RURAL/REMOTE

Citizen voices critical for rural health care: researchers

By Fran Yanor, Local Journalism Initiative Reporter

Several rural health groups are calling for the creation of citizen health councils as a way to genuinely involve rural patients in healthcare policy-making.

“Citizen patients want a voice in their healthcare system,” said Dr. Jude Kornelsen, co-director of the Centre for Rural Health Research at UBC. “We don’t have a codified or systematic way of providing a mechanism for real citizen patient voices in healthcare planning.”

A recent review by Kornelsen’s group laid out the rationale and benefits of citizen health council models around the world and a survey of rural residents showed enthusiasm for rural health councils.

According to the review, citizen health councils are formed “to improve decision-making and population health outcomes, to ensure public trust and accountability, and to promote inclusivity, community ownership and community empowerment.”

Dr. Ray Markham, executive director of the B.C. Rural Coordination Centre, which advocates for rural health in BC, likens the intention behind citizen health councils to the First Nations approach of ‘nothing about us, without us.’

“Whenever you get into equity in conversations, often people will want to speak for somebody,” said Markham, who also practices family medicine in Valemount. “But fundamentally, we really need to explore how the people who are affected, or where the inequity sits, have a meaningful voice in shaping what happens.”

Genuine citizen-patient engagement is more than a board or council position he says.

“You can have 10 people sitting around a table and one or two patients bringing a patient perspective,” Markham said. “But some of these groups will have a very strong infrastructure sitting behind them.”

Unless the imbalance is recognized and corrected, the patient’s voice could get lost in the policy mill.

Accountability is essential, said Kornelsen.

“How well do they work in achieving the citizen patient voice?” Kornelsen asks. “There’s some things that we have to be thinking mindfully about, like ensuring that it’s not just a tick-box exercise, that it is authentic voice, and that it represents all spectrums.”

The BC Rural Coordination Centre funds groups to pull together that collective perspective and has convened a citizen group to bring the community perspective to provincial government-level conversations, said Markham. He said the Centre for Rural Health Research is doing the same thing, but also looking at how to change the system.

A survey of 180 rural B.C. communities in 2019 by the Centre for Rural Health Research revealed significant interest in citizen health councils.

“They know what’s happening on the ground,” said Kornelsen. “And from the most important perspective, which is those receiving health care.”

More than 1,900 rural residents identified concerns which might be constructively addressed by meaningful citizen engagement. One pressing concern identified by some was the need for greater or more consistent access to primary and specialist health care.

People understand a community under 10,000 won’t have specialist and sub-specialist care, said Kornelsen. “They get that, but why is the first recourse leaving the community to access care?”

Some participants suggested specialists could operate rotating clinics with reduced hours in different communities. Others wondered if some specialist consultations could be done in the community from the family physician’s office via telephone or video chat.

Other top issues were cost and transportation. For instance, a surgical patient may have to travel to a regional centre or even Vancouver for a pre-operative consultation, return again for the actual operation, then go back a third time for a post-operative follow-up.

“People spend more than $2,000 per person, on average to leave their community,” said Kornelsen. “It might be okay for people who can afford it, but there’s a lot of people who can’t.”

Edward Staples, president of the BC Rural Health Networks, says it’s about honouring the community perspective.

“It’s really a matter of bringing together the health care providers, the elected officials and the end community members to find ways to work together to improve the services in a particular community.”
https://www.therockymountaingoat.com/2020/06/citizen-voices-critical-for-rural-health-care-researchers/

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Rural residents spending $2,200 in travel per medical condition: survey

By Fran Yanor, Local Journalism Initiative Reporter

Rural B.C. residents who travelled outside their community for medical care paid an average of $2,200 in out-of-pocket expenses for visits related to a single health condition between 2017 and 2020, according to a survey by UBC’s Centre for Rural Health Research.

“When I actually saw the number, that blew me away,” said the Centre’s co-director and UBC associate professor Dr. Jude Kornelsen. “That’s a lot of money.”

The findings are no surprise to Valemount resident Bryan Hannis, who estimates his family has incurred tens of thousands of dollars in expenses over the years.

“All of my tests and my wife’s tests are out of town and some of them are multiple appointments per year,” said Hannis.

Whereas people living in urban centres can reasonably access non-urgent care such as specialists’ consultations and diagnostic testing, those living in rural areas often need to travel long distances to receive similar care, according to the Out-of-Pocket Costs for Rural ResidentsWhen Traveling for Health Care report.

“The disproportionate impact of being rural and trying to access specialist services is huge,” said Kornelsen. “Most people who are urban-dwelling don’t realize this.”

Survey participants from across the province (including 26 per cent from the north) were asked to estimate their out-of-pocket spending for one health issue requiring travel outside their community at least once between 2017 and 2020. Seventy-five per cent said they’d traveled between one and six times for a single health issue, racking up expenses for transportation, food, accommodations, lost wages, childcare, as well as, costs for a travel companion.

The highest costs were reported by patients living in remote locations and those requiring treatment for chronic conditions.

