Indigenous inequalities in cancer: what role for health care?

INTRODUCTION: Poorer cancer survival in Indigenous populations contributes to health inequalities in both New Zealand and Australia.
METHODS: We reviewed recent evidence of cancer treatment and outcomes among Māori and non-Māori New Zealanders and examined the range of factors that may contribute to poorer survival in Māori.
RESULTS: There is clear evidence that Māori have poorer cancer survival compared with other ethnic groups, particularly European New Zealanders. Two recent studies show that Māori patients receive poorer quality treatment for cancers of the lung and colon, even after adjusting for patient factors. These findings suggest the need to consider how the health-care system as a whole may disadvantage Indigenous patients. DISCUSSION: We present a framework for considering how inequalities may arise in the delivery of cancer care, taking account of the health system as a whole - including the structure and organization of cancer services - as well as treatment processes and patient factors. A key feature of this framework is that it directs attention towards system-level factors affecting cancer care, including the location, resourcing and cultural focus of services. Our analysis suggests a need to look beyond individual patient factors in order to improve the quality and equity of cancer services and to optimize cancer survival in Indigenous populations.