Rural poverty

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Rural poverty refers to poverty found in rural areas, including factors of rural society, rural economy, and rural political systems that give rise to the poverty found there.[1] Rural poverty is often discussed in conjunction with spatial inequality, which in this context refers to the inequality between urban and rural areas.[2] Both rural poverty and spatial inequality are global phenomena, but like poverty in general, there are higher rates of rural poverty in developing countries than in developed countries.[3] Eradicating rural poverty through effective policies and economic growth remains a challenge for the international community [3][4]

Prevalence[edit]

The first target of the Millennium Development Goals is to decrease the extent of extreme poverty by one-half by the year 2015.[5] Poverty remains a predominantly rural problem,[6] with a majority of the world’s poor located in rural areas.[1] It is estimated that 76 percent of the developing world’s poor live in rural areas, well above the overall population share living in rural areas, which is only 58 percent.[7] Disparities between rural and urban areas is on the rise, particularly in many developing and transitional countries.[2][3] Globally, rural people and rural places tend to be disadvantaged relative to their urban counterparts [8] and poverty rates increase as rural areas become more remote.[9] Individuals living in rural areas tend to have less access to social services, exacerbating the effects of rural poverty.[3]

Contributing factors[edit]

Lack of infrastructure[edit]

Rural poverty is often a product of poor infrastructure that hinders development and mobility. Rural areas tend to lack sufficient roads that would increase access to agricultural inputs and markets. Without roads, the rural poor are cut off from technological development and emerging markets in more urban areas. Poor infrastructure hinders communication, resulting in social isolation among the rural poor, many of whom have limited access to media and news outlets. Such isolation hinders integration with urban society and established markets, which could result in greater development and economic security. Moreover, poor or nonexistent irrigation systems threaten agricultural yields because of uncertainty in the supply of water for crop production. Many poor rural areas lack any irrigation to store or pump water, resulting in fewer crops, fewer days of employment and less productivity. Both a lack of roads and insufficient irrigation systems result in greater Work Intensity in many rural communities.

Researchers at the ODI conducted a literature review to assess the relationship between all types of roads and both their security impacts and the effects of road building on access to for example health and education (service delivery) particularly in fragile, sparsely populated and/or ill-served rural areas in developing countries.

They found no direct evidence relating to the security impact of road infrastructure, and that only theoretical linkages of infrastructure development are discussed in studies. There are various direct and indirect channels through which transport infrastructure may affect security and peace building. They agree that infrastructure programmes can potentially play three roles in a fragile context: as an engine of economic recovery and improved service provision, as part of a process of strengthening institutions, and in stabilisation and peace-building.

They claim the state of evidence regarding these causal links is weak but some aspects of infrastructure development, including but not exclusive to road construction, has been shown to be effective in fragile country contexts. Quick Impact has not yet proven to be effective in enhancing peace building and security in Fragile and Conflict Affected States.

Their literature search presented some evidence of road development resulting in employment sometimes for the most vulnerable and/or poor groups. They found case studies show road development programmes can produce short-term employment opportunities in fragile and conflict affected regions particularly applying to programmes where rural road development is carried out through community-driven development or with special emphasis on inclusion through participatory methods. Evidence is mostly limited to number of hours of employment generated or individuals employed and include little rigorous impact evaluation.

There was also some evidence that rural road construction reduced isolation for minority groups and provided more opportunities for inclusion in wider economic activity. However, this evidence did not relate directly to reducing conflict or improving security. Poverty and isolation literature defines this as access to inputs and output markets, access to education and health services, and access to labour opportunities through which road access contributes to reduced poverty.

Mostly qualitative evidence found suggests that rural road construction or maintenance has a positive impact on public service delivery. In general rural road development leads to improved access of both users and suppliers. This occurs due to a reduction in commuting time, as well transport costs but these benefits tend to accrue disproportionately to the influential and well-educated. Rural communities tend to ascribe great importance to road development and perceive it to improve access to markets, health and education facilities.[10]

Insufficient access to markets[edit]

A lack of access to markets - whether due to poor infrastructure or productivity, limited education, or insufficient information - prevents access to both labor and capital. In many rural societies, there are few job opportunities outside of agriculture, often resulting in food and income insecurity due to the precarious nature of farming. Rural workers are largely concentrated in jobs such as owners-cultivators, tenant farmers, sharecroppers, informal care workers, agricultural day-laborers, and livestock herders. Without access to other labor markets, rural workers continue to work for extremely low wages in agricultural jobs that tend to have seasonal fluctuations and thus little income security. In addition to labor, the rural poor often lack access to capital markets and financial institutions, hindering their ability to establish savings and obtain credit that could be used to purchase working capital or increase their supply of raw materials. When coupled with scarce job opportunities, poor access to credit and capital perpetuates rural poverty.[3]

