2013 Memento TheNew Health Caledonia Situation in 2013 www.dass.gouv.nc Main health facilities in New Caledonia* H Public hospitals Private clinics Provincial health facilities ARCHIPEL DES BELEP Secondary medical centers and facilities Specialised services Medical districts and medico-social centers Belep Ouégoa Poum Bondé LOYALTY ISLANDS Pouébo Mouli PROVINCE Koumac St-Joseph CHN P Thavoavianon** H Ouloup Kaala-Gomen Hienghène Hnacoam Hnaeu OUVÉA Touho Siloam Wedrumel Poindimié Dueulu NORTHERN Voh Nathalo PROVINCE H CHN R-D Nébayes** Chépénéhé Mou Koné Ponérihouen Hmeleck Wé Népoui Houaïlou LIFOU Tiga Rawa Poya Kouaoua Pénélo Bourail Canala La Roche Thio La Foa Tadine Wabao Hnawayatch MARÉ DumbéaNord SOUTHERN PROVINCE Païta Unia Dumbéa Yaté NOUMÉA Plum Goro Mont Dore Boulari Ile Ouen Family counselling center Gaston Bourret Hospital H Vao Multi purpose counselling Magenta Hospital H medical center (ESPAS-CMP) ILE DES PINS Raoul Follereau Center H School medical center Col de la Pirogue Center Health education and promotion H office Albert Bousquet Hospital H Islands Province medical center Mother and child protection centers and school medical centers Montravel (PMI) Baie des Citrons Clinic Kaméré (CMS) Anse Vata Clinic Saint-Quentin (CMS) Magnin Clinic * The health facilities and staff available to the people of New Caledonia are detailed in Chapter II: Health Services ** The Koumac and Poindimié (Northern Province) hospitals each have a medico-psychological unit attached to the Albert Bousquet ‘CSH’ (Specialised Hospital Centre) + Mother and Child Health Centres in Poindimié and Koumac 2013 Sommairecontents 04 Demographic characteristics ...................P. 04 Population Medical causes of death .........................P. 05 Medical causes of perinatal death ...........P. 06 Infectious diseases ..................................P. 07 Chronic diseases ....................................P. 16 07 Mental illnesses .......................................P. 21 Health status Societal issues ........................................P. 24 Population group approach .....................P. 29 Health service organisation .....................P. 32 Health sector 38 General ...................................................P. 38 accounts Cost of health care ..................................P. 39 Non-medical 41 Environment ............................................P. 40 factors Economic and social data .......................P. 42 and health Direction des affaires sanitaires et sociales de la Nouvelle-Calédonie (New Caledonia Health and Social Affairs Service) Service des actions sanitaires (Health Action Department) Phone : (+687) 24 37 00 / Fax : (+687) 24 37 14 Email : [email protected] Website : www.dass.gouv.nc Population DEMOGRAPHIC CHARACTERISTICS The population of New Caledonia grew by 5.9% between the 2009 population census and the estimated population at 31 December 2012. Civil status data for 2013 were not published due to the need to make arrangements for the 2014 census. (4) (7) (3) (1) (6) (2) (5) rate Rate Infant at birth according Live births mortality Birth 01/01/2012 of increase Crude perinatal Life expectancy Life expectancy Fertility index Fertility mortality rate Population as atPopulation Number of deaths to place of residence Crude mortality rate 1 374 New Caledonia 260 000 11.9 4 389 17 2.18 3.9 5.1 13.5 74 / 80.4 (2013) Islands Prov. * 17 400 10.8 331 19 2.9 3 143 8.1 77.6 / 73.5 Northern Prov. * 47 000 11.7 829 17.7 2.3 3.6 274 6 79.7 / 75.4 Southern Prov. * 195 600 12 3 218 16.6 2.2 4 937 4.6 80.7 / 77.9 France 81 65.585 857 792 000 12.5 2.01 3.3 560 000 8.8 (in 000) INSEE together Fr. Polynesia ISPF 12.3 2.01 5.5 76.2 268 270 16.6 4.6 (2012 figures) (2010) (2012) (2010) together Australia (mid 2011) 22.7 million 1.2 14 1.9 4 6 79/84 New Zealand 4.400 000 62 543 15 2.2 5 28 964 7 79/83 INSEE - ISEE - INED *The 2013 data on provincial residents are unavailable. The natural growth rate1 Representing the difference between the crude birth and crude death rates for the year concerned, this rate stood at 11.9‰ in 2012. The birth rate2 : has been constantly falling since the 1960s, from 34.5 in 1965, to 23.4 in 1985 and 17‰ in 2012; a sharp rise in the birth rate was recorded in 2012, with 6.5% more births being recorded.. Trends in the various demographic rates 16,2 17 11 11,9 Rate for 1000 5,6 5,1 5,2 4,5 1980 1985 1990 1995 2000 2005 2006 2007 2010 2011 2012 Birth rate (16,7) Natural growth rate (4,6) Infant mortality rate (11,9) Mortality rate (4,8) Fertility index3 2.28 per 1 000 women of reproductive age. A decrease in the fertility rate range by age between 1981 and 2005 can be observed, with a rising average age for motherhood (28.9 in 2012). Crude mortality rate4 : 5.1 per 1 000. After a distinct drop in the 1970s and 1980s, the crude death rate has been decreasing more slowly for the past 10 years. It remained below 5 deaths per 1000 between 2004 and 2010. For the past 2 years, it has again risen above 5 per 1 000. 