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.