Targeting rural inequities: current priorities for rural health

HIV Australia | Vol. 10 No. 2 | October 2012

PENNY HANLEY and HELEN HOPKINS outline key health and wellbeing issues for people in regional and rural areas.

National Rural Health Alliance

The National Rural Health Alliance (the Alliance) is made up of 34 national organisations representing rural and remote health interests, including health professionals (nurses, doctors, pharmacists, dentists, paramedics and a range of allied health workers), health educators, researchers and students, health service providers and managers, Indigenous organisations and health consumer networks.

The organisations in the Alliance work collaboratively to improve the health and wellbeing of people in rural Australia. The Alliance takes a broad view of health and is concerned with a wide range of health determinants, including social, economic, cultural and environmental factors.

Research is increasingly showing that beyond medicines, doctors, nurses, nutritious food and healthy activity, a person’s good health is largely determined by the community in which he or she lives: its infrastructure, services, educational facilities, employment opportunities, capacity for personal interaction and social inclusion, and the extent to which its members have control over their lives.

Currently rural people face an annual health care deficit of at least $2.1 billion, and a range of other inequities. At the annual face-to-face meeting of Council in September 2012, the Alliance set eight priorities for rural health. These are: to help reduce smoking rates in rural areas; to work for better oral health; high-speed broadband; HECS reimbursement for nursing and allied health (as well as medicine); Medicare Locals needs assessments and Healthy Communities reports that target rural inequities; healthy ageing and aged care in rural and remote areas; better mental health services; and quad bike safety.

These priorities and their importance in implementing health reforms that work for rural people are discussed below. The Alliance would welcome further information from the readers of HIV Australia about the relevance of these issues to their own rural networks or of other key issues for rural health.

As well as finding constructive ways to raise current priorities with governments, the health sector and the public about key issues that must be addressed to achieve our common goal of equal health for all Australians by 2020, the Alliance hosts collaborative public forums and seminars with other policy and advocacy organisations.

For example, this year the Alliance co-hosted the National Oral Health Forum in August, the 3rd Rural and Remote Health Scientific Symposium in June and the Joint Policy Think Tank on national health reform in rural and remote areas in April. All submissions, fact sheets, publications, proceedings of seminars and conferences and so forth are published on the Alliance website, www.ruralhealth.org.au

The 12th National Rural Health Conference to be held in Adelaide from 7–10 April 2013 will provide a great opportunity for more than 1,000 people from all round Australia with an interest in rural health, to add their voices to recommendations for improving rural health.

Some current priorities for rural health

Preventing chronic disease: smoking as a sentinel issue

Improvements in health status and life expectancy for rural people are not keeping up with those in Australia’s major cities.

The Council of Australian Governments (COAG) Reform Council¹reports that, in 2008–09, whereas 17.6% of people in the major cities were smokers, the figures were 27% for outer regional areas and up to 35% for remote and very remote areas. Unless the smoking rate in rural areas is reduced, Australia will not meet its national target to reduce smoking rates to 10% by 2018.

Urban-centric strategies often don’t work well in rural and remote areas. The Alliance believes that the Australian National Preventive Health Agency (ANPHA) should devote a significant proportion of its resources to the particular challenges of preventing chronic conditions in rural and remote communities – commensurate with the extent of health need.

The Alliance is confident that finding ways to reduce rural smoking rates will have important lessons for health promotion and illness prevention for a range of other health risk factors and chronic conditions that contribute to the greater burden of disease in rural and remote communities.

Oral health

The oral health measures announced in this year’s federal Budget and in August 2012 are very welcome. Having fully funded on-budget programs targeting children and low income adults will place oral health services on a firmer footing than has been provided to date.

However, no real progress will be made in improving oral health for people in rural and remote areas unless there are adequate numbers of dentists, therapists and hygienists in those areas.

There are also some concerns about putting the new children’s and low-income adults’ programs into practice. For one thing, successful implementation will need to involve more collaboration between public dental services and private practitioners.

There is also uncertainty about how the new system can cater properly for the dental care needs of elderly people who make up a growing proportion of the population in rural areas, including those in residential aged care facilities.

The States and Territories must be encouraged by every means to meet the quite evident public demand for improved oral health services by maintaining their own financial effort.

Broadband

High-speed broadband is essential infrastructure for households, businesses, services and health. By whatever means, people in all parts of Australia should have access to high-speed broadband at the same affordable price.

The Alliance is pushing for special programs to enable broadband connection early for those with the greatest need, such as families who are geographically isolated, Aboriginal and Torres Strait Islander communities, and people with a disability.

These programs would provide support through Regional Development Australia Committees or community organisations for people with high needs to get through the application process, negotiate with internet service providers and complete installation.

Medicare Locals needs assessments and Healthy Communities Reports

The next priority is support for making the needs assessment reports by Medicare Locals public and ensuring the Healthy Communities Reports² monitor how well needs are met within their area, as well as in one Medicare Local compared with another. Local people will then be able to be closely involved in the priorities of Medicare Locals.

