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Pacifika Health Needs Assessment

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Table of Contents

Executive summary

Introduction

Health inequalities

Health determinants

Pacific demographics

Health risk factors

Life expectancy

Mortality

Hospitalisation

Disability

Primary Health Organisations

Prioritisation

 

Executive summary

We know from Census 2006 data that Pacific peoples represent 11.2.1% of the total Auckland DHB population (approximately 50,000) and that the population is demographically young – approximately 50% are under age 25.  Auckland DHB’s Pacific population is comprised of several ethnic groupings which include Tongan, Samoan, Cook Islands, Fijian, Tokelauan and Niuean.  Samoan followed by Tongan are the two largest cultural groups identified among Pacific people.

Pacific men and women have the lowest life expectancy in Auckland (compared to Maori and Other) and for Pacific men this is particularly true if they are in the lower socioeconomic group.

In terms of deprivation, Pacific peoples are the most deprived with 73% of the population living in the most deprived areas, versus 57% for Maori and 33% for Other.

Introduction

Auckland DHB recognises the importance of understanding the needs of its Pacific population in order to make improvements to their health status and to reduce inequalities. 

A Pacific Health team has been established to provide Auckland DHB with advice, support and to assist in developing effective strategies that will address the needs of the Pacific population and improve their health

A Pacific Health Advisory Committee has also been established to provide Auckland DHB with community perspectives about improving the health status of Pacific. The committee members comprise representatives from the Pacific community and Auckland DHB Board members. 

Vision: Healthy Pacific communities with access to quality health care

ADHB has identified 5 key priority areas under Our Health 2020 and has developed a strategy (the Healthy Village Action Zones) for delivering on these to its Pacific population.

The Healthy Village Actions Zones (HVAZ) is an innovative framework for collaborative action by key stakeholders and Pacific communities, joining together to improve health outcomes for Pacific peoples. The HVAZ framework is informed by the best elements and learnings from previous community and church-based health initiatives, Pacific concepts of community well-being, and an understanding of the challenges and opportunities for Pacific peoples in the current environment characterised by District Health Boards, Primary Health Organisations and local governments taking greater responsibilities for the health and well-being of the populations they serve.

The starting point of the Healthy Village Action Zones framework is the Pacific population group whose high health needs is clearly documented and where an active community readiness is demonstrated through church groups (Over 80% of Pacific peoples belong to a Christian church -statistics New Zealand 2007), and the future development, responsibility and sustainability of the model will be through existing service providers (PHOs), other health and disability providers, sectors and agencies

HVAZ is a model of self-determination and an integrated community-led development that will create an environment in which future opportunities and initiatives can be cultivated and nurtured. It provides a catalyst for a wide range of activities to take place in the Pacific communities takes a holistic approach and delivers comprehensive primary healthcare

There is already much strength and leadership in the Pacific community. HVAZ uses this platform to support and build their capacity, capabilities and to encourage Pacific people to take ownership/responsibility for their own health.

As the enabler of HVAZ, ADHB provides the infrastructure and facilitates the interactions between the community groups (the churches) with the health care providers, PHOs, other sectors and agencies. The processes put into action by HVAZ are by no means exclusive to churches. Other communities of interest will be incorporated under the framework guided by the HVAZ evaluation.

The five key priority areas for Pacific that ADHB will focus on for 2008-2009 are:

 

  1. Building Healthy Pacific Communities e.g. Healthy Village Action Zones

 

2.      Increase the capacity & capability of the Pacific Health and Disability Workforce e.g. Pacific Workforce Development plan

 

  1. Pacific Provider and Workforce Development e.g. Pacific providers

 

  1. Mainstream Responsiveness e.g. Pacific Best Practice guidelines

 

  1. Performance Improvement e.g. Pacific health needs analysis by ethnic group

 

Health Inequalities

Health inequalities are consistently seen whether we measure health by prevalence of risk factors, access and use of services, or health outcomes.    Inequalities in health status between groups are unjust and inequitable, avoidable and detrimental to all New Zealanders.  Inequalities do exist between Pacific peoples and other population groups and we must address.

 

Health determinants

Determinants of the health and wellbeing of Pacific peoples often lie outside of the direct influence of the health and disability sector.  Some of the most obvious are age, sex and hereditary factors, but there is a growing body of evidence for less direct determinants of health.  These determinants are varied and include factors such as income and employment, housing conditions, urban design, water quality and education as outlined in Figure 1.

