Mistakes drive 20% of our healthcare costs. Our system needs to invest in decent systems that prevent mistakes, like unified patient records.

The Quality Improvement Committee has been tackling some of those.

That focus will be picked up by the new quality agency proposed in the Horn Ministerial Review Group…

caring for the elderly rather than treating them

It's a big mindset change. The health system must stop trying to expensively 'cure' disabled people and concentrate its efforts on making sure supports are provided for productive everyday living. Or get another branch of public service to manage it; one without…

I can see the cause for your confusion. That graph is not for all health spending. It is for health spending on public health and prevention, i.e. smoking cessation etc. We spend more than Germany in this respect, but not on the whole health system including hospitalisation. This is…

Given the disparity between relative health spends between Germany and NZ (NZ spends 50% more per head than Germany), can someone explain to me why health care in NZ isn't significantly better?

I am not familiar with German health stats, but I can see from rankings in international tables that…

"NZ spends 50% more per head than Germany"

Sorry, but this is wrong.

Actually, figure 15 in the article shows exactly that (in ppp terms for 2000) and was the catalyst for my comment.

I'm not bashing administrators per se.

I do have issues, however, with a…

But lets not get into bashing administrators. The best hospitals are where the docs and administrators work together well,...

I get that large institutions need administrators and good ones. And many of the administrators we have in the various institutions are very good.

My issue is that we have a…

You don't have to introduce agricultural subsidies to subsidise good food. Subsidies can go to the consumer rather than the producer.

How are you going to ensure that this money gets spent on fresh foods, instead of cheaper unhealthy alternatives? Do you think you're going to make everybody upper middle…

Sorry, but this is wrong.

Germany has a pretty good health system, true. Most of Europe does. But lets get real – they spend a LOT more. They are richer and spend more in every dollar earned. And they are up against…

...can someone explain to me ...

One part of the explanation is that Germany is bigger. A significant number of pharmaceutical companies and medical suppliers ARE German. Hence it is cheaper for the German health system to buy German products than for the NZ health system to buy the same…

the expectations are crazy

Did a sub editor (Does PA have those) chose it or is this a distillation of the authors assessment of the situation?
The questions it raises for me range from
Well when have…

Economies of scale certainly play a role. A private (ie consultant's) MRI facility in a catchment area of say 300,000 population runs 6 days a week from 0700 to 2100. It's probably not the only one in the immediate region.

And the next region with a catchment of >300,000…

Actually, I do. http://mainzdailyphoto.blogspot.com/2007/10/my-mate-christoph-233.html

I can find out from Christoph if you'd like

PM me via the blog

I go to the gym, I ride my bike, I don't puff when I walk anywhere.…

As the resident Germans here do you have any info on the Germans expelled from Prussia, now Poland?

I have found a silence from some other sources I've asked & and shrill responses from others.

It seems ethnic cleansing (either way) is not a particularly…

Given the disparity between relative health spends between Germany and NZ (NZ spends 50% more per head than Germany), can someone explain to me why health care in NZ isn't significantly better?

I am not really sure, but one explanation could be that the bigger population makes it easier to…

-got it in one jb.

Also, the system keeps getting tinkered with by pollies, and there is never enough input – let alone consultation with workers@the-coalface(nurses, radiotherapists et al within the hospital structure) let alone primary healthcare givers – e.g GPs-

In Germany:
There IS no waiting list for an ENT consultant (at least 6 months in Nelson/Marlborough with…

I take it fresh foods will be cheaper?
Food doesn't have to be fresh to be good for you.

Thanks Peter. I know this
But what I was trying to point out is taxes on low nutrition value foodstuffs would seem to be a pointless exercise if, even when it…

t's PAS heresy to suggest that I was overweight because I ate badly and didn't exercise and lost weight by changing that, but it does happen to be true

Nobody I think is denying that 'eat less and exercise' is good advice – well, the Listener did once, in the…

it's PAS heresy to suggest that I was overweight because I ate badly and didn't exercise and lost weight by changing that, but it does happen to be true

Sigh. That's such an annoying mischaracterisation of my 'side' of the debate. Of course that happens. (I'm actually married to someone…

Fresh foods are always more expensive, because they have such a limited shelf life compared to processed.

