Exploits - Central Health

Transcription

Exploits H ealth Service A rea
Com m unity Profile
2014
Bishop’s Falls
Phillip’s H ead
Botwood
Point ofBay
Point Leamington
Peterview
Cottrell’s Cove
Glover’s H arbour
N orthern Arm
Fortune H arbour
Leading Tickles
2
A cknow ledgem ents
The development ofthe Exploits H ealth Service Area Community Profile 2014 was a result ofa
collaborative effort by many individuals, groups and organizations. Special thanks go out to
the citizens ofExploits, Community Advisory Committee, and the Primary H ealth Care
Leadership Team and Central H ealth for their commitment and contributions to this report
and the great work accomplished over the past several years. The information and data
collected and presented in this profile will aid in guiding our work in primary health care for
the next 4 years and we look forward to maintaining and enhancing partnerships with our
communities and organizations in our continuance to deliver quality health services and
programs for the citizens ofExploits.
Index of A cronym s
Throughout this profile there are many acronyms frequently used to identify individuals,
facilities, organizations and geographical areas. The following is a list offrequently used
acronyms in the report.
EH SA - Exploits H ealth Service Area
CAC - Community Advisory Committee
PH C – Primary H ealth Care
PH CLT- Primary H ealth Care Leadership Team
CD PM – Chronic D isease Prevention and Management
CCH S – Canadian Community H ealth Survey
CRH A – Central Regional H ealth Authority
CN RH C – Central N ewfound H ealth Care Centre
JPMH C – James Paton Memorial H ealth Care Centre
CYFS – Child Youth and family Services
CH A – Community H ealth Assessment
LSD – Local Service D istrict
Exploits Primary Health Care
3
Table of Contents
1. Introduction ......................................................................................................................................... Page 6
1.1 Central H ealth .......................................................................................................... Page 7
1.2 W hat is a Community H ealth Assessment...................................................... Page 7
1.3 Profile Information and D ate .............................................................................. Page 7
2. The Exploits H ealth Service A rea................................................................................... Page 8
2.1 H istory......................................................................................................................... Page 8
2.2 Geographic Profile................................................................................................... Page 9
2.3 Population................................................................................................................Page 10
2.4 Migration ................................................................................................................. Page 13
2.5 Live Birth Trends.....................................................................................................Page 14
2.6 Section Summary...................................................................................................Page 15
3. The D eterm inants of H ealth............................................................................................Page 16
3.1 Education................................................................................................................. Page 16
3.1.1 Level ofEducation................................................................................Page 16
3.1.2 School Enrollment and Graduation Rate......................................Page 17
3.1.3 School Environment............................................................................Page 19
3.1.4 Education Summary ............................................................................Page 19
3.2 Employment & W orking Conditions................................................................Page 20
3.2.1 Local Industry ........................................................................................Page 20
3.2.2 Employment Rates...............................................................................Page 22
3.2.3 Youth Employment Rates................................................................. Page 24
3.2.4 Employment Insurance Incidence..................................................Page 24
3.2.5 Employment and W orking Conditions Summary ....................Page 26
3.3 Income and Personal Status.............................................................................. Page 26
3.3.1 Personal Income Per Capita .............................................................Page 26
3.3.2 SelfReliance .......................................................................................... Page 28
3.3.3 Income Support Assistance Status ................................................ Page 29
3.3.4 Income and Personal Status Summary ........................................ Page 31
3.4 H ealthy Child D evelopment ..............................................................................Page 31
3.4.1 N umber ofChildren and Age Range............................................. Page 31
3.4.2 Lone Parent Families and Income ................................................ Page 32
3.4.3 Prenatal Care..........................................................................................Page 32
3.4.4 Early Childhood Learning and Child Care Services.................. Page 33
3.4.5 Live Birth and Low Birth W eight......................................................Page 34
3.4.6 Child, Youth and family Services ....................................................Page 35
3.4.7 H ealthy Child D evelopment Summary ........................................Page 36
3.5 Physical Environment ...........................................................................................Page 36
3.5.1 H ousing ................................................................................................. Page 36
3.5.2 W ater Q uality........................................................................................ Page 40
3.5.3 Roads ...................................................................................................... Page 41
