375
health system and "topping up" the government shortfall themselves, while the poor will be trapped in RHAs that provide only the most basic of care. Helen Clark calls it "the demolition of the public health system". "No one has to look after the service needs of the whole population", she says. She believes the fragmentation of the health system is being promoted to create a market so that "competing players fight it out to attract the funds of consumers". The magnitude of change, she says, "is unknown anywhere else in the world". Indeed, the rest of the world will be able to watch the outcome of the New Zealand experiment to create a health market out of a public health system with interest, if with a degree of disbelief.
public
Sandra
Coney
1. Simon
Upton, Minister of Health. Your Health and the Public Health. Wellington. 1991.
USA: Return of measles In pre-vaccine days, measles
cases in the USA used to After mass vaccinations started in year. the sixties, the number dropped, to a low of about 1500 by 1983. However, the goal of eradicating measles has now faded from view. In 1989 and 1990, epidemics broke out sporadically, particularly among black and Hispanic children of pre-school age, in the poverty-ridden inner cities of such metropolitan areas as Los Angeles, Houston, Chicago, Philadelphia, and New York. In New York alone there have been 15 measles deaths. The epidemics have subsided in recent weeks, but the Centers for Disease Control expects them back. Continuing importation of measles through Hispanic persons who are recent immigrants is a factor contributing to the outbreaks. Inevitably, the rising cost of paying for the vaccine to cope with these measles flare-ups has become an issue in Washington. The Public Health Service had asked President Bush to budget for an emergency fund for this purpose, but he demurred. He explained to a gathering in the White House rose garden in June that he was sending a team to six cities, instead, to "learn why kids aren’t getting immunised". Nevertheless, he has requested an increase in vaccine money, and the legislation to provide it is being debated in Congress. Maintaining supplies of vaccines for the municipal health programmes is not the only factor to be tackled. Identifying and vaccinating toddlers in poor families is another. "The principal cause of the measles epidemic is failure to deliver vaccine to children at the recommended age", says a report by the Government’s National Vaccine Advisory Committee that was published in January. "Although immunization levels are 97-98 per cent at the time of school entry, they are reported to be as low as 50 per cent among two-year-olds in some inner city populations." Persuading some of the parents of children even to allow vaccination can be frustrating in itself. In Philadelphia, the First Century Gospel and Faith Tabernacle Churches teach faith healing and forbid members to accept medical care. Nearly 500 measles patients-close to half the totalbelonged to this faith. 6 of the children died, and it took a court order to vaccinate 8 schoolmates of the same denomination. Parental resistance, however, is just part of the problem. The National Vaccine Advisory Committee says personnel in emergency rooms and public acute care units should be routinely vaccinating the children of welfare families and often do not.
average 500 000
a
Donald Henderson, associate director for life sciences at the White House and a former leader in the World Health Organisation campaign to eradicate smallpox, believes that many changes in the child vaccination programme are in order. He told Susan Okie of the Washington Post that the US record for vaccinating children aged two and under is probably worse than that in any country in the western hemisphere except Bolivia and Haiti. The resurgence of measles as well as whooping cough, he said, means that preventable infections, including poliomyelitis, may be making a comeback. J. B. Sibbison
Germany: HIV tests for health workers The Federal Health Minister Gerde Hasselfeldt enraged the medical profession by her response in an interview published recently in a glossy weekly magazine. When asked whether she could imagine the introduction of obligatory HIV-test for doctors, she replied that if doctors did not undergo tests voluntarily the Government would have to think about stricter regulations. The question had been prompted by reports from the United States of several patients having been thought to have acquired their HIV infection from a dentist, and where a new law had been introduced to make it obligatory for health workers who do invasive procedures to undergo HIV tests. Furthermore, there was at the time a bill going through the US Congress to imprison and fine health workers who undertook invasive procedures while knowingly infected. Dr Karsten Vilmar, head of the General Medical Council (Bundesaerztekammer) in Cologne, issued a press statement expressing strong opposition to obligatory HIV-tests for doctors and other health personnel and pointing out that a single negative test was of no value. Writing in a daily medical newspaper the president of the Surgeons Society, Dr Karl Hempel, similarly expressed his anger about the health minister’s remarks. He saw no reason why doctors should have to undergo an HIV-test if patients did not. Many people were thus surprised when the General Medical Council and the Federal Health Ministry in Bonn published a common statement on HIV-tests for doctors. It states that those doctors and dentists who might sustain bleeding injuries during their work should undergo HIVtests voluntarily. Those negative should be retested regularly, whereas those positive should not continue to do invasive procedures and that they should possibly switch to another field of medical practice. There should be accurate support for infected surgeons and dentists by the employers and the doctor’s organisations. Annette Tuffs
Medicine and the Law Sleepwalking, "disease of the mind"? Under English law, for a person to be guilty of a crime he must be found not only to have committed the act but also to
guilty intent (mens rea). Where the act was involuntary (ie, without will) he may be able to plead automatism. In ordinary (or sane) automatism the direction
have had
for the act comes from an outside force or cause such as the effects of a drug; in insane automatism the lack of intent is
health system and "topping up" the government shortfall themselves, while the poor will be trapped in RHAs that provide only the most basic of care. Helen Clark calls it "the demolition of the public health system". "No one has to look after the service needs of the whole population", she says. She believes the fragmentation of the health system is being promoted to create a market so that "competing players fight it out to attract the funds of consumers". The magnitude of change, she says, "is unknown anywhere else in the world". Indeed, the rest of the world will be able to watch the outcome of the New Zealand experiment to create a health market out of a public health system with interest, if with a degree of disbelief.
public
Sandra
Coney
1. Simon
Upton, Minister of Health. Your Health and the Public Health. Wellington. 1991.
