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Te Hau o te WhenuaTe Hau o te TangataTe Hau o te WhenuaTe Hau o te Tangata
He pūrongo Hauora o ngā Iwi Māori i te Rohe o Tamaki Makaurau
A report on Mäori Public Health in the Auckland Region
Rātonga Hauora ā iwi o Tamaki Makaurau Auckland Regional Public Health Service 2005
ISBN: 0-473-10103-3
MihimihiToi tū te Mana, Toi tū te Whenua
Toi tū te Tangata
E ngā iwi, e ngā reo, e ngā karanga maha,
nau mai, piki mai, kake mai, hei whakapuāwai ki te take mö ngā āhuatanga o te Ao Tūroa
Tuatahi, ka mihi atu ki te runga rawa tö tātou Kaihanga, nāna i tuku ngā taonga katoa o te ao
Tuarua, ka mihi atu ki te hunga mate e kore e kitea kanohitia i runga i te mata o te whenua. kāti, waihotia rātou i runga i te whāriki o te rangimarie.
Ki a tātou te hunga ora e noho nei i waenganui i ngā pitopito o ngā maunga katoa, me ngā whānga o te Manukau me te Waitematā
tēnā koutou, tēnā koutou, tēnā koutou katoa.
Ka huri ake, he mihi tautoko mö ngā körero kua whakawhiti ki runga i te tuhinga o tēnei Rīpōata, me kī, Te Hau o te Whenua, Te Hau o te Tangata.
Anō te rangatiratanga o te whakaaro, mö te mahi tahi,
ki te whakairinga i te hauora o ngā iwi maha o tënei rohe.
Kia tū te arataki hei oranga mö te iwi.
Nā reira, tēnā anō tātou katoa.
ii
www.arphs.govt.nz
ForewordThe Auckland Regional Public Health Service (ARPHS) is concerned with the improvement in the health and wellbeing of people in the Auckland region. As outlined in our Strategic Plan 2004-2007, the ARPHS has an important part to play in focusing on how public health services can best contribute to health gain.
This report represents our commitment to making a difference and improving the lives of all people residing in the Auckland region. We are committed to eliminating inequalities in health within our region, and fundamental to this approach is our commitment to the indigenous people, the Mana Whenua and Mataawaka, of Tamaki Makaurau.
Mäori health must be understood in the context of the social, cultural and economic position of Mäori in the present day, as well as the effects of the past on Mäori of today. Public health practice in Aotearoa/New Zealand recognises the interconnectedness of public health and development of whānau, hapü, and iwi.
Te Hau o te Whenua, Te Hau o te Tangata is our snapshot of Mäori Public Health in the Auckland region. We hope to follow up on this report at regular intervals, to update epidemiological data, and to evaluate our communities’ needs on an ongoing basis.
We hope it is a valuable resource for your purposes whether they be funding and planning, research, study, personal or other.
Finally, I would like to acknowledge all of those people who helped to get this report to where it is today. There are hundreds of you, too many to name individually. Without your help, knowledge, tautoko, and manaaki, this resource would not have been possible. Thank you.
Monica Briggs
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Table of ContentsList of fi gures..................................................................................................................... v
List of tables...................................................................................................................... vii
Introduction....................................................................................................................... 1
Ngä Manawhenua o Tamaki Makaurau me ngä Mataawaka.Mäori of the Auckland Region.............................................................................. 8
- Population density........................................................................................................... 12
- Iwi affi liations of Auckland Māori..................................................................................... 15
- Projected population trends............................................................................................ 19
- Age distribution................................................................................................................ 19
Mauri Ora: Te Ao Mäori......................................................................................... 25
- Te Reo Māori................................................................................................................... 25
- Access to marae.............................................................................................................. 28
- Access to Māori television............................................................................................... 32
- Access to Māori education.............................................................................................. 33
- Kapa Haka...................................................................................................................... 33
Waiora: Environmental protection....................................................................... 35
- Drinking-water................................................................................................................. 36
Toiora: Healthy Lifestyles..................................................................................... 45
- Nutrition and physical activity indicators.......................................................................... 45
- Threats to good health from contemporary high-risk lifestyles........................................ 51
Whaiora: Participation in society......................................................................... 61
Te Mana Whakahaere: Autonomy......................................................................... 69
Ngä Manukura: Leadership.................................................................................. 73
- Ngä Manukura indicators................................................................................................ 73
Mäuiui..................................................................................................................... 79
- Introduction..................................................................................................................... 79
- Communicable diseases................................................................................................. 80
Notes about methodology..................................................................................... 110
- Ethnicity and census data............................................................................................... 110
- Ethnicity and health data................................................................................................. 112
Appendix I: Geographic terms and boundaries................................................. 113
- Territorial electoral wards................................................................................................ 113
- Census area units........................................................................................................... 115
- Manawhenua geography................................................................................................. 125
References............................................................................................................. 126
iv
