Building capacity for rural and remote research

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The article1 by Gordon Gregory, Executive Director of the National Rural Health Alliance covering the second Rural and Remote Health Research Scientific Symposium is justifiably upbeat. Participants were keenly aware of the progress since the previous meeting two years ago. What is the future of rural research in Australia and how do we build capacity? Remarkably, by comparison with Europe or North America we have a higher proportion of identifiable academic units undertaking rural research including the 11 University Departments of Rural Health, some Rural Clinical Schools and regional campuses. It is a substantial governmental investment. Nevertheless, when one adds up all the active researchers they amount to a fraction of the number that one might find in any single Metropolitan Institute like Baker IDI or the Burnett. There is a severe shortage of midcareer researchers in rural and remote research. Clearly, we have a long way to go. We are still not clear what rural research is. Is it research conducted from a rural base or research into rural problems? Rural people die from much the same things as anyone else: cancer, heart disease and diabetes. Is it the higher prevalence that distinguishes rural and remote populations? What is the health disparity that we call rurality? Is it because there is a higher prevalence of risk factors or is it poorer access to services, or both? Only one study has been done comparing risk factors in a rural population and metropolitan areas.2 Overall, the comparison shows little difference in the risk factors, which cannot be accounted for by socioeconomic circumstances or age difference but further analysis is required to see how much of the variance in cardiovascular disease events is explained by these. Overall, apart from smoking, risk factors in Australia have not improved as much as they could have done. Improving health promotion is important. It looks as though access is what matters most and therefore research into new models of care will increase in importance. How will we build capacity? Without research funding there is not much we can do. Category one grants from the Australian Research Council or the National Health and Medical Research Council (NHMRC) go very heavily on the track record of the applicant, the significance of the health topic and the scientific merit of the proposal. Few rural researchers have enough of a track record to be the leading chief investigator and probably need to team up with metropolitan researchers to strengthen their applications. Choosing to work in areas of national priority topics where implementation is feasible increases the significance, as does the rurality itself. Scientific merit is usually worth as much as both the other two criteria put together. Again, to increase the chance of funding requires collaborating with leading researchers often from big metro centres. Participation on NHMRC grant review panels gives great insight into how the process works and what successful applications look like and cost. Agreeing to review grants for the NHMRC gives further insight. There are other sources of funding that are worth mentioning. The Primary Health Care Research Evaluation and Development funding has helped novice rural researchers but its future is uncertain. Both the Australian Primary Healthcare Research Institute and beyondblue have been generous in supporting rural and remote researchers. Successful grant writing is a team sport. The team gets better with practice and understanding what role each player has in contributing to success. Building a team of people who willingly work together – despite geographic and organisational boundaries – is probably the only way to achieve success.