Melissa Sweet writes:
Rural health advocates have called for a National Sustainable Development Unit to be established to work across government sectors and jurisdictions in addressing climate change and other planetary health threats.
The unit would be charged with implementing an Australian response to the United Nations Sustainable Development Goals (SDGs). As Croakey reported this week, we are not on track to achieve any of the 17 SDGS, and our “shameful” scorecard shows we are going backwards on many.
More than 1,000 delegates attending the 15th National Rural Health Conference in nipaluna/Hobart yesterday presented their priority recommendations to Senator Bridget McKenzie, the Federal Minister for Regional Services.
These included a call for all political parties and governments to respond to the Uluru Statement from the Heart and commit to a process of truth-telling and agreement-making to eradicate discrimination and racism, and improve the health and wellbeing of Aboriginal and Torres Strait Islander people.
Delegates also called for increased investment in Aboriginal Community Controlled Health Services, in measures “to grow and sustain the vital workforce” of Aboriginal and Torres Strait Islander health professionals, and urgent action to address “the unacceptable number” of suicides in remote communities.
Address poverty and other determinants of health
The recommendations, whose presentation followed the release at the conference of the Australian Council of Social Service’s health policy for the federal election, also call for whole-of-government efforts to tackle rural poverty, and other measures to urgently address the ecological, social, economic and cultural determinants of health.
The conference recommended that rural health services be funded and required to implement the National Climate Health and Wellbeing Strategy, which has not been taken up by the Federal Government since its release by health organisations in 2017.
Professor Jenny May, who chaired the conference recommendations committee, said delegates were looking for a whole-of-government response on climate change.
“Our rural communities are very concerned about the impact of climate change,” she said in an interview.
“They are very aware of the climate changing around them and that is having impacts on what they do and the quality of their lives.”
Delegates also called for development of “wellbeing indicators” so that measurements of rural health could go beyond economic capital indicators and include measures of other capitals such as human, health, spiritual, cultural, knowledge, and environmental capital.
They urged the creation of a new Ministerial Department for the First 2000 days of life – the Early Years Minister – to be based in the Department of Prime Minister and Cabinet with the Treasury responsible for the policy development, funding, monitoring and reporting.
Rural Generalist Pathway
Meanwhile, rural health groups welcomed McKenzie’s announcement at the conference of $62.2 million over four years to implement the long-awaited National Rural Generalist Pathway, but noted that little detail had been provided.
The Rural Doctors Association of Australia said in a statement the funding was a “positive step forward” despite being less than what the association had hoped for.
“Crucially, we still need to see the fine details behind the Government’s announcement,” said RDAA President Dr Adam Coltzau.
The Australian College of Rural and Remote Medicine (ACRRM) also welcomed the investment while noting that details were still to come.
Below are the conference’s priority recommendations in full.
Aboriginal and Torres Strait Islander health
The gap in Aboriginal and Torres Strait Islander health outcomes remains completely unacceptable and the most pressing issue for all Australians. We confirm our commitment to urgent and comprehensive action to Close the Gap.
Conference delegates endorse the Uluru Statement from the Heart, and call on all political parties, state and territory governments to respond from the heart and commit to engaging in a process of truth-telling and agreement-making to eradicate discrimination, racism and improve health and wellbeing.
We also call for urgent commitment of funding to expand aboriginal community controlled comprehensive primary health care services to not only diagnose and treat health issues, but to work in partnership with other sectors to tackle underlying determinants of health such as housing, education and employment. We need to stop using surgical solutions to tackle social problems. We must commit to the eradication of preventable conditions such as Rheumatic Heart Disease and Ear Disease, through community-led local-level cross-agency action.
We recognise the essential role of Aboriginal Health Practitioners and workers in the provision of culturally safe services, including as mentors and trainers of non-Indigenous staff. We call for a greater investment in training, support and career pathways for Aboriginal and Torres Strait Islanders in health, to grow and sustain the vital workforce. There needs to be widespread recognition of the unique contribution they bring and the need for support to enable them to meet both cultural obligations in addition to professional obligations (walking in two worlds)
Determinants of health must be addressed #1
Any comprehensive rural health strategy must address determinants of health and wellbeing and eradicate diseases of poverty. Specifically ecological, social, economic and cultural determinants need to be addressed as a matter of urgency. The National Rural Health Conference delegates call on all governments to commit to:
- A whole of government approach to rural poverty. This includes taxation and welfare reform such as increasing the NEWstart allowance and stable housing
- A fully funded comprehensive National Rural Wellbeing Strategy that addresses ecological, social, economic and cultural determinants of health and wellbeing for rural, regional and remote communities. This strategy must have a long term view and be implemented in a “silo busting” approach.
- Change the way our health is measured. Start measuring wellbeing outcomes of rural communities that go beyond economic capital indicators. Wellbeing indicator measures must include measures of other capitals such as human, health, spiritual, cultural, knowledge, and environmental capital.
- The creation of a new Ministerial Department for the First 2000 days of life (the Early Years minister). The new department should be situated in Prime Minister and Cabinet with the Treasury Departments responsible for the policy development, funding, monitoring and reporting. The early years strategy should take into account service designs for life events.
- Recognise the importance of epigenetics in health and how this negatively impacts upon the transmission of intergenerational trauma, resulting in life long morbidity. For example, maternal stress is related to the development of diabetes and renal failure. It is essential to improve the health of both mother and father before conception.
