“Urban narcissism” was not a term I had heard before.
It was used recently by associate professor Michael Clements, a GP in Townsville, the vice-president of the Royal Australian College of General Practitioners and chair of the college’s rural division.
He owns Clements Medical, which services far north Queensland, and often travels as far as 800km from his home. He and his doctors fly out to remote patients in Normanton, Doomadgee, Karumba, Magnetic Island and many other towns. But in his advocacy work, Clements still comes up against the attitude that medical care should only happen where doctors want to provide it.
“Some doctors say: ‘I choose to live in the city and if people want good healthcare, they’ve got to come to me’,” he says. “If they want to live in Woop Woop, then that’s their fault. They just have to travel and deal with it.
“Urban narcissism is this concept that medical care only happens where they want to provide it and care is best in the city.”
This is not a new view and it is worth pointing out that rural people can have prejudicial attitudes towards urban people too. (If I hear about latte sippers again, I may scream.)
And there has long been a tension surrounding the level of services required in rural and remote communities, in a very large country with a relatively small population and an even smaller number of taxpayers.
But, increasingly, healthcare in rural areas is not working for either the population nor the healthcare workers who serve them, because care is getting more expensive and complex and patient expectations are rising. Added to the burden are the bureaucratic rules which determine how services operate along various regional boundaries and state borders – so much so that some injured people have called their neighbours rather than emergency services.
Frankly, the dollars aren’t there to pay for these complexities. A report commissioned by the National Rural Health Alliance from Nous consultancy dug into multiple government and academic datasets last year and found the annual spending gap between urban and rural citizens was $6.55bn, or close to $850 a person a year.
Bear in mind that equal spending per capita does not necessarily equate to the same level of services between cities and the regions, because it costs more to deliver healthcare the further you are from a capital city. That makes the real gap even larger.
If you are thinking you have heard this sad song before, let me remind you of the statistics.
As recently as 2021, a woman living in a remote area was expected to die 16 years earlier than a woman in a city. Men in remote areas are expected to die 13 years earlier than their city counterparts, according to Rural Flying Doctor Service Best for the Bush 2023 report.
The NRHA report showed patients don’t have access to, or are putting off, seeing health workers. In some places, that means medicating symptoms more because of lack of access to doctors. If you can’t see a physiotherapist or pain specialist about a chronic back injury, you take a pill. If you have blurry vision and can’t see a specialist, you continue to drive and use the $10 chemist glasses to read.
Rural people present with worse conditions and that drives increased hospital spending. Indeed, we are fronting up to emergency departments more, at a rate of 423 per 1,000 people compared with 309 in urban centres.
Some don’t get help unless a limb is dangling. The report found obvious geographical differences in leading causes of preventable deaths rates between major cities and very remote settings. Diabetes deaths are 3.8 times higher in remote areas, suicide rates are 2.3 times higher and coronary artery disease is 1.7 times higher.
It is not much better for allied health and disability services. NDIS patients in remote areas receive less than 70% of the funding for each person as their urban counterparts. You can’t use the funds if you don’t have the service providers. Rural and regional people access one-third less funding for dentistry work than urban areas, and that disparity increases as you get to more remote communities.
Yet, compared to our population share, rural industries such as farming, mining, and tourism make up a disproportionately large portion of Australia’s economic output. If you can’t get good healthcare (or education or childcare), who will be in those workforces?
Many people discovered this during the regional migration boom, when new residents tried to access services in their new towns. Some suggested, it was tougher than they thought with “no family, no friends and no backup”.
Still, you may continue to think that smaller and more spread out populations in rural and remote areas do not justify increased spending.
I don’t think many rural people expect a teaching hospital in a town of 2,000. We just want a doctor. As Clements points out: “We need people out here [in remote Australia], because that’s how we function and that’s how we eat, and that’s how we survive”.
Without the most basic of services like adequate healthcare, it might be time for all of us in the regions to move to larger cities. It would cause your inner-city house prices and rent to rise but, honestly, it would be way more efficient.
