Rethinking the rural health deficit: Does sense of belonging have an influence? Peter Kitchen and Allison Williams School of Geography & Earth Sciences McMaster University James Chowhan DeGroote School of Business McMaster University Rural Research Workshop Ottawa. May 5, 2011 What is Sense of Belonging?Sense of belonging is a psychological constructbased on a person’s attachment to and socialcomfort with their community, friends, family,workplace, or personal interests (e.g. activities orhobbies).Research has shown that there is an associationbetween sense of belonging and physical andmental health
Research Questions1) What are the major health, social and geographic determinants of sense of community belonging?2) How does this sentiment vary across the urbanto rural continuum and among settlements ofdifferent size?3) Does the rural health deficit need to be re-examined in the context of a broader view ofhealth? Literature• Maslov (1954): belonging as an important human need• Anant (1966): belonging as a link to mental health and mental illness• Hagerty and colleagues (1990s and 2000s): belonging correlated with stress and depression
Literature Statistics Canada:• Ross (2002): sense of community belonging associated with self-perceived health• Turcotte (2005): community belonging improved across the urban to rural gradient• Shields (2008): sense of community belonging lower in urban areas and strong association with self-perceived health and mental health Data• Statistics Canada’s 2007/08 Canadian Community Health Survey (CCHS) Master File• Sample: Adults aged 18 or over (n=116,258)• Dependent variable: Sense of belonging to local Community• Question: How would you describe your sense of belonging to your local community? Would you say it is: (very strong, somewhat strong, somewhat weak, or very weak)?
Data: Independent Variables Health Geography Socio-Economic (control)Self-perceived Census rural Age, SexhealthSelf-perceived Metro. Influence Aboriginal andmental health Zone immigrant statusPerceived life Province Household incomestressPerceived work EducationstressPhysical activity Dwelling type Household type Housing tenure Defining Rural The Metropolitan Area (CMA) and Census Agglomeration (CA) Influenced Zones (MIZ) were used. A Metropolitan Influence Zone (MIZ) refers to the population living outside the commuting zones of larger urban centres (CMAs and CAs). Four zones: CMA/CA Strong MIZ Moderate MIZ Weak/No MIZ
Methods of Analysis• Descriptive statistics: contingency tables• Ordered logit regression modeling (dependent variable: sense of community belonging – 4 point Likert scale)• Analysis conducted using Stata 11• Individual sample weights employed• Bootstrap techniques applied Results Overall and Mental Health Sense of belonging to local community by health status% Very strong/somewhat 70 60 66.0 66.5 strong belonging 61.5 50 54.5 57.0 40 43.7 30 20 10 0 Self-perceived health Perceived mental health Excellent/very good Good Fair/poor (Canadian Community Health Survey 2007-08 respondent aged 18+)
Life and Work Stress Sense of belonging to local community by level of stress% Very strong/somewhat 80 70 strong belonging 60 68.5 66.3 50 62.6 62.7 56.7 58.6 40 30 20 10 0 Perceived life stress Perceived work stress Not at all/not very A bit Quite a bit/extremely (Canadian Community Health Survey 2007/08 respondents aged 18+) Geography: Province Sense of belonging to local community by province of residence % Very strong/somewhat strong belonging Canada 68.0 Territories 73.7 BC 68.6 Alberta 64.1 Saskatchewan 73.2 Manitoba 71.5 Ontario 68.5 Quebec 59.7 New Brunswick 68.8 Nova Scotia 72.1 PEI 74.0 NFLD/Labrador 81.8 0 20 40 60 80 100 (Canadian Community Health Survey 2007/08 respondents aged 18+)
Geography: Metro. Influence Zone Sense of belonging to local community by place of residence% Very strong/somewhat 100 strong belonging 80 75.6 60 69.8 61.8 63.7 40 20 0 Metropolitan Influence Zone (MIZ) CMA/CA Strong MIZ Moderate MIZ Weak or no MIZ (Canadian Community Health Survey 2007/08 respondents aged 18+) Ordinal Logit Regression Model 1: Health variables only Model 2: Health plus geography variables Model 3: Health, geography plus SES (control) variables
