Ethnic mortality trends report
Ethnic mortality trends report
Mäori and Pacific peoples have made little, if any, life expectancy gains in the past two decades, according to a joint Ministry of Health and Otago University report released today.
In contrast, life expectancy improved dramatically for European New Zealanders from 1980-1999.
The report -- Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980-1999 -- aims to give policy makers and others accurate estimates for mortality rates during a time of significant structural change in the country's economy and society.
Ministry of Health spokesman Dr Don Matheson said while the results are not unexpected, they are still of great concern.
"We've known for some time that ethnic identity is an important dimension of health inequalities in New Zealand, but this is the first time that robust ethnic mortality rates have been available, allowing the full extent of the disparity to be documented. Such health inequalities are unacceptable," the Ministry's Deputy Director-General of Public Health said.
``The report clearly supports ongoing efforts in the health and disability sector to reduce health inequalities, helping New Zealanders to live healthier, longer lives.
``We're already doing a lot of work in this area. The Government has recognised the importance primary health care plays in reducing health inequalities by spending more than $400 million over three years on implementing the Primary Health Care Strategy.
``Fundamental to this policy are Primary Health Organisations (PHOs), and in the past year about 1.7 million New Zealanders have enrolled in PHOs. Of these, more than 800,000 people are now paying no more than $20 to visit the PHO.
``We believe that by making low-cost primary health care more accessible we can make a real difference to improving the overall health of New Zealanders and reducing health inequalities, particularly for high needs groups such as Mäori and Pacific peoples.''
The report shows European New Zealanders now live 10 years longer on average than Mäori; in the early 1980s there was a seven-year difference. And Pacific people now live an average of six or seven years less than European New Zealanders, compared with three to four years less in the early 1980s.
The main contributor to the growing inequality in survival chances between the ethnic groups is differing chronic disease mortality in middle and old age. Among the chronic diseases, heart disease death rates fell for all ethnic groups but at a much faster rate for European New Zealanders than others. So heart disease remains the leading contributor to the overall mortality disparity.
``Cancer, diabetes and chronic lung disease also make a substantial contribution to differing survival rates,'' Dr Matheson said.
``Cancer death rates actually increased for Mäori and Pacific peoples while they decreased among European New Zealanders. Of particular note, Mäori bowel cancer death rates have nearly doubled in the past 20 years, while Pacific people's bowel cancer death rates have increased approximately 10-fold.''
The report says the mortality trends coincide with major social and economic changes in New Zealand in the 1980s and 1990s.
``The ethnic mortality trend information reported today should mobilise all sectors of the Government and the community to redouble our efforts to address this legacy of increasing ethnic inequality in survival chances,'' Dr Matheson said.
``Reducing health inequalities is a priority, but not just for the Ministry. It requires ongoing commitment across the sector. When you look at these mortality trends, you can see why it's everyone's business.
``Every key piece of work undertaken in the Ministry looks at how we can reduce health inequalities, especially inequalities between ethnic groups.''
Important Ministry policy documents that have reducing inequalities for ethnic groups as one of their key objectives are The New Zealand Health Strategy, He Korowai Oranga, the Mäori health strategy and its associated action plan Whakatätaka, the Primary Health Care Strategy and the Pacific Health and Disability Action Plan.
Questions and Answers
What does Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980-1999 aim to do? Its objectives are to estimate: - trends in mortality rates among Mäori, Pacific and non-Mäori/non-Pacific ethnic groups during the 1980s and 1990s - differences in mortality rates between Mäori, Pacific and non-Mäori/non-Pacific ethnic groups during the 1980s and 1990s.
How does Decades of Disparity estimate the ethnic mortality trends and differences? It used the New Zealand Census-Mortality Study (NZCMS) -- the principal instrument by which the Ministry of Health monitors social inequalities in health -- which involves anonymous and probabilistic linkage of census and mortality records.
This allowed researchers to correct for the undercounting of Mäori and Pacific deaths that has long been known to occur, especially before the changes in death registration processes in late 1995.
By working out the undercount of Mäori and Pacific deaths across the 1980s and 1990s, researchers were able to move on to accurately calculate ethnic trends in mortality during this time. For further information on the NZCMS, go to: www.moh.govt.nz
What is the key finding of Decades of Disparity? Mortality rates declined steadily over the observation period for both genders and all ages for the non-Mäori/non-Pacific ethnic group. By contrast, both Mäori and Pacific ethnic groups showed little change.
Was this result unexpected? No, it has long been acknowledged that Mäori and Pacific peoples have poorer health than European New Zealanders. It is a serious concern, however, that during the 1980s and 1990s, life expectancy improved for European New Zealanders but stayed much the same for Mäori and Pacific peoples.
Why is there such a disparity in the first place? This is a complex area, but in New Zealand, as elsewhere, inequalities in health exist among socioeconomic groups, ethnic groups, people living in different geographic areas and males and females.
These inequalities are not random: in all countries more socially disadvantaged groups have poorer health, greater exposure to health risks and poorer access to health services.
In countries with a colonial past, such as New Zealand, indigenous peoples have poorer health, even when socioeconomic position is taken into account.
In September 2002 the Ministry of Health published the Reducing Inequalities in Health framework to help target this problem. For more information on Reducing Inequalities in Health go to www.moh.govt.nz
What is the Ministry of Health doing about reducing health inequalities? The New Zealand Health Strategy, published in December 2000, provides an overall framework for the health sector, with the aim of directing health services at those areas that will ensure the greatest benefits for our population. It focuses in particular on tackling inequalities in health.
The strategy has identified three priority objectives to reduce inequalities: ensure accessible and appropriate services for people from lower socioeconomic groups ensure accessible and appropriate services for Mäori ensure accessible and appropriate services for Pacific peoples
It has been recognised that primary health care will play a crucial part in reducing health inequalities. A key step towards this is the Primary Health Care Strategy released in February 2001.
The Government has made available more than $400 million over three years to implement the Primary Health Care Strategy, ensuring that primary health care services focus on better health for all New Zealanders and actively works to reduce health inequalities between different groups.
Other key pieces of Ministry work that have been informed by reducing health inequalities include: He Korowai Oranga -- Mäori Health Strategy (November 2002) Whakatätaka: Mäori Health Action Plan 2002?2005 (November 2002) The Pacific Health and Disability Action Plan (Feb 2002) Health of Older People Strategy (April 2002) Youth Health: A Guide to Action (Sept 2002) Towards a Cancer Control Strategy for New Zealand: A discussion document (December 2002)
For more information on these documents, go to www.moh.govt.nz
What else is the Ministry doing in this area? The Ministry has an ethnicity data collection project which aims to improve the health sector's ability to monitor over time trends in health status, particularly that for Mäori, and Pacific peoples. Improved ethnicity data will enable better decision making by health and disability workers and by communities to reduce health inequalities.
Who wrote Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980-1999? This study was a joint project of the Public Health Intelligence group of the Ministry of Health and the Wellington School of Medicine and Health Sciences, University of Otago.
To view Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980-1999 go to: www.moh.govt.nz