List of Figur Figure 1: The Auckland Regional Public Health Service Region 9Figure 2: Proportion of Auckland Māori total population per ward, 2001 10Figure 3: Māori as a proportion of total population by ward, 2001 12Figure 4: Māori as a proportion of CAU population, 2001 13Figure 5: Māori population density (persons per square km) 2001 14Figure 6: Māori population* by age and sex Waitemata DHB, 2001 20Figure 7: Population pyramid for Māori in Auckland DHB 20Figure 8: Population pyramid for Māori in Counties Manukau DHB 21Figure 9: Projected Māori population for Waitemata DHB by age group (medium series) 22Figure 10: Projected population for Auckland DHB Māori by age group (medium series) 22Figure 11: Projected Māori population for Counties Manukau DHB (medium series) 23Figure 12: Percentage Māori reporting speak Te Reo by age group and DHB, Auckland 2001. 26Figure 13: Competence in Te Reo Māori and population density by CAU 2001 27Figure 14: Marae of Waitemata District Health Board 29Figure 15: Marae of Auckland District Health Board 30Figure 16: Marae of Counties Manukau District Health Board 31Figure 17: Predicted reception coverage of Māori Television 32Figure 18: Location of marine biotoxin monitoring sites in the Auckland region 39Figure 19: Location of beach water quality monitoring sites in the Auckland region 41(data supplied by territorial authorities) Figure 20: The proportion of healthy weight, overweight and obese 46Māori children (aged 5-14 years) Figure 21: Prevalence of overweight and obesity in Māori adult males (>15 years) 46from national surveys in 1997 and 2002/03 Figure 22: Prevalence of overweight and obesity in Māori adult females 47(>15 years) from national surveys in 1997* and 2002/03† Figure 23: Māori children’s vegetable consumption 48Figure 24: Māori children’s fruit consumption * 48Figure 25: Vegetable consumption in Māori males 49Figure 26: Vegetable consumption in Māori females >15 years 49Figure 27: Auckland Māori youth alcohol use compared to the rest of New Zealand 52Figure 28: Alcohol retail outlets in the Auckland region 53Figure 29: Māori youth smoking – ever 54Figure 30: Māori youth smoking - weekly smoker 55Figure 31: Proportion of Māori smoking by census area unit 56Figure 32: Percentage of Māori students who have ever taken marijuana by age 58Figure 33: Proportion of school children who have attended ECE 61Figure 34: Percentage of Māori children attending ECE 62Figure 35: Qualifications of Māori (15 yrs and over) in Auckland region by sex 63Figure 36: Proportion of tertiary students who are Māori 64Figure 37: Number of Māori registered medical practitioners 64Figure 38: Māori enrolments 70
v
Figure 39: Household tenure (own or partly own usual residence) for Māori in 71Auckland region by age, 2001 Figure 40: Māori membership of Auckland Boards of Trustees (1997 to 2003) 74Figure 41: Hepatitis B status of Māori adults 81Figure 42: Rates of tuberculosis in Māori in the Auckland Region, 1994-2003 83Figure 43: Rates of tuberculosis in Māori by DHB, 1998-2003 83Figure 44: Hospitalisations for rotavirus in Māori children aged 0-4 years by DHB, 1998-2003 84Figure 45: Pertussis notifi cations and hospitalisations in Māori children aged0-4 years in the Auckland Region, 1999-2003 85Figure 46: Pertussis notifi cations in Māori children by age and hospitalisation status 86Figure 47: Map of overcrowding 87Figure 48: Rates of meningococcal disease in Māori aged less than fi ve yearsby DHB, 1998-2003 88Figure 49: Rates of meningococcal disease in Māori aged over fi ve years by DHB, 1998-2003 88Figure 50: Rates of meningococcal disease in the Auckland Region by age, 1998-2003 89Figure 51: Hospitalisations for chronic rheumatic heart disease in Māori by DHB, 1998-2003 90Figure 52: Ambulatory sensitive hospitalisation rates in Māori (aged 0-74 years)by DHB, 1991-2002 (age-standardised to WHO population) 91Figure 53: Preventable injury hospitalisation rates in Māori (aged 0-74 years) by DHB,1996-2002 (age-standardised to WHO population) 92Figure 54: Avoidable mortality rates in Māori (aged 0-74 years) by DHB, 1996-2001(age-standardised to WHO population) 93Figure 55: Low birthweight (<2500g) rates in Māori babies in Auckland by DHB, 1999-2003 93Figure 56: Māori infant mortality rate by DHB, 1996-2000 96Figure 57: Māori SIDS mortality rate for all of New Zealand, 1996-2000 96Figure 58: Exclusive or full breastfeeding at three months by Māori women inAuckland by DHB, 2002-2004 98Figure 59: Hospitalisations for poisoning in Māori infants (aged 0-4 years) by DHB, 1999-2003 99Figure 60: Hospitalisations for falls in Māori children aged 0-4 years by DHB, 1998-2003 99Figure 61: Hospitalisations for burns in Māori children aged 0-4 years by DHB, 1998-2003 100Figure 62: Percentage of Māori children passing hearing screening tests at school entryby DHB, June 1998-July 2003 101Figure 63: Average DMFT of Māori Year 8 (Form 2) children by DHB, 2002-2003 102Figure 64: Asthma hospitalisations in Māori children (aged 5-14 years) by DHB, 1998-2003 103Figure 65: Teenage birth rate in Māori by DHB, 2000-2002 104Figure 66: Motor vehicle traffi c accident mortality in Māori youth (aged 15-24 years) inAuckland, 1996-2000 105Figure 67: Ischaemic heart disease mortality in Māori under 65 years of age by DHB, 1996-2000 106Figure 68: Ischaemic heart disease mortality in Māori over 65 years of age by DHB, 1996-2000 107Figure 69: Stroke mortality in Māori aged 65 years and older by DHB, 1996-2000 108Figure 70: Hospitalisations for falls in Māori adults aged 65 years and older, 1999-2003 109Figure 71: DHB, Territorial Authority and Ward Boundaries, 2001 114Figure 72: Waitemata DHB census area units 116Figure 73: Auckland DHB census area units 119Figure 74: Counties Manukau DHB census area units 122Figure 75: Locations of iwi rohe within Tamaki Makaurau. 125
vi
List of Tabl Table 1: A summary of Te Pae Mähutonga 5Table 2: Territorial Local Authority electoral wards with proportion of Māori greater than forthe region overall 11Table 3: Iwi affi liations of people of Māori descent usually living within the Auckland region, 2001 15Table 4: Māori ethnic group population changes between 2001 and 2016 by Territorial Authority 19Table 5: A. listening, B. reading and C. writing. Te reo profi ciency for Auckland Māoriover 15 years compared to New Zealand, 2001 28Table 6: Overall profi ciency by age group. Auckland compared to all New Zealand, 2001 28Table 7: Participation in Kapa Haka competition 33Table 8: Hazards commonly associated with untreated roof-water and groundwater 36Table 9: Use of alcohol by children aged 13 to 18 in the Auckland Region 51Table 10: Use of alcohol among Auckland Māori children by age 52Table 11: Percentage marijuana use by Māori females and males 57Table 12: Percentage marijuana use by Māori age groups 57Table 13: Occupation (Major group) for employed Māori usually resident population15 years of age and over, 2001 65Table 14: Sector (major group) for employed Māori usually resident population15 years of age and over, 2001 66Table 15: Māori Electorate : Please refer also to the maps of the Auckland region, whichillustrate the development of a new Māori electorate in 2003. 70Table 16: Percentage of Māori voter turn out 70Table 17: Index of Local Government Electoral Wards in the Auckland Regional PublicHealth Service Region 115Table 18: Index of Census Area Units in the Waitemata DHB district 117Table 19: Index of Census Area Units in the Auckland DHB district 120Table 20: Index of Census Area Units in the Counties Manukau DHB district 123
vii
IntroductionWhen this report was first discussed, it was akin to setting off on an ocean voyage. There was general agreement about where we wanted to go – to produce an innovative report from a Māori perspective for the region of Tamaki Makaurau – but the experience was one of paddling through uncharted waters, with unforseen winds and ocean currents. Clouds sometimes obscured the heavens, making navigation a challenge!
