Pacific Population Health Profile Analysis to support localities planning by CCDHB Report prepared for Capital and Coast District Health Board November 2019 Acknowledgements This report has been prepared for Capital and Coast District Health Board by Pacific Perspectives Limited. The authors include Pacific Perspectives’ team members: Brenden Mischewski, Dr Corina Grey, David Nicholson and Dr Debbie Ryan. The preparation of this report was supported by Jonathan Malifa. PPL acknowledges the extensive contributions made by the employees of Capital and Coast District Health Board and the assistance provided by Dr Michael Walsh of Waitematā and Auckland District Health Boards. Every effort has been made to provide accurate and factual content. The authors cannot accept responsibility for any inadvertent errors or omissions that may have occurred. B Contents 2 Executive Summary 26 Modifiable health risk factors 3 Abbreviations 27 Excess Body Weight 4 Introduction 28 Smoking 4 Methodology 29 Pacific Child and Youth Health 4 Regions 29 Immunisation rates 5 Anonymised data 30 Oral health 5 Interim demographic data 32 Long-term conditions 5 Pacific people: a term of convenience 32 Diabetes Prevalence 5 Accuracy of population estimates 33 Diabetes Control 5 Mapping 34 Assessment of cardiovascular risk 6 Overview 36 Access to Primary Healthcare 6 Key findings 36 Enrolment in primary healthcare services 7 The analysis in this report indicates that: 37 Barriers to access 8 Population 38 Hospital services utilisation 8 Health Outcomes 38 Utilisation of CCHDB hospital services 8 Health Service utilisation 39 Use of emergency department services 9 Risk Factors, Immunisation and screening 41 Use of inpatient services 10 Demography of Pacific communities 44 Use of outpatient services in the Wellington region 47 Acute bed days 12 The Pacific population of the CCDHB region 48 Did Not Attend Rates 13 A diverse population 49 Pacific Workforce at CCDHB 16 A stable population 50 References 17 Selected socioeconomic characteristics 19 Socioeconomic Deprivation 53 Appendix one: Matrix of geographical groupings, 21 Pacific Health Outcomes Wellington region 21 Life expectancy 55 Appendix two: Population age 24 Amenable mortality distribution, Wellington region and 25 Ambulatory Sensitive Hospitalisations, selected communities 0–4 and 45–64 year olds 1 Executive Summary This report contains a high-level summary of key health status, risk factors and outcome indicators for Pacific people in the Wellington region, with a particular focus on those communities served by the Capital and Coast District Health Board (CCDHB). This report is intended as an input into planning by the This report presents data about key health statistics for CCDHB for the development of a localities approach Pacific people in the CCDHB region and looks across to planning and service integration across the wider the wider Wellington region for evidence that the Wellington region. health system is meeting the needs of Pacific people. The report draws on a mix of publicly available data There are marked differences across almost all of the on the performance of the health system, internal indicators reviewed between Pacific and non-Pacific performance monitoring reporting by CCDHB, hospital people. While Wellington’s Pacific communities enroll service utilisation data and bespoke analysis by experts in primary health organisations (PHOs) at high rates, in the performance of health system. many Pacific people report unmet primary healthcare needs, often due to the unavailability of appointments The report incorporates data relating to the Hutt and costs associated with appointments and Valley and Wairarapa District Health Boards where prescriptions. appropriate as Pacific communities’ use of health services is not limited by the boundaries between district health boards. The results suggest that Pacific people experience large, pervasive disparities in health risk factors, use “The results suggest that of health services and health outcomes. The report identifies significant clustering of Pacific people and Pacific people experience describes how people in these communities interact large, pervasive disparities with the regional health system. These communities in health risk factors, use present an opportunity for a localities-based approach to the provision of health services. of health services and The Pacific population in the Wellington region is health outcomes. relatively stable and clustered around Porirua harbour ” (the Waitangirua-Titahi bay arc), the Hutt River (the Lower Hutt Valley), the southern suburbs of Wellington (the Strathmore to Berhamphore corridor) and the suburb of Wainuiomata. These barriers appear pervasive. Pacific people are Wellington’s Pacific