Angel's+Among+Us.+Geography's+affect+on+morbidity+and+mortality.

Student Name: James Gardiner Student Number: n8623945 Tutor Name: Michelle Newcomb

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The cultural artefact is an Australian television commercial for Angel Flight called “Signs” that was uploaded to YouTube. The commercial portrays scenes of different signs in rural and remote Australia that state the long distances to specific health care professionals and medical equipment (for example, Heart Specialist 860KMS), as opposed to other information usually depicted on these types of signs. However, it does contain one scene in a metropolitan area where the sign does not state health care professional or medical equipment, but states “Loved Ones 1,112 KM”. The commercial ends with a plane flying over what seems to be rural Australia and the phrase “Help is never far away”.

Public Health Issue
This television commercial represents the severe lack of accessibility to health care services that is affecting Australians living in inner regional to very remote Australia, regions classified by the Accessibility/Remoteness Index of Australia (Queensland Treasury and Trade, 2013). This is a public health issue because rural and remote Australians currently suffer from significantly worse health outcomes than Australians living in major cities, including, but not limited to, higher incidences of; suicide, mental health issues, injury, road vehicle accidents, asthma, diabetes and infant mortality. The greater number of Aboriginal and Torres Strait Islander people in remote areas, with their poorer overall health outcomes, are reflected in these statistics, but there is still clearly a higher mortality for non-indigenous people in these areas, then those in major cities (Phillips, 2009).

Literature Review
Australia is a large continent with a population base that is very limited. Twenty-two million people occupy a space similar in size to the United States and 84% of the population live within 50 km of the coast (Alston, 2012). Thus the vast inland areas of the country where much of our agricultural production takes place are occupied by about 16% of the population making the rural experience one of vast, uncompromising landscapes and limited social interactions (Alston, 2012). Agriculture has been a significant part of Australia’s post-colonial history and a major export industry. The number of farming families working in agriculture has been in steady decline since the 1950 and in the fifteen years to 2001 as many as 22% of farm families have left the industry (Australian Bureau of Statistics, 2003). This flight of farm families is 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). Also the difficult financial conditions associated with agriculture in recent times has driven many farming families from rural and remote areas. This loss of families has a significant impact on the well-being and health of those families and communities left behind as networks and services decline ( Muenstermann, 2009).

Rural constituents and their representatives do not feel that rural Australia has its 'fair share', as was shown during the 2010 federal election (Bourke, Coffin, Taylor, & Fuller, 2010). On occasions, rural Australians gain a political opportunity to voice concerns about health, education, employment, infrastructure, support of the agricultural sector and other issues. Interestingly, during the election, there were inferences about whether or not rural, regional and remote areas of Australia deserve increased spending and infrastructure, as if these regions have been subsidised by urban Australians ( Bourke et al., 2010) . The inference seems to ignore the fact that rural products are exported, value-added and consumed in urban Australia and contribute substantially to the national economy. It also undermines the cultural and historical value of rural Australia as well as the rights of remote, rural and regional Australians to have infrastructure comparable to people in urban areas.

Increased political attention during the past two decades has contributed not only to growth in a body of rural health literature but common knowledge about rural health in Australia. What typifies public perceptions of 'rural health' is poorer health status, poorer access to health care and the lack of staff, particularly doctors (Bourke et al., 2010). Rural and remote Australians have higher rates of injury mortality, especially road accidents, higher rates of communicable diseases, disability and homicide as well as higher rates of smoking and alcohol consumption (AIHW, 2008) . It is also common for babies from these areas tend to have lower birth weights and children to have poorer teeth quality (AIHW, 2008). These differences are not consistent across rural and remote Australia, with higher rates in areas with a higher proportion of residents who have lower incomes, education and socioeconomic status (Beard, Tomaska, Earnest, Summerhayes & Morgan, 2009).

Access to care is a common issue in rural and remote Australia, often viewed simplistically as distance and availability (Bourke et al., 2010). However, access masks 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) . Rural and remote health services are a complex web of individual actions, community control, local culture, government regulation from several levels, risk management in various ways and a combination of autonomy and surveillance at all levels <span style="font-family: 'Times New Roman',serif; font-size: 16px; line-height: 1.5;">(Bourke et al., 2010) <span style="font-family: 'Times New Roman',serif; font-size: 12pt; line-height: 1.5;">. Each negotiate their own pathway and emerge in many forms with some key strengths in addition to the well-known problems discussed above.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The lack of health care staff, including nurses, doctors, allied health professionals and health managers in rural and remote Australia is another well known issue ( <span style="font-family: 'Times New Roman',serif; font-size: 16px; line-height: 1.5;">Wakerman et al., 2008 <span style="font-family: 'Times New Roman',serif; font-size: 12pt; line-height: 1.5;">). High workloads with high rates of burnout and increased waiting times adds pressure on the workforce to be clinically focused and work long hours. This work pattern makes recruitment and retention of staff difficult, further compounding the workforce shortage (Lyle et al., 2007).

