TT-iffilEl HF..LTR OF PEOPLE TI XT( QJ( Tii1(
S
? ALA I
V S
P, I
A
S
A ACKNOWLEDGEMENTS
The- current Locality Profile Working Group (Carolyn Wilson, Ginia Gouman, Alexius Pepper, Ryan Thompson, Clare Pascoe, Nikki Douglas, Angela Bensemann, Ruth Richards, Clare Baxendale, Helen Watson, Tor Wainwright and Jesse Kokaua) would like to acknowledge those who have contributed over the past three or four years: Chris Clarke, Alex Watt, Ron Craft, Toni Foster, Gail Tipà, Jane Docherty, Christine Theissen, Nigel Dickson, Diana Rothstein, Kirsten Coppell, Brian Cox, Jo-ann Eggers, Phil Hider, Katie Pascoe, Wendy Black. We would also like to acknowledge the work of all who commented on earlier drafts of this document, both colleagues throughout the country and residents of the Southern region.
Z. CONTENTS
FOREWORD 1
INTRODUCTION 2
THE SOUTHERN REGION AND ITS PEOPLE 4 THE LOCALITIES 4 The localities defined The five Christchurch city localities THE PEOPLE 6 Where people live Changes in the size of the population Age groups Ethnic groups Economic status Families GEOGRAPHICAL ACCESS TO HEALTH SERVICES 17
LIFESTYLE AND ENVIRONMENT 19 LIFESTYLE 19 Smoking Alcohol consumption Diet Obesity Exercise ENVIRONMENTAL HEALTH 22 Water quality Air quality Food safety Waste disposal and hazardous substances Workplace health and safety Road safety Violence Communicable diseases
HEALTH, ILL-HEALTH AND DISABILITY 25 LIFE EXPECTANCY AND DEATHS 26 Life expectancy Death rates HOSPITAL ADMISSIONS 28 First admissions and total admissions Causes of admission to hospital Locality differences in admissions Acute admissions Length of stay Where people go for hospital treatment USE OF GENERAL PRACTICE SERVICES 33 Visits to the family doctor The use of medicines DISABILITY 34 Physical and sensory disability Intellectual disability MENTAL ILLNESS AND ALCOHOL AND DRUG ABUSE 38 OVERALL MEASURES OF HEALTH AND HEALTH NEED 41 People s view of their own health Socio-ecorfomic measures of health need Womation, Centz UQJA Ministry of. Health Wellingt3n HEALTH DIFFERENCES WITHIN THE COMMUNITY 44 Socio-economic differences Maori health Pacific Islands and other communities Men s and women s health Rural and urban health differences
KEY HEALTH ISSUES FOR EACH AGE GROUP 48 CHILDREN (0-14 YEARS) 48 Main causes of death and hospital admission Low birth-weight babies Birth defects and disabilities Sudden Infant Death Syndrome (cot death) Immunisation and infectious diseases Respiratory illness Hearing problems Motor vehicle crash deaths and injuries Child abuse and family violence Dental health TEENAGERS AND YOUNG ADULTS (15-24 YEARS) 56 Main causes of death and hospital admission Motor vehicle crashes Suicide Teenage pregnancy and termination of pregnancy Sexual health Smoking Alcohol and drug abuse Mental ill-health
ADULTS FROM YOUTH TO MID-LIFE (25-44 YEARS) 60 Main causes of death and hospital admission Childbirth Abortion and infertility Diabetes Mental ill-health
MID-LIFE ADULTS (45-64 YEARS) 62 Main causes of death and hospital admission Coronary heart disease Cancer Adverse effects of chronic conditions
THE ELDERLY (65 YEARS AND OVER) 67 Main causes of death and hospital admission Disability and independence Stroke Hip fractures Pneumonia, influenza and chronic respiratory disorder Dementia Multiple illnesses
CONCLUSION 70
APPENDICES APPENDIX A - CHRISTCHURCH LOCALITIES 71
APPENDIX B - PREGNANCIES, BIRTHS AND TERMINATIONS 73
APPENDIX C - TABLES AND SOURCES OF FIGURES IN THE TEXT 80
REFERENCES 113 health Funding Authority
• . South Office 229 Moray Place 28 September 1998 P0 Box 5849 DUNEDIN New Zealand • ./ Telephone 03 477 4222 Facsimile 03 474 0080
Please find en4 a copy of The Health of People in the South , a health status profile of the West Coast, Canterbury, Otago and Southland regions.
This document was compiled over the past two years by staff of the Southern Regional Health Authority (now Health Funding Authority). In 1996 the SR}TA presented thirteen draft locality profiles to the public for comment. Feedback from this consultation was incorporated into this overall regional profile, which retains considerable dçtail about each locality and puts it into a regional and national context.
Information on census data, deaths and hospital admissions etc have been updated for this regional profile. This profile also contains additional information that was collected for a draft summary paper on key health problems of the region, prepared earlier in 1998 as a background document for primary health care professionals.
We hope you will find this profile interesting and useful as a summary of some baseline information about the health of people in the southern region of New Zealand.
If you would like further copies, they can be obtained from:
Dunedin Office Health Funding Authority P.O.Box 5849 Dunedin
Yours sincerely
Jesse Kokaua MENTAL HEALTH RESEARCH ANALYST STATISTICIAN
"4 North %4r Midland Central South It Mana Ha— A Rob, 0 T, Raki 11 ThthogH..o • FOREWORD
Ko te mana hauora S Ko te mana takata "The health of the people is the strength of the people"
This is a document about people in the southern region - Canterbury, West Coast, Otago and Southland - and some measures of their health. We have written it for everyone who has an interest in health.
The south is unique in that quite a large proportion of its population is scattered sparsely over a vast geographic area. Many small rural communities are often faced with barriers of distance, terrain and weather in getting to health services. The Health Funding Authority has to meet the challenge of ensuring these communities get the basic services they need and have good access to more specialised services in the larger centres.
Some indicators, for example child road deaths, show the south to be better than the rest of the country but nevertheless they are still high by international standards and should therefore be seen as unacceptable.
Rates of ill-health and premature death from most causes are clearly higher than average in low income and disadvantaged groups and areas. Peoples health is shown to be closely linked to their socio-economic situation, which reinforces the importance of the Health Funding Authority working inter-sectorally with other agencies to address issues such as housing, employment, income, education and road safety.
Maori also show much higher than average rates of ill-health and premature death from many causes. This is linked both to socio-economic disadvantage experienced by Maori and to the cultural barriers that prevent easy access to health services. This highlights the importance of the Health Funding Authority working with Maori to develop effective ways of redressing this health imbalance.
Lack of response to illness prevention and health promotion campaigns by those who most need it is a matter of concern. Low income people and Maori, the groups most at risk of illness and premature death, tend to use GPs and screening services less than they need to, and are admitted to hospital more often than average and with more severe illnesses. It is crucial that the Health Funding Authority work with these groups to find effective ways of making sure they get the primary health and preventive services they need.
Like the statement "ko te mana hauora, ko te mana takata, this document is uniquely for and by people of the south. We would like to present this document to the Health Funding Authority and people of the southern region with hopes that they will make good use of it. No reira He mihi aroha tenei kia koutou katoa. Tena koutou, tena koutou, tena koutou katoa. E noho mai ra
Elizabethcdkinningham Kath Fox General Manager, Maori Health Southern Regional Director, Health Funding Authority
Disclaimer In spite of the best efforts to obtain accuracy of the information in this report, the Health Funding Authority cannot guarantee that the information supplied contains-no errors. INTRODUCTION lop, S The purpose of this report - this document pulls together data from many sources to give an overview of the health of people in the south of New Zealand, comparing local areas within the region to the region as a whole and to New Zealand. This report is intended for a wide variety of readers - health professionals, planners, policy makers, organisations providing health and disability services, trainees and students, researchers, community groups, non-government organisations and local and national politicians.
Why do a health status profile? - it is essential to know what changes are occurring over time in the ill-health and levels of disability of people in the community, because this enables us to plan for health and disability support services, and to evaluate whether they are having any effect. Knowing how levels of ill-health and disability vary among people of different ages, gender, ethnic and social background is important to be able to make sure that services are reaching those in most need of them.
A health status profile is one part of a basic planning tool-kit. Because it covers such a broad range of topics it necessarily skims the surface of each, giving an overview to set them in context.
The next steps would be to look at what services are available to meet these identified needs, how people are using these services, whether there is a better way of tackling the greatest health needs within a set funding level, and how priorities should be set among them. These are all different exercises that are beyond the scope of this report. However, we hope that the data presented here will provide a baseline for further analyses and discussion.
A traditional view of health - how people define their own health, and how different communities define and value different aspects of health, varies considerably. How health is defined in this paper has been coloured by the type of data that is available. Traditional indicators of health, such as death rates, hospital admissions and common public health measures have been used. Many of these indicators are proxy measures that give only an indirect and limited way of assessing how healthy a group of individuals may be.
While it is important to look at this basic information, it can encourage a focus on the causes of ill-health, rather than on the fostering of good health. Many people have pointed out the need for a broader view of health to include social, emotional and spiritual dimensions, and to consider measures of well-being rather than just ill-health.
The type of data that is most easily available also encourages a view of ill-health or disability as something that happens to an individual, and to look mostly for individual and bio-medical solutions. It is clear that many of the health issues described in this paper (e.g. low birth-weight babies, child abuse) cannot be addressed successfully unless the whole context of people s lives is taken into account. Individual events that are often intensely personal, like teenage suicide, when considered as a group can also be seen as an indicator of the health of the community as a whole. More needs to be done to develop measures of social health and well-being.
Focus on what can be improved - this document gives most attention to where ill-health, injury and disability could potentially be prevented - for instance, to premature death rather than all deaths. The report also focuses on the differences in health among social and ethnic groups, because these differences often show where improvements are possible.
The report looks more at preventable or controllable conditions (like hepatitis or diabetes), and less at the serious illnesses and medical interventions (like kidney dialysis) which may be needed when these conditions are not successfully controlled. It focuses on illnesses (like cardiovascular disease) that have varied over time or among social groups, rather than on those (like schizophrenia) where the incidence appears to be fairly stable over time and among different populations. Background to the report - during 1995-96 the Southern Regional Health Authority collected a wide range of information on the health of the localities in the region. These were collated into 12 draft Locality Profiles which were presented to the public for comment in 1996. During this consultation we held 25 meetings with communities and health professionals -around the region to discuss the profiles, and received 170 submissions, representing the views of approximately 2300 people. This document incorporates these views and also includes additional and more recent data available to us. In addition, the feedback from the consultation and answers to specific queries that were raised will be available in a separate companion document later in 1998.
Further information - the information presented here tends to raise as many questions as it may answer, necessitating more detailed analysis of the data. It is hoped that information about the sources and limitations of the data will enable the reader to explore further.
Health profiles are of limited usefulness unless they can be updated to see what changes have occurred. We are updating much of the locality-level data in this paper internally on a regular basis, and we are also preparing an internal paper which documents where and how the data is stored and updated within the Health Funding Authority.
3 THE SOUTHERN REGION AND ITS PEOPLE
THE LOCALITIES
Figure 1. The southern region showing Regional Council boundaries, localities and Territorial Local Authorities (TLAs) which make up the localities.
West Coast (1 (1) Westport District (2) Greymouth District (2) (3) Buller District North Canterbury (2) (1) Kaikoura District (2) Hurunui District
Canterbury (1) Waimakariri District (2) -• (2) Selwyn District Central Lakes (3) Banks Peninsula District (1) Central Otago District (2) Queenstown-Lakes Dis rs Christchurch (2) (1) Christchurch City Mid Canterbury Southland (1) Ashburton District (1) Southland District Timaru (2) Gore District 1 South Canterbury (1) TImaru District Queen1wn, Otago j (2) MacKenzie District Alexandra RegiO ( (3) Waimate District Oamaru Waitaki I (1) Waitaki District Southland Region Dunedin (1) Dunedin City Baiclutha (1) Gore, Clutha 4 (1) Clutha District
Invercargill (1) Invercargill City TLA boundary I within a locality I
Locality boundary
Regional Council boundary I
Major towns and cities
4 The localities defined
For the purpose of this exercise, the southern region covers four regional council areas - West Coast, Canterbury, Otago and Southland. These regions comprise 21 territorial local authority areas (TLAs). Most health-related figures (eg numbers of cot deaths) are too small to analyse reliably by local authority area, and yet regional data is not detailed enough to be useful for understanding local need. So the Southern Regional Health Authority defined an intermediate level of population group which, was called a "locality".
A locality may be a single local authority area, or may be made up of a group of local authority areas, or may be part of a local authority area as in the case of Christchurch City.
The localities correspond to the following Territorial Local Authority areas:
LOCALITY TERRITORIAL LOCAL AUTHORITY AREAS
West Coast Buller, Grey and Westland North Canterbury Hurunui and Kaikoura Canterbury Selwyn, Waimakiriri and Banks Peninsula Christchurch Christchurch City Mid Canterbury Ashburton South Canterbury Timaru, Mackenzie and Waimate Waitaki Waitaki Dunedin Dunedin City Central Lakes Central Otago and Queenstown Lakes Clutha Clutha Invercargill Invercargill City Southland Southland and Gore
Where data is not available at locality level, more aggregated information may be presented. This may include the regional council areas or former area health board/Crown Health Enterprise (CHE) areas (West Coast, Canterbury, South Canterbury, Otago and Southland). Explanation is given in the text as to how these and other aggregations correspond to the locality boundaries defined above.
Small numbers - caution needs to be taken in interpreting rates and percentage data for North Canterbury and Clutha, particularly for relatively infrequent events such as deaths. The populations of these localities are small enough for even a chance increase in such numbers to have a disproportionate effect on rates.
The five Christchurch city localities
Christchurch data in itself often does not tell us very much in relation to the whole region. The city includes 40% of the southern region s population and therefore strongly colours the regional average. Because of this it was decided to divide the city into population groups that were more comparable in size with the other localities we had identified in the region. The city has few natural geographical boundaries, so another way of dividing it up was sought. We settled on a measure of socio-economic status which could be easily used, was based on available censu data, and showed how health status measures vary according to socio-economic differences.
The five Christchurch localities were constructed by ranking the city s suburbs (census area units) according to a socio- economic scale, then clustering them into five areas of roughly equal size. These have been ranked from Christchurch 1 (disadvantaged) to Christchurch 5 (advantaged). Appendix A shows which suburbs fell into which locality, and discusses the scale in more detail.
5 THE PEOPLE F11,R61401ii I
Vs/here people live
The distribution of the population of the southern region is one of extremes. There is a large urban population living in relatively densely-settled coastal cities, and a widely scattered population living mostly in the rural hinterland.
As Figure 2 shows, most (72%) of the region s 783,000 residents live in major or secondary urban areas, particularly Christchurch (40%), Dunedin (15%), Invercargill (7%) and Timaru (5%). (Appendix C, Table 1)
Figure 2. The distribution of population around the region, 1996 The remaining 205,000 people (28%) living in minor urban 120,000 and rural areas are scattered 110,000 widely over a vast region. 100,000 90,000 80,000 Christchurch is the most 70,000 densely populated area (682 60,000 people per sq. km.), followed by 50,000 Invercargill (108 people/sq. 40,000 km.). Other areas are relatively • 30,000 sparsely populated, which 20,000 results in the southern region 10,000 0 having less than half the b . number of people per square c? 1 kilometre of New Zealand as a whole (six people per sq. km, compared to 13 people). (Appendix C, Table 1)
Whether people live in the city or a rural area can make a difference to getting the health services they need. People living in urban areas generally have good geographic access to a variety of health services. However, for many rural people, getting to health services can be hampered by distance, the availability and cost of transport, the terrain and the weather.
Visitors - unless stated otherwise, all of the data presented in this report refers to the usually resident population of the southern region. However, the census also collects information on the total population of an area. The total population comprises everyone who is in that locality on census night (5 March 1996) whether or not they usually reside there. A comparison of usually resident and total population is a useful indicator of the number of visitors to a locality.
The locality with the largest difference between resident and total population was Central Lakes, where the total population including visitors was 20% more than the resident population, an addition of nearly 6,000 people. Other areas with relatively high proportions of visitors were Christchurch 1 and 4, North Canterbury, West Coast, and Southland. (Appendix C, Table 1)
I Changes in the size of the population
Projected population growth - the southern region is projected to have almost static population growth in contrast to the rest of New Zealand which is predicted to grow faster. This has implications for our health funding as funding is linked to population size, and the proportion of funding coming to the south will drop relative to other regions. It also has implications for the expected demand on health services in the future.
As Figure 3 shows, the southern region s population is expected to grow more slowly than that of New Zealand as a whole, dropping from a current yearly increase between 1991 and 1996 of just over 1% to an increase by 2001 of only 0.9% a year, and becoming static by 2011. In contrast, the population of New Zealand as a whole is projected to grow about twice as fast as this, and the northern region s population is expected to increase about three times as fast. 1 (Appendix C, Table 2)
The slow population growth in the south reflects both a birth rate that is lower than the national average and expected to drop further, and a slightly higher-than-average death rate, which is partly due to the slightly higher proportion of older people in the southern region.
Figure 3. Population growth, southern region and New Zealand, 1986-2011 Changes in where people live - Queenstown and the rural commuter belt around Christchurch (particularly Waimakiriri and Selwyn) have been the fastest growing areas in the region and this trend is expected to continue. Christchurch and Dunedin are the next fastest growing localities.
The size of the population has generally grown more in the north of the region than in the south. Invercargill, Southland, Waitaki and Clutha have lost population over the past 10 years and are expected to continue to lose population in the next 10 years. (Appendix C, Table 3)
In some rural localities (e.g. Waitaki) a relativelhigh number of younger people have moved away from the area, leaving the community with a disproportionately high number of elderly people in relation to the rest of the population.
1) These projections are based on the Statistics New Zealand series of population projections assuming medium fertility, mortality and migration based on the 1996 usually resident population. 7 Figure 4. Actual and projected population growth by locality, 1986 to 2006
rM
IN Actual Increase 1986-1996 Expected Increase 1996-2006 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2
0
-2 -3 -4 -5 -6 -7 -8 -9 a a a a a 04
a. 0E
Age groups
The age distribution of the population and how this is likely to change over time has an impact on the services that will be needed. The following description of the age distribution is based on data from the 1996 census.
An older population than the national average - the southern region has a smaller proportion of children under 15 years compared to New Zealand as a whole, and slightly fewer people in the main child-rearing ages of 25-44 years. The region has more people in the 15-24 year age group and 45 year and older age groups than the national average. (Appendix C, Table 4)
Figure 5. Proportion of people in each age group, southern region and New Zealand, 1996
15 r-
15 to 24 years 25 to 44 years 25 to 44 years 5 to 14 years
5 to 14 years 1 to 4 years Undo, 1 yea 45 to 59 years to 59 years 75 years and 1 to4jeas 6J to 14 years 60 to 64 years to 64 years 75 years and over 65 to 74 years Southern Region New Zealand
8 The southern region has a slightly higher propotion of residents over 75 years of age than the country as a whole; 5.5% compared to 4.8% for New Zealand.
Localities with higher-than-average proportions of people in the 75+ year age group include Waitaki, the less advantaged areas of Christchurch, and Mid and South Canterbury.
Figure 6. Percentage of people aged 75 years and over, by locality, 1996
8% 7% 6% 5% 4% 3% 2% 1% 0% \1 " . • , - is I
The ageing population - the proportion of the population over 45 years of age is increasing, while the proportion in younger age groups is dropping. The number of people aged over 65 years is projected to grow by about 8% between 1996 and 2006, although the total population of the region is expected to increase by only 5.7% in that time.
The 15-24 age group showed the largest drop (9%) between 1986 and 1996, and is expected to drop further (by 13.3%) from 1996 to 2006. (Appendix C, Table 5)
Because people over 45 years - and particularly those over 65 years - use health and disability services more than younger people, the increase in these older age groups in the next 10 to 20 years means we can expect increased demand on health and disability services.
Figure 7. Actual and projected numbers of people in each age group, southern region, 1986 to 2006 Ethnic groups
The ethnic mix of the population has an impact both on the type and extent of illness and disability that may be found, and also on the type of services that may be most effective. Some illnesses, such as diabetes or skin cancer, are more common among certain ethnic groups. Ethnic groups vary in the age structure of their communities, and thus the health problems that are most pressing. Health services are often most effective if they are tailored specifically by and for the communities for which they are intended.
The Maori population - about 55,500 Maori live in the southern region, comprising 7% of the total population. This is a lower percentage than for New Zealand as a whole, where 14.5% of the population is Maori.
Figure 8 shows that in all localities the proportion of Maori in the population increased between 1991 and 1996. Localities with the highest proportion of Maori population are Invercargill (12.4%) and Christchurch (10.8%).
Figure 8. Proportion of Maori by locality, 1991 and 1996
Ed 1991 •1996 15%
12%
9%
6%
3%
0% Cj .1 6, / I I
Figure 9. Proportion of Maori who descend from each iwi in the southern region, 1996
35%
30%
25%
20%
15%
10%
5%
0 0) ) 0) 0) D) ) fl) ) ) ) ) )
$ 1.1$ I 4I IV I/I) i/////.?I /f cY so .1 c,o
Either area is not specified or specific Iwi is not stated
10 In terms of numbers, most of the Maori population resides in Christchurch, Dunedin and Invercargill, with smaller communities in most rural localities. (Appendix C, Table 6) Maori are more likely than average to be living in socially disadvantaged areas.
Over one third (35%) of Maori in the southern region are affiliated to Ngai Tabu, with Ngapuhi (12%), Ngati Porou (10%) and Ngati Kahungunu (8%) being the next most common iwi. (Appendix C, Table 7)
Figure 10 shows that the Maori population in the southern region is young compared to the region as a whole. Over a third (36%) of Maori are under 15 years of age compared to 21% for the region, and 2.5% of Maori are over 65 years of age compared to 13% for the region. (Appendix C, Table 8)
The Maori population is expected to increase faster than that of the region as a whole, partly because of this younger age structure and because on average Maori tend to start their families earlier and to have larger families.
Figure 10. The age structure of the Maori population compared to the total southern population, 1996
IMaori Fal Total resident population 13% 12% 11% 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0%
1- 0)iiiii, , 0) , 0) - 0)I1III1III1/ 0) 0) 0) CO Co t C\J C) ) CO Co I
People of European, Asian, Pacific and other ethnic origins - people of European descent make up the largest proportion of those living in the southern region, particularly in the more rural localities. At 86% of the region s population, this is markedly higher than for the New Zealand population as a whole, where 72% of people are of European descent.
People of Asian origin are the third most common ethnic group in the region, with numbers more than doubling since 1991 to over 20,000, of whom 12,600 live in Christchurch. This group comprises 3% of the region s population, compared to 4% of the New Zealand population.
2) For more information on the Maori population of the southern region, see Kokaua et at, 1996.
11 Over 10,000 people of Pacific Islands origin live in the region, mainly in Christchurch, Dunedin and Invercargill, and comprise 1% of the region s population (compared to 5% nationally).
Figure 11. Number of southern region residents by ethnicity and locality, 1996 The number of residents of other ethnic 120,000 origin has also increased since 1991. Christchurch now has sizeable communities of new migrants from African countries, including refugees from Somalia. 100,000 (Appendix C, Table 6)
The Pacific Islands communities and new migrant communities tend to have a smaller proportion of elderly people than 80,000 the region as a whole, and a correspondingly higher proportion of children and young people.
60,000 Economic status
Health, disability and life expectancy have 40,000 been closely linked to social and economic status, using measures such as income, employment, housing and car ownership. Income and the ability to earn have been 20,000 shown to have a definite impact on people s health through effects on housing, nutrition, education and other factors, as well as on people s ability to access services. IC The following data on income, ê e b a •.. •5 C) unemployment, rental housing and car c? C? 71/I C? ownership show how a large city, such as Christchurch, contains the extremes of both advantage and disadvantage.
The relative economic disadvantage of Maori is also evident in comparison to the region s population as a whole.
Household income - the median income for households in the southern region in 1996 was $30,000, which was lower than the national median household income of $35,000.
As Figure 11 shows, the sharpest disparity in income within the region can be seen in Christchurch city, which had both the locality with the highest median income of the region (Christchurch 5 at $45,000) and the locality with the lowest income (Christchurch 1 at $26,000).
The median income of Maori households is $18,236, much lower than the average of even the lowest geographic locality. (Appendix C, Table 9)
3) Krishnan, et al, 1994. 4) Crampton & Howden-Chapman, 1996; National Health Committee, 1998. 12 Individual income - a similar pattern to that shown above is evident for individual incomes. The proportion of southern region individuals with an income of less than $10,000 was 32%, compared to a national average of 30%.
Within the region, Christchurch 5 had the lowest proportion (28%) of people with an income under $10,000, while the highest proportion was found in the West Coast locality (35%).
Looking at Maori as a group in the region, 44% of individuals have an income of less than $10,000, a much higher percentage than any of the geographic localities. (Appendix C, Table 10)
Unemployment - of the adults 15 years of age or over who were either working or actively seeking work, 6.9% were unemployed in 1996, compared to 7.4% for the whole of New Zealand. The percentage of unemployed adults in the south had dropped from a level of 9.8% in 1991. Figure 12. Median income of households by locality, 1996
Figure 13 Proportion of adults 15 years or over who are unemployed and actively looking for work, by locality, 1991 and 1996
• 1991 • 1996 20%
15%
10%
5%
0% . : 9: 1,1,11/I -s.
4?
Central Lakes and Southland had the smallest proportion (3.3%) of unemployed people in 1996, while Christchurch 1 had the highest proportion (13.3%).
Maori had a higher proportion (17.7%) of unemployed adults than even the highest locality average.
Figure 14 shows the highest proportion of unemployed people is in the 15-19 year age group, with 18.5% of this age group in the southern region unemployed in 1996. This is much the same as the national rate of 18.4% of people in this age group. (Appendix C, Table 11)
13 Figure 14. Percentage of labour force who are unemployed, by age group, southern region and New Zealand, 1996
Rental housing - home ownership in New Zealand reflects both economic security and status, and also the degree of control people have over their personal environment. Health is affected by housing in various ways, including the physical state of the property (heating, dampness etc), the number of people living in the house (overcrowding), and the extent to which people shift house.
Slightly fewer households in the southern region rented their homes rather than owning them - 22% compared to 25% of New Zealand households.
Christchurch 5 had the lowest percentage of households living in rented housing (13%), while Christchurch 1 had the highest (46%).
A high proportion (44%) of Maori households live in rented housing. (Appendix C, Table 9)
Figure 15. Proportion of households living in rental housing by locality, 1996
50%
40%
30%
20%
10%
0% 2 Z
I 1111/1/ Q! 41 01
5) National Health Committee 1998; Jamieson K, 1998.
14 Car ownership - having a car makes it easier for people (especially the elderly and those with children) to get to health services, as well as to the social, sporting and recreational activities that contribute to health. Not having personal transport makes it harder for people living outside the major cities to get to these services, since good public transport is much less available.
In 1996 there were 11.5% of households in the southern region with no access to a car. This compares to 16% nationally. Christchurch 5 had the fewest households without a car (5%), while Christchurch 1 had the greatest proportion of households without a car (23%). (Appendix C, Table 9)
Figure 16. Proportion of households with no access to a car, by locality, 1996
25%
20%
15%
10%
5%
0% A A . -. • $
/ 1/
Families
The make-up of households and family groups has an impact on people s health and the demand for health services. It may reflect the amount of social support that people can draw on to help them through times of illness or disability, and the type of support services that may be needed.
Families with dependent children - of the 206,000 families in the southern region, 41% had dependent children at home, a little less than the New Zealand average (44%).
Christchurch 5 had the lowest proportion of families with children (36%) and Invercargill had the highest (46%).
Maori families were considerably more likely (54%) to have children at home than southern region families as a whole. (Appendix C, Table 12)
15 I
Single parent families - slightly fewer families with children in the southern region had only one parent (24,5%) compared to 27% nationally. This proportion has increased since 1991 in almost all localities, but has declined among Maori as a whole.
Figure 17. Proportion of families with children that are single-parent families, by locality, 1991 and 1996
1991 • • 1996 50%
40%
30%
20%
10%
0%
0 • s •.- 00
I()
Christchurch 1 has the highest proportion (47%) of families with children that are single-parent families. Invercargill and the West Coast also have a higher-than-average proportion of single parent families. Christchurch 5, Canterbury and Mid-Canterbury have lower-than-average proportions.
Maori had a relatively high proportion of single parent families - 30% of all families with children. (Appendix C, Table 12)
Households with one occupant - more southern region households are households where one person lives alone - 23% compared to 21% nationally. This probably reflects the slightly older average age of the southern region population. Between 1991 and 1996 there was a rise in the proportion of one person households in almost all localities.
Canterbury (the rural area surrounding Christchurch) has the lowest proportion of one person households (17%), while Christchurch 1 has the highest (33%). Waitaki, Mid Canterbury and South Canterbury also have a higher-than-average proportion of one person households.
Maori have a lower than average proportion (14%) of one-person households. (Appendix C, Table 9)
fii GEOGRAPHICAL ACCESS TO HEALTH SERVICES
,I.
The southern region covers a vast and diverse geographic area. Although 67% of the region s population live in the four largest coastal cities of Christchurch, Dunedin, Invercargill and Timaru, the remaining 285,000 people are scattered widely around the region in smaller communities. The geographic isolation and comparatively small numbers of people in each community present particular challenges for making sure people have good access to health services.
Figure 18 shows the time it takes residents in each part of the region to travel to the six major hospitals in the southern region: Christchurch Hospital, Dunedin Hospital, and the four district hospitals at TImaru, Ashburton, Southland and Greymouth.
Figure 18. Driving times to six major hospitals in the southern region - Christchurch, Dunedin,, Southland, Timaru, Ashburton and Grey Hospitals - by locality
Over 180 minutes 120 to 180 minutes 90 to 120 minutes 60 to 90 minutes 30 to 60 minutes Under 30 minutes
Grey Hospital r.
North Canterbury
Canterbury West Coast ,. Christchurch
Christchurch Hospital Central Lakes r Mid Canterbury Ashburton Hospital South Canterbury Hospital Southland
Waitaki
Dunedin Dunedin Hospital
Clutha
Invercargill - Southland (Kew) Hospital
17 Between 1994 and 1996 the Minister of Health published guidelines for the Regional Health Authorities on the longest time that people could be expected to spend travelling to specific health services. 6 This section looks at the extent to which some of these guidelines are met.
In some cases the southern region as a whole meets the recommended policy guidelines for a given service but specific localities do not. For this reason, access times within each locality were analysed separately.
A locality meets a national guideline if the proportion of people living within a certain travel time to a particular service is greater than the proportion specified in the national guidelines, (whether or not that service is in the same locality). For example, a national guideline for access to Basic Trauma services is that the service
"shall be available to 90 percent of people within 60 minutes of travelling time by car from home."
Tables 13a and 13b in Appendix C give details of the percentage of people within each locality having access to each service. For instance, 97% of Canterbury residents live within 60 minutes of a Basic Trauma Service provided in Christchurch but only 85% of Central Lakes live within 60 minutes of the service provided in Queenstown.
