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NORTHLAND AREA HEALTH BOARD

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èuary 1989 qA

MOH Library El - 989 - .. I 100760M 1No IO,O

FOREWORD

Planning for, and action on matters to do with health and ill health need accurate and relevant data on the population, the main causes of ill health, and on social and economic indicators. The objective of the "Area Health Profile" is to present available information in a concise, understandable and visually arresting way Boardwide, and by territorial authority.

Information on Northlands population, its size, structure and projected future development is fundamental to planning for health as well as other issues. While causes of death emphasise ill health rather than health, it is of course most important data, especially when looked at in terms of premature death. All the main causes of premature death in Northland are preventable to greater or lesser degrees. This must be a spur for increased effort to promote health and prevent Ill health. This involves all of us as matters of health are germane to other local bodies, agencies and community groups as well as the Northland Area Health Board.

Social and economic conditions cannot be separated from health issues and the profile contains a certain amount of local information on these subjects. In the future we hope to be able to present a health profile with more emphasis on health status as opposed to ill health and deaths. Meanwhile I believe the "Area Health Profile." should stimulate debate and progress, both in the Northland Area Health Board, its staff and committees, as well as other local bodies, groups, and the community at large.

D M G Beasley Chairman Northland Area Health Board HEI only

NORTHLAND AREA HEALTH BOARD COMMUNITY HEALTH SERVICES

AREA HEALTH PROFILE

Date Due

Ph.D

a1th

Initiated and Financed by

COMMUNITY HEALTH SERVICES

T°tI;ea%thU 0O2G0 We11ifl° (a. f2132-a i. TABLE OF CONTENTS Page

FOREWORD 1 POPULATION TRENDS .. 1

2 MORTALITY .. .. 3 All Causes of Death .. 3

Age Structure and Mortality .. 7 The Seven Most Common Causes of Death and Premature Death in Northland 9 2.1 Motor Vehicle Accidents 10 2.2 Coronary Heart Disease 12 2.3 Lung Cancer 14 2.4 Stroke .. 15 2.5 Emphysema and Chronic Bronchitis 16 2.6 Cancer of the Bowel 17 27 Breast Cancer 18

3 CIGARETTE SMOKING IN NORTHLAND 19

APPENDICES

APPENDIX A Most Common Causes of Death in New Zealand 20

APPENDIX B Neighbourhoods in the Northland area 21 B1.a Counties and Boroughs 21 B1.b Whangarei City 24

B1.c Statistical Summary of the Northland Neighbourhood 26

B2 Update on Health and Equity 27

B3 Mortality and Population Characteristics in Northland Neighbourhoods 29

B3.a Mortality 29

B3.b Population Characteristics: Far North District 30 Whangarei District 31 Kaipara District 32 Mangonui and Whangaroa 33

Kaitaia .. 34 Hokianga 35 Bay of Islands 36

Kaikohe .. 37 WhangareiCounty 38

Whangaréi.City .- 39 Otamatea 40 Hobson 41 Dargaville 42 1. POPULATION TRENDS The Northland Area Health Board serves an area extending north from Kaiwaka to Cape Reinga. In the 1986 Census there were 124,947 people usually resident in the area. It is New Zealands seventh largest Area Health Board and Is comparable in size to Taranaki Area Health Board or the Palmerston North Hospital Board. Northlands population is somewhat younger than the New Zealand average, with 27% under 15. A smaller proportion of Northland people are over 65, only 9.5%. The graph shows that this situation is changing. The darker bars represent the present population. The lighter bars show the projected population for the year 2011. The number of children will remain relatively stable. Working age adults over 35 will be much more numerous. A considerable increase in the number of aged people will have an impact on the health care services. PRESENT POPULATION AND PROJECTED POPULATION IN 2011

Age group

80+

70-79

60-69

50-59

40-49

30-39

20-29

10-19

0-9

I I I I I I I I I I I I I I F-1 r-- I I I —T--1 I 12 10 8 6 4 2 0 2 4 6 8 10 12 thousands of females thousands of males

1986 Census M Projected 2011 The number of live births to women in the Board Area has been increasing since 1980 in parallel with the increasing number of women of child-bearing age. Projections show little increase in the number of women aged under 35, so the number of live births each year will remain fairly steady. PAST AND PROJECTED LIVE BIRTHS IN NORTHLAND

Average annual number of births, 1974 to 2109

250

200 Live births

150

100

74 84 87 94 104 79 86 89 99 109 Years since 1900

2 2. MORTALITY It is very hard to find a measure of the health of our people in Northland. We can only look at the age at which death occurs and at the causes of death if we want to compare Northland with New Zealand as a whole. The causes of death which prevent people from reaching a ripe old age are most likely to be preventable causes. We want to know which deaths are preventable. Because of our small population, however, we can only look at the commonest causes of death.

All causes of death Compared to New Zealand as a whole, people in Northland have a favourable life expectancy. Because our population is younger that is not surprising. But people in Northland are slightly better than New Zealand as a whole even when we adjust the figures for the age distributions. All the figures on mortality we use which are adjusted this way are called age-adjusted rates. To make comparisons easy, we have used the average rate per 1000 people per year for all the figures. The graph shows another feature of mortality. At all ages males are more likely to die than females. For each of the years 1980 to 1985 females in Northland had 6.0 deaths per thousand while males had 9.7 deaths per 1000. ALL CAUSES OF DEATH

Average annual deaths per 1000, age-adjusted

10 9 8 7 6 5 4 3 2 1 0 Female Male

U New Zealand 0 Northland

3 We can look at the death rates for each age group. The graph shows the very sharp increase in the rates in the older age groups. The excess mortality for males compared to females is also apparent.

