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Geographic Classification for Health (GCH): Developing a new rural-urban classification for NZ health research and policy

This project builds on work previously published by this team:

Fearnley D, Lawrenson R, Nixon G. “Poorly defined” – unknown unknowns in New Zealand rural health. New Zealand Medical Journal 129 (1439) 77 – 81, 2016

The limited urban / rural analyses of routinely collected data undertaken in Aotearoa New Zealand (NZ) has failed to demonstrate the health inequalities that are evident in similar countries. This is at odds with evidence of disparities in access to individual health services and the observed poor health status of residents of rural towns. It is possible that the apparent lack of effect of rurality on health outcomes in NZ is an artifact arising from the definition of 'rural' used in health statistics.

Aims

To develop a ‘fit for health purpose’ rural-urban classification for analysis of health data (at national and local levels), and to use it with key national data collections to determine the magnitude of urban-rural health disparities in health outcomes and access to health services in Aotearoa/New Zealand.

Design and methods

Statistics NZ Is completing work on a new rural urban classification, the Urban Accessibility Classification (UAC). The UAC is a generic classification not designed for use in health.

The research team will modify the UAC with health and health services in mind. Potential modifications will then be tested using enrolment in general practices classified as rural or urban by local PHOs and by using a co-design process to get ‘on the ground’ feedback from the rural health stakeholders.

The resulting Geographic Classification for Health (GCH) and the most commonly used existing Stats NZ classification (Urban/rural experimental profile; UREP) will be used to analyse routinely collected data from the Ministry of Health to quantify current levels of urban/rural inequity in health service access and outcomes and the extent to which older classifications may have been masking disparities.

Research impact

A fit for purpose process of classifying residential addresses as either urban or rural will generate a better understanding of health outcomes and healthcare access for rural New Zealanders. Better informed health policy can then drive the innovation needed to deliver an effective and efficient health service for all New Zealanders, regardless of where they live. This has particular importance to those whose health status is most vulnerable to the additional burden of distance – those with high levels of deprivation, the elderly, and those with disabilities.

Funding

The study is being funded with a NZ Health Research Council Project Grant.

Co-design and stakeholder input

Feedback from stakeholders is an important aspect of this project. It is essential that the GCH groups together communities that are similar with respect to health services. It needs to ‘makes sense on the ground’ to NZ’s rural health stakeholders. It also needs to meet the analytical needs of NZs health research community.

If you have an interest in rural health, health research or health policy, and interested in providing feedback on the proposed Geographic Classification for Health, we would like to hear from you.

Please feel free to contact via email.
Email michelle.smith@otago.ac.nz

Project team

This team includes researchers who have previously worked together from the University of Otago and the University of Waikato, with expertise in rural health, health geography, Māori health, biostatistics, data management and population health.

Associate Professor Garry Nixon – Rural Health

Garry is in clinical rural practice in Central Otago (28 yrs.) and Associate Dean Rural University of Otago. He teaches the postgraduate rural diploma which provides regular contact with the next generation of NZ’s rural doctors. He brings expertise is rural health and in leading project teams that are geographically dispersed. Garry is the PI on the project.

Gabrielle Davie

Gabrielle is Senior Research Fellow (biostatistician) at the University of Otago. She has 16yrs’ research experience using NZ’s administrative health data. Gabrielle is the  Deputy Director of the Injury Prevention Research Unit and co-lead of the Dunedin School of Medicine Administrative Data for Health Research Hub. Gabrielle will lead the Dunedin based team, provide biostatistical advice and lead the analysis of routinely collected national health data sets.

Dr David Fearnley

Rural hospital doctor for over 18 yrs including Clinical Director roles and undertaking consulting work to DHBs on rural health services. He was first author on a paper highlighting the problems with NZ’s rural health data (2016 with GN&RL). He will provide a rural health perspective to the data analysis, lead the write up of publications and be involved in implementation in the rural health and DHB sectors.

Jesse Whitehead

Jesse is a PhD candidate (spatial equity, accessibility, and sustainability of GP services in Waikato) at the National Institute of Demographic and Economic Analysis, University of Waikato, with a background in geography and GIS analysis of health services. He will liaise with Statistics NZ and work on both the rural-urban classification and the  GIS accessibility index. Jesse is well connected in the NZ and overseas rural health communities and will have an important role in translating the geographic aspects of the findings for those in the rural health and health research sectors.

Brandon De Graaf

Brandon is a Research Fellow (Data Manager/Programmer), University of Otago. His expertise is in information science including programming, geocoding, process optimization and automation. Brandon will provide data management, geospatial and machine modeling and analysis, and produce physical maps for publications.

Associate Professor Sue Crengle

Sue is a GP, Public Health Medicine Specialist and senior Māori health researcher, University of Otago.  She has experience in co-design studies and helped develop the NZ Index of Multiple Deprivation. Sue will advise on the Māori specific analyses, interpretation of data and facilitate engagement with Māori stakeholders including implementation in the Māori health research community.

Professor Ross Lawrenson

Ross is Professor of Population Health (University of Waikato), Population Health Advisor Strategy and Funding at Waikato DHB and NZ Rural GP Network board member. He brings expertise in epidemiology and health services research with a long history in rural health research including co-design studies with rural/Māori communities.

Michelle Smith

Michelle’s role on the project is as research nurse/assistant. Michelle is an Associate Charge Nurse at Dunstan Hospital, Central Otago. She has expertise working on other rural health research projects including a current project on to validate a rural chest pain pathway. 

Advisors

Professor John Humphreys, (Emeritus Professor Rural Health Geography, Monash Uni.) and Professor John Wakerman (Menzies School of Health Research, Alice Springs) are recognised Australian authorities in this field. They developed the Modified Monash classification (MMM) that has recently been adopted by the Australian Govt. for the allocation of rural primary care funding. They have published extensively, including on the development of the MMM and research translation in evidence based rural health policy.

Dr Katharina Blattner is a senior lecturer rural health University of Otago, and Senior Medical Officer for Hauora Hokianga. Kati brings expertise in rural health service delivery research, and a Hokianga perspective (a remote, predominantly Māori, Northland community). She is well placed to assist with the uptake of the UIC-H in the rural sector.