Study objective: To investigate whether the Index of Multiple Deprivation 2000 (IMD) is more strongly related to inequalities in health in rural areas than traditional deprivation indices. To explore the contribution of the IMD domain “geographical access to services” to understanding rural health variations. Design: A geographically based cross sectional study. Setting: Nine counties in the south west region of England. Participants: All those aged below 65 who reported a limiting long term illness in the 1991 census, and all those who died during 1991–96, aged less than 65 years. Main results: The IMD is comparable with the Townsend score in its overall correlation with premature mortality (r ² = 0.44 v 0.53) and morbidity (r ² = 0.79 v 0.76). Correlation between the Townsend score and population health is weak in rural areas but the IMD maintains a strong correlation with rates of morbidity (r ² = 0.70). The “geographical access to services” domain of the IMD is not strongly correlated with rates of morbidity in rural areas (r ² = 0.04), and in urban areas displays a negative correlation (r ² = −0.47). Conclusions: The IMD has a strong relation with health in both rural and urban areas. This is likely to be the result of the inclusion of data in the IMD on the numbers of people claiming benefits related to ill health and disability. The domain “geographical access to services” is not associated with health in rural areas, although it displays some association in urban areas. This domain is potentially important but, as yet, inadequately specified in the IMD for the purposes of health research.

Census data are commonly used in geographical analysis and to inform planning purposes, though at the disaggregate level the basis of enumeration poses difficulties. In this paper an approach to surface generation is described that offers the prospect of revealing an underlying population distribution from centroid-based data which is independent of zonal geography. It is suggested that this can serve a wide variety of analytical, cartographic, and policy purposes, including the creation of spatial indicators of economic and social conditions and enhancing the value of census data. The approach is illustrated by reference to an analysis of part of the valleys of South Wales, in the United Kingdom.

This paper explores the geographical accessibility of health services in urban and rural areas of the South West of England, comparing two measures of geographical access and characterising the areas most remote from hospitals. Straight-line distance and drive-time to the nearest general practice (GP) and acute hospital (DGH) were calculated for postcodes and aggregated to 1991 Census wards. The correlation between the two measures was used to identify wards where straight-line distance was not an accurate predictor of drive-time. Wards over 25 km from a DGH were classified as 'remote', and characterised in terms of rurality, deprivation, age structure and health status of the population. The access measures were highly correlated (r²>0.93). The greatest differences were found in coastal and rural wards of the far South West. Median straight-line distance to GPs was 1 km (IQR = 0.6–2 km) and to DGHs, 12 km (IQR = 5–19 km). Deprivation and rates of premature limiting long term illness were raised in areas most distant from hospitals, but there was no evidence of higher premature mortality rates. Half of the wards remote from a DGH were not classed as rural by the Office for National Statistics. Almost a quarter of households in the wards furthest from hospitals had no car, and the proportion of households with access to two or more cars fell in the most remote areas. Drive-time is a more accurate measure of access for peripheral and rural areas. Geographical access to health services, especially GPs, is good, but remoteness affects both rural and urban areas: studies concentrating purely on rural areas may underestimate geographical barriers to accessing health care. A sizeable minority of households still had no car in 1991, and few had more than one car, particularly in areas very close to and very distant from hospitals. Better measures of geographical access, which integrate public and private transport availability with distance and travel time, are required if an accurate reflection of the experience those without their own transport is to be obtained.

In this paper, postcoded data are used to develop spatial interaction models for the registration of individuals with different health centres. With use of a cell-based representation of urban space, indices of accessibility to and market areas for such services are devised. The empirical work relates to a study area in the City of Bristol, and reveals patterns of use of general practitioners at a level of detail not previously available. Some implications for locational planning in the primary health-care sector are also considered.