Analysis by Keith Rankin.
A few weeks ago this article from Stuff (24 Sep) was drawn to my attention: The shocking stats that prove Covid19 does not kill equally. While I have some problems with the article’s interpretation of the data, by and large the article itself was reasonable. Less so the headline, which is different in the online version of the story. (The print version omits the sensationalist word ‘shocking’. I wonder if there is a general pattern to present online versions of stories in a more sensationalist manner?)
In fact, there’s nothing surprising about the Covid19 statistics indicating more Māori and Pasifika deaths. The charts in the article, however, perpetrate the erroneous interpretation in the headline, that Covid19 is in some evil sense discriminatory. (In particular the chart that shows death rates of people aged over 90.) The facts are that, among population subgroups, Covid19 mortality reflects differences in general mortality.
With respect to recent data (ie since the beginning of August), just two Pasifika people have died of Covid19 (as the ‘underlying cause); one in their 70s, and one aged under 60 (though 20 others have died ‘with’ Covid19). Ten Māori have died of Covid19 in that recent time period (32 others ‘with’ covid), only one of whom was over 90. In that same time period, 176 people of ‘European or other’ ethnicity died of Covid19, 56 of whom were aged over 90.
While the article was about the whole pandemic, not just its recent phase, it remains no more useful to focus on deaths of Pasifika aged over 90 than it does to focus on Pakeha aged over 100. Regardless of Covid19, the probability that a New Zealander of Pacific Island descent will reach the age of 90 is similar to the probability that a Pakeha New Zealander will reach 100.
Life Expectancy by Ethnicity
Ethnicity statistics in Aotearoa New Zealand should always be treated with caution. For example, a person with just one Māori great-grandparent would typically be classified as Māori, regardless of the ethnicities of the other seven great-grandparents. (This suggests that the mortality and morbidity statistics are even worse for people whose predominant ethnicity is Māori, especially for people who are perceived as Māori [either due to their name or to their appearance].)
If we try to compare socio-economic ‘apples’ with socio-economic ‘apples’, we have almost no data which can give the true picture. My suspicion is that a dapper Māori man such as Scotty Morrison has a similar life expectancy as his Pakeha equivalents. And my suspicion is that a Pakeha solo-mum with three children in emergency housing has a similar life expectancy as a Māori solo-mum in the same situation. Generally, we are very light on evidence that Māori and Pasifika people have lower life expectancies than their Pakeha neighbours.
The problem is that, in proportion to their sub-population totals, relatively more Māori and Pasifika are in impoverished or facing other stressful life circumstances. The telling Covid19 statistics are shown in the table below. The median ages of death for the different ethnicities, estimated from Ministry of Health covid mortality data, are:
|Median ages for Covid19-linked deaths|
|Dying ‘of’ Covid19||76.3||79.6||81.8||86.7|
|Dying ‘with’ but not ‘of’ Covid19||67.8||75.8||79.1||83.9|
|Dying ‘with’ and ‘of’ Covid19||71.6||76.8||80.4||85.2|
|source: NZ Ministry of Health|
We may regard the final row of the above table as valid estimates for life expectancy for each sub-population. It’s not a pretty picture for Māori. What it says is that Māori have significantly more health comorbidities than other ethnic groups. In particular, this represents the socio-economic circumstances that many Māori face; this reflects significant inequality among Aotearoans in general, and also within the Māori sub-population. It reflects the substantial problem in New Zealand of rural poverty. It reflects historical circumstances faced by indigenous peoples throughout the ‘new world’. Some of that is due to biological circumstances which go back into deep history. These include being at the wrong end of the immunity gradients for most diseases during the globalisation phases of world history; and it reflects – for example – an evolutionary context which, among other things, makes Māori (and Pasifika) people comparatively intolerant to alcohol and sugar. (In Eurasia, tolerance to alcohol was a biological adaptation to the problem of water-born diseases. In England a culture developed, especially among men, of drinking ‘small beer’ instead of water. In other places, wine and other fermented drinks were partial substitutes for water.)
The above ‘life-expectancy’ table (especially the second row) also suggests that people with substantial comorbidities are more likely to get Covid19 as well as being more likely to die of Covid19.
Getting back to the interpretation of the Stuff article, because life expectancy for Māori and Pasifika is so much lower than for Pakeha, it means that we should be comparing covid mortality rates for Māori/Pasifika in their 60s with Pakeha in their 70s, comparing Māori/Pasifika in their 70s with Pakeha in their 80s, and Māori/Pasifika in their 80s with Pakeha in their 90s. A randomly chosen Māori person of a particular age, in essence, is as likely to die (from any cause) within twelve months as a similarly chosen Pakeha person ten years older.
While discrimination is certainly part of the ‘historical circumstance’ problem many Māori face, Covid19 doesn’t add to that problem; it simply reflects it. (And we should note that historical discrimination is more nuanced than intellectually-lazy words like ‘colonisation’ or ‘imperialism’ convey. Subsequent to the era of industrial capitalism which began at scale around 200 years ago, life expectancies have increased, with the life expectancies of ‘white’ people (and latterly East Asian people) increasing the most. While non-imperial historical counterfactuals might have had a smaller life-expectancy gap between Polynesian peoples and (say) Anglo-Celtic peoples, it is unlikely any such counterfactuals could have achieved a higher life expectancy for Māori than Māori have now.
