FACTORS AFFECTING HEALTH, Study notes of Public Health

Download FACTORS AFFECTING HEALTH and more Study notes Public Health in PDF only on Docsity! a f+ S Arte a ti ae sftt....0if HEALTHY COMMUNITIES PARTNERSHIP Hald folk imand and Norfol 91Factors Affecting Health FACTORS AFFECTING HEALTH Factors affecting health, the social and economic conditions in which people are born, grow, live, work, and age, are called the social determinants of health. Since the mid 1980s, the understanding that these determinants of health are critical to the health and well-being of populations has grown and the determinants of health are now almost univer- sally accepted by health systems across the world. (Wilkinson & Marmot, 2003). The Public Health Agency of Canada identified 12 key determinants of health in 2010 (Public Health Agency of Canada, 2010): • Income and social status • Social support networks • Education and literacy • Employment / working conditions • Social environments • Physical environments • Personal health practices and coping skills • Healthy child development • Biology and genetic endowment • Health services • Gender • Culture For the purposes of this report, five factors affecting health are discussed: • Housing • Poverty • Safety • Sense of belonging • Transportation Data reported in this section are from a wide variety of sources - organizational utilization data, national census, en- forcement agency occurrence data and national and local survey data. 94 Factors Affecting Health HOUSING According to Humans Resources and Skills Development Canada, “A safe and comfortable place to live is fundamental to our sense of wellbeing. When housing is inadequate or unavailable, individual as well as community wellbeing may suffer (Human Resources and Skills Development Canada, 2011).” As the largest component of a household budget, housing is also recognized as an important factor in the financial security of Canadians (Human Resources and Skills Development Canada, 2011). Numerous studies show that the lack of quality housing and homelessness are “clear threats to the health of Canadians (Mikkonen & Raphael, 2010).” Between 2009 and 2010, about 100 women and their families used emergency housing available through Haldimand- Norfolk Women`s Services (Figure 54). Illustrated in Figure 55, the number of applications for social housing remained fairly stable between 2008 and 2010. Among the types of applicants, the number of single individuals applying for social housing increased from 151 in 2008 to 167 in 2010. For the years 2008 – 2010, between 115 and 120 applicants were housed each year. Utilization of these services reflects a number of factors, including demand and available agency resources and should not be considered as a reflection of need. There are a number of groups and organizations working to address affordable housing in the community including Haldimand-Norfolk Social Housing, Salvation Army Family and Community Services (Dunnville office) and Haldimand and Norfolk Women’s Services. The Haldimand- Norfolk Health Unit recently prepared a report for Norfolk County’s Health and Social Services Committee outlining key poverty issues for residents in Haldimand County and Norfolk County, including affordable housing. ANALYSIS • There are several agencies providing housing support in Haldimand County and Norfolk County including Haldimand-Norfolk Social Housing, Salvation Army Family and Community Services (Dunnville office) and Haldimand and Norfolk Women’s Services. • Haldimand and Norfolk Women’s Services provides emergency and transitional shelter for women and their families who are victims of domestic violence. Utilization data presented in Figure 54 shows that between 2009 and 2010, slightly more than 100 women and their families used emergency shelter, and use of transitional housing increased from 116 in 2009 to 148 in 2010. Haldimand-Norfolk Housing 95Factors Affecting Health Figure 54: Supportive and Transitional Housing, Women and Families, by Type, Haldimand and Norfolk Counties, 2009-2010 Data Source: Haldimand-Norfolk Women’s Services, Annual Reports 2009 and 2010. • Social housing had 826 housing units in Haldimand and Norfolk counties combined for the years 2008-2010 (Haldimand-Norfolk Health and Social Services Housing Division, 2011). • Between 115 and 120 applicants were housed each year for 2008-2010 (Haldimand-Norfolk Health and Social Services Housing Division, 2011). • The typical waiting list duration was between one and three years, depending on the housing location (Haldimand-Norfolk Health and Social Services Housing Division, 2011). • Demand for Haldimand-Norfolk Social Housing remained fairly stable between 2008 and 2010. Figure 55 illustrates that Haldimand-Norfolk Social Housing received 279 applications for supportive housing in 2008 and 286 in each of 2009 and 2010. • The number of families and single individuals under 65 who apply for social housing increased from 89 families and 151 single individuals under 65 to 92 families and 167 single individuals under 65 in 2010 (Figure 55). 