Health and health care of rural populations in the UK: is it better or worse?

Abstract

Objective -To review available evidence on the problems facing rural health care in the UK. In particular, to determine whether the health of rural populations is worse than that of town dwellers and how the quality of health care is influenced by rurality. Criteria for inclusion and exclusion of articles -A wide variety of publications and data sources were used. A number of computerised databases with different specialisations (for example medical, health care management) were used to identify relevant published articles. In addition, reports, reviews, and surveys produced by agencies for local circulation were identified by approaching academic, service, and voluntary bodies thought likely to have an interest in rural health. Although this "grey" literature is not subject to peer review, the relative lack of relevant UK publications made it a useful data source for illustrative purposes. Similarly, published articles based on rural health in other developed countries were used when UK data were lacking. Conclusions -Although the evidence concerning the health and health care of the UK rural populations is suggestive, it is very general and further research is needed. Levels of urban health seem to be generally worse than in rural areas, but contradictions do exist. The evidence on quality of care suggests that service accessibility is a central problem, and rural populations have poorer access than others. Within rural populations, such disadvantage is not uniformly experienced -it affects some groups more than others. In addition, the NHS does not seem to have a consistent policy about whether rurality should influence resource allocation, and how it should be incorporated. (J Epidemiol Community Health 1994;48:16-21) While the health and health care of rural populations are seen as specific concerns in many other developed and developing countries,1 concern in Britain has focused mainly on the problems of towns.2

Relationship of Attendance Rates for Health Examinations to Voter Turnout for Prefectural Governor and Socioeconomic Factors in 99 Municipalities of Gifu Prefecture, Japan.

“…Another interpretation of larger turnout in rural areas is the higher percentages of elderly people. Voter turnout of the elderly in Japan is also higher than that of younger voters as reported elsewhere (Wilbers,1991;Binstock,1992), although Watt et al (1994) (Wang et al, 1994;Ciatto et al, 1992 which results in lower attendance rate in the subjects at high risk (Vernon et al, 1990). …”

Can a mortality excess in remote areas of Australia be explained by Indigenous status? A case study using neonatal mortality in Queensland

“…7 Throughout the world, research into rural and remote health is hindered by the lack of widely used, consistent and robust classification of w hat constitutes an urban, rural or remote area. 8 We have presented the results in this paper according to the Rural, Remote and Metropolitan (RRMA) classification for comparability with published work. 1,7 The other classification scheme commonly used in Australia is the Accessibility/Remoteness Index of Australia (ARIA) 9 and we obtained the same patter n when we used that scheme.…”

Identifying Change Over Time in Small Area Socio-Economic Deprivation

“…< Table 6 about here > Deprivation has previously been shown to vary across area types (Bradford et al, 1995;Martin et al, 2000;Sloggett and Joshi, 1998;Congdon, 1994) (Mackenzie et al, 1998;Wardle et al, 2002) although there may be less necessity for a car in urban than rural areas (Watt et al, 1994) rates of non-home ownership change very little, but in Mining & Manufacturing, the differences are more marked. In London, though there are a large differences in rates between quintiles 4 and 5 and over the decade, rates of non-home ownership increase in the middle deprived quintiles 2 to 4.…”