Editorial—‘Somewheres’, ‘Anywheres’ and rural health in Australia

Abstract

A few years ago, British author David Goodheart¹ made an interesting observation of two groups on either side of the faultline of British society and politics: the ‘Somewheres’ and the ‘Anywheres’. While his broad brushstroke characterisation can be criticised on a number of levels, it has shed light on a number of worrying social, political and ideological rifts, and may also be useful for stimulating discussion in regard to rural health services and research.

According to Goodhart, Somewheres are people who are more locally rooted in a specific place or a community. Their identity and loyalties are linked to their place of origin or local community, and they are unlikely to move away. In comparison, Anywheres are more mobile; their identities are achieved through education and career progress. Goodhart goes on to suggest that it is the Somewheres that have been largely, and are still, overlooked in contemporary politics, economics and decision-making. He sees that it is the Anywheres who hold substantial financial, political, cultural (and service provision) power.

There are many limitations to the simplistic Somewhere/Anywhere dichotomy. However, there are also potential resemblances between rural-community-Somewheres and health-professional-Anywheres (which are even more pronounced for First Nations people in rural and remote communities). A reality for the majority of rural and remote health professionals, researchers, managers and educators is that we fall into the Anywheres category. We tend not to come from the communities in which we work, our identities tend to come from our professions and our education, and we wield considerable power over health services and beyond. One of the questions we face is how we can manage such tension for the benefit of rural health.

In Australia, we have a historical tradition of orienting health services and research to local communities. For example, rural PHNs seek to understand community needs to improve coordination and care in regional areas. We have a proud tradition of UDRHs (and some RCSs), which seek to strongly ground health research and education into their local rural and remote communities. Likewise, the publication history of the AJRH includes many accounts of research projects which are strongly grounded in local rural, remote and Indigenous communities, or that genuinely seek to better understand the perspectives and needs of rural community members. Furthermore, in light of the 30th anniversary,² we can note that many of the member bodies of the NRHA have strong roots in rural communities.

However, we should always keep in mind that things change. The original place-based vision of the UDRHs is now spread across 19 centres and contexts. The pull of metropolitan centres of gravity and metropolitan universities is strong. The push for more and more FIFO or DIDO workforce arrangements is ongoing. The ubiquity of working online brings into question the necessity of being place-based. The reality is that we will have to manage this tension if we are to avoid a deepening faultline in the area of rural health.

Managing this tension means that those of us who wield influence in rural places need to work hard to ensure Somewheres are genuinely being represented. That means recruiting and retaining staff from our local communities where we can. It means including rural community members at all levels of our planning and decision-making. We need to continue to listen carefully to rural community members, to have formal mechanisms for such listening and to be accountable to acting on the needs and aspirations of local rural communities. We need to strengthen rural communities with health services that they really want, ensuring benefits flow to all. We need to prioritise research methods and research projects that help us better understand and genuinely engage with rural communities.

No ethics is approval necessary.