HEALTH OF COMMUNITIESCommunity Health AssessmentPalmerston North Hospital Area A wealth of health Westerberg, VM 5/2/2011Community Health Asessment with community inventory, health indicators, health needs assessment, annotated bibiliography, recommendations and appendices of statistics.
Table of Contents i. Executive Summary1. Introduction2. Methods3. Findings in the Palmerston North Hospital Area (PNHA) Community Inventory 3.1. Housing 3.2. Industry and Employment 3.3. Health Services 3.4. Social Cohesion 3.5. Transport and Mobility 3.6. Media4. Discussion of Key Findings 4.1. Health Services 4.1.1. Primary Health Services in the PNHA 4.1.2. Secondary and Tertiary Services in the PNHA 4.2. Income and Employment 4.2.1. The effects of income and employment in the PNHA 4.2.2. Main industries and employers 4.3. Housing 4.3.1. Housing in the PNHA 4.3.2. Insulation 18.104.22.168. Insulation in the PNHA houses 4.4. Social Cohesion 4.4.1. Social Cohesion in the PNHA5. Annotated Bibliography6. MidCentral District Health Board Summary of Health Indicators 6.1. Background 6.2. MidCentral Health 2009 Health Needs Assessment
6.2.1. Population 6.2.2. Socioeconomic disadvantage 6.2.3. Health Status 6.2.4. Health Status Disadvantage 6.2.5. Avoidable Disadvantage 6.2.6. Avoidable Hospitalizations 6.2.7. Access to Health Services7. Conclusions8. Recommendations9. References10. Appendices 10.1. Appendix 1: Community Inventory Completed 10.2. Appendix 2: Community Survey Template 10.3. Appendix 3: MidCentral District Health Board – 2009 Health Needs Assessment – Raw Data 10.4. Appendix 4: Deprivation Index Areas 10.5. Appendix 5: Statistics New Zealand – 2006 Census –Raw Datai. Executive SummaryThis report was conducted in an attempt to evaluate the health status of thePalmerston North Hospital Area (PNHA), a very small residential suburb in theinland city of Palmerston North, some 140km North of the capital city of New
Zealand, Wellington, as part of the assessment for the Massey University 300-levelpaper, Health of Communities.The objective was to identify relevant issues within the community that could havean impact on the local residents‘ health status.Given that many highly-paid, mainly health-related, professionals live in this level 2degree of deprivation community (Statistics NZ, 2006; NZ Parliament, 2009), itwould be logical to infer that residents have a good health status, as according tothe Ottawa Charter of Health Promotion (World Health Organization [WHO], 1986)the top two key determinants of health are income and employment. Housing isalso a primary determinant of health (WHO, 1986) and of an adequate standard ofliving to which everyone has the right to (United Nations Educational, Scientific andCultural Organization [UNESCO], 1945). Good housing is associated with goodphysical and mental health outcomes (WHO, 1986; Housing New Zealand, 2006).The fact that all four Palmerston North hospitals and approximately eighteenmedical clinics are located in the PNHA, was another issue to explore in relation tohealth outcomes. The distance and time to travel to healthcare services influencehealth outcomes and are particularly relevant in emergencies and in ruralcommunities. Proximity influences a person‘s predisposition to seek medical care,specifically elderly or disabled people (Pearce, Witten & Bartie, 2006).Finally, the health of individuals in a community is also linked to local socialcohesion, to that feeling of belonging and of community pride which differentiatescommunities of place from communities of interest (Taylor, Wilkinson & Cheers,2008). The PNHA may have well started as the former and developed into the latter.1. INTRODUCTIONNgāti Rangitāne were the local Māori iwi (tangata whenua) living in the area thenknown as Te Ahu-a-Turanga (Palmerston North City Council [PNCC], 2011). They hadbeen the only inhabitants of the island they called Aotearoa (the island of the longwhite cloud) for five centuries when a trader, Jack Duff, became the first knownEuropean to explore the area in 1830. Shortly after, Charles Hartley, another trader,heard from tangata whenua of a clearing in the forest, he managed to get there and
made his discovery known to the Wellington Provincial Government. They appointedsurveyor J.T. Stewart to purchase the land Hartley had discovered and put him incharge of the design of the Papaioea settlement, near the north bank of theManawatu River. It was officially re-named Palmerston North (PN) in 1920, after theViscount of Palmerston and former Prime Minister of Great Britain, Henry JohnTemple (PNCC, 2011). ―North‖ was added to the name by the Post Office not toconfuse it with Palmerston in the South Island.Stewarts plan consisted of a series of wide and straight streets, laid out in arectangular pattern, with the focal point being an open space of 17 acres (7 ha)later known as The Square. Landmarks named after Stewart included StewartCrescent in Palmerston North and Mt Stewart, near Sanson.Surveyor J.T. Stewart The first Post Office in town (1878) addeddesigned Palmerston North the suffix “North” to Palmerston [Source: NZ History, 2008]As the settlement grew, the forest diminished to make way for farms, and todayvirtually no remnant of it survives (PNCC, 2011). So, by 1877, the settlement was anisolated village whose main industry was sawmilling.Rapid growth was evident only 50 years after the arrival of the settlers with thecreation of businesses, schools and hotels (PNCC, 2011). The police station, thefirebrigade, the post office, the train station, the public gardens, the library and thecentral square were all inaugurated by the 1880‘s.The first population census was done in 1890. The Maori were excluded until 1939,when the government had to account for those who had enrolled in the armedforces during World War II (WWII) and for their families (NZ History, 2008).
The PN Hospital opened in 1893 with one nurse, Eleanor Tasker, the first registerednurse in New Zealand.World War I saw Palmerston North with a flu epidemic which killed 1 in 5 people.Historian Geoffrey Rice (2005) suggested that the disproportionate death ratesamong Maori (about seven times that of Europeans) was due to lack of immunityagainst the flu virus and to their ‗lower standards of housing, clothing andnourishment‘.Further decimation of the Maori population took place when 16,000 Maori soldiersjoined WWII. Maori men enlisted for a variety of reasons: to escape poverty or life inthe backblocks or to follow their mates (NZHistory, 2008). 1920 Te Koura cenotaph in 28th Maori Battalion survivors in Egypt, 1943 memory of Maori influenza victims [Source: NZ History, 2008]In the mid 60‘s, Massey University inaugurated as the city boundaries andpopulation grew. The newly created urban and intercity bus networks contributed tothe further development of the city, which already had a train station (1886) and anairport (1936). Relevant Palmerston North features
Top educational facilities Very well connected Lots of quality health servicesThe city covers an area of 326 square kilometres and is estimated to be home to apopulation of 80,700 (Statistics NZ, 2006). A considerable proportion of itspopulation consists of students attending Massey University, Universal College ofLearning (UCOL) and International Pacific College or the various PapaioeaCampuses of Te Wananga o Aotearoa during the academic year. Over half of thecitys population is under the age of 35 and the city, known by locals as ―Palmy‖,has been marketed as Student City (PNCC, 2011)The present report faced limiting factors. One of them was having to infercommunity data from a windshield survey which only allowed the use of the senses.Other, more cumbersome but also more yielding of information, research methodslike surveys and structured interviews were not allowed. Being a foreigner who hasbeen in New Zealand for eighteen months, means lack of connections to the areaand their people, excepting a few neighbours. This was compensated by theestablishment of informal talks with residents who were curious about someonetaking repeated walks, and lots of pictures and notes of their neighbourhood. Thisinteraction resulted in a better understanding of the PNHA residents (who they are,what they do, what they look like, their reaction to the researcher as a neighbourand vice versa) and to the making of new acquaintances. Therefore, this limitationturned out to be an opportunity.Another, more significant, limitation is a word count of 2,500 words. This limitationis tried to be compensated for by the inclusion of different items, like tables, charts,pictures and appendices with relevant supporting or complementary information.
