My five-point plan going forward

1. Invest 10% of the health budget in actual health. That means directly addressing the things that cause poor health. Commit to an additional 2% of the health budget allocated to this for the next 20 years. Even then the mismatch and bias to sickness, not health is outrageous, but right now we invest less than 1% of the health budget in actual prevention and staying healthy. Right now, we are getting exactly what we invest in. Nothing = nothing.

2. Immediately upgrade the Health Promotion Agency from a barely funded backwater government label to an actual effective entity overseeing and implementing a range of effective, large-scale public campaigns and infrastructure support for health behaviours. This would include moving all physical activity and health work currently done by Sport NZ and Te Whatu Ora to this agency, disbanding MPI’s Health Star Rating system and moving nutrition health promotion to this agency. A starting budget would be $500 million increasing for the next 20 years on achievements.

3. The Tertiary Education Commission would actively take part in health workforce development including health coaching, mental health coaching, and other health-focused workforces, which could engage the current sub-clinical workforce into new roles.

4. We would scrap and restart our mental health strategies with a focus on the prevention and treatment of mild to moderate problems. This would include a widespread focus on psychological literacy in schools, workplaces, and in the community. We would rethink how we can help develop competent and helpful peer support networks everywhere.

5. We should establish a national advisory group that not only includes health, but also our best business minds, and our best high achievers.  This new group would be one that has an abundance mindset. Our health and wellbeing has been crushed by a shrivelling deficit model. The way we think about our health and wellbeing is a national priority and most of the best ideas over the next 20 years aren’t going to come from the health sector itself. In fact, left to review themselves the health sector is likely to want more and more of the same broken approach.  We must and can break out of this.

This is why its not working!

Whenever I talk to anyone, from all walks of life, any age, about their priorities they rate being well, healthy, them and their family being happy and content in life, as the most important things for them. I’ve never heard anyone leave these out of the top three. 

Yet why is it that so many of us fail to meet our own primary expectations?

Let’s have a look at the shortcomings of the current health system. Let’s see what we can do to improve it.

What’s wrong?

In the current state of the New Zealand health system, it is obvious that the focus is overwhelmingly skewed towards sickness rather than promoting health. The proverbial  “ambulance at the bottom of the cliff” scenario. Our system is reactive, not proactive, sickness and crisis-activated. 

This is a classic chicken-and-egg situation, where inattention to the cause of the problem means we are overwhelmed with the consequences of the problem. The less attention and investment we pay to the cause the worse the problem gets. This sucks more resources into the band-aid downstream solution. We are never strong enough or can learn to swim well enough to get upstream and figure out how to stop people from falling into the river in the first place.

The best we can seem to do is try and detect the early signs of diseases like colorectal, breast, and prostate cancer. The idea of a health system that improves the actual causes of poor health – the social determinants and the big three health behaviours – eating, sleeping and moving is conspicuous in our $28 billion annual spend only by their utter absence.

The overwhelming burden of disease is preventable (primary prevention) in the first place, and if you have such a chronic condition (the majority of the population) then this is treatable and potentially can be reversed using preventive lifestyle medicine techniques. The efficacy of these techniques are well known, highly effective and quite cheap.

Prevention is cure

The palaeolithic genes we evolved with still exist, and the palaeolithic hunter-gatherer lifestyle does not. The mismatch between the environment we have evolved to, and the modern world – artificial food, ultra-processed food, artificial light, cars, Uber, Netflix, mobile devices, vaping and on and on is toxic. The pathological interaction between our genes, which we can’t change, and the environment and our behaviour is the cause of modern chronic disease and is almost all of the strain on the health system.

To overcome this mismatch we are going to have to work pretty hard and put in place some really serious hacks to get things working well, without going back to living in caves and hunting and gathering all our food.

Let’s face it, we want the perks of modern life, but we still want health.

No one believes that more people taking more medicines is the way out of this.

I’m not criticising this because I want all of this as well, And we can have it, but we are going to either sacrifice the quality of our life or go hard as a society to normalise moving, eating healthy, sleeping well, connecting with nature, and living closer to how we evolved. 

Being fit, eating better, sleeping well, being connected and being armed with robust thinking strategies is actually the prerequisite to negotiating the ups and downs of a life well lived.

Because one of the things we most crave is wellbeing, a healthy life, and a lifespan free of disability. And…given we are going into this with an abundance mindset, it’s a complete no-brainer to provide the ways and means for people to move more, access cheap healthy food, and be the best that they can be.

This is a win-win-win situation. We have happier healthy people, we have a more equal society, and we have a sustainable way of solving the problems in our health system (see above).

Our dwindling health workforce

So who would even do the work when we get the courage to reorient to the actual cause of the problem and therefore find actual solutions?

Unfortunately, we have a health workforce that is:

• Outrageously mismatched for the demand they face. For example, we have only about 20% of the psychologists we currently have a demand for.

• Dwindling quickly as the workforce ages, health professionals move overseas for better working conditions including pay, and retirement of the ageing workforce. This is true of nurses, GPs, and specialists of all types, especially psychiatrists and psychologists.

