Health Disparities for Canada’s Remote and Northern Residents: Can COVID-19 Help Level the Field?

Despite having one of the best public health systems in the world, Canada is a country of extreme disparity in health services. It’s major and most specialized medical services are located within its most highly populated “centres”—which are not “central” at all. Greater Toronto, Canada’s most populated metropolitan area, offers access to wide array of medical services, including hospitals, care facilities, specialized clinics, and treatment centres. But the region is situated between zero and 150 kilometres from the country’s southern border. On the country’s west coast of British Columbia, Greater Vancouver, Canada’s second most populated region offers a similarly wide array of services, hospitals, care facilities, specialized clinics, and treatment centres. This region is situated between zero and seventy-five kilometres from the country’s southern border. The extreme southern location of these services renders them largely inaccessible to the residents living in Canada’s northern and remote areas.

To address this geographic disparity, regional hubs offer a range of specialists and specialized services. For example, the city of Prince George, British Columbia, with approximately 75,000 residents, is located just over 550 kilometres north of the Canada/United States border. The city serves as a regional hub for much of the northern half of the province, offering a hospital, care facilities, some specialized clinics, and treatment centres. However, given the province’s mountainous terrain, access from northern British Columbia communities is extremely limited; furthermore, Prince George offers none of the highly specialized services of Greater Vancouver. The situation is not much better in the northern portions of Canada’s other provinces. The province of Manitoba’s northern portion is comprised primarily of lakes. With few highways, access to and from larger centres is “fly in, fly out.”

Educational programmes for Health and Allied Health care practitioners demonstrate a similarly skewed pattern. Of Canada’s ninety-seven universities, only twelve are located in central, northern, or remote locations. Of those twelve, few offer Medical or Allied Health programmes. The consequence is that the vast majority of Medical and Allied Health practitioners are trained in Canada’s southern, urban centres where they learn urban and metropolitan models of and approaches to practice and leave with limited understanding of, or skills for, practice in smaller or more remote settings. Indeed, northern and rural settings are often portrayed as “challenging,” “lacking,” and “undesirable” (Roberts et al. 2021). It is no surprise, therefore, that few graduates choose to relocate from the urban, southern settings in which they have been trained, to more northern or remote settings. If they do choose to practice in such settings, they quickly find that they are lacking the knowledge and skills they need and must re-orient and learn on the job. The unfamiliar nature of this practice leads many to leave these settings within a year or two.

These challenges of recruitment and retention lead to the third issue impacting disparity of access—namely availability of medical personnel. It is widely known that the simple act of creating “positions” for healthcare services, does not result in personnel that fill those positions. Indeed, northern and remote communities can wait months and even years to fill vacant positions, and when they do, the individual hired may remain in the position less time than it was previously vacant (Cosgrave 2020). In addition, these positions typically cover large catchment areas which can make travel at certain times of the year impossible. Thus while a child living in a northern or remote setting may, in theory, be “entitled” to regular occupational or physical therapy or speech services, access to such services is another matter entirely.

A major initiative to address geographical disparities in access to health services has been advances in telehealth using various forms of telecommunications technology, from telephones (landline or mobile); to home, office, or hospital-based videoconferencing (Agarwal et al. 2020; Evans, Medina, and Dwyer 2018). In general, telemedicine (in this paper the term is used interchangeably with telehealth) reflects what Lovo, et al. (2022), refer to as virtual health technologies to deliver health services.Footnote 2 It enables individuals in smaller, rural ,or remote settings to connect with healthcare providers and specialists in larger, urban settings and enables healthcare providers and health specialists to provide a range of services to rural and remote settings.

While telemedicine has been used for many years for people living in northern or remote areas of Canada, the COVID-19 pandemic “mainstreamed” its use in larger centres as well (Rush et al. 2021). This “mainstreaming” of a previously limited approach to healthcare has resulted in much closer examination of its potential; its strengths, as well as its limitations and drawbacks (Arnold and Kerridge 2020). Three aspects are worth noting.

First, while telemedicine may have helped reduce disparities for residents in northern and remote areas, it appears to disproportionately benefit well-connected, technologically savvy residents; residents who have and understand internet access (Rush et al, 2021). Large areas of northern and remote Canada have limited or no internet access, and many residents lack the knowledge, skills, hardware, or software to use the internet (Leaman and Chung-Tiam-Fook 2020). Though the landscape is constantly changing, a recent Canadian report noted that “[W]hile most Canadian communities do have Internet coverage, in many rural communities, the available speeds are so low that they only allow for a limited number of uses” (Ruimy 2018, 12). This same report suggests reaching target speeds in Canada’s rural areas will take anywhere from ten to fifteen years.

Second, there is a notable lack of training for healthcare practitioners on telemedicine. This is not surprising given that, prior to the pandemic, this approach was largely used by and with those living in northern and remote settings consequently knowledge and skills to enhance its use has not been part of most urban biased medical or allied health curriculums (Malliaras, et al. 2021; Pourmand, et al. 2021). For example, in a recent study of allied health clinicians, primarily physical therapists, only 21 per cent agreed they had been trained to provide telehealth services to people with musculoskeletal conditions (Malliaras et al. 2021).

Third, telemedicine may not be an effective substitute for hands on healthcare treatments, despite innovative interdisciplinary approaches that connect urban healthcare providers with health practitioners in rural and remote localities (Lovo et al. 2022). Some health services, such as physical or occupational therapy, may simply require direct patient contact (Malliaras et al. 2021).

留言 (0)

沒有登入
gif