Public support for cancer prevention, screening, treatment and care policies in Aotearoa New Zealand: a synthesis of evidence from a national survey

Cancer policy in Aotearoa New Zealand is often characterised as politically challenging and is frequently justified by assumptions that the public may not support more ambitious prevention or health system reform. But are these assumptions valid? Is there truly major disagreement across political divides on cancer prevention, screening, treatment and care? Or is a broad public consensus being overlooked in policy decision making? These questions matter because failure to implement effective cancer policies carries substantial social, health, equity and economic costs, including avoidable morbidity, premature mortality and increasing pressure on the health system.

This viewpoint article addresses this gap by synthesising findings from a co-ordinated programme of national survey research (hereafter “the survey”), providing what we consider to be the first cross-cutting investigation of public support for key public health and health service interventions across the cancer continuum in Aotearoa New Zealand. The body of work being discussed comprises a shared methods paper¹ and seven topic-specific papers.^2–8

Aotearoa New Zealand is facing growing challenges in cancer control as the population increases and ages, which is expected to drive a substantial rise in cancer cases and place significant pressure on the health system. At the same time, persistent inequities remain, with Māori, Pacific people and those living in deprived areas experiencing higher rates of cancer incidence, later diagnosis and poorer survival outcomes. These inequities (some of which are in conflict with Te Tiriti o Waitangi obligations) are compounded by barriers to access, differences in exposure to risk factors and workforce and system constraints. Together, an ageing population and entrenched inequities mean the demand for timely, equitable cancer prevention, diagnosis and treatment will continue to intensify in the coming decades.⁹ There is strong public support for policies that improve access to services and reduce avoidable barriers, including among Māori. This alignment between public values and equity-focussed cancer policy is consistent with, but does not replace, the Crown’s responsibilities under Te Tiriti o Waitangi to ensure that cancer prevention and care reforms deliver tangible improvements in Māori health outcomes.

The findings across the seven papers are presented in two broad sections here. The first focusses on policies to reduce cancer risk, including measures addressing tobacco and alcohol use, ultraviolet radiation exposure, unhealthy food and beverage environments and human papillomavirus (HPV) vaccination. It also considers public views on industry influence and lobbying of government decision makers relevant to the implementation of these prevention policies. The second examines policies related to screening, diagnosis, treatment and ongoing care.

Ethical approval

Ethical approval was granted by the University of Otago Human Ethics Committee (25/1184).

Cancer prevention

As 30–50% of cancers can be prevented, prevention is fundamental to reducing the population burden of cancer.¹⁰ Failure to invest in effective cancer prevention results in avoidable illness, premature mortality, lost productivity and increasing pressure on an already stretched health system, with significant social and economic consequences.¹¹ Policies that reduce the appeal, availability and affordability of unhealthy products, increase affordability and access to healthier options and create environments that support healthy behaviours offer substantial public health and equity benefits.^12–14 There is consistent evidence that these population-level measures, particularly fiscal and regulatory interventions such as taxes on sugary drinks or restrictions on tobacco marketing, are more effective and more equitable than interventions focussed primarily on individual behaviour change.^12–14

Examples of restricting the appeal, availability and affordability of unhealthy products and improving affordability and access to healthier options include government actions to reduce the cost of healthy food and increase the provision of protective infrastructure, such as shade, to reduce ultraviolet radiation exposure. Together, such practical measures form a core component of comprehensive prevention strategies, particularly when implemented alongside complementary regulatory and fiscal policies.

Substantial majority support was observed for most population-level prevention policies presented. This included high support for key policies such as reducing the cost of healthy food (around 89% overall support), excluding the junk food and sugary drinks industry from policy development (around 79%) and doing more to keep people safe from alcohol-related harm (around 71% agreement). Importantly, majority support for these policies was broadly evident across major political party groups, including those intending to vote for parties that have not consistently supported such measures. These findings refute arguments that population-level prevention measures do not have public support. Around 80% also supported efforts to increase HPV vaccination rates.

In many cases, levels of support were inconsistent with the policy positions or actions of the parties that Aotearoa New Zealanders indicated they would vote for. Notably, the three world-leading tobacco control measures repealed by the current Government remained strongly supported, with support levels of approximately 77–84%, including majority support among supporters of the current coalition parties. More members of the public disagreed with the repeal of these policies than agreed across all voting intention groups, further highlighting the disconnect between public preferences and recent policy decisions.

One important subset of population-level prevention policies relates to the regulation of marketing, which influences purchasing behaviour and contributes to harmful consumption patterns, particularly among children and young people.¹⁵ There was high public support for policies that restrict or prohibit the marketing of unhealthy commodities (such as unhealthy food or drinks), indicating strong social acceptability for minimising or eliminating exposure to such marketing. Rigorous restrictions are already in place for tobacco in Aotearoa New Zealand, so there is a strong precedent.

