Rural residents need research
2
Editorial Rural residents need researchThe celebrated Beveridge Report was published in the UK during the Second World War in 1942 and cap- tured a widespread desire for reconstruction or social progress following the wartime privations. 1 He identi- fied five giant evils that beset British society: squalor which referred to inadequate housing and environ- ment, ignorance, want – a lack of the means for health subsistence, idleness or unemployment and disease. Following the war, a number of major developments, including the creation of the British National Health Service, attempted to address these evils in what is now commonly referred to as the welfare state. Almost ever since, governments of different political persua- sions have been accused of attempting to dismantle the welfare state. What Beveridge and his committee got right was that dislocation and despair had many causes and that soci- etal reconstruction and social progress required con- certed action on a number of fronts. While we can argue about the extent of inequities in Australian society, these five ‘giants’ have not been slain, and major reforms in education, 2 health 3 and other fields are being discussed, and in some cases, implemented. We still rely, perhaps overly so, on committees and groups of formally appointed experts to address social problems, interpret available evidence, recommend policies and sometimes to delay decisions. We hope that evidence will inform action and those actions can in due course be evaluated and reconsidered. One such group has been established led by Simon McKeon. The Strategic Review of Health and Medical Research in Australia is expected to report in late 2012. 4 The review group is charged with examining whether Australia’s investment in health and medical research is appropriate given the changes in society and its needs and developments in the research sector such as the rise of large research institutes, collaborative national and international research networks, and the development of research from a cottage industry to a multinational enterprise. Consideration of society’s needs is an interesting question. Clearly, a cure for cancer would bring huge benefits. Such research objectives catch the public imagi- nation and result in major public, private and philan- thropic investments. New discoveries are reported on the nightly news, and we are familiar with the ubiqui- tous pictures of laboratory staff using pipettes to place unknown substances in test tubes for analysis. Australian society has other concerns including the health disparities suffered by its rural and remote com- munities, the rise of chronic diseases and the increasing recognition of co-morbid mental and physical disease. Rural and remote populations are ageing, have poor access to specialist and sometimes primary health care services and we have relatively poor health outcomes. To what extent are these needs being met by health and medical research and could the research system be better tuned to address societal requirements? Around 30% of Australians live outside the State capital cities in communities categorised as rural, regional or remote. These residents have poorer health outcomes, and there is little evidence that these dispari- ties are improving. It follows to this writer that these communities are not best served by service models based on metropolitan assumptions. If these disparities are to be addressed, research is needed in the fields of population health and health services research that incorporates an understanding of the importance of context and culture on health. Some of this research will require novel methods drawn from the social sciences, public and population health, health services research and implementation science. It will need to address the issue of small numbers and the challenges of mixed methods and qualitative research as well as the challenge of community participation in research design, conduct, reporting and translation. Research funding will need to adapt to these realities or risk being largely irrelevant to rural Australians. Considerable investment has been made in rural research capacity in the last 20 years, and it is important to build upon these investments. The University Depart- ments of Rural Health have researchers who are resident in most rural and some remote Australian communities. The groups work alone and in collaboration with other rural and remote researchers. While it is helpful to work with ‘missionary’ researchers from metropolitan institu- tions, an authentic rural and remote research capability is essential to achieving improved health outcomes in rural and remote Australia. The costs of collaboration for rural and remote researchers can be ameliorated by the coming of the National Broadband Network, but for many, that is still some years off. These costs are high and real and require further infrastructural investments. The project-based funding endemic in the research sector does not sit well with the need to research long-term diseases, health Aust. J. Rural Health (2012) 20, 101–102 © 2012 The Author Australian Journal of Rural Health © National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2012.01275.x
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Transcript of Rural residents need research
Editorial
Rural residents need researchajr_1275 101..102
The celebrated Beveridge Report was published in theUK during the Second World War in 1942 and cap-tured a widespread desire for reconstruction or socialprogress following the wartime privations.1 He identi-fied five giant evils that beset British society: squalorwhich referred to inadequate housing and environ-ment, ignorance, want – a lack of the means for healthsubsistence, idleness or unemployment and disease.Following the war, a number of major developments,including the creation of the British National HealthService, attempted to address these evils in what isnow commonly referred to as the welfare state. Almostever since, governments of different political persua-sions have been accused of attempting to dismantle thewelfare state.