96 Factors Affecting Health Figure 55: Social Housing Applicants by Type, Haldimand County and Norfolk County, 2008-2010 Data Source: Haldimand-Norfolk Social Housing, March 2011 99Factors Affecting Health Figure 57: Low-Income Cut-Offs After Tax Income, Private Households 15 Years and Older, Haldimand County and Urban Areas, 2006 Data Sources: Census, Community Profiles, by Health Region, 2006.Data Notes: Private household refers to a person or a group of persons (other than foreign residents) who occupy the same dwelling and do not have a usual place of residence elsewhere in Canada. • Considered by Norfolk County urban areas and after tax income for all residents 15 years and older in 2006, Figure 58 shows that Simcoe had the highest percentage (8.8%) of private households living below the low income cut-offs followed closely by Delhi (8.1%). Waterford has the lowest percentage of residents 15 years and older (4.1%) who were living below LICOs in the County. Figure 58: Low-Income Cut-Offs, After Tax Income, Private Households 15 Years and Older, Norfolk County and Urban Areas, 2006 Data Sources: Census, Community Profiles, by Health Region, 2006. Data Notes: Private household refers to a person or a group of persons (other than foreign residents) who occupy the same dwelling and do not have a usual place of residence elsewhere in Canada. • When considered by private households of persons 17 and under and using before tax income (data using after tax income was not available), the proportion of private households of persons 17 and under who reported incomes below LICOs increased slightly from 2001 to 2006 in Haldimand and Norfolk counties combined, from 10.6% to 10.8%, and in Ontario from 17.0% to 18.0%. 100 Factors Affecting Health Figure 59: Ontario Works Caseload, Haldimand and Norfolk Counties Combined, 2006-2010* Data Source: Haldimand-Norfolk Health and Social Services, Ontario Works Caseload, 2010. *Data is shown for January-October annually. Data excludes data for November and December caseload. • Figure 59 shows that the number of individuals on the Ontario Works caseload increased 44.0% between 2006 and 2010, from 9,720 to 14,000. • The cost of a nutritious food basket estimates the cost it would take to feed a family of four (male and female adults aged 31-50 years, one boy aged 14-18 and one girl aged four to eight years) with nutritious foods. In Haldimand County and Norfolk County combined, the estimated cost increased 2.2% between 2009 and 2010, from $163.80 in 2009 to $167.53 (Haldimand-Norfolk Health Unit, 2011). • Student Nutrition Programs are provided in schools offering breakfast or snacks for all children. Student Nutrition Programs, such as breakfast and snack programs are offered in schools and after-school programs. The programs intent is to support healthy growth and development by providing healthy food to all children. Figure 60 illustrates the growth in this program since 1998 when just seven programs served 280 children and youth. By 2010 there was an almost five-fold increase in the number of programs since 1998 with 40 programs were providing nutritious breakfast and snacks to 7000 children and youth ( Haldimand-Norfolk Health Unit, 2006). Figure 60: Student Nutrition Programs, Haldimand and Norfolk Counties Combined, 1998, 2005, 2007, 2008, 2010 Data Source: Health and Social Services, 2010 101Factors Affecting Health SAFETY Community perceptions of safety are important. A community’s perception of safety contributes to a sense of well- being, allows individuals freedom of movement, and reduces unintentional injuries. There are other elements of safety that impact on health. A Canadian research study shows a strong relationship between the commission of crimes and the use of alcohol and drugs (Pernanen K, 2002) (Toronto Drug Strategy Initiative, 2005). The Haldimand-Norfolk Healthy Communities initiative identified safety as an important indicator of the community’s health. The Haldimand-Norfolk Healthy Communities initiative is not alone in considering safety as an important component of health. In 1999, the Ontario Public Health Association built on evidence from the National Forum on Health (1997) to recognize violence as a social determinant of health and a public health issue (Ontario Public Health Association, 1999). Speaking specifically of family violence, the Forum found that family violence had a negative impact on equity, socio-economics, mental, physical and spiritual well-being. In passing a resolution to formally recognize violence as a public health issue in 1999, the Ontario Public Health Association wrote, “Violence is a major contributor to premature death and disability in Ontario. It is a force that damages the physical, mental and spiritual health of individuals. It also threatens basic institutions in Ontario such as the family and the community (Ontario Public Health Association, 1999).” In this section, safety was considered by five variables provided by the Ontario Provincial Police (OPP), Haldimand Detachment and Norfolk Detachment: • Primary offences are all offences reported in a jurisdiction. A primary offence may also be logged as a domestic, violent, or property offence. • Domestic offences are those offences that occur within a domestic relationship. • Violent offences are those offences that involve physical harm to another individual. • Property offences are offences in which property was involved, but no individuals are injured. • Motor vehicle collisions (MVCs) are motor vehicle collisions that are reported to the police. Another critical aspect in the concept of safety is unintentional injuries. Unintentional injuries have been discussed extensively in Health