Nationally, the amenable mortality rate declined from 2001 to 2009. In 2007 New Zealand's rate was a little lower than the 31-country average for members of the Organisation for Economic Co-operation and Development.
Gisborne's chief health official, Jim Green, of the Tairawhiti DHB, attributes his area's nationally high rate to poverty and ethnicity in part.
"We have the most highly deprived population of any DHB in New Zealand, a factor which is associated with, but not completely related to, the Maori population proportion in the DHB being the highest - and significantly higher than any other DHB."
He says that although the estimates were adjusted for variations in each health district's age structure, factors not taken into account were ethnicity, sex and deprivation.
He produced a 2001-2004 graph showing that inclusion of those factors brought Tairawhiti's rate into the mid-range, with Waitemata on the lowest rate and Auckland DHB just slightly higher.
Mr Green makes the same argument about ministry data showing his region had the highest rate of hospital admissions that could have been prevented by treatment in primary care.
However, Tairawhiti DHB is trying to bring these rates down through various programmes.
Schemes to improve primary care and integrate it with hospital care are at the forefront, Mr Green says, noting that the Treasury paper describes this as a way forward for the health system. They have led to "a reduction in the utilisation of the emergency department at Gisborne Hospital in favour of more appropriate care in the community", and a reduction in acute admissions.
Counties Manukau DHB, whose rate of primary-care-preventable hospital admissions is well above the national level, acknowledges it is a problem.
The board's chief medical adviser on primary and integrated care, Dr Campbell Brebner, says this is not necessarily an indicator of the quality of primary care and the causes include poverty, high health needs and having fewer GPs per capita than most areas.
