Tupu Ola Moui Volume 4: Health System – Part One

Introduction

This report is part of the Tupu Ola Moui: Pacific Health Chart Book series, which provides comprehensive and up-to-date data on the health of Pacific peoples in Aotearoa New Zealand.

Designed as a clear and accessible resource, this series offers straightforward descriptions of key health data to enable users to further analyse and interpret their implications. The Tupu Ola Mouiseries serves as a foundational reference point for understanding the current state of Pacific health.

This volume of the Chart Book series relates to Te Mana Ola: The Pacific Health Strategy:

• priority area 2: Te pāruru’anga, te apii’anga, e te akateretere’anga no te ora’anga meitaki – Disease prevention, health promotion and management for good health, and
• priority area 4: Haitiaaga moui malolo – Access.

These priority areas focus on ‘prioritising disease prevention, health promotion and good health and wellbeing throughout the life course and ensuring that timely, high-quality services are reaching Pacific peoples, wherever they live’.

The other reports in this series are:

• Tupu Ola Moui Volume 1: Pacific Population in New Zealand
• Tupu Ola Moui Volume 2: Pacific Health Workforce
• Tupu Ola Moui Volume 3: Healthier Environments
• Tupu Ola Moui Volume 5: Health System – Part Two

Glossary

Ambulatory sensitive hospitalisations

Hospitalisations relating to potentially preventable conditions through interventions delivered in the primary health care setting.

Amenable mortality

A collective term for deaths that could have been avoided through effective and timely health care.

Body mass index (BMI)

A numerical value calculated from a person’s weight and height to assess whether they are underweight, normal weight, overweight or obese.

Caries-free

A term used in dentistry to describe a person who has no cavities (dental caries) in their teeth.

Confidence interval (CI)

A range that likely contains the true population value with a given level of confidence, such as 95%.

Maternities

All live births and all fetal deaths at 20 weeks’ gestation or beyond, or weighing at least 400g if gestation is unknown.

New Zealand Index of Deprivation (NZDep)

An area-based measure of relative socioeconomic status based on nine Census variables, displayed as deciles or quintiles. Each NZDep decile contains about 10% of small areas in New Zealand, where deciles 1 and 2 (or quintile 1) represent areas with the least deprived scores and deciles 9 and 10 (or quintile 5) represent areas with the most deprived scores.

Pacific peoples

People who identify with one or more of the following ethnic groups: Samoan, Cook Islands Māori (Cook Islanders), Tongan, Niuean, Tokelauan, Fijian and other within the statistical definitions of ‘Other Pacific peoples’ and ‘Pacific peoples not further defined (nfd)’.

Defined comprehensively by Stats NZ within the ‘Aria’ classification tool.

Other Pacific peoples

The ethnic groups of Indigenous Australian, Hawaiian, i-Kiribati, Nauruan, Papua New Guinean, Pitcairn Islander, Rotuman, Tahitian, Solomon Islander, Tuvaluan, Ni Vanuatu and Pacific peoples not elsewhere classified.

Summary

This report provides an overview of the health system’s performance for Pacific
peoples, covering life expectancy, maternal and child health and access to health care.

Life expectancy and mortality

The life expectancy at birth of Pacific peoples born in 2022 was 77.3 years, which was 6.1 years less than that of non-Māori, non-Pacific people.

The age-standardised mortality rate for Pacific peoples dropped by one-third between 2000 and 2021 to 550.4 per 100,000 people.

Among Pacific peoples, amenable mortality, defined as deaths that could have been avoided through effective and timely health care, has decreased, but it remains 2.3 times higher compared to amenable mortality for non-Māori, non-Pacific people.

Maternal and child health

Over 2006–2021, maternal mortality for Pacific mothers was 21.2 per 100,000 maternities: almost twice that of European mothers. The infant mortality rate among Pacific peoples has varied over the past decade and was 8.2 per 1,000 live births in 2022 compared to 7.6 per 1,000 live births in 2013.

Four-fifths of Pacific infants were referred to a Well Child Tamariki Ora provider by 50 days of age in 2023. In 2022, Pacific mothers were more likely to register with a lead maternity carer during the first trimester (53.4%) than they were a decade earlier (33.0% in 2009). Pacific registration rates still remain lower than all other ethnic groups.