See this is a more practical reason as to why the monetary incentive/disincentive wont work when it comes to dietary choices. Quite apart from everything else.

So

Could you imagine the 'nanny state'…

A lot of my reluctance to exercise comes from competitive sports at school. I was shit and therefore discouraged from participating which meant I both stayed shit and became increasingly self-conscious about my physical abilities.

I had the same bad experiences at school: a couple years ago when I decided…

educators among us: have any people seriously studied…

Edit function = good
Brain-edit function = still being established

I was never noted as absent from PE (which I…

I also wonder about the role of modern medications in the "obesity epidemic". Weight gain…

I take it fresh foods will be cheaper?

Fresh foods are always more expensive, because they have such a limited shelf life compared to processed.

Dyan: I'm curious as to why you make this point so strongly.
I do disagree with you, but not from the perspective of Sport is good…

Also we need to move away from the confused notion that sports in any way deliver significant amounts of exercise to people, especially children.

I'm curious about this too Dyan. Can you explain more?

Now, if only we could diminish the whisky & wine component...!

Never!

Some things are too important to exclude just to get another year of life – besides I'm sure I can find a study that says Pinot Noir is good for you :)

Also we need to move away from the confused notion that sports in any way deliver significant amounts of exercise to people, especially children.

Dyan: I'm curious as to why you make this point so strongly.

I do disagree with you, but not from the perspective of Sport is good…

What I meant by getting over the nanny state conversation is that we (as an electorate) have already spurned some relatively minor measures to counter obesity.

Spurned minor measures ? Sorry I'm not following you.
Was a trial program ended because of lax participant involvement?
Or have blanket campaigns had…

Could you imagine the 'nanny state' backlash if taxing poor quality foods was raised?

It's probably more effective to impose any penalties on the manufacturer as highly processed foods are the problem.

The "built environment" is the most important factor in this whole thing. Cities and buildings must be built…

What I meant by getting over the nanny state conversation is that we (as…

Getting primary care to help people manage weight, diet and exercise issues better would be a good start, but as with smoking prevention means a lot more than health care changes.

So does that mean identifying problem people early? How?
Tho' that does kind of suggest something you don't seem…

i've got nothing against people who live longer because of their healthier choices, all power to them, but during those extra 20-30 years of life they are going to be riddled with expensive ailments, regardless of how much they've looked after themselves at 44

When looking at the…

I don't think it's something that even can be resolved, one way…

Basically, what I'm saying here is that the mental side of this affliction is huge. There is no other gatekeeper to my fingernails than myself.

It reminds me of Nanni Moretti's excellent Dear Diary, the doctors episode, where he suffers from dermatitis, and they tell him it's all in his…

we know more about eczema than we ever have before, and are constantly inventing new treatments. Here we have something that it is much harder to invent evolutionary reasons for the rise of.

Eczema sounds terrible, it sounds like a thousand mosquito bites. There has been some encouraging work at…

Aw! I don't want just women to talk about this!

I wasn't excluding any others of the male sex from joining in, just me.

Bart. That seems like a topical issue. I don't know the pay structures within the health system.

The obesity and personal responsibility issues seem to have captured the collective imagination. There is much more in the book on obesity which I won't repeat here, but suffice to say that prevention is better than…

It seems to me that one of the causes of modern obesity is very similar in many ways to the causes of…

However it seems to me there are many such conversations, about many of the institutions that surround us, that need to be started.

Yup. And if I were to generalise I'd say that in most cases the problems occur when you start paying managers more than people who actually know…

I don't think that was the suggestion.

I was exaggerating for effect...sorry.
But yes It is a problem and one that I don't think is considered carefully enough.
It's great if this book is a starting point for a deep conversation within our society for the future of healthcare.
However…

There's considerable and mounting evidence, for example, that early childhood experiences (such as developing a loving bond with a mother) can have a positive impact on a lifetime's worth of health outcomes,

Yeah good, so mum stays at home and looks after baby. So does that mean she dont need…

So people will fare better in less intensive industrial places, but there wont be any doctors or hospitals, cause it's expensive and anyway doctors don't like living away from cafes?

