blue toned graveyard with some cloud and dove illustrations and a green graph

Death by numbers (Image: The Spinoff)

SocietyJuly 25, 2024

Eight graphs that show how we die in NZ

Contributing writer

Death by numbers (Image: The Spinoff)

What the numbers reveal about when and how we die, assisted dying applications, the cost of being buried, suicide rates, and more.

This piece includes references to suicide. Please take care.

In 2023, 37,884 people in New Zealand died, a number that is slowly climbing as New Zealand’s population ages. It’s predicted that there will be 52,700 deaths per year in New Zealand by 2042.

Data from Te Whatu Ora, Statistics New Zealand and local councils reveals more about each of these deaths. Here are five graphs that show how life expectancy and causes of death are distributed unevenly, the impact of the assisted dying law, the role of policy in changing (or not changing) death rates, and what councils charge for a standard burial.

When will you die? It depends on your ethnicity

Want to understand how healthcare inequity plays out? New Zealand’s life expectancy rates between different communities provide a stark example, showing that Māori and Pasifika have shorter lives than Asian and Pākehā New Zealanders on the whole. Māori men, particularly, have the shortest lives out of any broad demographic group in New Zealand.

The other big trend in life expectancy is its slow increase. Most people know that length of life has increased dramatically in the last century, but realising that in 1950 the average New Zealand man lived until just 67 makes it remarkable that both men and women now live until at least 80 on average.

The reason for this is partially due to improvements in knowledge and access to healthcare, as well as reducing causes of death: cleaner water meaning fewer infectious diseases, laws about road safety reduce road deaths, and healthcare improvements extend the lives of those with deadly genetic or chronic health conditions. If you want to know more about this, you can try inserting different birth years into Stats NZ’s How long will I live? calculator (although it doesn’t account for ethnicity).

Everywhere in the world, women live longer than men, and this holds true in New Zealand. There are a few reasons for this: with only one X chromosome, men are more likely to have genetic disorders; in infancy, boys are also usually more prone to infectious diseases. In young adulthood, more men die in accidents, by suicide, and by violence. Compared to other countries, New Zealand’s gap of 3.7 years between male and female life expectancies is relatively small: in Russia, women live more than a decade longer than men.

How will you die? It also depends on your ethnicity

Infections aren’t a common cause of death in New Zealand, but non-communicable disease is the biggest killer. Combined, cancer, heart disease, diabetes, respiratory disease and suicide cause 90% of deaths in New Zealand. Cancer is the leading cause of death, with 10,487 people dying of it in 2021, the most recent year for which full data is available. Circulatory disease was the cause of death of another 10,297 people, while other circulatory disease, cerebrovascular disease (like strokes) and respiratory diseases caused another 11,133 deaths combined.

New Zealand is fairly similar to other wealthy, ageing countries in this make-up of different causes of death; heart disease in particular is the most common, and increasing, cause of death around the world. Differences in sex and ethnicity are again a reminder of unequal health outcomes: Māori are much more likely to die of chronic respiratory diseases than other groups, and Pacific people are much more likely to die of diabetes. Men have much higher rates of death from heart diseases and from external causes of death, including assaults, road accidents and suicide.

What happens to assisted dying applications?

Assisted dying is an option that was introduced in 2021, following a 2020 referendum. It allows people who have a terminal disease and have been given less than six months to live the possibility to die at a time and place of their choosing – if their application is approved by two registered medical professionals.

A patient must ask their medical professional for information about this option; medical professionals cannot bring it up with patients themselves. “We will talk to your specialists, your GP and hospice staff, and look through all your files to ascertain that you have less than six months to live. It is a very thorough and rigorous process,” an independent medical practitioner who assesses applications told The Spinoff last year.

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The annual report for the year ending December 2023 (as well as November and December 2022, to make the reports align with calendar years) shows that while 420 assisted deaths happened during this time, more of the people who applied died in the process or were found ineligible for a variety of reasons. With the majority of those who apply Pakehā, researchers are talking to family members about the experience of the service, looking at how safeguards are operating and whether the option can be accessed equally.

How does policy change death rates?

For Death Week last year, Emma Vitz looked at how changes in policy, like the introduction of seatbelts, have changed the rate of road deaths in New Zealand. Road deaths are an example of an outcome where policy can have a very clear and immediate impact on an issue.

With other causes of death, it’s much harder to see immediate impacts of changing policy: more New Zealanders today are dying of cancer, for example, which is partially because we are living longer, and cancer is a non-infectious disease that is very complicated to treat – it can’t be avoided by better sanitation. There are also dozens of muddying factors: in the last 50 years, the advance of techniques like chemotherapy, widespread screening programmes for breast cancer and the use of the HPV vaccine have made some cancer types less common and less lethal.

One example of a cancer type that has been affected by policy is lung cancer, which is much, much more common in people who smoke regularly. Lung cancer diagnosis and death rates have been steadily (but slowly) declining since the 1980s, as smoking has become increasingly regulated. Because the disease often develops after decades of smoking, the impact of specific policies is less obvious, and delayed by years: lung cancer death rates peaked more than 30 years after tobacco consumption peaked in 1953. However, lung cancer remains New Zealand’s deadliest cancer type today.

