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We congratulate the New Zealand government for the unprecedented steps taken to protect our population from the potentially catastrophic threat to public health posed by the COVID-19 pandemic.

In recent weeks, we have witnessed the capacity of government to enact sweeping changes which alter the day-to-day lives, economic fortunes and civic freedoms of all New Zealanders. As citizens, most of us have followed the new rules, buying into the premise that by doing so, we’re saving lives.

The medical community has been unanimous in supporting the need for action against the novel coronavirus COVID-19. Modelling provided to the Government by Prof Wilson from The University of Otago suggests that, without intervention, up to 3.32 million New Zealanders could be infected with Covid-19, 146,000 requiring hospital admission, 36,600 requiring ICU-level care, and 27,600 potential deaths.1 For context, in 2017 there were 33,599 deaths from all causes in New Zealand.2

We should not simply aim to survive the pandemic, but to filter our perception of what is possible through this lens. We need to reflect carefully on the fact that in 2020 our political leaders united in bipartisan agreement to make dramatic changes to our way of life in the interests of public health. How should we ensure that this impetus for change is captured to improve the future health of the same citizens who withstood fear, uncertainty, job losses, restriction on their freedom of movement and separation from their loved ones for the greater good?

We have entrenched problems in the health system in New Zealand which, until now, have seemed hopelessly lost causes. Advocates for Māori health equity, tobacco control, alcohol law reform, gambling harm prevention and reform of the obesogenic food environment have languished in the antechambers of MPs’ offices, battling ignorance, reluctance to act, well-funded and highly connected corporate lobbyists, and the inertia of institutional legacies. Tobacco and obesity alone are two of the leading causes of morbidity and mortality, contributing 9.1% and 7.9% respectively to our overall health loss, quantified in DALYs.3,4

With the exception of a few significant wins in tobacco control, such as the excise tax increases, plain packaging and the introduction of Smokefree Environments legislation5, advocates for New Zealanders’ health have heard time and again that the necessary changes are too hard and too inconvenient to implement. We have fiddled around the edges of issues like alcohol harm, which are corrosive and permeate across generations, because our political leaders have had little appetite to impinge on people’s personal freedoms for the greater good. One of the most egregious missed opportunities has been in the regulation of the obesogenic environment, an oversight which has led to unprecedented increases in co-morbidities related to obesity, including many of the risk factors for complications from infection with COVID-19; diabetes, coronary artery disease and hypertension.6

There is a range of evidence-based public health interventions which would have far-reaching positive consequences for the health of the entire population, if they were to be implemented with the same commitment seen in recent weeks. Importantly, they would contribute to addressing health equity as Māori are more likely than non-Māori to be affected by the morbidity and mortality associated with each of these issues. The following interventions could be rapidly implemented and would have long-lasting benefits for the population, and would contribute to reducing inequities if paired with Māori-led capacity development and leadership.

1. Full implementation of the recommendations from the 2010 report of the Law Commission on the regulatory framework for the sale and supply of liquor. This includes increased excise taxes, regulation of alcohol advertising and sponsorship, and increased investment in treatment and support services.7

2. Introduction of a tax on sugary drinks in line with the NZ Dental Association Consensus Statement on Sugary Drinks,8 which aligns with advice from the WHO.9

3. Limitation of marketing of junk food to children and increased authority of local authorities to audit licensing of fast food premises with a view to reducing the availability of outlets as outlined in the NZ Medical Association 2014 policy briefing on tackling obesity.10

4. A commitment to reducing pokies in the communities most affected by gambling-related harm, stringent regulation of the emerging online gambling industry, and the introduction of sustainable funding opportunities for communities to reduce the reliance on pokies revenue.

5. Introduction of supply reduction policies for tobacco to complement existing interventions, in order to reach the New Zealand Government’s Smokefree 2025 goal.5

There is no doubt that COVID-19 is a significant threat and that extraordinary measures are warranted. Beyond COVID-19, we should remember the potential for significant health protection with strong leadership and bipartisan commitment for novel public health interventions.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Emma Espiner, Final Year Medical Student, University of Auckland, Auckland; Communications Lead, Hāpai Te Hauora, Auckland; Selah Hart, CEO, Hāpai Te Hauora, Auckland; Garth Poole, Honorary Associate Professor, Surgeon, Middlemore Hospital, Auckland; Tamara Glyn Mullaney, Senior Lecturer, University of Otago, Christchurch; Consultant General and Colorectal Surgeon, CDHB; Su Mei Hoh, Colorectal Fellow, Auckland City Hospital, Auckland.

