After years of seeing the rural health sector getting less funding and support than their metro counterparts, researcher Tim Baker heard about a new concept that came out of the Scandinavian countries, which he thought went a long way to explain why the problem just kept persisting. 

"When big cities are seen as the center of everything," Baker says, "It gives rise to a narcissistic view in city dwellers that their urbanised view of the world is definitive." 

Therein lies the concept of "geographic narcissism": the notion that metropolitan experience is more valuable than rural experience and that people only practice in rural areas because they are unable to "make it" in the city.

The concept was first coined by Swedish psychologist Malin Fors and described in an article in the journal Psychoanalytic Psychology. Fors used the term to explain the rural-urban interactions she encountered while working in a small town north of the Arctic Circle in Norway. 

Tim Baker, who is an Associate Professor and Director at the Centre for Emergency Rural Health at Deakin University, told the Western Plains App the concept had also been described in other terms such as "urban splaining" – rural people are "talked down to" by their city counterparts. 

"For example, rural healthcare professionals are often asked by their urban contacts why they left the city. And when will they be going back? As if you only go there because you can't get a job in an urban area". 

"Rural professionals often laugh with recognition when hearing of geographic narcissism. But they often internalize these stereotypes, and it becomes a kind of self-identity". 



Timothy Baker. Image: Deakin University. 

Late last month the National Rural Health Alliance released a new report detailing a comprehensive analysis confirming what many of us suspected - a disparity between health spending per capita between metropolitan and nonmetropolitan areas. 

The Nation Rural Health Alliance's "Evidence Base for Additional Investment in Rural Health report found that "In the financial year FY2020-21, the health-spend shortfall between urban and rural citizens was $6.55 billion, or $848.02 per capita, per year". 

"This analysis shows the need for greater and more strategic investment in the health of rural Australians. There is clear evidence that per-person spending on healthcare is not equitable and that this inequity is contributing to poorer health outcomes experienced in rural areas," the report concluded. 

Baker's own most recent research presented at the National Rural Health Alliance's Rural Health Symposium, there is no difference in the types of medical conditions people are presenting within rural emergency hospital rooms than in metropolitan rooms: with heart, lung, and brain conditions all the most likely reasons people end up in emergency rooms. 

"EDs in all areas saw a similar spectrum of common diagnoses" The only difference is that "EDs in small rural towns saw the highest percentage of patients over 65 years old. Remote and very remote EDs saw the highest proportion of indigenous patients". 

To him, this reinforces the fact that rural hospitals have the same needs as metropolitan areas, but it might be the big hospital down the road from the people allocating the funding than the rural hospital six hours away that needs it more. 

"Geographical narcissism is all about self-centredness," he said, "The view that metropolitan places are of superior quality and have superior people." 

In that respect when it comes to funding allocations to rural health - it looks like this idea of metropolitan superiority has become a self-fulfilling prophecy.