The Canadian contribution and data set prepared as part of the Global Media and Internet Concentration (GMIC) project offers an independent academic, empirical and data-driven analysis of a deceptively simple yet profoundly important question: have telecom, media and internet markets become more concentrated over time, or less? Media Ownership and Concentration is presented from more than a dozen sectors of the telecom-media-internet industries, including film, music and book industries.
Canada’s coal-fired electricity regulations were published in 2012 and were the first federal regulations targeting greenhouse gas (GHG) emissions from stationary sources. They have since been strengthened. This case study tells the policy story of how the regulations came about, and how in the space of 18 months the government’s regulatory approach evolved from one based on emissions intensity, to cap-and-trade, to capital stock turnover. It also tells the technical story of how a simple regulation based on the length of time a facility has to operate can still build in elements of trading and other flexibilities. It ends with some observations around lessons learned.
The pollution prevention provisions of Canada’s Fisheries Act, and the regulations made pursuant to those provisions, form the core of Canada’s federal water pollution regime. The Act applies nationally, and the sectoral regulations apply to an ever-expanding list of activities. The regime is actively enforced. The Canada’s Fisheries Act and the Canadian Environmental Protection Act, 1999 (CEPA) 1 together form the key underpinnings for Environment and Climate Change Canada’s pollution regulations. The Canada’s Fisheries Act also takes an unusual approach to pollution prevention: a general prohibition against pollution in the Act itself, while the regulations under the Act permit pollution under specified conditions.
The Canada’s Fisheries Act itself is over 150 years old. Where did the modern regime come from, and how did it take the form it has today? That is the subject matter of this Case Study.
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 Carleton 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 small size coupled with remoteness of rural communities in Canada, Australia, and Sweden introduce challenges in accessing sufficient health services (1-3). The sparse health services in rural areas impose “the tyranny of distance” on rural and remote populations, necessitating lengthy travel times to receive care. Despite the increased challenges rural communities face, a dearth of research on rural health persists, particularly rural youth health (4,5).
A broad scoping review was undertaken to identify literature regarding rural youth health in Canada, Australia, and Sweden. The studies were coded according to
population focus, health focus, access, and general. The scoping review produced the Rural Youth Health Scoping Review Database, which provides an overview of the available research on rural youth health.
Rural and remote communities in both Australia and Canada have a higher burden of mental illness relative to their urban counterparts. Suicide rates, particularly, are higher across all age groups among men in rural communities as compared to metropolitan areas. Mental health issues are especially present in younger populations within these communities. Additionally, rural and remote communities tend to have higher proportions of Indigenous origin individuals, who face additional challenges and service barriers.
Rural and remote communities often encounter significant barriers to accessing mental health care. Individuals from these communities may be serviced solely by general health care providers that are not trained in mental health treatment. Travelling away from the community to alleviate this issue only further hinders accessibility as these individuals must travel larger distances to access specialized health services. When services are accessed, those from rural and remote communities are met with longer wait times than their urban counterparts. With no specialized treatment within the rural or remote community and inaccessible treatment outside the community, mental health care must shift to informal caregivers and the community as a whole.
Rural and remote communities are often not trained in mental health care. Interventions to address rural and remote youth mental health are needed to equip communities with the tools and skills to overcome access barriers and support community members. A review of recent literature related to rural and remote youth mental health interventions was conducted. The aim of the review is to characterize these mental health interventions in Australia and Canada and examine how they relate to youth.
Rural and remote communities in Australia and Canada experience barriers to accessing healthcare services (1). These barriers are especially pronounced when attempting to access more specialized health care services, such as paediatric (2–4). Both countries have implemented programs that aim to bridge the gap between rural communities and specialized healthcare. One such service is telepaediatrics.
Telepaediatrics, as part of telehealth, refers to any paediatric health-related service, network, or medical tool that transmits voice, data, images and information through telecommunication programs as part of providing health services (5–7). Telehealth services are ideal because they remove the need to relocate the rural patient to urban specialist sites (5–7).