Determinants of health must be addressed #2
Applying a rural-proofing lens to ensure that all governments policies are developed and implemented in such a way that social and health inequalities do not increase, and that unintended outcomes are mitigated. This will require government investment in climate change adaptation strategies that enable rural health services, the health workforce and communities to adapt to climate change impacts.
Invest in, and mandate that all rural health services implement the National Climate Health and Wellbeing Strategy and increase funding for community resilience and capacity building and preparedness for climate change services and programs and initiatives.
The creation of a National Sustainable Development Unit. This department could work across government sectors and jurisdictions to own and implement an Australian response to the United Nations Sustainable Development Goals, crucially addressing climate change and other planetary health issues. This department would have remit to ensure that rural communities can transition effectively to meet challenges in population shifts, renewable energy, agricultural industry adjustment, ocean and river acidification, changes in land use, and biodiversity loss.
Access
Primary care services in rural and remote communities are fragmented and not well coordinated. We call upon the government to take immediate action to develop an integrated primary health care system which maximises the value of MBS funding streams, state government funded primary health care positions and PHN commissioned funds to create comprehensive primary care services such as exists in the Aboriginal Community Controlled Health Organisations.
Federal and state funding mechanisms frequently result in short term funding commitments to employing organisations, including non-government organisations. This further frustrates attempts to establish employment certainty for prospective and current employees and is a major issue associated with rapid staff turnover and inability to recruit. We call upon governments to ensure that for all remote and very remote locations, all funding agreements are established on a rolling annual review basis for a minimum three-year term.
Current market based models for service delivery and workforce recruitment and retention are not viable for rural areas. For example NDIS do not yet have adequate measures in place to promote equity of access for people living in rural and remote areas. We need funding support for long term collaborative models that are co-designed with communities and front line workers.
Urgent action is required to address the unacceptable number of Indigenous deaths caused by suicide in remote communities. Governments need to commit to working with Aboriginal and Torres Strait Islander leaders to implement preventative strategies to address the underlying factors contributing to this.
Workforce
Over 20% of the poorer health outcomes experienced by the 7 million people that live in rural, regional and remote Australia is impacted by the continued under-representation or absence of the health workforce. Urgent action is required to redress the maldistribution of the health workforce. The conference calls on government to:
- Invest at least the same level of funding that has been directed to the supply and distribution of locally trained GPs to the other health professions necessary to provide comprehensive health care in outer regional, rural, and remote Australia.
- Promote and fund growth in the number of rural generalist roles across all health professions
- Consider pooled funding and support the development of an integrated primary care system which maximises federal and state funding streams across health, disability, housing, aged care and education sectors. Exemplars of this comprehensive primary care model exist in the Aboriginal community controlled health sector. The solutions will vary according to local community need – collaborative models need to be co-designed with communities and front line workers.
- Identify workforce gaps across service and policy silos (housing, disability, aged care, education and health) and increase flexibility in funding to enable collaborative workforce models for allied health. Including increasing the number of MBS funded occasions of service by allied health services, including dental and oral health services, to 10 per profession per year where a market based service model is suitable
- Support nursing and midwifery led models of care in rural and remote areas with a focus on the role of nurse practitioners.
- Commit to addressing the shortfall of medical specialist services in outer regional, remote and very remote areas.
Enabling our workforce through infrastructure and support
We call on the Government to provide ongoing and increased support to our rural and remote workforce to improve recruitment, retention and community care. This will be done through:
- Supporting capital investment in non metropolitan areas upgrading the NBN to enable the use of technology
- Supporting the use and access to telehealth through better connectivity and funding mechanisms such as changes to MBS.
- It needs to be recognised that telehealth supports healthcare workers and does not replace the need for highly skilled workers in our rural communities
- Continue to support locally developed guidelines that acknowledge the needs of local population and resources available. The current ACSQHC Guidelines do not always meet the needs of rural areas.
- Provide and invest safe workplace which is free of violence and culturally safe
- Invest in wellness programs for the rural workforce
- Enable activities that encourage the development of partnerships between all service providers including public, private and not for profit organisations.
Research
We call on the Government to:
- Require research funding provided through the Medical Research Future Fund Missions, already covering areas such as cancer, genomics, to include research within and upon rural and remote health commensurate with the burden of rural and remote disease and disability. With MRFF Mission commitments of $1.3 billion to date, and given 28% of the population lives in rural and remote Australia, on a purely population basis this would amount to an existing commitment of $364 million – without taking into account the higher disease burden.
- Measure rural research and projects by their community impact and their capacity to embed, respond and translate to their locations and not just by metrics such as number of academic papers.
- Invest in a clearing house function of rural health research creating the capacity to share information and support researchers to design, scale and translate research with and for the benefit of rural and remote Australians.
And finally…
Professor Jenny May said the recommendations held an overarching message on diversity and inclusivity.
“No one wants things done “to them”, rather health services need to be designed “with them”. We should send a clear message on the requirement for rural and remote persons to be included in all policy discussions and determinations being made on their behalf.”
Diehard Croakey readers may be interested to contrast and compare the 2019 recommendations above with those from the National Rural Health Conferences in 2017 and 2015.
Watch this interview with Professor Jenny May
Bookmark stories from the conference here.
