Whatever improvements are made in the spatial distribution of health professionals and services, it will always be the case that more specialised health interventions will be available face-to-face only in larger centres.
This is due to the high cost of specialised services and the need for a critical mass of patients for each of them. There are two options for connecting patients from remote areas with the specialised interventions they need. Either the patient must travel to a larger centre for face-to-face consultations; or the patient and the clinician can have virtual meetings using video, audio and text to link up online.
The coronavirus pandemic has had the effect of dramatically increasing government support for health videoconferencing. This is a good thing as long as telehealth, in all of its manifestations, continues to be seen as a second-best option and that efforts to provide face-to-face contact between patients and clinicians are not diminished. The NRHA will no doubt continue to monitor developments on this front.
But what of the other option? Is it possible that the pandemic might also lead indirectly to a greater proportion of people in more remote areas having face-to-face access to a wider range of specialist health services?
This could come about through the further development of regional centres. And that would meet several of the needs now confronting governments more urgently as a result of the pandemic.
Not infrequently the ultimate conclusion of a social determinants approach to better health is that regional development is the best omnibus medium-term strategy to be adopted, including for recruiting and retaining health and other professionals in country areas.
Regional development and good health are mutually supportive. By providing jobs, services and infrastructure, regional development contributes to the social determinants of good health. In return, a healthy community provides one of the bases for successful local businesses.
Writing in 2005 Richard Stayner concluded that:
'- inland Australia would appear to have few rural centres with a high inherent potential for population growth. The key brute economic facts of inland rural Australia are its relatively low densities of population and production, and its disadvantage compared with the capacity of the cities to offer access to dense networks of knowledge rich resources that are increasingly important to new economic activity.’ Stayner, Richard, Changing economics of rural communities, in Sustainability and Change in Rural Australia, ed Chris Cocklin and Jacqui Dibden, University of New South Wales Press, Sydney, 2005.
For some time now Australia's major cities have displayed increasing diseconomies of size, as evidenced by traffic congestion, commuting time, low affordability of housing, income inequality, and concerns about environmental sustainability and economic productivity.
Despite this it has been estimated that Australia's four major cities will grow by nearly 15 million people over the next 35 years. If too few centres have the 'inherent potential' for population growth, governments will need to intervene if the growth of the major metropolitan centres is to be kept within reasonable bounds.
Net international migration gain has been the most significant driver of metropolitan population growth, while internal migration has underpinned the growth of other regional centres. This situation will certainly change, at least for a short time, due to greater uncertainties than ever before about the health and safety, security and feasibility of international migration.
A reconfiguration of Australia's pattern of population settlement will make both the capital cities and other regional centres more liveable, equitable, efficient and environmentally sustainable.
And it would also meet a number of critical requirements in Australia's recovery from the economic setbacks brought about by the pandemic.
The fiscal context might seem to make any government's intervention less likely given that for years to come there will be a struggle between tax revenue and expenditures. (It is to be hoped that, even if nothing else has changed, this struggle is unaffected by the rebirth of a 'deficit phobia'.)
Offsetting the fiscal environment is the fact there are some strong national reasons why the federal government should invest rapidly and significantly in regional development.
For one thing the further development of infrastructure, especially for transport, in the major cities is becoming more expensive and more fraught in political and environmental terms.
As already described, regional development and good health are mutually reinforcing. There is probably no cheaper or surer way to equalise health status and health services between metropolitan and country areas than through the creation of diverse economies and good jobs in country areas. And if they can be assured of good local health services, workers and entrepreneurs will more readily stay in those country areas.
Then there is the situation facing universities in regional centres. As we understand it, some regional universities are currently feeling the financial pinch, with the loss of revenue from overseas students compounding a fundamental financial fragility.
It is essential that Australia maintains and builds up its high quality universities in regional areas. In many areas including STEM and health sciences there is ample evidence of the significant contribution made for local students by regional universities. Where health professionals for rural and remote areas are concerned, much more is expected of the practice in country towns and rural regions of 'growing their own'.
For another thing, it will help enormously in rebuilding the economy and providing jobs if Australia has some major projects of national significance. One of these, a very fast train between Brisbane and Melbourne, which would have particular significance for rural Australia, is the subject of a following piece for Partyline.