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Topic 13: Health

A good standard of health contributes to quality of life and enables people to participate in society and the economy. Good health is not simply the absence of physical disease, but also the enjoyment of mental well-being, in which every individual can have the opportunity to realise their potential, cope with the normal stresses of life, work productively, and make a contribution to their community.

Health is the result of a complex web of relationships, affected by social, economic, and structural factors, such as educational attainment (see topic 10), income and housing (see topic 12), access to recreational facilities, and access to affordable, effective medical care. Increasing prevalence of illness and disability in a population has direct and indirect economic consequences, by reducing the stock of human capital and requiring additional funding for care and treatment.

Main results

Between 1996 and 2006, health expectancy at birth increased but with gender and ethnic disparities. The five-year survival rates for people diagnosed with selected cancers increased between 1994 and 2006, and the overall suicide rate decreased by 10 percent from 1987 to 2006.

One in 15 New Zealand adults has a high or very high probability of having an anxiety or depressive mental illness. Approximately 1 in 7 adults has a healthy lifestyle.

Table 13.1
Health indicators – key results

Health indicators - key results.

What the indicators tell us

Health expectancy at birth (indicator 13.1)

Health expectancy is an estimate of the average number of years a person will live without requiring assistance with everyday activities. It is a summary measure of a population’s health that captures both ‘quantity’ and ‘quality’ of life. Improvements in health expectancy reflect changes in social and economic conditions, lifestyle changes, medical advances, and better access to health services.

Health expectancy at birth increased steadily for all females between 1996 and 2006, from 67.5 years to 69.2 years. The health expectancy for all males increased over the same period, from 64.7 years to 67.4 years, closing the gender gap most rapidly between 2001 and 2006 (see figure 13a).

There are ethnic differences in health expectancy. In 2006, there was a 5.0 year difference between the average female and the average Māori female healthy expectancy, and a 5.4 year difference between the average male and the average Māori male.

Between 2001 and 2006, life expectancy also increased. Life expectancy at birth is an estimate of the full number of years that a person will live, on average. It is important to compare this with health expectancy to take account of the number of years people require assistance to live. Between 1996 and 2006, the number of years lived dependently increased by 0.9 years for men and 0.8 years for women.

Health expectancy at birth for total population and Maori, by sex.

Prevalence of healthy lifestyles (indicator 13.2)

The risk of developing many chronic diseases is affected by the way people live. Historically, global human morbidity (disease or illness) and mortality were most affected by infectious diseases. While these remain threats, New Zealanders are now more likely to die prematurely from non-infectious diseases such as coronary heart disease, stroke, type 2 diabetes, and various cancers. These four diseases caused 63 percent of deaths in New Zealand in 2005 (Ministry of Health, 2009).

Healthy behaviours, such as non-smoking, safe drinking, taking sufficient physical activity, eating adequate amounts of fruit and vegetables, and maintaining a healthy weight, decrease the risk of developing the serious non-infectious diseases listed above. These five components have therefore been combined into a measure of a healthy lifestyle.

In the Ministry of Health’s 2002/03 Health Survey, 13.1 percent of adults were classified as having a healthy lifestyle. Five years later, the proportion was basically unchanged at 13.5 percent. There are, however, ethnic differences for this indicator. About 1 in 6 people of European ethnicity (15.7 percent) have a healthy lifestyle, while only 1 in 16 Māori (6.4 percent) and 1 in 25 Pacific peoples (4.0 percent) engage in all five healthy behaviours.

The two healthy behaviours people are least likely to undertake are sufficient physical activity and eating five or more servings of fruit and vegetables per day. Men are less likely to drink alcohol safely or eat sufficient fruit and vegetables, while women are less likely to undertake sufficient physical activity (see figure 13b).

Prevalence of healthy lifestyles, by behaviour and sex.

Childhood immunisation coverage (indicator 13.3)

Although chronic non-infectious illnesses are major causes of morbidity and mortality in New Zealand, diseases that are preventable by vaccination still occur. These diseases would have a significant effect on health in the absence of vaccination. Vaccination rates are a good indicator of people’s access to, and the effectiveness of, health care received in the community, such as from a general practitioner.