The project team and all the contributors to this resource have undertaken a process in consultation with Māori. Based on feedback we have produced non-comparative health data and focused on health and wellbeing perspectives. We acknowledge unintentional areas of omission and oversight. Where possible and appropriate, the forthcoming regional State of Public Health report will address issues of inequality and disparities in health outcomes, and produce data for specific population groups.
The selection of Te Pae Mähutonga health promotion framework, eloquently articulated by Professor Mason Durie, was made after a period of consultation with Māori providers, academics, and community stakeholders. There was discussion and debate about whether Te Whare Tapa Whä; Te Pae Mähutonga, or any framework from a health promotion perspective, was appropriate for a report about Māori health and wellbeing. There was considerable debate about whether or not to include information about illnesses and whether to include this illness information in the body of the report or in an appendix. A member of the project team sought permission from Professor Durie to use his paper as a potential framework, as “a symbolic chart for mapping the dimensions of health promotion”, focusing on health determinants from a Māori perspective.
The decision to use Te Pae Mähutonga as a framework meant there would be components of this framework for which there would be little available information. In other sections, the challenge was to select the most appropriate information for the component of Te Pae Mähutonga.
Guidance on all matters of Tikanga was given by ‘Ngä Pou Äwhina’.
The project team brought together people with diverse disciplines and world views who had a strong commitment to look at Te Pae Mähutonga, from both a theoretical and practical perspective, to deliver an innovative report for Māori.
Te Pae Mähutonga does not explicitly discuss how ill health might be considered in relation to the framework. This report on Māori Health and wellbeing focuses on health promotion. However it is appropriate for any report on the state of health in a community to describe the occurrence of ill health. We have researchers who have provided invaluable information on the occurrence of ill health within the Māori population of the Auckland region. This information can be utilised by planners and funders, and those interested in hospitalisation and other data.
This report presents the information on ill health in two ways: firstly as a backdrop to wellness information within Te Pae Mähutonga framework; and secondly within a section called ‘Mäuiui’ which focuses on illness.
The indicators include those of public health proposed by the Auckland Regional Public Health Service (ARPHS) communicable disease control team. These indicators were chosen because of their importance to burden of disease, or because they are associated with important public health programmes ARPHS undertakes to prevent these illnesses. In some sections where data have not been available at a local or regional level we have included national data where relevant.
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Some indicators were chosen to be consistent with the public health Indicator Framework published by the Ministry of Health in the document “An indication of health, 2004”.
The ARPHS will be publishing the following reports and publications in the near future:• State of Public Health in the Auckland Region • Auckland Regional Environmental Health Blueprint• Health Impact Assessment on Urban Intensifi cation
We want to increase understanding of the impact of social and environmental factors in the health of the region; provide better information for Māori to participate in the decisions around their health; help identify public health priorities for District Health Boards and Territorial Local Authorities among others; and to provide an opportunity to understand the state of public health for Māori in our region.
The framework of Te Pae Mähutonga was chosen to lay the foundation of our report, and to guide us throughout. We hope our report is useful for all readers who have an interest in the state of Public Health in our region.
We hope you enjoy reading Te Hau o te Whenua, Te Hau o te Tangata.
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Why a report on Māori public healthPublic health has been defined as the science and art of preventing disease and prolonging life through the organised efforts of society. Public health seeks to influence and inform the processes that reshape society and promote health. Because of this Auckland Regional Public Health Service (ARPHS) recently identified “Influential Information” as a key area for development over the next 5 years in its strategic plan.
As a first step we have decided to commence producing regular reports that monitor the progress of our region with respect to Public Health. In taking a broad view of what public health is we aim to measure progress not only in terms of disease or health outcomes but also with respect to those aspects of the social and physical environment that affect health. We hope that by focusing attention on trends we can highlight areas needing more attention as well as areas where society’s efforts are leading to improved health. With any undertaking to monitor change over time it is necessary to establish a consistent way of measuring things. Thus much of our initial energy has focused on establishing a monitoring framework that specifies what things we should measure and how they can be defined. And in setting out to establish such a framework we wanted to ensure that any framework we developed reflected a partnership with Māori both in recognition of our obligations under the Treaty of Waitangi and because of disparities between Māori and Non-Māori health.