2. METHODSHistory records were obtained through the PNCC, the New Zealand History and theHistory of New Zealand web pages. The colour pictures in this work were takenduring the windshield survey of the PNHA on February 2011. Income andemployment information was obtained from the National Health Committee (NHC)and the Public Health Advisory Committee (PHAC) web sites, whereas specificinformation about the PNHA comes from the online 2006 Census of Statistics NewZealand (NZ). Data and tables on morbidity rates as well as Health Servicesinformation came from the Ministry of Health (MOH) and the MidCentral DistrictHealth Board (MCDHB) web pages. Industries and Employers details were retrievedfrom the MCDHB webpage and from notes in the community inventory.The community inventory, based on that by Gerberich, Stearns and Dowd (1995),was performed during the community survey of Stanley Avenue, a representativestreet in the PNHA neighbourhood on March 23, 2011, and only the points whichwere relevant for the community were included. Details about the area, namelymap with boundaries, were extracted from the 2006 Statistics NZ Census andchecked by a walking (windshield) survey in which notes and impressions about theneighbourhood were recorded on a smart phone and then transcribed. Informationabout housing was gathered from the WHO, UNESCO, PHAC, Housing NZ, QuotableValue (QV) and the PNCC web sites, and also from the PN library literature.Literature from the Massey University library and observations from the community
inventory provided information about social cohesion. Media information wasprovided by the community inventory findings.Key words were used to search online databases for documentation for theannotated bibliography: ―income health inequality‖ produced 44,900,000 results,the first one was chosen; ―healthy housing in New Zealand‖ produced 11,900,000results, the third one was chosen; ―good housing leads to good health‖ gave10,900,000 results, the tenth one was selected; ―housing and health nz‖ gave42,100,000 results, the second one led to a link to the Otago University webpagewhere ―housing health‖ in the search box led to the article selected; finally,―association community capital and health‖ produced 44,100,000 results, thesecond one on page two was chosen and the full text in PDF was selected to accessthe full article.
3. Findings In The Palmerston North Hospital Area Community Inventory The complete community inventory is included in this document under Appendix 1. With the exception of health and education services, the remaining goods and services needed for everyday living are outside the suburb but within walking distance in the nearby census areas of PN Central and Takaro. Completion of the community inventory highlighted the following issues, the most relevant ones are mentioned first and further studied more in detail under ―Discussion of Key Findings‖. 3.1 Housing The PNHA is primarily a residential suburb. Most houses in the area were built between 1914 and 1930, a few in the 50‘s, and are predominantly weatherboard dwellings, some of them have brick façades. The architectural design is quite homogeneous and harmonious. The average house has a floor area of 175m2, and a land area of 780 m2 (QV, 2009), a front and back garden (English-style gardens with trees), and a private driveway with a two-car garage. Heat pumps and insulation are common and intended to keep houses at an adequate temperature throughout the year. Many trees can be seen not just in gardens, but also along the streets, making them attractive for walking. Neighbourhoods that look cared for and
relaxing, with visible sidewalk activity enhance social cohesion and experience less crime (Jacobs, 1993).3.2 Industry and Employment By far the most relevant industry in the area is health services. The most common occupation of the PNHA residents is that of ―Professionals‖, namely health professionals, with double the amount of professionals than in Manawatu-Wanganui (MW), 16%, and a much higher rate than the 18% in NZ (Statistics NZ, 2006). The main employer is the MCDHB (MCDHB, 2009). Private employers run the large number of private clinics in the area. Another employer is the Ministry of Education, as the PN Boys High School (HS), Russel Street School and the Mana Tamariki Maori School are located in the area. Private employers include many private kindergartens like First Steps, School‘s Out, Learn-A-Lot, Rewanui and Wananga. There is a bus stop on the same or opposite side of the street of every school, but not so near the kindergartens.3.3 Health Services The PNHA gathers all four hospitals in town and up to eighteen medical clinics, which is the most relevant feature of the area. They are all within easy walking distance for residents, and the non- residents can access them by car or by bus (bus stops are located on Featherston St and Heretaunga St). Neighbours, especially elderly ones, find it is reassuring and convenient to live close to doctors homes and practices, and to the PN Hospital, especially in emergencies. Until 2011, parking was free at the PN Hospital car park, now patients and workers are charged for parking there.3.4 Social Cohesion With considerable numbers of residents working in the area, the amount and quality of time they have to invest in relationships with family, friends and neighbours can be theorized to be quite good. Additionally, many indicators suggest that good social cohesion exists in the PNHA. Parents collecting and delivering school children for
other parents, offering and asking for favours, seeing children play in different gardens, and knowing many of their neighbours‘ names are just a few of those indicators.3.5 Transport and Mobility Although many neighbours own up to three cars, traffic is hardly noticeable. The grid design of the streets divert the traffic to the large peripheral roads. It is very safe and easy for pedestrians, cyclists and drivers to move around, in an out of the area. The two-way streets are wide, but the trees make them look narrower. Bicycle paths exist only on the larger streets. Road signalling and maintenance is very good in the area, the roads are visibly cambered, have storm drains, and are uniformly asphalted. The wide footpaths are made of concrete, are in very good condition and mildly banked. Driveways allow easy accessibility for push and wheel-chairs at short intervals.3.6 Media Every household in the area has aerials, many of them also have satellite dishes, meaning that they have ready access to television. The local cell phone tower is located in the PN Hospital. Residents also have specific sources of community information as several free newspapers and publications are delivered daily in the mailboxes: The Tribune (―your window to the community‖), the Manawatu Guardian (―Manawatu‘s leading community news provider‖), The Manawatu Standard (limited free edition), the Russell Street School Community Newsletter (seasonal delivery), real estate pamphlets about rentals and sales in town, and political pamphlets during election periods are examples of the variety of community specific media in the PNHA.
