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Regional Australians at the frontline of the climate emergency and health workforce crisis

Introduction by Croakey: Last week, Independent Federal Member for Indi Helen Haines moved to amend the Government’s Climate Change Bill to ensure rural and regional Australians would benefit from actions on climate change, highlighting her commitment to rural health.

Her commitment stems from witnessing first hand the increasing impacts of climate emergencies and the wide gaps in health outcomes for rural and regional Australians, Haines told delegates in a pre-recorded speech at the 16th National Rural Health Conference.

“Climate change is a health crisis, and regional Australians are at the frontline of it all”, she said.

In her speech, Haines also discussed the urgent need for increased funding and commitment to improving rural health infrastructure, including a single-site hospital at Albury-Wodonga, and the rural heath workforce.

Haines highlighted that the Murray Darling Medical Schools Network Program produced only 15 new doctors each year out of hundreds of applications.

“I’ve seen how transformational these programs are and we need our Federal Government to stump up and continue these, and to expand them. I’m campaigning for the new Government to triple the amount of places at the Murray Darling Medical School and to look at expanding it to allied health too,” Haines told delegate.

Read her full speech below, published with permission.


Helen Haines writes:

I’d like to start by acknowledging the Traditional Owners of the lands from which I’m coming to you today – the Ngunnawal and Ngambri people of the Canberra district – I’m in Parliament House.

I wish to pay my respects to those Elders past and present and to acknowledge 60,000-plus years of continuous First Nations culture in this land of ours, the longest continuous culture in the world.

I’d also like to assert my sincere and passionate support for the Uluru Statement from the Heart and my very dear hope that in the term of this Parliament the nation delivers a resounding yes to the referendum on a constitutionally-enshrined Voice to Parliament. As the Parliament opened last week the Prime Minister reiterated strongly his intention to make this a reality.

Sadly I can’t be with you in person but it’s an honour to be invited to address this, the 16th National Rural Health Conference. I’ve attended many such conferences in the past and I know how wonderful it is to catch up with friends and colleagues and to learn of the latest research programs, the wonderful work that’s happening in rural health right across Australia.

Rural health is my life’s work. As some of you may know, prior to being elected to Parliament in 2019 I spent over 29 years working as a nurse, a midwife and a rural health researcher. In fact one of my first jobs in the country was as the matron of the Chiltern Bush Nursing Hospital, a tiny hospital in North East Victoria with a close-knit team and a vibrant local community, a place where I had the opportunity to utilise my full scope of practice as a nurse and a midwife, a place where I had the opportunity to work with an inter-disciplinary team which was just crucial to addressing the complex needs of our community.

I’ve had many jobs since, but the lessons I learned then have served me well everywhere I have gone since. A career in rural health should be something everything health professional should be absolutely desperate to have.

Of course it’s not all a bed of roses, there are many hills to climb to achieve health equity in rural health. There are many hills to climb when it comes to moving government policy along a continuum that recognises and funds models of care that are contextually right and effective in a rural environment.

In fact, one of the reasons I ran for Parliament in the first place was to try to make a difference on issues relating to rural health, to bring my professional experience into the federal debate. The argument that successive Australian governments have let down rural and regional Australians on health is pretty clear.

It’s a stark fact, as illustrated by the Mitchell Institute, that for every Medicare dollar spent in the city, 94 cents is spent in regional areas, 75 cents in remote areas and 56 cents in very remote areas. Interestingly, inner regional Australians do a bit better, with a spend of a dollar and four cents.

There are countless examples of models of care that work for rural Australia, but it still remains true that regional Australians have higher rates of chronic disease, we die younger and have less access to healthcare than our metropolitan cousins. And we can never forget that Indigenous Australians are disproportionately affected by these health challenges.

My community in the electorate of Indi knows these challenges well. The survival rate for cancer is four percent lower for regional Victorians than those Victorians that live in the metropolitan area of Melbourne. Benalla, a small town in my electorate, has double the state average of mental health conditions, and the suicide rate in the Murray region, where I represent, is four percent above the rest of the state.

While we’re seeing access to improvements to care, the availability of mental health professionals to meet the need remains abysmally low. And it remains true that it is a sorry fact that one-third of all chronic disease is in fact preventable, you all know that, and yet 1.3 percent of the health care budget is spent on disease prevention.

