Bowel Cancer Screening Program in Australia and Impact of Social Determinants Assessment 1 Answer

Introduction:

The Bowel cancer screening test is an initiative projected based on government approval which aims to provide free screening test which can diagnose the bowel cancer in a very early stage so it can be the cure in an effective way. It is difficult to conduct an early diagnosis especially to the age group of 50 to 74 and belongs to the indigenous group of Australia. Because of the socio-cultural barriers. Also, the people do not develop any major symptoms at the early stage, and at a later stage, it is very difficult to treat.  Thus, early diagnosis is necessary for this aspect (Harfield et al., 2018). The poor prognosis is the main reason for this initiative and the essay outlies a critical analysis of the initiative in respect of major social health determinants. In this essay a discussion of Bowel cancer screening program in Australia focusing on impacts on social determinants of health on the program. 

Discussion:

To address the severe disease i.e. bowel cancers some several strategies and measures have been taken. It has been seen that bowel cancer didn’t develop any symptoms in the early stage and symptoms began to see where the disease reaches the advanced stage and that stage is very critical to recovering and high chances of probable death of the patient. It is also identified the maximum number of people who died is over 50. To minimize such mortality rates an early screening program has been introduced. The screening is focused to the age group of 50 to 74 age group people who have not developed any obvious symptom and screening test is aim to focus on detecting the bowel cancer in the earliest stage possible because in that stage it is easier to cure (Lew et al., 2018). The screening test is free for the targeted age group because most of the indigenous people in Australia (like Aboriginal and Torres Islander people) are poor and such screening test needs high uptake. In the initial phase, there are several obstacles and barriers faced at conducting the screening and it is highly seen in the women population group. To overcome such barriers the screening kit has been mailed directly to the persons enrolled in the screening. The test can be taken in the house and then sent back to the laboratory. The test results are mailed directly to the patient or to the doctor they nominated. If the test result came positive then the patient is advised to immediately contact the nominated doctor (Ee & St John, 2019). A quality framework also has been adopted which states the quality of service that the bowel cancer screening program is providing and how successfully it achieves the target they are projected. Also, a primary health care strategy has been adopted to encourage and guide the indigenous people of Australia to participate in the screening program.  The screening test aims to minimize the mortality rate of bowel cancer by detecting it at early so it can be cured effectively. From all these initiatives it can be expected that more people engage the screening test which will help to minimize the death rate in an effective manner (Ee & St John, 2019).

The relationship of Indigenous Australians with their country or homeland is important for cultural continuity. 'Homeland' is a cultural or ancestral relationship with the people of Aboriginal & Torres Strait Islands. The old natives are the custodians of Australian knowledge and a continuation of indigenous history and culture. Indicators of cultural integration include language, participation in cultural events, and cultural identity. Indigenous people have more health issues than non-Indigenous people. The experiences of colonialism and the long-term effects of colonialism led to imbalances in domestic health, including physical health, physical, social, mental health, and well-being. Aboriginal & Torres Strait Islanders are shy to talk about taking samples for bowel cancer screening (Harfield et al., 2018). Due to the sensitivity of the subject, some patients may want to talk with their local physician or nurse. Others may want to speak with the islanders’ health professionals. Like other important things, men want to talk to male health professionals and women may want to talk to women health professionals. In some parts of Australia, indigenous and Torres Strait Islanders are concerned about whether the system will be used against witchcraft or exploitation. Arrangements should be made for the safe collection, storage, and transport of samples with very concern and not hurt their cultural aspects. Native Australians generally have a higher mortality rate after cancer, especially compared to non-Indigenous Australians, especially with non-early diagnosis and treatment of cancer. Non- Early diagnosis means that patients with more advanced disease may experience worse treatment outcomes; Indigenous people are also less likely to receive treatment (Harfield et al., 2018). Because of the socio-cultural barriers, it is difficult to participate in indigenous people with higher age groups.

Early screening of Bowel cancer is a great way to reduce the high age indigenous death by early detection of abnormal changes in the bowel. Targeting population screening is a viable option, and complies with WHO standards for population screening. Also, it involves noticeable early precursor lesions, generally found in the form of an adenomatous polyp, which in most cases is asymptomatic with a long period of latency; If detected early, it provides an opportunity for early diagnosis; There will be a higher effective treatment rate if diagnosed early and much probability of cure. The bowel cancer screening implementation team was selected to detect small amounts of blood in the stool which called as Faecal Occult Blood Test (FOBT) in Australia’s indigenous population (Department of Health, Australia, 2017). The presence of blood in the stool indicates that abnormalities such as a previous ulcer or cancer may be present in the intestine. Various research indicates that regular population tests with FOBT reduce the risk of death. To implement effectively, high-level policy decisions are made about the program. There are several agreements and other financial management arrangements provided at the national level for this program so poor indigenous people don’t face issues regarding money. Contracts governing the recruitment process include the quality and distribution of FOBT equipment, FOBT analysis of pathological donor, program registration, PFUF management, and evaluation & project reporting are developed based on accepted performance indicators. The project is monitored and evaluated from time to time in accordance with PBSF's screening procedures. Performance Indicators (PIs) have agreed to measure the effectiveness of the program in achieving the goal of reducing mortality associated with bowel cancer in Australia (Department of Health, Australia, 2017). This plan is only available to the indigenous and non-indigenous aged 50, to 74 years. Besides, continuous screening provides an assessment of events (new disease) from the final screening, which does not distinguish between new and old cases also those cases which opposed to an early screening. Bowel Cancer screening programs partially address survival discrepancy among indigenous people in Australia by facilitating early diagnosis. Implemented in a culturally strategic manner, screening for bowel cancer helps to reduce mortality from disease.

