Southland Māori Health Profile 2011

Transcription

1 Health Profile 2011

2 Table of Contents 1 Executive Summary... 3 Section 1 Population Health Introduction Demographic Profile Socioeconomic Determinants of Health Risk and Protective Factors Health Status Cardiovascular Disease Respiratory Disease Diabetes Cancer Communicable Disease Injury Oral health Disability Section 2 Child and Youth Health Tamariki / Child and Rangatahi / Youth Health Health Status Respiratory Tract Infections and Conditions Lower Respiratory Tract Illness Skin Infections Gastroenteritis Unintentional Injury Oral Health Sexual and Reproductive Health Section 3 - Service Utilisation Health Service Utilisation References Appendix 1: Information/Data Sources Appendix 2: Data notes Appendix 3: Glossary of Terms

3 1 Executive Summary 1.1 Demographics and Social Determinants of Health The demographic structure and socioeconomic conditions of a population are major determinants of the health of the population. In, 12,230 people identified as in 2006, comprising 11 percent of the population in the 2006 Census. Birth rates (2007) were higher amongst populations in compared to non- populations. The age profile for in in 2006 was similar to that nationally in that the population was more youthful than the non- population. Population growth is projected to continue at higher rates in populations compared to non- populations in Otago, such that will comprise 14 percent of the population in The age structure of the population in is projected to change by 2026, with growth in all age categories and significant growth in the over age 65 years group. A greater proportion of lived in higher deprivation areas than non- in. Overall, in are less well off compared to European/Others with respect to a number of indicators from the 2006 Census, including: living in a household with a low income, not owning the home lived in, living in a single parent family, unemployment, being without school qualifications, living in a crowded household, having no access to a telephone and having no access to a car Protective Factors and Risk Factors Nutrition The New Zealand Health Survey (2006/07) results reflected the prevalence of healthy nutrition was lower for than non- but this was not a statistically significant difference. Physical activity The New Zealand Health Survey (2006/07) reported the rate of participation in regular physical activity was higher for than non-. This was not a statistically significant difference. Obesity According to NZHS results, the prevalence of obesity was significantly higher for in than for non-. The prevalence of being overweight was lower for than non- in. This was not a significant difference. Tobacco According to 2006 Census data, the prevalence of regular smoking amongst the population was considerably higher in (42 percent) compared to European populations (23 percent). Rates were highest amongst females (45.8 percent). Additionally, 40.4 and 54.1 percent of youth aged years and years, respectively, were regular smokers. According to 2006 Census data, 57.3 percent of children lived in a household with a smoker, compared to 33.2 percent of European children in. Medicated high blood pressure and high cholesterol As identified in the New Zealand Health Survey 2006/07, the prevalence of medicated high blood pressure and high cholesterol was lower for than for non- in but this difference was not statistically significant. 3

4 1.2 Health Status Over the period , rates of avoidable hospitalisation in were significantly higher than non- rates but significantly lower than New Zealand rates. The leading causes of avoidable hospitalisation for were angina, ENT infections (ear, nose and throat), respiratory infections, dental conditions and COPD. Avoidable mortality rates ( ) were significantly higher among than among non- populations. The main causes of avoidable mortality in were similar for and non- populations, with ischaemic heart disease, lung cancer, suicide and stroke included in the five most common causes for both populations. COPD was more common in, replacing colorectal cancer as a common cause of avoidable mortality in non- populations. Some caution is required with some of these statistics; low statistical significant and wide confidence intervals may be result of the small size of the measured groups Health Service Utilisation As at 1 January 2011, nine percent of people enrolled in the Southern PHO from identified as. NZHS data (2006/07) indicate that in were also less likely than non- to have visited a GP in the last six months, but this difference was not statistically significant. in were also more likely than non- to have had an unmet need for a GP, but this difference was not statistically significant Cardiovascular Disease Cardiovascular disease hospitalisation rates ( ) for females and overall were significantly higher than rates for respective non- populations. Cardiovascular disease mortality rates (2003) were significantly higher for females and overall in, compared to respective non- populations. Ischaemic heart disease Ischaemic heart disease hospitalisation rates ( ) for females were significantly higher than rates for non- females. Overall rates of ischaemic heart disease mortality ( ) were higher for than non- populations in but these differences were not statistically significant. Stroke (cerebrovascular disease) Stroke hospitalisation rates ( ) for females were higher than non- female rates, although these differences were not statistically significant. The stroke mortality rate ( ) for women was almost twice the rate for non- women in ; this was a significant difference Respiratory Disease Asthma In, rates of hospitalisation ( ) due to asthma were significantly higher than rates for non-, when rates were considered for female and combined male/female populations. COPD Rates of COPD hospitalisation ( ) were higher for in compared to non- populations; this difference was statistically significant for the female population and the population overall. 4

