NEW ZEALAND’S HEALTH in wartime

Korero (AEWS), Volume 2, Issue 18, 11 September 1944, Page 9

NEW ZEALAND’S HEALTH in wartime

A KORERO REPORT

A high tribute to the progressive way in which New Zealand dealt with its health problems was paid by Dr. Edith Summerskill, a member of the recent Parliamentary delegation from the United Kingdom, in a radio talk. “ From what I have seen in New Zealand, there can be no doubt that your standard of medicine and surgery are high and your hospitals are very well run,” said Dr. Summerskill. She has been most favourably impressed with her visit to the Otago Medical School and to note that the approach to disease was from the right angle — that of prevention. The training was very thorough and this was no doubt a vital factor in the low mortality rate. She had also been impressed with the conduct of confinement in hospital and to learn at the Queen Margaret Hospital that every woman in childbirth was given an anaesthetic irrespective of whether the case was normal or abnormal. “This is twentieth century approach to midwifery indeed,” she said. Dr. Summerskill described New Zealand’s dental nursing service as “ unique.” Dental hygiene was of primary importance, but no other country possessed the services of nurses trained in fillings and extractions.—A newspaper report. rough five years of war, conditions I have arisen which might menace New Zealand health seriously. Thousands of people have moved to the cities for war-production work, often to live in cramped and difficult conditions. Homes have been broken up as their menfolk have left for the Armed Forces. Hundreds of women and older persons not used to factory work have for the first time entered industry to work at high pressuremany in night shifts and with overtime hours. Rationing has been introduced. There have been shortages of some types of food, shortages of fuel for cooking and for heating. Doctors have

left their practices in large numbers for war service, leaving often only a skeleton group to carry on medical duties which the war has made more exacting than ever. For many people there is the constant emotional strain of war. How, in such difficult conditions, has our national health been keeping ? The answer appears to be surprisingly good. A study of vital statistics and medical reports shows a position that at least is satisfactory. If there has been deterioration m some directions, there has also been improvement in others. You have to be careful if you start looking at vital statistics. They can get you into trouble. For instance, with the discovery over the years of powerful curative drugs, increased medical knowledge, and improved methods of treatment, you imagine that people’s chances of living longer, their lives freer from disease, are better. To substantiate your ideas you study the vital statistics of New Zealand. With surprise you find the death-rate has been increasing for more than ten years. The explanation is not that the population is becoming less healthy, but that it is growing older. Immigration of people in early adult age has kept New Zealand’s death-rate perhaps the lowest in the world. Now these immigrants are passing into the older age groups. The deathrate, therefore, is increasing, and will continue to increase for many years. Also contributing since the war to the increased death-rate is the absence from New Zealand of many thousands of the healthiest young men. There is no need for worry —your chances of living to a greater age than your grandmother are improving with the passing of every day. After the last war the worst influenza pandemic (universal epidemic) of all time caused more deaths in many countries than the war itself. There were thousands more cases than hospital

beds. At times it was impossible to recruit enough able-bodied men to bury the dead. After five years of fighting, a time already longer than that of the Great War, there has been no such epidemic. New Zealand, with other countries, is taking every precaution to prevent the start and to kill the spread of a pandemic, always possible when people with resistance lowered are living closely together in difficult conditions.

New Zealand has had, though, an epidemic of cerebro-spinal meningitis which was the most severe in the country’s history. It followed a year behind a severe epidemic in Great Britain and the United States. In the Great War this disease flared up in New Zealand military camps and towns with high loss of life. In 1942 and 1943, the two years of the outbreak in New Zealand, the number of cases was the highest on record. But the case fatality rate was the lowest. Nowhere are the extraordinary advances which medicine has made in the last generation better shown than in the control of this infection. During the last war it killed between forty and fortyfive of each hundred persons stricken. To-day, thanks to the sulpha group of drugs, only about twelve of each hundred cases are fatal. The sulpha group of drugs, of which adequate supplies were obtained in New Zealand to meet such an emergency, have revolutionized the treatment of meningitis and reduced the danger of its complications. In other fields their miracle-working properties are as beneficial. Particularly effective is their use in the treatment of the streptococcal infections and of the pneumonias caused by bacteria. The death-rate has been halved. Virus pneumonia, however does not respond to sulpha therapy, and unfortunately has the effect of raising perceptibly the total mortality-rate from pneumonia.

Twenty years ago the maternalmortality rate in this country was more than five deaths for each thousand live births. Last year it was little more than two —if deaths from septic abortion are not included the figure is reduced to slightly more than one and a half. In spite of a higher birth-rate (and an increase in the number of first-born children, a group in which maternal mortality is always higher), the crowding of hospitals and other difficult conditions, the -work of saving mothers has, since the war, become even more effective. Last year such deaths were the lowest ever recorded in New Zealand. Here, too, the sulpha drugs have proved particularly effective, and together with the continuing of the obstetrical work of the medical and nursing professions are from year to year perceptibly reducing child-birth risk and infection. New Zealand has the lowest infantmortality rate in the world. Since the war the position has at least been maintained, and perhaps slightly improved. The figures for 1941 and 1942 actually are records. A great deal of the success achieved is from legislative and educative measures which are constantly being extended. New Zealand has a record to be proud —its methods to reduce infant mortality are being studied and adopted in other countries to an everincreasing extent. The control which has been gained over the communicable diseases of childhood has continued unabated. In the “ eighties ” New Zealand lost more than sixty children between the ages of one month and one year out of every thousand ; to-day the figure is less than ten. No longer is diphtheria the problem it once was. Measles, whooping-cough, and scarlet fever are still common, sometimes their outbreak causes alarm, but no longer are they such serious causes of child mortality. In building the health of her babies and children to such a high level New Zealand has led the world. The work will continue. War conditions have always provided fertile ground for the spread of tuberculosis. In the last war the gains made over the disease in the previous decades