What Beveridge and his committee got right was thatdislocation and despair had many causes and that soci-etal reconstruction and social progress required con-certed action on a number of fronts. While we can argueabout the extent of inequities in Australian society, thesefive ‘giants’ have not been slain, and major reforms ineducation,2 health3 and other fields are being discussed,and in some cases, implemented. We still rely, perhapsoverly so, on committees and groups of formallyappointed experts to address social problems, interpretavailable evidence, recommend policies and sometimesto delay decisions. We hope that evidence will informaction and those actions can in due course be evaluatedand reconsidered.
One such group has been established led by SimonMcKeon. The Strategic Review of Health and MedicalResearch in Australia is expected to report in late 2012.4
The review group is charged with examining whetherAustralia’s investment in health and medical research isappropriate given the changes in society and its needsand developments in the research sector such as the riseof large research institutes, collaborative national andinternational research networks, and the developmentof research from a cottage industry to a multinationalenterprise.
Consideration of society’s needs is an interestingquestion. Clearly, a cure for cancer would bring hugebenefits. Such research objectives catch the public imagi-nation and result in major public, private and philan-thropic investments. New discoveries are reported onthe nightly news, and we are familiar with the ubiqui-tous pictures of laboratory staff using pipettes to placeunknown substances in test tubes for analysis.
Australian society has other concerns including thehealth disparities suffered by its rural and remote com-munities, the rise of chronic diseases and the increasingrecognition of co-morbid mental and physical disease.Rural and remote populations are ageing, have pooraccess to specialist and sometimes primary health careservices and we have relatively poor health outcomes.To what extent are these needs being met by health andmedical research and could the research system be bettertuned to address societal requirements?
Around 30% of Australians live outside the Statecapital cities in communities categorised as rural,regional or remote. These residents have poorer healthoutcomes, and there is little evidence that these dispari-ties are improving. It follows to this writer that thesecommunities are not best served by service models basedon metropolitan assumptions.
If these disparities are to be addressed, research isneeded in the fields of population health and healthservices research that incorporates an understanding ofthe importance of context and culture on health. Someof this research will require novel methods drawn fromthe social sciences, public and population health, healthservices research and implementation science. It willneed to address the issue of small numbers and thechallenges of mixed methods and qualitative research aswell as the challenge of community participation inresearch design, conduct, reporting and translation.Research funding will need to adapt to these realities orrisk being largely irrelevant to rural Australians.
Considerable investment has been made in ruralresearch capacity in the last 20 years, and it is importantto build upon these investments. The University Depart-ments of Rural Health have researchers who are residentin most rural and some remote Australian communities.The groups work alone and in collaboration with otherrural and remote researchers. While it is helpful to workwith ‘missionary’ researchers from metropolitan institu-tions, an authentic rural and remote research capabilityis essential to achieving improved health outcomes inrural and remote Australia.
The costs of collaboration for rural and remoteresearchers can be ameliorated by the coming of theNational Broadband Network, but for many, that is stillsome years off. These costs are high and real and requirefurther infrastructural investments. The project-basedfunding endemic in the research sector does not sit wellwith the need to research long-term diseases, health
Aust. J. Rural Health (2012) 20, 101–102
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© 2012 The AuthorAustralian Journal of Rural Health © National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2012.01275.x
behaviour change or system change, and the number oftenured rural health researchers in Australia is verysmall.
To improve rural and remote health outcomes, moreattention is needed to build relationships between ruralhealth researchers, policy-makers, clinicians, managersand communities to facilitate evidence-based policy,systems and care. Developments in rural health policyand practice require routine, high-quality and transpar-ent evaluation, and if the old solutions are not working,we need to find new ones.
Strategic Review of Health and Medical Research inAustralia4 must not restrict itself to metropolitan inter-ests and assumptions and must embrace the needs ofrural and remote Australians. Perhaps we could learnfrom Beveridge and his recognition that social progressis complex. While the giants of squalor, ignorance,want, idleness and disease can dress differently, they
have not disappeared. In Australia, rural health researchis an important part of the solution.
David PerkinsEditor-in-Chief
References1 Social insurance and allied services. Report by Sir William
Beveridge. London: HMSO, 1942.2 Australian Government. Review of funding for schooling.
Final Report. (Gonski Report). Canberra: Department ofEducation, Employment and Workplace Relations, 2011.
3 Australian Government. A healthier future for all Austra-lians – final report of the National Health and HospitalsReform Commission – June 2009. Canberra: AustralianGovernment, 2009.
4 Strategic Review of Health and Medical Research.[Cited 27 Apr 2012]. Available from URL: http://www.mckeonreview.org.au/9903/Home/
102 EDITORIAL
© 2012 The AuthorAustralian Journal of Rural Health © National Rural Health Alliance Inc.
