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Rethinking Rural Health Ethics pp 139–160Cite as

The Big Picture: Ethics, Health Policy, Health Systems and Rural Health Care

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Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 72))

Abstract

This chapter demonstrates the value of macro level analysis for rural health ethics and rural health care. We draw together several different strands of discussion about the design and delivery of health care in rural settings, and incorporate the values of place, community and relationships, to help illustrate the ways in which both the deficit perspective and idealisations of rurality may influence health policy decisions. As part of this analysis, we also critically engage with neo-liberalism as a pervasive element in these decisions. The chapter concludes with a macro level analysis of the recruitment and retention of health providers in rural settings to illustrate the relevance of this approach for rural health ethics.

The choices each country makes with respect to health policy reflect the extent to which it is a just and caring society (Shah 1998, 283).

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References

  • Abelson, J., F. Miller, and M. Giacomini. 2009. What does it mean to trust a health system? A qualitative study of Canadian health care values. Health Policy 91 (1): 63–70.

    Article  Google Scholar 

  • Asthana, S., A. Gibson, G. Moon, et al. 2003. Allocating resources for health and social care: The significance of rurality. Health and Social Care in the Community 11 (6): 486–493.

    Article  Google Scholar 

  • Australian Commission on Safety and Quality in Healthcare. 2012. Small rural and remote hospital issues with implementing the national safety and quality health service standards project: Final report. Sydney: Australian Commission on Safety and Quality in Healthcare.

    Google Scholar 

  • Ayres, J. 1994. 1993 Le Tourneau Award: The use and abuse of medical practice guidelines. Journal of Legal Medicine 15 (3): 421–443.

    Article  Google Scholar 

  • Barnett, R., and P. Barnett. 2003. “If you want to sit on your butts you’ll get nothing!” Community activism in response to threats of rural hospital closure in southern New Zealand. Health and Place 9 (2): 59–71.

    Article  Google Scholar 

  • Bell, A., F. McDonald, and T. Hobson. 2016. The ethical imperative to move to a seven-day care model. Journal of Bioethical Inquiry 13 (2): 251–260.

    Article  Google Scholar 

  • Blackstock, K., A. Innes, S. Cox, et al. 2006. Living with dementia in rural and remote Scotland: Diverse experiences of people with dementia and their carers. Journal of Rural Studies 22 (2): 161–176.

    Article  Google Scholar 

  • Buykx, P., J. Humphreys, J. Wakerman, et al. 2010. Systematic review of effective retention incentives for health workers in rural and remote areas: Towards evidence-based policy. Australian Journal of Rural Health 18 (3): 102–109.

    Article  Google Scholar 

  • Callahan, D. 2002. Ends and means: The goals of health care. In Ethical dimensions of health policy, ed. M. Danis, C. Clancy, and L. Churchill, 3–18. New York: Oxford University Press.

    Google Scholar 

  • Canadian Rural Revitalization Foundation. 2015. State of rural Canada report, ed. S. Markey, S. Breen, A. Lauzon, L. Ryser, and R. Mealy. http://sorc.crrf.ca. Accessed 15 Mar 2017.

  • Castleden, H., V. Crooks, N. Schuurman, et al. 2010. “It’s not necessarily the distance on the map …”: Using place as an analytic tool to elucidate geographic issues central to rural palliative care. Health and Place 16 (2): 284–290.

    Article  Google Scholar 

  • Charles, C., and S. DeMaio. 1993. Lay participation in health care decision making: A conceptual framework. Journal of Health Politics, Policy and Law 18 (4): 881–904.

    Article  Google Scholar 

  • Cook, A.F., and H. Hoas. 2000. Where the rubber hits the road: Implications for organizational and clinical ethics in rural healthcare settings. HEC Forum 12 (4): 331–340.

    Article  Google Scholar 

  • Crooks, V., H. Castleden, N. Hanlon, et al. 2011. “Heated political dynamics exist…”: Examining the politics of palliative care in rural British Columbia, Canada. Palliative Medicine 25 (1): 26–35.

