Rural communities face hidden health inequalities, report warns

Nation.Cymru staff

People living in rural parts of west Wales face poorer access to healthcare, transport, food and online services, a new report has warned.

Hywel Dda University Health Board’s latest Director of Public Health annual report says distance, limited public transport and poor digital connectivity can contribute directly to health inequalities across Carmarthenshire, Ceredigion and Pembrokeshire.

The health board covers a quarter of Wales’ landmass and is the second most sparsely populated in the country.

While relatively few communities are among the most deprived in Wales overall, 69 of the region’s 235 local areas are in the most deprived 10% for access to services.

The report argues that conventional measures of deprivation can therefore overlook disadvantage which is dispersed across rural communities.

It says access should itself be treated as a health inequality, taking account of factors including travel times, transport costs, digital connectivity and Welsh-language needs.

The pressures are expected to increase as the population ages.

People aged 65 and over currently account for around 26% of the Hywel Dda population, rising to a projected 34% by 2047, compared with 29% across Wales.

The number of people living with conditions including diabetes, atrial fibrillation, heart failure and cancer has also increased significantly.

The report estimates that between 30% and 50% of households in the region may experience transport poverty, while more than 2,000 premises fall below the Broadband Universal Service Obligation.

Around 70% of local areas are also among the two most deprived categories for access to food, while Hywel Dda has the lowest rate of walking or cycling to school of any health board area in Wales.

The findings challenge what the report describes as perceptions of a rural advantage, with high car ownership, local food production and access to the natural environment not necessarily translating into equal access to services, healthy diets or active lifestyles.

Smoking

At the same time, the report identifies strengths within the region.

Adult smoking prevalence stands at 7.7%, compared with 13% across Wales, while local smoking cessation services reach 9% of smokers compared with 5% nationally.

It also highlights high levels of volunteering, neighbour support and community trust.

Dr Ardiana Gjini, Executive Director of Public Health for Hywel Dda, said: “This report celebrates the many benefits of living, working and growing older in Mid and West Wales from our communities, culture and Welsh language to the spirit of volunteering and mutual support that helps people thrive.

“It also highlights some of the challenges we must address together. In a rural area, access matters. Distance, transport, digital connectivity and the availability of local support can have a significant impact on people’s health and wellbeing.”

Prevention

The report calls for coordinated action by the NHS, councils, communities, the third sector and national organisations.

Its recommendations include designing services around the realities of rural life, improving access to healthy food and physical activity, supporting healthy ageing, tackling digital exclusion and investing in community-led prevention.

It also calls on the Welsh Government, national NHS bodies and other public organisations to “rural-proof” major decisions on funding, capital investment, digital programmes and changes to services.

The report says decisions should take account of travel times, public transport, digital coverage, workforce sustainability, Welsh-language needs, seasonal pressures and the region’s older population.

The Social Model for Health and Wellbeing focuses on improving the wider conditions that help people stay healthy by working with communities, councils and other public services.

The health board’s 20four7 Prevention Model is intended to make preventing ill health part of everyday healthcare and help services connect people with community support earlier and more consistently.

Dr Gjini said: “The encouraging news is that we already have many of the foundations in place, with public services and communities working together.

“Through initiatives such as our Social Model for Health and Wellbeing and the 20four7 Prevention Model, we must make prevention everyone’s business and ensure that health is considered in every decision we make.”

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