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Healthcare in a rural setting

January 2005
Board of Science

The local provision of facilities for disabled people
The Disability Discrimination Act characterises disability as follows:
• there must be a physical or mental impairment
• the impairment must adversely effect the person’s ability to carry out normal day to day activities
• the adverse effect must be substantial
• the adverse effect must be long term (meaning that it has lasted or is likely to last for more than 12 months). [go to reference 106]

Research in the US found that while people living in rural areas generally experienced barriers to access to healthcare, these problems were further exacerbated for people with disabilities. [go to reference 107] In the UK, most disabled people have the same kind of health needs as the rest of the population, but they may also have some specific health needs related to their particular impairment or condition. [go to reference 108] Firstly, accessibility difficulties can occur because most of the specialised healthcare services are centred in the larger towns, as well as meeting groups, voluntary groups and information resource centres. This can be exacerbated by the transport difficulties that can be found in rural areas, as highlighted earlier. Secondly, the Office of Population Censuses and Surveys (OPCS) [go to reference 109] found that greater proportions of disabled people are found in those aged 50 years and over (figure 3). As highlighted earlier, there is a greater proportion of older people in rural areas and these age groups experience difficulties accessing healthcare.

Figure 3: disabled people in particular age groups expressed as percentage
Source: Office of Population Censuses and Surveys [go to reference 109]






Case study – Living with mental health difficulties in rural areas (UK)
The Rural Community Network (NI) magazine highlights the additional difficulties that people with mental health problems living in rural areas as opposed to urban areas may face. [go to reference 110]

• The sense of isolation experienced in some rural areas can exacerbate conditions, and feelings of loneliness can lead to a greater sense of alienation.
• A culture of self-sufficiency sometimes found in rural areas can make people reluctant to seek help.
• A lack of privacy in small, tightly-knit communities can make the stigma associated with some mental health difficulties more apparent.
• Specialised mental health services may not be available in rural areas and local GPs may not have the specialist knowledge required.
• Many people with mental health difficulties may have their driving license suspended, and a lack of public transport in rural areas can make accessing healthcare services difficult.

In America, research suggests that healthcare providers need special training to help them identify and treat people with disabilities. In addition, alternative strategies for delivering services are needed to address the health problems of people with disabilities in rural areas. These should include mobile service units, the use of telemedicine to allow rural healthcare professionals to consult urban-based colleagues, and the use of trained non-professional community workers. [go to reference 107]

More research is needed in the UK to explore the health needs of disabled people living in rural areas. However, the substantial evidence that people living in rural areas have difficulty accessing healthcare services strongly implies that these difficulties will be compounded for people with disabilities. A range of healthcare services are needed, such as mobile services. For example, the centrally-based disability information and resource centre in South Ayrshire is less easily accessed by people living in rural areas than those living in urban areas. The establishment of a mobile disability resource centre is therefore being considered, to deliver services more conveniently to the rural communities of South Ayrshire. [go to reference 111] It is also suggested that there is a place for trained local volunteers to provide information and resources, and help to reduce the isolation that may be experienced by people with disabilities in rural areas through networking and ‘buddy systems’.

Recommendation 13
A range of healthcare services are required to meet the needs of people with disabilities, for example mobile services and voluntary services provided by trained local community members. Further research is needed in the UK to comprehensively define the healthcare needs of disabled people living in rural areas.