Poor Health Status of Rural Communities in Australia - Essay Example

Note: If you need anything please just send a message. Thanks! Context and Principles of Community Development Poor health status of rural communities in Australia Contents Contents 2 1. Introduction Community development is generally building social capacity and economic development that can help a particular community improve their health, enhance knowledge and skills, and ensure social and economic stability. For this reason, the selected context in this study is poor health status of rural communities in Australia which according to statistics has much higher death rates compared to major cities of the country. Moreover, the social determinants of poor health in these remote areas are poor living conditions, income, power and resources, and inequities that are complex social issues. The following sections discusses community development, the selected context which is poor health in rural communities, the barriers facing community development in this area, the suitability of selected community development principles to the selected context, and the most relevant principles that can effectively increase cooperation and compliance to healthy lifestyle promotion and ensure sustainability of the programme. 2. Community Development There are a number of definitions for community development but the most common is improving the quality of lives of residents from low to moderate income communities through some form of asset building (Ferguson & Dickens 1999, p.5). It includes social capacity building (Phillips & Pitmann 2009, p.49) and economic development leading to improved health, education, recreation, social and economic security. Its basic philosophy is to work for the well-being of people within a particular community, stimulate and promote conditions for social, cultural and economic progress through coordinated methods with emphasis on responsibility and action at the local level (Jayapalan 2001, p.330). Community development according to Craig et al. (2011) consists of values and practices that play an important role in eradicating poverty and disadvantage. It is commonly performed by public authorities, services and agencies working hand in hand with communities in increasing the latter’s ability to manage their own effectively (p.11). Community development generally promotes social change that primarily include combating social exclusion, poverty, and discriminations in terms of race, disability, age, gender, and sexual orientation. It deals with empowerment and participation and public issues and policies affecting the community (Purcell 2005, p.6). In community development, everyone is engage with each other transparently and with respect regardless of diversity (Cheers et al. 2007, p.63). In the context of rural residents well being community development according to Cavaye (2011), builds physical, human, social, and environmental capacity. It is a process that enables more options and choices, increase participation, equity, enable actions that can change the economic, social, cultural, and environmental situation of a particular community, creates more jobs, income, infrastructure, and communities that can effectively manage change by themselves (p.18). 3. Causes of Poor Health in Rural Communities and Barriers in Community Development The study conducted in 2008 about key disparities in the health of people living in urban, regional, and rural areas of Australia suggest that the health of people living in rural and remote areas is not only different but worse. Residents of rural and remotes areas have shorter life, with higher rates of health risks factors and chronic diseases, and with generally poor dental health. Their poor health is not associated with rural setting but more identified with lower income, less education, geographical isolation, poor transport and communication facilities, and shortage or completely lack health-care services (Newton 2008, p.295). The 2005 survey figures from the Australian Bureau of Statistics shows that about 35% of Australian population are living outside the city or rural or remote areas. The same survey shows that deaths from diabetes, renal failure, circulatory and respiratory diseases, and others are much higher in rural or remote areas. For instance, the ratio of deaths due to renal failure in remote areas is 1.18 to 2.88 depending on the extent of remoteness compared to 1 to 1.04 in cities or urban areas. Similarly, the prevalence of health risk factors and health conditions in rural areas is much higher. For instance, smoking, alcohol consumption, physical inactivity, and obesity are more prevalent in rural areas than major Australian cities. More importantly, the number of health-care workers in rural areas is far less than those assigned in major cities. For instance, there is an average of 100 general practitioners in cities while only 67 in remote areas; there is an average 119 specialist in the cities compared to 5 in remote areas; there is also an average of 919 registered nurses serving in major cities while only 828 in rural and remote areas (Newton 2008, p.300). According to Phillips (2009) people living in rural and remote Australia have poorer health risk factor profiles since they tend to smoke, consume more alcohol, obese, and do less physical activity. They commonly have lower education, income, receiving less health-care services. Since travel distance and driving speed in rural areas are much greater coupled with bad roads, residents are more vulnerable to accident. The high risk factors present in rural or remote areas contribute to about 70% of deaths. For instance, 19% of rural residents died of coronary disease; 18% died of circulatory diseases; 6% died of diabetes; 9% died