Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research?

Abstract

We reviewed evidence of any apparently significant 'rural-urban' health status differentials in developed countries, to determine whether such differentials are generic or nation-specific, and to explore the nature and policy implications of determinants underpinning rural-urban health variations. A comprehensive literature review of rural-urban health status differentials within Australia, New Zealand, Canada, the USA, the UK, and a variety of other western European nations was undertaken to understand the differences in life expectancy and cause-specific morbidity and mortality. While rural location plays a major role in determining the nature and level of access to and provision of health services, it does not always translate into health disadvantage. When controlling for major risk determinants, rurality per se does not necessarily lead to rural-urban disparities, but may exacerbate the effects of socio-economic disadvantage, ethnicity, poorer service availability, higher levels of personal risk and more hazardous environmental, occupational and transportation conditions. Programs to improve rural health will be most effective when based on policies which target all risk determinants collectively contributing to poor rural health outcomes. Focusing solely on 'area-based' explanations and responses to rural health problems may divert attention from more fundamental social and structural processes operating in the broader context to the detriment of rural health policy formulation and remedial effort.

Towards an understanding of the relationship of functional literacy and numeracy to geographical health inequalities

“…Evidence on associations with regard to rurality is more mixed (Riva et al, 2009). Smith et al (2008), in an international comparative review, note that rurality can link to access to and provision of health services but may not confer health disadvantage, while Midouhas and Flouri (2013) suggest that UK children do not vary in numeracy skills with respect to urban or rural residence but reading age tends to be higher in major urban areas.…”

Adding Specialized Clinics for Remote-Dwellers with Chronic Kidney Disease

“…Assuming that improving access to nephrology care by reducing travel time would lead to improved outcomes and lower hospitalization rates, as suggested by observational studies (1)(2)(3)(4)(5)(6)(7)(8)(9), establishing this additional clinic would represent good value for money, with ICURs ranging from $4000 to $8000/QALY in most scenarios. However, if reducing distance to specialized care does not reduce the risk of hospitalization or mortality, the cost-effectiveness of establishing a new clinic may be considerably less attractive-although it still might be economically attractive by current standards.…”

“…Although kidney disease occurs throughout the province, specialized renal care is provided in 17 clinics that are predominantly located in the more densely populated southern half of Alberta ( Figure 1). Multiple studies (1)(2)(3)(4)(5)(6)(7)(8)(9) have shown that distance from health services is inversely associated with clinical benefits. We recently showed (10) that markers of good-quality care in CKD patients in Alberta decreased with increasing distance from the practice location of the closest nephrologist.…”

O Papel Transformador do Estudante de Medicina no Cenário da Endemia de Hanseníase no Brasil: Relato de Experiência

“…A distribuição da hanseníase na população brasileira é profundamente desigual no que diz respeito aos espaços geográficos e às condições econômicas e sociais, como ocupação, escolaridade e renda 11,12,13 . Alguns estudos apontam que, em geral, os habitantes de áreas rurais não só têm dificuldade em acessar os serviços de saúde, como também recebem diagnós-ticos tardios 14,15 . O ensino médico deve ofertar conteúdos e práticas que promovam a construção de competências profissionais que superem a tríade agente-hospedeiro-ambiente e levem em consideração a complexidade da determinação social das doenças tanto nas populações quanto nos indivíduos 16,17 .…”