Dental health

In 2022, one in three Pacific five-year-olds had no tooth decay or cavities, but on average Pacific five-year-olds had 3.3 decayed, missing or filled teeth. Hospitalisation rates for dental care among Pacific children under five years of age that were potentially preventable through primary health care interventions were relatively high, at 1,539 per 100,000 in 2024.

Oral health among 12- and 13-year-old Pacific young people improved between 2005 and 2022: 64.8% had no tooth decay or cavities (up 26 percentage points) and the number of decayed, missing or filled teeth on average more than halved between 2010 and 2022 (from 2.0 to 0.8).

Rheumatic fever

Rheumatic fever has been a persistent issue for Pacific peoples in recent times. In 2023, there were 26.4 notifications and 25.6 hospitalisations per 100,000 Pacific peoples. These rates were dramatically higher than those recorded for non-Māori, non-Pacific people.

Immunisations

Immunisation rates among Pacific children were very high between 2015 and 2017 (around 95%) but have steadily declined since then. Immunisation rates for Pacific peoples were lower at all milestone ages in 2023 than those recorded for non-Māori, non-Pacific children.

Obesity

Around one in five (18.0%) Pacific children had a body mass index (BMI) higher than the 98th percentile (WHO), which was 4.1 times higher than the equivalent rate for non-Māori, non-Pacific children (4.4%).

Cost as a barrier to primary care

Cost was a barrier to accessing primary care in the last 12 months for only 1.5% of Pacific children in 2023/24, but in that year one in five (22.3%) Pacific adults had not visited a general practitioner (GP) because of cost in the last 12 months, and one in ten (9.1%) had not picked up a prescribed medicine because of cost in the last 12 months.

Health targets

Around two-thirds (68.3%) of Pacific peoples experienced timely care at an emergency department, three-fifths (61.7%) received timely access to elective surgery and four-fifths (82.4%) received timely access to cancer treatment in 2023.

Data: Core population health indicators

Life expectancy

The life expectancy at birth of Pacific peoples born within the period 2020–2022 was 77.3 years.

Life expectancy at birth for Pacific peoples increased by 3.0 years between 2003 and 2022.

Pacific peoples experience lower life expectancy than non-Māori, non-Pacific people – a difference of 6.1 years in 2022 (averaged across 2020 to 2022).

Higher levels of socioeconomic deprivation are associated with lower life expectancy, particularly for Māori and Pacific peoples.

In quintile 2, where data is first available for Pacific peoples, life expectancy is 79.8 years; this is lower than the 85.2 years recorded for non-Māori, non-Pacific populations.

As deprivation increases, life expectancy for Pacific peoples continues to decline. It was 78.2
years in quintile 3 and 77.4 years in quintile 4.

In the most deprived quintile (quintile 5), life expectancy for Pacific peoples was 77.0 years, which, while higher than the 74.2 years recorded for Māori, was significantly lower than the 81.6 years for non-Māori, non-Pacific people.

Mortality

The age-standardised mortality rate for Pacific peoples was 550.4 per 100,000 people in 2021.

The mortality rate for Pacific peoples declined by one-third (32.8%) between 2000 and 2021.

This decline was mirrored in the Māori and non-Māori, non-Pacific populations.

As a result, the relative difference in the mortality rate of Pacific peoples and non-Māori, non-Pacific peoples reduced only modestly, from 1.8 times higher to 1.7 times higher.

The age-standardised amenable mortality rate per 100,000 Pacific peoples was 151.1 in 2020, down from 281.1 in 2000.

The amenable mortality rate among Pacific peoples has halved over the past two decades, mirroring improvement for other ethnic groups.

Pacific peoples were 2.3 times more likely than non-Māori, non-Pacific people to experience amenable mortality in 2020.

Data: Maternal and child health

Maternal mortality

The maternal mortality rate among Pacific peoples was 21.2 per 100,000 maternities, based on data pooled from 2006 to 2021.

The maternal mortality rate per 100,000 maternities for Pacific mothers (21.2, 95% confidence interval (CI) 13.4–31.8) was the second highest after the rate for Māori mothers (22.9, 95% CI 17.4–29.5).

This rate was almost twice that of European mothers (12.5, 95% CI 9.1-16.6), though this difference is not statistically significant.

If maternal mortality rates for Māori and Pacific women were the same as for European women, overall maternal mortality in New Zealand would be 30% lower.

