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Guest Editorial
Rural Health Symposium
Brian Cheers
Associate Professor; Director, Centre for Rural and Regional Development, University of South Australia - Whyalla Campus, SA.
Jane Edwards
Centre for Regulation and Market Analysis, University of South Australia, South Australia
Article Text
This symposium, Rural health: patients and practitioners, focuses on sociological analysis of rural health issues. Three of the four papers consider the experience of rural practitioners. Current concerns about the difficulties involved in recruiting and retaining health care professionals in rural settings makes examination of their experience timely. Amanda Kenny's paper challenges some dominant themes in recent sociological literature on general practice, particularly the erosion of medical power by managerialism, corporatisation, and increasing numbers of salaried, rather than self-employed, practitioners. Kenny suggests that such factors tend to be less relevant in rural communities. By contrast with their urban counterparts, rural medical practitioners continue to experience considerably more autonomy and power. A worrying consequence is more constrained access to health care in rural areas. The paper is a welcome caution against applying metro-centric theory and research to analysis of rural health issues.
In the second paper, Angela Durey argues that the traditional model of rural general practice assumes that GPs are male and have wives who attend to domestic labour and child-rearing. Such a model, she suggest, sits oddly with the experience of women rural general practitioners. The male-centered, 'heroic', model of practice, where GPs work long hours - leaving little time for their families - does not fit the many women practitioners who struggle to balance work and domestic life. For the most part, this balancing act is perceived by both male and female GPs as a personal problem, whereas, as Durey observes, it is a structural feature of rural general practice. Durey's findings have important implications for the issue of how to sustain general practice in rural areas.
Lee Thompson's paper focuses on the ways in which the professional identity of rural nurses is enmeshed with techniques of governance, requiring a considerable degree of self-surveillance by nurses. Rather than celebrating the much-vaunted autonomy of rural nurses, Thompson analyses the constraints they experience. She identifies the struggles that rural nurses confront in reconciling the demands of professional practice and maintaining a personal life in the face of community and professional expectations to fulfil 'duty of care' obligations. These issues, too, have implications for the recruitment and retention of health care workers in rural settings.
Eileen Willis, Meryl Pearce and Tom Jenkin switch the focus from rural health practitioners to the social determinants of health: in this case, the impact of the River Murray's degradation on the well-being and livelihoods of local Aboriginal people. The parlous state of this important river system is attracting considerable attention although, as is so often the case, the impacts of its degradation on Indigenous Australians have received very little. This paper is welcome for re-dressing that imbalance. The authors reconcile what are frequently treated as divergent approaches to Indigenous health problems: those focusing on disrupted cultural practices, on the one hand, and those concentrating on the material environment, on the other. In doing so, they draw our attention to the idea of 'balance' between all aspects life, culture, and community, which is deeply embedded in Indigenous ways of knowing. This paper shows that the River Murray is both a site for culture and a material environment: both elements need to be incorporated into sophisticated analyses of Indigenous health.
Together, these four papers demonstrate the value of sociological analysis that examines health and health care issues in terms of the specificities of place and people.
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