In inland and rural areas, it is more difficult to attract professionals in sufficient numbers and with the right profile, in addition to low population densities. It is because there are fewer professionals and fewer users that the greatest difficulty in maintaining the quality of care can be explained. In Portugal, this discussion was more visible in the case of maternity and obstetric emergenciesbut the question arises in all aspects of care.

Although this problem is not recent and affects most countries, the influence of geography on the poorer health of the population and on poorer indicators of access, integration and safety of care does not seem arouse the desired interest. Therefore, it is important to raise the question again: is the quality of health care deteriorating in rural areas compared to urban areas?

Since it is not possible to give a standard answer, it is by focusing on chronic diseases that the best answer can be tested. Dementia is one of the best examples of chronic diseases, as it requires clinical follow-up between different specialties and between primary, hospital and continuing care. Also because consultations, emergency episodes and hospitalizations are higher compared to other diseases.

The results of a international study recent studies show that there are indeed significant differences between rural and urban areas in terms of the health of people with dementia.

Mortality is higher in rural areas. More fateful outcomes are explained by the fact that access to medical consultations is less and that there are more hospitalizations. Therefore, the evidence points to poorer clinical follow-up and more cases of disease decompensation. Poorer clinical follow-up and less integration of care also result in less use of continuing care and higher consumption of antipsychotics.

The various countries included in the study, including the United States, Canada, Scotland, Ireland, China, Australia, Sweden, Mexico, India, Germany and Italy , are not comparable in terms of wealth, size, governance model and health characteristics. This means that the fact that these results were found in such different realities makes it possible to logically deduce that something similar is happening in other countries.

This will be the case of Portugal. To our knowledge, there are no similar analyzes for the Portuguese population. However, the influence of geography on health outcomes has been well studied in the country.

Therefore, even though strong data on dementia is lacking, policymakers and health authorities do not need more evidence to consider geography as an important determinant of public health.

What emerges from this study on dementia is that the lower quality of care inside has a lot to do with the lack of professionals, but that in addition there must be greater availability and better articulation between primary, hospital and continuing care.

It is true that the Ministry of Health and the Board of Directors of the SNS have chosen these two areas as priorities. This is where the attraction of rural doctors and the expansion of local health facilities come into play.

Examining each of these measures requires depth to be explored in other texts. For now, the positive note remains that political attention has prioritized the search to blur the geographic inequalities that define 1st and 2nd citizens.