• Georgina te Heuheu
Associate Minister of Health

It gives me great pleasure to officially open this 47th Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand here today in Wellington.

I am very happy to welcome you to our lovely capital city. I understand that it was a long time ago indeed that Wellington hosted a meeting such as this.

It's also an honour to be amongst you today - you are cardiologists, cardiac surgeons, doctors, many other specialists and other health professionals from throughout Australia and New Zealand, and indeed from overseas. The work that you do to promote good cardiac health, scientific research and best practice is important to the health of both our peoples, in Australia and New Zealand.

Daily you provide services for people who need them. Continually you are looking for improvements. We need you to do this, for while there have been huge advances, heart disease is still the number one killer in New Zealand - particularly in people over 45 years.

Your gathering here is vital to make treatment advances and to reduce the risk of heart disease or heart attack.

Your work as individual professionals, and as members of the Cardiac Society, isromoting the fight against cardiac disease. Every day, you take practical steps which can help to improve the health and wellbeing of countless New Zealanders.

It is appropriate that one of the main themes of this year's meeting is the history of cardiology. There is much we can be proud of. If we look back, we can see significant advances in the last twenty or thirty years. Coronary artery bypass grafting and angioplasty are important examples of progress.

Twenty years ago, if you suffered a major heart attack, you probably died. Now, because of new treatments and management techniques, people are very likely to survive and be helped back to good health.

The statistics in the past ten years show what New Zealand has achieved. Heart disease leading to heart attack was responsible for 23 percent of all deaths in 1996. But ten years before, the figure was 27 percent. Rates of death are declining. But despite these significant advances, it remains the fact that heart disease is still the most common cause of death in New Zealand.

So what is New Zealand doing about this?

In the next year, we will spend $6.8 billion on health and disability services in New Zealand. As a result of an increased health budget, more people are getting more operations, including heart surgery.
?And I can almost hear you saying that whatever proportion of the $6.8 billion is going to heart treatment, it's still not enough! But as we all know, the demand for more services here, as in all other areas, exceeds the limited resources available.

Late last week in Wellington, there was a meeting of cancer specialists. They were calling for a national cancer control strategy and greater emphasis on cancer services, which given the high death rates from cancer is also understandable. But it does serve to illustrate the many claims there are for the health dollar.

Governments in many countries face this challenge - how do we stretch the money available for health in order to cover all the needs that people have, to cover the range of services that are possible, and ensure that all patients have fair access. This is not just access to heart surgery, but to the whole range of health services people need - and I might add, to all the other social services that New Zealanders expect.

With the technological advances in all areas of medicine, including cardiology, we can do so much more for people. That is wonderful - and it is a dilemma.

There is a need to make careful priority decisions based on how effective a service will be, compared to the cost involved. The aim is to balance the health of all New Zealanders in a way that is fair, while maintaining a realistic eye on the amount of money available. It's a delicate balance to achieve.

As part of the government's health strategy we are looking at ways to ensure that those with the greatest need and ability to benefit are given priority access to health services. A key initiative is the introduction of booking systems to replace waiting lists.

This system manages patient access to elective services. Where patients' needs are not immediate - where their condition means they can wait for services - the Government's policy on access to surgery is based on need and ability to benefit. Booking systems mean that higher priority people are booked for treatment within six months, while lower priority patients are given ongoing care and regular reviews by their GP in consultation with hospital specialists.

The system is honest - it is not promising people services we cannot afford to deliver. And it is flexible enough to allow the re-referral of patients if their situation changes. The booking system also gives us a far better idea of where the areas of highest need are. This has allowed us to increase funding to areas of proven need - of which cardiac is one. In May we announced a further $254 million over the next three years to increase the level of elective surgery.

As professionals, you are contributing to these initiatives. Your expertise is being drawn on for clinical working parties which are developing national cardiac tools to ensure all people are assessed consistently. Although such tools have been used over the past three years, they have lacked consistent standards. Many of you are contributing to ensure greater consistency and fairness.

I assure you that the assessment tools will not be static. New evidence will continue to emerge, and the tools will continue to be refined as new evidence comes to light.

I would now like to move to another important theme of your conference.

While we are providing services whch give the most benefit to those most in need, we also need to ensure that the services we deliver take into account the social and cultural needs of our patients.

I am pleased to hear that your conference will be looking at the impact of ethnicity on heart disease. It is important to the future wellbeing of both our countries that we focus on the health of Mäori and Aboriginal people.

Here in New Zealand, figures from 1996 show there has been an 18% decline in the death rates of Maori from heart disease compared with 1985 figures The rates are still significantly higher than the non-Maori rates, however - and this is obviously an area to work on. Indeed, in relation to Ischaemic heart disease, 230 deaths per year would be avoided if Maori and non-Maori rates were closer.

The good health of peoples is critical to the well-being of a nation. In this context, the health of Maori people is of ongoing concern to a great many of us, both in Government and outside.

Since the early 1990's the government has been committed to improving Mäori health through improving mainstream services and through the establishment of a significant number of Maori Health providers. This has led to a strong focus on prevention and health promotion. For example, many marae are now smokefree and far more diet conscious, and the benefits of exercise are being promoted through marae-based programmes.

In my view, those initiatives point to where the real answer lies in the future - and where we can make real improvements. For the reality is that much heart disease and many deaths from cardiac failure can be avoided. It is generally considered that about half the improvement in mortality over recent years is due to changes in risk factors (smoking, diet and exercise) and half is due to better treatments.

It is in this area we can all show greater leadership. And especially when such a lot can be achieved if we all take responsibility for simple things - walking to the shop, not driving; reducing the amount of fat we eat; stopping smoking.

I see it as a partnership of effort - a partnership where individuals' own everyday activities can reinforce the effectiveness of the treatments and surgical interventions which you perform daily. But both must be equally supported and advanced hand in hand.

As a final comment, I'd like to come back to the theme of your meeting here. In the last 47 years, cardiac services have come a very long way. People with conditions which were not operable in the past can now be helped back to a healthy life through surgical developments such as coronary artery bypass grafting. Your work as professionals has contributed to these advances.

Improved techniques and treatments have occurred because of careful practice and well-founded research - and because you share those findings with each other as part of Scientific meetings. I wish you well in your discussions here, in this 47th Scientific meeting of your Society.