Describe the health issue
Discuss about the Nursing Public Health for Australian Institute Health and Welfare.
Bowel cancer or colorectal cancer has become one major public health issue in Australia due to the high prevalence of incidence in Australia. Bowel cancer was the third most diagnosed type of cancer in Australia in 2013 and it is estimated to become the second most commonly diagnosed cancer in Australia. The rate at which incidence of bowel cancer is increasing is understood from the fact that 6, 986 cases were reported in 1982 compared to 14, 962 cases in 2013 (Australian Institute Health and Welfare (AIHW) 2017). It is estimated that around 17, 000 new cases of colorectal cancer will be diagnosed in Australia in 2018. In 2014, bowel cancer was the second leading cause of death contributing to about 4, 071 deaths in Australia. The age standardized mortality rate in 2014 was 15 deaths per 100, 000 person and it is estimated that deaths from colorectal cancer is expected to increase to 4, 129 cases by 2018 (Australian Government| Cancer Australia 2018)).
Another issue for Australia is inequalities in bowel cancer incidence and mortality rate. For all types of cancer, the age standardized incidence rate and mortality rate for all cancer is higher for indigenous Australians compared to non-indigenous Australian (Young et al. 2015). For indigenous Australians, the highest five year prevalence rate was found for colorectal cancer in 2013. 612 new cases for colorectal cancer was diagnosed in indigenous Australian in 2009-2013. The disparities in colorectal cancer incidence is also understood from the fact that indigenous Australians diagnosed with colorectal cancer has 58% chances of survival compared to 67% survival chance for non-indigenous Australians (AIHW 2018).
There is different modifiable and inherited risk factor for the development of colorectal cancer. Firstly, the risk increases with age and people above 50 years are more likely to be suffering from bowel cancer. Secondly, smoking, alcohol consumption, obesity and physical activity are some modifiable risk factor for developing bowel cancer. Increased prevalence of smoking and alcohol consumption are the contributing factor for increases in new cases of bowel cancer in indigenous Australians. Cigarette smoking is one of the common risk factor for colorectal cancer and direct association between cigarette smoking and risk of bowel cancer has been established in research (Wei, Lin and Chang 2011). Tobacco use is widespread among the Aboriginal and Torres Strait Islander people. About 39% of indigenous people above 15 years were daily smokers in 2015 and people living in remote areas were more likely to smoke compared to those in non-remote areas (Greenhalgh, Bayly and Winstanley 2017). Hence, for this reason, smoking is one of the influencing factors for increases risk of bowel cancer in indigenous population.
Influencing factors for a marginalized group
Chronic alcohol use is also an important factor contributing to disparities. According to 2012-2013 Health Survey, indigenous Australians rate for single occasion risk guidelines was 1.1 times higher than non-indigenous groups (pmc.gov.au 2017). Ahmed, Shahid and Episkenew (2015) gave evidence regarding increased risk of several cancers as well as colorectal cancer due to chronic alcohol consumption. Poor socioeconomic condition of aboriginal people can also be linked greater rate of alcohol consumption and risk of cancers. Experience of poverty, discrimination and physical violence increases risk of alcohol use in the target population group (Beckmann et al. 2015). Another reason for poor survival chances of indigenous Australians for bowel cancer is the disparities observed in participation for bowel screening. Unequal participation in bowel screening affects the rate of cancer incidence and mortality in indigenous Australians. Poor attendance in bowel screening reduces the likelihood of receiving treatment and delayed diagnosis too. The cumulative effect of this entire factor is high likelihood of bowel cancer diagnoses with poor survival rate. Due to presence of such risk factors, disparities have been observed in incidence rate of colorectal cancer.
The National Bowel Cancer Screening program is one health promotion campaign in Australia that is working to reduce the prevalence of bowel cancer cases in Australia. It is a population based screening program and the main aim and objective of the program is to promote early detection of bowel cancer and reduce the rate of mortality due to bowel cancer in Australia. The main features of the program is providing screening to people without any obvious symptoms and detect cancer at an early stage so that it is easy to treat. The immunochemical Faecal Occult Blood Test (FOBT) is the main test that is used in the program. The test detects blood in faeces after taking a sample of faeces. The FOBT kit is sent to eligible people by mail and the response is sent back to laboratory for analysis. Patients with positive test need to visit clinician and follow-up services for discussion on treatment. A National Program Register has been created that that collects data related to diagnosis and survival rate. It supports at risk individual to get free screening every two years and increase their chances of survival (cancerscreening.gov.au 2018).
