Rural and Remote Women's Health

Brainstorm Podcast Interview:

Guy Rowlison and Susi Tegen NRHA

 [00:00:00] My guest today came to Australia from her native Austria as a teenager, an immigrant and carer. She's lived, worked in and promoted the cause of rural and remote Australia most of her life. And a list of achievements, advocacy, and professional roles is nothing short of inspiring. She was also recently appointed CEO of Australia's peak body for rural, regional, and remote health, representing over 40 national organizations from health consumers, healthcare professionals and service providers through the health educators, students, and the indigenous health sector Chief Executive of the National Rural Health Alliance.

Susie, Tegan, welcome. Thank you. I hope you will. I am. You know, that's, that, that's something that we say on a daily basis, isn't it? To, lots of people and and the response is usually, yeah. You know, how you going? Yeah, I'm good. I'm okay. But that's not always the case, is it? But look, we, we might explore that a little bit later.

I don't wanna embarrass you too much, but, having read through what is a pretty remarkable personal and [00:01:00] professional resume, can you briefly walk me through your journey to this? Uh, it's interesting because often we hear about how the opportunities in rural, remote and regional Australia aren't as positive, and in fact they are because of the pure fact that you don't have as many people living there.

And if you are a person that is willing to try new things and is willing to have a go . In those regions in rural and remote Australia, um, actually is very forgiving and is very welcoming in you exploring different career options and, I'm really lucky I've been able to work in agriculture or primary industries.

I've been able to work in education and I've also worked in medicine and health, uh, and then tertiary education. Purely it's all been purely [00:02:00] because I've just been at the right place at the right time and I was willing to take up the opportunities and, um, and sometimes make those opportunities. And, uh, rural and remote Australian people are welcoming, but they also are willing to support people to try new things and.

So I've been extremely fortunate to follow the things that I feel passionate about. You are a very humble woman and you're, you're underselling what you've done throughout, not just your professional career, but what you're doing now. Which leads me to, the alliance. Who exactly makes up the alliance, and what role does it play as far as key issues that affect health and wellbeing in, in rural and remote a.

So the National Rural Health Alliance, uh, supports almost 50 different national organizations, um, that represent health consumers or [00:03:00] patients, healthcare professionals or, or, or medical professionals. There could be anything from Allied Health to, um, health service management to paramedicine. To colleges of, um, you know, medical professionals and, um, they follow the whole of the medical or health journey in a career.

But we also represent those organizations that look after patients or consumers from birth to death. And those, entities that support research from. To, uh, commercialization or, um, implementation of policies. And so we really, have quite a large remit for that 30% of the population that live in rural and remote Australia, which is about, you know, it's close to 9 million [00:04:00] people.

 And it's, and it's a really important entity. Um, it's a, nimble entity, but it's an important entity because, you know that 30% of the population has some major access issues, uh, partly because of workforce shortages, partly because of the tyranny of distance, partly because the sector. That 30% of the population, um, have been so resilient and so, active in ensuring the Australian economy is doing well, , that people often don't think they need that support.

And so we are here to pull like-minded, um, entities together to ensure that that access. and that support, and that policy is developed at a national level,[00:05:00] for state and federal governments, but also for us to work on key initiatives so that the community is serviced. And one of those initiatives I'm gathering is, Emotional wellbeing, uh, all those sort of things that come along with, with living in rural, remote, uh, parts of, of this country.

So if I can just turn to say the emotional health and wellbeing conversation and, it's quite often a case that it turns to the health of men, which of course has its own personal and social challenges. But if we can turn our attention to women specifically, what are the challenges women are facing, particularly in the areas of mental health and emotional support in rural and remote area?

 I mean, it, it is an enormous issue in rural and remote. Um, again, because of those, issues I raised before, like tyranny of distance and access to support. And the thing about women, and it must be in the genetics or just in [00:06:00] the, you know, the roles that women take on, uh, but they support their children.

They support their spouses, they support their in-law. and they also support their own parents. And you know, you can see some of that in. The, uh, situation with superannuation and savings by the end of their career or the end of their life because they come out with much less superannuation than men and they come out with much less savings.

Indeed, some women, uh, above the age of 60 in particular, if they're single. Uh, you know, live in poverty. About 34% of women live in poverty and, you know, despite the fact that they make up 47.4% of the workforce. And so they are dealing with the [00:07:00] stresses of their career, the stresses, a family, an extended family, um, they're dealing with the stresses that are in addition to.

What already, is a very tough environment, purely because of the floods, droughts, the climate, challenges. And then you also have the perinatal depression and anxiety, which affects 15 to 20% of the population or women. Um, You know, I'd like to think that we can focus on both men and women, uh, because the services need to be there in the first place for families, for men and women that live in these communities.

