Systematic review of Aboriginal and Torres Strait Islander peoples' experiences and supportive care needs associated with cancer

BACKGROUND

Persistent disparities exist between Aboriginal and Torres Strait Islander peoples (the Indigenous peoples of Australia) and non-Indigenous Australians associated with cancer, with Aboriginal and Torres Strait Islander peoples experiencing a longer time to treatment, higher morbidity rates, and higher mortality rates. This systematic review aimed to investigate findings and recommendations in the literature about the experiences and supportive care needs of Aboriginal and Torres Strait Islander peoples with cancer in Australia.

METHODS

A qualitative systematic review was conducted using thematic analysis. Database searches were conducted in CINAHL, Informit, MEDLINE, ProQuest, Scopus, and Web of Science for articles published between January 2000 and December 2021. There were 91 included studies which were appraised using the Mixed Methods Appraisal Tool. The included studies reported on the experiences of cancer and supportive care needs in Aboriginal and Torres Strait Islander populations.

RESULTS

Six key themes were determined: Culture, family, and community; cancer outcomes; psychological distress; access to health care; cancer education and awareness; and lack of appropriate data. Culture was seen as a potential facilitator to achieving optimal cancer care, with included studies highlighting the need for culturally safe cancer services and the routine collection of Aboriginal and Torres Strait Islander status in healthcare settings.

CONCLUSION

Future work should capitalize on these findings by encouraging the integration of culture in healthcare settings to increase treatment completion and provide a positive experience for Aboriginal and Torres Strait Islander peoples with cancer.

Data, Big Tech, and the New Concept of Sovereignty

Despite the massive amount of data and sophisticated computing capacity, Big Tech has evolved into the new data sovereigns that governments must accept in the data era. Data mining and application determine the true value of data; in this regard, Big Tech is tough to replace. The so-called "Fourth Industrial Revolution" is reshaping the emerging global order, and at its core are Big Tech firms. They not only express their concerns and spread their values and ideologies but also make their strong presence felt in international affairs, as Big Tech appears to be transforming into a new type of Leviathan. With access to significant amounts of data, the rise of Big Tech poses a challenge to sovereignty's exclusivity and superiority, assuming the position of de facto data sovereign. The article holds that the Big Tech firms, by virtue of their technical advantages, have not only deconstructed the traditional concept of sovereignty, but also formed a complex symbiotic relationship.

Sovereignty in the Digital and Contact Tracing Apps

Recently, the concept of sovereignty in the digital has attracted much attention. Several publications dealing with this concept assume that it can best be described as a network of different, overlapping exercises of power. Nevertheless, there is a need for further research on how exactly sovereignty in the digital can be understood. In order to contribute to a better understanding of this concept, I illustrate its complex structure using contact tracing apps as a paradigmatic example. I conduct a narrative review to show what sovereignty looks like in the context of these apps. In the context of digital contact tracing apps, sovereignty is best understood as a complex network of three actors-nations, (big tech) companies, and individuals-that exercise various forms of power against or on behalf of each other to claim sovereignty for themselves and to either weaken or strengthen the sovereignty claims of other actors. Since large parts of the results can be generalized from the particular context of contact tracing apps, they contribute to a better overall understanding of the concept of sovereignty in digital. This might, in turn, be helpful for discussions about this technology as well as about the regulation and governance of the digital in general.

