The UDRH Program and the RCS Program were designed as workforce strategies to address the shortage of health practitioners within rural and remote Australia. Their separate but parallel development in the late 1990s followed a growing recognition of the worsening shortage of medical and other health practitioners in rural Australia, and was accompanied by the growth of peak bodies and professional colleges, such as the Australian College for Rural and Remote Medicine (ACRRM) and the Services for Australian Rural and Remote Allied Health (SARRAH), which advocated for additional support for health professionals in order to retain services in rural communities. All of this occurred in a national climate of decreasing services to rural communities among other sectors, including banking and retail services, which had created a sense of crisis regarding the viability of rural Australia.
The challenge of providing adequate health services to people in rural and remote Australia has existed since the earliest days of the nation. As the country has experienced ebbs and flows in population growth, the question of how to provide well for people outside of metropolitan areas has been debated, not only with regard to health care but also with regard to basic services such as transport, banking tele-communications and retail services. Within the last ten years, Australia's significant health workforce shortage has been mirrored by a decline in rural population. Due to a variety of forces including drought, the 'flight' of young people from rural communities, and restructuring within the agricultural sector, many localities within rural Australia have lost population to urban areas. Figure 2 below highlights the extent of rural population decline, with approximately 60% of non-urban statistical local areas (SLAs) losing population between 2001 and 2006 (light-coloured areas indicating SLAs experiencing a decline in population).
Figure 2 – Population increase in Australia, June 2001 to June 2006
Source: ABS, Regional Population Growth, Cat. No: 3218.0.
The issues affecting the provision of health care in areas where population density is low, settlements small, and distances large are aggravated by 'problems of isolation, population transience and the high capital costs of infrastructure. Coupled with this is the ongoing difficulty of recruiting and retaining an appropriate workforce' (Wakerman et al, 2006).
The recent Report on the audit of health workforce in rural and regional Australia (Department of Health and Ageing 2008a) aimed to provide an up-to-date picture of health workforce distribution in rural and regional areas, although it was limited in coverage to those professions currently registered in all States and Territories and for which current data across States and Territories are broadly comparable, as well as being those occupations that are covered under the Medicare Benefits Schedule. The report found that, with the exception of nurses, the availability of medical and health professionals in rural and regional areas was generally low to very poor. This maldistribution is compounded by changing workforce characteristics, including a trend towards fewer working hours and an ageing working population (Department of Health and Ageing 2008a). Other studies have indicated that reported access to services is also worse in rural and regional areas (see for example Hausdorf et al 2008).
It is difficult to consider rural health without acknowledging the unacceptable health care outcomes experienced by Indigenous Australians, 47% of whom live in rural and remote Australia (Australian Bureau of Statistics 2008). In most cases, rural health strategies have endeavoured to integrate with Indigenous health strategies, with varying degrees of success.
Wakerman et al (2006) suggest that rural health care policy since the early 1990s has been driven by two key assumptions:
- that the health of rural and remote populations is worse than their urban counterparts; and
- that healthcare resources are substantially less available to rural and remote populations than to urban populations.
Specific policies have been identified to address these issues, and rural health measures became a part of annual health budgets from the early 1990s. The most significant focus of such policy developments has been to improve the rural health workforce shortage, with some success, partly due to the investment the Commonwealth Government has made towards this goal. In addition, there have also been efforts to directly address specific health issues in rural areas (Wakerman et al 2006).