Friday, 22 March 2019

My column in this week's Insights newsletter - now a bit dated. The newsletter comes out at noon; our national moment of silence was an hour and a half after that.
Last week feels like it was a year ago. And the past week has made the world feel a little smaller.

Last night, the Rt. Hon. Stephen Harper, Prime Minister of Canada from 2006 through 2015, addressed members and guests of the Initiative at our annual retreat.

We found that Laureen, Prime Minister Harper’s wife, had lived in Christchurch as a young woman. Streets and buildings that stood as backdrop in news scenes playing in international media, for the second time in a decade and again for terrible reasons, were ones she remembered.

The world is smaller than we think.

Harper’s address reminded us that New Zealand and Canada remain rather special places in a world growing worryingly dark.

While living standards globally are better than ever, Europe, the UK and America have polarised – not along traditional left/right lines but on a newly emerging populist/elitist axis.

Trump and Brexit are obvious examples, but so too are right-wing populism in Germany and France, and the strange marriage of the populist left and right in the Italian government – which Harper likened to a coalition between Trump and Bernie Sanders.

Drawing on his recent book, Right Here, Right Now, Harper said this polarisation is inevitable when mainstream policy stops addressing the concerns of lower and middle-class voters.

In America, for what seems the first time, voters are telling pollsters they expect their kids to have a worse standard of living than they do. That builds an appetite for populism, and while populists have a keen nose for policy failures, they offer no positive policy agenda to solve the problems.

Harper rightly noted that Canada and New Zealand stand apart from those trends. In both countries, household income growth has been broadly shared across the distribution. We have not seen the income stagnation present in America. That makes for a better polity. It also makes for a country better able to accommodate migration; Harper noted Canada’s welcoming attitude to migrants and strong growth in immigration.

Populist resentment fuels anti-migrant sentiment. See Europe, the UK and America. In New Zealand, a broken housing market gave us a too-xenophobic 2017 election campaign. But last Friday’s tragedy brought us together rather than drive us apart.

During our moment of silence this afternoon, let us remember the victims – and renew our commitment to building a better New Zealand for all New Zealanders.
Subscribe to our newsletter here.

Thursday, 21 March 2019

Punching Nazis?

In yesterday's Herald, on the relative merits of punching Nazis:
I keep coming back to one tweet. Amid a steady stream of rage driven by pain and sorrow, a note of grace. Twitter stalwart and all-round decent bloke Lew Stoddart wrote:
"The mosque on Clyde Street is besieged by flowers and candles. A steady stream of people from all walks of life arrived during the 15 or so minutes I was there, including local scarfies dressed up for St Patrick's day, with gifts, food, or just to pay respects.

"And their humility and depth of aroha is magisterial. 'We failed him,' they told me. 'He lived with us in this city & we let him turn out this way.' And they expressed sorrow for the decades he will spend in solitary confinement.

"The Clyde Street mosque was his original target."
But it wasn't the only such note. We also heard Farid Ahmed forgive his wife's killer, saying he would pray for him. "I think probably he went through some trauma in his life, probably he wasn't loved … I don't hate him at all, not at all."

And it might be the only way out of this.

A year ago, Mother Jones reported on the American "Life After Hate" movement seeking to reform white supremacists: skinhead members of real and violent gangs. It is a terrible and difficult problem. Those who could not find pride in the content of their character found it instead in the colour of their skin.

When race becomes identity, stopping racism is a lot harder than, as is sometimes suggested on Twitter, finding Nazis to punch. At least according to the activists working to de-radicalise white supremacists, confrontation hardens attitudes rather than changing minds.

One of them said: "The uncomfortable truth is that the best way to reform racist thugs may be to offer them precisely what they aren't willing to offer others, and precisely what many people in this polarised political moment feel they least deserve: empathy."

It is hard counsel when every instinct screams for retribution. It is even harder counsel when we reflect on the injustice. It is blindingly obvious that we would be seeing far less compassion if a Muslim migrant had killed 50 white New Zealanders in a church. Every racist would, in that world, be emboldened.

But the logic of aroha is sound in either case. When attacked for being a member of a group it is far more natural to defend the group than to denounce it — especially when much of one's self-identity is bound up in group membership. It only hardens positions.

An invitation to talk with others who had doubts about their own membership in racist communities, and to then join with other "formers" as a new identity, can simply be more effective.

The statements of incredible grace from Friday's survivors should make us all want to be better people. If any members of Parliament regret having found electoral advantage in race-baiting and xenophobia, their own path to aroha may inspire others who badly need to make that journey.
Posting has been light and will continue to be this week - I'm up in Auckland for our Member's Retreat.

Friday, 15 March 2019

Vaccines

Hooray, New Zealand gets a measles outbreak. Whether it's due to middle-class antivaxxers, or kids whose parents just have a hard time getting them to the GP - who knows.

