The Politics of Good Health
The Politics of Good Health
With a $14 billion annual price tag, health is sure to be a strongly contested election issue come November. Peter Glensor has worked at the grassroots in community health and has also had extensive governance experience at DHB level. Michael Fitzsimons catches up with him for a progress report on how our health system is faring.
It is so common to hear of the shortcomings of New Zealand’s health system that it comes as something of a surprise to hear Peter Glensor, long-time health worker and administrator, deliver a different verdict.
“New Zealand has a good place internationally in terms of health outcomes. We have some of the best maternity figures in the world in terms of child and maternal mortality and a very good maternity system. We have good stats in terms of death rates and life expectancy – we are right up there in the wealthy world.”
A paper Peter delivered at the Australian Health Summit earlier this year expands on the positive message. According to a 2009 survey, 89.7% of New Zealanders report themselves to be in good health, a rate that tops international rankings. We have achieved immunisation rates of 88% for children. Our emergency department processing times have steadily improved, with 87% of patients being seen within six hours – a rise of 7% between September 09 and March 2010.
New Zealand’s rate of daily smoking of 18% in 2007 is the fourth lowest in the OECD, and we have close to the highest rate of decline between 1995 and 2007.
“This exciting data [on smoking],” says Peter, “is the fruit of years of intersectoral work, and a classic example of good public health work – where price increases, legislative changes, personal health interventions and social marketing campaigns work together to achieve a real health gain.”
On the health workforce front, the levels of job satisfaction among New Zealand physicians rate very highly, a fact at odds with the perception of dissatisfaction among our health specialists. A 2009 Commonwealth Fund survey of primary care physician work satisfaction has New Zealand right at the top, alongside Norway. Interestingly, our wealthy neighbour Australia comes 10th of the 11 countries surveyed.
So all in all there is a lot to take satisfaction in “but these are all matters that can be easily undone,” warns Peter.
“They can be easily undone by losing our sought-after health professionals to other countries, by failing to compete with overseas remuneration rates, by the continually rising costs of new technology and expensive pharmaceuticals that are coming onto the market all the time. A lot of us are worried about the current threat to Pharmac, a world-renowned drug-purchasing agency which has held our drug costs much more effectively than other countries. If Pharmac’s future comes under threat by some kind of free-trade negotiations, that would be very serious issue for us as a country.”
Another area of concern is the “serious inequalities within our population which can’t be neglected. If they are, they will come back to bite us. In times of economic pressure, the inequalities are likely to get worse.
Says Peter: “The rich-poor divide and the racial divide are reflected in all sorts of health conditions, not just the obvious ones. Ethnicity is a compounding factor so that even when you correct for social-economic status, being Maori, for example, means you are more likely to suffer poorer outcomes. Rich or middle class Maori are worse off than rich or middle class Pakeha.”
New Zealand’s health inequalities are also on the mind of the traditionally conservative New Zealand Medical Association (NZMA). In a strong statement issued in March, the NZMA calls on the Government to “urgently address the inequities in health status experienced by Maori, Pacific Island Peoples, refugees, migrants and other vulnerable groups.” It says a whole-of-government approach is required. In particular policies addressing education, employment, poverty, housing, taxation and social security should be assessed for their health impact.
The NZMA goes on to say “that economic growth should not be viewed as the sole measure of a country’s success and that the fair distribution of health, well-being and environmental and social sustainability are equally important goals.”
With a background in community health, Peter Glensor is well aware of the health disparities facing people on low incomes. He was a Methodist minister for 20 years before working as a community worker in a poor community in the Hutt Valley.
“As a community worker, health was a presenting issue from day one. In 1991, having tried other ways first, we began a general practice called the Hutt Union and Community Health Service. In time I became its manager and it quickly expanded – community-owned with salaried staff serving a very high-needs community. In the 90s a group of union health services around New Zealand, plus Maori and community health groups, came together to form a national network of community-owned primary health services in the face of a very hostile Government.”
The network was called Health Care Aotearoa and in 1997 Peter became its fulltime coordinator.