From age 55 onward until age 80 the rate for men In one five year age group Is greater than the rate for women in the next higher five year age group. This indicates that women have a markedly higher life expectancy than men. ALL CAUSES OF DEATH, BY 5 YEAR AGE GROUP

Average annual deaths per 1000 population 140

Male 120

Female 100

0 <1 <9 <19 <29 <39 <49 <59 <69 <79 <4 <14 <24 <34 <44 <54 <64 <74 80+

If we look just at death before age 65 it IS clear that deaths to infants under 1 year old is an important issue. The excess deaths for males 15-30 Is notable.

4 ALL CAUSES OF DEATH, BY 5 YEAR AGE GROUP

Average annual deaths per 1000 population aged under 65

18 Male 16 Female 14 12 10

0 <1 <9 <19 <29 <39 <49 <59 <4 <14 <24 <34 <44 <54 <64

Despite the apparently large columns for infant deaths, Northland Is better off than most places in New Zealand. The main advantage Northland has is in its "north-ness". The most Important cause of death In Infancy, especially after the first few weeks of life, Is Cot Death. Cot death, called the Sudden Infant Death syndrome, is much more common as one travels south in New Zealand. The rate is twice as high in places south of Christchurch than it is in Northland. DEATHS OF LIVE-BORN INFANTS BY CAUSE

Rates per 1000 live births per annum averaged over 1980-1985

10 9 8 7 6 5 4 3 2 1 0 NZ Northland •Cot death DOther causes

5 The life expectancy for Maori people is lower than for other New Zealanders. In Northland the favourable comparison with New Zealand as a whole only holds for Pakeha Northlanders. The figures used for the graphs are actually uncertain. Maori death rates in urban areas are likely to be lower than in rural areas because people facing death may choose to return to their home marae.

The population figures used which come from the 1981 Census name as Maori only those people who reported half or more Maori ancestry. The identification of a person as Maori or other at the time of death is made by the funeral director. It is unknown to what extent the funeral directors simply leave the question blank (so that it will be counted as other than Maori). It is also unknown to what extent the funeral director names as Maori a person who could not claim half or more Maori ancestry but who is a well-known and respected kaumatua. To complicate matters still further, the population figures from the 1986 Census use a different criterion for determining which people will be counted as Maori. When people were asked in 1986 to specify their ancestry they were given options which included Maori among other choices. People who did not choose any other origin than Maori are now counted as Maori. If a person responded choosing both Maori and European they are counted as part-Maori. While the total numbers of people counted as Maori did not change much between 1981 and 1986, there may have been regional or age-group shifts in denomination. ALL CAUSES OF DEATH, COMPARING MAORI AND PAKEHA

Average annual deaths per 1000, age-adjusted

16 NZ

14 Northland 12

Pakeha Maori Pakeha Maori Females Males A better way to view the different life expectancy of Maori people is to look at the age structure. Besides migration the age structure may differ because of higher birth rates as well as because of higher death rates. Both features contribute to the different age structure for Maori and Pakeha in Northland. The graphs which follow show first the two populations separately to the same scale. Using the 1986 Census definitions there are about five times as many Pakeha as Maori in Northland. The same figure for New Zealand as a whole is more than ten times as many Pakeha as Maori. The Maori age-structure is much more like a triangle than the Pakeha one. Many more children and young adults and very few older people characterise the Maori population. The Pakeha age-structure shows the effects of slightly lower birth rates. It looks like a column up to about age 45. After 45 death begins to take its toll of the Pakeha and the column gradually narrows. The narrowing gets more obvious after age 75.

AGE STRUCTURE OF MAORI AND PAKEHA POPULATIONS

1986 Census numbers and definition, 10 year age groups Age group

80+

70-79

60-69

50-59

40-49

30-39

20-29

10-19

0-9

3210123 76 5432101234567 thousands thousands female male female male

Maori Pakeha

7 The Maori age structure shows the effect of higher birth rates 10 to 20 years ago, with a bulge in the 10 to 14 year olds. The columnar shape for Maori stops abruptly at about age 30. The steeply dropping numbers from age 30 to 55 are an effect of several causes, such as migration and higher death rates at relatively young ages. The effect has been to burden the relatively few elders with responslb!ity for a large number of young people. There has been less expert guidance and advice available to young Maori people than would have been the case were the balance of ages more even. The graph below shows the difference in the age structures of the two groups in Northland. We have changed the scales so that the young people in each group look the same size. From age 30 onwards the Pakeha adult population is relatively more numerous. As health care services are used much more by the older people in society, it is obvious that Pakeha people will be making proportionately more use of services than Maori people. COMPARISON OF MAORI AND PAKEHA POPULATION STRUCTURES

1986 Census numbers and definition, 10 year age groups

Age 6 r11T 80+ 70-79

60-69 50-59

40-49

30-39

20-29

10-19

0-9

Females Males

Maori IM scaled to same dimension as Pakeha Table 1 THE SEVEN MOST COMMON CAUSES OF DEATH IN NORTHLAND Order Cause Deaths per year

Averaged over 1980-86

1st Heart Disease 261

2nd Stroke 90

3rd Lung Cancer 47

4th Emphysema/Bronchitis 38

5th Motor Vehicle Accidents 34

6th Cancer of the Bowel 33

7th Breast Cancer (women) 17

The order of importance of these causes of death is different if we look at the years of life lost after age 15 and before age 65. These can be called pre-pension years of life lost. They are the years when most adults are paying income tax. The years lost represent a loss of revenue to government. They are also losses to the workforce (paid and unpaid).

