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Our current research examines the maintenance of individual and community health in rural Atlantic Canada.1 In particular, it considers the various strategies employed by rural Atlantic Canadians to maintain their health under circumstances of population change, including population loss. Demographic change and health reform in Atlantic Canada, specifically health regionalization as the devolution of responsibilities for health and the delivery of health services from provincial to sub-provincial levels in Nova Scotia, constitute the research context. Our research demonstrates that while health regionalization intends to account for local circumstances, its implementation in Nova Scotia is hampered by the lack of recognition of rurality as a key determinant of health in a province where almost half of the population, 44%, still resides rurally.2
This research report proceeds in three stages. First, we briefly outline the move toward health regionalization in Nova Scotia. second, while acknowledging its limited generalizability, we draw upon qualitative data from the small, rural town of Parrsboro, Nova Scotia (population 1,529) located on the shores of the Minas Basin in Cumberland County, to challenge some assumptions in the implementation of health regionalization in the context of rurality. The case study, carried out in 2003, includes data from focus groups and semi-structured interviews with a total of sixty-one town residents, including seniors and youth. Third, we make specific recommendations for strengthening the health of rural communities in Nova Scotia.
Health Regionalization in Nova Scotia
Health regionalization, claimed to be an integrative, community-based approach to health, has been implemented in many Canadian provinces, among them British Columbia (Fuller, 2001), Alberta (Scott et al., 2001), Manitoba (Wilson &. Howard, 2001), Newfoundland and Labrador (Botting, 2001), and Nova Scotia (Clow, 2001). Regionalization was first introduced as a model of health responsibility and delivery in Nova Scotia over thirty years ago. Since 1972, various provincial Department of Health reports have supported regionalization and called for the establishment of community-level health boards as planning and administrative bodies accountable to regional and district-level health authorities, thereby delegating a range of responsibilities from provincial to sub-provincial levels. Health, in these reports, is consistently designated as a community responsibility. The 1972 report, Health Care for Nova Scotia: A New Direction for the Seventies, suggests the orientation and allocation of responsibilities for health services...