5 1.2.4 Diabetes The Ministry of Health estimated there were 8,704 people with diabetes in Otago and 4,696 people with diabetes in in 2008, giving a total of 13,400 in the Southern District. Of the total, 817 were, 221 Pacific and 12,362 of Other ethnicities. The peak prevalence of diabetes for and Pacific populations was in the age group, while for Others the prevalence peaked later between years (LDT 2008). Of who accessed the Get Checked programme in in 2008, 65 percent had good or satisfactory HbA1c levels (indicative of good management), compared to 72 percent for Other populations. When the ethnicity of diabetic smokers was considered, 21 percent of with diabetes smoked in 2008, compared to 10 percent of Pacific People diabetics and 10 percent of diabetic Others. Using a BMI over 30 to indicate obesity, sixty nine percent of and fifty percent of non-, non- Pacific people with diabetes in were considered obese in diabetes hospitalisation rates ( ) were significantly higher than rates for non- populations. The rate of admission for renal failure due to diabetes for in was ten times higher than the rate for non-. This was a significant difference Cancer Age standardised all cancer registration and mortality rates for and non- in the Southern DHB district (comprised of Otago and DHBs) from demonstrated no significant differences by ethnicity. This may be due to small numbers. All cancer hospitalisation rates ( ) for were significantly lower than rates for non- populations although this difference was only significant for the male and combined population (males and females). Rates of lung cancer hospitalisation ( ) were much higher for females and the combined population in compared to non-. These differences were statistically significant. Rates of hospitalisation for prostate cancer in ( ) were higher for compared to non- but these differences were not statistically significant. Rates of hospitalisation for breast cancer and prostate cancer in ( ) were lower for compared to non- but these differences were not statistically significant. Rates of colorectal cancer hospitalisation over the same time period were lower for compared to non- populations in but these differences were not statistically significant. Breast Screening For the 24 months ending 31 December 2009, breast screening coverage for women aged in the population was below target at 51 percent, while the former DHB achieved 74 percent breast screening coverage for the total eligible population. Cervical Screening For the 36 months ending January 2010, the former District Health Board achieved almost 77 percent coverage of the total eligible population, Over the same time period, the screening rate for women in (45 percent) was considerably below the target screening rate Communicable Diseases For the time period , campylobacteriosis notification rates for were significantly lower than rates for non-. Cryptosporidiosis notifications rates for were lower than the rates for non- but these differences were not significant. The rate of salmonellosis notifications in was significantly higher than the national rate. 5

6 rates were significantly higher than New Zealand rates, but slightly lower than non- population rates. Immunisation Coverage For the 12 month ending 30 June 2010, in had slightly lower coverage rates for immunisation than New Zealand European children at 6 months and 18 months but immunisation rates were similar across all other milestone ages. Immunisation rates for in were higher at all milestone ages than for nationally. European/Other and populations have already surpassed the Ministry of Health targets for 90 percent of two-year olds to be fully immunised by July Unintentional Injury Over the time period , unintentional injury hospitalisation rates for females and for overall were significantly lower than respective non- rates. Unintentional injury hospitalisation rates for were also significantly lower than rates for New Zealand during this same time period. The rate of unintentional injury mortality for males and overall in for the period was similar to the rate for non-. The rate of unintentional injury mortality for males and overall in for the period was lower than the rate for New Zealand but this difference was not statistically significant Oral Health According to data from the NZHS 2006/07, in were significantly less likely than non- to have seen an oral health care worker in the previous 12 months. 1.3 Child and Youth Health Rates of infant mortality (2003/05) were higher in for than for non from 2003 to 2005 but this was not a statistically significant difference Breastfeeding From , rates of exclusive/full breastfeeding at six weeks, three months, and six months were lower for at every age. The rates for in were slightly higher at three and six months than national rates for Hospitalisations From , the most common causes of hospitalisation for children in age 0-4 years were similar for and non- children, including respiratory infections, health supervision and care of other healthy infant and child, disorders related to length of gestation and foetal growth and ENT infections. Dental conditions were leading causes of hospitalisation for while gastroenteritis was a leading cause among non- children in. For children aged 5-14 years, the most common causes of hospitalisation were similar for and non- children in, with the most common causes for both populations including ENT infections, dental conditions, falls, and chronic diseases of tonsils and adenoids. Exposure to inanimate mechanical forces was a main cause of hospitalisation for, replaced by respiratory infections in non- populations. Ambulatory sensitive hospitalisation (ASH) From , the most common causes of ambulatory sensitive hospitalisations (avoidable hospitalisations) for children age 0-4 years in were dental conditions, gastroenteritis, acute respiratory tract infections and asthma. For the most part, ASH rates in ( ) have been higher for European compared to children but the reasons for this are not known. 6

7 1.3.3 Respiratory Tract Infections and Conditions Hospitalisation for Upper Respiratory Tract Infection Rates of URTI (both croup and other acute URTIs) admissions from for children age 0-14 years were generally higher in Europeans than in. Rates of waiting list admissions for tonsillectomy were higher for Europeans than in and New Zealand from From in, the rate of otitis media admissions was very similar for and European children. In contrast, the rate of waiting list admissions for grommets in was significantly higher for than for Europeans from 1998/98 onwards and continues to increase. Over the time period , audiometry failure rates at school entry fluctuated widely from year to year in. Data are not available by ethnicity. Hospitalisation for Lower Respiratory Tract Infections Rates of hospitalisation for bronchiolitis for children less than one year of age in were considerably higher than rates for European children, especially in the period Admission rates for viral or bacterial pneumonia in children and young people in were similar to rates for European children. Hospitalisation for Asthma Rates in decreased over the period for both and Europeans, with the rate increasing slightly from 2006/ Skin Infections From 1996 to 2007, rates of hospitalisation for serious skin infection for were similar to rates for European children and young people. The rates for children and young people in were generally lower than rates for nationally over the period from 1996 to Gastroenteritis From 1996 to 2007, rates of hospitalisation for gastroenteritis for were lower than rates for European children and young people, although rates for rose sharply in 2006/07. The rates for in were generally lower than rates for nationally over the period from 1996 to Unintentional Injury Risk factors for injury related mortality and hospital admission include gender (male), ethnicity (), and age (late teens to early twenties). Discounting the perinatal period, over the mid 1980 s to 1990 s, injury has been the main cause of death for New Zealand children aged 0-14 years. From in, falls and injury caused by inanimate mechanical forces were the leading causes of injury admissions in children age 0-14 years. Data are not available by ethnicity. From , for young people (15-24 years), inanimate mechanical forces, falls, and transport related injuries were the main causes of injury related admission. Analyses are not presented by ethnicity. From in, land transport deaths were the major contributor towards child death from unintentional injury. Data are not available by ethnicity. In, the mortality rate for children and young people due to unintentional, non-transport injury fluctuated dramatically over the period , precluding precise estimates of trends. In general, rates were higher than New Zealand rates. Rates could not be determined by ethnicity in because of small numbers Oral Health In 2009, the mean DMFT score (decayed, missing or filled deciduous teeth) and proportion of children who did not have caries (tooth decay) for five year olds and Year 8 students (12 to 13 year olds) demonstrated that children in had higher rates of decayed, missing or filled teeth and 7

