PDHPE Health Priorities in

Australia Report

People in Rural and Remote Areas

By Isaac Tancredi

Table of ContentsPeople in Rural and Remote Areas..............................................................................................................................2

Australian Standard Geographical Classification Remoteness Structure..............................................2

The nature and extent (trends) of the health inequities....................................................................................3

Mortality Rates................................................................................................................................................................ 3

Life Expectancy................................................................................................................................................................3

The sociocultural, socioeconomic, and environmental determinants.........................................................4

Sociocultural.....................................................................................................................................................................4

Socioeconomic.................................................................................................................................................................4

Environmental.................................................................................................................................................................4

The roles of individuals, communities, and governments................................................................................4

Individuals.........................................................................................................................................................................4

Communities.................................................................................................................................................................... 4

Governments.................................................................................................................................................................... 5

Bibliography.......................................................................................................................................................................... 5

People in Rural and Remote AreasThe purpose of this report is to highlight the health inequities experienced by individuals in rural and remote areas. The Australian Bureau of Statistics uses the Australian Standard Geographical Classification (ASGC) Remoteness Structure to classify between areas in Australia. They categorise it into five areas; major cities, inner regional, outer regional, remote and very remote as seen in the image below (Australian Bureau of Statistics, 2014).

Australian Standard Geographical Classification Remoteness Structure

In June 2012, 70% of Australia’s population lived in major cities, while 18% lived in inner regional areas, 9% in outer regional areas, and both 1% in remote and very remote areas (Australian Institute of Health and Welfare, 2014).

The nature and extent (trends) of the health inequitiesIndividuals living in rural and remote areas are significantly more likely to be smokers, drink alcohol in hazardous amounts, be overweight or obese and more likely to be physically inactive compared to their major city counterparts (Australian Institute of Health and Welfare, 2008). They are more likely to have a poorer access to work and their incomes and education levels are also significantly lower (Australian Institute of Health and Welfare, 2008) meaning their knowledge and ability to gain knowledge on their health is hindered.

2011 census data showed that 45% of the remote and very remote population are Indigenous, compared to the 3% of Indigenous in the Australian population (Australian Institute of Health and Welfare, 2014). This results in the higher mortality rates and lower life expectancy of rural and remote areas as ATSI’s have a large impact on these numbers.

Mortality RatesCompared to major cities, people living in rural and remote areas experience higher death rates, which equate to 4,400 excess deaths each year in these areas (Australia Institute of Health and Welfare, 2015). These high death rates could be the result of a significantly higher population of Indigenous Australia living in these areas (Australia Institute of Health and Welfare, 2015).

The main contributions to the higher death rates have been identified as coronary heart disease, circulatory diseases, motor vehicle accidents, and diseases such as emphysema. Reasons for these higher death rates may relate to the differences in access to health services, risk factors, such as smoking, and the regional/remote areas (Australian Government, 2014). Rural Australian children experience higher illness burden and significantly higher death rates than metropolitan area children (Australian Institute of Health and Welfare, 2003).

Life ExpectancyLife expectancy is generally declining as the remoteness of an area increases (Australia Instituteof Health and Welfare, 2015). Life expectancy for males in Very Remote areas was 72.2 years, compared to Major Cities where they experience a 77.9 life expectancy, a difference of 5.7 years of life. Respectively, life expectancy of females in Major Cities is 83.9 years, whilst Very Remote areas have a life expectancy of 78.5 years, a similar 5.4 year difference between areas as males (Australia Institute of Health and Welfare, 2015).

These figures are seen to be significantly affected by two factors: Indigenous mortality rates and the older generations migrating to more remote areas (Australia Institute of Health and Welfare,2015). Life expectancy for Indigenous people has been reported as 56 years for males and 63 years for females (Australian Bureau of Statistics, 2014). A large proportion of the remote area

Map of Australia categorised into Major Cities, Inner Regional, Outer Regional, Remote and Very Remote areas (Australian Bureau of Statistics, 2014)

population is Indigenous, 45%, impacting on the lower average life expectancy experienced in these areas. The possible migration of the elderly towards less remote areas is likely to increase the average life expectancy in remote areas (Australia Institute of Health and Welfare, 2015).

