First joint health needs assessment of WDHB and MDHB residents

A report on the health status of Whanganui and MidCentral District Health Board (DHBs) residents has found that while mortality rates have improved, the rates for WDHB residents were consistently higher than MDHB and national rates.
It is the first time a health status report has been written across the two DHBs.  The report is part of their commitment to work together under the centralAlliance.  Considering the health status of the entire population is a prelude to a joint approach to health service planning across the two DHBs.
MDHB funding division clinical advisor and report author Dr Richard Fong looked at demographics, socio-economic disadvantage, general health status and the major causes of mortality across both DHBs. The report, presented to MDHB’s community and public health advisory committee on Tuesday 5 July, will go before the WDHB committee in August.
Both DHBs had higher proportions of Maori, lower proportions of Pacific people, and higher numbers of people over 65 years in their districts, compared to New Zealand. Dr Fong said over time mortality rates had fallen for both DHBs and New Zealand, implying improved health status.
He said in comparing socio-economic disadvantage (which research shows to be associated with poorer health status) MDHB has a greater proportion of people with higher scores of socio-economic deprivation compared with New Zealand, and Whanganui has an even greater proportion than MDHB.
Both DHBs have communities with higher deprivation scores. In MidCentral DHB it is Horowhenua and Otaki. In Whanganui DHB it is Wanganui and Ruapehu.
Dr Fong said ‘all cause’ (all causes of death) mortality was used as a general indicator of population health status – the healthier the population, the lower the all cause mortality rate. While mortality rates have been improving for most population groups across both DHBs, Pacific mortality numbers are too small to identify a pattern.
Although they have declined over the years, Whanganui DHB mortality rates have been consistently higher than the MidCentral and New Zealand rates. And MidCentral’s all cause mortality rates are higher than the national average, although the gap has been closing. It is now five percent.
Looking across the two DHBs, the population groups experiencing poorer health status are: Maori; Pacific peoples; people who are socio-economically disadvantaged; Horowhenua residents; and Whanganui (especially Wanganui, and Ruapehu District Councils) residents.
The major causes of mortality, which helps indicate which health conditions should receive the most attention to improve the health of populations, were the same for both DHBs. They are:
  • Circulatory disease (diseases of the heart and blood vessels) – usually responsible for about 40% of deaths
  • Cancer – around 25% of deaths
  • Respiratory disease – 8-9% of deaths
  • External causes (deaths due to accidents, and injuries) – 5-6% of deaths, and
  • Conditions of the endocrine, metabolic, and immunity systems (especially diabetes) – around 6% of deaths.
All DHBs closely monitor health trends and they use the information to adjust the services they provide.
Based on this kind of demographic and health status information MidCentral DHB made the decision to boost community health services, with particular attention to chronic conditions.
MidCentral senior portfolio manager Primary Health Care Craig Johnston said: “Starting back in 2004 MidCentral identified that our population was not as well as it should be, and that to improve health we needed more primary health care, not more hospital services.  Since then we have invested about $8millon a year in additional services. Most of the new services have been aimed at chronic conditions like diabetes, cardiovascular disease and respiratory disease, improving the management of these conditions in the community so people stay well without the need to go to hospital.
“Horowhenua and Otaki come through as being particularly needy communities. In all our investments we have paid particular attention to these communities.  We make sure they have more resources per head of population than other communities. And when we are setting up new initiatives and services, we usually do it first in Horowhenua so the local people get the benefits first.
“Improving the health of a population takes a long time – particularly when you are thinking about diabetes and cardiovascular disease, both of which are life long conditions. The fact that the all cause mortality rate for MidCentral is moving closer to the New Zealand average we take as an indicator that our extra services are starting to pay off. In future we want to be better than the New Zealand average.
“We are also looking forward to working with Whanganui DHB to achieve similar gains for the total population.”