Waikato University research fellow Dr Jesse Whitehead is concerned that up until recently rural health data hasn’t painted the full picture of rural health outcomes in New Zealand.
This comes after a new project uncovered a 21% higher mortality rate in rural communities through the use of a new classification, when previously data showed no difference between rural and urban.
The project, led by Dr Garry Nixon of Otago University and accompanied by Dr Jesse Whitehead, found that previously ‘rurality’ was not accurately classified. The project was inspired by Nixon’s experience in his day-to-day work as a rural hospital doctor in Otago.
“So the background of this project is that in general the New Zealand health research has shown that there is no difference in health outcomes between rural and urban populations,” Whitehead said.
“And so the project lead on this, [Dr] Gary Nixon, has figured that this is most likely incorrect and this isn’t really what they’re seeing in their day-to-day work.
“So they thought one of the reasons is maybe the way that rurality has been classified, so we put together a new classification.”
Previous classifications had been masking differences in health outcomes between rural and urban communities, and Whitehead says the new thresholds “make more sense for the rural health context”.
But although previous classifications masked differences in health outcomes, he says at large they weren’t entirely incorrect.
“Previous classifications from Stats NZ using most of the health research, they’re not inaccurate necessarily, but they’re just generic classifications for generic purposes,” he said.
“So we’ve now kind of tailored it to say, that if we’re thinking about sort of morality and health, you do need to think about how long it takes to get to a major center.
“And even some of the smaller centers that might not have GP clinics and other health services, so we think our classification reflects that reality a lot better.
“Most people agree that health policy and decision-making should be evidence-based, but if the evidence that you’re using isn’t really reflecting reality then it’s not going to be good for the community.”
Dr Jesse Whitehead
Waikato University research fellow
Previous classifications indicated that between 2013-2017 there were 498 deaths per 100,000 people, a figure which has jumped to 851 using the new classification.
This is compared with 703 deaths per 100,000 people in urban areas between the same period.
He says that they will now be able to use these new findings as a more accurate baseline for the project, and are now digging deeper into why these differences may be happening.
“So what we have now is raw data, so it’s just sort of you know counting up all the deaths. So one thing we want to do is look at why this might be happening,” he said.
“As I mentioned it could be stuff like access to services, it could be the age profile as rural populations are a lot older than urban areas, stuff like socio-economic profiles in a lot of these communities and so on.
“And the other thing now is that now that we’ve got a classification that we think is really accurate and it’s fit for purpose for health research, we can dig into more detail on a range of health outcomes.
Following recent milestones, the project has secured funding for the next three years from the Health Research Council of NZ totalling almost $1.2 million.
This will allow for a deeper look into things like regional variation, and other considerations like some farmers moving into urban centres in their older years, which could further skew mortality rates.
On the back of these new findings, Whitehead says he is optimistic about what it means for future research and public health policy.
“I guess most people agree that health policy and decision-making should be evidence-based, but if the evidence that you’re using isn’t really reflecting reality then it’s not going to be good for the community,” he said.
“All the policies and strategies we’ve had up until now are based on that misunderstanding that people in rural areas are just as healthy as people living in urban areas, when our research has unmasked a big difference between the two.
And we’re hoping going forward that the information can be used to design better policy, and make better decisions that work better for rural communities.”
