Poverty, deprivation and poor access to healthcare are driving premature deaths in south Auckland, experts say.
And recently released figures show it has the worst rates in the Auckland region.
"Amenable mortality" is defined as the premature death of a person under 75 that could have potentially been avoided, if they had received effective and timely healthcare.
The most up-to-date figures released by Counties Manukau District Health Board under the Official Information Act are from 2018 and show 634 people died that year, compared to 418 for the Auckland health board in 2018 and 508 for Waitematā.
This equates to 111.8 deaths per 100,000 people in the Counties Manukau health board area, compared to 84.7 in Auckland and 82.6 in Waitematā.
The 2018 populations served by each health board were Counties Manukau 567,000, Auckland 493,300 and Waitematā DHB 615,100.
The most common causes of such deaths in south Auckland are coronary heart disease, diabetes, cerebrovascular disease, suicide, chronic obstructive pulmonary disease and breast cancer.
Epidemiologist Dr Alistair Woodward said deprivation and poverty were the two main drivers behind the high level of premature deaths in Counties Manukau.
Woodward is a professor at the University of Auckland's School of Population Health.
He said people in poverty are often living in substandard housing and have lower incomes, which contributes to poorer health outcomes and an increase in premature deaths.
"If you've got more socially disadvantaged people and more people with conditions like heart disease and diabetes, you are going to get more people falling through the cracks. And that's what amenable mortality is."
But he said most factors that determine the country's negative health statistics are socio-economic - a result of what is happening in our homes, schools and workplaces, and not the healthcare sector.
Former Association of Salaried Medical Specialists (ASMS) executive director Ian Powell agreed with Woodward and said that deprivation and poverty have a flow-on effect in lower socio-economic areas like Counties Manukau.
"If you are poor and struggling financially it's much harder to get access to healthcare, aside from just turning up in a hospital emergency department."
And he said as a result people in poorer areas also often seek treatment later for their ailments. He said access problems in areas like Counties Manukau are also compounded by a shortage of doctors.
"But overall, it's often about social determinants outside of the healthcare system, such as poor housing and low incomes, that are the problem."
Counties Manukau Health chief executive Margie Apa said the numbers of amenable mortality cases had increased slightly between 2016 to 2018, but she said this was mainly due to Auckland's growing and ageing population.
Apa said the Counties Manukau was working with the other health boards in the region to help reduce such deaths.
"Activities for example are aimed at reducing smoking rates, improving management of cardiovascular disease and increasing access to primary and secondary care."
Dr Rawiri McKree Jansen is the clinical director for the National Hauora Coalition and has been an outspoken advocate for Māori health for a number of years.
He wasn't surprised to hear the premature death statistics from Counties Manukau.
"You could say it's shocking, but it's not - and isn't that a sad example of the state of our healthcare system?"
McKree Jansen said he hopes the Government's planned reforms for the health system will be used to address such dire statistics.
The Government plans to create a new agency, Health New Zealand, to replace the country's 20 district health boards.
A new Māori Health Authority will also be created to help target health inequalities faced by tangata whenua and will also have the power to commission health services and develop policy.