Rural poverty in Canada is part of rural poverty worldwide, albeit Canada is among the richer countries in the world.From Bahrain to Qatar: These are the 25 richest countries in the world Canada is 21st of 25. Published by USA Today on November 28, 2018, retrieved on May 5, 2019
Access to care
Nursing Government
Nurses have been self governing within the province of Ontario since 1963.CNO, 2012 The College of Nurses (CNO) assure that all nurses within the province are registered through the CNO and that all nurses meet the requirements established by them. Requirements are based on knowledge and expertise of practice and that all nurses work within their scope of practice. Self governing occurs when the body of professionals are governed by members of its own profession.Canadian Nurses Association, 2007 Nurses in Ontario have the responsibility to work according to professional standards and Code of Ethics.CNA, 2007 Nurses can contribute to the making of regulations and standards by providing knowledge from evidence based practice, as well as theoretical knowledge to help ensure best practice when providing quality care. Regulatory bodies are responsible for ensuring that all who practice nursing are competent and continue to build on their skills through continuity of education and skill development. “Regulatory bodies develop and maintain standards of nursing practice that specify the level of performance expected of registered nurses to provide safe, competent and ethical care".CNA, 2007, p.2 Nursing Practice standards are put in place to provide the public the same quality of care despite location. The CNO is responsible for providing quality care to the public including making healthcare accessible.
Barriers to accessing health care
For those living in rural Canada, they may face various challenges when trying to access health care. Difficulties which rural areas experience when accessing health care include long distances between health services, lack of transportation, increase amount of elderly, fewer health care providers, and limited awareness of resources available.Crosato & Leipert, 2006 To receive Federal funding from the government, the Canada Health Act acknowledges that five principles must be met, these include universality, accessibility, comprehensiveness, portability, and public administration.Wilson, Rosenberg, 2004 For those living in rural communities, these five principles are not always met. With 90% of Canada identified as geographically rural, and approximately a quarter of the population are dwelling within rural areas with fewer than 10,000 people, this is a concern when identify health barriers.Crosato & Leipert
Health care is considered accessible when within a 30-60 minute drive in rural settings, and emergency vehicles are considered accessible when there is less than a thirty-minute drive.Glazier, Gozdyra, Yeritsyan, 2011 This is a concern in emergency situations as an individual has a long wait time before being provided medical attention. Transportation is a significant factor that is a barrier to accessing health care. In rural areas an individual may have to travel great distances to seek medical attention, road quality may be very poor, weather conditions effecting driving, and rural areas seldom have access to public transportation.Arcury, T. A., Preisser, J. S., Gesler, W. M., & Powers, J. M. (2005). Access to transportation and health care utilization in a rural region. The Journal of Rural Health, 21(1), 31-38. The elderly have the greatest need for transportation services, a challenge to this is services is they may have to be booked a week in advance. Also, with the baby boom generation, there will be an increasing number of elderly needing access to health care. A large percentage of people over 65 have a number of comorbidities, and need regular visits to a family doctor, the cost of regular transportation to a healthcare provider can be substantial. For many living in rural poverty, financial difficulties impede a person from being able to own a vehicle.Halseth & Ryser, 2010 The need for transportation to health care will only decrease when there is greater availability to health care programs, this involves bringing more health care providers to rural areas.
Other factors affecting rural poverty and accessing health care are lower socioeconomic status. Although the Canada Health Act provides everyone with access to health care without financial obligation, people of lower socioeconomic status typically had lower education level and were less likely to seek medical advice from a health care professional.Harrington, Wilson, Rosenberg, Bell, 2013 Other health risks associated with low income and low education are an increase in high risk behaviors leading to poor health including smoking, obesity, and substance abuse specifically alcohol.Cutler & Llera-Muney, 2009 People of higher income have means to pay for resources which could improve health, such as weight loss programs, gym memberships, smoking cessation programs, rehabilitation facilities where as people of lesser income are unable to pay for privately owned health enhancing programs. The low income families continue with the high risk behaviour despite limited finances this includes smoking and the price of cigarettes. People of lower socioeconomic status are less likely to look long term at their health compared to higher income families who would be more likely to contribute to program to benefit their health. Those of higher socioeconomic status are more likely to think of long term health and take preventative measures to promote good health.
Resource accessibility
Rural areas struggle with being able to provide resources to people within their community to help reduce the challenges of social poverty. Many living within poverty need assistance from food shelters, homeless shelters, drug and alcohol abuse programs, counseling programs, and women’s shelters. Many of these programs in rural communities are organized by volunteers which may have little or no training, and the buildings which the programs are run from may be lacking in suitable infrastructure. There may be limited funding available to these programs which effects staffing and resources which can be provided to those seeking assistance. Individuals at risk for living in poverty are those with mental health issues, disabilities, single mothers, individuals suffering from addiction, and immigrants unable to speak English. This is challenging as resources established to support disadvantaged groups are closing as a result of little funding and inability to effectively support these groups. The individuals seeking the assistance are left to cope on their own. Community donations and volunteers play a large role in community support remaining open to the public in rural setting.
Physician accessibility
The Canadian public feel that accessing health care is perceived as poor, people wait longer periods of time to see physicians.Wilson &Rosenberg, 2005 There are increasing number of health practices being privatized which decreases the accessibility for those living in rural poverty. There a few physicians available to support this population. With around 20% of Canadians residing in rural Canada, only 8% of the physicians practice within this area. Lacking in rural areas is the number of health specialists accessible to Canadians.Jennissen, 1992 An average of 4 million Canadians go without a family physician.Randall, Crooks, & Goldsmith, 2012 There is also a high physician turnover rate in rural areas due to increased workload, geographic and social isolation.Randall et al., 2012 This can be challenging as many individuals who seek specialized care need to have a referral from a family physician. When there is a high physician turnover rate then individuals are having to develop a trusting relationship and provide previous medical history to a new family physician. This beings challenges as some relationships take years to develop trust with a family physician, and a bad experience with one can bring challenges when having to transfer to a new physician.
“Rural communities are understood as places with small populations, limited material and financial resources, and a heightened vulnerability to health service and health human resources shortages as a consequence of their distance from urban centres”.Randall et al., 2012, pg.2 With rural areas having a high population of elderly an increasing number of individuals living with one or more chronic illness, the need for rural area physicians and specialists are rising. Chronically ill patients account for over half of family physicians visits. In Canada, individuals who need to see a specialist wait an average of four weeks to three months.Harrington, Wilson, Rosenber & Bell, 2013 This increases health risk for those living in rural poverty, as there is a greater difficulty accessing health care. There is an increase in number of those living with chronic illness, greater elder population, and fewer health care professionals available in rural communities. For those living in rural poverty, the Canada Health Act ensures that health care is provided at no financial expense including hospital care, surgical procedures, dental surgeries, primary care doctors, and specialists are covered through provincial health insurance plans.Harrington, Wilson, Rosenberg, & Bell, 2013 This enables individuals to receive care despite being unable to pay for care.
Vulnerable populations
Poverty among rural Canadians is a continuing issue within Canada. Although rural living can be challenging for any population, there are several groups in which are considered more vulnerable to poverty. Several contributing factors such as employment, education, geographical location, cost of living and low income are definite issues among these specific groups. With that being said, many of these populations are finding themselves struggling to keep above the poverty line.
Single-parent families
Lone families or single parent families are incredibly susceptible to poverty in Canada, especially those who reside in rural areas. Although single male parent families are at risk, families with a woman as the only parent are at a much greater risk. Women who are raising their families on their own are at a huge risk for poverty among Canada. Women in rural Canada are at disadvantage for employment opportunities due to the lack of jobs within the community. Formal education is also a challenge for rural women because of the general low income status and high cost of education. Without formal education, rural women often cannot find good paying jobs that provide stability and benefits to support their families. In order to find affordable housing for a single parent income, one must often look outside of town to more remote areas. Although housing is cheaper, the employment opportunities decrease; causing women to look for employment closer to town or within the community. By having to travel to work, vehicle costs or alternative transportation costs are increased. Wages in rural Canada are lower than those in urban areas, which contributes to the overall lower income and poor income status among these families. For women supporting a family, the poor wages, low employment rate, high cost of living and lack of financial support are the risk factors in which increase the incidence of poverty among this population. This creates a huge expense for travel and transportation, as well as child care. If the children in the family attend school, transportation to school is often limited to those residing in remote areas. Providing or paying for alternative transportation for children to attend school is also an additional cost.
The elderly