Figure 1: Determinants of Health, Source: Dahlgren and Whitehead 1991

A model like this is useful because it illustrates that health is determined by a complex and varied combination of factors, and that each factor can contribute to health outcomes in a variety of ways.

 

The Social Report 2007 reports on a number of socioeconomic determinants of health and some of these are highlighted below.

 

Improvements are seen in educational achievements of Pasifika over the last 20 years.  For example, the percentage of Pasifika with at least an upper secondary qualification has increased from 36.7% in 1986 to 65.9% in 2006 and the rates for those with a tertiary qualification 1.8% to 8.8% in the same period.  These rates are, however, considerably lower than for all other population groups.

 

The proportion of Pasikifa living in households with gross real income less than 60% of the median equivalised national income benchmarked at 2001, has dropped from 27.8% in 1986 to 25.4% in 2006.  The data does show there was increase poverty for Pasifika in the 1990s and into the early 2000s (see Table 1 below)

Table 1:  Population with low incomes, by ethnicity (measured as households with gross real income less than 60% of the median equivalised national income benchmarked at 2001)

For Pasifica, rates of household crowding, as measured by the proportion of the population living in crowded housing (i.e. requiring one or more additional bedrooms, as defined by the Canadian Crowding Index), has decreased from 56.5% in 1986 to 49.6% in 2006.  These figures for overcrowding are substantially higher than for other population groups (see Table 2 below).

Table 2:  Household crowding, by ethnicity

 

In terms of connectedness, telephone access fro Pasifika has increased from 78.5% in 1996 to 90.5% in 2006 and internet access has increased by 18.2% in 2001 to 33.8% in 2006. Again, these figures are considerably lower than other population

Pacific Demographics

Approximately 50,000 Pasiifika live in the Auckland DHB area, which represents 11.2% of the total Auckland DHB population.  The Pasifika population is a ‘young’ population (see Table 3 and 4 and Figure 2 below).

 

Table 3: Auckland DHB resident population by age and ethnicity (priorititised), 2006

Table 4: Auckland DHB Pacific resident subpopulations by age and ethnicity (total response), 2006

Figure 2: Auckland DHB Māori, Other and Pacific population structures, 2006

Pacific subpopulations

The Samoan population is the largest Pacific subpopulation, numbering 21,879 or 40.18% of the total Pacific population.  The next largest group is the Tongan group at 14,811 or 27.2%.  The smallest population group is the Tokalauan group at only 387 or 0.71% (see Figure 3 below).

Figure 3: Pacific subpopulation - number and percent, Census 2006

Pacific population by age groups

The Pacific population is a young population, with approximately 66% of the population being under age 25 (29,685).  12.6% of the population are 0-4 years of age, 23.6% 5-14 years and 18.3% aged 15 – 24 years.  On the other hand, only 4.8% (2,631) are aged 65 or over (see Figure 4 below) 

 

Figure 4: Pacific population by age group - number and percent, Census 2006

Pacific peoples’ location

The following table (Table 5), figure (Figure 5) and map (Figure 6) shows the locations of the Pacific population within the Auckland DHB region.  The highest population density areas for Pacific are in the high deprivation and low socio-economic wards of Avondale-Roskill and Tamaki-Maungakekie.

Table 5: Pacific population by Auckland City ward, Census 2006

Figure 5: Pacific population by Auckland City ward, Census 2006

Figure 6:  The Auckland DHB Pacific population, Census 2006 (pink colour = high density; green = low density)

Socio economic status

Most Pacific peoples (73%) live in the most deprived areas of the Auckland DHB region (deciles 8-10) as shown in Table 6 and Figure 7 below:

Table 6:  Auckland census 2006, deprivation by ethnicity

Figure 7:  Pacific population by age deprivation, census 2006 (Q5 and Q4 are most deprived)

Table 7 below shows socio economic deprivation by the Pacific subgroups.

Table 7:  Pacific population sub-group by deprivation, census 2006

Health Risk factors

A number of modifiable health risk factors impact on our health and wellbeing.  These include physical activity (or rather a lack of it!), nutrition, smoking, drug and alcohol use.  These risk factors impact to cause more proximal risk factors, such as obesity, hypertension (high blood pressure) and hypercholestolaemia (high blood cholesterol levels).