Acknowledgements

Correspondence

Emma Espiner, Final Year Medical Student, University of Auckland, Auckland.

Correspondence Email

ewehipeihana@gmail.com

Competing Interests

Nil.

1. Wilson N. Potential Worse Case Health Impacts from the COVID-19 Pandemic for New Zealand if Eradication Fails: Report to the NZ Ministry of Health http://www.health.govt.nz/system/files/documents/publications/report_for_chief_science_advisor_-_health_-_24_march_final.pdf 24 March 2020. Accessed 13 April 2020.

2. Statistics New Zealand website. Mortality 2017 data tables. http://www.health.govt.nz/publication/mortality-2017-data-tables 18 December 2019. Accessed 13 April 2020.

3. Ministry of Health website. Looking upstream: Causes of death cross-classified by risk and condition, New Zealand 1997. Revised edition. Public Health Intelligence Occasional Bulletin Number 20. http://pdfs.semanticscholar.org/36a1/3a037abed70b401bfd62890e8329776e7f88.pdf March 2004. Accessed 13 April 2020.

4. Liu M, Tobias M, Turley M. Health Loss in New Zealand: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study, 2006–2016. http://www.moh.govt.nz/notebook/nbbooks.nsf/0/F85C39E4495B9684CC257BD3006F6299/$file/health-loss-in-new-zealand-final.pdf August 2013. Accessed April 13, 2020.

5. Ministry of Health website. Tobacco Control. http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control Updated 21 February 2020. Accessed 13 April 2020.

6. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;(E-publication 8 February).

7. New Zealand law commission website. Alcohol in our lives: curbing the harm. Report 114. http://www.lawcom.govt.nz/sites/default/files/projectAvailableFormats/NZLC%20R114.pdf April 2010. Accessed 13 April 2020.

8. New Zealand Dental Association website. NZDA Consensus Statement on Sugary Drinks. http://www.nzda.org.nz/about-us/news/nzda-consensus-statement-on-sugary-drinks May 2017. Accessed 13 April 2020.

9. World Health Organisation website. Taxes on Sugary Drinks: Why do it? http://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf;jsessionid=BF253A1F54A21492E92634777528B0A4?sequence=1 2017. Accessed 13 April 2020.

10. New Zealand Medical Association website. Policy Briefing: Tackling Obesity. http://global-uploads.webflow.com/5db268b46d028bbc0fc0b537/5e26a5145f16d0d4bd430a54_Tackling%20obesity%20.pdf May 2014. Accessed 13 April 2020.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

We congratulate the New Zealand government for the unprecedented steps taken to protect our population from the potentially catastrophic threat to public health posed by the COVID-19 pandemic.

In recent weeks, we have witnessed the capacity of government to enact sweeping changes which alter the day-to-day lives, economic fortunes and civic freedoms of all New Zealanders. As citizens, most of us have followed the new rules, buying into the premise that by doing so, we’re saving lives.

The medical community has been unanimous in supporting the need for action against the novel coronavirus COVID-19. Modelling provided to the Government by Prof Wilson from The University of Otago suggests that, without intervention, up to 3.32 million New Zealanders could be infected with Covid-19, 146,000 requiring hospital admission, 36,600 requiring ICU-level care, and 27,600 potential deaths.1 For context, in 2017 there were 33,599 deaths from all causes in New Zealand.2

We should not simply aim to survive the pandemic, but to filter our perception of what is possible through this lens. We need to reflect carefully on the fact that in 2020 our political leaders united in bipartisan agreement to make dramatic changes to our way of life in the interests of public health. How should we ensure that this impetus for change is captured to improve the future health of the same citizens who withstood fear, uncertainty, job losses, restriction on their freedom of movement and separation from their loved ones for the greater good?

