Chronic Condition Management in Remote Australia

This assignment explores the prevalence of diabetes in rural and remote regions of Australia, the challenges and barriers to accessibility in these regions, and the impact of demographic, sociological, and cultural factors on health practitioners and patient populations. The lack of accessibility and proper infrastructure is one of the major contributing factors leading to diabetes being a severe chronic public health issue in rural and remote regions inhabited by minority communities.

Running head: CHRONIC CONDITION MANAGEMENT IN REMOTE AUSTRALIA
Chronic condition management in remote Australia
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CHRONIC CONDITION MANAGEMENT IN REMOTE AUSTRALIA
Table of Contents
Introduction:....................................................................................................................................2
Diabetes in rural or remote regions:................................................................................................2
Challenges of rural and remote environments:................................................................................3
Geographical, environmental, sociological and cultural factors:....................................................4
Impact on the health practitioners:..................................................................................................5
Conclusion:......................................................................................................................................6
References:......................................................................................................................................7

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Introduction:
Health care accessibility has been a health care related concern of various developing
nations. However, the developed nations are no exception to this condition either. Taking the
example of Australia, the remote and rural regions mostly inhabited by the aboriginal or other
such indigenous communities still live amidst eccentric lack of health infrastructure and
accessibility; which in turn leads to reduced health outcomes, decreased life expectancy and poor
management of chronic diseases or public health (Ricci-Cabello et al. 2013). Considering the
public health issues, one such health issue is diabetes which can lead to severe co-morbidities in
case adequate interventions and management by care professionals is not provided. The lack of
accessibility and proper infrastructure is undoubtedly one of the major contributing factors
leading to diabetes being a severe chronic public health issue in rural and remote regions
inhabited by minority communities. This assignment attempts to discover the prevalence of a
specific health issue such as diabetes on the rural and remote regions of Australia, the challenges
and barriers to accessibility in these regions, impact of demographic of epidemiological factors
and the impact of these factors on health practitioners
Diabetes in rural or remote regions:
As per the population census data from the past couple of years, close to 28% of the total
Australian populations have been reported to be living in the rural or remote regions of Australia.
Most of these rural and remote populations of this nation are indigenous or multiethnic that are
socially backward and have limited health literacy (Parliament.vic.gov.au. 2018). On a similar
note, these rural or remote populations of Australia have much lower life expectancy, higher
burden of chronic diseases and most importantly very poor access to health care. There are
various co-morbid disorders that the rural populations of the Australia, the burden of Diabetes is

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the highest. As per the statistical data shared by the government reports, the mortality rates due
to Diabetes is considerably 2 and 4 times higher for remote and very remote areas of the
Australian when compared to the Australian cities. As per the report by AIHW, diabetes has
been considered as the 6th leading cause contributing to the burden of diseases in Australia
(Aihw.gov.au 2018).
In terms of the population living in rural or remote Australia, the prevalence rates are
much higher. On a more exploratory note, Australian females living in rural or remote regions
have 1.3 times higher type 2 diabetes incidence rates than the female population from cities. One
of the major causes that have been identified leading to the higher incidence of diabetes is due to
reduced help-seeking or reporting behavior among these women and the level on awareness.
Most of these women have no clear understanding of what lifestyle modifications to undertake to
better manage the diabetes. As a result, the hospitalization rates for the rural women in Australia
due to type 2 diabetes is also considerably higher; and one of the major contributors to the
burden of diabetes on these remote and mostly indigenous populations are the sociocultural
factors or determinants of health (Ruralhealth.org.au. 2018).
Challenges of rural and remote environments:
There are various challenges that are underpinned with the lacking or reduced service
delivery situation with respect to health care and living conditions of the inhabiting populations.
First foremost, the remoteness or the geographical locations is needed to be discussed. It has to
be mentioned that the remote and rural regions face the communication barrier by the highest
degree (Zimmet et al. 2014). The climatic condition, remoteness and the lack of easy
transportation from the city areas are considerably the most significant barriers facing these
populations. It has to be mentioned in this context that the remote regions also lack a qualified

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health care staff to assist to the issues of the rural patient populations suffering from conditions
such as diabetes which demands considerable and detailed disease management. However, due to
the lack of communication, accommodation and proper infrastructure in the rural and remote
regions, most of the qualified health care staff refrain from being placed in such regions. As a
result the staffing ratio is extremely low for these regions (Wakerman et al. 2017).
On a more elaborative note, diabetes is a long-term health condition and the key
management techniques for these diseases is associated with health promotional activities and
lifestyle modifications that targets better blood sugar management and weight management.
However, there is considerable challenges associated with conducting such promotional and
awareness campaigns in the rural or remote regions, for instance, communication barriers such as
language, lack of culturally appropriate programs, and along with that lack of proper
infrastructure are certain issues that restrict the implementation of proper health promotion
implementation. Along with that, lack of public policies emphasizing on improvement of the
health promotional activities and primary care facilities for better education of the diabetic
patients in health promoting behaviors is another challenge in improving care facilities for the
patients in rural and remote areas (Ruralhealth.org.au. 2018).
Geographical, environmental, sociological and cultural factors:
Exploring the challenges further, the geographical barriers including remoteness and
transportation not only affect the health care staff of the organization but it also impacts the
health status of the population as well. Remote hilly or coastal regions are associated with higher
levels of hardship and complications in life which undoubtedly leads to more health related
complications (Ruralhealth.org.au. 2018). The climatic changes sustained by these rural regions
have significantly affected the agricultural patterns of the nation, leading to economically