4. DISCUSSION OF KEY FINDINGS 4.1 Health Services The MCDHB is a Government entity dependent of the MOH, and is one of 21 district health boards established nationally on January 1, 2001 under the NZ Public Health and Disability Act (NZPHD) (MOH, 2000). The MCDHB is responsible for ―improving, promoting and protecting‖ the health of local residents and the communities in which they live. For that purpose, they carry out Health Targets, Health Assessment and Performance Overview reports. These reports provide an overview and comparison of district health board activity against a set number of national criteria. The clinical assessment, treatment and care provided by the MCDHB is predominantly secondary with some tertiary intervention level and specialist input into primary. Starfield stated that one way to reduce health inequities can be achieved through the provision of affordable quality health services (2007). 4.1.1 Primary Health Services in the PNHA Primary care refers to services provided by GP, dental, midwife, nurse, optometrist and audiology practices, and community pharmacies (MOH, 2010). These professionals may refer a patient to a specialist for secondary care. The overrepresentation of medical and other health clinics in the area results in short waiting lists and times. Unfortunately, despite the competence, professional fees are uniform and quite high. The average consultation fee is $120 and late cancellations and no-shows have a standard penalty fee of $100. 4.1.2 Secondary and Tertiary Health Services in the PNHA
Secondary care is the service provided by medical specialists who generally do not have first contact with patients, for example, cardiologists, gynaecologists and dermatologists. Most specialists combine work in a hospital or large clinic with their private practice. The PN Hospital, the Aorangi Hospital, the Southern Cross and the Arohanui Hospice all offer secondary health care. Other large medical clinics in the PNHA that offer secondary care are 169 Medical Centre, Fertility Associates and the Sydney Health Centre among many others in the area. Tertiary services are offered by the PN Hospital, and means the offer of subspecialized health care. Example of secondary care is a surgeon, tertiary care would be provided by a surgeon who subspecializes in Neurology (a neurosurgeon) or in Orthopaedics (orthopaedic surgeon).4.2 Income and employment Income is the single most important modifiable determinant of health and is strongly related to health and well-being (NHC, 1998). As income levels decline, mortality, morbidity and bad self-reported health status increase (PHAC, 2004). The main factor determining adequate income is participation in (adequately) paid employment (NHC, 1998). Employment enhances social status, improves self- esteem, provides social contact and a way of participating in community life. In turn, unemployment is detrimental to both physical and mental health and unemployed people in New Zealand report poorer health status than people who are employed. While employment is important for good health, some (usually low paid) occupations carry risks to health such as injury (NHC, 1998). Howden- Chapman (1999) stated that positions in the lower work hierarchy are associated with higher morbidity and mortality rates. 4.2.1 The effects of Income and Employment in the PNHA Statistics in the 2006 NZ Census provided the community profile of the PNHA. Looking at income, 23% of the PNHA residents have an annual income of over $50,000, almost
double the proportion of the MW people, as only 12% have that income, and more than three times as much as those living in NZ as a whole, with a 7.5%. Not surprisingly, the most common occupation, just over 30%, of the PNHA people is that of ―Professionals‖ mainly health professionals (doctors, nurses, technicians, administratives), double than the amount of Professionals in MW, 16%, and much higher than the 18% in NZ. Those professionals are attracted to the area by the large availability and proximity of suitable workplaces.4.2.2 Main Industries and Employers The main, almost exclusive, industry in the PNHA is health services and the main employer is the MCDHB. They employ a staff of around 1,800 to deliver healthcare mainly in the PN Hospital, the fourth largest tertiary teaching hospital in New Zealand (MCDHB, 2010). The Aorangi Hospital is a locally owned and operated private hospital. The Arohanui Hospice provides specialist palliative care for patients with serious chronic, advanced or terminal conditions. The Southern Cross Hospital and Specialist Centre, is a private surgical facility, part of the national network of Southern Cross hospitals. Metlifecare is a high-standing retirement village with rest home and full healthcare services. Other large medical clinics in the PNHA are The Foot Clinic, He Puna Hauora (Maori Health Services), 169 Medical Centre, Fertility Associates, Sydney Health Centre, Belinda Genet & Associates Physiotherapy, Pain Management Rehabilitation Services, and The Stress Management Centre among many others.
Leading Fertility Clinic in NZ Spoilt for choice 4.3 Housing Adequate housing is a primary determinant of health (WHO, 1986) as well as a fundamental human right (UNESCO, 2003). Poor housing is associated with poverty streaming from social inequities and with bad physical and mental health outcomes (WHO, 1986; Kingi, 2002). More than half of the average family‘s income goes to paying house- related expenses, which reduces the amount of funds available for quality food and clothing and for the use of supplies (gas, electricity, fuel) among other restrictions (PHAC, 2004). The measures of affordability, accessibility and habitability that underpin the right to housing show that Maori, Pacific, disabled and dependent people are the most disadvantaged in NZ. Dampness, coldness, toxic indoor air (radon, asbestos, mites, tobacco smoke, carbon monoxide), tenure, overcrowding, poor building materials and design, and unsafe supplies installations, have long-term deleterious effects on people‘s lives (Housing NZ, 2006). Environmental determinants of household- related health are also outdoor conditions like neighbourhood, social cohesion and safety. Poor housing occurs in deprived neighbourhoods. The social costs of such combination usually results in sickness, injuries and deaths, delinquency and crime, school and work absenteeism, decrease in industrial efficiency and productivity, increase in medical expenses, lowering of the quality of citizenship, increase of family disintegration, and social unrest (Wood, 1937). 4.3.1 Housing in the PNHA
The PNHA is one of Palmerston Norths most sought after areas. Most houses in the PNHA were built between 1914 and 1930, a few in the 50‘s, and are predominantly weatherboard dwellings, some of them have brick façades. The average house has a floor area of 175m2, and a land area of 780 m2, has high ceilings, a front and back garden with trees, a private driveway with a two-car garage, a tool shed, three bedrooms, a bathroom and a toilet, a dining room, a living room, two fireplaces, heat pump, an open-plan kitchen, a laundry room and French doors opening up to the back garden (QV), 2009). Insulation is common, but not double-glazing. All houses are carpeted. Sale prices are around $300k, rental prices are around $320/week (QV, 2009). The architectural design is quite homogeneous and harmonious. Trees predominate in gardens and along the streets, making them attractive for walking, and neighbourhoods that look cared for and relaxing, with visible sidewalk activity enhance social connectedness and experience less crime (Jacobs, 1993). Trees also improve air quality, reduce traffic noise and increase property value. The City Council takes care of street trees in the area so that their branches and roots do not affect street and footpath safety (PNCC, 2011). The city design, with a grid structure, ensures the diversion of traffic away from the neighbourhood while it provides excellent communication with the main traffic arteries around the PNHA.Quality houses are common in the PNHA Properties typically have 2-car garages
4.3.2 Insulation A key issue of quality housing is without doubt insulation. A recent study funded by the New Zealand Energy Efficiency Conservation Authority (EECA) and carried out by Howden- Chapman et al. (2007) in which Massey University took part, evaluated the impact of insulating houses on the health of occupants. The study concluded that insulation resulted in significant improvement of health outcomes, fewer hospital admissions, fewer days off school or work, and less energy consumption. 22.214.171.124 Insulation in the PNHA houses Insulation cannot be evaluated by observational methods like a windshield survey. The 2009 QV databases indicate that most houses in the area have some kind of insulation but that double-glazing is not common. This may be one of the reasons why people in the area have lower rates of respiratory-related hospital admissions than the MidCentral population (MCDHB, 2009).4.4 Social Cohesion Social cohesion is defined as the quality of social relationships that are the basis of trust, mutual obligations and respect in communities, and it has been shown to help protect people and their health. Inequality is corrosive of good social relations (WHO, 2003). Wilkinson (1996) argues that the healthiest societies in the world are not the richest countries, but those in which income is distributed most evenly and levels of social integration and cohesion are highest, as in Japan and Sweden. Societies and, particularly, communities with high levels of income inequality tend to have less social cohesion and more violent crime, and vice versa. Many studies have shown the association between strong social cohesion and good health in communities (Kunitz, 2008).
