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Aust. J. Rural Health (2015) 23, 124–126
Editorial Industry and rural health: Part of the problem or part of the solution? In Australia and internationally, rural-based industries are an important component of the national landscape. Resource-based industries (such as mining, gas, petroleum) and primary industries such as agriculture feature prominently in rural Australia and play a significant role in the economic, socio-cultural and environmental forces affecting communities. Factors affecting health and well-being of rural communities are important for the operation, social license and sustainability of each of these industries. Issues relating to the mining and resources sector have been in sharp relief recently with a national focus on the health of workers in remote locations, their working patterns and the impact of industry on communities and the environment. The debate concerning the health risks and social and environmental impacts of the resources sector on rural communities and rural environments is complex. It is important to acknowledge the role of industry as a whole in improving health care delivery in rural communities while acknowledging the need to better understand impacts and health consequences as a result of increasing economic activity. As a result, examination of the role of industry in addressing the health needs of communities, families and employees in rural workplaces and employment is a useful starting point. In March 2015, the University of Newcastle’s Centre for Resources Health and Safety* hosted a symposium that brought together senior organisational, industry and community representatives to discuss the health needs of communities and workplaces in diverse resource intensive regions. This symposium aimed to review the health service needs in the minerals and resources sector, and the communities of rural and regional Australia in which these industries operate. The goal was to identify priorities and health needs in the resources sector and their communities and to facilitate partnerships across research, community and industry to pursue these priorities. Attended by representatives from local government, health research institutions, health service providers and *The Centre was established in 2013, funded by Aspen Medical Services. The symposium was supported by the University of Newcastle Research Division and Newcastle Institute for Energy and Resources, and Aspen Medical Services. © 2015 National Rural Health Alliance Inc.
industry, including mining and agriculture, the symposium provided a unique opportunity to link the health sector of regional Australia with the work, safety and environment representatives from the resources sector. Key themes emerged including models of health care that might best address the health needs in industry and rural communities, emerging issues in workplace health in the resources sector and the broader setting of the challenges facing rural and remote regions. Underpinning these themes was the importance of robust working partnerships between researchers across diverse disciplines, health service providers, industry groups and rural communities in achieving the goals for improving health in rural and remote Australia. Provision of health care within workplaces in rural regions confronts the limitations of existing models of health service provision: the partitioning of primary care from secondary level services; the lack of integration of physical and mental health care; the difficulties in integrating prevention programs within existing health services; and the difficulties in tailoring services to population characteristics and needs. Examples of community-led integrated models of health care can be found in Aboriginal Community Controlled Health Services that provides not only a model for rural health services but also opportunities for engagement with Aboriginal health services to meet needs of Aboriginal workers. Developments in web-based or e-health programs may provide new opportunities for improving access to health information and health care to both the resources sector and rural communities. ‘Digitally enabled’ rural health care has the potential to extend the reach and scope of health information and services to rural and remote communities, with exemplars from recent innovations in evidence-based e-health interventions for mental health problems and substance use disorders.1 Strategies to improve the engagement with such services; and broader availability and acceptability to the community in general and health service providers will require close consideration. Employment and work are important parts of people’s lives. Working life plays an important role in health and well-being.2 The characteristics of the workplace can be protective as a source of connection, social inclusion and involvement with others. It is a source of doi: 10.1111/ajr.12210
EDITORIAL
personal esteem, role and identity, and of course financial security. Work can also involve hazards and risks, both physical and emotional. Furthermore, the workplace can provide unique opportunities to promote health and well-being, communicate constructive values and culture around health, support individuals affected by illness through early recognition, promote access to resources and treatments if needed and support individuals through recovery and return to work.3 More recently, like other industries in Australia and internationally, the resources sector is turning its attention to the mental health elements of workplace health and safety, with growing recognition of the health, economic and social benefits of these programs. The University of Newcastle’s Centre for Resources Health and Safety has been leading a partnership with the mining industry at a state and national level to develop an industry-wide strategy for mental health in the workplace. This builds on existing health and safety frameworks of risk prevention, mitigation and response, widely adopted in the industry and incorporates evidence-based strategies across the spectrum of mental health promotion, early intervention and recovery (Blueprint for Mental Health in the Mining Industry).4 This approach indicates the importance of industry engagement and establishes an ongoing partnership to identify key research questions and methods appropriate to the workplace. While mental health is a major recent focus, emerging priorities for workplace programs in the resources sector also include substance use, obesity, fatigue management and addressing musculoskeletal injuries, all indicating the importance of programs that integrate physical and mental heath-related interventions. Strategies for effective engagement between communities, health service providers and industry can go far to identify shared challenges and develop future solutions. Issues identified in this program include the challenges presented by environmental hardship (such as drought) and the benefits of programs developed in close collaboration with rural communities and organisations such as the Rural Adversity and Mental Health Program (led by the NSW Centre for Rural and Remote Mental Health) (http://www.ramhp.org.au/) and government agencies (such as Rural Support Programs) to promote local outreach support to agricultural communities and to support growth of local leadership. These programs encompass similar principles to those of more highly structured industries (such as the mining and mental health programs) and incorporate health promotion with increasing recognition of health problems and available resources. They are achieved through partnership with industry leaders and developed to be relevant to the target population.5 Whether referring to the resources industry or to the agriculture sector within rural communities, similar principles apply to targeted © 2015 National Rural Health Alliance Inc.
