Components of Rural Health Disadvantage in Victoria - Essay Example

Running head: Components of Rural Health Disadvantage in Victoria Health and Social Care Name Institute Date Components of Rural Health Disadvantage in Victoria Introduction Rural health is one of the areas which have really attracted much research partly because of the growing concerns about the changing patterns of the rural health status but also political shift where a lot of emphasis is drawn towards rural areas. However, not much has been done to clearly to bring out the rural disadvantages. More recently, there appears to have been an increasing need by policy-makers for an inclusive categorization to direct the allocation of health care funds to rural areas. Nevertheless, these efforts have ignored the disadvantage aspect that supports the troubles linked to health care provision in these rural areas (Bourke, 2001). Various reasons have been brought forward in explaining why most rural areas are in challenged in terms of health care services for instance McGrail and Humphreys (2009 attribute the poor health status to distance from capital or major cities. Particularly, they argue that distance unswervingly impacts on the eligibility and quantity of health care that rural communities get and thus how well the crisis of medical staff shortages in rural areas is addressed. Others believe that is has to do more with population increase (Bourke, Sheridan, Russell, Jones, DeWitt, & Liaw, 2004) while others attribute it to shortage of health professionals, a major obstacle to achieving the health Millennium Development Goals and improving health service access (Humphreys 1999). Critical question from these past studies is whether the rural disadvantage a real phenomenon or is it just a question of access to medical care. The aim of this paper is to shed more light and discuss in details the rural disadvantages with respect to Victoria. The starting point is conceptualization of key concepts followed by thorough description of the major components of rural health disadvantages in Victoria and consequently a conclusion based on the foregoing description and discussion on the major component of the rural health disadvantages Conceptualization of Rural areas The way rural is understood is quite important especially in terms of policy geared towards health care services. Rurality is a multi-faceted concept and has attracted a wide range of definitions. Numerous authors have debated "what constitute a rural area” and sought definitions based on distinctiveness and distinctiveness like small population density and undersized population centers, remote populations and great distances, together with practical ecological, farming and other financial activities (Humphreys, 1998). According to Jones, Humphreys and Wilson, (2005) an area is said to be rural if it is not urban however, the line between urban and rural is quite arbitrary. In Australia, remoteness and rurally has been defined to include areas which do not have adequate access to health and workforce needs, as well as the inadequacy in terms of resources allocated to meet these needs, including staff and physical resourcing (Humphreys, Wakerman, & Wells, 2006). Components of rural health disadvantages in Victoria The major components of rural health disadvantages in Victoria include but not limited to health promotion, illness prevention, management and active treatment of illness and injury. Various studies have come to an agreement that health status is unequal across Victoria with significant diversities observed between the wellbeing status of individuals residing in the metropolitan areas or cities compared to those living in rural Victoria as confirmed by comparative studies on health status of both rural Victoria and the metropolitan areas conducted by Victorian Burden of Disease. The two studies established that, generally, rural Victorians are more probable to experience a variety of unfavorable health conditions and probable to die young. In particular, the studies found that mortality rate was higher in rural Victoria than in urban regions of Melbourne while in terms of morbidity, the rural Victoria had a poorer health status than urban Victoria, though with main discrepancies inside rural and urban regions (Humphreys, Hegney, Lipscombe, Gregory, & Chater, 2002). There are various interlinking factors explaining why people who live in rural and remote Victoria tend to have higher rates of diseases as indicated by relative socioeconomic disadvantage index which range from greater physical risks, reduced access to health services, particularly emergency services and less access to other health-benefiting determinants such as education, employment or good income as well as good transport. This is compounded by social isolation, conditions of economic decline and drought. People living in rural Victoria consequently have lower standards of health and a lower socioeconomic status than their metropolitan counterparts (Hunter, 2007). A more recent data from the Socio-Economic Indexes for Areas (SEIFA) indicates that the lower socioeconomic status in much of rural Victoria significantly affects or impacts on the people’s ability to pay for alternative services, if they are available. Many of these people cannot afford some of these services. In particular, the relative socioeconomic disadvantage index measure was 998.88 for rural Victoria compared with 1,020.56 for metropolitan areas (Moore, Sutton and Mayberry, 2010). In addition, most if not all of the rural populations, experience higher rates of unemployment. Again, there are a greater relative numbers of low-income households compared to those of metropolitan populations. Furthermore, transport is also very poor as most many communities in the rural Victoria reside in locations where access is greatly challenged by distance and poor terrain. Consequently, communities rely in most cases on community care and local health services which are not reliable (Rural directions, 2009). As indicated in the foregoing paragraphs, a large proportion of population or rural areas of Victoria depends significantly on the local health services and Bush Nursing Centers (BNC). These centers depend on occasional visits by medical officers. Another challenge is relates to the issue of retaining as well as attracting doctors to these rural communities and those who are able to be ‘on-call’ (Strasser, Hays, Kamien & Carson, 2000). In fact, studies indicated that about forty percent of patients with emergency issues are more likely to be treated by a nurse as opposed to a doctor in the Victorian rural hospitals (Bourke, 2001). The outcome of this trend, unchallenged medical power in rural and remote settings, access to safe services, inflexible division of labor create gaps, poor inter-professional relations and communication and also the fact that nurses operating without a supportive clinical governance framework, all these impact negatively in terms of the health service delivery of Rural areas of Victoria. The