Australian Institute of Health and Welfare (2022) Rural and remote health, AIHW, Australian Government, accessed 05 December 2022.
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Around 7 million people – or 28% of the Australian population – live in rural and remote areas, which encompass many diverse locations and communities (ABS 2022c). 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.
This report uses the Australian Statistical Geography Standard Remoteness Structure, 2016 (ABS 2021d) which defines remoteness areas in 5 classes of relative remoteness:
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 2021d).
This report uses the term ‘rural and remote’ to cover any area outside of Australia’s Major cities. Due to small population sizes, data for "Outer regional and remote" and "Remote and very remote" areas are sometimes combined for reporting.
The majority of Australians live in Major cities compared with rural and remote areas. As at 30 June 2021, the proportion of Australians by area of remoteness was:
Aboriginal and Torres Strait Islander people are more likely to live in urban and regional areas compared with more remote areas. However, the proportion of the total population who are Indigenous increases with remoteness from 1.8% in Major cities, to 32% in Remote and very remote areas based on estimated Indigenous population projections for 2021 (AIHW 2021i). Indigenous Australians have lower life expectancies, higher burden of disease, poorer self-reported health and a higher likelihood of being hospitalised than non-Indigenous Australians (AIHW 2022a; AIHW and NIAA 2020, 2021).
See Indigenous Australians
On average, people living in Remote and Very remote areas are younger than those in Major cities. Figure 1 shows the age and sex breakdown of each of the remoteness areas for 2020.
Figure 1: Australian population, by age groups, sex and area of remoteness, 2020
This graph shows the age and sex for each of the remoteness areas by age groups 0-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84 and 85+. The graph shows that on average, people living in Remote and very remote areas are younger than those in Major cities. The highest proportion of older Australians aged 85+ live in Inner regional and Outer regional areas.
In 2021, 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 (57%), Outer regional (54%) and Remote and very remote areas (57%) had completed Year 12, compared with three-quarters (77%) of those in Major cities (ABS 2021e).
Similarly, a smaller proportion of people aged 20–64 living in Inner regional (23%), Outer regional (18%) and Remote and very remote areas (19%) had completed a bachelor’s degree or above, compared with those in Major cities (41%) (ABS 2021e). Young people from rural and remote areas may be more likely to move to metropolitan areas to study and subsequently stay after completing their studies (Mackey 2019). 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 and Glover 2014; Regional Education Expert Advisory Group 2019).
Labour force data shows, in general, people aged 15 and over living in metropolitan (greater capital city) areas are more likely to be employed than people living outside these areas (ABS 2022b). This may be due to lower opportunities and access to work outside metropolitan areas and the smaller range of employment and career opportunities in these areas (ABS 2022b; 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 2022b).
Since March 2020, the impact of the COVID-19 pandemic has had a number of effects on a variety of health and non-health related activities, including employment.
See ‘Chapter 4 The impacts of COVID-19 on employment and income support in Australia’ in Australia’s welfare 2021: data insights.
Nationally representative estimates on risk factors and chronic conditions are derived from the Australian Bureau of Statistics' (ABS) National Health Survey (NHS).
Previous versions of the NHS have primarily been administered by trained ABS interviewers and were conducted face-to-face. The 2020–21 NHS was conducted during the COVID-19 pandemic. To maintain the safety of survey respondents and ABS Interviewers, the survey was collected via online, self-completed forms.
Non-response is usually reduced through Interviewer follow up of households who have not responded. As this was not possible during lockdown periods, there were lower response rates than previous NHS cycles, which impacted sample representativeness for some sub-populations. Additionally, the impact of COVID-19 and lockdowns might also have had direct or indirect impacts on people’s usual behaviour over the 2020–21 period.
Furthermore, there were changes to some modules used to collect information on risk factors as part of the 2020–21 NHS. Due to these changes, results from the NHS 2020–21 are not comparable with previous surveys. The AIHW are conducting further analyses to understand the impact of these changes for specific population groups before updating these data.
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, based on self-reported data from the NHS and after adjusting for age, 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 (Figure 2; Table S2).