This indicator shows the percentage of children aged two years who are immunised, according to the vaccination schedule. In 2005, the proportion of immunised two-year olds was 77 percent. A 90–95 percent coverage rate is required to prevent disease outbreaks. Figure 13c shows the immunisation rate for selected ethnic groups, and that fewer Māori children were vaccinated than children from other ethnic groups.

National childhood immunisation coverage at age two years, by ethnic group.

Prevalence of psychological distress (indicator 13.4)

The 2006/07 Health Survey found that 6.8 percent of New Zealand adults have a high or very high probability of experiencing mental illness, particularly an anxiety or mood disorder.

For Māori and Pacific peoples, adults were 1½ to 2 times more likely to have a high or very high probability of a mood or anxiety disorder compared with adults in the total population (see figure 13d).

There is also a clear difference between males and females across all ethnic groups, with more women exhibiting a heightened risk of mental illness than men. The World Health Organization (2007) has also reported that women are more likely to be diagnosed with depressive or anxiety disorders than men.

Proportion of population aged 15 years and over with a high probability of anxiety or depressive disorder, by ethnic group.

Suicide rate (indicator 13.5)

Internationally, suicide is a major cause of death, and every year more New Zealanders die by suicide than in motor vehicle accidents. An international comparison of suicide rates in 13 countries between 2002 and 2005 showed that New Zealand’s 2005 suicide rate was the fourth-highest for males and fifth-highest for females. New Zealand’s youth (15–24 years) suicide rate is also very high, with the second-highest male youth and third-highest female youth rate (Ministry for Social Development, 2008).

Population suicide rates reflect the prevalence of severe mental distress and may indicate the limits of the health system to assist and care for those experiencing extreme psychological distress. The rates are age-standardised (see ‘About the indicators’ below).

The total population suicide rate increased in the mid-to-late 1990s, but has been declining since then and is now lower than it was in the late 1980s. In 2006, the total population suicide rate was 12.2 people per 100,000. This had declined from a high of 15.1 people per 100,000 in 1998, and is 10.1 percent lower than in 1987 (see figure 13e).

Suicide rates are relatively high for people aged 15–24, Māori, and those living in socially deprived areas. There are three times as many completed suicides among males than females, although females are more likely to attempt suicide or self-harm.

Suicide rates for total population and youth, 1987–2006.

Avoidable hospital admissions (indicator 13.6)

Every year people are admitted to hospital with conditions that could have been treated in a community setting. The number of these types of avoidable hospital admissions can indicate people’s access to, and the effectiveness of, community health care services. This indicator compares rates for these admissions over time.

Avoidable hospital admission rates are affected by social conditions such as housing quality and income, personal variables such as age and ethnicity, and geographic factors such as location and access to affordable health care in the community. Avoidable admissions are also affected by the quality of community care and the links and communication between general practitioners and hospitals. Reducing avoidable hospital admissions may allow resources to be used in other priority areas.

Across the whole population, the avoidable hospital admission rate decreased 3.8 percent between 2001 and 2008. However, there were differences across ethnic groups. The rate for Pacific peoples was about 2½ times greater than the ‘European and other’ rate, while the rate for Māori was twice that of the ‘European and other’ category (see figure 13f).

Avoidable hospital admission rates by ethnic group.

Cancer-survival probabilities (indicator 13.7)

Cancer is the second leading cause of death (after heart-related disorders) and a major cause of hospitalisation. This indicator reports five-year survival probabilities for people diagnosed with two common types of cancer in New Zealand: bowel (colorectal) cancer and female breast cancer. The probabilities are relative as they compare death rates for those diagnosed with cancer with rates for the population as a whole.

Five-year survival is affected by both the stage of the cancer when detected and the effectiveness of treatment (Welch, Schwartz, & Woloshin, 2000). Therefore, five-year cancer survival rates indicate the effectiveness of community and institutional (such as hospitals) health care systems.

