3. “Health?”
1. the general condition of the body or mind with reference to
soundness and vigor: good health; poor health.
2. soundness of body or mind; freedom from disease or
ailment: to have one's health; to lose one's health.
3. a polite or complimentary wish for a person's health,
happiness, etc., especially as a toast: We drank a health to our
guest of honor.
4. vigor; vitality: economic health.
WHO definition of Health :
“Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity.”
4. “Rural?”
• NZ Statistics
• Local authorities
• Universities and
academics
• Ministry of Health
• Rural Providers
• International
“There is no one accepted
definition of what it
means to be a rural
community.”
5. New Zealand
Urban areas
Main urban Satellite urban
Independent
urban
Rural areas
Rural with high
urban influence
Rural with
moderate urban
influence
Rural with low
urban influence
Highly rural /
remote rural
NZ Statistics definitions
6. New Zealand Stats Definitions adapted
by the National Health Committee
“Rural “
• Highly Rural/Remote Areas
• Rural Areas with Low Urban Influence
• Independent Urban Areas
• Rural Areas with Moderate Urban Influence
‘Urban’
• Main Urban Areas (population of 30,000 and over)
• Satellite Urban Areas
• Rural Areas with High Urban Influence
7. New Zealand
Urban areas
Main urban Satellite urban
Rural with high
urban influence
Rural areas
Independent
urban
Rural with
moderate urban
influence
Rural with low
urban influence
Highly rural /
remote rural
NZ Statistics definitions
adapted
12. Historical Context
In the 19th Century lived
in rural areas.
By 2001 New Zealand
one of the most
urbanised countries in
the world.
Between 1881 and 2001
the population of urban
New Zealand increased
by over 1,500 percent,
compared with an
increase in rural areas
of 83 percent.
In 1916, there were 501,258
people in rural areas (excluding
Mäori).
In 2001, there were 532,740
people in rural areas (including
Mäori).
13. New Zealand Rural Demography
• Urbanisation over the past 150 years – but still
22% of population rural, occupying 80% of the
land.
• Larger proportion of children
• Higher median age
• Older Maori population compared to urban
• Higher deprivation in most rural areas
• (Lowest deprivation in rural areas with high urban
influence)
• Lowest levels of employment in more rural areas.
16. Why does “rural health” matter?
We believe in democracy, the rule of
law, tolerance, freedom, equality,
security, fairness, honesty, and the All
Blacks.
17. Urban : Rural Disparities
Internationally
Increased risk of avoidable death
Work injuries more severe
More MVAs
Animal contact diseases
Higher alcohol and tobacco consumption
Higher stress related illness
18. Rural vs Urban Health Outcomes
Australia
• Higher rates of suicide.
• Injury from motor vehicle accidents.
• Melanoma.
• Cervical and prostate cancers.
• Cardiovascular disease.
• Obesity.(1)
19. NZ Rural physical, mental and social
well-being
• Worse outcomes for cancer. (1)
• Rural Maori have a lower life expectancy than urban Maori.
• Higher rates of injury, poisoning and spinal disorders.
• Higher rates of female current smokers.
• Less likely to have seen a general practitioner (GP) in the
last year.
• Less likely to have had test, a vaccination, or be diagnosed
with a chronic disease.
• Higher rate of using public hospitals in the last year.(2)
• Higher risk of male suicide.(3)
• Higher rates of animal and poor water associated
diseases(4)
21. Rural : Urban disparity cycle
• Poverty
• Low health status
• High burden of disease
• Low productivity
Solution : Good health increases well being, and therefore increases social and
economic productivity.
Ill health effects not just the poor but whole economies .
(World Health Organization. Global Forum for Health Research.
10/90 Report. Switzerland: WHO; 1999.)
22. Workforce Issues
• 25% of practices are
looking for nurses or
GPs nationally
• 57% of rural GPs are
international medical
graduates and the
average age of a rural
GP is between 50 and
55 years.
• Locally we have
vulnerable practices in
all areas for various
reasons – family
pressures, ageing,
isolation, after hours
pressures, finances..
23. access is the rural health issue
• rural needs are different
• local services are preferred
• communities need “safety net”
• resources concentrated in cities
• communication and transport difficulties
• rural health workforce shortages
Rural Health Around the World
24. Rural Practitioners
• wide range of services
• high level of clinical responsibility
• relative professional isolation
• specific community health role
• specialist partnership not putdown
“Extended Generalists”
25. Inter-professional teamwork
- workforce shortages
- people embedded in communities
- it’s about the relationships
- “do the necessary”
Much talked about in the cities actually
happens in rural communities
Improved efficiency, improved efficacy, reduced harm,
reduced waste, improved satisfaction.
26. What is needed for Sustainable
Rural Health Services ?
• health service authority/agency
support
• health care providers
• community participation
27. Rural Based Medical Education
• great response to workforce shortages
“grow your own”
• socially accountable
• rural specific knowledge and skills
• high quality learning environment - more
hands-on experience, greater procedural
competence, more common conditions.
