Kōrero: Death rates and life expectancy

Whārangi 5. Māori epidemiological transition

Ngā whakaahua

Recovery

After 1891 Māori life expectancy began to increase, reaching 35 for men and 30 for women in 1911. In the later 1890s the Māori population also began to grow, following a decrease in childhood deaths and an increase in the number of people surviving to have children.

Rapid population recovery occurred in the early 1900s, assisted by gains in immunity to diseases among Māori. Immunity improved over time, as a result of repeated exposure to European diseases. The effects of illness were increasingly less severe. Another factor was the spread of Māori-led health initiatives initiated by former students of Te Aute College, including the doctors Peter Buck (Te Rangi Hīroa) and Māui Pōmare.

Improvement, 1900–1945

In the first half of the 20th century Māori life expectancy continued to rise. This improvement owed much to the efforts of Peter Buck and Edward Ellison, who worked through the Division of Māori Hygiene which had been established in the Department of Health in 1921. In 1926 life expectancy at birth for Māori men was 42; for women it was 40. By 1945 Māori men could expect to live to 49 and women to 48. However, Māori life expectancy still lagged well behind that for Pākehā. There were several reasons.

Most Māori continued to live in communities in isolated rural areas. They remained vulnerable to severe epidemics of illnesses such as measles, often accompanied by diarrhoea, bronchitis, pneumonia and dysentery. The Māori death rate during the influenza pandemic of 1918 was eight times that of Pākehā. Serious epidemics occurred regularly in Māori communities until the 1940s.

Smallpox scare

Unlike many other countries, New Zealand did not suffer devastating diseases such as typhus, malaria or bubonic plague. An outbreak of smallpox in 1913 was contained by public health measures, and limited in its impact because many Māori had been vaccinated by missionaries. Māori doctor Peter Buck played a major role in responding to this epidemic. He later published a significant paper comparing numbers of deaths for vaccinated and un-vaccinated Māori.

Māori were also still severely disadvantaged socially and economically, with poorer housing and nutrition than Pākehā. Diseases such as tuberculosis were closely associated with socio-economic factors such as overcrowded housing.

Rapid advances, 1945–1966

From 1945 to 1966, the epidemiological transition of the Māori population accelerated. There was a major decline in infant mortality and in deaths at all ages from infectious diseases. Life expectancy increased. During the period there was a major shift of Māori from rural communities to urban centres, which gave them better access to health facilities. Māori also, like Pākehā, benefited from improvements in medical technology. Most significantly, targeted health and social security measures directed at housing and support for families together helped combat the scourge of tuberculosis.

Tuberculosis

Tuberculosis is a highly contagious disease that affects many parts of the body, but usually the lungs. In pulmonary tuberculosis, patients have chest pain, cough blood, and lose weight. They can easily infect other people by coughing, sneezing, speaking and spitting, and bad living conditions help the disease to spread. Until the development of antibiotics in 1946, there was no effective cure.

Māori and tuberculosis

The rapid reduction in Māori tuberculosis mortality between 1945 and 1961, in a period when medical treatments were not yet fully developed, was a triumph for public health in New Zealand. In the 1930s Dr Harold Turbott carried out a health survey among Māori on the East Coast, which showed high levels of conditions that usually accompanied tuberculosis – poverty, malnutrition and overcrowded housing. The survey stimulated an attempt to reduce health inequalities between Māori and non-Māori, focusing especially on tuberculosis. Health policy was synchronised with social policy following the passage of the Social Security Act 1938. Measures included taking chest X-rays of 10% of Māori each year, sending people with tuberculosis to sanatoriums, and giving families of tuberculosis patients nutritional supplements, income support and top priority for state housing assistance.

Men, women and life expectancy

As well as a continuing increase in life expectancy there was a gender shift. Until 1945 Māori men had a greater life expectancy than women, although for some cohorts of men bursts of improvement in life expectancy were followed by periods when life expectancy decreased slightly. From 1951 this changed, reflecting the Pākehā pattern of women tending to live longer than men. In 1951 Māori life expectancy was 54 for men and 56 for women, and by 1961 it was 59 for men and 61 for women. In 1976 it was 63 for men and 68 for women, rising to 67 for men and 71 for women in 1996. Analysis of the life expectancy of particular birth cohorts suggests that Māori born in the early 1940s, especially men, were more likely to die by the time they reached their sixties than non-Māori.

The life-expectancy gap between Māori and Pākehā narrowed considerably from the 1970s. However, in the 21st century Māori life expectancy was still below non-Māori levels. In 2013 Māori men could expect to live to 73, compared with 80 for non-Māori men. Māori women had a life expectancy of 77, compared with 84 for non-Māori women.

Me pēnei te tohu i te whārangi:

Ian Pool, 'Death rates and life expectancy - Māori epidemiological transition', Te Ara - the Encyclopedia of New Zealand, http://www.TeAra.govt.nz/mi/death-rates-and-life-expectancy/page-5 (accessed 15 October 2019)

Story by Ian Pool, published 5 May 2011, reviewed & revised 14 Mar 2019