Restructuring and Health in Canadian Coastal Communities
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- Dolan, A.H., Taylor, M., Neis, B. et al. EcoHealth (2005) 2: 195. doi:10.1007/s10393-005-6333-7
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Environmental and socioeconomic restructuring has had profound consequences for coastal communities in Canada. The decline of traditional resource-based industries—fisheries, forestry, and mining—and the emergence of new economic activities, such as tourism and aquaculture, compounded by concurrent shifts in social programs, have affected the health of environments, communities, and people. Drawing on research conducted as part of the interdisciplinary major collaborative research initiative Coasts Under Stress, we examined the implications of interactive restructuring for the health of people and communities on Canada’s east and west coasts. The research is guided by a socioecological framework that identifies the pathways from interactive restructuring through health determinants to health risks and health outcomes. The utility of the proposed framework is exemplified by a specific place-based example in Prince Rupert, British Columbia, and a case-based example from coastal communities in Newfoundland and Labrador. A focus on interactive restructuring draws our attention to the many challenges associated with promoting health in a context of rapid and often accelerating environmental and institutional change that is relevant to other areas and contexts.
Key wordsrestructuringcoastal communitiessocioecological framework of restructuring and healthCanada
Canadian coastal resource–dependent communities have experienced major socioeconomic changes over several decades that are linked to the decline of traditional resource-based industries—forestry, fisheries, and mining—and the advent of new economic activities associated with tourism, aquaculture, and offshore energy development. Changes in the resource potential and socioeconomic circumstances in coastal communities are linked to broader national and international adjustments (restructuring) associated with such processes as globalization and related trade liberalization, but the dynamics and consequences of these changes vary between regions and communities and, within communities, between different social groups. To understand their relationship to health, interactive effects need to be tracked through biophysical, work, and other built environments into policy frameworks, changes in demographics, and social support.
Given the profound changes occurring on Canada’s coasts, the Coasts under Stress (CUS) project (http://www.coastsunderstress.ca) set out to investigate how restructuring in coastal British Columbia and coastal Newfoundland and Labrador is affecting the health of coastal communities, their people, and their environments. CUS emerged from concerns that the health of coastal communities and particularly of some populations within those communities was threatened and that interactive, multidimensional restructuring was enhancing this threat. CUS is a Social Sciences and Humanities Research Council/National Sciences and Engineering Research Council–funded (two of Canada’s federal research granting agencies) 5-year collaborative research initiative led by a team of researchers at the University of Victoria and Memorial University. The main focus of CUS was to perform comparative case studies of restructuring–health interactions at multiple levels (household, community, region, and province) in multiple sectors (fisheries, forestry, tourism, mining, and offshore oil and gas) and in multiple contexts (work, schools, and health services) on Canada’s east and west coasts while paying particular attention to how restructuring was affecting the health of coastal communities, residents, and environments.
The principal aim of this article is to draw on the rich empirical findings from CUS with examples from the west and east coasts to examine biophysical, community, and human health as consequences of interactive restructuring and to highlight the potential pathways linking restructuring and health, by using a socioecological framework.
We take restructuring to be the human-induced acceleration (deceleration) in change in the statistical, spatial, or temporal distribution of a measurable physical, biological, economic, or social variable. We further distinguish environmental (physical and biological), social, industrial, and institutional restructuring.
Physical restructuring is human-induced change in physical structure (e.g., mining or paving) or in the concentration and spatial distribution of elements or compounds (e.g., irrigation, release of greenhouse gases, or release of contaminants such as dichlorodiphenyltrichloroethane or drilling fluids). Biological restructuring is human-induced change in population size, density, spatial structure, or demographic structure of other species, as well as human-induced changes in biodiversity (Levin, 2001). Industrial restructuring refers to work-related changes in industry structure, including work reorganization (deskilling and reskilling), downsizing, and outsourcing (Kozlowski et al., 1993), and changes in employment structure and options, such as the movement toward more contingent, casual, flexible, and part-time labor. Social restructuring refers to socioeconomic processes such as urbanization and development; community structural and demographic changes, such as migration; age structure changes; and changes in community, household, gender, and generational dynamics. Institutional restructuring refers to changes in government policies and programs that alter federal discount rates or the delivery of public services and social programs or that privatize, deregulate, or liberalize trade agreements.
