Cirican and the Open University developed this webinar series to present ideas and innovation for levelling up in rural places. This post summarises ideas presented in the second of these webinars: Tackling Health Inequalities. A big thank you to Dr Lincoln Sargeant from Public Health Torbay, Dr Colin Lorne from The Open University, Sheena Asthana from the Plymouth Institute of Health and Care Research and Diana Crump from Living Options Devon. The next and final seminar in this series looks at Digital Futures: the role of IT.
A brief summary of health inequalities in rural locations and the challenges they face
Rural communities face different challenges when compared to those living in more urban settings. Some of these differences can impact the inequalities these communities face, and this in turn can impact their individual health and the health of their local communities. Keeping place at the centre of discussions is fundamental to these discussions as they allow us to understand local contexts. This context is necessary when discussing and looking to address health inequalities and the impacts these can have on these different communities.
But what can affect these changing local contexts? Housing for one can present a particular challenge, both inadequate housing conditions and insufficient housing in an area can present a hurdle for local communities. When coupled with generally poor or sparse transport links, low numbers of inaccessible housing can present a real barrier to residents while making the ownership of a car a necessity in many cases. This can in turn can impact the connectivity rural locations in terms of ability to travel both around and in and out of the local area. Connectivity is often an issue in other ways too with rural locations typically seeing poor connectivity, e.g. poor satellite and internet coverage. Rural locations have a generally older population due to opportunities available in more rural locations, often meaning additional health risks can be seen in the area. It also is important to remember that these additional barriers can impact disabled people or those living with disabilities in more extreme ways. While this is a non-exhaustive list, this allows us to see that factors such as these can impact rural, local areas in both socio-economic and health terms meaning we need to think about rural health in a nuanced way.
Defining the problem:
When thinking about health in rural communities, defining the problem itself can be the difficult first step. What counts as a rural community? How is each rural location similar? How do they differ? These can be key questions to understand, address and (in some cases) overcome. What is important to appreciate is that rural communities do share commonalities and often they are faced with similar challenges, as described above!
But it is also important to understand that there are a range of various rural locations and communities who are both perceived differently and who actually face distinct challenges. Take for instance coastal communities, as discussed by Sheena Asthana. These locations are often perceived idyllically by others across the country as seaside holiday locations and rarely do people look beyond their holiday appeal to some of the inequalities they can face as communities. In this discussion we were asked to look and think beyond the “North-South phenomena” to truly understand how these rural, coastal communities share more similarities than many locations in the South will share with one another and many locations in the North will share with one another.
Hiding behind the averages:
Another important challenge to address comes from the way data is gathered, analysed, understood and actioned upon.
The way data is gathered, broken-down and reported on can mean that inequalities in these rural locations can be hard to identify and therefore address. IMD in particular can present a real barrier to addressing rural inequalities. The way IMD is currently calculated and presented does not identify all key areas of need and does not always adequately paint a full picture of a deprivation within a community. In fact, in some instances in rural settings there can be large pockets of communities facing real disadvantage and deprivation which do not get presented in the data. Geographical classifications can be large and undescriptive and therefore, when averages are drawn, these do not always account for the full understanding of local community deprivation, need and inequality that can exist in the area.
But what can we really do?
So that leads us to ask: What can we really do about rural health inequalities? Some things may be beyond people or the communities’ control, for instance access to funding or size of funding available. But there are things we can do.
Above all else, when thinking about addressing some of these challenges, it is important to make local communities aware of these issues and ensure that others across the country are also made aware. There is an important role for advocacy when discussing rural health inequalities. It is fundamental to empower local people to make decisions, be involved and to be heard. Allowing the voices of those living in rural communities to be heard and to ensure they have a platform to discuss these issues faced is an important way to involve local communities in decision-making. By doing so, this opens channels of communication and brings new discussions to fore. It provides a vital first step for local people to start to challenge some of the issues they may face and begin to understand how to best address some of the impacts these can have.