Re: ‘An overview of cancer and beliefs about the disease in Indigenous people of Australia, Canada, New Zealand and the US’Aust NZ J Public Health. 2009; 33: 109‐18.

While we acknowledge that disparities in cancer incidence and outcomes between Indigenous and non-Indigenous peoples are an important issue, we have concerns about this paper for five reasons. First, this article aims to “explore the similarities and differences in Indigenous understanding and beliefs around cancer in Australia, Canada, New Zealand and the US. also. the situation regarding cancer among these populations. ”. However, the authors make no attempt to justify the validity of a comparison of four highly distinct and disparate Indigenous populations. The overriding assumption seems to be that the commonality of ‘being Indigenous’ overrides the distinctly different historical, political and cultural contexts in which these populations live. Second, in their review the authors appear to have omitted the majority of the published literature, certainly from New Zealand, and possibly from other countries (for example, references 1-10). Third, the conclusions that the paper makes about “delayed presentation”, and Indigenous peoples being “less likely to access and continue treatment” or being “non-compliant”, are victim blaming. Not only are they not supported by evidence, they encourage a simplistic and deficit-model approach to cancer disparities. There is a lack of consideration of the extensive evidence dealing with systematic and health service related factors showing that Indigenous people are less well served by health services (rather than the other way around). In addition, there is no discussion of the potential role of racism and colonisation, which are common to these populations. Fourth, the hypothesis that poorer cancer outcomes are due to different belief systems among Indigenous people is controversial. Although the authors suggest caution in interpreting the findings, they make generalised statements on Indigenous populations in four countries based on five studies. In the case of New Zealand, this appears to be based on one study focused on cervical cancer. The selection of quotations to support what appear to be a priori themes selected by the authors is highly problematic and misleading, and risks encouraging essentialist assumptions about Indigenous peoples. as defined by a monthly RRV disease incidence >95% confidence interval (CI) above long-term average (i.e. > CI upper limit of 0.19/1,000 person months), and that a threshold level of 117 mm monthly rainfall would predict an outbreak of RRV disease with 85% specificity and 87% sensitivity. We also found that using the SARIMA method other environmental factors such as mean minimum and maximum temperature, average relative humidity and maximum tide were not statistically significant predictors of RRV disease incidence in Broome. It is our hope that in remote regions of Australia, such as Broome, particularly those in which the burden of RRV disease is high, communication between local Bureau of Meteorology offices, local government environmental health officers, population health units, health care providers and local media, using free, accessible, local climate data could be used to direct mosquito population control efforts and alert the public when the risk of RRV disease infection is likely to be high, in an attempt to partially alleviate the burden of this debilitating disease in these remote communities.