Around the world, the health status of people in rural areas is generally worse than in urban areas. In South Africa, infant mortality rates in rural areas are 1.6 times that of urban areas. Rural children are 77% more likely to be underweight or under height for age; 56% of rural South Africans live >5 km from a health facility; and 75% of South Africa’s poor people live in rural areas.2
Critical factors in the relationship between poverty and health are population and environmental health issues. 80% of the poor in Latin America, 60% in Asia and 50% in Africa live on marginal lands of low productivity and high susceptibility to degradation. This tends to encourage migration from rural areas to the cities. However, in the world’s cities, more than one billion people live without facilities for garbage disposal or water drainage, and breathe polluted air.3
With the concentration of poverty, low health status and high burden of disease in rural areas, there is a need to focus specifically on improving the health of people in rural and remote areas, particularly if the urban drift is to be reversed. The WHO International Development Program’s has highlighted this, with specific objectives for policies and action which promote sustainable livelihoods including access for people to land, resources and markets, as well as better education, health and opportunities for rural people. These objectives seek to contribute to lowering child and maternal mortality, and to improve basic health care for all, including reproductive services. Achievement of this is linked to protection and better management of the natural and physical environment.
The emphasis on poverty as well as other social and economic factors has led to a tendency to focus on those issues rather than directly addressing health issues. The 10/90 Report on Health Research, 1999 presents an alternative view: “The global community should recognize that good health is a way out of poverty”. It results in a greater sense of wellbeing and contributes to increased social and economic productivity. The impact of ill health on productivity affects not only the poor, but societies and economies as well”.3 Drawing these points together, there is a particular need to focus on the health and well-being in rural and remote areas so as to break out of the poverty–ill health–low productivity downward spiral.
The low health status and variable patterns of illness and injury in rural areas are related not only to poverty. In general, the rates of avoidable deaths in rural and remote areas are higher than in the cities. Generally, work injuries are more serious and more severe in rural areas, which to some extent follows from the stoicism and the ‘too tough to care’ mindset particularly amongst farmers and agricultural workers.4 in fact, in Australia, the tractor is the most dangerous machine with which people work. Forty percent of work injuries are associated with tractors, even though only 5% of the workforce work with tractors.5 Similarly, there are dangers in other rural pursuits such as mining, fishing and timber work.
The specifics differ from country to country; however, there are always some illnesses which are peculiar to living and working in rural areas. These include zoonosis, such as hydatids and leptospirosis, as well as other illnesses with animal vectors such as mosquitoes.
As a generalization, lifestyle-related illnesses are more common in the rural areas. The peaks and troughs of the economic cycle tend to impinge more directly on rural communities, with economic downturns often placing severe pressure on these communities. Consequently, there are significant levels of stress in a situation where generally counselling, support groups and other mental health services are limited if available at all. Commonly, in rural areas, there is a higher alcohol and tobacco consumption, and standards of nutrition vary when compared with the cities.
Roger Strasser 2003; Family Practice, Volume 20, Issue 4, 1 August 2003, Pages 457–463
Boulle A. Rural health care and rural poverty—inextricably linked—policy in progress. HST Up-Date 1997; 28: 6–7.
World Health Organization. Global Forum for Health Research. 10/90 Report. Switzerland: WHO; 1999.
Hegney D. Agricultural occupational health and safety; farming families presenting a challenge to wellness. Aust J Rural Health 1993; 1: 27–33.
Fragar L. Agricultural health and safety in Australia. Aust J Rural Health 1996; 4: 200–206