Otago Māori Health Profile

Transcription

1 Māori Health Profile 2011

2 Table of Contents 1 Executive Summary... 2 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 & Youth Health Tamariki / Child and Rangatahi / Youth Health Health Status Respiratory Tract Infections and Conditions Skin Infections Gastroenteritis Unintentional Injury Oral Health Sexual and Reproductive Health Section 3 Service Utilisation Health Service Utilisation References Appendix 1: Glossary of Terms Appendix 2: Information/Data Sources Appendix 3: Data notes P a g e

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, 12,500 people identified as Māori in 2006, comprising approximately seven percent of the population in the 2006 Census. Birth rates (2007) were higher amongst Māori populations in compared to non-māori. The age profile for Māori in in 2006 was similar to that nationally in that the Māori population was more youthful than the non-māori population. Population growth is projected to continue at higher rates in Māori populations compared to non-māori populations in, such that Māori will comprise 8.7 percent of the population in Overall, Māori in are less well off compared to non-māori 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. A greater proportion of Māori lived in higher deprivation areas than Europeans/Others in Nutrition, Physical Activity and Obesity Nutrition The New Zealand Health Survey (2006/07) results reflected the prevalence of healthy nutrition behaviours (having three or more servings of vegetables or two or more servings of fruit per day) was lower for Māori than Europeans/Others in but this was not a statistically significant difference. Physical activity The New Zealand Health Survey (2006/07) results indicated the rate of participation in regular physical activity was higher for Māori than Europeans/Others in. This was not a significant difference. Obesity According to NZHS results, the prevalence of obesity was significantly higher for Māori in than for European/Others. Tobacco According to the 2006 Census, the rate of smoking in Māori was considerably higher than the rate for all other ethnicities. More Māori women in smoked daily (38.3%) than men (35.0 percent), which was consistent with the national profile for Māori. According to 2006 Census data, 31.8 percent of Māori and 18.6 percent of European young people aged years in were regular smokers. ASH surveys in 2998 found that a higher proportion of Māori youth was exposed to smoking at home than non-māori, but like non-māori, this proportion is decreasing over time. 1.2 Health Status Avoidable Mortality Avoidable mortality rates were significantly higher among Māori than among European/Other ethnic groups. This difference was significant for Māori men in and for Māori overall. Avoidable mortality rates were higher for Māori women than for European/Other women but these differences were not statistically significant. 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.

4 The main causes of avoidable mortality in were similar for Māori and European/Other Populations, with cardiovascular disease, colorectal cancer and intentional injuries included in the five most common causes for both populations. Stomach cancer and unintentional injuries were more common in Māori, replacing lung cancer and respiratory diseases as common causes of avoidable mortality in European/Other populations. Avoidable hospitalisation Over the period , Māori rates of avoidable hospitalisation in were significantly higher than European/Other rates but significantly lower than New Zealand Māori rates. This difference was significant for Māori women and Māori overall. The leading causes of avoidable hospitalisation for Māori were respiratory infections, angina, cellulitis, asthma and ENT (ear, nose and throat) infections. This pattern was similar to avoidable hospitalisations for European/Other populations, with asthma amongst Māori replaced by gastroenteritis amongst European people. Health service utilisation As at 1 January 2011, six percent of people enrolled in the area of the Southern PHO identified as Māori. NZHS data (2006/07) indicate that Māori in were less likely than non-māori to have visited a GP in the previous 12 months, but this difference was not statistically significant. NZHS data also indicate that Māori in were more likely than non-māori to have had an unmet need for a GP; this difference was not statistically significant Cardiovascular Disease Cardiovascular disease mortality rates ( ) were higher for Māori than Europeans/Others in, but these differences were not statistically significantly. Ischaemic heart disease Overall ischaemic heart disease mortality rates were higher for Māori in compared to European/Others but these differences were not significantly different. From , ischaemic heart disease hospitalisation rates for Māori females were higher and rates for Māori males lower than rates for Europeans/Others, but these were not statistically significant differences. Stroke (cerebrovascular disease) Stroke hospitalisation rates ( ) for Māori were much lower than rates for European/Others, although these differences were not statistically significant. The stroke mortality rate ( ) for Māori was much higher than the rate for European/Other populations but this was not a statistically significant difference Respiratory Disease Asthma From in and nationally, Māori rates of hospitalisation (for males and the combined male-female population aged over 14 years) due to asthma were significantly higher than rates for Europeans. The number of avoidable hospital admissions for the general population (age 0-74 years) and children (age 0-4 years) was much higher for Māori compared to Other populations in the Southern DHB ( ). Chronic obstructive pulmonary disease (COPD) COPD hospitalisation rates ( ) were higher for Māori in compared to European/Other populations but this result was not significantly different. 3 P a g e