The sociocultural, socioeconomic, and environmental determinants

SocioculturalPoor indicators such as smoking and alcohol abuse have serious negative effects in rural and remote families. Children being raised in families that have a high smoking rate are more likely to become smokers as they grow older (HSC PDHPE, 2015) and be more at risk at developing lung cancers in the future. Children that also have parents that are obese, are physically inactive, drink in a risky manner and have high cholesterol levels may be more likely to gain these factors through age (HSC PDHPE, 2015). These factors are highly prevalent in these regional and remote areas (Australian Government, 2014).

SocioeconomicPoor education opportunities and a lower socioeconomic status are the main determinants to why individuals living in rural and remote areas may not be achieving the same health levels as their major city counterparts (Australian Institute of Health and Welfare, 2008). They also experience more occupational and physical risks as more risky and dangerous jobs take place in rural and remote areas e.g. farming and mining work (Australian Government, 2014). All of these factors combine and build upon each other leaving these individuals with lower health standards.

EnvironmentalThe environmental determinants of rural and remote people can include the risks of transportation and the limited access to health care services and technology. Some of these individuals are constantly driving longer distances at higher speeds on country roads resulting in a much higher risk of motor vehicle accidents (Australian Government, 2014). Because of their limited access to health care services and technology these people may miss many health beneficial opportunities such as immunisation, healthy choices information, health management, surgery and medical care, emergency care, rehabilitation and aged care services (Australian Institute of Health and Welfare, 2008).

The roles of individuals, communities, and governments

Individuals Individuals in rural and remote areas can address the health inequities by self-empowerment, gaining the motivation towards good decision making and taking responsibility for their health (HSC PDHPE, 2015). An improvement of knowledge, employment opportunities and income levels can be gained by staying in school and attending rural and remote universities, (HSC PDHPE, 2015) for example, Charles Sturt University in Wagga Wagga and Bathurst in country NSW, Australia. Through this knowledge, individuals can go out to communities and raise awareness of a health issue, assisting in informing and empowering others.

Communities Communities are able to provide relevant health care services and support services for the rural and remote (HSC PDHPE, 2015). An example of this is the development of Multi-Purpose Service Programs which aim to improve access to health services, increase service coordination, increase economic viability and improve community participation (NSW Government, 2015). This will help improve the health status of rural and remote communities by spreading knowledge and awareness and assisting in the development of prevention of health issues.

GovernmentsGovernments can implement their funding into rural priorities that occur in rural and remote areas such as attracting and retaining health professionals to work in remote areas and to provide sustainable and quality health services (HSC PDHPE, 2015). An initiative implemented by the government is the Rural Health Outreach Fund (RHOF) which aims to improve access to medical specialists, GPs and other health providers in rural and remote areas (Department of Health, 2014). This allows the individuals in these areas to address their health issues and seek medical attention if needed.

Conclusion

BibliographyAustralia Institute of Health and Welfare. (2015). Rural, regional, remote Australia: a study on

mortality. Canberra: Australian Government.

Australian Bureau of Statistics. (2014, June 10). Remoteness Structure. Retrieved November 16, 2015, from Australian Bureau of Statistics : http://www.abs.gov.au/websitedbs/D3310114.nsf/home/remoteness+structure

Australian Government. (2014, July 27). Impact of rurality on health status. Retrieved October 20, 2015, from Australian Institute of Health and Welfare: http://www.aihw.gov.au/rural-health-impact-of-rurality/

Australian Institute of Health and Welfare. (2003). Rural and Remote Area Children . Sydney: Australian Government.

Australian Institute of Health and Welfare. (2008, March 31). Rural, Regional and Remote Health. Canberra, ACT, Australia.

Australian Institute of Health and Welfare. (2014). Australia's Health. Canberra: Australian Government .

Department of Health. (2014, November 27). Rural Health Outreach Fund. Retrieved November 23, 2015, from Australian Government: Department of Health: http://www.health.gov.au/internet/main/publishing.nsf/Content/budget2011-flexfund-rural13.htm

HSC PDHPE. (2015, May 15). People in Rural and Remote Areas. Retrieved November 23, 2015, from PDHPE.net: Health Priorities in Australia: https://www.pdhpe.net/health-

priorities-in-australia/what-are-the-priority-issues-for-improving-australias-health/groups-experiencing-health-inequities/people-in-rural-and-remote-areas/

NSW Government. (2015, August 21). Rural Hospital and Health Services: Multipurpose Services (MPS). Retrieved November 23, 2015, from NSW Government:Health: http://www.health.nsw.gov.au/rural/rhhsp/pages/default.aspx