Regions far from cities have fewer health system resources relative to potential needs than regions with or close to a city
Strong health systems in regions that provide equitable access and can respond effectively to emergencies are essential to the overall health and well-being of populations, as well as a foundation for economic and social development. The performance of health systems can be measured across five dimensions: health status, risk factors for health, capacity and resources, access to care and quality of care (OECD, 2023).
Health status differences between remote and other regions persist after the pandemic. At the pandemic’s peak, life expectancy gains in the last decade were cut by half in large metropolitan regions and by more than two-thirds in regions far from an FUA. In 2023, the life expectancy gaps between remote and metropolitan regions were 2.4 years (Figure 4.5). Cardiovascular mortality, another health status indicator, was 19% higher in remote regions than the national average (Figure 4.6). Finland had the largest relative disparities between metropolitan and remote areas (67% or 263 vs. 440 deaths per 100 000 inhabitants), whilst Hungary had the largest absolute difference (604 vs. 813 deaths per 100 000 inhabitants).
Regions also face different exposure to health risks. Obesity, which can lead to several chronic conditions, was more common (2 p.p. higher) in regions far from a midsize/large FUA than in other region types on average across 11 OECD countries with available data. Metropolitan and near a midsize/large FUA region typically have higher exposure to air pollution, causing respiratory and chronic diseases. Pollution levels, measured by particulate matter (PM2.5) concentration, were, on average, well above the World Health Organization (WHO) guidelines in those regions (13.8 and 12.1 microgram per cubic metre (μg/m3) vs. the recommended level of 5) and above levels in remote regions (9.3 μg/m3) (Figure 4.9 and Figure 4.1). The five most polluted OECD small regions, all in Chile, have PM2.5 concentrations more than ten times above the WHO guidelines.
Health resources – in particular, health workforce and inpatient care capacity – are often less available in regions far from cities. Regions far from a midsize/large FUA have 12% fewer doctors per inhabitant than the national average, while metropolitan regions have 4% more doctors (Figure 4.7). Although the distribution of nurses and hospital beds is more even across different regions, in 13 countries with available data, 30% of people live in regions (124 out of 367) below the national average for doctors, nurses and hospital beds per inhabitant. More than half of these less-equipped regions are far from a midsize/large FUA (67/124 regions).
People who live far from cities also struggle to access healthcare physically. In regions far from a midsize/large FUA, 9% of the population cannot reach a general hospital in less than 45 minutes’ drive (Figure 4.8). The ease of reaching a hospital varies within these regions, with up to 11% of people in rural areas unable to reach a hospital within 45 minutes compared to as little as 1% of people living in small cities. In countries with vast, thinly populated areas or islands, like Greece, a significant portion of people living far from cities cannot get to a hospital within 45 minutes, even in towns and small cities. However, this is not the same everywhere. In Australia, for example, almost everybody living in towns within regions far from a midsize/large FUA can access a hospital.
Quality differences in access to healthcare across places remain difficult to evaluate without more granular data. More human resources and capacity have been associated with higher quality at the national level, while there is no clear pattern with respect to health spending (OECD, 2023). Available survey data for OECD countries show that, in 28 out of 38 OECD countries, a larger share of people in rural areas report dissatisfaction with the availability of quality healthcare compared to those in cities (35% vs. 28%). This difference is bigger for men (8.5 p.p.) than for women (5.1 p.p.).