We define health in three categories. Human health is both a physical state and a self-determined condition based on a person’s sense of well-being as determined in part by his or her ability to lead a fulfilling life. Building on the population health literature, health is socially determined, meaning that many factors interact (such as genetic predisposition, social circumstances, environmental conditions, lifestyle choices, and access to health care) to influence aggregate health outcomes (Evans and Stoddart, 1994).
Community health is defined in terms of its ability to promote positive human health outcomes (e.g., providing social support, employment, and healthy lifestyle choices) and in terms of its intrinsic value, for example, aggregate-level attributes (e.g., high levels of social support, low levels of economic inequalities, and other indicators of social dysfunction) that represent community-level condition (diminished or flourishing) (Duhl, 1996; Hancock, 2002).
Biophysical health refers to the contribution of the biophysical environment to maintaining both biological and social organization within the context of meeting human goals (Nielsen, 1999). For example, it refers to relatively low levels of human-induced morbidity or mortality of humans and/or other species, as well as relatively low levels of contaminants and other exposures that induce mortality or morbidity in humans or other species. However, the health of communities and the biophysical environment also extends to interactions of communities with their environment in ways that sustain quality of life and promote resilience in response to stressors. Interactive restructuring refers to the multidimensional processes that are reshaping biophysical, social, institutional, and industrial structures: changes in one arena interact with those in other arenas with potential consequences for health at all levels.
Our case studies are not comprehensive and represent only a fraction of the breadth and depth of CUS research, which will be presented in several books currently in preparation (of particular relevance are Ommer [unpublished data], and Sinclair and Ommer [unpublished data]). Our west coast example is place based and explores multidimensional restructuring in a single coastal community. It identifies evidence of health consequences and links these back to interactive restructuring via multiple pathways. Our east coast example is case based and concentrates on the interactive effects of environmental, industrial, and institutional restructuring and their consequences for the health of working-age men and women, as well as for youth in fisheries-dependent communities. We identify some of the pathways between interactive restructuring and the following social determinants of health: education, physical and work environments, related health services, and social support.
Case Study 1: Prince Rupert, British Columbia
Depletion of the salmon stocks on British Columbia’s coast is a consequence of historical overfishing that has been associated with years of political controversy domestically (between fishers and governments) and internationally (between Canada and the United States). The effects of overfishing have been amplified by a combination of changes in environmental conditions (e.g., sea temperatures) that may be linked to long-term climatic changes (Pacific Fisheries Resource Council, 1999), as well as changes in the demand for wild fish influenced by regional and global aquaculture industries (Fischer et al., 1997). In 1996, the consequences of this cumulative overfishing, coupled with the effects of El Niño, resulted in the combined salmon catch (1995 and 1996) being the lowest 2-year total in many years (Gislason et al., 1996).
The federal government’s policy response to this environmental restructuring was to introduce in 1996 the Pacific Salmon Revitalization Plan (Mifflin Plan) as an attempt to conserve the salmon stocks and to restore the sustainability of the fishery. The plan forced a number of restrictions on fish harvesters, including restrictions on fishing areas and gear, and fundamentally restructured the fisheries sector. Overall, these measures (institutional restructuring) reduced the number of commercial salmon licenses in British Columbia from 4112 in 1996 to 2557 in 1999. Almost 6500 (or 40%) of British Columbia’s commercial salmon jobs have disappeared since the early 1990s (Gislason, 1998). In Prince Rupert, 257 salmon jobs were lost (approximately 3% of total community employment) between 1995 and 1997 (Gislason, 1998).
The restructuring of the commercial fishery (industrial restructuring) also extends to fish processing, an area that has been subject to various degrees and forms of restructuring since the 1980s in response to world markets, trade liberalization, and high interest rates. In recent years (mid to late 1990s), because of competition from farmed varieties and declining wild stocks (especially salmon), the fish-processing industry was further rationalized through the closing of nonviable operations and mergers, thus resulting in the elimination of cannery jobs.
