The Atlantic RURAL Centre:
Building Research Capacity to Understand Physical
and Social Environmental Influences on the Health
of Atlantic Rural Canadians
MANITOBA CENTRE FOR HEALTH POLICY
The Need to Know Team Annual Meeting
January 30-31, 2006
Dr. Judy Guernsey, Dalhousie University
Director, 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
Population Health - Key Elements from The Population Health
Template, 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
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Defining “Rural”
Rural and Small Town Definition (RST) – Statistics Canada:
Regions (Census Sub-Divisions) outside the commuting zone of
larger urban centres (with 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 following five
categories, according to the degree of influence a CMA/CA has:
URBAN
RURAL
- CMA/CA
- Strong MIZ (Commuting flow of >=30%)
- Moderate MIZ (Commuting flow of 5-30%)
- Weak MIZ (Commuting flow of 1-5%)
- No MIZ
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Understanding Rural Health and Its Determinants
Pong, DesMeules, Heng, Lagace, et al. - CPHI – (report due out 2006)
Methods
• Data sources: Canadian Annual Mortality Data 1986-1996 and
the 1996 Census data.
• Age-standardized mortality rates and standardized mortality
ratios have been calculated.
• All cause and cause-specific mortality rates and ratios have
been stratified by provinces/territories, rural and urban
categories, age (0-4, 5-19, 20-44) and sex.
• Selected causes of death: All-cause, infectious and parasitic
disease, all cancer, diabetes, coronary heart disease, chronic
obstructive lung disease, motor vehicle accidents, other
injuries and poisoning, suicide.
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All-cause mortality
Standardized mortality ratios by age and MIZ, allcause mortality, Canada 1986-1996
3
2.5
2
SMR
0-4
5-19
20-44
1.5
1
0.5
0
CMA/CA
Strong
MIZ
Moderate Weak MIZ
MIZ age
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
Courtesy: Legace, Desmeules, Pong et al.
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Cause-Specific Mortality
Standardized mortality ratios for people aged 20-44 by MIZ, chronic and
infectious diseases, Canada 1986-1996
3.5
3
2.5
CMA/CA
Strong MIZ
2
SMR
Moderate MIZ
Weak MIZ
No MIZ
1.5
Canada
1
0.5
0
Infectious
and parasitic
diseases
Cancer
Diabetes
CHD
COLD
Suicide
Note: Pattern means SMR statistically significant at p<0.01
Other injuries
and
poisonings
Accidents
Source: Canadian Annual Mortality data 1986-1996 and 1996 Census, Statistics Canada
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BC Vital Statistics 1998 by Health
Region:
Areas with
significantly
higher mortality
Areas with
significantly
lower mortality
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The ‘rural’ population health landscape
• Declining
primary resource reliant economies
• Societal transition, including changing demographics
• Less access to public goods
• Hazardous occupations
• Unrecognized or unmonitored physical environmental
concerns
•Social cohesion and resiliency
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Resource reliant economies are those that are primarily reliant on
natural resource extraction or utilization
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Prince George
527
Port Alberni
507.4
522.6
Dawson Creek
824.5
570.6
Red Deer
Brooks
828.4
592.3
Flin Flon
1129
562.2
Sudbury
1028.8
530.8
Sault Ste Marie
1005.5
662.5
Kirkland Lake
1175.2
513.1
Kapaskasing
989.1
525.3
Hawkesbury
1066.7
541.3
1308.5
515.8
Thetford Mines
966
575.6
Cowansville
1040.2
632.4
Chicoutimi-Jonquiere
1025.4
558.9
Asbestos
992.6
533.5
Saint John
958
646.6
Grand Falls
964.5
553.2
Edmundston
963.8
597.9
Dalhousie
894.7
503.6
Bathurst
842.6
544.7
1020.4
609.1
Sydney
Mortality Atlas of
Canada, 1984
974.7
612.9
Timmins
Sydney Mines
Data source:
882.5
459.5
Val-d'Or
Selected
Resource
Reliant
Canadian
Communities
1023.3
452.8
Chilliwack
Age
Standardized
Mortality Rates:
Males and
Females
963.9
917.9
1163.9
556.9
Springhill
965
429.3
Stephenville
1001.4
Grand Falls
519.3
Cornerbrook
523.7
974.9
903.6
504.4
Canada
0
200
400
Canada females
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600
881.6
800
1000
1200
1400
Canada males
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The ‘rural’ population health landscape
• Declining
primary resource reliant economies
• Societal transition, including changing demographics
• Less access to public goods
• Hazardous occupations
• Unrecognized or unmonitored physical environmental
concerns
•Social cohesion and resiliency
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•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.
