Why were New Zealand levels of life-expectation so high at the dawn of the twentieth century?

With population ageing becoming an issue of major importance for societies in the developed countries, in both the scientific and policy communities there is widespread interest in the determinants of these structural changes. The focus has been on declines in fertility, arguably the major causal factor, but increasingly analyses are turning to the other major determinant, improving survivorship. This paper relates to this aspect of ageing but not to fertility per se

A cohort history of mortality in New Zealand

This paper uses the generational life tables to track historical mortality experience for New Zealand Pakeha and Māori. The key research questions we seek to explore concern with why was Pakeha life expectation so high so early, and why did this survival advantage disappeared by the mid 20th century and what has happened since? For the Māori population what was the impact of contact on Māori mortality, what were the changes that have occurred and why, and what has happened to Māori mortality recently? A key finding from the cohort mortality analysis is that gains in survivorship have momentum effects that propel this advantage forward as survivors move up through the age-groups. That said, however, periods of gain may be followed later by cohort deterioration occurring among the same generations later in their life cycle, and even by further cycles of reprise and deterioration. These cycles of gain, deterioration, reprise etc are more evident for males, and particularly for Māori. Policy implications of these findings are discussed

Differential trends in the compression of mortality: Assessing the antecedents to current gaps in health expectancy in New Zealand

Health Expectancies (HEs) for New Zealand show significant differentials between Maori and non-Maori, but also by gender and period. These differentials correlate with findings from both generation and synthetic life-tables relating to New Zealand’s epidemiologic transition. At the beginning of that transition quartile 1 (Q(1)), and Median (Med) d(x) values were close and centred at young ages; during the transition the gap became very wide; at the transition’s end the gap again narrowed. Cohort and synthetic trends in d(x), l(x), M, Qs and Meds are reviewed and linked to recent HEs. Data point to epidemic polarisation. Cohort analysis allows the evaluation of the role of past experiences on the recent HEs, and thus point to possible strategies for reducing gaps in both d(x), and HEs

Population Ageing and Government Health Expenditures in New Zealand, 1951-2051

The paper uses a simulation model to assess the effects of population ageing on government health expenditures in New Zealand. Population ageing is defined to include disability trends and “distance to death”; government health expenditures are defined to include both acute and long-term care. The model results suggest that population ageing is associated with a large increase in expenditure share of people aged 65 and over, which rises from about 29% of total government health expenditure in 1951 to 63% in 2051. Analysis of demographic and health trends over the period 1951 to 2002 suggests, however, that these trends account for only a small proportion of the total growth in health expenditure. Most expenditure growth is attributable to other factors, such as an expansion in the range of treatments provided, and increases in input prices such as wages. Growth in this non-demographic component of health expenditures has reached 3-4% per year over recent years. Projection results for the period 2002 to 2051 suggest that restraining government expenditure on health to 6-12% of GDP would require long-run growth rates for the non-demographic component of health expenditure that are significantly lower than current rates. In other words, future demographic changes may be less threatening than is often assumed, but it would still not be possible to maintain current growth rates for government health expenditure and avoid substantial increases in the ratio between expenditure and GDP.Fiscal projections; Government health expenditure; Health status; New Zealand

Restructuring and hospital care: Sub-national trends, differentials, and their impacts; New Zealand from 1981

An analysis of the "nation's health" is the central concern of this study. Its genesis was a detailed, technical, time-series research on regional and ethnic differentials in health in New Zealand. But as this work progressed it became increasingly evident that the results of this more narrow analysis could make a wider contribution to the development of a knowledge-base on health trends and on the impacts of policy on these. In a sense, the analysis provides a demographic audit of health trends over the last two decades. The focus here is different from that in most other studies on restructuring of the New Zealand health system as their concern was either to review in detail the rewriting of policy per se, and attendant structural and institutional changes (Fougere 2001), or to identify how these changes relate to changes in mortality (Blakely et al. 2008). The research question reported here was, instead, to analyse the most crucial of health outcomes, „how long we live and how often we end up in hospital‟, identified in the earlier quotation, to report patterns and trends in hospital use nationally and sub-nationally over the period under review, and to determine the degrees to which various sub-populations benefited, or did not benefit, from these changes. The analysis focuses on the hospital sector in the system, but it will also show relations between this and other sectors, formal (e.g. primary health) and less formal (notably the healthcare afforded sickness and invalid beneficiaries). Thus two questions are addressed: 1. whether or not the nation‟s population health improved over the period and; 2. whether or not there was a convergence in patterns of health gain across its constituent sub-populations defined geographically and ethnically. This monograph deals with sub-national differences in health in New Zealand over a period of substantial socio-economic restructuring and associated radical changes in health policy, health systems and their related information systems (see also, Text Appendix A). It complements the recently published analysis of national ethnic trends in mortality (Blakely et al. 2004), but differs in several critical respects. That study reviewed health status by emphasising aetiologies and causes of death. In contrast, the present analysis focuses on actuarial dimensions of both mortality and morbidity and on health as measured by functional capacity rather than the disease orientated „burden of disease‟. It goes beyond health status issues to look at the system itself, to assess whether health policy outcomes were generated more through efficiency-gain (economic or service delivery, such as those resulting in a convergence sub-nationally of supply and demand effects), or through health gains, or ideally, by both. To do this, and as a by-product to analyse changes in health status and the system in an era of restructuring, innovative methodologies and composite time-series indices combining the two dimensions of a „nation‟s health‟, needing hospital care and longevity, have had to be custom-designed. To achieve this objective, the ensuing analysis is often technical, and may introduce concepts that are unfamiliar to some readers. In order to look at possible inequalities of outcome, comparisons were made between regions and ethnic groups, as well as age-groups and genders, and as a result, in places the analysis becomes rather complex