4.4.1 Social Cohesion in the PNHA Buckner (1988) developed the Neighbourhood Cohesion Index (NCI) in which cohesion was operationally defined as neighbours ―doing/asking favours to each other‖ ―visiting each other‖ ―asking each other for advice‖. Cohesion has also been related to trust (Marmot & Wilkinson, 1999). Based on how cohesion has been defined, residents of the PNHA show evidence of high connectedness, as it is common to see neighbours getting together on different occasions (New Year‘s Eve, ANZAC day, or when somebody is ill or moving in or out). Most locals know their neighbours‘ names. Additionally, every new resident is given a ―Neighbourhood watch‖ list showing names and phone numbers of other neighbours in order to report suspicious activity (possible burglars). It is also common to see someone collecting the mail of their next door neighbour who is away, or someone taking a basket of garden fruit or muffins to a neighbour. Doors are frequently left unlocked, children can be seen playing in different gardens and mothers can be seen delivering school children at other houses.5. ANNOTATED BIBLIOGRAPHY The annotated bibliography below summarizes and critically evaluates five relevant studies (mainly journal articles) that support the research in this work. Deaton, A. (2003, Spring). Health, income and inequality. National Bureau of Economic Research (NBER). Retrieved April 12, 2011 from http://www.nber.org/reporter/spring03/health.html
The author states that people with higher incomes (related to employment)and education levels live longer than poorer, unemployed and less-educatedpeople. Deaton mentions that lower mortality and morbidity rates areassociated with almost any positive indicator of socioeconomic (SE) status, arelationship known as "the gradient‖. At the bottom of the SE gradient areethnic minorities, the unemployed and dependent people. A relevant remarkmade in this article is that adverse health effects of lower permanenthousehold income accumulate over childrens lives, so that the children ofpoorer parents reach adulthood with lower health status and educationalattainment - the latter, in part, as a consequence of the former. The articleconcludes that income inequality is less important than other largerdimensions, such as political or gender inequality. However, Deaton fails toblame bad political economies by name, like those that legislate againstminimum wages, progressive taxation or subsidization other than someprescription medication.Gilbertson, J., & Green, G. (2008). Affordable homes, strong communities: Good housing and good health? Retrieved April 12, 2011 from http://www.housinglin.org.uk/Topics/browse/Housing/hwb/?parent=36 91&child=1573This study funded by the British Department of Health aims to demonstratethat home improvement to better environmental determinants of household-related health (indoor and outdoor housing conditions) are not cost/resulteffective. Although the authors acknowledge that the links between theseenvironmental factors and health have been documented, they claim that theimpact of housing investment on health has not always demonstrated betterhealth outcomes, as housing improvements often occur as part of largerregeneration schemes. The local socio-economic and cultural context, thepolitical environment, the wider neighbourhood context including factors suchas unemployment, educational attainment, the level of anti-social behaviour,fear of crime, etc., may well be of greater importance in determining healththan housing conditions. But top-down solutions are slow and expensive, while,as Housing NZ (2006) demonstrated, bottom-up initiatives lead to fasterresults with minimal resources, giving a comforting sense of achievement.
Housing New Zealand (2006, September). Report of the outcomes evaluation (year two). Retrieved April 12, 2011 from http://www.hnzc.co.nz/utils/ downloads/B896E26809CB14C04FA6CB95CEBAAC21.docHealthy Housing is a joint Housing NZ and District Health Board‘s initiativelaunched in January 2001 that aims to reduce the risk and rates of housing-related diseases and improve the health outcomes of tenants in somedeprived areas of NZ. Healthy Housing reports denounce social inequitieswhich are ultimately corrosive of health. They address the need to uphold theTreaty of Waitangi, the enhancement of communities‘ social and physicalenvironments and to provide strong social services, to ultimately reduceinequalities in health care administration and access in housing. This reportconcludes that the positive relationships between providers, communityworkers and tenants, the promotion of family participation in decision-making,and the providers proactivity in the implementation of the minor homeimprovements tenants suggested (mostly insulation, space distribution andappearance changes), all resulted in resident‘s reporting positive changes infamily life, participation in community activities, more social cohesion, andincreased health and well-being. This article supports the findings of Howden-Chapman et al‘s (2004) and advocates the empowerment of community-based strategies for health improvement.Howden-Chapman, P., Crane, J., Baker M.G., Cunningham, C., Saville-Smith, K., Blakely, T., Cunningham, C., Woodward, A., ODea, D., & Brunton, C. (2004). The Impact of Insulating Domestic Houses on the Health of Occupants: An Intervention Study. Retrieved April 12, 2011 from http://search.otago.ac.nz/search?q=Housing+Inequalities+Health&btnG =Search&site=uow&entqr=0&sort= date%3AD%3AL%3Ad1&output=xml_ no_dtd&client=uow&numgm=5&ud=1&oe=UTF-8&ie=UTF-8& proxystylesheet=uowIn this multi-agency, community-based NZ study, the researchers wanted totest the hypothesis that insulating domestic houses would make them warmerand that this would improve household dwellers‘ health and wellbeing. Thestudy is particularly relevant as, according to the authors, this issue had notpreviously been systematically examined. They selected two hundred
households in each of seven deprived communities where someone had ahistory of respiratory problems. They insulated half the houses and the nextwinter compared them with the non-insulated houses. Results showed asignificant association between insulation and better health for all theoutcomes measured, which included self reported general health, energyconsumption, frequency and severity of respiratory signs and symptoms, daysoff school and work, number of visits to the doctor and hospital admissions.But these initiatives need to be continued beyond the research project‘s timelimits in order to make a difference in other households and in othercommunities.Kunitz, S.J. (2008, August). Comments on the diversity in associations between community social capital and health. International Journal of Epidemiology, 37 (6), 1393-1394.The author equates social capital, that is, the connections within and betweencommunities, with social cohesion. Kunitz acknowledges the many studiesevidencing the relationship between social cohesion and health incommunities, but this study looked at why some neighbourhoods with highsocial capital have unhealthy outcomes while some low social capitalneighbourhoods have healthy outcomes, thus implying that other factorsbesides social cohesion may contribute to the health of local residents. Amongthose factors are the larger political, socio-economical and institutionalcontexts. It is pointed out that it may be difficult to extrapolate findingsbetween nationalities. Social cohesion does not seem to matter much in TheNetherlands, a small, relatively homogeneous and generous welfare state withuniversal entitlement to health and other social benefits and services. Socialcapital may be relevant to health in settings that are largely devoid ofuniversally available services. This apparently controversial study shows thatsocial networks can be good or bad depending on the setting, as residents ofneighbourhoods with a high index of criminality are likely to have bad healthand social outcomes. Findings of the PNHA community survey are, therefore,not surprisingly positive for social cohesion outcomes in the area.