5 1.2.4 Diabetes The Ministry of Health estimated there were 8,704 people with diabetes in and 4,696 people with diabetes in Southland in 2008, giving a total of 13,400 in the Southern District. Of the total, 817 were Māori, 221 Pacific and 12,362 of Other ethnicities. The peak prevalence of diabetes for Māori populations was in the age group, while for Others the prevalence peaked approximately 10 years later between years (LDT 2008). Of Māori who accessed the Get Checked programme in in 2008, 62 percent had good or satisfactory HbA1c levels (indicative of good management), compared to 77 percent for European/Other populations. The ethnicity of diabetic smokers was reported; 26 percent of Māori diabetics smoked in 2008, compared to 18 percent of Pacific People diabetics and 10 percent of diabetic Others. Using a BMI over 30 to indicate obesity, sixty four percent of Māori and 48 percent of non-māori, non-pacific people with diabetes were considered obese in Diabetes hospitalisation rates ( ) for Māori were significantly higher than rates for European populations. Over the same time period in and nationally, Māori rates of hospitalisation due to renal failure as a long term complication of diabetes were significantly higher than rates for European/Other populations Cancer Age standardised cancer registration and mortality rates for Māori and non-māori in the Southern DHB from demonstrated no significant differences by ethnicity. This may be due to small numbers. Rates of hospitalisation for lung cancer, breast cancer, and prostate cancer in ( ) were higher for Māori compared to non-māori but these differences were not statistically significant. Colorectal cancer hospitalisation rates ( ) for Māori in were similar to non-māori rates and higher than rates for New Zealand Māori, but these differences were not significant. Breast Screening For the 24 months ending 31 December 2009, breast screening coverage for Māori women aged in the population was below target at 67 percent, while the former DHB achieved 79 percent breast screening coverage. Cervical Screening For the 36 months ending January 2010, the former District Health Board had one of the highest screening rates in the South Island for the total eligible population, achieving over 79 percent coverage. Over the same time period, the screening rate for Māori women in (49.5 percent) was considerably below the target screening rate Communicable Diseases Māori salmonellosis notifications were significantly higher than New Zealand Māori rates, but significantly lower than European/Other population rates. For the 12 months ending 30 June 2010, Māori in had slightly lower immunisation coverage rates at 6 months than non-māori, (72 percent for Māori compared to 78 percent for non-māori) but immunisation coverage rates were similar at all other milestone ages. Immunisation rates for Māori in were higher at all milestone ages than for Māori nationally Unintentional injury Over the time period , unintentional injury hospitalisation rates for Māori were similar to rates for European/Other populations. Unintentional injury hospitalisation rates for Māori were significantly lower than rates for New Zealand Māori during this same time period. Unintentional injury mortality rates for Māori males and Māori overall in for the period were higher than rates for European/Others but these differences were not statistically significant. The rate of unintentional injury mortality for Māori males and Māori overall in for the 4 P a g e

6 period was lower than the rate for New Zealand Māori but this difference was not statistically significant Oral health According to the NZHS 2006/07, Māori in were significantly less likely than Europeans/Others 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 Māori than for European/Other people but this was not a statistically significant difference Breastfeeding Rates of exclusive/full breastfeeding at six weeks, three months, and six months for Māori and European/Others in (from ) were lower for Māori at every age. However, Māori infants in were more likely to breastfeed than New Zealand Māori infants at every age Hospitalisation From , the most common causes of hospitalisation for children in age 0-4 years were similar for Māori and non-māori 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. Asthma was a leading cause of hospitalisation for Māori while gastroenteritis was a leading cause among European/Other children in. For children aged 5-14 years, the most common causes of hospitalisation were similar for Māori and non-māori children in, with most common causes for both including ENT infections, respiratory infections, chronic diseases of tonsils and adenoids and asthma. Diabetes was a main cause of hospitalisation for Māori, replaced by dental conditions in European/Other populations. Ambulatory sensitive hospitalisation From , the most common causes of ambulatory sensitive hospitalisations (avoidable hospitalisations) for children age 0-4 years in were acute upper respiratory tract infections, gastroenteritis, asthma and dental conditions. ASH rates increased for both Māori and European children from Rates were higher for European children until , at which time rates for Māori children surpassed rates for European children Respiratory Tract Infections and Conditions Upper respiratory tract infection (URTI) Admissions for acute URTI and croup/laryngitis/tracheitis were higher for European children than for Māori children during the mid to late 1990s. However, ethnic differences were less consistent over the past 4 years. Rates of waiting list admission for tonsillectomy were higher for Europeans than Māori in and New Zealand, but in recent years rates appear to be declining in European children. From 1996 to 2007 in, waiting list admissions for grommets were higher for European than for Māori children, but declined significantly over this time period. The rate of grommets insertion for Māori children also declined over this time period and remained lower than the European rates. Lower Respiratory Tract Infections There were no consistent differences in bronchiolitis admission rates between Māori and European infants under one year of age. Admission rates for viral or bacterial pneumonia in Māori children and young people in were slightly higher than rates for European children. 5 P a g e

