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Nov 4, 2010

Cancer and Indigenous health: the pitfalls of assumption-based policy

Why is there so little policy attention to the toll that cancer takes upon Indigenous Australians? Research involving interviews with senior bureaucrats and government ministers thro

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Why is there so little policy attention to the toll that cancer takes upon Indigenous Australians?

Research involving interviews with senior bureaucrats and government ministers throws some light on the possible answers to this question. Perhaps policy is being based upon assumptions, rather than the evidence about cancer’s impact on Indigenous health.

Daniel Vujcich writes:

When providing an account of Indigenous health policy making in Australia, the historian need not venture too far into the archives.  The dominance of social Darwinist thinking until the middle of the twentieth century meant that Indigenous people were long assumed to be on an unchangeable course of demographic decline.

The consequences were two-fold.  First, the widespread acceptance of the ‘doomed race’ theory meant that research was largely geared towards accumulating information on Indigenous people for posterity’s sake; that is, before they became extinct.

Second, the formulation of Indigenous health policies was viewed as a futile exercise, save in so far as those policies might either protect the white population from the perceived threat of contagion, or shield Indigenous people “from overt injustice and brutality – for the short time they had left upon this earth” (Thomas, 2001).

Today, most research is concerned with finding ways of improving Indigenous health outcomes.  Moreover, the public rhetoric associated with State and Federal Indigenous health policies is built on a belief that the Indigenous population can (and should expect to) live long.

One might conclude from this that the ‘doomed race’ theory is dead.  However, closer scrutiny of the policy landscape suggests that fatalism is alive and well when it comes to addressing some aspects of Indigenous health.

To demonstrate this point, I draw upon the issue of cancer. 

A generous amount of Indigenous health money is rightly spent on collating and analysing health information and data; that data clearly and consistently shows that a large proportion of Indigenous deaths are caused by cancer.

For instance, the 2008 Health and Welfare of Aboriginal and Torres Strait Islander Peoples report reveals that cancer resulted in 15.1% of total Indigenous Australian deaths between 2001 and 2005 (behind circulatory diseases at 26.6% and external causes at 16.2%). The report also demonstrated that cancer was the second largest contributor of Indigenous life years lost in 2003 behind cardiovascular disease.

Yet cancer rarely features as a specific concern in Indigenous health policies and strategy documents; while it technically falls within the broad catch-all category of ‘chronic disease’ in the National Strategic Framework for Aboriginal and Torres Strait Islander Health, in practice, policy action in that category seems to be skewed towards endocrine, nutritional/metabolic and circulatory diseases.

Of course there may be convincing reasons for the relative dearth of policies to explicitly address cancers among the Indigenous population; these might include issues of cost effectiveness, demand side factors, or the fact that other policies (such as those aimed at reducing alcohol and tobacco consumption) go some way to addressing cancers of the lip, mouth, throat, lungs and intra-thoracic organs which account for about a third of Indigenous cancer deaths.

However, my own research suggests that the absence of specific cancer policies may not be the product of a considered approach to health decision making.

Last year I conducted interviews with current and former senior bureaucrats and Ministers directly responsible for the formulation of Indigenous health policy.  Their responses led me to conclude that misplaced assumptions continue to play a role in the way in which Indigenous health issues are prioritised for government action.

One Minister described the dearth of cancer policies in the following way: “Well … if you don’t live very long, obviously trachoma is more of a problem than cancer”.  Another Minister offered a virtually identical explanation: “Cancer was not seen to be such a particular issue for the very simple reason of life expectancy.  It becomes a more acute issue the longer you live.”

Meanwhile a former Director-General of a State Health Department expressed surprise when told that cancer was one of the leading causes of Indigenous death, saying “I wouldn’t have put it as a high cause”, and a third Minister omitted it from his list of “biggest killers” of Indigenous people, instead citing cardiac disease, renal disease, diabetes, smoking and accidental or violent death.

The findings lend weight to the anthropologist Tess Lea’s (2009) impression that “many government programs don’t want to amass deep empirical knowledge about social issues at all.  They simply want a data system to collect data … that is part parcel of the rituals of accountability in government.”

It is one thing to choose to place evidence behind considerations such as budgetary or resource constraints, consumer demand or practical problems associated with devising effective policies; it is another to base a decision which affects the way in which Indigenous people live and die on assumptions which are contrary to the available evidence.

The challenge for academics, policy makers and the media is to engage with and utilise the health information and data being generated in order to more closely scrutinise the way in which Indigenous health issues are prioritised; by failing to do so, we risk repeating the mistakes of our fatalistic forebears by allowing inaccurate assumptions to justify political indifference or inaction.

• Daniel Vujcich is a graduate of the University of Western Australia.  He is currently on a Rhodes Scholarship to the University of Oxford where he has completed a Master’s degree in International Development, and now reads for a doctorate in Public Health.  His research relates to the way in which Indigenous Australian health policies are formulated.

Daniel has pitched an investigation into the neglect of Indigenous people with cancer to YouCommNews, a new initiative to enable community members to commission and fund journalistic investigations.  The pitch is looking for a journalist to take it on, and people to help fund it.

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