Thus we wanted to ensure that the things we monitor over time represent not only a broad concept of what public health is but also a Māori view of what public health is.
This particular report presents the findings of our initial assessment of public health from a Māori perspective. We report not only on the health of Māori but on the public health of the region from a Māori perspective. The aim is to provide information not only on trends in Māori health but on those aspects of the social and physical environment that affect the health of all people within the region as seen through Māori eyes.
It is hoped that the report will increase community understanding of the impact of social and environmental factors in the health of the region, provide better information for Māori to participate in decisions around their health, help to identify public health priorities for DHBs, Primary Health Organisations and Territorial Authorities and will provide an opportunity to celebrate the successes of Māori public health initiatives. It is also hoped that as we continue to produce reports on the state of public health we can incorporate at least some of the Māori public health indicators identified in this report.
How this work was produced
From the outset it was recognised that the processes employed through out the project would be as important as any report produced at the project’s completion. ARPHS foresaw that the benefits for Māori would be highly dependent on the process, the development and nature of the partnership and the integrity of the participants. Therefore the project began by consulting Māori as to whether ARPHS should be doing a report on this theme and if so what framework should be used.
The project was guided through out by a Māori tikanga advisory group (Ngä Pou Äwhina) and the project team comprised of Māori and Non-Māori investigators working in collaboration. By adopting this approach it was hoped that the project would produce a resource that more accurately reflected a Māori perspective as well as met information needs defined by Māori in the region.
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An internal reference group was formed from the different parts of the service. The members of this group provided expert advice on analyses and indicators relevant to their programme area.
Selection of a framework
The project team drew on findings from consultation with local Māori, a Tomaiora seminar at the School of Population Health, and reviews of existing health and well being indicator frameworks to develop a framework.
Consultation findings suggested that Māori supported the use of a framework that included aspects of social and environmental well being not normally considered to be dimensions of health per se.
The following frameworks and indicator sets were reviewed:• New Zealand Health Strategy (1) and its tool kits• Māori specific indicators � He Korowai Oranga (2) and it’s action plan Whakatātaka (3) � Te Pae Mähutonga (4) � Te Ngahuru (TPK’s Māori outcome indicators) (5)• Local Government � The Quality of Life in NZ’s Biggest 8 Cities report (6) � Long term council community plans• The Ministry of Social Development’s Social Report (7)• The Ministry of Health Public Health Intelligence group’s 50 health indicators (cited in (8))• DHB targets (from DHB strategic plans)• The Environmental Health Indicator piloted by the Ministry of Health, EnHealth and ESR (9)• Ministry for the Environment – Environmental Indicators for Transport (10)
These reports were considered at a workshop held by the project team and Kaumätua group. The group considered the relevance of each framework and conducted a stakeholder analysis for the project that identified Māori healthcare providers as the highest priority group. This process resulted in the choice of Te Pae Mähutonga (4) a framework developed by Professor Mason Durie for health promotion, as the overarching framework for the report.
Te Pae Mähutonga is the Māori name for one of the most important constellations of stars in the southern sky. This constellation also known as the “Southern Cross” has provided a vital navigation tool for both Māori and Non-Māori for centuries. The framework uses the four stars of the cross and the two pointers to signify six key dimensions to the promotion of Māori health.
The four stars of the cross are:1. Mauri Ora – Access to Te Ao Māori (the Māori world)2. Waiora – protection of the physical environment3. Toiora – promotion of health lifestyles4. Whaiora – participation in wider society
The pointers are: 5. Ngä Manukura – Māori leadership6. Te Mana Whakahaere – Māori autonomy
Under each of these key areas five objectives or considerations are identified.
4
These objectives are listed in table one below:Table 1: A summary of Te Pae Mähutonga* Star of Te Pae Mähutonga Objectives or key considerationsMauri Ora – Access to Māori resourcesGood health depends on secure cultural identify.
Language and knowledgeCulture and institutions such as maraeEconomic resources eg land, forests, fisheries, factoriesSocial resources eg whanau, Māori social services and networksOther societal domains where being Māori is facilitated eg Māori sports clubs
Waiora – Environmental protectionA spiritual element that connects human wellness with air, terrestrial and water environments. Human development must be harmonised with the environment to ensure that
Water is free of pollutants
Air is free of irritants and toxins
Earth is abundant in vegetation
Noise levels are compatible with human well being
There are opportunities for people to experience the natural environment
Toiora – Healthy LifestylesHealth is threatened by risk laden lifestyles and behaviours. These include patterns of nutritional intake, use of alcohol, tobacco and other substances, road use practices, sexual practices, physical activity, financial prudence, use of unsafe machinery and disregard for the safety of others. The objectives for this dimension of health correspond to levels of intervention that can be used to address specific risks
Minimise the harm from risky behavioursInterventions are well targetedRisks are identified and managedInterventions are culturally relevantInterventions support development
Whaiora– participation in societyWell being is dependent on the terms which people participate in society and on the confidence with which they can access services. The objectives for this area are the aspects of society for which full participation is critical for health
EconomyEducationEmploymentKnowledge societyDecision making
Ngä Manukura – Māori leadershipHealth professionals and agencies need to work in concert with community leaders to ensure health is promoted effectively. Objectives correspond to the key elements of health leadership
Community leadershipHealth leadershipTribal leadershipCommunicationAlliances between leaders and agencies
Te Mana Whakahaere – AutonomyCapacity for self governance is central to good health and positive well being. Autonomy means a capacity to organise and assert a measure of control over development. Objectives correspond to key aspects of autonomy
Community control of community affairsRecognition of collective aspirationsAdoption of relevant processesSensible measures and indicatorsEnhanced capacity for self governance
Selection of indicators
The six stars of Te Pae Mähutonga provided a conceptual framework for describing public health in Māori terms. However the framework was developed as a framework for guiding health promotion rather than as a framework for monitoring the state of public health per se. Thus having selected this framework the project team was now faced with the challenge of identifying specific measurements that would provide an indication of public health within these conceptual areas.__________________________________* Adapted from Durie’s Te Pae Mahutonga model
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In attempting to identify indicators the project team were cognisant of the requirement for selected indicators to meet a number of criteria. These include having some broader significance about the area of interest, and being available, reliable and affordable. Rather than attempting to define indicators, and collect data to derive them from scratch, the project has taken a pragmatic approach that attempts to gather indicators from existing frameworks.
