Rural Areas and Health
Introduction
People who reside in rural and remote areas generally have poor health than their major city counterparts, and this notion is reflected through higher levels of mortality, disease, and health risk factors. Poor health care is one of the challenges facing rural communities in Australia. The quality of health care deteriorates as one move away from the major cities. Physical availability is still an issue in many rural healthcare centers, as most medical practitioners prefer to work in urban areas. Despite numerous initiatives to improve the health needs of Australian communities that reside in rural areas, people are still suffering from inadequate facilities. The rural population in Australia is on the decline, despite other rural areas experiencing growth and prosperity. Inequalities in health care can be solved if necessary steps are taken to address inequalities in the affected areas. This study will focus on the drivers and outcomes of geographical discrepancies in health, and recommendations to address divergent health profiles.
Drivers of Health Care Disparities in Australia
Provision of adequate, quality, and sustainable health care services has been a huge challenge to the Australian government, particularly in rural and remote regions. According to a report by Australian Institute of Health and Welfare (AIHW) of 2010, one-third of the total population in Australia resides outside the three key cities (Guzys and Petrie, 2013). This group of people lives in remote areas along the coastlines, as well as the interior Australia, where access to health care facilities is a huge problem. Although living in the countryside has its own advantages, rural residents are considered poorer in health than people living in cities. The mortality and morbidity rates are quite high among rural population while many people suffer from chronic illnesses in rural areas than in urban centers. According to Australian Bureau of Statistics (ABS), the number of deaths per 100,000 people in rural Australia in 2008 was 42% higher than that of urban centers (“Health Outside Cities,” 2011). Many children in rural areas are born with low birth weight due to lack of proper antenatal care. Prevalence of mental health problems is high among rural residents than urban residents.
The well-being of rural residents relies on the quality and access of health care. The geographical location has played a key role in the provision of health care in the rural areas, as distance from one health facility to the other determines the accessibility of health care (Bourke, Humphreys, Wakerman and Taylor, 2012). Geographical location is characterized by socioeconomic status, standard of living, and indigenous traits. The rural location is a specific setting where rural health outcomes happen. Distance from the cities and poor transport system has been the major hindrance to accessing medical facilities for numerous rural Australians. Where transport seems to be the impediment to health care provisions, the government has not been able to devise ways to access such services to the rural residents. People living in rural areas are three times more likely to die through road accidents than in metropolitan areas due to the need to travel for long distance (“Health Outside Cities,” 2011).
The success of health care provision is measured according to accessibility of GPs within a given geographical area. Concentration of healthcare professionals is quite high in major cities (392 full-time practitioners for every 100,000 people) compared to remote areas (206 full-time health practitioners for every 100,000 people), which is relatively low (Ware, 2013). Areas that have few GPs are likely to experience poor health outcomes, as the few health care professionals are expected to deal with a large number of patients in a day. In major cities, GPs are allocated a manageable number of patients in a given day, thus, making sure that every patient is satisfied with the services offered in the health care facility. Inequalities in geographical allotment of GPs are linked with deprived health outcomes (Mazumdar, Konings, Butler & Stewart McRae, 2013). When assessing the distribution of GPs in the rural areas, the assessors may not come up with the right figure because some GPs work in more than one center, and they are likely to be counted twice in the process.
Most rural and remote regions in Australia are sparsely populated, thus, placing a heavy burden on the health care services providers. Low population in some regions has contributed to lack of proper road transport, hence, creating an immediate problem in accessing health care services. Health care services are only established where population seems to be concentrated in a cluster (Luck & Race, 2011). Centralization of health care facilities in regional centers has made it difficult for patients from rural areas to access those services. Facilities in rural areas are relatively few, and have to provide community-wide integrated health care services, which include mental health services, aged care, and other public health services.
Australian government has not devised any plan to identify the appropriate levels of health services to enhance equality. Traveling for maternity services for expectant mothers has proved to be a financial burden in the rural areas. Although Australia is considered the safest country to give birth in, there exist disparities in terms of birth outcomes between Aboriginal people and other Australian women, which are demonstrated through high rate of preterm birth, which is 13.3% and 8%, respectively, and low birth weight, which is 12.4% and 5.9%, respectively (Bar-Zeev, et al., 2013). Most Aboriginal people have cited affordability as a barrier to proper medical services. The issue of affordability is a rare case in urban areas, as most urban area residents have medical coverage that guarantees efficient services.
