In reply: Pap smear participation rates, primary healthcare and Indigenous women

Michael D Coory, Patricia S Fagan, Jennifer M Muller and Nathan AM Dunn
Med J Aust 2003; 178 (10): 525-526. || doi: 10.5694/j.1326-5377.2003.tb05339.x
Published online: 19 May 2003

In reply: Black has argued that the role of evidence in policy development is to create concern and set agendas.1 This was the aim of our article. Although there has been a national, organised approach to preventing cervical cancer since 1991, our study found that screening rates for Indigenous women still lag well behind those of non-Indigenous women. Workers in Indigenous health might have suspected as much, but valid data have not previously been available for a wide geographical area. As Murray and Lopez point out, the lack of good data on a health issue is often taken to mean that the problem is not important.2

We agree that the development of effective programs should be done in consultation and partnership with Indigenous communities. However, there is an additional need to influence decision-makers and budget-holders at national, State and regional levels. An evidence base that identified effective interventions would facilitate this process. Such evidence need not come from randomised controlled trials. On the other hand, case reports of successful interventions in a single community that cannot be sustained when key personnel leave are not very persuasive. It is also useful to demonstrate that the situation is not hopeless. The encouraging finding from our study was that the participation rate in cervical cancer screening was more than 50% in three of the 13 communities studied.

  • Michael D Coory
  • Patricia S Fagan
  • Jennifer M Muller
  • Nathan AM Dunn


  • 1. Black N. Evidence-based policy: proceed with care. BMJ 2001; 323: 275-279.
  • 2. Murray CJ, Lopez AD. Evidence-based health policy — lessons from the Global Burden of Disease Study. Science 1996; 274: 740-743.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.