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OPINION: Death by Postcode – the Great Divide in NSW

The NSW Parliament has announced an Inquiry into health outcomes and access to health and hospital services in rural, regional and remote New South Wales following the tragic stories of Allan Wells and John Stingemore in Cobar reported in the Sydney Morning Herald and on 60 Minutes.

This long-promised Inquiry was first mooted following an ABC Four Corner’s investigation into the circumstances surrounding the death of Broken Hill teenager Alex Braes in 2017. It has taken 3 years, but rural and remote communities finally have an Inquiry to find out what is going wrong with our health system.

But what will an Inquiry achieve? In my view, not much if it goes the way of every other inquiry into rural and remote health which simply documents individual cases of adverse outcomes and recommends band aid solutions.

This time we need to get the Inquiry right. We need to face up to the reality that the people are dying every day in rural and remote NSW because of a systemic failure to invest the right resources in the right places in rural and remote communities.

The simple fact is that one of the leading causes of premature death in NSW today is your postcode.

For example, if you live in a small town like Cobar in western NSW the average age of death is 77.5 years compared to 84 years in Coogee, a difference of 6.5 years.

In 2018, there were 3,606 premature deaths outside of major metropolitan and regional centres. Despite this, the NSW Rural Health Plan – Towards 2021 contains no specific or measurable state-wide targets to address the disparity in health outcomes.

"Postcode-related inequality is a major killer in NSW and we owe it to all citizens to ensure that everyone has access to safe and high-quality medical care regardless of where they live".

By comparison, there were 354 premature road deaths in NSW in 2018. In response, NSW has implemented the Road Safety Strategy committing the State to reduce road deaths and injuries by 30 percent. In 2016-17 the NSW Government delivered funding of $309 million to support this strategy.

The Greater Sydney Commission has committed to ensure that all Sydney residents have access to jobs and essential services like health within 30 minutes of their homes which has resulted in a multi-billion investment program in infrastructure and services.

This is not a criticism of needed investments in reducing road deaths and making Sydney more liveable. It is a criticism of the fact that our willingness to take resolute action, and to be held accountable for delivering change, is heavily influenced by where we live.

Imagine if there were a commitment that all people in NSW have access to a local GP within 30 minutes of their home and a 24/7 local emergency department staffed by a doctor within an hour. This would create a tangible goal against which to allocate resources and hold ourselves accountable for the outcomes.

This Inquiry is a once-in-a-lifetime opportunity to formally recognise postcode-related health inequality as a systemic issue in our State. If the Inquiry is to achieve anything, the terms of reference need to be amended to focus on where the real problem exists – rural and remote NSW.

The inclusion of comparatively well-resourced regional cities in the Inquiry terms of reference will dilute the focus on poorly served rural and remote communities. While these places have their challenges, the situation in Bourke and Brewarrina is not the same as large regional centres like Bathurst and Ballina.

It also misses the point that the deaths of Allan Wells, Bryan Ryan, Alex Braes and many other rural and remote people did not occur in hospitals in well-resourced regional cities, but in under-funded and overstretched rural and remote hospitals. To include regional cities in the Inquiry may create a false impression about the geography of the rural health crisis we face in our State.

This is an opportunity for the Parliament to focus on health challenges and opportunities in rural and remote NSW and drive positive change by establishing minimum standards and goals for health outcomes. Without clear and measurable goals there will be no driver to improve health access and services in these communities or for health providers to focus on what needs to be done at a local level.

Postcode-related inequality is a major killer in NSW and we owe it to all citizens to ensure that everyone has access to safe and high-quality medical care regardless of where they live.

Mark Burdack is the CEO of Rural and Remote Medical Services (RARMS) and a Hon Adjunct Senior Lecturer in the La Trobe University School of Rural Health. RARMS is the largest charitable provider of on-site and Telehealth care in rural and remote NSW.

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