John Menadue. The Coalition, Barnaby Joyce rural poverty and rural health. (Repost from 16 January 2016)

It is not surprising that independents are making headway in country electorates. But what is the ALP doing?  

When listening to Coalition members of parliament it is hard to understand that coalition members represent the poorest electorates in the country. Furthermore, these electorates have the worst health services in the country – by a country mile.

I seldom hear Coalition MPs from the bush express their concern about rural poverty and poor health. I cannot recall any real effort by coalition MP’s to address the health problems in their constituencies.

The National Party primarily sees its role as a junior to the Liberal Party and easily bought off with a few ministerial posts. That tugging the forelock by the Nationals is often at the expense of the people they should be serving. When National Party members speak about rural issues it is invariably on behalf of their wealthier constituents. They speak volubly about roads and marketing but rarely about health

The eleven poorest federal electorates measured by median household income per head are all Coalition seats – Barker (Liberal), Grey (Liberal), Bass (Liberal), Braddon (Liberal), Mallee (National), Wide Bay (National), Lyons (Liberal), Page (National), Lyne (National), Hinkler (National) and Cowper (National).

On the mainland the poorest seven electorates are rural and all represented by the National Party. What was that about the ALP representing the poor in Australia?

The health of rural people is the worst in the country and mainly because they are poor. The social determinants of health tell us very clearly that poverty and poor health are linked.

In January this year the National Rural Health Alliance which covers 37 affiliated bodies concerned with rural health, reported:

  • The health of rural people lags well behind that of their city counterparts.
  • The state of indigenous health is a national disgrace and around 70% of the nation’s aboriginal and Torres Strait islander people live outside the major cities.
  • Other areas of rural and remote health in which urgent attention is needed includes mental health, oral and dental health, and maternity services.
  •  The prevalence rate of risky alcohol consumption in causing lifetime harm is much higher for rural people. In the major cities, the risk of lifetime harm from alcohol is 19% of the population, 22% in inner regional areas, 25% in outer regional areas, and 31% in remote and very remote areas.
  • Anti-smoking campaigns have been less successful outside the major cities.
  • The rate of obesity is higher in country areas, and ranging from 62% in major cities to 73% in remote areas.

Despite the poor health in country areas, the health services available are much inferior. The National Rural Health Alliance also reported in January this year:

  • Access to primary care, dental care, allied health and specialist services is becoming more difficult and in many regions requires greater time and expense on travel and accommodation.
  • Shortage of doctors, nurses, allied health professionals, paramedics and dentists persist, with the seriousness of these shortages only partly masked by success in recruiting overseas trained workers.
  • The shortage of health service professionals is acute in remove areas.
  • The viability of many rural hospitals is uncertain and there has been a serious loss of capacity for maternity services and other procedural care in rural areas.
  • Many young health professionals are not prepared to ‘go bush’ under existing conditions.
  • Infrastructure in rural and remote areas for health services and health related activity is limited and being further eroded by lack of ongoing investment.

The Grattan Institute estimates that if we continue with current policies it will take 65 years before people in many parts of rural and remote Australia have the same access to GP services as city people.

The government provides a $7 billion annual subsidy for private health insurance (PHI) which benefits the wealthy and enables policy holders to jump to the head of the queue for private hospital admission. But there are very few private hospitals in the country. As a result the benefits of this large subsidy for PHI go largely to wealthy people in the cities. Over a half of the payments from PHI goes to patients in private hospitals. I have not heard a squeak from any member of the National Party about this and how it disadvantages their constituents.

The needs of country people particularly in mental health are alarming. Medicare expenditure on mental health services per head of population in 2011-12 was as follows: major cities $42, inner remote $31, outer remote $18, rural and very remote $9. These services were provided by psychiatrists, GPs, clinical psychologists, other psychologists and other allied health professionals.

It is very hard to find a psychiatrist in most of our country areas.

Surely it is time that Liberal and National members of parliament who represent some of the poorest people in Australia did something to look after the health of their constituents. They seem focused on the wealthier people in their constituencies and doffing their caps to the Liberal Party which really does represent the big end of town.


John Laurence Menadue is the publisher of Pearls & Irritations. He has had a distinguished career both in the private sector and in the Public Service.

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8 Responses to John Menadue. The Coalition, Barnaby Joyce rural poverty and rural health. (Repost from 16 January 2016)

  1. Julian says:

    A big thank you John and to posters.

    The more light that can be shone here the better.

    Dr. Burkitt raises a crucial point when he says: “The extraordinary thing is that these people vote for the coalition – rusted on country voters who just shrug their shoulders.”

