Warren Lindberg reflects on Black November: when neighbours risked their lives to help neighbours

25 Jun 2018 11:47 AM | Anonymous
Following last year’s World War 1 commemoration, the names of those whose lives were lost and of the great battles – Gallipoli, the Somme, Passchendaele, Monte Casino, the Coral Sea – are respectfully recalled on memorials around the country.

However, another event resulting in greater loss of life and far-reaching consequences has been barely noted outside academia – that is, the 1918 influenza pandemic.

Unfairly labelled at the time as the ‘Spanish’ flu, it is estimated to have killed at least 50 million people globally, including between 8 and 9,000 New Zealanders (around 1% of the total population), disproportionately Māori (estimated 5%).

Samoans have especial reason to remember the 1918 flu, following so soon after New Zealand’s seizure of Samoa from the Germans in 1915.  In November 1918 the NZ Administrator permitted flu-infected passengers to disembark from a NZ ship.  Within weeks, 90% of the Samoan population was infected; subsequently 30% of adult men, 22% of adult women and 10% of children died.

Sickness and death were not evenly distributed across the population. Because influenza is spread so easily via droplets from coughing and sneezing, it is particularly virulent where people live or work in close contact – in 1918 this included the armed forces and areas where men worked closely together such as mining. Unsurprisingly, Māori and others living communally or in over-crowded urban conditions with poor access to medical help were disproportionately affected.

Most influenza deaths occur from secondary infection from opportunistic pneumonia bacteria, and most can be avoided by vaccination. In NZ, the pneumococcal vaccine for babies is free, and there is a National Immunisation Register for everyone born since 2005. But old-fashioned hygiene – covering coughs and sneezes and hand-washing – are still the most reliable way to avoid infection.

In a world where globalisation and anti-microbial resistance expose us to new strains of familiar and unfamiliar diseases, the possibility of a pandemic as virulent as 1918 is a threat we all need to take seriously. Just as in 1918, every new threat to our health hits those already most disadvantaged.

New Zealand’s most thorough chronicler of the 1918 flu epidemic is Geoffrey Rice, Emeritus Professor of History at the University of Canterbury, whose book Black November, first published in 1988 and updated in 2012, was motivated by his father’s childhood memory of the appalling sights he witnessed in the small timber and railway town of Taumarunui. A nine-year-old at the time, he recalled lighting fires in the morning in houses where the adults were ill, and finding a woman asleep in bed beside the body of her husband, blackened in death.

Professor Rice wrote this in a memory of the 1918 flu epidemic for the Stuff news website in November last year: “It has often been said that New Zealand’s losses in that war ‘forged the nation’ out of a collective sense of shared grief and loss. Yet it can also be argued that the experience of the 1918 flu, when neighbours risked their lives to help neighbours, and communities rallied to care for the sick, helped confirm the more admirable qualities of the Kiwi character: bravery, compassion, fairness, resourcefulness, good humour and optimism in the face of adversity”.

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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.

Ngā mihi,
Warren Lindberg

CE Public Health Association of New Zealand


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