Liz Tucker says smallholders need to find a voice for better health care THE week from September 28 to October 4 is Rural Health Week, an annual event run by the Institute of Rural Health (IRH).

This year's theme is "a breath of fresh air, making tracks to health and wellbeing in the countryside."

If you live in the country, particularly in a remote area as many of you do, the IRH is your health champion. It is a charity that relies on project funding, runs on a shoe-string budget in the Welsh borders by a small group of dedicated ladies with a big national agenda.

Their sole purpose is to raise health issues inherent to rural living and try and get something done about it. They try to make a difference at the professional level by training, influencing and providing researched information to health professionals and ultimately Governments with the hope that they will do something about for the much quieter rural minority.

Traditionally farming families stayed for generations where they were, now many in farming, particularly smallholders have come from a diverse array of backgrounds and locations, embracing the land not just for income but to find a more fulfilling, sustainable way of living.

If you did a street poll on what people really wanted to do with their life, I am sure the majority would say move to the country, renovate an old barn, grow veg and keep animals. It has an idyll of clean air, slower pace, peace, quiet, good community spirit and less stress but in reality this is not always the case. A World Health Organisation report concluded that there was an overall "urban health advantage" and a "rural inferiority" in health status and care.

Even if we have the same problems as everyone else there are key issues effecting rural dwellers that make it much harder to get the same level of care and treatment. IRH research got a 100 per cent resounding yes from Primary Care Trusts when asked if there were any major constraints in rural healthcare delivery. The biggest problem is transport and access to services. Not surprisingly uptake in services declines substantially the further away it is. This must also play a big part in another highlighted problem, rural patients being diagnosed at a later stage of disease. Travel may be a problem but the other main factor involved is concern over confidentiality.

Rural folk apparently find it much harder to ask for help or support because they are concerned it will quickly become public gossip and they can't face the embarrassment, particularly in a mental health situation. As a smallholder myself, one of its benefits is being able to avoid the majority of people and distance yourself from their activities but we all need to know there are people we can rely on otherwise the world becomes a very lonely place.

In the same way as I ignore the outside world in my rural paradise, I disregard all these gloomy reports because this is not my experience. Over recent years there has been an increasing exodus to the countryside, particularly smallholdings. The Government Commission for Rural Communities estimates rural migration increasing by 18 per cent within 20 years compared with just a nine per cent urban influx. Unfortunately one in five rural households simply just don't earn enough. Another issue is that the majority of rural migrants are elderly, while the urban urge happens in the young, adding additional strain to rural healthcare resources.

These issues are even more acute for smallholders as we are generally even more isolated and remote but are left alone to wield chainsaws and the like on a daily basis. Apart from the increased risk of accidents, if a health problem arises a farmer will firstly be more reluctant to seek help and secondly find it especially difficult to maintain a treatment regime.

The Countryside Agency has developed a concept of rural proofing' - improved health quality in all rural areas. Unfortunately it is also another one of those annoying buzzwords, which immediately make me feel a bit cynical as my first thought is of a Whitehall man in suit who has never seen a chicken lay an egg, getting a huge salary for writing a report that hardly anyone will ever see. But rural proofing' is now a mandatory requirement that will help push forward policies specifically aimed at addressing the health needs of rural dwellers.

So the policies are in place but they are limited by an element of reluctance from us rural folk to make their own voice heard. Perhaps a desire for peace, tranquillity, less social contact and a more natural way of living makes us more reluctant to get help.

A greater integration in both health and social care is recognised as the way forward and the IRH have helped push forward and influenced local initiatives as well as highlighting the overall issues. There are now Red Cross Village Warden Schemes, rural support websites and stress councelling services spreading over rural areas, often run with the help of local voluntary groups who can recognise specific local issues.

The problem is many don't know there is this help available.

The aim of Rural Health Week is to highlight, to health professionals, the good work already being done in rural communities, in the hope that others will follow suit.

If you live rurally you don't need buzzwords or big reports to know where the problems lie but at the end of the day if we want better health services we need to stand up and be heard.

Smallholders are used to sharing, borrowing and swapping equipment, animals, produce and around here even the odd partner.

For local communities to make a difference to the healthcare they receive in their area you need a collective voice, know who to aim it at and be specific about what the issues are. You could call it "Smallholders-Sickness," now that's a buzzword! For more details log onto www.Rural-health.ac.uk/policy/RHWEEK.PHP