Table 2 THE SEVEN MOST IMPORTANT CAUSES OF PREMATURE DEATH IN NORTHLAND Order Cause Years lost 15-64

Averaged over 1980-86

1st Motor Vehicle Accidents 841

2nd Heart Disease 616 3rd Suicide 224

4th Lung Cancer 135

5th Cancer of the Bowel 134

6th Stroke 113

7th Breast Cancer (women) 101 2.1 MOTOR VEHICLE ACCIDENTS - THE 5th MOST COMMON CAUSE OF DEATH IN NORTHLAND, BUT - THE CHIEF CAUSE OF PREMATURE DEATH. - THE RATE OF DEATH FROM ROAD TRAFFIC ACCIDENTS IN NORTHLAND IS SIGNIFICANTLY HIGHER THAN FOR NEW ZEALAND AS A WHOLE. - FOR MEN 15 TO 44 YEARS OLD 30 PERCENT OF DEATHS WERE IN ROAD TRAFFIC ACCIDENTS.

DEATHS FROM MOTOR VEHICLE ACCIDENTS

Average annual deaths per 1000, age-adjusted

0.5

0.4

0.3

0.1

Ef Female Male

• New Zealand 0 Northland

AVERAGE No. OF DEATHS PER YEAR OF NORTHLAND RESIDENTS FROM MOTOR VEHICLE ACCIDENTS (1980-1986) Deaths Men 24 Women 9 Men 15 to 44 17 Women 15 to 44 5

10 As for New Zealand generally, road accidents are a major cause of accidental death. In Northland since 1980 road accidents have accounted for just over half of all deaths due to injury.

The comparison with all of New Zealand shows that for both men and women Northland has very high death rates. Perhaps the quality of the roads in the North has something to answer for. But the differential for men over women suggests that something about the behaviour of young men explains the high death rate.

While the problem of drivers whose judgment is impaired by alcohol or other drugs is general throughout New Zealand, the drivers in Northland may be more frequently at risk. These drivers place others at risk as well. Between 1980 and 1986 22 children were victims of road accidents.

Table 3 MOTOR VEHICLE ACCIDENT DEATHS AND DEATHS FROM OTHER INJURIES IN NORTHLAND

Numbers of deaths by age and sex for the years 1980 to 1986 Females Males Road deaths Other Road deaths Other injuries injuries

Aged under 15 10 14 12 14

15-44 38 15 117 92

45-54 6 1 16 10

55-64 7 10 17 24

65-74 4 9 6 17

Over 75 ii 45 2 26

Bailey, in 1977, found 50% of all fatal road accidents involved alcohol. [Health Facts New Zealand. Department of Health. Wellington. 1983. p87.

11 2.2 CORONARY HEART DISEASE

- THE COMMONEST CAUSE OF DEATH IN NORTHLAND (30 % OF ALL DEATHS) - THE SECOND MOST IMPORTANT CAUSE OF PREMATURE DEATH IN NORTHLAND - THE MOST IMPORTANT RISK FACTORS ARE PREVENTABLE

DEATHS FROM HEART DISEASE

Average annual deaths per 1000, age-adjusted

3.5

2.5

1.5

0.5

Female Male

• New Zealand El Northland

MAJOR PREVENTABLE RISK FACTORS

Smoking cigarettes High blood pressure High blood cholesterol

12 OTHER RISK FACTORS - MOST OF WHICH ARE PREVENTABLE Lack of regular exercise Obesity Stress Diabetes Softness of tap water Personality type Family history

AVERAGE No. OF DEATHS PER YEAR OF NORTHLAND RESIDENTS FROM HEART DISEASE (1980-1986) Deaths Men 161 Women 100 Men 15 to 64 52 Women 15 to 64 15

13 2.3 LUNG CANCER

- THE THIRD MOST COMMON CAUSE OF DEATH IN NORTHLAND. - 4th GREATEST CAUSE OF PREMATURE DEATH IN NORTHLAND. - THE PATTERN IS VERY SIMILAR TO THAT FOR NEW ZEALAND AS A WHOLE. - WOMEN IN NORTHLAND SHOW SLIGHTLY HIGHER RATE THAN WOMEN IN THE WHOLE OF NEW ZEALAND. - LUNG CANCER IS PREVENTABLE. CIGARETTE SMOKING IS BY FAR AND AWAY ITS GREATEST CAUSE.

DEATHS FROM LUNG CANCER Average annual deathsper 1000, age-adjusted 0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 Female Male

- New Zealand E: Northland

AVERAGE No. OF DEATHS PER YEAR OF NORTHLAND RESIDENTS FROM LUNG CANCER (1980-1986) Deaths Men 34 Women 14

14 2.4 STROKE - THE 2ND MOST COMMON CAUSE OF DEATH IN NORTHLAND. - THE 6th GREATEST CAUSE OF PREMATURE DEATH IN NORTHLAND. -MEN IN NORTHLAND FARE SOMEWHAT WORSE THAN MEN IN NEW ZEALAND AS A WHOLE. - STROKES CAUSE MUCH DISABILITY AND MAYBE A HEAVY BURDEN TO PATIENTS AND THEIR FAMILIES. - A LOT OF RESOURCES ARE DEVOTED TO TREATING AND REHABILITATING PATIENTS WITH STROKES, BOTH IN HOSPITAL AND IN THE COMMUNITY. - THE RISK OF STROKE CAN BE GREATLY REDUCED BY DETEC- TING AND TREATING PEOPLE WITH HIGH BLOOD PRESSURE. DEATHS FROM STROKE

Average annual deaths per 1000, age-adjusted 1.1 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Female Male

- New Zealand m Northland

AVERAGE No. OF DEATHS PER YEAR OF NORTHLAND RESIDENTS FROM STROKE (1980-1986) Deaths Men 45 Women 45

TOTAL NUMBER OF ADMISSIONS TO HOSPITALS IN NORTHLAND NORTHLAND DUE TO STROKE IN 1985=245 Average duration of stay = 50 days No. of bed days = 12,226 days

15 2.5 EMPHYSEMA AND CHRONIC BRONCHITIS - THE FOURTH MOST COMMON CAUSE OF DEATH IN NORTHLAND. - MEN IN NORTHLAND SHOW A SLIGHTLY LOWER RATE THAN MEN IN THE WHOLE OF NEW ZEALAND - EMPHYSEMA AND BRONCHITIS ARE LARGELY PREVENTABLE. - CIGARETTE SMOKING IS THE GREATEST CAUSE.

