Agora: Red Deer Polytechnic Undergraduate Journal
Volume 16:1 2025 Agora Conference Proceedings

Breaking the Cycle of Neglect:
Strengthening Healthcare Access for
Rural Communities in Alberta
Nicholas Baker
Neglect is an apt description of the attention and
compassion given to rural communities across Alberta. In rural
communities, cases of drug poisonings, mental health crises,
suicide, HPV transmission, and chronic health conditions are all
on the rise (Reilly, 2021). The lack of attention paid to rural
healthcare has escalated from a problem to a crisis, resulting in
a breakdown in the province's health care delivery system. The
crisis

strains Alberta's

healthcare

system,

while

rural

communities report lower life expectancies compared to urban
areas (Yangzom et al., 2023). The current healthcare delivery
system is insufficient to meet the needs of rural communities.
The paper provides individual accounts of how living in a rural
community impacts one's health and wellbeing. In addition, the
paper includes the thoughts of a rural Registered Nurse and their
revelation of what reality can be in rural emergency centres.
Healthcare is a human right regardless of the place you live.
Alberta is a province that often boasts about its economic might
and budget surpluses but rarely uses the resources to affirm the
53

right to healthcare in rural communities across Alberta. This
paper provides a case study analysis and individual concerns, of
how the situation developed over decades, what the current state
of healthcare is in Alberta, and what we can do to move forward.
History of Rural Healthcare in Alberta
The Origins of Rural Healthcare Challenges in Alberta
Since its establishment in 1905, Alberta has been a
province where residents relied on one another for survival.
Early European settlers often turned to the knowledge of their
elders, particularly mothers and grandmothers, for health
treatments. At that time, Alberta’s understanding of healthcare
was described as being at an elementary school level (Alberta
Bureau of Public Health, 1925). Due to the remoteness of many
communities and a shortage of medical professionals, healthcare
services and infrastructure were limited, and rural areas were
often overlooked. This neglect laid the foundation for longstanding disparities in rural healthcare. As a result, early
Albertans had to depend on home remedies such as berries and
roots to treat various ailments. The knowledge passed down
through generations enabled settlers to treat minor wounds by
making their own salves—topical ointments made from
beeswax and herbs for skin conditions (National Museum of

54

American History, n.d.). They also learned to set broken bones
to promote healing (Alberta Bureau of Public Health, 1925).
The leading causes of death among Albertans during the
early days of Alberta was Influenza, Pneumonia, and violent
means (McLaren et al., 2024). This data was collected by the
Department of Agriculture, as this was the department tasked
with collecting vitals statistics. During the period of 1910-1930,
communicable diseases posed a great threat to Albertans' health.
Communicable diseases were decimating communities, and
with the onset of the 1918/1919 Influenza pandemic it resulted
in the deaths of over 4300 Albertans (McLaren et al., 2024). It
was after the Influenza pandemic that the Alberta Government
established the Department of Health. A change occurred after
1919, as communities provided waterworks, sewage and
immunization services to the population, the leading causes of
death among Alberta's switched from communicable diseases to
a less transmissible form of death. In the 1930’s, diseases of the
heart and cancer surpassed communicable disease as the leading
cause of death among Albertans, and have remained the
dominant causes of death to the present day (McLaren et al.,
2024).
In the early 1920s, Alberta faced a persistent shortage of
physicians. The shortage was caused by the high demand needed
during WWI to aid in the war effort in Europe and to care for

55

Alberta's rapidly growing population. This gap in medical care
allowed for an emerging healthcare profession—Nursing—to
take on a crucial role in providing healthcare to those living in
rural and remote areas. Established in 1919, the District Nursing
Service was a group of nurses who provided both nursing and
limited medical care to residents living more than 60 miles from
the nearest railway station (Franchuk, 2020). The district nurses
of the time worked under a much larger scope of practice
compared to the nurses of modern day. The nurses were
authorized by the Public Health Nurses Act of 1919 to provide
services including midwifery, dispense medications, and make
diagnoses, while working under a physician (Franchuk, 2020).
These nurses were instrumental in bringing healthcare to
isolated communities and were often the only healthcare
providers for miles. Despite their importance this essential
service was inexplicably discontinued with the implementation
of Medicare in the 1970s (Alberta Department of Health, n.d.).
1990’s Budget Cuts
The 1990s were a transformative period for Alberta’s
healthcare system, driven by an economic downturn. After a
considerable increase in the price of crude oil per barrel,
climbing from around $30 per barrel in 1973 to over $150 in
1980 (Macrotrends, n.d). This surge in oil prices resulted in

