Rural poverty in Canada
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Rural poverty in Canada is part of rural poverty worldwide, albeit Canada is among the richer countries in the world.[1]
Access to care
Nursing Government
Nurses have been self governing within the province of Ontario since 1963.
Barriers to accessing health care
For those living in rural Canada, they may face various challenges when trying to access health care. Difficulties which rural areas experience when accessing health care include long distances between health services, lack of transportation, increase amount of elderly, fewer
Health care is considered accessible when within a 30-60 minute drive in rural settings, and emergency vehicles are considered accessible when there is less than a thirty-minute drive.
Other factors affecting rural poverty and accessing health care are lower socioeconomic status. Although the
Resource accessibility
Rural areas struggle with being able to provide resources to people within their community to help reduce the challenges of social poverty. Many living within poverty need assistance from food shelters, homeless shelters, drug and alcohol abuse programs, counseling programs, and women’s shelters. This is challenging as resources established to support disadvantaged groups are closing as a result of little funding and inability to effectively support these groups. The individuals seeking the assistance are left to cope on their own. Community donations and volunteers play a large role in community support remaining open to the public in rural setting.
Physician accessibility
The Canadian public feel that accessing health care is perceived as poor, people wait longer periods of time to see physicians.[14] There are increasing number of health practices being privatized which decreases the accessibility for those living in rural poverty. There a few physicians available to support this population. With around 20% of Canadians residing in rural Canada, only 8% of the physicians practice within this area.[6] Lacking in rural areas is the number of health specialists accessible to Canadians.[15] An average of 4 million Canadians go without a family physician.[16] There is also a high physician turnover rate in rural areas due to increased workload, geographic and social isolation.[17] This can be challenging as many individuals who seek specialized care need to have a referral from a family physician.[17] When there is a high physician turnover rate then individuals are having to develop a trusting relationship and provide previous medical history to a new family physician. This beings challenges as some relationships take years to develop trust with a family physician, and a bad experience with one can bring challenges when having to transfer to a new physician.
“Rural communities are understood as places with small populations, limited material and financial resources, and a heightened vulnerability to health service and health human resources shortages as a consequence of their distance from urban centres”.[18] With rural areas having a high population of elderly an increasing number of individuals living with one or more chronic illness, the need for rural area physicians and specialists are rising.[17] Chronically ill patients account for over half of family physicians visits.[17] In Canada, individuals who need to see a specialist wait an average of four weeks to three months.[19] This increases health risk for those living in rural poverty, as there is a greater difficulty accessing health care. There is an increase in number of those living with chronic illness, greater elder population, and fewer health care professionals available in rural communities.[17] For those living in rural poverty, the Canada Health Act ensures that health care is provided at no financial expense including hospital care, surgical procedures, dental surgeries, primary care doctors, and specialists are covered through provincial health insurance plans.[20] This enables individuals to receive care despite being unable to pay for care.[20]
Vulnerable populations
Single-parent families
Lone families or single parent families are incredibly susceptible to
The elderly
Children and young adults
Children living in
Indigenous people
Canadian aboriginal people living in
Individuals with disabilities
Individuals with
Health outcomes
People in rural areas experiencing poverty are having poorer health outcomes than their urban counterparts as evidenced by a lower self-reported general health and a higher inability to engage in major activities because of their health.[44]
Admissions
Canadians living in rural poverty are facing poorer hospital outcomes. When looking at Canadians diagnosed with congestive heart failure being admitted to hospital, lower admission rates were found in metropolitan areas than non metropolitan areas. A visit to a metropolitan hospital costs more as they are more services such as angiography available to metropolitan citizens.[45] Hospital admissions are also greater at the end of life for rural Canadians living in poverty relative to their urban counterparts due to lack of end of life outpatient services.[46]
Recovery
The recovery process of Canadians after surgery and risk of infection can be increased by a short length of hospital stay, alcoholism, diabetes, obesity, and living in a rural residency. Rural poverty potentiates the risk of post-op infection as well. Alcoholism, diabetes and obesity are often health outcomes related to rural poverty which makes recovering from any illness of surgery more difficult for Canadians living in rural poverty.[47]
Social supplementary
Rural Canadians who live in poverty have a difficult time accessing care and social supports. This includes the availability of health care resources and number of health care professionals that are accessible to these citizens. The lack of access and available supports directly affect the health of rural Canadians living in poverty.[48]
