‘Really complicated’: Lifestyle factors and city–rural health gaps

Even if Australians were to meet all the recommended dietary and physical activity guidelines, there would still be a disparity between the number of people dying from heart disease in the country compared to the city.
 
That’s what new research, published in the Journal of Public Health Nutrition, has found.
 
According to the study’s lead author Dr Laura Alston, people who live outside of a major city are 23% more likely to die prematurely from heart disease than those in metropolitan areas – which equates to about 37 extra deaths per 100,000 people.
 
Dr Alston, who lives in rural Victoria, told newsGP that she was surprised by some aspects of the research.
 
‘I did think that maybe, if we did reach the public health targets, that rural populations would see a big [health] benefit,’ she said.
 
‘But, at the same time, I know that a lot of the gap between metropolitan and rural areas isn’t just lifestyle-related. It’s really complicated, there’s a lot of issues leading to the health outcomes we see.’
 
Dr Alston said there is a pervasive belief that the increased mortality rate in heart disease in rural and remote areas can be attributed to lifestyle factors.
 
‘In talking to policy-makers, some of them said, “Well, rural communities don’t really help themselves; they smoke too much, they drink too much”,’ she said.
 
‘That’s sort of the general perception; that we’re unhealthy and we decide to be.
 
‘I think this is evidence that even if we were doing our absolute best [in terms of lifestyle factors] we’re still in a bad position. There’s still a large proportion of the gap that’s attributable to things that aren’t in our lifestyle.’
 
The study modelled data from the Australian Health Survey and adjusted for differences in population size.
 
The lifestyle factors analysed in the study included eating five serves of vegetables and two serves of fruit a day, eating enough fibre, limiting salt and fat intake, reducing alcohol intake, not smoking and completing 30 minutes of exercise five times a week.
 
The study showed that if all Australians met the same dietary and physical activity targets, 118 regional Australians would die from heart disease for every 96 deaths in a metropolitan area. 
 
‘So that gap would be reduced by 40%, which is a significant effect and certainly shows the importance of lifestyle factors to reduce heart disease mortality across all population groups,’ Dr Alston said.
 
‘Lifestyle factors are crucial, and while they don’t close the city–country divide, they do reduce it,’ she said.
 
‘But when we crunch the numbers that’s still an extra 22 deaths per 100,000 people in regional areas, and it’s something we need to be paying attention to.
 
‘Often we hear the message that if we could all meet these benchmarks then rural populations would be just as healthy as those in the cities.
 
‘But there’s so much more to this issue than rural lifestyles.’
 
However, Dr Alston said those exact issues are difficult to pinpoint.
 
‘It’s a really hard one because we don’t have really hard evidence on what [the cause] actually is,’ she said.
 
‘I do think our health services are doing the best job they can, but they are under-resourced for our communities’ needs.
 
‘People are sicker, chronically, than what our health services can deal with – and that goes for hospitals and community care. There’s not enough allied health support, there’s not a lot of specialist support.’
 
Dr Alston said other potential contributing factors to higher heart disease mortality in rural and remote areas could include issues such as drug misuse, stress and lower socioeconomic status.
 
Isolation and its effect on mental health may also contribute, with Dr Alston mentioning evidence linking mental health issues and heart disease.
 
GPs in rural, regional and remote areas, Dr Alston said, also face increasing burdens due to communities’ often-poorer health, in a system that requires better resources and services.
 
‘From a GP’s perspective, I’m sure a lot would agree they feel under-resourced and under pressure in the rural communities they service,’ she said.
 
‘Overall, it really makes me feel we need a lot more research on what’s going on for rural communities across the board.’

heart disease lifestyle research rural health