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Cancer Control Strategy in NZ
The journey & impact for Māori -what we have learnt along the way?
#CancerCrossroads
Shelley Campbell
The impact on Māori cancer outcomes
Source: NZ Census Mortality Study (NZCMS)
The impact on Māori cancer outcomes
Source: NZ Census Mortality Study (NZCMS)
1990 – 1999 GOVERNMENT: HEALTH IS A BUSINESS ERA
› Purchaser/provider split
› Competition, user pays
› 4 RHA’s – 1 HFA
› CHE’s – HHS’s
› IPA’s established
› Department of Health became Ministry of Health
› Planning document for national Cancer Control Strategy (’95)
› Smokefree Environments Act
› Auahi Kore & tobacco sponsorship ends
› Cancer Registry Act
› Pharmac established
› Breast Screening Aotearoa - national Breast screening established
› Investment in Kaupapa Māori providers
› Eru Pōmare Hauora reports
› HFA equity principles for prioritisation and purchasing
› MAPO Māori co-purchasing agencies
› Decades of disparities reports
› Hui Whakapumau – Whaiora: Māori health development
› Te Kete Hauora established in MOH
Rememberedfor
Cancer strategy
Key cancer control activity
Māori-specific
milestones
& activity
2000 – 2008 GOVERNMENT: CLOSING THE GAPS
› New health and disability legislation
› DHB’s & PHO’s established
› Collaboration
› 10 health targets
› 2003 Cancer Control Strategy
› Cancer Action Plan 2005 – 2015
› 4 Regional Cancer Networks
› HPV programme roll out
› Bowel Cancer Taskforce leading to national Screening pilot
› Cancer Control Council established
› Dedicated Cancer Control team in MOH
› Hauora reports – Māori Stds of Health
› Unequal Impact Report 1
› Health Equity Assessment Tool (HEAT)
› Foreshore & seabed debate
› He Korowai Oranga – national Māori health strategy
› Tatau Kahukura – Māori health chartbooks
› Whanau Ora Taskforce
› Māori affairs select committee enquiry into tobacco industry
› Māori health committee for research
Rememberedfor
Cancer strategy
Key cancer control activity
Māori-specific
milestones
& activity
2009 – 2017 GOVERNMENT: BETTER SOONER MORE CONVENIENT
› Universal healthcare
› Reducing advisory groups & committees
› Horn Report – Meeting the Challenge
› National Health Board & Health Workforce NZ
› Quality Commission & HPA established
› Whanau Ora service development
› Cancer Action Plan 2005 – 2010
› Integrated annual workplans – MOH, DHB & regional networks
› NZ Cancer Plan: Better Faster Cancer Care 2015
› Smokefree Aotearoa 2025
› Increased focus on supportive care
› Review of Cancer Registry
› Reviews of Regional Cancer Networks
› Voice of Experience report
› Coming Ready or Not report
› Faster Cancer Treatment Indicators
› Bowel Cancer Screening pilot & rollout
› CCNZ disestablished
› Hei Āhuru Mōwai established
› Unequal Impact Report 2
› He Korowai Oranga Strategy
› Te Kete Hauora disestablished
› Te Ara Mate Pukapuka ki te Waipounamu
› No Quality without Equity report
› Whanau Ora roll out
Rememberedfor
Cancer strategy
Key cancer control activity
Māori-specific
milestones
& activity
1990 – 1999 GOVERNMENT
HEALTH IS A BUSINESS ERA
2000 – 2008 GOVERNMENT
CLOSING THE GAPS
2009 – 2017 GOVERNMENT
BETTER SOONER MORE CONVENIENT
2018 GOVERNMENT
› Purchaser/provider split
› Competition, user pays
› 4 RHA’s – 1 HFA
› CHE’s – HHS’s
› IPA’s established
› Dept Health became Min of Health
› New health and disability legislation
› DHB’s & PHO’s established
› Collaboration
› 10 health targets
› Universal healthcare
› Reducing advisory groups & committees
› Horn Report – Meeting the Challenge
› National Health Board & Health Workforce
NZ
› Quality Commission & HPA established
› Whanau Ora service development
› Health reviews
› Child poverty and well-being focus
› Public health and inequity refocus
