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What are the critical health issues for rural and remote communities? A wide-ranging preview of the 12th National Rural Health Conference

The 12th National Rural Health Conference kicks off in Adelaide this Sunday. As previously reported, experienced rural health journalist Marge Overs will report from the conference for Croakey readers, and you can also follow her reports on Twitter – @movers5  (and check the #ruralhealthconf stream).

As a preview, Marge conducted the Q and A below with the National Rural Health Alliance’s executive director, Gordon Gregory, in which he explains why the conference should be an important agenda-setter for the federal election, and supports the work of Medicare Locals and the Australian National Preventive Health Agency.

He also outlines the most pressing healthcare and population health issues for rural and remote communities.

And it sounds like those heading to the conference had better pack their dancing shoes…

 ***

Q: How many National Rural Health Conferences have you been to, and how have they changed over the years?

Gordon Gregory: The National Rural Health Conferences pre-date the Alliance – in fact it was the first conference, held in Toowoomba in 1991, that recommended there should be a body like the Rural Health Alliance.

The second conference, held in Armidale in 1993, was organised by a steering group, which, after the event, morphed into the National Rural Health Alliance.

So the first conference I attended was in Mt Beauty in 1995. By then the Alliance was nearly 2 years old and it must have been the largest project it had managed to date.

The first two conferences had had 200 or so delegates and we expected around 300 for Mt Beauty. Errol Dunn, of the Mt Beauty Tourism Bureau, worked with us on the ground and we held it in the brand new basketball hall in town. The evening before the conference opened there was a community working bee with turf being laid outside the hall. Most of the shops down the main street had little handwritten notices: “welcome to rural health conference”.

The Minister (Carmen Lawrence) flew in by helicopter to open the conference. Sabina Knight was by then our Chairperson, Margaret Hancocks was a key contributor to organisation of the event, and Leanne Coleman and Lexia Smallwood were already involved – as they are still. (We used Anne Cahill’s photocopier.)

Keynote speakers included Gavin Mooney and one Denis Napthine, then Parliamentary Secretary to the Victorian Minister for Health. The proceedings from that conference, available on the Alliance’s website, include a picture of Louis Peachey asking a question of Minister Lawrence, with the caption: Louis Peachey: “Why must it always be made harder for us? – if health workers want to work in the bush, encourage them!”

So perhaps too little has changed!

***

Q: Why is the National Rural Health Conference different to other health conferences?

Gordon Gregory: Many of those who attend the biennial National Rural Health Conference report how special it is. It has the natural advantages of being in a good cause and populated by a group who are necessarily spread thinly around the country.

What this means is that when they meet in a central place with colleagues who face many similar delights and challenges, they readily form a temporary community and work and party hard. They get on well together.

The conference unashamedly tries to be many things to many people. It has a large number of concurrent sessions with both general and peer-reviewed papers. It has an exhibition, which allows people who are normally quite isolated to catch up with technical and service developments – and enthusiastically collect free goodies to take back to their families.

It attracts leading keynote speakers who can inform and inspire. It is a marvellous networking opportunity: normally about 40% of those who attend have been before so there is a lot of catching up with old friends and much making of new friends.

It has a recommendations process, which connects the views of delegates directly with the policy development, and advocacy processes. It has a lively formal dinner at which it is normally impossible to find much space on the dance floor.

The Conference deals with a very wide range of issues relating to the social and economic determinants as well as health services, research and outcomes relating to health more narrowly defined.

It does not have separate streams for nurses or podiatrists or doctors; instead, it projects through its content and its processes a strongly multi-professional or interdisciplinary approach in which the whole team is working together.

And it celebrates some of the successes and champions, by formally recognising some sector leaders and local heroes through the presentation of awards.

***

Q: Health Minister Tanya Plibersek will speak at the conference. What do you most hope she will tell the conference?

Gordon Gregory: The people of rural and remote areas, including those who work in the health sector, are a pretty patient and resilient lot. What they want to know above all is that the governments of the day understand them and their circumstances and will do whatever they can to improve access to services and health outcomes.

