1. Community Taxonomies (CPHI, CIHI) Roger Pitblado Denis Heng Irene Koren Mobility of Healthcare Providers (HHR, CIHI) Roger Pitblado CPHA Annual Conference Halifax, 2008 Canada’s Rural Communities: Understanding Rural Health and Its Determinants

3. Health Determinants of Health

5. 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.

6. Based on 138 health regions; ordered by % rural. Matches: Health Determinants vs Health Status

7. Work based on 2,071 Census Subdivisions as Communities

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

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

11. “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.

12. “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.

13. Physician Rural-Urban Migration Counts and Rates All health occupations 0.3 -0.6 0.3

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

15. All healthcare occupational groups.

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

17. Proportions of Healthcare Workforces Found in RST 2001 (Bar figures indicate absolute changes in the proportions since 1991)

18. “.... 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