DEATHS FROM EMPHYSEMA OR BRONCHITIS

Average annual deaths per 1000, age-adjusted 0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 Female Male

• New Zealand 0 Northland

AVERAGE No. OF DEATHS PER YEAR OF NORTHLAND RESIDENTS FROM EMPHYSEMA OR BRONCHITIS (1980-1986) All deaths Deaths due to Cigarette smoking Men 27 20 Women 14 10

16 2.6 CANCER OF THE BOWEL - THE FIFTH MOST COMMON CAUSE OF DEATH IN NORTHLAND. - THE 6th GREATEST CAUSE OF PREMATURE DEATH IN NORTHLAND. - NORTHLAND MEN AND WOMEN HAVE SLIGHTLY HIGHER RATES THAN NEW ZEALAND AS A WHOLE. - RISK FACTORS FOR THIS CANCER INCLUDE DIETS LOW IN FIBRE AND HIGH IN SATURATED FATS. - EARLY DETECTION OF THE CANCER CAN IMPROVE THE OUTCOME. DEATHS FROM CANCER OF COLON OR RECTUM

Average annual deaths per 1000, age-adjusted

0.4

0.3

0.2

0.1

Female Male

• New Zealand 0 Northland

AVERAGE No. OF DEATHS PER YEAR OF NORTHLAND RESIDENTS FROM BOWEL CANCER (1980-1986) Deaths Men 18 Women 16

17 2.7 BREAST CANCER

- THE SEVENTH MOST COMMON CAUSE OF DEATH IN NORTHLAND. - THE 7th GREATEST CAUSE OF PREMATURE DEATH IN NORTHLAND. - IN WOMEN IT IS THE COMMONEST CAUSE OF CANCER DEATH. - WOMEN IN NORTHLAND SHOW A SLIGHTLY HIGHER RATE THAN WOMEN IN THE WHOLE OF NEW ZEALAND - COMPREHENSIVE MAMMOGRAPHY SCREENING CAN INCREASE EARLY DETECTION AND REDUCE THE DEATH RATE. DEATHS FROM BREAST CANCER

Average annual deaths per 1000, age-adjusted

0.4

0.3

0.2

0.1

[] Female

• New Zealand 0 Northland AVERAGE No. OF DEATHS PER YEAR OF NORTHLAND RESIDENTS FROM BREAST CANCER (1980-1986) Deaths Women 17

18 3. CIGARETTE SMOKING IN NORTHLAND

In the 1981 Census people were asked about their cigarette smoking. In Northland 26 % of men and 21 % of women answered that they smoked more than 10 cigarettes per day. More reported that they had never smoked, 40 % of men and 53 % of women.

There are variations in the rates of smoking within the communities of Northland. Among people in Kerikeri, Haruru Falls and Paihia 35 % of men reported smoking more than 10 cigarettes per day while in the county areas of the Bay of Islands on 23 % of men reported such heavy smoking. For women the percentages were 30 % and 18 %.

Each year cigarette smoking in Northland accounts for the deaths of:

18 women and 38 men from heart disease 9 women and 8 men from other circulatory disease

9 women and 27 men from lung cancer 6 women and 26 men from other cancers

10 women and 20 men from bronchitis/emphysema.

Each year cigarette smoking in Northland accounts for:

46 women and 85 men admitted to hospital for heart disease 53 women and 83 men admitted to hospital for other circulatory. disease

23 women and 70 men admitted to hospital for lung cancer 9 women and 39 men admitted to hospital for other cancers

58 women and 80 men admitted to hospital for bronchitis or emphysema

And the number of hospital bed days used in Northland each year that can be attributed to cigarette smoking is:

931 days for heart disease patients 5623 days for patients with other circulatory disease

1193 days for lung cancer patients 625 days for other cancer patients

2374 days for bronchitis/emphysema patients

19 APPENDIX A: Most common Causes of Death in New Zealand Table A.1 THE SEVEN MOST COMMON CAUSES OF DEATH Order Cause Deaths per year

Averaged over 1980-85 1st Heart Disease 9016 2nd Stroke 3144 3rd Lung Cancer 1369 4th Emphysema/Bronchitis 1325 5th Cancer of the Bowel 946 6th Motor Vehicle Accidents 672 7th Breast Cancer (women) 522

Averaged over 1980-85 1st Motor Vehicle Accidents 3328 2nd Heart Disease 3068 3rd Suicide 1652 4th Lung Cancer 674

5th Cancer of the Bowel 564

6th Breast Cancer (women) 542 7th Stroke 430 APPENDIX B: Neighbourhoods in the Northland Area The census areas in the board area have been grouped into homogeneous (and contiguous where possible) neighbourhoods usually of more than 4000 people. In other words localities that share common features and are, in most cases, beside each other are described in one section. For certain local authority areas you must "pick and match" from a number of the pen portraits to get the picture of an area, eg, Hobson County and Te Kopuru. Bi. Pen portraits of the neighbourhoods based on data from the 1986 Census

B1.a Counties and Boroughs

Whangaroa, Mangonui and Kaitaia

About one-third of the seventeen thousand or so residents of Mangonui and Whangaroa reported Maori as their only ethnic identification. Many people reported thmseIves as actively seeking work, over 6 % of the adult population. So the area is short nearly 760 jobs. The relatively large number of people on a benefit, 15.5 %, can be related to the unemployment level. Another possible effect of needing work is the proportion of men and women who were separated or divorced from their partner, 7.5 %. In Kaitaia one in seven households is without a car.

