NSW State of Play 2023: governments being 'city-centric' has consequences that follow remote & outer regional populations to their graves

 

The Australia Institute, media release, 14 February 2023:

New analysis reveals residents born in Far West NSW are suffering substantially worse health outcomes than residents in Sydney.

People in Far West NSW are dying earlier than they should, from avoidable causes, and while suicide rates have steadied in Sydney, they are on the rise in the most remote parts of the state.

The report warns of serious and growing inequality in health outcomes between city and country residents and recommends immediate investment in the sector.

Key points:

• Life expectancy: People born in the Far West have a life expectancy 5.7 years less than those in Sydney, with the divide worsening

• Premature death: Residents in Far Western NSW are 2x more likely to die prematurely than those in Sydney

• Avoidable death: ‘Potentially avoidable deaths’ are 2.5x more likely in the Far West than in Sydney

• Suicide: Residents in the NSW Far West are 2x as likely to commit suicide than those in Sydney, with a clear upwards trend in suicide rates

“Far West NSW is in serious need of medical attention. Where you live shouldn’t dictate how long you’ll live, but unfortunately in NSW it does” said Kate McBride, Researcher at The Australia Institute.

“Those in the Far West have significantly poorer health outcomes, inferior access to health services and face substantial financial challenges to access services.

“Life expectancy, premature deaths, and ‘potentially avoidable’ deaths are key statistical indicators of whether our health system is working. It is clear from the analysis in this report, sirens should be sounding from the Far West of the state.

“There’s a compelling case for significant investment across the continuum of care, from disease prevention to rehabilitation and ongoing care, in regional NSW.

“The first release in a series, this report reflects a wider national trend: That the health system is failing those living in regional and remote Australia” said Kate McBride.

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RELATED RESEARCH

Kate McBride, The Unlucky Country: Life expectancy and health in regional and remote Australia. Part 1: NSW, February 2023.

FULL REPORT

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Excerpts from the McBride report:

“Australia has the world’s third highest life expectancy at 84.3 years. However, this national average masks the fact that the ‘lucky country’ has some rather less lucky residents. In every state and territory, those in regional and remote areas have life expectancies several years lower than in the city.

New South Wales (NSW) is a stark example of this divide. Life expectancy in Far West NSW is 79.1 years compared to 84.5 years in Sydney. This more than five-year gap has grown from relative parity at the turn of the millennium to the current gap. Today, a person in far west NSW is more than twice as likely to die prematurely (under 75) than someone in Sydney.

While there are many possible reasons for this discrepancy, overall, people die of the same causes in urban and remote parts of NSW; a comparison of the top causes of death in each area reveals that the top 10 are almost identical. However, regional and remote people are dying younger and from preventable causes at much higher rates than those in Sydney. Deaths considered ‘potentially avoidable’ are more than two and a half times as common in the far west than in the state’s capital.

It has been known for years that there is a suicide issue in regional Australia. Suicide rates in far west NSW—already more than twice as high than those in Sydney—are continuing to rise, while those in urban areas remain steady. But while suicide is a significant problem, it is only the tenth leading cause of death in the region. Suicide tends to take people at a younger age than other causes and as a result can disproportionally skew life expectancy, having said this there are other factors likely at play.

In 2022, a NSW Parliamentary Inquiry into health outcomes and access to services in rural, regional, and remote NSW found that people outside urban areas had significantly poorer health outcomes, inferior access to health services, and faced substantial financial challenges to access services.

This divide between life expectancy in the cities and in the country is a problem that extends beyond far western NSW. The city/country divide exists across Australia, and it is growing. Inequity between Australians living in capitals and remote areas is a significant problem that demands government intervention, particularly concerning overwhelmed and under resourced health systems.”

NOTE: I draw to the attention of "North Coast Voices" readers, living in what is the Australian Bureau of Statistics' Coffs Harbour-Grafton Level 4 Statistical Area, the fact that the combined populations of Clarence Valley and Coffs Harbour City have a projected life expectancy at birth which is 3.9 years lower than that of the population of the Greater Sydney metropolitan area. Only the projected life expectancy at birth for the Far West and Orana region has a worse comparative figure.

The only differences are dehydration and suicide (more below) in the Far West being replaced by heart failure and breast cancer in Greater Sydney. The similarity in causes of death suggests that the factors driving lower life expectancy in the far west are not due to different physical conditions or different lifestyles, but to how causes of death are prevented and managed. [my yellow highlighting]

Sadly, what the preceding paragraph is politely hinting at is that there is a culture within governments which tolerates and, perhaps even relies upon, inequality of access to health care along with an acceptance of delivery of poorer quality health care to those living in remote areas of New South Wales, as one of the tools which allows the provision of a much higher quality of health care to those living in metropolitan centres and inner regional areas on the fringes of major cities. 

That is where the bulk of the state's electorates and voter numbers are concentrated and, it will come as no surprise that ahead of the March 2023 state election little electoral growth was expected in the western half of New South Wales [Report of the Electoral Districts Redistribution Panel on the draft determination of the names and boundaries of electoral districts of New South Wales, 9 Nov 2020].

