From the 1920s to the 1940s the Māori population increased rapidly, reaching 115,646 in 1945. However Māori health continued to lag far behind that of non-Māori.
The first systematic study of Māori living conditions, in the 1930s, revealed that a high proportion of the population were living in houses of a poor standard, often with overcrowding, polluted water supplies and unsatisfactory sanitary facilities. In 1934 official statistics indicated that the Māori death rate was more than double that of non-Māori. An East Coast study in 1935 showed the mortality rate for Māori suffering from tuberculosis was around 10 times the rate for Pākehā. The disparity was about the same in 1947. In this period tuberculosis was the single largest cause of death among Māori. The Māori death rate from typhoid fever was falling, but in 1937 it was still nearly 40 times the Pākehā rate. Infant mortality was much higher among Māori than in the non-Māori population. In 1938 it was four times higher.
Efforts to improve Māori health
When the Department of Health was restructured in 1920, in the aftermath of the influenza epidemic of 1918, it included a Division of Maori Hygiene, headed at first by Te Rangi Hīroa, and later by another Māori doctor, Edward Ellison.
In 1931 the division was abolished and oversight of Māori health was included in the general responsibilities of the department. Te Rangi Hīroa helped to revive the Māori councils (renamed Māori health councils), and they continued their work until 1945.
Government expenditure on health
Politician Āpirana Ngata continued to fight to improve Māori health in the 1920s and 1930s. Māori doctor Māui Pōmare was minister of health from 1923 to 1926.
Government expenditure on Māori health increased greatly in the 1930s. A programme for controlling tuberculosis in Māori communities was implemented on the East Coast, and then extended to other districts. Inoculation against typhoid was introduced to Māori districts early in this period, with a focus on schoolchildren. Typhoid became uncommon.
A scheme for improving Māori housing was introduced under the Native Housing Act 1935, although not many new houses were built under this scheme until after the Second World War. Another Māori health initiative was a project for installing modern pit privies, which the government, pushed by Ngata, implemented in 1938.
Nurses and hospital births
The number of native health nurses (known as district health nurses from 1930, and public health nurses from 1952) increased, and they gave added emphasis to preventive work and to mothers and children. Most Māori births were assisted by relatives or traditional attendants until the 1920s. The Department of Health encouraged hospital births in an effort to reduce the gap between Māori and non-Māori maternal mortality rates. By 1937, 17% of Māori births took place in hospital. This proportion increased rapidly after maternity care became free in 1939. By 1947 about half of Māori births took place in hospital.
Hospitals and cultural barriers
There is little evidence of any conscious or deliberate effort to lessen cultural barriers and make hospitalisation an experience more congenial to Māori in the 1920s and 1930s. Nevertheless, increasing numbers of Māori were now willing to enter hospital. Fees were a barrier to admission, but in 1939, under the Social Security Act 1938, hospital admission was made free for all patients. The act also introduced universal medical benefits, in 1941. All citizens could now see a doctor at little cost, although in rural districts where many Māori lived there were sometimes few resident practitioners.