4. Our children are well protected from infectious disease with 94 per cent of 8-month-olds receiving the primary course of immunisation. (Auckland District Health Board)
5. Auckland's outdoor playground: great access to beaches, quiet reserves, playing fields, local pools, regional parks. (Dr Michael Hale, Healthy Food Guide nutritionist Claire Turnbull)
To view our interactive map Commuting interactive: How transport has changed in New Zealand click here.
5 Challenges
1. Health literacy: The ability to obtain and understand basic health information and services required to make appropriate decisions. GPs, health workers and the Auckland, Counties Manukau and Waitemata district health boards agree improved health literacy is important to achieving better outcomes.
2. Changing demographics: Health systems have to improve to meet the needs of Auckland's diverse communities. Thirty-one per cent of Aucklanders are Asian, 11 per cent Pacific and 8 per cent Maori, with nearly 200 different languages spoken in the Auckland region. (Auckland, Counties Manukau and Waitemata district health boards)
3. Unacceptably high rates of obesity, particularly among Pacific peoples and Maori. The Counties Manukau District Health board area, where about 40 per cent of New Zealand's Pasifika population live, has an adult obesity rate of 40 per cent - the highest in the country. About 12 per cent of New Zealand's Maori live in the district, according to Statistics New Zealand. Overall, only one in three Aucklanders are at normal weight. (Professor Boyd Swinburn, Population Nutrition and Global Health at the University of Auckland, Alfred Deakin, Professor and Director of the World Health Organisation Collaborating Centre for Obesity Prevention at Deakin University in Melbourne and Claire Turnbull)
4. Modifying people's behaviour: The choices people make about lifestyles is one of the biggest determinants of future health. Influencing people to make the best choices is crucial to improving health and wellbeing in the city. (Dr Allan Moffitt and Waitemata District Health Board)
5. Inactivity and sedentary lifestyles. Most Aucklanders aren't active enough to keep healthy. They don't walk or cycle to work, or just for pleasure. According to Statistics New Zealand, about 5 per cent of workers cycle or walk to work, with the rest opting to take public transport or drive. (Claire Turnbull, Dr Michael Hale and Professor Boyd Swinburn)
Ben Dowdle, 20, arts/commerce conjoint degree student at Auckland University, campaign director of Unmask Palm Oil, semifinalist for Young New Zealander of the Year
"In health, the challenge is to meet the demand for services. The Ko Awatea Centre at Middlemore Hospital is trying to do this by supporting self-management for 50,000 people living with long-term conditions by December 2016. It is a community rather than a hospital-focus," Mr Dowdle said.
Bonnie Zhang, 30. Moved to Auckland from Guangzhou, China, in Sept 2013.
Health services in Auckland are great, Ms Zhang says.
And she says the bedside manner is "very good".
"Most of the things are free of charge - I think the medical policy is quite good for residents here."
Hazel Cocker, 23. Moved to Auckland from Shropshire, England, in June 2013.
Ms Cocker is on a working holiday visa. While she and her boyfriend - who is from Auckland - are due to leave New Zealand in March, the couple plan to return to Auckland to live after spending some time travelling abroad.
"I've spent so much money on doctors here - GPs because I'm not eligible to sign up anywhere because I'm not a resident.
"Each time I go, I've got to pay the full amount and my prescriptions and stuff - it's a bit of a nightmare."
The GP visits had been for routine things, such as an infection on her foot from an insect bite. It had not been worth claiming for the incidents on her travel insurance, Ms Cocker said.
She had also been to hospital once since arriving in New Zealand.
"I had loads of scans and x-rays and things and it was all completely free because of the health agreement between the UK and here.
"It seems a bit silly that you have to pay so much for the doctor and then it's free when you get to hospital," she said.
Katie Wolf, 36. Moved to Auckland from Atlanta, Georgia, in the US, in Dec 2011.
Mrs Wolf and her husband had their first child Hazel, now 2, in Auckland.
The couple are expecting their second child next month.
"This has got to be one of the best places to have a baby in the world," Mrs Wolf said.
The maternity services available to parents such as having a midwife visit your home and Plunket follow-up were amazing.
"It's a very family-friendly culture,"she said.
"The free thing is obviously great but it's really just the fact that the midwife comes to your home, that I got to go to Warkworth [Birthing Centre] for four nights after I had my baby. It's that kind of mentality."
