Around 7 million people—about 28% of the Australian population—live in rural and remote areas, which encompass many diverse locations and communities (ABS 2019d). These Australians face unique challenges due to their geographic location and often have poorer health outcomes than people living in metropolitan areas. Data show that people living in rural and remote areas have higher rates of hospitalisations, deaths, injury and also have poorer access to, and use of, primary health care services, than people living in Major cities.

Despite poorer health outcomes for some, the Household, Income and Labour Dynamics in Australia (HILDA) survey found that Australians living in towns with fewer than 1,000 people generally experienced higher levels of life satisfaction than those in urban areas and major cities (Wilkins 2015).

How is remoteness area classified?

The Australian Statistical Geography Standard Remoteness Structure, 2016 defines remoteness areas in 5 classes of relative remoteness across Australia:

  • Major cities
  • Inner regional
  • Outer regional
  • Remote
  • Very remote.

These remoteness areas are centred on the Accessibility/Remoteness Index of Australia, which is based on the road distances people have to travel for services (ABS 2018a).

The term ‘rural and remote’ covers all areas outside Australia’s Major cities. It is worth noting that Major cities excludes some capital and large cities such as Hobart and Darwin (ABS 2018a). Due to small numbers of people living in some remoteness areas, data have been combined. However, this has been avoided where possible (ABS 2018c).

Profile of rural and remote Australians

Age

On average, people living in Remote and very remote areas are younger than those in Major cities. In 2017:

  • Remote and very remote areas had a higher proportion of people aged 0–14 (22%) than Major cities (19%) and Inner regional and outer regional (19%) areas
  • Remote and very remote areas also had a higher proportion of people aged 25–44 (30%) than Inner regional and outer regional areas (23%) but, was similar to Major cities (30%)
  • Remote and very remote areas had a lower proportion of people aged 65 and over (11%) than Inner regional and outer regional areas (19%) and Major cities (14%) (ABS 2018b).

This page provides an overall picture of the health of rural and remote Australians. Poor health outcomes among people in these areas are influenced by the high proportion of Aboriginal and Torres Strait Islander people living in these areas. In 2016, 18% of people living in Remote and 47% in Very remote areas were Indigenous compared with 1.7% in Major cities. However, more Indigenous Australians live in non-remote areas (81% of Indigenous Australians) than remote areas (19% of Indigenous Australians) (AIHW 2019f).

Indigenous Australians have lower life expectancies, higher rates of chronic and preventable illnesses, poorer self-reported health and a higher likelihood of being hospitalised than non-Indigenous Australians. Therefore, differences in health with increasing remoteness could also be explained by the poorer health of the Indigenous population living in these areas (AIHW 2014).

See Profile of Indigenous Australians.

Education

In 2019, people aged 20–64 living in rural and remote areas were less likely than those in Major cities to have completed Year 12 or a non-school qualification. Around half the people living in Inner regional (53%), Outer regional (52%) and Remote and very remote areas (55%) had completed Year 12, compared with three-quarters (75%) of those in Major cities (ABS 2019a).

Similarly, a smaller proportion of people aged 20–64 living in Inner regional (21%), Outer regional (18%) and Remote and very remote areas (20%) had completed a bachelor’s degree or above, compared with those in Major cities (37%) (ABS 2019a). However, people may be more likely to move to metropolitan areas to study and subsequently stay after completing their studies (Australian Clearinghouse for Youth Studies 2015). The education levels of people living in rural and remote areas are also influenced by factors such as decreased study options, the skill and education requirements of available jobs and the earning capacity of jobs in these communities (Lamb & Glover 2014; Regional Education Expert Advisory Group 2019).

Employment and income

In general, people aged 15 and over living in metropolitan areas are more likely to be employed than people living outside these areas (AIHW 2019f). This may be due to lower levels of access to work outside metropolitan areas and the smaller range of employment and career opportunities in these areas (ABS 2019c; NRHA 2013).

People living in rural and remote areas also generally have lower incomes but pay higher prices for goods and services (NRHA 2014). In 2017–18, Australians living outside capital cities had, on average, 19% less household income per week compared with those living in capital cities, and 30% less mean household net worth (ABS 2019b).

Health risk factors

Health risk factors such as smoking, overweight and obesity, diet, high blood pressure, alcohol consumption and physical activity can influence health outcomes and the likelihood of developing disease or health disorders.

In 2017–18, people living in Inner regional and Outer regional and remote areas were more likely to engage in risky behaviours, such as smoking and consuming alcohol at levels that put them at risk of life-time harm, compared with people living in Major cities (AIHW 2019f) (Figure 1).

More recent data for daily tobacco smoking and alcohol consumption levels, including for very remote areas, is available at Alcohol, tobacco & other drugs.
 

This chart shows the prevalence of health risk factors including, current daily smoking, excessive alcohol consumption, inadequate fruit intake, inadequate vegetable intake, daily sugar drink consumption, insufficient physical activity, overweight and obesity and high blood pressure by remoteness area. For most risk factors, prevalence was higher in Inner regional and Outer regional and remote areas compared with Major cities with the exception of inadequate vegetable intake, insufficient physical activity and high blood pressure which were similar.

