Rural health needs rural dimension

NEW guidance aimed at local authorities assuming public health responsibilities is helpful, but it needs a rural dimension, argues Brian Wilson.

The National Institute for Health and Clinical Excellence (NICE) has begun to publish a series of public health briefing notes for local government. These are written to help local authorities and their partner organisations, as responsibilities for public health transfer across to them from the NHS in 2013.

NICE has produced its guidance documents with input from a Local Government Reference Group. It suggests they can be used, alongside evidence from Joint Strategic Needs Assessments, to inform the development of joint Health and Wellbeing Strategies.

The first three briefing notes cover physical activity, tobacco and workplace health. Due to be published in the months ahead, other examples will cover obesity, walking and cycling, partnership working and health economics.

The transfer of public health responsibilities is a significant structural reform and while it makes sense in many ways the Rural Services Network has expressed its deep concern about the funding arrangements. Current proposals are for some 25% less funding per head in rural areas than in urban areas and for no weighting to be given to sparsity costs.

According to the briefing note on physical activity, around two thirds of adults do not meet the Chief Medical Officer's physical activity recommendations and the figures for children are worse still. This inactivity has been estimated to cost the NHS over £1 billion per year in direct costs.

NICE lay out the case for encouraging people to become more physically active. There is an economic productivity gain to be had, since physically active workers take 27% fewer days of sickness leave. There are savings to be made by other public service providers, not least if older people manage to maintain healthy and independent lives. Health inequalities can also be reduced, as children from lower socio-economic backgrounds are typically the least active. And there may be congestion or air quality gains if people can be encouraged out of their cars.

These are strong arguments, but there is undoubtedly a rural dimension to this and one which appears to be overlooked by the NICE briefing note. Making even a short journey by foot or encouraging a child to cycle to school is difficult, if not dangerous, in many rural areas.

The road accident statistics are evidence of that. It is unclear why the guidance, in suggesting more cycle paths are created, then adds "particularly in urban areas". Of course, large numbers of rural communities have fought for and many councils have introduced lower speed limits or traffic calming measures.

The briefing note also recommends making sports and leisure facilities "easy to reach and use". Whilst few would disagree with that principle, the practicality in smaller and dispersed settlements cannot be ignored. Accessing more formal leisure facilities may require a fair journey and perhaps not one that can be undertaken by public transport.

It may also mean that children from rural places have to rely more heavily on sports facilities provided at school. That can include after-school activities and their participation may be affected by the availability of transport home after the normal school day finishing time.

There are, of course, many things that rural local authorities and their partner organisations either can do or already do. Lots of these will happen at the very local level and they may happen informally. It would be good to see some of that reflected in the guidance and appearing among examples on the 'shared learning' pages of NICE's website.

The rural dimension to this policy agenda is not one that should be sidelined. Data from the 2008 Place Survey, reported in the Rural Services Network's State of Rural Public Services 2011 report, showed that rural residents made less use of sports and leisure facilities, and made less use of parks and open spaces than their urban counterparts. Fewer than half had used sports and leisure facilities within the previous six months. This strongly hints at a link with poor rural accessibility.

It would be fascinating to hear the views and experience of upper tier local authorities who will shortly be taking on these public health responsibilities.

This article was written by Brian Wilson whose consultancy, Brian Wilson Associates, can be contacted at Brian also acts as RSN Research Director.


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