Health Care in Rural Communities: Exploring the Development of Informal and Voluntary Care

Nation-state restructuring has resulted in significant political, economic and social change in rural communities. One manifestation of this transformation has been the changing nature of local governance, characterised by the re-working of central-local relations and public- private responsibilities, such that local informal and voluntary sectors now play an active and direct role in the organisation and delivery of health care services. This paper investigates the relationship between the changing nature of local governance and the provision of health care services, and places it within the context of rural communities and population aging in Canada. In particular, it considers the ascendancy of informal and voluntary sectors with respect to homecare in rural Ontario, and features an analysis of data from the National Population Health Survey and the National Survey of Giving, Volunteering and Participating, representing user (demand) and provider (supply) perspectives respectively. The results provide a cross-section of informal and voluntary home care in the late 1990s, which indicates that informal and voluntary sectors are major players in the local organisation and delivery of health care services in rural communities. This suggests that the current state of health care provision in rural communities of Ontario is affected very much by the changing nature of local governance associated with restructuring. The 'snap-shot' of health care in rural communities presented in this paper highlights the need to examine further the relationship between governance and health care services at the local level. It also points to the need for more detailed data sets that integrate health, informal and voluntary care data at meaningful geographical and administrative scales to reflect clearly rural communities in Canada.health care; rural communities

Aging and Health: An Examination of Differences between Older Aboriginal and non-Aboriginal People

The Aboriginal population in Canada, much younger than the general population, has experienced a trend towards aging over the past decade. Using data from the 2001 Aboriginal Peoples Survey (APS) and the 2000/2001 Canadian Community Health Survey (CCHS), this article examines differences in health status and the determinants of health and health care use between the 55-and-older Aboriginal population and non-Aboriginal population. The results show that the older Aboriginal population is unhealthier than the non-Aboriginal population across all age groups; differences in health status, however, appear to converge as age increases. Among those aged 55 to 64, 7 per cent of the Aboriginal population report three or more chronic conditions compared with 2 per cent of the non-Aboriginal population. Yet, among those aged 75 and older, 51 per cent of the Aboriginal population report three or more chronic conditions in comparison with 23 per cent of the non-Aboriginal population.Aboriginal people, health status, health care use

Remaking Medical Geography

Medical geography has a long tradition of examining the spatial distribution of diseases and medical care resources. With the shifts in theory, methodology, and changing health issues, medical geography is remaking itself in three complementary modalities. First, in taking into account new theories it is remaking itself as the geography of health and health care. Secondly, in taking into account new methodologies, it is contributing to the global interest in seeking new ways of understanding the spatial distribution of diseases and medical resources. Thirdly, in focusing on issues such as HIV/AIDS, health and the environment and vulnerable populations such as the elderly and immigrant women, it is increasingly contributing to public policy at various geographic scales

Age-Friendly Cities and Older Indigenous People: An Exploratory Study in Prince George, Canada

Cities around the world are responding to aging populations and equity concerns for older people by developing age-friendly communities plans, following the World Health Organization’s guidelines. Such plans, however, often fail to account for the wide diversity of older people in cities, with the result that some older people, including Indigenous older people, do not see their needs reflected in age-friendly planning and policies. This article reports on a study involving 10 older First Nations and Métis women in the city of Prince George, Canada, comparing the expressed needs of these women with two age-friendly action plans: that of the city of Prince George, and that of the Northern Health Authority. Four main categories were raised in a group discussion and interview with these women at the Prince George Native Friendship Centre: availability of health care services, accessibility and affordability of programs and services, special roles of Indigenous Elders, and experiences of racism and discrimination. There are many areas of synergy between the needs expressed by the women and the two action plans; however, certain key areas are missing from the action plans; in particular, specific strategies for attending to the needs of Indigenous and other older populations who often feel marginalized in health care and in age-friendly planning

Moving around a large city in Latin America: The mobility challenges faced by older adults with disabilities

A growing body of research has shown that barriers in the urban environment can be disabling by reducing the ability of older people to manage independently in the community, but also because they can negatively affect health by limiting the possibilities to move outside the home. In this study, we ask how obstacles in the urban environment are associated with the need for help to go to places in the community. To respond to this question, we used the Annual Household Survey of the City of Buenos Aires, Argentina 2018, which had a specific questionnaire for people with disabilities. From this sample, we selected adults aged 65 years or older with difficulties in at least one of six domains: vision; hearing; upper and lower body mobility; cognition; self-care; and communication. The final sample consisted of 513 persons (weighted = 109,316). First, we conducted a principal component analysis identifying three factors from variables of obstacles to access and use the urban environment: transportation; outdoor spaces; and information. Second, through a logistic regression model, we observed a direct relationship between these factors and the need for help to move in the community, controlling for sociodemographic characteristics, health status, and number of disabilities. This paper provides evidence on the significance of improving urban spaces to reduce dependent mobility. In Latin America, cities still face many challenges in becoming more age-friendly.Fil: Prieto Flores, María Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Confluencia; Argentina. Universidad Nacional de La Pampa. Facultad de Ciencias Humanas. Instituto de Geografía; ArgentinaFil: Rosenberg, Mark W.. Queens University; Canad