USA: Return of measles In pre-vaccine days, measles
cases in the USA used to After mass vaccinations started in year. the sixties, the number dropped, to a low of about 1500 by 1983. However, the goal of eradicating measles has now faded from view. In 1989 and 1990, epidemics broke out sporadically, particularly among black and Hispanic children of pre-school age, in the poverty-ridden inner cities of such metropolitan areas as Los Angeles, Houston, Chicago, Philadelphia, and New York. In New York alone there have been 15 measles deaths. The epidemics have subsided in recent weeks, but the Centers for Disease Control expects them back. Continuing importation of measles through Hispanic persons who are recent immigrants is a factor contributing to the outbreaks. Inevitably, the rising cost of paying for the vaccine to cope with these measles flare-ups has become an issue in Washington. The Public Health Service had asked President Bush to budget for an emergency fund for this purpose, but he demurred. He explained to a gathering in the White House rose garden in June that he was sending a team to six cities, instead, to "learn why kids aren’t getting immunised". Nevertheless, he has requested an increase in vaccine money, and the legislation to provide it is being debated in Congress. Maintaining supplies of vaccines for the municipal health programmes is not the only factor to be tackled. Identifying and vaccinating toddlers in poor families is another. "The principal cause of the measles epidemic is failure to deliver vaccine to children at the recommended age", says a report by the Government’s National Vaccine Advisory Committee that was published in January. "Although immunization levels are 97-98 per cent at the time of school entry, they are reported to be as low as 50 per cent among two-year-olds in some inner city populations." Persuading some of the parents of children even to allow vaccination can be frustrating in itself. In Philadelphia, the First Century Gospel and Faith Tabernacle Churches teach faith healing and forbid members to accept medical care. Nearly 500 measles patients-close to half the totalbelonged to this faith. 6 of the children died, and it took a court order to vaccinate 8 schoolmates of the same denomination. Parental resistance, however, is just part of the problem. The National Vaccine Advisory Committee says personnel in emergency rooms and public acute care units should be routinely vaccinating the children of welfare families and often do not.
average 500 000
a
Donald Henderson, associate director for life sciences at the White House and a former leader in the World Health Organisation campaign to eradicate smallpox, believes that many changes in the child vaccination programme are in order. He told Susan Okie of the Washington Post that the US record for vaccinating children aged two and under is probably worse than that in any country in the western hemisphere except Bolivia and Haiti. The resurgence of measles as well as whooping cough, he said, means that preventable infections, including poliomyelitis, may be making a comeback. J. B. Sibbison
Germany: HIV tests for health workers The Federal Health Minister Gerde Hasselfeldt enraged the medical profession by her response in an interview published recently in a glossy weekly magazine. When asked whether she could imagine the introduction of obligatory HIV-test for doctors, she replied that if doctors did not undergo tests voluntarily the Government would have to think about stricter regulations. The question had been prompted by reports from the United States of several patients having been thought to have acquired their HIV infection from a dentist, and where a new law had been introduced to make it obligatory for health workers who do invasive procedures to undergo HIV tests. Furthermore, there was at the time a bill going through the US Congress to imprison and fine health workers who undertook invasive procedures while knowingly infected. Dr Karsten Vilmar, head of the General Medical Council (Bundesaerztekammer) in Cologne, issued a press statement expressing strong opposition to obligatory HIV-tests for doctors and other health personnel and pointing out that a single negative test was of no value. Writing in a daily medical newspaper the president of the Surgeons Society, Dr Karl Hempel, similarly expressed his anger about the health minister’s remarks. He saw no reason why doctors should have to undergo an HIV-test if patients did not. Many people were thus surprised when the General Medical Council and the Federal Health Ministry in Bonn published a common statement on HIV-tests for doctors. It states that those doctors and dentists who might sustain bleeding injuries during their work should undergo HIVtests voluntarily. Those negative should be retested regularly, whereas those positive should not continue to do invasive procedures and that they should possibly switch to another field of medical practice. There should be accurate support for infected surgeons and dentists by the employers and the doctor’s organisations. Annette Tuffs
Medicine and the Law Sleepwalking, "disease of the mind"? Under English law, for a person to be guilty of a crime he must be found not only to have committed the act but also to
guilty intent (mens rea). Where the act was involuntary (ie, without will) he may be able to plead automatism. In ordinary (or sane) automatism the direction
have had
for the act comes from an outside force or cause such as the effects of a drug; in insane automatism the lack of intent is
