Remote and Rural Context

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

When practicing in a remote or rural setting it is important you develop an understanding of the contextual factors that impact the health of your clients, and the ways services are delivered.

This section provided as brief overview of some of the elements that influence the remote and rural context. Read through each of the pages and think about these issues in the context of your community, and consider how this will change the way you provide services.

Access

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

When working in a remote or rural setting it is vital to recognise the importance of access and how this impacts service delivery and client care.

Almost invariably remote and rural communities experience reduced access to health services, including allied health. Remote and rural communities are characterised by limited local health care services, limited private health services, and an absence of specialist services. The reduced access generally increases with remoteness, that is, the more remote the community the more limited access. Further access to the existing services is often disrupted by workforce shortages, and high staff turnover, which interrupt continuity of care.

The access to health care services is often compounded by several other elements of remote and rural life. Travelling distances for example, are often significant with population widely dispersed, and transport options limited and costly.

Access to health services is also affected by cultural factors. When working with Aboriginal people for example, access to the health service will be affected by: the appropriateness of the services available; English language competency; and a host of other issues. Refer to the Cultural Safety page for more information.

Health services have adopted several service delivery models that go some way to overcome these disparities in access, including OutreachPrimary Health Care and Telehealth. Refer to these pages for more information. 

Access & You

The above summary highlights some of key issues arising limited access to health services, however to broaden your understanding seek out more information. Think about access within the community you work with: 

  • What access to health services do those within your community have? 
  • What factors impact on their ability to access the services available?
  • How does this affect the way health services are delivered?

Defining Remote and Rural Context

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

The way remoteness and rurality are defined and understood is important. Defined remoteness or rurality is used to assess health and workforce needs, and the resources allocated to meet these needs, include staff and physical resourcing, and other funding.

A number of different classification systems have been developed to define remoteness and rurality in Australia. These tend to define in terms of the size of a community, distance from population centres, and access to services.  The following systems are commonly used to define remoteness areas or rurality:

  • Australian Standard Geographical Classification (ASGC-RA). The ASGC defines remoteness by Census Collection Districts on the basis on the average ARIA score within the district. The remoteness of local areas is then assessed and classified by the ARIA categories: major cities, inner regional, outer regional, remote and very remote. ASGC-RA was last revised in 2016.
  • Modified Monash Model Areas (MMM) is a custom remoteness classification developed by the Department of Health. It aims to improve categorisation of metropolitan, regional, rural and remote areas. This is achieved by factoring both geographical remoteness and town size into a single classification. It was designed to address disparity in the uptake of incentives between towns where there may be a significant difference in population size but shared the same ASGC-RA remoteness classification. MMM is now being used for a significant number of Department of Health programs. MMM was last revised in 2015.

Click here to access more information on the different official geographical classifications in use in Australia.

Click here for information about the ASGC-RA.

Defining Remote & Rural & You

Take the time to find out where your community lies within these classifications and the implications this has in terms of access to resources and the ways services are delivered. To find the classification for your community search here.

Below are links to some resources that will help to develop your understanding of the ways remoteness and rurality are defined and the diversity within these categories.

Useful Resources

  • Wakerman J. Defining Remote Health. Australian Journal of Rural Health, Vol. 12, pp. 210–214; 2004.
  • Rural, Regional and Remote Health: a guide to remoteness classifications (Australian Institute of Health and Welfare).
  • Doctor Connect. Department of Health. Available at http://www.doctorconnect.gov.au/
  • Couper ID. Rural hospital focus: defining rural. Rural and Remote Health 3 (online), 2003: 205. Available at: http://www.rrh.org.au/publishedarticles/article_pr....
  • Measuring Remoteness: Accessibility/Remoteness Index of Australia (ARIA) Revised Edition. (Commonwealth of Australia; 2001).

Demography and Population

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

Approximately a third (31.5%) of the Australian population live in remote or rural areas of the country. Of these, about 45% live in regional cities, large towns and surrounding agricultural areas, about 45% live in small country towns and their surrounding agricultural areas, and about 10% live in remote and very remote areas. 

The population profile and demography of remote and rural areas varies from that in metropolitan or urban centres. While it varies between communities, remote and rural areas generally have slower population growth than metropolitan and urban centres, with some areas experiencing population declines. Rural communities tend to have more children but fewer young adults. Remote areas tend to have even more children, but fewer older people.  

In terms of education and employment, people living in remote and rural areas generally have lower levels of education. Employment opportunities are often limited within remote and rural communities, and household incomes also tend to be lower than in metropolitan or urban areas. 

The type of diversity within remote and rural areas also varies from that of metropolitan and urban centres. Over two thirds of Australia’s Indigenous population reside in remote and rural areas. Additionally, immigration to remote and rural communities tends to be lower than in metropolitan and urban centres. 

Access to resources is lower for people living in remote and rural areas, and tends to decrease with remoteness. The affordability and availability of commodities such as food and petrol is often significantly lower, again decreasing with remoteness. Remote areas in particular are less likely to have access to basic food items, including fresh fruit and vegetable.  

