In an ideal world, geography would make no difference to health care. There would be the same level of service provision in the bush and the outback as there is in the city and there would be no difference in health outcomes.
But the world is not ideal. Australia is a vast land, similar in size to the continental USA. Most Australians (72%) live in major cities – and so most health services and specialists are concentrated there too.
Yet the need, paradoxically, is greater in rural and remote areas. In 2018, after adjusting for age, the total burden of disease and injury in Australia rose with increasing remoteness, according to the Australian Institute of Health and Welfare (AIHW).
Distance is a significant barrier to healthcare for those living in rural and remote areas. While many places have a small primary care presence, specialist care is elusive in the bush and most people must travel to the nearest large city for their consultations, tests and procedures. The time and cost involved in this are often prohibitive.
Improving healthcare in rural and remote areas cannot rely on an expectation that sick people should travel long distances to access specialist services. We need to invest in taking healthcare to the people. Mobile facilities are the way to do that.
Rural and remote life in Australia
The AIHW reports that around 7 million people, or 28%, of Australians live in rural and remote areas.
There are many upsides to living in a rural or remote area. As the National Rural Health Alliance notes, there’s often more social cohesiveness and community involvement and a better work-life balance. Being surrounded by natural beauty can also have a restorative effect.
One rural doctor finds much to admire in her patients yet also notes the difficult conditions many of them face.
With their patience, resilience, blunt honesty and determination, north-west Queenslanders endure and survive illness and trauma like few others in the country could. Their pain tolerance is so high. About half of the people with septic joints will walk in using them. I’ve had people with ruptured spleens reporting no pain in the abdomen.
However, I am aware that much of what brings my patients to the hospital, outside of rodeo injuries, stems from extreme poverty and incredible levels of disempowerment…We also see diseases that are rarely seen in cities such as syphilis, rheumatic fever, and TB.
Dr Julia de Boos, Director of Emergency Medicine Training, Mount Isa Hospital
People living in rural and remote areas are:
- Less likely to have completed Year 12
- Less likely to be employed
- Have a lower level of income yet pay higher prices for goods and services
- More likely to have arthritis, asthma or diabetes
- 1.4 times more likely to experience partner violence than those living in cities
- 24 times more likely to be hospitalised as a result of domestic violence than their city counterparts
- More likely to be Indigenous
- More likely to engage in risky health behaviours like smoking or drinking to excess
- More likely to die prematurely
- 3-4 times more likely to die in a motor vehicle accident than their city counterparts.
In short, this is a group of people who need good access to healthcare. Yet, as the AIHW notes,
People living in rural and remote areas face barriers to accessing health care, due to challenges of geographic spread, low population density, limited infrastructure, and the higher costs of delivering rural and remote health care.
The National Rural Health Alliance reports that Australians living outside major cities are:
- Three times more likely to rate access to general, specialist and mental health services as poor
- 40% less likely to use Medicare than those in major cities.
Almost 43,000 Australians have no access to any primary care services and 65,000 have no access to a GP within a 1-hour drive from home.
Poor access to primary care has consequences. It leads to higher rates of potentially preventable hospitalisations (PPH). Compared to major cities, the rate of PPHs is higher by 11% in inner and 22% in outer regional areas, 70% in remote areas and 154% in very remote areas.
How mobile healthcare benefits communities
The idea of taking healthcare to the people who need it is not new. It is over 100 years since Reverend John Flynn began campaigning for an aerial medical service to throw a ‘mantle of safety’ over the Australian outback, a vision which took shape in 1928 as the Aerial Medical Service, the forerunner to the Royal Flying Doctor Service.
More recently, many other services have begun delivering specialist healthcare to the bush including:
- Heart of Australia, which delivers monthly specialist medical investigation and treatment clinics to 33 regional, rural and remote area communities across Queensland. Specialties include cardiology, endocrinology, gastroenterology, gynaecology, neurology and gerontology.
- The Lions Outback Vision Outreach Service, which transports ophthalmologists to rural and regional communities in Western Australia.
- The specialist outreach program run by Queensland’s North West Hospital and Health Service. Services include cardiology, orthopaedic surgery, diabetes education and childhood immunisation.
These services all aim to overcome the tyranny of distance. They seek to improve health outcomes through easier access to healthcare, earlier diagnosis and more convenient treatment.
- “We’re 300 km from Dalby, which is 100 km from Toowoomba, which is 100 km from Brisbane, so you have to be able to get down there, find accommodation and you have to be able to afford it. It’s a real headache.”
- “How am I gonna get days off work to do that, how am I gonna find the money? The convenience of having the truck is probably what set me on the path to getting proper assistance.”
- “I’ve been here about 43 years and been to the doctor maybe 6 times until I felt this flutter. You’ve got to organise someone to look after this place [the farm] so you can go to Brisbane. It’s tough. Then the Heart of Australia truck came to us.”
- “If we didn’t have the Heart of Australia truck here, [my husband’s] follow-up treatments would have required even more trips to the city.”
- “It’s easy. It’s only walking distance to see the doc.”
- “Just as good as any service I got in Brisbane, I can tell you that.”
Other benefits of mobile healthcare facilities
Mobile healthcare yields other benefits too. Travel creates a considerable carbon footprint. Requiring rural and remote patients to travel to the city means many individuals covering hundreds of kilometres by road or air.
Taking healthcare to the people, in contrast, means one small team of professionals travelling to a central location where they can treat numerous patients from that township and its outlying areas. It’s a much smaller carbon footprint.
If you’d like to explore how your hospital or health service could use a mobile facility to support patients in rural and remote areas, please contact Q-bital Healthcare Solutions.