What is health anyway? Perceptions and experiences of health and health care from socio-economically disadvantaged rural residents

The divide between rich and poor in Australia is starkly apparent in health status statistics; the poorest Australians have the poorest health, and many live in rural Australia. However, little is known about financially deprived rural citizen's perceptions of their own health and their expectations of health care services. As a result, exploratory in-depth interviews were conducted with eleven rural residents dependent upon government income support. Ten of the eleven participants had chronic health problems, and these were being addressed symptomatically. The children of the participants also required interventions for a range of physical, emotional and mental problems. The participants relied on local services and local practitioners to provide suitable interventions and to direct them to other services if required. They had minimal knowledge, control or choice in the type of intervention or outcomes. In this group, poor health was normalised and future health not considered. Thus, those with most to gain from health promotion and prevention activities and social inclusion programs are unlikely to benefit because they may normalise poor health. Concepts of good health, health literacy, informed consent, choice of intervention or practitioner are meaningless in this rural context of deprivation. These findings suggest that the population who endure the burden of ill-health will be by-passed by current and popular public health techniques of health promotion because rural people with poor health have low expectations of their own health and health care. Similarly, health service providers have high expectations of health and the rational choices of the population they serve. Thus, there is a major disconnect between the expectations of both.