6. MIDCENTRAL DISTRICT HEALTH BOARD SUMMARY OF HEALTH INDICATORS 6.1. Background As part of the MOH, the District Health Boards (DHBs) are responsible for the provision of funds for health and disability services in their district. There are 21 DHBs in NZ and they have existed since 1 January 2001 when the NZ Public Health and Disability Act 2000 came into force. Statistics NZ is the original source for all the population data shown in the DHB reports (MCDHB, 2011). The 2006/07 NZ Health Survey is the fourth national population- based health survey carried out by the MOH (MCDHB, 2011). The first Health Survey was in 1992/93, followed by surveys in 1996/97 and 2002/03. The 2011 Census was not held on 8 March 2011 as planned, due to the Christchurch earthquake on 22 February 2011.
The DHB surveys collect information on New Zealanders‘ health that is not accessible through health system records, as these are confidential. It measures self-reported physical and mental health states (including diagnosed health conditions), modifiable risk and protective factors for health outcomes, and the use of health care services, for the non-institutionalised resident population of all ages. The survey results are weighted in order to be representative of the overall New Zealand‘s resident population and are compared with earlier surveys so that conclusions can be drawn (MOH, 2008).6.2 MidCentral Health 2009 Health Needs Assessment The MidCentral Distric Health Board (MCDHB) ―2009 Health Needs Assessment‖ report aims to provide information about the health status of MidCentral‘s population, how it has varied with regard to previous reports, what health conditions have the greatest relevance over the population, and how the MidCentral community compares to the rest of NZ. Below is a summary of the key points from this report. 6.2.1 Population MidCentral‘s population is growing, mostly in PN, but that population is increasingly ageing, with increasing proportions aged over 65 and reducing proportions of under 14. The proportion of Maori, Pacific, and Asian residents is increasing. Although the population age balance in non-European ethnicities is younger, they are expected to become older in the future (MCDHB, 2009). 6.2.2 Socioeconomic disadvantage The health status of MidCentral‘s socioeconomically disadvantaged population appears to be worse than New Zealand‘s socioeconomically disadvantaged people (mortality comparisons across time). The NZ Health Survey 2006 found that people who live in socioeconomically disadvantaged
neighbourhoods were more likely to smoke, more likely to be sedentary, and were less likely to have a primary care provider, and the Ministry of Social Development research shows households experience socioeconomic hardship because of multiple factors acting together. The factors include: low income; housing rented rather than owned; people who have experienced divorce; significant life events, for example newly found unemployment, or death of partner; personal health problems that disadvantage a household; having dependent children; Maori or Pacific ethnicities; people with multiple financial payments they find difficult to meet (MCDHB, 2009).6.2.3 Health Status The overall self-reported health status of MidCentral residents is improving, being now rated as excellent or very good, but this perception of well-being declines as age increases, and only half of the people over 75 describe their health as very good. About 90% of parents rate their children‘s health as excellent or very good. European ethnicities are more likely to rate their health as excellent or good compared to Maori, Pacific and Asian ethnicities.6.2.4 Health Status Disadvantage People who experience health status disadvantage In MidCentral district are: Maori and Pacific peoples, the socioeconomically disadvantaged, and Horowhenua residents. In general, the health status of those population groups with poorer state of health has been improving although the gap compared with MidCentral‘s residents overall is still present. In general, people with disadvantaged health status experience the same health conditions as the population overall, but more frequently (MCDHB, 2009).6.2.5 Avoidable Mortality
―Avoidable mortality‖ is mortality that could be prevented. MidCentral‘s age-adjusted rates of avoidable mortality have been higher than equivalent NZ rates. The five main causes of avoidable mortality in the MidCentral area are: cardiovascular disease, malignancy, respiratory disease, injuries, endocrine- metabolic diseases (predominantly diabetes). However, for PN the rates change, as causes of death for injuries are more common than respiratory causes, and perinatal causes of death are more common than endocrine-metabolic causes.6.2.6 Avoidable Hospitalizations ―Avoidable hospitalisations‖ are hospital admissions that could be prevented. MidCentral‘s age-adjusted rates of avoidable hospitalisations have been lower than equivalent NZ rates. MidCentral hospitalisations are significantly influenced by lower health service access as well as community disease needs. The improving avoidable hospitalisation rates coincide with better access to primary care services.6.2.7 Access to Health Services Increasing hospitalisation rates for disease groups linked with long-term conditions (like asthma and diabetes) and decreasing mortality rates for the same disease groups suggest an improvement in health service access for people experiencing chronic conditions. There is evidence that health service underuse by people in most need of services is going down (avoidable hospitalisation patterns compared to avoidable mortality patterns) (MCDHB, 2009).
7. Conclusions 1. The preliminary community health analysis of the PNHA agrees with the existing literature in that health and income and employment are related. 2. The lower rates of respiratory disease mortality in the PNHA may be related to the presence of trees in gardens and streets and to quality housing. 3. There is evidence of strong social cohesion in the PNHA, which is another relevant determinant of health, mostly mental health.
8. Recommendations 1. Insulation standards in NZ should be raised based on the growing literature and on supporting evidence-based studies on community health. 2. Project development requires contextual understanding of community factors and profiles if they are to be sustainable. 3. Effective health needs approaches need to take into consideration relevant research, empirical evidence, and the active participation of healthcare workers and the community. 4. Economical and social politics are needed for a more democratic distribution of wealth, on one hand (macro level of intervention), and fot the provision of the funding required for community-based health promoting initiatives (intermediate level of intervention) on the other.
