Rural Locales Research Articles

Epilepsy stigma in the Republic of Guinea and its socioeconomic and clinical associations: A cross-sectional analysis

ObjectiveWe aim to quantify the degree of epilepsy stigma perceived by people living with epilepsy (PLWE) in the Republic of Guinea (2019 gross national income per capita, 930 USD) and analyze the demographic, social, and clinical factors associated with epilepsy stigma in this setting. MethodsA prospective convenience cohort of PLWE was recruited at the Ignace Deen Hospital in Conakry and evaluated by U.S. and Guinean neurology-trained physicians. A survey instrument exploring demographic, social, and clinical variables was designed and administered. The primary outcome measure was the Stigma Scale of Epilepsy (SSE), a 24-item scale with scores ranging from 0 (least stigma)–100 (most). Regression models were fit to assess associations between SSE score and pre-selected demographic, social, and clinical variables of interest. Results249 PLWE (112 female; mean age 20.0 years; 22 % from rural locales; 14 % of participants >16 years old with no formal schooling; 11 % seizure-free for >=6 months) had an average SSE score of 46.1 (standard deviation = 14.5) points. Children had an average SSE score of 45.2, and adults had an average score of 47.0. There were no significant differences between self- and guardian-reported SSE scores (means = 45.8 and 46.5, respectively), p = .86.In univariate analyses, higher stigma scores were associated with more seizures (p = .005), more depressive symptoms (p = .01), and lower household wealth (p = .03). In a multivariable model including sex, educational level, household wealth, generalized tonic-clonic seizures, seizure frequency, and seizure-related burns, only higher seizure frequency (β = −2.34, p = .03) and lower household wealth (β = 4.05, p = .03) were significantly associated with higher SSE scores. ConclusionIn this Guinean cohort of people living with poorly-controlled epilepsy, there was a moderate degree of perceived stigma on average. Stigma was associated with higher seizure frequency and lower household wealth—both potentially modifiable factors.

Teacher Knowledge in Transition Planning: Does Locale Matter?

The Individuals With Disabilities Education Act mandates transition planning to occur in conjunction with the individualized education program for secondary age students with disabilities beginning by age 16, or earlier. To fulfill this mandate, teachers must possess a depth of content and pedagogical knowledge related to the transition planning process. However, the majority of special educators do not receive coursework dedicated to transition in their undergraduate programming. Furthermore, teachers in under-resourced and underserved rural districts may have inequitable professional development opportunities to bolster their transition planning knowledge. This lack of transition-related education potentially leads to inadequate and noncompliant transition plans for students with disabilities. The current study examined differences in teachers’ knowledge based on locale: rural ( n = 75), suburban ( n = 48), and urban ( n = 64) from one southern state. Determining whether differences are identified by locale can inform the allocation of resources to provide high-quality, evidence-aligned professional development models to improve teacher knowledge in underserved and under-resourced rural locales. In addition, identifying gaps in teacher knowledge will inform pre-service and in-service teacher preparation. We provide an avenue of needed future research to improve transition-planning processes for students with disabilities.

Perceptions of Diseases of Despair by Members of Rural and Urban High-Prevalence Communities

<h3>Importance</h3> Diseases of despair (ie, mortality or morbidity from suicidality, drug abuse, and alcoholism) were first characterized as increasing in rural White working-class populations in midlife with low educational attainment and associated with long-term economic decline. Excess mortality now appears to be associated with working-class citizens across demographic and geographic boundaries, but no known qualitative studies have engaged residents of rural and urban locales with high prevalence of diseases of despair to learn their perspectives. <h3>Objective</h3> To explore perceptions about despair-related illness and potential intervention strategies among diverse community members residing in discrete rural and urban hotspots. <h3>Design, Setting, and Participants</h3> In this qualitative study, high-prevalence hotspots for diseases of despair were identified from health insurance claims data in Central Pennsylvania. Four focus groups were conducted with 60 community members in organizations and coalitions from 3 census block group hotspot clusters in the health system between September 2019 and January 2020. Focus groups explored awareness and beliefs about causation and potential intervention strategies. <h3>Main Outcomes and Measures</h3> A descriptive phenomenological approach was applied to thematic analysis, and a preliminary conceptual model was constructed to describe how various factors may be associated with perpetuating despair and with public health. <h3>Results</h3> In total, 60 adult community members participated in 4 focus groups (44 women, 16 men; 40 White non-Hispanic, 17 Black, and 3 Hispanic/Latino members). Three focus groups with 43 members were held in rural areas with high prevalence of diseases of despair, and 1 focus group with 17 members in a high-prevalence urban area. Four themes emerged with respect to awareness and believed causation of despair-related illness, and participants identified common associated factors, including financial distress, lack of critical infrastructure and social services, deteriorating sense of community, and family fragmentation. Intervention strategies focused around 2 themes: (1) building resilience to despair through better community and organizational coordination and peer support at the local level and (2) encouraging broader state investments in social services and infrastructure to mitigate despair-related illness. <h3>Conclusions and Relevance</h3> In this qualitative study, rural and urban community members identified common factors associated with diseases of despair, highlighting the association between long-term political and economic decline and public health and a need for both community- and state-level solutions to address despair. Health care systems participating in addressing community health needs may improve processes to screen for despair (eg, social history taking) and codesign primary, secondary, and tertiary interventions aimed at addressing factors associated with distress. Such actions have taken on greater urgency with the COVID-19 pandemic.

