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.

Testing for COVID-19 in NZ to Achieve the Elimination Goal - Public Health Expert

Apr 06, 2020

Nick Wilson,1 Ayesha Verrall,1,2 Len Cook,3 Alistair Gray,3 Amanda Kvalsvig,1 Michael Baker,1 (1epidemiologists, 2infectious disease physician, 3statisticians) In this blog, we raise ideas for how New Zealand might optimise testing to both identify cases in the community as part of the COVID-19 elimination strategy, and to confirm when the virus has been completely eliminated from the country. These are urgent issues to clarify in order to minimise time spent under lockdown conditions and allow the economy and health system to return to more normal functioning. The priority is to continue testing symptomatic people, with the sensitivity of case detection expanded by steadily broadening the case definition and ensuring wide geographic and demographic coverage. After that, testing to assess the elimination goal could involve testing of higher-risk exposed groups, potentially using pooled specimens and serology, along with sewage testing. Along … Read More

Might a ‘Coasean’ social contract mitigate overall societal harm from COVID-19? - Public Health Expert

Apr 03, 2020

Brian Williamson1, Prof Nick Wilson2 (1Economic consultant, UK; 2University of Otago Wellington) In this blog, we outline how a win-win social contract could be forged to address the major dimensions of response to the COVID-19 pandemic when using a mitigation strategy: the particular need to protect older people from high death rates and the desirability of maximising freedom from lock-downs and economic wellbeing for nearly everyone else. The social contract could take a range of forms, but one approach could be for a government to offer a period of extra payments to older age-groups to commit to home quarantine, with the option of opt out either with no payment or an insurance surcharge reflecting risk until either a vaccine arrived or until protective immunity arose in the population. In response to the COVID-19 pandemic, most countries have adopted a ‘flattening … Read More

Avoidable hospitalisations: Helping our health system get through COVID-19 - Public Health Expert

Mar 25, 2020

Associate Prof George Thomson, Louise Delany, Prof Nick Wilson While it is possible that New Zealand can use intense public health controls to eradicate COVID-19 from the country – we must also plan for other scenarios where thousands of New Zealanders are sick – including many urgently hospitalised.1 Better resilience for our health system in the face of COVID-19 must include reducing current avoidable pressures that are not COVID-related. Emergency policies should include the reduction of preventable injuries that currently take a toll on hospital and health resources. These include those caused by alcohol, avoidable home accidents and road crashes. Increased alcohol prices, reduced sales hours, and reduced or banned advertising of alcohol would make significant and valuable differences for hospital staff, medical centres and patients. Even with reduced private road traffic, two immediate policies to help are (1) … Read More

The maths and ethics of minimising COVID-19 deaths in NZ - Public Health Expert

Mar 23, 2020

Prof Tony Blakely, Prof Michael Baker, and Prof Nick Wilson The NZ Government must do more to clearly articulate its COVID-19 strategy: eradication or ‘flattening the curve’ mitigation. But to do so means understanding the maths and ethics of both these strategies. In this blog, we adapt our work for Australia (just published in this blog) to the NZ setting. The NZ Government is rapidly ratcheting up its control measures to deal with the threat of the COVID-19 pandemic. But in our view at least, there is still insufficient clarity about what strategy it is taking. Is it going for eradication (as was the successful goal for the SARS pandemic and seems to have been achieved in China for COVID-19), or is it going for ‘flattening the curve’ (mitigation) as per the traditional approach with influenza pandemics? Similarly, in … Read More

Proposed Vaping Regulations for NZ: Strengths and Limitations - Public Health Expert

Feb 25, 2020

Janet Hoek, Richard Edwards, Andrew Waa, Nick Wilson, George Thomson Minister Jenny Salesa announced the Government’s long-awaited Smokefree Environments and Regulated Products (Vaping) Amendment Bill on Sunday 23 February.  The Bill contains some important provisions as it works to strike a balance between ensuring regulated products are available to smokers wishing to quit, while at the same time minimising uptake by young people. Its proposed extension of prohibitions on advertising and sponsorship from tobacco products to all vaping and smokeless tobacco products, including e-liquids, are important steps.  However, there are also opportunities for the Bill to go further to protect young people from vaping uptake. In this blog, we discuss the provisions, as summarised in the Ministry of Health’s Factsheet, and outline important questions that we argue the final Act should address. The Bill brings the prospect … Read More