8 a lower rate of being decay-free than non-. children with fluoridated water supplies had lower DMFT scores than children with non-fluoridated water suppliers. From 2000 and onwards in were more likely than non- children to be admitted to hospital for dental caries Sexual and Reproductive Health Teenage birth rates (15 to 19 year olds) for in were three to four times higher than rates for Europeans over the period from 1996 to Since the rate of teenage births has increased significantly for in. 8

9 Section 1 Population Health 2 Introduction The New Zealand Public Health and Disability Act, 2000, indicates that one of the functions of a DHB is: To regularly investigate, assess, and monitor the health status of its resident population, any factors that the DHB believes may adversely affect the health status of the population, and the needs of that population for services (Clause 23(1)(g)). Health needs assessments and health profiles provide DHBs with evidence to underpin funding decisions, in order to achieve health gains for their populations. This Health Profile is one component of a Southern DHB Health Needs Assessment, focusing on the health status of the population in. 2.1 The DHB Planning Cycle At a national level, the two overarching strategies of the New Zealand health and disability sector are the New Zealand Health Strategy (NZHS) and the New Zealand Disability Strategy (NZDS). These strategies are supported by other more focused strategies that provide direction in identified areas. DHBs determine population health priorities for their district, taking into consideration national priorities and guidance. District Annual plans specify how DHBs plan to provide health and disability services for their populations. Figure 1: The DHB planning cycle New Zealand Health Strategy New Zealand Disability Strategy Health Needs Assessment Prioritise work and funding programme (strategic and annual plan) Monitor and report on outputs and outcomes Agree annual plan / funding agreement with Minister of Health Implement plans Manage provider relationships (includes payment) Purchase Source: Ministry of Health (2000) 9

10 2.2 Purpose of Health Profile This health profile provides a snapshot of health status in. In addition, key indicators are presented in relation to socio-economic determinants of health, risk and protective factors for health, health status and health service utilisation. This information will assist the Southern DHB to determine priorities for service planning, in the context of national health priorities and health targets, in order to ultimately achieve health gain for the Southern DHB population in. This profile will be used in tandem with the Otago Health Profile. Key information is presented through charts and graphs. Health indicators are used to provide salient information, with comparisons made between ethnicities at a district level and with national data, to provide context. Indicators are consistent with those used in monitoring national data on a regular basis. Methods and data sources are provided in the Appendix 2. Key sources of information include the following: Hauora: Standards of Health IV (2007) Te Rau Hinengaro: The New Zealand Mental Health Survey (2006) Cancer: New Registrations and Deaths 2007 (2010) A Portrait of Health: Key Results of the 2006/07 New Zealand Health Survey (2008) The Health Status of Children and Young People in (2008) The Determinants of Health for Children and Young People in (2009) Smoking Prevalence Rates, Census 2006 (2007) Local Diabetes Team Report (2009) The Social Report Website of the Ministry of Social Development DHB Health Needs Assessment (HDIU, 2008) Statistics New Zealand Census 2006 data (2008) Draft Southern DHB Local Cancer Plan (2010) 10

11 3 Demographic Profile KEY FINDINGS: In 12,230 people identified as in comprised 11 percent of people in the 2006 Census. Birth rates (2007) were higher amongst in compared to non- populations. The age profile for in in 2006 was similar to that nationally in that the population was more youthful than the non- population. Population growth is projected to continue in populations in, such that will make up 14 percent of the population in Ngai Tahu/Kai Tahu was the most common iwi affiliation indicated by in. The age structure of the population in is projected to change by 2026, with growth in all age categories and significant growth in the over age 65 years group. covers a total of 37,285 square kilometres, approximately 12 percent of New Zealand s land area (Local Government Online). This is the second largest area in New Zealand and consists of 109,925 people, eleven percent of whom are. The area is sparsely populated (2.8 people per kilometre) when compared to the national average (13.1 people per kilometre). Southern DHB has eight territorial authorities varying is size and catchment. is comprised of four territorial authorities: Gore District, Invercargill City, Queenstown Lakes District and District. represent approximately 12 percent of the population in Invercargill City Territorial Authority, 9 percent in rural TA, 9 percent in Gore and just under 6 percent in the Queenstown Lakes District. Comparing absolute numbers, most live in Invercargill City and District. Table 1: Number and proportion of in each territorial authority,, Otago, and New Zealand, 2006 Territorial Authority No. of 2006 Census Pop as % of TLA popn. Gore District 1,119 12,465 9% Invercargill City 6,689 54,195 12% Queenstown-Lakes District 1,263 22,737 6% District 2,606 29,895 9% Central Otago District 1,161 17,235 7% Clutha District 1,482 17,601 8% Dunedin City 7, ,940 6% Waitaki District 1,087 20,802 5% and Otago TAs 22, ,870 8% New Zealand 526,281 3,737, % Source: Statistics New Zealand Note: Privacy concerns can cause small population numbers to be rounded which leads to slight differences in the total populations given here compared to other tables. 11

