People in remote NSW have far shorter lives than city-dwellers and are much more likely to die from preventable illnesses or suicide.
The Australia Institute has revealed the alarming life expectancy divide between the city and the bush in a report called The Unlucky Country, the first in a research series to examine the national disparity.
Those who live in far-west NSW have a life expectancy of 79, compared to 84 for people living in Sydney.
The gap has widened dramatically since 1999, when outback residents were living longer than those in the city, the report said.
There are similar disparities in Queensland, South Australia and Western Australia. The most pronounced gap is in the Northern Territory, where those who live in Darwin are expected to live until they're 81 compared to 74 for people in the outback.
The think tank said the figures made a compelling case for significant investment in rural healthcare and should set "alarm bells ringing".
"The gap between city and country is already unacceptable and it is getting worse," the report said.
"In 2023, there is no excuse for the bush being considered out of sight, out of mind.
"While there will be no silver bullet to address the situation, the first step to addressing a problem is admitting there is one."
The analysis found people in far-western NSW are twice as likely to die prematurely as those in Sydney, and two and a half times more likely to suffer a potentially avoidable death from conditions like chronic illnesses.
While national suicide rates are steady, people in remote NSW are twice as likely to die by suicide and the rate is rising, the report found.
The leading causes of death are similar in the city and in far-west NSW, including heart disease, diabetes, lung cancer and dementia, but suicide ranks in the top 10 in the bush.
"The similarity in causes of death suggests that the factors driving lower life expectancy in the far west are not due to different physical conditions or different lifestyles, but to how causes of death are prevented and managed," the researchers said.
The findings echo the recent Best for the Bush report by the Royal Flying Doctor Service, which found 44,000 remote Australians do not have a primary health service within an hour's drive.
The service predicts that by 2028 there will be less than a fifth of the number of GPs in remote areas compared to the cities and only a third of the number of psychologists.
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