Editorial

Abstract

As demonstrated in the recent federal election, rural constituents and their representatives do not feel that rural Australia has its 'fair share'. On occasions, rural Australians gain political clout to voice concerns about health, education, employment, infrastructure, support of the agricultural sector and so forth. Interestingly, this time there have been inferences about whether or not rural, regional and remote areas of Australia deserve increased spending and infrastructure, as if these regions have been subsidised by urban Australians. The inference seems to ignore the fact that rural products are exported, value-added and consumed in urban Australia and contribute substantially to the national economy. It also undermines the cultural and historical value of rural Australia as well as the rights of remote, rural and regional Australians to have infrastructure comparable to their urban counterparts.Increased political attention during the past two decades has contributed not only to growth in a body of rural health literature but common knowledge about rural health in Australia. What typifies public perceptions of 'rural health' is poorer health status, especially among Indigenous Australians, poorer access to health care and the lack of staff, particularly doctors. Undoubtedly, the biggest issue in rural health, and in the nation, is Aboriginal and Torres Strait Islander wellbeing. Health differentials between Aboriginal/ Torres Strait Islanders and other Australians are numerous, including low birth weight babies, higher levels of infant mortality, chronic illness (diabetes, asthma, heart disease), infectious disease and mental illness, and higher rates of injury and suicide (AIHW, 2008; Carson, Dunbar, Chenhall & Bailie, 2007). These manifest in a seventeen year shorter life expectancy. Related to these health issues are poor housing, low employment and education rates, racism, social exclusion and a history of oppression and dispossession (Carson et al., 2007).To a lesser extent, there are also health differences at the aggregated level between rural/ remote and other Australians. Overall rural and remote residents have higher rates of injury mortality, especially road accidents, higher rates of communicable diseases, disability and homicide as well as higher rates of smoking and alcohol consumption. Babies from these areas tend to have lower birth weights and children have poorer teeth quality (AIHW, 2008). But these differences are not consistent across rural and remote Australia, with higher rates in areas with a higher proportion of residents who are Indigenous or who have lower incomes, education and socioeconomic status (Beard, Tomaska, Earnest, Summerhayes & Morgan, 2009).Another well-known issue is the lack of staff, including nurses, doctors, allied health professionals and health managers in rural and remote Australia. The shortage creates high workloads, leading to high rates of burnout and increased waiting times, which adds pressure on the existing workforce to be clinically focused and work long hours. This work pattern makes recruitment and retention of staff difficult, further compounding the workforce shortage. Access to care is another commonly cited issue, often viewed simplistically as distance and availability. However, access masks quality of care, cultural security and the appropriateness of the model of care, type of service and needs of the local community. In reality, rural and remote health are more complex than these well known issues. Rural and remote health services are a complex web of individual actions, community control, local culture, government regulation from several levels, risk management in various ways and a combination of autonomy and surveillance at all levels. Each negotiate their own pathway and emerge in many forms with some key strengths in addition to the well-known problems discussed above.In recent decades, rural health services, along with rural, Aboriginal and Torres Strait Islander communities, have developed innovative health care models and approaches to more effectively use resources to meet local needs. …