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impacting the farmland dependent rural populations. These socio-economic factors or
determinants of health are prevalent among the rural populations, which leads to reduced
lifestyle and improper eating habits that facilitate type two diabetes and other related
comorbidies. Exploring the sociological factures, the lack of proper employability and income is
another grave concern for reduced health outcomes of these populations as well. The lack of
economic stability leads to lower health acre seeking behaviors and regular health checkups for
blood sugar which further aggravates their type 2 diabetes (who.int 2018). Furthermore, the cost
of food and other basic resources is about 20% higher in these remote areas which further
contributes to their reduced health and prevalence of diabetes. Lastly, discussing the cultural
factors, as discussed above, most of the remote population is culturally diverse dominated by
aboriginals and Torres Strait islanders, which are also the first people of Australia. The racial
discrimination, lack of cultural safety in the existing care service delivery, inequality in the
service delivery, and the language barriers are the most important determinants impacting their
reduced health and lack of accessibility to care services with respect to managing chronic
conditions such as diabetes (Health.qld.gov.au 2018).
Impact on the health practitioners:
The impact of these challenges are considerably high on the health practitioners as well.
First and foremost, considering the geographical barriers, a health practitioner travelling to these
remote locations with scanty resources needs to overcome considerable burdens and
complications. As mentioned by Ricci-Cabello et al. (2013), the extremely low staffing ratio also
leads to high burnout which in turn affects their competence and skills. The policy outreach for
improving the health literacy and awareness of the rural populations is also very low. The
national government only spends 2.3% of its total health budget on the rural belts, especially in

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case of the health promotion which is extremely necessary for the diabetes management. With
the daunting lack of resources and the demographic barriers, it is extremely difficult for the
existing remote health practitioners to arrange for health promotional or screening programs in
these regions. Lastly, considering the sociocultural factors, the socio-economic condition, fear of
discrimination and stigmatization, and the lack of cultural safety and awareness has a significant
impact on the help seeking behavior and level of co-operation of patient population. Hence, it is
very difficult for the health care staff to reach out to the patient population regarding diabetes
management and prevention education. Even for the patients that access the health care facilities,
the language barrier and lack of cultural appropriateness leads to many complications to
adequate care delivery and eventually develops considerable burnout for the practitioners in
remote regions as well (Wakerman et al. 2017).
Conclusion:
On a concluding note, it has to be mentioned that there are various challenges and
barriers to health care accessibility, such as the geographical location, climate, transportation,
demographic factors, and even staff ratio for such locations. And as a result the impact of these
obstacles to equal care delivery in these regions are associated with poor management of chronic
diseases or specific health issues such as diabetes. However with equal efforts from the national
and global authorities and health care monitoring bodies along with local population and health
care staff, better management of diseases such as diabetes can be provided. With extra emphasis
on culturally appropriate health promotional education with subtle yet effective lifestyle
modifications in place, the care delivery situation and health status of patient population in high
risk can be successfully improved.

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References:
Australian Institute of Health and Welfare. (2018). Rural & remote health, Health conditions &
remoteness - Australian Institute of Health and Welfare. [online] Available at:
https://www.aihw.gov.au/reports/rural-health/rural-remote-health/contents/health-conditions-
remoteness [Accessed 17 Aug. 2018].
Ducat, W.H., Burge, V. and Kumar, S., 2014. Barriers to, and enablers of, participation in the
Allied Health Rural and Remote Training and Support (AHRRTS) program for rural and remote
allied health workers: a qualitative descriptive study. BMC medical education, 14(1), p.194.
Health.qld.gov.au. (2018). Nurse-to-patient ratios | Queensland Health. [online] Available at:
https://www.health.qld.gov.au/ocnmo/nursing/nurse-to-patient-ratios [Accessed 17 Aug. 2018].
Michiel Oosterveer, T. and Kue Young, T., 2015. Primary health care accessibility challenges in
remote indigenous communities in Canada's North. International journal of circumpolar
health, 74(1), p.29576.
Parliament.vic.gov.au. 2018. Challenges facing rural regional Australia in new times. [online]
Available at: https://www.parliament.vic.gov.au/archive/rrc/inquiries/YoungPeople/
submissions/76c_Iris_Simpson.pdf [Accessed 17 Aug. 2018].
Perry, L., Lowe, J.M., Steinbeck, K.S. and Dunbabin, J.S., 2012. Services doing the best they
can: service experiences of young adults with type 1 diabetes mellitus in rural Australia. Journal
of clinical nursing, 21(13-14), pp.1955-1963.

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Ricci-Cabello, I., Ruiz-Perez, I., Rojas-García, A., Pastor, G. and Gonçalves, D.C., 2013.
Improving diabetes care in rural areas: a systematic review and meta-analysis of quality
improvement interventions in OECD countries. PloS one, 8(12), p.e84464.
Ruralhealth.org.au. (2018). THE DETERMINANTS OF HEALTH IN RURAL AND REMOTE
AUSTRALIA. [online] Available at:
http://ruralhealth.org.au/sites/default/files/publications/factsheet-determinants-health-rural-
australia.pdf [Accessed 17 Aug. 2018].
Ruralhealth.org.au. 2018. Diabetes in Rural Australia. [online] Available at:
http://ruralhealth.org.au/sites/default/files/publications/fact-sheet-21-diabetes-rural-australia.pdf
[Accessed 17 Aug. 2018].
Wakerman, J., Humphreys, J., Wells, R., Kuipers, P., Entwistle, P. and Jones, J., 2017. A
systematic review of primary health care delivery models in rural and remote Australia 1993-
2006.
World Health Organization. (2018). Providing health care in rural and remote areas: lessons
from the international space station. [online] Available at:
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Zimmet, P.Z., Magliano, D.J., Herman, W.H. and Shaw, J.E., 2014. Diabetes: a 21st century
challenge. The lancet Diabetes & endocrinology, 2(1), pp.56-64.