Lecture 12 (Main Focus: Population) New Zealands Changing society

Implications for public health

Key Determinants of Population Change -> Focus is P of the GATE Frame which
represents the Population
Fertility Natural Capability to produce offspring
Birth Statistics Registered with
- Department of internal affairs
- Health information Directorate (Ministry of Health) maintains register
- Statistics New Zealand generates reports
General Trend to note
- Number of live births 1971-2913
- Graphs suggest that the number of life births in 1971 (64,460) were quite similar to the
number of life births in 2013 (64,340)
- Look at the Crude birth rate
- Denominator during the two time periods were different

We see that the crude birth rate for

1971 and 2013 were different
- Decrease in Fertility rate
- Increase in population
- 2nd graph:
- Age- Specific fertility rate (14-58)
considering woman within the fertile
range
- Also important to note that when we
consider the denominator:
- Males cant give birth so statistics are
standardized to exclude male
-1984 First IVF baby born in NZ
- Assisted Fertility treatments
- Fertility rates rapidly taken up by
>35 group
- Increasing trend in the above
30s age group

Fertility Associates Is 40 really the new 30? Promotion of Fertility Assistance

Overall trend
Decreasing Fertility rate in younger groups (Sexual Education, Precautions, Abortions)
Increasing Fertility rate in older groups (Fertility assistance)

Total Fertility rate

- Gives a measure as to how many children on average a family will have
- How many babies a mother will give birth to during the course of her total reproductive
lifetime
- Assumption that female maintains same Age specific fertility rate
- Trends in these changes in fertility rate is not unique to New Zealand

- Measures Family size

- General decrease since 1971 (~3.2) -> 1977 (Just below 2.1)
- Fluctuations (Increases during 1990, and 2008)
- Has changed with the role of woman changing as well i.e. social status of woman
Replacement level
- TFR level required for a population to replace itself without migration
- Number 2.1 is quite significant
- Takes into consideration that not ALL family have children
- Some family -> miscarriages, premature death
When TFR falls below the replacement level
- Government will need to reply on migration
- Migration policies incentives for migrants
Mortality
- Death statistics (Need to register death to the
coroner)
- Department of Internal affairs
- Health Information Directorate at the Ministry of
Health Maintain and Report
Mortality is Trending downwards (Death
rate -> Trending downwards)
- Death is increasing
- Population is also increasing

Infant Mortality rate:

- Denominator is the number of live births not the number of people
-COT Death -> sudden infant death syndrome
- NZ Cot Death study recommended:
- Baby sleeps in prone position
- Mum doesnt smoke during pregnancy and breastfeed (if possible -> not at all)
Crude Death Rate: Number of deaths/ total population per 1000
Standardized Death rate: Sum of [Expected deaths/ Standard population] per 1000
- Workshop activity
- There is a lot of variation
- i.e. Denmark compared to a third world country which is quite deprived in both
medical facilities and policies
- New Zealand -> reduction is largely due to the
- Medical intervention
- Research and publicized studies (raised awareness)
Trend in life expectancy in New Zealand, 1970 2013
- 1970-72 -> Studies suggested that females were more likely to live longer than males by
6.1 years
- 2010-2012 -> Females were more likely to live longer by 3.7 years
- Decrease in gap
- Overall increase in life expectancy for both genders
- Gap reduced
- However, even with all the medical policies, facilities, intervention Males are still not
doing all that may bring about the total gains in todays medical advancement
- Binge drinking culture
- Drink driving
Migration
- Origin and destination statistics
- Visitor information sheets when we leave the country
- Statistics New Zealand Maintain and report
- Short term visitors are not a subject of interest
Demographic measures of migration
Migration: Permanent of semi-permanent change of residency by an individual or group of
people
Impact: - Ethnic specific needs, rural doctor problem (migrating to Australia)
Consists of:
Internal migration
- Impacts on regional population growth i.e. Wellington -> Auckland
External migration
- Impacts on the national population growth
- PLT Permanent Long term
Net migration:
Arrivals Departures
Net migration rate:
(immigrants/ emigrants)/ total population per 1000

Trend
- No real trend
- Few peak periods i.e. 1974, 1997, 2004
- Educational purposes
- Emigration to Australia
Population Ageing
- Population ageing occurs
when the median age of a
countrys population
increases due to
- improved life expectancy
- Declining birth rates
-Happening in most highincome countries or will be
within 25-50 years

Types of Ageing
Numerical (Absolute): Absolute increases in the population that is elderly (aged 65 and
above)
- Improved Life expectancy interventions, behavioral improvement
- Reflects previous demographic patterns
Structural ageing:
- Increase in the proportion that is elderly (top-heavy in percentage population graphs)
- Driven by the decrease in fertility rate
- Began occurring in the 1800s
Median age 1971 26
Median age (predicted) 2051 43 Population is stabilized
Population impacts on ageing
-Natural decline -> occurs when there are more deaths than births in a population
- Combination of absolute and structural ageing
- Absolute: More elderly
- Structural Decreased fertility rate (decrease in population size)
- More elderly -> more deaths
Absolute decline: Insufficient migration to replace the lost births and increased deaths
(effects of natural decline)
- No migration to boost live birth count not replacing population growth
- Fertility rate is low but people are migrating out
- i.e. Japan and Germany
- Not expected to happen in NZ for +70 years

Dependency ratio
- Age population ratio of those typically not in
the labor force (working age population 1564) it is used to measure the pressure on
productive population
Limitations
- Includes people who are students,
jobless people, undermines the true
dependency ratio
- i.e. for every 100 people in a working
population, we are supporting X amount of
dependents
e.g. 35:100

Ageing population: impact on health

- e.g. prevalence of hearing loss expected to
double by 2051 policy altercations etc. to
cater for this change

2026 Dependency ratio is seen to cross,

where we support more elderlies than youth
(which doesnt change much)
- Impact: Superannuation etc. on top of
dependency ratio
- Historically we have been supporting the
age of 0-14 because children need more
services/ support and our tax etc.