Differences Between Those Living Within and Outside of Australia’s Major Cities (VCE SSCE Health and Human Development): Revision Notes

Differences Between Those Living Within and Outside of Australia's Major Cities

Introduction

Australia's vast landscape creates unique health challenges for its residents. People living outside major cities generally face worse health outcomes than those in urban areas, influenced by factors such as remoteness, access to services, social isolation, and environmental challenges like droughts, bushfires, and floods.

Defining geographical classifications

Australia uses specific classifications to categorise geographical locations based on remoteness:

Major cities include Melbourne and Geelong in Victoria. In other states, major cities are Sydney, Newcastle, Wollongong, Tweed Heads and the Tweed Coast, Brisbane, most of the Gold Coast and much of the Sunshine Coast, Adelaide, Perth, and Canberra and Queanbeyan.

Outside major cities encompasses three main categories:

• Inner regional areas: Near regional centres such as Hobart, Darwin, Bendigo, and Ballarat
• Outer regional areas: More distant from major centres
• Remote and very remote areas: Locations such as Genoa and Murrayville (Victoria contains no 'very remote' areas)

Population distribution

Approximately 28 per cent of Australia's population lives outside major cities, distributed as follows:

• 18 per cent in Inner regional areas
• 8.1 per cent in Outer regional areas
• 1.1 per cent in Remote areas
• 0.8 per cent in Very remote areas

Key differences in health status

A clear pattern emerges when examining health outcomes: health status declines as remoteness increases. Those in remote areas generally experience poorer health outcomes than those in regional areas, who in turn fare worse than major city residents.

Life expectancy

People living outside major cities have lower life expectancy than their urban counterparts. The gap widens with increasing remoteness:

• Rural areas: One to two years less than major cities
• Remote areas: Up to seven years less than major cities

Burden of disease

Those living outside major cities experience higher burden of disease from both fatal and non-fatal causes. The Disability-Adjusted Life Year (DALY) rates increase proportionally with remoteness.

Specific health conditions

People outside major cities experience higher rates of numerous conditions:

Cardiovascular conditions:

• Higher death rates from cardiovascular disease, including coronary heart disease
• Mortality rates overall are 1.4 times higher than major cities

Cancers:

• Higher rates of preventable cancers including lung cancer and melanoma
• Higher rates of detectable cancers such as cervical cancer

Chronic conditions:

• Higher rates of type 2 diabetes
• Higher rates of arthritis
• Higher rates of asthma and chronic obstructive pulmonary disease (COPD)

Injuries and mental health:

• Higher rates of avoidable deaths
• Higher rates of injury, with mortality from land transport accidents being 4 times higher
• Higher rates of suicide and self-inflicted injuries
• Higher rates of mental health disorders

Other conditions:

• Higher rates of dental decay

Factors contributing to variations in health status

Understanding the health disparities between urban and rural populations requires examining biological, sociocultural, and environmental factors that contribute to these differences.

Biological factors

Biological factors represent measurable physical and physiological characteristics that influence health outcomes. Five key biological factors contribute to poorer health status for those outside major cities.

Body weight

High body mass index (BMI) levels are approximately 10 per cent higher among people living outside major cities compared to urban residents. Elevated BMI increases the risk of developing serious conditions including type 2 diabetes, cardiovascular disease, and certain cancers. The higher prevalence of overweight and obesity in rural and remote areas directly contributes to the increased burden of these chronic diseases.

Blood cholesterol

People living outside major cities are 10 per cent more likely to experience high blood cholesterol than city dwellers. High cholesterol is a significant risk factor for cardiovascular disease and hypertension. This elevated prevalence helps explain the higher rates of heart disease and stroke observed in rural and remote populations.

Glucose regulation

Impaired glucose regulation is more common among people living outside major cities, with rates increasing as remoteness increases. Poor glucose regulation raises the risk of developing type 2 diabetes and kidney disease. This factor directly contributes to the higher diabetes burden observed in regional, rural, and remote areas.

Birth weight

The percentage of low birth weight infants is considerably higher in remote areas. In very remote areas, approximately 11.2 per cent of babies are born with low birth weight, compared to 6.6 per cent in major cities. Low birth weight babies face increased risks of developmental problems, health complications, and infant mortality.