Culture has played a significant part in the provision of health care in rural areas in Australia. Culture has made rural communities maintain their traditional ways of offering healthy care, partly because new methods are not accessible. Many medical professionals claimed that they experience some challenges when dealing with Aboriginal people due to their culture, particularly in communication. Lack of effective communication between health care providers and patients has resulted to fatalities due to faults related to diagnosis and overall health services. Aboriginal representation in the government and non-governmental organization is extremely low, making it difficult for Aboriginal people to enjoy equal medical services with other people in the country. Several attempts to enhance access to healthcare services in rural settings, such as community transport, have proved to be quite expensive compare to such services in the urban centers. Such services usually rely on volunteers to run, and because most volunteers are older people who are also not in good health, such services do not achieve their objectives.
Each community in rural areas has distinct needs while rural health nurses require to be skilled in order to meet those needs. Low health status in rural Australia is due to inadequate access to health care facilities, as well as few nursing practitioners. In most cases, rural health nurses operate within a limited budget, and are involved in matters of seeking grants and donations to improve health care services to the communities that they serve (Guzy & Petrie, 2013). This is quite different from urban centers, where large hospitals are adequate with specialized practitioners. In most rural areas, patients require specialized health services, which can only be sought from regional or metropolitan centers. Moreover, some of the GPs cannot handle certain illness and, thus, they are compelled to assist patients to seek medical attention from regional centers, which may incur extra costs to both the health care provider and the patient.
Attitude towards work is one of the drives towards poor health care provision in rural areas. New health care professionals aspire to work in large, well-resourced health care facilities, which offer professional support to advance skills for specialized practice, instead of generalized roles that are common in rural settings. The perception of rural health is geographically and demographically different from the city settings, as rural health services are characterized by inadequate access to medical services compared to metropolitan areas (Paliadelis, et al., 2012). Rural clinicians are expected to be generalists, as opposed to being specialists, which is practiced in urban areas. Due to this perception, most professionals in rural areas are unable to handle certain medical issues because they do not have the capacity to do so.
Power has can contribute to the level of health care in a given region. Decisions made by the government determine how particular initiatives deal with health care inequalities, as different communities react to initiatives in different ways. Under-utilization of small hospitals has become a problem due to lack of government’s effort to employ more medical professionals in such hospitals. Power has the capacity to shape people’s well-being, as resources are distributed according to the directives from the government. People who reside in Australian cities have adequate health care facilities with competent health care professionals while those who reside in rural and remote regions suffer from lack of adequate health care facilities.
Ageing Population and Health Care
The aging population is inflicting pressure on the health care providers, as their number keeps on increasing. Most of the aged people suffer from chronic illnesses that demand special care, which may not be available in the rural health care facilities. The “baby boomer” generation has become of age, and most of this population has contacted chronic diseases, leading to urgent care. Rural regions depend on primary care for the management of mental illness among the older people (Henderson, Crotty, Fuller & Martinez, 2014). However, access to GPs and their services has been hindered by differing health needs, inadequate specialists, travelling distances that reduces amount of time foe consultation. In addition, many GPs are not competent enough to handle mental problems, thus, many older people restrain from travelling long distances, only to be informed that their problems cannot be address in the center.
Older people who suffer from mental health problems usually experience social isolation in rural areas. Lack of social integration, as well as emotional support creates negative effects on mortality, leading to poor mental health outcomes (Byrne & Neville, 2010). Despite similar prevalence in mental health problems, older people in rural areas do not exhaust the use of GPs as their counterparts do in urban centers. The fear of stigma, as well as rural stoicism, prevents many older people from seeking healthcare service. Inability to handle older people who suffer from mental health problems leaves families and informal caregivers to handle such people, making their lives more miserable.
Outcome from Poor Health Care Services in Rural Areas
Hospital services are fundamental in the contemporary health care system, as they enhance the well-being of people who reside in rural and remote regions in Australia. Equitable access to healthcare facilities is the ultimate goal of any government. Lack of adequate health care facilities in rural Australia has led to unnecessary deaths, which could be avoided by establishing more health care facilities and employing competent and specialized health care providers. The current rural-urban health inequalities in Australia are unacceptable because they are denying rural and remote residents prospects, as well as opportunities to enjoy social and economic provisions. According to Guzys and Petrie (2013), rural Australians suffer more from health-related illness than their counterparts in cities. Poor health status has made life expectancy among rural Aboriginal people to be 14 years less compared to people living in Western Australian cities (Simpson, 2009).