Other causes of death are much harder to shift with policy. Suicide deaths have dropped slightly since the 1990s, where the rate increased to more than 15 people per 100,000 dying of suicide each year. Mental illness has become a bigger focus for health professionals and the government, and hundreds of millions of dollars have been poured into successive campaigns to lower suicide levels, particularly for youth.

But as a product of complex individual and social factors, it’s much harder to target suicide rates than it is to limit access to cigarettes or mandate seatbelts. Increasing funding to mental health services is just once piece of the puzzle: increasing community resilience, hope and resourcing makes a difference to those in need, but this can’t be achieved with any one policy or suicide prevention document. Since the peak in 1998, with a rate of 15.1 people dying of suicide per 100,000 people, suicide rates have hovered between 11 and 13 deaths per 100,000 people per year

What does it cost to get buried?

In New Zealand, there are a few options for what happens to someone’s body after they’ve died. Cremation is the more popular option, with 69% of bodies being cremated in 2023, according to a Funeral Directors Association report. Burials are the other main option (burials at sea are allowed, but uncommon, and water cremation isn’t an option in New Zealand at the moment), and bodies must be buried either in a council-run public cemetery; a denominational burial ground (like a Catholic or Anglican churchyard); an urupā; or a private burial ground. Bodies can be buried elsewhere, but the nearest District Court has to be notified first.

Council-run burial grounds are almost always bigger than other burial options. They’re also expensive: buying a plot of land costs a few hundred dollars at the very least, with the cost of interring a body (digging the grave) usually more than doubling the fee. Many areas also have limited space for new cemeteries, which is a conundrum for councils as burial grounds fill up.

The cost of buying a council-owned plot varies hugely around the country, roughly following other patterns of land value: smaller towns and rural areas are generally cheaper than bigger towns and cities. However, the pattern doesn’t entirely hold up, with New Plymouth being the most expensive place to be buried. While the cost of cremating a body varies, most people don’t have to purchase land to put ashes in, making it a generally less expensive option.

If you or someone you know is in need of support, get in touch:

TAUTOKO Suicide Crisis Helpline – 0508 828 865

1737 – Need to talk? Free call or text 1737 any time for support from a trained counsellor

Lifeline – 0800 543 354 – Free text 4357 (HELP)

Samaritans – 0800 726 666

Youthline – 0800 376 633, free text 234 or email talk@youthline.co.nz or online chat. Open 24/7.

Your local DHB Mental Health Crisis Assessment team

Keep going!

Letters from survivors of abuse in care.

OPINIONSocietyJuly 25, 2024

Is it harrowing? Absolutely. But here’s why you should read the abuse in care report

Lyric Waiwiri-Smith

Politics reporter

Letters from survivors of abuse in care.

It’ll probably be the longest and most difficult read of your life, but that’s all the more reason to do it. Lyric Waiwiri-Smith makes a case for delving into the final report of the Royal Commission of Inquiry into Abuse in Care.

Content warning: This article contains references to ableist language, physical, sexual and emotional violence, child abuse and neglect, and suicide.

Whanaketia – Through pain and trauma, from darkness to light, the final report of the Royal Commission of Inquiry into Abuse in Care, is available to read in full here.

A day before the Royal Commission of Inquiry into Abuse in Care released its findings, a six-year labour of pain, deputy prime minister Winston Peters used the term “retard” to describe a question posed in the House. It was fleeting, unprofessional and indicative of Peters’ severely lacking vocabulary and social sensibility, but worst of all, it reinforced a notion laid out by the abuse in care report: that those at the top of society have historically had little compassion for anyone whose reality does not reflect theirs.

Covering 3,000 pages and, in hard copy, weighing 14kg, the abuse in care report will most likely be the longest read of any person’s life. It will also likely be the most harrowing: violence in every form you could imagine, from spiritual and systemic to physical and sexual, is presented in these pages. It also details abuse you couldn’t picture in your worst nightmare. But it happened, it’s a part of our history, and these survivors have relived their experiences now, some for the first time in decades, to bring to light a part of our society that has too frequently been thrown in the too-hard basket. The report doesn’t just bring justice to survivors by allowing their voices to be heard – it also exposes the ways in which care facilities, churches, Crown agencies and key figures of our society have directly or indirectly allowed this abuse and worked to silence these New Zealanders.

Maybe if they were heard the first time, we would have fewer people incarcerated and connected to gang culture. Maybe if we were brave enough to look at and ask ourselves why we allowed this to happen, we could’ve prevented this cycle of abuse and neglect sooner. We live with its effects now, as abused children don’t stay children for ever: they grow up, and are forced to assimilate into a society they have learned not to trust. Sometimes, these children turn into adults who we’re told we can’t trust either.

