The World Health Organisation (WHO) defines the social determinants of health as the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.
The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. In Australia country people are subject to the same types of social disadvantage as can occur in cities (such as lower educational attainment, job uncertainties and unemployment, poor access to appropriate housing etc).
However, in rural and remote communities the health effects of this disadvantage are compounded by poor access to communications (such as high speed broadband, mobile phone coverage, public transport) and environmental challenges (such as drought, floods and bushfire).
In its recent Submission to the Senate Inquiry into the Extent of Income Inequality in Australia, NRHA highlights that income inequality (a primary determinant of health) has worsened for people in rural and remote areas over the past decade, and this has exacerbated access challenges to health, housing, education and work which they already face. NRHA calls for investment in regional development and jobs, through improved access to secondary education, high-speed broadband, renewable energy industries, and other means through which the economic base of rural regions can be strengthened.
The NRHA Media Release of 13 October 2014 makes a connection between Mental Health and Anti-Poverty Weeks, and there is a detailed Submission to the review of mental health services and programs. At its face-to-face meeting in Canberra in September 2014, Council of the Alliance confirmed the five top priority issues for the next few months in its CouncilFest Communique. They include the further threats to access to tertiary education for country people, and broadband connectivity.
The Alliance made a Submission to the Senate Inquiry into the proposed higher education reforms. Recent opinion pieces have described and analysed some of these matters. How to improve health services in the bush in the next ten years is an edited version of an address given by John Menadue in Adelaide in May 2014.
Measuring the fairness of the Federal Budget for rural people was the Alliance's initial response to the May 2014 Budget. Supporting the nation's disadvantaged makes the case for special measures that will ensure that "distance does not determine destiny". The socio-economic challenges of life in a rural or remote community are associated with significant health risk factors, such as higher rates of smoking, greater rates of disability and lower rates of physical activity.
The Alliance has produced an infographic on the higher rates of smoking in rural areas. The combination of remoteness and social disadvantage results in worse health outcomes, such as a greater rate of avoidable hospitalisations and avoidable mortality. The NRHA takes a broad view of health and is keen to pursue practical opportunities for addressing the social determinants of health in its work.
Some of our work with other organisations explores the inter-relationship between remoteness and the Socio-Economic Indexes for Areas (SEIFA) (which measures socio-economic conditions by geographical area). While SEIFA does not include any measure of rurality or reference to place, rurality itself appears to strongly influence most of the variables used in its calculation.
The NRHA is a member of the Social Determinants of Health Alliance (SDOHA), a collaboration of organisations in health, social services and public policy established to work with governments to reduce health inequities in Australia.
In 2013 the NRHA and the Australian Council of Social Service (ACOSS) came together to release A snapshot of poverty in rural and regional Australia highlighting the devastating impact of financial and other disadvantage on people's lives and on country towns and communities. The report shines a spotlight on some of the things that prevent people in country areas from attaining the basic standard of living and access to services that their urban counterparts take for granted.
Out-of-pocket health care costs are a particular issue for rural people and the Alliance made a Submission on the matter to the Senate. Earlier the NRHA made a submission to the Senate Inquiry into Australia’s domestic response to the World Health Organisation's (WHO) Commission on Social Determinants of Health report "Closing the gap within a generation". The Senate Committee’s 2013 Report recommended that the Government adopt the recommendations of the WHO Report and commit to addressing the social determinants of health relevant to the Australian context, noting the health consequences of living in rural and remote locations.
For more information, see the NRHA’s Fact Sheet: The Determinants of Health in Rural and Remote Australia
Read an editorial written by three NRHA Council members in the Australian Journal of Rural Health (AJRH).
Consider the 2012 NATSEM publication The cost of inaction on addressing the social determinants of health.
Your thoughts and comments on practical ways for the NRHA to progress this work are welcome.