Academic literature on the topic 'Aboriginal History'

Since leaving ‘the bush’ I have been continually surprised at the ignorance that still exists about Aboriginal people and their languages. When people chat to me, and it is revealed that I used to work in Aboriginal schools in the Northern Territory, they say things like “Do you speak Aboriginal then?… Maybe you could make a sign for us saying ‘Welcome to our Kindergarten’ in Aboriginal?” I then have to explain that there are many, many different Aboriginal languages, not just one, and to say or write such things in any one of these languages requires a lot more than a mere literal translation. When I began doing research on the topic of writing in Aboriginal languages. I was again surprised at the sorts of comments people made to me. Comments like “How can you do research on writing in Aboriginal languages; I thought the Aborigines didn't even have an alphabet!”

Since leaving ‘the bush’ I have been continually surprised at the ignorance that still exists about Aboriginal people and their languages. When people chat to me, and it is revealed that I used to work in Aboriginal schools in the Northern Territory, they say things like “Do you speak Aboriginal then?… Maybe you could make a sign for us saying ‘Welcome to our Kindergarten’ in Aboriginal?” I then have to explain that there are many, many different Aboriginal languages, not just one, and to say or write such things in any one of these languages requires a lot more than a mere literal translation. When I began doing research on the topic of writing in Aboriginal languages. I was again surprised at the sorts of comments people made to me. Comments like “How can you do research on writing in Aboriginal languages: I thought the Aborigines didn't even have an alphabet!”

In the 1870s, an intense quest revealed to scientists that pituri, an important Aboriginal commodity, was sourced from the plant Duboisia hopwoodii?a shrub named after a well-known colonist. But it was Aboriginal people and white explorer-pastoralists from the Mulligan River region in far western Queensland who provided the samples and alerted scientists to the important chemical properties of pituri. Subsequently, there was a proposal to change the name of the plant to Duboisia pituri. Whom should the plant have been named after, the colonist or the Aborigine?

It has been argued that a variety of pressures—a history of colonial exploitation, socio-economic decline, and psycho-environmental factors—have contributed to Aboriginal alcoholism and alcohol related crime. Other analyses have connected Aboriginal drinking patterns with a well established set of social relationships which support and continue to maintain Aboriginal life-style alcoholism. In the search for effective and long-term “solutions” to this addiction the author urges a deeper understanding of Aboriginal drinking relationships and the potential of these relationships to offer real rehabilitative alternatives for Aboriginals.

Australia has a fairly established literature that seeks to explain, on one hand, the pre-colonial Aboriginal society and economy and, on the other, the relationship that emerged between the First Peoples’ economic system and society, and the settler economy. Most of this relies on theoretical frameworks that narrate traditional worlds dissolving. At best, these narratives see First Peoples subsumed into the workforce, retaining minimal cultural residue. In this paper, I argue against these narratives, showing the ways Aboriginal people have disrupted, or implicitly questioned and challenged dominant forms of Australian capitalism. I have sought to write not within the earlier framework of what is called Aboriginal History that often concentrated on the governance of Aborigines rather than responses to governance. In doing this, I seek to bring into view a history of Aboriginal strategies within a capitalist world that sought to maintain the most treasured elements of social life - generosity, equality, relatedness, minimal possessions, and a rich and pervasive ceremonial life.

The last two decades have seen rapid changes in many facets of Aboriginal society, including morbidity and mortality. The same period has witnessed a dramatic increase in writing about and by Aborigines and this has necessitated a re-examination of the national “history” to include the indigenous people of Australia. Medical workers in Aboriginal Australia should be alert to the historical forces determining patterns of ill-health. Psychiatry in particular must develop this perspective if it is to participate with Aborigines in addressing emergent patterns of behavioural distress including suicide, parasuicide, ludic behaviour and self-mutilation. This paper demonstrates the importance of the socio-historical frame in the examination of these behaviours from one discrete region in isolated Aboriginal Australia: the Kimberley.

