Rural+Health+is+Everyone's+Problem

Alexandra Clarke n8893799 Tutor: Judith Meiklejohn
 * RURAL HEALTH IS EVERYONE'S PROBLEM **

**Cultural Artefact:** [] media type="custom" key="24294680" align="center"

The ‘Angel Flight Signs’ video clip is an advertisement by Angel Flight Australia that was designed to depict realistic rural scenes whilst also highlighting the vast distances facing regional people requiring health services (Angel Flight Australia, 2013). Angel Flight is a charity that org anises non-emergency flights for country people in order to assist them in obtaining professional healthcare (Angel Flight Australia, 2003). The Angel Flight Signs advertisement was intended to stimulate awareness of the struggles experienced by regional Australians and to mobilise support for the cause. The advertisement depicts the travel associated with rural healthcare in a clear and clever manner, where several signs are used to portray the distance necessary for certain health services and treatments. For example, the first scene shows an elderly man sitting at a bus stop next to a sign that reads ‘Heart Specialist, 860kms’. The commercial concludes with a visual of a small plane flying over an outback landscape, followed by the Angel Flight message that ‘Help is never far away’.
 * CHOSEN ARTEFACT **



Geographic distribution has significant influence on a range of health risks and outcomes. The overall health outcomes of rural Australians are poorer in comparison to urban populations, and organisations such as Angel Flight aim to reduce disparity and equalise health status across all geographic areas (Australian Institute of Health and Welfare, 2013). The Angel Flight advertisement distinctly demonstrates the relationship between rural living and reduced health, whereby signs are used to signify the inadequate healthcare in regional Australia, and the subsequent distances required to gain access to health services. Considering approximately one third of the Australian population live in regional areas, poor rural healthcare is a significant issue that needs to be comprehensively investigated and addressed on a national scale (Australian Institute of Family Studies, 2013). Angel Flight recognises the health disadvantages experienced by rural Australians and works to minimise the health effects of living regionally by addressing issues of poor health, lack of finances and long distances through providing travel assistance to access health services.
 * PUBLIC HEALTH ISSUE **



The relationship between rural populations and poor health outcomes is a globally complex issue facing Australia today. The term ‘rural’ includes all non-metropolitan, regional and remote areas (Queensland Treasury and Trade, 2013). Recent data from the Australian Bureau of Statistics illustrates that approximately one third of the population live in rural areas (Australian Bureau of Statistics, 2010). The graph below illustrates the geographic distribution of rural Australians, and emphasises the immense distances between remote areas and major cities (Australian Institute of Family Studies, 2006).
 * LITERATURE REVIEW **



Research from the Australian Institute of Health and Welfare (AIHW) concludes that the life expectancy and mortality of rural Australians is noticeably worse than for those living in metropolitan areas (Australian Institute of Health and Welfare, 2008).



The 2008 National Health Survey also demonstrates poorer health in rural locations, where rates of health risk behaviours such as smoking, excessive alcohol consumption and obesity were significantly higher outside major cities (Australian Bureau of Statistics, 2008). The physically demanding occupations common in regional communities means that people living remotely were also more likely to have sustained a long-term health condition as a result of injury (Australian Bureau of Statistics, 2008). Increasing rates of mental health issues among remote populations (particularly males) is another recently identified trend, whereby men living in regional areas were 1.3 to 2.6 times more likely to commit suicide than their metropolitan counterparts (Australian Institute of Health and Welfare, 2009).

These concerning trends are the result of a multitude of disadvantages experienced by rural Australians each day. People living in rural regions suffer substantial restrictions to goods, health services, education, employment and social interaction (Smith, 2008). Each of these deprivations ultimately leads to decreased health and wellbeing (Smith, 2008).

Lack of access to healthcare is arguably the most significant factor in the poor health of Australia’s rural population. Angel Flight acknowledges the scarcity of healthcare in regional Australia in their ‘signs’ commercial, which provides an accurate depiction of the daunting distances facing rural people who require care in a professional facility.

The poor provision of health services in rural areas is primarily due to the high costs involved in establishing and maintaining a rural health service. Often, a lack of qualified staff in remote areas leads to increased costs to recruit and retain doctors, nurses and allied health professionals from major cities (Russell, 2013). In addition, a low intake of patients eventually results in a depletion of skills among health professionals, and therefore a decrease in effective treatment outcomes (Bourke, 2012). This in turns leaves rural Australians without appropriate services, and a subsequent requirement to travel long distances to obtain adequate professional healthcare.

