For Aboriginal and Torres Strait Islander people, health and connection to land, culture, community, and identity are intrinsically linked. Health encompasses a whole-of-life view and includes a cyclical concept of life-death-life. The strengths of Aboriginal and Torres Strait Islander cultures have continued to evolve despite the ongoing impacts of colonisation, systemic discrimination and intergenerational trauma, including through the Stolen Generations.
The Australian Cancer Plan (the Plan) considers an intersectional and health equity approach for Aboriginal and Torres Strait Islander people. This is more than recognising the multiple backgrounds, experiences, and ways Aboriginal and Torres Strait Islander people identify. This approach addresses the way membership of multiple groups may impact people’s health and wellbeing needs and ability to access care.
The Plan is underpinned by Key Principles and Best Practices for co-design in health with First Nations Australians. These Principles include First Nations leadership, Culturally grounded approach, Respect, Benefit to community, Inclusive partnerships and Transparency and evaluation.
Cancer is the leading cause of death for Aboriginal and Torres Strait Islander people, and the gap in cancer mortality between Aboriginal and Torres Strait Islander and non-Indigenous Australians is widening.[7][19]
Aboriginal and Torres Strait Islander people are more likely to be diagnosed with cancer, more likely to die from cancer, and have a lower 5-year relative survival compared to non-Indigenous Australians.[1][7] The age-standardised incidence rate and age-standardised mortality rate of all cancers are 13% and 37% higher, respectively, for Aboriginal and Torres Strait Islander people compared to non-Indigenous Australians.[1] Many factors contribute to this gap, including social disadvantage (such as lower education and employment rates), high smoking rates, poor nutrition, physical inactivity, and poorer access to health services.[1][20]
Aboriginal and Torres Strait Islander people live in all parts of the nation, from urban to regional, remote and very remote areas. Aboriginal and Torres Strait Islander people are more likely to live in urban and regional areas than remote areas, although the proportion of the total population who are Aboriginal and Torres Strait Islander is generally higher in more remote areas.[19] People living in remote areas may have poorer access to care and are less likely to participate in Australia’s national population screening programs for bowel, breast, and cervical cancers.[1][21][22][23]
The Plan aims to support Aboriginal and Torres Strait Islander knowledge, strength, and sovereignty in a health system that achieves equity for Aboriginal and Torres Strait Islander people affected by cancer.
Shared decision making, collaborative partnerships and cross-sector approaches with Aboriginal and Torres Strait Islander people are promoted at the system, service, and individual level. The Plan will act as one mechanism to identify and address individual and institutional racism and discrimination across cancer services. Through the adoption of co-design approaches to achieve the priority actions in the Plan, Aboriginal and Torres Islander people will have a genuine say in the design and delivery of policies, programs and services that affect them, to achieve better life outcomes.
The Plan gives priority to accountability for the delivery of culturally safe services by all health professionals, and for the establishment of further training opportunities and support programs for Aboriginal and Torres Strait Islander health professionals in the cancer sector. The Plan will strive to strengthen specialist and targeted services to be culturally responsive and to reform mainstream health programs in collaboration with the Aboriginal Community Controlled Health sector. The Plan will also build the capacity and capability of Aboriginal Community Controlled Health Services to support Aboriginal and Torres Strait Islander people with cancer.
The Plan supports the National Agreement on Closing the Gap[8] (CtG Agreement) to enable Aboriginal and Torres Strait Islander people and governments to work together, to overcome the inequality experienced by Aboriginal and Torres Strait Islander people and achieve life outcomes equal to all Australians.
Year: 2020
Author: Australian Government
The National Agreement on Closing the Gap aims to enable Aboriginal and Torres Strait Islander people and governments to collaborate and overcome the inequity experienced by Aboriginal and Torres Strait Islander people, to achieve life outcomes equal to all Australians.
The National Agreement on Closing the Gap was developed in partnership between Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations (the Coalition of Peaks).
Year: 2023
Author: National Aboriginal Community Controlled Health Organisation
The Aboriginal and Torres Strait Islander Cancer Plan aims to improve outcomes for Aboriginal and Torres Strait Islander people with cancer.
Year: 2021
Author: Department of Health and Aged Care, Australian Government
The National Aboriginal and Torres Strait Islander Health Plan 2021–2031 aims to improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people over the next 10 years.
The National Aboriginal and Torres Strait Islander Health Plan was developed in full and genuine partnership led by Aboriginal and Torres Strait Islander people.
Year: 2020
Author: Australian Health Practitioner Regulation Agency
The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020–2025 aims to produce consistency and quality improvement in matters of Aboriginal and Torres Strait Islander health and cultural safety across the Ahpra National Registration and Accreditation Scheme.
Year: 2022
Author: Cancer Australia, Australian Government
Our Mob and Cancer was developed for Aboriginal and Torres Strait Islander people by Aboriginal and Torres Strait Islander people to consolidate information about cancer, including cancer types, prevention, diagnosis, treatment, living with cancer, finding support and clinical trials.