In addition to regulatory approaches, fiscal policies influence affordability by either increasing the cost of unhealthy commodities or reducing the cost of healthy options, and they are associated with changes in purchasing behaviour and consumption.¹⁶ These measures were widely seen in this survey as appropriate mechanisms for supporting prevention, including sugar-sweetened beverage taxes and increased alcohol taxes. While support for fiscal measures was generally lower than for other interventions, it still reflected majority endorsement.

Beyond specific regulatory and fiscal levers, the public also expressed substantial support for addressing commercial influences on public health policymaking. The survey indicated substantial public support for introducing restrictions on industry lobbying and for excluding the alcohol and unhealthy food industries from public health policymaking. This support extended to specific, concrete policy measures, including requiring politicians and senior staff to observe a stand-down period before taking up lobbying roles for the junk food, alcohol and sugary drinks industries, and mandating clear rules to ensure lobbyists act fairly and responsibly.

Across all seven papers, consistent patterns emerged, including high public support across cancer policy and practice domains and little evidence of polarisation by voting intention in most policy areas. Taken together, these findings indicate that population-level prevention policies are both publicly acceptable and politically feasible, removing a frequently cited constraint on preventive policy action. However, as previously observed in tobacco control, industry interference can delay, weaken or even reverse effective regulation even in the presence of strong public support, underscoring the importance of clear and enforceable protections.¹⁷

Cancer screening, treatment and care

Screening, timely diagnosis and effective access to treatment and care offer substantial opportunities to improve cancer outcomes in Aotearoa New Zealand. International comparisons indicate that there is considerable scope to improve cancer outcomes in Aotearoa New Zealand through earlier diagnosis, more timely treatment and greater system-level investment.¹⁸

Public support for policies across cancer early detection, treatment and care was consistently high, exceeding 90% for every policy examined in this domain, indicating broad endorsement of publicly funded, accessible and timely cancer services. Importantly, this high level of support was observed across all major political party groups, with limited variation by voting intention. Strong support was evident for timely access to diagnostic services and treatment pathways designed to minimise avoidable delays. Support for increased health funding remained consistently high across the political spectrum.

Investment in health services emerged as a shared public priority, alongside widespread concern about the long-term sustainability of the health system, particularly the health workforce. As with prevention policies, these findings indicate that support for core components of cancer control, including screening, diagnosis and treatment, is not politically polarised by voting intention and reflects a broad and consistent pattern of public support. Together, these findings suggest that the principal barrier to strengthening cancer services in Aotearoa New Zealand is unlikely to be public acceptability, but rather the translation of this consensus into political action. Willingness to contribute financially to the public health system through taxation was strong, with around two-thirds of people prepared to pay more tax. Support was highest when revenue was earmarked for health services. These findings suggest that the public recognises that additional investment must be sourced and is broadly willing to support increased taxation to achieve this.

These findings indicate support not only for increased funding, but specifically for funding models that provide visibility, earmarking and confidence over how resources are raised and allocated. A levy-based approach, analogous to the Australian Medicare tax levy, provides one example for creating a dedicated funding stream for health services. Comparable arrangements operate in several European countries and function in practice as forms of collectively funded health insurance.¹⁹

Overall, these patterns indicate strong public endorsement of a cancer health system that prioritises early diagnosis, co-ordinated treatment and continuity of care. Support was evident for system-level approaches emphasising performance, fairness and responsiveness, including adequate resourcing of cancer services and access to supportive and palliative care.

While across this survey we have not explored every possible policy option, those examined are all supported by strong evidence, demonstrated effectiveness in other jurisdictions and endorsement from leading international agencies, including the World Health Organization,¹⁵ the Organisation for Economic Co-operation and Development¹¹ and the World Cancer Research Fund.²⁰

Conclusion

This survey research demonstrates a clear public mandate for evidence-based cancer policy across cancer prevention, screening, treatment and care in Aotearoa New Zealand. A significant majority of Aotearoa New Zealanders are willing to contribute financially to the health system through earmarked taxation. However, Aotearoa New Zealanders also recognise that treatment-focussed responses are not enough and they widely support prevention. Substantial and often cross-party support for cancer prevention policies highlights the travesty of current inadequate action and the need to hold politicians to account when such policies are not fully, if at all, implemented. A potential barrier identified in this work is concern about industry interference in policymaking, with strong public support for restrictions on lobbying. Overall, barriers to action are political rather than societal, underscoring the need for decisive political leadership that is consistent with Te Tiriti o Waitangi and public expectations.