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Dietitians: a critical missing ingredient

By Paula Goodyer

Getting professional help to improve your eating isn’t easy in New Zealand’s health system.

“The threshold for seeing a publicly-funded dietitian is really high. Someone in their 30s with a high HbA1c and high blood pressure wouldn’t be eligible, for example,” says Kath Eastwood, general manager of Dietitians NZ. “We are so under-resourced that in some cases pregnant women with gestational diabetes can’t see a dietitian. “

So why is it so hard to see a dietitian? There are 30 per cent fewer dietitians in NZ compared to Australia, Canada, the US and the UK. Lack of jobs is one reason, along with barriers to studying dietetics.

“Currently the dietetic qualification in NZ is a five year Master’s degree that’s only offered in. Auckland. This makes dietetic training quite inequitable and is one of the drivers of limited diversity in the workforce -it’s not representative of the community it serves,” says Kath.  “And, like most allied health professionals, we’ve perhaps not done enough to demonstrate our economic and clinical value in the past, and it’s had an impact on our ability to create more job opportunities. “

But that all changed in May  when Dietitians NZ released A Critical Missing Ingredient - the case for increased dietetic input in Tier 1 health services, a new report that  delivers a strong case for the role of dietitians in helping prevent chronic disease and saving money at the same time. When New Zealand’s Minister of Health announced major reforms in April to create a more equitable health and disability system focussed on prevention and primary care, Dietitians NZ seized the moment. It commissioned the report from the NZ Institute of Economic Research to show how dietitians can help reduce the burden of preventable disease, especially with cancer, diabetes and mental illness - conditions with a big impact on health, the economy and society. 

And while it’s designed to raise awareness among decision makers in NZ’s health system, the report presents so much evidence for the role of dietitians in preventing and managing chronic disease that it’s relevant to dietitians anywhere.  

More dietitians in primary care can help take the load off secondary care

A healthy diet could save the health system around NZ$420 per person per year, says the report - and if 10 per cent of New Zealanders improved their diet, the health system could save NZ$210 million each year just in cardiovascular disease and diabetes - although in reality, the savings flowing from better diets could extend to other conditions including osteoarthritis, cancer, low back pain, asthma, dementia, sleep apnoea, depression and digestive conditions.

Key points include:

  • For every dollar spent on dietetic support in primary care, the country receives a health and social cost saving benefit of up to NZ$99 over five years.
  • Dietitians can ease a GP’s workload -up to 25 per cent of GP visits are nutrition related and could be covered by a dietitian instead.
  • Nutrition intervention outcomes are greatest when delivered by dietitians compared to all other health professionals - and are delivered at a lower cost.

“More dietitians in primary care would take the load off secondary care,” says Kath. “At the moment about 60% of dietitians work in hospitals and only 6% in primary care or the community. We need to significantly grow the workforce in primary care so that dietitians aren’t the ambulance at the bottom of the cliff like they are now. “

 More Māori dietitians and extended prescribing rights -what the report recommends 

  • The development/funding of interdisciplinary models of care, with a focus on creating more dietetic roles in primary care.
  • Accelerating/funding recruitment and training of dietitians, especially Māori dietitians.
  • Allowing dietitians to prescribe common medications used in many conditions dietitians treat -e.g. Metformin - enabling more comprehensive and responsive care.
  • Establishing national competency frameworks for specialist and generalist dietitian roles - and supporting nutritionist roles in Tier 1 settings. Nutritionists can increase the capacity for dietetic interventions for lower risk patients, while dietitians focus on more complex patients.

Where do dietitians in NZ go from here? 

“Health New Zealand is expected to start developing new models of care over the next 12 months. We need to continue making our voices heard at all levels – government as well as local planning and funding teams, and engage more with GPs to make sure we’re not left behind,” says Kath Eastwood. “People don’t know what they don’t know and research cited in a new report from Allied Health Aotearoa New Zealand has found there’s a lack of awareness among GPs about the role of allied health workers generally. Yet GP practices in NZ have health coaches to support doctors by coaching patients to change behaviour - and that’s good. Dietitians can not only support the work health coaches do but also, given our knowledge of medical nutrition therapy, can help  people with more complex conditions. The sandpit is big enough for everyone.”

Kath Eastwood (nee Fouhy) NZRD  is a sports dietitian who formerly worked with elite athletes and para athletes at High Performance Sport NZ.