A Fair Go

National Rural Health Alliance

There are a host of reasons for healthcare disparity, some of them largely unavoidable, but many more are to do with a certain innate inequality of how the nation’s healthcare resources (totalling around $130 billion per year or more than $5,000 per head of population on average) are divided and spent. Monitoring these inequalities and lobbying for redistribution is the National Rural Health Alliance (NRHA), which celebrates its 21st birthday in June. Gordon Gregory, the NRHA’s Executive Director, told Healthcare in Focus that all Australians should have equitable access to appropriate health services, regardless of where they live. The diverse communities of rural and remote Australia should be healthy and health-promoting places in which to live and work and the 30 per cent of Australians who live in rural and remote areas should receive a ‘fair go’ of 30 per cent of the resources. The Alliance has set itself the specific target of equal health by 2020, although Gordon candidly acknowledges that this is unlikely to be met.

The Alliance harnesses, speaks for, and tries to unify the voices of a startling assortment of over 30 professional bodies. It is a sort of ‘acronym central’ from ACHSM to SARRAH. “It is an extraordinarily broad, inclusive collaborative group,” says Gordon. “There are differences of opinion, of course, but one of the magic things about the Alliance is that we spend most of our time focusing on the things we agree on and then lobbying and advocating on the basis of those items.” A hidden benefit of this arrangement, he adds, is that where there are differences of professional opinion on policy, they can be thrashed out between the parties privately and impartially so that some broad consensus can be reached. NRHA believes that the disability sector, aged care and health care are “pretty much one and the same thing in the bush. It may make sense to separate them in the city but in the bush you have the same small number of people involved in all three.”

The goal of the Alliance is not just to improve the lot of those working in rural health but to improve the health of all who live in rural and remote areas. Thus, says Gordon, it is right and proper that they should address workplace issues as a factor in well-being. “Life expectancy is still poorer across the board. Based on existing evidence, there is a four-year overall difference in life expectancy at birth between someone born in a rural area and one born in a major city.” Worse still, according to the Royal Australasian College of Physicians, if you compare an average male from a more remote shire such as Darling in northwest NSW with one from Mossman in Sydney, the gap extends to 11 years. This is independent of Indigenous issues – where the gap is already 13-17 years, depending on how it is measured (NRHA campaigns for all non-urban Australians regardless of ethnicity).

Why? It’s reasonable to suppose that the further you live away from ‘civilisation’, the less access you have to health services. But, “there is a combination of factors. Partly it is because there is a greater proportion of Indigenous people in very remote areas, partly it’s about access to health services. But mainly it is the other things you get when living in remote areas.” In aggregate, the people of rural and remote areas are older, have lower incomes, are less educated, engage in more risky behaviour (such as smoking, heavy drinking and/or dangerous driving), their occupation is more likely to be dangerous (mining, agriculture or forestry, to name a few), and they are more likely to have a disability.

He says progress is being made in terms of both budgets and programmes to improve the health and lot of the rural population. “I would say the tide is coming in, albeit not as quickly as we would like.” A decade ago, for example, the Commonwealth provided schemes only for doctors to go to the bush, whereas now there are modest schemes for nurses and allied health professionals. “Although the latter do not yet match the former, they are a definite step in the right direction.” So the recipe should call for more hospitals in rural areas? No, says Gordon. “Our view is that in Australia we are too hospital-centric. We need to focus more on primary care, health promotion and early intervention.”

The NRHA takes a keen interest in the development of ‘e-health’. Because of its potential for helping to overcome the effects of distance, people living in rural areas stand to benefit substantially from e-health in its various guises. However, rural and remote communities have the poorest infrastructure and thus a limited capacity to access and make use of e-health applications. “We believe that whoever is in government should commit to providing [rural residents] the same speed of broadband access at the same price as in urban areas.” Given that proviso, says Gordon, things like tele-health, PCEHR (Personally Controlled Electronic Health Record) and related e-programmes “offer considerable benefit.” The PCEHR in particular, is advantageous to rural people (as well as ‘grey nomads’ who wander round the country) who are more likely than their urban counterparts to be cared for by multiple clinicians. “But really most of this ‘gee whiz’ technology has to be predicated on the concept of having equivalent access at the same price.”

Gordon says that in some sectors – including mental health and cancer – the treatment someone in a rural area will receive is markedly inferior to that in the city. A few types of cancer are more prevalent outside metro areas, but even pre-supposing equality of incidence, “we know that, having been diagnosed with a cancer, the rate of survival, or the length of time one might be expected to survive, is lower in rural areas because the diagnosis is likely to have been later.”

At the end of its second decade there remains much for the Alliance to do. Gordon says there needs to be an answer to the problems of how we deliver health services, how we provide early intervention and how we bring urban standards of health care to the outback. He talks about ‘health’ rather than ‘medicine’, but points out there is a need for more professionals – doctors, pharmacists, podiatrists, optometrists, paramedics, dentists, midwives, sports science practitioners and, in particular, nurses – which depends in part on government stimulus to supply rural areas. There is currently a $2.1 billion dollar primary healthcare deficit for rural people (the gap between urban and rural access to Medicare, PBS and allied public-funded services). “We are working our butts off to make sure that gap does close.”

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April 27, 2018, 9:13 AM AEST

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