Maori Surviving Cancer. Equity focus for Cancer Control / Cancer Survival

Transcription

1 Maori Surviving Cancer Equity focus for Cancer Control / Cancer Survival

2 My background Clinical; curative and palliative care Public health; Maori Strategy Unit Waikato -Midland Network NSU - indicators breast cancer treatment Maori Strategic Advisor NSU Te Kete Hauora; national cancer priorities Prostate, HPV, Bowel and other cancer governance groups

3 Regional Cancer Networks Cancer Equity Forging new ground regional focus on Maori and Pacific established Today's presentations; high quality evidenced based, equity focused, systems approaches Where to from here?

4 Systems approach System is the problem not the patient Opposite of victim blaming approach Maori are more likely to die of cancer because they have cultural problems.... eating problems, self control problems, smoking problems, genetic problems,.. to shy, to lazy, fatalistic Then they present late

5 ... Systems Assume inequities occur at every step of cancer pathway... unless proven otherwise Diagnosed late, referred late, seen late, offered treatment late, receive treatment late, receive lower quality treatment.... Small inequities add up to big ones

6 ... Systems... Non-standardised care = inequities invitation to breast cancer screening pathway treatment for bowel and lung cancer regional co-ordination ordination for service collaboration Local community involvement Health promotion Maori involvement in setting cancer control priorities

7 Conclusion

8 Waka with experts on board Systems approach Regional co-ordination ordination Local involvement; mana whenua Clinical excellence Evaluate services Kaupapa Maori approach Get it right for Maori, get it right for all

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10 INCIDENCE smoking screening SITE

11 Lung 1 st cause of cancer death for Maori 1st for contribution to inequity in overall cancer deaths - 48% 14th for inequities in treatment - 19% 10 th for inequity in stage at diagnosis 51% 130 diagnosed pa -10% less than n-mn 285 diagnosed 3.27 x >n-m 232 die - 59% higher than n-mn 19% higher stage adjusted risk of death after diagnosis for M

12 Lung... Prevention; not cancer control but collaboration between cancer and tobacco control Chest x-ray x for coughing ex/current smokers Explore screening Identify causes of inequities in treatment Then fix standardised systems equity focused approach

13 Breast 250 year diagnosed, 70 die, 28% higher incidence, 73% more likely to die than n-n M, stage adjusted risk of death after diagnosis 32% Invitation to screening pathway non - standardised. Health promotion / kaimahi under threat Regional co-ordination ordination and mana whenua involvement non-standardised

14 Prostate 5 th cause of cancer death for Maori 4 th for contribution to inequity in overall cancer deaths 3 rd for inequities in treatment - 76% 1 st for inequity in stage at diagnosis 354% 130 diagnosed pa, (10% less than n-m) n 33 die (59% higher than n-m) n 76% higher stage adjusted risk of death after diagnosis for M

15 liver 6 th for cause of cancer death for Maori 5 th Contribution to inequity in cancer deaths 8 th Inequities in treatment 33% 0 Inequity in stage at diagnosis 6% better for Maori

16 Liver... Hep B immunisation Screening and surveillance Research reasons for inequities in treatment and fix

17 Bowel 3 rd Cause of cancer death for Maori 0 Contribution to inequity in cancer deaths 13 th Inequities in treatment 22% 9 th Inequity in stage at diagnosis 59% Risk of death after diagnosis 22% higher for Maori once stage accounted for Research on causes of inequities; yay!

18 Procedure Maori less likely elective surgery removal of the primary tumor treated in a specialist public cancer treatment facility patients with stage III cancer referred to or reviewed by an oncologist offered or receive chemotherapy

19 Procedure Maori more likely longer waiting times for chemotherapy Less lymph nodes removed during surgery Require emergency surgery Die after elective surgery 5 times as likely

20 Incidence Early diagnosis Treatment Research screening access to access to bowel rates and quality and quality cancer risk of colon of and -oscopy treatment protective factors for Maori

21 East Coast Breast Screening Iwi led Collaboration with central provider Maori centric service Standardized and evidence based approach to invitation to screening; screening lists, transport, health promotion, local involvement, women focused, regional co-ordination. ordination.

22 Learning Breast Screening Ngati Porou; 4 yrs hard work to overcome barriers/ encourage services to share data / become responsive to Maori Requires passion and dedication

23 Directory CCN Evidence based; literature, hui and fono Maori and Pacific involvement Information key Collaboration Regional co-ordination ordination Information = power

24 Taranaki Piki te Ora Nursing Services Ltd Contracting with Maori providers is an equity focused activity Access to services Information = power Maori want control over their own lives Wanting to be smoke free DNA for cervical cancer; follow up

25 Learning Regional collaboration WINZ Ensure health services are aware of Maori support roles within the sector Audience = key stakeholders = groundwork for local /mana whenua involvement in regional co-ordination ordination

26 Whanganui Systems focus Educate health professionals Evidence based; very through information gathering Maori focused; 79% participants Maori Get it right for Maori get it right for all

27 Learning Focus on systems Evaluate services from a Maori perspective Kaupapa Maori research methodology Hui waka tool Need regional specific information Regional co-ordination ordination

28 Hawkes Bay Cancer Society Mainstream recognising importance of partnership with Maori Gathering evidence for future Collaboration Regional co-ordination; ordination; data base of services and relationships, Cancer Society and Te Kupenga Hauora Ahuriri

29 Learning Power sharing; it wasn t t our day Supporting mainstream organisations to take first steps Evaluation by Maori Knowledge is power

30 Maori Cancer Coordinators CCN Kete Ora for whanau Action research training Kaupapa Maori Maori centric resources Developed by Maori for Maori Using Kaupapa Maori methodology Regional coordination; collaboration with organisations uphold mana

31 Tairawhiti Local Cancer Network Maori Cancer Forum in Rotorua an inspiration for navigator position Community hui 1 st step Established mainstream health providers as barriers Getting men bit of a problem Rushing slowly Sustaining the position

32 Learning Evidence based; community provided data The importance of hui Passionate staff pushing for progress Kaupapa Maori, by Maori for Maori Whanau Ora funding model helped greatly in collaboration Clinical staff and community in facilitated forum We need Maori faces...especially in the Cancer Society

33 Wairarapa Cancer Society Demystifying Cancer Project Big learning project Systems focused Maori focused Maori participation in design of project Evidence based; whanau interviews No standardised regional coordination for referral to support services Whanu support saves cancer resources Cost to whanau

34 Hutt Local Cancer Network Interim update... Advisory Groups important Health promotion; Pacific Radio Maori advisory groups recommended systems approach; focus on working with providers Workshops Evaluation

35 Hutt and CCDHB Working with Pacific Communities Collaboration Our families do not see the line that divides our 2 DHBs there was no ill meaning behind it; it was just the way it happened... Pacific Radio Information is power

36 Discussions Policy key Maori work force important other wise we are always going to be consumers Maori Providers need support to be able to compete with DHBs for workforce Demystifying Cancer Workshops have been a leverage point for action in many areas Maori advisory groups Cancer Society stepping up; leading the way for other NGOs

37 Maori Cancer Governance determines cancer policy for Maori RCN EMs developing regional Maori Cancer Control Governance Groups; mana whenua with representatives from along the care pathway National Maori Cancer Control Governance Groups; representatives from the regional groups and clinical expertise MoH, National Cancer Society Governance...

38 Equity framework for RCNs Getting strategic about Maori cancer control... in development will; allow identification of priorities for action; attract resources more equity focused funding; promote equity focused research, support collaboration, raise profile of Maori cancer control issues

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40 Conclusion