Māori and Pacific New Zealanders won't get bowel cancer screening from 50 because of pressure on colonoscopy services - despite the ministry's own expert advisory groups wanting the change.
The decision has dismayed experts who say it sends a message that "Māori and Pacific people have to 'wait' for equity".
The bowel cancer screening programme was piloted for 50 to 74-year-olds, but when extended nationally that range was tightened to 60-74 - a good fit for the Pākehā majority, but less so for Māori and Pacific, given more of those groups develop cancer earlier.
For example, about 26 per cent of bowel cancers in Pacific peoples occur between 50-59 years old, compared to about 11 per cent in the non-Māori or Pacific population.
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Amidst backlash, the Ministry in 2019 held meetings with Māori and Pacific health leaders, resulting in overwhelming recommendations to drop the screening age.
The ministry has now responded, with a decision not to act until after the screening programme is fully rolled out, by around December next year (11 of 20 DHBs currently have screening).
Lowering the age would require about 10 per cent more screening colonoscopies, the ministry estimated, and services were already struggling.
"Whilst we acknowledge the need to extend the age range to increase health gains for Māori and Pacific peoples ... the only viable and safe option is to introduce the change once the programme is fully rolled out," the ministry's deputy director-general of population health, Deborah Woodley, wrote in an email announcing the decision.
, jointly written with the new Cancer Control Agency, went to Health Minister David Clark on June 30, and was released to the Herald under the Official Information Act soon after Woodley's email on Friday night.
It was written after Prime Minister Jacinda Ardern and Associate Health Minister Peeni Henare asked for advice, and noted the ministry's national screening advisory committee and bowel screening advisory committee, and the cancer agency's advisory council advocate lowering the screening age for Māori and Pacific.
However, the report stressed "it is important to particularly focus on cancers where the most stark inequities exist", including lung and cervical cancers. Dropping the bowel cancer screening age "will have a minimal equity impact relative to other interventions", and "we should consider introducing targeted lung cancer screening."
Some DHBs had asked to pilot a lower age threshold, the ministry noted, but many health boards that started screening struggled with colonoscopy demand, resulting "in significant numbers of symptomatic people having to wait beyond the maximum clinically recommended timeframe".
"Within current financial, clinical and other resource constraints there is always a question about the best value for money for addressing health inequities, including within cancers."
Lowering the screening age "risks setting back progress on delivering the overall programme", and it was better to focus on lifting existing participation.
Dr Rawiri McKree Jansen, co-chair of the National Māori Bowel Cancer Screening Network, told the Herald that was "an assertion it is acceptable to delay a pro-equity intervention because a properly resourced programme has not been designed; that Māori and Pacific people have to 'wait' for equity".
His co-chair, Shelley Campbell, chief executive of the Cancer Society's Waikato/Bay of Plenty division, said over the past 18 months there had been a wide range of "highly debatable" reasons why dropping the age was apparently problematic, including lack of DHB support and rickety IT systems.
"We cannot keep talking about the importance of equity in health systems and then failing to take the steps necessary to achieve it."
Cancer screening expert Dr Nina Scott, chair of Hei Āhuru Mōwai Māori - the national Māori cancer leadership group - said screening "cannot be left to just quietly steam ahead ignoring the advice of experts - knowingly and needlessly making inequities worse".
That view was shared by Bowel Cancer NZ medical adviser and associate professor at the University of Otago Medical School, Dr Sue Crengle, who noted it jarred with the Government's commitment to equity.
Dr Rhys Jones, senior lecturer at Te Kupenga Hauora Māori, University of Auckland, said there was a very clear message from the hui called by the ministry in February last year - it was untenable to continue with the "manifestly racist" status quo.
One DHB wanting to drop the age for is Tairāwhiti, which joined the screening programme this month. Chief executive Jim Green said it had agreed with the ministry to review things well before the end of the first year, and "we are confident we would have capacity".
Dr Melissa McLeod, senior research fellow in the Department of Public Health, University of Otago, Wellington, said she couldn't understand why a pilot programme wasn't run, given there were such DHBs with capacity to do so.