Purpose The purpose of this paper is to examine the ways in which the mobility of indigenous people in Victoria during the 1960s enabled them to resist the policy of assimilation as evident in the structures of schooling. It argues that the ideology of assimilation was pervasive in the Education Department’s approach to Aboriginal education and inherent in the curriculum it produced for use in state schools. This is central to the construction of the state of Victoria as being devoid of Aboriginal people, which contributes to a particularly Victorian perspective of Australia’s national identity in relation to indigenous people and culture. Design/methodology/approach This paper utilises the state school records of the Victorian Department of Education, as well as the curriculum documentation and resources the department produced. It also examines the records of the Aborigines Welfare Board. Findings The Victorian Education Department’s curriculum constructed a narrative of learning and schools which denied the presence of Aboriginal children in classrooms, and in the state of Victoria itself. These representations reflect the Department and the Victorian Government’s determination to deny the presence of Aboriginal children, a view more salient in Victoria than elsewhere in the nation due to the particularities of how Aboriginality was understood. Yet the mobility of Aboriginal students – illustrated in this paper through a case study – challenged both the representations of Aboriginal Victorians, and the school system itself. Originality/value This paper is inspired by the growing scholarship on Indigenous mobility in settler-colonial studies and offers a new perspective on assimilation in Victoria. It interrogates how curriculum intersected with the position of Aboriginal students in Victorian state schools, and how their position – which was often highly mobile – was influenced by the practices of assimilation, and by Aboriginal resistance and responses to assimilationist practices in their lives. This paper contributes to histories of assimilation, Aboriginal history and education in Victoria.

This dissertation focuses on the work-for-pay exchange between aboriginal people and immigrants of European stock--the two most prominent cultural groups in the early history of British Columbia--and follows the patterns of this exchange from its origins through to the 1970s. It examines both the material and the rhetorical construction of the "Indian" as a part of British Columbia's labour force, a process described as racialization, and emphasizes, as well, the transformation of meaning inherent in cross-cultural exchange. It is a province-wide analysis, the core of which is a micro-history of one aboriginal group, the Songhees people, who live in the area now occupied by Victoria, the capital city. This examination challenges the long-standing view that aboriginal people were bystanders in the economic development and industrialization of British Columbia outside, and after, the fur trade. From the establishment of the Colony of Vancouver Island in 1849, through Confederation with Canada in 1871 and to the 1885 completion of the Canadian Pacific Railway, aboriginal people comprised the majority of the population in present-day British Columbia, and the majority of the work force in agriculture, fishing, trapping and the burgeoning primary industries. This dissertation charts the subsequent decline in participation of aboriginal people in the capitalist economy from 1885 to 1970. Using a micro-historical study and close attention to aboriginal voices it offers a set of explanations for the changing proportions of work, both paid and unpaid, and state welfare payments. The micro-history reveals that the Songhees people engaged in two distinct but connected economies and were already familiar with forms of labour subordination prior to the European introduction of a capitalist economy. The Songhees participation in paid labour for Europeans was facilitated by these existing forms of labour organization and depended on the co-existence of their other economies; the Songhees used earnings from capitalist paid labour to expand their non-capitalist economies. After 1885, new state policies repressed the non-capitalist aboriginal economics and therefore diminished the underlying motivation for aboriginal participation in capitalist work. At the same time, an influx of labour-market competition and a variety of racialized laws and practices restricted the Songhees' ability to get work. Increasingly they were left with seasonal, low-skill and low-wage labour, a niche that maintained them so long as it was combined with a subsistence economy and involved the full participation of adult and adolescent family members. In the late 1940s and 1950s this pattern too was remade. Legal restrictions dramatically limited the subsistence economies; technological change curtailed the demand for seasonal labour in the canning, fishing and agricultural sectors, particularly affecting aboriginal women workers; and, compulsory schooling regulations began to reduce labour available to the family economy. At the same historic moment when the combined wage and subsistence economies ceased to be able to support them, the state extended some existing social welfare programs, such as Old Age Pension, to Indians, and expanded other programs, including Family Allowance, to all Canadians. In examining the patterns of aboriginal-non-aboriginal exchange relations over the long-term, this dissertation argues that high rates of unemployment and welfare-dependency among contemporary aboriginal communities are relatively recent historical phenomena, with observable roots and causes.

