Are our rural communities conducive to ageing well?

Escape to the country, swapping bustling city life for a rural idyll, is such a common experience we have a popular TV series to facilitate such a move.  

There are lots of upsides to a life in the country, including more green space, strong social connections and on average better health and prosperity.  
But the latest annual report from the government’s Chief Medical Officer (CMO) suggests people need to be clear-eyed about the potential downsides of life in the countryside.  
Newspaper headlines covering the report from Professor Chris Whitty summarised the findings as Dreaming of a rural retirement? Beware the health risks.  
So is the rural retreat later in life just a television fiction?  

More than one in four (28%) of people in smaller rural areas are aged 65 or over, compared with fewer than one in eight (12%) in London.  

Younger people often move away from rural areas for education and employment, while many people do move into rural and coastal areas later in life.  This means that some rural communities are experiencing population ageing earlier, and more intensively, than elsewhere. The proportion of older people in some rural communities now is what is projected to be the proportion projected nationally in 50 years' time.

However, while our rural areas and small towns are ageing particularly rapidly, services and infrastructure have not necessarily kept pace. The report makes it clear that this is not just about the NHS.  

One of the attractions of a rural life, plenty of space, can be one of the main barriers if health declines. Remoteness, living miles away from services, combined with limited public transport, is an issue highlighted in the CMO report and backed up by our own, earlier research.  

A County Councils Network report in 2023 also highlighted how rural bus services have fallen to a historic low with more than one in four bus routes in county and rural areas vanishing over a decade. 

In many rural communities, stopping driving in later life without access to public or community transport can have a huge impact. This impacts not only getting to a GP appointment but access to shopping, seeing friends, volunteering and participating in community life.  

When somebody loses access to a car, it shouldn’t mean losing independence as well. One of the CMO’s recommendations is for wider use of phone and video health appointments to help those away from cities and towns. This has huge potential to improve access to health services by reducing the distance barrier, but only if people can make use of them. 

Phone coverage and digital infrastructure still lag behind in many rural areas. Digital literacy is also a significant risk for many older people in rural areas, as well as those that care for them, so these services will still need to offer flexible offline alternatives.  

Alongside this, there should be more support for people of all ages to develop their digital skills so as not to be left behind by telemedicine advances.  

Housing is another fundamental to health and to the prospects of ageing well. Our own earlier rural research highlighted issues with older, harder-to-heat homes as well as smaller rural populations which can lead to more limited options for people who want to move home without leaving their community.

Staying put can have its own issues. While levels of home ownership in rural areas are higher, this can disguise issues like fuel poverty, with homeowners that are asset rich but cash poor and struggling to keep warm or maintain their homes.  
 

We need accessible, adaptable new homes, investment in improving existing homes and more choice for people who want to ‘rightsize’ to a home that suits their needs locally.

Or as Prof Whitty succinctly said: “We ought to be making all new houses in these areas possible for someone to age in and maintain their independence. It’s perfectly possible to design that.”

It is also important to note that rural communities are diverse in both landscape and population. 
While they may share a lot in common with other rural areas elsewhere in the country, they will all have their own specific challenges when it comes to connecting their residents to services, information and social opportunities.  

On average, rural authorities are much more likely to be among the country’s wealthiest and healthiest parts of the country. But averages can also hide pockets of quite significant disadvantage so we need to identify hidden deprivation more effectively and give local places the tools and resources to develop solutions with older residents.  

Instead of waiting until somebody becomes frail or loses their independence, we should ask much earlier whether our homes, transport and communities will work for the older population we know is coming. And we should involve older residents themselves in answering that question.   

Lots of local town and parish councils are already making strides to become more age-friendly and inclusive including working with residents in installing seating, supporting social activities, providing community transport, or creating neighbourhood plans that set out the local housing needs for their older population. 

The new CMO report calls for a national strategy on health in rural areas and we welcome greater focus on this important issue. Every area of England is ageing, even if not all at the same rate.  This is reshaping demand and opportunities in both rural and urban areas, across health and social care, but also public services, the labour market and local economies.   

We need national and local government plans to consider demographic change, across different types of geographies and we need an ageing population strategy to join up policy areas from health and social care to pensions, housing, communities, transport and employment.