This month the Government announced it was redirecting $36 million tagged to lower the bowel cancer screening age for Māori and Pacific people from 60 to 50.
Instead, the cash would be spent lowering the screening age for the total population from 60 to 58.
The decision seemed a pragmatic one for the Government — Health Minister Simeon Brown telling Stuff it would save 176 more lives, over 25 years, than lowering the age for Māori and Pasifika only.
However, as a briefing paper on the options says, this decision costs Māori and Pasifika lives – “significantly fewer” of which will now be saved.
‘If they had gone with the evidence that we had seven years ago, my cancer would have been caught. Most likely’
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Regardless of the arithmetic of this funding switch, many Māori were already alarmed by coalition government policy and laws.
As AUT Māori health professor Jacquie Kidd (Ngāpuhi) explains, to Māori, the Government seems more concerned about political “optics of equality” for all, over equity.
Modelling showed, as early as 2017, that keeping the screening age the same for everybody “looks like equality but actually creates more inequity”, she says.
Non-Māori were already screened more, and Māori and Pasifika had higher levels of bowel cancer at earlier ages.
“So . . . anything that puts us at a similar age is going to increase the inequities.”
Still, previous health minister Shane Reti requested options for spreading the money across the total screening population.
Of the three new options, the one chosen will save significantly fewer Māori and Pasifika lives than the original plan, and won’t address health inequities.
The Government only seemed to worry about equality when applied to ethnicity, Kidd said.
Otherwise it would call for free vaccinations for all, “not just babies and oldies”, she said, or offer everyone free breast cancer screenings, not just women.
Meanwhile, equity was everywhere in the health sector, she said. “We’re built on that because we’re built on need.”
The spending change would save more Pākehā lives, she said, “it won’t save [more Māori] lives”. And inequity would get worse.
‘So I have no idea why I’m still here. But I am, so that’s all good.’
“It really is about whose life has more value. At the moment, it’s always such a fight to get people to think about doing anything slightly different just to bring Māori into the ballpark.”
Kidd said people needed to look at the bigger picture, which was that Māori die about seven years earlier on average than everybody else.
“It is a lot of life, and it’s a lot of those grandparent moments and those great-grandparent moments that we lose.”
People might think differently about equity if they kept that life-expectancy gap in mind, she said, “but they all seem to think about it in terms of personal loss”.
‘I was pretty pissed off, to be honest’
Kidd received her first bowel cancer screening kit through the mail about four months after a terminal bowel cancer diagnosis.
“I was pretty pissed off, to be honest.”
She discovered she had bowel cancer after a colonoscopy four years ago, when she was 58.
‘Flourishing is our endgame. We’re just trying to get on the ladder.’
Just getting the colonoscopy was a battle, despite her health literacy. Fortunately Kidd kept pushing, with the tumour just about ready to block her gut. “That is painful, it gives me the heebie jeebies just thinking about what it would have been like.”
When she was 59, doctors found it had spread “and that’s when I got the terminal diagnosis”.
“So I have no idea why I’m still here. But I am, so that’s all good.”
Decisions like the one to repurpose the screening money made Kidd feel angry, but mostly, she was just “really sad”.
“If they had gone with the evidence [on screening ages] that we had seven years ago, my cancer would have been caught. Most likely. The surgeon’s really sure, it would have been a polyp.”
‘Saving as many lives as possible’
Brown explained to Stuff that the changes were only the first step in progressively lowering the screening age to 45, to align with Australia.
It would continue “as capacity for colonoscopies allows”.
It would save 176 more lives over the next 25 years than would be the case if the eligibility age was lowered only for Māori and Pasifika, Brown said.
Meanwhile, the Government would launch targeted initiatives to increase screening rates for Māori, Asian and Pacific peoples, he said.
This would include a planned $19 million spend that would boost promotion, resources and facilities for returning testing kits across the country.
Kidd said research showed Māori health inequity was a compounding problem. Small discrepancies in treatment accumulated at every decision point, that when combined “makes a massive difference”.
At the end of the day, equity was not the endgame for Māori.
“Flourishing is our endgame. We’re just trying to get on the ladder.”
- This article, written by former Kaitiaki coeditor Joel Maxwell, was first published in Stuff.
- See also Jacquie Kidd’s 2023 Kaitiaki interview: ‘I feel it was inevitable‘ and Bowel screening dangerous for Māori.