“Yarn for Life aims to reduce feelings of shame and fear associated with cancer and highlights the importance of normalising conversation around cancer and encouraging early detection of the disease.
It also emphasises the value of support along the patient journey.”
Professor Jacinta Elston, Pro Vice-Chancellor (Indigenous), Monash University, said that finding cancer early gave people the best chance of surviving and living well.
“Yarn for Life seeks to empower Aboriginal and Torres Strait Islander people to participate in screening programs, discuss cancer with their doctor or health care worker openly, and if cancer is diagnosed, complete their cancer treatment.”
Australia’s first Australian Aboriginal surgeon Associate Professor Kelvin Kong, University of Newcastle : continued below
In a national first, Cancer Australia has launched Yarn for Life, a new initiative to reduce the impact of cancer within Aboriginal and Torres Strait Islander communities by encouraging and normalising discussion about the disease.
Cancer is a growing health problem and the second leading cause of death among Indigenous Australians who are, on average, 40 percent more likely to die from cancer than non-indigenous Australians.
The multi-faceted health promotion Yarn for Life has been developed by and with Indigenous Australians, and weaves the central message that it is okay to talk about cancer by sharing personal stories of courage and survivorship from Aboriginal and Torres Strait Islander people.
Yarn for Life features 3 individual experiences of cancer which are also stories of hope.
“While significant gains have been made with regard to cancer overall, Aboriginal and Torres Strait Islander people continue to experience disparities in cancer incidence and outcomes. Cancer affects not only those diagnosed with the disease but also their families, carers, Elders and community,” said Dr Helen Zorbas, CEO, Cancer Australia.
Associate Professor Kong said it was also important for health services to support better outcomes for Indigenous patients by being culturally aware.
“For Aboriginal and Torres Strait Islander people, health and connection to land, culture community and identity are intrinsically linked. Optimal care that is respectful of, and responsive to, the cultural preferences, sensitivities, needs and values of patients, is critical to good health care outcomes.”
The Yarn for Life initiative is supported by two consumer resources which outline what patients should expect at all points on the cancer pathway.
Finding cancer early gives you the best chance of getting better and living well. The good news is there are things you can do to find cancer early. If there are any changes in your body that could be due to cancer, it’s really important to have them checked out. Speak to your health worker about:
any new or unusual changes in your body
how you are feeling
whether you are in any pain
whether anyone in your family has or had cancer
any other problems that are worrying you.
Free screening programs
It’s also important that you and your family participate in screening programs for breast, bowel and cervical cancers.
You can find out more about these free programs including how old you need to be to participate at cancerscreening.gov.au. Remember most of us will need to go to a check-up or screening at some point in our lives—so there’s no shame in talking to family or friends about it as well as your health care worker.
” The Australian Chronic Disease Prevention Alliance recommends that the Australian Government introduce a health levy on sugar-sweetened beverages, as part of a comprehensive approach to decreasing overweight and obesity, and with revenue supporting public education campaigns and initiatives to prevent chronic disease and address childhood obesity.
A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia.
Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns.
Health levy on sugar-sweetened beverages
ACDPA Position Statement
The Australian Chronic Disease Prevention Alliance (ACDPA) recommends that the Australian Government introduce a health levy on sugar-sweetened beverages (sugary drinks)i, as part of a comprehensive approach to decreasing overweight and obesity.
Sugar-sweetened beverage consumption is associated with increased energy intake and in turn, weight gain and obesity. Obesity is an established risk factor for type 2 diabetes, heart disease, stroke, kidney disease and certain cancers.
Beverages are the largest source of free sugars in the Australian diet. One in two Australians usually exceed the World Health Organization recommendation to limit free sugars to 10% of daily intake (equivalent to 12 teaspoons of sugar).
Young Australians are the highest consumers of sugar-sweetened beverages, along with Aboriginal and Torres Strait Islander people and socially disadvantaged groups.
Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption.
A health levy on sugar-sweetened beverages in Australia is estimated to reduce consumption and potentially prevent thousands of cases of type 2 diabetes, heart disease and stroke over 25 years. The levy could generate revenue of $400-$500 million each year, which could support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.