Year: 2018
Author: Cancer Australia, Australian Government
The Optimal Care Pathway (OCP) for Aboriginal and Torres Strait Islander people with Cancer provides guidance to health practitioners and service planners on optimal care for Aboriginal and Torres Strait Islander people with cancer across the cancer continuum. This guide was developed to complement tumour-specific OCPs and intends to support the delivery of health services that are culturally safe and responsive.
Development of the OCP was undertaken in partnership with Aboriginal and Torres Strait Islander people including researchers, policymakers, health professionals and community.
Year: 2015
Author: Cancer Australia, Australian Government
The National Aboriginal and Torres Strait Islander Cancer Framework (the Framework) provides high-level guidance and direction for the many individuals, communities, organisations, and governments whose combined efforts are required to address disparities and improve cancer outcomes for Aboriginal and Torres Strait Islander peoples.
Development of the Framework was undertaken in partnership with Aboriginal and Torres Strait Islander people including researchers, policymakers, health professionals and community.
Year: 2022
Author: Department of Health and Aged Care, Australian Government
Co-designed with Aboriginal and Torres Strait Islander people, the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan aims for Aboriginal and Torres Strait Islander people to be fully represented in the health workforce by 2031. It includes actions to attract, recruit, and retain workers across all roles, levels, and locations within the health sector.
Year: In development
Author: Department of Health and Aged Care, Australian Government
The Aboriginal and Torres Strait Islander Genomics Health Guiding Principles (the Guiding Principles) and the associated Guiding Principles Summary has been developed by the Aboriginal Torres Strait Islander Advisory Group on Health Genomics.
The Guiding Principles aim to support policymakers, researchers, clinicians and Aboriginal and Torres Strait Islander communities to deliver culturally safe and accessible clinical genomics services and genomics research activities for Aboriginal and Torres Strait Islander people. This framework is currently under development.
Year: 2016
Author: Australian Health Ministers’ Advisory Council
The Cultural Respect Framework commits the Commonwealth Government and all states and territories to adopt cultural respect principles into their health systems from developing policy and legislation through to the planning and delivery of services.
Year: In development
Author: Australian Centre for the Prevention of Cervical Cancer
The National Strategy for the Elimination of Cervical Cancer will aim to eliminate cervical cancer for all people with a cervix across the diverse communities in Australia.
Year: 2020
Author: Australian Government
The National Agreement on Closing the Gap aims to enable Aboriginal and Torres Strait Islander people and governments to collaborate and overcome the inequity experienced by Aboriginal and Torres Strait Islander people, to achieve life outcomes equal to all Australians.
The National Agreement on Closing the Gap was developed in partnership between Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations (the Coalition of Peaks).
Year: 2023
Author: National Aboriginal Community Controlled Health Organisation
The Aboriginal and Torres Strait Islander Cancer Plan aims to improve outcomes for Aboriginal and Torres Strait Islander people with cancer.
Year: 2021
Author: Department of Health and Aged Care, Australian Government
The National Aboriginal and Torres Strait Islander Health Plan 2021–2031 aims to improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people over the next 10 years.
The National Aboriginal and Torres Strait Islander Health Plan was developed in full and genuine partnership led by Aboriginal and Torres Strait Islander people.
Year: 2020
Author: Australian Health Practitioner Regulation Agency
The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020–2025 aims to produce consistency and quality improvement in matters of Aboriginal and Torres Strait Islander health and cultural safety across the Ahpra National Registration and Accreditation Scheme.
Year: 2022
Author: Cancer Australia, Australian Government
Our Mob and Cancer was developed for Aboriginal and Torres Strait Islander people by Aboriginal and Torres Strait Islander people to consolidate information about cancer, including cancer types, prevention, diagnosis, treatment, living with cancer, finding support and clinical trials.
Year: 2018
Author: Cancer Australia, Australian Government
The Optimal Care Pathway (OCP) for Aboriginal and Torres Strait Islander people with Cancer provides guidance to health practitioners and service planners on optimal care for Aboriginal and Torres Strait Islander people with cancer across the cancer continuum. This guide was developed to complement tumour-specific OCPs and intends to support the delivery of health services that are culturally safe and responsive.
Development of the OCP was undertaken in partnership with Aboriginal and Torres Strait Islander people including researchers, policymakers, health professionals and community.
Year: 2015
Author: Cancer Australia, Australian Government
The National Aboriginal and Torres Strait Islander Cancer Framework (the Framework) provides high-level guidance and direction for the many individuals, communities, organisations, and governments whose combined efforts are required to address disparities and improve cancer outcomes for Aboriginal and Torres Strait Islander peoples.
Development of the Framework was undertaken in partnership with Aboriginal and Torres Strait Islander people including researchers, policymakers, health professionals and community.
Year: 2022
Author: Department of Health and Aged Care, Australian Government
Co-designed with Aboriginal and Torres Strait Islander people, the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan aims for Aboriginal and Torres Strait Islander people to be fully represented in the health workforce by 2031. It includes actions to attract, recruit, and retain workers across all roles, levels, and locations within the health sector.