Patient and Visit Characteristics of Families Accessing Pediatric Urgent Care Telemedicine During the COVID-19 Pandemic.

Introduction: Telemedicine expansion during the coronavirus pandemic improved health care access for some. However, studies show disparate uptake among marginalized communities, where minority patients experience higher infection rates. We examined changes in pediatric telemedicine utilization as related to social determinants of health and characteristics of families accessing care. Materials and Methods: This IRB-approved study is a retrospective, cross-sectional comparison of completed visits for parent-initiated, urgent care telemedicine services received by a pediatric health care system between January to May 2019 and January to May 2020. Patient and visit characteristics were evaluated by region (Florida or Delaware Valley) and year for age, race, gender, ethnicity, zip code, language, median household income, insurance type, and patient draw. Results: Outcomes varied by region. Pediatric patient visits jumped by 172% in 2020 from the year prior. In Florida, the proportion of Hispanic patients utilizing telemedicine increased, as did patients utilizing government-supported health insurance during the pandemic (ps < 0.05). Practically meaningful, although nonsignificant increases in patient language diversity were found across years in both regions (ps > 0.05). Rural patient utilization remained low (2-5%; ps > 0.05). Discussion: Changes in telemedicine use were observed among pediatric patients in vulnerable populations during the coronavirus disease 2019 (COVID-19) pandemic. Despite increased utilization among Hispanic and low-income families, access to virtual care remains a challenge among patients residing in rural locales. Conclusion: Researchers, health care providers, and policymakers should examine the implementation of varying mitigation strategies that support equal access and use of virtual health care among an increasingly diverse, post-COVID-19 pediatric patient population.

Pharmacists promote COVID-19 vaccine acceptance in rural locales.

Pharmacists promote COVID-19 vaccine acceptance in rural locales.

Outcome disparities in rural versus urban patients with head and neck cancer: Leveling the playing field.

e18529 Background: Multiple studies indicate that rural patients experience disproportionately adverse cancer related outcomes, compared to their urban counterparts. This has been attributed to inequities in access to healthcare, monetary and technological resources, disease characteristics, adverse health status and lower life expectancy of rural populace. Whether treating patients with uniform protocols can help mitigate outcome disparities remains to be determined. Methods: We conducted a retrospective cohort study to evaluate survival outcomes of Head-Neck Squamous Cell Cancer (HNSCC) patients from rural versus urban locales. Only patients with locally advanced HNSCC who completed radiotherapy (RT) at the Emily Couric Clinical Cancer Center were included. Rural patients had access to affordable lodging for the duration of radiotherapy (RT), were treated regardless of health insurance status and by the same multidisciplinary team. Patients with distant metastases were excluded. Patients were classified as urban or rural using the Rural-Urban Commuting Areas (RUCA) zip-code database. Overall survival (OS) was analyzed using Kaplan-Meier curves and log-rank test. OS was modeled with a COX proportional hazards model, adjusting for several covariates including race, age, gender, HPV status, smoking, treatment received (RT, chemotherapy, surgery) and stage. Results: 230 patients with Stage I-IVB HNSCC who met the inclusion criteria were analyzed, of which 136 were categorized as residentially urban and 94 were categorized as rural. Approximately 83% were male, 87% were Caucasian and 71% were smokers (52% current smokers and 19% former smokers). In addition to RT, 42% patients had undergone surgery and 57% received chemotherapy. There was no statistically significant difference in OS for patients residing in rural vs urban zip-codes (HR 1.36, p = 0.24). Rural patients were less likely to undergo surgery (34% vs 44%, p = 0.04), and more likely to receive chemotherapy (67% vs 54%, p = 0.0325), likely indicating more advanced tumor stage at diagnosis. Conclusions: Rural and urban patients had similar OS when treated with similar treatment protocols. Improving access to uniform treatment regimens may help mitigate the widening gap in cancer-related outcomes between rural and urban populations.

