The nationals may be heading into the wilderness, forever

Non-union rural workers may well be attracted to Kevin Rudd. IN RECENT decades, the Nationals have defied predictions of their demise. They have weathered the passing of agrarian socialism and the rapid decline in the farm population and - after the debacle of the "Joh for PM" campaign two decades ago - the party has successfully rallied around more limited goals of political survival and influence in the Coalition. Their parliamentary representation has fallen,...

Rural primary health care workers and research : what is their present capacity?

Aims & rationale/Objectives : The main objectives of this project were to:
- conduct an audit of research skills and experience of primary health care staff in nine south western Victorian not-for-profit agencies
- identify capacity for research in five pre-identified areas
- investigate unpublished research endeavours/innovative projects taking place in the linked community organisations.
Methods : A 9-item survey was developed and will be distributed to all primary health care staff at the nine agencies via the internal email system of each organisation. The survey was developed after consultation with several agency directors, to obtain an organisational perspective on research capacity issues. Staff were also invited to take part in informal focus groups exploring key themes.
Principal findings : This study is in progress, and is expected to be completed at the end of March, 2007. Expected findings are the identification of primary health care staff's capacity for research, and discussion of relevant organisational assistance which would develop their research skills or enable continued participation in research.
Discussion : Phase 2 of the Australian PHC Research, Evaluation and Development Strategy aims to support the development and expansion of the primary health care research workforce. Findings from the current study will support this goal by assisting rural primary health care workers to identify the training and support they need to undertake quality research. The data could also be used to: a) assist the consortium to identify common research interests; b) to inform the consortium regarding the potential for collective research efforts; and c) to support funding submissions from the consortium or from individual agencies.
Implications : These findings will help to inform improved strategic planning in relation to building research capacity. The data could also be used by participating agencies to support applications for research grant funding.
Presentation type : Poster
Session theme : Building research capacity

Height, weight and well-being for rural, urban and migrant workers in China

In general, the happiness literature has paid little attention to the relationship between physical appearance and well-being. In this paper, we examine the link between weight, height and well-being for three distinct samples in China given that attractiveness effects likely vary greatly across sociocultural contexts. As China has recently undergone rapid economic transformation in the urban areas, this empirical exercise is particularly interesting because it can highlight how changing social norms have affected the relationship between physical appearance and subjective well-being. For the rural and migrant samples, we find that for both men and women, big and tall individuals have higher levels of well-being. This is consistent with the notion that the strong are better off when more labor intensive work is the norm. For the urban sample and for urban males in particular, no well-being penalty is found for being obese, unlike previous results based on Western samples. It is very likely that the unique Chinese cultural practice of network building banquets and feasting is behind this finding.

New money for mental health : will it make things better for rural and remote Australia?

New Australian government funding for the Better Outcomes in Mental Health Care initiative is a significant step forward for mental health, with general practitioners now able to offer direct referrals to psychologists, social workers, occupational therapists and Aboriginal health workers. Incentives for better teamwork between GPs and other mental health professionals have been introduced, but may have unintended consequences, including an exacerbation of workforce shortages in rural and remote areas. Possible solutions to these shortages include rural scholarships for students in the mental health professions; recruitment and retention of students coordinated by university departments of rural health; better access to continuing professional development; and federally funded rural positions and additional financial incentives for rural mental health practitioners.

Responding to rural skills shortages : innovations using vocational education and training

Aims & Rationale/Objectives
To locate, analyse and make accessible innovative models of health training and service delivery that have been developed in response to a shortage of skills.

Methods
Drawing on a synthesis of Australian and international literature on innovative and effective models for addressing health skill shortages, 50 models were selected for further study. Models were also identified from nominations by key health sector stakeholders. Selected models represent diversity in terms of the nature of skill shortage addressed, barriers overcome in developing the model, health care specialisations, and customer groups.