The five-year survival probabilities increased for bowel and female breast cancer across the three reported time periods. In the 1994–98 period, 78.7 percent of female breast cancer patients survived five years after diagnosis. This increased to 84.4 percent in the 2002–06 period.

For bowel cancer, 57.3 percent of patients were alive five years after diagnosis in the 1994–98 period. The five-year survival rate increased to 60.8 percent by 2002–06. While Māori bowel cancer patients have lower five-year survival probabilities, they have seen much greater survival gains. Just over one-third of Māori diagnosed with bowel cancer survived five years in 1994–98, but nearly half survived in 2002–06 (see figure 13g).

Five-year cancer-survival probabilities, for total population and Maori, by cancer type.

About the indicators

Health expectancy at birth (indicator 13.1)

In New Zealand, independent life expectancy at birth is used to measure years of healthy life expected, according to year of birth. It is defined as the expectation of life without the need for assistance from another person or a complex assistive device (whether daily or intermittently).

Independent life expectancy is a summary measure of the population’s health as it combines both mortality and morbidity. It is calculated by the Ministry of Health using data from the 1996, 2001, and 2006 post-censal Household Disability Surveys.

Prevalence of healthy lifestyles (indicator 13.2)

The data for this indicator is from the New Zealand Health Survey, conducted for the Ministry of Health. The 2006–07 data was collected from October 2006 to November 2007. The 2002–03 data was collected from September 2002 to January 2004. Proportions are age-standardised to minimise the effect of differences in age composition when comparing rates for different populations. The World Health Organization compiles a standard population to reflect the average age structure of the world’s population, which enables international comparisons between countries.

The five healthy behaviours are defined as:

  • non-smoking – daily non-smoking
  • healthy drinking – abstaining or safe alcohol consumption
  • physically active – more than 30 minutes moderate activity on at least five days per week
  • adequate fruit and vegetable intake – at least three servings of vegetables and two of fruit per day
  • maintaining a healthy weight (not obese) – body mass index under 30.

Unhealthy behaviours can increase the risk of developing cancers and cardiovascular disease. Obesity and physical inactivity also increase people’s risk of type 2 diabetes, while excessive alcohol consumption is associated with social and emotional problems, as well as physical trauma.

Childhood immunisation coverage (indicator 13.3)

The data for this indicator comes from the National Childhood Immunisation Coverage Survey, conducted for the Ministry of Health. The principal caregivers for 1,563 children aged two years were interviewed between January and March 2005. Time series information about vaccination rates will be available in the future from the National Immunisation Register.

Prevalence of psychological distress (indicator 13.4)

The 2006/07 New Zealand Health Survey (Ministry of Health, 2008) was carried out from October 2006 to November 2007, surveying 12,488 adults (aged 15+ years). The indicator shows the proportion of respondents assessed as having a high or very high probability of experiencing a mental disorder, especially anxiety or depressive disorders.

Suicide rate (indicator 13.5)

The data is from the Ministry of Health. Suicide rates per 100,000 are age-standardised to a standard world population. As comparison of suicide rates between countries can be affected by the different age structures of the populations, age-standardisation is used (see indicator 13.2). A death can only be officially classified as suicide on completion of an inquest.

Avoidable hospital admissions (indicator 13.6)

This indicator covers a sub-category of hospitalisations from causes considered to be treatable in non-inpatient care settings. The data is from the Ministry of Health, which classifies these hospital admissions as ‘ambulatory sensitive’.

Cancer-survival probabilities (indicator 13.7)

The five-year relative cancer survival probability reports the number of people who are alive five years after diagnosis, adjusted for underlying mortality risks.

The rates are calculated by the Ministry of Health using data from the New Zealand Cancer Registry and Statistics NZ life tables. The time periods refer to cancers diagnosed in that period.

New Zealand has one of the highest bowel (colorectal) cancer death rates in the world. Bowel cancer is the most common cause of cancer mortality for the population as a whole. Breast cancer is the most common cause of cancer mortality among women.

Table 13.2
Health indicators – defining principles

Health indicators - defining principles.

See part C for the complete list of defining principles for all indicators.

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