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Many of the things researchers and theorists have been saying about this issue over the past decades has been based on statistics and surveys. While both acceptable options for the gathering of data, trying to classify rural and remote Australia as one place is impossible and what may be a major problem in one rural part of Australia may not be one in another part. This report acknowledges this fact, but is unable to talk specifically due to limitations. Health strategies on a national level and a community level will be needed if the differences in health outcomes are to be improved.

<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: 16px;">Society and culture are crucial to consider when trying to understand and redress the severe lack of accessibility to health care services that is affecting Australians living in inner regional to very remote Australia. The social and cultural group most affected by this public health issue are Australians living rural and remote regions of Australia, which include Indigenous Australians and refugees living in these areas ( <span style="font-family: 'Times New Roman',serif; font-size: 16px; line-height: 1.5;">Sypek, Clugston, & Phillips, 2008).

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Explaining culture is difficult because it is inherently intangible and has been variously conceptualised (Farmer et al., 2012). A common thread in definitions is that a culture collectively shares knowledge, norms, behaviours, values, attitudes and beliefs (Halloran, 2004). Culture is not confined to observable phenomena nor is it bounded or static. The word culture is used periodically in the rural health literature, and empirical phenomena are sometimes attributed to it, raising questions of whether there is such a thing as a ‘rural culture’. Rather, people living in remote and rural Australia could be categorised as sharing ‘social location’(Dutta, 2011).

<span style="font-family: 'Times New Roman',serif; font-size: 12pt; line-height: 1.5;">Identifying as a rural or remote Australian depends on if someone lives or lived remotely or if they have been influenced greatly by someone who has, for example parents now living in the city. Someone who identifies as a rural or remote Australian could likely be self-reliant, independent and have a reluctance to seek help due to a commitment to stoicism (Alston, 2012). In addition, they are more likely to undertake risk-taking behaviour, such as driving, <span style="font-family: 'Times New Roman',serif; font-size: 16px; line-height: 1.5;">smoking and excessive drinking, while <span style="font-family: 'Times New Roman',serif; font-size: 12pt; line-height: 1.5;"> not undertake preventive health behaviours. Rural and remote Australia also suffers from inequitable gender relations (Alston, 2012). <span style="font-family: 'Times New Roman',serif; font-size: 16px; line-height: 1.5;">Health systems tend to acknowledge culture as a challenge of facilitating equitable service access for clients. Limitations in delivering a one size fits all rural health care package affect the diversity and choice of experiences that can be offered for all cultural groups (McBain-Rigg, 2011).

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">As stated earlier, in the decades after the 1950s, there has been a steady decline of people living in the rural and remote areas of Australia. This social change era has caused a decline in networks and services, especially in regard to opportunity for social interaction (Alston, 2012). Furthermore, the commitment to stoicism leading to reluctance to seek help is worsening the health outcomes of rural and remote Australians, especially in mental health issues ( <span style="font-family: 'Times New Roman',serif; font-size: 16px; line-height: 1.5;">Rughani, Deane, & Wilson, 2011) <span style="font-family: 'Times New Roman',serif; font-size: 12pt; line-height: 1.5;">. When people do not use the available services, it is hard to justify supplying more. This decline in services and reluctance to use the remaining services are both important factors in regards to the accessibility of health care services in rural and remote areas.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Awareness of the severe lack of accessibility to health care services that is affecting Australians living in inner regional to very remote Australia is important because it will allow an opportunity to rectify the situation. This issue should be discussed because there is a significant difference in the health behaviours and health outcomes of people from major cities and people from very remote areas. Furthermore, the public perception of ‘rural health’ is poorer health status, poorer access to health care and the lack of staff, particularly doctors (Alston, 2012). They are also seen as less educated and undertake risky behaviours, especially in lower socioeconomic areas ( <span style="font-family: 'Times New Roman',serif; font-size: 16px; line-height: 1.5;">Beard et al., 2009). This can lead to an increased amount of health outcomes described before and all these factors show that severe lack of accessibility to health care services is an issue that needs to be addressed. While this issue affects all rural and remote Australians, the lack of accessibility has a greater impact on people who live in very remote areas then people who live in inner regional areas <span style="font-family: 'Times New Roman',serif; font-size: 16px;">(Beard et al., 2009) <span style="font-family: 'Times New Roman',serif; font-size: 16px; line-height: 1.5;">. In addition, people in major cities are not affected by this issue. Public health experts should focus on implementing health strategies that will allow for rural and remote Australians to access health services without having to travel great distances, or devise a way to transport rural and remote Australians to their required facility. This should be done so that Australians living in these areas do not have to rely on services like Angel Flight.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Analysis of the Artefact and My Own Learning Reflections
<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">My cultural artefact is the Australian television commercial for Angel Flight called “Signs” that was uploaded to YouTube. The artefact represents the severe lack of accessibility to health care services that is affecting Australians living in inner regional to very remote Australia. It is a good symbol of this public health issue because it portrays the great distances that rural and remote Australians have to travel to access health care services that anyone living in major cities has easy access too. Personally, this artefact shows me the kindness in people as Angel Flight is a not-for-profit organisation who provide free flights to those in need, and while they cannot not fix this public health issue, they are trying their best to lower its impact on the health of rural and remote Australians. Furthermore, as a future health care professional, I would like to work in rural and remote areas and help people, like the people in Angel Flight or the Royal Flying Doctors Service.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">As a result of this assessment piece, I have learnt about the health differences between Australians with different accessibility to goods, services and opportunity for social interaction (Queensland Treasury and Trade, 2013). I found rural and remote health an interesting issue before the start of this assessment, and will continue in the future to study it and work to better the health outcomes in these areas. This assessment has taught me many things about rural and remote health I did not take into consideration before, such as the commitment to stoicism, and this has changed the way I think about the health of these Australians.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">References
<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">AIHW (2008). Rural, regional and remote health- Indicators of health system performance. Rural Health Series No. 10, Cat. no. PHE103. Canberra: Australian Institute of Health and Welfare.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">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

