The third annual report from the COAG Reform Council on the National Healthcare Agreement quantifies a litany of health issues faced by people living in rural and remote Australia. It’s not just a handful of people in extremely remote locations who are affected. Outside Major Cities the disadvantage is widespread.
This should be seen as a rallying cry for continued action by governments, professional associations and industry bodies to remedy the situation by increasing their focus on improving the health of people living in rural and remote Australia.
People living outside Major Cities wait longer to see a GP and for elective surgery, have higher rates of many preventable diseases, lower rates of cancer survival and poorer access to mental health care. The elderly in rural areas are competing for limited aged care places or being forced to relocate to larger centres. And access to hospital-based sub-acute care (such as rehabilitation and geriatric services that help people recover and function after injury or illness or with age) falls dramatically as soon as you are outside the cities.
The COAG Reform Council’s report confirms a higher incidence of low birth weight babies in regional and, especially, remote areas - influenced by the higher proportion of births in more remote areas that are to Aboriginal and Torres Strait Islander women. Teenage birth rates increase strongly with remoteness yet more remote areas also have a lower rate of antenatal visits for women in their first trimester of pregnancy.
People in rural and remote areas experience a higher incidence of lung cancer and melanoma. The former relates to the adult smoking rates in rural and remote areas which are proving very hard to shift (in contrast to falling smoking rates in the cities). This should be of particular concern to health promotion authorities if the national target for smoking rates is to be achieved.
Lower cancer survival rates reflect lower levels of access to primary and preventive care as well as the poorer capacity of rural centres to provide high quality, appropriate specialised care. Five-year cancer survival rates decline as remoteness increases, due at least in part to poorer access to treatment services and later stage at diagnosis.
There is also a higher prevalence of end stage renal disease outside the Major Cities, with the rates being much higher in remote and very remote areas. Optometry services are also less available outside the Major Cities.
The rate of potentially preventable hospitalisations is higher outside the Major Cities, with potentially avoidable emergency department visits increasing by 18 per cent in Very Remote areas. Outside Major Cities, the proportion of people receiving mental health services under Medicare decreases with remoteness. People in remote areas with a mental illness are one third as likely to have access to clinical mental health services, and less likely to have a GP mental health treatment plan in place.
Elderly people in rural areas face a triple whammy: substantially lower availability of residential aged care places; dramatically longer times waiting in hospital beds before entry to an aged care facility; and much lower rates of hospital separation for subacute services (eg rehabilitation, palliative care, geriatric evaluation and management, and psycho-geriatric care - all of which help older people to stay at home in their community).
There are people disadvantaged by low income, joblessness and poor infrastructure in many regions, but there is a serious concentration of inequity in rural and remote areas. Cost and the inability to pay is a pervasive barrier to healthcare. For example, one third of people in disadvantaged areas report not being able to see a dentist because of the cost.
The Alliance is grateful to the COAG Reform Council for the special attention it gives to rural and remote issues, including through the production of a supplement to its main report dealing specifically with outcomes by remoteness. Detailed reporting of the performance of our health system in response to government investments is critical to identifying gaps as they emerge or fail to close. Further targeted investments in rural and remote health and wellbeing by the Federal, State and Territory Governments to which the Council has provided its report are both justified and urgent.
Gordon Gregory - Executive Director: 02 6285 4660