Multiplying and Dividing - The University of Auckland

Chapter 13A Political Ecological Perspective on Housing Conditions andTuberculosis Transmission among Māori in Two Different GeographicalAreas during the Early- and Mid-20th CenturyCatherine FinnRates of tuberculosis among Māori are currently, and have historically been, eight to ten timesthose of Pākehā (Lange 1999:30, Turnbull 2002:8). In 1936, the age-sex standardised rate oftuberculosis mortality for Māori was 50.4 per 10,000 people, as compared with the Pākehārate of 5.3 (Finn 2007:45). Tuberculosis mortality was responsible for between 17.2 and25.9% of total Māori deaths between 1918 and 1945. This is in comparison to the Pākehāsituation, in which tuberculosis deaths made up between 3.7 and 7.4% of total Pākehā deathsduring this time period (Finn 2007:46).The links between tuberculosis, marginalisation and substandard housing are well established(see Farmer 1997a:347, Leon 2001:69-70, Acevedo-Garcia 2000, and Drucker et al. 1994).Because Māori have experienced the ill-effects of colonisation, it is likely that the differencein rates between Māori and Pākehā can be seen as the transposition of social inequalities uponthe biologies of these two populations (Farmer 1997b:429, Goodman and Leatherman 1998:5,Ward 1999:1). The relationship between social inequality and tuberculosis occurs through anumber of pathways, with housing conditions being one. Overcrowded, poorly ventilated anddark housing conditions are common among marginalised populations, and there is evidencethat housing conditions were more often substandard and overcrowded among Māori thanamong Pākehā (Department of Health Head Office 1957-75, Downey 1946:3-17, Trott1940:8-19, Wang and Lin 2000:249).However, while these population-level differences are important and are likely to reflectwidespread social inequalities, local level factors were also at play to create differences withinthese populations. Important differences in housing conditions occurred within the Māoripopulation, and accounts suggest that the rates of tuberculosis also varied between Māoricommunities, households and individuals (Allen and Phillips 1933:55-56, Boston 1948,Dowling and Banks 1943:56, Simpson 1940). My interest in the concept of local biologies(Littleton 2007) within the Māori population was sparked by contemporary eye-witnessdescriptions by medical students doing their final year dissertations in the Rotorua region inthe North Island of New Zealand in the 1940s (Figure 1) (see Dowling and Banks 1943,Simpson 1940). They contrasted the health and housing conditions of Māori living in thepredominantly rural area surrounding the urban centre of Rotorua city, with two kāinga(Māori-style settlements) 1 , Whakarewarewa and Ohinemutu, within Rotorua city (Figure 2).The authors of these studies concluded that the health of the kāinga residents in the urbancentre was better than that of their rural neighbours. Simpson (1940) based his analysis onnumbers of Māori from the two areas who were hospitalised for various diseases, and foundthat a higher proportion of those Māori hospitalised for TB came from the surrounding ruralarea. For instance, he found that in 1936, 83% of Māori hospitalised for TB came from thesurrounding rural area (Simpson 1940). While his conclusions would not be seen asconclusive today - we would need rates and age-standardised ones at that - it seems likely thatSimpson was seeing a difference, as his data was not just based on cases, but on otherobservations and discussions with very well-informed district health nurses. Further supportfor this difference is also supplied by a slightly later dissertation. Dowling and Banks (1943)examined 15 schoolchildren from Whakarewarewa who had tested positive in the Mantoux163