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This guest blog provided by Dr. Hazel Lynn, Medical Officer of Health, Grey-Bruce Health Unit

Generally, rural residents of Canada are less healthy than their urban counterparts. They have higher overall mortality rates and shorter life expectancies and are at elevated risk for death from injuries such as motor vehicle collisions and suicide. They are also disadvantaged for cardiovascular disease and diabetes. - Canadian Institute for Health Information

There is a clear urban-rural divide when it comes to health status of Canadians. The ten healthiest regions across the country are all metropolitan; the top eight are located in or around the metro areas of Toronto and Vancouver and the remaining two in the Calgary and Quebec City. Conversely, the ten sickest regions are located in rural and isolated areas of Quebec, Ontario and Saskatchewan.

In 2013, the National Research Council and Institute of Medicine in the United States published a report on life expectancy and well-being in that country. Called, “Shorter Lives, Poorer Health” the report concluded: “Government investment in public health infrastructure and attention to the foundational drivers of poor health such as poverty and social isolation should be the major areas of discussion as we work towards achieving a healthier population.”

Unfortunately, recent changes in the funding for local Public Health Units across Ontario provides increases in funding to the urban areas while decreasing funding for the rural, northern and sparsely populated areas. This new, so called, ‘equity funding formula’ serves to increase the inequity between the rural and urban residents.

The choice of equity factors considered, the accuracy of the data and the weighting of those criteria are subjective. Indicators such as the Ontario Marginalization Index (dimensions that contribute to the process of marginalization: residential instability, material deprivation, dependency and ethnic concentration) is problematic as it relies the long form census data which is no longer available. Estimates of the aboriginal population and non-census populations are also inaccurate. Geography affects not just distance to services but also to food, education and job opportunities which affect our health more than the availability of hospitals and clinics. Urban populations, particularly those with new immigration and English as a second language, are weighed heavily in the funding formula. There is no equity in a process that systematically increases funding to the healthiest part of the province at the expense of the least healthy and most disadvantaged.

When introducing the Public Health Act to the British Parliament in 1875, Benjamin Disraeli stated that public health is the foundation for “the happiness of the people and the power of the country. The care of the public’s health is the first duty of a statesman.”

Sources:

J. Filipp, Z. Gallinger, A. Motskin; Do You Live in One of the Unhealthiest Places in Canada?, The 10 and 3 (online), September 2015, at: http://www.the10and3.com/do-you-live-in-one-of-the-unhealthiest-places-in-canada/

Department of Health and Social Security (U.K), Report of the Working Group on Inequalities in Health, (Black Report), 1980 at: http://www.sochealth.co.uk/national-health-service/public-health-and-wellbeing/poverty-and-inequality/the-black-report-1980/

S. Woolf, L. Aron, Shorter Lives, Poorer Health, Board on Population Health and Public Health Practice, National Research Council and Institute of Medicine, 2013, at: http://www.nap.edu/catalog/13497/us-health-in-international-perspective-shorter-lives-poorer-health R. Bayer, S. Galea, Public Health in the Precision-Medicine Era, The New England Journal of Medicine 373.6, August 2015, at: http://www.nejm.org/doi/full/10.1056/NEJMp1506241

Read the resolution from Grey-Bruce Board of Health opposing the new funding formula in light of the impact on rural and northern health units.

GBHU BOH Resolution 2015-88, Public Health Funding.pdf (913.27 kb)