12 Table 2 below presents ethnicity data for the population. Approximately 11 percent of s total population identified as in 2006, as illustrated in Table 2. In the prioritised method, each respondent is allocated to a single ethnic group using the priority system ( > Pacific peoples > Asian > European/Other). For example a person who selects (when asked their ethnicity) both and European would only be included in the grouping. Table 2: Ethnicity of the population in, Census 2006 Ethnic Group Number Percent 12, % Pacific % Asian % European/Other % 109, % *Note: Privacy concerns can cause small population numbers to be rounded which leads to slight differences in the total populations given here compared to previous tables. 3.1 Iwi Affiliation Table 3 presents the number of people in Otago and indicating Iwi affiliation at the 2006 Census. Ngāi Tahu/Kāi Tahu was the most common affiliation in Otago and, followed by Ngāpuhi, Ngāti Porou and Kahungunu grouping. A number of individuals did not know or did not want to comment on Iwi affiliation. It should be recognised that many individuals belong to more than one iwi. This is not an exhaustive list of iwi affiliations; it includes information relating only to the largest iwi affiliations in Otago and. Other iwi affiliations are included in the not elsewhere included category. The full list is available on line from Statistics New Zealand (Census 2006). Te Rūnanga o Ngai Tahu is the Iwi authority and overall representative governing body of Ngai Tahu Whānui being descendents of the Ngai Tahu, Ngati Mamoe and Waitaha tribes. Te Rūnanga o Ngai Tahu is made up of 18 Rūnanga Papatipu, and hold Mana Whenua status for both Otago and : Otago has three distinct Rūnanga: Te Rūnanga o Moeraki (Moeraki), Kāti Huirapa Rūnaka ki Puketeraki (Karitane), and Te Rūnanga Otākou (Dunedin). has four mana whenua roopu: Te Rūnanga o Awarua (Bluff), Waihopai Rūnaka (Invercargill), Hokonui Rūnanga (Gore), and Oraka Aparima Rūnaka (Colac Bay). Table 3: Iwi affiliation by Otago and Regional Council, Statistics NZ, 2006 Iwi Otago Ngāi Tahu / Kāi Tahu 4,680 4,632 9,312 Don't Know 3,579 2,721 6,300 Ngāpuhi 1,599 1,236 2,835 Ngāti Porou 1,209 1,116 2,325 Kahungunu grouping 1,119 1,083 2,202 Kāti Māmoe ,008 Tuhoe Ngāti Kahungunu ki Te Wairoa Ngāti Tuwharetoa Other Iwi affiliation 9,585 6,813 16,398 23,397 19,407 42,804 Notes: This table gives an approximation of iwi affiliation by Otago and Regional Councils as Regional Councils do not align to DHB boundaries. 12

13 3.2 Population Age Distribution Table 4 compares the age distribution for and non- in in In, 34 percent of are aged less than 15 years compared to 19 percent of non- Only 4 percent of are aged 65 years and over, compared to 14 percent of non- Table 4: populations by age group, and non-, Statistics NZ, 2006 Non- population n % n Percent n % % 18,085 19% 22,225 20% % 11,885 12% 14,285 13% % 28,785 29% 32,055 29% % 25,315 26% 27,185 25% % 13,625 14% 14,175 13% 12, % 97, % 109, % Source: Statistics NZ The significant differences in the age structure of these populations are highlighted in pictorial representations (Figure 2 below). The triangular shape of the pyramid for indicates a large proportion of the population tends to be younger, with steadily diminishing proportion of the population in the older age groups, and few in the 60 years and older age group. In contrast, the more pear-shaped pyramid for non- is comprised of relatively small younger age groups due to lower reproductive fertility rates, along with larger proportions within older age groups. Figure 2: Age distribution of population by and non Source: Statistics New Zealand, Census

14 3.3 Population Projections Birth Rates Birth rates for in are substantially higher than for non-, but rates are lower than for in New Zealand as a whole (see Table 5). Higher birth rates result from a combination of a younger population with proportionally more women of child-bearing age and higher fertility rates for compared to non-. Table 5: Live births registered in 2007, for mothers of all ages, by ethnic group, and New Zealand, 2007 Indicator New Zealand Non- Non- Live births ,289 49,831 65,120 Female Population (15-49 years) 3,016 23,205 26, , ,574 1,033,110 Rate (live births per 1,000 women) Source: Statistics New Zealand/HDIU Notes: Live births = the number of births registered during 2007, for mothers of all ages. Female population (15-49 years) = the number of people in the female population aged years in Projected Population Statistics New Zealand develops population projections, basing assumptions on medium fertility, mortality, migration and inter-ethnic mobility for and other populations. The 2006 census enumerated 12,230 who resided in. Population projections predict the population will increase by 3450 (28.2%) to 15,680 by The non- population in is expected to increase by 2.4 percent (5785 people) between 2006 and Table 6: Projected populations, Non- population n % n Percent n % , % 97, % 109, % , % 99, % 113, % , % 100, % 114, % , % 100, % 115, % , % 100, % 115, % Source: Statistics New Zealand/ HDIU As a consequence of the projected population growth patterns within and European populations, the proportion of the population that identifies as is projected to increase, within and nationally. In, the proportion of is projected to increase from 11 percent of the total population in 2006 to 14 percent in The age structure of the population in is projected to change by As previously noted, in 2006 the proportions of the population under 15 years and over 65 years were 34 percent and 4 percent respectively, as shown in Table 7. In 2026 the respective proportions are projected as 33 percent and 9 percent, representing little change in the younger age group and a doubling of the older age group. 14

