The Determinants of Health for Children and Young People in Counties Manukau

368 Pages·2010·5.26 MB·English

IN COUNTIES MANUKAU
a
b
The Determinants of Health for
Children and Young People in
Counties Manukau

This Report was prepared for Counties Manukau DHB by Elizabeth Craig,
Gabrielle McDonald, Anne Reddington and Andrew Wicken on behalf of the
New Zealand Child and Youth Epidemiology Service, November 2009

This report was produced as a result of a contract between the DHB and the Paediatric Society of
New Zealand, on behalf of 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 is collected from District Health Boards
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.

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Cover Artwork: Tui and Chicks, by Kiri Gillespie
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T C
ABLE OF ONTENTS
Table of Contents .......................................................................................................... iii
List of Figures ................................................................................................................. v
List of Tables ................................................................................................................. xi
Executive Summary ..................................................................................................... xvii
INTRODUCTION ................................................................................................................ 1
Introduction ..................................................................................................................... 3
WIDER MACROECONOMIC AND POLICY CONTEXT ...................................................... 5
THE CHILDREN‟S SOCIAL HEALTH MONITOR: INTRODUCTION .................................. 7
Introduction to The Children‟s Social Health Monitor ....................................................... 9
THE CHILDREN‟S SOCIAL HEALTH MONITOR: ECONOMIC INDICATORS ................. 17
Gross Domestic Product (GDP) .................................................................................... 19
Income Inequality .......................................................................................................... 21
Child Poverty and Living Standards .............................................................................. 24
Unemployment Rates ................................................................................................... 33
Children Reliant on Benefit Recipients .......................................................................... 40
Young People Reliant on Benefits ................................................................................. 46
THE CHILDREN‟S SOCIAL HEALTH MONITOR: CHILD HEALTH AND WELLBEING
INDICATORS ................................................................................................................... 55
Hospital Admissions and Mortality with a Social Gradient in Children ........................... 57
Infant Mortality .............................................................................................................. 69
SOCIOECONOMIC AND CULTURAL DETERMINANTS ................................................. 77
HOUSEHOLD COMPOSITION ......................................................................................... 79
Family Composition and Divorce ................................................................................... 81
Household Crowding ..................................................................................................... 89
EDUCATION: KNOWLEDGE AND SKILLS ...................................................................... 95
Education: Knowledge and Skills Introduction ............................................................... 97
Participation in Early Childhood Education .................................................................... 98
Enrolments in Kura Kaupapa Māori ............................................................................ 105
Educational Attainment at School Leaving .................................................................. 111
Senior Secondary School Retention Rates ................................................................. 118
School Stand-Downs, Suspensions, Exclusions and Expulsions ................................. 124
Truancy and Unjustified Absences .............................................................................. 131
RISK AND PROTECTIVE FACTORS ............................................................................. 135
Tobacco Use in Pregnancy ......................................................................................... 139
Exposure to Second-Hand Cigarette Smoke in the Home ........................................... 147
Tobacco Use in Young People .................................................................................... 155
Alcohol Related Harm ................................................................................................. 167
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INDIVIDUAL AND WHĀNAU HEALTH AND WELLBEING ............................................. 175
SAFETY AND FAMILY VIOLENCE ................................................................................ 177
