Financial Exclusion in Rural and Remote New South Wales,Australia: a Geography of Bank Branch Rationalisation, 1981–98

The provision of financial services in rural Australia is a significant public policy issue, reflected in the high level of media and political interest in the recent spate of branch closures. There are, however, many aspects of the current debate regarding the delivery of financial services to rural communities that are, at best, less than ideal and, at worst, erroneous. Using telephone directories for New South Wales, non‐metropolitan bank branch listings for the period 1981 to 1998 were collated. A recategorisation of these data according to the Rural, Remote and Metropolitan Areas classification reveals, amidst a spatial realignment of financial service provision, that rural and remote New South Wales have been disproportionately affected by a relatively recent and concerted withdrawal of services. The research demonstrates that corporate‐level responses to increased competition within the financial system are significantly more important in deciding rural access to banking services than local and regional population trends. Indeed, two‐thirds of rural localities that have lost branches had experienced healthy population growth during the study period. In the wake of the post‐deregulation reconfiguration of the bank branch network, the socio‐economic marginalisation of rural communities is being compounded, a process of ‘financial exclusion’ recognised in other parts of the developed world.     

‘It’s a very isolating world’: the journey to HIV care for women living with HIV in British Columbia,Canada

HIV health services research conventionally defines place in terms of proximity to care. However, understandings of place must also include the social spaces that women living with HIV (WLWH) occupy which shape their experience of health and access to care. Drawing on focus group data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study, we explored how 28 WLWH navigate geographic place and social space in attempting to access HIV-related healthcare within and across a range of urban to rural localities in British Columbia (BC), Canada. We describe how existing services, even if physically close, can be socially marginalizing as women confront HIV stigma, racism, and classism, which operate to exclude women from the places and spaces they must access for care. We also emphasize how women enact ‘geographies of resistance’ and succeed in carving out their own safe options for care and support. Finally, we share recommendations identified by women themselves towards developing local and community-driven ‘geographies of change’ that support the health and healing of diverse communities of WLWH. Our findings stress the urgent need to acknowledge and redress socio-spatial barriers to care and to work with WLWH to co-create a therapeutic landscape that reflects women’s diverse identities, localities, emotions, and experiences.     

The Americans With Disabilities Act as Engine of Social Change: Models of Disability and the Potential of a Civil Rights Approach

The Americans With Disabilities Act, based on the civil rights/minority group and independent living models of disability, may enhance access to health care, personal assistance, employment, the electoral process, and smoke-free environments for people with disabilities. However, this essential law cannot resolve these key issues. Supplemental theoretical and policy approaches will be necessary to promote fundamental change.     

The greying of resource communities in northern British Columbia: implications for health care delivery in already-underserviced communities

The delivery of 'rural' health care services has long confronted the geographic problems of distance, low user densities, low-order facilities and caregiver shortages. As a result, rural and remote communities across Canada have struggled with health care delivery. For rural and remote communities in resource hinterlands, population ageing driven by industrial restructuring presents a significant departure from past experience. Drawing on examples from northern British Columbia (BC), this paper examines this context of ageing in rural and remote locations with the purpose of highlighting impending challenges for health care service provision. In the first part of this paper, we provide a demographic overview of population change and ageing in northern BC. In the second part, we present data on the availability of services throughout the region to support seniors who age-in-place. Population ageing, in areas that have never dealt with this issue before, highlights not only important servicing questions but also important policy questions about how to provide for needs that the policy and community context are not presently equipped to meet.     

General practice access in regional and remote Australia for ageing populations

Identifying and removing access barriers to the timely provision of comprehensive health care is increasingly important for the wellbeing of Australia's rapidly ageing and frail populations, particularly those in non‐metropolitan settings. This study has examined if current general practice (GP) locations in non‐metropolitan South Australia (SA) and Western Australia (WA) are geographically accessible to the rapidly growing frail and prefrail populations known to have a high level of health service use and reduced mobility. Geospatial analysis linking 60‐kilometre GP service catchments, 2016 population counts, and 2027 population projections has estimated that the size of the frail and prefrail population that live outside these GP service catchments will double, reaching 7,800 people by 2027. The maldistribution of GP locations was most evident in WA. As regional and remote populations continue to age, the challenge of health service provision, including geographic access to care, must be resolved to ensure that populations in these areas have the best opportunity to age well. Geospatial methods linking service and demographic information, such as the approach used in this analysis, can aid in planning the equitable provision of health care for older Australians.     

