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Child and youth health

by Kerryn Pollock

In the 20th century New Zealand children and young people were among the healthiest in the world. Most are healthy in the 21st century, and can expect to grow up to be healthy adults. But some have much poorer health than others.


Health status of children and young people

Most New Zealand children and young people are healthy and grow up to become healthy adults. However, there are health imbalances within the child and youth population, primarily associated with family socio-economic status and ethnicity.

International comparisons

For much of the 20th century New Zealand was proud of its child health record. Infant mortality, a major health indicator, was the lowest in the world in the early decades and the second-lowest in 1951. Improvements in living standards, smaller families, free and subsidised public health care, family income support and post-Second World War prosperity contributed to this record.

However, New Zealand slipped relative to other rich countries in the 1960s. In the 1970s New Zealand was still in the top third for most child health indicators, but had fallen within this group. By the early 2000s it had dropped to the bottom third. Various broad explanations have been offered, including poor parenting education and skills, fragmented health services, market-led reform of the New Zealand economy in the late 1980s and 1990s, income inequality, changes in welfare policy and internationally low government spending on children.

Money matters

Government spending on children increases with age in New Zealand and across Organisation for Economic Co-operation and Development (OECD) countries. Spending on children aged 0–5 years mainly takes the form of cash benefits to parents, tax breaks and childcare. Spending on children aged 6–11 is mainly on eduction and to lesser extent cash payments and tax breaks. For those aged 12–17 public expenditure is overwhelmingly on education. New Zealand per capita government spending on children is in the mid-range for OECD countries.

This does not always mean that the health of children got worse overall. Rates for different indicators improved, but to a lesser extent than in other countries, which caught up with and then surpassed New Zealand.

New Zealand did not fare so well internationally in the early 21st century. An OECD report published in 2009 on child health in the 30 OECD countries found that New Zealand had:

  • the highest youth (15–19 years) suicide rate
  • the second-lowest immunisation rate for measles and the fifth-lowest for whooping cough
  • the 10th-highest infant (0–364 days) mortality rate
  • the seventh-highest child (0–19 years) mortality rate.

Overall, New Zealand was ranked 29 out of 30 for child health and safety.

New Zealand’s youth suicide rate at 15.6 per 100,000 of those aged 15 to 19 years from 2009 to 2013 was the highest among 41 countries in the European Union and the OECD – countries defined as 'rich countries' by the United Nations Children's Fund. However, across these countries, suicide was the leading cause of death for those in this age group accounting for 17.6% of all deaths.

Warning note

Health researchers say that a cautionary approach should be taken when making international comparisons of suicide rates. The level of proof required to classify a death as suicide varies between countries. In New Zealand the investigation process is very thorough and the number of unclassified deaths is low. By comparison, there may be undercounting of suicides in other countries. The stigma attached to suicide may affect the way deaths are classified.

Death and hospitalisation rates

The causes of death for children and young people differ depending on age. In the 2010s sudden unexpected death in infancy was the most common cause of death in post-neonatal babies (29–364 days). Medical conditions like cancer were the leading cause of death in children (1–14 years) and car accidents were also a significant cause. For young people (15–24 years) the leading cause of death is intentional injury (suicide and assault).

Injury and poisoning combined were the most common cause of acute hospitalisation of both children and young people. Other significant causes for children were gastroenteritis and respiratory diseases, and for young people abdominal and pelvic pain and mental-health issues.

Māori and Pacific children and young people had the highest rates of mortality followed by those of European and other ethnicities. Asian children and young people had the lowest rates of mortality. Male children and young people were more likely to die before they turned 25 and much more likely to die as a result of intentional injury (69%) or unintentional injury (76%).


Socio-economic status, ethnicity and health

The socio-economic position of a child is a major determinant of health status. In New Zealand Māori and Pacific children suffer more ill health than other ethnic groups.

Deprivation

Children living in deprived circumstances are more likely to have poor health. For example in the early 21st century, those in the most deprived neighbourhoods were 28 times more likely to be hospitalised with rheumatic fever than those in the least deprived neighbourhoods. Their risk for bronchiectasis (a lung disease) was 15.6 times greater and for cot death 10.6 times greater. 

