Getting the health system we deserve: nurses and other health workers have an ethical responsibility to vote in the upcoming general election. They are in a unique position to ascertain the impact of different political parties' health policies on those they care for and that's why they must participate in the election.

It is not necessary to took far beyond our shores to see countries where the universal right to vote is under threat or nonexistent. Nurses in other countries often work in very difficult circumstances, where breaches of human rights regularly occur. In contrast, in New Zealand, everyone's vote counts and there is a well-established tradition of participation. Furthermore, the public service is considered to be one of the most corruption-free in the world. It is in this healthy climate that I am challenging nurses and other health workers to participate in the general election this year.

All health workers, especially nurses, need to be politically active at the time of a general election. It is nurses' responsibility to act as advocates for patients, nurses and the health care system itself--they cannot stand on the sidelines. NZNO is not a partisan organisation. It does not support any one particular political party. It does not tell members how to vote. It supports political activism. In other words, members are encouraged to make health care a front Line issue in the coming election. Nurses and other health workers are in a unique position to do this. (1)

Power to allocate public money

The election of a government gives politicians the power to allocate public money for the provision of services to the public. In New Zealand, statutory Law places responsibility for the funding and provision of the bulk of health services in the hands of the government. That may be either a one-party government or a coalition of political parties. By showing their preference through voting, nurses and other health workers will influence which parties' health policies are put into action. The most responsible nursing vote is the one that is well-informed, realistic and which takes into account what will work best in the delivery of an effective health service. This requires knowledge of published statistical and other research evidence, including knowledge of how New Zealand's health status compares with that of other similar countries. Is New Zealand doing better or worse than others? Are health gains improving over time? What kind of political system provides the best health service? What aspects of the health service and social system are unique to New Zealand? What challenges face New Zealanders in the future? What responsibility do New Zealand health workers have to help people gain better health in other countries?

NZNO policy objectives

Other areas of knowledge are just as important and are outlined in the ten NZNO policy objectives for the 2005 general election (see p 20). These suggest that the health service is more Likely to be effective if it is supported by systems that pay all workers adequately, by fair processes for establishing pay and conditions and adequate funding.

Reducing health disparities between different groups in the population, recognising the role of the primary care sector in promoting health and preventing disease, countering poverty and keeping workers safe--all of these activities contribute to an effective health service.

Reducing the existing student loan burden would undoubtedly improve access to education and help to allay the shortage of nurses. The result would be the provision of a better quality health service to New Zealanders. Nurses should be aware of these things as they cast their individual vote.

But nurses' responsibility does not end at voting. It extends to letting others know what they know. Nurses can educate their families, friends and the community in which they live. They can pass on their assessment of the performance of the current government in health care and industrial relations. They can assess proposed policies against their experience and knowledge and tell others.

They have an ethical responsibility to consider what each political party has to offer and to take that into consideration when they cast their vote. Nobody knows more about how the current government's health and social policies have affected New Zealanders than health workers themselves. Nobody is in a better position to predict how other political parties, if they became the government, might change the health service for better or worse.

The current coalition government has now had six years to implement its strategies for better health care. How nurses will vote in the coming election will depend on their evaluation of health service developments since 1999. Most nurses will recall working and Living during the previous regime from 1990 to 1999. They will need to consider whether a National-Led government is Likely to revert to some of the policies introduced in the '90s. Opposition parties, to some extent, have an advantage over the current regime in the run up to an election They can present their policies and promises, sound very convincing, and then when elected renege on those promises. On the other hand, a government that has been in power for some years will be judged on actual performance.

Influencing health policy

Furthermore, nurses can influence future health policy directions by encouraging others to vote. The more people who vote, the more likely it is that future policy directions will reflect the support of the general public. Nurses can assist people to get their names on the electoral roll and gain access to polling stations. Such political activism will help more people to cast an informed vote. Nurses need to talk to other nurses and other health workers and engage in discussion and debate--make health care a top election issue.

Nurses, like other citizens, are not just concerned about the health service itself. Taxation systems, industrial relations, education, social welfare policy and justice all have an impact on health. Of course, political activism also includes direct Lobbying of current MPs and other aspiring politicians.