15 Table 7: Population projections for population in, medium series Age group (years) Non No. % No. % No. % No. % % 5,140 33% 18,085 19% 16,045 16% % 5,730 37% 32,715 33% 28,860 28% % 3,390 22% 33,270 34% 32,680 33% % 1,420 9% 13,625 14% 22,445 22% 12, % 15, % 97, ,030 99% Source: Statistics New Zealand, Census 2006, medium series Note: *These projections have as a base the estimated resident population of as at 30 June 2006 and incorporate medium fertility, medium mortality, medium migration, and medium inter-ethnic mobility assumptions for each area. Much of the population growth for will be amongst those aged 15 or younger, but there will also be significant growth in all other age categories, including those aged 65 plus years. Much of the population growth amongst the non- population will be within the older age groups. The DHB will need to take this expected population growth into account in terms of service planning, prioritisation processes and service delivery, especially in relation to services for young people and services for the elderly Life Expectancy Similar to New Zealand as a whole, life expectancy in has continued to increase over the last decade (Figure 3). However, life expectancy in the area remains lower than that of the average New Zealander. Females still have a higher life expectancy in and nationally, but the gap between males and females is decreasing at and national levels. Figure 3: Life expectancy for males and females in the and New Zealand Source: Statistics New Zealand, based on data from for and New Zealand people Table 8 below illustrates life expectancy for males and females living in, compared to life expectancy for New Zealand and non- populations. Life expectancy for New Zealand is considerably lower than life expectancy for New Zealand as a whole. Life expectancy at birth in 2006 was 70.4 years for males and 75.1 years for females, compared to 79.0 years for non- males and 83.0 years for non- females. There is no information on life expectancy for in. 15

16 Table 8: Life expectancy, and New Zealand, 2006 Life Expectancy (Years) Area Male Female New Zealand non New Zealand Source: Statistics New Zealand 16

17 4 Socioeconomic Determinants of Health KEY FINDINGS: Overall, in are less well off compared to non- with respect to a number of indicators from the 2006 Census: In, a higher proportion of aged over 15 years had lower incomes compared to Europeans/Others. were significantly less likely to own their own home than Europeans/Others in. The unemployment rate for over age 15 in was significantly higher than the rate for Europeans/Others although it was lower than the rate for in New Zealand. A lower proportion of over 15 years in had attained NCEA Level 2 or a higher qualification compared to Europeans/Others. were more than twice as likely as Europeans/Others in to live in a dwelling where there were insufficient bedrooms for the number of people living in the house. Significantly higher percentages of in did not have access to a telephone or cellphone compared to European/Others. A significantly greater proportion of than Europeans/Others in did not have access to a motor vehicle. in were more represented in the highest deprivation areas (deciles 9 and 10) and less represented in the lowest deprivation areas (deciles 1 and 2) than non- in. 4.1 Socioeconomic Status Socio-economic status is an important determinant of health. Socio-economic factors such as income, education, employment and housing make significant contributions to health status (Ministry of Health 2002; Public Health Advisory Committee 2004). Unequal distribution of these socio-economic determinants contributes to differences in the health status of and non- (Ministry of Health and University of Otago 2006). The New Zealand deprivation index, NZDep2006, is a measure of socio-economic deprivation for small geographical areas (meshblocks) based on nine socio-economic variables measured in the 2006 Census. A weighted sum of these variables is calculated for all of New Zealand. The variables, in order of weighting, are: receiving a means tested benefit, living in a household with a low income, not owning the home lived in, living in a single parent family, unemployment, being without school qualifications, living in a crowded household, having no access to a telephone and having no access to a car (Salmond et al. 2007). Mesh blocks are distributed into ten deciles according to their summary deprivation score. Decile 1 contains the 10 percent least deprived areas and decile 10 comprises the 10 percent most deprived. The deprivation of different populations (for example geographical populations such as or ethnic groups such as and non-), can be assigned based on the meshblock area in which the individuals that make up that population live. Populations can then be compared to each other or against national profiles. Figure 3 illustrates that in New Zealand higher proportions of than non- live in areas of high deprivation; fewer live in areas of low deprivation compared to non-. Nationally, 42 percent of live in areas with the two highest deprivation scores (deciles 9 and 10), compared to 7 17

18 percent in areas with the two lowest deprivation scores (deciles 1 and 2). This compares to 16 percent of non- living in the areas with the highest deprivation scores and 22 percent living in areas with the lowest scores. Figure 3: Deprivation profile New Zealand, and non-, New Zealand, 2006 Source: Statistics New Zealand Figure 4 shows that in are more likely to live in areas with higher deprivation scores than non- (42 percent of living in areas with the three highest deprivation scores i.e. deciles 8, 9 and 10, compared to 20 percent for non-). Eighteen percent of live in the areas with the lowest deprivation scores (deciles 1 and 2) compared to 32 percent for non-. Figure 4: Deprivation profile, and non-,, 2006 Source: Statistics New Zealand Figure 5 illustrates that in live in areas with relatively lower deprivation scores than in all of New Zealand. Nationally, 41.7 percent of live in areas with the two highest deprivation scores (deciles 9 and 10), compared to 7.8 percent in areas with the two lowest deprivation scores (deciles 1 and 2). In, 24.6 percent live in areas with the two highest deprivation scores (deciles 9 and 10), compared to 17.9 percent in areas with the two lowest deprivation scores (deciles 1 and 2). 18

