By Kate Moodabe
GM, Total Healthcare PHO
One thing the New Zealand health sector has learned about delivery of care in 2020 is that we have to be innovative; we have to be responsive; and our response needs to be timely.
So far, this has largely worked well for us – albeit with the recent lockdown hiccups in Auckland. We have shown we can pivot in our response to the COVID-19 pandemic.
Now the healthcare sector has to take those lessons learnt into our delivery of chronic care for patients in other areas such as diabetes, heart disease, cancer and smoking cessation.
For, while we have been responding to COVID, Ministry of Health and DHB resources have been captured by it, to the detriment of our response to these disease states that are the main contributors to our mortality rates.
We know that a person with type 2 diabetes is 10 times more likely to die of COVID, and someone with type 1 diabetes is five times more likely. But, instead of funding newer diabetes drugs, we are still using medications from the 1950s.
A SGLT-2 inhibitor that reduces high blood glucose levels in type 2 diabetes and produces weight loss – not life-threatening weight gain – is not being funded. This drug has been shown to reduce mortality in people with moderate to high cardiovascular risk, as well as to reduce health failure admissions. Its cost has been put at about $100 per patient per month.
We even have a newer formulation of metformim – a diabetes medicine from 1956 still in wide use – that is not being funded, which sees better compliance in type 2 diabetes patients with once-daily dosage and far fewer side-effects.
Smoking cessation programmes are a priority for DHBs, but we have had no new national data collection since the end of 2019.
We have a new self-administered swab test for HPV, which leads to cervical cancer, that can improve compliance – again, it is not being funded. Not only is its use less embarrassing and easier for women, its enhanced accuracy over the current screening test means mortality from cervical cancer could be reduced by a further 15–17%.
The fact that this test is not being rolled out nationally is costing lives.
We have already seen years of underscreening of cervical cancer among women and, in particular Māori and Pacific Island women, which has meant the mortality rate for cervical cancer – a preventable cancer – among Māori is 2.5 times higher than non-Māori.
A measles outbreak in 2019 and the COVID pandemic this year has seen screening rates drop to 51% coverage overall and only 44% for Māori women. The first six months of 2020 saw 55,000 fewer cytology screens across the country compared to the same period last year.
While the Ministry of Health has plans to take up the new test there are delays in its implementation. At the very least, we want to see this swab-test funded and offered as soon as possible for our high needs Māori women who are not presenting for screening – either regularly or at all – and hopefully provide a proof of concept that will see its uptake throughout New Zealand.