What's more, once a new government is elected, whether it is dominated by one party or by a coalition of two or three parties, nurses and other health workers cannot afford to sit back. It is up to political nurse and health worker activists to engage with the new regime and provide advice on which to base new policy initiatives. Certainly, a change in government can indicate a radical change of policy direction. This may include radical changes to the health service and the industrial relations within it. It is for this reason NZNO members must take heed of the election Later this year. What kind of health service does NZNO support? There are three significant health issues that face the informed voter at this election. The first and most serious of these is the way "race" is being portrayed by different political parties. They accuse their opponents of supporting policies based on race. They argue that policies, eg health care policies, should, instead, be based on need.

'Race' a discredited concept

This argument suggests that race and need are both used as the basis for developing policies and that needs-based policies are superior to those based on race. These accusations have been made almost exclusively with regard to any policies that may benefit Maori. The word 'Maori' is misinterpreted as meaning the same as 'race'. In fact, any reference at all to race as a basis for government policies is not useful. Race is a scientifically discredited concept, reflecting outdated notions of "blood" with "identity". (2) What is more significant for Maoridom and for everyone is the social meaning of being Maori. In the health service, this includes a shorter life expectancy, greater likelihood of cardiac disease, the highest rate of Lung disease in the world for Maori women, a Lower income, and experiencing discrimination from health care providers. This situation justifies the development of specific policies to assist Maori to Live Longer and more healthy lives. He Korowai Oranga The Maori Health Strategy sets out the blueprint for sensitivity to Maori need in the health service. (3) The proliferation of Maori providers in the health sector is evidence of the recognition of Maori health need.

The Ministry of Health's financial support in recent years to Maori seeking health professional qualifications is further evidence of a government commitment to improving the health of Maori. The recent higher Maori employment rate will assist Maori health. Voters committed to a nation where health disparities no Longer exist will make a choice that supports measures designed to fulfill Maori need.

The second issue facing health-aware voters is the potential significance of a primary health service that works. The fundamental ideas behind the primary health care ethos are that people have an active say in their health care, that they don't have to go too far to get it, and that it happens in a way that makes sense to them. Furthermore, they are supported by a social system that fosters their health, regardless of what population group they are in. The Primary Health Care Strategy Launched new ways of organising primary health care. (4) This was accompanied by substantial government funding and represents a real commitment to providing the kind of care and support aimed at keeping all the population as healthy as possible. In the long term, these strategies should make significant inroads into the current high costs of secondary services. There is no precedent for this commitment.

Treatment of older people

The third main issue for the ethically responsible health worker, who wants to make her vote count, is how older people are regarded and treated. There is a danger that people will equate old age with disease. This belies the fact that older people live healthy and independent lives, many of them continuing to make substantial contributions to the community. The recent removal of means testing and the small increase in government funding for residential care are insufficient expressions of state responsibility for those who need care. There is a desperate need for state-funded training and decent pay for workers in this sector. In particular, those older people who wish to remain in their own homes deserve the best possible care from a workforce which is respected and valued through decent wages and conditions. These measures, as indicators of increased state support in the future, are vital for effective protection and care for those older people who cannot care for themselves. A party that supports the continued privatisation of residential care for older people is in danger of putting older people at risk.

A professional responsibility

The right to vote is a hard-won freedom. It is also a professional responsibility because of the power voting gives to politicians to support or dismiss the kind of health service nurses and other health workers consider effective. A general election can herald a major swing in health policy direction. The people who experience the impact of this most acutely are health workers and patients.

Current key election issues for NZNO relate to whether to support race as a basis for policies or not, whether to support the continued roll out of the primary health care strategy or not; and what rote the state should play in the funding and provision of care for older people. Nurses and other health care workers have a responsibility to vote, to educate others, to encourage others to vote and to continue to be political activists, regardless of who comes to power.

Educate, lobby, argue, and convince family, friends and neighbours that it is worth their while to vote as an expression of freedom. Vote for a government. Vote for a health service. Vote for an equitable industrial relations environment. Vote for a society that cares the way nurses do.

References

(1) McPherson, D. (2005) President's report: Nurses' votes count. British Columbia Nurses" Union Update; 24 : 3, 3-4.

(2) Ryan, A., Carryer, J., & Patterson, L. (2003). Healthy concerns: Sociology for New Zealand nursing and midwifery students. Auckland: Pearson Education.

(3) King, A., & Turia, T. (2002) He Korowoi Oranga: Maori Health Strategy. Wellington: Ministry of Hearth.

(4) King, A. (2001) The primary health core strategy. Wellington: Ministry of Health.

NZNO professional services manager Joy Bickley Asher