Arts & Social Sciences
Te Kura Kete Aronui

Abstract

Goodwin, L.K.P. (1997). The public health commission.

This study is a 'retrospective' process evaluation of the Public Health Commission (PHC), which was an integral feature of the National Government's 1993 health reforms. The PHC was set up as a Crown entity, separate from the Ministry of Health, with the statutory objective "to improve and protect the public health" (Health and Disability Services Act 1993, p.7). For the first time in New Zealand's history, public (population based) health was given a separate standing from sickness and individual treatment services. A pool of experts committed to public health were brought together, to carry out the three main functions the PHC was assigned to undertake. These were to:

• monitor the state of the public health and to identify public health needs
• advise the Minister of Health on matters relating to public health
• and purchase, or arranging the purchasing of, public health services (Health and Disability Services Act 1993).

The primary focus of this study was to elucidate the viewpoints of Midland public health workers at Crown Health Enterprises (CHEs) and the Regional Health Authority (RHA), on the three main functions the PHC was assigned to undertake, during its short two year history. Secondly, to provide an insight into the perceptions of public health workers, of the future of public health in New Zealand, in light of the disestablishment of the PHC. Fourteen key informant interviews were carried out and extensive archival research was undertaken to provide a broad contextual base to this research.

Results indicated that the PHC had successfully raised awareness of public health issues and gave public health a focus, on a national level, that was strategic in direction. The strengths identified of the PHC's policy advice was that their advice was independent, they consulted widely, and produced high quality publications, and that that advice was accessible to the public. The PHC's purchasing function was identified as it's weakness, due to one yearly contracting rounds which were a protracted process, and required a large amount of paper work. Health protection officers also identified that the unclear boundary between the PHC and the Ministry of Health, and no standardized monitoring system in health protection, further compounded this. However, a strength of the PHC's purchasing arrangements was that it provided clear guidelines of what services were required. Two key issues dominated public health workers viewpoints of the future of public health, firstly the dangerously low level of funding in public health to effectively provide the services required, and secondly, that public health services need to be pulled out of CHEs. To protect public health funding, reduce the conflicts of interest, increase public visibility and to work towards greater co-ordination of public health services. Recommendations are forwarded, as a result of participant viewpoints. This research also discusses the need for future research in public health, and an array of suggestions is provided.