Unpacking the Complexities of Rural Healthcare in Canada: Exploring Health Systems, Determinants of Health, Disparities, and Future Directions

Moving through the units in this course I have reflected on myself, my profession, and my place in the healthcare system. I have explored Canadian healthcare systems, concepts of health and contributing factors to health. I have examined multilevel ways of looking at health and healthcare, including investigating health disparities and marginalized populations. Studying these topics has allowed me to reflect on my own professional goals and interests and has provided me with insights into my career.  This has been an unexpectedly useful learning journey because I have further cultivated an existing interest in rural healthcare and gained insight into how my profession and career may grow into this area of interest

In my final blog post I will attempt to synthesize the topics explored in this course by examining the intricate relationships between health systems, determinants of health, health disparities, and future directions for rural healthcare in Canada.

As I have reviewed in past posts, rural communities face distinct health challenges that differ from those in urban settings. Understanding these challenges through multilevel models is essential for delivering tailored health services to these populations.

Identifying Health Systems and Determinants of Health

Health systems consist of various organizations, institutions, and resources that provide healthcare services. Parts of Canada’s healthcare system are publicly funded, ensuring coverage for many individuals regardless of their income. However, access and quality of care can vary widely due to geographical and socio-economic barriers (DesMeules, et al., 2011).

Health is shaped by many factors which are known as the determinants of health. These determinants offer vital insights into why health outcomes differ across various groups. Determinants include the social and economic environment, the physical environment, and the person’s individual characteristics and behaviours. These can be things like income, education, housing, race, gender, nutrition, social support, access to healthcare, genetics and beyond (BCCDC). About 75% of our overall health is determined by social factors (BCCDC).

These social factors strongly affect the rates of chronic disease and injury, leading to different levels of health and well-being for different groups and contribute to some of the disparities seen in rural regions (Williams & Kulig, 2011).

The Role of Multilevel Models in Understanding Health

Multilevel models provide an innovative lens for examining how individual, community, and societal factors interact to shape health outcomes. For example, a person’s health may be influenced not only by their lifestyle choices but also by the availability of healthcare services and the support they receive from their community. We explored this in more depth in a past blog post that looked at applied the ecological model to rural health. Some of the factors that can affect health are:

• Individual factors, such as genetics, age, education, knowledge, attitudes, beliefs, and personality.

• Interpersonal factors, such as social connections and family characteristics which can provide support or create barriers to healthy behavior.

• Community factors, such as formal or informal social norms, resources and service systems, and infrastructure that can limit or enhance healthy behaviors.

• Societal factors, including local, state, and federal policies and laws that regulate or support health actions and practices for disease prevention including early detection, control, and management (Rural Health Information Hub)

  
  

In rural areas, the ecological model can shed light on how these factors interact. For example, while urban dwellers often have better access to healthcare services, rural residents may struggle with geographic isolation, insufficient healthcare resources, and inconsistent health policies (Hale, Grzybowski, & Ramdin, 2021).

Marginalized Populations and Rural Health Disparities

The concept of marginalization refers to relegating to an unimportant or powerless position within a society or group (Merriam-Webster). Marginalization in healthcare refers to the systematic disadvantages that certain groups experience when trying to access medical services, information, and support. In Canada, marginalized groups include Indigenous peoples, low-income individuals, racialized communities, and those living with disabilities. These communities face multiple layers of disadvantage that impact their health outcomes. Systemic racism, economic instability, and social isolation all contribute to a lack of access to care.

Marginalization, social determinants, rural living, and healthcare intersect in various ways but one of the most obvious is with Indigenous people. Just over half of the Indigenous population in Canada live in a rural area (Statistics Canada, 2021). Indigenous communities in rural areas face significant health challenges (Williams & Kulig, 2011). Indigenous populations experience lower life expectancy, higher rates of infant mortality, higher rates of disease, and injury, as well as higher rates of mental health disorders and suicide (Richmond & Cook 2016). Recognizing and addressing these disparities is critical. Effective healthcare strategies must actively engage with these populations in culturally appropriate ways to promote health equity. (Richmond & Cook 2016)

Future Directions for Rural Healthcare in Canada

To improve rural healthcare in Canada, several key strategies must be prioritized:

Enhancing Access to Healthcare Services

Improving access to healthcare services is crucial. One effective approach is the expansion of eHealth services. E-Health is ‘interactive communication and information technology aimed at enhancing community quality of life and/or individual health outcomes’ (Hage, et al. 2013). It includes various digital strategies such as videoconferencing, internet/social media outreach, and cellphone apps and can encompass many health services like access to lab reports, virtual appointments, and online health programs/groups for example. This is of particular note in rural/remote areas because of the challenges with access to traditional health services. Through these methods we can connect patients in remote areas with healthcare providers, reducing travel time and improving access.

