‘The tyranny of distance’: rural health inequities persist

Alisha Dorrigan

15/12/2023 3:16:07 PM

Health disparities between those living in urban and rural areas have been laid bare in the National Rural Health Alliance’s latest analysis.

Aerial view of Australian desert.
People living in rural and remote areas are more likely to die from preventable illness.

For the more than seven million Australians who live in rural or remote areas across the country health disparities remain stark, according to a new analysis.
The latest data released in the National Rural Health Alliance’s (NRHA) Rural Health in Australia Snapshot 2023 suggests that the further an individual lives from an urban centre, the lower their life expectancy and the higher the likelihood they will die from a preventable illness.
NRHA Chief executive Ms Susi Tegen says workforce shortages and ‘the tyranny of distance’ are both major contributors to health inequities that see shorter lifespans, a greater disease burden and fewer healthcare dollars spent on people living in rural and remote areas.
‘There is clear evidence that per-person spending on healthcare is not equitable, and that this inequity is contributing to poorer health outcomes in rural areas,’ Ms Tegen said.
‘Fit-for-purpose funding is critical to ensure that the necessary policy and infrastructure is in place.’
According to the NRHA analysis, the all-cause death rate per 100,000 people in males is 569 in major cities, which increases to 925 in very remote areas. A similar trend is seen for females with 409 deaths per 100,000 in major cities compared to 644 in very remote areas.
These figures include deaths from preventable causes, with both men and women more than twice as likely to die from potentially avoidable causes in remote regions.
The data presented also details the health funding disparities that remain for those living outside of major cities, with NRHA estimating this as a $6.55billion deficit in healthcare expenditure.
One reason for this is that people living remotely under-utilise Medicare, using services up to 50% less than their urban and inner regional counterparts, including GP services. Almost 45,000 people living in these areas have no access to primary healthcare within a one-hour drive from their home.
‘The biggest deficits are in accessing primary health care which then leads to higher rates of costly and potentially preventable hospitalisations and increased hospital expenditure,’ Ms Tegan said.
‘This is a sad reflection on the rest of Australia, when not every citizen has the same access to a basic healthcare need.’
Rural and regional areas continue to have an inadequate supply of most healthcare professionals, owing to a maldistribution of the healthcare workforce, with the number of GPs servicing remote regions also declining in recent years.
Deputy Chair of the RACGP Rural Council Dr Rod Omond told newsGP that strengthening the primary care workforce and adequately funding training pathways are both essential when it comes to overcoming rural and remote health challenges.
‘To encourage more GPs into the rural sector, and decrease some of the shortages that we’re very aware are occurring, there needs to be increased emphasis on the training of GPs in the rural and remote sector,’ he said.
‘The most important thing is to have GPs in those areas with suitable training, to both have enough spread of GPs so that people can access them when they need to, but also to have the skills to be able to minimise trips to specialists and to other tests, which is a major factor in why it’s difficult for rural people to access the care that they need.’
If there is adequate nursing support for GPs and local allied health services, Dr Omond says health outcomes in rural and remote area can be improved.
‘What you really want to do is to get more of the services that urban people have immediately available into rural sectors. While you can’t get all of them there – you can’t have a big hospital in every town with all the facilities that they have – but increased numbers of GPs and some other services that GPs can then refer to locally will make a difference,’ he said.
‘So such measures as the rural generalist program, and that’s not only the hospital type skills, but GP skills in specialised areas, tend to improve the access of rural people to medical care.’
RACGP Rural Council Provost and National Clinical Head of Rural Pathways Dr Karin Jodlowski-Tan told newsGP that while there is no simple solution when it comes to rural health, team-based training and support in these settings can overcome some of the challenges.
‘It may be that there’s a place with great workforce need but they don’t have a supervisor, so we’ve been supporting practices to build that capacity by getting a team of remote supervisors working with an on-site support team which may be nurses, practice managers and other allied health that can support someone,’ she said.
‘For example, you’ve got a region or cluster of small towns where you’ve got a solo GP who may be getting towards retirement age and they can’t have a registrar – there’s no succession plan for those communities.
‘We’ve been working with some of these [regions] as a group so that between all these GPs, they can actually support registrars in their region and within their practices by covering for each other.
‘We’ve been looking at novel and innovative ways of enabling these capacities and succession plans to be built through GP training.’
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A.Prof Christopher David Hogan   19/12/2023 5:59:12 PM

An effective health system relies on more than numbers of available health care providers .
Community Health Literacy- the understanding of the function of the body & mind in health & disease and the way our health system operates- is currently terrible.
If they ever learnt about health at school, such knowledge is now outdated .
The internet does not provide education but a poor quality mix of clashing opinions that leads folk to listen to those who share the same misconceptions & biases.
We rely on adequate community health literacy so that people can lead healthy lifestyles, live in healthy communities , understand health promotion & work in partnership with health providers.