PUBLIC HEALTH

Dominion, Volume 12, Issue 148, 18 March 1919, Page 6

PUBLIC HEALTH

PLAYTHING OF POLITICIANS

THE NEW BOARD

SOME CANDID CRITICISM

Some very free and illuminating expressions of opinion regarding public health administration were offered to tho Epidemic Commission by Dr. Makgill, of the Healch Department, yesterday. Dr. Makgill informed the Commission that the evidence had beon prepared in consultation with his' colleagues, nnd that it did not express merely his own opinion.

.After ,o statement of the functions 'of tho Public Health Department, Dr. Makgill said that many Public Health matters were dealt with by other State Departments and by local governing bodies. Such being the case, it was essential that the relotionship of tho Department to such other Departments and public bodies should be clearly defined. Yet this was wherein the legislation was most woik. Was tiio Public Health Department to bo merely nn advisory body? If so it should have no mandatory pow- 1 ers and no responsibilities in local government. If it was to bo a mandatory body, then the powers of control should -bo. definite and ample, and the constitution of the Department should be such that it could override the indifference or opposition of public bodies, and compel them to take action where, the general welfare of the State was involved. In a democratic country such powers, could not be vested in one or two State servants, nor could their enforcement with safety be left to the judgment of any but a body which included a reasonable proportion of sanitary experts. "Tho present status of the Department is," he said, "therefore, most unsatisfactory. It lacks powers where powers are most needed. It possesses powers in theory which cannot be exercised in prac- ■ tieo, and its functions are directly controlled by a Ministry devoid of expert knowledge. Yet- tho burden of responsibilitv is thrust by Press and public on the shoulders 'of Departmental officers, tinder the best of conditions a Department dealing with public health has many difficulties apart from legislative defects. In tho execution of its functions it has to trample on vested interests. Its activities bring in no revenue, but increase taxation and raise local rates. . Its triumphs are for the most part apparent only in the course of year.?, and aro discernablo only by a study of tedious statistics. It brings, then, little glory to aspiraiits to distinc- . thin in local or general politics. Its officers cannot - with any self-respect advei'lwe the success of their schemes, with the result that such credit'as they might claim is often appropriated by others. for example, the reduction in infantile mortality which has been secured in tho last fifteen years. We hear much of the'Plunket nursing service in this connection, and rightly, too, no doubt, for they have done useful service. But wb.oev.ir thinks of holding fashionable public meetings to land the activities of the small, overworked band of Public Health inspectors whose work has played by far the greatest part in reducing irifaiit'mortality? ... "Public indifference is ■ the principal handicap to sanitary'reform. It is only when danger threatens that this, indifference is momentarily cast aside, and then our citizens or their representatives for the most part find sanitary salvation by allotting the sack-cloth and ashes to the Department which they have themselves starved and neglected in times of peace. ... At times a political aspirant finds it -useful to arouse a passing, interest in some branch of public health, and to this end somo simple facts will.be decked in lurid colours to attract attention But his interest in the subject soon ceases, and the public, pacified by the discovery of tho deception, sinks back into peaceful indifference. Sanitary progress caD only be secured by taking public health out of the sphere of politics, 'and bv establishing a continuity of policy of which one item should be the education of the public to seek after sanitary righteousness. To this end it- is necessary to- establish a strong controlling body representing various grades of publio opinion, and seasoned by a liberal admixture, of expert knowledge in tho sciences and trades with which sanitary work is most directly concerned. '. "in the Public Health Amendment ■Act of 1918, clause 2, an attempt /has been made to establish such a body by ther creation of a Board of Public Health. Unfortunately, when we examine into the powers of this,board we find that they, are" merely an advisory board reporting to the Minister their opinions on public health questions. .The board cannot direct the enforcement of any sanitary works, cannot initiate precautions, cannot bring pressure to bear' on local bodies,'or' give directions to tho Departmental' officers. Their recommendations Ko't) the Minister, and thus are subject to thoso political considerations inseparable from Cabinet control. In the same Act district advisory boards may be-con-stituted by the Minister.'- Their function' is to report tin matters which he may refer to them, a variety of sanitary debating club, in fact, to whom • subjects for discussion will bo allotted, and whose resolutions may be duly pigeon-holed if they run contrary to popular prejudice' or aro otherwise inconvenient. Little of value heed bo anticipated from tho creation of these bodies as at present constituted." . ,

■ Beferring to the' Act of 1900, which also wus passed in a hurry at a time when there was a plague scare, Dr. Majc(,'ill said: "No great change can with safety be attempted suddenly, more especially constitutional changes in Stale administration. The Act, instead of following the lines taught by experience in BriViin, broke new ground, and as a result we find • these useless powers conferred on health officers . which might have been possible, of administration in Prussia, but.certainly not in New Zealand. Evidently legislators, even in pissing tlio Act, took alarm, for every now and then one finds that to these extraordinary powers a check string is attached Riving the real control to tho Minister. .. . The Act invites—hay, coinDels—Ministerial interference in 'matters regarding which ho has no special knowledge. He is also a court of appeal where a local body combats the mandate of the Chief Health Officer. We h.u-e been fortunate in New Zealand to haro had among the holders of the portfolio of Public .Health Ministers who ha/e not taken undue advantago of those controlling, powers. Yet. Ministers are politicians, and politicians reflect popularwishes rather than scientific needs, of whim popular clamour is naturally ignorant. Then, again, with a political head wo have a lack of continuity in the policv of the Department, as a-result of the changes in the Ministry .duo to political upheavals. The national health is too precious an asset to be at the mercy of the changes which party politics may brine

. "Doubtless a Minister of Health is needed to represent tho claims of sanitation to Cabinet and to Parliament. The general expenditure must bo thus controlled, aa also tho amendments and additions to sanitary legislation. But here his functions should end, and the real controlling body should be a non-political boa-d of health, composed of persons with experience and expert knowledge, whose actions and decisions will bo founded on scientific laws and actuated by tho practical needs, of the community. To such a board the Departmental'officers would report, and tho local authorities would appeal, and its powers should be such that matters such as the passing of eanitiry by-laws and tho undertaking of sanitary works would be compulsory on its mnndate. To this end the decisions of the board in local government should be final and modified only on appeal to the Supreme Court. In West Australia and in Queensland these powers are delegated to a Commissioner of Public Health, but probably in New Zealand public opinion would . prefer a board such aa I have sketched."