Spatial variation in cervical cancer screening participation and outcomes among Indigenous and non‐Indigenous Australians in Queensland

Indigenous women continue to experience a disproportionately higher burden of cervical cancer than non‐Indigenous women in Australia. The National Indigenous Cervical Screening Project used probabilistic record linkage to combine population‐based administrative databases and identify Indigenous women on Pap Smear Registers. This study aimed to quantify the spatial variation by local government areas (LGAs) for Indigenous and non‐Indigenous women in Queensland in cervical screening participation rates and related outcomes. Empirical Bayes local geostatistical smoothing was performed to reduce the likelihood of spurious variation between small areas. The cohort included 1,091,260 women (2 per cent Indigenous) aged 20 to 69 with 2,393,708 Pap smears between 2006 and 2011. Indigenous women had smoothed LGA‐specific 5‐year participation rates (interquartile range (IQR) 38.9–53.3 per 100 eligible women) consistently lower than non‐Indigenous women (IQR 80.7–85.3). The non‐overlapping confidence intervals of these rates suggest that the Indigenous differential was significant. Compared with Indigenous women, non‐Indigenous women had consistently lower and more stable prevalence rates of histologically confirmed high grade abnormalities (IQR 8.0–10.1 versus 15.0–21.3 per 1,000 screened women). Although the LGA‐specific rates also suggest that a higher proportion of non‐Indigenous women were followed‐up within two months of an abnormal screening result, the wide confidence intervals for these estimates limit our ability to draw definitive conclusions about spatial patterns for this outcome. These findings highlight the importance of continued monitoring and ongoing efforts to identify drivers of these patterns and develop effective strategies to improve participation and potentially reduce the cervical cancer burden among Indigenous women.     

Welshness in ‘British Wales’: negotiating national identity at the margins

Popular interpretations of national identity often focus on the unifying qualities of nationhood. However, societies frequently draw hierarchical distinctions between the people and places who are ‘most national’, and those who are ‘least national’. Little attention is paid to these marginal places within the nation and the experiences of their inhabitants. This article helps to address this by analysing the ‘less Welsh’ British Wales region of Wales, a country that has traditionally possessed a hierarchical, regionally constituted nationhood. The article studies the British Wales region both ‘from above’ – considering how some areas develop as ‘less national’ – and ‘from below’, introducing empirical ethnographic work into ‘everyday Welshness’ in this area. Whilst previous work on hierarchical nationhood focuses on how hierarchies are institutionalized by the state, this article demonstrates how people at the margins of the nation actively negotiate their place in the nation. Whilst people in this area expressed a strong Welshness, they also struggled to place themselves in the nation because they had internalized their lowly place within the national hierarchy. The article demonstrates the importance of place and social class for national identity construction and draws attention to the role of power in the discursive construction of hierarchical nationhood.