A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia. Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns.
i ‘Sugar-sweetened beverages’ and sugary drinks are used interchangeably in this paper. This refers to all non-alcoholic water based beverages with added sugar, including sugar-sweetened soft drinks and flavoured mineral waters, fortified waters, energy and electrolyte drinks, fruit and vegetable drinks, and cordials. This term does not include milk-based products, 100% fruit juice or non-sugar sweetened beverages (i.e. artificial, non-nutritive or intensely sweetened). 2
The Australian Chronic Disease Prevention Alliance (ACDPA) brings together five leading non-government health organisations with a commitment to reducing the growing incidence of chronic disease in Australia attributable to overweight and obesity, poor nutrition and physical inactivity. ACDPA members are: Cancer Council Australia; Diabetes Australia; Kidney Health Australia; National Heart Foundation of Australia; and the Stroke Foundation.
This position statement is one of a suite of ACDPA statements, which provide evidence-based information and recommendations to address modifiable risk factors for chronic disease. ACDPA position statements are designed to inform policy and are intended for government, non-government organisations, health professionals and the community.
Chronic diseases are the leading cause of illness, disability, and death in Australia, accounting for around 90% of all deaths in 2011. One in two Australians (i.e. more than 11 million) had a chronic disease in 2014-15 and almost one quarter of the population had at least two conditions.
However, much chronic disease is actually preventable. Around one third of total disease burden could be prevented by reducing modifiable risk factors, including overweight and obesity, physical inactivity and poor diet.
Overweight and obesity
Overweight and obesity is the second greatest contributor to disease burden and increases risk of type 2 diabetes, heart disease, stroke, kidney disease and some cancers.
The rates of overweight and obesity are continuing to increase. Almost two-thirds of Australians are overweight or obese and one in four Australian children are already overweight or obese. Children who are overweight are also more likely to grow up to become overweight or obese adults, with an increased risk of chronic disease and premature mortality.
The cost of obesity in Australia was estimated to be $8.6 billion in 2011-12, comprising $3.8 billion in direct costs and $4.8 billion in indirect costs. If no further action is taken to slow obesity rates in Australia, the cost of obesity over the next 10 years to 2025 is estimated to total $87.7 billion.
Free sugars and weight gain
There is increasing evidence that high intake of free sugarsii is associated with weight gain due to excess energy intake and dental caries. The World Health Organization (WHO) strongly recommends reducing free sugar intake to less than 10% of total energy intake (equivalent to around 12 teaspoons of sugar), or to 5% for the greatest health benefits.
ii ‘Free sugars’ refer to sugars added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.
In 2011-12, more than half of Australians usually exceeded the recommendation to limit free sugar intake to 10%. There was wide variation in the amounts of free sugars consumed, with older children and teenagers most likely to exceed the recommendation and adults aged 51-70 least likely to exceed the recommendation. On average, Australians consumed around 60 grams of free sugars each day (around 14 teaspoons). Children and young people were the highest consumers, with adolescent males and females consuming the equivalent of 22 and 17 teaspoons of sugar each day respectively .
Beverages contribute more than half of free sugar intake in the Australian diet. In 2011-12, soft drinks, sports and energy drinks accounted for 19% of free sugar intake, fruit juices and fruit drinks contributed 13%, and cordial accounted for 4.9%. 3
Sugar-sweetened beverage consumption
In particular, sugar-sweetened beverages are mostly energy-dense but nutrient-poor. Sugary drinks appear to increase total energy intake due to reduced satiety, as people do not compensate for the additional energy consumed by reducing their intake of other foods or drinks[3, 7]. Sugar-sweetened beverages may also negatively affect taste preferences, especially amongst children, as less sweet foods may become less palatable.
Sugar-sweetened beverages are consumed by large numbers of Australian adults and children, and Australia ranks 15th in the world for sales of caloric beverages per person per day.
One third of Australians consumed sugar-sweetened beverages on the day before the Australian Health Survey interview in 2011-12. Of those consuming sweetened beverages, the equivalent of a can of soft drink was consumed (375 mL). Children and adolescents were more likely to have consumed sugary drinks than adults (47% compared with 31%), and consumption peaked at 55% amongst adolescents. Males were more likely than females to have consumed sugary drinks (39% compared with 29%).