56

economic prosperity for Alberta, however fortunes changed by
the mid 1980’s. From May 1980 to May 1986 the price per barrel
of oil dropped by $112.79 (Macrotrends, n.d). This massive
decline in oil prices resulted in economic hardships in Alberta,
similar to other areas of Canada (Canadian Broadcasting
Corporation, 2001). In response to the fiscal crisis, the Alberta
government, under Premier Ralph Klein, introduced sweeping
budget cuts as part of a broader effort to balance the provincial
budget. One of the most affected sectors was healthcare, with
funding for public health services slashed by a staggering 16%
(Thomson, 2019). These cuts had wide-reaching and lasting
consequences, particularly for rural communities that were
already grappling with inadequate healthcare services.
While the province’s urban centres had well-established
healthcare infrastructure and resources, rural communities faced
long-standing challenges in access to care. The budget cuts
exacerbated these challenges. Small towns, which depended on
local hospitals for essential medical services, saw a wave of
closures and reductions in the scope of healthcare available.
Rural hospitals, already understaffed due to the difficulty of
attracting healthcare workers to remote areas, experienced even
further reductions in personnel. As a result, many healthcare
professionals—doctors, nurses, and other support staff—
relocated to urban centres in search of more stable and higher-

57

paying opportunities. This migration created a deepening divide
between urban and rural healthcare access, a gap that continues
to be felt today.
In particular, the shortage of healthcare workers in rural
areas meant that residents faced increasing difficulties in
accessing even basic services such as primary care, emergency
services, and specialist consultations. The closure of rural
healthcare facilities compounded the isolation of these
communities, making it harder for residents to access timely and
effective care.
Current Day
In 2025, Alberta’s healthcare system is in crisis. Rural
areas in particular are facing significant challenges as the
number of healthcare professionals available to serve these
communities continue to dwindle. As the population ages, the
demand for healthcare services has increased, and the lack of
local care providers has only worsened the situation. Rural
healthcare professionals are retiring at higher rates, and the
inability to attract new talent has left a gaping hole in healthcare
delivery. The lack of health services disproportionately impacts
those over the age of 65. Statistic Canada (2023) reports 8.4%
of Canadians over the age of 65 used home care services, and
those 65 and older reported the highest rate of unmet home care

58

needs. It is expected that without immediate intervention,
Alberta will soon lack the capacity to care for its senior
population in the very communities they have lived in for
decades (MNP LLP, 2021).
The situation is further compounded by the opioid
epidemic,

which

has

disproportionately

affected

rural

communities. According to Pijl et al. (2022), the opioid crisis
has been exacerbated in rural Alberta due to limited access to
addiction treatment and mental health services. With fewer
healthcare facilities offering specialized services, rural residents
struggling with addiction often find themselves without
necessary support systems. This lack of reputable and evidencebased treatment options has led to higher rates of overdose and
addiction-related deaths in rural areas, making the opioid
epidemic another pressing issue that rural healthcare systems are
ill-equipped to address.
A Nurse’s Perspective
As a third-year BScN student, I would like to dedicate a
portion of this paper to the perspective of a Registered Nurse
who has spent the majority of her career in rural healthcare. The
following reflections are shared by Jean Smith, an RN and
Nursing Instructor at Red Deer Polytechnic. Jean has a wealth
of knowledge and experience in rural Alberta, having worked for

59

nearly four decades in various acute care roles in remote and
small-town health centres. I had the privilege of learning from
Jean during my six-week rural health clinical rotation at the
Rocky Mountain House Health Centre, where her mentorship
and insight deeply influenced my understanding of rural nursing
practice. I am sincerely grateful to her for sharing her story and
contributing her perspective to this topic.
As an RN who has worked in the rural acute care
environment in a variety of capacities for nearly 40 years, I have
experienced what it means when “I’m It” (Smith & VandallWalker, 2017, para. 31) due to lack of access to resources, but
also how the rural team works together like family to provide
patients the best care possible. For instance, when working one
day in the emergency department (ED) during an extremely busy
shift, the team was providing care for multiple high acuity
patients requiring transport to a higher level of care by either
ground ambulance or the Shock Trauma Air Rescue Service
(STARS). We called for extra help from the registered nurses
(RNs) on the acute care ward and of course they came to our
rescue. Our ED team only consisted of two RNs, a Unit Clerk,
and one physician. Given that we had no respiratory therapist, I
was “It” providing airway support for a patient, while the other
RNs worked with the physician providing the necessary
treatments to stabilize the other patients. A second physician was