Monitoring health inequalities: life expectancy and small area deprivation in New Zealand

BACKGROUND: Socioeconomic and ethnic inequalities in health are of great concern, and life expectancy provides a readily understood means of monitoring such inequalities. The objectives of this study are to (1) measure life expectancy by socioeconomic deprivation and ethnicity, and (2) describe trends in the deprivation gradient in life expectancy since the mid-1990s. METHODS: Three years of national mortality data have been combined with mid-point population denominators to produce life tables within nationally determined levels of small area deprivation (NZDep96) for three ethnic group: European, Mäori and Pacific peoples. This process has been repeated for the periods 1995–97, 1996–98, 1997–99 and 1998–2000. RESULTS: There was a strong relationship between increasing small area deprivation and decreasing life expectancy. Through the mid- to late 1990s, males living in the most deprived small areas in New Zealand experienced life expectancies at birth approximately nine years less than their counterparts living in the least deprived areas; for females the corresponding difference was under seven years. Mäori and Pacific life expectancies at birth were lower than those of Europeans at each level of deprivation. Over the study period (1995–2000) the gradient in life expectancy across deprivation deciles remained stable. CONCLUSION: Small area deprivation analyses of life expectancy could be repeated routinely at regular intervals, which would provide a useful approach to monitoring trends in socioeconomic, geographic, ethnic and gender inequalities in mortality

Mortality, morbidity and population health dynamics

This thesis is concerned with the dynamics of the health of populations with low levels of mortality, using the non-Maori population in New Zealand as a case study. The primary objective is to study patterns and trends in mortality and morbidity, their interactions, and their implications for the future. The key questions addressed in this thesis are central to the future evolution of population health. Given the significant declines in mortality, especially those at older ages that have occurred over the last two decades, will mortality declines at advanced ages continue much longer? Or will mortality become increasingly compressed into a narrow range of ages at death? Moreover, what are the implications for morbidity trends and any indications at present of future trends in population health? Will increased survivorship be accompanied by long periods in ill-health, or will morbidity move in tandem with mortality, or will durations surviving but in ill-health actually decrease? The thesis first establishes a theoretical platform by reviewing and synthesising transition theories and empirical observations into a general framework to guide the understanding of population health dynamics. It also forges a theoretical linkage between variations in the individual senescence process, which underpin the validity of demographic models of mortality and morbidity, and their population level manifestations. These theoretical extensions provide the context for an evaluation of contemporary theories on mortality trends and changes in morbidity in relation to mortality. In addition to using long term historical data spanning over a century and complemented by a population-based true cohort approach, this thesis also makes methodological advancements by adapting and developing a tool, known as health expectancy, for the analysis of population health. In particular, a new measure termed “hospitalisation expectancy” is developed. It integrates data on hospital utilisation and mortality to yield a summary measure of population health. The empirical study documents the shift in the forces of mortality of non-Maori, from younger to older ages, and from communicable causes of death to chronic degenerative diseases. Results of the mortality analysis by cohorts show that while there may be some indications of a future trend towards mortality compression, further increases in life expectancy at birth can be realistically expected. Empirical evidence of compression of morbidity is found in the trends of hospitalisation and the patterns of severe forms of disability. The causes of morbidity are becoming more diversified, dominated by non-lethal conditions; whereas the causes of mortality are becoming increasingly compressed into a few chronic conditions, namely cancers and cardiovascular diseases. It is also established in this thesis that the older population represents a heterogeneous group in terms of levels of susceptibility to ill-health. An empirical method for identifying heterogeneity is developed to show non-Maori inter-cohort differences in this property. Later in the thesis, a cohort based mortality projection of non-Maori at adult ages is undertaken. Various scenarios of morbidity responses to the projected mortality changes, incorporating the leading theories on future morbidity changes, are then modelled. To conclude the thesis, the implications for policy of further mortality declines at older age among an increasingly heterogeneous population are discussed

Population Ageing and Government Health Expenditures in New Zealand, 1951-2051

The paper uses a simulation model to assess the effects of population ageing on government health expenditures in New Zealand. Population ageing is defined to include disability trends and "distance to death"; government health expenditures are defined to include both acute and long-term care. The model results suggest that population ageing is associated with a large increase in expenditure share of people aged 65 and over, which rises from about 29% of total government health expenditure in 1951 to 63% in 2051. Analysis of demographic and health trends over the period 1951 to 2002 suggests, however, that these trends account for only a small proportion of the total growth in health expenditure. Most expenditure growth is attributable to other factors, such as an expansion in the range of treatments provided, and increases in input prices such as wages. Growth in this non-demographic component of health expenditures has reached 3-4% per year over recent years. Projection results for the period 2002 to 2051 suggest that restraining government expenditure on health to 6-12% of GDP would require long-run growth rates for the non-demographic component of health expenditure that are significantly lower than current rates. In other words, future demographic changes may be less threatening than is often assumed, but it would still not be possible to maintain current growth rates for government health expenditure and avoid substantial increases in the ratio between expenditure and GDP