While it has long been acknowledged that health is determined by a variety of social and physical factors, research into the interplay among these various determinants of health is still emerging. From 2001 to 2003, the Centres of Excellence for Women's Health examined the impacts of gender and rurality, two important and often neglected determinants, on women's health in Canada in order to generate an agenda for policy making and further research. As part of that national study, Rebecca Sutherns, Pamela Wakewich, Barbara Parker and Christine Dallaire conducted a review of the literature entitled, "Rural, Remote and Northern Women's Health in Canada: A Literature Review and Thematic Bibliography." (2) They noted that although Canadian research on rural, remote and northern women's health was limited at the time, momentum was clearly building.
This paper has been written as a follow-up to that review. It examines the Canadian literature on rural, remote and northern women's health published from January 2003 to June 2006. Using the same search strategy, format and analytical categories of the earlier piece, it offers an analysis of how the literature has evolved. Following a brief introduction to rural women's health in Canada, it presents the current research according to thematic categories. It then explores the scope, sufficiency, accessibility and methodology of that body of literature, reflecting on its strengths, gaps and tensions. It demonstrates that while some areas of rural women's health research continue to thrive, the overall level of activity in recent years has been disappointing.
The research strategy used in this project was the same to that used in the 2003 study. As before, the search endeavoured to find material both in peer-reviewed journals as well as through community resources, both in English and in French. The search included material which includes "health," "women" and "rural" both explicitly and implicitly. However, some databases and web sites were no longer accessible. (3) Refereed academic journals accounted for 68 percent of the entries found. Notable sources for non-academic publications include Prairie Women's Health Centre of Excellence, the Centres of Excellence for Women's Health collectively and Pauktuutit Inuit Women's Association, each of which contributed to the advancement of knowledge of rural women's health. Articles in this search were reviewed to determine their suitability in the database and were subsequently filed according to their theme. Although themes were matched to those identified in the previous research project, several new themes were established from the current search. Duplication was avoided by selecting the most appropriate category for each article.
Rural Women's Health in Canada
In this section, we provide a brief synopsis of rural women's health in Canada, to provide some context against which the results of this review can be understood. Roughly 20 percent of Canadians live in towns of under 10,000 people, which is Statistics Canada's definition of a rural place. This proportion varies widely by province and territory, ranging from 15 percent in British Columbia and Ontario to 68 percent in Nunavut. Close to 99 percent of Canada's ten million square kilometres are rural by area (Statistics Canada, (4) Society of Rural Physicians o[ Canada (5)).
Though the specific implications of living in rural, remote or northern locations vary widely, there is no doubt that rurality acts as a determinant of health in people's lives. It influences their physical environment, level of isolation, access to health care services and health status, as well as the attention paid to them by policy makers (Sutherns, 2005).
Although research specifically addressing the lives of rural women is quite limited, there is significant evidence to suggest that rural women's roles, health experiences, health status and health choices are heavily circumscribed by their gender and their location. …