Remoteness areas are defined into five classes of relative remoteness (major cities, inner regional, outer regional, remote, and very remote) and are based on road distance people must travel for services.[77] In Australia, around 28% of the Australian population (about 7 million people) live in rural or remote areas.[77]
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 1.1% in major cities, to 32% in remote and very remote areas.[19]
People identifying as belonging to diverse populations may identify across multiple priority population groups. This intersectionality can result in compounding impacts of social, cultural, commercial and environmental determinants of health on cancer experiences and outcomes.
People living in remote areas of Australia are 1.3 times more likely to die from cancer and have a lower 5-year relative survival rate compared to those living in major cities.[1] Additionally, people living in rural and remote areas have higher rates of hospitalisation, death, and injury, and have poorer access to and use of primary health care services than people living in major cities.[77]
Poorer cancer outcomes may be related to health workforce shortages in remote and very remote areas, despite having a greater need for medical services and practitioners with a broader scope of practice.[77][78]
People living in remote areas are also more likely to engage in risky behaviours, such as smoking and consuming alcohol at excessive levels, and are less likely to participate in cancer screening services compared to those living in major cities.[21][22][23][77]
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. Travel is a significant barrier to accessing health services and can lead to reduced access to cancer care across the care pathway. Additional costs associated with travel to metropolitan centres increases the impact of a cancer diagnosis on a person and their families.[77]
The Australian Cancer Plan aims to improve health equity for people living in rural and remote areas of Australia. This includes developing innovative models of care including digital health and navigation, improving access to optimal cancer care, and building the capability of the primary care workforce.
Year: 2018
Author: Department of Health and Aged Care, Australian Government
The Stronger Rural Health Strategy aims to improve the health of people in Australia through the supply of a quality health workforce that is distributed across the country according to community need.
Year: In development
Author: Australian Centre for the Prevention of Cervical Cancer
The National Strategy for the Elimination of Cervical Cancer will aim to eliminate cervical cancer for all people with a cervix across the diverse communities in Australia.
Year: 2016
Author: Department of Health and Aged Care, Australian Government
The National Strategic Framework for Rural and Remote Health promotes a national approach to policy, planning, design, and delivery of health services to improve health outcomes for rural and remote Australians. While primarily directed at policy makers at the national, state and territory levels, the strategy is also a tool for communities and local health service providers to plan services and programs according to local needs.
Year: 2022
Author: Queensland Health
Queensland’s Rural and Remote Health and Wellbeing Strategy 2022–2027 aims to create a system that is more connected and easier to navigate, empowers consumers and clinicians, increases participation in preventative programs, and creates sustainable healthcare models.
Year: 2021
Author: Queensland Health
Queensland’s Digital Strategy for Rural and Remote Healthcare aims to improve access to care and support better health outcomes for rural and remote Queenslanders through digital infrastructure, systems, and solutions.
Year: 2019
Author: WA Country Health Service
Western Australia’s Strategic Plan 2019–24: WA Country Health Service provides a roadmap for achieving a sustainable future, including greater equity for country communities through enhanced access to healthcare.
Year: 2017
Author: Queensland Health
Queensland’s Rural and Remote Health Workforce Strategy for Queensland outlines the overarching priorities and strategies for building the future rural and remote health workforce for Queensland.
Year: 2018
Author: Department of Health and Aged Care, Australian Government
The Stronger Rural Health Strategy aims to improve the health of people in Australia through the supply of a quality health workforce that is distributed across the country according to community need.
Year: In development
Author: Australian Centre for the Prevention of Cervical Cancer
The National Strategy for the Elimination of Cervical Cancer will aim to eliminate cervical cancer for all people with a cervix across the diverse communities in Australia.
Year: 2016
Author: Department of Health and Aged Care, Australian Government
The National Strategic Framework for Rural and Remote Health promotes a national approach to policy, planning, design, and delivery of health services to improve health outcomes for rural and remote Australians. While primarily directed at policy makers at the national, state and territory levels, the strategy is also a tool for communities and local health service providers to plan services and programs according to local needs.
Year: 2022
Author: Queensland Health
Queensland’s Rural and Remote Health and Wellbeing Strategy 2022–2027 aims to create a system that is more connected and easier to navigate, empowers consumers and clinicians, increases participation in preventative programs, and creates sustainable healthcare models.
Year: 2021
Author: Queensland Health
Queensland’s Digital Strategy for Rural and Remote Healthcare aims to improve access to care and support better health outcomes for rural and remote Queenslanders through digital infrastructure, systems, and solutions.
Year: 2019
Author: WA Country Health Service
Western Australia’s Strategic Plan 2019–24: WA Country Health Service provides a roadmap for achieving a sustainable future, including greater equity for country communities through enhanced access to healthcare.
Year: 2017
Author: Queensland Health
Queensland’s Rural and Remote Health Workforce Strategy for Queensland outlines the overarching priorities and strategies for building the future rural and remote health workforce for Queensland.
Comparatively fewer cancer services leads to limited access to cancer screening and prevention programs for people living in rural and remote areas. Stakeholders identified that greater accessibility of cancer screening and prevention services is needed to increase engagement in these services for people living in rural and remote areas.
Comparatively fewer cancer services leads to limited access to cancer screening and prevention programs for people living in rural and remote areas. Stakeholders identified that greater accessibility of cancer screening and prevention services is needed to increase engagement in these services for people living in rural and remote areas.
Stakeholders indicated that people living in rural and remote areas have less choice and access to healthcare, including supportive care. Most services are concentrated in metropolitan areas that require extensive travel and dislocation from family, and there is limited access to multidisciplinary health professionals.
Limited access to clinical trials and comprehensive health care impact opportunities for optimal experiences and outcomes for people living in rural and remote areas. Relatively scarce resources in rural and remote areas limit access to specialist expertise for complex cancer care and reduce opportunities for equitable cancer outcomes.
People living in rural and remote areas have more limited access to care across the cancer care pathway for reasons including availability of services and infrastructure close to home, and workforce shortages. People living in remote and rural areas also incur additional costs associated with travel because cancer services are more concentrated in metropolitan areas. Stakeholders noted that the ability to receive care from known, trusted health professionals (including via telehealth) can support delivery of optimal, person-centred cancer care for people living in rural and remote areas.
The limited availability of clinical trials in rural and remote areas was raised. New approaches to expand access to services and clinical trials for people living in rural and remote areas should be considered to increase cancer treatment and care opportunities for this population group.
Stakeholders emphasised that, compared to metropolitan locations, there are limited health professionals in rural and remote Australia, including specialists, primary care providers and nurses. The limited access to health services in rural and remote areas can act as a barrier to rural and remote Australians accessing timely and appropriate cancer care.
Investment in training, recruitment, and retention of the rural and remote workforce would increase the number of accessible cancer care services delivered in these areas.
In addition, increasing telehealth services was seen as an opportunity to increase accessible cancer care to this priority population group.
Cancer survivors in rural and remote areas can feel isolated, fearful, and disconnected from services when they return home from having treatment in urban centres.
The Australian Cancer Plan considers an intersectional and health equity approach for Aboriginal and Torres Strait Islander people. This is more than recognising the multiple backgrounds, experiences, and ways Aboriginal and Torres Strait Islander people identify. This approach addresses the way membership of multiple groups may impact people's health and wellbeing needs and ability to access care.
Implementation of each action should consider the compounding impacts of intersectionality across other priority population groups.