Four of the indicator frameworks mentioned above were identified as being most relevant to public health at a regional or local level. The frameworks were the Quality of Life in Eight Cities report, the Social Report, the public health intelligence indicators and the ESR environmental health indicator framework that was based on a WHO framework. Indicators from these datasets were also considered likely to be available and hence were considered as possible sources of data for indicators to measure progress on Te Pae Mähutonga objectives.
The four frameworks were compared to identify common categories and indicators. Indicators from each framework were then grouped into these common categories and compared to identify common indicators as well as indicators that were unique to a particular framework. A list of potential indicators was then compiled from these lists and circulated to the reference group. The project team then sought advice from the reference group on the most appropriate indicators for the six Te Pae Mähutonga health dimensions relevant to each programme.
Contributors were also asked to specify detailed definitions of indicators as well as information about the source and availability of data. The specific attributes of indicators included the time periods covered, geographic level of coverage and availability of indicator data by ethnic breakdown when this was relevant. For example use of Te Reo Māori was identified as a potential indicator or Mauriora. Data on use of Te Reo were available from two sources. The first was the 2001 Census and the second was the Māori Language survey carried out shortly after the census. Thus the time period specified was 2001, the geographic level was down to census area for census data and at regional level for survey data. Data were specific for persons identifying as Māori ethnic group.
Qualitative indicators of Mäori health
Some concepts of the framework could not be easily quantified in a meaningful way. From the outset the project envisaged including qualitative assessments of where things were at with respect aspects of Te Pae Mähutonga in Auckland. In particular it was anticipated that an understanding of the state of Te Manawhakahaere and Ngä Manukura would be not derived from quantitative indicators.
Thus qualitative data were collected through a series of interviews with key Māori public health workers in the region. These interviews were transcribed and summarised to capture non numerical indications of various aspects of Te Pae Mähutonga in the region.
Mäori health and disease outcomes
The Te Pae Mähutonga framework provided a way of thinking about the state of health determinants from a Māori perspective. The framework did not encompass physical health as an outcome per se however. In some cases there seemed to be arguments for linking specific health outcome indicators to one of the six Te Pae Mähutonga areas e.g. oral health could be linked to Waiora because of the importance of water fluoridation or life expectancy might be linked to Te Oranga (or participation in society). However generally speaking it seemed that most if not all 6 stars contribute to most health outcomes and thus it seemed more appropriate to report on the health outcomes aspects of Māori public health using a separate health outcomes or illness (Mäuiui) framework.
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Health status is frequently expressed in negative terms using measures of disease occurrence to indicate an absence of health. Health inequalities are also frequently used to enable comparisons between population subgroups and the measurement of trends over time. The project group decided to include data on disease but to do so in a way that that emphasised positive trends and highlighted positive approaches to improving health status.
While the group recognised the value of between ethnic group comparisons to highlight inequalities in health it felt the current inequalities that exist between Māori and Non-Māori health in New Zealand are currently well publicised. On the advice of the kaumätua group ‘Ngä Pou Äwhina’ and as a result of the wider consultation health outcome indicators were not compared with other ethnic groups. Rather comparative analyses were based on comparisons either over time or across place. This approach allowed the report to focus on inequalities and trends that exist among Māori within the region.
Feedback Hui and peer review
A hui was held at Pukaki Marae in early December. At the Hui the project team presented the framework with examples of indicator data presented in various formats such as maps, graphs and tables. The Hui provided an opportunity for representatives from a host of organisations, and community representatives to provide feedback on the range of indicators collected as part of this project, and their distribution under the particular stars and pointers of Te Pae Mähutonga. Many of these representatives had also been part of the consultation process earlier in the year.
The feedback was then used to reframe further analysis and the writing of a draft report that was reviewed by a team within the School of Population Health. It should be noted that there was considerable debate around the appropriateness of some indicators and where they should sit within the framework. A number of very useful criticisms were also provided by the peer review team. The project team have attempted to address all issues raised at the Hui and by the reviewers to the extent possible within the timeframe available. In some cases however it is clear that more work is required and we see this report as a fi rst step down a pathway travelling under the stars of Te Pae Mähutonga.
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Ngā Manawhenua o Tamaki Makaurau me ngā Mataawaka. Māori of the Auckland RegionA description of the demography of Mäori in the Auckland region was initially considered to be part of Mauriora in the framework presented at the Hui. After further consideration this discussion of the people and where they live has now been presented separately in this chapter. These two chapters should however be read in conjunction as providing information on Mauriora.
In this report the areas of interest have been defi ned geographically by the Auckland Regional Public Health Service’s (ARPHS) region of responsibility. Figure 1 shows the area is made up of the Waitemata, Auckland, and Counties Manukau District Health Board (DHB) boundaries, as well as the seven Auckland Territorial Authorities. Thus, for the purposes of this document, the region extends from Rodney District in the north to Franklin district in the south.
It should be noted that this region is not the same as that of the Auckland Regional Council (ARC) as the ARC does not have responsibility for the southern part of Franklin District. Any data that has been defi ned using the ARC boundaries does not cover the entire region of interest. The southern part of Franklin districts is, however, sparsely populated, so any discrepancies arising from the use of different boundaries is not signifi cant.
