Good health is crucial to the wellbeing of individuals, their families, and their communities. By keeping healthy, people are more able to lead rich and rewarding lives. People who are less healthy may find it more difficult to participate in sports and recreation, or arts and cultural activities, or simply to complete the tasks of daily living. They may also struggle to socialise with their family, friends and community .
Health and wellbeing are strongly influenced by a wide range of factors, both within and beyond the health system. Factors largely beyond the health system include environmental, social, and person-centred factors, many of which are reflected across the domains of the Canterbury Wellbeing Index [2-5].
Health is considered in this domain in terms of health status (self-reported health, acute medical admission rates, and proportion of the population accessing mental health services) and a number of factors that influence health status. The latter includes both behavioural factors (smoking, obesity, physical activity, and hazardous drinking) and health system factors (access to primary health care).
Key trends within health
There are ten indicators reported within this domain, and together, these indicators suggest a mixed pattern of effects on the wellbeing of greater Christchurch residents.
Self-rated health allows people to weigh up the different aspects of health that they consider most important. In the 2018 Canterbury Wellbeing Survey, eight-out-of-ten greater Christchurch respondents reported that their health was good, very good or excellent - unchanged from 2017. Year 10 students’ smoking continues to be in steady decline and the current result of 1.2% (the proportion of Canterbury DHB region Year 10 students who smoke every day) is low by both New Zealand and international standards.
The five indicators sourced from the adult New Zealand Health Survey (smoking, obesity, physical activity, hazardous drinking, and unmet need for primary care) all show a pattern for the Canterbury DHB region that is similar to New Zealand overall. The prevalence of adult smoking in the Canterbury DHB region continues to be in gradual decline, broadly consistent with the pattern for New Zealand overall. Adult obesity in the Canterbury DHB region is steadily increasing. In 2016/17 approximately three-out-of-ten Canterbury respondents were obese. The proportion of Canterbury DHB region respondents indicating that they are physically active has not changed over the last three to four years, and is similar to New Zealand overall: about half of the adult population reports at least 150 minutes of moderate-intensity or equivalent physical activity per week. The proportion reporting drinking alcohol at hazardous levels in the Canterbury DHB region also appears to be similar to New Zealand overall. One-out-of-five respondents in Canterbury and New Zealand drinks alcohol at levels that may be considered hazardous. Within the Canterbury DHB region, and for New Zealand overall, approximately one-in-four respondents reported some form of unmet need for primary care (on average; in a typical 12 month period) over the last five time-points for the New Zealand Health Survey.
The age-standardised rate of acute medical admissions is lower in the Canterbury DHB region than in New Zealand overall. Canterbury DHB’s rate has increased slightly faster than the New Zealand rate over the last ten years but remains approximately 25 percent lower than the rate for New Zealand overall. Finally, the proportion of the overall population accessing mental health services (combined Non-Government Organisations, primary mental health, and specialist mental health services) in the Canterbury DHB region has increased substantially over the last eight years. The picture varies by age group, with both a larger proportion accessing services and a greater rate of increase in this proportion for those aged 20 to 64 years.
Key equity issues within health
It is well known that both health status and access to the factors that support or promote health, are unevenly distributed within the population. Some population groups, (for example, on the basis of ethnicity or socioeconomic deprivation) are disproportionately affected by reduced access to health determinants and by health system factors that influence the accessibility and quality of care [6,7].
While the majority of greater Christchurch respondents reported good, very good or excellent self-rated health in the 2018 Canterbury Wellbeing Survey (approximately eight-out-of-ten), a higher proportion of Europeans (83.6%) reported better health compared with Māori (77.2%) and Pacific/Asian/Indian (71.6%) respondents.
In the Canterbury DHB region, the smoking prevalence for both Māori and Pacific respondents across the New Zealand Health Surveys from 2014 to 2017 is substantially higher than for all respondents (39.4% and 36.5%, respectively, compared with 15.2%).
Adult obesity is also unevenly distributed within the Canterbury DHB population. Across the 2014 to 2017 New Zealand Health Surveys, the prevalence of adult obesity was highest for Pacific respondents (63.4%); higher for Māori respondents (45.6%) and lowest for Asian respondents (11.2%); compared with all respondents in the Canterbury DHB region (26.6%).
Approximately two-in-five Māori respondents (36.3%) and a similar proportion of Pacific respondents (39.4%) in the Canterbury DHB region indicated an unmet need for primary health care during the period 2014 to 2017 (compared with 24.6% for all Canterbury respondents and 15.6% for Asian respondents). Adult respondents living in the most socioeconomically deprived neighbourhoods had statistically significantly higher rates of unmet need for primary health care compared with those living in the least deprived neighbourhoods.
