In Australia, just like some other regions of the world, one can be excused for thinking that life in the rural areas is much rosier than the metropolitan or the urban areas. Ideally, the benefits of living in the countryside include unpolluted air, reduced congestion, and fresh food from farms, spacious housing, clean flowing water, reduced stress, great communal support and the feel of belonging among other factors. The truth is that all these are just assumptions, as the recent statistics from the Australian sources reveal that people living in the remote areas experience a health differential that leans towards higher mortality and morbidity rates of some diseases as compared to their city counterparts (National Rural Health Alliance (NRHA), 1998). The rate of hospitalization is higher.
This paper is going to attempt alternative explanations to the health differential conditions and dismiss improving access to healthcare as the only solution this condition. The exploration of psychosocial and sociological concepts to would majorly be considered as the suggested alternatives.
It is a shocking realization that living in the countryside is describe as a health hazard. Humphreys & Rolley (1991) hold it that health is a general right for citizens of a country, but the variations in health situations that some section of a population experience open doors for speculations or research. In fact, the condition of Australia has been termed a crisis by Humphrey (1998).
The National Rural Health Policy Forum of Australia has it that the life of rural Australians is worse than that of others living in the towns (National Rural Health Policy Forum, 1999). The reasons underlined include suicide cases, injuries, road carnages, asthma, diabetes, and mortality rates that are very high in the remotes Australian areas. All these, apparently, result in overall higher death rates in the rural areas. Also differentially distributed are the cancer deaths whose heat map depends on the residential areas. The eating habits of urban residents have been on the spotlight as the causes to increased rates of diabetes and cancer, but the rates of these two diseases is are supposedly higher in patients residing in the remote rural areas than those living in the metropolitan vicinities.
A scrutiny into the hospitalization data shows that males and females from the rural areas are hospitalized for diabetes twice often as compared to the urban residents. This statistic is also still growing, explaining why cases of this disease are 25 percent higher for females in the remote areas as compared to the city dwellers (AIHW, 1998).
The death rate data grabbed from Australian statics between 1992 and 1996 compares the rate of deaths between the metropolitan areas and the remote areas because of injuries. It was noted that there was an increase from 53 to 77.5 deaths of males per 100, 000 population in the remote Australian residential areas (AIHW, 1998). Even though the female deaths rates due to injuries are lower than males, the trend maintains that the death rates from injuries increase with increase in the remoteness of the residential places. Therefore, living in the countryside is riskier than living in the metropolitan sections of Australia.
Another odd revelation from the death rate data comes from cases of suicide. The rate at which suicidal occurrences happen in Australia has remained static in the last century. Just like other cases, the rates at which males kill themselves is still higher than the females with the trend more frequent in the remotest of areas of the Australian countryside.
Sociodemographic data analysis
The sociodemographic presentations of 1994 by Remote and Metropolitan Area classification (RRMA) indicate how Australia is pretty much an urban state. By June 1996, more than 70 percent of Australian nationals were already living in urban centers, 90 percent of these were residing in the cities. The life expectancy is dependent on geographic locations. Urban dwellers have an upper hand in enjoying longer days of life compared to those living in the remote parts. Further demographic data show that males living in the rural areas have a life expectancy of 74.7 while the city residents stand at 75.6 years. Females in the rural areas enjoy about 80.8 compared to their metropolitan counterparts who live up to 81.2 years.
Between 1969 and 1994, study conducted by Burnley of New South Wales revealed that even though there was a decline in heart conditions i.e. Ischaemic heart disease (IHD), the age bracket that suffered the most was between 40 to 46 years. These included those residing in the small towns or rural areas and not those living in the urban coastal centers of New South Wales. Despite this outcome, the spatial variations remained constant thereby becoming difficult to explain. He however came to a conclusion that the poor life styles and the shortage of healthcare played a major factor here, but since this was unsatisfactory, he recommended further research on social, cultural, or material or structural factors as causative factors.
Causes of the health differentials in rural and urban Australia.
Various epidemiologists have tried to come up with the explanations to these findings of the health status in the rural and the urban dwellers. A section has pointed out the poor access to medical or health services, but to a certain degree. Lifestyle risk (behavioral) factors, socioeconomic, cultural, physical environmental and psychosocial factors are some additional causes for explanation. A consensus has fallen on the social determinants of health to be the better explanation to the health differential phenomenon.