In the 2001 census 130,221 people, usually living in the region, defi ned themselves as being ethnically Māori. The population was made up of 39,687 in the Waitemata district, 29,139 in the Auckland district, and 61,395 in the Counties Manukau district. After adjusting for the census undercount it is estimated that the Māori population of the three DHBs in 2001 was 146,700. Since 2001 the population has continued to increase. Statistics New Zealand projections based on 2001 census data suggest the Māori population of the same region will be 159,200 by June 2006.
(Please refer to Figures 71 -75, pg.114- pg.125)
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Waitemata DHB
Counties Manukau DHB
Auckland DHB
Rodney District
Franklin District
Manukau City
Waitakere City
Auckland CityNorth Shore City
Papakura District
Auckland City
Orewa
Pukekohe
Waiuku Tuakau
Maraetai
Wellsford
Warkworth
Riverhead
Helensville
Snells Beach
Muriwai Beach
Piha
Huia
Puhoi
Hunua
Naike
Omaha
Leigh
Pakiri
Wainui
Glorit
Awhitu
Mercer
Pokeno
Kaiaua
Claris
Aka Aka
Taupaki
Whatipu
Paerata
Te Hana
Waiwera
Tryphena
Matakana
Waimauku
Whitford
Clevedon
RamaramaKingseat
Waiatarua
Flat Bush
Alfriston
Glenbrook
Paremoremo
Komokoriki
South Head
Dairy Flat
Kaukapakapa
Coatesville
Glen Murray
Orere Point
Port Fitzroy
Happy Valley
Kawakawa Bay
Port Waikato
Mangatawhiri
Te Arai Point
Whangaparapara
Albany Village
Glenbrook Beach
Otara
Massey
Oneroa
Otahuhu
Remuera
Onetangi
Red Hill
Takanini
Takapuna
AvondaleNew Lynn
Birkdale
Henderson
Pakuranga
Devonport
Glen Innes
Papatoetoe
Mount Roskill
0 10 20 30 405KilometresSecondary/Tertiary Hospitals
District Health Board Boundaries
Territorial Authority Boundaries
Motorways and Highways
UrbanAreas
Figure 1: The Auckland Regional Public Health Service Region
Within the region the distribution of people can be further described with respect to smaller areas such as Territorial Authority electoral wards or census area units (CAUs).
9
Manurewa Ward (13.5%)
Massey Ward (5.8%)
Mangere Ward (6.5%)
Penrose Ward (8.7%)
Harbour Ward (4.7%)
Otara Ward (5.2%)
Papatoetoe Ward (5.3%)
0 10 20 30 405
Km
0 2 4 6 81
KilometresMāori Population by Ward
0.4 - 0.8%
0.9 - 1.8%
1.9 - 3.0%
3.1 - 6.4%
6.5 - 13.5%
50% of Region’s Maori Population
Proportion of Total 2001 RegionMaori Population
DHB Boundaries
There are 34 wards in the region and the geographic spread of Māori within the region can be visualised by measuring the proportion of the regions total Māori population living in each ward (figure 2). It can be seen that roughly half of Māori live in seven out of the 34 wards, with the greatest proportion (13.5%) living in Manurewa.
Figure 2: Proportion of Auckland Māori total population per ward, 2001
Source: Statistics New Zealand, Census 2001
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There is also variation in percentage of each wards total population with Māori ethnicity. Overall Māori make up just over 11% of the population. There are 16 wards in which Māori make up a greater proportion than for the region overall (table 1 and fi gure 3).
Table 2: Territorial Local Authority electoral wards with proportion of Māori greater than for the region overall
Ward name Māori population Total population % Māori Red Hill 3405 9930 34.3Manurewa 17535 65721 26.7Ardmore 2580 9939 26.0Onewhero 1848 7161 25.8Drury 1884 9594 19.6Otara 6792 35049 19.4Pukekohe 2826 14667 19.3Mangere 8460 45432 18.6Papatoetoe 6918 39588 17.5Waiuku 1077 7173 15.0Massey 7551 51369 14.7Henderson 5730 40086 14.3Pahurehure 1584 11205 14.1Penrose 11352 82683 13.7Gulf Islands 1011 8268 12.2
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Onewhero Ward (25.8%)
Hauraki Gulf Islands Ward (12
Massey Ward (14.7%)
Mangere Ward (18.6%)
Red Hill Ward (34.3%)
Penrose Ward (13.7%)
Manurewa Ward (26.7%)
Pukekohe Ward (19.3%)
Drury Ward (19.6%)
Ardmore Ward (26%)
Waiuku Ward (15%)
Otara Ward (19.4%)
Henderson Ward (14.3%)
0 7 14 21 283.5Kilometres
0 3 6 9 121.5
Km
Māori Population by WardProportion of Total Ward Population
3.4 - 5.6%
5.7 - 7.6%
7.7 - 11.1%
11.2 - 20%
20.1 - 34%
Auckland regional average 11.1%
DHB Boundaries
Figure 3: Māori as a proportion of total population by ward, 2001
Source: Statistics New Zealand, Census 2001
Population densityAt a finer geographic scale the distribution of Māori can be shown by CAU. Figure 4 shows Māori numbers as a proportion of total population for each area.
12
32%
30%
26%
26%
26%
30%
38%
32%34%
33%
25%
43%
32%
34%
28%
26%
40%
38%
0 10 20 30 405
Km
0 3 6 9 121.5
KilometresMāori Population by CAUProportion of Total Population
0% - 5%
6% - 10%
11% - 16%
17% - 26%
27% - 43%
Auckland regional average 11.1%
DHB Boundaries
Figure 4: Māori as a proportion of CAU population, 2001
Source: Statistics New Zealand, Census 2001
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Auckland Region Average 11.1%
Proportion of CAU Population Māori
0% - 6%
7% - 11%
12% - 19%
20% - 28%
29% - 43%
DHB Boundaries
CAU height represents Maoripopulation density
Matipo
Beachaven North
Burbank
Rowandale
Hyperion
PapakuraEast
Pukekohe North
Mangere South
Aorere
Weymouth
TamakiHelensville
Waiuku
Another useful measure is to calculate the concentration or density of the Māori population (number of people per square kilometre). Figure 39 represents this population density value as a height in a three dimensional map.