Hokianga

One fifth of the 6400 residents of Hokianga are school-aged children. Nearly half the population reported only Maori ethnicity in the 1986 Census. Almost 1 in 10 adults reported that they were actively seeking work. About 420 jobs are needed. As in the other northern counties the joblessness brings along with it many people on a benefit. Nearly one quarter of the adults in the Hokianga are on a means-tested benefit. Nine percent of the men and women were spearated or divorced. The isolation of the Hokianga is enforced by the 1 in 7 households who have no car. Relatively few households have more than one car.

Kerikeri together with Paihia and Haruru Falls

For the north Kerikeri is a socially advantaged community. Very few school-aged children and not many preschoolers need looking after. Few of the people reported "blue-collar" work and few were people who gained no training beyond secondary school. Remarkably few of the adults reported themselves as actively seeking work, less than 3 %.

21 Kaikohe Kaikohe contrasts sharply with Kerikeri. Nearly 10 percent of the population of Kaikohe are preschool children. Nearly half the population described themselves as having only Maori ethnic origin. With 160 jobs needed (in 1986, since then the situation has worsened) nearly one in 6 adults is on a means-tested benefit. More than one household in five has no car and few households have two or more cars. Kaikohe is a service town, so few people reported "blue-collar" occupations. Kawakawa together with Moerewa and Opua The other towns in the Bay of Islands County resemble Kaikohe more than Kerikeri. One third of the population are school-aged children or pre-schoolers. Six out of ten persons gave Maori as their only ethnic identification. In 1986 there were 215 people actively seeking work. These towns have been hard hit by job losses since then. Already in 1986 nearly 1 adult in every 6 was on a means-tested benefit. High levels of separated and divorced people were more notable in these towns than in Kaikohe, about 8 % of all the adults. The numbers of children and the broken relationships are compounded with transport difficulties. One in 7 households had no car at all. Few households had more than one. The towns have relatively few old people and very few households with people living alone. County areas in the Bay of Islands Outside the towns the picture is somewhat different. The numbers of people actively seeking work are much reduced. Even so, 625 jobs were needed in 1986 for the County people seeking work. Except that 1 in 3 people in the County areas reported only Maori ethnicity, the County is otherwise typical of non-urban areas in New Zealand. County areas in Whangarei County In few respects do the neighbourhoods in Whangarei County differ from other county areas in New Zealand. There are unusally high levels of households with two or more cars, few households where people live alone, and a high proportion of adults with some tertiary educational qualification. Hobson County Hobson County, too, differs little from other county areas in New Zealand. Nearly half the adults reported themselves as "blue- collar" by occupation. The number of children was high, too, with 1 in 5 of the population being a school-aged child.

22 Hikurangi and Te Kopuru Hikurangi township and Te Kopuru community contrast with the surrounding county areas. Nearly 30 % of the population gives Maori as the only ethnic identification. One in 5 of the population is a school-aged child. Joblessness was not notably a problem (in 1986) but vulnerability to unemployment is evidenced by the 3 out of 4 adults with no tertiary qualifications. Divorced and separated persons, people on a mean-tested benefit and carless households are also a feature of Hikurangi. Despite these features a very high proportion of families in Hikurangi owned their own homes, 86 percent.

Dargaville Dargaville differs little from the national norms. In 1986 there were few people actively seeking work, only 3 % of adults; 100 jobs would give the Borough full employment. While the number of older people was not disproportionate, 1 in 5 households in Dargaville contained a person living alone. , The number of carless households, too, was fairly high, nearly 1 in 6 households having no car at all.

Otamatea County The Otamatea County area is very representative of New Zealand county areas. There are many more children than usual, though, with 21 percent of the population being school-aged children. Of adults 44 % reported a blue-collar occupation.

23 B1.b Whangarei City

Whangarei has been divided into eight "neighbourhoods" which are groups of Census Area Units that resemble each other on social characteristics. They are not usually contiguous.

Each neighbourhood has been compared with neighbourhoods throughout New Zealand. Whenever a Whangarei neighbourhood was other than average for New Zealand, we describe the features that were outstanding.

Kamo and Whau Valley, Western Hills, Maunu, Parahaki

All these areas are not untypical of urban neighbourhoods in New Zealand. Their only notable feature is the low proportion of adults who are separated or divorced.

Tikipunga and Raumanga Heights

Tikipunga and Raumanga Heights are areas with a very high proportion of school-aged children and pre-schoolers too. About 1 in 3 of the population is under 15 years old. Few people over 65 live in these areas and few households contain people living alone. One in five of the people gave Maori as their only ethnicity. About 30 percent of adults reported a "blue-collar" occupation.

Otangarel This is a small neighbourhood which cannot be compared with other areas in Whangarei. An area with a very high proportion of rented housing, more than half the households are not owner-occupied. Of the adults 4 out of 5 had no qualifications past secondary school. Joblessness (in 1986) was very high, the highest in the Northland region. Just to relieve joblessness in Otangarel 150 jobs are needed. The poverty of the neighbourhood is illustrated by 30 % of households with no car, and nearly 30 % of adults on a means-tested benefit. One in 9 adults is separated or divorced. The neighbourhood has a very high prportion of pre-schoolers, nearly 1 in 8 of the population. Six out of 10 of the people gave Maori as their only ethnicity. On 7 of the twelve indicators chosen, Otangarei is more than 1.5 standard deviations from the mean for New Zealand urban neighbourhoods. The neighbourhood is small, only 600 households, but can be expected to provide many opportunities for disease prevention, health promotion and sensitive community development.