125
health programs: the need to build a firm evidence base from population health research regarding community characteristics and health care needs (including health risks) and maximising the use of the existing community assets. The latter includes supporting health practitioners to work more closely in outreach with other agencies and people in trusted roles in communities (e.g. agricultural agencies, industry site supervisors). Doing this with agreed roles and targets can ensure cohesive effort, reduce duplication of services and focus attention on under-served populations. Opportunities exist for programs across diverse industries to collaborate in their efforts to support rural communities. The work of the Australian Centre for Agricultural Health and Safety (http://www.aghealth.org.au/) provides an example of the health gains, through safety policy and the utilisation of national datasets to inform policy development and evaluation of the impact of practice changes. The focus on workplace health at an organisational or policy level needs to be informed by an appreciation of the personal experience of employment and work, the impact of workplace injury and fatalities. Furthermore, an awareness of the cultural and demographic diversity of rural communities and occupational groups is necessary to ensure programs are inclusive and promote ‘cultural’ safety and diversity. This is critical to promoting well-being in the workplace. Vigilance is needed to ensure that programs targeting occupational groups avoid stereotyped assumptions about such groups (e.g. a focus on ‘male-focussed’ approaches in what is assumed to be ‘male-dominated’ industry may alienate minority members of the workforce). Failure to do so risks further alienating those people socially isolated within rural regions. Health services and industry share the challenge of health care provision to those working in the industry and the communities in which the industry and its employees reside. While it is important not to overlook the significant needs of the unemployed and those isolated from the opportunities that work can bring,6 it is important to consider the gains that can be made from programs undertaken within industry. Broad benefits to the individual, their family and community, can be derived from industry investment in workplace health policy and practices.3 This includes those in the resourcebased industries or occupation-related organisations, such as those working with people employed in agriculture. Work setting and employment can provide a valuable vehicle to address health needs: not only mitigating work-related health risks but also providing a source of tailored and accessible forms of health information and health care. Furthermore, industry practices can promote good health and can encourage return to work for people affected by illness (helping to support maintenance of employment).
126
These themes argue for an active dialogue and collaboration between industry, health researchers and health service providers.7 As governments and communities work to address the health needs or rural populations, and notwithstanding the need to identify and mitigate any health and social impacts of industry development, it is critical that we continue to work with rural-based industries that are committed to the well-being of the communities they reside in. In this approach, we may find new opportunities to achieve important gains in access to health care in rural communities. Brian Kelly Aspen Chair Centre for Resources Health and Safety Professor of Psychiatry University of Newcastle Gerry Bobsien Research Development Officer University of Newcastle
References 1 Kay-Lambkin FJ, Baker AL, Kelly BJ, Lewin TJ. Clinicianassisted computerised versus therapist-delivered treatment
EDITORIAL
2
3
4
5
6
7
for depressive and addictive disorders: a randomised controlled trial. Medical Journal of Australia 2011; 195: S44– S50. LaMontagne AD, Martin A, Page AM et al. Workplace mental health: developing an integrated intervention approach. BMC Psychiatry 2014; 14: 131. Sorensen G, Landsbergis P, Hammer L et al. Preventing chronic disease in the workplace: a workshop report and recommendations. American Journal of Public Health 2011; 101: S196–S207. Kelly B, Skehan J, Considine R. A Blueprint for Mental Health. NSW Mining, 2013. [Cited 15 Apr 2015]. Available from URL: http://www.nswmining.com.au/NSWMining/ media/NSW-Mining/Publications/NSW-Mining-Blueprint -for-Mental-Health-and-Wellbeing.pdf Fragar L, Kelly B, Henderson A, Tonna A, Peters M. Partnerships to promote mental health of NSW farmers – the New South Wales farmers blueprint for mental health. Australian Journal of Rural Health 2008; 16: 170–175. Fragar L, Stain H, Perkins D et al. Distress among rural residents – does employment and occupation make a difference? Australian Journal of Rural Health 2010; 18: 25– 31. Australian Government Department of Health and Ageing. Strategic Review of Health and Medical Research, 2013.
© 2015 National Rural Health Alliance Inc.
