WA Health Translation Network

Management Committee Meeting No. 6/2019 Minutes

Tuesday 3 December 2019 7.30am to 9am

Location: Harry Perkins Institute, Meeting Room 272, 6 Verdun Street Nedlands, WA 6009 Zoom: https://uwa.zoom.us/j/670125784

Attendees Representative Members: Chair: Professor Gary Geelhoed, Executive Director WAHTN Curtin University: Professor Torbjorn Falkmer Harry Perkins Institute: Ms Emma Stone Institute for Respiratory Health and UWA: Professor Geoff Stewart St John of God Hospital: Professor Steve Webb Telethon Kids Institute and Aboriginal Health Representative: Mr Glenn Pearson The University of Notre Dame Australia: Professor Jim Codde The University of Western Australia: Professor Osvaldo Almeida Associates: Brightwater Acre Group: Dr Angelita Martini Platforms: Clinical Trials and Data Management Centre: Professor Peter Thompson Commercialisation Representative: Associate Professor Kevin Pfleger Consumer and Community Health Research Network: Ms Debra Langridge Mental Health Representative: Professor Vera Morgan Transdisciplinary Programs Representative: Professor George Yeoh Women’s Health Representative: Winthrop Professor Jeffrey Keelan Staff: WAHTN Chief Operating Officer: Dr Debbie Turner WAHTN Executive Officer: Ms Lauren White Apologies Dr Darren Gibson, Ms Sandra Bellekom, Professor Daniel Fatovich, Professor Rob Newton, Mr Bill Morgan, Professor David Morrison, Dr Aron Chakera, Dr James Flexman, Professor Steve Wilton, Ms Nicola Ware, Ms Janet Zagari, Ms Anita John, Mr Alan James, Dr Carolyn Williams, Ms Amanda Samanek, Dr Chris Kane, Professor Catherine Elliott, Dr Rashmi Watson.

1. Welcome The Chair welcomed members to the meeting. 2. Declarations of potential or perceived conflicts of interest

None

3. Minutes of the meeting held on 22 October 2019

It was RESOLVED that the Minutes of the Meeting of the Management Committee of 22 October 2019 were confirmed.

4. Business Arising

No business arising. 5. Executive Director’s Report The Executive Director provided a verbal update, which incorporated the following items:

• Guardianship and Administration Act Due to the interpretation of the Act by the Western Australian State Solicitor, all existing research projects involving patients who are unable to give consent at the time of recruitment are currently on hold. Latest information is that drafting has commenced on the revised Act and there is hope it will be presented to Parliament in February 2020. Researchers will have a chance to review the proposed legislation.

• Science on the Swan Planning for the 2020 Conference is currently on track. Organising Committee Meetings are being held monthly. AHRA will have a face to face meeting following SOTS 2020 with many of the Directors taking part in SOTS 2020.

• Medical Imaging Working Group Sufficient matched funding for the current National Imaging Facility (NIF) infrastructure, located in WA, has been confirmed to access Commonwealth funds. The total sought is $27million over 5 years. While not at this target yet, sufficient funds have been pledged to allow the project to progress to building and procurement planning. This is a great example of how WAHTN can be the catalyst to collaborate and secure funding. The WA Minister for Health has agreed to launch the initiative. Further information will be confirmed in due course.

• Biobanking OpenSpecimen software is currently being trialled with samples from the ORIGINS biobank located in Joondalup (in conjunction with the Telethon Kids Institute) to prototype the biobanking informatics platform. The software has the ability to capture specimens across Western Australia, which has always been a challenge for WA. Members were advised that there are currently discrepancies across the network of what the definitions of a biobank are (such as; opt in consent and the issue that the majority of samples are not collected for a specific purpose). The WA DNA Bank (located at MRF) was raised due to its pending closure at the end of 2019. Gary Geelhoed confirmed that this was due to a key funding partner withdrawing. The request to continue funding has been submitted to the WA Department of Health, to ascertain if discretionary funds are available.

