A rapid review identified 'gaps in governance, coverage and accountability' in tracking serious problems including heart disease and diabetes
The lack of a single national repository for health data was one of several gaps found in the country's public health surveillance regime.
Associate Minister of Health Ayesha Verrall, a former epidemiologist who has responsibility for New Zealand's public health systems, commissioned the review in 2021. An October briefing released to Newsroom under the Official Information Act shows "non-communicable disease (eg, cardiovascular disease and diabetes) and primary care activities have limited monitoring at a national level".
In public health, surveillance means collecting data and monitoring health determinants and outcomes.
Officials suggested that the reform of the health system and the creation of a new Public Health Agency will offer a chance to improve this record.
They also suggested pulling together a national surveillance directory which would list where information about different public health issues or objectives could be found and setting up "a dedicated surveillance advisory group with Māori and Pacific representation".
Verrall rejected the idea of a working group in handwritten comments on the document obtained by Newsroom.
"I am reluctant to have another 'blue skies' advisory group. Group needs to be engaged in operational practicalities or else its advice is useless."
The minister also expressed doubt later on in the document, when officials expanded on the possibility of an advisory group. "Really?" another handwritten annotation asked.
Verrall was more supportive of the second suggestion to create a national surveillance directory.
"The directory could help decision-makers to understand the scale of what is required, the gaps and where to allocate resources," officials wrote.
In a statement to Newsroom, Verrall said that "public health surveillance is an essential part of a well-functioning health system. The interim Public Health Agency has work underway to address surveillance, and will integrate the surveillance infrastructure that was developed for the COVID-19 response within the national system."
University of Otago epidemiologist Nick Wilson, a former colleague of Verrall's and one of the authors of a 2010 paper on designing robust public health surveillance systems, said the gaps identified in the paper weren't a surprise.
"It is stating the obvious, really," he said. "One of the reasons we did that study in 2010 on surveillance settings was because we were concerned about the general lack of strategic thinking and having a system approach to the whole topic.
"Everything seemed to be a bit ad hoc and bitsy, not integrated. Especially in a small country, you should be able to do these things pretty well."
The absence of a joined-up approach and the diffusion of responsibilities across a range of agencies was identified as an issue in the review.
"Overall, there is considerable public health surveillance activity being carried out by the public health sector. However, limited national public health surveillance leadership and coordination, alongside the lack of evaluation of existing surveillance systems, has led to gaps and inefficiencies in surveillance," officials reported.
"At the national and region levels surveillance methods are inconsistent, and communication and dissemination of intelligence does not reach key audiences in time."
Verrall asked officials for a list of "what concrete improvements can be made in the next 12 months". A second briefing released to Newsroom, dated November 25, offers examples of existing or proposed work programmes to improve surveillance systems. However, it acknowledges that non-communicable diseases which represent the leading causes of death in New Zealand aren't featured in the short-term options.
"Other than nutrition-related surveillance, the immediate activities in this briefing focus on communicable diseases," officials wrote. "Over the next 12 months, the longer-term approach to surveillance including surveillance of non-communicable diseases, will form a key part of the health and disability reforms."
The nutrition data will be hugely important when it comes through, Wilson said. Some of it will be sourced from New Zealanders' answers to questions about their dietary habits from the 2018 and 2019 New Zealand Health Surveys and the rest will come from a specially-designed national nutrition survey set to go live next year.
"Given the size of things like the obesity epidemic, things like the nutrition survey - the fact that they're now so out-of-date - is a bit of an indictment of the system," Wilson said. "The last one was 2009 for adults and it's nearly 20 years old for the child nutrition survey. Because obesity is going to drive things like diabetes and heart disease and cancer and the inequalities associated with those, that's another glaring example that the surveillance system hasn't been working."
Wilson agreed that the reset of the health system would provide a chance to do things better.
"The new Public Health Agency is a great opportunity to really upgrade surveillance. Especially if you can get a critical mass of public health officials and surveillance experts and biostatisticians and so on, all concentrated in that agency. And if it's well-resourced."
In her handwritten notes, Verrall made a similar point.
"As part of transition, technical surveillance ability must be brought in house," she wrote.