These more proximal risk factors have been shown to have major impacts on the development of a range of poor health conditions, including diabetes, heart disease, stroke and cancer.

Lack of physical activity

Regular physical activity is recognised as being beneficial for health.  A lack of physical activity is a risk factor for heart disease, stroke, hypertension, type 2 diabetes, colon cancer, and premature death.  Current recommendations are for 2.5 hours of moderate physical activity (similar to brisk walking) per week.

Physical activity is not measured on a national basis in New Zealand and is therefore not easy to gauge.  SPARC, in their 1997, 1998 and 2000 Sport and Physical Activity Surveys, interviewed a total of 16,500 New Zealanders – 12,500 adults (people aged 18 and over) and 4,000 young people (5–17-year-olds) about their participation in physical activity and sport.  Participants were chosen for the survey at random from 12 regions (covering the 17 regional sports trusts (RSTs)).  Data from Auckland Central has been used for the following findings.

Young people

Our young people exercise less than the national average.  Sixty-three percent of our young people are active, spending an average of 5.7 hours per week taking part in sports and active leisure.  This compares to 68% of all young New Zealanders being active for an average of 6.6 hours per week.

The proportion of young people from Auckland Central who are sedentary (no physical activities) increased from 9% in 1999 to 20% in 2001.

Adults

Sixty-eight percent of Auckland Central’s adults are active for more than 2.5 hours per week but half of these are active for 30 minutes or more on at least five days a week.

The more recent 2005 Quality of Life Residents Survey asked respondents in Auckland City how often they took part in physical activity.  This was defined as any activity, such as sport, brisk walking, running or gardening that increased their heart rate or breathing for 30 minutes or more.

Fifty-two percent of Auckland residents stated that they participated in physical activity at least weekly, while 34% stated they did some form of physical activity daily.  Six percent stated that they did not ever do any form of exercise or physical activity.

Physical activity frequency by ethnicity

Auckland City residents of Pacific and New Zealand European descent were the most likely to have participated in physical activity about once a week/daily (each with 89%), while Asian and Indian residents were less likely (74%).

Smoking

Smoking is an important, modifiable risk factor for a number of disease including lung cancer, bronchitis, emphysema, heart disease and stroke.  It is the major cause of preventable death in New Zealand with an estimated 4,300–4,600 deaths a year being attributable to smoking, including approximately 390 deaths caused by second-hand smoking (Alcohol Drug Association New Zealand 2004).

Smoking prevalence

Data specific for Auckland DHB was obtained from two sources for comparison - Census 2006 and the New Zealand Health survey 2003.  The comparability of data from these two different sources is difficult because the results from the NZHS were standardised while the census data was not.  However, looking at the crude numbers shows that the differences found are likely to be a conservative interpretation.

Using Census data smoking rates have decreased in Auckland from 18.6% in 1996 to 16.5% overall in 2006.  This is considerably lower than the New Zealand average of 20.7%.  The rate in 2003 according to the NZHS was 20.9% for Auckland and 23.4% for all New Zealand.

The highest smoking prevalence was reported for Maori in both Auckland DHB and New Zealand in total, followed by Pacific people and then European.  The lowest rate was reported for Asian people.

Table 8  Auckland DHB adult (15 years+) population current smokers, by ethnicity, 2006 vs 2003

Prevalence of passive smoking

Passive smoking refers to the exposure of non-smokers (including ex-smokers) to cigarette smoke in the home, car, workplace, and recreational or other settings.  Here we consider only the home environment.  Overall, one in 15 adult non-smokers (6.7%; 6.1–7.4) was exposed to cigarette smoke inside their home.  There was no significant difference in the proportion of male non-smokers (7.5%; 6.2–8.7) and female non-smokers (7.1%; 6.0–8.2) who were exposed to cigarette smoke inside their home.  In males, Maori non-smokers were significantly more likely than European/Other non-smokers to be exposed to cigarette smoke inside their home.  In females, Pacific non-smokers were significantly more likely to be exposed to cigarette smoke inside their home than European/Other non-smokers.

