The Dim-Post

February 24, 2012

What then?

Filed under: crime,health — danylmc @ 10:57 am

Jacinda Ardern has a column in the Herald about child abuse (she is opposed to it) and it asserts:

There will be those parents who have already proven time and again that they should not have the privilege and responsibility of raising another child. They are not the norm, but for them our response should be swift and simple – they don’t get to gamble with another child’s life.

I don’t care if this is seen as too interventionist. I’d rather that than more of the “waiting and seeing”.

I’m all for interventionism, but I do wonder how this would work. How do you stop abusive parents from having more children?

The first stage seems pretty simple. You introduce a mechanism in which CYFS or other authorities can red-flag individuals who abuse their children, presumably through some sort of judicial process. But how do you monitor men who have been red-flagged to see if they’re living in a house with children, or expecting another child with a new partner? Pregnant women will get picked up when they enter the health system, but red-flagged males will be harder. Do you need something similar to the sex-offender registry? (It might be a good idea to combine the two, sending the message that child abuse carries the same level of stigma.)

Say you do – what happens once you’ve flagged someone? You can offer them medical sterilisation, but you can’t compel them to accept it – even offering financial incentives takes you into very tricky ethical territory, especially since a huge proportion of those sterilised would be Maori. You run into the same problems with abortion, only more-so.

So do you remove children from the parents’ care at birth? That is, in itself, a form of child abuse, so the threshold for such an act would have to be very high. And where do they go? One of the main reasons we have the Domestic Purposes Benefit is that state agencies and religious organisations proved themselves dangerously inept at caring for and raising children. Are they adopted? Adopted children also face a horribly high rate of child abuse.

It’s very easy to say ‘some parents shouldn’t be allowed to have children’, but very hard to implement that sentiment as policy.

February 9, 2012

I too have an opinion on the Piri Weepu bottle-feeding controversy

Filed under: health — danylmc @ 10:25 am

Background here if you have no idea what this is:

Piri Weepu has defended his decision to bottlefeed his daughter after footage of the All Black bottle-feeding her was cut from an anti-smoking advertisement.

The two-second glimpse of the Rugby World Cup star feeding his 6-month-old daughter Taylor was removed following concerns from pro-breastfeeding organisations the high-profile of Weepu would sway people away from breastfeeding their children.

However the decision to cut the footage has been widely criticised, with some pointing out men and many women cannot breastfed.

There’s been a lot of talk about ‘breastfeeding nazis’, with the presumption that everyone knows that breast-milk is best, there’s already huge cultural pressure on women to breastfeed etc, so more breastfeeding advocacy is excessive. Well, that’s true of white, middle-class New Zealand. And some of the mid-wives Maggie and I encountered during our pre-natal classes were, frankly, crack-pots who approached the issue of breast-feeding with religious hysteria, in which infant formula was evil and failure to breast-feed was child abuse. (actual example: the mid-wife who taught the lactation class we attended insisted that women who failed to breast-feed wouldn’t be able to get jobs when they were ready to go back to work, because employers preferred to hire woman who breast-fed.)

But this pro-breastfeeding culture isn’t universal:

Ministry of Health data (2006) shows that only about 66% of the general population breastfeed their newborns with this figure reducing to 55% at three months and just 25% at six months. While 59% of Maori mothers breast feed their newborns, dropping to 45% at 3 months and down to 17% still breast-feeding at six months. At the same time 57% of Pacific mothers breast feed their newborns, 48% at 3 months, with 19% still breast-feeding at six months. There are several other studies done by various researchers and the general trend appears that breastfeeding rates are not improving for New Zealand mothers including Maori and Pacific populations and the national targets are not met.

I talked about this with the pediatricians at the neo-natal ward: many Maori and Pacific Island mums simply refuse to even attempt breastfeeding. Those cultural pressures don’t seem to be there. One of the many advantages of breast-milk are the immunological benefits: you simply can’t get those protective and anti-microbal factors from formula milk. And children from those demographics least likely to be breastfed are the ones most likely to go home to poorly insulated houses that are overcrowded and shared with adults who smoke. They’re the children who most need to be breastfed, and they aren’t. So that’s where pro breastfeeding organisations are coming from. They’re actually losing the battle.