At the same time that the federal government was restructuring the Pacific fishery, federal deficit reduction led to cuts to various social programs, including the very programs on which unemployed fishers and fish-processing workers had to rely (concurrent institutional restructuring). Under a new Employment Insurance (EI) program in 1996, fish harvesters saw a rapid decline in their benefits (Gislason, 1998).
The forestry sector, like the fishery, has expanded and contracted over the years in response to changes in global markets and in trade rules and practices (e.g., the North American Free Trade Agreement, international duties, and unstable foreign markets), excess capacity, and degradation of the natural resource base. Over the past several decades, the Skeena Cellulose pulp mill, one of two larger wood-processing facilities in Prince Rupert, was the most important employer in the forestry industry, was the single largest employer in Prince Rupert, and was responsible, in part, for population growth and stabilization. Periodically throughout the 1980s and 1990s, the mill experienced total or partial closures because of poor markets and labor unrest (industrial restructuring) that led to both temporary and permanent job losses. The effects of these closures on the local economy are evidenced by the 20–40% decrease in retail sales during the 1997 four-month closure (Culbert, 1997). The mill was officially closed in July 2001, resulting in an estimated 750 direct and 1331 indirect job losses (Prince Rupert Economic Development Commission, 2002).
Port facilities (Ridley and Fairview terminals) in Prince Rupert have also played a significant role in economic development. Seen as the vehicle for unprecedented growth, the federal government designated Prince Rupert’s port as the 10th National Port in Canada in 1972. Operations for the port were generally profitable until the 1995 termination of the Western Grain Transportation Act (institutional restructuring), an arrangement that provided farmers a subsidy to ship grain through Prince Rupert. Without the subsidy, farmers shipped grain to Vancouver, resulting in the layoff of 47 of 93 grain handlers (Sheremata, 1995). Despite economic incentives, the tonnage of grain exported through Prince Rupert continues to decrease and exports in general have declined substantially. For example, overseas exports have fallen from approximately $2 billion in 1997 to $319 million in 2003 (BC Stats, 2004). In addition, forestry companies in 2000 ceased using the Fairview terminal to transport pulp, which previously made up 30% of exports (Can Press, 2000a, b). At the same time, declining prices of coal and high production costs forced the Quintette coal mine closure, the primary exporter through Ridley port.
As a consequence of these changes in the fisheries and forest industry and in transportation, Prince Rupert experienced unprecedented outmigration (social restructuring), as evidenced in a 12.4% decline in its population from 1996 to 2001 (StatsCan, 2001). This outmigration has contributed to the slight aging of Prince Rupert’s population, from a median of 31 years in 1996 to 34.8 years in 2001 (StatsCan, 1996, 2001). In addition, average incomes in Prince Rupert declined in 1995 and again in 1997. In all years, average income changes were more variable (whether negative or positive) than for the province as a whole, and in 1997, while the provincial average income increased, Prince Rupert’s decreased (BC Stats, 2001). Because of the protracted downturn in the economy and outmigration (social restructuring), vacancy rates jumped considerably in the mid-1990s and continue to remain high at approximately 30% in 2003 according to Canada Mortgage and Housing Corp. Furthermore, because of the oversupply of houses, homeowners saw the equity in their homes plummet by more than 30% (City of Prince Rupert, 2001).
Environmental restructuring and responding political adjustments (e.g., Mifflin Plan; institutional restructuring) interacted to create changes in the fisheries workforce (e.g., fishers and fish plant workers; industrial restructuring). This occurred at the same time that provincial and federal governments were disinvesting in social programs, which were together and independently affecting the socioeconomic and social fabric of communities. Furthermore, concurrent restructuring in the forest sector (e.g., capital flight and rationalization; industrial restructuring) in response to global markets and domestic circumstances and in the transportation sector (e.g., cancellation of Western Grain Transportation Act; institutional restructuring) combined to create substantial changes in employment and employment security and, subsequently, community structure (e.g., outmigration and demographic changes; social restructuring).
