Innovation in rural health: Sound the trumpet!

Abstract

The first three articles of this edition of the Australian Journal of Rural Health address important innovations in rural health. Gardner et al.1 review what is known about the challenges of implementing quality improvement programs and draws on data from a systematic continuous quality improvement project in remote communities in Australia and Fiji, known as Audit and Best practice for Chronic Disease (ABCD), to synthesise lessons and discuss the potential for broader application in low and middle income countries, including Pacific Island countries and territories. They argue that the participatory action research approach supports innovation and broad-based change and the evidence it has produced extends the current knowledge base and facilitates the translation of knowledge into action, both for policy and practice. Reddy and colleagues2 describe two real world diabetes prevention programs, one in Montana based on US Diabetes Prevention Program, the other in Australia based on the Finnish Diabetes Prevention Study – the two landmark randomised control trials. Using qualitative research, they sought to determine whether there were specific rural context issues involved in implementation in Montana and Victoria Australia. They conclude that there were some rural issues but overall diabetes prevention programs can be implemented in any setting urban or rural without major adaptation. Humphreys and Wakerman3 review what factors seem to contribute to successful and sustainable health systems in rural and remote communities drawing on evidence from Australia, Canada and the USA. They identify good governance, leadership and management, adequate funding infrastructure and service linkages as crucial for optimal workforce recruitment. Needs must – workforce shortages and other factors frequently lead to innovation in rural health simply because necessity is the mother of invention.4 These papers cover the two great questions of rural health – how much can we explain the disparity by understanding risk factors for chronic diseases and how much of the disparity is the result of poor access to services?5 The authors of these papers have made a substantial contribution to our understanding of how we can improve rural health. The Australian government has policies to reduce rural and remote health disparities. Medical Schools are funded to ensure that 25% of students complete 50% of their clinical training in rural areas. Eleven University Departments of Rural Health around the country have been established by the Government to improve the health, health services and workforce of rural and remote Australia. Disparities in health due to rurality are well recognised internationally but the causes and consequences are incompletely understood.5 What is it about rurality that explains increased morbidity and mortality? We still need to see a comparative study of risk factors that takes into account socioeconomic circumstances such as education, income and occupation to separate out the explanation for rural excess morbidity and mortality. We are fortunate to have the publicly funded infrastructure to be able to undertake research into rural health, health services and workforce. We have also come of age. In the first round of Centres for Research Excellence in Primary Health Care funded by the Australian Primary Health Care Research Institute, rural and remote researchers performed outstandingly.6 One centre is looking at accountable and equitable primary health care provision in rural and remote Australia, a second is looking at building quality, governance, performance and sustainability in primary health care, and the third looks at indigenous primary care interventions in chronic disease. Two of the centres are rurally or remotely based and the third has a large rural component. By comparison with University Departments of General Practice, University Departments of Rural Health are well represented including Broken Hill, Centre for Remote Health, Greater Green Triangle and the School of Rural Health Bendigo. Rural health research in Australia has come of age. A new model of rural research is emerging. Each of the Centres is a multisite collaboration frequently involving metropolitan colleagues with distinguished track records in research. The next five years will see a flourishing of rural and remote research particularly since the centres have a role in building capacity at the postdoctoral level. Sound the trumpet!