Categories
Health

What’s behind New Zealand’s high suicide rate? It’s also the economics

Deaths of despair – Our youth are paying a high price for poverty and unemployment

Trigger Warning -This article contains material regarding suicide and mental health, that you may find disturbing.

“Every Life Matters… there is one goal at the core.

No suicides.

One death by suicide is too many. Every Life Matters”

David Clarke, Health Minister, introducing  Suicide Prevention Strategy NZ 2019-2029- Every Life Matters

Coming home, seeing your son or daughter has taken their own life. There is nothing that can prepare you for the shock. The grief, the guilt, life will never be the same. Darkness, depression. Strained relationships.

He was out of school for the best part of two years, despondent at not finding work, a stream of rejections, unsuccessful interviews. Money was tight since his father lost permanent employment. Work has been insecure since. The welfare benefits left little money on the table, if any, after paying rising rent and other essential expenses. It’s been tough.

New Zealand’s youth suicide rate is the highest in the developed world.

New Zealand’s economy started declining in the late 1960s when wool prices dropped. Then Great Britain, by far our largest trading partner, entered the European Common Market in 1973. EC agricultural subsidies meant access to lower-priced beef, lamb and dairy from Europe. This was followed by the OPEC oil price hike. Think Big policies by the Muldoon government failed to arrest the economic decline. 

Enter Rogernomics.

“For people who don’t want the government in their lives … this [Rogernomics] has been a bonanza. For people who are disabled, limited, resourceless, uneducated, it has been a tragedy.” –David Lange, New Zealand Prime Minister (1984–89), 1996

The Labour government came into power mid-1984, amid a deep economic crisis.  Roger Douglas, Finance Minister and chief architect of the economic reforms argued “Speed was enormously important to the change, are government departments necessary? Are they doing the job? Can they be trimmed? Be ruthless with the answers.” It was a blitzkrieg—shock therapy. Ideology driving change, whereas, in Australia, a far more measured and consultative approach was taken by the Hawke-Keating government.

Layoffs were massive in government departments and state-owned corporations – the postal service, telecommunications, state-owned banks, coal mines. Privatisations, the country’s family silver sold in depths of a recession at rock bottom prices, often to foreign corporations. Farmers went bankrupt, losing farms in their families for generations.

John Patterson of the Social Impact Unit visited those affected in Ohai. State Coal Mines had turned into Coal Corp overnight. “They started by closing two mines and sacking the men who worked there.” The last union meeting was finishing, and the miners were signing on to the unemployment benefit. All the men were there, but where were the women? The district nurse told Patterson that they were at home crying. 

All the men were there, but where were the women? The district nurse told Patterson that they were at home crying. 

Many who lost jobs invested their redundancy money and superannuation in the stock market; lost it in the market crash of 1987.

Unemployment was between 40 and 50% in South Auckland, many rural towns fared even worse, 80% in some areas. The young could find no jobs. Poverty rates soared.

Suicides followed.

Teen suicides doubled over the next five years. Youth suicides rose by 80%.

Ruth Richardson, the Finance Minister of the National government that followed slashed unemployment and other welfare benefits, in her infamous ‘Mother of all budgets’. The irrational belief was if the unemployed were desperate, jobs would miraculously appear.

The Employment Contracts legislation of 1991 weakened the bargaining power of unions. A cynical proclamation that a jobseeker can negotiate on equal terms with an employer. Or that terminations would be fair without union protection.

It made no sense that we made it easier to terminate staff while slashing unemployment benefits at the same time. Reducing taxes for the wealthy while at the same time cutting funding for essential services for those most vulnerable. A government for the people became one for just some of the people.

It made no sense that we made it easier to terminate staff while slashing unemployment benefits at the same time.

Globalisation over the following decades saw higher-paid, stable manufacturing jobs move overseas, replaced by more insecure lower paid jobs in the service sector.

The pre-Rogernomics youth suicide rate was lower than the current OECD average. The teenage suicide rate for teenagers increased by 100% during the period 1986 to 1990 compared to the previous five year period, 67% for the age-group 20-24 and 40% for 25-29-year-olds.