24 Kensington, Mairtown, Regent

The neighbourhood contrasts sharply with Otangarei. Fewer than 1 in 6 of the population Is under 15, but nearly 1 in 4 is over 65. One in 3 households contains a person living alone. Few people in the neighbourhood are actively seeking work, but 1 in 5 households is carless.

Woodhi II, City, Riverside, Horahora, Morningside

These areas are little different from the average for New Zealand urbans areas generally. Only the fact that 18 % of the population reported Maori as their only ethnicity distinguishes them.

Avenues, Otaika/Raumanga

More than 1 in 4 of the people in these areas reported only Maori ethnicity. One in 4 of the households were made up of people living alone but the age structure is balanced. Not many of the one-person households will be elderly people on their own. Jobs are in short supply, with 6 % of adults actively seeking work. It would take 140 extra jobs to employ them. One in 6 adults is on a means-tested benefit and more than 10 % of adults are separated or divorced.

These statistics suggest areas where mobility is high, with residents staying in one place a short time; Nevertheless, only 40 % of households are not owner-occupied.

Sherwood

Like Tikipunga Sherwood has a high proportion of children and over 1 in four adults reporting a "blue-collar" occupation. Like Tikipunga again about 1 in 5 persons gave Maori as their only ethnicity.

B1.c STATISTICAL SUMMARY OF THE NORTHLAND NEIGHBOURHOODS USING SOCIAL DATA FROM THE 1986 CENSUS

Neighbour- Size: Aae Structure Ethnicity No EnpioMient Social Needs Fk,use}olds hood House- 0-4 5-14 65 Maori terty Blue- Seeking On a Separated One- Owner- Carless Two or Average People Adults holds qual s collar work benefit or di vrtd person occpd nore cars i ncaie % % % % % % % % % % % % % $1986

Mangonui 12285 9015 3495 8.3 18.3 9.2 33.4 61.7 31.5 6.3 15.9 7.5 15.0 74.3 9.5 36.1 16534

Kaitaia 4920 3510 1458 9.0 19.7 10.6 33.2 63.0 20.5 5.4 14.6 7.4 17.7 70.6 14.2 30.3 18391

Ibkianga 6393 4428 1827 9.3 21.5 8.8 48.4 64.5 29.9 9.4 23.7 9.2 16.5 68.3 14.7 28.1 16765

Kerikeri 4029 3348 1248 5.3 11.6 13.0 8.2 57.5 18.9 2.9 7.2 7.0 18.3 69.8 10.0 36.8 16538

Kawakawa 3396 2286 918 10.2 22.4 5.9 58.2 68.3 29.9 6.3 15.6 8.0 10.5 68.9 14.5 27.8 18732

Kaikobe 3777 2658 1128 9.8 19.8 9.7 47.3 63.3 23.1 6.0 15.3 6.8 16.5 64.6 21.8 24.0 17412

Bay of 10947 7698 3147 9.0 20.7 7.1 33.9 64.7 37.7 5.7 11.7 6.8 11.5 71.8 8.5 39.9 16445 Islands

1angarei: Cnty out 18075 13182 5436 8.8 18.3 7.2 14.0 58.4 38.7 4.3 8.1 6.2 12.3 72.4 4.8 44.2 16743 Cnty in 2517 1830 738 8.1 19.2 6.1 19.5 60.5 31.8 4.6 7.9 6.1 10.6 74.4 5.8 50.8 17309 Hikurangi 1845 1272 564 9.1 22.0 9.3 28.5 76.9 33.7 4.3 13.5 7.8 16.8 86.1 13.3 40.4 18916

Whangarei City: 62.2Kam 5166 4026 1728 6.723.0 15.3 11.4 13.6 3.7 7.7 6.2 13.7 85.7 8.7 42.7 16445 Tikipunga 7818 5307 2304 9.8 22.3 5.2 20.7 61.7 29.0 5.2 9.8 7.6 9.5 69.9 8.6 38.3 17106 Whau Vly 4395 3432 1539 5.8 16.2 14.1 9.3 60.3 18.7 3.8 7.2 6.3 15.6 77.3 8.1 44.2 17942 Otangarei 2154 1458 600 11.7 20.6 10.3 61.1 79.6 23.7 10.5 28.8 10.7 19.0 49.3 29.0 21.2 17309 Mairt, 5211 4359 2052 5.2 11.1 23.8 10.7 61.0 16.2 3.2 9.4 8.4 32.8 70.6 21.7 24.1 17412 Woocfiill 5979 4791 1833 6.9 12.9 10.0 18.3 61.5 25.0 4.2 10.8 8.8 16.8 68.4 12.8 34.5 17803 Vinetck1 3063 2370 1095 7.4 15.2 12.2 26.8 65.2 25.8 5.9 16.8 10.5 25.2 62.2 20.3 26.3 17412 Sberxxl 6042 4362 1833 8.8 19.0 7.9 21.1 60.2 28.8 5.1 11.1 8.7 13.6 78.5 9.2 35.3 16956

Hobson 6120 4245 1818 9.5 21.2 6.8 15.5 69.4 48.8 3.2 8.2 4.9 12.5 68.5 6.4 43.6 16946 Dargaville 5322 3903 1743 8.4 18.2 13.2 20.0 70.6 26.8 3.0 10.3 6.7 21.2 72.9 15.3 31.5 17523 0taitea 5391 3774 1713 9.0 20.9 8.6 13.1 67.9 44.1 3.9 8.6 6.2 16.2 69.3 6.8 38.8 16775

