Doctors fear Govt instruction means they can’t talk freely about public health issues

by Glenn McConnell

Public health doctors are worried the government is trying to suppress their expertise - raising alarm about what they’re describing as “overreach”.

Medical officers of health have legal obligations to analyse how issues, such as alcohol policy, will impact health in their regions. These officers are trained doctors who have specialised in public health.

On Tuesday, doctors spoke on condition of anonymity to raise their concerns after a meeting earlier that day with the National Public Health Service director, Dr Nick Chamberlain.

He told those doctors that any advice they wanted to offer about issues in their regions needed sign off at a “national level”.

Doctors said his comments, as well as other comments from Health Minister Simeon Brown, and cuts to public health teams, were having a “chilling effect”.

Brown said he wanted medical officers of health to stop writing about issues such as fast food and “leading advocacy campaigns” on public health issues. Instead, he said their focus should be on “technical advice” and immunisation campaigns.

Labour health spokesperson Ayesha Verrall said the minister was attempting to “censor” public health experts.

Public health doctors have expertise in how social and environmental issues can impact the health of a population. They also offer expertise in how the policies of central and local government will improve or harm health.

But the latest rules from Te Whatu Ora / Health NZ, telling them any public comments need a “national level” approval, is raising concern that they won’t be able to effectively serve their communities.

In the past, medical officers of health have spoken often to media, councils and other groups about the issues they have identified.

Chamberlain held a meeting with medical officers of health on Tuesday. His comments during that meeting quickly sparked concern.

He explained what happened: “I took the opportunity at a regular medical officers of health meeting today to simply outline the process around council submissions going forward.

“I reminded them that all potential local or regional technical advice is to continue to be reviewed and approved at a national level before they can be submitted.”

He also confirmed that, as Stuff was told, there had been questions about whether Te Whatu Ora and the government had the legal ability to put in place that sign-off process. For example, the Alcohol Act imposes an obligation on medical officers of health to “inquire” and make submissions.

Those working in public health described a “chilling” environment, where doctors were trying to keep their heads down as cost-cutting continued.

Sensitivity around speaking out was detectable on Tuesday, when Stuff started asking questions about the meeting.

Minutes after contacting one respected public health expert to ask if they knew about any changes being made, a senior media advisor was in touch from Te Whatu Ora HQ.

And within an hour of that message being sent to the doctor, the health minister’s office was in touch to say they’d heard Stuff has been asking some questions.

But none of those on the ground felt comfortable speaking on the record, out of fear for their jobs.

The union for specialist doctors, the Association of Salaried Medical Specialists (ASMS), said any attempt to limit the ability for these doctors to speak publicly would be a breach of contract.

The collective contract included a provision protecting doctors’ ability to offer their professional expertise and advice in public.

Brown said he was fed up with seeing doctors giving advice on issues such as fast food restaurants.

Referencing the Wānaka McDonald’s issue, which saw a medical officer submit against the resource consent for another branch of the burger giant to be built, Brown said: “Writing submissions opposing a fast-food restaurant in Wānaka, as Health NZ did last year, is not what New Zealanders expect from their health service.”

“My expectation is that Health NZ should prioritise delivering healthcare services over engaging in broader advocacy efforts. This includes the National Public Health Service which should be focused on improving immunisation rates and tackling key health challenges, rather than weighing in on where fast-food outlets should be located,” he said.

Brown said medical officers of health had an “important role in providing local technical advice”, and that would continue.

“However, their role is to offer expert guidance, not to make policy decisions or lead advocacy campaigns,” he said.

But Verrall, the former health minister, said the minister shouldn’t be getting in the way of experts doing their jobs.

“Historically they have been able to make submissions on areas where their expertise is relevant. This is a step backwards for New Zealand,” she said.

Verrall said it appeared the government was censoring experts’ opinions and raised concern about how that could impact New Zealanders’ health.

“New Zealand will be better off when there is open debate about health risks. He should not be suppressing information about public health,” she said.

“Medical specialists employed in all fields of the health system have a right to speak out.”

She said health experts - like academics and educators - had a right to offer their expert opinions, and should not need sign off from a public service headquarters to speak publicly.

- Stuff