The+Outback+Boom-+The+Explosion+of+Poor+Health+in+Rural+Australia

n8566160 Tutor: Jey Rodgers

The Outback Boom: The Explosion of Poor Health in Rural Australia

This artefact is a cartoon picture of an overweight, unhealthy and depressed person. The small shirt with the words ‘Life. Be in it.’ represents a time past when this person had a much more active lifestyle. Wearing old clothes that they are to overweight to fit into and the melancholy expression shows that they are dwelling on the past.

Illustration: (Lobbecke, 2012)

The Public Health Issue The health inequalities are greater for rural and remote Australians than they are for people living in major cities. Two-thirds of the population live in major cities leaving one-third spread throughout the vast continent of rural Australia (ABS, 2012). Chaney (2009) described rural and remote Australia as the ‘backyard to the cities and as such receives backyard attention’ which is testament to the current health trends of rural Australians. Rural and remote Australians have higher rates of chronic and acute health conditions than people living in urban cities. They are more susceptible to stress and depression, have decreased access to healthcare and healthcare professionals, increased rates of suicide and more acute injuries and as a result, their life spans are shorter. D ue to their decreased health outcomes greater focus has been directed towards current rural health policy and the lack of a suitable framework.

Literature Review Rural and remote Australians have been shown to have higher rates of chronic health illnesses than people living in urban cities. According to the Australian Institute of Health and Welfare [AIHW] (2008), rural women have significantly higher rates of diabetes, cancer, osteoporosis and arthritis and rural men have significantly higher rates of bronchitis, cancer, arthritis and have more disabilities. Rural Australians suffer comparatively equal amounts for all other chronic health conditions except for osteoporosis, which is significantly less prevalent in indigenous communities as they do not live long enough to develop osteoporosis ( AIHW, 2008). Much of these chronic health conditions are a result of higher rates of smoking, excessive alcohol consumption, less healthy eating habits, reduced physical activity and being overweight (AIHW, 2008; Moates, 2005). Janus et al. (2007) studied obesity in rural Australia and argues that the ABS statistics on self-reported obesity is understated and is actually much more prevalent. The further remote Australians live, the more likely they are to have adverse health. Statistics in very remote regions of Australia are disproportionately negatively skewed and this is because Indigenous Australians make up 45% of the population in very remote regions of Australia (AIHW, 2008). Indigenous Australians have more chronic health conditions, more mental health illnesses, shorter life spans, higher infant mortality rates and less access to medical care. The divide between indigenous and non-indigenous Australians needs more attention however, is another predicament altogether as rurality has minimal impact on the health outcomes of indigenous Australians – they have poor health no matter where they live (Bourke, Coffin, Taylor & Fuller, 2010). Although chronic health and the associated impacts are important, mental health and suicide are additional issues being addressed in the literature.

Mental illnesses in rural Australia are not m ore or less prevalent than in urban centres however, the longevity and lack of prevention strategies means that mental illnesses are having a far greater impact on rural communities (National Rural Health Alliance [NRHA], 2009). For instance, Australian farmers have been particularly in the spot light of attention as suicide rates are up to 50% higher than urban male suicide rates and for every 300 millimetres of rain loss there is an 8% increase in the rate of suicides (Young, Dixon & Hogan, 2011). Male farmers tend to blame themselves in tough times and believe they have failed when actually the issue is much larger. Issues such as drought, government policy and rising costs associated with globalisation are beyond their control, which causes increased stress and anxiety leading some to breaking point and suicide (Alston, 2010). Although much of the literature focuses on the mental health of male farmers (Judd, et al.,2006; Young et al. 2011; Alston, 2010), another more recent issue is the impact that the mining boom is having on rural communities. Since the 1970’s mining companies have been increasingly moving away from local community development in favour of fly-in, fly-out operations though still placing extra burden on local infrastructure. This has led to segregation in mining communities between miners and non-miners. With reduced revenue from the local mines, communities have begun to breakdown with less local community bonding and activities resulting in people feeling isolated and powerless (Carrington & Pereira, 2011). Mental health is not only worse in rural communities but, the significant lack of health services is attributed to the lack of funding and lack of access to rural healthcare systems (NRHA, 2009).

