1. 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

2. 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
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

3. 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

4. 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

5. 4
Population more than 60 minutes from a hospital

6. 4 Hospitals used in this Study and their Category
Ministry of Health Hospital Services Plan
Hospitals used in this Study and their Category

7. 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

8. 4

9. 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%

10. 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

11. 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

12. 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.

13. 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.’ 

14. 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

15. Paper published in rural and remote health

16. “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

17. 4

18. 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