Defining rural in Aotearoa New Zealand: a novel geographic classification for health purposes

Saturday, September 17th, 2022 | claly44p | No Comments

Jesse Whitehead, Gabrielle Davie, Brandon de Graaf, Sue Crengle, David Fearnley, MicHelle Smith, Ross Lawrenson & Garry Nixon

NZMJ, Vol135, No 1559. Published August 5, 2022:

You’ve heard about it!  Now read in detail on how the Geographic Classification for Health in Aotearoa NZ was developed. A game-changer for rural health policy and delivery.


Aim: Describe the first specifically designed and validated five-level rurality classification for health purposes in New Zealand that is both data-driven and incorporates heuristic understandings of rurality. Method: Our approach involved: (1) defining the purpose and parameters of a proposed five-level Geographic Classification for Health (GCH); (2) developing a quantitative framework; (3) undertaking co-design with the National Rural Health Advisory Group (NRHAG), and extensive consultation with key stakeholders; (4) testing the validity of the five-level GCH and comparing it to previous Statistics New Zealand (Stats NZ) rurality classifications; and (5) describing rural populations and identifying differences in all-cause mortality using the GCH and previous Stats NZ rurality classifications.  Results: The GCH is a technically robust and heuristically valid rurality classification for health purposes. It identifies a rural population that is different to the population defined by generic Stats NZ classifications. When applied to New Zealand’s Mortality Collection, the GCH estimates a rural mortality rate 21% higher than for residents of urban areas. These rural–urban disparities are masked by the generic Stats NZ classifications. Conclusion: The development of the five-level GCH embraces both the technical and heuristic aspects of rurality. The GCH offers the opportunity to develop a body of New Zealand rural health literature founded on a robust conceptualisation of rurality.

Pacific doctor awarded rural health medal

Thursday, September 15th, 2022 | claly44p | 1 Comment

A Pacific doctor and Otago postgraduate student based in the Cook Islands, has been awarded the Dr Amjad Hamid Medal at the 2022 National Rural Health Conference held in Christchurch this month.

Dr Ruonamakin Rui Mafi (known as Dr Makin), who is practising medicine in the Cook Islands, says, “I’m so honoured to receive this award and for having been given the opportunity to study at the University of Otago by the Cook Islands Ministry of Health (Te Marae Ora).”

Dr Makin completed all her Otago study while based in the Cook Islands.

The Dr Amjad Hamid Medal is awarded to the student who achieves the highest grade in the University of Otago’s Cardiorespiratory Medicine in Rural Hospitals postgraduate paper.

The medal honours the memory of Dr Hamid, who was tragically killed in the 2019 Christchurch mosque attacks. It is awarded by the Royal New Zealand College of General Practitioners’ Division of Rural Hospital Medicine.

Dr Makin was born, raised and schooled in Kiribati and did her medical training at Fiji National University. During her internship she met her (now) husband, Dr Vakaola Mafi from Tonga, at Lautoka Hospital in Fiji. After her internship, Dr Makin worked in the ophthalmology department at Lautoka Hospital. In 2013, the couple decided to move with their young family to the Cook Islands to work and explore opportunities. In the Cook Islands, Dr Makin worked in a range of areas, including emergency and medical wards and obstetrics/gynaecology. She is currently working in primary care, emergency care and medical ward work when required, and also doing some work for the Cook Island Family Welfare Association.

The Cook Islands GP training programme, which includes University of Otago distance taught rural papers as the academic component, was established in 2016. Dr Makin started the rural programme papers in 2019 and has completed the Postgraduate Certificate (Rural and Provincial Hospital Practice). She is now undertaking her third paper (Medical Specialties) and is aiming to complete the Postgraduate Diploma in Rural and Provincial Hospital Medicine. Her ultimate goal is to combine clinical work and research.

Dr Makin says, “Further study has enhanced my clinical knowledge and skills in order to improve the management of our people in the Cook Islands, as well as the wider Pacific community…. A huge thank you to the University of Otago staff, my colleagues and family for their support.”

University of Otago Associate Dean Pacific (Christchurch) Dr Kiki Maoate says, “I congratulate Dr Makin on this wonderful achievement. It is also a great achievement for all the partners in the programme, in particular the Cook Islands Ministry of Health, and for Dr Makin’s family, for all their support….Juggling postgraduate study, especially distance learning, while working as a doctor can be demanding, but hopefully Dr Makin’s success will encourage other Pacific doctors to take this step.”

