From damp housing to unsafe work, doctors see every day the conditions worsening the health of thousands of New Zealanders. Dr George Laking of the Royal Australasian College of Physicians explains the four things we can do make a change for the better.
Physicians are specialist doctors who look after people with medical illnesses. We mostly don’t do operations. We listen to patients and whānau, find out what’s happening, and work out a plan for recovery.
Our plans may involve medicines, but we know health depends on a lot more. Health often requires linking people up with social supports. Most importantly, good health depends on change. We need to change the conditions that make health fail in the first place.
At hospitals, we often talk about the “revolving door” that keeps people coming back into care, again and again. The revolving door is there because the condition of people’s lives makes them sick. It does not need to go on like this. The Royal Australasian College of Physicians (RACP) can point to four things that, when we get them right, will lead to good health for all New Zealanders.
These four things have long been known. They’re summed up in words famously associated with former Prime Minister Norman Kirk: “People don’t want much – just somewhere to live, someone to love, something to do and something to hope for”.
You won’t find a better prescription for a nation’s health than these words. They’re the starting point of the RACP’s work to #MakeItTheNorm. They’re backed up by our knowledge, experience, and evidence of the things that matter for health:
- Somewhere to live: It needs to be the norm that everyone has healthy housing.
- Someone to love: It needs to be the norm that all whānau enjoy wellbeing.
- Something to do: It needs to be the norm that everyone has good work.
- Something to hope for: There needs to be justice. Everyone has to have a fair go.
As Aotearoa goes to the polls, the RACP has one question: what are our elected leaders doing to make these four things the norm?
Our members are physicians and paediatricians working mainly in hospitals, all over the country. Every day, in clinics and on the wards, we see how New Zealand gets it wrong. We see the harm caused by cold, mouldy and damp housing; by whānau life on subsistence incomes; by unsafe and precarious jobs; and most perniciously, by inequity – the uneven access to resources that leads to avoidable and unjust loss of health.
The links have long been known between health and the conditions in which we gestate and are born, live, grow, work, play and age. Here, in more detail, is the prescription for change we need to make Aotearoa a healthier place.
No one should be without proper shelter. We believe healthy housing is a human right. Public housing must be recognised as a societal good. All homes should be capable of energy-efficient heating and cooling. The UN Special Rapporteur on the Right to Housing described New Zealand’s situation as a “human rights crisis of significant proportions“.
Homes must meet the needs of our communities. Principles of universal design need to be a standard so all public housing is accessible. Currently, Kāinga Ora has over 900 people with disabilities waiting for accessible homes. Aotearoa needs to develop housing options that embrace multi-generational and multi-family homes, solutions such as papakāinga are already known in te ao Māori.
Work is good for health when the wellbeing of workers is centred and upheld. Employment can only alleviate whānau from poverty and increase societal participation when the pay is enough to stop hardship.
Work for many in New Zealand continues to be precarious, low-paid, and hazardous. The adult minimum wage is $18.90 an hour before tax, while a living wage is set at $22.10. The wealth held by the richest 1% of New Zealanders exceeds that of the average person by a factor of 68.
Aotearoa celebrated its essential workers through the Covid-19 lockdown. Yet we continue to restrict the pay of our supermarket workers, courier drivers, security guards, warehouse stockers and cleaners. All workers should be able to earn enough income to live with dignity. They should have enough sick leave to recover from illness. They should not have to rely on food banks as their wages do not meet the cost of living. For all these reasons, the RACP supports the living wage movement.
Whānau wellbeing encompasses the individual, their whānau, their community and their environment.
The Unicef Innocenti Report from August advises that children in Aotearoa continue in the lowest 15% of wellbeing across developed nations. Indeed, it found New Zealand was the worst of 38 countries for the mental wellbeing of children. Conditions like acute rheumatic fever and congenital syphilis are on the increase in Aotearoa. They’re rarely found elsewhere in the OECD because they’re preventable.
We need to have regard for the health of people at all stages of life. It’s not acceptable to fall short for any group, be they young or old, or physically able or disabled. The simple reason is that when any one person falls ill, the burden is carried across their whole whānau.
Although health equity has gained higher public consciousness, Māori still have seven years less life expectancy than non-Māori. We’re still at the start line on a journey to ensure every New Zealander has equality of outcome. New Zealand is a wealthy country – it doesn’t have to be this way for anyone. The suffering is preventable if we work together.
The year 2040 will be the bicentennial of Te Tiriti o Waitangi. The principles of Te Tiriti offer a constitutional framework to realise a just and equitable society. If we have culturally safe systems with no barriers to entry, and commit to sustained action on the social determinants, we can make good health the norm for all people in Aotearoa.