In rural and rural areas, it is more difficult to attract professionals in sufficient numbers and with the right profiles, besides the population density is low. Because there are fewer professionals and fewer users, the greater the difficulty in maintaining the quality of care. In Portugal, this discussion is more visible in cases maternity and midwifery emergenciesbut questions arise in all aspects of care.

Although this problem is not new and affects most countries, the effect of geography on poorer population health and poorer indicators of access, integration and safety of care does not appear to generate interest. Therefore, it is important to revive the question: is the quality of health services deteriorating in rural areas compared to urban areas?

Since it is impossible to give a standard answer, it is by looking at chronic disease that the best answer can be tested. Dementia is one of the best examples of a chronic disease, as it requires clinical follow-up between different specialties and between primary, hospital and ongoing care. Also because of consultations, emergency episodes and hospitalizations are higher than other illnesses.

Results from a international studies Recent studies have shown that there are indeed important differences between rural and urban spaces when it comes to the health of people with dementia.

Mortality is higher in rural areas. The more decisive outcome can be explained by lower access to medical consultations and by more hospitalizations. Therefore, the evidence points to poorer clinical follow-up and more cases of decompensated disease. Worse clinical follow-up and lower integration of care is also reflected in lower use of ongoing care and higher consumption of antipsychotics.

The various countries included in this study, including the US, Canada, Scotland, Ireland, China, Australia, Sweden, Mexico, India, Germany, and Italy, are disproportionate in terms of wealth, size, governance models, and health characteristics. That is, the fact that the results are found in such different realities allows the logical deduction that something similar is happening in other countries.

This will be the case for Portugal. As far as we know, there is no such analysis for the Portuguese population. However, the influence of geography on health outcomes has been well studied in this country.

Therefore, even though hard data on dementia is lacking, policy makers and health authorities do not need more evidence to view geography as an important determinant of public health.

What stands out in these dementia studies is that the poorer quality of care in rural areas has a lot to do with a lack of professionals, but in addition there has to be greater availability and better articulation between primary, hospital, and continuing care.

Indeed, the Ministry of Health and the SNS Implementing Agency chose these two fields as a priority. This is where the attraction of doctors to the countryside and the expansion of local health units come into play.

Examining each of these measurements requires depth to be explored in other texts. For now, the positive note remains that political attention has chosen to seek to blur the geographic inequalities that define citizens first and second as priorities.