Perfect is the enemy of good

The Herald editorial:

Too often in matters of health and safety today, perfection becomes the enemy of improvement. The refusal to finance sleeping pods for babies, and the regulation of e-cigarettes, seem to be two recent examples of this mindset. Until Health Minister Jonathan Coleman over-ruled his officials this week on the funding of the wahakura that can protect babies from being crushed by an adult sleeping beside them, the Ministry of Health had regarded them as an unwise encouragement of the unsafe practice of “co-sleeping” with babies.

Doubtless a woven basket or a plastic pod is not as safe as putting a baby to sleep in its own cot, but for many mothers there are clearly cultural instincts in play that have been resisting this advice. As Herald reporter Olivia Carville has disclosed, the pods have been recognised as a worthwhile second best by doctors familiar with sudden unexpected death in infancy (SUDI), by coroners who have held inquiries into these deaths and even by some district health boards that have provided pods out of their discretionary funds.

After the devices came into use, New Zealand saw the first drop in Maori infant mortality rates in a decade. Since they are not expensive, many might question the need for them to be publicly funded. But if that is what it takes to give babies a better chance of surviving in their mothers’ beds, the modest cost to the public is well worthwhile. The minister has now directed his officials to work with paediatric experts to develop a new “safe-sleep programme that incorporates the appropriate use of safe-sleeping spaces”. Hopefully the message will be: separate sleeping is best but these devices are better than nothing.

The same message is likely to be given to smokers now the Government has issued a consultation document on a proposal to legalise the sale of e-cigarettes that deliver nicotine. E-cigarettes, as the Ministry of Health concedes, are much less harmful than tobacco.

I agree with the editorial. On both issues what we seemed to have was a purist view by the Ministry of Health. The purist view is that you shouldn’t smoke at all (correct) and that you should never have your child sleep in bed with you (also correct).

But the reality is some people do smoke and some parents do have their babies in bed with them. And so the policy challenge is how do you minimise harm, even if you can’t eliminate it. The sleeping pods seem like a pragmatic response to protect babies, recognising not all parents follow best practice. Funding them doesn’t mean you stop telling parents not to have their babies in their bed, just as allowing e-cigarettes doesn’t mean you stop telling people the best thing is not to smoke at all.

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