cancer control strategy in nz · ›whanau ora service development ›cancer action plan 2005...

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)

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


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


› 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


› 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


Māori-specific

milestones

& activity

1990 – 1999 GOVERNMENT

HEALTH IS A BUSINESS ERA


CLOSING THE GAPS


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



› 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


› 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


› 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


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

cancer control strategy in nz · ›whanau ora service development ›cancer action plan 2005...

Documents