60

called and had arrived to assist the team. Even then, we required
extra hands for safe patient care, so I willingly stayed beyond
my shift to help. However, I also needed to pick up my children
from school. Like family, one member of the Environmental
Services team offered to retrieve my children from school and a
physician who was not involved in the ED activities offered to
look after them in the physicians’ lounge (approximately two
hours). The Environmental Services member also stopped by
Tim Hortons bringing beverages for the entire ED team. We
stabilized the patients as best we could and debriefed afterwards
with nourishment provided by our friend. The patients were
safely cared for and transported out. It was a good day! (Smith
& Vandall-Walker, 2017)
Jean’s account offers a vivid picture of the adaptability,
dedication, and community spirit required in rural nursing. Jean
sacrificing her personal time to go above and beyond her
responsibilities as a RN, showcases the true dedication and
commitment healthcare workers have for the communities they
serve. Jean's example also underscores a broader issue: the
increasing frequency with which RNs are required to take on
responsibilities that extend beyond their traditional scope of
practice due to staffing shortages and limited access to
specialized services. While nurses are often trained in advanced
skills such as airway management, these tasks are ideally

61

handled by professionals like respiratory therapists who
specialize in that domain. The problem arises when such
professionals are simply unavailable—leaving nurses to fill
those gaps, often without additional compensation, time, or
institutional support.
This growing expectation places significant stress on
rural nurses and can contribute to burnout, moral distress, and
workforce attrition. As the healthcare system continues to
grapple with resource limitations, it is crucial to recognize the
essential, multifaceted role that RNs play in rural settings.
Furthermore we need to ensure RNs are adequately supported,
trained, and staffed to meet these demands safely, so they can
serve Rural and Remote communities to the best of their
abilities.
A Rural Community Resident Perspective
While compiling this paper I wanted to include
the thoughts and opinions of those who live in rural
communities. For residents of rural communities, having a
hospital nearby provides a vital sense of security. It reassures
individuals that if the unthinkable happens—whether it be a
sudden illness, injury, or medical emergency—help is not far
away. Individuals across Alberta often feel a sense of comfort
and ease when their community has a healthcare centre.

62

However, in many rural and remote areas, including Swan Hills,
Alberta, this sense of security is rapidly eroding. The Swan Hills
Healthcare Centre has been forced on more than once occasion
to change its operating hours due to lack of physician services.
Furthermore, many of the services the healthcare centre
previously provided are not in use now as there are no qualified
technicians to operate this equipment such as the X-ray machine.
To better illustrate the personal experiences of those
living in rural communities, I posed two qualitative questions to
residents of Swan Hills. Members of the community graciously
answered my questions; their responses reflect sentiments
echoed by many in similar rural communities.
Question 1: What has having a hospital in Swan Hills
meant to you?
“Having a hospital in a small town like Swan Hills is
everything. Being in a remote community, having a hospital
where you can go to get medical attention is both practical and
emotional. For many, it offers a sense of security and peace of
mind, knowing that if something unexpected happens—whether
it is an injury, illness, or emergency—a hospital is nearby to get
immediate care. It is also an important economic anchor,
providing jobs and services for the local population.” —
Resident of Swan Hills

63

Question 2: How do healthcare disruptions impact your
life?
“Healthcare disruptions have a significant impact on life,
especially when they create uncertainty or affect access to
necessary care. It affects residents' emotional well-being,
leading to stress, anxiety, and even fear about not getting the care
needed in a timely manner. Healthcare disruptions mean
traveling out of town for treatment or prescription refills. Travel
expenses are another factor in healthcare disruptions.” —
Resident of Swan Hills
Another resident emphasized the stress of delayed
emergency care, stating:
“It is very stressful, as when emergencies happen, help is
over an hour away.”
These responses clearly demonstrate the critical
importance of local healthcare services in rural and remote
communities—not only for physical well-being but for
emotional and psychological health as well.
Hospitals also play a key economic role in rural
communities by providing high paying and respectable jobs to
the residents. Hospitals employ a wide range of professions,
including physicians, nurses, lab technicians, and janitorial staff.
When a hospital closes or operates below capacity, these
professionals are often forced to seek employment elsewhere—
64

