Name: Ellie Weterings
Student Number: n8880433
Tutor: Judith Meiklejohn







The cultural artefact is an advertisement for the Australian Air Doctor Ambulance service "Angel Flight". Throughout the commercial, the isolation and remoteness of towns in rural Australia is emphasized in terms of reduced access to health services and health care professionals. This is portrayed where the street signs and facility signs, which would usually convey a standard message, are made to demonstrate distances to the nearest health care service or equipment, for example ‘CAT scan Machine 730 kms’. The ad illustrates what it is like for people from rural areas being treated in urban cities where their loved ones are km away back home. Features of the ad including the isolated towns and roads, the elderly man, and the dull colour of the clip all help to emphasise the need for care in these areas, in this case Angel Flight.




THE PUBLIC HEALTH ISSUE
Geographic location can determine how well people are able to do in life, how happy they are, how healthy they are and how long they live. The public health issue, perfectly highlighted by this one minute advertisement, is the issue of rural Australians having a poorer health status due to less access to quality health services and health professionals. It is important to recognise that people living in these regional and remote areas have a shorter life expectancy as well as a higher prevalence of illness and disease risk factors than those living in major cities. These things together create a public health issue that Australians cannot simply ignore.


LITERATURE REVIEW

In Australia, 84% of the population live within 50 km of the coast (Alston, 2012). In Australia, geographic classification is determined by the Accessibility/Remoteness Index of Australia which helps to define remoteness of places by giving them a score between 0 (being high accessibility) and 15 (being high remoteness). Major Cities score from 0-0.20—relatively unrestricted accessibility to a wide range of goods and services whereas very remote areas score greater than 10.53-15—very little accessibility of goods, services (Queensland Treasury and Trade, 2013). Of the non-metropolitan population, collectively, these communities have a population the size of Sydney, Australia's largest city (Wakerman et al.,2008). Almost three-quarters of these small communities live in the rural and remote areas furthest from large population centres and they face losing their population, financial hardship and significant health disadvantage (Wakerman et al.,2008).

Increased political attention in the past decade has contributed to a growth of common knowledge about rural health in Australia. According to rural constituents during the 2010 federal election, rural Australia has not had its ‘fair share’ in terms of spending in regards to health, education, employment, infrastructure and support of the agricultural sector (Bourke et al., 2010). Interestingly, inferences have been made about whether or not rural and remote areas of Australia deserve increased spending and infrastructure ignoring the fact that rural products are exported, value-added and consumed in urban Australia and contribute substantially to the national economy (Bourke et al., 2010). It also undermines the cultural and historical value of rural Australia as well as the rights of rural Australians to have infrastructure similar to urban Australians (Bourke et al., 2010).


Life expectancies for males and females were highest in Major Cities and lowest in Very Remote areas. The life expectancy in regional areas is 1–2 years lower and in remote areas is up to 7 years lower (AIHW, 2008). All these trends can most strongly be illustrated in measures of mortality. Mortality rates were specifically high in remote/very remote regions compared to major cities for incidences of; suicide, mental health issues, injury, road vehicle accidents, asthma, diabetes and infant mortality (AIHW, 2008). Rural Australians also have worse health because there is lower physical activity, higher obesity, increased alcohol consumption and increased mental health problems, especially depression. Generally it can be said that mortality and illness levels increase with distance from major cities (AIHW, 2008).


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Figure 1. Population Distribution, by Remoteness Area and the percentage who are Indigenous Australians in each Remoteness Area (AIHW, 2001)

Typically, a public perception of ‘rural health’ is a poorer health status, especially among Indigenous Australians (Bourke et al., 2010). The health of Aboriginal and Torres Strait Islander peoples was generally worse than non-Indigenous Australians. 45% of the Indigenous population live in rural and remote Australia (see Figure 1) and the death rate generally is over three times higher than for non-Indigenous Australians in major cities (AIHW, 2008) . Health differentials between Aboriginal/Torres Strait Islanders and other Australians are numerous and are related to poor housing, low employment and education rates, racism, social exclusion and a history of oppression and dispossession (Bourke et al., 2010). But these differences are not consistent across rural and remote Australia, with higher rates in areas with a higher proportion of residents who arc Indigenous or who have lower incomes, education and socioeconomic status (Beard et al., 2009).




