After months of pressure from the media and opposition National Party, the Government has unveiled its action plan on cancer. The plan sensibly focuses on prevention and early detection, and maintains the independence of PHARMAC, all of which is great to see. But the bigger questions overhanging this announcement are: why focus on cancer? And: if the DHB model has failed on this issue, why should we believe it is working elsewhere?
The Scourge of Cancer
I want to start by acknowledging that I lost two of my beloved grandparents to cancer. It was heartbreaking watching them suffer lingering deaths. Maybe my Nana's death could have been prevented if the cancer had been detected earlier. Who knows?
It’s true, a lot more needs to be done to improve cancer detection, treatment, and prevention. It is also very clear that there’s a postcode lottery for treatment – where different DHBs deliver different treatments of different quality. Hopefully, the Government’s plan will make progress on these issues. It seems to be talking about the right things, but the devil is often in the details.
What About the Rest of the Health System?
The fact is that many of these problems exist throughout the health system. We often focus on treatment rather than prevention and early detection, which are far more cost effective. There are many examples of the postcode lottery in treatments – and by the way, it isn’t always rural areas that miss out. Many rural areas see much higher numbers of non-urgent operations than urban ones. They do this to keep the doctors they do have busy.
If DHBs are not delivering on cancer, why do we assume everything is tickety-boo elsewhere? It’s clearly not. Around the country, we have 20 DHBs with different CEOs and administration units. It is a hugely wasteful system, and for what? The idea of local input is a sham. Turnout for DHB boards is abysmal. And the Ministry of Health saddles DHBs with all sorts of requirements that make it impossible for them to be truly local.
The Bitter Truth
Why do we focus on the postcode lottery and lack of investment in cancer, but not in diabetes or rheumatic fever? Why do we so quickly forget about the one in five children hospitalised with respiratory illness that could have been avoided if they lived in warm, dry homes?
The harsh reality is that cancer is a middle-class problem. Politicians care about it because it afflicts elderly people who vote. And cancer remedies get highlighted because pharmaceutical companies want us to buy them.
We still have third-world diseases in this country – diseases that could easily be prevented and eliminated with greater effort. We have young children who may never live a full life, or whose lives are cut short due to misplaced priorities. Yet we don't talk about them because they come from poor families, who often don't vote, and whose diseases Big Pharma doesn’t have a ready cure for.
We have to ask ourselves: what are our priorities as a country? If we want our health dollars to help everyone live longer, we need to be very careful about how we spend them. We need to think smarter about how we approach this issue, figure out what works effectively, and not be subject to the whims of pharmaceutical companies.
This is exactly why we have PHARMAC. As I’ve explained, we need to give PHARMAC a break. Sure, PHARMAC could be more innovative and transparent (TOP has suggested using more citizen’s juries), but its basic model is sound.
Thankfully, the Government has preserved PHARMAC’s independence, which is why it will spend some of its funding increase on long-acting contraceptives. This is fantastic to see as these can have many benefits for women.
In recent times, we’ve seen a lot of media coverage comparing treatments you can get in New Zealand and overseas. However, what we don't hear is whether those treatments are effective for the price. We also don't talk about the fact that New Zealand is poorer than many countries we like to compare ourselves to. But heaven forbid we have a conversation about how to wean ourselves off speculating on property and investing in businesses instead.
Instead of fiddling with PHARMAC as many propose, we need to make the rest of our health system operate more like PHARMAC. In other words, we should invest where we get the best return for our health dollar. This would often involve focussing more on prevention and early detection.
Our health system decides priorities every day. PHARMAC is one of many organisations making tough decisions so that all New Zealanders get access to proven, safe, and cost-effective medicine. Cancer needs attention but in a smart, transparent, and sustainable way that doesn’t sink our health system and leave more kids behind.