Equity Issue	Likely exacerbation by COVID-19	Activity
Inequities in health promotion and cancer prevention. −Māori are substantially more likely to be diagnosed with poor-prognosis cancers (lung, stomach, liver, pancreas).−Pacific peoples are disproportionately impacted by poor-prognosis cancers including liver, stomach and uterus.−Drivers of these inequities include differences in rates of smoking, and certain infections (e.g. H pylori, Hepatitis B and C)	Māori and Pacific peoples are likely to be disproportionately impacted by deferral of preventive health activities during COVID.High incidence of cancers with highest levels of inequity driven by inequities in exposure to known carcinogens:−Tobacco −Alcohol −Chronic infection −Chronic non-communicable diseases including diabetes	Recommend national messages and strategies/funding targeted for Māori and Pacific peoples stop smoking services be continued and prioritised.
		Recommend that tobacco cessation activities continue as normal as is feasibly possible.
		Recommend advice, support and resources to minimise alcohol related harm be continued and prioritised.
		Recommend vaccination programmes for HPV and identification and treatment of Hepatitis B and C be continued and prioritised.
		Support increased flu vaccinations for Māori and Pacific peoples with comorbidities
Inequities in the receipt of early diagnosis.− Māori have poorer access to early diagnosis for several common cancers. −A significant driver of these inequities sit within the failings of the primary care system including access to and through primary care −Poorer access to and through secondary care services may also drive later diagnosis −Differential access to national screening programmes is also a driver of late diagnosis for screen-detected cancers	a) Diagnosis may be delayed by diversion of health services towards pandemic response. >b) Removal of diagnostic services will further exacerbate existing inequities in access to early diagnosis for Māori and Pacific peoples.c) Reduction in primary care utilisation during lock down likely to affect Māori and Pacific peoples disproportionatelyd) Barriers to accessing virtual consultations (eg due to phone/internet access, or whānau living in crowded homes without access to private space for virtual health consultation).e) Delays in diagnosis of poor-prognosis cancers will disproportionately impact cancer outcomes for Māorif) Cessation of screening programmes may exacerbate poorer outcomes and delay diagnosis and access to treatment	Recommend prioritising tumour streams where Māori and Pacific peoples are disproportionately represented and ensure they are targeted in diagnostic and treatment pathways during the return of diagnostic capacity.
		Recommend that decisions on pausing or restarting screening programmes should consider the equity impact of such decisions. Ensure that Māori and Pacific peoples are prioritised when screening programme restarted
		Develop communications reassuring whānau that it's ok to seek help for non-COVID-19 issues and encourage Māori and Pacific peoples to access services early
Inequities in the receipt of timely best-practice treatment. Social inequities in cancer outcomes can be driven by differences in the availability, affordability and accessibility of best-practice cancer treatment. −Best-practice treatment is less available to Māori, likely due to factors such as where treatment centres are relative to where Māori live −Best-practice treatment is less affordable to Māori, because of inequities in resources including transport (i.e. deprivation) and access to privately-funded care −Best practice treatment may be less acceptable to Māori, partially due to the scarcity of Māori treatment providers and navigators −Access barriers to cancer care for Pacific peoples include cost, geographical location of services, transport, understanding the nature and necessity, cultural and communication factors related to language, health literacy, and competing family and other commitments −Comorbidity is a cause of the inequitable cancer outcomes for Māori and Pacific peoples	a) Delays in the diagnosis of the poor-prognosis cancers more common among Māori (as above) will result in increased complexity of care once these cancers are diagnosed. b)  Regional variation in provision of services (as a result of COVID-19) will exacerbate inequities. Standardisation of care receipt across ethnic groups reduces inequities in cancer outcomes for Māori. c)  The diversion of publicly-funded services away from cancer may result in those with financial resources to seek treatment privately, further exacerbating existing inequities in care access. d) Increased pressure on health system during COVID-19 will exacerbate these ethnic biases and lead to systematic differences in treatment decisions.e) Presence of comorbidities for Māori and Pacific peoples is recognised as a complication in the treatment of cancer and is likely to be further exacerbated in the presence of COVID-19. f) Services that provide psychosocial support likely to be impaired.g) Accommodation and transport providers may close, making it difficult for whānau to access treatmenth) Heightened stress at an already emotionally stressful time. This could lead to increased need for support and a potential overwhelming of existing psychosocial support services.i) Growing financial hardship during COVID-19 and inability to access social welfare due to offices closing/unable to access the officej) Staff stress and burnout, reduced capacity for patient/whānau distress	Development of minimum treatment standards for oncology, radiation oncology, haematology at different hospital alert levels to ensure ongoing provision of services.
		Development of cancer surgical and radiology minimum treatment standards at different hospital alert levels to ensure ongoing provision of services.
		Recommend Cancer Nurses proactively contact Māori and Pacific patients to discuss what is happening with their treatments and other psychosocial needs are identified and met
		Advice to Primary Care Providers to ensure effective ongoing management of cancer and other comorbidities to mitigate adverse impact of COVID-19 on patient outcomes.
		Recommend regions work with private providers to follow the same treatment provisions at different hospital alert levels to ensure equitable provision of care during COVID-19 response.
		Facilitate Cancer Service resilience planning and support of cancer treatment services, with a particular focus on those with a high proportion of Māori patients so they are able to continue to provide care.
		Undertake stocktake and communicate available transport and accommodation options for those who have to travel for treatment
		Provide specific cancer and COVID-19 information and education on managing fear and anxiety for both patients/whānau and staff.
		Ensure accurate information about financial relief is available.
		Reinforce support options for staff self-care strategies.