9. ReferencesBuckner, J. C. (1988). The development of an instrument to measure neighborhood cohesion [Electronic version]. American Journal Of Community Psychology, 16 (6),771-791Deaton, A. (2003, Spring). Health, income and inequality. National Bureau of Economic Research (NBER). Retrieved April 12, 2011 from http://www.nber.org/reporter/spring03/health.htmlGerberich, S.S., Susan J. Stearns, S.J., & Dowd, T. (1995). A Critical Skill for the Future: Community Assessment. [Electronic version]. Journal of Community Health Nursing, 12 (4), 239-250Gilbertson, J., & Green, G. (2008). Affordable homes, strong communities: Good housing and good health? Retrieved April 12, 2011 from http://www.housinglin.org.uk/Topics/browse/Housing/hwb/?parent=3691&c hild=1573Housing New Zealand (2006, September). Report of the outcomes evaluation (year two). Retrieved April 12, 2011 from http://www.hnzc.co.nz/utils/ downloads/B896E26809CB14C04FA6CB95CEBAAC21.docHowden-Chapman, P (1999). Socioeconomic inequalities and health. In Peter Davies & Devin Dew (Eds.), Health and Society in Aotearoa New Zealand. Auckland: Oxfor University Press
Howden-Chapman, P., Crane, J., Baker M.G., Cunningham, C., Saville-Smith, K., Blakely, T., Cunningham, C., Woodward, A., ODea, D., & Brunton, C. (2004). The Impact of Insulating Domestic Houses on the Health of Occupants: An Intervention Study. Retrieved April 12, 2011 from http://search.otago.ac.nz/search?q=Housing+Inequalities+Health&btnG =Search&site=uow&entqr=0&sort= date%3AD%3AL%3Ad1&output=xml_ no_dtd&client=uow&numgm=5&ud=1&oe=UTF-8&ie=UTF-8& proxystylesheet=uowJacobs, M. D. (1993). Screwing the system and making it work. Chicago, IL: University of Chicago Press.Kingi, T. K. (2002). Hua Oranga: Best Health Outcomes for Maori. Palmerston North: Massey University.Kunitz, S.J. (2008, August). Comments on the diversity in associations between community social capital and health. International Journal of Epidemiology, 37 (6), 1393-1394.Marmot, M., & Wilkinson, R. G. (Eds.) (1999). Social determinants of health. Oxford: Oxford University Press.MidCentral District Health Board (2009). 2009 Health Needs Assessment. Retrieved March 17 from http://www.midcentraldhb.govt.nz/Publications/HNA/MidCentral District Health Board (2011). What a District Health Board does. Retrieved March 17 from http://www.midcentraldhb.govt.nz/About/DHBDoes.htmMinistry of Health (MOH) (2000). The New Zealand Public Health and Disability Act. Retrieved March 18, 2011 from http://www.moh.govt.nz/moh.nsf/0/e65f72c8749e91e74c2569620000b7c e?OpenDocument
National Health Committee (NHC) (1998). Active for Life: A call for Action. The health benefits of physical activity. Wellington: National Advisory Committee on Health and Disability.New Zealand History (2008). Retrieved March 13, 2011 from http://www.nzhistory.net.nz/war/maori-and-the-second-world- war/achievementsNew Zealand Parliament (2009). Electorates profiles data. Retrieved April 14, 2011 from http://www.parliament.nz/en- NZ/MPP/Electorates/EPData/c/b/7/DBHOH_Lib_EP_PalmerstonNorth_Data_ 5-Palmerston-North-Households.htmPalmerston North City Council (2011). Retrieved March 10, 2011 from http://www.pncc.govt.nz/About/History/Detail.aspx?id=2043Pearce, J., Witten, K., Hiscock, R., Blakeley, T. (2007). Are socially disadvantaged neighbourhoods deprived of health-related community resources? [Electronic version] International Journal of epidemiology 36, 348-353.Public Health Advisory Committee (PHAC) (2004). Health Impact Assessment. Retrieved March 18, 2011 from http://www.phac.health.govt.nz/moh.nsf/indexcm/phac-hiaQuotable Value (2009). Sample Property Reports. Retrieved March 17, 2011 from http://www.qv.co.nz/onlinereports/propertyreports.Rice, G.W. (2005). Black November: The 1918 Influenza Pandemic in New Zealand (2nd Ed.). Christchurch, NZ: Canterbury University Press.Starfield, B. (2007). Pathways of influence on equity in health: A rejoinder to Braveman and Wilkinson. [Electronic version]. Social Science & Medicine (64), 1371—1372
Statistics New Zealand (2006). Retrieved March 4, 2011 from http://www.stats.govt.nz/Census/2006CensusHomePage/QuickStats.aspxTaylor, J., Wilkinson, D., & Cheers, B. (2008). Working with communities in health and human services. Melbourne, NZ: Oxford University Press.United Nations Educational, Scientific and Cultural Organization (UNESCO)(1945). The Constitution of UNESCO. Retrieved on March 22, 2011 from http://www.unesco.org/new/en/unesco/about-us/who-we- are/history/constitution/Wilkinson, R.G. (1996). Unhealthy Societies: The Afflictions of Inequality. Routledge, London. Wood, E. E. (1937). The Costs of Bad Housing. [Electronic version]. Annals of the American Academy of Political and Social Science (190), 145-150,World Health Organization (WHO) (1986). Ottawa Charter for Health Promotion. Ottawa: World Health Organization.World Health Organization [WHO] (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Retrieved March 6, 2011 from http://www.who.int/social_determinants/thecommission /finalreport/en/index.html
APPENDIX 1 COMMUNITY INVENTORY COMPLETEDAuditor’s Community: Weather: name: Date: Palmerston North Hospital Area Time: Calm, clear, Virginia 23/03/2011 Street segment: 10:15 a bit chillyWesterberg Stanley St (btw Roy & Heretaunga) NOTES (pros/cons COMPONENTS ANSWERS , ideas, incidences ) BOUNDARIES, The Palmerston North Hospital Area (PNHA) is BORDERS & located in the north of the city and has a Started as usually resident population of almost 2,700. NAMES community Until 1971, this neighbourhood was part of the How is the Papaioea suburb (Statistics NZ, 2006). An of place. community almost perfectly rectangular area, the PNHA is defined? How is it delimited by four of the city’s main roads: Good designed? Is it well Tremaine Avenue (North), Featherston Street structure. communicated with (South), Ruahine St (East) and Rangitikei St other areas? Are (West). Interestingly, the names of most streets Convenient delimited by the four main roads are English, boundaries natural location. whereas the larger streets have Maori names. or built? How are The PNHA is very close to the train station and streets named? the airport (0.5 and 1.8 km respectively). The PNHA has a grid design and a ring road structure (the 4 main roads mentioned above) which directs traffic away from the houses. Accessibility is excellent to other main roads and to the city centre. Relate hospital The PNHA is primarily a residential suburb. GENERAL LAND density and Like in most parts of town, the land is flat, USE making walking and cycling easy. The skyline proximity Does a particular of the eastern end of the suburb is dominated with health type of land use / by the Palmerston North Hospital, for which it is outcomes. construction named. The PNHA also offers a wide range of predominate? views of the city and surrounding area. Neighbour How does land use Whatever land is not used for residential living s like it is used for one of two activities: health and characteristics proximity services and education. There are four affect residents’ hospitals in the suburb: the Palmerston North to hospital. health? Hospital, the fourth largest tertiary teaching