Not only do children in low income households have worse health than children in more comfortable material circumstances, but they are likely to have more health problems as adults. The longitudinal study of 1,000 children born in Dunedin in 1972/3 has demonstrated that children's experience of socioeconomic disadvantage can affect their adult health. Compared with those who grew up in high socioeconomic households, 26-year-olds from lower socioeconomic households had poorer dental health, higher levels of blood pressure, higher body mass index scores, lower levels of cardiorespiratory fitness and higher levels of alcohol dependence. This occurred even if their socioeconomic circumstances had improved. 

Crusader

Journalist Lesley Max drew attention to the poor health and welfare status of many New Zealand children in a 1986 Metro magazine article and then in a 1990 book, Children: endangered species? How the needs of New Zealand children are being seriously neglected: a call for action. She founded a social enterprise charity, the Great Potentials Foundation, which runs programmes for children, young people and their families living in adverse circumstances. Max was awarded the New Zealand Order of Merit in 2009 for her services to children.

Housing

The link between housing and health is well established. High rates of infectious diseases in children and young people are associated with damp and badly ventilated houses. Crowding (where there are not enough bedrooms for the number of occupants) is a contributing factor to meningococcal disease in children. The risk increases with each additional adult in the house.

While overall crowding has declined since the 1960s, it increased in some parts of the country, such as South Auckland, in the 21st century. In 2013, 22% of children and young people lived in crowded households.

Māori and Pacific health

In the 21st century the health of Māori and Pacific children was worse than that of other ethnic groups. This is a long-standing trend evident over the course of the 20th century and into the 21st century. While rates in important indicators like Māori and Pacific infant mortality improved over the long term, significant gaps between ethnic groups remain.

Pacific children and young people fare worst for many standard health indicators. In the early 21st century they experienced the highest hospitalisation rates by ethnicity for bacterial and skin infections, meningococcal and rheumatic heart disease, gastroenteritis and a range of respiratory diseases. Māori were second highest in these (apart from the rate for gastroenteritis) and highest for deaths and hospitalisation due to unintentional non-traffic injuries and deaths due to traffic injuries.

Differences between hospitalisation rates for Māori and Pacific and non-Māori and non-Pacific for acute upper respiratory tract infections, bronchiolitis among infants and pneumonia among 0–14-year-olds have been largely attributed to disparities in access to warm, dry housing and health food that are a consequence of income inequalities. Māori and Pacific children are more likely than children of other ethnicities to live in households experiencing economic hardship.

Despite these bleak statistics there were some improvements. Meningococcal admissions declined significantly from 2010 for both groups, while Māori tuberculosis and Pacific acute rheumatic-fever admissions declined from 2002. There was a significant decline in hospital admissions for skin infections among Māori aged 0–24 between 2010 and 2014, however, the rates remained twice as high as those for non-Māori and non-Pacific children and youth.

Economic and benefit reforms

Some health researchers argue there is a link between economic reforms and social-security benefit cuts in the 1980s and 1990s and the poor health of many New Zealand children. During this period income inequality increased, and by the mid-1990s exceeded the Organisation for Economic Co-operation and Development average.

Researchers believe cuts to benefits in 1991 had a measurable impact on child health. They cite increasing hospitalisation rates due to preventable conditions such as serious skin infections, meningococcal disease, tuberculosis and bronchiolitis between the early 1990s and early 21st century.


Infectious diseases and immunisation

Catching infections is part of growing up. Parents expect their children to get coughs and colds and common diseases like chicken pox, which about 90% of children catch (it is not part of the immunisation schedule). Bed rest and time off school and work (for parents) is usually the result.

Young children are more vulnerable to infectious diseases than other age groups because their immune systems are less developed. In the early 21st century infectious diseases accounted for 55% of acute hospital admissions of children under five-years-old. Māori and Pacific children under the age of five were more likely than those of European and other ethnicities to be hospitalised for infectious diseases. Some infectious diseases, like rheumatic fever, have long-term health effects. While rheumatic fever is rarely found among children in Western Europe and North America, it is still a serious threat to the health of Māori and Pacific children in New Zealand.

Rite of passage?

