The State of Child Health in Aotearoa NZ

Second State of Child Health Report from Cure Kids confirms the worsening impact of high-burden diseases

Cure Kids’ annual State of Child Health Report released 22nd June 2022 identifies four high-burden disease groups which are sending children in Aotearoa New Zealand to hospital at increasing rates.

Cure Kids is New Zealand’s largest charitable funder of medical and scientific research for children’s health. It partnered with the Paediatric Society of New Zealand, the Royal Australasian College of Physicians, and the New Zealand Child and Youth Epidemiology Service at the University of Otago to analyse data for the report’s second edition.

The report benchmarks the health of New Zealand children in relation to data on rates of dental disease, respiratory conditions, and skin infections in 2020. This report also reviews the impact of acute rheumatic fever and rheumatic heart disease for the first time. These conditions have serious acute and long-term effects on children and young people, which create significant burdens for communities and health systems.

The latest report reveals that overall, the rates of all four diseases are too high relative to other resource-rich countries, and for dental disease and respiratory conditions, hospitalisation rates are continuing to increase.

“New Zealand continues to report a disproportionate burden of disease among our tamariki and rangatahi,” says Cure Kids CEO Frances Benge.

“Our report aims to galvanise action to reduce these health issues. The statistics show what a daunting challenge we face: not only in the rates of disease, but also in the clear pattern of inequity. Reversing these trends will require collaborative efforts across New Zealand, and not just by the hardworking healthcare professionals who care for our children in hospitals and clinics around the country.”

Key findings

The report found that respiratory conditions are the leading cause of acute admissions to hospital for Kiwi children. Since 2000, the rate of hospitalisations for children with serious respiratory conditions has increased, most notably for acute bronchiolitis, asthma and wheeze. In 2020, one in seven children aged 2-14 years were being treated for asthma.

For dental disease, on average in 2019, 41% of 5-year-olds and 31% of Year-8 children had evidence of tooth decay. Since 2000, average rates of dental decay have declined overall, but the rate of hospitalisations for children with serious dental decay has increased steadily. Rates of tooth decay and hospitalisation have been consistently highest for Pasifika and Māori children, and those living in the most deprived areas had three times the number of tooth extractions as those in the least deprived areas.

For skin infections, the rate of hospitalisations for children with serious infections was increasing until 2011 but has since been gradually decreasing. Serious skin infections like cellulitis make up nearly 4% of hospital admissions for children, with the highest rates in 1-year-olds and other young children.

For the first time, the report investigates data for rheumatic fever and rheumatic heart disease. It found that rates of hospital admissions for children with acute rheumatic fever and rheumatic heart disease have remained high over the past 20 years in New Zealand, despite efforts to reduce them. This burden of disease is particularly high for Pasifika children, who were admitted to hospital for rheumatic fever 140 times more often than children of “European or Other” ethnicities. Māori children were admitted to hospital for rheumatic fever 50 times more often than children of “European or Other” ethnicities.

New Zealand’s Children’s Commissioner, Judge Frances Eivers, provided commentary on the State of Child Health Report, saying New Zealand is a long way from meeting the UN Convention on the Rights of the Child and its aspiration for every child to access the best healthcare possible.

“On many measures, New Zealand is currently one of the worst places in the developed world to be a child. Many of our mokopuna start accumulating health issues from their very first days, and by the time they are young adults they are carrying a heavy burden of disease. The burden is not equally spread. Almost one third of our mokopuna bear the brunt of health conditions, and therefore experience significant disadvantage, often along with social and economic deprivation, which is clearly shown to be associated with poor health,” says Judge Eivers.

Recommendations

Cure Kids says the collaborative research exercise highlighted worsening health trends since its 2020 report, as well as gaps in data and the need for initiatives to more closely monitor conditions over time.

“This report highlights the inexcusable inequity that exists in our health outcomes for children. We can no longer just provide the ambulance at the bottom of the cliff. Focused effort is required to detect and improve preventable risk factors, to identify and better manage mild disease, and to have better national data to enable us to evaluate and monitor healthcare interventions in real time,” says Professor Stuart Dalziel – Paediatrician and Cure Kids Chair of Child Health Research, at the University of Auckland,

“There is an urgent need for New Zealand to prioritise implementation of evidence-based measures to detect, prevent, and treat disease as early as possible, and to improve care for children. For all conditions listed in the report there is the potential to dramatically reduce the health burden affecting our children. New Zealand needs social and health policies that prioritise children such that every child in this country has access to the same health outcomes regardless of location, socioeconomic status, and ethnicity.”

With persistent inequalities linked to ethnicity and income highlighted, Cure Kids and its partnering organisations agree on the need to urgently prioritise equity in health outcomes for all New Zealand children. These measures should include leadership from Pasifika and Maori communities, and strategies to allow whanau to self-manage care for their children, with easier access to high-quality healthcare.

“Upstream measures designed to end poverty, and address risk factors such as unsafe housing conditions and poor nutrition, can be expected to have positive effects on all four of these health issues.”

Public health measures which are proven to prevent disease should also be urgently implemented wherever there is evidence. These include cost-effective preventive strategies at the national level to reduce risk factors tied to housing conditions, limit tooth decay due to unhealthy foods and drinks, and enable nurse-led school-based clinics and other child-centred services to address skin infections and sore throats.

However, where evidence gaps remain, there is a need for investment in health research. Experts are working to deliver a pipeline of vital information and tools that will accelerate the efforts of healthcare professionals. Cure Kids has made continued investments in research on all four of these health issues, with partners including other charities, the government, corporates, trusts and foundations, research institutions, and organisations in the healthcare sector.

The partners have already agreed that the mental health of children and young people in Aotearoa should be the next priority for addition into the next annual edition of the State of Child Health Report.