DISPROPORTIONATE ACCESS: People in rural communities have poorer health status and greater needs for primary healthcare, yet they are not as well served and have more difficulty accessing health care services than people in urban centres. Access to care that urban dwellers consider routine, such as mental health services, counselling, care of handicapped children, speech therapy, physiotherapy, occupational and work therapy, support groups and so on, is either rarely found in rural areas or is improvised by the very practitioners who are in such short supply. Problems with access to health services stem from severe shortages of health care providers for even the most basic health services. Rural communities often have difficulty accessing primary health care and keeping health care providers in their towns, let alone accessing diagnostic services and other more advanced treatments. This added burden on rural physicians, nurses and administrators only adds to the current problem of recruitment and retention. People in rural communities also have the added burden of paying for the high costs of travel in order to access the care they need. This often means days or weeks away from their family and social support, as well as the added cost of accommodation and meals. Then there is the hidden cost associated with adverse outcomes caused by having to transfer patients for care. Obstetrics is an example of where the absence of local maternity services is shown to increase prematurity of newborns, hospitalisations, and costs, even if the referral hospital is of the highest standard. The density of rural communities coupled with the need to provide acute interventions in the "golden hour" of trauma, the 30 minutes for caesarean and the other time-based standards that save lives, indicate that health facilities and medical services need to be located near the people. In some cases, the delays may have no adverse effect on prognosis, but it may cause considerable anxiety. In other cases, waiting leaves people in considerable pain, diminishes capacity or increases the risk of health decline or even death. Delays in the journey can, therefore, cause anxiety, prolong suffering and, in some cases, affect outcomes following care. IMPORTANCE OF RURAL HEALTH CARE A lack of rural services can have significant adverse effects on the local economy, it often does not realise savings, it may actually increase costs and it will further complicate efforts to attract new physicians. There is a strong link between health care accessibility and the sustainability of rural communities. According to his 2002 report on the future of health care, Commissioner Roy Romanow stated that “people’s choice of whether or not to live in smaller communities is affected by whether or not they can get reasonable access to health care.” Access to health care is an important factor in ensuring that people will be willing to live, and companies will be willing to develop industries in rural communities. Limited access to healthcare forces many rural Canadians to relocate to urban centres. Sustaining and improving rural health care is, therefore, extremely important to ensure the economic survival of rural communities allowing people to continue to live there.