The Angel Flight Signs advertisement also explores the prospect of mental illness due to loneliness and lack of support when staying in a healthcare facility for an extended time away from home. A study conducted by A. Grippo reveals a relationship between socially isolated patients and the development of depression (Grippo, 2007). The methodology used in this study was limited, however, as the findings merely indicated relevance between social isolation and the neuroendocrine responses relevant to depre ssion (Grippo, 2007).



In recent times rural health inequalities have been largely overlooked and have not been at the forefront in Australia’s primary healthcare approach. However, despite the recent lack of attention to rural health, the Australian Council of Social Service and the National Rural Health Alliance have recently begun lobbying the new Federal Government to do more to address inequality in regional and rural Australia (National Rural Health Alliance, 2013). Executive Director of the National Rural Health Alliance, Gordon Gregory recently spoke out and said, ‘People living in poverty in our country areas are missing out on opportunities and resources that the rest of us enjoy, such as adequate heath and dental care,’ (National Rural Health Alliance, 2013).

Previously, there have been several attempts by both Federal and State Governments to improve policies and increase rural health funding (Carey, 2013). However, these methodologies resulted in minimal improvement in regional health outcomes, meaning a more holistic approach to the issue is required (Bourke, 2012). A recent study has suggested that the Feder al Government undergoes a systematic review of healthcare services, and proceed to make all ‘core’ services more easily available to rural and remote Australians (Carey, 2013). Once adequate research is undertaken to identify a set of ‘core’ health services, policy makers, practitioners, consumers and researchers can work to make these services more available and affordable for rural people, and thus create a more equitable healthcare system in Australia (Carey, 2013). This methodology is limited however, as it is extremely difficult to devise a universal standard for ‘core’ health services, considering services required will differ depending on location, culture, age etc. (Black, 2012). However, an entirely different approach would be required in order to address obesity among middle-aged adults in a major city.

Culture and society play a major role in addressing rural health inequalities. Throughout Australian history, the absence of suitable healthcare has been a fundamental issue associated with living remotely (National Rural Health Alliance, 2013). Unfortunately, extreme travel time to see medical staff is often not viable for rural individuals/families who have large responsibilities in farming and agriculture. This encourages an attitude of disregard for illness or injury among rural communities, which usually results in prolonged time to consult a healthcare professional and hence a further decline of physical health. For example, rural health patients tend to be diagnosed with more advanced stages of cancer due a lack of health consultations resulting in the later discovery of the disease (Weaver, 2013).
 * CULTURE AND SOCIAL ANALYSIS **

The representation of regional Australians as tough, independent and carefree is another barrier preventing rural people from seeking healthcare, which ultimately leads to worsened rates of illness and injury.This barrier could be overcome by increasing health knowledge among rural communities, as remote Australians are not exposed to the same volume of health literacy messages as metropolitan people. It is highly important that all Australians place a high value on health and consult medical professionals whenever illnesses or injuries arise (Weaver, 2013).

A cultural group affected by geographic location in Australia is the Indigenous, where just under one third of the entire Indigenous population live in rural or remote areas (Australian Bureau of Statistics, 2010). The widespread regional geographic distribution of Indigenous Australians is demonstrated in the graph below. Indigenous people living in remote areas are more likely to have a higher sense of attachment to their culture as measured by their language, participation in cultural events, and social identification with their tribe, clan, or group (Australian Bureau of Statistics, 2010). The increased identification with Aboriginal culture in remote areas as opposed to major cities is supported by the ABS, where a study in 2008 showed that 42% of Indigenous people over 15 years old spoke an Aboriginal or Torres Straight Islander language at home, as opposed to less than 1% in major cities (Australian Bureau of Statistics, 2010). Indigenous Australians’ attachment to their culture means that they may rely heavily on traditional healthcare practices and may not effectively engage with more modern services. This is likely to lead to poorer overall health outcomes and therefore public health experts should be focusing on raising awareness and health literacy skills in this cultural group when addressing the issue of rural health.