were wiped out in many of the warring countries. New Zealand certainly was adversely affected. The figures of the present war years show a heartening contrast. In 1943 —our fifth year of war—deaths from tuberculosis reached a record minimum with less than four deaths for each ten thousand of the population. Fifty years ago the figure was more than twelve for each ten thousand of population, a rate which has been decreasing gradually during recent years. Since the war, however, the notifications of fresh cases of this disease have increased considerably. Conditions of war are only partly responsible. Medical examination of recruits for the Services has brought to light many cases that ordinarily would not have been discovered until they had reached a more serious stage. Also responsible for the increased notifications is the general practice, introduced in the last few years, of examining contacts of new cases. To determine to what extent the war is responsible for the increase in fresh cases is difficult, but, all things considered, it is more than likely that more active detective measures are responsible rather than war conditions.

Malnutrition in children in a country like New Zealand is surprising. It is also serious. Since the war, according to Health authorities, there has been a noticeable increase in New Zealand. There are several reasons. A greater lack of home control with fathers away with the Forces or else working long hours in industry. The result is more children on the streets, with less rest and less sleep. Many mothers have much of their time occupied with war work in factories, with less chance to give proper control and care. Some food costs, especially those of fruit and vegetables, have risen. Some types of food have been in shorter supply. These

are the reasons thought to be responsible for New Zealand’s wartime increase in malnutrition. Venereal disease, always a problem in time of war, gave alarm in the early years of the war. Returns of new cases caused concern, hospital departments were crowded. Even more serious was the number of persons who contracted the disease but who failed either to take medical advice or continue with treatment. Legislation giving the authorities wide powers of control was passed and, where necessary, used. To-day, the position is being held : it is certainly no worse, and there are signs of improvement. Analysis of the death-rate shows that there is an increase in the mortality from the diseases of middle life and old age. Cancer, heart-diseases, and other degenerative diseases are recording higher rates than ever before. But interpretation of the figures is needed. To a large extent the upward trend, which has continued for many years now, is caused by the growing age of the population —more and more people are passing into the age groups more affected by such diseases. For instance, the chance of ultimately dying of cancer is to-day probably no greater than it was fifty years ago-—but the fact remains that every year more people are dying of cancer. However, it is true to say that the medical profession has not yet been as successful in meeting the serious disease problems of old age as it has been with those of youth. This in itself is a reason more people die of cancer and heart-disease than fifty years ago —they are now saved from the epidemic and similar disease that took such high toll at the beginning of the century and live into age groups more affected by degenerative diseases. At present many thousands of our men are overseas fighting. When they return, especially from the tropics, it is possible they will introduce into this country diseases which at present are either non-existant or not a health problem. Already they are returning ; already steps have been taken that will meet the position. At present, for instance, the malaria-carrying mosquito

is not known in New Zealand. To guard against its introduction the Health authorities are working in close cooperation with the three branches of the Services. Quarantine regulations are rigorously enforced ; and all aircraft to come into the country are fumigated on landing. With such measures there is likely to be no danger. New Zealand’s birth-rate has increased, at least temporarily, a trend that has continued since 1935 (when fewer babies per thousand of the population were born than ever before). And this is important—the increase in the birthrate is not due to any marked increase in the number of first-born children. In 1938 first births accounted for 40-9 per cent, of the legitimate births. The percentages for the next three years are : 41-4, 41-7, and 40-2. Therefore, although the number of first births has increased considerably, the number of total births has increased to practically the same extent. Since the war the illegitimatebirth rate has increased, but only slightly.

Deaths and injuries from road accidents perhaps should not come under the heading of health, but as they contribute appreciably to our death-rate a summary of the present position will not be out of place. Not unexpectedly, because of the great reduction in the volume of traffic caused by war conditions, there has been an improvement —the number of fatalities in 1943 (which was 9 per cent, higher than in 1942) has decreased by more than 40 per cent, since 1939. Last year 145 persons were killed and 2,746 injured in road accidents in New Zealand. Many of the former general activities designed to reduce vehicular accidents have had to be stopped until after the

war, but the safety courses of traffic instruction for school-children have been

maintained and even extended. The effectiveness of this work is shown by the steady reduction in the numbers of school pupils injured (including killed) from 408 in 1938 to 106 last year — a reduction of nearly 75 per cent. It is hoped that, in addition to reducing the immediate accident-rate among juveniles, persistent instruction of the school-child will have a beneficial long-term result on the general road-accident rate in New Zealand. Taken as a whole, wartime health in New Zealand is at least satisfactory (especially when it is compared with other countries—Europe in particular). With the peace it will be better. Doctors who return from war service will be familiar with new techniques and remedies. Wartime developments in the use of blood plasma and in surgery and anaesthesia wdll help. And in increasing quantities there will be available such powerful curative drugs as penicillin, which in certain fields has proved more efficacious than the sulpha drugs. To-day penicillin is available in New Zealand hospitals, but only in small quantities to be used only as a last resort. After the war it will be produced in greater quantities and with the other drugs it may well be that before many years diseases which are dangerous to-day will be relegated to the position at present held by such diseases as smallpox and cholera — one-time medical problems of the world. Health programmes will be continued and intensified ; through the press and the radio education of the people will be carried on. Social security services, already in operation, will be of benefit to the people. New Zealand health will continue to be well served; it will continue to be as good as any in the world.