1 IGW : Rural and Indigenous Health

RURAL &

INDIGENOUS HEALTH

Written by: Amita Roy

2 IGW : Rural and Indigenous Health

Plan the town, if you like; but in doing it

do not forget that you have got to

spread the people. Make wider roads,

but do not narrow the tenements

behind. Dignify the city by all means,

but not at the expense of the health of

the home and the family life and the

comfort of the average workman and

citizen.

- Thomas Adams

3 IGW : Rural and Indigenous Health

Objectives:

1. Consider the determinants of health in rural areas

2. Consider the main differences between metropolitan and rural/Indigenous health

3. Consider the barriers to health in rural and remote locations

4. Relate back to Gippsland

5. Consider proactive measures to overcome any barriers and discrepancies between

health in the different sub-groups

Introduction Health is defined by the World Health Organisation as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This definition, when applied to rural and Indigenous communities has a specific meaning. Defining “rural” is difficult but important. Defined rurality is used to assess health needs, and the resources allocated to meet these needs, including staff and funding. Three classifications systems most commonly used to define ‘rural’ are: Rural Remote and Metropolitan Areas classification (RRMA)

uses population size and direct distance from the nearest service centre to determine seven categories

capital cities, other metropolitan centres, large rural centres, small rural centres, other rural areas, remote centres and other remote areas

Accessibility/Remoteness Index of Australia (ARIA)

uses a geographical information system (GIS) to define road distance to service centres to produce a sliding scale of remoteness and it includes five categories

highly accessible, accessible, moderately accessible, remote, and very remote

Australian Standard Geographical Classification (ASGC)

- defines remoteness by Census Collection Districts on the basis of the average ARIA score within the district. - The remoteness of local areas is then assessed and classified by the ARIA categories

major cities, inner regional, outer regional, remote and very remote

According to these definitions, approximately a third (31.5%) of the total Australian population and approximately two-thirds of (69%) of the Indigenous population live in remote or rural areas of the country.

4 IGW : Rural and Indigenous Health

Activity

Q. Where would Gippsland (Churchill) fall according to one of the

classification systems above? Do you think the classification

system is accurate?

Q. What do YOU think are the factors that make an area rural?

The term Indigenous is used to refer to Australian Aboriginal and Torres Strait Islander people. “Aboriginal health” means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total well-being of their Community.

What determines health? 1. Social determinants of health:

o Educational and employment opportunities o Income o Access to goods and services and in some areas access to basic necessities,

such as clean water and fresh food o Social engagement

2. Environmental factors:

o Occupational hazards o Safety on the roads o Geographic location – access and transport

3. Health attitudes and behaviour:

o Risk seeking behaviour o Drinking alcohol, smoking and recreational drug use

4. Personal genetic factors

What are the differences between rural/remote areas and metropolitan areas?

- More people are of a lower socio-economic status in rural/remote areas: less able to afford health services, healthy eating

- More occupational hazards e.g. farming - Dangerous roads - Geographically isolated – further to travel to health services, less health services

available - More socially isolated - More risk seeking behaviour

5 IGW : Rural and Indigenous Health

What are the consequences of these differences?

People living in remote and rural areas generally experience poorer health than their metropolitan counterparts.

- Lower life expectancy: Life expectancy in regional areas is one to two years lower than life expectancy in a metropolitan area, and up to seven years lower in remote areas.

- Higher rates of injury mortality, particularly arising from motor vehicle injury and workplace accidents.

- Higher rates of suicide. - Lower birth weights and higher rates of teenage pregnancy. - Higher rates of health risk behaviour such as smoking, alcohol consumption and poor

nutrition, and higher mortality rates from associated lifestyle disease such as diabetes, cardiovascular disease and respiratory disease.

For Australia’s Indigenous population: - A life expectancy of approximately twenty years less than all Australians. - Lower levels of access to health services – due to cultural and geographical reasons. - Higher rates of hospitalisation for most diseases and conditions, including diabetes

related conditions, skin diseases, respiratory disease and injury. - Higher incidences of low birth weights, and an increased likelihood of maternal and

infant in childbirth.

The story in Gippsland Compared to the whole of Victoria, people in the Latrobe and Baw Baw region:

- Have more people with lower individual and household incomes - Have higher DALYs and YLDs reflecting poorer health status - Have lower life expectancy - Engaging in more risky behaviour increasing risk factor for disease

6 IGW : Rural and Indigenous Health

What can be done to overcome these differences in health?

- Educating people living in rural areas about positive health behaviours o Healthy eating o Physical exercise o Protected sex o Abstaining from smoking, alcohol, recreational drug use o Positive mental health actions e.g. meditation

- Encouraging more adolescents to participate in tertiary education more employment opportunities

Encourage your school to develop programs that will target these education areas!

- Providing more health services in rural locations (providing more incentives for

doctors to practise in rural locations) o With cultural sensitivity training for Indigenous populations

Become a rural health service provider!

References:

- http://nrha.ruralhealth.org.au/cms/uploads/publications/03_welch_00.pdf - http://www.sarrahtraining.com.au/site/index.cfm?display=143627 - http://www.arhen.org.au/links/publications.html - http://www.rrh.org.au/publishedarticles/article_print_205.pdf - http://docs.health.vic.gov.au/docs/doc/3DC7BE765B5977B2CA257876000B9599/$FILE/GS101.pdf - http://docs.health.vic.gov.au/docs/doc/85AE791F62CA7F89CA257876001552A2/$FILE/HSBD101.pdf

Activity

Q. Brainstorm ways to achieve better health outcomes for people

living in rural locations.

Q. What are some barriers that are relevant to Indigenous people,

resulting in them having more adverse health outcomes?

Q. What can you do at your school or in your community to

increase awareness about positive health behaviours like healthy

eating and physical exercise?