Investigating trends in rural health outcomes: a research agenda

Recent research has highlighted the nature of spatial inequalities in health experience in the UK providing evidence of increasing spatial polarisation. However, these studies have tended to be largely concerned with variations in health in urban settings. Recent economic trends, particularly in the agricultural sector, have focused attention on the socio-economic status of rural populations. With a number of notable exceptions, relatively few studies have been concerned explicitly with issues of rural health. The aims of this paper are to firstly, review recent research which has begun to challenge the notion that rural populations are necessarily healthier than their urban compatriots and secondly, to identify a number of possible explanations for the trends identified in these studies. Variations are examined in relation to methodological problems, socio-economic trends in rural areas, changing accessibility to primary and secondary health care and lifestyle/behavioural factors. A research agenda is presented whereby these types of factors can be further investigated through an integrated approach to studying health variations within rural areas. Finally, the paper concludes by suggesting that more research is needed to investigate the main determinants of health experience and health status in a range of rural settings. (C) 1999 Elsevier Science Ltd. All rights reserved.