Members were advised that the annual Australasian Biospecimen Network Association Conference is being hosted in Perth, 26 - 28 October 2020. Further information: https://abna.org.au/

6. WAHTN Strategic Plan Project The Chair advised that the Strategic Plan is being finalised and will be sent to Executive Board and the Partner Members in January 2020 for review and comment. An options paper describing several potential legal models and governance structures will be provided for consideration at a meeting in mid-March 2020.

7. Australian Health Research Alliance (AHRA) 7.1 Annual NHMRC Symposium (19 – 20 November 2019)

Gary Geelhoed and Debbie Turner attended the Symposium. They noted that the AHRA profile was positive.

7.2 AHRA Face to Face Meeting (21 November 2019) Gary Geelhoed informed the Committee that he was elected as Deputy Chair of AHRA at the meeting and will take on the role of Chair in July 2020. He confirmed that secretarial support will be provided to the AHRA Chair and further information regarding the operational aspects of the position will be provided to Committee Members as it evolves. It was agreed by Committee members that this will strategically position WAHTN to bring additional funding and opportunities to Western Australia. This will be discussed at the next meeting of the WAHTN Executive Board with particular focus on how WAHTN should be positioned to maximise exposure at the interstate level. In addition to the Face to Face meeting, the sub-committee for the Consumer and Clinical Involvement (CCI) national initiative met to discuss current progress and future opportunities.

7.3 AHRA National System Level Initiatives (Data Driven Healthcare Improvement; Indigenous Research(er) Capacity Building and Health Systems Improvement and Sustainability) The Chair discussed these initiatives and advised that AHRA Executive Council meet on a monthly basis to discuss, each of the NSLIs are progressing according to timeframes and are currently on track.

7.4 National Indigenous Research(er) Capacity Building (NIRCB) Initiative Glenn Pearson provided an update on the National Indigenous Research(er) Capacity Building (IRCB) Initiative. There will be a meeting in Adelaide (27 - 28 February 2020) of the Indigenous Research(er) Capacity Building Network (IRNet) National Aboriginal and Torres Strait Islander Health Research Showcase 2020. A link to register for the event can be found here:

https://www.eventbrite.com.au/e/aboriginal-and-torres-strait-islander-health-research-showcase-2020-registration-80196681433

In addition, Glenn mentioned that the IRCB network have submitted an Expression of Interest (for the first stage) in response to an NHMRC call for a national capacity building initiative ($10M). Members will be updated as this progresses.

7.5 Rural Health and Medical Research Network – the Spinifex Network The proposed network was discussed at the Spinifex Symposium (convened in Alice Springs in November 2019), the purpose of the Symposium was to start a connected conversation with a view to responding to the many calls for a dedicated Rural Medical Research Alliance for Australia. This is an innovative and functional way to improve health and medical research outcomes and their impact in regional, rural and remote Australia. Gary Geelhoed informed the Committee that WAHTN has provided in principal support to the University of New England (in partnership with NSW Regional Health Partners) to develop a proposal for the Rural Medical Research Alliance. Attached to the Minutes is the documentation received from the Spinifex Symposium (Attachment 1).

8. Enabling Platforms Updates on the following Enabling Platforms were provided:

8.1 Consumer and Community Health Research Network Deb Langridge provided a verbal update on CCHRN, which included the following: • CCI Stakeholder Engagement Workshop is scheduled on 22 January 2020, focusing on best

practice and will give attendees an opportunity to brainstorm and share ideas. Invitations to key stakeholders will be circulated shortly.

• Recruitment is currently underway for 2 new team members (CCI Coordinator and Evaluation and Data Management Coordinator).

• A CCI Coordinator is now placed at the WA Department of Health.

8.2 Clinical Trials and Data Management Centre Peter Thompson updated members on the availability of two WAHTN Biostatistician Fellowships, 6 applications were received and shortlisting is currently underway.

8.3 Research and Education Training Program

Gary Geelhoed updated the Committee on the RETProgram. He confirmed that discussions have been held with the WA Department of Health to ensure there is an integrated and collaborative approach to research education across the state and at a broader level in 2020 and beyond. Additional funding from the Department is expected to be finalised by the end of the year. The new module between the Telethon Kids Institute and Menzies School of Health Research on Improving Aboriginal Children’s Lung Health will be available mid December 2019.

