People of Pacific Island ethnicity are an important and growing part of New Zealand society and culture. In 2013 they comprised 7.4% of the country’s population and were major contributors to New Zealand’s success in sport, music and the arts – and increasingly in business and academia. Despite this, Pacific people have some of the worst health statistics of all New Zealanders.
These ethnic disparities in health are attributable to adverse socio-economic circumstances such as high unemployment, low educational achievement, low income, overcrowding and cold houses. Pacific people also have a high prevalence of risk factors such as smoking, unhealthy diets and obesity. Furthermore, they have problems in getting access to quality health-care services.
The Pacific population has a high birth rate, putting Pacific people among the fastest-growing population groups in New Zealand. In 2013 the Pacific fertility rate was 2.73 births per woman, compared to the national rate of 2.02. In 2011 the median age of childbearing for Pacific women was 27 years, while the national median was 30 years.
The fertility rate for Pacific teenagers was higher than the total rate in the mid-2000s, suggesting lower use of contraception. Because children born to teenage mothers are at risk of low birth weight, perinatal mortality and socio-economic disadvantage, health advocates recommended that family-planning programmes targeted Pacific communities. Yet they also recognised that it was more acceptable in some cultures to have children young.
The health benefits of breastfeeding are well-known. But in 2009 Porirua breastfeeding advocate Ligi Igasia found many Pacific mothers were too embarrassed to attend public clinics teaching breastfeeding techniques. She began visiting them in their homes, and soon had a number of mothers breastfeeding their babies for more than six months.
In 2013, 36% of the Pacific population were aged under 15, compared with 20% of New Zealand’s total population. This reflected the community’s higher fertility rate. Only 5% of the Pacific population were aged 65 and over, compared with 14% of the national population. This imbalance was a product of immigration – people who migrate to New Zealand tend to be younger – and the higher death rate of Pacific people.
Data from 2005–7 showed that Pacific people had a considerably higher death rate (8.8 deaths per 1,000 people) than the total national population (5.8 per 1,000). In 2012–14 life expectancy at birth was 74.5 for Pacific males and 78.7 for Pacific females. This was lower than the national average of 79.5 for males and 83.2 for females.
Between 2004 and 2008 the leading causes of death among Pacific children aged under 15 were accidental threats to breathing and road accidents. For Pacific people aged 15–64, road accidents and suicide were the leading causes of death. Falls were the leading cause of death for Pacific people aged 65 and over.
Between 2000 and 2008 the avoidable death rate for Pacific people was approximately 50% greater than for the total New Zealand population. Avoidable deaths are those of people under 75 years of age where effective prevention, treatment options and health-care technologies are available.
All Pacific cultures have a holistic view of health with a strong spiritual dimension. This asserts that good health is the result of a balanced relationship between humans and their environment. Disease, injury and even death can occur if this balance is put out of kilter, sometimes as a result of wrongdoing by the victim or a family member. These beliefs may contribute to the tendency for some Pacific people to avoid doctors’ visits and health interventions.
While Pacific people have experienced real gains in social wellbeing since the mid-1990s – such as in educational achievement and paid work – their overall outcomes are poor compared with other New Zealanders. The New Zealand Health Surveys have also shown that the majority of Pacific people were less likely to report excellent or very good health than the total population.
While some improvements have been made, Pacific children have poor health compared to other children. In the 21st century the infant mortality rate was higher among the Pacific population than the national average – 6.9 deaths per 1000 live births in 2012 compared to a total population rate of 4.7. This rate is generally regarded as a good indicator of the socio-economic conditions in which children live. Significant improvements in child health indicators were reported between 2014 and 2018, except in oral health and childhood obesity.
Pacific children are more likely than others to be admitted to hospital for respiratory conditions, infectious and parasitic diseases, burns and unintentional injuries. Between 2006 and 2010 their hospitalisation rate for asthma was much higher than other ethnic groups – 10.55 per 1,000, compared to 3.46 for European children. In 2007 and 2008 notification rates for rheumatic fever for children aged under 15 were 30.7 per 100,000 for Pacific boys and 27.9 for Pacific girls, compared to 10.6 (boys) and 9.6 (girls) in the total population. These childhood problems are consequences of poverty, substandard housing and inadequate health care. Poverty rates were significantly higher among Pacific children than European children in 2012–14.
The Village Collective was set up in 1997 to tackle the high rate of pregnancy, abortion and sexually transmitted infections among Pacific youth in South Auckland. The group visited churches, community groups, and schools, using music, drama, dance and art to educate adolescents about sexual health and wellbeing. In 2009 Village Collective began its ‘Random Acts, Island Styles’ project, where it gave public music and drama performances, some of which were filmed and posted on YouTube.
Young Pacific people generally have death, disease and injury patterns similar to those of other young New Zealanders. Information about secondary school students is available through health and wellbeing surveys conducted in selected schools between 2001 and 2012. The 2012 survey found that a slightly smaller proportion of Pacific secondary students reported that their health was excellent, very good or good, but there was no difference in their reported levels of general wellbeing. Ninety-two per cent of Pacific students reported that they were satisfied with their lives.