3.5.4 Transportation ..................................................................................... Page 42
3.5.5 Safety........................................................................................................Page 43
3.5.6 Sense ofBelonging to the Local Community ........................... Page 43
4
Table of Contents cont’d
3.5.7 Exposure to Second H and Smoke ..................................................Page 44
3.5.8 Physical and Social Environment Summary ............................... Page 45
3.6 Personal H ealth Practices and Coping Skills ................................................ Page 46
3.6.1 Smoking ..................................................................................................Page 46
3.6.2 Alcohol Use............................................................................................ Page 49
3.6.3 D rug Use ................................................................................................. Page 50
3.6.4 Gambling .................................................................................................Page51
3.6.5 Physical Activity ................................................................................... Page 53
3.6.6 Mammography ....................................................................................Page 54
3.6.7 Cervical Screening............................................................................... Page 54
3.6.8 Prostate Screening ..............................................................................Page 55
3.6.9 Colorectal Cancer Screening ............................................................Page 56
3.6.10 Sexually Transmitted Infections....................................................Page 56
3.6.11 Immunization..................................................................................... Page 57
3.6.12 O ral H ygiene........................................................................................Page 58
3.6.13 Fruit and Vegetable Consumption ............................................. Page 59
3.6.14 Personal H ealth Practices and Coping Skills Summary ........Page 59
4. H ealth Services .....................................................................................................................Page 60
4.1 Primary H ealth Care Provider Profile...............................................................Page 60
4.2 General Practitioner Profile ...............................................................................Page 62
4.3 Primary H ealth Care Services ............................................................................ Page 63
4.3.1 The D r. H ugh Twomey H ealth Centre .......................................... Page 63
4.3.2 Exploits Community H ealth Centre .............................................. Page 64
4.3.3 Bishop’s Falls Medical Clinic .............................................................Page 64
4.3.4 Chronic D isease Prevention/Management ................................Page 64
4.3.5 Chronic D isease SelfManagement Program ............................. Page 64
4.3.6 Evening Physicians Clinics - D r. H ugh Twomey H ealth Centre .......Page 64
4.3.7 Telehealth Services ............................................................................. Page 65
4.3.8 Community Support Services ......................................................... Page 66
4.3.9 Rehabilitative Services........................................................................Page 66
4.3.10 H ealth Protection.............................................................................. Page 66
4.3.11 Mental H ealth and Addictions Services .................................... Page 66
4.3.11 Parent and Child H ealth Program ............................................... Page 68
4.4 Regional Services .................................................................................................. Page 69
4.5 N on Central H ealth............................................................................................... Page 69
4.5.1 Child, Youth and family Services.....................................................Page 69
4.5.2 H ealthLine.............................................................................................. Page 71
4.5.3 Alternate Family Care H omes.......................................................... Page 72
4.5.4 Supportive Services ........................................................................... Page 72
4.6 Secondary H ealth Care Services....................................................................... Page 74
4.7 Adjacency to Secondary H ealth Care Services............................................ Page 74
4.8 Migration Patterns ............................................................................................... Page 74
5
Table of Contents cont’d
4.9 Access to Family Physician/PH C Provider .....................................................Page 75
4.10 Satisfaction with H ealth Care ..........................................................................Page 75
4.11 Primary Reason for Use ofEmergency D epartment .............................. Page 75
4.12 H ealth Service Summary.................................................................................. Page 77
5. H ealth O utcom es or Status........................................................................... Page 77
5.1 SelfPerception ofH ealth.................................................................................... Page 78
5.2 SelfPerception ofMental H ealth......................................................................Page 78
5.3 Life Stress Status ....................................................................................................Page 79
5.4 O verweight/O besity .............................................................................................Page 79
5.5 Underweight........................................................................................................... Page 80
5.6 Chronic D isease Rates ......................................................................................... Page 81
5.6.1 D iabetes ..................................................................................................Page 81