“It's gym, like g-y-m not J-i-m”: Exploring the role of place in the gendering of physical activity

© 2017 Elsevier Ltd Physical activity is a highly gendered health behaviour, with women less likely than men to meet internationally accepted physical activity guidelines. In this article, we take up recent arguments on the potential of indoor spaces to illuminate processes shaping health, together with social theories of gender, to conceptualize the place of the gym as a window into understanding and intervening in wider gender disparities in physical activity. Using a triangulated strategy of qualitative methods, including semi-structured interviews, drawing, and journaling with men and women in a mid-sized Canadian city, we examine how gender influences exercise practices and mobilities in gym environments. Results of our thematic analysis reveal three socio-spatial processes implicated in the gendering of physical activity: 1) embodying gender ideals, 2) policing gender performance, and 3) spatializing gender relations. A fourth theme illustrates the situated agency some individuals enact to disrupt gendered divisions. Although women were unduly disadvantaged, both women and men experienced significant limitations on their gym participation due to the presiding gendered social context of the gym. Gender-transformative interventions that go beyond engaging women to comprehensively contend with the place-based gender relations that sustain gender hegemony are needed. While gyms are potentially sites for health promotion, they are also places where gendered inequities in health opportunities emerge

‘Where is the space for continuum?’ Gyms and the visceral "stickiness" of binary gender

© 2020 Informa UK Limited, trading as Taylor & Francis Group. This paper develops a visceral feminist geography of the gym to expand our understanding of how everyday physical activity environments are implicated in the gendered context of physical activity. The gender gap in physical activity is well-documented, with women around the world less likely than men to meet the minimum physical activity recommendations for health. Fitness gyms are popular venues for physical activity, but they are not necessarily inclusive places. Through a reflexive thematic analysis of interview and journaling data with 52 Canadian women and men gym users, we identify five visceral domains through which the gym enacts gender boundaries: the imaginary, bodily haptics, the soundscape, visual fields, and material "stuff". Each of these revealed a series of gendered dichotomies that, taken together, contribute to an overarching gender binary of unbounded masculinity and bounded femininity. We argue that these "visceralities" matter because the gym as an institution comes to codify gender differences in ways that perpetuate possibilities for practising physical activity as bifurcated ways of doing gender. One of our key findings is how women’s participation in the gym was underwritten by material expense and bodily preparatory practices that extend far beyond the gym into the geographies of their daily lives. Physical activity interventions that do not account for the multisensorial features of place may miss opportunities to reduce gendered inequities

Towards a critical geography of physical activity: Emotions and the gendered boundary-making of an everyday exercise environment

The information, practices and views in this article are those of the authors and do not necessarily reflect the opinion of the Royal Geographical Society (with IBG). © 2019 Royal Geographical Society (with the Institute of British Geographers) In this paper, we put forward a proposal for a critical geography of physical activity that attunes to experience while centring on the socio-spatial processes and power structures enabling and constraining physical activity participation. Drawing on our research that explored women's and men's emotional geographies of an everyday exercise environment – the gym – in a Canadian city, we show how this approach can identify otherwise invisible environmental influences on physical activity participation. Our thematic analysis reveals that the gym environment is generative of three place-based emotive processes of dislocation, evaluation, and sexualisation that collectively configure an unevenly gendered emotional architecture of place. Through this interstitial structure, the boundaries of localised hierarchies of masculinities and femininities become felt in ways that create tensions and anxieties, which in turn reinforce gendered boundaries on physical activity participation. Two additional themes reveal how gendered motivation and individual factors mediate negative emotional experiences. Our findings indicate that emotional geographies are one way in which gender disparities in physical activity are naturalised at the scale of the everyday exercise environment. Interventions for gender equity in physical activity would benefit from being empathetically attuned to the subtleties of place-based experiences. More widely, bringing emotions into geographies of physical activity sheds light on the larger question of the role of place in (re)producing gendered health inequities, with implications for geographical research on health and social justice. Future critical geographical inquiry is necessary to ensure that public health interventions are grounded in the experiential realities of practising physical activity in particular places