By Maryan Street
New Zealand has a long-standing reputation as a world leader in child health and development research. So why is it that our child health outcomes are so poor and so readily defined by affluence or poverty? In a society which throughout its history has prided itself on its egalitarianism, how is it that we are seeing increasing inequality and increasingly adverse health effects resulting from that inequality?
In an OECD report on child well-being, New Zealand was ranked second to last out of 30 countries in health and safety and, in fact, did not score well in any category. This is not new information. But it is true that in the last four years, the gap between rich and poor has widened at a rapid rate, and child health statistics have escalated alarmingly.
Socio-economic conditions have a major impact on children’s health. Children born into poverty and deprived conditions are more likely to be unwell and have a compromised start to life. Hospitalisations for conditions which reflect poverty, such as infectious skin diseases or respiratory illnesses, steadily increased for children in the 1990s and early 2000s, particularly in Māori and Pacific people. During this period, New Zealand experienced major socio-economic changes, the second largest increase in income inequality in the OECD, and a significant increase in child poverty. It is no coincidence that New Zealand was governed by a National-led government from 1990-1999.
These hospitalisations peaked in 2002 and then gradually declined as the Labour-led government paid attention to jobs and wage increases, reduced doctor’s fees, reduced prescription items (down from $15 an item to $3 an item), introduced a primary health strategy which delivered health services out in communities, and brought in Working for Families which lifted 270,000 children out of poverty over the next few years. But by 2010, these hospitalisations had increased again, to the extent that by that year, there had been 4,800 extra admissions to hospital compared with 2007.
Some work has been successful in recent years, for example, the immunisation programme started by the Labour-led government and continued by this government has seen more and more children immunised so that by the end of 2011, more than 90% of 2-year-olds are fully immunised and those disparities have reduced accordingly.
But we still have rates of rheumatic fever, an illness associated with poverty, which are 14 times higher than the OECD average. The burden of this falls predominantly on Māori and Pacifica children and children living in deprived areas. This is being addressed by treating the symptoms right now. The causes, however, are being neglected.
One recently emerging statistic which causes concern is that about 40% of children living in poverty are from families with at least one full-time worker. This means that employment is not working at lifting families out of poverty. Our wages are too low and the cost of living is outstripping annual increases in pay rates. Power prices mean cold houses; cost increases mean a lack of healthy food for children; damp, overcrowded houses mean the rapid spread of whooping cough, rheumatic fever and skin infections.
There have been and are numerous studies into child vulnerability and health outcomes. There is more than one Parliamentary select committee looking into related issues; there has been a Green Paper on Vulnerable Children. We seem to be falling over ourselves hearing the same submissions from the same interested and committed organisations and experts. What is lacking is the consistent political will required to address poverty and the causes of poor health outcomes. Labour will put children first and will tackle the adverse health outcomes children suffer from at their root cause, not just at their symptoms.
(Acknowledgement: Every child to thrive, belong and achieve? Time to reflect and act in New Zealand - Amanda J D’Souza, Nikki Turner, Don Simmers, Elizabeth Craig, Tony Dowell, NZMJ 30 March 2012, Vol 125 No 1352.)
Maryan Street is Labour’s Health Spokesperson