The Scottish Index of Multiple Deprivation is not an effective measure of deprivation for remote and rural areas. This geographical based index poorly represents rural disadvantage due to the dispersed nature of remote and rural populations and the type of deprivation experienced within rural areas may differ from that experienced by urban residents. A more remote and rural sensitive measurement is necessary to better articulate and understand rural deprivation. This in turn will support healthcare planning and delivery. Data collection and outcomes need to be responsive and sufficiently detailed to allow us to distinguish between different populations living in a particular data zone. The Scottish Health Survey, out of necessity and costs, takes very few sample points in a remote and rural area, which puts extrapolated inferences at some risk. An oversampling in remote and rural areas is needed to better determine population health needs, and to distinguish between and in subsidiary areas. Whilst there is a need to protect confidentiality, the use of pseudonymised data is one possible solution. However, in remote and rural areas the suppression of information due to small populations means that only aggregated data is available thus losing localised intelligence. A more flexible approach is needed with local control exercised by the caldicott guardian rather than centrally which is then subject to metropolitan issues/needs
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