Children's environmental health indicators

Household crowding

• Nearly one in five (18.2%) children lived in crowded households in 2023.
• Household crowding rates for children were much higher among Pacific peoples (42.3%), followed by Māori children at 28.4%.
• Nearly 1 in 3 children in Tairāwhiti (30.8%) and Counties Manukau (29.8%) lived in crowded conditions.

Damp dwellings

• Slightly over one in four children (26.0%) lived in dwellings that were always or sometimes damp in 2023.
• Pacific children and Māori children had notably high rates of living in damp dwellings, at 41.8% and 38.4%, respectively.
• Tairāwhiti had the highest rate of children in damp homes (45.4%), followed by Northland (38.5%).

Mouldy dwellings

• Over one in five children (21.1%) lived in dwellings where mould larger than an A4 sheet was always or sometimes present in 2023.
• Māori and Pacific children had notably high rates of exposure to mould, at 37.6% and 31.1%, respectively.
• More than one in three children in Tairāwhiti district (36.2%) and Northland district (32.3%) lived in homes where mould larger than an A4 sheet was always or sometimes present.

• Around 21,000 children aged 0–14 years and 197,000 adults were exposed to second-hand smoke in the home in 2023/24.
• Exposure to second-hand smoke for children has decreased considerably from 5.1% in 2012/13 to 2.2% in 2023/24.
• Children living in the most deprived neighbourhoods (NZDep2018 quintile 5) were 2.39 times as likely to be exposed to second-hand smoke in the home than those in the least deprived areas.

• Maternal smoking rates at two weeks postnatal have decreased from 13.7% in 2009 to 7.3% in 2021.
• The gap in smoking rates between Māori mothers and other ethnic groups continues to decrease. Smoking rates among Māori mothers have declined from 32.2% in 2009 to 19.5% in 2021.
• Maternal smoking rates have dropped by more than 30% across most health districts between 2009 and 2021, particularly in Tairāwhiti.

• In 2023/24, around 99,000 children aged 2–14 years were diagnosed with asthma and were currently taking asthma medication.
• There were 7533 hospitalisations in children aged 0–14 years in 2023, down from 7862 in 2022.
• Children under five years old continued to experience lower rates of asthma prevalence but higher hospitalisation rates, particularly among one-year-olds, compared to other age groups. In 2023, the hospitalisation rate for those aged 0–4 was 13 times higher than that of 10–14-year-olds.
• In 2023/24, Māori children aged 2–14 years experienced a higher prevalence of asthma compared to non-Māori children. In addition, Pacific children aged 0–14 years have consistently had higher hospitalisation rates than other children since 2001.
• Asthma prevalence and hospitalisation rates were higher in children living in the most deprived areas (NZDep 2018 quintile 5) than children living in the least deprived areas.
• Children living in main urban areas had higher hospitalisation rates than children living in rural areas in 2023.

• The number of LRTI hospitalisations among 0-4 year olds increased from 9415 in 2021 to 9968 in 2022.
• LRTI hospitalisations during winter returned to pre-COVID levels, but hospitalisations stayed high throughout the remainder of 2022, compared to 2019 levels.
• Infants (under one-year-old) continue to have the highest LRTI hospitalisation rates, but the rate for 1-year-olds (4546.8 per 100,000) was the highest recorded since 2001.
• Pacific children had three times the rate of LRTI hospitalisations as European/Other children in 2022.

• 46 babies died from SUDI in 2019, up from 37 deaths the previous year. There has been no improvement in SUDI rates since 2012.
• Pacific and Māori babies had five times the rate of SUDI as European/Other babies in 2015–19.
• Babies of younger mothers (younger than 25 years) had higher SUDI rates than babies born to mothers in older age groups.
• The SUDI rate for babies living in the most socioeconomically deprived areas (NZdep 2013 quintile 5) was more than seven times as high as babies in the least deprived areas (quintile 1).

• The number of meningococcal notifications declined from 42 (4.4 per 100,000) in 2022 to 21 (2.2 per 100,000) in 2023, primarily due to a decrease in notifications among the under-5 age group.
• Meningococcal B continues to be the most dominant strain in children aged 0–14 years.
• Infants (under 1-year-old) have had the highest rate of meningococcal disease since 2001. In 2023, the rate of meningococcal disease in this age group was 36 times the rate among children aged 10–14 years.
• Māori and Pacific children had the rate of meningococcal disease than European/Other children. Māori children also represent the majority of cases across all age groups, particularly among infants.
• Children living in the most deprived areas (NZDep 2018 quintile 5) had three times the rate of meningococcal disease as children living in the least deprived areas (quintile 1).

Non-occupational lead absorption notifications

• Lead absorption notification rates for children aged 0–14 years have decreased from 3.4 per 100,00 in 2022 to 0.6 per 100,000 in 2023.

• Hazardous substance notification rates for young children, 0–4 years, peaked in 2018–19 (5.9 per 100,000) and have roughly halved in 2021–22 (3.5 per 100,000).
• Roughly two-thirds of exposures involving children aged 0–14 years occurred in the home from 2018–22.
• The most common substances were household cleaning products, other harmful gases, pesticides/insecticides and air fresheners/fragrances/deodorants.

• Children aged 0–4 years continue to experience three times the hazardous substances-related hospitalisation rate of the next most affected age group from 2001–2022.
• Cleaning products are the most common hazardous substances causing hospitalisation in the 0–4 year age group (62/180 notifications).

Active transport to and from school

• In 2023/24, 38.8% of children aged 5–14 years used active transport to travel to or from school.
• There has been no notable change in the percentage of children using active transport to school
  since 2011/12.
• In general, older children (aged 10–14 years) were more likely to participate in active transport
  than younger children (5–9 years).

• In 2023/24, an estimated 13,000 children aged 0–14 years (1.4% of all children in that age group) experienced an unmet need for GP services in the past 12 months due to a lack of transport.
• The level of inequality was particularly stark for Māori children, who were more than four times more likely than non-Māori children to have experienced an unmet need for GP services due to a lack of transport.

• In 2016, 12 children aged 0-14 years died from traffic injury, the majority as vehicle occupants (8 deaths).
• The mortality rate for traffic injuries for children remained mostly unchanged between 2010 and 2016.
• In 2019, there were 269 hospitalisations for traffic injuries for children, most of which were for vehicle occupant injuries (56.5%) or pedestrian injuries (25.3%). 
• The overall traffic injury hospitalisation rate for children aged 0-14 years has been stable from 2012 onwards.
• Māori children had traffic injury mortality rates which were three times higher than those of children of other ethnicities and represented 52% of all traffic-related deaths between 2007–16.

Notifications of potentially waterborne diseases

• Children aged under four years experienced much higher notification rates for all waterborne diseases covered in this surveillance report.

• In 2022, 56% of the 33,202 five-year-olds seen by community oral health services had no history
  of dental caries. These children had 2.0 decayed missing or filled teeth on average.
• In 2022, 69% of the 45,595 children in school-year eight seen by community oral health services
  had no history of dental caries. These children had 0.7 decayed missing or filled teeth on average.
• Māori and Pacific children had poorer oral health compared to other ethnicities.
• Children in Te Tai Tokerau, Lakes, MidCentral and Counties Manukau districts tended to have
  worse oral health than those in other districts.

Vulnerability to climate change

• Young children aged 0 to 4 years have fewer sweat glands, making them more sensitive to heat on very hot days.  
• Young children require additional support to cope with unexpected weather events.