PACIFIC PEOPLE IN NEW ZEALAND DEBBIE RYAN AND INEKE MEREDITH MARMOT SYMPOSIUM WELLINGTON 13 JULY 2011 PACIFIC PEOPLE IN NZ 2011 Pacific peoples constitute 6.9% of NZ population (2006 Census) 38% Pacific population under 15yr of age By 2051 , NZ student population will rise from 1 in 10 as it is currently to 1 in 5 Poorer life expectancy Highest mortality rate for cerebrovascular disease Mortality rate for cardiovascular disease higher than that for non-Maori non-Pacific People Diabetes Obesity Amenable mortality PACIFIC CHILD HEALTH IN NZ 85% Pacific children completely immunised by age 2 Highest failure rates new entrant hearing tests At 5yr of age, only 32% Pacific children caries free Pacific children aged 5 -14yr are 6x more likely to be obese than other children in NZ Unintended pregnancy and longterm consequences: poor antenatal care, obstetric complications, low birth weight infants, poor educational attainment and child abuse (The Best Intentions: Unintended Pregnancy and the Well -Being of Children and Families, 2005) Rheumatic Fever Rheumatic Heart Disease Meningitis Highest hospitalisations for asthma ACUTE RHEUMATIC FEVER IN NZ Acute Fever Rheumatic Admissions in 0-24 Year Olds by Ethnicity, New Zealand 1996-2007 Source: New Zealand Child and Youth Epidemiology Service SERIOUS SKIN INFECTIONS Hospital Admissions due to Serious Skin infections in Children and Young People 0-24 years by Ethnicity, New Zealand 1996-2006 Source: New Zealand Child and Youth Epidemiology Service AVOIDABLE HOSPITALISATIONS NZHS 2006: Decreasing unmet need Pharmaceutical expenditure approximates that expected based on health need Increasing rates of emergency care self -presentation for less urgent conditions ASH rates per 1000 for Counties Manukau 0-74 year olds, by ethnicity 2001-2009 Pacific Maori non-Maori non-Pacific Source: CMDHB: Changes in Primary Health Care 2001 - 2009 FOCUS ON YOUTH Disadvantage at dif ferent stages of life af fects adult health (Power and Kuh 2006) Are there circumstances which make inequality later in life more likely? “Although all children gain from quality early childhood education, society benefits most from the investment in children from low -income or disadvantaged homes” (Improving the Transition, May 2011) A FOCUS ON REDUCING INEQUALITIES FOR PACIFIC PEOPLES SYSTEM RESPONSE Legislation NZ Public Health and Disability Act 2000 – “...to reduce health disparities by improving the health outcomes of Maori and other population groups...” National strategies New Zealand Health Strategy 2000 Primary Health Care Strategy 2001 Public Health Pacific Health and Disability Action Plan 2002 and Pacific Provider Development Fund Quality focus Evidence based guidelines Primary health care accreditation Performance management Research and evaluation Workforce development DETERMINANTS OF HEALTH AND EMPOWERMENT DHB Pacific community and church based programmes Enua Ola Lotu Moui Health Village Action Zones HEHA Housing programmes Anti-smoking Health prevention- immunisation (MenzB, childhood, Influenza, HPV), cancer screening, early childhood health checks Pacific unemployment rate in was 4.7%, (3.4%) in December 2007 compared with 26.1% (10.6%) in 1992. A NEW APPROACH – UNDERSTANDING “ADAPTIVE CHALLENGES”