There is an increasing proportion of the population in the Canterbury DHB region accessing mental health services, and the proportions differ between Māori, Pacific, and the overall (total) Canterbury DHB population. Among those aged 0 to 19 years, service utilisation by Māori is above the total population level, and by Pacific is below. Among those aged 20 to 64 years, the most notable difference is the higher access rates for Māori compared with the total Canterbury DHB population, with Pacific being similar to the total Canterbury DHB population. The data do not provide insight as to what extent the differences by ethnic group are driven by disease burden and/or by other factors, such as service provision, affecting access. However, the higher proportion of Māori in Canterbury accessing services suggests that this population has a greater burden of mental health disorder, compared to the total Canterbury DHB population. National data also show that Pacific people have both a greater burden of mental illness than the general population and low access to services relative to need.
What this means for wellbeing
The health indicators for greater Christchurch present a mixed picture and most results are similar to those for New Zealand overall. Many of the results are not supportive of individual and community wellbeing (for example obesity, physical activity, and hazardous drinking). In addition, the indicator breakdowns demonstrate persisting inequities for some population groups.
The relationship between the health indicators and wellbeing is complex. Two important examples are acute medical admissions and access to mental health care services. The overall relationship between increasing rates of acute medical admissions and the wellbeing of the Canterbury DHB population is unclear. While improved access to health care may support improved wellbeing, increased service utilisation may also represent a deterioration in the health and wellbeing status of the population. Acute medical admissions are likely to be amenable to addressing the wider factors that influence health and by the provision of good care in the community . Receiving care in the community that results in avoiding hospital admission is a positive outcome for most people. Lower admission rates are achieved through positive influences on the determinants of health or the provision of good community health care.
The relationship between increased mental health service access and wellbeing is similarly complex. It is relatively common for a person to experience mental health problems at some time in their life, and timely and equitable access to health care services is important for good health and wellbeing. However, increased mental health service access may reflect an increase in mental health burden in the population, with the initial and ongoing impacts of the Canterbury earthquakes being an important factor in the picture in Canterbury.
- Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P (2012) WHO European review of social determinants of health and the health divide. Lancet 380: 1011-1029.
- Keefe V, Reid P, Ormsby C, Robson B, Purdie G, et al. (2002) Serious health events following involuntary job loss in New Zealand meat processing workers. International Journal of Epidemiology 31: 1155-1161.
- Howden-Chapman P, Matheson A, Crane J, Viggers H, Cunningham M, et al. (2007) Effect of insulating existing houses on health inequality: cluster randomised study in the community. BMJ 334: 460.
- Ross CE, Wu C-l (1995) The Links Between Education and Health. American Sociological Review 60: 719-745.
- McKee-Ryan F, Song Z, Wanberg CR, Kinicki AJ (2005) Psychological and physical well-being during unemployment: a meta-analytic study. J Appl Psychol 90: 53-76.
- Cormack DM, Harris RB, Stanley J (2014) Investigating the Relationship between Socially-Assigned Ethnicity, Racial Discrimination and Health Advantage in New Zealand. PLoS ONE 8: e84039.
- Robson B, Harris R (2007) Hauora: Màori Standards of Health IV. A study of the years 2000–2005; Robson B, Harris R, editors. Wellington: Te Ròpù Rangahau Hauora a Eru Pòmare.
- Hider P (1998) Acute medical admissions: a critical appraisal of the literature. New Zealand Health Technology Assessment Clearing House.
- Peter M. Fayers, Hays RD, editors (2005) Assessing Quality of Life in Clinical Trials: Methods and Practice. 2 ed. Oxford: UK: Oxford University Press. 467 p.
- Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38: 21-37.
- CDHB (2017) Canterbury Wellbeing Survey, June 2017: Report prepared by Nielsen for the Canterbury District Health Board and partnering agencies. Christchurch: Canterbury District Health Board.
- Health Promotion Agency (2016) Smokefree facts and figures. Retrieved from www.smokefree.org.nz/smoking-its-effects/facts-figures
- Ministry of Health (2017) Annual Update of Key Results 2016/17: New Zealand Health Survey. Wellington: Ministry of Health.
- National Center for Chronic Disease Prevention and Health Promotion (US) (2014) The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Patterns of Tobacco Use Among U.S. Youth, Young Adults, and Adults. Atlanta (GA): Office on Smoking and Health, Centers for Disease Control and Prevention (US).
- U.S. Department of Health and Human Services (USDHHS) (1994) A report of the Surgeon General: Preventing tobacco use among young people. Atlanta, GA: Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
- U.S. Department of Health and Human Services (USDHHS) (2012) Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US).
- Ministry of Health (2013) Health Loss in New Zealand: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study, 2006–2016. Wellington: Ministry of Health.
- Banks E, Joshy G, Weber MF, Liu B, Grenfell R, et al. (2015) Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Medicine 13: 38.
- World Health Organization (2008) WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva: WHO.
- Ministry of Health (2018) Regional Data Explorer 2014–17: New Zealand Health Survey [Data File].
- Ministry of Health (2017) Methodology Report 2016/17: New Zealand Health Survey. Wellington: Ministry of Health.
- WHO (2007) Global Database on Body Mass Index. Geneva: World Health Organization.
- Ministry of Health (2017) Clinical Guidelines for Weight Management in New Zealand Adults. Wellington: Ministry of Health, Clinical Trials Research Unit.
