There is now a broad evidence-base that demonstrates the health of rural populations is different from populations in urban areas1-4. These differences may be due to various environmental, geographic, economic and cultural factors that have been termed recently the 'rural determinants of health', but are also likely to be due to peculiarities of the healthcare system5. In relation to the latter, difficulties of access to services, lack of continuity of care, challenges to comprehensiveness of care and problems in coordination in the health system are among the organizational determinants of rural health outcomes6,7.
It is estimated that just under half of the global population lives in a rural area, but fewer than 25% of doctors and only 38% of nurses work in these areas8. In Latin America, all countries have geographical areas of health professional deficit, which contribute negatively to health and social indicators. In Brazil, for example, while there is one doctor for approximately 430 inhabitants in the more developed and urbanized capitals of the states of the Southeast, in rural areas in the North of the country, the ratio is 1: 89449. In Argentina, Buenos Aires has ten times more doctors than Tierra del Fuego; Paraguay has five times more nurses in Asunción than in the rest of the country; and in Uruguay, 80% of doctors are in the capital where only 45% of the population lives10. In particular, El Salvador, Haiti, Honduras, Nicaragua and Peru are cited as being in a crisis situation with respect to this maldistribution of the health workforce11.
Working to reverse this deficit picture, and following the release of the global policy recommendations by the World Health Organization, there is a growing movement in the Latin American region to increase access to health workers in rural and remote areas8,12. This movement has its origins in the historic Alma-Ata Conference13 and has led to a renewed focus on the organization of health systems, and in particular on universal access, equity, comprehensiveness and social participation14. Supporting this have been proposals regarding the need for greater focus on human resources15, better distribution of these resources8,16 and scaling-up and transforming the education of health workers17 towards achieving these goals. The Ibero-American Confederation of Family and Community Medicine (CIMF), in partnership with various rural health-related associations, has an important role to play in this movement, bringing people, governments and other organizations together, discussing and divulgating information about the shortage of health professionals in rural areas, the importance of primary care18 and adequately preparing health professionals for the real health needs of the population.
In addition to these efforts, there is now an important international ally in the form of the Latin American section of the journal Rural and Remote Health. Rural and Remote Health has become one of the most important global scientific vehicles for issues of rural health research, policy, practice and education. The Latin American section was formally launched at the 12th World Congress of Rural Health that took place in April this year in Gramado, Brazil, and is ready to receive submissions. Through this new section, it is expected that the production and exchange of knowledge relevant to the health of rural populations in Latin America will be stimulated and better disseminated.
The Latin American section thus welcomes submission of original research as well as review articles, clinical case reports, letters to the editor, conference reports (for other possible formats, go to at http://www.rrh.org.au/background/InformationForAuthors.asp), which have both relevance for rural health in the Latin American region and are of international significance.
Our aim is that the section will also contribute to international knowledge development in the field, and to the standard achieved by the journal since it was first published in 2001. Read the section, submit your articles, encourage your colleagues to write, and help publicize this new ally in the region!
Leonardo Vieira Targa MD1, Ian Couper MFamMed2, Paul Worley PhD3
1Universidade de Caxias do Sul, Brazilian Working Party on Rural Medicine,2Centre for Rural Health, University of the Witwatersrand,
3School of Medicine, Flinders University
1Latin American & 2African Regional Editors, 3Editor-in-Chief
Rural and Remote Health
1. Fitzgerald TL, Lea CS, Brinkley J, Zervos EE. Colorectal cancer outcome inequalities: association between population density, race, and socioeconomic status. Rural and Remote Health 14: 2668. (Online) 2014. Available: www.rrh.org.au (Accessed 20 November 2014).
2. Leung J, McKenzie S, Martin J, McLaughlin D. Effect of rurality on screening for breast cancer: a systematic review and meta-analysis comparing mammography. Rural and Remote Health 14: 2730. (Online) 2014. Available: www.rrh.org.au (Accessed 20 November 2014).
3. Martínez J, Palacios S, Chavida F, Pérez M. Urban-rural differences in Spanish menopausal women. Rural and Remote Health 13: 1865. (Online) 2013. Available: www.rrh.org.au (Accessed 20 November 2014).
4. Gorbatova MA, Gorbatova LN, Pastbin MU, Grjibovski AM. Urban-rural differences in dental caries experience among 6-year-old children in the Russian north. Rural and Remote Health 12: 1999. (Online) 2012. Available: www.rrh.org.au (Accessed 20 November 2014).
5. Reid S, Worley P, Strasser R, Couper I, Rourke J. 'What brings us together': the values and principles of rural medical education. In: The Rural Medical Education Guidebook. WONCA: Bangkok, Thailand. (Online 2014). Available free for download at: http://www.globalfamilydoctor.com/groups/WorkingParties/RuralPractice/ruralguidebook.aspx (Accessed 24 September 2014).
6. Starfield B. Primary care: balancing health needs, services and technologies. New York: Oxford University Press, 1998.
7. Targa LV. Saúde Rural e a Medicina de Família e Comunidade. In: G Gusso, JML Ceratti. Tratado de Medicina de Família e Comunidade. Porto Alegre: Artmed, 2012; 431-442. (In Portuguese)
8. World Health Organization. Increasing access to health workers in remote and rural areas through improved retention. Geneva: World Health Organization, 2009.
9. Scheffer M, Biancarelli A, Cassenote A (Co-ord.). Medical Demography in Brazil: General data and descriptions of inequalities. São Paulo: Regional Council of Medicine of São Paulo State and Federal Council of Medicine, 2011.
10. Panamerican Health Organization. Observatório de Recursos Humanos em Saúde nas Américas, 1999-2004: lições aprendidas e expectativas para o futuro. In: Observatory of human resources in Brazil: studies and analysis. Brazil: Ministério da Saúde, 2004. (In Portuguese)
11. World Health Organization. World Health Report. Geneva: WHO, 2006. Available: http://www.who.int/whr/2006/whr06_en.pdf?ua=1 (Accessed 11 November 2014)
12. Buchan J, Couper I, Tangcharoensathien V, Thepannya K, Jaskiewicz W, Perfilieva G et al. Early implementation of WHO recommendations for the retention of health workers in remote and rural areas. Bulletin of the World Health Organisation 2013; 91(11): 834-840. Available: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862013001100834&lng=en. http://dx.doi.org/10.2471/BLT.13.119008. (Accessed 20 November 2014).
13. World Health Organization. Alma Ata Declaration. Alma Ata: Kazakhstan, 1978. Available: http://www.who.int/publications/almaata_declaration_en.pdf (Accessed 20 November 2014).
14. World Health Organization. The World Health Report 2008: primary health care - now more than ever. Geneva: WHO, 2008.
15. World Health Organization. Working Together for Health: The World Health Report 2006. Geneva: WHO, 2006.
16. World Health Organization. Migration of health workers: The WHO Code of Practice and the Global Economic Crisis. Geneva: WHO, 2014. Available: http://www.who.int/hrh/migration/14075_MigrationofHealth_Workers.pdf?ua=1 (Accessed 20 November 2014).
17. World Health Organization. Transforming and scaling up health professionals' education and training: World Health Organization guidelines 2013. Geneva: WHO, 2013.
18. Anon. Quito Declaration: Universal Coverage, Family and Community Medicine and social participation. Declaration of the 5th Summit of Family Medicine in Iberoamerica (V Cumbre Iberoamericana de Medicina Familiar). 12-14 April 2014. Quito, Ecuador. Available http://www.globalfamilydoctor.com/AboutWonca/PositionStatements.aspx (Accessed 19 September 2014).