The Moral Pitfalls of Cultivated meat: Complementing Utilitarian Perspective with eco-republican Justice Approach

The context of accelerated climate change, environmental pollution, ecosystems depletion, loss of biodiversity and growing undernutrition has led human societies to a crossroads where food systems require transformation. New agricultural practices are being advocated in order to achieve food security and face environmental challenges. Cultivated meat has recently been considered one of the most desired alternatives by animal rights advocates because it promises to ensure nutrition for all people while dramatically reducing ecological impacts and animal suffering. It is therefore presented as one of the fairest means of food production for the coming decades, according to utilitarian arguments. However, food security, environmental concerns and animal welfarism guided by a short-term utilitarianism could have techno-optimism bias and could result in some forms of oppression such as anthropocentrism. I argue that there are still deep-rooted moral issues in food systems that are not addressed primarily by lab-grown meat, mainly derived from a loss of sovereignty. Food practices developed in high-tech labs with artificial interventionism constrain the ability of living entities (that are used as food) to flourish on their own terms. This paper aims to explore how sovereignty entitlements for humans and nonhumans are often overlooked by advocates of cultivated meat and the moral challenges it may pose. Accordingly, a more than utilitarian approach framed by ecological and republican justice is proposed here to shed light on some pitfalls of food chains based on cellular agriculture.

Implementation of Indigenous Food Tax Policies in Stores on Navajo Nation

In 2014, the Navajo Nation Healthy Diné Nation Act (HDNA) was enacted and permanently approved in 2020; HDNA places a 2% surtax on unhealthy foods and beverages, while other 2014 legislation exempted healthy food items from the 6% regular sales tax. Little is known about Navajo Nation store manager/owner perspectives toward the HDNA and how best to support stores to implement the legislation. Purposive sampling was used to ensure a balanced sample of correct HDNA implementers, incorrect HDNA implementers, and stores which made healthy store changes over the past 6 years. Three community-based interviewers collected surveys by phone or in-person. Frequency of closed-ended questions was quantified, and open-ended responses were coded using thematic analysis. Of 29 identified sample stores, 20 were interviewed to reach saturation. Eleven of 20 stores made changes improving their healthy food environments. Barriers included lack of equipment (6/20) and low consumer demand (5/20). Facilitators included consumer awareness and increased produce supply options (5/20). Sixteen of 20 stores supported HDNA continuation. Facilitators to HDNA implementation included orientation and informational materials (6/20) and promotion of tax-free items (5/20). Barriers included confusion about the tax (6/20) and tax exemption (5/20). Suggestions for support included printed materials (6/20) and store training (5/20). HDNA benefits included greater awareness of healthy choices among staff (7/20) and customer-community members (2/20). Most managers and owners expressed receiving support for healthy store changes and HDNA, but also identified a need for added resources and support. Findings inform legislative action to promote timely and appropriate uptake of HDNA, and support equitable, healthy food systems.

Ocean resource use: building the coastal blue economy

Humans have relied on coastal resources for centuries. However, current growth in population and increased accessibility of coastal resources through technology have resulted in overcrowded and often conflicted spaces. The recent global move towards development of national blue economy strategies further highlights the increased focus on coastal resources to address a broad range of blue growth industries. The need to manage sustainable development and future exploitation of both over-utilised and emergent coastal resources is both a political and environmental complexity. To address this complexity, we draw on the perspectives of a multi-disciplinary team, utilising two in depth exemplary case studies in New Zealand and within the Myanmar Delta Landscape, to showcase barriers, pathways and actions that facilitate a move from Business as Usual (BAU) to a future aligned with the Sustainable Development Goals (SDGs) and the UN International Decade of Ocean Science for Sustainable Development 2021-2030. We provide key recommendations to guide interest groups, and nations globally, towards sustainable utilisation, conservation and preservation of their marine environments in a fair and equitable way, and in collaboration with those who directly rely upon coastal ecosystems. We envision a sustainable future driven by conflict mitigation and resolution,  where:(i)Change is motivated and facilitated(ii)Coastal ecosystems are co-managed by multiple reliant groups(iii)Networks that maintain and enhance biodiversity are implemented(iv)Decision-making is equitable and based on ecosystem services(v)Knowledge of the marine realm is strengthened-'mapping the ocean of life'(vi)The interests of diverse user groups are balanced with a fair distribution of benefits.

