Editorial: Narrow focus on rheumatic fever has not heated homes

Prime Minister Bill English. Photo / Mark Mitchell

One of the initiatives Bill English has brought to public administration in this country is the publication of 10 very precise targets for health, education and other state services.

They are as specific as, for example, to reduce the incidence of rheumatic fever by two thirds within five years. The targets were announced in 2012 and fell due in June.

Rheumatic fever had fallen by only a third.

This week we reported that, "health experts who were sceptical back then [2012] are furious now".

Otago University's Dr Nevil Pierse told our reporter, "Rheumatic fever was a small silo for a big problem. In focusing on rheumatic fever alone, the Government missed the big picture. Or they're refusing to see it."

The big picture, or course is poorly ventilated, damp houses. Rheumatic fever is one of the ailments suffered by children in those conditions.

But Pierse, a housing researcher, did not do justice to the programme's intentions.

Although rheumatic fever is a very serious illness in this country - the incidence, proportionate to population, was 14 times higher than in any other OECD country in 2011 - the target was chosen with the wider problem in mind.

Rightly or wrongly, English believes a single specific target is the best way to focus an organisation on all the practical steps that will help to meet it.

For a disease such as rheumatic fever, those steps obviously include finding ways to improve the heating and ventilation of houses where necessary.

If that can be fixed then not only rheumatic fever but asthma, bronchitis and pneumonia are likely to be reduced.

Given the target and $65 million to meet it, the Ministry of Health and district health boards set up school clinics to treat sore throats and community "drop-in" centres for advice on how to keep houses healthy and referrals for help.

The school clinics are credited with some success, the "healthy homes initiative" less so.

The Auckland DHB has been told the centres "were not rapid, drop-in, convenient or attractive to whanau and youth".

Messages either did not reach vulnerable families or were not understood. The same families kept getting sick. Some young people did not go for their penicillin injections. It can be hard to help people.

But health academics also blame the ministry's criteria for limiting help to households assessed as most needy on the basis of low income, overcrowding and having more than one child. Those who met those risk factors were visited by a nurse and given advice but the funds did not stretch to providing them with insulation or curtains and carpets.

Labour leader Jacinda Ardern says there should be no tolerance of such rental properties in this country and she is right. Labour proposes to make it illegal to provide a house that is not warm, dry and healthy.

But a law cannot force people to provide rental houses and public funds will always be finite. Priorities have to be set and ways found to reach the needy with advice and practical help.

This target was missed and those who are calling it a failure also complain that its funding has been reduced. They need to propose a better way to ensure money is spent on actions that produce results.