Rural New Zealanders have poorer health outcomes than their urban peers and the country suffers from a strained and maldistributed health professional workforce.
Rectifying these problems is no easy fix but one thing is certain — we need to support more rural health professionals to take up academic roles, combining the provision of healthcare to their community with educating the future workforce and undertaking health research.
There is a great deal of discussion about who among the universities is best placed to deliver academic rural health in New Zealand.
A lot of promises are being made, but are the right questions being asked?
The growth and recognition of academic rural health in New Zealand has been at best sluggish, and the absence of lived rural experience among the authors of research and reports into the health of rural people is considered normal.
This may in part be because so many New Zealanders have rural connections and are therefore confident they have the understanding to conduct research and teach on the rural health context.
These attitudes are further reinforced by the systematic bias that favours urban specialist expertise over rural experience and wisdom.
Malin Fors, a Norwegian rural academic, has labelled this bias ‘‘geographical narcissism’’.
Those of us living and working in rural communities and our representative bodies are not immune to the geographical narcissist within and are just as likely to defer to urban expertise — attendance at any rural health conference or continuing medical education activity will attest to this.
The possibility that useful knowledge could flow in both directions is seldom imagined.
An even greater barrier to building academic capacity in rural areas is that in New Zealand, resources must first flow through large urban institutions.
Even with the best of intentions, the universities struggle to overcome the financial incentive to concentrate research and education on urban campuses.
The rural context may be seen as a valuable source of clinical placements but seldom as home to the full range of academic activity in the way an urban surgical or medical department would be.
Despite this, and with few exceptions, the initiatives that have delivered insights into the health of rural New Zealanders, and grown the rural workforce, had their genesis in the rural context: daily clinical practice, teaching and research at the coalface.
This does not mean that close partnerships with those on the main campuses are not important — indeed they are as crucial in rural academic practice as they are in rural clinical practice.
But to deliver what is desperately needed, rural academic activity needs to grow and remain firmly embedded in the rural context.
The good news is we do not need to look far to find a template that could be adapted to suit the New Zealand context.
In Australia, three comprehensive government programmes have worked to ensure that health professional education and research are well-resourced and embedded in rural and regional communities.
These include the medical rural clinical schools, the multidisciplinary university departments of rural health and postgraduate rural training hubs.
Although these programmes are delivered by the universities, they are independent of their standard funding models, and must be delivered in rural and regional centres.
As a consequence, academic activity in rural Australian areas has flourished — in 2018, there were more than 1300 rurally based clinician academics working for multiple tertiary institutions.
Although all our universities are based in urban areas the debate continues to centre on which of them is best positioned to deliver rural health outcomes.
More important questions may be exactly where rural health research and education will have its home. By this I mean the full range of activity present in any other university department, not just undergraduate clinical placements, and whether it is possible to achieve this in the rural context, regardless of the institution involved, without first addressing the funding models in the way our Australian colleagues have done.
Getting it wrong will widen the health, health service and health workforce disparities that exist in New Zealand for decades to come. — Newsroom
■Garry Nixon is director of the University of Otago’s Centre for Rural Health, and a rural doctor at Dunstan Hospital in Clyde. This article is an amended version of a Journal of Primary Health Care editorial.