Social determinants of health and health outcomes
The poor health outcomes mentioned seem to be a product of the impact of social determinants of health in a rural setting for a person living in poverty. Social determinants of health are strong contributors of respective health outcomes education.[49] Causes of poverty in rural areas includes low income, lack of employment, the high costs of new housing construction, poor quality of housing (leading to higher costs for heating), poor health and lack of healthcare within a reasonable traveling distance, and low levels of education.[49] All of which are related to social determinants of health and impact health outcomes for those living in poverty. Specific social determinants of health that contribute to rural poverty and poor health outcomes include: income, employment and working conditions, economy, population demographics, housing, health, education, child and youth development, gender, and culture.[50] Social determinants of health are extremely relevant to the cause and effect of rural poverty and health. For example, those living in lower-income households tend to live in older, poor quality housing units which are often inadequately insulated and have high heat and utility costs.[51] This poor heating can affect health, and the high utility costs are often unrealistic for Canadians living in rural poverty. Also, the cause and effect element of rural poverty is certainly evident when looking at food as a critical component to health and a product of income. Many Canadians living in poverty find themselves without adequate food, or are unable to afford the appropriate groceries to support their family and their own nutritional and developmental needs.[52] It can be even more difficult for rural Canadians living in poverty as they have less access to social supports because of the greater distances between rural and urban centres, and cannot spend the money on gas and transportation to seek food security within urban areas where supports are often located.[52]
Health disparities
Poverty in Canada has extensive influence on the quality of many aspects of life for rural citizens. With social determinants of health in mind, poverty in rural areas can cause out-migration and population decline, poorer education outcomes, poorer employment opportunities due to transportation costs and child care costs, poorer living and eating conditions.[53] All of which directly affect health. The lack of education, employment and then income levels affect a rural Canadian’s ability to travel for work, or afford groceries. When the necessary social determinants of health are not being met, it has a direct effect on health outcomes for rural Canadians, and creates a strain or the few social supports available within rural communities.[53] Poverty also influences the personal life choices of those living in rural areas as they develop coping methods to face daily challenges which affect health as which creates the recognition that personal life “choices” are greatly influenced by the financial circumstance that people live with.[54]
Recognizing the gap
There is clearly a difference between rural and urban poverty in Canada and their respective health outcomes. When comparing rural and urban residents, rural Canadians tend to have lower education levels, lower levels of literacy, lower incomes, fewer job opportunities, fewer higher paying job opportunities, more seasonal employment, more housing that is in need of repairs, poorer health, and poorer access to health care services than urban Canadians.[53] In regards to health outcomes, and health care services related to stroke specifically, an association has been linked between low income, low hospital volume, and poorer stroke outcome.[55] This suggests that Canadians of different socio-economic groups may have equal access to health care facilities, but the quality of said facilities is often reflection of financial status of the residents of the area. The high-volume, urban hospitals are often not easily accessible to Canadians who live in rural poverty, magnifying the gap between rural and urban stroke outcomes, and overall health status.[55]
Closing the gap
In a response to the poor health outcomes and
References
- ^ From Bahrain to Qatar: These are the 25 richest countries in the world Canada is 21st of 25. Published by USA Today on November 28, 2018, retrieved on May 5, 2019
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- ^ Canadian Nurses Association, 2007
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- ^ a b c Arcury, T. A., Preisser, J. S., Gesler, W. M., & Powers, J. M. (2005). Access to transportation and health care utilization in a rural region. The Journal of Rural Health, 21(1), 31-38.
- ^ a b c d Halseth & Ryser, 2010
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- ^ a b c d Burns, Bruce, Marlin 2013, p.17
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- ^ a b Burns, Bruce, Marlin 2013, p.22
- ^ Wilson, MacDonald 2010, p.1
- ^ a b Wilson, MacDonald 2010, p.6
- ^ Burns, Austra; Bruce, David; Marlin, Amanda (2013). "Rural Poverty: Discussion Paper": 1–89.
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- ^ Burns, Bruce, Marlin 2013, p.28
- ^ Wilson, MacDonald 2010, p.8
- ^ a b c d e Wilson, MacDonald 2010, p.11
- ^ a b Wilson, MacDonald 2010, p.15
- ^ a b Wilson, MacDonald 2010, p.17
- ^ a b c Wilson, MacDonald 2010, p.20
- ^ a b Wilson, MacDonald 2010, p.21
- ^ a b Burns, Bruce, Marlin 2013, p.41
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- ^ Burns, Bruce, Marlin 2013, p.48
- ^ a b Burns, Bruce, Marlin 2013, p.35
- ^ a b c Burns, Bruce, Marlin 2013, p.44
- ^ Burns, Bruce, Marlin 2013, p.51
- ^ a b Saposnik et al 2008, p. 3363
- ^ Burns, Bruce, Marlin 2013, p.1
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- ^ Burns, Bruce, Marlin 2013, p.54
- ^ Burns, Bruce, Marlin 2013, p.14
- ^ Burns, Bruce, Marlin 2013, p.49
- ^ a b Mitton et al., 2007 p. 214
- ^ a b Mitton et al. 2007,p. 215