Defining rural in Aotearoa New Zealand: a novel geographic classification for health purposes.

Describe the first specifically designed and validated five-level rurality classification for health purposes in New Zealand that is both data-driven and incorporates heuristic understandings of rurality. Our approach involved: (1) defining the purpose and parameters of a proposed five-level Geographic Classification for Health (GCH); (2) developing a quantitative framework; (3) undertaking co-design with the National Rural Health Advisory Group (NRHAG), and extensive consultation with key stakeholders; (4) testing the validity of the five-level GCH and comparing it to previous Statistics New Zealand (Stats NZ) rurality classifications; and (5) describing rural populations and identifying differences in all-cause mortality using the GCH and previous Stats NZ rurality classifications. The GCH is a technically robust and heuristically valid rurality classification for health purposes. It identifies a rural population that is different to the population defined by generic Stats NZ classifications. When applied to New Zealand's Mortality Collection, the GCH estimates a rural mortality rate 21% higher than for residents of urban areas. These rural-urban disparities are masked by the generic Stats NZ classifications. The development of the five-level GCH embraces both the technical and heuristic aspects of rurality. The GCH offers the opportunity to develop a body of New Zealand rural health literature founded on a robust conceptualisation of rurality.

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