Public Health and Preventative Services

The NHS Long Term Plan for England commits to placing much greater emphasis on prevention, so that people remain healthier for longer.  The Prevention Green Paper similarly seeks to bring about ‘prevention at scale’, thereby reducing premature ill-health and disability.  Tackling health inequalities is also a headline objective, to reduce the social gradient in healthy life expectancy.  The Public Health England strategy document lists ten issues which form the focus of its work.  These include lifestyle issues (e.g. smoking, diet), environmental issues (e.g. clean air), educational issues (e.g. with mental health) and scientific advances (e.g. antimicrobial resistance, predictive prevention).

One likely challenge is measuring and targeting health inequalities where needs are scattered across rural geographies and so less visible.  Promoting public health messages to outlying communities may also require tailored approaches that make use of different opportunities.  Furthermore, ensuring prevention programmes or projects are accessible to residents from both large and small settlements will inevitably impact their effectiveness.

The following questions are intended to help improve rural service planning and design:

  1. Does the area’s Health and Wellbeing Strategy (or other prevention strategies) seek to measure and monitor indicators of public health and its determinants at a locality level?  What does doing so show about public health needs and priorities for rural localities?
  2. When assessing health inequalities to target relevant initiatives, what attempt is made to account for varying spatial patterns?  Does the approach identify both geographically scattered need, typical in rural areas, and clusters of need, typical in urban neighbourhoods?  How well do inequality indicators used cover both urban and rural aspects of deprivation?
  3. What approaches are used to promote public health messages, such as with campaigns on smoking cessation, a healthy diet and vaccination take-up?  How well do those approaches work in rural areas?  Could community-based organisations assist, such as parish councils, WI groups and village hall committees?
  4. How well equipped are those community pharmacies which are based in rural towns or settlements to offer health and wellbeing advice to their customers?  What scope exists to use them to improve access to professional health advice in rural areas?
  5. How are public health programmes providing lifestyle interventions delivered equitably and accessibly to rural communities, for example to reduce obesity or prevent diabetes?  Is there scope to extend their reach by making use of rural assets, such as village and church halls?
  6. How are programmes delivered in rural areas which assist with personal or sensitive issues, such as mental health, sexual health and alcohol or substance misuse?  How do they seek to address the potentially additional confidentiality risk within smaller communities?
  7. How are early years or best start in life programmes, which support the health and wellbeing of young children and their parents, delivered in rural areas?  Are there geographic gaps in their provision which should be addressed?
  8. To what extent are regular screening or health check programmes accessible to those from rural communities (including those who don’t drive or don’t have access to a car)?  Is there any evidence of low take-up or feedback citing access issues from some locations?
  9. What social prescribing opportunities, offering referral to non-clinical interventions, are available to or accessible to those living in rural communities?  Could social prescribing Link Workers be described as operating in ways that reach out to rural communities?
  10. To what extent is the potential role of digital technology, such as mobile phone Apps, being exploited to help people adopt healthier lifestyles, including those from rural communities who may have less access to traditional wellbeing services?
  11. Where public health goals are incorporated into other local strategies and plans, such as those for land use planning, transport planning and early years services, how far does that process consider whether there are particular rural needs or circumstances?
  12. How widely and effectively is information disseminated to resident communities and countryside visitors to help them identify and deal with outdoor hazards they might experience, such as tick bites and Lyme disease?
  13. Do clean air and pollution control programmes take account of issues which may affect specific rural communities, such as villages which sit astride busy trunk roads?
  14. How do plans produced for infectious disease control, where outbreaks occur, ensure that they can be effective in rural areas, where there is likely to be less local capacity within the health care system?

Case studies [not yet available]:

  • Farming Health Hub providing health and wellbeing services in Cornwall
  • E-enabled social prescribing in Lincolnshire

Other solutions to rural service delivery challenges could include:

  • Engaging with voluntary and community groups and their partnerships in rural areas, who are already likely to run a wide variety of health and wellbeing activities.
  • Running webinars on priority public health topics (which could be run jointly with primary care colleagues), giving residents an opportunity to improve their understanding.
  • Following the principals from the Ageing Better Programme, with coordinated actions and interventions aimed at those approaching old age, so that more avoid preventable disability.