Mapping the health gap for Maori with prostate cancer
TUE group of researchers maps cumulative hardship along the road that ends in prostate cancer – which claims a disproportionate number of Maori lives
Looking at the numbers of the whole population, you could say that New Zealand has made great strides in the fight against prostate cancer.
Even without a dedicated screening program, the number of cancers detected is increasing, while the number of men who die from the disease each year is decreasing.
Every year, more than 4,000 Kiwi men are diagnosed with prostate cancer – the most common cancer in men here – but with more and more successful tests and treatments, it has become more and more a disease with which they can expect to die.
Even so, it is still a very serious illness. Malignant cells that spread through the gland the size and shape of a walnut can be fatal and, before that, cause symptoms in a very private area that can hamper normal life.
But the tendency to successfully treat prostate cancer gives cause for optimism – when you consider the population as a whole.
At a more granular level, the results can be very different. The different realities that exist for the wide range of Kiwi men play a vital role in how they can have bright eyes on the future after a diagnosis.
Men in rural areas are more at risk, which can be largely attributed to their more difficult access to health services.
But there is one group that has not been able to reap the benefits of the healthcare system’s winning battle against this form of cancer. Maori men are 50 percent more likely to die from prostate cancer than non-Maori.
A project funded by Movember and led by a group of health researchers investigated why and what can be done about it.
They have found shortcomings every step of the way for Maori when it comes to being served by the wider health system – shortcomings which, cumulatively, negatively influence eventual outcomes for Maori.
Oranga TÅ«: A Healthy Stand is a project in the fight against prostate cancer in which researchers like Jacquie Kidd (NgÄpuhi), Associate Professor at TUE, mapped the path taken by Maori men when they face cancer – the diagnoses most likely to come in late, the least – more accessible health services and culturally inappropriate approaches from physicians.
Kidd said the prostate cancer results showed inequalities in the wider health system. “This is an important example, because it is not something that Maori men should die from,” she said.
And the reasons for this disparity are diverse, distributed at each stage of patient engagement in healthcare.
âThere’s this path from totally good to really not good,â Kidd said. âAnd every step of the way, there is a little difference in what is happening with the Maori. By the time you get to the end, you have this really profound difference. It’s the culmination of all these little things.
As a result, it takes an overview of the whole process to get a full picture of how these disparities occur.
Kidd said it could be compared to the challenge of getting the Covid-19 vaccine to rural Maori communities.
âThere is a deep-rooted and well-founded distrust of health services for Maori,â she said. âThen there’s the lack of accessibility to appropriate health services and a cultural understanding of the things you don’t go to the doctor for – some of which are symptoms of prostate cancer. “
By its nature, this form of cancer affects a sensitive area. This can cause problems like urinary incontinence or having to get up several times a night.
âYou don’t necessarily get Maori men to want to talk about these things,â she said. “These are symptoms that are really easy to push back, and to say I won’t go get it checked out, I’m sure it will.”
Add to that the mistrust and inaccessibility and you have a recipe for rampant health disparities.
âYou have a set of symptoms that people don’t really want to discuss, and then you have a health service that people don’t trust or can’t access,â Kidd said. “Put these things together and you’ll get a delayed diagnosis.”
And for those who show up for an exam, the project found that Maori men were more likely to get a âkeep and waitâ from the doctor than a promise of further investigation.
Another problem that Maori face when it comes to getting the medical care they need is the breakdown in communication between different health services.
âMost areas will see about seven Maori men diagnosed with prostate cancer per year,â Kidd said. âSo your average GP won’t see a lot of it and is definitely not involved in what might happen after treatment. “
She said there were often gaps in communication between GPs, hospitals and nongovernmental organizations – larger departments sometimes hampering smaller departments by not sharing referrals.
âGPs may be reluctant to send Maori to Maori health care providers because they will lose money,â Kidd said. A general practitioner had told the group that he was not referring patients there because they were not coming back.
âWhen you have GPs who are required to be in business because of the way the system is set up, then they are doing things for the lowest dollar, not necessarily for the benefit of the patient. It’s a generalization, but overall that’s how the funding system is set up.
So what to do?
Oranga TÅ« found two main solutions to these problems: increasing whanaungatanga (connection) and introducing a new community health role known as kaioriori.
Kidd said whanaungatanga is based on a holistic approach to Maori health, which takes into account cultural differences.
“The Maori health authority is a big step in the right direction,” she said, but admitted that she was as cynical as she was optimistic about making meaningful change.
Meanwhile, the group advocated for widespread adoption of kaioriori – a person who can guide whÄnau to health care in the community – “as a navigator or an aunt,” Kidd said.
âThis is how you get diagnoses earlier,â she said. âSomeone you can trust in the community who people already know you can talk to. “
Robert Dunne, national director of Movember, said the organization is proud to fund Oranga TÅ«.
âThe importance of spirituality and connection with people, land and history have often been overlooked in this space,â he said. âWe hope that this innovative approach taken with the Maori communities of Waikato and Dunedin can be applied throughout Aotearoa. Education, innovation and an open discussion about prostate cancer are needed to prevent Maori men from dying too young.
Kidd said that by providing culturally appropriate services in places where Maori are in need, this trend can be reversed.
âOur health sector must be committed to achieving equitable health outcomes for Maori,â she said.
âProstate cancer is treatable and doesn’t have to be a death sentence. “