MEDICAL MATTERS: With the holiday season in full swing, cities are noticeably empty. In contrast, the countryside fills up with a mixture of day trippers and holidaymakers keen to "get away from it all".
For the city-dweller, it is a chance to sample a slower, less stressful pace of life. And for some, the dream of moving to the country for a peaceful and more healthy life is born.
But is rural life the healthy idyll of our dreams? In general, research shows that rural residents enjoy better health and a longer life expectancy than city dwellers. Certainly, country people perceive themselves to be healthier than urbanites, a perception which in itself helps to improve health. However, some rural populations are less healthy than those living in certain urban areas, so life in the country is not without its hazards.
One of the biggest is road accidents. Although there are more crashes in cities, children involved in road accidents in rural areas are more likely to be killed or seriously injured. According to the Royal Society for the Prevention of Accidents, in 2003 almost a quarter of child pedestrians involved in an accident on rural roads in the UK were killed or seriously injured, compared with fewer than a fifth in towns.
There are several factors that make road accidents less survivable in deeply rural areas. Traffic moves at higher speeds, often on narrow roads. There is some evidence that seat belts are less likely to be worn in the country.
If you do have a crash, the emergency services have much further to travel, so that the "golden" first hour in which early treatment leads to improved survival is immediately eroded. In addition, a road accident in the early morning may not be discovered for many hours.
The isolation factor also plays a role in accessing other kinds of medical care. Rural people have much further to travel to hospital and this reduced level of access affects recovery rates from illness. Research has shown that the further a patient with heart disease lives from a hospital, the less likely they are to undergo cardiac procedures such as angioplasty or coronary artery bypass surgery. And research from the National Cancer Registry has found that the uptake of radiotherapy by cancer patients was much less for those living furthest away from radiation oncology centres in Dublin and Cork. Indeed it was this factor that influenced last week's decision by the Minister for Health, Mary Harney, to open two satellite radiation centres in Waterford and Limerick in addition to a core spine of larger cancer care units recommended by the Hollywood expert group.
Rural dwellers are up against an inexorable trend towards the centralisation of health care. This is having an effect on the local general practice; Government policy is to encourage the creation of larger group medical practices, so that the days of the isolated, single-handed rural GP are numbered.
As it is, rural residents are less likely to seek medical help and tend to present much later in an illness than their urban counterparts.
The centralisation of medical practices is likely to exacerbate this trend, especially for people who are dependent on poor levels of public transport in the countryside.
This in turn puts pressure on low-income households to run a car, thus compounding their poverty and thereby increasing the risk of poor health further.
The link between poverty and ill-health is well-established. It was described by Dickens.
A seminal UK report in 1982 - the Black Report - on inequalities and health put the link beyond doubt. Closer to home, the Institute of Public Health has shown a similar pattern for the island of Ireland.
However, unlike urban areas, where the concentration of people allows generalisations to be made about poverty and ill health, there is a much greater diversity within a small rural area. An affluent landowner or professional commuter lives next to a number of poorer, socially isolated neighbours.
However, the poorer residents may enjoy greater social support, so broad conclusions about health and rural living are harder to make.
Some diseases and conditions are more common in rural areas. Allergies, in the form of hay-fever are more common. Suicide rates, especially amongst older men, are greater. Infections transmitted to man by animals are understandably more frequent. Called zoonoses, they include conditions such as brucellosis, ringworm and leptospirosis.
If you find yourself in the woods or the fields over the coming weeks, and are bitten by the bug of idyllic rural living, ask the locals what it is really like to live there.
You are unlikely to be put off by what you hear, but there is certainly more to rural life than the stress-free existence imagined by many city residents during the relaxed reflections of holiday time.
Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he cannot answer individual queries.