Having made that point, it seemed to me that all the advocacy for breast-feeding during the pre-natal period wasn’t matched by post-natal support. Wellington Hospital has a really, really high throughput model, in which mothers and children are sent home as quickly as possible, long before proper feeding is established. I don’t know if that’s standard across New Zealand, but it seems like pro-breastfeeding organisations could put more energy into lobbying for improved maternity care. All that advocacy is pretty futile if the health system doesn’t actually follow through on it.

February 3, 2011

Profiles in leadership: Capital and Coast DHB CEO Shaun Drummond

Filed under: health — danylmc @ 8:26 am

Wellington Hospital chiefs will axe percolated coffee for staff from next month to save $190,000 a year.

To sweeten the latest cost-cutting initiative from Capital and Coast District Health Board, staff will still be provided with instant coffee, tea, Milo, a range of milk full cream, trim, calcium rich and soy and sugar and artificial sweetener.

In an email headed “Coffee Rationalisation”, the board’s operations director for non-clinical support services, Leena Singh, told staff that Capital and Coast, “like all businesses”, was not immune to the economic downturn.

But the latest cutback was a step too far for some. Chief operating officer Shaun Drummond was forced to defend the decision in an email response to an apparently disgruntled staff member.

He wrote that the cut had been “debated over a number of weeks” and had the full support of clinical and operational directors.

“If faced with changing the coffee we drink or keeping three allied health or nursing staff, I will always support changing the coffee.”

Staff coffee axed as recession bites, Dominion-Post. 23rd July 2009.

Capital & Coast District Health Board confirmed it paid for acting chief executive Shaun Drummond to fly to Townsville to visit family at weekends, but is refusing to say how much it cost. The board had a $47 million deficit last financial year.

A DHB spokeswoman confirmed yesterday that his flights home were paid as “part of his salary”. She refused to say how often he returned to Townsville, whether he flew business or economy class, or how much his flights cost.

The Dominion Post has been told he was flying business class. A business-class ticket on Air New Zealand from Wellington to Townsville, via Auckland and Brisbane, costs about $2800 return, according to the airline’s website.

Neither Capital & Coast chairwoman Virginia Hope, former chairman Sir John Anderson nor Mr Whelan were returning calls yesterday.

Health Minister Tony Ryall also declined to comment.

Taxpayers foot another travel bill, Dominion-Post. 3rd February, 2011.

August 2, 2010

Something

Filed under: health — danylmc @ 8:28 am

Another child murder last week provoked another round of pundits wringing their hands and insisting that ‘someone has to do something’, so just a reminder that ‘something’  could actually be a policy based solution. In the US some states have the Nurse-Family Partnership program in which a trained nurse is partnered with a first-time Mother who conforms to various at-risk criteria and the nurse then visits the Mother regularly for two and a half years beginning before the birth of the child.

The program has been extensively studied via randomised control trials and – in addition to other metrics – outcomes include:

  • 39-percent fewer injuries among children
  • 48-percent reduction in child abuse and neglect
  • 56-percent reduction in emergency room visits for accidents

Where would the government get the money to fund such a program? I can think of a few places, but that depends on whether you think a proven means of reducing child abuse is more important than ‘the aspirational wellness of the whanau.’

Just to end on a comic note, this NotPC post on reducing child abuse by abolishing the DPB (‘blood money’ if you’re a libertarian) is pretty funny.

July 22, 2010

One day . . .