More recent data for daily tobacco smoking from the National Drug Strategy Household Survey 2019 shows the age-standardised rate of daily smoking for people aged 14 and over increases with remoteness area, from 9.8% for those living in Major cities to 19.2% for those living in Remote and very remote areas (AIHW 2020b). See Alcohol, tobacco & other drugs.
Figure 2: Prevalence of the population with selected chronic conditions, by area of remoteness, 2017-18
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.
Health status, outcomes and service use are associated with age. This means that comparisons between population groups can be confounded by differences in their age distributions. Age-standardised rates are often used to compare outcomes for populations with different age structures, such as remoteness areas. As the purpose of this web report is comparisons between remoteness areas, age-standardised results have been used throughout. Unadjusted (crude) rates for health risk factors and chronic conditions are available in the supplementary data tables, and are often available in the referenced and/or linked reports.
Family, domestic and sexual violence is a major health and welfare issue in Australia. The ABS 2016 Personal Safety Survey estimated that 2.2 million adults had been victims of physical and/or sexual violence from a partner since the age of 15 (ABS 2017).
People living outside Major cities were 1.4 times as likely to have experienced partner violence than those living in Major cities. Additionally, people living in Remote and Very remote areas were 24 times as likely to be hospitalised for domestic violence as those in Major cities(AIHW 2019).
See Family, domestic and sexual violence.
The COVID-19 pandemic has impacted rural and remote communities in a multitude of ways. While the largest proportion of COVID-19 cases occurred in Major cities and decreased with increasing remoteness, a high proportion of residents in Very remote areas were affected by COVID-19. See 'Chapter 1 The impact of a new disease: COVID-19 from 2020, 2021 and into 2022' in Australia's health 2022: data insights. Health impacts from COVID-19 can be more severe for those with underlying chronic conditions or higher prevalence of risky health behaviours. With many of those increasing with remoteness, rural and remote communities are particularly vulnerable to enhanced health inequalities from COVID-19 (Lakhani et al. 2020). Additionally, some rural and remote communities face further challenges with the pandemic without the same resources available in urban centres, and longer travel distances required to access testing and vaccination (Carter et al. 2022). However, populations living in regional and remote areas are likely to have benefitted from the introduction of new Medicare Benefits Schedule telehealth services that came into effect in response to the pandemic.
See ‘Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights, and Impacts of COVID-19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme: quarterly data.
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, based on self-reported data from the NHS and after adjusting for age, 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 (Figure 3; Table S3). Additionally, the prevalence of multimorbidity – the presence of 2 or more chronic conditions in a person at the same time – was similar across remoteness areas (AIHW 2020a).
See Chronic disease and Chronic conditions and multimorbidity.
Figure 3: Prevalence of the population with selected chronic conditions, by area of remoteness, 2017-18
The age-standardised incidence rate of all cancers combined was highest in Inner regional and Outer regional areas in 2012–2016 (513 and 512 per 100,000 people, respectively), slightly lower in Major cities and Remote areas (both 487 cases per 100,000 people), and lowest in Very remote areas (422 cases per 100,000 people) (AIHW 2021f).
However, the incidence rate for all cancer for Very remote areas may be influenced by lower population screening participation rates, later detection of a cancer and lower life expectancy due to death from other causes (AIHW 2022b; Fox and Boyce 2014). Very remote areas had the highest incidence rate for cervical cancer, liver cancer, cancer of unknown primary site, uterine cancer and head and neck cancers (including lip).
In the period 2012–2016, people living in Major cities had the highest 5-year observed survival for all cancers combined (63%) while Very remote areas had the lowest (55%) (AIHW 2021f).
See Cancer in Australia 2021and Cancer.
Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury.
In 2018, 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 1.8 times as high as that of Major cities, while non-fatal burden rates – the rates of burden from living with ill health as measured by years lived with disability – were 1.1 times as high. Kidney and urinary diseases, injuries and infections were disease groups with noticeably higher rates of burden in Remote and very remote areas, compared with Major cities (more than twice as high) (AIHW 2021d).
