The case for spatial justice in rural and remote allied healthcare to promote equitable health outcomes

Rural and remote people die younger, sicker, and with more disability than urban people, yet paradoxically have poorer access to healthcare services, including allied health, than people who live in cities. Often rural geography is blamed, with rural places considered too distant, sparse, and different to allow easy service provision from cities. This framing of the rural as problematic often results in denial of necessary resources and infrastructure to appropriately shape rural health geography to meet the needs of rural people. But we can choose to see this issue differently, and in doing so, develop strategies that lead to equitable health care.
We propose an alternative approach to conceptualising rural and remote healthcare. Our critical review through the lens of spatial justice, suggests it is not rural geography which is the issue. Rather an urbanormative bias, coupled with capitalist and neoliberal values, frames rural places as unusual, difficult, and less valued than urban places. Borrowing from geography literature we apply Lefebvre’s concepts of conceived, perceived, and lived space to suggest how Australia’s rural health geography has been historically shaped to create inequitable health outcomes we see today. We then propose how it could be re-shaped to provide more equitable health outcomes situated in, and in response to place. We highlight the value of spatial analysis in identifying needs first and building place-based health systems from the ground up, including communities as both providers and receivers of health services, and engaging reciprocity and relationships in health care, to achieve health equity.