Filed under: health — danylmc @ 1:12 pm

Via Brad in the comments section of the euthanasia post, euthanasia advertising:

Death Panels

Filed under: health — danylmc @ 7:33 am

I’m cautiously in favor of legalising euthanasia. Giving people the chance to die with dignity is the right thing to do: but I’m nervous about the following combination of factors:

  • the last few months of a person’s life are the most expensive
  • we have a socialised healthcare system facing a perpetual budget crisis
  • our public debates and government policy directions are influenced by a clique of deranged neoliberal psychopaths who seem to be indifferent to the value of human life

Not hard to see how we could start out giving patients, doctors and families the right to make end of life decisions and wind up somewhere else.

July 21, 2010

Eaten!

Filed under: economics,health,Politics — danylmc @ 8:59 pm

NZPA reports:

A bid to remove GST on healthy foods to lower costs has been slammed by the Government.

Prime Minister John Key said the Government will not support Maori MP Rahui Katene’s bill, which defines healthy food as fruit and vegetables, breads and cereals, milk and milk products – excluding ice cream, cream products, condensed and flavoured milk – and lean meat, poultry, seafood, eggs, nuts, seeds and legumes.

The Government would not support the removal of GST on particular items, he said.

“In our view, what makes the system work well is the simplicity and its low administration costs. Once you start exempting one part, meat and vegetables, then why wouldn’t (you to) other parts of the food equation.”

Throwing in meat and dairy never made any sense but it’s a shame the bill won’t go to select committee.

My version of this bill would have been a revenue neutral carrot (ho ho) and stick approach. A small number of healthy foods exempted (fresh fruit and vegetables) and a small number of very unhealthy foods (potato chips, high sugar soda drinks) excised at a higher rate to pay for the GST exemption – with a regulatory body given the power to add or remove foods from either category as new research comes to light.

State intervention in food choices will eventually be seen the same way as state intervention in car seatbelts and tobacco prices – we can either address it now or put it off for twenty years while we argue about freedom and the nanny state and then do it anyway because our obesity related healthcare costs will be bankrupting the economy.

July 17, 2010

Help Wanted

Filed under: health,Politics — danylmc @ 4:54 pm

Qualified applicant with extensive experience of public health sector required to help dismantle public health sector. Ignorance of recent New Zealand economic history an advantage. Chilling laugh a must. Subject to dismissal after 90 days if performance is unsatisfactory. Enquire T Ryall.

May 19, 2010

More of this please

Filed under: health,media — danylmc @ 1:35 pm

I’ve complained in the past that our print fnord media frequently gives op-ed space to people like the Business Round Table’s Roger Kerr but not to members of UFO cults, devil worshippers, Shining Path Maoists, contrail conspiracy theorists or representatives of other such groups whose ideas have just as much public support and validity as Kerr’s. So it’s nice to see Stuff publishing an op-ed from the ‘Fluoride Action Network‘ arguing that fluoridation is a ‘fanatical’ conspiracy to poison the drinking water. [Hat tip: DPF]

April 22, 2010

EtOH

Filed under: health — danylmc @ 12:38 pm

DPF leaks the Law Commission’s review of alcohol laws and policies. My fantasy policy as regards almost all drugs is that they’re legal but heavily taxed to reflect the high external cost of drugs of abuse, so I’d be happy to see the excise increased but not the prescriptive policies around the sale of the drug.

There’s a serious clash of worldviews here: most medical and scientific experts on alcohol regard it as a powerful, dangerous and addictive drug (and seen through this light the Law Commission’s proposals seem very reasonable). But abuse of the drug is very widespread and normalised in our society and the general public isn’t going to appreciate being treated like addicts – even though a huge proportion of the population is exactly that. When it comes to alcohol there’s a cognitive dissonance that kicks in preventing people from regarding themselves as addicts because of the legal status of the drug – so someone might be enthusiastic about the imprisonment of cannabis users but totally opposed to any attempt to regulate their own drug of abuse (DPF calls the proposals ‘the worse kind of nanny state’ – a 10:30 PM sales curfew being worse, apparently, than throwing people in prison for years). The Law Commission’s proposals challenge the delusions and double standards around the drug laws, hence the inevitable outrage.

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