Between 2001 and 2012 there was a 4% decrease in the proportion of Pacific students with depressive symptoms, and their rates were very similar to those of New Zealand European students. However, Pacific students were slightly more likely to report self-harm and three times as likely to have attempted suicide in the last 12 months.
In 2012 about 20% of Pacific students surveyed had been or were currently sexually active, similar to the proportion of European students. A third of sexually active Pacific students reported using condoms and 50% used some form of contraception. Fifty percent of European students used condoms and three quarters used some form of contraception. This difference could explain the higher Pacific teenage pregnancy rate.
Pacific students (66% in 2012) were more than twice as likely as New Zealand European students (28% in 2012) to be overweight or obese. More Pacific girls (36%) were obese than Pacific boys (30%). However, Pacific students were more likely to report eating the daily recommended amount of fruit and vegetables.
Heart diseases were the leading cause of death among Pacific people (as in the general population). Reported rates of heart disease in the Pacific population were lower but death rates were higher compared to other New Zealanders. Deaths from heart disease have declined in New Zealand since the 1980s, but the rate of decline among Pacific people has been much lower. High blood pressure is more common among Pacific people than other New Zealanders, but they are less likely to seek treatment for this condition.
In 2006 a world expert on diabetes, Professor Martin Slink, warned that diabetes could wipe out Māori and Pacific Islanders by the end of the century. Māori males were 6.5 times more likely and Māori females 10 times more likely to die from diabetes than non-Polynesians, while the mortality rate for Pacific people was five times the non-Polynesian rate. While Polynesian people had genes that made diabetes more damaging, Slink said that the problem was exacerbated by Western lifestyles and diets.
In 2014/15 the prevalence of diabetes in Pacific people was almost three times the national figure, and complications were common. These included heart disease, stroke, blindness, kidney failure and lower-limb amputation. High obesity rates among Pacific people were one explanation for their propensity to develop Type 2 diabetes, which is usually linked to diet and increases with age. Experts also suggested that indigenous people were more susceptible to diabetes as they were not physiologically adapted to Western food and lifestyles.
In general, incidence of common cancers is similar to that of the total New Zealand population, but Pacific people tend to seek medical treatment later, when the disease is at an advanced stage. This may explain why the breast-cancer death rate among Pacific women aged 25–44 is higher than that for the general population. Pacific women are more likely to contract and die from cervical cancer, and are less likely to use screening services.
Higher Pacific disease and death rates are more likely to reflect poor access to health information and health care than inherent predisposition to disease. These disease and death rates are also the outcome of a higher prevalence of risk factors for some diseases. Unintentional injuries – such as falls and motor-vehicle crashes – are the leading causes of admission to hospital, followed by asthma, stroke and coronary heart disease. In 2002, despite similar rates of people admitted to hospital with heart disease, Europeans were three times more likely than Pacific people to have coronary bypass surgery, and seven times more likely to have angioplasty (a procedure to open blocked or narrowed heart arteries). This suggests that Pacific people did not always receive the best treatment for these conditions.
In areas where health providers had targeted programmes – such as the diabetes programme Get Checked – Pacific participants were as likely to have received proper care as other ethnic groups.
In 2013, adjusting for age, 26% of Pacific people were physically disabled, compared to 32% of Māori, 24% of Europeans and 17% of Asians.
The 2006 New Zealand Mental Health Survey showed that Pacific people had higher rates of mental illness than other New Zealanders. It found that 24.4% of Pacific people had experienced a mental disorder – such as anxiety, eating or bipolar disorder – in the previous 12 months compared to 20.7% of the national population. More worryingly, three out of four Pacific people with severe mental illness did not have access to adequate mental-health care services.
Health is affected by the interaction between personal and environmental factors. Environmental influences include physical, socio-economic, cultural and political factors, as well as the availability of health services. It is generally accepted that the socio-economic factors – especially education and income – are the most important determinant of population health status. Poor people with limited education generally have poor health.
Pacific people generally have lower socio-economic status than other New Zealanders – 42% live in decile 10 (most deprived) areas compared to 10% of the general population. While there has been some improvement since 1990, Pacific people remain worse off than other New Zealanders. Poor educational outcomes, high unemployment and low income levels have a major impact on Pacific people’s health and wellbeing.
Generally, more young Pacific people than others leave school without formal qualifications, but the proportion of Pacific people gaining the National Certificate of Educational Achievement (NCEA) Level 2 improved significantly in the 2000s and 2010s. Unemployment among Pacific people is higher than the national rate – 6.2% in September 2018, compared with 3.9% overall. Unemployment is a major cause of poverty, and of related health consequences for both adults and children.
In 2013 the median income for Pacific wage and salary earners was $19,700, compared with $28,500 nationally. Unlike for other ethnic groups, the Pacific median income was lower than in 2006, when it was $20,500. People on low incomes sometimes delay doctors’ visits until they are very sick.
Since the early 2000s social-housing provider Housing New Zealand has been insulating its older houses to improve tenants’ comfort and health. In early 2008 New Plymouth tenant Sally Falaniko’s house was insulated. In the 2007 winter her two sons and daughter had spent time in hospital with pneumonia, but the following winter her four kids were healthy and happy. The previous year Falaniko had constantly run her gas heater. Now she no longer needed to, saving a considerable amount on her gas bill.