    On this curious and persistent human quality, I offer the following comment:

    “…we tend to be quite flexible when it comes to practical matters. Most of us are willing to accept advice on how to remove a grease stain or chop a cucumber. No, it’s when our political, ideological, or religious ideas are at stake that we get the most stubborn. We tend to dig in our heels when someone challenges our opinions about criminal punishment, premarital sex, or global warming. These are ideas to which people tend to get attached, and that makes it difficult to let them go. Doing so affects our sense of identity and position in social groups — in our churches or families or circles of friends.” [1]. This author goes on to mention that stupidity is not a factor in this.

    [1] Article is highly recommended.

  2. Excellent article but if anything it is a gross understatement of the reality on the ground. I am a GP in one of the National held electorates you mention with a practice exclusively devoted to mental health. The situation in my region is catastrophic.
    There is a vast underclass of people with multigenerational poverty, poor education and social dysfunction whose lives are absolutely miserable and for whom services are increasingly less accessible for financial, transport and all manner of administrative reasons. The situation is made progressively worse with the development of more and more jails in regional areas drawing the families of long-stay inmates from cities into the regions but with no extra services to serve their higher than average needs.
    For example, Centrelink has recently unilaterally cancelled disability support pensions for many people on such payments for many years. Many such people have already been barely coping and often living in small hamlets more than 30 km from regional towns with multiple medical conditions, poor housing, pathetic communications and no public transport. These people are now being required to provide up-to-date documentation of their multiple medical conditions. These very often require specialist consultations which have to be arranged privately with gap fees in the hundreds of dollars as there are few public clinics even in the larger regional hospitals. People on pensions cannot afford this as most live from week to week at best. Add to this the fact that Centrelink now has abolished forms for doctors to report these conditions necessitating detailed letters from doctors which can take hours to prepare and for which there is no remuneration. Some patients thus get pushed from one doctor to another until they get to some bleeding-heart like me who is insane enough to believe that it is their duty to help. The doctor shortage is acute as described but so bad that in a large regional town near me, there are no GP practices open to new patients.
    The Medicare rebate freeze has made the situation far worse so that many GPs and most specialists don’t even bulk bill Centrelink recipients (who represent more than 60% of my patients). In the recent budget, the government announced that it was ending the freeze and that it was starting in this budget by moving to re-index the bulk bill incentive payment – looked great in the budget reports. The actual increase was a whole 10 cents (REPEAT TEN CENTS) on top of the existing $9.25! The government got the headline. The detail was an absolute insult. The substantive Medicare fee for a GP consultation of between 5 and 20 minutes is the grand sum of $37.05 giving a GP a total of $46.40 for a bulk billed patient consulting for 19 minutes. How can anyone run a practice on this?
    At the same time, more and more is being asked of us in terms of coordinated care, digitised medical records etc with almost no extra support.
    The extraordinary thing is that these people vote for the coalition – rusted on country voters who just shrug their shoulders. They hate The Greens because of policies such as gun control and are not interested in knowing anything about their other policies. Endlessly the Nationals refer to “the whacky policies” of The Greens but nobody much less the regional media ever challenges these statements.

    Keep up the good work John. At least it keeps this disillusioned soul going!

  3. michael lacey says:

    Good article for reference John! The nationals have been able to pull this stunt for a long time!

  4. Michael D. Breen says:

    I suppose it is implied in John’s article above, but health literacy in the bush is poor, almost displaced by magic in some areas. Then there is the paucity of serious NBN health opportunities. And preventative services like gymnasia (the modern temples of the city) are almost non existent in the bush. Poor fella my country.

  5. Clancy Benson says:

    Excellent article – and much needed. I live in a rural LNP seat – high unemployment, poor health, other services, no NBN. What do the National do for their electorates?

  6. Paul Wonnocott says:

    Thanks for this.The 2011-2012 Medicare statistics on mental health services are particularly pertinent. Mental Health Week commences 6 October and the Q&A on ABC TV that evening is on Mental Health in Regional Australia.

  7. w ch says:

    UK Labour Tony Benn politician said that private health insurance is about allowing wealthy people who dont have much wrong with them to jump the queue and get in front of the less wealthy who have a lot wrong with them. Keep up the good work Mr Menadue, your contribution is much appreciated.

  8. Jenny Haines says:

    When are people in rural and regional Australia going to wake up to the Liberals and Nationals – that they really don’t give a toss about people in these areas. No wonder many of these areas are going Independent.
    People in these areas should also rethink Labor and the Greens.

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