Figure 5: Māori population density (persons per square km) 2001
Source: Statistics New Zealand, Census 2001
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Iwi affiliations of Auckland Mäori
Māori living in the Auckland region are affiliated with iwi from throughout the country. The iwi affiliations of people with Māori descent were recorded in the 2001 census. People with a Māori birth parent, grandparent, or great grandparent were asked the name(s) of their iwi and their rohe.
Table 3: Iwi affiliations of people of Māori decent usually living within the Auckland region, 2001
Iwi and Region Number of people*
Te Tai Tokerau/Tamaki Makaurau (Northland/Auckland)Te Tai Tokerau/Tamakimakaurau (Northland/Auckland) Region, not further defined 2,310 Te Aupouri 3,570 Ngäti Kahu 2,784 Ngäti Kurï 2,094 Ngapuhi 42,234 Ngapuhi ki Whäingaroa-Ngäti Kahu ki Whaingaroa 804 Te Rarawa 5,337 Ngäi Takoto 168 Ngäti Wai 1,419 Ngäti Whätua 6,129 Te Kawerau 117 Te Uri-o Hau 291 Te Roroa 312
Hauraki (Coromandel)Hauraki (Coromandel) Region, not further defined 87 Ngäti Hako 213 Ngäti Hei 123 Ngäti Maru (Marutuahu) 762 Ngäti Paoa 1,107 Patukirikiri 24 Ngäti Porou ki Harataunga ki Mataora 147 Ngäti Pukenga ki Waiau 72 Ngäti Rahiri Tumutumu 24 Ngäti Tai 57 Ngäti Tamatera 423 Ngäti Tara Tokanui 51 Ngäti Whānau ngä 171
Waikato/Te Rohe Potae (Waikato/King Country)Waikato/Te Rohe Potae (Waikato/King Country) Region, not further defined 402 Ngäti Haua (Waikato) 696 Ngäti Maniapoto 6,450 Ngäti Raukawa (Waikato) 1,038 Waikato 11,868
Te Arawa/Taupo (Rotorua/Taupo)Te Arawa/Taupo (Rotorua/Taupo) Region, not further defined 2,433
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Ngäti Pikiao (Te Arawa) 840 Ngäti Rangiteaorere (Te Arawa) 36 Ngäti Rangitihi (Te Arawa) 147 Ngäti Rangiwewehi (Te Arawa) 261 Tapuika (Te Arawa) 126 Tarawhai (Te Arawa) 12 Tuhourangi (Te Arawa) 204 Ngäti Uenukukopako (Te Arawa) 51 Waitaha (Te Arawa) 33 Ngäti Whakaue (Te Arawa) 768 Ngäti Tüwharetoa 4,575 Ngäti Tahu (Te Arawa) 144
Tauranga Moana/Mataatua (Bay of Plenty)Tauranga Moana/Mataatua (Bay of Plenty) Region, not further defined 126 Ngäti Pukenga 261 Ngäiterangi 1,770 Ngäti Ranginui 969 Ngäti Awa 2,688 Ngäti Manawa 189 Ngäi Tai 423 Tuhoe 4,977 Whakatohea 1,791 Whānau -A-Apanui 1,671 Ngäti Whare 87
Te Tairawhiti (East Coast)Te Tairawhiti (East Coast) Region, not further defined 381 Ngäti Porou 10,794 Te Aitanga-A-Mahaki 480 Rongowhakaata 411 Ngäi Tämanuhiri 78
Te Matau a Maui/Wairarapa (Hawke’s Bay/Wairarapa)Te Matau a Maui/Wairarapa (Hawke’s Bay/Wairarapa) Region, not further defined 120 Rongomaiwahine (Te Mahia) 180 Ngäti Kahungunu ki Te Wairoa 1,836 Ngäti Kahungunu ki Heretaunga 675 Ngäti Kahungunu ki Wairarapa 492 Ngäti Kahungunu, region unspecified 2,916 Rangitane (Te Matau a Maui/Hawke’s Bay/Wairarapa) 90 Ngäti Kahungunu ki Whanganui a Orotu 174 Ngäti Kahungunu ki Tamatea 54 Ngäti Kahungunu ki Tamakinui a Rua 18
TaranakiTaranaki Region, not further defined 51 Te Atiawa (Taranaki) 1,536 Ngäti Maru (Taranaki) 120 Ngäti Mutunga (Taranaki) 159 Ngä Rauru 396 Ngä Ruahine 384
16
Ngäti Ruanui 918 Ngäti Tama (Taranaki) 105 Taranaki 1,071 Tangahoe 33 Pakakohi 30
Whanganui/Rangitikei (Wanganui/Rangitikei)Whanganui/Rangitikei (Wanganui/Rangitikei) Region, not further defined 6 Ngäti Apa (Rangitïkei) 126 Te Äti Hau Nui-A-Papaarangi 942 Ngäti Haua (Taumarunui) 144 Ngäti Hauiti 99
Manawatu/Horowhenua/Te Whanganui a Tara(Manawatu/Horowhenua/Wellington)Manawatu/Horowhenua/Te Whanganui a Tara(Manawatu/Horowhenua/Wellington) Region, not further defined 105 Te Atiawa (Te Whanganui a Tara/Wellington) 135 Muaupoko 141 Rangitane (Manawatü) 72 Ngäti Raukawa (Horowhenua/Manawatü) 1,278 Ngäti ToaraNgätira (Te Whanganui a Tara/Wellington) 285 Te Atiawa ki Whakarongotai 24
Te Waipounamu/Wharekauri (South Island/Chatham Islands)Te Waipounamu/Wharekauri (South Island/Chatham Islands) Region, not further defined 183 Te Atiawa (Te Waipounamu/South Island) 123 Ngäti Koata 84 Ngäti Kuia 87 Käti Mamoe 171 Moriori 87 Ngäti Mutunga (Wharekauri/Chatham Islands) 75 Rangitane (Te Waipounamu/South Island) 54 Ngäti Rarua 60 Käi Tahu 4,197 Ngäti Tama (Te Waipounamu/South Island) 48 Ngäti ToaraNgätira (Te Waipounamu/South Island) 18 Waitaha (Te Waipounamu/South Island) 60 Ngäti Apa ki te Waipounamu 27
Iwi Not Named, but Waka or Iwi Confederation KnownTainui 4,269 Te Arawa 3,492 Takitimu 21 Aotea 36 Mataatua 180 Mahuru - Mamari - Ngatokimatawhaorua - Nukutere - Tokomaru 18 Kurahaupo 3
17
Muriwhenua 30 Hauraki / Pare Hauraki 297 Turanganui a Kiwa 3 Te Tauihu o Te Waka a Maui 9 Tauranga Moana 279 Horouta -
