The CEO of the Healthy Communities Foundation Australia addressed a national gathering of rural health professionals and community representatives today in Perth with a challenging message: “I think we must now consider the uncomfortable possibility that we got it wrong”.
In his speech to the 17th National Rural Health Conference, Mr Burdack argued that while billions have been invested by one part of government in growing the rural medical workforce, other parts of government have been pulling support by cutting public sector jobs, centralising public services and failing to properly support economic adjustment in the face of drought and water buy-backs.
“For decades” he said “we have treated the problem of rural and remote health as a problem of medical workforce supply … Applying trickle down economics, we believed that if we increased medical workforce supply in the cities then more doctor would go bush. But at the same time, we were working to make rural towns less liveable and inviting” said Mr Burdack.
He went further to argue that “[a]ll we did was pump up the price of medical services nationally by over-skilling the workforce for jobs that no longer exist, creating a fiscal crisis that will we hand down to our children”.
He argued for a fundamental rethink of rural health policy, arguing that workforce shortages are a symptom of under-investment in rural liveability and economic capacity, rather than the cause of rural health challenges.
He argued that governments spend too much time talking to industry bodies and other vested interests when deciding rural health policy, and not enough time talking to rural people. “If the only people you talk to about rural health are professional workforce associations, there is no surprise that the only solution you get is workforce. That is why it is critical that we start talking to the people who really understand what’s going on in rural health - rural people” he said.
He argued that investing in jobs, economic growth and social infrastructure not only helped rural towns to address the drivers of poor health, but also made them more attractive places to live for doctors, teachers, paramedics and other professionals. We can train thousands of new rural generalists if we like, but if we do not also reinvest in the liveability of rural towns these new doctors will continue to go to the cities and push up the price of health care for all Australians.
The Foundation is using a new approach to health planning with rural people that focuses holistically on all the things communities need to do to attract and retain health workforce, rather than focussing solely on one type of health worker.
“The reality today is very different to 20 years ago. GPs are no longer the Jacks and Jills of all trades like they once were. Over the last 20 years GPs have become specialists which is not generally what we need to meet the every day needs of rural towns.
The Healthy Communities Foundation Australia has been busy consulting rural and remote communities across Australia from South Australia to the Northern Territory, NSW to Queensland, over the last 2 years that have realised that they can no longer wait on others to solve the health crisis in their town.
The Foundation has designed the “Community Development for Health” framework specifically to help these communities to develop their own strategies, and to build more sustainable and resilient health and care systems.
“Community engagement remains anchored in a top-down, institution-centric and place-agnostic way of thinking that excludes rural and remote people from meaningful engagement in solving challenges only they understand. This reflects a deficit view that the health system is far too complex for rural and remote people to understand” said Mr Burdack.
“Yet given the failure of rural and remote health policy over the last two decades, maybe it is time to consider that perhaps it is rural and remote communities that are far too complicated for the health system to understand” he said.
The Foundation is currently facilitating community consultations with a number of rural and remote towns to help them to create their own local health plans, and to advocate for the resources they need.
More information please call 0418974988.
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