i k?, xtitj i k i...highest level of education 23 te mahi - labour force 25 nga kore mahi -...

" I k?, XTITJ . I k iA DEMOGRAPHIC & HEALTH

STATUS PROFILE

PREPARED FORTE TAHUHU HAUORA 0 TE TAIRAWHITI

BYANGELIQUE PARR

HEALTH & DISABILITY ANALYSIS UNITMIDLAND HEALTH March 1994

TABLE OF CONTENTS

INTRODUCTION ix

EXECUTIVE SUMMARY xiv

CHAPTER IPOPULATION COMPOSITIONDISTRIBUTION OF MAORI IN TAIRAWHITI ..............................2

AGE STRUCTURES...............................................5

POPULATION PYRAMIDS 5MALE/FEMALE RATIOS 8AGE STRUCTURES OF THE MAORI POPULATION WITHIN TAIRAWHITI9

1. TAMARIKI (0-14 years) 92. RANGATAHI (15-24 years) 93. NGA PAKEKE (25-64 years) 104. NGA KAUMATUA (65 years and over) 10

RURAL-URBAN DISTRIBUTION ...................................... 11

IWI............................................................ 12

CHAPTER IISOCIAL AND ECONOMIC FACTORS RELATING TO HEALTH

KO TE MOETANGA - MARITAL STATUS ...............................14

FAMILYTYPE ....................................................17

NGA WHARE - HOUSING .............................................20

TYPE OF HOUSING................................................. 22

KO TE MATAURANGA, NGA MAHI ME TE KORE MAHIEDUCATION, LABOUR FORCE AND UNEMPLOYMENT ...................23

HIGHEST LEVEL OF EDUCATION 23TE MAHI - LABOUR FORCE 25NGA KORE MAHI - UNEMPLOYMENT 26

II

KO TE UTU - INCOME. 29

(a) Family Incomes 29(b) Individual Incomes 31

INCOME SUPPORT ..................................................32.

NGA MAHINGA - OCCUPATION ...................................... 33

TE TOHU MAHI - INDUSTRY ........................................37

SUMMARY....................................................... 41

CHAPTER IIIHEALTH STATUSCHILD AND MATERNAL HEALTH ...................................42

SUMMARY - CHILDBEARING PATTERNS

42BIRTHS 42TOTAL FERTILITY RATES

43

AGE-SPECIFIC FERTILITY RATES 45TEENAGE CHILDBEARING 48CHILD-WOMAN RATIOS

49

BIRTH WEIGHTS

50INFANT DEATHS 52

Summary 52Perinatal Deaths 53Neonatal Deaths 54Post-Neonatal Deaths 55

Sudden Infant Death Syndrome 57Ratio of Neonatal to Post-neonatal Deaths 58Total Infant Deaths 59

LIFE EXPECTANCIES .............................................. 62RISK OF PREMATURE DEATH 63SUMMARY 65

DEATH RATES AND MAJOR CAUSES OF DEATH ......................65

SUMMARY 66DEATHS 66DEATH RATES 67AGE-SPECIFIC DEATH RATES AND THEIR MAJOR CAUSES

68

HOSPITAL DISCHARGES .......................................... 71

SUMMARY 71TOTAL DISCHARGES 72

ivDISCHARGE RATES FOR MEDICAL SPECIALITY AREAS 73AN AGE ANALYSIS OF DISCHARGE RATES 76

(a) Infants under 1 year 76(b) Young children (1-4 years) 79(c) Children (aged 5-14 years) 82(d) Young adults (15-24 years) 85(e) Working age adults (25-44 years) 88(f) Middle-aged adults (45-64 years) 91(g) Elderly (65 years and over) 93

MENTAL HEALTH ................................................ 96

MENTAL HEALTH SERVICES IN TAIRAWHITI 96MENTAL ILLNESS AMONG ADOLESCENTS (AGES 10-19 YEARS) 97MENTAL ILLNESS AMONG WORKING AGE GROUPS (AGED 15-64 YEARS)98MENTAL ILLNESS AMONG THE ELDERLY (AGED 65 YEARS AND OVER)100

CHAPTER IVACCESS TO PROVIDERSTRAVEL TIMES TO HEALTH PROVIDERS IN THE TAIRAWHITI REGION .... 102

TRAVEL TIMES - KEY FINDINGS 103TRAVEL TIME TO MATERNITY SERVICE PROVIDERS 105TRAVEL TIME TO AN OUTPATIENT SERVICE 108TRAVEL TIME TO A BASE HOSPITAL 111TRAVEL TIME TO A LEVEL 6 HOSPITAL (TERTIARY) 113

HEALTH SERVICE PROVIDERS IN TAIRAWHITI .......................115

Table 1.1Table 1.2Table 1.3

Table 3.1Table 3.2Table 3.3Table 3.4

Table 3.5

Table 3.6

Table 4.1Table 4.2

Maori Populations, Tairawhiti and Midland, 1991Male/Female Ratios', Tairawhiti and Midland, 1991Mainiwi by Affiliation, Tairawhiti, 1991

Total Fertility Rates: Tairawhiti and Midland, 1988-1991Child-Woman Rations, Tairawhiti and Midland, 1991Birth Weights (1), Tairawhiti and Midland, 1988-1990Infant Deaths Due to Sudden Infant Death Syndrome (SIDS),1988-1990Probability of Premature Death, Tairawhiti and Midland,1990-1992Death Rates, All AGes, Tairawhiti and Midland, 1990-1992

Travel Time to Health Services in the Tairawhiti RegionFamily Health Personnel, Total Population, Midland &Tairawhiti

V

28

12

445051

58

6467

104

116

VI

Figure 1.1Population and Boundary Map of Tairawhiti's Individual Wards, 1991 3

Figure 1.2Maori as a proportion of Total population, New Zealand, Midland, Tairawhiti andcomponent Wards, 1991 4

Figure 1.3Age-Sex Distributions, Tairawhiti and Midland, 1991 7

Figure 2.1Marital Status: Tairawhiti and Midland, 1991 16

Figure 2.2One- and Two-Parent Families with Dependent Children, Tairawhiti & Midland, 1991 19

Figure 2.3Housing Tenure, Tairawhiti and Midland, 1991 21

Figure 2.4Proportion of the Population with No Qualifications: Tairawhiti and Midland, 199124

Figure 2.5Age-Standardised Unemployment Rates(1), Tairawhiti and Midland, 199128

Figure 2.6Proportion of Families with Incomes Under $30,000, Tairawhiti and Midland, 199130

Figure 2.7Major Occupation Groups, Maori Population, Tairawhiti, 1991 36

Figure 2.8Distribution of Employment by Industry Group, Tairawhiti, 1991 40

Figure 3.1Age-Specific Fertility Rates, Tairawhiti and Midland, 1991 47

Figure 3.2Neonatal, Post-neonatal and Total Infant Death Rates, Tairawhiti and Midland,1988-1990 61

Figure 3.3Age-Specific Death Rates, Tairawhiti and Midland, 1990-1992 70

Figure 3.4Major Discharge Rates for Medical Specialties (All Ages), Tairawhiti and Midland,1990-1992 75

Figure 3.5Discharge Rates for Infants Under 1 year, Tairawhiti and Midland, 1990-199278

vi'

Figure 3.6Discharge Rates for Children Aged 1-4 years, Tairawhiti and Midland, 1990-1992.81

Figure 3.7Discharge Rates for Children Aged 5-14 Years, Tairawhiti and Midland, 1990-1992 84

Figure 3.8Discharge Rates for Young Adults Aged 15-24 years, Tairawhiti and Midland,1990-1992 87

Figure 3.9Discharge Rates for Adults Aged 25-44 Years, Tairawhiti and Midland, 1990-199290


Figure 3.11Discharge Rates for the Elderly Aged 65 Years and Over, Tairawhiti and Midland,1990-1992 95

Figure 4.1Travel Time to a Maternity Service, Tairawhiti and Midland 106

Figure 4.2Travel Time to a Maternity Centre, Maori and Non-Maori Populations, Tairawhiti106

Figure 4.3Travel Time to a Maternity Centre, Female and Total Population, Tairawhiti107

Figure 4.4Travel Time to an Outpatient Centre, Tairawhiti and Midland 110

Figure 4.5Travel Time to an Outpatient Centre, Maori and Non-Maori Population, Tairawhiti 110

Figure 4.6Travel Time to a Base Hospital, Tairawhiti and Midland 112

Figure 4.7Travel Time to a Base Hospital, Maori and Non-Maori Population, Tairawhiti112

Figure 4.8Travel Time to a Level 6 Hospital, Tairawhiti and Gisborne 114

Figure 4.9Travel Time to a Level 6 Hospital, Maori and Non-Maori Population, Tairawhiti114

VIII

APPENDIX ADATA TABLES: CHAPTERS 1, 2 and 3

APPENDIX BGLOSSARY OF MAORI TERMS USED

APPENDIX CA CAUTIONARY COMMENT FOR PROFILE USERS

APPENDIX DTECHNICAL ISSUES TO BE CONSIDERED IN THE ANALYSIS OFTAIRAWHITI'S POPULATION

ix

TAI RAWHITI

MAORI HEALTH PROFILE"Ka kohl te toi ka whal te mramatanga"

("If knowledge is gathered, enlightenment will follow")

WHAKAPUAKI (Introduction)

E nga waka, e nga reo, e nga kãrangarangatanga maha, e rigã mahuetanga iho a ratouma kua wheti]rangitia e, tënã koutou, tënã koutou, tênâ koutou katoa.

Ténel ka tuku te pukapuka nel hei arahi I nga mahi e hapai na e koutou, mo te iwiMãori.

Midland Health is committed to promoting the wellbeing of Mãori in accordance with theTreaty of Waitangi "...so that in the future Mãori will have the same oppurtunity to enjoy atleast the same level of health as non-Mãori."1

This preliminary report provides Iwi with information about

the characteristics of the Maori population in Tairawhiti, and comparisons with boththe Tairawhiti Total and Midland Maori populations

the socio-economic status of Maori in Tairawhiti

the health status of Maori in Tairawhiti

It provides a basis on which the Mãori health status in Tairawhiti can be reviewed so thathealth planners in particular can use this information to ensure that health services areprovided to meet Mãori needs.

THE MAORI POPULATION DEFINED

This report uses two definitions of the Maori population, both derived from the 1991 Censusof Population and Dwellings. The first population, 'health' Maori, comprises only thosepeople of sole Maori origin. That is, those people who specified Maori as being their onlyethnic group at the census. The second population, 'socio-cultural' Maori, is made up of the'health' Maori population plus those people who belonged to several ethnic groups, withMaori being one of them. For further details on the derivation of these two populationgroups, please see Appendix C.

The broader socio-cultural' population is considered to be a more realistic definition, so isthe focal population of this report. However, the 'health' Maori population is employed inparts of Chapter III to maintain a consistent base in calculating many of the health statusmeasures.

1Policy Guidelines to Regional Health Authorities, November 1992

x

The Ministry of Health's Health Information Service is currently developing strategies tostandardise the collection of Maori ethnicity data throughout the health sector.

DATA SOURCES

The data presented in this report came from four main sources:•registrations of births and deaths (from the Department of Statistics)•1991 Census Population and Dwellings (largely using 'Supermap')•cause of death data, and•hospital discharge data (both from the Ministry of Health).

Most of the census data relate to the population that usually lived in Tairawhiti at the timeof the 1991 Census. They exclude temporary visitors (both from elsewhere in New Zealandand overseas), but does not include any Tairawhiti residents who were overseas at censusdate. However, some data (where indicated) is based on the census night population andtherefore includes temporary visitors.

As noted earlier,the characteristics of Tairawhiti Maori are compared to the Total Tairawhitipopulation. While this latter group includes the Maori population, its characteristicsapproximate to those of the non-Maori population.

xiDATA PRESENTATION

As noted earlier, the characteristics of the Tairawhiti Maori population are compared withtwo other populations - the Total Tairawhiti population and the Midland Maori population.For comparable data relating to the Midland Total population, please refer to The Peopleof Midland, another demographic profile prepared by the Health and Disability Unit atMidland Health.

The key results of this report are presented in note form, and where appropriate, showngraphically.

All data used in this analysis are contained in Appendix A.

Comparisons are made between Tairawhiti Maori and Total (Maori and Non-maori)populations, and Tairawhiti Maori and Midland Maori, for comparable data relating toMidland Total population. Please refer to The People of Midland, Health & DisabilityAnalysis Unit, Midland Health.

ACKNOWLEDGEMENTS

A technical review of the data analysis has been carried out by the Population StudiesCentre, University of Waikato.

This report has been prepared with the assisance of seveal other members of the Healthand Disablility Analysis Unit at Midland Health:•Maria Rangiwha for background material, Maori language translation and information

on health service providers in Tairawhiti•Jesse Kokaua for preliminary data analysis and preparation of figures in this report•Lindsay Duirs for preliminary data analysis and proof reading of this report•Richard Hoskins for health status data (chapter 3)•Jaqui Moore for travel times to health providers in Tairawhiti (chapter 4)•Janet Crouch for the typing and preparation of this report•Janet Sceats, manager of Health and Disability Analysis unit, for guidance and

overall direction of the report

xl'

TE WAHANGA TUATAHIMIDLAND REGION

The Midland region covers close to twenty percent of the land area of New Zealand, andis made up of twenty-one Territorial Local Authorities (TLA's). It is situated in the middleof the North Island and therefore described by Mãori as "Te Puku o te Ika a Maui".

The Midland region is made up of four geographic regions:

1. WAIKATO"Waikato taniwharau, he piko he taniwha, he piko he taniwha"

2. TE MOANA 0 TOl

"Te Kai a te Rangatira, He kôreroHe Mana, He lhi, He Tapu"

3. TAI RAWHITI

" He makatanga I nga hihi o te rd kite motu"

4. TARANAKI

"Pô Wairaka I raru ai"

Kawa and Te Reo are markedly different from region to region within Midland. Every Mãorirelates to a waka. They also identify with the Maunga and Awa or Moana within theirtQrangawaewae/rohe.

In each of these rohe Midland has established a partner relationship with Iwi Mãori in theform of a Joint Venture. These Joint Venture Units will help to ensure that Midlandpurchases appropriate health services for Mãori, with a particular focus on their respectivelocalities. The Iwi Joint Ventures, their locations and populations are shown in Figure 1.1.

WAIKATO IWI JOINT VENTURE

The Joint Venture Unit in the Waikato Region was the first to sign their agreement withMidland Health at a ceremony held at Nga Miro Health Centre, Ngaruawahia. This wasattended by the Joint Venture Board representatives from the Waikato lwi and Midland andthe Minister of Health, The Right Honourable Bill Birch on Wednesday 8 September 1993.This Joint Venture Unit is called "Piki Te Ora" and consists of five Iwi of the Waikato Region:Tainui, Hauraki, Tuwharetoa, Maniapoto and Ngati Raukawa.

TARANAKI IWI JOINT VENTURE

Te Ara Tuhono o Taranaki Joint Venture agreement with Midland Health was signed onNovember 8th. Te Ara TOhono o Taranaki represent eight lwi in Taranaki, mainly Te Atiawaand Ngati Ruanui.

XIII

TAI RAWHITI IWI JOINT VENTURE

Two major iwi authorities are represented in the Tairawhiti region: Te ROnanga oTQranganui a Kiwa and Te ROnanga o Ngati Porou.The largest iwi in this region are NgatiPorou, Te Aitanga a Mahaki, Ngati Kahungunu and Tuhoe.

This Joint Venture Unit is known as Te Tahühü Hauora o Te Tairawhiti. Their agreementwith Midland Health was signed on 13th October 1993 with the Associate Minister of Health,the Honourable Catherine O'Reagan, in attendance.

BAY OF PLENTY IWI JOINT VENTURETe Tatau Pounamu represents 17 Iwi in Te Moana o Toi. Their Joint Venture agreementwas signed on 15th October 1993. The Iwi represented by this Joint Venture Unit are: TeWhanau a Apanui, Whakatohea, Ngati Awa, Tuhoe, Ngai Tai, Ngati Pikiao, Tuhourangi,Tuwharetoa ki Kawerau, Te Ika Whenua, Te Ure 0 Uenuku Kopako, Ngati Tahu, NgãtiRangiteaorere, Tapuika Waitaha, Ngaiterangi, Ngati Pukenga, Ngati Ranginul and Rautahi.Figure (i)Joint Venture Regional Boundaries Map and 1991 Populations

xiv

EXECUTIVE SUMMARY

POPULATION COMPOSITION

There were 17781 people who identified as Maori in Tairawhiti in 1991; they madeup 40% of the Total Tairawhiti population. This is the highest proportion for any areawithin Midland, and is twice the proportion for the Midland region as a whole.

The Maori population had a younger population structure than the total Tairawhitipopulation in 1991 - half of all Maori were under 25 years of age.

The distribution of the Maori population varied widely within Tairawhiti's wards. Thepopulations of 'rural' areas generally had higher proportions of Maori than 'urban'areas.

The largest iwi in Tairawhiti in 1991 was Ngati Porou, making up 55% of the Maoripopulation.

SOCIAL AND ECONOMIC FACTORS RELATING TO HEALTH

Tairawhiti Maori had differing social structures from those of the total Tairawhitipopulation, but were not too dissimilar to the Midland Maori population as a whole.However, Tairawhiti appeared to be 'disadvantaged' particularly with respect toeconomic status compared with the Total Tairawhiti and Midland Maori populations.

A larger proportion of Maori families had young children, were sole parent familiesand lived in rental accommodation than both the total Tairawhiti population andMidland Maori as a whole.

Maori had generally higher unemployment levels, lower incomes and a greaterproportions receiving income support than the Total Tairawhiti population andMidland Maori as a whole.

HEALTH STATUS

The picture relating to the health status of Tairawhiti Maori is mixed. Their healthstatus lags behind that of the total Tairawhiti population. However, for a number ofindicators, particularly with respect to maternal and child health, Tairawhiti Maori farebetter than Midland Maori as a whole, and in some cases New Zealand Maori aswell, despite their poorer social and economic status.

Tairawhiti Maori women had slightly smaller families than the Total Tairawhitipopulation and Midland Maori as a whole.

Although Tairawhiti Maori infant death rates were higher than for the Total Tairawhitipopulation, they were lower than for both Midland and New Zealand Maori as awhole.

While the life expectancy of Tairawhiti Maori has not shown any markedimprovements in recent years and remains lower than the total Tairawhiti population,

xv

it is still higher than for Midland Maori as a whole..

Maori death rates were lowest at the youngest ages (except infants under 1 year ofage) and increased with age. Tairawhiti Maori death rates were generally higher thanthe Total Tairawhiti population, but lower than for Midland Maori as a whole.

Tairawhiti Maori had higher discharge rates at all ages, than both the Total Tairawhitipopulation and for the Midland Maori population as a whole.

CHAPTER IPOPULATIONCOMPOSITION

2

DISTRIBUTION OF MAORI IN TAIRAWHflI

At the 1991 Census, 15,291 people identified themselves as Maori ('health' definition

or single origin). This made up 35% of Tairawhiti's Total population. In comparison,

Maori ('health' definition) made up only 17% of the Total Midland population - halfthe proportion found in Tairawhiti (Table 1.1).

Note: The following points relate to the 'socio-cultural' definition of Maori

17,781 people identified themselves as Maori ('socio-cultural' definition) and made

up 40% of Tairawhiti's Total population. This proportion is twice that found inMidland (Table 1.1).

12% of all Midland Maori ('socio-cultural') lived in Tairawhiti in 1991.

Within the Tairawh'iti region, some districts had higher proportions of Maori than

others [see Figures 1.1, 1.2 and Appendix Table A1.1]. For example, four-fifths of

all people living in Waiapu and Matakaoa Wards were Maori, compared with only

one in six people in the Taruheru Ward. Three Wards - Waikohu, Uawa, and Kaiti,

had about half of their populations belonging to the Maori ethnic group, while theremaining Wards had between one-quarter and one-third.

The proportion of Maori in Tairawhiti region was more than three times that for NewZealand as a whole - 40% compared with 13%.

Table 1.1hlFàori Populations, Tairawhiti and Midland, 1991

I 'Socio-Cultural' Definition J

'Health' Definition

Midland MaoriNumber 144,897 114,600

%ofTotal 21 17

Tairawhiti MaoriNumber 17,775 15,291

% of Total 40 35

Source:Department of Statistics, 1991 Census of Population & Dwellings.

Figure 1.1

Population and Boundary Map of Tairawhiti's Individual Wards, 1991

3

;

\ /

T*-

:Ua Ward.

\'N

&pk Ward

El = 294.00-- 500.00tl> 500.00-- 1000.00

> 1000.00 -- 2500.00:> 2500.00 -- 3500.00

> 3500.00 -- 4500.00> 4500.00 -- 5000.00

L/ \PatutiI Ward Tari'heru Ward

( \,Whataupoko Ward

ui Ward

• Kaiti Ward• Waikanae Ward

New Zealand

Midland Region

Ta iraw h iti

Matakaoa Ward

Waikohu Ward

Waiapu Ward

Cook Ward

Uawa Ward

Taruheru Ward

Patutahi Ward

Wainuj Ward

Whataupoko Ward

Waikanae Ward

Kaiti Ward

4Figure 1.2

Maori as a proportion of Total population, New Zealand, Midland, Tairawhitj andcomponent Wards, 1991

('Soclo-Cultural' definition)

zu406080100Percent Maori

Source:Department of Statistics, 1 g i Census of Population & Dwellings.

