Why Rural is Important: Romanow Report, 2002 (citing Statistics Canada)

The Atlantic RURAL Centre:The Atlantic RURAL Centre:

Building Research Capacity to Building Research Capacity to Understand Physical and Social Understand Physical and Social Environmental Influences on the Environmental Influences on the Health of Atlantic Rural CanadiansHealth of Atlantic Rural Canadians

MANITOBA CENTRE FOR HEALTH POLICYMANITOBA CENTRE FOR HEALTH POLICYThe Need to Know Team Annual MeetingThe Need to Know Team Annual MeetingJanuary 30-31, 2006January 30-31, 2006

Dr. Judy Guernsey, Dalhousie UniversityDr. Judy Guernsey, Dalhousie UniversityDirector, Atlantic RURAL CentreDirector, Atlantic RURAL Centre

Why Rural is Important:Romanow Report, 2002 (citing Statistics Canada)

Health indicators are worse for those in predominantly rural

Canadian regions

Why Rural is Important:Romanow Report, 2002 (citing Statistics Canada)

In the Atlantic provinces, 40% or more of the population is

rural

Guernsey -- Jan 31, 2006 -- NTK MCHP 4

Population Health - Key Elements from The Population Health Population Health - Key Elements from The Population Health Template, Health Canada, 2001Template, Health Canada, 2001

1. Focus on the Health of

Populations

2. Address the Determinants

of Health and Their Interactions

3. Base Decisions on Evidence

Etc

Defining “Rural”Defining “Rural”Rural and Small Town Definition (RST) – Rural and Small Town Definition (RST) – Statistics Canada:Statistics Canada:

Regions (Census Sub-Divisions) outside the Regions (Census Sub-Divisions) outside the commuting zone of larger urban centres (with commuting zone of larger urban centres (with 10,000 or more population) (CMA/CA). 10,000 or more population) (CMA/CA). These CSDs may be disaggregated into zones according to the degree of influence of a larger urban centre called MIZ.

Census Subdivisions (CSD) are classified into the Census Subdivisions (CSD) are classified into the following five categories, according to the degree following five categories, according to the degree of influence a CMA/CA has:of influence a CMA/CA has:

URBANURBAN - CMA/CA - CMA/CA - Strong MIZ (Commuting flow of - Strong MIZ (Commuting flow of >=30%) >=30%)

RURALRURAL - Moderate MIZ (Commuting flow of - Moderate MIZ (Commuting flow of 5-30%)5-30%)

- Weak MIZ (Commuting flow of 1-- Weak MIZ (Commuting flow of 1-5%)5%) - No MIZ- No MIZ



Understanding Rural Health and Its Understanding Rural Health and Its DeterminantsDeterminantsPong, DesMeules, Heng, Lagace, et al. - CPHI – (report due out Pong, DesMeules, Heng, Lagace, et al. - CPHI – (report due out 2006)2006)MethodsMethods• Data sources: Canadian Annual Mortality Data 1986-1996 and the Data sources: Canadian Annual Mortality Data 1986-1996 and the

1996 Census data.1996 Census data.

• Age-standardized mortality rates and standardized mortality Age-standardized mortality rates and standardized mortality

ratios have been calculated. ratios have been calculated.

• All cause and cause-specific mortality rates and ratios have been All cause and cause-specific mortality rates and ratios have been

stratified by provinces/territories, rural and urban categories, stratified by provinces/territories, rural and urban categories,

age (0-4, 5-19, 20-44) and sex.age (0-4, 5-19, 20-44) and sex.

• Selected causes of death: All-cause, infectious and parasitic Selected causes of death: All-cause, infectious and parasitic

disease, all cancer, diabetes, coronary heart disease, chronic disease, all cancer, diabetes, coronary heart disease, chronic

obstructive lung disease, motor vehicle accidents, other injuries obstructive lung disease, motor vehicle accidents, other injuries

and poisoning, suicide.and poisoning, suicide.