See Australian Australian Burden of Disease Study and Burden of disease.
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 than those living in Major cities.
In 2020, age-standardised mortality rates increased as remoteness increased for males and females:
Males had a higher mortality rate than females in all remoteness areas, with the highest difference in Remote areas –at 1.5 times higher (AIHW 2022b) (Table 1).
See Causes of death.
Median age at death (Males)
Age-standardised rate (deaths per 100,00) (Males)
Rate ratio (Males)
Median age at death (Females)
Age-standardised rate (deaths per 100,00) (Females)
Rate ratio (Females)
Source: AIHW 2022b
Figure 4 shows the 10 leading causes of death for each remoteness area for the period 2016–2020, with comparison to mortality to rates for Australia overall (AIHW 2022b).
Source AIHW 2022b; Table S4.
The rate of potentially avoidable deaths – deaths under the age of 75 from conditions that are potentially preventable through primary or hospital care, such as cancer screening and transport accidents – increased as remoteness increased. For more details on examples and definitions of potentially avoidable deaths see Potentially avoidable deaths.
In 2020, 17% of all deaths in Australia were potentially avoidable. For males and females, the rate increased with remoteness. After adjusting for age, the rates of potentially avoidable deaths were:
See Mortality Over Regions and Time (MORT) books.
Estimates of life expectancy at birth represent the average number of years that a newborn baby can expect to live, assuming current age-specific death rates are experienced through their lifetime. In 2018–2020, life expectancy at birth was lower for those living outside of metropolitan areas (Table 2; ABS 2021b).
Rest of NSW
Rest of Vic.
Rest of Qld
Rest of SA
Rest of WA
Rest of Tas.
Rest of NT
Source: ABS 2021b.
People living in rural and remote areas face barriers to accessing health care, due to challenges of geographic spread, low population density, limited infrastructure, and the higher costs of delivering rural and remote health care.
Medicare claims data from 2020–21 show that the number of non-hospital non-referred attendances per person, such as general practitioner (GP) visits, were lower in Remote and Very remote areas (4.7 and 3.4 per person respectively), than in Outer regional areas (6.1 per person), Inner regional areas and Major cities (6.8 per person for each area) (Department of Health 2022).
However, bulk-billing rates were highest in Very remote areas (91%) and Major cities (90%) and slightly lower but similar in regional areas (87% in both Inner regional and Outer regional areas) and lowest in Remote areas (86%) (Department of Health 2022).
People living in Remote and Very remote areas also have lower rates of bowel, breast and cervical cancer screening (AIHW 2021e, 2021g, 2021h).
See General practice, allied health and other primary care services and Indigenous Australians and the health system.
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 most health professionals including specialists (all doctors other than GPs who require a referral from another doctor) dentists, pharmacists, and other allied health professionals, there is a marked decline in the rate of clinical full-time equivalent (FTE) practitioners per 100,000 population once outside Major cities with the notable exception of nurses and midwives. The FTE rate for nurses and midwives is higher in Remote and Very remote areas compared with Major cities, Inner regional and Outer regional (Department of Health 2020) (Figure 5; Table S5).
Although the 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.
Figure 5: Employed health professionals, clinical full-time equivalent (FTE) rate, by remoteness area, 2020
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
In 2019–20, people living in Very remote areas were hospitalised at almost twice the rate as people living in Major cities and those in Remote areas at 1.4 times the rate. There was no difference in rate of hospitalisations for regional areas compared with Major cities (AIHW 2021a). People in Major cities had higher rates of rehabilitation care compared with people living in other remoteness areas (18 hospitalisations per 1,000 population compared with 13 for Inner regional areas, 8 for Outer regional areas, 4 for Remote areas and 3 for Very remote areas). In part, this may reflect the distribution of private hospitals across remoteness areas, as private hospitals accounted for 80% of rehabilitation care separations (AIHW 2021b).
Potentially preventable hospitalisations (PPH) are for 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 in 2019–20 was:
For more information on rural and remote health please see:
Visit Rural and remote Australians for more on this topic.
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