In the decades after the Second World War many Māori moved to the city. By 1971 over half the population was urban; by the 2001, 84% were. Housing and employment for many urban Māori became like that of working-class Pākehā.
Better housing, combined with increased immunity to infectious disease, helped the health transition that occurred for Pākehā in the late 19th and early 20th century take place for Māori. Rates of infectious disease (such as tuberculosis and influenza) and premature death fell, and life expectancy increased. The negative side of the transition – an increase in degenerative diseases, including cancer and heart disease – also occurred.
Māori women were not left behind in this shift, but their health remained worse than that of Pākehā women and, in some areas, worse than that of men – both Pākehā and Māori.
Major causes of death
The leading causes of death – cardiovascular diseases, cancer, respiratory diseases and diabetes – all hit Māori women hard. Rates are higher than for Pākehā women, with greater numbers dying, and doing so at an earlier age. Although rates of death dropped between 1981 and 2004, that drop was lower among Māori women (at 22%) than any other group.
A significant proportion of deaths among Māori women were avoidable, which is defined as those who were under 75 years of age and for whom effective prevention, treatment options and health-care technologies were available.
Relaxing with a cigarette
The link between smoking, stress and lack of money was spelt out by Māori women talking to Māori researchers. One of them said: ‘Well I never drank beer. I never gambled. When you’re stressed out and haven’t got any money you can’t go out for a social life. So what do you do? Have a smoke.’1
Circulatory diseases – coronary heart disease, hypertension, and angina – have been particularly high for Māori women since at least the 1970s. At 4.2 times that of Pākehā women, the risk of death from cardiovascular disease for Māori women remained high in the 1990s.
Māori women got cancer more often and were more likely to die from it than Pākehā women. In 2002–6 for every 100,000 Māori women, 228.3 got cancer, and 107.3 died of it. This mortality rate was 90% higher than that of non-Māori women. Lung, breast, colorectal and stomach cancer were the most frequent causes of death.
In 2006–7 Māori women suffered higher rates of asthma, bronchitis and emphysema than the general population. They were also more likely to suffer and die from chronic obstructive pulmonary disease (usually caused by bronchitis and emphysema).
Below the radar
Diabetes was unknown in the Pacific before the Second World War, and in the 2000s the rate among Māori could only be estimated. Professor Chris Cunningham of Massey University’s Research Centre for Māori Health suspected that ‘well over’ half of those with the disease didn’t know it.
Diabetes reached epidemic level in some Māori communities in the 2000s. In 2005 Māori women were 10 times more likely to die from diabetes than the general population (at 6.5 times that of the general population, the rate for Māori men was also very high).
Smoking, hazardous drinking, obesity, limited physical activity and low fruit and vegetable intake all increase the likelihood of health problems. Unemployment increases risky behaviour, and Māori were hit particularly hard during recessions and state restructuring from the 1970s on.
Access to health care is limited by cost, availability of doctors, and attitudes of medical personnel. Health problems are strongly concentrated among poorer women – for example, 50% of Māori women with cancer come from the bottom two deprivation deciles. For these women the cost of visiting a doctor and the money required to get there and back has sometimes been beyond their means.
Medical personnel have sometimes provided a lesser quality of care to Māori. Evidence that the care of women during childbirth has been affected by the mother being Māori is particularly strong.
Although rates of infectious disease fell in the decades after the Second World War, Māori continued to suffer them at a much higher rate than Pākehā. Rheumatic fever, for example, was common in the mid-1970s. Rheumatic heart disease, caused by rheumatic fever, killed Māori women aged 44–65 at 7.8 times the rate it killed Pākehā women, and at 1.7 times the rate for Māori men. In the 2000s rates of rheumatic fever climbed again, as overcrowded housing increased.