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Bureau of Statistics. (2003). 4102.0 - Australian Social Trends, 2003. Retrieved October 29, 2013, from http://www.abs.gov.au/AUSSTATS/abs@.nsf/2f762f95845417aeca25706c00834efa/cdcd7dca1f3ddb21ca2570eb00835393!OpenDocument

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Institute of Health and Welfare. (2008). Rural, regional and remote health: indicators of health status and determinants of health. Retrieved 2 November, 2013, from http://www.aihw.gov.au/publication-detail/?id=6442468076

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">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

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Bourke, L., Coffin, J., Taylor, J., & Fuller, J. (2010). Rural Health in Australia. //Rural Society, 20//(1), 2-9. Retrieved from http://search.proquest.com.ezp01.library.qut.edu.au/docview/853716655/fulltextPDF?accountid=13380

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Dutta, M (2007). Communicating about culture and health: theorizing culture centered and cultural sensitivity approaches. //Communication Theory, 17//(3), 304–328. doi: 10.1111/j.1468-2885.2007.00297.x

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Farmer, J., Bourke, L., Taylor, J., Marley, J. V., Reid, J., Bracksley, S., & Johnson, N. (2012) Culture and Rural Health. //Australian Journal of Rural Health, 20//(5), 243-7. doi: http://dx.doi.org.ezp01.library.qut.edu.au/10.1111/j.1440-1584.2012.01304.x

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Halloran, M. (2004). //Cultural maintenance and trauma in Indigenous Australia//. Annual Australia and New Zealand Law and History Society Conference. Perth, Western Australia.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Lyle, D., Klineberg, I., Taylor, S., Jolly, N., Fuller, J., & Canalese, J. (2007). Harnessing a university to address rural health workforce shortages in Australia. //The Australian Journal of Rural Health, 15(//4), 227-227. doi:10.1111/j.1440-1584.2007.00895.x

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">McBain-Rigg, K., & Veitch C. (2011). Cultural barriers to health care for Aboriginal and Torres Strait Islanders in Mount Isa. //Australian Journal of Rural Health, 19//, 70–72.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Muenstermann, I. (2009). Cross boundary farming: Can this challenging farming method save the Australian family farm? //Rural Society, 19//(3), 262-274. doi:10.5172/rsj.19.3.262

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Phillips, A. (2009). Health status differentials across rural and remote Australia. //Australian Journal of Rural Health, 17//(1), 2-2. doi:10.1111/j.1440-1584.2008.01029.x

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Queensland Treasury and Trade. (2013). Accessibility/Remoteness Index of Australia. Retrieved 14 September, 2013, from http://www.oesr.qld.gov.au/about-statistics/statistical-standards/national/aria.php

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Rughani, J., Deane, F. R., & Wilson, C. J. (2011). Australian journal of rural health: Rural adolescents' help-seeking intentions for emotional problems: The influence of perceived benefits and stoicism. //Youth Studies Australia, 30//(2), 63.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Sypek, S., Clugston, G., & Phillips, C. (2008). Critical health infrastructure for refugee resettlement in rural Australia: Case study of four rural towns. //Australian Journal of Rural Health, 16//(6), 349-349. doi:10.1111/j.1440-1584.2008.01015.x

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">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

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Free Trade>Sweatshops
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Dear Kathryn,

Your choice of artefact caught my attention to this subject immediately. I can't say I knew much about this topic before reading your wiki, but everything I knew had a negative connotation. Obviously that is because there should be, but it is nice to see that there are people in the world trying to change this. I believe that more people need to get behind ideas like this. It is just a shame how the easier and traditional way is to exploit our follow man.

Your wiki was informative and an eye-opener.

Thanks for the read.

Decriminalization
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Dear James,

This is not the type of subject I would go out, research and find enjoyment in, and therefore have little to no knowledge on the issue. However, your choice of artefact and consequent research covered many different ideas allowing me to get a broad understanding of what researchers and social theorists are saying about addiction and decriminalization. I found this wiki interesting and informative on a topic I will need to learn more about.

Specifically, I like how researching this topic changed your views on decriminalization of drugs.

Thank you for the read.