Problems with Rural Health Data Organization

In the context of rural health data, the foremost concern is that existing data are not widely accessible or organized in a way that is optimal for rural community service planning.¹ Current data structures have largely been developed through top-down approaches where regional and urban centres perspectives are privileged. For example, cancer care outreach is likely to be well organized while local primary care and generalist enhanced skills are often completely overlooked. While useful in providing a high-level view of the general population, this approach can obscure rural community realities and compromise effective planning at the local level. As a result, rural communities are all too often left underserved and neglected by an inadequate system.

Researchers at the Centre for Rural Health Research (CRHR) describe the challenges associated with small rural community data being overwhelmed by  larger community data when both are included in the same analysis. For example, when including data from both Prince George and Mackenzie, data from the much smaller community of Mackenzie could easily be overlooked.² Community Health Service Areas are an attempt by the Government of BC to break up the larger Local Health Areas into smaller community focussed areas. While this is laudable, the top-down specialist service planning framework continues to shine through. Data for communities like Mackenzie, for example, are interpreted through a series of databases organized to reflect cancer, transplant, and cardiac care, among others, rather than a bottom-up perspective that reflects the realities of the generalist care provided by local health care providers.² The residents of Mackenzie need local care provided by local health care teams and data that are guided by local administrators. Innovation at the local level can be monitored and evaluated based on efficacy and effectiveness. This is particularly important as the existing evidence supports the importance of primary care to the health of the population rather than the sophistication of sub-specialist services.³  Rural communities are served by generalists with enhanced skills and are in an ideal situation to generate evidence as to the efficacy and effectiveness of innovations in care. As we face increasing challenges associated with overarching ecosystem disturbances such as a global pandemic and climate hazard events this will become increasingly important. When attempting to address the health and climate challenges of rural communities, we must acquire the right kind of data. Rural data must be locally relevant and aligned with the specific question or challenge at hand in terms of type (quantitative, qualitative, longitudinal, etc.), scope (demographics, region, sample size, etc.), and scale (federal, provincial, regional, etc.).

Furthermore, what our current systems have failed to adequately recognize is the reality of rural-regional-urban interdependence. The failure of health services in a rural community is not only difficult for the local population but translates into stress on the regional and even urban centres which consequently, must adapt to support rural patients seeking care in urban areas.⁴ This stress, and the associated dysfunction, have been worsening for a long time but the pandemic and climate events have greatly accelerated the decay of the system and largely overwhelmed our ability to cope. The healthcare system is broken in many rural communities and fractures are apparent from rural to urban. Not only is there an urgent need to prioritize the health and capacity building of rural communities for their own benefit, but also to maintain the well-being of the larger system which is strongly influenced by rural sustainability. This has recently been evident in BC with challenges to sustaining care in regional centres such as William’s Lake, Kamloops, and Fort St. John, which has, in turn, has put increased stress on centres like Prince George and Vancouver.^5,6 A greater appreciation for the relationship between urban and rural contexts will initiate productive systems change driven by mutual benefit across the system.