Māori cancer equity my - PowerPoint Presentation

Slide1

Māori cancer equitymy 20 yr journey

Oritetanga mo te mate pukupuku Māori

Nina Scott, Ngāpuhi, Ngāti Whātua and Waikato, FNZCPHM, MPH, MBChB, nscott.waikato@gmail.com

Slide2

Young and starry eyed

through the organised efforts of society . . . suffering from cancer is largely avoidable

Powhiri

to

MoH

job 2000

Slide3

Inequities along the entire cancer pathwayBetween Māori and non-Māori

multiple small inequities = large impact multipronged, multilevel solutions required

Incidence 21%Ministry of Health. 2014. Cancer: New registrations and deaths 2011. Wellington: Ministry of Health.

Age-standardised

Mortality

72%

Risk

factors

P

revention

T

imely

diagnosis

T

imely

quality treatment

survival

Drivers/root cause – lack of Māori Equity Cancer

Control,

leadership , decision making, resourcing + action =

institutionalised racism

= colonisation

Slide4

Māori are nearly twice as likely to die from cancer than non-Māori

Ministry of Health. Cancer: New registrations and deaths 2013.

Slide5

.

Soeberg, Blakely, Sarfati et al. 2012. Ethnic and socioeconomic trends in cancer survival, New Zealand, 1991-2004

Māori have worse survival rates for almost all cancers

Slide6

Inequity at every treatment stepThis is clearly not due to genetics or an inherent cultural reluctance to present for care and is not fixable by information pamphlets

Slide7

LeadershipInvolvement of related sectors in decision-making Partnership

Evidence based decision-making Systemic approach - a comprehensive programme with interrelated key components sharing the same goals and integrated with other related programmesC

ontinuous quality improvement Stepwise approach to planning and implementing interventionshttp://www.who.int/cancer/nccp/en/

WHO

BASIC PRINCIPLES OF CANCER CONTROL

Slide8

20 years and not much actioninaction in the face of need a hallmark of institutionalised racism

Jones CP. Levels of racism: a theoretic framework and a gardener's tale. American journal of public health 2000; 90

(8): 1212-5.“How do you do Mr Governor? All we think is that you have come to deceive us. The Pakehas tell us so, and we believe what they say.”Mohi Tawhai - Waitangi Signatory number 145 From his speech before signing The Treaty of Waitangi and How New Zealand Became a British Colony . TL Buick

Slide9

“At all steps of the screening pathway, Māori women were served less well than other women” 2004 Summary report on the Invasive Cervical Cancer Audit 2004Quality . . . the cornerstone of screening

Slide10

National Screening Unit Standardising Breast Cancer Treatmenteliminating survival inequity Indicator

setEach with a huge work uprationaletargetsdata elements

Data dictionary – each data element defined Data collection Agreement and training on how to collect data by data collectors Proforma – surgical and pathologyData analysis and reporting Independent Māori monitoring

Slide11

Equity Focused Reporting

measure

+ report inequities = low hanging fruit indicator of what could be achieved for priority groups

at a minimum = the most privileged/non-Maori level

pinpoint

relatively

quick

+

cheap health

gains

Non-standardised

care = inequities

Inequities

highlight where

standardisation

is needed first

Slide12

Māori had significantly lower rates (35%) of having

no radiotherapy (surgery alone

) than all other ethnic groups (45–49%).

Slide13

inequities

between indigenous & non- indigenous people are unfair, preventable and

entirely remediable

Slide14

Leadership Partnership

National Bowel Cancer Working Group

National Bowel Tumour Standards GroupNational Bowel Cancer Screening Advisory Group

Cancer Treatment Advisory Group

National Screening Advisory Group

Bowel Screening Pilot Steering Group

Hei Ahuru

Mowai - National

Maori Cancer Leadership

Bowel Tumour

Standards Working

Group

National

Māori

Bowel Screening Network

Interim Cancer Agency Advisory Board

National Bowel Cancer Maori Equity Advisory

Group

Slide15

National Bowel Cancer Working Group Equity Statement 2014

The National Bowel Cancer Working Group is

concerned that there are differences in bowel cancer survival between groups of New Zealanders which are inequitable. Inequities, by definition, are unfair, avoidable and remedial.Maori Equity Statement revised

2017“We recognise that achieving health equity for Māori will require accelerated efforts

to realise a radical improvement in Māori health.”

Slide16

The bowel screening programme

will increase inequities Unless we;

Create a screening participation gap 73% M 58% n-M or,

Drop age by 10 yrs for Māori 50-74 M

60-74 n-M

Decrease blood

level

in screening test for M

Create extra health gain

along screening

pathway

Hei

Āhuru

Mōwai

met on May 16th and

discussed how bowel

screening could

have

either a positive or negative effect on equity.

. .

Slide17

Equity champions

National Bowel Screening equity hui and fono

National Pacific Bowel Screening NetworkNational Maori Bowel Screening NetworkTumu Whakarae

– National Māori DHB General Managers forum Midland DHB Chief Executives

Slide18

Bowel Screening Academic HuiNational Bowel Screening Programme

Drop age to 50 for

Māori

Māori leadership in the National Screening Unit

Improve participation for Māori

Set up a research support service

Support

value added

interventions

Explore

optimising

the FIT

level

National Bowel Screening Maori

Network co-chairs Shelly Campbell

and Dr Rawiri McKree- Jansen

Slide19

Screening Maori from age 50 will

double the number

of Māori cancers detected.>1/2 Maori BC

Dx pre 60yrs vs < 1/3 for n-M

Slide20

Bowel screening participation

target 60%

active

follow up

3 phone call attempts -

M + PI

non-responders

RCT

Maori participation up 7

46%

to

53%

Maori

vs “Other” equity gap

4.8

(57.5 / 52.7)

Pilot round

1 equity gap

13.7

Māori

=

46%

Other

= 59.7%

Slide21

United Nations Declaration on the Rights of Indigenous Peoples Maori have the right

to equity and development maintain, control, protect and develop their cultural heritage,

traditional knowledgedevelop and determine health programmes + administer programmes through their own institutions

. . + financial and technical assistance from States . . . for the enjoyment of the rights contained in this Declaration

enjoyment

of the highest attainable standard of physical and mental health.

States shall take the necessary steps

with a view to achieving progressively the full realization of this right.

Slide22

Share power + support Maori self-determinationEquity focus entire cancer care systemContinuous equity improvement

ID equity hotspots – develop and test interventions, evaluate Public equity monitoring

Quality Māori data / right to be counted + monitor the Crown. Equal explanatory and analytical powerMaori models. Holistic. Address determinants of health for individuals

, whanau and communities

Necessary steps

Slide23

“free, frank and fearless discussions in which there is zero tolerance for white fragility and racism, and in which there is an understanding that Māori & Pacific leaders’ knowledge and expertise will be privileged rather than undermined

.”Rhys Jones

Chin MH, King PT, Jones RG, et al. Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States.

Health policy. 2018;122:837-853. doi:10.1016/j.healthpol.2018.05.001.