A group of AUT researchers are mapping the cumulative difficulties along the road that end with prostate cancer - which claims a disproportionate number of Māori lives
Looking at the numbers across 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 caught is on the rise, while the number of men who die from the disease each year is decreasing.
More than 4000 Kiwi men are diagnosed with prostate cancer every year - the most common cancer in men here - but with more being tested and successfully treated, it has become more and more a disease they can expect to die with, not from.
Even so, it’s still a very serious disease. Malignant cells spreading through the walnut-sized and -shaped gland can be fatal, and before that, cause symptoms in a very private area that can get in the way of living a normal life.
But the trend towards dealing with prostate cancer successfully is cause for optimism - when considering the population as a whole.
On a more granular level, outcomes can differ greatly. The different realities that exist for the wide spectrum of Kiwi men play a vital role in how bright-eyed they can be about the future after a diagnosis.
Men in rural areas are at greater risk, which can be largely put down to the fact that it’s harder for them to access health services.
But there is one group that hasn't been able to reap the benefits of the healthcare system's winning battle against this form of cancer. Māori men are 50 percent more likely to die from prostate cancer than non-Māori.
A Movember-funded project led by a group of health researchers has been looking into why this is, and what can be done about it.
They found gaps at every step of the way for Māori when it comes to being served by the wider health system - gaps that cumulatively sway the eventual outcomes for Māori to the negative.
Oranga Tū: A Healthy Stand is a prostate cancer project through which researchers like AUT’s Associate Professor Jacquie Kidd (Ngāpuhi) have drawn a map of the path Māori men walk when dealing with cancer - from diagnoses that are more likely to come late, to less-than-accessible health services and culturally mismatched approaches from doctors.
Kidd said prostate cancer outcomes showed the wider health system’s inequities. “It’s an important example, as it’s not something that Māori men should be dying from,” she said.
And the reasons for this disparity are various, spread across each stage of the patients’ engagement with healthcare.
“There’s this pathway from completely well to really unwell,” said Kidd. “And every step of the way, there’s a small difference in what happens for Māori. By the time you get to the end, you’ve got this really profound difference. It’s a culmination of all these little things.”
Accordingly, it takes an overview of the entire process to get the full idea of how these disparities come about.
Kidd said it could be compared to the challenge of getting the Covid-19 vaccine into rural Māori communities.
“There’s a deep-seated and well-founded distrust of health services for Māori,” she said. “Then there’s the lack of accessibility for appropriate health services, and a cultural understanding of things you don’t go to the doctor for - some of which are symptoms of prostate cancer.”
By its very nature, this form of cancer deals with a sensitive area. It can cause problems such as urinary incontinence or having to get up multiple times a night.
“You don’t necessarily get Māori men wanting to talk about these things,” she said. “They are symptoms that are really easy to put off, and say I won’t go and get it checked out, I’m sure it will pass.”
Couple that with distrust and inaccessibility and you’ve got a recipe for endemic health disparities.
“You’ve got a set of symptoms that people don’t really want to discuss, and then you’ve got a health service that people don’t trust or can’t get to,” Kidd said. “Put those things together and you are going to get delayed diagnosis.”
And for those who do go in to get a check-up, the project found Māori men were more likely to get a ‘watch and wait’ from the doctor than a promise of further investigation.
Another issue facing Māori when it comes to getting hold of the medical care they need is the communication breakdown between different healthcare services.
“Most regions will see about seven Māori men diagnosed with prostate cancer a year,” Kidd said. “So your average GP won’t see that many, and certainly isn’t involved in what might happen post-treatment.”
She said there were often communication gaps between GPs, hospitals and non-government organisations - with larger services sometimes acting as barriers to smaller services by not sharing referrals.
“GPs can be reluctant to send Māori to Māori health providers as they’ll lose the money,” Kidd said. One GP had told the group they don’t refer patients there as they don’t come back.
“When you’ve got GPs who are required to be in business by the way the system is set up, then they’re doing things for the bottom dollar, not necessarily for the benefit of the patient. That’s a generalisation, but on the whole it is how the funding system is set up.”
So what is to be done?
Oranga Tū landed on two main solutions to these issues - increasing whanaungatanga (connectedness) and introducing a new community health role known as kaioriori.
Kidd said whanaungatanga relies upon a holistic approach to Māori health, which takes into account cultural differences.
“The Māori health authority is a huge step in the right direction,” she said, but admitted she was as cynical as she was optimistic about it making meaningful changes.
Meanwhile, the group advocated for the widespread adoption of kaioriori - a person who can guide whānau into healthcare from within the community - “like a navigator or an aunty”, Kidd said.
“That’s how you get earlier diagnoses,” she said. “Somebody trusted by the community that people already know that you can go and talk to.”
Robert Dunne, the country manager for Movember, said the organisation was proud to fund Oranga Tū.
“The importance of spirituality and connection to people, the land, and history have often been overlooked in this space,” he said. “It is our hope that this innovative approach taken with Māori communities in Waikato and Dunedin can be applied throughout Aotearoa. Education, innovation, and open discussion around prostate cancer is needed to stop Māori men from dying too young.”
Kidd said that by delivering culturally appropriate services in places where Māori are in need, this tide can be turned.
“Our health sector needs to commit to achieving equitable health outcomes for Māori,” she said.
“Prostate cancer is treatable and need not be a death sentence.”
