Portraying cancer in Australian film

(I originally published the following article on Croakey, Australia’s independent, in-depth social journalism for health blog, on 9 September 2015, under the title “Cancer on Screen”.  Click here to view the original article.)

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One in two Australian men and one in three Australian women will contract cancer in their lifetime. Cancer is a killer, second only to cardiovascular diseases as the cause of deaths in Australia. Cancer is also responsible for 35% of the “fatal burden”, or years of life lost by Australians due to premature death, way ahead of cardiovascular disease.

Despite this widespread prevalence in our lives (who does not know someone affected by cancer?), cancer is rarely presented in Australian film. Think about all of the deaths we witness on-screen, how many of them are from cancer? Lots of deaths, many of them violent (war, accidents, murder), but not much from cancer.

There’s a reason for this. Dying from cancer rarely pretty, it’s usually quiet and often hidden. A once clandestine and “whispered about” illness, it is now “often described as the defining plague of our generation”, writes Dr Siddhartha Mukherjee in his 2011 Pulitzer Prize-winning book, The Emperor of All Maladies: A Biography of Cancer.

It may be a “defining plague”, but you wouldn’t know it by watching Australian films. For reasons we can only guess at, two Australian films featuring cancer are now playing in Australian cinemas. It’s too soon to know if this is the beginning of a trend, or – more likely – a simple coincidence. However a cinema release, with its attendant large marketing budget and effort, indicates that a number of people think the topic worth portraying on-screen.

Last Cab to Darwin

Last Cab to Darwin stars Michael Caton as a Broken Hill taxi driver who travels to Darwin to commit assisted suicide because he is dying of inoperable stomach cancer and wants to avoid palliative care. Since its cinema release in early August, it has already grossed $6.2 million in Australian cinemas, and may still be playing long after the latest Mission: Impossible and The Man from U.N.C.L.E. (current large release American films) have disappeared. Despite its seemingly depressing euthanasia theme, Last Cab to Darwin – already listed by The Sydney Morning Herald as one of the 10 “greatest Australian road movies” – manages to be entertaining, wryly funny, uplifting and filled with heart-felt meaning. It sweeps its characters along its way with effective sub-plots that illustrate Aboriginal reconciliation (few recent Australian films have shown such intimate connections between Indigenous and non-Indigenous characters), the unique wonders of the Central Australian landscape and learning the ability to express and receive love.

Force of Destiny

The other Australian cancer film, Force of Destiny (tagline: “A journey of love on a transplant waiting list”), the latest by iconic Dutch-born Australian director Paul Cox, opened last week and stars David Wenham as a sculptor who contracts liver cancer. Fresh from the Melbourne International Film Festival and with an astonishingly beautiful production, the story focuses more on Wenham’s character’s actual battle with the disease.

Cox based Force of Destiny in part on his own life story: he is a cancer survivor and a transplant recipient. The film’s producers and distributors have taken an increasingly popular approach to Australian film marketing: setting up a series of special events, many of them associated with cancer charities, in order to reach the audiences that might not normally go to a small Australian film.

Any others?

The only other Australian cancer film I can easily recall is 2012’s Not Suitable for Children, an improbable but moderately successful romantic comedy in which Ryan Kwanten played a character diagnosed with testicular cancer who attempts to father a child before he becomes sterile. The comedy comes not from the cancer, but Kwanten’s character’s desperate attempts to find a suitable mother to bear his child.

The truth is that best films about cancer are not actually “about” cancer, but use cancer as a mechanism to illustrate other important, human emotional needs. This is why Last Cab to Darwin almost certainly will reach a much larger audience than Force of Destiny, with its particular focus on, well, cancer, as its main topic.

The American approach

Despite the clear popular success of Last Cab to Darwin and Force of Destiny’s marketing creativity and the strong will of its creator Paul Cox, Australian films have not yet moved to copy the American “weepie” formula where … let’s be honest, no spoilers are required … one of the main characters always dies from cancer. From Ali McGraw in 1970’s Love Story to Debra Winger in 1983’s Terms of Endearment to last year’s The Fault in Our Stars (from the pen of John Green, with three teen characters with cancer, two of whom die), Americans have created literally hundreds of films with cancer, especially teens, so much so that one commentator has asked that films “stop using cancer as a plot device”.