Lack of non-motorised load-carrying wheeled vehicles (handcarts and wheelbarrows)[edit]

Numerous international development organisations have studied, reported, recommended and agreed that lack of mobility impedes human progress and development. Yet there is very little evidence of anyone attempting to actually address and alleviate the problem by introducing handcarts and wheelbarrows into remote and rural areas where they would be most beneficial.

Rural versus Urban Poverty--United States[edit]

In the United States, where rural poverty rates are higher and more persistent than in urban areas, rural workers are disadvantaged by lower wages and less access to better paying labor markets.[8] As a result, underemployment and informal work are more prevalent in rural areas, and where formal employment is found, it acts as less of a buffer against poverty.[8] As a result, rural poverty in the U.S. is more persistent than urban poverty – 95 percent of persistent poverty counties in the U.S. are rural, while only 2 percent of persistent poverty counties are urban.[9]

Opening up of economies to international trade[edit]

Some macro-level economic changes have been associated with an increase in spatial inequalities.[2] There have been numerous studies showing a link between more open trade, accompanied by other neoliberal policies, and higher incidences of rural poverty and spatial inequalities[11][12][13][14] In China, for example, greater trade openness provides at least partial explanation for more pronounced rural-urban disparities,[11] and in Vietnam, trade liberalization has resulted in higher poverty rates in rural areas.[14] Both of these nations demonstrate that despite greater openness and growth, spatial inequalities do not necessarily decrease accordingly with overall economic growth. Moreover, the promotion of export-oriented agriculture has been linked to decreased food security for rural populations.[15][16]

Education and social service inadequacies[edit]

In many rural societies, a lack of access to education and limited opportunities to increase and improve one’s skillset inhibit social mobility.[3] Low levels of education and few skills result in much of the rural poor working as subsistence farmers or in insecure, informal employment, perpetuating the state of rural poverty. Inadequate education regarding health and nutritional needs often results in under-nutrition or malnutrition among the rural poor. Social isolation due to inadequate roads and poor access to information makes acquiring health care (and affording it) particularly difficult for the rural poor, resulting in worse health and higher rates of infant mortality. There have been noted disparities in both Asia and Africa between rural and urban areas in terms of the allocation of public education and health services.[4][17]

Case study: Africa[edit]

A study of 24 African countries found that “standards of living in rural areas almost universally lag behind urban areas.” [17] In terms of education, school enrollments and the ratio of girl-to-boy enrollments is much lower in rural areas than in urban areas. A similar trend is found in access to neonatal care, as those living in rural areas had far less access to care than their urban counterparts. There are also far more malnourished children in rural areas of Africa than in urban areas. In Zimbabwe, for example, more than twice the share of children are malnourished in rural areas (34 percent rate of malnourishment) than in urban areas (15 percent rate of malnourishment). Inequality between urban and rural areas, and where rural poverty is most prevalent, is in countries where the adult population has the lowest amount of education. This was found in the Sahelian countries of Burkina Faso, Mali and Niger where regional inequality is 33 percent, 19.4 percent, and 21.3 percent, respectively. In each of these countries, more than 74 percent of the adults have no education. Overall, in much of Africa, those living in rural areas experience more poverty and less access to health care and education.[17]

Women and rural poverty[edit]

Rural women are particularly disadvantaged, both as poor and as women.[3] Women in both rural and urban areas face a higher risk of poverty and more limited economic opportunities than their male counterparts.[18] The number of rural women living in extreme poverty rose by about 50 percent over the past twenty years.[3] Women in rural poverty live under the same harsh conditions as their male counterparts, but experience additional cultural and policy biases which undervalue their work in both the informal, and if accessible, formal labor markets.[19] The 2009 World Survey states that “women play an active role in agriculture and rural livelihoods as unpaid family labour, independent farmers and wage labour, often without access to land, credit and other productive assets.” [19] Women’s contribution to the rural economy is generally underestimated, as women perform a disproportionate amount of care work, work that often goes unrecognized because it is not seen as economically productive.[20] Though in some nations, cultural and societal norms prevent women from working outside the home, in other countries, especially in rural communities in Africa, women work as major food producers, improving household food and income security.[19][20] Families in extreme poverty are even more dependent on women’s work both inside and outside the home, resulting in longer days and more intense work for women [20] The feminization of poverty is a concept that is applicable in both urban and rural settings.

