Giving people a bigger say in rural health care

Posted on September 17, 2013

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Empowering local communities to determine what is important.

Empowering local communities to determine what is important.

A radical ‘grass roots’ approach for providing health care to rural Australia is being pioneered in a new La Trobe University research project valued at almost a million dollars.

Based on an award-winning community participation model in Scotland, it aims to turn on its head existing methods of planning and designing health services.

Head of the Bendigo-based La Trobe Rural Health School, Jane Farmer, says traditional health care models use a top down approach with policy makers, managers and health professionals, perhaps located in cities or interstate, developing service ideas that often can’t be delivered in country communities due to lack of staff, facilities or just too few local people.

‘The model in this study will empower local communities to determine what is important to them in terms of local health care needs and viable ways of meeting them in rural places.’

Six rural communities

Professor Farmer says six rural communities in Victoria and Queensland will take part in the three-year study, which is about to start recruiting local people to help design their own health care approach. The research team will evaluate the results and recommend how this can be translated into practice.

Professor Farmer: poor oral health is associated with a range of other health conditions.

Professor Farmer: poor oral health is associated with a range of other health conditions.

The project has been funded by a $418,000 Federal Government National Health and Medical Research Council grant and a further $525,000 from La Trobe University and partner institutions.

These are Loddon Mallee Murray Medicare Local, James Cook University, Townsville Mackay Medicare Local, Dental Health Services Victoria, the Royal Flying Doctors Service (RFDS Victoria and Queensland) and The Victorian Department of Health.

‘There’s incontrovertible evidence,’ says Professor Farmer, ‘that people living in rural places in Australia tend to experience poorer health than their metropolitan counterparts.

Focus on oral health

‘By involving people directly in the planning, design and delivery of their health services we hope we can improve the health of people living outside metropolitan cities,’ she says.

The project is based on an earlier study of Professor Farmer’s into community health participation in Scotland. Titled Remote Service Futures, it won a Scottish Government innovation award.

Professor Farmer says many health problems in rural Australia are public health issues of overweight, smoking, having high blood pressure and mental health problems.

‘We chose oral health as the basis for this study because, in the rural context, oral health is particularly important. There is devastating evidence that rates of complete tooth loss and untreated tooth decay are much higher in rural and remote areas than in urban areas,’ says Professor Farmer.

La Trobe Rural Health School in Bendigo: identifying ways to meaningful community participation.

La Trobe Rural Health School in Bendigo: identifying ways to meaningful community participation.

Links to other health conditions

‘Oral health is associated with a range of other health conditions and impacts greatly on overall well-being. It is linked closely with mental health, cardiac disease, cancer and diabetes, so it’s important that we investigate ways to address this issue.

‘For example, solutions could involve teaching kids at kinder or parent groups how to brush their teeth well, healthy food availability, involving local health workers in oral health care through to mobile dental clinics such as run in some places by RFDS.’

Professor Farmer says the trend in health policy decision-making all over the world is to engage more with local communities.

‘La Trobe University is committed to research that helps build healthy communities, so we are delighted the Federal Government has endorsed the important role of our research which aims to help people in rural areas.’

Major gap in knowledge  

Dr Mandy Kenny, Head of research at the La Trobe Rural Health School, says ‘Evidence suggests community participation is particularly significant for rural communities, but there is a major gap in knowledge of how community participation can occur.’

Loddon Mallee Murray Medicare Local CEO, Matt Jones agrees. He says Medicare Local is keen to identify ways in which meaningful community participation can occur. ‘This project provides a fantastic opportunity to involve local people in planning to improve services and health outcomes.’

Listen to Professor Farmer discuss the project on ABC Radio National’s Bush Telegraph: ‘There’s a strange culture that rural people have about addressing problems when they get sick but they don’t have (as strong) a prevention orientation as people in metropolitan areas…’

Read the Scottish Remote Service Futures report (pdf download)