Rural health promotion

It is now well documented that health status is not the same across Victoria with considerable differences existing between the health status of people living in the city and those living in rural Victoria, between men and women and between rich and poor areas. Two relatively recent, major Victorian studies confirmed that, overall, rural Victorians are more likely to suffer from a range of adverse health conditions and likely to die earlier:

• The Victorian Burden of Disease Study – Mortality found that the mortality burden is greater in rural Victoria than in metropolitan areas of Melbourne (and Geelong);
  
  
• The Victorian Burden of Disease Study – Morbidity found that rural Victoria has a lower health status than metropolitan Victoria, albeit with major differentials within rural and metropolitan areas.
  

Some of the specific mortality and morbidity data included:

• Ischaemic heart disease, chronic obstructive pulmonary disease, road traffic accidents and drowning are the main causes of death more commonly found in rural Victoria. Additional causes of the higher mortality burden in the more remote rural areas are asthma in men and women, and suicide, other transport accidents and machinery accidents in men.
  
  
• Rural people are twice as likely to die or suffer injuries as a result of road trauma, suicide and drowning than city people.
  
  
• Overall, rural males have higher rates of disease burden due to cardiovascular disease, cancer, neurological and sense disorders, chronic respiratory diseases, musculoskeletal diseases, and injuries than metropolitan males.
  
  
• Overall, rural females have higher rates of disease burden due to cardiovascular disease, cancer, neurological and sense disorders and musculoskeletal diseases than metropolitan females.

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In terms of risk factors for mortality and morbidity, the studies found that:

• For rural females, the major risk factors for disease - physical inactivity, high blood pressure and tobacco use - cause slightly more disease in rural areas than in metropolitan areas.
  
  
• For rural males, the major risk factors for disease - tobacco use, physical inactivity, high blood pressure and high cholesterol - cause more burden of disease in rural areas than in metropolitan areas while the risk factors of alcohol harm, illicit drugs and unsafe sex are linked to relatively less burden in rural areas.

With regard to rural mental health, while extensive research on rural/urban differences in prevalence of mental disorders has not been undertaken, various research data has indicated varying degrees of connection between rurality and mental health. For example:

• It is now documented that 'rurality'– living in a rural or remote location creates a higher risk of suicide. Suicide rates for males in rural and remote communities have increased steadily over the past 20 years, with rates for young males consistently higher in small rural communities than in metropolitan and regional areas. Rural Australia, in fact, has one of the highest rates of youth suicide in the world.
  
  
• Research on rurality, as measured by the ARIA (Accessibility Remoteness Index of Australia) measure of remoteness, has indicated a link between rural location and mental wellbeing. Individuals living in ARIA’s Highly Accessible (HA) and Moderately Accessible (MA) areas showed higher levels of positive affect (and absence of physical ill health) than those living in Accessible (A) and Rural and Remote (RR) areas. It is also known that substance use (alcohol, amphetamines, cannabis) varies according to rural remoteness.
  
  
• VicHealth developed a comprehensive Mental Health Promotion Plan 1999-2002, which targeted five population groups with demonstrably poorer access to those resources known to promote mental health and generally higher rates of mental health problems. The groups were: rural communities, young people, older people, Koori communities, and new arrivals to Australia.
  

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