Fifteen years of looking after public health

Retiring Southern District Health Board medical officer of health Marion Poore.PHOTO: PAUL TAYLOR
Retiring Southern District Health Board medical officer of health Marion Poore.PHOTO: PAUL TAYLOR
Southern District Health Board medical officer of health Marion Poore retired from the SDHB yesterday. She spoke to health reporter Mike Houlahan about a life’s
work devoted to community health.

Marion Poore's time with the Southern District Health Board has certainly been diverse: she began by implementing plans for a potential national pandemic and is leaving 15 years later after finishing a project on provincial housing development.

In between, in her role as medical officer of health, Dr Poore has been in the public eye on issues such as water quality, alcohol sales and vaccination.

The medical officer of health's role is about maintaining and improving the health of the community, and as a result that meant anything and everything could end up on her desk.

"I think at the start of a career you aren't really quite sure what you are letting yourself in for, but looking back I have to say it has been an incredibly rich experience with many different facets to it," Dr Poore said.

Dr Poore, who did both her initial medical training and a subsequent masters in public health at the University of Otago, came to the SDHB after 15 years as a GP in Pukekohe, south of Auckland.

However, her role began with a secondment to the Ministry of Health in Wellington to work on the national response to severe acute respiratory syndrome - a potentially fatal disease which had broken out in Asia and which was believed to pose a major public health risk worldwide.

"That was quite a challenge for this country and really highlighted the need for a whole of system response to health emergency situations and resulted in a much more joined-up process being developed over time.

"That will no doubt stand us in good stead for future disease outbreak situations"

While Dr Poore did not face a disease outbreak on that scale while with the SDHB, incidents of notifiable diseases such as measles and meningococcal disease have required her to dispense information and public health advice to the community.

The recent rash of measles cases in particular has highlighted issues around vaccination coverage.

In general the South did well, with around 92% of children having up to date vaccinations, but there were gaps in the older population, Dr Poore said.

"There does seem to be a view that vaccination is not necessary and can cause problems for people's health, but there is very good evidence that vaccination is an extremely effective way of preventing disease and in particular of preventing death and long term consequences of getting a disease that can be vaccinated against.

"We have to keep making sure our messages are relevant, timely, and reaching the people who perhaps need to have a little bit more conversation or understanding on whether they are going to choose to vaccinate their child or not."

Vaccination, like many areas of health, can be controversial.

In her role, Dr Poore has dispensed the best mainstream medical advice available, but she has on occasion incurred personal criticism.

Vaccination and water quality have been two highly controversial areas, and during the dispute over West's Ltd's bid for an alcohol sales licence, the drinks firm's owner accused Dr Poore of making a "full-scale assault" on the company.

"I guess that's part of the job. I certainly didn't take any of that personally," Dr Poore said.

"I had a job to do administering the sale and supply of alcohol act and we went through the appropriate process and the result came out as it came out."

Dr Poore is also often involved in the patient complaint process, another fraught intersection between the community and health professionals.

While the complaints process could be protracted and difficult for all parties, it was an important part of the health system, Dr Poore said.

"I think it is important to listen carefully to the voice of the people who are expressing their anger often, or their concern with a service that they have received or not received, or things have gone wrong.

"We need to listen and we need to understand them, investigate them thoroughly, and learn from them, because my experience has been that in every one of these kinds of situations there is something we can learn which results in a stronger system or a better way of doing things.

"I think it's good when people bring forward these concerns about a system."

While the south of the South Island was a marked contrast from Pukekohe, Dr Poore said many of the issues she encountered there - notably inequality - informed her work for the SDHB.

"I saw first-hand the adverse impacts of inequities in housing, in having jobs and not, and the consequences of that for families."

Those concerns have endured and informed the final large piece of work Dr Poore has carried out for the SDHB, an examination of housing quality, urban development, and their associated impacts on physical and mental health.

"We have started on a programme of work to address housing quality and shortages, but also to link that to the issues of air quality which are experienced in some of Otago's towns, but also in Invercargill and Gore ... it is a problem which is perfectly possible to solve, but very complex in that living in cold homes is not good for your health, and going out into really smoky air is not good for your health, either."

The SDHB has worked with a range of organisations and local authorities on the project, which Dr Poore hoped would herald "a much more joined up approach" to the issue.

Dr Poore's final day was yesterday.

She plans to take time out with family before looking at opportunities in the environmental and governance areas.

"I feel very positive about future and [am] looking forward to it."

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