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Wednesday, 9 October 2013

Rural, remote and northern development: Time for a dialogue on public (health) policy

Over 80% of Canadians live in urban settings with one-third of us living in one of the three big cities.  The urbanization of Canada mirrors what has occurred in many countries, and with migration into denser population centres, policies that support future city growth ranging from healthy built environments, public transportation and telecommunications dominate in provincial and national discussions.  Markets are greater and even using a free market approach supports bringing people to the product over local distribution centres.

All this begs the question of why support rural, remote and northern development? 

If you have not taken a trip lately to resource based communities such as mining, forestry and energy, the more typical rural community has  been planned from day one for being short lived.  Work camps will phase through construction and operation – with the operation designed to harvest the resource in a time limited fashion of years to decades.  Then, the camps can be packed up and rolled on to a new location.  Some secondary services may be provided by nearby communities, but most food, supplies and even the human resources are transported into the community.  Workers are typically on shifts ranging from 2-6 weeks in camp, and then out for 10-30 days.

Workers are usually not residents of the community, their permanent residence remains that of their home community – some transiting from large urban settings. When finished with one resource extraction project, it is merely a matter of moving on to another while retaining permanent residence elsewhere.  Camps are predominately male, 20-45 year olds.  Better run camps are dry and drug-free and strict behavioural expectations can result in immediate expulsion from camp and termination of employment. 

Hence we are challenged with many influences that support growth of cities while potentially ignoring rural areas.  For arbitrary discussion purposes, rural being defined as communities combined with their immediate feeder areas of less than 10,000 population.  Hence some agricultural zones are encompassed within urban areas and not included in this discussion.

The basic question is whether Canada, its provinces and territories should encourage de-urbanization, support sustainability of rural communities, and encourage geographic diversification.  Smaller communities are less efficient, service requirements are expensive, transportation costs are significant and there are many other reasons for not supporting rural growth.  Such conclusions have influenced politicians to give lip service to rural communities while implementing policies that do not support rural sustainability. 

Why is this a health question?  Rural communities typically have poorer health status, tend to indulge in more unhealthy behaviours and have more risk factors, and costs for providing health services are higher.  Our track history on addressing rural health has been poor, perhaps as a lack of commitment.

Prime Minister Harper might be commended for his annual excursions to Canada’s northern communities, as much to demonstrate Canada’s sovereignty in the area as for its benefits in supporting sustainability.  Media seem to enjoy excursions with politicians to “exotic” locations and such efforts lead to considerable publicity, out of proportion to the actual policy support of these areas. 

Fundamentally the question becomes what might be the reasons for developing a rural and remote sustainability strategy.  Here the reader is encouraged to post comments, send emails to drphealth@gmail.com and stimulate dialogue that can define our collective values, and to identify anomalies in policy that undermine rural development strategies. 

Please speak up. 


  1. As a public health physician for a smaller urban city surrounded by vast areas that would meet the above definition of rural areas, I clearly see the impacts of lack of investment or value of the rural life style. A sustainability strategy for these communities is sorely needed.

  2. If 80% of Canadians live in urban settings, ~7million are rural. Ignoring this population would be like shunning the GTA. However, this isn't too politically difficult to do as they are scattered and disconnected.

    As noted, rural Canadians tend to have poorer health status. Viewed as a vulnerable population facing inequity, the impetus for public health action is present. Politically-coerced urbanization might work, but it undermines autonomy and disregards the value of rural living. Anecdotally, I've felt the greatest sense of community in rural areas - let's harness that energy to improve health and well-being from within.