Marijuana smoking

More than one in three Auckland adults has tried marijuana in their lives (37%; CI 35–39) but this is significantly lower than the overall New Zealand rate of 42% (CI 40–43).  But for Maori, regardless of gender, 59% (CI 53–65) had smoked marijuana in their lives.  This compares to the European rate of 37% (CI 41–46), a Pacific rate of 32% (CI 24–40) and an Asian rate of 6% (CI 3–9).

Alcohol consumption

Alcohol is an important cause of morbidity and mortality.  Cirrhosis and other alcohol liver disease, pancreatitis, endocrine disorders, cardiomyopathy, gastritis, high blood pressure, haemorrhagic stroke, some cancer, intentional and unintentional injuries, unsafe sexual practice, domestic violence, criminal offending and mental disorders are all recognised adverse effects of alcohol consumption (MoH, 1998).  Alcohol use in pregnancy can result in birth defects (foetal alcohol syndrome).

A recent ALAC report estimated there are 1,040 alcohol-related deaths in New Zealand each year (3.9% of all deaths) and 980 deaths prevented by alcohol.  The burden of deaths falls largely on males, Maori and the young, mostly through injuries (51% of alcohol-related deaths).  There is a balance of 12,000 years of life lost each year (72% accounted for by injuries) through the use of alcohol.  A different study in the Auckland emergency department found that alcohol was related to 35% of injury cases seen.

 

Data presented here is from the New Zealand Health Survey 2003.  This survey used the AUDIT (Alcohol Use Disorders Identification Test) questionnaire to examine alcohol use.  The AUDIT is a 10-item questionnaire covering alcohol consumption, alcohol-related problems and drinking behaviour.  Each question is scored from 0–4 and the questionnaire has a maximum possible score of 40.  The higher the score, the more problematic the pattern of alcohol consumption is considered to be.  Individuals with an AUDIT score of 8 or above are likely to suffer physical, mental and or social effects as a consequence of their alcohol consumption (MoH, Our Health, Our Future).

Prevalence of past year alcohol use

Nationally eight out of 10 adults (83.5%; CI 82.7–84.4) reported having had a drink containing alcohol in the last year.  The prevalence of past year alcohol use was significantly higher in males (88.5%; CI 87.3–89.6) than in females (80.3%; CI 79.0–81.6).

In males and females the prevalence of past year alcohol use was highest in the European/Other ethnic group, followed by Maori, Pacific and Asian ethnic groups.

In males and females the prevalence of past year alcohol use was significantly higher in NZDep01 quintile 1 (least deprived) than in quintile 5 (most deprived).

Hazardous drinking

About one in five New Zealand adults (19%; CI 18–20) are hazardous drinkers, but in Auckland the prevalence was significantly lower than the whole of New Zealand (15%; CI, 14–17). Males had significantly higher hazardous drinking habits than females, regardless of their ethnicity.  The highest prevalence of hazardous drinking was for Maori and Pacific adults followed by European/Other but this difference was not statistically significant.  Asians had the lowest prevalence of 3 percent (CI, 1-5).and this was statistically significant.

 

Obesity and overweight

Obesity is associated with high incidence of all-cause mortality, cardiovascular disease, stroke and type two diabetes.  Relationships have also been identified between increasing body mass and increased blood pressure, cholesterol levels, gallstones, some cancers, obstructive sleep apnoea, osteoarthritis and some female reproductive disorders.

One of the commonly used obesity measure is the body mass index (BMI), calculated by dividing weight (kg) by height (metres) squared.  Figure 18 below shows the obesity prevalence from the 2003 NZ Health Survey (for Maori and Pacific this is a BMI equal or more than 32, whereas for ‘Others’ the BMI is equal to or more than 30).  The overall prevalence in New Zealand and Auckland DHB was around 20%, slightly higher than the result of the Nutritional Survey 1997.

Females were slightly higher than the males, except in Maori where females had lower prevalence than male; although the differences between genders were not statistically significant.  Pacific people had the highest prevalence rate of around 50% and for both males and females; the difference from other ethnicities was statistically significant.  Only around 5% of Asian people were categorised as obese using BMI, and the difference was statistically significant compared to all other ethnicities.  However in Auckland DHB, the European and Maori rates were 17% and 23% respectively, lower than the whole of New Zealand (though not statistically significant).  Comparing the national figures for Maori for 2003 and 1997, there were no major changes for females and very slight reduction in male prevalence.

