The Strategic Review of Health and Medical Research (the McKeon Review) is an important opportunity to assess the relationship between the body of effort in an important area of scientific endeavour and the national interest.
To be effective, health and medical research must encompass more than basic discovery and ‘biomedical inquiry’. For example it must also improve our understanding of the significance of the social determinants of health and provide an evidence base for analysis of health services.
If the national COAG objective for social inclusion is to be met, health research and consequent policy and program endeavour must give some priority to population groups with particular needs. A specific interest of the NRHA is the extent to which the national research sector is sensible of the needs of Australians who are geographically isolated and/or socio- economically disadvantaged.
In Australia some seven million people - one third of the population - live outside major cities. Overall they have higher rates of health risk factors, poorer access to health services and worse health outcomes than city people. Health research has an important role to play in improving health equity between rural and city areas.
Research answers developed in a metropolitan context do not always ‘translate’ to rural settings, where the potential gains from the resolution of challenges are greatest. Research to provide the evidence for health system change and support its dissemination and translation into practice may be out of scope under the NHMRC’s Act, and health services research still receives only 5 per cent of all NHMRC funding.
At present much of the research and evaluation to underpin systemic change is commissioned by government or let through competitive tenders, but not within a strategic health and medical research framework. These evaluations involve large investments of public money for short term consultancies without true scientific accountability.
The rural and remote health research sector has rapidly built a good reputation for the national and international contribution it is making to understandings about rural health and wellbeing. However the number of health researchers located rurally is small and needs to increase, as do training opportunities for them.
By being located in rural, regional and remote areas, University Departments of Rural Health (UDRHs) and Rural Clinical Schools (RCSs) are able to uniquely address health outcomes at community level in ways that are relevant to the health professional and health service patterns of those communities.
A proportion of the test sites or lead implementation sites for major government investments in health should occur in challenging rural and remote situations. This would serve those rural and remote places well and also, by meeting challenges where they seem most intractable, provide useful information for action elsewhere. There are opportunities in such areas as broadband applications, eHealth records, quality improvement and health promotion. The development and implementation of electronic health records in the Northern Territory is one such example: it has grown from community collaborations over a number of years and is now inspiring and informing work in other difficult settings.
Rural and remote areas are not homogenous. There are places with fluctuating populations and ‘casual’ patients with fly-in fly-out work. There are areas with seasonal local industries, and others with high proportions of Aboriginal and Torres Strait Islander people.
Developments in these sites need to be monitored and evaluated for local as well as systemic effectiveness and rural and remote health researchers should play a part. Industries and institutions that are ‘rural’ are likely to be more committed to support the search for applied results.
All of this diversity must be recognised in the national rural health research and health reform effort. Stronger links between health and medical research and program implementation will allow a systematic move towards to more equitable health outcomes across the country.
After the McKeon Review it is to be hoped that health research undertaken in rural locations on rural issues is given the recognition it deserves and the opportunity to continue making a major contribution to better health for the people of rural, regional and remote Australia.
This will help meet serious deficits and ensure that rural areas continue as incubators of health service and workforce innovation.