Blood pressure

Hypertension rates are 1.2 times higher in people living outside major cities compared to urban residents. High blood pressure significantly increases the risk of cardiovascular disease, including heart attack and stroke. This elevated prevalence contributes substantially to the higher burden of cardiovascular disease in rural and remote populations.

Sociocultural factors

Sociocultural factors encompass the social and economic circumstances that influence health. These factors often interact and compound each other, creating complex health challenges for people outside major cities.

Socioeconomic status

More than half of outer regional, remote, and very remote residents live in areas of socioeconomic disadvantage, compared to about one-quarter in major cities. This disparity stems from limited opportunities for education and employment in rural areas.

Lower socioeconomic status contributes to higher rates of risky health behaviours, including smoking and physical inactivity. These behaviours increase the risk of preventable diseases such as cancer and cardiovascular disease, ultimately contributing to lower life expectancy.

Unemployment

Higher unemployment rates characterise areas outside Australia's major cities. Unemployment is both a cause and consequence of lower socioeconomic status. The lack of employment opportunities in rural and remote areas creates financial hardship, limiting access to health-promoting resources and contributing to poorer overall health status.

Food security

People in rural and remote areas are 1.2 times more likely to experience food insecurity than city residents. Two main factors drive this disparity: high costs and lack of access.

Transporting food to remote areas adds significant costs, particularly for fresh produce. Consequently, people may rely more heavily on processed foods with long shelf lives, such as canned and packaged items. These foods often contain high levels of fat, salt, and sugar, contributing to increased rates of obesity, type 2 diabetes, and cardiovascular disease.

Early life experiences

Maternal smoking during pregnancy is significantly more prevalent in remote areas. Data shows that approximately 36.4 per cent of mothers in very remote areas smoked during pregnancy in 2016—five times the rate in major cities (6.9 per cent).

Social isolation

While people outside major cities often report high levels of community participation and strong community connections, they may still experience social isolation due to geographic distances. Social isolation results from limited contact with family, neighbours, and friends.

The consequences of social isolation are serious, contributing to higher rates of mental health disorders and suicide. Isolated individuals may experience loneliness and lack access to support during difficult times, increasing psychological distress and the risk of self-harm.

Environmental factors

Environmental factors relate to the physical surroundings and infrastructure that influence health. The unique environmental characteristics of rural and remote areas create distinct health challenges.

Infrastructure

Road conditions in rural and remote areas are generally poorer than in cities. Combined with longer driving distances, increased likelihood of wildlife crossing roads, and poor lighting at night, these factors contribute significantly to higher mortality and morbidity from transport injuries.

Water infrastructure also varies by location. Many remote communities lack access to mains water supplies, which are typically fluoridated. The absence of fluoridated water increases the risk of dental health issues, particularly dental caries, contributing to the higher rates of dental decay observed outside major cities.

Geographic location

Proximity to resources represents a significant challenge for rural and remote residents. The location of health services critically influences whether people can access healthcare when needed.

When specialist services or hospitalisation are required, family members often must take time off work to transport ill relatives to distant facilities. This creates additional financial costs and increases stress and anxiety for families.

Geographic location also determines access to various food types. Remote residents may struggle to access fresh foods such as fish, fruit, and vegetables, leading to greater reliance on processed foods high in fat, salt, and sugar. This dietary pattern increases the risk of overweight, obesity, cardiovascular disease, and type 2 diabetes.

Climate and climate change

Rural and remote residents experience greater hardship from climate conditions. Droughts, floods, and fires can severely disrupt farming operations, leading to unstable income. This income instability lowers socioeconomic status and increases stress levels.

Climate change is predicted to have a disproportionate impact on rural and remote areas compared to major cities. Increased frequency of natural disasters—including fires, floods, and droughts—affects health by increasing injury risk and mental health disorders. The relative isolation of remote areas particularly limits access to support services for dealing with climate change impacts.

Work environments

Common occupations outside major cities include farming, mining, and fishing. All these industries carry specific risks associated with their physical environments, including a higher risk of injuries. Research indicates that undersupply of work may lead workers to accept more hazardous working conditions.

Many rural and remote jobs are outdoors, increasing ultraviolet (UV) exposure. This contributes to higher incidence of skin cancer, particularly melanoma, among rural and remote populations.

Summary

The following diagram summarises the key factors contributing to health status variations between those living within and outside Australia's major cities:

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