Treatment delivery, not just discovery

Two stories in the Herald today have the related theme of health problems where we know the answer in theory, just not how to get it done in practice.

Prof. Norman Sharpe, from the Heart Foundation, describes NZ’s record on rheumatic fever as ‘shameful’.  I’d put it differently. NZ’s record on child poverty is shameful. The record on rheumatic fever is embarrassing.  Rheumatic fever is an anachronism. You couldn’t even put it in a soap opera nowadays.  It’s the sort of obscure historical disease that appears in ‘House‘.

Economic inequality is a major reason why the underlying infections spread widely in some subsets of Kiwi kids, but that isn’t the whole story.  The US and the UK have child poverty, but they don’t have rheumatic fever.  Rheumatic fever is an autoimmune reaction to untreated streptococcal throat infections.  Unlike many infectious diseases where antibiotic resistance is a problem, these streptococci are uniformly susceptible to ordinary penicillin. The cost to Pharmac of a 10-day course of penicillin is about $5,  but we obviously haven’t managed to set up an infrastructure that will reliably get the treatment to the kids who need it.

The other story had the slightly-misleading lead

Letting children out to play on their own could do a lot more to combat obesity, rather than structured exercise, a study shows.

The study actually looked about attitudes to ‘active play’ and ‘physical exercise’ in kids and families in a South Auckland school. The researchers found that ‘physical exercise’ was regarded as healthy, but active play was regarded as fun.  They suggest that encouraging kids to play outside in an unorganised way would be a more effective way of getting them to exercise.  We don’t know if this will actually work, but it is targetting the right part of the problem.  We know that exercise improves health, we just don’t know what to do to get people to exercise.

[Update: On Twitter, @dr2go says NZ isn’t an outlier.  That’s true for NZ as a whole, and the rates in Pakeha are similar to those in US whites.  I don’t think it’s true for Maori or Pacific children,  where the rates are higher even than US minority groups had in the 1960s (reference), and there’s been a big decline since then]