Ocean resource use: building the coastal blue economy

Humans have relied on coastal resources for centuries. However, current growth in population and increased accessibility of coastal resources through technology have resulted in overcrowded and often conflicted spaces. The recent global move towards development of national blue economy strategies further highlights the increased focus on coastal resources to address a broad range of blue growth industries. The need to manage sustainable development and future exploitation of both over-utilised and emergent coastal resources is both a political and environmental complexity. To address this complexity, we draw on the perspectives of a multi-disciplinary team, utilising two in depth exemplary case studies in New Zealand and within the Myanmar Delta Landscape, to showcase barriers, pathways and actions that facilitate a move from Business as Usual (BAU) to a future aligned with the Sustainable Development Goals (SDGs) and the UN International Decade of Ocean Science for Sustainable Development 2021-2030. We provide key recommendations to guide interest groups, and nations globally, towards sustainable utilisation, conservation and preservation of their marine environments in a fair and equitable way, and in collaboration with those who directly rely upon coastal ecosystems. We envision a sustainable future driven by conflict mitigation and resolution,  where:(i)Change is motivated and facilitated(ii)Coastal ecosystems are co-managed by multiple reliant groups(iii)Networks that maintain and enhance biodiversity are implemented(iv)Decision-making is equitable and based on ecosystem services(v)Knowledge of the marine realm is strengthened-'mapping the ocean of life'(vi)The interests of diverse user groups are balanced with a fair distribution of benefits.

Successful implementation of the Healthy Diné Nation Act in stores on the Navajo Nation

In 2014, the Navajo Nation Council passed the Healthy Diné Nation Act (HDNA), a 2% tax on unhealthy foods and beverages and a waiver of the 5% sales tax on healthy foods and water, to support health promotion and disease prevention among the Navajo people. Very little research has assessed implementation accuracy of food or beverage taxes and none were implemented within a sovereign Tribal nation. This study assessed the accuracy of HDNA tax implementation among 47 stores located on the Navajo Nation. A pair of tax-exempt items [e.g. a bottle of water and fresh fruit] and a pair of HDNA-tax eligible items [e.g. sugary beverage and candy bar] were purchased between July-December 2019. Receipts were retained to assess taxation. A total of 87.2% of stores accurately implemented the 2% tax on unhealthy items while 55.3% of the stores accurately implemented the 6% tax waiver on healthy items. In all, 51.1% of the stores accurately applied both taxes. There were no significant differences across store type (convenience or grocery stores and trading posts) or geographic region. In conclusion, almost all stores on the Navajo Nation accurately applied a 2% tax on unhealthy foods and beverages, while the proportion of stores applying a waiver on healthy foods was lower. Successful HDNA tax implementation among stores remains an important priority in achieving the goal to support health promotion and disease prevention among Navajo communities.

A Farewell to Homo Sacer? Sovereign Power and Bare Life in Agamben's Coronavirus Commentary

The article addresses Giorgio Agamben's critical commentary on the global governance of the Covid-19 pandemic as a paradigm of his political thought. While Agamben's comments have been criticized as exaggerated and conspiratorial, they arise from the conceptual constellation that he has developed starting from the first volume of his Homo Sacer series. At the centre of this constellation is the relation between the concepts of sovereign power and bare life, whose articulation in the figure of homo sacer Agamben traces from the Antiquity to the present. We shall demonstrate that any such articulation is impossible due to the belonging of these concepts to different planes, respectively empirical and transcendental, which Agamben brings together in a problematic fashion. His account of the sovereign state of exception collapses a plurality of empirical states of exception into a zone of indistinction between different exceptional states and the normal state and then elevates this very indistinction to the transcendental condition of intelligibility of politics as such. Conversely, the notion of bare life, originally posited as the transcendental condition of possibility of positive forms of life, is recast as an empirical figure, whose sole form is the absence of form. We conclude that this problematic articulation should be abandoned for a theory that rather highlights the non-relation between sovereign power and bare life, which conditions the possibility of resistance and transformation that remains obscure in Agamben's thought.

