Increasing geographical inequalities in health in New Zealand, 1980-2001

BACKGROUND: Recent studies have noted widening health inequalities between rich and poor areas in a number of OECD countries. This paper examines whether health in New Zealand has become more geographically polarized during the period 1980-2001, a time of rapid social and economic changes in New Zealand society. METHODS: Mortality records for each year between 1980 and 2001 were extracted for consistent geographical areas: the 21 District Health Boards operating in New Zealand in 2001 and used to calculate male and female life expectancies for each area. The geographical inequalities in life expectancy were measured by calculating the slope index of inequality for each year between 1980 and 2001. RESULTS: Although overall life expectancy has increased during the period of study, New Zealand has experienced increased spatial polarization in health, with a particularly sharp rise in inequality during the late 1980s and early 1990s. Since the mid-1990s regional inequality has remained at stable but high levels. The polarization in mortality was mirrored by a growth in income inequality during the 1980s and 1990s. CONCLUSIONS: Health inequalities as expressed geographically in New Zealand have reached historically high levels and show little sign of abating. In order to tackle health inequalities, a greater commitment by the New Zealand government to a more redistributive social and economic agenda is required. Furthermore, issues of differentiated and health selective migration, emigration, and immigration need to be addressed as if these are important they should matter more for New Zealand than for almost any other developed nation-state.