The most comprehensive source of data for rural areas is the Scottish Government's Rural Scotland Key Facts publication. This section does not seek to replicate all of the information contained within that publication, but instead draws out and expands upon key aspects relevant to public health.
Life expectancy and healthy life expectancy in rural and urban areas
Chart 1 (view chart) shows that life expectancy is greater in rural areas than in urban areas (see also the National Records of Scotland publication, Life Expectancy in Special Areas within Scotland, 2011-13). However, this is likely to be partially explained by the migration effects of healthy individuals moving to rural areas in retirement (Riva et al 2011). Although health inequalities (between deprived and less deprived areas as measured by Carstairs deprivation) in urban areas are wider than in rural areas, they rose slightly more quickly in rural areas between 1979 and 2001 (Levin and Leyland 2006).
Healthy life expectancy across the urban rural classification is shown elsewhere on the ScotPHO website.
Demographic differences between rural and urban areas
Although 95% of the Scottish land mass is rural, only 17% of the population live in such areas - see Chart 2 (view chart) .
One of the most striking features of rural areas is that the population is much more elderly than in urban areas. This can be seen in the population pyramids in the Excel spreadsheet showing the population structure of each category in the 8-fold urban / rural classification, for 2014. The biggest differences are in the age groups between 20 and 39 years, where there are much greater proportions of the total population in urban areas than in rural areas.
Deprivation in Scotland is measured most commonly by the Scottish Index of Multiple Deprivation (SIMD). This works best where there are spatial areas with relatively homogenous populations and is the best available source of data on multiple deprivation for the Scottish population. However, there is a concern that the greater diversity within datazones in rural areas leads to a lack of appreciation of the extent and depth of poverty for some people in rural areas. Furthermore, the use of ‘access to a car’ as a marker of deprivation in some indices means more in rural areas where it is essential for accessing services.
As a result of these concerns there has been interest in alternative means of capturing deprivation in rural areas, although there is no obvious suitable source of data routinely available. The options include:
- Using selected data from the Scottish Index of Multiple Deprivation after exclusion of the urban areas such that rural quintiles are created (see Income, employment and access deprived rural datazones using SIMD 2009).
- Including a measure of population loss as a marker of ‘fragility’ for rural areas (see Socio-Economic Briefing on Rural Scotland: Identifying Fragile Rural Areas: Paper 5 (611Kb)). This was found not to add additional insights to that already contained within the existing SIMD dataset and did not address the fundamental problem of the spatial basis of the index in rural areas.
- The use of council tax valuation band data to identify those living in cheaper housing as a proxy for deprivation (for example see Fone et al 2006). These data are collected and maintained by local authorities.
Clearly it would be ideal to have individual-level markers of social class, income, wealth and/or deprivation available to provide health intelligence for rural (and urban) areas. Work is underway to facilitate greater linkage of data in Scotland and this may improve the prospects for improving the measurement of deprivation in rural areas in the future.
A full discussion of the issues related to the measurement of deprivation in rural areas and elsewhere has been provided by Colin Fischbacher in Identifying "deprived individuals": are there better alternatives to the Scottish Index of Multiple Deprivation (SIMD) for socioeconomic targeting in individually based programmes addressing health inequalities in Scotland?.