Restructuring and Health Pathways
How, in combination, do these different types of restructuring interact with the different spheres of health introduced in our socioecological framework? Evidence points to negative consequences in community and human health, triggered, in part, by changes in biophysical health. Environmental conditions; regional, national, and international political relations (U.S.–Canada salmon wars); and global markets interacted to affect how salmon stocks were (mis)managed and, as a consequence, affected the abundance of Pacific salmon available for human use. This diminished biophysical health triggered a series of adjustments that interacted with restructuring along other dimensions to result in community and human health changes.
In terms of community health, interactive restructuring led to hundreds of job losses and a sustained high unemployment rate for the last two census years (1996, 16.4%; 2001, 15.4%) relative to the provincial average (1996, 9.6%; 2001, 8.5%) and reduced average incomes and wealth (StatsCan, 2001). Here, community health is defined in terms of its intrinsic value. Community health changes, revealed by Prince Rupert residents, were also notable. On the basis of a cross-sectional sample of households in 2002 (Dai and Taylor, 2003), Prince Rupert residents rated their satisfaction with their community as a place to live the lowest and their dissatisfaction with their community the highest when compared with three other case-study communities in British Columbia (Tofino, Ucluelet, and Port Hardy). Respondents also rated the economic situation of the community as the second most important concern and had the highest proportion, relative to the other communities, indicating that they had considered moving out of the area during the past year. In addition, whereas all communities indicated relatively high agreement that their community had social problems, Prince Rupert had the highest agreement for family violence, unemployment, and sexual abuse and the second highest (after Port Hardy) for alcohol and drug abuse. In addition, Prince Rupert had the highest proportion indicating that the community economic situation was somewhat or significantly worse than a year before. In general, survey results of perceived community health correspond with statistics that suggest negative community health consequences.
Apart from its intrinsic value, the community provides economic stability via secure employment opportunities and access to supportive community services and social networks that promote positive human health outcomes. In communities like Prince Rupert, increased psychosocial stress (e.g., isolation, anxiety, and depression) leading to higher rates of health-damaging behaviors (e.g., smoking and alcohol abuse) and other health-related effects (e.g., mental illness, family violence, and marital breakdown) have been noted as consequences of economic restructuring (Gislason et al., 1996). Our CUS research provides evidence over an 8-year period (1991–1999) of increased rates of circulatory diseases, diseases of the digestive system, and injuries and poisonings (Dolan et al., 2003). In addition, according to the 2002 survey data, Prince Rupert residents had the highest percentage reporting poor or fair health of the four case study communities, which, at 19%, was also substantially higher than the corresponding figures reported in the Canadian Community Health Survey for British Columbia and Canada (both 12%; Dai and Taylor, 2003). Furthermore, Prince Rupert had the highest percentage reporting a worsened personal financial situation and deterioration in personal employment situation.
This evidence suggests a probable relationship between a decline in material circumstances resulting from interactive restructuring (i.e., reduced income, employment, access to social assistance [e.g., EI], home equity, and increased financial stress) and poor health, as evidenced elsewhere (Evans and Stoddart, 1994; Adler and Newman, 2002; McLeod et al., 2003). Beyond obvious material implications of wealth on health (e.g., greater access to health-promoting activities, including health care, nutritious food, safe housing, schooling, and recreational opportunities), financial stress and other psychosocial stresses can negatively affect health and are associated with socioeconomic decline as a result of restructuring (e.g., Hertzman and Siddiqi, 2000; Kopp et al., 2000). Restructuring has led to increased unemployment and employment uncertainty, which are significant sources of psychosocial stress for displaced as well as surviving workers and their families (Kozlowski et al., 1993; Bartley, 1994; Witherill and Kolak, 1996). In Prince Rupert, many people spoke of their inability to plan for the future because of their unemployment and income insecurity. Several mentioned mental stress associated with financial uncertainty and the negative consequences of the economic recession on families, including divorce, spousal abuse, and separation. Others commented on the consequences of economic instability on their children. Our qualitative research found that youth are experiencing increased anxiety and stress as their future employment options within the community diminish. Family relations are affected as parents encourage their children to leave and consequently mourn their loss (Harris, 2002a, b).
