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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.