How Can Urban Parks Support Urban Indigenous Peoples? Exploratory Cases from Saskatoon and Portland

In Anglo settler states, parks and Indigenous peoples interact in myriad ways, given the tight connection between Indigenous peoples and land and that parks are manifestations of settler control of land and heritage. Current park–Indigenous research is limited by a focus on rural locales, despite that more than half of Indigenous peoples live in urban areas. This exploratory paper draws connections between literature rooted in urban Indigenous studies and park management. I argue the literature’s current emphasis on rural locales neglects to consider how urban parks, might contribute to reconciliation if they affirmatively support urban Indigenous identities and cultural activities. I use two mini case studies—the Meewasin Valley Authority (Saskatoon, Saskatchewan) and Fort Vancouver National Historic Site (Portland, Oregon)—to highlight some of the ways in which urban parks can support urban Indigenous peoples’ responses to persistent urban settler-colonialism.

#41: Examining the Role of Rurality on the Incidence of Acute Respiratory Illnesses, Overall Antibiotic Use and Inappropriate Antibiotic Use Among Young Children in Tennessee

Abstract Background The Centers for Disease Control and Prevention (CDC) defines inappropriate antibiotic use as prescribing antibiotics not in accordance with national and local evidence-based guidelines, wrong selection of antibiotics, wrong dosing of antibiotics, or wrong duration of antibiotic use. Inappropriate antibiotic use has been associated with the development and transmission of antibiotic-resistant organisms. Acute respiratory illnesses (ARI) are the leading causes of antibiotic use among children with rates of antibiotic use in Tennessee children among the highest in the United States. The reasons for this have not been adequately assessed, particularly in children enrolled in the Tennessee Medicaid (TennCare) program, who tend to live in low-income households and rural locales and are disproportionately underrepresented in database studies conducted in large managed care organizations. We sought to examine whether the rates of ARI-related overall antibiotic use and inappropriate antibiotic use among young children enrolled in TennCare vary by the rurality of their county of residence. Methods This was a retrospective cohort study of children aged 2 months–5 years enrolled in TennCare from July 1, 2007, to June 30, 2017. We used pharmacy and healthcare claims data to calculate the incidence of ARI and ARI-related antibiotic use. Each eligible child entered into the cohort at the earliest time when selection criteria were met, and follow-up continued from cohort entry until the earliest of loss of enrollment, death, end of study, or meeting exclusion criteria. ARI was identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10) and ARI-related antibiotic use was defined as an antibiotic prescription filled within 72 hours of an ARI. ARI-related antibiotic use was classified as potentially appropriate or inappropriate using a previously published CDC classification system. The rurality of children’s county of residence was defined as either mostly urban, mostly rural, or completely rural based upon the United States Census Bureau definitions. We calculated incidence rates for ARI, ARI-related antibiotic use, and ARI-related inappropriate antibiotic use. To assess the effect of rurality of residence on these outcomes, we used multivariable mixed-effects Poisson regression. These analyses accounted for other factors including child age, gender, race, underlying comorbidities, calendar year and month, and history of antibiotic exposure. Results In total, 813,432 children met enrollment criteria and contributed a total of 2,057,272 person-years for the cohort. Overall, the rate of ARIs, antibiotic use associated with ARIs, and inappropriate antibiotic use associated with ARIs has trended down over time (Figure 1A). There were higher rates of these three outcomes in children who live in mostly rural and completely rural counties compared with those who live in mostly urban counties (Figure 1B–D). Conclusions Children who live in rural counties in Tennessee are disproportionately affected by higher rates of ARIs, antibiotic use, and inappropriate antibiotic use compared with those who live in urban counties. These findings can inform targeted stewardship interventions to reduce inappropriate antibiotic prescribing and to decrease the rates of antibiotic-resistant infections.

