Chief Medical Officer's annual report 2026: health in rural areas and small towns
Professor Chris Whitty’s annual report discusses the health and wellbeing of communities in England’s small towns and rural areas.
Documents
Details
Most people in England live in cities. However, the great majority of the nation’s landmass is rural, with people living in small towns or scattered communities. The rural and small town population is not an urban population more widely dispersed, but systematically different in ways important for health and healthcare provision.
Many people move from cities to small commuter towns when they start families or retire to rural areas, while young adults often leave rural areas or small towns for cities to study or work. The resulting concentration of older adults in rural and small town England has, and increasingly will, lead to predictable patterns of higher healthcare need relative to the major conurbations. The old-age support ratio will become increasingly adverse - that is, the number of adults of State Pension age compared with working-age adults will continue to grow. The NHS must plan for the projected health needs of rural and small town populations, including ensuring sufficient numbers of primary care medical and nursing staff are being trained and supported to provide care appropriate to these settings.
Accessing healthcare services in rural settings can be challenging due to transport limitations and long distances, particularly for those without a car. We can improve equity in healthcare access through flexible appointments and, where appropriate, using telemedicine approaches.
Several industries and sectors with particular health needs are also exclusively or largely found in rural areas, including agriculture and military bases. Some diseases, including zoonoses (infections caught directly or through insect or tick vectors from animals), are more common than in urban areas.
Poverty remains a significant driver of poor health. However, rural poverty is often unseen, poorly measured, and averaged out with more affluent areas or not registered in national statistics. Improving our ability to identify and measure rural deprivation will help ensure public health resource in these settings is targeted towards those who will benefit most.
This report lays out these issues for rural areas and small towns and some potential solutions.
The chapters of the report are as follows:
- Understanding health in small towns and rural areas
- Local authority context
- Transport and access to healthcare services
- Deprivation
- Housing
- Epidemiological analysis of chronic disease in rural and urban communities in England, 2014 to 2023
- Zoonoses in a rural environment
- Agricultural communities
- Military communities
- Medical workforce
- General practice
- Medical education
- Effective approaches to health research in a rural environment