5

AGE STRUCTURESPOPULATION PYRAMIDS

A population pyramid graphically shows a population's age and sex composition. By

showing the proportions of males and females in each age group, it provides at a glance,

an image of a population's characteristics. Such pyramids have been constructed for the

'health' and 'socio-cultural' Maori, and Total populations, and are shown in Figure 1.3.

Comparison of Tairawhiti Maori and Tairawhiti Total populations

Both Maori populations ('health' and 'socio-cultural' definitions) had younger age

structures than the Total population in the Tairawhiti region [See Appendix 1.3 (a) -

(c)].

More than one-third of Tairawhiti Maori (of either sole origin 'health' or'socio-cultural'

groups) were under 15 years of age in 1991, compared with one-quarter of the Total

population.

More than half of both Maori populations (53% of 'health' Maori and 54.5% of 'socio-

cultural' Maori) were under 25 years of age, while 43% of Tairawhiti's Total

population was under 25 years of age.

At the other extreme of the age spectrum, only about 7% of both Maori groups were

in the retirement ages of 60 years and over, compared with 15% of the Total

Tairawhiti population.

Comparison of Tairawhiti Maori and Midland Maori[See Appendix Tables A1.3(a) and (b)]

Tairawhiti Maori population has a slightly older age structure than the Midland Maori

population.

The Tairawhiti Maori population had a slightly older age structure than the Midland

Maori population.

6

The proportion of Midland Maori ('health' and 'socio-cultural') in the under 15 years

age group, and in the 15-24 year age group, was slightly higher than that found inTairawhiti.

However, the Tairawhiti Maori population did have larger proportions of elderl when

compared with the Midland Maori population.

':4Figure 1.3Age-Sex Distributions, Tairawhiti and Midland, 1991(a) 'Socio-Cultural' Maori(b) 'Health' Maori -(c) Total Population

(a) "Socio-cultural" Maori (b) "Health" Maori

•: 85+

n8676 .j=91055054n7500 n7800

- 40-443539303425-2920-24

IV ------151910-14

59•-under 5

161412108 6 4 2 0 2 4 6 810121416161412108 6 4 2 0 2 4 6 810121416Percent MalePercent Female Percent MalePercent Female[Tairaw11iti -

I(c) Total PopulationL"-Mid1and•*.

-

Age Group (Years)85+

8084

50-54 k-

n=21675 A:.-n2247940-44

30-342529

20-24• ______15-1910-14

under 516 14 1210 8 6 4 2 0 2 4 6 8 10 1214 16

Percent MalePercent Female

Source:Department of Statistics, 1991 Census of Population and Dwellings.

8

MALE/FEMALE RATIOS [See Table 1.2]

There are not always equal numbers of men and women in a population, and particularly

for different age groups. This is seen in the male/female ratio, which is the number of

males per 100 females. A male/female ratio of 100 means there are equal numbers of men

and women. A male/female ratio above 100 means there are more men than women in the

population and a ratio less than 100 means there are more women.

Within Tairawhiti, Maori males outnumbered females in the youngest 'ages (0-14

years), but for all other ages there were more Maori women than men. This was

most marked at the older ages, with twice as many women than men aged 75 years

and over.

Male/Female ratios also had similar patterns when comparing Tairawhiti and Midland

Maori. However, the ratios showed fewer Maori men per 100 women in the older

age groups in Tairawhiti, than were found in Midland.

Table 1.2Male/FemaleRatios', Tairawhiti and Midland, 1991

MALE/FEMALE RATIO

Tairawhiti Midland

Age GroupSocio- Socia-(Years)CulturalHealth MaoriCulturalHealth Maori

Maori Maori

Under 5 103 104 102 104

5-14 104 107 103 104

15-24 98 98 97 101

25-44 90 92 91 93

45-64 90 90 95 96

65-74 83 82 90 88

75 and over 58 51 75 78

1Male/Female ratio = number of men per 100 women in each age group


AGE STRUCTURES OF THE MAORI POPULATIONWITHIN TAIRAWHITI[See Appendix Table A1.3(a) and (b)]

This section examines the age structures of the Maori population within Tairawhiti's

component wards. The 'socio-cultural' Maori population is used as the subject population,

and the analysis focuses on four broad age groups:

1. Tamariki - children (0-14 years)

2. Rangatahi - adolescents (15-24 years)

3. Nga Pakeke - adults (25-64 years)

4. Nga Kaumatua - the elderly (65 years and over)

1. TAMARIKI (0-14 years)

Proportion of the Maori population in this age group:About 33% of Maori in Tairawhiti were under 15 years of age in 1991. In the Cook and

Wainui Wards, this proportion was almost 40%.

Maori as a proportion of the Total Tairawhiti Population:More than half (52%) of all Tairawhiti children under 15 years of age were Maori. There

were however, great variations between the region's Wards. In the Taruheru Ward, only

20% of children were Maori; in contrast, almost 88% of children in Matakaoa and Waiapu

Wards were Maori.

TairawhitiMaori compared with Midland Maori:In all Wards e>cept Taruheru and Whataupoko, Tairawhiti had higher proportions of children

who were Maori thari the Midland region as a whole.

2. RANGATAHI (15-24 years)

Proportion of the Maori population in this age group:One in five Maori in Tairawhiti were young adults, 15-24 years of age. Although there was

little variation between the region's Wards, over half of them had proportionally fewer young

adult Maori than the Midland region as a whole.

10

The highest proportion of young adult Maori was in the Taruheru Ward (22%). However,

these young Maori made up less than 30% of all young adults in the Taruheru Ward;

Maori as a proportion of the Total Tairawhiti population:

Half of all young adults in Tairawhiti were Maori. However, the proportion of young adults

that were Maori varied widely between Wards, from less than 30% in the Taruheru Ward

to 90% in Matakaoa and Waiapu Wards.

Tairawhiti Maori compared with Midland Maori:

All Wards in Tairawhiti had higher proportions of young adults who were Maori than the

Midland region as a whole.

3. NGA PAKEKE (25-64 years)

Proportion of the Maori population in this age group:

Forty-one percent of Tairawhiti Maori were in the working age groups (25-64 years). There

were, however, twice as many Maori aged 25-44 years as those aged 45-64 years. The

Matakaoa Ward contained the largest proportion of working-age adult Màoft with 45% of

its Maori population aged 25-64 years.


One-third of all adults aged 25-64 in Tairawhiti were Maori. There were, however, great

differences between the constituent Wards. For example, just over 10% of all working-age

adults in Taruheru Ward were Maori; likewise 20% in Whataupoko Ward were Maori.

However, in Matakaoa Ward, 80% of working adults were Maori.


With the exception of Taruheru ward, all wards in Tairawhiti had higher proportions of

working-age adults who were Maori than the Midland region as a whole.

4. NGA KAUMATUA (65 years and over)

Proportion of the Maori population in this age group:

Only 4% of Tairawhiti Maori were aged 65 years and over in 1991. Waiapu Ward had the

highest proportion of Maori in retirement ages (6%), and Kaiti Ward the smallest (2%).

- - - - -

-

I I s1 It , c.-:-t_.

11


About 15% of all elderly people in Tairawhiti were Maori. This is almost three times the

proportion for the whole Midland region. Less than 10% of all elderly were Maori in Wainui,

Taruheru, Whataupoko, and Waikanae Wards. In contrast,. 75% of the population aged 65

years of age and over in Matakaoa Ward were Maori.

Some Wards contained large proportions of elderly Maori women. For example, 83% of

elderly women in Waiapu Ward were Maori, while only 58% of elderly men were Maori.


All Wards in Tairawhiti had higher proportions of elderly people who were Maori than the

Midland region as a whole.

SUMMARY

The Tairawhiti Maori population, like the Midland Maori population, is characterised

by its young age structure.

The proportions of Maori in the younger ages (under 25 years) is generally greater

in Tairawhiti's 'rural' Wards than the urban Wards which make up Gisborne City.

The proportion of the Total population that identified as Maori varied widely within

Tairawhiti's Wards. In general, Wards in 'rural' areas (most notably Matakaoa and

Waiapu Wards) had high proportions of Maori, whereas 'urban' Wards were

dominated by non-Maori populations. This was particularly noticeable within the

elderly age groups.

RURAL-URBAN DISTRIBUTION

Tairawhiti region contains one major urban centre, Gisborne, which contained 10,656 Maori

(socio-cultural group), or 60% of the total Tairawhiti Maori population. The remaining 40%

of the Maori population lived in smaller settlements and rural areas.

12

'WI[See Table 1.3]

According to the 1991 Census, the largest lwi in the Tairawhiti region was Ngati

Porou, with 10,101 people claiming this as their main tribal affiliation. This is 55%

of all Tairawhiti Maori.

A further 15% of Tairawhiti Maori belonged to Tuhoe, Te Aitanga a Mahaki or Ngati

Kahungunu Iwi.

One in ten Maori in Tairawhiti did not report an Iwi in the 1991 Census.

Table 1.3Main Iwi by Affiliation,Tairawhiti, 1991

Male FemaleTotalIwi

No.%No.%No.

Ngati Porou 4977275124281010155

Tuhoe 393242628194

Te Aitanga a Mahaki 5073597311046

Ngati Kahungunu 435250739425

Other 180610189310369920

Don't Know 90959125182110

TOTAL 90274994595118486100

Source:

Department of Statistics(1993), Iwi Population and Dwellinas, 1991 Census of

Population and Dwellings. Wellington. Table 2.

CHAPTER II

SOCIAL , ANDECONOMIC FACTORS

RELATINGTO HEALTH

14

This chapter describes a number of social and economic variables that are likely to have

an impact (either direct or indirect) on the health of Tairawhiti Maori.

The profile of Tairawhiti Maori is compared with both the Total Tairawhiti population and

Midland Maori, to highlight both similarities and differences.

Most of the data contained in this chapter are drawn from the 1991 Census of Populationand Dwellings; and relate to the 'socio-cultural' Maori population, as defined earlier in thisreport.

NGA WHANAU

KO TE MOETANGA - MARITAL STATUS

DefinitionMarital Status refers to the legal marital status of every person 15 years of age and over

in 1991. There are five marital status categories.

1. Never married

2. Married/Remarried

3. Separated

4. Widowed

5. Divorced

'De Facto' , refers to people living in a de facto relationship, which is an arrangement where

two persons v'hà are not legally married to each other live together as a couple.

Marital status figures have been age standardized for the population aged 15 years and

over to take into account differences in population composition between Tairawhiti andMidland.

15

Key findings


Forty six percent of Tairawhiti Maori over 15 years of age had never been married

in 1991, compared with 32% of the total population of Tairawhiti. This reflects in part,

the greater concentrations of Maori at younger ages (see Figure 2.1 and Appendix

Table A 2.1).

One-third of all Tairawhiti Maori were currently married in 1991, compared with 48%

of the total Tairawhiti population.

•In 1991, 1209 Maori or 10.5% of all Tairawhiti Maori were living in a defacto

relationship.

•Tairawhiti Maori were almost twice as likely to be living in a de facto relationship

(11%) as the total population (7%).

Comparison of Tairawhiti Maori and Midland Maori

• The marital status profile of Tairawhiti Maori closely resembled that of all Maori in

the Midland region. However, more Tairawhiti Maori were widowed, but fewer were

either currently married or living in a de facto union.

Widowed

Separated orDivorced

CurrentlyMarried

Never Married

Figure 2.1Marital Status: Tairawhiti and Midland, 1991

oio20304050Percent

N Tairawhiti Maori 9 Tairawhiti Total E3 Midland Maori


17

FAMILY TYPE

Definition

The 1991 Census defines a family as:

(I)a couple with or without a child (or children), or

(ii)one parent with a child (or children).

The focus of this report, is on families with dependent children.

A dependent child is a person:

(I)present in the dwelling at the 1991 Census, and:

-aged less than 16 years

-aged 16-18 years and still at school, or

(ii)temporarily absent from the dwelling at the 1991 Census and aged less than 16

years.

However, 'Families' that contained both dependent and adult children are excluded from this

analysis, thus the term 'only dependent children' is used in this section.

'Families with Dependent Children' are further divided into:

(I)one-parent (or sole-parent) families, and

(ii)two-parent families

Key Findings


Sixty percent of all Maori families in Tairawhiti had only dependent children in 1991

[see Appendix Table A2.2(a)].

Against this, half of all families in Tairawhiti had only dependent children, which is

10 percentage points less than for Maori families.

Maori families with only dependent children made up half of all families with

dependent children in Tairawhiti [see Appendix Table A2.2(b)], whereas Maori as a

whole made up 40% of the total Tairawhiti population.

18

Of those families with only dependent children:

• Forty-four percent of all Maori families in Tairawhiti with only dependent children

were sole parent families, compared with one-third of all Tairawhiti families with only

dependent children [see Figure 2.2 and Appendix Table A2.2(c)].

Comparison of Taira whit! Maori and Midland Maori

•The proportion of Maori families in Tairawhiti with only dependent children (60%)

was slightly below the proportion for all Maori families in Midland (62%).

•29% of all Midland families with only dependent children were Maori.

• Tairawhiti had a slightly higher proportion of one-parent families with only dependent

children than Midland as a whole - 44% compared with 41% [see Appendix Table

A2.2(c)].

• 'Nearly, two-thirds of all one-parent families with young children in Tairawhiti were

Maori,..,, compared with 43% for the whole Midland region [see Figure 2.2 and" Appendix Table A2.2(d)]. •

Trt'I I

19Figure 2.2One- and Two-Parent Families with Dependent Children, Tairawhiti and Midland, 1991

80

70

60

60

RinifiesDep 40

aila1

• 30

10

0

ltTAO lut Tvo Parat

TairawhitiMidland


20

NGA WHARE - HOUSING

Definition

Tenure refers to the nature of the occupancy of a permanent private dwelling. The

categories are:

1Owned with or without a Mortgage

2Rented or Leased

3Provided Rent Free

Key Findings

Comparison of Tairawhiti Maori with Taira whit! Total Population

Four out of every ten (40%) Maori households in Tairawhiti lived in rental

accommodation in 1991. This was only slightly higher than the figure (37%) for the

total Táirawhiti population. (see Figure 2.3 and Appendix Table A2.3).

Fifty percent of Tairawhiti Maori live in rented accommodation or rent-free housing

compared with 33% of the total Tairawhiti population.

The proportion of Tairawhiti Maori who owned their home with a mortgage (31%)

was very similar to that of the otal Tairawhiti population (33%).

However, the proportion of Maori who owned their homes freehold (that is without

a motrgage) (17%) was considerably lower than for the total population in Tairawhiti

(32%).

Maori occupied almost half of all rent-free dwellings in Tairawhiti in 1991-


Whereas 47% of Tairawhiti Maori owned their homes either with a mortgage or

freehold, 55% of all Midland Maori owned their homes with either freehold or with

a mortgage.

Midland Maori

21

Maori made up a higher proportion of all tenants in Tairawhiti (50%) than Maori inthe Midland region as a whole (27%) in 1991.

Figure 2.3Housing Tenure, Tairawhiti and Midland, .1991

Tairawhiti Maori Tairawhiti Total

lOwnedwith amortgageOwnedwithout amortgage

E3 Rent freeRented orleased


22

TYPE OF HOUSING

No census data could be obtained about the quality of housing used by Tairawhiti Maori.

However, in an interim report prepared by the Gisbome District Council's Chief Environment

Health Officer, concern was expressed about the levels of substandard housing in the

Tairawhiti region.

Two local surveys of housing stock, in Tokomaru and Waima, found housing in these areas

to be substandard in basic amenities. Further, a visual survey of houses in rural areas in

1989, found many requiring major repairs, or were considered beyond economic salvage

and should be demolished.

It was also noted that existing housing stocks were overcrowded, particularly in northern

coastal areas. A growing number of Maori in these northern regions are returning to

ancestral areas. Accommodation for these people ranges from vehicles and caravans to

make-shift constructions with few amenities or sanitary facilities.

Source: Burrows, P. (1993) Substandard Housin g and Derelict Buildin gs - Gisborneand East Coast Regions unpublished report, Gisborne District Council.

23

KO TE MATAURANGA, NGA MAHI ME TE KORE MAHIEDUCATION, LABOUR FORCE AND UNEMPLOYMENT

HIGHEST LEVEL OF EDUCATION

Definition

This report uses highest level of education as ascertained in the 1991 Census and the

proportion of the population over 15 years' (age-standardised) who left school with no

qualification, as measures of the educational status of the population.

Key Findings

Comparison of Taira whit! Maori and Taira whit! Total populations

The dominant feature of the education levels of Tairawhiti Maori was the large

proportion who had no qualifications - this was 51% for Maori men, and 48% for

Maori women. These figures are only slightly less than for all Maori in the Midland

region, but are considerably higher than the Total Tairawhiti population, where 34%

of both men and women had no qualifications (see Figure 2.4 and Appendix Table

A2.4).

Thirteen percent of Tairawhiti Maori men and 17% of Maori women had secondary

school qualifications, with over 20% of both Maori men and women having attained

some form of post-secondary or tertiary qualification.

However; fewer Tairawhiti Maori have post-secondary qualifications than the total of

the Tairawhiti population.

The most common qualification for Tairawhiti Maori men was either a Trade

Certificate or. School Certificate. The most common qualification for Tairawhiti Maori

women were school certificate passes.

24

Figure 2.4Proportion of the Population with No Qualifications: Tairawhiti and Midland,.1991

kc

40

Percertth

30no

Qualification

20

10

El

Nble FerreleI Talravh1i Tal 2 TalraMti Wboi U3 rIIclaid Nboti

(1) Standardised against the Total New Zealand populationaged 15-59 years.


25

TE MAHI - LABOUR FORCE

DefinitionInformation on New Zealand's labour force at the 1991 Census was derived from the

following questions to all people over 15 years of age:

"Do you work in a job, business, farm or profession?"

"Did you look for paid work in the last four weeks?"

"What methods did you use to look for paid work?"; and

"If a job had been available, would you have started last week?".

The labour force is divided into three broad groups:

(i) those employed full or part-time

(ii) those unemployed and actively seeking work (full or part-time)

(iii) those not working, and not seeking work, not available for work or both, are the 'non-

labour force' population

The first two groups make up the internationally accepted definition of the labour force.

Note: 'Employed' includes both full and part-time employment. In this report, the

unemployment rates relate only to those people who were actively seeking work.

This figure is lower than many measures of unemployment which may include many

of those in the 'not working' group. Some measures such as those published in

Statistics New Zealand's Household Labour Force Survey may also include those

in subsidised employment.

Key Findings

Comparison of Tàirawhiti Maori and Taira whiti Total population

•The Tairawhiti Maori labour force (those either working or unemployed) comprised

5,808 persons in 1991 - of whom 43% are women (see Appendix Table A2,5).

Proportionally fewer Tairawhiti Maori women than Maori men aged 15-64 years were

in the labour force - 45% compared with 64%.

26

Maori comprised only 33% of the total Tairawhiti labour force, but made up 39% of

the Total Tairawhiti population aged 15-64 years.

Twenty-eight percent of the female Maori labour force in Tairawhiti was part-time,

while for Maori men the proportion was only 11%. In comparison, more than one-

third of the total Tairawhiti female labour force was part-time, but only 8% of all men

in the total male labour force were part-time.

Less than half of Tairawhiti Maori (42%) aged 15-24 years were in the labour force,

compared with 52% of the Total Tairawhiti population.

Comparison of Tairawhiti Maori and Midland Maori populations

The distribution of Maori in the full- and part-time labour forces was the same in

Tairawhiti as for the Midland region as a whole.

However, the proportion of the total labour force that were Maori was twice as high

in Tairawhiti (33%), than for the Midland region as a whole (16%).

The proportion of young Maori aged 15-24 years that were in the labour force was

slightly lower in Tairawhiti (42%) than for the Midland region as a whole (46%).

NGA KORE MAHI - UNEMPLOYMENT

Comparison of Tairawhiti Maori and Tairawhiti Total population

In 1991, the age-standardised unemployment rates for Maori men and women in

Tairawhiti were 16.5% and 11.1% respectively. These are significantly higher than

for the total Tairawhiti population, who had unemployment rates of 10.1% for men

and 7.4% for women (see Figure 2.5 and Appendix Table A2.6).

Young Maori (aged 15-24 years) had higher unemployment rates (19% of women

aged 15-24 and 15% of men aged 15-24 years) than all Maori aged 15-59 years in

Tairawhiti.

27

Comparison of Tairawhiti Maori and Midland Maori populations

• Maori unemployment levels in Tairawhiti differed slightly to those for Maori in the

whole Midland region. Male unemployment in Tairawhiti was, higher (16.6..versus

16.3%), while female unemployment in Tairawhiti was lower (11.2% versus 11.5%).

•However, Maori youth unemployment rates were lower in Tairawhiti than Maori youth

unemployment in the Midland region as whole.

Twenty percent of young Midland Maori men were unemployed, compared with

19.3% in Tairawhiti; and 17% of young Midland Maori women were unemployed,

compared with the Tairawhiti rate of 14.7%.

28

Figure 2.5Age-Standardised Unemployment Rates(1), Tairawhiti and Midland, 1991

AS

•

•

4

'I ....HJ1• •

III•-- MIME

- - -- r41

I r

• - L

• - -HN

•

MaoriTotalMaoriTotal

Youth Total

UnemploymentUnemployment

(1)Standardised for age and sex against the total New Zealand population.Source:Department of Statistics, 1991 Census of Population and Dwellings.

29

KO TE UTU - INCOME

Definition

This report gives income details at two levels - for individuals and families.

Total (individual) income' is the total personal income for each individual aged 15 years and

over.