Injuries Arising from the Assault, Neglect or Maltreatment of Children ........................ 179
Injuries Arising from Assault in Young People ............................................................. 187
Child Youth and Family Notifications ........................................................................... 193
Family Violence .......................................................................................................... 197
MENTAL HEALTH .......................................................................................................... 205
Issues Experienced by Callers to Telephone Counselling Services ............................ 207
Access to Mental Health Services: Introduction, Methods and Evidence Based Reviews
................................................................................................................................... 211
Access to Mental Health Services in Children Aged 0-14 Years.................................. 216
Access to Mental Health Services: Late Childhood and Adolescence ......................... 229
Access to Mental Health Services: Late Adolescence ................................................. 236
Self-Harm and Suicide ................................................................................................ 258
IN DEPTH TOPICS ........................................................................................................ 267
Early Intervention Programmes for Socially Vulnerable Children ................................. 269
Shifting Services from Secondary to Primary Care ...................................................... 287
APPENDICES AND REFERENCES ............................................................................... 305
Appendix 1 : Statistical Significance Testing and Its Use in This Report ..................... 307
Appendix 2: Search Methodology for Policy Documents & Evidence Based Reviews . 309
Appendix 3: Data Quality Grading System for Indicators in this Report ....................... 311
Appendix 4: The National Minimum Dataset ............................................................... 314
Appendix 5: National Mortality Collection .................................................................... 318
Appendix 6: Measurement of Ethnicity ........................................................................ 319
Appendix 7: NZ Deprivation Index ............................................................................... 322
Appendix 8: Police Boundaries ................................................................................... 323
Appendix 9. Methods Used to Develop The Children‟s Social Health Monitor ............. 326
References ................................................................................................................. 329

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IST OF IGURES
Figure 1. Seasonally Adjusted Unemployment Rates vs. Numbers of Unemployment and
Domestic Purposes Benefit Recipients, New Zealand 1990-2008 ........................... 12
Figure 2. Gross Domestic Product (GDP): Percentage Change from Previous Quarter,
New Zealand June 2005-June 2009 ........................................................................ 20
Figure 3. Income Inequality in New Zealand: P80/P20 Ratio for the 1984-2008 HES Years
................................................................................................................................ 23
Figure 4. Income Inequality in New Zealand: Gini Coefficient for the 1984-2008 HES Years
................................................................................................................................ 23
Figure 5. Proportion of Dependent Children Aged 0-17 Years Living Below the Income
Poverty Threshold (Before Housing Costs), New Zealand 1982-2008 HES Years ... 26
Figure 6. Proportion of Dependent Children Aged 0-17 Years Living Below the Income
Poverty Threshold (After Housing Costs), New Zealand 1982-2008 HES Years ...... 26
Figure 7. Proportion of Dependent Children Living Below the 60% Income Poverty
Threshold (1998 Median, After Housing Costs) by Age and Number of Children in
Household, New Zealand 1986-2008 HES Years .................................................... 27
Figure 8. Proportion of Dependent Children Living Below the 60% Income Poverty
Threshold (1998 Median, After Housing Costs) by Household Type and Work Status
of Adults in the Household, New Zealand 1986-2008 HES Years ............................ 28
Figure 9. Composition of Dependent Children Who Were Living Below the 60% Income
Poverty Threshold (1998 Median, After Housing Costs) by Household Type and
Work Status of Adults in the Household, New Zealand 1986-2008 HES Years ........ 29
Figure 10. Living Standards Distribution of Families with Dependent Children by Family
Type and Income Source, New Zealand Living Standards Survey 2004 .................. 30
Figure 11. Living Standards Distribution of Families with Dependent Children by Family
Ethnicity, New Zealand Living Standards Survey 2004 ............................................ 31
Figure 12. Seasonally Adjusted Unemployment Rates, New Zealand 1986 (Quarter 1)-
2009 (Quarter 3) ...................................................................................................... 34
