New and Old Issues in Rural and Remote Health
About one-third of Australia’s population lives in regional, rural, and remote areas. That is around 7 million people.
On average, they don’t enjoy the same high standard of health and wellbeing as those who live in the cities, or the same access to health services and health-related infrastructure. There are a range of issues involved and it is the rural and remote people themselves who are best placed to understand the issues and to generate and manage solutions.
The return of the Turnbull Government following the 2016 Federal Election has resulted in significant impetus for rural health. Key among their election promises was to establish the role of a Rural Health Commissioner who would take responsibility for rural workforce issues including developing the Rural Health Generalist Pathway nationally.
The mal-distribution of the medical, dental and health workforce in Australia is a key barrier in the delivery of effective, comprehensive health care. There is a need for serious action to address the workforce needs in rural and remote communities, and the Rural Health Commissioner will be well placed to champion this.
Addressing the health deficit in rural and remote Australia requires more than addressing the distribution of the health workforce. There is great need for the Rural Health Commissioner to also champion initiatives that will:
- Support place-based approaches to meet local community health needs.
- Engage with and support the rural and remote Primary Health Networks in their work
- Engage with the social determinants of health and develop, promote and support actions to address these underlying causes of the health deficit in rural and remote Australia
- Engage with, support and promote policies to address the growing burden of chronic disease in rural and remote Australia
- Work across the sector to develop key indicators of rural health and report annually on progress in addressing the rural health deficit
- Champion the need for investment in rural health and the potential for considerable return on that investment.
Nationally, fiscal circumstances remain tight, with Commonwealth, state and territory governments all professing to be under-resourced. Commonwealth funding can only be found for new initiatives by finding savings from existing expenditure.
The health sector reviews undertaken in the previous Parliament have identified a range of strategic areas of focus in rural health policy. The review of the MBS continues, although it seems unlikely that major savings can be generated quickly to free money for important new proposals.
Among the areas where additional expenditure is desperately needed are mental health, chronic diseases and oral or dental health. In these areas, needs are particularly pressing for people in rural and remote areas.
The work of the Primary Health Care Advisory Group, chaired by Dr Steve Hambleton, is one of the drivers for change, recommending the staged implementation of Health Care Homes (HCH) to address complex and chronic care needs. HCH will make use of mixed payments and additional subsidies to participating practices, GPs and Aboriginal Medical Services. It will be coordinated through ten Primary Health Networks, of which half have substantial rural and/or remote constituents. It is important that evaluation of progress is undertaken over a prolonged period (3-5 years) to enable an accurate accounting of the potential effect on unnecessary hospitalisations.
Given the underlying importance of governments' financial capacities, anyone interested in the volume and effectiveness of health services must be more confident in seeing themselves as advocates for the sort of major economic change which will bring an end to the situation in which there is "no new money for good health ideas" and must become more engaged in the health economics of the issue and the way in which health affects other sectors of society (eg economic productivity).
Expenditure on health services should be seen as an investment in future productivity and reduced health spending, rather than merely as a current fiscal liability. In the absence of leadership from governments on a holistic approach to health and well-being, regional and local entities must step-up to demonstrate that close collaboration between education, employment, health, housing and transport is not only possible but also most desirable. Championing this integrated approach to health could be a role that would fit within the purview of the Rural Health Commissioner.
Another strategic activity of importance, particularly to rural and remote regions, is the government's planning and aspirations for the further development of Northern Australia. It is currently unclear whether this will be an ongoing focus of the Turnbull Government. The Alliance is on the record as saying that health and well-being services must be a significant part of this, not only because they will provide a productive workforce for industry in the North, but also because it is itself a major employer.
At various places on this website you will find information about the disadvantages faced by people, on average, in rural and remote areas. There is a health care deficit of $2.1 billion in rural and remote areas (based on 2005 data), reflecting relatively poor access to Medicare, the PBS and publicly-provided allied health services.
The Alliance needs regular input from people and organisations in rural and remote areas to ensure that its positions remain up-to-date, accurate and comprehensive.
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Voices from Council
Council of the Alliance meets throughout the year via teleconference. Once a year Council meets face-to-face to share knowledge and develop solutions - we call this annual get-together 'CouncilFest'.
The National Rural Health Alliance prepares fact sheets on a variety of issues relating to health in rural and remote areas. More