29th March 2019, Volume 132 Number 1492

Michael Walsh, Corina Grey

Life expectancy is one of the most widely used measures in demographic and health analysis, and in New Zealand is among the highest of any country.1 Equity in health outcomes…

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Summary

Achieving health equity is a priority. Upholding te Tiriti o Waitangi should eliminate institutional racism against Māori and contribute to health equity. Given the Waitangi Tribunal is investigating health-related breaches of te Tiriti o Waitangi, we argue institutional racism needs to be acknowledged and addressed within the health sector. Historically the Crown response can be characterised by denial and inaction. The Crown has the power and resources to take action through mechanisms such as those they are currently applying to child poverty and gender pay inequity. Anti-racism literature recommends planned, systems-based approaches to eradicate the problem. We need the government to uphold our Tiriti responsibilities and we require a plan to end racism in the New Zealand health system.

Abstract

Aim

To determine the contribution of avoidable causes of death to the life expectancy differentials in both Māori and Pacific compared with non-Māori/non-Pacific ethnic groups in New Zealand.

Method

Death registration data and population data for New Zealand between 2013–15 was used to calculate life expectancy. A recent definition of avoidable mortality was used to identify potentially avoidable deaths. Life expectancy decomposition was undertaken to identify the contribution of avoidable causes of death to the life expectancy differential in the Māori and Pacific populations.

Results

Nearly half of all deaths in Pacific (47.3%) and over half in Māori (53.0%) can be attributed to potentially avoidable causes of death, compared with less than one quarter (23.2%) in the non-Māori/non-Pacific population. Conditions both preventable and amenable contribute the greatest to the life expectancy differentials within both ethnic groups, when compared with non-Māori/non-Pacific. Cancers of the trachea, bronchus and lung are significant avoidable causes contributing to the life expectancy differentials in both male and female Māori, contributing 0.8 years and 0.9 years respectively. Avoidable injuries including suicide contribute 1.0 year to the differential in Māori males. Coronary disease, diabetes and cerebrovascular disease are the largest contributors to the differential in both Pacific males and females.

Conclusion

Avoidable causes of death are large contributors to the life expectancy differentials in Māori and Pacific populations. The findings provide further evidence of the need to address the determinants of health and ensure equitable access to health services to reduce the impact of avoidable mortality on inequalities in life expectancy. It also highlights the importance of looking beyond individual factors and recognising the role of healthcare services and the social determinants in improving health equity.

Author Information

Michael Walsh, Epidemiologist, Planning Funding and Outcomes, Waitemata District Health Board, Auckland; Corina Grey, Public Health Physician, Planning Funding and Outcomes, Waitemata District Health Board, Auckland.

Acknowledgements

The authors would like to acknowledge Karen Bartholomew for her helpful contribution. The opinions expressed in this article are those of the authors and not of Waitemata District Health Board.

Correspondence

Michael Walsh, Planning Funding and Outcomes, Waitemata District Health Board, Level 1, 15 Shea Terrace, Takapuna, Auckland.

Correspondence Email

michael.walsh@waitematadhb.govt.nz

Competing Interests

Nil.

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