'Family income' is the combined total income that persons aged 15 years and over in a

family unit receive. A family unit includes one or two parent families or couples only

(without children)

Key findings

(a)Family Incomes

Comparison of Tairawhiti Maori and Taira whit! Total populations

Maori families had lower incomes than other families in Tairawhiti. Maori families

had a median income of about $20,700,(i.e. 50% were below this level and 50%

above) compared with a median income of $27,800 for families in the Tairawhiti

total. population. . Also, 25% of Maori families reported an income of less than

$12,900. In comparison, 25% of all families in Tairawhiti had an income below

$16,700 (see Appendix Table A2.7(a)).

Fewer Maori families reported high incomes. Twenty-five percent of Maori families

had incomes over $33,600, while 25% of families in the Tairawhiti Total population

had incomes over $44,300.

A far higher proportion of Maori families had incomes under $30,000 than other

families in the Tairawhiti region - 45% of all Tairawhiti families were found in this

income group, compared with 56% of Maori families (see Figure 2.6 and Appendix

Table A2.8(a)).

30


•Tairawhiti Maori had a lower median income ($20,700) than for Maori in theMidland region as whole ($22,600) (see Appendix Table A2.7(a)).

•Fewer Tairawhiti Maori reported higher family incomes - 25% had incomes over$33,600, while 25% of all Midland Maori families had an income over $38,200.

• Fifty six percent of Maori families in Tairawhiti had a total income of under $30,000,and half of these families had incomes less than $15,000. These figures are higherthan for all Midland Maori families, where 26% had incomes under $15,000, and52% earned less than $30,000 (see Figure 2.6 and Appendix Table A2.8(a)).

Figure 2.6Proportion of Families with Incomes Under $30,000, Tairawhiti and Midland, 1991

60

50

40

Percent 30

20

10

0Tairawhiti Midland

E Maori Families • Total Families


31

(b)Individual Incomes

Comparison of Taira whit! Maori and Tairawhiti Total populations

.Half of all Maori women and 45% of Maori men aged 15 years and over, in

Tairawhiti, earned less than $10,000 in 1991. While a similar proportion of all

Tairawhiti women were found in this low income group, the proportion of all men

earning less than$10,000 was smaller at 32% (see Appendix Table A2.8(b)).

•Furthermore, 25% of Maori men earned less than $6,600. and 25% of Maori women

earned less than $6,400 (see Appendix Table A2.7(b)).

Comparison of Taira whit! and Midland Maori

The proportion of Tairawhiti Maori with low incomes was similar to the Midland

region as a whole, although the proportion of Maori on incomes under $10,000

was slightly higher in Tairawhiti - 45% compared with 43% for Midland region as a

whole. •

• Fewer Tairawhiti Maori had higher incomes - 25% of Tairawhiti Maori men had an

income over $19,000, while 25% of all Midland Maori men earned more than

$22,000. Twenty-five percent of both Tairawhiti and Midland Maori women received

more than $14,000 (see Appendix Table A2.7(b)).•

•

32

INCOME SUPPORT

Definition

Income support refers to payments, benefits, pensions, etc received from the Department

of Social Welfare, or other sources (including maintenance from a former partner whether

by formal or informal agreement) during the 12 months prior to the 1991 Census. However,

Accident Compensation lump sum payments, housekeeping allowances, 'pocket money',

board and other payments received from members of a respondent's household are not

included. This report focuses on four benefits:

1. Unemployment Benefit

2. Youth or Student Allowance

3. Sickness or Invalid's Benefit

4. Domestic Purposes Benefit

Benefits that are almost universal for particular subgroups of the population, such as

National Superannuation, Family Support of the Family Benefit (this benefit ceased in April

1991) have not been examined.

Key Findings


In the 12 months prior to the 1991 Census, 35% of Maori men and 21% of Maori

women aged 15 years and over in Tairawhiti received one of the four following

benefits - unemployment benefit, youth or student allowance, sickness or invalid's

benefit and the domestic purposes benefit (see Appendix Table A2.9)

Twenty-eight percent of Tairawhiti Maori men and 11% of Tairawhiti Maori women

received the unemployment benefit. A further 6% of women had received the

domestic purposes benefit and 4% of men had received a sickness or invalid's

benefit.

33

• The proportion of Tairawhiti Maori receiving these benefits was almost twice that of

the total Tairawhiti population. However, the most common benefits received were

the same for both groups: unemployment and sickness or invalid's benefits for men

and unemployment and domestic purposes benefits for women.


• A greater proportion of Tairawhiti Maori men received a benefit in the 12 months

prior to the 1991 Census than Midland Maori men as a whole - 35% of Tairawhiti

men compared with 32% of Midland Maori men. The proportion of Maori women

receiving a benefit was about the same, at around 21% (see Appendix Table A2.9).

• A greater proportion of Tairawhiti Maori (men and women) received each of the

above four benefits than Midland Maori, except for the youth or student allowance.

However, the proportions for both groups on the youth/student allowance were on

the very small - between 1 and 1.5% for both men and women.

NGA MAHINGA - OCCUPATION

Definition'Occupation' refers to the job, trade, profession or type of work in which. a person is

employed for financial reward or as an unpaid worker in a family business.

Information for this topic was derived from the Census question relating to people in the

workforce,.'defined here as those aged 15-59 years, gainfully, employed in full or part-timework. . .

34Key Findings

Comparison of Tairawhiti Maori and Tairawh it! Total populations

The major occupational groups of Tairawhiti Maori showed marked differences formen and women. Just over half (51%) of men were either agriculture and fisheriesworkers or machine operators. A further 14% worked in secondary occupations (thisgroup includes such occupations as building caretakers and cleaners, messengersand door keepers, refuse collectors, packers and freight handlers, and labourers).

For women, the major occupations were clerks (21%), service and sales workers(18%) and those in elementary occupations (14%) (see Figure 2.7 and AppendixTable A2.1 0(a)).

The major occupations of men and women in Tairawhiti were quite different for theTotal and Maori populations. Agriculture and fisheries workers and machineoperators made up only 40% of all male occupations, and the third largestoccupation group was trade workers (15%). Only 10% of Maori men worked inthese occupations, compared with 36% of all men in Tairawhiti (see Appendix TableA2.10 (a) and A2.10(b)).

For the Tairawhiti Total population, the largest proportions of women worked inclerical occupations (25%), as Service and sales workers (1 7%),and as professionals(17%). The proportion of Maori women in elementary occupations was twice thatfor all Tairawhiti women - 14% compared with 7%.

Only one in four Maori women worked as administrators, managers, professionalsand technicians compared with one-third of all women in Tairawhiti.


Only 15.5% of Midland Maori men were agriculture and fisheries workers, comparedwith 26.2% of Tairawhiti Maori men. Similar proportions were found for men workingas machine operators and in elementary occupations.

35

• While clerical service and sales occupations also employed the largest group of

Maori women in Midland, there were fewer women in elementary occupations in

Midland (9%) than in Tairawhiti (14%).

•There were fewer Maori women administrators, managers, professionals- and

technicians in Tairawhiti (26%) than in Midland as a whole (28%).

Pd Fas

C=Lpaticrs

Pa1 and Mactim Operakxsad ssars

Trades

.giciEhxe and RsyVbrkers

SadSes

Ckrks

Tncaais and .sscdePrdessionals

Prd&zskn"

LecisIdErs, Ad7iristratorsand

Figure 2.7Major Occupation Groups, Maori Population, Tairawhiti, 1991

36

0369121518212427Percent

IFelMale


in

37

TE TOHU MAHI - INDUSTRY

Definition

'Occupation' refers to the type of work a person does for financial reward or

as an unpaid worker in a family business, and throws light on their social and

economic status. In comparison, Industry reflects the economic patterns of

the community as a whole"'.

Census data on industry refers to the type of activity undertaken by the organisation,

enterprise or business within which a person is employed. The statistics reported here

have been standardised for age and gender against the total New Zealand population aged

15-59 years. Industry has been categorised into nine main groups. These are:

1. Agriculture, Hunting, Forestry and Fishing

2. Mining and Quarrying

3. Manufacturing

4. Electricity, Gas and Water

5. Construction

6. Wholesale and retail trade and restaurants and hotels

7. Transport, Storage and Communications

8. Business and Financial services

9. Community Social and Personal services

Key findings

More than one-quarter (28%) of all Tairawhiti Maori were employed in community,

social and personal services in 1991. A further 22% worked in manufacturing, and

21% in agriculture, hunting, forestry and fishing (see Figure 2.8 and Appendix Table

A2.11).

Maori men and women did not work in the same industries. Forty-three percent of

Tairawhiti Maori women worked in community social and personal services,

compared with 19% of Maori men. On the other hand, 29% of Maori men worked

2Waikato Area Health Board and Waikato Regional Council (1991) The People of WairoaWaikato.

38

in agriculture, hunting, forestry and fishing, compared with only 10% of Maori

women. However, the proportions employed in manufacturing were roughly equal -

21% of Maori women and 23% of Maori men.


The proportion of Tairawhiti Maori working in community social and personal

services (28%) was slightly higher than for the Total Tairawhiti populations (26%).

In contrast, more Tairawhiti Maori (22%) were found in manufacturing than the Total

Tairawhiti populations (16%). The proportions employed in agriculture, hunting,

fishing and forestry were the same (21%) for both groups (see Figure 2.8 and

Appendix Table A2.11).

The proportion of Tairawhiti Maori women employed in community services (43%)

and manufacturing (21%) was greater than for all Tairawhiti women (41% and 13%

respectively). However, fewer Tairawhiti Maori women worked in wholesale and

retail trades and restaurants and hotels (14%) than all Tairawhiti women (19%) (see


The proportion of Tairawhiti Maori men working in agriculture, hunting, forestry and

fishing (29%) was only slightly higher than all Tairawhiti men (27%), but Tairawhiti

Maori men working in manufacturing (23%) was noticeably higher than for all

Tairawhiti men (19%). On the other hand, far fewer Tairawhiti Maori men were

employed in wholesale and retail trade and restaurants and hotels (8%) than all

Tairawhiti men (14%).

Comparison of Tairawhiti Maori and Midland Mao,!

Significantly more Tairawhiti Maori worked in agriculture, forestry and fishing (21%)

than for all Midland Maori (13%). Similarly, the proportion working in community and

social services (28%) was greater than for all Midland Maori (24%). However, fewer

Tairawhiti Maori (22%) worked in manufacturing than for the whole Midland region

(25%).

•The distribution of Maori women over the nine industry groups was similar for both

Tairawhiti and Midland Maori. The majority of Maori women worked in community,

39

social, and personal services, although the proportion of Tairawhiti Maori women

(43%) was slightly higher than for all Midland Maori (40%). Similarly, more

Tairawhiti Maori women were found in manufacturing (21%) than all Midland Maori

women (18%). Slightly fewer Tairawhiti Maori women (14%) were found in

wholesale and retail trade than all Midland Maori women (17%).

The proportion of Tairawhiti Maori men working in agriculture, forestry and fishing

(29%) was almost twice that for all Midland Maori men (17%). Although the

manufacturing industry employed the next largest group of Tairawhiti Maori men

(23%), this was less than for Midland Maori men (29%).

Community, Social andPersonal Services

Business and FinancialServices

Transport, Storage andCommunications

Wholesale and RetailTrade and Restaurants

Construction

Electricity, Gas andWater

Manufacturing

Mining and Quarrying

Agriculture, Hunting,Forestry and Fishing

Figure 2.8Distribution of Employment by Industry Group, Tairawhiti, 1991

40

I

_____ 051015202530RTotaIMaoril Percent


0

(

41

SUMMARY

In sum, Tairawhiti Maori had differing social structures from those of the Total Tairawhitipopulation, and appeared to to be 'disavdantaged' particularly with respect to economicstatus.

A large proportion of Maori families had young and schOol aged children; asignificant proportion of these children were living in sole parent families.

0Half of Tairawhiti Maori were living in rental accommodation in 1991; Maôri also hada lower level of home ownership than the total population.

A larger proportion of adult Maori had no qualifications than the Total Tairawhitipopulation.

•Less than half of Tairawhiti Maori aged 15-64 years were in the labour force.

•Maori had higher unemployment rates than the total Tairawhiti population,particularly for the young.

•Maori families had lower incomes than other families in Tairawhiti; individual Maoriincomes were also lower.

•More Maori were beneficiaries than the Total Tairawhiti population.

• Fewer Maori were found in professional occupations than the Total Tairawhitipopulation. Maori men were predominantly agriculture and fisheries workers, whilethe largest group of Maori women were clerks and service and sales workers.

CHAPTER IIIHEALTHSTATUS

42

This third chapter examines the health status of Tairawhiti Maori, particularly in relation to

the rest of the Tairawhiti population, and to Maori in the Midland region as a whole: Three

broad aspects of Maori health are examined:

1. Maternal and child health, including fertility and infant mortality.

2. Life expectancy and mortality (analysis of death) - with particular focus on death

rates at specific ages, and the major causes.

3. The major reasons for hospital admissions of Tairawhiti Maori.

This information has been collected from the most recent available:

registrations of births and deaths

mortality and morbidity data provided by the Ministry of Health

1991 Census of Population & Dwellings

Most of the rates described in this chapter have been calculated using the 'Health' (sole

origin) Maori population as a base, to maintain consistency with the data from the Ministry

of Health and vital registrations from the Department of Statistics.

CHILD AND MATERNAL HEALTH

SUMMARY - CHILDBEARING PATTERNS

Tairawhiti Maori women generally had lower fertility levels than all women in Tairawhiti and

Maori women in the Midland region as a whole. However, Tairawhiti Maori teenagers had

higher levels of childbearing than both all Tairawhiti teenagers and Midland Maori as a

whole.

BIRTHS

There were 799 registered live births in Tairawhiti in the year ended 31 March 1991.

More than one-third of these births (38%) were Maori children. In comparison, 20%

of all births in the Midland region were Maori (see Appendix Table A3.1).

43

One out of every five Maori births in Tairawhiti were to a teenaged mother.

Most Maori births in Tairawhiti (60%) were to mothers in their twenties. A further

19% of Maori births were to Maori women in their thirties, and 2% of births to those

in their forties.

Comparison of Tairawhiti Maori and Tafrawhiti Total births

A greater proportion of Maori births were to teenage mothers (20%) than for the total

population (14%) in Tairawhiti.

Two-thirds (66%) of all births in Tairawhiti in 1991 were to mothers in their twenties,

compared with 60% for Maori (see Appendix Table A3.1).

Comparison of Tairawhiti Maori and Midland Maori births

The distribution of births to Maori mothers in Tairawhiti was similar to that of the

Midland region. However, the proportion of births to teenagers was greater for

Tairawhiti Maori (20%) than Midland as a whole (18%), while the proportion of births

to mothers aged 20-24 years was smaller in Tairawhiti (29%) than in Midland as

whole (33%) (see Appendix Table A3.1).

TOTAL FERTILITY RATES

The total fertility rate (TFR) is a measure of the number of children a woman would have

if she were to experience the fertility rates of a given year throughout her childbearing years.

It approximates 'completed family size' (see table footnote, Table 3.1).

Tairawhiti Maori

•In 1988, Tairawhiti Maori women, had on average, 2.32 children. By 1991 this had

fallen to 2.15 children (see Table 3.1);

44

Comparison of Maori and Total Tairawhiti populations

Childbearing rates for Tairawhiti Maori women fluctuated over the period 1988-1991,

possibly reflecting the small numbers involved. There is an indication that Maori

childbearing rates are converging with those of the total Tairawhiti population. In

1988, all Tairawhiti women had, on average, 2.28 children. Hence at that time Maori

women were having slightly larger families than other Tairawhiti women. By 1991

however, this pattern had reversed, with Maori women having 2.15 children,

compared with 2.37 children for all Tairawhiti women.

Comparison of Tairawbiti Maori and Midland Maori

Tairawhiti Maori appear to be having smaller families than all Midland Maori as a

whole. In 1988, the TFR for Tairawhiti Maori was 2.32 children per woman,

compared with 2.46 children per woman for Midland Maori. By 1991, family size had

dropped for both Tairawhiti and Midland Maori to 2.15 and 2.35 children respectively.

Table 3.1Total Fertility Rates: Tairawhiti and Midland, 1988-1991

Total fertility rate (1) for March YearEthnic Group

1988198919901991

Tairawhiti Maori 2.322.392.322.15

Tairawhiti Total population2.282.962.822.37

Midland Maori 2.462.422.462.35

(1)Total fertility rate in a particular year Is the number of births a woman would have during herentire reproductive life if she was exposed to the fertility rates characteristic of variouschildbearing age-groups in the particular March year to which the data refer.

Source:Department of Statistics, Vital Statistics.

Population Studies Centre, University of Waikato, unpublished tables.

In

45

AGE-SPECIFIC FERTILITY RATES

Fertility rates relate the number of births to women at specific ages to the number of women

at these ages. These rates eliminate distortions in the distribution of births that may occur

because of different age and sex distributions either over time or between different

population groups (eg, ethnic groups).

Fertility rates are used to compare the childbearing patterns for specific age groups of

women over time, or to see variations at different ages.

Age-specific fertility rates for Tairawhiti Maori women in 1991 show the following:

[see Figure 3.1 and Appendix Table A3.2]

Tairawhiti Maori

Tairawhiti Maori aged 25-29 years had the highest fertility rates in 1991, with 127

births per 1000 women in that age group. Women aged 20-24 years had the second

highest rate of 119 births per 1000 women.

Comparison of Tairawhiti Maori and Ta/raw/i/ti Total populations

Like Tairawhiti Maori, the highest childbearing rate for all Táirawhiti women in 1991

was for the 25-29 year olds. However, this rate for Maori women (127 births per

1000 women aged 25-29 years) was lower than for all Tairawhiti women (161 births

per 1000).

• Tairawhiti Maori women also had lower fertility levels than other Tairawhiti women

in the 20-24 and 35-39 year age groups. At other ages, that is 30-34 and 40-44

years, Maori childbearing was higher than for all women in Tairawhiti in 1991.

46


Women aged 20-24 years had the highest childbearing levels for all Midland Maori

in 1991, with 147 births per 1000 women aged 20-24 years. Therefore, the

dominant group of Maori mothers are 5 years older in Tairawhiti - 25-29 year olds

compared to 20-24 year olds for Midland Maori.

• Tairawhiti Maori women between 20 and 39 years of age had lower fertility rates

than for all Midland Maori. However, Tairawhiti women aged 40-44 years had a rate

twice (12 births per 1000 women) that for all Midland Maori (5 births per 1000

women).

47

Figure 3.1Age-specific Fertility Rates, Tairawhiti and Midland, 1991

180 TairW Mao—Tairawhiti Total

160 .___- --- Midland MaOriMidland Total

140 Ii•._.

120 -./ '..•

100 -,i •.'••iRate per 1,000

Vmen'I80 7:60 .:

40

20

0II

15-1920-2425-2930-3435-3940-4445-49Age Group (Years)


48

TEENAGE CHILDBEARING

New Zealand has the second highest teenage pregnancy rate of the OECD countries. In

1990 New Zealand recorded 35 births per 1000 women aged 15-19 years. The New

Zealand.Maori teenage fertility rate was more than twice this level, at 79 births per 1000

Maori women aged 15-19 years'.

Tairawhiti Maori

Tairawhiti Maori teenagers had a fertility rate of 76 births per 1000 women aged 15-

19 years in 1991 (see Figure 3.1 and Appendix Table A3.2).


Maori teenage childbearing levels (76 births per 1000 Maori women aged 15-19)

were about 19% higher than for all Tairawhiti teen women (64 births per 1000

women aged 15-19) in 1991. Thus levels of teenage childbearing in Tairawhiti were

'high by comparison with those found nationwide and internationally.


Maori teenage childbearing levels were only slightly higher in Tairawhiti (76.2 births

per 1000 Maori women aged 15-19 years) than for the Midland region as a whole

(75.8 births per 1000 Maori women aged 15-19 years) in 1991.

Department of Statistics (1993) Demographic Trends 1992, Table 2.5 Wellington.

49

CHILD-WOMAN RATIOS[See Table.3.2]

Another measure of family size, other than fertility rates based on births registrations data,

is the child-woman ratio derived from Census data:

Child-Woman ratio =Number children under 5 years of age

Number of women aged 15-44 years

The socio-cultural Maori population has been used to calculate these rates, as it gives a

more meaningful measure of Maori family size than the 'Health' Maori population.

Tairawhiti Maori

•At the 1991 Census, there were 0.55 children under 5 years for every Maori woman

aged 1544 years in Tairawhiti.


The child-woman ratio for the Total Tairawhiti population was, 0.44 children under 5

per woman aged 15-44 years in 1991.


The Midland Maori child-woman ratio was 0.58 children per woman in 1991. This

shows, once again, that childbearing levels were lower in Tairawhiti than the Midland

region as a whole.

This appears to contradict the fertility trends described earlier. However, the child-woman

ratio reflects childbearing patterns over the past five years, while the TFR is for only one

single year. The difference may indicate shifts in childbearing patterns, as shown in the age

specific fertility rates.

50

Table 3.2 :Child-Woman Ratios, Tairawhiti and Midland, 1991

Source: Department of Statistics, 1991 Census of Population and Dwellings.

BIRTH WEIGHTS

An infant's birth weight plays an important role in its relative state of health and well being

during the important first months of life. Infants with low birth weights (under 2500 grams)

are more susceptible to health problems, and may have a lower chance of survival than

those infants with a higher birth weight. Further, the incidence of low birth weight infants is

used as a measure of the health status of their mothers.

Because of the small numbers involved in this analysis, a three-year average for the period

1988-1990 has been used.

Tairawhiti Maori

During 1988-1990, there were, on average, 909 registered live births (Maori and

non-Maori) per year in Tairawhiti. Six percent of these infants had low birth weights

(under 2500 grams) (see Table 3.3).