Policies to combat rural poverty[edit]

Land reform[edit]

Access to land can alleviate rural poverty by providing households a productive and relatively reliable way to make an income.[3] The rural poor often have less access to land, which contributes to their poverty. The rural poor’s access to land can be improved by redistributing land from large farms above a certain size, government legislation that challenges some traditional land systems that keep land concentrated in the hands of a few, and settlement schemes which involves providing poor rural families parcels of newly developed or government owned land. Achieving legislative reform and implementing redistributive policies, however, is a difficult task in many countries because land ownership is a sensitive cultural and political issue. Yet in China, for example, land redistribution policies have found some success and are associated with a reduction in rural poverty and increased agricultural growth.[6][7]

Women and land reform[edit]

The development of legal measures to improve women’s access to land is linked with achieving greater gender parity.[19] This requires women to have the legal right to own land, as well as designating women as individual or joint owners of land parcels redistributed during reform. It also involves allowing women to have separate tenancy rights and granting women the right to claim an equal share of family land and resources upon divorce, abandonment, widowhood, and for inheritance purposes.[3] A lack of access to land and property is linked to poverty, migration, violence, and HIV/AIDS.[19] Increasing a woman’s access to land not only benefits herself, but also benefits her family and community both in terms of increased productivity and improved welfare for her children.[20] Beyond just legislative reform, for laws to actually guarantee women the right to land and equal inheritance, they need to be enforced; in numerous countries, despite women achieving equal land rights, long-standing social and cultural norms continue to bias policy implementation.[3][19]


Case study: Bangladesh[edit]

Improved infrastructure in Bangladesh increased agricultural production by 32 percent through its effect on prices and access to inputs and technology.[21] Improving roads and transportation systems also resulted in a 33 percent increase in the household income of the poor through the ability to diversify production, as well as an increase in savings and investment and better access to financial credit. Moreover, because of increased mobility among rural households, a rise in access to social services was noted, as well as an increase in overall health.

Technology[edit]

The development of appropriate technology can raise a farm’s productivity.[3] Successful technological developments that aid the rural poor are achieved through bottom-up policies that involve technological innovations that require few external inputs and little monetary investment. The most effective innovations are based on the active participation of small farmers, who are involved in both defining the problems and implementing and evaluating solutions. Smallholder technological developments have focused on processes such as nutrient recycling, integrated pest management, integration of crop agriculture and livestock, use of inland and marine water sources, soil conservation, and use of genetic engineering and biotechnology to reduce fertilizer requirements.

Access to credit[edit]

Providing access to credit and financial services provides an entry point to improve rural productivity as well as stimulating small-scale trading and manufacturing.[1][3] With credit, rural farmers are able to purchase capital that increases their productivity and income. Increased credit helps expand markets to rural areas, thus promoting rural development. The ability to acquire credit also combats systems of bonded or exploitative labor by encouraging self-employment. Credit policy is most effective when provided in conjunction with other services such as technology and marketing training.

Diversification[edit]

Agricultural diversification can provide rural families with higher income and greater food security.[3] Diversification, or a reallocation of some of a farm’s productive resources, reduces farming risk, especially risk related to unpredictable or extreme weather that may be due to climate change. Policies related to diversification have also focused on crop rotation to increase productivity, as well as improving the production of traditional food crops such as cassava, cowpeas, plantains, and bananas rather than promoting the growth of more precarious cash crops. These crops tend to be at the core of farming systems among the rural poor and are generally more drought resistant and can survive under poor soil conditions. Improving the productivity and marketing of these crops promotes food and income security among rural households.[3]

Rural Poverty in Canada[edit]

Access to Care[edit]

Nursing Government[edit]

Nurses have been self governing within the province of Ontario since 1963.[22] The College of Nurses (CNO) assure that all nurses within the province are registered through the CNO and that all nurses meet the requirements established by them. Requirements are based on knowledge and expertise of practice and that all nurses work within their scope of practice.[22] Self governing occurs when the body of professionals are governed by members of its own profession.[23] Nurses in Ontario have the responsibility to work according to professional standards and Code of Ethics.[24] Nurses can contribute to the making of regulations and standards by providing knowledge from evidence based practice, as well as theoretical knowledge to help ensure best practice when providing quality care.[24] Regulatory bodies are responsible for ensuring that all who practice nursing are competent and continue to build on their skills through continuity of education and skill development.[24] “Regulatory bodies develop and maintain standards of nursing practice that specify the level of performance expected of registered nurses to provide safe, competent and ethical care".[25] Nursing Practice standards are put in place to provide the public the same quality of care despite location. The CNO is responsible for providing quality care to the public including making healthcare accessible.

