Indigenous Health Issues in Australia

This assignment delves into the complex health challenges faced by Indigenous Australians, with a particular emphasis on the disproportionate rates of lung cancer within these communities. The provided research papers shed light on social determinants of health, cultural influences, smoking prevalence, and limited access to healthcare that contribute to these disparities. Understanding these factors is crucial for developing effective interventions and improving health outcomes for Indigenous populations.

Running head: PROGRAM DESIGN
PROGRAM DESIGN: LUNG CANCER AMONG INDIGENOUS COMMUNITIES IN
ARNHEM LAND
Name of the Student
Name of the Author
Author Note

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Executive Summary
Tobacco smoking is highly prevalent among the indigenous communities of Arnhem land
located in Australia. Lung cancer is highly prevalent among the indigenous communities of the
region. Various socio-economic, lifestyle, behavioral and biomedical factors are the important
determinants associated with the increased incidence of lung cancer. This report describes a
program design in order to prevent tobacco smoking among the indigenous community. The
program designs involves a number of intervention strategies aimed to reduce tobacco smoking
and enhance knowledge about the risk factors associated with smoking. The report also provides
a logic model describing the various plans and their outcomes. Various evaluation questions are
put forth. Moreover, communication strategies are described for effective communication with
potential stakeholders and partners. This study therefore provides an effective strategy to reduce
tobacco smoking and lung cancer among indigenous Australians.

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Table of Contents
Introduction......................................................................................................................................3
Intervention strategies......................................................................................................................4
School and community interventions..........................................................................................5
Tobacco or smoking cessation programs.....................................................................................5
Training or educational interventions..........................................................................................6
Screening programs.....................................................................................................................6
Provision of proper treatments.....................................................................................................6
Behavioral and Pharmacologic interventions for pregnant women.............................................7
Logic Model.....................................................................................................................................7
Evaluation questions........................................................................................................................9
Questions at the end of 1 year......................................................................................................9
Questions at the end of the program..........................................................................................10
Communication strategies with stakeholders................................................................................10
Conclusion.....................................................................................................................................12
Reference List................................................................................................................................14

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Introduction
Cancer is a disease in which the cells of the body function abnormally and multiply at a
rapid rate. These abnormal cells invade the surrounding tissues with healthy cells and damage
them. The rapid multiplication rate of the abnormal cells helps in its spread to other parts of the
human body, eventually resulting in death. 1,24,465 cases of cancer were diagnosed in Australia
in the year 2013 and in 2017, 1,34,174 cases were estimated to be diagnosed
(Canceraustralia.gov.au, 2017).
In Australia, lung cancer is the fifth most commonly occurring cancer. Estimates reveal that there
will be 12,434 new lung cancer cases in Australia by the end of 2017 (Www.aihw.gov.au, 2017).
In Australia, lung cancer is the primary cause of deaths due to cancer. Arnhem Land is located in
the northern territory of Australia. The northern territory consists of 28.3% indigenous
Australians (Steenkamp et al. 2012). The various risk factors associated with lung cancer are
lifestyle, environmental and biomedical factors (Www.health.qld.gov.au, 2017). The lifestyle
factor includes tobacco smoking and physical activity. Environmental factors include passive
smoking, air pollution, asbestos and radon exposure. Biomedical factors include past history of
lung cancer and presence of lung diseases. The indigenous population smokes six times more
tobacco than the non-indigenous population. Ambient particles of less than 10μm in size arising
from bushfires affect the indigenous population. Moreover, air pollution due to traffic affects the
indigenous women who are pregnant more than the non-indigenous population
(Canceraustralia.gov.au, 2017). Indigenous Australians work in asbestos mines and as a result
they have the highest incidence of lung cancer (Franklin et al. 2016). Physical activity has also
been found to be associated with lung cancer. Physical inactivity is linked to major health

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concerns among the indigenous Australians and one of them is lung cancer (Berry et al. 2014).
Due to European influence, they led a more sedentary lifestyle, which resulted in them
developing chronic diseases.
This report describes the various interventions that can help prevent the occurrence of
lung cancer among indigenous Australians. Moreover, it presents a logic model, designs
questions for evaluation and defines communication strategies with stakeholder groups.
Intervention strategies
The natural flora of Australia consists of several plants having high contents of nicotine.
The indigenous people chew and consume these nicotine rich plants. One of these processed
nicotine products is ‘pituri’, which is made from the leaves of a shrub named Duboisia
hopwoodii (Moghbel 2016). This plant has a high nicotine content of approximately 8%. There
were many processing plants for ‘pituri’ manufacturing in different regions of Australia. The
indigenous people including children chewed other nicotine rich bush tobacco plants. Due to its
mood enhancing effect, ‘pituri’ became quite popular among the indigenous population as a
symbol of friendship and social bonding. It also helped them to suppress their appetite and
served as a painkiller. It was very important for the indigenous people and was considered the
gold standard in Indigenous trading (Dawson et al. 2012). Tobacco smoking reached Australia
when the Indonesian island fishermen first came here in search of ‘trepang’ and pearls. These
anglers offered the indigenous tribes, tobacco and smoking pipes. The custom of tobacco
smoking using pipes is still used by the indigenous population of the eastern part of Arnhem
Land. It is a major part of their ceremonial and social life (Wesley, O'CONNOR and Fenner
2016).