Because those communities in rural and remote Australia have kept Australia. Out of two financial crises and have kept Australia in the condition it is currently. I know it's tough at [00:08:00] the moment with the 8%, uh, inflation rate, but I can still remember, you know, being on our farm when the inflation and the interest rate went up to 19% and it was really tough.

You know, it's, uh, it, it is not something that urban. People ever have to face, and I think we need to remember that when we make decisions in the city, when we rely so heavily on that economy doing well by the people in rural and remote. Because that's where the majority of our income comes from.

 I know you're saying that it, it, it's probably fair to say that the health of families, and to a bigger extent, communities, uh, depend largely on the wellbeing of women, yet the number of psychiatrists, mental health nurses, psychologists, that women in rural remote have access to compared to their city [00:09:00] counterparts, it's hardly on a level playing field, is it?

Oh, no. I mean, the discrepancy is, , it's actually, and I have to use this word without judging, but we are a western country and the discrepancy is so big. It's like a developing country in rural and remote. And I'm not saying all regions are the same. I mean, obviously some areas of regional Australia are doing quite well.

Um, Why is it that those communities are not able to access the services that everyone else enjoys? And so we need to make a case for men and women in those regions to be able to access those services. And it's a paradox because if you look at the, the indicators for satisfaction and feelings of wellbeing, Despite the, [00:10:00] uh, the earlier death of people living in rural and remote, in particular women, and the comorbidity issues that are great in rural and remote life satisfaction and feeling of wellbeing is much higher in the country.

And I think that's because communities pull. That's always been the case solve. It's always been the case, hasn't it? And, and no one wants to wear their dirty laundry. No one wants to be the first to put their hand up. So given that there are so many issues, um, that clinical research hasn't always addressed, particularly in emotional health and and wellbeing, would you agree that it's important that attitudes towards mental health and health professionals is understood from a rural perspective?

Uh oh. Look, um, there has been, um research that has looked at pharma [00:11:00] mental health. And don't forget, when we think about farmers, it's generally we think of a male. But actually there are some amazing women that are the brains behind the farms doing. So it's not just men in that sense. Um, and often there are teams that work on the farm.

And so, um, you know, so there, there has been some research, but most of the research has been completed in urban centers, uh, young people in particular in that age group of let's say 17, 18. To 25 are a big issue in rural and remote, and you see that by the alcohol, um, increase of alcohol consumption in that group.

You see it in the, um, car accidents and road accidents in, in that age group. [00:12:00] And you see it in the uptake of, um, support for mental health. And then you have the next generation of older. Um, uh, you know, older business people, whether they're farming or whether they're running small businesses or allied businesses like trucking.

And, and so there is still a great need to support, uh, men and women in rural and remote in terms of, uh research. But don't forget only 2.3%. Of the research dollar goes to rural and remote 2.3, even though we have 30% of the population in rural and remote, it's a travesty. Um, it's, it's not looking like it's gonna improve anytime soon.

We're hopeful. We've got our fingers crossed, got, uh, people such as yourself advocating for this sort of thing. It's something I, I wanted [00:13:00] to bring up and that you mentioned a little. About, um, I think you said 15 to 20% of women are affected by perinatal depression or anxiety. And I think that may have come from the Australian Journal of Rural Health or, those sort of people, um, that there are such depressive disorders.

In the community such as that. Um and they're likely to have higher, uh, percentages of parenting stress due to those limited services. Um, particularly also that there's probably not the network of family and friends nearby. What are the options or who should be, who should be turning to, as far as things like that?

You can firstly start off at the, at the mate level, the friend level, if somebody comes to you. I mean, obviously people in the community are not skilled to deal with mental illness or know how to help somebody that has suicidal, um, ideations, or is depressed. [00:14:00] However, there, there are opportunities when somebody reaches out or when somebody's acting strange because, you know, people know when something is not right.

and rather than withdrawing, um, because there is that stigma attached or because you might not know whom else to ring or to refer people to, um, you might for a friend look up online where there might be a service or a, an app that they might be able to use, or, or you might just invite a friend out for coffee a little bit more than you.

generally do, or, or, or invite them for dinner or, or something like that. Because sometimes it is at the stage where people feel like they're embarrassed to raise it or they feel like they're a failure because that's the way they feel. And that goes in the same as, um, you know, uh, [00:15:00] you know, Post, uh, you know, the first year of having a child, you know, who, where do you go to?