Health status

Chronic conditions

Chronic conditions are long-lasting and have persistent effects throughout a person’s life. They are becoming increasingly common and are influenced by a wide variety of factors.

In 2017–18, people living outside Major cities had higher rates of arthritis, asthma and diabetes, while mental and behavioural conditions were higher in Inner regional areas compared with Outer regional and remote areas and Major cities. However, rates of all other conditions were similar across remoteness areas (AIHW 2019f) (Figure 2). See Chronic conditions and multimorbidity and Indigenous health and wellbeing.
 

This chart shows the prevalence of chronic conditions including arthritis, asthma, back pain and problems, chronic obstructive pulmonary disease, diabetes, heart, stroke and vascular disease, mental and behavioural problems and osteoporosis by remoteness area. The prevalence of most chronic conditions was similar across remoteness areas but rates of asthma, arthritis and diabetes were higher outside of Major cities.

Burden of disease

In 2015, after adjusting for age, the total burden of disease and injury in Australia increased with increasing remoteness. Major cities experienced the least burden per population, while Remote and very remote areas experienced the most. The rate of disease burden in Remote and very remote areas was 1.4 times as high as that for Major cities.

This pattern was mostly driven by fatal burden (years of life lost due to premature death). In Remote and very remote areas, fatal burden rates were 1.7 times as high as that of Major cities, while non-fatal burden rates were 1.2 times as high. Kidney and urinary diseases and injuries were disease groups with particularly higher rates of burden in Remote and very remote areas, compared with Major cities (more than twice as high) (AIHW 2019b). See Burden of disease.

Deaths

People living in rural and remote areas are more likely to die at a younger age than their counterparts in Major cities. They have higher mortality rates and higher rates of potentially avoidable deaths—deaths under the age of 75 from conditions that are potentially preventable through primary or hospital care—than those living in Major cities.

In 2018, age-standardised mortality rates increased as remoteness increased for males and females:

  • Males living in Very remote areas had a mortality rate 1.5 times as high as those living in Major cities.
  • Females living in Very remote areas had a mortality rate 1.7 times as high as those living in Major cities (AIHW 2019e) (Table 1).

See Causes of death.

Table 1: Median age at death, mortality rate, and rate ratio, by sex and remoteness area, 2018

 

Major cities

Inner regional

Outer regional

Remote

Very remote

Median age at death (years) (Males)

79

78

76

73

68

Age-standardised rate (deaths per 100,000) (Males)

567

648

696

729

834

Rate ratio (Males)

1.0

1.1

1.2

1.3

1.5

Median age at death (years) (Females)

85

84

83

80

70

Age-standardised rate (deaths per 100,000) (Females)

405

463

467

488

680

Rate ratio (Females)

1.0

1.1

1.2

1.2

1.7

  1. Rates are age standardised to the 2001 Australian population.
  2. Rate ratio is the age-standardised mortality rate for each area divided by the age-standardised rate for Major cities.

Source: AIHW 2019e.

Health care

The challenges of geographic spread, low population density, limited infrastructure and the higher costs of delivering rural and remote health care can affect access to health care.

Primary health care

People living in Remote and Very remote areas generally have poorer access to health services than people in regional areas and Major cities. Medicare claims data from 2018–19 show that the numbers of non-hospital non-referred attendances per person, such as GP visits, were lower in Remote and Very remote areas (4.8 and 3.6 per person respectively), than in Outer regional areas (6.0 per person), Inner regional areas and Major cities (6.4 per person for each area) (Department of Health 2019).

People living in rural and remote areas face barriers to accessing health care, including that they often have to travel very long distances to get the care they need due to lack of nearby health services (AIHW 2020). However, bulk-billing rates were highest in Very remote areas (89%) and Major cities (87%) and slightly lower but similar in regional areas (84% in Inner regional and 85% in Outer regional areas) (Department of Health 2019). It should be noted that the above bulk-billing rates refer only to services where a bulk-billing option was provided. It should also be interpreted that these rates do not describe the proportion of patients who were entirely bulk-billed for their services.

People living in Remote and very remote areas also have lower rates of bowel, breast and cervical cancer screening and higher rates of potentially preventable hospitalisations (AIHW 2018, 2019a, 2019c, 2019d, 2020b).

See Primary health care and Indigenous Australians’ use of health services.

Health workforce

Australians living in Remote and Very remote areas experience health workforce shortages, despite having a greater need for medical services and practitioners with a broader scope of practice (AMA 2017). For nearly all types of health professions there is a marked decline in the rate of clinical full-time equivalent (FTE) practitioners per 100,000 population once outside Major cities. For example, the rate of specialists (all doctors other than GPs who require a referral from another doctor) substantially declined from 143 per 100,000 in Major cities to 83 in Inner regional areas, 63 in Outer regional areas, 61 in Remote areas and 22 in Very remote areas. However, the FTE rate for nurses and midwives is higher in Remote and Very remote areas compared with Major cities, Inner regional and Outer regional and remote areas (Figure 3) (ABS 2019d; Department of Health 2020).

