Addressing cancer inequities for indigenous populations: The New Zealand story

Abstract

The Indigenous Māori population of New Zealand experience greater cancer incidence, greater mortality, and poorer survival outcomes than the non-Māori population. The drivers of these inequities are complex, but include poorer access to timely diagnosis, less timely access to treatment and differences in the quality of care received. Upstream, the drivers of these proximal factors include historical trauma caused by colonisation and institutionalised racism – both of which reflect a failure of the British Crown (and latterly the New Zealand Government) to follow-through on guarantees made to Māori as part of Te Tiriti o Waitangi – our nation's founding document. However, while inequities in cancer incidence and outcomes persist, there are several elements of New Zealand's cancer control continuum that are performing well for Māori: there is evidence that an integrated, persistent focus to increase Māori participation in screening is possible, with substantial benefits in terms of survival parity; and child cancer services are achieving survival parity for Māori children diagnosed with cancer. Building on these successes, and eliminating cancer inequities for the Māori population, will require a multi-pronged approach that includes strong equity-focussed planning and prioritisation, and investment in the leadership, governance and monitoring required to see these plans to fruition.