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Closing the Gaps: Rural and Indigenous Health in Northern British Columbia

  • leier51
  • Dec 6, 2021
  • 8 min read

Introduction

I entered Critical Foundations in Health Disciplines with a keen interest in the health and health needs of the region I live and work in: northern British Columbia (B.C.). Whenever possible, I applied course concepts and learning activities to B.C.'s north. Performing a multi-level assessment on the quality of long-term care delivery in the north and assessing its population's vulnerabilities helped me to better understand the region's current health as well as its future health and health system needs. This final blog will examine the health and factors affecting the health of northerners, along with identifying key areas of focus towards meeting the current and future health and health care needs of the population.

The Health of northerners

Compared to B.C.'s provincial average, the life expectancy of northerners is 3.6 years lower at 78.8 years of age (Canadian Institute of Health Information, n.d.a). Further, B.C.'s northern population experiences higher rates of chronic disease in relation to the province. According to the Canadian Institute of Health Information (CIHI, n.d.a), as indicated in Table 1, northerners have higher rates of diabetes, chronic obstructive pulmonary disease, hypertension, obesity, as well as mood disorders. With exception to obesity rates, which are 5% above the provincial average in the north, diabetes, hypertension, mood disorders and chronic obstructive pulmonary disease rates range from 0.9% to 1.4% above provincial averages. B.C.'s northern population also scores lower or less desirable on determinants of health, as depicted in Table 2, such as heavy alcohol consumption and smoking (CIHI, n.d.a). Interestingly, the north's adult population scores higher in physical activity compared to the provincial average. Rasali (2016) points out that northern areas of the province also score lower compared to more urban areas in socio-economic status. A stand-out socioeconomic indicator – post-secondary education attainment – is considerably lower in the north at 53.8% in comparison to the provincial average of 66.4% (CIHI, n.d.a). To summarize, assessment of the health of B.C.'s northern population highlights the distinguishably lower health and health outcomes northerners experience in comparison to provincial averages.


Table 1:

Chronic Disease Rates of Northerners Compared to the Province of B.C.*

Region

Diabetes

Hypertension

Mood Disorders

Chronic Obstructive Pulmonary Disease

Obesity

Northern B.C.*

6.7%

17.4%

11%

5.2%

17.6%

Province of B.C.*

5.8%

16.2%

9.6%

3.8%

12.6%

*British Columbia



Table 2:

Determinants of Health Indicators of Northerners Compared to the Province of B.C. *

Region

Heavy Alcohol Intake

Smoking Status

Physical Activity Status

Post-Secondary Education Attainment

Household Food Insecurity

Unemp-loyment

Northern B.C.*

21.8%

17.6%

65.2%

53.8%

Unavail-able

6.3%

Province of B.C.*

18.8%

12.6%

64.8%

66.4%

7.6%

5.1%

*British Columbia



Factors affecting the health of B.C.'s northern population

Rurality

The rurality of northern B.C. is a key factor that contributes to the health status of its population. Among B.C.'s five regional health authorities, the north's Northern Health Authority (NHA) is by far the most vast. As depicted in Figure 1, the NHA's geographic catchment comprises approximately two thirds of B.C.'s land mass (Government of B.C., 2021). Though its geographical area is large, the NHA only delivers health services to ~300,000 people or approximately 6% of B.C.'s population (NHA, n.d.; Statistics Canada, 2021a). As CIHI (n.d.b) states "where people live impacts their health status and health care needs." It is well understood that significant differences exist between rural and urban populations with regards to health behaviours, health service access and utilization, health status, and overall health outcomes (CIHI, n.d.b). In Canada, people living in rural and remote areas are typically older, less affluent, and less healthy (Wilson et al., 2020). Research by Subedi et al. established that a gradient of preventable mortality by relative remoteness exists in Canada (2019). The recently developed national remoteness index, which explores the geographical variability of preventable mortality, validates the impact rural and remote living has on the health of Canadians.

Figure 2

Health Authority Regions in British Columbia

ree

From Regional Health Authorities, by the Government of British Columbia, 2021 (Regional health authorities - Province of British Columbia (gov.bc.ca). In the public domain.



Indigenous representation

Representing 20.5% of the region's population, B.C's north is home to a large proportion of Indigenous peoples. Furthermore, the region's northwest has the highest number of Indigenous people per capita in B.C. at 36% compared to the provincial average of 5.9% (CMTN, n.d. & Statistics Canada, 2017). The large proportion of Indigenous peoples in northern B.C. is a distinguishable factor that affects the health of the population. It is well understood that Indigenous people living in Canada are burdened with health disparities relative to non-Indigenous Canadians on most measures of health and well-being (McNally & Martin, 2017). From experiencing higher rates of infant mortality, injuries and suicide as youth, along with mental illness, addictions, and chronic diseases such as obesity and diabetes as adults, Canada's Indigenous population is vulnerable across the lifespan (Greenwood & de Leeuw, 2012; Key Health Inequalities in Canada, 2018).

