There’s been an effective and inexpensive drug treatment for decades - so why are the lives of so many Māori and Pasifika hampered by gout? Matthew Scott investigates how our healthcare system is leaving some people behind.
It was only when Dr Nicola Dalbeth started practising in England that she realised something was amiss back home.
She was used to seeing patients coming to her with biting pain in their joints, or swollen and ruddy feet.
One in 20 New Zealanders suffer from the condition, in which painful crystals in the joints form due to the buildup of uric acid in the blood.
After moving to the United Kingdom, there were far fewer people in the waiting room with stabbing pain in the joints. It was then that Dalbeth realised our relationship with gout is not the norm.
“It was clear we have a severe problem in New Zealand.”
Dalbeth is involved in the research and treatment of gout. She says the drug allopurinol taken daily can reduce the chance of a flare-up with minimal side effects.
But Māori and Pasifika are the least likely groups to get allopurinol dispensed regularly.
There’s a cruel irony to this.
“Given the severity of the disease amongst these groups, we should see more dispensing there - it’s a systems issue.”
The disease of kings
Public misconceptions about gout have fuelled stigma about the disease, say researchers.
People think gout is the result of an indulgent diet - a consequence for those who drink too much beer or eat too much seafood.
While purine-rich foods such as red meat, seafood and Marmite can trigger an attack, doctors say the idea this is the main cause of the disease is largely a myth.
Dalbeth says despite the idea that gout is a disease of extravagance, most of her patients don’t even drink.
“It goes way back amongst Pasifika and Māori. There’s evidence of it in ancient Polynesia,” she said.
She hopes education about the genetic component will allay the shame of the so-called ‘disease of kings’.
The gout divide
Dr Bruce Arroll sees a lot of gout in his clinic in Counties-Manukau, but it took a long time for him to open his eyes to the divide of who suffers the most.
“Why isn’t it a health target?” he said. “To be crude, it’s because it affects brown men.”
He says the Ministry of Health hasn't put serious work into tackling the issue for a number of reasons.
“It’s seen as an own goal,” he said. “And it doesn’t kill people - it just massively affects their lives.”
Gout may not lead directly to death, but it has wide-reaching effects, from job losses to kidney issues due to the use of painkillers to dull the agony of an attack.
Arroll wants to see public messaging reaching young Māori and Pasifika and educating them on the problem - and the easily accessible solution that comes daily from a blister pack.
“We need a Māori or Pasifika man to get up there and share like John Kirwan did about depression,” he said.
If we don’t start to get on top of health literacy around gout, thousands of New Zealanders will continue to suffer in silence.
“Gout isn’t urgent, but it is important,” said Arroll. “And if you don’t deal with the urgent, it becomes important.”
The changes the system needs
Providing transport, free appointments, medication delivery and extended hours of access will help to get more Māori and Pasifika on regular allopurinol.
A South Auckland clinic found just under 60 percent of their patients with gout had physical jobs, such as in roading or forestry - jobs it was difficult to get away from to go see the doctor and also jobs almost impossible to do in the midst of a gout attack.
Dalbeth and Arroll all want to see pharmacist-led reform, with more power given to community chemists to dispense and educate their patients about the need to take the pills every day.
A project in Northland has found success by combining healthcare and kaiāwhina, or non-regulated community health workers.
In the meantime, New Zealand is letting thousands of people live life as an act of pain endurance.
