Rural communities face a unique array of health issues, many of them intertwined with environmental issues. As rural demographics change, increasing the need for research, Dr. James Dosman, director of the Institute of Agricultural Rural and Environmental Health at the University of Saskatchewan, is working with colleagues to build research capacity in these areas.
Dosman is head of Public Health and the Agricultural Rural Ecosystem (PHARE), a CIHR strategic training program supported by the Institute of Infection and Immunity along with CIHR Institutes Cancer Research, Circulatory and Respiratory Health, and Population and Public Health (lead). The program is aimed at gathering the knowledge needed to address the challenges facing rural communities as they seek a healthy, safe and sustainable lifestyle. A focus will be the communication of outcomes to the public and the government to promote well-informed policies. To address many of the wide-ranging issues, which include water quality, ecosystem sustainability, and the physical isolation that leads to issues of health care access and service delivery, the "virtual" program has a strong support base of six participating universities (see table).
"All the pieces are coming together," says Dosman, explaining that pre-existing relationships among the mentors, and the existence of a precursor to the PHARE program, made the formation of a more formal structure a logical next step. "So when CIHR offered the training program grants, it was too good to miss." The program offers scholarship funding to Masters, PhD and postdoctoral applicants, and can support approximately 40 students with existing mentor capacity. Graduates receive a certificate as recognition and proof of their specialized training.
The PHARE program's promotional poster asks potential applicants, "Do your research interests stop at the city limits, or do you seek answers in the country, with the people who live there, and in the health of the land?" The program attracted Karen Marcinkiw from her career as a public health nurse and nursing instructor in Saskatoon and Regina to a Masters in Nursing program. "I just thought the opportunity to have interdisciplinary work across the country would be really interesting. In the College of Nursing there's not a lot of opportunity right now to work with people from other disciplines."
Shelley Kirychuk, Professional Research Associate with PHARE, says there's a huge need across Canada for research and knowledge in these areas. Although the United States has a strong research base, Kirychuk says, "We have some issues that are very unique and very different from the U.S., and we'd like to start addressing those in an interdisciplinary fashion." She describes the project of one student who will study nitrate levels, water quality and health effects in a rural Nova Scotia area, and of another working in toxicology who's studying air quality in and around large scale livestock facilities, for effects on both employees of the facility and on the nearby community. Marcinkiw is focusing on the post-partum health of rural women. Additional projects may cover the recruitment and sustainability of health professionals; social and cultural factors of subgroups of rural populations, including agricultural, migrant and seasonal workers, and the elderly; divergent mortality and morbidity characteristics in comparison to urban populations; and economic policy.
All trainees must participate in a virtual, comprehensive rural health class that incorporates the expertise of professionals based across the country, working in areas including demographics and physician access in rural Canada, occupational hygiene and toxicology, risk assessment issues, and rural demographics. Kirychuk says that in terms of recruiting trainees, "we don't delineate by discipline." She lists areas that applicants to PHARE can pursue as including epidemiology, hydrology, immunology and microbiology, molecular biology, agricultural sciences, engineering, occupational health and hygiene, cellular biology, health policy, health law, political science, and population health. Kirychuk says this should make for interesting interactions among the students, "because if you come from different disciplines or different parts of Canada, your views.may be very different."
In addition to the common course, interaction among the students is highly promoted. Students will attend an annual national PHARE conference with the various mentors involved in the program. At the first, held in Halifax in October 2002, Kirychuk says students spoke about their research projects, then discussed the similarities and differences of each others' projects. "When you come from different areas of Canada," says Kirychuk, "how do you define 'agricultural' differently; how do you define 'rural' differently?" Dosman adds, "They would have been doing the work anyway, but instead of training in their own areas and finishing with their own piece of the puzzle, this gives them an idea of the whole puzzle."
Kirychuk says the initial core of mentors incorporates researchers from the University of Saskatchewan, the University of Alberta, the University of British Columbia, Queen's University, the University of Laval and Dalhousie University. New mentors are becoming involved through a review process that ensures their students will receive the support and exposure to various disciplines required by the PHARE program. There is also an international component to the program. Already, exchanges and partnerships are in place with Finland, Denmark and the Netherlands. Kirychuk says that there have also been initial discussions with universities in Iowa and Sweden.
Dosman is certain the program will make a difference to its graduates. "They'll have the distinction of having been in the program, and hopefully they will become so excited by it that they'll want to pursue a research career." Karen Marcinkiw says she feels the program is opening up many different opportunities for her nursing career. "When you're looking at certain issues, such as rural health, just hearing from different people across the country as to their concept of 'rural' opens up your mind to so many different things."
For more information on the PHARE program, visit the Institute of Agricultural Rural and Environmental Health Website or email Shelley Kirychuk: kirychuk@sask.usask.ca.
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Members of PHARE | |
| J. Dosman, E. Barber, L. Babiuk, B. Reeder | University of Saskatchewan |
| A. Senthilselvan | Public Health Sciences, University of Alberta |
| S. Kennedy | School of Occupational and Environmental Hygiene, University of British Columbia |
| R. Brison, W. Pickett | Community Health and Epidemiology, Queen's University |
| Y. Cormier | Pulmonary Medicine, University of Laval |
| J. Guernsey | Community Health, Dalhousie University |