Note: Dr Makin’s husband, Dr Mafi, was the first Pacific Island-based doctor to be awarded the University of Otago’s Postgraduate Diploma in Rural and Provincial Hospital Medicine. See earlier story

Kōrero by Andrea Jones

Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand

Wednesday, August 24th, 2022 | claly44p | No Comments

Sue Crengle, Gabrielle Davie, Jesse Whitehead, Brandon de Graaf, Ross Lawrenson & Garry Nixon

OPEN ACCESS: Lancet Regional Health – Western Pacific 2022;28:100570. Published August 18, 2022 DOI:

This paper is the first to use the new Geographic Classification of Health ( to examine rural:urban differences and demonstrates how the GCH will impact health policy and research going forward.  Crengle et al. confirm that Māori living rurally face greater mortality incidence rates than non-Māori or urban-based Māori whereas previous studies, using older classifications, found rural Māori mortality was comparable to that of Māori living in metropolitan areas.


Background. Previous research identified inequities in all-cause mortality between Māori and non-Māori populations. Unlike comparable jurisdictions, mortality rates in rural areas have not been shown to be higher than those in urban areas for either population. This paper uses contemporary mortality data to examine Māori and non-Māori mortality rates in rural and urban areas. Methods. A population-level observational study using deidentified routinely collected all-cause mortality, amenable mortality and census data. For each level of the Geographic Classification for Health (GCH), Māori and non-Māori age-sex standardised all-cause mortality and amenable mortality incident rates, Māori:Non-Māori standardised incident rate ratios and Māori rural:urban standardised incident rate ratios were calculated. Age and deprivation stratified rates and rate ratios were also calculated. Findings. Compared to non-Māori, Māori experience excess all-cause (SIRR 1.87 urban; 1.95 rural) and amenable mortality (SIRR 2.45 urban; 2.34 rural) and in all five levels of the GCH. Rural Māori experience greater all-cause (SIRR 1.07) and amenable (SIRR 1.13) mortality than their urban peers. Māori and non-Māori all-cause and amenable mortality rates increased as rurality increased. Interpretation. The excess Māori all-cause mortality across the rural: urban spectrum is consistent with existing literature documenting other Māori health inequities. A similar but more pronounced pattern of inequities is observed for amenable mortality that reflects ethnic differences in access to, and quality of, health care. The excess all-cause and amenable mortality experienced by rural Māori, compared to their urban counterparts, suggests that there are additional challenges associated with living rurally.

New Zealand’s rural hospitals in 2021: findings from an exploratory questionnaire survey

Monday, August 22nd, 2022 | claly44p | No Comments

Katharina Blattner, Lynne Clay, Rory Miller, Garry Nixon, Sue Crengle, Lauralie Richard, Ray Anton, Tim Stokes

OPEN ACCESS Journal of Primary Health Care Published online: 18 August 2022

In 2021 I had the opportunity to work with Dr Kati Blattner on a project to explore the place of rural hospitals in Aotearoa, NZ.  My eyes were opened to the uniqueness of each and everyone of our rural hospitals and the challenges faced to provide equitable healthcare.  This short report presents one aspect of the research – a snapshot of how rural hospital leaders perceived the role of their hospital in a time of coronavirus and upcoming major change in the national health system. (L.C)


Introduction. There is a gap in our knowledge of the place and contribution of rural hospitals in the New Zealand health system. There is no current description of rural hospital services, no national policies and little published research regarding their value. Aim. To explore rural hospital leader perspectives of the role of rural hospitals. Methods. An on-line survey of rural hospital leaders conducted to capture perspectives on areas including facility nomenclature; access and equity; funding and the health reforms. Results. Fifty-five rural hospital leaders representing 19/24 rural hospitals responded. ‘Rural Hospital’ was the most common term used to describe facilities with 80% of respondents indicating this as their preferred term. Other descriptive terms varied widely from primary through to secondary care. Respondents indicated that the loss of rural hospital in-patient beds would be unacceptable to communities (median 0, IQR 0, 1). Scores on questions about ‘range of services’ (median 7, IQR 6, 8), ‘accessibility’ (median 7, IQR 6, 8) and how rural hospitals were addressing health equity (median 6, IQR 5, 7) were variable. The process for allocating funds to rural hospitals was perceived as lacking transparency (median 3, IQR 2, 5). National strategy and ‘local governance and control’ were both rated as important (median 9, IQR 7, 10 and median 9, IQR, 8, 10) for a rural hospital’s future. Discussion. By capturing a collective national rural hospital leadership voice, this study facilitates the understanding of the rural hospital concept. The findings inform subsequent research needed to gain a clearer picture of New Zealand rural hospital provision.

