Ageing for Health A Australians Rural - University of · PDF filelarge aggregate data set reports. –The majority of rural research begins with the implicit assumption of the uniqueness

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Ageing for

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Dr Peter Orpin

University Department of Rural Health

U N I V E R S I T Y O F T A S M A N I A

www.utas.edu.au/ruralhealth 2

Rural Ageing?

• Conceptualizing rural: How much sense

does it make to talk of ‘rural ageing’?

• What do we know about the rural

context that might differentially impact

the experience of ageing?

• Are we hearing the voice of rural older

people; and what does it say?

Some Qualifications

3

• Remote: a distinct case and experience that I

am not qualified to address

• Rural- Regional: combined under rural because

it is not a useful distinction to make in this

context

• Rural – Urban Comparison

– Limited research involving a direct rural–urban

comparison – mostly as broad analytical variables in

large aggregate data set reports.

– The majority of rural research begins with the implicit

assumption of the uniqueness of the rural

experience – descriptive rather than comparative

– Limitations of rurality classifications

Issues for rural aged research

• Lack of clarity around definitions of rural

• Tendency to over-generalise rural – lump together

otherwise disparate studies

• Overemphasis of rural-urban difference – ignore

similarities and other more powerfully discriminate

variables

• Absence of qualitative research

• Failure to acknowledge change

Scharf, T. (2001). "Ageing and intergenerational relationships in rural Germany." Ageing

and Society 21(5): 547-566.


Conceptualising Rural

• Formal Classification – basically service access

measures – spatial, geographical:

– Rural, Remote and Metropolitan Area Classification [RRMA]

• Population size, geographical distance

• From 1 – Capital city to 7 – Other Remote

– Accessibility/Remoteness Index of Australia [ARIA]

• ‘Unambiguously geographic’

• Distance to service centres classified according to size

• Highly Accessible (0-1.84) to Very Remote (.9.08-12]

– Australian Standard Geographical Classification – Remoteness

Area [ASGC-RA]

• Basically updated ARIA

• Relationally linked to ABS census data for updating.


Conceptualising Rural – ASGC - RA

• Strengths:

– Robust measure of (physical distance) access to services and

facilities – a framework for resource allocation.

– Responsive to numerical population shifts – census updates

• Limitations

– Takes no account of social, cultural, economic and

demographic profile changes

– Takes no account of technological change – in particular those

affecting the relationship between time and distance

• IT

• Transport

• Personal Mobility

– Contains anomalies

– Major City Classification [RA1] encompasses the bulk of the

Australian population – glosses over huge disparity


Conceptualising Rural – Popular Narrative

• Adversarially framed – versus urban

• Inequality – what urban has got

– Ease of living cp. struggle – nature, markets, urban centric and

disinterest

– Community social capital:

• Services, facilities, infrastructure – health, education, retail - choice

• Economic resources

• Health

• Demographic age spread – the young

– Personal social capital – education, income

• Superiority – what urban is not

– Community ‘close knit’, safety

– ‘Real’

– Backbone – life sustaining, wealth generation

– Environment

– Resilience, self-sufficiency 7

What do we know about rural that might

impact on rural ageing? – Disadvantages

• Baseline health – statistically poorer than urban

(AIHW)

– More and more disabling chronic disease

– Engage in more risky health behaviours –

occupational and recreational

– Utilise less primary health care services

– Die younger – misadventure, acute and end-stage

chronic

• Demography

– Older, and ageing faster

– Missing ‘middle’ demographic – young and early

middle-age


Disadvantages?

• Resources

– Socio-economic – fewer economic resources –

income, housing, equity

– Formal Social Capital - Lower levels of

secondary and post-secondary education and

credentialled occupational skills

– Technology – lag behind urban in take-up and

skills development around emerging technologies

9

Disadvantage?

• Distance, mobility and access – more limited choice

and more difficult access to:

– Services and infrastructure

– Socialisation, transport/mobility, occupational and recreational

opportunities all constrained by distance and economies of

scale

– Aged Care Provision: viability and sustainability constrained by

high costs (establishment and running) and staffing difficulties

– Lessening of choice partly driven, and largely addressed by IT

development – compound problem for those low in take-up and

familiarity

– Note: The degree to which choice and access are issues

depends very much on individual resources and expectations.


What do we know about rural that might

impact on rural ageing? – Advantages?

Note: the majority of these:

• Are strongly and popularly held perceptions

• Lack sound empirical evidence – difficult to measure

with rigour

• Can be a ‘two-edged’ sword depending on the

relationship between:

– The individual – social and cognitive traits, history;

– The time – rapid change;

– The place; and,

– The issue.

Much of the following draws on our own research listening

to the voice of older rural people


Advantages? - Community

• Inclusion/belonging [Exclusion]

– Strongly felt and pivotal to ageing well

– Takes time (multi-generational?) to develop real depth

– Lived versus imagined/constructed belonging

• Support

– Strong – if you fit

– Dominated by family

– Threatened by out-migration

– Reluctant help-seekers - importance of independence, personal

space and reciprocity

– Risks associated with lack of privacy and stigma

– Strong normative pressure – transgression brings exclusion

• Safety

– Largely perception but that is what matters.