4 The health situation in New Caledonia - Key features 2013 In 2012, the crude death rate rose in the Islands Province (8.1 as against 6.8 in 2011) fell in the Northern Province (6 in 2012, 6.5 in 2011), while remaining stable in the Southern Province (4.6). Life expectancy at birth5 : 77.1 years in 2012 (men: 74; women: 80.4), Life expectancy at birth is characterized by a regular increase, with higher gains for men than for women over the last 20 years and a continuing gap between men and women. Infant mortality rate6 : 3.9‰. After a sharp drop in the 1970s, this rate, which is an indicator of a country’s socio-economic and health development status, fell more gradually until the early 1990s, when it dropped below 10‰. Since 2001, a steady but flatter decrease trend can be observed, with the rate moving increasingly closer to that of metropolitan France (3.9‰). New Caledonia still has a young population (39.9% under 25 yrs old). Improvements in socio-economic and health conditions have helped in raising life expectancy and reducing mortality, in particular infant mortality, which is now close to the developed country rate. However, the fall in the fertility rate, which is still higher than that necessary to maintain current population size, points to future difficulties associated with an ageing population. MEDICAL CAUSES OF DEATH 1 374 medical death certificates were issued in 2013 (men: 810; women: 564). The following classification by disease group varies only slightly from year to year. In 2013, gender-disaggregated, the 5 main causes of death were as follows: Men Women Tumours 27.6% 30% Circulatory system 20.6% 23.9% External causes of morbidity 15.7% 9.2% Respiratory system 8.0% 10.4% Abnormal symptoms, signs and results 12.9% 10.3% It is noteworthy that the external causes of morbidity group remained the principal causes of death in the young population in 2013, accounting for 49.2 % of deaths in 15-24 year-olds. This group represents the leading cause of premature death in both sexes in New Caledonia, with 12 183 years of potential life lost (YPLL) between 2011 nad 2013. (YPLL is 3.6 times higher in men than in women). 1 Natural growth rate: difference between crude birth rate and crude death rate, expressed as a per 1000 population figure. 2 Birth rate: ratio of annual number of live births to total population at the half-way stage of the year concerned, expressed as a per 1000 population figure. 3 Fertility index or conjunctural fertility indicator: sum of all fertility rates by age for the year concerned. 4 Crude mortality rate: ratio of annual number of deaths to total population at the half-way stage of the year concerned, expressed as a per 1000 population figure. 5 Life expectancy at birth expresses the mean number of years of life awaiting a new-born child if the mortality trends at the time of birth do not change. 6 Infant mortality rate: the ratio between the number of deaths in children aged less than one year per 1 000 live births in the year under consideration. 7 Crude perinatal mortality rate: number of stillborn children and deaths between 0 and 6 days for 1 000 total births. The health situation in New Caledonia - Key features 2013 5 Breakdown of causes of death in 2013 Tumours 28,5% (N = 393) Diseases of the circulatory system 21,9% (N=302) External causes of morbidity and mortality 13,0% (N=179) Diseases of the respiratory system 9,0% (N=124) Diseases of the digestive system 4,2% (N=57) Certain infectious and parasitic diseases 3,7% (N=51) Diseases of the genito-urinary system 2,0% (N=28) Diseases of the nervous system 1,8% (N=25) Endocrinic, nutritional and 1,2% (N=17) metabolic diseases Mental discorders 1,1% Certain perinatal conditions 0,6% (N=8) Diseases of the skin and subcutaneous tissue 0,3% (N=5) Diseases of the blood or 0,2% (N=3) of haematological origin Osteo-articular 0,2% muscle and conjunctive tissue diseases Pregnancy, delivery 0,0% (N=0) and puerperality Congenital malformations 0,0% (N=0) and chromosomal abnormalities Eye and related diseases 0,0% (N=0) Diseases of the ear and apophysis 0,0% (N=0) Factors influencing health status 0,0% (N=0) Abnormal symptoms, signs and results N: 163, with 121 coded R96 to R99 nombres 050 100 150 200 250 300 350 400 450 MEDICAL CAUSES OF PERINATAL DEATH In 2013, 74 child deaths were reported through specific perinatal death certificates, making a total of 1 420 deaths for the 1993-2013 period.