“We became very involved in health policy development. Bill English, the Minister of Health of the day, took a shine to us, giving us some money to expand our model of primary health care around different places.”
Elements of the Health Care Aotearoa model – for example, capitation funding, a focus on multi-disciplinary teams and greater community engagement – were picked up in the Labour Government’s primary health strategy and the new Primary Health Organisation structure. Peter was appointed to the board for the transitional Hutt Valley DHB and has been on the Hutt DHB since then. These days he is also an appointed member of the Capital and Coast DHB and represents Lower Hutt on the Greater Wellington Regional Council.
Peter’s appointment to several DHBs reflects the current Government’s move to achieve greater regional collaboration between DHBs. A restructuring of DHBs to achieve this is likely in the future.
From his governance vantage point, he sees a constant tension between ensuring that our hospital services are as efficient and productive as possible while ensuring there is adequate funding to support the community and public health sectors.
“The political spotlight is on hospitals and surgery waiting lists, but the reality is that the health gains, as opposed to correcting things that are wrong, happen out in the community, in the public and primary health fields.”
A focus on the whole community needs to be at the heart of our health planning, says Peter, and that’s always a challenge.
“Are we able to look at the good of the whole nation? That means addressing health disparities because having an underclass which is sicker and dies earlier has all sorts of negative impacts on the whole nation. We must ensure that the health programmes we have in place are accessible and appropriate for everyone.”
“The political spotlight is on hospitals and surgery waiting lists, but the reality is that the health gains, as opposed to correcting things that are wrong, happen out in the community, in the public and primary health fields.” – Peter Glensor
“…economic growth should not be viewed as the sole measure of a country’s success … the fair distribution of health, well-being and environmental and social sustainability are equally important goals.” – New Zealand Medical Association, 2011
A New World is Possible - Paul Oestreicher
Canon Paul Oestricher was the keynote speaker at the Opening Plenary of the International Ecumenical Peace Convocation held in Kingston, Jamaica on 18 May 2011. We reprint this memorable address in two part. In the first part, Canon Paul asks for a radical move away from just war theory, to stand for the unique ethical contribution of Jesus: ‘love your enemies’, by paralleling William Wilberforce’s campaign to abolish slavery.
Wherever you come from, whatever your church tradition, you may be Orthodox or Catholic, Protestant or Charismatic, Evangelical or Liberal, Conservative or Radical, all of us have come here because we wish to be friends of Jesus, rabbi, prophet and more than a prophet. To each one of us he says: You are my friends, if you do what I command you ... This I command you, to love one another as I have loved you. Is anyone, anywhere, excluded from that love? Here is the answer that Jesus gave to his friends: It is said ‘you shall love your neighbour and hate your enemy’; but I say to you, love your enemies and pray for those who persecute you.
That is how the Man in whom we see the face of God spoke, lived and died. As his enemies were killing him, he prayed for them to be forgiven. Jesus was not only speaking to each of us individually, he was addressing the people of God as a holy community. The prophets of Israel spoke to their nation. Often the nation did not want to hear.
Gathered together in Kingston from all corners of the earth, Jesus speaks to us now, to us, a small cross section of his sanctified people. Do we want to hear him? Our record suggests that we do not. Most of our theologians, pastors and assemblies, Orthodox, Catholic, and Protestant, have bowed down ever since the time of the Emperor Constantine in the third century, bowed down deeply to empire and nation, rather than to the single new humanity into which we are born. We have made a pact with Caesar, with power, the very pact that the early Christians called idolatry. Because the newly converted ruler declared it to be our duty, we have squared it with our conscience to kill the Emperor’s enemies, and to do this with Jesus on our lips.
Under the sign of the Cross Christian nations have conquered and massacred the children of Islam. In 1914, my German father went to war with the words God with Us engraved on his belt buckle. The British soldiers whom he was trained to kill, had no doubt that the same God was on their side. When in 1945, a bomber set out, loaded with the world’s first nuclear weapon, a single weapon which was about to kill one hundred thousand women and children and men in the city of Hiroshima, the aircraft’s crew were sent on their way with Christian prayers. The war memorials in the cathedrals and cities of Christendom attest to the fact that we, like our brothers and sisters in Islam, regard those who have died in battle for the nation as having secured their place in heaven, and that now includes those in the coffins arriving from Afghanistan and draped in the ‘sacred’ Stars and Stripes.