19 Figure 5: Deprivation profile for, and New Zealand, 2006 Source: Statistics New Zealand Census Social and Economic Indicators Table 9 summarises some of the variables from the Census 2006 that make up the NZDep scores, all of which are considered important indicators of socio-economic status. The overall pattern is that for all the indicators are less well off compared to Europeans/Others. Income is an important determinant of health. Income is used as a measure of socio-economic position and is related to other measures such as education and employment (Blakely et al. 2007). Statistics New Zealand defines low income as the population of people living in households with real gross income less than 60 percent of the median household equivalised national income benchmarked at NB: Equivalised means that household incomes are weighted to take into account the fact that larger households require higher incomes than smaller households to achieve a given standard of living. In, a higher proportion of aged over 15 years had lower incomes compared to Europeans/Others. Home ownership is an indicator of income; the quality of housing is related to health (Howden- Chapman and Wilson 2004). were significantly less likely to own their own home than Europeans/Others in. Unemployment and occupational status are related to health (Ministry of Health and University of Otago 2006). The unemployment rate for over age 15 in was significantly higher than the rate for Europeans/Others, although it was lower than the rate for New Zealand overall. Higher levels of educational attainment are related to improved health outcomes (Wilkinson and Marmot 2003). A significantly lower proportion of over 15 years in had attained NCEA Level 2 or a higher qualification compared to Europeans/Others. Household overcrowding indicates lower socio-economic status and is associated with poor health (Baker, Zhang et al. 2006), particularly from infectious diseases (Baker, Milosevic et al. 2004). in were more than twice as likely as European/Others to live in a dwelling where there were insufficient bedrooms for the number of people living in the house. This was a significant difference. 19

20 Telephones facilitate social connection to others and a range of activities of daily living. Significantly higher percentages of did not have access to a telephone or cellphone compared to European/Others in the population. A significantly greater proportion of than Europeans/Others in did not have access to a motor vehicle. Table 9: Social and economic indicators, in adults over 15 years,, age standardised rates, percent with 95% CI, and New Zealand, 2006 Indicator New Zealand European/ Other European/ Other Lower income 21.8 ( ) Not living in own home, 15+ years 56.1 ( ) Unemployed, 15+ year 4.8 ( ) NCEA Level 2 or higher, 15+ years 38.9 ( ) Household crowding, all ages 9.6 ( ) 20.1 ( ) 45.4 ( ) 2.9 ( ) 53.0 ( ) 4.0 ( ) 24.0 ( ) 66.3 ( ) 6.9 ( ) 42.1 ( ) 21.2 ( ) 21.1 ( ) 48.4 ( ) 3.3 ( ) 63.1 ( ) 5.8 ( ) Living in household with no access to a telephone or cellphone, 15+ years 3.7 ( ) 1.5 ( ) 5.3 ( ) 1.2 ( ) Living in household with no access to a motor vehicle, 15+ years Source: HDIU/Statistics New Zealand 7.9 ( ) 3.7 ( ) 9.4 ( ) 4.0 ( ) Improving the health status of those who are socially disadvantaged is one of the seven underlying principles of the New Zealand Health Strategy. The strategy recognises that more effort is needed to address the health status of groups with low socio-economic status. Efforts need to focus particularly on and Pacific people. 20

21 5 Risk and Protective Factors KEY FINDINGS PROTECTIVE FACTORS In 2006/07, the New Zealand Health Survey results reflected differences between and non- populations over age 15 years. The prevalence of healthy nutrition was lower for than non- in but this was not a significant difference. The rate of participation in regular physical activity was higher for than non- in. Again, this was not a significant difference. RISK FACTORS According to NZHS results, the prevalence of obesity was significantly higher for than for non- in. The prevalence of being overweight was lower for than non- in. This was not a significant difference. As reported in the NZHS 2006/07, the prevalence of current daily smoking was significantly higher for in than for non- in, with a higher prevalence among women than men. rates of daily smoking in were also significantly higher than New Zealand rates. The prevalence of medicated high blood pressure and high cholesterol was lower for than for non- in but this difference was not statistically significant. According to 2006 Census data, the prevalence of regular smoking amongst the population was considerably higher in (42 percent) compared to European populations (23 percent). Rates were highest amongst females (45.8 percent). Additionally, 40.4 and 54.1 percent of youth aged years and years, respectively, were regular smokers. According to 2006 Census data, 57.3 percent of children in lived in a household with a smoker, compared to 33.2 percent of European children. Sources of data for many risk and protective factors are limited, with the main sources of data being the New Zealand Health Survey (NZHS). Additionally, data on smoking were collected in the Census 2006, and data are also collected through the annual Action on Smoking and Health (ASH) surveys of Year 10 school students. 5.1 Protective Factors Protective factors are health behaviours that promote the attainment or maintenance of an individual s wellbeing by supporting good health and preventing illness. Table 10 presents prevalence of protective factors in and New Zealand populations, as reported in A Portrait of Health: Key Results of the 2006/2007 New Zealand Health Survey. In, the prevalence of healthy nutrition behaviours (having three or more servings of vegetables or two or more servings of fruit a day) was lower for than for non-, but this was not a significant difference. The prevalence of regular physical activity by was higher than for non-, but again this was not a significant difference. 21

22 Table 10: Age-standardised protective factor prevalence (percent with 95% CI), 15+ years, and New Zealand, 2006/07 New Zealand Indicator Non- Non- 3+ servings of vegetables/day 2+ servings of fruit/day Female Male Female Male 72.3 ( ) 60.3 ( ) 66.8 ( ) 58.4 ( ) 43.4 ( ) 51.4 ( ) 78.6 ( ) 64.5 ( ) 71.8 ( ) 64.6 ( ) 47.3 ( ) 56.2 ( ) 63.5 ( ) 53.2 ( ) 58.8 ( ) 62.1 ( ) 46.1 ( ) 54.7 ( ) 69.1 ( ) 56.7 ( ) 63.1 ( ) 68.6 ( ) 50.3 ( ) 59.8 ( ) Regular physical activity Female 58.4 ( ) 54.4 ( ) 51.1 ( ) 47.7 ( ) Source: HDIU/NZHS Male 69.3 ( ) 63.4 ( ) 61.9 ( ) 58.0 ( ) 60.7 ( ) 55.6 ( ) 54.2 ( ) 50.8 ( ) 5.2 Risk Factors Risk factors are states or activities that increase an individual s likelihood of becoming unwell or contracting a disease. Table 11 presents risk factor prevalence for and New Zealand populations as reported in the A Portrait of Health: Key Results of the 2006/07 New Zealand Health Survey Obesity/Overweight It is important to maintain a health body size for good health and wellbeing. Evidence shows that children and adults who are obese are at increased risk of negative health outcomes, both short and long term (Ministry of Health 2003). Body mass index (BMI) was calculated from height and weight measurements for each participant in the NZHS. Participants could then be classified as obese or overweight if their BMI was above internationally defined levels. The prevalence of obesity was significantly higher for than for non- in. There was a lower but non-significantly different prevalence of being overweight for compared to the non- population in Current daily smoking The prevalence of current daily smoking was significantly higher for than for non- in, with a higher prevalence among women than men. rates of daily smoking in were also significantly higher than New Zealand rates. More detailed information about smoking is presented at the end of this section Hazardous drinking The prevalence rates of hazardous drinking were not significantly different between and non- in South Island DHBs, nor were there differences comparing South Island to New Zealand. 22