All localities met national guidelines for travel times to advanced trauma services, general practice, acute mental health in-patient services, forensic in-patient services and physical disability specialist services.
People of Christchurch, Mid Canterbury, South Canterbury, Dunedin and Invercargill have good access times and meet all national guidelines for travel times to services. The population in these areas comprise nearly three quarters (72%) of the southern region s population.
However the West Coast has the poorest access of all localities, failing to meet national guidelines for travel times to birthing facilities for ordinary and Caesarean births, basic and district trauma services, sexual health services or dentists.
Central Lakes and North Canterbury do not meet travel times guidelines for birthing facilities, basic trauma services, district trauma services, sexual health services or dentists. Central Lakes also does not meet guidelines for diagnostic imaging.
Southland and Waitaki do not meet guidelines for travel times to basic trauma services, sexual health services or dentists. Southland also does not meet guidelines for diagnostic imaging.
Clutha does not meet guidelines for travel times to birthing facilities, district trauma services, sexual health services or dentists.
6) Ministry of Health, 1994 and 1995.
18
LIFESTYLE AND ENVIRONMENT F
LIFESTYLE
Some aspects of people s lifestyles and habits have a definite impact on their health and the likely demand for health services. Smoking, alcohol intake, nutrition and exercise are significant public health issues. This section outlines some of these major lifestyle factors.
Smoking
Smoking clearly increases people s risk of illness, particularly heart disease, stroke, respiratory diseases and cancer (especially lung cancer).1 In the 1996-97 NZ Health Survey, 26% of men and 23% of women aged 15 years or more reported being a current smoker. The proportion of smokers in the southern region was the lowest in the country at 23%.
The 1996 Census also asked "Do you smoke cigarettes regularly, that is, one or more per day?" and got similar results. The 25- 34 year olds had the highest rate of smoking (28%) of all age groups.
Men were a little more likely to smoke than women of all age groups except the youngest. Young women aged 15 to 24 years are now more likely to be smokers than men of the same age. r Maori and Pacific people were markedly more likely to smoke than people of non-Maori/non-Pacific ethnicity. (Appendix C, Tables 14-15)
Although the overall number of smokers in the population has been dropping nationally, this has not affected all groups equally - the rate of smoking among Maori and Pacific people and among young women has remained static or in fact increased.
The number of young women who smoke is of concern. In 1993, one in five 15 year old girls smoked, compared to one in ten boys of the same age.9
Fire 19. Percentage of adults smoking, by age, sex and ethnicity, southern region, 1996
7) Galgali et al, 1997. 8) Public Health Commission, 1994b. 9) OTR Spectrum Research, 1993.
19
Nearly two-thirds of Maori women smoke during pregnancy, compared to one-third of non-Maori women. Smoking in pregnancy is linked to foetal and child ill health, including Sudden Infant Death Syndrome (cot death). (See page 51)
Census data shows that localities with a markedly lower-than-average rate of smoking include Canterbury and the three most advantaged Christchurch localities, Localities with a markedly higher-than-average rate of smoking include the two most disadvantaged Christchurch suburbs, Invercargill, Waitaki and the West Coast. These patterns are similar for men and women. These rates have been calculated taking the age differences among the localities into account by standardisation. (Appendix C, Table 14)
The strong link between smoking and socio-economic disadvantage shows up clearly in the differences among the five Christchurch localities. The link between smoking and socio-economic disadvantage has also been found in a more detailed analysis of smaller geographic areas within the southern region. A correlation has been shown between the average smoking rate and the socio-economic status score of each of the census area units within the southern region. 10
Figure 20. Percentage of adults smoking, by sex and locality, 1996
01 Female U Male 50% 45% 40% 35% 30% 25% 20% 15% 10% 5°h 0% I fi1J/ .- .. 0 " 0 C) C) 0 •. 5 CO j
Alcohol consumption
Heavy alcohol intake (described in the 1992-93 New Zealand survey as more than 20 drinks a week or an average of 3 drinks a day)" is a definite risk factor for illness, including hypertension, heart disease, stroke, liver cirrhosis and some cancers)
Alcohol consumption and related health problems have been dropping in New Zealand since 1978. The 1996-97 NZ Health Survey found that 25% of men and 9% of women aged 15 or more years reported a heavy alcohol intake. This is a slightly lower proportion for men than found in the 1992-93 NZ Health Survey (26% men and 9% women)." Despite this overall decline, alcohol intake remains high in New Zealand amongst a minority of the population, particularly among 15-24 year olds (33%) and among Maori (29%). The southern region had the highest proportion of adults with a heavy alcohol intake (19% compared to 17% nationally)."
Alcohol is a major factor in motor vehicle crashes, contributing nationally to 41% of fatal crashes in 1992.16 Alcohol is also a significant factor in family violence" and other criminal offences. 5 Alcohol dependency disorders are discussed in more detail on page 40.
10) Kokaua, 1997. 11) Statistics NZ/Ministry of Health, 1993. 12) Galgali et a!, 1997. 13) Public Health Commission, 1994b; Casswell, 1994. 14) Statistics NZ/Ministry of Health, 1993. 15) Statistics NZ, 1997b. 16) Public Health Commission, 1994b. 17) Palmer et al, 1994. 18) Spier et al, 1993. 20 Diet
Diet and nutrition are important risk factors for various diseases, including diabetes, coronary heart disease, stroke and some cancers. A balanced diet is important in keeping people healthy, although there is considerable debate on what constitutes a balanced diet.
High fat intake has been linked to poorer health and this is an area where the New Zealand diet has improved over the last two decades. New Zealanders now consume less animal fat" and total cholesterol levels declined by 6% in men and 9% in women between 1986-88 and 199394.20 However, most people still consume more saturated fat than the recommended daily levels." A high cholesterol level (defined as more than 5.2 mmol/L) increases the risk of coronary heart disease .21 -
An increase in fruit and vegetable intake is seen as likely to reduce the risk of some cancers, but little data is available on current intake as yet. 23
The intake of calcium appears to be lower than recommended among children and women in socio-economically disadvantaged areas. Pacific Islands and Maori infants and those in disadvantaged areas 24 also appear to be at higher- than-average risk of iron deficiency anaemia ,25
Obesity
Being overweight or obese" is a risk factor for high blood pressure and heart disease, adult-onset diabetes, respiratory illness, gall bladder and certain arthritic diseases."
The 1992-93 NZ Health Survey found 9% of New Zealanders aged 15 years and over to be obese. Men were more likely than women to be obese and the 45-59 year age group had the highest proportion of obese people. In addition, 19% adults aged 15 years and over were reported as being over-weight.
At the other end of the scale, 11% of adults aged 15 and over were reported to be underweight. Women were more likely than men to fall into this group. Being underweight is a risk factor for osteoporosis and may indicate poor health. Anorexia and other eating disorders associated with an altered perception of body image have increased over recent decades.
Exercise
Regular physical activity helps maintain health and mental well-being and reduces the risk of various illness, including coronary heart disease, colon cancer and diabetes, as well as falls and hip fractures in the elderly. A recent national report on the benefits of exercise recommended that most people can gain significant benefits from 30 minutes moderate physical activity a day.28
Only about one third of New Zealanders engage in physical activity to the level and duration recommended for cardiovascular fitness, and the percentage drops steadily with age. 9
The 1996-97 NZ Health Survey found that 85% of New Zealanders 15 years or older had undertaken some form of physical activity in the last week. This appears to be an improvement on the results of the 1992-93 NZ Health Survey, which found that only 45% of New Zealanders had participated in some form of exercise over the preceding week.
19) Public Health Commission, 1994b; Hillary Commission, 1990. 20) Jackson eta!, 1995. 21) ESR,1994a. 22) Galgali eta!, 1997. 23) Galgali et a!, 1997. 24) Public Health Commission, 1994b. 25) Crampton et al, 1994. 26) Body size is usually measured in terms of Body Mass Index (BMI), which is calculated as weight divided by height squared (kg/m2). Obesity is defined as a BMI of 30 or more, and overweight is defined as a BMI between 26 and 30 (Ministry of Health/Statistics New Zealand, 1993) 27) Ga!gali et al, 1997. 28) National Health Committee, 1998. 29) Public Health Commission, 1994b; Hillary Commission, 1990.
21 ENVIRONMENTAL HEALTH 0101 The physical environment that we live in - air, water, land, food - has direct and indirect effects on our health. The social environment we live in also has a strong influence on our health and well-being. This section covers just some of these influences, mostly those that are routinely monitored by health authorities.
Water quality
Drinking water - localities where a relatively high proportion of water supplies are reported as being of below marginal quality include South Canterbury (79% water supplies), Dunedin (75%), and the West Coast (61%).
Table 1. Percentage of water supplies listed as being below marginal quality, 1995
Locality % Giardia - estimates of the incidence of giardia in water are lower in the southern region than nationally, with Canterbury province West Coast 60.7 (including South Canterbury) being the worse affected, and North Canterbury 8.3 Southland the least affected. However, information on giardia is Canterbury 37.9 incomplete and the incidence is likely to be underestimated.30 Christchurch 2.8 Mid Canterbury 8.3 Recreational and shellfish gathering waters - South Canterbury 78.6 information on the quality of recreational and shell-fish gathering Waitaki 6.8 waters is available only for the Canterbury province. While Dunedin 75.0 recreational water quality was high at most sampled sites, sites that Central Lakes 4.1 were lower than guideline standards in 1996 included the Clutha not available Waimakiriri River at the Groynes and the river-mouth, the Avon Southland 11.1 River in Christchurch, the Selwyn River at Glentunnel and Upper Invercargill 0 Huts, the Cust River, the Ashburton River and the Opihi Lagoon.3 Source: ESR, 1995.
Air quality
Little information is available on air quality in the different localities of the region apart from Christchurch which has an air pollution problem, especially in winter months. Winter concentrations of both smoke and carbon dioxide regularly exceed air quality guidelines in Christchurch .3 The following information applies to Christchurch only, unless otherwise noted.
Smoke emissions improved between 1960 and 1975 and since then have remained relatively stable, apart from a rise in 1992 that coincided with restrictions on electricity use. Sulphur dioxide levels in Christchurch improved between 1960 and 1992 and are low in relation to guidelines.33
Carbon monoxide levels appeared to have changed little since the 1970s in most urban areas where this is measured. In Christchurch, the inner city guideline for safe levels of carbon monoxide emission was exceeded on 17 days in 1992. Levels of nitrous oxides also show little change over time, but emissions have been moderate compared to guidelines. Lead concentrations in all areas reduced significantly from 1986, when the lead content of high octane fuel was reduced and the use of unleaded fuel became more common.34
A recent Canterbury Regional Council report reviewed overseas studies of the link between air pollution and health and applied these findings to Christchurch. It concluded that air pollution in Christchurch could have contributed to 21-29 deaths each year and to 8-17 hospital admissions per year for respiratory and card io-pulmonary disease. 35 Other Christchurch studies, however, have questioned the nature of the link between air pollution and illness."
30) ESR - data for 1991-1993 in Eggers, 1996. 31) Canterbury Regional Council, 1997. 32) Public Health Commission, 1994b; Canterbury Regional Council, 1997. 33) ESR, 1994b; Canterbury Regional Council, 1997. 34) ESR, 1994. 35) Foster, 1996. 36) Dawson et al, 1983: Wilkie et al, 1995.
22 Food safety
Nationally, the reported numbers of cases of the food-borne illness campylobacteridsis, have increased markedly since 1980. The reason for this is not known but it is unlikely to be due solely to changes in reporting.37 Overall the southern region has relatively high rates of reported food-borne illnesses. In 1996 South Canterbury had the highest notified rate of campylobacter and salmonella illness in the country.38 It is unclear, however, whether this is the result of better reporting than elsewhere.
There is no systematic sampling and reporting of foods which exceed acceptable microbiological guidelines. Variations in the figures may therefore reflect better reporting or targeted sampling.
Waste disposal and hazardous substances
Liquid sewage waste is disposed of by sewerage systems or local alternatives (e.g. septic tanks). Solid waste is disposed of through rubbish dumps and other means. Safe waste disposal is important to protect people from disease, poisoning and injury.
This report has looked in detail only at the disposal of hazardous waste. More work is needed to document the disposal of sewage and other waste.
A 1992 report by the Ministry for the Environment examined the extent of the possible health risk from water or land that has been contaminated by hazardous substances. The report estimated the number and type of sites around New Zealand that are potentially contaminated by the by-products of industry using that site. The main concerns are ground- water contamination, residential development of former industrial, commercial and agricultural land, and abandoned industrial land and waste disposal sites. The survey estimated that there were 386 high risk sites within the southern region. (This survey did not include 600 timber treatment sites which were the subject of a separate government investigation.)
Workplace health and safety
Major causes of workplace-related ill-health and injury include trauma, asbestosis, noise, occupational overuse syndrome, substance-related poisoning, respiratory problems, infections, cancer and skin problems." Hazardous working conditions (e.g. heavy or monotonous work, daily contact with poisons, smoke, dust, acid, etc) have been seen as an important reason for the higher-than-average rates of ill-health and premature death among less advantaged groups in the community, particularly among men in these groups.4° As many New Zealanders die in work-place accidents each year, as die of cervical cancer .41
The rate of workplace injuries rose nationally by 11% between 1986 and 1991, even though the workforce had declined by 7% in that period.42
The most commonly reported work-related condition in the southern region in 1995-96 was occupational overuse syndrome, making up 63% of all notified occupational diseases. This occurs mainly in office workers and was reported by 166 pe ople. Notifications of noise-induced hearing loss have been increasing since 1992-93, while asbestos notifications have dropped from their peak in 1992-93. (Appendix C, Table 16)
37) Public Health Commission, 1994b. 38) ESR, 1997. 39) Occupational Safety and Health Service, 1996. 40) Fishwick et al, 1997; Lundberg, 1991. 41) Public Health Commission, 1994b. 42) Caradoc-Davies et al, 1997.
23 Road safety
The number of vehicles on the road increased by 3-6% a year between 1989 and 1996 in the Canterbury province. Deaths and injury from motor vehicle crashes have dropped during this time, relative to total passenger movements.43
However, New Zealand s high rate of car ownership takes its toll in high rates of road deaths and injuries by international standards.44
The southern region has a slightly lower road death rate than the national average. Between 1990 and 1994 there were on average 20 deaths per year caused by motor vehicle crashes in the region. In 1996 there were 1,163 admissions to hospital in the region from motor vehicle injuries, taking up over 10,000 bed-days.
Country people do die on country roads - residents in rural localities (particularly the West Coast but also Central Lakes, Clutha, North Canterbury and Waitaki) have a higher death rate from motor vehicle crashes per head of population than residents of urban localities. (Appendix C, Table 17)
Figure 21. Average annual number of deaths per 100,000 people from motor vehicle crashes, 1990-1994
25
20 0 0 0 01 0 10
I-, U E z
e
C - £ . .
This contrasts with most other causes of death which are generally lower in the rural localities (apart from the West Coast) than in the cities.
There were over 21,000 non-fatal casualties from road crashes in 1996. Nearly 700 of these were North Canterbury residents, a much higher rate than the regional average. Clutha and Central Lakes also had higher-than-average rates.45
Violence
Physical and emotional injury from assault and violence is a relatively small but significant cause of people seeking medical and other health services, including mental health services.
In 1996 there were nearly 7,000 convictions for violent assault in the southern region, with higher rates in the two main cities .16 In 1994 nearly 2,000 women and children used the emergency house facilities of women s refuges in the region to escape violence at home. This number has been rising over time .17
43) Canterbury Regional Council, 1997. 44) Public Health Commission, 1994b. 45) Land Transport Safety Authority data. 46) Police Department data. 47) National Collection of Independent Women s Refuges data.
24 Communicable diseases
Sexually transmitted diseases (STDs) - nationally, attendances at sexual health clinics of patients with viral diseases (genital warts or herpes) are increasing, while the number of people presenting with some bacterial diseases (such as gonorrhoea) is decreasing, although the incidence of the bacterial disease chlamydia has been increasing."
The southern region has a lower incidence of AIDS than nationally. 49 HIV infections result in significant hospital admissions and deaths in later life.
Meningococcal disease - since 1990 New Zealand has experienced an epidemic of meningococcal disease, with numbers and rates rising each year. Previous epidemics occurred in the mid 1960s and also between 1984 and 1987.
Tuberculosis (TB) - the number of new cases of TB has been increasing in New Zealand by about 5% a year since 1988. The current national rate of people with notified TB is 11.1 per 100,000 population. Most of the increase has been among new immigrants of non-European origin and also Maori or Pacific people."
HEALTH, ILL-HEALTH AND DISABILITY
The past fifty years have seen major improvements in health. However, considerable inequalities in health status and mortality remain both between countries and within countries, including New Zealand.
As life expectancy increases and the population ages, non-communicable and chronic diseases become relatively more significant as the cause of ill-health and premature death.5
This section looks at various indicators of health and disability, including life expectancy and death rates, hospital admissions, surveys of disability, and general measures of health status.
48) Lyttle, 1994. 49) AIDS Epidemiology Group, 1996. 50) Galloway et al, .1996 51) Beaglehole et al, 1997.
25
LIFE EXPECTANCY AND DEATHS
Although changes in overall life expectancy and death rates are not as dramatic a measure of improvement in health status in Western countries as they used to be, they are still a basic measure for monitoring changes in the health of the population.
Life expectancy
Life expectancy at birth in New Zealand has been rising over the past 30 years, mainly due to lower death rates among those over 50 years of age. More people are now living to an older age.
A decline in the death rates of newborns and infants, and in particular those from cot deaths from the late 1980s to mid 1990s, has also contributed to the overall rise in life expectancy.52
In the 1989-93 period, life expectancy at birth was slightly higher in the southern region than nationally, at 77.5 years for men and 81.8 years for women. This compared to national life expectancy of 77.0 years for men and 81.4 years for women. (Appendix C, Table 18)
Among both men and women, life expectancy was higher-than-average in Mid Canterbury, Canterbury, Central Lakes, rural Southland and the more advantaged Christchurch areas, and lower-than-average in Invercargill, the least advantaged Christchurch area and the West Coast.
Figure 22. Life expectancy for females and males by locality, 1990 - 1994
III Female I Male Life expectancy is higher for 85 females than males in all localities. (Appendix C, Table 19)
80 Life expectancy is higher nationally for non-Maori than Maori by eight to nine 75 years."
70 .. e , . . .
.c, C) .ct • I c.1 C 0
Death rates
The information on deaths in this report has been obtained from NZ Health Information Service, which links the deaths registered with the Justice Department with cause of death.
In the southern region, the collection of information on the ethnic group of a deceased person has traditionally been inconsistent and poorly done, resulting in unreliable information on death rates by ethnic group, and generally under- reporting of deaths of Maori. For this reason, death rates for Maori in this report have been based on national figures.
52) Statistics New Zealand, 1997a. 53) Statistics NZ, 1997a.
Deaths and death rates have mostly been presented for groups of five years at a time, such as the death rate for the period 1990 to 1994. This is because there are relatively so few deaths each year that analysing differences in death rates from different causes or for localities would not be valid based on one year s numbers only.
Overall death rates in the Figure 23. Rates of death from all causes, by locality, 1990-1994 (yearly average number southern region are of deaths per 100,000 people, age-adjusted)" generally lower than national rates, particularly in Canterbury, Mid- • Female • Male Canterbury, Central Lakes, 80r C and the more advantaged C). ou 70 Christchurch suburbs. C). 0 60 0 Invercargill, the more o 50 disadvantaged suburbs of . 40 -C Christchurch, and the West 30 Coast all show higher death 20 C) rates than the southern -C) E 10 region average, as well as z exceeding the rate for New - . s. Zealand as a whole. . ?- -r d • 00- C. - -o - C) .1 . C) j d V Overall death rates dropped ,-0 ° in all localities between 1984-88 and 1990-94, as they had nationally. (Appendix C, Table 20)
Figure 24 shows death rates from the major causes of death (heart disease, cancer, stroke, and respiratory illnesses) are much the same in the southern region as nationally, apart from a slightly higher rate of death from heart disease. (Appendix C, Table 21)
Figure 24. Major causes of death - southern region and New Zealand, 1990-1994 (yearly average number of deaths per 100,000 people, age-adjusted)
Southern Region U New Zealand 150 - 140 130 0 120 o 110 100 2 90 80
60 50 40 30 20 10 0
o IU 0 C.
C- 0 el /
54) This is a rate. For example on the West Coast between 1990 and 1994 there was a yearly death rate for men of 700 deaths per 100,000 men. However, as there are only around 16,000 men on the West Coast, the actual number of deaths per year is correspondingly smaller. 27 HOSPITAL ADMISSIONS
Admissions to hospital are sometimes used as a proxy measure for the extent of illness in a population in the absence of good information on the actual prevalence or incidence of illness.
However, this type of assumption must be made with caution. A high rate of admissions to hospital in a locality may be the result of several factors:
hospital beds in that area being more available;
general practitioners (GPs) being more willing to refer people for in-patient hospital care;
the hospital being more likely to accept their referrals;
people being admitted to hospital due to lack of community-based services enabling them to be treated at home or as an outpatient (e.g. residents of more rural areas); and
higher rate of illness in a community (which in turn may reflect an older or more disadvantaged population).
So the rate of hospital admissions cannot be seen as a simple indicator of the health or ill-health of an area. It needs to be backed up with other sources of information, such as health surveys, and attendances at hospital out-patient and day-patient clinics and general practices.
With this caution in mind, this section presents some information on patterns of overall admissions to general hospitals in the region.
This information comes mostly from data collected from general and maternity hospitals on their in-patients by the New Zealand Health Information Service. This data covers all public general and maternity hospitals and birthing facilities, and publicly-funded admissions to private general and maternity hospitals and birthing facilities. Admissions to psychiatric units in general hospitals are also included in this data. Psychiatric hospital admissions are excluded and they are detailed in the mental health section. Admission rates for Maori refer to all Maori in the southern region.
First admissions and total admissions
The 1996-97 New Zealand Health Survey asked about people s experience of using hospitals in the previous year. The survey found that 31% of the southern population had visited a public hospital for treatment during the year, with 8% being admitted as in-patients, 19% using outpatient facilities, 4% being treated as day-patients, and 13% using the emergency department.
Southern residents were slightly more likely than other New Zealanders to have visited a public hospital, and were particularly more likely to use public hospital outpatient clinics. Southern residents were also a little more likely (8%) than the national average to have used private hospital facilities in the past year." Some of these differences in usage probably reflect the slightly older age structure of the southern population, as survey results were not age standardised.
Looking at comparable data for southern residents from the 1992-93 New Zealand Health Survey, we can see that the proportion of people being admitted as in-patients has fallen since the early 1990s (from 14% to 8%), while outpatient and public emergency department attendances have both risen (from 16% to 19%, and from 7% to 13% respectively) .16
55) Statistics NZ/Ministry of Health, 1993. 56) Statistics NZ 1997b. 28 Hospital admission data - in 1996 there were over 126,100 admissions to public hospitals in the southern region, a rate of 15 visits for every 100 people. Of these 83,450, which is a proportion of 10% of all people, were first admissions.
Total admissions to public hospitals in the southern region rose by 8% between 1992 and 1993, then more slowly to 1995, and dropped a little in 1996. (Appendix C, Table 22)
Figure 25. Number of total admissions for males and females, southern region, 1992-1996 Although death rates for both Males infants and the elderly have been Females falling since the 1970s, both age 75,000 groups have had markedly 70000 increased rates of admission to 65,000 hospital during this period." 60,000 0 55,000 SQ000 Women are more likely than men 45,000 to be admitted to hospital, partly 40000 because of the greater use made of 0 35,000 hospitals through childbirth and 5) 30000 partly because of women s longer E 25,000 life expectancy. 20,000 z 15,000
ltaoo 4: 5,000 0 I I I 1992 1993 1994 1995 1996
Causes of admission to hospital
The most common causes of admissions to hospital for females were pregnancy and conditions related to birth, injury, and digestive, gynaecological and musculoskeletal disorders. For males, the most common causes of admission were injury, and digestive, musculoskeletal, respiratory, and ear, nose and throat disorders.
Figure 26. First and repeat admissions to hospitals by cause, southern region, 1996 Between 1992 and 1996 there was an (number of admissions per 100,000 people, age-adjusted) increase in all first admissions for diabetes, respiratory. - disease (particularly flu, asthma and chronic • First admissions FE Repeat admissions obstructive respiratory disease), heart 20,000 disease, and problems of the newborn. 5) Qw In the same period, there was a drop in ow 15,000 first admissions for motor vehicle 0 0 crashes and ear, nose and throat 0 problems. (Appendix C, Table 23) 10,000
- 5,000 E z 0 I I! I F F F I -10 F / 4,F Ii I / .1 1V
57) Pool, 1994. 29 Locality differences in admissions
Localities with a higher rate of first admissions than the regional average include the West Coast, South Canterbury, Invercargill, Mid Canterbury and the most disadvantaged area of Christchurch.
Following the pattern of first admissions, total admissions were higher-than-average for residents from the West Coast, South Canterbury, Mid Canterbury, Invercargill, and the most disadvantaged Christchurch locality. Lower-than-average admission rates were found in the more advantaged Christchurch localities and Canterbury.
Maori had a much higher rate of both first and repeat hospital admissions than any locality population. (Appendix C, Table 24)
Figure 27. First and repeat admissions to hospitals by locality, 1996 (number of admissions per 100,000 people, age-adjusted)
• First admissions X Repeat admissions 30,000
25,000
20,000 Q 0 15,000
10,000
- 5,000 z 0 - v . 5• .&
if C) if
30 Acute admissions
Acute admissions are when people are admitted to hospital in an emergency, as opposed to when they have an arranged admission for scheduled treatment or an operation. Localities with a higher rate of acute admissions than the national average in 1996 were Invercargill, the most disadvantaged Christchurch locality, Waitaki and South Canterbury. Lower than average rates of acute admissions were evident for residents of Canterbury, the advantaged Christchurch localities, North Canterbury and Dunedin.
Figure 28. Acute and non-acute admissions to hospital, by locality, 1996 (number of admissions per 100,000 people, age-adjusted)
I Acute admissions lU Non - acute admissions
30
25
20 0 0 2 15 0)
. 10 C) E 5 z
0 .. . . , 0. ) . .J J I (7 .. .c . 0. (7 (.7 C. C.) .00 0 / e .00
Maori had a much higher rate of acute admissions than the population of any locality. (Appendix C, Table 24)
The most common causes of acute admissions in 1996 were for pregnancy and birth-related conditions, and for digestive, respiratory and circulatory disorders.
The rate of acute admissions per head of population increased between 1991 and 1996 for a number of conditions, including infectious diseases, pregnancy and birth, problems of the newborn, and injury. The rate of acute admissions for gynaecological disorders has dropped. (Appendix C, Table 23)
Length of stay
The length-of time people stay in public hospital has been reducing, from an average of 4.9 days in 1992 to 3.5 days in 1996 for men, and less markedly for women. (Appendix C, Table 25)
The conditions with the longest average length of stay for general hospital patients were mental disorders (12 days), stroke (11 days), and motor vehicle crashes (6 days).
Overall, average length of stay dropped by 8% between 1992 and 1996, with particular drops in length of stay for flu, cancer, diabetes, and mental disorders treated in general hospitals. (Appendix C, Table 23)
31 Where people go for hospital treatment
Most people are admitted to the nearest hospital in their locality - 88% of Christchurch, Canterbury and North Canterbury patients used Christchurch hospitals in 1996, with only 1% using hospitals elsewhere in the region. 91% of Dunedin patients used Dunedin Hospital, with only 2% going elsewhere in the region. 93% of Invercargill patients used Southland Kew Hospital with 3% going elsewhere in the region.
Clutha patients were roughly split between Dunedin (54%) and Balclutha (40%) Hospitals, and Waitaki patients went to both Oamaru (48%) and Dunedin (44%) Hospitals. Of Ashburton patients, 73% used Ashburton Hospital and 20% used a hospital in Christchurch.
Residents of the more rural localities (particularly North Canterbury, Central Lakes, Southland and West Coast) were more likely than other residents to use hospitals outside the southern region, with 17%-28% patients admitted elsewhere. (Appendix C, Table 26)
Table 2. Percentage of residents in each locality going to each hospital, total admissions, 1996 (percentages under 4% have been omitted)
Locality of Residents Hospitals Southland Baiclutha Dunstan Dunedin Oamaru Timaru Ashburton All Greymouth Other Total (Kew (Clyde) Christ- Hospitals Residents Hospital) church hospitals
West Coast 9.1 73.2 17.1 100.00 North Canterbury 70.7 28.2 100.00 Canterbury 82.5 15.8 100.00 Christchurch 96.2 100.00 Mid Canterbury 73.7 20.2 100.00 South Canterbury . 90.9 5.9 .. 100.00 Waitaki 44.1 47.8 4.9 100.00 Dunedin 91.2 7.2 100.00 Central Lakes 10.1 30.5 37.7 20.2 100.00 Clutha 40.3 54.2 100.00 Southland 73.1 22.1 100.00 Invercargill 93.3 100.00 All southern region 8.0 23.6 6.0 53.2 4.2 1 100.00 residents
32 USE OF GENERAL PRACTICE SERVICES
Visits to the family doctor 5
Both the 1992-93 and the 1996-97 NZ Health Surveys found that more than four out of five of southern residents had visited their general practitioner (GP) at least once in the previous year, which is much the same as the national average. (Appendix C, Table 38) However, the 1992-93 survey showed that in New Zealand as a whole Maori were a little less likely to have visited a GP (78%) compared to European/Pakeha (81%) or Pacific Islands people (79%). 58
Fire 29. Number of subsidised visits to GPs per person, by locality, 1996-97
The Health Funding Authority does not have complete figures on the total number of visits made to GPs because data on non- subsidised visits is incomplete. However, analysis of the number of subsidised visits in 1996-97 showed that people in Christchurch and Dunedin visited their local doctor more often than the regional average. People in Canterbury, North Canterbury and Southland made fewest visits overall. (Appendix C, Table 27)
(The figures for Canterbury and Christchurch may be affected by the fact that a considerable number of Canterbury residents travel to Christchurch for work and use Christchurch GPs.)
The higher number of visits made to the doctor in the cities may reflect higher health need, which in turn may be explained by the city having a higher than average proportion of elderly people or people of low socio-economic status.
But like hospital admissions, visits to the OP can also be explained by other factors, such as the fact that in the two main cities there are more doctors per head of population than elsewhere, and also people have less distance to travel and therefore fewer geographic barriers to accessing services.
The use of medicines
The 1996-97 NZ Health Survey found that 69% of New Zealanders received prescription items in the previous year. This proportion was highest in the southern region at 71%.
In 1996-97 nearly $180 million was spent in the southern region on publicly subsidised medicines dispensed through community pharmacies. In 1995-96 this expenditure was equivalent to $229 per person, considerably higher than the national average expenditure per person of $202.