Figure 13. Unemployment Rates by Age (Selected Age Groups), New Zealand Third
Quarters 1986-2009 ................................................................................................ 35
Figure 14. Unemployment Rates by Age and Gender in New Zealand Young People 15-24
Years, Third Quarter 1986-2009 .............................................................................. 35
Figure 15. Unemployment Rates by Total Response Ethnicity, New Zealand 2007 (Quarter
4) - 2009 (Quarter 3) ................................................................................................ 36
Figure 16. Unemployment Rates by Qualification, New Zealand September 1987-2009 .. 37
Figure 17. Proportion of Those Unemployed by Duration of Unemployment, New Zealand
September 1987-2009 ............................................................................................. 37
Figure 18. Annual Unemployment Rates by Regional Council, Auckland Region vs. New
Zealand Years Ending September 1987-2009 ......................................................... 38
Figure 19. Quarterly Unemployment Rates by Regional Council, Auckland Region vs. New
Zealand 2004-2009 ................................................................................................. 39
Figure 20. Proportion of All Children Aged 0-17 Years Who Were Reliant on a Benefit
Recipient by Benefit Type, New Zealand April 2000-2009 ....................................... 42
Figure 21. Proportion of All Children Aged 0-17 Years Who Were Reliant on a Benefit
Recipient by Age and Benefit Type, New Zealand April 2009 .................................. 42
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Figure 22. Young People Aged 16-24 Years Receiving a Benefit by Benefit Type, New
Zealand April 2000-2009 ......................................................................................... 49
Figure 23. Young People 16-24 Years Receiving a Domestic Purposes Benefit or
Emergency Maintenance Allowance by Ethnicity, New Zealand April 2000-2009 .... 49
Figure 24. Young People 16-24 Years Receiving an Unemployment Benefit by Ethnicity,
New Zealand April 2000-2009 ................................................................................. 50
Figure 25. Young People 16-24 Years Receiving an Invalid‟s or Sickness Benefit by
Ethnicity, New Zealand April 2000-2009 .................................................................. 50
Figure 26. Young People Aged 16-24 Years Receiving a Sickness Benefit by Cause of
Incapacity, New Zealand April 2009 (n=8,519) ........................................................ 51
Figure 27. Young People 16-24 Years Receiving an Invalid‟s Benefit by Cause of
Incapacity, New Zealand April 2009 (n=7,353) ........................................................ 51
Figure 28. Hospital Admissions (2000-2008) and Mortality (2000-2006) from Conditions
with a Social Gradient in New Zealand Children Aged 0-14 Years (excluding
Neonates) ................................................................................................................ 61
Figure 29. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0-14
Years by Ethnicity, New Zealand 2000-2008 ........................................................... 62
Figure 30. Mortality from Conditions with a Social Gradient in Children Aged 0-14 Years
(excluding Neonates) by Ethnicity, New Zealand 2000-2006 ................................... 62
Figure 31. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0-14
Years by NZ Deprivation Index Decile, New Zealand 2000-2008............................. 63
Figure 32. Mortality from Conditions with a Social Gradient in Children Aged 0-14 Years
(excluding Neonates) by NZ Deprivation Index Decile, New Zealand 2000-2006 .... 63
Figure 33. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0-14
Years, Counties Manukau vs. New Zealand 2000-2008 .......................................... 67
Figure 34. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0-14
Years by Ethnicity, Counties Manukau 2000-2008 .................................................. 67
Figure 35. Total, Neonatal and Post Neonatal Mortality, New Zealand 1990-2006 ........... 70
Figure 36. Total, Neonatal and Post Neonatal Mortality by Ethnicity, New Zealand 1996-
2006 ........................................................................................................................ 70
Figure 37. Total, Neonatal and Post Neonatal Mortality, Counties Manukau vs. New
Zealand 1990-2006 ................................................................................................. 73
Figure 38. Proportion of Children Aged 0-14 Years Living in Sole Parent Households by
Ethnicity, Counties Manukau vs. New Zealand at the 2006 Census ........................ 83
Figure 39. Proportion of Children Aged 0-14 Years Living in Sole Parent Households by
NZ Deprivation Index Decile, Counties Manukau vs. New Zealand at the 2006
Census .................................................................................................................... 83
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 2006 Census......... 84
Figure 41. Marriage and Divorce Rates in New Zealand 1981-2008 ................................. 85
Figure 42. Median Age at Marriage and Divorce by Gender, and Median Duration of