The RGS module will be released shortly, with the anticipated release date of 19 December 2019. It was noted that the position of Head at RETProgram is being revised and Rashmi Watson will not be continuing in the role. Vera Morgan noted that her experiences with RETProgram and Rashmi Watson in developing a mental illness module was extremely positive and she enjoyed working with her.

9. Other Business • It was requested that information on the grants that were funded from the $6.1million

awarded to WAHTN be communicated.

• It was agreed that an Executive Summary of the WAHTN Management Committee Minutes will be made available within the WAHTN Newsletter and on the website.

• WAHTN’s Progress Report submitted to NHRMC has been uploaded to the NHMRC website.

WAHTNs Report, along with all accredited AHRTC and CIRH can be found here: https://www.nhmrc.gov.au/about-us/resources/what-are-translation-centres-doing-and-why

Next Meeting: The first half of the 2020 Management Committee meeting dates are as follows:

• Tuesday 4 February 2020, 7.30am - 9.00am • Tuesday 31 March 2020, 7.30am - 9.00am • Tuesday 26 May 2020, 7.30am - 9.00am

19 November 2019

Dear Professor Geelhoed,

We appreciate that given the relatively short notice about the event, your organisation was not able to

send a representative to the Spinifex Symposium in Alice Springs on 12-13 November. We were able

to gather 50 representatives from health and medical research across Australia (and we received

multiple emails and letters of support from those unable to attend), a very positive outcome.

As advised, the purpose of the Symposium was to start a connected conversation with a view to

responding to the many calls for a dedicated Rural Medical Research Alliance for Australia as an

innovative and functional way to improve health and medical research outcomes and their impact in

regional, rural and remote Australia.

It was a very successful event. A diverse and committed group from research, teaching and community

organisations, together with health service delivery and policy unit representatives worked together

over two days to explore opportunities to improve the current and future health outcomes of regional,

rural and remote Australians. The importance of new innovative research models was discussed and the

significance of having a connected collaborative network which seeks to develop, share and connect

both new knowledge and practice at point of use. Notes from the meeting have been provided

separately. The meeting also generated a consensus ‘Spinifex Statement’:

People living in rural, regional and remote locations deserve better health.

We will be rigorous, and use creative and non-traditional research approaches to improve health

outcomes for these Australians.

Our strength is in our rural roots, our will to collaborate and make change happen.

Spinifex, where it grows in the desert and near the coast, is a symbol of resilience. It can withstand

storms, winds and king tides. It has deep roots, it resists drought and stabilises the earth.

The symposium attendees agreed to work together to form a Rural Health and Medical Research

Network – the Spinifex Network. Determining the structure and functions of the network will take some

time as will the formal processes required by many organisations to finalise their network commitment.

The first task of the Network will be to develop a funding bid to take to government by the 31st March

2020. The group agreed that this work should not be delayed while Network governance details are

finalised. New South Wales Regional Health Partners and the Central Australia Academic Health Science

Network are committed to ensuring that a successful bid is engineered through collaborative processes

and submitted for funding, and will continue to lead this work on behalf of the group. The 50 people

who attended the Symposium can vouch for the commitment of the Network to an inclusive and

collaborative approach and this will continue - it is simply essential for long term success.

What do we need right now? Our ask of you is that by 1st December 2019, you/your organisation:

provides a letter of in principal support for the Network

makes a one-off contribution from your discretionary funds of $2,000 - $5,000 (based on

organisational size) to support bid development. This will contribute to supporting meetings

with multiple agencies and Ministers and commissioning an economic analysis. (The University

of New England has already recruited $50,000 to support the bid.)

nominate individuals who are able to contribute to bid development, and/or act as a critical

reader and support the wider communication and promotion of the Network.

As the bid is finalised, we will ask you for a further letter of support for the bid itself.

Between now and the submission, we will host a bid development forum. Post bid submission (31st

March), we’ll organise a meeting to discuss and agree proposed governance for the on-going network

and membership arrangements.

