Amid widespread concerns about significant job losses and precarious work at Australian universities, planned changes to university funding also may have significant repercussions for the health of rural, regional and remote communities.
Dr Gabrielle O’Kane, CEO of the National Rural Health Alliance (NRHA), investigates.
Gabrielle O’Kane writes:
As the rural health peak body, we are particularly interested in higher education policy because education is a key determinant of health in rural, regional and remote Australia.
Access to quality and affordable education is one of the ways in which we can make rural communities more healthy, prosperous and sustainable. So we watched with interest when the Australian Government recently announced a range of measures to reform the university sector, particularly in regional areas.
Overall, while there are some positive measures targeted specifically at rural, regional and remote students, these risk being undermined by broader funding cuts and fee increases.
To start with the positives – some measures that look promising at first glance include guaranteeing Commonwealth-supported places for Aboriginal and Torres Strait Islander students when they are admitted to their university of choice, as well as specifically recognising regional and remote students as a target group in the Higher Education Participation and Partnerships Program.
Some other measures also look positive but time will tell. The new Regional Education Commissioner office is welcome, and we certainly look forward to working with them once they are appointed. Nevertheless, we will have to wait and see to assess the effectiveness of this Commissioner. We also welcome the establishment of more Regional University Centres, but will follow progress closely to make sure they are well-resourced, appropriately-located, and genuinely benefit students in the right areas.
We also support measures that help students from rural, regional and remote Australia travel to access higher education, such as paying relocation costs and helping them travel home during their first year of study. This has been a hard-fought campaign by many, including one of our member organisations, the Isolated Children’s Parents’ Association.
Workforce matters
But what does all of this mean for the future health workforce in rural, regional and remote Australia?
For medical and dental degrees, the student contribution will remain the same and the Commonwealth contribution will increase. On the face of it, this means more money for universities to deliver these degrees, which looks like good news. However, while allied health degrees are getting cheaper for students, the Commonwealth funding will remain the same, meaning a lower income for the universities overall.
It is not clear yet though how universities will respond to these changed funding models, and what it means for the future of the health workforce in rural Australia. Higher education institutions, including through University Departments of Rural Health, play an incredibly important role in attracting, training and retaining a highly-skilled, flexible health workforce, which is desperately needed in rural, regional and remote Australia.
This is more important than ever in a time of disruption and policy change. As Professor Jon Wardle points out, the overall funding reduction for regional universities will surely make it more difficult to train the future health workforce.
Bolstering the research capacity in rural Australia is especially important and we’re pleased that the new reform package contains a new annual grants program for regional universities. We need to ensure though that enough of this money goes towards rural health research.
Let’s not forget that there is a significant deficit in rural health research – a 2018 paper put rural-specific research at 2.4% of National Health and Medical Research Council-funded projects. Compare that to the 30% of people who live in rural, regional and remote Australia and it becomes clear the need to invest more in research.
Determinants of health
But crucially, if we want to look at the impact of these higher education changes on the health of rural communities, we need to look more broadly than just health degrees and health research.
At the Alliance, we focus on the upstream impacts on people’s health, so consequently, apply a social determinants of health lens to examine issues. This means looking at how we can improve some of the key determinants of health, such as income, employment, housing and transport.
Education is a prime example. According to the Australian Institute of Health and Welfare, education “equips people to achieve stable employment, have a secure income, live in adequate housing, provide for families and cope with ill health by assisting them to make informed health care choices”. While university study isn’t the best choice for everybody depending on their individual circumstances, it’s important that the option is there.
That’s why the increase to student contributions for degrees such as humanities, law and commerce is of concern. A humanities degree, for example, is incredibly valuable – in addition to the job prospects in many fields, it teaches critical thinking and other important skills. And there are obvious connections to the health system – Indigenous Allied Health Australia quite rightly point to the impact on cuts to humanities for people studying social work, for example.
It’s fair to say that we don’t know exactly how price-sensitive students are when it comes to picking a degree (or choosing whether to undertake higher education at all), but that it plays a role. The reality is that more expensive degrees might put some rural students off tertiary study completely, and that can’t be a good thing for the overall health of these communities.
Let’s not forget too that rural students often face other costs involved in attending university such as needing to move further away and live out of home. While there’s no doubt that many students don’t consider cost as much of a factor because it can be deferred through the HELP program, keep in mind that in the 2019-20 financial year you start paying back your student loans once your income reaches $45,881.
While a regional focus is welcome and we do look forward to working with the Government to ensure that these measures are effective, more work will need to be done to ensure that we have the pipeline of skilled health workers going into rural, regional and remote Australia. But all this work could be undermined if we put up further barriers to rural students attending university, regardless of what they want to study.
Further reading
Health and medical experts sound the alarm on university funding changes
Don’t attack the humanities – they’re important for health too