Australians living in areas with the highest levels of socioeconomic disadvantage were more likely to have consumed sugary drinks than those in areas of least disadvantage (38% compared with 31%). Half of Aboriginal and Torres Strait Islander people consumed sugary drinks compared to 34% of non-Indigenous people. Amongst those consuming sweetened beverages, a greater amount was consumed by Aboriginal and Torres Strait Islanders than for non-Indigenous people (455 mL compared with 375 mL). 4
The health impacts of sugar-sweetened beverage consumption
WHO and the World Cancer Research Fund (WCRF) recommend restricting or avoiding intake of sugar-sweetened beverages, based on evidence that high intake of sugar-sweetened beverages may increase risk of weight gain and obesity[7, 11]. As outlined earlier, obesity is an established risk factor for a range of chronic diseases.
The Australian Dietary Guidelines recommend limiting intake of foods and drinks containing added sugars, particularly sugar-sweetened beverages, based on evidence of a probable association between sugary drink consumption and increased risk of weight gain in adults and children, and a suggestive association between soft drink consumption and an increased risk of reduced bone strength, and dental caries in children.
Type 2 diabetes
Sugar-sweetened drinks may increase the risk of developing type 2 diabetes. Evidence indicates a significant relationship between the amount and frequency of sugar-sweetened beverages consumed and increased risk of type 2 diabetes[12, 13]. The risk of type 2 diabetes is estimated to be 26% greater amongst the highest consumers (1 to 2 servings/day) compared to lowest consumers (<1 serving/month).
Cardiovascular disease and stroke
The consumption of added sugar by adolescents, especially sugar-sweetened soft drinks, has been associated with multiple factors that can increase risk of cardiovascular disease regardless of body size, and increased insulin resistance among overweight or obese adolescents.
A high sugar diet has been linked to increased risk of heart disease mortality[15, 16]. Consuming high levels of added sugar is associated with risk factors for heart disease such as weight gain and raised blood pressure. Excessive dietary glucose and fructose have been shown to increase the production and accumulation of fatty cells in the liver and bloodstream, which is linked to cardiovascular disease, and kidney and liver disease. Non-alcoholic fatty liver disease is one of the major causes of chronic liver disease and is associated with the development of type 2 diabetes and coronary heart disease.
There is also emerging evidence that sugar-sweetened beverage consumption may be independently associated with increased risk of stoke.
Chronic kidney disease
There is evidence of an independent association between sugar-sweetened soft drink consumption and the development of chronic kidney disease and kidney stone formation. The risk of developing chronic kidney disease is 58% greater amongst people who regularly consume at least one sugar-sweetened soft drink per day, compared with non-consumers.
While sugar-sweetened beverages may contribute to cancer risk through their effect on overweight and obesity, there is no evidence to suggest that these drinks are an independent risk factor for cancer. 5
A health levy on sugar-sweetened beverages
WHO recommends that governments consider taxes and subsidies to discourage consumption of less healthy foods and promote healthier options. WHO concludes that there is “reasonable and increasing evidence that appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption, especially if aimed at raising the retail price by 20% or more”.
Price influences consumption of sugar-sweetened beverages[24, 25]. Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption. While a health levy would result in lower income households paying a greater proportion of their income in additional tax, the financial burden across all households is small, with minimal differences between higher- and lower-income households (less than $5 USD per year).
A 2016 study modelled the impact of a 20% ad valorem excise tax on sugar-sweetened beverages in Australia over 25 years. The levy could reduce sugary drink consumption by 12.6% and reduce obesity by 2.7% in men and 1.2% in women. Over 25 years, there could be 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of ischaemic heart disease and 1,100 fewer strokes. In total, 1,600 deaths could potentially be prevented.
The 20% levy was modelled to generate more than $400 million in revenue each year, even with a decline in consumption, and save $609 million in overall health care expenditure over 25 years. The implementation cost was estimated to be $27.6 million.
A separate Australian report is supportive of an excise tax on the sugar content of sugar-sweetened beverages, to reduce consumption and encourage manufacturers to reformulate to reduce the sugar content in beverages. An excise tax at a rate of 40 cents per 100 grams was modelled to reduce consumption by 15% and generate around $500 million annually in revenue. While a sugary drinks levy is not the single solution to obesity, the introduction of a levy could promote healthier eating, reduce obesity and raise revenue to combat costs that obesity imposes on the broader community.
