Marmot Symposium – NZMA and the University of Otago

  • Tony Ryall

Good afternoon.

Thank you for the opportunity to open your symposium this afternoon. I expect there will be a lot of interest. Not the least of which follows a call by the symposium organisers for higher taxes, significantly more regulation and lifting the age of entitlement for National Superannuation!.

May I welcome your keynote speaker Sir Michael Marmot to New Zealand.

In your report “Fair Society, Healthy Lives” you described “The central ambition of [your] Review [was] to create the conditions for people to take control of their own lives”. We all share that ambition.

Your focus is on the role of the wider determinants of health and well-being…income, education, employment, and social background. 

Indeed, these all have an impact on every part of our lives and our health.

As you’d expect, as Minister of Health my opening remarks today will focus on the work that the public health service is doing strengthening the role and impact of disease prevention, one of the key objectives of the Marmot Report.

And I will also touch on some of the Government’s considerable work improving the wider determinants of Health.

Sir Michael, you come to us today from Britain.

Protecting our public health service

In your country, many public servants, including doctors and nurses, are facing a two-year wage-freeze. Pensions are being reduced.

There are large-scale savings planned within the National Health Service totalling GBP 20 billion. It is estimated 50,000 NHS staff will be made redundant over the next few years.

Around the globe, governments are making tough and often unpopular decisions to make ends meet.

In Ireland, the former Health Minister was pelted with red paint by protesters as tempers grew over her Government slashing 5% off the health budget.

The Irish have also reduced the minimum wage, cut welfare spending and made tertiary education more expensive.

Austerity measures around the world are impacting on individuals, families and communities.

Fortunately New Zealand's economy has weathered the storm better than most.

This Government has taken the deliberate decision to take a long term view of our country's economic challenge. 

We are putting in more money - even if we have to borrow it – currently $300 million a week. Because we know eventually we will be able to pay it back.

In health alone, we have invested $1.5 billion of new money over 3 budgets… half of all new government spending.

We are confident that the New Zealand economy is coming right and we are protecting New Zealand’s most vulnerable from the sharp edges of recession.

I am sure you will hear a lot today about redistributing money from one part of the community to another.

That was certainly a theme of the organisers’ recent NZMJ article.

What remains fundamental to protecting New Zealanders into the future is a strong growing economy.

That is how you get good jobs and secure incomes. It is only through a strong growing economy that can we afford the social investments we want to make.

We have to grow the cake…be it a low calorie, low carbon, gluten-free cake!

And that is what the whole of government is doing …empowering families through building a stronger economy.

Sir Michael, I’ve taken the opportunity to read your report and it’s clear we in New Zealand are moving on many of the recommendations you made.

Improving care for patients

Our government came to office with a mandate to improve services for patients… people wanted us to put the service back into public health. New Zealanders wanted us to re-engage clinicians in decision-making.

And they wanted us to focus on fewer, more important things…to get better value for their tax dollars.

And with the support of our health workforce, we have.

Against the backdrop of the worst financial situation in 80 years, we have remained determined to grow and protect the public health service.

Health targets improving quality

That can be seen in the very significant progress being made in the Six National Health Targets.

The Health Targets focus on key areas patients want improved. Three are hospital focused, and three focus on disease prevention and health promotion.

The three hospital targets in particular focus on improving timeliness and the quality of care.

Quality is a major feature of the targets…because getting care in a timely way means better patient outcomes.

Patients are getting elective surgery faster…with procedures up 20% over three years.

Cancer radiation waiting times have been slashed from 15 weeks to the world gold standard of four weeks.

And hospitals are providing emergency care sooner than ever before.

Strong focus on prevention that works

As you stated Sir Michael much of chronic disease follows disadvantage.

The National Government has selected a discrete number of high impact, high return preventive health targets; immunisation, smoking and heart disease/diabetes.

These represent a mutually supporting “all of society” set of measures rather than spot welding goals.

This was intentional as public health dollars had been spread too thinly, on too many projects over ten years with very little health gain to show for it.

The results in our target areas have been immediate and successful, even internationally significant. Focus and accountability achieve results.

Immunisation rates at all time high

Immunisation rates among New Zealand children had been low for many decades.

Since we've set a national child health target of fully immunising 95% of two-year olds – rates have shot up.

From around 70% only three years ago, to 90% of two year olds now fully immunised –– across all socio economic and ethnic groups. And it's still climbing…on track to meet our goal….a goal of equally high expectations across all ethnic groups.

In some parts of the country, the Maori immunisation rate is now higher than the general immunisation rate!

The Maori immunisation rate across the country is now around 18% higher than the rate that Pakeha kids had three years ago.

