By Melissa Nightingale
Senior Reporter, NZ Herald - Wellington·NZ Herald·
5 Sep, 2024
People in the most deprived areas are 60% more at risk of developing dementia
Māori and Pacific people have a higher prevalence of dementia, which researchers say is not due to ethnicity, but disadvantage
Only half of Māori and Pacific dementia sufferers receive diagnoses, often at late disease stages
People living in New Zealand’s most deprived areas are 60% more at risk of developing dementia than those in the least deprived areas - and Māori and Pacific people are taking the brunt of the risk.
New research from the Department of Psychological Medicine at the University of Auckland shows social disadvantage is a factor fuelling the country’s soaring rates of dementia.
The findings indicate Māori and Pacific people are not at more risk of dementia due to their ethnicity as such, but because they are overrepresented in areas of deprivation.
Risk factors for dementia 'cluster around social deprivation'. Photo / 123RF
These figures are exacerbated by poor rates of diagnoses for these groups, and a lack of tailored support for patients and their whānau.
“I think, at every step of the health system, Māori and Pacific people are drawing the short straw,” said Dr Etuini Ma’u, who co-authored the study with Sarah Cullum and Gary Cheung.
He said this new research shifted the blame away from ethnicity alone, but the way Kiwis and the Government look at dementia needed to change.
“One of the issues is that you look at some of the risk factors for dementia and you say ‘this is personal responsibility, these are behaviours and lifestyles that people have chosen to engage in’,” he said.
“I think we need to shift the entire focus and say ‘these are risk factors that cluster around social deprivation’.”
The Lancet Commission Report 2024 found there are 14 risk factors which, if eliminated completely, would prevent or delay 45% of dementia cases worldwide. The risk factors are:
Early life
Less education
Mid life
Hearing loss
High LDL cholesterol
Depression
Traumatic brain injury
Physical inactivity
Diabetes
Smoking
Hypertension
Obesity
Excessive alcohol
Later life
Social isolation
Air pollution
Visual loss
Ma’u said most of these factors could be connected to poverty, noting a recent study showed, for example, there were about seven times more vape shops in the most socioeconomically deprived areas in New Zealand. He said in Auckland social-deprived areas were closer to main roads and motorways, which contributed to poor air quality.
“We are being let down by a system that continues to foster inequities,” he said.
Despite having a higher prevalence of dementia, only half of Māori and Pacific people with the condition receive a diagnosis, and more than half of these people only get diagnosed once they are at a moderate to severe stage of their disease.
These figures are exacerbated by poor rates of diagnoses for these groups, and a lack of tailored support for patients and their whānau.
“I think, at every step of the health system, Māori and Pacific people are drawing the short straw,” said Dr Etuini Ma’u, who co-authored the study with Sarah Cullum and Gary Cheung.
He said this new research shifted the blame away from ethnicity alone, but the way Kiwis and the Government look at dementia needed to change.
“One of the issues is that you look at some of the risk factors for dementia and you say ‘this is personal responsibility, these are behaviours and lifestyles that people have chosen to engage in’,” he said.
“I think we need to shift the entire focus and say ‘these are risk factors that cluster around social deprivation’.”
The Lancet Commission Report 2024 found there are 14 risk factors which, if eliminated completely, would prevent or delay 45% of dementia cases worldwide. The risk factors are:
Early life
Less education
Mid life
Hearing loss
High LDL cholesterol
Depression
Traumatic brain injury
Physical inactivity
Diabetes
Smoking
Hypertension
Obesity
Excessive alcohol
Later life
Social isolation
Air pollution
Visual loss
Ma’u said most of these factors could be connected to poverty, noting a recent study showed, for example, there were about seven times more vape shops in the most socioeconomically deprived areas in New Zealand. He said in Auckland social-deprived areas were closer to main roads and motorways, which contributed to poor air quality.
“We are being let down by a system that continues to foster inequities,” he said.
Despite having a higher prevalence of dementia, only half of Māori and Pacific people with the condition receive a diagnosis, and more than half of these people only get diagnosed once they are at a moderate to severe stage of their disease.
This meant there were families and communities caring for people with dementia without any access to funded supports.
“Even those who get a diagnosis, we know that many of them don’t even use the supports that are on offer.”
This was because the supports were not tailored to the communities that needed them.
Focusing on a “whole of Government” move to addressing dementia, rather than putting so much of the onus on an individual’s behaviours, meant policies could be put in place tackling the food, tobacco and alcohol industries that people in deprived areas were more strongly targeted by.
Forty per cent of Māori and Pacific people live in the lowest two deciles in New Zealand, and these groups were also between 45% and 80% more at risk of developing dementia than Pākehā.
“We know the number of people living with dementia in NZ is expected to double in the next 20 years and triple in the same period for Māori and Pacific peoples,” Ma’u said.
“We know the 14 risk factors for the disease as outlined in the recently-released Lancet Commission Report and we know good policy can change that trajectory.”
Recent estimates indicate reducing 12 of the 14 risk factors in NZ by just 10% could result in 3000 fewer people with dementia, Ma’u said.
“Most risk factors build up across a lifetime. It is their incremental and cumulative damage to the brain that eventually leads to dementia. This shows the importance of promoting brain health in early life and midlife, even when the immediate dementia risk is deemed to be low.”
Other possible changes to areas of social deprivation included more green spaces and cycleways, creating facilities people were encouraged to use that could increase healthy habits.
“I think we can do a lot to prevent dementia. I think we really need to relook at the way we’re targeting it and I think we really need to be looking at these much more broad population level legislations and policies that increase our ability to live a healthy lifestyle.”
Melissa Nightingale is a Wellington-based reporter who covers crime, justice and news in the capital. She joined the Herald in 2016 and has worked as a journalist for 10 years.
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