A Survey of Policy Responses to the Rural Attorney Shortage in the United States

This chapter surveys the short history of policymakers’ and scholars’ attention to the rural lawyer shortage in the United States, discussing this phenomenon as one aspect of a burgeoning rural access-to-justice (A2J) crisis. A number of initiatives to narrow the rural-urban justice gap are currently afoot in the United States, including the expanded use of paralegals and various interventions based on artificial intelligence and other technologies. These, however, are beyond the scope of this chapter, which focuses on the rural attorney shortage. We categorize policy responses to that problem into several overlapping strands: (1) programs that provide financial incentives and other supports for lawyers to practice in rural locales; (2) programs that channel urban attorney resources to rural areas; and (3) programs focused on cultivating and expanding the pipeline to rural practice. Where possible, we provide status reports on initiatives in an effort to document and publicize their progress, thereby informing future policymaking. Finally, we discuss briefly the medium- to long-terms impacts that changes driven by the COVID-19 pandemic may have on the legal profession and delivery of legal services in rural America.

Keeping Up With the Joneses: District Adoption of the 4-Day School Week in Rural Missouri

In recent years, rural school district adoption of 4-day school weeks has grown markedly. Despite this rapid growth, scant empirical evidence has documented the factors associated with district adoption and subsequent effects on student, labor, and economic outcomes. We examine the spread of the 4-day school week in rural Missouri, where over 10% of the state’s districts have adopted the policy in the past decade, the majority over the past 2 years. To help policymakers understand why districts forgo a day of instruction and to contextualize postpolicy effects, we conduct a survival analysis to assess student, district, and staff characteristics associated with policy adoption. We find that the presence of nearby 4-day school week districts most strongly predicts policy adoption. Adopting districts typically offer lower teacher salaries than nearby districts and have declining student enrollments. Our findings may inform policy focused on teacher recruitment and retention in rural locales.

Bioclimate in Built Environment

The bioclimatic aspects are associated with building environmental performance that makes a building help minimum impact on the environment, attention to human health and safety, minimum energy consumption. The ergonomic design of buildings contributes to maintaining the bioclimatic aspects of the buildings. The study reflects building structure and materials used depend on occupant choices, lifestyle, and economic viability. Therefore, the low-cost mud houses of the coastal regions often follow local practices. The dwelling pattern (two adjacent rooms opening to the corridor) was more prevalent in rural and semiurban areas. The housing exteriors are typical rural locales, commonly comprising agricultural fields, vegetation areas, and ponds. The statistical analysis covering different bioclimatic components, such as transportation availabilities, surrounding environment, and building structure, indicated a significant difference among remote rural, rural and semi-urban residences. The climatic conditions of the four village blocks covered in the study were hot and humid. The component structures provided a basis to explore further the possible influence of additional passive design options in constructing dwellings in coastal rural and semi-urban areas and enhancing thermal comfort. Selective passive design solutions indicate improvements in yearly total thermal comfort hours. Given the viability of poor residents in coastal rural and semi-urban areas, introducing interventions like passive solar direct gain, high thermal mass, night flush, natural and fan-forced ventilation, and evaporative cooling can improve the extent of ~18% in yearly thermal comfort hours. An overall bioclimatic analysis of the rural and semiurban coastal dwellings suggests that some passive design strategies can substantially enhance the thermal comfort of the inhabitants.

More than sweat equity: Young people as volunteers in conservation work

Abstract This paper examines how young people come to be enrolled and engaged in programmes of unpaid environmental conservation in rural areas. Set within a theoretical debate regarding the nature of unpaid work and its relationship to voluntary and coercive forms of environmental action, the paper identifies four pathways and two types of recipient organisations through which young people become involved in efforts to protect and enhance rural landscapes and locales. Drawing on a combination of extended survey and in-depth qualitative research in the west and south of rural England, the paper considers the systems of governance that surround the organisation of these unpaid activities and shows how these are rationalised and designed as practical and embodied experiences of citizenship. The paper argues that enhancing participation rests less on how to foster more young participants into the conservation sector than how to structure these activities in more productive ways that go beyond simple ‘sweat equity’. The findings have implications for the training and organisation of volunteers in other sectors.

From Ethnography to Webnography: Changing Contours of Field Research in India1An earlier version of the paper was presented in the M. N. Srinivas Centenary Conference, organised by the Institute for Social and Economic Change, Bengaluru on 29–30 August 2017. Several of the issues raised in this paper are to be traced to the very insightful discussions with the doctoral students

Contributions of M. N. Srinivas to the understanding of changing nature of caste, village and politics have been well documented and continue to be under focus several decades after his scholarly formulations on them. This article is an attempt to focus on the nature of changes that are occurring in the realm of his contributions to the field of social science research methods—especially to the tradition of intensive field research whether in rural or urban locales. Not only have the field sites’ amenability to research has undergone a major change, the institutional context in which social research is practised have radically transformed. This article is an attempt to track some such changes in both the contexts and to reflect upon the emerging challenges to social science research in general and the idea of ‘field’ research in particular. One of the questions it raises and attempts to answer is: Is sociology and social anthropology becoming more dependent on secondary data, and the source becoming a web than the field?

