Rural, city health service divide growing

On average, one in two Australian men and one in three women will contract cancer before the age of 85. The situation is worse in rural Australia, where cancer incidence and mortality rates are higher.
On average, one in two Australian men and one in three women will contract cancer before the age of 85. The situation is worse in rural Australia, where cancer incidence and mortality rates are higher. Bet_Noire

THERE is an old saying in Alice Springs that is trotted out whenever a friend or loved one falls ill: "In pain? Catch a plane.”

The saying highlights the varying standards of health care that have been available in the region over the years and under governments of all stripes.

For while most who visit the Alice Springs Hospital come away proclaiming its virtues, the horror stories aren't far behind for those who go looking.

Admittedly, the hospital suffered badly from a botched major upgrade under Denis Burke's millennial CLP Government and has been undergoing almost constant salvage and rectification works since.

Staff have laboured long and valiantly under the daily inconvenience of building works over some 15 years.

As one building insider told me a few months ago, it might have proven cheaper to tear down the whole thing and start again, rather than try to fix it.

I'm afraid I could not say definitively either way, but it would certainly be interesting to see the bill.

To Alice Springs' less-than-preferable situation, add a relative scarcity of visiting specialists and the problem starts to become clear.

To be fair, it's not just Alice Springs that has a problem.

"In pain? Catch a plane” could very well apply to much of regional and remote Australia.

In fact, as any cancer patient well knows, distance from a big city can be almost as dangerous as the dreaded diagnosis.

And that is exactly the finding of a new report on cancer outcomes in rural Australia, released late last month.

Entitled A Rural Perspective: Cancer and Medical Research, the new Garvan Rural Health Report was launched at the National Farmers' Federation 2016 National Congress, in Canberra.

Cancer remains Australia's second-biggest killer after coronary heart disease, with 44,108 deaths recorded in 2013, says the report, which predicts 46,880 deaths during 2016, about 30% of Australia's total for the year.

Importantly, the research confirms that the further a cancer patient lives from a major city, the more likely they are to die within five years of diagnosis.

One of the problems, as evidenced in Central Australia, is a lack of oncologists, specialists and other health providers in rural areas.

But the report also probes other risk factors that are unique to rural and remote regions.

On average, one in two Australian men and one in three women will contract cancer before the age of 85.

The situation is worse in rural Australia, where cancer incidence and mortality rates are higher, with a growing gap between urban and rural outcomes.

With two-thirds of Australia's 24 million people jammed into cities covering a mere 0.7% of the land surface, the 7 million who remain must avail themselves of services that are spread increasingly thinly across regional centres and areas classed as remote.

The health care repercussions of this service disparity are that remote Australians die around three years younger than their city counterparts.

Challenges in the bush vary, but most common is the need to travel great distances to reach even basic hospital services.

And as the report notes, there are 80% fewer specialists in remote Australia compared with major cities.

For oncologists this is particularly chronic, the research finding 94% fewer of them in rural areas than in cities.

Generally speaking, the standard of care in rural and remote areas is also poorer by comparison to the city, and a direct bearing on survival rates.

Facilities are generally smaller and with fewer services available.

That means that in the Centre, air transfers to better-equipped facilities in Adelaide or Darwin are frequent, hence the plane-for-pain adage.

Compounding the situation is the general character of remote and rural groups, where lack of education and lower incomes are more common and rates of private-health membership are lower.

This affects how people seek help, with poor English and dependency on government benefits further contributing to poorer outcomes.

The effects are worse in the indigenous community, where the life expectancy gap is greater, with men dying 10.6 years younger at 69.1 years, and women 9.5 years earlier at 79.9 years.

Melanoma finds a higher incidence among rural populations, resulting in 60% more deaths from the condition among farmers.

The reason is their higher exposure to the sun during a lifetime spent working outdoors.

Other risk factors such as drinking, smoking and obesity are also worse overall in the bush.

And while lung cancer remains the deadliest form of cancer, prostate cancer runs a close second for men and breast cancer for women, with colorectal cancer coming in third.

Perhaps most distressing of all, even if a remote or rural patient does manage to get cancer treatment, half will drop their chemotherapy before completion.

Moreover, there is a decreased likelihood that patients will undergo radiation therapy in remote and very remote areas, with no discernible improvement to outcomes during the decade to 2010.

As a result, those in very remote areas are most likely to die from cancer, but unfortunately also enjoy the dubious distinction of being least likely to be diagnosed.

Cancer was the second- biggest cause of indigenous death after circulatory disease, and accounted for 20% of deaths recorded for the demographic from 2008-12. The Garvan report estimates that cancer costs Australia more than $4.5billion in direct health system costs (based on a 2013 study using 2008-9 figures).

Topics:  health rural

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