Restructuring also affects the type and distribution of employment, as well as income distribution. Job losses vary by sector, as does the creation of new opportunities, with the result that substantial and sustained employment and income redistribution are occurring in many sectors and areas. Income inequality can affect population health as a consequence of how people perceive their social and economic circumstances relative to those within their own communities (peers) or relative to others of a larger reference group (e.g., all Canadians; Raphael, 2001; Veenstra, 2003). In this context, anxiety, feelings of inferiority, low self-esteem, and perceived societal unfairness can create or compound ill health (Wilkinson, 1996; Wilkinson et al., 1998; Veenstra, 2002). In Prince Rupert, there was concern that the Mifflin Plan benefited big companies at the expense of small boat owners, because the only ones who could afford to buy or “stack” retired licenses were larger and wealthier companies. Thus, respondents noted that the plan disproportionately affected small independent fishers and smaller communities because money earned from fishing in the north (Prince Rupert area) no longer remained in the community but instead went south, where most of the larger vessels now originate. Furthermore, the fishing industry in the south is also seen as more diverse and flexible and in a better position to adapt to rapid industry changes.
Beyond material and psychosocial explanations of restructuring–health relationships, communities can play a role in facilitating social relationships and networks and in promoting feelings of safety, belonging, reciprocity, and trust (examples of social capital) that are all linked to positive health outcomes (Hanson and Ostergen, 1987; Hirdes and Forbes, 1992; Putnam, 1993; Rogers, 1996; Kawachi et al., 1997; Kawachi and Kennedy, 1997; Wilkinson et al., 1998; Berkman et al., 2000; Fukuyama, 2000; Gorski, 2000). In Prince Rupert, because of declining populations and shifting personal priorities, there is a sense that people have become more insular and less involved in community activities. Whether tough times bring people together and build social cohesion (e.g., Cattell, 2001) or further divides the haves and the have-nots (e.g., Wilkinson, 1996) is still not well understood, because the associated theory and empirical evidence of social capital are still quite embryonic. What our research in Prince Rupert suggests is that perceptions of community conditions are indeed associated with health outcomes. The link to social and economic restructuring was supported by the strong correlations between community satisfaction and perceptions of community problems (especially unemployment and alcohol and drug abuse) and the strong correlations with declining economic opportunities. The results of statistical modeling of both general health status and emotional health confirmed the effects of social capital and cohesion factors after controlling for the effects of lifestyle and sociodemographic determinants, thereby supporting the combined effects of economic and social restructuring on residents’ health (Dai and Taylor, 2003).
In these examples, interactive restructuring affected human health by influencing incomes, employment, and work and family environments, as well as social capital and social support. Our Prince Rupert example illustrates how population health changes may be linked to changing socioeconomic circumstances in the community; however, just as families need economic stability via secure employment opportunities and access to supportive community services and social networks, communities require strong families to promote and maintain healthy communities (Weissbourd, 2000). Industrial and social restructuring have interacted with community health to change the socioeconomic and structural conditions of Prince Rupert. People and businesses have left and, along with them, skills and wealth that once went back into the community to support infrastructure and social programs. For example, Prince Rupert residents linked the closure of Skeena Cellulose with outmigration and diminished social capital via a change in the abundance and availability of skilled labor. When people left Prince Rupert, important skills and knowledge went with them. These are lost potential investments in social capital (e.g., volunteers for social programs and kids’ activities; social infrastructure).
Similarly, the health of the environment is dependent on community health. Other things being equal, an economically prosperous community is more likely to have the resources to invest in environmental stewardship than a community experiencing economic hardship. When dealing with degraded renewable resources, stewardship generally requires short-term restraint for potential longer-term gains. Populations and communities with limited resources operating in a policy and industrial framework that promotes short-term benefits over long-term gains and extraction over investment in recovery are poorly positioned to promote stewardship. Furthermore, eroded social infrastructure along with market-oriented ideologies may serve to promote short-term interventions over longer-term sustainable solutions. Thus, community-level determinants (e.g., community wealth and social capital) can mediate the combined effects of restructuring on the management of the biophysical environment. Current debates around the aquaculture industry demonstrate the tension between short-term economic survival and longer-term environmental consequences.
