Te Ohonga Ake : the determinants of health for Māori children and young people in

277 Pages·2016·2.44 MB·English

SERIES TWO

Te Ohonga Ake
The Determinants of Health for
Māori Children and Young People
in New Zealand
Series Two

This Report was prepared for the Ministry of Health by Jean Simpson, Judith
Adams, Glenda Oben, Andrew Wicken and Mavis Duncanson of the NZ Child
and Youth Epidemiology Service
March 2016

This report was produced as the result of a contract between the Ministry of Health and the Paediatric
Society of New Zealand. The report was written by the New Zealand Child and Youth Epidemiology
Service (NZCYES). The NZCYES is located in the Department of Women’s and Children’s Health at
the University of Otago’s Dunedin School of Medicine. While every endeavour has been made to
use accurate data in this report, there are currently variations in the way data are collected from
DHBs and other agencies that may result in errors, omissions or inaccuracies in the information in
this report. The NZCYES does not accept liability for any inaccuracies arising from the use of this
data in the production of these reports, or for any losses arising as a consequence thereof.
Acknowledgements
This report arose as a result of a contract with the Ministry of Health. The report was produced by
Jean Simpson, Judith Adams, Glenda Oben, Andrew Wicken and Mavis Duncanson of the NZ Child
and Youth Epidemiology Service (NZCYES).
The Ministry of Health provided the resources for a senior Advisory Group to oversee the production
of this report, with the membership of the Te Ohonga Ake Advisory Group comprising: Paula Searle,
Dr Papaarangi Reid, Dr Jo Baxter, Darna Appleyard, Kathrine Clarke, Dr Paula King and Natalie
Talamaivao.

Suggested citations:
Simpson J, Adams J, Oben G, Wicken A, Duncanson M. Te Ohonga Ake: The Determinants of
Health for Maori Children and Young People in New Zealand: Series Two. Te Ohonga Ake series
for the Ministry of Health. Dunedin: NZ Child & Youth Epidemiology Service, University of Otago;
2015.

Robson, B. Te toto o te tangata, te oranga o te iwi. Differential impact of income and wealth inequities
on Māori children and young people In: Simpson J, Adams J, Oben G, Wicken A, Duncanson M. Te
Ohonga Ake: The Determinants of Health for Maori Children and Young People in New Zealand:
Series Two. Te Ohonga Ake series for the Ministry of Health. Dunedin: NZ Child & Youth
Epidemiology Service, University of Otago; 2015; p32-34.

This work is licensed under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0
International License http://creativecommons.org/licenses/by-nc-nd/4.0/ with the exception of the
cover artwork as acknowledged below.

Te Ohonga Ake
The literal translation of Te Ohonga Ake is the Awakening. In the context of this report it refers to
an awakening towards the reality of Māori child and youth health status in New Zealand. While
many of us have been acutely aware of poor outcomes for Māori children and young people in this
country, this report confirms our concerns and provides strong evidence for everyone to wake up,
pay attention and take action to improve the lives of our most precious asset, our mokopuna.
Cover Artwork: Whakapapa – Family Tree by Coree Te Whata-Colley
T C
ABLE OF ONTENTS

Table of Contents .................................................................................................................. 5
List of Figures ....................................................................................................................... 7
List of Tables ...................................................................................................................... 12
INTRODUCTION AND OVERVIEW .................................................................................... 15
Introduction and Overview .................................................................................................. 17
Viewpoint: Te toto o te tangata, te oranga o te iwi. Differential impact of income and wealth
inequities on Māori children and young people.................................................................... 32
REGIONAL DEMOGRAPHIC PROFILE.............................................................................. 35
Introduction to Regional Demography ................................................................................. 37
THE WIDER MACROECONOMIC AND POLICY CONTEXT .............................................. 45
CHILD POVERTY AND LIVING STANDARDS ................................................................... 47
Child Poverty: Measurement and Policy Solutions .............................................................. 49
Child Poverty: Income-based Measures .............................................................................. 51
Child Poverty: Material Hardship ......................................................................................... 59
Child Poverty: Severity and Persistence.............................................................................. 65
OTHER MACROECONOMIC INDICATORS ....................................................................... 71
Gross Domestic Product (GDP) .......................................................................................... 73
Income Inequality ................................................................................................................ 76
Unemployment Rates .......................................................................................................... 79
Children Reliant on Benefit Recipients ................................................................................ 87
Young People Reliant on Benefits ....................................................................................... 93
Young People Not in Employment, Education or Training (NEET) ...................................... 99
SOCIOECONOMIC AND CULTURAL DETERMINANTS .................................................. 105
HOUSEHOLD COMPOSITION ......................................................................................... 107
Children in Sole Parent Households .................................................................................. 109
Household Crowding ......................................................................................................... 113
EDUCATION KNOWLEDGE AND SKILLS ....................................................................... 121
Early Childhood Education ................................................................................................ 123
Māori Medium Education .................................................................................................. 127
Highest Educational Attainment at School Leaving ........................................................... 131
Senior Secondary School Retention and Tertiary Participation ......................................... 136
School Stand-downs, Suspensions, Exclusions and Expulsions ....................................... 140
Truancy and Unjustified Absences .................................................................................... 145