The National Bowel Cancer Screening Program has been launched for reducing bowel cancer incidence for Australian population. The program is expanding and targeting to cover all Australians between 50 and 74 years of age by 2020. The program began in 2006 and till 2014, 2.5 million Australians were screened for bowel cancer and 3 , 989 people were found to be have suspected or confirmed cases. The outcome of the program revealed that people were screening had 15% less risk of dying from bowel cancer and they were less likely to be diagnosed with advanced stage of bowel cancer (cancerscreening.gov.au 2018). The review of the effectiveness of the National screening program for Aboriginal and Torres Strait Islander people has revealed that the participation rate of the marginalized group was 23.5% compared to 40% for other Australians. Hence, the program has been effective, however it has failed to maintain equity in participation rate. The main barrier that has been identified in the process is cultural barrier to screening process. For example, Aboriginal and Torres Strait Islander people were embarrassed about taking a faecal sample. There were also concerns regarding the use of sample for black magic or surgery Australians (Christou, Katzenellenbogen and Thompson 2010). Hence, lack of cultural sensitivity in the screening programs affected equal participation of indigenous group in the program (Sun et al. 2018)
Health promotion campaign to address the health issue
As the national screening program was a population based program, the alignment of the program with the principles of primary health care is important. The five principles of primary health care is accessibility, community participation, health promotion, appropriate use of technology and inter-sectoral collaboration (McMurray and Clendon 2015). The program has addressed the principle of accessibility by providing screening test to all Australian population by means of mail. It has also addressed community participation and inter-sector principle by involving GPs, health care staffs and other staffs in follow-up health services and data collection process. Equity is one prerequisite of good health and the addressed inequity by targeting universal or free screening for all. This helped to increase screening rate for bowel cancer and address. Appropriate use of technology is another principle which involves used of technology that is affordable, feasible and culturally acceptable. However, the screening program overlooked cultural acceptability factor while selecting the kit for screening. Due to lack of consideration regarding cultural acceptability of the program, the acceptance rate of the program was low for the marginalized group of indigenous Australians (Christou, Katzenellenbogen and Thompson 2010).
After reviewing the impact of the National Bowel Cancer Screening Program on screening rate and diagnosis of bowel cancer, it has been found that the program has helped to increase screening process and reduce risk of dying from bowel cancer by 15%. However, by comparing the outcome between indigenous and non-indigenous Australians, it has been found that equal participation rate was not achieved for indigenous Australia. Lack of cultural sensitivty affected the optimal performance of the program. As many cultural concerns such as hesitance to talk about fecal sample and risk of sorcery influence the participation rate, it is recommended to involve general practitioners in giving information about screening. Furthermore, preference of indigenous people regarding talking with male or female GPs or non-indigenous clinician should be considered to increase participation rate. Hence, it is recommended to involved GP in screening process to positively influence participation in bowel screening using FOBT.
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Citation details (author, year, title, journal, volume, issue, pages) |
Unbiased summary including main findings of research |
Critique of text including strengths, weaknesses and significance. |
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Christou, A., Katzenellenbogen, J.M. and Thompson, S.C., 2010. Australia’s national bowel cancer screening program: does it work for indigenous Australians?. BMC public health, 10(1), p.373. |
The research article investigated about the characteristics of National Bowel Cancer Screening Program resulting in discrepancies in uptake and analysis of organization and socio-cultural barrier in poor participation rate. The review of journal articles revealed that the program is not reaching Indigenous Australians due to nature of the test and cultural perceptions of cancer. By evidence regarding lack of cultural sensitivity in the program, the research gave the implication regarding modifying the content of the program to address the social and cultural needs of Aboriginal people. |
The main weakness of the program is the use of literature review method to evaluate the finding. However, the strength of the program is that it gave evidence regarding ways to increase participation rate of indigenous Australians in the program. The significance of the study is that it gives the right guidance to modify the content of the program. |
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Sun, J., March, S., Ireland, M.J., Crawford?Williams, F., Goodwin, B., Hyde, M.K., Chambers, S.K., Aitken, J.F. and Dunn, J., 2018. Socio?demographic factors drive regional differences in participation in the National Bowel Cancer Screening Program–An ecological analysis. Australian and New Zealand journal of public health, 42(1), pp.92-97. |
Another study examined geographic variations in participations rate in the national bowel screening program. The date related to participation was extracted from local government areas and analysed. The study finding revealed poor participation rate in remote areas compared to other areas. The study gave the indication that indigenous status and cultural background are important drivers of disparities in participation. |
The weakness of the study is it ecological study design which could not establish true association. However, the strength of the study is that gave novel evidence regarding the reasons for regional variation in participation. The research is significant as it given implication to use culturally relevant strategies to implement health promotion program. |
