Christina Malatzky

When the social meets health in rural Australia: confronting the disconnect

ABSTRACT What happens in contemporary rural Australian communities when health consumers, health practitioners and health services intersect is the focus of this article. Using a hypothetical case of intimate partner violence, we analyse the power relations within what we call the ‘intersecting space’ to examine how each of these three central and ‘typical’ actors – rural consumers, health practitioners and rural services – is positioned. Drawing on Foucault’s concepts of power and discourse, we deconstruct dominant discourses of sameness and neutrality which (i) marginalise the perspectives and needs of rural health consumers, (ii) immobilise the ability of health practitioners to connect the social to health and (iii) restrict the flexibility of rural health services to address the social as part of health need. We argue that these discourses of sameness and neutrality have generated a longstanding disconnect that constrains social and health care systems, thwarting the production of client-centred care. We suggest that system-level change is required to provide client-centred, integrated and inclusive rural health care that recognises and addresses the social as a fundamental part of health.

Don't shut up: Australia's first paid parental leave scheme and beyond

Abstract Through the perspective of womens conflicting roles, this paper examines the capacity of the Australian Paid Parental Leave scheme to assist Australian families negotiate paid work and parenthood. Drawing on comparisons with other nation-state policies and interview data with Western Australian women, this paper argues that womens choices remain limited despite the introduction of the Paid Parental Leave scheme. I suggest that while Paid Parental Leave is an important reform for gender equality and improving work/life balance for many Australian families, it is not sufficient. The policy and culture of Australian workplaces need improvement.

Prioritising the cultural inclusivity of a rural mainstream health service for First Nation Australians: an analysis of discourse and power

ABSTRACT In the context of persisting health inequities within many multicultural and socially diverse countries like Australia, there is a call for health services to implement culturally inclusive systems and practices. Nowhere is this more important than in regional, rural and remote Australia where consumers are diverse, health services are scarce, and services designed for particular groups of the population are lacking. Drawing on interviews with 20 staff of a rurally-based, mainstream community health service, this article examines the role of discourse in the transition to a culturally inclusive health centre. In doing so, the power struggles inherent in such a process are highlighted. The article contends that improvements in the health outcomes of First Nation and culturally Other groups within the Australian population is contingent upon systematic resistances that disrupt and re-arrange existing dominant discourses. This calls for a disruption of current race relations in both broader social fields as well as those supporting biomedical assumptions about the delivery of healthcare in the mainstream health sector. Alternative discourses must be promoted in both these fields.

Different perspectives on the key challenges facing rural health: The challenges of power and knowledge

OBJECTIVE To examine the effects of dominant knowledge in rural health, including how they shape issues central to rural health. In particular, this article examines the roles of: (i) deficit knowledge of rural health workforce; (ii) dominant portrayals of generalism; and (iii) perceptions of inferiority about rural communities in maintaining health disparities between rural- and metropolitan-based Australians. DESIGN A Foucauldian framework is applied to literature, evidence, case studies and key messages in rural health. Three scenarios are used to provide practical examples of specific knowledge that is prioritised or marginalised. RESULTS The analysis of three areas in rural health identifies how deficit knowledge is privileged despite it undermining the purpose of rural health. First, deficit knowledge highlights the workforce shortage rather than the type of work in rural practice or the oversupply of workforce in metropolitan areas. Second, the construction of generalist practice as less skilled and more monotonous undermines other knowledge that it is diverse and challenging. Third, dominant negative stereotypes of rural communities discourage rural careers and highlight undesirable aspects of rural practice. CONCLUSION The privileging of deficit knowledge pertaining to rural health workforce, broader dominant discourses of generalism and the nature of rural Australian communities reproduces many of the key challenges in rural health today, including persisting health disparities between rural- and metropolitan-based Australians. To disrupt the operations of power that highlight deficit knowledge and undermine other knowledge, we need to change the way in which rural health is currently constructed and understood.

A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services

BACKGROUND The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. OBJECTIVE The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. DESIGN This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucaults concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. RESULTS The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. CONCLUSION The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated.