Aotearoa-New Zealand is expecting the number of older adults to double in the next 20 years. Despite publicly funded health and welfare support for older citizens, the aging experience differs across ethnic groups. This creates opportunities and challenges for health and social services to deliver culturally safe and equitable care for all older New Zealanders. Longitudinal and large data sets are pivotal for characterizing the aging experience from birth to advanced age. The New Zealand research funding system responded to predicted demographic changes by increasing funding in order to inform and address key health and well-being issues for older people. In addition, government strategies and policies increasingly focus on social aspects of aging and health inequities and require researchers and organizations to be better connected to end-users. New Zealand needs to continue to fund research that identifies unique and courageous service delivery solutions that result in positive social, financial, psychological, and physical aging for older New Zealanders.
Aotearoa-New Zealand is a nation of 4.9 million people located in the South Pacific Ocean. Māori, the Indigenous people of New Zealand, have a distinct culture that is protected, along with health and well-being, by New Zealand’s founding document—the Treaty of Waitangi. Ground-breaking gerontology research in New Zealand includes Life and Living in Advanced Age Cohort Study (LiLACS NZ), the world’s first longitudinal study that includes a significant Indigenous population aged 80 years and older; Indigenous health and well-being research; the Otago Exercise Programme, which is an evidence-based strength and balance falls prevention program utilized around the world; and the Dunedin Multidisciplinary Health and Development Study, an internationally renowned birth cohort study with more than 95% retention at age 45. This article summarizes New Zealand’s demographics and inequities in aging and health, the current funding environment, large data sets and tissue collections that can be accessed for health and well-being research, emerging issues, and research and social policies that are driving changes in gerontology research in New Zealand.
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Demographics and Health Inequities
People aged 65 and older currently constitute 15% of New Zealand’s population, with just over half (53.4%) being women (Statistics New Zealand, 2019). Almost 80% of older New Zealanders identified with a religion. Christianity was the most prevalent (75.7%) religious affiliation, followed by Hinduism (11.2%), Buddhims (9.2%), and Islam (3.6%; Statistics New Zealand, 2013a, 2013b). Like most Western countries, the number of older New Zealanders has almost doubled since 1998, increasing from 0.44 to 0.74 million people. Ongoing increases in life expectancy mean that the older population in New Zealand is predicted to double to 1.30 million in the next 20 years, and the 85+ age group is expected to double in the next 40 years.
Māori currently account for 15% of the total population. However, the Māori population age structure is relatively young, with only 5.8% of the population more than 65 years of age identifying as Māori compared with 82.9% European, 2.5% Pacific, 6.3% Asian, and 2.5% other (Statistics New Zealand, 2019). Higher fertility rates, lower life expectancy, and higher rates of premature mortality for Māori compared with non-Māori contribute to these differences (Statistics New Zealand, 2019). Life expectancy for Māori is 7 years shorter than non-Māori in New Zealand, and health statistics show Māori experience the worst health and well-being with greater disability compared with other ethnicities (Statistics New Zealand, 2019). Although life expectancy is increasing for all New Zealanders, Māori are predicted to have a reduced life span for the foreseeable future.
Māori health and well-being have always been rights protected by the Treaty of Waitangi signed in 1840. This right aligns with the United Nations adoption of the Declaration on the Rights of Indigenous Peoples in 2007, which states that Indigenous people have the right to identity, language, employment, health, education, and cultural expression. The World Health Organization has recognized that health care systems must address “inequities rooted in discrimination.” Positive aging has been compromised for Māori through lifelong socioeconomic disadvantage, poorer education status, reduced quality of housing, fewer employment opportunities, racism, and increased exposure to the criminal justice system (Edwards, Theodore, Ratima, & Reddy, 2018). Colonization has involved, and continues to involve, significant trauma for Māori associated with the appropriation of Māori land, urbanization, socioeconomic deprivation, cultural subjugation, and loss of political power (Wirihana & Smith, 2014). Historical insult and contemporary experiences of colonization see Māori experiencing differential exposure to the determinants of health, differential access to and through health care services, and differential access to high-quality health care (Reid & Robson, 2007).
Health inequities have arisen from systemic racism. A Waitangi Tribunal, a forum for historical grievances to be raised and addressed (Boast, 2006), began in 2016 on the Health Services and Outcomes Inquiry into health inequities experienced by Māori. The Tribunal has found serious Treaty breaches by the Crown that require an increased commitment to redesign the health system to address persistent Māori health inequities to enable positive Māori aging (Chin et al., 2018). Over the next 20 years, higher birth rates that occurred between 1945 and 1975 and increased immigration from Pacific and Asian regions from the 1970s onward will contribute to an increasing rate of growth for older Māori, Pacific, and Asian populations (160%–240%) compared with the older European population (50%; Statistics New Zealand, 2019).