Status, Unintentional Injuries (page 59). Offences reported are actual occurrences, not a rate using a standardized population. Because of the different total population in Haldimand County and Norfolk County, this data should not be used to compare the experiences of the two counties, and it is not possible to compare against rates for the same categories of offences in Ontario. The OPP reported offences for four categories between 2006 and 2010: the overall offence category of “primary offences” (Figure 61) and then the sub-categories of domestic offences (Figure 62), violent offences (Figure 63) and property offences (Figure 64). The number of motor vehicle collisions for 2006-2010 is reported in Figure 65. Overall, the number of primary offences shown in Figure 61 decreased in Haldimand County by almost 10% (9.6%) between 2006 and 2010, while in Norfolk County they fluctuated but ultimately increased slightly from 20,827 to 20,867 in the five years. Likewise, the number of violent offences (Figure 63) and property offences (Figure 64) reported in each county fluctuated or declined between 2006 and 2010. The most significant decreases were among violent offences in Haldimand County which decreased 26.8% between 2006 and 2010, and property offences in Norfolk County which decreased 13.2% for the same time period. Likewise, the number of reported motor vehicle collisions decreased in each county. Figure 65 illustrates that in Haldimand County, the number of reported MVCs decreased by almost 20% (19.3%) and in Norfolk County the total number reported decreased by 5.2%, between 2006 and 2010. 104 Factors Affecting Health Figure 63: Violent Offences Reported, Haldimand County and Norfolk County, 2006-2010 Data Source: Ontario Provincial Police, Haldimand Detachment and Norfolk Detachment, February 2011 • The number of property offences reported in Haldimand County (Figure 64) fluctuated between 2006 (1550) and 2009 (1717), but ultimately remained unchanged at 1550 in 2010. • In Norfolk County the number of property offences reported to the OPP (Figure 64) declined more-or-less steadily from 2640 in 2006, to 2372 in 2007, increased to 2458 in 2008 before declining to 2379 in 2009 and 2291 in 2010, an overall decrease of 13.2% between 2006 and 2010. Figure 64: Property Offences Reported, Haldimand County and Norfolk County, 2006-2010 Data Source: Ontario Provincial Police, Haldimand Detachment and Norfolk Detachment, February 2011 • Motor vehicle collisions (MVCs) reported to the OPP in Haldimand County and Norfolk County between 2006 and 2010 are shown in Figure 65. In both Haldimand County and Norfolk County, MVCs fluctuated but ultimately declined during the time period. • In Haldimand County there were 864 MVCs were reported in 2006, the number increased in 2007 (996) and 2008 (910) before decreasing in 2009 (853) and 2010 (697), an overall decrease of 19.3%. • MVCs in Norfolk County followed a similar pattern. In 2006, 1140 motor vehicle collisions were reported to OPP in Norfolk County. The total number of MVCs increased to 1212 in 2007 before decreasing to 1134 in 2008 and 1073 in 2009 before increasing slightly to 1081 in 2010, an overall decrease of 5.2% in the time period. 105Factors Affecting Health Figure 65: Motor Vehicle Collisions Reported, Haldimand County and Norfolk County, 2006-2010 Data Source: Ontario Provincial Police, Haldimand Detachment and Norfolk Detachment, February 2011 106 Factors Affecting Health SENSE OF BELONGING A sense of belonging is an important aspect of an individual’s sense of well-being. According to Health Canada: A feeling of belonging to a country, region, and local community can influence people's sense of identity and the extent to which they participate in society. Generally, a strong sense of belonging is positively associated with better self-reported physical and mental health. A strong sense of belonging also contributes to individual and community wellbeing (Human Resources and Skills Development Canada, 2011). Moreover, Mikkonen and Raphael (2010) noted that being socially excluded, or having a poor sense of belonging, had adverse social and health effects. They reported that socially excluded Canadians were more likely to be unemployed and earn lower wages and have less access to health and social services and education (Mikkonen & Raphael, 2010). Human Resources and Skills Development Canada has determined that an individual’s sense of belonging could be assessed by participation in political activities, participation in social activities, charitable donations and volunteering. (Human Resources and Skills Development Canada, 2011). Building on these findings, this report considers “sense of belonging” using the Canadian Community Health Survey results for Haldimand and Norfolk counties combined in 2005, 2007 and 2008 for residents 12 years and over and for youth, 12-19. Rates for Haldimand and Norfolk counties combined were compared to rates reported in Ontario. Confidence intervals are reported to help understand the reliability of the data. Municipal election voter turn-out in 2010 for Haldimand County and Norfolk County is also reported. Residents of Haldimand and Norfolk counties combined reported a stronger sense of community than other residents in Ontario in 2005, 2007 and 2008, with the sense of belonging becoming stronger over time. Figure 66 illustrates that in 2005, six out