As an Aboriginal author, my thesis is grounded in an Indigenist paradigm; a paradigm that places Indigenous experiences at the center of inquiry and whose goals are to “serve and inform the Indigenous struggle for self-determination” (Rigney, 1997, p. 119). Hence, this thesis is an auto/ethnographic journey based on my lived experiences. Apart from my memories I draw on family documents as well as other printed source material, such as the diaries of my Grandfather and departmental files. In the era when I was growing up, the cliché of; “Children should be seen and not heard” was popular. Not only that, my mother often told us that we children were never to tell anyone our business or talk about our personal life. Therefore, I never spoke freely about my family’s life, my growing up years and how I was ashamed of being an Aboriginal when I was younger. While was raising my four grandchildren, I started thinking about my family’s history and how my children and grandchildren knew little of our history. Through reading articles and books by Indigenous authors I came to better understand our history and have come to appreciate that our history must be documented by Indigenous peoples. Although many stories have been written about Indigenous peoples by non-Indigenous writers, these writings tend to perpetuate misconceptions and stereotypes about the First Peoples of Australia. An Indigenist approach seeks to debunk these misconceptions and place the Indigenous experience at the center of the inquiry. Reflecting on the stories written by Indigenous authors, I decided to follow their example and tell my family’s story as best I could, despite my mother’s injunction never to tell anyone “our business”. Therefore, Annie’s Mob is the story of my own life as well as the story of my family, given that my life has unfolded within the context of my family and the historical times in which we lived. I hope my story will encourage other women and men to document their history and leave their stories as a legacy for the future.

The issues of political sovereignty and self-government that preoccupies so many aboriginal peoples today were also central when Innocent IV began his deliberations about the right of non-Christian peoples to dominium, the right to exercise political power and to own property. The question for both Innocent IV and Hostiensis was: did non-Christian peoples have de iure dominium? Innocent IV, basing his argument on natural law, affirmed the universal human right of peoples to political sovereignty. Hostiensis, arguing from a theological base, denied de iure dominium to all non-Christian peoples. Because they both supported the Church's mission to evangelize the nations their theories differed little when it came to implementation. In the era of European colonial expansion the issue of dominium was shunted aside in favour of working out relations among the colonial powers themselves. In this context of inevitable European expansionism, the papacy, including Alexander VI, tried to carry out a two-fold ministry of protecting and evangelizing the newly discovered peoples. Alexander's solution was to use the conflict and rivalry between the colonizing powers, and the mechanism of a line of demarcation, to ensure for the Church a space for evangelization. This overriding missionary concern of the papacy was confronted with new ideological challenges during the pontificate of Paul III. Paul III affirmed the humanity of the Indian peoples and defended aspects of dominium, but within the sphere of Iberian political sovereignty. He did this principally because an authentic response to the Gospel message required freedom on the part of those receiving it. Thus justice issues were seen as subordinated to, and as necessary conditions for, the work of evangelization. Leo XIII and his successors took the issue of universal natural rights for granted. In doing so they brought Catholic social teaching on slavery into line with modern teaching and practice. More importantly, Leo XIII began to treat human rights concerns as issues in themselves, and not just as necessary conditions for the successful reception of the Gospel. Leo also retrieved a fuller understanding of dominium. A review of this Catholic social teaching as applied to "minorities," and particularly to "aboriginal peoples," from Leo XIII to John Paul II reveals both continuity and innovation. The earlier overriding concern for evangelization has definitely continued. What is new is that issues of justice, development, and more recently, liberation, are now seen as integral to, and constitutive of, evangelization. This shift occurred principally during the pontificates of John XXIII, and Paul VI. In the pontificate of John Paul II, a growing ecological consciousness has influenced the teaching on the rights of aboriginal peoples. I submit that the Vatican has recognized the special relationship that aboriginal peoples have with the land. Thus the right to an adequate land base for indigenous peoples has been supported in a unique way by linking it with the fundamental right to life. (Abstract shortened by UMI.)