[1] Perinatal and Maternal Mortality Review Committee. 2024. Sixteenth Annual Report of the Perinatal and Maternal Mortality Review Committee | Te Pūrongo ā-Tau Tekau mā Ono o te Komiti Arotake Mate Pēpi, Mate Whaea Hoki: Reporting Mortality and Morbidity 2021 | Te Tuku Pūrongo mō te Mate me te Whakamate 2021. Wellington: Te Tāhū Hauora Health Quality & Safety Commission.

Infant mortality

The infant mortality rate among Pacific peoples has varied over the past decade.

In 2022, the infant mortality rate among Pacific peoples was 8.2 per 1,000 live births, compared to 7.6 per 1,000 live births in 2013.

The Pacific infant mortality rate remained higher than those of other ethnic groups in 2022, being 1.9 times higher than the rate for Asian infants, 2.1 times higher than that for European or Other infants, and 1.4 times higher than the rate for Māori infants.

Live births

The number of live births among Pacific peoples slightly declined over the decade, with minor fluctuations.

While there were slight increases in some years, the overall number declined from 6,438 in 2013 to 5,997 in 2022.

Compared to other ethnic groups, Pacific peoples had a lower number of live births, but the trend was less variable than the trend for the European/Other group, which experienced a significant decline.

Meanwhile, Māori and Asian births showed an overall increase.

Well Child Tamariki Ora

Around four-fifths of Pacific infants were referred to a Well Child Tamariki Ora provider by 50 days of age.

Pacific infants are generally less likely to access Well Child Tamariki Ora services than non-Pacific infants.

In 2024, a lower proportion of Pacific infants had referrals by 50 days of age (81.3%) compared to non-Pacific infants (86.8%).

Pacific infants recorded rates lower than non-Pacific infants in 13 of the 17 indicators in Figure 8.

The most significant disparities were for children at a healthy weight at age four (64.1% versus 81.6%), breastfed at three months (40.8% versus 55.8%) and breastfed at six weeks (51.4% versus 65.7%).

The measured performance of some indicators was higher among Pacific children.

Pacific children with mental health needs (a high SDQ-P1 score) were more likely to be referred to a specialist than non-Pacific children (75.2% versus 67.9%), as were those with a high BMI (>98th percentile) (97.5% versus 90.4%).

Parents of Pacific children were more likely to receive information about sudden infant death syndrome (89.7% versus 84.4%), and their children were more likely to be enrolled with an oral health service (100.0% versus 98.4%).

[1] SDQ-P is screening tool designed to identify emotional and behavioural issues in children and adolescents. The ‘P’ denotes that the score refers to the parent version that specifically involves parents or primary caregivers completing the questionnaire based on their observations of their child's behaviour.

Lead maternity carer registrations

Pacific mothers in 2022 were more likely to register with a lead maternity carer (LMC) during the first trimester than they were a decade earlier.

The proportion of Pacific mothers registered in 2022 was 53.4%, an absolute increase of 20.4 percentage points from 33.0% in 2009.

Despite this improvement, Pacific registration rates remained lower than rates for other ethnic groups.

In 2022, European mothers had the highest registration rate (87.6%), followed by Asian mothers (82.2%), Indian mothers (77.3%) and Māori mothers (62.5%).

Data: Specific child health issues – Dental health

Caries-free five-year-olds

Around one in three Pacific children had no tooth decay or cavities at five years of age in 2022.

The proportion of Pacific five-year-olds who were caries-free in 2022 was 33.5%, compared to 34.6% in 2005, representing a 1.1 percentage point decline.

In 2022, the proportion of caries-free children was highest among non-Māori, non-Pacific children (66.4%), followed by Māori children (39.0%).

Decayed teeth in five-year-olds

Pacific five-year-olds had higher numbers of decayed, missing or filled teeth (DMFT) compared to non-Māori, non-Pacific children.

In 2022, the average number of DMFT teeth among Pacific children was 3.3: higher than the number for Māori children (3.1) and non-Māori, non-Pacific children (1.4).

Over the 2005–2022 period, Pacific children’s average DMFT numbers fluctuated, reaching peaks of 3.9 in 2007 and 3.8 in 2020.