Demography, Population & You

Think about the population within the community you work with: 

  • Who lives in the community? What age or cultural background are the majority of the residents?
  • How accessible is education, employment, food and housing? 
  • How does this affect the way health services are delivered?

Useful References

Health Profile

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

People living in remote and rural areas generally experience poorer health than their metropolitan counterparts. Being aware of this health differential, and how it impacts on service delivery will increase you understand of remote and rural health and inform the way you deliver services. It is also important to recognise the difference between remote and rural, and variation between individual communities.

The health profile of remote and rural areas are characterised by:

  • Lower life expectancy, deceasing with remoteness. Life expectancy in regional areas is one to two years lower than life expectancy in a metropolitan area, and up to seven years lower in remote areas.
  • Poorer self reported health, with people in regional and remote areas less likely to report very good or excellent health.
  • Higher rates of injury mortality, particularly arising form motor vehicle injury and workplace accidents.
  • Higher rates of suicide.
  • Lower birth weights and higher rates of teenage pregnancy.
  • Higher rates of health risk behaviour such as smoking, alcohol consumption and poor nutrition, and higher mortality rates from associated lifestyle disease such as diabetes, cardiovascular disease and respiratory disease.

Additionally, social determinants of health impact the health of people living in remote and rural areas, with people living in remote and rural areas experiencing reduced educational and employment opportunities, income, access to goods and services and in some areas access to basic necessities, such as clean water and fresh food. 

Indigenous Health Differentials

When considering the health profile of remote and rural Australians it is important to include the specific health profile of Indigenous people. Indigenous people experience significantly poorer health than the broader population. This health disparity is evident in both morbidity and mortality statistics. The health profile of Indigenous people is characterised by:  

  • A life expectancy of approximately years twenty less than all Australians.
  • Lower levels of access to health services.
  • Higher rates of hospitalisation for most diseases and conditions, including diabetes related conditions, skin diseases, respiratory disease and injury.
  • Higher incidences of low birth weights, and an increased likelihood of maternal and infant in childbirth. 

Remote & Rural Health & You

Think about the health profile of the within the community you work with: 

  • What are the health priorities in the community?
  • How does this affect the way health services are delivered? 

 Useful References

Remoteness and Rurality

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

Rurality and remoteness can be considered as a set of characteristics, including greater distances, lower socioeconomic status, lower educational levels, higher proportions of Indigenous people, specific occupational health and safety risks, a relatively close relationship with nature, specific cultural attitudes, poor access to services and smaller population centres.

There are a number of ways in the above characteristics can impact of health services, including the:

  • Prevalence of a health-related condition
  • Rate of incidence of a health-related event
  • Cost and timing of an intervention
  • Type and range of health professional and worker delivering the service
  • Way in which the service is delivery (i.e. model of care, delivery mode)
  • Total health impact of particular rates of incidence and prevalence.

What is most important to note, is that each of these characteristics has both a downside or risk (on which the sector has traditionally focused) and a potential upside or benefit.

For example, the relative scarcity of services means poor access and stretched services, with the potential consequence of poor staff morale and considerable queuing. The upside of this might be that the services are better integrated and more easily navigated by consumers because of their relative scarcity, and their delivery more rewarding for those who provide them. Certainly, there do seem to be fewer professional turf wars in more remote areas. As another example, the ‘greater distances’ characteristic can be seen as ‘distance from help’ (risk or downside) or ‘greater independence’ (benefit or upside). 

Remoteness, Rurality & You

When considering the impact of rurality and remoteness of the way you delivery your services, think about the impact from both a risk (downside) and benefit (upside) perspective. Remote and rural practice brings many opportunities for innovative health services and practice, as well as the traditionally considered challenges. 

Useful References

  • Gregory G. Impact of rurality on health practices and services: Summary paper to the inaugural rural and remote health scientific symposium. Australian Journal of Rural Health, vol 17, pp. 49-52; 2009.

Links and Further Reading

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

Spend some time developing a better understanding of the context of remote and rural health, broadly and in relation to the specific community you are working with.

Below we have identified some useful resources. It addition to these and those identified in this section, you should find out more about the area or community you’re working in. This will give you a better understanding of the particular local context, and the issues you should be mindful of. Begin with the local shire office, library and tourist centre.

  • Australian Bureau of Statistics
  • Liaw ST, Kilpatrick S (eds). A Text Book of Australian Rural Health. Canberra: Australian Rural Health Education Network; 2008.
  • Dade Smith J. Australia's Rural and Remote Health: A Social Justice Perspective. Tertiary Press; 2007.
  • D Wilkinson, I Blue, editors. The New Rural Health: Oxford University Press; 2002.
  • Bourke L, Sheridan C, Russell U, Jones G, DeWitt D, Liaw D. Developing a Conceptual Understanding of Rural Health Practice. Australian Journal of Rural Health, vol 12, pp. 181–186; 2004.
  • Australian Institute of Health and Welfare