Health Inequalities Faced by Rural Communities

Health Inequalities Faced by Rural Communities

Introduction

People residing in remote and rural regions face difficulties in accessing proper health services, many of which struggle to recruit and retain workers. Whereas researchers have highlighted these issues in Australia and across the world, rural health remains reactive to the present issues and lacks a profound understanding. The following paper presents a multitude of issues that can be used to illustrate certain remote and rural health inequalities in Australia better.

Literature Review

Australia is typically described as a successful nation yet studies indicate that many Australians are at a disadvantage and have poor health. Some scholars argue that individuals who live in remote and rural regions in the nation have poorer life opportunities in comparison to their counterparts in urban regions and that health status reduces with increasing remoteness (Wakerman et al., 2008). The Human Rights and Equal Opportunities Commission revealed that the health of people living in remote and rural regions of Australia is poorer than those living in metropolitan areas and cities. Illness and mortality rates go up as the distance from urban areas increases. Lower levels of employment and socioeconomic status, poor access to health facilities and services, occupational hazards, and exposure to harsher surroundings may explain and contribute to most of these inequalities (Wakerman et al., 2008). Also, a large percentage of the population in the more remote regions of the country are Aboriginal and Torres Strait Islander people, who typically have poorer health status.

Sinclair et al. (2013) believe that rural communities in contemporary Australia are typified by a diverse population including indigenous and non-indigenous citizens and immigrants. People in rural regions perceive themselves as different from those in urban regions; they take pride in their heritage and the kind of lives they live. Nonetheless, life in remote areas has transformed. Rural communities are reducing, and there is a large movement of people from remote regions. Sinclair et al. (2013) these transformations as the “rural crisis” showing that this phenomenon is ascribed to novel managerialist tendencies, a government policy that has endorsed centralization as an effective strategy, and decades of drought. Due to this, rural communities encounter numerous cultural, economic, and social challenges, which affect the viability of these communities. Globalization has had an indirect effect on the downfall of the rural sector, transformed population demographics, and an overall loss in circulating money (Sinclair et al., 2013). The youth move from rural regions out of necessity to urban regions that offer better opportunities for employment, career development, and education. This experience, according to (King, Smith, & Gracey, 2009), along with the inability of communities to match the opportunity available in cities and urban areas, functions as a recruitment and retention deterrent for professionals in rural areas.

To that extent, Jang-Jaccard et al. (2014) explain that the workforce of rural areas is comprised of nurse (who form 65% of the overall health workforce), indigenous health workers, pharmacists, medical staff, allied health workers, and others, with the percentage and diversity of works inversely associated with remoteness. Vaccines are recorded for each health professional group, with the rate increases the more remote the location.

Jang-Jaccard et al. (2014) recognize that the shortage of rural physicians has been a priority of the government for many years. The scholar states that a variety of strategies have tried to address the crisis of doctors in rural regions including recruitment of trained physicians from abroad, the creation of the Rural Workforce Agencies (RWA), and financial incentives. Studies show that some physicians regard rural communities to be culturally and socially backward and query the financial viability of practicing in rural regions (Richmond & Ross, 2009). Doctors also cite poor collegiate reinforcement, restricted access to locum relief, and decreased career advancement opportunities as variables that negatively impact their decision to practice in remote areas.

Bourke et al. (2014) believe that state and national projects have failed to address the individual issues highlighted by doctors like resourcing and housing needs, and family education. The issues and reinforcement structures needed by doctors are the same as those stated by nursing and allied health workers. Unfortunately, there has been minimal regard for the needs of this workforce. The Australian Institute of Health and Welfare (AIHW), states that the nursing workforce in rural areas is in crisis (Bourke et al., 2014). In the advent of the new millennium, a warning was issued in every Australian territory and state that the percentage of nursing graduates was inadequate to preserve the workforce and that the shortfall was most acute in rural regions. Sharkey & Horel (2008) assert that the nursing profession has attempted to draw attention to the underlying issues in this crisis; nonetheless, the government has been sluggish to acknowledge and take accountability in addressing nursing issues. A national nursing workforce committee (national Nursing and Nursing Education Taskforce) was credited with a task to investigate and come up with strategies to address nursing issues highlighted in the Senate Inquiry into Nursing and the National review of nursing Education (Bourke et al., 2014). It seems that a scenario of crisis must be perceived before the Australian government recognizes nursing issues.