Socioeconomic status (SES) as a Social determinant of health differentials
The social determinants of poor health status of the rural Australia cannot be approached without soliciting the views held by social theorists like Karl Max and Pierre Bourdieu. The social concepts they hold are key to dissecting the phenomenon at hand. Karl Maxs ideologies about the social classes and the characteristics that make each class to either succeed or fail certain consequential natural norms are an insight. Karl maxs theory of stratification in the society determines the chances of survival. He argues that the society is stratified into two groups, the bourgeoisie and the proletariat. The bourgeoisie are the owners of means of production, factories and wealth makers while the proletariat are the workers who fully depend on the former for chances of survival. Similar to this view, the researchers of the Australian case have concluded that the evidence on socioeconomic status and health in Australia is unequivocal: those who occupy positions at lower levels of the socioeconomic hierarchy fare significantly worse in terms of their health (Turrell, Oldenburg, McGuffog & Dent , 1999).
The education, income and occupation are the parameters within which socioeconomic status is measured. When approached from the perspective of income, there is a direct proportion between income and health. Australians who earn less income are likely to suffer the increased morbidity rates of diseases like chronic ailments, disability among other illnesses. The fact that the salaries are not similar due to various situations and the geographic locations; it is therefore difficult compare (Haberkorn, Hugo, Fisher & Aylward, 1999). Nevertheless, the city residents are most likely to earn higher than the rural counterparts are and so are able to gain access to medical care and information on preventive measures against most illnesses.
The health differential may be assumed to differ in favor of the metropolitan dwellers than the rural one when the annual taxable income is included in the equation. The other determinant is number of families with children who depend on the government for pensions and other beneficial assistance. The proportion of families of low-income working families and the lastly, the adults from 25 years and above who benefit from labor markets, all these are predominantly located in the metropolitan regions of Australia as compared to the remote areas. The mining towns and the wine producing towns like Riverina, a south western section of New South Wales exist, but are not just enough for the whole population of the area to thrive on.
Further exploration of the status of education as an element of socioeconomic status and the prospects of employment in Australia show a revelation that rings a bell, as to why the death rates are higher in the rural and not the metropolitan areas. The number of people with tertiary qualifications continues to rise in the rural areas; on the contrary, the number is still low in the rural areas. The morbidity rates for cardiovascular and respiratory diseases therefore increase in the rural areas as a result of the inability to secure employment despite having the papers. Studies have also shown that the young men in the rural areas are at more risk of committing suicide and developing mental problems because of unemployment. These are exhibited frequently in the rural areas.
Huggins (1997) therefore, concludes that "low socio-economic status is the single best indicator of premature death amongst Australian males". Simply improving medical healthcare cannot single handedly solve this problem.
Environmental factors
Overexposure to injuries resulting from manual work like farm work, combined with the sorry conditions of roads in the rural areas contribute to the rural health differential. Parker et at al (2001) adds that agriculture is the major cause of occupational injuries and the related diseases in the rural Australia. In addition to working in the farms and being exposed to injuries and risk related to the farm machines, the remote dwellers live within their farms and this just worsens their exposure to the mentioned dangers (Wolfenden & Sanson- Fisher, 1993).
The documented injury trends so much shows the nature of employment. In areas where animals are kept for beef and dairy products, the varieties of injuries reported are animal related. Workshop related injuries are recorded from sheep farm while injuries from handling farm tools and equipment appears to cut across. Wolfenden & Sanson- Fisher (1993) claim that both the farming environment itself and the diversity of production processes that are carried out daily on farms, contribute to the high rate of injury in the rural areas.
Another report from NHMRC shows that almost certainly due to a combination of factors including exposure to travel, patterns of alcohol use, and conditions of motor vehicles, seat belt use and access to emergency medical services. It may also be due to fewer deterrents in the form of lower levels of policing on country roads to check on speeding and drink driving"
Poor road conditions in the rural Australia create more accidents than in the cities where the roads are well maintained. Poor policing on such roads has also been reported to influence these statistics.
During emergencies, the poor roads do not permit urgent means of reaching the victims through ambulances. This is a perfect environmental factor standing on the way to access to medical services (Humphreys, 1998). In addition, the high expense of traveling made so by the increased fuel prices just add salt to the injury (Bond 1993). Improvement of health services would not make any sense if the conditions of the roads in the rural areas remain the same.
Behavioral or risk-taking factors as causes to health differential
NHRA (1998) holds it that "Sensation seeking and aggression have been found to be the main reasons adolescent men drive recklessly" To concur with this claim, the higher amounts of accidents in the rural areas than the metropolitan are down to the aggressive risk-taking behaviors in their d...
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