Geographical Barriers
Remoteness of residence directly impacts on the accessibility of health services.
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A cross-sectional screening survey in 2015 identified a number of locations in which the prevalence of RHD among Indigenous children was significant, with a substantial level of previously undetected disease (Figure 1) [1]. These locations have among the lowest population densities in Australia (Figure 2) and fall within the "very remote" category of the Accessibility Remoteness Index of Australia (ARIA), indicating geographical remoteness and a great degree of difficulty for people to access vital services [2,3].
Figure 1. Northern Australian locations where there were known cases of Indigenous children with rheumatic heart disease in 2015. Obtained from Roberts et al. [1].
Figure 2. The population density of Australia in June 2013, measured by the number of people per square kilometre. Note that the locations shown on Figure 1 predominantly contain less than 0.1 person per square kilometre. Obtained from the Australian Bureau of Statistics [2].
Geographical isolation is accompanied by a number of barriers that hinder the eradication of ARF and RHD among Indigenous Australians. These are explored in the following mind-map:
GEOGRAPHICAL
ISSUES
Large distances to hospitals or medical centres with greater time periods required to reach these places [5].
The high cost and accessibility of transport - in rural and remote Australia this is compounded by seasonal road access, variable road quality, or the need to travel by a different type of transportation (for example, by air instead of road) [5].
Additional "costs" to family (arranging for care of dependents, unable to meet cultural responsibilities) and work (taking time off work without pay, the stigma associated with asking for time off work) when needing to travel with a child for treatment [5].
Low supply of health care facilities [4].
Shortage of specialists, resulting in deficiencies in providing cardiological consultancy services [6].
Lack of trained health-care professionals willing to stay in remote regions for extended periods of time, making it difficult to provide good follow-up care. For instance, the average stay for nursing staff in remote NT is 6 weeks [6].
Lack of cultural training among non-Indigenous health-care workers that stay in communities [7].
Indigenous health workers - the key players in remote areas - are scarce and often burdened by a massive amount of work and responsibility in an isolated community [6].
These geographical factors clearly overlap with one another and intersect with many of the socioeconomic barriers described on the previous post, leading to complex patterns of disadvantage [8]. Greater levels of remoteness lead to a "clustering" of adverse health determinants such as overcrowding, lower incomes and poorer levels of education [5]. In turn, this increases the burden of disease within communities and intensifies the problems inherent in being geographically distant from health care services.
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References
[1] Roberts KV, Maguire GP, Brown A, Atkinson DN, Remenyl B, Wheaton G, et al. Rheumatic heart disease in Indigenous children in northern Australia: differences in prevalence and the challenges of screening. Med J Aust. 2015;203(5):221e1-7.
[2] Australian Bureau of Statistics. Regional Population Growth, Australia, 2012-13 [Internet]. 2014 [cited 2017 Feb 20]; ABS cat. no. 3218.0. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Products/3218.0~2012-13~Main+Features~Main+Features?OpenDocument.
[3] Australian Institute of Health and Welfare. Rural, regional and remote health: A guide to remoteness classifications [Internet]. 2004 [cited 2017 Feb 20]; AIHW cat. no. PHE 53. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459567.
[4] Usmani ZA, Chai-Coetzer CL, Antic NA, McEvoy RD. Obstructive sleep apnoea in adults. Postgrad Med J. 2013;89(1049):148-56.
[5] Woods C, Usher K, Edwards A, Jersmann H, Maguire G. The tyranny of distance – mapping accessibility to polysomnography services across Australia. Australian Indigenous Health Bulletin. 2015;15(3):1-9.
[6] Parnaby MG, Carapetis, JR. Rheumatic fever in Indigenous Australian children. J Paediatr Child Health. 2010;46:527-33.
[7] Brown A, McDonald MI, Calma T. Rheumatic fever and social justice. Med J Aust. 2007;186(11):557-8.
[8] McLafferty SL. GIS and health care. Annual Review of Public Health. 2003;24(1):25-42.
Posted 20th February, 2017