Chapter 80 Health

a rural perspective

There are advantages, in terms of health, of living and working in rural areas, but providing appropriate health care in sparsely populated and remote areas brings its own particular challenges as well as additional costs for members of the public and health care providers alike.

Health and health care needs

There are common characteristics relating to health and health care in remote and rural areas; however it is important to remember that not all rural communities are the same. Although by definition remote and rural areas are geographically distant from urban centres and are often sparsely populated, different rural areas will have distinct demographic, geographic and socioeconomic profiles. For example, a small fishing community in Shetland will have a very different population from that of a deprived village in Wales where the main source of employment was a coalmine which closed down 15 years ago. This in turn will determine health priorities and challenges.

Although the particular health needs will vary, rural communities in developed countries often have a relatively high ageing population. Social care needs and support services then become a priority. Injuries relating to certain occupations such as farming, fishing, game-keeping or forestry are also more common in rural areas. Rural communities in many industrial countries are also becoming increasingly dependent on tourism which brings seasonal variations in health care need. This may be in the form of people with chronic conditions, accidental injury resulting from increasingly popular adventure sports or greater numbers of road traffic accidents. Research comparing the health of rural and urban populations in the UK is inconclusive and varies with type of condition. Canada and Australia, with many more remote and rural communities and generally greater travelling distance, have invested more in rural health research.

Access to health care is also complex. Rural communities may benefit from improved access to primary care compared to urban populations but are disadvantaged in terms of access to secondary and specialized care. There is consistent evidence to suggest that people in rural areas have lower levels of health service use and that they present later with medical problems. Later presentation and diagnosis of diseases can have an impact on prognosis and morbidity and mortality.

How do you think it would be different as a doctor in a small rural town compared to a big city?

Rural communities

Service provision is often less comprehensive in rural areas compared to many urban ones, not just with regard to health care, but also education, libraries, financial services or entertainment. Service provision is poorer because of distance to (health) services, poorer public transport and the fact that transport is at the mercy of the weather. Moreover, over the past decades we have seen the decline of services in many rural areas in the UK with the closure of small schools, garages, pharmacies, pubs, post offices and the discontinuation of local bus services. Local GP surgeries and community hospitals have suffered the same fate. For example, in England the number of maternity units fell by 17.3% in an 8-year period from 341 in 1996 to 282 in 2004 (Community Health Statistics, 2006). Many of these units were located in rural parts of the country. Although it is generally accepted that it is impossible to have a full-scale academic hospital or an opera house in every village and hamlet of the country (see pp. 154–155) for reasons of economies of scale, the decline in service provision may be less acceptable to local communities.

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

Intelligence The social implications of the new genetics Cognitive-behavioural therapy Childhood and child health Social class and health Placebo and nocebo effects

Stay updated, free articles. Join our Telegram channel

Join

Full access? Get Clinical Tree