Barriers to Accessing Health Care[edit]

For those living in rural Canada, they may face various challenges when trying to access health care. Difficulties which rural areas experience when accessing health care include long distances between health services, lack of transportation, increase amount of elderly, fewer health care providers, and limited awareness of resources available.[26] To receive Federal funding from the government, the Canada Health Act acknowledges that five principles must be met, these include universality, accessibility, comprehensiveness, portability, and public administration.[27] For those living in rural communities, these five principles are not always met. With 90% of Canada identified as geographically rural, and approximately a quarter of the population are dwelling within rural areas with less than 10,000 people, this is a concern when identify health barriers.[28]

Health care is considered accessible when within a 30-60 minute drive in rural settings, and emergency vehicles are considered accessible when there is less than a thirty minute drive.[29] This is a concern in emergency situations as an individual has a long wait time before being provided medical attention. Transportation is a significant factor that is a barrier to accessing health care. In rural areas an individual may have to travel great distances to seek medical attention, road quality may be very poor, weather conditions effecting driving, and rural areas seldom have access to public transportation.[30] The elderly have the greatest need for transportation services, a challenge to this is services is they may have to be booked a week in advance.[30] Also, with the baby boom generation, there will be an increasing number of elderly needing access to health care. A large percentage of people over 65 have a number of comorbidities, and need regular visits to a family doctor, the cost of regular transportation to a healthcare provider can be substantial. For many living in rural poverty, financial difficulties impede a person from being able to own a vehicle.[31] The need for transportation to health care will only decrease when there is greater availability to health care programs, this involves bringing more health care providers to rural areas.[30]

Other factors affecting rural poverty and accessing health care are lower socioeconomic status. Although the Canada Health Act provides everyone with access to health care without financial obligation, people of lower socioeconomic status typically had lower education level and were less likely to seek medical advice from a health care professional.[32] Other health risks associated with low income and low education are an increase in high risk behaviors leading to poor health including smoking, obesity, and substance abuse specifically alcohol.[33] People of higher income have means to pay for resources which could improve health, such as weight loss programs, gym memberships, smoking cessation programs, rehabilitation facilities where as people of lesser income are unable to pay for privately owned health enhancing programs.[33] The low income families continue with the high risk behaviour despite limited finances this includes smoking and the price of cigarettes.[33] People of lower socioeconomic status are less likely to look long term at their health compared to higher income families who would be more likely to contribute to program to benefit their health.[33] Those of higher socioeconomic status are more likely to think of long term health and take preventative measures to promote good health.[33]

Resource Accessibility[edit]

Rural areas struggle with being able to provide resources to people within their community to help reduce the challenges of social poverty. Many living within poverty need assistance from food shelters, homeless shelters, drug and alcohol abuse programs, counseling programs, and women’s shelters.[31] Many of these programs in rural communities are organized by volunteers which may have little or no training, and the buildings which the programs are run from may be lacking in suitable infrastructure.[31] There may be limited funding available to these programs which effects staffing and resources which can be provided to those seeking assistance. Individuals at risk for living in poverty are those with mental health issues, disabilities, single mothers, individuals suffering from addiction, and immigrants unable to speak English.[31] This is challenging as resources established to support disadvantaged groups are closing as a result of little funding and inability to effectively support these groups. The individuals seeking the assistance are left to cope on their own. Community donations and volunteers play a large role in community support remaining open to the public in rural setting.

Physician Accessibility[edit]

The Canadian public feel that accessing health care is perceived as poor, people wait longer periods of time to see physicians.[34] There are increasing number of health practices being privatized which decreases the accessibility for those living in rural poverty. There a few physicians available to support this population. With around 20% of Canadians residing in rural Canada, only 8% of the physicians practice within this area.[26] Lacking in rural areas is the number of health specialists accessible to Canadians.[35] An average of 4 million Canadians go without a family physician.[36] There is also a high physician turnover rate in rural areas due to increased workload, geographic and social isolation.[37] This can be challenging as many individuals who seek specialized care need to have a referral from a family physician.[37] When there is a high physician turnover rate then individuals are having to develop a trusting relationship and provide previous medical history to a new family physician. This beings challenges as some relationships take years to develop trust with a family physician, and a bad experience with one can bring challenges when having to transfer to a new physician.

