Distance+is+Deadly+-+Health+Outcomes+for+Rural+and+Remote+Australians

Name: Elena Kopp Student Number: n8304441 Tutor: Dr Mangalam Sankypellay Topic: Social Identities, Physiologies and Human Health: How does geography affect morbidity and mortality?



The photo depicts a fictional road, the “Forgotten Rural Highway”, which is representative of the realities faced by many who live in rural and remote areas in Australia. It shows how it is common for the nearest town where supplies can be bought to be a large distance away. Shops are not just around the corner and a great deal of travel is often needed to reach these areas. Furthermore, the nearest town does not necessarily have appropriate healthcare and even greater distances may need to be travelled to reach the care that is needed. These issues need to be addressed so that the people who live in these areas are not forgotten like the highway.

**Public Health Issue ** Rural and remote Australian’s experience substantially poorer health outcomes than people living in major cities and regional areas. Mortality rates are higher and the life expectancy is shorter outside of major cities. The people in these areas are more likely to die of diseases such as coronary heart disease and emphysemia. They are also more likely to be obese and have type-2 diabetes or asthma.  These health outcomes are exacerbated by the large distances that need to be travelled to buy fresh food, the costs involved in doing so and the limited access to health care. Access is limited in terms of the large travel distances as well as the shear lack of health professionals located in remote areas.

**Literature Review ** According to the Australian Standard Geographical Classification, 68% of Australians live in major cities, 20% live in inner regional areas, 9% in outer regional, 2% remote and 1% very remote areas ( ABS, 2011) . Health outcomes are substantially poorer in areas outside of major cities, which is demonstrated by 1.2-1.7 times higher death rates (AIHW, 2007). The morbidity statistics from the Australian Institute of Health and Welfare show that people in rural areas do not live as long as people in urban areas (AIHW, 2007). Trends that show a decrease in life expectancy and increase in death rates when remoteness increases have been found (AIHW, 2007).  While there is a much larger population of indigenous people in these areas which does contribute to the differences, death-rates for the non-indigenous population are still higher than in major cities (Rickards, 2011). The causes of these high death rates are important to understand in order to identify the factors contributing to them. People living outside of major cities are more likely to die of coronary heart disease and other circulatory diseases or die due to cancer or chronic obstructive pulmonary disease such as emphysema (AIHW, 2007). They are also more likely to have type-2 diabetes or asthma, die due to an infectious disease, have poor dental and oral health, be overweight or obese and have a disability (AIHW, 2007). It is important to understand the societal factors that influence individual’s health to see what is contributing to the differences in metro and rural areas. The development of coronary heart disease and type-2 diabetes is largely associated with exercise and food consumption (NRHA, 2011). In rural and remote areas, many people find it more difficult to maintain a healthy diet both due to higher expenses from transport costs and a lack of healthier foods in remote stores (NRHA, 2011). In the Health Food Access Basket study, compared with Brisbane, the same basket of healthy food cost 24% more in remote stores and 33% more in stores that were very remote and 2000km or more from Brisbane (Queensland Health Treasury, 2006). Furthermore, not only is healthier food and food in general more expensive in these areas, rural and remote Australia has a greater percentage of people significantly poorer than in major cities with exception to mining and wine producing regions (AIHW, 2007).

Socioeconomic status (SES) in terms of income, education and occupation have all been found to be contributors to health - lower the SES status, the lower the health (AIHW, 2008). Unfortunately, education levels are also lower in rural regions which may be due to difficulties with access to schools and the greater distances to get to them (Rickards, 2011). Attracting and retaining qualified teachers is also an issue in these areas due to remoteness (NRHA, 2010). In very remote areas, the amount of 19 year olds that completed year 12 was only 40 percent, compared with 72 per cent of 19 year olds in regional areas and major cities (NRHA, 2010). Furthermore, lower levels of education are associated with higher levels of unemployment which has many risk factors associated with it ( Hammarstrom & Janlert, 2003) . Not only is there lower income, which reinforces lower SES, people who are unemployed are more likely to smoke, use illicit drugs and drink alcohol at hazardous levels ( Hammarstrom & Janlert, 2003) . Higher smoking rates contribute to the increased deaths from lung cancer and emphysema and increased alcohol consumption has many risk factors such as fatalities from drink-driving and liver damage (Room, Thomas & Jürgen, 2005). Higher drinking rates, however, are not only associated with lower education and unemployment.  In rural Australia there is a big drinking culture where alcohol consumption is associated with values such as mate-ship and hardiness (NRHA, 2011). The limited range of places for socializing and recreation means that local sports clubs and pubs are common areas to socialize which may contribute to excessive drinking and smoking among rural Australians (NRHA, 2011). <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Additionally, all of these aforementioned health issues experienced by rural and remote Australians are further exacerbated by the poorer access to healthcare. The range and choice of health services are limited because of costs and insufficient revenue for private practitioners which leads to generalisation and a lack of specialists (Farmer, Munoz and Threlkeld, 2012). Furthermore, patients must travel great distances to reach appropriate healthcare which means that preventable problems are often left until it is too late (Farmer et al., 2012). In major cities, there are approximately 324 medical practitioners for every 100 000 people. In remote areas, this drops to 136 per 100 000 who live in areas hundreds of kms wide (NRHA, 2010). This shows that not only are health outcomes poorer in rural and remote areas, but access to healthcare is as well (Farmer et al., 2012). **<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Cultural and Social Analysis ** <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">It is beneficial when looking at the health outcomes for rural and remote Australians to focus on the social determinants of health. Many of the problems that these people experience are due to socially determined factors that are difficult to influence on an individual level. At the 2011 World Conference on the Social Determinants of Health, it was outlined that structural factors that effect social positions of individuals are the main cause of health inequities (CSDH, 2011). The unequal distribution of power, income, goods and services directly effects people’s access to health care, schools, work conditions, leisure activities and their communities (CSDH, 2011). This is true for people in remote and rural areas and is not something that just naturally occurs (Farmer et al., 2012). Outback Australia was once considered to be the true face of Australia in which capable farming men and women grew crops, endured isolation and carried the nation (Farmer et al., 2012). Unfortunately, government policy in the 1980’s lacked support for agriculture and did not help rural Australia respond to the challenges that globalization presented (Farmer et al., 2012). The lack of focus and awareness of issues faced by rural and remote Australians is something that continues to contribute to the problem. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">This issue is clearly something that needs to be addressed if rural and remote Australians are ever to experience equitable opportunities and health outcomes. Three general principles of action were outlined in the Social Determinants of Health World Conference (CSDH, 2011). They provide a guide as to what the focus should be on in terms of equitable health not only for rural and remote Australians but all of Australia and the rest of the world. The Three principles of action outlined were:


