When rural and remote health researchers met in Canberra recently, they were asked to consider why their sector’s work over the past decade or more had not led to the health gains that might have been expected.
Discussions at the 6th Rural and Remote Health Scientific Symposium suggested there are many ways of answering this question.
A presentation by Professor Leonie Segal from the University of South Australia highlighted inbuilt structural inequities in how health funds are spent – with, for example, far too little investment in early childhood and families and in preventing and addressing trauma.
The far-reaching impact of institutional racism was also mentioned repeatedly, including by Rural Health Commissioner Paul Worley – and see more on this in some of the video interviews below.
On a related theme, the challenges of attracting and retaining a high quality health workforce that meets the needs of rural and remote communities were also oft-discussed.
However, the conference also highlighted the sector’s successes and history of innovation, as well as ways forward.
The lessons from Aboriginal and Torres Strait Islander communities – including the importance of taking strengths-based approaches, and listening deeply to the needs and aspirations of patients and communities – resonated more widely.
Below are video interviews conducted by Jennifer Doggett with symposium speakers and participants, followed by some final tweets from the event.
Room for improvement
Professor Jenny May, from the Department of Rural Health at the University of Newcastle, said while the rural and remote health sector had been at the forefront of developing team-based and multidisciplinary care, it was embarrassing that health outcomes remained so poor for many people in rural and remote areas. There remained enormous variability in the quality and accessibility of health services in rural and remote Australia. “We still are not delivering that consistent level of quality accessible primary care,” she said. “For that I am sorry.” May said the answer was not calling for rural specific funding, but for mainstream funding that acknowledges different ways of operating and allows us to build careers for rural health clinicians and researchers so that we have a resident population in the areas where it is needed. May stressed the importance of available, accessible “foundational primary healthcare”.
Representative workforce matters
Dr Chris Bourke, Strategic Programs Director, Australian Healthcare and Hospital Association, distinguished between personal and institutional racism, with the latter manifest in services providing poorer outcomes for some groups. Institutional racism was about an organisation’s policies, funding and accountability, and its failure to incorporate Aboriginal people and perspectives in those frameworks. The health workforce should be representative of the workload, or the needs of the population being served, he said.
Professor Alan Cass, Director of the Menzies School of Health Research, spoke powerfully of the need to better serve Aboriginal and Torres Strait Islander patients, families and communities bearing a high burden of kidney disease. People had to move hundreds or thousands of kilometres away from their family and country for dialysis. In the NT, almost one in 40 Aboriginal adults are on dialysis, with more than 800 having haemodialysis three times a week and it is forecast there will be over 1,000 people in a few years. “This is a remarkable burden of illness.” Cass spoke about the importance of better prevention and early intervention as well as more equitable access to kidney transplants. “Research is beginning to clarify that for Aboriginal, as well as non Aboriginal, people there is a survival benefit for transplantation.” He stressed the importance of not making assumptions about what patients understand or want or how they might benefit from a treatment but “that we do the research to give the best evidence to inform those discussions and that we talk with people to ensure their treatment wishes”.
An appetite for transformational change
Professor John Wakerman, Associate Dean at Flinders NT, said discussions at the conference revealed an appetite for transformational change in rural and remote health. “We have a lot of research evidence to guide us.” He also said the development of rural and remote health infrastructure over the past 20 years, including academic infrastructure, was something to be proud of. “What that has produced is not only workforce but also a whole lot of evidence about how health systems can be improved,” he said.
Final conference tweets
Warm thanks to all #6rrhss tweeps