Mining sick: Creatively unsettling normative narratives about industry,environment, extraction,and the health geographies of rural,remote, northern,and Indigenous communities in British Columbia

Rural, remote, northern, and Indigenous communities on Turtle Island are routinely—as Cree Elder Willie Ermine says—pathologized. Social science and health scholarship, including scholarship by geographers, often constructs Indigenous human and physical geographies as unhealthy, diseased, vulnerable, and undergoing extraction. These constructions are not inaccurate: peoples and places beyond urban metropoles on Turtle Island live with higher burdens of poor health; Indigenous peoples face systemic violence and racism in colonial landscapes; rural, remote, northern, and Indigenous geographies are sites of industrial incursions; and many rural and remote geographies remain challenging for diverse Indigenous peoples. What, however, are the consequences of imagining and constructing people and places as “sick”? Constructions of “sick” geographies fulfill and extend settler (often European white) colonial narratives about othered geographies. Rural, remote, northern, and Indigenous geographies are discursively “mined” for narratives of sickness. This mining upholds a sense of health and wellness in southern, urban, Euro‐white‐settler imaginations. Drawing from multi‐year, relationship‐based, cross‐disciplinary qualitative community‐informed experiences, and anchored in feminist, anti‐colonial, and anti‐racist methodologies that guided creative and humanities‐informed stories, this paper concludes with different stories. It unsettles settler‐colonial powers reliant on constructing narratives about sickness in others and consequently reframes conversations about Indigenous well‐being and the environment.     

Social geographies of rural mental health: experiencing inclusions and exclusions

A dominant urban focus in previous research on the social geographies of mental health has obscured the experiences of people with mental health problems living in rural localities. Critiquing this urban focus, we report on research conducted in the rural and remote Scottish Highlands. Evidence derived from in-depth interviews with over 100 users of psychiatric services in the Highlands is deployed to investigate the complex socio-spatial dynamics of inclusion and exclusion experienced by these users on a daily basis. A discussion of the explanations that users themselves offer of their experiences is accompanied by a theoretical framing of these issues pivoting on relations of proximity–distance and intimacy–repulsion.     

Counselling in rural Scotland: care,proximity and trust

People living in small rural communities tend to interact with each other in multiple aspects of their lives and are generally less anonymous to one another than those living in urban places. This density of social connectedness tends to militate against the boundaries normally associated with professionalised forms of care. This article explores how these tensions are negotiated by people who have developed local counselling services in two rural areas in Scotland. Counselling is becoming increasingly widely used as a response to a variety of forms of distress and is argued to constitute a modern urban and feminised form of care. However, notwithstanding its urban origins and associations, people in some rural places in Scotland have successfully arranged for training to be delivered locally to men as well as women. Nevertheless they recognise that for many rural residents, counselling continues to be alien and viewed with suspicion. They describe how they protect the identities of service-users using locational and social network strategies. They also discuss the issues that flow from the challenges of providing well-boundaried relationships. In so doing they point to an inverse relationship between social proximity and trust, thereby supplementing existing accounts of the disadvantages of social proximity in rural places.     

Rural–Urban Migration and Gender Disparities in Child Healthcare in China and India

This article assesses the impact of rural–urban migration on gender disparities in children's access to healthcare in China and India. Much research has shown widespread discrimination against girl children in both countries, including in health investments, contributing to the well‐known problem of Asia's ‘missing’ women. Much less clear is the impact of the massive rural–urban migration now occurring in China and India on discrimination against daughters. Migration is usually thought to have a positive effect on child health, because of improved access to healthcare facilities, but this is not necessarily equally beneficial for both sons and daughters. Based on fourteen months of fieldwork with rural migrant families in Shenzhen (China) and Mumbai (India), this article argues that where migration improves access to healthcare, it may increase rather than decrease the gender gap in treatment of child illness in the short term, as resources are concentrated on the treatment of sons. Furthermore, it is not the case that rural–urban migration necessarily leads to better access to healthcare even for sons: some forms of migration may actually have an overall negative effect on child health outcomes. For these two reasons, development strategies focusing on large‐scale rural–urban migration should not be seen as a short‐term solution to problems of gender inequity in child health.     

An Examination of the Stochastic Distribution of Spatial Accessibility to Intensive Care Unit Beds during the COVID-19 Pandemic: A Case Study of the Greater Houston Area of Texas

Sufficient and reliable health care access is necessary for people to be able to maintain good health. Hence, investigating the uncertainty embedded in the temporal changes of inputs would be beneficial for understanding their impact on spatial accessibility. However, previous studies are limited to implementing only the uncertainty of mobility, while health care resource availability is a significant concern during the coronavirus disease (COVID-19) pandemic. Our study examined the stochastic distribution of spatial accessibility under the uncertainties underlying the availability of intensive care unit (ICU) beds and ease of mobility in the Greater Houston area of Texas. Based on the randomized supply and mobility from their historical changes, we employed Monte Carlo simulation to measure ICU bed accessibility with an enhanced two-step floating catchment area (E2SFCA) method. We then conducted hierarchical clustering to classify regions of adequate (sufficient and reliable) accessibility and inadequate (insufficient and unreliable) accessibility. Lastly, we investigated the relationship between the accessibility measures and the case fatality ratio of COVID-19. As result, locations of sufficient access also had reliable accessibility; downtown and outer counties, respectively, had adequate and inadequate accessibility. We also raised the possibility that inadequate health care accessibility may cause higher COVID-19 fatality ratios.     