Split into 16 booklets, numbered zero to 15, the report covers the bases of why, how, when and where abuse was experienced, with five case studies focused on reports of abuse and neglect within the Jehovah’s Witnesses, at the Whakapakari boot camp, Hokio Beach School and Kohitere Boys’ Training Centre, Van Asch College and Kelston School for the Deaf, and the Kimberley Centre. Survivor experiences are dotted throughout the booklets, though the final, the 15th, is dedicated solely to these stories.

The first four parts of the report lay out the circumstances, nature and extent of the abuse and neglect experienced in care, the reasoning for the report and its methodology, and recommendations to the government to ensure environments such as these are eliminated from New Zealand society. Part five of the report, titled Impacts, details the effects these decades of abuse have had on victims, which the reports estimates to be between 113,000 and 253,000 children, young people and adults between 1959 and 2019. This is around a third of people in care settings over this period, and a disproportionate number of these victims were Māori.

Erica Stanford, minister in charge of the government response to the inquiry, reads the report (Photo: Supplied)

As detailed in the report, time in care has provided a direct pathway for many survivors to gang membership or imprisonment, particularly those who are Māori or Pasifika, as well as sex work. The camaraderie and protection offered by gang life felt far more meaningful for some survivors than the degradation experienced at the hands of church or state, and the rampant abuse ultimately became normalised, with these learned behaviours sometimes continued into adulthood. Gang members and prisoners often seem to us as shadowy boogeymen; we have an idea of how they’re shaped (big, imposing, strong) and what they represent (fear, violence, criminality), and these ideas are reinforced by the media and government. In reading this report, the veil is lifted, the child inside of the “boogeyman” is looking back at you and saying “I was scared of a bad person, too.”

In his witness statement, survivor Poihipi McIntyre wrote: “to survive [Kohitere] I had to become a bully and use violence against others. This changed me. I lost empathy and became numb to witnessing and engaging in physical violence. To me, Kohitere was a training ground for jail.” A separate statement from survivor Jesse Kett paints a similar picture: “I first went to jail when I was 17 years old, for burglary and arson. I was in Waikeria prison for about nine months. To me it was like a holiday compared to Waimokoia. It was also better than most foster homes because everyone was treated and fed the same. I think I’m quite institutionalised because I don’t mind being in jail.”

The generational effects of abuse and neglect in care are far-reaching and complex, and it’s for these reasons the report recommends a $10,000 compensation be made to family members who have been cared for by survivors. The account of one faith survivor, whom the report named Mr JP, summed up the cyclical effects: “I have not been able to find my whakapapa. I had hoped to let my son know so that he could one day let his children know. But my son is dead now. He committed suicide in prison.”

The report’s sixth part uses a te Tiriti o Waitangi and human rights lens to unpack the levels and effects of abuse and neglect in care. It details a widespread loss of culture and language for Māori and Pasifika, and how this has impacted victims. The following instalment, part seven, looks at the factors that allowed abusive and neglectful environments to thrive in care. At 336 pages, it is one of the longer sections of the report, and perhaps the most difficult to read, covering the extent to which this abuse was covered up, the environments which allowed this behaviour to thrive, and the many ways these children were failed.

Gang members at a Royal Commission of Inquiry into Abuse in Care hearing (Photo: Tommy de Silva)

Christina Ramage’s survivor experience sits in part seven. She describes a lifetime of sexual assault and abuse, and how this was taken advantage of by those who should have kept her safe: she was raped by doctors while confined in a straightjacket, and later given a nonconsensual abortion by a nurse after being raped by a psychiatrist. Renée Habluetzel’s experience is here too: under the thumb of Mrs Miles of Christchurch’s Little Acres Children’s Home, she was given violent beatings and was made to feel like an object.

Reading this report may very likely make you feel hopeless, angered, saddened and full of grief for the futures that were never realised. But there’s something else to take away from this as well: that, despite incredible adversity, compassion and healing is possible. Some survivors have found forgiveness and understanding, and others haven’t – that’s their journey – but as readers we can all learn how to act compassionately towards those whose lives have been made difficult by forces larger than them, and the lasting effects of this, whether it has provided a pathway to jail or an escape from the care system, where abuse still occurs. We have to be willing to listen.

These stories are long and confronting, so take care when you read this report. Linger on the karakia at the front of each booklet, feel the mana within the witness statements, learn what abuse and neglect looks like in all its forms, and encourage others to do the same, so that no New Zealander faces these horrors again.

It’s the same sentiment present in Te Pāti Māori’s Debbie Ngarewa-Packer’s call for an apology from Peters over his mindless use of an ableist slur in parliament, a place that has allowed a culture of abuse and neglect to thrive, where leaders of ministerial departments that have willingly swept survivors’ stories under the rug decide on the future of Aotearoa. “The history of the word ‘retarded’ is bad enough to be hearing in this House, in fact people have endured years of abuse because of that very name,” Ngarewa-Packer said. “It is unparliamentary for a minister of that seniority, and age group, to be saying that in the House.” At speaker Gerry Brownlee’s request, Peters withdrew his word. If we don’t recognise what behaviours have led us here, we’ll never change.

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Lyric Waiwiri-Smith
— Politics reporter