Does it matter what it is? 4 ‘Rural’ Health What is it? Does it matter what it is? Intro myself Thanks organisers Garry Nixon Assoc. Dean Rural, University of Otago Rural Generalist, Dunstan Hospital, Clyde

4 “It is the common experience of people living in rural communities that major administrative and planning decisions are made in the … city by people with little of no experience of living and working in rural areas” Ron Janes – GP Wairoa Benign neglect of rural health: is positive change on the way? NZ Family Physician. 1999. The Myths Urban people understand rural issues Centralisation saves money Rural areas can’t manage their own health care Rural hospitals only deal with minor illnesses and accidents

4 Modeling population access to NZ public hospitals . Brabyn L - Uni of Waikato Skelly C. - Public Health Intelligence Unit, MoH International Journal of Health Geographics. 2002

4 Average Travel Time in Minutes to the Closest Hospital by DHB Dept of Geography Waikato Uni Public Health Intelligence Unit MoH Average Travel Time in Minutes to the Closest Hospital by DHB

4 Population more than 60 minutes from a hospital

4 Hospitals used in this Study and their Category Ministry of Health Hospital Services Plan Hospitals used in this Study and their Category

Developing a New Index of Rurality for Exploring Variations in Health Outcomes in Auckland and Northland. Zhao J et al Social Indicators Research July 2019 4

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4 Keeping them interested: a national study of factors that change medical student interest in working rurally (in NZ) Kent et al Rural and Remote Health. June 2018 Rural intention at entry 33% Rural intention at exit 38%

4 Intended location of practice at entry and exit to a NZ medical programme: But they made no mention of this in the discussion – hence letter from some of us Rural hospital medicine – no 8 on list just after O+G - almost 4% of medical graduates If you are having trouble staffing your rural hospital you might ask tomorrow why HWFNZ aren’t creating more places on this programme Developing NZ’s medical workforce: realising the potential of longitudinal career tracking. Poole et al. NZ Med J May 2019

4 Update on rural health workforce initiatives There are currently two rural immersion training programme sites in the North Island, and we’re in discussions with providers about setting up a third …. in the South Is …. MoH, 30 Aug 2019

4 Is does matter who we and we define and own it. If we don’t – then there are plenty of experts in the city – all very well meaning – who will define it for us.

4 MCNZ definition of a rural hospital: ‘A rural hospital is a hospital staffed by suitably trained and experienced generalists, who take full clinical responsibility for a wide range of clinical presentations. While resident specialists may also work in these hospitals, cover is limited in scope or less than full time.’ 

4 Rural Generalism … a broad scope of care in the rural context that encompasses: Comprehensive primary care Hospital care Emergency care Advanced skill sets A population health approach Working as part of a multi-professional team Cairns consensus 2014

Paper published in rural and remote health

“Independent Urban Areas” = Rural NZ towns Lowest Medain Income Household expenditure Highest proportion of people on community wage – job seeker or invalids benefits Lowest rates of access to the internet and other telecommunications Highest likelihood of having a disability Highest dependency ratio Are the oldest in NZ – median age is about 3 yrs older. Higher proportions in the 60 t0 70, 70 to 80 and > 80 bands Highest proportion of Maori “Independent Urban Areas” = Rural NZ towns

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4 I have talked about the importance of rural health defining and owning and speaking for itself. But that’s not what occupies me the most – I think its around growing capacity. Sure definitely the clinical capacity around rural generalist practice – but also the leadership, teaching and research This creates the evicence that we are really missing The other pillar is alliancing