Academic journal article Health Sociology Review

When the Social Meets Health in Rural Australia: Confronting the Disconnect

Academic journal article Health Sociology Review

When the Social Meets Health in Rural Australia: Confronting the Disconnect

Article excerpt

Introduction: the disconnect between health and the social

In White Australian service systems, the social and health are understood and treated distinctly. We argue that there is a disconnect between these systems that marginalises health consumers and constrains the ability of health practitioners and services to provide inclusive, client-centred care. In deconstructing this disconnection, we identify an 'intersecting space' between three key actors, health consumers, health practitioners and health services. Understanding the space in which these actors intersect is about acknowledging and exploring the complex power relations maintaining the disconnection between health and the social, which, we suggest, has particularly critical consequences in rural Australia.1

Rural Australian communities are home to some of the nation's most disadvantaged and marginalised residents who experience poorer health outcomes than metropolitanbased residents (Alston et al., 2006). Health in rural communities is challenged by the difficulties of providing care to people living in geographically isolated areas. Rurally based residents have less access to and limited choices of services and less access to specialist services (Dade Smith, 2016; Liaw & Kilpatrick, 2008; Smith, Humphreys, & Wilson, 2008). Thus, rural health services must cater to the diverse needs of everyone living in rural communities because they may be the only local option, or one of a few options (Allan, Ball, & Alston, 2010). Furthermore, many rural health professionals are known to community members outside their service role, resulting in blurred boundaries for professionals and consumers (Bourke et al., 2004; Crowden, 2010).

By drawing on a hypothetical case, based on the authors' research and practice experiences, and using three key actors as 'ideal types' (see Bombak, 2015) to highlight the disconnection between the consumer, the GP and the health service in a rural context, this article makes a conceptual contribution. Following Weber (1949) and others (see Bombak, 2015; Oakley, 1997; Torr, 2008) an 'ideal type' is a conceptual construction founded in theorists' observations of what are undeniably complex social realities, synthesised into a cohesive analytical category. While serving as useful tools for their examination and description, it is recognised that ideal types are 'abstractions from ever-fluctuating, multi-perceived social realit[ies]' (Bombak, 2015, p. 260). Here, a patient, a GP and a health service manager are employed in a case study as 'typical' actors representing 'ideal types' to illustrate the dominant discourses preventing holistic, client-centred care despite the reflective practice and intentions of the professionals involved.

Case study

In a small town in rural Australia, Liz enters her local medical clinic. She has a regular appointment to get her HbA1c levels checked. She had planned a morning in town, 30 minutes' drive from her family's property. Now she does not want to talk about her diabetes and health behaviours. She wants to avoid showing anyone the marks on her skin, she just wants to be alone. She had got the children on the school bus and her husband's father and his mate (also their neighbour) had 'dropped in'. The medical appointment seemed a better option than being home serving coffee to the three men. She was also afraid of reprimand from the young receptionist if she cancelled or changed the appointment at the last minute. So she is walking in to her local medical clinic. At reception is Mary, a woman she knows from her family so she avoids eye contact and keeps her head down. As instructed, she takes a seat and waits. She breathes deeply trying to make the most of just sitting but is anxious about the conversation that is to follow. She is called by the GP (family doctor) and walks slowly up the hall to the doctor's room. Now she wants to turn and run and is considering her options when the GP says 'Come on, I have a lot of patients to see today. …

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