Australian Universities Accord. Part 2: University research.

As noted in our earlier editorial, the Australian Universities Accord (AUA), https://www.education.gov.au/australian-universities-accord has been described as a once-in-a-generation review of every aspect of higher education in Australia. The final report will include recommendations and performance targets, which will seek to improve the quality, accessibility, affordability and sustainability of higher education. While some key rural and Indigenous health stakeholders have contributed to the review, we think it is vital that the AJRH community should be informed and engaged in these matters. As the review unfolds, it is incumbent on all of us to use the opportunities that arise to advocate for rural and remote health, education and research within Australian universities. To that end, being clear about our priorities and concerns will be vital. We are highlighting these implications in two parts. This issue focuses on university research, and our previous editorial considered university education. Research and development are linchpins to improving the health and well-being of individuals and communities, especially those underserved by traditional health care systems. It is vital to guide policy-makers, health care providers and communities towards healthier futures that will enable human, social and environmental flourishing. Universities Australia https://www.universitiesaustralia.edu.au/ calculates that increasing support for higher education research and development by just one per cent, lifts productivity and increases the size of the Australian economy by $24 billion over a 10-year period. The challenge for researchers and stakeholders focused on rural and remote health is how that research should be actualised. Submissions to the Australian Universities Accord indicate that currently, research funding (through competitive Commonwealth schemes) is concentrated in a small number of metropolitan-based universities, and it is disproportionately focused on specific disciplines. In general, our concern is that continuing with this concentration will further constrain the culture of innovation and investigation in remote, rural and regional Australia. It is precisely this culture which we require to improve rural health. Our starting point should be to better understand local health needs, promote preventative care, encourage local participation, strengthen health infrastructure and ultimately improve access to high-quality care. Some submissions argue that greater specialisation and differentiation is required. They have called for key universities to concentrate on advanced research and others on undergraduate teaching and professional training. This might include more focused national doctoral-level training and priority research centres. Their thesis is that more specialised institutions can achieve excellence within their sphere (whether fundamental research, applied research, undergraduate education, professional training, etc.). They argue that this would enable better leveraging, more effectively concentrate expertise, provide a critical mass, optimise infrastructure, focus partnerships with industry and better fulfil national priorities. Should we welcome such a reorientation? Would it provide us with the focus and impetus we need to make major gains in some of the vexing questions that plague rural, remote and Indigenous health? Would such a concentrated focus provide us with radical new solutions? Our contention is that such specialisation has strengths and limitations and may only be part of the solution for rural, remote and Indigenous research. A hallmark of rural and remote health is the focus on context. There is an understanding that the varied characteristics of our rural and remote contexts necessitate contextually relevant responses. While the wicked problems facing rural, remote and Indigenous health, health care and systems may indeed require radically new perspectives, strategies, policies and teams, they must come through research partnerships which are deeply embedded in those contexts. Many medical and treatment questions can indeed be researched in metropolitan settings and will have universal application. They can readily be translated to rural and remote settings. However, for the majority of more multidimensional questions, research must be contextually relevant, incorporating the nuances of implementation or engaging with the rural context, service, system, structural, cultural and other factors. Research serves as a catalyst for community participation which is essential to foster a sense of ownership and trust, both of which are crucial for the long-term success of any initiative being introduced. Beyond the initial research, meaningful and contextually relevant implementation is equally vital. Ideally, such implementation will include working closely with rural, remote and Indigenous communities, with local funding models and structures, with local staffing arrangements and with local providers and professionals. That will be best achieved through ongoing research partnerships. Likewise, appropriate scaling of research interventions is best ensured when they emerge out of existing relationships. When rural, remote and Indigenous health service providers have been integrally engaged, they will have the optimal capacity to innovate. They will be positioned to lead research-driven solutions that will recognise health disparities, address endemic diseases and incorporate lifestyle factors specific to rural and remote populations. Furthermore, they will be able to tailor services that bridge the geographical divide and deliver quality place-based health care. Another key concern of the AUA is research funding and how it should be allocated. As health researchers, we understand all-too-well that the funding pot is limited, and we want to see the best use of limited funds. We are also deeply committed to hallmarks such as excellence, rigorous methods, eminent teams and track record as likely to result in outcomes. However, since our area of research is characterised by relevance to practice and access, we realise that we also need to balance these hallmarks against the right locally generated questions, with the right team, in the right location. In such a case, quality is evident in contextually relevant methods, multidisciplinary research and projects, which are focused on the public good and potential social impact. Such studies will require a breadth of teams and a plurality of ways of conducting research. Understandably, the AUA has a strong interest in industry partnerships. Again, we strongly endorse the focus on practical and relevant research. For the rural health research community in many cases, the focus of partnerships and commercialisation should be broadened beyond traditional industries to include collaboration with the public and community sectors. As noted above, we hold that contextually relevant research which uses participatory approaches is going to be better value, in solving real-world problems, and will be more readily translated into practice. In particular, this will be exemplified in greater support for Indigenous-led research and for a stronger Indigenous voice in research. As reflected in the above points, rural, remote and Indigenous health researchers look towards the greater establishment of thriving, diverse research ecosystems across Australia well beyond the metropolitan centres. Beyond specialisation, this will require a commitment to ensure that research funding, teams and infrastructure are spread across the nation to position us to unlock valuable insights that will ultimately lead to better health outcomes for all Australians living in Indigenous, remote, rural and regional communities. As before, we welcome comments and discussion on these matters. All authors contributed equally to writing this editorial. No ethics approval is necessary.