Principal Findings
Rural and remote areas have become home to a set of innovative service delivery models. Models identified encompass local, regional and state/national responses. Local responses are usually single health service-training provider partnerships. Regional responses, the most numerous, tend to have a specific focus, such as training young people. A small number of holistic state or national responses, eg the skills ecosystem approach, address multiple barriers to health service provision. Typical barriers include unwillingness to risk-take, stakeholder differences, and entrenched workplace cultures. Enhancers include stakeholder commitment, community acceptance, and cultural fit.

Discussion
Of particular interest is increasing numbers of therapy assistants to help address shortages of allied health professionals, and work to formalise their training, and develop standards of practice and policy. Other models likely to help address skill shortage amongst VET health workers focus on recruiting, supporting and training employees from a range of disadvantaged target groups, and on providing career paths with opportunities for staff to expand their skills. Such models are underpinned by nationally recognised qualifications, but each solution is targeted to a particular context in terms of the potential workforce and local need.

The mobile skilled workforce : optimising benefits for rural communities

Many small rural communities with ageing populations and limited opportunities for young people are not attracting skilled workers, but have a flow of skilled people through the community as locums, seasonal workers or contractors. This project investigated the question: how can rural communities capture maximum benefit from professional and other highly skilled workers in the context of an increasingly mobile and transitory workforce? It found that rural communities derive a wide range of benefits from mobile skilled workers. Effectiveness of the integration process determines the nature and extent of mobile skilled worker contribution to the community. Community settings that encourage and support mobile skilled worker integration are identified in terms of culture, leadership and interactional infrastructure. These same settings also influence mobile skilled worker retention in rural communities. Rural communities need to be proactive in matching worker and community characteristics, and this begins with the recruitment process. Mobile skilled workers need assistance and support to develop a primary social contract, and the process needs to be monitored. This is a community-wide responsibility and requires a coordinated, whole-of-community approach. This is the first Australian study to explore how rural communities can capture the advantages from highly skilled mobile workers. Rural communities that make the most of the available pool of skills can increase resilience, identification and uptake of opportunities such as new enterprises, good practice in natural resource management, enhanced social and leisure opportunities, and the quality and range of local services. The importance of this report is that it provides a broad range of strategies for rural communities wanting to know how to optimise the benefits they derive from mobile skilled workers, regardless of their location or rural industry base.

The rural and regional ambulance paramedic : moving beyond emergency response - report to the Council of Ambulance Authorities Inc. March 2006

Serious long-term recruitment and retention problems amongst rural health workers in Australiacontribute to inequitable health service access for rural Australians. In response, new healthcaremodels with flexible workforce roles are emerging including expanded-scope paramedic roles.

This research project was born from the view that expanding ambulance paramedics’ scope ofpractice offers the potential to improve patient care and the general health of the community.New healthcare models with flexible workforce roles are clearly needed in rural Australia andexpanded-scope paramedic roles are valuable innovations.

Researching maternal, neonatal and child health service use in rural and pastoralist Ethiopia: A key informant research approach

Like many nations in sub-Saharan Africa, Ethiopia has both a high neonatal mortality rate and maternal mortality ratio and is unlikely to meet Millennium Development Goals 4 and 5 by 2015. This working paper examines how Key Informant Research (KIR) in rural and pastoralist Ethiopia will identify facilitators and barriers to the use of maternal, neonatal and child health services. The methodology is informed by Participative Ethnographic Evaluation Research (PEER) and Key Informant Monitoring (KIM). Key Informant Research (KIR) training will provide research skills to Health Extension Workers (HEWs) and Non-government organisation (NGO) staff to enable them to develop research questions, collect data and participate in preliminary data analysis. This will enable the identification of strategies that improve the identification of risk, enhance early referral, increase access, affordability and acceptability of skilled birthing services in rural and pastoralist Ethiopia.