23 Table 11: Age-standardised risk factor prevalence rates (percent with, 15+ years, and New Zealand, 2006/2007 New Zealand Indicator Non- Non- Overweight Obesity Female Male Female Male 26.3 ( ) 30.3 ( ) 28.2 ( ) 49.5 ( ) 48.6 ( ( ) 27.9 ( ) 38.7 ( ) 33.3 ( ) 29.4 ( ) 28.3 ( ) 28.8 ( ) 28.1 ( ) 32.4 ( ) 30.2 ( ) 40.5 ( ) 39.7 ( ) 40.1 ( ) 29.9 ( ) 41.4 ( ) 35.6 ( ) 24.0 ( ) 23.1 ( ) 23.6 ( ) Female 59.2 ( ) 19.3 ( ) 44.2 ( ) 14.4 ( ) Current daily smokers Hazardous drinking (SI DHBs excl CDHB) Source: HDIU/NZHS Male Female Male 51.3 ( ) 55.5 ( ) 22.4 ( ) 34.9 ( ) 29.0 ( ) 24.4 ( ) 21.8 ( ) 10.2 ( ) 31.5 ( ) 22.1 ( ) 38.3 ( ) 41.5 ( ) 22.2 ( ) 40.9 ( ) 30.9 ( ) 18.2 ( ) 16.2 ( ) 12.7 ( ) 29.2 ( ) 20.6 ( ) Prevalence of Medicated Risk Factors Table 12 presents the prevalence of high cholesterol and high blood pressure for which medication was taken, as reported in A Portrait of Health: Key Results of the 2006/07 New Zealand Health Survey. The prevalence of both risk factors was lower for than for non- in but this difference was not statistically significant. At the national level, were significantly less likely to have medicated high cholesterol and hypertension. This may be due to lack of diagnosis or fewer prescribed medications rather than a lower burden of disease from these risk factors. 23

24 Table 12: Medicated risk factors, 5+ years, age standardised prevalence rates, percent with 95% CI, and New Zealand, 2006/07 New Zealand Indicator Non- Non- Self-reported medicated high cholesterol Self-reported medicated high blood pressure Source: NZHS/HDIU Female Male Female Male 3.8 ( ) 5.4 ( ) 4.5 ( ) 8.2 ( ) 8.3 ( ) ) 6.2 ( ) 8.3 ( ) 7.2 ( ) 11.7 ( ) ) 11.3 ( ) 3.7 ( ) 5.3 ( ) 4.4 ( ) 8.2 ( ) 8.3 ( ) 8.2 ( ) 6.1 ( ) 8.1 ( ) 7.0 ( ) 11.6 ( ) 10.8 ( ) 11.2 ( ) Hypertension (raised blood pressure) is considered to be the most important risk factor for stroke. Gentles et al. (2006) reported that the prevalence of raised blood pressure was higher in compared to non-, non Pacific people. Effective treatment of high blood pressure can effectively reduce the risk of stroke. Scragg et al. (1993) found that were less likely than non- and non-pacific people to receive treatment for hypertension. 5.3 Tobacco Exposure to tobacco smoke is a well established risk factor for health problems, both for the smoker and those exposed to environmental tobacco smoke. Health problems related to tobacco smoke include cancers of the lung, larynx, pancreas, kidney, mouth, oesophagus, stomach, cervix and bladder; ischaemic heart disease, peripheral vascular disease and stroke; chronic obstructive pulmonary disease (COPD); and reproductive and childhood effects such as preterm delivery, stillbirth, low birth weight and sudden infant death syndrome (SIDS) (Woodward and Laugesen 2001; U.S. Department of Health and Human Services 2004) Prevalence of Smoking The prevalence of cigarette smoking is defined by the New Zealand Census and New Zealand Health Survey as the proportion of the population over the age of 15 years who currently smoke cigarettes. According to the 2006 Census, the rate of regular smoking in was considerably higher than that for all other ethnicities. Prevalence of daily smoking was higher for women in (45.8%) than men (38.4%), which was consistent with the national profile for tobacco use. Similar to national statistics, 42 percent of aged 15 years and over in were current daily smokers as shown in Table