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Due to the high rates of smoking observed among the Yolngu community of the East
Arnhem Land, various intervention strategies are designed to reduce the occurrence of lung
cancer among these indigenous people (Pearson and Helms 2013). Low socio-economic status,
poor income, lack of education and high rates of unemployment are generally associated with
high smoking rates among the indigenous men and women (Shepherd, Li and Zubrick 2012).
School and community interventions
The indigenous youths of Australia, start smoking at an early age, which in turn increases
the risk of developing lung cancer and other chronic diseases. Various community interventions
as well as those in schools can be carried out in order to reduce tobacco consumption among the
younger generation of the indigenous community. Anti-tobacco programs can be carried out to
prevent smoking among the indigenous youths (Robertson et al. 2012).
Tobacco or smoking cessation programs
Culturally sensitive service programs are needed in order to reduce tobacco smoking
among the indigenous Australians. Moreover, because of their financial difficulties they are
unable to use these intervention services. Thus, nicotine replacement therapy (NRT) should be
freely provided to them in order to ensure that a large number of people adapt these intervention
strategies. The NRT involves the use of nicotine patches, gums, among others (Sørensen 2012).
These patches inject nicotine in the body without the need for smoking. However, smoking along
with the use of nicotine patches can result in a significant amount of nicotine in the body
resulting in serious consequences.

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Training or educational interventions
The indigenous people have misconceptions about cancer and this prevents them
to adopt the various intervention programs. Thus, various training and education programs can
be carried out in order to provide them with resources that would enhance their knowledge about
cancer, particularly lung cancer and the serious health risks associated with it. Various
psychosocial factors play important roles in preventing the indigenous people from taking
treatments (Thewes et al. 2016). These include false beliefs they have about cancer outcomes
and that cancer is contagious. These programs should address the indigenous people by being
respectful to their culture and their traditional healing techniques and medicines.
Screening programs
Various screening programs can be carried out to diagnose the presence of lung cancer
among the indigenous people. Moreover, it would also help to determine the stage of the cancer
and thus proper treatments can be carried out. Free screening programs involving the use of
computed tomography scans and chest X-rays help to determine the stages of lung cancer in
these individuals (Davidson et al. 2012). Since, the indigenous population suffers from poor
transportation, free mobile screening services should be provided to them. Moreover,
transportation should be made available to them so that they can reach the screening centers
(Infrastructure.gov.au, 2017).
Provision of proper treatments
Proper treatments can be provided to the indigenous Australian population by creating
links between government cancer services and the indigenous health services.

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Behavioral and Pharmacologic interventions for pregnant women
Pregnant indigenous women also consume large amounts of tobacco through smoking.
Various socio-economic factors play an important role. Poor income, lack of education and
unemployment causes these women to take up smoking. Moreover, depression and various
stressful situations also enhance smoking rates among the women (Passey et al. 2013). These
approaches provide counseling, financial help and self-help strategies to these women.
Moreover, free NRT should be provided to them in order to enable them to quit smoking.
Moreover, they should also be educated about the ill effects of smoking on the developing fetus.
Smoking gives rise to rise to various birth deformities and low birth weight babies. It is
necessary to inform them about these consequences associated with smoking.
Logic Model
A logic model provides an overall view of the program planned to carry out intervention
strategies concerning a particular issue. It provides the information about the extent of the
problem, the risk factors, barriers, necessary resources, target groups and the probable outcomes
that will be associated with the intervention strategies carried out. The logic model summarizes
the abundance of lung cancer cases among the indigenous population. It provides the key
determinants or factors that may be responsible for the high incidence of lung cancer among the
population like environmental, lifestyle and biomedical factors. It also defines the barriers that
pose a problem to the indigenous community members in getting proper treatments and facilities.
These include the socio-economic problems, misconceptions and poor transport facilities. It
describes the resources needed for the intervention program like lung cancer screening
equipments, provisions to carry out NRT, funding, experts like doctors, researchers, nurses,
stakeholders and partners.

