Here's proof: rural and remote health research critically underfunded

Rural health research attracted an average of just 1.1% of National Health and Medical Research Council (NHMRC) funding from 2000 to 2014.

That's despite a third of Australians living in rural and remote areas.

A recent article by Lesley Barclay, Andrew Phillips and David Lyell called Rural and remote health research: does the investment match the need? investigated levels of funding to health research which would benefit country Australia.

It provides evidence for what has long been suspected: that rural and remote health has been critically underfunded.

The article was published in the April edition of the Australian Journal of Rural Health - the National Rural Health Alliance's peer reviewed journal.

Every year the NHMRC distributes around 800 million dollars in medical and health research funding.

This money funds research into cancer ‘cures’, better ways of addressing cardiovascular disease, diabetes, better surgical procedures, valuable epidemiological studies, better public health initiatives, social determinants of health, preparing for the health effects of climate change, and so on. The NHMRC also prioritises research that helps to improve the health of Aboriginal and Torres Strait Islander peoples.

But, is the benefit afforded by the bulk of NHMRC research (such as better treatments, medicines, more effective surgery, or better preventive health practices) equally available across the country, to the poor, the ethnically diverse, Aboriginal and Torres Strait Islander people, or to people who live in rural and remote Australia? The short answer appears to be “no”.

Gordon Gregory, former CEO of the National Rural Health Alliance has put it this way: “If a major breakthrough is dependent on communication, technology, a critical mass of patients, on cost and affordability, or on the services of clinicians, then rural people will not be the main beneficiaries.”

NHMRC funded research translates into improvements in a whole range of health interventions, but access to these interventions is unevenly distributed across the country.
 
For example, mental health expenditure by government, and access to psychiatrists, psychologists and mental health nurses are much poorer in rural and remote Australia than in the major cities. Any improvement or breakthrough in treating or managing mental illness will be less available for people in rural and remote Australia, simply because there are fewer health professionals to provide that treatment or management.

Similar patterns apply for other conditions, with the availability of medical specialists, dentists, pharmacists and the full range of allied health professionals in much lesser supply outside Major cities.

It is hardly surprising that health outcomes outside major cities are worse, with a combination of: poorer social determinants such as lower incomes and more limited access to work and education; a poorer risk factor profile, including higher rates of smoking and overweight; and lower access to health services. Research into any of these in relation to living in rural and remote locations has to be a priority.

The authors argue that to address this shortfall, research that seeks to address the imbalance in service delivery or to otherwise benefit the health of people living in rural and remote Australia should be given priority. This includes a need for research that specifically benefits the 65 per cent of Aboriginal and Torres Strait Islander people who live outside Major cities.

“Research is needed to improve rural and remote social determinants and to develop and evaluate services that are fit for purpose and designed in ways that enable optimal clinical supervision and quality control, sometimes in challenging circumstances”.

Although the percentage of the funding pool distributed by NHMRC specifically benefitting people living in rural and remote Australia has increased in the decade to 2014, how much should it be? Clearly, there is some degree of access to the fruits of medical research even for those living in the most remote locations, but until the level of access to services and the health profile of people living in these areas reaches that of major cities, a greater level of research funding commitment can be argued.

The full article Rural and remote health research: Does the investment match the need? Can be found at
https://doi.org/10.1111/ajr.12429