    Article  Google Scholar 

  • Daniels, N. 1996. Justice, fair procedures and the goals of medicine. Hastings Center Report 26 (6): 10–12.

    Article  Google Scholar 

  • Daniels, N., B. Kennedy, and I. Kawachi. 2002. Justice, health, and health policy. In Ethical dimensions of health policy, ed. M. Danis, C. Clancy, and L. Churchill, 19–47. New York: Oxford University Press.

    Google Scholar 

  • Danis, M. 2008. The ethics of allocating resources toward rural health and health care. In Ethical issues in rural health care, ed. C. Klugman and P. Dalinis, 71–98. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Elsom, S., B. Happell, and E. Manias. 2009. Nurse practitioners and medical practice: Opposing forces or complementary contributions? Perspectives in Psychiatric Care 45 (1): 9–16.

    Article  Google Scholar 

  • Farmer, J., L. Philip, G. King, et al. 2010. Territorial tensions misaligned management and community perspectives on health services for older people in rural and remote areas. Health & Place 16 (2): 275–283.

    Article  Google Scholar 

  • Florin, D., and J. Dixon. 2004. Public involvement in health care. British Medical Journal 328 (7432): 159–161.

    Article  Google Scholar 

  • Gutmann, A., and D. Thompson. 2002. Just deliberation about health care. In Ethical dimensions of health policy, ed. M. Danis, C. Clancy, and L. Churchill, 77–94. New York: Oxford University Press.

    Google Scholar 

  • Hanlon, N., and M. Rosenberg. 1998. Not so new public management and the denial of geography: Ontario health care reform in the 1990s. Environment and Planning. C, Government & Policy 16 (5): 559–572.

    Article  Google Scholar 

  • Haraway, D. 1988. Situated knowledges: The science question in feminism and the privilege of partial perspective. Feminist Studies 14 (3): 575–599.

    Article  Google Scholar 

  • Hardwig, J. 2006. Rural health care ethics: What assumptions and attitudes should drive the research? American Journal of Bioethics 6 (2): 53–54.

    Article  Google Scholar 

  • Humphreys, J., J. Wakerman, D. Pashen, et al. 2010. Retention strategies and incentives for health workers in rural and remote areas: What works? Canberra: Australian Primary Health Care Research Institute.

    Google Scholar 

  • Hussain, R., M. Maple, S. Hunter, et al. 2015. Fly-in-fly-out and drive-in-drive-out model of health care service provision for rural and remote Australia: Benefits and disadvantages. Rural and Remote Health 15: 3068.

    Google Scholar 

  • Institute of Medicine. 2012. The role of telehealth in an evolving health care environment: Workshop summary. Washington, DC: National Academies Press.

    Google Scholar 

  • Institute of Medicine Committee on the Future of Rural Health Care. 2005. Quality through collaboration: The future of rural health care. Washington, DC: National Academies Press.

    Google Scholar 

  • Kawachi, I., S.V. Subramanian, and N. Almeida-Filho. 2002. A glossary for health inequalities. Journal of Epidemiology Community Health 56 (9): 647–652.

    Article  Google Scholar 

  • Kearns, R., and A. Joseph. 1997. Restructuring health and rural communities in New Zealand. Progress in Human Geography 21 (1): 18–32.

    Article  Google Scholar 

  • Kenny, N. 2002. What good is health care? Reflections on the Canadian experience. Ottawa: CHA Press.

    Google Scholar 

  • Kenny, N., and M. Giacomini. 2005. Wanted: A new ethics field for health policy analysis. Health Care Analysis 13 (4): 247–260.

    Article  Google Scholar 

  • Kingdon, J. 2002. The reality of policy making. In Ethical dimensions of health policy, ed. M. Danis, C. Clancy, and L. Churchill, 97–116. New York: Oxford University Press.

    Google Scholar 

  • Lahey, W. 2011. Medicare and the law: Contours of an evolving relationship. In Canadian health law and policy, ed. J. Downie, T. Caulfield, and C. Flood, 3rd ed., 1–67. Markham: LexisNexis Canada.

