Where next, for rural and remote health?

What are the identified priorities for rural health? (And what’s missing?)

Marie McInerney
Melissa Sweet
Sunday, May 28, 2017

Climate emergency, Social determinants of health, Poverty, Newstart/JobSeeker, Internet access, Indigenous health, Health reform, Rural and remote health, Public health and population health, #ruralhealthconf

This is the final instalment of Croakey Conference News Service coverage of the recent National Rural Health Conference in Cairns.

It is in three parts:

a reflection by journalist Melissa Sweet on the strengths and limitations of the rural and remote health sector
an overview of key conference themes by David Butt, CEO of the National Rural Health Alliance
and a Twitter-wrap of some #ruralhealthconf discussions not previously covered by Croakey.

Lift your gaze

Melissa Sweet writes:

At the recent National Rural Health Conference in Cairns, the collective strength of the rural and remote health sector was evident.

As one speaker privately observed, it would be rare to find anyone talking about “New South Wales health” or “urban health” with the passion that unites people around rural and remote health.

No doubt this reflects the solidarity of those who share a sense of grievance that rural and remote health fares poorly, in access to both the social determinants of health and to services. It probably also reflects the belief that there is something special about rural and remote communities, notwithstanding their immense diversity.

However, perhaps there also are some drawbacks to this sense of exceptionalism. The rural and remote health sector often looks to what distinguishes it from the wider health sector and broader public debates, rather than emphasising the commonalities of the issues affecting everyone’s health.

The impacts of social and economic inequality on health are not only a concern for rural and remote communities. A failure to link concerns about rural health inequalities into wider national and global debates about inequality is a missed opportunity, both for raising awareness about the issues at play, as well as for identifying potential solutions.

It seems unlikely that we could ever end rural health inequities without addressing wider social, economic and health inequities. People living in rural, remote and regional areas are affected by wider policies that entrench poverty and punitive approaches for people already doing it tough (such as plans for drug testing of Centrelink recipients), as well as more general determinants of health such as structural racism.

A report published last year found that 55 per cent of Newstart recipients and almost one-in-five of all children under the age of 15 are living below the poverty line.

Another report, published last year by KPMG, recommended increasing Newstart payments, and cited the Business Council of Australia stating that the inadequacy of Newstart was “a barrier to employment” that “risks entrenching poverty”. It also cited OECD concerns about the inadequacy of Newstart.

Clearly, rural and remote communities have much to gain (including better health and wellbeing) if the influential rural health lobby could find its way to join up with wider advocacy campaigns addressing poverty and inequitable policies across the board.

Poverty is directly mentioned in only one of more than 120 recommendations from conference participants in the Sharing Shed’s online forum although, as the tweets below show, it did feature in at least some conference discussions.

However, the social and economic inequalities that underpin poorer rural and remote health outcomes are not explicitly mentioned among the key themes to have emerged from the conference (as outlined below).

Glaring omissions

Climate change is another obvious gap in these key themes, although conference participants put forward three related recommendations.

Perhaps the omission is not surprising given that climate change was not a high-profile topic throughout the conference.

But it is surprising given that the impacts of climate change on rural and remote health and wellbeing are already very evident to many, and are only going to increase.

It was also surprising to discover (thanks to a Sharing Shed recommendation) that the National Rural Health Alliance does not have a formal position paper on climate change and rural health. In response to Croakey’s queries, however, the Alliance did provide this statement:

The National Rural Health Alliance acknowledges that climate change poses a growing risk to the health and wellbeing of people living in regional, rural and remote communities, through more frequent severe weather events, longer droughts and changes in rainfall patterns. This will impact upon the health and economic and social welfare of individuals and communities.”

Perhaps the next National Rural Health Conference, in Hobart in 2019, will incorporate a meaningful focus on climate change – not least because we will soon have our first Framework for a National Strategy on Climate, Health and Well-being, thanks to work led by the Climate and Health Alliance.

This document is scheduled for launch at Parliament House in Canberra next month. Significantly, the launch is to be co-sponsored by Minister for Aged Care and Minister for Indigenous Health Ken Wyatt, Shadow Minister for Health and Medicare Catherine King, and Leader of the Australian Greens Senator Richard Di Natale.

Given that King committed at the Cairns conference to supporting a National Rural Health Strategy, it seems likely that this topic will also feature prominently at the 15th National Rural Health Conference.

Hopefully this next conference will continue to ensure strong representation from Aboriginal and Torres Strait Islander health experts and community members, a noted feature of the Cairns program, as suggested by the tweet below, commenting on the presentation by Janine Mohamed, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM).

Conference reflections

David Butt writes:

Four days of frenetic activity. That is probably the best way to describe the 14th National Rural Health Conference. Every two years, the National Rural Health Alliance gathers together the most influential people in rural health in Australia and internationally and from the broader social and human services sector to discuss rural health and wellbeing in Australia.

The result is a conference that is at times insightful and at times confronting with moments of inspiration and exhilaration.