Rural people generally understand about the impossibility of overcoming the tyranny of distance and its impact on access, costs and service systems. They don’t expect small communities to have the same services and facilities as regional centres or the metropolitan areas but they feel righteous indignation if they are not remembered and understood.

At the previous conference, in Perth in March 2011, Nicola Roxon gave a detailed and sympathetic speech in which she did much more than merely reiterating the litany of special programs provided for rural and remote areas. She recognised the challenges that rural communities and professionals face, and outlined how the federal government would deal with these as it progressed health reform, institutional change and new investments.

In Adelaide there will be the opportunity for Minister Plibersek to reassert the government’s intention to accommodate the circumstances of rural and remote areas through both ‘mainstream’ services and special, flexible services for smaller places through such things as block funding of smaller hospitals, MPSs, targeted mental health and dental health initiatives, reinvestment in critical services that have run down, and the maintenance of infrastructure.

The government’s credibility on such major commitments will be enhanced if relatively minor irritants like the ASGC-RA classification system can be fixed up.

***

Q: What is a pressing rural healthcare issue that will be explored at the conference, and what are its implications for the federal election?

Gordon Gregory:
One: How smoking rates can be reduced in rural and remote areas to match falling rates in major cities – and whether both sides of politics will commit to further investments in health promotion and illness prevention, including through the Australian National Preventive Health Agency.

Two: What the future will be for Medicare Locals? They provide real hope for the coordination of primary care (still usually centred on general practice) and any return to organisations that are only focused on medicine would be a gross mistake.

Three: What general commitment both sides of politics can give to rural regions that are not prospering (perhaps through a de facto royalties for regions approach)?

Four: What confidence people can have in federal, state and territory governments collaborating on health care rather than engaging in politics and blame shifting?

***

Q: What is a pressing rural population health issue that will be explored at the conference and what are its implications for the federal election?

Gordon Gregory: The conference will deal with a range of population health issues, none of which is more pressing than the health of Aboriginal people and Torres Strait Islanders. There will be a colloquium on Indigenous eye health. There will also be sessions on oral health, women’s health, mental health, child and family health, disability care, and hearing health.

***

Q: Do you think rural and remote health concerns will be important in the federal election? What will be needed to make them count?

Gordon Gregory: It is the Alliance’s challenge to make sure that rural and remote health concerns are on the agenda in the election context. It is a difficult task with all governments inexplicably claiming to be in the same situation as Cyprus, and with so many competing interests, and so little attention overall given to policies as distinct from politics.

But the timing of the 12th Conference could hardly be better coming shortly before the next election is due. So we’ll be encouraging everyone at the event to have their say and to require governments to join them in committing to a bright future for rural and remote communities!

***

Q: One of the strengths of the National Rural Health Conference is that it showcases excellent grassroots work in rural and remote communities. What’s your insider’s tip for a speaker or session that will highlight such work?

Gordon Gregory: The top-ranked abstract overall was for a paper to be delivered by Sue Cowan and Fiona MacPhee on “Integrating aged care assessment for older people of north-east Victoria”, to be presented in concurrent session A2.

A favourite of NRHA staff is going to be Kevin Bird’s presentation on “Team sport as a catalyst for Yolngu girls’ participation in healthy behaviours” (D1). Given the importance of oral health and its appalling status in rural and remote areas, concurrent session E6 must be important. It will include an update from ARCPOH on the situation and four important practical stories.

***

Q: What in your view is the most important plenary session and why is it so important?

Gordon Gregory: Probably the penultimate one, which will see Bob Wells and Jane Hall talking about what needs to be done to build a rural health service for the present and then Marie Lally galvanising us to take it upon ourselves and succeed.

***

Q: What will be the most controversial topics at the conference?

Gordon Gregory: Despite the political uncertainty, I don’t expect people at the conference to disagree much about what needs to be done and when and by whom. There will of course be differences of opinion about what are the first priorities and which are of secondary importance.

Underlying the general agreement will be the hope that governments can somehow give greater attention to the social and economic determinants of health (education, employment, regional development, community and public transport, health promoting infrastructure).

