Nineteen per cent of the population of England live in rural areas which make up 85 per cent of the land. These areas are very diverse, ranging from open countryside with a scattering of small towns and villages to coastal communities dependent on fishing or tourism, former mining areas and commuter villages.
One local authority area can contain a number of different rural communities as well as cities and towns and can exemplify health inequalities with life expectancy differing across different groups by up to 10 years. Because of this diversity, local authorities need to understand in some detail the character of their rural populations and the health issues facing them.
Overall, health outcomes are more favourable in rural areas than in urban areas. But broadbrush indicators can mask small pockets of significant deprivation and poor health outcomes. There is an absence of detailed statistical information on health outcomes in rural areas, as national statistics often do not reveal differences within small areas. Work is currently under way in a number of universities and local authorities to develop more appropriate indicators for rural areas.
Both sparsity and rurality appear to affect poverty levels and consequently the health of people in rural areas. Sparse areas on the fringes of towns and urban settlements have the highest proportions of poor households, although no area type is poverty free.
Rural communities are increasingly older. The younger population tends to decline the more rural the settlement type. Older people experience worse health and have greater need of health and care services. Financial poverty in rural areas is highly concentrated amongst older people. Health and care
needs are difficult to separate for those with multiple and complex needs and reductions in resources for social care are compounded by high delivery costs and organisational challenges in sparse areas.
Reductions in resources to care for the older population, issues of access to health and care services, travelling and transport issues and lack of community support in some areas contribute to pressures on local government and the NHS to take a place-based approach to health needs.
Many local authority functions have a health impact. Local authorities can therefore influence health outcomes in rural areas through working with the NHS to improve access to services, but also through tackling the social determinants of health through their public health, social care, planning, housing, economic, education, regulatory and other roles.
District councils in rural counties are key players in addressing health issues, being responsible for planning, housing and leisure services as well as environmental health. Town and parish councils can also play a part, both in developing understanding of the health profile of their residents and in a proactive role of promoting health in their communities.