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Fixing rural, remote health: time to go beyond tokenistic “Akubra & moleskins’ responses

This is the first article in a Croakey mini series on rural and remote health, following the launch this week at the National Press Club of the National Rural Health Alliance’s five key priorities for ‘Fixing Rural and Remote Health’ (see the full statement below).

nrha-featureThe series will feature speeches delivered at the launch from:

  • Geri Malone, Chair of the National Rural Alliance
  • Janine Mohamed, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM)
  • Martin Laverty, CEO Royal Flying Doctors Service Of Australia.

It was clear that there are high expectations for the Federal Government’s yet-to-be-appointed Rural Health Commissioner – a key 2016 election promise announced by the National Party, to ‘act as a champion for rural health causes’.

Speakers said the role must be set up for success and judged on whether it leads to reduced health inequalities in rural and remote Australia compared to metropolitan Australia, with the need to address the social determinants of health, including poverty, inequality, racism and prejudice.

(Croakey has asked the office of Health Minister Sussan Ley for details on when an appointment is likely and will update this post when we hear back.)

Each of the speakers outlined personal stories and case studies to illustrate problems and solutions in rural health care. Among their key points:

  • Australia has a health worker “distribution problem”
  • inadequate and fragmented services mean having to navigate a highly time-consuming “maze” to address health needs
  • rural and regional Australians should be able to birth and die close to where they live, and Aboriginal and Torres Strait Islander women particularly must be able to safely birth “on Country”
  • Aboriginal community controlled organisations are subject to “obscene” amounts of time and effort arguing for the renewal of funding contracts which diverts frontline staff and contributes to a lack of progress in Closing the Gap
  • telehealth is not the panacea many funders and bureaucrats like to think it is
  • health care models that work in urban settings do not necessarily translate to the rural and remote sector
  • technology, relaxation of demarcation between clinician roles and certainty of funding sources are key to flexible primary care access
  • health prevention has failed in pockets of rural and regional Australia
  • reducing the disparities in health and wellbeing experienced by those living in rural and remote Australia can dramatically improve participation adn productivity and increase Australia’s economic growth.

Malone said Australians, including our politicians, attest to having a strong affinity with the bush – “they  like to romanticise the lifestyle, reinforce the myths and promote the romantic images of the bush, and they wear the Akubras and moleskins  to prove they do”.

But she said in reality that connection was superficial.

“Scratch the surface and the actual investment in services be they health,  education, communications and business is tokenistic at best.”

rural-abcHer view was reinforced by the fact that no mainstream political journalists attended or covered the launch and that a media conference by the Prime Minister Malcolm Turnbull scuppered plans to broadcast it live on ABC News 24 TV.

However you can watch it now on iView (till 6 December).


National Rural Health Alliance: Statement of key priorities

We call on the Government to make these priorities the remit of the Rural Health Commissioner, with relevant key performance indicators developed to report progress. We call on the re-establishment of the Council of Australian Governments (COAG) Rural Health Committee to lead improved integration and report on cross-jurisdictional activities.

  1. Unlock the economic and social value of the 7 million people living in regional, rural and remote Australia by reducing the gap in health and wellbeing outcomes compared with people living in cities.

– This will dramatically improve participation and productivity, and increase Australia’s economic growth.

  1. Introduce incentives to support getting the right workforce into rural and remote areas – work on distribution incentives rather than simply supply, particularly for allied health professionals and nurses and midwives.

– Focusing on workforce incentives to attract and retain valuable health professionals in rural and remote areas would pay for itself through increased productivity and economic growth, driven by healthier rural and remote residents.

  1. Improve health outcomes for Aboriginal and Torres Strait Islander people, which worsens with increasing remoteness.

– We need greater focus on improving child health, education, and wellbeing and to support indigenous families to give them the best start in life. It should involve a holistic early childhood strategy which informs high quality, locally responsive and culturally appropriate programs with stable, long term funding.

  1. Support the 15 Primary Health Networks covering rural and remote communities to make a real impact on rural and remote health outcomes

– The Alliance applauds the fact that the Government has used a weighted population formula in distributing funds to the PHNs. And they need long-term contracts to attract quality staff and ensure certainty for communities.

  1. The Alliance supports the best start in life for mothers and babies, focusing on the first 1000 days – from conception to the age of two.

– The Alliance believes that the best investment in the long term health and wellbeing of children, Australia’s future, is in ensuring they have the best possible start in life.

– We should build on the First 1000 Days program, which targets Aboriginal and Torres Strait Islander communities, as an exemplar program to support women and children across all communities.

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Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
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#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness