Letter to the Listener 28 July 2017 in response to Fever Pitch (Listener 21 July 2017)
Catherine Woulfe’s thorough investigation of rheumatic fever brings to the surface a range of important questions not only about this cruel disease, but also wider issues about health policy. The Government’s bold initiative to reduce the incidence of rheumatic fever as one of its 'Better Public Service' targets in 2012 certainly raised awareness of rheumatic fever for the general public as well as communities and families directly affected. But even when medical science and the public have a clearer understanding of the immediate causes of rheumatic fever, interventions like the $65m ‘sore throats matter’ still won’t stop the epidemic.
Ramona Tiatia’s blunt description of the experience of affected families not only painted a picture of the impact on affected families and communities, it also highlighted the invidious choices our health funders face. How much should we prioritise health spending between response to the urgent need of young people whose lives and potential can be devastated by the disease versus the expense of addressing the economic and social factors that underlie the reasons we have this epidemic at all?
As several of the clinicians interviewed pointed out, it’s only when the poverty and over-crowded housing issues are addressed that we will make a real difference.
Rheumatic fever illustrates the contradictions in our health system identified in the recent American Commonwealth Fund report. Of the 11 countries the Fund monitors, the work our health professionals do is ranked among the highest. But our overall performance as a health system falls to the middle ranking because of our poor performance on access and equity. The Fund also notes that our per capita expenditure is among the cheapest.
Failure to invest in real prevention - that is, poverty, housing, good nutrition etc. - will continue to drive conditions like rheumatic fever, whether the immediate cause is strep throat or skin sores, until we invest upstream.
Why not spend more on these conditions - the economic and social determinants of health?
We all pay in the long run - the young people whose misery we tolerate and whose potential remains unfulfilled, the families whose sacrifices are unrewarded, and the taxpayer who picks up the tab.
CE Public Health Association of New Zealand