Tele-mental health with marginalized communities in rural locales: Trainee and supervisor perspectives.

The provision of mental health care via technology has been used successfully for several years with rural communities The COVID-19 pandemic, however, led to a substantial surge in usage of tele-mental health as therapists sought to maintain continuity of care for their clients when in-person sessions became unsafe and the need for services increased Based on our experience with tele-mental health, especially synchronous digital video conferencing, in an underserved rural state as 2 trainees and a supervisor, we offer our perspective on considerations for tele-mental health with clients from marginalized communities Three themes are explored: utilizing a multicultural lens, being an advocate, and promoting flexibility within fidelity (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Electric vehicles and rural business: Findings from the Warwickshire rural electric vehicle trial

The aim of this paper is to examine the impact of rurally based Small/Medium enterprises (SMEs) adopting electric vehicle (EV) technologies as part of their transport strategies. Existing research has demonstrated significant knowledge gaps relating to the impact of EV uptake on transport costs and planning for rurally based businesses. Instead, much of the literature has focused on the challenges faced by urban users of this technology. The paper extends the academic discourse surrounding the transition of the automotive sector to a zero emissions future by focussing on socio-technical factors in technology adoption. Importantly, the paper provides a rural emphasis on such change by reporting the results of a two-year EV demonstrator trial undertaken by sixteen businesses located in rural areas of Warwickshire, England, encouraging a much need shift in policymaking awareness. An important component of the research was to examine multi-level perspectives of technology adoption for rural firms and to question whether EVs would lead to locked-in transport technology pathways. The results of this trial gave a range of important insights into the outcomes of enterprises embracing commercial EVs for personal and business transport purposes. Evidence from the participants suggests that should EVs receive significant support in terms of infrastructure enhancement and technical developments they may prove a suitable substitute for existing transport provision in their rural locales.

Changing Livelihoods in Rural Eastern Cape, South Africa (2002–2016): Diminishing Employment and Expanding Social Protection

Despite long-standing patterns of agrarian change in South and Southern Africa, rural locales remain home to millions of people, characterised by widespread poverty and vulnerability. This is evident in South Africa’s former ‘homelands’, the site where this study examined changes in rural livelihoods over a 14-year period. Detailed survey data (collected in 2002 and 2016) from two villages in the Pondoland region of Eastern Cape province, and augmented by in-depth fieldwork, are analysed to explore the drivers of contemporary livelihood change. Key livelihood activities are examined, namely paid employment, social grant receipt, horticulture and livestock production, marine-resource and firewood harvesting. So too are changes within, and between, these diverse livelihood activities over time. Both monetised (income-earning) activities, and ‘unremunerated’ or unmonetised activities (for example, subsistence agriculture or marine-resource harvesting) are measured, aggregated and compared, in order to consider the drivers, consequences and prospective future trajectories of livelihood change. Key findings for impoverished households in the villages are that waged work has decreased significantly, while expanding social welfare provision has prevented plunges into deeper poverty. Agriculture and marine-resource harvesting remain dynamic, albeit unevenly engaged in by villagers. Amid these larger patterns, local-level variations are evident, with discrepant employment and agricultural production patterns across villages. The role of the state is ambiguous, being both a restrictor and enabler of local livelihoods. As jobs and other livelihood opportunities diminish, the villagers express frustration with the state, but remain simultaneously heavily reliant on state fiscal transfers, through grants and public employment schemes. The findings speak not only to the dynamics of rural livelihoods in South Africa’s former homelands; they also point to changes in rural dwellers’ livelihoods, within contexts of agrarian change, rural dispossession, inequality and receding prospects for employment, increasingly evident across the global south.

