Health care in rural and remote regions of Australia has been a priority of the government health department. Supply and retention of medical practitioners in remote regions has been an important area of concern for the health policy makers. This paper aims at evaluating the health care facilities available in the Broken Hill region of Australia. Broken Hill is located in the southern part of New South Wales (NSW) and is one of the largest towns with a vibrant mining industry. The paper describes the health related conditions in Broken Hill. It also shows the present available sources of healthcare in the region and the kind of medical benefit and medical workforce available in the region. Further, the paper also describes some strategies that can be taken in order to recruit and retain health care professionals in remote regions. The first part of the paper will deals with the population and present health care facilities available in the region. Further, a thorough analysis is done on the cultural groups available in the region, and how health care access and approaches differs for them. Further, this section also deals with the health care needs of the community and the way the cultural groups affects these needs.
Populations and health
Broken Hill is one of the largest mining towns of Australia. The area is rich in minerals like lead, zinc, and silver. The overall population of the city shows that it has been declining at an average rate of -0.41 percent from 2004 through 2008 (ABS, 2010). The population of Broken Hill in 2008 was 200001 (ABS, 2010). The demographic segregation of the population by age is shown in figure 1. The figure shows that the maximum pupation belong to the age group of 0 to 24 years (30.9 percent) and then to the age group 45 to 64 years (27.7 percent). This shows that the pupation of Broken Hill is mostly young with majority of the city’s population belonging to the below 45 age group.
The population density of the city is 117.4 per person per square kilometre (ABS, 2010). The estimated ratio of indigenous population is the total population of the region is 6.7 percent (ABS, 2010). Figure 2 shows that 90.1 percent of the population of Broken Hill was born in the Australia and the rest 9.9 percent were foreign born. Therefore, the percentage of foreign-born nations and immigrants is low in the city.
Further, the household census of 2006 showed that there were 7695 households in the region (ABS, 2010). Total number of families in the region was 5105 in 2006, out of which, 1483 were couple families with children under the age of 15 years and 725 were the number of single households with children under 15 years (ABS, 2010). According to the 2006 census, the whole region is located in the outer region of NSW with no population belonging to the remote or very remote areas (ABS, 2010). Further, 97.4 percent of the population belonged to the urban areas with only 2.6 percent of the pupation of the city belonging to the rural area (ABS, 2010). One concern in the area is that 64.3 percent of the population above 15 years of age undertakes voluntary or unpaid work. Further a large 19 percent of the population take care of own children without pay (ABS, 2010). This high rate of unemployment in the region is a concern as health care is directly related to higher income groups.
The health and wellbeing of the Broken Hill community is strongly related to the wellbeing of the mining industry, as the region’s economy is directly dependent on it. Therefore, mining is one of the main occupations in the region. The allied rural areas of Broken Hill have industry of sheep rearing. Further, more than 80 percent of the population of Broken Hill is below 65 years of age. Agriculture, forestry, and fishing form the largest group of businesses in the region. Further 43.6 percent of the population has some kind of qualification while the rest do not have any qualification indicating that more than half of the population are uneducated (ABS, 2010). This description provides a brief overview of the community at Broken Hills.
Therefore, it is important to understand the health care facilities available at Broken Hill. Health services in Broken Hill have received the accreditation from the Australian government. The total number of hospitals in Broken Hill is 6 (NSW Government, 2009). The health care services available in Broken Hill are through Broken Hill Medical care, Nachiappan General Practice, Weimija Aboriginal Corporation, Outback Women’s Health and Family Practice, Royal Flying Doctors Service, and Maari Ma Health Aboriginal Corporation (NSW Government, 2010). The main aim of the medical service providers for Broken Hill in Australia are to improve the present and long-term care for patients, increase the availability of clinical information, and increase the availability of information regarding the patients to the medical service providers. Broken Hill Base Hospital and Health Services is a public hospital, Broken Hill Community Health Centre is a public and community health centre, Broken Hill Consultation-Liaison and Broken Hill Mental Health Service is a mental health centres, and Broken Hill Sexual Assault Service provides services for sexual assaults. Therefore, the main area of the health services available in Broken Hill is general health care facilities provided through the public hospital and community health care centre. The rest of the service providers specialize in mental health service and relief for sexual assault cases. Therefore, these are specialized treatment centres. Overall, Broken Hill area has high unemployment and lower incomes compared to NSW average, and are more likely to have left school at a young age.
Workforce and services
The Broken Hill health council plays an important role in designing the health care requirements of the community. The presence of lead, zinc, and silver is estimated to have affected public health to a great extent. This has increased the presence of lead in children’s blood level. It is believed that many children with high lead content in blood do not reach the clinics for check up and therefore increase the problem and risk (University of Sydney, 2010). This has led to lower IQ among children. The remedy program that has been initiated by the government for the purpose is a home remedy for the exposed children. Alcohol misuse is another issue in Broken Hill. This is first dealt by the police and then by the emergency department (ED). Overall there are more than 6300 residents every year are admitted in hospitals in Broken Hill (Kennedy, 2005). However, research shows that at Broken Hill the rate of admission in hospitals is less than that in NSW (Kennedy, 2005). Further, there is a great deal of hospital admissions in the region for digestive diseases. The reason for admissions in hospitals due to social and respiratory diseases has declined in Broken Hill from 2000 through 2003 (Kennedy, 2005).
