Comparing health care workforce in circumpolar regions: patterns, trends and challenges

Abstract

Background: The eight Arctic States exhibit substantial health disparities between their remote northernmost regions and the rest of the country. This study reports on the trends and patterns in the supply and distribution of physicians, dentists and nurses in these 8 countries and 25 regions and addresses issues of comparability, data gaps and policy implicationsMethods: We accessed publicly available databases and performed three types of comparisons: (1) among the 8 Arctic States; (2) within each Arctic State, between the northern regions and the rest of the country; (3) among the 25 northern regions. The unit of comparison was density of health workers per 100,000 inhabitants, and the means of three 5-year periods from 2000 to 2014 were computed.Results: The Nordic countries consistently exceed North America in the density of all three categories of health professionals, whereas Russia reports the highest density of physicians but among the lowest in terms of dentists and nurses.The largest disparities between “north” and “south” are observed in the Northwest Territories and Nunavut of Canada for physicians, and in Greenland for all three categories. The disparity is much less pronounced in the northern regions of Nordic countries, while Arctic Russia tends to be oversupplied in all categories.Conclusions: Despite efforts and standardisation of definitions by international organisations such as OECD, it is difficult to obtain an accurate and comparable estimate of the health workforce even in the basic categories of physicians, dentists and nurses . The use of head counts is particularly problematic in jurisdictions that rely on short-term visiting staff. Comparing statistics also needs to take into account the health care system, especially where primary health care is nurse-based.List of Abbreviations ADA: American Dental Association; AHRF: Area Health Resource File; AMA: American Medical Association; AO: Autonomous Okrug; AVI: Aluehallintovirasto; CHA: Community Health Aide; CHR: Community Health Representative; CHW: Community Health Worker; CIHI: Canadian Institute for Health Information; DO: Doctor of Osteopathic Medicine; FTE: Full Time Equivalent; HPDB: Health Personnel Database; MD: Doctor of Medicine; NOMESCO: Nordic Medico-Statistical Committee; NOSOSCO: Nordic Social Statistical Committee; NOWBASE: Nordic Welfare Database; NWT: Northwest Territories; OECD: Organization for Economic Co-operation and Development; RN: Registered Nurse; SMDB: Scott’s Medical Database; WHO: World Health Organization

Inequal distribution of nursing personnel: a subnational analysis of the distribution of nurses across 58 countries

“…During the development of the State of the World’s Nursing report, relatively few countries reported their subnational nursing headcounts, suggesting it was not available for health workforce and health services planning. While some studies of health workforce density and distributional equality have included nurses [ 32 – 34 ], there have not yet been dedicated studies examining how the subnational density of nurses relates to equality in service coverage and other indicators of health equity relevant to UHC.…”

To stay or not to stay: the role of sense of belonging in the retention of physicians in rural areas

“…Across the circumpolar region, the recruitment and retention of rural physicians continues to be a struggle that has met with varying degrees of success. North America (USA and Canada) has lower density of rural physicians than the Nordic countries, whereas Russia reports a paradoxical situation of high physician‐population ratios but a chronic physician shortage, especially general practitioners (GPs) in rural areas [ 3 , 4 ]. The largest disparities between “north” and “south” are observed in the Northwest Territories and Nunavut (Canada), and in Greenland [ 3 ].…”

“…North America (USA and Canada) has lower density of rural physicians than the Nordic countries, whereas Russia reports a paradoxical situation of high physician‐population ratios but a chronic physician shortage, especially general practitioners (GPs) in rural areas [ 3 , 4 ]. The largest disparities between “north” and “south” are observed in the Northwest Territories and Nunavut (Canada), and in Greenland [ 3 ]. Some countries have introduced educational and financial initiatives to lure GPs to rural areas [ 5 ].…”

Availability of health workforce in urban and rural areas in relation to Canadian seniors

“…However, those that include both physicians and nurses do not extend the analysis at the sub‐provincial level . A study by Young et al compares health care workforce (physicians, dentists, and nurses) in circumpolar countries and regions, including the three Canadian territories . However, the Canadian provinces are not considered.…”

“…10 A study by Young et al compares health care workforce (physicians, dentists, and nurses) in circumpolar countries and regions, including the three Canadian territories. 11 However, the Canadian provinces are not considered. Moreover, the age structure of the population is generally not taken into account, even though it varies considerably from one province to another.…”