Case Study 2: Coastal Communities in Newfoundland and Labrador
Working on Newfoundland’s west coast and in Southern Labrador, CUS researchers have examined the effects of interactive restructuring on working age and young people in fishery- and forestry-dependent communities. We performed a series of key informant interviews and interviews with men and women employed in fisheries, forestry, and tourism concerned with the employment, income, and health effects of restructuring and with household strategies in response to that restructuring (Macdonald et al., 2004). Research on the relationship between restructuring and youth health included a study of youth in a single larger community and drew on some school-based research as well [Jackson et al., unpublished data]. Linked research has examined the relationship between restructuring and outmigration and the health of the older women left behind in forestry-dependent communities [Botting, unpublished data] and some of the occupational health risks associated with restructuring from groundfish to shellfish processing (Neis and Grzetic, 2004). In this discussion, we summarize some of the main themes emerging from this research with a focus on fishery-dependent groups, while acknowledging that in some east coast communities, as in Prince Rupert, restructuring in both fisheries and forestry sectors and from these sectors to tourism has occurred simultaneously, thus amplifying the challenges confronting individuals, households, and communities.
Environmental, industrial, institutional, and social restructuring have interacted to change the socioecological dynamics of Canada’s east coast communities and populations with related consequences for the social determinants of health and for the fit between health and other social services and the health needs and requirements of local people. Since the early 1990s, shortages in groundfish resources and probable related increases in shrimp, crab, and, possibly, lobster resources (environmental restructuring) have interacted with policy initiatives designed to further limit access to marine fish resources, reduce processing capacity, reduce reliance on EI, download the costs of fisheries infrastructure and surveillance onto the industry, and constrain the costs to government of education and health services (institutional restructuring). In turn, environmental and institutional restructuring have interacted with industrial restructuring (from groundfish to shellfish harvesting and processing) to change the spatial distribution of fishing and processing work; the location, nature, and seasonality of employment; incomes and wealth distribution; and occupational health risks. Related social restructuring in the form of changing household dynamics within the smaller boat fisheries, increased high school completion rates and investment in postsecondary education, and increased outmigration have interacted with other forms of restructuring to change the age profile of industry workers, recruitment of young people to the fishery, and related challenges for fishery workers and their communities.
Government closure of the cod fishery led not only to direct unemployment of fish harvesters, but also to fundamental changes in fish processing (industrial restructuring), which led to massive structural changes in many east coast outport communities (e.g., outmigration, demographic changes, and social restructuring; Ommer, 2002; Neis and Kean, 2003). Policy responses to overfishing that targeted the individuals directly affected, treating them as though they were autonomous from each other, from larger communities, and from future generations, and that relied on traditional industrial adjustment programs designed for use in urban, industrial environments rather than single-industry resource towns were spatially, temporally, and organizationally misaligned with the lives of those whose behavior and situation they sought to change. This misalignment had serious and often unanticipated consequences for the options and choices of these people, their communities, and their health and that of fisheries resources in the longer term (Neis and Williams, 1997; Bavington et al., 2004). Thus, individual fish harvesters and processing workers were generally able to access adjustment incomes and sometimes training, but relatively few resources were directed toward community development, and those who were indirectly affected by the moratoria were not eligible for support.
Restructuring and Health Pathways
The relationships between interactive environmental, industrial, institutional, and social restructuring and human and community health are mediated through their effects on such known health determinants as physical and work environments, income, education, employment, and gender roles (Bavington et al., 2004; Grzetic, 2004). Changes to east coast fisheries over the past two decades triggered by environmental restructuring and moratoria in the groundfish fisheries have changed the species targeted and associated fishing gear, as well as the spatial dynamics of fisheries: more fishing occurs further from shore and further from home communities. The fleet structure has also changed with the disappearance of most of the large trawlers; hence, harvesting concentrates more on smaller vessels less than 65 feet long.
Indications of the occupational health consequences of this interactive restructuring between industrial and environmental change are reflected in a dramatic decline in workers’ compensation claims from the large offshore trawlers in the mid 1990s and, since then, increased claims from the smaller boat sector, as well as an increase in search and rescue incidents, with events concentrated in the midshore area, where changes have been most dramatic (Pelot et al., 2000; Neis and Howse, 2003). Since the mid 1990s, access to shrimp and crab has triggered a major expansion in the boat-building and fiber-glassing industry in Newfoundland and Labrador. These new facilities created some alternative employment in rural and remote areas, but the rapid and largely unregulated development of the industry contributed to styrene (a known neurotoxin) exposures among boat-building workers. Dealing with this industry has been a major challenge for provincial occupational health and safety regulators (Dunphy, 2005).
