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Whanganui Communities I I I pauIAMA WHIRINAKI I Interwoven Paths I I o I I I I I I I I I The Report of the Central RHA Wanganui Need'S Assessment I MOH Library IIII I 95503M I I I I I I POUTAMA WHIRINAKI I INTERWOVEN PATHS The title ofthis report was given by Te Roopu Awhina - the Advisory Group I ofTe Ihonga Hauora, the Central Regional Health Authority. The name literally means "Interwoven Pathways" and its translation is intend~d to I portray the interwoven paths ofTe Ihonga Hauora and the people ofthe Whanganui communities. I It is also likened to the untamed surging rapids and the tranquility ofthe Whanganui river. I "From the mountains to the sea I flow, I am the river and the river is me. " "Ko au te awa, ko Ie awa ko au, I e rere marika ana ki te moana. " I I I I I Published by the Central Regional Health Authority I Wellington. New Zealand March 1996 I ISBN 0-47~~20208~3 I WJ{ 'I I CONTENTS I I EXECUTIVE SUMMARY 7 I CONSULTATION 9 CHAPTER 1: INTRODUCTION 11 I Needs Assessment Studies in the Central Region 12 Criteria for selection oflocalities 12 I Definition of the study area 12 I CHAPTER 2: SOCIO-DEMOGRAPHIC PROFILE OF WANGANUI 15 Highlights 16 I Source and Presentation of Data 17 Demographic Profile 17 I Total population 17 Population trends 17 Ethnic group populations 18 I Age/sex profile 20 Social Profile 22 I Family type 22 Household income 22 I Income support 23 Unemployment 24 I Accommodation 24 Educational qualifications 24 Access to private transport 25 I Summary 25 I CHAPTER 3: THE HEALTH STATUS OF W ANGANUI 27 Highlights 28 I Introduction 29 Hospitalisation 30 I Causes of death 31 Important health issues 32 Information Centre Ministry of Health Age-specific causes ofhospitalisation and death 44 Wellington 1 Summary 50 /1 I Poutama Whirinaki Interwoven Paths I CHAPTER 4: WANGANUI HEALTH SERVICES - WHAT THEY ARE AND HOW THEY ARE USED 53 I Highlights 54 Primary Care Services 55 I Secondary Health Services 64 Mental Health Services 66 I Alcohol and Drug Services 67 CHAPTER 5: CONSUMER VIEWS 69 I Highlights 70 Introduction 71 I Themes 72 Cost ofservices 72 I Choice 75 Continuity ofcare 76 I Other barriers to health services 76 Transport 77 I Weekend help 78 Horne visiting 78 Waiting times 78 I Quality issues 80 Early childhood services 82 I Information 82 Pharmacies 83 I Dental care 83 Provider attitudes 83 I Cultural 84 Carer relief 84 Characteristics ofsatisfactory services 84 I Priorities for change 85 I CHAPTER SIX: NGA IWI MAORI 0 ROTO 0 WHANGANUI - MAORI IN WHANGANUI 87 I Highlights 88 Introduction 89 I What Maori had to say 91 Issues raised at the consultation hui 92 Current services and their responsiveness to Maori health needs 99 I I Poutama Whirinaki -Interwoven Paths 2 I I CHAPTER 7: THE VIEWS OF COMMUNITY GROUPS 103 I Highlights 104 Introduction 105 I Overview 106 Who the groups represent 106 I Services used 106 The Most Important Health Issues for Wanganui 107 Major themes 107 I Social and political issues 107 Access 108 I Positive Aspects of Services Used 110 Access 110 I Information and communication III Customer satisfaction III I Aspects ofHealth Services That Are Not Meeting People's Needs 112 Access 112 Information and communication 114 I Consumer satisfaction 115 Suggested Improvements 116 I Access 116 Information and communication 118 I Increased resources 118 Priorities for Improvement 119 I Access 119 Information and communication 120 I Increased resources 120 CHAPTER EIGHT: HEALTH PROVIDERS' VIEWS 123 I Highlights 124 Introduction 125 ,I Our approach 125 Health Issues in Wanganui 126 I Children and adolescents 126 Elderly people 129 I Women's health issues 130 Maori 132 People who cannot pay for services 133 I People with mental health problems 133 Rural communities 135 I Other vulnerable groups 135 _I 3 Poutama Whirinaki - Interwoven Paths I Barriers to health care 136 Strengths of health care services available 138 I Problems in the provision of services 139 I CHAPTER 9: CONCLUSION AND RECOMMENDATIONS i41 Conclusion 142 I Key facts about Wanganui and its people - and what that means for health services 142 I Key health issues 144 Sexual health issues 148 Dental services 149 I Children and family health services 149 Services for older people 150 I Specialist services 151 Summary 155 I Strategic Framework 156 Macro issues 156 I Health service strategies 159 Timetable and estimated cost 170 Three year implementation plan 170 I BIBLIOGRAPHY 173 I ACKNOWLEDGEMENTS 175 I APPENDICES 177 Appendix A: Advisory/Liaison Group 178 I Appendix B: Socio-Demographic Tables 179 Appendix C: Health Status Tables 182 Appendix D: Maori Groups 188 I Appendix E: Responses Received From Community Organisations 189 Appendix F: Wanganui Providers