Rural deprivation and ill-health in England "in danger of being overlooked"

Rural communities are in danger of being overlooked when it comes to poverty, deprivation and ill-health, warns a new report from Public Health England.

In England 9.8m people – or 19% of the population – live in rural settings ranging from coastal villages to market towns to large, open expanses like the Yorkshire Dales.

But experts caution that while on average people in rural areas have better health than those in cities, the popular idea of affluent bucolic life is a misconception.

Instead, they say, official statistics have failed to capture the reality that many residents scattered across rural communities face deprivation, poverty and poor health.

“Within a rural community there are significant inequalities between parts that actually are very wealthy and parts that are quite deprived,” said Dr Rashmi Shukla,
Public Health England’s regional director for the Midlands and East of England and lead author of the report.

Published by the Local Government Association (LGA) and Public Health England, the research sheds light on a number of issues affecting the health and wellbeing of rural communities, including low-paid work, unemployment of young people, high costs of housing and fuel poverty.

Access to health services is also of concern, the authors note, with GPs, dentists and other services further away than in urban areas. Indeed, while 97% of urban households lie within 8km of a hospital, the figure for rural households is just 55%.

In addition, rural areas often lack of public transport, while poor broadband and mobile phone network availability hinders communication and access to online health services, banking, and shopping.

“Even people who may not be materially disadvantaged may have difficulties connecting and may be more socially isolated as a consequence of that,” said Shukla.

Social isolation, she adds, is a particular problem for older people – a sector of society that is larger in rural communities, with 23.5% of residents over the age of 65, compared to 16.3% in urban areas.

An ageing rural population, the authors point out, brings a number of challenges. These include the fact that older people often have poorer health and greater care needs, issues compounded by the greater distances to healthcare services and poor public transport. “Financial poverty in rural areas is also highly concentrated amongst older people, with around one-quarter of those in poverty in pensioner households,” the authors add.

Izzi Seccombe, chairman of the LGA’s Community Wellbeing board, said that many of the services that could help tackle these issues have been under pressure.

“What local authorities have all seen is a reduction in government grant,” she said. “While they have tried to protect the services for vulnerable people, like social care, some of our other services that we deliver – which can be subsidised transport, can be library services, it can be grants to the voluntary sector – those have been squeezed.”

The report encourages local authorities to take action to improve healthcare for rural areas, urging them to look closely at the particular challenges facing different communities. The authors also highlight successful initiatives including the “Fish Well” health improvement project in Norfolk, that offered quayside health checks, advice and support to fishermen that they would otherwise have found difficult to access.

The authors also highlight the need for official statistics that look more closely at conditions experienced by those living in the countryside, and at different areas within it, pointing out that current approaches don’t pick up small pockets of deprivation, and tend use measures that are more relevant in urban areas, such car ownership.

“A lot more digging needs to be done to understand the level of deprivation within rural communities,” said Shukla. “Just under 10m of our population live in these communities and a proportion of them are under severe hardship. We need to address that,” she added.

Seccombe agrees. “We must not forget our vulnerable people in more isolated communities,” she said.

Rural deprivation and ill-health in England "in danger of being overlooked"