There is public support for a levy on sugar-sweetened beverages. Sixty nine percent of Australian grocery buyers supported a levy if the revenue was used to reduce the cost of healthy foods. A separate survey of 1,200 people found that 85% supported levy revenue being used to fund programs reducing childhood obesity, and 84% supported funding for initiatives encouraging children’s sport.
An Australian levy on sugar-sweetened beverages is supported by many public health groups and professional organisations.
” Australia has the highest incidence of melanoma and other skin cancers in the world, and while skin cancer is more common in people with light skin, it’s a dangerous misconception that darker skinned people aren’t at risk.
In a 2014 study, one third of Aboriginal and Torres Strait Islander participants from Northern and Central Australia had vitamin D deficiency, which carries some very negative health implications: low vitamin D levels are linked to an increased risk of diseases like diabetes and heart disease.
Given the burden of these chronic diseases in Aboriginal and Torres Strait Islander people, and their contribution to a much reduced life expectancy, more research is needed on the role of sun exposure and vitamin D.
Across all aspects of the healthcare system, overcoming the disadvantage within Indigenous heath is, and needs to be, a priority – dermatology is no exception.”
Fair or freckled skin, red or blond hair and blue or green eyes: these are the common calling cards of skin cancer susceptibility. But while the risks in darker skinned people is generally reduced, it’s certainly not absent.
In Aboriginal and Torres Strait Islander people – a group with diverse, but commonly darker skin tones – melanoma and other skin cancers are less prevalent than in the non-Indigenous population, but still cause deaths every year.
Public health campaigns – think ‘slip, slop, slap’ – are often targeted to light skinned people, however the inequalities in the availability and appropriateness of health care can impact how different groups access diagnosis and treatment.
Some studies out of the US and UK suggest that, when people of colour (POC) do get skin cancers, they’re often diagnosed at a later stage and carry a higher mortality risk.
Combine this with the dearth of research on skin cancer in darkly pigmented people (studies on skin cancer in Aboriginal and Torres Strait Islanders are particularly sparse), and the picture for darker skinned people is pretty unclear.
What it can do is look at what skin cancers are, how different types of pigmentation can change a person’s risk of skin cancer, and go over some other health considerations for sun protection in dark skin that you can bring up with your doctor.
The skin you’re in, and where it could become cancerous:
Some quick human biology: your skin is your largest organ, and is made up of the epidermis (upper layer) and the dermis (lower layer). When skin is exposed to the sun, ultraviolet (UV) rays can damage its DNA, causing the uncontrolled growth of abnormal cells.
The most common types of skin cancer all begin in the epidermis (the upper skin layer), and are handily named after the types of cells they start in:
Basal cell carcinoma (BCC): the basal cells are column-shaped and form the bottom layer of the epidermis. BCC can look like a lump or scaly patch, pale, pink or dark in colour. It’s usually slow growing, rarely spreading to other parts of the body. The earlier it’s found, the easier it is to treat.
Squamous cell carcinoma (SCC): the squamous cells are in the upper layer of the epidermis. SCC can look like a thickened scaly spot or rapidly growing lump, and tends to grow quickly. If left untreated, it can spread to other parts of the body, but this isn’t very common.
Melanoma: melanocytes are located in the basal cell layer and produce melanin pigment. Melanoma are aggressive tumors, and while this cancer is less common than BCC and SCC, it’s much more likely to spread to other parts of the body (like your brain, bones and lungs) through your lymphatic system and bloodstream.
Pigmentation – what’s it got to do with skin cancer risk?
The colour of a person’s skin is strongly influenced by their skin pigments, which are determined by their genetics and lifestyles factors, like sun exposure.
Remember those melanocytes (where melanomas form)? These cells produce melanin and package it in organelles called melanosomes. The melanin in skin comes in two main types: eumelanin is black or brown protective pigment, while pheomelanin is a yellow-red colour.
The type and amount of melanin each person produces will affect their pigmentation (skin colour). Eumelanin is abundant in darker skinned people, who produce more melanin than people with light skin.