Maori babies were over-represented among low birth weight infants. They accounted

for 44% of infants under 2500 grams, but 38% of all births.

Just under 8% (7.8%) of all Tairawhiti Maori infants born each year during 1988-

1990 had low birth weights (under 2500 grams).

51

Comparison of Tairawhiti Maori and Total Tairawhiti populations

A greater proportion of Maori infants (7.8%) had birth weights less than 2500 grams

than for the total population (6.1%) in Tairawhiti during 198871990.


The proportion of Maori infants with low birth weights was lower in Tairawhiti (7.8%)

thanforMidland Maori as a whbe (8.6%):

A greater proportion of all low birth weight infants in Tairawhiti were Maori (44%)

than for the Midland region as a whole (28%). However, Maori made up a greater

proportion of all births in Tairawhiti (38%) than in the Midland region as a whole

(20%); therefore there were similar patterns in both areas.

Table 3.3: Birth Weights (1), Tairawhiti and Midland, 1988-1990

TAIRAWHITI MIDLANDBirth Weight

MaoriTotal Maori Total(grams)

No.%No.%No.%No.

Under 2500247.8556.12208.67876.2

2500 and over28492.285493.9234991.41904.93.8

TOTAL 308100.0909 100.02569100.012690100.0

(1)Annual average for the period 1988-1990.Source:Department of Statistics, Vitals data:

52

INFANT DEATHS

Infant death rates are used as a measure of general medical and health status as "...the

risks of death in the first year of life are particularly susceptible to intervention through

health and medicine 112 . -

Reductions in infant death rates generally result from declines in deaths of infants older than

one month. Where infant death rates are low, a higher proportion of deaths occur at early

ages - particularly within the first 28 days of life. A large proportion of these deaths also

occur within the first week of life. This is because the causes of these early infant deaths

are often those not easily prevented by modem medical and health practices - for example,

congenital malformations and extremely premature birth. However, many causes of later

infant deaths, for example infectious diseases or poor nutrition, are considered to be

preventable.

This report examines four groups of infant deaths:

(I)Perinatal infant deaths;

(ii) Neonatal infant deaths;

(iii) Post-neonatal infant deaths; and

(iv) Total infant deaths.

Summary

Tairawhiti Maori infant death rates were higher than those for the Total Tairawhiti population

during 1988-1990. However all of the above four groups of infant death rates were lower

for Tairawhiti Maori than both Midland Maori and New Zealand Maori as a whole. Therefore,

Tairawhiti Maori have fared quite well. But there is still considerable room for improvement,

particularly given that New Zealand's infant death rates are considered to be quite high in

comparison with other OECD countries.

Yaukey, D (1985) Demography - the Study of Human Population. St Martin's Press, New York.

53

Perinatal Deaths

A measure of early infant death is the occurrence of perinatal deaths. This is the number

of late fetal deaths (after the 28th week of pregnancy) plus deaths of infants less-than 1

week old. These two groups are combined into one measure because they show very

similar causes of death.

As there were relatively few perinatal infant deaths in Taira whiti, average data for the three

year period 1988-1990 have been used, to smooth out the effects of the vers' small

numbers.

Numbers

There were very few perinatal infant deaths in Tairawhiti during 1988-1990. There were 13

perinatal infant deaths during this 3 year period, with 6 (or 46%) of these being Maori. In

comparison, only 20% of all perinatal infant deaths in Midland as a whole were Maori (see


Per/natal Death Rate

The perinatal death rate is the number of perinatal deaths per (1000 live and still births).

During 1988-1990 New Zealand had a perinatal death rate of 8.1 perinatal deaths per 1000

(live and still births). The equivalent rate for all New Zealand Maori was 7.9 perinatal deaths

per (1000 live and still births).

Tairawhiti Maori

The perinatal death rate for Tairawhiti Maori was 6.5 perinatal deaths per 1000 (live

and still births) for the 1988-1990 period (see Appendix Table A3.3).


The perinatal death rate was considerably higher for Tairawhiti Maori (6.5 perinatal

deaths per 1000 live and still births) than for the total Tairawhiti population (4.8

54

perinatal deaths per 1000 live and still births) during 1988-1990 (see Appendix

Table A3.3).


The perinatal death rate for Tairawhiti Maori (6.5 perinatal deaths per 1000 live and

still births) was slightly lower than for Midland Maori as a whole (6.6 perinatal deaths

per 1000 live and still births) during 1988-1990 (see Appendix Table A3.3).

Hence, while Tairawhiti Maori had lower perinatal infant death rates than both

Midland and New Zealand Maori as a whole, there is still scope for improvement.

Neonatal Deaths

• Neonatal infant deaths are those that occur to infants between birth and the end of the first

28 days of life. As the number of neonatal infant deaths in Tairawhiti are very small for any

one year, average data for the three-year period 1988-1990 has been used, to smooth out

the effect of these very small numbers.

Numbers

There were few neonatal infant deaths in Tairawhiti during 1988-1990. There were 5

neonatal infant deaths during the 3 year period, with 3 (or 60%) of these being Maori (see

Appendix Table A3.3).•

Neonatal Infant Death Rates

The neonatal infant death rate is the number of neonatal infant deaths per 1000 live births.

During 198-1990 New Zealand had a neonatal infant death rate of 4.5 neonatal infant

deaths per 1000 live births; the New Zealand Maori rate was 4.8 neonatal deaths per 1000

live births. •

55

Tairawhiti Maori

The neonatal death rate for Tairawhiti Maori was 3.2 neonatal deaths per 1000 live

births for the 1988-1990 period (see Figure 3.2 and Appendix Table A3.3).


The neonatal death rate was considerably higher for Tairawhiti Maori (3.3 neonatal

deaths per 1000 live births) than for the total Tairawhiti population (1.8 neonatal

deaths per 1000 live births) during 1988-1990 (see Figure 3.2 and Appendix Table

A3.3).


The neonatal infant death rate was lower for Tairawhiti Maori (3.2 neonatal deaths

per 1000 live births) than for all Midland Maori (4.2 neonatal deaths per 1000 live

births) during 1988-1990 (see Appendix Table A3.3).

•Hence, while Tairawhiti Maori had lower neonatal infant death rates than both


Post-neonatal Deaths

Post-neonatal infant deaths are those that occur to infants between 29 days of age and the

end of the first year of life. As the number of post-neonatal infant deaths in Tairawhiti are

very small for any one year, average data for the three-year period 1988-1990 has been

used, to smooth out the effect of these small numbers.

Numbers

There were few post-neonatal infant deaths in Tairawhiti during 1988-1990. There were 15post-neonatal infant deaths during the 3 year period, with 6 (or 40%) of these being Maori.

A similar proportion of all post-neonatal infant deaths in Midland as a whole were Maori (see


56

Post-neonatal Infant Death Rates

The post-neonatal infant death rate is the number of post-neonatal infant deaths per 1000

live births. During 1988-1990 New Zealand had a post-neonatal infant death rate of 11.5post-neonatal infant deaths per 1000 live' births; the New Zealand Maori rate was 11.5 post-neonatal deaths per 1000 live births. An 'OECD country with low infant death rates is

Norway. In 1991, Norway's post-neonatal ' infant death rate was 2.7 post-neonatal deaths

per 1000 live birth S.3

Tairawhiti Maori

The post-neonatal death rate for Tairawhiti Maori during 1988-1990 was 6.5 post-neonatal deaths per 1000 live births for the 1988-1990 period (see Appendix Table

A3.3).

Companion of'Talrawhit/ Maori and Tainawhiti Total populations

The post-neonatal death rate was higher for Tairawhiti Maori (6.5 post-neonatal

deaths per 1000 live births) than for the total Tairawhiti population (5.5 post-neonataldeaths per 1000 live births) during 1988-1990 (see Appendix Table A3.3).


The post-neonatal infant death rate was significantly lower for Tairawhiti Maori (6.5post-neonatal deaths per 1000 live births) than for all Midland Maori (9.2 post-

neonatal deaths per 1000 live births) during 1988-1990 (See Appendix Table A3.3).

Hence, while Tairawhiti Maori had lower post-neonatal infant death rates than both


Statistisk Arbok 1993, Statistics Norway.

57

Sudden Infant Death Syndrome

A significant component of post-neonatal death rates is sudden infant death syndrome

(SIDS) (cot death). A reduction in SIDS deaths is a major health goal in New Zealand.

During 1988-1990 there were on average, 569 infant deaths due to SIDS, per year, in New

Zealand; 153 (or 27%) of these were Maori infants.

Tairawhiti Maori

During 1988-1990 there were 9 infant deaths due to SIDS in Tairawhiti; 3 of these

infants were Maori (see Table 3.4).

The SIDS death rate for Tairawhiti Maori during 1988-1990 was 1.08 Maori infant

SIDS deaths per 1000 live births. This rate is considerably lower than that for the

Total Tairawhiti population, and both Midland and New Zealand Maori populations

(see Table 3.4).

•During 1988-1990, the post-neonatal Maori infant death rate was 6.5 post-neonatal

Maori infant deaths per 1000 live Maori births. Most SIDS deaths occur during this

post-neonatal period. Therefore, Tairawhiti Maori deaths due to SIDS

accounted for 17% of this rate. In comparison, 29% of the Midland Maori post-

neonatal infant death rate was attributable to SIDS deaths; against this, 64% of the

New Zealand . Maori post-neonatal infant death rate was attributable to SIDS deaths.

• Therefore, the occurrence of perinatal infant deaths (particularly. those infant deaths

due to SIDS) was very low for Tairawhiti Maori during 1988-1990, and in fact was

lower than Maoriin both Midland and New Zealand as a whole. In this respect, then,

Tairawhiti Maori have fared very well. ,

58

Table 3.4: Infant Deaths Due to Sudden Infant Death Syndrome (SIDS), 1988-1990

(1) Infant deaths per 1000 live births.

Source: New Zealand Health Information Service, Ministry of Health.

Ratio of Neonatal to Post-neonatal Deaths

Where infant death rates are low, a high proportion of infant deaths occur during the

neonatal period. This is because deaths during the post-neonatal period can be prevented

more easily than neonatal deaths. This is shown by the ratio:

Number of Neonatal Deaths

Number of Post-neonatal Deaths

A ratio less than 1.00 indicates that there are more neonatal infant deaths than post-

neonatal infant deaths; a ratio greater than 1.00 shows more neonatal infant deaths.

An OECD country with low infant death rates in Norway. In 1991 Norway's neonatal/post-

neonatal ratio was 1.34. That is, there were more neonatal infant deaths than post-neonatal

infant deaths. In comparison, the New Zealand neonatal/post-neonatal ratio during 1988-

1990 was 0.85. This shows that a large proportion of New Zealand's infant deaths occur

during the post-neonatal period, so are potentially preventable.

59

Tairawhiti Maori

C Tairawhiti Maori had a neonatal/post-neonatal ratio of 0.50 during 1988-1990. That

is, for every one neonatal infant death, there were two post-neonatal infant deaths.

The total Tairawhiti population had a neonatal/post-neonatal ratio of 0.33 during

1988-1990. That is, for, every one neonatal death there were three post-neonatal

deaths. Therefore, proportionally more Tairawhiti Maori infant deaths occurred during

the neonatal period than for the total Tairawhiti population. While the Tairawhiti Maori

neonatal/post-neonatal ratio was 'better' than that for the Total Tairawhiti population,

it was still less.. than for New Zealand as a whole, indicating some considerable

scope for improvement. .

Total Infant Deaths

The final measure of infant deaths in this report is the 'total' infant death rate (number of

deaths of infants under 1 year of age per 1000 live births): This combines the neonatal and

post-neonatal death rates above '. New Zealand's total infant death rate in 1988 was 10.1

infant deaths per 1000 live births. It is considered, by international standards, to be quite

high. In comparison, Germany's infant death rate in 1988 was 7.5 infant deaths per 1000

live births.'

Numbers

There were few infant deaths in Tairawhiti during 1988-1990. On average, there were 20

infant deaths, per year, with 9 (or 45%) of these being Maori. In comparison, 33% of all

infant deaths in Midland as a whole were Maori [see Appendix Table A3.3(a)].

Department of Statistics (1993), New Zealand Official Yearbook 1993. Wellington.

60

Infant Death Rates

Tairawhiti Maori

There were on average, 9.8 infant Maori deaths per 1000 live births in Tairawhiti

during 1988-1990. There are, however, differences in male and female infant death

rates (see Figure 3.2 and Appendix Table A3.3).


Maori infant death rates were higher than for the Total Tairawhiti population which

had 7.3 infant deaths per 1000 live births during 1988-1990 (see Figure 3.2 and


Comparison of Tairawhiti Maori and Midland Maori Infant Deaths

The Tairawhiti Maori infant death rate (9.8 infant deaths per 1000 live births) was

considerably lower than for Midland Maori as a whole (13.5 infant deaths per 1000

live births) during 1988-1990 (see Appendix Table A3.3).

Cause of death

The major causes of Maori deaths in New Zealand in 1990 were perinatal conditions

(such as respiratory conditions and birth trauma) and sudden infant death syndrome or

SIDS (cot death).

61Figure &2Neonatal, Post-neonatal and Total Infant Death Rates, Tairawhiti and Midland, 1988-1990

14

12

10

Infant: 8Deaths per1000 Live

Births6

4

2

0Tairawhiti Midland Tairawhiti Midland Tairawhiti Midland

NeonatalPost-neonatalTotal Infant

Death RateDeath Rate Death Rate

Source:Department of Statistics, Vital Statistics

62

LIFE EXPECTANCIES

Life expectancy is the average remaining lifetime (in years) for a person who survives to the

beginning of an indicated age interval. 5 Normally the current age-specific mortality data are

employed and thus the life table reflects what would occur if the population were to

experience, over their lifetimes, the current risks of death. The most commonly quoted data

from these tables are 'life expectancy at birth' and this is the average number of years a

person would be expected to live. This is what is employed here.

Life expectancies have been calculated using:

census populations for 1986 and 1991; and

iithree years of deaths data around these census years, i.e. the years 1985-1987 and

1990-1992.

Life expectancies at birth for the Maori and Total populations are shown in Appendix Table

A3.4. It should be noted that in some instances the number of deaths involved in this

analysis are very small and may affect some of the results presented here.

Maori women generally live longer than Maori men in Midland and Tairawhiti. This is similar

to the experience of the New Zealand and Midland total populations.

Tairawhiti Mao,!

Tairawhiti Maori males had an estimated life expectancy of 69.4 years in 1990-1992;

this is slightly less than their life expectancy of five years earlier (1985-1987) of 69.5

years (see Appendix Table 3.4).

Tairawhiti Maori females have also seen a decline in their life expectancy, from 75.9

years in 1985 -1987 to 73.5 years in 1990-1992.

These declines in life expectancy, suggest some decline in the health status of

Tairawhiti Maori. It may reflect the effect of small numbers. However, this trend

follows the lack of improvement seen elsewhere in Midland and in New Zealand as

Pool, I. (1991), Te Iwi Maori - a New Zealand Population Past, Present and Projected AucklandUniversity Press, Auckland.

63

a whole. The reasons for this apparent lack of improvement is not known, and will

be further investigated by the Midland RHA in the future.


The life expectancy of male Maori (69.4 years) and female Maori (73.5 years) was,

on average, 2.1 years lower than for the Total Tairawhiti population in 1990-1992,

which had life expectancies of 71.0 years for all men and 76.1 years for all women.

This is a reversal of the pattern in 1985-1987, where Tairawhiti Maori (men and

women) had similar life expectancies to the Total Tairawhiti population.

Comparison of Tairawhiti Maori, Midland Maori and New Zealand Maori

Tairawhiti Maori men and women had a life expectancy 4.1 years higher than

Midland Maori as a whole in 1990-1992. This continues a trend from 5 years earlier

(1985-1987) when Tairawhiti Maori had a life expectancy 4.5 years higher than

Midland Maori and 2.8 years higher than for all New Zealand Maori. However, the

differences in life expectancy have narrowed.

RISK OF PREMATURE DEATH

The next measure of health status in this report is to give some estimate of the probabilityof premature death.

In this report, this is seen as the probability or likelihood of someone dying between the

ages of 45 and 65 years.

This measure has been chosen as a measure of the health status of the middle-aged adult

population. Even though the death rates for this age group are considerably lower than for

the elderly (aged 65 years and over), many of their deaths may have occurred

unnecessarily and so are potentially preventable.

64

Tairawhiti Maori

Maori men in Tairawhiti had a 23% probability of dying between 45 and 65 years ofage in 1990-1992. Maori women had an 18% likelihood of dying between 45 and65 years of age (see Table 3.5).

Comparison of Tairawhiti Maori and Total Tairawhiti populations

Tairawhiti Maori had a slightly higher chance of dying between the ages of 45 and

65 years than the total Tairawhiti population (see Table 3.5).


The likelihood of a Tairawhiti Maori man or woman dying between 45 and 65 years

of age was less than for all Midland Maori in 1990-1992. Midland Maori men, as a

whole, had a 33% likelihood of dying between 45 and 65 years of age, and Midland

Maori women had 27% chance of dying in this age group (see Table 3.5).

Table 3.5:Probability of Premature Death, Tairawhiti and Midland, 1990-1992

Probability of Premature Death (1)Ethnic Group and Gender

Tairawhiti Midland

Maori population - Male 0.23 0.33

Maori population - Female 0.18 0.27

Total population - Male 0.22 0.18

Total population - Female 0.13 0.12

(1)Probability of dying between ages 45 and 65 years.

Source:Population Studies Centre, University of Waikato, unpublished Life Tables.

65SUMMARY

Tairawhiti Maori had a life expectancy of 71.4 years in 1990-1992, and has shown a declinesince five years earlier. However, their life expectancy is still higher than that for MidlandMaori as a whole. Tairawhiti Maori also have less likelihood than Midland Maori of dyingbetween 45 and 65 years of age. But Tairawhiti Maori can still be expected to live shorterlives than the total Tairawhiti population.

DEATH RATES AND MAJOR CAUSES OF DEATH

This part of the report examines the death rates of Tairawhiti Maori and has three mainparts.(i) Analysis of death rates (for all ages);(ii) Analysis of death rates for specific age groups; and(iii) A preliminary analysis of the major causes of death for those age groups.

The data used in this analysis has come from three main sources1. 1991 Census of Population and Dwellings.2. Death registrations for the three year period 1990-1992.3. Cause of death data from theMinistry of Health.

Death rates have been calculated by:Average number of deaths for years 1990-1992

1991 Census Population

This gives an 'average' ratefor the three years 1990-1992 (centred around the 1991Census year), and has been used instead of calculating death rates for a single year inorder to reduce the effect of any year to year variations.

Death rates are expressed in terms of the number of deaths per 1000 people (in a particularpopulation).

66A comprehensive analysis of the major causes of death for the Tairawhiti Maori and totalpopulations over 1990-1992 was not possible as the data is not currently available from theMinistry of Health. In the interim, the principal causes of death for all Maori in New Zealandare employed here"

SUMMARY

Tairawhiti Maori death rates were higher than the Total Tairawhiti population, exceptfor children and young adults (aged 1-24 years).

Tairawhiti Maori had lower death rates than for Midland Maori as a whole.

Death rates were lowest at the youngest ages (except infants under 1 year of age)and increased with age.

Sudden, infant death syndrome was the largest cause of death to New Zealand Maoriinfants under 1 year of age. -

Young Maori (aged 1-24) died mostly as a result of motor vehicle crashes andaccidental causes.

The most common causes of death of middle aged and elderly Maori was heartdisease and cancer.

DEATHS

For the period 1990-1992 there were 368 deaths, per year, in Tairawhiti with 72(20%) being Maori. In comparison, 13% of all deaths in the Midland region as awhole were Maori (see Table 3.6).

6 Source: Department of Health (1993), Mortality and Demo graphic Data 1990, Health InformationService, Wellington.

El

(

67

DEATH RATES

Death rates have been calculated for both Midland and Tairawhiti populations, for all agescombined (see Table 3.6). These rates have been standardised against the tothl NewZealand population, to remove the effects of differing population age and sex distributions.

Comparison of Tairawhiti Moor! and Total populations

Tairawhiti Maori had a higher death rate (10.7 per 1000) than for the Total Tairawhitipopulations in 1990-1992, which had a death rate of 8.8 deaths per 1000 population(see Table 3.6).

Comparison of Tairawhiti Moor! and Midland Maori

• The death rate for Tairawhiti Maori was less than for all Midland Maori in 1990-1992;Midland Maori as a whole recorded 13.3 deaths per 1000 population.

Table 3.6: Death Rates, All Ages, Tairawhiti and Midland, 1990-1992

Number of Deaths and Death Rate (1)

Tairawhiti MidlandEthnic group

No.RateNo.Rate

Maori population (2) 7210.763813.3

Total population 368 8.85201 8.3

(1) Number of deaths per 1000 persons. Death rates have been standardised by age and sex

against the total New Zealand usually resident population.

(2) Health' Maori population.

Source:Department of Statistics, Vital Statistics.

Department of Statistics, 1991 Census of Population and Dwellings.

68AGE-SPECIFIC DEATH RATES AND THEIR MAJOR CAUSES[See Appendix Tables A3.5 and A3.6]

The above death rates do not show the distribution of people dying at different ages. The

proportion of people dying, for example, under 5 years of age, is not the same as for 20-24

year olds, or for 60-64 year olds. With the exception of deaths of infants under one year,

death rates generally increase at successively older ages. Also, the predominant cause(s)

of death is not the same for all ages, nor is it the same for men and women.

