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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Dissanayake A, Dupuis A, Burton CL, Soreni N, Peters PA, Gajaria A, Arnold P, Crosbie J, & R Schachar. (2024) “Racial/Ethnic Disparities in Youth Mental Health Traits and Diagnoses within a Community-based Sample.” Canadian Journal of Psychiatry. .

Abstract

Objective

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Sheppard-Perkins M, McGaughey T, Peters PA & F Darroch. (2024) “Exploring the Use of Geographic Methods to Understand Sexual- and Gender-based Violence: A Scoping Review.” Gender, Place & Culture. .

This research was led by Dr. Francine Darroch of the Health and Wellness Equity Research Group.

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.

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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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ShelterCare: The Integration of Health and Housing Services as an Evidence-Based Shelter Model

Ayshia Baile, April 23, 2023

Homelessness is a multifaceted issue which is incredibly prevalent across Canada. It was estimated in 2016 that at least 35 000 individuals experience homelessness on any given night, with more than 235 000 Canadians every year (Gaetz et al., 2016). This estimate does not include ‘hidden homelessness’ which is thought to be up to 50,000 people per night nationwide encompassing those who do not have permanent housing and temporarily stay with friends, relatives, in their vehicles, or other undocumented spaces, avoiding unsheltered homelessness (Gaetz et al., 2013). Due to the Covid-19 pandemic, routine homelessness enumerations have been delayed, although studies have projected a rising incidence in homelessness since the onset of the pandemic with estimated continued growth considering the impeding recession if no effective interventions are implemented (Falvo, 2020). This issue runs deeper than lack of stable housing as there are many social, economic, and systemic barriers faced by individuals who experience homelessness, making it a complex problem which requires comprehensive solutions. Of utmost concern, are the severe health impacts of poor housing and homelessness. Homeless populations have been described in literature as being vulnerable to the ‘tri-morbidity’ of social marginalization being mental illness, addiction, and physical illness highlighting the main health risks associated with homelessness (Gicas et al., 2020). Lack of stable housing decreases overall quality of life, exacerbates chronic health conditions and medical complications, and presents significant barriers to health access which negatively impacts individuals who experience homelessness and public healthcare systems. Homelessness requires immediate interventions and should be a priority for all governing bodies in Canada but, as housing is a key social determinant of health, it should be a critical priority for health and healthcare decision makers. With the multitude of proposed models and pilot projects being conducted to address health inequities afflicting the homeless population, which solutions have promising measurable benefits and should be prioritized by health policymakers?

ShelterCare is a housing intervention that was originally thought to be a utopian model for ending chronic homelessness but was given the opportunity to demonstrate its potential as an incredibly impactful evidence-based intervention due to the COVID-19 pandemic. These pilot projects have exemplified the need for the program to address systemic barriers to housing for homeless populations and drastically improve the health of marginalized individuals. Demonstrating similar positive outcomes to other evidence-based housing interventions like Housing First, but while considering the state of housing and escalating opioid crisis, this model can fill significant gaps and better support individuals who have experienced chronic homelessness to secure and maintain permanent housing.

This paper reviews current housing and shelter interventions and evaluate the overall improvements to health and quality of life of the homeless population. Based on currently piloted housing initiatives and comparing to previously explored solutions, the ShelterCare model will be reviewed in-depth for its impact on health. The perspectives and impact of key stakeholders will be considered including municipal and provincial governing bodies, regional public health, hospital, and community health officials, related non-profit and community advocacy leaders, social services sector, and clients themselves, as cross-sector collaboration is required to effectively implement this intervention. An approach to engaging with these stakeholders as well as a model for continuous evaluation of its impacts will be outlined, highlighting the gaps this service would fill and how it could be implemented effectively.

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ShelterCare Final Paper

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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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by Tomoko McGaughey, MPH, MSc Student

In the fall of 2021 I was assigned as a Teaching Assistant for an undergraduate class where the students are building their skills in research, including the developing a research proposal as a group project. It has been amazing to see how much interest and knowledge these students carry in different areas of health, ranging from maternal health impacts on fetal development, air quality and lung health, or the gastrointestinal effects of ginger beer. To see this kind of work so early in their academic career has shown me that the next generation will go amazing places as their knowledge basis grows.

This experience has also highlighted the importance of teaching young academics about ethics early in their careers. It is not surprising that early undergraduates lack a comprehensive picture of research ethics and health equity – and it has prompted me to think about what training or guidance might be useful for students at this stage.

Students in Health Sciences are clearly interested in making the world better for individuals who are marginalized or underserved, and there they demonstrate a large appetite for learning. However, no matter how well meaning our research is, it doesn’t mean we can ignore that we are hoping to do research on fellow human beings who have thoughts, feeling and their own struggles they are experiencing daily. Further, that doesn’t mean we can remain ignorant of our own shortcomings when it comes to research ethics and engaging with people who are different than us.