Updating the role of the state: the case of housing in New Zealand - Public Health Expert

Feb 17, 2020

Prof Philippa Howden-Chapman Housing policy is building up to be the key election issue again. In this blog I reflect on the importance of the role of the New Zealand Government in improving access to affordable housing. I look at what the Government has been doing to increase quality public housing and to reduce homelessness and why the public housing waiting list is getting longer. The challenge Healthy, safe, affordable housing is a critical foundation of population health and wellbeing. Shortages in many OECD countries, including New Zealand and Australia, have led to increasing homelessness. This is not a new phenomenon. It has been recognised by numerous academics and commentators for more than a decade. However, prevailing neo-liberal policies largely over the last decade, led to little investment in public housing. By 2016, the lack of affordable housing was … Read More

Getting Through Together: Ethical Values for a Pandemic - Public Health Expert

Feb 14, 2020

Ruth Cunningham, Charlotte Paul, Andrew Moore Public health responses to infectious diseases such as COVID-19 require us to draw on our common humanity and be explicit about our values. Recognising this will help us make good decisions in difficult situations so that, for example, the need to impose restrictive measures and to protect ourselves does not conflict with fairness, respect, and neighbourliness.  In Aotearoa/NZ, Getting Through Together already provides a statement of shared values which can be used to guide a wide range of responses. In response to Wilson and Baker’s timely piece on preparing for a potentially severe novel coronavirus (COVID-19) pandemic, Shanthi Ameratunga raises the spectre that ‘keeping it out’ could morph into ‘keeping them out’. Her observation is a proper reminder that epidemics require us to draw on our common humanity as … Read More

NZ Should Prepare for a Potentially Severe Global Coronavirus Pandemic - Public Health Expert

Feb 10, 2020

Prof Nick Wilson, Prof Michael Baker In this blog we briefly summarise our assessment of the highly uncertain new coronavirus threat. Given its potential to become a severe and prolonged global pandemic, a precautionary response now means activating all components of our pandemic plan, with a particular focus on ‘keep it out’. NZ has many natural and institutional advantages in managing this major health and economic threat. Now is the time for maximum proactivity. There is much we still don’t know about the threat posed by this new coronavirus. It appears to be highly transmissible and is spreading rapidly in China with a doubling time of about a week, as reported on 31 January [1]. It also has a concerning case fatality risk (CFR) of perhaps a few percent (albeit less than SARS). However, the exact risk for people currently … Read More

A preventable measles epidemic: Lessons for reforming public health in NZ - Public Health Expert

Feb 05, 2020

Prof Michael Baker, Prof Nick Wilson, Louise Delany, Prof Richard Edwards, Prof Philippa Howden-Chapman The current national measles epidemic in New Zealand is amongst the largest we have experienced in the last 40 years. It can be linked to the problems created by long-term erosion and fragmentation of national public health capacity. Fortunately, the present Health and Disability System Review provides an opportunity to describe and build the kind of public health capacity needed to manage measles, pandemics and other population health threats. We argue for consolidating a range of dispersed public health activities into a strong national agency, Public Health Aotearoa, to take responsibility for the multiple public health challenges faced by NZ. Introduction The current measles epidemic affecting New Zealand (NZ) is the result of multiple systems failures over a decade or more. In this blog, we argue … Read More

Tobacco Excise Taxes and the Smokefree 2025 Goal: Some Ways Forward - Public Health Expert

Jan 16, 2020

Janet Hoek, Richard Edwards, George Thomson, Andrew Waa, Nick Wilson Debate over tobacco tax increases has intensified as research indicates potentially conflicting policy directions. On the one hand, excise tax increases continue to stimulate quit attempts among smokers yet, on the other hand, they may lead to financial hardship for some smokers and increase retail crime. In this blog, we explore how allocating a proportion of tobacco tax revenue to assist smokers, and funding other complementary measures, could help avoid unintended outcomes and support continuation of an effective policy intervention. As the last scheduled tobacco excise tax increase came into effect on 1 January 2020, critics called on the Government to stop increasing the cost of tobacco, a measure they argue causes unacceptable hardship to some smokers and pose risks to those selling tobacco products.  New Zealand First, a … Read More