Third World Disease In A First World Country: Poverty And Acute Rheumatic Fever In New Zealand’s Māori and Pasifika


Acute rheumatic fever (ARF), a ‘third world disease’ found commonly in developing countries of Sub-Saharan Africa, is running rampant among the Māori and Pasifika children of New Zealand (N.Z.). The disease is a complication of Group A Streptococcal infection that affects Māori and Pākehā (New Zealanders of European descent) equally. Yet ARF, which causes long-term damage such as permanent heart defects, is a sickness of poverty affecting Māori and Pasifika kids almost exclusively. While the incidence of infection remains low for Pākehā, this easily preventable but devastating disease is rising steadily in Māori and Pasifika with deadly consequences for generations of children.

According to Diana Lennon, Professor of Population and Child Health at The University of Auckland, acute rheumatic fever is an “illness of poverty and overcrowding.” Infections are “not a genetic problem” but an indicator of inequality, having an effect on young ones who “can’t get access to healthcare and don’t have decent housing.” The greater rates of sickness in Māori and Pasifika are a sad but unsurprising reflection of N.Z.’s population; almost 25% of Māori people comprise the country’s most deprived decile compared to just 6% of the Pākehā population.

Given that ARF is the most extreme example of unnecessary health disparity in the country, the New Zealand government classifies the disease as a major health priority. The leadership has invested NZD$65 million in tackling it through raising awareness and improving housing and access to treatments in priority communities. Yet rates are still increasing. At present, a Māori child is 25.3 times more likely to be admitted to hospital with acute rheumatic fever than a Pākehā child, and a Pasifika child is 44.2 times more likely, despite comprising just 4.7% of the country’s population. Overcrowded and poor quality housing is a key factor, but action here “takes too long,” Professor Lennon believes. While waiting for accommodations to be improved, attention must be focused on deprived kids with poor nutrition and little access to healthcare who are most susceptible to infections and have the fewest resources to deal with them.

New Zealand is a first world country, yet its brutal history and treatment of the Māori underlies this problem since they were indigenous to N.Z. before the arrival of Captain Cook in 1769. A series of wars took place between the Māori and the colonial New Zealand government, resulting in the confiscation of three million acres of Māori land, leading to a long-lasting socioeconomic impact. In the 1920s, ARF mostly had an effect on Pākehā, but in the 20th century Māori began migrating into cities en masse. In 1936, 83% of them lived in rural communities, but by 1986, 83% had moved into urban environments, living in poor quality, cramped housing – a far cry from their resource-rich native lands. Cases of acute rheumatic fever in Māori began to increase in line with the rising deprivation. The disease is thought to follow pharyngitis, a simple infection of the pharynx caused by Group A Streptococcus, a common bacterium. The body’s inflammatory response to it can affect the joints, nervous system and skin, but the most significant complications affect the heart, permanently damaging it and its valves, potentially requiring open heart surgery, often being life-shortening. These problems are aggravated by poverty where poor nutrition limits the body’s ability to fight infections in cold, damp, crowded housing facilitates where they spread.

For a developed first world country, this deprivation and avoidable health disparity is N.Z.’s shame to bear. For Māori and Pasifika people, a preventable and easily treatable illness, shortening the lives of their kids, is a tragedy. Among the many injustices the authority is working to rectify, the hope is that increasing quality accommodations and access to healthcare for the most deprived will alleviate their suffering. The country needs a seismic shift in its socioeconomic structure; otherwise, the futures of generations of Māori and Pasifika children will be blighted by the unnecessary suffering caused by acute rheumatic fever.