Iwi Named but Region Unspecifi edTe Ätiawa, region unspecifi ed 585 Ngäti Haua, region unspecifi ed 405 Ngäti Maru, region unspecifi ed 456 Ngäti Mutunga, region unspecifi ed 81 Rangitane, region unspecifi ed 138 Ngäti Raukawa, region unspecifi ed 1,239 Ngäti Tama, region unspecifi ed 69 Ngäti Toa, region unspecifi ed 162 Waitaha, region unspecifi ed 60 Ngäti Apa, region unspecifi ed 72
Hapü Affi liated to More Than One Iwi 3,162 Don’t Know 30,570 Not Elsewhere Included(2) 9,693
Total People 149,082
Source: Statistics NZ census 2001
* Note: people are counted for each iwi group to which they belong
About 20% (30,570/149,082) of Auckland people with Māori decent stated they did not know which iwi or Rohe they belonged to.
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Projected population trends
Statistics New Zealand has produced population projections (based on 2001 census data) for different ethnic groups at the Territorial Authority level. These projections are subject to a number of qualifications. For example, the breakdown by ethnicity is on a total response basis. In other words persons with more than one ethnicity are counted in each ethnic group.
According to medium projections the Māori population is expected to increase from 156,100 in 2006 to 180,800 by 2016. Despite this growth the proportion of the region’s population with Māori ethnicity is expected to stay fairly constant at around 12%. This is because of projected changes to other ethnic group populations during the same period.
Within Auckland the greatest increases in absolute numbers are projected to occur in Manukau city and in Rodney district in relative terms (Table 4).
Table 4: Māori ethnic group population changes between 2001 and 2016 by Territorial Authority
Territorial Local Authority pop increase % increaseRodney District 2900 41North Shore City 3400 25Waitakere City 7700 32Auckland City 5200 16Manukau City 13200 27Papakura District 3400 33Franklin District 1800 21
Source: percentages calculated from data supplied by Statistics NZ (medium series projection 2001-base)
Age distribution
Māori have a relatively young population. The 2001 age structure of the Māori population in each of the region’s DHB areas is shown in figures 6 through 8. Of particular note is that there are only very small numbers of people who are older adults (65 years and over). Nationally, only 3.37% of the Māori population are older adults.
The graphs describing the age distribution DHB figures are constructed using the same scale. This enables the population pyramids to be compared. Apart from the greater population numbers for Counties Manukau it is clear there are also differences in age structure. Counties Manukau has a greater proportion of the population under 15 whereas Auckland DHB has a ‘bulge’ in the 20 to 29 age group.
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5000 4000 3000 2000 1000 0 1000 2000 3000 4000 5000
under 5
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
90-94
Ag
e
Population (number)Female Male
5000 4000 3000 2000 1000 0 1000 2000 3000 4000 5000
under 5
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
90-94
Ag
e
Population (numbers)Female Male
Figure 6: Māori population pyramid by age and sex for Waitemata DHB, 2001
Figure 7: Māori population pyramid by age and sex for Auckland DHB
20
>
5000 4000 3000 2000 1000 0 1000 2000 3000 4000 5000
under 5
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
90-94A
ge
Population (numbers)Female Male
Figure 8: Māori population pyramid by age and sex for Counties Manukau DHB
These differences will impact on the age structures of each DHB as the population grows. Expected changes to the age structure of each DHB are shown in figures 9, 10 and 11. Each DHB is expected to have lower proportions of Māori under 15 and 15 to 39 years. In contrast, the proportion of the Māori population in the 40 to 64 and over 65 age groups will increase. These changes are, however, projected to be more marked in the Auckland DHB.
Source: graphs based on population estimates for 2001 provided by Statistics NZ
21
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Under 15 15-39 40-64 65+age group
% o
f Mao
ri po
pula
tion
2001 2006 2011 2016
2001 2006 2011 2016
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Under 15 15-39 40-64 65+age group
% o
f Mao
ri po
pula
tion
Figure 9: Projected Māori population for Waitemata DHB by age group (medium series)
Figure 10: Projected population for Auckland DHB Māori by age group (medium series)22
2001 2006 2011 2016
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Under 15 15-39 40-64 65+age group
% o
f Mao
ri po
pula
tion
Figure 11: Projected Māori population for Counties Manukau DHB (medium series)
Source: graphs based on proportions calculated from data supplied by Statistics NZ. (DHB population aggregated from Territorial Authority estimates) 23