Teen suicide rate kept climbing, except in the decade 2001 to 2010. The teen male suicide rate is now 82% higher than the pre-Rogernomics period, for teen females, it is a staggering 6 times higher, a rise of 620%. The youth suicide rate is still 60% higher than the pre-1985 rate. It’s unclear why the female teen and youth suicides have risen steeply than male.

Racial differences are stark. Teen suicide rates for Maori are over 3 times the rate of European and Pacifica island more than 2 times. The teen suicide rate for Maori females is nearly 5 times that of non-Maori.

The teen suicide rate for Maori females is nearly 5 times that of non-Maori.

Statistics for attempted suicides for Maori are similar to European, while suicide rates are much higher for Maori and Pacifica. The health system and society are less successful in protecting Maori, Pacifica even once the peril is evident.

International comparisons are even starker. Our male youth are dying at five times the rate in Australia, the females two times.

Our male youth are dying at five times the rate of Australians.

“My theory is – we don’t really go that far into other people, even when we think we do. We hardly ever go in and bring them out. We just stand at the jaws of the cave, and strike a match, quickly as if anybody’s there.”
― Martin Amis, A Suicide Note

The youth suicide rate in the most deprived areas is nearly four times that of the most affluent.

The unemployed are dying at over twelve times the rate of the rest of the working-age population.

The unemployed are dying at over 12 times the rate of the working-age population.

Our unemployment benefits at 34% of previous income are one of the lowest in the OECD, 38th out of 41 countries, just half of the OECD average. It is easy to imagine the shock of an overnight income drop of 66%, on top of losing one’s livelihood, especially for people with little savings and low disposable income. It’s easy to imagine the stresses in coping with this much drop in one’s income.

Our unemployment benefits at 34% of previous income are one of the lowest in the OECD, just half of the OECD average.

The Labour party promised transformational change coming into power in 2017. They have stopped mentioning the word ‘transformation’. The problem of low core benefits remains unresolved. Welfare is a political issue. Beneficiaries are victims of politics, the ‘dole bludger’ label has meant increasing benefit levels is unpopular.

“You have Scandinavian ambitions in terms of quality of life and public services, but a US attitude to tax.” – Laura Clarke, British High Commissioner to New Zealand, 2020

Changes to our tax system since 1985 and low productivity increases have meant a massive transfer of wealth to those on high incomes. The size of the pie hasn’t increased, just the share for the wealthy. We are one of the very few countries in the world with no capital gains tax and tax income from the first dollar earned. High housing costs have further diminished disposable income of the poor.

We have successfully reduced suicide rates – for those over 55 years. To a level even lower than the pre-Rogernomics era, 36% to 65% lower. Pre-1985 youth suicide rates were much lower than adult rates, just over half of those 45+ years. Now the situation is reversed, youth rate is approximately 60% higher, and it’s worse for the teens. The baby boomers have benefited most by the wealth transfer post-Rogernomics and the property boom.

We have successfully reduced suicide rates – for those over 55 years, now 36% to 65% lower than even pre-Rogernomics era.

Each life lost to suicide has a combined loss of contribution to society, the economy and the individual’s family of $3.4 Million as per the Auditor General. The cost for last year’s 685 lives was approximately $2.2 Billion or 1% of our GDP. This doesn’t include the cost of attempted suicides.

New Zealand doesn’t track suicide statistics by cause. We have no idea if it is depression or drugs, whether it’s sexual abuse or lack of social support. Or a combination of factors which carries a much greater risk. Nor does it track numbers of suicides with prior attempts. Our Chief Coroner releases provisional figures annually.  However, final numbers and detailed statistics by the Ministry of Health follow three years later, of little use to evaluate the success of any prevention strategy.

A dedicated Suicide Prevention Commissioner was appointed in 2019, and an Office for Suicide Prevention established. A new Suicide Prevention Strategy for the period 2019-2029, “Every Life Matters” followed. The government has allocated significant funding for mental health and resources, signalled that reducing suicides is a high priority. While the new plan mentions stable employment and access to secure housing as two of the protective factors for suicide, it doesn’t mention any action to improve these areas.  