About 80% of these medicines are prescribed by GPs, with the remainder prescribed by private specialists or doctors working in public hospital outpatient clinics. This expenditure on pharmaceuticals does not include the medicines that are supplied to hospital in-patients. Localities with a higher-than-average expenditure on community-dispensed medicines include Waitaki, South Canterbury and Christchurch. Christchurch accounts for 44% of the region s total expenditure and as such affects the regional average considerably. (Appendix C, Table 28)
58) Stats NZIMoH, 1993, and unpublished regional data from the survey, Statistics NZ, 1997b 33 Until recently, public-spending in the southern region on community-dispensed medicines has been rising since at least the mid-1980s at a rate of around 8%, or $12 million, per year.59
However, although the southern region still spends more on pharmaceuticals than the rest of New Zealand, the rate of growth in this spending has been slowing more markedly in the south than elsewhere. This is especially so for OP-prescribed medications as budget-holding arrangements encourage GPs to evaluate their prescribing patterns.
Figure 30. Public spending on community-dispensed medicines per person, 1996-97
$350 $300 $250 $200 $150 $ 100 $ 50 $0 •"; E 5 ..g I .4 •e s I IS c,o C ccc 4
DISABILITY 5PE 140
The information in this section has been taken from the 1996 New Zealand Household and Residential Disability Survey 1996, together with data from the Health Funding Authority s needs assessment database. These two data sources are not wholly comparable - the national survey data are an estimate based on interviews with a sample of people, while the Health Funding Authority data is based on the complete number of people who meet criteria for entitlement to services. These two sources of data also vary in the age group that they are discussing - this is explained further in the text.
It is important to note that people with physical disabilities as a result of ageing have not been included in the data presented in this section. Age-related disability is also discussed further on page 68, and long-term mental disability on page 38.
Physical and sensory disability
A physical or sensory disability is a physical or sensory condition which means a person is unable to do things that would normally be possible for people of a similar age. It includes impairment of sight and hearing.
The 1996 New Zealand Household and Residential Disability Survey estimates that 109,007 southern region adults over the age of 15 years have a physical disability. This is 18% of the adult population and compares to a national rate of 14%. The national survey estimates that 74,044 southern region adults have a sensory disability, a rate of 12% of adults. This compares to a rate of 9% for New Zealand as a whole. The higher rate of physical and sensory disability in the south may reflect the higher proportion of elderly people in the southern region compared to New Zealand as a whole.
59) Mckendry et al, 1993; McKendry et a!, 1994
34 Having a disability does not necessarily mean that people require assistance in their daily life. The national survey defined three levels of need for assistance: Ti = having a disability but not requiring any assistance; T2 = having a disability and requiring some assistance; and T3 = unable to cope without assistance. Table 3 shows that among southern adults an estimated 15,886 people with physical disabilities and 9,134 people with sensory disabilities were in T3, the group requiring high levels of support. This represented 14.6% of all adults with physical disability, and 12.3% of adults with sensory disability.
Table 3. Estimated number and percentage of people aged 15 years and over with a physical or sensory disability, southern region and New Zealand, 1996
Disability Level of need Southern region New Zealand
Number Percentage of all adults Number Percentage of all adults
Physical Ti needs no assistance 43,605 7.2 149,340 5.5 T2 needs some assistance 49,516 8.2 173,600 6.4 T3 unable to function without assistance 15,886 2.6 67,105 2.5 Total 109,007 18.1 390,046 14.4 Sensory Ti needs no assistance 30,498 5.1 89,517 3.3 T2 needs some assistance 34,411 5.7 125,018 4.6 T3 unable to function without assistance 9,134 1.6 33,489 1.2
Total 1 74,044 1 12.3 1 248,024 9.1
Source: unpublished tables from the New Zealand Household and Residential Disability Survey, 1996.
Health Funding Authority needs assessment data - this data shows that 3,604 southern residents in 1997 were assessed as requiring assistance with their physical or sensory disability, a rate of 461 per 100,000 people aged 15 years or more. Of these, 222 people (6.2%) had a sensory disability and 3,382 people (93.8%) had a physical disability.
People assessed as having physical or sensory disabilities were more likely than the overall population to be female (58%). Teenagers, young adults and the elderly were over-represented in this group compared to the population as a whole, with a third of people assessed falling into either of these age groups. Only 2.7% (98 people) were Maori, much fewer than the 7% of the population who are Maori.
35 Of people with a physical and sensory disability, 63% live in Christchurch, Dunedin or Invercargill, much the same as the 61% of the regional population. However, the proportion of people assessed as having a physical or sensory disability ranges among localities from a low of 232 per 100,000 in North Canterbury to a high of 788 per 100,000 in Invercargill. (see Figure 31)
Three levels of need are used where a physical or sensory disability is identified; Level 1 to Level 3, with Level 3 indicating the requirements of a higher level of support. Almost all people assessed as having a physical or sensory disability were assessed as being at Level 1 (98%), indicating a moderate level of support is required. (Appendix C, Table 29)
Figure 31. People assessed as having a physical or sensory disability, by locality, 1997 (number of people with a disability per 100,000 people - not age adjusted)
Intellectual disability
An intellectual disability is where a person has a more limited intellectual capacity and difficulty with understanding than would normally be found in an individual of similar age.
The 1996 New Zealand Household and Residential Disability Survey - this survey estimated that 4,751 southern region residents over 15 years of age have an intellectual disability, a rate of 766 per 100,000 adults compared to 737 per 100,000 for New Zealand as a whole.
Using the same levels of needs (Ti, T2, T3) as used for physical disability,, and looking at people of all ages, including those under 15 years, the survey that estimated for New Zealand as a whole 42% of people with an intellectual disability fell into the third group - unable to cope without assistance. Most clients (85%) in residential services fell into this group. (Appendix C, Table 30)
36 Health Funding Authority needs assessment data - while the national survey gives a valuable insight into the prevalence and needs of people with intellectual disability, the data is not strictly comparable to that collected by the Health Funding Authority from needs assessment claims for 1997. This is because the individuals in each dataset are assessed according to different criteria.
The needs assessment data show 1,902 southern residents who have an intellectual disability, a rate of 243 per 100,000 people.
People assessed as having an intellectual disability are younger on average than the regional population - 71% are under 25 years of age and 51% under 15 years, compared to 36% and 20% respectively of the total population. Males made up 53% of those who were assessed as having an intellectual disability. Around 3.1% (59 individuals) were Maori, much lower than the 7% of Maori in the total southern population.
Figure 32. People assessed as having an intellectual disability, by locality, 1997 (number of people with a disability per 100,000 people - not age adjusted)
500
a) 400 0 a) 0 0 0 300 0 0
a) 200 I., 0 100 z
Ef
(5 4Y NZ, I / k V ell IV I j i.
Seventy one percent of assessed clients lived in Christchurch, Dunedin or Invercargill, compared to 61% of the southern population. This partly reflects the availability of specialist and residential services in these cities, as place of residence was based on where the client now lived, whether or not this was a residential service or private home.
Figure 32 thows that the proportion of people with an intellectual disability ranged among the localities from 95 per 100,000 in North Canterbury to 476 per 100,000 in Invercargill.
Most (95%) people who were assessed as having an intellectual disability needed moderate levels of support (Level 3) while 2% were assessed as needing high levels of support. (Appendix C, Table 31)
37 MENTAL ILLNESS AND ALCOHOL AND DRUG ABUSE 1i.
;P57I
Mental illness is often temporary and may occur at any time during a person s life. Ongoing chronic mental illness can lead to psychiatric disability.
The following section deals only with severe or chronic mental illness that requires specialist and/or long-term support. Much mental illness of a less severe or more transient nature is treated in the community by a variety of public and private practitioners, including GPs, community mental health centres, counsellors, etc. It is acknowledged that this is an area where insufficient data has been collected.
This section also deals only with alcohol and drug abuse and dependence where it leads to specialist treatment. Other health and social problems that are related to misuse of alcohol, such as motor vehicle crashes and assault, are dealt with in other sections.
The prevalence and incidence around the region of diagnosed mental illness (here including alcohol and drug abuse) is not easy to assess. Community surveys provide a good measure of the extent of problems, but are limited to specific geographic areas. While local studies are the most useful, surveys done elsewhere can also provide estimates for a local population where data is unavailable.
Data on in-patient admissions to psychiatric hospitals can show trends over time and by region. However, like any hospital admission data, it needs to be interpreted with caution; as changes over time may reflect changes in clinical practice rather than changes in the actual prevalence of mental illness.
In addition to these data sets, the Health Funding Authority collects information on the number of assessments of people needing assistance due to mental illness.
Some specific forms of mental illness, including anorexia, suicide and dementia, are dealt with in more detail under specific age groups.
The 1996 New Zealand Household and Residential Disability Survey - this survey estimated that 23,141 southern residents aged 15 years or over have a psychiatric disability, or 3.8% of adults compared to 2.9% for New Zealand as a whole. -
Looking at levels of need, nationally just over a quarter (28%) of people with a psychiatric disability were estimated to be unable to cope without assistance. In the southern region an estimated 4,785 adults fall into this group of highest need, or 20.7% of all people with a psychiatric disability. Nationally an estimated 27.3% of these people live in residential facilities and institutions. (Appendix C, Table 32)
Other community surveys and studies - a comprehensive Christchurch community survey of mental illness in the area showed that about one third of adults have at some stage met criteria for at least one of the main psychiatric disorders, by internationally recognised definitions." Alcohol abuse becomes less common with age, while affective disorders become more important." About 1% of the population suffers from schizophrenia."
Some health professionals believe that the number of intravenous drug abusers is increasing in New Zealand." Certainly the number of people enrolled at methadone clinics has also increased." Overall, the number of "hard" drug users in this country remains relatively small by world standards 6 although if overseas trends are followed the number of young people exposed to the use of illicit drugs may be increasing.66
60) Wells et al, 1989. 61) Oakley-Browne et al, 1989. 62) Albrecht et al. 1992, 63) New Zealand Doctor, 1997a. 64) New Zealand Doctor, 1997b. 65) Thornton, 1991. 66) Robert et al, 1997. 38 Psychiatric hospital admission data - the following data are based on admissions to public psychiatric hospitals. They do not include out-patient or day-patient treatment at these hospitals, at public hospitals in general or at public community-based clinics. They also do not include admissions to psychiatric services at general public hospitals, nor admissions to private psychiatric hospitals, such as Ashburn Hall in Dunedin.
Caution must be used in interpreting these figures because they are considerably affected by recent changes in mental health services and the availability of professional staff in the localities. In particular, the move towards
deinstitutionalisation 67 from 1992 onwards has meant that more services are being delivered in a community setting rather than in public hospitals.
Figure 33 shows the causes of admission for the 3,091 southern residents admitted to First admissions Repeat admissions • • a public psychiatric hospital in 1,000 1993, the most recent year for C? which data is available. 800 C? Affective psychoses, 0 schizophrenic disorders and 600 other psychotic conditions
5? accounted for 36% of first
C) admissions. The three diagnoses of alcohol 200 dependence , drug dependence and alcohol and drug-related disorder accounted for 26% of I /J////47 all first admissions. Depression
J. and other non-psychotic / disorders made up another 24% do of first admissions. The pattern 4 for total admissions was similar to that for first admissions. (Appendix C, Table 33) Figure 33. First and repeat admissions to public psychiatric hospitals by diagnoses, southern region, 1993 (number of admissions per 100,000 people, age - adjusted)
Figure 34 (Appendix C Table 34) shows that residents of Christchurch 1 and the West Coast have the highest rate of first admissions. The total admission rate for Invercargill was three times higher than its first admission rate, indicating a relatively high rate of re-admissions.
• First admissions $ Repeat admissions 1,500 V 1,200 Ow 0 0 900 0 0 600 aw
300
Figure 34. First and repeat admissions - , , -) - 4 - : S S to public psychiatric hospitals by ?I/i C7Q. •4 iifi///.4 cYc? locality, 1993. . (number of admissions per 100,000 people, age adjusted)
67) The resettlement of people living in an institution to living in the community.
39 Health Funding Authority needs assessment data - this showed that 2,869 adult southern residents were assessed as requiring assistance with their mental illness in 1997, a rate of 367 per 100,000 people. People assessed as needing this assistance were on the whole similar to the regional population: 50% were aged between 15 and 44 years compared to 58% of the region s population, 51% were male, and 6.3% were Maori.
Far more people (74%) assessed as requiring assistance lived in Christchurch, Dunedin or Invercargill, compared to the region s population (61%). This probably reflects the greater availability of services in these cities. This may also account in part for the differences in locality rates which range from 11.3 per 100,000 in Central Lakes to 56.8 per 100,000 in Dunedin. (Appendix C, Table 35)
Figure 35 People assessed as needing assistance because of mental disability, by locality, 1997 (number per 100,000 people, not age-adjusted)
600
500 aw
400
300
ow 200 E a Z ux
0
,. . (Y IS 4 / I
Health Funding Authority data on alcohol and drug treatment clients - in addition to the needs assessments database, the Health Funding Authority also has separate data on admissions to Queen Mary Hospital, Hanmer Springs.
There are 337 alcohol and drug treatment clients on the needs assessment database and 312 admissions to Queen Mary Hospital in 1997.
Of the people on the combined datasets, most (72%) are male, and the 15-44 year age group is over-represented relative to the overall population (78% compared to 58%). Twenty percent of clients are Maori, about three times the proportion of Maori in the general population. Of the Maori clients, 48% attended the Taha Maori programme at Queen Mary Hospital.
Alcohol and drug treatment clients are more likely to be living in Christchurch, Dunedin and Invercargill than the general population (74% compared to 61%). However, only 53% of Queen Mary Hospital clients and 42% of Taha Maori programme clients reside in those localities.
Although the needs assessment data do not give details on the localities within Christchurch, locality data are available for Queen Mary Hospital clients. Of the latter, seven times as many clients came from Christchurch 1 as Christchurch 5. (Appendix C, Table 36)
40 If OVERALL MEASURES OF HEALTH AND HEALTH NEED
People s view of their own health S
New Zealand Health Survey 1996-97 Other sections in this report have quoted results from the 1996-97 New Zealand Health Survey. This was a survey of the general public looking at the use of and preference for health services, lifestyle practices, health status and socio-demographic status.
An interesting measure that was included in the New Zealand Health Survey was the Short Form 36 (SF36), a multi- dimensional questionnaire measuring perceived well-being." The questionnaire gives eight scores, each ranging from 0 (poorest health) to 100 (best health). The eight scores represent the following dimensions: mental health, role limitations from emotional conditions, social function, vitality, general health, bodily pain, role limitations from physical conditions and physical function. Generally, the first four scores represent wellness and the last three scores represent bodily function. It is possible to provide mental health and physical health summary scores" but those scores will be developed in the Ministry of Health s national report currently being produced.
Table 4 shows the average scores reported by southern region residents who share similar characteristics (age, sex, etc.). Those results show:
• Age - older people are more likely to report lower scores than younger people in the bodily function scores (bodily pain, role limitations from physical conditions and physical function). The mental health score appears to increase with age, aresult also noted by Midland Health. • Sex - women have similar bodily function scores to those of men but are more likely to report poorer wellness scores (mental health, role limitations from emotional conditions, social function, vitality) than men. • Maori - Maori also have similar bodily function scores to those of non Maori but are more likely to report poorer wellness scores (mental health, role limitations from emotional conditions, social function, vitality) than non Maori. This difference is marked for mental health. • Urban/rural - people living in minor urban areas (small rural centres) are more likely than people in all other areas to report poorer scores in all dimensions, except role limitations from physical conditions. • Asthma sufferers and people with a disability - are more likely to perceive their health as poorer than people who do not have asthma or a disability. • Employment among working aged people - people in any kind of employment (part time or full time) are more likely to perceive their health as better than people who aren t in the labour-force and more particularly those who are in the labour-force but are unemployed.
68) Ware J, eta!, 1993. 69) This measure was first used in New Zealand by Midland Health in 1984-85 (Wheadon et a!, 1995) and has been used in local research, such as in measuring Maori well-being (Kokaua et al, 1995) 70) Ware J et a!, 1994. 41 Table 4. Average score out of 100 for different dimensions of health, southern region residents, 1996-97 Note: a high score means good health/functioning.
Mental Role- Social Vitality General Bodily Role Physical Health Emotion Function Health Pain Physical Function
All 15 years and over 77.7 84.5 86.7 65.0 74.2 77.3 79.8 85.2 15 to 24 years 74.9 83.2 86.3 64.8 74.0 78.6 85.9 92.9 25 to 44 years 76.7 83.5 85.8 64.0 75.4 78,9 83.4 89.8 45 to 64 years 78.6 88.1 88.7 66.2 75.6 76.2 80.8 84.2 65+years 81.5 82.8 86.1 65.4 69.6 74.0 63.2 67.2
Female 75.1 82.0 85.0 62.1 73.7 76.3 79.3 84.3 Male 80.4 87.1 88.5 67.9 74.6 78.4 80.4 86.2
Maori 74.5 79.3 84.0 62.3 69.9 76.4 77.1 85.8 Non Maori 77.8 84.6 86.8 65.1 74.4 77.4 80.0 85.2
Main urban 77.2 84.3 87.1 64.5 75.1 77.5 81.2 86.2 Secondary urban 81.1 88. 88.0 66.8 75.0 78.3 83.0 84.1 Minor urban 75.0 79.4 83.3 62.1 70.5 73.7 78.6 80.6 Rural 78.4 84.9 85.6 67.9 72.4 78.7 73.6 85.5
Asthma 73.7 77.1 81.2 58.4 61.5 70.8 69.9 76.4 No asthma 78.5 86.2 87.9 66.4 77.1 78.8 82. 87.2
Disability 72.2 72.8 74.3 55.2 57.7 59.9 54.7 70.3 No disability 79.9 89.6 92.1 69.6 81.3 85.0 91.4 92.7
Income under $30,000 75.7 77.3 83.6 64.7 71.2 75.2 77.1 82.5 Income $30,000+ 78.5 86.4 87.8 65.3 75.8 78.2 80.9 86.9
Total 15 to 64 years 76.9 84.8 86.8 64.9 75.1 78.0 83.2 88.8
Employed full time 81.0 91.8 89.1 70.5 77.6 80.7 84.3 90.7 Employed part time 81.5 86.7 89.6 65.7 78.2 81.3 85.6 85.0 Unemployed 73.1 74.7 83.4 62.0 71.1 71.4 66.5 84.3 Non labour-force 75.8 77.8 87.0 58.6 70.4 76.0 68.0 74.9
Source: Statistics NZ - data from 1996-97 NZ Health Survey.
Socio-economic measures of health need
Ways of measuring the overall health need of any geographic locality have been developed in several countries. These are based on a combination of social and economic characteristics that have been shown to be strongly linked to ill- health. They are a useful tool for indicating which communities have a higher or lower than average need for health services. Several measures have been developed in recent years to accomplish this, the most notable are the Jarman Index, the Townsend index, the HEQ index, MHIRD, NZDEP91 and more recently the NZDEP96. These are discussed elsewhere."
71) Kokaua, 1997.
42 NZDEP9 1 - a measure of socio-economic deprivation - the NZDEP91 is a score for a geographic community which summarises several indicators of social or economic deprivation in that community. Specifically, the indicators used are measures of unemployment, sole parent families, marital status, households with no cars, rental housing, low income, education and income support. More detailed discussion of the construction of the NZDEP91 and the reason for its application in the southern region can be found elsewhere."
The measure was applied to all census area units 13 in the region. As with most summary measures, there is no way of telling if a particularly deprived area is that way because of a particularly poor result in one category or uniformly poor results in all indicators. However, experience would suggest that if an area is extremely poor it is due to the latter.
Figure 36 shows the NZDEP91 scores for the localities in the southern region standardised to the southern region as a whole (i.e. southern region = 1000). It shows the distinctive trend from the high score of the group of socio- economically deprived areas in Christchurch 1 to the low score of the group in Christchurch 5. In addition to Christchurch 1, Invercargill and the West Coast are the two most disadvantaged areas. Conversely, Canterbury and Central Lakes accompany Christchurch 5 as the most advantaged areas.
An adjusted NZDEP9 1 score - to see how well the NZDEP9 1 score correlated to more direct measures of ill- health, it was calibrated against hospital admission and mortality data for selected causes. 74 These causes were specifically: cancer, heart disease, chronic obstructive respiratory disease, strokes suffered by under 65 year olds, motor vehicle crashes, suicide at any age, and infant cot death. These were chosen as representing largely preventable deaths and illnesses. Table 38 in Appendix C shows the 20 most advantaged and 20 most disadvantaged census area units in the southern region, and the localities they fall into, using the adjusted NZDEP9 1.
Figure 36 shows, the scores for the adjusted NZDEP9 1 show a good correlation with the NZDEP9 1. The adjustment process has exaggerated the extreme scores, particularly in Christchurch, Invercargill and the West Coast. Figure 36A also shows the scores for the localities in the southern region standardised to the southern region as a whole (i.e. southern region = 1000). So if a locality has a score of 1000, the estimated number of years lost from those causes in that locality is the same as for the southern region as a whole. Similarly, if a locality has a score of 2000, the estimated burden of ill-health is twice that for the southern region as a whole.(Appendix C, Table 37)
Figure 36. NZDEP9 1 and adjusted NZDEP9 I scores by locality
El Standard I Adjusted 1,500
1,400 muiuuiuui 1,300 11111 ilIlIllUlihUll
"zoo11111 UIUIIIIIIIIIIU
1,100 Pill Pilliliuillill
1,000 Ii MEN 16MINNIP-10 IIIITJI
900 iii lii Lull AMINl
800 IllilliLl lulilIlIll 700 !ii!1!lkilul!lul!! .5, 4 •8 . " .5 .5 § .7i d d do B 0
/ Ce
72) Crampton et al., 1997 and 1996 73) Census area units are geographical units roughly equivalent in size to a city suburb, or a rural township or rural area (eg Bryndwyr, Washdykc, Milton, Rakaia). 74) Specifically the NZDEP91 has been regressed against the total combined years of life lost through mortality and years spent in hospital as a result of the causes shown above.
43 HEALTH DIFFERENCES WITHIN THE COMMUNITY
Socio-economic differences
Ill-health and lower-than-average life expectancy are closely and consistently associated with social and economic disadvantage, as indicated by factors like low income, unemployment, and poor housing.
Poorer people tend to have more health problems, use primary care less than their ill-health warrants, have a lower uptake of screening and preventive programmes, are admitted to hospital more than average for almost every diagnosis, and die younger.75
Furthermore, there is evidence that the disparity in health between advantaged and disadvantaged groups has been increasing in New Zealand."
Figure 36 page shows, areas with high rates of social and economic disadvantage include Invercargill, the West Coast, and some suburbs of Christchurch, including the inner city. The use of a socio-economic measure to divide Christchurch into five localities for the purpose of this profile means that the socio-economic differences within Christchurch are brought out more sharply than they are for other localities. Around the region there are also other pockets of socio-economic disadvantage, particularly some of the small rural towns in Southland, Waitaki and South Canterbury.
Much of the data in this report shows, socio-economically disadvantaged localities tend to have higher than average rates of premature death and hospitalisation for many causes.
Maori health
Maori fare worse than non-Maori on most health indicators both nationally and in the southern region, with higher hospital admissions in all age groups, and higher death rates nationally in age groups over 25 years from many causes.77
Obtaining valid figures on death rates for Maori in the southern region is hampered by the small numbers involved. There has also been a long-standing problem, particularly in the southern region, in obtaining accurate data on Maori deaths as well as hospital admissions. This is due to inconsistency in the ways in which people are identified as Maori by hospital staff and undertakers, and the tendency to under-report people as Maori."
75) National Health Committee, 1998; Pearce et al, 1983; Barwick, 1992a; Benzeval et al, 1995; Reinken et al, 1985; White, 1994. 76) Kawachi et al, 1991; Benzeval et at, 1995. 77) Dune M, 1994b; Te Puni Kokiri, 1993; Pomare et at, 1995. 78) Te Puni Kokiri, 1993. 44
Table 5. Death rates, Maori and non-Moon, New Zealand, 1987-1991 (number of deaths per 10,000 people in each age group)
Deaths 19874991 - rates per 10,000 population Maori Non-Maori
16 Under 1 year (per 1,000 live births) - all causes (mainly cot death) 9 1-4 years - all causes 4 6 5-14 years - all causes 2 3 15-24 years - all causes 11 12 25-44 years - all causes 18 13 128 45-64 years - all causes 74 45-64 years - heart disease 32 20 45-64 years - cancer 35 30 45-64 years - respiratory disease 11 4 45-64 years - stroke 7 4
Source: Pomare et al, 1995.
Nationally, death rates for Maori children and young people are lower than for non-Maori. However, death rates for Maori infants (babies under one year) and for adults over 25 years of age are higher than for non-Maori for many causes.
Rates of hospital admissions from most causes for Maori in the southern region have been consistently higher than for the population as a whole, as may be seen in many other figures in this report. Table 5 shows some of the conditions for which admission rates for southern region Maori are markedly higher than that of the southern population as a whole.
Hospital admissions for children under the age of 15 years are generally lower for Maori than the total population, except for respiratory problems. However, from young adulthood until old age, hospitalisation rates are higher for Maori than for the population as a whole. This is particularly so for respiratory problems of all types, heart disease and in later years, for stroke and diabetes. Digestive disorders and cancer are two of the few diagnoses where Maori tend to be under-represented in hospital admissions. Maori also tend to be under-represented in admissions of the 65 and over age group, except for respiratory disease, (Appendix C, Table 39)
The disparities in health between Maori and non-Maori have been related to the greater socio-economic disadvantages experienced by Maori as a whole," and to a lower usage of primary health services for various reasons.
More detail on Maori health may be found in the Southern Regional Health Authority s Maori Health Status Profile."
79) Public Health Commission, 1994b. 80) O Dea, 1993; West et al, 1980; Davis, 1986; Pomare, 1988. 81) Kokaua et al, 1996
45 Pacific Islands and other communities
The many diverse groups and communities that make up our population each have their own particular health issues which need to be understood if services are to reach them most effectively. Obtaining good information on the health needs of specific ethnic communities is difficult, particularly in the southern region, because of inconsistency and inaccuracy in how ethnic identity is recorded and also because of the small numbers involved.82
Pacific Islands communities - a comprehensive national study of the health of Pacific Islands people found that, when adjustment is made for the under-reporting of deaths, the overall death rate for the 1987-1991 period for men and women was lower for most causes than for the New Zealand population as a whole. However, death rates for men were higher than the national average for stroke and lung cancer, and for women death rates were higher for diabetes.
Pacific people were more likely than the national average to be admitted to hospital. This could reflect the younger age structure of the communities and the consequent greater number of admissions for childbirth. Hospitalisation rates are also higher for both women and men for respiratory illness, stroke and diabetes. Registrations of new cancers in Pacific people are higher than the national rates for many types of cancer including trachea, lung, prostate, stomach, liver and leukemia, among men and cancer of the cervix, ovary and uterus among women.83
The 1996-97 New Zealand Health Survey estimated that Pacific people were more likely to have experienced an injury, but less likely to be disabled than the general southern population. This probably reflects the younger age structure of the communities compared to the regional population. Pacific people were more likely to have visited a OP and to have been a hospital in-patient in the past year, but less likely to have used outpatient or accident and emergency facilities. Caution is needed in interpreting these results, as the sample was very small. (Appendix C, Table 40)
Asian, new migrant and other communities - little information is available on the health of Asian and other ethnic communities within the region. The 1996-97 New Zealand Health Survey gives some information on the small sample of "Other" respondents! This group was least likely of southern respondents to have a disability, to have been injured in the past year, or to have visited a OP. (Appendix C, Table 40)
New migrants from Asia may often have different health needs and issues in dealing with health services than those whose families have been settled in New Zealand for generations. New migrants who have arrived here as refugees, such as from Somalia, may also have quite specific health needs.
82) Bathgate et a!, 1994. 83) Bathgate et a!, 1994. 84) See, for example, Chen, 1993. 85) That is, people whose ethnic origin is other than Pakeha/European, Maori or Pacific Island
46 Men s and women s health
Men s and women s experience of health and contact with health services are on average quite different, as are their attitudes and behaviour toward health issues. Men s lower life expectancy and higher death rates are in part due to higher rates of cot death, to accidents and injury in young men,nand to more ill health in men over 50 years (particularly due to heart disease).
Most women have more contact with health services than men, both as users of services and as informal providers. Hospital admission for childbirth accounts for most of women s hospital use in the 25-44 year age group. Women are also more likely than men to bear the responsibility for getting health services for their children, and for caring for elderly, sick or disabled relatives,
There is a greater socio-economic differential in health among men than among women. This may reflect the broader range of occupations held by men and the impact of hazardous and poor working conditions on men s health. Some male and female health differences are converging, with rates of smoking, lung cancer, 91and heart disease increasing among women, 92 and rates of depression increasing among men.93
Rural and urban health differences
Apart from the higher rate of death and injury due to motor vehicle crashes in rural areas, there appear to be few significant differences in the health of rural and urban dwellers independent of socio-economic differences. There tend to be fewer social and economic differences within rural localities than within urban localities, with fewer extremes of affluence and poverty and correspondingly less disparity in health status.94
The 1996-97 New Zealand Health Survey did not reveal particularly large differences in rates of asthma, diagnosed diabetes or smoking among people living in rural areas, small towns or major cities. Rural residents were a little less likely than the regional average to have a disability, while those in small rural towns (minor urban areas) were most likely to have been injured during the past yeaa
Those in secondary urban areas (larger towns such as Timaru) were most likely to have both visited the OP in the past year and to have used the public hospital. People in major cities were more likely to have used the hospital as an out-patient or day-patient, or to have used a private hospital. (See Appendix C, Table 40)
The differences between city and rural dwellers can also be seen to some extent throughout the report in the comparisons of the localities. Some localities are predominantly urban (the five Christchurch localities and Invercargill), while others are predominantly rural (North Canterbury, Central Lakes, Clutha, Southland, Waitaki). Others include both a sizeable urban centre and a extensive rural hinterland (Dunedin, South Canterbury, Mid Canterbury and West Coast).
86) Mitchell eta!, 1992. 87) Public Health Commission, 1994b. 88) Bell eta!, 1996. 89) Public Health Commission, 1994b; Dept of Statistics/Ministry of Women s Affairs, 1990. 90) Lundberg, 1991. 91) OTR Spectrum Research, 1993. 92) Bell et al, 1996. 93) Romans-Clarkson eta!, 1990. 94) Source: Statistics NZ . 1996 census; Canterbury Area Health Board, 1990. 47
F Z , KEY HEALTH ISSUES FOR EACH AGE GROUP /21
Each age group faces different risks to health and well-being. This section highlights some of the main health issues that people face at each stage of their life.
Health issues for women and children arising from pregnancy and childbirth are discussed in the section for children and the sections for adults aged 15-24 years and 25-44 years. In addition, Appendix B looks in more detail at pregnancy, childbirth and terminations.
CHILDREN (0-14 YEARS)
Main causes of death and hospital admission
Deaths - childhood deaths from all causes for the five-year period ending 1994 were fewer in the southern region than nationally. This represented a shift from the situation ten years earlier, where the southern infant death rate was noticeably higher than the national rate, because of southern s higher than average cot death rate. Since the 1984-88 period, cot deaths have dropped to below the national rate.