The latest American film in this genre, Me and Earl and the Dying Girl – in which the dying teenage girl has leukaemia – also opened last week, fresh from audience awards at both the Sydney Film Festival and Sundance. This gives Australia two cancer film releases in one day, with three in the cinemas. Is this a record?

Dr Brian Bowring, Tasmanian rural general practitioner, receives AM honour

Today, 10 June 2013, the Australian Queens Birthday “Honours List” includes my former colleague Dr Brian Bowring, a past Chair of the Rural Health Education Foundation and a rural general practitioner in northern Tasmania.  Dr Bowring received an “AM” – a Member in the General Division of the Order of Australia, for “significant service to medicine in rural and regional areas, and as a general practitioner”.

Dr Brian Bowring lives in George Town, Tasmania, a small industrial rural community located about one hour north of Launceston.   He was born in Hobart and graduated in medicine from the University of Tasmania.  Aside from his role with the Rural Health Education Foundation, Dr Bowring has been the Chair and Treasurer of the Board of General Practice Training Tasmania, Chair of Rural Workforce Tasmania and Deputy Chair of what is now Rural Health Workforce Australia.

I worked closely with Dr Bowring for more than eight years, reporting directly to him for the majority of my time when I was the CEO of the Rural Health Education Foundation from January 2003 through August 2011.  (He took the role of Chair of the Foundation in October 2002 and left that position in December 2010.)

He is a highly skilled medical educator and has been a generous and tireless campaigner for and practitioner of rural health, making an important impact both within his home state of Tasmania as well as nationally.  I have seen him “in action” doing everything from chairing meetings to staffing exhibition conference tables in places as diverse as Perth and Launceston.  His ability to “connect” with rural and remote health practitioners is unparalleled. I am proud of the eight-plus years that I worked closely with him and very pleased that his life and work has been honoured in this way.

To see the details of this honour on the website of the Governor General of Australia, go to this link and scroll down to page 40.

A photo of Dr Brian Bowring appears below:

 

New Croakey blog post on Indigenous eye health project

My blog post on Croakey about the Rural Health Education Foundation’s Indigenous eye health project has just been published on Croakey, the health blog of Crikey.  This post details the program A Clear View, which will be a simultaneous satellite broadcast, interactive webcast and National Indigenous Television (NITV) broadcast on Tuesday 26th July 2011 – certainly the first time these three media have all been used at the same time.  Admission:  I am the Executive Producer of the program.

Digital inclusion, health and wealth in Australia

The following is the text of a blog post which appeared today (15 July 2011) on Croakey, the health blog of Crikey.  You can read the original post by clicking here.

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I recently identified the possibility that without positive intervention, the growth of broadband internet could mean that more than three million Australians would be left on the wrong side of the digital divide, and that this would have significant public health implications.

There is a great deal which we do not yet know or understand about what impacts broadband will have on our lives.  A report on broadband adoption and economic benefits for the Australian Communications and Media Authority (ACMA) notes (p. 18) that:

The adoption of generic new technologies such as broadband creates a multitude of economic effects that ripple through markets and communities, potentially for many years.  Their cumulative effects are complex, often profound and have the potential to change work patterns, social relationships, economic activity and settlement patterns.

Despite the optimistic forecasts of the July 2010 Access Economics Telehealth report, it is also important to recognise that the use of broadband for Australian consumer applications is still in its infancy.

A 2009 article by University of Miami academic María E. Davalos and colleagues warns that telehealth evaluation studies to date may not be reliable because of their small sample sizes, lack of uniform methodologies, scant use of randomised control trials, lack of long-term impacts and disparate estimation methods.

Health is clearly not a top driver of broadband take-up:  the ACMA internet service market report of July 2011 does not specifically mention health matters as part of the listing of most popular activities which people do online.

The evaluation of a ground-breaking pilot digital inclusion initiative undertaken in a Melbourne public housing estate by the non-profit organisation Infoxchange does indicate positive benefits for health, although the main direct economic benefits were in education and employment.

