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A longitudinal review of rural health policy in Ontario
Abstract
This article examines the Ontario Ministry of Health policy response to persistent rural health challenges over the last 5 decades. Rural health policy responses are grouped into policy “paradigms” for purposes of this high-level analysis. Key policies are assessed in terms of progress, limitations, and lessons learned for policy-makers and rural health leaders.
... Global research has highlighted significant resource challenges associated with delivering care to older people in rural settings when compared with urban regions. Rural regions have lower levels of access to health, specialist and support services, and have experienced greater levels of centralisation, withdrawal and standardisation of health and aged care services, which has led to more regionalised service delivery approaches that can reduce health and aged care service availability in rural regions [23][24][25][26][27]. Additionally, rural health providers experience financial pressures associated with service delivery to geographically isolated rural regions [25], and challenges in recruiting and retaining an adequate and qualified rural health and aged care workforce [28]. ...
... However, there is little international evidence relating to how a 4Ms approach to age-friendly care can actually be used to guide the design of rural models of age-friendly integrated care at a regional level. This is particularly important in the context of continued centralised, regionalised approaches to rural primary and geriatric care delivery [26,27]. Specifically, there is a need to identify the processes, activities and outputs that support or inhibit the co-design of an integrated model for age-friendly care in rural contexts, in order to understand some of the potential enablers and barriers to the co-design of age-friendly care models in rural settings. ...
In the context of increased rates of frailty and chronic disease among older people, there is a need to develop age-friendly, integrated primary care models that place the older person at the centre of their care. However, there is little evidence about how age-friendly integrated care frameworks that are sensitive to the challenges of rural regions can be developed. This protocol paper outlines a study that will examine how the use of an age-friendly care framework (the Indigo 4Ms Framework) within a co-design process can facilitate the development of models of integrated care for rural older people within the Upper Hume region (Victoria, Australia). A co-design team will be assembled, which will include older people and individuals from local health, aged care, and community organisations. Process and outcome evaluation of the co-design activities will be undertaken to determine (1) the processes, activities and outputs that facilitate or hinder the co-design of a 4Ms integrated approach, and (2) how the use of the Indigo 4Ms Framework within a co-design process contributes to more integrated working practices. This protocol contributes to the development of a field of study examining how rural health and aged care services can become more age-friendly, with an emphasis on the role of co-design in developing integrated approaches to health care for older adults.
... Several studies have found that increased travel time affects patient-care decisions as it relates to their cancer treatment (18,23,24) and more specifically when travel for treatment was longer than 1 hour, there was an associated increase in unmet patient needs (25). In a longitudinal review of rural health policy in Ontario, other rural health challenges included lower population health status scores and difficulty in recruiting and retaining healthcare professionals (26). The cancer care gradient across Canada is an important population health determinant (27); rural residence negatively affects access to treatment and decisions regarding treatment plan (28). ...
The aim of this review is to discuss the current health disparities in rural communities and to explore the potential role of telehealth and artificial intelligence in providing cardio-oncology care to underserviced communities. With advancements in early detection and cancer treatment, survivorship has increased. The interplay between cancer and cardiovascular disease, which are the leading causes of morbidity and mortality in this population, has been increasingly recognized. Worldwide, cardio-oncology clinics (COCs) have emerged to deliver a multidisciplinary approach to the care of patients with cancer to mitigate cardiovascular risks while minimizing interruptions in cancer treatment. Despite the value of COCs, the accessibility gap between urban and rural communities in both oncology and cardio-oncology contributes to health care disparities and may be an underrecognized determinant of health globally. Telehealth and artificial intelligence offer opportunities to provide timely care irrespective of rurality. We therefore explore current developments within this sphere and propose a novel model of care to address the disparity in urban vs. rural cardio-oncology using the experience in Canada, a geographically large country with many rural communities.
... Este fenómeno se fortalece con la centralización de los diferentes programas de salud que se emiten desde el gobierno central puesto que, como reconocen los participantes de las entrevistas, los lineamientos son poco flexibles y limitan el accionar de las entidades territoriales. Sobre esto es importante considerar que, para la definición de los problemas, se deben tener en cuenta las comunidades como parte del éxito para la generación e implementación de acciones de salud, pues la mayoría de las soluciones innovadoras de salud rural provienen de "abajo hacia arriba" (a lo queSabatier (1986), llama como Bottom -up) y no "de arriba hacia abajo"(Top-down), por lo que es necesario propiciar un liderazgo local(Whaley 2019). ...
