Australian Journal of Rural Health最新文献

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 worki

Considering this, it can feel like not much has changed. What then is the role of the National Rural Health Alliance (the Alliance) 30 years on from its formation? I would argue that given the ongoing disparity in health outcomes for rural and remote Australians, the Alliance continues to be of significant relevance.

Third-sector organisations make a significant contribution to the economy, as well as being a key component of a strong community. Two of the ways third-sector bodies achieve this are by supporting sector development and providing recommendations to the government.⁴ The National Rural Health Alliance as a peak body, and therefore a part of this third sector, continues to bring value to the sector through the role it plays in developing the sector and by advocating to the government for actions to improve the health outcomes of people living in rural and remote Australia.^4-6 This remains the central role of the Alliance, and it will need to continue to evolve to support and respond to the changing context in rural and remote Australia.

In supporting the growth and development of the National Rural Health Conference and the establishment of the Rural and Remote Symposium, the Alliance provides an example of how it supports sector development. At the most recent conference held in 2022, 700 delegates from health and related services supporting rural and remote Australians attended the 16th National Rural Health Conference.⁷ As a response to the changing contexts in which we live, the Alliance worked with its partners and introduced the Rural and Remote Symposiums in 2007,⁸ with planning underway for the 10th offering in 2025. Both forums support sector development through the sharing of research, stories of the lived experience of health recipients and providers, and creating and strengthening networks. At these events, the Alliance picks up on threads of conversation and through this has observed not only the continuing, but also emerging themes faced by those working in rural and remote Australia. Over the past 30 years, the intersecting challenges around climate and health are just one example of the unfolding issues that could be found when listening closely and analysing what is being said. The Alliance must continue to refine and develop its offerings in the area of sector development to provide contemporary opportunities and different ways to hear from those working on the front line to understand the daily and strategic challenges and ensure that the ongoing issues remain at the forefront of consideration for advocacy and solution development.

The Alliance also listens through its many publications and its regular engagement with an ever-growing member body. This growth in membership brings a breadth and diversity to the voices that influence the Alliance position statements, submissions and policy advice, ensurin