Since there were just over 70 registered Maori deaths, per year, in Tairawhiti during 1990-

1992, the number of deaths for any one age group were very small (see Appendix Table

A3.5). Therefore, the age-specific death rates were also very low. For this reason, it is

difficult to draw any conclusions from these rates, particularly when comparing the Tairawhiti

Maori death rates with those for the Total Tairawhiti population or the Midland Maori

population.

However, several interesting trends have emerged from this analysis.

Infant deaths aside, the lowest death rates for both the Maori and Total populations

in Tairawhiti and the Midland region as a whole were at the youngest ages, and

progressively increased with age (see Figure 3.3). Therefore, the highest death rates

are for the elderly, aged 65 years and over.

Tairawhiti Maori had consistently lower death rates than the Midland Maori

population at all ages; this suggests Tairawhiti Maori had a comparative advantage

to Maori living in other parts of the region (see Appendix Table A3.6).

Tairawhiti Maori appeared to have lower death rates than the Total Tairawhiti

population for the younger age groups (under 25 years). Maori death rates were

higher for age groups over 25 years.

The differences in the age-specific death rates for the Maori and Total populations

did not appear to differ as markedly in Tairawhiti as in the Midland region as a

whole. This suggests that the ethnic differences are not as pronounced in Tairawhiti

69

as elsewhere, and therefore that the Tairawhiti Maori population was. not as

disadvantaged in this respect.

Cause of Death

The major cause of death for young New . Zealand Maori (between I and 25 years

of age) in 1990 appeared to be unintentional injuries, particularly motor vehicle

crashes.

The major cause of death amongst New Zealand Maori aged 25-44 years in 1990

was motor vehicle crashes. Heart disease, suicide (for Maori men) and cancers (for

Maori women were also significant causes.

lschaemic heart disease (heart attacks, angina and chronic ischaemic heart disease)

was the number one cause of death for both middle-aged Maori (45-64 years) and

of elderly Maori in New Zealand in 1990. Other major, causes were cancers

(particularly lung cancer) respiratory disease and (for Maori women) strokes and

diabetes.

Figure 3.3Age-Specific Death Rates, Tairawhiti and Midland, 1990-1992

70

FIRI

EE

•i

I. :I]

10

[I]inderl 1to4 5to14 15to24to4445to64 65&

over

Age Group (Years)

Tarav4iti90 TaIraVAti-.-- Midland Maori -.-- Midland TotmaodTotal

Source:Department of Statistics, 1991 Census of Population and Dwellings.Department of Statistics, Vital Statistics.

71

HOSPITAL DISCHARGES

This final section examines the relative state of health and wellbeing of Tairawhiti Maori.This has been done by examining the state of 'ill-health' of Maori, which is drawn frbm thedischarge data of patients from public hospitals for the years 1990-1992. These dischargedata also include people who died while in hospital.

These data are presented in terms of the medical speciality within which a person wastreated. For example, accident/vehicle crash victims may be admitted to one of severaldifferent areas, depending on the type of injuries they were suffering from. They relate topersons who live in Tairawhiti and were discharged from any public hospital in NewZealand.

SUMMARY:

Maori made up just under half of all hospital discharges in.. Tairawhiti during 1990-1992.

Tairawhiti Maori had higher discharge rates at all ages, than both the Total Tairawhitipopulation and for the Midland Maori population as a whole.

The highest discharge rates were for infants under 1 year of age, and for the elderly(65 years and over). .

Orthopaedics treated a significant proportion of all Tairawhiti Maori in all age groupsother than infants under 1 year.

A large number of discharges, at all ages except 15-44 years, were from respiratorymedicine.

Obstetrics (ie, pregnancy and childbearing) and gynaecology accounted for a highproportion of hospital discharges for women aged 15-64 years.

72Cardiology (heart disorders) patients were mainly in the older age groups (over 45years of age), and in particular the elderly age group (65 years and over).

TOTAL DISCHARGES

Hospital discharges examined fall into three broad groups.1. Medical discharges.2. Pregnancy and childbirth (or obstetrics) discharges.3. Surgical discharges.

Taira whit! Maori

During 1990-1992, per year there were, on average, 3761 discharges of TairawhitiMaori residents. These discharges made up 44% of all discharges for the Tairawhitipopulation. In comparison, Midland Maori accounted for 24% of all discharges in theMidland region as a whole (See Appendix Table A3.7). But remember, Maori madeup 40% of the Total Tairawhiti population and 22% of the Total Midland populationin 1991:

Taira whit! Maori discharges

Almost half of all Tairawhiti Maori discharges (48%) were medical discharges, 19%related to pregnancy and childbirth, and the remaining 32% were surgical discharges(see Appendix Table A3.7).

Comparison of Taira whit! Maori and Ta!ra whit! Total populations

A greater proportion of Tairawhiti Maori discharges were medical than the TotalTairawhiti population (43%) and a smaller proportion of Maori discharges weresurgical ones.

73


Tairawhiti Maori had a higher proportion of medical but a lower proportion of surgical

discharges and pregnancy and childbirth discharges than forMidland Maori as a

whole.

DISCHARGE RATES FOR MEDICAL SPECIALITY AREAS

Within the above three groups are a number of speciality areas (see Appendix Table A3.7)

The rates to be described below are for people of all ages combined. However, as with the

death rates discussed earlier, the pattern of discharges vary with age. Thus an analysis of

age-specific discharge rates will also follow.

Discharge Rates -

Total discharge rates relating to these speciality areas have been calculated for the Maori

and Total populations for Tairawhiti and Midland (see Figure 3.4 and Appendix Table A3.7).

These are expressed in terms of the number of hospital discharges per 100,000 people per

year for the period 1990-1992. The rates have been standardised against the total Midland

population.

Tairawhiti Maori

The highest discharge rates for Tairawhiti Maori were for obstetrics/delivery (ie,

pregnancy and childbirth - 6993 discharges per 100,000 female population) and

secondly, gynaecology. (3786 per 100,000 population). The third largest group of

Maori discharges were for respiratory medicine. Other significant discharge rates

were for orthopaedics, cardiology and gastroenterology (see Figure 3.4 and


74

Comparison of Ta!rawhiti Maori and Taira whit! Total populations

Obstetrics and gynaecology also had the highest discharge rates for the Total

Tairawhiti population, but were only about two-thirds those of the Maori population

- obstetrics discharges (specifically related to the delivery of a child) were 4951 per

100,000 females for the, Total Tairawhiti population compared with 6993 discharges

per 100,000 population for Tairawhiti Maori (see Appendix Table A3.7).

The discharge rate for Tairawhiti Maori relating to respiratory medicine was nearly

twice that of the Total Tairawhiti population (1744 discharges per 100,000

population).


The highest discharge rates for Midland Maori were the same three groups as for

Tairawhiti Maori - obstetrics, gynaecology and respiratory medicine. While the

discharge rates of Tairawhiti Maori were lower than Midland Maori as a whole for

obstetrics and gynaecology, Tairawhiti Maori had higher respiratory medicine

discharge rates (see Appendix Table A3.7).

Vascular Surgery

Urology

Cirthopaedics

hthalrrdogy

Neuroajrgery

Maxitofacat & PiaRensuolve

Gynaeoslogy

General Surgery

Ear Nose and Throat

Cardioorac Surgary

Bums

Cbsbetrics • Other

ctrstetrtos - Delivery

- Neoms

eumstology

Respiratory Medicine

Renal Medidne

Neurology

Infectious Ciseases

1-loerratology & lrrnu,ology

Gastroenterology

Endocrinology

Dermatology

Cardiology

75

Figure 3.4Major Discharge Rates for Medical Specialties (All Ages), Tairawhiti and Midland,1990-1992

01000200030004000500060007000

Discharges per 100,000 PopulationITairawhiti Maori 19 Tairaviti TotalMidland Maori

(1) Rates standardised for age and sex to Total Midland.population.


Ministry of Health, New Zealand Health Information Service.

76AN AGE ANALYSIS OF DISCHARGE RATES[See Appendix Tables A3.8, A3.9 and A3.10(a) to A3.10(g)]

(a)Infants under 1 year

This discussion excludes discharges of newborn infants.

Summary

For infants under 1 year of age, Tairawhiti Maori had higher discharge rates than both theTotal Tairawhiti population and the Midland Maori population. The main speciality area fromwhich Tairawhiti Maori infants were discharged was respiratory medicine.

Discharge Numbers and Rates

Tairawhiti Maori

Tairawhiti Maori infants had the highest discharge rate for any Maori age-group(104,823 discharges per 100,000 population), representing numerically an averageof 406 infants discharged per year during 1990-1992. This largely reflects that mostchildren are born in public hospitals - newborns accounted for 64% of all Maori infantdischarges (see Appendix Table A3.9).

'Newborn' discharges aside, the major specialities where infants received treatmentwere respiratory medicine (54 discharges), gastroenterology (largely for treatmentof vomiting and diarrhoea) (21 discharges) and 'ear, nose and throat' (19discharges) [see Appendix Table A3.1 0(a)].


While the above four medical specialties (newborn, respiratory medicine,gastroenterology and 'ear, nose and throat') had the highest discharge rates for allinfants in Tairawhiti, the discharge rate for Tairawhiti Maori infants (104,823 infantdischarges per 100,000 population) was significantly higher than all Tairawhiti infants

77

(79,649 discharges per 100,000 population) (see Figure 3.5 and Appendix Table

A3.9).


• As for Tairawhiti Maori, the four highest discharge rates for all Midland Maori infants

were respiratory medicine, 'ear, nose and throat' and gastroenterology [see

Appendix Table A3.10(a)].

•Tairawhiti Maori infants had higher discharge rates than all Midland Maori infants as

a whole.

Discharges per100,000 population140000

120000

100000

80000

20000

Figure 3.5Discharge Rates for Infants Under 1 year, Tairawhiti and Midland, 1990-1992

78

Male Female Male FemaleMaori Total

Source:Department of Statistics, 1991 Census of Population and DwellingsMinistry of Health, New Zealand Health Information Service.

79(b)Young children (1-4 years)

Summary

For young children aged 1-4 years, Tairawhiti Maori had higher discharge rates than boththe Total Tairawhiti population and the Midland Maori population The main speciality areasfrom which young Tairawhiti Maori children were discharged were respiratory medicine, 'earnose and throat' and orthopaedics.


Tairawhiti Maori

• The discharge rate for young Tairawhiti Maori children was 28,910 discharges per100,000 population, representing numerically an average of 451 young Maorichildren, per year, during 1990-1992. Although this discharge rate was only one-quarter that for Maori infants under 1 year, it was higher than for any other agegroup in the Tairawhiti Maori population between 5-64 years (see Appendix TablesA3.8(a) and A3.9).

The highest discharge rates for young Maori children were for respiratory medicine(158 discharges), 'ear, nose and throat' (91 discharges), and orthopaedics (surgeryrelating to bones and joints) (36 discharges) [see Appendix Table A3.1 0(b)].

Comparison of Tairawhit! Maori and Tairawh!ti Total populations

• The discharge rate for young Tairawhiti Maori children (28,910 discharges) was 50%higher than for all Tairawhiti youngsters (19,332 discharges per 100,000 population)(see Figure 3.6 and Appendix Table A3.9).

• Respiratory medicine had the highest discharge rate for all Tairawhiti children.However, young Maori children aged 1-4 years had nearly double the discharge ratefor this cause of all Tairawhiti children in that age group.

80


Young Tairawhiti Maori children had a higher discharge rate than Maori pre-

schoolers in Midland as a whole (24 574 discharges per 100,000 population) (see


Respiratory medicine had the highest discharge rate for Midland Maori pre-

schoolers, but the Midland rate was lower than the rate for Tairawhiti Maori

preschoolers.

r.

81

Figure 3.6Discharge Rates for Children Aged 1-4 years, Tairawhiti and Midland, 1990-1992

Discharges per100,000 population

140000

120000

100000

i.I.I.I.:

[11111111

IiI,I,I.

20000

ElMale Female Male Female

Maori Total

Source:Department of Statistics, 1991 Census of Population and Dwellings.Ministry of Health, New Zealand Health Information Service.

82

(C)Children (aged 5-14 years)

Summary

For children aged 5-14 years, Tairawhiti Maori had higher discharge rates than both the

Total Tairawhiti population and the Midland Maori population. The main speciality areas

from which Tairawhiti Maori children were discharged were 'ear nose and throat' and

orthopaedics.


Taira whit! Maori

The discharge rate for Tairawhiti Maori children aged 5-14 years was the lowest for

all age groups - 11,058 discharges per 100,000 population, representing numerically

an average of 348 discharges per year during 1990-1992 (see Appendix Table

A3.9).

Comparison of Taira whit! Maori and Tairawh!ti Total populations

The discharge rate for Tairawhiti Maori children was 28% higher than for all

Tairawhiti children aged 5-14 years (8642 discharges per 100,000 population) (see

Figure 3.7 and Appendix Table A3.9).

Ear, nose and throat' speciality was the major source of discharges for all Tairawhiti

children, but the discharge rate for Maori children was higher for this speciality than

all Tairawhiti children [see Appendix Table A3.10(c)].

Comparison of Ta!ra whit! Maori and Midland Maori

Tairawhiti Maori children had a higher discharge rate than for Maori children in the

Midland region as a whole (8945 discharges per 100,000 population) (see Appendix

Table A3.9).

83

The highest discharge rate for Midland Maori children was also the for ear, nose

and throat' speciality, but the Tairawhiti Maori rate was slightly higher than for

Midland [see Appendix Table A3.1O(c)].

84Figure 3.7Discharge Rates for Children Aged 5-14 Years, Tairawhiti and Midland, 19901992


140000

120000

100000

60000

IIISISII]

20000



85(d)Young adults (15-24 years)

Summary

For young adults aged 15-24 years, Tairawhiti Maori had higher discharge rates than boththe Total Tairawhiti population and the Midland Maori population. The main speciality areasfrom which young Tairawhiti Maori adults were discharged were obstetrics and gynaecology(women only) and orthopaedics.


Tairawh!ti Maori

The discharge rate for Tairawhiti Maori aged 15-24 years was24,530 discharges per100,000 population, representing numerically an average of 730 discharges per yearduring 1990-1992 (see Appendix Table A3.9). .

The highest discharge rates for young adult Tairawhiti Maori were from obstetrics(women only) (340 female discharges), gynaecology (66 female discharges) andorthopaedics (71 discharges) [see Appendix Table A3.10(d)].

Comparison of Tairawhiti Maori and Ta!rawhiti Total populations

The discharge rate for young adult Maori was 42% higher than for all young adultsin Tairawhiti (17,254 discharges per 100,000 population) (see Figure 3.8 andAppendix Table A3.9).

Obstetrics (specifically related to delivery of a child), gynaecology (both women only)and orthopaedics were the specialties with the highest discharge rates for all youngadults in Tairawhiti. However, young adult Maori had higher discharge rates in theseareas [see Appendix Table A3.10(d)].

86


• The discharge rate for young adult Maori was 10% higher in Tairawhiti than for the

Midland region as a whole, where the discharge rate was 22,363 discharges per

100,000 (see Appendix Table A3.9).

• Young Maori women from Tairawhiti had slightly lower discharge rates than the

Midland region as a whole, for obstetrics and gynaecology. However the discharge

rate for orthopaedics was higher for young Tairawhiti Maori men and women than

for Midland Maori in this age group [see Appendix Table A3.1 0(d)].

Discharges per100,000 population140000.

120000

i[IIIISIIISJ

@off$$

tAk A"

87Figure 3:8Discharge Rates for Young Adults Aged 15-24 years, Tairawhiti and Midland, 1990-1992


Source:Department of Statistics, 1991 Census of Population and Dwellings/Ministry of Health, New Zealand Health Information Service.

88(e)Working age adults (2544 years)

Summary

For working age adults aged 25-44 years, Tairawhiti Maori had higher discharge rates thanboth the Total Tairawhiti population and the Midland Maori population. The main specialityareas from which working age Tairawhiti Maori were discharged were obstetrics andgynaecology (women only) and orthopaedics.


Tairawhiti Maori

Tairawhiti Maori aged 25-44 years had a discharge rate of 22,768 discharges per100,000 population, representing numerically an average of 988 discharges per yearduring 1990-1992 (see Appendix Table A3.9).

The highest discharge rates were for obstetrics (related to delivery of a child) (216female discharges), for gynaecology (164 discharges) and orthopaedics (100discharges) [see Appendix Table A3.10(e)].


Tairawhiti Maori aged 25-44 years had a discharge rate 33% higher than for allTairawhiti adults aged 25-44 years (17,073 discharges per 100,000 population) (seeFigure 3.9 and Appendix Table A3.9).

The highest discharge rate for all Tairawhiti adults was from obstetrics (related todelivery of a child). However, the obstetric discharge rate for Maori women washigher than for all Tairawhiti women in this age group (see Appendix TableA3.1 O(e)).

89


•The discharge rate for Tairawhiti Maori was 8% higher than for Midland Maori aged

•25-44 years as a whole (21,039 discharges per 100,000 population) (see Appendix

Table A3.9). •

•The highest discharge rate for Midland Maori aged 25-44 years was also obstetrics

(delivery-related). The obstetrics discharge rate for Tairawhiti Maori women aged

25-44 years was lower than for the Midland region as a whole [see Appendix Table

A3.1 O(e)].


• 140000

120000

100000

80000

[.1iISI'II]

20000

90Figure 3.9Discharge Rates for Adults Aged 25-44 Years, Tairawhiti and Midland, 1990-1992



91(f)Middle-aged adults (45-64 years)

Summary

For middle-aged adults aged 45-64 years, Tairawhiti Maori had higher discharge rates thanboth the Total Tairawhiti population and the Midland Maori population. The main specialityareas from which middle-aged Tairawhiti Maori were discharged were obstetrics andgynaecology (women only) and orthopaedics.


Taira whit! Maori

Tairawhiti Maori aged 45-64 years had a discharge rate of 23,063 discharges per100,000 population, representing numerically an average of 512 discharges per yearduring 1990-1992 (see Appendix Table A3.9).


The discharge rate for Maori aged 45-64 years was 32% higher than for all 45-64year olds in Tairawhiti, who hada discharge rate of 17,518 discharges per 100,000population (see Figure 3.10 and Appendix Table A3.9).

The highest discharge rate for the Tairawhiti population aged 45-64 years was forCardiology. However, the Maori discharge rate for cardiology was higher than forall 45-64 year olds in Tairawhiti (see Appendix Table A3.10(f)).


•Tairawhiti Maori 45-64 had a discharge rate 12% higher than Midland Maorias a whole aged 45-64 (see Appendix Table A3.9).

• The highest discharge rate for Midland Maori aged 45-64 years was from cardiology.However, the cardiology discharge rate 'for Tairawhiti Maori was higher (seeAppendix Table A3.10(f)).

Discharges per100,000 population140000

120000

100000

11?111191

20000

El

-- -

92


I

Male Female Male Female- -Maori Total

Source:Department of Statistics, 1991 Census of Population and DwellingsMinistry of Health, New Zealand Health Information Service.

I- - -

93

(g)Elderly (65 years and over)

Summary

For the elderly aged 65 years and over, Tairawhiti Maori had higher discharge rates than

both the Total Tairawhiti population and the Midland Maori population. The main speciality

areas from which elderly Tairawhiti Maori were discharged were cardiology, respiratory

medicine, gastroenterology and orthopaedics.


Tairawhiti Maori

The discharge rate for elderly Tairawhiti Maori was 49,321 per 100,000 population,

representing numerically an average of 327 discharges per year during 1990-1-992

(see Appendix Table A3.9).

The highest discharge rate was from cardiology (10,809 discharges per 100,000

population). Other major discharge areas were respiratory medicine,

gastroenterology, orthopaedics and neurology (disorders of the nervous system) (see

Appendix Table A3.10(g)).


Elderly Maori had a discharge rate 37% higher than all elderly people in Tairawhiti

(36,093 discharges per 100,000 population - see Figure 3.11 and Appendix Table

A3.9)..

The highest discharge rate for all elderly people in Tairawhiti was from cardiology.

The Maori rate was, however, higher than for other elderly people in Tairawhiti. In

fact, elderly Maori discharge rates were higher than the total elderly population in

Tairawhiti for all major speciality areas (see Appendix Table A3.10(g).

94


Elderly Tairawhiti Maori a discharge rate 14% higher than elderly Maori in the

Midland region as a whole (43,196 discharges per 100,000 population) (see


The highest discharge rate for all elderly Midland Maori was also from cardiology,

but it was lower than for elderly Maori in Tairawhiti. With the exception of respiratory

medicine, Tairawhiti elderly Maori had higher rates all the major speciality areas [see

Appendix Table A3.10(g)]


140000

120000

1000oo

E;I.I,I,Is]

[.IIIIIII$]

iEsIsIsII]

20000

[I]

I

95

Figure 3.11Discharge Rates for the Elderly Aged 65 Years and Over, Tairawhiti and Midland,1990-1992.



96MENTAL HEALTH

In the absence of local data it is difficult to find national studies that are representative ofa population such as that in Tairawhiti especially for its Maori population. The two studiescited here have not identified a prevalence among Maori. However, they have beenincluded to be indicative of the prevalence of mental illness within Tairawhiti. A further noteof caution must be given concerning the suicide rates whose levels are relatively small.While we have attempted to 'minimise the effect of small number distortions by averagingover three years, distortions are still evident particularly in the smaller adolescent andelderly sub-populations.

Mental Health Services in Tairawhiti

Tairawhiti Healthcare is the main provider of mental health and drug and alcohol servicesin Tairawhiti with an inpatient service at Gisbome and some community based services atboth Gisbome and Te Puia. A range of services may also be provided by local voluntaryorganisations and whanau.

