More questions than answers

Abstract

Western culture assumes that research is meant to provide answers to important questions and that it is no longer safe to rely on the unsupported opinions of experts, elders, priests, politicians or professionals. Clinical practice and public policy should be informed by research and public discourse should make reference to evidence in addressing messy problems. As the ongoing Murray-Darling water allocation dispute demonstrates, the facts are not straightforward, their interpretation is contested and there are many competing policy proposals depending in part on the interests and values of proponents. The Australian Journal of Rural Health occasionally publishes papers which attempt to set out facts and point to gaps in our knowledge, findings that are inconsistent with other studies and leave us with more questions than answers.1 In this edition, the discussion by Fragar et al.2 of all cause mortality of male farmers and farm managers (farmers) in Australia is one such study. The finding appears simple: all cause mortality was 33% higher (1999–2002) for farmers than for the Australian male population after appropriate standardization. Selected specific cause mortality was also higher and the reasons for this warrant further investigation. The publication of an analysis based on ‘elderly’ data is justified because changes in Australian Bureau of Statistics occupational coding in 2003 mean that this data is no longer available and we cannot readily see whether this inequity has persisted, improved or deteriorated. The analysis highlights important knowledge gaps such as the mortality patterns of female farmers in Australia, the differences in farmer mortality between developed nations and the reasons for variations in specific cause mortality. All cause farmer mortality is lower in Scandinavia and the USA than in comparable urban populations but in Australia it is higher. Is this Australian anomaly caused by provider-side access problems due to the pattern and distribution of rural health services or by consumer-side problems such as health behaviours, delayed presentation and service utilization? Are there protective factors which explain why overseas farmers have lower mortality rates than their urban neighbours? Unexplained, adverse differences in rural health outcomes warrant explanation. Better understanding of these and related questions is needed before appropriate action can be taken to improve the health of Australian farmers. The Journal rightly publishes papers about local innovations in rural health services but this paper points to the importance of making data collected by public entities available to researchers so that important inequities can be identified and key questions of rural and remote access addressed. Research alone is not the answer to public policy but a clear understanding of the dimensions and causes of problems is a good first step. Following this ‘basic’ research, fine-grained analysis of health disparities is needed because solutions are likely to be complex and multi-component. Highlighting serious inequities is an important first step but it raises many further questions for rural researchers and policy makers.