We have entrenched problems in the health system in New Zealand which, until now, have seemed hopelessly lost causes. Advocates for Māori health equity, tobacco control, alcohol law reform, gambling harm prevention and reform of the obesogenic food environment have languished in the antechambers of MPs’ offices, battling ignorance, reluctance to act, well-funded and highly connected corporate lobbyists, and the inertia of institutional legacies. Tobacco and obesity alone are two of the leading causes of morbidity and mortality, contributing 9.1% and 7.9% respectively to our overall health loss, quantified in DALYs.3,4

With the exception of a few significant wins in tobacco control, such as the excise tax increases, plain packaging and the introduction of Smokefree Environments legislation5, advocates for New Zealanders’ health have heard time and again that the necessary changes are too hard and too inconvenient to implement. We have fiddled around the edges of issues like alcohol harm, which are corrosive and permeate across generations, because our political leaders have had little appetite to impinge on people’s personal freedoms for the greater good. One of the most egregious missed opportunities has been in the regulation of the obesogenic environment, an oversight which has led to unprecedented increases in co-morbidities related to obesity, including many of the risk factors for complications from infection with COVID-19; diabetes, coronary artery disease and hypertension.6

There is a range of evidence-based public health interventions which would have far-reaching positive consequences for the health of the entire population, if they were to be implemented with the same commitment seen in recent weeks. Importantly, they would contribute to addressing health equity as Māori are more likely than non-Māori to be affected by the morbidity and mortality associated with each of these issues. The following interventions could be rapidly implemented and would have long-lasting benefits for the population, and would contribute to reducing inequities if paired with Māori-led capacity development and leadership.

1. Full implementation of the recommendations from the 2010 report of the Law Commission on the regulatory framework for the sale and supply of liquor. This includes increased excise taxes, regulation of alcohol advertising and sponsorship, and increased investment in treatment and support services.7

2. Introduction of a tax on sugary drinks in line with the NZ Dental Association Consensus Statement on Sugary Drinks,8 which aligns with advice from the WHO.9

3. Limitation of marketing of junk food to children and increased authority of local authorities to audit licensing of fast food premises with a view to reducing the availability of outlets as outlined in the NZ Medical Association 2014 policy briefing on tackling obesity.10

4. A commitment to reducing pokies in the communities most affected by gambling-related harm, stringent regulation of the emerging online gambling industry, and the introduction of sustainable funding opportunities for communities to reduce the reliance on pokies revenue.

5. Introduction of supply reduction policies for tobacco to complement existing interventions, in order to reach the New Zealand Government’s Smokefree 2025 goal.5

There is no doubt that COVID-19 is a significant threat and that extraordinary measures are warranted. Beyond COVID-19, we should remember the potential for significant health protection with strong leadership and bipartisan commitment for novel public health interventions.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Emma Espiner, Final Year Medical Student, University of Auckland, Auckland; Communications Lead, Hāpai Te Hauora, Auckland; Selah Hart, CEO, Hāpai Te Hauora, Auckland; Garth Poole, Honorary Associate Professor, Surgeon, Middlemore Hospital, Auckland; Tamara Glyn Mullaney, Senior Lecturer, University of Otago, Christchurch; Consultant General and Colorectal Surgeon, CDHB; Su Mei Hoh, Colorectal Fellow, Auckland City Hospital, Auckland.

Acknowledgements

Correspondence

Emma Espiner, Final Year Medical Student, University of Auckland, Auckland.

Correspondence Email

ewehipeihana@gmail.com

Competing Interests

Nil.

1. Wilson N. Potential Worse Case Health Impacts from the COVID-19 Pandemic for New Zealand if Eradication Fails: Report to the NZ Ministry of Health http://www.health.govt.nz/system/files/documents/publications/report_for_chief_science_advisor_-_health_-_24_march_final.pdf 24 March 2020. Accessed 13 April 2020.

2. Statistics New Zealand website. Mortality 2017 data tables. http://www.health.govt.nz/publication/mortality-2017-data-tables 18 December 2019. Accessed 13 April 2020.

3. Ministry of Health website. Looking upstream: Causes of death cross-classified by risk and condition, New Zealand 1997. Revised edition. Public Health Intelligence Occasional Bulletin Number 20. http://pdfs.semanticscholar.org/36a1/3a037abed70b401bfd62890e8329776e7f88.pdf March 2004. Accessed 13 April 2020.

