ABSTRACT:
Rural and remote municipalities experience persistent structural inequities that challenge the organization and sustainability of primary health care (PHC) and health systems. In Brazil, geographic isolation, low population density and historical underinvestment contribute to unequal living conditions and health outcomes. Previous studies have documented significant disparities in access to services, workforce availability and health indicators in rural and remote territories.¹² This study analyzes sociodemographic and health system indicators according to municipal classification as urban or rural-remote, highlighting regional inequalities and implications for health equity. A descriptive ecological study was conducted including all Brazilian municipalities, classified as urban or rural-remote based on accessibility and proximity to urban centers. Population-weighted indicators were estimated for Brazil, the Semi-arid region and the Legal Amazon. Data were obtained from publicly available sources, including the Demographic Census, Atlas Brasil, social protection databases and national health information systems. Indicators were grouped into social, demographic and health dimensions, following analytical approaches applied in studies on rural and remote health systems.¹³ Marked disparities were observed between urban and rural-remote municipalities. Rural-remote areas showed lower Human Development Index values, reduced access to water, sanitation and electricity, lower income levels and higher dependence on social protection programs. Health system indicators revealed high PHC coverage in rural-remote municipalities, contrasting with limited availability of hospitals, specialized services and health professionals. Similar to findings in previous national analyses, these territories presented lower health workforce density and worse health outcomes, particularly in the Semi-arid region and the Legal Amazon.²⁴ Rural-remote municipalities in Brazil face persistent health inequities despite high PHC coverage, reflecting structural limitations in service availability, workforce distribution and regional development. Addressing these disparities requires differentiated public policies, sustainable financing and territorial approaches recognizing rurality and remoteness as determinants. Strengthening health systems in these contexts is essential to advance equity and access.