typically in more urban areas. As healthcare professionals and
their families leave, this outmigration contributes to further
population decline in rural areas. With shrinking populations,
health facilities struggle to recruit and retain staff, creating a
cycle of under-resourced care. One resident noted:
“Our hospital does not serve us and does not contain the
necessary services that are tailored to the community of Swan
Hills. The hospital has a birthing suite, but no babies have been
born here in years.”
The lack of accessible healthcare also places a burden on
working residents. One individual shared:
“Having to take the whole day off work is a huge
inconvenience for me. I have to take off an entire day just to
access basic healthcare.”
In summary, the absence or reduction of healthcare
services in rural communities like Swan Hills impacts far more
than just health outcomes—it touches every aspect of daily life,
from employment and population stability to emotional wellbeing and economic productivity.
Indigenous Communities
Those living in Indigenous communities are particularly
hard hit by the crisis unfolding in rural healthcare. The crisis
grows more complex when we review the state of rural

65

Indigenous communities in Alberta. Beyond geographical
location, Indigenous communities face additional barriers rooted
in a long history of systemic racism and colonization. These are
not abstract concepts, but real and ongoing forces that shape the
lived experiences of Indigenous peoples. The result of systemic
racism and colonization has fractured the fragile relationship
that exists between Indigenous peoples and the healthcare
system in Alberta and across Canada (Canadian Medical
Association, n.d.). This historical trauma, compounded by
present-day inequities, has fostered deep mistrust in a system
that has often failed to recognize or respect Indigenous ways of
knowing, being, and healing.
Access to care remains one of the most pressing issues.
As many as 50% of First Nations, Métis, and Inuit individuals
report not having access to a regular healthcare provider
(Yangzom et al., 2023). Not having a primary provider means
limited opportunities for early intervention, continuity of care,
or preventative health services—gaps that can have devastating
consequences. This is yet another disparity that exists for those
of Indigenous heritage compared to non-Indigenous peoples.
The consequences of this unequal access are reflected in health
outcomes: Indigenous peoples experience significantly higher
rates of chronic health conditions such as diabetes, heart disease,
and respiratory illness, as well as disproportionately poorer

66

mental health statuses (Yangzom et al., 2023). These health
inequities are not just medical concerns—they are indicators of
social injustice.
Addressing the healthcare crisis in Indigenous rural
communities requires more than just infrastructure and funding.
It demands a culturally safe, trauma-informed approach that
centres reconciliation, respect, and partnership with Indigenous
communities. Solutions must be Indigenous-led and reflect the
voices, needs, and knowledge systems of the people they intend
to serve. Rebuilding trust and restoring equity will take time, but
it begins with recognizing the historical harms and acting with
accountability and humility.
Primary Care Networks: A Strategy to Address the Issue
One solution to address this crisis is the expansion of
Primary Care Networks (PCNs) across Alberta, specifically in
Indigenous and rural communities. PCNs operate using a
collaborative care model that includes family doctors, nurses,
pharmacists, and social workers. This team-based approach
ensures patients receive timely, community-based care, reducing
the risk of expensive complications or hospitalizations (Health
Canada, 2024). PCNs care models include routine checks, early
screening, and chronic disease management. Expanding PCNs
would provide access to preventive and primary care for over

67

800,000 Albertans (Canadian Rural Revitalization Foundation,
2024). The Canadian Institute for Health Information (n.d.)
found in 2023-2024 over 17% of cases that presented to the
emergency room could have been treated with Primary Care
services. The expansion of PCNs into rural and Indigenous
communities will improve healthcare accessibility, addressing
issues such as rural isolation, limited facilities, and poverty. This
strategy requires a comprehensive, publicly funded plan. Public
funding ensures equitable access to healthcare services, ensuring
no one is denied care based on their socioeconomic status or
geographic location (Canadian Medical Association [CMA],
2024). In addition, the public funding model ensures that the
care services that Albertans require or want are made readily
available to them. Private models often favour cheaper services
and will often avoid costly services in order to protect profit
margins. As stated before in this essay, Healthcare is a right, and
it should always be placed above profits.
Why Address the Issue?
There are a number of reasons why we should be
providing high-quality healthcare to those living in rural and
remote communities. This paper addresses two reasons, which
the author believes are both practical and reasonable. The first
reason being that, as citizens of Alberta—like those who lived