• From the Ministry of Healths mental health stocktake, the staffing level per 100,000in local communities provided by Tairawhiti Healthcare is 24 clinical staff and 4 nonclinical staff. As a general indicator for these levels, Andrews (199l) recommendeda level of around 35 full time staff at community level.

Staffing levels provided for inpatient services are 50 full time clinical staff at Gisborneand Te Puia, per 100,000 population. The level recommended by Andrews (1991)is around 40 full time staff per 100,000 population.

The overall levels of staffing are comparatively similar to those recommended by Andrews(1991). There appears to be slightly higher inpatient staff levels and an equivalently levelof community staff levels.

Andrews, G. (1991) The Tolkein Report -a Description of a Model Mental Health Service. NewSouth Wales.

97

Mental Illness Among Adolescents (ages 10-19 years)

The prevalence estimates of mental illness among adolescents in Tairawhiti are based upon

the rates found among 15 year olds in a longitudinal study performed in . Dunedin-' (see

Appendix Table 3.11).

The reported time series for rates of suicide are a crude rate per 10,000, i.e. the number

of suicides expected in a population of 10,000 adolescents, averaged over a 3-year period,

eg 1987 to 1989 (see Appendix Table 3.12).

Adolescents suffer mainly from anxiety, attention deficiency and conduct disorders.

Considerably , higher rates are reported among females major depressive episodes,

anxiety and non aggressive conduct disorders. Aggressive conduct and attention

deficit disorders are largely male dominated.

Suicide among Maori adolescents occurs largely among males (2 suicides per

10,000 population aged 10-19 years) especially in recent years. The same pattern

is evident among non-Maori adolescents though the rate of suicide is more

consistently . about 1.5 suicides per 10,000 population aged 10-19 years.

Mcgee, R., Feehan, M., Williams, S., Partridge, F., Silva, P.A., and Kelly, J. (1990) DSM IllDisorders in a large sample of adolescents, in Journal of the American Academy of Child andAdolescent Psychiatry 29(4) 611-619.

It is acknowledged the quoted rates have been derived from a 15 year old population anddifferences in the ethnic composition between Tairawhiti and Dunedin. For want of a more accuratemeasure of Mental Health among adolescents, the above quoted rates were applied to the Tairawhitipopulation aged 10-19 years of age

I

98Mental Illness Among Working Age Groups (aged 15-64 years)

National discharge rates for 199210 have been applied to the Midland and Tairawhitipopulations and adjusted for age structure to give an estimate of the number of working agepeople discharged for treatment of a mental illness (see Appendix Tables 3.13 and 3.14).

Many studies have been performed concerning the prevalence of mental illness in NewZealand society. The prevalence of mental illness amongst working age adults in Tairawhitihas been estimated using the Chistchurch Psychiatric study 198911 (see Appendix Tables3.15).

The rates of suicide for working age adults in Tairawhiti and Midland are age standardisedto the New Zealand Total population (see Appendix Table 3.16)

Admission rates

First admissions, among Maori in this age group, are largely composed ofschizophrenia, affective psychoses, stress and alcohol and drug abuse. Alcohol anddrug abuse is extremely high among males.

Rates of admission among Tairawhiti Maori are systematically lower, compared toMaori in Midland overall.

Tairawhiti Maori have higher rates of first admissions, compared to non-Maori inTairawhiti, for almost all main diagnoses.

For all Psychiatric Illness Diagnoses almost twice as many Maori are admitted, eg38/10,000 Maori males compared with 21/10,000non-Maori males. A relatively largedifference can be seen among those diagnosed with schizophrenia, drug abuse andalcohol abuse, with Maori rates being higher than non-Maori.

Ministry of Health (as yet unpublished) 1992 Mental Health data. Wellington.

Wells, J.E., Bushnell, J.A., Hornblow, AR., Joyce, P.R., and Oakley-Browne, M.A. (1989)Christchurch Psychiatric Epidemiology Study, Part 1: Methodology and Lifetime Prevalence forSpecific Psychiatric Disorders, inAustralian and New Zealand Journal of Psychiatry 23:315-326.

99

Maori have a rate of re-admission three times that of Maori first admission rateswhile the rate of re-admission for non-Maori is twice that of first admission rates fornon-Maori.

Re-admission is particularly high for those diagnosed as schizophrenic where Maorihave a readmission rate that is 10 times the rate of first admissions compared to fivetimes for non-Maori.

Prevalence of Mental Illness

• Prevalence estimates include all levels of severity but imply a large differencebetween levels mental illness and the use of mental health services indicated above.Andrews (1991) also reported a difference of 16% in need of mental health services

Eand 3% receiving services in Australia.

•Indicated are far higher levels of anxiety related disorders and alcohol and drugabuse than are being admitted for treatment.

Mortality

Suicide rates are also lower among Tairawhiti Maori, 2 per 10,000 compared to therates for Maori in all of Midland, 2.7 per 10,000. The rate for Maori in Midland ishigher than the rate for non-Maori.

Maori suicide is lower than non-Maori and predominantly occurs among males.Almost two Maori males per 10,000 compared with almost three per 10,000 non-Maori males. The rate among Maori women is zero compared to slightly less thanone per 10,000 non-Maori women.

Maori in Tairawhiti compare favourably to Maori throughout Midland. However, Maori appearto utilise services more than non-Maori and recursive episodes for many diagnoses appearsmore common among Maori. Suicide is largely a male problem and there seems to be littledifference between the Maori or non-Maori.

100Mental Illness Among the Elderly (aged 65 years and over)

National discharge rates for 199212 have been applied to the Midland and Tairawhitipopulations and adjusted for age structure to give an estimate of the number of older-peopledischarged for treatment of a mental illness (see Appendix Tables 3.17 and 3.18).

The rates of suicide for older people in Tairawhiti and Midland are age standardised to theNew Zealand Total population (see Appendix Table 3.19)

First admissions for Tairawhiti Maori are mainly diagnosed as organic psychoses andschizophrenia. Males have also a high rate.of alcohol abuse while females alsoreport high rates of affective diagnoses.

Suicide has been restricted solely to non-Maori Males in Tairawhiti, however the rateappears to be declining in recent years.

Apart from alcohol abuse most of the mental illnesses reported in this group are largely agerelated.

Ministry of Health (as yet unpublished) 1992 Mental Health data. Wellington.

CHAPTER IVACCESS TOPROVIDERS..

102

TRAVEL TIMES TO HEALTH PROVIDERS IN THETAIRAWHITI REGION

INTRODUCTION

Travel time to four types of health service has been calculated for small geographic areas

in the Tairawhiti region. The services are:

•maternity

•outpatient

•level 4-5 (base hospital), and

•level 6 (tertiary) hospital.

Travel time is based on distance (km), and estimated speed of travel by a private car to a

health service. Health service type classification is based on the New South Wales Role

Delineation Model. It is recognised that in 1991 14% of households in Tairawhiti did not

have access to a car.

INFORMATION PRESENTATION

The tables and figures contained in this section of the profile require some explanation.

1.Table 4.1 shows:

•The percentage of the population that will reach each health service within each of

the six time periods, (15 minutes, 30 minutes, 1 hour, 14 hours, 2 hours, 3 hours,

4 hours, 5 hours, 6 hours), and -

•The percentage of population in Gisborne Territorial Local Authority (Tairawhiti) that

will reach a health service within each time period.

103

2.Figures 4.1-4.9

The time to reach a particular service is shown on the horizontal axis.

•The vertical axis shows the proportion of an area's total population, from 0 to 100%.

• The graphed line shows the proportion of the total population that access a health

service in no more than x minutes. For example, 73% of the Tairawhiti population

(or 32,073 out of 43,935 people) access a base hospital (Tairawhiti Healthcare Ltd)

in 30 minutes or less. The access times for Midland's total population to a similar

level of health service are shown for comparison.

Travel Times - Key Findings

• Travel times , to the four types of health service for people in the Tairawhiti region is

varied. Even so, the majority of Tairawhiti's population (70 - 75%) can reach a

maternity centre, outpatient centre and base hospital within 15 minutes (see Table

4.1). This is a higher percentage than for the Midland region as a whole, showing

better access. However, travel time to a level 6 hospital for people living in the

Tairawhiti region is much longer than Midland overall

•Ninety-nine percent of Tairawhiti's population are able to reach a maternity or

outpatient centre within an hour while the remaining 1% need up to 2 hours.

•Ninety-nine percent of Tairawhiti's population needs up to 2 hours to reach a base

hospital and 6 hours to reach a level 6 hospital.

•The difference in travel times for people in Tairawhiti and the Midland region overall

was the greatest for level 6 hospitals and outpatient centres.

•Travel times to maternity centres for the Tairawhiti population paralleled travel times

for Midland overall.

104

TABLE 4.1:

TRAVEL TIME TO HEALTH SERVICES IN THE TAIRAWHITI REGION

Cumulative percentage by travel time to reach a health service

Healthup toup to UP to toup toup

Health ServiceConsumer1530up to1 ,.

up toup to 4 hrs5 hrsto 6

1 bhrs2hrs 3hrsminsmins hrs

Maori 70989999.9100----

Non-Maori959899100-----

MaternityFemale 78849999.9100----

Service

Tairawhiti75819999.9100----

Midland 67909999.9100----

Maori 70799999.9100----

OutpatientNon-Maori95959999.9100----

• ServiceTairawhiti75819999.9100----

Midland 43689599100----

• Maori 6367818897100---

Non-Maori6262699697100---Base Hospital

Tairawhiti7273909297100---

Midland 5371929799100---

Maori 000000112100

Level 6Non-Maori00000015100

HospitalTairawhiti000000112100

Midland 12203055708590• 93100

105

TRAVEL TIME TO MATERNITY SERVICE PROVIDERS

The Tairawhiti RegionMtnii Cth'es xv in upper case

ea

1

^--' - 40ct-Pt3IINGS

To1aBay

• . Three-quarters of people living in Tairawhiti can reach a maternity centre within 15

minutes (see Table 41 and Figure 4.1). In comparison abouttwo-thirds (67%) of the

population living in the Midland region have a travel time to a maternity centre of

between 0-15 minutes. Because the Tairawhiti region covers a large geographical

area and .a reasonable number of the population is particularly isolated, a small

percentage of people will take a long time to reach a maternity centre (maximum

travel time in the Tairawhiti region is 100 minutes to a maternity centre).

Within the Tairawhiti region only 5% of the non-Maori population takes longer than

15 minutes to reach a maternity centre (see Figure 4.2). In comparison 30% of the

Maori population take between 30 minutes and 2 hours to reach a maternity centre.

These percentages indicate a closer distance to maternity centres for non-Maori and

greater isolation from maternity centres for Maori.

Over three quarters of the female population in Tairawhiti can reach a maternity

centre within 15 minutes while most of the remaining 25% take between Y2 - 1 hour

(see Table 4.1 and Figure 4.3).

Figure 4.1:Travel Time to a Maternity Service: Tairawhiti and Midland

Percentaqe of Population100

80

60

40

20

001530 45607590105120

Travel Time (minutes)

106

Figure 4.2:Travel Time to a Maternity Centre, Maori and Non-Maori Populations: Tairawhiti

Prrntoe of Pooulation100

80

60

40

20

—Non Maori

.1

01530 456075

Travel Time (minutes)90105120

Figure 4.3:Travel Time to a Maternity Centre, Female and Total Population: Tairawhiti

Ptrr'ntriP rf POflLJItiOfl•100

80

60

40

20

01530 45607590105120


107

108

TRAVEL TIME TO AN OUTPATIENT SERVICE

The Tairawbiti Region(Outnt Cifrs am in .ppr case

Three-quarters (75%) of the people living in the Tairawhiti region can reach an

outpatient centre within 15 minutes, compared with 76% of the Midland population

as a whole (see Table 4.1 and Figure 4.4). A higher proportion of people in the

Tairawhiti region can also reach an outpatient centre within 15 - 30 minutes travelling

time than for the Midland region overall.

Because a large proportion of the Tairawhiti population live in Gisborne City or along

the coast, travel time to an outpatient centre is reasonably fast. Only 1% of

Tairawhiti's population takes longer than an hour to reach an outpatient centre. For

the remaining Tairawhiti population (20 - 25%) who live in isolated rural areas, these

people have to travel long distances on winding gravel roads, resulting in some of

the longest total travel times within the Midland region.

109

Most Non-Maori people (95%) can reach an outpatient centre within 15 minutes with

the remaining 5% taking between 4 - 2 hours (see Table 4.1 and Figure 4.5). In

comparison, slightly less than three-quarters of the Maori population can reach an

outpatient centre in 15 minutes and 99% of Maori can reach an outpatient centre

within an hour. The longest travel time for Tairawhiti Maori to reach an out-patient

centre is 100 minutes.

Figure 4.4:

Travel Time to an Outpatient Centre: Tairawhiti and Midland

Percentacie of Population100

80

60

40

20

0

0153045607590105 120

110

Figure 4.5:Travel Time to an Outpatient Centre, Maori and Non-Maori Population: Tairawhiti

Percentage of Population

100 ____ - - A A A A

::H1TIii::....

[Maori

40 -------------------------------------------------Maori

20f

.........................................................................

0153045607590105120

TRAVEL TIME TO A BASE HOSPITAL,

The Tairawhiti Region(The' Basv Hospital is in z.pper c.sE'

a

ToBay

.'.,'.'

On average, travel time to a Base Hospital is between 0-15 minutes for just over half

(53%) of the population living in the Midland region (see Table 4.1 and Figure 4.6).

The proportion of people reaching a Base Hospital within the same 15 minute period

'is much higher for the Tairawhiti region (72%), because many people in the

Tairawhiti region live in Gisborne City (70%).

In comparison to non-Maori, a greater proportion of Maori can reach a base hospital

in the shorter time periods (see Table 4.1 and Figure 4.7). Because of the base

hospital location (Gisborne), this would suggest that a greater proportion of the Maori

population live around the Gisborne urban area and more non-Maori live further

away, along the coast. Therefore, while non-Maori have better access to outpatient

and maternity centres than Maori, non-Maori have a longer distance to travel to

reach base hospital health services.

111

112

Figure 4.6:Travel Time to a Base Hospital: Tairawhiti and Midland

60

Ex

20

0015 30 45 60 75 90 105 120 135 150 165 180

rf Prni iltirin100

Figure 4.7:Travel Time to a Base Hospital, Maori and Non-Maori Population: Tairawhiti

Drr'ntri rf PrniiIitirn100

80

[;I.1

20

15 30 45 60 75 90 105 120 135 150 165 180

Travel Time (minutes)I

TRAVEL TIME TO A LEVEL 6 HOSPITAL (TERTIARY)

Level 6 Hospitals in the North Island(Lee1 6H4ita1s are i n Upper Case Le'te)

AU

New

•Because of the limited number of level 6 hospitals in New Zealand and Tairawhiti's

geographic location, travel time by private car from Tairawhiti to a level 6 hospital

can take up to 6 hours. Only 1% of Tairawhiti's population can reach a level 6

hospital within 4 hours - the rest need 5 to 6 hours (see Table 4.1 and Figure 4.8).

In comparison to non-Maori, the Tairawhiti Maori population has a slightly higher

percentage of people who will reach a level 6 hospital within 5 hours travelling time

(see Table 4.1 and Figure 4.9). Again this would indicate a greater proportion of

Maori living near or around the Gisborne City and more non-Maori living along the

coast.

113

114Figure 4.8:Travel Time to a Level 6 Hospital: Tairawhiti and Midland

Percentage of Population100

80

we

Ex

20

0060120180240300360


S.

4•

20

0060120180240300360


Figure 4.9:Travel Time to a Level 6 Hospital, Maori and Non-Maori Population: Tairawhiti

Percentage of Population100

115

HEALTH SERVICE I PROVIDERS IN TAIRAWHITI

There are a variety, of health services specifically for Maori in the Tairawhiti region. Virtually

all of them are based in Gisbome City, although some extend their services outside of

Gisborne to include the more isolated rural areas. The types of health services that are

available for Maori in Tairawhiti include:

•general practitioners

•district nurses

•community health workers (including marae-based clinics)

•hospital-based services

•health education services, particularly for women and children

•community rehabilitation, counselling and support services

•health-related social services

•dietician

•alternative medicine

Further information, including the names of partcular health providers is available from

Midland health. This list is, however, not exhaustive; other services may exist that are

presently unknown to Midland Health.These will become apparent during the next round of

contract negotiations with health providers.

The following table gives the numbers of General Practitioners, and the numbers of District

and Public Health nurses for both Midland, and the Tairawhiti region. In 1991, the Tairawhiti

region had only slightly fewer GPs and practice nurses per 10,000 population than the

Midland region as a whole, but had a considerably higher ratio of community nurses (4.9

per 10,000 population) than the Midland region (2.9 per 10,000).

116Table 4.2Family Health Personnel, Total Population, Midland & Tairawhiti, 1991

MIDLANDTAIRAWHITI

Total number of General Practitioners 437 26.8

Total number of District Nurses 147.3 16.4

Total number of Public Health Nurses 53.4 5.2

Number of GPs per 10,000 population 6.4 6.1

Number of Practice Nurses per 10,000 population4.7 4.6

Number of Community Nurses 2.95 4.92(District and Public Health) per 10,000 population

Note: all data as Full Time Equivalents (half day = 0/1 FTE)

Source:Ministry of Health, "Assessment of Geographical Access to Family HealthServices Providers", 1993NZ Medical Council, Report to Midland Health, 1993 (data from March1991)

•APPENDIX A.

DATA TABLES: Chapters 1,2 and 3

Table A1.1 Percentage of Total population in each age group that are Maori (1), by sex and functional age groups: Tairawhiti andMidland, 1991

• •::: RegionUnder lQyears __652éars and over,..•AiiAges. . ...MaleFemaleMaleFemaleMaleFemaleMale. Female::Male:FemaleTotal

Midland Region31 3226 -281711866212121Tairawhiti 53525051343716154040140

WARDS:Matakaoa 8988899381837579848685Waikohu 5154637039453838465149Waiapu 8889908974845883808683Cook 3637372821212011272627Uawa 5354586842452640465148Taruheru 2319.29261115413161717Patutahi 50435047343835364141 -41Wainui -36353229222396262526Whataupoko 3130 -313119 20772222.22Waikanae 5148404427308 9323232Kaiti 66165162167143• 492014525352

(1)Maori refers to the 'socio-cultural' Maori population

Source:Department of Statistics, 1991 Census of Population & Dwellings

Table A1.2(a)

Maori 'Health' Populations by age and sex, Tairawhiti & Midland,1991

Midland Region TairawhitiAge Group

(Years) Male Female Male Female

Number I%I Number I %Number I%1 Number I%Under 1 1153312.70148812.5820112.6818612.381-4 5898110.3856829.8379210.567689.855-9 6369111.21604810.47816110.887719.8810-14 6279111.05607810.52813110.847479.5815-19 6321111.12593410.27837111.167749.9220-24 I538219.471562819.74163318.44173219.3825-29 149598.73546319.45161818.24172319.2730-34 44407.81503418.71157917.72163618.1535-39 36186.37369016.39150716.76150116.4240-44 29075.1298515.17136914.92140515.1945-49 21993.87234014.05130614.08133314.2750-54 20973.69T214213.71125513.40129413.7755-59 117433.071177613.07126713.56129113.7360-64 112902.27141612.4512253.0024913.1965-69 18521.5091811.5911441.921441.8570-74 4560.8056710.981751.001231.5875-79 2700.4831810.5514210.56660.8580-84 1170.2117110.301910.1213010.3885+ 6310.1118710.151910.1212110.27TOTAL 15682011001 577-961 --

80100175001100_78001100

Table A1.2(b)Maori 'Socio-Cultural' Populations by age and sex, Tairawhiti &Midland, 1991

Midland Region TairawhitiAge Group

(Years) Male-Female Male Female

Number I% I Number L % I Number I %Number I%Under 1 20632.91202912.76124212.79123512.581-4 837311.7518164111.09953110.981923110.135-9 830711.6518097110.99967111.151941110.3310-14 903112.6718717111.84102411.811982110.7915-19 813311.4118043110.9298711.38191810.0820-24 63638.93-686719.327088.1618168.9625-29 163058.851713119.68

-

74818.62186219.4730-34 48226.77555317.5415877-6.77169817.6735-39 44106.19460016.25157116.58158016.3840-44 32464.553413T4.63142814.93145514.9945-49 30474.27316914.3013994.60142914.7250-54 21933.0822863.102913.35132713.5955-59 15622.1916462.232102.4212461.2.7060-64 114282.00159912.1724612.84127613.0365-69 191811.299681.3214111.62116611.8270-74 15670.8016880.93991+15112211.3475-79 12590.36132710.44 13710.4316110.6780-84 1,1790.25123110.3112610.3014410.4985+ 1690.10111410.1511210.1412410.26TOTAL 17127411001736411100186771100191051100

Estimated population figures only - see Technical AppendixSource:Department of Statistics 1991 Census of Population and Dwellings

Table A1.2(c)Total Population by age and sex, Tairawhiti, 1991

Ta Ira WhitiAge Group

(Years) Male.FemaleNumber %Number%

Under 1 45912.1241411.841-4 175518.101716-17.635-9 198619.16198918.8510-14 186018.5818338.1515-19 1 197419.1117977.9920-24 1 14286.5915787.0225-29 15517.1617497.7830-34 17047.86117467.7735-39 16357.54116087.1540-44 14526.70113415.9745-49 1 107714.97111255.0050-54 95414.4019874.3955-59 1 92714.289514.2360-64 8974.149484.2265-69 7683.547983.5570-74 5402.497233.2275-79 3901.8015792.5880-84 20110.9313511.5685+ 1 11710.54125511.13TOTAL 121675100-001 224791 100.00