More information is available at cirh.org.au/spinifex

For all enquiries and letters of support please contact :

Liz Egan, Project Officer

Office of the Vice-Chancellor, University of New England

Email eegan@une.edu.au

Very much hoping that you can join the group on this journey,

Kind regards,

Prof Christine Jorm Mr Chips Mackinolty

NSWRHP CAAHSN

Establishing an Australian Rural Health and Medical Research Network (RHMRN)-the Spinifex Network

It was agreed on 12/13 November 2019 at the Spinifex Symposium in Alice Springs that a network be established, with its first task being to create a detailed business case for rural health and medical research funding.

Building a new future in rural health and medical research1 for Australia A new Rural Health and Medical Research Network (RHMRN)-the Spinifex Network, will address the health inequities

within Australia, resulting from disparities of opportunity and resourcing linked to the defining human spatial

geography of this nation. The Spinifex Network will provide much-needed practical infrastructure for a national

research partnership focused on rural health and medical research to deliver health equity for rural Australians. The

Network will be enabled through a partnership, collaboration and engagement model addressing critical research

questions relevant to rural Australia. The key priorities include:

1. Improving access to healthcare that meets the needs of rural communities, through technology, workforce

and new models of care.

2. Developing a health driven future for sustainable rural communities by responding to the unique health

challenges of place, including identifying, measuring and responding to place-based determinants such as

economic, ecological, social and cultural factors; community priorities and future aspirations; health inequity

and by working with adjacent sectors (eg agriculture, education, social services) to disrupt disadvantage.

Why Australia needs a Rural Health and Medical Research Network now - the gap between

city and rural residents is widening As the genuine miracles of modern medicine multiply, the gap between care available to those who reside in

metropolitan domains and those in rural communities widens. Subspecialists, sophisticated diagnostic tests, highly

complex surgery and cutting-edge drug regimens are only available in large cities; rural residents often go without, or

suffer extended time away from family and community to access care. They also often face significant unreimbursed

costs for travel and accommodation.1 This is not just a growing problem for Australia, and here as in other nations

creative solutions to these inequities are possible. To date, research focused on ameliorating geographical disparities

in clinician distribution (such as general practitioner shortages) has dominated over medical research into the redesign

of technology-enabled, complex medical care for delivery in rural and remote scenarios. The provision of innovative,

vertically-integrated health care that operates to ensure equity of outcomes through a patient-centred approach is

necessary for the 30% of Australia’s population that live outside major cities.

1 The term rural is used throughout this document to refer to regional, rural and remote areas and communities in Australia. This is for ease of reference only and not intended to discount the often substantive differences in context and social determinants across these geographic classifications, resulting from level of remoteness.

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Rural residents are already older and sicker than their major city counterparts and will become more so; the burden

of disease in Australia’s non-metropolitan regions is growing. Residents in these communities suffer premature deaths

at 1.3-1.9 times the rate of their city counterparts. Their shorter lives are due to death from obesity, heart disease,

diabetes, suicide and motor vehicle accidents.2 They are more likely to have chronic health conditions including

arthritis, asthma, back problems, deafness, diabetes, heart, stroke and vascular disease.2 Compared with those living

in cities, people in rural areas are more likely to smoke, drink hazardous quantities of alcohol, be overweight or obese,

have lower levels of education and reduced access to work. Overall, people in rural Australia experience 1.3 times the

burden of disease compared with city dwellers (1.7 times for very remote residents).

Why Australia needs a Rural Health and Medical Research Network now - rural and remote health issues need locally developed place-based solutions

It is well-documented that different models of support are required to deliver healthcare in regional, rural and remote

locations: delivery challenges include geographic spread, low population density, limited infrastructure and higher

costs for the provision of a full suite of medical and healthcare support. There are fewer general practitioners,1 p11 and

many fewer specialist medical practitioners, nurses and allied health practitioners (e.g. half as many physiotherapists,

occupational therapists and psychologists per head of population in outer regional areas as in the cities3). Rural context

matters in all care, whether considering a place-based solution for individuals with severe mental illness living in a

small community,4 nursing to support patients with Parkinson’s disease,5 physiotherapy for rehabilitation after

physical injury,6 or safe ways to administer chemotherapy or immunotherapy.7 8 When individuals and communities

are engaged in redesign of services they will benefit from, solutions are feasible and effective in the local context and

common challenges with other sectors of the economy become apparent (e.g. connectivity, workforce, data).

