Hague Kevin: Budget Debate 
Hague Kevin: Budget Debate 
[Volume:663;Page:11527] 
KEVIN HAGUE (Green) 
: 
 Talofa lava. Malo le soifua. In the days since the Budget the Government has been attempting to defend its treatment of health by expressing health spending as a proportion of GDP. This defence is suggestive of a more fundamental issue. In the relationship between the economy the environment and society this Government—and many before it to be fair—have put the cart before the horse. Protection and restoration of the environment and a fair and just society are not just “nice to haves” if it suits the economy. Rather they are the goals that we have an economy for in the first place—or at least they should be. 
Surveys in New Zealand and elsewhere routinely show that when people are asked about what is most important in life and encouraged to think before answering most people say they believe that happiness health and a future for our kids are the most important and that monetary wealth ranks quite a long way down the list. That suggests that education and health services along with other services geared to meeting our greatest needs and to what we really believe is important should be the central targets of the Budget. Instead this is a Budget that has at its centre big tax cuts for the already rich a continuation of the Government’s orgy of apparently boundless spending on motorways and big subsidies to encourage more pollution. 
The Government is funding this low-quality spending by increasing borrowing from overseas by widening the gap between the haves and have-nots and by underfunding core Government services. As Russel Norman said in his speech on Budget day this is a Budget of deficits: fiscal environmental and social and above all there is a deficit of vision. The Government has cynically calculated that New Zealanders will be blinded by what for most will be a small income tax cut so will be less able to see the increase in GST the steady erosion of Government services and above everything else the fact that the tax cut will be paid for by our children in the future. 
I have spoken several times in this House about the relationship between poor health status and marginalisation. Ill health injury and early death are not randomly distributed but are clustered in communities either geographic communities or communities of identity that are dispersed right through society as well as in communities that are marginalised by poverty or by discrimination. Poor housing poor educational and social welfare outcomes and crimes are also clustered in precisely those same communities. This is a Budget that will increase poverty and will therefore increase ill health. 
I am talking about not only absolute poverty but also relative poverty. Both are strongly associated with adverse health outcomes which is an extremely well-established finding at the international level. For example the World Health Organization convened a Commission on Social Determinants of Health which reported last year on what would be required to meet the aspirational goal of achieving health equity within a generation. It stated: “Social justice is a matter of life and death. It affects the way people live their consequent chance of illness and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others. A girl born today can expect to live for more than 80 years if she is born in some countries—but less than 45 if she is born in others. Within countries there are dramatic differences in health that are closely linked with degrees of social disadvantage. Differences of this magnitude within and between countries simply should never happen.” I continue to quote from the report: “Social and economic policies have a determining impact on whether a child can grow and develop to its full potential and live a flourishing life or whether its life will be blighted. Increasingly the nature of the health problems rich and poor countries have to solve are converging. The development of a society rich or poor can be judged by the quality of its population’s health how fairly health is distributed across the social spectrum and the degree of protection provided from disadvantage as a result of ill-health.” 
This same connection between social and economic disadvantage and ill health has been established strongly in New Zealand research too. I think of the work led by Professor Tony Blakely on the 
 Decades of Disparity 
 for example or Dr Jamie Pearce’s work demonstrating dramatic differences in health outcomes depending on wealth. Pearce concludes: “If policy makers are committed to reducing health inequalities then more redistributive economic policies are required.” 
But we have a Minister of Health and a Government that have removed the goal of reducing health inequalities. It is beyond dispute that this Budget will widen income inequalities and thereby exacerbate existing health inequalities which will produce overall worse health outcomes especially for the poorest citizens but in fact overall as well. It is simple mathematics that those on the lowest incomes will at best be no worse off—at least to begin with because once inflation kicks in those extra few dollars will be cold comfort—while those on the highest incomes will be substantially better off. So if we believe that good health is indeed one of the goals for our society then this Budget will take us further from it. Good health services are essential for good health outcomes of course and can help to mitigate the ill health effects of marginalisation. 
Now for the second year running the Government has cut the funding for Vote Health in real terms. I have heard the Minister deny that but his denial was half-hearted and his mathematics does not stand up to the slightest scrutiny. Indeed even in his own media release to accompany the Budget he says that the $512 million increase “will help protect our public health services in real terms against inflation and fully fund population growth.” In other words the funding increase will not be adequate to cover population growth and inflation let alone the ageing of the population that is driving demand. What is more a substantial proportion of that $512 million is not even available for increasing costs and increasing demand because it has been earmarked for new services. The New Zealand Council of Trade Unions and the Association of Salaried Medical Specialists have calculated that the sector will need at least an increase of $555 million just to stand still. 
Although the Budget documents are written to maximise opacity it seems clear that the sector will be at least somewhere between $100 million and $160 million short of this target in the first year at least. This means that we will see more services slashed in order to deliver Tony Ryall his balanced budgets. If we were to hazard a guess at where those cuts can be expected then the first places I would look are those areas of the sector that used to have targets but no longer do: public health diabetes management mental health services dental health and home-based support services for older people. It is the same old trick; although the Minister trumpets new money for more elective surgery new machines and new expensive drugs these will all be bought by savage cuts to the community-based services that actually make the biggest difference for most people. 
Dr Gareth Morgan in his book  
Health Cheque 
 identifies public health services intended to keep people well as services requiring more investment because they provide by far the best health gain for money. He conversely identifies the more specialised end of the services spectrum—where massive resources are used to prolong life by short periods often with very low-quality—as the area we need to look at if we are to live within a constrained Budget. The problem with Mr Morgan’s rational approach with which I agree is the 3-year electoral cycle and in this Government’s world view dominated as it is by the immediate over the important that makes these services the prime targets for cuts. 
In conclusion I tell members that I do not know how many community-based mental health services or diabetes checks will pay for the Minister’s new positron emissions tomography scans but our children will certainly know. Fa’afetai soifua.