NSW Upper House report on health & hospital services in regional, rural and remote areas of the state documents instances of lack of access to specialist services, understaffing, poor treatment outcomes, inadequate ambulance presence, long wait times, high out-of-pocket expenses and discrimination

 

It is hardly a secret that the NSW public health & hospital system has been under stress for much of the last two years and remains under stress in 2022.

Nor is it a secret that the ongoing global Covid-19 pandemic and seasonal respiratory disease have played a big part in this organizational stress.

However, they are not the only contributing factors and in rural, regional and remote areas health services stress has been building for decades.

There is a reported absence of a GP or chronic shortage of health professionals in: Bonalbo, Eurobodalla, Gunnedah, Deniliquin, Edward River, Manning Valley, Port Stephens, Temora, Glen Innes, Gulgong, Wee Waa, Wollondilly, Mid-Western Regional Council, Coleambally, Warren Shire Council, Broken Hill, Wentworth, Merriwa, Tenterfield, Parkes, Coonamble, Gwydir, Bourke, Hay and Leeton, with another 41 Western and Far West NSW towns identified as being at risk of not having a practicing General Practitioner within the next 10 years.

Often there is only one doctor on duty at smaller regional, rural or remote hospitals and 27 per cent of all adverse events (clinical incidents or mishaps) occurred in rural and remote health services.

In addition, the NSW Ambulance service is frequently overwhelmed by a combination of low staff numbers on a given day, vehicles tied up by being 'ramped' at over stretched hospitals and increased travel times.

A NSW Upper House inquiry was established on 16 September 2020 to inquire into and report on health outcomes and access to health and hospital services in rural, regional and remote New South Wales.

It received 720 submissions.

The following are extracts from the Inquiry report tabled in the NSW Parliament on 5 May 2022.

NSW LEGISLATIVE COUNCIL, PORTFOLIO COMMITTEE NO. 2, REPORT 57, May 2022, “Health outcomes and access to health and hospital services in rural, regional and remote New South Wales”

Committee comment

3.126 As already outlined in this report, the inquiry has heard evidence from a number of witnesses providing first-hand examples of inadequate health services and care in rural, regional and remote New South Wales. There is no doubt that doctor and clinician workforce issues are a key, if not the key to explaining many of these experiences. The committee acknowledges and appreciates the many doctors and clinicians who gave up their time and shared their expertise and personal experiences to inform the inquiry of the issues they face in rural and remote settings, including their ideas about ways to improve the current situation. These accounts provided detailed and thoughtful evidence as to both the challenges and opportunities to address them.

3.127 It is clear to the committee that the availability of doctors and clinicians in rural and remote locations is short, in some cases critically short of where it needs to be. While Chapter 2 detailed the impact this shortage is having on members of the community, the committee has also heard doctors and clinicians describe the unsustainable working conditions, particularly with respect to hours of work arising from insufficient supply of doctors and clinicians to cover the available work demands. The committee is concerned about doctor and clinician shortages and maldistribution in rural and remote settings, and the risks it poses to the health of community members, doctors and clinicians alike.

3.128 Consequently, the committee finds that rural, regional and remote medical staff are significantly under resourced when compared with their metropolitan counterparts, exacerbating health inequities…..

3.130 Indeed, there can be little doubt that the doctor workforce challenge is complicated and compounded by the division of responsibilities between Commonwealth and State. In fact, both levels of government acknowledged the Commonwealth/State divide as one of the most challenging aspects of health care delivery. But the existence of these challenges is not new. The committee is of the view that efforts to overcome them have been inadequate to date, ultimately failing to achieve the necessary structural reform. Consequently, the committee finds that the Commonwealth/State divide in terms of the provision of health funding has led to both duplication and gaps in service delivery.

3.131 The committee therefore recommends that the NSW Government urgently engage with the Australian Government to establish clear governance arrangements and a strategic plan to deliver on the reforms recommended below to improve doctor workforce issues. This should occur at the ministerial level to ensure the necessary political and policy momentum is maintained. We also believe that with a renewed commitment to work together to break down barriers and achieve health reform, progress can be made on those initiatives that both levels of government have identified as meritorious, but where progress has been slow or non-existent.

3.132 Despite the role played by the Australian Government, the committee also believes that, given the interdependency between primary health and hospital care, there is a need for the NSW Government to investigate ways to support the growth and development primary health sector in rural, regional and remote areas and support the sector’s critical role in addressing the social determinants of health and reducing avoidable hospitalisations for the citizens of New South Wales. [my yellow highlighting]

The report made 44 specific recommendations which are outlined on pages xv to xxii of the report found at:

https://www.parliament.nsw.gov.au/lcdocs/inquiries/2615/Report%20no%2057%20-%20PC%202%20-%20Health%20outcomes%20and%20access%20to%20services.pdf

Formal response from the Perrottet Government in not due until November 2022.