In both males and females, the prevalence of obesity was significantly higher in NZDep01 quintile 5 (most deprived) than quintile 1 (least deprived).

Overweight is defined as a BMI more than or equal to 25 for European and Others and over or equal 26 for Maori and Pacific.  One in three adults was overweight.  Overall males had statistically significantly higher prevalence than females for the whole of New Zealand and Auckland DHB (male 39%, CI 36–42; female 27%, CI 24–30).  This finding was repeated in all the ethnic groups; however males were only statistically significantly higher than females in the European ethnicity.

Combining both obese and overweight prevalence is shown in Figure 18 below, more than half of the population were obese or overweight.  However, Auckland had slightly lower prevalence than New Zealand.

Figure 8:  Prevalence of overweight and obesity, New Zealand vs Auckland DHB, by ethnicity and gender, 2003

Poor nutrition

There is increasing epidemiological evidence that fresh fruit and vegetable consumption offers protection against cancer at many sites, especially the colon and lung, and diets high in fruit and vegetables are also protective against ischemic heart diseases (IHD).  Currently, New Zealand adults are recommended to eat five or more servings of fresh fruit and vegetables each day (MoH, Our Health, Our Future, 1999).

Fruit and vegetable intake was measured in the New Zealand Health Survey 2003 by asking the participant about the number of servings they eat each day on average.  The information about the serving size was provided as guidelines.

Over half of the adults ate the recommended two or more servings of fruit every day, however females have higher prevalence of this protective factor than males in all ethnic groups, with statistically significant differences overall and in Europeans.

Nationally, in both males and females, the proportion of adults eating two or more servings of fruit each day was lowest in the 25–34 years age group, and then increased with age.  In males, the proportion eating two or more servings of fruit each day was similar in all NZDep01 quintiles.  Females living in NZDep01 quintile 1 (least deprived) were significantly more likely than females living in quintile 5 (most deprived) to eat two or more servings of fruit each day.

Overall two out of three people eat the recommended three or more servings of vegetables every day with a similar pattern for gender differences to fruit (above) and more variation between ethnic groups overall.

Nationally, in both males and females, the proportion of adults eating three or more servings of vegetables each day increased with age.  In both males and females, the proportion of adults eating three or more servings of vegetables each day was higher in NZDep01 quintile 1 (least deprived) than in quintile 5 (most deprived), although the difference was significant only for females.

Figure 9 below shows that around 40% of the population had achieved the five servings' recommendation.  However, females were significantly more likely to eat the recommended number of servings than males.  Asian and Pacific people tend to eat fewer vegetables than the other ethnicities.  However, all the community tend to have the same level of fruit intake.  In all the ethnicities, females tend to comply better than males with recommended fruit and vegetables intakes.

Figure 9:  Prevalence of the recommended five servings (two fruit and three vegetables), New Zealand vs Auckland DHB, by ethnicity and gender, 2003

Life expectancy

There is considerable ethnic variation in life expectancy in the Auckland DHB region.  Figure 10 below shows that Pasifika males in the highest socioeconomic quartiles have better life expectancy than those in the lower quartiles but for females the picture is not so clear.

Figure 10: Auckland city life expectancy (2003-2006) by ethnicity, gender and deprivation

Mortality

Of the 2,260 people who died in Auckland DHB in 2005, 130 (6%) were identified as Maori and 205 (9%) as Pacific people.  The Auckland mortality rate for Pacific people was the third lowest nationally (out of fewer DHBs with sufficient numbers to calculate rates).  For “Others” (non-Maori non-Pacific people) almost all the DHBs had similar rates.  See Table 9 below:

Table 9:  All-cause mortality (Age-standardised rates per 1,000)

Figure 11 shows the trend for mortality comparing Auckland DHB to New Zealand by ethnicity.  All mortality rates for all ethnicities decreased between 1996 and 2005, however, Auckland DHB is decreased more rapidly than New Zealand overall.

Figure 11:   Mortality trend by ethnicity, Auckland DHB vs New Zealand, 1996–2005

In 2005 only 18% of non-Maori non-Pacific (Others) deaths occurred before 65 years of age, compared with 57% for Maori and 43% for Pacific people.  Seven percent of Maori deaths occurred after age 85 years compared to 40% for Others and 11% for Pacific people.