of 10 (63.2% CI ±4.7) residents 12 and over in Haldimand and Norfolk counties combined reported a strong sense of well-being, similar to Ontario residents (63.5% CI ± 0.8). By 2008, the rate reported among residents in Haldimand and Norfolk counties combined increased to three-quarters (75.2% CI ± 5.7) while in Ontario the rate remained stable at about six out of 10 (65.1% CI ± 1.1). Sense of belonging among youth 12-19 in Haldimand and Norfolk counties combined and Ontario for 2005, 2007 and 2008 is reported in Figure 67. In this case, youth in Haldimand and Norfolk counties combined also reported an increase in their sense of belonging. By 2008 almost nine out of 10 youth (88.0% CI ±10.5) in Haldimand and Norfolk counties combined reported a strong sense of belonging while fewer, three-quarters (74.2% CI ± 2.5) reported a strong sense of belonging. Confidence intervals overlapped between the Haldimand and Norfolk counties combined rates reported in 2005, but not in 2007 and 2008. Building social inclusion activities in Haldimand County and Norfolk County is not the single identified domain of any organization. It is the result of action taken on multiple fronts to build social engagement and participation in the community. Efforts should include all facets of the community and in particular those with an interest in social and community services, parks and recreation, municipal services, social justice, education and health. 15Confidence intervals (CI) are a statistical confidence calculation that shows with 95% confidence the lower and upper range in which the true rate falls. It is calculated using the total number of individuals in the population compared to the total number of individuals reporting the type of behaviour in question. 109Factors Affecting Health Figure 67: Strong Sense of Belonging, Youth 12-19, Haldimand and Norfolk Counties Combined and Ontario, 2005, 2007, 2008 Data Source: Canadian Community Health Survey 2005, 2007 and 2008. Statistics Canada, Share File, Knowledge Management and Reporting Branch, Ontario MOHLTC. Data Notes: Annual estimates were used because these estimates present the most up-to-date population health characteristics and are updated yearly. High sampling variability, interpret with caution. High sampling variability data is not releasable. NC: Not able to compute. Not stated includes don’t know, refuse, and not stated. Percentages are rounded up. Prevalence of strong sense of belonging = Very Strong, or Somewhat Strong. Prevalence of weak sense of belonging = Somewhat Weak or Very Weak. On average there is about a 2% difference between the estimated produced between the Ontario Share File and the Master File used by Statistics Canada. The Ontario Share File has fewer respondents than the Master File. In order to be included in the Share File, Ontario residents must consent to sharing their information. Moreover, since the sample is much smaller (12-19) it may be more sensitive to fluctuations in the estimates. Data is shown including confidence interval range, a statistical confidence calculation that shows with 95% confidence the lower and upper range in which the true rate falls. • The proportion of residents aged 18 and older who vote in municipal elections is also considered an indicator of sense of belonging because it indicates level of engagement in the community. Voter turn-out in Haldimand County was reported by ward only. In the three County wards, voter turn-out was 37.3%, 44.3% and 47.1%. (Haldimand County, 2010) • In Norfolk County, the overall voter turn-out was slightly lower, at 35.7% (Norfolk County, 2010). 110 Factors Affecting Health TRANSPORTATION Transportation has long been an issue of concern for residents in Haldimand County and Norfolk County. As a rural community with numerous several small towns and numerous hamlets and villages spread over almost 3,000 square kilometres, the ability to travel between centres, as well as to access services in larger centres is important. There have been several efforts to provide some level of public transportation within Haldimand County and Norfolk County, and to connect people with centres outside the counties (Haldimand-Norfolk Health and Social Services Department, 2009). The latest initiative in 2009 was lead by the Haldimand and Norfolk Rural Transportation Initiative (H&N RTI) which included membership from the Best Start Network, Children’s Aid Society of Haldimand and Norfolk, Grand Erie Training & Adjustment Board, Haldimand-Norfolk R.E.A.C.H., Haldimand and Norfolk Women’s Services, Norfolk District Business Development Corporation, Norfolk County (as the Consolidated Municipal Service Manager for Haldimand and Norfolk counties) and the United Way of Haldimand and Norfolk. As part of this effort, the H&N RTI conducted a public survey to determine attitudes towards public transportation among residents of Haldimand County and Norfolk County. The results of this survey are reported in this section. The survey was made available on-line and paper versions were distributed to selected populations that may not have had access to a computer. The survey was also available in two local newspapers that were distributed to all residents in Haldimand and Norfolk. Through these means 1,259 Haldimand and Norfolk residents completed the survey. Raw data for the survey was not available and thus the figures included here are copied