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Indigenous inequalities in cancer: what role for health care?
Author(s) -
Hill Sarah,
Sarfati Diana,
Robson Bridget,
Blakely Tony
Publication year - 2012
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12041
Subject(s) - disadvantage , medicine , indigenous , cancer , cancer survival , ethnic group , health care , health equity , inequality , equity (law) , colorectal cancer , family medicine , public health , nursing , economic growth , ecology , mathematical analysis , mathematics , political science , law , economics , biology , sociology , anthropology
Poorer cancer survival in I ndigenous populations contributes to health inequalities in both N ew Z ealand and A ustralia. Methods We reviewed recent evidence of cancer treatment and outcomes among Māori and non‐ M āori N ew Z ealanders and examined the range of factors that may contribute to poorer survival in Māori. Results There is clear evidence that M āori have poorer cancer survival compared with other ethnic groups, particularly E uropean N ew Z ealanders. Two recent studies show that M āori 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 I ndigenous 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.