of chronic obstructive pulmonary diseases while 15% died of either lung or prostate cancer (p.5). Despite many attempts or initiatives to provide the health need of Australian communities living in rural and remote areas, the population generally continue to show poorer health outcomes compared to those living in major cities (Humphreys et al. 2002, p.2-14). Moreover, there are still shortages and misdistribution in health workforce and expenses are barriers particularly in extremely remote areas. In terms of community development, rural and remote health status has a number of key contextual issues for service delivery, practice, and outcomes. For instance, in terms of equity and rights, existing rural health inequalities and inequities are not acceptable since these people are already disadvantaged particularly in their prospects and opportunities for social and economic well being. Health inequalities include life expectancy, higher risks of disease and risks factors such as tobacco use, obesity, alcoholism, and others that are associated with their social status. Their geographical location is an impediment to availability of adequate health services while their socioeconomic status and lifestyles are products of rural and remote life (Humpreys & Wakerman 2008, p.8). Barriers preventing community development in rural and remote include insufficient funding, poor coordination, access and equity, irresponsiveness to needs, cultural diversity, quality of care, sustainability, and accountability (Humpreys & Wakerman 2008, p.10). In fact, the National Health and Hospital Reforms Commission or NHHRC in 2009 was still figuring out how to improve health services in rural areas and surprisingly, the final report submitted in the same year was about building and funding hospitals and providing professional health services than resolving social issues such as poverty, unemployment, and cheaper food supply. It was only in 2010 that the Preventive Health Taskforce considers the social determinants of poor health, high-risk drinking, obesity, and so on but still not clear if such initiatives will going to address the general social inequalities responsible for this unhealthy lifestyle (National Rural Health Alliance, 2011, p.3). The choice to eat healthy food, being physically active, to drink or not to drink alcohol, and not to smoke requires empowerment (Friel 2009, p.1). In other words, people’s decision to live a health life is influenced by their financial and social circumstances. Therefore, people with low income, illiterate, living and working in poor conditions, and excluded from mainstream society are likely to die early. The socio-political, socio-economic, socio-environmental, and socio-cultural environments are social determinants of risk factors affecting rural communities such as obesity, alcohol, and tobacco. For instance, obesity is more prevalent among disadvantaged group while living healthy is associated with empowerment or material, psychosocial, and political stability (Friel 2009, p.7). In contrast, social exclusion prevents effective participation of the unemployed, single mothers, the ages, the working poor, and those that are living rural or remote areas. Social exclusion is the inability of the capitalist system to protect the poor against key risks associated with levels of education, low income, unemployment, poor housing, health problems, and family breakdown (Dibden 2005, p.159). In Tesoriero (2010), empowerment is one of the principles that must be taken into account in community development as social exclusion and oppression are big barriers to development (p.240). Similarly, Kenny (2011)’s objectivity and impartiality in community development requires commitment to powerless people and respect their rights to self-determination (p.23). Moreover, social inequalities such as unemployment, poverty, and lack of adequate health-care are social injustices that must be address through recognition of rural communities’ rights for social, economic, political, cultural, environment, and personal development. By analysis, these principles are actually barriers and solutions by themselves. For instance, absence of empowerment results to social inequities and inability of communities to solve their problems and manage their own future. In contrast, considering the principle of empowerment as part of community development initiatives to address poor health in Australia’s rural communities avoids the consequences mentioned above and facilitates better health because compliance to suggested healthy lifestyle will be taken by individuals as responsibility. Similarly, absence of social justice and respect for human rights will likely result to opposition of any traditional approach to community development particularly those that are based on one-size-fits-all and oppressive methodologies. In contrast, community developments that take into account the value of social justice and respect for human rights will be welcomed as if they were gifts with divine origin. For instance, when the community know and feel that such community development recognized their right to employment, better living conditions, adequate health services, and so on they will be enthusiastic about the programme and cooperate with less effort on the part of the community worker. The reverse however is reluctance and disrespect regardless of the clear economic and health benefits of the community development programme. 