JoAnn Jaffe
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Papers by JoAnn Jaffe
This knowledge synthesis (KS) project explored how remote and rural (RR) places face a complex array of social, political and economic obstacles in their access to sustainable, accessible, and appropriate transportation, and in exercising mobility rights. Growing vulnerability and inequality between these places contribute to growing vulnerabilities and inequalities among RR residents and the rest of Canada. The pattern of, and access to, public transportation in Canada, reflects the history of natural resource development and seldom considers the effects of the lack of transportation on health and welfare, human capabilities, education, climate change, and sustainable development. Mobility, however, shapes the conditions and lived experiences of gender, poverty, disabilities, and older-age; it either restricts or enables citizen participation.
We take seriously the ways that vulnerability and transportation disadvantage are products of the structuring impacts of unequal mobility. For instance, insufficient or absent access to mobility–especially affordable public transportation–determines the ability of individuals and communities to achieve a sustainable livelihood, societal participation, personal and collective safety, and access to essential and non-essential services, resources, opportunities, and rights. Mobility- and transportation-linked possibilities and vulnerabilities are not experienced equally. These realities led us to adopt an intersectional approach that recognizes how individuals’ circumstances are shaped, constructed, and constrained by systems and structures over which they have little control. Given neoliberal restructuring, we paid close attention to how the systematic removal of public transportation alongside increasing, near-exclusive emphasis on automobility, is implicated in the production and exacerbation of vulnerability for RR persons, communities, and regions of Canada.
This knowledge synthesis (KS) project explored how remote and rural (RR) places face a complex array of social, political and economic obstacles in their access to sustainable, accessible, and appropriate transportation, and in exercising mobility rights. Growing vulnerability and inequality between these places contribute to growing vulnerabilities and inequalities among RR residents and the rest of Canada. The pattern of, and access to, public transportation in Canada, reflects the history of natural resource development and seldom considers the effects of the lack of transportation on health and welfare, human capabilities, education, climate change, and sustainable development. Mobility, however, shapes the conditions and lived experiences of gender, poverty, disabilities, and older-age; it either restricts or enables citizen participation.
We take seriously the ways that vulnerability and transportation disadvantage are products of the structuring impacts of unequal mobility. For instance, insufficient or absent access to mobility–especially affordable public transportation–determines the ability of individuals and communities to achieve a sustainable livelihood, societal participation, personal and collective safety, and access to essential and non-essential services, resources, opportunities, and rights. Mobility- and transportation-linked possibilities and vulnerabilities are not experienced equally. These realities led us to adopt an intersectional approach that recognizes how individuals’ circumstances are shaped, constructed, and constrained by systems and structures over which they have little control. Given neoliberal restructuring, we paid close attention to how the systematic removal of public transportation alongside increasing, near-exclusive emphasis on automobility, is implicated in the production and exacerbation of vulnerability for RR persons, communities, and regions of Canada.
Health care restructuring has been a tug-of-war between maintaining the five pillars of medicare (accessibility, portability, universality, comprehensiveness, and public administration) and controlling health care costs (Rosenburg and James, 1994; Haislmaier, 1991). This struggle has resulted in a shift from institutional to community and home care for acute and chronic conditions (Armstrong and Armstrong, 1996). In Saskatchewan, efforts to control health care expenditures have led to hospital closures, fewer acute care beds in rural areas (Braden, 1998), reduced numbers of doctors and nurses (Eisler, 1996), an out-migration of medical specialists, and fewer beds in long-term care institutions (HSURC, 1994). At the same time, additional funding has gone to home care (HSURC, 1998; Kyle, 1998).
There has been a shift to community care for persons with disabilities and reduced spending for long-term care institutions for the aged. There has been a shift from hospital to home care, with increased out-patient and day surgeries, early release programs, and reduced long-term care in hospitals (Braden, 1998) With these changes, we have seen a shift from care provided by skilled health professionals to caregiving by less-skilled family and home care workers (Armstrong, 1997).
This shift from institutional to community care appears to be about where health services are offered--in hospitals or homes. In fact, it is about much more. It represents a profound shift in philosophy away from the principles of medicare and toward the privatization of health care. Since home care does not fall under the umbrella of the Canada Health Act, universality is compromised. In Saskatchewan, regional health districts are responsible for home care services, and the range of services and eligibility policies vary among the districts. Some services that would be available by rights to hospital patients under the Canada Health Act must be purchased by persons receiving care at home (Armstrong and Armstrong, 1996).