Considerations for Research Ethics

According to (RN, PhD, Ryerson University), there are .

• First, is to protect human participants,
• Second is to ensure that research is conducted in a way that serves interests of individuals, groups and/or society as a whole, and
• Third is to examine specific research activities and projects for their ethical soundness (e.g. management of risk, protection of confidentiality, and process of informed consent).

Although some efforts have been made by students based on these three objectives, the route some students have chosen illustrates that they do not fully understand the impact their work may have on individuals and the groups they are trying to serve, and that they do not have insights from this community.

My concerns in how ethics is approached lie in the way we are looking at engaging with those whose lives we are studying. We require a sound, ethical process to engage with ANY community – let alone those who are often under or poorly served by the health system or seen as potentially vulnerable.

Questioning your own research

In line with teachings from early on in my academic career, and the objective presented by Dr. Walton, I ask myself three questions when considering the ethics of a research project, placing myself in the participants shoes:

1. Would I feel like this research project is causing not only myself but my community any harm (physical or emotional)?
2. Do I feel like I am being ostracised because of how I identify?
3. Am I respecting the autonomy of this community group and taking into consideration any historical vulnerabilities they may have experienced?

Patient engagement

In addition to the above, it is extremely important to consult with any communities before considering conducting research on them. This perspective is foundational in the shift to across the health sciences. At the outset, engagement could simply include a series of conversations and/or focus groups, including general community members and individuals who are identified to be leaders or informed on the topic you are researching, sampling their opinion on issues that should be addressed through research. Things like language to be used or avoided, references, important events or cultural considerations, and/or individuals that should be taken into consideration during the research process can be captured through the research process, when they may not have been identified otherwise.

Taken further, patient engagement could include the incorporation of individuals through the research process, either through study design planning, data collection, and data analysis so the community’s perspective is considered throughout the whole research process. This continued consultation and reiteration process can allow communities to have their voice heard in a way that is respectful to their boundaries and experiences. This engagement is essential when  communities, and I completely see why and the importance behind it. When systems consistently threaten your autonomy, silence your advocacy, or neglect and even threaten your health, we need to ensure our research does not replicate this same system.

Final thoughts

Since coming to �Ӱ�ԭ��, I have seen how the student, administrative, and teaching bodies of this university are extremely inclusive, supportive, accepting and understanding. This is something that drew me to �Ӱ�ԭ�� and I want to do my part to ensure that this inclusiveness extends to health research, and how students are learning about the ethics of what they are being trained for. I can see how our undergraduate students are very well-meaning, want to change the world for the better, and improve the quality of life of those in their local communities. However, I hope that while these young scholars are exploring their dreams, they will continue to consider the implications of their work on those around them.

At the end of the day, I’ve written this short post because I not only care about protecting those who are vulnerable when it comes to research, but also because I care about the futures of the students around me. You all have a bright future but let’s try to make our work more inclusive and understanding as we move forward in this already very scary world.

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Rachpaul CC, Sendanyoye C, Mahling A, Sourial M, & Trto S. (2021). “Report: Service Provision for Children and Youth with Disabilities in Rural Canada and Australia.” Spatial Determinants of Health Lab, �Ӱ�ԭ�� University: Ottawa ON. DOI: 10.22215/sdhlab/2021.2.

A full PDF of this report is also available.

BACKGROUND

Children and youth with disabilities residing in rural and remote regions of Canada and Australia are faced with limited availability and accessibility of appropriate allied health services. As a result, children and families oftenfacing difficulties obtaining a timely diagnosis (1) and experience fewer options for support services compared to their urban counterparts (2-6). Common accessibility barriers include geographic isolation, limited transportation options, long travel distances, limited number of available health care providers, increased wait times to obtain services, and high costs for appropriate services (6,7). Health service provision that takes into consideration rural and remote contexts is required to mitigate challenges imposed by geographic location.

There is limited data available regarding the prevalence of children and youth with disabilities in rural and remote communities. A greater understanding of existing resources to support children and youth with disabilities in hard-to-reach areas warrants further investigation.  To better inform this topic, a structured scoping review and thematic analysis was conducted.

Additionally, there are challenges in adequately collecting data pertaining to children and youth with disabilities. Much of this challenge is due to the lack of consensus regarding the inclusion of disability types and classifications. The UN Convention of the Rights of Persons with Disabilities (8) and the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) developed a definition of disabilities by combining pertinent elements of the definition (1). Disability is defined as, “children and adolescents who require additional resources because of exceptional gifts and talents, physical, sensory, cognitive and learning challenges, mental health issues as well as problems due to social, cultural, linguistic or family factors” (2).