The occupational health risks in fish processing have changed with the shift from groundfish to shellfish processing caused by environmental restructuring and the related moratoria. Thus, whereas the injuries associated with groundfish processing tend to be cuts, falls, and cumulative trauma disorders, those associated with snow crab processing include occupational allergy and asthma (Cartier et al., 2003; Howse et al., in press), as well as cumulative trauma disorders (Solberg et al., 2005). Because the plant design and diagnostic and compensation infrastructure necessary to prevent occupational allergy and asthma are complex, poorly understood, and fundamentally different from those required for dealing with acute injuries such as cuts and falls, rapid environmental and industrial restructuring have contributed to the number of workers at risk of these occupational diseases and to unnecessarily high levels of exposure and shortcomings related to diagnosis, treatment, and compensation (Neis et al., 2004).
Closure of the cod fisheries, industrial restructuring from groundfish to crab and shrimp, and automation and market changes in shellfish processing have combined with a strong downsizing and professionalization policy agenda to reduce the number of processing jobs in fishery-dependent communities and to increase seasonality in both fishing and processing (O’Reilly, 2004). Limited real incomes for male fish harvesters, especially those in small inshore boats with limited or no access to crab and shrimp, and fewer processing jobs for women have enhanced the economic pressures on fishing households. At the same time, policy and other changes (increased license fees; observer fees; union, professional, and wharfage fees; and the gasoline costs associated with fishing further offshore) have driven up the real costs of fishing. Household responses to these challenges have included changes in crew composition with related implications for occupational health and for the longer-term future of small boat fisheries and the communities that depend on them.
One response to lower incomes for fishing families and increased costs has been for more women to fish with their husbands. This practice helps to concentrate the income from fishing enterprises in fewer households and ensures that such households can access the multiple incomes from EI that are often crucial for household survival. However, traditional gendered divisions of labor mean that women often have limited knowledge of key aspects of fisheries, such as navigation and engine repair, that have important implications for safety (particularly if something happens to their husbands at sea). Those who wish to address these and other gaps in their training have had difficulty accessing training programs in their areas and at a reasonable cost. Their incomes are being jeopardized by discriminatory fishing EI legislation that does not properly recognize onshore work traditionally performed by women. Interviews with women fish harvesters also suggest that many are not receiving appropriate support or safety training for their roles aboard fishing boats (Grzetic, 2004).
Environmental and industrial restructuring and policy initiatives are also contributing to the demise of rural communities and the health of their residents over the longer term. Rural schools can be central to the civic health of rural communities (Mulcahy, 1999), and since the mid 1990s, government has moved to close many rural schools (Government of Newfoundland and Labrador, 2004). In the 1990s, while fisheries restructuring reduced employment options for young people, thus simultaneously increasing the need for them to pursue postsecondary education and reducing their access to summer jobs that would have helped them fund their education (such as fishing or summer fish-processing work), policy changes contributed to an increase in the tuition costs associated with postsecondary education, thus making it more costly for them to remain in school (Government of Newfoundland and Labrador, 1998). Outmigration, dwindling school populations, and limited access to teachers and teaching resources are making it difficult for young people in rural areas to get the training they now believe they need to succeed in the world outside their communities and, in most cases, outside the province [Jackson et al., unpublished data].
Moreover, communities with few young people face challenges in sustaining activities and programs for them and for other local groups. Civic institutions are an important part of the social capital of small communities, but they are difficult to sustain with dwindling and aging populations [Ommer, unpublished data]. Finally, social restructuring in the form of outmigration and related demographic shifts raises questions about who will care for the elderly and for the disabled in these communities and how they will be cared for with dwindling incomes, including ensuring that they have access to health services that are increasingly remote from the community. Self-reported negative health effects of outmigration on older women left behind when their children move away and self-reported positive health effects associated with spending time with grandchildren point to some of the ways social restructuring might interact with other forms of restructuring to affect health [Botting, unpublished data].
