Indigenous Australians: Targeting smoking is key to reducing cancer inequality

The health inequalities regarding cancer care facing the indigenous population of Australia are explored in the second of a series of Reviews in the June edition of The Lancet Oncology, authored by Dr Joan Cunningham and Dr Alice Rumbold, Menzies School of Public Health Research, Casuarina, Northern Territory, Australia, and colleagues.

Indigenous Australians (Aborigines and Torres Strait Islanders) have a range of socioeconomic disadvantages compared with other Australians, consistent with the ongoing legacy of colonisation, dispossession, and social disruption. Indigenous life expectancy is about 17 years less than for other Australians.

The authors say: “An assessment of recent data of cancer in Indigenous Australians shows that, although they are less likely to have some types of cancer than other Australians, Indigenous people are significantly more likely to have cancers that have a poor prognosis, but are largely preventable, such as lung and liver cancer. Indigenous people with cancer are diagnosed at a later stage, are less likely to receive adequate treatment, and are more likely to die from their cancers than other Australians.”

The patterns of Indigenous cancer incidence and mortality are largely explained by the higher prevalence of risk factors, most notably smoking, and by inadequate health-system performance. Improvements in data quality and availability are still needed to enable the monitoring of patterns, identification of regional variation, and assessment of control programmes. But the authors say: “However, there is already sufficient information to identify priorities and inform appropriate remedial action. A decrease in tobacco use is crucial for decreasing the burden of cancer (and other chronic diseases) in Indigenous Australians. With half of Indigenous adults being daily smokers, and no evidence of any measurable decrease in smoking over the past decade, it is apparent that tobacco-control programmes up to now have been inadequate and ineffective. Such programmes need to be designed to be effective in the context of social disadvantage, and need to address the social and cultural role of smoking in Indigenous people.”

They add that across-the-board health-service improvements are needed for Indigenous Australians in both urban and remote areas, ranging from health education and health promotion to public health programmes (such as screening and immunisation) primary care, and specialist curative and palliative services. Indigenous involvement should be a central element in these service improvements. The authors conclude: “Effective mainstream services can be adapted to be culturally appropriate for Indigenous people, as shown, for example, by the Northern Territory Well Women’s Screening Programme. The resultant decrease in cervical cancer in the Northern Territory suggests that rapid change is possible, at least for some cancers.”

Dr Alice Rumbold, Menzies School of Public Health Research, Casuarina, Northern Territory, Australia T) +61 8 8922 8505 E) alice.rumbold@menzies.edu.au