Health equity and rurality in Northern Ontario
Date
2021-07-28
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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.
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Keywords
Health equity, rurality, Northern, remote, access to healthcare, health outcomes, social determinants of health, socioeconomic status