All-cause mortalityStandardized mortality ratios by age and MIZ, all-

cause mortality, Canada 1986-1996

0

0.5

1

1.5

2

2.5

3

CMA/CA StrongMIZ

ModerateMIZ

Weak MIZ No MIZ Canadaage

SMR0-4

5-19

20-44

Note: Pattern means SMR statistically significant at p<0.01

Source: Canadian Annual Mortality data 1986-1996 and 1996 Census, Statistics Canada

Courtesy: Legace, Desmeules, Pong et al.


Cause-Specific MortalityStandardized mortality ratios for people aged 20-44 by MIZ, chronic and

infectious diseases, Canada 1986-1996

0

0.5

1

1.5

2

2.5

3

3.5

Infectiousand parasitic

diseases

Cancer Diabetes CHD COLD Suicide Other injuriesand

poisonings

Accidents

SMR

CMA/CA

Strong MIZ

Moderate MIZ

Weak MIZ

No MIZ

Canada

Note: Pattern means SMR statistically significant at p<0.01

Source: Canadian Annual Mortality data 1986-1996 and 1996 Census, Statistics Canada








BC Vital BC Vital Statistics - Statistics - 1998 by 1998 by Health Health Region:Region:

Areas with Areas with significantly significantly higher higher mortalitymortality

Areas with Areas with significantly significantly lower lower mortalitymortality


The ‘rural’ population health landscapeThe ‘rural’ population health landscape

• Declining primary resource reliant economiesDeclining primary resource reliant economies

• Societal transition, including changing demographicsSocietal transition, including changing demographics

• Less access to public goodsLess access to public goods

• Hazardous occupationsHazardous occupations

• UnrecognizedUnrecognized or unmonitored physical environmental or unmonitored physical environmental concernsconcerns

•Social cohesion and resiliencySocial cohesion and resiliency


Resource reliant economies are those that are Resource reliant economies are those that are primarily reliant on natural resource extraction or primarily reliant on natural resource extraction or

utilizationutilization

http://www.mathsyear2000.org/numberland/54/fishing.jpg



Age Standardized Mortality Rates: Males and Females

Selected Resource Reliant Canadian Communities

Data source:

Mortality Atlas of Canada, 1984

881.6

903.6

974.9

1001.4

965

1163.9

1020.4

842.6

894.7

963.8

964.5

958

992.6

1025.4

1040.2

966

1308.5

1066.7

989.1

1175.2

1005.5

1028.8

1129

974.7

828.4

882.5

824.5

1023.3

917.9

963.9

504.4

523.7

519.3

429.3

556.9

609.1

544.7

503.6

597.9

553.2

646.6

533.5

558.9

632.4

575.6

515.8

541.3

525.3

513.1

662.5

530.8

562.2

612.9

592.3

459.5

570.6

452.8

522.6

507.4

527

0 200 400 600 800 1000 1200 1400

Canada

Cornerbrook

Grand Falls

Stephenville

Springhill

Sydney

Sydney Mines

Bathurst

Dalhousie

Edmundston

Grand Falls

Saint John

Asbestos

Chicoutimi-Jonquiere

Cowansville

Thetford Mines

Val-d'Or

Hawkesbury

Kapaskasing

Kirkland Lake

Sault Ste Marie

Sudbury

Timmins

Flin Flon

Brooks

Red Deer

Chilliwack

Dawson Creek

Port Alberni

Prince George

Canada femalesCanada females Canada malesCanada males










•The share of Canada’s population living in rural and small town areas has •declined from 34 percent in 1976 to 22 percent in 1996.