Co-mortality and critical states
The final issue of importance to note is that ’cause of death’ is not a simple discrete matter. In an important sense, probably most deaths are due to ‘old age’, but few other than the Queen of England have the privilege of having ‘old age’ listed as their sole cause of death.
The reality is that most deaths have more than one ‘clinical’ cause, and environmental events such as pandemics can kill in non-clinical as well as clinical ways. (Poor quality, under-resourced, or inaccessible health services count here.) In the fable of ‘the straw breaking the camel’s back’, ‘straw’ would never be listed as the sole cause of that camel’s subsequent death. The camel was in a critical state before the straw added, fatally, to its burden.
It’s interesting that ‘comorbidity’ is listed as a word in the dictionary, but ‘comortality’ is not.
Co-mortality is the reason why an ‘excess deaths’ approach is the best indicator of the scale of epidemic deaths. The sadness is that demography is the poor cousin of social science. Much core demographic data – births by sex, deaths by age/sex and place of birth, arrival/departures by age/sex and place of birth – is hard to find in even the rich world. In many countries it remains largely absent. Population censuses are required to make up for poor record-keeping; but too often they are under-resourced, and the value of the core demographic information is under-understood. In New Zealand we remain substantially ignorant about intra-national population movements.
Almost all the Covid19 deaths tallied – whether ‘with covid’, of ‘covid’, or ‘as a consequence of covid’ – are in fact co-mortal deaths. Very few people have died of Covid19 without some other vulnerability being present.
What matters most is an understanding of critical states. Typically, when things go wrong there are multiple causes. Today we use the increasingly popular (and indeed overused) phrase ‘perfect storm’ to indicate the problem. A person is in a critical state when just one additional factor will kill them. (High blood-pressure is one oft-cited factor that can contribute to a person being in a critical state.)
Surprisingly, a person in a critical state may to all intents and purposes be healthy. One person may be much more vulnerable than another to a particular fatal illness, but not obviously so. One seemingly small trigger event may have a fatal impact on that person, but may have no impact on the other person. For a person in a critical state, a trigger event may be sufficient to cause death. (Or, as in ‘chronic fatigue syndrome’ which incorporates ‘long covid’, a trigger event can initiate a long period of chronic unwellness for some people but not others.) An otherwise healthy individual with, say, the Huntingdon’s gene may in fact be in a critical state; one small trigger may unleash the uncurable disease.
‘Old age’ is a critical state; a state which some people – and some peoples – reach earlier than others.
Systems may or may not be in a critical state. (The name ‘critical state’ comes from the nuclear sciences.) A highly stressed population is likely to be in a critical state; especially a population having to constantly negotiate with unsympathetic bureaucracies, permanently raising the levels of cortisol in the bloodstream. A homeless person will likely be in a critical state, meaning that a trigger such as a covid infection could have elevated consequences.
If Māori are more likely to be homeless, or have no socially-approved source of income, then Māori are more likely to die in a pandemic. And die at younger ages.
Is Covid19 a trigger that’s causing human existence to unravel? I suspect that a keyword search on the word ‘existential’ would show a big uptick this decade. Growth capitalism, the way we practice it, is a system that places most people in a near-critical state. (If a critical state is when one more aggravation is fatal, then a near-critical state is when two more aggravations are fatal.) There are signs that this comparatively mild infectious disease has triggered a turning point in global history, and that’s partly because the climate system was already in a critical state.
While Covid19 has been a disease of the rich, and spread mainly by the rich, it is a disease that has revealed the widespread comorbidities – critical states and near-critical states – which our economically vulnerable populations experience. So while the (often oblivious) privileged sub-populations spread covid more while suffering less – not unlike the environmental consequences of careless human behaviour – it is the sub-populations in critical and near-critical states who die the most.
Our systemic problems are our systems in critical states; superficially they may have looked healthy before 2020. Since then, for those willing to see, Covid19 has become the highlighter, not the central problem. If we are homo sapiens – wise ‘men’ – we will look to solutions which destress our systems. What we should not do is aggravate our systemic problems by converting near-critical systems into critical systems; into systems that can become ‘perfect storms’, destroyable by mere straws.
Is Covid19 returning?
My recent statistical analyses suggest ‘yes’. See my Tourist Europe again: Covid19 Waves compared (Evening Report, 17 October 2022). Spain has just had its worst round of Covid19 deaths since April 2020. Covid’s arriving now, in those full aircraft coming here. October is peak season for people flying from Europe to New Zealand. And of course, covid is circulating domestically, and is known to resurge as immunity wanes. It is far too soon to think that Covid19 has become just a winter problem.
If New Zealand’s ability to cope in 2020 and 2021 was weak, and required drastic emergency measures then, New Zealand’s ability to cope this summer may be even weaker. Aotearoa New Zealand is now facing a ‘cost-of-living crisis’, in an economy with severe labour shortages. The New Zealand economy is in a critical state; it is ‘supply inelastic’, meaning it has no surge capacity to respond to a new imported crisis.
Policy is now focussed on creating a recession, the only way today’s policymakers believe they can respond to recent increases in the price level. (Refer to these RNZ stories: Domestic inflation rise ‘a shocker’ – economists; Analysis: Inflation rate higher than expected; Unemployment next challenge for economy – experts.)
New Zealand as a whole was not in a critical state in February 2020. It’s closer to being in such a state today. Marginalised sub-populations will be affected most from any trigger events this decade. Many, but by no means all, vulnerable New Zealanders are of Māori or Pasifika ethnicity.
Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.