This report summarizes the complete scoping review aims to provide a clear understanding of allied health service provision for children and youth with disabilities living in rural and remote communities in both Canada and Australia. This is accomplished through a comprehensives synthesis and comparative analysis of the existing literature, including identifying gaps in the literature and recommendations for future research and policy improvement.

KEY FINDINGS

SOLUTIONS AND BARRIERS

The scoping review process resulted in 33 peer-reviewed articles met inclusion criteria. The thematic analysis identified both successes and barriers to allied health service provision in rural areas pertaining to three key service needs: 1) diagnostics and assessments, 2) service availability, and 3) service accessibility. The review identified 7 major barriers and 5 major solutions in establishing adequate health service for children and youth residing in rural and remote Canada and Australia, as outlined in the figure below.  Service modality was identified as a major finding in playing a significant role in addressing barriers, with finding supportive technology and mixed modes of service provision as a solution.

Findings suggest inadequate service availability in rural communities for children and youth with disabilities because of the following:

• Disadvantages in obtaining diagnosis;
• Limited support services due to geographic isolation, transportation, and travel barriers;
• Limited number of available health care providers; and,
• Increased time and cost associated with obtaining services (1, 2-7).

Articles reported numerous solutions to address the above domains. Telepractice and technology-based programs are presented as being the single reported solution in all three major domains (9, 13, 16-24). This potential solution addresses both in-person and telehealth programs having the potential to be effective for diagnostic and assessment purposes (15-18).  The solution of utilizing the internet and social media breaks service availability barriers in improving child communication skills, its aim to improve parent’s knowledge of their child’s diagnosis, and collaboration between families and service providers (10-12,14, 20, 25-27).

Lastly, the solution of telepractice services improves service accessibility for children with disabilities in rural communities (13).  Technological integration into rural communities can be utilized to improve access to occupational therapy and the engagement of mental health services (13, 28-30). Barriers to service accessibility can be addressed by improving training, infrastructure, education on attitude change towards technological advancements, and ensuring cultural and linguistic diversity (31).

FURTHER CONSIDERATIONS

There has been increased attention being paid to children and youth with disabilities over the past decades as evidenced from this review. The data collected for children and youth with disabilities in rural communities of Canada are sparse, making it difficult to ascertain research and policy needs.

This review provides an overview of existing problems and possible resolutions in improving both research and policy for children and youth with disabilities in rural Canada and Australia. The literature on this topic primary focuses on research in Australia. Future Canadian research can learn from both the successes and ongoing challenges in Australia. In addition, research within a Canadian context should incorporate provinces and territories that are neglected in this field of study. Through building on existing research and discovering new opportunities, rural health policy can be better informed. This can be accomplished via collaboration between communities, researchers, stakeholders and policy makers. Although ongoing challenges exists within diagnostic and assessment, service availability and service accessibility; through innovative services and strengthening resources within communities, rural-centered delivery models for children and youth with disabilities in Australia and Canada can be developed.

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Barnabe J., Petrie S., & P. Peters. 2020. Virtual Triage and Teletriage in Rural Canada and Australia: A Rapid Review. Spatial Determinants of Health Lab Ottawa, ON. doi: 10.22215/sdhlab/2020.2.

A complete PDF is also available for download.

Public Health Topic

Health care services and healthcare infrastructure in rural areas is continuously adapting in to meet the needs of rural and remote populations. Rural populations are unique and diverse, where there is a diversity of individuals within communities, and an equivalent diversity between communities. There are documented differences in health behaviours, health literacy, perceived health, and health outcomes between and within rural regions and rural communities. While geographic accessibility is often considered the primary driver, differences go beyond distance and include elements of demographic change, economic restructuring, and continued reductions in health and services.

The features of rural health care delivery are further underscored in the wake of the COVID-19 global health pandemic, a rapidly evolving situation which is undoubtedly putting pressure on already strained rural emergency departments (ED). In attempts to alleviate strain on front-line health provision and ensure the safety of the public, many healthcare facilities have rapidly implemented or have scaled-up eHealth solutions such as virtual triage and urgent care systems. These are virtual (virtual triage) or telephone systems (teletriage) in which patients can contact a physician or other healthcare professional who will guide them to appropriate care. The objective of these interventions is most often to reduce the overall number of in-person visits to EDs, potentially tackling ED overcrowding and misuse.

