In recent years, health, economic, and environmental crises have brought rural areas back into the spotlight, as evidenced by the France Ruralités plan, adopted in 2023. Yet perceptions of rural areas remain mixed: the “countryside” is idealized as a haven of nature and community spirit that attracts remote workers, but rural life is also associated with isolation, an aging population, and the disappearance of public services—especially healthcare. This special report from La Santé en action offers various perspectives to highlight the diversity of rural areas, their vulnerabilities, and their potential for innovation in the face of contemporary challenges.

Pollution in the countryside, too

With 88% of French municipalities classified as rural and a population of 22 million, they are home to nearly one-third of the population. Due to socio-economic and demographic vulnerabilities, health indicators there are generally unfavorable, with life expectancy at birth two years lower than in urban areas. Several studies show that rural areas are just as exposed to pollution as cities, whether it involves pesticide exposure in agricultural areas or nuisances caused by industrial or road infrastructure.

Proximity to food-producing areas is not a protective factor either, as in many regions, the share of local agriculture in residents’ diets is negligible, with the bulk destined for export. The shortage of healthcare workers has an immediate impact but also one in the longer term, since pressures on the supply side tend to reduce the emphasis on prevention among healthcare professionals. Finally, mobility issues particularly affect young people, hindering their ability to access education or employment, to seek recreation, pursue cultural activities, play sports, and lead a fulfilling social life.

A Proliferation of Initiatives

However, as this issue highlights, rural communities are not standing still. Stakeholders—whether from institutions or community organizations, professionals, or local elected officials—are launching a growing number of initiatives. In Puy-de-Dôme, a community of municipalities has launched a network of wellness ambassadors, in which volunteers, social workers, and elected officials take turns to combat the isolation of older adults and offer preventive measures for healthy aging. In the Vercors, the “En route pour la santé” bus, run by a family center, travels the mountain roads to meet with young people, particularly to discuss mental health. Across France, the Bouge ton coq association is revitalizing villages that have lost their local shops by helping volunteer residents set up a community-run grocery store, which serves as both a place for socializing and for shopping. In Lorraine, a regional food project by a community of municipalities includes a social component to provide everyone—including the most disadvantaged—with high-quality, locally sourced food through group purchases from local farmers and the creation of shared community gardens on municipal land.

Health-Promoting Urban Planning in a Rural Context

While these initiatives demonstrate a strong commitment to promoting health, they would nevertheless benefit from being grounded more firmly in scientifically validated frameworks. The concept of health-promoting urban planning is beginning to take hold in small towns, as seen in this project for a nature school in a municipality of 4,000 residents in the Eure department. However, these developments must be accompanied by initiatives tailored to the rural context to encourage behavioral changes, such as buying bread by bike or on foot rather than by car.

Rural areas, through their diversity and capacity for innovation, offer valuable lessons. They remind us that health is not limited to access to healthcare, and that public policy must also address living conditions, the environment, and the factors that foster social cohesion.