Across a range of measures, the health status of Australians living in rural areas tends be lower than for Australians living in major cities. These patterns are also evident across many of the major determinants of health status. For example, in 2004-05, tobacco use was between 15% and 30% higher outside of major cities and risky or high risk alcohol consumption was between 16% and 30% higher outside of major cities (AIHW 2008).

Life expectancy decreases with remoteness, with people in very remote areas having life expectancy that is 6.9 years (males) and 6.2 years (females) lower than their counterparts in major cities (AIHW 2008). Similar patterns are evident in relation to mortality rates. As is shown in Table 12 standardised mortality ratios are higher outside of major cities, particularly for the population under age 65. A major contributor to lower life expectancy and higher mortality is Aboriginal and Torres Strait Islander people, who make up larger proportions of rural and remote populations. Aboriginal and Torres Strait Islander populations have an even significantly

Table 12 – Standardised mortality ratio relative to major cities (2002-04)

Statistic Inner regional Outer regional Remote Very remote Indigenous
Total 1.07 1.11 1.05 1.00 3.20
Total <65 years 1.14 1.23 1.10 1.13 4.87

Source: AIHW 2008


Beyond life expectancy and mortality, self-reported health status is lower outside of major cities, with people in rural areas reporting their health to be very good or excellent at a 10% lower rate.

Several indicators suggest rates of chronic disease prevalence are higher in rural and remote Australia. Table 13 presents data on rate ratios for several key chronic illnesses, based on self-reported data. Higher rates are reported for several of the chronic diseases, but not all, although this may reflect some of the weaknesses for self-reported data.

Table 13 – Chronic disease self-reported prevalence rate ratios by region (2004-05)
Disease Major cities Inner regional Outer regional and remote All regional/ remote
Diabetes 1.00 1.03 1.04 1.03
Cerebrovascular disease 1.00 0.78 1.19 0.93
Osteoporosis 1.00 0.90 0.67* 0.82*
Asthma 1.00 1.22* 1.08 1.16*
Bronchitis 1.00 1.17 1.36* 1.24*
Coronary heart disease 1.00 1.14 0.63* 0.95

Source: AIHW 2008 *Statistically significant difference to Major Cites



Table 14 presents rate ratios for incidents rates for several common cancers across remoteness areas. With the exception of breast cancer, incident rates tend to be higher in rural and remote areas. (Breast cancer incidence will be impacted by the participation in mammography screening.) Incident rates tend to be lower than average in very remote areas.

Table 14 – Standardised cancer incidence ratio by region (2001-03)Top of page
Cancer type Major cities Inner regional Outer regional Remote Very remote
Colorectal (all) 1.00 1.04* 1.04* 1.01 0.77*
Breast (female) 1.00 0.98* 0.91* 0.89* 0.78*
Prostate (male) 1.00 1.03* 1.02 1.01 0.78*
Lung (all) 1.00 1.02 1.09* 1.11 1.36*
Melanoma (all) 1.00 1.24* 1.15* 1.11* 0.78*

Source: AIHW 2008 *Statistically significant difference to Major Cites



While there are mixed indicators in terms of self-reported cancer prevalence and incidence, there are clearer indicators in relation to mortality related to common chronic diseases (Table 15). Across several of the major causes of death, mortality ratios are significantly higher than for major cities.

Table 15 – Standardised mortality ratios by region and cause of death 2002-04
Cancer type Major cities Inner regional Outer regional Remote Very remote
Prostate cancer (male) 1.00 1.20* 1.21* 1.00 0.79
Lung cancer (male) 1.00 1.05* 1.11* 0.96 1.30*
Lung cancer (female) 1.00 1.05* 1.12* 1.13 1.11
Diabetes (male) 1.00 1.06* 1.32* 1.89* 3.27*
Diabetes (female) 1.00 1.12* 1.42* 2.47* 5.45*
Coronary heart disease (male) 1.00 1.09* 1.15* 1.16* 1.42*
Coronary heart disease (female) 1.00 1.07* 1.08* 1.08 1.46*
Other circulatory disease (male) 1.00 1.16* 1.30* 1.47* 1.94*
Other circulatory disease (female) 1.00 1.18* 1.27* 1.45* 2.44*

Source: AIHW 2008 *Statistically significant difference to Major Cites



The disease burden of the Aboriginal and Torres Strait Islander population is significantly higher than for the rest of the Australian population. While there are several diseases with lower rates of self-reported incidence, other diseases are many times as prevalent in the Aboriginal and Torres Strait Islander population. Table 16 shows the higher rates of disease amongst Aboriginal and Torres Strait Islander people for some common diseases.

Table 16 – Aboriginal and Torres Strait Islander chronic disease self-reported prevalence rate ratios by region (2004-05)
Disease Major cities Inner regional Outer regional Remote/very remote
Diabetes 3.22* 3.18* 4.12* 5.48*
Cerebrovascular disease 0.93 2.06 1.61 3.01
Osteoporosis 0.99 1.24 0.82 0.33*
Asthma 1.79* 1.76* 1.42* 0.91
Bronchitis 2.32* 3.09* 2.06* 0.64*
Coronary heart disease 3.80* 1.92 2.04 2.03

Source: AIHW 2008 *Statistically significant difference to Major Cites (total population)



In summary, there is strong evidence that health needs in relation to a range of chronic illnesses are higher for people living in rural and remote Australia. A major factor driving this pattern is the poorer health status of Aboriginal and Torres Strait Islander peoples, but health disadvantages are also experience by non-Indigenous Australians living in rural and remote areas.

There is also a considerable body of evidence related to other health conditions. The evidence of differentials in eye health for Aboriginal and Torres Strait Islander people were estimated in the National Indigenous Eye Health Survey (Taylor et al. 2009). The survey found that while Aboriginal and Torres Strait Islander children have better vision than other Australian children, they were exposed to a range of factors that contribute to poor eye health in later life. It was estimated that Aboriginal and Torres Strait Islander adults have more than six times as much blindness compared with other Australian adults, and more than three times as much vision loss.

The survey also found 35% of Aboriginal and Torres Strait Islander adults had never had an eye examinations. An estimated 94% of vision loss for Aboriginal and Torres Strait Islander people was potentially preventable. Refractive error was the most common reason for vision loss. However, only 20% of Aboriginal and Torres Strait Islander adults wore glasses compared with 56% in the mainstream.

Cataracts causing blinding was 12 times more common for Aboriginal and Torres Strait Islander adults, but could be prevented through timely access to eye surgery. In the survey sample, 37% of Aboriginal and Torres Strait Islander adults had diabetes, but only 20% had had an eye examination in the last year. Only 37% of those needing laser surgery had actually had the surgery. Six out of the ten remote communities included in the survey showed evidence of endemic Trachoma. An estimated 1.4% of older Aboriginal and Torres Strait Islander people had trichiasis.

In responding to these health needs for rural and remote populations, building a strong system of primary care is a major priority. However, for managing many of the chronic and acute illnesses, there is also an imperative to facilitate access to appropriate specialist medical and allied health care.Top of page