As a country, we have adopted the view that egalitarianism is quintessential to the Australian character – summed up by the notion that everyone here is given a ‘fair go’. But the factors which shape our individual and collective health are not weighted equally.
The social determinants of health will inform an individual’s health and wellbeing throughout their lifetime. Gender, economic status, disability, cultural practices, connection to Country, sexuality – and, yes, rurality – collide with the impacts of urban bias, ableism, racism, sexism, ageism, climate inaction, heteronormativity, poverty, mental health stigma and the legacy of colonisation. This complex set of interactions will influence how we are affected by illness and injury, and how we will fare accessing health services. The difference between equality and equity is an important distinction which explains why a ‘fair go’ must be tailored to the specific needs of any given community.
Earlier this year, Women’s Health Goulburn North East (WHGNE) surveyed residents of communities across north-east Victoria and the Goulburn Valley, to better understand the impacts of the COVID-19 pandemic on the health and wellbeing of rural Victorians. Survey respondents expressed the sense that existing inequities were exacerbated during the pandemic. Vulnerable residents were most severely impacted, experiencing increased risk of family violence and homelessness, which in turn has contributed to the overall decline in mental health and wellbeing within communities.
The perceived pressures on women during the pandemic were multilayered, with one respondent commenting: ‘I do feel the burden of change rested solely with me to work from home, care for children too young for childcare, remote teaching of older children and going to the supermarket but nowhere else.’
The gendered expectations on women to accept multiple, concurrent responsibilities during lockdowns has been cited as impacting mental health within the recent Stronger Futures study.
Respondents to our Community Voices survey from the healthcare sector were similarly under immense strain: ‘From late 2021 our fear has been for the mental health of ourselves and our colleagues.’
The burnout experienced by healthcare workers is indicative of a stretched system. One respondent poignantly reflected on service provision in their community: ‘Most services and supports aren’t really available. They say they are, but the waiting list might be more than six months. I don’t even bother seeking support anymore. Nobody does anything, nobody cares, no-one has enough time, no-one has the resources.’
The question then becomes how to embed consideration for the social determinants of health and provide equitable services to diverse communities during times of emergency and recovery. The answer to this question is not an easy one, but one we must all ponder as the global pandemic continues and extreme climate events increase.
Rural communities are particularly at risk of poor health outcomes during times of disaster and recovery, due to limited services and isolation – the tyranny of distance and urban bias. At WHGNE we apply a gendered and rural lens to our health promotion work in the prevention space. Prevention means working within the systems and structures of society to address the underlying factors which manifest as inequitable structural and health outcomes. Our work uses quantitative data to fill in the big picture, but we also value lived experience that centres the voices of rural women – after all, statistics are not people.
The Community Voices survey highlights the stark need for emergency prevention, planning, response and mitigation that considers both the existing social inequities in any given community and the aftermath of disaster on mental health – particularly in smaller, rural communities vulnerable to climate emergencies and barriers to access. If we can address inequity, we might just achieve equality.