School of Medicine, University of Limerick, Limerick, Ireland.
Department of Obstetrics and Gynaecology, Hurely Medical Center/Michigan State University, USA.
Rural Remote Health. 2024 Nov;24(4):8700. doi: 10.22605/RRH8700. Epub 2024 Nov 20.
Ireland has one of the most rural populations in Europe. Rurality presents challenges when accessing health services but should not be perceived as problematic and in need of a structural fix. Structural urbanism where health care is viewed as a commodity for individuals, rather than an infrastructure for populations, innately favours larger urban populations and has detrimental outcomes for rural health. In this article we present a brief account of advocacy led by rural GPs, their communities, and the political and policy implications of their efforts.
In the period 2010-2016, Irish rural general practices were struggling for viability. Two key financial supports, distance coding and the Rural Practice Allowance, were withdrawn. This directly contributed to the founding of the 'No Doctor No Village' public campaign, following which the Rural Practice Allowance took shape as the Rural Support Practice Framework and was expanded to cover a larger number of rural practices. The World Rural Health Conference in June 2022 at the University of Limerick invited over 600 expert delegates who contributed to the authorship of the Limerick Declaration, a blueprint for advancing rural health in Ireland and internationally. This created a new momentum in advocacy for Irish rural general practice, which has drawn financial investments, sparked research interest building capacity for a pipeline to train rural general practitioners.
Local voices have driven monumental change in the Irish healthcare context. For these communities, the policy and politics of rural health are mere tools to maintaining or restoring their way of life. The biggest lesson to be learned is that unrelenting community commitment, when supported by the capacity to advocate, can influence politics and policy to generate sustainable outcomes and thriving communities.
爱尔兰拥有欧洲最农村化的人口之一。农村地区在获得医疗服务方面存在挑战，但不应将其视为存在问题，需要进行结构性修复。结构主义城市主义将医疗保健视为个人的商品，而不是人口的基础设施，天生有利于更大的城市人口，并对农村健康产生不利影响。在本文中，我们简要介绍了农村全科医生及其社区领导的倡导工作，以及他们努力的政治和政策影响。
在 2010 年至 2016 年期间，爱尔兰农村全科医生的业务难以维持。两项关键的财政支持，即远程编码和农村实践津贴，被取消。这直接导致了“没有医生就没有村庄”公共运动的成立，随后农村实践津贴演变成了农村支持实践框架，并扩大到覆盖更多的农村实践。2022 年 6 月在利默里克大学举行的世界农村卫生大会邀请了 600 多名专家代表参加，他们为利默里克宣言的撰写做出了贡献，该宣言是爱尔兰和国际上推进农村卫生的蓝图。这为爱尔兰农村全科医生的倡导工作创造了新的动力，吸引了财政投资，激发了研究兴趣，为培训农村全科医生的人才库建设提供了能力。
当地的声音推动了爱尔兰医疗保健背景下的巨大变革。对于这些社区来说，农村卫生的政策和政治只是维持或恢复他们生活方式的工具。最大的教训是，坚持不懈的社区承诺，在有能力进行倡导的支持下，可以影响政治和政策，以产生可持续的结果和繁荣的社区。