7 Asthma From 1996, hospitalisation rates for Māori children were initially similar to European children, but rates for Māori children and young people increased from From 1996 to 2007, rates for asthma admissions were lower for Māori children than for New Zealand Māori children Skin Infections From 1996 to 2007, rates of hospitalisation for serious skin infection for Māori were initially similar to European children and young people but have increased since The difference between Māori and Europeans was much greater nationally, where the admission rate for Māori children and young people was more than double that for Europeans over the period Gastroenteritis From 1996 to 2007, rates of hospitalisation for gastroenteritis for Māori were lower than rates for European children and young people. The rates for Māori in were also lower than rates for Māori nationally over the period from 1996 to Unintentional Injury Risk factors for injury related mortality and hospital admission include gender (male), ethnicity (Māori), 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 Oral Health In 2009, the mean DMFT decayed, missing or filled deciduous teeth) score and proportion of children who did not have caries (tooth decay) for five year olds and Year 8 students (12) show that Māori children in had higher rates of decayed, missing or filled teeth and a lower rate of being decayfree than non-māori. Māori children with fluoridated water supplies had lower DMFT scores than Māori children with non-fluoridated water suppliers. Māori and non-māori of all ages in were equally likely to be admitted to hospital for dental caries. Māori in were less likely than New Zealand Māori to be admitted to hospital for dental caries Sexual and Reproductive Health Teenage birth rates (15 to 19 year olds) for Māori in were higher than rates for Europeans over the period from 1996 to Teenage birth rates for Māori teenagers were considerably lower than New Zealand Māori rates. 6 P a g e

8 Section 1 Population Health 2 Introduction The New Zealand Public Health and Disability Act, 2000, reflects that one of the functions of DHBs 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 Māori Health Profile is one component of a Southern DHB Health Needs Assessment, focusing on the health status of the Māori population of the DHB s area. 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 the DHB, 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). 7

9 2.2 Purpose of Māori Health Profile This health profile provides a snapshot of Māori health status in. In addition, key indicators are presented in relation to socio-economic determinants of health, risk and protective factors for health and health service utilisation. This information will assist the DHB to determine local priorities for service planning, in the context of national health priorities and health targets, in order to ultimately achieve health gain for the Māori population in. This profile will be used in tandem with the Southland Māori Health Profile. Key information is presented through charts and graphs. Health indicators are used to provide salient information, with comparisons made between ethnicities and against 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 Appendix 2. Key sources of information include the following: Hauora: Māori Standards of Health IV (2007) 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) 8

10 3 Demographic Profile Southern DHB is the southern most DHB in New Zealand and comprises the provinces of and Southland. The province covers a total of 32,000 square kilometres, approximately 12 percent of New Zealand s land area (Local Government Online). Around two thirds of the population live in and one third in Southland. The province has an estimated population of 184,610 people, 6.8 percent (12,500) of whom are Māori (New Zealand Statistics). Southern DHB has a significant rural population and approximately 40 percent of the population lives outside the two main cities of Dunedin and Invercargill. Southern DHB has eight territorial authorities (TLAs) varying in size and catchment. The province is comprised of four territorial authorities: Dunedin City, Central, Clutha and Waitaki District. Māori comprise 6 percent of the population of Dunedin City, 5 percent of the population in Waitaki, 8 percent of the population of the Clutha district and 7 percent of the population of Central. Comparing absolute numbers, most Māori live in Dunedin City (7,356 or 66 percent), followed by Clutha District (1,482 or 13 percent). Table 1: Number and proportion of Māori in each territorial authority,, Southland, and New Zealand, 2006 Territorial Authority 2006 Census No. of Māori Total Pop Māori 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% Southland District 2,606 29,895 9% Central 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% Total Southland and TAs 22, ,870 8% Total New Zealand 526,281 3,737, % Source: Statistics New Zealand, 2006 *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 information. Table 2 below presents ethnicity data for the population. In the prioritised method, each respondent is allocated to a single ethnic group using the priority system (Māori > Pacific peoples > Asian > European/Other). For example a person who selects (when asked their ethnicity) both Māori and European would only be included in the Māori grouping. Approximately 6.8 percent of s total population identified as Māori in 2006, as illustrated in Table 2. Table 2: Ethnicity of the population in, Census 2006 Ethnic Group Number Māori 12, % Pacific % Asian % European/Other 161, % Total 184, % Percent *Note: Privacy concerns cause small population numbers to be rounded which leads to slight differences in the total populations given here compared to previous tables. 9