Unless we change, unless the Church moves to the margins and becomes the alternative society that unconditionally says no to war, no to the collective murder that every embattled nation or tribe, every warring alliance, every violent liberation movement, every fundamentalist cause, and now the War on Terror declares to be just, until we throw this justification of war, this ‘just war’ theology into the dustbin of history, unless we do that, we will have thrown away the one unique ethical contribution that the teaching of Jesus could make both to the survival of humanity and to the triumph of compassion.
I commend to you Karen Armstrong’s highly significant Charter of Compassion. The Hindu prophet Mahatma Gandhi thought that Christianity would be a good idea - if only Christians practised it. If we were to show compassion for those whom we have good reason to fear, the new world that Jesus called the Kingdom would have come a little closer. That is within our power. Albert Schweitzer in his philosophy of civilisation simply called it: reverence for life.
This Convocation will not yet be the Universal Christian Peace Council of which Dietrich Bonhoeffer dreamed, long before Hitler’s obedient servants hanged him. But we could help to pave the way to such a Council, a Council speaking with the authority of the whole Church, if, here and now in Kingston, we were ready to say: it is impossible both to love our enemies and to kill them, it is impossible both to reverence life and to be in league with the military-industrial complex, the killing-machine that rapaciously consumes levels of wealth that are beyond our mathematical imagination.
War and the arms trade that feeds it cannot make life for the people on our small planet more just or more secure. It is not simply that crimes are committed by all sides in every war. War itself is the crime. Its preparation alone, globally consumes more than a hundred times the resources that could provide clean water to every child on this planet. Even before the latest perversions of science and technology are put to their lethal use, thousands of children die unnecessarily for lack of clean water.
Jesus was not an idealistic dreamer. He was and remains the ultimate realist. The survival of our planet demands nothing less than the abolition of war. Albert Einstein, the great physicist and humanist, already knew that early in the last century. He repeated it often with a clarity and credibility that few Christian pacifists have matched.
The abolition of war is possible. It is as possible as was the abolition of slavery, the slavery that still haunts the history of this nation of Jamaica. Wilberforce and his evangelical friends who campaigned to end it, were thought to be unrealistic dreamers. Slavery surely was part of our DNA, necessary to every society’s economic survival. The churches were up to their necks in maintaining slavery, the bishops of the Church of England unanimously upheld it. In the same way, many Christians are wedded to a society that cannot let go of the cult of the good soldier or even the holy warrior. Wilberforce and his determined friends triumphed against all odds. Slavery was made illegal. Its defenders withered away. That needs to become the fate of war. If the churches of the world fail to embark on such a campaign, we will have nothing of unique significance to say on the subject of world peace.
What are our chances of winning this battle? Some will say: slavery, exploitation, and trafficking in human beings still goes on. Yes, but it is universally acknowledged as both morally wrong, and illegal. Passing legislation to abolish war will not immediately eliminate armed violence. What it will do is to make absolutely clear that to resolve conflicts by military means is illegal, with its perpetrators brought before an International Court of Justice.
Will we then remain in bondage to the principalities and powers, or will we wrestle with them and thereby enter into the glorious liberty of the children of God?
This struggle, if we embrace it, will be at least as tough as that of Wilberforce. Devotion to and respect for every nation’s military tradition is as undiminished in church as in state. The Roman dictum: si vis pacem, para bellum, if you want peace, prepare for war, holds sway. It is a powerful lie. Yet those who believe it are neither stupid nor evil. History, however, shows that if we prepare for war, war is eventually what we get. Jesus put it quite simply: Those who live by the sword, will die by the sword.
