Abstract

Rurality and remoteness are policy-relevant concepts for planning and evaluating equitable access to services across Canada, yet existing measures rely on categorical, urban-centric, and coarse spatial definitions that obscure variation in accessibility across the rural-urban continuum. The Canadian Accessibility and Remoteness Index Plus (CARI+) is a small-area accessibility index at the dissemination-area level. It is based on road-network travel to stratified service centres, including population centres and 24-hour emergency departments stratified by settlement size. Category-specific scores are capped at 3, summed to produce an overall score, then normalized.

We examined the CARI+ values against socio-demographic indicators and compared them with the Index of Remoteness (IOR). CARI+ yields a more even population distribution than the IOR (39% vs 77% in the most accessible category) and reveals socio-demographic gradients: material deprivation and Indigenous identity increase with remoteness, while educational attainment and immigrant representation decline. In very remote areas, CARI+ identifies 25% of Indigenous residents and 27% of the population with less than high school education, versus 78% and over 50% respectively under the IOR. The CARI+ provides a transparent, service-specific, high-resolution measure of accessibility that addresses key limitations of existing Canadian indices and supports nuanced analysis for health and social service planning.

This article is part of our , which aims to make disaggregated data on health and social service access available for researchers and planners in Canada.

Read the Article:

Citation

McGaughey, T., & P. A. Peters. 202670:. Introducing the Canadian Accessibility and Remoteness Index (CARI+). Canadian Geographies / GĂ©ographies canadiennes, 70, e70082. 

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What do we know? Rural obstetrical care in Canada has limited local access, meaning many women must travel, sometimes over two hours, to give birth. Care is often provided by fewer specialists and more family physicians, and services vary widely between communities. These gaps can affect outcomes and reflect that rurality is a key social determinant of health. There are fewer obstetrical specialists in rural areas, so care depends heavily on family physicians and limited staff, which affects consistency of care.

What do we want to know? We want to know whether access to rural maternity care has improved since 2011, how to reduce travel and service gaps, and whether some maternal health risks and deaths are preventable with better access and resources.

How does it affect people? Limited access to rural OB care can lead to worse birth outcomes, increased stress, and financial strain due to travel. It also impacts overall health because rurality acts as a social determinant of health, affecting both mothers and newborns. Long travel times can lead to delayed care, emergency deliveries, and higher stress, which can affect outcomes.

ArcGIS StoryMap

An is a web-based digital storytelling tool created by that combines interactive maps and 3D scenes with multimedia content—like text, photos, audio, and video. It allows anyone to build immersive, visual narratives without needing prior GIS () experience.

View the complete ArcGIS StoryMap at: .

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Presentation to Central OHT Collaborative June 13, 2024.

The link between communities, places, and health is well-established in the scientific and public health literature. Differences in the characteristics of places can help explain differences in health inequalities. Place-based analysis offers a lends to better understand the health needs of local communities, evaluate gaps in health service accessibility, and show where opportunities to intervene exist. Access to care should not be determined by where people live.

As part of our collaboration between the and ‘s , we presented to representatives of Ontario Health Teams from across the province. This work demonstrates a pilot project for our place-based geographic analysis of the factors influencing mammography screening at the local level, and builds on our prior collaborations.

The objective of this project was to see how geoanalytic results can be used in health system planning and point-of-care, with the goal of improving the health of local populations. For this project, the mammography screening use-case makes use of existing data that can be integrated with local-level data on social determinants and health accessibility. Building from our prior work with geographically weighted regression, this project facilitated the creation of an interactive geospatial visualization tool to provide OHTs a resource for developing upstream engagement strategies.

The project demonstrated how a data-centred, place-based approach enhances understanding of an OHT’s attributable population.

The mammography screening interactive tool is .

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Objective: The objective of this review is to determine the scope of spatial modelling approaches used to evaluate geographic access to health and care services in rural Canada.