• Without a robust supply of replacements. The length and cost of training, as well as the demand to fulfil these roles, is an issue. 

• The training given to health professionals is outrageously mismatched with the actual causes of poor health. The curriculum space for nutrition, fitness, sleep, connection and robust thinking tools is more or less absent in medicine. 

This means we will have to rethink how we can possibly meet a standard of care matching the wealth and privilege we have become accustomed to in New Zealand.

Notwithstanding all of the above issues of cost, inadequate workforce, workforce loss due to overseas migration and retirement, and lowered demand and ability to train we still have a problem of health inequality, which given the above pressures is due to grow further unless we act innovatively. Perversely those most in need have the least access to everything useful.

To keep doing what we are doing is not sustainable in the health sector, we not only need to change, we will have to change innovatively and decisively. We need to do this now. Medical inflation runs at 10% per annum. That compounding increase means that more and more of our budget gets spent on making sick people less sick (general health), and miserable people slightly less miserable in the mental health arena. That means less on roads and transport, education, tourism, business, and the environment. 

Doing the same thing year after year in the health system is amongst the most illogical and therefore dumbest applications of government spending. That’s saying something.

The solution is not to reduce everyone to poor access, so now we are equal. Nope, that’s dumb. We can move forward to an abundance mindset, something so lacking in health that most won’t even know what this means.

An abundance mindset is one where we are a wealthy, first-world, developed, future-focused productive country facing the facts and investing and working hard to achieve what we can for everyone. 

That dream must firmly be placed in the space of having a health system that first concentrates and invests in health. It does this in a local and constrictive, culturally relevant and useful way that gets actual outcomes.

Just to be clear, culturally constructive, but still useless is still useless.  

We would be happy to finally lead the world at something in health. This could be a source of not only national wellbeing because we are a more robust version of ourselves, but we have helped the world see what is possible.

It’s obvious we are going to need a new way of thinking about the health workforce.

To be repetitive, no one thinks that more of the same but with more money will get us a better outcome, other than slightly less sick, sick people and slightly less miserable, miserable people.

Workforce training and redevelopment

There is an outrageous mismatch between health and medical curriculums, best practice health behaviour change, ecological public health, and best practice preventive medicine. So first up, we are going to need to train our health professionals about things that make them healthy. The training curriculum for existing health professionals needs to lift the skills in this area. 

We also have a massive underutilised workforce. The subclinical aged care and disability sectors have carers who are with people, in high contract roles, and have the time and perhaps aspiration of doing better and improving the health of those they care for. 

This upskilling of this workforce is a win-win-win-win-win scenario. A win for a readily available workforce who can help coach and make changes in the living conditions and health behaviours of the people they care for. They can understand some of the social determinants and their importance, and implement behaviour changes around diet, physical activity and sleep quality. 

It’s a win because the cost and time of training is comparatively low.

It’s a win because it gives a low-pay workforce hope of progression and ultimately being part of really making a difference. It gives hope. 

It’s a win because they will take these same techniques home themselves and impact directly on themselves, their families and their communities. The degree of health literacy will improve across the community. 

It’s a win because it allows health professionals to work collaboratively with these subclinical professionals, and work at the satisfying and more complex areas of their scope – diagnosing, prescribing, and de-prescribing.

It’s a win because we might be able to actually be healthier and address the downward slide of the human condition and leave the world a better place for the next generation. 

What could such a model look like?

We’ve made a start already with health coaching. So far we’ve trained about 1500 health coaches here at PREKURE. That’s what we do. They come from existing health professionals who want to practice a new version of medicine, from people changing into a new health career,  often after their own health journey, and from those new to the workforce altogether.

They end up working in primary health care, mental health care, diabetes care and in their own niche health coaching business. They can specialise with extra training in metabolic health and nutrition, and mental health coaching.

This is 6 months, 7-10 hours a week to become a health coach who can register with the Australia-New Zealand professional body. This is important for quality assurance, credibility, and indemnity insurance. 

Further specialisation might be about the same amount of extra training.

This is a fast and focused route to being able to help people live a life of heath. It has the added benefit of the gentle pressure to walk the talk yourself.

What we’ve got right so far.

We’ve got a growing new health profession going. We’ve demonstrated spectacular results in areas like Type 2 diabetes reversal, where we commonly see half of the people treated achieve full reversal of their diabetes diagnosis. All who turn up achieve some improvement. 

We have workforce development partners like Pasifika Futures, Procare, Kahui Executive, AIA, Sovereign, and Mahi Tahi Hauora where we train their community health workforce in health coaching and mental health coaching. 

What we’ve got wrong so far.

We don’t yet have a sustainable government funding model for this beyond the Te Pou health coach course, which only amounts to a week’s training. It covers none of the things we at PREKURE do, and the governing professional body ‘The Health Coaches’ Association of NZ and Australia’ mandates that a professional Health Coach should do. 

We need to join and partner with the government and other purpose-led organisations to get a funding model that works. This isn’t by itself the answer, but it is part of the answer.

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