26 B2. Update on Health and Equity B2.a Counties and Boroughs The analyses described in Health and Equity have been repeated for the 1986 Census data. Outside the urban areas the characteristics of the first principal component were very little changed. The definition of risk features: few two-car households many carless households many one-person households many adults on means-tested benefits many separated or divorced adults few "blue-collar" workers many people over 65 As before, the second principal component features: high proportion of Maori people high proportion of under 5s many adults actively seeking work few people over 65 Neighbourhoods scoring high on the first principal component are marked with an ; those high on the second component are marked with a I. None of the neighbourhoods marked with an were in the lowest 2.5 percent, they were not at the very high risk. Clearly there is a division between the northern part of the Board area, where most neighbourhoods are at high social risk, and the southern part. Outside the urban area

Code name Description Mangonui / Mangonui and Whangaroa counties (excluding Kaitala) Kaitaia Kaitaia Borough Hokianga / Hokianga (and including Russell) Kerikeri Kerikeri, Paihia, Haruru Falls Kawakawa 1 Opua, Kawakawa, Moerewa Kaikohe / Kaikohe Borough Bay of I I Bay of Islands County (excluding towns mentioned) County outer Whangarei County (excluding Whangarei MUA, Hikurangi) County inner Whangarei County in Whangarei MUA Hikurangi Hikurangi & Te Kopuru Hobson Hobson County (excluding Dargaville) & Maungaturoto & Kaiwaka Dargaville Dargaville Borough & Ruawai Otamatea Otamatea County (excluding towns mentioned) [Mangawhai alone rates a ]

27 B2.b Whangarei City

Inside the urban areas, too, the character of the first principal component was little changed. The definition of risk features:

many adults on a means-tested benefit few two-car households many carless households many separated or divorced adults few owner-occupied households many adults actively seeking work

The second principal component features:

• few one-person households few people over 65 a high proportion of under 5s many "blue-collar" workers.

Neighbourhoods scoring high on the first principal component are marked with an ; those high on the second principal component are marked with a I. Whangarei City Neighbourhoods

Code name Description

Kamo Kamo Tikipunga I Tikipunga, Raumanga Heights Whau VIy Whau Valley, Western Hills, Maunu, Parahaki Otahgarei I Otangarel Mairtown Kensington, Mairtown, Regent Woodhill Woodhill, City, Riverside, Horahora, Morningside Avenues Avenues, Otaika/Raumanga Sherwood Port Limeburners, Sherwood Rise, Onerahi

Otangarei is a neighbourhood scoring very high on the first principal component. It falls into the very high social risk category. It represents Whangareis neighbourhood most like Point England in Auckland or Otara in South Auckland. The Avenues neighbourhood is an inner city area, Whangareis equivalent to Grafton in Auckland, merged with Otaika/Raumanga,an area of more residential but low income status, like Aucklands Grey Lynn.

28 B3. MORTALITY AND POPULATION CHARACTERISTICS IN NORTHLAND NEIGHBOURHOODS

To ensure sufficient accuracy the neighbourhoods used here are the local authorities. The mortality (from all causes) is compared for men and for women, among the neighbourhoods. For each of the neighbourhoods are presented the present and projected age structure and the Maori and Pakeha age structures overlaid. B3.a Mortality Average annual mortality from all causes, age-adjusted rates per 1000, 1980-1986

Otamate

Dargavil]

Hobson

City

Whang ar

Kaikoh

3o1 Coun

Bol Towr

Hokiang

Kaitaia

Mangoni

12 109876543210 012345678910 12 14

Females Males B3.b Population Characteristics The figures which follow display for each neighbourhood the population trends and the ethnic composition of the current population.

29 Projected Population Structure in 2011 Compared to 1986

In the Far North District a significant increase in the number of 45 to 59 year olds is forecast.

Projected 2011 75 plus Actual 1986

45-59

30-44 I

15-29

0-14 6000 4000 2000 0 2000 4000 6000 1...... Females Males

Ethnic Distribution Pakeha

Maori

75 plus I;f:f:f:ffj

60-74 I

45-59 I

30-44 F

15-29 F

..: .. 0-14

4500 3500 2500 1500 0 1500 2500 3500 4500 1111111 1 1 I_L I Ill_L Ull 1111111111 1 1 111 I[I liii II III lIII I llII I IIII U llI 111111 I l l ll p llii i iilI i llll I

Females Males

Projected Population Structure in 2011 Compared to 1986

In the Whangarei District a significant increase in the working age population is forecast.

Projected 2011 .,5 plus

I Actual 1986 60-74 I

45-59

30-44 I

15-29

0-14 9000 0 9000 Females dales

Ethnic Distribution Pakeha

I Maori

75 plus

60-74 I

45-59 1 30-44 I

15-29 I

0-14 Ii 6600 0 6600 ...... I

Females Males

31 Projected Population Structure in 2011 Compared to 1986

In the Kaipara District fewer children and more older people are forecast for 2011.

Projected 2011 75 plus El I Actual 1986 60-4 I 0 - Ww" 45-59 I

30-44 I

15-29

0-14

6000 4000 2000 0 2000 4000 6000 I.u.I.I.I.I.I.I.I. J.l.,.I.I.I.I.I.I.I. 111

Females Males

Ethnic Distribution Pakeha There are relatively few people classified as Maori in the region. El

Maori

75 plus

• 60-74

45-59

30-44

15-29

0-14

2000 1600 1200 800 400 400 800 1200 1600 2000 I,I,I,I,I,I.l,I,I,I, 1U • U I I I I 1 . 1 . 1 1•1• I I

Females Males

32 Projected Population Structure in 2011 Compared to 1986

Projections for Mangonui and Whangaroa Counties suggest a large increase in the retirement-age population. El Projected 2011

75 plus - Actual 1986

60-74 ------45-59 -I 30-44

15-29

0-14 1600 800 0 800 1600 I , II , I , u I II,I,I.I.i.i.l.I.I.I.I.I. Females Males

Ethnic Distribution El I 75 plus

60-74

30-44

15-29

0-14

1200 800 400 0 400 800 1200 I______— ------I

Females Males

Projected Population Strücture.in 2011 Compared to 1986

In Kaitaia the age structure is forecast to change little before 2011, except for an increase in 45 to 59 year olds.