But what doesn't make sense to me is why school-based immunisations aren't comprehensive.

Year 7 and 8 students get immunisations at school - for schools that are participating. The kids there get their tetanus, diptheria and whooping cough booster, and the HPV vaccine. 

There's a national vaccinations register, so the public health nurses going into the schools to deliver vaccinations would know which kids haven't had their measles shots. 

So my dumb questions:
  1. Why aren't vaccinations provided at all schools rather than just at some schools? It seems far more efficient to send one nurse out to vaccinate a year-cohort of 20-100 kids than to send 20-100 families each to the GP for a vaccination. 
  2. Why aren't the public health nurses providing the MMR vaccine along with DPT for Year 7 kids for those kids who missed the shot when they should have had it? The shots are government funded anyway already, via the GP. But it's cheaper and more comprehensive for the government to provide them via the public health nurse who's already at the school than through GP offices. 
What am I missing? Is this a doctor-cartel thing where they really like getting the revenue stream from in-GP-office shots?

Thanks to @mikeythenurse for relevant discussion.

Midwife-led care

Midwife and researcher Ellie Wernham and Prof Diana Sarfati discuss their work showing worse outcomes under midwife-led care, and the Ministry of Health's coordination with the College of Midwives in response to that work.



Government policy might not change, but you can update your practice.

The practice we followed a bit over a decade ago:

  1. Find a midwife the second you think you're pregnant - or even earlier. Get one with proper training, not just the midwife certificate. You want a midwife who had rigorous nurse's training prior to going in for specialisation in midwifery. The ones who have training go very quickly. If you wait, you will be left with a midwife with weaker training. 
  2. Pay for shared care with an obstetrician anyway. In 2008, we paid a fixed price of $2k; in 2010, it was $3k. At the time, it was about the same price as a decent flat-screen TV; we kept the old CRT around for a few more years instead. Having your obstetrician available on-call during delivery to provide a c-section if needed is worth it. 

Previously: The Midwives have a history

Wednesday, 13 March 2019

Reducing harm or barking at cars?

There’s an old joke about the neighbourhood dog that loved to chase cars down the road – what would it ever do if it caught one?

The Government has been a bit like that with tobacco harm reduction. A very promising car has come around the corner and stopped. And the puzzled dog is standing there growling at it.

For decades, government has wanted to reduce smoking rates. Why? Smoking causes cancer, myriad respiratory problems, and shortens lives.

To reduce smoking, government used the tools it had at hand – which have gotten some of the job done, even if it was at a cost.

Tobacco excise collects at least three times more in tax than smoking costs the health care system. The 2001 McLeod Tax Review found the relatively low excise rates then in place to be indefensible – if their purpose was to compensate the Government for smoking’s cost to the health care system. Background documents for the Cullen tax review suggested that continued excise hikes would do relatively little to further reduce smoking rates, while imposing substantial regressive burden on poorer communities that continue to smoke.

Plain packaging regulations with graphic warnings may discourage kids from starting smoking, but the evidence is weaker than you might hope: SmokeFree regulations have made smokers pariahs, increasingly barred from places where decent people might witness their habit.

Even though smoking rates have declined, nothing suggests that current policy will achieve the Government’s goal of getting smoking down to less than 5 percent of the population by 2025.

And so we come to the promising car that has come around the corner – new and safer ways of accessing nicotine.

Spend any time walking around a downtown urban centre and you will notice the clouds of vapour coming from former smokers who have switched to a less harmful alternative. Rather than berating smokers for their habit, vaping offered a way of delivering nicotine without combustion’s nasty consequences.

But vaping is hardly the only alternative out there.

Nicotine gum and patches have long been prescribed as stop-smoking solutions, but simply haven’t worked for a lot of smokers trying to quit.

Swedish snus is a powdered tobacco contained in a small sachet that looks like a teabag; users place the sachet behind their lower lip. Snus is far safer than smoking or traditional chewed tobacco, has been an important part of Sweden’s decline in smoking rates since the 1980s, but has only recently became available in New Zealand. And new technology that heats tobacco rather than burn it, and consequently avoids creating the carcinogens that come with combustion, is now on the market too.

There have to be a wide variety of options available for people wanting to cut down or quit smoking because different things work for different people. And making that work requires regulatory and tax frameworks that are fit for purpose rather than refitting those designed for cigarettes.

Last week’s headlines told us Philip Morris offered to stop selling cigarettes in New Zealand if it received a tax break – along with a rather smug reply from the Prime Minister that the company could feel free to stop selling cigarettes any time it liked and shouldn’t need a tax break to do it.

But the reporting really missed what has been going on.

