The fact that rural Canadians are less healthy than their urban cousins has been well documented but Canada’s chief public health officer says it is not necessarily because there are fewer health-care facilities in rural areas.
David Butler-Jones from the Public Health Agency of Canada told the Senate agriculture committee study on rural poverty that when Saskatchewan closed 50 small rural hospitals, results were not what many predicted.
Critics predicted deaths and declining health services for affected residents.
He said follow-up research showed that health indicators, particularly death rates, improved across the province generally but “the greatest improvements were in communities that shut their hospitals and the least improvement was in those that kept them open.”
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Butler-Jones said the lesson is that healthiness flows from many factors, including income, education and family and community connections.
“It is not simply an issue of hospitals and access to medical care but the type of medical care that you have access to as well as other factors within the community.”
He said the death rate for rural Canadians in the 20 to 44 year age group is double the urban rate for the same age group. Between ages 45 and 64, the death rate is 20 percent higher.
Jennifer Zelmer, vice-president for research and analysis at the Canadian Institute for Health Information, told the Senate committee that farm-related injuries for those younger than 20 and older than 60 are twice the rate of workplace accidents in other sectors. Deaths from motor vehicle accidents were up to three times higher in rural areas than in urban areas.
And there are lifestyle-related differences.
“Rural Canadians are more likely to smoke, to be exposed to second-hand smoke and to be overweight or obese,” she said.
However, she also said research has found health benefits from living in rural Canada.
“They tended to report lower levels of stress and a stronger sense of community belonging than those in urban areas,” she said.
Butler-Jones said public health professionals have a much broader definition of poverty than economists.
“From our perspective when we talk about poverty, it is not simply an issue of money,” he said. “It is also an issue of poverty of connections, poverty of relationships, poverty of education and poverty of being able to engage and being part of a community.”
Butler-Jones, who is Canada’s chief public health officer, also argued that health policy is not always the greatest influence on the health of Canadians.
He said the same Saskatchewan NDP government that closed rural hospitals also created a welfare policy that maintained children’s health, prescription drug and dental benefits for low-income families even after they moved off welfare and into low-income jobs. It made the move from welfare more attractive.
Butler-Jones called it one of the policies that had “the biggest impact on health in Saskatchewan in the last decade of the last century.”
In most jurisdictions, a move off welfare into the job market means “your income may be only slightly more but you lose those plans for your kids. In Saskatchewan, if you go off welfare you still maintain those plans.”