It’s one of the reasons that I am a co-chair of the Parliamentary Friends of Health Promotion. We know there is a problem, many of us in the Parliament are health professionals and we know there is a problem and we’ve continued to try to lobby successive governments to make a difference on the health spend in the preventative space.

Climate change

Regional Australians are also at the frontline of the health impacts of climate change. A few summers ago my region in North East Victoria was one of many places blanketed in heavy bushfire smoke for many, many months. Beautiful Alpine towns like Bright, like Walwa, Harrietville edged out the world’s megacities like Beijing and Delhi for the sad record of having the planet’s most toxic air. For months our kids, our pregnant women, our elderly breathed in this toxic mix of carbon monoxide, sulphur dioxide and nitrogen dioxide.

Across Australia the Black Summer bushfire smoke resulted in over 1,100 hospitalisations for cardiovascular problems, and over 2,000 hospitalisations for respiratory problems , and over 1,300 asthma presentations in emergency departments. On top of this, 445 deaths can be directly attributed to the deadly smoke – 445.

A 2019 study by Abdo and colleagues of 535,895 pregnant women in Colorado who were exposed to wildfire smoke in their second trimester found a significantly increased risk of preterm birth. That large study concluded that as climate change is expected to increase, the frequency and intensity of wildfires will increase the health burden on expectant mothers and their babies.

We know from research out of Melbourne University that five years after the Black Saturday fires, 22 percent of people in highly affected communities were reporting symptoms of mental health disorders. After the most recent Black Summer fires I visited a bushfire-affected community in Indi where the school principal told me 60 percent of kindergarten children at their school had been assessed by a psychologist as showing signs of trauma from summer bushfires – 60 percent of those little children.

The devastating floods that we have seen in the last year also take their toll. And when drought comes again, as it surely will, that too will leave scars.

Climate change is a health crisis, and regional Australians are at the frontline of it all.

Because of these reasons, because of the glaring gap in health outcomes for regional Australians, and because climate change will present many new challenges – indeed challenges already (being seen) – I have made rural health a focus of my time as the member for Indi.

Because I take my role as an Independent member of Parliament very, very seriously I took to the election a comprehensive and fully costed suite of policies on rural health, mental health and aged care to the election. I don’t want to be a politician who only points out all the problems, I want to use my time in Parliament to work closely with my community, to develop together the solutions that we need, and to fight for the government to take action.

Community priorities

The priorities that my community put to me are these. First, they say, we need to fund rural hospitals. The fundamental infrastructure in rural health services is lagging behind the needs of the community. Many of our health services are ageing and no longer fit for purpose and there’s little transparency in how government decides to fund infrastructure in health care.

Albury-Wodonga is one of the many communities in desperate need of a new hospital. Albury-Wodonga Health runs one of the busiest regional health services in the state of Victoria. It’s the only cross-border health service in the nation. In 15 years the population in this cross-border community will grow by one-third.

Regionalisation is happening in front of our very eyes. For years we said, build it and they will come. Well here’s the thing: on the border, they have come, but we haven’t built it. By 2040 we are going to need a hospital capable of handling 150,000 emergency presentations, 4,000 surgeries and 1,900 births every year. Yet the current hospital has been in and out of Code Yellows for the past 12 months.

We desperately need a new single-site hospital, and we need it now. The stories of why include problems with a workforce split across the state border, across multiple sites, and the very, very familiar stories to all of you of rural people having to travel vast distances to the city for specialist care, when in fact the population now warrants that specialist care being available close to home.

I have campaigned hard for the Federal Government to provide a $300 million contribution to a new hospital, and I reiterate that call today. And the community and staff, they are very active campaigners alongside me too, as are the local media outlets. People power has worked in the past to get specialist cancer services on the border and we are activating similar campaigning now to get this world class single-site hospital.

But so many smaller hospitals are in a similar position. In my electorate, in small towns from Mansfield to Bright and Benalla, we have small rural health services who barely get a look in when it comes to Federal and State funding for hospital infrastructure and equipment. It’s a story that gets repeated across regional Australia – small rural health services are left under-resourced.

The Federal Government has taken leadership and set up a dedicated funding scheme for rural hospitals before; well it is time it did it again. It really needs to come to the table again. So I’m fighting to establish a dedicated $1 billion fund for rural hospitals, to upgrade infrastructure and equipment, and to have transparent guidelines and a pathway to apply.