communities are resilient with less likely during childhood to get immunised and strong cultural and spiritual connections, locally, access oral health care, receive cardiovascular risk nationally and internationally. However these assessments and support to manage key health risk communities experience high levels of socioeconomic factors during adulthood and be supported to manage deprivation and poor access to education, employment their long-term conditions as they age. and home ownership. The economic resources of these The effects on communities and families are significant. communities are deeply constrained with a medium At a population level, Pacific people live 7.9 fewer years net worth of just $12,000 – nine times lower than that than non-Māori non-Pacific people and are twice as of New Zealand Europeans. likely to die from potentially avoidable causes. 2 Pacific Population Health Profile The cost to the health system is also high. Use of CCDHB Emergency Department (ED) services by Pacific people is growing by 3.5% per annum, Abbreviations twice the rate for the non-Pacific population. Pacific people are also twice as likely as the ASH Ambulatory sensitive general population to have used the hospital’s hospitalisations ED more than five times since 2014/15. BMI Body mass index Use of inpatient services by Pacific people is growing by 2.6% per annum compared to CCDHB Capital and Coast DHB 1.8% for non-Pacific people. Pacific people are 20% more likely than non-Pacific to have an DHB District Health Board inpatient admission and are 1.4 times as likely to be among the group of high users who had 8.1 dmft decayed, missing or filled teeth admissions over the past five years. (marker of the severity of dental disease) Pacific people are less likely than the total population to access outpatient services and DNA Did not attend their use of these services is growing more slowly (1.2% per annum) than the general ED Emergency Department population (1.8% per annum). Among the 12,000 outpatient appointments for Pacific people each HbA1c glycated haemoglobin, year, the DNA rate was around 15.0%, twice that a measure of how well diabetes of non-Pacific people. has been managed This report suggests that an equity strategy consistent with the localities approach requires HVDHB Hutt Valley DHB CCDHB to work in collaboration with the MoH Ministry of Health communities and primary care practices in the localities identified with high concentrations of NHI National Health Index Pacific people. An integrated and family-based approach, addressing the health and social non-Māori Non Māori non Pacific people needs of Pacific families, closer to home and non-Pacific addressing not just acute illnesses, but also prevention and optimal management of long- NZ New Zealand term conditions, is recommended. NZDep New Zealand Deprivation Index PHO Primary healthcare organisation PPL Pacific Perspectives Ltd Stats NZ Statistics New Zealand WDHB Wairarapa DHB Pacific Population Health Profile 3 Introduction In May 2019, Capital and Coast District Health Board (CCDHB) commissioned Pacific Perspectives Limited (PPL) to prepare a Pacific population health profile to build a robust evidence base for Pacific health improvement. The evidence is intended to inform and support the CCDHB’s localities approach across the wider Wellington region and the 3DHB Pacific Plan. This Pacific population health profile aims to: collate and present data and explain the results for the Pacific population health profile. • Build a robust evidence base for Pacific health that will support health services to identify areas for Regions Pacific health improvement. Information is presented at several geographical • Better inform localities planning and service levels, depending on the context. These levels include integration activities for Pacific populations across the Wellington region, CCDHB proper, and the cities, the wider Wellington region. towns and suburbs that are home to significant • Provide Pacific communities with up to date and concentrations of Pacific peoples. relevant information about their health status to Data is presented at the level of the Wellington better inform community-driven (population health) region to show how the regional Pacific population activation. interacts with hospital services. • Provide information to support knowledge transfer Our analysis of the utilisation of CCDHB hospital and information sharing across sectors for Pacific services by Pacific peoples includes information about populations. people who live in Lower Hutt City but access inpatient • Develop an evidence base to inform inter-sectoral services at Wellington hospital. This approach reflects approaches to address the social determinants of the important