Use of the word Health an ‘inverted euphemism’.

Localised District Health Boards have been dumped and a  centralised bureaucracy established.

[*1]

DHBs were set up to be responsible for the integration of all health services in a particular area officially known as “resident populations”. They were responsible to monitor the health status of that population.

Recently, suddenly, and with little discussion, a new Centralised bureaucracy was announced. Apparently, this was necessary because a patient in one geographic area receives state funding for a particular drug or treatment while a patient with similar clinical needs in another area does not. The Government, not the DHBs control the funding.

The question, “Restructuring yet again is the solution to what problem?” springs to mind.

Some answers include ‘The problem is the cost. Healthcare has become commoditized, politicised’ ‘We have a healthcare system that is only one big Accident & Emergency centre.’ ‘DHBs are stubborn, and always too slow.’

Even if those are correct diagnoses, is restructuring the answer? Remember health care is delivered by people. In an effective organisation the people are clear on what they are supposed to do and enabled to be able to do that.

The key word of diagnosis (in my opinion) is ‘politicised’. Restructuring is often synonymous with Politics.

During my service in the Public Health system, I experienced four restructures plus the one that created the opportunity for me to be employed.

The process of restructuring faces many challenges leading to most organisations failing to successfully implement it, usually because it is imposed from the top down with little or no real engagement of the people who do the actual work. The great Peter Drucker is credited with saying “Culture eats strategy for breakfast”. In other words, no matter how big or clever the plans, unless the team is onboard, you ain’t going nowhere. 

In the words of someone whose opinion I respect, "...perhaps because we are so good at organizing, we tend as a nation to meet any new situation by reorganizing; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralization."

Bad policy is more harmful than flesh eating bugs.

By sheer coincidence I came across a book ‘Curious kiwi words’ by Max Cryer (2002). I looked up ‘Health’ and here is what he said:

“Although the word health normally indicates that a body is functioning well, in New Zealand it’s often used to mean sickness. In spite of their titles, the Ministry of Health, health insurance, health professionals, health clinics and health legislation are entirely concerned with problems related to illness. Television and radio have health reporters who report on various matters to do with ill health…

The word health is probably an optimistic gesture towards what people want it to be (i.e. healthy) but the fact remains, that during their working day, health professionals only ever meet people who are ill.

For a while there was a moderate attempt to substitute the word wellness as a sort of middle ground, but the word never took off.”

Max referenced a social commentator, Richard Wolfe, who called the word ‘Health’ an “inverted euphemism’.

[*1] The Dominion Post / 28 October 2022 / Murdoch Cartoon / page 13