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Abstract
The research reported here uses New Zealand data on smoking behavior that were collected in the 1981, 1996, and 2006 national censuses. Evaluation of the extent to which differential migration patterns among smokers, former smokers, and nonsmokers contributed toward geographical inequalities in health in New Zealand suggests that the effect of selective migration appears to be significant over the long term. This effect includes the arrival of large numbers of nonsmokers from abroad to the most affluent parts of New Zealand. The recording of these events and the high quality of the census in New Zealand provides evidence of one key mechanism whereby geographical inequalities in health between areas can be greatly exacerbated across a country—differential migration by health status. This assertion has important implications for studies monitoring spatial inequalities in health over time, and research investigating “place effects” on health.
La investigación en la que se basa este artículo utiliza datos de Nueva Zelanda sobre la conducta de fumadores, registrados en los censos nacionales de 1981, 1996 y 2006. La evaluación del grado con que los diferentes patrones de migración observados en fumadores, ex fumadores y no fumadores contribuyen a las desigualdades geográficas de la salud en Nueva Zelanda sugiere que el efecto de la migración selectiva parece ser significativa en el largo plazo. Este efecto incluye la llegada de un gran número de no fumadores desde el extranjero a las partes más opulentas del país. El registro de estos hechos, y la alta calidad del censo neozelandés, proveen evidencia de un mecanismo clave en el cual las desigualdades geográficas de salud entre diferentes áreas pueden agravarse mucho a través de un país—migración diferencial de acuerdo con el estatus de la salud. Este aserto tiene importantes implicaciones en estudios dedicados al monitoreo de desigualdades espaciales en salud a través del tiempo, y en las investigaciones que indagan sobre “los efectos del lugar” en la salud.
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Acknowledgments
The authors thank Ewan Jonasen from Statistics New Zealand for extracting the census records. Thanks also to Paul Bealing for creating the map, and to John Pritchard for producing the diagram. The comments from the three anonymous reviewers were extremely useful. Jamie Pearce was a member of staff at the Department of Geography, University of Canterbury, New Zealand, when the analyses were undertaken.
Notes
aTotal population is the usually resident population aged 15 and over (the age group for which smoking status is known).
bThe deprivation figures show the percentage of the resident population in each district health board who were among the most deprived 30 percent of New Zealanders. Deprivation is measured using the 2001 New Zealand Deprivation Index.