Bourke et al. (2014) argue that professionals in the rural setting have mutual practice characteristics that discrete to their urban peers. Bourke et al., (2014) suggest that rural health workers have diverse practice skills and a wide range of practice, are isolated in the professional sense, and find it hard to gain access to professional advancement initiatives but have more freedom in their practice. They conclude that rural health professionals have a huge workload and often exist in a fishbowl (Bourke et al., 2014). They maintain that rural practice requires practitioners to be highly skilled, can work in a setting that has poor resources with minimal collegiate reinforcement, and have a wide well-developed foundation of knowledge.

Whereas numerous studies suggest that rural health workers should have specialist training before commencing practice in these settings, maintains that the nursing practice in rural areas must be general (Regan & Wong, 2009). However, there is perpetual debate regarding the knowledge and skill level needed by rural nurses. Australian governments at each level (territory/state, Commonwealth) are being obliged to center on addressing the shortage of rural health professionals; it seems that the preparation for programs in rural regions at the undergraduate and postgraduate levels is an area that is being focused on as a constituent of the recruitment and retention strategy. Numerous Australian universities have incorporated undergraduate health initiatives on rural health issues and the associated clinical experience. There is an increasing body of studies that show that graduates who are recruited from rural areas and taught in rural universities are more probably to practice in remote regions after graduation.

Rural health workers report that preserving their knowledge-base and the value of their skills is hard. They state that an inability to get locum reprieve and backfill roles as restricting factors. The need for many rural health professionals to move to get professional development is stated in the studies as an important factor in the decision of health workers to stay or work in rural practice. Bourke et al. (2014) argue that the anticipation that rural practice is a life-long commitment has been a deterrent for many graduates to consider the challenge of practicing in remote areas. In recent times, issues like personnel security and safety have been considered as issues of concern that are affecting the recruitment and retention of workers in rural healthcare settings.

Current Efforts to Mitigate the Health Inequalities faced by Rural Communities

The recruitment of health workers is a primary concern for all government levels in Australia. To increase the percentage of undergraduate health students to regard rural practice, numerous incentive initiatives have been deployed. The Australian government has provided funds for scholarship programs like the Undergraduate and Postgraduate Rural and Remote Nurses Scholarship Scheme (CURRNS), John Flynn Medical Scholarship Scheme, the Undergraduate Allied Health Scholarship Scheme (CRRAHS), and the Rural Australian Medical Undergraduate Scheme (RAMUS) (Wilson et al., 2009). Additionally, a rural medical scholarship initiative that has been bonded has been deployed to increase the percentage of graduate medical students working in rural regions of the country. The Australian Government has reinforced the creation of the University Departments of Rural Health who are given the duty of facilitating and strengthening multidisciplinary learning, professional development, and training, which includes the creation of remote medical clinical schools and the placement of students to enhance the exposure of medical students to rural healthcare settings.

Funding has been availed to numerous professional bodies to reinforce remote and rural practice like Association for Australian Rural Nurses (AARN), Council of Aboriginal and Torres Strait Islander Nurses (CATSIN), Services for Australian Rural and Remote Allied Health (SARRAH), Council Remote Area Nurses Australia (CRANA), Australian College of Rural and Remote Medicine (ACRRM), and Rural Doctors Association of Australia (RDAA) (Wilson et al., 2009). More recently the government has declared a transformation of the Medicare rebate scheme and more funds to aged care services. Under the changes made to Medicare, Divisions of General Practice get extra funding, which includes interventions initiated by nurses and rebates for practice (Wilson et al., 2009). Also, incentive programs have been availed to reinforce the general development of medical practice in rural regions.