Table A1.3(a)'Socio-Cultural' Maori populations - by age group, and sex: Midland, Tairawhiti and component wards, 1991

Usually Resident Population by age and sex forAreaAge Group.(Years) WARD Tairawhiti Midland

& GenderMatakaoaWaikohii WaiapuCookUawaTaruheru PatutahiWainul Whataupoko WaikanaeKaiti Region

Under 5 Male 93661443660156042 144213324120910350Female 96661233957154536 114231339117610116Total 189132267751173010578 258444663238520466

5to14Male 14711421351873310266 195369579197717436Female15012919854117308460 189330531190516908Total 29724341110520463186126 3846991110388234344

15-24Male 123931924575366948 186297480169514496Female111961622784306945 183375510173414910Total 234189354721596613893 369672990342929406

25-44Male 228144264721503611187 267393531233418783Female198135297631354512996 285477696259520697Total _.42627956113528581240183 5528701227492939480

45-64Male 120751593360157824 11118027011460229Female120781472172247227 14421034812788700Total 240153306541323915051 255390618242416929

65 to 74 Male 3315306153189 2439512401485Female 2712486219213 2766482881656Total 6027 781236123912 51105995283141

75+Male 331233030 6121575507Female 1832709063 15-2721129672Total 21639312093 2139362041179

All Ages Male 7475101014246450138441276 93315032250867671286Female7205191002210495153426270 95717162493910573659Total 14671029201645694529186754618903219474317781144945


Table A1.3(b)Total populations - by age group, and sex: Midland, Tairawhiti and component wards, 1991

Usually Resident Population by age and sex for Area

Age Group (Years) WARD :. : Tairáwhlti Midland& GenderMatakaoa Walkohu WalapuCookUawaTaruheru PatutahiWainul Whatäüpoko WàikanaeKaiti Region

Under 5Male1111291629011466117117 402396495221730963

Female11412314193111759696 339453480213330081

Total225252303183225141213213 741849975435061044

5to14Male159225243153165141210180 699744867384958137

Female165237219156210159207180 669705852381955251

Total3244624623093753004173601368144917197668113388

15-24Male138147213123129126138150 600747771340255011

Female12013818396123117147153 597846765337853469

Total2582853962192522432853031197159315366780108480

25-44Male279366348324348279330363124812391128634298523

Female2433123452763002733333841296132013236453101808

Total52267869360064855266374725442559245112795200331

45-64Male153189225171156198219150 759855732384962928

Female138162186132156180192159 861990804400562910

Total291351411303 3123784113091620184515367854125838

65to74Male 4236513351514566 294417210130521531

Female3630573654454863 342546249151824192

Total 7866108691059693129 636963459282345723

75 and ove Male 61212111218241530 16524912670511427

Female21913q_l1821272745 2854382581118817379

Total 27211543039514275 450687384189328806

All Ages Male888110412639069818851074105641674647432921669338520

Female837101111648079758761050108043895298473122494345090

Total1725211524271713195617612124213685569945906044163683610


Table A2.1Marital Status: Tairawhiti and Midland, 1991

Ethnic Group :TairawhitiIMidlandNumberi Number

Maori: Never Married 5325146.28142471147.13Currently Married (1)I 3759132.67130702134.07Separated 88517.691695717.72Divorced 40813.551348313.86Widowed 72316.2814665 .5.18Not Specified. 40513.521184212.04Total Maon Mantal Status 11505100 009012010000Defacto 1209110.51110167111.28Non-Maori: Never Married 5049124.471107463125.64Currently Married (1) 11568156.061241344157.59Separated 80113.8811634713.90Divorced 93614.5411959914.68Widowed 177318.591296791-7.08Not Specified 50712.461461711.10Total Non-Maori Mantal Status206341100.00 141904910000Defacto 102014.9412322015.54Total: Never Married . 10374132.281149934129.45Currently Married (1) 15327147.691272046153.43Separated 168615.2512330414.58Divorced 134414.18123082 14.53Widowed . 249617.771.3434416.75Not Specified 91212.841645911.27Total Marital Status 32139100.00509169100"00.Defacto 1222916.9413338716.56

(1)Includes first marriages and persons remarried.


Table A2.2(a)Maori and Total Populations by Family Type: Tairawhiti and Midland, 1991

(1) Families with adult children, dependent and adult children, and couples only.Source:Department of Statistics, 1991 Census of Population and Dwellings.

Table A2.2(b)Ethnic Composition of Family types: Tairawhiti and Midland, 1991

(:1)On basis of ethnicity of parents - described as 'Maori' if one or both parents identify themselves as Maori.(2) Families with adult children, dependent and adult children, and couples only.


Table A2.2(c)Maori and Total Families with Dependent Children by Number of Parents: Tairawhiti and Midland, 1991

Talrawhltl Midland______________________Family type _____Maorl Total _____Maorl TotalNumber T% Number % Number NumberOne-parent families 1245 44.15 1890 33.30 9705 4066 22578Two-parent families 1575 55.85 3786 66.70 14166 5934 61032All families 2820 100.00 5676 100.00. 23871 100.00 83610

27.00

73.00

100.00


Table A2.2(d)One- and Two-parent Families with Dependent Children, by Ethnic Group: Tairawhiti and Midland, 1991

(1)On basis of ethnicity of parents - described as 'Maori' if one or both parents identify themselves as Maori.

Source:Department of Statistics, 1991 Census of Population and Dwellings... .

Table A2.3 Housing Tenure(1): Tairawhiti and Midland, 1991

Tairawhiti MidlandNumber% I_Number

Maori populationOwned with a mortgage1425130.7413773137.77Owned without mortgage78616.966156116.88Provided rent free 49510.68228316.26Rented or leased 184539.81113590137.27Tenure not specified 811.81 166311.82TENURE TOTAL 4635100.001364681100.00

Total populationOwned with a mortgage486033.328940137.97Owned without mortgage4686132.1379002133.57Provided rent free 10687.321287315.47Rented or leased 367525.250781121.58Tenure not specified 288.1.973333.. 1-.42TENURE TOTAL114586100.001 2353081100.00

(1)Permanent private dwellings


13

Table A2.4 Highest Qualification Gained (1): Tairawhiti and Midland, 1991

(1)Age standardised against total New Zealand population aged 15-59 years.


Table A 2.5: Labour Force (1): Tairawhiti and Midland, 1991

• . __________Tairawhltj: Midland•:,Labour Force Status::'.:::': .Male Female .... Male Female . .

- Number%Number%Number%Number%Maori PopulationPail-time Labour Forceemployed 2375477917734435310unemployed 12021893834217434total (2) 3757708132646 -6628214

Full-time Labour Forceemployed .2145421350241849844983422unemployed 73214435863031537178total (2) 29165618093225242601380031

Non-Labour Force18813630965514328342482855

Not specified 54148153114231

TOTAL 516610056101004219810044886100

Total PopulationPad-time Labour ForceemplOyed 5644218116989453665717unemployed 213235432424154993total (2) 81062574191256464280119

Full-time Labour Forceemployed 804359432931140547647519834unemployed 116796755173018102815total (2) 930968505237159600738655039

Non-Labour Force34772661954546677219055241

Not Specified 13219312013116711

TOTAL 113605110013824100121888911001219912100

(1):Labour force comprises persons 15-64 years of age.(2)Includes persons who did not specify their employment status (ie, whether employed or unemployed).

Source:Department of Statistics, 1991 Census of Population and Dwellings

Table A 2.6 : 'Total' (1) and Youth Unemployment Rates: Tairawhiti and Midland, 1991

'Total' Unemployment RateYouth (15-24 years)Ethnic Group(population aged 15-59 years)Unemployment Rate

Midland;:.'.. MidlandTairawhiti

% % % %

MaoriMale 16.32 16.64 19.97 19.29

Female 11.52 11.15 17.00 14.71

Non-MaoriMale 7.83 7.25 12.85 11.93

Female 6.54 5.71 11.97 .9.71

TOTALMale 9.54 10.91 14.73 15.59

Female 7.64 8.03 13.38 12.28

(1) Standardised for age and sex against the total New Zealand usually resident population.

Source:Department of Statistics, 1991 Census of Population & Dwellings.

Table A2.7(a)Family Incomes - Quartile Ranges: Midland and Tairawhiti, 1991

Tairawhiti Midland IE

IncomesMaori Total Maori TotalMaleFemaleMaleFemaleMaleFemaleMaleFemale

$$..$.$$,$$$Lower quartile65936351833766616581589989216642

Median 10276952815556102431146994781797110799

Upper quartile1858714010259481645722187141932955818158

Inter-quartile1199476581761197961560682942063611516Range

Source;Department of Statistics, 1991 Census of Population and Dwellings.

Table A2.7(b)Personal Incomes -Quartile Ranges: Midland and Tairawhiti, 1991Quartile Talrawhith MidlandRangeMaorlTotalMaoriTotal_____ $$$$Lower quartile12869167471340918878

Median20720277522259232045

Upper quartile33635442893816150604

Inter-quartile20766275422475331726Range


Table A2.8(a)Family Income: Tairawhiti and Midland, 1991

TairawhitiIMidlandNumber%Number

MaoriUnder $15,000 1314128.1710101126.07Under $30,000 2592155.5612007651.82Total 466511001387391100

Non Maori Under $15,000 630. 9.401422919.99Under $30,000 2505137.3952710137.02Total 66991100.14239211100

TotalUnder $15,000 1944117.11124330113.43Under $30,0001 5097144.85172786140.18Total I11364110011811311100


Table A2.8(b) ..Age Standardised (1) Individual Income: Tairawhiti and Midland,1991

Proportion under $10,000 -Tairawh,tiMidland

MaoriMale 44.7342.80Female 49.7349.95

Non-Maori Male..25.9526.47Female 43.1842.55

TotalMale 32.2629.05Female :44.6643.45

(1)Standardised - by age and sex against the total New Zealand usually residentpopulation.

Source:, Department of Statistics, 1991 Census of Population and Dwellings

Table A2.9 Proportion of the Population Receiving Income support: Tairawhiti and Midland, 1991

Unciuployment Ucnctit Youthl4twOcn(Allowanrn 510eeel1i,vllde Benefit, Domestic Purposes Benefit All Benefits CoveredTlrawtillIMidLandTalrawlilllMLijLandTalrawhltlMidlandTairawbItIMidlandTalrawbillMidland

Number I%Number%Number%Number%Number%Number%Number%Number%Number%Number%MaoriMale 15361'28011121125.34721.316631.502224.0516983.84781,425851.32190834.791415732.00

Female6901145521711.04691.147021.4917729413142.783365,5725175.33127221.11975020.63Non Maon Male-6966.87156367.53900.8928621.381741.7236541.76150.153300.169759.622248210.62

Female3993.8084543.941020.9730391.421261.2029521.3810209719440.917296.9413897.64TotalMale 223214.2926847110.651621.0435251.4039612.5453522.12930.60191510.36128831846366391454

Female10896.59136715.221711.0337411.433031.8342661.634382.6544611.70200112.11261399.99


Table A2.10(a)

Major Occupational Groups - Maori population: Tairawhiti andMidland, 1991

Talrawhltl MidlandOccupation MaleIFemale Male Female

Number I%I Number I%I Number%Number I%Administrators/Managers 10814.881815.8419305.001597. 6.00Professionals 1054.75118613.4219064.871350113.57Technicians 1054.751997.14110535.668318.36Clerks 783.531285120.5615492.952127121.39Service/Sales Workers 1205.43124917.97110325.551806118.16Agricultural/Fisheries Workers579126.191.1027.361288615.52 6.03Trades Workers 1868.411120.871232512.5Q115611.57Machine Operators 552127.9711359.74502527.021iiioj11.16Elementary Occupations 31514.251192113.85316817.04189418.99Armed Forces 910.411310.22300.161910.09Not Specified 542.44423.036903.714654.68TOTAL 2211100.003597100.00118594100.001285391100


Table A2.10(b)

Major Occupational Groups - Total population: Tairawhiti andMidland, 1991

Tairawhltl MidlandOccupation MaleIFemale Male!Female

Number I%I Number I%I Number1%I Number IAdministrators/Managers 82219.9013698.3711609511.261747019.80Professionals 6908.31 14716.94120428.4311856115.56Technicians 69018.31139318.91131199.18726619.53Clerks - 2763.3211119125.37143023.01 1 19305.00125.33Service/Sales Workers 5016.031744116.87187396.11 11781.00115.46Agricultural/Fisheries Workers2112125.43136318.2312945720.619204.0012.08Trades Workers•. 1233114.854811.0912508017.551029.001.35Machine Operators 1185114.2724915.6512071814.504062.005.33Elementary Occupations 654f7.882916.601108427.592517.003.30Armed Forces 910.11310.071050.07124.000.03Not Specified 13211.598411.09124151.69116982.23TOTAL 183041100.00 1127141100.0011100.0012191261100.00

Source:Department of Statistics, 1991. Census of Population and Dwellings.

Table A2.11 (a)Major Industry Group - Maori population: Tairawhiti and Midland, 1991

Midland________________Industry Group Male Female.•.<... Male Female_____

Number%Number%Number%Number%Agriculture, Hunting, Forestry and Fishing 63328.671359.74314116.90693'6.98Mining and Quarrying 60.2730.222941.58300.30Manufacturing 51623.37288

201 _____8531928.61177917.91

Electricity, Gas and Water 421.90 00.004172.24270.27Construction . 1808.15181.30193210.39900.91Wholesale and Retail Trade and Restaurants and Hotels1747.8819213.8517859.60169817.09Transport, Sotrage and Communication 1295.84302.1612456.703813.84Business and Financial Services. 512.31846.066363.427147.19Community, Social and Personal Services 41418.7559442.86291915.70398740.14Not Specified 693.13392.819094.894894.92Total 22081100.271138699.7818591100,00993399.55


Table A2.11(b)Major Industry Group - Total population: Tairawhiti and Midland, 1991

Tairawhiti MidlandIndustry Group .. Male JmaIe jlale Fem!!e_____

Number%Number%Number%Number%Agriculture, Hunting, Forestry and Fishing 224126.9845910.383038721.26969912.73Mining and Quarrying 150.1830.0715811.111740.23Manufacturing 145217.4858213.162917220,41853211.20Electricity, Gas and Water 1291.55120.2728532.00-4260.56Construction. 7358.85571.2914010 909811.29Wholesale and Retail Trade and Restaurants and Hotels116113.9883718.932177115.241575620.68Transport, Sotrage and Communication 4295.16902.0478755.5125623.36Business and Financial Services 4475.3846510.5295736.70909011.93Community, Social and Personal Services 153018.42182441.252238915,672718035.67Not Specified 1772.137817632822.3017672.32Total 83071100.11442299.66142899100.007620399.95

Source:Department of Statistics, 1991 Census of Population and DwellingsNote: Owing to rounding, individual figures do not always sum to the total shown.

Table A3.1 Live Births by Age Group, Maori and Total populations: Tairawhiti andMidland, 1991

Age Live Births (1) in Each Group Tairawhiti I ___________ Midland

(Years)MaoriITotal Maori TotalNumber I Number F %Number. I%Number%

15-1959119.60115114.3945017.82124319.92

20-2487128.9024730.91182532.673222125.71

25-2992130.5628135.17173128.95443613540

30-3446115.289912.39138315.1712798122.33

35-391213.99486.011184.6717195.74

40-44 siF1.6691.13116J0.6311080.86

45-49 010.00100.001210.08140.03

Total3011100.00799100.0012525100-00112530100.00

(1)Registered live births for the year ended 31 March 1991.


Table A3.2 Age Specific Fertility Rates: Tairawhiti and Midland, 1991

Area Fertility Rate 1) for Maternal Age Group (Years):i 15-1920-2425-29 1 30-34 1 3549 1 40-44 i 4549

Maori PopulationTairawhiti176.231118.851127.25172.33123.95112.3510:00

Midland. 75.831146.591133.81176.08131.9815.3610.21

Total PopulationTairawhiti164.001156.531160.66156.70129.8516.710.00

Midland 143.911127.841167.251101.01129.0414330.04

(1)Number of live births (March year) per 1,000 female population in each age groupas enumerated at the 1991 Census of Population and Dwellings..

Source:Department of Statistics, 1991 Census of Population and Dwellings.Department of Statistics, Vital Statistics.

Table A3.3 Perinatal, Neonatal, Post-neonatal and Total Infant Deaths and Death Rates(1), Tairawhiti and Midland, 1988-1990

(a)Number of Perinatal and Infant Deaths: Tairawhiti and Midland, 1988-1990

(1) Number of fetal deaths (after 28 weeks pregnancy) plus deaths of infants less than 7 days old.(2) Number of deaths of infants 28 days of age or less.(3) Number of deaths of infants aged between 29 days and under 1 year.(4) Number of deaths of infants under 1 year of age.(5) These rates have been calculated using an annual average of births and deaths for the three year period 1988-1990.(6) Number of fetal deaths (after 28 weeks pregnancy) plus deaths of infants less than 7 days old (per 1000 live births and late fetal

deaths).(7):Number of deaths of infants aged 0-28 days per 1000 live births.(8).. Number of deaths of infants aged 1-11 months per 1000 live births.(9)

Number of deaths of infants under 1 year of age per 1000 live births.

SourceNew Zealand Health Information Service, Ministry of Health.Department of Statistics, Vital Statistics.

(b)Infant and Perinatal Death Rates: Tairawhiti and Midland, 1988-1990(5)

(1) These rates have been calculated using an annual average of births and deaths for the three year period 1988-1990.(2) Number of fetal deaths (after 28 weeks pregnancy) plus deaths of infants less than 7 days old.(3) Number of deaths of infants 28 days of age or less.(4) Number of deaths of infants aged between 29 days and under 1 year.(5) Number of deaths of infants under 1 year of age.

• (6)Number of fetal deaths (after 28 weeks pregnancy) plus deaths of infants less than 7 days old (per 1000 live births and late fetaldeaths).

(7)Number of deaths of infants aged 0-28 days per 1000 live births.

• (8)Number of deaths of infants aged 1-11 months per 1000 live births.

(9)Number of deaths of infants under 1 year of age per 1000 live births. •

Source:New Zealand Health Information Service, Ministry of Health. •Department of Statistics, Vital Statistics.••

Table A3.4 Life Expectancies at Birth: Tairawhiti, Midland and New Zealand,1985-1987 and 1990-1992

(1)Figures are for 1989 -1991.

Source:Department of Statistics (1993) Demog ra phic Trends, 1992, Wellington.Department of Statistics, New Zealand life tables, 1990-1992, News. Release10 December 1993.Population Studies Centre, University of Waikato.

Table A3.5 Average Annual Number of Deaths by Age Group, Maori and TotalPopulations; Tairawhiti and Midland, 1990-1992


Table A3.6 Age-Specific Death Rates, Maori and Total Populations: Tairawhiti andMidland, 1990-1992(1)

(1)For infant death rates under 1 year, see Table A3.3(b)

Source:Population Studies Centre, University of Waikato.

Table A3.7 Hospital Discharges and Standardised Discharge Rates(1): Tairawhiti and Midland, 1990-1992

Medical, Täirãwhltl Maori Tairawhltl Total Midland Maori Midland Total•Surgical, or 8tandardise.d7 Standardised Standardised

Obstetric Group Rate: Rate Rate Rate• Numberper 100,000(2)Numberper 100,000 (2)Numberper 100,000 (2) Number per 100,000 (2)

Cardiology 213 2,558603 1,3951,148 1,9147,8041,141Dermatology 103 783194 440498 4761,715 256Endocrinology 31 324 78 177244 3461,154 169Gastroenterology 281 2,291781 1,7721,734 1,8659,0871,329Haematology and Immunology 88 682201 453404 4592,491 364Infectious Diseases 53 300113 249330 2681,200 175Neurology 236 1,778558 1,2641,276 1,2855,736 839Renal Medicine 94 819236 544537 6392,364 346Respiratory Medicine 471 3,286786 1,7442,783 2,8037,7871,139Rheumatology 46 449118 268203 2211,198 175Total Medical Discharges 1,61713,2713,668 8,3069,15610,27640,5725,933Newborns 258 1,686475 1,0771,696 1,4805,112 747Obstetrics - Delivery 450 6,9938564,9513,655 7,30712,1384,438Obstetrics - Other 201 3,117343 1,9861,118 2,2283,1971,169Total Preg & Childbirth Discharges 909 5,2691,675 397706,469 4,84220,4472,990Burns 19 107 26 56106 82263 39Cardiothoracic Surgery 11 113 38 88 90 107657 96Ear Nose and Throat (ENT) 240 1.410435 9441,806 1,3575,928 867General Surgery 164 1,142 24 541,277 1,268391 57Gynaecology 270 3,786529 1,2122,5604,5837,8351,146Maxillofacial and Plastic/Reconstructive 10 62571 2,606 75 639,5662,771Neurosurgery 14 114 48 111139 142747 109Ophthalmology 89 822262 597438 6552,362 345Orthopaedics 351 2,6559402,1441,972 1,93110,1751,488Urology 55 418186 430384 4022,716 397Vascular Surgery 22 178 63 146194 2431,396 204Total Surgical Discharges 1,235 0713,121 7,098 8,9668,50042,0386,147TOTAL (Med, Sürg.& Preg.) 3,761274118,46419,17324,59123,618103057115,070

(1) Standardised for age and sex to the Total Midland population.(2) Annual average rate for the period 1990-1992.

