Creating place‐based health and wellbeing networks in rural and remote communities

The National Rural Health Alliance (the Alliance) released its new strategic plan 2019-20221 in September 2019, following my appointment as Chief Executive Officer (CEO) in July. The strategic plan marks a shift in the direction of the Alliance, which is reflected in our vision for “healthy and sustainable rural, regional and remote communities.” The word “sustainable” in this context encompasses the three interrelated elements of (a) society—including the principles of equity, empowerment, accessibility and inclusiveness—(b) the environment and (c) the economy, with the view that health policies must integrate human and planetary health, as well as promote economic vitality in a way that does not compromise other aspects of sustainability.2, 3 This seems particularly pertinent in the context of persistent drought across many parts of Australia and the catastrophic bushfires that swept through Queensland, NSW, Victoria and South Australia this summer. The physical and mental health and well-being of so many rural communities across Australia will be affected for many years to come, augmented by the devastating impact that these severe weather events have had on our natural and built environment and the economy. To achieve the vision for health and sustainable rural, regional and remote communities, the Alliance proposes the creation of six placed-based health and wellbeing networks (PBHNs) in rural and remote communities in Modified Monash Model (MMM) areas 4-7. It relies on a modest outlay from the Australian Government and illustrates our commitment to achieving the vision for healthy and sustainable rural, regional and remote communities. The PBHNs expand on an earlier demonstration site concept4 by promoting a holistic, person-centred model of care that focusses on preventive health and integrates health services with community and social services. The underlying philosophy for the PBHNs is that health care moves beyond the paradigm of service delivery to a broader framework that privileges wellness and well-being over sickness, while striving for more sustainable communities. At the community level, the health sector is projected to be a large employer in regional Australia in coming decades.5 Indeed, the viability of this sector is essential to local people's livelihood, to the livability of places, and to the health and well-being of residents. However, building viable rural and remote health care businesses is challenging in thin market contexts. Many allied health professionals in rural areas frequently work across multiple sectors to earn a livable wage. They may make up a full-time equivalent by working part-time with the local health district, taking on roles in the NGO sector funded by the local Primary Health Network (PHN), working within an aged care facility, or conducting private practice. Nevertheless, to make a rural public-private partnership model attractive to health professionals, exploring alternative funding arrangements—such as pooled funding arrangements between State and Commonwealth Governments—is imperative. The National Rural Health Commissioner has recommended the formation of Rural and Remote Allied Health Consortia (RRAHC), which will need to be supported with government funding. The multidisciplinary RRAHC will form the basis of the PBHN model and are designed to be flexible, allowing people to receive a range of allied health public and private services. Services may be delivered either through face-to-face appointments or telehealth services that will be connected to general practitioners and nurse practitioners, specialists, community pharmacists, dentists and local health district services (including acute care or midwifery). To meet the need for “localised” workforce recruitment and retention strategies, the PBHNs will consider a range of incentives that are not just financial in nature. Concepts such as sense of place, place attachment and belonging in place will be considered in the development of person-centred approaches. In line with this concept, the project will also draw on findings from the implementation of Cosgrave's whole-of-person retention improvement framework incorporating three key life domains (workplace/organisational, role/career and community/place), which was trialled in 2018-2019 by two rural public health services in Victoria.6 To support social connection of health workers, especially newcomers, the PBHNs will consider establishing a Recruitment and Community Connector position, in line with the model developed in Marathon, Ontario, Canada.7 Further evidence from Canada indicates that a distributed model of medical education into rural and regional communities can have a positive economic benefit for those communities.8 Hence, training of GPs and allied health professionals in their respective rural generalist pathways, as well as Aboriginal and Torres Strait Islander health practitioners and workers, will be incorporated into these PBHNs. They will have links to University Departments of Rural Health, Rural Clinical Schools, Regional Training Hubs and Aboriginal Community Controlled Health Services, providing professional support and development. It is expected that the PBHNs will operate across the health, community, education, disability and aged care sectors for preventive health and early intervention programmes, to address the needs of an ageing population, the epidemic of chronic conditions and the rising costs of health care.9 To address the social and ecological determinants of health, aligning with building healthy sustainable communities, the PBHNs will work with local groups to create community food hubs, similar to The Stop10 programme in Toronto, Canada. Such programmes can improve understanding of sustainable food systems, offer practical solutions to food insecurity, increase physical activity and promote social cohesion. It is envisaged that these community food hubs could become thriving centres for community engagement in food production and preparation, involving young children, adolescents and the elderly. In addition to a place-based community food hub, the Orange Declaration suggests that place-based interventions for those with mental health problems—that are holistic, integrated and co-designed by local communities—show promise and could be evaluated through this initiative.11 Rural, regional and remote communities in MMM areas 4-7 that currently have poor access to high quality, affordable and integrated care provide an excellent avenue in which to test the efficacy of alternative funding and service delivery models via the proposed PBHNs. Their focus on preventive health, increasing social cohesion and promoting strong and viable health and community services, will all contribute to advancing healthy and sustainable rural, regional and remote communities.

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