Additionally, improving the recruitment and training of local staff and deploying mobile health clinics to underserved areas can provide vital services, such as health screenings and preventative care, making healthcare more accessible.

Integrating Social Determinants into Healthcare Models

Healthcare providers should incorporate social determinants of health into patient care. For instance, screening for issues like housing, financial resources, and transportation can reveal challenges that affect health.

In respect to indigenous health, a decolonizing model seeks to look at the context leading to health disparities and the compounding effects of various biological, social, cultural, and political factors that affect the health of indigenous people (Nguyen, et. al. 2020).  Decolonizing health policy would recognize the unique culture of Indigenous peoples, including acknowledging their inherent right to be self-determining and the Indigenous knowledges they hold (Williams & Kulig, 2011).

There is good evidence to suggest that creating supportive healthcare environments that recognize social determinants can bring about health improvements (Williams & Kulig, 2011).

Building Community Resilience

Strengthening community networks is vital for fostering resilience in rural populations. Support systems can empower individuals to take control of their health. One unique way to approach this could be in improving the shared values of the community through attitude and culture.  

In rural communities an interesting phenomenon can occur wherein the inherent qualities of individuals that lead them to be healthy can in turn positively influence the overall health of the community. This positive feedback loop happens when enough people in a community share healthy values. The collective mindset influences the development of infrastructure and programs through fundraising, volunteering, and the election of like-minded officials. This in turn attracts more similar people who contribute to maintaining the culture, and in time the overall health of the community improves. This reciprocal trend suggests that the attitude of individuals can be a key determinant of the health of the community and could possibly have implications for building community resilience (Hale, Grzybowski, & Ramdin, 2021).

A Healthier Future for Rural Canadians

As a rural Canadian who has lived and worked in rural resource-based areas my entire life the future of rural healthcare is particularly important to me. The future of rural health in Canada hinges on our understanding of health systems, the determinants of health, and their interplay through multilevel models. We must prioritize improving access to healthcare, addressing social determinants, and building local community resources and resiliency in order to create effective healthcare solutions.

References:

DesMeules, M., Pong, R.W., Read Guernsey, J. Wang, F., Luo, W., Dressler, M.P. (2011) Chapter 2: Rural Health Status and Detirmanants in Canada. In Williams, A.M. & Kulig, J.C. (Eds.) Health in rural Canada. UBC Press. https://www.ubcpress.ca/asset/9079/1/9780774821728.pdf

Hage, E., Roo, J.P., van Offenbeek, M.A. et al. Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review. BMC Health Serv Res 13, 19 (2013). https://doi.org/10.1186/1472-6963-13-19

Hale. I. Grzybowski, S., Ramdin, Z. (2021). What makes a healthy rural community?. Canadian Journal of Rural Medicine 26(2):p 61-68, DOI: 10.4103/CJRM.CJRM_22_20 https://journals.lww.com/cjrm/fulltext/2021/26020/what_makes_a_healthy_rural_community_.6.aspx

Nguyen, N. H., Subhan, F. B., Williams, K., & Chan, C. B. (2020). Barriers and Mitigating Strategies to Healthcare Access in Indigenous Communities of Canada: A Narrative Review. Healthcare, 8(2), 112. https://doi.org/10.3390/healthcare8020112

Statistics Canada. Canada’s Indigenous population. https://www.statcan.gc.ca/o1/en/plus/3920-canadas-indigenous-population

Richmond, C.A.M., Cook, C. Creating conditions for Canadian aboriginal health equity: the promise of healthy public policy. Public Health Rev 37, 2 (2016). https://doi.org/10.1186/s40985-016-0016-5

Rural Health Information Hub. Ecological Models. https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models/ecological

Williams, A.M. & Kulig, J.C. (2011). Chapter 1; Health and Place in Rural Canada. In Williams, A.M. & Kulig, J.C. (Eds.) Health in rural Canada. pp. UBC Press. https://www.ubcpress.ca/asset/9079/1/9780774821728.pdf