No Canadian left behind?
If our system is universal, why do statistics show rural and Aboriginal Canadians have less access to health care, and are sicker as a result?
Universal health care is part of Canada’s identity, but the lack of care in our rural and Aboriginal communities leaves some feeling un-Canadian.
“I was a family physician in rural practice for over 20 years and twice I had individuals who chose to go blind rather than travel to the big city to access an eye specialist,” says Dr. Roger Strasser, founding dean of the Northern Ontario School of Medicine. “So you can hardly say the system is meeting the needs of those patients.”
Those patients were scared of leaving their community, he explains. “If you’ve never been to a big city, it’s really terrifying. People who grow up in rural areas feel comfortable there. They want to access health care [close to home].”
That’s not easy when almost a third of Canadians live in rural areas with access to one tenth of our country’s physicians. The result: rural Canadians have more illnesses and a shorter life expectancy than their urban peers. Specifically, First Nations men and women live seven and five years less, respectively, than other Canadians.
And things are about to get worse. In July 2010, the Canadian Journal of Rural Medicine (CJRM) found one in seven rural physicians are planning to move from their communities within the next two years.
Despite the fact that Canada’s urban population is growing and small towns are disappearing, rural and Aboriginal health care should not fall further through the cracks. Beyond the fact that all Canadians deserve the same access to care, rural Canada generates the country’s fuel and food supply, and as arctic sovereignty issues heat up, access to health care in the far north will be critical to keeping a population settled there.
Before nurse practitioner Renate Bennett’s small forestry community of Caledonia, N.S. banded together eight years ago to build a local health care facility, she was working out of a small trailer without heat or running water. We’re not wealthy, she says, “but people were able to find $100 because they were committed enough to having this building.” Bennett knows some communities are not as fortunate. “Sooner or later, if people can’t access primary health care in a rural community, they’re going to end up in a larger centre.”
Frieda Prince, social development worker for the Lower Similkameen Indian Band in the Okanagan Valley of B.C., agrees. “All those people in Vancouver, Toronto, and Montreal come from somewhere, usually the smaller communities. When you look at your Downtown Eastside, wherever that is in whatever community you’re in, that's usually made up of people migrating to the larger centres from [rural] communities.”
Instead of promoting a diaspora from rural to urban centres, Dr. Strasser says the best health care solutions come from the rural communities themselves. “There is a tendency to take models from the city and somehow try to miniaturize them. Worst case scenario, it leads to a collapse of the health service.”
The urban formula for determining where to locate care facilities based on population density is one example of this collapse. When applied to rural communities, facilities are often concentrated in one area, which means surrounding districts have to travel far distances. Instead, Dr. Strasser says planners should look at integrated health services, which mix emergency, short-term, and long-term care beds in the same facility. But that means having versatile practitioners.
“Rural practitioners provide a wider range of services,” says Dr. Strasser. “They carry a higher level of clinical responsibility, in relative professional isolation.”
That isolation presents both challenges and opportunities. With fewer health providers, people get overworked and don’t last very long, says Dr. Michael Jong, Associate Professor with the Northern Family Medicine Education Program (NorFam) at Memorial University. But once there is a “reasonable” number of peers, the broad scope of practice available to doctors means they’ll stay, says the CJRM’s July survey. And there are other exciting benefits.