› MOH leadership refresh
› Wai 25/75 Hearings
› Planning document for national Cancer
Control Strategy (’95)
› 2003 Cancer Control Strategy
› Cancer Action Plan 2005 – 2015
› Cancer Action Plan 2005 – 2010
› Integrated annual workplans – MOH, DHB
& regional networks
› NZ Cancer Plan: Better Faster Cancer Care
2015
› Smokefree Environments Act
› Auahi Kore & tobacco sponsorship ends
› Cancer Registry Act
› Pharmac established
› Breast Screening Aotearoa - national Breast
screening established
› 4 Regional Cancer Networks
› HPV programme roll out
› Bowel Cancer Taskforce leading to national
Screening pilot
› Cancer Control Council established
› Dedicated Cancer Control team in MOH
› Smokefree Aotearoa 2025
› Increased focus on supportive care
› Review of Cancer Registry
› Reviews of Regional Cancer Networks
› Voice of Experience report
› Coming Ready or Not report
› Faster Cancer Treatment Indicators
› Bowel Cancer Screening pilot & rollout
› CCNZ disestablished
› Bowel cancer roll out & review
› Re-set of Cancer Society research agenda
› HP Research Cancer Conference
› Cancer Care at a Crossroads Conference
› Investment in Kaupapa Māori providers
› Eru Pōmare Hauora reports
› HFA equity principles for prioritisation and
purchasing
› MAPO Māori co-purchasing agencies
› Decades of disparities reports
› Hui Whakapumau – Whaiora: Māori health
development
› Te Kete Hauora established in MOH
› Hauora reports – Māori Stds of Health
› Unequal Impact Report 1
› Health Equity Assessment Tool (HEAT)
› Foreshore & seabed debate
› He Korowai Oranga – national Māori health
strategy
› Tatau Kahukura – Māori health chartbooks
› Whanau Ora Taskforce
› Māori affairs select committee enquiry into
tobacco industry
› Māori health committee for research
› Hei Āhuru Mōwai established
› Unequal Impact Report 2
› He Korowai Oranga Strategy
› Te Kete Hauora disestablished
› Te Ara Mate Pukapuka ki te Waipounamu
› No Quality without Equity report
› Whanau Ora roll out
› New equity frameworks developed MOH
› Ministerial briefing on improving Cancer
Equity in Aotearoa - HQ & S Comm
› Indigenous call to action in Lancet
Remembered for
Cancer strategy
Key cancer control activity
Māori-specific
milestones
& activity
1
2
3
4
5
6
Victim blamingDeficit models
genetics
Cultural stereotypes
Cultural reluctance to present for care
compliance
Care derived inequityFocus on systemLate diagnosis, under-treatment, differences in access, care & treatment
RacismPrejudice & discriminationDifferential access to opportunities
Risk factorsIndividual risks & lifestyle focusSocio-eco determinantsInequity generating environments
Health system responsiveness
Bias‘hard to reach’ groups
Cultural competence
The Equity Lens
The successes & achievements
1. Achieving equity in survival outcomes for children and adolescents with cancer
2. Demonstrated that integrated, persistent focus to increase Māori participation in screening (e.g. bowel) and outcomes (e.g. breast screening pathway) is possible
3. Improvements in quality ethnicity data & evidence
4. Improved inequity reporting from regional cancer networks
5. Greater visibility & capability in Māori cancer workforce across the sector
6. Recognised value of whānau & spirituality in cancer journey
Strategy is great but
implementation
matters
Greater accountability &
focus on system
performance & monitoring
A determined
focus on
inequities works
Our progress can’t be
reliant on political
ideology
Lessons learnt
Clear sustained
effort on inequities
across the pathway
Prioritise those with the
worst outcomes in
policy, planning,
funding & care
Cancer control needs
longer term horizon &
commitment
Deliberately design
health care services
that work for Māori
New models of sector
wide engagement & stewardship