11 3.1 Iwi Affiliation Table 3 presents the number of people in and Southland indicating Iwi affiliation at the 2006 Census. Ngāi Tahu/Kāi Tahu was the most common affiliation in and Southland, 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 and Southland. 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 and Southland: has three distinct Rūnanga: Te Rūnanga o Moeraki (Moeraki), Kāti Huirapa Rūnaka ki Puketeraki (Karitane), and Te Rūnanga Otākou (Dunedin). Southland 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 and Southland Regional Council, Statistics NZ, 2006 Iwi Southland Total 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 Total 23,397 19,407 42,804 Notes: This table gives an approximation of iwi affiliation by and Southland Regional Councils as Regional Councils do not align to DHB boundaries. 10

12 3.2 Māori Population Age Distribution Table 4 compares the age distribution for Māori and non-māori in, highlighting the significant differences in the age structure of the populations. The Māori population is a relatively young population group, with fewer people living greater than 65 years of age. Children comprise a much higher proportion of Māori populations compared to non-māori. In, 32 percent of Māori are aged less than 15 years compared to 17 percent of non- Māori. Only three percent of Māori are aged 65 and over, compared to 15 percent of non- Māori. Table 4: populations by age group, Māori and non-māori, Statistics NZ, 2006 Māori Non-Māori Total population n % n Percent n % % 28,450 17% 32,460 18% % 29,940 17% 33,000 18% % 43,240 25% 46,490 25% % 44,360 26% 46,130 25% % 26,120 15% 26,530 14% Total 12,500 99% 172, % 184, % Source: Statistics NZ The significant differences in the age structure of these populations are highlighted in pictorial representations (Figure 2). The triangular shape of the pyramid for Māori indicates a large proportion of the population tends to be younger, with a 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-māori 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 Māori and non-māori 2006 Source: Statistics New Zealand 11

13 3.3 Population Projections Birth Rates Birth rates for Māori in are substantially higher than for non-māori, but rates are lower than for Māori in New Zealand (see Table 6). Higher birth rates result from a combination of a younger Māori population with proportionally more women of child-bearing age and higher fertility rates for Māori compared to non-māori. Table 5: Live births registered in 2007, for mothers of all ages, by ethnic group, and New Zealand Indicator Māori European/ Other Total* Māori New Zealand European/ Other Total* Live births ,289 36,781 65,120 Female Population (15-49 years) 3,280 38,631 45, , ,167 1,033,110 Rate (live births per 1,000 women) Source: Statistics New Zealand/HDIU Notes: *Totals includes Pacific and Asian Populations. 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 Growth Statistics New Zealand develops population projections, basing assumptions on medium fertility, mortality, migration and inter-ethnic mobility for Māori and other populations. The 2006 Census enumerated 12,500 Māori who resided in. Population projections predict the Māori population will increase by 4730 (37.8 percent) to 17,230. The non-māori population in is expected to grow at a much slower rate, increasing by only six percent (9780 people) between 2006 and The proportion of the population that identifies as Māori is projected to increase as a consequence of the projected population growth patterns within Māori and European populations. The proportion of Māori in is projected to increase from almost seven percent in 2006 to almost nine percent in 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. Table 6: Projected populations,, Māori Non-Māori Total population n % n Percent n % , , % 184, % , , % 191, % , , % 194, % , , % 197, % , , % 199, % Source: Statistics New Zealand/ HDIU. 12

14 3.3.3 Projected Population Age Structure The age structure of the Māori population in is projected to change by 2026, with a slight reduction in the proportion of the population aged 0-14 years and years and an increase in the proportion of the Māori population over age 65 years. In 2006 the proportions of the Māori population in aged under 15 years and over 65 years were 32 percent and three percent respectively. In 2026 the respective proportions are projected at 30 percent and nine percent, representing a slight reduction in the younger age group and tripling of the older age group. Table 7: Population projections for Māori population in DHB, medium series Age 0-14 Age Age Age 65+ All Ages n % n % n % n % % % % 12, % % % 13, % % % 15, % % % 16, % % % 17,230 Source: Statistics New Zealand Note: *These projections have as a base the estimated resident population of Māori as at 30 June 2006 and incorporate medium fertility, medium mortality, medium migration, and medium inter-ethnic mobility assumptions for each area 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. Life expectancy for people in is higher than that of the average New Zealander. Females still have a higher life expectancy than males, but the gap between males and females is decreasing at regional and national levels. Figure 3: Life expectancy for the Region and New Zealand, 2006 Source: Statistics New Zealand Note: 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 non-māori and Māori populations. Life expectancy at birth for New Zealand Māori is considerably lower than life expectancy for non-māori. Life expectancy for New Zealand Māori in 2006 was 70.4 years for males and 75.1 years for Māori females, compared to 79.0 years for non-māori males and 83.0 years for non-māori females. Overall, in 2006, Māori life expectancy at birth was at least eight years less than that for non-māori of both genders. There is no specific information on Māori life expectancy in. 13

