BMA report shows how rural healthcare is being neglected

A new BMA report, released today (Friday, 21 January 2005) shows how rural healthcare is being neglected. A key message from the report, Healthcare in a rural setting, is that many health policies developed for urban areas do not work in rural ones.

Rural areas make up four-fifths of the UK landmass and include up to a quarter of the population. The proportion of older people living in rural settings is higher than in the general UK population therefore doctors may have to deal with more cases of chronic disease such as heart disease, stroke and mental illness.

Despite the image of the 'rural idyll' there are poor people experiencing disadvantage throughout rural areas and they often live near people with very different circumstances. This results in pockets of deprivation existing alongside relative affluence. Deprivation and poverty are important determinants of health and disease.

Healthcare in a rural setting focuses on four key areas: medical education and training; recruitment and retention of medical staff; accessibility; and the impact of distance and sustainability of services.

Remoteness, lack of public transport services and the centralisation1 of health services mean that many people in rural areas can have difficulties in accessing healthcare. There is evidence that some health outcomes for rural patients are poor compared with those from urban areas, as a consequence of this. For example, the further patients live from specialist cancer centres, the poorer the chances of survival.

The lack of public transport in many rural and remote areas means that residents have to rely on private transport. This means those who cannot afford to drive, or are unable to, such as young and older people, can have severe difficulties in accessing healthcare. Improving rural public transport is vital to improve accessibility of available health services.

Commenting on the report, Dr Vivienne Nathanson, the BMA's Head of Ethics and Science, said: "The UK needs to learn from countries like Australia, the USA and Canada which have developed innovative solutions to the problems affecting rural healthcare."

She added: "A major problem is the myth of the 'rural idyll'. Deprivation in rural communities has been ignored for a long time. There is a real case of the haves and the have-nots. There are those with private transport who can access services, while those with lower incomes have limited access and choice."

The report sets out a plan of action to tackle the difficulties affecting the provision of rural healthcare provision. Key recommendations include the following:

• Transport needs to be improved in rural and remote communities and must be integrated in any health service planning for these areas
• Innovative healthcare services must be provided to allow patients to reach those services and have a choice about the facilities that they use
• The use of telemedicine should be expanded
• Students from a rural background should be encouraged to apply to medical school
• All medical students should have the opportunity to choose a rural placement.