The first report from New Zealand's new Cancer Control Agency, Te Aho o Te Kahu, is being criticised for failing to evaluate Pharmac or the Government's work in improving outcomes for Kiwi cancer patients.
Released on Tuesday, the report provides a snapshot of the current state of cancer in New Zealand in order to measure progress in the future. Yet while the report acknowledges that New Zealand has progressively slipped behind the rest of the developed world over the past 25 years, it fails to sufficiently critique Government policy - and the agency responsible for deciding which cancer drugs are subsidised for public use.
Pharmac plays a critical role in negotiating lower prices for potentially life-saving medications, but has long been plagued by budget woes. Currently, Australia funds 66 more cancer drugs than New Zealand, as New Zealand slips further behind in regards to subsidising and survival rates.
Speaking to The AM Show on Tuesday, Patient Voice Aotearoa chairman Malcolm Mulholland - and a critic of the Pharmac model - noted that just one page of the report is dedicated to evaluating the agency.
"The big shortcoming of the report is that within 152 pages, there's just one dedicated to Pharmac, which for us has been a massive issue," he said.
"I think they could have examined Pharmac a hell of a lot more… it doesn't deal with the biggest issue that confronts Pharmac, which is its lack of budget."
Although Te Aho o Te Kahu is independent of the Ministry of Health, it is not independent of the Government. The report does not critique the Government's performance or policies over the last three years, leaving a significant gap in its evaluations, says Mulholland.
"It's very absent of any criticism towards the Government. It doesn't talk about Māori wanting the age of bowel screening to be lowered to 50. It doesn't talk about women wanting to see the age of breast screening extended to the age of 74.
"There are some big gaps in terms of what have been the hot topics over the past two to three years."
Our trans-Tasman neighbour is approving more and more drugs to combat the disease while Aotearoa sits "right behind the eight-ball", Mulholland says.
Yet Te Aho o Te Kahu chief executive Diana Sarfati argues that the report has painted an honest picture of cancer in New Zealand. She claimed that assessing the Government's record would be "extremely difficult" - and "not very useful".
"I think trying to understand all the mechanisms through which all the different aspects of cancer care and control have occurred in the past, would be extremely difficult to do, and actually not very useful - because we're looking at where we go from here to improve things going forward," Sarfati told The AM Show.
"It's difficult to do a direct comparison [to Australia] because as you know, one of the strengths of Pharmac is that it negotiates lower prices so the amount of money spent is not necessarily a good measure. The number of drugs is also a little bit problematic because sometimes a number of drugs do very much the same thing.
"So what we need to look at is what additional drugs might make a big difference to outcomes, and that's a different question - it's part of that broader work on where we should be best investing to improve cancer outcomes."
The report also revealed that Māori are still twice as likely as non-Māori to die from cancer, and are 20 percent more likely to develop the disease. The agency found that cancer survival rates for all ethnicities have improved over the last 20 years, but not as quickly as in other high-income countries. Of the roughly 25,000 people diagnosed with cancer in New Zealand each year, nearly 3,000 are Māori.
"We have to look at inequities in this country. At the moment, how well you do depends on who you are, and that represents some [systemic] failure that we have to address urgently," Sarfati said.
Although the report discusses the inequities between Māori and non-Māori in regards to funded drugs, it fails to acknowledge how inequity is widened when Māori and Pasifika people are required to pay for non-funded treatments.
"The inequity is exacerbated when Māori and Pasifika are put in a position of having to fund non-funded drugs, because they tend to be poorer. All of these issues are missing," Mulholland said.
Sarfati argued that it's about achieving a "balance" between what a nation wants and what it can realistically achieve.
"It's true that no country in the world can afford everything that it wants in relation to cancer," she said.
"We're doing well in some areas but we do have work to do."
To mark World Cancer Day on Thursday, Te Aho o Te Kahu will launch a library of chemotherapy drugs to assist research into cancer outcomes.