4. Liu M, Tobias M, Turley M. Health Loss in New Zealand: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study, 2006–2016. http://www.moh.govt.nz/notebook/nbbooks.nsf/0/F85C39E4495B9684CC257BD3006F6299/$file/health-loss-in-new-zealand-final.pdf August 2013. Accessed April 13, 2020.

5. Ministry of Health website. Tobacco Control. http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control Updated 21 February 2020. Accessed 13 April 2020.

6. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;(E-publication 8 February).

7. New Zealand law commission website. Alcohol in our lives: curbing the harm. Report 114. http://www.lawcom.govt.nz/sites/default/files/projectAvailableFormats/NZLC%20R114.pdf April 2010. Accessed 13 April 2020.

8. New Zealand Dental Association website. NZDA Consensus Statement on Sugary Drinks. http://www.nzda.org.nz/about-us/news/nzda-consensus-statement-on-sugary-drinks May 2017. Accessed 13 April 2020.

9. World Health Organisation website. Taxes on Sugary Drinks: Why do it? http://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf;jsessionid=BF253A1F54A21492E92634777528B0A4?sequence=1 2017. Accessed 13 April 2020.

10. New Zealand Medical Association website. Policy Briefing: Tackling Obesity. http://global-uploads.webflow.com/5db268b46d028bbc0fc0b537/5e26a5145f16d0d4bd430a54_Tackling%20obesity%20.pdf May 2014. Accessed 13 April 2020.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

We congratulate the New Zealand government for the unprecedented steps taken to protect our population from the potentially catastrophic threat to public health posed by the COVID-19 pandemic.

In recent weeks, we have witnessed the capacity of government to enact sweeping changes which alter the day-to-day lives, economic fortunes and civic freedoms of all New Zealanders. As citizens, most of us have followed the new rules, buying into the premise that by doing so, we’re saving lives.

The medical community has been unanimous in supporting the need for action against the novel coronavirus COVID-19. Modelling provided to the Government by Prof Wilson from The University of Otago suggests that, without intervention, up to 3.32 million New Zealanders could be infected with Covid-19, 146,000 requiring hospital admission, 36,600 requiring ICU-level care, and 27,600 potential deaths.1 For context, in 2017 there were 33,599 deaths from all causes in New Zealand.2

We should not simply aim to survive the pandemic, but to filter our perception of what is possible through this lens. We need to reflect carefully on the fact that in 2020 our political leaders united in bipartisan agreement to make dramatic changes to our way of life in the interests of public health. How should we ensure that this impetus for change is captured to improve the future health of the same citizens who withstood fear, uncertainty, job losses, restriction on their freedom of movement and separation from their loved ones for the greater good?

We have entrenched problems in the health system in New Zealand which, until now, have seemed hopelessly lost causes. Advocates for Māori health equity, tobacco control, alcohol law reform, gambling harm prevention and reform of the obesogenic food environment have languished in the antechambers of MPs’ offices, battling ignorance, reluctance to act, well-funded and highly connected corporate lobbyists, and the inertia of institutional legacies. Tobacco and obesity alone are two of the leading causes of morbidity and mortality, contributing 9.1% and 7.9% respectively to our overall health loss, quantified in DALYs.3,4

With the exception of a few significant wins in tobacco control, such as the excise tax increases, plain packaging and the introduction of Smokefree Environments legislation5, advocates for New Zealanders’ health have heard time and again that the necessary changes are too hard and too inconvenient to implement. We have fiddled around the edges of issues like alcohol harm, which are corrosive and permeate across generations, because our political leaders have had little appetite to impinge on people’s personal freedoms for the greater good. One of the most egregious missed opportunities has been in the regulation of the obesogenic environment, an oversight which has led to unprecedented increases in co-morbidities related to obesity, including many of the risk factors for complications from infection with COVID-19; diabetes, coronary artery disease and hypertension.6

There is a range of evidence-based public health interventions which would have far-reaching positive consequences for the health of the entire population, if they were to be implemented with the same commitment seen in recent weeks. Importantly, they would contribute to addressing health equity as Māori are more likely than non-Māori to be affected by the morbidity and mortality associated with each of these issues. The following interventions could be rapidly implemented and would have long-lasting benefits for the population, and would contribute to reducing inequities if paired with Māori-led capacity development and leadership.