    Google Scholar 

  • Laurence, C., V. Williamson, K. Sumner, et al. 2010. “Latte rural”: The tangible and intangible factors important in the choice of a rural practice by recent GP graduates. Rural and Remote Health 10: 13–16. www.rrh.org.au. Accessed online 17 Nov 2011.

  • MacLellan, L., I. Higgins, and T. Levett-Jones. 2015. Medical acceptance of the nurse practitioner role in Australia: A decade on. Journal of the American Association of Nurse Practitioners 27 (3): 152–159.

    Article  Google Scholar 

  • Mahowald, M. 1996. On treatment of myopia: Feminism, standpoint theory and bioethics. In Feminism & bioethics beyond reproduction, ed. S. Wolf, 95–115. Oxford: Oxford University Press.

    Google Scholar 

  • Malone, R. 1999. Policy as product: Morality and metaphor in health policy discourse. Hastings Center Report 29 (3): 16–22.

    Article  Google Scholar 

  • Martin, D., J. Gibson, and P. Singer. 2008. Priority setting. In The Cambridge textbook of bioethics, ed. P. Singer and A. Viens, 251–256. Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • McDonald, F., and C. Simpson. 2013. Challenges for rural communities in recruiting and retaining physicians: A fictional tale helps examine the issues. Canadian Family Physician 59 (9): 915–917.

    Google Scholar 

  • McGregor, S. 2001. Neoliberalism and health care. International Journal of Consumer Studies 25 (2): 82–89.

    Article  Google Scholar 

  • Mechanic, D. 1996. Changing medical organization and the erosion of trust. Milbank Quarterly 74 (2): 171–189.

    Article  Google Scholar 

  • Ministry of Health. 2014. The guide to he korowai oranga: Māori health strategy. Wellington: Ministry of Health.

    Google Scholar 

  • Ministry of Health British Columbia. 2015. Rural health services in BC: A policy framework to provide a system of quality of care. Vancouver: Ministry of Health British Columbia.

    Google Scholar 

  • Nelson, W., and J. Schmidek. 2008. Rural healthcare ethics. In The Cambridge textbook of bioethics, ed. P. Singer and A. Viens, 289–298. Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Nelson, W., G. Lushkov, A. Pomeranz, et al. 2006. Rural health care ethics: Is there a literature? American Journal of Bioethics 6 (2): 44–50.

    Article  Google Scholar 

  • Niemira, D. 2008. Ethical dimensions of the quality of rural health care. In Ethical issues in rural health care, ed. C. Klugman and P. Dalinis, 119–131. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • OECD. 2015. OECD reviews of health care quality: Australia 2015: Raising standards. Paris: OECD Publishing.

    Google Scholar 

  • Panelli, R., L. Gallagher, and R. Kearns. 2006. Access to rural health services: Research as community action and policy critique. Social Science and Medicine 62 (5): 1103–1114.

    Article  Google Scholar 

  • Pesut, B., J. Bottorff, and C. Robinson. 2011. Be known, be available, be mutual; A qualitative ethical analysis of social values in rural palliative care. BMC Medical Ethics 12 (19): 1–11.

    Google Scholar 

  • Phillips, R., and J. Margolis. 1999. Toward an ethics of organizations. Business Ethics Quarterly 9 (4): 619–638.

    Article  Google Scholar 

  • Pugh, R. 2007. Dual relationships: Personal and professional boundaries in rural social work. British Journal of Social Work 37: 1405–1423.

    Article  Google Scholar 

  • Pugh, R., and B. Cheers. 2010. Rural social work: An international perspective. Bristol: Policy Press.

    Google Scholar 

  • Queensland Health. 2014. Queensland remote and rural services framework. https://publications.qld.gov.au/storage/f/2014-06-06T00%3A38%3A43.498Z/rural-remote-service-framework.pdf. Accessed 10 Jan 2014.

