Across OECD regions, populations are ageing and in some cases beginning to decline. This demographic megatrend presents new development challenges but also opportunities, especially for rural areas. To help policymakers navigate these changes the OECD has launched a new sub-series of work: Preparing Regions for Demographic Change. This report – Delivering Quality Education and Health Care to All – is the first in that sub-series.

This publication could not be timelier, coming as it does when governments across the globe are working under unprecedented pressure to manage the sanitary, social and economic crisis of the COVID-19 pandemic, while also maintaining key services for all their people, wherever they live. However, the pandemic has reinforced the need to act on existing gaps across places, for example in levels of staffing and skills and, indeed, infrastructure, both physical and digital. In the areas of health and education, for example, the pandemic has heavily increased demand for care and lockdowns have forced children to study online from home. These demands have exacerbated long-standing place-based disparities in access to medical resources, the incidence of comorbidities, environmental health risks, school quality, income disparities and digital divides, among others. The prospect of population decline and ageing puts many rural communities at risk of even higher unmet needs.

While the delivery of education and health services are nationally co-ordinated and funded in many countries, the financial costs of dealing with the crisis will be severe, putting increasing pressure on the public purse and constraints on governments, bolstered by the rollout of vaccines, to accelerate the recovery. This report highlights the critical role that subnational governments and local organisations can play in that process and their ability, by tailoring delivery models to leverage local strengths, to generate and drive efficiencies in the delivery of key services. The report also identifies a number of place-based recommendations to better design and deliver education and health services in rural regions that can help mitigate existing inequalities and support communities facing ageing and depopulation.

While the challenges of societal ageing and population decline are significant, they are, to some extent, a consequence of past successes. Today, OECD member populations are living longer, healthier lives and they are better educated and more prosperous than ever before. However, whilst this is true at the national level, it is also true that these gains have not always been spread equally within countries and challenges remain. This year, as the OECD celebrates its 60th anniversary, the publication series Preparing Regions for Demographic Change aims to help overcome those place-based challenges and support even better lives for all in the years to come.

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