Primary health care services in remote communities



My name's Robyn McDermott. I'm a public health
doctor and for 25 years I've been working in rural and remote areas in primary health
care and particularly looking at the health transition and the fact that now we're
faced with a big health gap between people living in remote areas and everybody else,
indigenous people and everybody else, and the big part of that health gap is chronic
disease. About 10 years ago in Queensland as part of the Northern Territory intervention,
there was some new policies introduced into communities with respect to controlling the
supply of alcohol into these communities in order to reduce some of the consequences,
a lot of violence, a lot of abuse of women and children, a lot of disruption, children
not going to school, not getting fed, probably for example. There was no question that there
was literally a public health emergency fuelled by alcohol, particularly in some of the remote
communities in the Northern Territory and in Queensland. One of the projects that we
were doing as a part of our CRE was looking at the impact of some of these plans over
the last 10 years, particularly asking people in the communities what their experience of
it was and to try and capture some of the unintended consequences of that and so, Alan
Clough who's one of our CRE investigators, undertook extensive community consultation
about this and interviewed over a thousand people in four of the North Queensland communities,
including local government members and policy people. And it found that some of the
unintended consequences were that there was criminalisation of offences which, for you
and I living in Canberra, Sydney, Brisbane perhaps, wouldn't be criminal offences and
that had the downstream impact of making it difficult for these people, subsequently,
to get employment in the public sector, for example, or in local government because they
had a record. The other thing that people were saying was that if you just look at the
supply side restriction and you don't look at the demand side reduction, then you get
a very much unbalanced sense of what works and certainly the alcohol management plans were
very much focussed just on the supply side reduction and not on supporting communities
to either for rehabilitation or for prevention in the first place. These issues are very
important and now they're feeding into discussions with local government about where to next,
in terms of policies for these communities. So, I think that's been an extremely interesting
and valuable journey, not just for the communities, but for local government. What it means is
that there's no simple solutions to this and it's an iterative process and we must look
for unintended consequences of policies that have been made in a particular context in
the past.

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