1. Full implementation of the recommendations from the 2010 report of the Law Commission on the regulatory framework for the sale and supply of liquor. This includes increased excise taxes, regulation of alcohol advertising and sponsorship, and increased investment in treatment and support services.7

2. Introduction of a tax on sugary drinks in line with the NZ Dental Association Consensus Statement on Sugary Drinks,8 which aligns with advice from the WHO.9

3. Limitation of marketing of junk food to children and increased authority of local authorities to audit licensing of fast food premises with a view to reducing the availability of outlets as outlined in the NZ Medical Association 2014 policy briefing on tackling obesity.10

4. A commitment to reducing pokies in the communities most affected by gambling-related harm, stringent regulation of the emerging online gambling industry, and the introduction of sustainable funding opportunities for communities to reduce the reliance on pokies revenue.

5. Introduction of supply reduction policies for tobacco to complement existing interventions, in order to reach the New Zealand Government’s Smokefree 2025 goal.5

There is no doubt that COVID-19 is a significant threat and that extraordinary measures are warranted. Beyond COVID-19, we should remember the potential for significant health protection with strong leadership and bipartisan commitment for novel public health interventions.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Emma Espiner, Final Year Medical Student, University of Auckland, Auckland; Communications Lead, Hāpai Te Hauora, Auckland; Selah Hart, CEO, Hāpai Te Hauora, Auckland; Garth Poole, Honorary Associate Professor, Surgeon, Middlemore Hospital, Auckland; Tamara Glyn Mullaney, Senior Lecturer, University of Otago, Christchurch; Consultant General and Colorectal Surgeon, CDHB; Su Mei Hoh, Colorectal Fellow, Auckland City Hospital, Auckland.

Acknowledgements

Correspondence

Emma Espiner, Final Year Medical Student, University of Auckland, Auckland.

Correspondence Email

ewehipeihana@gmail.com

Competing Interests

Nil.

1. Wilson N. Potential Worse Case Health Impacts from the COVID-19 Pandemic for New Zealand if Eradication Fails: Report to the NZ Ministry of Health http://www.health.govt.nz/system/files/documents/publications/report_for_chief_science_advisor_-_health_-_24_march_final.pdf 24 March 2020. Accessed 13 April 2020.

2. Statistics New Zealand website. Mortality 2017 data tables. http://www.health.govt.nz/publication/mortality-2017-data-tables 18 December 2019. Accessed 13 April 2020.

3. Ministry of Health website. Looking upstream: Causes of death cross-classified by risk and condition, New Zealand 1997. Revised edition. Public Health Intelligence Occasional Bulletin Number 20. http://pdfs.semanticscholar.org/36a1/3a037abed70b401bfd62890e8329776e7f88.pdf March 2004. Accessed 13 April 2020.

4. Liu M, Tobias M, Turley M. Health Loss in New Zealand: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study, 2006–2016. http://www.moh.govt.nz/notebook/nbbooks.nsf/0/F85C39E4495B9684CC257BD3006F6299/$file/health-loss-in-new-zealand-final.pdf August 2013. Accessed April 13, 2020.

5. Ministry of Health website. Tobacco Control. http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control Updated 21 February 2020. Accessed 13 April 2020.

6. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;(E-publication 8 February).

7. New Zealand law commission website. Alcohol in our lives: curbing the harm. Report 114. http://www.lawcom.govt.nz/sites/default/files/projectAvailableFormats/NZLC%20R114.pdf April 2010. Accessed 13 April 2020.

8. New Zealand Dental Association website. NZDA Consensus Statement on Sugary Drinks. http://www.nzda.org.nz/about-us/news/nzda-consensus-statement-on-sugary-drinks May 2017. Accessed 13 April 2020.

9. World Health Organisation website. Taxes on Sugary Drinks: Why do it? http://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf;jsessionid=BF253A1F54A21492E92634777528B0A4?sequence=1 2017. Accessed 13 April 2020.

10. New Zealand Medical Association website. Policy Briefing: Tackling Obesity. http://global-uploads.webflow.com/5db268b46d028bbc0fc0b537/5e26a5145f16d0d4bd430a54_Tackling%20obesity%20.pdf May 2014. Accessed 13 April 2020.

Contact diana@nzma.org.nz
for the PDF of this article

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