Even in the best of times the political environment, like the weather, is fickle. In 2009 the challenges faced by human society are momentous, and the world's political leaders are trying to be 'saviours' of a world that seems to be in despair. How can the small and emerging academic discipline of rural health position itself to be relevant when issues such as climate change and the global financial crisis dominate the news? It would be easy to concede that at this level, rural health just isn't so important - a mere pastoral diversion from larger issues.
Over the first 18 months of the Australian Federal Rudd Government we have had the opportunity to review the White Paper on a proposed Carbon Pollution Reduction Scheme to combat climate change. The critics have warned that such changes are too expensive and that it is unnecessary for this country to take the lead on such a globally contentious issue.
The unravelling of the world's economy since the failure of US Babcock & Brown's investment bank in late 2008 has provided climate change nihilists an opportunity to defer any real response to climate change. For the last 18 months, instead of having nightly news reports on cripplingly low water storage levels, entire segments of the news have been devoted to hourly variations in the stock market and wonderings about when the flow of money will start again to alleviate the current credit drought.
It is an interesting exercise to draw parallels between climate change and the current financial crisis. With the benefit of hindsight, economic experts now agree that the warning signs of a credit bubble are now apparent and should have been easily visible when the stock market accelerated wildly with inflated stock prices based on bonds backed by worthless securities. Now the bubble has burst. Fixing the problem is much more challenging than it would have been 2 or 3 years ago. Similarly, there are commentators who see the current wide variations in weather patterns as a sign of normality when most argue that, like the credit crunch, the climate crunch may not be far away, if not already upon us.
Rural communities, however, are under no such illusion, for rural residents are already experiencing the impact of climate change1. Farmers have witnessed previously viable agricultural businesses failing to yield produce; yet these same farmers are expected to overcome the climate challenge to ensure Australia's food security. Farmers already know that increasing fluctuations in weather patterns will lead to more severe floods, droughts, heat waves and bushfires. The year 2009 commenced with the bottom end of Australia engulfed in flames and the 'Top End' awash with floods. Rural Victoria has been in drought since 2002 with current inflows to the crucial Murray River at crippling, record lows.
The minerals and energy resource boom of the last decade brought with it investment, employment and some services to inland Australia and its regional centres. These benefits are disappearing as mining investment recedes with the global recession, leaving rural communities hapless victims in the backwash of the global financial meltdown.
However, this cataclysm may also be catalyst for the emergence of a stronger rural Australia. Rural health research has taught that the whole community must be involved in finding solutions that will succeed locally2, and a recurrent research theme is that community assets are needed to address complex problems. Within each rural community there exists resiliency and domains of strength that must to be built on in times of crisis, enabling adaption to new and emerging environments. In recent decades rural communities have demonstrated this by diversifying their economies so that they are less dependent on traditional farming. The range of rural products has been broadened to food production, tourism and other service industries, and small scale manufacturing.
Health research is often criticised for morbidly describing ill health. However, by taking an holistic view of the determinants of health, privileged access is offered to the effects of the unprecedented changes that are occurring now and will continue. Australian rural health research infrastructure is situated in regional universities and campuses, universities departments of rural health and rural clinical schools. Rurally based researchers are ideally placed to measure the health and social effects of climate change, unemployment and the credit squeeze. As residents, researchers and health professionals we can bring about change. The severity of the global recession affords us an opportunity to engage our rural communities and take advantage of "community policy laboratories" where innovations can be tested and complex, contemporary issues assessed on multiple dimensions simultaneously. If an innovation proves successful, the results can assist in the development of policy initiatives on a national scale.
The combination of clinical, public health and research skills that make up the discipline of rural health lends itself to this new agenda. As community leaders, rural health professionals have a record of engaging their communities in order to jointly address the social and environmental determinants of health3. Rural health researchers have the tools to build collaboration among sectors, and to conduct participatory research that is broadly based and embedded in the local rural social context. With such academic-community partnerships, research takes advantage of and incorporates traditional methods to measure changes and find solutions.
A commitment to equity means that rural health research will be sensitive to unintended rural impacts flowing from national policy and community responses to external threats. These include positive effects. The global recession could result in small rural communities becoming sites for generating renewable energy, or developing economically sustainable projects that will insulate them from future economic shocks. Rural communities could take the lead in building a cleaner and more sustainable Australia by testing strategies to improve the environment. Many regional centres and rural towns are already leaders, having put up their hands to be carbon neutral and invest in alternative energy sources4. And new forms of natural resource management are incorporating Indigenous Australian knowledge - and offering Aboriginal employment opportunities5.
Many rural areas are beginning to flourish. As cities implode from high rents, chaotic traffic and job scarcity, rural towns and regional centres are looking more attractive. They are more affordable, have greater natural and social amenities and are only a mouse click away from urban friends, family and colleagues. In addition, the economic stimulus initiatives already approved by the Australian Parliament will improve roads, telecommunications and schools, and offer greater access to higher education. This will benefit rural towns where local government has often struggled to renew decaying infrastructure from a limited rates base.
Slowing down the pace of growth gives rural towns and regional centres time to develop long-term international partnerships for projects in the minerals and energy sector. Potential benefits to local communities include building up a skilled local workforce through education and training. Cultural and other exchanges may flow from this and can underpin a sustainable structure that is less vulnerable to the fickle nature of the financial markets.
However, increasing international engagement should not only be for national benefit. Australian's small Pacific neighbours are immediately vulnerable to the effects of climate change and need a voice on the world stage to ensure their pressing needs are considered. Rather than have the world retreat behind its borders and ignore the plight of other nations, rural health research within an international community can identify the collective path out of the economic mess - and ensure that it is also environmentally sensitive.
How does all this benefit health? Vibrant communities attract workforce professionals, including those in the health sector. Progressive communities are able to maintain community assets such as local businesses, sporting clubs and other voluntary organisations, and to create an environment that is safe and inclusive. More important, communities where there is employment and training for all decrease social and economic disparities, thereby narrowing health inequalities and promoting general wellbeing.
In 10 years we will look at the current period and judge the choices made and directions taken. When we look back, let us ensure that the discipline of rural health is distinguished by its holistic vision, based on inclusive and ethical research, evident in our contribution to creative solutions amid cataclysmic community changes.
1. Australian Bureau of Statistics. Farm management and climate 2006-07. Canberra, ACT: ABS, 2008.
2. Taylor J, Wilkinson D, Cheers B. Working with communities in health and human services. Melbourne, VIC: Oxford University Press, 2008.
3. Kilpatrick S, Cheers B, Gilles M, Taylor J. Boundary crossers, communities, and health: exploring the role of rural health professionals. Health & Place 2009; 15: 284-290.
4. Hatfield-Dodds S, Carwardine J, Dunlop MPG, Klein C. Rural Australia providing climate solutions. Preliminary report to the Australian Agricultural Alliance on climate change. Canberra, ACT: CSIRO Sustainable Ecosystems, 2007.
5. Campbell D, Stafford Smith M, Davies J, Kuipers P, Wakerman J, McGregor M. Responding to health impacts of climate change in the Australian desert. Rural and Remote Health 8: 1008. (Online) 2008. Available: www.rrh.org.au (Accessed 5 May 2009).