Public health experts fear critical programmes for disease prevention and detection could be lost or downgraded with looming budget cuts at the National Public Health Service.
A document leaked to RNZ shows the service - which oversees health promotion, disease prevention and protection - is proposing to axe staff and pull back on projects, after being stripped of millions of dollars in funding.
- National Public Health Service provisional budget $401.4m - down from $415m last year
- Internal review proposes cuts to current FTE, community provider organisations and projects
- Senior doctors say public health measures - including immunisation campaigns, infectious disease control and trying to help people stop smoking - should be seen as critical investments, not costs
- Health NZ not confirming which programmes in line for cuts
- Public health workers suffering burnout due to workload and "bureaucratic challenges".
Public health campaigner Professor Boyd Swinburn - who chairs the Health Coalition Aotearoa, said it was critical work - but largely undervalued.
"It's the emergency rooms and waiting lists the scream the loudest and therefore get responded to - but all the prevention side is a bit hidden.
"And it tends to be the one that cops the chop, I have to say."
An internal document obtained by RNZ (which was presented to National Public Health Service staff at a meeting last week) showed job losses were likely, along with cuts to projects and contracts with community organisations.
The service had $29 million dollars shaved off its budget this year and while it had since got about half of that back, its funding allocation (of about $401m) was still uncertain.
A staff member, whom RNZ has agreed not to name, said many clinical positions were already vacant.
"We've been told it's likely we're going to lose those vacant positions - but I'm working 11 hours plus days to keep up.
"It sounds dramatic, but there are often staff crying in the toilets because we are so worried about what's happening to our programmes."
The national public health director, Dr Nick Chamberlain, was "widely respected by staff", a staunch advocate for a clinical, evidence-led approach, and had overseen a service that delivered new programmes (including the HPV vaccination campaign and extended breast screening) on time and even under budget, the clinician said.
Public health is "frontline" - union
Last month, in an all-staff newsletter, Te Whatu Ora chief executive Margie Apa and commissioner, Lester Levy, said "changes" required in order for the agency to live within its means, "won't impact frontline clinical delivery where the care is directly for patients".
The head of the senior doctor's union, Sarah Dalton, told RNZ she was so alarmed by this, she immediately wrote to management, asking for urgent clarification on the plans for public health.
"Any idea or suggestion that what they do is secondary to an effective health service is outrageous.
"Unfortunately I have not had a substantive response from them."
Te Whatu Ora responds
In a written reply to RNZ's questions, Apa said the agency was still working to set budgets and "power up regions" to deliver better health outcomes.
"We will not discuss changes outside of unions and staff before they are fully communicated to any relevant team."
New Zealand's chronic under-investment in public health became painfully clear at the start of the Covid-19 pandemic, when health authorities were forced to scamble to get adequate contact tracing and infection controls in place.
The Public Health Communication Centre director, Professor Michael Baker, said the National Public Health Service only received about 1.5 percent of the health budget now, (about $400m) "and that is not enough"
"Governments have to actually invest in public health because no-one else will.
"And so it's a critical function for our state and a critical use for our taxpayer money, and I'm very concerned if the Government is reducing its investment in prevention.
"It's already very low - it needs to be going up, not down."
Burnout due to "bureaucratic challenges"
A workforce survey by the Public Health Association last week found more than half (53 percent) reported burnout or signs of burnout in the last 12 months, due to workload (46 percent), lack of resources (45 percent) and what they called "bureaucratic challenges" (60.5 percent).
Its chief executive, Dr Cadence Kaumoana, said while she could not speak to the government's intentions behind further budget reductions, it was "clear that our public health workforce is already feeling the strain of these decisions".
"Public health cannot continue to function effectively without the necessary resources and workforce support," she said.
"Any budget reductions across the public health sector and in public health functions will have a direct impact on both the health and well-being of the public health workforce and the communities they are tasked to serve."
