Friday, September 6, 2019

Bob Edlin: Maori demand “partnership” in new cancer agency

A modern-day interpretation of the Treaty of Waitangi – contentiously bringing “partnership” into considerations –  is encouraging Maori demands for equal representation on a new health agency.
The government has announced it will establish a national Cancer Control Agency by December as part of a 10-year strategy, which includes achieving cancer survival equity by 2030.
This triggered a Maori health leader’s insistence on equal representation within the new agency and her call for Maori to decide what this means in practice.
Radio New Zealand’s Checkpoint, reporting on this response, noted that Maori are nearly twice as likely to die from cancer as non-Maori.
The report contained no data to illustrate this or to show the total death rate and the Maori figure for comparative purposes.
But according to this New Zealand Herald report, cancer is the number one killer in New Zealand.
More than 23,000 people are diagnosed every year and that number keeps climbing, according to figures released by the Ministry of Health today.
The data showed that more than 9500 people died from cancer each year, representing 31 per cent of all deaths recorded in New Zealand.  
Comparative rates between Maori and non-Maori can be found on a Ministry of Health website.
The difference is a matter for concern.   The reason(s) for the difference is a matter calling not for politicking but for research.
Significantly, researchers from several universities are hoping to find the explanations
The researchers have been awarded a $2 million grant by the Cancer Society.
According to a press release from Otago University, four cancer research groups within the University of Otago have joined with Massey University and Victoria University of Wellington to become the Cancer Society Research Collaboration (CSRC).
The collaboration will be led by senior Otago staff:  Professors Janet Hoek, Diana Sarfati and Louise Signal, Associate Professor Sue Crengle and Drs Richard Egan and Rachael McLean.
Hmm. Five women and one bloke.
One of those women, Professor Sarfati, happens to have been named interim director of the newly announced Cancer Control Agency.
Nobody (at least, nobody we are aware of) has questioned the gender mix in these appointments.
Ethnic disparities in cancer death rates seem to be a greater concern than gender disparities.
Associate Professor Sue Crengle says New Zealand has well documented inequities in cancer, the most significant between Māori and non-Māori. 
The collaboration has a particular focus on finding ways to eliminate these differences. 
“The collaborative aims to reduce both the incidence and impact of cancer in New Zealand and to reduce inequities,” Professor Crengle says.
While the researchers do their research, the Ministry of Health has been promoting the fiction that “Treaty” principles include “partnership”.
… has committed to honouring the Treaty, saying it “will work in partnership with tangata whenua and support tangata whenua-led processes, actions and decision-making”.
In the same Radio NZ report, Hei Āhuru Mōwai – Māori Cancer Leadership Aotearoa chairperson Nina Scott provided the answer to the profound question about the cause(s)  of the race disparity in cancer death rates.
“I am really pleased that the ministry’s talking about true partnership with Māori because that hasn’t happened before and that’s why we have such massive inequities between Māori and non-Māori with regards to cancer, so we’re more likely to get it, we are diagnosed later and our treatment is slower through the system and our treatment has poorer quality and the system doesn’t do holistic-type care that we should be doing in this country.”
She said the previous cancer strategy was good, but ultimately failed because there was no partnership.
“I’m pleased with a lot of the content and what I am really interested in looking at is how that actually manifests in real terms, how that partnership is manifest and who is going to sit where, quite frankly.”
The research team – may we suggest – should go to Dr Scott for the answers they seek and for an oh-so-simple recommendation:
  • A lack of partnership has caused the Maori/non-Maori disparities.
  • The panacea therefore is partnership
According to Radio NZ, Dr Scott declined to elaborate on what this partnership should look like in the new cancer agency, saying that she wanted the wider Maori population to decide.
Having said that, she elaborated:
“I think there needs to be a Māori Treaty partner at every level, especially at the higher top levels, obviously, but at the same time we can’t just rely on one person, we also need to have that collective input.”
She said she would be asking the Ministry of Health for resources to hold wānanga across the country to hear from Maori.
She was pleased the ministry has included a mātauranga Māori framework in its strategy, which Hei Āhuru Mōwai has been pushing for.
This framework – as Point of Order understands it – merges medical science with the spiritual, metaphysical and supernatural.
“I’d call it a fundamental right to have those models, and that the state needs to support the development of those models because New Zealand signed up to the United Nations Declaration on the Rights of Indigenous Peoples.”
Otago University public health physician and cancer epidemiologist Diana Sarfati, having been named the interim director of the agency, told Checkpoint the ambitious goal of  cancer survival equity by 2030 may be attainable only for some cancers.
“There’s slightly different mechanisms at play for different cancers, so I think in some cases we will be able to meet that aim and in some areas it may be a bit longer.
“When we look at survival outcomes for the cancers where we have well developed screening programmes – so, cervical and breast cancer screening … the women who are diagnosed through those screening programmes, the survival inequities disappear. So we know we can do it, but it does take a lot of effort and it does take a lot of focus and being very clear and having quality indicators and measuring those and holding systems to account.
“We’re going to be working with Māori to identifiy what is going to work best for them – it’s an ambitious goal but we will be working towards that.”
We suspect this might not meet Dr Scott’s partnership test.
Bob Edlin is a veteran journalist and editor for the Point of Order blog HERE.

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