15 Table 8: Life expectancy, and New Zealand, 2006 Life Expectancy (Years) Area Male Female New Zealand non-māori New Zealand Māori Source: Statistics New Zealand 14

16 4 Socioeconomic Determinants of Health KEY FINDINGS: Overall, Māori in are less well off compared to non-māori with respect to a number of indicators from the 2006 Census: Māori were significantly less likely to own their own home than Europeans/Others in. The unemployment rate for Māori over age 15 in was significantly higher than the rate for Europeans/Others although it was lower than the rate for New Zealand Māori. A lower proportion of Māori over 15 years in had attained NCEA Level 2 or a higher qualification compared to Europeans/Others. More than twice as many Māori as Europeans/Others in lived in a dwelling where there were insufficient bedrooms for the number of people living in the house. Significantly higher percentages of Māori did not have access to a telephone or cellphone than European/Others in the population. More Māori than Europeans/Others in did not have access to a motor vehicle. A higher proportion of Māori lived in higher deprivation areas than Europeans/Others in. Māori in were less represented in the highest deprivation areas (9 and 10) and better represented in the lowest deprivation areas (1 and 2) than Māori nationally. From , the proportion of Māori with low incomes in was consistently higher than the proportion for Europeans/Others. 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 Māori and non-māori (Ministry of Health and University of 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 Māori and non-māori), 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. 15

17 Figure 4 illustrates that in New Zealand higher proportions of Māori than non-māori live in areas of high deprivation; fewer Māori live in areas of low deprivation compared to non-māori. Nationally, 42 percent of Māori live in areas with the two highest deprivation scores (deciles 9 and 10), compared to 7 percent in areas with the two lowest scores (deciles 1 and 2). This compares to 16 percent of non- Māori living in the areas with the highest deprivation scores and 22 percent living in areas with the lowest scores. Figure 4: Deprivation profile New Zealand, Māori and non-māori, New Zealand, 2006 Source: Statistics New Zealand Figure 5 shows that Māori in are more likely to live in areas with higher deprivation scores (deciles 8, 9 and 10), with 24 percent of Māori living in higher deprivation areas compared to 19 percent of non-māori. Thirteen percent of Māori live in areas with the lowest scores (deciles 1 and 2) compared to 18 percent of non-māori. Figure 5: Deprivation profile, Māori and non-māori,, 2006 Source: Statistics New Zealand 16

18 Māori in live in areas of relatively less deprivation (NZDep scores) compared to Māori in all New Zealand. Table 10 provides additional detail in relation to numbers and proportions of Māori in and New Zealand by area of deprivation. Māori in were less represented in the areas with high deprivation scores (9 and 10) and better represented in the areas with the lowest scores (1 and 2) than Māori nationally. Table 9: Deprivation, by decile, and New Zealand, 2006 Decile New Zealand Māori Non-Māori Māori Non-Māori Number % Number % Number % Number % % 20,340 12% 19,020 3% 407,637 11% % 14,113 8% 24,435 4% 396,924 11% 3 1,200 11% 20,193 12% 28,830 5% 391,833 11% 4 1,152 10% 17,028 10% 33,096 6% 382,407 11% 5 1,359 12% 19,689 12% 39,366 7% 373,137 10% 6 1,197 10% 15,192 9% 49,350 9% 368,670 10% 7 1,830 16% 23,523 14% 57,879 10% 358,503 10% 8 1,887 17% 20,109 12% 72,459 13% 345,585 10% % 10,788 6% 97,323 18% 329,961 9% % 6,930 4% 134,616 24% 285,990 8% Total 11, % 167,905 99% 556,374 99% 4,129, % Source: Statistics New Zealand Notes: *Total does not equal 100% due to rounding Privacy concerns cause small population numbers to be rounded which leads to slight differences in the total populations given here compared to previous tables Social and Economic Indicators Income 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 Table 10 below lists the proportion of people with low incomes in from 1986 to 2006, demonstrating that the proportion of Māori with low incomes in was consistently higher than the proportion for Europeans/Others. Table 10: Proportion of population with low incomes, by ethnicity,, 2006 Māori Europeans/Others Total* Number % Number % Number % % % 28,035 21% 29, % 39,651 30% 42, % 37,494 27% 41, % 30,369 23% 33, % 27,888 20% 31, Source: Statistics New Zealand Note: *Total includes Pacific, Asian and Other ethnicities. 17