Current Knowledge

Overcrowding, long wait times, and lack of resources is a persistent issue in countries with publicly guaranteed health systems, with EDs being disproportionately affected. This is especially prevalent in rural Canada and Australia, where rural healthcare access and resources are limited. Although it is a complex problem, one of the main contributing factors to this pressure is the growing number of patients presenting to EDs with non-urgent complaints, many of whom are seeking primary care. Although seeking non-urgent care from the emergency department is seen as inappropriate to health system planners, it is often the only choice rural patients have. Over 4.7 million Canadians do not have a primary care provider and only 25% report they have a usual place of care such as an urgent care clinic, a luxury that is hard to come by in rural areas. A similar reality is seen in Australia, where access to general practitioners in regional or remote areas is limited, with many reporting visiting ED’s because a general practitioner was not available.

Initiatives such as telehealth and virtual visits have been suggested to bridge the gaps seen in rural healthcare and are part of broader eHealth initiatives that include electronic medical records, remote health monitoring, and other electronic health technologies. Identified benefits of using eHealth services for primary care provision include reducing the burdens that come with travelling long distances, increasing access to care, and cost savings across various domains. Despite perceived benefits, implementation is often non-existent, difficult, or slow. Cost, technological issues, and slow acceptance by providers is a recurring issue for successful long-term eHealth implementation.

Teletriage and virtual triage are eHealth initiatives proposed to mitigate rural healthcare gaps. Teletriage is the use of telephone conferencing services to guide patients to appropriate care based on patient presentation, the urgency of the condition, and the policy of the organization. Virtual triage is where secure video connections are integrated with secure voice. Various telephone triage initiatives have been slowly developed and implemented across Canada, and Australia. Despite the evidence of success with teletriage, virtual and video integration with these systems has been met with resistance, with few adopting it. However, amid the COVID-19 pandemic, Canadian and Australian healthcare providers have been advised to provide virtual care where possible, resulting in the rapid creation and scaling up of exiting teletriage platforms and integration of virtual triage.

Key Evidence

• Telephone triage (teletriage) has been slow to expanded in Canada and Australia.
• Teletriage is effective, safe, with high levels of reported patient satisfaction.
• Teletriage can provide an alternative to primary acute care when not available.
• Virtual triage is recent with most new platforms implemented due to the COVID-19 pandemic.
• Integration of video creates multiple layers of care, further improving effectiveness.
• Many of the limitations of tele- and virtual triage are related to existing inequalities in rural areas.
• Tele- and virtual systems can be effective at deferring patients from emergency departments.

Policy Recommendations

• Platforms need to be flexible, responsive, and tailored to regional circumstances
• Successful platforms are locally-based
• Leadership across stakeholders is essential to success
• Platforms are partnerships and collaborations
• Advertising and messaging are important
• Platforms use and create data, which must be analysed continuously

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Mahling A, M LeBlanc, & PA Peters. (2020). “Rural Resilience and Community Connections in Health: Outcomes of a Community Workshop.” Spatial Determinants of Health Lab, �Ӱ�ԭ�� University: Ottawa ON. DOI: 10.22215/sdhlab/2020.1.

Full PDF available.

Canadians living in rural communities are diverse, with individual communities defined by unique strengths and challenges that impact their health needs. Understanding rural health needs is a complex undertaking, with many challenges pertaining to engagement, research, and policy development. In order to address these challenges, it is imperative to understand the unique characteristics of rural communities as well as to ensure that the voices of rural and remote communities are prioritized in the development and implementation of rural health research programs and policy. Effective community engagement is essential in order to establish rural-normative programs and policies to improve the health of individuals living in rural, remote, and northern communities.

This report was informed by a community engagement workshop held in Golden Lake, Ontario in October 2019. Workshop attendees were comprised of residents from communities within the Madawaska Valley, community health care professionals, students and researchers from �Ӱ�ԭ�� University in Ottawa, Ontario, and international researchers from Australia, Sweden, and Austria. The themes identified throughout the workshop included community strengths and initiatives that are working well, challenges and concerns faced by the community in the context of health, and suggestions to build on strengths and address challenges to improve the health of residents in the Madawaska Valley.

The objectives of this report are:

• To define rural health in the Canadian context
• To provide an in-depth discussion of both the strengths and barriers impacting the health of residents in Ontario’s Madawaska Valley
• To outline current rural health policy in contrast with the experiences of these communities
• To determine potential future direction and recommendations based on the key findings of this report.

These objectives are met through an overview of rural health challenges in Canada, the identification of themes to highlight areas of importance in the context of health in the Madawaska valley, a brief overview of policy in relation to those themes, and recommendations to address challenges and establish improved rural-normative policy in Canada.

This report places the perspectives of rural residents at the forefront of the discussion and uses the themes, strengths, and challenges identified by workshop participants to frame the discussion and develop recommendations.

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