  • Rawls, J. 1971. A theory of justice. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Roberts, M., J. Hsiao, P. Berman, et al. 2004. Getting health reform right: A guide to improving performance and equity. New York: Oxford University Press.

    Google Scholar 

  • Romanow, R. 2002. Building on values: The future of health care in Canada. Final report. Ottawa: Commission on the Future of Health Care in Canada.

    Google Scholar 

  • Rural Health Services Review Committee. 2015. Rural health services review: Final report. Edmonton: Government of Alberta.

    Google Scholar 

  • Rushing, W. 1975. Community, physicians and inequality: A sociological study of the maldistribution of physicians. Lexington: D.C. Heath and Company.

    Google Scholar 

  • Scott, A., A. Gilbert, and A. Gelan. 2007. Socio-economic research group policy brief No 2. In The urban-rural divide: Myth or reality? Aberdeen: The Macaulay Institute.

    Google Scholar 

  • Shah, C.P. 1998. Public health and preventive medicine in Canada. Toronto: University of Toronto Press.

    Google Scholar 

  • Simpson, C., and F. McDonald. 2011. ‘Any body is better than nobody?’ Ethical questions around recruiting and/or retaining health professionals in rural areas. Rural and Remote Health 11: 1867. Accessed 3 Mar 2016.

    Google Scholar 

  • Standing Council on Health. 2011. National strategic framework for rural and remote health. Canberra: Department of Health.

    Google Scholar 

  • Toussaint, S., and D. Mak. 2010. “Even if we get one back here, it’s worth it …”: Evaluation of an Australian remote area health placement program. Rural and Remote Health 10: 1546. Accessed 3 Mar 2016.

    Google Scholar 

  • Townsend, T. 2009. Ethics conflicts in rural communities: Privacy and confidentiality. In Handbook for rural health care ethics: A practical guide for professionals, ed. W. Nelson, 126–141. Hanover: Dartmouth College.

    Google Scholar 

  • Upshur, R. 2008. Introduction. In The Cambridge textbook of bioethics, ed. P. Singer and A. Viens, 241–242. Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Wakerman, J., and J. Humphreys. 2011. Sustainable primary health care services in rural and remote areas: Innovation and evidence. Australian Journal of Rural Health 19 (3): 118–124.

    Article  Google Scholar 

  • ———. 2012. Sustainable workforce and sustainable health systems for rural and remote Australia. Medical Journal of Australia Open 1 (Suppl 3): 14–17.

    Article  Google Scholar 

  • Walker, B., D. Porter, and I. Marsh. 2012. Fixing the Hole in Australia’s Heartland: How Government needs to work in remote Australia. Alice Springs: Desert Knowledge Australia.

    Google Scholar 

  • Welsh Assembly Government. 2009. Rural health plan: Improving integrated service delivery across Wales. Cardiff: Welsh Assembly Government.

    Google Scholar 

  • Winghofer, E., P. Timony, and N. Gauthier. 2014. “Rural” doesn’t mean “uniform”: Northern vs Southern rural family physicians’ workload and practice structures in Ontario. Rural and Remote Health 14: 2720. Accessed 6 Feb 2016.

    Google Scholar 

  • World Health Organization. 2010a. Increasing access to health workers in remote and rural areas through improved retention: Global policy recommendations. Geneva: WHO.

    Google Scholar 

  • ———. 2010b. Telemedicine: Opportunities and developments in member states. Geneva: WHO.

    Google Scholar 

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Authors and Affiliations

  1. Department of Bioethics, Dalhousie University, Halifax, NS, Canada

    Christy Simpson & Fiona McDonald

  2. Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia

    Christy Simpson & Fiona McDonald

Authors
  1. Christy Simpson
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  2. Fiona McDonald
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Simpson, C., McDonald, F. (2017). The Big Picture: Ethics, Health Policy, Health Systems and Rural Health Care. In: Rethinking Rural Health Ethics. International Library of Ethics, Law, and the New Medicine, vol 72. Springer, Cham. https://doi.org/10.1007/978-3-319-60811-2_9

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