Average numbers for Māori children also gradually decreased from 3.8 in 2005 to 3.1 in 2022, while numbers for non-Māori, non-Pacific children remained the lowest throughout the period: generally 1.3 on average.

Dental-related hospitalisations

Rates of ambulatory sensitive hospitalisations due to dental issues were relatively high among Pacific infants and young children in 2024.

The rate at which Pacific children aged 0–4 years were hospitalised for dental care that was potentially preventable through primary health care interventions was 1,539 per 100,000 children in 2024.

This rate was more than three times that for non-Māori, non-Pacific children (456) and higher than the rate for Māori children (1,286).

Caries-free 12- and 13-year-olds

The oral health of Pacific young people aged 12 and 13 years improved markedly over the decade to 2022.

The proportion of Pacific 12- and 13-year-olds who were caries-free in 2022 was 64.8%, compared to 38.8% in 2005, representing an absolute 26 percentage point increase.

In 2022, the proportion of caries-free young people in this age group was highest among non-Māori, non-Pacific children (73.3%). The rate for Māori children in the same year was 59.2%.

There were improvements in this indicator for all groups between 2005 and 2022.

Decayed teeth among 12- and 13-year-olds

The number of DMFT among Pacific 12 and 13-year-olds fell markedly between 2010 and 2022.

In 2022, the average number of DMFT teeth among Pacific people aged 12 and 13 was 0.8. This number more than halved since 2010 (when it was 2.0).

The average number of DMFT for Pacific people at these ages was higher than that for non-Māori, non-Pacific children (0.6) but lower than that for Māori children (1.2) in 2022.

Data: Specific child health issues – Rheumatic fever

Acute rheumatic fever notifications

Acute rheumatic fever notifications fluctuated between 2001 and 2023.

There were 26.4 acute rheumatic fever notifications per 100,000 Pacific peoples in 2023, compared to 7.5 per 100,000 in 2022. The 2023 rate is similar to rates recorded over the past two decades.

Pacific peoples remain disproportionately affected by rheumatic fever, with a notification rate 3.2 times higher than the rate for Māori (8.3 per 100,000) and 264.0 times higher than the rate for non-Māori, non-Pacific (0.1 per 100,000).

Acute rheumatic fever hospitalisations

Acute rheumatic fever hospitalisations also fluctuated over the two decades to 2023.

There were 25.6 acute rheumatic fever hospitalisations per 100,000 Pacific peoples in 2023.

Hospitalisations fell to just 7.6 per 100,000 in 2021, but the current rate is similar to those recorded over the past two decades.

Pacific peoples remain disproportionately affected by rheumatic fever, with a hospitalisation rate 3.0 times higher than the rate for Māori (8.4 per 100,000) and 85.3 times higher than the rate for non-Māori, non-Pacific (0.3 per 100,000).

Data: Specific child health issues – Immunisations

Immunisation by milestone ages

In the 12 months ending September 2024, immunisation rates for Pacific children ranged from 48.6% to 80.3% across different milestone ages.

While immunisation rates for Pacific children were slightly higher than equivalent rates for Māori, they were consistently lower than rates for non-Māori, non-Pacific children at every milestone age.

The smallest gap between Pacific and non-Māori, non-Pacific children occurred at 12 months (7.1 percentage points) and 60 months (8.0 percentage points).

The most significant gaps were at 6 months (19.5 percentage points lower) and 18 months (23.1 percentage points lower).

Immunisation rates at eight months

Pacific childhood immunisation rates at age eight months declined over time.

Immunisation rates for Pacific children aged eight months peaked at 95.2% in 2016 and regularly exceeded those recorded among other ethnic groups before 2020, except among Asian children.

The decline in immunisation rates among Pacific children predated the COVID-19 pandemic but appeared to accelerate over the five years to 2024.

In 2024, immunisation rates among Pacific children were 16.4 percentage points lower than those for Asian children and 9.2 percentage points lower than those for children from other (non-Māori, non-Pacific and non-Asian) ethnic groups.

Data: Specific child health issues – Obesity and growth

Childhood body mass index

In 2023, around one in five Pacific children had a BMI higher than the 98th percentile (WHO).

A BMI higher than the 98th percentile for age and gender is a measure of childhood obesity.

The proportion of Pacific children who met this criterion was 18.0% in 2023. This rate was 4.1 times higher than that of non-Māori, non-Pacific children (4.4%).