The fact that Indigenous Canadians experience higher levels of morbidity and mortality on a declining socioeconomic gradient highlights the significant impact that social determinants of health have on Indigenous peoples (Government of Canada, 2018a). Take education attainment for example – a key ingredient in the recipe for socioeconomic status. Among 25-34 year olds, high school attainment rates are considerably lower for Indigenous Canadians at 72% compared to 92% for non-Indigenous Canadians (The Conference Board of Canada, n.d.). Moreover, the Government of Canada (2018b) reports that 48.4% of Indigenous peoples have a post-secondary qualification compared to 64.7% of Canada's non-Indigenous population. CIHI (n.d.a) data indicates that B.C.'s north has a 53.8% post-secondary education attainment rate in comparison to the provincial average of 66.4%. Assessment of the health of Canada's Indigenous peoples in relation to the health of B.C.'s northern population affirms that the region's strong Indigenous representation is a key factor influencing its health and health outcomes.



Areas of focus: now and into the future

My exploration of the current health along with the future health and health care needs of Canadians led me to establish two areas of focus for B.C.'s north: health system capacity and Canada's Truth and Reconciliation Commission (TRC) calls to action. Health system capacity is a national level priority with a number of factors affecting health systems' abilities to meet care demands including our aging population, staffing challenges specific to rural and remote regions, along with the COVID-19 pandemic to name a few. According to Statistics Canada (2021b), seniors currently represent 19% of the country's population and are projected to reach as high as 25% by 2059. As the country's elderly population increases, so will the requirements for elder care. According to Deloitte (2021), elder care demands will double by 2031. Understanding that our current health care system already faces significant challenges in meeting elder home care, assisted living and long term care needs, I do wonder if it is capable of meeting such a significant increase in care demands over the coming years; in particular, in rural and remote regions. According to the Canadian Nurses Association (2020), the proportion of nurses working in rural and remote settings is declining, which is of significant concern given the proportion of nurses working in these areas is already lower than more urban areas. Now, factor in the COVID-19 pandemic and the impact it has had and will continue to have on the health sector. As Lopez et al. (2021) reports, nurses are experiencing considerable untoward effects on their physical, psychological and social wellbeing. The cumulative impact of these stressors has and will continue to affect nursing recruitment and retention for years to come (Lopez et al., 2021). I trust Plato's proverb "necessity is the mother of invention" will hold true for the ability of Canada's health care system, in rural and remote areas in particular, to meet the growing demands it is facing now and in years to come (Jowett, 1894).

Progressing on the TRC's calls to action is of the utmost importance for Canada. Regions with significant Indigenous representation such as B.C.'s north stand to benefit the most from reconciliation gains. Of the 94 calls to action, seven fall under the category of health (TRC, 2015). While progressing on TRC health oriented calls to action is likely to improve the healthcare Canada's Indigenous population receives along with its overall health, focusing on the seven calls alone will not close the gap in health between Indigenous and non-Indigenous Canadians. Fortunately, progress on other TRC priorities such as education-based calls to action will also help to close the Indigenous health gap. Intentional efforts to improve Indigenous education attainment rates is a high impact TRC call to action. Along with narrowing the Indigenous education gap, improved Indigenous education attainment rates will help to address the population's socioeconomic and overall health related vulnerabilities. Further, progress made in education attainment may also serve as a catalyst for increasing Indigenous representation in health-related post-secondary programming and ultimately the health sector, another priority area in the TRC's calls to action.


Conclusion

Examining B.C's northern population helped me to understand why northerners on a whole are more vulnerable than their neighbors to the south. The region's geography, which is the reason why many choose to live in northern B.C., brings with it health related risks not experienced by more urban populations. Being home to a high proportion of Indigenous peoples adds additional obstacles to achieving health parity within the province. One key obstacle is workforce representation; in particular, in professions requiring post-secondary attainment. The fact that Indigenous Canadians are underrepresented in post-secondary education is a significant obstacle that requires action. I am hopeful that rural and remote regions such as B.C.'s north will lead the way in mobilizing Indigenous youth to increased post-secondary education attainment levels on route to greater representation in Canada's rural and remote health sector – the area that needs them the most.



References


Canadian Institute for Health Information. (n.d.a). Your Health System: Northern Health.

Retrieved November 9, 2021 from https://yourhealthsystem.cihi.ca/hsp/indepth?

Canadian Institute for Health Information. (n.d.b). Rural Health Care in Canada. Retrieved


Canadian Nurses Association. (2020, May 29). CIHI data reveals more nurses overall but fewer

Coast Mountain College. (n.d.). Student Services: Vision. Accessed November 12, 2021 from

Deloitte. (2021, March 25). Canada's Elder Crisis: Addressing the doubling demand.

Greenwood M.L., & de Leeuw S.N. (2012). Social determinants of health and the future well-

being of Aboriginal children in Canada. Pediatric Child Health; 17(7): 381–84.

Government of British Columbia. (2021, June 9). Regional health authorities. Retrieved

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National Portrait – Executive Summary - Canada.ca. https://www.canada.ca/en/public-

Government of Canada. (2018, July 25b). The educational attainment of Aboriginal peoples

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Executive Summary - Canada.ca. https://www.canada.ca/en/public-

Jowett, B. (1894). Plato's Republic: The Greek Text.


Lopez, V., Anderson, J., West, S., & Cleary, M. (2021). Does the COVID-19 Pandemic Further

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Subedi, R., Greenberg, T. L., & Roshanafshar, S. (2019). Does geography matter in mortality?

An analysis of potentially avoidable mortality by remoteness index in Canada. Health

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