following section details some of these key issues. Although it is a common believe that other professional groups for instance nurses and paramedics are in a position to meet the emergency care needs of residents. These groups of professional are particularly challenged in their work practice especially in the wake of unchallenged medical power as dictated by their superiors, the doctors. As a results of this, Tham, Humphreys, Kinsman, Buykx, Asaid, Tuohey, & Riley (2010) have argued that rural communities are still easily mobilized into public action with the prospect of losing their doctor having observed in their study on rural health servicers in Victoria, that medical power and dominance continued to be ‘firmly entrenched’ . They were of the opinion that doctors position in Victorian rural communities was attributed to the view that they were ‘extricable linked to the sustainability of the hospital and the whole community. This medical power can be associated with more emphasis on acute health service delivery as opposed to prevention that is, sickness rather than wellness. Secondly, it can also be associated with the development of a culture whereby some if not all rural nurses and other professionals become reluctant to make urgent medical decision but instead, preferring to reschedule to the doctor’s opinion. This is very dangerous in cases of emergencies putting health of many rural Victorians at risk. Again, with the domination and medical power, there is a high tendency for lack of teamwork, poor to non-existent inter-professional communication and diminished motivation as well as work commitment let alone lack of development of alternative models within the health professional workforce and fragmentation of health service delivery. According to Humpreys et al. (2002) this kind of medical dominance in the rural communities can really compromise not only the level of healthcare options available to these communities but also the potential dependence on one or two individuals which can reduce health services resilience like a primary care nurse practitioner who can provide a sensible response to inadequate medical support in rural communities. The issue of inadequacy of doctors put many people in the rural areas at risk of unsafe services. Sullivan, Francis, and Hegney (2008), assert that, in Victoria, the critical shortages of doctors lead rural communities to ‘take any doctor for any amount of time’ (Sullivan, Francis, & Hegney, 2008). This is clearly a demonstration that nurses and other professionals are extremely at powerful position thus has implications for access to safe emergency services. They should be empowered adequately so that they can provide the needed safe emergency services. Poor inter-professional relations and communication is yet another issue that merit intervention. As a result of dominance by medical doctors, the end result has always been the poor inter-professional relations. The association between positive, honest, respectful, inter-professional relationships and patient outcomes are well demonstrated most dramatically when their evident lack contributes to health service catastrophes such as those that occurred at Bristol Royal Infirmary, Bundaberg Hospital, King Edward Memorial and other areas (Smith, Humphreys, and Wilson, 2008). Several studies have confirmed that there is a strong relationship that exists between patient safety and outcomes, error rates and team collaboration as well as communication (Tham, Humphreys, Kinsman, Buykx, Asaid, Tuohey, & Riley, 2010). Effective teams, through their mutual respect and capacity to question each other, have inbuilt quality assurance and ability to respond flexibly to the changing needs of their communities. The relationship between doctors and nurses in small rural health services is co-dependent; the nurse and doctor need each other to operate effectively as a team (Wilson, Couper, De Vries, Reid, Fish, & Marais, 2009). Another drawback of health services in the rural is the fact that most health service providers, in this case, nurses usually operate without a significant supportive clinical governance framework. Incidentally, in Victoria there are small rural health services that are often forced to respond to emergency presentations in the absence of direct and indirect medical support and supervision. This is obviously as a result of absence of sound or clear clinical governance structures that could afford them, their employers and their patients’ protection (Stamm, Piland, Lambert, & Speck, n.d). In addition, health providers like nurses sometimes extend or expand their practice to take care or compensate for the nonexistence of medical, pharmacy, radiography and other allied health professionals (Sullivan, Francis, & Hegney 2008). It is not surprising to find for instance nurses administering and supplying medications, taking X-rays, carrying out physiotherapy and sometimes even counseling patients. Arguably, this is often the only means to sustain a health service in a smaller community. This calls for a formal recognition of nurses as important health providers. Unless this nursing role is formally acknowledged, the appropriate clinical governance and legal infrastructure will not be put in place to support rural nurses and ensure safe practice (Smith, Humphreys, and Wilson, 2008). In overall, illness or generic disease prevention and control strategies are inadequate. Especially due to the fact that people residing in more remote areas may need special attention and specific health problems may have to be targeted (Ricketts, 2000). Rates of hospitalization for preventable chronic diseases are higher in rural Victoria as are unavoidable. Apart from insufficient control strategies, some of this is due to the distance experienced by rural residents a strong indication that they are at greater health risks. From the foregoing paragraphs, it is clear that a health disadvantage in Victoria is a real phenomenon that needs very urgent intervention. Various interventions can be used in controlling this unfortunate trend. The need to address the rural health in Victoria is not a question of only health departments alone but much of the efforts should also emanate from other institutions. It calls for a joint intervention. Those other areas like education, employment, roads, housing, and food—need to be significantly considered and engaged with to improve the general socioeconomic status of the people while also maintaining sustainable communities. Again, evaluation is a crucial guide for the development of health practice and services while embarking on the need assessment. On the same vein, the government needs to come up with incentives that would attract medical personnel in the rural Victoria so as to arrest insufficient number in these areas (Peterson, Northeast, Jackson, and Fitzmaurice, 2007). References Bourke, L. (2001). Australian rural consumers' perceptions of health issues. The Australian Journal of Rural Health, 9(1), 1-6. 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