Introduction: Canada’s health and social policy agenda has made the requirement for equal access to primary and secondary health services for rural populations a key priority. Most rural health research in Canada has focused on measuring patterns of health outcomes or modelling geographic access to a narrow range of services, health conditions, or within specific regions. This scoping review will provide an in depth look at the spatial modelling currently being used to evaluate the barriers and facilitators for access to health and care services and will provide direction for further research.

Inclusion criteria: This review will consider studies that include any person accessing health and care services in Canada, focusing on those who reside in rural or remote communities, or access health services in those areas.

Methods: Published primary studies, reviews, opinion papers, reports, theses, and dissertations published in English or French across all dates will be searched in databases including CINAHL via EBSCO, PubMed, ProQuest, Scopus, Web of Science and Dissertations and Theses Global. Following the search, all titles and abstracts will then be assessed against the inclusion criteria for the review. Potentially relevant papers will be assessed in detail against the inclusion criteria. The data extracted will include geographic location, service under study, analytic methodology, data included, and specifics of the spatial models employed.

Scoping Review Protocol

Download the complete protocol here.

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Madeleine Sheppard-Perkins, Tomoko McGaughey, Paul Peters, & Francine Darroch.

Abstract

Geographic methods of inquiry are being increasingly employed to discern and visualize geographical patterns associated with increased risk of sexual- and gender-based violence (SGBV). As such, this scoping review systematically collated academic literature and subsequently synthesised (1) the time trend of studies employing geographic methods to understand SGBV, (2) the context in which geographic methods are being used to understand SGBV (i.e. objectives), (3) study characteristics, and (4) the methods and data sources used. A total of six databases were searched: Gender Studies, PsychINFO, Scopus, PudMed, Cochrane, and Campbell. Following title-abstract (n = 3354) and full-text screening (n = 159), 42 studies met data extraction criteria. From our review, there is clear momentum in the use of geographic methods to understand trends in SGBV. The majority of studies stated objectives aligning with assessing risk of SGBV (n = 35, 83.3%), while the remaining aimed to assess SGBV service availability. As research expands, there is notable focus on urban and suburban areas and a dominant dependence on institutional data sources (e.g. hospitals and police data), which hold certain caveats when it comes to structural barriers to SGBV data collection, such as fear of reporting and historic distrust in institutional services. Dovetailing the employment of big data sources with community-facilitated SGBV data collection methods may be a promising avenue for neighbourhood-specific efforts to inform policy and practice.

Download the article: .

Citation

Sheppard-Perkins, M. D., McGaughey, T., Peters, P. A., & Darroch, F. E. (2025). Exploring the use of geographic methods to understand sexual- and gender-based violence: a scoping review. Gender, Place & Culture, 32(3), 313–341. https://doi.org/10.1080/0966369X.2024.2307583

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Addressing Health Inequities and Enhancing Population Health Management Strategies Through GeoAnalytics

The link between communities, places, and health is well established in the scientific and public health literature, and differences in the characteristics of places can help explain differences in health inequalities. Place-based analysis, as illustrated in this project, offers a lens to better understand the health needs of local communities, evaluate gaps in health service accessibility, and show where opportunities to intervene exist.

The Ontario health system has become more locally oriented with the introduction of , providing a vital link between health policy makers, health service providers, and local communities. OHTs are sources of expertise in data collection, analysis, and evidence-based approaches to improve population health and health equity. As such, there is tremendous potential for these organizations to conduct analyses that are relevant and impactful for local health services and health outcomes.

This project reviewed the potential role of geoanalytics for Ontario Health Teams via an examination of place-based analytic approaches at the local level, examination of use-case scenarios for emergency department visits and mammography screening, and an evaluation of the potential for geoanalytics within a population health framework.

Importantly, we are concerned here with how the analytic results can be used in health system planning and point-of-care, with the goal of improving the health of local populations. For this project, use-cases have been selected to make use of existing data available to and for those that can lead to impactful interventions and upstream engagement strategies in the short-term.

The final evaluation further discusses the potential for spread and scale of the analytic frameworks, data systems, and tools at the Provincial level. Looking towards future digital infrastructure, a geoanalytics approach has strong potential to integrate with existing health data systems and provide a much-needed link between often-inaccessible health administrative data and locally relevant population statistics.

