A dying shame

Why the bush needs better models of care

Source: APNA Primary Times Spring 2020 (Volume 20, Issue 2)

Dr Ruth Stewart in a helicopter over the Torres Strait in early 2019 on her way from Thursday Island to Mer Island to do a clinic.

As a resident of Thursday Island in the Torres Strait, I am living on borrowed time.  I am now 60 years of age. On average, women in Queensland have a life expectancy of 83 years, but for the residents of Torres Strait Islands and the Cape York Peninsula that drops by 23 years.1 The maths is not hard, but the facts are.

“On average, Australians living in rural and remote areas have shorter lives, higher levels of disease and injury and poorer access to and use of health services, compared with people living in metropolitan areas. Poorer health outcomes in rural and remote areas may be due to multiple factors including lifestyle differences and a level of disadvantage related to education and employment opportunities, as well as access to health services.”2

These statistics will not be turned around by any one program or indeed by any one person, not even by a National Rural Health Commissioner, but they can be changed by teams of people committed to improving the health of rural and remote communities working in coordination. My role as the National Rural Health Commissioner is to draw together those stakeholders around the country who can make the difference.

Over the past 50 years Australia has developed a world leading health care system with General Practices being the primary care gateway into increasingly subspecialised networks of care. This works well in large urban centres but it fails in smaller communities. Subspecialist business models cannot survive in rural and remote areas and people in the bush therefore can have difficulty engaging with appropriate health care.


I have worked as a Rural Generalist doctor in private practice in Victoria, in public services in Queensland and briefly in the Northern Territory and in my leadership roles I have had close contact with people delivering health care all across Australia.  I know that there are amazing people giving their utmost for the health of their communities.  The will is there, but what we need now is the right models of care for those willing and able people to provide the best care for their communities.

Those of us who work beyond the city limits know about team care. In fact, we could teach our city colleagues quite a bit on the matter. We need Rural Generalist models of multidisciplinary team care where generalist doctors, nurses and allied health practitioners work together to care for the widest range of unselected patients and undifferentiated conditions. I am constantly aware that nurses form the major part of the Australian health workforce and that in very remote communities highly skilled and dedicated Remote Area Nurses are often the only resident health care professionals.  Any rural or remote models of care must incorporate this understanding.

"What we need now is the right models of care for those willing and able people to provide the best care for their communities."

Professor Paul Worley the inaugural Rural Health Commissioner did a lot of work to develop consensus on what National Rural Generalist programs for doctors and allied health professionals will look like. One of the major expectations of me during my two-year term is to see these implemented.

I look forward to working with the community of Australian rural nurses in all roles to devise the best models of care for rural and remote Australians. Let me know what you think will help!

Feel free to email me your thoughts at NRHC@health.gov.au



  1. The Health of Queenslanders 2018, Report of the Chief Health Officer Queensland. Queensland Health
  2. Rural & remote health. Australian Institute of Health and Welfare, October 2019.

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