For those among us who tan in the sun, exposure to UV rays increases the production of melanin by the melanocytes; when the melanin accumulates in the epidermal layers, a tan builds up and the skin darkens.
Melanin helps protect skin against the sun’s rays by absorbing UV radiation in the surface layers, reducing the risk of cellular DNA damage that can lead to skin cancer.
This protective melanin helps reduce skin cancer risk in dark skinned people.
The flip side – dark skin and vitamin D deficiency
While this melanin barrier can protect against UV damage, it can also make it more difficult for darker skinned people to get the Vitamin D they need.
Vitamin D, known as the ‘sunshine vitamin’, is produced when our skin is exposed to ultraviolet B (UVB) light. Melanin filters this light, reducing the penetration of UVB and putting darker skinned people at a higher risk of vitamin D deficiency.
A local perspective: sun exposure and health risks for Aboriginal and Torres Strait Islander people
While the research on skin cancer in Aboriginal and Torres Strait Islanders is pretty thin on the ground, some stats published in the Australian Institute of Health and Welfare give a general picture of melanoma incidence:
Between 2005-2009, the rate for melanoma in Indigenous Australians was 9.3 cases in 100,000 people, compared to 33 cases per 100,000 in non-Indigenous Australians.
For BCC and SCC cancers, the data is extremely limited, as, unlike melanoma, these cancers aren’t mandatory to report in state and territory registries.
To gain a better understanding of what skin cancer risks are at play for the diverse Aboriginal and Torres Strait Islander population, more research is needed.
Over 200 people joined together at Musgrave Park in Brisbane on Sunday 2 February ahead of World Cancer Day to raise cancer awareness, prevention, early detection and treatment for Aboriginal and Torres Strait Islander peoples.
The walk highlighted the importance of getting regular check ups, investigate early detection and to talk openly about all types of cancer and treatment.Reported by Ross Murray
Senior Research Fellow at Menzies School of Health Research, Associate Professor Gail Garvey says that cancer is the second leading cause of death amongst Indigenous people accounting, for greater numbers than diabetes or kidney disease. However, there is remerging myth amongst Aboriginal and Torres Strait Islander peoples that cancer will inevitably lead to death.
‘World Cancer Day was the trigger for having the event and it was all about dispelling the myths,’ says A/Prof Garvey.
‘I guess like many cultures Aboriginal and Torres Strait Islander peoples don’t speak openly about cancer, so this in turn can affect how someone understands cancer or how they even share what information is available about cancer. So what we wanted to do is have a day where people can speak openly about cancer and try and dispel some of those myths.’
A/Prof Garvey says that one of the myths amongst Indigenous Australians is they might think cancer is contagious or that it’s pay back, bad luck or even that it’s a result of something that they’ve done to bring on the disease. She says that Aboriginal and Torres Strait Islander peoples might feel ashamed about having cancer which in turn fuels the fear of early detection.
‘One of the real problems is that our people tend not to participate in screening programs because they’re worried about finding out about results … so they’re more likely to ignore a lump, bump or something a bit unusual,’ she says.
‘The word cancer itself is something that our community relate to equalling death.’
‘ [Aboriginal and Torres Strait Islander peoples] do have higher mortality rates; that’s one of the reasons why communities see cancer as equalling death.’
Given the myths that surround cancer in Indigenous communities, A/Prof Garvey says that when patients do receive the news they have cancer they are more likely to return home to die.
‘But it’s so hard to translate to communities that there could be surgery or chemotherapy which could improve chances of survival, but [the common response] is ‘No I’ve got cancer, so that means I’m going to die’.
For more information about cancer research or information for Aboriginal and Torres Strait Islander peoples, click here.
Cancer now biggest killer in Australia, ahead of heart disease: WHO report
Cardiovascular disease as a whole still the most common cause of death
The Heart Foundation says while cancer may have overtaken heart disease as Australia’s biggest killer, when cardiovascular disease is looked at as a whole, it adds up to be the most common cause of death.
Heart Foundation national director Dr Rob Grenfell says cardiovascular disease, which includes strokes as well as heart and vascular diseases, killed 45,622 people in 2011.
It was closely followed by cancer, which claimed the lives of 43,721 Australians.
