Rural Health - The 5W's and 1H of Rural Health

The 5W's and 1H of Rural Health

The impact of “place” on health has gained increased attention. Does where people live, work, and play make a difference in terms of access and utilization of health services? According to place does matter, in some cases. When discussing the role of place in health as a concept, health status and health behaviors, including health services utilization, are shaped by an aggregate of interacting factors encapsulated in specific geographic locations. Researchers have attempted to compare the health of rural and urban dwellers. In doing so, several questions have been brought to the forefront of this discussion including: (1) Where is rural? (2) Who lives there? (3) What is their health status? (4) Why can we expect these health outcomes? (5) When can we expect real changes? and (6) How can we help? The following sub-sections will provide insight into how these questions have been answered. More specifically, they will discuss variations in rural definitions, socio-demographic characteristics of rural dwellers, health outcomes and determinants of health across rural areas, as well as highlight the impact of policy and research on the improvement of the health of this population sub-group.

Before reviewing these sub-sections lets first consider the reasons for reviewing rural health and exactly why it deserves our attention. The rural communities found in various parts of the world, whether it be Canada, the United States, Australia, the United Kingdom, Africa, or China to name a few, have diverse social, geographic, and economic characteristics. Most rural communities have a larger proportion of elderly and children, with relatively small populations of people of working age (20 -50 yrs) which is resulting in a higher dependency ratio. Rural communities show a health disadvantage for many health measures. Compared to their rural counterparts, rural individuals have poorer socio-economic conditions, have lower educational attainment, exhibit less-healthy behaviors (smoking, alcohol consumption) and have overall higher mortality rates. Simply put, in general, rural individuals are characterized as being less healthy overall in comparison to their urban counterparts. We must try to reduce the health disparities between rural and urban populations and to do this we must conduct specialized research and then implement various policies and programs with the rural population being part of the equation (rural proofing policies or rural lens considerations).

When considering rural health a few key terms must firstly be defined. Geographically, equality suggests that there should be an even distribution of services per head of population. In equity, the equality in relation to need is the most important factor. For example, as a general rule there is a conflict between efficiency and equity in all planning and resource allocation. Where efficiency, is to provide services that maximize health benefit while minimizing cost. For example, when a province or territory is sparsely populated, more health care dollars may be put towards transportation costs. For example, almost 13% of health care spending in the Northwest Territories goes toward medical transportation which is significantly higher than the national average of less than 2%.