The role of the arts in promoting and inspiring better health is an intrinsic component of the conference and, at the end, conference recommendations were handed to the Assistant Minister for Health, the Hon Dr David Gillespie MP.

This year, the keynote speeches that were central in setting the themes that emerged from the conference were those by:

Sister Anne Gardiner, the 2017 Senior Australian of the Year who asked us all to stop trying to close gaps and instead build bridges; and
Professor Jonathan Sher, who advised that it is better to stop gaps from opening up through delivering primary preventive care, commencing with preconception.

The need for a new National Rural Health Strategy and Plan was a strong message from the conference. The last iteration of a National Rural Health Plan was developed in 2011 but is now no longer in use. Conference called for a new national rural health strategy and long term funding for an associated national implementation plan.

As mentioned, Professor Jonathan Sher’s call (as reported at Croakey) to address primary prevention, commencing at preconception, was also a central pillar of the conference discussions.

Delegates believed this issue should be taken up through the Council of Australian Governments (COAG), which should be tasked with developing and implementing a manifesto for childhood development across all levels of government.

The manifesto should:

recognise the moral, social, scientific and economic case for the importance of building strong families and acknowledge the 1001 critical days from when a baby is conceived until age two
recognise this period of life is crucial to increase children’s life chances and that it is essential to ensure all babies have the best possible start to life, and
target those most in need and most at risk, with a particular focus on those who are disadvantaged in rural and remote Australia and among Aboriginal and Torres Strait Islander peoples.

Supporting a broadened focus on primary prevention could be through a fund established to support pre-conception health at academic, clinical and community levels through a national grants program.

Broadband access: an ongoing concern

One of the continuing issues in rural and remote communities that impacts health and all sectors is the need for reliable, stable access to high-speed broadband. This is vital to health to support the use of telehealth in rural and remote Australia and has been a theme of past conferences.

Despite progress with the NBN roll-out, many rural and remote communities still do not have access to broadband sufficient to support telehealth – particularly those communities only able to access satellite broadband. The conference sought the introduction of minimum service obligations legislation, to ensure universal access to high-speed broadband in rural and remote areas, as a fundamental enabler of health, education and business.

The arts and health movement has been a long-term collaborator with National Rural Health Conferences and the benefits of the arts in improving health are largely untapped. The conference sought to develop the Arts in Health sector to improve health through connecting people, opening conversations and delivering physical and psychological benefits.

Research and research translation is at the centre of innovation and service development in rural and remote Australia. The conference is a showcase for developments to support rural and remote Australia and the work undertaken through the research facilities dedicated to rural health.

Among the research needs identified by the conference, it was noted that a national Rural Health Excellence Network modelled on Creative Commons is necessary for the dissemination and application of examples of effective practice, quality research and timely data to inform service planning, policy development and further research.

The Multi-Purpose Service (MPS) program was developed in Australia to provide a flexible service model that was well adapted to deliver culturally appropriate health and aged care services in small rural and remote communities.

Conference delegates suggested this model should be expanded to include social support, disability and education services (including VET and university training), so they are responsive to local community needs, have strengthened viability and support local employment.

Anticipated appointment

The appointment of the first National Rural Health Commissioner later in 2017 is being anticipated by the rural health sector. The Conference strongly supports the Rural Generalist Pathway, the Commissioner’s first major activity, being broadened to embrace the full rural and remote health professional workforce (including allied health professionals).

However, it was strongly recognised that the Rural Health Commissioner would not and could not be the single solution to the challenges of rural and remote health and wellbeing.

In particular, it was important that the Australian Government did not abrogate all policy and implementation issues to this single position. Rather, the Government must continue to be accountable and responsible for a long-term reform agenda, which works to bridge the divide in health outcomes between rural and remote communities on the one hand, and metropolitan communities on the other hand.

In contrast, the Commissioner should be focussed on a few key priorities and should work to make sure those priorities are done well, in consultation with rural and remote stakeholders.

The National Rural Health Alliance will be working with our Council to determine which of the recommendations we will be including in our work program for the next two years and will be disseminating all the recommendations of the conference widely, encouraging other health organisations to take up the challenges identified through the conference.

• Watch this interview with NRHA chair Geri Malone and CEO David Butt at the end of the conference.

Final selection of tweets

Further details about the presentations referenced in the tweets below can be found in the conference program.

(Some #ruralhealthconf tweets were previously published here.)

Read more about this work by the CWAA and FARE here.

Professor Sabina Knight (above) was commenting on a presentation on primary healthcare reform by the University of Queensland’s Professor Claire Jackson.

Indigenous health

A strong conference theme was the “cultural incompetence” of many health services and professionals, and the harms this causes.

Dr Megan Williams presented on #JustJustice. (Watch a recording of her presentation).

Dr Mark Wenitong presents…

Yarning circles as a community response to ice (crystalline methamphetamine): Stephanie King

Other sessions

Read more about the Food Ladder program here (using “the most effective technologies to feed the most disadvantaged communities in a global social enterprise movement”.)