A number of Australian pilot broadband health consumer applications are currently underway, including a Western Australian CSIRO rural and remote eye screening project, falls prevention, chronic illness monitoring in the Hunter Valley and a Townsville diabetes management project.

Although we do not yet have much data, this does not mean that broadband for health is not important:  clearly it is, if for no other reason that there is now a widespread assumption (and thus a de facto requirement) that we will all access information online.

American media commentator Peter Osnos (a Fellow at the Century Foundation in the USA) noted in a 6^th July article that:

The free information services of the past are gradually being eliminated or reduced…. Telephone books are disappearing because they are an environmental nuisance. Telephone information calls can now cost up to $2. The assumption is that shifting material onto the Internet seems to be cost-free, when in fact we are paying the telecommunications providers whatever price they set. The move to digital communications — with all the benefits we attribute to the process — is irreversible, and the costs have been accepted by those who can afford the changes with barely a ripple.

Osnos goes on to write that his monthly household “spend” for two adults living in Connecticut on telephone (two mobiles, two landlines), broadband and cable TV was US$487 per month, plus electricity (estimated at $40/month) to power it all.

This pattern is being replicated in Australia.  My Sydney household’s adult monthly “spend” for a similar pattern (two landlines and two mobiles, plus broadband) averages about Aus$350 – without the cable TV, plus electricity – and thus is reasonably equivalent.  That’s $4200/year, which would be a very significant sum for a low income family.  And just this week I went through the exercise of attempting to obtain my family’s Medicare and private health insurance statements for the last financial year:  the assumptions were that it would all happen online.

Positive trends are evident, with the current Australian Government paying particular attention to what is broadly termed “digital inclusion”.  On 1^st July, the NBN Co launched an interim broadband satellite service for residents, small businesses and Indigenous communities in rural and remote Australia who can’t currently access broadband services comparable to those available in metropolitan areas.

And on 7^th July, The Minister for Broadband, Communications and the Digital Economy, launched the 2011-12 Regional Telecommunications Review, that will examine telecommunications services in regional, rural and remote parts of Australia.

All of this attention is great, but it is early days yet, and the Government can still get distracted by other – and more pressing – political matters (carbon tax, anyone?).

As Osnos warns, “redress(ing) the digital divide was an early agenda item for the Obama administration, but (with) so much else to grapple with now, little momentum seems left for that effort.”

The Digital Divide returns to Australia with implications for health

My blog on “Croakey” – the health blog of crikey.com.au – on the digital divide and how it will impact health, has just been published today, and has been extensively tweeted.  The title is “The digital divide: A profound public health issue that needs work”, and identifies the fact that there will be at least 3.4 million Australians who will have a major difficulty participating in the online world.  All of this will have profound public health ramifications, not to mention social and economic disadvantages.  The full post is also re-produced below:

Now that the much-discussed National Broadband Network (NBN) is underway, many people assume that it is just a matter of time before we are all fully connected. Except that we will soon start hearing a phrase that was in common usage some ten years ago: the digital divide.

This concept has slipped from the public radar in recent years under the onslaught of smart phones, i-Pads, other “tablets” and the bewildering and growing collection of digital devices that will operate under the law of “if it can be connected, it probably will”.

The recent Sydney launch (at the annual CeBIT technology conference) by Senator Conroy, the Minister for Broadband, Communications and the Digital Economy, of the new National Digital Economy Strategy is very welcome, and it is particularly good to see the attention now being paid to those in danger of being left behind in the latest online revolution.

The NBN website clearly states the problem:

Thirty-seven per cent of people aged 55-64 did not use the internet in 2008-09, compared with 69 per cent of people aged 65 or more. Similarly, 34 per cent of people earning less than $40,000 a year did not use the internet in 2008-09 and nor did 34 per cent of people living in outer regional and remote areas. People with a profound or severe disability requiring assistance with core activities have significantly lower access to the internet and broadband than other Australians. For example, about 28 per cent of people with a disability requiring assistance with core activities have broadband access in comparison to about 48 per cent of people who do not need assistance with core activities.

In other words, if you are poor, Indigenous, old or disabled and live in outer regional/remote areas of Australia, your chances of being “online ready” are pretty low.