The suicide prevention strategy for Australia touches on training for frontline employees in non-health areas such as social services, income support, employment and the courts’ system. It also emphasises the need to create awareness and training for employees on the other side of the fence, especially those working in employment support settings for referrals and improving employability.

Most suicide prevention strategies are driven by the Health sector, and focus on healthcare, not the broader economic issues that impact suicides.

Most suicide prevention strategies focus on healthcare, not the broader economic issues that impact suicides.

Are we throwing money someway down the cliff? Ignoring a vital part of the picture? Why does a Zero Suicide strategy only target a 20% reduction by 2030? Will this government be bold enough to address our benefits system? Is transformational change a mirage?

Will our young and the poor keep paying with their lives for an economic system that fails them?

Note – Suicide Prevention office and the Ministry of Health was contacted for this article, and no response received.

Where to get help: Lifeline: 0800 543 354 Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7). This is a service for people who may be thinking about suicide, or those concerned about family or friends. Depression Helpline: 0800 111 757 (24/7) Samaritans: 0800 726 666 Youthline: 0800 376 633 (24/7) or free text 234 (8am-12am), or email talk@youthline.co.nz

Categories
Health

Diabetes kills – 6 times more people than car accidents

Diabetes, along with closely linked heart disease, is responsible for the deaths of more New Zealanders each year than any other condition.

My mother died of diabetes complications. She struggled with this disease for years. She took insulin orally at first, as her condition worsened she had to go to the hospital for injections. She was hospitalised many times and finally became another casualty of diabetes. She took her medicine faithfully, lifestyle changes- probably not.

John’s story is probably typical for a diabetic and highlights challenges faced in tackling the disease. “The word is relentless because that’s how it feels. My first response to being diagnosed with Type 2 diabetes in 2009 was one of frustration and resentment. I didn’t want to be diabetic. I was frustrated that it meant changing my lifestyle, which at the time, I hadn’t prepared to do. I did nothing.

My wife and I were with my daughter up in Ripon one day in 2017, and I remember waking up Friday morning and being very, very breathless. They rushed an ambulance to me. Looking into the eyes of my wife and daughter and thinking ‘I’m not ready to die’. Self-inflicted and I’ve done this to them; a result of my non-engagement.

I vowed then if I got through it, then I would start to make some changes to the way I lived. I would take this seriously”

6% of our total population have diabetes (another 2% have diabetes without being aware of it). Incidence of diabetes has nearly doubled over the last 12 years, population increase, aging of the population and rising obesity, being the contributing factors. People of Māori, Pacific and South-Asian ethnicity, and the socioeconomically disadvantaged; bear a disproportionate burden of obesity and type 2 diabetes.

The prevalence rate for Maori/Pacific is three times that of European. The mortality rate for Maori/Pacific is even higher, nearly five times that of European/Other. Prevalence of diabetes among people aged 65 and over is 15 to 20% of the population. The aging population and rising obesity mean that the number of diabetics is likely to increase further.

The age at which we get diabetes is also getting younger. Those who get diabetes below the age of 40 have a much higher rate of developing other complications like heart disease and early mortality. Incidence of diabetes for the age group 30-39, while still low, has doubled over the last 12 years.

New Zealand has a diabetes problem, fuelled in part by high rates of obesity. It is the largest and fastest-growing health issue we face in New Zealand. Our pacific island neighbours have some of the highest incidences of diabetes in the world. While the Ministry of Health doesn’t have an estimate of the budget spent on Diabetes, NHS in the UK estimates they spend a whopping 10% of their total budget on diabetes.

What is diabetes?

Diabetes is a disease where your body cannot control its blood sugar levels properly due to a lack of insulin. Or your cells have become resistant to insulin. There are two types of diabetes. About 10% of people with diabetes have Diabetes1, which is more likely to be hereditary and not preventable. The vast majority have Diabetes 2, which is closely linked to obesity. There is no cure for diabetes, but it can be prevented and controlled.