This is a combination of natural population change and net outward migration










Index Definition / Main idea

Economic Stability Smooth economic growth, without strong surges and recessions. Less fluctuation is preferred

Global exposure and integration

Degree of international linkages and exposure to global market in local industries

Social Progress Progress towards sustainable development. Balancing present requirements with future needs

Local Institution Capacity

Capability and potential for self-reliance and effective and efficient operating

Competitiveness Capacity to achieve sustained income and employment growth relative to others

Regional Disparity Differences in SES and opportunities

Resource Reliance Degree of employment in primary industry

New Rural Economy Dimensions (www.nre-concordia.ca)New Rural Economy Dimensions (www.nre-concordia.ca)


Social determinant Rural context Income and social status

- Substantially lower average incomes - Higher proportion of social assistance

Employment and working conditions

- Higher unemployment - Higher underemployment – part-time and seasonal

work - More hazardous working conditions and exposures

to toxic substances, particularly in resource jobs Education - Lower levels of formal education (fewer high school

diplomas, fewer university degrees) - Lower levels of literacy

Housing - Higher proportion of substandard housing, particularly for aboriginal populations

Health care services - Lack of health promotion programs, lack of diagnostic services, restricted access to emergency and acute care, large distances to services

- Major shortages of nurses, GP’s, and specialists Social environment - Stronger social networks

- Strong sense of community

Rural Canada in the context of social determinants of health (Reference: Bartlett L Guernsey J, 2005)


Access to physicians by latitude










http://www.maretec.fo/saleslist%20doc/FT191.htm


Fatality rates by Major Fatality rates by Major Industrial Sector, 1993-Industrial Sector, 1993-1995, Canada1995, Canada((Pickett W Hartling L Brison R Guernsey J Fatal work-related farm Pickett W Hartling L Brison R Guernsey J Fatal work-related farm injuries in Canada, 1991-1995. CMAJ 160, 1843-1848)injuries in Canada, 1991-1995. CMAJ 160, 1843-1848)

0

10

20

30

40

50

60

70

80

1st Qtr

annual rate per 100,000

Mining

Logging and Forestry

Construction

Agriculture

Manufacturing

Finance

• Mining, logging and agriculture in top four

• 314 deaths from work related farm injuries

• 50 occurred in Atlantic Canada

• MVTC (93-95) = 6.7 per 100,000


Agricultural Fatalities by class of injury, gender and age group (1990-1996)

Machinery Non-Machinery

Age Group

Males Females Males Females

0-14 48 10% 15 36% 8 4% 4 21%

15-59 227 49% 24 24% 118 61% 11 58%

60+ 187 41% 3 7% 67 35% 4 21%

Total 462 100 42 100 193 100 19 100

Dimich-Ward H Guernsey J Pickett W Rennie D Hartling L Brison R Gender differences Dimich-Ward H Guernsey J Pickett W Rennie D Hartling L Brison R Gender differences in the occurrence of farm-related injuries. Occ Env Med May 2003in the occurrence of farm-related injuries. Occ Env Med May 2003


Occupation Disrupted: Impacts, Challenges, Occupation Disrupted: Impacts, Challenges, Coping StrategiesCoping StrategiesSmith L Townsend E Guernsey J Journal of Occupational Science April Smith L Townsend E Guernsey J Journal of Occupational Science April 2003 vol 10 (1), 14-202003 vol 10 (1), 14-20

““six months after I was home, my wife left and took the six months after I was home, my wife left and took the kids. I just about went crazy”kids. I just about went crazy”

““I had nothing.. No insurance of any kind”I had nothing.. No insurance of any kind”““My insurance policy was inadequate.. I was eligible My insurance policy was inadequate.. I was eligible

for $1000..”for $1000..”““friends … planted sprayed and harvested crops my friends … planted sprayed and harvested crops my

first year after the accident”’first year after the accident”’

Most startling to learn that farmers are ineligible for Most startling to learn that farmers are ineligible for employment insurance and disability pensions if employment insurance and disability pensions if have assetshave assets










Nitrogen oxides emissions in Canada Nitrogen oxides emissions in Canada

--


Ammonium is a measurable fraction of the fine particle mass across Canada (10-20%).