Figure 37. Five main causes of death for infants under one year, southern region and New Zealand, 1989-1993 compared to 1990-1994 (yearly average number of deaths per 100,000 people in that age group)
• 1989-931 1989.93 Southern Region. • New Zealand Of the 355 infants under one year old who died • 1990-94 J 1990.94 } o in the region between 1990 and 1994, about a third died from unknown causes (which include 1,000 cot death), another third from birth defects, and the remaining third from a variety of other birth-related causes. Deaths from all causes have been decreasing over time. (Appendix C, 800 - aw Table 41)
0 The death rate among 1-14 year olds was a 0 little lower in the southern region than 0 600 -4 nationally. Of the 180 children who died between 1990 and 1994, the most common causes of death were cancer, motor vehicle 400 I crashes, drowning and birth defects. (Appendix C. Table 42)
I 200
I .1 CY qj I / TZlIis$iIIfluilL.Q-. , I V
48 Hospital admissions - Nearly two thirds (65%) of the 4,317 admissions of infants in the southern region in 1996 were of newborns needing care after birth. Another 20% were for respiratory or digestive disorders. The number of infant admissions to hospital dropped by an average of 2% a year between 1992 and 1996. (Appendix C, Table 43)
About a quarter of the 8,137 admissions of 1-14 year olds were for injury, another quarter for ear, nose or throat problems, and 14% for asthma or other respiratory disorders. Admissions for the 1-14 age group rose by an average of 6% a year between 1992 and 1996. (Appendix C, Table 44)
Figure 38. Five main causes of death for children 1-14 years, southern region and New Zealand, 1989-1993 compared to 1990.1994 (yearly average number of deaths per 100,000 people in that age group)
Figure 39 shows that localities with the highest rate of both first and repeat admissions per 100,000 children were the least advantaged Christchurch locality, Invercargill and the West Coast. Localities with lower-than-average admission rates were North Canterbury, the most advantaged Christchurch areas and Canterbury. Maori children had a far higher rate than was found for any of the localities. (Appendix C, Table 45)
Figure 39. First and repeat admissions to hospital for 1-14 year olds, by locality, 1996 (number of admissions per 100,000 people in that age group)
• First admissions 101 Repeat admissions 15,000
0 12,000 0 0 0 0 9 9,000
6,000
- 3,000 E a z 0 .4. 4. .0 4. t. 0 0 7 00
49 Low birth-weight babies
About 6% or 600 of the 11,000 or so babies born each year in the southern region weigh less than 2,500 grams at birth. (Appendix C, Table 47)
Low birthweight babies are significantly more likely than those of average birthweight to die or to be disabled by cerebral palsy,. intellectual disability, epilepsy; deafness and other conditions."
Low birthweight is linked, to premature .birth and is more common among infants born in poorer circumstances .16 Research has shown that premature birth can be reduced to some extent by good ante-natal care, as well as good nutrition and by not smoking during pregnancy. 17
However, a high proportion of low birthweight babies being delivered in any locality may also reflect the availability of good specialist obstetric and neonatal care in that locality.
Figure 40. Percentage of babies that are of low birthweight babies (2,500 grams or less), by locality, 1990-1994
8%
7%
6%
5%
4%
3%
2%
1%
0%
48 4 ? P • e . $ (7 (7. (7(7 P - , G0
Birth defects and disabilities
About 2-3% of all children are born with some form of birth defect such as cleft palate, with a small number experiencing more serious conditions such as spina bifida, haemophilia etc. 98 This rate is lower among Maori than non-Maori.
About two out of every 1,000 children born have some form of cerebral palsy. 1° The prevalence of cerebral palsy has been rising in developed countries because of the more frequent survival of very low birthweight babies due to better neonatal intensive care. 01
95) Bendich, 1993. 96) National Health Committee, 1998. 97) Ministry of Health, 1996a. 98) Dept of Health, 1991. 99) Pomare et al, 1995. 100) de Boer et al, 1990; Rosen et al, 1990. 101) Bhushan et al, 1993.
50 Sudden Infant Death Syndrome (cot death)
New Zealand s rate of Sudden Infant Death Syndrome (SIDS or cot death) in 1993 was among the highest in the OECD group of countries. 02 In the southern region, one third of all infant deaths are attributed to cot death and it is the most common cause of death in the first year of life, with 104 babies dying during the five year period from 1990 to 1994.
New Zealand and southern region cot death rates, however, dropped markedly from the late 1980s to the mid 1990s. This was in response to extensive education campaigns on the value of side and back sleeping positions for babies the importance of breast-feeding, and not smoking during pregnancy)°3 This trend, most apparent initially in non-Maori babies, now appears to be levelling out.
The death rate for Maori children does not appear to have decreased as much as that of non-Maori children, and Maori babies have a much higher-than-average risk of cot death)° 4 (Appendix C, Table 48)
Figure 41. Deaths from Sudden Infant Death Syndrome, by locality, 1984-1994 (yearly average number of deaths per 1,000 infants)
0 1984,88 0 1989-93 7 1990-94 20
In a a 15 0 0
U,
2.)
0
E za 0 P11^ I . V V 111.1 2 41 liii..llJJ11JRI f All
102) Public Health Commission, 1994b. 103) Ministry of Health, 1996b 104) Ministry of Health., 1996b.
51. Immunisation and infectious diseases
Immunisation coverage in the southern region is as high or higher than other regions. Both national and southern region coverage has increased since the early 1990s, though improved figures may also reflect more accurate information collection.105 In some areas where there has been an intensive campaign to increase coverage (e.g. Christchurch), over 90% of two year olds have received all their immunisations. "(Appendix C, Table 49)
Epidemics of vaccine-preventable childhood infectious diseases such as measles and whooping cough still occur in the southern region," which suggests that vaccination coverage levels are still less than ideal. °5
The rate of meningococcal disease, including meningitis, in the southern region (and New Zealand) has been increasing markedly, °9 and is particularly high among pre-school children, Maori and Pacific people and in Southland residents."
Hepatitis B is more common in New Zealand than other comparable developed countries, with a national study finding indicators for hepatitis in 25% of Maori children and 10% of non Maori children, although southern region rates are lower than those of other regions. Hepatitis B is a preventable cause of liver failure and cancer in later life."
Figure 42. Percentage of two-year olds who were fully immunised, southern region, 1992 and 1995
105) Ministry of Health, 1996b. 106) See also Bell et al, 1997. 107) ESR, 1996. 108) Menon et al, 1993. 109) ESR, 1997. 110) ESR,1997. 111) Skegg, 1994.
52 Respiratory illness
This is a major cause of hospital admission for children in the southern region, with over 1,400 admissions of 1-14 year olds to public hospitals in 1996. Nearly 80% of respiratory admissions were for asthma, and many are potentially preventable."
Asthma death rates in children have been dropping in New Zealand since the 1980s. Hospital admissions for asthma rose during the 1980s, to level out and drop in the. 1990s. It is not clear to what extent there has been a change in the actual prevalence of asthma - the changes in admission rates may also reflect changes in the medical management of the condition."
Maori and Pacific Islands children and children from low income families are no more likely to contract asthma but are considerably more likely to be admitted to hospital with a severe attack of asthma. This may reflect differences in access to primary care and the management of asthma in its less severe stages."
Respiratory admission rates are especially high in areas of greater socio-economic disadvantage, such as Invercargill, West Coast and the poorer areas of Christchurch. (Appendix C Table 50)
Figure 43. First admissions to hospital for 1-14 year olds for respiratory illnesses, 1996 (number of admissions per 100,000 people in that age group)
2,000
Ow
Sw
- 500 z
/1/i -V I
112) Blainey et al, 191. 113) Skegg, 1994 114) Pomare eta!, 1991; De Boer et a!, 1990; Garrett et al, 1989; Mitchell et a!, 1989.
53 Hearing problems
Six percent of five year old New Zealand school entrants failed the hearing test in 1994/95. This percentage has been dropping overall since the early 1990s, but has remained fairly static or increased among Maori and Pacific Islands children." About 10% of children in New Zealand under five years of age suffer from otit-media with effusion (glue ear)." Applying these percentages to the southern region suggests that around 650 five year olds each year are failing their hearing test, and over 5,000 children under 5 years of age may have otitis media. Glue ear and its complications are an important cause of hearing loss and developmental problems in children." A higher prevalence of glue ear has been linked to lower socio-economic status," lack of breastfeeding," 9 and passive smoking. 2°
Motor vehicle crash deaths and injuries
This country has the highest death rate for road related crashes in the OECD group. 2 For New Zealand children aged between 1-14 years, motor vehicle crashes are the most common cause of death, accounting for 20% of all deaths in this age group. The southern region has a lower rate of child deaths from road crashes than the rest of the country, but motor vehicle crashes still accounted for 5 deaths a year in the region between 1990 and 1994- 16% of all fatalities in children aged between 1-14 years. (Appendix C, Table 42)
Child abuse and family violence
Though accurate numbers are hard to get, increasing demand on services" (such as women s refuges, child protection teams and family counselling centres) suggests that as well as growing community awareness and concern for the problem, the actual incidence of family violence may also be increasing."
In the 1996/97 year, 783 children or young persons in the southern region were assessed by the Children, Young Persons and their Families Service as being seriously abused or needing some kind of intervention. This comprised over 1% of all children under 15 years, a higher rate than nationally."
115) Ministry of Health, 1996b 116) Chalmers eta!, 1989. 117) English et al, 1973. 118) Hood et al, 1975. 119) Stahlberg et al, 1986. 120) Strachan et al, 1989. 121) Public Health Commission, 1994b. 122) Ministry of Health, 1996b. 123) National Collective of Independent Women s Refuges Inc, 1993. 124) Children, Young Persons & Their Families Service, 1997.
54 .1 .15.
Dental health
Since the 1970s the overall dental health of New Zealanders has been improving." However, this trend may now be coming to an end. 116 Large inequalities exist in the dental health of the population - a Manawatu study showed that children from poorer families had significantly more missing and filled teeth than those from affluent families. 117
The dental health of Form 2 children in the southern region is a little worse than the national average, with the Southland CHE district noticeably worse, particularly in non-fluoridated areas. (Appendix C, Table 51)
People residing in areas with fluoridated water appear to have better dental health than people living in areas where the water is not fluoridated."
Figure 44. Dental health of Form 2 children in fluoridated and non-fluoridated areas, by CHE areas, 1993 (the average number of missing or filled teeth per child)
Fluoridated Areas Non-Fluoridated Areas 2.5
(2
8)
8) 8) -o 1.5
0 to 1.0 : E ]0.5
z0.0
0 1 4 ; 4 Gto
CO
125) Hunter et al 1992. 126) Public Health Commission, 1994b. 127) Thomson, 1993. 128) Treasure et al, 1991; Ministry of Health, 1996b.
55 TEENAGERS AND YOUNG ADULTS (15-24 YEARS)
Main causes of death and hospital admission
Deaths - of the more than 500 young people who died in the five years between 1990 and 1994, motor vehicle crashes contributed to 42% of these deaths, suicide to 24%, and cancer to 6%. The overall death rate for young people in the southern region was lower than the national rate and like the national rate, has dropped slightly over the past five years. (Appendix C, Table 52)
Hospital admissions - the number of young people admitted to southern region hospitals dropped by an average of 5% a year between 1992 and 1996. The most common cause of hospital admission was pregnancy (50% of all female admissions). (Appendix C, Table 53)
Localities with a markedly higher than average rate of admission were West Coast and Invercargill, South Canterbury and Waitaki. The three most advantaged Christchurch areas had markedly lower-than-average admission rates. Maori had a much higher rate of admission than any locality. (Appendix C, Table 54)
Figure 45. First and repeat admissions to hospital for 15-24 year olds, by locality, 1996 (number of admissions per 100,000 people in that age group)
• First admissions 19741 Repeat admissions
C ow 0 0 0 C 0
ow
C
E C DDpDI-. E z flbWUDUflIfl
I
56 Motor Vehicle Crashes
Motor vehicle crashes are the main cause of death for young adults, comprising two out of five deaths in this age group in the years between 1990 and 1994. In this period, 156 young men and 55 young women died in road crashes in the southern region. Southern death rates are similar to the national average, and the number of deaths and hospital admissions due to road crashes in the region (and New Zealand) has been declining. 129 High rates of both hospital admission and death have been observed in the West Coast, Mid Canterbury, Waitaki and Central Lakes. (Appendix C, Table 55)
Figure 46. Deaths from motor vehicle crashes, males and females aged 15-24 years, by locality, 1990-1994 (yearly average number of deaths per 100,000 people in that age group)
IN Female 0 Male 120
100
80
60
40
20
0
c. • - C -e- -.-. -, .-. - .1 &IQ -. MIZ M CJ Q
129) Ministry of Health, 1996b.
57 Suicide
New Zealand has one of the highest death rates from suicide for young people in the world." Between 1985 and 1991, the suicide rate almost doubled for 20-24 year old New Zealand men and rose by over 70% for young women of the same age, though the rate appears to have levelled out more recently."
Young people in the southern region have the highest suicide rate in the country, although small numbers mean that a slight variation in numbers may affect the rate considerably. In the five years between 1990 and 1994, there were 105 suicides among young men and 13 suicides among young women aged 15-24 years, a rate of 33 deaths for every 100,000 males and 4 deaths for every 100,000 females. In 1994, 168 women and 93 men were admitted to hospital due to attempted suicide. Although small numbers mean that locality differences should be interpreted with caution, within the southern region North Canterbury, South Canterbury and the two most disadvantaged areas of Christchurch had the highest rates. People who lived in Christchurch had 30% more suicides than the southern region as a whole. The southern region in turn had 7% more suicides than New Zealand as a whole .131 (Appendix C, Table 56)
Figure 47. Deaths from suicide in young people aged 15 - 24 years, 1984 - 1994 (3 year moving average, yearly number of deaths per 100,000 people in that age group)
The risk of suicide is higher among males, young people from low income families, those with substance abuse, depression or other emotional problems. The risk is also higher among young people from unhappy families, those who have experienced sexual abuse, and those who are dealing with issues of sexual orientation. 133 (Appendix C, Table 57)
Nationally, in the past, rates of suicide among Maori were lower than average, but recently they have risen in young Maori men to equal those of non-Maori men. 114
130) Public Health Commission, 1994b; Barwick, 1992b. 131) Ministry of Health, 1996b; Ministry of Health, 1997; Barwick, 1992b. 132) Coppell et al, 1998 133) Ministry of Health, 1996b. op cit. 134) Abbott, 1994
58 Teenage pregnancy and termination of pregnancy
In New Zealand the rate of births to teenage mothers is among the highest insimilarly developed countries." In the southern region there were 662 births in 1996 to mothers under the age of 20 years, comprising 8% of all live births. (See Appendix B for a fuller discussion of pregnancies, births and terminations.)
Teenage mothers on the whole are less likely to have adequate financial and social support for parenting, and their children are more likely to be low birthweight and to have more health problems than average. 37
The number and rate of births to teenage women peaked nationally in the early 1970s, then declined, and rose again in the 1980s.
Both Maori and Pacific teenagers in the southern region have a higher rate of births than non-Maori/non-Pacific teenagers.
Invercargill and the West Coast had significantly more live births to non-Maori/non-Pacific teenage mothers than the regional average, and Invercargill had more than the regional average for Maori teenagers. Dunedin and Central Lakes had fewer births to non-Maori/non-Pacific teenagers than the regional average. (Appendix B, Table 4)
Since 1990 the rate of births to teenagers in the southern region has dropped among young non-Maori/non Pacific women (linked to an increase in pregnancy terminations in this group), but has remained steady among young Maori and Pacific women. 39
Pregnancy terminations performed on teenagers account for about 20% of all terminations in the southern region. In 1994 there were 559 abortions to young women under 20 years in the southern region, slightly fewer than the number of live births to this age group." Pacific teenagers, followed by non-Maori/non-Pacific teenagers, were most likely to terminate their pregnancy, and Maori teenagers least likely.
The rate of births to young women decreased between 1990-1994. This has been off-set by an increase in the number of terminations, resulting in no significant change in the combined rate of birth and terminations.
Sexual health
Teenagers and young adults are the group most at risk of sexually transmitted diseases (STDs) which carry a possible risk of cervical and penile cancer, ectopic pregnancy and sub-fertility." Young women have a higher rate of STDs than young men.
Smoking
Over 80% of adult smokers start their habit in their teenage years, with most starting between the ages of 13 and 15 years. 42
More New Zealand teenage girls than boys are now regular smokers - a reversal of earlier trends. 4 Nearly one third of young women 15-25 years old are smokers, compared to 28% of young men. Over 60% of New Zealand teenage women smoke during pregnancy. 45
135) Maski!!, 1991. 136) Boulton-Jones et at, 1995. 137) Fraser eta!, 1995. 135 Dickson et at 1996. 138) Statistics NZ - births data. 139) Dickson eta!, 1996. 140) Dickson eta!, 1996. 141) Maski!!, 1991; Evans eta! 1993. 142) Stanton eta!, 1989. 143) Ford eta!, 1995. 144) OTR Spectrum Research, 1993. 145) Alison et al, 1993.
59 Alcohol and drug abuse
The rate of hospital admissions for alcohol-related conditions is higher for young males than any other group in the population. In New Zealand, drunkenness has been linked with road crashes, and particularly with motor vehicle crashes involving teenagers. More young people are now being treated by alcoholism treatment47 agencies - this may reflect both a real increase in problems as well as the improved availability of services. 149
Drug abuse is dealt with on page 40.
Mental ill-health Psychological problems appear to be more common amongst young people than in the past. 5° A Christchurch study found that nearly a quarter of adolescents have already, at some stage in their lives, met criteria for at least one of the main psychiatric disorders, by the internationally used American DSM-111 / DSM-IIIR definitions." The majority of those young people have not received help for their condition." Anxiety disorders were the most common problem found amongst adolescents." National studies estimate that between 4% and 14% of school-girls have an eating disorder. 114
ADULTS FROM YOUTH TO MID-LIFE (25-44 YEARS) irEy 621100_;0, tI, Main causes of death and hospital admission U5 Deaths - death rates from all causes were a little lower than the national average for both women and men in this age group in the southern region.
For women between 25 and 44 years, cancer (mainly breast cancer) is the most common cause of death.
For men in this age group, motor vehicle crashes are the leading cause of death in the southern region as in New Zealand. Suicide is still an important cause of death, and heart disease and cancer are the other most common causes of death. Work-related deaths and injury are also significant." (Appendix C, Table 58)
Figure 48. Five main causes of death for 25-44 year olds, males and females, southern region and New Zealand, 1990-1994 (yearly average number of deaths per 100,000 people in this age group)
146) Public Health Commission, 1994b. 147) Land Transport Safety Authority, 1992. 148) Begg et al, 1992. 149) Abbott, 1994. 150) Abbott, 1994. 151) Ferguson et- al, 1993. 152) Homblow et al, 1990. 153) Maskill, 1991. 154) Wakeling, 1996; Maskill, 1991. 155) Langley et al, 1989. Hospital admissions - The number of 25-44 year olds admitted to hospital dropped by an average of 2% a year between 1992 and 1996. Major causes of admission were pregnancy and birth (55% of all female admissions) or gynaecological disorders (14% of female admissions). (Appendix C, Table 59)
Localities with a markedly higher-than-average rate of admissions for this age group include South Canterbury, West Coast, Waitaki, Mid Canterbury, Dunedin and Invercargill. The only localities with a markedly lower-than-average admission rate were the two most advantaged Christchurch areas. Maori had a very much higher admission rate than was found in any locality. (Appendix C, Table 60)
Figure 49. First and repeat admissions to hospital, by locality, for 25-44 year olds, southern region, 1996 (number of admissions per 100,000 people in that age group)
• First admissions • Repeat admissions 25
Ow 0
0 0 o 15 0 0 10
ES z 0 . . -Q -Q IS/i 5-, .?f GJ I is
( CO I C, /
- Childbirth
There has been a significant trend in the southern region (and nationally) towards women delaying their child-bearing until they are older, along with a trend towards smaller families.
Based on birth rates for women aged 10 - 49 years in the 1990-96 period, the average woman in the southern region could be expected to have given birth to 2.2 children in her lifetime. The average age of women giving birth during 1990-1996 was 28 years.
West Coast, North Canterbury and Southland have more births per women than the regional average, while Christchurch and Dunedin cities have the lowest rate.
(See Appendix B for a more detailed discussion of pregnancies, births and abortions in the southern region.)
61 Abortion and infertility
The rate of pregnancy terminations per 1,000 women has been rising since 1985. At the 1995 rate of 16.4 terminations per 1,000 women aged 15-44 years, New Zealand s termination rate is higher than that of the United Kingdom but lower than that of Australia, the United States or Japan. Most terminations are performed on women aged 20-29 years. 116
Information on abortion by locality cannot be given, as most terminations are performed in Christchurch or Dunedin and no data is available on the residence of the woman. 157
There has also been an increase in demand for infertility treatment in New Zealand."
(See Appendix B for a more detailed discussion of pregnancies, births and abortions in the southern region.)
Diabetes
About 1.5-2% of adults aged 15-65 years have been diagnosed with diabetes, with an estimated 1.5-2% having undiagnosed diabetes." Unrecognised and uncontrolled diabetes can lead to serious complications, such as kidney failure, heart disease, blindness and limb amputation. It can also lead to greater susceptibility to sickness and injuries-" Non-Europeans are more likely than people of European origin to contract diabetes .161
Mental ill-health
A Christchurch study showed that about one third of adults have at some stage in their lifetime met criteria for at least one of the main psychiatric disorders, according to the internationally recognised definitions. 16 However, this report has shown in an earlier section on mental illness that relatively few people actually seek treatment or assistance for their mental illness, given that 40 adults per thousand are estimated to have a psychiatric disability but only 10 per thousand require assistance or treatment. Furthermore, the HFA s assessment databases show that only 4 per thousand actually receive assistance or treatment.
MID-LIFE ADULTS (45-64 YEARS) ^i ^ jAl15 Main causes of death and hospital admission 1 Deaths - death rates from most causes for the 45-64 age group in the southern region were a little lower than the national average. Cancer accounts for 44% of all deaths in this age group, followed by coronary heart disease (25%), stroke (5%) and chronic obstructive respiratory disease (4%).
Death rates from all the main causes have been declining over the past 10 years in the southern region in line with national rates. (Appendix C, Table 61)
Figure 50. Five major causes of death for people aged 45-64 years, males and females, southern region and New Zealand, 1990-1994 (yearly average number of deaths per 100,000 people in that age group)
156) Statistics NZ, 1997a. 157) Dickson et a!, 1996. 158) Gillett et a!, 1995. 159) Scragg et al, 1991; Brown et a!, 1984. 160) Simmons, 1996. 161) Borman, 1980. 162) Wells et a!, 1989. 62 Hospital admissions - Circulatory problems (20% of all admissions) was the most common reason for hospitalisation in this age group.
The rate of hospital admissions in this age group dropped by an average of 2% a year between 1992 and 1996. (Appendix C, Table 62)
Localities with a markedly higher rate of hospital admissions than the regional average were the West Coast, South Canterbury, the most disadvantaged Christchurch area, Invercargill and Mid Canterbury. Localities with a markedly lower hospitalisation rate were the three most advantaged Christchurch areas, Canterbury and North Canterbury. Maori had a very much higher admission rate than any locality. (Appendix C, Table 63)
Figure 51. First and repeat admissions to hospital for 45-64 year olds, by locality, 1996 (number of admissions per 100,000 people in that age group)
• First admissions Repeat admissions 25,000
0 20,000 C 15,000 0C -4
-o4 10,000 SW
5,000
Jill(?d.e , jf// il//i I/i 9 . . 0./ ,o 4.
Coronary heart disease
Coronary or ischaemic heart disease" is a major cause of death (especially for men) in the 45-64 year old age group in the southern region, as it is throughout New Zealand. New Zealand has a high death rate from heart disease by international standards."" In the southern region, coronary heart disease accounted for one quarter of all deaths in the 45-64 year age group between 1990 and 1994. (Appendix C, Table 64)
The overall coronary death rate for 1990-1994 was slightly lower in the southern region than the national average. However, rates in some localities were markedly higher than the national average, including Invercargill, the two most disadvantaged Christchurch localities and South Canterbury. Central Lakes, Clutha and the three most advantaged Christchurch localities have markedly lower rates than the regional or national averages.
163) Coronary heart disease is here treated as equivalent to ischaemic heart disease as shown in hospital discharge and mortality data. 164) Ministry of Health, 1996b; Beaglehole et al, 1994. 63 National death rates from coronary heart disease have been dropping, probably in part due to lower fat consumption and less smoking, as well as to better access to medical services." The drop in coronary death rates is most marked among people in this age group, and those belonging to higher socio-ecorsomic groups, and non-Maori in all age groups."
The rate of hospital admissions in 1994 was seven times the rate of deaths from coronary heart disease, and has continued to increase."
Figure 52. Deaths from heart disease, for 45-64 year olds, by sex and locality, 1990-1994 (yearly average number of deaths per 100,000 people in that age group)
U Female UI Male 400
350 1: 300
2C 200 150 I- 100 z 50
..r 4. C, ? - i 4 2? 2? 2? ? C,C, All 2? ./ s Cf
High blood pressure - in the 1996-97 NZ Health Survey, 11.7% of all people over 15 years reported having high blood pressure, which is a risk factor for coronary heart disease. There was little difference in the rates for Maori and European/Pakeha. The percentage rose to 18.2% of those 45-64 years and to 41% of those over 65 years. The overall percentage for the southern region was 12.1%, possibly reflecting the slightly older population of the region.
Cancer
Cancer is the most common cause of death in this age group, and accounts for over half the deaths of mid-life women. 69 The overall incidence of cancer in the southern region is slightly higher than the national average. The death rate from all forms of cancer is about the same for men in the southern region compared to the national rate. 7°
Some localities (e.g. Invercargill, West Coast and the most disadvantaged Christchurch area) have much higher death rates for cancer than the regional or national average. (Appendix C, Table 65)
The incidence of and death rate from colorectal cancer was slightly higher than nationally, while lung cancer and cervical cancer in women was lower than nationally. These rates may partly be explained by the lower proportion of Maori in the southern population.
165) Jackson et al, 1995; Bell et al 1996. 166) Kawachi et al, 1991; Beaglehole et al, 1994. 167) Public Health Commission, 1994b 168) Statistics NZ, 1997. 169) Public Health Commission, 1994b. 170) Cox, 1997. 64 - -
There was a drop in the overall death rate from cancer between 1984-88 and 1991-94 in the southern region, in line with national trends. However, death rates from some forms of cancer have been increasing while others have dropped. Hospital admission rates are three times higher than the death rate for cancer and have increased in recent years. (Appendix C, Table 61)
Detailed information for specific types of cancer have not been analysed in a locality breakdown, so the following sections on specific cancers are based largely on national and regional data.
Breast cancer - breast cancer was the leading cause of cancer death for women between 1984 and 1993. Death rates have shown a substantial rise over recent years, but now appear to be levelling Out, while the number of new cases of breast cancer is rising." In the southern region, 1,462 women died of breast cancer in the ten years between 1984 and 1993, a rate of 27 deaths per 100,000 women. This was a little higher than the national rate of 26 deaths per 100,000 women. 172
Neither incidence nor death rates for breast cancer appear to vary significantly between Maori and non-Maori. 171 However, a study of breast cancer cases between 1976 and 1985 found that survival was significantly lower-than-average in Pacific Islands women. This difference disappeared when the severity of the illness at the time of diagnosis was taken into account. This suggests that Pacific Islands women in New Zealand may not be receiving access to services or diagnosis until later, when their disease has become more severe. 74
Breast cancer mammography screening has been shown to be effective in reducing deaths among women over 50 years of age, 75 and a pilot programme in Otago/Southland has achieved a high (around 80%) participation rate amongst eligible women. 116
Lung cancer - lung cancer is the leading cause of cancer death in men, linked to the high prevalence of smoking by men in previous years, although death rates are now dropping. In contrast, women s death rates from lung cancer are still rising, reflecting the increase in smoking by women over the past 30 years. 77 Between 1984 and 1993 in the southern region 2,246 men and 814 women died of lung cancer. 78
Figure 53. Deaths from cancer (all types) for 45-64 year olds, by sex and locality, 1991-1996 (yearly average number of deaths per 100000 people in that age group)
U Female U Male 400
350 4) 0 4) 0 0 0 o0 200 -4 I., 4) 150
100
50
. 5. .- -1 •$ C • . ?
I / oF
171) McGee eta!, 1994; Public Health Commission, 1994b. 172) Cox, 1997. 173) Armstrong et a!, 1996. 174) Pomare eta!, 1995. 175) Skegg et a!, 1989. 176) Elwood, 1991. 177) McGee et a!, 1994; Public Health Commission, 1994b 178) Cox, 1997.
65 The incidence of lung cancer is particularly high among Maori, and the rate for Maori women is now higher than for Maori men, 79 The continuing relatively high rate of smoking among teenage girls of all ethnic backgrounds is of concern, as it is a major risk factor for this disease.
Cervical cancer - national death rates for cervical cancer have declined since 1980 and more rapidly since 1992, possibly linked to wider screening coverage. The incidence of new cases has remained steady. 8° Between 1984 and 1993 there were 193 deaths from cervical cancer in the southern region, 8 a lower rate than nationally. Both deaths and new cases of cervical cancer appear to have dropped more rapidly among non-Maori women in the southern region than they have nationally." The rate of new cases of cervical cancer among Maori has continued to be more than twice that of non-Maori, and the risk is also higher-than-average among disadvantaged people. 113
Having regular cervical smears and timely, appropriate treatment can do much to reduce illness and deaths from cervical cancer. 84 In the southern region, cervical screening coverage of the eligible population is now over 84%, the highest of the four regions. Within the region, coverage is highest in Otago and lowest on the West Coast. 8
Stomach, bowel and prostate cancer - national death rates from stomach cancer have dropped markedly over recent decades, while deaths from bowel and prostate cancer have risen slightly. Non-Maori men continue to have the highest rate of new cases and deaths from bowel cancer, although there has been an 80% increase in the rate of new cases amongst Maori over the last two decades. 86 Colorectal cancer was responsible for the deaths of 1,417 men and 1,389 women in the southern region between 1984 and 1993, a higher rate than nationally."
Skin cancer - the rate of new cases of melanoma significantly increased in New Zealand between 1981 and 1990, and the risk is higher-than-average for non-Maori and those of higher socio-economic status. The risk of death rises steadily with increasing age. Compared to many other types of cancer, skin cancer affects relatively high numbers of young and middle-aged people. The risk of melanoma is linked to sunburn and possibly to intermittent exposure to the sun. 88 In the southern region, 211 men and 160 women died from melanoma between 1984 and 1993.89
Adverse effects of chronic conditions
Middle age is often the time when the long term consequences of chronic conditions such as diabetes, heart disease, alcohol abuse or chronic hepatitis start to become apparent. These consequences can include alcoholic dementia, liver cancer, and kidney failure necessitating dialysis or surgery.
179) Pomare eta!, 1995. 180) Ministry of Health 1996b. 181) Cox, 1997. 182) Cox, 1997. 183) Pomare et al, 1995; Ministry of Health, 1996b. 184) Skegg, 1989. 185) Ministry of Health - national cervical screening programme data for November 1997 186) McGee eta!, 1994. 187) Cox, 1997. 188) Ministry of Health, 1996b. 189) Cox, 1997.
i. THE ELDERLY (65 YEARS AND OVER) AF
Main causes of death and hospital admission
There is a much higher chance today than in earlier years that an elderly person will live to an even older age and thus be at risk of illness and hospitalisation. Once sick, however, older people are less likely to die than in previous years. This in part explains why the rate of hospital admission for older people has risen faster since the 1970s than for the population as a whole." People over 65 years in the southern region made up 31% of all hospital admissions (40,000 of 126,000 total admissions) in 1996.
