title: Mortality, morbidity and population health dynamics

authors: Cheung, Jit

abstract: This thesis is concerned with the dynamics of the health of populations with low levels of mortality, using the non-Maori population in New Zealand as a case study. The primary objective is to study patterns and trends in mortality and morbidity, their interactions, and their implications for the future. 

The key questions addressed in this thesis are central to the future evolution of population health. Given the significant declines in mortality, especially those at older ages that have occurred over the last two decades, will mortality declines at advanced ages continue much longer? Or will mortality become increasingly compressed into a narrow range of ages at death? Moreover, what are the implications for morbidity trends and any indications at present of future trends in population health? Will increased survivorship be accompanied by long periods in ill-health, or will morbidity move in tandem with mortality, or will durations surviving but in ill-health actually decrease? 

The thesis first establishes a theoretical platform by reviewing and synthesising transition theories and empirical observations into a general framework to guide the understanding of population health dynamics. It also forges a theoretical linkage between variations in the individual senescence process, which underpin the validity of demographic models of mortality and morbidity, and their population level manifestations. These theoretical extensions provide the context for an evaluation of contemporary theories on mortality trends and changes in morbidity in relation to mortality. 

In addition to using long term historical data spanning over a century and complemented by a population-based true cohort approach, this thesis also makes methodological advancements by adapting and developing a tool, known as health expectancy, for the analysis of population health. In particular, a new measure termed “hospitalisation expectancy” is developed. It integrates data on hospital utilisation and mortality to yield a summary measure of population health.

The empirical study documents the shift in the forces of mortality of non-Maori, from younger to older ages, and from communicable causes of death to chronic degenerative diseases. Results of the mortality analysis by cohorts show that while there may be some indications of a future trend towards mortality compression, further increases in life expectancy at birth can be realistically expected. Empirical evidence of compression of morbidity is found in the trends of hospitalisation and the patterns of severe forms of disability. The causes of morbidity are becoming more diversified, dominated by non-lethal conditions; whereas the causes of mortality are becoming increasingly compressed into a few chronic conditions, namely cancers and cardiovascular diseases. It is also established in this thesis that the older population represents a heterogeneous group in terms of levels of susceptibility to ill-health. An empirical method for identifying heterogeneity is developed to show non-Maori inter-cohort differences in this property. 

Later in the thesis, a cohort based mortality projection of non-Maori at adult ages is undertaken. Various scenarios of morbidity responses to the projected mortality changes, incorporating the leading theories on future morbidity changes, are then modelled. To conclude the thesis, the implications for policy of further mortality declines at older age among an increasingly heterogeneous population are discussed.

text: Mortality, morbidity and population health dynamics This thesis is concerned with the dynamics of the health of populations with low levels of mortality, using the non-Maori population in New Zealand as a case study. The primary objective is to study patterns and trends in mortality and morbidity, their interactions, and their implications for the future. 

The key questions addressed in this thesis are central to the future evolution of population health. Given the significant declines in mortality, especially those at older ages that have occurred over the last two decades, will mortality declines at advanced ages continue much longer? Or will mortality become increasingly compressed into a narrow range of ages at death? Moreover, what are the implications for morbidity trends and any indications at present of future trends in population health? Will increased survivorship be accompanied by long periods in ill-health, or will morbidity move in tandem with mortality, or will durations surviving but in ill-health actually decrease? 

The thesis first establishes a theoretical platform by reviewing and synthesising transition theories and empirical observations into a general framework to guide the understanding of population health dynamics. It also forges a theoretical linkage between variations in the individual senescence process, which underpin the validity of demographic models of mortality and morbidity, and their population level manifestations. These theoretical extensions provide the context for an evaluation of contemporary theories on mortality trends and changes in morbidity in relation to mortality. 

In addition to using long term historical data spanning over a century and complemented by a population-based true cohort approach, this thesis also makes methodological advancements by adapting and developing a tool, known as health expectancy, for the analysis of population health. In particular, a new measure termed “hospitalisation expectancy” is developed. It integrates data on hospital utilisation and mortality to yield a summary measure of population health.

The empirical study documents the shift in the forces of mortality of non-Maori, from younger to older ages, and from communicable causes of death to chronic degenerative diseases. Results of the mortality analysis by cohorts show that while there may be some indications of a future trend towards mortality compression, further increases in life expectancy at birth can be realistically expected. Empirical evidence of compression of morbidity is found in the trends of hospitalisation and the patterns of severe forms of disability. The causes of morbidity are becoming more diversified, dominated by non-lethal conditions; whereas the causes of mortality are becoming increasingly compressed into a few chronic conditions, namely cancers and cardiovascular diseases. It is also established in this thesis that the older population represents a heterogeneous group in terms of levels of susceptibility to ill-health. An empirical method for identifying heterogeneity is developed to show non-Maori inter-cohort differences in this property. 

