w1 Rural health lecture

Question 1

What is the defintion of a rural settlement by rural urban classification?

Answer 1

Areas are rural if they fall outside of settlements with more than 10,000 residents.

Question 2

What are the six elements of rural health and wellbeing?

Answer 2

Public/population health and occupational health
Infrastructure
Community development and social capital
Healthy rural economy
Healthy rural environment
Heal care delivery and systems

Question 3

Give a statistic to show the extent of global rural poverty.

Answer 3

In 2017 70% of extreme poverty cases where in rural areas in developing countries.

Question 4

What are some problems that a rural hospital in a developing country may face?

Answer 4

Lack of funding
Limited resources
Infrastructure problems
Difficulty retraining trained staff
Late presentation of disease
High rates of infectious disease and trauma.

Question 5

What are some characteristics of the changing face of farming?

Answer 5

Bigger and fewer farms as farms merge
Many family farms are no longer viable unless diversifying
Long hours of work
Psychologically and physically demanding
Financial uncertainty
High levels of occupational hazards.

Question 6

What are some of the occupational hazards that farmers face?

Answer 6

Machinery
Weather events
Cattle - attacks and zoonotic diseases
Isolated location - long time to receive medical attention.

Question 7

What are the employment trends in rural areas compared to urban areas?

Answer 7

Rural areas have lower levels of unemployment that urban areas.
However, the level of pay is significantly lower in rural areas.
Hence the weekly expenditure as a proportion of earnings is higher in rural areas.

Question 8

What is life expectancy like in rural areas?

Answer 8

Rural areas have a higher average life expectancy by two years than urban areas.
Has lower potential life of years lost.

Question 9

What does the WHO suggest are the main problems facing healthcare in rural settings in Europe?

Answer 9

High inequalities between urban and rural
Lack of data on rural healthcare
Lack of qualified healthcare workers, greater demand for them
Greater distance to reach secondary care
Less access to pharmacies
Financial barriers of individual patients, less likely to have insurance or use private clinics
Poor housing, transport and infrastructure undermines health.

Question 10

How is the distances to reach further services in rural areas being tackled by rural GPs?

Answer 10

GP surgeries will employ a pharmacist so able to dispense common medication
Will take more medication and equipment to GP appointments, provide more secondary care.
Patients will be referred sooner to secondary care as need to consider how fast the patient will deteriorate hence be unable to reach help in time.

Question 11

What issues might individual GPs face in their GP surgery in a rural area?

Answer 11

More accidents and emergency work
More clinical skills work (smaller gap between primary and secondary care)
Less access to CPD and training.
More professionally isolated.
More out of hours and unscheduled work
Important to work as a team to integrate working and resourcefulness.
Are remote from specialist services and support.

Question 12

What are community hospitals?
Why are they important in rural areas?

Answer 12

Small local hospitals often found in rural areas, that are focused on short-term intermediate or rehabilitation care after a visit to main hospital.
Medical service may be seasonal, provided by GPs with consultant support.
Often diagnostic, minor injuries and maternity wards.
Useful in rural areas: patients better access to family and support, smaller distance to travel home or to main hospital, relieves burden on main hospital and GP.

Question 13

What are some trends in rural housing?
What are the consequences of this on rural communities?

Answer 13

Increasing in price due to gentrification. More second homes and holiday homes. Cornwall house prices are 19% the average UK annual salary.
5% of rural houses are classed as affordable (23% in urban)
CONSEQUENCES: outpricing communities breaking support networks, local services including pharmacies close as fewer customers all year round, hard to recruit local workers, household expenditure increases.

Question 14

How much does rural housing contribute to the total amount of unaffordable housing?

Answer 14

Almost 50% of the most unaffordable places to live in England are in rural locations.

Question 15

How are road accidents related to rural health?

Answer 15

Rural roads have a lower absolute number of crashes but a higher number of fatalities as a result of crashes. (21 per 100 million)

Question 16

Why are fatalities in rural car crashes higher despite having a lower absolute number of crashes than urban roads?