Minority nations and attitudes towards immigration: the case of Quebec

Growing international migration constitutes a tremendous challenge for contemporary democracies, no more so than for minority nations. An important challenge for the latter is one of acceptance of immigration from the native‐born population, in a context in which immigrant can be seen as both a cultural and a political threat. In this article we ask what explains attitudes towards immigration in minority nations. More specifically, we seek to provide answers to these questions: What is the impact of cultural insecurity on attitudes towards immigration in minority nations? Is strong attachment to a minority nation associated with less positive attitudes towards immigration? And finally, are proponents of independence for minority nations more likely to favour a reduction in the level of immigration than those who oppose it? The article seeks to answer these questions by exploring the case of Quebec.     

Organizing for British national strategy

In December 1968 Ernest May asked how the US government could gain access to ‘long‐headed’ staffers to provide greater strategic depth to foreign policy. The challenge of long‐term strategy persists: how should government be organized to support it, how can the right people be found to staff it and how can political leaders make time for longer‐term policy‐making given the challenge of the immediate? The policy planning staff in the Foreign and Commonwealth Office have traditionally had the task of supporting longer‐range, broader foreign policy. A small group of diplomats—later leavened by externals from the media, non‐profit and private sectors—was meant to generate an improved approach to British interests and policy. As Robert Wade‐Gery recalls of its role in the 1960s, there was a push to forge fresh links with outside thinking. Did it work? Former policy planners can be circumspect about its achievements. One former British planner said he felt like ‘a spare part rattling around in a tin’, while former American planners have written about the challenge of injecting fresh thinking when detached from decision‐making. Other planners were dragged into operational work or speechwriting. Many planners nonetheless enjoyed the opportunity to think more broadly. Policy planning can be intellectually rich without being the source of actionable strategic thinking about the long‐term national interest. This article suggests that a greater focus on people rather than systems might help to foster more strategic, anticipatory and innovative thinking about the national interest.     

Indigenous health organizations,Indigenous community resurgence,and the reclamation of place in urban areas

Research around the world has been nearly unanimous about the positive impacts of Indigenous‐led health organizations on Indigenous peoples' qualitative experiences in health care, in the face of often negative experiences in non‐Indigenous‐led health care settings. Urban environments, including health care environments, are areas of increasing attention with regard to Indigenous peoples' health in Canada. In this study, which took place in the northern city of Prince George, British Columbia, 65 Indigenous community members and health services workers participated in interviews and focus groups, describing their experiences with urban Indigenous‐led health organizations—defined in this study as non‐governmental organizations that prioritize the values and practices of local Indigenous communities. Employing perspectives on place and relationships drawn from Indigenous critical theory and Indigenous community resurgence to analyze the findings of this qualitative study leads to a focus on how relationships impact and can even constitute places, enabling new understandings of the roles of Indigenous‐led health organizations in urban Indigenous community resurgence.     

Geographies of Isolation: How Workers (Don’t) Access Support for Problems at Work

Abstract: This paper is concerned with the social and spatial processes adopted by workers who face problems at work. Using interview data with minority ethnic workers in three local communities in London, the paper explores the mechanism people use to seek help and advice and what resources are available from local community organisations. Key findings suggest that many workers, both unionised and non‐unionised find themselves isolated and unable to access the support they need.     

What about effective access to cars in motorised households?

Most Canadian urban centres are facing difficulties with public transport systems. As car ownership has increased, urban areas have experienced a long‐term decrease in per capita ridership. At present, a significant proportion of riders in most cities is considered to be transit captives, which usually refers to carless individuals or members of carless households. But, what about members of motorised households without effective or real access to a car as, for instance, two‐income households with only one car? Do these ‘restricted car users’ constitute a significant, but somewhat hidden, segment of the transit market? The initial purpose of this paper was to learn more about individuals with restricted or no‐car access who live in car‐owning households: Who are they? Where do they live? Do their numbers fluctuate significantly throughout the day? More specifically, how has car access in motorised households changed in the past two decades? Sociospatial profiles of motorised household members with restricted car access are presented for 1981 and 1996. The second purpose was to analyse restricted car access in motorised households by using a multivariate model of car access for motorised households in the Québec metropolitan area. To achieve these objectives, we developed a logical typology of forms of ‘restricted car access’ based on a combination of variables, or resources, qualifying the degree of car access enjoyed by individuals at any given moment during the day: availability of a car, possession of a driver's licence and a driver at the disposal of other household members. This typology was then applied to the 1981 and 1996 origin–destination survey data obtained from the Québec Census Metropolitan Area.     

