Have a heart

16 September 2013

Rural folk not to blame for cardio disease, says James Dunbar.

New research has found that rural people may be unfairly blamed for contributing to their high rates of cardiovascular disease.

The research by the Greater Green Triangle University Department of Rural Health has found that social and economic factors have a powerful influence on cardiovascular outcomes, regardless of where people live.

It found families with low incomes and living in areas of poor infrastructure and relatively poor access to health services have higher rates of cardiovascular disease.

The findings cast doubt on long-held views that the unhealthy behaviours of rural people contribute to their high rates of cardiovascular disease.

The `Comparison of Australian rural and metropolitan cardiovascular risk and mortality: the Greater Green Triangle and North West Adelaide Population Surveys.’ have been published in the British Medical Journal this week and could have profound policy implications.

GGT UDRH Director and contributing researcher, Professor James Dunbar, said there are significant health inequalities between rural and metropolitan residents of Australia.  Death rates are about 10 per cent higher among people who live outside of major cities.  

Professor Dunbar said the geographical disparities were well known, but for a full understanding of complex relationships between causes and effects, attention also needs to be paid to socio-economic status.

“Our study demonstrates that rurality does not automatically equate to worse cardiovascular risk or outcomes,” Professor Dunbar said. “The myth that rural people exercise less, drink more alcohol and are fatter and less healthy and therefore contribute to their poorer health outcomes has been perpetuated because until now statistics have not been categorised by socio-economic status.”

The study compared important measures of physical and biomedical risk between a rural population (Greater Green Triangle in south-west Victoria and south-east South Australia) and an urban population (north-west Adelaide) and was conducted in conjunction with Population Research and Outcome Studies, University of Adelaide.  

It included physical waist, hip and blood pressure measurements, and blood tests for cholesterol and blood sugar levels.

“This gives us much more accurate information compared with the more common approach of using self-report information,” Professor Dunbar said.  

The study found that despite the geographical differences of the two populations, measures of cardiovascular risk as well as rates of death from cardiovascular disease were remarkably similar.  

“It is not, then, a simplistic rural versus metropolitan problem,” Professor Dunbar added. “High cholesterol, smoking and high blood pressure explain 75 per cent of heart attacks and strokes. These risk factors apply to everyone but there tends to be higher levels in those in low socio-economic circumstances,” he said. “Rural people are generally older, poorer and less educated and therefore over-represented in cardiovascular disease figures.”

Professor Dunbar said Australia has been slow in implementing appropriate solutions to important health inequalities. 

“This is the first study to take into account socio-economic circumstance which indicates there are not enough national risk factor studies in Australia.”

Professor Dunbar said solutions must be guided by high quality data that is context specific.  “This includes using accurate biomedical data as well as indicators of socio-economic status,” he said.

“No longer can governments dismiss the health disparity as being inherently or solely attributable to location. The solution to health inequity, wherever it exists, is for governments and communities to work together to ensure greater investment in areas lacking in infrastructure, services and access on the basis of unmet need.”

The research summary report in the British Medical Journal

Greater Green Triangle region map The Greater Green Triangle.

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