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Building on Strengths: Challenging the Rural Health Deficit Discourse

Updated: Nov 2, 2022

They say 'necessity is the mother of all invention'. In this regard, rural and remote Australia has a lot of which to be proud in its approach to delivering sustainable rural and remote health care. Successful models of rural and remote health education, training and service delivery abound.


One of the things that I hope to have communicated this week is that there are some extraordinary communities doing some extraordinary things in rural and remote health.


If we are to move forward on rural and remote health, this is what we need to be talking about and promoting.


We need to get rid of the deficit discourse that has been imposed on us (and frankly that we play up to from time to time) and take our lead from Australia’s Aboriginal and/or Torres Strait Islander communities and talk collectively about our strengths (see https://apo.org.au/sites/default/files/resource-files/2018-05/apo-nid172676_1.pdf).

There are working, proven and successful solutions to the rural and remote health crisis, the most effective of which are designed and developed with rural and remote communities (see https://rsph.anu.edu.au/research/projects/systematic-review-primary-health-care-delivery-models-rural-and-remote-australia).


Over the last week I have tried to set out a number of themes about rural and remote health. These are not original thoughts and have been informed by numerous discussions with rural and remote people and other experts in rural and remote health.


What people are telling me, and what the research says, is fairly clear:


(1) we need to invest in community-led place-based planning, and start listening to rural and remote people as the acknowledged experts in rural and remote health.

(2) we need to immediately support the many established, proven, sustainable and successful models of rural and remote health care that have been shown to work.

(3) primary health care is rural and remote health care, and we need a clear plan for rural and remote health with this at the centre.

(4) we need to invest in integrated models of care that address social determinants, prevention, early intervention and chronic disease management to stop the flood of rural and remote people going into our hospital system and dying from preventable conditions and to make it more sustainable to deliver the on-the-ground health and medical care that our communities need.


I am inspired every day in my work by the strength and resilience of rural and remote Australians.


To start a strengths-based conversation about rural and remote health, I thought I would nominate my favourite programs and encourage everyone to tell me about others of which I am not aware.


The award, of course, goes to James Cook University which is the global leader in recruiting, training and retaining the right people to become doctors and health professionals in rural and remote communities.


The “Work Integrated Learning” Award - Charles Sturt University

I have always been so impressed with Charles Sturt University pharmacy, physio and para-medicine schools. They don't just provide an outstanding clinical program, but embed into the degrees 'work integrated learning' that gives graduates work-ready skills to become professionals in rural and remote communities.


The “Rural and Remote Health Service” Award - The Healthy Communities Foundation Australia ( formerly RARMS)

OK, so there is a huge amount of bias here. I have selected THCFA, although there are numerous excellent examples around the place, for creating a model of sustainable health service delivery in rural and remote communities that is responsive to local need (for others see: https://rsph.anu.edu.au/research/projects/systematic-review-primary-health-care-delivery-models-rural-and-remote-australia).


I know this is a work in progress, but we cannot really go past South Australia Health and its Health in All Policies approach that aims to integrate health outcomes into every decision of the State.


The Queensland Health Rural and Remote Health Service Framework makes it easy for rural and remote people to find out what services they can expect to receive at their local hospital and what type and level of staffing.


Best “Rural and Remote Integrated Care” Award

I think there are joint winners here.

GP/VMO Model - NSW Health

For best primary health and hospital integration we cannot go past the GP/VMO model in NSW. The model has ensured access to integrated primary health and hospital care for decades, and has been down to deliver better health outcomes.


Care Coordination - Victoria Health As for integration of human services and primary health, the winner has to be Victoria Health for its Care Coordination program. OK, so it’s not true integration but Victoria is way ahead of the field in understanding the need to build better coordination across the health and human services domains.


The NSW Human Services Outcomes Framework is a clear winner for me. From a community perspective it is clear and coherent, showing how things are linked and how different parts of government need to work together with NGOs and local communities to deliver better outcomes more cost-effectively.

This goes to HeathAccess Hospital Support and Aged Care Support. HealthAccess has a stated position that it is not there to replace rural and remote health and medical workforce, or be a substitute for securing permanent GPs. It is designed to support GPs, make rural and remote practice more attractive and fill unavoidable gaps when this is appropriate and safe. Not only that, it lives up to this commitment.


Most “Committed to Rural and Remote Healthcare” Award

We cannot go past International Medical Graduates (IMGs) who have taken up the responsibility for delivering the care and health service our communities need when no-one else would. Without these highly skilled GPs we would be talking about rural and remote health in the past tense. They have enriched our communities, ensured they continue to be great places to live and saved many, many rural and remote lives.


And finally, the:


“Rural and Remote Health Experts” Award

The winner is rural and remote people, of course.

No doubt you will have your own views. Let me know.

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