Exploring rural health inequalities at a local scale: the case of Portneuf, Québec.

BACKGROUND The most common way of accounting for the countryside in health studies has been to compare it, as a whole, to the city. Furthermore, most of the work on small area health inequalities has been confined to major urban centres. To counter this trend, in this paper, we explore small area health inequalities in the predominantly rural county of Portneuf (population = 44,545), Québec. Such information can be of interest for local health planning. METHODS Three sources of data were used to define neighbourhood units: historical data, socio-economic data and perceptions of local stakeholders. Demographic, socioeconomic and general health status indicators were calculated by neighbourhood unit. For health status indicators, data came from mortality files (1998 to 2002), hospitalization files (2001/02) and the 2001 census for disability (individuals who reported being often limited in their daily activities) and the reference population. RESULTS The county of Portneuf was subdivided into 8 neighbourhoods. Differences between neighbourhoods were noticeable for demographic, socio-economic and all health status indicators. The greatest differences were found between the town of Pont-Rouge (population=4975) and the hinterland of the towns of Donnacona (population=6125) and Saint-Marc-des-Carrières (population=3160). The most striking was a difference of 6 to 8 years of disability-free life expectancy between the two groups, to the advantage of Pont-Rouge. CONCLUSION Although measuring rural health inequalities at a local level has some methodological limitations, true health inequalities exist in the county of Portneuf. These now need to be examined further.