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RISK AND PROTECTIVE FACTORS ............................................................................... 149
WELL CHILD SERVICES ................................................................................................. 151
Introduction to Well Child Tamariki Ora Services .............................................................. 153
Immunisation Coverage .................................................................................................... 154
Plunket Children Receiving Core Well Child Contacts ....................................................... 159
The B4 School Check ....................................................................................................... 162
B4 School Check: Hearing and Vision Screening .............................................................. 166
Oral Health ........................................................................................................................ 175
Community Oral Health Services ...................................................................................... 175
Hospital Admissions for Dental Caries .............................................................................. 178
SUBSTANCE USE ............................................................................................................ 183
Smoking in Pregnancy ...................................................................................................... 185
Second-hand Cigarette Smoke Exposure ......................................................................... 191
Tobacco Use in Young People .......................................................................................... 194
Census Data ..................................................................................................................... 194
ASH Year 10 Survey ......................................................................................................... 197
Alcohol-related Hospital Admissions ................................................................................. 199
HEALTH OUTCOMES AS DETERMINANTS .................................................................... 203
SOCIOECONOMICALLY SENSITIVE HOSPITALADMISSIONS AND MORTALITY......... 205
Hospital Admissions and Mortality with a Social Gradient ................................................. 207
Infant Mortality and Sudden Unexpected Death in Infancy ................................................ 214
SAFETY AND FAMILY VIOLENCE ................................................................................... 219
Injuries Arising from the Assault, Neglect or Maltreatment of Children .............................. 221
Injuries Arising from Assault in Young People ................................................................... 227
Child Youth and Family Notifications ................................................................................. 232
Family Violence ................................................................................................................. 238
APPENDICES AND REFERENCES ................................................................................. 241
Appendix 1: Statistical Significance Testing and its use in this Report .............................. 242
Appendix 2: The National Minimum Dataset ..................................................................... 244
Appendix 3: The Birth Registration Dataset ....................................................................... 250
Appendix 4: The National Mortality Collection ................................................................... 251
Appendix 5: The Measurement of Ethnicity ....................................................................... 252
Appendix 6: The NZ Deprivation Index .............................................................................. 256
Appendix 7: Police Area Boundaries ................................................................................. 257
Appendix 8: Methods Used to Develop the Child Poverty Monitor ..................................... 258
Appendix 9: Diagnostic Shifts in Coding ............................................................................ 261