Healthcare in rural and remote Australia is disproportionately inadequate compared to major cities. Healthcare has less funding, less infrastructure, less staff and less p reventative measures. Moates (2005) states that just under 30% of Australians live in regional Australia though have access to only 20% of the Medicare rebate funding and are serviced by just 15% of the national health workforce. This inadequate allocation of funding can be attributed to the government health-funding model whereby funds are directed through the private health sector to ease the burden on the public system. However, rural Australians do not have the same amount of private health cover as urban Australian, which has meant that there is less funding per capita for rural Australians (Lokuge, Denniss & Fraunce, 2005). Attracting healthcare workers, especially doctors, is an ongoing problem in rural Australia. Healthcare workers are working longer hours in multiple roles and in small communities where having a separate social life is virtually impossible (Wakerman, 2008). The current healthcare model is tailored towards the urban populace and does not take into account the diversity that is required for rural communities. Humphreys and Wakerman (2008) believe that healthcare for rural populations does not need to be as extensive as it is urban centres as long as primary healthcare services are adequate for and when they are required. Furthermore, they outline that healthcare needs to be modelled at each healthcare service level (macro, meso & micro) to ensure that community needs are met at state, regional and local levels.

Cultural and social analysis In 1999, the federal, state and territory governments implemented the ‘Healthy Horizons’ framework with a vision of rural Australians being as healthy as ‘other’ Australians (NRHA, 2002), however a decade later and the health of rural and remote Australians is still below ‘other’ Australians. More recently, the government has built on Healthy Horizons and outlined the National Strategic Framework for Rural and Remote Health, which has the same vision with a new focus on a collaborative health service delivery, strong leadership, governance and accountability (Australian Health Ministers’ Conference [AHMC], 2012). Wakerman (2008) believes that it is imperative to understand the nature of rural-urban inequalities and that a negative view of the bush is neither beneficial nor vindicated. The difficulty is that for all of regional Australia, fewer than 30% of the population, occupy 99.7% of the Australian con__t__inent (AHMC, 2012). This has left rural and remote communities with little voice in the public arena where the dominant urban view is that rural people are backward, ‘middle of nowhere’, homogenous and politically conservative. On the contrary to this view, the rural populace has a great diversity with different political, historical, social and economic perspectives in communities orientated to mining, agriculture, fishing, tourism and indigenous economies (Bourke, Humphreys, Wakerman & Taylor, 2012).

Bourke et al. (2012) presents a conceptual framework to understand the diversity of rural and remote health requirements. Applying Giddens’ theory of structuration provides a focus for recognising the spatial (geographic isolation, locale) and social relations that communities and health professionals are constrained by in relation to the broader health structures. Focussing on six key concepts of geographic isolation, rural locale, local health responses, the broader health systems, power and social structures allows understanding of the relationship between agency and structure, both local and broader. This will give communities, health professionals, politicians, and advocates power to adapt and apply healthcare at multiple levels with an understanding of the health structure required for that rural and remote region/community. Although this theory provides a means to a solution, changing the urban populaces’ perception, and giving more power, funding, and autonomy to local communities may be difficult to achieve. With further focus on possible solutions to the health divide rather than people who are obese, smoke __ r __ s, alcoholics or incompetent, will provide further assistance in bridging the divide between rural and urban Australia. The National Rural Health Alliance is one such organisation that is providing a voice for rural and remote communities to be heard in the wider community and in the political forum with a vision of all Australians to be as healthy as each ‘other'.

Artefact and Reflection of Learning Rural and remote Australians have been known to smoke more, drink more and exercise less. ‘Life. Be in it.’ represents the growing number of rural and remote Australians who are finding themselves with decreased health and are looking to the past to see where it all went wrong for them. There is growing concern throughout Australia that rural Australians are disproportionately more obese. Through lack of education and unhealthy habits – smoking, drinking, diet, exercise ­– more and more rural Australians are finding themselves overweight and depressed and as a result, have higher rates of chronic health conditions. Because newspapers are degrading them, as this caricature does, urban Australians have typecast rural Australians as being lazy and overweight. The actual truth to the issue goes much deeper than this and has many variables to consider such as isolation, access to adequate healthcare, less prevention strategies and lack of education opportunities. Another concern is that people in the city complain of having to provide extra funding for the ‘bush’ (Bourke, 2012), however this is not true and realistically they are rather getting what is owed. Despite the academic research, I highly doubt that rural Australia will have equal health outcomes with the cities anytime soon. Being able to understand that each region, each district, each town and each rural community is unique and requires their own approach to their health determinants will help me to stand back and think objectively so as to refrain from judgment and consider what is really going on for that community.

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Young, M., Dixon, J., & Hogan, A. (2011). Rural and remote food security: multiple determinants//.// In G. Gregory (Ed.), //Proceedings of the 11th National Rural Health Conference//: National Rural Health Alliance. Retrieved from []

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