Whose rural? Shaping rural psychiatry training in Aotearoa New Zealand

Defining rurality matters in healthcare. Evidence supports the singularity of the rural experience and its detrimental impact on health outcomes and, specifically, on mental health. Yet, no internationally accepted definition of 'rural' exists. In Aotearoa New Zealand, the Geographical Classification for Health (GCH) has set out to describe rurality in terms of health outcomes from a primary health lens, using distance and population density to better understand and address health inequities between geographical areas. Adopted in the latest national health strategy, the GCH has limitations specifically in the context of considering new approaches to overcoming the historical shortage of a psychiatry workforce in areas beyond large metropolitan centres. As Aotearoa New Zealand implements the RANZCP's Rural Psychiatry Roadmap, contextual sensitivity will be key, with lessons learnt from Australian experiences critical in ensuring effective and efficient changes are made to improve workforce distribution through training systems. Careful consideration of the GCH when implementing the Roadmap, underpinned by a nuanced definition of rurality, will help the RANZCP fulfil its social contract with all communities across Aotearoa New Zealand and Australia, including those that face geographical challenges.