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Lung cancer in
Indigenous population Resources
Interventions and
target groups
Outcomes
Estimated 1,34,174 cases of cancer in 2017 of which 12,434 estimated lung cancer cases.
tors:
bacco smoking and lack of physical activity.
like working in asbestos mines, air pollution from bush fires.
past history and presence of lung diseases.
ons.
s.
ted with cancer and its outcomes
Lung cancer screening techniques like computed tomography scan, chest X-Ray.
Supply of nicotine patches and gums.
Funding
Experts like doctors, researchers and nurses
Stakeholders and Partners
School and community interventions, anti-tobacco programs.
Targets: Children, teenagers and adults
Nicotine replacement therapy (NRT).
Targets: Children, teenagers and adults
Training and education
Targets: Children, teenagers and adults
Screening programs and treatments
Targets: Adults, particularly pregnant women.
Counseling, financial help, self-help strategies, education about smoking related birth deformities, free transport
Targets: Women, particularly pregnant women.
Enhanced knowledge and skills of healthcare staff.
Enhanced knowledge of the indigenous population about health risks associated with tobac
Early diagnosis of lung cancer
Reduction in smoking among children, pregnant w
Reduced rates of lung cancer
Better transportation, education and employment
Logic Model

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The logic model also summarizes the necessary strategic interventions and the target
population. Lastly, the logic model defines the various outcomes of the interventions. The
outcomes of these interventions can be enhanced knowledge and improved skills of the
healthcare workers, enhanced knowledge of the indigenous population, use of nicotine patches
that help to carry out a successful NRT, increased awareness about the health risks associated
with tobacco smoking, early detection of lung cancer and other lung diseases. The long term
effects of the intervention strategies may involve reduced tobacco smoking among the
indigenous community, particularly the children and teenagers, reduced rates of smoking among
pregnant women and subsequently, there will be reduced rates of lung cancer related deaths
among the indigenous communities in Australia.
Evaluation questions
It is necessary to carry out evaluation programs in order to determine the knowledge,
behaviour and attitude of the indigenous population. These evaluations can be carried out in the
form of questionnaires that can be distributed among school students and the indigenous adults
attending the intervention program.
Questions at the end of 1 year
The questions that can be asked at the end of 1 year of the intervention program are as
follows:
(1) What are the concepts and beliefs associated with cancer?
(2) What are the reasons behind tobacco smoking among the Indigenous population and the
health risks associated with tobacco smoking?

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Questions at the end of the program
The questions that can be asked at the end of the intervention program are as follows:
(1) What were the barriers that prevented participation in the intervention program?
(2) Was the intervention program culturally sensitive and did it respect the cultural and social
norms of the indigenous population?
(3) What is the smoking frequency and what are the side-effects associated with the therapy or
treatment?
Communication strategies with stakeholders
Various interventions are needed to prevent or reduce the consumption of tobacco among
the Indigenous population of Australia. In order to ensure the success and continuation of the
intervention program, stakeholders and partners are needed who are interested in the program
and can provide the necessary resources to carry out the interventions successfully.
Appropriate and effective communication strategies are needed to engage and maintain
contact with key stakeholders and partners associated with the intervention programs. Meetings
and conferences need to be carried out with the stakeholders in order to consult and discuss the
effectiveness and improvements that can be done in association with the intervention programs
(Www.ag.gov.au, 2017)
The key stakeholders should include both indigenous and non-indigenous populations.
The primary stakeholders who can be associated with the program for tackling smoking among
the indigenous population are the board members of grant receiving organizations, health service
staff, teachers, recreation and sport workers, the youth, indigenous community leaders and staff
from indigenous health organizations.

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The secondary stakeholders may include the representatives from different states
involved with intervention program, representatives from health departments and indigenous
community members. Other stakeholders can include the community elders, store managers,
researcher, and scientists, among others. Proper communication about the outcomes of the
intervention program would attract the stakeholders to carry out such programs in the future.
Their interest and support would help to eradicate the smoking problems associated with the
indigenous Australian population. Stakeholders may also contribute in effective program
planning in support of the intervention.
Some of the stakeholders could include the Planning and Population Health Directorate,
Ambulatory and Primary Health Care Directorate, South Eastern Sydney Local Health District
Facility and Clinical service councils like the mental health council, Royal hospital for women
clinical council, among others. Others may include the committees steering the smoke free
facilities, cancer facilities, governance committees like district executive teams, directors of
nursing meeting, among others. Others are the nursing and midwifery board and the New South
Wales cancer institute (Www.seslhd.health.nsw.gov.au, 2017)
Effective partnerships are also needed to ensure the successful running of the program.
The partners provide the necessary resources to carry out the program effectively. These partners
include the clinical and community health care services, general practitioners, nurses, non-
government organizations, indigenous organizations, local governments, cancer institutes, among
others (Minichiello et al. 2016). An advisory board can be generated consisting of indigenous
members who can determine the efficacy of the intervention program and ensure that the
program is based keeping in mind the social and cultural practices of the community.

