Geographical classifications to guide rural health policy in Australia

The Australian Government's recent decision to replace the Rural Remote and Metropolitan Area (RRMA) classification with the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA) system highlights the ongoing significance of geographical classifications for rural health policy, particularly in relation to improving the rural health workforce supply. None of the existing classifications, including the government's preferred choice, were designed specifically to guide health resource allocation, and all exhibit strong weaknesses when applied as such. Continuing reliance on these classifications as policy tools will continue to result in inappropriate health program resource distribution. Purely 'geographical' classifications alone cannot capture all relevant aspects of rural health service provision within a single measure. Moreover, because many subjective decisions (such as the choice of algorithm and breakdown of groupings) influence a classification's impact and acceptance from its users, policy-makers need to specify explicitly the purpose and role of their different programs as the basis for developing and implementing appropriate decision tools such as 'rural-urban' classifications. Failure to do so will continue to limit the effectiveness that current rural health support and incentive programs can have in achieving their objective of improving the provision of health care services to rural populations though affirmative action programs

The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear

BACKGROUND: Based on the hypothesis that a vicious cycle of dental fear exists, whereby the consequences of fear tend to maintain that fear, the relationship between dental fear, self-reported oral health status and the use of dental services was explored. METHODS: The study used a telephone interview survey with interviews predominantly conducted in 2002. A random sample of 6,112 Australian residents aged 16 years and over was selected from 13 strata across all States and Territories. Data were weighted across strata and by age and sex to obtain unbiased population estimates. RESULTS: People with higher dental fear visited the dentist less often and indicated a longer expected time before visiting a dentist in the future. Higher dental fear was associated with greater perceived need for dental treatment, increased social impact of oral ill-health and worse self-rated oral health. Visiting patterns associated with higher dental fear were more likely to be symptom driven with dental visits more likely to be for a problem or for the relief of pain. All the relationships assumed by a vicious cycle of dental fear were significant. In all, 29.2% of people who were very afraid of going to the dentist had delayed dental visiting, poor oral health and symptom-driven treatment seeking compared to 11.6% of people with no dental fear. CONCLUSION: Results are consistent with a hypothesised vicious cycle of dental fear whereby people with high dental fear are more likely to delay treatment, leading to more extensive dental problems and symptomatic visiting patterns which feed back into the maintenance or exacerbation of existing dental fear

The Amenity Principle, Internal Migration, and Rural Development in Australia

Arguably, rural land markets in Australia are currently in a high state of flux, with a panoply of competing interests seeking to capitalize on both the traditional and a range of newly emergent values anchored in land. Amenity-led migration is, we argue, an important strand of this renewed interest in rural lands, albeit one that is highly spatially selective. Employing a predictive and synoptic model of migration attractiveness across southeastern and southwestern Australia, we test its associations with migration currents into and out of rural communities for the 1990s and 2000s. This article finds that communities with high relative accessibility—to metropolitan and urban centers and the coast—and an established or emerging tourism industry have been most likely to experience net migration gains. Yet amenity migration also intersects with more traditional rural land uses and, in particular, irrigated agriculture. Farming, and the biophysical environment and cultural landscape it both draws on and produces, is an important attractor of amenity migratio

The amenity complex: Towards a framework for analysing and predicting the emergence of a multifunctional countryside in Australia

The definitive version is available at www.blackwell-synergy.comThere is growing consensus among academics, regional development organisations and rural communities that the future growth and development of rural regions is increasingly dependent upon their ability to convey, to both established and prospective residents, the ‘amenity’ of their local physical, social and economic environments. However, little research to date has sought to identify exactly what comprises ‘amenity’ in the rural context, or has examined how this conceptually slippery quality is distributed across rural Australia, or how it influences local demographic, socio-economic and land use change. This paper attempts a broad scale investigation of rural amenity in the south-east Australian ecumene, identifying its core components in this context, mapping its distribution and assessing the nature of its influence over in-migration rates over the past three decades. The paper finds that, at a macro-scale, amenity tends to follow a general gradient from high to low according to distance from the coast, and that its relationship with in-migration rates has increased substantially between 1976–1981 and 1996–2001.Neil Argent, Peter Smailes, Trevor Griffi

Information and support for women following the primary treatment of breast cancer

The definitive version is available at www.blackwell-synergy.comObjective To examine the need for, use of and satisfaction with information and support following primary treatment of breast cancer. Design Cross-sectional survey. Participants Cohort of 266 surviving women diagnosed with breast cancer over a 25-month period at a tertiary hospital, Adelaide, Australia. Time since diagnosis ranged from 6 to 30 months. Main outcome measures Need for, use of and satisfaction with information and support. Results Women reported high levels of need for information about a variety of issues following breast cancer treatment. Ninety-four percentage reported a high level of need for information about one or more issues, particularly recognizing a recurrence, chances of cure and risk to family members of breast cancer. However, few women (2–32%) reported receiving such information. The most frequently used source of information was the surgeon followed by television, newspapers and books. The most frequently used source of support was family followed by friends and the surgeon. Few women (<7%) used formal support services or the Internet. Women were very satisfied with the information and support that they received from the surgeon and other health professionals but reported receiving decreasing amounts of information and support from them over time. Conclusions Women experience a high need for information about breast cancer related issues following primary treatment of breast cancer. These needs remain largely unmet as few women receive information about issues that concern them. The role of the surgeon and other health professionals is critical in narrowing the gap between needing and receiving information.Jane C. A. Raupach and Janet E. Hille