In the later 20th century the Māori population continued to increase, especially in the 1950s and 1960s, and increasingly Māori moved from rural to urban areas.
After the Second World War a tuberculosis campaign began to bear fruit among Māori. From the early 1950s decreasing rates of tuberculosis incidence and mortality were recorded, particularly when Māori were immunised against it. In 1964 the Health Department stated that tuberculosis was no longer a significant cause of death among Māori.
Māori infant mortality fell steadily from the late 1940s, although in the early 21st century it was still higher than the non-Māori rate.
Typhoid outbreaks were rare by the 1950s.
In overall health status the Māori population continued to lag behind the non-Māori population. In a 1960 study the Māori mortality rate was still about twice that of non-Māori, with the greatest gap seen in the years of infancy and childhood. Māori were affected more than non-Māori by degenerative conditions such as diabetes, cancer, heart disease and stroke, which had not been much in evidence before. Lessening impact from infectious disease was offset by increasing impact of non-communicable illnesses. High rates of sickness and death from degenerative conditions were still being recorded at the end of the 20th century.
Though the gap was closing in the 21st century, clear heath disparities remained. In 2012–14 Māori life expectancy at birth was 6.8 years lower than non-Māori for women and 7.3 years for men. In the 2010s Māori men were almost three times as likely as non-Māori men to die of lung cancer; Māori women were over four times as likely as non-Māori women. Māori died from heart disease at more than twice the rate of non-Māori. Māori were two times more likely to have diabetes than non-Māori, and diabetes complication rates were also higher. Despite great improvements, and a significant rise in life expectancy, Māori were still worse affected than non-Māori by almost every known health condition.
Factors in disparity
Continuing disparities between Māori and non-Māori in the areas of employment, income and education were an important factor in health inequalities. Housing conditions played a part too. Lifting the standard of Māori dwellings, especially in rural areas, was a slow process. The official housing programme was faced with the problem of keeping up with the rapid increase in the Māori population, which meant that overcrowding persisted even when large numbers of new houses were built. The problem of substandard housing had not been entirely eliminated.
Māori and the health system
With so many families moving to towns and cities, Māori had better access to health facilities. But barriers of cost and culture were often still present. The government’s public health programmes continued to target Māori communities when distinctive needs were identified, and this had a considerable impact on Māori health status.
Hospitals were fully funded by the government from 1957, removing the perception that Māori did not contribute enough to hospital costs through the local authority rating system. By 1959 the proportion of Māori births occurring in hospital had risen to about 90%, and the figure continued to rise. There have been Māori doctors, nurses and other health workers for more than a century – in greater numbers in the early 21st century. But Māori are still under-represented in the health workforce at all levels.
Attitudes to health
In the second half of the 20th century the government began to take a more bicultural approach to Māori health needs, partly in response to Māori demands for greater involvement in issues concerning their health. The new trend intensified in the 1980s. It included enabling Māori to participate more in the planning and implementation of health programmes, and making greater acknowledgement of distinctive Māori values and practices in the health area.
Te Hui Whakaoranga (the Maori Health Planning Workshop) held in Auckland in 1984 was a landmark in this change. Soon marae-based health schemes and other Māori health providers began to emerge, offering medical care ‘by Māori, for Māori’. The government publicly committed itself to ending the disparities between Māori and non-Māori health.
Māori still retained many of their traditional ideas about health. Officials in the health sector gradually developed a greater understanding of Māori approaches to health and sickness, and government policies showed a greater acceptance of these approaches and their value for health care. Tohunga still practised in many Māori communities, and Pākehā were increasingly willing to view their work more positively. The Tohunga Suppression Act was repealed in 1962. Twenty years later the health authorities began to show a willingness to accept traditional healing practices as complementary to Western medicine, and even to recognise tohunga and incorporate their work into the mainstream health system.