Advance Australia unfair: inequality in healthcare

The Australian healthcare system is the site of one the nation's most intense battles against inequality, and it is not only between the rich and the poor. Rural communities continue to struggle with a lack of access to quality healthcare services as compared to Australia's urban communities, leaving them marginalised by comparatively poorer health outcomes.

Here is the conundrum: the Australian health landscape is burdened by unfavourable demographic factors, having a relatively small population spread across a huge geographical landmass, combined with significant resource shortages.

The World Bank quantifies our population density as 3 people per square kilometer, rendering Australia as one of the most sparsely populated countries globally. To further complicate matters, the Australian Department of Health and Ageing identifies that approximately 90 per cent of the population resides in just 14 per cent of the land area, leaving the remaining 10 per cent of the population spread across 86 per cent of the land.

What all these numbers ultimately mean is that tough allocative decisions are required, ideally to maximise the Australian population's access to scarce health resources.

Unfortunately, the current allocation system focuses too heavily on urban populations at the expense of rural populations and is leading to the emergence of some glaring health inequalities which render urban populations as the 'haves' and rural populations as the 'have nots' of healthcare access and health itself.

Statistically speaking, this misallocation and subsequent lack of access have translated into alarmingly increased morbidity and mortality rates among rural populations.

To paint the picture, the Australian Bureau of Statistics estimates that the prevalence of mental illness in rural populations is a staggering 16 per cent greater than that of metropolitan areas. This is just the tip of the iceberg with a higher rural prevalence in various other diseases including asthma, arthritis, hypertension and cancer.

This problem is not new, but the increasing urbanisation of Australia combined with its ageing population has certainly exacerbated it. The established history of this challenge brings with it a long list of attempted strategies but no lasting mitigating policy has yet to be developed.

The current strategy to improve rural healthcare access is based on labour force financial incentives, migration placement, health degree positions bonded to rural employment and an increased reliance on locum 'fly in fly out' health professionals.

None of the aforementioned approaches have made produced any significant reduction in the inequality of access faced by rural populations, so where do we look next?

Technological advances have previously closed the gap of isolation in many other areas of rural life, and health is no longer the exception to the rule. As the 2021 NBN completion date draws closer and with some of the network already in action, Australia finds itself on the cusp of a new technological era. The advent of this new era brings with it a significant potential to redress the current inequality of health resource access of rural populations.

The NBN, the most significant investment in Australia's information and communications infrastructure in history, is expected to deliver high-speed broadband nationwide. This will provide the speeds necessary to undertake high-quality, uninterrupted telemedicine services.

Telemedicine primarily involves the conduction of remote real time face-to-face electronic consultations between geographically separated individuals. A sick individual in Cobar, for example, could hold a consultation and potentially receive a diagnosis from a doctor in Sydney without leaving their home. Importantly, this distance-transcending tool has enormous potential for such a sparsely populated country such as Australia, potential that has yet to be harvested.

Currently in Australia small telemedicine initiatives exist on the peripheries of health care and only in isolated pockets. Until the Australian Government announced the NBN tele-health pilot program in January 2012, these initiatives were undertaken by private enthusiasts, and consequently are few and far between.

Australia lags behind other countries, such as Canada and Britain, in the dissemination of a publicly funded and mainstream integrated telemedicine scheme. We continue to struggle with inequality of access, yet there has been no real concerted effort to establish the groundwork for a far-reaching and large-scale telemedicine initiative. This is despite the successes of similar programs internationally and considerable support from health professionals.

What is needed now is to fast track such an initiative with its key focus on the improved delivery of healthcare to rural Australian populations. This requires bipartisan support from Canberra to guarantee funding and support, irrespective of the results on the September election.

This is not an issue that can be ignored or postponed. Irrespective of where they live, all Australians should have equality of access to the necessary health services.

The development of a national telemedicine system presents a unique opportunity to facilitate this.