Maori Cancer Leadership Group through the organised efforts of society . . . lung health inequities are avoidable and fixable Dr Nina Scott, Ngati Whatua, Waikato, FNZCPHM, MPH, MBChB, DipComChildH, DipChildH Chair Hei Ahuru Mowai, National Maori Cancer Leadership Group [email protected]
care access 3. Health care quality Inequities are differences between groups which are Unfair – Avoidable - Fixable Assume inequities occur at every step of every care pathway unless proven otherwise small inequities add up to big inequities, so there is no silver bullet, but if I had to pick one, it would be standardisation of care inequities point to where standardisation is needed first, and show what can be achieved at a minimum for Maori, plus show where to get relatively cheap and quick health gains for the total population Jones CP. 2001. Invited commentary: “Race”, racism and the practice of epidemiology. American Journal of Epidemiology 154: 299–304. Whitehead M. 1992. The concepts and principles of equity and health. International Journal of Health Services 22: 429–445. p. 431
“The most likely explanation for this [inequity] is that Maori have a cultural reluctance to present for health care” Lamb DS, Bupha-Intr O, Bethwaite P, et al. 2008. Prostate cancer – are ethnic minorities disadvantaged? Anticancer Research 28: 3891–6. Its all about the ‘gaze’ where we look for the defects
surgery Maori less likely removal of primary treated in specialist public facility stage III referred or reviewed by oncologist offered or receive chemo longer wait times for chemo Maori more likely 5 x less lymph nodes removed require emergency surgery die after elective surgery Hill, S, Sarfati, D., Blakely, T., Robson, B., Purdie, G., Dennett, E., Cormack, D., Dew, K., Ayanian, J. Z. and Kawachi, I. (2010), Ethnicity and management of colon cancer in New Zealand. Cancer, 116: 3205–3214. doi: 10.1002/cncr.25127
do the data say for Maori and Pacific? Data are numbers and stories • Where and what are the equity gaps? • How are we going to close the gaps? • Who can we partner with? Equity in determinants of lung health, access, timeliness and quality of lung health care
C. Improving Māori health through clinical assessment: Waikare o te Waka o Meihana. N Z Med J. 2014;127(1393). http://journal.nzma.org.nz/journal/127-1393/6108
• Leadership • Involvement of related sectors in decision-making • Partnership • Evidence based decision-making • Systemic approach - a comprehensive programme with interrelated key components sharing the same goals and integrated with other related programmes • Continuous quality improvement • Stepwise approach to planning and implementing interventions
public health programme designed to reduce and achieve equity in the number of lung disease cases and deaths and improve quality of life for patients with lung disease and their whanau/fanau, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation, making the best use of available resources. http://www.who.int/cancer/nccp/en/
are differences in bowel cancer survival between groups of New Zealanders which are inequitable. Inequities, by definition, are unfair, avoidable and remedial. Our approach to addressing inequities in bowel cancer survival is to standardise care in the areas along the diagnosis to treatment pathway, where inequities are most likely to occur. National Bowel Cancer Working Group Equity Statement 2014
setting, research, quality control and reporting Quality ethnicity data collection, analysis, reporting. Equal explanatory and analytical power Identification of inequity hotspots along care pathways, development of initiatives to achieve equity, monitoring “Achieve lung health equity, improve lung health for all’ Achieving Lung Health Equity
DECILE 10 BURDEN LUNG BREAST BOWEL STOMACH PROSTATE SITE LUNG BREAST PROSTATE LIVER BOWEL RANKED BY BURDEN AND PREVENTABILITY From a project using; Unequal Impact II: Maori and Non- Maori Cancer Statistics by Deprivation and Rural Urban Status, 2002 – 2006
Treatment Smoking prevention Smoking cessation Screening Quality improvement Quality improvement Integration of treatment services for tobacco addiction along the cancer pathway
for staff Project promotion Staff ABC audit Support 4 staff to quit Repeat ABC audit Staff do not smoke during working hours and do not bring tobacco on site >50% patients and visitors are aware that the site is smoke and tobacco free >95% of clinical staff trained in ABC Support plans are in place for all staff who smoke Audit > 95% of pregnant patients who smoke are charted NRT Annual support plans for all staff who smoke. Two yearly audit > 95% of pregnant patients who smoke are charted NRT Two yearly audit > 85% of patients aware that the site is tobacco free Hapu Mama Smokefree Pregnancies Tupeka Kore framework Incubation Onewa sliver Tuhua Bronze Pounamu gold Tupeka Kore nirvana 38 pregnant women who smoke admitted to Hospital 8/38 21% given NRT Goal = >95% 3 /38 8% referred Incentives Pilot >70% quit rate 1st/2nd trimester, Maori /Pacific women, $250 vouchers over 12 weeks. Carbon monoxide validated.
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