Conversely, lack of ownership in solution development makes implementation challenging, and limits sustainability

and spread.

Why Australia needs a Rural Health and Medical Research Network now –embedded practitioner researchers are key to rural clinical communities and increased rural economic prosperity

Government has made major investments in rural medical schools; this is continuing with the new Murray Darling

Medical Schools Network. The early evidence of the uptake of rural and remote practice after rural medical student

training has also set expectations for similar programs for other health professionals.9 However, retention is essential

to ensure the return on the investments made in rural student training will be sustained. Key factors that affect

retention include work variety, workplace culture, professional opportunities, sense of community and spousal

employment.10 11 Currently, high achieving young clinicians must accept that settling in a rural area is likely to prevent

them excelling in medical research. Yet it is a myth that research excellence is the sole province of large research units;

small teams are more likely to innovate.12 In Canada, establishing the ‘Regional Medical Campus’ impacted the quality

of professional life, research, medical practice, and regional development.13 It is detrimental for Australia to continue

with a process of medical research funding inequity that exacerbates rural economic inequality.

It is undeniable that innovation and technological change drive productivity and growth, and knowledge-intensive

services can enable productivity growth in lagging regions: research and development intensity correlates with a

region’s GDP per capita.14 The Medical Research Future Fund (MRFF) ‘is investing to supercharge the growth of

Australia’s health and medical research, while fuelling jobs, economic growth and export potential’.15 The RHMRN-

Spinifex Network is timely and relevant.

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Why Australia needs a Rural Health and Medical Research Network now - fostering new opportunities for Australian rural research

The preferencing of the ‘biomedical bubble’ in research funding has constrained the kind of research needed for rural

health issues, resulting in persistent inequity in Australia’s healthcare system. This is largely attributed to the situation

‘where supporters of biomedical science create reinforcing networks, feedback loops and commitments beyond

anything that can be rationalised through cost-benefit analysis.’14p6 This results in resources being drawn away from

alternative ways of improving health – e.g. influencing the social, economic, environmental and behavioural

determinants of health outcomes, reducing variation in care quality, and from research on care versus cure (e.g. for

dementia).14p22 In 2018 basic science received 45% of NHMRC expenditure, clinical research 31%, public health 13%

and health services research just 4.4%. Although 30% of the population lives rurally, only 2.4% of NHMRC funding

goes toward research that specifically aims to develop and deliver health benefits to people who live in rural or remote

Australia.16 Sustainable solutions for the management of chronic disease in rural and remote areas will not be derived

solely from frontier biomedical research; a holistic approach is necessary. NHMRC medical research funding is now

being supplemented by the very substantial MRFF. The MRFF has a very different albeit complementary mission, with

attention toward population need: ‘It’s about giving hope to Australians in need, where previously there was none,

and creating the opportunity to have a better and longer life’.15 Equally other MRFF emphases, on innovation and

translational research, also increase the alignment of this fund with the much-needed focus on rural research.

A Rural Health and Medical Research Network - critical mass enabled through innovative and inclusive partnership creates modern research success

It takes a team to solve healthcare’s complex and ‘wicked problems’. Multidimensional consortia involving consumers,

practitioners and researchers from diverse fields, engaging government and industry, and working across states and

territories are now taking precedence over specialized research groups. It is also now recognized that translation into

practice needs to be considered from the genesis of research, not after ‘completion’ of the frontier intellectual tasks.

To achieve genuine research impact, partnerships and co-design with patients, consumers, community, practitioners

and system managers is necessary; strong partnerships are a de facto requirement for effective 21st century research

outcomes. The Rural Health and Medical Research Network- the Spinifex Network will provide much-needed

practical infrastructure for national collaborations in a research sector that has historically been challenged by

dispersed practitioners, lack of critical integrated mass and underfunding.

There are many critical research questions, but early thinking suggests that the research focus of the Rural

Health and Medical Research Network-the Spinifex Network could address the following questions:

How might we:

1. Demonstrate innovation in rural health and medical research delivering economic value to rural communities?

2. Enact new research funding models to strengthen the capacity and impact of the rural health research ecosystem?

3. Deliver real-time research and data collection with those who deliver health care and monitor outcomes in rural communities?