• Lived versus imagined/constructed community - incomers 12

Advantages? – Social and Cultural Resources

• Networks and Engagement

– Critical to ageing well

– Threatened by increasing incapacity, role and licence loss, out-

migration, changing occupational and gender roles

– Critical factor match with perceptions and expectations not size of

network

– Voluntary and functional network consolidation (socio-emotional

selectivity) with decreasing capacity and energy

– Concern for incomers

• Resilience (self-sufficiency, stoicism)

– ‘Just get on with it’ ‘Make the best of what you have’

– Cohort rather than (purely) rural effect? – ‘proved in the fire’

– Flipside - fatalism and reluctant help-seeking

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Advantages? – Environment

• Healthy/Unhealthy

– Environmental amenity – aesthetic, recreational, ‘clean, green’

– Physical exertion

– Food production

– Pesticides and chemicals

– Stress – droughts, fires, making ends meet

• Safety and Freedom

– Perceptions of safety – visibility, ‘looking out for’, traffic.

– Hazardous – poorly formed footpaths, inadequate lighting, out-

dated infrastructure

– Dangers for cognitively impaired


Rural Change

• Popular narrative of decline and widening urban-rural

disparity

• Research suggests:

– Increasing diversity, greater spread within urban-remote continuum

– A limited number of rural communities in economic and population

decline or at significant risk

• Higher RA index

• Heavily reliant on a single industry – e.g. agriculture, mining, manufacture

• Low amenity

– Many rural communities showing economic, social and population

growth

• Especially coastal and peri-urban (commuting and short trip tourism)

• High amenity – townscapes, landscapes, recreational, cultural/historical

• Regional hubs

• Diversified industry including tourism and niche agriculture

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Rural Change – Counter-urbanisation/Incomers

• Sea’ and ‘Tree’ changers

• Commuters – limit on local embedment

• Economic refugees

• Driving rural change – cultural churn

– First two with greater resources – economic, educational, mobility,

agency

– Estimated numbers vary widely and distribution uneven but high

impact on destination areas

– Commodification of rurality and rural culture – elite consumption and

cost structures

– Community activism – reconstructing community

– Blurring the urban-rural boundaries

– Doubtful ‘embeddedness’


Rural Change – Impact on Ageing

The ‘two speed’ community

• Long term older rural residents:

– Lack of economic and educational resources balanced by:

• Deep local networks (esp. family), sense of belonging and supports - but

eroding

• Undemanding stoicism and self-reliance – reluctant help-seeking

– Challenges (apart from ageing itself):

• Eroding connections and support bases (esp. family) and familiar forms

and norms

• Difficulties maintaining traditional community organisations

• Incomers

– More resources (educational, financial cultural) and greater agency –

increasing choice

– More mobile and flexible but lack of deep local support bases, esp.

family

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The Collective Voice

• The Collective ‘Rural’ Voice

– Generally appears as a separate category in the large data sets and

reports (AIHW, ABS, Productivity Commission)

– Well represented in the political and policy discourse and practice

– Consistent message/persistent issues – inequality, choice, access,

distance

• The Collective ‘older person’s’ voice

– Lobbying voice becoming louder

– Danger of becoming categorised as a problem

– Limited discourse around the experience of ageing

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The voice of the older rural person

Major evidence gaps

• The voice of the individual older person

– Major silence in the literature

– Ageing as an individual experience requiring a flexibly

individualised holistic response – absence of individual voice

hides tensions within broad, inflexible, siloed policy settings

• Lack of formal small area and local data, especially

change oriented forward planning data

• Growing diversity, variations across environmental-

resource ‘fit’, and cultural churn, bring into question the

utility of broad categorisation, including rural – at least

without supplementation and qualification from small

area, local and individual understanding


Rural: A good place to grow old?

Yes! - and - No!

Depends:

– Where you are

– Who you are

– What your expectations are

– What challenges you face

– What resources you bring to meeting

those challenges.


References

Australian Bureau of Statistics (2011). Regional Population Growth, Australia, 2009-10 3218.0. Canberra, Australian

Bureau of Statistics.

Australian Institute of Health & Welfare (2007). Older Australia at a glance 4th Edition Cat. no. AGE 52. Canberra,

Australian Institute of Health and Welfare.

Australian Institute of Health & Welfare (2008). Rural, regional and remote health: Indicators of health status and

determinants of health. Canberra, Australian Institute of Health and Welfare.

Australian Institute of Health & Welfare (2008). Rural, regional and remote health: Indicators of health system

performance. Canberra, Australian Institute of Health and Welfare.

Australian Institute of Health & Welfare (2011). Australian health expenditure by remoteness. A comparison of

remote, regional and city health expenditures. Health and Welfare Expenditure Series. Canberra, Australian Institute

of Health and Welfare. 50.

Australian Local Government Association (2001). This is as good as it gets - 2001 State of the Regions Report.

Canberra, Australian Local Government Association.

Baum, S., K. O’Connor, et al. (2005). "Commentary says the bush is in bad shape: Is that really the case?" Fault

Lines Exposed 1(1): 06.01-06.39.

Baum, S., K. O’Connor, et al. (2005). "Mining, tourism, sea-changers and agriculture." Fault Lines Exposed 1(1):

04.01-04.30.

Carstensen, L. L. (1992). "Social and emotional patterns in adulthood: support for socioemotional selectivity theory."

Psychol Aging 7(3): 331-338.

Curry, G. N., G. Koczberski, et al. (2001). "Cashing Out, Cashing In: Rural change on the south coast of Western

Australia." Australian Geographer 32(1): 109-124.

Hamilton, C. and E. Mail (2003). "Downshifting in Australia." A sea-change in the pursuit of happiness.

Ragusa, A. T. (2010). "Country landscapes, private dreams? Tree change and the dissolution of rural Australia."

Rural Society 20(s): 137-150.

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Documents

Ageing for Health A Australians Rural - University of · PDF filelarge aggregate data set reports. –The majority of rural research begins with the implicit assumption of the uniqueness