Kaupapa Māori research project reveals structural racism in prostate cancer care

Friday, 22 October 2021

The Ministry of Health's top Māori executive John Whaanga says its research consistently shows Māori aren't getting the same treatment or access to services resulting in different health outcomes. First published 2019.

Prostate cancer project Oranga Tū has mapped “the cancer pathway” for Māori men, revealing significant gaps in service provision and barriers to health that have whānau seeking help through emergency departments.

Associate Professor Jacquie Kidd (Ngāpuhi), who co-led the Movember-funded project, said whānau were left to do their own research without the guidance they needed to feel safe and confident they had the right tools to get through diagnosis and treatment.

“Health services need to include Māori when making decisions about service delivery.

“They need to be aware of the barriers that arise through colonisation and racism, and actively address those barriers for Māori within their organisations and in relation to their communities,” says Kidd.

Associate Professor Jacquie Kidd says new research shows the health funding system creates barriers for Māori men with prostate cancer.

* Facing up to a deadly diagnosis: The men navigating prostate cancer

* Kaupapa Māori solutions key to better Māori cancer outcomes, hui told

A breakdown in communication between health services has created inequity for Māori with prostate cancer, researcher says.

Almost 4000 men in Aotearoa are diagnosed with prostate cancer each year, and 600 men will die from it, the report said. Within that group, Māori men are diagnosed later, experience poorer health outcomes, and are 50 per cent more likely to die than non-Māori.

The kaupapa Māori project used Te Whare Tapa Whā, a world reknown Māori health philosophy created by Tā Mason Durie, to form its framework. It used a Māori lens to analyse the Māori specific data, looking at the cancer journeys of 15 men, their whānau and 30 Māori and non-Māori service providers.

Te taha tinana, focused on the physical dimensions of the men’s experiences. Te taha hinengaro, the mental health aspects such as stress, anxiety, and maintaining mana. Te taha whānau included the views of family members, and te taha wairua, looked at spiritual elements like religion.

Initially, Kidd said, researchers approached the participants to map their progress through the health system. What they discovered, it wasn’t the men or their families at fault for any lapse in care, it was the lack of cohesion between different types of services causing problems for the men.

It became clear to Kidd and her team, the system needs an overhaul to help patients navigate the cancer pathway.

Some participants told researchers they were anxious about the process and didn’t receive the information they needed to make decisions about their treatments.

One man said, “I never felt that I was given all the information about the various treatment options available to me, particularly radiation. It wasn’t until much later when I was at the Prostate Cancer Foundation that I heard about all the options.”

Another said the disconnect between his general practitioner and the specialist left him waiting for his biopsy results.

MÄori men need a multidimensional hauora approach to get the best outcomes after being diagnosed with prostate cancer, researcher says.

“My diagnosis wasn’t confirmed until I went back to the GP and got the results of the biopsy, and he had to ask the specialist for them who finally gave him a diagnosis of prostate cancer.”

Kidd said this disconnect was causing unnecessary anxieties for whānau.

Kidd said current health system funding was rigged to put smaller service providers, often Māori health providers, in competition with larger primary healthcare organisations. This stopped referrals going to the sites that would help whānau deal with the stress of the diagnosis with a multidimensional hauora focus, not just clinical.

“The lack of whanaungatanga (kinship) between the services actually creates this gap. The Pākehā services would know how to reach these [Māori] services, but don’t know who works there.

“This is structural racism, it’s built into the funding structures.”

But closing the gaps between whānau and health services could be achieved if primary health organisations engaged in whanaungatanga between themselves, other services, and the communities where whānau live with a trusted guide to help them find the right services for their families, Kidd said.

“Our vision is for a healthcare map for whānau, where all services are connected and whānau can see everything available to them. This includes whānau knowing how to get in the front door of all services, and services reaching out to support whānau,” says Kidd.

Kidd said the project was another file to be added to the stack that showed the system had set up barriers for Māori seeking equitable healthcare.

“This is just another piece of research that says what Māori already know.

“To a certain extent, there’s a real hope that the Māori Health Authority will change the culture.”

Robert Dunne, Movember NZ country manager, said the organisation funded Oranga Tū because it recognised the importance of improving Māori health outcomes.

“Education, innovation, and open discussion around prostate cancer is needed to stop Māori men from dying too young,” Dunne said.

“The importance of spirituality and connection to people, the land, and history have often been overlooked in this space.

“It is our hope that this innovative approach taken with Māori communities in Waikato and Dunedin can be applied throughout Aotearoa.”

As part of the project, a cinematic short film was produced that captures the lived experience of Māori men with prostate cancer in Aotearoa, including some of the tāne who participated in this research.