The most recent demographic changes have brought new organizational dynamics of social, political, and economic systems, which consequently have accentuated the gaps that exist between rural and urban areas. Generally, the government´s response to health problems in rural areas is more applicable to the total population, rather than considering the particularity of people living in dispersed conditions. Objective: To identify the morbidity and mortality profile in rural and urban areas of Antioquia and evaluate the health response in rural areas of the 2016-2019 Departmental Health Plan. Methodology: A sequential mixed study with two components. The first is a retrospective, descriptive, cross-sectional design, ecologic study (epidemiological) aimed at identifying and comparing the morbidity and mortality profiles of the rural population through the use and analysis of mortality records from 2010 to 2014 adjusted using the Global Burden of Disease 2010 (GBD2010) methodology and the perceived health variable of the Estudio Nacional de Salud Bucal IV 2014 (ENSAB IV 2014). As a part of this first analysis, standardized rates for urban and rural areas were compared for mortality and frequencies were compared for morbidity. The second is an evaluative study composed of a documentary analysis of the health plan and its annexes (Annual Operational Investment Component 2016-2018) as well as semi-structured interviews with the executors of the Plan. Results and conclusions: The results of the study demonstrate that there is a problem concerning the availability, quality, and use of data when evaluating rural conditions (rurality). Furthermore, the investigation reaffirms that there are differences in morbidity and mortality in terms of the prevalence between urban and rural areas. Lastly, it is evident that the variable of “rurality” apart from having multiple definitions, has not been included in the formulation of health policies to the extent one would expect as the population in the rural sector should be accounted for in the 2016-2019 Departmental Health Plan.
Background:
Premature mortality is a meaningful indicator of both population health and health system performance, which varies by geography in Ontario. We used the Local Health Integration Network (LHIN) sub-regions to conduct a spatial analysis of premature mortality, adjusting for key population-level demographic and behavioural characteristics.
Methods:
We used linked vital statistics data to identify 163,920 adult premature deaths (deaths between ages 18 and 74) registered in Ontario between 2011 and 2015. We compared premature mortality rates, population demographics, and prevalence of health-relevant behaviours across 76 LHIN sub-regions. We used Bayesian hierarchical spatial models to quantify the contribution of these population characteristics to geographic disparities in premature mortality.
Results:
LHIN sub-region premature mortality rates ranged from 1.7 to 6.6 deaths per 1000 per year in males and 1.2 to 4.8 deaths per 1000 per year in females. Regions with higher premature mortality had fewer immigrants and higher prevalence of material deprivation, excess body weight, inadequate fruit and vegetable consumption, sedentary behaviour, and ever-smoked status. Adjusting for all variables eliminated close to 90% of geographic variation in premature mortality, but did not fully explain the spatial pattern of premature mortality in Ontario.
Conclusions:
We conducted the first spatial analysis of mortality in Ontario, revealing large geographic variations. We demonstrate that well-known risk factors explain most of the observed variation in premature mortality. The result emphasizes the importance of population health efforts to reduce the burden of well-known risk factors to reduce variation in premature mortality.
Today, 25% of Canadians live in rural and remote parts of Canada. The evidence is that these Canadians do not enjoy the same health status as citizens living in more urban settings. This article explores four persistent healthcare challenges: population demographics, place, professionals, and public participation. By exploring solutions that some rural communities have used to address these challenges, this article aims to provide insights into lessons that have been learned that they may be considered and potentially applied to both rural and urban environments in the interest of better healthcare for all.
Rural health policy is the laws, regulations, rules, and interpretations that benefit or affect health and health care for rural populations. This paper examines how rural health policy is viewed in the broader field of public policy, discusses the role of advocacy in developing rural health policy, and suggests ways to make that advocacy more effective. This paper critically reviews policy statements and policy positions taken by key opinion leaders and the leading stakeholders in rural health policy to determine how advocacy for rural communities is expressed. It is not clear how the rural health advocacy coalition is viewed by the professional policy world or the public: as an issues network pressing for fair and equal treatment or as an interest group seeking special advantages. This paper also explores the types of claims that rural advocates make in the specific context of Medicare policy to determine to what extent those claims reflect a central theme of fairness and inclusiveness in national policies versus claims that benefit special interests. The paper suggests that the rhetoric of rural advocates can be better structured to advocate for policies on the basis of a progressive sense of fairness.
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