- Reconciliation Week and findings from an Aboriginal health evaluation (04/06/2016)
- Evaluation amidst complexity: 8 questions evaluators should ask (04/12/2015)
- To count or not to count: Australian population data (20/02/2015)
- My pick of readings on scaling up health interventions amid complexity (12/12/2014)
- Scaling up health interventions: What works? isn’t the most important question (04/12/2014)
Are immigrants really the backbone of rural Australia’s health and education services?
Tuesday, 30th April
For a decade it was my job to worry about the health workforce in rural and remote Australia. Our university department of rural health, like 11 others through the country, did our part to promote regional centres, country towns and remote areas as a rewarding place for Australian graduates to practice. We promoted health careers to country Year 10 students and advocated for favourable admissions policies in university health courses. We offered stimulating rural practicums that let final year university students see how attractive working away from the cities could be.
My colleagues in education said they had the same problem filling teaching posts in the country and encouraging new teachers to stay.
The flip side of the promotion of rural careers was the spectre of international recruitment. International graduates–that is, people who had gained their qualifications in another country (usually their birth place)–were necessary to fill these positions until enough Australian graduates could be persuaded to take them up.
With the 2011 census data I delved into this common assumption that rural and remote health and education depends on immigrants. I wanted to look at this because it is in such stark contrast to the general absence of immigrants outside of capital cities that I have shown in previous posts here and here. Perhaps away from the capital cities immigrants play a disproportionately important role in vital social services? That would surely mean that the average Australian born person living in the country would be familiar (and positive) towards immigrants in their community.
To answer this I looked at numbers of people working as school teachers, doctors or nurses in Australia’s major cities, inner regions, outer regions (that’s Geraldton), remote (country towns) and very remote (isolated regions such as the Pilbara) areas. (If you would like to know where your favourite community falls on the remoteness scale check out the lovely maps in this great ABS publication.)
The graph shows that the further away from the major cities you get, the more likely it is that the school teacher, doctor or nurse you encounter will have been born in Australia.
The only exception to the trend of increasing proportions Australian born is of doctors in the small countries towns (remote in ABS terminology) where immigrants make-up 60% of doctors compared to 54% in major cities. In this case the difference is made up by a higher proportion of doctors born in New Zealand, the United Kingdom, South Africa and Zimbabwe. Doctors born in Asian countries are more likely to be working in cities.
And that is as it should be. Immigrants make up a higher proportion of people living in capital cities and it is only natural that they should also comprise a higher proportion of professionals.
But what does it mean for the issue of immigration and rural areas?
My first observation is that the view that immigrants are filling the gap in rural services is completely overstated. It is a political message to advocate for incentives for Australian born professionals, building on the xenophobia of some country voters.
My second observation is that despite workforce shortages, it is even harder to attract people born outside of Australia to work away from the cities than it is to attract the Australian born. Migration researchers talk about push and pull factors. Are the cities retaining skilled foreign born professionals because it is so great working and living in cities or are rural areas failing to attract them because the work and social environment are not attractive? Or is it that there are more bureaucratic obstacles for rural employment?
My third observation is that the city is keeping the skills for itself, leaving outlying areas starved for the new perspectives and skills that immigrants bring. This is not just true in teaching and health care. The trend is the same for all professions. The proportion of professionals born in Australia increases the farther away from cities.
Why, in a country so dependent on immigration to enrich our economy and culture are rural areas missing out? Are regional and rural communities actually hostile towards immigrants, driving them away instead of embracing them?
My next post will look at the connectedness of immigrants to their communities. Perhaps I’ll find the answer in those tables.
Data for this post come from the Australian Bureau of Statistic’s 2011 Census. I generated the tables using the excellent TableBuilders Pro program on the ABS website.