4. Share local ‘place based’ solutions to drive needs based rural health research and sustainable communities?

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References: 1 Swerissen, H., Duckett, S. & Moran, G. Mapping primary care in Australia. (Grattan Institute, 2018). 2 AIHW. Rural and Remote Health: Web Report, <https://www.aihw.gov.au/reports/rural-health/rural-remote-

health/contents/access-to-health-services> (2017). 3 Australian Institute of Health and Welfare. Vol. National health workforce series no. 5. Cat. no. HWL 51. (AIHW, Canberra,

2013). 4 Fitzpatrick, S. J., Perkins, D., Luland, T., Brown, D. & Corvan, E. The effect of context in rural mental health care:

Understanding integrated services in a small town. Health & place 45, 70-76 (2017). 5 Coady, V., Warren, N., Bilkhu, N. & Ayton, D. Preferences for rural specialist health care in the treatment of Parkinson’s

disease: exploring the role of community-based nursing specialists. Australian Journal of Primary Health 25, 49-53 (2019). 6 Kingston, G. A. Commentary: Rehabilitation for Rural and Remote Residents Following a Traumatic Hand Injury.

Rehabilitation Process and Outcome 6, 1179572717734204 (2017). 7 Honeyball, F. Safety of delivering chemotherapy by community nursing staff supervised by telemedicine in remote New

South Wales (NSW). Journal of Clinical Oncology 36, 82-82 (2018). 8 Hamilton, B., Xu, K., Honeyball, F., Balakrishnar, B. & Zielinski, R. Patterns of immunotherapy use and management of

toxicities in regional and tertiary settings. Internal medicine journal (2019). 9 Lyle, D. & Greenhill, J. Two decades of building capacity in rural health education, training and research in Australia:

University Departments of Rural Health and Rural Clinical Schools. Australian Journal of Rural Health 26, 314-322 (2018). 10 May, J., Walker, J., McGrail, M. & Rolley, F. It’s more than money: policy options to secure medical specialist workforce

for regional centres. Australian Health Review 41, 698-706 (2018). 11 Cosgrave, C., Malatzky, C. & Gillespie, J. Social determinants of rural health workforce retention: a scoping review.

International journal of environmental research and public health 16, 314 (2019). 12 Wu, L., Wang, D. & Evans, J. A. Large teams develop and small teams disrupt science and technology. Nature 566, 378

(2019). 13 Levesque, M. et al. Physician perceptions of recruitment and retention factors in an area with a regional medical campus.

Canadian medical education journal 9, e74 (2018). 14 Jones, R. & Wilsdon, J. The Biomedical Bubble: Why UK research and innovation needs a greater diversity of priorities,

politics, places and people. (2018). 15 The Australian Government Department of Health. Medical Research Future Fund,

<https://www.health.gov.au/initiatives-and-programs/medical-research-future-fund> (2019). 16 Barclay, L., Phillips, A. & Lyle, D. Rural and remote health research: Does the investment match the need? Australian

Journal of Rural Health 26, 74-79 (2018).

We acknowledge the Arrernte people as the traditional custodians of Mparntwe (Alice Springs) and the surrounding region - the land on which participants gathered for the Symposium.

We pay our respects to the Elders past, present and emerging, for they hold the memories, the traditions, the culture and share the hopes of Aboriginal and Torres Strait Islander peoples across the nation.

Acknowledgement of the Arrernte people

A note on terminology The term rural is used throughout this report to refer to regional, rural and remote areas and

communities in Australia. This is for ease of reference only and not intended to discount the

often substantive differences in context and social determinants across these geographic

classifications, resulting from level of remoteness.

Purpose of this report This is a summary of the Spinifex Symposium convened in Alice Springs on 12-13th November,

2019.

It is a high-level snapshot of key themes, insights and group decisions arising from the

Symposium presentations and discussions.

Spinifex Symposium

at a glance

Rural communities and health and medical research

Key themes and insights

Our agreed research flagships

Our Spinifex Statement

Taking the network forward

Rural communities and health

and medical research

Approximately one in three Australians live rurally.