Unless we learn to resolve our conflicts – and conflicts there will always be – unless we learn to resolve them without militarised violence, our children’s children may no longer have a future. Love of those who threaten us, care for the welfare of those whom we fear, is not only a sign of spiritual maturity, but also of wordly wisdom. It is enlightened self- interest. Military strategists glimpsed that when, in the Cold War they spoke of common security. If my potential enemy has no reason to fear me, I am safer too.
So, it is time for the still small voices of the historic peace churches, hitherto respected but ignored, to be taken seriously. That is the main reason why, as an Anglican priest, I have also chosen to be a Quaker, a member of the Religious Society of Friends. Quaker history, often a story of suffering, witnesses to the biblical insight that love casts out fear.
This is a eulogy given at a recent funeral. It speaks of the relationship between two people of differing age and the grace that flowed from their honesty and their ability to relate in trust and to speak freely of God.
I knew Jack for 13 years only. I met him on my first day at Alcoholics Anonymous. We were at a Southern Area Assembly at Hanmer Springs on 31 October 1997. I was only one day sober, so I don’t remember much. But this elderly gentleman in a blazer with a walking stick came up to me and said, “Good to see you again, Paul. Keep coming back.” I thought, well, I have never met this old guy before. I must have been here too long, as I thought Queen Mary Hospital was full of fruitcakes and delusional people. I said to Mike who was walking beside me, “How did he know my name?” Mike informed me that it was on my name tag and that I was the fruitcake. He then told me that Jack had been sober for 39 years. I laughed and thought, yep, delusional, how could anyone be 39 years sober? I was only 31 years old.
Not long after that Jack become my sponsor. He became my inspiration, the genuine humble and serene person I wanted to be. Jack taught me how to pray, how to forgive, how to serve others and most of all how to love. I never knew what love was then, but today I do. I had told so many I loved them in a blithering state in the early hours after some big night out. But sober, I only ever said it to one man. That was Jack. I really did love him, and he allowed me to tell him.
Jack was the only person that I could be myself with. I didn’t need a mask. I didn’t need to impress him or lie to him.
I spoke at my mother’s funeral in Cromwell back in 1999. As I was speaking I looked up through the crowd and saw Jack looking back at me. I knew then that everything was going to be OK. I didn’t even know that Jack was going to be there. But he had driven his little Lada all the way to Cromwell from Dunedin stopping only twice for cat-naps along the way.
Jack always put others before himself. He had shown me the meaning of unconditional love. My memories include his gentle but deep spiritual faith – that nothing happens by mistake; that with God all things are possible; that we need to thank God that people and all things are exactly the way God means them to be; to pray for others and to see the good in them. Jack often told me he thought God was an alcoholic because God did not like being told what to do.
Then I did not know about serenity and humility but now I think of Jack and I understand. We spent many hours together at meetings, in the car, at assemblies and at his home. And when I left Dunedin four years ago for Hokitika I missed the regular contact with Jack. But our relationship didn’t end, it changed. We spoke every Wednesday night, sometimes about a problem, sometimes about the cricket but always about God. Jack had given me the most incredible gift – he introduced me to God and made sure I kept in regular contact with God.
Jack often said in relation to Heaven that if it is so good up there, why do we have to hang around here for so long? We laughed and agreed that there is more forgiveness needed in this world and more alcoholics suffering who may need our help.
I am sure that as Jack approaches his creator at the pearly gates there won’t be a judgment interview, there will be a red carpet as he arrives home.
Jack, I love you. I miss you. I am sad but so, so blessed to have had you in my life.
God grant me the serenity
To accept the things I cannot change
The courage to change the things I can
And the wisdom to know the difference.
The anonymity of the eulogist is preserved in line with the traditions of Alcoholics Anonymous and at the request of Jack’s family
Is the Catholic Church being faithful to Mary?
Is the Catholic Church being faithful to Mary?