Flora Apulu, 23, mentoring services manager Genesis Youth Trust, chairwoman of Auckland Council youth advisory panel
"In my experience, young people are not accessing health services as much as they need to," Ms Apulu said.
"Even when offered free health checks they are not coming in. There are issues around teen pregnancy and kids with STDs because they did not know where to go and who to talk to and the stigma attached.
Health services should take the responsibility to take services to younger people," she said.
25 Solutions
Start the conversation
1. Better understanding between health workers and their patients.
Counties Manukau District Health Board (DHB) serves a diverse population which brings its own challenges.
Increasing the level of health literacy among patients is a huge part of achieving better health outcomes, says Margie Apa, Counties Manukau director of strategic development.
"Our job as a healthcare system is to try to make every contact with patients count by using simple language, asking questions and being responsive to patients in terms of their knowledge."
There is plenty of room for improvement on both sides, Ms Apa says.
"It's almost [like] teaching our colleagues to break these complex [medical] issues down to really small bite-sized chunks of information that patients can then receive.
"Also encouraging patients to ask questions - I think particularly among Maori and Pacific [people] which is a big population group for Counties; the community is so respectful of the knowledge and expertise of clinicians that they don't think it's appropriate to ask.
"The more they ask, the more that will tell the clinician or health professional where their knowledge is at or how much more they need," she said.
Dr Margaret Wilsher, Auckland DHB chief medical officer, says better health literacy means giving people tools to understand what it was to be healthy.
"We really need people to stand up and accept that responsibility but we can't expect them to do it if we don't enable them ... if we don't provide the materials that enable health literacy [and] if we don't provide the access to primary care in an area where they live."
2. Engage with communities to see how they would like healthcare delivered.
Aucklanders are changing and the health system must adapt, Dr Wilsher says.
Things like booking online, which is very popular in other industries such as commercial air travel, need to be an option for patients, she says.
"We need to get better at being more responsive to people in the community to enable them to take responsibility of their care."
3. Promote healthy, everyday choices in our health services and communities, such as daily exercise, smoking cessation and responsible consumption of alcohol. — Dr Dale Bramley, Waitemata District Health Board chief executive.
4. Better screening of long-term health conditions. While long-term health conditions like diabetes are becoming more prevalent, many can be managed and prevented if those at risk are identified and treated early on, Dr Dale Bramley says. For example, in the Waitemata DHB area, it is estimated up to 5 per cent of the population suffer from the disease.
"If the number with diabetes continued to rise at this rate, it would affect 20 per cent of the population in 20 years' time. The majority of long-term conditions are preventable or could be better managed," he says.
5. Create health plans for individuals so people can stay healthy and well. — Dr Allan Moffitt.
6. Improve access to healthcare for Maori and Pacific people through targeted initiatives like the Pacific Health Action Plan - a community-driven plan aimed to help significantly improve the health of the Pacific population in Auckland. — Dr Bramley.
7. Increase the number of services more locally accessible in the community. The targeted Maori diabetes service Te Hononga Oranga run by the Waitemata DHB at the Whanau Centre in Henderson is an example of this.
8. Facilitate better access to mental health services in Auckland by working closely with primary care and non-government organisation partners. — Dr Bramley.
Let's get tech-savvy
9. Change the way we deliver care to be more efficient: use of technology and "virtual care" so people can have their needs met without a face-to-face interaction if it's appropriate. — Dr Moffitt.
10. Secure health information sharing between health organisations.
Better information-sharing systems would make things easier for health workers and patients, Dr Wilsher says.
"At the moment, we all have different health information systems and we don't share that information readily, partly because our systems don't talk to one another," she says.
"We're looking for the days where we can have one health record [which] for example our patients, the hospital staff and the GP can use ... in a secure way.
"That would avoid duplication but it would also empower the patient to ... take charge. They could look at their own results, they could look at their own records, the could enter their blood pressure recordings so the doctor in the hospital could look at how that is going in their community."
11. Get more value from our health dollars as our population ages and our diabetes prevalence increases.
As Aucklanders get older and heavier, we rely increasingly on health services to tackle what goes wrong, Dr Wilsher says.
"We're generally living healthier but because more of us are living to be ... over the age of 80, more things will go wrong. We're also getting heavier and we are more likely to get diabetes and diabetes complications.
"We know what's available and we expect the health dollar to be spent on us [but we] need to use it wisely because health dollars aren't growing at the same rate as the medical problems that present to our front door.
"The only way we are going to be able to meet that demand and not compromise quality is to do things more efficiently and better," Dr Wilsher says.