Marriage Ending in Divorce, New Zealand 1987-2008 ............................................. 85
Figure 43. Proportion of Children and Young People 0-24 Years Living in a Crowded
Household by Ethnicity, Counties Manukau vs. New Zealand at the 2006 Census .. 91
Figure 44. Proportion of Children and Young People 0-24 Years Living in a Crowded
Household by NZ Deprivation Index Decile, Counties Manukau vs. New Zealand at
the 2006 Census ..................................................................................................... 91
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Figure 45. Proportion of Children and Young People 0-24 Years Living in a Crowded
Household by Ethnicity and NZ Deprivation Index Decile, New Zealand at the 2006
Census .................................................................................................................... 92
Figure 46. Licensed and Licence-Exempt Early Childhood Education Enrolments by
Service Type, New Zealand 1990 - 2008 ............................................................... 100
Figure 47. Proportion of New Entrants Who Had Previously Attended Early Childhood
Education by Ethnicity, New Zealand 2000-2008 ................................................... 102
Figure 48. Proportion of New Entrants Who Had Previously Attended Early Childhood
Education by School Socioeconomic Decile, New Zealand 2008........................... 102
Figure 49. Proportion of New Entrants (Year 1) Who Had Previously Attended Early
Childhood Education, Counties Manukau vs. New Zealand 2000-2008 ................. 103
Figure 50. Proportion of New Entrants (Year 1) Who Had Previously Attended Early
Childhood Education by Ethnicity, Counties Manukau 2000-2008 ......................... 103
Figure 51. Number of Ministry of Education Funded Kura Kaupapa Māori and Kura Teina,
New Zealand 1992-2008 ....................................................................................... 106
Figure 52. Total Number of Students Involved in Māori Medium Education by School
Sector and Form of Education as at 1 July, New Zealand 2000-2009 .................... 109
Figure 53. Highest Educational Attainment of School Leavers, New Zealand 1995-2008113
Figure 54. Highest Educational Attainment of School Leavers by Ethnicity, New Zealand
1995-2008 ............................................................................................................. 113
Figure 55. School Leavers with a University Entrance Standard by Ethnicity and School
Socioeconomic Decile, New Zealand 2008 ............................................................ 114
Figure 56. Highest Attainment of School Leavers, Counties Manukau vs. New Zealand
1995-2008 ............................................................................................................. 115
Figure 57. Highest Attainment of School Leavers by Ethnicity, Counties Manukau 1995-
2008 ...................................................................................................................... 115
Figure 58. Apparent Senior Secondary School Retention Rates at 16.5 and 17.5 Years by
Gender, New Zealand 2002-2008 .......................................................................... 119
Figure 59. Apparent Senior Secondary School Retention Rates at 16.5 and 17.5 Years by
Ethnicity, New Zealand, 2002-2008 ....................................................................... 120
Figure 60. Apparent Senior Secondary School Retention Rates at 16.5 and 17.5 Years by
School Socioeconomic Decile, New Zealand 2008 ................................................ 120
Figure 61. Age-Standardised Participation Rates in Tertiary Education for Domestic
Students by Ethnicity and Qualification, New Zealand 2001-2008 ......................... 121
Figure 62. Apparent Senior School Retention Rates at Age 16.5 and 17.5 Years, Counties
Manukau vs. New Zealand, 2002-2008 ................................................................. 122
Figure 63. Apparent Senior School Retention Rates at 16.5 and 17.5 Years by Ethnicity,
Counties Manukau 2002-2008 ............................................................................... 122
Figure 64. Age Standardised School Stand-Down, Suspension, Exclusion and Expulsion
Rates by Ethnicity, New Zealand 2000-2008 ......................................................... 126
Figure 65. Age Standardised School Stand-Down, Suspension, Exclusion and Expulsion
Rates, Counties Manukau vs. New Zealand 2000-2008 ........................................ 128
Figure 66. Age Standardised School Suspension Rates by Ethnicity, Counties Manukau
vs. New Zealand 2000-2008 .................................................................................. 128
Figure 67. Unjustified Absences by School Year Level, New Zealand 2004 and 2006 .... 132
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Figure 68. Unjustified Absences and Frequent Truancy by Ethnicity and Gender, New
Zealand 2006 ........................................................................................................ 132
Figure 69. Unjustified Absences and Frequent Truancy by Ethnicity and School
Socioeconomic Decile, New Zealand 2006 ............................................................ 133
Figure 70. Unjustified Absences and Frequent Truancy by Ethnicity, Counties Manukau vs.