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Ahmed, S., Shahid, R. K., and Episkenew, J. A. 2015. Disparity in cancer prevention and screening in aboriginal populations: recommendations for action. Current Oncology, 22(6), 417. |
The study reports about disparities in cancer prevention and screening in aboriginal population. The study gives theoretical perspective regarding health determinant and challenges in cancer care for aboriginal population. |
The weakness of the study is the lack of primary research method for analysis. However, the strength is string discussion on risk of cancer by linking it with health determinant factor. The significance is the direction given to eliminate disparities in cancer control and prevention. |
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Wei, P. L., Lin, S. Y., and Chang, Y. J. 2011. Cigarette smoking and colorectal cancer: from epidemiology to bench. Journal of Experimental & Clinical Medicine, 3(6), 257-261. |
The study discussed about the link between cigarette smoking and colorectal cancer. It provides a review of epidemiological studies to prove the positive association between cigarette smoking and colorectal cancer. |
The strength of the study is strong evidence to prove positive association between cigarette smoking and colorectal cancer. By showing the impact of nicotine on inducing colon cancer growth, the study gives the implication to consider cigarette smoking in prevention strategies for colorectal cancer. |
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Young, J.P., Win, A.K., Rosty, C., Flight, I., Roder, D., Young, G.P., Frank, O., Suthers, G.K., Hewett, P.J., Ruszkiewicz, A. and Hauben, E., 2015. Rising incidence of early?onset colorectal cancer in Australia over two decades: Report and review. Journal of gastroenterology and hepatology, 30(1), pp.6-13. |
The study aimed to investigate about the rise in prevalence of colorectal cancer in Australia. By means of systematic review of literature, the study gave detail regarding potential risk factor of colorectal cancer in young adults. |
The research has significant implication in public health as it gives the implication to increase patient awareness aided by stool and screening test for early detection of colorectal cancer. |
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Beckmann, K.R., Bennett, A., Young, G.P., Cole, S.R., Joshi, R., Adams, J., Singhal, N., Karapetis, C., Wattchow, D. and Roder, D., 2015. Socio-demographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study. BMC health services research, 16(1), p.24. |
The study examined socio-demographic differences in survival for colorectal cancer in South Australia. By using population wise data base, the socioeconomic status (area level), geographical remoteness, clinical characteristics, comorbid conditions, treatments and outcomes were assessed. The disparities were reported in terms of socioeconomic group and area of residence. |
The limitation of the study was inability to account for lifestyle risk and treatment difference on outcome. The strength is establishing link between remoteness, socioeconomic characteristics and disparities. The study is significant as it gives implication to identify cause of disparities. |
Reference:
Ahmed, S., Shahid, R. K., and Episkenew, J. A. 2015. Disparity in cancer prevention and screening in aboriginal populations: recommendations for action. Current Oncology, 22(6), 417.
AIHW 2018. Cancer in Aboriginal & Torres Strait Islander people of Australia. Retrieved from: https://www.aihw.gov.au/reports/cancer/cancer-in-indigenous-australians/contents/cancer-type/colorectal-cancer-c18-c20
Australian Government| Cancer Australia 2018. Bowel cancer statistics. Retrieved from: https://bowel-cancer.canceraustralia.gov.au/statistics
Australian Institute Health and Welfare (AIHW) 2017. Cancer compendium: information and trends by cancer type. Retrieved from: https://www.aihw.gov.au/reports/cancer/cancer-compendium-information-and-trends-by-cancer-type/report-contents/colorectal-cancer-in-australia
Beckmann, K.R., Bennett, A., Young, G.P., Cole, S.R., Joshi, R., Adams, J., Singhal, N., Karapetis, C., Wattchow, D. and Roder, D., 2015. Sociodemographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study. BMC health services research, 16(1), p.24.
cancerscreening.gov.au 2018. National Bowel Cancer Screening Program – Fact sheet
Christou, A., Katzenellenbogen, J.M. and Thompson, S.C., 2010. Australia’s national bowel cancer screening program: does it work for indigenous Australians?. BMC public health, 10(1), p.373.
Greenhalgh, EM, Bayly, M, and Winstanley, 2017. Prevalence of tobacco use among Aboriginal peoples and Torres Strait Islanders. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues.. Available from https://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-9-prevalence-of-tobacco-use-among-aboriginal-peo
McMurray, A. and Clendon, J., 2015. Community Health and Wellness-E-book: Primary Health Care in Practice. Elsevier Health Sciences.
pmc.gov.au 2017. ABORIGINAL AND TORRES STRAIT ISLANDER
HEALTH PERFORMANCE FRAMEWORK 2017 REPORT. Retrieved from: https://www.pmc.gov.au/sites/default/files/publications/indigenous/hpf-2017/tier2/216.html
cancerscreening.gov.au 2018. National Bowel Cancer Screening Program – Fact sheet
Retrieved from: https://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/nbcsp-fact-sheet
Sun, J., March, S., Ireland, M.J., Crawford?Williams, F., Goodwin, B., Hyde, M.K., Chambers, S.K., Aitken, J.F. and Dunn, J., 2018. Socio?demographic factors drive regional differences in participation in the National Bowel Cancer Screening Program–An ecological analysis. Australian and New Zealand journal of public health, 42(1), pp.92-97.
Wei, P. L., Lin, S. Y., and Chang, Y. J. 2011. Cigarette smoking and colorectal cancer: from epidemiology to bench. Journal of Experimental & Clinical Medicine, 3(6), 257-261.
Young, J.P., Win, A.K., Rosty, C., Flight, I., Roder, D., Young, G.P., Frank, O., Suthers, G.K., Hewett, P.J., Ruszkiewicz, A. and Hauben, E., 2015. Rising incidence of early?onset colorectal cancer in Australia over two decades: Report and review. Journal of gastroenterology and hepatology, 30(1), pp.6-13.
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