28. Impact of Rural Based
Medical Education
• more skilled rural
doctors
• enhanced rural
health care
• improved rural
health outcomes
• broader academic
developments
• economic
developments for
regions
29. Australian Rural Recruitment Initiatives
Recruitment Initiative Oz Response
Rural Upbringing Preferred entry and bonding
schemes
Positive undergraduate
experience
Rural Based Medical
Education
Rural Undergraduate
Support and Coordination
Supported
Postgraduate
education
Rural Postgraduate Training
- GP and Specialist
30. Australian Health Retention Initiatives
Retention Activity Oz Response
Academic involvement Rural Clinical Schools
University Departments of
Rural Health
Recognition and
reward
Retention Payments
Support from “the
system”
Rural and Remote GP
Program
Rural Workforce Agencies
Active community
engagement
Patient participation in rural
clinical schools
31. New Zealand Rural Recruitment Initiatives
Recruitment Initiative NZ Response
Rural Upbringing Preferred entry schemes
Positive undergraduate
experience
“Grassroots” clubs
6th year GP run for 6 weeks
Limited place “immersion” in
5th year
RHIIP 6 weeks in Gisborne /
Whakatane
Supported
Postgraduate
education
PGGP 3 months opportunity
Voluntary bonding scheme
32. NZ Rural Health Retention Initiatives
Retention Activity NZ Response
Academic involvement Dept. of rural health Otago Uni
Waikato clinical school
Auckland Uni
Recognition and reward “rural premium” payments
Support from “the system” “alliancing”
Active community
engagement
?
38. Although the number of people living in rural NZ is growing ….
… the proportion of the population living in rural NZ is falling …
This effects the way central government sees rural NZ and the people living there.
Editor's Notes
http://www.who.int/about/definition/en/print.html
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
The Definition has not been amended since 1948.
http://dictionary.reference.com/browse/health
Highly Rural/Remote Areas: These areas have minimal dependence on urban areas in terms of employment. They cover 48.4 percent of New Zealand’s land area, are home to
1.6 percent of the population, and have a population density of 0.5 people per square kilometre.
Rural Areas with Low Urban Influence: The majority of the population in these areas works in a rural area. These areas cover 35.8 percent of New Zealand’s land area, are home to 5.5 percent of the population, and have a population density of 2.3 people per square kilometre.
Independent Urban Areas: These areas have little or no connection to a Main Urban Area, are often service centres for the surrounding rural communities, and have an interdependent relationship with them. The NHC considers these features most relevant to the question of access to rural health services. Independent Urban Areas are the least affluent of the seven categories.
Rural Areas with Moderate Urban Influence: In these areas a large percentage of the resident employed population works in a minor (population of 1,000–9,999) or secondary (population of 10,000–29,999) urban area, or a significant, but smaller, percentage works in a main urban area. These areas are a lesser focus of this report, sharing some qualities with more remote communities and some with peri-urban communities.
This NHC report defines as ‘Urban’ the three Urban/Rural Profile categories:
Main Urban Areas (population of 30,000 and over)
Satellite Urban Areas (towns with 20 percent or more of the population working in Main Urban Areas)
Rural Areas with High Urban Influence, which are near Main Urban Areas and the services they provide.
Highly Rural/Remote Areas: These areas have minimal dependence on urban areas in terms of employment. They cover 48.4 percent of New Zealand’s land area, are home to
1.6 percent of the population, and have a population density of 0.5 people per square kilometre.
Rural Areas with Low Urban Influence: The majority of the population in these areas works in a rural area. These areas cover 35.8 percent of New Zealand’s land area, are home to 5.5 percent of the population, and have a population density of 2.3 people per square kilometre.
Independent Urban Areas: These areas have little or no connection to a Main Urban Area, are often service centres for the surrounding rural communities, and have an interdependent relationship with them. The NHC considers these features most relevant to the question of access to rural health services. Independent Urban Areas are the least affluent of the seven categories.
Rural Areas with Moderate Urban Influence: In these areas a large percentage of the resident employed population works in a minor (population of 1,000–9,999) or secondary (population of 10,000–29,999) urban area, or a significant, but smaller, percentage works in a main urban area. These areas are a lesser focus of this report, sharing some qualities with more remote communities and some with peri-urban communities.
This NHC report defines as ‘Urban’ the three Urban/Rural Profile categories:
Main Urban Areas (population of 30,000 and over)
Satellite Urban Areas (towns with 20 percent or more of the population working in Main Urban Areas)
Rural Areas with High Urban Influence, which are near Main Urban Areas and the services they provide.
Whakatane, Opotiki, and Kawerau are all classed as “independent urban communities”
Whakatane, Opotiki, and Kawerau are all classed as “independent urban communities”
Independent Urban Areas: These areas have little or no connection to a Main Urban Area, are often service centres for the surrounding rural communities, and have an interdependent relationship with them. The NHC considers these features most relevant to the question of access to rural health services. Independent Urban Areas are the least affluent of the seven categories.
Independent Urban Areas: These areas have little or no connection to a Main Urban Area, are often service centres for the surrounding rural communities, and have an interdependent relationship with them. The NHC considers these features most relevant to the question of access to rural health services. Independent Urban Areas are the least affluent of the seven categories.
In Australia 40% of work injuries are related to tractors, only 5% of people work with tractors.
Further to travel by road to work , so more likely to have an MVA
Animal contact – zoonoses, leptospirosis, hydatids, animal vectors
Economic changes felt more acutely in rural areas.
(1)
Smith K, Humphreys J, Wilson M. 2008. Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research? Australian Journal of Rural Health 16: 56– 66. p 57.
Sources:
Robson B, Purdie G, Cormack, D. 2010. Unequal Impact II: Māori and Non-Māori Cancer Statistics by Deprivation and Rural–Urban Status, 2002–2006. Wellington: Ministry of Health.
Ministry of Health. 2007. Urban–Rural Health Comparisons: Key results of the 2002/03 New Zealand Health Survey. Wellington: Ministry of Health
3. Min S. 2008. Suicide trends in New Zealand 1993–2003: Are there differences between rural and urban incidence rates? PhD thesis, University of Auckland.
4. Duncanson M, Russell N, Weinstein P, et al. 2000. Rates of notified cryptosporidiosis and quality of drinking water supplies in Aotearoa, New Zealand. Water Research 34: 3804–3812.