The National Health Performance Authority is to produce Healthy Communities Reports for each of the 61 Medicare Locals – 26 of which have at least a substantial proportion of rural people. These reports will provide valuable evidence of health outcomes within and among Medicare Locals.

They will also highlight the importance of data on health services and health outcomes – and show up the existence of gaps in the evidence needed to ensure improvements in health are being effected.

Workforce

Because of the shortage in rural and remote areas of both health positions and staff to fill them, some of the multidisciplinary health service models that might work well in more remote areas are not possible.

Health services sometimes have to employ short-term contract staff at pay rates that seem excessive and are detrimental to the morale and tenure of permanent health professionals in the area. What is required is a local multidisciplinary team of health professionals who are flexible and able to work effectively.

Key members of these teams are nurses, midwives and allied health professionals. To increase the number remote areas, the Alliance strongly supports the recommendation from the recently-published Senate Committee Report³ that HECS reimbursement should be available to allied health and nursing graduates on the same terms as it is currently available for medical graduates.

The Alliance recommended 20 steps including greater equivalence in incentives for recruitment, retention, placements and training of rural health professionals across the board as part of improving rural health services and workforce.⁴

Mental health

There has been additional investment in mental health services, including through EPPIC (Early Psychosis Prevention and Intervention Centre) and Headspace. The effectiveness of these programs is limited in rural and remote areas by their ‘central place’ nature.

In addition, the challenges of providing mental health services in rural and remote areas due to the shortage or absence of GPs and of allied health professionals, illustrate the need for a quite different approach to the delivery of mental health programs through primary care.

One way forward would be a trial of supported primary mental health care teams in areas that have poor access to GPs and are at a distance from regional centres in which much of the new money is currently being spent. Such teams would include mental health nurses and psychologists. It would also be important to upgrade the skills other health staff to give them greater capacity to deal with mental health issues.

Aged care

The package of aged care measures under the banner Living Longer, Living Better is designed to improve the system for consumers. The new agencies involved (the Aged Care Reform Implementation Council, the Aged Care Financing Authority and the single Gateway to services) are no doubt going to be important.

However, these new administrative arrangements do not ease the day-to-day challenges facing the aged care sector in rural and remote areas.

These challenges are mainly related to staffing matters and financial security for residential aged care facilities and community care; and serious shortages of resources and staff for aged care in the home. The rural aged care sector is seriously short of infrastructure and in some regions has to compete for staff and other resources with the mining sector.

It is to be hoped that the Aged Care Financing Authority will give particular consideration to the financial sustainability of residential aged care facilities and community care in rural and remote areas.

Quad bike safety

The Alliance strongly supports the ‘Mt Isa Statement on Quad Bike Safety’ dated 3 August 2012. It calls for the Federal Government to mandate an Australian crush protection device design standard for roll over protection on all quad bikes, and for manufacturers to comply with safety design specifications. Quad bikes are now the largest single cause of fatalities on Australian farms; 160 people have died in quad bike accidents since 2001.

Conclusion

The Alliance believes that people should have their essential health care needs met as locally as possible, irrespective of where they live. Essential services may include preventive health care; maternal, family and child health services; general hospital care; aged and community care; and end-of-life care, as well as primary care.

However, there will be times in many people’s lives or situations when it is not practical for the necessary specialised expertise to be available locally. Further, until current health workforce shortages are addressed, stop-gap measures will be needed to improve or even maintain access in many rural and remote communities.

The Alliance is supportive of measures to improve access to health care for rural and remote people through measures such as outreach services, improvements to Patient Assisted Transport Schemes, telemedicine and other support for remote health service providers, so long as these work with and do not become substitutes for essential services as locally as possible.

The Alliance believes that rural Australians will be well served by Government adoption of a National Rural Health Plan to underpin the practical implementation of the National Strategic Framework for Rural and Remote Health.

Such a plan would incorporate benchmarks, targets and programs. It should draw on the demonstrated capacity of rural Australia to develop innovative and effective services that are underpinned by community ownership and resources that are focused on local needs.

References

1 Council of Australian Governments (COAG) Reform Council. (2012). Healthcare 2010–11: comparing outcomes by remoteness. COAG Reform Council, Sydney. The full report can be downloaded at: www.coagreformcouncil.gov.au

2 Healthy Community reports are performance measures built into the National Health and Hospitals Network. See: Department of Health and Ageing. (2010). Medicare Locals. Discussion on Governance and Functions. Australian Government, Canberra. Retrieved from: www.yourhealth.gov.au

3 The Senate Community Affairs References Committee. (2012). The factors affecting the supply of health services and medical professionals in rural areas. Parliament House, Canberra. Retrieved from: www.aph.gov.au

4 National Rural Health Alliance. (2012). Twenty steps to equal health by 2020. Retrieved from: http://nrha.ruralhealth.org.au

Penny Hanley is Media and Communications Manager at the National Rural Health Alliance. Helen Hopkins is Policy Advisor at the National Rural Health Alliance.