A population that experiences health disparity is one where the health status- disease incidence, prevalence, morbidity and mortality differ significantly compared to the health status of the general population. Rural-urban health disparities are differences in health status between rural and urban regions of a geographic location. It is also called spatial inequality when it involves unequal distribution of resources in space. Globally, rural populations always experience significant health disparities when compared to urban populations, even in the same countries. These disparities are frequently characterized by indicators such as higher incidence of disease and disability, increased mortality rates, lower life expectancies, and higher rates of pain and suffering. Reasons and risk factors for the above indictors are broad and vary from population to population, some of them include geographic isolation, lower socio-economic status, higher rates of health risk behaviors, limited access to healthcare, socioeconomic status, unhealthy behaviors, chronic conditions and limited job opportunities. Research has also shown that residents of rural areas are usually older, poorer, have fewer physicians or resources to cater for them and are less likely to have employer-provided healthcare coverage.

The uneven distribution of healthcare resources between rural and urban areas results from fewer and farther service locations, cultural beliefs, lay understanding of illnesses by patients, reduced funding, limited access to health services, discontinuous education, insufficient health professionals and inadequate mobility in rural areas. Access to health care overall is a challenge to rural residents because they have a lower proportion of the population insured, face greater barriers in traveling to primary, preventative, prenatal, and emergency care providers, and have less diversity in health care resources to choose from. Rural residents are left without or reduced availability of these services, increasing the physical barriers to quality and timely healthcare.

From the preceding paragraphs, it is clear that there has been much progress in understanding rural-urban health disparities; however, some challenges persist. Irrespective of the long history of biomedical treatment of diseases in Africa, culture still informs the understanding and treatment of some chronic and debilitating illnesses such as diabetes, more so in the absence or lack of access to biomedical health facilities. This is a major cause of rural-urban health disparities. Federal, state and non-profit organizations work to reduce these disparities and improve the health and overall well-being of rural residents. Some organizations provide funding, information, and technical assistance to be used at the state, regional, and local level, while others inform state and federal legislators to help improve the understanding of issues affecting population health and healthcare in rural areas. Since 1992, the World Organization of Family Doctors- WONCA has developed specific focus on rural health through the WONCA Working Party on Rural Practice. This Working Party has attracted national and international attention to major rural health issues through World Rural Health Conferences and WONCA Rural Policies. The World Health Organization (WHO) has also formed partnerships to help tackle and solve some rural health challenges. An example is the Memorandum of Agreement between WONCA and WHO which emphasizes the important role of family doctors in primary health care and includes Rural Health Initiative.

Background:

Currently, marijuana is the most commonly used recreational drug in the United States and Canada. The Cannabis Act available on the government of Canada website creates a legal framework for regulating the production, distribution, sale, possession and use of cannabis across the country. The three major goals of this Act include:

• Keep cannabis out of the hands of youth
• Keep profits out of the hands of criminals
• Protect public health and safety by allowing adults access to legal cannabis

Effective October 17, 2018 and subject to provincial or territorial restrictions, adults who are 18 years of age or older would be able legally to possess up to 30 grams of cannabis, share up to 30 grams of legal cannabis with other adults, buy dried or fresh cannabis and cannabis oil from a provincially-licensed retailer in provinces and territories without a regulated retail framework, purchase cannabis online from federally-licensed producers, grow cannabis from licensed seed or seedlings and make cannabis products such as food and drinks at home.

The Act recognizes the use of cannabis for medical purposes and allows access for people who have the authorization of their healthcare provider. Using factors such as age restrictions and restricted promotion of cannabis, the Act limits the accessibility of cannabis by under-age youth. The Act also protects public health by creating stringent safety and quality regulations as well as public education to raise awareness about safety measures and potential health risks. The government has committed about $46 million over the next five years for cannabis public education and awareness activities.

Rationale for legalization:

To reduce criminalization: Criminalizing cannabis does not prevent young people from using the drug; instead, it traps many Canadians in the criminal justice system. Over 50% of all drug offences reported by police are cannabis-related. In 2016 specifically, over 23,000 cannabis-related charges were laid. Arresting and prosecuting these offenses is costly for the Canadian criminal justice system and these charges confer severe long-term consequences on the individuals charged. Decriminalizing cannabis for adults will keep Canadians who consume cannabis out of the criminal justice system and reduce burden on the courts.

Health implications:

Many people argue that legalizing cannabis will do more harm than good since it will become easily available, accessible and misused. The Canadian Pediatric Society and the Centre for Addiction and Mental Health publicly disclosed that marijuana is harmful and can negatively affect the brain, especially that of young people. Marijuana is also toxic to neurons, and its regular use can actually change developing brains. Based on evidence that suggests the human brain continues to mature until age 25, the Canadian Medical Association (CMA) recommends a minimum age of 21 to purchase and use marijuana.

Some Canadians believe that recent legalization of marijuana reflects the fact that the government is only interested in hastening the delivery of a campaign promise without being patient and careful enough to analyze the health impacts of the policy. Many also fear that the legalization of marijuana will significantly increase impaired driving and road accidents.

Impacts of short-term use include impaired memory, judgment and motor coordination, paranoia and psychosis while impacts of long-term use include addiction, impaired cognition and brain development, poor educational outcome and reduced personal and life satisfaction.

Human Genetics Programs use genetic and genomic approaches to improve the understanding of the etiology of rare and complex inherited diseases, to characterize healthy variation in humans of different ancestry and to advance knowledge of human population evolution, demography and history. Research areas include:

• Genomics of biomedical resources
• Complex traits in diverse populations
• Integrated genomics of inflammation and immunity

The first Human Genetics team at the World Health Organization was structurally located in the Division of Biomedical Sciences and was majorly hematological. Following advances and rapid progress in genetic technology and human genome research, WHO set up the Hereditary Diseases Programme (HDP) in the early 1980s to support international activities on the development of medical genetics services. Then, the international Human Genome Project which was introduced in the 1990s increased the scope of the Hereditary Disease Programme at WHO. Consequently, the Hereditary Disease Programme has gradually expanded in focus and includes prevention and control of major hereditary single-gene diseases (such as thalassemia, cystic fibrosis, hemophilia, and hemochromatosis); congenital malformations and common diseases with genetic predispositions.

The HDP was successfully sustained and developed over the years and was renamed the Human Genetics Programme (HGN) in 1995 as a part of the Division of Non-communicable Diseases and Mental Health (NMH). The grouping of the Programme under NMH showed the evolution of genetic discoveries in major non-communicable diseases particularly cancer, diabetes, cardiovascular diseases and asthma. Presently, HGN mainly focuses on

• Providing updated information on medical genetics to countries
• Building capacity for the development of genetic services
• Giving technical advice on national genetic programs to improve genetic health services
• Promoting progress and transfer of experience and knowledge through a global network of collaborating centers, NGOs, regional and country offices and partners
• Standardizing genetic technologies for disease control
• Identifying and responding to the ethical, legal and social issues (ELSI) of human genetics
• Developing genetic approaches for the control of major common diseases