1. Rural health Concepts and issues

2. Concepts and definitions There is no single universally applied definition of ‘rural’ –In Australia, the word ‘rural’ is frequently taken to mean everything that does not include the capital cities and major metropolitan centres. –It is recognised that ‘remote health’ has unique aspects.

3. Concepts and definitions There is no single ‘rural’ community –There is no single rural community, in the same way that there is no single metropolitan area. Being upfront about recognising the diversity and heterogeneity of rural and remote communities and the similar differentiation of health status are fundamental to rural and remote health.

4. Concepts and definitions Rural issues cannot be considered in isolation from metropolitan areas –One difficulty in interpreting data is that different patterns of service provision in urban and rural areas can lead to invalid comparisons of resource usage and access to services. For example, rural areas make greater use than cities of hospital emergency departments as a source of primary care services and of hospital beds as a source of aged care services.

5. Health and rural communities There are some major health challenges shared by all Australian communities –Mental health –Diabetes –Cardiovascular health –Arthritis and musculoskeletal conditions –Injury prevention and control –Cancer control –Asthma.

6. Health and rural communities The seven national health priority areas point to the challenges shared by rural and urban communities, but the diverse nature of rural communities often results in a preference for different ways of managing specific health problems and risks. –Broad solutions may not be appropriate. –Strategies may need to be tailored to suit.

7. Health and rural communities Most of the Australian national health priority areas are exacerbated in rural areas due to: –Difficulties attracting and retaining medical and other health professionals –High and increasing rates of diabetes among Aboriginal and Torres Strait Islander people –Very high rates of rheumatic fever and rheumatic heart disease among Aboriginal and Torres Strait Islander people –High rates of smoking in rural areas –Lack of access to timely treatment in emergency situations –Lack of access generally to specialised services providing acute care, rehabilitation and secondary prevention interventions.

8. Health and rural communities The health status of individuals is dependent on the ‘health’ of rural communities –A community, which has lost local services, becomes dysfunctional and the quality of life is reflected in rates of mental illness, suicide statistics and the numbers of people, particularly young people, leaving the region.

9. Health service delivery issues Changing perceptions and expectations New models: doing more with less New models: integrated, interprofessional services New models: e-health.

10. Health service delivery issues Changing perceptions and expectations –Communities and individuals, regardless of where they live and work, expect access to a range of services: health, transport, education, business, commerce, communications and welfare services. These services feel the impact of, and are affected by, fiscal constraints and workforce availability. Traditional models of health care are not able to fulfil expectations – or need. New models are evolving.

11. Health service delivery issues New models: doing more with less –Recruitment and retention of suitably qualified clinicians and other health professionals to rural and remote areas has become increasingly difficult.

12. Health service delivery issues In 2001, 80% of doctors lived in major cities, compared with 67% of the Australian population This meant that: –In major cities there were 308 doctors per 100,000 population –175 doctors per 100,000 population in Inner Regional areas. –77 per 100,000 population in Very Remote areas.

13. Health service delivery issues New models: integrated, interprofessional services –It is not helpful to conceptualise rural and remote health as a system of vertical programs. Successful and sustainable rural and remote health should be part of the horizontal integration of a range of sectors and services across communities.

14. Health service delivery issues Interprofessional practice is where health professionals work together across disciplinary lines to pool competencies in approaching problems and issues relating to health care. This facilitates comprehensive delivery of services to individuals. Given the shortage of health professionals in rural areas, interprofessional practice offers a significant opportunity to do more with less.

15. Health service delivery issues New models: e-health –The increasing capacity of information and communication systems is offering new options for the delivery of health and related services; for health information management and practice; and for access to health statistical data as well as better and more reliable data sources.

16. Health service delivery issues E-health is being seen as one solution to the problems of accessibility, quality and cost of medical care. E-health is being used for: –Direct clinical consultations –Professional case conferences –Professional development and continuing education –Location of health and medical information—by both consumers and health professionals. E-health facilitates and supports inter- professional education.

17. Health service delivery issues There are a number of issues to be addressed before e-health becomes an integral aspect of rural health services. These include: –access to appropriate and affordable infrastructure –medico-legal matters (duty of care, confidentiality) –universal recognition of medical registration –high telecommunications costs –issues of re-imbursement.