And who are the people who will most need the chronic disease monitoring systems the Government is starting to put in place? The poor, the elderly, the disabled and the residents of outer regional and remote Australia.

The July 2010 Access Economics tele-health report (PDF) concluded that “Tele-health offers the potential for significant gains to Australia’s population, especially for people who are elderly or who live in rural or remote communities.”

That’s good news, but a key complication of the NBN is that just because you build it, they may not come – to paraphrase the famous tag-line from the Kevin Costner film Field of Dreams (Phil Alden Robinson, 1989). Internet access does and will cost money, and it will take some level of technical expertise and digital literacy to gain and maintain that access.

This issue was brought into sharp relief at CeBIT’s e-Gov conference, with presentations by Martha Lane Fox and Graham Walker of Office of the UK Digital Champion. They presented some interesting facts: 8.7 million adults in the UK never use technology, and people who are “offline” over-estimate the costs of being online by a factor of three.

The “addressable market” (by business) in the UK is estimated to be 80% of the population: they will find their own way online. It’s the final 15 to 20% that really need the help.

We have no reason to assume that the situation is different here in Australia, and our vast distances to outer regional and remote locations will only exacerbate the problems.

The Government has clearly recognised this, in Minister Conroy’s announcement of $23.8 million over three years for a “Digital Communities Initiative”, which will establish “‘Digital Hubs’ in each of the 40 communities that will first benefit from the NBN” in order “to improve their digital literacy skills”. A related program provides $10.4 million over four years to continue the “Broadband for Seniors” program.

It’s a great start. But with more than 22,600,000 Australians, even a conservative estimate of 15% digitally deprived residents means that almost 3.4 million Australians will fall on the other side of that divide. That’s a lot more than 40 digital hubs can address.

This is not just an information access issue; it is a profound public health, social welfare and economic challenge.

Without full participation in the online world, we are in danger of relegating substantial parts of our population to generations of compounded disadvantage of health, education and employment.

The Government’s current efforts can only be a start. What we need is concerted action by local and state government, community and business to connect all Australians.

Debates over NBN funding only obscure what will cost tens of billions of dollars down the track if we do not start to plan for these challenges now.

Digital TV and rural health in Australia

I have just published an article on “Croakey”, the health and medical blog of Crickey – an Australian current affairs website.  The article, entitled “Is rural health going to miss out on the opportunities of digital TV?” discusses the new digital satellite platform about to be launched in Australia, and how it is not – at this stage – providing any access to health communication organisations such as the Rural Health Education Foundation, of which I am the CEO.

New report on Crikey’s health blog ‘Croakey’

The Rural Health Education Foundation – of which I am the CEO – has a  simultaneous live webcast and satellite broadcast of an important Aboriginal and Torres Strait Islander health program entitled Sharing Solutions: Indigenous Communities Tackling Chronic Disease (live at 8.00pm Sydney time on Tuesday 27^th April).  This program is featured in a report which I have contributed (entitled “Some good news in Indigenous health”) to the Australian current affairs website Crikey’s health “blog”, which is called “Croakey”.

I have also accepted an invitation from Crikey to be a member of the Crikey Health and Medical Panel (known as “CHAMP”).  Established in 2000, Crikey is a daily Australian electronic bulletin (with a readership of about 30,000) aimed at providing independent news.  CHAMP was established to enhance public debate about health, to encourage public health advocates to engage in debate, and to help the media to identify public health advocates and issues as sources for articles.

ABC Radio interview on Indigenous TV program

My interview on ABC Radio North Queensland (Cairns) went to air this morning – about the Rural Health Education Foundation’s program “Sharing Solutions”, preventing and treating chronic disease in Indigenous Australians.  The ABC link is http://www.abc.net.au/news/stories/2010/04/07/2865896.htm and the news release is at http://www.rhef.com.au/2010/04/05/all-indigenous-panel-tackles-chronic-disease-in-april-27th-broadcast/.

Diabetes Channel video

A video of me has just (October 23) been released on the Australian Diabetes Channel, which is run by Diabetes Australia – NSW.  In this short segment, I discuss the work of the Rural Health Education Foundation and its four-part educational television series on diabetes type 2.  Go to http://www.diabeteschannel.com.au and click on the News and Research tab to view the video.