Later in the thesis, a cohort based mortality projection of non-Maori at adult ages is undertaken. Various scenarios of morbidity responses to the projected mortality changes, incorporating the leading theories on future morbidity changes, are then modelled. To conclude the thesis, the implications for policy of further mortality declines at older age among an increasingly heterogeneous population are discussed.

year: 1999

title: A Model for Meeting Content Storage and Retrieval

authors: Luz, Saturnino

subjects: computer science

abstract: This paper presents a model for storage of remote Internet-based multimedia meetings and information retrieval from textual and time-based content. The model builds on a theory of content mapping that exploits temporal and contextual relationships between media streams. Two prototypes are presented which illustrate the application of the model to a virtual meeting environment, and to a system for visualisation of meeting records on mobile devices. Implications of the proposed content mapping model with respect to interface design and non-linear browsing of time-based media are also discussed.

text: A Model for Meeting Content Storage and Retrieval This paper presents a model for storage of remote Internet-based multimedia meetings and information retrieval from textual and time-based content. The model builds on a theory of content mapping that exploits temporal and contextual relationships between media streams. Two prototypes are presented which illustrate the application of the model to a virtual meeting environment, and to a system for visualisation of meeting records on mobile devices. Implications of the proposed content mapping model with respect to interface design and non-linear browsing of time-based media are also discussed.

year: 2005

title: Reclaiming the Māori language for future generations: Flax root perspectives. Tīkina te mana o te reo Māori: Te pūtaketanga o te pā harakeke

authors: Peters, Murray Hamaka

subjects: te reo Māori

abstract: Using a combination of semi-structured interviews, focus group discussion and questionnaires (designed to elicit as many comments as possible), this thesis explores, through their own voices, the attitudes and practices of a group of people, mainly Māori but including a few Pākehā (non-Māori) who are attempting to reclaim te reo Māori (the Māori language), for themselves, their families and, above all, their children and grandchildren. Many of them were brought up in a context in which one or more parents, caregivers or relatives spoke te reo Māori fluently but few were given the opportunity to acquire the language naturally in infancy, generally because of a desire to protect them from the discrimination suffered by their elders. Those who were brought up to speak te reo Māori often suffered from language attrition at a time when the English language began to feature prominently in their lives. A few have attended kōhanga reo and kura kaupapa Māori. Many have attended courses in the Māori language and culture, often at considerable personal cost. Some have achieved their dream of becoming fluent speakers of the language; some have suffered frustration and disappointment. Whatever their own experiences, almost all of them want their children and grandchildren to be fluent speakers of the language, believing that this will give them confidence and a genuine sense of identity and belonging. Although the majority are committed to using te reo Māori as much as possible at home, especially when speaking to their children and grandchildren, most experience difficulties in doing so. These difficulties relate, in general, to their own lack of confidence and/or limited competence in the language, the fact that some of their friends and/or members of their immediate or extended family are monolingual in English, and resistance from some of the children, particularly as they grow older and are increasingly influenced by the dominant language and culture. Among those involved in this research project, there was widespread awareness of the importance of inter-generational transmission of te reo Māori and evidence of considerable commitment to learning the language and/or improving their existing competence in it. However, although the attempts of these adults to use te reo Māori in the home are clearly of considerable importance, they often, where they lacked a high level of oral proficiency, met with confusion, frustration, tension and resistance as their children grew older. This, combined with the fact that there are currently so few domains in society at large in which the language can be used naturally, has led many of them to develop strategies aimed at ensuring that their children and grandchildren, as they grow towards adulthood (a) appreciate the sacrifices made by so many in order to give them the opportunity to learn the language and the responsibilities associated with these sacrifices, (b) are recognised and rewarded for their linguistic achievements, and (c) are encouraged and assisted to involve themselves in contexts where they can use the language. This includes encouraging them to become involved in kapa haka and other culturally significant activities in which the language plays a prominent part, promoting as much engagement as possible with friends and whānau who have a high level of proficiency in the language (including involving them and their friends in marae-based activities), and inviting into their homes people who are fluent speakers (which sometimes involves a conscious effort on the part of the adults to cement friendships with fluent speakers and to encourage them to interact with their children). These are things which all parents and caregivers can do, irrespective of their own language competence. 