In both New Zealand and the southern region, coronary heart disease and cancer are the two leading causes of both death and hospital admission in this age group. Chronic respiratory disorders and stroke are the next most common causes of death and hospital admission. (Appendix C, Tables 66 and 67)
Figure 54. Five major causes of death, for 65+ year olds, by sex and locality, 1990- 1994 (yearly average number of deaths per 100,000 people in that age group)
Southern Region New Zealand Female • Female Male Male 2,000
1,500 0 0 0 11000
1.
- E 500
Ischaemic Cancer Strokes Pneumonia CORD heart disease and influenza
Deaths - death rates from most causes for the 65+ age group in the southern region were a little higher than the national average. Overall, death rates have been dropping over time in the south, in line with national trends. Coronary heart disease accounted for 29% of all southern deaths in this age group, followed by cancer (23%), stroke (12%), and pneumonia, flu or chronic obstructive respiratory disease ( CORD) (11%). (Appendix C, Table 66)
190) Pool, 1994.
67
Hospital admissions - the number of 65 + year olds admitted to hospital dropped by an average of 1% a year between 1991 and 1996. Major causes of admission were coronary or other heart disease (39% of all admissions) and cancer (14%). (Appendix C, Table 67)
Localities with a markedly higher than average rate of admissions for this age group include West Coast, Mid Canterbury and South Canterbury. Localities with a markedly lower-than-average admission rate were all the Christchurch areas, Canterbury and North Canterbury. Maori had a relatively high admission rate compared to the average. (Appendix C, Table 68)
Figure 55. First and repeat admissions to hospital for 65+ year olds by locality, 1996. (number of admissions per 100,000 people in that age group)
• First admissions j Repeat admissions 55,000 aw 50,000 aw 45,000 0 40,000 0 35,000 C 0 -4 30,000 25,000 Ow 20,000
- 15,000 E 10,000 z 5,000 0 -9 2 •,, - -C - . ;;. .. C) . r -C -C 0 ? C) . Cj J/ C) C) -C .f r I
Disability and independence
Most elderly people remain relatively fit and independent in their own homes. 191 In the southern region just over 7,000 people over the age of 65 years, or 7% of that age group, live in long-stay hospitals or rest homes. It is over the age of 75 years and even more after 85 years that many people need help with daily life. 92
A minority of elderly people develop disabilities as a result of arthritis, stroke, poor sight or hearing, incontinence or dementia.
Information on the number of people aged 45 years or more who have an age-related disability can be found in the Health Funding Authority s database of people claiming for assistance because of such disability. Age-related disability is defined here as a physical, intellectual or psychiatric condition related to the onset of the aging process that involves a decline in the individual s level of functioning. This includes conditions which can affect younger people but which are more often found amongst older people (such as stroke). It does not include conditions which most often affect younger people, even through they may continue into old age (such as multiple sclerosis).
During 1997 there were 25,629 people in the southern region who had been assessed as having an age-related disability and requiring one or more support service funded by the Health Funding Authority. This comprised 25% of the population aged 45 years and over, and 46% of those aged 75 years and over. (Appendix C, Table 69)
The vast majority of this group were over 65 years, and 77% were over 75 years. Only 30% were men. Maori were under-represented relative to their proportion in the population, accounting for less than 1% of this group.
Most of the elderly (59%) with age-related disabilities lived in Christchurch, Dunedin or Invercargill, much the same proportion as the general population. The proportion of people assessed as having an age-related disability ranges from 4.6% in Canterbury to 11.5% on the West Coast. 191) Koopman-Boyden, 1993. 192) Koopman-Boyden, 1986. 68 Table 6 shows the number of people with an age-related disability needing different levels of care. Most people (63%) needed the lowest level of care, with only 11% needing long-term hospital care of some sort. This comprised about 3,000 people, or just 3% of people aged 65 years or more.
Table 6 Number and rate of people assessed as having age-related disabilities, showing levels of care needed, southern region, 1997
Levels of care Number of people % 1 - community support services or lower-level rest home support 16,147 63.0 2 - moderate rest home support 1,819 7.1 3 - high level of rest home support 2,307 9.0 4 - dementia services 897 3.5 5 - long-term hospital (general) 1,768 6.9 6 - long-term hospital (specialised) 256 1.0 Residents of rest homes receiving hospital level care 2,435 9.5 Total 25,629 100.0
Source: Health Funding Authority needs assessment data, 1997.
Stroke
As people age, stroke becomes an increasingly common cause of death, disability or hospital admission. Stroke results in 10% of people being admitted to hospital and accounts for 12 % of all deaths. However, over the past two decades, death rates for all ages from stroke have markedly decreased in New Zealand, especially among non-Maori."
Hip fractures
New Zealand s incidence of fractured hip is one of the highest in the world."" Hip fractures are the leading cause of hospitalisation for non-fatal injury, and the second most common cause of injury-related death, 95 Most result from a fall and involve elderly people. Elderly non-Maori women with osteoporotic (weak) bones are particularly susceptible to these injuries - each year four out of every 100 New Zealand women over the age of 85 years are admitted to hospital with a fractured hip." In 1996 there were 1,004 admissions to southern region public hospitals for hip fracture.
Residents of rest homes, particularly if they are receiving psychoactive medication, have been shown to have ten times the average risk of hip fracture-"
Regular physical exercise has been shown to have a protective effect on maintaining bone density in women over 65 years.
Pneumonia, influenza and chronic respiratory disorder
Pneumonia, influenza and chronic respiratory conditions are common causes of death and hospital admissions in the elderly. Together they accounted for about 11% of all deaths in the southern region amongst this age group in 1990-1994, and 13% of all 1996 hospital admissions.
Dementia
The risk of suffering from cognitive impairment increases with age, due to Alzheimers disease, Parkinsons disease and dementia resulting from stroke. Among people 65 years and over, 4-6% experience cognitive impairment, with 1-2% experiencing this in a severe form. The rate of dementia has increased markedly in recent years. °
Multiple illnesses
Elderly people are more likely to suffer from more than one condition at once, and it can be difficult to -distinguish iymptoms of illness from side-effects of treatments. °
193) Public Health Commission, 1994b; Beaglehole et al, 1994. 194) Langley et al, 1987. 195) Public Health Commission, 1994b. 196) Burry et al 1984. 197) Elliot et al, 1992; Langley et al 1987. 198) Wetherall, 1993. 199) Gideon et al, 1993. 200) Public Health Commission, 1994b. 201) Abbott, 1994. 202) Wilkinson et al, 1995.
Re CONCLUSION
What does this document achieve? I1 We hope that it:
• informs communities about their health and what affects it; • contributes to the debate about where resources could best be used to improve health; • points to sources of data to which interested readers can go for more in-depth information; • challenges the reader to address the inequities that exist in health status both within the southern region and between this region and the rest of New Zealand; and • provides a snapshot at a point in time which can be used to measure future performance and answer the questions: Are the people of the southern region getting more or less healthy? Are gaps narrowing or widening? Are resources being used effectively to improve health and equity? Key findings
What does this review say about the health of people in the southern region and how this can be improved? Here are some of the key findings that emerge:
• The south is unique in that its relatively small rural population scattered sparsely over a vast geographic area. Many small rural communities are often faced with barriers of distance, terrain and weather in getting the basic services they need as well as access to more specialised services in the larger centres.
• A long life is often considered good , a sign of a prosperous nation. Increasingly longevity of life often goes hand in hand with increased use of health services; There is no doubt that medical and other advances in health services improve longevity, but inequalities still remain in life expectancy among different groups in our community.
• People s health is closely linked to their socio-economic situation - housing, employment, income, education, family support etc. This is clearly evident throughout this report in the consistently higher-than-average rates of ill-health and premature death that are found in low income and disadvantaged groups and areas.
• Maori also show much higher than average rates of ill-health and premature death from many causes. This is linked both to the greater socio-economic disadvantage experienced by Maori as a whole, and to the cultural barriers that prevent easy access to health services.
• Lifestyle and the environment affect people s health. People have some individual control over lifestyle choices (e.g. smoking). However the environment (e.g. water quality) can often only be influenced by the individual indirectly through collective action with others.
• It is a matter of concern that current campaigns to promote health and prevention illness are taken up least by those who most need them. Low income people and Maori, the groups with the highest rates of illness and premature death, tend to use GPs and screening services less than they need to, and are admitted to hospital more often than average with more severe illnesses.
• Some indicators of health or well-being show the south to be better than the rest of the country, yet worse by international standards (e.g. child road deaths) and so point to the possibility of improvement. Other indicators by their very nature (e.g. diabetes-related illnesses) are important to address just because they are preventable, irrespective of whether the southern region is shown to be better or worse than the rest of the country or the rest of the world. All of these issues need to be considered when the Health Funding Authority and the public discuss how to set priorities in order to obtain the best levels of health within the constraints of funding for health services.
70 APPENDIX A
CHRISTCHURCH LOCALITIES
Why make five sub-localities within Christchurch?
The population of Christchurch makes up forty percent of the residents of the southern region. Considered as one locality, this population would be about five times the size of most of the other localities, and would strongly colour the regional average.
Within Christchurch city there are major variations in socio-economic status and health status. These differences cannot be examined using data for the whole of Christchurch. -
Christchurch has few natural geographic boundaries and there is no easy or useful way of dividing the city geographically. We therefore sought another way of dividing the city into areas of comparable size to other localities in the southern region.
How the city was divided into sub-localities
We used a measure of socio-economic status, the Health and Equity Quotient (HEQ), which is based on census data and is a commonly used measure of social advantage/disadvantage in the health sector. The Health and Equity Quotient is made up of variables taken from census information about each Census Area Unit (CAU) which make up the city. There are 106 CAUs in Christchurch City, most of them being the size of a small suburb.
The HEQ score correlates closely with results that can be obtained from using the NZDEP91 203 score, which is also based on similar census variables. Although this report contains a section comparing the localities on the basis on NZDEP91, we retained the use of HEQ for the division of the Christchurch city CAUs largely due to lack of time to recalculate them on NZDEP91. (See Kokaua, 1997, for a discussion of these measures).
CAUs were given HEQ scores, then ranked, and divided into five groups of roughly equal overall population size. The CAUs in each sub-locality are not necessarily contiguous geographically.
Table 1 shows how each CAU was ranked and which sub-locality it fell into.
203) Explained in the section on overall measures of Health and Health Need, page 41
71
Table 1. Christchurch census area units, clustered by socio-economic score (HEQ) A high value reflects a lower degree of social advantage, a low score reflects a higher degree of social advantage.
Census area Usually Health & Census area Usually Health &
unit name resident Equity unit name resident Equity
population Quotient population Quotient
1996 score 1996 score Christchurch 1 (disadvantaged) Avon Loop 4,176 2.2 Parklands 5,757 -0.1 Phillipstown 3,414 2.0 Islington 2,187 -0.1 Linwood 4,269 1.8 Styx 2,538 -0.1 Waltham 924 1.7 Mairehau 2,787 -0.2 Addington 2,769 1.7 Papanui 3,333 -0.2 South Richmond 2,373 1.6 Heathcote Valley 1,494 -0.2 Riccarton South 369 1.6 Belfast 3,561 -0.3 Aranui 4,677 1.6 Dallington 3,399 -0.3 Cathedral Square 834 1.4 Merivale 3,117 -0,3 Sydenham 5,196 1.3 Barrington South 2,841 -0.4 North Linwood 2,424 1.0 Aorangi 5,118 -0.4 Middleton 816 1.0 Christchurch 4 3,561 -0.3 Ensors 3,393 1.0 Opawa 3,372 -0.4 Woolston South 2,271 1.0 South Brighton 3,795 -0.5 Jellie Park 2,256 1.0 Sumner 3,714 -0.5 Edgeware 3,393 0.9 Travis 2,361 -0.5 Bromley 3,015 0.9 Beckenham 2,379 -0.5 Hagley Park 1,590 0.8 Bishopdale 2,532 -0.5 St Albans East 4,545 0.8 Harewood 2,751 -0.5 Riccarton 3,354 0.8 St Martins 4,269 -0.6 Avonside 3,171 0.8 Redwood South 2,856 -0.6 Christchurch 2 Redwood North 3,561 -0.6 Spreydon 3,345 0.8 Wainoni 4,434 -0.6 East Linwood 1,893 0.8 Wigram 1,347 -0.6 New Brighton 2,568 0.8 Burwood 2,898 -0.6 Ferrymead 1,884 0.8 Rapaki Track 1,494 -0.6 Woolston West 3,141 0.7 Wairarapa 1,767 -0.7 Bexley 3,666 0.6 11am 4,116 -0.7 Casebrook 2,463 0.5 Marshland 4,377 -0.7 Rawhiti 4,155 0.5 Rutland 5,019 -0.7 Shirley West 3,678 0.5 Hoon Hay 2,892 -0.7 Broomfield 2,469 0.4 Christchurch 5 (advantaged) Riccarton West 3,888 0.4 Kaimahi 4,593 -0.8 Chisnall 2,796 0.3 Strowan 4,134 -0.8 North Beach 4,431 0.3 Halswell East 939 -0.9 Barrington North 5,040 0.3 Hoon Hay South 1,863 -0.9 Wharenui 2,235 0.3 Burnside 2,292 -1.0 Sr Albans West 2,652 0.2 Sawyers Arms 2,631 -1.0 Hornby North 2,886 0.2 Fendalton 2,703 -1.0 Styx Mill 2,304 0.1 Moncks Bay 3,309 -1.0 Upper Riccarton 2,517 0.1 Oaklands 5,376 Templeton 2,838 0.1 Masham 3,003 Christchurch 3 McLeans Island 246 -1.2 Sockburn 5,211 Halswell South 2,082 -1.2 Shirley East 3,441 Merrin 1,542 -1.2 Somerfield 3,459 Westburn 2,709 -1.2 Northcote 2,322 Russley 2,790 -1.2 Homby South 4,890 Bryndwr 2,793 -1.2 Hilimorton 4,677 Avonhead 3,474 -1.2 North Richmond 2,859 Yaldhurst 660 -1.3 Hawthornden 3,165 -1.4 Halswell West 315 -1.5
72
APPENDIX B
PREGNANCIES, BIRTHS AND TERMINATIONS
This Appendix describes recent patterns of child bearing in the southern region, showing how this varies with the age of the mother, where she lives and her ethnicity. Information is also included on the number and rates of legal terminations of pregnancy. Birth, pregnancy and termination rates among young people are presented in more detail. A note on methodology
The number of live births, the age of mother, her ethnicity, and where she lived have been obtained for 1990 - 1997 from Statistics New Zealand, who obtain them from birth registrations.
This Appendix deals only with live births. It does not include pregnancies which result in miscarriage and still births, which in 1991 made up less than 1% of all known pregnancies.
The number of terminations by mother s age and ethnicity for 1985-1994 have been obtained from the information completed for the Abortion Supervisory Committee on all legal terminations. More recent data were not available. The limitations of these data are described more fully later in the section on terminations.
Rates have been derived using female population estimates for the year of the event, based on the 1996 census. Live births
The simplest measure of birth rate is the "general fertility rate", that is the number of live births (regardless of the age of the mother) divided by the number of women aged 15 to 45 years. The term "fertility rate" in this context is the same as "live birth rate".
Table 1. General fertility rate (number of live births per won-tan aged 15-45 years) by ethnicity, southern region, 1990-1997
1990 1991 1992 1993 1994 1995 1996 1997
Allwomen 1.97 1.93 1.87 1.84 1.77 1.77 1.73 1.70 Non-Maori/non-Pacific Islands women 1.91 1.89 1.83 1.81 1.73 1.73 1.73 1.67 Maori women 2.52 2.28 2.25 2.05 2.08 2.00 2.14 2.12 Pacific Islands women 2.78 2.79 2.40 1 2.07 1 2.40 1 2.39 1 2.73 1 2.67
Table 2. General fertility rate (number of live births per woman aged 15-45 years) by ethnicity and locality, 1990-1997
Non-Maori/non-Pacific Maori women Pacific Islands women Islands women
Number of Ratio of Number of Ratio of Number of Ratio of live births per locality rate live births per locality rate live births per locality rate woman 15-45 to regional woman 15-45 to regional woman 15-45 to regional years rate years rate years rate
West Coast 2.6 1.3 2.6 1.2 North Canterbury 2.8 1.4 2.3 1.1 Canterbury 2.1 .1.0 2.2 1.0 Christchurch 2.6 1.0 0.9 2.1 1.0 2.6 Mid Canterbury 2.5 . 1.2 2.3 1.0 South Canterbury 2.4 1.2 2.4 1.1 Waitaki 2.5 1.2 1.7 0.8 Dunedin 1.8 0.9 1.7 0.8 2.8 1.0 Central Lakes 1.8 0.9 1.9 0.9 Clutha 2.6 1.3 2.4 1.1 Southland 2.6 1.3 2.9 1.4 Invercargill 1 2.3 1.1 2.8 1.3 3.8 1.4 Southern region 1 2.0 1 1.0 2.2 1.0 2.7 1.0
73 The following tables show recent trends in child bearing by age of the mother and her ethnic group. Here a different measure of fertility is used, an age-specific birth rate per 1,000 women, which shows more clearly the differences among the age groups.
Table 3. Numbers of live births per 1,000 women, by age and ethnicity, southern region, 1990-1997
All Ethnic groups 1990 1991 1992 1993 1994 1995 1996 1997 Under 15 years 0.2 0.2 0.1 0.0 0.1 0.2 0.2 0.1 15 to 19 years 31.5 28.3 25.5 23.3 21.4 21.2 22.7 21.2 20 to 24 years 81.6 79.9 73.7 70.4 66.1 64.6 59.8 54.9 25 to 29 years 147.5 137.4 129.8 124.7 119.7 118.6 112.9 111.2 30 to 34 years 99.1 103.9 107.0 108.4 104.7 105.5 104.0 102.4 35 to 39 years 30.5 32.9 34.9 35.6 36.8 38.8 40.0 43.0 40 to 44 years 4.0 4.4 4.1 4.7 4.2 5.6 7.0 7.9 45+ years 0.4 0.1 0.2 0.1 0.4 0.1 0.3 0.4
Non-Maori/non- Pacific Islands Under 15 years 0.2 0.2 0.0 0.0 0.0 0.1 0.1 0.0 15 to 19 years 26.8 25.4 22.3 20.3 18.3 17.5 16.7 16.6 20 to 24 years 75.6 74.5 69.6 66.5 61.7 59.9 55.2 49.3 25 to 29 years 146.0 136.6 129.3 125.3 119.3 118.1 115.2 111.2 30 to 34 years 99.3 1 104.3 106.9 109.5 105.1 107.1 1 108.4 105.2 35 to 39 years 30.3 32.7 34.5 35.6 36.3 38.8 41.1 43.7 40 to 44 years 4.2 4.3 3.9 4.5 5.1 5.3 6.7 7.9 45+ years 0.3 0.1 0.2 0.1 0.4 0.1 0.2 0.4
Maori Under 15 years 0.5 0.4 0.4 0.4 0.7 0.7 0.3 0.6 15 to 19 years 73.6 52.0 53.7 49.6 46.2 50.3 59.0 56.6 20 to 24 years 152.1 137.1 121.0 115.3 109.3 103.9 112.2 109.3 25 to 29 years 164.8 144.1 133.1 116.9 120.3 125.6 127.3 126.6 30 to 34 years 81.3 90.5 96.9 90.0 93.5 78.9 84.5 84.2 35 to 39 years 32.2 32.0 38.3 31.0 41.0 35.8 33.7 39.4 40 to 44 years 0.0 1.2 7.2 6.5 5.1 6.3 11.6 8.7 45+ years 0.0 1.7 10.0 8.7 6.7 8.0 14.5 10.8
Pacific Islands Under 15 years 0 0 0 0 0 0 0 0 15 to 19 years 46.6 43.2 32.0 33.1 36.0 40.7 43.2 58.0 20 to 24 years 135.6 144.1 86.9 77.7 95.4 117.9 133.3 112.7 25 to 29 years 173.5 159.4 145.7 125.1 135.4 110.8 123.3 146.8 30 to 34 years 153.7 128.2 154.0 117.0 133.7 127.1 140.1 138.3 35 to 39 years 42.4 51.6 56.9 52.2 60.4 52.8 84.9 65.1 40 to 44 years 4.8 32.0 4.3 8.2 19.5 29.7 21.3 13.6 45+ years 8.0 49.7 1 6.4 11.6 26.6 39.3 27.4 17.1
Teenage births
The live birth rates for young women aged 15-19 years belonging to the three main ethnic groups are shown for each locality in Table 4. There are few (three in 1994) live births to young women under 15.
Young women of non-Maori/non-Pacific Islands origin living in Invercargill and the West Coast had a higher live birth rate than the regional average during the 1990-1997 period. Young Maori women in Invercargill also had a higher live birth rate than he regional average, while non-Maori/non-Pacific Island women in Dunedin had a lower than average birth rate. These differences were statistically significant.
74 Table 4. The average yearly number of live births, live birth rates, and the ratio of locality birth rates to regional birth rates, for women aged 15-19 years, by ethnicity and locality, 1990-1997
Locality Non-Maori/ Maori Pacific Islands non-Pacific Islands Average Average Ratio of Average Average Ratio of Average Average Ratio of yearly yearly locality yearly yearly locality yearly yearly locality number number rate to number number rate to number number rate to of births of live regional of births of live regional of births of live regional births per rate births per rate births per rate 1,000 1,000 1,000 women women women 115-19 years 15-19 years 15-19 years West Coast 33 33.0 1.6 8 80.6 1.2 North Canterbury 6 18.3 0.9 3 98.2 1.4 Canterbury 32 15.6 0.8 8 56.6 0.7 Christchurch 236 20.6 1.0 67 69.4 1.0 14 51.4 0.9 Mid Canterbury 16 18.6 0.9 4 83.3 1.0 South Canterbury 44 23.2 1.2 10 82.1 1.1 Waitaki 18 23.3 1.0 3 80.1 1.3 Dunedin 88 15.0 0.7 16 46.4 0.7 5 47.6 1.1 Central Lakes 12 14.0 0.7 3 49.3 0.5 Clutha 13 21.2 1.1 4 51.8 0.9 Southland 31 21.0 1.1 12 60.6 1.2 Invercargill 67 33.7 1.7 32 94.3 1.5 4 56.3 1.2 Rest of region 2 54.9
Southern region 597 20.4 1.0 170 69.2 1.0 25 51.5 1.0
It is not known what proportion of live births are unwanted (but these will be less than the number unplanned). Differences in live birth rates do not necessarily mean difference in rates of unwanted pregnancy. They could be related to other factors such as socio-economic differences or enrolment in tertiary education etc.
The live birth rate among teenage women may also be affected by access to termination of pregnancy services. In 1994 terminations for young women were predominantly performed in Christchurch and Dunedin (Table 6). However, the lack of data on place of residence of women having terminations means that we have no way of knowing how many of these women came to the cities from other areas to have a termination.
The live birth rate to non-Maori/non-Pacific Islands young women aged 15-19 years for the southern region as a whole has been dropping over the period 1990 - 1997. The drop was marked in Invercargill, but no such drop is found for the West Coast. These two localities continue to have the highest rates of live births in this age group. For young Maori women no such drop is seen since 1991. For the whole of the region the decrease in live birth rates is linked to an increased rate of terminations of pregnancy for this age group. (See Appendix B, Table 9) However, this cannot be examined by locality, so these trends should be interpreted with caution.
75 Terminations of pregnancy
In 1994, the last year for which termination data were available, there were 2,577 legal terminations of pregnancy. performed in the southern region. Table 5 shows the rate of legal terminations reported to the Abortion Supervisory Committee for 1994 by age and ethnic group.
Table 5. The number of terminations of pregnancy per 1,000 women by age and ethnicity
under 15 15-19 20-24 25-29 30-34 35-39 40-44 45 years years years years years years years years or over All women 0.3 18.7 26.7 18.0 12.4 8.0 2.3 0.1 Maori women 0.4 14.4 27.2 23.7 10.6 3.4 3.2 0.0 Pacific Islands women 0.0 21.6 68.1 35.7 26.3 22.6 4.2 0.0 Non-Maori/non- Pacific Islands women 0.3 19.1 26.0 17.4 12.3 8.0 2.2 0.1
Residence of women having terminations - different numbers of terminations are performed in different localities within the region. (Appendix B, Table 6) However, this does not reflect the termination rate of women within each of these localities, as the place where terminations are performed may not be the same as place of residence of the woman having the termination.
Table 6. Number of terminations of pregnancy by age and place performed, 1994
Place where Under 15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total termination years years years years years years years years was performed
West Coast 0 0 0 0 0 0 0 0 0 Canterbury 8 417 636 400 303 186 51 2 21003 Mid and South Canterbury 0 6 5 0 2 1 0 0 14
Otago 1 0 1 124 196 1 109 1 68 38 1 8 0 543 Southland 0 4 3 2 7 0 1 0 17 Total 8 551 840 511 380 225 60 2 2,577
204) TImaru and Ashburton Hospitals.
76 It is difficult to ascertain accurately the number of women in each locality having terminations, as information on the woman s place of residence is not provided to the Abortion Supervisory Committee. Where terminations are performed at public hospitals, information on the residence, age and ethnicity of the woman is routinely sent to the New Zealand Health Information Service (NZHIS) as part of hospital discharge data.205 However, one major free-standing clinic in the southern region does not send data to NZHIS, so that information on residence, age and ethnicity are incomplete for the southern region. For the purposes of this report, this clinic provided us with information on the place of residence of women receiving terminations of pregnancy, but not on their age or ethnicity.
Table 7 uses this data to estimate the number of women in each locality having terminations, and the number of pregnancies that result in terminations or live births. (The proportion of terminations to pregnancies that result in either a live birth or a termination is referred to here as the termination of pregnancy ratio.)
Table 7. The number of terminations and the ratio of terminations to live births by residence of woman, 1993 -1996
Residence of woman Number of Number of pregnancies Terminations as a % (by regional council terminations resulting in either of all pregnancies area) terminations or (termination of live births pregnancy ratio)
West Coast 335 2,305 15% Canterbury 6,736 28,841 23% South Canterbury 368 3,177 12% Otago 2,098 11,762 18% Southland 804 6,618 12% Total 10,341 52,715 20%
A comparison of Tables 6 and 7 suggests overall that, if terminations are available locally, they are more likely to be obtained. However, care needs to be taken in interpreting these figures, as they will be affected by the age and ethnicity characteristics of the regional council areas, factors that are known to affect the uptake of terminations.
205) National Minimum Data Set (NMDS).
77 Age and ethnicity of women having terminations - Table 8 shows how the proportion of pregnancies that resulted in either a live birth or a termination varied by the age and ethnicity of women.
Table 8. The number of terminations of pregnancy (TOPs) and live births, and the termination of pregnancy ratio, by age and ethnicity, southern region, 1994
Ethnicity of Under 15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total women years years years years years years years years Non-Maori /non-Pacific Islands TOPs 7 506 747 1 454 353 1 214 56 2 1 2,339 Live births 1 451 1,700 3,148 2,966 1,002 131 8 9,407 TOP ratio 88% 53% 31% 13% 11% 18% 30% 20% 20%
Maori TOPs 1 34 61 42 17 4 3 0 162 Live births 2 127 271 259 179 1 61 6 2 907 TOP ratio 33% 21% 18% 14% 9% 6% 33% 0% 15%
Pacific Islands TOPs 0 11 32 1 15 10 7 1 0 1 76 Live births 0 19 47 58 52 19 5. 0 200 TOP ratio 37% 41% 21% 16% 27% 17% 28%
All women TOPs 8 551 840 511 380 225 60 2 2,577 Live births 3 597 2,018 3,465 3,197 1,082 142 10 10,514
TOP ratio 73% 48% 29% 1 13% 11% 17% 30% 17% 1 20%
The recent trends in the termination of pregnancy ratio for age groups 15-19 years and 20 - 24 years are shown in Appendix B, Table 9.
The rate of live births to the whole population of young women aged 15-19 years significantly decreased between 1990 and 1994. This was due to a increase in the number of terminations, since there has been no significant change in the overall combined live birth and termination of pregnancy rate. Terminations as a proportion of all pregnancies resulting in live births or terminations increased from 37% in 1990 to 48% in 1994. However, this drop in the live birth rate was only statistically significant for non- Maori/non-Pacific Islands young women.
For the whole population of women aged 20-24 years, again the rate of live births dropped and the rate of termination of pregnancy increased. However in this age group the combined live birth and termination of pregnancy rate also decreased. This pattern was seen for each ethnic group, but the trend did not reach statistical significance for the Pacific Island women (this may be due to the smaller number resulting in less ability to detect differences within this ethnic group).