Rural risk environments, opioid-related overdose, and infectious diseases: A multidimensional, spatial perspective

BackgroundMuch remains unknown in rural risk environments, despite a growing crisis in these areas. We adapt a risk environment framework to characterize rural southern Illinois and describe the relations of risk environments, opioid-related overdose, HIV, Hepatitis C, and sexually transmitted infection rates between 2015 and 2017. MethodsOver two dozen risk environment variables are summarized across zip-code (n = 128) or county levels (n = 16) based on availability and theoretical relevance. We calculate data attribute associations and characterize spatial and temporal dimensions of longitudinal health outcomes and the rural risk environment. We then use a “regional typology analysis” to generate data-driven risk regions and compare health outcomes. ResultsPervasive risk hotspots were identified in more populated locales with higher rates of overdose and HCV incidence, whereas emerging risk areas were isolated to more rural locales that had experienced an increase in analgesic opiate overdoses and generally lacked harm-reduction resources. At-risk areas were characterized with underlying socioeconomic vulnerability but in differing ways, reflecting a nuanced and shifting structural risk landscape. ConclusionsRural risk environment vulnerabilities and associated opioid-related health outcomes are multifaceted and spatially heterogeneous. More research is needed to better understand how refining geographies to more precisely define risk can support intervention efforts and further enrich investigations of the opioid epidemic.

Interpersonal violence and violent re-injury in the Northern Territory.

To analyse incidence of prior emergency department presentations for interpersonal violence and demographics for a series of hospital admissions for interpersonal violence injuries. Retrospective analysis of trauma registry. A tertiary hospital and primary referral centre for trauma in the Top End of the Northern Territory. Patients hospitalised from 2010 to 2015 for injuries due to interpersonal violence with an injury severity score>9. Patient demographics, injury location, assault mechanism, alleged perpetrator, time/day of event, alcohol involvement, clinical outcome and prior emergency department presentations for interpersonal violence. A total of 248 admissions for patients with Injury Severity Score>9 due to interpersonal violence were identified. Indigenous females over-represented non-Indigenous females (35.4% vs 5.0%, P<.001). The majority of victims had evidence of alcohol intake at presentation. Victims of single-punch head injuries were mostly male and non-Indigenous, whilst Indigenous persons experienced significantly more blunt and penetrating weapon injuries (66.7% and 68.1%). Forty-three per cent of patients had a preceding emergency department presentation for interpersonal violence; female gender, Indigenous ethnicity, evidence of alcohol intake, and urban location of injury were independent risk factors for prior interpersonal violence presentation. Interpersonal violence is a recurring disease for a just under half of those presenting to a Top End hospital with moderate to severe injuries. Indigenous ethnicity, female gender and evidence of alcohol intake are predictive of prior interpersonal violence presentations. Patient under-reporting and incomplete data may underestimate the true prevalence of interpersonal violence presentations in rural and remote locales.

Why place matters: A rurally-orientated analysis of COVID-19’s differential impacts

This paper considers the implications of COVID-19 during the early stages – or ‘first wave’ – of the 2020 pandemic in relation to the enduring urban/rural dichotomy within high-income economies. Drawing on popular media/news stories and political discourse that emerged during this time, we examine how dominant constructions of dichotomised places (urban/rural) have been transformed in ways that highlight how rural places are positioned in contestations over resources and control of spaces. This examination is contextualised within an understanding of the enduring healthcare maldistribution between urban and rural places in geographically large and sparsely populated high-income countries, which renders many rural locales decidedly vulnerable when it comes to the testing/diagnosis, treatment and management of COVID-19. We argue that scholars engaged in place-sensitive research have a critical role to play in working with and empowering rural communities to increase broader public and political understanding of precisely why place matters during public health crises. • COVID-19 highlights enduring urban/rural dichotomies but related meanings have shifted. • Health workforce maldistribution heightens the vulnerability of rural communities. • Place-sensitive research and disaster responses are required for rural communities.

Place-Based Sustainability Planning: Implications & Recommendations for Rural Northwestern Ontario

First published advance online December 17, 2019As rural regions in Northwestern Ontario are faced with dynamic changes, it is important they are equipped with the tools and strategies needed to maintain healthy environments, resilient communities, and robust economies. There is a need for innovative approaches to rural planning that incorporate the values and tools of sustainability planning and, as such, will be more equipped to address the diverse strengths and challenges of rural regions. This article attempts to identify the potential for place-based and northern adaptations of sustainability planning. It highlights challenges for sustainability planning in rural areas and discusses how smart growth approaches have the potential to guide planning processes in rural locales. It then examines an existing rural smart growth framework and gaps in that framework from a northern perspective. The article concludes with some proposed adaptations to the rural smart growth framework to address the unique characteristics and needs of northern, rural communities and regions; adaptations that might help to further development of regional, place-based, sustainability planning in Northwestern Ontario and across Canada’s Provincial North.