from the H&N RTI report. It is clear that the vast majority of respondents (92%) to the Rural Transportation Initiative survey believed that a public transportation system is needed in Haldimand and Norfolk counties. Almost seven out of 10 (68%) of survey respondents reported that they would use public transportation if it were available, chiefly for recreational and social activities (69%) and to attend medical appointments (59%). Figure 68 showed that individuals who were students, retired, unemployed and other had the greatest difficulty travelling whenever they needed / wanted to. More than half of all respondents in all types of employment and education who responded to the RTI survey reported a willingness to use public transportation if it was made available to them (Figure 70). These survey results indicate both the need for, and willingness to use, public transportation services among residents who were surveyed in Haldimand and Norfolk counties. Without transportation, it becomes difficult for people residing in rural communities to access any services – and from a health perspective - physicians, wellness clinics, early childhood resource centres, fitness opportunities, socialization program and educational opportunities. Numerous service providers already offer transportation services for clients, either through funded programs, volunteer drivers, or fee-for service (Haldimand-Norfolk Health and Social Services Department, 2009). Continued collaborative efforts, like those of the Haldimand and Norfolk Rural Transportation Initiative, will be needed to address this important issue. ANALYSIS • Nine out of 10 respondents (92%) to the Rural Transportation Initiative survey reported that they believed Haldimand and Norfolk counties needed a public transportation system. There was no difference between residents of Haldimand County and Norfolk County (Haldimand-Norfolk Health and Social Services Department, 2009). • Nine out of 10 (92%) of low income respondents reported that they are prevented from travelling some or all of the time due to a lack of public transit (Haldimand-Norfolk Health and Social Services Department, 2009). • Overall, seven out of 10 (68%) of survey respondents reported that they would use public transportation if it were available to them (Haldimand-Norfolk Health and Social Services Department, 2009). • Almost seven out of 10 (69%) survey respondents reported that they would use public transportation for recreational and social activities and almost six out of 10 (59%) reported that they would use public transportation to attend medical appointments (Haldimand-Norfolk Health and Social Services Department, 2009). 111Factors Affecting Health • Respondents who were younger reported that they would use public transportation more frequently for recreational and social activities (81%) followed by attending employment (73%) (Haldimand-Norfolk Health and Social Services Department, 2009). • Respondents who were older reported that they would use public transportation more frequently to attend medical appointments (75%) followed by recreational and social activities (63%) (Haldimand-Norfolk Health and Social Services Department, 2009). • Considered by income status, survey respondents with a lower income level were more likely to use public transportation for medical appointments (78%) and recreational and social activities (77%) (Haldimand-Norfolk Health and Social Services Department, 2009). • Figure 68, Figure 69, and Figure 70 show the results to three different H&N RTI survey questions, exactly as reported in the H&N RTI report. Raw data was not available for analysis. Responses are provided by type of respondents for each survey question. The types of respondents were categorized as follows: elementary / high school student, employed part-time, college / university student, unemployed, employed full-time, retired, and other. Three survey questions are reported here: ƒ Are you able to travel wherever you need to or want to? ƒ Does the lack of public transportation service prevent you from travelling? ƒ If public transportation were available, would you use it? • Ability to travel, illustrated in Figure 68, was clearly impacted by individual’s education or employment status. Survey respondents who were who were students, retired, unemployed and other had the greatest difficulty travelling whenever they needed / wanted to. Ride Norfolk 114 Factors Affecting Health Figure 70: Willingness to Use Public Transportation by Education/Employment Status, Haldimand and Norfolk Rural Transportation Initiative Survey, 2009 Data Source: Haldimand-Norfolk Rural Transportation Initiative Study, 2009 115 Bibliography • Air Resources Board, State of California. (2005). Proposed Identification of Environmental Tobacco Smoke. Retrieved 2010 January from Air Resources Board: www.arb.ca/gov/toxics/ets/finalreport/finalreport.htm • C. Ungerleider, D. K. (2008 March). Public Health Agency of Canada. Retrieved 2011 March from The Social Determinants of Health: Education as a Determinant of Health: http://www.phac-aspc.gc.ca/ph-sp/oi-ar/10_ education-eng.php • Canada Institute for Health Information. (2006). How Healthy Are Rural Canadians. Ottawa: Canada Institute for Health Information. • Canadian Paediatric Society. (2004). Preventing injuries from all-terrain vehicles. 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