PUBLIC-HEALTH AND THE REFORMS - THE NEW-ZEALAND EXPERIENCE

The main aim of a national public health service is to conserve and im prove the population's health. The health service reforms introduced i n 1992 proposed the establishment of a Public Health Commission, which was to be responsible for health monitoring, public health policy adv ice and the purchase of public health services. These reforms, impleme nted in 1993, while emphasising a purchaser-provider separation also e armarked a budget for public health activities to be administered by t he Commission. Such protection of funding is unusual. Public health ac tivities span a wide range of measures to protect and promote health a s well as to prevent disease. Many of these measures have been, and wi ll continue to be, carried out at a local level. The results of some o f these measures are not usually seen in the short term. Improvement o f the population's health also requires proactive measures which are o utside the traditional health service. The demonstration of quantifiab le benefits to the public's health from such measures may require an e ven longer term. It is mainly in this area of activity, however, that the achievements of the Commission will be judged. Beginning with a sh ort summary of the history of public health services in New Zealand, t his paper looks briefly at the events that led to the establishment of the Public Health Commission, before moving on to describe its achiev ements to date, the challenges it faces and its impact on public healt h service provision. Based on such observations and an analysis of the strengths and weaknesses of the Commission, the paper attempts an app raisal of the public health function in the reformed health service, a function that will almost certainly be observed with interest in othe r countries. Certain ways of improving the public health function are outlined in the conclusions.