How would the face of the Church look if it were to wear a more humble and participative face – more in accord with the way Mary was in her time? In this time of transition within the Church, how might the Church take up these possibilities and reflect Mary’s face and attitudes
A Midwife Generation
The new Superior General of the Marist Brothers, Emili Turu, is a much respected figure in the Union of Major Superior Generals. I was privileged to hear him on the topic of Mary in the Church. It began with him asking me to read the following extract:
I believe that a new Church is coming. It will be browner and poorer, more sensuous and feminine, less clerical and more collegial, less concerned about charity and more conscious of justice and more multilingual and polycentric than the one we know now. That Church will better reflect the diversity of God’s Trinitarian life. It will be a new Church… yet it can only come with the passing of this one. I dare to suggest that it is our task to facilitate the present Church’s passing in order to assist in the birthing of the new. Paradoxically, hospice workers are also the midwives of new life.
The prophetic vocation is to help the community to accept a loss they cannot admit and to embrace a hope they cannot dare to believe. Prophets do this by attending to the present groans of the people and positing an alternative future vision. This, I believe, is the essence of being a spiritual leader in the Church during the time of transition.
(Fr. Bryan Massingale, Archdiocese of Milwaukee).
A New Pentecost! A New Church
There is so much in this passage that is Marist and in accord with the vision of the early Marists on building a new Church. Do we believe a new Church is coming? Not only is it coming; it has to come! One with a Marial face? Pope John Paul II spoke clearly on this issue when he reminded the Curia that the Church was Marial before it was Petrine. Certainly we have to wonder what happened to Mary in the post-Vatican II church. It was not because of the loss of sound writing in Mariology, an enriched area with papal documents such as Marialis Cultus and Redemptoris Mater and the balanced writing of a host of scholars, but it has not been getting through to the people in the pews, let alone some religious who carry her name. I am not referring to Marian devotions, which are perhaps the main area of visible crisis. Paul VI wisely stated that we are to be completely free in the area of devotion to Mary.
Only when we face the truth contained in the above statement can we accept the truth that God is doing something new in history, either with us, without us, or against us, can we become part of the solution – or remain part of the problem. Rahner was quite right in his statement that the Christian of the future will either be a mystic… or will cease to be. The other dimension is the risk to be a prophet, or better to accept prophetic mysticism, the call to live prophetically.
Let Go! Let Live!
When Pope Benedict recently spoke to the gathered group of new Cardinals he reminded them that their position was one of service and not of power. This is an important reminder that a Marial Church wears the face of the three ‘Nos!’ – no to power, no to prestige, and no to position. The humble role of service, the face of the Mary of the Visitation, fits well into such a call. Back in 1970 a German theologian named Josef Ratzinger spoke the following words:
Today the Church has become for many the main obstacle to faith; in it can be seen only the struggle for human power, the poor theatre of those who, by their observations, want to absolutise official Christianity and paralyse the true spirit of Christianity. We may well ask if the situation is any different today from then?
Any mother faces the challenge of letting go of her children. Mary had this experience in her life. In Luke’s gospel, Simeon speaks of a sword of sorrow piercing Mary’s heart. Luke does not place her at the foot of the Cross but quickly brings her into Pentecost. It is John’s gospel alone that places Mary at the Cross with the Beloved Disciple. The sword of sorrow in Luke contains a different focus. It is the pain of separation for the mission of her Son and the consequent rejection that he suffers in it.
A number of years ago, Pope John Paul II in speaking to the Marist major superiors put to them the challenge of building a Marial church. Br. Emili has picked up this challenge and has placed it within his letter to the International Marist Youth Meeting to take place in Madrid this year. To go with Mary in haste to a new land must also include a new way of being church, ‘together, with enthusiasm, hand in hand with Mary.’ The hope in the letter is the concrete task of going towards a Marial Church, discovering its Marial face and making it obvious through their lives. Bro Emili says:
There are many young people who perceive the Church as authoritarian, clerical, masculine, negative and remote. John Paul II invited us as Marists some years ago to work towards building a ‘Marial’ Church, or it may be, a Church which reflected Mary’s face and attitudes, and therefore manifested itself in a communion which is fraternal, participative and close to us. It seems to me a beautiful thing to offer ourselves to this challenge: to work together to offer our world and our Church the attractive face of Mary, woman and mother; it would be a great contribution, with a great prophetic dimension.