Although the clinical FTE rate for GPs increases with increasing remoteness, care should be taken in interpreting the data, as work arrangements in these areas have the potential to be more complicated (NRHA 2017). For example, there may be poor differentiation between general practice for on-call hours, activity for procedures and hospital work for GPs working in rural and remote areas, which affects the accuracy of statistics on GP supply and distribution (Walters et al. 2017).

See Health workforce.
 

This chart shows the clinical FTE rate of health professionals including dentists, general practitioners, nurses and midwives, occupational therapists, optometrists, pharmacists, physiotherapists, podiatrists, psychologists and specialists by area of remoteness. The clinical FTE rate of most health professionals declined outside Major cities. Optometrists and podiatrists had the lowest rates in Remote and Very remote areas and Nurses and midwives had the highest rates.

Potentially preventable hospitalisations

Potentially preventable hospitalisations (PPH) are conditions where hospitalisation could have potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management, usually delivered in primary care and community-based settings. When compared with Major cities, the rate of PPH for those in Very remote areas was 2.5 times as high and in Remote areas was 1.7 times as high in 2017–18. For regional areas, the PPH rates were slightly higher than for Major cities (AIHW 2019a). See ‘Potentially preventable hospitalisations—an opportunity for greater exploration of health inequity’ in Australia’s health 2020: data insights.

Where do I go for more information?

For more information on rural and remote health please see:

Visit Rural and remote Australians for more on this topic.

References

ABS (Australian Bureau of Statistics) 2018a. Australian Statistical Geography Standard (ASGS): Volume 5—Remoteness structure, July 2016. ABS cat. no. 1270.0.55.005. Canberra: ABS.

ABS 2018b. Population by age and sex, regions of Australia, 2017. ABS cat. no. 3235.0. Canberra: ABS. Derived by AIHW from SA1 estimated resident population.

ABS 2018c. Remoteness structure. Canberra: ABS. Viewed 14 May 2019.

ABS 2019a. Education and work, Australia, May 2019. ABS cat. no. 6227.0. Canberra: ABS.

ABS 2019b. Household income and wealth, Australia, 2017–18. ABS cat. no. 6523.0. Canberra: ABS.

ABS 2019c. Labour force, Australia; detailed electronic delivery, December 2018. ABS cat. no. 6291.0.55.001. Canberra: ABS.

ABS 2019d. Regional population growth, Australia, 2017–18. ABS cat. no. 3218.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2014. Australia's health 2014. Cat. no. AUS 178. Canberra: AIHW.

AIHW 2018. Australia’s health 2018. Australia’s health series no. 16. Cat. no. AUS 221. Canberra: AIHW.

AIHW 2019a. Admitted patient care 2017–18: Australian hospital statistics. Health services series no. 90. Cat. no. HSE 225. Canberra: AIHW.

AIHW 2019b. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.

AIHW 2019c. BreastScreen Australia monitoring report 2019. Cat. no. CAN 128. Canberra: AIHW.

AIHW 2019d. National Bowel Cancer Screening Program: monitoring report 2019. Cancer series no. 125. Cat. no. CAN 125. Canberra: AIHW.

AIHW 2019e. National Mortality Database. Findings based on our unit record analysis. Canberra: AIHW.

AIHW 2019f. Rural & remote health. Cat. no. PHE 255. Canberra: AIHW. Viewed 29 October 2019.

AIHW 2020. Coordination of health care: experiences of barriers to accessing health services among patients aged 45 and over. Cat. no. CHC 04. Canberra: AIHW.

AMA (Australian Medical Association) 2017. Rural workforce initiatives 2017. Canberra: Australian Medical Association. Viewed 17 June 2019.

Australian Clearinghouse for Youth Studies 2015. Engaging young people in regional, rural and remote Australia. Tasmania: Australian Clearinghouse for Youth Studies. Viewed 24 June 2016.

Department of Health 2019. Annual Medicare statistics. Canberra: Department of Health. Viewed 16 September 2019.

Department of Health 2020. Health workforce data tool. Canberra: Department of Health. Viewed 20 February 2020.

Lamb S & Glover S 2014. Educational disadvantage and regional and rural schools. Melbourne: Mitchell Institute for Health and Education Policy, Victoria University.

NRHA (National Rural Health Alliance) 2013. A snapshot of poverty in rural and regional Australia. Canberra: NRHA. Viewed 25 June 2019.

NRHA 2014. Income inequality experienced by the people of rural and remote Australia. Canberra: NRHA.

NRHA 2017. Health workforce. Canberra: NHRA. Viewed 25 June 2019.

Regional Education Expert Advisory Group 2019. National Regional, Rural and Remote Education Strategy: final report. Canberra: Department of Education. Viewed 20 February 2020.

Walters L, McGraik M, Carson D, O’Sullivan B, Russell D, Strasser R et al. 2017. Where to next for rural general practice policy and research in Australia? The Medical Journal of Australia 207:56–58.

Wilkins R 2015. The Household, Income and Labour Dynamics in Australia Survey: selected findings from waves 1 to 12. Melbourne: Melbourne Institute of Applied Economic and Social Research.