Simeon Brown Rejected Officials’ Advice To Have Lower Bowel Screening Age For Māori, Pasifika

Jimmy
Ellingham, Checkpoint
reporter

• 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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