Aust. J. Rural Health (2015) 23, 124–126
Editorial Industry and rural health: Part of the problem or part of the solution? In Australia and internationally, rural-based industries are an important component of the national landscape. Resource-based industries (such as mining, gas, petroleum) and primary industries such as agriculture feature prominently in rural Australia and play a significant role in the economic, socio-cultural and environmental forces affecting communities. Factors affecting health and well-being of rural communities are important for the operation, social license and sustainability of each of these industries. Issues relating to the mining and resources sector have been in sharp relief recently with a national focus on the health of workers in remote locations, their working patterns and the impact of industry on communities and the environment. The debate concerning the health risks and social and environmental impacts of the resources sector on rural communities and rural environments is complex. It is important to acknowledge the role of industry as a whole in improving health care delivery in rural communities while acknowledging the need to better understand impacts and health consequences as a result of increasing economic activity. As a result, examination of the role of industry in addressing the health needs of communities, families and employees in rural workplaces and employment is a useful starting point. In March 2015, the University of Newcastle’s Centre for Resources Health and Safety* hosted a symposium that brought together senior organisational, industry and community representatives to discuss the health needs of communities and workplaces in diverse resource intensive regions. This symposium aimed to review the health service needs in the minerals and resources sector, and the communities of rural and regional Australia in which these industries operate. The goal was to identify priorities and health needs in the resources sector and their communities and to facilitate partnerships across research, community and industry to pursue these priorities. Attended by representatives from local government, health research institutions, health service providers and *The Centre was established in 2013, funded by Aspen Medical Services. The symposium was supported by the University of Newcastle Research Division and Newcastle Institute for Energy and Resources, and Aspen Medical Services. © 2015 National Rural Health Alliance Inc.
industry, including mining and agriculture, the symposium provided a unique opportunity to link the health sector of regional Australia with the work, safety and environment representatives from the resources sector. Key themes emerged including models of health care that might best address the health needs in industry and rural communities, emerging issues in workplace health in the resources sector and the broader setting of the challenges facing rural and remote regions. Underpinning these themes was the importance of robust working partnerships between researchers across diverse disciplines, health service providers, industry groups and rural communities in achieving the goals for improving health in rural and remote Australia. Provision of health care within workplaces in rural regions confronts the limitations of existing models of health service provision: the partitioning of primary care from secondary level services; the lack of integration of physical and mental health care; the difficulties in integrating prevention programs within existing health services; and the difficulties in tailoring services to population characteristics and needs. Examples of community-led integrated models of health care can be found in Aboriginal Community Controlled Health Services that provides not only a model for rural health services but also opportunities for engagement with Aboriginal health services to meet needs of Aboriginal workers. Developments in web-based or e-health programs may provide new opportunities for improving access to health information and health care to both the resources sector and rural communities. ‘Digitally enabled’ rural health care has the potential to extend the reach and scope of health information and services to rural and remote communities, with exemplars from recent innovations in evidence-based e-health interventions for mental health problems and substance use disorders.1 Strategies to improve the engagement with such services; and broader availability and acceptability to the community in general and health service providers will require close consideration. Employment and work are important parts of people’s lives. Working life plays an important role in health and well-being.2 The characteristics of the workplace can be protective as a source of connection, social inclusion and involvement with others. It is a source of doi: 10.1111/ajr.12210
EDITORIAL
personal esteem, role and identity, and of course financial security. Work can also involve hazards and risks, both physical and emotional. Furthermore, the workplace can provide unique opportunities to promote health and well-being, communicate constructive values and culture around health, support individuals affected by illness through early recognition, promote access to resources and treatments if needed and support individuals through recovery and return to work.3 More recently, like other industries in Australia and internationally, the resources sector is turning its attention to the mental health elements of workplace health and safety, with growing recognition of the health, economic and social benefits of these programs. The University of Newcastle’s Centre for Resources Health and Safety has been leading a partnership with the mining industry at a state and national level to develop an industry-wide strategy for mental health in the workplace. This builds on existing health and safety frameworks of risk prevention, mitigation and response, widely adopted in the industry and incorporates evidence-based strategies across the spectrum of mental health promotion, early intervention and recovery (Blueprint for Mental Health in the Mining Industry).4 This approach indicates the importance of industry engagement and establishes an ongoing partnership to identify key research questions and methods appropriate to the workplace. While mental health is a major recent focus, emerging priorities for workplace programs in the resources sector also include substance use, obesity, fatigue management and addressing musculoskeletal injuries, all indicating the importance of programs that integrate physical and mental heath-related interventions. Strategies for effective engagement between communities, health service providers and industry can go far to identify shared challenges and develop future solutions. Issues identified in this program include the challenges presented by environmental hardship (such as drought) and the benefits of programs developed in close collaboration with rural communities and organisations such as the Rural Adversity and Mental Health Program (led by the NSW Centre for Rural and Remote Mental Health) (http://www.ramhp.org.au/) and government agencies (such as Rural Support Programs) to promote local outreach support to agricultural communities and to support growth of local leadership. These programs encompass similar principles to those of more highly structured industries (such as the mining and mental health programs) and incorporate health promotion with increasing recognition of health problems and available resources. They are achieved through partnership with industry leaders and developed to be relevant to the target population.5 Whether referring to the resources industry or to the agriculture sector within rural communities, similar principles apply to targeted © 2015 National Rural Health Alliance Inc.
