Extent and nature of poverty in Australia and the impact on rural health

Abstract

The Senate Standing Committee on Community Affairs is conducting an Inquiry into the extent and nature of poverty in Australia.1 The National Rural Health Alliance (the Alliance) made a submission to this Inquiry in February 2023, with findings expected in October 2023.2 The Alliance believes that all Australians, wherever they live, should have access to comprehensive, accessible and high-quality health, disability and aged care, as well as other social assistance services. The Alliance does not consider that poor access to services, suffering ill health or premature death should be accepted outcomes of living in rural Australia. The Alliance highlights the multidirectional inter-relatedness of health, education and poverty and explores these concepts in further detail in its submission to the Senate Inquiry. Reducing poverty is good for health outcomes as well as social and economic outcomes. Investing in actions to address poverty, and other determinants of health, is an investment in human capital and is central to health and well-being in rural Australia, as are measures that ensure universal access to health care for those who experience inequity. Universal and structural social service approaches to reducing economic inequality are also essential to addressing poverty and health inequity. Due to the inter-relatedness of poverty and ill health, such approaches must work alongside co-designed and tailored solutions that are adaptable and flexible and build upon strengths and capabilities in local communities. This is especially critical in rural areas where there are thin or failed markets and services or support are lacking. Rural areas are not mini-metropolitan areas where a city solution can be ‘helicoptered in’ to solve a specific rural problem (no matter how well-intended). Tailored measures are likely to be more accepted and embraced by residents, especially if they are co-designed and inclusive of diversity within the community and when shared ownership can help drive the outcomes. The disparities also extend to research in rural Australia. Poverty is relative. It involves people experiencing deprivation and making difficult life decisions about necessities (for example, choosing to use limited finances to pay for meals or medications, but not both). The affordability of food, groceries, energy, housing, fuel or transport and other essentials (including medicines, out-of-pocket health costs) plays an important role in these decisions. Access to high-quality, affordable health care, regardless of where you live, is important to reducing poverty and improving the health, well-being and broader social and economic goals of rural communities. The Grattan Institute has noted that poorer people are not getting the GP services they need, with disadvantaged Australians facing barriers to care. Furthermore, there are even higher access barriers for allied health services. Compared with GP care, allied health services have higher average out-of-pocket charges and make up a bigger share of household spending on health.9 This is without considering barriers related to workforce shortages and long wait times in rural areas. The National Preventive Health Strategy 2021–2030† provides direction for preventive health action across the course of life. It also presents an opportunity to build sustainable systems, address increasing burden of disease and reduce health inequities, as well as improve preparedness for emerging health threats.10 Preventive health actions can build on strengths and mitigate risks. The focus on providing the best start in life and across the life course, and its potential to influence actions outside the health sector given the crossover in risks and protective factors, can provide a focus for community co-design. These principles align with the Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS) model proposed by the Alliance as a solution for providing primary care services in rural areas where the market is failing or has failed.‡ While the causes of poverty are complex, as are the multifaceted responses required, the Alliance argues that improving access to health care and supporting the healthcare workforce in rural Australia will lead to significant improvements in health and well-being and lower the rate of poverty experienced. This will, of course, advantage not only rural Australians but all who benefit from the food supply, exports and gross domestic product (GDP) supplied by the 30 per cent of the population who live outside metropolitan centres. Margaret Deerain: Writing – review and editing; writing – original draft.