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GeoAnalytics Project Evaluation

ArcGIS StoryMap

– this StoryMap presents the geoanalytic results for the emergency department and mammography screening use-case scenarios. This StoryMap was created as part of the Rural R:ISK project funded by the Social Sciences and Humanities Research Councile (SSHRC).

Health geoanalytics can support public health organizations such as OHTs in making informed decisions, optimizing resource allocation, and improving the efficiency of their operations. This may lead to cost savings by reducing waste, targeting interventions effectively, and improving overall health outcomes in the population.

Infographics of Health Indicators for Southlake Community OHT

Steering Committee Members

This project was guided with the expert input from a steering committee and contributing stakeholders.

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A National Epidemic with Severe Local Implications: A Global to Local Review of Substance Use to Analyze the State of Addictions in Rural Eastern Ontario

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A National Epidemic with Severe Local Implications

This research (summarized below) is also presented as an interactive ArcGIS Storymap available at the following link..

Substance Use in Canada

The dramatic rise in substance-use disorder prevalence across North America has become an urgent and escalating health issue in need of rapid intervention. In 2012, Statistics Canada conducted a study concluding that 6 million Canadians met the criteria for substance-use disorder, but even this value is thought to be an underestimate (1). It is likely this statistic has increased greatly since 2012 when considering the surging overdose crisis and significant increase in opioid-use, as well as opioid-related deaths in the past three years (2). In 2017, the cost of substance use was calculated to be $46 billion, a 5.4% increase since 2015, which factored for associated healthcare, lost productivity, criminal justice, and other direct costs (3). Substance use and addictions in Canada is therefore multifactorial, involving social, health, and economic implications.

Substance use and addiction is a global public health crisis that has rapidly escalated over the last decade. Substance use disorder is one of the most prevalent causes of morbidity and mortality internationally (4), with alcohol- and opioid-related harms being of most concern. The United States of America and Canada have historically had the highest prevalence of opioid drug use mostly due to the availability of such drugs when compared to less developed countries and have both seen an even greater increase in use since the emergence of Covid-19. Of greatest concern, is the spike in opioid deaths which has also more than doubled since 2010 (5). Canada and the United States have the highest rates of prescribed opioids worldwide, and although the US sees considerably more opioid-related deaths, per capita opioid use, and alcohol-attributed health deficits, recent data shows Canada is paralleling increases in these areas which is a cause of great concern (6). Continuing health professions education programs have begun to gain a hold on prescription opioids and their potentially harmful effects, but there has been a major increase in non-pharmaceutical opioid use across Canada which accounted for 90% of apparent opioid deaths from January to June 2021 (7).

The life expectancy of Canada has levelled for the first time since World War II, with one of the main contributors being opioid-related deaths. This negative trend was first observed in British Columbia, which has been in a declared public health emergency since 2016 due to significant opioid-related deaths, but life expectancy has since begun to plateau for all of Canada. Most deaths seen in the past five years have been males between the ages of 20-49, which therefore has a significant impact on life expectancy, with alcohol and drug use identified as the most important risk factor among young adults (7).

Alcohol and opioid use are currently a major focus for substance use disorder harms, as these sectors have seen the greatest increase in associated harms and affect the most individuals, although it should be noted that an increase in stimulant use as well as polysubstance use has been observed in the past few years. Substantially less mortality is seen with these substances, and toxic supply is less of a concern, but many of the initiatives and treatment options addressing the opioid crisis can also benefit those impacted by stimulant addiction and polysubstance use. Other addiction disorders such as gambling can also have detrimental effects on overall health and wellbeing of Canadians, but this report will have a greater focus on drug addiction and substance use disorder, specifically regarding opioid use, as it is an incredibly urgent public health crisis causing the death of thousands and therefore requires immediate intervention.

Our interactive ArcGIS Storymap provides further analysis of this epidemic for rural Eastern Ontario, highlighting both the harms and the services available in this region.

Link to the complete Storymap: .

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