How many hospital in New Zealand (MCDHB, 2010), the Muchhealthcare centres Aorangi Hospital, a locally owned and operated sought out private hospital, the Arohanui Hospice providesare there? area, prices specialist palliative care for patients withProportionate for serious chronic, advanced or terminal gettingcommunity? Are conditions and the Southern Cross Hospital higher.they easily and Specialist Centre, a private surgical facility,accessible? How? Is part of the national network of Southern Cross Good tothere acoustic hospitals. Metlifecare is a high-standing keep itcontamination from retirement village with rest home and full residential. healthcare services. Other large medical clinicsambulance sirens? in the PNHA are The 18 clinics are: The FootAre there any rest Clinic, He Puna Hauora (Maori Healthhomes for the Services), 169 Medical Centre, Fertilityelderly? How do Associates, Metlife, Bruce Rhind Surgery, Rossresidents feel about Hayton Surgery, Sydney Health Centre,living in the area? Belinda Genet & Associates Physiotherapy, Mike Cleary Surgery, Pain Management Rehabilitation Services, The StressAre there schools? Management Centre, John JosephPrivate, public, free, Ophthalmology, Dilhan Cabraal Head, NeckMaori, special, and Throat Surgery, Dixon Internal Medicine,ages? How do D.A. Wilde Urogynaecology, Jagga GPs,children travel to McRae Podiatry. Neighbours, especially theschool? Uniformed? older ones, find it is reassuring and convenient to live close to doctors homes and practices,Cultural variety and to the PN Hospital, especially inobserved? emergencies. Three rest homes are in theAccessible by bike neighbourhood: The Rimu Lodge, Metlife andor bus? Bicycle Willard home.parking? Bus stops?Where? Number? Several schools are within the area: Russell Street School, Palmerston North Boys HighBoth sides? School, Queen Elizabeth College and the ManaPedestrian Tamariki Maori School (which offerscrossings? School kindergarten, school and high-school servicessigns? Are there for Maori, by Maori, and more importantly,many children strictly in Maori). There is one dancingwalking or cycling academy (Dean McKerras School of Dance), a music academy (Sound Hound Studio) and ato school? Maori Carving school (Whakairo) which receives students from all over the world. There are also many kindergartens: kindergartens like First Steps, School’s Out, Rewanui, Wananga and Learn-A-Lot, the latter offers 20 hours of free child care for residents. There is a bus stop on the same or opposite side of the street of every hospital and school, but not so near the kindergartens. There is only one grocery store in the area, City Garden, and one highly rated Japanese
restaurant, Yatai, that does not have takeaway services. The two Palmerston North Hospital cafés are open to the public 7 days a week.HOUSING The PNHA is one of Palmerston Norths most sought after areas. Most houses in theSize? Age? Feel good PNHA were built between 1914 and 1930, aCondition. few in the 50’s, and are predominantly area, calm,Detached or weatherboard dwellings, some of them have makes youconnected? Owned brick façades. The average house has a want to goor rented?.Gardens floor area of 175m2, and a land area of 780 out for a(size, front and m2, has high ceilings, a front and back stroll.back?, fences? garden (usually English-style gardens with trees), a private driveway with a two-carcondition? flowers? Trees good garage, a tool shed, three bedrooms, atrees?) Number of bathroom and a toilet, a dining room, a in summercars in driveways living room, two fireplaces, heat pump, an for shade,(what type of car? open-plan kitchen, a laundry room and good forAge, condition) French doors opening up to the back rainDo houses have garden (Quotable Value [QV], 2009). contention. Insulation is common, but not double-good direct access glazing (QV, 2009). All houses areto footpath and carpeted. Supplies like water, electricity and Trees makestreet? Architectonic gas are all provided. Sale prices are around car goharmony? $300k, rental prices are around $320/week slower.Telephone lines, (QV, 2009). The architectural design is quiteinternet, satellite TV homogeneous and harmonious. People areantennas. Trees predominate in gardens and along seen the streets, making them attractive forGas, electricity, walking, and neighbourhoods that look walkingwater supply cared for and relaxing, with visible sidewalk around,available? activity enhance social connectedness and talking,Good mail delivery? experience less crime (Jacobs, 1993). walking Trees also improve air quality, reduce traffic pets, noise and speed, and increase property children value. The City Council takes care of street playing. trees in the area so that their branches and roots do not affect street and footpath safety. The city design, with a grid structure, ensures the diversion of traffic, together with its fumes and noises, away from the houses. Other similarly looking and built constructions in the area, excepting hospitals and schools, are medical clinics, rest homes, and kindergartens. There are no official buildings.TRANSPORT & Cars are overrepresented in a such a small MoreMOBILITY community, and it is common to see cars sheltered parked by the kerb because the two-car
garages are occupied. They drive very bus stops,How do people get slowly in the neighbourhood, so they are free buses hardly noticeable. The two-way streets arein and out of the for all wide, but the trees make them lookneighbourhood? narrower. They are pedestrian and cyclist studentsWhat transportation friendly. Bicycle paths exist only on themeans do residents larger streets. The traffic lights are only Lowuse? located in the main ring roads. Road intensityStreets, footpaths, signalling and maintenance is very good in streetroads, cycle lanes? the area, the streets are properly cambered lights so (the convexity is evident to the naked eye)Easy access to main that light and uniformly asphalted. The approx. 1.5mroads, city centre, wide footpaths are made of concrete, in does notshopping centres? very good condition and mildly banked. botherEasy access to main Driveways allow easy accessibility for push neighboursbus terminals, train and wheel-chairs at short intervals. There is .station and airport? lawn between them and the kerb, where trees are planted. The shallow gutters andAre streets good the storm drains keep heavy rain away fromlooking? Alike? the road. Findings relate to both sides of theSense of harmony, street. The only judder bars are seen by thethat they belong Palmerston North Hospital entrance, attogether? Grid Gate 1. There are no traffic lights inside thestreet layout? neighbourhood. They are all located by or inAre streets broad or the 4-road ring road. Pedestrian crossings and speed limit signs exist near hospitalnarrow? Condition. and school entrances. Drop off zone andAre there bicycle yellow no parking lines near hospital andlanes? Blockages? school entrances; no parking zones areCondition? applicable before & after school.Is there a footpath Unsheltered bus stops are located on theon each side? Are large streets and buses do not drive through the neighbourhood. There is only onethey wide enough? sheltered bus stop, the one by RussellAre they in good Street School. The grid design of the streetscondition? make it very easy for pedestrians, cyclistsAre there ramps or and drivers to move around, in an out of thesimilar? area.Are the streets welllit? Are streetsnoisy? Pollution? Airquality.Many cars instreets? Are therebus stops? Where?Are they sheltered?Are street namesEuropean or Maorinames?Are there traffic
lights?Are therepedestriancrossings?Are theremailboxes?Are there people(age) in the streets?Are there animals,(pedigreed) pets?Are streets clean?Well maintained?Good road signs?Are roads visiblycambered?Are footpathsbanked?Do streets have sidedrains?Are there carsparked in thestreets?Are streets invitingfor walking, cycling?Are there trees inthe streets?Are there footpathlawns?Who keeps thestreets clean?General feelingabout transit andmobility. All the houses in the neighbourhood haveMEDIA & aerials, many of them also have satellite Good to dishes, meaning that they have readyCOMMUNICATION have so access to television. The local cell phoneWhat kind of local tower is located in the Palmerston North manycommunication Hospital. Residents also have specific newspapermeans are there? sources of community information as s, getAny community several free newspapers and publications soaked inspecific ones? are delivered daily in the mailboxes: The mailboxes, Tribune (“your window to the community”), letters too. the Manawatu Guardian (“Manawatu’s leading community news provider”), The Manawatu Standard (limited free edition), Better