- Ministry of Health (2018) Obesity. Retrieved from www.health.govt.nz/our-work/diseases-and-conditions/obesity
- Ministry of Health (2016) Annual Update of Key Results 2015/16: New Zealand Health Survey. Wellington: Ministry of Health.
- Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, et al. (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378: 804-814.
- Drewnowski A (2009) Obesity, diets, and social inequalities. Nutr Rev 67 Suppl 1: S36-39.
- Physical Activity Guidelines Advisory Committee (2018) 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services.
- McLean G, Tobias M (2004) The New Zealand Physical Activity Questionnaire: Report on the validation of the NZPAQ-long and NZPAQ-short form physical activity questionnaires. Wellington: Sport and Recreation New Zealand.
- Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, et al. (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35: 1381-1395.
- Ministry of Health (2017) Annual Data Explorer 2016/17: New Zealand Health Survey [Data File].
- Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG, World Health Organization (2001) AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care. Geneva: World Health Organization.
- Ministry of Health (2013) Hazardous drinking in 2011/12: Findings from the New Zealand Health Survey. Retrieved from www.moh.govt.nz/NoteBook/nbbooks.nsf/0/81BF301BDCF63B94CC257B6C006ED8EC/$file/12-findings-from-the-new-zealand-health-survey.pdf
- Braillon A, Dubois G (2005) Alcohol and public health. Lancet 365: 1387.
- Health Promotion Agency (2016) Alcohol – the Body and Health Effects: A brief overview. Wellington: Health Promotion Agency.
- GBD 2016 Alcohol Collaborators (2018) Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 392: 1015-1035.
- Connor J, Broad J, Rehm J, Vander Hoorn S, Jackson R (2005) The burden of death, disease, and disability due to alcohol in New Zealand. NZ Med J 118: U1412.
- Hall JJ, Taylor R (2003) Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries. Med J Aust 178: 17-20.
- Winnard D, Crampton P, Cumming J, Sheridan N, Neuwelt P, et al. (2008) Population Health – Meaning in Aotearoa New Zealand? A discussion paper to support implementation of the Primary Health Care Strategy. Auckland: Auckland Regional Public Health Service.
- Neuwelt P, Matheson D, Arroll B, Dowell A, Winnard D, et al. (2009) Putting population health into practice through primary health care. NZ Med J 122: 98-104.
- Schluter PJ, Hamilton GJ, Deely JM, Ardagh MW (2016) Impact of integrated health system changes, accelerated due to an earthquake, on emergency department attendances and acute admissions: a Bayesian change-point analysis. BMJ Open 6: e010709.
- Galenkamp H, Deeg DJH, de Jongh RT, Kardaun JWPF, Huisman M (2016) Trend study on the association between hospital admissions and the health of Dutch older adults (1995–2009). BMJ Open 6: e011967.
- Canning UP, Kennell-Webb SA, Marshall EJ, Wessely SC, Peters TJ (1999) Substance misuse in acute general medical admissions. QJM: An International Journal of Medicine 92: 319-326.
- Kessler RC, Angermeyer M, Anthony JC, R DEG, Demyttenaere K, et al. (2007) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6: 168-176.
- Ministry of Health (2017) Office of the Director of Mental Health Annual Report 2016. Wellington: Ministry of Health.
- Ministry of Health (2018) PRIMHD: Mental health data. Retrieved from www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections/primhd-mental-health-data
- Oakley Browne MA (2006) Lifetime prevalence and lifetime risk of DSM-IV disorders. In: Oakley Browne MA, Wells JE, Scott KM, editors. Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry of Health.
- Kessler RC, Foster CL, Saunders WB, Stang PE (1995) Social consequences of psychiatric disorders, I: Educational attainment. American Journal of Psychiatry 152: 1026–1032.
- The Mental Health Commission (1998) Blueprint for Mental Health services in New Zealand. How things need to be. Wellington: The Mental Health Commission.
- The Mental Health Commission (2012) Blueprint II Improving mental health and wellbeing for all New Zealanders. How things need to be. Wellington: The Mental Health Commission.
- Cerdá M, Tracy M, Galea S (2011) A prospective population based study of changes in alcohol use and binge drinking after a mass traumatic event. Drug & Alcohol Dependence 115: 1-8.
- Fergusson DM, Horwood J, Boden JM, Mulder RT (2014) Impact of a Major Disaster on the Mental Health of a Well-Studied Cohort. JAMA Psychiatry 71: 1025-1031.
- Galea S, Nandi A, Vlahov D (2005) The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev 27: 78-91.
- Gluckman P (2011) The psychological consequences of the Canterbury earthquakes. Wellington: Office of the Prime Minister’s Science Advisory Committee.
- Kessler RC, McLaughlin KA, Koenen KC, Petukhova M, Hill ED, et al. (2012) The importance of secondary trauma exposure for post-disaster mental disorder. Epidemiology and Psychiatric Sciences 21: 35-45.
- Lock S, Rubin GJ, Murray V, Rogers MB, Amlot R, et al. (2012) Secondary stressors and extreme events and disasters: a systematic review of primary research from 2010-2011. PLoS Curr 4.