Our food and drink
12. Get sugary drinks out of our schools, council venues, hospitals, churches, marae and sports and event centres.
Sugary drinks, which include soft drinks, flavoured milk and juices, are the number one source of sugar in the New Zealand diet, according to the Ministry of Health.
Dr Gerhard Sundborn and Dr Rob Beaglehole, members of FIZZ (Fighting against sugar in softdrinks) and the New Zealand Beverage Guidance Panel, are relentless campaigners against the promotion and availability of sugary drinks to children.
"Sugary drinks have no nutritional value whatsoever. Sugary drinks are cheap, readily available and accessible, and are one of the most widely advertised products, particularly to children, adolescents, and low income people," Dr Beaglehole says.
"The health effects of a diet high in sugar are well known and our poor health statistics clearly reflect this. New Zealand is in the midst of an obesity epidemic. We are the third most overweight and obese population in the OECD and rank 12th globally. More than a third of all New Zealanders aged over 15 are overweight and just over a quarter are obese."
13. More high-profile personalities helping to promote the dangers around sugary beverages and providing healthy role models for children - especially in Auckland's low socio-economic areas where sugary drinks consumption in adolescents is worse. — Dr Beaglehole and Dr Sundborn.
14. Have fast food chains make the majority of beverages sugar-free. The sugar-free option should also be the default one and actively promoted over the sugar version. — New Zealand Beverage Guidance Panel.
15. Tax sugary drinks to make them less affordable and raise awareness around health risks.
"What we're saying is there's no difference between sugary drinks and alcohol and tobacco in terms of the harm it's doing to children," Dr Beaglehole says.
"We don't give our 2-year-old kids tobacco to smoke, we don't give our 2-year-old kids alcohol to drink but we do give our 2-year-old kids sugary drinks to drink."
16. Businesses could have a sugar-free beverage week to promote healthy choices. — Dr Beaglehole.
17. Water fountains in more places so people can fill up water bottles or grab a quick drink when they're out and about. — Nutritionist Claire Turnbull.
18. Have community teams work closely with adults who buy and cook food for the household.
"These are the people we motivate to make healthier changes by inviting them to our nutrition cooking demonstrations; the changes must start from these family members," South Seas Healthcare Trust health promotions team leader Shaun Tautali says.
South Seas is a primary and community healthcare provider based in Otara, with more than 4,000 patients from some of Auckland's most high-needs communities.
19. More support from local boards to limit the number of fast food places in low-socioeconomic areas. For example, the Otara Town Centre has 16 takeaway outlets and a Subway. — Mr Tautali.
20. Support healthy food options being offered at an affordable price. — Ms Turnbull.
Get a better grassroots approach
21. Attract the best candidates for general practice by making it more appealing to graduates.
Health systems around the world led by primary care achieve better outcomes at lower costs, and New Zealand is no different, Dr Moffitt says.
Keeping people engaged in primary care can reduce the demand at hospital level and achieve higher satisfaction in the health system, he says.
Because a patient values the relationship they have with their GP, as well as other staff members at a practice, securing the best people for the job is a large part of achieving this, Dr Moffitt says.
"The reality is, out of new entrant medical students about half of them say they want to do general practice. By the time they graduate ... about 10 per cent of them say they want to do general practice.
"We really have a challenge to get the best quality of medical students going into what is actually quite a difficult ... job, as opposed to - well they've ... failed in all the specialist things they try and they end up doing general practice and they're not really satisfied with it," Dr Moffitt says.
Get moving
22. Have bars and restaurants offer a wider range of non-alcoholic and low-sugar drinks. — Ms Turnbull.
23. Adopt a local alcohol policy to stop the worst bingeing. Trading hours should be reduced with consistent closing times so people don't drive home after a late-night drink in town. — Dr Michael Hale.
24. Develop a good-quality network of cycleways and walkways, including one across the harbour bridge, so people can safely get to their destination on bike or on foot. — Dr Hale and Ms Turnbull.
25. Strengthen the Auckland Plan to create a sustainable, healthy transport system for the future. — Professor Boyd Swinburn.
The series
• Monday: Transport
• Tuesday: Economy
• Yesterday: Housing
• Today: Health and wellbeing
• Tomorrow: Recreation and leisure.
Now it's your turn
What are your ideas for improving Auckland? They could be a way to perk up your local park, or a big-ticket investment for the whole city and beyond. Email newsdesk@nzherald.co.nz.
