Newspapers have reported this under headlines such as: “Chief Medical Officer issues warning to anyone moving to countryside” (DevonLive) and “A rural retirement could be bad for your health, warns Whitty” (The Times).

These miss the point. The challenges of providing care are: here, now, chronic and getting worse.

Prof Chris Whitty uses measured tones which, in Owl’s view belie the urgency. Will “Urban Labour” get the message?

The report provides more ammunition for our MPs who collectively seem to be on the same page following the suspension of maternity services at North Devon Hospital Trust, Barnstaple.

Here is a flavour of what he has to say.

The rural and small town population is not an urban population more widely dispersed, but systematically different in a number of ways important for health and healthcare provision….

The sparser population also means that healthcare is more spread out, with even primary care often distant, and secondary care a day’s round trip. There is also less capacity to sustain specialist services which are common in cities. The lack of regular public transport is one of the key challenges of providing health and social care in rural areas. Those who do not have a car or cannot drive due to illness may find accessing general practices difficult and secondary care (for example, outpatient clinics) even more so. Social care and health workers often rely on public transport. If people cannot drive safely, this can be much more isolating than in cities with dense public transport networks….

For those leading the NHS and public health we must avoid assuming that models of healthcare that work in cities can simply be translated to a rural or small town setting. Training and systems need to reflect the different realities of providing healthcare in these settings….

In full – Prof Chris Whitty: Forward to Chief Medical Officer’s annual report 2026

Health in rural areas and small towns

While most people in England live in cities, the great majority of the country’s landmass is rural, populated with people living in small towns or scattered communities. The urban majority depend on rural England, often without giving it much thought except as a very beautiful place for leisure – which it is. Some critical sectors rely on rural areas including agriculture and forestry, much of the armed forces, and several industries which need to be sited away from cities or require large amounts of land. Families associated with several of these sectors have particular health challenges.

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 for cities to study or work. Due to this internal migration the rural population is significantly older on average than in the cities. The rural and small town population is therefore not an urban population more widely dispersed, but systematically different in a number of ways important for health and healthcare provision.

Rural poverty is often unseen, poorly measured, averaged out with more affluent areas or not registered in national statistics. Work in some important rural sectors including farming and tourism can be seasonal and low paid. Limited or non-existent public transport makes access to a car and being able to drive often essential for work.

The sparser population also means that healthcare is more spread out, with even primary care often distant, and secondary care a day’s round trip. There is also less capacity to sustain specialist services which are common in cities. The lack of regular public transport is one of the key challenges of providing health and social care in rural areas. Those who do not have a car or cannot drive due to illness may find accessing general practices difficult and secondary care (for example, outpatient clinics) even more so. Social care and health workers often rely on public transport. If people cannot drive safely, this can be much more isolating than in cities with dense public transport networks.

Set against these challenges, rural areas also have some significant inbuilt advantages for health. Communities are often stable and very supportive. Air pollution is usually minimal. There is the potential to access beautiful spaces for physical activity, although getting to the jumping-off point frequently requires a car, as walking and cycling safely on winding roads with fast traffic and no pavements is hard even for the young and fit.

General practice is even more clearly the bedrock of healthcare provision in rural and small town settings than in cities. Attracting healthcare staff can in some areas be very difficult, especially if they have young families. Rural and remote practice can require a wider range of skills and ability to work with minimal back-up from secondary care hospitals compared to city-based colleagues. Many GPs, nurses and others working in rural areas love the professional breadth and community-based care this brings, but current training often does not prepare them for this kind of medicine.

We have the opportunity to improve health and provision of care in rural areas and small towns for now. We also have to plan for the future, when the rural and small town population will be getting significantly older, while the major cities retain their current, younger demographic structure.

In the immediate future we must explore the potential for new opportunities, including telemedicine, to make the provision of some aspects of healthcare more accessible to those with limited transport a long way from secondary care. We also need to ensure we are training enough primary care medical and nursing staff to be able and want to provide care in rural and small town settings.

For national policymakers we need to recognise the ageing of the rural population makes this a national, not just a local, issue to solve, and find better ways to address the health impact of rural poverty.

For those leading the NHS and public health we must avoid assuming that models of healthcare that work in cities can simply be translated to a rural or small town setting. Training and systems need to reflect the different realities of providing healthcare in these settings.

For those undertaking the nationally important role of working in rural health we need to work together to harness new technologies, as well as ensure the voice of rural health is heard in decision-making.

Improving rural health is entirely possible and should be seen as a national investment in the future as well as the here and now.

Finally, I would like to thank the many people across the country who helped in the preparation of this report, and in particular the editor Dr Alex Thompson.

Prof Chris Whitty

Chief Medical Officer for England

[Full Executive Summary worth the read, it includes a lot of interesting facts and figures – Owl]