Rural deprivation and ill-health in England "in danger of being overlooked"

Rural communities are in danger of being overlooked when it comes to poverty, deprivation and ill-health, warns a new report from Public Health England.

In England 9.8m people – or 19% of the population – live in rural settings ranging from coastal villages to market towns to large, open expanses like the Yorkshire Dales.

But experts caution that while on average people in rural areas have better health than those in cities, the popular idea of affluent bucolic life is a misconception.

Instead, they say, official statistics have failed to capture the reality that many residents scattered across rural communities face deprivation, poverty and poor health.

“Within a rural community there are significant inequalities between parts that actually are very wealthy and parts that are quite deprived,” said Dr Rashmi Shukla,
Public Health England’s regional director for the Midlands and East of England and lead author of the report.

Published by the Local Government Association (LGA) and Public Health England, the research sheds light on a number of issues affecting the health and wellbeing of rural communities, including low-paid work, unemployment of young people, high costs of housing and fuel poverty.

Access to health services is also of concern, the authors note, with GPs, dentists and other services further away than in urban areas. Indeed, while 97% of urban households lie within 8km of a hospital, the figure for rural households is just 55%.

In addition, rural areas often lack of public transport, while poor broadband and mobile phone network availability hinders communication and access to online health services, banking, and shopping.

“Even people who may not be materially disadvantaged may have difficulties connecting and may be more socially isolated as a consequence of that,” said Shukla.

Social isolation, she adds, is a particular problem for older people – a sector of society that is larger in rural communities, with 23.5% of residents over the age of 65, compared to 16.3% in urban areas.

An ageing rural population, the authors point out, brings a number of challenges. These include the fact that older people often have poorer health and greater care needs, issues compounded by the greater distances to healthcare services and poor public transport. “Financial poverty in rural areas is also highly concentrated amongst older people, with around one-quarter of those in poverty in pensioner households,” the authors add.

Izzi Seccombe, chairman of the LGA’s Community Wellbeing board, said that many of the services that could help tackle these issues have been under pressure.

“What local authorities have all seen is a reduction in government grant,” she said. “While they have tried to protect the services for vulnerable people, like social care, some of our other services that we deliver – which can be subsidised transport, can be library services, it can be grants to the voluntary sector – those have been squeezed.”

The report encourages local authorities to take action to improve healthcare for rural areas, urging them to look closely at the particular challenges facing different communities. The authors also highlight successful initiatives including the “Fish Well” health improvement project in Norfolk, that offered quayside health checks, advice and support to fishermen that they would otherwise have found difficult to access.

The authors also highlight the need for official statistics that look more closely at conditions experienced by those living in the countryside, and at different areas within it, pointing out that current approaches don’t pick up small pockets of deprivation, and tend use measures that are more relevant in urban areas, such car ownership.

“A lot more digging needs to be done to understand the level of deprivation within rural communities,” said Shukla. “Just under 10m of our population live in these communities and a proportion of them are under severe hardship. We need to address that,” she added.

Seccombe agrees. “We must not forget our vulnerable people in more isolated communities,” she said.

Rural deprivation and ill-health in England "in danger of being overlooked"

The Cancer Journals record a new way for women to face ill-health

“This is it Audre, you’re on your own,” wrote black feminist poet and writer Audre Lorde in The Cancer Journals, a collection of diary entries and essays in which she recorded her experience with breast cancer. Published first in 1980, Lorde’s book predates the popularity of the cancer memoir, now an established genre of sorts. “I have cancer, I am a black feminist poet. How am I going to do this now?” she asks. She does do it, and her book radiates with rebellion, even four decades later.

I do not have cancer, but I am a feminist and one diagnosed with an avalanche of overlapping autoimmune diseases. There is a particular dread, I’ve learned, in labelling oneself as “sick”: with its looming and corrosive reality, the word threatens to engulf everything else. Sick writers, both male and female, have often reflected on how illness overwhelms their work. In a letter to a friend, the tuberculosis-addled Kafka wrote: “My head and lungs have come to an agreement without my knowledge.” True for all the unwell, his description points to the particular irony that sickness represents for feminists, those against the equalling of a woman’s worth with her physical self. Does sickness, with its attendant infirmity, its gloomy shadow over the intellectual, represent feminist defeat?

Lorde’s account does not allow such prognostications of surrender. Her diagnosis comes months after an initial cancer scare and a lump that proves (after a harrowing period of waiting and wondering) to be benign. It is not so the second time, and agonising days are spent in the hospital between the biopsy that bears the bad news and the mastectomy that excises her right breast. The violence is not limited to the excision; beyond the fog of pain lie the expectations of a culture that wants, even demands, that women look a certain way. Then as now, it is other women who are selected to deliver the news regarding the requirements of conformity and compromise. In Lorde’s case, “a kindly woman” comes bearing “a soft sleep bra and a wad of lambswool pressed into a pale pink breast-shaped pad”. The message is clear: the absent breast must be made up for somehow, such that Lorde’s one-breasted deviation from the ideal female form is never visible. “You’ll never know the difference,” the woman insists. “I knew sure as hell I’d know the difference,” Lorde concludes.

She is both brave and right. Embracing her one-breasted self, Lorde refuses to render invisible her difference and the experience of pain that is somehow embarrassing to others. Not only does she refuse to wear the prosthesis home from the hospital, she shirks it completely, refusing to be cowed even when a previously decent nurse accuses her of damaging the morale of other patients. In this, a head-on, one-breasted confrontation with societal expectation, Lorde reveals the nobility and worth of strength that is tested. It is not an incidental or reactive position; in Cancer Journals, Lorde explains the feminist rationale behind it. Cosseted in prosthesis, literal or figurative, she argues, women are kept from confronting loss, of breasts or of formerly healthy selves. Entrapped in the “terror and silent loneliness” of denial, they experience a second victimisation. No feminist must permit this.

There is inspiration in Lorde’s position, for me and for all women who have spent time in doctors’ offices and surgeries, feeling estranged from the strong or whole selves of a bygone before. Before reading The Cancer Journals, I had long inhabited their ranks. Arming myself with many medications and some delusion, I believed in the words of the lady who first offers Lorde a prothestic breast; I would “never know the difference” between my pre- and post-sick self. Lorde’s argument proved the vacuity of this. Making my way through the book’s pages, I found a different model of feminist power – not a sidestepping of sickness, but a defiant avowal of the reality of pain and respect for the transformed self it leaves behind. I emerged as neither a contradiction nor an oxymoron, but a vanguard, a model, for others less brave.

The Cancer Journals record a new way for women to face ill-health