And, and, and there are some really great initiatives, where communities are pulling together and saying, you know, we have these services available, and I'd like to say those people that actually work on the ground in terms of service providers. Doing an amazing job, whether it's their rural gp, whether it's the allied health professionals, the psychologists, the psychiatrists that might visit, if there isn't a, a local service, um, and, and they're trying to offer the best service they can, it's just that there isn't enough funding .

To support it in term, and I was just going to say, there are services online as well. , um, which are things like looking on the Black Dog Institute website. There are resources and [00:16:00] support. Some of these are apps. They're digital tools and apps. Some are information sheets where people might just look at those and find out a little bit more about the symptoms or the things that they need to look out for if they know somebody in the community.

There's also beyond. That has tips and strategies. Um, and then there is health direct, uh, gov au that actually has some information about the mental health services or speaking with your GP about mental health. Um, and there's also some information about low cost or free mental health services. So it's really, um, you know, several levels.

The sort of things you could do if you know there is a friend or a family member or, um somebody that you [00:17:00] might know that is just not quite right, um, because you shouldn't be expected to deal with everything in terms of yourself or. Supporting somebody else. Of course, interestingly too, , and I know we talk about, there's various levels of research that have been done in, in, in various segments and sectors, but from what I could see, there is also very limited research on women in rural and remote related to their help seeking behaviors.

 And when it comes to anything from domestic issues through to finance, and even diverse groups. . That's, that's a big one, isn't it? Because women do tend to put their partner's health first. They're probably more likely to speak about their partner's problems. And, and, and while that whole, you know, women talk and men don't, um, women will tend to put other people first, won't they?

And it begs the question. Are we [00:18:00] focusing enough or the research or or or stature trigger? Are we focusing enough on women's mental health and emotional wellbeing? Because we know just through anecdote and probably be through research that. Women do put themselves almost at the bottom of the, the pile when it comes to family, partners, children, friends, communities.

Would that be right? Well, even their pets, , even their pets. I've read, I've read some research about how. people rate themselves about what sort of things they prioritize. And it's quite interesting. It's even pets and their neighbor. Um, uh, so, um, I mean, don't quote me on that one, but, um, I have read that research, so, um, look, it's, it's interesting, isn't it?

I mean, part of it is how do we ensure that we actually look at that research when we know. Uh, or, or how do we match the research with some of the other data we have about [00:19:00] women? And as, as I was saying before, it's about the superannuation. It's about the banking and about the wealth creation. Because we know that if somebody is in a good financial position, they tend to also look after their health.

And so how do we ensure that there is not that compartmentalization of only looking at mental health? But why don't we look at the whole. Of that particular person, which is woman for example, or man. Um, the second thing is, is that how can we ensure that some of the research is actually carried out in rural and remote, and if the research has been carried out in an urban center, And it's generalized about women, or there's only a very small percentage of women that are in, for example, regional.

And regional is not the same as remote and rural. Hmm. Um, if it, if it [00:20:00] is a small group of people from regional, well then let's look at the implementation of what we can do about those high risk groups. Or that high risk group of women, because we need to translate that research into a local solution.

And, um, we've been advocating for local solutions to not just health and medical workforce issues, but also for mental health. Because if we don't look for local solutions, you're going to have a city-based model, which will not. In the environment where the women and the men and the children that need the support, they will not access it.

And that is why there's such a large underspend, a $4 billion underspend in rural and remote, because you're not going to have the workforce. [00:21:00] And because the grants and the funding rounds that are available through federal and state government funding, Is not going to meet the need of those communities and they won't match when the applications go in.

You're going to have panels that are urban based, that don't understand rural and remote, and you're also going to have, uh, criteria that don't meet the need of those communities. So it's quite interesting and, you know, something that people don't often think about either. If you look at medical research, so let's say we're looking at, uh, depression drugs.

Don't forget, we have to take out all the anomalies of people. So we are looking for people that don't have, you know, certain illnesses. We have to look at people that don't. [00:22:00] Uh, s you know, uh, don't go through, let's say, um, periods. They can't be pregnant because you're trying to find, the cleanest amount of data from somebody.

And so that starts, that actually deletes a whole lot of women in research because. They often have chronic disease, so all of chronic disease, , you know, you just, you, you have to make sure that women are still, that 47 or 50% of the population in research, you haven't deleted them because you have toit.

All of those other criteria that you don't want to. Does that make sense? It makes complete sense, but it doesn't, doesn't . On the surface you think I can understand what the number crunches and those that are doing these things need to, um, they need to, you know, objectify their, their outcomes, but holistically, every, everyone [00:23:00] is a, is shouldn't just be a.

At the end of the day, um, well, we need to be able to offer the services and, and, and, and what's needed, uh, west of the divide. Well, exactly. And you know, 62.2% of aboriginal people in Australia live in rural and remote and, you know, they also have a worse health outcome. Um, and suicide is a fifth leading cause of death for indigenous people.

