"We always talk about the bush being a good lifestyle, but you die out here," Andrew Lewis, the mayor of Bourke Shire, one of the worst affected areas, said. Andrew Lewis, mayor of Bourke, is frustrated by the lack of healthcare services in western NSW. "It's a 'she'll be right' attitude. Next thing you know, you're dead." Only Western Australia and the Northern Territory fall behind NSW's remote life expectancy of 67.8 years. Life expectancy in North Korea is 69, while in Iraq it is 68.5, according to the World Health Organisation.

Western Australia has to deliver health services to an area three times the size of NSW, while the Northern Territory has a life expectancy equivalent to that of Liberia, now in the midst of the Ebola crisis in West Africa. For the past decade the same towns in western NSW have featured in the bottom 10 areas for death rates: Walgett, Forbes and Bourke among them. Scott McLachlan, the chief executive officer of the Western NSW Local Health District, the government arm responsible for the area, said he was not surprised by the results. "It is something we are determined to fix through changing lifestyles. Western NSW has some of the highest rates of obesity and smoking in the country."

In 2013, the standardised death rate in Bourke was three times that of the top performing areas in NSW, the Snowy River in the state's south and Manly in Sydney. One of the key factors is the size of the Aboriginal population, among whom a chronic lack of health services and a mistrust of Western healthcare continues to harm the population, Cr Lewis said. Mr McLachlan cites chronic diabetes, obesity and heavy smoking rates as principal factors in the high mortality rate. The Snowy River has less than half the Aboriginal population of the average NSW town, while Manly has up to 10 times less. Wealthy Anglo-Saxon dominated suburbs such as Mosman and Woollahra on Sydney's north shore and eastern suburbs topped the life expectancy list over the past decade, despite ageing populations.

Residents in those suburbs can expect to live well into their 80s. Dr Zakia Hossain, a demographer and sociologist from the University of Sydney, said she was not surprised by the results. "Western NSW is the area that we have always needed to work on. There is clearly a long way to go." The under-resourced areas continue to lose facilities. Bourke's Medicare Local service is under threat and its birthing hospital had to close in March. The Local Health District cited the lack of permanent GPs with the necessary obstetric and anaesthetic skills as the main reason.

The decisions have frustrated Cr Lewis. He called on the state government to commit to a health system in the western region. Mr McLachlan insists that the state's integrated healthcare plan will deliver services to the region. But the experiment will be limited to five towns over the next three years before best practice measures are introduced. "It is incredibly hard to recruit the qualified professionals to the area," he said. The chief executive officer of the Rural Doctors Association of Australia, Jenny Johnson, said that one of the most significant issues was the "ongoing maldistribution of doctors in rural areas". "We need more doctors with the appropriate skills, not just specialists," she said.

"We need to turn one-doctor towns into two-doctor towns." Dr Johnson said that there were also issues on the patient side of the equation. "For many, the distance and the expense involved with getting adequate treatment is too great for them to seek it out when it's necessary." While NSW rural health continues to struggle, Tasmania's model is flourishing, in part due to its small size. It is the only state in the entire country to manage life expectancy across very remote areas effectively.

"Tasmania's two most remote areas are both islands – Flinders Island and King Island – and both of these communities are serviced by community health centres," the Tasmanian Health Minister, Michael Ferguson, said. "Access to these centres can be significantly better than in remote areas interstate, which in turn leads to better overall primary healthcare, especially from a prevention perspective."