Some issues have a much more direct and immediate impact on our health system than others, one of these is our roads. Photo / File
Once more, Northland is top of the country not just geographically, or in temperatures, lifestyle or natural beauty. But road fatalities. And the region seems to be ignored when it comes to funding to improve our roads and highways. It's time for that to change, says Dr Nick Chamberlain.
Something that isn't always appreciated (by the public, media, and healthcare workers) is how much impact our health system can and does have on the health of our population.
When you're busy treating a patient who is acutely unwell or when you're saving someone's life, this may seem irrelevant, but health interventions can only contribute about 20-30 per cent of population health gain.
It's highly significant, but lifestyle (30 per cent), social determinants of health (such as income, employment, education, housing, etc) (30 per cent) have as great an impact. In case you were wondering, the final bit is due to genetics (10 per cent) and bad luck.
The huge impact of factors outside health on health is why, as a chief executive of a District Health Board, quite a lot of my time involves working with other sectors. However, some sectors and issues have a much more direct and immediate impact on our health system than others. One of these is our roads and Land Transport NZ (NZTA).
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This time last year, I read a media article about several high-risk roads that were going to get special attention and investment over the next year or so because of their high accident rates.
I noted with consternation that the closest area to Northland was the Dome Valley, ie, it appeared that Northland had been forgotten. This is at a time when we had a reported 40 road traffic deaths in Northland, which was over 10 per cent of the national total despite us having less than 4 per cent of the population.
I asked our Public Health team to research how Northland ranked against other District Health Boards and whether we consistently had high death and injury statistics so that I could understand why we were not getting the appropriate investment in our roads.
I assumed that despite 2017 and 2018 being bad years, overall we must have a relatively low injury and death rate. What else could explain why we were yet again being ignored?
Northland data was compared with regional data from Auckland, Waikato, Bay of Plenty, Canterbury, as well as national data. These areas were chosen because they have been perceived as having some of the highest motor vehicle accident rates in New Zealand.
A detailed analysis of motor vehicle accidents in Northland from 2013-2018 using multiple databases showed that:
• On balance, Northland appears to have the highest morbidity and mortality rates resulting from motor vehicle accidents in New Zealand
• Northland had the highest fatality rate caused by motor vehicle accidents in 2017 and 2018
• The rate per 100,000 population for motor vehicle fatalities and non-fatalities in Northland appears to be increasing
• Northland had a higher number of hospital discharges due to motor vehicle accidents than all other regions considered in each year. Northland's rate per 100,000 hospital discharges was much higher than the national average
• Māori have much higher morbidity and mortality than non-Māori, although some data is a bit patchy
So, data and science tell a very sobering tale I'm afraid, but one that can be told again and again when it comes to Northland. Once more, we are top of the country not just geographically, or in temperatures, lifestyle or natural beauty.
It's the same tale that is played out when comparing national health statistics - be it cardiovascular disease, stroke, cancer, suicides, meningococcal and other infectious disease rates.
However, this one is not because of poverty, our rapidly growing (easily the highest growth DHB over the past five years) and aging (over 20 per cent of our population is over 65), 35 per cent Māori, nor our rurality; although some may be contributors.
Obviously, the quality of Northland's cars, drugs, alcohol, speed and stupidity (no seatbelts, etc) all have an impact.
However, the most significant avoidable contributor is our roads. We appear to have been forgotten by the NZTA, and we have not had the same level of investment in our roads that other regions have had, nor the level of investment that our population deserves.
Over the past 10 or so months I've been liaising with the NZTA, and recently a senior official met with me and a number of other social sector and council leaders (we have a monthly Social Wellbeing Governance Group meeting that I chair).
The NZTA weren't aware of this data and are keen to work with us and have Northland DHB represented on their road safety group. That's all well and good, but I'm really clear that the only satisfactory response is increased investment in Northland roads commensurate with the amount of harm being caused on them.
Having just read about Vision Zero, the concept of a safe road safety system - zero road deaths for your family or loved ones. A wish and a philosophy we should all have for ALL road users - Drive to the conditions and get home safely.
What a wonderful aspiration, and one I'd support if we had a level playing field. But we don't - something happens immediately north of Warkworth - the roads get rougher - road noise increases significantly, the quality of the road deteriorates the further north one drives - narrow, crowded roads, with minimal passing lanes, deep culverts, uneven camber, bumps and potholes must be a significant contributor to our very high accident rates.
As you drive further north you eventually reach the stretch of road between Ruakākā and Hikurangi which is literally a "killing field" - we have plotted all the road fatalities in Northland, and that stretch of road alone has had more than 30 deaths from 2013-2018.
I assume that like the NZTA, our politicians and policymakers didn't know these figures. That is why we have not been considered for greater investment. I'm confident that we have been forgotten yet again, but also confident that once these statistics are examined, all is not LOST.
One of the best decisions leaders can make is to reverse a bad decision, and the evidence is crying out for this to happen. We have a real opportunity for a large slice of the new Infrastructure fund to be dedicated to Northland. Our population growth and (hopefully) a much larger port demand not only safety improvements such as median barriers but also more passing lanes (or extra lanes) to avoid any more congestion than we are already experiencing.
Please, fix our roads. Let's not LOSE any more Northlanders, let's not clog up our ED, ICU and wards; help us to play on a level playing field so that Northlanders can embrace ZERO deaths among our families and loved ones.
• Dr Nick Chamberlain is chief executive of Northland District Health Board
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