Abstract
Persistent inequities in cancer outcomes for Māori and Pacific peoples remain one of the most significant challenges facing the Aotearoa New Zealand health system. These disparities are evident across incidence, stage at diagnosis, access to treatment and survival. While often attributed to behavioural risk factors, the predominant drivers are structural, including barriers to access, health system design, workforce limitations and broader socio-economic determinants. Despite long-standing recognition, progress has been inconsistent and insufficient. Addressing these inequities requires a shift from description to accountability, with equity embedded as a core performance metric. Culturally aligned services, improved access to care, strengthened primary care and the use of registry-based data to drive quality improvement are essential components of a system capable of delivering equitable outcomes. Comprehensive cancer centres could offer a further opportunity to reduce variation and improve access to high-quality multidisciplinary care. In parallel, screening policy must better reflect epidemiological realities, including the earlier onset of colorectal cancer among Māori. Equity in cancer care is fundamental to the definition of a high-performing health system. Without measurable progress, equity remains deferred—and therefore denied.