Supporting Cancer Control for Indigenous Australians: Initiatives and Challenges for Cancer Councils
Shahid, Shaouli, Beckmann, Kerri R., Thompson, Sandra C., Australian Health Review
As in other developed countries, the Australian population is ageing, and cancer rates increase with age. Despite their substantially lower life expectancy, Indigenous Australians are also experiencing concerning cancer statistics, characterised by increasing rates, later diagnosis, higher mortality, and lower participation in screening than the non-Indigenous population. Eighteen months after the first national Indigenous Cancer Control Forum, this environmental scan within the state-based Cancer Councils was undertaken to map activities in service provision in Indigenous cancer control with a view to sharing the lessons learned. The findings show that although most of the organisations had tried to work with Indigenous communities on cancer issues, there have been difficulties in building and sustaining relationships with Indigenous organisations. Lack of having Indigenous staff internally, few Indigenous-specific resources, and few planned, long-term commitments were some of the major impediments. Some of these limitations can easily be overcome by building and improving regional or local partnerships, providing cultural awareness training to internal staff, and by building the capacity of Indigenous organisations. Health promotion projects of the Cancer Councils directed at Indigenous people could be more effectively implemented with such considerations.
Aust Health Rev 2008: 32(1): 56-65
THE NUMBER OF recorded cancer deaths in Australia continues to increase, attributed in part to the increase in cancer incidence that occurs in an ageing and an expanding population.1,2 Until recently, cancer was seldom identified as a priority health issue for Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians.*3 The immediate health and welfare problems of Indigenous Australians across the lifecourse are well documented,4"6 and these may have distracted attention from the fact that cancer has become one of the major causes of death for these people. Interest about cancer among Indigenous populations may also be affected by their lower incidence of many cancers and their shorter life expectancy. Moreover, cancer rates in Indigenous Australians may under-represent the real burden because of misclassification and under-ascertainment of Indigenous status.7-9
Nevertheless, available data show that Indigenous Australians are experiencing an increasing rate for some cancers.3 For almost all cancers, they experience later diagnosis, lower 5-year survival and a higher mortality rate than non-Indigenous Australians.10 Indigenous women have lower participation in mammography and Pap smear screening than non-Indigenous women.1112 It has also been reported that the overall response rate was significantly lower for Indigenous people than the general population in the Bowel Cancer Screening Pilot Program that ran between November 2002 and June 2004 at three sites in Australia.13 Moreover, while the last two decades have seen a 30% reduction in cancer mortality rates in Australia, there has been little impact upon Indigenous cancer mortality.14 The need to prioritise cancer prevention and control was recognised in the National Indigenous and Torres Strait Islander Health Strategy 2001, where cancer was documented as one of three major chronic diseases for Indigenous Australians.15
The first national forum to discuss Indigenous cancer issues, held in Darwin in August 2004, highlighted various gaps that exist around responding appropriately to these issues. Many strategies were proposed to improve their poorer cancer outcomes. Increased government funding, boosting research on cancer among Indigenous Australians by enhancing their ownership over the data, and involving them in partnership with non-Indigenous health professionals to ensure appropriate service design and delivery mechanisms were a few of the significant recommendations. At the conclusion of the forum, the peak non-government organisations providing advocacy for prevention and care for cancer in Australia, The Cancer Council Australia and its statebased affiliates, committed to factoring Indigenous issues into their policy development and advocacy for cancer prevention and care. …