In doing these things, those who currently feel that they have little to offer in relation to the revitalization of the language can experience a genuine sense of involvement and empowerment. Accepting that there are currently many parents and caregivers who cannot realistically become involved in genuine inter-generational transmission of the language in the home does not mean accepting that they have nothing to offer. 

Mā te kōwhiringa o ngā uiuitanga hangā ngāwari, te whiriwhiri ā rōpū kanohi, me te puka patapātai (hei tōngia mai ngā kōrero whānui kē atu o tēnā, o tēnā), ka whakatewhatewha te tuhinga nei i ngā waiaro me ngā ritenga o tētehi rōpū e ngana ana ki te haumanu i te reo Māori hei taonga mō rātou ko ō rātou whānau, ā, mō ā rātou tamariki, mokopuna hoki. Te nuinga o te hunga nei he Māori; he tokoiti anō he Pākehā. He tokomaha o rātou i tipu ake i roto i te horopaki o te reo Māori, arā, kotahi neke atu o ō rātou mātua rānei, kaitiaki rānei, whanaunga rānei he matatau ki te reo Māori. Ahakoa rā, kāore te nuinga i whāngaihia ki te reo i ā rātou e pēpi ana, kei whakapai kanohitia pērā i ō rātou tūpuna. Ko rātou te hunga i tipu reo Māori mai, ka memeha haere tō rātou reo nō te tino putanga ake o te reo Pākehā ki ō rātou ao. He tokoiti o tēnei rōpu i kuraina ki te kōhanga reo me te kura kaupapa Māori; he tokomaha anō i whai wāhi ki ngā akoranga reo Māori me ōna tikanga, hāunga rā te nui o te nama. Ko ētehi, kua ea ngā wawata, kua matatau ki te reo; ko ētehi atu anō, kua pāngia kētia e te hōhā me te hēmanawatanga. Heoi, ahakoa ngā wheako ake o tēnā, o tēnā, he hiahia nō te nuinga kia matatau ā rātou tamariki me ā rātou mokopuna ki te reo, kia tū pakari ai, kia tū Māori ai ki tēnei ao. Te nuinga o tēnei rōpū he manawanui ki te kōrero Māori i te kāinga i te nuinga o te wā, koia anō rā i ā rātou e kōrero ana ki ā rātou tamariki me ā rātou mokopuna. Heoi anō, kei reira anō ngā papatoieketanga, e pā ana ki ō rātou ake tītengi rānei, ki te takarepatanga o tō rātou reo rānei, me te mōhio anō ko ētahi o ō rātou hoa, whānau, whānau whānui anō hoki, he reo tahi kē, arā, ko te reo Pākehā te reo kawe. Anō hoki, ko ētahi o ngā tamariki, i ā rātou e pakeke haere ana ka kaha papare i te reo Māori, ka whakawaia kētia rātou e te reo Pākehā me ōna tikanga. I waenganui i te hunga i whai wāhi ki tēnei kaupapa rangahau kua kitea he mārama pū te nuinga ki te tino hiranga o te tuku ihotanga o te reo; kua kitea hoki tō rātou kaingākau nui ki te ako i te reo, ki te whakapakari rānei i tō rātou reo. Hāunga tērā, me ō rātou ngana anō ki te kawe i te reo Māori i te kāinga, ko ngā mātua kāore anō kia tino eke te reo ā-waha ka mate i te pōraruraru, te pōkaikaha, te āwangawanga, me te kaha papare a ngā tamariki e pakeke haere ana. Nā runga i tērā, me te take anō hoki he ruarua noa iho ngā wāhi o te hapori whānui i ēnei rā kia taea te reo Māori te rere noa, kua whakapuāwaitia e te tokomaha o tēnei rōpū ētahi rautaki hei ārahi i ngā tamariki me ngā mokopuna i ā rātou e pakeke haere ana, kia mārama rātou ki ngā whakahere tinana a te marea kia whai wāhi ai rātou ki te ako i te reo, me ngā here e haere kōtui ana ki ērā āhuatanga, kia whakanuia, kia utua hoki ngā tamariki i runga anō i ngā whakatutukitanga reo, kia manaakitia hoki rātou ki te whai wāhi anō ki ngā horopaki reo Māori. Hei konei ka ākina rātou ki te uru ki ngā kapa haka me ngā tino kaupapa anō o te ao Māori e whakatairanga nei i te reo. Anō hoki, ka whakahauhautia kia piritata ki ā rātou hoa me ō rātou whanaunga e tino mōhio ki te reo, me te whakauru hoki ki ngā mahinga marae. Waihoki, ka pōwhiritia te hunga matatau ki te reo ki te toro mai ki ō rātou kāinga (nā reira, me whakapau kaha anō ngā mātua ki te whakahoahoa, ki te patipati, ērā tāngata kia whakaae mai ki te noho ki te taha o ngā tamariki whakaputa kōrero ai). Koinei ngā mea ka taea ai e ngā mātua katoa, e ngā kaitiaki katoa, ahakoa kei hea te tohungatanga o tō rātou reo.  Mā reira, ka whai wāhi tonu, ka whakamanahia tonu tēnei hunga e pōhēhē nei pea he iti noa iho tā rātou hei koha atu ki te whakarauoratanga o te reo. Nō reira, hāunga rā te whakaaro he nui ngā mātua me ngā kaitiaki tamariki i tēnei wā e kore e tino whai wāhi ki te tukunga iho o te reo i te kāinga, ehara i te mea he kore noa iho tā rātou hei koha atu ki tēnei kaupapa whakahirahira.