Some dangerous infectious diseases were so common in the 19th century that they were almost an accepted part of childhood. Diphtheria was rife in 1870s Christchurch but there is very little mention of it in the records of the Christchurch Board of Health for this period. At the same time the chairman of the board questioned whether typhoid cases should be officially recorded because the disease was such a ‘normal’ cause of death.

19th-century diseases

The types of infectious diseases which affect the health of children and young people have changed over time, though some present in the 19th century remained in the 21st century. Typhoid, a bacterial infection associated with poor sanitation, was a major killer in the 19th century and was still present until the mid-20th century. Other dangerous diseases in this period included diphtheria and scarlet fever. Improvements to sanitation and rising living standards helped eliminate these as major causes of child death and illness.

20th-century diseases

While tuberculosis (TB) declined throughout the 19th century, and did not affect children to the same extent as other infectious diseases, it remained a dangerous illness in the 20th century. Infected children were sent to sanatoriums, where treatment was a regime of fresh air, sunlight and nutritious food. Effective drugs and vaccines were available from the 1940s and the sanatoriums closed over the next two decades. TB rates among children continued to fall after this, but resurged between 1992 and 2001 before dropping again.

Poliomyelitis (polio) was one of the most significant child and youth diseases of the first half of the 20th century. It was difficult to treat and not eliminated until vaccines were developed in the 1950s and 1960s.

Diseases in the 1990s and 21st century

While rising living standards, improvements in antibiotics and immunisation programmes controlled and minimised the impact of many infectious diseases by the late 20th century, they were not wiped out as some commentators had predicted. In the 1990s hospital admissions and deaths due to meningococcal disease increased sharply, which signalled an epidemic. Diseases associated with poverty, such as rheumatic fever, were more common in New Zealand than in other Organisation for Economic Co-operation and Development (OECD) countries in the early 21st century, while childhood diseases prevalent in the 19th century, such as measles and whooping cough, were still present.

Immunisation

Immunisation is the process by which the body develops a defence mechanism against infections and disease. Administering vaccines made of weakened viruses or bacteria is one way of creating immunity. In 2018 immunisation against 12 infectious diseases was available free of charge.

Anti-vaccination verse

In 1885 the Observer newspaper published the ‘Vaccination funeral march’, a song written by an anti-vaccination group and sung to the tune of the popular hymn ‘Rock of ages’. It also referenced the Christmas carol ‘Hark the herald angels sing’: ‘Hark! the Herod-demons sing / Vaccination! Glorious King! / Hark! the weeping Rachels cry / Let us die, and let us die / Vaccination, skin and bone / Sits upon his gory throne / They have slain our bonny boys / Festered o’er their infant joys / Swine that rend us for our pearls / They have slain our little girls.’1

Vaccines have been available since the 1840s. Immunisation of infants was compulsory from 1864 to 1920 (apart from a brief period in 1872) and children were supposed to be immunised before they could attend school. In reality, many children were not immunised, while vaccines were not available for all diseases. From 1900 parents who had a conscientious objection to vaccination could apply for an exemption if their child was four months old or younger. Since 1920 immunisation has been a matter of parental choice.

Immunisation has always had periods of controversy. Some parents believe it is harmful, ineffective or unnecessary and choose not to vaccinate their children. This in part has accounted for New Zealand’s low immunisation rates compared to other OECD countries. Health authorities say vaccinations are safe, and the best, most cost-effective way of protecting children from disease.

Footnotes
    • The New Zealand Observer, 18 April 1885, p. 8. Back

Cot death, obesity and other child-health issues

Cot death

When a baby dies suddenly and the cause is unexplained, this is described as ‘sudden unexpected death in infancy’ (SUDI) and ‘sudden infant death syndrome’ (SIDS) by health professionals. The commonly used term is cot death.

In the 1980s SUDI rates in New Zealand were high compared to other countries and were not declining. A study found that babies whose parents smoked, who were put to sleep on their fronts or who were not breastfed had a higher chance of cot death or SUDI. Babies living in poor housing with parents on very low incomes were most at risk.

The rate of SUDI dropped from 4 per 1,000 live births in 1986 to 0.8 per 1,000 live births in 2014. The Māori rate was much higher – it also dropped, but in 2014 it was 1.7 per 1,000 live births. The rates for Pacific babies was lower at 0.8 per 1,000 live births, but higher than the rate for European and other babies (0.4 per 1,000 live births) and Asian babies (0.1 per 1,000 live births).

