Introduction
Good health is critical to wellbeing. Without it, people are less able to enjoy their lives to the fullest extent, their options are limited, and their general levels of contentment and happiness are likely to be reduced.
Good health has two core dimensions: how long people live and the quality of their lives. The desired outcomes recognise both aspects. As well as enjoying long lives, people want to be free from the pain, suffering and incapacity that injury and illness bring.
The desired outcomes also acknowledge that not all people can live fully independent lives. For some, illness or disability means they need support from families, government agencies or other networks. Getting this support is an important part of social wellbeing.
Injury and illness (both mental and physical) inhibit people's ability to participate in education, training and employment, leading to reduced economic standards of living. They can also reduce people's ability to participate in other areas of life, such as family life, socialising with friends, joining community activities and taking part in recreation and leisure pursuits, which leads to feelings of frustration and isolation.
A range of factors affect and are affected by health outcomes, including genetic predisposition, behaviour, the physical and social environment and the availability of health services. Increasing attention is being paid to the interaction between socio-economic and health outcomes. People with low incomes, poor housing and few qualifications are likely to have disproportionately poorer health.11
Indicators
Six indicators are used in this chapter. Taken together, they provide an overall picture of the state of the nation's health now and the likely trends in the future. They cover both the length and quality of life and include both physical and mental health. The indicators are: health expectancy, life expectancy, disability requiring assistance, suicide, cigarette smoking and obesity.
The first four indicators are relevant to the current state of the nation's health. Together, they directly measure the desired outcomes relating to long and healthy lives, and people's ability to participate in society. The last two indicators are strong predictors of future health outcomes.
Health expectancy refers to the number of years a person can expect to live independently, ie free of disability needing assistance from another person or from a complex assistive device. This is a summary measure of population health integrating both the length of life (life expectancy) and the quality of life (disability requiring assistance) dimensions of health.
The next two indicators measure each dimension of health separately. Life expectancy measures the survival experience of the population: how long people live. It is an indicator of fatal health outcomes. Disability requiring assistance measures non-fatal physical health outcomes and health-related quality of life. There may be some disquiet among the disability community about the inclusion of this indicator under the Health domain and whether having functional limitations necessarily, of itself, restrict people's opportunity to live healthy lives, or to participate in society. People's ability to participate in society also depends on the extent to which they receive the supports they need to enable them to live independently, and on the physical and social environment being accessible and inclusive.
The suicide rate serves as a proxy for mental health outcomes. Though the indicator covers the suicide rate for society as a whole, it includes details of youth suicide rates. New Zealand's youth suicide rates are high by international standards.
The last two indicators are strong predictors of future health outcomes. The links between cigarette smoking and poor health are widely recognised. For example, cigarette smoking (active and passive) is a risk factor for many cancers, respiratory, and cardiovascular diseases, and has been linked with low birth weight, Sudden Infant Death Syndrome, and other adverse child health outcomes. Obesity is linked with poor health outcomes, such as increased risk of heart attacks, strokes, type 2 diabetes, and some cancers.12
