Life expectancy disparities among ethnic groups widen

4.00pm - By MICHAEL DALY

There are growing disparities in life expectancy among Maori, Pacific and European New Zealanders, according to a major study released today.

The joint report, by researchers from Otago University's Wellington School of Medicine and Health Sciences and the Health Ministry, shows European New Zealanders now have a life expectancy around 10 years longer than that for Maori.

The Decades of Disparity study also found cancer death rates had increased for Maori and Pacific people, while those for European New Zealanders had fallen.

Researchers found the life expectancy for Maori females increased from 69.4 years between 1981 and 1984, to 71 years between 1996 and 1999. For Maori males life expectancy increased from 64.6 to 65.8.

For non-Maori, non-Pacific Island females the increase was from 77.2 to 80.8 years, while for males in the same group the improvement was from 70.9 to 75.7 years.

Life expectancy for Pacific Island males increased from 66.7 to 67.9 years, while Pacific females slipped back from 74.8 to 73.9 years.

While the incidence of cancer was much the same between ethnic groups, Maori and Pacific people had about twice the mortality rate.

Maori bowel cancer death rates had nearly doubled in the past 20 years, while those for Pacific people had increased approximately tenfold.

Male Maori lung cancer rates were 3.5 times greater than European males by the late 1990s, and female Maori lung cancer rates were five times greater than female Europeans.

Maori and Pacific breast cancer mortality rates had increased, and by the late 1990s were 1.5 to two times higher than for Europeans, whose rates had decreased.

The report pointed to major economic and social changes starting in the early 1980s as a factor in the disparities.

Co-author Tony Blakely said the mortality rates for European men had fallen 30 per cent in the past 20 years. For European women it was 26 per cent.

"In contrast Maori and Pacific mortality rates have only decreased modestly, if at all," he said.

"It's a fairly important report. What we've done is collected 20 years of data... and the results are quite dramatic.

"These are quite divergent patterns, quite startling patterns."

Maori had enjoyed large increases in life expectancy from the 1950s to the 1970s, but discrepancies between Maori, Pacific and European life expectancy emerged in the 1980s.

The patterns were "clear and disturbing", Dr Blakely said.

He told NZPA it was known that education, income and other social factors affected people's health status.

People on lower incomes could find it more difficult to buy fresh fruit and vegetables for a healthy diet, and to live somewhere conducive to good health.

Issues related to work opportunities could cause separation from society for many people and "get under the skin", leading to such things as alcohol-related diseases and injuries, he said.

The increase in cancer death rates among Maori and Pacific peoples "really caught us by surprise", Dr Blakely said.

With some cancers, changing diets could be a factor, but overlying the whole issue was the quality of health services and access to them.

He pointed to the large number of steps someone needing major health care would have to go through.

"We don't know where along that track it breaks down," he said.

Other findings in the study included:

* Heart disease death rates had fallen across all ethnic groups in the past two decades but the decrease was greatest for European New Zealanders, and

* injury mortality rates had fallen in all ethnic groups, with Europeans having about half the rate of Maori.

Co-author Bridget Robson said Maori leaders in the 1980s had predicted government policies would make Maori the shock absorbers of the economy.

"Increasing Pakeha advantage in access to and power over socio-economic resources is the primary cause of these health inequalities," she said.

Public Health Association spokeswoman Marty Rogers said the research showed there had been no improvement in Maori mortality over the past 20 years.

Ms Rogers said there had been debate about spending on services for Maori but the research clearly showed not enough was being done.

"The research validates the Public Health Association's strong stance that Maori health should be very high on the Government's agenda."

Policymakers needed to pay heed to the message that many of the answers to poor Maori health statistics lay outside the health services themselves, she said in a statement.

Housing, education and economic policies all had a major effect on the health and wellbeing of communities and it was crucial government agencies started working together, instead of trying to solve issues in isolation.

"We keep hearing about the need for government agencies working more collectively but many of these agencies continue to operate as silos."

It was also important the Government assessed the impact of all its policies on the health and wellbeing of Maori, Ms Rogers said.

The researchers pointed out that the divergence in life expectancy started at the time of the economic reforms in the early 1980s.

"People need to understand that policy in areas such as housing or economics can have a major downstream effect on health.

"Meningococcal disease is one example of where changes in housing policy have created overcrowding and we have seen an epidemic of the disease."

Health Ministry spokesman Don Matheson said while the results were not unexpected, they were still of great concern.

"We've known for some time that ethnic identity is an important dimension of health inequalities in New Zealand, but this is the first time that robust ethnic mortality rates have been available, allowing the full extent of the disparity to be documented. Such health inequalities are unacceptable," Dr Matheson, the ministry's deputy Director-General of Public Health, said.

"The report clearly supports ongoing efforts in the health and disability sector to reduce health inequalities, helping New Zealanders to live healthier, longer lives."

The ministry was already doing a lot of work in this area. The Government had recognised the importance primary health care plays in reducing health inequalities by spending more than $400 million over three years on implementing the Primary Health Care Strategy.

"Fundamental to this policy are Primary Health Organisations (PHOs), and in the past year about 1.7 million New Zealanders have enrolled in PHOs," Dr Matheson said.

"Of these, more than 800,000 people are now paying no more than $20 to visit the PHO.

"We believe that by making low-cost primary health care more accessible we can make a real difference to improving the overall health of New Zealanders and reducing health inequalities, particularly for high needs groups such as Maori and Pacific peoples," he said in a statement.

The ethnic mortality trend information reported today should mobilise all sectors of the government and the community to redouble efforts to address the legacy of increasing ethnic inequality in survival chances, he said.

"Reducing health inequalities is a priority, but not just for the ministry. It requires ongoing commitment across the sector. When you look at these mortality trends, you can see why it's everyone's business."

- NZPA

University of Otago:

Widening mortality gaps between Maori, Pacific and European New Zealanders

Herald feature: Maori issues