To read the full article, click on: https://www.therockymountaingoat.com/2020/08/rural-residents-spending-2200-in-travel-per-medical-condition-survey/


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S. Ashleigh Weeden
July 8, 2020

The COVID-19 pandemic has exposed the “place blindness” that causes policy-makers to overlook the specific needs and potential of rural Canada.The first six months of this new decade have forced us to reconsider nearly everything: how we work, how we connect with each other and, with increasing urgency, the purposes, functions and futures of the structures and institutions at the core of our social and economic systems. The COVID-19 pandemic and the widespread reckoning with racism brought about by the latest resurgence of the Black Lives Matter movement are both happening in the shadow of a global climate emergency. The confluence of crises has forced our collective hand. These are not polite invitations to consider incremental change, they are radical disruptions that are shaking us by our collective shoulders and asking: What will you do now?

If we have learned anything in the first half of 2020, it’s that our public institutions and policy machinery can be far more nimble than we sometimes give them credit for. We’re doing things we didn’t think we could do before — from the universal income support of the Canada Emergency Response Benefit to a massive shift in public consciousness and engagement with anti-racism movements. Many of our assumptions about the way we do government can and should be re-examined. It’s not so much that the convergence of multiple crises has broken our socio-economic systems, it’s that they have exacerbated the cracks and crevices that were already there, with the kind of acute clarity that means they can no longer be ignored.

One such increasingly volatile fault line is the rural-urban divide. The tendency toward conflict between rural and urban communities, despite their many interconnections, long predates this unexpectedly chaotic year. Contributors to Policy Options noted the growing disconnect between rural and urban Canada in 2017. In 2018, the economic geographer Andrés Rodríguez-Pose drew direct links between such divides and their socio-economic and political consequences by calling the geographic distribution of growing populism “the revenge of the places that don’t matter.” Whether it’s the glaring ineffectiveness of the way we approach investments in rural broadband, the social and economic pressures linked to “disaster gentrification” or renewed awareness of the centrality of rural places in providing critical resources like energy or food (and the racialized dynamics of the labour of some parts of Canada’s agri-food system) — 2020 has surfaced serious sinkholes in Canadian rural policy.

Curious about the following questions? 
– Do we value rural places?
– Is there a “right to be rural”?
– Who gets to decide what happens next?
– Realizing the radical potential of rurality
Read more by clicking on:  The COVID-19 pandemic has exposed the “place blindness” that causes policy-makers to overlook the specific needs and potential of rural Canada.

RURAL-URBAN DIVIDE

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Rural Site Visit Project

Two and a half years after its inception, the RCCbc Site Visit project has reached its half-way point with over 100 rural BC communities visited.

For more information, click on: RCCbc Rural Site Visit Project

The Rural Site Visits Project engages health partners (health professionals, health administration, policy makers, community, and academic institutions) within each community visited. From these meetings, information is collected, anonymized and analyzed into themes to identify the major themes affecting health care delivery in BC rural communities. 

As a commitment to the communities, RCCbc is providing bi-annual Community Feedback Reports to provide updates on project progress and share learnings from innovative solutions found throughout the visits. Please note that each report encompasses feedback from all rural communities engaged since the beginning of the Project.

June 2017 – December 2018 (PDF) Report #1
June 2017 – June 2019 (PDF) Report #2
June 2017 – December 2019 (PDF) Report #3
June 2017 – May 2020 (PDF) Report #4

101 Rural Subsidiary Agreement (RSA) communities representing all corners of the province have been visited, more than 350 meetings with the Health Care partners recorded and over 4,000 pages of valuable transcribed feedback generated. 

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New UBC chair determined to improve health care for B.C.’s rural residents


BC Gov News + Vancouver Sun
Cheryl Chan – January 21, 2017
If you have a stroke in Vancouver, you can be at Vancouver General Hospital in less than half an hour, receiving highly specialized medical care from on-site neurologists. 
But what happens if you have a stroke in Dease Lake, a community of about 450 almost 1,000 kilometres northwest of Prince George, or you suffer a traumatic injury in the Eastern Kootenays that requires a higher level of care beyond what the local hospital can provide?
These are the questions Dr. Dave Snadden is keen to tackle in his new role as founding chair in rural health at the University of B.C. “How does that patient get access to the same degree of expert care that would give us a good outcome?” said Snadden. “That, to me, is the challenge of rural health.”
The Rural Co-ordination Centre of B.C., which works on behalf of the Joint Standing Committee on Rural Issues (a partnership between the ministry of health and Doctors of B.C.), has been advocating for the creation of the rural health chair because it saw the need for rural areas to have a champion.
Co-ordination centre communications manager Sharon Mah noted 25 per cent of British Columbians live in rural areas, yet only 15 per cent of doctors practice in rural settings: “They’re under-represented,” she said.
Studies also show people in rural communities tend to have poorer health outcomes than urban dwellers.
https://vancouversun.com/news/local-news/new-chair-at-ubc-takes-on-rural-health

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