“Rural communities are understood as places with small populations, limited material and financial resources, and a heightened vulnerability to health service and health human resources shortages as a consequence of their distance from urban centres”.[38] With rural areas having a high population of elderly an increasing number of individuals living with one or more chronic illness, the need for rural area physicians and specialists are rising.[37] Chronically ill patients account for over half of family physicians visits.[37] In Canada, individuals who need to see a specialist wait an average of four weeks to three months.[39] This increases health risk for those living in rural poverty, as there is a greater difficulty accessing health care. There is an increase in number of those living with chronic illness, greater elder population, and fewer health care professionals available in rural communities.[37] For those living in rural poverty, the Canada Health Act ensures that health care is provided at no financial expense including hospital care, surgical procedures, dental surgeries, primary care doctors, and specialists are covered through provincial health insurance plans.[40] This enables individuals to receive care despite being unable to pay for care.[40]

Vulnerable Populations[edit]

Poverty among rural Canadians is a continuing issue within Canada. Although rural living can be challenging for any population, there are several groups in which are considered more vulnerable to poverty.[41] Several contributing factors such as employment, education, geographical location, cost of living and low income are definite issues among these specific groups.[42] With that being said, many of these populations are finding themselves struggling to keep above the poverty line.[42]

Single Parent Families[edit]

Lone families or single parent families are incredibly susceptible to poverty in Canada, especially those who reside in rural areas. Although single male parent families are at risk, families with a woman as the only parent are at a much greater risk.[43] Women who are raising their families on their own are at a huge risk for poverty among Canada.[44] Women in rural Canada are at disadvantage for employment opportunities due to the lack of jobs within the community. Formal education is also a challenge for rural women because of the general low income status and high cost of education. Without formal education, rural women often cannot find good paying jobs that provide stability and benefits to support their families. In order to find affordable housing for a single parent income, one must often look outside of town to more remote areas. Although housing is cheaper, the employment opportunities decrease; causing women to look for employment closer to town or within the community.[45] By having to travel to work, vehicle costs or alternative transportation costs are increased. Wages in rural Canada are lower than those in urban areas, which contributes to the overall lower income and poor income status among these families. For women supporting a family, the poor wages, low employment rate, high cost of living and lack of financial support are the risk factors in which increase the incidence of poverty among this population.[45] This creates a huge expense for travel and transportation, as well as child care. If the children in the family attend school, transportation to school is often limited to those residing in remote areas. Providing or paying for alternative transportation for children to attend school is also an additional cost.[45]

The Elderly[edit]

Elderly people living in rural areas are at an increased risk for poverty in rural areas in Canada.[43] Elderly individuals, especially one family women, in rural Canada are at a great risk for poverty and low economical status. With a more direct focus on elderly poverty, rural women over the age of 65, are found to have a much lower annual income than adults living in non-rural communities. Over 19% of women over the age of 65 were living in poverty in Canada, as opposed to 10% of elderly males. There are several factors that put the rural elderly, especially women, at risk of poverty.[46] Annual income for the elderly in rural areas is much lower than those in urban areas. Rural women over the age of 65 had the least amount of public sector funding and government support out of all of the Canadian populations.[47] Only 41% of their annual income was through financial support, meaning that they are required to rely on their pension or personal savings to support themselves. For many, this is not enough to meet their daily living needs, let alone health care expenses and additional cost of living expenses.[48] Due to the decreased population density in rural areas in Canada, there is a mass shortage of public services that are offered to individuals. Although all populations are affected, the elderly experience a major negative impact.[49] For example, transportation becomes a major issue. More than 25% of the elderly living in rural areas did not own or have access to a car. This means that other means of transportation is required; however there are very limited public transportation services available, especially for individuals living in extreme remote areas.[49] Finding methods of transportation can become expensive and often discouraging for elders. The elderly in rural Canada often live in older, single family homes that often have larger property sizes. Maintaining a home is costly.[49] Maintenance such as cutting the grass or shoveling snow can be too much for the elderly to complete, therefore help is needed in order to keep up. In rural areas, public services are often hard to find and can be expensive.[49] Maintaining their homes can create an added cost to individuals, whereas in previous year they would have been able to perform these tasks themselves. With the lack of services, the elderly often find they are unable to maintain their homes or perform maintenance duties.[49]