Heart disease alone killed 21,500.
Dr Grenfell says cancer and cardiovascular disease have common risk factors such as smoking, obesity and inactivity and could be tackled together.
“As a group of diseases, cancers and cardiovascular diseases are attributable to 60 per cent of the country’s deaths and both are largely preventable,” he said.
“If we were to have a coordinated approach to the management of these risk factors we would reduce the prevalence of preventable deaths.”
Rethink Sugary Drink is a partnership between Cancer Council Australia, Diabetes Australia and Heart Foundation (Victoria), and aims to raise awareness of the amount of sugar in sugar-sweetened beverages and to encourage Australians to reduce their consumption.
According to research by the Centre for Physical Activity and Nutrition Research at Deakin University, children who consume more than one serving (250mL) of sugary drink per day are 26 per cent more likely to be overweight or obese.
DEBATE :Should we tax soft drinks ?
Australia’s leading health organisations are urging the government to introduce a federal tax on sugary soft drinks in a bid to curb obesity rates. Citing a recent US study, the campaign claims that a daily can of soft drink can lead to a weight gain of 6.75kg per year. But is their data actually accurate?
The Cancer Council of Australia, Diabetes Australia and the National Heart Foundation have joined forces to tackle the nation’s addiction to soft drink — and they’re not above using shock-tactics to get their point across.
In the above TV ad, a man gleefully slurps down a glass of liquefied fat, which supposedly indicates what you’re really ingesting when you have a soft drink. Hmm.
“Soft drinks seem innocuous and consumed occasionally they’re fine, but soft drink companies have made it so they’re seen as part of an everyday diet – there’s an entire aisle dedicated to them in the supermarket, most venues and workplaces have vending machines packed with them, they’re often cheaper than bottled water and are advertised relentlessly to teenagers,” Craig Sinclair, Chair of the Public Health Committee at Cancer Council Australia said in a campaign announcement.
“But sugary drinks shouldn’t be part of a daily diet — many people would be surprised to know that a regular 600ml soft drink contains about 16 packs of sugar and that’s a lot of empty kilojoules. Yet they’re being consumed at levels that can lead to serious health issues for the population – it’s time to stop sugar-coating the facts.”
Over the past twelve months, Australian consumers purchased an estimated 447 million litres of cola-flavoured soft drinks — which is enough for nearly 4 million Pepsi baths. When combined with all other soft drink flavours, the total fizzes out to a massive 1.28 billion litres.
A significant proportion of this amount is being consumed by kids, with nearly half of all children aged between two and 16 drinking sugar-sweetened beverages on a daily basis. The campaign is thus urging Federal Government to implement restrictions that will reduce children’s exposure to marketing of sugary drinks.
“State governments too can help to address the problem by limiting the sale of sugary drinks in all schools and encouraging places frequented by children and young adults such as sporting grounds to reduce the availability of these drinks,” said Kellie-Ann Jolly, acting CEO of the Heart Foundation (Victoria).
In addition to reducing availability in the playground, the campaign is also urging the government to introduce a tax on sugar-sweetened soft drinks in a bid to reduce consumer intake. Presumably, a taxation would lead to cheaper diet soft drinks, although we wouldn’t put it past manufacturers to hike up the price of their entire range to avoid “consumer confusion” or somesuch bollocks. Tch, eh?
Here are the key aims of the ‘Rethink Sugary Drinks’ campaign in full:
A social marketing campaign, supported by Australian governments, to highlight the health impacts of sugar-sweetened beverages consumption and encourage people to reduce their consumption levels. An investigation by the Federal Department of Treasury and Finance into tax options to increase the price of sugar-sweetened beverages or sugar-sweetened soft drinks, with the aim of changing purchasing habits and achieving healthier diets.
Comprehensive restrictions by Australian governments to reduce children’s exposure to marketing of sugar-sweetened beverages, including through schools and children’s sports, events and activities.
Comprehensive restrictions by state governments on the sale of sugar-sweetened beverages in all schools (primary and secondary), and encouraging restriction at places frequented by children, such as activity centres and at children’s sports and events (with adequate resources to ensure effective implementation, monitoring and evaluation).
An investigation by state and local governments into the steps that may be taken to reduce the availability of sugar-sweetened beverages in workplaces, government institutions, health care settings and other public places.