Answer 16

Higher speed limit - more dangerous crashes
Longer time before reached by emergency services
Less likely to be seen by a passerby to call an ambulance/ provide help.

Question 17

How does travel access vary in rural areas?

Answer 17

Rural areas have a higher proportion of car owners than urban areas, cars must be used for more simple tasks as services are further away.
Public transport is more irregular and infrequent so car-dependent.

Question 18

What is access to services like for rural areas?

Answer 18

Poorer access to services. x% of resident have access to these services in 4km.
80% GP surgery (including a branch surgery)
57% NHS dentist
48% secondary school

Question 19

What is the importance of alternative emergency access in rural areas?

Answer 19

Helicopters and mountain rescue services
Quicker access, longer distances, more remote locations without carparks etc.
Reduces the waiting time in an emergency, improving the prognosis.

Question 20

What is fuel poverty like in rural areas?

Answer 20

Proportion of rural area in fuel poverty in 2019 is relatively equal to urban areas.
However, for groups in fuel poverty rural areas have a greater gap income that needs to be gained to leave fuel poverty.

Question 21

Why is the ageing population an important influence on rural health?

Answer 21

Rural areas have a greater proportion of the ageing population and ageing population in poverty.
These are more likely to develop long term health conditions or require daily support services.

Question 22

What are some statistics around the prevalence of chronic disease in rural areas?

Answer 22

Around 50% have more than one chronic disease
80% of GP consultations are for people with chronic disease.

Question 23

Give some statistics around farm accidents and rural health.

Answer 23

Timber workforce - 1 in 100 of workforce but 1 in 4 of work related fatalities
Injury by cattle is the biggest work related killer
Agriculture has the highest rate of fatal injury
High rate of musculoskeletal health problems

Question 24

What are zoonoses?

Answer 24

An infection that can be transmitted from an animal to a human (does not then normally spread between humans)
People with a weekend immune system are at a higher risk.

Question 25

What is Orf?

Answer 25

A zoonotic viral skin infection,
Spread by direct contact with sheep and goats.
Causes small red, itchy lesions that enlarge slowly over weeks to form large blisters.
Caused by a parapoxvirus
May also have flu-like symptoms and fatigue
Often burns itself out in 6 weeks.

Question 26

What is ringworm/tinea?

Answer 26

A zoonotic disease caused by a fungal infection spread from cattle.
Causes a rash with an outer rim of scaly skin and an inner clear area.
Can also be introduced to cattle from badgers and deer.
No effective treatment
Public health risk is reduced by pasteurising milk and testing cattle.

Question 27

What is leptospirosis (Weil’s disease)?

Answer 27

A zoonotic disease caused by leptospira spread by animals.
Bacteria spreads from water to rodent vectors then into humans.
Most at risk: sewage workers, slaughters, milking farmers and canoeists.
Enters by mucous membranes, eyes and broken skin.
90% of people suffer from flu like symptoms, 10% of cases will be more serious.

Question 28

Give some examples of zoonotic diseases.

Answer 28

Lyme Disease
Q Fever
Leptospirosis
RIngworm
Orf

Question 29

What are the symptoms of Leptospirosis (weils disease)?

Answer 29

Abdominal pain
Jaundice
Skin rash
Red eyes
May also have muscle aches, headaches, fever chills and vommitting.

Question 30

What is Q fever?

Answer 30

A zoonotic disease spread form sheep, cattle and goats.
Caused by coxiella burnetti bacteria, when breathed into lungs.
Mainly causes flu-like symptoms
Prolonged exposure can cause more life threatening symptoms, miscarriage or premature birth.
Most at risk: farmers, vets and meat packers.

Question 31

What is Lyme disease (lyme borreliosis)?

Answer 31

A zoonotic disease that uses ticks as a vector.
2,000 - 3,000 a cases per year in England in Wales
History taking : walking in long grass or woodland
Can be managed by removing the tick and early diagnosis and treatment.
Mainly treated by antibiotics.
More serious cases can develop to have neurological presentations.
Presents as target lesions, inner red rash, followed by a clear ring then an outer red ring.