Pearls and Irritations

The impacts of drought and climate change on health and wellbeing are threatening to increase the growing gap in health status between Australians who live in metropolitan and rural areas. Yet the Morrison Government and its National Party partners have lost focus on rural health, they have failed to focus on a national drought strategy and are international laggards in climate change action. Rural families and communities are suffering as a result.

Across the nation, poor rainfalls, scorching winds, and higher than normal temperatures are contributing to an evolving disaster in rural Australia. In and around many towns and farms, water supplies are dangerously low, feed is in short supply and out-of-control bushfires are burning. Tony Walker, writing in the Sydney Morning Herald, has detailed how the lack of a Government drought strategy is accelerating disaster.

There is substantial evidence of the ways in which drought impacts mental health. A paper published last year in the Medical Journal of Australia used data from the Australian Rural Mental Health Study to show that farmers – especially those who are younger, more geographically isolated, and already under financial stress – experience significant stress about the impacts of drought on themselves, their families and their communities.

There is a strong association between suicides of farmers and drought (the suicide rate for Australia’s farming men is about double the general male population). Drought also has an impact on social networks which are important modulators of mental health in rural communities, perhaps because, ironically, there is a reduction in help-seeking behaviour.

The socio-economic impact of drought extends beyond the farm into the wider rural communities; in particular, young people are at risk of mental health problems, especially as employment opportunities and social networks, which are protective factors, are eroded.

In the face of such unequivocal evidence about increased rural mental health needs, it is shocking to see that the Morrison Government is doing little or nothing to improve access to mental health services. Of the extra $100 million announced by the Prime Minister late last month for farmers and drought-affected communities, only a small and unknown proportion will go to mental health ($13 million was provided in payments to local government areas for “water infrastructure upgrades, mental health support and other projects deemed necessary”).

We have heard nothing from the National Party on their constituency’s growing need for improved healthcare and mental health services. There is growing discontent about not just water policy but health, education and transport in areas once considered the bastion of the National Party. The swing against the party in the NSW election surely sent a message about the discontent in rural seats.

John Menadue, writing earlier this year, highlighted the failure of the National Party’s parliamentary members to give serious attention to rural poverty and poor rural health. Barnaby Joyce has admitted that the Nationals face “political annihilation” for their failures.

Yet, as I have previously written, there is currently little or no focus from the LNP Government on rural health, and the Nationals, apparently willingly, allowed Morrison to abandon the position of Minister for Rural Health, last held by Bridget McKenzie in the Turnbull Government.

The Nationals (and Health Minister Greg Hunt) seem to have put their all their rural health reform eggs in one basket, relying on the 2019 Budget measure to support a national pathway program for rural generalists (these are medical practitioners who have received specialist training to meet the general practice, emergency care, and other specialist needs of rural and remote communities – basically what we used to call procedural GPs).

This proposal was a major recommendation from the December 2018 report from the National Rural Generalist Pathway Taskforce and it is widely supported by organised medicine. It is not new, but is a matter of coordination at a national level what is already happening in the states, and ensuring an alignment of issues such as entry points into training, approved scope of practice, and employment arrangements. Issues yet to be resolved include the Medicare reimbursements these doctors can claim and how they will be paid for services delivered in hospitals (and whether these fees will differ from those current procedural GPs can charge).

This approach is necessary but not sufficient to address the rural health problem (it might accurately be called a crisis). For example, it is hoped to train 350 such generalists each year, but with a 5-6 year training requirement, it will be some time before the new doctors are working unsupervised in the communities that need them. (We might also note that the current funding provision of $62 million is only for the next four years.)

And it is not clear that medical graduates will be keen to take up these training places. A recent national survey has found that the number of medical students who want to become GPs has dropped to the lowest level since 2012.

Other issues include the fact that there is little here to address mental health needs. The numbers of psychiatrists, mental health nurses and psychologists in rural and regional areas are only a fraction of those in major cities. A report last year from the National Mental Health Commission highlighted the problems Primary Health Networks face in commissioning mental health services. Failure to address the full mental health workforce needs will put additional pressures on rural GPs.

Also, it is unreasonable to expect these trained medical professionals and their families to move to and stay in rural areas without the possibility of affordable and available locums to enable them to take holidays, upgrade their training and address family needs.

All the meteorological evidence indicates that drought conditions across the nation are unlikely to ease soon, and the adverse weather events will be aggravated by climate change. Just days ago, the Director-General of the World Health Organisation urged world leaders to act to protect health from climate change. It’s time for Dr Paul Worley, the National Rural Health Commissioner, to find his voice on this subject and for the public health and farming communities to join him in pressuring the Government for action. Today would not be too soon.

Dr Lesley Russell is an Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney.

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