Expecting the unexpected? Improving rural health in the era of bushfires, novel coronavirus and climate change

摘要

This summer, the Australian bushfires gripped the nation. Even before the fires were under control, the shared consciousness of the nation had shifted to a new threat; novel coronavirus was sweeping through China and South-East Asia and fears about when it would hit Australia were rife. For city-dwelling Australians, COVID-19 sent the population into a toilet paper stockpiling hysteria, and bushfires were already a dwindling memory. For rural Australia, the health impact of bushfires and COVID-19 had yet to be fully realised. Likely, there will be a substantial increase in respiratory problems associated with exposure to smoke. A sharp rise in mental disorders—depression, anxiety and post-traumatic stress disorder—can also be predicted. COVID-19 will disproportionately affect remote communities, where access to health services is challenging exacerbated by an ageing population and higher co-morbidities. Even before the summer bushfires, the river land regions of rural Australia had been experiencing the longest periods of protracted drought in living memory. In stark contrast, extreme flooding in Queensland has had a profound effect on many farming communities. It seems we are living in an era where we need to expect the unexpected, and for Australians living in rural and remote communities, the effects seem to be particularly harsh. In rural Australia, there are particular demographic and societal challenges that might explain why the population is particularly susceptible to crises. Young people tend to leave rural areas in search of better education and employment opportunities. As a consequence, the birth rate is declining, and the population is ageing.1 People living in rural communities are more likely than their city-dwelling cousins to experience multiple physical and mental health problems (multimorbidity).1 As a consequence, people have shorter lives and an increased prevalence of disease and experience barriers to accessing health services.1 The median age of death in women in 2017 was 85 in major cities and 69 in very remote communities.1 The Commonwealth Government has attempted to address these health inequalities by investing in rural educational opportunities and clinical placements as a mechanism for encouraging clinicians to come and work in these communities. There is little evidence that this has been successful at leveraging more health professionals to come and work in the bush. For example, in 2013 in South Australia, there were seven psychologists in remote Australia. This increased to nine in 2017, in comparison with 1086 psychologists in the city in 2013 which increased further to 1275 in 2017.2 The aim of this special edition is to ask questions and consider potential solutions to the complex health challenges that face rural Australians. We use the word “complex” advisedly; rural Australians will often experience both a combination of both mental and physical health problems. Environmental challenges—fire, drought, floods and novel virus—layer in additional complexity. Perhaps now is an opportune time to reflect and consider how rural communities can come together to find novel ways of working to improve their health and well-being. We think there are five key challenges that need to be addressed to transform the health and well-being of rural Australians. Health care interventions are often focused on the individual, at alleviating a particular illness symptom. Often the social community context is ignored or overlooked. For example, with older people with memory problems, there is a tremendous emphasis on getting them a timely diagnosis. For many people living with memory problems, getting a brain scan and having a definitive diagnosis make not a jot of difference to the quality of their life. What they require are communities in which they are welcome and where they are active participants. There are examples in Australia of memory cafes that are informal and social gatherings where people feel w