Age-specific mortality rates show that Maori and Pacific people have a higher mortality rate for age groups 50 years and over.

The age-standardised rate and relative risk (compared to Other ethnic groups) by age group, gender and ethnicity for the period 2003–2005 in Auckland DHB show that rates for Maori and Pacific people are higher compared to Other.

 

Hospitalisation

Pacific people in Auckland DHB have the second highest total hospitalisation rates, after Māori. Table 10 shows all-cause hospital admission rates by ethnicity for Auckland DHB compared with the other DHBs in the Auckland region.

Table 10: Total Hospitalisations (Age-standardised rates per 1,000)

Figures 12 and 13 below show discharge rates and cost weights by ethnic groups.  Regardless of length of stay Pacific people and Maori, have the highest hospitalisation rates.  Rates for all groups remain relatively constant. 

A similar pattern is seen for cost weights, although the rates are falling, particularly for longer lengths of stay, and the Maori and Pacific rates are closer together.

Figure 12:  Auckland DHB hospital discharge rates by ethnicity and length of stay, 2001-2005

Figure 13:  Auckland DHB hospital discharge cost weight rates by ethnicity and length of stay, 2001-2005

Avoidable hospitalisation

Fifteen percent of Auckland DHB general hospitalisations were categorised as avoidable by either primary care interventions or public health strategies.  Auckland DHB’s rate was similar to Waitemata, and ranked at number seven out of 21 DHBs.  There were slight decreases in the avoidable hospitalisation rates for the period 2001-2005.  Ambulatory sensitive avoidable discharges (ASH, sensitive to primary care interventions) make up the main portion of avoidable hospitalisations, compared to public health measures (PH). 

Pacific people’s ASH was the highest, followed by Maori, both ethnic groups had nearly double the rate of Non Maori Non Pacific, at 51/1000, 50/1000 and 25/1000 respectively.  However, the PH for both Maori and Pacific people was similar with rate of around 7/1000 population, again nearly double the rate of Non Maori Non Pacific at 3/1000. 

Causes of avoidable hospitalisation varied by age, gender, ethnic group and socio-economic status.  Most common conditions were angina and ischaemic heart diseases, diabetes, respiratory related conditions (asthma and COPD), and infections / infectious conditions (gastroenteritis, cellulitis and ENT infections).

The top avoidable conditions amenable to primary care for both Maori and Pacific people were gastroenteritis and diabetes.  However, for Non Maori Non Pacific the top condition amenable to primary care was ischemic heart disease.

There was not much change in ASH and PH rates by ethnicity between 2001 and 2005 as shown in Figure 12 below.  Pacific people’s ASH was the highest, followed by Maori, both ethnic groups had nearly double the rate of non-Maori non-Pacific, at 51/1,000, 50/1,000 and 25/1,000 respectively.  However, the PH for both Maori and Pacific people was similar with rate of around 7/1,000 population, again nearly double the rate of non-Maori non-Pacific at 3/1,000.

Figure 14:  Avoidable hospitalisation (ASH and PH) rates by ethnicity, Auckland DHB, 2001–2005

Disability

In 2001, Statistics NZ conducted the household disability survey which examined the day to day living arrangements and activity restrictions of 7,256 adults and children with disability living in households. An analysis of the information from this survey along with data from the 2001 Census has been published in Living with Disability in New Zealand. All of the information for this section has been sourced from this report.

In New Zealand in 2001, 22% of adults and 11% of children living in households had a disability. This was an estimated 716,500 people, half of whom were in the 25 to 64 year age group. 

Disability increases with age and rates are much higher in older age groups.  Eighty-seven percent of people aged 85 years and older and 58% of people aged 75 to 84 years had a disability.  Males had a slightly higher rate of disability than females, and a contributing factor to this disparity was the higher rate among boys than girls (13% and 9%).

The rate of disability, by age-standardised rate of disability per thousand people, was highest for Māori (24), followed by European (18), then Pacific (17) and then Asian/Other ethnic groups (13). 

Twenty percent of Pacific people with a disability were children, compared to 9% for Europeans and 11% for Asian/Other ethnicities. 

