Overview

Editors:

Lisa Bourke
University of Melbourne, VIC

Juli Coffin
Combined Universities Centre for Rural Health

Jeffrey Fuller
University of Sydney, NSW

Judy Taylor
University of South Australia, SA

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).

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.

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.

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.

However, while community controlled health services are given control over governance and management of these services, control is limited by funding, government-determined targets and objectives, and a focus on health exclusive of educational, political, emotional and cultural issues. Thus, control is conditional based on Western understandings and pre-determined outcomes ingrained in mainstream institutions. This leaves Aboriginal and Torres Strait Islander services and health professionals juggling disparate cultural goals, protocols and restrictions.

It is time to challenge mainstream understandings of 'control' in order to re-construct meanings and partnerships required for effective service provision. Perhaps Aboriginal and Torres Strait Islander communities and services ought to be trusted and allowed to provide services, learn from their successes and grow from their mistakes. A new approach and some radical re-thinking is required for change and this Special Issue seeks to act as a catalyst for this.

This Special Issue on rural health presents a range of analyses that question how well rural health models, services and knowledge improve health and wellbeing. It highlights the complexity of Aboriginal health, reiterating that there are no quick answers but a long process of developing cultural security and inclusion is required. In doing so, these papers acknowledge the diversity of Aboriginal, rural and remote voices.

The issues highlighted in this volume make it clear that change is required from mainstream, calling on us to be open to Aboriginal cultures, to befriend our Aboriginal neighbours and to challenge discourses that perpetuate discrimination and exclusion of Aboriginal people.

This Special Issue focuses on rural social research relating to rural communities & societies and is highly relevant to researchers, teachers, students, policy developers, managers, decision makers, and health care workers interested in health issues in emerging and mature regional economies.

Table of Contents

Editorial: Rural health in Australia
Lisa Bourke, Juli Coffin, Judy Taylor, Jeffrey Fuller

What health services within rural communities tell us about Aboriginal people and Aboriginal health
Bronwyn Fredericks

Fear of flying
Jenny Baker

Killing the mockingbird: Systems failure and a radical hope for re-grounding responsibility and access to health care in a Mallee town community
Ian Coldwell

Understanding contexts of family violence in rural, farming communities: Implications for rural women's health
Sarah Wendt, Jennie Hornosty

Virtue ethics and rural professional healthcare roles
Andrew Crowden

Rural responses to H1N1: A flexible model for community collaboration
Denise O'Farrell, Debra Larsen Aubrey

What is health anyway?: Perceptions and experiences of health and health care from socio-economically disadvantaged rural residents
Julaine Allan, Patrick Ball, Margaret Alston

Adopting a proactive approach to good health: A way forward for rural Australians
Joy Penman, Bronwyn Ellis

Book Reviews

Rotary in Maleny: 50 Years of Service
Jack Wilcox AM
Reviewed by Don Boadle