Prior to Covid, successive governments’ approaches to public health meant that we had central government ready and able to command District Health Boards to stop the sale of soda at hospital cafeterias, but unable to tell whether hospital staff were vaccinated during a measles outbreak caused by failure to make sure everyone was getting their measles shots.
I worry that a new Public Health Agency will find itself tempted to shift back to those kinds of priorities once Covid is eventually in our rearview mirrors – and potentially even before then.
This week’s column at Newsroom argues that the proposed Public Health Agency should be split into two parts, with one party focused on contagious disease.
The problem was not a fragmented DHB system. Rather the problem was that public health efforts from the Ministry of Health and granting agencies focused on non-communicable disease at the expense of communicable disease.
And it is all too easy to see how that problem emerges.
Governments have a harder time dealing with things that impose longer term risk than with things imposing present costs. Hospitals must deal, all the time, with the costs associated with diabetes, with smoking, and with harmful alcohol use. While smokers pay a lot more in tobacco excise than they cost the government, the health system still bears the burden. And health professionals who deal daily with those suffering the longer-term consequences of poor diet, heavy drinking, and smoking can be powerful advocates for focusing on those problems.
So, it is always tempting, when resources are scarce, to shift focus away from workstreams dealing with longer term risks towards ones dealing with current problems. For a public health system, contagious disease is a bit like sewage network maintenance for a city council. There is always something that is a more pressing concern until suddenly there is not.
That is one reason that a dedicated agency, like Taiwan’s, can provide impressive results. Having only one job means less chance of being diverted into other tasks.
And our Ministry of Health, pre-Covid, was frequently diverted.