 * 1) <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age
 * 2) <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally.
 * 3) <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">A start to achieving this and helping people already facing health issues in rural and remote areas would be to introduce strategies to make access to healthcare easier. Funding to attract health professionals to remote areas to increase accessibility as well as continued support and donations to organisations such as the Royal Flying Doctor Service are all beneficial. The Royal Flying Doctor Service is an organisation that focus on the large distances rural and remote Australians must travel to receive healthcare. They provide 24 hour emergency services to people in even the furthest corner of Australia.

**<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Analysis of Artifact ** <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">At first glance the artifact simply looks like a normal highway sign in a country area of Australia. Upon further inspection it is clear that it is represents so much more. The Forgotten Rural Highway symbolises the challenges faced every day by people who live in rural and remote Australia. Not only is it a large distance to reach the nearest town, but it is often even further to reach appropriate health care. As a whole, the artifact represents distance. This distance relates to so many aspects of life in these areas. Distance to schools, distance to shops, greater costs and limited choices because of these distances. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Before I started researching this topic I had never really given much thought about the troubles experienced by people who live in rural and remote Australia. I had no idea of the high mortality rates that are evident compared with major cities. I knew that obviously they had to travel greater distances to get to places but had never thought about how that actually effects everyday life, especially health. I think it is highly beneficial that awareness of these issues occurs and information is spread, as I believe it is not something that many people even consider. This research has really made me appreciate and acknowledge the importance of organisations that help people in these areas and I hope they continue to receive support. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Furthermore, addressing the issue by looking at the social determinants of health is an approach that I think is beneficial. I think it can be applied to majority of social groups who experience inequitable health outcomes. It is something I will try to do in the future as it helps to take the blame off the individual and focus on the broader picture.

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<span style="background-color: #ffffff; display: block; font-family: 'Times New Roman',serif; font-size: 12pt; text-align: center;">References <span style="background-color: #ffffff; font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Bureau of Statistics. (2011). //Australian Standard Geographical Classification//. <span style="background-color: #ffffff; font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Institute of Health and Welfare (2007). Rural, regional and remote health: A study on mortality. Canberra: AIHW. <span style="color: #121212; font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Institute of Health and Welfare. (2008). Rural, regional and remote health: indicators or health status and determinants of health. Canberra: AIHW, 2008. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">CSDH (2011). //Closing the gap in a generation: health equity through action on the social determinants of health//. Final Report of the Commission on Social Determinants of Health.Geneva: World Health Organization. <span style="color: #121212; font-family: 'Times New Roman',serif; font-size: 12pt;">Farmer, J., Munoz, S., & Threkheld, G. (2012). Theory in rural health. //Australian Journal of Rural Health, 20//, 185-189. doi: 10.1111/j.1440-1584.2012.01286.x <span style="background-color: #ffffff; font-family: 'Times New Roman',serif; font-size: 12pt;">Hammarstrom, A., & Janlert, U. (2003). Unemployment – an important predictor for future smoking: a 14-year follow-up study of school leavers. //Scandinavian Journal of Public Health, 31//, 229-232. doi: 10.1080/14034940210164902 <span style="background-color: #ffffff; font-family: 'Times New Roman',serif; font-size: 12pt;">National Rural Health Alliance Inc. (2010). Measuring the metropolitan-rural inequity. //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Fact Sheet 23, //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">1-3. <span style="background-color: #ffffff; font-family: 'Times New Roman',serif; font-size: 12pt;">National Rural Health Alliance Inc. (2011). The determinants of health in rural and remote Australia. //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Fact Sheet 28, //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">1-2. <span style="background-color: #ffffff; font-family: 'Times New Roman',serif; font-size: 12pt;">National Rural Health Alliance Inc. (2011). Alcohol use in rural Asutralia. //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Fact Sheet 30, //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">1-2. <span style="background-color: #ffffff; font-family: 'Times New Roman',serif; font-size: 12pt;">Queensland Health Treasury (2006). Healthy food access basket survey. Brisbane: HFAB. <span style="background-color: #ffffff; font-family: 'Times New Roman',serif; font-size: 12pt;">Rickards, L. (2011). Rural health: Problems, prevention and positive outcomes. //Health,// 149-173. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Room, R., Thomas, B., & Jürgen, R. (2005). Alcohol and public health. //The Lancet//, //365//(9458), 5-11.