Despite the resilience of our rural communities, there is inequity in accessing healthcare

and a growing disparity in health outcomes.

On average, Australians living in rural and remote areas have shorter lives, higher levels of

disease and injury and poorer access to and use of health services, compared with people

living in metropolitan areas. This results in:

o 1.3 times the burden of disease (1.7 times for very remote residents)

o 1.3 - 1.9 times the rate of premature death.

People living in rural Australia are more likely to have a chronic health condition (including

arthritis, asthma, back problems, deafness, diabetes, heart, stroke and vascular disease).*

* AIHW. Rural and Remote Health: Web Report (2019) https://www.aihw.gov.au/reports/rural-health/rural-remote-

health/contents/rural-health

The problem to be solved: The gap in health outcomes between those living in

rural and metropolitan areas is widening

Health inequalities* are due to factors including:

o social determinants such as income, education and employment opportunities

o higher rates of risky behaviours such as being overweight, tobacco smoking and alcohol

use

o higher rates of occupational and physical risk, for example from farming or mining work

and transport-related accidents.

It is well-documented that different models of support are required to deliver healthcare in

regional, rural and remote locations to address delivery challenges which include

geographic spread, low population density, limited infrastructure and higher costs for the

provision of a full suite of medical and healthcare support.

o When individuals and communities are engaged in redesign of health care and services

from which they will benefit, solutions are feasible and effective in the local context.

* AIHW. Rural and Remote Health: Web Report (2019) https://www.aihw.gov.au/reports/rural-health/rural-remote-

health/contents/rural-health

What we know: Rural ‘placed based’ health and medical research is needed to

reduce inequality and transform health outcomes

It takes a team and collaboration to solve the complex issues facing rural healthcare in Australia and

around the world.

Multidimensional consortia involving researchers from diverse fields, engaging government and

industry, and working across states and territories are now taking precedence over specialised

research groups.

It is also now recognised that translation into practice needs to be considered from the genesis of

research, not after completion.

To achieve genuine research impact, partnerships and co-design with patients, consumers, community,

practitioners and system managers is necessary to improve outcomes and impact in rural Australia.

The Rural Health and Medical Research Network- the Spinifex Network was endorsed by

participants as an important coalition to unite rural voices across Australia, to pursue new

and creative approaches to place-based health and medical research in order to address the

health inequities experienced by rural communities.

How: A Rural Health and Medical Research Network to accelerate translational

research and knowledge exchange for equitable health outcomes in rural Australia

Key Spinifex Symposium

themes and insights

Rural communities have a history of innovation and have been referred to as Australia’s ‘incubators

of innovation’

There is an opportunity to reconceptualise and redefine a health driven future for rural economies

Success in this pursuit requires us to:

o reframe how health outcomes could be for people in rural communities and be bold in our

pursuit of these outcomes to disrupt disadvantage

o strengthen our intra and intersectoral collaborations (our ‘joined-upped-ness’)

o develop models to better measure economic impact of improved rural health on communities

and the contribution that local health and medical research makes to local economies

Demonstrate how innovation in rural health and medical research delivers

economic value to rural communities

Traditional medical research funding is failing to meet the health research priorities of rural

Australia.

o For example, less than 3% of National Health and Medical Research Centre (NHMRC) funding

goes toward research specifically aimed to create health benefits to people who live in rural or

remote Australia.

A new and diversified rural research funding model is required that includes:

o Traditional research funding sources such as the NHMRC and the Medical Research Future Fund

(MRFF) – including new funding vehicles within these sources that will support and develop

indigenous and non-indigenous ‘practitioner researchers’

o Health service funding (‘industry funded R&D’) – with a focus on quality improvement and

implementation science

o Private sector and business investment such as venture capital for rural start-ups

o Philanthropic funding through establishing stronger relationships and creating linkages between

the rural research sector and philanthropic organisations

o Incentives for health and medical research to be co-funded by other public sectors – to deliver

for adjacent industries such as agriculture, education and social services.

