Rural and remote areas tend to overlap with areas identified as the most disadvantaged in Australia (ABS 2018a). Australians living in rural and remote areas, on average, have shorter lives, higher death rates, higher levels of disease and injury, and poorer health outcomes compared with people living in metropolitan areas (AIHW 2019b, 2020b). This can be linked to multiple factors including lifestyle risk factors, socioeconomic disadvantages and poorer access to health services (NRHA 2011).
The health disadvantages of communities in rural and remote Australia can also be impacted by the availability of health care services. Accessibility issues, such as access to dental, general practitioner and community services, and higher prevalence of health risk factors, such as higher rates of smoking, disability and physical inactivity, can all contribute to poorer health outcomes (NRHA 2011).
For more information, see Rural & remote health.
In Australia, chronic conditions and diseases are the leading cause of ill health, disability and death, having a significant impact on the health sector in all regions. Although the prevalence of many health conditions does not vary between people living in areas of increasing remoteness, some conditions are reported more frequently among people living outside of Major cities. These include mental and behavioural conditions, arthritis, back pain and asthma (AIHW 2019b). Alongside the factors identified above, differences in the rates of these chronic conditions may contribute to the poorer health outcomes of Australians living in rural and remote communities.
Similar patterns in health conditions and remoteness are observed among older Australians (aged 65 and over) specifically. For example, compared with older people living in Major cities, older people living in rural and remote areas have a higher prevalence of chronic conditions such as arthritis, asthma and chronic obstructive pulmonary disease (ABS 2018c). Although differences exist in these specific conditions, no differences were detected between remoteness categories in the presence of multiple chronic conditions more generally in 2017–18: around 1 in 2 older people reported having 2 or more chronic conditions in Major cities (50%), Inner regional (51%) and Outer regional, remote and very remote areas (50%). In comparison, around 1 in 6 (17%) older people in Inner regional areas, and around 1 in 5 in Major cities (21%) and Outer regional, remote and very remote areas (23%), reported having no chronic conditions (ABS 2018c).
The differing sociodemographic profiles of urban and remote communities also likely explain some of the divergence in health conditions and outcomes between these regions. For instance, there are differences in age composition and other demographic characteristics associated with health and wellbeing. At 30 June 2020, around 1 in 10 (9%) people living in Very remote areas were aged 65 and over, compared with 1 in 7 (15%) in Major cities. Moreover, at 30 June 2016, around 1 in 5 (22%) older people living in Very remote areas were Aboriginal and/or Torres Strait Islander people, compared with only 0.5% in Major cities (ABS 2018b). Indigenous Australians tend to develop chronic conditions earlier in life and are more likely to have higher rates of hospitalisations and poorer health outcomes than non-Indigenous Australians (AIHW 2019b).
For more information on Aboriginal and Torres Strait Islander health by remoteness, see Aboriginal and Torres Strait Islander Health Performance Framework (HPF) report and Older Aboriginal and Torres Strait Islander people.
The prevalence of disability among older Australians has remained stable over recent years. Based on data from the 2018 Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers (SDAC), 1 in 2 (50%) older people had disability in 2018. This was similar in 2015 (51%) and 2012 (53%) (ABS 2019a; AIHW analysis of ABS 2019c). Even though the proportion of older people with disability has been stable, the number of older people with disability has increased:
- 1.94 million in 2018
- 1.80 million in 2015
- 1.72 million in 2012 (AIHW analysis of ABS 2013, 2016, 2019c).
Of these older Australians with disability, 1 in 3 (34%) lived in rural and remote areas (AIHW analysis of ABS 2019c). Overall, the prevalence of disability among older Australians did not vary systematically by level of remoteness, with a slightly lower prevalence of older Australians with disability in Major cities (49%) and Outer regional areas (49%), and a slightly higher prevalence in Inner regional (52%) and Remote areas (55%) (AIHW analysis of ABS 2019c). However, looking solely at those older Australians with disability who report mild limitations in core activities, a step-wise relationship between prevalence of disability and level of remoteness was observed: lowest in Major cities (19%), followed by Inner regional (21%), Outer regional (22%) and Remote (27%) areas. This relationship does not extend to those older Australians with disability who report other levels of limitation in core activities; for example, moderate limitations were most prevalent in Inner regional areas (8.7%), whereas severe limitations were most prevalent in Remote areas (9.1%).
People living in rural and remote areas are more likely to die at a younger age than their counterparts living in Major cities among both men and women. 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 (Figure 2D.2).
Across Australia in 2018, the median age at death decreased as remoteness increased for both sexes and the overall population. Men had the lowest median age at death across the remoteness areas: 68 years in Very remote areas compared with 79 years in Major cities (Table 2D.1). Of the total number of deaths that occurred in Very remote areas in 2018, 2 in 3 (67%) were premature deaths – people aged under 75. Around 3 in 5 (61%) of these premature deaths were considered to be potentially avoidable. In contrast, 33% of all deaths were premature deaths in Major cities, of which nearly half (48%) were considered potentially avoidable (AIHW 2020c) (Figure 2D.2). As discussed in ‘Chronic conditions’ below, the differences between remoteness areas may be due to the characteristics of the population.