Perhaps the picture you paint is too rosy - distributions of education 
and higher education are worsening and the gaps between 'haves' and 
'have-nots' are deepening. The drift from state-run schools to the 
private school sector is increasing, and state-run schools are 
significantly underfunded with increasing concentrations of kids who 
have difficulties of various types.

Access to the public health system is still guaranteed but waiting lists 
are weeks and weeks to see a specialist. And for elective surgery (which 
now apparently includes most bone fractures) it may take a week or more 
to be listed for surgery (my son waited 9 days to have multiple 
fractures of elbow, tibia and fibula, fixed last year in the public 
system) or two years for a hip replacement, for example.

There is little if any evidence, that the increased number of rural born 
students to medical school actually results in increased numbers of 
those doctors practising in rural areas. There are new strategies 
emerging such as rural clinical schools, but the realities of rural 
health care are stark with an over-reliance on overseas trained doctors 
who work valiantly but under enormous pressure, in small rural 
communities who are desperate for a doctor, and ageing nursing workforce 
and desperate shortages of allied health staff and they are all educated 
under predominantly acute clinical models of care that do not prepare 
them for the realities of community based practice, prevention and 
health promotion which are sorely needed to cope with the incidence and 
prevalence of chronic diseases. Oh and STIs are on the march, with 
chlamydia and gonorrhea now endemic, and then there are violence against 
women rates, shocking rates of depression and mental illness for whom 
services are sparse, especially in rural areas. And let us not forget 
that the health of Aboriginal and Torres Strait Islander Australians is 
among the worst in the world. There is much to be done in Australia - 
keep the rose-coloured glasses in the bottom drawer for the time being.

regards
Helen

Robert C Bowman wrote:
> In Rural WONCA (international FP) in Seattle in October, it was interesting
> to discuss the great improvements in Australia in health care. Australia,
> Ireland, South Africa, and Kenya keep popping up as areas far more upbeat
> now that in times in the past. Australian contacts were by far the most
> enthusiastic, and for good reason.
>
> Rather than beating down all of the usual powerful medical and medical
> education lobbies, there seemed to be a more direct approach that took into
> account all of the different perspectives. The core 3 areas regarding
> distribution of health resources were identified and addressed. Those in
> charge already understood the key issues and as insiders, were able to get
> the right situations implemented, even with the usual professional type
> oppositions.
>
> It also appears that distributions of education and higher education had
> also been addressed, a great foundation for any change.
>
> Australia is, as far as I know, the first and only nation that has reversed
> the decline of rural born admissions to medical schools. The nation was
> once over 25% (as was the US decades ago) and declined to 10% and then rose
> again to 19%. The effort required changes in education, admissions,
> distributions of medical training, new schools focused on GPs and rural
> GPs, and support for physicians in rural practices. In the US, the declines
> have resulted in less than 10% admitted despite over 20% of the population
> rural.
>
> There are 4 tiers of US admissions 1) 3 - 10 times probability  - children
> of professionals/highest income/most urban/Asian  2) usual admissions at
> slighly below average probability of admission - typical urban, higher
> income rural, top income white and some middle income  3) 50% probability
> of admission compared to population - rural, Black, lower middle quartile
> income   4) 25% probability of admission - Hispanic, low income rural,
> lowest income quartile, minority plus rural     Those most socially,
> geographically different, fail to gain admission in the US.
>
> In Australia, the gaps have been closed for geographic origins and the
> distributions that follow with reasonably supportive health policy.
>
> The government leaders in charge of the major decisions clearly sought out
> solutions from the best sources of information.
>
> The United States has a very different scenario, as is seen in the news
> daily. We admit few different types of students to college and medical
> school, fail to support medical education, fail to train students to meet
> national needs, fail to influence them to meet national needs, and fail to
> support those that make the "correct choices" such as careers and locations
> outside of major medical centers.
>
> There are many such areas that when suppressed, may end up in worsening
> consequences, such as the dismissal of the Army Secretary to address the
> real problems of goverment.  On NPR the top brass reaction to the appaling
> conditions of the veterans returning from the Iraq war was, why did they
> not report it? A top brass not aware of the very vulnerable population of
> soldiers (like research on certain populations who are vulnerable) who have
> been trained to respect authority and chain of command is a sad situation,
> one that seemed to have been addressed post-Vietnam, (read Colin Powell
> biography) but may be recurring.
>
> When I sent preliminary reports about physician workforce in primary care
> and rural and underserved areas to the Federal Office of Rural Health
> Policy, they were appreciative, but did not pursue the implications. (I am
> proud of the RuralMed folks in Canada, who do a superb job, much better
> than we in the US, and have a bit more success although not all that is
> needed)
>
> I did not ask for funding from the Office of Rural Health Policy. I mainly
> wanted the information to go out about what was happening in admissions and
> in health policy, but the work was guaranteed to generate controversy. This
> office, like so many others, decided not to rock the boat. It has become a
> matter of survival for all such agencies, the ones who feel the pulse of
> the nation and report vital signs, but the lines are down. All of the
> agencies that are attached to lower and middle income populations are
> running scared. We in family medicine focus on Title VII and each of the
> groups has their own little pot of gold that is not so deep and does less
> and also gets zeroed out every year, making all of us individually and
> collectively, waste time on getting our own little piece and preventing
> much needed reforms and restoring the flow of appropriate and essential
> information that is needed to to run government effectively. We also fail
> to rat on our own primary care  "brethren" who are all less than 50%
> primary care except for general peds. It is no wonder that the government
> gets a confusing message.
>
> Robert C. Bowman, M.D.
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-- 
Professor Helen Keleher
Head, Department of Health Science	
Monash University
School of Primary Health Care
Peninsula Campus
McMahons Road
PO Box 527
Frankston  Vic  3199

PA: Pauline O’Brien: +61 3 99044476

Ph: +61 3 9904 4465 Fax: +61 3 9904 4812
http://www.med.monash.edu.au
Monash Provider No. 00008C

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