Master of Arts
One of the difficulties in writing a regional history such as this thesis was the sensitivity surrounding the appropriate choice of terminology and spelling conventions. Conflicts have arisen between conforming to the standardisations of the History Discipline and a desire to accommodate the wishes of the indigenous communities in the geographical area of this study. The absence of trained linguists in the white community during the initial colonisation period has resulted in a considerable divergence of opinion over the nomenclature and spelling derivatives surrounding the indigenous people living in what is no w known as the Geelong-Ballarat region. The first white chroniclers referred to the Wathawurrung by a myriad of different names (over 100 different names were recorded by Clark for the people in this study area) including: Watowrong, Wartowrong, Wot o wrong, Watourong, Wodowrow . Throughout the text ofthis work 1 have applied the term Wathawurrung' to all indigenous groups in primary documents that involve the known language area of the Wathawurrung. Where there is some doubt as to which tribe is being referred to 1 have included other language groups that the writer ma y have also been referring to. " From Preface"

The thesis examines the history of Central Australia and specifically the development of health services in the Northern Territory. The continuing colonial realtionships between Aboriginal and non-Aboriginal Australia are explored as a reason for the peristence of poor Aboriginal health status, including the cycle of vself destructive behaviours. It rovides an explanation of the importance of community agency to address community problems, and the potential of community controlled ABoriginal health services as vehicles for such community action.

The thesis examines the history of Central Australia and specifically the development of health services in the Northern Territory. The continuing colonial realtionships between Aboriginal and non-Aboriginal Australia are explored as a reason for the peristence of poor Aboriginal health status, including the cycle of vself destructive behaviours. It rovides an explanation of the importance of community agency to address community problems, and the potential of community controlled ABoriginal health services as vehicles for such community action.

The Nabarlek uranium mine is located in the Alligator Rivers Region of the Northern Territory of Australia. The site lies in the wet/dry topics with an annual rainfall of about 1400mm, which falls between October and April. The site operated as a “no release” mine and mill between 1979 and 1988 after which time the facility was mothballed until decommissioning was required by the Supervising Authorities in 1994. The dismantling of the mill and rehabilitation earthworks were completed in time for the onset of the 1995–96 wet season. During the operational phase accumulation of excess water resulted in irrigation of waste water being allowed in areas of natural forest bushland. The practice resulted in adverse impacts being observed, including a high level of tree deaths in the forest and degradation of water quality in both ground and surface waters in the vicinity. A comprehensive environmental monitoring programme was in place throughout the operating and rehabilitation phases of the mine’s life, which continues, albeit at a reduced level. Revegetation of the site, including the former irrigation areas, is being observed to ascertain if the site can be handed back to the Aboriginal Traditional Owners. A comprehensive review of proximal water sampling points was undertaken in 2001 and the data used to provide a snapshot of water quality to assist with modelling the long term prognosis for the water resources in the area. While exhibiting detectable effects of mining activities, water in most of the monitoring bores now meets Australian drinking water guideline levels. The paper reviews the history of the site and examines the accumulated data on water quality for the site to show how the situation is changing with time. The paper also presents an assessment of the long term future of the site in respect of water quality.

