The more I travel round Australia, the more I am attracted to the concept of the Healthy Town – a twin to the Tidy Town. The Healthy Town concept challenges a number of myths.
One myth is that rural Australia is less healthy than urban Australia. If this thesis is true, then it is all the more reason to promote the concept; if it is not true then it is still a good idea to promote the merging of health status and quality of lifestyle.
There is always another myth of the idyllic village life. Ronald Blythe in his 1967 study of a Suffolk village, Akenfield, remarked that "The first thing a newcomer does when arriving in a village is to begin to claim it. He doesn’t state or stake his claim, he simply starts to feel his way towards the village’s identity, recognise it for what it is and shape himself to fit it. He will often envy the old indigenous stock – there are eighteen families in Akenfield descended from people living in the village in c 1750 – but in effect his life will be freer than theirs. The sometimes crushing limiting power which the village exerts on families which have never escaped will be unknown to him."
Apart from the gender specific nature of his exploration and the fact that the comment is about England, it is an insight which provides a basis for that attachment to buildings such as the local hospital, for it has been the hospital in which the community has been born and in turn died. The hospital provides a feeling of security for the continuation of life in that township. The fact that towns value the longevity of the family connection is one of the matters which clashes with a society, where employment is fluid and location in the world of cyberspace increasingly interchangeable if not irrelevant.
But that is the anonymity of urban areas, where the concept of Healthy Cities hits the wall of indifference, because the community vanishes into the vast suburban expanse.
However, encouraging a township to badge itself as a healthy community is to encourage the community to explore its meaning. Is it a question of facilities – of having a doctor, a pharmacist, a nurse, an array of allied health professionals – or is it a state of mind borne by the community? A community with information about its lifestyle is a community with the power to discriminate about the best way to obtain services. Such services can well fit within the rubric of allocative efficiency and yet preserve the distinct identity of the particular community’s needs. While no community can claim without extensive proof to be unique, many communities can claim that they are distinct, sharing in common various traits with other communities but not so as to be exact templates.
Once a town adopts a Healthy Town concept, then it can interpret its health in terms of its knowledge about its own population. If this can be placed in a disease framework, then the six national health priority areas – cancer, cardiovascular disease, injury, asthma, diabetes and mental health – are a useful reference point. In remote communities, infection can be added as a seventh priority area. How a community handles the preventative and treatment components of each of these is one step towards the community understanding the parameters of healthy town – at least from a clinical perspective.
However, healthy towns also depend on the quality of lifestyle. Sometimes, this is manifest in the way the professionals in each town work to counter the problems posed by social dislocation, professional isolation, community acceptance and succession planning. For instance, "rural" may be described in terms of social dislocation – either as "the place to which your spouse will not go" or "where you need to send your children away to school".
The fear of social dislocation underpins the whole matter of having health professionals work in rural areas. While the two above definitions on first reading may appear flippant, each underpins an important career decision. The first is the need to have an attractive recruiting strategy for recent graduates so they will enter rural practice. This is particularly important given the increasing number of women in the health professional workforce, apart from their traditional role as nurses. In pharmacy, most of the graduates are now women. In medicine the proportion of women approximates that of men in recent graduations, although there are differences between the schools.
The second is the perception that secondary education in the city is a better platform for intellectual and social development than is the country high school. Whether this is true or not, there is a perception that has to be answered, as quality of life and intellectual attainment do have a long term synergy. The healthy town then becomes one that factors these considerations into the delivery of the most appropriate workforce to itself.
Similarly, it is not conducive to a healthy town to have isolated professionals, to have a community where there are divisions within the community, especially if the division is caused by two warring medical practices, and where there is no plan to ensure succession planning. It would be a deeply imprinted "plus" if the community takes upon itself to control the actual recruitment and retention of its workforce, to harness the myriad resources which government and private sources are attempting to establish to address such issues.
I well remember the country town with a formidable reputation for taking on the State government whenever there was a dispute over the regulation and/or the reward, monetary or otherwise, for particular agricultural effort. The town was known as a group of "hard bargainers" and I reminded the community of that fact when they appeared to be dilatory when it came to the doctor in town threatening to leave. Health to them was another matter, and they did not know what to do if the doctor left, apart from throwing money at the receding figure driving out of town.