A total of 87 young people died in the Lakes region between 2012 and 2016, latest child mortality figures show.
The figure, which is higher than most other district health boards in the country, is being described as "crushing" and "never failing to disappoint" by health professionals.
But Children's Commissioner Andrew Becroft said there were some encouraging signs in the figures, and they should be looked at as an opportunity to work better together.
The Child and Youth Mortality Review Committee has recently released its 13th report which outlines 87 young people aged between 28 days to 24 years died between 2012 and 2016.
Totals across the country's 20 health boards ranged from 27 to 356.
Becroft said there was cause for concern when looking at the mortality rate per 100,000 people in the area.
"If you take the rate per 100,000 then for the Lakes DHB at least, the numbers are higher than the national average.
"So that's a little window into the issues facing those in that DHB, like housing, low socioeconomic [conditions].
"On one sense the figures are a little crushing, but on the other hand they are an opportunity to do better by our youth."
In the Lakes DHB the overall mortality rate across all age brackets, from 2012 to 2016, is 47.52 in 100,000. That is the fourth highest across the country's 20 DHBs but a decrease from 49.55 in the 2011-2015 report.
The rate is the second highest across other health boards in the 10 to 14 age bracket, third highest in the 20 to 24 bracket and fourth in the 15 to 19 bracket.
Lakes District Health Board quality, risk and clinical governance director Dr Sharon Kletchko said the board was working to reduce youth deaths through multiple measures, including by supporting whanau ora approaches and establishing the Rotorua Children's Team.
"Our local primary care system is assisting those neighbourhoods with greater poverty to access care that supports the child, their whanau and their local communities."
The health board has also been working with government agencies and health and social services providers to support at-risk families and youth.
But, Kletchko said, as a health board with high levels of social deprivation, the population had some of the highest levels of health inequality.
"The patterns involve children who live in disadvantaged neighbourhoods with poor housing. Areas where their parents struggle daily to put sufficient food on the table. Areas where educational attainment is limited. Areas where children are exposed to second-hand cigarette smoking."
But it's not all bad news.
Nationwide, 2621 children and young people died between 2012 and 2016. Of those, 483 died in 2016 which is the lowest number in a single year since the Child and Youth Mortality Review Committee was established in 2002.
Rotorua Parents' Centre president Amy O'Hagan said that was encouraging, and the result of hard work on many fronts.
"There has been a massive amount of work behind the scenes from Plunket, Healthy Homes Rotorua and others. Midwives work tirelessly to make sure kids are safe," O'Hagan said.
"Obviously that's still too many [deaths] but there's been some hard work.
"We want people to make sure they are doing the best by their kids."
Nationwide, the leading cause of death was medical conditions at 38.8 per cent, followed by unintentional injury at 27.7 per cent and intentional injury at 25.3 per cent.
Although the causes of deaths weren't broken down by DHB, nationwide they changed with age.
From age 15, suicide is the leading cause of death.
Becroft said he was encouraged by legislation addressing child poverty, as well as the mental health inquiry.
"We know that for the age group 15-plus, the issues are suicide and car accidents. So I think it's a reminder to us all about the importance of responsibly supervising and encouraging teenage drivers.
"Our suicide rates are world leading in the wrong way and that's particularly concerning for every community.
"Where there's high stress in families, family violence, real material deprivation and with volatility of teenage years, all these factors are at play in terms of our high suicide rates."
Te Rūnanga Ngāti o Pikiao Trust project leader Michael Naera said mental health needed to be everyone's business because its effects were traumatising and emotionally draining.
"These statistics are not surprising but they never fail to disappoint me."
Mortality in Lakes DHB from 2012 to 2016:
28 days to 1 year: 12 deaths (1.60 in 1000)
Ages 1 to 4: 7 deaths (22 in 100,000)
Ages 5 to 9: <3 (rate not calculated due to small numbers)
Ages 10 to 14: 9 (23.56 in 100,000)
Ages 15 to 19:27 (75.92 in 100,000)
Ages 20 to 24: 30 (95.85 in 100,000)
Total: 87 (47.52 in 100,000)
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call 111.
If you need to talk to someone, the following free helplines operate 24/7:
DEPRESSION HELPLINE: 0800 111 757
LIFELINE: 0800 543 354
NEED TO TALK? Call or text 1737
SAMARITANS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234