People living in more inaccessible regions of Australia do not always have the same opportunities for good health as those living in urban centres(Wakerman et al.,2008). They are disadvantaged with regard to educational and employment opportunities, income, access to quality goods and services, and in some areas access to basic necessities, such as clean water and fresh food. Reduced access to primary health care providers and health services as well as medical workforce shortages is a huge contributor to the poor health of rural Australians (Wakerman et al.,2008).


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Figure 2. Prevalence of General Practitioners across Australia (ABS, 2001)

In major cities, there are approximately 324 medical practitioners for every 100 000 people whereas in remote areas, this drops to 136 per 100 000 (NRHA, 2010). Figure 2 shows the prevalence of general practitioners across Australia represented by the blue dots (ABS, 2001). Community controlled health services are limited by funding, government-determined targets and objectives, and a focus on health exclusive of educational, political, emotional and cultural issues (Bourke et al., 2010). Isolated communities are often too small to support traditional models of health delivery locally, so residents must access health care providers and services from larger urban centres (Wakerman et al.,2008). However patients must travel to reach suitable healthcare which means that preventable problems are often left until it is too late. Access to services is a common issue in rural and remote Australia and should not mask the importance of quality of care, cultural security and the appropriateness of the model of care, type of service and needs of the local community (Wakerman et al.,2008).



Health workforce shortages in rural areas is an increasingly important issue that needs to be addressed, as with the lack of health care staff (eg nurses, doctors, allied health professionals) there will be a further effect on the availability of health services (Wakerman et al.,2008). When working in a remote environment results in high workloads with high rates of burnout and increased waiting times, it adds pressure on the workforce to be clinically focused and work long hours (Bourke et al., 2010). This work pattern makes recruitment and retention of staff difficult, further compounding the workforce shortage (Bourke et al., 2010).


Socioeconomic status is important because it influences mortality and health generally. Populations with low socioeconomic status have higher rates of death than populations with high socioeconomic status. In relation to economic status, in the Health Food Access Basket study, compared with Brisbane, a basket of healthy food containing the same ingredients is 24% more costly in remote stores and 33% more costly in very remote stores (Queensland Health and Treasury, 2010). With a greater percentage of Australians with a lower socioeconomic status living in rural regions, healthy food can become unaffordable and thus a poor food diet will reduce one’s health status.


CULTURAL AND SOCIAL ANALYSIS
Society and culture are crucial to consider when trying to understand and address this population health issue; being a poorer health status among rural and remote Australians due to lack of accessibility to health services, shortage of health professionals and lower socioeconomic status. The social and cultural group affected by this public health issue are non-Indigenous Australians living in rural and remote regions of Australia, as well as Indigenous Australians. As written above, although the public health issue is a poor health status among rural Australians, Indigenous Australians pose the biggest risk for having poor health among these rural communities.

Culture in rural areas can be seen through various organised communities and groups that collectively share the same language, values, behaviours etc, such as Indigenous Australians, however culture is not confined and there has been questions raised of whether there is such thing as a ‘rural culture’. There is an importance of identifying as rural Australian as these people contribute to the nation and contribute to the diversity in culture and our heritage. Rural communities have a way of connection and a positive social recognition that has developed. Valuing rural Australians is especially important as we need to recognise and understand the role they play and importance in providing them with health support to improve their community health through wider access, education, technology, government initiatives etc.
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Figure 3. (CSC, n.d.)
For an example, agriculture is a significant part of Australia in terms of culture and history and as a major export industry. It currently accounts for 22% of Australia’s exports but only 3% of our GDP (Alston, 2012). The number of families working in agriculture has been in steady decline, due to ongoing rural restructuring brought about by technological advances, the amalgamation of properties into larger farms and the retirement of older farmers (Alston, 2012). It is also a result of farm families being driven out by the difficult financial conditions associated with agriculture in recent times (Alston, 2012). This era of loss of rural culture, not only in terms of agriculture, has a significant impact on the well-being and health of those families and communities left behind as networks and services decline (Alston, 2012).

