Scottish Government

Social Focus on Urban Rural Scotland 2003

chapter four: Health and Care

Our health and that of our children is of great importance in all of our lives. This is reflected in the fact that overall spending on NHS in Scotland is nearly 7 billion in 2002. The recent publication Partnership for Care: Scotland's Health White Paper states, 'Scotland's health is improving but the scale of the challenge is still daunting. Scotland's death rates are among the highest in the world for cancer and coronary heart disease. Life expectancy is consistently lower than in other European Union countries. We have rising rates of suicide, particularly among young men, and rising numbers of young people, in particular girls in their early teens, being treated for self-harm. This reflects a complex interaction of different factors relating to life choices, life styles and life circumstances. Our objective is to improve Scotland's health and reduce the health inequalities within our society. Poor health is strongly linked to deprivation and inequality.'

Poverty and Social Exclusion in Rural Scotland suggested that there is perhaps a perception that rural residents are healthier than many of their urban counterparts.

This chapter presents data, mainly from the Scottish Household Survey, on aspects on health and care in Scotland using the six fold urban and rural classification. It is by no means an exhaustive comparison of health issues in urban and rural areas. There are many other sources of health information available but they are not readily available using the six fold classification. In order to ensure consistency with other chapters, only data which can be presented using the six fold classification are included here.

The results show that there are some significant health differences between people in urban and rural areas, for example:

• people in rural areas generally report better health than those in urban areas;
• they are less likely to be disabled or suffer from a long term limiting illness than those in urban areas and;
• they are less likely to smoke than those in urban areas.

but for other aspects of health there appears to be little difference between the different areas:

• for those that smoke, the average number of cigarettes smoked is the same in urban and rural areas
• the number of times people visit their GP annually.

Self assessed health

The Scottish Household Survey (SHS) asks respondents to assess their state of health over the last twelve months and Table 4.1 shows the percentage of adults who stated that their health was good, fairly good or not good by the different area types. People in rural areas generally report that their health is better than those in urban areas. This feeling of well-being increases in a linear manner; people in smaller towns report that their health is better than people in urban areas and those in rural areas report better health than those in small towns.

Chapter 2 highlighted that remote areas of Scotland have an older age profile than the more urban areas. Age is known to have an affect on self perception of health - older people tend to report their health as less good. It is useful to spilt these data into under and over 65 year olds to see whether the differing age profile has any effect on the results.

Chart 4.2 shows the percentage of under 65 year olds and over 65 year olds who view their health to be "not good". For both of these age groups, the proportion of people who describe their health as not good is higher in urban areas than in rural areas. For all area types the proportion is higher for 65 years and older than for under 65 year olds.

Source: Scottish Household Survey

In addition to age, exercise is an extremely important determinant of the well-being of an individual, yet 58 per cent of adults in Scotland do not walk for pleasure or to keep fit. In his foreward to the Strategy on Physical Activity, the Chairman of the Physical Activity Task Force states that Scottish people live in 'very inactive times' and that 'there are three times as many inactive Scots as there are Scots who are smokers.'

The SHS does not ask any detailed questions on exercise habits, but respondents are asked how often they walk for pleasure or to keep fit.

There is a significantly higher proportion of people within rural areas who walk at least once a week for pleasure or to keep fit. The difference is most marked in the proportion who walk 6 or 7 days a week: only 10 per cent within large urban areas as opposed to 20 per cent in accessible rural areas and 18 per cent in remote rural areas.

Disability

Adults in urban areas are more likely to have a disability or long term limiting illness than those living in rural areas. Whilst there are small differences between the urban areas and small towns and between small towns and rural areas these differences are not significant.

As with self assessed health, age has a large effect on the rates of disability and long term illness; older people are more likely to be disabled than younger ones. Chart 4.5 shows the proportion of adults aged under 65, and 65 and older who are disabled using the 3 fold classification. For both age groups the proportion of adults with a disability or long term limiting illness is highest in urban areas.

Source: Scottish Household Survey

Care provision

The SHS asks the head of the household whether there is any one in the home who needs regular help or care because of disability, illness or old age. There is a small but significantly higher proportion of adults receiving care in large urban areas than in rural areas which is consistent with there being a higher incidence of disability and long-term illness in these areas.

The head of household is also asked whether household members provide care to others either within or outside of the home. 13 per cent of adults in Scotland do provide help to others but there are no significant differences between the different areas.

Smoking

A significantly higher proportion of adults from urban areas smoke compared to rural areas however there is no difference in the average number of cigarettes smoked per day (15.9 cigarettes).

Once again, the age structure of the population will have an effect on these results; results from the SHS show that younger people are more likely to smoke than older ones and the urban areas have a higher proportion of younger people than the rural areas. However, when the data are compared for both the under 65 year old age group and the over 65 year old group there is still a significantly higher proportion of adults smoking in urban areas than in rural areas.

Consultations with GP

Analysis of the SHS shows that there is no difference in the proportion of adults registered with a GP between urban and rural areas; it is virtually 100 per cent in all parts of the country. Survey respondents are asked to rate how satisfied they were with their last visit to their GP and again, there were no significant differences between urban and rural areas with 92 per cent replying that they were either very satisfied or fairly satisfied. The number of times that an individual consults their GP over a 12 month period is also the same irrespective of whether they live in an urban area, a small town or a rural area (Chart 4.8).

Source: Scottish Household Survey

The Scottish Executive Environment and Rural Affairs Department carried out a study on the geographic Availability of Services in Rural Scotland during 2002 which involved calculating the drive times to 20 key services. One of these services was the nearest GP surgery. Over 95 per cent of households in urban areas or small towns in Scotland live within 5 minutes drive of a GP surgery however in rural areas this figure drops to 55 per cent. (Table 4.9). Looking at these drives times in conjunction with the results on number of visits to GP, it appears that the household drive time to the surgery does not affect how often an individual visits their GP.