People who live in the country are less likely to survive cancer

Bad for your health, this. Image: Getty.

It is easy to romanticise about escaping to the country, with its clean air, green space, and idyllic views. But our latest research, a review of 39 studies from around the world, suggests the need for a bit of an adjustment: it turns out that people living in rural locations are less likely to survive cancer.

We previously found that people in the northeast of Scotland who live more than an hour away from a cancer treatment centre are more likely to die within the first year after their diagnosis. We were interested in whether studies from other parts of the world also found differences between urban and rural cancer survival. We also wanted to understand reasons why people living rurally might be disadvantaged.

We examined studies that observed people with cancer over time. The studies calculated the risk of a person dying from cancer depending on whether they lived in urban or rural locations. One of the things that can complicate research comparing urban and rural living is that pockets of poverty can exist geographically, and poverty negatively affects cancer survival. For this reason, we only included studies that accounted for deprivation levels.

The 39 relevant studies that we found were all from developed countries, mostly the US, Canada, the UK and Australia/New Zealand. They covered a large variety of different cancer types and involved more than 2m people. Thirty of these studies found a clear survival disadvantage for rural people compared to their urban counterparts.

We wanted to find out exactly how much of a disadvantage rural patients had and we were able to aggregate the results of 11 of the studies. This led us to conclude that rural people are 5 per cent less likely to survive cancer than those living in urban areas.

Understanding why

The authors of the original studies suggested reasons why people living rurally might do worse after a cancer diagnosis. It is possible that they behave differently to city dwellers. They might be more likely to smoke or consume more alcohol, for example. It is also possible that rural people are more stoical, and might put off seeking help for symptoms.

The transport situation. Image: Sam Burriss/creative commons.

Access to services is also likely to be important. Most developed countries centralise their specialist cancer services within major cities, and this could potentially lead to disadvantages for rural people.

Some studies suggest that patients who live far away from specialist centres might be treated differently – not receiving radiotherapy, for example. Travel burden, transport infrastructure, and the way that cancer services are organised are important considerations. It might be, for example, that people in rural areas are more likely to avoid long journeys to city hospitals for treatments that will only make small improvements to their life expectancy.


Whatever the case, more research is needed to determine exactly which factors are at play, and which are the most important. Equally, it raises questions about survival rates for other illnesses in people living in the countryside.

There are many advantages to living in rural areas, and we are certainly not suggesting that everyone should move to the city. The big question is what we could do to improve cancer outcomes in people who live far away from cancer centres. Recognising that there is a problem is a good starting point, and research to build a deeper understanding of the problem could be coupled with innovative strategies to reduce rural cancer inequality.

One area of promise is digital/communications technology, such as getting people to communicate with clinicians via the internet. Possibilities would include everything from more automated appointment reminders to apps that help people to examine themselves online. On the whole, however, we need to better understand the problem better before we start proposing solutions. Having established that there is a definite disadvantage to living in the countryside if you have cancer, we now need to get to the bottom of it.

The Conversation

Rosalind Adam, Clinical Lecturer, University of Aberdeen; Peter Murchie, Professor of Primary Care, University of Aberdeen, and Romi Carriere, Doctoral Researcher, Epidemiology, University of Aberdeen.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 
 
 
 

Could twin towns bring Britain back together?

An unlikely pair. Image: Wikimedia Commons.

Twin towns: an irrelevant novelty to most of us, a peculiar name on a village’s welcome sign. But could linking one British town to another – a domestic reinterpretation of this long-standing European practice – help bring Britain back together in a time of national crisis?

Born in the aftermath of World War II, town twinning aimed to foster cooperation and solidarity across Europe. Communities entered formal alliances, nurturing friendships and shared histories. Coventry forged links with Dresden and Volgograd, then Stalingrad, marking the devastation faced by their citizens during the war.

The democratisation of Greece, Spain and Portugal during the 1970s led to a new wave of twin towns across Europe, as did the fall of the Soviet Union a decade later. Since its inception, the focus of town twinning has been on uniting people through relationships. It is a testament to the initiative’s success that many of these remain to this day; Coventry recently enjoyed a performance at the city’s cathedral by Volgograd’s children’s choir.

While European relations have improved since the 1940s, unity at home has received less attention. As a result, Britain is riven with deep economic, political, educational and cultural divides. These fault lines are increasingly determined by geography, with a growing gap between our big metropolitan cities and almost everywhere else.

In comparison to other European countries, we face staggering levels of regional inequality; six of the ten poorest regions in northern Europe can been found in the UK. As outlined by Alan Milburn, the government’s former social mobility tsar, “the country seems to be in the grip of a self-reinforcing spiral of ever-growing division. That takes a spatial form, not just a social one.”

These divisions are poisoning our body politic. As Adam Smith argued in The Theory of Moral Sentiments, putting yourself in someone else's shoes is vital for developing a moral compass; in doing so "we conceive ourselves enduring all the same torments, we enter as it were into his body, and become in some measure the same person with him..." But this is difficult when we have little interaction or experience of those with opposing views.

This is increasingly likely in geographically polarised Britain, with the places we live dominated by people who think alike. Our political leaders must commit time and energy to bridging these divides, just as the leaders of Europe did in the aftermath of the Second World War. By forging links between different parts of the country, a new era of domestic town twinning would do just that.


School exchanges between sister towns would offer an opportunity for children to be exposed to places, people and perspectives very different to their own. This would allow future generations to see things from an alternative and opposing perspective. It may also embed from a young age an awareness of the diversity of experiences seen by people across our highly unequal country.

MPs would be encouraged to spend time in their constituency’s sister town. First-hand exposure to voters in a very different part of the country would surely soften the views of even the most entrenched parliamentarian, making for a more civil debate in the Commons. Imagine the good this would do for Parliament today, with Brexit gridlocked because of the unwillingness of MPs to compromise.

In 2016 the Carnegie UK Trust launched its Twin Towns UK programme, a pilot linking twenty towns across the UK to examine how they might develop together. Emerging benefits include a reduction of insularity and a greater awareness of the bigger picture. Its focus was not on bridging economic divides – towns with similar socioeconomic characteristics were twinned – but initial outcomes from the scheme suggest a broader programme of domestic town twinning could have a powerful impact.

Looking further back, Camden has been twinned with Doncaster since the 1980s, a relationship that unionised Camden Town Hall workers forged in a display of solidarity with striking miners during the 1980s. Funds were raised to feed families of striking workers at the pit and Camden locals even drove north to deliver presents at Christmas. Though the relationship appears less active today, it serves as a powerful reminder of twinning’s capacity to bring people from very different places together.

As we prepare for Brexit it’s imperative that we protect existing twin town relationships with our European partners. This is of vital importance when we know sadly many of these are under threat from austerity and gloriously un-PC mayors. But we should look to breathe new life into these traditions too, where possible. Domestic town twinning would do just that: a step towards bringing Britain back together, just as a continent was reunited after the devastation of war.

Ben Glover is a researcher at the think tank Demos.