Year: In development
Author: Department of Health and Aged Care, Australian Government
The Aboriginal and Torres Strait Islander Genomics Health Guiding Principles (the Guiding Principles) and the associated Guiding Principles Summary has been developed by the Aboriginal Torres Strait Islander Advisory Group on Health Genomics.
The Guiding Principles aim to support policymakers, researchers, clinicians and Aboriginal and Torres Strait Islander communities to deliver culturally safe and accessible clinical genomics services and genomics research activities for Aboriginal and Torres Strait Islander people. This framework is currently under development.
Year: 2016
Author: Australian Health Ministers’ Advisory Council
The Cultural Respect Framework commits the Commonwealth Government and all states and territories to adopt cultural respect principles into their health systems from developing policy and legislation through to the planning and delivery of services.
Year: In development
Author: Australian Centre for the Prevention of Cervical Cancer
The National Strategy for the Elimination of Cervical Cancer will aim to eliminate cervical cancer for all people with a cervix across the diverse communities in Australia.
To improve cancer outcomes for Aboriginal and Torres Strait Islander people, stakeholders identified that it is critical to address the racism and discrimination experienced by Aboriginal and Torres Strait Islander people across the health system. Addressing the cultural determinants of health and the social determinants of health and providing culturally safe and appropriate screening approaches and early detection programs, including those which take into consideration broader family and community, could further improve cancer outcomes for Aboriginal and Torres Strait Islander people.
Connecting with Aboriginal and Torres Strait Islander communities to maximise cancer prevention among Aboriginal and Torres Strait Islander people was considered important. Ways to connect with Aboriginal and Torres Strait Islander communities include engaging with Aboriginal and/or Torres Strait Islander Health Services, organisations and health professionals.
To improve cancer outcomes for Aboriginal and Torres Strait Islander people, stakeholders identified that it is critical to address the racism and discrimination experienced by Aboriginal and Torres Strait Islander people across the health system. Addressing the cultural determinants of health and the social determinants of health and providing culturally safe and appropriate screening approaches and early detection programs, including those which take into consideration broader family and community, could further improve cancer outcomes for Aboriginal and Torres Strait Islander people.
Connecting with Aboriginal and Torres Strait Islander communities to maximise cancer prevention among Aboriginal and Torres Strait Islander people was considered important. Ways to connect with Aboriginal and Torres Strait Islander communities include engaging with Aboriginal and/or Torres Strait Islander Health Services, organisations and health professionals.
Stakeholders observed that increasing equitable access to culturally safe cancer care was crucial to addressing institutional racism and discrimination within Australia’s health system. Greater availability of trusted, culturally safe services is regarded as central to improving quality of life and cancer outcomes.
Improving community knowledge about cancer, prevention, treatments, and survivability would contribute to improved outcomes. Benefits emphasised included community-based action, engagement, and empowerment to build understanding for Aboriginal and Torres Strait Islander people affected by cancer, along with their families, carers, and community.
Remoteness and affordability were raised as factors significantly impacting the ability of Aboriginal and Torres Strait Islander people to readily access cancer care.
Aboriginal and Torres Strait Islander people are a heterogenous group, and their voices should help guide a system of optimal care. They have poor access to culturally appropriate supportive care, treatment, and palliative care due to systemic barriers, including racism and discrimination.
Stakeholders highlighted the need to implement consistent approaches to identify Aboriginal and Torres Strait Islander people in data and health systems, and nationally consistent legislation on health data privacy and health information law. The need to ensure Indigenous Data Sovereignty by implementing Aboriginal and Torres Strait Islander governance of the collection and use of cancer data and research was emphasised.
Barriers to closing the gap in outcomes for Aboriginal and Torres Strait Islander people include the lack of Indigenous Data Sovereignty and access to cancer clinical trials.
Stakeholders also noted the need to invest in cancer research seeking to understand health inequities in Aboriginal and Torres Strait Islander people.
Stakeholders emphasised that health professionals providing cancer care to Aboriginal and Torres Strait Islander people need to be trauma-aware, healing-informed and culturally safe and responsive, to ensure that the delivery of cancer care meets the needs of Aboriginal and Torres Strait Islander people.
There should be greater integration of cancer care services with care provided by Aboriginal Community Controlled Health Services and other Aboriginal and Torres Strait Islander health bodies.
In terms of the Aboriginal and Torres Strait Islander workforce, the number of Aboriginal and Torres Strait Islander people working in cancer care should be increased through a focus on recruitment, retention, and building capability.
Stakeholders noted that there needs to be greater recognition of the existing Aboriginal and Torres Strait Islander workforce, including recognising their strengths and the role they play in cancer care.
The Australian Cancer Plan considers an intersectional and health equity approach for Aboriginal and Torres Strait Islander people. This is more than recognising the multiple backgrounds, experiences, and ways Aboriginal and Torres Strait Islander people identify. This approach addresses the way membership of multiple groups may impact people's health and wellbeing needs and ability to access care.
Implementation of each action should consider the compounding impacts of intersectionality across other priority population groups.