Has Mortality Become Geographically Polarised in New Zealand? A Case Study: 1981-2000 (2006)
AuthorsTisch, Catherine Francesshow all
In the New Zealand context, considerable academic and government attention has been given to the socioeconomic and ethnic disparities in health, and how they have evolved over time. Despite evidence of clear regional health patterning within New Zealand, there has been very little research monitoring how the geographical trends in health have evolved over time. The period 1980 to 2001 is very important in New Zealand's contemporary history, as it was a time of rapid social and economic change. For this reason, researchers are motivated to examine the extent to which health differentials evolved during the same period. The reduction of health inequalities are at the top of the Government's health agenda, it is therefore important not only to monitor the success, or otherwise, of a reduction in social inequalities, but also, geographic inequalities. This thesis examines the extent of geographic inequalities in mortality in contemporary New Zealand, and whether or not mortality has become geographically polarised between 1981 and 2000. This thesis builds on research carried out in New Zealand, and seeks to delve deeper into the specifics of the geographic variation of mortality. Importantly, it fills several knowledge gaps during this period, which include: the geographic inequality of cause-specific mortality, the difference in regional cause-specific mortality between males and females, and the inequalities of mortality at a finer geographic resolution. A significant debate revolves around the relative contribution of compositional and contextual explanations for the geographic variation of health outcomes. The research undertaken in this thesis examines the contribution of population change and deprivation to the geographic inequalities of mortality. Numerous key findings were identified in this research, four of which are as follows: In 2000, significant geographic inequalities in cause-specific mortality existed within New Zealand; between 1981 and 2000 the geographic mortality gap remained relatively stable; and when the geographic areas are sorted by deprivation, the results indicate that there has been a widening of the mortality gap. Analysis of the relationship between population change and mortality provide cautious support for the finding that mortality rates are higher in areas that have experienced population decline and conversely, that mortality rates are lower in areas where there has been a growth in population. The high and stable levels of geographic inequality should be of great concern to policy makers as the results of this research indicate that policies addressing health inequalities in New Zealand are not sufficiently potent.