Written by Professor Rod Thomson, Interim Director of Population Health for Cheshire East
When we think of health inequalities, our minds often turn to deprived urban areas. But living in a rural community brings its own set of challenges and they’re not always obvious in the national statistics.
In Cheshire East, our 394,000 residents are spread across 12 market towns and countless villages and hamlets. This brings beauty, space, and strong community spirit but also means longer journeys to GPs, hospitals, jobs, and essential services. Poor public transport, patchy broadband, higher fuel prices, and fewer affordable homes all affect people’s daily lives and health.
For many rural residents, the reality is a reliance on cars, with low-income households often spending a large share of their income on fuel just to get to work or attend appointments. Limited bus services can increase social isolation, restrict job opportunities, and make it harder to access care. Digital exclusion is another risk. Slow or unreliable internet connections can limit opportunities for work, learning, and online services, leaving some communities further behind.
Rural areas also tend to have older populations. In some communities, over a quarter of residents are aged 65 or over, which places extra demand on NHS and social care services. And while councils like ours have to commission services in multiple locations to ensure access, we receive significantly less public health funding per head than many urban areas. For Cheshire East, that’s £49.84 per person in 2025/26, compared to £159.30 for Kensington and Chelsea.
Successive governments have recognised that rural health inequalities exist, but little has been done to address the funding gap. If we are serious about tackling inequalities, rural needs must be both properly understood and fairly resourced.
I would encourage you to read a longer briefing paper on this topic, which you can find by clicking here.
