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Alternative medicine ‘trusted’ in rural areas

Large study confirms poorer health for women outside city areas. By Amber Forsyth

Rural and regional women were more likely to use complementary and alternative medicines than women in cities, Australia's largest study of rural health has found.

This was not from any dissatisfaction with conventional medicine but instead reflected their strong social networks and sense of trust.

"As far as we can see, it's simply that complementary and alternative medicine has more appeal to people in country areas. They are more used to trusting in things," said Professor Annette Dobson, from the University of Queensland and director of the Longitudinal Study on Women's Health.

This finding was contrary to common perceptions that complementary medicine was predominantly a city trend.

Of the 40,000 women tracked for this longitudinal study, half were from rural and regional areas. The research project examined differences in health outcomes, as well as access and use of health services.

The report also confirmed that women living in regional and remote areas continued to experience poorer health than their city counterparts.

The further women lived from the major cities, the more likely they were to suffer from higher mortality rates, obesity and the related conditions of diabetes and hypertension.

"It certainly is the case that while most groups in Australia are getting fatter, people in rural areas are quiet significantly more obese," said Dobson.

Access to services in general was also worse for rural and regional women. In particular, specialty services such as cancer diagnosis and some hospital procedures were less common as remoteness increased. And major cities had greater use of obstetric interventions such as epidurals and emergency or elective caesareans.

The study found that procedures such as hysterectomies were also much more common in country areas, due to poorer access. "Rural women are presumably seeking definitive treatment earlier and are choosing to have hysterectomies, whereas perhaps in cities they may try other treatments," Dobson said.

In the treatment of heart disease, rural women also received poorer advice on medication and self-management strategies. Dobson highlighted the importance, for example, of heart failure nurses, but noted that this kind of service was not available in country areas.

To improve access to speciality services and improved diagnosis, Dobson called for nurses to work across a wider range of specialist services and for the broader use of telemedicine.

"With national broadband and telemedicine, there would be a real chance of doing things differently and giving people in rural areas much greater access."

In terms of the wellbeing of the studied cohort, country women came out on top. They reported feeling safer, more secure and cared more for each other more than city women.

"Generally speaking women in country areas have a much greater sense of community, neighbourhood and belonging. It was very striking that feelings of security and safety reduced amongst women as you approached the centres of the big cities," Dobson said.

The extension of incentives for rural doctors to bulk bill patients in outer metropolitan areas saw dramatic improvements in the availability of bulk-billing services and improved access for rural populations to primary care.

However, regional centres which missed out in the 2004 legislation were still disadvantaged.

The study is a collaboration between UQ and the University of Newcastle and is funded by the Department of Health and Ageing. It has followed more than 40,000 women since 1996, taking a comprehensive view of all aspects of health throughout their lives.

The Rural, remote and regional differences in women's health report can be downloaded at www.alswh.org.au.

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