Results of Ordinal Logit Regression Analyses Mode1 1 Model 2 Model 3 Independent Odds S.E. Odds S.E. Odds S.E. Variables ratios ratios RatiosSelf-perceivedhealth Excellent/Very Good Reference Good 0.935*** 0.021 0.930*** 0.021 0.878*** 0.021 Fair/poor 0.888*** 0.033 0.851*** 0.032 0.714*** 0.028Self-perceivedmental health Excellent/Very Good Reference Good 0.737*** 0.018 0.721*** 0.018 0.717*** 0.018 Fair/poor 0.472*** 0.027 0.455*** 0.025 0.493*** 0.027Perceived life stress Not at all/not very Reference A bit 0.803*** 0.017 0.802*** 0.017 0.867*** 0.019 Quite a bit/extremely 0.708*** 0.020 0.740*** 0.022 0.814*** 0.025 Results of Ordinal Logit Regression Analyses Geography Variables Mode1 1 Model 2 Model 3 Independent Odds S.E. Odds S.E. Odds S.E. Variables ratios ratios Ratios Province Quebec Reference Nfld/Labrador 2.280*** 0.158 2.200*** 0.151 PEI 1.697*** 0.138 1.664*** 0.138 Ontario 1.452*** 0.051 1.427*** 0.053 Manitoba 1.401*** 0.078 1.379*** 0.079 Saskatchewan 1.524*** 0.069 1.515*** 0.070 Territories 2.417*** 0.240 2.719*** 0.256 Metropolitan Influence Zone CMA/CA Reference Strongly MIZ 1.026 0.056 0.986 0.054 Moderate MIZ 1.414*** 0.052 1.343*** 0.052 Weak or no infl. 1.694*** 0.048 1.631*** 0.049
Selected Socio-Economic Variables Mode1 1 Model 2 Model 3Independent O.R. S.E. O.R. S.E. O.R. S.E.VariablesImmigrant status Immigrant 1.016 0.031 Non-immigrant ReferenceAboriginal status Aboriginal 0.976 0.048 Non-Aboriginal ReferenceDwelling type Single detached Reference Double/row/duplex 0.925** 0.030 Low-rise 0.930 0.041 High-rise 0.778*** 0.058 Other 0.959 0.055Household type Unattached individual Reference Couple living alone 1.054* 0.030 Couple with children 1.327*** 0.045 Lone parents 1.105** 0.044 Summary • A very strong association between SoCB and health (especially mental health) even when controlling for geography and SES • SoCB becomes stronger across the urban to rural continuum (rural areas & small towns) • Lower SoCB among lone-parent families (compared to couples with children) and those living in high-rise apts (compared to detached homes)
Sense of belonging and the rural health deficit • Research shows a clear health deficit in rural/small town Canada: - health outcomes (self-rated health, life expectancy, chronic conditions, disease, accidents, etc) - access to health resources (acute care hospitals, primary health care) • Canadian Institute for Health Information (CIHI) • Statistics Canada • Numerous Canadian rural health researchers Three-way contingency table: the urban health advantage Sense of belonging to local community by place of residence and self-rated health 80 % Reporting Excellent/Very 70 Good Self-rated health 60 64 62 50 56 58 59 49 49 40 41 30 20 10 0 Very strong Somewhat Somewhat weak Very weak Strong Sene of belonging to local community CMA/CA Strong MIZ Moderate MIZ Weak or no MIZ
Discussion• Do the findings of this research suggest a type of paradox?• How can regions with lower health outcomes have higher SoCB when health is found to be such a strong contributor to SoCB?• It appears that rural and small-town residents are able to overcome this health deficit• Social capital may be a factor Conclusion On-going research has pointed to the fact that SoCB is much higher in rural and small-town Canada despite the presence of a health deficit. These communities are clearly benefiting from a number of social and organizational factors leading to enhanced SoCB. However, our understanding of what exactly these factors are and how they are related to health and well-being is limited.
Further research Quantitative research that directly measures both SoCB and social capital in rural and urban areas. Ethnographic study of a small-town to uncover the social, cultural and political dynamics at play in creating a strong SoCB as related to issues such as trust and reciprocity. Re-examine the notion of a health gap between urban and rural residents by broadening the definition of health to include sentiments such as belonging. Questions• Why is SoCB so low in Québec?• With respect to SoCB and health is there a certain resiliency in rural communities and small towns?• Should the definition of health include a person’s sense of belonging?