What the research shows

Cancer policy and system design

Crown cancer strategies and plans read against te Tiriti o Waitangi, descriptions of how the cancer system is organised, and arguments about how it should be built instead.

9 papers, 5 of them summarised from less than the whole paper.

• Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context (opens in a new tab)

  Summarised from the whole paper· 2024

  framework development and adaptation: scoping review of existing equity-focused implementation frameworks, interviews with 25 stakeholders and researchers, then iterative refinement with a Māori Advisory Group and a Consumer Advisory Group

  Our summary of what it found

  The authors adapted an existing implementation-science framework (EquIR) for the Aotearoa New Zealand context, producing a framework with Te Tiriti o Waitangi as its foundation, a whānau-centred focus, five core constructs (collaborative design, anti-racism, Māori and priority-population expertise, cultural safety, values-based practice), and a four-step implementation pathway: planning, pathway design, monitoring, and evaluation. It is intended for mainstream health services planning how to implement an intervention equitably.

  Why it matters: A generic implementation framework built for the Aotearoa context, rather than imported unchanged from overseas, gives services a structured way to plan how a cancer intervention or programme is rolled out so it does not simply replicate existing inequities.

  Limits: The paper states the framework has not yet been empirically tested or validated in real-world implementation, and that its evidence base draws mainly on Māori health inequities, which may limit how directly it transfers to other populations or settings.

  Read as: full text (via the open-access PMC mirror, PMC10822165, after the publisher's own page and a Springer login redirect both failed)

  Written for this website from the paper, not the authors’ abstract.

• Supporting implementation of interventions to address ethnicity-related health inequities: frameworks, facilitators and barriers – a scoping review protocol (opens in a new tab)

  Summarised from the whole paperBMJ Open· 2023· doi:10.1136/bmjopen-2022-065721

  Papillon Gustafson, Yasmin Abdul Aziz, Michelle Lambert, Karen Bartholomew, Rachel Brown, Peter Carswell, Adam Fusheini, Mihi Ratima, Patricia Priest, Sue Crengle

  study protocol only, no results; six-stage scoping-review method (Arksey and O'Malley, extended by Levac et al), MEDLINE and CINAHL plus grey literature, 2011 to search date

  Our summary of what it found

  This is a protocol, not a finished review. It sets out how the authors planned to search MEDLINE, CINAHL and grey literature from 2011 onward to map equity-focused implementation frameworks and the facilitators and barriers to using them, using a two-part research question. No results are reported here. The first part of that work - the frameworks themselves - was subsequently published as a completed review by an overlapping author group (Implementation Science, 2023, DOI 10.1186/s13012-023-01304-0), which states the second part, on facilitators and barriers, would be published separately.

  Why it matters: It shows the methodical groundwork behind identifying which implementation approaches actually help close ethnicity-related health gaps, rather than asserting one works.

  Limits: Protocol only - it reports methods, not findings, and results should be sought in the completed review(s) it led to, not in this document. Restricted to English-language sources and weighted toward New Zealand grey literature. I read the full protocol text via the PMC open-access copy.

  Read as: full text (PMC open-access copy) - protocol only, no results reported

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Te Aho o Te Kahu: weaving equity into national-level cancer control (opens in a new tab)

  Summarised from the abstractThe Lancet Oncology· 2022· doi:10.1016/S1470-2045(22)00279-0

  Michelle Mako, Jason Gurney, Moahia Goza, Myra Ruka, Nina Scott, Gary Thompson, Diana Sarfati

  commentary describing an agency's structure and programme, not an empirical study

  Our summary of what it found

  Written by staff of Te Aho o Te Kahu, the paper describes how the agency built equity into its core structure from the outset, rather than adding equity as a separate programme on top of standard operations. It uses Te Tiriti o Waitangi as the organising framework and sets out the equity-focused initiatives taken since the agency's founding, along with the challenges it says remain in reaching equitable cancer outcomes for Māori.

  Why it matters: It is a first-person account from inside the one agency responsible for national cancer control policy, so it shows how equity commitments were meant to be built into the system rather than only how they were experienced by patients.

  Limits: Only the abstract was available; the authors' own account of an agency they work for is not independent, and the abstract itself does not specify what evidence backs the equity claims - that sits in the unread full text.

  Read as: abstract only, via the Europe PMC record. The Lancet Oncology and ScienceDirect both returned 403 to direct fetch; Europe PMC lists this record as not open access and gives no PMC copy; the Otago repository holds only the citation, not the manuscript; ResearchGate offers the abstract with a request-full-text gate. No open-access full text could be found anywhere.

  Written for this website from the paper, not the authors’ abstract.

• Telehealth as a tool for equity, pros, cons and recommendations (opens in a new tab)

  Summarised from the whole paper· 2021

  viewpoint / commentary, no new data collected

  Our summary of what it found

  Written as the COVID-19 lockdown pushed much routine healthcare onto phone and video, this viewpoint sets out the case for and against telehealth as a tool for equity for Māori and Pacific people. It argues telehealth can reduce transport, time and cost barriers to care and widen the pool of clinical expertise available to remote or small communities. It also names the offsetting risk directly: care delivered this way depends on people having a phone, data and digital literacy, so without deliberate attention to equity, telehealth can widen rather than narrow access gaps, and not all care can safely move to phone or video. It recommends collecting connectivity data alongside standard health data, resourcing telehealth roles embedded in Māori and Pacific communities, funding more research led by Māori and Pacific researchers into telehealth experience, and building a telehealth strategy with Te Tiriti o Waitangi and equity as guiding principles.

  Why it matters: It sets out the equity trade-offs of telehealth at a point when many services, cancer follow-up appointments among them, moved quickly to phone and video, and argues telehealth needs an equity-first strategy or it risks widening rather than narrowing the access gap for Māori and Pacific people.

  Limits: This is a viewpoint from health researchers, not a study reporting new data of its own; it draws on modelled and survey evidence cited in its references. The authors declare no competing interests.

  Read as: Full text, read directly from the NZMJ PDF (all pages, including author declarations and references)

  Written for this website from the paper, not the authors’ abstract.

• A critical Tiriti Analysis of the New Zealand Cancer Control Strategy (opens in a new tab)

  Summarised from the whole paper· 2020

  Heather Came, Jacquie Kidd, Teresa Goza

  Critical Tiriti Analysis, a five phase policy analysis method applied against the preamble and articles of the Maori text

  Our summary of what it found

  The authors examined the Cancer Control Strategy against the preamble and the articles of the Maori text of te Tiriti. They found little tangible connection to te Tiriti or to other Maori health strategy documents. The document does not record how Maori were involved in its design, and no Maori individual or group is named in its acknowledgements. Across 23,000 words it uses the word wairua three times and wairuatanga not at all, and mentions rongoa once, listed among complementary and alternative medicines. They note that in 2015/16 only 1.86 per cent of Vote Health was invested with Maori providers. Their recommendation is that future cancer control strategies be built with te Tiriti and tikanga as the central considerations.

  Why it matters: It is a documented, methodical account of how a national cancer strategy failed its own founding obligations, and it was written to inform the strategy that replaced it.

  Limits: The authors state that the fifth phase of the method, a final assessment by Maori following Maori protocols, is to be presented in a later paper.

  Read as: full text, supplied by Brooke from the publisher page (complimentary access)

  Written for this website from the paper, not the authors’ abstract.

• A critical te Tiriti analysis of the New Zealand cancer action plan 2019–2029 (opens in a new tab)

  Summarised from the abstractJournal of Cancer Policy, vol 26, article 100252 (published December 2020)· 2020· doi:10.1016/j.jcpo.2020.100252

  Heather Came, Jacquie Kidd

  Critical te Tiriti Analysis - a five-phase qualitative policy-assessment framework - applied to one Crown policy document

  Our summary of what it found

  Applies the Critical te Tiriti Analysis framework to the New Zealand Cancer Action Plan 2019-2029. The authors score the Plan 'fair' - level 2 of 4 - on te Tiriti compliance, an improvement on the 2003 Cancer Control Strategy but still lacking detail on mātauranga Māori, kaupapa Māori approaches and Māori public health. They argue that lack of specificity makes it hard to hold the Crown to account for delivery against the Plan.

  Why it matters: Gives Hei Āhuru Mōwai a citable, methodical, independent assessment of the Crown's ten-year cancer plan to draw on when pressing for more specific te Tiriti commitments.

  Limits: Read the published abstract only, via Semantic Scholar's indexed record of the publisher's abstract - not the full article. The full text, including the detailed five-phase scoring and reference list, was not reached: ScienceDirect returns a 403, and no open-access copy was found at Europe PMC, AUT's institutional repository, or Community Research's own tracking page for Critical Tiriti Analysis outputs (which lists this one as paywalled).

  Read as: abstract (indexed via Semantic Scholar's API record of the publisher's listed abstract); full text not reached

  Written for this website from the paper, not the authors’ abstract.

• Addressing cancer inequities for indigenous populations. The New Zealand story (opens in a new tab)

  Summarised from the abstract· 2020

  Jason K. Gurney, Shelley Campbell, Stephanie Turner, Nina Scott

  commentary written by four Maori researchers, cancer care providers and patient advocates

  Our summary of what it found

  Maori have higher cancer incidence, higher mortality and poorer survival than non-Maori. On 2002 to 2006 figures the age and sex standardised incidence rate was 220 per 100,000 for Maori against 185 for non-Maori, and mortality 112 against 63, so Maori were around 20 per cent more likely to get cancer and around 80 per cent more likely to die of it. The authors trace the drivers to poorer access to timely diagnosis, less timely treatment and differences in the quality of care received, and upstream of those to colonisation and institutional racism. They also name parts of the system that are working: sustained effort to lift Maori participation in screening has produced survival gains, and child cancer services are achieving survival parity for Maori children.

  Why it matters: It is the reference statement of the problem, written by Maori practitioners rather than about them, and it is unusual in naming what is already working as well as what is not.

  Limits: A commentary rather than a new analysis, and the headline incidence and mortality figures come from a 2002 to 2006 study, so they describe that period rather than the present.

  Read as: abstract, highlights and section openings, supplied by Brooke from the publisher page; the full text is behind a paywall

  Written for this website from the paper, not the authors’ abstract.

• Health service provider responses to indigenous peoples with cancer: An integrative review (opens in a new tab)

  Summarised from the abstract· 2018

  integrative review of 9 studies

  Our summary of what it found

  This integrative review searched for published studies on how health services respond to indigenous people with cancer. It found only nine such studies, most from the United States. Where services built culturally appropriate activities, resources and environments around the indigenous population they served, the review found increases in cancer knowledge, fewer treatment interruptions, better access to cancer care and clinical trial enrolment, and higher satisfaction with care. The authors flag the small number of published studies as itself worth asking about.

  Why it matters: It is evidence that culturally focused service delivery changes measurable outcomes for indigenous cancer patients, and a reminder that this evidence base is thin worldwide.

  Limits: I read the abstract, not the full text, so I cannot confirm whether any of the nine included studies were set in Aotearoa or involved Māori. The authors themselves note how few eligible studies they found.

  Read as: abstract (verbatim, via Europe PMC; Wiley Online Library itself blocked automated access with a cookie-consent page)

  Written for this website from the paper, not the authors’ abstract.

• Viewpoint. Equity by 2030. Achieving equity in survival for Māori cancer patients (opens in a new tab)

  Summarised from the abstract

  viewpoint/commentary, no original dataset

  Our summary of what it found

  A viewpoint proposing a goal of equal cancer survival between Māori and non-Māori by 2030, put forward after a panel of Māori cancer leaders reviewed the history of cancer control and its effect on Māori. It states Māori are around twice as likely to die of their cancer as non-Māori, and argues this gap comes mainly from failures in the health system rather than from differences in the disease itself. It calls for better stage-at-diagnosis data, improved primary care access, wider screening, more consistent treatment, and resourcing weighted toward closing the gap.

  Why it matters: It set a named target and timeframe that the later survival and stage-at-diagnosis papers on this list can be read against.

  Limits: A viewpoint piece rather than original research. The authors themselves note no single intervention will be enough, and that prevention measures will not shift survival for people already diagnosed.

  Read as: abstract/summary, via the NZMJ journal page

  Written for this website from the paper, not the authors’ abstract.