Access to social insurance in urban China: a comparative study of rural-urban and urban-urban migrants in Beijing

 Since 1958 the hukou (household registration) system has assigned Chinese citizens either a rural or urban status. Some studies argue that the rural-to-urban migrants in China who do not have urban hukou are not entitled to urban social insurance schemes, due to institutional discrimination, which applies differing treatment to urban and rural hukou (chengxiang fenge). Although rural-urban migrants participate less in the social insurance system than their counterparts with urban hukou, a closer examination of recent policy developments shows that migrants actually do have the legal right to access the system. This implies that discrimination between rural and urban workers has been declining, and distinctions based on household registration status are less able to explain China's current urban transition. This paper provides a new way of examining Chinese migrants' social insurance participation, by adopting a framework that includes both rural-to-urban migrants and urban-to-urban migrants, which are an important, but less studied, migrant group. Among our key findings are that urban migrants are more likely to sign a labour contract than rural migrants; urban migrants have higher participation rates in social insurance than rural migrants; having a labour contract has a greater impact than hukou status in determining whether Beijing's floating population accesses social insurance; and urban migrants who have signed a labour contract have higher participation rates in social insurance than either rural migrants or urban migrants without a labour contract. © 2013 Elsevier Ltd.

Effects of intergroup contact on attitudes of Chinese urban residents to migrant workers

 One consequence of China's marketisation has been the emergence of a 'floating population' - rural Chinese who migrate to China's cities to work. Many urbanites have negative attitudes towards such migrants. To understand how these negative attitudes might be ameliorated, the paper employs Allport's influential contact hypothesis to investigate whether urbanite-migrant friendships affect attitudes. More negative attitudes were observed among males and older urbanites. There was no effect of simply knowing a migrant, supporting Allport's thesis that non-intimate contact is not sufficient to affect attitudes. Friendship alone did not influence attitudes, but interaction effects were detected between having migrant friends and each of age, income and education. Negative attitudes were reduced among urbanites in older, higher-income and higher-education groups if they had a migrant friend. © 2006 The Editors of Urban Studies.

Which rural migrants receive social insurance in Chinese cities? Evidence from Jiangsu survey data

This article draws on a survey of internal migrant workers in China's Jiangsu province to shed light on the characteristics of migrant workers who receive social insurance and explain why some migrants take up social insurance while others do not. Of the factors which potentially explain which migrants receive social insurance, gender, past earnings, ties to the city to which the migrant had moved, the ownership type of the enterprise in which the migrant works and residential registration status are all found to be statistically significant predictors. The article concludes with the suggestion that the high level of scepticism with respect to social protection that has been reported as being manifest among migrants is justified. There is little likelihood the majority of migrant workers who have moved to China's towns and cities will be able to access the social insurance benefits traditionally available to those with urban registration. Copyright © 2005 SAGE Publications London.

Determinants of wage arrears and their implications for the socioeconomic wellbeing of China's migrant workers: Evidence from Guangdong province

The recent unprecedented scale of Chinese migration has had far-reaching consequences. Within China, many villages have been drained of their young and most able workers, cities have been swamped by the ‘floating population’, and many rural migrants have been unable to integrate into urban society. Internationally, the Chinese have become increasingly more mobile. This Handbook provides a unique collection of new and original research on internal and international Chinese migration and its effects on the sense of belonging of migrants.

Chronic disease self-management in Aboriginal communities : towards a sustainable program of care in rural communities

The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project. The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.

Enhanced primary care : a rural perspective

BACKGROUND: The Enhanced Primary Care (EPC) program is designed to promote better management of and improved health outcomes for people with chronic illness. Specific Medicare item numbers provide government funding to encourage general practitioners to take up health assessments, care plans and case conferences. AIM: We investigated elements of the EPC program from a rural general practice perspective.

METHOD: Questionnaires summarising experience of EPC for patients and health care providers, undertaken over four weeks at three rural general practices, and observation.

RESULTS: The EPC program assisted the management and coordination of care for patients with multidisciplinary care needs. General practitioners were generally positive about the EPC program. The main barrier was the extra time required. The main concern of allied health workers was the lack of appropriate remuneration for their participation. Patients were positive in their responses, but many appeared to lack the motivation and self management skills to take full advantage of the program.

DISCUSSION: Strategies seeking to increase the uptake of EPC items need to address efficiency and accessibility, and funding for participating health professionals.