78 Table 9. Rates of terminations, live births, combined terminations + live births, and termination of pregnancy ratios for teenage women by ethnicity, southern region, 1990 - 1994 (Number per 1,000 women in each age group)
1990 1991 1992 1993 1994
All ethnic groups .A Terminations 15 16 17 15 19 B Live birth 25 24 22 22 21 C Live birth + Terminations 40 40 40 37 40 Ratio (A^C) 37% 41% 44% 41% 48%
Non-Maori/ non-Pacific A Terminations 15 16 17 15 20 Islands women B Live birth 21 21 19 19 18 C Live birth + Terminations (A+B) 36 37 37 34 38 Ratio (A^B) 43% 44% 48% 45% 53%
Maori women A Terminations 10 16 12 13 15 B Live birth 70 52 57 56 55 C Live birth + Terminations (A+B) 80 68 69 68 69 Ratio (A-- C) 12% 24% 18% 19% 21%
Pacific Islands A Terminations 9 17 35 20 21 women B Live birth 47 43 33 33 36 C Live birth + Terminations (A+B) 56 60 67 53 57 37% 37% Ratio (A^C) 15% 28% 1 52% 1
79 APPENDIX C
Get.-W1110AM LIST OF TABLES
Table 1 Locality populations and population density, 1996 Table 2 Actual and projected change in population, southern region and New Zealand, 1986-2011 Table 3 Actual and projected change in usually resident population by locality, 1986-2006 Table 4 Age structure by locality, 1996 Table 5 Actual and projected population change over time by age group, southern region, 1986-2006 Table 6 Ethnicity of the usually resident population, by locality, 1991 and 1996 Table 7 Iwi affiliation of Maori in the southern region, 1996 Table 8 Age structure of the Maori, Pacific people and total resident population, southern region, 1996 Table 9 Characteristics of households in the southern region by locality, 1996 - income, home ownership, car ownership, single person households. Table 10 Socio-economic characteristics of individuals aged 15 years and over, by locality, 1991 & 1996 - income, the proportion of people on a benefit, and the unemployed as a proportion of the labour force Table 11 Unemployment by age group, people 15 years and over, southern region and New Zealand, 1996 Table 12 Proportion of families with children - that have only one parent, by locality, 1991 and 1996 Table 13a Proportion of people living within 30 and 60 minutes travel by car to selected services, by locality, and 13b 1996. Table 14 Percentage of people smoking in each locality by sex and ethnicity, 1996 Table 15 Percentage of people smoking by age, by sex and ethnicity, southern region, 1996 Table 16 Occupational disease notifications, 1992-93 to 1995-96 Table 17 Deaths from motor vehicle crashes, all ages, by locality, 1990-1994 Table 18 Life expectancy for males and females, southern region and New Zealand, 1984-1988 compared to 1989-1993 Table 19 Life expectancy for males and females by locality, 1990-1994 Table 20 Deaths by locality, 1984-1988, 1989-1993, and 1990-1994 Table 21 Major causes of death, southern region and New Zealand, 1984-1994 Table 22 Total admissions to general public hospitals, males and females, southern region, 1992-1996 Table 23 Causes of general public hospital admissions in the southern region, 1992-1996 - first, total and acute admissions Table 24 Admissions to general public hospitals by locality - first admissions, total admissions and acute admissions, and average length of stay, 1996 Table 25 Average length of stay in days, males and females, southern region, 1992-1996 Table 26 Number and percentage of patients admitted to hospitals in the southern region by domicile of the patient, 1996 Table 27 Subsidised OP consultations 1996-97 by locality Table 28 Expenditure on pharmaceuticals per head by locality, 1996-97 Table 29 Numbers and characteristics of people with physical and sensory disability, by locality, 1997 Table 30 Estimated number and rate of people with an intellectual disability, southern region and New Zealand, 1996 Table 31 Number and characteristics of people assessed as needing services for intellectual disability, by locality, 1997 Table 32 Estimated number and rate of people with a mental disability, southern region and New Zealand, 1996 Table 33 Number and rate of first admissions and total admissions to public psychiatric hospitals by cause, southern region and New Zealand, 1993 Table 34 Number and rate of admissions and visits to public psychiatric hospitals by age and by locality, 1993 Table 35 Number and characteristics of people assessed as needing services for mental disability, by locality, 1997 Table 36 Number and characteristics of clients of alcohol and drug treatment programmes, by locality, 1997 Table 37 NZDEP91 by locality Table 38 The 20 most advantaged and most disadvantaged census area units within the southern region, using the adjusted NZDEP91 Table 39 First admissions for some selected diagnoses and age groups, Maori and all first admissions compared, 1996 Table 40 Some health differences among southern region residents by urban and rural residence and by ethnicity, southern region, 1996 Table 41 Five major causes of death for babies under one, southern region and New Zealand, 1984-1994 Table 42 Five major causes of death for children 1-14 years, southern region and New Zealand, 1984-1994 Table 43 Hospital admission for under one year olds by major causes, southern region, 1996 Table 44 Hospital admission for 1-14 year olds by major causes, southern region, 1996 Table 45 First and total admissions and average length of stay for children under 1 year, by locality, 1996 Table 46 First and total admissions and average length of stay for 1-14 year olds, by locality, 1996 Table 47 Low birthweight babies (under 2,500 grams), numbers and rates by locality, 1990-1992 Table 48 Sudden Infant Death Syndrome - number and rate of deaths by locality, 1984-1994 Table 49 Immunisation coverage by regional health authority area, 1992 and 1995 Table 50 First admissions to hospital for respiratory illnesses, 1-14 year olds, by locality, 1996 Table 51 Dental health of form 2 children by CHE area, 1993 Table 52 Five major causes of death for 15-24 year olds, southern region and New Zealand, 1984-1994 Table 53 Hospital admissions for 15-24 year olds by major causes, southern region, 1996 - numbers and rate per 100,000 Table 54 First and total admissions to general hospitals and average length of stay for 15-24 year olds, by locality, 1996 Table 55 Death and hospital admission from motor vehicle crashes, 15 to 24 years, by locality, 1990-1994 Table 56 Deaths from suicide and hospital admission from suicide attempts by locality, 15-24 year olds, 1990-1994 Table 57 Male and female aged 15-24 years, suicide, Christchurch, southern region and New Zealand, 1984-1995 Table 58 Five major causes of death for 25-44 year olds, southern region and New Zealand, 1984-1994 Table 59 Hospital admissions for 25-44 year olds by major causes, southern region, 1996 Table 60 First and total admissions and average length of stay for 25-44 year olds, by locality, 1996 Table 61 Five major causes of death for 45-64 year olds, southern region and New Zealand, 1984-1994 Table 62 Hospital admissions for 45-64 year olds by major causes, southern region, 1996 Table 63 First and total admissions and average length of stay for 45-64 year olds, by locality, 1996 Table 64 Deaths and hospital admissions from coronary heart disease by locality, 45-64 year olds, 1990-1994 Table 65 Deaths and hospital admissions from all cancers by locality, 45-64 year olds, 1990-1994 Table 66 Five major causes of death for 65 years and older, southern region and-New Zealand, 1984-1994 Table 67 Hospital admissions for people aged 65 years and older by major causes, southern region, 1996 Table 68 First and total admissions and average length of stay for people 65 years and older, by locality, 1996 Table 69 Numbers and characteristics of people aged 45 years and older with an age-related disability, by locality, 1997
81
A TABLES The source for tables 1-12 in Statistics NZ - 1986, 1991 and 1996 Census of population and dwellings. If0 Southern Region \/ New Zealand - % Change from 1996 . ..Change from I996 1986 95.3 I .9 a 1991 I I 1996 100.0 CU U 0 2001 2006 .J__ 105.7 JL 109...... (West Coast 32,484 35,631 : 1.39 North Canterbury 12,921J 14,148 1 1.21 Canterbury L41L6,12316.52 Table 2 Actual and projected change in population, Christchurch 1 disadvantaged L 59,2291 63,J n southern region and New Zealand, 1986-2011 Christchurch 2 Christchurch 3 na.J j: Christchurch 4 nal N-Jr Christchurch 5 advantaged - _na1 Mid Canterbury - 4.061 U1) South Canterbury T3.951 - -- Waitaki Cr . Dunedin 5.37] Central Lakes L.JLjicil Clutha 2.811 Southland 1.3QJ Invercargill 108.37
Christchurch 41— — --:—I (..)I 0I_It S 4 C Southern region J —r —ii i- - 00J- I5) t-n New Zc1d______3,61 41
Table 1 Locality populations and population density, 1996 ]_ : O_M]D J-401 ]GO 5.) 0-A0 - 0 1J1..T:1iIIiY2006 (Under l5years N..) 166384j_159 1771 162528 L 159569j 156610: -4 Ez. 15 to 24 years - — —I 0 J \ 0 t.) 0 133,4221L,47fli21,447113,31][iO.,i8Oj 0 0000 0000 25 to 44 years [1i[_223 806J[ 234 837 ___7754 220,670 o 0 0 0 00 0 0 . 0 00 45 to 64 yearsEf4,O5ILI,277j4Lj79,237JLi97,8o0J fl\r - years .L,937jL94,749j - iO3,i37jL,334JLii, N.) All ages 45 624R74 - . f-4 ) N. — N-) 0\ — ip o Pko 0 (0 LJLIi - GO — .1 Table 5 Actual and projected population change over time by age --4_ Jt21 l J
group, southern region, 1986-2006 Ii so (Note: because these are taken from different sets of projections the
columns may not add to the totals). 4- GO —.1 -41 0 N..) 0 CD I —4 GO
______Under (Wt Coast -- 489 2,115 5,169 3,948 9,870 5,592 1,311 2,295 1,653 North Canterbury 189 804 2,070 1,299 3,828 2,484 600 1,083 570 Canterbury 918 3,867 9,717 8,300 20,343 11,904 2,526 4,368 2448 Christchurch 1 disadvantaged 834 3024 6,402 12 5l3j 19,932 7587 1653 -3-1666"- - 3,567 I Christchurch2 rfl3513j 7968101371 19002 8760] 22T7f636j Christchurch 3 897 6931 8 838110 47j - 20880 10 3831 2 4811 5388[fT371] Christchurch iL±?7J_IIL 19197 fTöiThL2 601i 5274J133j Christchurch 5 advantaged f78r 2 ] 9 126 i71rrr7jir 13 392 3ir631rT461rTm181 Mid Canterbury ______7,i61jL4,491 ib..1,197JL....;28Q1L1, South Canterbury 8052[ _573]r 15 186rf 627]L___2625] 5 O2 2 Waitaki 3,168 l[08 —_i,iI3jTO7Jf T, Dunedin - - 15_0571_____24 _98]3372917_925427585]6 Central Lakes - 3,834______ILJ,915J ,531 T3T41E1316 Clutha 802j2 355 4061__135 r5T38jE Southland 7731.. 5 T311 7548fi 827 flT67J[F Invercargill —2 O461]_86j2 rM&i, southern region 12,963jiii,54ijL15,762jL5,552J936jLi______3O83J - Christchurch 4,C 39 71Lii 552L944EC ___11_649J _23 7931[J Southern region [10,3 109,293 iE12T4______48371__44flll_ 233] jr-4 New Zealand
Table 4 Age structure by locality, 1996 82
European - , Maori Pacific Island Other —.1 Total Th Li Li 1991 j 1996 j J. 1991 1996 West Coast 28,917 28,149 2,013 2,832 120 165 na 194 171 45 . 31,221 32,484 North Canterbury 11,298 11,376 738; 1,104 27 57 na 18 12,099 12,921 Canterbury 52,188 , 57,867; 2,997 4,194 29 345 na - - 7_71 09!_55,749; - 64,70l Christchurch 1 disadvantaged 1,752 Chrisrchurch 2 ,59°IE Christchurch 3 Christchurch 4 - Christchurch 5 advantaged Mid Canterbury South Canterbury Waitaki Dunedin Central Lakes Clutha Southland [ Invercargill
ristchurch 1 . Sotirlern region
Table 6 Ethnicity of the usually resident population, by locality 1991 and 1996
ZZXZHHlZZZZ as asas sq
Er > CD .._ a -t.-- as as ,c -4 S.) -0 asasco., . asc p > Sq as (a 0 c c 0 as p ,J1 0.055 p aso < or-, 0 -. (DC 0 p0) 0 L S 0 ,0. p — Os 0 p_ 8 . ? 550
as 0-t j°L p Oas 0 I CD CD C L a) 0 CD C. 00 (a0 0( CD — 0 CD -. sq 0\ 0 -.5 P Os 0 0 0 D)
CD La 0 C 0 CD p
H05sehols in Rented Households with (Single PenoTotal r 1or Leased Accomodstiors no Cars Households 1i,fHotasehslds 1Median umber % )umber % "1Number ° L IncomeJLJJL $27,782 5,025 20.5 3063 12.5 5,940 24.3 24,495 North Canterbury $27,796 2,085 21.1 - - 561 5.7 2,139 21.7 - 9873. Canterbury $35,895 70711 15.6 ... 2421 5.3 7,635; 16.8; 45,399; Christchurch 1 disadvantaged $,51L22531 45.9Th1i055i 2.51J607132.8149062i Christhsrch 2 $281L128I -28.3 -C6421 _14.6]F_ fl69]24T51P456091 Christchurch 3 $32 rIC1L 22 1 1L 53 11 3lflTO 7 3TTrT4i1 7 I3J Christchurch 4 Christchurch 5 advantaged Mid Canterbury South Canterbury Waitaki
Central Lakes Clutha Southland lnvercargill
rMri, southern region Christchurch - Southern region 24.)2026il 15.
Table 9 Characteristics of households in the southern region by locality, 1996 - income, home ownership, car ownership, single person households
83
Income Unemployed Table 10 Socio-economic characteristics of individuals aged 15 years and over, by locality, $ % % %I 1991 & 1996 - income, the proportion of people on a benefit, and the unemployed as a 1996 L1996 1996 199±_i !L proportion of the labour force. (West Coast $15,484 35.2 7.3 10.9 North Canterbury $15,346 34.6 6.5 7.7 Canterbury $18,357 30.4 4.5 7.4 Christchurch 1 disadvantaged $15,423 33.4 13.3 11.O Christchurch 2 r$161524[ -33.9 9.8 7.8 Christchurch 3 30.2 6:61r6.i Christchurch 4 [$18 9741J - 296 5. I Christchurch 5 advantaged [$21208[28:f 5:1jr5.P1 Mid Canterbury r$1776IiT2211 4T[6.71 South Canterbury [$15,987 26 - 6.4fl1a5l [::$16 307 Waitaki - •7 I Dunedin [$1 7,104 1[34:9 Central Lakes [$17,531 fl23 3:36.7] Clutha [$17104[31 0 4.48.2] Southland r$11;0r29:5. Invercargill rs18:322Tr29.7 7:1r1o.41
Maori, southern region $13,475 L.43J 17.7 iL 82 Christchurch $18,314-, 39] :8h1[iTjQI41 Southern region $L7,58oi[II73 1.81 69 IT9.8] (New Zealand $187 23) 30 .2)
(Thouthern Region )(- :Nw. Zld Nurnb( ber (15-19 years 6,477. 18.5 14,124 18.4 20-24 years L586 121 123OO_ll8 25-34 years [Th 504L6 8 17 190E7 6] 35-44 years L4,5ii4.6j[i,465.77775 .5] 45-59 years ELIU[T 43118< 60-64 years cj 65+ years [ 11 7.IL 1 .2 468.L__J .5] All ages _____ 69,198 7.) Table 11 Unemployment by age group, people 15 years and over, southern region and New Zealand, 1996
r- - 1996 - 1991
Number % Number %
(West Coast - -, 975 25.4 897 21.1 North Canterbury 273 18.5 372 19.9 Canterbury 1203 16.2 1014 13.6 Christchurch 1 disadvantaged ft 2751 47.3 2564 Christchurch 2 2301 350T 1992 331 Christchurch 3 [1878 142 r 244 Christchurch 4 [i362206 9831[i7.2] Christchurch 5 advantaged r996[15.7 :LiIQrTTh[41 Mid Canterbury 1[459-[ 167r443[142J South Canterbury 1305[ 212 E13621r9J Waitaki [432[ 18.3nr 465 r 167 Dunedin i0226.0:: 3054[22.5j Central Lakes [546 [ 3489[15 91 I Clutha Southland [807f15 6 -851 [-----13.8 Invercargill r1986r3o:9Tr2o46.rz6.2
[Maori, southern region L2802[ 29.9L 2103 L3 .3 Christchurch [Ii9288[29.0 8886[25.5] Southern region !F 20715 ]24520125r2L4] New Zealand - -- 11347)4/L95860)25J, Table 12 Proportion of families with children - that have only one parent, by locality, in 1991 and 1996
84
Specialised Sexual 2 I o1 Health Services :O
" Diagnostic Imaging 1 C70 c:1
I neral Practice ELtCUI IBirthing Facilities ICaesarean - rir LJ JLHLUU°HF ° f -T 1flQ11 Birthing Facilities
1 riBas ic TraumaI s,Id Ic Ic Os r— m 00 r— i1_ nnnrnnnLLThL JDistrict Trauma S Sf i Service Lr 00
ni p n 0 0 Advanced Trauma 4i O Services tHL±i. 11HUTULL • Christchurch 5 r j Dunedin,Southland, 0 1— N-—S S -s 0 .- 0 u-SOs ) 0 X Timaru or Grey — Hospitals J JL Li L, I :boL JIL1fl or rchristchurch 1 Dunedin Hospital 1 I - HF ;F^^ r F^^ F F
I - V
E E 1 E E B BE BE:B BIB B B EE BE E E E B 000000000 0 0 00000000 00 551 0 r51 0 r51 0 r510 S51 O 51 -0 51 0 5515055150 55150551
S - - m —4 V
-
ft J
C - C a C - - -C a0 C 8 a 0 u . I o . U ccc Cz zz0, <
West Coast - 18.0 27,9 16.1 17.8 18.1 25.0 7.0 18.3 North Canterbury - 15.2 25.7 6.0 _13.6 17.0 i 27.5 , 27.0 16.2 Canterbury - 123 25.311 20.5 11:9: 141 r 20.7 16.2 .r Christchurch I disadvantaged 1 19.6 1921 208 [284r202T.2TT Christchurch 2 [ 16.6 16.0 1 l7.3L 47iI 22.8 Christchurch 3 LI14.5. Christchurch ... 11.3 Christchurch 5 advantaged [ 9.0 23.2 9.7 22.7 Mid Canterbury [ 15.0 12.5 17.0 .L.,26.7 J. 11.5 South Canterbury 16.2 21.1 14.[ 25.3 JL 19.7 Waitaki J[ 16.0 18.3 r 21.1 r 7.0 Dunedin . ___ Central Lakes LI7.LJ Clutha Southland . 1. Invercargill 13.3
r Christchurch L__14 TTi 14.9 14.9 -1- 23.7 AL 21. Southern region _jIIjAII::J 15.1 15. 7._1L.,236JL 20.
Table 14 Percentage of people smoking in each locality, by sex and ethnicity, 1996 Source: Statistics New Zealand 1996 Census
(15 to 2425,tq3435 to .44 45to 5.,4i55 to 64 i65,to.74( 75+ - filaori men 34.2 41.1 40.2 , 35 27.2 20 16.3 Pacific Island men . - 23.7k.,.. 33.6 35.9 36.2 26.7 L . I Non-Maori/Pacific Island men J[ 23_.0 .L__28. 24.224.2J .L 22.7.,.. 19.1 1 13.7.,.. 7.9 I All men - 23 4j28 27F 247 22 P 19 1 [ 13 5 78 Maori women 42.2JL47.44 4 29.6j 16.7 Pacific Island women -[ 25.6J[ - 28.526.5 .[TiTTi1L 14 :1TTT Non-Maori/Pacific Island women - 23.2 L3LII 21.6..,E20.21 153 All women-, - _____ J[ 27.6k 22.3,[ 20.6jrL 10.5
Table 15 Percentage of people smoking by age, by sex and ethnicity, southern region, 1996 Source: Statistics NZ 1996 Census (Small numbers mean some rates have been omitted).
Number of Notifications -
0
C 0 Southern region total Asbestos . 91 19 L Solvent induced neurotoxicity or other chemical disease16 Noise induced hearing loss , 4 r 40] Asthma or other respiratory disease 7 241. 4177_7_2_11211 PccupationalOveruse Syndrome 12 JOccupational infectious disease L 12
Southern region - - - percentages Aslstos 63.6!j -- 13.0. Solvent induced neurotoxicity or other chemical disease 11.2.L 20.3]. 1 Noise induced hearing loss _.,7.81. 6.8 Asthma or other respiratory disease ...42J Occupational Overuse Syndrome [ 70.3 Occupational infectious disease 8.4-L _4.2j 4.2 Other tr. _.L l 100.0...._,100.O 100.0 Table 16 Occupational disease notifications, 1992-93 to 1995-96
86
7 7- -.-- I eli Southern Region New Zealand Ca (Female " Male ( maIe " Male 0 (184-1988 i 80 0.L 75.2 79.3 74.1 ,,1989-1993 81.8[, 77. 81.4 7 uu)_Cli COOJ O0 j Table 18 Life expectancy for males and females, southern • WtOmst 7 20.9 region and New Zealand, 1984-1988 compared to North Canterbury 2 15.7 1989-1993 C-terbuly 9 15.1 Qhtnth 1 disadvantaged 7 - 9.9 Christchurch 2 8 13.6 1Female Christchurch 6TL &j ( West Coast Christchurch 4 8 79.9 74.4 P North Canterbury Gstchech 5 advantaged 81.0 75.7 Canterbury 82.9 77.6 Mid Canterbury 4LII4 ISouth Canterbury Christchurch 1 disadvantaged 79.3. 73.8 Christchurch 2 80.1 Waitaki 4 1[ 15.4 74.5 Christchurch 3 Dunedin 12 [9.7 81.5 77.6 Christchurch 4 76.9 Central Lakes 81-4!
Clutha Christchurch 5 advantaged 81.9t-. 77.7. Southland Mid Canterbury 82.51- [Invercasgill South Canterbury 80.5[ 76.3 Waitaki 81.11- [ 75.8. Dunedin . 81.0[ [Giristchurth 37 L Central Lakes 82.6[8.6] Southern region 100 [ 12.6 vZealand 529 14 Clutha 80.5 F 763 Southland I 81.7 P 76.9 Table 17 Deaths from motor vehicle crashes, all ages, Invercargill 78.8 73.7 by locality, 1990-1994 Source: Land Transport Safety Authority, District reports Christchurch 80.976.2, Southern region . - 80.8[ ms. .,New Zealand . 80.5 76.0 Table 19 Life expectancy for males and females by ETable 20- See next page locality, 1990-1994 V Southern region New Zealand Number of deaths I Rates 100.000 people Number of deaths Rates 100,000 people ITI 1984-1986 1989-1993, 1990-1994j984-1986,,1989-1993, 1990-1994 1984-1986, 1989-1993 1990-1994b984-1986L1989-1993L1990-1994 "Cancer 7,639 8,380 8,218 142 144 139 31,125 34,146 33,748 144 144 140 Coronary Heart Disease 9,526 8,792 8,378 158 129 , 120 36,779 . 34,587 33,147 ,, 154 128 119 Strokes 3,485 3280 2676 L11153 44 T-"35 13,940 13453 10,835 L _54 45 -- 35 I Chronic Respiratory disease 1,8851,715 1,432t - 31 25 rzi 7,367 [ 7,176 5932 [31 26 r 21 OtherformsoIheartdisease , 1,400 [L355 1,366 L 23 19 18 5,185 T486 5,570 E 21 19 - iT Pneumonia and influenza 1,605 L.j,395 1,369 .L_26_ 18 [ - 16 6,594 [ 5,509 5,290 ,r26 17 16" Motor vehicle accidents . . 670 .L 650 501 [ 17 16 [ 13 3,718 [ "i ,412 2,649 , 21 19 L 15 Suicide - 540L 525 432 ["T3 13 [i - 2088 [2331 1866 [ IT - 13 [iiY Other injury 700 ET313 575 E1 10 1LiT 3129 [ 2,867 22967[-7-1T---296 [ iT 10 [11 All other causes 6-089 t.,, 6 032 j., 5792 "iñ. 105 t,,, 94, 24221 [25288,, MAO/ ffl,1 111 C, IOQ.j
Table 21 Major causes of death, southern region and New Zealand, 1984-1994 Rates are calculated as the yearly average number of deaths per 100,000 people in each 5-year period (age standardised). Source: New Zealand Health Information Service, mortality data
------\ . _____ 1984-1986 1 1989-1993 1990-199411984-1986 1989-1993 (Number Females 67,229 71,139 71,691 74,155 73,261 Males "478f0J - 52334r52698r53c17852,845 . Total . 115,039 rT23 73 12089 127333 126106 Rate per 100,000 population Females 15,604 165 95 16,333 r -f6,79T 16,401 Males 12,475 13 6791[ 13,157 [ f3 788 13,171H Total - 14,040 p15i 37iF .....14745 p15291 14,786 \Yearly % change in total rate [78,, -2.6p 37 -33-
Table 22 Total admissions to general public hospitals, males and females, southern region, 1992-1996 Source: New Zealand Health Information Service, NMDS
87
Number of Deaths in each 5-Year Pe Rates-Yearly Average Number Of Deaths Per 100,000 People In Each 5-Year Period __ L 1t198488 - 1989-93 i J( 90-94 T 9- 194 LiJLMale1Lital iL Male LToc - Qale 1JL1pmL _ L_MaicJL_Total... Female JLMale j Total J West Coast 703 933 1,636 661 874 1,535 630 765 1395 519 901 697 463 819 631 433 698 562 North Canterbury 158 274 432 181 276 457 165 247 412 427 734 582 406 670 541 358 573 470 Canterbury 635 887 1,522 619 979 1,598 625 941 1566 369 587 478 - 297 565 424 282 523 397 ------Christchurch 1 disadvantaged 1,478 1,578, 3,056 1,410 1,397 - 2,807 1334 1284 2618 487 929 664 456 813 L 607 434 742 564 Christchurch 2i,54LT,646 3,188 L636J1 1,641 :i 14861 l49O 2976 534 L - 914 1 697 469j 790 613 417 711 r 548 Christchurch 3 i,J{ 1,177 fl539 fl68 1126f 2494 37 L rir 566[ 447 3411 530r424 Christchurch 4 i42]6 1077J[ 2 1O 4J_718 _i 552 381 632j86 440j Christchurch 5 advantagedLj:,249 —250 ET49 —91 , 154J 1 ,92 IL 2,4461 TI[IITiQ[ 2235 T 341[ 69_ A9 475 ._336iL QL.42i Mid Canterbury 511fJiJ9 76[I F 1,057 44I[ 5671{ 1013 430 H 771 579 337 17-60577463 305 1 576 1 431 1 South Canterbury PT3371[14541[ 2,791 1,6] 1378 j2 744 130-1][IL B2 F 2624 Waitaki 5oiL6Q1ll - 532 602L 1134 Dunedin ,( 2,784 2,914Jfl6982,670j[2,583[3253 411 L 682 526 375 1 608 jL 474. 00 I3fE7i1i[ - -E -I I---- 1 Central Lakes j T7 Lj42 356 __4 759 Clutha 323 EiJiILJl 395 712 Southland 5jfE1,4i 803 fl36 .jnvercargill [T385.jT1f938 1,322
iis&Jrch L 6,491-16,737Jt 13,22&6,656SL6,6T113 30,5.. __6304 526 371JL. 608
Southern region L5,8k7,:7i733,L1. 323 . 387L _572 71,513) 532g7. 386 609
Table 20 Deaths by locality, 1984-1988, 1989-1993, and 1990-1994 Source: New Zealand Health Information Service, mortality data
Cz o
-V <0., V O- Ec .9
"Rate per 100,000 population" cz EE Number of First Admissions Per Year (Aged Standardised) Male Reproductive ______0 L 1j [ 1514L 352 IL 176 1686 -9.o%]Lt:o - 11L17 Liver and Pancreas IL 9 [ _ 699 163[JL--141 [ _4 2206 IL - .:jJL -• °t Endocrine [557j[_493 ri0r_117][_i25[121 1262 52 850 00%I 75%[ 19% Blood I 464L445][iII99I[83jL9jL9Q 1303 Myeloproltfevative 362[37L 732, [i[75j[ 1445 -5.1%IL - Substance Abuse j Tö[T64i[ 267F[387IIF 307 76k92,1 iT 2 192 Table 23 Causes of general public hospital admissions in the southern region, 1992-1996 - first, total and acute admissions Source: New Zealand Health Information Service, NMDS First Admissions U Total Admissions Acute Admissions Total Days Stay, All Admissions 0 0 0 01 0 a) CCo C - C I- C I I- 0 C Cz E Cz 0 Cq C >0 z "West Coast 4,509 13,032 6,943 19,355 3,270 9,119 47.1 2.9 North Canterbury 1,181 9,153 1,860 14,058 990 7,463 53.1 3.6 Canterbury 5,309 8,321 8,162 12,612 4,132 6,480 51.4 3.8 Christchurch 1 disadvantaged 61861 11,455. 10,298 17,060 5,906: 10,275 60.2 3.7, Christchurch 2 6,481 . , 10,078, 9,879 :15,093, 5,492 = 8,659 57.4 3.5: Christchurch 3 i,otJoo,HJJ 8 , 749 [-f78o 4 ,813 288 57.o[ 3.5 Christchurch 4 I 5445 E8418 siio ]Li2 i 4447 j976 Christchurch 5 advantaged L 5,082E817 F 7587iffl-01L 4 , 291-1 58.9.L Mid Canterbury 3 092 LT1Tö1LE42,3sEJ7s South Canterbury rll,341ET,95. 5,879L,840 251,[ 10618 Waitaki 4028 34 Dunedin 3,535 ; 10,5421 [19-1820 E14 766 9 , 93 il L:17473 H 50.6[ Central Lakes 3,07 11-9, 801 P 4 848 ET4 668 ã7Ej b Clutha i;E] 2931 L151151577975 52.8 Southland 4,446:EfoJ2] [6,783ET5,169, - 3,625 L473 [Invercargill Lr: 1I7481 [-Maori. southern region -3,527A- 16,754 5,218 . L25,466 . 3,135115,576 61.2. Christchurch 29,737 [19,321 jH 44,623 EJ,1Ik 24,949 [18,OQ6j 58.2 Southern region 83,450 lO.bJ... 126.106iCi.786 " 67,952IiIiD ... 55.4 Table 24 Admissions to general public hospitals by locality - first admissions, total admissions and acute admissions, and average length of stay, 1996 Source: New Zealand Health Information Service, NMDS ( 1992 "- i993 1994 995: ( 1996 rFemales 4.9 L 4.5A 4.2 3 9j 3.5 Males 4.2J 4.0J3.73.5) Table 25 Average length of stay in days, males and females, southern region, 1992-1996 Source: New Zealand Health Information Service, NMDS Table 26- See next page (Expenditur de ( Head Of 1996. 1997 Per Head ] Number LPppulationJ /West Coast $7,037,000 $217 West Coast 67,399 2.0 North Canterbury $2,157,000 - $167 North Canterbury 16,316 Canterbury $9,045,000$1401 Canterbury 76,818 L 1.2] Christchurch $80 130 0001 $2J (Christchurch 883, 1 60 j[..,2.9J Mid Canterbury I$5623,000$2J Mid Canterbury 47,8. 75 1.9 South Canterbury $13,267,0oqTi$4] ISouth Canterbury 131,179 iE,J Waitaki r$6,692,000E13 101 Waitaki L48,314 11 . 2. fl Dudin Dunedin J 318,7571..2.7,j Central Lakes $4,634,000771T59 Central Lakes _60,494iI._ 2.1J Clutha Clutha 39,000[12.2j Southland r$6477 ,000[$fl] Southland 65,317 1 1.5] Invercargill $1 2,568,O0O$261 Invercargill 115,846 iT 2.21 Southern region $179,485,000 Southern region - - ;1,870,475 .Jt 2.4J ^New 7e ajand - $,0O0,000 Table 27 Subsidised OP consultations 1996/97 by locality Table 28 Expenditure on pharmaceuticals per head by Source: Health Benefits Limited locality, 1996-97 Source: Health Benefits Limited a- - U , - a x x as Cd -5 C14 i -o. a• -s--o c - . . -E • a JE o •-OCZ o o aO - 0 x ox Q:x 0-E ox 0 0 • West Coast L_ 1-11, 5,146.. P 1,200 7,026 North Canterbury Canterbury 2 _J1 571E 7 .1 . ][i1i,3T1 8,660 Christchurch 1 Mid Canterbury South Canterbury .., L I Waitaki - ______Dunedin . Central Lakes Clutha Southland E,42 inverrgillca Southern region residents ______Non Southern Region ResidentsL68 Table 26 Number and percentage of patients admitted to hospitals in the southern region by domicile of the patient, 1996 Source: New Zealand Health Information Service, NMDS 0 Cs V 0 CS CS I CS i .. > Ca I a Cz I — ,. u . V - B 2 + E ZrL F2 _____ West Coast 125 8 133 409 2.3 33.8 1.5 32.3 6.8 17.3 42.1 99.2 1North Canterbury 29 30 232 0.0 0.0 . 30.0 0.0 .. 33.3 . 36.7 .100.0 Canterbury 24 211 L326 3.8 L...... 43.0 4.7 7.1 ...L._137t . 3.8.5L 100.Q Christchurch iO 1,478 IIII 477 29 4281 - 33.9[97. Mid Canterbury 4.5 E404i 3.4.1 41[ 2.2 [ 11.2]f39.4:c 98.91 South Canterbury 206 20]1 226 JE4 4.9ro1r 32.7. Waitaki 356 Dunedin Central Lakes i12JL..384L._ 5.4 - .1.8. [----41.0- Clutha .0.0 [ 25.0 Southland 2.1 42.0: Invercargill 62 LL 33.4ft 42.3. Other 18 Southern region - all people with physical/sensory disability L 2.7JL_.42.011 . -1-941 34-4%- 7- I 36,1J Southern region -resident populatjnjcT__TIi V_ _7.1 )L.....492 _13.3) Table 29 Numbers and characteristics of people with physical and sensory disability, by locality, 1997 Source: HFA South needs assessment database for 1997. Estimate of Numbers and Rates (People 15 Years and Over) Southern RegionNew Zealand I 8 8 G) _o L_JL Q (Total _J iD ___K_18,52o)C, 144) Not aged-standardised Level of Need, New Zealand Only, All Ages [Household Survey Residential Survey Combined Surveys Liii 1 ii__I iI (Ti (Needs No Assistance) 4,895 138 L7 269 471 139 1T (Needs Some Assistance) L13, 801 1,017—L:7JL 385 1 I(Cannot Function Without Assisnce,4921 325 2159 7,6221fl3,6511 3831 Total Not aged-standardised Table 30 Estimated number and rate of people with an intellectual disability, southern region and New Zealand, 1996 Source: New Zealand Disability Survey, Statistics NZ, 1996/97 S Table 31 Number and characteristics of people assessed as needing services for intellectual disability, by locality, 1997 Source: HFA South needs assessment database for 1997. 93 People 15 Years and Over Southern- Region_J New Zealand J ------. .v--- 8 1 0 Q 1LJ Ti (Needs No Assistance) 7,583 1,261 29,056 1,071 T2 (Needs Some Assistance) 1077 i z9r3 33j 1,155 T3 (Cannot Function Without Assistance 634] . 3d4I) L4JL77,574)L.52.) Not aged-standardised All Ages Level of Need, New Zealand Only IHousehold_Survey11ResidentiaI Survey "mbined Suryey rb w) 0 -riTrb_r 0 ______i_ LUJ 5 (i (Needs No Assistance) . 32,591 921 - - 32,591 921+ T2 (Needs Some Assistance) 2671L1,223 571 2,016 r43,83 1,229j IT3 (Cannot Function Without AssistanceLZ1J L6Q7 ___8,063JL__28,411L_29,546 L828 ial 121J Table 32 Estimated number and rate of people with a mental disability southern region and New Zealand, 1996 Source: New Zealand Disability Survey, Statistics NZ, 1996/97 - 1NurnberJr%1Numberr °"° 1 (Xicohol dependence 1 550 13.5 455 14.7 Drug dependence 261 6.4 234 7.6 Non-dependent drug use 118 2.§,:L lo^ 3 .3, All Drug or Alcohol related 929 ]L 2? .8ll 792j - 25.6 Affective psychoses 714[ 17.5j[ 50OJLj6.2J Schizophrenic disorders IL573]L14.1][ 4O5][i 13.11 I Other non organic psychoses i57jE 3 .9][ - 126E 4.1] Organic psychotic conditions [ii[ 2.9Jr 93]L 3.01 Depression not specified elsewhere F 7Qii LJ1IJF__3 ---F .7 Neurotic disorders r22][142[ Personality disorders L4:7j 141:[ j Adjustment reaction [ 148 :EiL 13OiL1i r General psychiatric examination/observation 1 25f fI] 239 7.7 Otherl 29fIL_ ]L 2221L Tota - - -. - Table 33 Number and rate of first admissions and total admissions to public psychiatric hospitals by cause, southern region and New Zealand, 1993 Source: New Zealand Health Information Service - mental health data 94 First Admissions Total Admissions 0 0 -o .0 Cz 00, 00, z OR Z (West Coast - 222 682 276 818.4 North Canterbury 43 333 48 366.3 Canterbury 143 221 170 265.2 Christchurch 5 advantaged 683 1,154 826 Christchurch 2 - 345 67j 41 Christchurch 3 - 216 Christchurch 4 L 21j T4I - Christchurch 1 disadvantaged 1[ 223 F--219- Mid Canterbury L 6L 25d7j [ 67 South Canterbury jIF- L Waitaki r 69: [ 67 Dunedin 1 -518: ---4:31 r6951 Central Lakes Clutha [ 34_ Southland IL 50 95 Invercargill 1 465 Other 344 L 354 Christchurch [ 1,643 321 r Southernregion 3,435j __43J 4,430.) Table 34 Number and rate of admissions and visits to public psychiatric hospitals by age and by locality, 1993 Source: New Zealand Health Information Service - mental health data o co 0o cc CS o : - . 9 I 5) 0 0 V 0 S -o Cz CS E -o Ul In In c CZ 1 -I I- West Coast - 54 0.0 48.1 18.5,-,-- 1 31.5 North Canterbury L 34 5.9 41.2 35.3 8.8 44.1 Canterbury [ 134 39.6113.4 Christchurch - 1,279. 1 8.1 .51 -- 25.41 12.6 Mid Canterbury 1. - 54 - 44 .41 South Canterbury L 217 [ 37.31L__jQ4 28 .1 7A Waitaki 94 3ii[j1.7. Dunedin 671 -18.-9 E----12 4IITIi23.2 Central Lakes L 33 21.L 3.0 24YE 33.3 oi Clutha [ 11.5 51.91 Southland 66 6.1 Invercargill 8.3 IL Other 61 3.3145.L11.51.9 Southernregio _,9- 367 iJUIIIL if Table 35 Number and characteristics of people assessed as needing services for mental disability, by locality, 1997 Source: HFA South needs assessment database for 1997. 95 0 12 i 0 , t2 0 ca Cz = 0: C) 0 - -o 2 Cz 0 2 oc ax 0.— E2 West Coast - ii L•T 12.1.L 81.8 North Canterbury 12 [511i[ 27.8j Canterbury 17 2 12j .12.9II1 Mid Canterbury 12 2 18.8 South Canterbury [ f_297[ Waitaki 12 1[4jfl _1 1 Dunedin rI[__44Jr1 Central Lakes 4_t Qi 3 JE Clutha iJ[ oi_6iL11 Southland 4EI Invercargill 9 rr19 62 Other Christchurch n region Table 36 Number and characteristics of clients of alcohol and drug treatment programmes, by locality, 1997 Source: HFA needs assessment database, including data from HealthLink South on Queen Mary Hospital clients West Coast 1036 1113 North Canterbury 1003 997 Canterbury 967J 890 Christchurch 1 1116r14z Christchurch 2 Christchurch 3 Christchurch 4 Christchurch 5 Mid Canterbury South Canterbury Waitaki Dunedin Central Lakes Clutha Southland Invercargill 1025 Christchurch Table 37 NZDEP91 by locality Most advantaged Most disadvantaged 1NZEP911 I NZEP91fl Census Area Unit Locality (adjusted Census Area Unit Locality (adjusted)] Templeton Christchurch 2 221 7,322 Westmorland Christchurch 5 411 Crinan Invercargill 4,014 Holmwood Christchurch 5 439 Aranui Christchurch 1 Jr Cashmere East 1 Christchurch 5 Phillipstown Christchurch 1 2,621 Hawthomden Christchurch 5 [461 Middleton Christchurch 1 Cashmere West Christchurch 5 -AAA 1 Avon Loop Christchurch 1 2,517 Mt Pleasant Christchurch 5 Blackball West Coast Westburn Christchurch 5 South Dunedin Dunedin Kennedys Bush Christchurch 5 Addington Christchurch 1 Deans Bush Christchurch 5 South Richmond Christchurch 1 2,325 Halswell South Christchurch 5 Jellie Park Christchurch 1 Maori Hill Dunedin Waltham Christchurch 1 Helensburgh Dunedin Linwood Christchurch 1 Kelvin Heights Central Lakes Fryati Dunedin 2,157 Bushy Point Invercargill Granity West Coast Bryndwr Christchurch 5 508 Hector-Ngakawau West Coast Rosedale Invercargill Ohai Southland Otatara Invercargill L 513 Sydenham Christchurch 1 Merrin [ Christchurch 5 5iJ___ Appleby-Kew Invercargill Myross BushJftercargill ______516] West Coast Table 38 The 20 most advantaged and most disadvantaged census area units within the southern region, using the adjusted NZDEP91 Maori 11 All o o .a . C: I !fl iI -d Z< z-<-o Under 1 year rAll causes 276 28,395 4,317 41,554 Respiratory 55 5,658 451 4,341 Digestive 28 2,881 421 4,052 LNewborns 151 15,535 2,798 26,932 1-14 years 8,137 5349 1 All causes 539 4,513 Injury r 140,1,130 1919 1262 Ear, nose & throat 153L 1235 2,1-9-9-,: 1 446 7551 Respiratory [ 12_1 977 1148[ Digestive 86 r 64 1457 95 15-24 years - All causes 73i][9,22L2,181ft7,488 Pregnancy Injury 425J[ Asthma E2611 ET$1 r Respiratory 17]LJL. 31]L311] Digestive [ii7j E_ l-,20 6^ F___8_ 4 Liver and pancreas 1301 11-1 25 to 44 years All causes niiLi LL945ii Asthma PELY5J Chronic obstructive respiratory disease Motor vehicle crashes Injury Respiratory Circulatory Digestive 45 to 64 years All causes - 4641 _2,41UL 13,199L8,21 Coronary Heart Disease L_L 286 [LiöLIII94 Other Heart Disease Cancer Stroke Diabetes Flu 7I 551 Asthma Chronic obstructive respiratory disease 65 and older All causes Injury Respiratory Circulatory 722 Digestive Musculoskeleta1 3 Table 39 First admissions for some selected diagnoses and age groups, Maori and all first admissions compared, 1996 Source: New Zealand Health Information Service - NMDS 97 Ii U Southern region 5) New Zealand >- s Total Number of DeathsRateIf_ j- Yearly Average Number Total Number of Deaths Rates -Yearly Average Number 0 in Each 5 Year Period of Deaths Per 100,000 children in Each 5 Year Period of Deaths Per 100,000 children Cs 4 years during each 5-year pen - years during each 5-year pen 5) 1 14 U 5) ______l989-1993j29Qj994 198419881 i989:i993I WQ-J2241i24d28 19891993 AL! causes 1 1 V 280 [2O54 180 35 2824 917 fl63) 1013 41 __3 Motor vehicle accidents 35J[ 27 Cs 5[ & 184 233 184j 81 6 Cancer -- _i_k:136 i36[_65 0 - 5i5l iO3I 2J1 N- Cs Birth defects . _201 231141 3j[ IT1I31LJ25JF_4 4 Pneumonia and Cs o 5,L_ k_ 18jr23J22 )L - c influenza j 1 5 2)1_)L_0 — Table Five major causes ,D V 42 of death for children 1-14 years, southern region and New Zealand, 1984-1994. ,C Source: New Zealand Health Information Service - mortality data F) U) 0 a)— 0 V z MD V o U 8 Southern New Zealand Cs 0 -- Cl) otat Number of Deaths ates - Yearly Average Number I Number of Deathi Rates - Yearly Average Numbe 0 in Each 5 Year Period U of Deaths Per 100,000 Infants in Each 5 Year of Deaths Per 100,000 Infants 0 during each 5-year period during each 5-year period 0 0 1 0 i-ii causes Ca Unknown, includ. cot death V 0 Birth defects V 8 Other birth-related causes 0 C/) Pneumonia and influenza 13.0)L50)L,, 0.0J 0 50)120j1O)[9O 4.0 a) Table 41 Five major causes of death for babies under one, southern region and New Zealand, 1984-1994. Source: New Zealand Health Information Service - mortality data First Admissions Total Admissions 7---- -.-..- V 1 0 0 E -0 ICz AW causes 4,317 i 100.0: 41,554 L9 66,486 1.8 Newborns 2798b64.8j 26 6.7 Respiratory LLJPi 4 Digestive 421[ Ear, nose and throat F-214 [öT Infectious diseasesL124[ 2.9T11 Musculoskeletal 94L2.2TL Nervous system 92fTiII:r Circulatory [ 64 Skin 65 Kidney [ 62J[ 1.4r Endocrine 57 j[ 1.3 [- Male reproductive 24 j 0.6jr Injury ______Eyes Liii7{i0.3LIi Mental disorders _j 17 .Jl. O. Table 43 Hospital admission for under one year olds by major causes, southern region, 1996 Source: New Zealand Health Information Service - NMDS First Admissions 11al Tot Admissions 0 CO 0 .3 C) V 0 .43 .90 0 - E- C) O - co 0 C C - I V ) Zj a (All causes 81137 IC 5,349 6954 1.8 Major diagnostic categories rEar, nose and throat Digestive Respiratory Musculoskeletal Nervous system Infectious diseases Injury r Skin r Eyes Makrproducve__T Table 44 Hospital admission for 1-14 year olds by major causes, southern region, 1996 Source: New Zealand Health Information Service - NMDS First Admissions II Total Admissions Cs CD 0 0 0 o 0 6 6 C) 0 - - E E West Coast i. 182 37,6I 283 58,592 4. North Canterbury 112 ;[ 60,215 184 98,925 4.1 Canterbury 52,832 836 191,O68 4.4 Christchurch I disadvantaged[ 438 [52 708 718 E6 4Qi 49 Christchurch 2 L 419 JL4j. 85j[ 6751r76,o14 4.6 Christchurch [ 371T44,48][ 6iT E72,418 5.0 Christchurch 4 62i 774 4.2 Christchurch 5 advantaged 668jL102,611 iTJ Mid Canterbury 155] 46,131 iT 271 J 80,655 36], South Canterbury 718154i0F7-2 63 35,929 6.0 Waitaki 72Jr 28,235 105 41 j 77 6.6 Dunedin 291[J,133 L384 7,887 9.4 Central Lakes L__J4iL.11_199L50,?jL_3.5 Clutha 87]f868li4o 51,282 t___.4.41 Southland278j4212f1t44 4q42 391 Invercargill 325iL44,218jL4536i,633 L5.2 rMaori southern region [T...9J276 2E__i43 Christchurch [,010[9,926[ -3,30-1F 81,992][ 4.5 Southern region 65,4.81 Table 45 First and total admissions and average length of stay for children under 1 year, by locality, 1996 Source: New Zealand Health Information Service - NMDS First Admissions I Total Admissions C)- 8. CS C). CS cz C) C) I C) to CS E 475 6,513.1 615 8,432.7 1.8 North Canterbury 111 38542 129 44792 1.7 Canterbury 564.1 41575 685 50494 2.2 Christchurch 1 disadvantaged 668 r 7095 1 892 [i9-,471-2-- 2.O Christchurch 2 7o8J6,174.8f947r252, 1.8j Christchurch 3 61788Tflã Christchurch 4 5 74.1 4,873.5t 737 1.81 Christchurch 5 advantaged Mid Canterbury 2221 .4,389Jfiii266 South Canterbury 15,787.3j[ 765 Waitaki 757 -5,32Q-4-F-28285-5 1.6 Dunedin 413 1.7 Central Lakes 1.7 Clutha 1.5 Southland 4,825.1 iL .6271 6,1 2.5 Invercargill 2.3 ori, southernregion ristchurch 1.7 Luthern region 8,137 5,349.i,L 10,2021L,711.2 1.8 Table 46 First and total admissions and average length of stay for 1-14 year olds, by locality, 1996 Source: New Zealand Health Information Service - NMDS 100 1 Table 47 Low birthweight babies 0r- (under 2,500 grams), numbers and o rates by locality, 1990-1992 - F Source: Statistics NZ - births data o.a -rc I North Canterbury Canterbury Christchurch Mid Canterbury South Canterbury Waitaki Lakes Clutha 129 [ 2,278]L 5. Maori Mothers Pacific Islands Mothers Non-Maori, Non-Pacific All Live Births Southern I 1990-94 R 1989-93 11 1984-88 ,- ¶ 0 0 0 0 o I CD H8 E — I E 1 E — I I u I • Do 111 LJ .1 3.6 !E North Canterbury 1 L 10r 22O Canterbury 5 fl12 6fllT4 17[ 4 Christchurch 1 disadvantaged 3oir Christchurch 2 Table 48 Sudden Infant Christchurch 3 Death Syndrome - number Christchurch 4 and rate of deaths by Chiisthurch 5 advantaged locality, 1984-1994 Mid Canterbury South Canterbury Maori child rates are Waitaki taken as a proportion of Dunedin children born to Maori Central Lakes Clutha mothers Southland or the middle year of each 5 Invercargill year period. Maori, southern region Source: New Zealand Christchurch Health Information Service Southern region - mortality data Percentage of 2 year olds who have received full immunisation Table 49 Immunisation coverage by regional health authority area, 1992 and 1995 Source: Ministry of Health, 1996 101 -o 1I to I is s) 0 o E z West Coast 1.49j 63 864 Canterbury and South Canterbur1 1[ 1 .42 Otago 1.97] North Canterbury 14 r 486 LJJj[ Canterbury 79 582 Southland 1.85JL2.43] Christchurch 1 disadvantaged Southern region Christchurch 2 New Zealand Christchurch 3 Christchurch 4 Table 51 Dental health of form 2 children by CHE area, 1993 Christchurch 5 advantaged 87 Mid Canterbury 22 South Canterbury 77 Waitaki 20 Table 52 See next page Dunedin 108 I] Central Lakes 30 Clutha 21 Southland 56 Invercargill 103 o - CD Maori, southern region 121 V -r- Christchurch i±L West Coast 466 1132 686 1667 2.7 North Canterbury 99 7205 142 10335 2.4 Canterbury .477 1 5131 671 7220 3.0 Table 50 First admissions to hospital for respiratory Christchurch I disadvantaged _99411 8Z96 - 1400T H 684, 2.7 illnesses, 1-14 year olds, by locality, 1996 Christchurch 2 L 696 6800 950k 281 2.5 Source: New Zealand Health Information Service - Christchurch 3 7.9i1 Christchurch 4 F 474 ; -----49-- -- 639 -6644 NMDS Christchurch 5 advantaged 2.8. Mid Canterbury South Canterbury 734 i . 10656J 17055j - --517J_79. Waitaki - 273 -----10436102 [l5367 3.5 Dunedin 1806 7762 2376 10211 2.7, Central Lakes 477 Lu9l9. 2.5] Clutha 210 1] 8046 275 105--6] Southland - 4828025703 11705 3.3 Invercargill J3Q_ 10749 ,jl74 15203 3.2] K6.—Or-l ,-southern region.731_Lj8184_1069L26592 - 2.4 Christchurch [ 3187.[189JL 4320J[ä0 2.6j Southern reeion.._ Ii. 9181 j 74881 126951 10355T Table 54 First and total admissions to general hospitals and average length of stay for 15-24 year olds, by locality, 1996 Source: New Zealand Health Information Service - NMDS Number Rate per 100,000 1 0 Percentage Average Yearly 15-24 Year Olds : hange Between 1992-1996 ------5>:. 8 p. -r -- Total Female Male Total Z 0 Z LL causes isl7c 1Ct6 Q1R1 QQQ7 4QRc 7 489 14 7R -S% 1% -6% ajor diagnostic categories Digestive Musculoskeletal Nervous system Injury Female reproductive Ear, nose and throat Skin Respiratory Infectious diseases Kidney Mental disorders Circulatory Liver and pancreas Substance abuse Table 53 Hospital admissions for 15-24 year olds by major causes, southern region, 1996 - numbers and rate per 100,000 Source: New Zealand Health Information Service - NMDS 102 Total number of deaths in each 5-year period Southern region New Zealand 1989-93 1984-88 1989-93 1990-94 CT All causes 162..L. 474.. 393 ... .5.18.. III_IL,7 L.3,05_7.39___1,828•2,458 Motor vehicle accidents 58 216 74 211L339_ILi,159 1_3241 _997j[ 1 ,321 j[ 25Oj7 2_IL02.J Suicide and self-inflicted L 22 L_1 10. Tö_Il l8IJI98J381 L88JL_552]164o_44_I[5 lOT] Cancer J[T1[18 36 39 -jE8DE 109 r74j1_111_IF185[Ti69TT1OiJi7T] CORD IL .. J . 9J 10 I I iir 1 53152 L Qther accidents _2JL7 19 I Rate of deaths in each 5-year period per 100,000 Southernregion New Zealand 1989-93 1990-9 1984-88 - -4, . ejCMalC.Total CFemal1(TMi -MaleC.3TotaU (Female I_M ale "All causes 50140. 8JL155..i LiO3J i2 I _.46 __132__ 90 J Motor vehicle accidents LIITiJLIii64, flE1 43JL1 iTh —159._55..J[Ii7I Suicide and self-inflicted i_7_IL_26_ L_43J1_ 1L3 _2&j 16J 6_I3_IL23iL 532jLj9.._I1 Cancer - _- _6 - _5.. flr 1 - - 7L 7_IL _ coRt LT_ o[ :11 —i-IJEo:r... 4T][ 4T]fl.__.i1 .....2.JE. -flE iT]LJT]1 Other, accidents ______L-____1L__5 - _ 7jJj -)L _6&3J Rate of deaths in each 5-year period per 100,000 Chronic obstructive respiratory disease Table 52 Five major causes of death for 15-24 year olds, southern region and New Zealand, 1984-1994. Source: New Zealand Health Information Service - mortality data Deaths 1990-1994 Jumbers Admitted To Hospital 1994J Number r 1ate per vcrage NumbRate per Year Per -- 100,000 People L 100,000 People FZIle Malej[Total j Male Female jLjyj k - jLFemale JL_Male 1 2 29 107 5 24 233 1116 North Canterbury 0 0 31 27 2 2 278 278 Canterbury 1 3 20 73 9 37 194 796 Christchurch 1 disadvantaged 1 1 9 16 15 1, 37 248 612 Christchurch 2 1 3 20 158 14 L -----18 272L350 Christchurch 3 rr 8[45 9 3flT185 r636] Christchurch 4 2 1 10lT4[210 fl2951 Christchurch 5 advantaged - Mid Canterbury South Canterbury Waitaki Dunedin" Central Lakes [Clutha [Southland [Invercargill city [&istchurch Southern region kNew Zealand Table 55 Death and hospital admission from motor vehicle crashes, 15 to 24 years, by locality, 1990-1994 Source: New Zealand Health Information Service - mortality data and NMDS Numbers Admitted To Hospital 1994 Average Number Rate per Number Ratef— per Per Year 100,000 People 100,000 People FemaleMale Female Male FernaJ[ Male j Fern JL Male 27 • 5 326 233 North Canterbury 0 0 31 53 1 1 139 139 Canterbury - 0 1 5 21 7 7 151 151 Christchurch 1 disadvantaged 0 4, 6 66 33 18 546 298 Christchurch 2 0 T 37, 4 [ 58 13 [ l2 253 233 Christchurch 3 - - Christchurch 4 fl21[ Christchurch 5 advantaged - Mid Canterbury South Canterbury _0 riTi"1 43 65j 167 Waitaki 0 - _____ Dunedin 0 ]=--2–]E 3 1-9 41:1 4r 3.5 Central Lakes 7-51L__ Fl 288 Clutha -=177— Southland Tflr 1r - 5ETiTlir 159 Invercargill 8 74 - 761 47 295 Southern region :L-I 3 Table 56 Deaths from suicide and hospital admission from suicide attempts by locality, 15-24 year olds, 1990-1994 Source: New Zealand Health Information Service - mortality data and NMDS Female and Male Suicide Respectively, 15-24 years, 3 year totals 1 1984 LjL 1986 985.LJ987 ( i 1988JL..j989Jr [ 1990.,LJ99LJL1992- __ L.1993l994LJ995 Christchurch Female 6 6 8 66 4 5 4 6 6 -.-.. ---- f------. Southern female , 12 ... 11 L.... .16.. 12 9. ii.. 1O.,j_.11.._ - .15 NZ female 58 [1.J68 .65 F64. 55LL5249.L..59i __76 CHCHmaIe L 13 15 EI37[IIiiii[4O ___ 45 _[._ 42___41J Southern male_:70 L L43._. 47E77 [i9iT 82 E87 _I NZ male L183. - 219[266 308L 32EiIi330ETii__33l L ,332_ 342_ E _] RatePer100,000FemalesorMalesRespectively,15-24Years,3YearAverage fl 1 ______-l.l984 Ll985_.A 1986 L1987,_. 1988 .L.1989JL 1990L1991..L_ 1992 _L_1993...1L 1994.L..l995 Christchurch Fernale 7.7 7.7 10.3 7.8 7.8 5.2 6.6 5.2 7.87.8 Southern female 6.2-, 5.7 L_8.4.. 6.3L 6.4 4.9.L --6.0-- . 5.5. 6.0 NZ female 1 L64 70 Jr8 2". 7iif_75 64 ______9 411_ CHCH male -- L .164 - 9OJE:T 473L_552 567 L. 5l_7.. 52 L_5431 53_17E Southern male29 5 . 391 _[2 7 41 2 L___36 9 36 45_5L _468_L...... J INZ male -- l 7 LL-3-163593 37 738lk39 1 41.2 ir__] Table 57 Male and female aged 15-24 years, suicide, Christchurch, southern region and New Zealand, 1984-1995 Source: Coppell et al, 1998 104 Rate of deaths in each 5-year period per 100,000 Fancer otor vehicle accidents I [Suicide and self-inflicted Ischaemic heart disease -Strokes Table 58 Five major causes of death for 25-44 year olds, southern region and New Zealand, 1984-1994. Source: New Zealand Health Information Service - mortality data AverageF vPrage( Number Rate per 100,000 I NumberPercentage Average Yearly chge Between 1992-1996 ___Of__-44 Year Oldsises v oI umber Average _fmaleJLMaIeJLT0mLJ Female lAdisionJL9fY!..iPaynyi Allcauses - T 17,021 - 5,917 22,938 14,629 5,086 9,857 1.4 3.4 -1.7 1.1 -5.1 Major diagnostic category ... Pregnancy 9,307 - 9,307 7,999 - 4,000 1.4 3.2 1.6 1.7 -6.4 Female reproductive j2,505 2,5052,153 - 1,077 1.1 1.5 -4.9 0.0 L -3.8 Digestive -- L 1,204 .L 1,113 2,317 [1,035j 957 996 1.2 2.4 2.0 1,088Musculoskeleral 714 [1 ] 1 980 L614jJ 851 12 4 T2L Nervous system [ 564[23T 187 485j 535 [5l0 L F2 4[ T3fl06fI 7] Skin _____5ffl5T62442 452 jTfi1E f4]1 11 LiO3:r :I8J Injury 392 I 37-5-[7771 .21r2.7 FT 6.5 EJC Respiratory[385 Tr1o6jL 331r 276 L 303 [ i.2JL 3.9 .-2.8][ -2.3] Circulatory [ 309 j90JE 699 266 )[ 333 E 3D0 [ 1 .3jC" T J[ -1.4 L __1.JE6.2 Ear, nose and throat 319 L 3ii r 0_.L 271 .JL 7 771. 1.1 [T 1.8 10.2TTT][ -0.12 Mental disorders 264 2iTL 478 1.4 L1J441_. - 2.7 r1.i1r -3.4 Kidney 247 T91L 426 E 1T54 J83TJ 13 Q5J4i Liver and pancreas 288 1_3 L3 311 i6][7jJ Infectious diseases 156 1i9[ 12L 1 LL T L_____4606JL 10J Male reproductive ( -11.7JJLIII2ii1[i- ii 190 L 95 1 -13.2 iL_ z.j[ 11.4] Endocrine 75 . 75:ll 150T64i 64r41L 1JTL 3.61LTi.fl .. -4j3 Eyes 59 90 - 1 CE1 9 L_1 9 T8] Blood [55 5o 105 [_ .47J[43 L.451[ 1 4 L 3 2 1_138 J[ 10 5iö] Myeloproliferative (leukaemia) 41 2 ,. 9.9T 15.4] ...... -1.9 Substance abuse .J- 34j49 )829L - L1X 6.2JL . Table 59 Hospital admissions for 25-44 year olds by major causes, southern region, 1996 Source: New Zealand Health Information Service - NMDS First Admissions Total Admissions C) Q t "T CD 0 V>.. 5) West oast 1 1,288 12,793 1,727 17,153 2.68 North Canterbury 309 8,085 461 12,062 3.62 Canterbury 111,532 7,510 2,290 _11,226J 3.58 Christchurch 1 disadvantaged L 1,97 1L9,604 2,743 [ . 13,352 138 Christchurch 2 .D694 [8,983 2,430 2,886 3.12 Christchurch F T 758-!7352L2,249 L11,821 Christchurch 41,492 3J Christchurch 5 advantaged L_1,210JL7,613J[ J TC Tö,87j L 3.12-j Mid Canterbury [842 2311 South Canterbury Eö3 1,485.j[ 2,83L.18,781Ii1 Waitaki [91FiT,76j[ 972 :LJ,84oJF:--j-.475, Dunedin L,831 -11,0; F 5,128 I Central Lakes [94][76TJ pT 75Lj4,243[2.98] Clutha EL1L9,35]. it 703 12,ET Southland iE F] F-1, .Invercargill 1;783 TiIiT1,Th.I15,6661 3.781 P ator southern region [1111 L17 2JL 1 592 24 8211L 3.19 J I Christchurch[7,958L..,57jEfl,259 --[7_12,1381F.73.27] LSouthern region j22,938 .J\_-.9,85.7J Table 60 First and total admissions and average length of stay for 25-44 year olds by locality, 1996 Source: New Zealand Health Information Service - NMDS 106 Total number of deaths in each 5-year period Rate of deaths in each 5-year period per 100,000 Southern region New Zealand ------1984-88 1989-93 Il 1990-94 1984-88 1989-93 1990-94 All causes 566 Cancer 2 276 294 11 285 Coronary Heart Disease Strokes CORD Chronic obstructive respiratory disease Table 61 Five major causes of death for 45-64 year olds, southern region and New Zealand, 1984-1994. Source: New Zealand Health Information Service - mortality data Number Rate per 100,000 1 Average F 1 Percentage Average Yearly 1 45-65 Year Olds r Change Between I992.19j j Number OfDays Of Visits yg Jta onsi ILDays Stay ,u causes 6.633 6.566 13.199 8.274 8,154 8,214 -1.55.1 -2.4 1.5 -7.8 Major diagnostic category Circulatory 972 1,696 2,668 1,212 2,106 1,660 1.4 4.4 -1.3 -1.6 -0.8 Digestive Musculoskeletal Respiratory Nervous system Female reproductive Skin Kidney Injury Liver and pancreas Ear, nose and throat Eyes -- Mental disorders Infectious diseases Myeloproliferative (1 Endocrine Blood Male reproductive Substance abuse Pregnancy Burns Table 62 Hospital admissions for 45-64 year olds by major causes, southern region, 1996 Source: New Zealand Health Information Service - NMDS Chronic Obstructive Respiratory Disease First Admissions Total Admissions 60 C50 Cz CZ CL4 X C z z - West Coast 831 11,986 1,306 18,837 3.7 North Canterbury 217 7,050 322 10,461, 4.6 Canterbury - 799 5545 1241 54 Christchurch I disadvantaged 901[ 9748 1,406 If,, 56 Christchurch 2 8[ 8i74i465 Jio) 55 Christchurch 3 733 i[ i 1L11 -- 52 Christchurch 4 7T5 604][ 1 134]8JL 5& Christchurch 5 advantaged 765TTI4.901i[ 1,129 7,233][4 Mid Canterbury .South Canterbury - - L..R5, 1- JL _.0 Waitaki Dunedin 3,259 :cr 777:rCentral Lakes —ior 4.8 [Clutha Southland 801 [ 8,56QjLI 193 1 1 ,750JL ___4.7_ 1,045J11,Qs197rLInvercargill 5.9 aori, southern region Christchurch Southem region 13,199J8,2.14).20,250i(.J2402A Table 63 First and total admissions and average length of stay for 45-64 year olds, by locality, 1996 Source: New Zealand Health Information Service - NMDS 108 I Deaths 1990-1994 Numbers Admitted to Hospital 1994 1 - -- 8 8 8 8 - V V CD Q S 03 S I z _ I- LL VLL V V V as o-_ - V 10 M SO West Coast 81 E287 14 r7 448 1652 North Canterbury 1i[45.L,J5L 8 [i8j 569 1193 Canterbury ,[ 3 j[13 j 6917410 F - F016, Christchurch 1 disadvantaged ] 3 ]Lj 81, [ 368 29 68 655[T4 Christchurch 291_1[_._,263j.29j1_80[...53[ j35 ] Christchurch [. _3 JE1IIO _ 67][ 34ST4 Christchurch 4 [_3j3L__13JL,216J[_____20 . _90 310[ i451 Christchurch 5 advantaged _3114____ 7- , 419_7_ 92J[ 34Q[ 1245] Mid Canterbury L_i & 3_219 __13L29JL 48417iööi South Canterbury 4 7Q L,265j 5791 tT58 Waitaki [ 1 5, 51)[ 22j 61[ Z7Jt 1ITii1] Dunedin r [ijZ3, 83 L,,2J21 ,,_,.5 . 