Angel Flight recognises the health disadvantages experienced by rural Australians and works to minimise the health effects of living regionally by highlighting and addressing issues of poor health, lack of finances and long distances (Angel Flight Australia, 2013). The Angel Flight Signs advertisement therefore provided the perfect visual representation of the lack of healthcare in rural areas, and the vast travelling distances that must be undertaken to access professional care. It served as the perfect representation of the serious health disadvantages facing rural Australians today, as not only did it explore physical isolation, but also emotional isolation. This assessment piece has opened my eyes to the inequality in healthcare status between metropolitan and rural residents, something I had not previously paid much attention to. The studies referred to in this assignment have identified funding and resources as a major factor in effectively addressing rural health issues. However, it seems to me that with a competition for funding across all government programs, such financial support may not be so easily attainable.
 * ANALYSIS OF ARTEFACT AND PERSONAL REFLECTION **

The information I have gained through this assessment has prompted an interest for me in rural health and mobilised my support for the equalisation of health status in Australia. I have learned that is vitally important for Australia to recognise the contribution that regional communities have made to Australia both historically and currently, and to continue to advocate for action to positively develop their health status. Considering distance and scattered distribution, it can be very difficult for rural Australians to have a united voice, and therefore I believe that nation-wide support for rural communities is essential in order to ensure steady improvement in health outcomes and continued success of regional contribution to the Australian economy.

**// Reference List //** Australian Bureau of Statistics (2009). City and the Bush: Indigenous Wellbeing Across Remoteness Areas. Retrieved from the Australian Bureau of Statistics website: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features10Sep+2010

Australian Bureau of Statistics (2010). City and the Bush: Indigenous Wellbeing Across Remoteness Areas. Retrieved from the Australian Bureau of Statistics website: http://www.abs.gov.au/ausstats/abs@.nsf/Products/3218.0~2009-10~Main+Features~Main+Features

Angel Flight Australia (2013). //Angel Flight Charity//. Retrieved from Australian Bureau of Statistics website: http://www.angelflight.org.au/index.cfm

Australian Institute of Family Welfare (2011). //Families in regional, rural and remote Australia.// Retrieved from the Australian Bureau of Statistics website: http://www.aifs.gov.au/institute/pubs/factssheets/2011/fs201103.html

Australian Institute of Health and Welfare (2008). //Rural, Regional and Remote Health.//Retrieved from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459832

Black, G., Roberts, R., & Li-Leng, T. (2012). Depression in rural adolescents: relationships with gender and availability of mental health services. //Rural And Remote Health//, //12//2092.

Carey, T., Wakerman, J., Humphreys, J., Buykx, P., & Lindeman, M. (2013). What primary health care services should residents of rural and remote Australia be able to access? A systematic review of "core" primary health care services. //BMC Health Services Research//, //13//178. doi:10.1186/1472-6963-13-178

Grippo, A., Gerena, D., Huang, J., Kumar, N., Shah, M., Ughreja, R., & Carter, C. (2007). Social isolation induces behavioral and neuroendocrine disturbances relevant to depression in female and male prairie voles.//Psychoneuroendocrinology//, //32//(8-10), 966-980.

Health & Place [Health Place] 2012 May; Vol. 18 (3), pp. 496-503. //Date of Electronic Publication:// 2012 Mar 02.

National Rural Health Alliance (2013). //Time to release the facts on poverty in rural Australia.// Retrieved from: http://www.ruralhealth.org.au/media-release/time-face-facts-rural-poverty-australia

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

Russell, D., Wakerman, J., & Humphreys, J. (2013). What is a reasonable length of employment for health workers in Australian rural and remote primary healthcare services?. //Australian Health Review: A Publication Of The Australian Hospital Association//, //37//(2), 256-261. doi:10.1071/AH12184

Smith, K., Humphreys, J., & Wilson, M. (2008). Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research?.//Australian Journal Of Rural Health//, //16//(2), 56-66.

Weaver, K., Geiger, A., Lu, L., & Case, L. (2013). Rural-urban disparities in health status among US cancer survivors.//Cancer//, //119//(5), 1050-1057. doi:10.1002/cncr.27840

**REFLECTION** http://healthcultureandsociety2013.wikispaces.com/page/messages/Fashion+and+Sweatshops

http://healthcultureandsociety2013.wikispaces.com/page/messages/Close+The+Gap%2C+A+Campaign+200+Years+Late