Opening of Conference 5th National Rural Health Conference Adelaide, South Australia, 14-17th March 1999 Proceedings 5 TH NATIONAL RURAL HEALTH CONFERENCE Opening of Conference WELCOME: WIRUNA PALYANTJA The Fifth National Rural Health Conference opened with a traditional Aboriginal welcome performed by the Aboriginal dance group Yura. The Chairperson of the National Rural Health Alliance, John Lawrence, thanked the group for their messages and gifts of welcome and at the same time acknowledged the Kaurna people as part of the First Nation of Australia. In his opening address Mr Lawrence reminded delegates that, although the Conference processes would be intense and there remains much to be done to improve health and other services to rural and remote communities, it was important not to lose sight of the positive side of country life: …don’t let us ever forget that most of us have a passion for the bush, its special history, our way of life, the beauty and spirituality, and the determination of those who live there. Many of us have been going through hard times, but please make sure in the next three days we celebrate these qualities, particularly in our health services, that make rural and remote life so satisfying. The Lord Mayor of Adelaide, Dr Jane Lomax-Smith, and the South Australian Deputy Premier, the Hon Rob Kerin MP, delivered brief welcoming messages. In welcoming delegates to Adelaide Dr Lomax-Smith emphasised the aptness of holding the National Rural Health Conference in Adelaide given the historically close links that exist between the South Australian capital and rural and remote areas of the State. Mr Kerin welcomed delegates on behalf of the South Australian Government. In his brief address Mr Kerin referred to South Australia's unique situation as a State without large regional centres and the challenges this presented in ensuring the delivery of appropriate health services to rural and remote consumers. He went on to acknowledge that any future regional development planning must be done in a context broader than economic development, it must also deal with issues such as quality of life, access to health services and especially access to primary health care services. The Federal Minister for Health and Aged Care, Hon Dr Michael Wooldridge MP, then presented the opening keynote address. Dr Wooldridge gave delegates an overview of the Federal Government's current policy priority areas in relation to rural and remote health and the rural and remote health workforce. They include: • working to increase doctor numbers in rural and remote areas; • public health; • Aboriginal and Torres Strait Islander health; and • medical research in the broad sense, including Public and Primary Health Care. Dr Wooldridge also summarised some of the recent and proposed policy responses of the Federal Government on rural and remote health issues, including: • Co-ordinated Care Trials; • an achieved increase in doctor numbers in rural areas; • the establishment of University Departments of Rural Health at Broken Hill and Mt Isa; 1 5 th NATIONAL RURAL HEALTH CONFERENCE • the introduction of John Flynn Scholarships for medical undergraduates; • consideration of the introduction of Medicare payments to psychiatrists for telepsychiatry consultations; and • the establishment of rural retention payments for doctors. The Minister concluded by informing delegates that the Federal Government has appointed Dr Jack Best, Chair of the Strategic Research Development Committee at the National Health and Medical Research Council, to undertake a 'stocktake' of rural and remote health initiatives. A report on the 'stocktake' is due to Government in August 1999. Dr Wooldridge and the Hon Dean Brown MP, South Australian Minister for Human Services, Disability Services and the Ageing, then formally launched the publication: Healthy Horizons: A Framework for Improving the Health of Rural and Regional Australians 1999-2003 (Mr Brown's speech is in Section 2 of these proceedings). The Hon Michael Wooldridge, Federal Minister of Health and Aged Care presents the Opening Keynote Address 2 5 TH NATIONAL RURAL HEALTH CONFERENCE Opening Keynote Address Hon Dr Michael Wooldridge MP. Federal Minister for Health and Aged Care Deputy Premier, my colleagues, Health Minister Mr Dean Brown, Ms Lomax-Smith, John Lawrence, ladies and gentlemen, I am delighted to be able to join you for this terribly important Conference It may not surprise you to know that Health is not the most sought after portfolio of government. It is reported that when Jim Bacon announced his new Ministry recently in Tasmania, he was going to tell the Ministers what portfolios they got and then go straight into a press conference. It was reported that the press conference didn't go ahead because the Health Minister had burst into tears and run out of the room and couldn't be found. Perhaps it is uncommon for the Health Minister to get reappointed, but I was delighted to have the opportunity to be Health Minister again in the second Howard Government for two simple reasons: First is, probably like everyone here in the room, I care very deeply about health care in this country; and secondly, Health, perhaps of all portfolios, has enormously long lead times. Things that one might do take a long time to come into fruition, and to have a chance to have a second term as Health Minister gives you the chance to get the benefits, or otherwise, of successes or failures. I said the Health Care System means a lot to me because I am a product of it. It was my basic training, it was my early working life. I think in Australia we are all fortunate to have a very fine health system, in spite of the stresses, strains and criticisms. Can I give you just two simple examples? Someone I know quite well, 12 months ago was involved in a horrific car accident. They were in a coma for several days and sustained very bad trauma to the liver, amongst other things. When they awoke from the coma, they had a round of doctors discussing whether or not this person might be in need of a liver transplant. He rang me up when he was well enough to get on the telephone again and just said, "I've got to tell you, I think the health system is not all that bad when I woke up from the coma to find that the discussion amongst the people around my bed is whether or not I could be provided with a liver transplant". Three weeks ago, I was up at Torres Strait on Moa Island. I was watching some kids playing, young kids running around in nappies. There was a little girl who caught my eye, about 12 months old, I noticed, after looking at her for some time, that she had a scar from her neck right down to her abdomen. I asked what had happened to her. She had been born on Moa Island. She had been blue, particularly sick at birth, and was cared for overnight in a primary health care centre, before she was evacuated to Thursday Island the next morning. 3 5 th NATIONAL RURAL HEALTH CONFERENCE That afternoon she was in Cairns and 24 hours later, she was in Brisbane receiving open-heart surgery to repair a substantial cardiac defect. It made me think perhaps that things are not too bad when an island child can be evacuated and be receiving advanced cardiac surgery within 36 hours of birth. I talk on many talkback shows. I talk with many hosts and am usually berated about the various failings in the health care system. I have come up with a standard response - I say to the host, "That's fine, tell me somewhere else in the world you'd rather be sick." I haven't yet had a reply. Therefore, by and large, we have a health system of which we can be proud. Where it does fail though, is in its responsibility to many areas in rural and remote Australia. It's sad that the little Islander girl had a better chance of getting open-heart surgery than she did at getting basic primary health care. Being Health Minister gives one the privilege of at least setting one's own priorities. I have four main priorities that I am trying to pursue these next three years - medical numbers in Rural Australia, Public Health, Aboriginal Health, and Medical Research. Perhaps those four together encapsulate the challenge of rural and remote health in Australia. I'll talk about what is happening in each of those areas. The number of doctors in rural Australia rates as the continual contentious political issue. I talk of doctors, not in any sense that they are the only important health professionals, or even the most important health professionals in rural Australia, but because the Commonwealth of Australia has a specific responsibility for doctors and Medicare. We don't have direct responsibility for nursing or other allied health professions. We made a very simple mistake in Australia some 40 years ago. Up until 1956 you could matriculate and walk into Medical School with no restrictions. The first quota was introduced by the University of Melbourne in 1956. By 1966 you needed three A's to get into Medical School. By 1976 you needed 4 A's and by 1986 you needed five A's. As we made it harder and harder for young people to get into medical school, we also progressively excluded country kids as medical students. You can't convince me that a child educated in rural Australia does not have a degree of educational disadvantage. So while 25 per cent of children live and are educated in rural Australia, at the University of Sydney only five per cent of their intake have a rural background.