• Primary Health Care for All

    I decided a few weeks ago to step down from my role as Chair of the Board of EBPHA, the Eastern Bay Primary Health Alliance. As I confessed to my friends and colleagues at a farewell they had kindly organised for me this week, I had known very little about how the health sector actually worked when I had been asked to take on the role eight years ago.

    Like most people, I had been vaguely aware that primary health care was about visiting the doctor when you felt unwell or needed health advice, and it also provided a range of other nursing and specialist services, all designed to keep you in good health so that you did not need to go into hospital.

    What I hadn’t realised was how complicated were the arrangements that made all this possible. I rapidly learned that primary health care depended on the skill, experience, commitment and sheer hard work of a dedicated team of qualified people, working as a team under the expert leadership, first, of our foundation Chief Executive, Steve Crew, and then of his successor, our excellent, able and young Chief Executive, Michelle Murray.

    My job was the relatively simple one of chairing a Board, comprising clinicians and representatives of iwi and of the wider community, and enabling them to provide to our
    excellent executive arm the strategic vision and leadership that would enable them to perform their important work to the best effect.

    I was fortunate in leading a Board that naturally gelled and was united in its determination to get the best possible results for the community we served. As our title indicated, our focus was the Eastern Bay of Plenty – with a particular emphasis on the “Eastern” – and the particular issues faced by our region were, for us, always front of mind.

    We have in the Eastern Bay a high proportion of Maori patients and we constantly struggle to eliminate the unacceptable disparity in health outcomes between Maori and pakeha. We also have a greater incidence of poverty and of the problems that it throws up. Factors such as these combine to create difficulties that are greater here than elsewhere.

    Poverty often means damp, overcrowded and unhealthy housing, and poor diet, from which flow a number of health risks. It can also mean that people are less able to travel to get medical care and, with less access to modern electronic media, are more difficult to contact. Cultural issues can mean a resistance to immunisation for small children and to breast and cervical screening.

    We have learned that there is no point in simply bemoaning these factors. We have to accept them for what they are and need to work with them and at times to use them to our advantage. We have come to understand, for example, that health care for Maori is greatly more effective if it is made available and delivered in a culturally appropriate way and – as often as possible – by Maori themselves.

    Does any of this matter? Yes, of course it does. If we can reduce the incidence of conditions like diabetes and rheumatic fever, if we can improve the mental health of our young people, if we can enhance the care available to the ill and elderly, then we not only lessen the burdens on our hard-pressed hospital services, but we greatly lift the quality of life of our own people.

    As I give up my own responsibilities, I am absolutely confident that I leave behind a team of friends and colleagues who are totally committed to providing the huge blessing of good health to our whole population. I wish them well in the important and valuable work that they do.

    Bryan Gould
    5 September 2018

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