25 Table 13: Prevalence of regular smoking, 15+ years (%), by gender and ethnicity within and New Zealand, 2006 Females Males total NZ European 22.6% 24.2% 23.4% 19.4% 45.8% 38.4% 42.1% 42.2% Pacific Peoples 39.3% 41.6% 40.4% 30.3% Asian 11.1% 28.8% 18.7% 11.1% MELAA 23.6% 15.4% 19.7% 15.1% Other ethnicity 17.6% 20.0% 18.8% 16.6% totals 22.9% 24.6% 23.8% NZ totals 19.5% 21.9% 20.7% Source: Statistics New Zealand Notes: Ethnicity presented is based on grouped total response. MELAA stands for Middle Eastern, Latin American, African The definition of a regular smoker for the census is someone who smokes cigarettes regularly, i.e. one or more cigarettes a day. Table 14 below illustrates prevalence of regular smoking by age and ethnicity at the 2006 Census. Across all age groups, the age-specific rates for were considerably higher than those for European, Asian and other ethnicities, both nationally and in. Pacific people in also demonstrated very high regular smoking rates. Table 14: Prevalence of regular smoking by age group and ethnicity age 15+,, 2006 Age Group European Pacific Peoples Asian MELAA Other ethnicity New Zealand years 40.4% 25.1% 39.6% 23.3% 17.4% 26.2% 18.8% years 54.1% 39.3% 52.2% 33.3% 30.2% 39.2% 29.8% years 49.8% 34.3% 47.9% 22.2% 22.9% 27.9% 33.9% 28.6% years 43.7% 28.1% 45.0% 18.7% 23.3% 23.8% 28.2% 25.6% years 43.5% 24.2% 55.0% 15.6% 20.2% 24.6% 23.3% years 37.0% 21.1% 22.2% 13.2% 16.4% 21.0% 18.7% years 28.6% 18.3% % 18.0% 15.2% 65+ years 15.1% 8.5% % 8.6% 8.0% totals 42.1% 23.4% 40.4% 18.7% 18.8% 23.8% NZ totals 42.2% 19.4% 30.3% 11.1% 15.1% 16.6% 20.7% Source: Statistics New Zealand Notes: Ethnicity presented is based on grouped total response. MELAA stands for Middle Eastern, Latin American, African. Dashes represent rates that are not reported due to counts <15 There are many areas in where smoking rates for those aged 15 years and over were exceptionally high (over 50 percent), including Otautau, West Invercargill, Mararoa River, Nightcaps, Crinan, Heidelberg, East Gore and Mataura. 25

26 5.3.2 Prevalence of Smoking in Youth The Action on Smoking and Health (ASH) survey is undertaken throughout New Zealand to investigate smoking prevalence in youth. A total of 21 secondary schools from and Otago participated in the latest survey (2008) of smoking amongst year 10 students. Paynter (2009) reported trends over time, showing that there has been a decrease in the number of youth who are smoking or experimenting with smoking in. The proportion of year 10 students who were daily smokers decreased significantly from 16.7 percent in 1999 to 9.8 percent in 2008 (see Table 15 below). Data are not available by ethnicity. Table 15: Smoking behaviour in Year 10 students (aged ~15) within, ASH survey, Smoking status Daily Regular Never number Source: Paynter 2009 According to 2006 Census data, 44.4 percent of and 28.1 percent of European young people aged in were regular smokers (refer below to Figure 6 from Craig et al. 2008). Rates of regular smoking in were higher than national rates of 39.4 percent for and 20.3 percent for European young people. Figure 6: Proportion of Young People aged years who were regular smokers by ethnicity, and New Zealand,

27 5.3.3 Smoking and Deprivation A correlation exists between smoking prevalence and deprivation, although it is probable that ethnicity is a significant factor in this difference. are over represented in deciles with the highest deprivation scores and also have significantly higher rates of smoking than non-, in and nationally (Refer Figure 7 below from Craig et al. 2008). Youth smoking in was higher than national averages across all deprivation index deciles. youth smoking rates ranged from 15.9% for the most affluent decile (Decile 1) to 44.4 percent for those living in Decile 10 areas (refer to Figure 7 below from Craig et al. 2008). Figure 7: Proportion of young people aged Years who were regular smokers by NZ Deprivation Index Decile, and New Zealand, Pregnancy and Smoking Cigarette smoke contains a range of toxins, including nicotine and carbon monoxide, which rapidly cross the placenta, and in the context of chronic use, often result in levels in the foetal compartment which exceed those seen maternally (Rogers 2009). Further, smoking in pregnancy has been associated with a range of adverse pregnancy outcomes including stillbirth, preterm birth and intrauterine growth restriction, with dose-response relationships consistently being observed, and with the risk being reduced if women give up smoking during pregnancy (Rogers 2009). In addition, smoking during pregnancy is thought to increase the risk of later adverse outcomes for children including Sudden Unexpected Deaths in Infancy (SUDI) and neurobehavioral problems such as attention deficit disorders, hyperactivity, learning difficulties and an increased risk of smoking in later life (Rogers 2009). In from , tobacco use in women giving birth was higher for than for all other ethnic groups; this is similar to the national trend, as illustrated in Figure 8 below from Craig et al Rates of tobacco use in women giving birth were higher in and European women than in respective New Zealand ethnic specific averages. 27

28 Figure 8: Proportions of women giving birth who used tobacco by ethnicity, , and New Zealand Parental Smoking In New Zealand during 2008, national ASH surveys indicated that 38 percent of Year 10 students had a parent who smoked; parental smoking rates were higher for compared to other ethnicities. From in, the proportion of year 10 students who reported at least one parent smoking decreased from 46 to 39 percent. The proportion who reported living in homes where people smoked inside decreased significantly from 44 percent in 2001 to 24 percent in 2008 (Paynter 2009). The New Zealand Census 2006 presented similar findings, with 35 percent of New Zealand children aged 0-14 years living in a household with a smoker. Prevalence was higher for compared to all other ethnicities. According to Census data, in in percent of children aged 0-14 years lived in a household with a smoker. During this time, 57.3 percent of children lived in a household with a smoker, compared to 33.2 percent of European children in (see Figure 9 below from Craig et al. 2008). Figure 9: Proportion of children 0-14 years living in a household with a smoker at the 2006 Census, by ethnicity, and New Zealand 28