Friday 24 April 2020

Public Health Priorities

New Zealand's public health system has pivoted admirably to focus on the current pandemic. But the neglect of communicable disease for rather a long time ahead of this has had costs.

The public health system's focus on noncommunicable disease may make sense if you only look at the current burden of disease, prior to this year. But contagious and noncommunicable disease are very different things. If I decide to live an unhealthy lifestyle and have worse health as consequence, the costs of that to others are not particularly high. There is a fiscal transfer through the public health system, but that is mostly pecuniary - unless you think that people are living substantially less healthy lives because they know that the system will cover the health costs down the track. But any real, Pareto-relevant, technological externality is small. Concerns about noncommunicable disease are largely paternalistic.

Communicable disease is different. There are real and substantial external costs from it, and real public good benefits from its suppression. If I am currently risky, my staying home provides benefits to everyone with whom I'd otherwise come into contact, whether on the bus, in a restaurant, or anywhere else.

And as much as public health people hate seeing anyone enjoying a soda, a soda has never resulted in a month-long nation-wide lockdown and economic collapse.

Every time I've complained about this, the well-thinking people have told me that government can walk and chew gum at the same time. It can both focus on banning people from doing the things they enjoy doing while also keeping on top of communicable disease.

Yeah. About that.

Here's Georgina Campbell over at The Herald.
Thousands more face masks have been found with crumbling elastic and deemed unfit for purpose in the fight against Covid-19.

Earlier this month it was revealed there were 90,000 masks with corrupted elastic at Capital and Coast DHB and a further 10,000 at Hutt Valley DHB.

South Canterbury DHB has since reported there were 58,000 N95 masks in its pandemic stock, but due to their age, guidance has been sought from the Ministry of Health on whether they could be used during the Covid-19 pandemic, DHB chief executive Nigel Trainor said.
The public health system, broadly speaking (which I take to include the Ministry of Health, the DHBs, the HRC granting system, and the universities doing the research, and the cluster of government-funded NGOs), has managed to do a lot of things recently.

It has managed to ban sodas in hospital cafeterias.

It has managed to put cameras on a pile of kids to take pictures every five minutes, and to scour those pictures for evidence of evil brands that are hurting children by their presence.

It has put huge effort into blocking new bottleshops in places like Khandallah, with months-long hearings processes.

It has prioritised working out the regulations around vaping even in the middle of a pandemic, with MoH resources being put to supporting that committee.

But it has not managed to check that the DHBs are doing stock rotation on its PPE supplies for a pandemic. A public health system that protected its workers from soda did not bother to make sure its workers would have reliable access to PPE. 

This isn't a Labour government failure. It's a failure of the administrative state over the past decade in chasing after noncommunicable disease at the expense of preparedness for communicable disease.

Places like Taiwan have been able to avoid lockdowns because they've had a public health system ready for pandemics.

It is interesting to imagine a counterfactual in which public health had maintained a focus on communicable disease. Where grant money went into ensuring best-practices for scale-up of contact-tracing rather than having people watch sports matches to count alcohol brand exposure. Where central government was telling DHBs to check their PPE stocks rather demanding that they ban soda in the hospitals.

Let's hope that the system can maintain a focus on communicable disease coming out of this.

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