Editorial

Rural health research: What sort of investment is needed?ajr_1264 49..50

Walking through Sydney over Christmas I came face toface with an enormous new biomedical research centreprovided by a generous benefactor to contribute to theglobal fight against cancer. Regardless of politics, I wasencouraged by the generosity of the donor and won-dered whether similar investments would contribute toaddressing the poor outcomes in rural and Indigenoushealth. I notice that the National Rural Health Alliancehas toned down its requests to government for aNational Rural Health Research Institute to an annualresearch allocation to the Australian Primary HealthCare Research Institute of $500 000 per annum dedi-cated to rural health research. The thorny question thatarises in my mind is what sort of investment(s) willmake a difference to the health of rural and remoteresidents. The recent history of Australian health policysuggests a simple theory is at work in the minds ofpolicymakers and rural residents: more doctors in thebush means better rural health.

A recent study by Schofield et al.1 calculates thatequal utilisation of general practitioner (GP) servicesrelative to need across Australia would mean thatpeople in regional areas outside capital cities wouldreceive 5.7 million additional GP visits per year, an 18%increase based on 2005 figures. Would such an invest-ment, if it could be implemented, contribute to animprovement in rural health or would it simply increaseequity in expenditure?

Complex adaptive systems theory is a source of inter-esting ideas about how entities might adapt and survivewithin particular environments. It suggests that thoseentities require appropriate sophistication, or ‘requisitecomplexity’ to use the jargon, to adapt to particularsettings. Failure to achieve such complexity limits theperformance of the entity and ultimately threatenssurvival.

This edition of the Australian Journal of Rural Healthcontains a number of research papers, some reportingexploratory or pilot studies, which address stubborn andlongstanding problems or gaps in our knowledge. Twopapers address rural medical workforce issues. Somersand Spencer2 look at career intention among undergradu-ates, and Jones et al.3 examines personality factors in therecruitment and retention of rural GPs. Another twopapers address specialist mental health care in ruralsettings using novel delivery mechanisms or treatments:Dunstan and Tooth4 examines treatment delivery usingvideoconferencing, and Wallis et al.5 discusses the use of

behavioural activation. A third pair of papers examinescardiovascular risk and acute myocardial infarctions.McNamara et al.6 suggests that collaboration betweenGPs and community pharmacists could improve the careof those with high cardiovascular disease risk, andKinsman et al. 7 reports that the introduction clinicalpathways made little difference to high standards of carein groups of rural emergency departments. Each of thesepapers addresses important problems in the complex‘eco-system’ of rural health making solid but sober con-tributions to our understanding of these challenges.

A review paper by Buykx et al.8 challenges researchgroups to monitor and measure the impact of theirresearch to facilitate better communication with ouraudiences and ultimately better policy, practice andhealth outcomes. Careful and considered research,which misses its target, is unlikely to facilitate thesophisticated response needed to improve rural health.

In short, generous donations for rural health researchwould be welcome, equitable resource allocation as sug-gested by Schofield would be helpful, but improvingrural health depends in large part on skilled researchersworking in partnership with rural clinicians addressingthe thorny problems that mar rural and remote health.

David Perkins, PhD

Editor in Chief

References1 Schofield DJ, Shrestha RN, Callander EJ. Access to general

practitioner services amongst underserved Australians: amicrosimulation study. Human Resources for Health 2012;10: 1.

2 Somers GT, Spencer RJ. Nature or nurture: the effect ofundergraduate rural clinical rotations on pre-existent ruralcareer choice likelihood as measured by the SOMERS Index.Australian Journal of Rural Health 2012; 20: 80–87.

3 Jones MP, Humphreys JS, Nicholson T. Is personality themissing link in understanding recruitment and retention ofrural general practitioners? Australian Journal of RuralHealth 2012; 20: 74–79.

4 Dunstan DA, Tooth SM. Treatment via videoconferencing: apilot study of delivery by clinical psychology trainees. Aus-tralian Journal of Rural Health 2012; 20: 88–94.

5 Wallis A, Roeger L, Milan S, Walmsley C, Allison S. Behav-ioural activation for the treatment of rural adolescents withdepression. Australian Journal of Rural Health 2012; 20:95–96.

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© 2012 The AuthorAustralian Journal of Rural Health © 2012 National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2012.01264.x

6 McNamara KP, Dunbar JA, Philpot B, Marriott JL, ReddyP, Janus ED. The potential of pharmacists to help reduce theburden of poorly managed cardiovascular risk. AustralianJournal of Rural Health 2012; 20: 67–73.

7 Kinsman LD, Rotter T, Willis J, Snow PC, Buykx P, Hum-phreys JS. Do clinical pathways enhance access to evidence-

based AMI treatment in rural emergency departs. AustralianJournal of Rural Health 2012; 20: 59–66.

8 Buykx P, Humphreys J, Wakerman J et al. ‘Making evidencecount’ – A framework to monitor the impact of healthservices research. Australian Journal of Rural Health 2012;20: 51–58.

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© 2012 The AuthorAustralian Journal of Rural Health © 2012 National Rural Health Alliance Inc.