Children and Young Adults[edit]

Children living in rural Canada are negatively affected by poverty and low income situations; especially children from single parent families. Single parent families in rural communities are more likely to have a low income and poor economical status.[49] Child poverty is an issue in rural Canada due to the decreased job opportunities and stability for families in low income situations. In addition, financial support is often not enough to ensure the children are provided with the basic essential of daily living.[50] Children who grow up in poverty are less likely to improve their economical status as they grow older. Children of poverty are less likely to achieve a high school diploma or a post secondary education, due to the financial strain of the family and inability to afford to get to school or to move away.[49] This same idea ties into the issues of young adults and rural areas. Young adults in rural Canada are extremely susceptible to poverty for many additional reasons. Jobs are incredibly hard to find for young adults because of their lack of experience. Employers will often require experience in order to be a successful candidate. With the huge shortage of jobs already existing, young rural Canadians find it challenging to start their careers.[51] In addition, formal education or post secondary is often set aside because of the lack of funding and affordability to leave their community. There are very few post secondary institutions located in remote and rural Canada, meaning that most people would have to travel or relocate in order to attend.[51] This is often impossible for those living in these communities. Furthermore, financial assistance or employment insurance is not always an option because in order to be eligible, one must obtain a specific amount of working hours. If a young adult is unable to find work, this type of assistance would be denied due to the lack of worked hours and employment.[44]

Aboriginals[edit]

Canadian aboriginal people living in rural areas are considered among the poorest populations.[52] There are several factors in which contributes to poverty among aboriginals in Canada.[53] Despite many beliefs, poverty risk factors continue to exist for aboriginals living on and off the reserves [54] Although the Canadian aboriginal population living off of the reserves are at risk of poverty, individuals living on the reserves demonstrate a much greater risk.[55] Lack of employment, poor paying jobs, alcohol abuse, poor access to health care and low education levels are all areas in which contribute to the increased risk of poverty.[56] The overall earnings of aboriginal Canadians living in rural areas in significantly lower than non-aboriginals living in more urban areas.[53] Many Canadian aboriginals reside on reserves where their families grow and their communities develop. There is a massive job shortage among these reserves. With that being said, many attempt to seek employment outside of the reserves within the rural community.[57] However, due to the remote and isolated geographical location of many aboriginal communities, jobs are scarce even off of the reserves. Within the Algonquin native reserves, approximately 90% of the residents are unemployed. For aboriginal’s who are employed and living in rural areas, they are paid much less than those living in more urban areas.[58] Wages in rural Canada are typically much lower than those in urban areas, simply because the economical status of rural communities are often lower and small businesses cannot afford to pay large wages to their employees.[58] Also, many of the rural jobs are seasonal or temporary for these individuals, meaning that they may be out of work for many months of the year.[58] In addition, the cost of living is a major contributor to aboriginal poverty in rural Canada. The cost of food and daily living supplies are more expensive in rural areas than in urban cities.[58] This is because the cost to transport these supplies to rural distributors is much more. Although some rural housing and land may come at a lower cost than urban areas, the maintenance and up-keep of the housing is a costly factor that contributes to poverty among aboriginals.[58] While the education rate among Aboriginals living in rural Canada is much lower than urban areas, there is vicious cycle that occurs when examining the correlations.[43] Among aboriginal Canadians, on and off the reserve, 32% have not achieved their high school diploma, as opposed to 15% of non-aboriginal Canadians.[59] On the other hand, approximately 8% of aboriginal men in Canada have a university degree, as opposed to 25% of non-aboriginal men.[59] There are several reasons in which contribute to the gap in educational levels. For rural aboriginals in Canada, poverty can affect the availability as well as eliminate educational options. Some individuals find that they have to leave high school in attempt to find a job to help support their struggling families.[60] Post secondary school is incredibly expensive, and for people living in poverty, college or university is not a realistic goal.[43] Therefore, the vicious cycle takes place. People cannot find jobs because they do not have the educational background, but in yet their families cannot afford the cost of education.[60] In terms of gender and aboriginal poverty in Canada, there does tend to be a gap between aboriginal men and women when it comes to income and economical status.[61] Among aboriginal individuals living in rural Canada, women are less likely to have employment and often have a much lower annual income.[61] In many cases, aboriginal women are the primary caregivers for their children and the elderly in their families.[61] Women who are able to seek employment often have difficulty due to the job shortages, as well as requirements for education and experience.[62] This can cause a serious financial strain on the families, especially for single parent families trying to manage all of their expenses.[62]

