1. Area of study 1 Dot point 4 c Variations in the health status of population groups in Australia, including: Males and females Higher and lower socio-economic groups Rural and remote populations Indigenous populations http://aso.gov.au/titles/tv/four-corners-far- care/clip2/

2. Rural and Remote* Rural and Remote populations: People who live in areas situated outside any city or metropolitan (urban) area that has a population greater than 100, 000. Australia’s rural & remote areas are often thought of as being hot & dry farming areas, the so called “outback” or “the bush”. In fact, they reflect the variety of Australian life. Many R & R areas are in coastal areas, some are where there is industry e.g. wine production, farming, mining & tourism. All R & R areas are some distance away from the major population centres. 66% of Australia's population live in major cities, 31% in rural and 3% in remote areas. People living in rural and remote areas face barriers to accessing health services, higher costs of and difficulty sourcing food, harsher environmental conditions and relative social isolation. Areas are classified via the Australian standard geographical classification: An Index value 0-15>based on locality of services.  Major Cities(MC):0-0.2 highest level of access to goods and services  Inner Regional (IR) :0.2-2.4  Outer Regional (OR):2.4-5.92  Remote (R) : 5.92-10.53  Very Remote(VR):10.35-15 highest level of remoteness from goods and services Although indigenous Australians make up just 2.4 % of the total Australian population, they constitute 24% of the population in remote areas, including 45% of the population in the very remote areas.(AIHW 2008)

3. Rural & Remote Populations* Experience worse health outcomes Lower life expectancy> as remoteness increases, life expectancy decreases. Rural 2 years lower and remote up to 7 years lower. Higher mortality- 1.1 times higher in rural and 1.2 times higher in remote Higher rates of preventable cancers( lung, melanoma and detectable cancers> cervical. Higher death rates of cardiovascular disease. Higher rates of coronary heart disease. Higher rates of avoidable deaths. Higher rates of diabetes. Higher rates of dental decay. Higher road injury and fatality rates Higher rates of obesity and HBP

4. Rural & Remote Populations* Higher death rates from chronic diseases. Higher prevalence of mental health problems Higher rates of alcohol and smoking Higher incidence of poor antenatal and post-natal health and perinatal death.( shortly before and just after birth> up to 28 days. Higher incidence of low birth weight babies in very remote areas Higher injury rates due to rural accidents Higher rates of communicable diseases i.e. Ross river fever and higher rates of STI’s Face barriers to accessing health services and higher costs and difficulty in sourcing fresh food. Experience harsher environmental conditions and social isolation Children living in rural and remote regions suffer from more decayed, missing and filled teeth than metropolitan children> lack of adequate fluoridation.

5. Biological determinants Overweight and obesity are higher in Rural and remote areas (10%), therefore higher risk of type 2 diabetes, impaired glucose regulation. 10% more likely to experience high blood cholesterol. % of low birth weight infants is higher in remote and very remote areas >8.4%. National rates> 6.0%. Infants born in Remote areas were 40% more likely to be LBW. Higher rates of hypertension in rural and remote areas than MC > 1.2 times higher. Higher rates of CVD. Rural and remote populations are 10% more likely to have high cholesterol.

6. Behavioural determinants- people living in rural and remote areas are : More likely to smoke- 21% compared with 15% in urban areas> increasing risk of cancer, CVD and respiratory disease. 1/3 of mothers who gave birth in very remote areas smoked (36%) during pregnancy compared with 11% in major cities> LBW babies and asthma. More likely to drink at risky levels compared to MC> increasing risk of obesity and diseases elated to alcohol consumption, e.g. cirrhosis of the liver, CVD and injury due to risk taking behaviour. More likely to be sedentary than those in MC, leading to obesity, CVD, type 2 diabetes & lower life expectancy. More likely to eat recommended amount of vegies than urban dwellers, but likely to eat less fruit and low fat milk. Farmers and outdoors workers in rural and remote areas are reluctant to use UV protection.

7. Physical Environment determinants Poorer road quality Poorly lit roads and a lack of road signage Higher speeds, further to travel Greater driving distances and higher speed limits.( wild life Reduced proximity to resources i.e. health care, transport, recreational facilities, supermarkets & employment. Greater exposure to harsh climates and the effects of climate change i.e. droughts, floods and fires threaten lives and income. Individuals have limited access to support services. Less access to fluoridated water. More dangerous work environment.

8. Social determinants: people living in rural and remote areas: Lower incomes- more likely to rely on social security payments. Receive lower income & lower education levels. Housing prices in rural areas are cheaper. Work in farming, mining, fishing- under supply of jobs means workers accept conditions that are less safe> increasing injury risk. Higher rates of unemployment, 4.5% compared with 4%. Have fewer opportunities for employment, especially skilled professional and more likely to be out of work, particularly the under 25 year age group. In 2007 experienced higher rates of unemployment than MC > low SES> low health status, resulting in increased rates of CVD, diabetes, respiratory disease, injury and overall mortality. Higher rates of community participation but may also be socially isolated> geographical location, economic and personal barriers and social exclusion. Social isolation> increased mental illness rates. 1.2 times more likely to experience food insecurity than city counterparts, due to inflated food costs as a result of high costs of transport and less availability of fresh fruit and vegetables. Therefore high consumption of processed food> high rates of obesity, diabetes, CVD. Less likely to have access to GP’s, hospitals and other medical services, therefore conditions may be untreated for longer and may be come life threatening. May need to travel to access health care.

9. Summary*