Personal Assistance Services: The Hub of the Policy Wheel for Community Integration of People with Severe Physical Disabilities

The success of persons with severe physical disabilities in living independently in the community, engaging in self-directed productive activities, and staying healthy depends, in part, on getting and maintaining adequate personal assistance with basic tasks such as getting out of bed and tending to personal hygiene. Although few policymakers would disagree with the contention that many people with disabilities need assistance with daily tasks, there is considerable debate about who should provide assistance, what services should be included, who should pay, who should be entitled to publicly provided and paid services, how much assistance should be provided, and who should control its administration. The prevailing model for delivery of personal assistance services has been primarily medical, with control of services by health care professionals, rather than independent living, with control by consumers receiving services. Traditionally there has been an institutional bias of funding for disability-related service, despite its much higher expense than community-based personal assistance services and its violation of basic human rights. Proponents of various solutions to health care reform have given little consideration to the provision of support services for people with disabilities. The advantages of implementing a uniform national system for the delivery of personal assistance services based on consumer control are discussed.     

Children,social capital and health: increasing the well‐being of young people in rural Wales

This paper explores the usefulness of employing the concept of social capital within a research project investigating the best ways of meeting the health and well‐being needs of young people living in rural Wales. The first part of the paper provides an overview of some of the current research exploring the relationship between social capital, health and young people. The second part provides an overview of findings from an action research project to illustrate how social capital is conceived and applied in this context. It concludes by stating that children and young people do actively generate, draw upon and negotiate their own social capital, and that this is an under‐utilised resource in terms of promoting health and well‐being.     

AIDS Activism in Pakistan: Diminishing Funds,Evasive State

This article draws on a year of ethnographic fieldwork in the HIV/AIDS sector of Pakistan at the moment of rolling back a World Bank‐financed programme. Classified by UN agencies as at ‘high risk’ of a generalized HIV epidemic, Pakistan has an epidemiology driven by injecting drug use, and a Penal Code and Islamist legislation which criminalize non‐therapeutic drug use and extra‐marital sex. In recent years, a sharp increase in the numbers of registered HIV‐positive people has necessitated a shift from HIV prevention among ‘high risk groups’ to the provision of care to those living with HIV/AIDS. The rolling back of external funding, which was further compounded by the effects of devolution on the Ministry of Health, created challenges for AIDS activism in Pakistan, as reflected in the everyday lives — and deaths — of the patient‐activists and their community‐based organizations. This article recounts the story of one such aspiring AIDS activist caught in multiple dilemmas emanating from these macro‐processes. This story throws light on the limitations of the complex agency of actors in development, and shows how the shifting loci of power from the state to non‐state entities in the global neoliberal order impacts the provision of vital services like HIV prevention and AIDS control.     

On the targeting and cost-effectiveness of anti-poverty programmes in rural India

This article is motivated by a concern for the cost‐effectiveness of anti‐poverty outlays; much of its focus is on the targeting of Rural Public Works (RPW) and the Integrated Rural Development Programme (IRDP) over the period 1987–93. It is argued that benefits to the rural poor of larger outlays on these two major anti‐poverty programmes are likely to be limited, given their mistargeting. Large sections of the rural poor were not covered in 1987. Worse, the non‐poor were in a majority among the participants. Although the evidence is mixed, there was a worsening of the targeting of both RPW and IRDP, with RPW maintaining a slight superiority, over the period 1987–93. Yet IRDP was more cost‐effective in both years, using a somewhat limited measure of cost‐effectiveness. Large unspent balances due largely to slow disbursal of allocations and bunching of expenditure in a few months are linked to changes in cost‐effectiveness. Wastage and diversion of funds are unavoidable, in a context of corrupt bureaucracy and capture of locally elected bodies such as Panchayats by a few influential persons. Short of drastic changes in the design and implementation of RPW and IRDP, substantially larger outlays may thus accomplish little in terms of poverty alleviation.     

乡村旅游对贫困山区农户多维贫困的影响研究

在分析乡村旅游对农户多维贫困影响机理的基础上,利用陕西4市22个乡村旅游扶贫村农户调查数据,采用内生转换回归模型,定量分析了乡村旅游对贫困山区农户多维贫困的影响。研究发现:多维贫困程度越深,农户参与旅游比例越低,乡村旅游不具有天然益贫性;参与旅游能够显著减缓农户的多维贫困。从单维贫困看,乡村旅游对调查地农户的经济、教育、生活水平和权利维度具有显著的减贫效应,其中对生活水平的减贫效应最大,健康维度效应不显著;参与和未参与乡村旅游的农户在多维贫困以及经济、生活水平维度的减贫影响因素存在着显著差异,而在教育、健康、权利维度的减贫影响因素差异不大。据此,从乡村旅游经营、精准帮扶、权益保障等方面提出对策建议。