaders in terms of high tobacco prices). But in other ways NZ Governments have acted sub-optimally … Read More

And now the Brits are doing it: A sugary drink tax levy on the industry - Public Health Expert

Apr 03, 2018

Prof Tony Blakely, Prof Nick Wilson, Dr Anja Mizdrak, Dr Cristina Cleghorn From 1 April 2018, the UK is putting in place a type of sugary drinks tax – actually a “soft drinks industry levy”. This blog reviews how they are doing it, early signs of its success, and ponders its relevance for NZ.  We also take this opportunity to point out some problems with a recent NZIER Report on sugary drink taxes.  This is not an April fool’s joke.  On 1 April, the British put in place a sugary drinks tax – actually, a tiered soft drinks industry levy.  The UK is joining many other countries and numerous jurisdictions that now have some variety of a sugary drinks tax,1 a public health measure that is rapidly gaining traction amongst countries concerned about their growing rates of obesity and … Read More

A century of health inequalities in NZ – new data - Public Health Expert

Mar 26, 2018

Prof Nick Wilson, Dr Matt Boyd, Dr Andrea Teng, Prof Tony Blakely Everyone knows that socio-economic inequalities in health exist – in recent times. But one thing we do not know is whether they have always been there. We have just published a study that looks at two historical datasets – with one of these suggesting life span differences by occupational class as measured 100 years ago. We find strong differences in life expectancy by occupational class among men enlisted to fight in the First World War (but not actually getting to the frontline). Whilst not definitive evidence (it is hard to get perfect evidence from 100 years ago!), it does suggest that socio-economic inequalities in mortality have existed for at least 100 years in NZ. In this blog we also take the opportunity to discuss what might be done … Read More

Dietary counselling – how effective and cost-effective is it? - Public Health Expert

Mar 20, 2018

Prof Nick Wilson, Dr Cristina Cleghorn, Dr Linda Cobiac, Dr Anja Mizdrak, Prof Cliona Ni Mhurchu, Prof Tony Blakely In this blog we consider recent literature (particularly reviews) on the effectiveness and cost-effectiveness of dietary counselling as a health intervention. Most studies suggest that dietary counselling is effective though the benefits are typically modest and short-term. The literature on cost-effectiveness is mixed, and there is substantial uncertainty about long-run cost-effectiveness given the typically short-term trials involved. Addressing the obesogenic environment will have potentially (much) larger gains, and due to substantial reductions in obesity-related disease it is likely to be cost-saving. However, governments, policy-makers and the public are often interested in counselling interventions, necessitating close attention to cost-effectiveness of these interventions relative to more structural changes to the environment. In NZ, dietary counselling is delivered by dietitians, practice nurses, … Read More