Enact new research funding models to strengthen the capacity and impact of the

rural health research ecosystem

Geographical and vocational maldistribution continues to present a challenge to the delivery of

appropriate and accessible health care for rural Australians

Training health professionals as researchers (or ‘research practitioners’) makes good economic

sense and supports culturally aware and relevant place-based research. As well as being trained,

they need to be supported to do research as part of their work. They will increase research

activities in rural communities (trojan horse model) and create community support for health and

medical research

Developing a robust pipeline of rurally based researchers (with a focus on Indigenous researchers

and health care professionals) will help to achieve the required critical mass and support

sustainability

Empowering and activating Indigenous researchers should be supported through clear pathways

from the ages of 15-17yrs (e.g. traineeships and cadetships in schools)

Piloting non-indigenous community controlled primary healthcare organisations

Rurally based health researchers are so important because of the concept of ‘place’. When in place, a person

understands the contextual issues essential to the delivery of appropriate health care. Their research is enabled

through regional relationships - based on trust and credibility with individuals, services and with the academic

community. Symposium Participant

Real-time research and data collection with those who deliver health care and

monitor outcomes in rural communities

The importance of place is embedded within First Nations cultures worldwide.

Understanding the unique needs, priorities and desires of each rural community is essential to

developing effective and sustainable place-based solutions that meet the needs of local communities

(including models of care, health services and workforce).

Share local ‘place-based’ solutions to drive needs based rural health research and

sustainable communities

Enduring community support

requires:

o Community engagement and

co-design

o Long term relationships

(evolving the FIFO model)

o Targeted whole of community

projects/precincts (including

intersectoral approaches)

Every rural community is different

Our agreed research priorities

Access to healthcare to meet the needs of rural communities, through

o technology

o workforce and

o new models of care.

A health driven future for sustainable rural communities by responding to the

unique health challenges of place including:

o identifying, measuring and responding to place-based determinants such as

economic, ecological, social, cultural and demographic factors

o developing a holistic model of health determinants

o understanding community priorities and future aspirations

o health inequity – e.g. reducing disparities in end of life care and disrupting

disadvantage by supporting children and young people.

Research flagships to guide our research priorities

Research flagships align with the Australian Medical Research and Innovation Priorities, to be

assessed against the criterion of Benefit/Impact, Relevance, Quality and Feasibility.

1

2

Strengthening

Indigenous healthBuilding rural

researcher capacity

Delivering rural

prosperity

Access to healthcare to

meet the needs of rural

communities

A health driven future for

sustainable rural

communities by responding

to the unique health

challenges of place

Bringing our research priorities together

CROSS-CUTTING THEMES

Intersectoral collaboration is an essential enabler for both research

flagships

21

Our Spinifex Statement

Our Spinifex Statement

The following statement represents a collective statement of purpose and intent for the future

of the network and was endorsed by Symposium participants.

People living in rural, regional and remote locations deserve better

health.

We will be rigorous, and use creative and non-traditional research

approaches to improve health outcomes for these Australians.

Our strength is in our rural roots, our will to collaborate and make

change happen.

Spinifex, where it grows in the desert and near the coast, is a symbol of resilience. It can withstand storms,

winds and king tides. It has deep roots, it resists drought and stabilises the earth.

Taking the Network forward

Mobilising our network

There was strong endorsement of RHMRN- the Spinifex Network, and its objective of Health Equity for

Rural Australians

Consensus was reached to:

Work together on the development of a bid for national research funding (MRFF Mission), and

Establish a formalised network structure.

Where to from here?

Invitations for membership to RHMRN, the Spinifex Network, will be extended to participants and invitees

Participants to canvass in-principle support from their organisations (to join RHMRN as a partner, sponsor or

associate)

Explore opportunities for tangible support and contributions (both financial and in-kind)

Seek individual nominations for the Interim Consultation Group to support the funding bid

Delivery of a proposal for dedicated national rural health and medical research funding by 31 March 2020.

Acknowledgments

The Spinifex Symposium organising

partners would like to thank:

o All symposium participants from

across Australia who so generously

shared their expertise, insights and

passion for rural health research.

o The University of New England for

its financial support.

For more information on the Spinifex

Symposium or the Rural Health and

Medical Research Network, please

contact Christine Jorm or see

http://cirh.org.au/spinifex for updates

on activities.