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This is a combination of natural population change and net outward migration
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The ‘rural’ population health landscape
• Declining
primary resource reliant economies
• Societal transition, including changing demographics
• Less access to public goods
• Hazardous occupations
• Unrecognized or unmonitored physical environmental
concerns
•Social cohesion and resiliency
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New Rural Economy Dimensions (www.nre-concordia.ca)
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
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Rural Canada in the context of social determinants of health
(Reference: Bartlett L Guernsey J, 2005)
Social determinant
Income and social
status
Employment and
working conditions
Rural context
-
Education
-
Housing
-
Health care services
-
Social environment
-
Substantially lower average incomes
Higher proportion of social assistance
Higher unemployment
Higher underemployment – part-time and seasonal
work
More hazardous working conditions and exposures
to toxic substances, particularly in resource jobs
Lower levels of formal education (fewer high school
diplomas, fewer university degrees)
Lower levels of literacy
Higher proportion of substandard housing,
particularly for aboriginal populations
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
Stronger social networks
Strong sense of community
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Access to physicians by latitude
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The ‘rural’ population health landscape
• Declining
primary resource reliant economies
• Societal transition, including changing demographics
• Less access to public goods
• Hazardous occupations
• Unrecognized or unmonitored physical environmental
concerns
•Social cohesion and resiliency
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Fatality rates by Major Industrial
Sector, 1993-1995, Canada
(Pickett W Hartling L Brison R Guernsey J Fatal work-related farm injuries in Canada, 1991-1995.
CMAJ 160, 1843-1848)
80
70
Mining
60
Logging and Forestry
Construction
50
Agriculture
40
Manufacturing
30
Finance
20
10
0
1st Qtr
annual rate per 100,000
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• 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
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Agricultural Fatalities by class of injury, gender and
age group (1990-1996)
Machinery
Males
Females
Non-Machinery
Males
Females
48
10% 15
36%
8
15-59
227
49% 24
24%
118 61% 11 58%
60+
187
41% 3
7%
67
Total
462
100
100
193 100
Age
Group
0-14
42
4%
4
35% 4
21%
21%
19 100
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 2003
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Occupation Disrupted: Impacts, Challenges,
Coping Strategies
Smith L Townsend E Guernsey J Journal of Occupational Science April 2003 vol 10 (1), 14-20
“six months after I was home, my wife left and took the
kids. I just about went crazy”
“I had nothing.. No insurance of any kind”
“My insurance policy was inadequate.. I was eligible for
$1000..”
“friends … planted sprayed and harvested crops my
first year after the accident”’
Most startling to learn that farmers are ineligible for
employment insurance and disability pensions if
have assets
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The ‘rural’ population health landscape
• Declining
primary resource reliant economies
• Societal transition, including changing demographics
• Less access to public goods
• Hazardous occupations
• Unrecognized or unmonitored physical environmental
concerns
•Social cohesion and resiliency
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Nitrogen oxides emissions in Canada -
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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
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Funding:
CIHR Centre for Research Development on Physical and
Social Environmental Factors and Their Influences on
Health - $2.4 million (2004-2011)
Mission:
To enhance our understanding of physical and
socioeconomic environmental influences on health and the
capacity of rural Atlantic Canadians to respond to these
challenges.
Eight Atlantic Academic Institutions:
Dalhousie University, Memorial University, Mount Allison
University, Saint Mary’s University, Nova Scotia Agricultural
College, University of Prince Edward Island, University of
New Brunswick, NSCC Centre of Geographic Sciences
Lead Government Partner:
Environment Canada Atlantic Environmental Sciences
Network
Our Objectives:
1.
2.
3.
4.
Provide a locus for exchange of ideas between
researchers, government agencies, concerned citizens,
and rural Atlantic Canadians
Foster trans-disciplinary research interactions and
initiatives in Atlantic Canada
Create enhanced training opportunities for students
and rural health professionals in Atlantic Canada
Include research on innovation uptake and
implementation by policy makers and health service
providers in Atlantic Canada
Our Thematic Research Areas:
1.
2.
3.
4.
Resource Reliant Communities
Social Cohesion and Community Resiliency
Rural Occupational and Environmental Health Hazards
Special Rural Populations
Current 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
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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