Rural Health

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The Rural Health issue in the Atlas of Canada has been created at a time when interest in rural health is very high. Unfortunately, it is also a time when both governments at all levels and rural researchers have relatively few resources to adequately describe or analyze rural health. This is partly due to a lack of data and also due to a poorly developed rural health research infrastructure (for example, minimal funding, few research institutes and/or investigators with a focus on rural health).

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Despite the limitations, there are a number of characteristics of rural health that we can draw particular attention to, in addition to those general health indicators that are provided elsewhere in the Atlas. Before we can outline those characteristics we have to deal with the term "rural". What does "rural" mean in the context of rural health in Canada? Of the many definitions that are employed in Canada, only one is used in this section of the Atlas.

• Defining "Rural"

Given this rural designation, the Rural Health issue examines two selected topics.

• The first is perhaps the most important non-medical determinant of health - age. Here, age is explored in terms of our aging population. Are the populations of rural Canada aging faster than in urban Canada?
• The second topic is related to access to health care. Distance is used as a proxy measure of access and examples are provided that deal with the question "How far is it to the nearest physician?"

Defining "Rural"

Census Divisions (CDs)

Census Division is the general term applied by Statistics Canada to represent counties, regional districts, regional municipalities or similar types of legislated areas. These are relatively large geographical units, intermediate in size between municipalities and provinces/territories. In Newfoundland and Labrador, Manitoba, Saskatchewan and Alberta, provincial law does not provide for these administrative geographic areas. Therefore, census divisions have been created by Statistics Canada in cooperation with these provinces for the dissemination of statistical data. In Yukon Territory, the census division is equivalent to the entire territory. For the 1996 Census, Canada is made up of 288 census divisions.

For well over a decade, CDs have been classified in terms of their degree of rurality using what is known as the OECD (Organisation for Economic Co-operation and Development) classification system. A community is defined as rural if its population density is less than 150 people per square kilometre. Using this system, CDs are initially identified using one of the following three designations:

• predominantly urban: less than 15% of the population in the CD lives in rural communities
• intermediate: 15% to 50% of the population in the CD lives in rural communities
• predominantly rural: more than 50% of the population in the CD lives in rural communities

In Canada, Predominantly Rural CDs may be further subdivided into the following categories:

• metro-adjacent: rural CDs that are adjacent to metropolitan centres
• non-adjacent: rural CDs that are not adjacent to metropolitan centres
• northern hinterlands

For more detailed discussions of the OECD classification system and related Canadian geographical definitions of "rural", see Bollman and Biggs (1992) and the articles listed under Rural and Small Town Canada Bulletin in References and Links. Of the latter, the du Plessis et al. (2001) paper is a particularly useful and up-to-date review.