I don't think that was the suggestion. The idea is that you have lots of medical centres, some with quite…

All right, health it's a serious business,( I can do serious) it needs deep thought and its a mine field.
Our genetic make ups are vastly different, evolution has served us up…

I presume you meant "is" there?

You presume wrong — because there's still patches where I'm tempted to drown my troubles in a G&T or twenty with a couple of ciggies to take the edge off. :)

But QFT that making a lasting lifestyle change isn't as easy as flipping a switch.

I presume you meant "is" there? Then again, I'm reading Psychocybernetics, a self-help book written in 1960 by a plastic sourgeon who had discovered Weiner* and according to him it's exactly as easy as flipping…

What you describe is all part and parcel of Type 2 diabetes, and you are right having Polynesian ancestry makes you highly prone to developing it. When exposed to a modern western diet. The two are inextricably linked.

Um, yes... but I also have a couple of high risk factors…

Now can we stop with the PC manning of hysterical barricades for political reasons and talk about reality, please?

Actually Peter, perhaps you could be less of a jerk about it. It should be possible to discuss public health without being rude and didactic.

So you're saying that... people can totally lose a lot of weight if they just put their minds to it, as long as we don't infantilise them... except for the people who can't... but even if they don't, they could…

However none of that makes it biologically impossible to lose significant amounts of weight once you are obese. People do it all the time without even a stomach stapling.

And are…

You are right about basic BMI scores which is why they should by now be modified by the hip/waist ratio correction factor. I am overweight on strict BMI since I have big muscles and dense bones yet I have very little body fat.

However you say you are 'fit…

With the genetic component, some people are simply going to be overweight/fat no matter what they do. Someone like me, who is fit enough, strong, healthy and has a hip/waist ratio…

History, intermingling of peoples, changed dietaries, a deep ancestral desire for (within my whanau) fat -…

Great post.

I liked your pointing out that we need more than doctors to set health priorities. This is largely because when all you see are sick people (yes, okay and the worried well), you get a warped view of how prevalent ill health is. Which is why we…

What you describe is all part and parcel of Type 2 diabetes, and you are right having Polynesian ancestry makes you highly prone to developing it. When exposed to a modern western diet. The two are inextricably linked.

Jared Diamond reckons that the fact that non European peoples are…

Much the same way people who exercise too much become addicted to the endorphins.

Ahem, I get my endorphin hit after a mere 30min of running, and it doesn't have to be hard. I dont' call that 'too much'. It only seems so to people who exercise inadequate amounts.

And *ignoring the genetic componenents* in any discussion…

I have a heavily-built strong Polynesian frame (which I am happy to have) -and osteoarthitis…

Once you are a fat person it is HUGELY unlikely (perhaps 95% unlikely?) that you are going to lose large amounts of weight and keep it off permanently.

Bugger...
So I'm 95% likely to remain a Foxtrot Bravo * for the rest of my shortened miserable life.... And I…

I'm afraid I'm considered one of the main offenders on that count

I wasn't thinking of you at all, Dyan! Seriously.

This conversation is, nine times out of ten, totally judgeypants and dispiriting

I'm afraid I'm considered one of the main offenders on that count, but my point of view and intention could not be farther from a position of judgement.

My involvement in sci/med conferences concerning obesity – as someone…

'it's not rocket science'

duh it's biology bro :)

Can we not turn this into a fat fight?

George, I'm afraid that once someone says 'it's not rocket science' I have been programmed to respond. ;)

But yes. This conversation is, nine times out of ten, totally judgeypants and dispiriting and I'd probably prefer not to have it again…

there are plenty of other issues that deserve attention from this article

Agreed

However like many writers talking about health there is an underlying assumption that things can be improved by political changes. IMO the problem is always political involvement in health.

