Rural health care and epistemic injustice: Implications for education

PROBLEM: There is a global shortage of rural health human resources (RHHR) linked with documented poorer health outcomes in rural areas. This crisis continues to grow despite well-intentioned efforts within health professional education and health care systems to educate, attract and retain rural health care professionals (HCPs). Interventions to attract rural practitioners have focused on outreach: recruiting learners from, and longer exposure to, rural environments and communities. Despite evidence that these strategies can support the development of rural practitioners, they have been insufficient to address the growing magnitude of RHHR shortages. ANALYSIS: The authors propose considering impediments and barriers to this challenge through the lens of epistemic justice. Rural ways of knowing are less valued in educational culture that is most often situated in urban settings, with urbanormative values, and considers biomedical, technologically supported and specialised standards of health care as aspirational practices. This contrasts with generalist models of care in rural contexts where biomedical and scientific knowledge must be considered along with contextual, relational, experiential and ethical ways of knowing. Considering rural practice as 'lesser than' its urban counterparts creates conditions for epistemic injustice and its associated harms which can undermine the best efforts to develop resilient rural HCP. IMPLICATIONS: Epistemic justice is a framework to consider this complex challenge. The authors propose epistemic humility, embedded in the continuum of health professions education, as a strategy to make visible and value the multiple ways of knowing required for rural practice. This provides a novel approach to address the growing disparity in RHHR.