Social networks key to improving health in NZ

Turning
conventional thinking about health and healthcare on its
head by championing social networks is vital if New
Zealanders want to improve their health outcomes, and
ultimately save the nation money, says a leading public
health expert.

Pro Vice-Chancellor of the College of
Health Professor Paul McDonald spoke to members of the
Auckland Regional Public Health Service, which provides core
public health services across three Auckland district health
boards.

“The old way of thinking just doesn’t
cut it. Most people think significant public health
challenges — heart disease, cancer, diabetes and related
risk factors like tobacco use and obesity — are medical
problems with social fallout. But in reality, they are
social problems with medical consequences.

“What if we
thought about heart disease, stroke, cancer, respiratory
disease, type II diabetes, and certain types of mental
illness as ‘communicable’ conditions which are spread
through social, cultural, economic, and political systems
— rather than spread principally by viruses or
bacteria?”

Professor McDonald says the emphasis needs to
shift from personal lifestyle “choices” and individual
primary care clinical treatment to collective
responsibility. “Only then will we be able to alter the
transmission systems and carriers of disease through
economic policy, employer practices, exposure to media, and
exposure to health-enhancing products,” he says.

“NZ has higher rates of income inequality than the
OECD average. 15 percent of Kiwis live in poverty. And when
it comes to our children, it’s not good news. Nearly 20
percent of children in this country aged 15 and older do not
have enough contact with family and friends. 16 percent felt
lonely in the past year. Nearly one in four of those aged 15
and older have low levels of trust in others.

“For
adults, there are similar worrying trends. People who smoke
also have high body mass indexes (BMIs). They are sedentary,
prone to depression and anxiety. And they’re marginalised
from mainstream society so they tend to cluster together
which only exacerbates their challenges. Let’s stop
blaming individuals. Let’s accept that we have failed them
as a society and that we all collectively must work together
to solve these problems. That’s what it will take to
improve health and wellbeing for not only this generation of
New Zealanders but for those to come.”

Professor
McDonald says classic epidemiological models have
misunderstood and under-estimated the important of social
influences by reducing it to the notion of social support.

“Research now tells us that smoking, obesity, as well
as smoking cessation and obesity reduction are a consequence
of complex social networks. This means people we don’t
know – total strangers – may be powerful and
as-yet-unexplored sources of future public health
intervention. It’s far more effective at making us
healthier than running to the doctor.”

Professor
McDonald says this radical topsy-turvy approach will not
only improve the health of all Kiwis and fundamentally
reduce illness and disability in the long term, it will also
cost less and save New Zealand taxpayers a lot of
money.

“One American study found increasing public
health measures saved $596 billion and 4.5 million deaths
over 25 years. This compares to an extra cost of $1.1
trillion for traditional preventative and chronic care to
save 3.4 million deaths.”

Professor McDonald has worked
extensively in tobacco reduction, and says, typically,
nicotine addiction is “managed” by pushing more
pharmaceuticals and referring people to medical
professionals. “But these efforts are expensive and only
marginally effective at a population level compared to
alternative approaches.”

He has a better solution —
certainly for younger smokers. “I found that being
connected to your community is highly related to whether
young adults smoke or try to quit. While still important for
seniors, connectedness plays less of a role in smoking
status.”

Professor McDonald says we need to focus
interventions on those ‘friends of friends’ who have
made recent changes, to surround young people with a large
group of stable low-risk people. And the burgeoning world of
social media is a great place to start to change unhealthy
behaviours. “Use Facebook and other virtual tools to
induce social contagion,” he says.

A study in 2012
changed voter turnout among 61 million people by encouraging
people to tell their Facebook friends whether they had voted
yet. This is a classic example of how powerful changing the
dynamics of networks can affect large groups of people –
rather than targeting individuals at risk.

“We need more
collective actions that harness the power of networks to
make NZ healthier and happier.”

A 2013 study indicated
improvement in social cohesion and reducing poverty were
each more than twice as powerful in reducing disability and
chronic disease among Canadian adults compared to primary
care or health behaviour interventions.

“There’s an
election on and this is something all politicians need to
address. Voters need to ask: Why are all the political
parties trying to outbid each another in the health sector?
It will cost us hundreds of millions of dollars in the
coming years and the reality is we just don’t have it. But
if they opt to back social interventions rather than pouring
money into increasingly costly medical care, they would
profoundly improve health and wellbeing across the country
at a much lower cost.”

Professor Paul McDonald is the
Pro Vice-Chancellor of the College of Health at Massey
University. He is an internationally recognised researcher
and scholar, his work informs public health policies,
programmes, and human resource capacity. His most recent
work explored building human capacity and complex planning
models for public and population health. Professor McDonald
holds a PhD in Health Studies (population health).

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