Interviewed 190 I I I I I Poutama Whirinaki -Interwoven Paths 4 I. I I LIST OF FIGURES I Map ofWanganui and core area 13 I 2 Population proportion by ethnic group, for sub-areas ofWanganui District, 1991 19 3 Population proportion by life cycle age group, Wanganui District sub-areas, 1991 21 I 4 Population proportion by life cycle age group, by ethnic group, Wanganui District, 1991 21 'I 5 Household income distribution, by sub-area ofWanganui District, 1991 23 6 Dwelling tenure type, sub-areas ofWanganui District, 1991 24 I 7a All causes of hospital isation by gender and area, 1989-1994 30 7b All causes of hospitalisation by ethnicity and area, 1989-1994 30 I 8 Major causes ofhospitalisation for infants under one by area, 1989-1994 45 'I 9 Major causes of hospitalisation for children 1-4 years by area, 1989-1994 45 10 Major causes ofhospitalisation for children aged 5-14 years by area, 1989-1994 46 I 11 Major causes ofhospitalisation for males aged 15-24 years by area, 1989-1994 46 12 Major causes ofhospitalisation for females aged 15-24 years by area, 1989-1994 47 I 13 Major causes ofhospitalisation for males aged 25-44 years by area, 1989-1994 47 I 14 Major causes of hospitalisation for females aged 25-44 years by area, 1989-1994 48 15 Major causes ofhospitalisation for males aged 45-64 years by area, 1989-1994 48 I 16 Major causes of hospitalisation for females aged 45-64 years by area, 1989-1994 49 17 Major causes ofhospitalisation for adults aged 65-74 years by area, 1989-1994 49 'II 18 Major causes of hospitalisation for adults aged 75 years and over by area, 1989-1994 50 I 19 GMS claim rate per head of population 1993/94 56 :1 20 Dental benefit claims per adolescents 58 I :1 'I :1 5 Poutama Whirinaki -Interwoven Paths LIST OF TABLES I I Projected usually resident population by age group, Wanganui District, 1991, 2006 (medium variant) 18 I 2 Iwi affiliation, Wanganui District Council, 1991 20 I 3 All causes ofdeath by gender, ethnicity and area, 1988-1992 31 4 Asthma hospitalisations by ethnicity, area and age, 1989-1994 33 I 5 Diabetes hospitalisations by ethnic group and area, 1989-1994 34 6 Coronary heart disease hospitalisations by gender, ethnicity and area 1989-1994 34 I 7 Other heart disease hospitalisations by gender and area 1989-1994 35 I 8 Cerebrovascular disease hospitalisations by gender, ethnicity, and area, 1989-1994 35 9 All cancer hospitalisations by gender, ethnicity and area, 1989-1994 36 I 10 Leading causes ofcancer hospitalisations, 1989-1994 36 I 11 Grommets surgery hospitalisations by age, gender and ethnicity, 1989-1994 37 12 Fracture hospitalisations by gender, ethnicity, and age, Wanganui 1989-1994 39 I 13 Motor vehicle crashes hospitalisations by gender, ethnicity and age, Wanganui 1989-1994 40 I 14 Intentional self-harm hospitalisations by age, gender and ethnicity, Wanganui 1989-1994 41 I 15 Head injuries hospitalisations by age, gender and ethnicity, Wanganui 1989-1994 42 I 16 Psychoses and paranoid states by admission type and gender, Wanganui 1987-1991 43 17 Schizophrenic disorders - readmissions by age, gender and ethnicity, I: Wanganui 1987-1991 43 18 Neuroses and depressive disorders hospitalisation by age, gender and ethnicity, I,' Wanganui 1987-1991 44 19 Hospital-based services provided at Good Health Wanganui 64 ,I I Poutama Whirinaki - Interwoven Paths 6 I I EXECUTIVE SUMMARY I This report presents the findings of a health needs assessment project carried out in Wanganui in 1995 and I makes recommendations on the basis ofthose findings. Wanganui was selected as one of the priority areas for the conduct of a comprehensive needs assessment I project, on the basis ofkey socio-economic factors associated with low health status and high health need. Locality studies which focus on particular high need areas have been used by Central RHA to target different I resources and/or improved services to the people in those areas to achieve health gains. The project focused on those suburbs adjacent to the west side of the Wanganui river, and two eastern suburbs. These suburbs, which in the report are collectively called the core area, were in turn selected, I because socio-economic indicators and previous studies suggested these were areas of higher health need relative to other parts of Wanganui. While people from a wide range of socio-economic groups and backgrounds live in both the core area and the rest ofWanganui, important population differences exist. The I core area has a higher proportion of younger people and Maori. Average household income and formal educational levels are low, unemployment and income support levels are high and children in the core area are more likely to be brought up in a single parent family.
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