Molecular sovereignties: patients, genomes, and the enduring biocoloniality of intellectual property

Monoclonal antibodies are revolutionizing cancer treatments, but come at an increasingly problematic price for health services worldwide. This leads to pressing demands for access, as in the case of Kadcyla. In 2015, patients in the United Kingdom invoked the sovereign rights of the Crown in order to demand access to this expensive yet potentially life-saving medicine that had prior been de-listed due to price. This article interprets this campaign as an act of sovereign reassertion against a fundamental exclusion, which, however, ultimately fails to challenge the concrete mechanism enabling this exclusion—intellectual property (IP). By connecting this example to other declarations of molecular sovereignty, the article argues that the use of sovereignty can perpetuate further exclusion. Drawing on the notion of biocoloniality (Schwartz-Marín and Restrepo 2013) it points out that the intellectual property regime contains a deeply embedded fiction of the world as terra nullius, a blank uninhabited canvas ripe for discovery and appropriation. This decontextualised vision of life as property works to exclude populations and patients from playing a significant role in determining the use of technologies and treatments. Instead of countering this fundamental exclusion, the concept of sovereignty further entrenches this assumption and merely contests the assignation of this property.

Sovereignty, privacy, and ethics in blockchain-based identity management systems

Self-sovereign identity (SSI) solutions implemented on the basis of blockchain technology are seen as alternatives to existing digital identification systems, or even as a foundation of standards for the new global infrastructures for identity management systems. It is argued that 'self-sovereignty' in this context can be understood as the concept of individual control over identity relevant private data, capacity to choose where such data is stored, and the ability to provide it to those who need to validate it. It is also argued that while it might be appealing to operationalise the concept of 'self-sovereignty' in a narrow technical sense, depreciation of moral semantics obscures key challenges and long-term repercussions. Closer attention to the normative substance of the 'sovereignty' concept helps to highlight a range of ethical issues pertaining to the changing nature of human identity in the context of ubiquitous private data collection.

Sovereignty and social justice: how the concepts affect federal American Indian policy and American Indian health

The health disparities that are prevalent among American Indian and Alaska Native (AI/AN) communities are connected to the ideology of sovereignty and often ignored in social work and public health literature. Therefore, the purpose of this paper is to examine the health outcomes of American Indians from the time of contact with European settlers to the present through the ideology of sovereignty and federal government AI health policy. The foundation for the health outcomes of AIs and the governmental policies affecting them lie in the ideology of tribal sovereignty. This ideology has greatly impacted how the government views and treats AIs and consequently, how it has impacted their health. From the earliest treaties between European settlers and AIs, this legal relationship has been and remains a perplexing issue. With the examination of tribal sovereignty comes the realization that colonization and governmental polices have greatly contributed to the many social and health problems that AIs suffer from today. Understanding that the health disparities that exist among AI/AN populations cannot only be attributed to individual behavior and choice but is driven by societal, economic and political factors may be used to inform social work education, practice, and research.

Wait Up!: Attachment and Sovereign Power

Sociologists and feminist scholars have, over many decades, characterised attachment as a social construction that functions to support political and gender conservatism. We accept that attachment theory has seen use to these ends and consider recent deployments of attachment theory as justification for a minimal State within conservative political discourse in the UK since 2009. However, we contest that attachment is reducible to its discursive construction. We consider Judith Butler's depiction of the infant attached to an abusive caregiver as a foundation and parallel to the position of the adult citizen subjected to punitive cultural norms and political institutions. We develop and qualify Butler's account, drawing on the insights offered by the work of Lauren Berlant. We also return to Foucault's Psychiatric Power lectures, in which familial relations are situated as an island of sovereign power within the sea of modern disciplinary institutions. These reflections help advance analysis of three important issues: the social and political implications of attachment research; the relationship between disciplinary and sovereign power in the affective dynamic of subjection; and the political and ethical status of professional activity within the psy disciplines.