‘Unfair’ healthcare in bush

Health outcomes have never been so polarised between the city and the bush according to Carole Reeve, a leading remote health expert who spoke at the Rural Medicine Australia conference last week.

Those living in North Sydney have the highest life expectancy - 84.6 years - but in remote Australia it plummets to 76 years of age - the same as Ecuador.

In fact, the frequency of health services is the same as the South American country and so is the rate of disease.

These alarming statistics were part of Dr Carole Reeve's keynote presentation.

Dr Reeve is a senior lecturer at the Centre for Remote Health in Alice Springs, Northern Territory.

But you don't have to go as far as remote Australia to see a significant difference in life expectancy.

Ms Reeve said just 390 kilometres out of Sydney, in areas such as Gunnedah, 4.6 years of life have been lost.

Locals have to travel further for care and have longer wait times - although a lack of doctors was not entirely the problem, with Australia as a whole having more doctors per head than ever, according to Australian College of Rural and Remote Medicine (ACRRM) president Richard Murray.

Dr Reeve and Professor Murray said it was also about reduced access to fresh food and facilities such as walking tracks.

The trend of lower life expectancy continues and worsens the more remote the town.

"What we have in Australia and most of the rest of the world is not equal care, but inverse care," Dr Reeve said.

"What we need is the opposite, we need fair care.

"Our health services are designed to meet the needs of the average Australian, and while we have some of the best health outcomes in the world, we are not all average Australians."

Inverse care refers to a term proposed by British general practitioner Julian Tudor Hart in 1971.

His inverse care law relates to the principle that the availability of good medical or social care varies inversely with the need of the population served.

Dr Reeve said the risk factors for poor health increased by 30 per cent for Australians who didn't live in major cities.

These included education and poverty among other risk factors.

"We can see mortality rates are increasing for chronic disease the further we get away from cities."

But Dr Reeve said the solution to the "unequality" wasn't necessarily funding.

"Although money helps, it's not just about money.

"Despite the United States spending 20 times as much on health as Cuba it achieves nearly the same outcomes."

Instead, Dr Reeve said basic public health infrastructure was the essential foundation required.

"Other key factors are the health of the community of which we work and play.

"The evidence is growing that lifestyle risk factors are less about poor choices and more about the environment in which we live.

"Our cardiovascular health is linked to the distance we live from green parks and obesity and exercise are linked to the pleasantness and the safety of our surroundings.

"While our food choices are associated with affordability and accessibility."

Professor Murray agreed that people became healthy based on where they lived, worked and played.

However, he said the solution to the problem of lower life expectancy in the bush was not to do with the supply of doctors.

"It's not just about numbers, we in Australia have more doctors per head of population (3.4 per 1000 people) than we've ever had at any point in our history."

This was more than New Zealand, Canada, United Kingdom and the United States.

"In the city that's one doctor for every 245 people," Professor Murray said.

"Even though it's true in rural areas and outer regional and remote areas the supply is less, we have one per every 400 people, that's still not a bad supply.

"It's more about having the right person in the right place with the right skills doing the right job."

That was the role of the rural generalist - the "jack of all trades" doctor which the bush has always had.

The doctor who could provide community primary care as well as work in the hospital, provide emergency care and more.

He said the problem the industry faced was continuing the supply of the rural generalist.

"We need these all-rounders and that is now the critical step for us."