Individuals with Disabilities[edit]

Individuals with disabilities living in rural Canada are at high risk of living in poverty. Disability is defined as a long term difficulty with daily living activities such as mobility, learning, hearing or communicating.[42] People living with a disability may find it challenging to work, depending on their condition. Among the rural jobs, many of which involve physical labor and less than ideal working conditions.[63] Some individuals with disabilities would be unable to work in these conditions. This contributes to the risk of poverty among rural residents, because the inability to work has a significant impact on their income.[63] Disability support services are available; however the cost of living is incredibly high. Especially for those living in rural areas, home care and home services are limited which creates a challenge for some. In addition, rural living has an increased risk of injury due to the remote locations and few health services. This also because a challenge for individuals with a disability.[42]

Lack of Resources[edit]

Health Conditions[edit]

Health Outcomes[edit]

Rural Poverty Affect on Health Outcomes[edit]

People in rural areas experiencing poverty are having poorer health outcomes than their urban counterparts as evidenced by admission rates, recovery length and complications, and lack of social and nursing supports.

Admissions[edit]

Canadians living in rural poverty are facing poorer hospital outcomes. When looking at Canadians diagnosed with congestive heart failure being admitted to hospital, lower admission rates were found in metropolitan areas than non metropolitan areas. A visit to a metropolitan hospital costs more as they are more services such as angiography available to metropolitan citizens.[64] Hospital admissions are also greater at the end of life for rural Canadians living in poverty relative to their urban counterparts due to lack of end of life outpatient services [65]

Recovery[edit]

The recovery process of Canadians after surgery and risk of infection can be increased by a short length of hospital stay, alcoholism, diabetes, obesity, and living in a rural residency. Rural poverty potentiates the risk of post-op infection as well. Alcoholism, diabetes and obesity are often health outcomes related to rural poverty which makes recovering from any illness of surgery more difficult for Canadians living in rural poverty[66]

Social supplementary=[edit]

Rural Canadians who live in poverty have a difficult time accessing care and social supports. This includes the availability of health care resources and number of health care professionals that are accessible to these citizens. The lack of access and available supports directly affect the health of rural Canadians living in poverty [67]

Social Determinants of Health and Health Outcomes[edit]

The poor health outcomes mentioned seem to be a product of the impact of social determinants of health in a rural setting for a person living in poverty. Social determinants of health are strong contributors of respective health outcomes education.[68] Causes of poverty in rural areas includes low income, lack of employment, the high costs of new housing construction, poor quality of housing (leading to higher costs for heating), poor health and lack of healthcare within a reasonable traveling distance, and low levels of education.[68] All of which are related to social determinants of health and impact health outcomes for those living in poverty. Specific social determinants of health that contribute to rural poverty and poor health outcomes include: income, employment and working conditions, economy, population demographics, housing, health, education, child and youth development, gender, and culture.[69] Social determinants of health are extremely relevant to the cause and effect of rural poverty and health. For example those living in lower-income households tend to live in older, poor quality housing units which are often inadequately insulated and have high heat and utility costs.[70] This poor heating can affect health, and the high utility costs are often unrealistic for Canadians living in rural poverty. Also, the cause and effect element of rural poverty is certainly evident when looking at food as a critical component to health and a product of income. Many Canadians living in poverty find themselves without adequate food, or are unable to afford the appropriate groceries to support their family and their own nutritional and developmental needs.[71] It can be even more difficult for rural Canadians living in poverty as they have less access to social supports because of the greater distances between rural and urban centres, and cannot spend the money on gas and transportation to seek food security within urban areas where supports are often located [71]

Health Disparities[edit]

Poverty in Canada has extensive influence on the quality of many aspects of life for rural citizens. With social determinants of health in mind, poverty in rural areas can cause out-migration and population decline, poorer education outcomes, poorer employment opportunities due to transportation costs and child care costs, poorer living and eating conditions.[72] All of which directly affect health. The lack of education, employment and then income levels affect a rural Canadian’s ability to travel for work, or afford groceries. When the necessary social determinants of health are not being met, it has a direct affect on health outcomes for rural Canadians, and creates a strain or the few social supports available within rural communities.[72] Poverty also influences the personal life choices of those living in rural areas as they develop coping methods to face daily challenges which affect health as which creates the recognition that personal life “choices” are greatly influenced by the financial circumstance that people live with.[73]

