Health, regional Australians and research

Key themes from Resilient Regions Week 2017

By just about any measure of health and wellness the facts are that Australians living in the cities are better off than their country cousins. 

Compared to people living in Brisbane, Sydney or Melbourne, regional Australians live shorter lives, have higher levels of chronic disease, are more likely to be overweight or obese, and smoke and drink more.

A report by the Garvan Research Foundation in 2015 also added to the list higher reported rates of high blood pressure, suicide, diabetes, and dementia[i].

For those of us working on attempting to build stronger more resilient regions, these indices are troubling.

In part they explain why the Institute for Resilient Regions (IRR) at the University of Southern Queensland (USQ) is building one of its core research programs around strategies and solutions for healthier better regional living.

Over the past two years, for example, we have worked closely with the Cancer Council Queensland on a partnership aimed at reducing the five-year gap in survival between metropolitan and regional Queenslanders diagnosed with colorectal cancer.

A recent systematic review by the IRR program team tasked with building regional resilience in cancer control (BRRICC) have found that distance from health service is not always the main factor in shaping regional health:

“Individuals with colorectal cancer living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres”.[ii]

Most recently the Institute has launched a partnership with the Prostate Cancer Foundation of Australia with a plan to research more effective means of engagement for rural and regional men.

There is a compelling need for action. Men in regional Australia diagnosed with prostate cancer are upwards of a third more likely to die of the disease than their city counterparts .[iii]

Resilient Regions Week 2017 focus on regional health

Looking to engage directly with the people who live the regional patient experience or staff the healthcare system in rural and remote centres, in July we organised our annual major public engagement exercise wholly around the questions of rural and regional health and healthcare.

Over five days in Toowoomba, Ipswich and Springfield the Institute’s signature Resilient Regions Week featured invited expert and stakeholder discussions about how to overcome the urban/regional divide and actually achieve better health and well-being in regional communities – particularly by reducing the incidence and impact of major chronic diseases.

Two international keynote speakers attended as part of our partnership with CCQ.

Professor Heather Bryant from the Department of Community Health Sciences and Oncology at the University of Calgary and Chief Scientific Officer at the Canadian Partnership Against Cancer was joined by Professor Anil D’Cruz, Director of the Tata Memorial Hospital in Mumbai to lend insight to building effective health engagement strategies, particularly in disadvantaged and poorer communities.

They were joined by a line-up of local health care researchers and leaders including: Professor Jeff Dunn AO, Dr Kerrie Freeman CEO of the West Moreton Hospital and Health Service, Professor Scott Kitchener leader of rural health at Griffith University, Dr Dan Manahan, Director of Medical Services (Rural) at Darling Downs Hospital and Health Service, Associate Professor Jacki Shirmer, University of Canberra, Ms Jane Williamson, Chair of the Central West Hospital and Health Service and Dr Jeanette Young, Chief Health Officer, Queensland.

Focusing on the social and behavioural bases of health

If there was a clear message to come out of Resilient Regions Week this year, it was the complex regional health and well-being issues of Australia will not be solved simply by throwing more money at them.

The importance of the world we live in framing health behaviours and outcomes was made very clear by Dr Kerrie Freeman who told delegates that access to health care accounted for only 10% of population health outcomes, with up to 90% explained by social determinants.

Dr Freeman pointed to the some of the poorer peri-urban areas around Brisbane evidencing some of Queensland’s highest hospitalisation rates, with socio-demographic factors significantly increasing the health burden in these areas.

Besides confirming the need for a vastly improved community engagement in health and well-being issues in rural and regional Australia, delegates to Resilient Regions Week also strongly asserted the need for empirically rigorous evidence-based policy and relevant regulatory frameworks around health services.

Participants were reminded of the importance of policy being grounded in the facts by the launch of  A/Professor Jacki Shirmer’s Carers in regional Australia: 2016 Regional Well-being Survey Report which pointed to the human and social impact being wielded on families not so much by the ailing elderly but by drug and alcohol abuse among the young.

Emphasising that “health is everybody’s business” and a life course long engagement, Queensland’s Chief Health Officer, Dr Jeanette Young echoed the dominant themes of the week when she said the focus for Queensland Health was the promotion of well-being, delivery of healthcare, connecting healthcare systems and pursuing innovation.

Dr Young acknowledged that while substantial improvements have been made in some health outcomes, in a large far flung state like Queensland regional disparities in health and well-being derived from a mix of factors including lifestyle which evidenced in disproportionate levels of chronic disease in some regional areas.

The CHO identified social and behavioural change were key elements to achieving improved health outcomes in regional areas, but achieving it was difficult, complex and possible only over time.

She emphasised the importance of healthy lifestyles for reducing obesity and the incidence of chronic disease.

Going forward, she said, a whole-of-community approach was needed involving partnerships between local businesses, government, researchers and community organisations.

In short, partnerships, policy and public programs would all be better off when grounded on robust critically inquiring research, extensive data, and open useful shared information.

What came out of Resilient Regions Week 2017?

Across the events marking Resilient Regions Week a broad range of opportunities were identified for research and innovation in clinical practice, policy and stakeholder collaboration.

Overall there was a general call for well designed and engaged research that assisted:

  • Better understanding of the social determinants of health and development of interventions to address the social, demographic and lifestyle factors contributing to poorer health outcomes for regional populations;
  • Development of collaborative partnerships between government, community, practitioners and researchers to develop and implement effective behaviour change interventions for better health and better living;
  • Greater attention being given to patient-centric health care and strategies that delivered quality of life not just extension of life;
  • Process innovation and reform that made the health system more user friendly;
  • Better utilisation of regional practitioners and regional health services;
  • More effective deliberative engagement with the community.

In forthcoming blogs I will report on some of these themes in greater detail as reflected in stakeholder discussions during Resilient Regions Week

Notes:

[i] Garvan Research Foundation (2015) Medical Research and Rural Health – Garvan Report 2015

[ii] Ireland, M. J., March, S., Crawford-Williams, F., Cassimatis, M., Aitken, J. F., Hyde, M. K., … Dunn, J. (2017). A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia. BMC Cancer17, 95. http://doi.org/10.1186/s12885-017-3067-1

[iii] Yu XQ et al (2014) “Geographic variation in prostate cancer survival in New South Wales”, Medical Journal of Australia 200(10) 586-590

[i] This report has been prepared by Professor John Cole and Dr Sonja March drawing on notes of proceedings compiled by Dr Fiona Crawford-Williams, Dr Belinda Goodwin and Ms Arlen Rowe.

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