text: Reclaiming the Māori language for future generations: Flax root perspectives. Tīkina te mana o te reo Māori: Te pūtaketanga o te pā harakeke Using a combination of semi-structured interviews, focus group discussion and questionnaires (designed to elicit as many comments as possible), this thesis explores, through their own voices, the attitudes and practices of a group of people, mainly Māori but including a few Pākehā (non-Māori) who are attempting to reclaim te reo Māori (the Māori language), for themselves, their families and, above all, their children and grandchildren. Many of them were brought up in a context in which one or more parents, caregivers or relatives spoke te reo Māori fluently but few were given the opportunity to acquire the language naturally in infancy, generally because of a desire to protect them from the discrimination suffered by their elders. Those who were brought up to speak te reo Māori often suffered from language attrition at a time when the English language began to feature prominently in their lives. A few have attended kōhanga reo and kura kaupapa Māori. Many have attended courses in the Māori language and culture, often at considerable personal cost. Some have achieved their dream of becoming fluent speakers of the language; some have suffered frustration and disappointment. Whatever their own experiences, almost all of them want their children and grandchildren to be fluent speakers of the language, believing that this will give them confidence and a genuine sense of identity and belonging. Although the majority are committed to using te reo Māori as much as possible at home, especially when speaking to their children and grandchildren, most experience difficulties in doing so. These difficulties relate, in general, to their own lack of confidence and/or limited competence in the language, the fact that some of their friends and/or members of their immediate or extended family are monolingual in English, and resistance from some of the children, particularly as they grow older and are increasingly influenced by the dominant language and culture. Among those involved in this research project, there was widespread awareness of the importance of inter-generational transmission of te reo Māori and evidence of considerable commitment to learning the language and/or improving their existing competence in it. However, although the attempts of these adults to use te reo Māori in the home are clearly of considerable importance, they often, where they lacked a high level of oral proficiency, met with confusion, frustration, tension and resistance as their children grew older. This, combined with the fact that there are currently so few domains in society at large in which the language can be used naturally, has led many of them to develop strategies aimed at ensuring that their children and grandchildren, as they grow towards adulthood (a) appreciate the sacrifices made by so many in order to give them the opportunity to learn the language and the responsibilities associated with these sacrifices, (b) are recognised and rewarded for their linguistic achievements, and (c) are encouraged and assisted to involve themselves in contexts where they can use the language. This includes encouraging them to become involved in kapa haka and other culturally significant activities in which the language plays a prominent part, promoting as much engagement as possible with friends and whānau who have a high level of proficiency in the language (including involving them and their friends in marae-based activities), and inviting into their homes people who are fluent speakers (which sometimes involves a conscious effort on the part of the adults to cement friendships with fluent speakers and to encourage them to interact with their children). These are things which all parents and caregivers can do, irrespective of their own language competence. 

In doing these things, those who currently feel that they have little to offer in relation to the revitalization of the language can experience a genuine sense of involvement and empowerment. Accepting that there are currently many parents and caregivers who cannot realistically become involved in genuine inter-generational transmission of the language in the home does not mean accepting that they have nothing to offer. 