Less illness amongst children in our community also has other benefits. Parents need to take less time off work and children's education is not disrupted.

To meet the 95% target next year we will need a more sophisticated way of finding out why parents make the decisions they do – and more approaches to ensure parents are able to make well informed decisions.

Smoking at a turning point

On tobacco, this government has created a turning point in the campaign against smoking…with more actions than ever before on a scale never seen before.

The Government has passed an unprecedented 30% increase in tobacco tax…the most effective way to prevent and deter smoking. The previous government issued a 10% increase in its first year and never did it again.

Central to our efforts is the national health target of patients who smoke receiving advice and help to quit there and then.

This is engaging the public health service like never before. From zero to 90% in six DHBs in less than two years.

Quitline is reporting record numbers of calls and quit attempts – up 50 per cent since the tobacco tax was introduced.

And we have backed this effort with massively improved access to smoking cessation treatments…up 82% in 18 months.

Legislation to phase out tobacco displays will soon pass. And plain packaging is inevitable.

When it comes to non-communicable diseases, dealing with tobacco offers the best impact for dollars spent. Smoking rates are still too high and we can’t let up on this.

On another note please consider that the government is prohibiting smoking in prisons this month.

It’s a strong signal that we are trying many measures, in all sorts of contexts, to reduce smoking.

Better heart health

Diabetes and cardiovascular disease also affect a growing number of New Zealanders.

We’re targeting improvements to the detection, risk assessment and management of these diseases. 

Not only have community clinicians increased the number of cardio-vascular risk assessments, there are good improvements in the level of diabetes management. And of course this target is supported by the effort against smoking.

This year we’ve set a target of 90% of eligible patients having their heart disease risk assessed. And we’re expecting even better performance in this area.

Wider Determinants of health

But as you say Sir Michael, Health cannot do it alone.

Keeping kiwis healthy goes beyond the health service.

Warmer homes = healthier families

New Zealand homes are on average six degrees centigrade below World Health Organisation recommended minimum levels.

National and the Green Party worked together to introduce a significant public subsidy for insulating the homes of tens of thousands of New Zealand families: $360m for 190,000 homes.

We know that warmer, drier homes bring health benefits, especially for those with respiratory illness or other conditions.

We’ve done 100,000 homes in two years. The previous government managed a paltry 4,000 homes a year…talk about a lack of commitment.

History will show that this programme made an enormous impact on improving the public health, and the futures of kiwi families.

I am confident that this will come to be seen as the single most significant new public health initiative of the decade.

HeatSmart is also an essential partner to the Government's $12 million rheumatic fever initiative announced in the Budget.

Action on Rheumatic Fever

Maori and Pacific people – mostly children – living in cold overcrowded homes are most likely to get rheumatic fever – and they are 20 and 37 times respectively more likely to be admitted to hospital with first time acute rheumatic fever than anyone else.

Eradicating this third world disease from our shores has actually been a health priority since 2001. But nothing ever happened…except more poor kids got the disease.

Our $12 million investment in the budget this year aimed right at this disease will support a massive campaign across high prevalence communities involving school based sore throat clinics for over 22,000 children.

Our work in child health is being further supported with the Budget’s $21 million investment into additional WellChild visits focused particularly on first time mothers, which for many will more than double the number of visits they receive in the first two months of baby's life.

And we have also invested over $33 million in a raft of initiatives to improve quality and safety in the maternity service. Additionally, $44 million is being invested in services for vulnerable children in state care.

Whanau Ora

As a government we are working across the community on the wider determinants of health to improve the health and prospects of all New Zealanders…what you call reducing the steepness of the social gradient.

Sir Michael, as you have pointed out, there is a strong need to weave the different strands of activity supporting individuals and families more effectively… and removing barriers to community participation and action.

The Whanau Ora policy is a major step forward in helping families take responsibility for improving their lives… to work on all the things that impact on family well-being.

Whanau Ora aims to end the 5 cars up the drive way syndrome… where endless agencies work on individual problems in isolation of each other and the needs of the whole family.

Already 15,000 whanau members are involved, with over 3,200 whanau assessments already undertaken by the National Hauora Coalition.

These assessments see support workers helping families deal with the myriad of issues affecting their well-being from work to education to ill-health.

Whanau Ora is about a coordinated service meeting the needs of individuals and families.

Contracts are integrated and services work together. It’s a model of what the future could look like.


Ladies and gentlemen I am sure this symposium will be an interesting event.

The best thing for our nation’s health and wellness is a strong growing economy that creates jobs and opportunity, and allows our country to afford quality health, education and social support.

Thank you for the opportunity to speak to you and I wish you well for the afternoon ahead.