“100% Pure” – Public Health Goal Setting

 

The “100% Pure” marketing of NZ is marketing hype and an easy target for UK tabloid journalists (see this NZ Herald piece). Nevertheless, there is a case for striving to achieve the “100% level” with certain threats to public health – for example, by achieving Smokefree New Zealand by 2025.

This blog suggests public health goals worth aiming for, through 100% elimination of a hazard or risk. Namely, tobacco, human papilloma virus (HPV), measles, and rotavirus.

New Zealand already has a few 100% elimination successes. It was quick off the mark with polio vaccination (the last polio case from wild virus in NZ was 51 years ago). It is one of the few countries to have eliminated brucellosis and also hydatids – a benefit to both the agricultural sector and human health. And more recently it spent $70 million to successfully eliminate the southern salt-marsh mosquito (a potential disease vector for Ross River Fever).

In other areas there has been the 100% phase out of leaded-petrol, the complete end to asbestos imports and an end to the use of ozone-damaging CFCs (chlorofluorocarbons). The country also has a world leading nuclear-free law that prohibits nuclear weapons in NZ territory.

We have two current national 100% goals that have been articulated by NZ policy-makers. The most well known is the Smokefree Nation by 2025 goal. But the path to achieving this goal is short on detail, and so a nice “100%” touch would be to have a law that actually prohibited all commercial tobacco sales in that year. Then any residual “smokers” would need to either grow their own tobacco or use highly regulated supplies of government-dispensed nicotine products.

Another 100% goal New Zealand has signed up to is the World Health Organization’s goal of regional measles elimination by 2012. Great progress in recent years has been made by the Government in increasing immunisation coverage – and so despite some measles outbreaks last year, this goal might well be achievable in the near future (albeit a little after the target date).

But what else should we have? A good candidate is to aim to become 100% free of rotavirus outbreaks by adding rotavirus vaccination to the childhood immunisation schedule. While an up-to-date cost-effectiveness analysis may need to be done, it is likely to be a worthwhile investment (based on a 2009 study). This is because the vaccine is effective and fairly low cost, and the disease is common and has widespread health societal impacts. These include working parents staying at home to care for sick children.

Another goal is to be 100% free of cases of cervical cancer in women born this century. This is achievable given the availability of HPV vaccination in NZ (which our analyses indicate is a cost-effective intervention in this country). But it could be delivered at much higher coverage levels (than the current 47% level) with some simple steps. For example, making it only available for 12-year-old girls at schools with no other free options (so as to reduce parental ambivalence). If the UK and various Canadian Provinces can get over 80% HPV vaccination coverage, so should NZ.

 

This is a health focused blog, but it is worth mentioning that the country could also go for 100% goals to protect the environment – which, let’s not forget, is probably the biggest long-term issue for public health. Possible candidates are Sir Paul Callaghan’s goal of a predator free NZ (see him discuss it on YouTube). While eliminating some exotic pest species will be a major challenge, eradicating wild deer (as is proceeding in Northland) may be reasonably feasible start. Another goal might be to achieve 100% renewable energy generation for NZ, like Iceland and Norway have done.  Also to have the national vehicle fleet being 100% comprised of a mix of hybrids or electric-powered vehicles by 2050.

Given New Zealand’s historical successes with achieving the 100% elimination of some hazards, it is timely for a bit of fresh and visionary thinking by Kiwi political leaders

For further information:

Wilson N, Baker MG. Celebrating 50 years of polio elimination in New Zealand: but inadequate progress in eliminating other vaccine-preventable diseases. N Z Med J. 2012 Nov 9;125(1365):67-74.

Wilson et al. Lessons for Zoonotic Disease and Vector Eradication – from past success in New Zealand. http://www.otago.ac.nz/wellington/otago024538.pdf