Inaugural Professorial Lecture – Professor Sue Crengle

Thursday, August 18th, 2022 | claly44p | No Comments

Hauora Māori – an ongoing journey

Sue Crengle (Kāi Tahu, Kāti Māmoe, Waitaha) is a GP and Public Health Physician.

Sue’s research focuses on Māori health equity and inequities in health status and health outcomes. She has a particular interest in health services research (especially primary care), youth health and mental health.

Sue uses Kaupapa Māori quantitative and qualitative methods and has had an increasing focus on trialling interventions to assess their impact on Hauora Māori outcomes.

This event will be live-streamed, from 5:25pm Tuesday 23 August 2022, and will be available after the event here.

Professor Sue Crengle’s IPL video stream

Date Tuesday, 23 August 2022
Time 5:30pm – 7:00pm
Audience Public,Undergraduate students,Postgraduate students,Staff,Alumni
Event Category Health Sciences
Event Type Inaugural Professorial Lecture
Campus Dunedin
Location Archway 1 Lecture Theatre, Union St East, Dunedin, Dunedin
Cost Free
Contact Name Bailey Mclean
Contact Phone +64 3 471 6113
Contact Email

Rural Recognition at 2022 RNZCGP: Awards and Honorary Fellowships

Thursday, July 28th, 2022 | claly44p | No Comments


Ma pango ma whero, ka oti te mahi (by black and red together the work is done).

Congratulations to Marara Koroheke-Rogers and Hone Taimona recognised with Honorary Fellowships to the Royal New Zealand College of General Practitioners. Ngā mihi nui ki a koe – huge gratitude to you on behalf of your Otago colleagues and the numerous rural medicine trainees and experienced doctors who have learned from you through our rural postgraduate papers, in partnership with Hauora Hokianga (@hokiangahealth).

In 2006, the Dunedin School of Medicine shifted the teaching of the rural context and Hauora Māori components of our rural postgraduate programme out of a Dunedin classroom and onto the Pa-te-Aroha Marae at Whirinaki in the South Hokianga. This was not just a change in location but a change in direction for the entire programme.

Marara and Hone, with Hauora Hokianga, have been partners since those early days. They occupy crucial roles that link the local health service, the community and the teaching.  Marara and Hone have also been active members of research teams and co-authors on publications.

“Marara and Hone are pioneers in delivering this type of postgraduate medical education. The knowledge they bring needs to be at the centre of all our rural health teaching and research” Associate Professor Garry Nixon, Department of General Practice and Rural Health.



Congratulations to Dr Jeremy Webber and Dr Sean Hanna who were honoured with Distinguished Fellowship awards. The Fellowship is awarded to GPs who have demonstrated sustained contributions to general practice, medicine, or the health and wellbeing of the community.

The next generation steps up. Dr Jeremy Webber was the first person to get a Fellowship in Rural Hospital Medicine the proper way, that is by doing the training programme and he has now turned that into a FDRHMNZ (Dist.)  Jeremy expanded his world view by spending time working in Australia before returning home and almost immediately taking on some important leadership roles, at Taupō hospital, in the Division of Rural Hospital Medicine as Chair of the Board of Studies and the first Clinical Director Rural Health for Hauora Taiwhenua. Thanks for your efforts Jeremy and the great way you approach the people and issues you deal with.  Jeremy is also the packhorse in any Godzone Team and the powerhouse in any packraft. Ngā mihi


Dr Sean Hanna is a Wellington-based general practitioner, who has been the medical educator for Otago’s Rural Medical Immersion Programme since its early days. He is highly respected for his work as a specialist general practitioner in Takapūwāhia Porirua, his commitment to delivering health care to young people, his advocacy for equity in healthcare and his contribution to education. He has also made a significant contribution to rural health both in his RMIP role and as a rural doctor in the Hokianga.




