Deprivation and poor health in rural areas: inequalities hidden by averages

Poor health and social deprivation scores in 570 wards in East Anglia, UK, were much less associated in rural than in urban areas. The deprivation mea sure most closely related to poor health in the least accessible rural ward s was male unemployment, but use of this measure did not remove the urban-r ural gradient of association strength. Neither did replacing wards by small er enumeration districts as the units of analysis. The differences between urban and rural correlations were removed by restricting the comparison to wards with the same unemployment range and combining pairs of rural wards w ith similar deprivation values. Apparent differences between rural and urba n associations are therefore not due to the choice of deprivation indices o r census areas but are artifacts of the greater internal variability, small er average deprivation range and smaller population size of rural small are as. Deprived people with poor health in rural areas are hidden by favourabl e averages of health and deprivation measures and do not benefit from resou rce allocations based on area values. (C) 2000 Elsevier Science Ltd. All ri ghts reserved.