There are challenges around being asked where you come from in Australia as there is a perception and association between rural and remote communities and poor education, lower socioeconomics, lack of opportunities, as well as poor health and other stereotypes. There is stigma associated with some rural/lower socioeconomic areas, and there is health risks associated with that. The issue of poor health outcomes in regional and remote areas is relevant within the context of Australian culture and society, and needs to be addressed to minimise the effects of divided responsibilities and the disparate funding systems and to provide for more integrated services that meet service needs as close as practicable to where people live.


ANALYSIS OF THE ARTEFACT AND LEARNING REFLECTIONS
The cultural artefact is an advertisement for the Australian Air Doctor Ambulance service "Angel Flight". It puts perspective on the troubles that people living in rural areas face, in particularly the issue of severe lack of accessibility to health care services and professionals. Through showing the distances required to travel by these isolated Australians, the clip portrays the public health issue clearly. When this clip plays on someone’s television in a urban city, it will represent how isolated these communities are from services that we have readily access to. It touches people and makes them thankful for the support and infrastructure around them living in urban areas. I had no perception about the distances that was actually required to travel to health specialists and services and it definitely touched me in that I can be thankful for that when I need medical advice or prescriptions, or when I do my half yearly skin check and orthodontist appointment, I can easily. The ad is for Angel Flight, and regardless of recognising how tough rural Australians live, I am also grateful that there are services and organisations that are able to provide health care in different forms to rural Australians. Also, for me having family that live in remote regions in Australia this clip brings home memories and as a future health care professional, I would like to be able to have the opportunity to help and support locals in these areas and improve their wellbeing and access to services.

I have learnt throughout this assessment just how much geographic location can determine how well people are able to do in life, how happy they are, how healthy they are and how long they live. I have seen the perspective of rural Australians on this issue and learnt the importance of identifying as a rural Australian and the importance of ensuring they received the same rights to spending and infrastructure as people living in urban Australia. It has changed the way I view health of rural Australians.




REFERENCES
Alston, M. (2012). Rural male suicide in Australia. Social Science & Medicine, 74(4), 515-522. Retrieved from http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/pii/S0277953610003862

Australian Institute of Health and Welfare. (2010). Improving access to primary care in rural and remote areas. Retrieved from http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/factsheet-gp-05#.UkFCNjBgy9w

Australian Institute of Health and Welfare. (2008). Rural, regional and remote health: Indicators of health status and determinants of health. Retrieved from http://www.aihw.gov.au/publication-detail/?id=6442468076

Beard, J., Tomaska, N., Earnest, A., Summerhayes, R., & Morgan, G. (2009). Influence of socioeconomic and cultural factors on rural health. The Australian Journal of Rural Health, 17, 10-15. doi: http://dx.doi.org.ezp01.library.qut.edu.au/10.1111/j.1440-1584.2008.01030.x

Bourke, L., & Coffin, J., & Fuller, J., & Taylor, J. (2010). Rural Health in Australia. Retrieved from http://go.galegroup.com.ezp01.library.qut.edu.au/ps/i.do?action=interpret&id=GALE%7CA249059428&v=2.1&u=qut&it=r&p=HRCA&sw=w&authCount=1

National Rural Health Alliance. (2010). Measuring the metropolitan-rural equity. Retrieved from http://ruralhealth.org.au/sites/default/files/fact-sheets/Fact-Sheet-23-%20measuring%20the%20metropolitan-rural%20inequity_0.pdf

Queensland Health and Treasury. (2010). Healthy Food Access Basket (HFAB) Survey. Retrieved from http://www.health.qld.gov.au/ph/documents/hpu/hafb-2010.pdf

Queensland Treasury and Trade. (2013). Accessibility/Remoteness Index of Australia. Retrieved from http://www.oesr.qld.gov.au/about-statistics/statistical-standards/national/aria.php

Wakerman, J., Humphreys, J. S., Wells, R., Kuipers, P., Entwistle, P., & Jones, J. (2008). Primary health care delivery models in rural and remote Australia: A systematic review. BMC Health Services Research, 8(1), 276-276. doi:10.1186/1472-6963-8-276





LEARNING ENGAGEMENT AND REFLECTION TASK

1. http://healthcultureandsociety2013.wikispaces.com/share/view/64686616
2. http://healthcultureandsociety2013.wikispaces.com/share/view/64686640