It's just, it's enormous. 60%. Uh, you know, if you're looking at suicide in, um, in Australia, 60%, it's 60% higher in rural and remote than. Urban centers, what steps do we need to take? Susie? As far as I, as I say, I know the advocacy that you personally and, and the alliance, [00:24:00] it's member groups, um, all those on the ground have been pushing for, for, for, not years, but decades.

Decades. Um, what, what, what needs to be the steps that we have to take? Well, um, let me turn it around. If I were a company, and I had a profit making part of the business, and I would want to keep on growing that , part of the business, right? Because then I can fund the rest of the, or cross subsidize the rest of the business, right?

So if 30% of the population is a major contributor to the Australian economy, So the thing I didn't mention before is that 30% of the population of Australia brings in 50% of the tourism income. So if I'm, if I'm a company and I [00:25:00] invest in that 30% of the population and really work on their health, really work on their education and really build vibrant communi, You will then start seeing more people wanting to live there.

You will see more people wanting to remain in rural and remote Australia, and you would see healthier people that would cost the government less money. They would have to use less of that taxpayer's income and less of that income that comes in through the businesses that are in rural and. So it makes sense to me to actually make it equitable per capita for rural and remote people to get the same investment in health as the city gets, because that's where a lot of your [00:26:00] money's coming from.

There's a lot of light bulb moments, aren't there? We just need a few more light bulbs to be going off, don't we? Yeah. it. It's equity. It is equity. And the problem with rural and remote communities and regional communities is that they don't winge enough and they don't go to Parliament House and don't say.

we are not going to work. You know, that is, I think that's the biggest problem. And I know I'm making it very simplistic and I'm, you know, smiling about it. But those communities are amazing and as, as an immigrant that has been welcomed by Australia, I, I just love rural and remote Australia because I just think that they're amazing, you know, the things that they have to deal.

you know, and, and I've lived in urban and in, in regional Australia, and [00:27:00] I think we are really lucky. Australia is a lucky country because of rural and remote, and we need to look after them. We're, we're, there's no doubt we're making strides, but we're, we're not making them nearly quickly enough to where we need to be.

Um, With, uh, with the Alliance and, and its member groups, what, what are the services that may be specifically available for those looking to maybe begin their journey? Um, and, and, and reach out. Yeah. Uh, with the Alliance, the, the Alliance really looks after the professionals and makes sure that they are supported in rural and remote.

So that's the allied health professionals, the doctors, the, you know, specialists, um, the, the nurses, the nurse practitioners, the pharmacists, you know, the ambulance, um, people, the rfds. So they're, they're all trying. Their very best to ensure that the services are available. And in [00:28:00] terms of the people on the ground, um, please try to utilize the services that you have, and if you don't have them, there are many.

Um, one 300 numbers. Um, but the Black Dog Institute, the Beyond Blue, uh, number, which is 1 302 2 4 6 3 6, um, but there are some amazing apps now and telehealth has opened up. Uh, the use of, um, being able to speak to a psychologist, a psychiatrist to a gp. It's not instead of, but it is an addition to which has allowed people to be much closer to the health professional, um, and to speak to, uh, you know, a service professional that can open up the opportunity to have a [00:29:00] convers.

And that is also for carers, for carers of people that have disabilities or are older. Um, but also those at the very at risk groups that are in, um, you know, in the LGBTIQ+, um, area. Um, those people that are isolated. And suffer, um, from mental health issues and of course long covid because we do have quite a few people in the community that are finding it very difficult to get back to where they were before they had covid.

It's been a long road. Um, not obviously for those that, uh, don't necessarily, uh, have the, the networks and, and the, the services, but holistically, as a nation, it's been a tough couple of years for us. Um, if there was one [00:30:00] message that, uh, you'd like to get out, what, what would that be? Oh, support each other.

Support each other at the grass roots. and then, you know, contact some of the people that I've spoken about because they're willing to help and they're able to help. And then if you are not receiving that help, make sure that you speak with your local politicians. Make sure that you speak with your Farmers Federation, um, your industry groups because they are also there to support you because in the end, they rely on you as a, as an employee, as a.

um, to add value to the economy and society and, um, you know, we are happy to support, all those entities that work as part of our membership. Um, and we work heavily with, um, governments. [00:31:00] So federal and state governments please work with us and work together, uh, because the people on the ground don't care where the service comes from.

They would just like to access the service that they pay the taxes for. As I say, we're making strides, but just not quickly enough. Susie, Tegan, I appreciate your advocacy, the work you and so many, people are doing in this space. Thank you. Thank you.