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Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies

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Authors:
Summary:

New Zealand census mortality data from 1981 to 2001 were analysed for any change in disparities between income and mortality during a period of major structural and macroeconomic reform and for how different diseases contributed to these disparities. All-cause mortality rates declined over the 25-year study period in all groups stratified by sex, age, and income, except for 25–44 year olds of both sexes on low incomes among whom there was little change. In all age groups pooled, relative inequalities increased from 1981–4 to 1996–9, then stabilised in 2001–4. Absolute inequalities were stable over time, with a possible fall from 1996–9 to 2001–4. Cardiovascular disease was the major contributor to the observed disparities between income and mortality, but decreased from 45% in 1981–4 to 33% in 2001–4 for males and from 50% to 29% for females. A corresponding increase in cancer occurred; from 16% to 22% for males and from 12% to 25% for females.

Comment:
This study from NZ showed that when the economy was restructured, although overall death rates declined, the disparities between ‘rich’ and ‘poor’ (based on household income) actually increased. As the authors state, there is not enough evidence to conclude that the reforms on their own explained the findings. However, the editor of BMJ pointed out that although it is much easier to utilise research that tackles risk factors at the individual level, studies such as these that ‘map associations between trends in inequalities in health determinants and in health outcomes are necessary for an evidence-informed debate about policies to tackle widening health inequalities’.
Reference: BMJ. 2008;336:371-5
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

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