Philip Morris makes one of the newer reduced harm products. Its Iqos device heats non-combustible tobacco rather than burn it. Iqos is less harmful than smoking, but perhaps not quite as safe as vaping – the science is still being settled on that one. Nevertheless, ‘heets’ (the tobacco sticks used in Iqos) face the same tobacco excise rate as cigarillos. Excise on cigarette tobacco is just over $1,300 per kilogram or about $0.92 per cigarette. Excise on other tobacco products, from cigars and cigarillos to snus and ‘heet’ sticks, runs just over $1,150 per kilogram of tobacco.

In every other aspect of tobacco control policy, the Government has been adamant that price is an effective deterrent. That is why it imposes excise taxes that cost a pack-a-day smoker more than $6,700 per year, despite the regressive effects of that tax regularly highlighted in Statistics New Zealand’s inflation updates.

If the Government wants people to switch from smoking to less harmful alternatives, why does it impose the same tax on combustible tobacco as on tobacco that is used less harmfully? A 10-gram packet of snus selling for $21, containing 15 sachets, draws about $11.50 in excise – or about $0.77 per sachet. A 10-gram packet of cigarillos would draw the same excise.

It gets worse. Iqos sticks are subject to smoked tobacco’s plain packaging rules with graphic warnings about the dangers of cigarettes. It could well be worth having a warning on the packs that while they are safer than cigarettes, they aren’t candy. But how does it encourage uptake of reduced-harm alternatives if their packages look just as dangerous as the actually dangerous products?

The dog just does not know what to do with the car it has caught, so it sticks to what it knows – growling. When the Prime Minister quipped that Philip Morris could simply stop selling cigarettes here, she absolutely missed the point. Other cigarette companies would fill the gap in the market. But if reduced-harm products had a greater price advantage over cigarettes through a risk-proportionate excise regime, more smokers overall might switch.

Vaping is a really important part of tobacco harm reduction. But it is not a solution that will work for all smokers. Making sure the regulatory regime is right for other reduced-harm products matters. That means a much lower excise rate for reduced-harm tobacco products – or even zero excise through 2025 – and a bit of sanity in the rules around product packaging.

Tuesday, 12 March 2019

Morning roundup

This morning's worthies:

Monday, 11 March 2019

YIMBY - local bottle shop edition

The local Khandallah DVD shop finally closed down. We'd rented DVDs there roughly once a month - there's a lot of older stuff that just doesn't stream in New Zealand.* So, it looks like we'll have to drive out to Aro Video a bit more often for those things.

In its place, a bottle shop has applied for permission to open. The Council website provides a lot of ways for people to lodge objections but doesn't make any provision for those, like me, who'd like to say Yes In My Back Yard.

So I've mailed the following letter to their Objections address. I don't know whether it will do any good, but remain ever-hopeful.
Secretary of the District Licensing Committee
PO Box 2199
Wellington 6140

Re: Application of The Bottle-O Khandallah, 5 Ganges Road, Khandallah

Dear DLC,

I am writing in support of the application to open a bottle shop at 5 Ganges Road, Khandallah.

I have lived on Nicholson Road, an 8-minute walk from the proposed location, since 2014 with my young family. I am very happy with the excellent beer and wine selection at the local New World; I will be very happy to also have easier access to a local bottle shop. We otherwise do our spirits shopping at Moore Wilson or at Johnsonville, neither of which are particularly convenient.

I expect a Khandallah-based shop will provide a range and selection that suits the local market, and I will appreciate having access to that within an easy walk. Some might object that Ngaio or Johnsonville bottle shops are close enough and that one in Khandallah isn’t needed. Well, Ngaio has a butcher shop, but the Khandallah butcher shop runs a brisk trade; Johnsonville has two Countdowns but our New World also does well. A bottle shop in the village will do no harm and will be great for those, like me, who like to do our shopping while walking from home.

I also strongly urge that the DLC weigh customer access against the inevitable police or medical officer objections demanding more limited hours. Khandallah town centre runs until about 9pm; the application requests that the shop is open until 9pm. The shop should be allowed to run until 9pm, which matches the hours of the local New World. Professionals like me will often do their shopping after getting the kids to bed – so, in the 8-9pm period. I’m generally rushing through at a quarter to nine. Earlier closing times would be an undue burden.

Since the Council website provides a lot of information about how to object to things and no particular way for those who don’t want to object to make their views known, I thought it worthwhile to send in this note. I hope to be a happy customer of the shop, one of the countless moderate drinkers who impose no harm on anyone, who pay far more in excise than we should, and whose views are rarely heard when these sorts of applications are made.

Yes In My Back Yard, please. And perhaps consider making some changes to your consultation website so you might hear more from those of us who welcome things like this.

Sincerely,

If we all start submitting in support of stuff that usually draws objection, maybe the equilibrium changes a bit.

Previously: For a bigger Khandallah


* We subscribe to Netflix, Amazon Prime, Neon, and Anime Lab. Egads but Neon is terrible.