Rural Health EBOP Style..

What do we mean by “rural health” ?

“Health?” 1. the general condition of the body or mind with reference to soundness and vigor: good health; poor health. 2. soundness of body or mind; freedom from disease or ailment: to have one's health; to lose one's health. 3. a polite or complimentary wish for a person's health, happiness, etc., especially as a toast: We drank a health to our guest of honor. 4. vigor; vitality: economic health.

WHO definition of Health :“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

“Rural?” • NZ Statistics• Local authorities • Universities and

academics • Ministry of Health • Rural Providers • International“There is no one accepted definition of what it means to be a rural community.”

New Zealand

Urban areas

Main urban Satellite urban Independent urban

Rural areas

Rural with high urban influence

Rural with moderate

urban influence

Rural with low urban influence

Highly rural / remote rural

NZ Statistics definitions

New Zealand Stats Definitions adapted by the National Health Committee

“Rural “ • Highly Rural/Remote Areas• Rural Areas with Low Urban Influence• Independent Urban Areas• Rural Areas with Moderate Urban Influence

‘Urban’ • Main Urban Areas (population of 30,000 and over) • Satellite Urban Areas• Rural Areas with High Urban Influence

New Zealand

Urban areas

Main urban Satellite urban Rural with high urban influence

Rural areas

Independent urban

Rural with moderate

urban influence

Rural with low urban influence

Highly rural / remote rural

NZ Statistics definitions adapted

Rural Urban

Rural Urban

Historical Context In the 19th Century lived

in rural areas. By 2001 New Zealand

one of the most urbanised countries in the world.

Between 1881 and 2001 the population of urban New Zealand increased by over 1,500 percent, compared with an increase in rural areas of 83 percent.

In 1916, there were 501,258 people in rural areas (excluding Mäori).

In 2001, there were 532,740 people in rural areas (including Mäori).

New Zealand Rural Demography

• Urbanisation over the past 150 years – but still 22% of population rural, occupying 80% of the land.

• Larger proportion of children• Higher median age• Older Maori population compared to urban • Higher deprivation in most rural areas• (Lowest deprivation in rural areas with high urban

influence) • Lowest levels of employment in more rural areas.

BOPDHBGeographical area

BOPDHBGeographical area

Why does “rural health” matter? We believe in democracy, the rule of law,

tolerance, freedom, equality, security, fairness, honesty, and the All Blacks.

Urban : Rural Disparities Internationally

Increased risk of avoidable deathWork injuries more severeMore MVAsAnimal contact diseasesHigher alcohol and tobacco consumptionHigher stress related illness

Rural vs Urban Health Outcomes Australia

• Higher rates of suicide.• Injury from motor vehicle accidents.• Melanoma.• Cervical and prostate cancers.• Cardiovascular disease. • Obesity.(1)

NZ Rural physical, mental and social well-being

• Worse outcomes for cancer. (1) • Rural Maori have a lower life expectancy than urban Maori. • Higher rates of injury, poisoning and spinal disorders.• Higher rates of female current smokers.• Less likely to have seen a general practitioner (GP) in the last

year. • Less likely to have had test, a vaccination, or be diagnosed with

a chronic disease. • Higher rate of using public hospitals in the last year.(2)• Higher risk of male suicide.(3) • Higher rates of animal and poor water associated diseases(4)

Why does “rural health” matter?

Rural : Urban disparity cycle

• Poverty • Low health status • High burden of disease• Low productivity

Solution : Good health increases well being, and therefore increases social and economic productivity.Ill health effects not just the poor but whole economies .

(World Health Organization. Global Forum for Health Research.10/90 Report. Switzerland: WHO; 1999.)

Workforce Issues• 25% of practices are

looking for nurses or GPs nationally

• 57% of rural GPs are international medical graduates and the average age of a rural GP is between 50 and 55 years.

• Locally we have vulnerable practices in all areas for various reasons – family pressures, ageing, isolation, after hours pressures, finances..

access is the rural health issue• rural needs are different • local services are preferred• communities need “safety net” • resources concentrated in cities• communication and transport difficulties• rural health workforce shortages

Rural Health Around the World

Rural Practitioners

• wide range of services• high level of clinical

responsibility• relative professional isolation• specific community health role• specialist partnership not

putdown

“Extended Generalists”

Inter-professional teamwork

- workforce shortages- people embedded in communities- it’s about the relationships - “do the necessary”

Much talked about in the cities actually happens in rural communities

Improved efficiency, improved efficacy, reduced harm, reduced waste, improved satisfaction.

What is needed for Sustainable Rural Health Services ?

•health service authority/agency support •health care providers•community participation

Rural Based Medical Education• great response to workforce

shortages“grow your own”

• socially accountable • rural specific knowledge and skills• high quality learning environment -

more hands-on experience, greater procedural competence, more common conditions.

Impact of Rural Based Medical

Education• more skilled rural

doctors• enhanced rural

health care• improved rural

health outcomes• broader academic

developments • economic

developments for regions

Australian Rural Recruitment Initiatives Recruitment Initiative Oz Response

Rural Upbringing Preferred entry and bonding schemes

Positive undergraduate experience

Rural Based Medical EducationRural Undergraduate Support and Coordination

Supported Postgraduate education

Rural Postgraduate Training - GP and Specialist

Australian Health Retention Initiatives Retention Activity Oz Response

Academic involvement Rural Clinical SchoolsUniversity Departments of Rural Health

Recognition and reward

Retention Payments

Support from “the system”

Rural and Remote GP ProgramRural Workforce Agencies

Active community engagement

Patient participation in rural clinical schools

New Zealand Rural Recruitment Initiatives Recruitment Initiative NZ Response

Rural Upbringing Preferred entry schemes

Positive undergraduate experience

“Grassroots” clubs 6th year GP run for 6 weeks Limited place “immersion” in 5th year RHIIP 6 weeks in Gisborne / Whakatane

Supported Postgraduate education

PGGP 3 months opportunity

Voluntary bonding scheme

NZ Rural Health Retention Initiatives Retention Activity NZ Response

Academic involvement Dept. of rural health Otago Uni Waikato clinical school Auckland Uni

Recognition and reward “rural premium” payments

Support from “the system” “alliancing”

Active community engagement

?

Whakatane Hospital

Although the number of people living in rural NZ is growing ….

… the proportion of the population living in rural NZ is falling …

This effects the way central government sees rural NZ and the people living there.