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Emergency Medicine News:
doi: 10.1097/01.EEM.0000415095.35556.45
Screened & Examined

The Nuances of New Zealand Public Health (French Fries Aside)

Ballard, Dustin MD

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Dr. Ballard is an associate emergency physician at Kaiser-Permanente in San Rafael, CA, and the chair of the CREST ED Research Network. His writing credits include co-authorship with Angela Ballard of the award-winning travel narrative A Blistered Kind of Love: One Couple's Trial by Trail (Mountaineers Books, 2003) and authorship of The Bullet's Yaw (IUniverse, 2007). Dr. Ballard writes a biweekly-medical column for the Marin Independent Journal, which he posts on his blog: http://incisionanddrainage.blogspot.com. He is currently working at Starship Children's Hospital in Auckland, New Zealand.

Soon after arriving in Auckland for a six-month sojourn, I picked up the local paper (The New Zealand Herald), and was surprised to read this from columnist Paul Holmes:

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The New Zealand Fire...
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"Now, my health. It seems to have been a matter of speculation since last Sunday and I don't want you to think I'm on my last legs, so here's what happened.... It was all to do with damage done by radiotherapy during the first days of the prostate cancer treatment a decade ago....

"In mid-January, my bladder shut down. That is to say, its ability to drain itself was blocked by an enlarged prostate strangling the urethra. So I could not pee. Meantime, the bladder continued to swell, and believe me, this must be one of the most painful conditions in the world. The immediate solution is to insert a catheter to drain the bladder, a moment of immense relief. And you walk round with the bag attached to your leg until they can do what I call a re-bore.

"Sounds weird and unpleasant, I know, but it's happened to me now a few times over the years, and you kind of get used to it.

"But it's what can happen after prostate cancer. Like any cancer, it is a nasty, unpredictable thing, and its effects can hang round for years and change your life forever.”

I read this, and then re-read it to be sure. Did a prominent newspaperman just describe a personal and painful medical condition in a public and matter-of-fact manner? Why, yes, he had. And it occurred to me that one would be hard-pressed to read such an account in the mainstream American media.

This had me asking, are we Americans a bit squeamish about our health? You certainly don't see much about bladder blockage on the opinion page of the New York Times, but it's not just that. Rightly or wrongly, many Americans would prefer to keep matters of reproductive and mental health (among others) private. I would wager that there are precious few (if any) U.S. neighborhoods that feature billboards urging men to "Give it a shot. There are 1,000,001 reasons to be a donor.” Sperm donor, that is.

Such billboards are abundant here in Auckland. You also are unlikely to find your local paper running a feature on male cosmetic surgery entitled "Beauty and the Bloke.”

What you will find in the United States is a large number of people addicted to prescription narcotics. But while the United States is facing an unprecedented epidemic of prescription drug misuse and abuse (prescription narcotic-related deaths numbered 14,800 in 2008), what there is of Kiwi statistics on the topic suggests it is nary a problem here. The most recent published report I could find documents 92 prescription drug abuse deaths in the whole of New Zealand for 2001 and 2002.

Why the difference? From my observations so far and from what people tell me, it seems that Kiwis with chronic pain are better able to manage their pain with a regimen of Tylenol and the occasional happy hour. Or it could have something to do with the fact that hydrocodone is not available here in New Zealand. When I asked a Kiwi physician about this drug, she replied, "Haven't heard of it. Related to morphine, is it?”

But there could be more to it. Limited investigation, some of it quite dated, suggests cultural differences between Americans and Kiwis when it comes to pain perception and disability. A comparison study of 100 chronic low back pain patients in each country found that "despite nearly similar between-country reports of pain frequency and intensity, the U.S. patients, at pre- and post-testing, reported greater emotional and behavioral disruption as a correlate of their pain.” (Pain 1985;21[1]:77.)

A more recent qualitative study of rural Kiwi workers with low back pain observed a return-to-work ethic in spite of pain driven by a "‘can do’ attitude to work, managing [low back pain] within the context of having job control and flexible work practices.” (J Occup Rehabil 2011;21[3]:395.)

Am I saying that Americans are prudes and wimps when it comes to health? No, I have no such authority, and we Americans have no such monopoly. Besides, who's to say that health squeamishness is a detrimental trait? I'm just pondering why there appears to be a health-minded difference between New Zealanders and Americans.

Over the next half-dozen or so columns, I will explore various angles and nuances of this question, incorporating stories and observations from New Zealand and relating them, when applicable, back to the U.S. system. I hope not to, as a Kiwi might say, "Make you a whole lot of knackered,” which translates loosely to "bore you to sleep.”

We must address size and population density to start off this endeavor. New Zealand is a country roughly half the size California with only 4.5 million people. The San Francisco Bay area registers just about this many all by itself.

Don, a rather sharp-tongued tour guide, told us, "Four-point-five million. That is not so many that you couldn't fit them all in your backyard and still have room for a game of golf.” Topics that make it into The New Zealand Herald would surely be drowned out by other news in the United States. For instance, it's front section news that a woman "abducted” a newborn baby from its mother after asking and receiving permission to take the baby for a stroll. Articles also appear regularly about hospital food and clothing. The sticky stripe socks are, by the way, considered a smashing success!

New Zealand, however, does have a high-profile epidemic in progress. A nationwide surge of late night chip (French fry) cooking house fires (1,005 of them in 2008-2009) prompted the Kiwis to launch a public service campaign called "Don't drink and fry.” If you have a moment, pull up the TV ads on YouTube; they are richly entertaining. (See FastLinks.) Somewhat remarkably, this campaign seems to have contributed to a nearly 40 percent decrease in frying fires in 2009-2010.

So size matters, in the nature of what's news and what demands public health attention. But there is more to this topic of comparative squeamishness than that. Next time, I will explore the role of fear, in particular the fear of losing health coverage or not having it all, and how this affects a culture's approach to health and wellness.

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FastLinks

* Watch a New Zealand "Don't Drink and Fry” commercial at http://bit.ly/DontDrinkandFry.

* Visit the New Zealand Fire Service Youtube channel to view all of its "Don't Drink and Fry” videos: http://bit.ly/NewZeaFS.

© 2012 Lippincott Williams & Wilkins, Inc.

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