1. Martin Gorringe Rural Communities Policy Unit Defra What is Rural Proofing & Why is it Important?

2. Rural Urban Definition Rural-urban definition Rural-urban definition is a statistical tooI based on population not land use or sector http://www.defra.gov.uk/statistics/files/rural-urban-guidance-notes.pdf Classify each Output Area (OA) by:- Settlement type: Urban (population is 10,000 or more at Census 2001) Rural town and fringe Rural village Rural hamlets and isolated dwellings Context: Less sparse Sparse (very low residential density for 30km around)

3. Rural Proofing and Government Rural proofing – Government commitment Defra acting as Rural Champion/ centre of expertise Local Level guidelines for local authorities National level guidelines Lord Cameron independent review of rural proofing

4. The Rural USP 86% of England’s land is rural; 20% of the population live in rural areas; Nearly 10m people in settlements with populations < 10,000 Nearly a quarter of all older people live in rural areas (55+) Rural areas are ageing at a faster rate than urban areas. Fastest rate of growth is amongst the oldest old (age 85+). In 2009, 15% of all older people in rural areas lived below the poverty threshold. Around 23% of rural households are in fuel poverty vs 18% of urban households (2009) 38% of rural households are off the gas grid vs 9% of urban households

5. The Rural USP Road fuel is around 2 pence per litre more expensive in sparse rural areas than the national average. Only 50% of households in villages and hamlets have an hourly or better bus service within 13 minutes walk (compared with 96% of households in urban areas) Public transport is more limited in rural places. In 2009 42% of households in the most rural areas had a regular bus service close by, compared to 96% of urban households Residents in villages and hamlets spend 20 - 30% more on transport than those in urban areas

6. Rural Health – No Problem? Overall health outcomes more favourable in rural areas : Life expectancy is higher, Infant mortality rate is lower and PYLL from common causes of premature death is lower Average life expectancy is highest in Rural 80 areas (80% of area classified rural) 2009-11, male life expectancy was two years longer than urban areas and Females born in Rural-80 areas in life expectancy is one and a half years longer than urban areas. Infant mortality is lower in rural areas: In 2011, the infant mortality rate in rural areas was 3.7 deaths per 1,000 live births, compared with the England average of 4.3 deaths

7. Rural Health – no problem? PYLL from common causes of death is lower in rural areas. PYLL from cancer in predominantly rural areas was 134.7 years per 10,000 people - over 15 years lower than the 150.6 per 1,000 in urban areas PYLL from stroke or related diseases in predominantly rural areas was 12.5 years per 10,000 people, lower than the 16.6 PYLL per 10,000 people in predominantly urban areas PYLL from Coronary Heart Disease in predominantly rural areas was 36 years per 10,000 people - lower than the 51.2 years per 10,000 people in urban areas This means that fewer people living in rural areas are dying prematurely than those living in urban areas.

8. Why Rural Proof Health ? Positive health outcomes for rural areas = health equity Significant inequalities around access to services Access to GP’s - Travel distance – acute centres and specialist treatment = further away Distance decay – patients access services less the further away they are. Cost of service provision – Community care, economies of scale, staff retention

9. Why Rural Proof Health ? 80% of rural residents live within 4km of a GP Surgery, compared with 98% of urban population 57% of rural residents live within 4km of an NHS Dentist, compared with 98% of urban population around one-sixth of Primary Care Trusts (PCTs) with the worst health and deprivation indicators were located in rural or significantly rural areas. www.defra.gov.uk/statistics/rural www.gov.uk/government/publications/national-rural-proofing-guidelines

10. Travel Times in Devon

11. Help is at hand Rural proofing for health toolkit http://www.ruralproofingforhealth.org.uk/

12. Rural Proofing for health Toolkit

13. Questions?