References ....................................................................................................................... 264
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IST OF IGURES
Figure 1. Māori population distribution at 2013 census by age group .................................. 38
Figure 2. Distribution of Māori children and young people (0–24 years) at the 2013
Census by NZ Deprivation Index decile, compared to non-Māori non-Pacific children and
young people ...................................................................................................................... 39
Figure 3. Proportion of dependent children aged 0–17 years living below the 60%
income poverty threshold (relative and fixed-line) after housing costs, New Zealand
1982–2013 HES years ........................................................................................................ 53
Figure 4. Proportion of dependent 0–17 year olds living below the 60% income poverty
threshold (relative) before and after housing costs, New Zealand 1982–2013 HES years
........................................................................................................................................... 54
Figure 5. Proportion of dependent children aged 0–17 years living below the 60%
income poverty threshold before housing costs, New Zealand 1982–2013 HES years ....... 54
Figure 6. Proportion of population living below the 60% income poverty threshold after
housing costs by selected age-group, New Zealand 1982–2013 HES years ....................... 55
Figure 7. Proportion of dependent children aged 0–17 years living below the 60%
income poverty threshold after housing costs by age, New Zealand 1984–2013 HES
years ................................................................................................................................... 56
Figure 8. Proportion of dependent children aged 0–17 years living below the 60%
income poverty threshold, after housing costs, by number of children in household, New
Zealand 1984–2013 HES years .......................................................................................... 56
Figure 9. Proportion of dependent children aged 0–17 years living below the 60%
income poverty threshold after housing costs by household type, New Zealand
1984−2013 HES years ........................................................................................................ 57
Figure 10. Proportion of dependent children aged 0–17 years living below the 60%
income poverty threshold after housing costs by work status of adults in the household,
New Zealand 1984–2013 HES years .................................................................................. 58
Figure 11. Proportion living in material hardship, for children 0–17 years and selected
sub-groups, New Zealand 2007–2013 HES years ............................................................... 61
Figure 12. Proportion of children aged 0–17 years experiencing material hardship* by
ethnicity and family income source, NZ Living Standards Survey 2008 ............................... 64
Figure 13. Trends in the proportion of those who are both income poor and materially
deprived, New Zealand 2007–2012 HES years ................................................................... 67
Figure 14. Proportion of dependent children aged 0–17 years living below the 50% of
median income poverty threshold, New Zealand 1982–2013 HES years ............................ 67
Figure 15. Proportion of children with current and persistent low incomes, Statistics New
Zealand’s Survey of Family, Income and Employment (SoFIE) 2002–2009 ........................ 69
Figure 16. Gross Domestic Product (GDP): percentage change from previous quarter,
New Zealand March quarter 2006 to June quarter 2014 ..................................................... 74
Figure 17. Real Gross Domestic Product (GDP) per capita and real average ordinary
time hourly earnings, New Zealand March quarter 1975 to March quarter 2014.................. 75
Figure 18. Income inequality in New Zealand as assessed by the P80/P20 ratio for the
1982–2012 HES years ........................................................................................................ 77
Figure 19. Income inequality in New Zealand as assessed by the Gini coefficient for the
1982–2012 HES years ........................................................................................................ 78
7
Figure 20. Seasonally adjusted quarterly unemployment rates, New Zealand March
1986 to June 2014 .............................................................................................................. 80
Figure 21. Unemployment rates by age (selected age groups), New Zealand years
ending June 1987–2014 ...................................................................................................... 81
Figure 22. Unemployment rates by age and gender in young people aged 15–24 years,
New Zealand years ending June 1987–2014 ...................................................................... 81
Figure 23. Quarterly unemployment rates by ethnicity, New Zealand March 2008 to June
2014 .................................................................................................................................... 82
Figure 24. Unemployment rates by qualification, New Zealand years ending June
1987−2014 .......................................................................................................................... 82
Figure 25. Proportion of those unemployed by duration of unemployment, New Zealand
years ending June 1987–2014 ............................................................................................ 83
Figure 26. Quarterly unemployment rates by regional council, upper and mid North
Island regional councils vs. New Zealand March 2006 to June 2014 ................................... 84
