Selfie tweeted by Paul Worley, with Hugh Taylor, Luis Salvador-Carulla, and Lesley Fitzpatrick (L)

Profiling the diversity of rural and remote health research – and some questions about its impact

Melissa Sweet
Jennifer Doggett
Thursday, April 12, 2018

#6rrhss, cultural safety, health and medical research, Indigenous health, primary health care, public health, racism, rural and remote health, Social determinants of health

The successes and challenges facing rural and remote health research were a trending national topic on Twitter yesterday, thanks to diligent tweeps attending the 6th Rural and Remote Health Scientific Symposium.

As Jennifer Doggett and #6rrhss tweeps report below, one of many big questions up for discussion was this: how to ensure that the commitment of so many in the sector translates into action that benefits communities and their health and wellbeing?

Jennifer Doggett writes:

From food deserts in Tasmania to chiropractic care in the Pilbara, the first day of the 6th Rural and Remote Health Scientific Symposium showcased innovative, diverse and community-focussed rural health research undertaken by established, early career and student researchers all over rural and remote Australia.

Reports of long-term and well-established initiatives, such as research into the so-called ‘leaky pipe’ of eye care service pathways for Indigenous Australians, highlighted the ongoing need for research to inform rural health policies and programs.

As the only developed country in the world still dealing with preventable trachoma-caused blindness, Professor Hugh Taylor from the University of Melbourne reminded delegates that despite a robust body of research in this area, there are still many challenges in translating this research into practice.

He also stressed the learnings from this project around linking primary care to other areas of the health system for addressing broader health challenges in rural communities.

Other smaller scale research projects reported at the Symposium addressed issues such as nutrition, drug and alcohol use, and overweight and obesity in rural communities (see some snapshot tweets below).

A common theme of these presentations was the need to tackle the environmental, practical and cultural barriers to reducing risk behaviours, such as the availability of fresh food in rural and remote areas and the stigma surrounding drug use and addiction.

Mapping and metrics

Mapping, measuring and classifying rural health metrics were the focus of several presentations.

Professor Luis Salvador-Carulla, Head of the Centre for Mental Health Research at Australian National University, explained the importance of developing a shared taxonomy for measuring access to health care and service provision to enable comparison across diverse rural and remote communities.

South Australian researcher Dr John Glover described how he uses local level data to map changes in health outcomes and social determinants in communities over a period of time.

His presentation was followed by Rachel Whitsed, who described her research of spatial patterns of disease, including mapping the correlation between health status and topography.

Plenary sessions challenged delegates to ask ‘big questions’ about rural health research and its role in influencing health policies and practices.

Successes and failures

Rural Health Commissioner Paul Worley urged attendees to both acknowledge our rural health successes and admit our failures, citing the establishment of multi-disciplinary departments of rural health as a success, particularly in relation to linking research and practice. He identified the ongoing influence of institutional racism within the health system as a failure.

He encouraged the rural health sector to recognise the diversity and uniqueness of rural communities, as well as to identify the commonalities that allow policies and programs to be ‘scaled up’ across wider areas.

A panel of eminent rural health researchers, including professors Lesley Barclay, Lucie Walters, David Lyle, Ross Baillie and Dennis McDermott discussed how far rural health research had come since the establishment of the first rural clinical school in 1997.

They gave some historical context for the initiative and identified some of the major successes, including moving from an optional one or two week rural placement for medical students twenty years ago to the opportunity to undertake an entire medical degree in a rural setting today.

However, Barclay noted that despite these successes, rural health research still only received 1.1 percent of NHMRC funding, citing this recent publication.

Barriers to impact

A panel chaired by senior health policy expert Bob Wells, and including John Humphreys, John Wakerman, Sue Lenthall and Paul Worley, reflected on the influence that rural health has had (or not had) on health policies and programs.

The panellists all acknowledged that rural health research, overall, had not delivered the changes to health policies and programs that had been hoped for by the research community. They cited a number of reasons for this, including ongoing workforce shortages, political apathy and institutional racism.

As indicated by the presentation cited below, questions were also raised about the usefulness of traditional academic metrics.

A question from the floor on whether the rural health sector should advocate for ‘revolutionary change’ in the rural health sector, similar to that achieved by the NDIS, prompted a discussion on research support for more radical changes.

Bob Wells offering his preferred model of health care funding and delivery, involving community-based primary health care organisations with local governance.

The resulting discussion about the political reality and relative benefits of incremental versus systems change sets the scene for the address by Minister for Rural Health, Senator Bridget McKenzie, to open Day 2 of the Symposium.

• See below for further tweet reports from the conference.