Do public health programmes work?
There is an increasing body of work that shows that public health programmes are effective in improving the health of the community. OECD figures in 2001 notes a dramatic increase in New Zealander’s life expectancy due in part to public health interventions.
In some of the following examples, short-term indicators were measured to demonstrate progress towards achieving long-term outcomes. These will be measured over a longer time-frame.
Māori nutrition training programmes
What:
Training courses providing basic nutrition knowledge and skills to Māori community people empowering them to promote nutrition in their communities.
Results:
Changes in kai and nutrition practices on marae, Kōhanga reo and in other Māori organisations and whānau were observed: a greater variety of food was available, consumption of fat, salt and sugar decreased, consumption of salads and drinking-water increased. An unintended result was that the number of smokefree venues increased.
Te Pataka O Te Tai Tokerau Outcome Evaluation Report. Alcohol and Public Health Research Unit, May 1998.
Kia Oranga Tinana Mo Waipareira Outcome Evaluation Report, Alcohol and Public Health Research Unit, May 1998.
Taro o Te Ora outcome Evaluation Report, Alcohol and Public Health Research Unit, May 1998.
Kai Te Hauora Outcome Evaluation Report, Alcohol and Public Health Research Unit, May 1998.
A city-wide injury prevention programme
Who:
Māori, Pacific and general public health providers, community organisations, the police and City Council.
What:
Joint planning and action on how to reduce injury levels within the city.
Results:
There have been marked increases in the use of child restraints in motor vehicles, swimming pool fencing, fire guards, stair guards and protective equipment for sport. Injury levels in the city have significantly reduced since the project began. In other parts of the same urban area where the programme was not operating, injury rates rose over the same period. Outcome evaluation findings demonstrated significant reductions in hospitalisation rates for all age groups in the city with the injury prevention programme.
Waitakere Community Injury Prevention Project, Improves Safety Practices. Injury Prevention Research Centre, Fact sheet No 23, December 1998.
Evaluation of the Waitakere Community Injury Prevention Project. Coggan, C. et al. Injury Prevention, 2000:6.
Immunisation
What:
Promotion in New Zealand of immunisation against Haemophilus influenzae type B (Hib).
Results:
As a result of public health surveillance, the New Zealand Immunisation Schedule was revised to include immunisation against Hib.
"Prior to the introduction of immunisation in 1994, Hib was the commonest cause of life-threatening bacterial infection in children under the age of five. However, since the vaccine was introduced in January 1994, there has been a dramatic reduction in the incidence of this disease – as has occurred in other countries. There has been an over 80% reduction in disease within six months of adding the vaccine to the schedule.”
Immunisation Handbook, Ministry of Health, 1996.
Flouridation of water supplies
What:
Promotion of the fluoridation of drinking-water supplies for communities of 1000 or more people.
Results:
Fluoridation significantly reduces rates of tooth decay. It is estimated that water fluoridation prevents between 58,000 and 267,000 decayed, missing or filled teeth in New Zealand each year. Based on current levels of 50 percent of the population receiving fluoridated water, it is estimated that the annual cost savings are up to $14.3 million. As well as these dollar savings, there are savings for individuals in terms of time and reduced discomfort and pain.
Water Fluoridation in New Zealand. Public Health Commission, 1995.
Safe drinking water supplies for small communities and marae
What:
The Hokianga Drinking-Water Pilot involved the development, installation and evaluation of safe drinking-water supplies for small, generally marae-based, communities in the Hokianga region. Once completed, the drinking-water treatment plants are operated and maintained by the communities themselves.
Results:
Safe drinking-water was provided to 34 communities and marae at a cost of $1.5 million. In a number of overseas studies, cost-benefit ratios of a safe drinking-water supply have been assessed to lie in the range of 8-50 (i.e. the benefits greatly outweigh the costs).
The project evaluation reports are very positive of the benefits that have accrued. The direct benefit is that small communities now have safe water supplies. Incidental benefits are that people in those small communities have developed ownership over the water supplies, an increased sense of empowerment and an increased awareness of health issues. The project has made other communities aware of the benefits of safe drinking-water.
Ministry of Health. Unpublished reports. January to July 2001