Policy Bite: Rural priorities and progress – Australia

November, 2017

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Background

WONCA has had a Working Party on Rural Practice for many years, and it is very active – holding an annual global conference, having an active communications and social media presence, a specific link with our Young Doctors Movements (Rural Seeds), and providing resources such as the Rural Medical Education Guidebook. Their vision is “health for all rural people around the world”, and, as for WONCA as a whole, one of the key aims of their advocacy is to ensure governments recognise the importance of family medicine and its rural and remote workforce. It is therefore a source of celebration that Prof Paul Worley, a member of the WONCA Rural Working Party, has been appointed as the first Rural Health Commissioner of Australia. Paul has had a distinguished career in rural health both as a practitioner and an academic in addition to rural general practice: he was Dean of Medicine at Flinders University from 2007 – 2017, is a past President of the Rural Doctors Association (South Australia), was a founding member of the RACGP Faculty of Rural Medicine and Vice President of ACRRM, and more recently was appointed as Executive Director for Medical Services with the Country Health South Australia local health network.

I (the President, Amanda Howe) visited Paul’s programme at Flinders in 2000, to understand the way in which it enhanced learning both for the students and the communities who hosted them, and found inspiration for the work that I subsequently undertook in a new medical programme in the U.K. Paul was passionate about the value of getting students and residents out into rural communities, and helping them to learn in a meaningful way about the needs of the patients and the value of rural service.

Points raised in his inaugural speech included his intention to improve the Australian national training pathway for rural generalist practice, drawing on the many years of active experience of trying to create an intention to practice in rural primary health care at an early stage in medical training. He also actively recognised the experience of the indigenous people, saying “I would like to acknowledge that we are building on thousands of years of health training in this place that of course has been undertaken by our aboriginal peoples, and we acknowledge that what we do is building on their culture of healing; their culture of community; and their culture of family; which exist so poignantly in rural Australia. I acknowledge that that culture exists still today, and respect those people….” . Paul will be prioritising this population in his work, as their health profile remains much worse than that of most other Australians.

He also acknowledged the distress and anxiety that a lack of health services in rural areas can cause to anyone living there, and the need to feel that help is on hand. “The care that we provide is the bedrock for hope in our rural communities and I hope that as the champion for rural health Australia on your behalf we can increase that hope - because health is a human right”.

One of his arguments for addressing the inequities of rural health care is the link between preservation of health and social productivity. Health can be seen as an economic investment – Paul said that “we know that globally there is a 9 to 1 leverage for every dollar that is invested in the health workforce and we know that one of the outcomes of that health workforce is increased length of life - for every increased length of life of one year there is a 4% increase in GDP, so this investment in us all by the federal government is also an investment in the prosperity of rural communities - and the prosperity of rural communities has a great impact on the prosperity of our nation. So this is not something just for rural Australia, but is also something for the whole of Australia”.

WONCA’s Working Party on Rural Practice champions all these areas – effective education for rural family practice, strong exposure to rural settings and role models during basic and postgraduate training, and a key need to ensure governments are held to account for delivering an effective workforce for rural as well as urban areas. Recent position papers coming out of the last Rural Conference in Cairns also emphasise the particular challenges of sustaining rural settings – physically, because of the added threats of natural disasters and climate change, and psychologically because of the risks of burnout. These are, of course, challenges that all of us as citizens and professionals may need to address, but have added dimensions when put in the rural context. The model of appointing a national Commissioner to act as a champion and hold government to account is a novel one, and it will be interesting to see how much it adds to the Australian strategic approach to rural health. Certainly, having a family doctor at the helm is something to be proud of. Well done Paul! You have our support from your friends in WONCA.

The video of Paul's speech

(Speech commences at 5:54)