Ethnic Differences in Premature Mortality over Three Decades – the Intersection Between Indigeneity, Social Class and Preventability

This study uses national-level mortality data to investigate the changing social class and ethnic patterns in premature mortality in New Zealand men from 1975 to 2006. During this period there was a political struggle for recognition of indigenous rights, a social policy focus on inequality, and major macro-economic reform. We used information from national death registrations and national census data from the five yearly national population censuses from 1976 to 2006 to examine changing patterns in social class differences in all cause, preventable, and non-preventable mortality for Maori and non-Maori men under the age of 65. Our results show that social class differences in male mortality have increased since 1975. Maori male mortality was significantly higher than non-Maori mortality in each social class for preventable, non-preventable and all causes of mortality. The social class mortality differences within Maori were markedly greater than those within non-Maori.

Despite focussed efforts to improve Maori health, the inequality between Maori and non-Maori in premature mortality appears to be increasing, even when social class differences are taken into account. The persistently higher Maori rate of potentially preventable deaths indicates that the health sector is still not meeting the serious health needs of many Maori.  It also appears that there is increasing social stratification developing within the Maori population such that the social class differences in mortality within Maori are now larger than the inter-ethnic differences between Maori and non-Maori. We present several reasons why decades of indigenous development have not overcome ethnic differences in a fundamental marker of population health such as premature mortality but have resulted in increased inequality within the indigenous population.