Māori health researcher and GP Professor Sue Crengle says Aotearoa cannot close the lung cancer gap while the health system continues to deliver services that treat everyone the same, despite vastly different levels of risk, access and need.
Crengle, of Kāi Tahu, Kāti Māmoe and Waitaha descent, is a senior University of Otago researcher whose work has focused on Māori health equity, cancer, cardiovascular disease, quality of care and health services.
Lung cancer remains the leading cause of cancer death in Aotearoa, and Māori continue to carry a disproportionate burden. Te Aho o Te Kahu has previously reported Māori mortality rates from lung cancer are three to four times higher than non-Māori, while University of Otago research has highlighted Māori are four times more likely to die from lung cancer than non-Māori.
Crengle says the reasons are complex and cannot be reduced to individual behaviour alone.
Higher exposure to risk factors, later diagnosis, barriers to primary care, cost, transport, racism within the health system, comorbidities, and unequal access to specialist treatment all contribute to poorer outcomes for Māori.
She says early diagnosis remains one of the biggest challenges. Lung cancer is often detected late, when treatment options are more limited and survival rates are lower.
For many Māori whānau, barriers begin well before diagnosis. They can include difficulty getting timely GP appointments, the cost of visits, whakamā about symptoms, lack of culturally safe communication, long travel distances, and delays moving through referral and diagnostic pathways.
Crengle has been involved in Māori-led research exploring lung cancer screening, including work to design a process that is equitable, effective and acceptable for Māori. International evidence shows low-dose CT screening can reduce lung cancer deaths, and researchers argue any future screening programme in Aotearoa must be built with Māori from the start rather than added on later.
She says whānau awareness is also critical. Māori need clear, trusted information about symptoms such as a persistent cough, coughing blood, unexplained weight loss, chest pain, breathlessness and repeated chest infections.
But awareness alone is not enough if services remain hard to reach.
Crengle says whānau must be supported by culturally safe primary care, Māori health providers, cancer navigators, clear referral pathways and practical help with transport, appointments and treatment information.
At the centre of the issue is whether equal treatment creates equitable outcomes.
Crengle says a system that offers the same service to everyone can still disadvantage Māori because it ignores the different starting points created by colonisation, poverty, racism and unequal access to care.
She says equity means giving people what they need to achieve the same standard of health, not simply offering identical services and expecting identical results.
For Māori lung cancer outcomes to improve, she says the system must invest in Māori-led screening, earlier diagnosis, faster treatment, whānau-centred support, stronger Māori data, and health services that are accountable for closing inequities rather than merely recording them.
The message is clear: if Aotearoa wants to save Māori lives, the health system must stop pretending one-size-fits-all care is fair care.
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