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 2019 Canterbury Wellbeing Survey, more than eight-out-of-ten greater Christchurch respondents reported that their health was good, very good or excellent - unchanged from 2018. Year 10 students’ smoking in Canterbury and New Zealand has been in steady decline since the early 2000s. However, the 2019 result of 1.8 percent (the proportion of Canterbury DHB region Year 10 students who smoke every day) suggests a possible upswing in youth smoking in Canterbury (up from 1.2% in 2018). In addition, the proportion of Year 10 students in the Canterbury DHB region who vape every day has increased statistically significantly from 1.1 percent in 2015 to 2.2 percent in 2019. Further data points are required to ascertain any ongoing trends in youth smoking and vaping in Canterbury.
The five indicators sourced from the 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 2017/18 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 four years and is similar to New Zealand overall: about half of respondents report 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 a level that may be considered hazardous. Within the Canterbury DHB region, and for New Zealand overall, between approximately one-out-of-four and three-out-of-ten respondents reported some form of unmet need for primary care (on average; in a typical 12-month period) over the last seven years.
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 in line with the New Zealand rate over the last ten years but remains approximately 30 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 nine 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 2019 Canterbury Wellbeing Survey (84.8%), a higher proportion of Europeans (85.0%) reported good, very good or excellent health compared with Māori (83.2%) and Pacific/Asian/Indian (80.7%) 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 events such as the Canterbury earthquakes and Christchurch mosque attacks of March 2019 being important factors in the picture in Canterbury.
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