How does the communication of information affect the pipeline industry? People are becoming more aware of the pipeline industry and how it may affect individuals and landowners in the future. Corporations are producing commuications tools to alleviate the lack of knowledge and the hidden value of energy pipelines. This case study examines two projects: “Passing through Edson” examines a winter pipeline construction job in Edson, Alberta. The story is told by the people on the job. We examine the environmental issues, economic impact, Native employment, and winter construction techniques. The “Boy Chief” video examines the impact of an archaeological dig on the prairies. In this program we have insight into the aboriginal history of the area and how the pipeline company is helping people learn more about the Native way of life. The paper examine how communication tools like these, allow employees access to information when communicating to stakeholders.

In the third volume (卷, juan) of an 18th-century woodblock publication Images of Tributaries of the Ruling Qing Dynasty (Huang Qing zhi gong tu, 皇清职贡图), among others non-Han ethnic groups, there are thirteen illustrations of Taiwan’s indigenous peoples, including a brief description of their costumes, disposition, and customs. This volume contains illustrations of various types of Taiwanese “barbaric” natives that reveal a great deal about Qing imaginative conception of savagery. They are classified both by administrative divisions and by categories of civilized (熟番) and uncivilized (生番) depending on their adoption of Chinese culture. The entries begin with the civilized savages of Taiwan county, then south to Fengshan county, and then north to Zhuluo county, Zhanghua county, and finally Danshui sub prefecture. The submitted uncivilized savages follow again in sequence from south to north. Last are the uncivilized savages of the inner mountains. The illustrations thus proceed from the most civilized one through increasing degrees of savagery. In each of the thirteen pictures, the differences between the savage figures and civilized figures are emphasized. The depictions of the physical appearances of the civilized and uncivilized savages can demonstrate their relative levels of civilization. The Qing Dynasty’s ethnographical description, which recorded the social culture of the historical tribes, now became particularly valuable because of the lack of a great amount of information on the indigenous tribes of Taiwan. It is quite necessary to study the society, traditions and cultural features of Taiwanese indigenous people in different periods, especially after their integration into the Qing Empire. Huang Qing zhi gong tu is regarded as a very important source for a detailed investigation of different ethnical types of peoples who inhabited the island of Taiwan. We have to analyze the history of aboriginal culture alongside Chinese culture to gain a more rounded insight into the culture and history of Taiwan.

The Northern Gateway Pipelines project drew more attention from the Canadian public than most in recent Canadian history. Northern Gateway has proposed to construct and operate an oil pipeline, a condensate pipeline, associated facilities, two tunnels, powerlines, multiple pump stations, a land tank terminal, and a marine transportation terminal to be located near Kitimat, British Columbia. Not since the Canadian Pacific Railway has a project raised the interest of Canadians. The regulatory review and assessment process for Northern Gateway was extensive. The Canadian government established a Joint Review Panel to preside over the assessment and review process. To ensure that stakeholders and potentially affected aboriginal communities were heard, the Panel embarked on an extensive public hearing and consultation program. They received thousands of letters of interest, and 4,300 requests for public statements. The Panel heard from approximately 1,200 registered participants in 19 locations. The regulatory hearings spanned a period from September 2012 to June 2013. Opposition to the project stemmed primarily from concerns about the effect of oil spills on freshwater and marine environments and human use. Others were concerned about the expanded development of oil sands. The environmental assessment undertaken by Northern Gateway was extensive, as was the mitigation proposed by the project to avoid or minimize environmental effects resulting from the project. The project incorporated new and innovative approaches to minimize environmental effects. The paper introduces the project and the latter part discusses the extraordinary measures proposed and undertaken to minimize potential risks to the environment.

