Friday, September 13, 2013

More rheumatic fever in Northland

Remember the government's Better Public Services targets and how they were going to cure all manner of ills up to and including a reduction in the incidence of rheumatic fever in children? The targets were criticised at the time for failing to address underlying problems such as lack of jobs or affordable childcare, but that hasn't stopped us wasting a bunch of money on them. 

One of the targets that came in for the heaviest criticism was that aiming to reduce rates of rheumatic fever in children. First, let's be clear:  no one wants rheumatic fever in our communities. It's a disease of poverty and should have gone the way of smallpox. It is an indictment that is in New Zealand at all, even worse that it is present at levels seen in developing countries. The key reason children get rheumatic fever is that they live in cold, damp housing. If we want to get rid of rheumatic fever, we need to ensure children live in decent housing that's not overcrowded. How hard is that?

Too hard, it seems. The government's preferred method of dealing with high rates of rheumatic fever was throat swabs. According to the Ministry of Health:
If you live in a high risk area or are Māori or Pacific and have a sore throat, please see a doctor or nurse quickly. There are throat swabbing programmes running in many primary and intermediate schools in high risk areas. If your doctor or nurse thinks you may have strep throat, you’ll be given antibiotics to clear up the infection before it can develop into rheumatic fever. It’s important to take the full course of antibiotics to stop the infection.
In order for this to work, you need to know you live in a high-risk area; you may need to see a doctor after-hours which you may not be able to afford; and your child's school needs to have a throat swabbing programme. It also assumes that even if everything else goes to plan, you can afford to fill out the prescription. To be fair, the Ministry is also offering 'housing-related interventions' through its Healthy Homes Initiative in Auckland, but this only applies to people living in state houses.

So given its head-in-the-sand approach to dealing with poor quality housing, it was not surprising - but still discouraging - to hear on Radio New Zealand's news this morning that rates of rheumatic fever in Northland have not only not fallen but seem to be up from last year. Unfortunately, this item was tucked away in the Te Manu Korihi news whereas it really needed to be part of the main news, and the Minister hauled in for questioning (maybe he was later). 

It's clear this National government dislikes social housing, and is bailing out of providing it as fast as it can. But is it really cheaper to leave low-income families to the vagaries of the housing market then pick up the pieces through the health system, including heart operations, and children who may be impaired for the rest of their lives? The government bangs on incessantly about working across sectors and improving efficiencies, so let's see some. Because what we're doing isn't working.  

Post-script: A visiting Swedish paediatrician and MP, Dr Anders W Jonsson, has been quoted as saying that until he came to New Zealand he had never seen a child with rheumatic fever in his life. New Zealand used to rank with the likes of Sweden in its children's healthcare, but baby won't you look at us now.