Health care approach and need differ from community and other social differences (Campbell & Jovchelovitch, 2000). In terms of health services provided to a community of mostly Australians, with only 9 percent foreign-born population and 6 percent indigenous people, it must be noted that mostly the population of the region. Further, the region has more female population than male where female population in 2008 was 51 percent of the total population and male population was 49 percent (ABS, 2010). Further as the unemployment rate in the region is high, and the number of non-paid household heads shows that that there is a great deal of low income pockets in the region. This therefore, indicates towards a low level of health availability (Campbell & Jovchelovitch, 2000). As has been acknowledged by the Australian Health department, in Australia there is a great disparity in the health care services available in relatively rural areas and to people with lower income. Further, the life expectancy of the people residing in NSW between 2001 and 2007 improved (ABS, 2010 ). Therefore, it can be expected that the life expectancy in Broken Hills improved too. The most causes of death in the region has been due to cancer, heart diseases, and cerebrovascular diseases (ABS, 2010 ). A few health risk indicators in NSW region are daily smokers, alcoholism, and obesity (ABS, 2010). According to the government data:
“For the total NSW population, comparisons of risk factors between 2001 and 2008 show that more people are overweight or obese (up from 49.8% to 55.7%), more people are sedentary or only undertake low levels of exercise (up from 69.8% to 71.7%) and more people are drinking alcohol at risky or high risk levels (up from 10.8% to 13.3%). By contrast, 19% of the total NSW adult population in 2008 were current daily smokers, down from 22% in 2001.” (ABS, 2010)
The medical practitioners available in Broken Hill are general practitioners (GP), nurses, dental workforce, and allied health workforce. In NSW the supply of GPSS in cities is ample with 6110 are available in major cities, while only 50 are available in remote and 3 in very remote areas. In outer regional areas like Broken Hill, there are only 412 GPs (Australian Government, 2008). Therefore, per 100000 populations there are 67.7 GPs in areas like Broken Hill (Australian Government, 2008). In Broken Hills, there are 708 health workers and 21 medical workers (Australian Government, 2008). There are 367 nursing service providers and 25 dental practitioners. Broken Hill therefore has 1 GP per 1000 population. This indicates the importance of the presence of all the GPs in the city as each is responsible for 100 populations.
In ASGC-RA 2 area when a doctor leaves without replacement it creates excess pressure on the other available doctors. As in case of Broken Hill, when 1 doctor is responsible for 1000 population, therefore, when this doctor leaves without a replacement, the whole load of the 1000 population falls on the other available doctors. This reduces the quality of medical care provided by them to the people. thus, it is important to have GP doctors as well as replacements for such doctors ready as this will increase the cost of health care provided to the people of the region.
Therefore, retention and recruitment of such doctors is important. As these doctors reduce the cost of sending patients to the nearest major city, thus, reducing the cost of health care, it is important to retain these doctors with higher pay, and greater motivation. Therefore, during recruitment, candidates who are highly self-motivated and comfortable to acclimatize to the rural surroundings should be appointed. For the cost of attrition of these doctors are high. In terms of retention, doctors must be provided with greater self-esteem and status than other GPs as they were agreeing to stay in a remote location. Thus, retention and recruitment of the GPs are important. Further recruitment of doctors originally hailing from the remote areas may help, as they are already familiar with the region. Training and educating GPs can become a motivating factor ans thus retain greater number of GPs.
Rural and Remote Health Service Delivery
As a GP in a remote and rural location the first criterion that must be considered is to understand the risks that the major diseases that afflict the Community in the region. As in case of Broken Hill, the main problem faced by the region is lead infection and digestive problems. Therefore, understanding this form of disease is important. Confidentiality should be practiced in case of rural patients in similar manner, as it would be done for urban patients. The first role as a GP would be of medical assistance and any confidentiality required for the case should be respected. In case of primary health care, the GP must understand the prescriptions to be given due to the limited nature of the financial constraint of the patient as well as of the government funding. Further there should be greater importance on patient care that should be emphasized through the nurses and primary health care providers. Further, use of computer and technology in the remote areas can get limited due to the low availability of such technology.
In conclusion, it can be stated that there is a great need for GPs and other medical practitioners in the remote areas of Australia. Therefore, from the case study of Broken Hill it can be understood that GPs assume high importance in remote areas where 1 GP is responsible for 1000 people and leave without replacement can become a problem for proper health care provided to the people.
- ABS. (2010). 1338.1 – NSW State and Regional Indicators.
- ABS. (2010). National Regional Profile: Broken Hill (C) (Statistical Local Area).
- Australian Government. (2008). Report on the Audit of Health Workforce in Rural and Regional Australia.
- Campbell, C., & Jovchelovitch, S. (2000). Health, Community and Development: Towards a Social Psychology of Participation. Journal of community and applied social psychology, 10 (4) , 255-270.
- Kennedy, C. (2005). Health in Murdi Paaki.
- NSW Government. (2009). Annual Report 2008-09.
- NSW Government. (2010). Greater Western Area Health Service.
- University of Sydney. (2010). Broken Hill Department of Rural Health. Web.