Simeon Brown said there would targeted campaigns to increase bowel screening rates among Māori, Asian and Pacific peoples. Photo: RNZ / REECE BAKER
- Advice to Health Minister Simeon Brown about bowel screening age changes released
- Officials recommend lowering age slightly more for Māori and Pacific people, if the age is 58 for general population
- Brown does not do this, prompting criticism
- He says investing more in growing participation rates will save lives
Health Minister Simeon Brown rejected advice from officials to lower the bowel screening age to 58 for the general population and 56 for Māori and Pacific people, just-released documents show.
According to projections, that means there will be 111 fewer prevented deaths from the disease for Māori and Pacific people over the next 25 years.
When speaking to RNZ last week, Brown promised to release advice from the Ministry of Health about his announcement to have a screening age of 58 for everyone, and he has now done so.
The change will be introduced from later this year and expands the screening from the 60-74 group presently eligible.
Brown's announcement means scrapping plans introduced by the previous Labour government to have Māori and Pacific people - who are at risk of the disease at a younger age - screened at 50.
But the government has allocated funds to raise participation for these groups, a move Brown said would save lives.
Previous health minister Dr Shane Reti asked officials for options to reallocate the $36 million budgeted over four years for lowering the screening age for Māori and Pacific, as the government looked to act on its 2023 promise to match Australia's then-screening age of 50.
Shortly after taking the health job, Brown last week announced a first step towards that - lowering the age to 58.
He said that would prevent 176 deaths over 25 years compared with keeping the age at 60 for the general population, and lowering it to 50 for Māori and Pacific people.
GP and chief clinical officer for the Tuwharetoa Iwi Māori Partnership Board Rawiri McKree Jansen is unhappy with the minister's approach.
"We need a differential starting age to address the fact that half of all Māori bowel cancer occurs before the age of 60, and over time we definitely want to reduce the eligibility age for everybody.
"The expectation that we might have from Māori communities is that you start at age 50 for Māori and Pacific and bring down the age for everybody to 58."
This would be followed by further drops in the future, he said.
"It's deeply concerning that the minister seems to think that it's okay not to save Māori lives. The bowel screening programme was going to save something in the order of 300 Māori lives from bowel cancer - preventable deaths.
"He's making decisions about shifting that funding to save other lives and, what, Māori lives are not worth saving? It's deeply troubling."
Brown has hit back at that, saying advice from officials is that upping the Māori and Pacific screening rate to 60 percent, from below 50 percent now, will prevent 244 more colorectal cancer cases and 154 deaths over 25 years.
The government's allocated $19m for this.
Officials recommended a slightly lower screening age for Māori and Pacific people of 56, estimated to prevent 148 cases and 111 deaths compared with a blanket age of 58.
Officials' preferred option though would use 100 percent of the available funds over four years, compared with 92 percent for a universal drop to 58.
Brown did not follow the advice, telling Checkpoint: "To save as many lives as possible, we need to screen as many people as possible. We are going to do that by lowering the age of eligibility for all New Zealanders, while undertaking targeted campaigns to increase screening rates among Māori, Asian and Pacific peoples.
"We have lowered the age for all New Zealanders to access bowel cancer screening and will continue to lower it to align with Australia as capacity for colonoscopies allows."
Co-chairperson of the Māori cancer leadership network Hei Āhuru Mōwai, Dr Nina Scott, said even the officials' preferred option was not good enough for reducing inequities.
On average Māori lived seven years less than the general population, and the latest bowel screening move was not helping reduce that.
"To make the health gains equal for both groups the age for Māori is 50 and the age for non-Māori is 60. We need to find another way of making it equity-neutral and 56 just wouldn't cut the mustard either."
Patient Voice Aotearoa chairman Malcolm Mulholland said he knew of young Māori and Pasifika people diagnosed with aggressive bowel cancer.
There seemed to be no argument with the evidence that those groups were more at risk earlier, so the decision to ignore officials' advice was hard to understand, he said.
"We are talking about 111 people, all of whom are connected to a whānau, to a family, to a community. We're talking about a loved grandfather, uncle, aunty, grandmother, a family member.
"I guess this is where you've got to weigh up cost over life and I don't think he's [Brown's] landed on the right option."
Bowel Cancer chief executive Peter Huskinson said a screening age of 45 for the general population, as since last year was the case in Australia, and 35 for Māori and Pasifika was possible.
He recently met with Brown with a proposal about that and looked forward to working with him to achieve it, but was concerned the minister did not follow officials' advice on this occasion.
"It's disconcerting that the minister has not chosen, of the options he was given, the one that would save the most lives.
"It's almost like balancing trade-offs, without looking at a bigger opportunity that's become available to him."
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