Guest editorial: Integrated care in rural, remote or island communities

Abstract

Most of the literature on integrated care relates to policy and implementation experience in urban settings with little focus on the challenges and solutions for remote, rural or island communities. These places have small, dispersed populations living in areas that are relatively underserved for healthcare facilities, transport and housing infrastructure. High levels of outward migration of younger adults and a growing trend for inward migration in later life result in ageing populations with high levels of chronic disease (Whitty, 2023). Geographical isolation and lack of economies of scale drive up costs for infrastructure, transportation, communication and energy, impacting on workforce recruitment and retention across public services. This results in a reduced workforce skills base particularly for the healthcare workforce. Having to travel long distances to access specialist healthcare, may result in delays in diagnosis or treatment and/or negative patient and carer experience (Kvig et al., 2017).Despite the limited literature on integrated care in remote, rural or island communities, this is far from a marginal issue. According to World Bank population estimates, the global rural population is around 43% with rates higher in low and middle income countries (48%), compared to 25% in the EU and 19% in the OECD nations. Two thirds of the 42 countries classified as small states (population of 1.5 million or less), are islands that have limited economic opportunities and are particularly vulnerable to natural disasters and climate change (World Bank Group, 2019). The term "rural" traditionally refers to areas with sparse populations situated at a distance from specialised health services. This geographical remoteness defines the practice of healthcare professionals working in these regions, presenting unique challenges compared to their urban counterparts. Achieving health equity requires a comprehensive understanding of the factors contributing to the observed regional health disparities, including rurality (Kurpas et al., 2021). Efforts to minimise rural-urban healthcare differences demand strategic interventions that acknowledge and address the distinct challenges faced by rural primary care systems. As primary care systems navigate the intricate landscape of healthcare delivery, acknowledging the specific challenges faced by rural practitioners is essential for fostering equitable health outcomes across diverse geographical contexts. Recognising and redefining the nuances of rural, remote and island healthcare is crucial for developing targeted interventions.This special issue brings together nine papers that shed some light on these nuances and interventions. The papers reflect research and practice in remote, rural or island communities from seven countries, spanning four continents. Examples from the global south offer useful lessons for population health approaches in underserved communities in the global north. The collection will not only be of interest to practitioners, managers, policymakers and aca...