68

here before us—we have a responsibility to help one another
when they are in need. The second reason being that providing
high-quality and efficient healthcare to rural and remote
communities can actually be a cost-saving measure for the
province and individuals' own funds.
A Moral Responsibility
Access to quality and affordable healthcare is a
fundamental right in Canada, enshrined in both national values
and public policy, regardless of a person's geographical location.
Yet, as this paper has demonstrated, individuals living who
reside in Albertan rural and remote communities are not being
equitably served by the current healthcare delivery systems.
Despite consistent recognition of healthcare as a public good,
these communities continue to face systemic neglect. This is
particularly troubling when viewed in the context of Alberta’s
economic prosperity. The province of Alberta frequently reports
one of the highest gross domestic products (GDP) in the country.
In 2023, Alberta’s GDP reached 336.3 billion dollars—an
increase of 4.8 billion, or 1.5%, from the previous year (Statista,
2024; Statistics Canada, 2024). This economic strength
underscores a stark contradiction: the province has the financial
capacity to support robust healthcare infrastructure, yet rural
healthcare continues to deteriorate.

69

This is not simply a policy failure—it is a moral failure.
The disparity cannot be justified by population size or
geography alone. People in rural and remote areas do not have
fewer healthcare needs. In fact, due to geographic isolation,
higher rates of chronic disease, mental health challenges, and
limited access to preventative care, their needs are often more
complex (Laurent, 2002). So why do they have less access to
care? This disconnect raises ethical questions about equity,
justice, and our collective priorities as a society. It suggests that
the barriers are not purely logistical or financial, but rooted in
long-standing systemic inequities and a lack of political will.
Addressing this is not just a matter of improving service
delivery—it is a matter of doing what is right.
Cost Savings
Primary Care Networks (PCNs) can address minor
health ailments before they escalate into chronic conditions
(Alberta Primary Care Network, 2024). This proactive care
model can drastically reduce healthcare costs in rural and
Indigenous communities. Treating severe illnesses such as
diabetes or heart disease in inpatient settings is significantly
more expensive than preventive care (Alberta Primary Care
Network, 2024). Additionally, individuals in Indigenous and
rural communities who lack access to primary or preventive care

70

often present at emergency rooms, further increasing healthcare
expenses and depleting system resources (Basu & Phillips,
2016). Rural and Indigenous populations also face barriers such
as limited local healthcare facilities and the need to travel long
distances for care. Expanding PCNs reduces the need for costly
transportation and accommodation, which are often necessary to
access urban healthcare services. While PCNs often exist in
some form in large urban centres such as Red Deer, PCNs are
not present in rural and remote communities, where they are
desperately needed. Furthermore, consistent preventive care
within PCNs can reduce hospital readmission rates by managing
chronic conditions more effectively (Centers for Disease Control
and Prevention [CDC], 2021). These measures not only improve
health equity but also ensure more efficient resource utilization,
creating long-term savings for Alberta's healthcare system while
enhancing the quality of life for rural and Indigenous
populations.
Conclusion
Improving healthcare access in rural, remote and
Indigenous communities is not merely a policy challenge—it is
a moral imperative grounded in the values of equity,
reconciliation, and human dignity. The voices of rural nurses and
community members underscore the urgency of addressing long

71

standing barriers to care, and the expansion of Primary Care
Networks offers a practical, community-centred solution. By
investing in culturally safe, locally driven models of care and
ensuring that healthcare professionals are supported and retained
in underserved areas, Alberta has an opportunity to lead the way
in creating a more just and responsive healthcare system. This
paper and the ideas presented within it are not the only path
forward in addressing the crisis in rural healthcare and Alberta’s
healthcare system as a whole. However, it offers a starting point
for how we can begin the journey toward improving healthcare
access and services for those living in rural and remote
communities. The path

forward

must

be

shaped

by

collaboration, evidence-based treatment, respect for Indigenous
sovereignty, and a commitment to health as a human right. Now
is the time for action—because where someone lives should
never determine if they live.

72

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