19 Other indicators of socio-economic status Table 11 summarises some of the other indicators of socio-economic status that make up the NZDep scores. Overall, Māori in are less well off compared to Europeans/Others with respect to a number of indicators from the 2006 Census. This is also true for the New Zealand Māori population as a whole. Home ownership is an indicator of income; the quality of housing is related to health (Howden- Chapman and Wilson 2004). Māori 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 2006). The unemployment rate for Māori over age 15 in was significantly higher than the rate for Europeans/Others, although it was lower than the rate for Māori in New Zealand. Higher levels of educational attainment are related to improved health outcomes (Wilkinson and Marmot 2003). A significantly lower proportion of Māori 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). More than twice as many Māori as non-māori in lived in a dwelling where there were insufficient bedrooms for the number of people living in the house. This was a significant difference. Telephones facilitate social connection to others and a range of activities of daily living. Significantly higher percentages of Māori did not have access to a telephone or cellphone than European/Others in the population. Significantly more Māori than Europeans/Others in did not have access to a motor vehicle. Table 11: Social and economic indicators, in adults over 15 years,, age-standardised rates, percent with 95% confidence intervals, and New Zealand, 2006 Indicator, percent New Zealand, percent Māori European/ Other Māori European/ Other Not living in own home, 15+ years 59.2 ( ) 46.8 ( ) 66.3 ( ) 48.4 ( ) Unemployed, 15+ year 5.3 ( ) 3.3 ( ) 6.9 ( ) 3.3 ( ) NCEA Level 2 or higher, 15+ years 52.1 (50.5, 53,8) 63.7 (63.3, 64.2) 42.1 ( ) 63.1 ( ) Household crowding, all ages 8.6 ( ) 3.8 ( ) 21.2 ( ) 5.8 ( ) Living in household with no access to a telephone or cellphone, 15+ years 3.0 ( ) 1.1 ( ) 5.3 ( ) 1.2 ( ) Living in household with no access to a motor vehicle, 15+ years 8.8 ( ) 5.3 ( ) 9.4 ( ) 4.0 ( ) Source: Statistics New Zealand 18

20 4.1.2 Access to heating There is a body of evidence that inadequate household heating can have negative health consequences for the occupants. Most homes in Dunedin (86 percent) were built prior to 1978 and the majority are either uninsulated or insufficiently insulated. Many people in Dunedin experience fuel poverty, i.e. they cannot afford to keep their homes warm. It is estimated that from 7 to 36 percent of households experience fuel poverty, depending on definitions used to define adequate temperature (Povey and Harris 2004). 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 Māori and Pacific people. 19

21 5 Risk and Protective Factors KEY FINDINGS PROTECTIVE FACTORS In 2006/07, the New Zealand Health Survey results reflected differences between Māori and European/Other populations over age 15 years. The prevalence of healthy nutrition was lower for Māori than Europeans/Others in. This was not a significant difference. The rate of participation in regular physical activity was higher for Māori than Europeans/Others in. This was not a significant difference. RISK FACTORS According to NZHS results, the prevalence of obesity was significantly higher for Māori in than for European/Others. The prevalence of being overweight was lower for Māori than European/Others in. This was not a significant difference. The prevalence of current daily smoking was significantly higher for Māori in than for European/Others, with a higher prevalence among Māori women than Māori men. The prevalence of medicated high blood pressure and high cholesterol was lower for Māori in than for European/Others but this difference was not statistically significant. According to the 2006 Census, the rate of smoking in Māori was considerably higher than that for all other ethnicities. More Māori women in smoked daily (38.3%) than men (35.0%), which was consistent with the national profile for Māori. A smaller proportion of Māori aged 15 and over in were current daily smokers (37 percent) compared to Māori in New Zealand (42 percent). According to 2006 Census data, 31.8 percent of Māori and 18.6 percent of European young people aged years in were regular smokers. Rates of regular smoking in were lower than national rates of 39.4 percent for Māori and 20.3 percent for European young people. In 2008, a higher proportion of Māori youth was exposed to smoking at home than non- Māori, but like non-māori, this proportion is decreasing over time. Sources of data for many risk and protective factors are limited, with the main sources of data being the New Zealand Health Survey (NZHS, Ministry of Health 2008). Other than the NZHS, data on smoking were collected in the Census 2006, and these data are also collected through annual Action on Smoking and Health 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 12 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 Māori than European/Others, but this was not a significant difference. The prevalence of regular physical activity by Māori was higher than for Europeans/Others, but again this was not a significant difference. The prevalence of some protective 20