The relationships between restructuring and health are inherently complex. We have introduced a socioecological framework of restructuring and health that distinguishes four different types of restructuring—environmental, institutional, industrial, and social—that interact to affect three related spheres of health—biophysical, community, and human. These spheres are not mutually exclusive but are inherently codependent such that the health in any one sphere is dependent on the health of the others. Our framework further situates these interacting spheres within the broader processes of restructuring, thus demonstrating that the line between determinant and consequence is often blurred. What is clear is that effects of interactive restructuring are geographically situated; they interact with specific places to have place-specific outcomes. They are expressed on local landscapes, in social relationships, and, ultimately, in physical and psychosocial challenges for local people.
In the context of our socioecological framework, our case studies illustrate that temporal and spatial misalignment in environmental policies can lead to environmental degradation, which poses, in turn, serious risks to income, employment, social support, and other health-related aspects of life in coastal communities. Institutional responses to this degradation will interact with industrial processes and with household and community dynamics to affect the health of people, their biophysical environments, and the spatial and social conditions of communities. In our case studies, a history of unsustainable harvest practices led to the undermining of the economic base of fisheries and forestry in coastal communities, increased social inequality, shaped household strategies for survival, contributed to outmigration and the changing age structure of local populations (social restructuring), and changed work-related health risks. Policies and programs introduced in response to environmental restructuring seem to have, in some cases, exacerbated risk and, not surprisingly, have often had unintended consequences.
As our case studies demonstrate and as illustrated in our socioecological framework, the determinants of human, community, and biophysical health are a mix of factors near and distant in time and space and organizationally, such that the adequacy of any explanation of particular health outcomes depends on an analysis that encompasses that mix. Our case studies demonstrate that the relationships between interactive environmental, industrial, institutional, and social restructuring and human and community health are mediated through their effects on such known health determinants as physical and work environments, income, employment, education, and gender roles. In addition, restructuring–health interactions are historically situated, can change over time and space, and will have uncertain future outcomes. Furthermore, restructuring can change the relative power and resources of social groups (employers and workers, men and women, and parents and children), as well as the fit between education or training, health services, work and physical environments, populations, and health services, thereby enhancing or potentially jeopardizing population and community health. This underscores the necessity to draw on a variety of methods, actors, knowledge systems, and scales of investigation to understand and monitor the relationship between restructuring and the health of people, communities, and environments.
Our socioecological framework helped guide our thinking, study, and analysis of restructuring and its consequences for coastal communities. It was a first step in bridging different and diverse disciplines and broadening our understanding of biophysical–social relationships and their implications for Canadian coastal communities. Our framework does, however, have wider application than the coastal communities being examined by CUS. Resource-dependent communities around the world are vulnerable to changes in global markets and institutions. Furthermore, given their inherent dependency on natural environments, they are increasingly vulnerable to large-scale environmental changes, such as human-induced climate change. The processes at work in our coastal communities are indicative of the relationships in other communities. Our framework offers a means of situating health with a specific locus and focus within the complex set of multiscaled and interacting social, ecological, and institutional determinants and provides a heuristic device to aid in understanding multifaceted restructuring and health interactions common in other communities around the world. Although every community is distinct, the complexities of interactive restructuring, its unforeseen outcomes, and its role in accelerating change are generalizable. Changes occurring in resource-dependent coastal communities require such a socioecological framework to help identify the different pathways through which large-scale changes are expressed on local geographies and experienced in the lives of people.
The authors thank the Canadian Natural Sciences and Engineering Research Council and the Canadian Social Sciences and Humanities Research Council for supporting this project and for jointly funding Coasts Under Stress (http://www.coastsunderstress.ca). We also acknowledge the CUS research team for their valuable feedback on earlier versions of this article, as well as several reviewers who provided insightful and constructive feedback. A version of this article was presented at the 10th International Symposium in Medical Geography in Manchester, UK, in July 2003. Special thanks also go to Ken Josephson, Ole Heggen, and Carrie Holcapek for producing the figures and to Mia Reimers for helping to compile Prince Rupert community information.