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Apart from meetings and conferences, potential stakeholders and partners can be
informed through mass media like electronic communication channels, social media, among
others.
Conclusion
Tobacco smoking is highly prevalent among the indigenous communities in Australia.
This report describes the prevalence of lung cancer among the indigenous populations in Arnhem
Land located in the northern territory of Australia. The indigenous population considers tobacco
smoking to be a part of their social custom and as a result, this causes the incidence of tobacco
smoking to be more prevalent among them than the non-indigenous population. Various
lifestyles, environmental and biomedical factors are responsible for the significant number of
lung cancer cases that arise from the indigenous communities. Moreover, poor socio-economic
conditions are also the reasons associated with increased rates of smoking among the indigenous
communities. Pregnant women of the indigenous population are also involved in smoking
tobacco, which poses a serious risk to their unborn child. Moreover, they have various
misconceptions about cancer and its outcomes. The barriers that prevent them to get health
services include beliefs, social customs, poor education and lack of proper transport facilities.
This study provides the various intervention strategies like education and training, NRT, anti-
tobacco programs, screening programs, counseling, among others. The need to provide them
with free screening programs and transport facilities are also described in this report. A logic
model has been provided that defines the various strategies, resources and outcomes of the
intervention program. Moreover, evaluation questions are also provided that would help to
determine the success of the intervention strategies. Finally, communication strategies are
necessary to inform the potential stakeholders and partners about the outcome of the various

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interventions. Thus, it is necessary to design an efficient program with the help of various
government and non-government organizations to ensure that the number of lung cancer cases
decreases among the indigenous Australians.

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Reference List
Berry, N.M., Miller, M.D., Woodman, R.J., Coveney, J., Dollman, J., Mackenzie, C.R. and
Koczwara, B., 2014. Differences in chronic conditions and lifestyle behaviour between
people with a history of cancer and matched controls. The Medical Journal of
Australia, 201(2), pp.96-100.
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Davidson, P., Luckett, T., Newton, P., Agar, M., Daly, L. and Sibbritt, D., 2012. Best
practice in early assessment and diagnosis of lung cancer: a rapid review. Cancer.
Dawson, A.P., Cargo, M., Stewart, H., Chong, A. and Daniel, M., 2012. Aboriginal health
workers experience multilevel barriers to quitting smoking: a qualitative study. International
journal for equity in health, 11(1), p.27.
Franklin, P., Reid, A., Olsen, N., Peters, S., de Klerk, N., Brims, F., Threlfall, T., Murray, R.
and Musk, A.B., 2016. Incidence of malignant mesothelioma in Aboriginal people in
Western Australia. Australian and New Zealand journal of public health, 40(4), pp.383-387.
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Oct. 2017].

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Minichiello, A., Lefkowitz, A.R., Firestone, M., Smylie, J.K. and Schwartz, R., 2016.
Effective strategies to reduce commercial tobacco use in Indigenous communities globally: a
systematic review. BMC public health, 16(1), p.21.
Moghbel, N., 2016. Investigations into the pituri plant: nicotine content, nicotine conversion
to nornicotine, nicotine release and cytotoxicity of Australian native Nicotiana spp.
Passey, M.E., Bryant, J., Hall, A.E. and Sanson-Fisher, R.W., 2013. How will we close the
gap in smoking rates for pregnant Indigenous women?. The Medical Journal of
Australia, 199(1), pp.39-41.
Pearson, C.A. and Helms, K., 2013. Indigenous social entrepreneurship: The Gumatj clan
enterprise in east Arnhem land. The Journal of Entrepreneurship, 22(1), pp.43-70.
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Sørensen, L.T., 2012. Wound healing and infection in surgery: the pathophysiological impact
of smoking, smoking cessation, and nicotine replacement therapy: a systematic
review. Annals of surgery, 255(6), pp.1069-1079.

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Steenkamp, M., Rumbold, A., Barclay, L. and Kildea, S., 2012. A population-based
investigation into inequalities amongst Indigenous mothers and newborns by place of
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