Health and health services
As in other parts of the UK, people in Somerset have differing needs, depending on their age, gender, where they live and the way they lead their lives. Here, we look at differences in the health (and access to health care) between those living in rural and urban areas and also explore possible reasons for them.
Note that most of our analysis focuses on three broad categories based on the ONS Rural-Urban 2011 classification:-
- Urban City and Town
- Rural Town and Fringe
- Rural Villages and Dispersed
The folowing report was prepared for the Somerset Joint Strategic Needs Assessment 2014/15.
- Health Need in Rural Areas
A summary of health need in rural areas, including data on disease prevalence, hospital use, mortality, lifestyle-related conditions and GP practice satisfaction
Key messages for Somerset
In general, compared to those in urban areas, people in rural areas:-
- have a longer life expectancy
- live healthier lives
- have fewer long term health conditions
- do not have as much emergency hospital treatment
- are not referred for as much specialist secondary care
- have lower death rates
- are slightly more satisfied with their GP service
- The older population in rural areas has more emergency and elective hospital treatment – possibly as a result of risk aversion behaviour of GPs
- Small towns appear to have higher death rates than both villages and urban areas
- Self-reported health in the 2011 Census was slightly better for those in the rural villages than in the rural or larger towns.
The 2014 Somerset Children and Young People Survey also identified some differences in health-related behaviours between pupils from rural and urban areas:-
- Rural pupils were more likely to say their parents/carers smoked and that the pupils themselves had smoked or were still smoking
- Rural secondary pupils were more likely to have been offered cannabis and knew someone who takes drugs to get high
- They were less likely to have a health clinic at their school but more likely to know who their school nurse is and how to access the nurse.
- Rural secondary pupils were less likely to do or enjoy physical activities, or to eat vegetables most days, but were more likely to have walked to school that morning.
More intelligence is provided below but for the detailed data, please download the Excel document available at the foot of the page.
The simplest and most comprehensive measure of health inequality is life expectancy. Even after combining 5 years' data, the estimates of life expectancy have quite a large measure of uncertainty. Nevertheless the clear pattern is for higher life expectancy in the isolated villages and rural areas, lower in the small towns and lowest in urban areas (see Chart 1). Life expectancy is closely associated with wealth and deprivation, and these may well mask specifically ‘rural’ factors.
Chart 1 Life Expectancy by Rural-Urban areas (2009-13)
Based on data on obesity, smoking and substance misuse-related hospital admissions, rural residents appear to lead healthier lives. It might be expected that this will reinforce the effect of greater prosperity in rural areas and help explain the apparent better health outcomes.
However, the Somerset Children and Young People Survey results indicate that school-age children in rural areas are more likely than their urban counterparts to experience smoking and cannabis, through either personal use, their peers or family.
The people living in rural areas appear to be healthier than those living in urban areas as there is less recorded disease in GP practices in rural areas. This is the case for the majority of long term conditions with the exception of Atrial Fibrillation (a problem with heart rhythm).
Disease Prevention and Detection
Analysis of disease prevention and detection indicators such as screening, vaccination. breastfeeding initiation and Health Checks, there is not much difference in rates between rural and urban areas. However, rural areas are significantly better than the county average for:-
- Breastfeeding prevalence at 6-8 weeks
- Flu vaccinations for those aged 2 and 3
- % of eligible people in the most deprived areas who received a Health Check
- Chlamydia screening uptake (ages 15-24)
- Cervical cancer screening coverage (ages 25-49)
The large numbers of people mean that some small observed differences can be statistically significantly different when there is no clinically significant difference between the rates.
Admissions to hospital
Rural areas have consistently lower rates than urban areas for emergency admissions.
Emergency admissions reflect unexpected need that has not been either identified or controlled in the community or through planned hospital treatment. It is likely that areas with easy access to hospitals will have a higher emergency admission rate to hospital than areas with poorer access and this could to some extent explain the difference. It is also likely that areas of high deprivation have a higher need for emergency admissions, and these tend to be in urban areas. Hence it is difficult to disentangle whether the reason for the lower admission rates from rural areas is as a result of poorer access or less deprivation or maybe something else relating to rurality.
First outpatient appointment rates (which reflect the number of people that GPs refer on for specialist care) are in general lower in rural than urban areas. As elective admission rates are very similar, this suggests that a higher proportion of those referred from rural areas need admission. This might reflect a higher threshold of need before referral being used in rural areas and/or the easier access to visit hospital in urban areas.
However, although in general rural rates are less than urban rates there are two notable exceptions: the rates for emergency and elective admissions for those aged 75 or more. This might be as a result of a “better safe than sorry” philosophy: to treat the rural elderly at a lower threshold so that care is provided in a “safe” environment rather than run the risk of dire emergencies occurring at a great distance from help. The same thinking would not, in general, apply to younger people where emergencies are not usually to be expected.
Death rates were, in general, lowest in the most rural group of areas. However, the highest death rates were found in the rural town group of areas (see Chart 2). The pattern is unexpected. It is not a surprise that the group of urban areas has the highest premature death rate, as this is highly related to deprivation and associated lifestyles, nor that the group of isolated villages has the lowest rates (as the prevalence of disease is lower). What is not expected is that so many of the causes of death show the highest rates in the small towns and large villages. This does not seem to be related to deprivation in these places.
Chart 2 Death Rates for Leading Causes of Death in Somerset, 2013/14 Download supporting data:-