Living in Rural Canada: Obstacles in Health
There are inherent challenges in receiving healthcare that come with living in rural Canada. Not having access to care because of distance and living remotely is a reality for far too many Canadians. Ninety-five percent of Canada’s landscape is considered rural, with about 30% of the population inhabiting these areas (sencanada.ca). The healthcare needs of the rural population are different than those living in urban area related to different demographics, social determinants of health, and occupational hazards (sencanada.ca). Studies indicate there is a relationship between place and health; with health status decreasing the further one lives from an urban center (healthassociation.ns.ca).
The CHA
The Canada Health Act (CHA) of 1984 is a set of standards of healthcare for Canadians by the federal government. The purpose is “…to protect, promote, and restore physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” (canada.ca).
Although funds are distributed to the population at the provincial level, the same principles apply across Canada. The principles include: public administration, universality, comprehensiveness, accessibility, and portability (canada.ca). Canadians who live in rural and remote parts of the country have the same right to healthcare as those who live in urban areas; however, the care is not always available in a timely manner or without hardships such as traveling and being separated from family and community (sencanada.ca).
Social Determinants of Health
There are some indicators that provide insight into the health of a population, such as life expectancy, death rates, and infant mortality (sencanada.ca). Statistics of the rural population of Canada compared to the urban population show a decreased life expectancy for men and women, increased death rates and a higher infant mortality rate (sencanada.ca). The socioeconomic determinants of health, those attributes that are modifiable, such as education level, income level, and employment rates contribute to the health disparity between rural and urban populations. On all fronts, rural populations fare worse than the urban populations. There are many contributors to this phenomenon. In rural communities, the rate of high school drop out is 16.4%, compared to urban areas at 9.2% (SORC, 2015). Attainment of some post-secondary education is less in the rural population than urban counterparts (SORC, 2015). Unemployment rates in rural areas exceed those of urban areas (SORC, 2015). Combined with the lower average household income, these factors contribute to a higher level of poverty, which makes it difficult for people to eat healthy foods and live in appropriate housing (healthassociation.ns.ca). Rural populations also have higher rates of smokers, obesity, and sedentary behavior (healthassociation.ns.ca).
What makes Rural Canadians Vulnerable?
The effects of poverty in rural areas are rarely seen, therefore not acknowledged as they should be by politicians and policy makers (healthassociation.ns.ca).
There is a trend of young people leaving rural areas to pursue education and employment in urban areas, then little effort invested in the youth who do stay. This leaves the rural population with an increasing concentration of seniors who need care and do not contribute to tax revenue through employment (SORC, 2015). The spiral effect of less tax revenue is the decreasing of public services such as community centers and the closing of hospitals, schools, and health centers (healthassociation.ns.ca). Consequently, less new businesses open and it is difficult to recruit newcomers to the rural areas (healthassociation.ns.ca).
There are fewer primary healthcare providers in rural areas. Primary care providers manage chronic conditions, treat illnesses, and help to alleviate strain on acute care facilities like emergency rooms (healthassociation.ns.ca). Access to specialty physicians is markedly decreased in rural areas as specialists tend to be distributed in urban areas (healthassociation.ns.ca). Therefore, there are fewer doctors in the places with the sickest people. Additionally, rural areas have less access to long term care, mental health and health promotion resources (healthassociation.ns.ca).
Recruitment and retention of healthcare professionals in rural areas is difficult because of the professional isolation and demanding workloads experienced by practitioners (healthassociation.ns.ca). Additionally, there are fewer work, cultural, recreational, and social opportunities for their families in rural settings (healthassociation.ns.ca & sencanada.ca).
Transportation, or lack thereof, is a barrier to people in rural communities obtaining healthcare services. People may not have vehicles because they cannot afford one or may not have a reliable vehicle to drive long distances (healthassociation.ns.ca). Public transportation is non-existent in many communities (healthassociation.ns.ca). People may choose not to travel, or delay traveling, which can compromise their health outcomes (sencanada.ca). Also, there are people who are immobile, too sick or isolated to travel (healthassociation.ns.ca).
Food insecurity is a critical issue for many people living in rural regions. Access to nutritional and affordable food is challenging, especially since there is a rapid decline in local grocery stores (Center for Rural Affairs, 2010). It costs more to ship fresh food to rural regions than urban areas and the demand for food is less (ruralhealthinfo.org). As the cost is high and the income of many people in rural regions is lower than urban areas, few people in rural areas consume the recommended daily servings of fruits and vegetables and other nutrient dense foods (ruralhealthinfo.org).
The Future
There is an increase in the use of nurse practitioners, pharmacists, and paramedics to manage chronic illnesses in rural regions (healthassociation.ns.ca). These healthcare providers can work in conjunction with an off site physician (healthassociation.ns.ca). Utilization of these services has proven to decrease healthcare costs, lower smoking rates, and increase fitness levels in communities where this change in healthcare delivery has occurred (healthassociation.ns.ca).
Advances in telehealth have made access to specialized care for those in rural and remote areas a reality. Using technology to connect providers with patients via video conferencing can provide access to specialist consultation (healthydebate.ca). Advances such as robots with connected stethoscopes, ultrasound, dermatoscope, ophthamoloscope and otoscope capabilities enable specialists to perform physical assessments remotely with the help of a nurse guiding the instruments (healthydebate.ca). Patients can be monitored from home for changes in vital signs, lab values, and signs or symptoms of distress, which can help reduce disease exacerbations requiring a higher level of care (sencanada.ca).
The application of a multilevel model of health promotion, such as the Socioeconomic Model (SEM), could facilitate change in the delivery of healthcare in rural areas. On a federal and policy level, the government has created an advisory committee on rural health, which reports to the Minister of Health on how the federal government can help to improve the health of rural Canadians (sencanada.ca). Also at the federal level, the Office of Rural Health is an advocate for the health of rural Canadians with policy implementation and healthcare strategy changes and initiatives, including funding for projects (sencanada.ca). On the community level, focus on research pertaining to healthcare in rural Canada would be helpful, as much research is done on urban healthcare and the needs of the populations are different (sencanada.ca). On an organizational level, medical schools and associations can expose students to rural healthcare opportunities and provide incentives to pursue a career in a rural area (sencanada.ca).
Rural healthcare has unique challenges and needs. These needs should to be identified and focus on possible strategies for remediation should be made to give rural Canadians the same opportunity for healthcare as their urban counterparts.
References:
Bailey, J (2010). Rural grocery stores: importance and challenges. Center for Rural Affairs. Retrieved from: http://files.cfra.org/pdf/rural-grocery-stores.pdf
Government of Canada. (2017). Canada Health Act. Retrieved from: https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html
Health Association Nova Scotia (2013). Rural Health and Service Delivery in Nova Scotia: A Profile and Recommendations for Discussion. Retrieved from: https://www.healthassociation.ns.ca/sites/base/pages/mpe section/policydocuments
Healthy Debate. Retrieved from: http://healthydebate.ca/2015/06/topic/telemedicine-across-canada
Rural Health Info. (2018). Rural hunger and access to healthy food. Retrieved from: https://www.ruralhealthinfo.org/topics/food-and-hunger
The Standing Senate Committee on Social Affairs, Science and Technology (2002). The Health of Canadians- The Federal Role. volume Two: Current Trends and Future Challenges. Retrieved from https://sencanada.ca/Content/SEN/Committee/371/soci/rep/repjan01vol2-e.pdf