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

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

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  1. The Atlantic RURAL Centre:Building Research Capacity to Understand Physical and Social Environmental Influences on the Health of Atlantic Rural CanadiansMANITOBA CENTRE FOR HEALTH POLICYThe Need to Know Team Annual MeetingJanuary 30-31, 2006Dr. Judy Guernsey, Dalhousie UniversityDirector, Atlantic RURAL Centre

  2. Why Rural is Important:Romanow Report, 2002 (citing Statistics Canada) Health indicators are worse for those in predominantly rural Canadian regions

  3. Why Rural is Important:Romanow Report, 2002 (citing Statistics Canada) In the Atlantic provinces, 40% or more of the population is rural

  4. Population Health - Key Elements from The Population Health Template, Health Canada, 2001 • Focus on the Health of • Populations • Address the Determinants • of Health and Their Interactions • Base Decisions on Evidence • Etc Guernsey -- Jan 31, 2006 -- NTK MCHP

  5. 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 - CMA/CA • - Strong MIZ (Commuting flow of >=30%) • RURAL- Moderate MIZ (Commuting flow of 5-30%) • - Weak MIZ (Commuting flow of 1-5%) • - No MIZ

  6. Guernsey -- Jan 31, 2006 -- NTK MCHP

  7. Understanding Rural Health and Its DeterminantsPong, 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. Guernsey -- Jan 31, 2006 -- NTK MCHP

  8. All-cause mortality 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. Guernsey -- Jan 31, 2006 -- NTK MCHP

  9. Cause-Specific Mortality Note: Pattern means SMR statistically significant at p<0.01 Source: Canadian Annual Mortality data 1986-1996 and 1996 Census, Statistics Canada Guernsey -- Jan 31, 2006 -- NTK MCHP

  10. Guernsey -- Jan 31, 2006 -- NTK MCHP

  11. Guernsey -- Jan 31, 2006 -- NTK MCHP

  12. Guernsey -- Jan 31, 2006 -- NTK MCHP

  13. Guernsey -- Jan 31, 2006 -- NTK MCHP

  14. Guernsey -- Jan 31, 2006 -- NTK MCHP

  15. Guernsey -- Jan 31, 2006 -- NTK MCHP

  16. BC Vital Statistics - 1998 by Health Region: Areas with significantly higher mortality Areas with significantly lower mortality Guernsey -- Jan 31, 2006 -- NTK MCHP

  17. 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  18. Resource reliant economies are those that are primarily reliant on natural resource extraction or utilization Guernsey -- Jan 31, 2006 -- NTK MCHP

  19. Guernsey -- Jan 31, 2006 -- NTK MCHP

  20. Age Standardized Mortality Rates: Males and FemalesSelected Resource Reliant Canadian CommunitiesData source:Mortality Atlas of Canada, 1984 Canada males Canada females Guernsey -- Jan 31, 2006 -- NTK MCHP

  21. 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  22. 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. Guernsey -- Jan 31, 2006 -- NTK MCHP

  23. This is a combination of natural population change and net outward migration Guernsey -- Jan 31, 2006 -- NTK MCHP

  24. 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  25. New Rural Economy Dimensions (www.nre-concordia.ca) Guernsey -- Jan 31, 2006 -- NTK MCHP

  26. Rural Canada in the context of social determinants of health (Reference: Bartlett L Guernsey J, 2005) Guernsey -- Jan 31, 2006 -- NTK MCHP

  27. Access to physicians by latitude Guernsey -- Jan 31, 2006 -- NTK MCHP

  28. 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  29. Guernsey -- Jan 31, 2006 -- NTK MCHP

  30. 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) • 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  31. Agricultural Fatalities by class of injury, gender and age group (1990-1996) 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  32. Occupation Disrupted: Impacts, Challenges, Coping StrategiesSmith 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  33. 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  34. Nitrogen oxides emissions in Canada - Guernsey -- Jan 31, 2006 -- NTK MCHP

  35. 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 Guernsey -- Jan 31, 2006 -- NTK MCHP

  36. 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

  37. Our Objectives:1. Provide a locus for exchange of ideas between researchers, government agencies, concerned citizens, and rural Atlantic Canadians2. Foster trans-disciplinary research interactions and initiatives in Atlantic Canada3. Create enhanced training opportunities for students and rural health professionals in Atlantic Canada4. Include research on innovation uptake and implementation by policy makers and health service providers in Atlantic CanadaOur Thematic Research Areas: 1. Resource Reliant Communities 2. Social Cohesion and Community Resiliency 3. Rural Occupational and Environmental Health Hazards 4. Special Rural Populations

  38. Current Centre Research Activities New! • 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

  39. Guernsey -- Jan 31, 2006 -- NTK MCHP

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