Changing causes of death
In the 21st century Māori and Pākehā faced similar health issues. There had been a shift in causes of death, from communicable to non-communicable diseases. For both Pākehā and Māori, acute infectious, respiratory and diarrhoeal diseases and tuberculosis had given way to causes of death such as heart conditions, strokes and cancers. These chronic disorders, generally associated with old age, did occur in the past, but were more prominent in the 21st century because most people survived longer.
Proportions of non-communicable diseases causing death were changing. Public health measures were increasingly successful at reducing coronary heart disease and its risk factors. As a result, cardiovascular diseases were becoming less dominant causes of death, with cancers increasing in relative significance.
Implications for policies and services
In the early 21st century, most people survived into the retirement age group, and long-term ill-health requiring intensive hospital care occurred typically amongst older people. Many middle-aged and older people required pharmaceutical interventions such as blood pressure medication, but their ability to cope with the physical challenges of daily life (often called ‘health expectancy’) was overwhelmingly reported as good, as in other OECD countries.
The radical but long-term changes in causes of death have had major implications for New Zealand health policies. Many health institutions and services were designed for conditions prevalent much earlier in the epidemiological transition. Meeting emerging situations was likely to be a major challenge.
Health expectancy is a measure of being able to undertake daily living tasks appropriate for a particular age. In the early 21st century Māori health expectancies in old age were close to those of Pākehā, but this was because their survival rates beyond late middle age were well below those of Pākehā, and only the hardy reached old age.
This was a challenge for health policy, which had to cater for the needs of the majority, yet respond to minority populations such as Māori, Pacific people and other disadvantaged groups.
Closing the survival gap
In the 21st century most Māori and non-Māori of both sexes were surviving to middle age. But in late middle age and early old age, Māori levels of survival fell well below those of non-Māori. This is partly a consequence of higher levels of infectious diseases and inflammation among Māori during childhood. Out of any group of people born at the same time, only 38% of Māori men and 50% of Māori women would reach the age of 80, compared with 60% (men) and 71% (women) for New Zealanders of all ethnic groups combined. In the early 21st century Māori men and Pasifika men were increasingly likely to be using health services and this may have a positive impact on their health and life expectancy in the future.