22 factors (3+ servings of vegetables/day, regular physical activity) appeared higher in Māori than New Zealand Māori but this was not a significant difference. Table 12: Age-standardised protective factor prevalence, 15+ years, and New Zealand, 2006/07 New Zealand Indicator European/ Other European/ Other Female 72.0 ( ) 81.8 ( ) 63.5 ( ) 72.3 ( ) 3+ servings of vegetables/day Male 60.3 ( ) 67.2 ( ) 53.2 ( ) 59.3 ( ) Total 66.5 ( ) 74.8 ( ) 58.8 ( ) 66.0 ( ) Female 59.7 ( ) 66.5 ( ) 62.1 ( ) 69.1 ( ) 2+ servings of fruit/day Male 44.4 ( ) 48.3 ( ) 46.1 ( ) 50.2 ( ) Total 52.6 ( ) 57.7 ( ) 54.7 ( ) 59.2 ( ) Regular physical activity Female 60.7 ( ) 59.1 ( ) 51.1 ( ) 49.8 ( ) Male 72.0 ( ) 66.0 ( ) 60.7 ( ) 55.6 ( ) Total 65.9 ( ) 62.4 ( ) 55.6 ( ) 52.6 ( ) Source: HDIU/NZHS Note: European/Others are non-māori, non-pacific, non-asian. 5.2 Risk factors Risk factors are states or activities that increase an individual s likelihood of becoming unwell or contracting a disease. Table 13 presents risk factor prevalence for and New Zealand as reported in the New Zealand Health Survey 2006/ 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 Māori in than for European/Others. There was a lower but non-significantly different prevalence of being overweight for the total Māori population in compared to the European/Other population. However, the proportion of Māori men who were overweight was significantly lower than the proportion of European/Other men in Current daily smoking The prevalence of current daily smoking was significantly higher for Māori in than for European/Others, with a higher prevalence among Māori women than Māori men. Māori rates of daily smoking were similar to New Zealand Māori rates. More detailed information about smoking is presented at the end of this section. 21

23 5.2.3 Hazardous drinking The prevalence rates of hazardous drinking were not significantly different between Māori and non- Māori in South Island DHBs, nor were there differences comparing South Island Māori to New Zealand Māori. Table 13: Age-standardised risk factor prevalence, percent with 95% confidence intervals, 15+ years, and New Zealand, 2006/2007 New Zealand Indicator European/Other European/ Other Female 26.8 ( ) 29.6 ( ) 28.1 ( ) 31.1 ( ) Overweight Male 30.8 ( ) 40.2 ( ) 32.4 ( ) 42.2 ( ) Total 28.7 ( ) 34.9 ( ) 30.2 ( ) 36.6 ( ) Female 36.5 ( ) 21.4 ( ) 40.5 ( ) 23.7 ( ) Obesity Male 35.9 ( ) 20.7 ( ) 39.7 ( ) 22.9 ( ) Total 36.2 ( ) 21.1 ( ) 40.1 ( ) 23.3 ( ) Female Current daily smokers Male 38.8 ( ) Total 42.0 ( ) Hazardous drinking (SI DHBs excl CDHB) Female Male Total 22.4 ( ) 34.9 ( ) 29.0 ( ) 11.7 ( ) 33.2 ( ) 22.1 ( ) 22.2 ( ) 40.9 ( ) 30.9 ( ) 12.7 ( ) 29.2 ( ) 20.6 ( ) Source: HDIU/NZHS Note: European/Others are non-māori, non-pacific, non-asian 22

24 5.2.4 Prevalence of Medicated Risk Factors Table 14 presents the prevalence of high cholesterol and high blood pressure for which medication was taken, as reported in the NZHS 2006/07. The prevalence of both risk factors was lower for Māori in than for European/Others but these differences were not statistically significant. At the national level, Māori 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. Table 14: Medicated risk factors, 5+ years, age standardised prevalence rates, percent with 95% CI, and New Zealand, 2006/07 New Zealand Indicator European/Other European/Other Female 4.2 ( ) 6.8 ( ) 3.7 ( ) 6.1 ( ) Self-reported medicated high cholesterol Male Total 5.9 ( ) 4.9 ( ) 9.0 ( ) 7.8 ( ( ) 4.4 ( ) 8.1 ( ) 7.1 ( ) Self-reported medicated high blood pressure Female Male Total 9.6 ( ) 9.7 ( ) 9.6 ( ) 14.0 ( ) 12.5 ( ) 13.3 ( ) 8.2 ( ) 8.3 ( ) 8.2 ( ) 12.0 ( ) 10.7 ( ) 11.4 ( Source: HDIU/NZHS Note: European/Others are non-māori, non-pacific, non-asian 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 Māori compared to non-māori, non-pacific people. Effective treatment of high blood pressure can effectively reduce the risk of stroke. Scragg et all (1993) found that Māori were less likely than non-māori 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 (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, a lower proportion of Māori aged 15 years and over in were current daily smokers (36.7 percent) compared to Māori in New Zealand (42.2 percent), as shown in Table 15. However, the rate of smoking for Māori was considerably higher than that for all other ethnicities in. A greater proportion of Māori women in smoked daily (38.3 percent) than men (35.0 percent), which was consistent with the national profile for Māori. 23