Most of these initiatives, however, have centered on reinforcing medicine with minimal consideration of nursing and associated services. The potential appeal of rural practice is made complex by the increased levels of vacant posts that stay uncopied due to poor recruitment strategies and lack of appointments (Pong, DesMeules, & Lagacé, 2009). Consequently, this leads to increasing workload by incumbent professionals, frustration, and gaps in the provision of service. The frustration felt by the marginalized workers becomes visible and may result in some professional seeking employment in other areas, opting for urban areas or simply abandoning the health sector in general.

Numerous local governments in rural and remote regions and Australia have reacted to the acute shortage of health workers and developed practices and policies designed to appeal to staff. It appears clear that a multi-sectoral strategy for recruitment and retention is required if the issues of the workforce are to be addressed (Pong, DesMeules, & Lagacé, 2009). Whereas governments have deployed recruitment programs, there has been restricted consideration of sustainable retention approaches, even though it is acknowledged that the national government is reinforcing rural mentorship programs for undergraduate nursing students, and, more recently, the incoming nursing workforce in rural areas to restrict social and professional isolation. Nonetheless, access to education, addressing the workload problem, safety, and facilitating proper levels of remuneration packages and incentive for all health workers, especially nurse and other health workers, remain the objective with minimal evidence that sustainable plans are being developed.

Conclusion

Every citizen has the right to an equitable scope of health services. It is acknowledged that with exceeding remoteness, the range of services that can be facilitated is restricted when economies of scale form the basis of funding. This management approach is prevalent in all sectors including health, education, banking, and policing and has led to the centralization and rationalization of numerous services that at one point were diversified across Australia. The effect on rural regions has been a decline of most rural economies and a related shift of human capital to urban centers in search of a career and educational opportunities.

The wide depiction of rural communities as strangled by problems like the one stated above decrease the potential of these areas to attract and retain health workers. Rural practice is hard but rewarding and must be sold if these regions are to be adequately served. Government initiatives like remuneration and incentive initiatives must be deployed with industry and local government strategies to endorse rural practice, and rural living of health workers are to be recruited and retained. Additionally, the percentage of students taking health education course must be increased, and preparation for rural practice included in each health course if the needs of the workforce are to be met.

References

Bourke, L., Humphreys, J. S., Wakerman, J., & Taylor, J. (2012). Understanding rural and            remote health: a framework for analysis in Australia. Health & Place, 18(3), 496-503.

Jang-Jaccard, J., Nepal, S., Alem, L., & Li, J. (2014). Barriers for delivering telehealth in rural Australia: a review based on Australian trials and studies. Telemedicine and e-Health, 20(5), 496-504.

King, M., Smith, A., & Gracey, M. (2009). Indigenous health part 2: the underlying causes of the health gap. The Lancet, 374(9683), 76-85.

Pong, R. W., DesMeules, M., & Lagacé, C. (2009). Rural–urban disparities in health: How does Canada fare and how does Canada compare with Australia?. Australian Journal of Rural Health, 17(1), 58-64.

Regan, S., & Wong, S. T. (2009). Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency (Doctoral dissertation, University of British Columbia).

Richmond, C. A., & Ross, N. A. (2009). The determinants of First Nation and Inuit health: A critical population health approach. Health & place, 15(2), 403-411.

Sinclair, C., Holloway, K., Geoffrey Riley, A. M., & Auret, K. (2013). Online mental health resources in rural Australia: clinician perceptions of acceptability. Journal of medical Internet research, 15(9)

Sharkey, J. R., & Horel, S. (2008). Neighborhood socioeconomic deprivation and minority composition are associated with better potential spatial access to the ground-truthed food environment in a large rural area. The Journal of nutrition, 138(3), 620-627.

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.

Wilson, N., Couper, I., De Vries, E., Reid, S., Fish, T., & Marais, B. (2009). Inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health, 9(1060).