Supporting 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.
Equity in cancer outcomes is central to the Australian Cancer Plan (the Plan). If the Plan does not shift the dial for those whose outcomes are poorest, it will not have been successful.
Aboriginal and Torres Strait Islander people are more likely to be diagnosed with cancer, have poorer survival outcomes, and die from cancer when compared to non-Indigenous Australians.[1] Every day around five Aboriginal and Torres Strait Islander people are diagnosed with cancer.[1] Aboriginal and Torres Strait Islander people are approximately 40% more likely to die from cancer than non-Indigenous Australians, and the gap is widening.[1]
This Strategic Objective of Achieving Equity in Cancer Outcomes for Aboriginal and Torres Strait Islander people complements the ambitions, goals, and actions identified for Strategic Objectives 1–5 which apply to all Australians including Aboriginal and Torres Strait Islander people. The development of this Strategic Objective has been co-led by Aboriginal and Torres Strait Islander people and Cancer Australia’s Leadership Group on Aboriginal and Torres Strait Islander Cancer Control.
Underpinning the development of the 10-year ambition and 5-year and 2-year goals for this Strategic Objective was the recognition of issues relating to Aboriginal and Torres Strait Islander people that need to be embedded in the Plan. These include:
Equity in cancer outcomes for Aboriginal and Torres Strait Islander people cannot be achieved through piecemeal action. It can only be achieved through concerted and collaborative effort throughout Australia and across the cancer care ecosystem.
Aboriginal and Torres Strait Islander people and communities are diverse. This diversity includes distinct language, kinship and cultural traditions, religious beliefs, family responsibilities, and personal histories and experiences. Importantly, this diversity also extends to the health needs of Aboriginal and Torres Strait Islander people and communities.
Supporting 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.
In achieving this ambition, Aboriginal and Torres Strait Islander people affected by cancer will have equitable health outcomes.
The knowledge of Aboriginal and Torres Strait Islander people will be valued and built upon to design and embed a culturally appropriate cancer care system that will provide consistent and culturally safe care.
All Aboriginal and Torres Strait Islander people will experience their care free from discrimination. They will engage with and be served by a system that respects the diversity of Aboriginal and Torres Strait Islander people including their culture, their right to self-determination, geographical location, age, gender, sexual orientation, health status and education level.
Collaborative partnership and cross-sector approaches are developed and enhanced at the system, service and individual level; individual and institutional racism and discrimination across cancer services are identified and addressed.
In achieving this 2-year goal, health services and systems will be informed by active and meaningful partnerships and engagement with Aboriginal and Torres Strait Islander people with cancer including their carers, families and communities to move towards the 5-year goal and realise the 10-year ambition.
Approaches will be embedded within and across health systems and cancer care services, and at the individual health professional level.
As with the development of the Plan, collaborative partnerships and a variety of formal and informal mechanisms are utilised to facilitate Aboriginal and Torres Strait Islander involvement in developing and implementing cultural safety across standards of care.
Individual and institutional racism and discrimination will be called out and addressed, recognising that different forms of discrimination can coexist and impact the experience of racism.
Collaborative partnership and cross-sector approaches are developed and enhanced at the system, service and individual level; individual and institutional racism and discrimination across cancer services are identified and addressed.
In achieving this 2-year goal, health services and systems will be informed by active and meaningful partnerships and engagement with Aboriginal and Torres Strait Islander people with cancer including their carers, families and communities to move towards the 5-year goal and realise the 10-year ambition.
Approaches will be embedded within and across health systems and cancer care services, and at the individual health professional level.
As with the development of the Plan, collaborative partnerships and a variety of formal and informal mechanisms are utilised to facilitate Aboriginal and Torres Strait Islander involvement in developing and implementing cultural safety across standards of care.
Individual and institutional racism and discrimination will be called out and addressed, recognising that different forms of discrimination can coexist and impact the experience of racism.
Priority is given to accountability for the delivery of culturally safe services by all health professionals; training opportunities and support programs are established for Aboriginal and Torres Strait Islander health professionals in the cancer sector.
In achieving this 5-year goal, the pathway to equity in cancer outcomes will be progressed through ongoing engagement with, and leadership by, Aboriginal and Torres Strait Islander people and communities. This will be achieved through two specific areas of focus.
Stakeholders raised a number of considerations in relation to achieving equity in cancer outcomes for Aboriginal and Torres Strait Islander people.
While some of these considerations have been captured under Strategic Objectives 1–5, a critical issue highlighted by stakeholders was that system-level barriers exist for Aboriginal and Torres Strait Islander people, including limited access to culturally safe services, systemic racism, discrimination, and social factors such as income inequality.
The provision of culturally safe and accessible cancer care to Aboriginal and Torres Strait Islander people must be prioritised, including through greater support for the Aboriginal and Torres Strait Islander health workforce.
The delivery of culturally safe care by the broader cancer workforce is also key to improving equity for Aboriginal and Torres Strait Islander people. Education, training, and engagement programs, as well as the development of information and resources, must be co-designed with Aboriginal and Torres Strait Islander stakeholders.
Identifying service gaps and areas of excellence to inform continuous improvement across the cancer system could strengthen the evidence base to assess the experiences, effectiveness, and appropriateness of cancer-related services for Aboriginal and Torres Strait Islander people.
For Aboriginal and Torres Strait Islander people, culturally safe care as close to home as possible is critical. Travel away from home, including access to appropriate accommodation for patients and carers, can be an insurmountable barrier to accessing cancer care.
Additionally, stakeholders recommended a strengths-based approach to addressing disparities in cancer outcomes for Aboriginal and Torres Strait Islander peoples and a close alignment to the National Agreement on Closing the Gap.[8]