Sources:

New Zealand Health InformationService, Ministryof Health.Department of Statistics, 1991 Census of Population and Dwellings.

Table A3.8 Average Annual Number of Hospital Discharges by Age Group, 1990-1992

(a)Tairawhiti Maôri Population

Medical, Surgical Average Annual Number of Hospital Discharge s in Each A ieGrouupJars):or Obstetric Group Under 11-45-1415-2425-4445-6465 and overTotal

Cardiology 4.67.3.672.009.6740.0081.3371.67213.00Dermatology 5.0014.0018.0015.6724.3317.339.00103.33Endocrinology 2.332.000.002.675.0012.337.0031.33Gastroenterology 21.3332.3332.6741.3365.3350.0038.33281.33Haematology and Immunology 1.3315.3333.673.679.3314.33103388.00Infectious Diseases 8.6716.339.677.007.332.331.6753.00Neurology 70033.0035.0044.0056.6735.6724.33235.67Renal Medicine 4.003.67.5.3319.3320.6726.3315.0094.33Respiratory Medicine 54.00157.6740.6739.6758.0072.0049.33471.33Rheumatolo 0.333.6710.006.334.6712.00.9.0046.00Total Medical Discharges 10867281.67::18760018933291.3332367235671617.33Newborns 258.001.330.000.000.000.000.00259.33Obstetrics - Delivery 0.000.000.33232.67216.000.67000449.67Obstetrics - Other 0.000000.33106.6794.330.000.00201.33Total Pregnancy & Childbirth Discharges258 000;00:.0 .67339.33:310.330.67.0.00909.00Burns 0.008.332.673.333.671.000.3319.33Cardiothoracic Surgery 0.670.330.330.672.674.002.6711.33Ear Nose and Throat 19.0091.0070.0015.3321.3315.008.00239.67General Surgery 8.6715.6715.3327.6757.3330.338.67163.67Gynaecology 0.330.671.6766.33164.3331.675.002700Maxillofacial and Plastic/Reconstructive 0.001.331.673.003.000.670.3310.00Neurosurgery 0.670.001.002.333.336.330.6714.33Ophthalmology 2.339.3313.677.6711.0027.0018.0089.00Orthopaedics 6.3335.6749.0071.00100.33 . 55.6733.00351.00Urology 1.008.336.677.0010.00100012M055.00Vascular Sur9ery- 9•990000.000.0012.006.67 ?JZTotal Surgical Discharges 39.00169.33160.33201.33386.00...77rg _• 91.33TOTAL (Mcd, Surg, Preg) 405.67451.00348.00730.00987.67512.601327.003761.33

Source:New Zealand Health Information Service, Ministry of Health.

(b)Tairawhiti Total Population

Medical, Surgical......... ._______ AvF.I.

ra9eAflnualNUmbéofHopial.:Discyès . in Each. c e Group (Years):orObstetri :::c : Group Under I 1.4............... 5-1415-2425-44•4564...65 and over . . .TotI

Cardiology 8.674.334.6713.0072.67209.00291.00603.33Dermatology 6317.6721.3324.00406744.333933193.67Endocrinology 6.676.007.005.3376723.0022.3378.00Gastroenterology 38.3362.0075.6780.00145.33178.67200.67780.67Haematology and Immunology 1.6716.6756.005.0021.3337.0063.67201.33Infectious Diseases 11.3326.3318.3313.6718.6713.3311.00112.67Neurology 13.6762.0067.6783.67116.6793.00 121.67558.33Renal Medicine 5.678.0010.6733.3345.0059.007467236.33Respiratory Medicine 64.33195.6772.6759.0077.67121.67194.67785.67Rheumatology 0.335.3316.679.6722.3324.0039.33117.67Total Medical Discharges 157,00404.00T1::::: 35067326 67568 00803.00.: 1058 333667.67Newborns 475.331.670.670.000.000.000.00477.67Obstetrics - Delivery 0.000.000.33317.67537.001.000.00856.00Obstetrics - Other 0.000.000.33146.33196.670.000.00343.33Total Ch'Pregnancy & ildbirth Discharges476.310000;67464.00733:67T1.00,000167467Burns 0.0011.003.334.335.331.000.6725.67Cardiothoracic Surgery 1.670.671.331.675.6714.3312.6738.00Ear Nose and Throat 30.00140.67118.3335.0042.0030.6738.00434.67General Surgery 13.3324.3333.3351.33137.67120.67148.33529.00Gynaecology 0.6711.672.00104.33346.6782.003333570.67Maxillofacial and Plastic/Reconstructive 0.332.331.675.009.333.671.3323.67Neurosurgery 0.670.674.004.6712.3315.0011.0048.33Ophthalmology 3.0019.0027.0015.3337.0058.67102.00262.00Orthopaedics. 10.3349.67101.00142.00237.00196.33203.67940.00Urology 0.6712.0025.6745.3373.3363.0032.67252.67VascularSur9eyta

0000.000.3303 Tol Surgja! Disces 6300267003113337867881335740064600312133TOTAL (Med, Surg, Preg) 695.33671.00662.671169.332183M01378.001704.33. 8463.67

Source:New Zealand Health Information Service, Ministry of Health.

Table A3.9 Discharge Rates by Age: Tairawhiti and Midland, 1990-1992

Region Gender

AnnualUnder..i

Maori _Pop ulationTairawhiti Female83,085

Male128,315Both104,823

MidlandFemale '72,972Male100,493Both86,528

Total _Pop ulationTairawhiti Female72,544

Male86,057Both79,649

MidlandFemale. 51,639Male. 64,365Both58,051

Discharge Rate per1-4r .5-14

24,0328,65633,94113,63628,91011,05819,7477,30029,58510,66024.5748.945

16,278

7,82322,317

9,45619,332

8,64211,740

5,63616,892

7,22914.356

6.453

00 Population in_EachAge Group (Years):

15-2....544 ...I 5- -64and Over

_36,66735,34326,211 '"61,171

12,683' 11,25820,22340,712

24,53022,76823,06349,321

34,99433,44423,70546,454

9, 5779,53517,76140,417

22,36321,03920,66543,196

23,91124,54517,26931,350

10,6519,48217,77842,460

17,25417,07317,51836,093

19,58221,18512,74326,058

7,2346,92812,820 ,'35,537

13.32114.17312,782130,251

Source:New Zealand Health Information Service, Ministry of Health.Department of Statistics, 1991 Census of Population and Dwellings.

Table A3.10 Discharge Rates by Major Medical. Specialty by Age Group: Tiarawhitiand Midland, 1990-1992

(a)Infants Under 1 Year of Age

*Annual average over three years.**Rate per 100000 Maori population rates using 'Health' definition (see Introduction).

(b) Young Children 1-4 Years of Age

*Annual average over three years.**Rate per 100,000 Maori population rates using 'Health' definition (see Introduction).

(c) Children 5-14 Years of Age


-

(d)Adolescents and Young Adults 15-24 Years of Age

*Annual average over three years.**Rate per 100,000 Maori population rates using 'Health' definition (see introduction).

Females only.

(e) Adults 25-44 Years of Age.

Tairawhjtj MidlandMedical Specialty Maori I TotalMaoTT TcI Rate ** I RateI Rate ** I RaOstetrics(delivery) 11042018333 I11268Obstetrics (other') 7Q7 I I

L/flhIpdeUJCS 231318541176911181Total discharge rate* 22768117073121039114171

*Annual average over three years**Rate per 100,000 Maori population rates using 'Health' definition (see Introduction).

(f) Adults 45-64 Years of Age


(g)Adults Over 65 Years of Age

*Annual average over three years.**Rate per 100,000 Maorr population rates using 'Health' definition (see Introduction).

SourceNew Zealand Health Information Service, Ministry of Health.Department of Statistics, 1991 Census of Population and Dwellings.

Table A3.11 Estimated Prevalence of Mental Illness among Adolescents: Tairawhiti,1991

(DSM II) Mental DisorderEstimated number (1) of adolescents:MaleFemaleITotal

Overanxious 1581 2841 442Separation Anxiety 561 95 150Simple Phobia 711197 269Social Phobia 471 32 79Major Depressive Episode 641205 269Dysthymia 321 791 110Attention Deficit Disorder 111 471 158Aggressive Conduct Disorder 1191 01 118Non Aggressive Conduct Disorder. 15812681 427Oppositional 32 951 127

(1) Estimated prevalences obtained by applying the results of the Dunedin longitudinalstudy [McGee et al (1990)] to the total Tairawhiti population aged 10-19 years asenumerated at the 1991 Census.

Table 3.12Suicide Rates: Tairawhiti and Midland, 1986-1991.

(1)Number of suicides per 10,000 people aged 10-19 years as enumerated att eh 1991Census

Sources:Ministry of Health, New Zealand Health Information Service.Department of Statistics, 1991 Census of Population and Dwellings.

Table 3.13Expected Inpatient First Admissions for Treatment of Mental Illness,Working Age Population:. Tairawhiti and Midland, 1991

(a) Tairawhiti

(b) Midland

(1) Estimated by applying the 1992 New Zealand admission rates to the Tairawhiti andMidland populations aged 15-64 years as enumerated at the 1991 Census.

(2) Number of first admissions per 10,000 population aged 15-64 years as enumeratedat the 1991 Census.

Age standardised using the New Zealand rates.

Sources:Ministry of Health, unpublished 1992 mental health data.Department of Statistics, 1991 Census of Population and Dwellings.

Table 3.14 Expected Inpatient Re-admissions for Treatment of Mental Illness,Working Age Population: Tairawhiti and Midland, 1991

(a) Tairawhiti

(b) Midland

(1) Estimated by applying the 1992 New Zealand admission rates to the Tairawhiti . andMidland populations aged 15-64 years as enumerated at the 1991 Census.

(2) Number of first admissions per 10,000 population aged 15-64 years as enumeratedat the 1991 Census.


Sources:Ministry of.Health, unpublished 1992 mental health data.Department of Statistics, 1991 Census of Population and Dwellings.

Table 3.15Estimated Prevalence of Mental lllness,Working Age Population:Tairawhiti, 1991

(1) Number of Tairawhiti population aged 15-64 years with a mental disorder. Estimated*by applying the results of the Christchurch Psychiatric Study (1991) to the Tairawhiti

population as enumerated at the 1991 Census.(2) Number of persons with mental disorder per 10,000 population aged 15-64 years at

the 1991 Census.

Source:Christchurch Psychiatric Study (1991).Department of Statistics, 1991 Census of Population and Dwellings.

Table 3.16 Age Standardised Suicide Rates, Working Age Population: Tairawhitiand Midland, 1986-1991

(1) As enumerated at the 1991 Census.(2) Three-year average.

Source:Ministry of Health, New Zealand Health Information Service.Department of Statistics, 1991 Census of Population and Dwellings.

Table 3.17Expected Inpatient First Admissions for Treatment of Mental Illness,Elderly Population: Tairawhiti and Midland, 1991

(a) Tairawhiti

(b) Midland


(2) Number of first admissions per 10,000 population aged 65 years and over asenumerated at the 1991 Census. .

Age standardised using the New Zealand rates. .


Table 3.18Expected Inpatient Re-admissions for Treatment of Mental Illness,Elderly Population: Tairawhiti and Midland, 1991

(a) Tairawhiti

(b) Midland


(2) Number of first admissions per 10,000 population aged 65 years and over asenumerated at the 1991 Census.



Table 3.19 Age Standardised Suicide Rates, Elderly Population: Tairawhiti andMidland, 1986-1 991

(1) As enumerated at the 1991 Census.(2) Three-year average.

Source:Ministry of Health, New Zealand Information Service.Department of Statistics, 1991 Census of Population and Dwellings.

APPENDIX B

GLOSSARY OF MAORI TERMS USED

TERMMEANING

Aroha All encompassing love

Hap] Groups of whãnau who have common ancestral links

Iwi Groups of hapu who have common ancestral, geographical,historical and water links

Wairua.Spirit/spiritual health

Hinengaro Mental and emotional health

Tinana Body/Physical health

Ora Well, life, to be in tune with one's life essence

Tamariki Children

Rangatahi Adolescents

Wãhine Women

Tâne Men

Pakeke Adults

Kaumãtua Elderly

Kuia Elderly woman

Whãnau Family/relationships which have blood links to a commonancestor

Ma rae

Kawa

Te Reo

Waka

Maunga

Awa

Moana

TO rangawaewae

Meeting ground/place

Tribal customs and protocol

Language

Canoe (ancestral)

Mountain

River

Sea

Stamping ground

1... -.-.._-.'•:--

LI

APPENDIX C

A CAUTIONARY COMMENTFOR PROFILE USERS

This Appendix outlines the technical issues addressed in this profile of Tairawhiti .and itssub-regional components. Further details regarding the statistical methods used in theanalysis are outlined in Appendix D.

Six major technical issues were addressed during the preparation of this profile. Theseshould be taken into account, not only by users of this profile, but also by other analysts,particularly those using Supermap.

1. Problems with the analysis and interpretation of data relating to small populations.

Many of the sub-populations within Midland are small in size. It is particularly noticeable inthe age and gender distributions of, for example, some of the smaller Territorial LocalAuthority populations and regional ethnic populations (eg older ages for Maori ). The useof such small population counts in the calculation of proportions or rates gives rise topossible distortions similar to those encountered in small samples. Rates that may appearto be an extreme local characteristic may actually reflect the small base population.

2. Regional sub-divisions within Midland

The Midland Region reaches from Thames-Coromandel, Hauraki and Waikato Districts inthe north: to Taupo District in the south; and from Taranaki Region in the west to Gisborneand Opotiki Districts in the east. Territorial Local Authorities have been used to examinelocal population variations within the Midland region. These areas have moderately sizedpopulations, which hepls avoid distortions due to small populations.

3. Problems with population definitions

Ethnicity

The definition of 'Maori' adopted in this report is derived from the 1991 Census ofPopulation and Dwellings, and is the most widely accepted statistical definition of 'Maori' inNew Zealand. Census respondents were asked to record, by means of self-identification orself affiliation, the ethnic groups with whom they felt they shared a common origin or senseof cultural identity. The Maori ethnic group as used in this report, is those people who gaveNew Zealand Maori as either their sole ethnic group or as one of several ethnic groups.

Two problems arise from the use of this definition. Firstly, many health data sources do not,at present, allow for multiple responses to ethnicity questions. The sole Maori population -those people who stated New Zealand Maori to be their sole ethnic group at-.the 1991Census of Population and Dwellings, has been used as the base for calculating any ratesthat use health data.

For other analyses a broader definition of 'Maori' is used - the Maori ethnic group. Thisgroup is made up of all people who stated they belonged to the Maori ethnic group, eithersolely or as one of several ethnic groups.

A priority list was used to assign an individual to an ethnic group so that they were countedonly once. First of all, those people who specified Maori were counted. Of the remainder,

those who specified a Pacific Island ethnic group were counted. The remainder comprisepeople largely of European origin. This procedure severely reduces the size of the PacificIsland population in particular, as many of these people also identify as Maori.

Census Populations

There are several different statistics used by the Census of Population and Dwellifigs todefine the population present in an area. Wherever possible, the base population used inthis analysis is the 1991 Census "usually resident" population. This population comprisespeople who usually lived in Midland, and includes those residents of Midland who were inother regions of New Zealand on Census night. However, this population excludes residentswho were temporarliy overseas on census night.

4. Adjustments to counter distortions due to age and gender

Almost all health and socio-economic characteristics vary by age and gender. Conversely,certain health and socio-cultural population characteristics used in this profile are affectedby the age and gender structure of a population. Wherever necessary and possible (datacategories permitting) a conventional technique, direct standardization, has been used toproduce a comparative statistic that is adjusted for the different population structures ofTI-As within Midland (see Appendix D for methodology).

5. Populations with inappropriate categorical divisions

In Supermap data for the New Zealand Maori (socio-cultural) population were available onlyin the 9 irregularly spaced age groups for males and females:

-under 5-5to14-15to19-20to24-25to34-35to44

45 to 59-60to64-65to74-.75to84-85 and over.

These data were required in 19 age groups for males and females (under 1, 1 to 4, 5 to 9,and in five year groups to 85 and over). It was decided, because of cost, to investigate theuse of an interpolative procedure to derive the required 19 age groups from the S.upermapdata for the construction of population pyramids (see Appendix D for methodologicalreview).

Issues 1, 2 and 3 featured in all aspects of the analysis, and had to be dealt with beforefurther analysis could be undertaken. However, isues 4 and 5 were tackled as the problemswere encountered.

APPENDIX D

TECHNICAL ISSUES TO BE CONSIDEREDIN THE ANALYSIS OF TAIRAWHITI'S

POPULATION

ADJUSTMENTS TO COUNTER DISTORTIONS DUE TO AGE AND GENDER

As noted in Appendix C, a conventional technique, direct standardization, has beenemployed in this profile to produce a comparative statistic that is adjusted for the differentpopulation structures of Tairawhiti and Midland. The formula for the computation of theage/gender standardized statistic is given by;

9TLA = iglgfldE px N, /N

where 6.is the age standardized proportion for a given TLA.Pi is the proportion of the population, for that TLA, that

exhibit a particular characteristic in age and gendercategory I.

N, INis the proportion of the New Zealand population in theith age and gender category.

POPULATIONS WITH INAPPROPRIATE CATEGORICAL DIVISIONS

In Supermap, data for the New Zealand Maori (socio-cultural) population were available onlyin the 9 irregularly spaced age groups for males and females:

—under 5•

fri

—15to19—20to24-:.25to34.—35to44-45to59.—60to64—65to74—75to84-85 and over

However, these data were required in 19 age groups (under 1, 1 to 4, 5 to 9, in five yeargroups to 80 to 84, and 85 and over); It was decided, because of cost, to investigate theuse of an interpolative procedure to derive the required in 19 age groups from the availableSupermap data. Several "difference"-type formulae can be used, as outlined in Shryockand Siegel'. However, these methods were not suitable because of the irregular intervallengths of the Supermap data, and the first interval required separating. An alternativemethod was used. It is intuitively simpler and uses the fundamental method of polynomialinterpolation.

METHODOLOGY

Step I The original data, adjusted to allow for irregular interval widths,were used to produce a least squares exponential curve.

Shryock, H. S. Siegel, J. S. and Associates, The Methods and Materials ofDemography. 1976 Academic Press

A polynomial of any degree less than or equal to 9 could havebeen used, however, the physical shape of the populationseemed to indicate that an exponential would have been themost appropriate 2 . Thus the interpolated curve was calculated inthe form as follows:

Y=axexp(X$)

where Y represents the data and X the centre of the age bandwidth (the latter is scaled to be centred at 0 and within±10). This can easily be calculated using a simplestatistical package.

The desired set is obtained by calculating a new set ofdata Y,9, using the same coefficients computed above and anappropriately scaled and centred age band, X,, as follows:

= axexp(X,J?)

Step 2 The final data were adjusted so the shape of the curve and thetotals in the nine original age groups were retained. This wasdone by scaling the original data by 'weights' calculated from thecurve, so that the sum of the totals in each ofthe nine originalintervals equals the original total.

A final adjustment was made to the first age bands. It was foundthat assuming the population was evenly spread for ages 0-4years produced a fairly true distribution. Thus the age group wasdivided at a ratio of 1:4 to produce the required under 1, and Ito 4 age groups respectively.

Empirical Results

Both steps described above were tested on two populations for which the required 19 ageband data were available. They were:

1. Total New Zealand Maori population (from the 1986 Census of Population andDwellings), by gender; and

2. Total Waikato Area Health Board Maori population, (from the 1986 Census ofPopulation and Dwellings), by gender.

Table D.1 shows that while the first step produced summed absolute deviations greater than13% of the total populations, the second step produced summed absolute deviations lessthan 4%.of the same total populations.

2 As it turns out a polynomial of degree higher than 5 is no worse than the exponential fit.

second method was employed to calculate the necessary Maoripopulation pyramids and as the base populations in necessary age

Consequently, thepopulations for thestandardizations.

Table D.I.Comparison of raw interpolated numbers and adjusted interpolatednumbers by their summed absolute deviations from the actual data.

COMPARING REGIONAL VARIATIONS TO AN OVERALL REGIONAL PROPORTION

Comparative proportions of the population structure varies - sometimes quite largely. In thissection, a method is outlined for the. specification of a value that measures the spread ofproportions recorded in the other TI-As, around that for the whole Region. The methodoutlined is an adaptation of the method outlined in appendix one of "Diversity and Change".A measure of spread is devised for the distribution of TLA proportions for which themeasure of location is the proportion for the whole Region.

An adjustment is made, so that each TLA's proportions is compared to Midland by thenatural log of the odds ratio for that TLA, relative to Midland. A further adjustment is madein that a population weighted standard deviation for the TI-As is computed.

The mean of this comparative distribution is the logarithm of the overall regional proportionand the formula for our measure of spread is given by:

= TLA (y,-yM)2xPJP

is the square root of the summed population weightedsquared deviation given in the formula above.is the natural logarithm of the odds ratio for each TLArelative to Midland.is the natural logarithm of the odds ratio for Midland(which equals 0).is the population of the TLA that when summed foreach TLA is equal to the total Midland population P.

where

yt

yM

P t

Population Monitoring Group (1989), Diversit y and Change: Regional Populations inNew Zealand. PMG Report No. 5, New Zealand Planning Council, Wellington.

In this analysis, it was considered that the values of y, outside 0.6751 weighted standarddeviations from the value of y, were moderately extreme.

This figure is analogous to an upper and lower quartile limit for a normal distribution with thesame mean and standard deviation.

i k?, xtitj i k i...highest level of education 23 te mahi - labour force 25 nga kore mahi -...

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