Opinion & Commentary
Welfare is killing Kiwis softly
If you believe the editorial in the most recent edition of the New Zealand Medical Journal, a toxic combination of bad social and economic policies is responsible for killing thousands of New Zealanders each year. To cut the premature death toll associated with smoking and obesity related diseases such as lung cancer and Type-II diabetes, Professor Tony Blakely urges the New Zealand government to provide better ‘social protections across the lifecourse.’
The NZMJ has endorsed a provocative report released last week by the World Health Organisation, Closing the Gap in a Generation. The report examines the so-called social determinants of ill-health in countries around the world, and principally attributes unequal health outcomes across different socio-economic groups to the ‘inequitable distribution of power, money and resources’.
Applying this framework to New Zealand and attributing ill health to what is vaguely termed social injustice might induce a warm inner glow. But blaming relative measures of poverty is a highly political and contestable finding, which ignores the reality of the situation.
This underplays the increasingly important role which lifestyle choices play in determining individual wellbeing. For over twenty years, government-sponsored public health campaigns, together with a range of schools-based programs, have drummed into us the “do’s and don’ts” essential to protect our health. Today, no New Zealander can reasonably claim to be ignorant of the health risks associated with smoking tobacco, with excessive alcohol consumption, and with eating too-much fatty and sugary food.
The problem is that some people – more in the middle classes – have heeded this advice and started jogging their way to wellness, and some – concentrated in lower-income groups - have not. In the final analysis, governments, no matter how well-intentioned, have limited control over personal behaviours which ultimately depend upon people deciding to modify unhealthy habits.
True to type, however, members of the public health lobby refuse to admit that much of the difference in health outcomes is explained by lack of personal responsibility. They prefer to argue that the real problem, in relation to the misnamed obesity ‘epidemic’ for instance, is lack of government-funded access to preventive health services.
Hence Professor Blakely urges the government to fundamentally redesign the health system to help people make healthy decisions. The paternalistic solution proposed is to give health professional even more taxpayer’s dollars to restate the bleeding obvious and tell obese people that to lose weight they must eat less and exercise more.
Welcome to Nanny State NZ, Version 2008: welfare from the cradle to the (hopefully) not so early grave. What is entirely overlooked is that the free-flow of welfare payments in New Zealand is truly responsible for killing thousands of Kiwis softly every year.
Worse health outcomes and unhealthy lifestyles are inextricably linked to the higher levels of long-term unemployment and entrenched welfare dependence experienced in lower socio-economic communities. In suburbs as similar and as far-flung as the industrial estates of Britain and the mean streets of South Auckland, smoking rates, obesity levels, and incidence of heart disease remain stubbornly higher than average. And there is an equally strong association between employment, healthier lifestyles and better health all around the world. What we intuitively know to be true is correct. Welfare makes people sick, and work and all its beneficial personal and social consequences helps people stay well.
The health debate has moved in this direction in post-apology Australia. While much attention has recently been paid to the alleged 17-year gap in life expectancy between Indigenous and other Australians, the 17-year gap is actually a statistical fabrication. This figure averages the difference between people who identify as Indigenous and live, work and have similar life expectancy to all other Australians in mainstream society, and those indigenous Australians who are trapped in welfare dependent communities. The latter group, terrible to say, have even lower life expectancy than is suggested, and the real gap is somewhere in the vicinity of 25-years of life lost.
Rather than portray ill-health as a social and health policy problem that only the government can solve, the NZMJ would have been better advised to concentrate on the behavioural causes of death and disease. It’s time we recognised the ill effects of welfare, which disempowers so many New Zealanders and robs people of the capacity to control their own health and wellbeing.
Dr Jeremy Sammut and Luke Malpass are researchers at the Centre for Independent Studies www.cis.org.nz
