On December 15, 2016, the Honourable Navdeep Bains (Minister of Innovation, Science and Economic Development) announced the launch of Connect to Innovate.1

Connect to Innovate is a program that aims to build infrastructure to bring broadband Internet (i.e. Internet access that is always on, as opposed to dial-up) access to 300 rural and remote Canadian communities through investing up to $500 million over the next five years. Most of this funding is earmarked for creating backbone infrastructure, which is basically the equivalent of building “Internet roads” into communities. This will give hospital, schools and band offices Internet access. This also opens the door to other innovations like eLearning and telemedicine.

“Our government is committed to ensuring that all Canadians, businesses and institutions have access to the opportunities and tools they need to grow and succeed in Canada and abroad.  By increasing access to high-speed Internet, the Connect to Innovate program enhances our rural and remote communities’ ability to innovate, participate in the digital economy and create jobs for middle-class families.  This investment will improve the daily lives of Canadians.”

-The Honourable Navdeep Bains,
Minister of Innovation, Science and Economic Development

What this program is aiming to address is digital divides. Digital divides “refer to disparities among different population groups or geographical regions in their access to broadband systems.”2 In Canada, issues of geography, history and culture have created gaps in technological access and skills.3 Digital divides reflect a number of subdivisions and inequalities within the Canadian population, including:

  • Geographical location (urban vs. remote/rural);
  • Culture and language (e.g. Indigenous vs. non-Indigenous; Anglophone vs. Francophone; immigrant vs. non-immigrant);
  • Income level (low-income vs. high-income);
  • Educational level;
  • Age.3-4

The geographical and cultural divisions that affect rural and remote communities interest me most – which won’t come as a surprise to anyone who’s had to spend about 10 minutes in the same room as me. Rural and remote communities within Canada face a number of inequities, including high unemployment rates, lower education levels, an aging population, and the outmigration of young people.5 These challenges can make it more difficult to access healthcare, as well as recruit and retain healthcare professionals. Rural and remote communities often face a number of health challenges, including (but not limited to) generally poorer health, shorter lifespan, and higher infant mortality rates.6 Despite having greater need, they often receive less services; a phenomena that Hart coined as the inverse care law back in the 1970s:

“In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support, and inherit more clinically ineffective traditions of consultation, than in the healthiest areas; and hospital doctors shoulder heavier case-loads with less staff and equipment, more obsolete buildings, and suffer recurrent crises in the availability of beds and replacement staff. These trends can be summed up as the inverse care law: that the availability of good medical care tends to vary inversely with the need of the population served.”7

It’s concerning that some 45 years later the inverse care law is still a thing within Canada, and indeed many other countries. The World Health Organization estimates that about half of the world’s population resides in remote or rural areas, but most healthcare professionals live in cities.8

My PhD focuses on using technology to improve access to care, particularly within these communities. Some strategies that have been employed include telemedicine (e.g. the Ontario Telemedicine Network) and electronic consultations (e.g. the Champlain BASE eConsult service). However, a lot of thought has to go into using technology within rural and remote communities because these inequalities extend into the digital realm. Namely Internet access. Videoconferencing for telemedicine in particular requires a half-decent (and reliable) Internet connection. Rural communities – including remote Indigenous communities – often have few options for Internet service providers, and limited access to cable lines.3 Additional infrastructure is needed within these communities, but this comes with a pretty hefty price tag (hence government programs like Connect to Innovate, Connecting Canadians, and Broadband Canada: Connecting Rural Canadians Programs).

I’ve heard a bit of griping about government funds being “wasted” so people can watch Netflix. However, most of the funding is for developing backbone infrastructure within communities. Very little of the funding will go towards last-mile projects, which go directly to people’s homes. More importantly, these improvements offer tremendous opportunities for eLearning, telemedicine, and enhancing the economies of rural and remote communities.

And besides, living in an urban centre doesn’t give any of us more of a right to waste an evening (or sizeable portion of the weekend) binge watching Netflix.

References:

  1. Government of Canada. Enhanced broadband access coming to rural and remote communities across Canada. December 15, 2016. http://news.gc.ca/web/article-en.do?nid=1170069. Accessed December 17, 2016.
  1. McMahon R, O’Donnell S, Smith R, et al. Digital divides and the ‘first mile’: framing First Nations broadband development in Canada. Int Indig Policy J. 2011;2(2).
  1. Howard PN, Busch L, Sheets P. Comparing digital divides: internet access and social inequality in Canada and the United States. Can J Commun. 2010;35(1):109-128.
  1. Haight M, Quan-Hasse A, Corbett BA. Revisiting the digital divide in Canada: the impact of demographic factors on access to the Internet, level of online activity, and social networking site usage. Information, Commun Soc. 2014;17(4):503-519.
  1. Moazzami, B. Strengthening rural Canada: fewer & older: the coming population and demographic challenges across rural Canada. A Pan-Canadian report. 2015.
  1. Kulig JC, Williams AM. Health in rural Canada. Vancouver, BC: UBC Press; 2012.
  1. Hart JT. The inverse care law. Lancet. 1971;1(7696):405-412.
  1. World Health Organization. Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. Geneva, Switzerland: WHO; 2010.
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