Category Archives: Health

Research and Destroy

Studies of race relations are sometimes used to bolster prejudice, not reveal the truth.    Listener: 10 February, 2007.     Keywords: Health; Maori; Social Policy;    Don Brash’s January 2004 Orewa speech may have been a key event in New Zealand race relations. The earlier foreshore and seabed decisions had stirred a restlessness about…
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Economic Impacts Of Alcohol-related Problems

  Paper for the conference “Alcohol: Evidence-based Impacts and Interventions”, sponsored by the Center for Alcohol Studies, of the Health System Research Institute and the Department of Mental Health, Ministry of Public Health, Thailand, held 13 -14 December, 2006 in Bangkok.   Keywords: Health;   This paper is dedicated, with affection and respect, to the…
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Is the New Zealand Health System Spending Enough on Pharmaceuticals?

New Zealand Future Medicines Policy Summit, 29-30 May, 2006, Wellington

Keywords: Health;

My task is to set out briefly the issues that this panel of economists has been asked to address: whether the New Zealand health system is spending enough on pharmaceuticals. I’ll divide the answer into two. Is New Zealand spending enough on health care? Is New Zealand spending enough on pharmaceuticals in the health budget?

Can We Improve the New Zealand Health System?

Keywords: Governance; Health;

Discussions on the effectiveness of the health system need to separate out the funding from the provision. The Labour Government has poured a lot of money into the public health system in recent years (the boost actually began earlier under the National-NZF coalition government in 1996), and it has been disappointed by the results. It has concluded that there is something wrong on the providing side.

Health Status and Income Inequality

This version was revised in March 2006.

Keywords: Distributional Economics; Health;

Introduction and Summary

This paper brings together some recent research about the relationship between health status and income inequality. It focuses upon a set of propositions which challenge the conventional wisdom. They are:

1. That in a rich country poverty – low material standard of living – probably does not directly impact on health, but does indirectly through stress which income differences generate.

2. The increase in household inequality in the period of the late 1980s and early 1990s was more due to changes in tax, benefit, and government spending policies than it was due to market liberalisation. However, the market liberalisation increased stress on New Zealanders.

3. There is some evidence that income inequality may be increasing, due to factors such as globalisation and technological change.

4. The most common poor New Zealand household is a couple with children who are of Pakeha ethnicity, who own their home (usually with a mortgage), and who depend upon wages for their main income. There are other groups who have higher incidence of poverty, but because they are smaller they do not involve as many people. This means that effective poverty eradication involves working on a broad front rather than targeting minority groups.

5. Illness does not correlate well with income, unless age is controlled for. The sick in New Zealand are the elderly, although the paper goes on to argue that policies aiming to reduce poor health in the long term need to target those with low incomes and low in the socioeconomic status hierarchy.

Alcohol – Socioeconomic Impacts (including Externalities)

Draft for “The Encyclopedia of Public Health”

Keywords: Health; Regulation & Taxation;

Depending on the cultural context and particular circumstances, the same drink of alcohol can generate a feeling of benign prosperity, or moroseness, or stupor. The immediate health benefits for the individual may also be benign (or even beneficial), or the drink may result in injury or death – in the short run from accident or in the long run from one of the diseases alcohol can precipitate. The consequences for others may also be benign or beneficial, or damaging or mortal from violence or collateral accident. Someone may be born as the result of intentional or unintentional impregnation. The loss of production due to poorer workplace productivity or non-attendance from drinking alcohol may cause financial loss to the drinker and possibly to others. Among the many sectors of the economy alcohol may, or may not, especially generate additional costs in the criminal system, in the health system, and in the transport system. The national budget probably gains from the specific tax it levies on alcoholic beverages, but these levies may, or may not, cover its costs from the consumption of alcohol.

New Zealand’s Pharmaceutical Policies: a Fresh Look

This report, commissioned by Pharmac, reviews the report by Castalia Strategic Advisers New Zealand Pharmaceutical Policies: Time to Take a Fresh Look.   Keywords: Health;   INTRODUCTION   In August 2005, Castalia Strategic Advisers, published a report New Zealand Pharmaceutical Policies: Time to Take a Fresh Look. The report was commissioned by Pfizer New Zealand…
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Heart Gains: David Hay, Pioneer Cardiac Physician

Listener: 24 September, 2005.

