In the last 12 months we have had two stories in the news about promising professional rugby players whose careers have been disrupted or curtailed due to childhood illnesses associated with poverty in New Zealand: Robbie Fruean (Crusaders) and Buxton Popoali’I (Highlanders).
Sadly these are just high profile representatives of a further 140 plus children who would have contracted rheumatic fever in the same year as each of them.
Even worse it is reported that each year a similar number of New Zealanders die from the consequences of rheumatic fever in earlier childhood.
Governments take all sorts of steps to reduce the road toll (2013 = 254) but seem less committed to reducing these preventable deaths. Is it because it only affects the poor?
The medical facts
The Cardiac Society of Australia and New Zealand noted in 2007 ‘Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are a signiﬁcant cause of disease among Maori and Paciﬁc children in New Zealand (affecting 1 in 3 children), with signiﬁcant morbidity and mortality among young adults. ARF, an auto-immune response to group A streptococcus (GAS) infection of the upper respiratory tract, may result in damage to the mitral and/or aortic valves resulting in RHD. Recurrences are likely in the absence of preventative measures and may cause further cardiac valve damage.’
‘New Zealand has had high rates of ARF and RHD for many decades. The decline in incidence of ARF seen in other developed countries has not been evident in New Zealand. Socioeconomic deprivation is linked with higher rates of both ARF and RHD. In 2003, the rate for ARF was 3.8 per 100,000 exceeding that in other western countries. Most of the 141 new cases reported in that year occurred in the ﬁve to 14 year age group…. New Zealand has an efﬁcient secondary prophylaxis programme and the need for valve surgery for recurrent episodes is decreasing. However, there has been no attempt to prevent ﬁrst attacks and eradicate the disease.’
(Extracts from Rheumatic fever in Māori: what can we do better?)
‘The rate of Acute Rheumatic Fever (ARF) in New Zealand is increasing. Between 2005 and 2010, the rate of ARF doubled from 1.9 reported cases per 100 000 population to 3.8 per 100 000’
‘In New Zealand, ARF has been a notifiable disease since 1986. Despite this, it is likely that there are significantly more cases of ARF in New Zealand than are currently being reported to health services. A 2008 review of ARF cases (1999–2007) in the Bay of Plenty and Lakes Districts DHBs found 147 cases, where only 75 had been previously reported.’
‘It is widely believed that this over representation is due to a combination of overcrowded living conditions, poverty and decreased access to treatment options.’
What it means to the children affected
Fletcher, David, 1952-. Fletcher, David, 1952- :’There’s something for everyone in my new budget.’ ‘There’s nothing for children.’ ‘Don’t think of them as children… Think of them as non-voters.’ Dominion Post, 23 April 2005.. Ref: DX-105-193. Alexander Turnbull Library, Wellington, New Zealand. http://natlib.govt.nz/records/22304777
Children diagnosed with rheumatic fever need to have monthly injections for 10 years, or until they are 21 years old, whichever is longer. If the child has damage to their heart valve they may need injections until they are 30 years old.
With the best will in the world, we are expecting our poorest parents (who may be working long hours to pay the bills) to put aside a day each month to get injections for their children. Each missed appointment increases the chance of heart failure later.
What is the economic cause?
For Sale. “And the extensive indoor-outdoor living area opens out to this, er, unique children’s sleepout!” 14 November, 2007. Nisbet, Alastair, 1958- :[Digital cartoons dated from November 2000 onwards]. Ref: DCDL-0008138. Alexander Turnbull Library, Wellington, New Zealand. http://natlib.govt.nz/records/22722880
Living in crowded and unhealthy accommodation is associated with the spread of rheumatic fever and other diseases linked with poverty. One of the main reasons for the Labour Government’s programmes for the building of State Housing in the 1930’s was to eradicate all of these diseases of poverty. Could those politicians ever have thought we could allow them to return when we are so much richer as a country now?
What is current Government policy?
National have spent money on programmes to test for and vaccinate against rheumatic fever, and all credit to them for doing so.
They have also claimed credit for the insulation of homes, providing healthier living conditions, though this was strictly speaking a Green Party policy that they accepted in return for support. In recent times the Government’s enthusiasm has decreased, despite the policies undoubted success.
The way forward
Most media reviews of the current situation talk of a “disgrace” (2010, 2013). Until Governments choose to improve the factors that cause the poor living conditions then any funding to mitigate the symptoms will be a temporary solution. New Zealand will remain in the spotlight as one of the very few first world countries left with 3rd world diseases.
Forget New Zealand being a land of opportunity for all, this disease of inequality is a life sentence and condemns over 140 poor children each year to a lifetime of poor health and needless early death.
We have the resources to sort this. What we currently lack is the political will to make the necessary redistribution of wealth and income.