A fear of being judged, stigmatising encounters with healthcare providers and a lack of local bulk-billing services were among the key findings of the project aimed at empowering change in Launceston's northern suburbs.
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Our Community Our Care was the focus of an anticipatory care project that explored the barriers preventing people from leading healthier lives.
"I don't feel comfortable; I feel like I have to tell my whole life story to convince them to bulk bill me; the Northern Suburbs sucks when it comes to healthcare" - these were just some of the views of northern suburbs residents when asked about their local healthcare system.
Our Community, Our Care was a joint venture between the Northern Suburbs Community Centre and Ravenswood Starting Point Neighbourhood House, with research from the University of Tasmania.
It operated as part of a broader Anticipatory Care Action Learning Project, aimed at exploring how to best improve the health and wellbeing of Tasmanian communities at risk of some of the poorest health outcomes in the country.
Culminating late last year, the project shed new light on the experiences of its community, with a fear of judgement, ongoing stigmas and a lack of bulk-billing services among the key findings.
But what started as a purely health-focused approach on how to improve outcomes quickly evolved. The deeper those involved delved, the bigger the questions became.
What is anticipatory care?
Anticipatory care is a systematic approach designed to support a person's existing and future health needs, by identifying who is at risk and how to keep them well for longer.
Launceston's northern suburbs were among four communities who took part in the project, along with Ulverstone, Clarence and Flinders Island. Generally, these suburbs have higher rates of chronic illness, and potentially preventable hospitalisations than Tasmanians overall.
The report also identified significant financial, physical, psychological and emotional barriers preventing people in the community from accessing safe health support.
The northern suburbs project utilised the area's Our Community Our Care team to explore issues preventing people in the community from leading healthier lives.
By engaging hundreds of residents through specific activities, the project identified a number of barriers to anticipatory care. The flagship program of the OCOC activity was Adventure Play - a physical activity program with a trauma-informed approach for people aged 10 to 16.
It focused on work to increase access to GPs, transport access, physical activity and social connection, safe responses for people experiencing trauma and community pride.
"We wanted to know how they understood health, about their experience of the health system, and what supports or gets in the way of better health outcomes for the residents of Launceston's northern suburbs," the report reads.
OCOC project manager Fakington Wilde said it was a rewarding job because he was able to ask community members specific questions and then go looking for the answers.
"We had certain expectations, some, at the beginning of the project. But by the end, the directions the community drove us in and took us to was amazing. I never would have predicted what we did and what we achieved," he said.
"I think it's important to not just be a person with the answers, but a person who can take questions to places and find answers.
"Connections were formed through the local advisory group, interviews and art sessions where we had conversations about their health and what's important to them."
And, Mr Wilde said often the feedback were surprising.
"When we started, it was a very health-focused approach. But by the time it ended we were talking about infrastructure such as transport," he said.
"So some of the things we achieved included new bus routes in the community - which also relates to health. Because people can't access health services if they can't physically get to them."
So, what did they find?
The project identified four major opportunities for change, by increasing: safety, access, connection and resources in the community.
"Sometimes it feels like I'm being handballed around the place-no one seems to want to fix things" was among the feedback from participants of the program, in regards to the stigma identified.
"Residents with whom we talked report experiencing demeaning or stigmatising encounters with many providers, which make them unwilling to return, or to try other similar services," the report reads.
"Medical services (GPs) have historically been seen as central to anticipatory care, but in this community, access to GPs is restricted by lack of bulk- billing, and distance. We have found that there are many other services that can play a part in anticipatory care."
Examples include police, non-government organisations, pharmacies, allied health practitioners, council, public transport, schools, shops, community organisations and infrastructure planners.
Dr Susan Banks, the senior research fellow for the anticipatory care project, said it became clear that people didn't want to access services where they felt like they didn't belong.
"We knew there was something keeping people out of the system, and it's partly that stigma. But it's also partly that people just don't have money to access resources and places where they could get help," she said.
"Services aren't necessarily designed to meet the needs of broad spectrum people. So they are not safe for people to access. Stigma is just a form of a lack of safety. Where people look at them funny, because people go - 'you're not dressed like me, you don't sound like me'.
"Those sorts of things are really important, and they are also important learnings for us as researchers, in terms of thinking about how we go into communities as well. We need to be culturally safe in all sorts of way."
Where to from here?
The report noted that the changes made to the anticipatory care system within the OCOC site had been significant, planting the seeds for "new ways of thinking and working" in the community. However, there are now new opportunities to maintain and build what has already been established.
For local action, the project recommends the continuation of trauma-informed ways of working, such as those carried out through the Adventure Play program.
It also calls for more flexible funding models from all levels of government that "promote and support" collaboration, along with a review of subsidies for GPs servicing rural and remote areas to include outlying and disadvantaged communities.
"Many people in areas with poor supply of GPs are not on a GP's 'books' and so may be excluded from bulk-billed telehealth," the report reads.
What the project also hadn't anticipated was the impact of COVID-19. Richard Eccleston, the University of Tasmania's founding director of the Institute of Social Change, said the project's community-focused approach became even more relevant in the context of a global pandemic.
"It's really innovative because it's thinking about improving wellbeing and particularly chronic disease in a whole of community way," he said.
"A lot of focus often goes into what services are needed, or perhaps how we can help individuals. But this approach is from a community perspective. It's also a really relevant approach, given the COVID recovery.
"Quite often it's actually not the health services that need changing. There might be something on the surface ... what members of the community are experiencing. Whether they are being stigmatised, or marginalised, or they don't know what services are available. So just building those community bonds and connections in these cases, really has changed people's lives."
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