This challenge is heightened by a current lack of data on the prevalence of many older-aged conditions in Māori, Pacific, and Asian peoples (e.g., dementia). As a result, New Zealand lacks detailed information on the distribution and burden of older age disorders within these groups. This issue will only be exacerbated by the lack of complete, reliable, and robust data associated with the poorly conducted 2018 Census in New Zealand (Kukutai & Cormack, 2018). New Zealand needs to respond to these opportunities and challenges for health and social services to deliver culturally safe and equitable care for all older New Zealanders.
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Areas of Gerontology Research Strength
For many decades, New Zealand research priorities have been focused on the health and well-being of older adults. One area of research strength in New Zealand is longitudinal studies. Table 1 outlines five longitudinal studies, their locations, websites, and names of the director or principal investigator. Data from these longitudinal studies are not publicly available, but access may be granted by the director or principal investigator. These established data sets often have small numbers of Māori and Pacific participants, in part because of lower proportions of these ethnicities in some of the sampled regions when these cohorts were established, which limits their use for understanding Māori and Pacific experiences of aging in New Zealand. Exceptions are the LiLACS NZ, New Zealand Health, Work and Retirement Study and the Pacific Islands Families Study.
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The ongoing Dunedin Multidisciplinary Health and Development Study (also known as the Dunedin Study) was founded by Dr. Phil Silva in the Dunedin School of Medicine at the University of Otago in 1972. The Dunedin Study has followed 1,037 babies born between April 1972 and March 1973 at Queen Mary Maternity Hospital in Dunedin and has just completed 45th-year assessments with the cohort (Poulton, Moffitt, & Silva, 2015). The study began with a psychological development and health behavior focus, but has broadened to include measures of physical and sensory function, and has produced more than 1,200 publications. Brain and body imaging were included in the most recent assessment. With the cohort now middle-aged, the study will significantly improve understanding of the lifelong determinants of health and well-being into older age. Retention of the living cohort at each assessment period averages 95%–97%, an incredible feat over almost half a century.
The Christchurch Health and Development Study began in 1977. During this time, they have followed the health, education, and life progress of 1,265 children born in the Christchurch urban region. The cohort has been studied from infancy, and was recently interviewed for their 40-year assessment, and has produced more than 500 publications. This study will also significantly contribute to knowledge about aging in New Zealand.
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LiLACS NZ is a longitudinal study of New Zealanders living in advanced age. It aims to determine the predictors of successful advanced aging and understand the trajectories of advanced age health and well-being in Māori and non-Māori New Zealand populations. LiLACS NZ is the world’s first longitudinal study of an Indigenous population aged 80 and older. Māori participants were aged 80–90 years, and non-Māori participants were more than 85 years of age when the research began in 2010. A strength of this research is that the number of Māori participants (n = 421) is large enough to have equal explanatory power and that the findings will have the same precision as non-Māori (n = 516). The research describes the health status of Māori and non-Māori in advanced age, explores factors that have affected older people’s health and independence, how health and social services can better support older people and provide information on how to stay healthy, well, and independent as they get older Dyall et al., 2014.
The New Zealand Health, Work and Retirement Study conducts research with people more than 55 years of age who live in New Zealand. The study began in 2006 and includes a biennial health and work survey, and links to national health data sets. In the nine waves of this longitudinal study completed to date (2006-2018), 48.3% (n = 5293) of participants have been of Māori descent (Allen, Alpass, & Stephens, 2019). The study will provide information on issues such as health, work, retirement, and housing, and provides New Zealand residents with the opportunity to share their experiences to help inform national and international discussions on these important issues.
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The Pacific Islands Families Study is a longitudinal cohort study tracking the health and development of 1,398 Pacific children and their parents since the children were born at Middlemore Hospital in South Auckland in 2000. It is the only prospective study specifically of Pacific peoples in the world. The study aims to determine optimum pathways for Pacific children and families during critical developmental periods by identifying risk and resilience factors that influence positive and negative outcomes. This study makes strategic recommendations to improve the health and well-being of Pacific children and families and address social disparities in New Zealand. The study uses web-based surveys, telephone or face-to-face interviews where participants reside. Like the Dunedin Study, retention has been consistently high.
A longitudinal study that includes a larger proportion of Māori and Pacific peoples in the cohort is the Growing Up in New Zealand study, led by Professor Susan Morton at the University of Auckland’s Centre for Longitudinal Research—He Ara ki Mua. This study will follow the development of 7,000 children from birth until 21 years of age— it has not been envisaged to examine adult or older adult experiences and so has not listed in Table 1. However, ongoing support would be invaluable for a more well-rounded understanding of aging in New Zealand.
New Zealand also has research centers that conduct research focused primarily on older adults. These research centers have niche expertise, such as housing and environments, health, Māori health, culture and language, and workforce participation. Table 2 details the names, locations, and areas of gerontology research center expertise. Some excellent research teams are not listed because they did not meet the criterion of having a gerontology-focused research center.
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