Keywords: Health;

Although we think of lung cancer as the disease of tobacco, the weed is associated with other cancers, with respiratory disease (such as emphysema), and with heart and circulation conditions (cardiovascular disease). Not only do the chemicals in tobacco smoke trigger mutations within cells that lead to cancer, and damage the lungs, but they also stiffen the walls of the blood vessels. That requires the heart to work harder, so smokers are more prone to coronary heart disease (CHD) and stroke. Stopping smoking is the best way of preventing heart disease.

Further Developments in Estimating the Social Costs Of Substance Abuse


The views in this report on the Avoidable Costs of Substance Abuse Workshop (Ottawa June 21-22) are my own and do not reflect those of the others involved. It focusses on issues particularly pertinent to New Zealand. The paper was presented to a seminar of officials on 7 August, 2005. Comments Welcome [1]

Keywords: Health;


This report is on The Avoidable Costs Workshop held in Ottawa, Canada June 21-22, under the sponsorship of the Office of Research and Surveillance, Health Canada (Bureu de la rechercher and de la surveillance, Sante Canada).

Developing International Guidelines for Estimating Avoidable Costs

By David Collins and Helen Lapsley: Remarks on the Draft

Workshop on Guidelines for Estimating the Avoidable Costs of Substance Use and Abuse, sponsored by Health Canada, June 22-23, 2005, Ottawa.

Keywords: Health;

Thankyou for the invitation to attend what is proving to be a very interesting seminar in, if I may so, a pleasing and attractive city. As one would expect, David Collins and Helen Lapsley have contributed a valuable paper, albeit as they insist, a preliminary draft.

Globalisation and the Public Health

For Annual Conference of the Royal Australasian College of Physicians, 10 May 2005.

Keywords: Globalisation & Trade; Health;


The Royal Society of New Zealand has awarded me a grant from the Marsden Fund to study globalisation. The ultimate output will be a book. Today I want to set out the economists’ framework for thinking about globalisation, and to use it to consider the problem of alcohol control and the interaction between countries.

The Gains from Reducing Waiting Times

Paper to the Wellington Health Economist’s Group, 21 April 2005.

Keywords: Health;


This paper demonstrates that there can be substantial health benefits – as valued by economists – from reducing waiting times, far more than from the single earlier treatment necessary to get the reduction underway. For while the individual benefits from the treatment, all those that follow her or him also benefit from earlier treatment even though no additional resources are necessary.

Medical Misadventures: Should Patients Be Compensated for Managerial Failure?

Listener: 26 February, 2005.

Keywords: Health; Social Policy;

An earlier column Accidents Will Happen (April 17, 2004) commended the proposed change in the ACC compensation criteria from medical error (which involves fault) and medical mishap (with a rare and severe outcome) to the situation where unexpected treatment injury occurs. The column worried that the opportunities the new scheme promises for prevention might be overlooked. I gather the ACC is instituting a programme to improve the medical safety cultures of health professionals. Great. As the column concluded, the biggest gains from the reform may be that there will be less medical misadventure.

Taxing Alcoholic Beverages in New Zealand

Revised Version of Paper for “Thinking Drinking: Achieving Cultural Change by 2020″, Melbourne, 21-23 February, 2005.

Keywords: Health; Regulation & Taxation;

I thought a useful contribution would be to describe the recent history of alcohol taxation in New Zealand, explaining the principles underlying the changes and discussing some unresolved issues.

Compensating for Waiting Time Failures

Submission to the Select Committee on Health In Regard to the Injury Prevention, Rehabilitation, and Compensation Amendment Bill (2004, No 3) by Brian Easton and Alan Gray.

Keywords: Health; Social Policy;

Summary of Submission

We support the general approach of the Bill to remove the notion of fault in medical misadventure and to extend rehabilitation and compensation to all those who suffer treatment injury. However, we do not believe there should be any exemption for treatment injury as a result of resource shortages. This is inconsistent with the Bill’s general principles.<

The Gains from Reducing Waiting Times

There is an accompanying letter A Strategy for Dealing with Excessive Waiting Times.

Keywords: Health;

This note has a simple purpose: to demonstrate the gains from reducing waiting times are somewhat larger than they might at first seem: an economic evaluation of the benefits reducing waiting times is likely to suggest there are very high returns. Essentially this arises because while a shortening of waiting times may appear superficially to benefit just a few people – the numbers in the backlog which are treated – all the subsequent patients are benefited by the shortening of the waiting times. Thus there is a spectacular multiplier from reducing waiting times which makes the gains for the outlay to reduce the backlog far larger than they at first seem.