GUEST BLOG: Ian Powell – Reckless Disregard or cruelty (or even Trumpian!)

When something occurs in Aotearoa New Zealand’s health system that at the very least is reckless, the best response in my view is to be direct.

Don’t be equivocal or adopt a misplaced ‘on the one hand but on the other hand’ position. Call a spade a spade (even a shovel if appropriate).

Directness was the response of general practitioner former Te Aka Whai Ora (Māori Health Authority) clinical director Dr Rawiri McKree Jansen to Health New Zealand’s sudden decision to terminate the targeted bowel screening programme for Māori and Pacific peoples, starting at age 50, rather than 60. But his was not a solitary direct voice.

Good journalism by NZ Docter’s Alan Perrott

The decision and response is well covered by NZ Doctor journalist Alan Perrott (16 January; paywalled.

“Wrong on so many levels”

This arbitrary decision has perplexed health professionals involved with the programme. Perrott reports their anger that the evidence from epidemiological research, which shows Māori and Pacific peoples develop the disease at an earlier age than others, was being disregarded.

Dr McKree Jansen: decision “obscene

Dr McKree Jansen described the decision as “… wrong on so many levels, it’s offensive. And the fact we are going to be able to talk about a body count because of this is obscene.”

National Bowel Screening Programme

Bowel screening is implemented through the National Bowel Screening Programme. It was first trialled in Waitemata District Health Board from 2012 to 2017 before being rolled out nationally. It is free for people aged 60 to 74 years old.

A Ministry of Health evaluation of the Waitemata trial concluded that the national rollout should include an equity focus. The targeted approach for Māori and Pacific peoples was a logical consequence of this conclusion.

Shane Reti: an erroneous claim leads to moral injury

The equity based targeted programme began in Waikato DHB in December 2022 followed by Tairawhiti and MidCentral DHBs. In defence of the programme’s cessation last year then Health Minister Shane Reti erroneously claimed that it was only meant to be a two year pilot.

However, Perrott reports that it was always understood by those involved to be a phased rollout with the intention of eventually covering the country. This was consistent with the approach taken for the full national programme.

Dr Jo-Scott-Jones: decision leaves a sense of moral injury and makes bowel screening programme increase inequity

Dr Jo Scott-Jones is a GP who is the clinical director of the Pinnacle Midlands Health Network. He was on the governance group for the targeted programme. Scott-Jones told Perrott that he has no recollection of it being called a pilot in Waikato.

He describes the decision as leaving “a sense of moral injury” in all those involved. In his words:

This was a logical thing to do, and I was proud to be part of it. It was the right thing to do and now we’re ‘nope, this isn’t happening any more’…clearly this [bowel screening is now a programme that increases inequity and I’m not proud of that at all. [emphasis added]

‘Reckless disregard’ of risk; lacking evidence

Sir Collin Tukuitonga tells it like it is

Public health specialist and academic Sir Collin Tukuitonga argues that the Government is now risking lives to meet its coalition agreements. He pulls no punches:

It’s a reckless disregard for people’s health to meet an ideology that everyone should be treated the same regardless of risk. It’s incredible, but I guess it isn’t a surprise given they have already repealed the tobacco laws…I just don’t know what else to say.”

Dr Sue Crengle: decision contrary to the evidence

His bluntness is reinforced by Dr Sue Crengle, GP, public health academic and medical advisor at Bowel Cancer NZ. She observed that ending this targeted programme is contrary to all evidence.

I can’t begin to explain the logic behind this decision. Having different starting ages (for screening) was evidence-based and clearly this decision is a move away from that.

Something Trumpian

The practical impact of this decision to switch from equity to inequity is that more than half of those who will get bowel cancer will now do so before they can be tested.

Sir Collin Tukuitonga is right to call this out as “reckless disregard” of risk. I would go further and call it cruelty.

A touch of Donald Trump?

This does resonate somewhat with Donald Trump’s current rampaging presidency based on ‘Make American White Again’; maybe not a lot but still too much.

 

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion