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 Maori and non-Maori New Zealanders and examined the range of factors that may contribute to poorer survival in Maori. Results There is clear evidence that Maori have poorer cancer survival compared with other ethnic groups, particularly European New Zealanders. Two recent studies show that Maori 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.