This paper will seek to address the rapidly evolving issues relating to the impact of aboriginal interests upon resource development projects. In particular, this paper will address the interaction between aboriginal interests and pipeline projects and recent judicial decisions that have impacted upon this interaction. This paper will specifically discuss the extent of consultation obligations with aboriginal people and strategies that may be employed by proponents of pipeline projects. More specifically, this paper will address the following: Distinctions between various types of constitutionally protected aboriginal interests, including, treaty rights (both historic treaties and comprehensive land claim agreements), aboriginal rights, including aboriginal title, and Me´tis rights; Understanding the obligations of government and third party resource developers to consult with aboriginal people, including consultation and accommodation of aboriginal interests and compensation issues; - Consultation as part of the regulatory approval processes for both provincially and federally regulated pipelines, including both National Energy Board requirements and provincial requirements (British Columbia and Alberta); and - The practical realities of consultation, including the scope of remedies for the unjustified infringement of aboriginal interests; and how to create a more effective consultation process and protect the interests of proponents of pipeline projects.

13 uranium mines operated in the South Alligator Valley of Australia’s Northern Territory between 1953 and 1963. At the end of operations the mines, and associated infrastructure, were simply abandoned. As this activity preceded environmental legislation by about 15 years there was neither any obligation, nor attempt, at remediation. In the 1980s it was decided that the whole area should become an extension of the adjacent World Heritage, Kakadu National Park. As a result the Commonwealth Government made an inventory of the abandoned mines and associated facilities in 1986. This established the size and scope of the liability and formed the framework for a possible future remediation project. The initial program for the reduction of physical and radiological hazards at each of the identified sites was formulated in 1989 and the works took place from 1990 to 1992. But even at this time, as throughout much of the valley’s history, little attention was being paid to the long term aspirations of traditional land owners. The traditional Aboriginal owners, the Gunlom Land Trust, were granted freehold Native Title to the area in 1996. They immediately leased the land back to the Commonwealth Government so it would remain a part of Kakadu National Park, but under joint management. One condition of the lease required that all evidence of former mining activity be remediated by 2015. The consultation, and subsequent planning processes, for a final remediation program began in 1997. A plan was agreed in 2003 and, after funding was granted in 2005, works implementation commenced in 2007. An earlier paper described the planning and consultation stages, experience involving the cleaning up of remant uranium mill tailings and other mining residues; and the successful implementation of the initial remediation works. This paper deals with the final planning and design processes to complete the remediation programme, which is due to occur in 2009. The issues of final containment design and long term stewardship are addressed in the paper as well as some comments on lessons learned through the life of the project.

This paper examines renewable energy developments on Aboriginal lands in North-West Western Australia at three scales. It first examines the literature developing in relation to large scale renewable energy projects and the Native Title Act (1993)Cwlth. It then looks to the history of small community scale standalone systems. Finally, it examines locally adapted approaches to benefit sharing in remote utility owned networks. In doing so this paper foregrounds the importance of Aboriginal agency. It identifies Aboriginal decision making and economic inclusion as being key to policy and project development in the 'scaling up' of a transition to renewable energy resources in the North-West.

Professor Leslie R. Marchant was a Western Australian historian of international renown. Richly educated as a child in political philosophy and critical reason, Marchant’s understandings of western political philosophies were deepened in World War Two when serving with an international crew of the merchant navy. After the war’s end, Marchant was appointed as a Protector of Aborigines in Western Australia’s Depart of Native Affairs. His passionate belief in Enlightenment ideals, including the equality of all people, was challenged by his experiences as a Protector. Leaving that role, he commenced his studies at The University of Western Australia where, in 1952, his Honours thesis made an early case that genocide had been committed in the administration of Aboriginal people in Western Australia. In the years that followed, Marchant became an early researcher of modern China and its relationship with the West, and won respect for his archival research of French maritime history in the Asia-Pacific. This work, including the publication of France Australe in 1982, was later recognised with the award of a French knighthood, the Chevalier d’Ordre National du Mèrite, and his election as a fellow to the Royal Geographical Society. In this festschrift, scholars from The University of Notre Dame Australia appraise Marchant’s work in such areas as Aboriginal history and policy, Westminster traditions, political philosophy, Australia and China and French maritime history.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.