Addressing Equity


27 Jun 2019

Guest editorial
Dr Sue Crengle,
Southland GP, Associate Professor at University of Otago, and Chair of Te Waipounamu Māori Leadership Group for Cancer.

Dr Sue Crengle, Chair of Te Waipounamu Māori Leadership Group for Cancer

In examining how health services are struggling to change in order to meet the needs of Māori, Dr Crengle says its essential Māori outcomes are at the forefront when developing these services…

Too often we acknowledge Māori have poorer outcomes, but struggle to do anything to address it. Equity is identified as a priority, but there are barriers to change – existing systems are entrenched and complex, services are stretched, resources are limited, and the number of Māori is small.

It’s time for us all to admit that saying ‘equity’ repeatedly does not change outcomes. We need to use the data and evidence we have available to understand where inequities for Māori exist, and use it to drive behaviour change.  When we know there are inequities, there is no excuse for continuing on the same path.

One example of services that could consider Māori needs better is the National Bowel Screening Programme. Māori health leaders are calling for the National Bowel Screening Programme age range to be lowered to 50 years old for Māori, based on new evidence showing Māori are diagnosed with bowel cancer younger than non-Māori (the current age range is 60-74 years for all ethnicities).

We know that for Māori with bowel cancer, 60 percent of women and 50 percent of men will be diagnosed before the age of 60. This is compared with non-Māori, where only 30 percent are diagnosed before 60.  If the current age range remains, the National Bowel Screening Programme could actually increase inequity as it will potentially pick up 70 percent of non-Māori bowel cancer, but less than half of Māori bowel cancer.

It is unconscionable that a screening programme could have such substantial inequity built into it. We estimate that a more tailored approach, with an age range that supports Māori needs, will result in an additional 400 colonoscopies each year nationwide. This is a significant additional resource, but how can you justify implementing an unfair system?

There has been a significant effort to achieve comparable participation rates in bowel screening for Māori and other ethnic groups, and this has resulted in positive engagement between Māori communities and the bowel screening programme. However, in this case, achieving equitable outcomes doesn’t just mean equal participation. If there is a genuine commitment to ensuring equity of outcomes for Māori, not just in the bowel screening programme but across health services, consideration of equity for Māori needs to be at the forefront of service planning and improvement – not just talking about equity, but changing the way we behave.

Te Waipounamu Māori Leadership Group for Cancer are working with Southern Cancer Network (SCN) to understand Māori experience of cancer and to improve outcomes for Māori across the SCN work programme. Te Waipounamu Māori Leadership Group for Cancer and SCN are embedding equity assessments and developing progress and outcomes measures (by ethnicity) as part of SCN’s standard practice. Equity always needs to be considered,, even when there are obstacles and even when changing behaviour and processes are hard.

Southern Cancer Network Manager Nicholas Glubb appreciates the partnership SCN has built with Te Waipounamu Māori Leadership Group for Cancer, “The input we receive from the Māori Leadership Group has underpinned how we think about developing our workplan and projects. Cancer services still have more to do to achieve equity of access and outcomes, and the Māori Leadership Group are providing advice and insight on how we can make meaningful change.”

Te Waipounamu Māori Leadership Group for Cancer is a multidisciplinary group, made up of consumers, NGOs, GPs, DHB clinicians and managers from around the South Island. Collectively, they provide input on setting SCN priorities, and provide advice, support and oversight to activities from Southern Cancer Network’s workplan.

Published on: Thursday, June 27th, 2019, under General