What is pre-diabetic?

Pre-diabetics have a high sugar level, but below the threshold considered diabetic. 16% of the population aged 45 and younger is pre-diabetic. An estimated 40% of Maori, Pacific and Indian population aged 35-39 in Auckland are pre-diabetic.

Diabetes Prevention

For most of us, diabetes can be prevented by eating healthy and exercising. It can also be detected at the pre-diabetic stage with a simple blood test, with a good chance of preventing from progressing to full-blown diabetes.

Living with diabetes

In theory, this is an easily solvable problem, Screen and blood test everyone at high risk. Prevent or control with medication and lifestyle changes. Unfortunately, this is easier said than done, numbers are on the rise in almost every part of the world. One of the most challenging issues is changing lifelong habits of diet and sedentary lifestyle.

Diabetes Initiatives – New Zealand

‘Living well with diabetes 2015-2015’ project launched by the Ministry of Health is the main initiative to reduce diabetes. This plan targeted a 20 to 30 per cent reduction in the rate of new cases by 2020 as well as targets for reducing deaths, life expectancy and reducing complications. The broad action areas targeted by the plan are sound, and it aims to reduce diabetes using a mixture of awareness, information, screening and intervention. There is a lack of detail on which parts of the plan are complete, and the ministry has no status update (it is currently gathering this data from the DHBs). The program has not achieved ambitious goals set; however, the increase in the prevalence of diabetes appears to have slowed down.

There are broad-based initiatives which will reduce diabetes. ‘Healthy families NZ’ promotes the diet and an active lifestyle. Health star rating a voluntary code for food labelling.

Diabetes New Zealand is a non-profit aiming to provide information and support, also an advocacy group for people with diabetes and those at high risk.

International Initiatives

International Diabetes Federation has done a comprehensive analysis of over 70 trial programs carried out all over the world to come up with some of the success factors in tackling diabetes. Many of their recommendations have come from studies done in Australia,

Some of these ideas are

  • Diabetes screening- Using an online risk assessment tool.
  • Blood testing for those identified as high risk.
  • Comprehensive lifestyle intervention programs, through group counselling sessions, telephone or webchat. Currently, all states in Australia run these programs.
  • Medication where appropriate
  • Public Health initiatives- A sugar tax, promotion of healthy diets in schools and kindergartens, prominent food labelling and regulation of food/soft drink marketing.

Is there value in screening the whole population say over the age of 45?  Probably, this is not something current practised. Is it worthwhile running public awareness campaigns, similar to drink driving or dangerous driving? Possibly.

Challenges

Getting people identified as diabetic, pre-diabetic or high risk to get tested and make the diet and lifestyle changes required has been challenging. Changing a lifestyle and diet, bedded in over many decades, is not easy. Psychological support is very much an essential part of treatment and long-term care.

Keeping safe- what can you do?

  • Healthy diet and exercise would be a perfect place to start.
  • If you don’t have diabetes or unsure, use ‘Are you at risk’ online monitoring tool from diabetes NZ,  https://www.diabetes.org.nz/are-you-at-risk.
  •  If you are high risk, arrange for a blood test, with your GP.
  • If you already have diabetes, nothing is important as following your GP’s advice and making those lifestyle changes stick!
  • Diabetes NZ recommends an annual diabetes check-up and has a range of resources to help you. Their Facebook page has an online community for support, and there are also several other Facebook groups.

Diabetes by Numbers

  • 6% of the total population has diabetes          
  • 2% of the total population have diabetes without being aware of it
  • 15-20% of the population aged over 65 have diabetes
  • 85% increase in diabetic patients since 2005
  • 5-10% of our health spending is on diabetes
  • Three times – the prevalence of diabetes amongst Maori, compared to non- Maori
  • Five times – the mortality rate of Maori vs Non -Maori
  • 16% of population below 45 are pre-diabetic
  • 40% prevalence of pre-diabetes among Maori, Pacific, Indian aged 35-39

Acknowledgements