4. Suitability of Selected CDPs to Poor Health Status of Rural Communities There are a number of community development principles presented in Tesoriero and Kenny’s work. However, in terms of poor health status in Australia’s rural communities and in consideration of the social issues involved it may be appropriate to select those that can significantly impact understanding and eradication of the social root causes of poor health. Moreover, since poor health problems in rural communities is a combination of various issues, it is best to be holistic about it and consider the relationship between issues and corresponding processes required. a. Holism The principle of holism is generally required in any community development. However, this principle is selected in this context for specific reason. The problem surrounding poor health status in rural or remote communities is not just a matter of promoting a healthy lifestyle but a number of social, economic, race, and cultural issues. For instance, poor health is associated with unemployment in the sense people cannot buy nutritious food if they do not have money. Similarly, smoking and excessive alcohol consumption are associated with culture and social inequalities that made this people turn to vice in order to momentarily ease their sufferings caused by poor living conditions and remoteness. Moreover, the growing and continuous poor health status in rural communities despite several community development efforts in the past is an indication that their actual needs are not being met for a number of reasons. One probable cause was the failure of previous interventions to recognise and eradicate the social issues involved in poor health. Another is the failure of the programme to sustain development in rural communities due to lack of solid commitment and empowerment. b. Social Justice and Human rights –Addressing the structural and discourses disadvantage According to Tesoriero (2010), social just include addressing class, gender, age, disability, sexuality, and race oppression. These structural oppressions are other forms of disadvantage linked to individual needs, problems, and sufferings which community development initiatives must equally consider. The suitability or relevance of this principle in resolving poor health problems in rural communities is in the fact that social justice makes people happy, trusting, and cooperative in community programmes that not only make their lifestyle healthy but supported their social and economic needs. A community development initiative that knows knows class, race, gender, culture, sexuality, and disability. A community development initiative recognising community members rights as people deserving nothing else but quality education, health, and living conditions. The impact of a community development based on this principle may be more intense since poor health is evidently a product marginalisation and disempowerment. Addressing both structural and discourse disadvantage can lead to better and wider cooperation among members of community which can greatly ease promotion of healthy lifestyle and ensure sustainability of the programme. c. Process, outcome, and vision Contrary to some belief that outcome of a community development is more important than the process of delivery, addressing poor health in rural communities needs both to succeed. For instance, too much concentration on the process can lead to ignorance of the development’s structural context as in promoting healthy lifestyle without considering the ultimate goal of the programme which is sustainable health and better living conditions. If one community development is only interested in seeing reduced death rates in rural communities then the programme is not being realistic in the sense that low death rates does not necessarily mean that more people employed, living a healthy lifestyle, nutritious food are accessible and affordable, and excessive consumption of alcohol and tobacco has stopped. The statistics may be merely suggesting that health care is now widely available or some members of the community already migrated to the city or other parts of the country due to unemployment and poor living conditions in that particular community. For the above reasons, how such development is achieved is very important since the process that made it happen is a reflection of the outcome. In terms of sustainability, the process can help us determine if the programme will last by examining the integrity of the process and its ability to achieve long-term vision. For instance, a politically motivated process as well as deceitful and manipulative tactics can never truly empower people and therefore likely to fail in the near future. d. Empowerment and self-determination Sustainability is always an important principle of community development since without it, the outcome will be temporary and the community will likely go back to where it was before. This is the reason why the principle of empowerment and self-determination is very important in community development particularly those that are dealing with problems originating from various social and cultural issues. For instance, the poor health status in rural community involved social issues such as unemployment, low income, poor housing, education, and so on that must be address before any lifestyle change can occur. However, resolving these issues through aid or assistance from somewhere else is impractical since it’s a temporary solution. The key to sustainability is to eradicate dependence and building self-managed community that has the ability and resources to resolve their future problems. Therefore, empowering the community reduces their dependence on external support not only because they will be dependent on their own capability but learn in the process. For instance, once a particular rural community livelihood is established unemployment will be reduced and income will increase resulting to better living conditions. However, if the community is not empowered to take control of this livelihood or generate more sources of income, such development will not last long and again they will need another community development programme. In contrast, empowered and self-managed community will do its best to sustain what they have and if everything goes right, such empowerment will lead to a progressive community with minimal health problems. 