Primary health organisations

There are currently six Primary Health Organisation’s (PHO) in the Auckland district but this will soon reduce to five.  They are:

·         Auckland PHO Limited

·         AUCKPAC (Pacific-Led)

·         ProCare Network Auckland

·         Tamaki Healthcare Charitable Trust (Māori-Led)

·         The Tongan Health Society Incorporated (Pacific-Led)

·         Tikapa Moana PHO Trust (until 30 June 2008, after which this PHO will become part of Auckland PHO Ltd.)

The following table (Table 11) shows client ethnicity within all Auckland DHB PHO’s.  The largest number of Pasifika are enrolled with ProCare.

Table 11: Number of clients enrolled within an Auckland District PHO by Ethnicity.

Comparing the 2006 Census data and PHO enrolment highlights that more Pacific peoples were enrolled with an Auckland DHB PHO by the 1st April 2007 than the resident population.  The excess are Pacific peoples residing outside of the Auckland district.  The Auckland DHB recognises the issues associated with this including ethnicity data collection, access to primary care services and Pacific-led health service providers, and effective service delivery to Pacific clients by mainstream PHOs. 

Use of Pacific health providers

The percentage of Pacific people who had attended a Pacific health provider was identified from the New Zealand Health Survey 2002/03 as those who stated they had seen a healthcare worker at a Pacific health provider in the last 12 months.  Results were presented for the Pacific ethnic group only due to the small number of non-Pacific using these services (see Table 12 below).

Table 12:  Percentage of Pacific people who saw a healthcare worker at a Pacific health provider in the past 12 months

Nationally, one in 11 Pacific adults (9.4%; 5.8–13.0) had seen a healthcare worker at a Pacific health provider in the last 12 months.  Among Pacific adults visiting a Pacific health provider, the most common types of healthcare worker seen were:

o        doctors (60.8%; 36.4–85.2)

o        nurses (17.2%; 5.1–29.2)

o        health promoters (10.7%; 0.0–23.0).

 

The most common reasons Pacific adults gave for seeing a healthcare worker at a Pacific health provider were:

o        a routine check-up or health advice (51.1%; 35.6–66.6)

o        a short-term illness or temporary condition (27.4%; 7.7–47.1)

o        a disability, long-term illness or chronic condition (15.4%; 4.7–26.0).

 

The main reasons given by Pacific adults for choosing a Pacific health provider were:

o        ”I feel more comfortable talking to someone who understands my culture” (74.4%;
57.9–90.9)

o        “it was cheaper than going to another provider” (37.7%; 18.2–57.3)

o        “I find they are willing to spend more time discussing my health” (31.8%; 15.0–48.5)

o        “they are interested in the impact that my health and its treatments has on my aiga or family” (25.9%; 15.5–36.3)

o        “they were the closest provider” (14.6%; 2.7–26.5)

o        “I was referred to them by a friend or relative” (11.9%; 2.7–21.1).

 

Overall, almost all Pacific adults who saw a Pacific health provider about their health were very satisfied (43.6%; 25.8–61.3) or satisfied (55.5%; 37.8–73.3) with the consultation.  Of the few Pacific adults dissatisfied or very dissatisfied with the consultation, the reasons given were:

o        “costs too much”

o        “didn’t like doctor or couldn’t talk to doctor or doctor wouldn’t listen”.

 

Overall, one in 32 Pacific adults (3.1%; 1.3–4.9) said they had wanted or needed to see a Pacific health provider in the last 12 months, but were not able to.

There was no difference in the proportion of Pacific males (3.2%; 0.0–6.7) and females (3.3%; 0.9–5.7) that reported an unmet need for a Pacific health provider.

 

Among the few Pacific adults who reported an unmet need for a Pacific health provider, the most common reasons given were:

o        “couldn’t get in touch with the provider”

o        “none in my area”

o        “couldn’t get an appointment soon enough or at a suitable time or it was after hours”

o        “had no transport to get there”.

 

Prioritisation

Figure 15 below shows the top ten major priorities for Auckland DHB by ethnicity.  These are calculated by combining data for mortality, years of life lost (YLL), avoidable mortality and avoidable hospital discharges.  For Pacific, the highest priorities are ischaemic heart disease, diabetes, COPD and then cancer.      

Figure 15:  Top ten major priorities for Auckland DHB by ethnicity