When we began the round in the ICU that morning, I recognized Margaretta immediately. She was embarrassed to be back with her 7-month-old son – his sixth hospital admission with bronchiolitis. She worried that we would think she was a bad mum and that Lucio would be taken away from her. On the same day, on the paediatric wards, there were 5 kids admitted with acute rheumatic fever and many more with preventable respiratory disease and skin infections.
Although Lucio’s is an extreme case, the winter months see an enormous influx of infants like him into our hospital. In almost every case, a major contributing cause is cold, damp and over crowded houses. It is of course no surprise that those most affected by this are the poor – in South Auckland, predominantly Pacific people and Maori.
On the adult wards, the beds are always overflowing with increasingly young people, with life threatening complications of type 2 Diabetes. Again a largely preventable disease associated with obesity.
Despite all the good things we have achieved as a nation why is it that we are not doing better at preventing the preventable?
Should this not embarrass us?
Does this not cost the health systems millions of dollars and effectively prevent many people from making a productive contribution to their families, communities and our nation?
“Of course” is the answer to all of those questions!
We have measured, reported, written and talked about these issues for a long time. In addition, “Prevention” has been a key policy plank for the Ministry of Health and healthcare providers for many years. But despite all of that, the tide still seems to be going out on many of these “wicked issues”. We do not need any more reports describing the problems – we need to recognize that our fragmented, siloed attempts to address them have not worked in the past and will never work in the future.
Wicked or complex problems like Obesity or Child Poverty are the stuff of real life and result from a myriad of different issues – there is no silver bullet solution to them. Instead they require a more detailed plan of attack. One that involves many different domains of activity applied over a long period of time to eliminate or reduce the specific problem we seek to address within a specified timeframe.
This kind of thinking is not rocket science – it is a reflection of the complexity of real life; but mapping the major contributing drivers that contribute to those problems and devising and executing a plan to deal with each of them apparently is! To date governments have not been that good at this.
In a former life as the Principal Medical Advisor to the Minister of Health and Director General of Health, I once wore a hat with WOG written across the hatband. WOG stood for Whole of Government. The hat was a reminder to the executive team of the MoH to overcome the siloed and fragmented nature of our thinking and behaviour, to work more collaboratively to help address many of the complex real life problems we had an interest in solving. However, on its own, Hat and Hope was not a plan.
The siloed, fragmented, well-meaning, stroboscopic interventions of the public service largely continue. Budgets and agendas continue to be jealously protected within government departments, and across them, and our world continues to be ruled by bright-eyed (sometimes worn out) well-meaning folk with new ideas and recent epiphanies. As for the hat, it soon became my much needed protection from the sun and worn exclusively in the privacy of my own garden.
In this context, the report “Solutions to Child Poverty in New Zealand” is of great practical value and a challenge to the nation on a number of fronts:
- It provides a clear roadmap or DRIVER DIAGRAM, based on the best evidence available, to reduce Child Poverty from its current levels by a defined amount within a specified time period.
- It is the work of an expert group and as such is apolitical and not driven by any specific ideology.
- It is a challenge to the nation, and in particular to the government. Whether they will have the humility to accept this gift from a group of experts and demonstrate the leadership necessary to successfully implement the recommendations that will emerge as a result of the submissions made on the report will be something to watch closely!
This report is a Driver Diagram
and as such, has generic value in how to approach wicked and complex problems (like Obesity, should we wish to make this a priority).
Significant benefits of the Driver Diagram are:
- It allows us to break any broad aim, graphically, into increasing levels of detailed actions that must or could be done to achieve the stated aim.
- It helps provide a clearly defined unambiguous, measurable goal and a timeframe for results.
- It keeps our thinking linked to the overall aim.
- It allows participants and reviewers to see the logical links between the individual pieces of work that they are engaged in and how they and the work they do contributes at every level of the plan and to achieving the ultimate goal;
- It supports the development of measures, which are used to determine progress toward the goals of the individual action plans that contribute to the overall aim.
So I say Thank You to Russell Wills and the Expert Committee that has delivered this most practical of gifts to the nation.
It is now for the government to respond!
Did I really mean that?
Well yes and no – I hope they will embrace the methodology but I am not holding my breath.
The real beauty of this report is in how it empowers all of us who care about Child Poverty in NZ, to take a greater level of interest in work that is already taking place and to lobby for more. It has the potential to bring us the joy and hope that comes from contributing in a meaningful way to something we all care passionately about – improving the lives of kids, families and communities, in ways that we can see, touch and importantly, measure. A few of you may have heard of the work going on at the Epuni School in Lower Hutt reported on national radio in August this year? The programme highlighted the work of a volunteer called Julie who has helped transform the school through the kids’ and their families’ involvement in gardening, growing their own, healthy cooking and eating.
I suspect there will be 1000s of similarly brilliant projects occurring in schools all over NZ that would significantly populate the driver diagram to reduce child poverty. The real problem for all of us is that we don’t know about most of them and those like Julie and Epuni School may not know of similar good work going on elsewhere and vice versa. The same for the work of many projects including the Manaiakalani Trust in Glenn Innes and Panmure in raising kids’ educational achievement through e-learning.
Imagine if we had a better handle on all of these really good projects and could map them against the driver diagram to reduce Child Poverty in NZ and make that a public document for all to see.
The real power in this report is how that approach might provide a structure to empower communities, public and private organisations and individuals, to better focus their resources and attention on individual pieces of work that both spin their own wheels but also contribute in a measurable way to reducing the scandal that is Child Poverty in this country.
Director of Clinical Leadership, Ko Awatea.
Intensive Care Specialist, Middlemore Hospital, CMDHB.