75 plus Projected 2011

60-74 I Actual 1986 45-59 I

30-44 I

15-29

0-14

700 500 300 100 0 100 360 500 700

I I I I I I I I I I I I I I I I I

Females Males

Ethnic Distribution El, Pakeha

75 plus I

60-74 F

45-59

30-44

15-29

0-14 F

450 250 100 0 100 250 450 u"i"u uunpuuu.iurrr 11111111111111111111111111

Females Males

Projected Population Structure in 2011 Compared to 1986

For the Hokianga the forecast for 2011 has a much higher proportion of adults, especially aged 45 to 59, than at present. Projected 2011 75 plus I Actual 1986 60-74

45-59

30-44

15-29

0-14

1000 - 500 0 500 1000 I I I I I I I I I I I I I I I I I I I I I Females Males

Ethnic Distribution.

People classified as Maori are about half the population except in the 30 to 44 age group.

75 plus El Is 60-74 Maori

45-59

30-44

15-29 Fl 0-14 I I I

500 300 100 0 100 300 500 gui till. 111111 IlililIli igi trill iii 1 11 1 1 1 1 11 II I 1111111 II III1IIIII 11 1111 lull. IllIllilIl 11111111 llj Females Males

Projected Population Structure in 2011 Compared to 1986

The forecast for Bay of Island County areas shows people over 45 as nearly doubling in number by 2011.

Projected 2011

75 plus Actual 1986 60-74 1

45-59 I

30-44

15-29

0-14

3000 2000 1000 0 1000 2000 3000

1••II•!!IulurIIuJuuuuruIlwrIu,,..,uI.,I.yu ii

Females Males

Ethnic Distribution El Pakeha

Maori

75 plus

60-74

30-44

15-29

0-14

1800 1000 0 1000 1800

Females Males

36 Projected Population Structure in 2011 Compared to 1986 Fewer children and more adults over 45 are forecast for Kaikohe in 2011.

Projected 2011

75 plus III Actual 1986

60-74

45-59

15-29

0-14 I

550 400 200 0 200 400 600 . ,TIuJul.,uul,u,uIuIuuuIulII,lIuuuuuuuuuuluuhuIuuruuluuluIl,uII Females Males

Ethnic Distribution Pakeha Under age 30 almost half the people in Kaikohe are classified as Maori. I Maori

75 plus I

60-74

45-59

30-44

15-29

0-14

300 200 100 0 100 200 300

J .... IIIIlIll. II . i.. •-1IIIIIu II IllIllIllI l lI IuIuluuluulIll Females Males

37 Projected Population Structure in 2011 Compared to 1986 The forecast for Whangarei County shows people over 45 as nearly doubling in number by 2011.

Projected 2011 75 plus

Actual 1986 60-74 I

5-59

30-44

15-29

0-14 3500 2000 1000 0 1000 2000 4000 ...... I Females Males

Ethnic Distribution El Pakeha

Maori 75 plus

60-74

45-59

30-44

15-29

0-14

2400 1000 0 1000 2400 UIIIIIIIIIIIIIIIIIIIIIIIIII Females Males

38 Projected Population Structure in 2011 Compared to 1986 Whangarei city closely resembles the Whangarei District in population.

75 plus I ...... El Projected 2011

60-74 Actual 1986

45-59

30-44

15-29 I

0-14

5500 4000 2000 0.....a.. 2000 4000 5500

Females Males

Ethnic Distribution El Pakeha

Maori 75 plus .

60-74

45-59

30-44 ______

15-29

0-14

4500 3000 2000 1000 0 1000 2000 3000 4500 11111111 III Ito J Till III I III III I IIII I lIII I IIII I 11111111 u IIIIIIJIuuI I u I uIuuIuIuUIuII uuluIII

Females Males

39 Projected Population Structure in 201.1 Compared to 1986 In Otamatea the forecasts show a large increase in people over 45 by the year 2011.

Projected 2011 75 plus I Actual 1986 60-74

45-59

30-44 MENEM

15-29

0-14 1000 500 0 . 500 1000 I I I I I I I I I I I I I I Females Males

Ethnic Distribution LI Pakeha

Maori 75 plus 91

60-74

45-59

...... xx. . . 30-44 ...... 15-29 ......

...... 0-14 .... .

1000 0 500 1000

Females Males

Projected Population Structure in 2011 Compared to 1986 Hobson County can expect fewer children by 2011 and an increase in the numbers of people over 45.

Projected 2011 75 plus I

I Actual 1986 60-74 I

4559 . 30-44 :

15-29

0-14 1 800 400 0 400, 800

Females Males

Ethnic Distribution El Pakeha

Maori 75 plus

...... 60-74 .

45-59 I

30-44 I

15-29

0-14 700 400 100 100 400 700 I I I I I I I I I I I I. I I I I

Females Males

Projected Population Structure in 2011 Compared to 1986

In Dargaville some further aging of the population structure is forecast.

El Projected 2011

75 plus I Actual 1986 60-74

45-59 I •. If

30-44

15-29 0-14 I 650 0 650 ...... I Females Males

Ethnic Distribution Pakeha

Maori

75 plus

60-74

45-59 1

30-44 XX

15-29 I

0-14 500 300 100 100 300 500 III Females Males

42 This report has been prepared for the Northland Area Health Board by Dr Judith Reinken of FFMS Consultants: Newtons Road, Omapere or 2 P!unket St, Wellington

NORTHLAND AREA HEALTH BOARD Co &gt;

NORTHLAND AREA HEALTH BOARD Co >