Rod Jackson: A public health triumph – nothing happened

We are incredibly fortunate that most Kiwis don't even know anyone who has been infected by Covid-19. Photo / Getty Images

COMMENT:

Public health is not about public hospitals but about the health of whole populations and the main measure of success in public health is invisible because nothing happens. Public health doctors and epidemiologists (the public health scientists) don't cure cancer, they prevent it from happening in the first place. They don't undertake heroic operations to save the lives of our families and friends injured in car crashes, they prevent the crashes from happening. They don't save the lives of Covid-19 patients in the intensive care units of our public hospitals, they prevent the spread of infection.

The signs of our greatest successes are invisible to most people. My own field is the epidemiology of heart disease. Did you know that heart disease deaths have fallen by 90 per cent in New Zealand since 1967? Most New Zealanders, including a surprising number of my clinical colleagues, have no idea of this extraordinary but invisible achievement, much of it due to public health interventions around diet and smoking. We don't register it because we can't see an event that doesn't happen.

Now, as New Zealand is emerging from the greatest threat to life since World War II, some members of the public, some from the business community, political lobbyists, radio talk-show hosts and some politicians, are turning on the Prime Minister and her public health and epidemiology advisers, whose actions have saved thousands of lives. In the United Kingdom, hundreds of people are still dying every day because their political leaders did too little, too late and who are now appropriately too scared to end their belated lockdown. In the United States, the denigration of science and public health has led to a disaster that is still gaining momentum. The self-taught armchair epidemiologists, who so confidently yet naively, criticise New Zealand's response, have evidently blocked out the war-zone scenes in Italian and American hospitals and do not understand why you cannot compare New Zealand's situation to Australia's.

We are incredibly fortunate that most New Zealanders don't even know anyone who has been infected by Covid-19. As a child growing up in small-town New Zealand in the 1960s, I had a number of classmates whose parents or grandparents dropped dead from heart attacks in their 40s and 50s. I thought it was normal. It's certainly not normal now. In 1978, when I was a young doctor working in the coronary care unit at Middlemore Hospital, we had an unwritten rule not to admit anyone to the unit over the age of 65 because we were overflowing with young men and women with heart attacks. Now, most of the patients in coronary care units are over 65. This phenomenal success in preventing premature heart disease is invisible to most people.

So I know from personal and professional experience that it's going to be difficult for most people to balance the invisible Covid-19 catastrophe that didn't happen here against the very visible pain and suffering of economic hardship. But you can't work if you or the people around you are sick or dying and many of you will be too scared to go out if even if you are not sick. This is happening right now in many countries similar to our own. I'm not even sure I would feel safe walking on Bondi Beach today given the two new cases of unknown source reported nearby in the past few days.

Professor Rod Jackson. Photo / Supplied

Next time you try to balance the invisible health gain against the visible economic pain, please stop to look at the videos of scenes in New York hospitals from a few weeks ago or the refrigerated trucks of corpses outside a Brooklyn funeral home, to see what health pain looks like. Or just check on the ongoing restrictions, much greater than ours are now, in many countries

Don't shoot the heroes. We hope this will be the only experience most New Zealanders will ever have of visible public-health heroes. They are only visible here because of the contrast with how Aotearoa New Zealand has handled the pandemic compared with the failure of many governments to even listen to public health experts. New Zealand initially required the blunt force of a level 4 lockdown rather than being able to rely on a sharper strategy based primarily on case finding and contact tracing, because our public-health services were invisible to successive governments and desperately underfunded.

Based on most epidemiological predictions, the worst is still to come in many countries unless they maintain belatedly introduced restrictions. Please open your eyes, New Zealanders, and look at what is happening across the world before you criticise our extremely effective public-health strategy and before you demand a premature return to level 1.

• Professor Rod Jackson is a cardiovascular disease epidemiologist at University of Auckland.