Harm reduction go-slow

New Zealand’s slowness to act on health harms was on show last week.

There was some good news for those who have been advocating for better community input into liquor sales with the passing of an amendment to alcohol laws introduced in 2012. This will hopefully make it much harder for big booze to hold up the setting of local alcohol policies by councils specifying hours of sale and the number and location of alcohol outlets.

It is a long way from a comprehensive regime to reduce alcohol harm, but it is a step in the right direction.

The other good news was director-general of health Diana Sarfati’s announcement of a pause on the use of surgical mesh to treat stress urinary incontinence in women.

Since there have been concerns raised about the safety of this procedure here and overseas for at least a decade, it is difficult to understand why a more cautious approach to this was not taken much earlier. The argument that some women were fine after having this surgery should never have been used as a reason to ignore that for many others the results of it were debilitating. It is a little like saying smoking tobacco is OK because it does not kill everyone who does it.

As those advocating for banning the procedure point out, in some women it might take decades for problems to surface and much more needs to be done to assess the long-term impacts.

Dr Sarfati has made it clear the "time-limited pause" is not a ban and it may be possible for the procedure to be carried out if a multi-disciplinary team agree there is no viable alternative. Any use would only happen after extensive consultation and review. We would hope this will be properly monitored. It is not clear why no specific time was given for the pause, something which might have been helpful to those women waiting for treatment. Up to a year has been suggested.

This is to allow for tailored training and certification for surgeons performing the procedure, establishing a registry of all patients who could benefit from it, reviewing patients and the decision to carry out the procedure at multi-disciplinary meetings, and using a structured and guided informed consent process for patients. It would be good to see this pause time also used to gain greater understanding of whether there needs to be more surgical training involving alternatives to using mesh.

Another known harm where authorities have been dragging their feet to do anything meaningful was in the news last week — that involving workers’ exposure to crystalline silica in the engineered stone industry and their risk of developing the potentially fatal disease silicosis.

There has been a lack of urgency in proper monitoring of businesses by WorkSafe, with reports that while in February it had identified 78 businesses which were not compliant with protective measures for silica dust inhalation, by the end of July only 17 had been reassessed and some of them were still found wanting.

Australian epidemiologist Prof Lin Fritschi, who has been conducting research into the Australian situation, describes it as a disastrous combination of poor practice and a terrible product.

She says it is impossible to get the dust down to an acceptable level even with wet cutting, and banning engineered stone is the only option.

The most recent Australian research said one in three of those working with the product showed signs of silicosis which she described as unconscionable.

Plans to ban the product in Australia have yet to materialise.

Here, the Council of Trade Unions wants to see a ban on all engineered stone products, apart from managing or removing engineered stone already in place.

In an election year, it would be good to see politicians taking a stand on this. Perhaps they could reflect on Prof Fritschi’s observation that if there was a photocopier in the Beehive killing one in three politicians "you can imagine that it might be banned straight away".