There is evidence that reductions in ammonia air concentrations will lead to a decrease in fine particle mass, particularly in winter

- Bob Vet, Meteorological Service of Canada, 2003- Bob Vet, Meteorological Service of Canada, 2003

Funding:Funding:CIHR Centre for Research Development on Physical and CIHR Centre for Research Development on Physical and Social Environmental Factors and Their Influences on Social Environmental Factors and Their Influences on Health - $2.4 million (2004-2011)Health - $2.4 million (2004-2011)

Mission:Mission:To enhance our understanding of physical and To enhance our understanding of physical and socioeconomic environmental influences on health and the socioeconomic environmental influences on health and the capacity of rural Atlantic Canadians to respond to these capacity of rural Atlantic Canadians to respond to these challenges. challenges.

Eight Atlantic Academic Institutions: Eight Atlantic Academic Institutions: Dalhousie University, Memorial University, Mount Allison Dalhousie University, Memorial University, Mount Allison University,University, Saint Mary’s University, Nova Scotia Agricultural Saint Mary’s University, Nova Scotia Agricultural CollegeCollege, , University of Prince Edward Island, University of University of Prince Edward Island, University of New Brunswick, NSCC Centre of Geographic Sciences New Brunswick, NSCC Centre of Geographic Sciences

Lead Government Partner: Lead Government Partner: Environment Canada Atlantic Environmental Sciences Environment Canada Atlantic Environmental Sciences NetworkNetwork

Our Objectives:Our Objectives:

1. 1. Provide a locus for exchange of ideas between Provide a locus for exchange of ideas between researchers, government agencies, concerned citizens, researchers, government agencies, concerned citizens, and and rural Atlantic Canadiansrural Atlantic Canadians2. 2. Foster trans-disciplinary research interactions and Foster trans-disciplinary research interactions and

initiatives in Atlantic Canadainitiatives in Atlantic Canada3. 3. Create enhanced training opportunities for students Create enhanced training opportunities for students

and rural health professionals in Atlantic Canadaand rural health professionals in Atlantic Canada4. 4. Include research on innovation uptake and Include research on innovation uptake and implementation by policy makers and health service implementation by policy makers and health service providers in Atlantic Canadaproviders in Atlantic Canada

Our Thematic Research Areas:Our Thematic Research Areas:

1.1. Resource Reliant CommunitiesResource Reliant Communities2.2. Social Cohesion and Community ResiliencySocial Cohesion and Community Resiliency3.3. Rural Occupational and Environmental Health HazardsRural Occupational and Environmental Health Hazards4.4. Special Rural PopulationsSpecial Rural Populations

Current Centre Research ActivitiesCurrent Centre Research Activities• NTK TEAM application to CIHR • Atlantic Injury Research Partnership proposal• Developing collaboration with New Rural

Economy initiative (Concordia University)• SafetyNet fisheries cohort study (Neis,

Bornstein, Binkley) – Coasts under Stress• Early childhood environments and Health NB

(Willms)• PEI Population Health Research Unit

development• Arsenic collaboration (Mount Allison, COGS, Dal)• Atlantic Provinces Agricultural Safety and Health

Council• Collaboration with McGrath NET grant Mental

Health in Young Rural Women models of care• Student fellowship support


RURAL Centre Investigators:

Dr. Marian Binkley Dr. Robert Maher

Dr. Stephen Bornstein Dr. Patrick McGrath

Dr. Fred Burge Dr. Barbara Neis

Dr. Ron Colman Dr. Christiane Poulin

Dr. Arla Day Dr. Michael Ungar

Dr. David Fleming Merv Ungurain

Dr. Graham Gagnon Dr. Madine VanderPlaat

Dr. Robert Gordon Dr. John VanLeeuwen

Dr. Richard Gould Dr. Paul Veugelers

Dr. Judy Guernsey Dr. Swarna Weerasinghe

Dr. George Kephart Dr. Douglas Wilms

Dr. Donald Langille

Documents

Why Rural is Important: Romanow Report, 2002 (citing Statistics Canada)