In a WHO survey (2010), 60% of member countries had telehealth services in place but only 30% of these programs were implemented as part of routine care (8). Only 3 member countries had established telepaediatric services in place (8). No previous investigations examine the use of telehealth programs in urban versus rural settings (8). This review aims to identify the common barriers to telepaediatric services in rural Australia and Canada and outlines suggestions for future implementation.
Although health care is widely accessible in most developed countries, rural areas often struggle to adequately meet health care needs. Challenges in accessing and receiving adequate health care introduce large variations in disease levels, level of treatment, life expectancy,and overall health status for rural populations. eHealth, or electronic health,defined here as any electronic medium used to access health services,is a method used to bridge the gap between rural and urban centers to improve health care access. Including the above definition, eHealth also includes any technology designed to improve efficiencies and reduce costs in relation to health care. By providing a comprehensive overview of feedback from past interventions, policy-makers and program developers can develop strategies to improve the implementation and the use of eHealth technologies.
A review of recent literature related to eHealth technologies in Canada and Australia was conducted to better understand specific barriers and enablers for the uptake, acceptability, and success of eMental health programs.
It has been shown that the more “rural” or “remote” a community, the access to mental health services decreases. By mitigating barriers and promoting enablers, successful eMental health integration can increase access to mental health services for rural residents.
eMental health aims to bridge the gap between rural and urban mental health services by introducing electronic methods such as teleconferencing or videoconferencing for psychological services, virtual referral to psychiatrists, and sharing of electronic records. Successful integration of the technology remains a challenging task, with key actors, enablers, and barriers all influencing its success.
Rural and remote communities comprise around32% and 22% of Australia’s and Canada’s population. However, only 14% and 16% of family physicians in Australia and Canada, respectively, practice in these communities, resulting in a disproportion in access as compared with urban areas. An erosion of health services occurs when the number of physicians and other health care providers in a region is insufficient or these professionals are non-existent. Even when existing in a rural and remote region, providers are often overburdened. Inaccessibility to services in rural and remote communities’ results in poor health outcomes for all involved.
In Canada, 1 in 7 physicians will leave rural practice within two years. Strategies to address these turnover rates and the lessening interest in entering rural practice have focused on supporting recruitment and retention initiatives (RnR) to first bring physicians into rural practice and then encourage physicians to continue in rural practice beyond the short-term.
These programs have so far been insufficient or ineffective to address the lack of physicians in rural and remote areas. A review of recent literature related to RnR initiatives focused on rural physicians in Australia and Canada was conducted to investigate the strengths and limitations of initiatives. Further, this review critically examines the short and long-term feasibility of initiatives and develops a conceptual framework for designing or examining RnR initiatives.
This report was prepared for the Centre for Rural Medicine in Storuman, Sweden, as part of the Free Range international student exchange program.
See also Carleton's Spatial Determinants of Health Lab: https://carleton.ca/determinants
This report is provides guidance for research teams who are currently planning or are in the midst of
implementing an e-health intervention in rural communities. It describes the important factors which need to be considered when scaling - up a pilot project from one context to another, and demonstrates what a successful project needs to maximize the probability that it will achieve the
desired level of spread within the healthcare system.
This report can be used as a reference for people who wish to implement a novel intervention
into a new environment. Ideally it will be used in the early stages of intervention design to help researchers understand how a complex adaptive system functions and why navigating one is important for the outcome of their intervention. To begin, the report covers some basic terminology used when discussing complex adaptive systems and highlights the importance of working with these ideas moving forward.
Next, in-depth discussions about sense-making, leverage points, self-organization, and agent-based modelling provide evidence of the complexity of implementation. Finally, the principle of antifragility is discussed, as well as a tangible example of an intervention which has been designed with antifragility in mind. Finally, the conclusion summarizes the key findings of the report, offers future directions, and identifies some of the
Special thanks to the Toolkit researchers, including Tara McWhinney, Aaron Kozak and Evan Culic for their contributions towards building this toolkit. Cette publication est aussi disponible en français.
This Community-Based Research Toolkit is intended for community organizations trying to decide if they want to conduct research, and whether they should seek an academic partner to work with to conduct this research. This toolkit is designed as a project development checklist that acts as a guide for things to consider for community organizations conducting a research project.