And while there will always be a solid appreciation of the tremendous value of medicine, there is sure to be a shared understanding that it is teamwork that counts.

***

Q: The Sharing Shed is a way for delegates to put forward recommendations before and during the conference. How does the Alliance collate these recommendations to ensure fair representation, and how much say do delegates have in deciding the Alliance’s priorities?

Gordon Gregory: Presenters at the Conference have been encouraged to provide recommendations with their papers before the Conference. Every person at the conference will be encouraged to go online to record their support for existing recommendations from other delegates and to write their own proposal.

Although they won’t be able to comment, people who are not at the conference will be able to observe developments with the recommendations.

The recommendations committee will be working behind the scenes to monitor the Sharing Shed as well as Twitter and Lesley Fitzpatrick will bring priority recommendations to plenary sessions for general scrutiny and will invite input from delegates with regard to the general priority areas to be covered and important elements to be included.

There will also be a round table session at which delegates will be able to discuss proposed recommendations. Lesley will present the priority recommendations to a final plenary session for the approval of delegates.

More information about the Sharing Shed is here.

***

Q: What is your most memorable moment from the last National Rural Health Conference?

Gordon Gregory: Our overwhelming recollection of each Conference is the energy of the people. Having so many enthusiastic representatives of the rural health sector, all in one place, being stimulated by presentations and conversations, creates quite a hubbub and buzz – and helps to re-energise us all.

Another strong memory from Perth is of the presentation of Christine Jeffries-Stokes and Annette Stokes about the use of sand stories to assist in health promotion and diabetes prevention in the Western Desert.

***

Q: What recommendation from the last National Rural Health Conference has had the most impact on improving rural and remote health?

Gordon Gregory: It is always difficult to attribute policy activity to particular proposals or particular organisations – and the NRHA is inherently modest.

The 11th Conference gave unqualified support for the Federal Government’s unprecedented action on smoking cessation (including plain packaging), which must have given it some additional comfort on the matter. The Conference singled out ear conditions as being an important and eminently fixable part of poor Indigenous health – and there has been some priority given to this. It provided guidance on and support for Medicare Locals.

It called for the National Food Plan to relate strongly to health as well as to food production matters and this call has been heeded. It also called for Health Workforce Australia to lead work on an interdisciplinary framework for training in support of health service managers, and HWA’s Health LEADS activity fits the bill on that.

***

Q: What recommendation hasn’t had the impact that you would have liked?

Gordon Gregory: The 11th Conference called for Commonwealth and State/Territory governments to agree and fund a national arts and health program. Arts/cultural and health departments are jointly considering a National Arts and Health Framework but despite strong and widespread support, its status is currently unclear.

***

Q: How can Croakey readers interact with the conference?

Gordon Gregory: Croakey readers will be able to monitor the recommendations as they are received through accessing the Sharing Shed online. All keynote sessions and concurrent sessions one, two, three and four will be streamed online within 24 hours of the presentation in Adelaide. There will be NRHA media releases.

You can follow @NRHAlliance on Twitter and search for conference tweets using #ruralhealthconf. And read Croakey (which has a category collating posts related to the conference).

• Post Script: Online registrations are closed but, according to today’s National Rural Health Alliance Eforum bulletin, you can still register by filling out a hardcopy registration form and returning by fax to 02 6285 4670 or email: register now!

Previous Croakey posts on the conference are here.

• Details and declarations re the Croakey Conference Reporting Service are outlined here.

 

Looking for Gordon

 

Gordon Gregory and Emeritus Professor John Humphreys

Thanks to Leanne Coleman for providing this explanation: The photos above were taken in front of the delegate mural at the 5th National Rural Health Conference in Adelaide in 1999. The NRHA Council bought the T-shirts for Gordon and John as a joke.

 

Comments 2

  1. A great oral history, we need something like this for other organisations and associations.

  2. rlynch01@bigpond.com says:

    Thank you Croakey so much for your excellent coverage of the Rural Health Conference: between you & NITV I am learning or considering lots which I will think about implementing in my practice when I return to remote next week, and go on doing that. Rosemary Lynch RAN

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