Health equity and rurality in Northern Ontario

Abstract

Background: The current climate in Ontario, Canada is one where access to health and social services, healthcare experience and health/social outcomes vary widely across the province. The existing health disparities in Ontario disproportionately affect those living in rural and northern areas. Current indicators used to measure this variability have been developed in the context of health systems in more densely populated areas and may not be relevant for more rural and remote geographic areas. As such, the objectives of this thesis were: (1) to develop a health equity measurement approach specific to Northern Ontario based on input from Northern Ontario health decision-makers, and (2) to operationalize a rurality measurement approach for Northern Ontario. Methods: This two-phase exploratory sequential mixed methods study included a qualitative inquiry followed by a descriptive rurality measurement. The first phase explored health equity measurement in the context of Northern Ontario through in-depth interviews with Northern Ontario health equity key informants. The resulting thematic analysis informed a proposed Northern Ontario health equity measurement approach and the rurality stratifier exploration in phase-two. The second phase included a descriptive analysis using secondary data. The two rurality measurement approaches included were Statistical Area Classification Type and the Remoteness Index. Chi -squared tests for independence were used to assess the level of association between all classification methods including alternate categorization approaches within the Remoteness Index measure. Results: The thematic analysis in phase-one revealed four health equity indicators of relevance to Northern Ontario: infant mortality, overall mortality, perceived health status, and satisfaction of health care received. Furthermore, two stratifiers were identified as uniquely important to measuring health equity in Northern Ontario contexts. These two stratifiers included geographic position (rurality), as well as material welfare (income). The descriptive analysis of the rurality stratifier in phase-two recommended two methods of categorization using the Remoteness Index to consider as a complement or replacement to the Statistical Area Classification Type approach. Conclusion: This exploration of health equity measurement in the context of Northern Ontario proved to be a feasible and productive way to engage key informants in health equity indicator/stratifier selection and recommendation. Certain health equity stratifiers – including rurality – are elusive to define and measure; however, the Statistical Area Classification Type and Remoteness Index should both be considered as rurality measures in Northern Ontario.