Role of Transport in Rural Health Inequalities Becky Morton South West Community Transport Program Western District Health Service

People living in rural and remote areas have higher rates of death from causes such as heart disease, chronic obstructive pulmonary disease, diabetes and some cancers 1 Hospital admission rates for ischemic heart disease are 15% to 22% higher in rural Victoria and diabetes admissions increased from 2% higher in to 11% in Australia’s health AIHW cat. no. AUS 73. Canberra: AIHW 2. Your Health : A report on the health of Victorians 2005 Melbourne: DHS

WHY? Centralization of specialist health services Closure of small rural health services Reduction in hours worked by GP’s in rural and remote areas Cultural attitudes of rural people re seeking assistance Lack of information Dietary habits and access to food Lower education levels

Private Car Easiest and most flexible method Cost and travel time can be a barrier Numerous journeys may be required Having to stay overnight or longer Timing of appointment

31% of older people who are no longer able to drive reported that they found it hard to visit their doctor or hospital and as many as 5% do not attend appointments. Harris, A. and Tapas, D. 2006, Transport and Mobility: Challenges, innovation and improvements RACV

Public Transport Analysis of access to bus stops and train stations for people over 65 in the Loddon Mallee Region concluded that 48% did not have access to public transport and that the further one lives from a major rural centre the less likely is provision of public transport. Corcoran, S., James, E.L. and Ellis, J.M. 2005, Do elderly Victorians in rural areas have access to public transport? Road & Transport Research vol. 14: no.1, pp.38-43

Difficulties of Using Public Transport An 80 year old woman living in Hamilton has to attend a monthly appointment in Ballarat with her cardiologist. The bus to Ballarat leaves Hamilton at 7am and arrives back in Hamilton at 10.15pm.

Some Other Problems Weekly services Wrong destination Interstate vs V Line No bus stop in your town

Local Transport Small towns no local transport Few inter-town services Operate weekly or fortnightly Sometimes access is restricted

Accessible transport Limited taxi services in rural areas Some services do not have WATs 40% of buses in rural Victoria are low floor, but these are concentrated in regional centres

Accessible transport A young woman who needs a wheelchair lives in a small rural community where there is no accessible transport or regular public transport. In order to attend a weekly hydrotherapy session she must arrange for a taxi to come 65kms to collect her, take her to her appointment 45kms away, wait and then take her home. The cost of the journey would be around $200 even with a multi purpose taxi card discount.

State Government response Meeting our Transport Challenges – $10.5billion over 10 years Rural Initiatives– Transport Connections  Community Engagement  Increase use of existing resources Improvements to public transport infrastructure Support for country taxi services

Solutions, solutions ????????…. Minimum standards  Service frequency based on population density  Suitable for urban centres  Rural demand fluctuates Flexible responsive transport  Locally based and coordinated  Understands needs of individual