The Eric Elder Medal is awarded in honour of Dr Eric Elder, who was an inspired rural GP affectionately known as the grandfather of vocational training in New Zealand. The medal is generally awarded to a rural general practitioner.  This year the award has gone to Dr Nina Stupples – congratulations Nina!

Dr Nina Stupples has worked in her Westport community for 13 years, providing consistent and quality care to her patients and ensuring they have access to high quality hospital care when required. She has been instrumental in the developing Rural Hospital Medicine in New Zealand, being the Chair of the Rural Hospital Division from 2010 until 2014, laying the foundation for the first truly generalist training programme in the country. The key feature of this programme was combining both Rural Hospital Medicine and Rural General Practice into a single training programme, with dual fellowship being an option in both vocational scopes of practice.

Nina has mentored many registrars in Westport, alongside her day-to-day practice and involvement with the Division, and she also teaches students in the Rural postgraduate programme and Rural Medical Immersion Programme at the University of Otago.  New Zealand rural health has benefitted from Nina’s hard work and dedication to the profession.

The allied health workforce of rural Aotearoa New Zealand: a scoping review

Wednesday, July 20th, 2022 | claly44p | No Comments

Walker Sarah M., Kennedy Ewan, Nixon Garry, Blattner Katharina (2022) The allied health workforce of rural Aotearoa New Zealand: a scoping review. Journal of Primary Health Care.

 Open Access

 Great to see a focus on rural allied health professionals (AHP) who are often under-appreciated when we consider optimising health outcomes in our rural communities.  The lack of published material will not be surprising to AHP living and working in rural/remote Aotearoa and I applaud Sarah and colleagues for starting this narrative and highlighting important areas for research that could address rural AHP workforce capacity, capability, recognition and career progression.



Introduction: The allied health workforce is a crucial, if at times poorly visible, component of modern healthcare systems. The services provided by allied health professionals may be particularly important for underserved populations, including rural and remote communities.

Aim: To determine what is currently known through research about the allied health workforce in rural Aotearoa New Zealand.

Method: A scoping review of diverse sources of literature from Aotearoa New Zealand was obtained from seven databases (July 2011–July 2021).

Results: Eighty-nine articles were identified, of which 10 met the inclusion criteria; nine empirical studies and one narrative review. The included research fell into two main categories: geographic workforce distribution (n = 8), and the role of the rural allied health workforce (n = 2).

Discussion: The paucity of research that meets the criteria for inclusion makes it difficult to draw conclusions about the allied health workforce in rural Aotearoa New Zealand. There is a focus in both the international rural allied health literature and the Aotearoa New Zealand rural medical and nursing literature on: measuring geographic workforce distribution; and rural-specific training. This suggests that these issues are important to the rural workforce. Similar research is needed in Aotearoa New Zealand to inform policy and ensure the rural allied health workforce reaches its full potential in improving health outcomes for rural New Zealanders.

Congratulations to Rural Health Researchers!

Friday, July 1st, 2022 | claly44p | No Comments

Our shining stars, Dr Rory Miller and Assoc Prof Garry Nixon are among 22 University of Otago researchers to receive Health Research Council funding in the latest round.  Check out the full report. – well worth it for the photos! 

Awesome to see rural health research being supported!

“Dr Rory Miller, of the Department of General Practice and Rural Health, will assess a pathway to allow patients who develop chest pain to remain closer to their communities and whanau by accessing blood testing technology which is as accurate as those available in urban emergency departments.”

“Associate Professor Garry Nixon, of the Department of General Practice and Rural Health, is seeking to better understand the impact of rurality on health outcomes and healthcare delivery.  Aotearoa has not undertaken much research into the health status of rural communities, so he wants to find out how rurality, ethnicity and socioeconomic status interact to impact on health outcomes and access to health services for New Zealanders, how people move between urban and rural areas when they become unwell, and how much public healthcare rural New Zealanders consume, in dollar terms, compared to their urban compatriots.”


26th July 2022 – CME Webinar: Bare Bones of Flaming Joints

Wednesday, June 22nd, 2022 | claly44p | No Comments

Want to know the latest on inflammatory arthropathy? – well tune in on the 26th July at 730pm and I think we will answer most, if not all of your questions!
Register in advance for this meeting:

After registering, you will receive a confirmation email containing information about joining the meeting.

For more information contact Dr Lucinda Thatcher, Rural CME Convenor