Health should not rely on goodwill

We often hear that New Zealand has one of the highest rates of bowel cancer in the world which makes it hard to understand our relative apathy about diagnosing it early. More than 3000 New Zealanders are diagnosed and 1200 die from it every year, making it our second most fatal type of cancer.

After years of pressure, the Government eventually allocated nearly $40 million over four years to a national bowel cancer screening programme in the 2016 Budget, aimed at people aged from 60 to 74.

It is an extension of a pilot scheme that launched in 2014 in Waitemata, where it caught 164 people in two years who did not even exhibit the symptoms of bowel cancer and would probably not have normally presented to a doctor.

An evaluation report for the Ministry of Health called the Waitemata programme ‘‘an exceptionally costeffective health intervention’’.

Versions of the screening programme will be rolled out slowly across different district health boards, with Canterbury set for a start date somewhere between July 2018 and June 2019.

But is this too little, too late? An initiative of 12 Christchurch doctors would suggest that there are two things wrong with that picture. It comes to Canterbury at least a year too late and it sets the age of eligibility a decade too high.

Bowel cancer is increasingly striking the relatively young. An Otago University and Christchurch Hospital study found that colon cancer in New Zealand men under 50 increased by 14 per cent between 1995 and 2012 and rectal cancer increased by 18 per cent. Rectal cancer in women under 50 increased by 13 per cent in the same period.

Approximately 10 per cent of bowel and rectal cancers now occur in people under 50.

Christchurch colorectal surgeon Frank Frizelle told The Press this week that the cash-strapped Christchurch District Health Board (CDHB) rarely has the resources to extend its clinic to those under 50, which is why he teamed up with nearly a dozen others to offer their services for free or a small fee to screen under-50s at the Canterbury Charity Hospital and St George’s Hospital.

Obviously their generosity and altruism should be applauded. We know that doctors and other medical specialists already work long and stressful hours and that conditions are far from ideal in post-earthquake Canterbury.

The surgeons’ collective response also illustrates the seriousness of the threat that bowel cancer poses to those who will be too young for national screening programmes.

But while welcoming their activity, it is also reasonable to worry about whether a precedent is being established. We should not expect to see charity hospitals and other forms of philanthropy pick up the slack of an underfunded public health system.

Programmes such as these should be the state’s responsibility and more resources must be found. Dedicated surgeons and specialists working for free in their spare time should really be seen as a last resort.