Around 25% of children had asthma in the 21st century, with much higher rates for Māori and Pacific children.

Obesity

Obesity and overweight in New Zealand children increased in the late 20th century. This is a global trend associated with decreased levels of physical activity and increased consumption of energy-dense food and drink. People on lower incomes are more likely to be obese than those on higher incomes because less nutritional food is cheaper and easier to prepare than healthier options.

In 2017/18, 12% of children aged 2–14 years were obese. Rates were higher among Māori (17%) and Pacific children (30%).

Excessive weight in childhood can cause health conditions such as asthma, liver disease and type-2 diabetes. It is also associated with poor health and early death in adulthood.

Other issues

Ear infections are common in young children. Glue ear (an infection of the middle ear) can result in hearing loss if untreated. This affects children’s speech, learning abilities and social interactions. Exposure to cigarette smoke, a family history of ear infections and spending time in day care are risk factors.

Nut-free zone

Peanuts and tree nuts like cashews are banned in many early childhood centres and schools because they are a common cause of allergic reactions in children. Some people argue that banning nuts entirely is not possible and making claims about nut-free status can create a false sense of security. Allergy New Zealand says simple bans on their own are not enough and that schools need to have plans to minimise the exposure of vulnerable children to nuts, and ensure staff are trained to deal with emergencies.

While rates of asthma among children rose in the 1990s, the percentage of children aged 2–14 years with medicated asthma dropped from around 17% in 2015/16 to 14% in 2016/17. Rates were highest among Māori and Pacific children and those living in the most deprived areas.

Eczema is associated with asthma and is found in 15–20% of children and it is most prevalent among Māori and Pacific children.


Youth health issues

Accidents

Young people are popularly associated with risk-taking. Such behaviour is part of growing up and a way of learning through new experiences. However, adverse consequences of risky behaviour make a significant contribution to death and illness rates.

Between 2012 and 2015 the majority of deaths among youth (15–24 years) due to unintentional injury were the result of car accidents. The late teens was the most risky period. Males are far more likely to be involved in serious injury crashes and to die from car accidents. Most fatal crashes involving drivers aged 15 to 24 years occur on the open road and deaths are mainly due to high speed. Most young people who die in car crashes are either drivers or passengers in cars driven by young drivers. Alcohol and drugs, losing control of the vehicle and high speed were the most frequent causes of fatal accidents involving young people.

Suicide

Until the 1980s, young people had the lowest suicide rates in New Zealand. Young male suicide rates increased significantly from the 1970s. Though young female rates were much lower, they also increased. As a result, young people had the highest suicide rate by the late 1980s. It peaked in 1995 and dropped in the early 21st century. Fluctuations in rates of youth suicide occurred in the 2010s with a peak of youth suicide deaths in 2012.

Teenage suicide garners much public attention, but more deaths in the youth category actually occur in the 20–24 age group. Young males in their 20s and 30s tended to have higher rates than teenagers in the 21st century. From the age of 17 onwards, the number of male suicide deaths is twice that of females. There is far less variation in female suicide rates by age. More young women than men attempt suicide, but the death rate is lower because they use less lethal methods. Rates for Māori and Pacific young people are higher than those for non-Māori and non-Pacific youth. Deaths due to suicide are also higher among young people living in the most deprived areas in New Zealand.

New Zealand's suicide rate at 15.6 per 100,000 of those aged 15–19 years for the period 2009–13 was the highest amongst 41 countries of the European Union and the Organisation for Economic Co-operation and Development countries defined as 'rich countries' by the United Nations Children's Fund.

Sexual activity

Studies have found that 10–30% of young people have sex by age 15 and around 50% by ages 16 or 17.

Births to teenage mothers (15–19 years) declined after the early 1970s, though they increased slightly in the early 2000s. However, the number of induced teenage abortions increased and teenage pregnancy rates correspondingly increased after 1980. By 2003 there was one abortion for every teenage birth. New Zealand has a higher teenage birth rate than most comparable countries, except for the United States.

