More New Zealand children are killed by diseases linked to cold, damp, and overcrowded housing than in car crashes or drownings.
Parrs Park, a low-income suburb with a diverse ethnic population, has some of the worst rates of preventable, poverty-related child diseases in Auckland. The area counted more than 140 potentially avoidable hospitalisations among its 2000 children during 2016 alone - six times that of a suburb like Remuera, across town.
The statistics do not make Parr's Park unique. In fact, every town around the country has areas just like it - and worse - where children are getting sick largely because of cold, damp, overcrowded homes.
Health data shows that each year 20 children are killed by diseases linked to unhealthy housing - more than 350 since the millennium. Half of those were from pneumonia. Asthma and wheeze took 33. Bronchiolitis claimed 15.
The deaths peak in winter, hospitals flooded as soon as it gets cold. Maori and Pacific children die at twice the rate of Europeans. The very poor die at 14 times the rate of the very rich, with a recent report from the Asthma and Respiratory Foundation describing the effect of deprivation as "near exponential".
"Across all respiratory health indicators, by far the most relentless and disturbing pattern was the high degree of inequality," the report said.
Hospitalisations caused by poverty-related conditions have increased since 2000 - up to 43,000 last year. Respiratory diseases, in particular, are growing at much more severe rates. A recent Otago University study found 53 per cent of children hospitalised with preventable, poverty-related diseases would be readmitted. For children with a smaller subset of conditions linked more strongly to housing and crowding, that figure jumped to 80 per cent. Doctors argue the hospitalisations are a result of embedded child poverty levels combined with a relentless housing crisis. A recent study from Otago shows 42,000 people now live in "precarious" housing such as garages, caravan parks and cars, with those families believed to be behind a solid swathe of the hospitalisation statistics.
"In New Zealand we have created a triple jeopardy for poor health," says expert paediatrician Professor Innes Asher. "Poverty, unhealthy housing and inadequate basic health care puts health at risk, but when the three are combined...poor physical health is almost inevitable, as in Dickens' times."
In West Auckland, Te Whanau o Waipareira social workers have the anecdotes behind the data. Their clients come both from private rentals and state housing, from Kelston to Massey.
"We have workers who are taking mums and their babies to the doctor four times a week with respiratory illness," says Alisha Tamepo-Pehi, a lead clinician. "The majority of our whanau can't afford heating. They don't have the basic necessities - beds, clothing, blankets. There are people sleeping on the floor, it's damp, it's dusty, there's drafts coming up."
Dr Cass Byrnes, a respiratory paediatrician at Auckland's Starship hospital, sees the impact of those living conditions every day. On a single day last week there were 40 children on the general ward with respiratory illnesses. In summer, those children would fill only two or three beds. "We have waves of kids coming in the minute it gets cold," Byrnes says. "We try to delay discharges but the wards are packed. The problem is, the kids just can't get symptom free - they go home with antibiotics to the same environment that cause the problem." Byrnes says not just the number but the severity of cases are getting worse. Rates of bronchiectasis, an irreversible, life-threatening lung disease caused by repeated chest infections, have tripled in just 15 years. "It's a Third World disease, the kind of thing that if you were going to see it, the patients would be in their eighties. Now we are diagnosing it younger and younger," Byrnes said. "Internationally people are astonished at the numbers we have here. It's completely terrifying."
10 years ago, clinicians were raising the same concerns about another poverty-related disease: rheumatic fever. In 2011, New Zealand's rheumatic fever rates were 14 times higher than any other OECD country. It was labelled a "national disgrace". Eventually, the pressure got too much and the government allocated $65 million to combat its spread. The goal was to reduce the rate by two-thirds, to 1.4 cases per 100,000 people. Six years later, that goal is still unmet. Health experts who were skeptical back then are furious now, saying targeting just one disease was never going to work, but instead diverted funds away from the wider issue.
"Rheumatic fever was a small silo for a big problem," says Otago University's Dr Nevil Pierse, deputy director of the housing research unit He Kainga Oranga. "In focusing on rheumatic fever alone, the government missed the big picture. Or, they're refusing to see it."
Warm Up New Zealand was a government initiative to provide insulation subsidies. Launched in 2009, it offered grants covering up to 60 per cent of insulation costs both for low-income families and the general population. It was immensely popular, with 241,000 homes insulated in the first phase. However, criteria were narrowed, with the current scheme only applicable to rental homes with low-income tenants. It's no longer so popular. Of the 20,000 grants available, just 3300 have been paid out.
"It's deeply disappointing," says Philippa Howden-Chapman, a professor of public health at the University of Otago. "There's a real reluctance of landlords, who are providing a service, to maintain that service. It's a reluctance I can only put down to the fact that most landlords aren't concerned about depreciation but only capital gains." Howden-Chapman says with up to 800,000 uninsulated homes in New Zealand, she was staggered the government reduced such an important programme. "It's both a social and a moral argument - children end up with compromised health for their whole lives, and they die." She cites statistics highlighting New Zealand's inadequate homes - half of houses are damp and mouldy, half have bedrooms that are never heated. Five per cent of children live in severely crowded homes.
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