Rates of risky behaviors are usually higher in rural settings than in major cities. According to ABS, people who reside in rural and remote regions are 30% more likely to experience long-term health conditions that happen due to physical injuries caused demanding occupations (“Health Outside Cities,” 2011). ABS also reported that people who reside in rural areas are 23% more likely to experience back pain than in cities. Lack of exercise among rural people has contributed to their poor health. They believe that their daily activities are sufficient to exercise their bodies. The rate of suicide in rural areas is higher than in major cities in Australia due to a large number of Indigenous people living in such areas, as well as easier access to lethal weapons (Byrne & Neville, 2010). In addition, reckless driving along poor roads in rural areas, and lack of emergency services to respond to such accidents depicts high incidences of suicides. However, prevention and risk estimation for suicide is lacking in many rural settings.
The rural health care practitioners are essential to enhance health and well-being of elderly people in rural areas. According to the Department of Health and Ageing in Australia, there exists a shortage of rural medical workforce, which makes the life of elderly people miserable (Nay & Garratt, 2010). To many elderly people in rural Australia who have become short sighted, accessing medical facilities has become a nightmare, as they do not have skilled drivers to take them to the nearest city for treatment. Besides, public transport is pathetic and, in other place, non-existent, thus, the only way to seek medical attention is through community help. Community transport should be enhanced while community drivers should be trained on first aid so that they can operate emergency equipment in community vehicles (Le, et al., 2012).
Many elderly people have stopped driving due to poor sight and incapacitation, and this tends to deny them their independence to move freely. For those who still have the strength to drive, the fear of losing their driving licenses to the law enforcement dissuade them from seeking medical attention from the nearest medical centers (Nay & Garratt, 2010). The cost of transport has hindered many rural people from seeking medical services, as they have to travel long distances to seek such services. On average, 90% of Australians visit general practitioners (GPs) at least once per year for various medical reasons, but this frequency is very low among rural residents (Luck & Race, 2011). In rural areas, the number of GPs per person is too low compared to urban centers. In some areas where there are airlifting services, lack of adequate funds to run the programs has made life of patients quite difficult. Lack of funds to support “fly-in, fly-out” has made provision of health services in rural and remote areas difficult while some practitioners contemplate on leaving their centers due to poor remunerations (Corderoy, 2013).
Power is one of the greatest determinants of health care outcomes in Australia. According to Bourke, Humphreys, Wakerman and Taylor (2012), power has the capacity to create a difference, to convert something from its original state to another, as a product of a larger system. The government can restrain some health care practices through prescribing procedures that have to be followed, thus, denying citizens what they are supposed to receive.
Interventions to Address Rural Health Problems
Addressing challenges facing the rural communities in Australia is not a simple task, as it will involve covering large distance without encountering human settlements. However, some policy options that have worked in other places can be applied to rural and remote regions to enhance equality in the provision of health services. If the government is incapable of taking health services to the needy, then it should contemplate on taking patients to the nearest health services. This can be achieved through establishing proper road network and communication services. If well managed, community transport can assist rural communities to access healthcare facilities with ease.
Maintaining quality health care can be achieved through innovations that include funds pooling, integrated services, and eHealth. Such innovations will be the basis of rural health policies for the future in Australia. Innovations would help in facilitating communication among the government, healthcare providers and patients. Funding grants should be made available to support general practitioners to motivate them to continue offering their services to rural population.
Older people, as well as retirees in the countryside may require specialized care due to their conditions. The government should provide safe transport system that would enhance access to healthcare facilities, as well as facilitating social interaction. Most rural residents prefer to spend their retirement years within their community, hence more residential care services are required (Anderson & Malone, 2014). A great number of the retirees suffer from chronic illness, and most of them are not capable of accessing health care facilities. Thus, the government should come up with an alternative model to cater for the ageing population in the rural and remote regions. The government should implement a program where retired and aged people are advised to register to the nearest public offices so that medical providers can visit them in their homes to assess their health conditions. As the number of ageing people continue to rise, the government should endeavor to develop proper transport network to access their residents with ease.