Recognizing the Gap[edit]

There is clearly a difference between rural and urban poverty in Canada and their respective health outcomes. When comparing rural and urban residents, rural Canadians tend to have lower education levels, lower levels of literacy, lower incomes, fewer job opportunities, fewer higher paying job opportunities, more seasonal employment, more housing that is in need of repairs, poorer health, and poorer access to health care services than urban Canadians.[72] In regards to health outcomes, and health care services related to stroke specifically, an association has been linked between low income, low hospital volume, and poorer stroke outcome.[74] This suggests that Canadians of different socio-economic groups may have equal access to health care facilities, but the quality of said facilities is often reflection of financial status of the residents of the area. The high-volume, urban hospitals are often not easily accessible to Canadians who live in rural poverty, magnifying the gap between rural and urban stroke outcomes, and overall health status [74]

Closing the Gap[edit]

In a response to the poor health outcomes and health disparities specific to rural poverty in Canada, there have been many coalitions and initiatives that nurses, physicians and researchers are attempting to implement in order to close the gap between rural and urban health outcomes.[75] Changes in research are being called for as there is an evident lack of research that focuses on rural poverty, but plenty of studies done for urban poverty in Canada.[76] Nurses and organizations are recognizing areas for further research in areas such as rural immigrants, foreign migrant workers, rural family violence, labour force mobility of low income households, barriers specific to rural health settings, rural aboriginal homeless, rural adolescents, and more longitudinal studies measuring long-term outcomes related to health care gaps.[77] More information on rural poverty in Canada would aid in the evolution of much needed interventions towards ending the long-term poverty found in rural Canada.[78] Many studies have illustrated the need for rural networks and supports to address a broad spectrum of personal and social needs. Unfortunately many of these “solutions” only provide short term fixes and are not able to work long term to assist rural Canadians in their journey out of poverty.[79] One successful group “The Nurse-Physician Collaborative Partnership” was developed to provide improved access and quality of services to chronically ill elderly living in rural areas by sharing the care between the two professions. The partnership found that interdisciplinary homecare was beneficial, reduced cost and improved health outcomes.[80] This approach also reported high levels of patient satisfaction.[80] Patients favoured the in-home interventions implemented by the nurse and physician collaboration as it decreased cost expenses of traveling and made receiving care possible if a lack of transportation was available. The collaborative partnership reduced patient anxiety about their health concerns and increased their confidence in managing their own health issues.[81] The program addressed several common health outcomes of rural Canadians living in poverty as it reduced the number of hospital admissions, length of hospital stay, the number of emergency room and ambulatory care visits, and the number of tests needed [81]

See also[edit]

References[edit]

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Further reading[edit]

Arcury, T. A., Preisser, J. S., Gesler, W. M., & Powers, J. M. (2005). Access to transportation and health care utilization in a rural region. The Journal of Rural Health, 21(1), 31-38.

Barnes, Nancy & Bern-Kluf, Mercedes (2010). “Income characteristics of rural older women and implications for health status”, Journal of Women & Aging, 11(1): 27-37.

Burns, Austra, Bruce, David & Marlin, Amanda (2013). “Rural Poverty: Discussion Paper”, 1-89

Daneman, N., Lu, H., & Redelmeier, D. (2010). Discharge after discharge: predicting surgical site infections after patients leave hospital. Journal Of Hospital Infection, 75(3), 188-194. doi:10.1016/j.jhin.2010.01.02

Jin, Y., Quan, H., Cujec, B., & Johnson, D. (2003). Rural and urban outcomes after hospitalization for congestive heart failure in Alberta, Canada. Journal Of Cardiac Failure, 9(4), 278-285

Menec, V., Nowicki, S., & Kalischuk, A. (2010). Transfers to acute care hospitals at the end of life: do rural/remote regions differ from urban regions?. Rural & Remote Health, 10(1), 1-12 Mitton, C., O'Neil, D., Simpson, L., Hoppins, Y., & Harcus, S. (2007). Nurse-physician collaborative partnership: a rural model for the chronically ill. Canadian Journal Of Rural Medicine, 12(4), 208-216

Saposnik, G., Jeerakathil, T., Selchen, D., Baibergenova, A., Hachinski, V., & Kapral, M. (2008). Socioeconomic status, hospital volume, and stroke fatality in Canada. Stroke (00392499), 39(12), 3360-3366