New Zealand's rate dropped from 33 births per 1,000 women aged 15–19 years in 2008 to 19 in 2015, but declines in other comparable countries meant it remained high internationally. The Māori teenage birth rate is higher than the national average, but has also been steadily declining.

Fun times

In 1954 a committee investigated teenage delinquency and sexual behaviour after Hutt College students were found having sex in movie theatres and on the banks of the Hutt River. The committee’s report (known as the Mazengarb Report) painted a dark picture of teenage morality in New Zealand. Not all readers found this troublesome. In later years Bob Jones, who was a teenager at the time, recalled meeting ‘Australians who had read about this in Australia and had come over here – I'm talking about chaps of about 19 and that – coming over to this sort of sexual festival – this great Mecca … of course they probably were bitterly disappointed I imagine.’1

Over half of sexually active young people normally use contraception. Condoms are most popular, while the pill is more likely to be used by young women in their late teens and early 20s. The younger people are when they first have sex, the less likely they are to use contraception.

Chlamydia, gonorrhoea, genital herpes and genital warts are the most common sexually transmitted infections to affect young people. Chlamydia is far more common in females, particularly those aged 15–19, while age and gender differences are less distinct for gonorrhoea.

Alcohol

In 2014/15, 57% of 15–17-year-olds and 86% of 18–24-year-olds had drunk alcohol in the past year. The older group had the highest consumption level of all ages. They also had the highest proportion of hazardous drinkers – 34% compared to 18% for the total population.

Alcohol consumption increases in the late teens and 20s. Overall, young people aged 15–24 are more likely to binge drink on one occasion than any other age group.

Buying not drinking

In the 2010s New Zealand liquor law defined who could purchase alcohol (people aged 18 and over), not who could drink it – there was no legal minimum drinking age. It was illegal to buy alcohol for a person under 18 unless the purchaser was a guardian or parent of that person, or they were attending a private social gathering (like a wedding).

Smoking

Tobacco smoking is the single largest cause of preventable illness and death in New Zealand, and most smokers start in their teens. However, teenage smoking habits have changed – 28% smoked regularly (at least monthly) in 2000, compared to 6% in 2014. Those who had never smoked increased from 33% in 2000 to 77% in 2014.

Girls are more likely to smoke than boys but levels for both dropped between 2000 and 2014. Smoking prevalence was highest among Māori, though levels dropped steadily over the 14-year period.

Recreational drugs

A 2007/8 survey found the most common age New Zealanders first try recreational drugs was 15–17 years. Past-year drug use was highest in teenagers and young adults compared to older groups. Cannabis was the most popular drug and research in 2012/13 indicated that its use in the previous year was highest among youth (15–24 years), men and Māori. Use by men and women decreased as they got older.

Footnotes

Primary health initiatives

Plunket

The Royal New Zealand Plunket Society provides free health and welfare services for children aged five and under. Plunket nurses take over from midwives and other maternity carers when a baby is between four to six weeks old.

Plunket was founded by Dr Frederic Truby King in 1907. In this period, improving maternal and infant health was seen as critical to producing fit and productive citizens. While Plunket’s self-proclaimed success in reducing infant mortality rates single-handed was overstated, providing mothers with breast and formula feeding and hygiene advice probably contributed to this reduction.

Women’s movement

Though Plunket was founded by a man, the work of the organisation was sustained by women – both professional nurses and women volunteers. It became the most successful and well-known voluntary organisation in the country. By 1959 there were around 600 Plunket branches and 250 mothers’ clubs, all staffed and run by women. The School Medical Service was also dominated by women.

Health and education

The School Medical Service was established in 1912 and continued the work of Plunket into the school years. Initially run by the Department of Education, the service was overseen by the school hygiene division of the Department of Health from 1921. Public health nurses employed by the department later took over this work.

Children were medically examined by doctors three times during their time at school. Those with health problems were seen more regularly. Nurses visited children in their homes. They helped treat minor complaints and sent those with more serious problems to doctors. Teachers were also supposed to instruct children on topics like healthy eating and personal hygiene.

Nutrition became a major focus. Most school children were given a half-pint (0.2 litres) of milk each school day between 1937 and 1967. Free apples were also distributed until 1948.