Rural health workforce

But buildings of course are only part of the picture, you all know that. We need people to staff our healthcare services. In my time as a rural health researcher I spent a decade studying the best ways to grow and retain a strong regional health workforce, and we’ve got to start by nurturing the talent that we already have locally, the evidence backs this up.

Young people have enormous potential but we often lose them to universities and hospitals in the cities because we don’t have enough opportunities locally for education and training in health careers. We need to build better and more successful models like the Murray Darling Medical Schools Network Program  – that’s at La Trobe University in Wodonga in my electorate.

It’s a great success but it only produces 15 new doctors each year, and 15 is nowhere near enough. This is a school that had hundreds of applications for just 15 places. I spent many many years working in the University Department of Rural health program and I’m sure there are many of my former colleagues in the audience today.

I’ve seen how transformational these programs are and we need our Federal Government to stump up and continue these, and to expand them. I’m campaigning for the new government to triple the amount of places at the Murray Darling Medical School and to look at expanding it to allied health too.

I am committed to building a pipeline of health workers who stay in my region, in the North East of Victoria, for generations to come. But I want that for every rural, remote and regional area across the nation.

I also think we need to triple the funding for mid-career regional health workers so that they can upskill. Our health workers have been stretched to the limit because of the pandemic, and because of the work they carried before this.

We shouldn’t be playing catch-up, we should be investing in health workers so that they have the skills they need to deliver the health care that we require. I want to see every health worker have access to $20,000 in funding to upskill. It doesn’t matter if it’s for course fees, childcare costs, supplementary income – whatever it takes to support our health workforce to grow professionally.

Right now, federal funding for this is oversubscribed and it excludes major regional towns such as Wodonga, in my electorate, for no clear reason. We’ve got to fix that. This means health workers will not have to move to big cities to advance their careers; it means that our health workers, particularly mid-career, can get the specialist training that we need to provide the specialist care right where people live.

If we create opportunities for long-term, fulfilling health careers in our region, in our rural areas, in our remote areas, we all benefit.

We need to do better in building mental health workforce in our regions too. Rural, regional and remote Australia has about 28 percent of the population, but just 13 percent of psychiatrists, 17 percent of all  psychologists and 23 percent of mental health nurses. And of course, the more remote you are, the lower those numbers are.

One of the best things the previous government did was to forgive the university debt of any medical doctor or nurse practitioner who worked in remote or regional Australia. I think we should expand this scheme to mental health workers, to bring more psychologists, psychiatrists, mental health nurses and social workers out into the regions.

Finally, we need to invest more in developing specialised mental health services for complex conditions like eating disorders. Eating disorders affect around one million Australians at any one time, that’s around four percent of our population. But accessing the support needed for recovery is nigh on impossible in many parts of rural and regional Australia.

The previous Government did, perhaps, more than any other government ever on eating disorders, but still I have spoken to dozens of families in my electorate who have to travel to Melbourne or Sydney to access eating disorder supports because there simply is not anything available closer to home, and when they return there is no support available to back in the care they have just had.

One specialist psychologist in Albury-Wodonga told me she had to turn away 43 patients from her practice last year alone.

Finally, and in conclusion, I would say the pandemic has seen scores of people appreciating the benefits of rural and regional Australia, but what is clear is that rural and regional Australia needs a substantial investment in healthcare.

We all know we are operating in a time of substantial economic challenge, a trillion dollars of debt and a government determined to return the budget to surplus. It will be challenging to make the case to invest further in rural health, but it’s a case we simply must make.

As an Independent member of the Federal Parliament I have a platform, and I intend to use it to prosecute some of the issues I have spoken about today. I have the ability to develop and table private members’ bills to advance important legislative priorities in this place, and I’m determined to be a sensible and rational voice; a voice of the regions, a voice of rural and remote Australia to this Government.

That is the benefit of being an Independent – no matter who is in power, I can work with them. And I want to work with all of you too. Together we can make a change.

From Twitter

 


You can join the conversation from the 16th National Rural Health Alliance conference on the hashtags #16nrhc #ruralhealthconf. Bookmark this link for our stories and follow the #16nrhc Twitter list.

 

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