Abstract: Australia is a country of extremes. It is the hottest and driest of the permanently inhabited continents, with a relatively small, low-density population, the majority of which is dispersed around the coastline. In terms of distance alone, residents of Australia’s most remote communities are among the most isolated on Earth. Much effort over the past few decades has been invested in attempts to define and measure rurality in the context of health. This process has been driven by the recognition that residents of rural and remote communities have health needs and outcomes that differ from those of their urban counterparts. In Australia, several different classification systems have been used, with the current system, the Australian Standard Geographical Classification system for Remoteness Areas (ASGC-RA) considered by some experts in the field to be imperfect for the purposes of health policy planning and resource allocation. This has led to the more recent development of other indices specifically for use in the health context, as well as the growing recognition that use of remoteness areas alone is insufficient to distinguish the unique health needs of remote communities. While geography and distance remains key characteristics of remote communities in Australia, there are other critical differences between rural and urban communities that contribute to the disparities in health outcomes observed between them. These differences relate to demographic, industrial, economic, environmental and social factors which distinguish urban from rural communities and contribute to the unique concept of what “rural” means in the Australian context. With respect to health, there is a broad trend towards increasing morbidity and mortality with increasing remoteness, with the majority of the excess health burden due to circulatory disease and injuries. While the association between rurality and poor health, as measured in crude terms by life expectancy and/or death rates, is one that has been observed in other developed countries such as the USA and Canada, it has proven difficult to generalise a trend across countries. A recent review of the ‘rural-urban’ health differential in developed countries found that rurality was not necessarily an independent risk factor for poor health but rather a reflection of the increased health risk in rural areas due to the effects of socioeconomic disadvantage, exposure to environmental and occupational hazards, lack of access to health services and risk-taking behaviours. Demographic characteristics also contribute to the differences in health outcomes observed between rural and urban communities in Australia. While in the non-Indigenous population there is a trend towards increasing age with remoteness, the most marked demographic difference between urban and remote communities in Australia is the proportion of the population who are Indigenous. The Indigenous to non-Indigenous ratio rises sharply with remoteness, and there is little doubt that the overwhelming excess health burden borne by Aboriginal and Torres Strait Islander people is one of the major drivers of the increased morbidity and mortality in remote Australia communities. While the trend is not linear, that is, Indigenous mortality does not necessarily increase with remoteness, and studies that have attempted to “control” for Indigenous ethnicity have reached different conclusions regarding the relative contribution of ethnicity to poor health in rural communities, it nevertheless seems clear that a large part of the excess health burden in remote communities is attributable to the higher proportion of those populations who are Indigenous. In the most remote communities, which are the focus of this study, the effects of remoteness and Indigenous 11th National Rural Health Conference 2 ethnicity may in fact be compounded, with the combined effects resulting in greater health disadvantage than either characteristic alone. The purpose of this study was to examine the epidemiological factors which contribute to the excess health burden in the most remote communities in Australia, in an attempt to ascertain which factors contribute most strongly to this phenomenon, as well as identify which communities seem to be performing relatively better or worse when compared with others within this diverse and inhomogeneous group, in order to better facilitate planning and resource allocation from a health policy perspective.