You Talk, We Listen: Advancing Health Economics Methods for Rural and Remote Health Research by Gathering Local Communities’ Knowledge and Experiences in Health Care Decision Making

Project Summary

Health economics is the study of resource allocation in health care. Resources might be monetary, such as private or governmental funds, as well as non-monetary, such as health professionals and other staff, equipment and social support.

Health resources are scarce and policy makers are faced daily with complex decisions of how to allocate these resources to improve the health and well-being of the populations they serve.

The goal is for the allocation to be efficient—in other words, for the available resources to be used where they can produce the “best possible outcomes.” What is meant by “best possible outcome” is context-specific and depends, amongst other things, on the population values and contextual factors such as demographics, culture and geography.

The scarcity of resource in health care that is felt across settings, even in affluent urban areas, is exacerbated in rural and remote settings. The very low population density, harsh climates and long distances from main treatment centers pose obvious problems.

For researchers based in urban areas, how strongly these problems affect health care and how they might be overcome is far from obvious.

This work starts from the premise that efficient resource allocation in BC needs more input from rural and remote communities and aims to establish a connection between health economists, predominantly based in the Lower Mainland, and communities in rural and remote BC.


Our goals were:

  1. To establish links between the health economics community, predominantly based in the Lower Mainland, with communities, policy-makers and researchers in Northern BC
  2. To create an opportunity for health economists to learn from rural and remote communities about resource allocation and health priorities in BC
  3. To explore novel ways of communicating and engaging with a diverse audience with the principles of resource allocation and prioritization in health care through arts-based research and KT activities
  4. To empower communities in rural and remote BC to communicate their priorities to relevant audiences including researchers, decision-makers and the general public

Project Findings

We learned from participants located in 18 communities across Northern BC, through:

  • Three online focus group sessions with nine community members
    • This included an interactive hypothetical resource allocation activity
  • Three ‘photovoice sessions,’ a photography-based research method that engages participants as co-analysts of the data they gather.
    • Two online with community members and Indigenous women studying at UNBC
    • One in-person with members of The New Hope Society in Prince George
  • One-on-one telephone interviews with thirty-one decision makers (municipal officers, healthcare professionals, non-governmental organizations)


Our results show that community members across Northern BC have a significant awareness of the reality of resource constraints and understand the bureaucratic and political realities that shape the need for trade-offs. However, from this deep understanding they do not accept these realties as an excuse for shortcomings. Rather, they believe there should be a core suite of services that are accessible to everyone including those in rural and remote regions.

They note that funding models need to facilitate the provision of core services in a way that reflects an understanding of the unique needs of rural and remote northern communities and designed to maximize equity in access. Additionally, they noted that community members should be able to access financial and logistical support when accessing services outside community to guarantee equity in access to health services.

Our findings revealed and challenged actual and potential biases in decisions made, and priorities set, for these areas when allocating health care resources. This includes nuanced understanding of how per capita funding, designed to provide equitable access to health care does not support such equity in Northern BC.


Based on our photovoice activity and results, we will produce a photobook (a hardcopy plain language document) which will be shared with our participants, as well as various community partners and decision makers. Every library in Northern BC will also receive a copy.

This project is part of the Health Economics and Simulation Modelling Cluster.


Magda Aguiar, Lead
Glory Apantaku
Theresa Healy
John Grogan
Lara Frederick
Jasmine Thomas
Caitlin Chew
Jiahui Zhang
Mark Harrison
Attilio Fiumarella
Sarah de Leeuw