What do changes to education policy have to do with access to health care in the bush? In the following piece Gordon Gregory, Executive Director and Alice Sisley, Project Officer, from the National Rural Health Alliance (NRHA) connect the dots between economic and health policies and warn that recent changes in the education sector could have a detrimental impact on the health of rural communities.
This is Part 2 of a series of articles on current rural health issues from the NRHA. Part 1, on the NRHA’s annual rural ‘Councilfest’, can be read here. Part 3 will focus on the introduction of primary healthcare networks and their impact on rural communities, and will be published at Croakey shortly.
Readers might also be interested in the recent Wonky Health column by Dr Tim Senior on the broader impact of deregulation of higher education on the health sector.
Gordon and Alice write:
Some of the provisions of the Higher Education and Research Reform Amendment Bill 2014 appear likely to have a deleterious effect on regional universities and on access to tertiary education for students from rural and remote areas. If this were to be the case it would be a major setback for educational access and equity, and ultimately another barrier to national efforts to provide a fair proportion of professionals (including health practitioners) to rural areas.
People in rural and remote areas are already disadvantaged when it comes to access to education. Although more likely to participate in vocational education, they are less likely than city people to complete high school and less likely to commence tertiary studies.
In 2011, 81 per cent of 16-year-olds in the major cities were in full-time secondary education, compared with 74 per cent of those in outer regional areas and 65 per cent of those in remote areas. In 2012, over 35 per cent of school leavers in the major cities participated in higher education, compared with 16 per cent in outer regional areas and just 12 per cent in remote areas.
As a result of these numbers, there is a significant gap in educational attainment between the people of the major cities and of rural Australia. In 2011 31 per cent of people aged 25-64 living in major cities held a Bachelor degree or above. The figure was 18 per cent in Inner regional areas, 15 per cent in Outer regional areas and 12 per cent for Very remote areas.
Furthermore, the Australian Council for Educational Research (ACER) reports that young people in rural and regional Australia are less likely to aspire to a higher education than those in metropolitan areas. Sixty-three per cent of young people in metropolitan areas intended to enrol in higher education, compared with 39 per cent in regional and 32 per cent in remote areas.
A significant barrier to university participation by people from rural areas is the additional cost involved. Only 12 per cent of tertiary education is provided in rural and regional areas, and over half of the rural and remote students undertaking tertiary study have to live away from home. Despite their lower incomes on average, rural families have to pay some $25,0001 a year extra for a child to relocate to attend university or TAFE education. This is on top of the standard university fees charged.
To ensure that students from rural and remote communities are not disadvantaged, there are two main options: for the public purse to defray the higher costs for them of attending institutions (universities, TAFEs) in the major cities; and/or supporting the development and capacity of institutions in regional centres.
Regional universities provide access to tertiary education relatively close at hand for people living in rural and remote areas. The training they provide has particular relevance for rural areas because of its setting. The current shortages of professionals in rural and remote areas, including health professionals, could be eased by raising Year 12 completion levels in non-metropolitan areas, and by positive discrimination to assist rural students gain access to university and TAFE courses.
Universities in regional centres play a critical role in providing a pipeline for students from rural areas to go through all stages of education and training until they end up practising back in rural areas. Regional universities have a key role to play in helping to achieve equity of access to university education.
They are also critical parts of the regional employment and social infrastructure, widening the employment base of communities, developing the skills base of regions through training, partnerships and professional development and providing centres of regionally-based research directed to rural and regional economies which are critical to development of the local community.
For all of these reasons it is important that regional universities are not disadvantaged by the changes to the Higher Education legislation. Many of the second reading speeches in the Lower House alluded to various ways in which regional universities would be set back, compared with the group of eight, by the provisions in the Bill. They have a higher proportion of students from low-income families and much higher proportion from rural and regional areas than the universities in the capital cities. If the universities increase their fees to make up for the cuts in government funding, people from rural areas will be less able to afford the costs of the degree due to their low income and, in particular, less able to compete for places in the group of eight universities given both the fee structure and the cost of establishing a second home in the city.
Whatever arrangements are agreed for student fees, the provisions currently in place to maintain quota systems to ensure a fairer representation of rural students in health professional courses and additional support for Aboriginal and Torres Strait Islander health students must be preserved.
The proposal to charge interest on the HECS loan at the long-term bond rate will be regressive – penalising those who fail to secure high wages quickly after graduation. Under the proposed reforms, if someone takes time out of the labour market, their debt will grow at six per cent while their wage could be expected to grow at 3-4 per cent. These changes would have a disproportionate impact on women, because many of them will choose to take time out from their paid jobs to start a family.
Faced with escalating fees and longer periods of debt, many students will be reluctant to undertake courses that do not have clear pathways to high remuneration, jeopardising the provision of safe, competent health services.
For example, most students who graduate with medical degrees in Australia will have been at university for at least seven years before full-time employment. The lowering of the Higher Education Loan Program (HELP) debt repayment threshold to $50,638 per year, and starting their working lives with a large debt, may well lead medical graduates to put remuneration before their vocation and job satisfaction when it comes to choosing a specialty and a setting for their work. There is already a serious mal-distribution of GPs in Australia and it is concerning that the increased cost of a medical degree could mean that recruiting GPs to rural and remote communities may well become even more difficult.
The new proposal for Commonwealth Scholarships, which provide support for students who are disadvantaged by location and/or socio-economic status, would favour universities that can charge the highest fees rather than the universities with the largest number of disadvantaged students.
However improved access for rural people to tertiary education begins with primary and secondary schooling. Scholarships for tertiary study will do nothing to help individuals who have not succeeded through Year 12. Investing in school education is the fairest and surest way to have greater participation in higher education of people from groups that are currently disadvantaged.
The Alliance is concerned that there appears to be little recognition of the differential effect that the proposed measures in the Bill are likely to have on students in rural and remote areas, nor of the impact of the changes on the supply of health (and other) professionals to remote communities.
Regional universities are critical parts of the social fabric of rural and regional communities and their students play an important part as mentors for younger local students. Coupled with the proposed changes in fees and student payments, the potential adverse effects of some of the Bill’s provisions on the vitality and sustainability of regional universities are a matter of great concern.
1 Charles Sturt University. Submission to the inquiry into Rural and Regional Access to Secondary and Tertiary Education Opportunities. August 2009