Health is affected by many factors, which can generally be divided into five broad categories that determine health: physiological, environmental, behavioral, and genetic effects. Physical effects include social and economic conditions that affect the health of people and communities, also known as social decision-makers of health (ODPHP, 2014). Addressing social determinants is very important to improve health and reduce health inequalities.

Social exclusion is a diversified and dynamic process driven by the unequal relations of communication at various levels, including political, economic, domestic group, cultural, personal, community, social, the country as well as global levels. It covers the characteristic features of unequal access to rights, skills, and resources that lead to health inequality. Social exclusion leads to various problems such as living conditions, depression, discrimination of opportunities, low income, low positive self-esteem, etc. Indigenous, people of Australians are linguistically, and culturally, diverse populations, obscuring key geographical differences determining their health benefits access (World Health Organisation, 2017). The health inequality experienced by Indigenous peoples is linked to systematic discrimination. Historically, the islanders of Torres Strait did not have the same opportunity to be as healthy as other people. This is due to the inefficiency of essential services, low access to health services including primary health care, and the lack of health infrastructure in some Taurus Strait Island communities. The participation rate of Aborigines and Torres Strait Islanders in the screening test is much lower than other Australians. Thus, while developing strategies for bowel cancer screening test it is specifically focused on indigenous people because of their lack of access to the health care system also the high death rate because of Bowel cancer (McLeod et al., 2017).  

Early child life development considered the most important aspect of the human lifespan. The social, cultural, language and cognitive aspects are a very important aspect in the early child life development stage because it provides a deep impact in their behavior taste and preferences. The colonial lifestyle for a long time makes indigenous people of Australia very rigid which develops narrow-minded thinking. From the early stage, they are accessible to various health benefits provided by the government. The lower literacy rate and lesser educational availability impact in a very bad manner in the early childhood phase also their lack of accessing various opportunities put obstacles in their psychological development (World Health Organisation, 2017). This have partly major influence because in this program because the screening test is focused on higher age group people however this people’s early-stage life was difficult and does not have accessibility to various health benefits thus creates a narrow-minded personality that makes it difficult to conduct screening on early stage. Thus they are included in a qualitative program where they are providing essential knowledge and also outlines the problems that will occur if the screening test is done on an earlier stage. 

Socio-economic status is a root cause of health inequality because SES has potential resources such as wealth, knowledge, respect, and beneficial social relationships that protect health and well-being, but time is the essence of illness and death. Socioeconomic status (SES) emphasizes three key propositions of health: health behavior, environmental risk, and health care. SES influences the survival of various cancers (World Health Organisation, 2017). The incidence of bowel cancer follow-up was very low for participants in the lowest socioeconomic areas. As mentioned earlier, the indigenous people are, living in linguistically and culturally diverse backgrounds, both externally or internally in areas with low socioeconomic status, and their access to health benefits, especially bowel cancer screening tests is low due to money and cultural barriers. The previous experiences of colonialism and the long-term effects of colonialism led to imbalances in domestic health, including, social, mental and physical health, and well-being. The cultural emotional, and social, aspects of the community are very significant that has been overlooked by major health services. Therefore, it is not surprising that major health services pose additional challenges in gaining the trust of indigenous people (Zhang et al., 2017).  In the context of healthcare delivery, Indigenous community-regulated health services emphasize the importance of a holistic approach to Torres Strait Island health care, where mental and physical well-being is consistent with cultural and historical context. Torres Strait Islanders are ashamed to talk about sampling feces. Due to the sensitivity of the subject, some patients may want to talk to a local physician or nurse about their health issues. In some parts of Australia, indigenous people are concerned about whether the current process of the bowel cancer screening test system and feared that it will be used against exploitation or witchcraft. Arrangements should be made for the safe collection, storage and transport of samples with ensuring them that it is a safe process there is such intention is enforced which the feared. Thus creates a major issue regarding that socio-economic position influence very highly this screening program which leads to a free screening test for higher age people of indigenous people of Australia (Harfield et al., 2018). So from the socio-economic aspect, the screening can partially address issues for indigenous people of the selected age group. 

Conclusion:

The initiative program is already evaluated by the Australian Government. Thus such facts are buy conducting the local survey and with the help government, various awareness program is also conducted as well. However, the screening programs partially address the survival discrepancy among indigenous people in Australia by facilitating early diagnosis. As the screening test incurs no cost for the targeted age group it is beneficial because most of the indigenous people in Australia (like Aboriginal and Torres Islander people) are poor. It must be noted that and screening test needs high uptake to identify bowel cancer. Implemented in a culturally strategic manner, screening for bowel cancer helps to reduce mortality from disease. From the above discussion, it can be concluded that it is very important to participate in this screening program to reduce the death rate and it has been confirmed from the research various people who died by Bowel cancer belong to the high age group and most of them are indigenous people. The socio-cultural aspects are the main barriers that are very difficult to overcome. Thus, the screening test is focused mainly on the indigenous people providing the free screening test and cost-efficient medical care services so the death rate can be reduced.