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Monday, 12 May 2014

Transportation and Health: A Rural Reply. Part 6

The Transportation and Health series has resulted in several supplementals.  First was a distinct push back from rural Canada, and rightly so.  With major themes like abandoning the single passenger vehicle for taking public transit, active transit and mass transit, the reply was that just doesn’t work where services aren’t provided and distances are too far.  

There are 33 census metropolitan areas in Canada, dwelling locations for 21.5 of Canada’s nearly 34Million people.  The smallest CMA being Peterborough at just over 115,000 people.  That leaves about 1/3rd of Canada living in communities of a size where convenient public transit may be questionable.  Hence the accusations of an urban bias are likely justified.

Just under 20% of Canada lives in “rural” areas as defined as outside a population centre and less than 1000 people and less than 400 persons per square kilometer. Census areas are defined by populations greater than 10,000 of which there are 114 smaller than Peterborough, and home to some 4.3 Million persons .

Whether you live in Whitehorse, Val D’Or, Yellowknife, Prince George or Elliot Lake – one shares a commonality of a midsized community with many resources, but long commutes to major urban centres. 

One of those key needs to commute is rapidly becoming specialized health services.  Anyone living in rural areas will speak about the logisitics of arranging to see a specialist, which may require a multiple day commute, only to have a 30 minute chat.   Or to accommodate families, drivers or friends who accompany someone for interventional treatment such as radiotherapy, surgery or even to deliver a baby.  

Hence the challenges of rural transportation.  At a recent conference in a rural community, someone asked if there was not a need for more park space in their community to increase physical activity.  Surrounded by some of Canada’s best natural resources, the question was almost absurd.  Their issue was how to transport folks efficiently for medical appointments out of town.   Collusion amongst major intercity bus carriers precludes a competitive environment, and bus schedules don’t align with medical appointment needs even where such appointments try to cater to out of town attendees.  The costs for bidding on new bus routes extending into hundreds of thousands of dollars, and public transit solutions predominately limited to within catchment area solutions and not addressing intercity public transit along main provincial corridors. As noted subsequently by a rural colleague, insurance costs for volunteer agencies or good neighbour solutions can be a significant barrier to local solutions unlike the urban setting where driving a neighbour to the doctor is not considered something unusual by insurance companies. 

As an added challenge, an isolated First Nations community is grappling with medical transportation costs approaching $2 Million for some 1000 residents.  Most of the medical transport for minor health services not available in the community.  Many provinces and territories also have rural health subsidization programs that defer some costs for persons needing to seek medical or hospital care out of the region. Others limit such subsidization for those on social assistance. 

An innovative universal shared transportation system is in place in Northern BC NHConnections .   Such programs demonstrate that transportation solutions that contribute to wellbeing can be supported through innovation. Telehealth provides many options for reducing travel, limited on one hand by technology and on the other hand by volume driven solutions that still require face to face visits for payment of service.

While much of urban Canada may benefit from the shift to active transportation and public transit, rural Canada’s solutions will require deregulation of the bus industry, creative healthy transport solutions and adoption of telecommuting solutions like Telehealth.  

1 comment:

  1. Twitter response @Danu1Donahue May 14
    @drphealth Absurd comment about green space indeed! Insurance issues prohibitive to rural volunteer transport. That too is absurd!

    Dr. P Health ‏@drphealth May 15
    @Danu1Donahue Great point and added to blog. Rural good neighbour solutions may be precluded by insurance company rules.

    Dr. P Health ‏@drphealth May 15
    @Danu1Donahue De nada Dr.P.Rural solutions are challenging due to low tax base for public funded transportation services. Thanks for noting.