5. The Most Relevant Principles in Resolving Poor Health Problems in Rural Communities There is no question about the equal importance of the four community development principles mentioned in the previous section but in terms of relevance to the selected context, social justice and empowerment will be the first in line. Social justice means a lot to many people since it is about equality, fairness, and respect for human rights. Absence of social justice in a community often result to discriminate living such as poor health care services, crowded housing, unemployment and lack of income generating facilities, and so on. Remoteness of one community does not necessarily mean they cannot enjoy the quality of city life since as Australian citizens they also deserve equal treatment from government. The scarcity of health-care services and lack of employment for instance is not an excuse since it is generally the responsibility of government to provide these needs. Similarly, since education often lead to better life, absence of educational facilities lead to the opposite condition. Social inequalities therefore can do more harm than poor health itself as it can replicate its effects to other communities as well. The principle of social justice and human rights can help community workers effectively address the social issues responsible for unhealthy lifestyle while minimising opposition and ensuring greater cooperation and compliance from the community. Empowerment and self-determination is relevant in the sense that sustainability of community development is as important as the processes and outcome of the programme. For instance, healthy lifestyle prevents diseases thus promotion and maintenance of healthy diet and physical activity must continue through life. However, this will not be possible if the community is always reliant from external support over and over again. The community development programme must provide the community with resources, opportunities, knowledge and skills to progress and solve internal problems through their own effort in the future. Empowerment and self-determination is as important as social justice thus it should be taken into account as an essential part of the long-term solution to eradicate sources of poor health in rural communities. 6. Conclusion Poor health status in rural communities in Australia is not just a matter of unhealthy lifestyle that cannot be resolved by directly promoting healthy food and active life. Similarly, the root causes of poor health and high death rates in the rural or remote communities cannot be addressed solely by building and funding hospitals and increasing professional health-care services. The problem is evidently much deeper and if one community development intends to succeed, it must take into account and resolve the various social issues first before embarking on health promotion and intervention. The four community development principles discussed earlier are all useful but the most relevant is social justice and empowerment since the root causes of poor health in rural communities are social issues. In general, community development that will be applied in the selected context will benefit from principles eliminating inequalities in our society promoting and sustaining good health through empowerment. 7. Reference list Cavaye J. (2011) Understanding Community Development, Cavaye Community Development, pp. 1-19 Cheers B, Darracott R, & Lone B, (2007), Social Care Practice in Rural Communities, Federation Press, Australia Craig G, Mayo M, Popple K, Shaw M, & Taylor M, (2011), The Community Development Reader: History, Themes and Issues, The Policy Press, United Kingdom Dibden J, (2005), Sustainability and change in rural Australia, UNSW Press, Australia Ferguson R. & Dickens W, (1999), Urban Problems and Community Development, Brookings Institution Press, United States Friel S. (2009), Health Equity in Australia: A policy framework based on action on the social determinants of obesity, alcohol, and tobacco, National Centre for Epidemiology and Population Health, The Australian National University, pp. 1-52 Humphreys J, Hegney D, Lipscombe J, Gregory G, & Chater B, (2002), Whither Rural Health? Reviewing A Decade of Progress in Rural Health, Australian Journal Rural Health, 10, p.2-14 Humphreys J. & Wakerman J, (2008), Primary health care in rural and remote Australia: Achieving equity of access and outcomes through national reform, National Health and Hospitals Reform Commission, Australia, pp.1-28 Jayapalan N. (2001), Indian Society and Social Institutions, Atlantic Publishers & Distribution, New Delhi Kenny S. (2011), Developing Communities for the Future: Community Development in Australia, Fourth Edition, Nelson ITP, Melbourne National Rural Health Alliance, (2011), A Brief History of Health Reform in Australia, online, available at http://nrha.ruralhealth.org.au/reform/?IntCatId=42 Newton P, (2008), Transitions: Pathways Towards Sustainable Urban Development in Australia, Springer, Australia Philips A. (2009), Health status differentials across rural and remote Australia, Australian Journal Rural Health, 17, pp.2-9 Philips R. & Pittman R, (2009), An Introduction to Community Development, Taylor & Francis, United Kingdom Purcell R, (2005), Working in the Community: Perspectives for Change, Lulu Publishing, United States Tesoriero F, (2010), Community Development: Community-based alternatives in an age of globalisation, Pearson Education, Australia Read More