July 2016 RWNZ submission on New Zealand Health Research Strategy

RWNZ submission on health research strategy

Health Research Strategy

Ministry of Health

PO Box 5013

WELLINGTON 6140

healthresearchstrategy@mbie.govt.nz

Rural Women New Zealand Submission on the New Zealand Health Research Strategy:

Public discussion document Introduction to RWNZ

1. Rural Women New Zealand (“RWNZ”) is a not‐for‐profit member based organisation that reaches into all rural communities and advocates on issues that impact on those communities. We welcome the opportunity to provide a submission to the Ministry of Health (“MoH”) on its discussion document on the New Zealand Health Research Strategy. Improving health outcomes and equity of access to healthcare in rural communities is a key strategic focus of our organisation.   Overview of our submission

2. RWNZ strongly support the development of a health research strategy to enable New Zealand to take a more cohesive and connected approach to its investment into health research.  In this submission we argue that research into rural health outcomes and access to healthcare for rural populations must be a key investment priority for this health research over the next 10 years.

3. A recent literature review conducted by the University of Otago, has highlighted that there is a significant research gap in New Zealand in relation to rural health and healthcare issues, compared to similar jurisdictions. This is despite, growing evidence domestically and internationally to suggest that rural populations are disproportionately disadvantaged across a range of health and social wellbeing indicators. Some of these studies suggest that the health outcomes for rural are similar to the figures for Maori and Pasifika populations in New Zealand. There are also well known barriers of access to healthcare services in rural parts of New Zealand, which could be causing disparities in health outcomes between rural and urban populations.

4. Greater investment into rural health research is urgently needed to improve our understanding of the specific health issues faced by rural New Zealanders and to better inform government funding and delivery of health services for this at risk population group. A first priority of this research must be to establish a consistent definition of rurality. We think that better research into rural health issues must be considered a key step towards achieving the MoH’s goal of health equity for all New Zealanders.   There is a significant lack of research in New Zealand on rural health issues and disparities between rural and urban health outcomes

5. A recent literature review conducted by the Department of General Practice and Rural Health, University of Otago has identified a serious lack of rural health research in New Zealand, when RWNZ submission on health research strategy compared to similar jurisdictions 1. This purpose of this literature review was to identify studies comparing rural versus urban health outcomes in New Zealand as well as issues with the delivery of health care services in rural areas.  In total, only 38 studies were identified between 1946 and the present, with 7 of the papers published prior to 20002 .  In the same time period over 4,000 articles were published related to rural health and healthcare in Australia; over 2,000 in Canada and over 600 in Scotland.

6. There are also issues with the reliability of current Government research on rural health outcomes due to problems with the way that Statistics NZ currently defines ‘rural population’.   These imperfect definitions underpin most data published by the Ministry of Health and other national bodies. Consequently, basic statistics such as mortality rates for rural New Zealanders may be misrepresenting the situation.    Existing research suggests that rural populations are likely to be disadvantaged across a range of health and social wellbeing indicators

7. While government led research on rural health outcomes is limited. The studies that have been conducted do indicate that rural populations, are severely disadvantaged across a range of health indicators.  Some of these studies also suggest that the health outcomes for rural are similar to the figures for Maori and Pasifika populations in New Zealand, with high numbers of these population groups living in rural areas.

8. Poorer health outcomes in rural areas are consistent with international research on disparities in health outcomes for rural populations. They also reflect well‐recognised barriers of access to healthcare services known to exist in rural New Zealand.  For example, compared to urban populations, the research suggests that rural New Zealanders experience:    poorer access to early detection and screening diagnostic interventions and treatments. For example, people living in rural communities have poorer rates of access to cardiac investigations, CT scanning diagnostics and screening for breast and prostate cancer.   While, mobile breast screening services has improved accessibility in rural areas, women who do not qualify for a mammogram, still must travel to receive this service. These women cannot opt to pay to receive the mobile service.    less exposure to primary medical care due to geographical barriers to access and a shortage of primary health care professionals in rural areas. The ratio of General Practitioners to patients in rural areas remains significantly lower in rural areas.3     higher rates of infectious diseases like salmonella and campylo bacteriosis, giardiasis.    higher rates of chronic diseases including advanced stage breast cancer, advanced prostate cancer and greater mortality rates from these diseases.    higher rates of traumatic brain injuries. For example, the incidences of moderate to severe TBI in rural populations is reported by one study to be almost 2∙5 times greater than in urban populations.

1 Doolan‐Noble, F. 2016. Comparison of rural v urban health in New Zealand. Paper prepared for the Rural Health Alliance Conference.

2 A review of the literature from 1946 to present day was undertaken in OVID database (OVID provides access to online bibliographic databases, academic journals and     other products mainly in the area of the health sciences). In addition, a search was conducted in Google Scholar.

3 WHO. 2014. New Zealand health system review. Health Systems in Transition,

4(2). Retrieved from http://www.wpro.who.int/asia_pacific_observatory/hits/series/Nez_Health_Systems_Review.pdf RWNZ submission on health research strategy  an increased risk of mental health issues, including depression and suicide, related to high levels of social isolation and vulnerability to economic fluctuations. In particular, increasing suicide rates amongst farmers has become a growing concern following economic downturns in the dairy industry. In New Zealand last year, there were 564 deaths by suicide, with males making up 75 per cent of deaths and the majority living in rural communities. According to government figures 27 farmers committed suicide last year in New Zealand, compared to 22 in the previous year and 19 in 2012/2013.

9. Australian studies also indicate that those living in rural areas, have higher rates of cardiovascular diseases like congestive heart failure and poor incidences of renal replacement therapy.

Conclusion

10. Poorer health outcomes, and access to healthcare services among rural populations reflect serious unmet needs among this population group. Greater investment into rural health and healthcare research is urgently required to better understand the specific health issues facing rural New Zealanders and to better inform the funding and delivery of health services to rural populations.

11. RWNZ thanks the MoH for the opportunity to submit on the exposure bill.  Please do not hesitate to contact me using the contact details below if you would like to discuss our submission further.

Penelope England

Chief Executive Officer

Rural Women New Zealand

penelope.england@ruralwomen.org.nz

Acknowledgements to: Margaret Pittaway National Councillor, Health Portfolio