One of the chief justifications for the campaign is a recent study published in the Journal of the American Medical Association which found that consuming one can of soft drink per day could lead to a 6.75 kg weight gain in one year.
We think it’s worth pointing out that the majority of soft drinks manufactured in the US are sweetened with high fructose corn syrup rather than cane sugar. This means that any study conducted in the US is largely irrelevant to Australia. Indeed, a 2010 study from Princeton University found that rats that ingested high fructose corn syrup gained significantly more weight than rats that ate an equal calorie amount of table sugar.
With that said, there’s no denying that soft drinks are a key contributor to obesity in Australia which makes this campaign a worthy one (disingenuous comparisons to the US aside). You can learn more about the particulars of the campaign at the official Rethink Sugary Drinks website. We’ll also have a diet soft drink taste-test roundup, coming soon.
Dianne McCarthy is 54 and has stage-four lung cancer. From her bed in a Northern Territory Palliative Care Unit, she explains that the diagnosis came as a shock. “I was in hospital for something else and they found it my lungs. That was just a few weeks ago.
“I’ve lived with Rheumatoid Arthritis since I was 25, so I am used to being sick. But God must be saying my time is up. I’m trying to face it with a peaceful heart. My kids aren’t ready though.”
Dianne’s 20-year-old daughter Klarissa sits by her mother’s bedside. She casts her eyes to the floor. “They’ve given us about two months. But they can’t really say for sure.”
Just a couple of years ago, after heart disease, cancer was the third ranked killer of Australian Aboriginals and Torres Strait Islanders. Having recently risen above kidney disease – it’s now the second.
Though there are no hard facts as to when cancer first began affecting Aboriginal Australia, scientists link its increased appearance to improved life span. “It’s only recently that we’ve learnt about cancer in the Indigenous population, but that’s not because the disease wasn’t there,” says Associate Professor Patricia Valery from the Menzies School of Health Research.
“Earlier on people were dying from infectious disease, such as measles, cholera, flu and tuberculosis. As life expectancy improves, we’re starting to see more cancer.”
Getting a handle on how widely cancer’s made its mark among this group has been testing, owing to the fact that cancer registries didn’t use to identify patients by their ethnic background.
For the past eight years, Valery and her colleague Associate Professor Gail Garvey have been filling in the blanks. As Garvey says: “What really stands out is that the likelihood of an Indigenous person getting cancer is similar or even lower to that of a non-Indigenous Australian. But the mortality rate is far higher. There are lots of question marks as to why this is. That’s our journey. To try and work this puzzle out.”
On a wet Brisbane morning, Valery and Garvey – the latter of whose family originate from Kamilaroi country in northwest New South Wales – discuss the reasons behind this disadvantage.
A key reason, as in Dianne McCarthy’s case, is late diagnosis. Indigenous cancer sufferers often have multiple health issues, making it hard for GPs to detect the disease in the first place. And as this group are up to ten times more likely to live remotely than are non-Indigenous Australians, access to healthcare is often difficult.
Garvey says: “Chemotherapy, radiotherapy and surgery are the three most common treatments for cancer. From our research in Queensland we know that Aboriginal and Torres Strait Islander people are less likely to receive these.”
“And having radio and chemo often means additional costs for transport and accommodation, and being away from family. So even just accessing treatment is a challenge.”
Garvey and Valery report there’s also a lack of open discussion and general awareness of cancer in many communities. “There’s no Aboriginal word for cancer,” says Garvey. “They see cancer as death. So it’s not talked about. It’s kept very quiet.”
A review by Dr Sophia Koefler from James Cook University in Queensland confirms this assertion. She cites a study of Western Australian Indigenous people interviewed about their attitudes and beliefs towards cancer. Its findings were surprising.
“Many Indigenous people believe cancer is contagious. They attribute cancer to spiritual curses, bad spirits or as punishment from a past misdeed,” she writes. “In addition, the Indigenous cancer sufferer may feel ashamed of their ‘wrongdoings’ and hide their symptoms, delaying diagnosis.”