Figure 27. Quarterly unemployment rates by regional council, lower North Island and
South Island regional councils vs. New Zealand March 2006 to June 2014 ........................ 85
Figure 28. Proportion of all children aged 0–17 years who were reliant on a benefit
recipient by benefit type, New Zealand as at end of June 2000–2014 ................................. 91
Figure 29. Proportion of all children aged 0–17 years who were reliant on a benefit
recipient by age and benefit type, New Zealand as at end of June 2014 ............................. 91
Figure 30. Proportion of young people aged 16–24 years receiving a benefit by benefit
type, New Zealand June 2000–2014 ................................................................................... 94
Figure 31. Proportion of young people aged 16–24 years receiving benefit by benefit
type and ethnicity, New Zealand as at June 2014 ............................................................... 96
Figure 32. Proportion of young people aged 16–24 years receiving a Supported Living
Payment by cause of incapacity, New Zealand June 2014 (n=7,888) ................................. 97
Figure 33. Labour force status of young people by age and gender, New Zealand 2014 .. 100
Figure 34. Seasonally adjusted quarterly NEET rates in young people aged 15–24 years,
New Zealand March 2004–June 2014 ............................................................................... 101
Figure 35. Young people not engaged in employment, education or training by age and
caregiving status, New Zealand years ending June 2005–2014 ........................................ 101
Figure 36. NEET rates in young people by gender and ethnicity, New Zealand years
ending June 2009–2014 .................................................................................................... 102
Figure 37. NEET rates in young people aged 15–24 years by regional council, North
Island councils vs New Zealand years ending June 2005–2014 ........................................ 103
Figure 38. NEET rates in young people aged 15–24 years by regional council, South
Island councils vs New Zealand years ending June 2005–2014 ........................................ 104
Figure 39. Proportion of children aged 0–14 years who lived in sole parent households
by ethnicity, New Zealand at the 2001, 2006, and 2013 Censuses ................................... 110
Figure 40. Proportion of children aged 0–14 years living in sole parent households by
ethnicity and NZ Deprivation Index decile, New Zealand at the 2013 Census ................... 111
Figure 41. Proportion of children aged 0–14 years by the number of bedrooms spare or
required in their household, New Zealand at the 2013 censuses, by ethnicity ................... 114
Figure 42. Proportion of children aged 0–14 years living in crowded households by
ethnicity, New Zealand at the 2001, 2006 and 2013 censuses .......................................... 115
8
Figure 43. Proportion of children aged 0–14 years living in crowded households by
ethnicity and NZ Deprivation Index decile, New Zealand at the 2013 census .................... 116
Figure 44. Number of enrolments of Māori children in licensed Early Childhood
Education services by service type, New Zealand year ended June 2000–2013 ............... 124
Figure 45. Proportion of new entrants who had previously attended Early Childhood
Education by ethnicity, New Zealand 2001–2013 .............................................................. 125
Figure 46. Proportion of new entrants who had previously attended Early Childhood
Education by school socioeconomic decile and ethnicity, New Zealand June 2013 .......... 125
Figure 47. Number of Kura Kaupapa Māori and Kura Teina, New Zealand 2000–2013 .... 129
Figure 48. Number of Students Involved in Māori Medium Education by School Sector
and Form of Education, New Zealand 2000–2013 ............................................................ 129
Figure 49. Highest educational attainment of school leavers, New Zealand 2009–2013 ... 132
Figure 50. Educational Attainment of School Leavers by Ethnicity, New Zealand
2009−2013 ........................................................................................................................ 132
Figure 51. School Leavers with a University Entrance Standard by Ethnicity and School
Socioeconomic Decile, New Zealand 2013 ....................................................................... 133
Figure 52. Proportion of secondary school students staying at school until at least 17
years of age by ethnicity, New Zealand 2009–2011 .......................................................... 137
Figure 53. Age-standardised participation rates in tertiary education for domestic
students by ethnicity, New Zealand 2006–2013 ................................................................ 139
Figure 54. Age-standardised participation rates in tertiary education for domestic
students by ethnicity and selected qualification, New Zealand 2006–2013 ........................ 139
Figure 55. Age-standardised rates of stand-downs and suspensions by ethnicity, New
Zealand 2000–2013 .......................................................................................................... 142
Figure 56. Age-standardised rates of exclusions and expulsions by ethnicity, New
Zealand 2000–2013 .......................................................................................................... 142
Figure 57. Distribution of suspensions by type of behaviour, New Zealand 2013 .............. 144
Figure 58. Total unjustified absences and frequent truancy by ethnicity, New Zealand
2011–2013 ........................................................................................................................ 146
Figure 59. Immunisation coverage by milestone age and ethnicity New Zealand, year
