The National Strategic Framework for Rural and Remote Health (the Framework) was developed through the Rural Health Standing Committee, a committee of the Australian Health Ministers’ Advisory Council, and agreed by the Standing Council on Health, the committee of Ministers of Health, in late 2011. It was launched in 2012. The Framework was developed through a consultative process that included significant input from the National Rural Health Alliance (the Alliance) and other rural and remote health stakeholders, including State and Territory governments.
While the Framework can be accessed through the Department of Health website, it is not in use. No reporting has ever been undertaken to present an update on progress, recognition of the range of policies and programs implemented by Commonwealth, State or Territory Governments to address the goals of the Framework, or to examine the effectiveness of the Framework in addressing those goals.
Further, the health workforce strategy developed as a companion document to the Framework – National Health Workforce Innovation and Reform Strategic Framework for Action 2011– 2015 – is also no longer in use, having been archived when the Health Workforce Agency was disbanded in 2014.
At the time, the Alliance called for a National Rural and Remote Health Plan to be developed to operationalise the Framework, but this never eventuated. The role of a comprehensive Framework to guide and direct better health outcomes in rural and remote communities is critical. Where players from communities, jurisdictional and private health providers and federally-funded organisations come together to meet the challenges of delivering health services in rural and remote communities, it must be through a shared understanding of the issues and a clear vision for the future.
At the outset, the Framework acknowledged that the people who live in rural and remote Australia “tend to have lower life expectancy, higher rates of disease and injury, and poorer access to and use of health services than people living in Major cities”.
Drawing on the Australian Institute of Health and Welfare publication Australia’s Health 2010, the Framework identified key areas of concern with regard to the health of people in rural and remote communities, particularly:
· higher mortality rates and lower life expectancy;
· higher road injury and fatality rates;
· higher reported rates of high blood pressure, diabetes, and obesity;
· higher death rates from chronic disease;
· higher prevalence of mental health problems;
· higher rates of alcohol abuse and smoking;
· poorer dental health;
· higher incidence of poor ante-natal and post-natal health; and
· higher incidence of babies born with low birth weight to mothers (in very remote areas).
The Framework does not include data quantifying these concerns. In referring back to Australia’s Health 2010, the data used to describe the health of people in rural and remote Australia is from 2004-2006 – it was already up to six years old at the time the Framework based on it was launched. It is very difficult to plan appropriately to address inequality when data is this out of date.
Perhaps the biggest gap in the Framework is that it does not link the inequities it identifies in rural and remote health generally to the five goals it develops. While this is largely due to a lack of narrative, what this lack of narrative does is lose the unifying rationale for the five goals and how they will work together to make a difference to the inequities identified in the Framework. If this was simply a lack of a coherent narrative to drive the needed policy responses, it may be excusable. But unfortunately, the lack of this coherent narrative has resulted in:
· lack of recognition of the need for baseline indicators against which progress can be measured and reviewed;
· loss of the connectedness of the goals – at the Commonwealth level we now see rural health reduced to workforce policy responses without a clear understanding of how those responses will actually lead to improvements in health outcomes and the range of health inequities in rural and remote communities; and
· undermining one of the most crucial needs underpinning the Framework as a whole – the need for quality and TIMELY data.
The lack of good quality, current, data is apparent as soon as you begin to seek answers to the question “what has the Framework achieved?”
In developing this Discussion paper, the Alliance is seeking to undertake a high level, selective assessment using publicly available data to ascertain to what extent progress is being made in addressing health concerns and inequities in rural and remote Australia, referencing back to the goals and outcomes set out in the Framework. Where related specific programs stemming from the Framework can be identified and their outcomes assessed, this will be included in the discussion. Given there are nine specific issues identified in the Framework and set out in dot point format above, the Alliance will seek information on only three to discuss whether any change in outcomes following the implementation of the Framework can be assessed accurately, and if so, what outcomes were achieved.