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The risk of dying from Covid-19 is at least 50% higher for Maori than for New Zealanders of European descent, according to our study published today.
Historically, Maori and Pacific populations are at increased risk of hospitalization and death from pandemics. During the 2009 influenza pandemic, the infection rate among Maori was twice that of Pakehā (European New Zealanders). Maori were three times more likely to be hospitalized and almost three times more likely to die.
Our results show that if Covid-19 were allowed to become widespread in New Zealand, it would have a devastating impact on Maori and Pacific communities.
Greater risks for Maori and Pacific people
Evidence from abroad shows that ethnic minority communities are at a higher risk of serious health problems due to Covid-19. In some parts of the US, Pacific Islanders are being hospitalized up to 10 times more than other ethnic groups. In the UK, ethnic minority and black groups are suffering death rates twice those of whites.
Our study was based on international data on risk factors for death from Covid-19, including heart disease, diabetes, and asthma. We combined them with data on the prevalence of these conditions in different ethnic and age groups in New Zealand.
We also take into account the fact that Maori and Pacific people have a lower life expectancy and higher unmet health care needs than European New Zealanders.
We found that the risk of death from Covid-19 was at least 50% higher for Maori. It could be more than double the rate for European New Zealanders if the level of unmet health care need is actually higher than official data can capture. The risk to Pacific residents could also double that of European New Zealanders.
One of the immediate reasons for the increased risk faced by Maori and Pacific people is that they have higher rates of existing health problems. These are strongly associated with more severe Covid-19 outcomes.
The Maori and Pacific populations are, on average, younger than Pākehā. But they have a shorter life expectancy and tend to experience health problems at a younger age. They also experience higher rates of unmet need for health care and higher levels of poverty, which has been shown to have a significant effect on death rates.
For these reasons, Maori and Pacific people are also at a higher risk of becoming seriously ill and having to go to hospital as a result of Covid-19. Unfortunately, we are now beginning to see this happen. Covid-19 cases among Maori and Pacific people have been roughly twice as likely as other ethnic groups to require hospitalization.
Poor housing contributes to increased risk
Our study looked at the risk of death only once someone has been infected with Covid-19. But there are other factors that increase the risk of infection among Maori and Pacific people.
A recent study from the United Kingdom showed that infection rates were much higher for people living in a large household or in poorer areas, while the epidemic in China indicated that around 80% of community transmission came from the homes.
Approximately 25% of Maori and 45% of Pacific people live in overcrowded houses. They are also more likely to work in jobs or workplaces with higher health risks, including infection.
Covid-19, therefore, would be a double whammy for these communities: a higher rate of infection and an increased risk of serious illness or death after infection.
Implications for the Covid-19 response
These findings show the potentially devastating impact that Covid-19 could have on Maori and Pacific communities in New Zealand. The pandemic has the potential to intensify existing social inequalities that result from colonization and systemic racism.
Our healthcare system was under pressure prior to Covid-19 and was already being challenged by its uneven care. The results of our study reinforce the importance of controlling the virus and preventing it from spreading to communities at risk. It also highlights the need for measures that work well for affected communities to protect groups at risk.
A “one size fits all” approach will result in higher rates of preventable illness and death for Maori and Pacific communities. Te Rōpū Whakakaupapa Urutā, the National Maori Pandemic Group, has clearly argued that if New Zealand is to avoid these outcomes, the response to the pandemic must focus on fairness.
Routine monitoring and reporting of the impact of the pandemic must explicitly address equity. That will require an approach that supports communities to design and deliver interventions that are effective for them.
