'Stagnant or going backwards': rural health in poor state, states NRHA

The latest annual snapshot by the National Rural Health Alliance (NRHA), drawing on health and demographic data across Australia, has revealed the burden of disease is still hitting people harder the further away they live from a major city.

The report found men in very remote regions are more than 2.5 times as likely to die from a condition which could have been prevented, increasing to 2.8 times as likely for women, compared to major cities.

NRHA chief executive Susi Tegen said there was a clear inequity.

"The services aren't there. It's also because of the tyranny of distance and the cost of delivering a service," Ms Tegen said.

"Rural communities are so used to having very limited services - and they've been through droughts, floods, fires - and they're so resilient that often go, 'Well, it's okay, I'll just have to deal with it, without the service'."

More than 70 per cent of adults in rural areas are overweight or obese, compared to around 65pc in major cities, while rates of smoking, drinking and drug use are also all higher as communities became more remote.

But in small towns of less than 5000 people, residents have access to almost 60pc fewer health professionals than in major cities on a per capita basis.

The trends are not encouraging - according to the report, Medicare is used as much as 50pc less in rural areas compared to cities.

Ms Tegen said the state of rural health was "either stagnant or going backwards".

"When it was developed 40 years ago, [Medicare] was meant to be a public health subsidy for patients to go and see a clinician, whether it's a psychologist or a doctor," Ms Tegen said.

"I think the increase of expectation that there is bulk-billing and the pressure on clinicians to bulk bill has meant that patients are not able to see doctors, because many doctors don't want to work in a system where their business model fails."

The report comes amid concern the current approach to healthcare is losing relevance in rural areas and struggling to attract new faces to the workforce.

The federal government recently launched a major review of health worker distribution across the country and the policies used to classify demand in metropolitan, regional and remote communities.

But Ms Tegen said the situation is more urgent than "reviewing and reforming".

"The market fails in rural, remote and regional communities in terms of healthcare delivery," Ms Tegen said.

"We don't expect that a lawyer or an accountant or a shopkeeper brings down their cost because we want to do something for the community. There needs to be a change in expectation and more support from the government, whether it's federal or state government."

But life in the country has plenty of upsides compared to the inner-city, with the report finding people in rural areas are generally enjoying a better work-life balance, less loneliness and a greater sense of belonging.

It's also pointed to the restorative benefits of the natural sounds and scenery, as well as higher levels of fundraising, volunteering and sporting activities.

"People are more satisfied with the relationships that they have in the community," Ms Tegen said.

"They seem to enjoy being able to be around other people that are similar... farming communities for example, or wine industry communities, mining communities - they all seem to be huddled together."

Ms Tegen said Australia needs to develop a national rural health strategy which acknowledges the unique nature of rural communities.

"We need to be more flexible with funding, we need less red tape, and we need to allow for community-led, population health, status-funded models of care," Ms Tegen said.

"This community is providing significant economic benefits to Australia and we really need the communities to be supported."