A major five-year study has found Māori are more likely to experience multiple health conditions at once, with infections, and chronic diseases and poverty combining to worsen outcomes for whānau.
The research, led by Professor Michael Baker at the University of Otago, is among the first internationally to examine how these factors interact, a concept known as “syndemics”.
“This is the idea that health events don’t happen in isolation,” Baker said.
“Infectious diseases, long-term chronic diseases, and the social determinants of health, things like poverty and poor housing, all occur together, and not by accident. They’re interrelated.”
The five million dollar programme, funded by the Health Research Council, brought together seven projects under the SYMBIOTIC research umbrella, focusing on preventable conditions that disproportionately affect Māori.
Baker says the findings highlight a “vicious cycle”, where long-term conditions increase vulnerability to infections, and infections in turn lead to more serious chronic illness.
“So it becomes a vicious cycle, and we need to break that cycle,” he said.
“What’s different is that we’re looking at all these factors in an integrated way. If someone has multiple chronic conditions, it greatly increases their risk of being hospitalised with an infectious disease. That hasn’t been looked at before in New Zealand in a comprehensive way.”
The “good news” says Baker is that we as a society can alter every part of this cycle.
Baker said one example is Helicobacter pylori, a bacterial infection that is the leading cause of stomach cancer.
“If you treat that infection effectively, you almost eliminate stomach cancer,” he said.
“That infection is driven by household crowding. Chronic infection leads to stomach ulcers and cancer, so we need to understand who is most at risk and introduce better screening and treatment programmes.”
He also pointed to the widespread use of antibiotics in early childhood.
“Around 95 percent of children under five have had a course of antibiotics, which can alter gut bacteria for years and affect many aspects of health,” he said.
The study also found Māori and Pacific people remain two to three times more likely to be hospitalised with infectious diseases, which still account for more than a quarter of acute hospital admissions nationwide.
While the research outlines system-level patterns, those impacts are being felt daily by whānau.
Cheryl Davies, a public health researcher and founder of the Tū Kotahi Māori Asthma Trust at Kōkiri Marae, says the reality is often much more complex than a single diagnosis.
“Our whānau are living with maybe a long-term condition, and then they might have an infectious disease like COVID or influenza,” she said.
“Just hearing the impacts of that, not only on them, but on their whānau as well, has been really powerful.”
Davies says the current health system often struggles to respond to that complexity.
“Fifteen-minute GP appointments often don’t give enough time when you have more than one health condition,” she said.
“So whānau are forced to choose what they can share in that timeframe.”
She says a lack of continuity of care and limited time with clinicians means the broader realities of whānau life, including housing conditions and wider family dynamics, are often overlooked.
“Often when we talk about overcrowding, our whānau don’t see it that way, but it can impact how illness spreads through a household, affecting the whole whānau, not just the individual.”
Davies says solutions already exist within communities, but need to be better resourced and connected to the wider health system.
“Organisations like our Whānau Ora collective play a critical role in the long-term health and wellbeing of whānau,” she said.
“If someone’s coming in multiple times with respiratory conditions, we can look at their housing and refer them into services to address those issues, but that needs to be linked up with primary care so we’re working together.”
Without that support, she says the consequences are immediate.
“You see an increase in acute GP visits, and then whānau end up in emergency departments when it’s actually preventable.”
Baker says addressing the issue requires a shift beyond treating illness in isolation, towards tackling the underlying drivers of inequity.
“Many of these differences are driven by social and economic factors, employment, education, housing,” he said.
“If we intervene in smarter ways, we not only improve people’s lives, but we also reduce pressure on the health system.”
The research was grounded in a partnership with Kōkiri Marae in Lower Hutt, where findings were shared with community providers, clinicians and whānau this week.
Baker says that connection is critical to ensuring the solutions work in practice.
“There’s no point imposing solutions that aren’t feasible or accepted,” he said.
“Because we’ve been working closely with communities, we’re confident the solutions we’re finding will work, because communities are telling us they will.”