Tokelauan children had the highest proportion of children with a BMI higher than the 98th percentile (24.7%), followed by Tongan children (23.1%), then Samoan children (19.4%), Niuean children (17.4%), Cook Islander children (13.8%) and Fijian children (9.2%).

Data: Health care access – Primary care

Unmet primary health care needs due to cost among children

Cost is rarely a barrier to accessing GP care for Pacific children.

Adults and caregivers for Pacific children rarely cited cost as a reason their children could not visit a GP in the past 12 months in 2023/24 (1.5% of respondents).[1]

This rate had much reduced from a peak of 8.9% recorded in 2013/14.

This decline coincided with the removal of fees for GP visits and co-payments for dispensed prescriptions for children aged less than 14 years in 2015.

Pacific children were 1.3 times as likely as non-Pacific children to experience cost as a barrier to access in 2023/24 after adjusting for age and gender. However, the difference was not statistically significant.

Readers should note that cost is one of many potential barriers to accessing healthcare, including GP care.

[1] This data point is considered to be of low quality, so it should be interpreted with care.

Unmet primary health care needs due to cost among adults

One in five Pacific adults cited cost as a barrier to accessing GP care.

The proportion of Pacific adults who cited cost as a reason they did not visit a GP in the last 12 months in 2023/24 was 22.3%.

This proportion has been reasonably stable over time once possible sampling error is accounted for, excluding a sharp decline in 2021/22, when it fell to 11.0%.

Pacific adults were, however, 1.4 times as likely as non-Pacific adults to report cost as being a barrier to access in 2023/24 after adjusting for age and gender.

Unfilled prescriptions

One in 10 Pacific adults did not collect prescribed medicines because of cost in 2023/24.

The proportion of Pacific adults who cited cost as a reason they did not collect prescribed medicines in 2023/24 in the last 12 months was 9.1%.

The proportion of the Pacific adult population who cited cost as a barrier in this context has varied over time, peaking at 19.3% in 2015/16.

Pacific adults were 2.2 times as likely as non-Pacific adults to cite cost as a barrier to accessing prescribed medicines in 2023/24 after adjusting for age and gender.

Data: Health care access – Health targets

Note: Performance of the health system in relation to timely access to specialist appointments is not currently able to be reported by ethnic group.

Shorter stays at emergency departments

Around two-thirds of Pacific peoples experienced timely care at an emergency department in 2023.

The proportion of Pacific adults who presented at an emergency department and were admitted, discharged or transferred within six hours in 2023 was 68.3%, down from 93.9% in 2014.

This proportion was 26.7 percentage points below the Government’s target of 95.0% in 2023.

The proportion of the Pacific adult population who experienced timely emergency department care was almost at the target between 2014 and 2017 (around 92–94%), but declined steadily over the following years.

A lower percentage of Pacific adults were admitted, discharged or transferred from an emergency department within six hours than the equivalent figure for Māori (an absolute 6.1% less) and Asians (an absolute 3.8% less).

Shorter waits for treatment (elective surgery)

Around three in five Pacific peoples received timely access to elective surgery in 2023.

The proportion of Pacific adults who experienced timely elective surgery in 2023 was 61.7%, down from 94.3% in 2013.

This proportion was 33.3 percentage points below the Government’s target of 95.0% in 2023.

The proportion of the Pacific adult population who experienced timely elective surgery exceeded the target between 2014 and 2018, but declined over the following years – most dramatically in 2021.

A higher proportion of Pacific peoples received timely elective surgery than Māori and non-Māori, non-Pacific, especially after 2016.

In 2023, the percentage of Pacific peoples receiving elective surgery within four months was an absolute 3.3% higher than Māori and 0.9% higher than non-Māori, non-Pacific.

Faster cancer treatment

Most Pacific peoples received timely access to cancer treatment in 2023.

The proportion of Pacific adults who experienced timely cancer treatment in 2023 was 82.4%, down from 89.6% in 2013.

This proportion was 12.6 percentage points below the Government’s target of 95.0% in 2023.

Over the decade 2013–2023, the proportion of the Pacific adult population who experienced timely cancer treatment was at its lowest level in 2023.

A lower proportion of Pacific peoples were receiving timely cancer treatment than Māori (by an absolute 4.3% points) and non-Māori, non-Pacific people (by an absolute 3.1% points).