25 Table 15: Prevalence of regular smoking, 15+ years (percent), by gender and ethnicity within and New Zealand, 2006 Females Males Total NZ Total European Māori Pacific Peoples Asian MELAA Other ethnicity total NZ total Source: Statistics New Zealand Notes: Ethnicity presented is based on grouped total response. MELAA stands for Middle Eastern, Latin American, African Prevalence of Smoking by Age and Ethnicity Table 16 below illustrates prevalence of regular smoking by age and ethnicity at the 2006 Census. In, smoking rates were highest amongst those aged years, with those aged years most likely to smoke regularly. Those in the year age group were less likely to be regular smokers. Rates declined in the older age groups, with the lowest rates being amongst those over 65 years. Across age groups, the age-specific rates for Māori were considerably higher than those for non-māori, both in and nationally. Table 16: Prevalence of regular smoking by age group and ethnicity age 15+,, 2006 Age Group Māori European Pacific Peoples Asian MELAA Other ethnicity Total Total New Zealand years 27.3% 15.7% 21.3% 6.5% 9.6% 11.3% 15.7% 18.8% years 40.1% 25.5% 30.0% 12.5% 15.3% 20.1% 25.5% 29.8% years 48.3% 29.1% 34.8% 12.7% 20.7% 22.8% 29.1% 28.6% years 41.4% 26.3% 37.3% 9.4% 12.5% 23.4% 26.3% 25.6% years 42.0% 23.1% 33.0% 8.6% 15.2% 19.6% 23.1% 23.3% years 31.2% 18.9% 23.5% 9.3% % 18.9% 18.7% years 30. 3% 16.6% % 16.6% 15.2% 65+ years 15.7% 8.0% % 8.0% 8.0% total 36.7% 19.5% 28.3% 10.0% 13.7% 17.2% 19.5% 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 have been suppressed due to counts <15 There are many areas where Māori smoking rates were exceptionally high in, including Milton, Balclutha, Kaitangata, Lawrence, Middlemarch, Ranfurly, Cromwell, Central Oamaru and South Dunedin, where more than 50 percent of Māori aged 15 years and over were classified as regular smokers 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 Southland participated in the latest survey (2009) of smoking amongst year 10 students. 24

26 Paynter reported trends over time in the National Year 10 Snapshot Survey, , demonstrating 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 15.8 percent in 1999 to 5.1 percent in 2008 (see Table 17 below). Data are not available by ethnicity. Table 17: Smoking behaviour in Year 10 students (aged ~15) within, Smoking status Daily 15.8% 18.1% 12.5% 12.9% 12.5% 9.2% 10.4% 8.1% 6.7% 5.1% Regular 30.5% 33.6% 23.8% 24.5% 21.5% 16.5% 18.5% 13.3% 12.0% 11.4% Never 29.6% 29.2% 33.3% 36.1% 39.3% 43.0% 46.1% 54.1% 58.4% 61.7% Source: Paynter 2009 According to 2006 Census data, 31.8 percent of Māori and 18.6 percent of European young people aged years in were regular smokers (refer Figure 6 below). Rates of regular smoking in were lower than national rates of 39.4 percent for Māori 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, 2006 Source: Statistics New Zealand, Craig et al 2008 Note: European/Other are non-māori, non-pacific, non-asian Parental Smoking In New Zealand during 2008, ASH surveys nationally indicated that 38 percent of Year 10 students had a parent who smoked; parental smoking rates were higher for Māori compared to other ethnicities. From in, the proportion of year 10 students who reported at least one parent smoking increased from 35 percent to 38 percent. However, the proportion who reported living in homes where people smoked inside decreased significantly from 29 percent in 2001 to 22 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 Māori compared to all other ethnicities. Findings in were similar to New Zealand results overall (see Figure 7 below from Craig et al. 2008). 25

27 Figure 7: Proportion of children 0-14 years living in a household with a smoker at the 2006 Census, by ethnicity, and New Zealand Smoking and Deprivation A correlation exists between smoking prevalence and deprivation, although it is probable that ethnicity is a significant factor in this difference. Māori are over represented in the areas with the highest deprivation scores and also have significantly higher rates of smoking than non-māori, regionally and nationally (Refer Figure 8 below from Craig et al. 2008). Figure 8: Proportion of young people aged Years who were regular smokers by NZ Deprivation Index Decile, and New Zealand, 2006 Source: Statistics New Zealand, Craig et a.l 2008 Note: European/Other are non-māori, non-pacific, non-asian 26