Health care restructuring and regionalization were promoted as means of increasing accountability in the health care system by making it more democratic (Hurley et al., 1993), yet family caregivers, as a group, are not represented on health district boards, and changes in the health system are often made without their participation. Accountability works more on the consumer-based model, wherein caregivers choose which services to purchase, but have little say in determining which services are available.
Policy-makers are introducing rapid changes to the health system, yet little is known about their impacts on rural informal caregivers. Policies appear to be based on myths and assumptions about rural women, families and communities.
Rural women informal caregivers are virtually invisible to many policy-makers, because caregiving for ill and disabled people is considered an extension of women's domestic responsibilities (Henderson, 1998). The devolution of care to wives, mothers, daughters, and sisters is based on "traditional" ideas that women's employment is non-existent, unessential, or part-time (Pless, 1984; Armstrong and Armstrong, 1996). Women are assumed to be available for caregiving, regardless of their age, health, or existing responsibilities. As a result, caregivers are seeing their workloads increase, often with little recognition, little training, no financial compensation, no protection in case of injury, and no workers' benefits. (ICUW, 1997).
It is assumed that rural families have strong ties across generations, that adult children live in the area, and that they are available to care for aging parents. Today few families have more than one or two relatives residing in the same community. Like their urban counterparts, rural families are small and highly mobile. Family support for the ill or aging is most often undertaken by one family member--usually female (Montgomery and Hirshorn, 1991; Barris, 1998). These women may be uneasy or unhappy about their role as caregivers. They may feel inadequate, guilty, or even unwilling to provide care, but see little choice (Braithwaite, 1996). When demand for care is intense, family relations can become strained as caregivers are overwhelmed by exhaustion and resentment (ICUW, 1997).
Rural families are thought of as propertied, financially stable and homogenous. However, inequalities are increasing in rural areas and many families find themselves financially strapped (Ames et al., 1994). Rural people often lack income security when faced with long-term illness or disability (Black et al., 1993). Many rural women caregivers have limited income due to retirement or lack of paid employment (Mui and Morrow-Howell, 1993). Policy-makers often overlook the financial situation of rural families, assume the cost of living to be low in rural areas, and ignore hidden costs like transportation. (Richardson, 1988).
Rural places are considered idyllic, yet isolation, lack of public transportation, and the limited social resources of small communities can place intolerable stresses on those giving and receiving care (Richardson, 1988). Poor quality housing and insufficient health and social services characterize many rural communities. Distance makes access to services more difficult and adversely affects rural women's ability to provide care (Giarchi, 1990).
Rural communities are thought of as close-knit and neighborly, yet stress from isolation is a serious concern (Richardson, 1988). Geographic dispersal of the population means that people risk isolation from neighbors and services. Rural depopulation represents a decline in social resources; fewer people are available as social supports. Inadequate transportation, fewer family supports, and a lack of daycare and respite facilities limit caregivers' access to assistance or relief (Giarchi, 1990). While caregivers' experiences vary, isolation and lack of social support can affect their well-being.
Canada's population is aging, particularly in rural areas. In 1991, nearly one-third of Canadians over 65 lived in rural areas (CMHC, 1991; Hendryx, 1993). Rural centres have higher proportions of elderly people and higher rates of long-term disability and chronic illness than cities (Wilkins, 1992). It is estimated that 80% of elder care is provided by family members, primarily women (Barris, 1998). In 1997, Statistics Canada reported that nearly three million Canadians were looking after someone with chronic health problems. As the population continues to age, Canadians will have to care for older family members, and caregivers themselves will be older.
The differences between urban and rural places, and the challenges faced by rural informal caregivers need to be taken seriously in the formulation of health policies. Yet very little is known about rural informal caregivers in Saskatchewan. What are their social and economic situations? What difficulties do they experience as caregivers? What resources and supports are available? What solutions do they see?
All are available on the website of CRIAW-ICREF https://www.criaw-icref.ca/publications/here-today-gone-tomorrow-public-transportation-and-vulnerabilities-in-rural-and-remote-canada/
Study was supported by funds from SSHRC & Infrastructure Canada