1LiJ521t 514 E7 1401 Central Lakes [1- 39 JLj61J . ±711 34j 600jEThfl Clutha I 1 t3 34 177 iojf 21[ , 5551 i ö64] Southland . I 4 TJo. 87j2O[ 39.f4fl_ T3 Invercargill L_5 1QL7,j10J[7384. 51 , ?5[ 1013 ______JChristchurch t17 L.65 61jL238j 124 3,97j[ 415][,1j Southern region I_- 49 I177 68 240 403JL1009j 5271[TI1 \,N,ew.ZeaIanci______. 244 7J 76J249JNo nationalfomaticAIi Table 64 Deaths and hospital admissions from coronary heart disease by locality, 45-64 year olds, 1990-1994 Source: New Zealand Health Information Service - mortality data and NMDS Table 65 Deaths and hospital admissions from all cancers by locality, 45-64 year olds, 1990-1994 Source: New Zealand Health Information Service - mortality data and NMDS 109 Total number of deaths in each 5-year period Southern region New Zealand 1984-88 1989-93 111990-94 198 1989-93 1990-94 ______(FemaleiIotaDCFemaIjCFeaeMaITotal1tMa1ci(FnaM(Tota (All causes 12 689L12_O61j 24750 13 2433L 12 187 D-5,430 12605 11 412 IL 24 017 48 167 L 46853 L95 0201 501841 48099 98283 147610 45506 93 116 j F Ischaemic Heart Disease TL4_ IEJL7 u1EoflLi 129 JTJ [Ii1L14 807J[ 28 345 1L13 155 14 263 Cancer L3EI2 1LJL 0291L 2 4J[ 3 143_]EJ [ 2 719 ]L3 022JL 5 741 10922 jQ9 971J[10 353 j[12 384][22737f10439j 12 187E2226J 999[Strokes I 19321JL1_178][_3 1l0F916]L1 072JE2988JLj 570J 7iJL 2442J7593][_ 4663 Cl2256JI_ _7440 j E4546J L 11986 1r5 F 3649647J I Pheumonia and Influen a LIiJE 588 j[i 82ULIjj1 345L j 1Q0JLi3Z9 JL4615 J LTIJE Q E249 059 l2böö7 CORD i1.454)I1 ,054Y._1 C2,304J3,67A) I i9Z8,.3,036 4,964) Rate of deaths in each 5-year period per 100,000 Southern region New Zealand ______^8488 [1989-93 1990-94 1984-88 1989-93 1990-94 1ThFTl -] LF ^L.—a I NET All causesL4__933_jL6 8425 709 L5__059L 5 750 L5_4686 5355 4982 L5 893 ... II 5242 D__S53JL 4576 L_5_ 96 jj 5176 L4 274 5542 4 iTiI Ischaemic Heart Disease 1 3JET_ L1JL1PL 1J72J!___ 1 480H664 c111L112JLi J JLI1EI1 L 2L LI Cancer 944 LI54 1197 J937.L1 484 I__16 Strokes_7f5- l- -1668JE]E 117171111_731_[150611_[13j11][__.584_ 1 r409J 1___ _507 1L2z91111 522 1E11716 78 F70-F-IC-5 Ph -- and Influenza L 334 275 ic:i 288 CQ1D Table 66 Five major causes of death for 65 years and older, southern region and New Zealand, 1984-1994. • Source: New Zealand Health Information Service - mortality data U r-- Number Rate per 100,000 Average Average Percentage Average Yearly 45-65 Year Olds NumberNumber..Change Between 1992-1996 L Days of VisitsOf F emale 4_jylale I Total J Female Ljale JL - Total JL _. (TOtal 1 12,146 10,237 22,383 20,402 23,499 21,711 1.8 8.9 -0.9 1.0 -10.0 Major diagnostic category Circulatory 2,880 2,842 5,722 4,838 6,524 5,550 1.4 6.8 -0.1 -2.3 -5.5 Digestive 1 802 1 768 3,510 3 027 4,058 --3,463 1 2 6.0 0.3 -1.2 -3.4 Musculoskeletal 2I3[1095 3,308 [3717 2,514 1 3 20 - 12 93 - 42 3 124 6 Respiratory 1401[T5! 3,005 3 638 2,915 1 4 8 2 44jL 2 1 [ T1T 4 21[ 5T L 23O Nervous system L 1225 L091 2,504- [T24 Li Eyes 92iiIIji.570 1 ii TTT 8 7[T1IIIQ1C 18 1 Skin F— 9iff 753J— 1,448 1 534 1,22811 40511 r 35 III 0-2, Kidney1 2fl8431 74[T21 1[ 53T Ti 1 Ir- u Mental disorders 453J[275 728 [7LLF7ö1. 12 4T 051 5t 199 Male reproductive L 89 - . i :AJ1 5.5 -13.2 -_-3.6jf-7.2 Liver and pancreas 3-38 L__304 642 568 623 13[ 725j34 L721 Injury325 [3___583 546 571 ITT E 7 [TT TFP 101 Ear, nose and throat [303 236L 539 542 3723 i I1f4 r -iy[ i6T _127 Blood 24f[ 22549 410 3W_455 1538 L LL Female reproductive 444 Endocrine —235-1— 17 1 406 ]E 393 L 4 1 1 JO - 08 96] Meloproliferative (leukaemia) I _182F7i _____ 30 475 3771fl _ijE 74 J[ 33 L .4.3 Infectious diseases r 155 .L±4JL 297 O1 326E8j[ 5.02.O[ [ Substance abuse 16i[_3[46 ][ _2__69JL 4[_k[I_1Q 1 J :45.31 urns 132JLiXIEI _5II1 5 _1.i;TToL Table 67 Hospital admissions for people aged 65 years and older by major causes, southern region, 1996 Source: New Zealand Health Information Service - NMDS Average First Admissions Total Admissions Days Stay 11 0+ 0+ 9+ - 1 - .. V ..D 0.. V 0.. Z C V V 1,120 28240 2, 133 53782 7.9 North Canterbury 291 17478[ 558 33514 11.5 Canterbury [12iinrf73 2096 30969 10.2 Christchurch 1 disadvantaged F T 2i46 r 2605 J, 3600T 92 Christchurch 2 L_i,75JELI4[TIIL1 Christchurch 3 1.680 i1 i 2.811 1 30601 9.1 Christchurch 4 Christchurch 5 advantaged Mid Canterbury South Canterbury Waitaki 830j[ 22752 1,457 [ 39940 77 Dunedin ,2jL24603L,42IL432O8 9.3 Central Lakes 821 ]98Lfl6OO 6.7 Clutha - 503 ][ s924J[ 43812 Southland Invercargill 1,581 1 23760 2,78011 41779 rMaori, southern region I1 jL 23 267..L 247 it Christchurch 8,075119269:r13,425rT32035 9.1 Southern region 22,383 )i711 X 39,221;rT0 8.9 Table 68 First and total admissions and average length of stay for people 65 years and older, by locality, 1996 Source: New Zealand Health Information Service - NMDS Age, Sex and Ethnicity of People with an Age-related Disability V I UI co, West Coast Li 252j 114 [09 289 216 L 752 North Canterbury E1[ 4.7jL 0.0 .L 35.& 23.9J 74.3j Canterbury Christchurch L9,i1L9.2JL 0.3 L30.LL21.2.L75.3I] Mid Canterbury South Canterbury L 1,733 Waitaki LI9ALii o IoiL 276JLiT] 813 Dunedin [73 87i[ 10.3J[T0.2L_26.2i[__._20.OJLTh.51 Central Lakes 24[TI0.3[ 29.3iL157JL79.6 Clutha 5348.9 6.2[ 32.-4,7--- 9.5 6.6 Southland ______...... 6.2 ____1.Oj[ 32.3 2O.8 3174.3 Invercargill [Other regions J1_2,363 ft .JL.0JL27JL 13.2] L84.5J Sotihern regionL25,629) 97)Q4)301JL 191)7iQ) Table 69 Numbers and characteristics of people aged 45 years and older with an age-related disability, by locality, 1997 HFA needs assessment database 112 REFERENCES Abbott M, 1994. Mental health. In Spicer et at, 1994. Benzeval M, Judge K, Whitehead M, 1995. Tackling inequalities in health - an agenda for action. London: AIDS Epidemiology Group, 1996. AIDS - New Zealand. Kings Fund. Issue 25. Bhushan V, Paneth N, Kiely JL, 1993. The impact of lbrecht H, Chaplow D, Peters J, 1992. Forensic improved survival of low birthweight infants on psychiatry and prison liaison service in Auckland. recent secular trends in the prevalence of cerebral New Zealand Medical Journal, 105: 334335. palsy. Pediatrics, 91(6):1094-1100. on L, Counsell A, Geddis D, Sanders D, 1993. Blainey D, Lomas D, Beale A, et al, 1991. The cost of Report from the Plunket National Child Health acute asthma: how much is preventable? Health Study: smoking during pregnancy in New Zealand. Trends, 22: 151-153. Paediatric and Perinatal Epidemiology, 7(3): 3 18-333. Borman B, 1980. Diabetes mellitus morbidity in New Armstrong W, Borman B, 1996. Breast cancer in New Zealand: a geographic study. Social Science and Zealand: trends, patterns and data quality. New Medicine, 14b: 185-189. Zealand Medical Journal, 109: 221-224. Boulton-Jones C, Mclnnerny K, 1995. Teenage Barwick H, 1992a. Impact of economic and social factors on pregnancy and deprivation. British Medical Journal, health Wellington: Public Health Association. 309 (6967): 398-399. Barwick H, 1992b. Youth Suicide Prevention project - Brown CR, Hider PN, Scott RS, Maipress WA, Beaven workshop report and literature review. Wellington: DW, 1984. Diabetes mellitus in a Christchurch Dept of Health. working population. New Zealand Medical Journal, 97: 487-488. Bathgate M, Alexander D, Mitikulena A, Borman B, Roberts A, Grigg M, 1994. The health of Pacific Burry H, Hughes 0, 1984. Femoral neck fractures: a Islands people in New Zealand. Wellington: Public preventable phenomenon? New Zealand Medical Health Commission. Journal, 97: 856-859. Beaglehole R, Bonita R, 1994. Cardiovascular diseases Canterbury Area Health Board, 1990. Health Status In Spicer et al. 1994. Profile. Christchurch: CAHB. Beaglehole R, Bonita R, 1997. Public health at the Canterbury Regional Council, 1997. Regional crossroads. Cambridge: Cambridge University Environmental Report 1995-96. Christchurch: CRC. Press., Caradoc-Davies T, Hawker A, 1997. The true rates of Begg D, Langley J, Chalmers D, 1992. Motor vehicle road injury among workers in New Zealand: comparing crashes during the fourteenth and fifteenth years of 1986 and 1991. Disability Rehabilitation, 19(7): 285- life, New Zealand Medical Journal, 105: 150-15 1. 292. Bell C, Swinburn B, Stewart A, Jackson R, Tukuitonga Casswell 5, 1994. Alcohol-related problems. In Spicer C, Tipene-Leach D. 1996. Ethnic differences and et al., 1994. recent trends in coronary heart disease incidence in New Zealand. New Zealand Medical Journal, 109: 66- Chalmers D, Stewart I, Silva P, et al, 1989. Otitis media 68. with effusion in children: the Dunedin study. London: MacKeith Press. Bell DW, Ford RP, Slade B, McCormack SP, 1997. Immunisation coverage in Christchurch in a birth Chen, SN, 1993. The health needs of Chinese children and cohort. New Zealand Medical Journal, Vol 110, p440- families in Christchurch. Christchurch: Healthlink 442. South CHE. Bendich A, 1993. Lifestyle and environmental factors Children, Young Persons &. Their Families Service, that can adversely affect maternal nutritional status November 1997. Press release. and pregnancy outcomes. Annals New York Academy of Sciences, 768: 258-265. 113 Coppell K, Kokaua J, Gouman 0, 1998. Suicide in the Elwood J, 1991. New Zealand s first population based Southern Region. Unpublished report to Health breast cancer screening programme. New Zealand Funding Authorty. Medical Journal, 104: 258-260. Cox B, 1997. Cancer in the Southern Region. English 0, Northern J, Fria T, 1973. Chronic otitis Unpublished report to SRHA. media as a cause of sensorineural hearing loss. Archives of Otolaryngology, 98: 18-22. Crampton P, Farell A, Tuohy P, 1994. Iron deficiency anaemia in infants. New Zealand Medical Journal, ESR (Institute of Environmental and S 107: 60-61. Research Ltd), 1994a. Total diet Unpublished report to the Ministry of Crampton P, Howden-Chapman P (eds), 1997. Socio- Wellington. economic inequalities and health - proceedings of the Socio- economic Inequalities and Health Conference, 9-10 ESR (Institute of Environmental Science and Rarc December 1996. Wellington: Institute of Policy Studies. Ltd), 1994b. Air Pollution Monitoring in. Zealan 1960-1992. A report for the Ministry of Health/Public Crampton P, Salmond C, Sutton F, 1997. NZDEP9I Health Commission. Auckland: ESR. Index of Deprivation: Instruction Book Wellington: Health Services Research Centre. ESR (Institute of Environmental Science and Research Ltd), 1995. Register of community drinking, water Davis P, 1986. Office encounters in general practices in supplies in New Zealand. Christchurch: ESR. the Hamilton health district II: ethnic group patterns among employed males. New Zealand ESR (Institute of Environmental Science and Research Medical Journal, 99: 265-268. Ltd), 1996. The New Zealand Public Health Report, Vol 3 (5). Dawson KP, Allan J, Ferguson DM, 1983. Asthma, air pollution and climate - a Christchurch study. New ESR (Institute of Environmental Science and Research Zealand Medical Journal, 96: 165-7. Ltd), 1997. The New Zealand Public Health Report, Vol 4(2). De Boer G, Saxby J, Soljak M, 1990. Child Health Profile 1989. Wellington: Dept of Health. Evans B, Tasker T, MacRae K, 1993. Risk profiles for genital infection in women. Genitourinary Medicine, Dept of Health, 1991. A National Genetics Service for 69(4): 257-261. New Zealand: a discussion document. Wellington: Dept of Health. Ferguson D, Horwood L, Lynskey M, 1993. The prevalence and co-morbidity of DSM-111-R Dept of Statistics/Ministry of Women s Affairs, 1990. diagnoses in a birth cohort of 15 year olds. Journal of Women in New Zealand. Wellington: DoS/MoWA. the American Academy of Child and Adolescent Psychiatry, 32: 1127-1134. Dickson N, Kokaua J, 1996, Information related to strategy on sexual and reproductive health - Fishwick D, Pearce N, D Souza W, Lewis 5, Town I, pregnancy rates among young people. Unpublished Armstrong R, Kogevinas M, Crane J, 1997. draft paper, Southern Regional Health Authority, Occupational asthma in New Zealanders - a Christchurch. population-based study. Occupational and Environmental Medicine, 54(5): 301-6. Dune M, 1994a. Maori perspectives on health and illness. In Spicer et al., 1994. Ford R, Scragg R, Weir J, Gaiser J, 1995. A national survey of cigarette smoking in 4th form school Dune M, 1994b. Whaiora - Maori health development. children. New Zealand Medical Journal, 108: 454-458. Auckland: OUR Foster E, 1996. Health effects of suspended particulate. Eggers JA, 1996. Locality Physical Environment Report. Technical Report R(96)2, Christchurch: Unpublished paper for the SRHA Christchurch: Canterbury Regional Council. SRHA. Fraser A, Brockert J, Ward R, 1995. Association Elliot JR, Hanger HC, Gilchrist NL, Frampton C, between young maternal age with adverse Turner JO, Sainsbury R, Gillespie WJ, 1992. A reproductive outcomes. New England Journal of comparison of elderly patients with proximal Medicine, 332(17): 1113-1117. femoral fractures and a normal elderly population. New Zealand Medical Journal, 105: 420-422. 114 Galgali 0, Beaglehole R, Scragg R, Tobias M, 1997. Kokaua J, Wheadon M, Sceats J, 1995. A discussion Potential for prevention of premature death and paper about the SF36 as a health status measure and disease in New Zealand. New Zealand Medical its usefulness for measuring Maori well-being. Journal, 110:7-10. Unpublished paper, Health and Disability Analysis Unit, Midland Health, Hamilton. Galloway Y, Baker M, Brett M, 1996. Tuberculosis increases again in 1995. The New Zealand Public Kokaua J, Baird D, Paul A, Cunningham E, 1996. Maori Health Report, 3 (12), Health: a profile, Ko Te Mama Hauora 0 Te Iwi. Dunedin: Southern Regional Health Authority. rett JC, Mulder J, Wong-Toi H, 1989. Reasons for racial differences in A&E attendance rates for Kokaua J, 1997. Deprivation scores using 1991 census asthma. New Zealand Medical Journal, 102: 121-4. data. Internal unpublished report, Southern Regional Health Authority, Dunedin. on A, Ward A, Ward A et al, 1993. The benefits of exercise in post-menopausal women. Australian Koopman-Boyden P (ed), 1993. New Zealand s ageing Journal of Public Health, 17: 23-6. society. Auckland: Daphne Brassall Assoc. Gillett W, Peek J, Lilford R, 1995. Costs and effectiveness Koopman-Boyden P, 1986. Population ageing in New of infertility services in New Zealand: a decision Zealand: some characteristics and policy analysis. Wellington: National Advisory Committee implications. New Zealand Population Review, 12(2): on Core Health and Disability Support Services. 92-106. Health Funding Authority/Ministry of Health, 1998. Krishnan V, Shoeffel F, Warren J, 1994. The Challenge of Disability in New Zealand - an overview. (In press), Change: Pacific Island Communities in New Zealand, Wellington: HFA/MoH. 1986 to 1993. Wellington: New Zealand Institute of Social Research and Development. Hillary Commission, 1990. Life in New Zealand Survey: summary report. Dunedin: University of Otago. Land Transport Safety Authority, 1992. Motor crashes in New Zealand. Statistical statement for the calendar year Hood D, Elliot R, 1975. A comparative survey of the 1992. Wellington: LISA. health of elite Maori and Caucasian children in Auckland. New Zealand Medical Journal , 81: 242-243. Langley J, McLoughlin E, 1987. A review of research on unintentional injury: a report to the Medical Research Hornblow AR, Bushnell JA, Wells JE, Joyce PR, Council of New Zealand. Auckland: Medical Oakley-Browne MA, 1990. Christchurch Research Council of New Zealand. psychiatric epidemiology study: use of mental health services. New Zealand Medical Journal, 103: Langley J, McLoughlin E, 1989. Injury mortality and 415-417. morbidity in New Zealand. Accid Annal Prv, 21(3):243-254. Hunter P, Kirk R, de Liefde B, 1992. The study of oral health outcomes. The 1988 NZ section of the WHO Lundberg 0, 1991. Causal explanations for class second international collaborative study. Wellington: inequality in health - an empirical analysis. Social Health Services Research Centre. Science & Medicine, 32 (4): 385-393. Jackson R, Lay-Yee RL, Priest P, Shaw L, Beaglehole R, Lyttle H, 1994. Surveillance report: disease trends at 1995. Trends in coronary heart disease risk factors in New Zealand sexually transmitted disease clinics Auckland 1982-1994. New Zealand Medical Journal, 1977-1993. Genitourinary Medicine, 70: 329-335. 108: 451-454. Maskill C (ed), 1991. A health profile of New Zealand Jamieson K., 1998. Poverty and hardship in Christchurch. adolescents. Wellington: Dept of Health. Findings from the Target Week Survey data. Christchurch: Christchurch City Council. McGee R, Elwood M. Cancer, 1994. In Spicer et al., 1994 Kawachi I, Marshall 5, Pearce N, 1991. Social class inequalities in the decline of coronary heart disease McKendry M, Muthumaia D, 1993. Health Expenditure among New Zealand men, 1975-1977 to 1985-1987. Trends in New Zealand 1980-1992. Wellington: Dept International Journal of Epidemiology, 20: 393 -398; of Health. 115 McKendry M, Muthumala D, 1994. Health Expenditure O Dea D, 1993. Maori health service utilisation: an initial Trends in New Zealand - update to 1993. Wellington: data compilation. Wellington: Ministry of Health. Dept of Health. Oakley-Browne MA, Joyce PR, Wells JE, Bushnell JA, Menon A, Belton A, Jocelyn R, Fraser G, 1993. Pertussis Hornblow AR, 1989, Christchurch psychiatric outbreak in Otago 1993. Communicable Disease New epidemiology study. Part 2: six month and other Zealand, 93: 146-148. period prevalences of specific psychiatric disorders. Australian and New Zealand Journal of Psychiatry, 23: Ministry for the Environment, 1992. Potentially 327-340. 4 contaminated sites in New Zealand - a broad scale assessment. Wellington: MftE Occupational Safety and Health Service, 1996. R on the Notifiable Occupational Disease Sys Ministry of Health, 1994. Policy guidelines for Regional Wellington: OSH. Health Authorities, 1994-95. Wellington: MoH. OTR Spectrum Research, 1993. Cigarette Smokin Ministry of Health, 1995. Policy guidelines for Regional Prevalence Report. Unpublished report to the Health Authorities, 1995-96. Wellington: MoH. Public Health Commission, Wellington. Ministry of Health 1996a, Population-based health Palmer V, Kent D, McAnulty J, 1994. Alcohol and outcomes. Unpublished draft paper. Wellington violence against women. New Zealand Medical MoH. Journal, 107: 140. Ministry of Health 1996b. Progress on Health Outcome Pearce NE, Davis PB, Smith AH, Foster FH, 1983. Targets 1996. Wellington: MoH. Mortality and social class in New Zealand I: Overall male mortality. New Zealand Medical Journal, 96: Ministry of Health, 1997. Suicide Trends in New Zealand, 281-285. 1974-1994. Wellington: MoH. Pomare EW, 1988. Groups with special health care Mitchell EA, Taylor BJ, Ford RP, Stewart AW, Becroft needs. New Zealand Medical Journal, 101: 711-713. DM, Thompson JM, Scragg R, Hassall IB, Barry DM, Allen EM et al, 1992. Four modifiable and Pomare EW, Tutengaehe H, Ramsden I, Hight M, other risk factors for cot death: the New Zealand Pearce N, Ormsby V, 1991. He Mate Huango - Maori study. Journal of Paediatrics & Child Health, 28 Asthma Review. Wellington: Ministry Maori Affairs. (Suppl. s3-8). Pomare EW, Keefe-Ormsby V, Ormsby C, Pearce N, Mitchell EA, Stewart AW, Pattemore PK, Asher MI, Reid P, Robson B, Watene-Haydon N, 1995. Harrison AC, Rea HH, 1989. Socio-economic Hauora - Maori standards of health III, a study of the status in childhood asthma. International Journal of years 1970-1991. Wellington: Eru Pomare Health Epidemiology, 18(4): 888-890. Research Centre. National Collective of Independent Women s Refuges Pool, 1994. Cross-comparative perspectives on New Inc, 1993. NCIWR Annual Report 1993. Zealand s health, In Spicer et al, 1994. Unpublished report, NCIWR, Wellington. Public Health Commission, 1994a. Fact sheet No 94.04, National Health Committee, 1998. Active for life - a call Wellington: PHC. for action. The health benefits of physical activity. Wellington: NHC. Public Health Commission, 1994b. Our Health Our Future. Wellington: PHC. National Health Committee, 1998. The social, cultural and economic determinants of health in New Zealand: Reid I, Chin K, Evans M, Cundy T, 1996. Longer action to improve health. Wellington: NHC. femoral necks in the young: a predictor of further increases in hip fracture incidence? New Zealand National Mental Health Consortium, 1989. Report. Medical Journal, 109:234-235. Wellington: Dept Health and Social Welfare. Reinken J, McLeod JW, Murphy TID, 1985. Health and New Zealand Doctor, 1997a. Needle refund scheme Equity. Wellington: Dept of Health. dealing with problem. 22 January. Robert I, Barker M, Li L, 1997. Analysis of trends in New Zealand Doctor, 1997b. How to treat: drug deaths from accidental drug poisoning in teenagers, addiction. 2 October. 1985-1995. British Medical Journal, 315 (7103) 289. 116 Robertson MC, Gardner MM, 1997. Prevention of falls in Strachan D. Jarvis M, Feyeraband C, 1989. Passive older populations: community perspective. Wellington: smoking, salivary cotinine concentrations, and middle National Advisory Committee on Health and ear effusions. British Medical Journal 298: 1549-1552. Disability. Te Puni Kokiri, 1993. He Kakano - a handbook of Maori Romans-Clarkson S, Walton V, Herbison G, et al, 1990. health data. Wellington: TPK. Psychiatric morbidity among women in urban and rural New Zealand: psychosocial correlates. British Thomson W, 1993. Ethnicity and child health status in Journal of Psychiatry, 156: 84-91. the Manawatu-Wanganui Area Health Board, New Zealand Dental Journal, 89: 12-14. m MG, Dickinson, JC, 1990. The incidence of cerebral palsy. Archives of Disease in Childhood, Vol Thornton N, 1991. Injecting drug users and HIV/AIDS. 65(6): 602-6. Wellington: Department of Health. Lg R, Baker J, Metcalf P, Dryson E, 1991. Prevalence of Treasure E, Dever J, 1991. The prevalence of dental caries diabetes mellitus and impaired glucose tolerance in a in 5 year old children living in fluoridated and non- New Zealand multi-racial workforce. New Zealand fluoridated communities in New Zealand. New Medical Journal, 104: 395-397. Zealand Dental Journal, 88: 9-13. Simmons D, 1996. Diabetes and its complications in New Triggs 5, O Connor P, Turner 5, 1994. Four in ten - a profile Zealand. International Epidemiological Perspectives, of New Zealanders with a disability or long-term illness. 109(1025):245-247. Wellington: Ministry of Health. Skegg D, 1989. How not to organise a cervical screening Wakeling A, 1996. Epidemiology of anorexia nervosa. programme. New Zealand Medical Journal, 102: 527-528 Psychiatric Research 62 (1). Skegg D, Paul C, Benson-Cooper D, Chetwynd J, Clarke Ware JE, Snow KK, Kosinski M, Gandek B, 1993. SF-36 A, Fitzgerald N, Gray A, St George I, Simpson A, Health Survey Manual and Interpretation Guide. Boston: 1989. Mammographic screening for breast cancer: The Health Institute, New England Medical Centre. prospects for New Zealand. New Zealand Medical Journal, 101: 531-533. Ware JE, Kosinski M, Keller SD, 1994. SF-36 Physical and Mental Health Summary Scales: A Users Manual. Skegg D, Cox B, 1994. Asthma, hepatitis B and AIDS. In Boston: The Health Institute, New England Medical Spicer et al, 1994. Centre. Somerville A, Barnett P, Malcolm L, 1976. The Wells JE, Bushnell JA, Homblow AR, Joyce PR, Oakley- intellectually handicapped in North Canterbury - a basis for Browne MA, 1989. Christchurch psychiatric service planning. Christchurch: Health Planning & epidemiology study, Part 1: methodology and lifetime Research Unit. prevalence of specific psychiatric disorders. Australian & New Zealand Journal of Psychiatry, 23: 3 15-326. Spicer J, Trlin A, Walton JA, 1994. Social dimensions of health and disease - New Zealand perspectives. West 5, Harris B, 1980. Health need and primary care, Palmerston North: Dunmore Press. New Zealand Medical Journal, 93: 264-267. Spier P, Norris M, 1993. Convicting and sentencing of Wetherall M, 1993. Medical profile of patients with offenders in New Zealand, 1983-1992. Wellington: fractured neck of femur. New Zealand Medical Journal, Dept of Justice. 106: 389-390. Stahlberg M, Ruuskanen 0, Virolainen E, 1986. Risk Wheadon M, Sceats J, Kokaua J, 1995. The validation of factors for recurrent otitis media. Paediatric Infectious the SF36 on a New Zealand population. Unpublished Diseases, 5: 30-32. paper, Health and Disability Analysis Unit, Midland Health, Hamilton. Stanton W, Silva P, Oei I, 1989. The prevalence of smoking in a Dunedin sample followed from age 9 to White K, 1994. Social construction of medicine and 15 years. New Zealand Medical Journal, 102: 657-659. health. In Spicer et al, 1994. Statistics NZ 1997a, Demographic Trends 1995 Wilkie AT, Ford RPK, Pattemore P, Schluter PJ, Town I, Wellington: Stats NZ. Graham P, 1995. Prevalence of childhood asthma symptoms in an industrial suburb of Christchurch. New Statistics NZ 1997b, 1996-97 New Zealand Health Survey Zealand Medical Journal, pl88-ll. Final Report. Report prepared for MoH and RHAs. Unpublished report, Stats NZ, Wellington. Wilkinson T, Sainsbury R, 1995. Diagnosis related groups based funding and medical care of the elderly: a form of Statistics NZ/Ministry of Health, 1993. A Picture of Health. elder abuse? New Zealand Medical Journal, 108: 63-65. Wellington: Stars NZ/MoH. 117 NOTES iioiiitio1 Cen Ministry of Health Wellington 118 mgm 77 A Im t1