In short if spending the health budget was…

Obesity is the modern world's take on the mind-body problem.
I always say it's a glandular problem. The pineal gland, to be precise.

Some people think the pineal is the seat of the soul.
So is it, either get fat, or find god. Now those are bleak choices, luckily there…

I happen to have a strong opinion, but I think that there are plenty of other issues that deserve attention from this article, and the debates about fat/obesity/weight are more heat than light in the great majority of places, including here.

Sorry for characterising obesity as a disease/disability that language isn't ideal but in the terms of the discussion it seemed appropriate.

It's a way of seeing it that seems more empowering than considering it 'inbuilt'. Whether it's true is another matter. Indeed, if it's not true, it's a false sense…

It is patently not possible for obese people to "simply" change their diet or even "simply" change their exercise habit.

Most of the successful treatment of obesity now focuses on treating the patients lifestyle over periods extending to…

Obesity is the modern world's take on the mind-body problem.

I always say it's a glandular problem. The pineal gland, to be precise.

then they would eat less and so lose weight. It is not rocket science.

I know I am going to regret this, but that is currently, unless we create some magic bullet, false. Once you are a fat person it is HUGELY unlikely (perhaps 95% unlikely?) that you are going…

Peter, not everyone is able to lose weight, for a variety of reasons.

I will be first in the queue to argue that you cannot blame people for their obesity. However it is not true that not everyone can lose weight. Even without exercise, an awful lot of it is…

Because if the little old lady didn't get married or have children, she's *worth less*. We all know this! (Meh.)

I'll let the authors talk to their reasons for inclusion themselves, but I think this is just the attempt to use extremes to make the point. The "imagery" of someone…

It vacillated between PR for primary and preventative health care and having a good old dig at whiny rich people, well they must be richish enough to have a computer and the ability to go to "hypochondria.com", I would have…

Why offer up a false choice between options/call for 'hard choices' (needed because of a tight public purse) – solely within ONE aspect of state funded social care? Why not propose a choice* between (say) more roads and better health…

...and former treasury analyst Geoff Simmons...

You mean someone who worked for the organisation of which was said (to quote our glorious leader):

"Treasury can’t tell us what the deficit is going to be in December let alone what’s happening in 2030 or 2040"??

That Treasury?

After that I read…

Not sure why the Remuera nonagenarian had to be a spinster, but that's a quibble.

Because if the little old lady didn't get married or have children, she's *worth less*. We all know this! (Meh.)

And I don't know about NZ, but over here they offer everyone over 50 statins routinely. Which is as big an admission as you are ever going to get that govt has given up on the idea that people can be persuaded to look after themselves properly.

Peter, not everyone…

Not sure why the Remuera nonagenarian had to be a spinster, but that's a quibble.

If only we had some sort of Health Credit Trading Scheme.

hmm, a discount on my tax (or over here, National Insurance) would be welcome. The problem is of course that while on average, doing what I'm doing will reduce my ill health burden on society, that doesn't mean it…

If only we had some sort of Health Credit Trading Scheme.

"20 laps of the Olympic-length pool gives you one credit: a subsidised nurse appointment for your cervical smear, to be used within the next six months."

I think primary care and preventative care are great things, of course, but…

You're planning to be one of those people who lives forever and breaks our superannuation bank, aren't you? For shame!

Nope. With my familial inheritance I intend to be a bright burning comet, to be fit enough so that when the decline comes it comes swiftly and decisively. I am…

If only we had some sort of Health Credit Trading Scheme.

Genius.

For the record I'm 44 and I run 55-65km per week and eat a pretty healthy diet, I obviously don't smoke and drink very moderately.

If only we had some sort of Health Credit Trading Scheme.

For the record I'm 44 and I run 55-65km per week and eat a pretty healthy diet, I obviously don't smoke and drink very moderately.

You're planning to be one of those people who lives forever and breaks our superannuation bank, aren't you? For shame!

We need a system that impartially draws the line where public health treatment ceases because it is too expensive to keep a person alive for too short a time.

Oh my god. It's a Death Panel (TM)!