Spoil sport

In the 1940s New Zealand ice cream manufacturers tried to get ice cream into schools along the same lines as the free milk scheme. However, Department of Health nutrition officer Dr Muriel Bell opposed this proposal, and school children had to be satisfied with straight milk. The New Zealand Ice Cream Manufacturers’ Association said: ‘If the Health Department cannot at present give approval for daily ice cream for school children, a time seems not far distant when we shall at least see better-advised communities abroad giving children what they like, and what, in the case of good ice cream, is nourishing.’1

In the early 21st century most schools had an on-site nurse, while children received medical examinations and care from their family doctor. The health issues most promoted in schools were physical activity, sun protection and remaining smoke free. Children in schools in areas defined as having high health needs were given free fruit. Some children in low-deprived areas were also provided with free breakfasts funded by private businesses or charities.

Health camps

Children’s health camps are places where children aged 5–12 with health, family-related, behavioural and learning problems are cared for temporarily. Individual programmes designed to improve health and well-being are drawn up for each child. In the 2010s there were seven camps (by then called 'children's villages'), run by Stand Children's Services, Te Maia Whanau, which received government funding for this service.

The first health camp opened at Turakina (near Whanganui) in 1919. For the first few decades malnourished and pre-tubercular children were the main focus. After the Second World War social and emotional problems were increasingly emphasised. From the late 20th century child-abuse victims were also cared for and there was a renewed focus on malnutrition.

General practice care

From 2015 most general practitioners (GPs) saw children under the age of 13 for free. Prescriptions for this group were also free. Fees for older children and young people varied depending on the practice, and prescriptions attached the standard $5 per item charge. From December 2018 free visits were also available to 13-year-olds.

Youth health care

Young people (15–24 years) were traditionally not considered to have particular health issues and needs. This was because most had good health and low levels of chronic illness, and used health services less than other age groups. On the other hand, death rates increase significantly from around 14, mainly because of increases in unintentional injury and suicide.

In the late 20th century more notice was taken by health researchers of issues which affect youth. The first national youth health and well-being survey was undertaken in 2001 and the Ministry of Health produced a Youth Health Plan of Action in 2002 that recognised that there was a need for young people to participate in the development of health policy and have input into service development.

Primary health services for young people took a ‘one-stop shop’ approach from the 1990s. Services available from one provider usually encompassed physical, mental, emotional and social health needs. An example of this type of primary health service for young adults is the 298 Youth Health Centre in Christchurch, which provides free sexual, mental and GP services to young people. Evolve youth health and social support service provides similar services in Wellington. Both facilities are part of a network of Youth One Stop Shops around New Zealand that respond to the health needs of young people.

Another youth health initiative is Bounce, which is facilitated by the New Zealand Red Cross. It provides online information about health and well-being for young people. It developed following the 2010–11 Canterbury earthquakes and is a peer-led project run by young people for young people.

Kidz First Centre for Youth Health in Auckland provides specialised support and care for young people with health issues and youth development concerns, including transgender care. The focus is on young people but also support for their whānau.

Children’s hospitals

The first hospital wards for children appeared in the 1880s. The Princess Mary Hospital for Children opened on the grounds of Auckland Hospital in 1918. Its services were absorbed into Starship Hospital, the major stand-alone children’s hospital in New Zealand, which opened in 1991.

Kidz First Children's Hospital was established in 2000 as a purpose-built facility to deliver family centered health care in South Auckland – a culturally diverse community. Like Starship Hospital it offers inpatient paediatric surgical and medical care, and includes a Child Protection Service. A Wellington Regional Children's Hospital will open in 2021.

Most hospitals in New Zealand had children’s wards that provided a child-friendly environment for patients.

Footnotes
    • Quoted in Derek A. Dow, Safeguarding the public health: a history of the New Zealand Department of Health. Wellington: Victoria University Press, in association with the Ministry of Health and with the assistance of the Historical Branch, Dept of Internal Affairs, 1995, p. 143. Back

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How to cite this page: Kerryn Pollock, 'Child and youth health', Te Ara - the Encyclopedia of New Zealand, http://www.TeAra.govt.nz/en/child-and-youth-health/print (accessed 25 June 2019)

Story by Kerryn Pollock, published 5 May 2011, reviewed & revised 29 Nov 2018