Overcrowding and poor-quality housing is a major social and public health problem for Pacific families. In 2013, 40% of Pacific people lived in overcrowded houses, compared to 20% of Māori, 18% of Asians and 4% of European people. Overcrowding encourages the spread of diseases, including rheumatic fever, tuberculosis, meningococcal disease and skin infection.
Pacific people are heavily reliant on rental housing, and make up a quarter of Housing New Zealand’s clients. Since the early 21st century Housing New Zealand’s Healthy Housing programme – where state houses are insulated and extended to accommodate larger Pacific families – has significantly reduced the incidence of infectious diseases.
Population groups who live in cohesive and mutually supportive societies generally have better health. Some traditional support structures within New Zealand Pacific communities have been eroded, and many individuals and families have limited social support. Churches play an important role in supporting some Pacific families, but young New Zealand-born people may not be connected to their family, church and community.
Pacific people are disproportionately affected by chronic diseases caused by smoking, poor diet and physical inactivity. Several studies have shown that more than 65% of Pacific people are obese. Obesity is one of the major causes of poor health, especially diabetes, for adult Pacific people. It is also a growing problem among Pacific children and young people. Results from the 2014/15 New Zealand Health Survey showed that 10.8% of New Zealand children aged 2–14 were overweight or obese. The figures were worse for Māori and Pacific children – 14.8% and 29.7% respectively. A major cause of obesity is the consumption of unhealthy food and sugar-sweetened beverages, and lack of regular physical activity.
A 2007 Otago University study found almost 11% of New Zealand Pacific Island children were extremely obese, compared to just 0.8% of European and other non-Māori children. Researcher Dr Alisa Goulding said, ‘Most parents probably didn’t realise their children are so heavy and so fat.’ 1 Their size posed health threats like Type 2 diabetes. Goulding said that more research was needed to discover the reasons for the ethnic differences and find ways to prevent severe obesity in children.
The drinking patterns of Pacific people are also more harmful, with higher reported rates of violence associated with drinking than for the general population. A 2003 study found that 57% of Pacific people drank alcohol, compared to 85% of the total population. However, Pacific people had a greater average annual consumption of alcohol (21 litres) than the New Zealand average (11 litres). Moreover, 33% of Pacific drinkers consumed enough to feel drunk at least weekly – as against 9% of drinkers nationally.
This general pattern was confirmed in the 2014/15 New Zealand Health Survey. Fifty-six per cent of Pacific people 15 and over had consumed alcohol in the past year, compared to a national figure of 79.5%, but they had higher rates of hazardous drinking.
While tobacco use in New Zealand has declined, the prevalence of smoking remains higher among Pacific people, especially men. In 2014/15, 24.7% of Pacific people smoked, compared with 16.6% of all New Zealanders.
Hospital admissions for preventable conditions such as asthma and diabetes are two to three times as high among Pacific people as other New Zealanders. Pacific people with asthma are seen more often in hospital emergency departments and are less likely to receive preventive therapy. Pacific people with diabetes develop more complications as a result of their disease. Children of Pacific origin are six times as likely to be admitted to hospital with pneumonia as other New Zealand children. These problems probably stem from delays in seeking care that are compounded by traditional beliefs about health and illness, poor access to primary care providers and lack of confidence in hospital services.
Teuila Percival, an Auckland paediatrician of Samoan descent, commented that ‘[a] Samoan nurse once explained to me about “the Pacific touch.” What is the Pacific touch? It is taking the time to stop and pray with a family. It is taking the time to teach a young mother to cook. It is being committed and dedicated and passionate about our people. The Pacific touch is that quality that sets a special few of our nurses and health workers apart.’2
Pacific people were less likely to go to doctors’ surgeries and medical centres, leading to more of them being admitted to hospital than the general population. From the late 20th century this began to change, as Pacific-owned primary health care services were set up. The first was West Auckland’s Pasifika Healthcare, in 1989.
By 2000 there were 30 Pacific-owned health-provider organisations around New Zealand. They were a response to ongoing problems with access to primary health care which was market-driven, medically focused and sometimes unresponsive to the needs and expectations of Pacific people. There was also no provision for public input into primary health-care service delivery, and a severe shortage of doctors who could speak a Pacific language. Pacific-owned health services have improved choices for Pacific people, but the majority of the Pacific population continue to be served by mainstream providers.
In the 2010s Pacific people in New Zealand continued to be low users of health-care services despite having high health needs. Targeted health initiatives for Pacific people were developing, but more substantial changes were needed to make health services more accessible.
'Ala Mo'ui progress report – Pacific child health. Wellington: Ministry of Health, 2018.
Foliaki, S., and others. ‘Pacific people.’ In Te rau hinengaro: the New Zealand mental health survey, edited by Mark A. Oakley Brown, J. Elisabeth Wells, and Kate M. Scott, 179–180. Wellington: Ministry of Health, 2006.
Tupu ola moui: Pacific health chart book. Wellington: Ministry of Health, 2004.