the Russell Street School Community mailbox Newsletter (seasonal delivery). The locals standards. are also mailed real estate pamphlets about rentals and sales in town, and political pamphlets during election periods. They are Good to kept very well informed of community- see related activities. No noticeboard or sign diversity in advertising can be seen in the political neighbourhood outside election periods. support on elections.SOCIAL COHESION Residents of the PNHA show evidence of(as operationally high connectedness, as it is common to see Good to neighbours getting together on differentdefined by Buckner show occasions (New Year’s Eve, ANZAC day, or(1988) , Marmot when somebody is ill or moving in or out). concern,(1987), and as Most locals know their neighbours’ names. could beobserved by the Additionally, every new resident is given a perceivedauditor) “Neighbourhood watch” list showing names as intrusion and phone numbers of other neighbours in (noseyIs there evidence of order to report suspicious activity (possible neighbours burglars). It is also common to seesocial cohesion? ) someone collecting the mail of their nextGeneral feel about door neighbour who is away, or someonethe community. taking a basket of garden fruit or muffins to Neighbour a neighbour. Doors are frequently left s pick up unlocked, children can be seen playing in garbage different gardens and parents can be seen flying collecting and delivering school children around and from and to other houses. Feels like a community of interest rather than a dispose of community of place (it was created as the it. latter). Letters overflowin g mailboxes are collected and kept until return (nice?) There is one grocery store, City Garden onRETAIL (food, Featherston St, very accessible and easy to Good to see. A pharmacy and a post office arealcohol, other) keep located inside the PN Hospital. There are no alcohol outlets or any other kind of store residentialAre there any shops in the neighbourhood, but distances are character,
in the community? short in such a small suburb. Countdown, butAre there any New World and Woolworths are all an disabled estimated 20-minute walk or 5-minute driverestaurants or bars? people away if you need to buy food, drinks orWhere are they household goods. About the same time may likelocated? Are there needs to be invested to go to the city centre conveniencalcohol outlets? district if you need clothes, cosmetics, es closer.Where do residents books, or the like.buy their food?RECREATION The only specific recreational are is theAre there any Bowling Club on North St. The large North Maybe PN Street park belongs to the PN Boys HS andindoor or outdoor Boys HS is their play and training grounds. Childrenrecreational can be seen playing in the attractive playingfacilities? Where do gardens and streets, and elderly people groundschildren play? look comfortable and safe talking to other could beWhere do residents locals as they walk their pets around the shared withhang out? neighbourhood. Access to parks, public community gardens, cinemas and other amenities out of would require travelling out of the area. school hours.CULTURAL Although European influence predominates,DIVERSITY Maori presence is also evident in the community. There are three highly ratedls there evidence of schools: Mana Tamariki, Wananga andcultural diversity? Whakairo, all run by Maori. There is one Maori health centre across the street from Mana Tamariki school, called He Puna Hauora. The Palmerston North Hospital has a wing dedicated to Maori health, Te Whare Rapuora. Children of different ethnicities are seen going and coming to the schools and kindergartens. No further evidence of cultural diversity could be documented.WORSHIP There are small Christian-looking chapels inAre there any the PN Boys HS and in the PN Hospital, and in front of the latter there is a catholicreligious centres church, St Mary. No evidence of any other(temples, churches, worship area was noted.mosques)?COMMUNITY The land between the PN Boys HS andGROWTH North St was redeveloped last year and Neighbour turned into a boys’ residence with cateringWhat evidence is s complain services. Likewise, the land in front of thethere of growth or PN Boys HS is currently being redeveloped aboutdecline? and a Mitre10 warehouse is planned to be Mitre10, built there. Some home improvement they would activity is frequently seen. have preferred a park or
garden or playground for kids. APPENDIX 2 COMMUNITY SURVEY TEMPLATEAuditor’s Date: Time: Community: Weather: name: Street segment: NOTES (pros/cons COMPONENTS ANSWERS , ideas, incidences ) BOUNDARIES, BORDERS & NAMES How is the community defined? How is it designed? Is it well communicated with other areas? Are boundaries natural or built? How are streets named? GENERAL LAND USE Does a particular type of land use / construction predominate? How does land use and characteristics affect residents’ health?
How manyhealthcare centresare there?Proportionate forcommunity? Arethey easilyaccessible? How? Isthere acousticcontamination fromambulance sirens?Are there any resthomes for theelderly? How doresidents feel aboutliving in the area?Are there schools?Private, public, free,Maori, special,ages? How dochildren travel toschool? Uniformed?Cultural varietyobserved?Accessible by bikeor bus? Bicycleparking? Bus stops?Where? Number?Both sides?Pedestriancrossings? Schoolsigns? Are theremany childrenwalking or cyclingto school?HOUSINGSize? Age?Condition.Detached orconnected? Ownedor rented?.Gardens(size, front and
back?, fences?condition? flowers?trees?) Number ofcars in driveways(what type of car?Age, condition)Do houses havegood direct accessto footpath andstreet? Architectonicharmony?Telephone lines,internet, satellite TVantennas.Gas, electricity,water supplyavailable?Good mail delivery?TRANSPORT &MOBILITYHow do people getin and out of theneighbourhood?What transportationmeans do residentsuse?Streets, footpaths,roads, cycle lanes?Easy access to mainroads, city centre,shopping centres?Easy access to mainbus terminals, trainstation and airport?Are streets goodlooking? Alike?Sense of harmony,that they belongtogether? Gridstreet layout?Are streets broad ornarrow? Condition.
Are there bicyclelanes? Blockages?Condition?Is there a footpathon each side? Arethey wide enough?Are they in goodcondition?Are there ramps orsimilar?Are the streets welllit? Are streetsnoisy? Pollution? Airquality.Many cars instreets? Are therebus stops? Where?Are they sheltered?Are street namesEuropean or Maorinames?Are there trafficlights?Are therepedestriancrossings?Are theremailboxes?Are there people(age) in the streets?Are there animals,(pedigreed) pets?Are streets clean?Well maintained?Good road signs?Are roads visiblycambered?Are footpathsbanked?Do streets have sidedrains?Are there carsparked in thestreets?Are streets inviting
for walking, cycling?Are there trees inthe streets?Are there footpathlawns?Who keeps thestreets clean?General feelingabout transit andmobility.MEDIA &COMMUNICATIONWhat kind of localcommunicationmeans are there?Any communityspecific ones?SOCIAL COHESION(as operationallydefined by Buckner(1988) , Marmot(1987), and asobserved by theauditor)Is there evidence ofsocial cohesion?General feel aboutthe community.RETAIL (food,alcohol, other)Are there any shopsin the community?Are there anyrestaurants or bars?Where are theylocated? Are therealcohol outlets?Where do residents
buy their food?RECREATIONAre there anyindoor or outdoorrecreationalfacilities? Where dochildren play?Where do residentshang out?CULTURALDIVERSITYls there evidence ofcultural diversity?WORSHIPAre there anyreligious centres(temples, churches,mosques)?COMMUNITYGROWTHWhat evidence isthere of growth ordecline?
APPENDIX 3MIDCENTRAL DISTRICT HEALTH BOARD – 2009 Health Needs Assessment – RawDataPopulation Data
Avoidable causes of mortality - MidCentral Avoidable causes of mortality – Palmerston North Avoidable causes of Hospitalization- Avoidable causes of Hospitalization- MidCentral Palmerston North
APPENDIX 4Deprivation Index AreasMidCentral (lighter colours = less deprived) Palmerston North (darker greens= less deprived)[Source: MCDHB, 2009] [Source: NZ Parliament, 2009]
APPENDIX 5STATISTICS NEW ZEALAND – 2006 Census - Raw DataPNHA = Palmerston North Hospital AreaMW= Manawatu-WanganuiNZ = New Zealand STATISTICS NEW ZEALAND CENSUS 2006 DATA PNHA - MW MW - NZ