ended 30 June 2014 ......................................................................................................... 157
Figure 60. Immunisation coverage by milestone age and ethnicity, New Zealand years
ended June 2009–2014 .................................................................................................... 158
Figure 61. Plunket Well Child contacts by ethnicity, type of contact, and year, New
Zealand years ended June 2006–2013 ............................................................................. 160
Figure 62. Proportion of children receiving their B4 School Check by ethnicity and by
deprivation, New Zealand 2012–2014 (years ending 7 July) ............................................. 163
Figure 63. Proportion of children starting their B4 School Check before 4.5 years of age
by ethnicity and by deprivation, New Zealand 2012–2014 (years ending 7 July) ............... 165
Figure 64. Proportion of children failing audiometry and who required rescreening or
referral by ethnicity, New Zealand B4 School Check 2012–2014 (years ending 7 July)..... 168
Figure 65. Proportion of all children failing audiometry who required rescreening or
referral by NZ Deprivation Index decile, New Zealand B4 School Check 2012–2014
(years ending 7 July) ......................................................................................................... 169
9
Figure 66. Proportion of children not already under care with a visual acuity of 6/12 or
worse in one or both eyes by ethnicity, New Zealand B4 School Check 2012–2014
(years ending 7 July) ......................................................................................................... 172
Figure 67. Proportion of children not already under care with a visual acuity of 6/12 or
worse in one or both eyes by NZ Deprivation Index decile, New Zealand B4 School
Check 2012–2014 (years ending 7 July) ........................................................................... 173
Figure 68. Percentage of children who were caries-free at 5 years and mean DMFT
scores at 12 years, New Zealand 2000–2012 ................................................................... 176
Figure 69. Percentage of children who were caries-free at age 5 years by ethnicity, New
Zealand 2003–2012 .......................................................................................................... 177
Figure 70. Mean scores for the number of decayed, missing or filled permanent teeth
(DMFT) at age 12 years by ethnicity, New Zealand 2003–2012 ........................................ 177
Figure 71. Hospital admissions for dental caries in all children and young people aged
0−24 years, New Zealand 2000–2013 ............................................................................... 179
Figure 72. Hospital admissions for dental caries in Māori children and young people by
age, New Zealand 2009–2013 .......................................................................................... 179
Figure 73. Hospital admissions for dental caries in children and young people aged 0–
24 years by ethnicity, New Zealand 2000–2013 ................................................................ 181
Figure 74. Maternal smoking status of babies born in New Zealand, by maternal age
and ethnicity 2008−2012 ................................................................................................... 190
Figure 75. Proportion of children aged 0–14 years living in a household with a smoker
by ethnicity, New Zealand at the 1996, 2006, and 2013 Censuses ................................... 192
Figure 76. Proportion of children aged 0–14 years living in a household with a smoker
by ethnicity and NZ Deprivation Index decile, New Zealand at the 2013 Census .............. 193
Figure 77. Proportion of young people aged 15–24 years who were regular smokers by
ethnicity, New Zealand at the 1996, 2006 and 2013 Censuses ......................................... 195
Figure 78. Proportion of young people aged 15–24 years who were regular smokers by
ethnicity and NZ Deprivation Index decile, New Zealand at the 2013 Census ................... 196
Figure 79. Proportion of Year 10 students who were daily smokers by gender and
ethnicity, New Zealand 1999–2013 ................................................................................... 198
Figure 80. Alcohol-related hospital admissions in young people aged 15–24 years by
ethnicity, New Zealand 2000–2013 ................................................................................... 200
Figure 81. Alcohol-related hospital admissions in Māori children and young people aged
0–24 years by age and gender, New Zealand 2009–2013 ................................................ 201
Figure 82. Hospital admissions for conditions with a social gradient in children aged 0–
14 years (excluding neonates) by ethnicity, New Zealand 2000–2013 .............................. 211
Figure 83. Hospital admissions for medical conditions with a social gradient in children
aged 0–14 years by health specialty on discharge and DHB reporting practice, New
Zealand 2000–2012 .......................................................................................................... 212
Figure 84. Mortality from conditions with a social gradient in children aged 0–14 years
(excluding neonates) by ethnicity, New Zealand 2000–2011 ............................................. 212
Figure 85. Total infant, neonatal and post neonatal mortality by ethnicity, New Zealand
1996–2011 ........................................................................................................................ 217
Figure 86. Sudden unexpected death in infancy (SUDI) by ethnicity, New Zealand
1996−2011 ........................................................................................................................ 218
10