125
health programs: the need to build a firm evidence base from population health research regarding community characteristics and health care needs (including health risks) and maximising the use of the existing community assets. The latter includes supporting health practitioners to work more closely in outreach with other agencies and people in trusted roles in communities (e.g. agricultural agencies, industry site supervisors). Doing this with agreed roles and targets can ensure cohesive effort, reduce duplication of services and focus attention on under-served populations. Opportunities exist for programs across diverse industries to collaborate in their efforts to support rural communities. The work of the Australian Centre for Agricultural Health and Safety (http://www.aghealth.org.au/) provides an example of the health gains, through safety policy and the utilisation of national datasets to inform policy development and evaluation of the impact of practice changes. The focus on workplace health at an organisational or policy level needs to be informed by an appreciation of the personal experience of employment and work, the impact of workplace injury and fatalities. Furthermore, an awareness of the cultural and demographic diversity of rural communities and occupational groups is necessary to ensure programs are inclusive and promote ‘cultural’ safety and diversity. This is critical to promoting well-being in the workplace. Vigilance is needed to ensure that programs targeting occupational groups avoid stereotyped assumptions about such groups (e.g. a focus on ‘male-focussed’ approaches in what is assumed to be ‘male-dominated’ industry may alienate minority members of the workforce). Failure to do so risks further alienating those people socially isolated within rural regions. Health services and industry share the challenge of health care provision to those working in the industry and the communities in which the industry and its employees reside. While it is important not to overlook the significant needs of the unemployed and those isolated from the opportunities that work can bring,6 it is important to consider the gains that can be made from programs undertaken within industry. Broad benefits to the individual, their family and community, can be derived from industry investment in workplace health policy and practices.3 This includes those in the resourcebased industries or occupation-related organisations, such as those working with people employed in agriculture. Work setting and employment can provide a valuable vehicle to address health needs: not only mitigating work-related health risks but also providing a source of tailored and accessible forms of health information and health care. Furthermore, industry practices can promote good health and can encourage return to work for people affected by illness (helping to support maintenance of employment).
126
These themes argue for an active dialogue and collaboration between industry, health researchers and health service providers.7 As governments and communities work to address the health needs or rural populations, and notwithstanding the need to identify and mitigate any health and social impacts of industry development, it is critical that we continue to work with rural-based industries that are committed to the well-being of the communities they reside in. In this approach, we may find new opportunities to achieve important gains in access to health care in rural communities. Brian Kelly Aspen Chair Centre for Resources Health and Safety Professor of Psychiatry University of Newcastle Gerry Bobsien Research Development Officer University of Newcastle
References 1 Kay-Lambkin FJ, Baker AL, Kelly BJ, Lewin TJ. Clinicianassisted computerised versus therapist-delivered treatment
EDITORIAL
2
3
4
5
6
7
for depressive and addictive disorders: a randomised controlled trial. Medical Journal of Australia 2011; 195: S44– S50. LaMontagne AD, Martin A, Page AM et al. Workplace mental health: developing an integrated intervention approach. BMC Psychiatry 2014; 14: 131. Sorensen G, Landsbergis P, Hammer L et al. Preventing chronic disease in the workplace: a workshop report and recommendations. American Journal of Public Health 2011; 101: S196–S207. Kelly B, Skehan J, Considine R. A Blueprint for Mental Health. NSW Mining, 2013. [Cited 15 Apr 2015]. Available from URL: http://www.nswmining.com.au/NSWMining/ media/NSW-Mining/Publications/NSW-Mining-Blueprint -for-Mental-Health-and-Wellbeing.pdf Fragar L, Kelly B, Henderson A, Tonna A, Peters M. Partnerships to promote mental health of NSW farmers – the New South Wales farmers blueprint for mental health. Australian Journal of Rural Health 2008; 16: 170–175. Fragar L, Stain H, Perkins D et al. Distress among rural residents – does employment and occupation make a difference? Australian Journal of Rural Health 2010; 18: 25– 31. Australian Government Department of Health and Ageing. Strategic Review of Health and Medical Research, 2013.
© 2015 National Rural Health Alliance Inc.
