Community Taxonomies (CPHI, CIHI)Roger Pitblado

Denis HengIrene Koren

Mobility of Healthcare Providers (HHR, CIHI)Roger Pitblado

CPHA Annual ConferenceHalifax, 2008

Canada’s Rural Communities: Understanding Rural Health and Its Determinants

Health

Determinants of

Health

Census(28 variables)

– Demography –Income and Housing affordability–Dependency ratios

CCHS(29 variables)

– Self perceived health status– Use of health care services– Health behaviours

Non-CCHS

(31 variables)

– Death rates due to cancers– General mortality rates– Life expectancy, PYLL, etc.

Based on 138 health regions; ordered by % rural.

Matches: Health Determinants vs Health Status

Work based on 2,071 Census Subdivisions as Communities

61.8

41.8

30.2

52.3

-10.5

37.9

30.2

23.3

-14.0

-26.3

22.3

3.8

-19.3

0.5

-11.4

0 200 400 600 800 1000

Medical sonographers

Audiologists/Speech-language pathologists

Respiratory therapists

Occupational therapists

Medical radiation technologists

Dental hygienists and therapists

Physiotherapists

Dentists

Medical laboratory technologists

Medical laboratory technicians

Pharmacists

Dental assistants

Licensed practical nurses

Physicians

Registered nurses

Number per 100,000 Population

Healthcare Provider to Population Ratios, Canada 2001(Bar figures indicate percentage changes in the ratios since 1991)

750

1,250

1,750

2,250

2,750

3,250N.L

.

P.E

.I.

N.S

.

N.B

.

Que

.

Ont

.

Man

.

Sas

k.

Alta.

B.C

.

Y.T

.

N.W

.T.

Can

ada

Num

ber pe

r 100,0

00 P

opul

atio

n

Other

Technical

Dental

Rehabilatative

Pharmacists

Physicians

Nurses

“Compositional” Healthcare Provider to Population Ratios by Province/Territory and Canada, 2001

“There has been, in fact, very little progress in the comprehensive measurement of the health workforce since the 1964 Hall report.” Haddad and Scully 2002 HealthcarePapers.

“How many regulated and unregulated health care providers move each year and what is the impact of their migration on health care services?” CIHI 2001 Canada’s Health Care Providers.

“Within Canada, inter-provincial migration is not a big concern, although the urban-rural balance is.” Priest, What’s Ailing Our Nurses? CHSRF 2006.

“.. a majority of RNs whose migration is associated with going to school after their initial nursing education, do not return to the jurisdiction where they were first registered.” Pitblado et al. 2005 CJNR.

“In the midst of one of Nova Scotia’s worst health-care labour disputes, disgruntled lab technologists flocked yesterday to the welcoming arms of an Alberta recruiter.” 2001 Canadian Press article, The Globe and Mail.

“Recruitment and retention strategies are being pursued by every province as they grapple with chronic shortages of physicians (both GPs and specialists), nurses, radiation technologists and other professionals. Provincial health ministers are openly complaining about bidding wars between provinces over a dwindling resource pool, with everyone trying to outdo the other with signing bonuses and other contractual bells-and-whistles.” July 28, 2000 Health Edition.

Physician Rural-Urban Migration Counts and Rates

1986 - 1991 1991 - 1996 1996 - 2001Non-movers (Counts)RST 3,092 3,399 3,673LUC 35,290 40,513 43,023

Internal migrants (Counts)RST to LUC 783 821 1,017LUC to RST 417 650 628

Total net-migration to RST -366 -171 -389Migration Rates (%) RSTIn-migration rate 10.8 15.4 13.4Out-migration rate 20.2 19.5 21.7

Net-migration rate -9.4 -4.1 -8.3Source: SMDB, CIHI.

General population -0.0 1.4 -0.9Source: Census of Population, Statistics Canada.

Migration Counts and RatesCensus Migration Periods

All health occupations 0.3 -0.6 0.3

Physician Rural-Urban Mobility

Net-Migration Rates for Large Urban Centre (LUC) and Rural and Small Town (RST) Areas

-3.0

-2.5

-2.0

-1.5

-1.0

-0.5

0.0

0.5

1.0

1.5

8687

8788

8889

8990

9091

9192

9293

9394

9495

9596

9697

9798

9899

9900

0001

0102

0203

0304

1-Year Migration Periods

Net

-mig

ration R

ate

(%)

RST Net-Migration LUC Net-Migration

RST Net-migration By Age Group

To

tal

To

tal

To

tal

20-2

9

20-2

9

20-2

9

30-3

9

30-3

9

30-3

9

40-4

9

40-4

9

40-4

9

50-5

9

50-5

9

50-5

9

60+

60+

60+

-12.0

-10.0

-8.0

-6.0

-4.0

-2.0

0.0

2.0

4.0

6.0

8.0

1986-1991 1991-1996 1996-2001

Mig

rati

on

Rat

e (%

)

All healthcare occupational groups.

-12 -9 -6 -3 0 3 6 9 12 15

Registered nurses

Licensed practical nurses

Medical laboratory technologists

Audiologists/Speech-language pathologists

Physiotherapists

Dentists

Dental assistants

Pharmacists

Physicians

RST Net-Migration Rates (%)

1986-1991 1991-1996 1996-2001

Rural and Small Town Canada Net Migration Rates for Selected Healthcare Occupational Groups for Three 5-Year Mobility Periods

-0.6

-0.4

-0.1

1.7

1.9

0.8

0.6

-4.6

1.6

1.1

-1.0

2.2

-1.1

-1.6

0.0

-2.0

0 5 10 15 20 25 30

Registered nurses

Licensed practical nurses

Medical laboratory technologists

Medical laboratory technicians

Respiratory therapists

Medical radiation technologists

Medical sonographers

Audiologists/Speech-language pathologists

Physiotherapists

Occupational therapists

Dentists

Dental hygienists and therapists

Dental assistants

Pharmacists

Physicians

General population

Percentage Rural

Proportions of Healthcare Workforces Found in RST 2001

(Bar figures indicate absolute changes in the proportions since 1991)

“ .... You can’t use em if they aint there!!!”

Canada’s Rural Communities:Understanding Rural Health and Its Determinants

Component 4.

Geographic Patterns of Healthcare Utilization