12 February 2020

I acknowledge the traditional owners of the Canberra area, the Ngunnawal and Ngambri peoples, and pay my respects to their elders past, present and emerging.

As we do that, we should be honest as we were in the Parliament this morning that we are not on track to meet our national target to Close the Gap in Indigenous life expectancy. In fact, this years Closing the Gap report includes the alarming finding that we are actually going backwards on Indigenous cancer mortality, which is one of the two leading killers of Indigenous Australians.

And so we must recommit ourselves to the urgent national task of Closing the Gap. Given that Indigenous life expectancy is around six years less in remote areas than in cities, you will play an important part in that as you already do.

I also acknowledge the Deputy Prime Minister, Minister Hunt and other colleagues who are with us today.

But most importantly, I acknowledge the rural doctors whove travelled from around Australia, including Rural Doctors Association President Dr John Hall. Regional and rural health disparities have been a focus of mine in my time as Shadow Health Minister, and will remain one of our most important health priorities in the lead up to the next election and beyond so its good to be with you.

I particularly want to mention the work that some of you, and many of your peers, have done in bushfire-affected areas over the summer.

Weve heard story after story about doctors going above and beyond to serve their communities.

But weve also heard, loud and clear, frustration from doctors whove wanted to do more but havent been allowed to do so due to red tape.

Im very supportive of the proposals you have put to the Government to address this.

First, to ensure that GPs are integrated into local disaster responses. You point out that while this has happened in some areas this summer, its been patchy.

Mandating the inclusion of GPs in state and local disaster management plans strikes me as a sensible step to make the most of our medical workforce when disaster strikes.

And second, to establish a national register of qualified doctors who can be deployed to disaster areas.

Again, this has happened in an ad hoc way this summer, and I acknowledge the work of some Rural Workforce Agencies and Primary Health Networks.

But climate change means that bushfires and other natural disasters will get worse, not better.
A consistent national approach to deploying the best possible doctors is the least we can do.
And so I say to the Minister today: these proposals have Labors full support, and I hope and expect to work with the Government on them.

But of course, rural health challenges didnt begin with this summers bushfires, and they wont end with the current floods.

When I spoke at your conference on the Gold Coast a couple of months ago, I highlighted the ultimate rural health inequality lower life expectancy.

Around Australia, life expectancy falls as remoteness increases.

Its 82 years in our cities, around 80 in our regions, 76 in remote areas, and just 67 in very remote areas.

Put bluntly, people in regional, rural and remote Australia die up to 15 years earlier on average.
We tend to think of poor service provision as the cause of that disparity. Of course thats true to an extent, and Ill come to it in a moment.

But service provision only responds to the flow-on effects of poorer health outcomes in the first place.

Education and employment rates are lower in the bush sometimes much lower.

Social determinants like those contribute to the much higher prevalence of risk factors that we see in the bush.

People in rural and remote Australia are 13 per cent more likely to be inactive. Theyre 50 per cent more likely to drink at risky levels. And theyre 69 per cent more likely to smoke.

And so its no surprise that the overall burden of disease is 10 per cent higher in regional areas, 30 per cent higher in rural areas and a staggering 70 per cent higher in remote Australia.

Ive been calling for stronger national action on the social determinants of health, and on preventive health, throughout my time in the portfolio, and will continue to do so.

Theres nowhere where that is more important than in rural Australia.

Turning to service provision I dont need to tell anyone in this room about the maldistribution of our medical workforce, and the way that contributes to the health divide between cities and the bush.

As a country weve known about that problem for a long time. Disturbingly, there are warning signs it could get worse.

Im very concerned that the GP rural training program has been undersubscribed for successive years.

You have also highlighted the closure of rural hospital services, and in some cases rural hospitals themselves.

Now, to give credit where its due, the Government is seeking to address many of these issues in its Stronger Rural Health Strategy.

Labor has supported most of that Strategy, including in the Parliament. While we do not agree with everything in the Strategy, we have given it bipartisan support wherever possible.

But your President John Hall describes the state of play in this way:

The Morrison Government has so far done a decent job of identifying and developing programs that will help build the pipeline of doctors But these programs are under-resourced, and simply need more money and renewed focus to get them out of the starting blocks. The clock is ticking.

So its clear we need to do more.

And I think there are two immediate opportunities in front of us today.

The first is to finally implement the National Rural Generalist Pathway.

I very much welcome the Governments confirmation today that the 100 places announced in the 2019 Budget will be allocated to the College of Rural and Remote Medicine, ACRRM.

Frankly the timelines here are tight, because that first intake is due to commence next year, and needs to be enrolled in the coming months.

Its critical that those deadlines not be missed.

And its also critical that there be secure ongoing funding for the Pathway.

We very much welcome the Governments initial investment to establish the Pathway.

And we welcome todays announcement of a trial of a single employer model in the Murrumbidgee PHN. A single employer model will be one important enabler of the Pathway.

But we also agree with the Association that the continuation of the Pathway should not depend on the annual Budget process. Certainty of both funding and policy is needed.

The second opportunity is the return of general practice training to the College of Rural and Remote Medicine, and the College of GPs.

Again, Labor welcomes this change. Its an opportunity to address the looming national shortage of GPs, and particularly the shortages in rural areas.