Mā te kōwhiringa o ngā uiuitanga hangā ngāwari, te whiriwhiri ā rōpū kanohi, me te puka patapātai (hei tōngia mai ngā kōrero whānui kē atu o tēnā, o tēnā), ka whakatewhatewha te tuhinga nei i ngā waiaro me ngā ritenga o tētehi rōpū e ngana ana ki te haumanu i te reo Māori hei taonga mō rātou ko ō rātou whānau, ā, mō ā rātou tamariki, mokopuna hoki. Te nuinga o te hunga nei he Māori; he tokoiti anō he Pākehā. He tokomaha o rātou i tipu ake i roto i te horopaki o te reo Māori, arā, kotahi neke atu o ō rātou mātua rānei, kaitiaki rānei, whanaunga rānei he matatau ki te reo Māori. Ahakoa rā, kāore te nuinga i whāngaihia ki te reo i ā rātou e pēpi ana, kei whakapai kanohitia pērā i ō rātou tūpuna. Ko rātou te hunga i tipu reo Māori mai, ka memeha haere tō rātou reo nō te tino putanga ake o te reo Pākehā ki ō rātou ao. He tokoiti o tēnei rōpu i kuraina ki te kōhanga reo me te kura kaupapa Māori; he tokomaha anō i whai wāhi ki ngā akoranga reo Māori me ōna tikanga, hāunga rā te nui o te nama. Ko ētehi, kua ea ngā wawata, kua matatau ki te reo; ko ētehi atu anō, kua pāngia kētia e te hōhā me te hēmanawatanga. Heoi, ahakoa ngā wheako ake o tēnā, o tēnā, he hiahia nō te nuinga kia matatau ā rātou tamariki me ā rātou mokopuna ki te reo, kia tū pakari ai, kia tū Māori ai ki tēnei ao. Te nuinga o tēnei rōpū he manawanui ki te kōrero Māori i te kāinga i te nuinga o te wā, koia anō rā i ā rātou e kōrero ana ki ā rātou tamariki me ā rātou mokopuna. Heoi anō, kei reira anō ngā papatoieketanga, e pā ana ki ō rātou ake tītengi rānei, ki te takarepatanga o tō rātou reo rānei, me te mōhio anō ko ētahi o ō rātou hoa, whānau, whānau whānui anō hoki, he reo tahi kē, arā, ko te reo Pākehā te reo kawe. Anō hoki, ko ētahi o ngā tamariki, i ā rātou e pakeke haere ana ka kaha papare i te reo Māori, ka whakawaia kētia rātou e te reo Pākehā me ōna tikanga. I waenganui i te hunga i whai wāhi ki tēnei kaupapa rangahau kua kitea he mārama pū te nuinga ki te tino hiranga o te tuku ihotanga o te reo; kua kitea hoki tō rātou kaingākau nui ki te ako i te reo, ki te whakapakari rānei i tō rātou reo. Hāunga tērā, me ō rātou ngana anō ki te kawe i te reo Māori i te kāinga, ko ngā mātua kāore anō kia tino eke te reo ā-waha ka mate i te pōraruraru, te pōkaikaha, te āwangawanga, me te kaha papare a ngā tamariki e pakeke haere ana. Nā runga i tērā, me te take anō hoki he ruarua noa iho ngā wāhi o te hapori whānui i ēnei rā kia taea te reo Māori te rere noa, kua whakapuāwaitia e te tokomaha o tēnei rōpū ētahi rautaki hei ārahi i ngā tamariki me ngā mokopuna i ā rātou e pakeke haere ana, kia mārama rātou ki ngā whakahere tinana a te marea kia whai wāhi ai rātou ki te ako i te reo, me ngā here e haere kōtui ana ki ērā āhuatanga, kia whakanuia, kia utua hoki ngā tamariki i runga anō i ngā whakatutukitanga reo, kia manaakitia hoki rātou ki te whai wāhi anō ki ngā horopaki reo Māori. Hei konei ka ākina rātou ki te uru ki ngā kapa haka me ngā tino kaupapa anō o te ao Māori e whakatairanga nei i te reo. Anō hoki, ka whakahauhautia kia piritata ki ā rātou hoa me ō rātou whanaunga e tino mōhio ki te reo, me te whakauru hoki ki ngā mahinga marae. Waihoki, ka pōwhiritia te hunga matatau ki te reo ki te toro mai ki ō rātou kāinga (nā reira, me whakapau kaha anō ngā mātua ki te whakahoahoa, ki te patipati, ērā tāngata kia whakaae mai ki te noho ki te taha o ngā tamariki whakaputa kōrero ai). Koinei ngā mea ka taea ai e ngā mātua katoa, e ngā kaitiaki katoa, ahakoa kei hea te tohungatanga o tō rātou reo.  Mā reira, ka whai wāhi tonu, ka whakamanahia tonu tēnei hunga e pōhēhē nei pea he iti noa iho tā rātou hei koha atu ki te whakarauoratanga o te reo. Nō reira, hāunga rā te whakaaro he nui ngā mātua me ngā kaitiaki tamariki i tēnei wā e kore e tino whai wāhi ki te tukunga iho o te reo i te kāinga, ehara i te mea he kore noa iho tā rātou hei koha atu ki tēnei kaupapa whakahirahira.

year: 2014