When an Indigenous person develops cancer it’s often one of the more fatal varieties, too. Valery says this is partly due to lifestyle. Lung and liver cancer feature prominently among the group, which can be linked to smoking, chronic (long-term) infection with hepatitis B virus and high alcohol consumption.
According to figures reported by the Cancer Council, Indigenous lung cancer mortality rates here are 3.6 times higher than non-Indigenous rates. And in 2003, Indigenous Australians were 12 times more likely to die of hepatocellular carcinoma (HCC, the most common type of liver cancer) than the general population.
With late diagnosis, poor awareness and difficulties surrounding care considered, Garvey and Valery believe that one of the keys to turning the high cancer death rates around is focusing on the first year post-diagnosis.
“In that year, Aboriginal people have a 50 per cent higher chance of passing away than a non-Indigenous person does. But if they make it through to the second year – survival rates are about the same.”
The keys messages, they say, are for patients to take up cancer screening, seek medical help early if they have symptoms, adhere to treatments and attend appointments. More broadly, Valery and Garvey say there’s a strong need to raise GP awareness and training and develop large scale, Indigenous-specific prevention programs surrounding smoking and alcohol intake.
“Until now cancer has not been a high priority on the Indigenous health agenda, despite the number of deaths it brings about,” Garvey says.
That fact, however, is changing rapidly. Just three months ago, the researchers received funding for a Centre for Research Excellence – in cancer and Indigenous peoples.
“This will allow us to bring together key researchers, practitioners, and consumer advocacy groups from across Australia,” says Garvey.
More specifically, the Centre has a number of aims – each of them historic, ambitious and wide-ranging in scope.
Key to these is launching the National Indigenous Cancer Network (NICAN) in partnership with the Lowitja Institute, the Australian Indigenous Health InfoNet and Cancer Council Australia. This will ensure research data and cancer knowledge is shared nationally, and thereby cancer is tackled collaboratively.
“At present, cancer initiatives and research largely operates with state-based borders. So, we’re trying to share and build upon the activities cancer researchers are doing at a national level,” she says.
“Instead of us doing something here in Queensland and something different happening in the Northern Territory and New South Wales, we’re aiming to work together more closely. That way we can grow from we already know and get better data about what to do about lowering cancer diagnoses and deaths.”
Specifically, Garvey and Valery intend to work with partners to ensure the latest, nationally collated information is available to researchers, practitioners and families. The four organisations will also combine heads to develop a strong, forward-looking cancer research strategy.
While the Centre will address all types of cancer, it will also pursue cancer-specific initiatives, such this one that relates to cervical cancer:
“We’ll conduct Australia’s largest ever data linkage project – Indigenous or non-Indigenous – linking cervical screening data with hospital data and cancer registry data. This will investigate Indigenous women’s participation in cervical screening , comparing it with non-Indigenous women, and we’ll also examine whether follow-up after an abnormal Pap test result varies by Indigenous status, remoteness of residence, and socioeconomic status,” says Garvey.
“Most importantly, the Centre will allow us to train a new generation of researchers – including Indigenous researchers – in Indigenous cancer control. Lifting the cancer burden will have a huge impact on families, individuals and health services.”
As the researchers pack up their documents and prepare to get on with the rest of their day, the rain continues to fall in Queensland.
In the Northern Territory, Dianne McCarthy grows weaker. While this forward-looking news may be too late for her, McCarthy’s case underlines one of Valery and Garvey’s key messages: the importance of catching cancer early.
As McCarthy says: “I smoked most of my life, but I tell my kids this: quit now. You don’t have to die young.”
What else is Menzies doing to reduce the cancer burden in Indigenous Australia?• We’re investigating unmet supportive care needs of Indigenous Australians diagnosed with cancer in Queensland• We’ve begun a study to test the effectiveness of an intervention combining patient navigation, cancer education and communication coaching to improve Indigenous cancer patients’ experiences through their cancer journey and their cancer outcomes. Cancer Australia has provided initial funding for this project; further funding will be sought in 2013.• There are gaps in research regarding what happens to Indigenous people with a cancer after they are discharged, as well as how they use services in the Primary Health Care setting. We have been funded by the National Health and Medical Research Council (NHMRC) to investigate that gap, and to develop an audit tool for cancer care with a focus on culturally appropriate support, follow up and communication between health care systems.