A medical coronary heart stent for clearing arteries affected by heart disease is a great, but costly advancement. So when do we start addressing the causes? Photo / Ross Setford, File
A medical coronary heart stent for clearing arteries affected by heart disease is a great, but costly advancement. So when do we start addressing the causes? Photo / Ross Setford, File
Opinion
OPINION
With the future financial sustainability of our health system in question and an underlying concern about maintaining the health status of New Zealanders, it is ironic that our most common and costly health conditions are the most preventable.
Even though there are significant potential health and financial gains fromshifting the emphasis of our health spend more quickly and comprehensively to disease prevention, the current health system hasn't enabled this to anywhere near the level required.
These common and costly preventable conditions are chronic or non-communicable diseases, which are long-term conditions with considerable adverse consequence to people's health and lives.
The most prevalent chronic diseases in New Zealand are diabetes, heart and blood vessel disease, cancer, lung disease, kidney disease and mental and addiction illnesses. In this context, prevention covers healthy living that limits the onset of these chronic diseases in the first instance, as well as the early detection and optimised clinical management of existing chronic diseases and their associated complications.
With chronic diseases becoming the main driver of healthcare demand and therefore cost, the necessity to rebalance healthcare spend from clinical treatments and interventions to prevention and wellbeing will become even more compelling.
The effects of prevention take time, so, consequently, over the next two decades, the healthcare funding landscape in New Zealand will need to shift to a greater emphasis on prevention.
A NZ Herald cartoon graphically shows the bombardment of New Zealand with unhealthy choices. Illustration / Anna Crichton, File
It's important to clarify that this is conceived as a both-and, rather than an either-or. We will need treatments and interventions, as well as an enhanced focus on prevention and wellbeing. What does need to be reconsidered is the balance between them.
Healthy behaviours need to be effectively promoted and incentivised, while accessible early detection and diagnosis of disease is expanded. If not now – then when?
An emphasis on preventing disease requires a fundamental change in the direction of our current health system, with its clear precedence for clinical treatments and interventions.
As important as they are, clinical treatments and interventions won't facilitate the required improvements to future population health outcomes, as social determinants of health - such as employment, education and housing - are more influential than treatments and interventions to both population length and quality of life.
What makes the current approach to prevention even more perplexing is that research has shown the effectiveness of health promotion, early detection and disease prevention interventions that are focused on key risk factors.
These risk factors include smoking, alcohol consumption, unhealthy food choices, physical inactivity, psychological harm and air quality, all requiring both mindset and behavioural modification to effect the necessary change.
Lester Levy. Photo / Supplied
Perhaps the hesitancy to reprioritise the current health spend towards prevention more quickly is due to the scale, scope and entrenched nature of these chronic diseases in our communities?
The fear of the epidemic extent of these chronic diseases may discourage policymakers, who possibly consider the considerable individual and collective mindset and behavioural changes required to overcome these diseases as too challenging, far-reaching and slow.
They may also be deterred by the many determinants of health required to be tackled to achieve the desired outcome of a healthier population.
Unquestionably, there are hurdles to overcome and it will not be straightforward, but moderating the risk of chronic diseases through lifestyle modification is both possible and cost-effective.
Crucially, it also has significant potential to reduce health inequalities, which are a major stain on our current health system. Perhaps the new mindset and resolve of the health reforms will harness the undeniable proof of the effectiveness of prevention and inspire bolder and more urgent action.
• Dr Lester Levy has more than 30 years of governance and management experience across both the public and private healthcare systems in New Zealand.