Education and training of health care providers in the rural areas is paramount in reducing inequality in offering quality health care. Rural residents should be encouraged to undertake health careers within the rural environment. Australian government should endeavor to establish nursing colleges in rural areas as a strategy to enhance the quality of health care. The value of presenting nursing experience in rural settings has been proved successful, as medicine and nursing students are likely to practice their professions in the rural areas (Luck & Race, 2011). Each center in the rural area should have at least one specialized doctor to handle emergency cases.
Conclusion
The health outcomes of rural people in Australia is generally worse compared to the urban residents because rural people experience geographic isolation, inadequate healthcare providers, socioeconomic problems, lack of proper public transport, and greater exposure to injuries. Culture has also restricted some rural communities from accessing healthcare facilities while many medical practitioners favor urban environment to rural settings. The outcome of such actions is high mortality and morbidity rates, high rates of chronic illness, low life satisfaction, and low life expectancy. The ageing population is the most affected by poor healthcare, as accessibility is a great challenge to them. The government should endeavor to eliminate geographical isolation through establishing proper road network and communication service to guarantee rural communities equal healthcare services as the urban residents. More medical colleges should be established in rural and remote areas to train Indigenous people on specialized treatments. Specialized services should be enhanced, particularly to older people, who usually suffer from chronic illnesses.
References
Anderson, J., & Malone, L. (2014). Suitability of the Multi-Purpose Service Model for Rural and Remote Communities of Australia. Asia Pacific Journal of Health Management, 9(3), 14-18.
Bar-Zeev, S., Barclay, L., Kruske, S., Bar-Zeev, N., Gao, Y., & Kildea, S. (2013). Use of Maternal Health Services by Remote Dwelling Aboriginal Women in Northern Australia and Their Disease Burden. Birth: Issues in Perinatal Care, 40(3), 172-181. doi:10.1111/birt.12053
Bourke, L., Humphreys, J. S., Wakerman, J., & Taylor, J. (2012). Understanding drivers of rural and remote health outcomes: A conceptual framework in action. Australian Journal Of Rural Health, 20(6), 318-323. doi:10.1111/j.1440-1584.2012.01312.x
Byrne, G., & Neville, C. (2010). Community mental health for older people. Sydney: Elsevier.
Corderoy, A. (2013, December 4). Rural health services in remote NSW at risk as changes made to fly-in, fly-out. The Sydney Morning Herald, New South Wales. Retrieved on 14 March 2015 from http://www.smh.com.au/nsw/rural-health-services-in-remote-nsw-at-risk-as-changes-made-to-flyin-flyout-20131203-2yoq9.html
Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. Cambridge: Cambridge University Press.
Health Outside Major Cities (2011). Australian Bureau of Statistics, Australian Social Trends. Retrieved on 14 March 2015 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Mar+2011
Henderson, J., Crotty, M. M., Fuller, J., & Martinez, L. (2014). Meeting unmet needs? The role of a rural mental health service for older people. Advances in Mental Health, 12(3), 182-191. doi:10.5172/jamh.2014.12.3.182
Le, Q., Nguyen, H. B., Auckland, S., Hoang, H., & Terry, D. (2012). Access to health care services in an Australian rural area–a qualitative case study. International Journal of Innovative Interdisciplinary Research, 1(3), 29-36.
Luck, G. W., & Race, D. (2011). Demographic change in Australia’s rural landscapes: Implications for society and the environment. Dordrecht [etc.: Springer.
Mazumdar, S., Konings, P., Butler, D., & Stewart McRae, I. (2013). General practitioner (family physician) workforce in Australia: comparing geographic data from surveys, a mailing list and medicare. BMC Health Services Research, 13(1), 1-15. doi: 10.1186/1472-6963-13-343
Nay, R., & Garratt, S. (2010). Older people: Issues and innovations in care. Chats wood, N.S.W: Elsevier.
Paliadelis P.S., Parmenter G., Parker V., Giles M., & Higgins I. (2012). The challenges confronting clinicians in rural acute care settings: a participatory research project. Rural and Remote Health. Retrieved on 14 March 2015 fromhttp://www.rrh.org.au/articles/subviewaust.asp?ArticleID=2017
Simpson, A. (2009). Improving the health of rural and remote Aboriginal communities through state-wide education and employment initiatives. In 10th National Rural Health Conference, 1-7.
Ware, V. (2013). Improving the accessibility of health services in urban and regional settings for Indigenous people.Australian Institute of Health and Welfare, Closing the gap. Retrieved on 14 March 2015 from http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs27.pdf