New Zealand 2006 ................................................................................................ 133
Figure 71. Proportion of New Zealand Women Giving Birth During 2004-2008 Who Used
Tobacco vs. Proportion of Female Smoking at the 2006 Census, by Age .............. 140
Figure 72. Proportion of New Zealand Women Giving Birth During 2004-2008 Who Used
Tobacco vs. Proportion of Women Smoking at the 2006 Census, by Age and (Total
Response) Ethnicity ............................................................................................... 141
Figure 73. Proportion of Women Giving Birth Who Used Tobacco by Maternal Age and NZ
Deprivation Index Decile, New Zealand 2004-2008 ............................................... 141
Figure 74. Proportion of Women Giving Birth Who Used Tobacco, Counties Manukau vs.
New Zealand 2000-2008 ....................................................................................... 142
Figure 75. Proportion of Women Giving Birth Who Used Tobacco by Maternal Age,
Counties Manukau vs. New Zealand 2000-2008 ................................................... 143
Figure 76. Proportion of Women Giving Birth Who Used Tobacco by Ethnicity, Counties
Manukau vs. New Zealand 2000-2008 .................................................................. 143
Figure 77. Proportion of Women Giving Birth Who Used Tobacco by Maternal Age and
Ethnicity, Counties Manukau vs. New Zealand 2004-2008 .................................... 144
Figure 78. Proportion of Women Giving Birth Who Used Tobacco by NZ Deprivation Index
Decile, Counties Manukau vs. New Zealand 2000-2008 ........................................ 144
Figure 79. Proportion of Year 10 Students With Parents Who Smoke or Who Live in a
Home With Smoking Inside by Ethnicity, New Zealand ASH Surveys 2001-2008 .. 149
Figure 80. Proportion of Year 10 Students With Parents Who Smoke or Who Live in a
Home With Smoking Inside by School Socioeconomic Decile, New Zealand ASH
Surveys 2001-2008 ............................................................................................... 149
Figure 81. Proportion of Year 10 Students With Parents Who Smoke or Who Live in
Homes With Smoking Inside, Counties Manukau vs. New Zealand, ASH Surveys
2001-2008 ............................................................................................................. 150
Figure 82. Proportion of Children 0-14 Years Living in a Household With a Smoker by
Ethnicity, Counties Manukau vs. New Zealand at the 2006 Census ...................... 151
Figure 83. Proportion of Children 0-14 Years Living in a Household With a Smoker by NZ
Deprivation Index Decile, Counties Manukau vs. New Zealand at the 2006 Census
.............................................................................................................................. 152
Figure 84. Proportion of Children 0-14 Years Living in a Household With a Smoker by
Ethnicity and NZ Deprivation Index Decile, New Zealand at the 2006 Census....... 152
Figure 85. Daily Smoking Rates in Year 10 Students by Gender and Ethnicity, New
Zealand ASH Surveys 1999-2008 ......................................................................... 157
Figure 86. Daily Smoking Rates in Year 10 Students by Gender and School
Socioeconomic Decile, New Zealand ASH Surveys 1999-2008 ............................. 157
Figure 87. Daily Smoking Rates in Year 10 Students by Parents Smoking Status, New
Zealand ASH Surveys 2001-2008 ......................................................................... 158
Figure 88. Daily vs. Never Smoking Rates in Year 10 Students, Counties Manukau vs.
New Zealand ASH Surveys 1999-2008 ................................................................. 158
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