The Australian Rural Health Game: An innovative approach to social determinants education

In February 2025, 301 first year medical students at The University of Sydney took part in their initial teaching on the social determinants of health. Traditionally, engaging students in the social determinants of health, the non-medical factors influencing health and the cause of unfair and avoidable differences between rural and urban populations, has been a challenging task.

However, at The University of Sydney, we’ve been doing things differently. We have created a serious board game for learning. The Australian Rural Health Game (the Game) was created in response to the consistent challenge in rural health education; helping learners understand and internalise the complexities of the rural social determinants of health.

The Australian Rural Health Game represents one year in the life and health of fictional patients living in rural Australia. Players select one of eight patient profiles and are exposed to risk and protective events throughout the Game. Players might experience rental stress, racism, or unemployment. The protective elements of the Game include connection to community, access to comprehensive and inclusive healthcare as well as education level and income. At the end of the Game, players determine whether their overall health has improved, deteriorated, or remained stable.

The Game is intentionally designed to limit the agency of players and demonstrate the impact of the social determinants on players’ overall health and wellbeing. Advancing in the Game is controlled by the social determinants. Risk and protective cards are based on rural health evidence to enrich the learning experience. The main purpose of the game is to demonstrate that the social determinants have a measurable and predictable effect on the health outcomes of rural people. The Game also challenges learners to consider ways in which the rural social determinants of health can be addressed at the level of the individual and community.

And the results speak for themselves; after the session in February, students wrote that “I loved the boardgame …it really made you think about the intersectionality of each inequity in a person's health over their life” and “I enjoyed the team-based learning activity of playing the Rural Health Game. By participating in the game and sharing our reflections, I gained insight into social determinants of health that I had not considered before and some shocking data. This experience will provide valuable perspectives as I begin my clinical training.”

The Australian Rural Health Game was developed by a team of clinicians and academics at The University of Sydney with a unique combination of clinical and education experience. We have worked with Schools across the University to enhance the Game’s applicability as an interprofessional learning tool for students in programs such as medicine, nursing, dentistry, allied health, pharmacy, and social work. The Game is grounded in the concept of Universal Design for Learning, which along with its accessibility features, enhances the learning experience through combining engagement and action.

Consistently positive feedback from students and rural health educators has encouraged the team to explore ways in which the Game can be more widely shared as a simple and accessible solution to the complex problem of teaching evidence-based rural health information. A hardcopy format of the Game is currently being prepared for a small print run. We are also working to create a digital version to support remote play and increase access to the Game.

We hope the Game can be used widely because all health professionals, health service providers and policymakers, no matter where they work, require a sound understanding of the rural social determinants of health and their impact on rural health inequities.

You can register your interest in receiving further information about the game here.