The case for spatial justice in rural and remote healthcare

People living in rural and remote places experience shorter lifespans, more illness, and more disability than urban people, yet paradoxically, have lower access to health services and professionals. The blame for poor access to healthcare commonly is attributed to the geography itself, with researchers and policy makers suggesting rural and remote places are too distant, sparse, and different from urban places to provide equitable health services. However, we use concepts from the field of critical geography to argue that global geography has been modified for millennia to suit human needs and ambitions, and blaming rural geography for healthcare service inadequacies ignores this vital fact.

We propose a paradigm shift to reevaluate rural and remote healthcare through the lens of spatial justice. Spatial justice suggests that a person’s experience of justice is related to the space in which they live, and these geographies are shaped by human choices. Drawing from insights in critical geography literature, we employ Lefebvre’s conceptual framework of conceived, perceived, and lived space to suggest how Australia's rural health landscape has historically been moulded to yield the inequitable health outcomes prevalent today.

In light of this understanding, we advocate for a reshaping of rural health geography to foster more equitable health outcomes. By approaching rural healthcare from the perspective of spatial justice, we suggest focusing on need rather than equality of service. We suggest leveraging spatial analysis to identify localised needs and constructing health systems that are firmly rooted in the specific contexts of rural communities. We advocate empowering communities to participate both as providers and recipients of healthcare services. This entails recognising the intrinsic value of local knowledge and fostering reciprocal relationships within the healthcare ecosystem.

We suggest that incorporating spatial justice principles into healthcare planning and delivery may provide the language and advocacy model to achieve tangible improvements in rural and remote health workforce issues, infrastructure, education, and training.