5.6.2 H igh Blood Pressure ...........................................................................Page 82
5.6.3 Cardiovascular D isease ......................................................................Page 83
5.6.4 Arthritis ................................................................................................... Page 83
5.6.5 Asthma ....................................................................................................Page 84
5.6.6 Chronic O bstructive Pulmonary D isease..................................... Page 84
5.6.7 Cancer ......................................................................................................Page 84
5.6.8 Mood D isorder ..................................................................................... Page 85
5.6.9 Stroke ......................................................................................................Page 85
5.7 Chronic Pain........................................................................................................... Page 85
5.7.1 Pain or D iscomfort, Moderate or Severe ..................................... Page 86
5.7.2 Pain or D iscomfort that Prevents Activities ............................... Page 86
5.8 Participation and Activity Limitation ............................................................ Page 86
5.9 D isability or D eath ............................................................................................ Page 86
5.10 Morbidity and Mortality .................................................................................. Page 87
5.11 H ealth O utcomes or Status Summary ....................................................... Page 90
6. Community Assets ................................................................................................................Page 90
7. Strengths, Challenges and O pportunities .................................................................... Page 92
8. Summary .............................................................................................................................. Page 101
9. Reference List ...................................................................................................................... Page 104
10. Appendix A (Community Consultation Session, N ovember 14, 2013) .......... Page 105
11. Appendix B (H ealth Provider Consultation Survey Results – 2014) ................ Page 120
12. Appendix C (Glossary ofTerms) .................................................................................. Page 128
6
1. Introduction
1.1 Central H ealth
Central H ealth is the second largest health region in N ewfoundland and Labrador, serving a
population ofapproximately 95,000 and offering a full continuum ofhealth care services that
are dispersed throughout the region. As seen in the figure below, the Central H ealth region
extends from Charlottetown in the east, Fogo Island in the northeast, H arbour Breton in the
south to Baie Verte in the west. Central H ealth is challenged by its rural land mass as the
geographical area encompasses more than halfofthe total land mass ofthe island.
Map of Central H ealth G eographic A rea
Exploits H ealth
Service A rea
The organization has approximately 3,000 employees including salaried physicians and over
900 volunteers. W ithin the region there is a diverse array ofprimary, secondary, long term care,
community health and some enhanced secondary services. These services are provided
through a number ofhealth centres, long term care (LTC) facilities and two regional referral
centres. There are 842 beds throughout the central region comprised of264 acute care, 518
LTC, 32 residential units and 28 bassinets. Central H ealth is also responsible for the licensing
and monitoring ofpersonal care homes and approval ofhome support agencies within the
region. The organization partners with the Miawpukek First N ation to support health services
delivery in Conne River.
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1.2 W hat is a Com m unity H ealth A ssessm ent?
O ne ofthe responsibilities ofa health authority within the provincial Regional Health
Authorities Act is to assess health and community service needs in its region on an ongoing
basis.
A Community H ealth Assessment (CH A) is a dynamic, ongoing process undertaken to identify
the strengths and needs ofthe population, to enable community-wide establishment ofhealth
priorities, and facilitate collaborative action planning directed at improving community health
status and quality of life. The purpose of a community health assessment is to collect, analyze
and present information so that the health of the population can be understood and
improved, and to provide evidence to inform health service planning. It provides baseline
information about the health status of community residents, encourages collaboration with
community members, stakeholders, and a wide variety of partners involved in decisionmaking processes within the health care system, tracks health outcomes over time, and helps
to identify opportunities for disease prevention, health promotion and health protection.
(CH AG 2009, Manitoba)
Understanding the communities it serves will ultimately provide Central H ealth with evidence
based knowledge to help it work towards its vision ofHealthy People,Healthy Com m unities.
1.3 Profile Inform ation and D ata
The information and data (qualitative and quantities) collected and presented in this profile
came from a variety ofsources such as: Community Accounts, Statistics Canada, Central H ealth
and citizens, groups and local organization throughout Exploits. Challenges exist with finding
data specific to a given geographic. O ften data is unavailable. Therefore, throughout this
report information and data from Local Area 43 (Badger, Grand Falls – W indsor, W ooddale all
Exploits communities) was often utilized to represent the EH SA when specific data was
unavailable. In addition, individual community data was combined to represent the EH SA as
well. In some cases data was just unavailable and this is communicated frequently throughout
the profile. The presentation of the data and information in this profile is meant to be clear
and concise to the reader and it’s achieved through the use of tables, charts, graphs and
textual form.
8
2. The Exploits H ealth Service A rea
2.1 H istory
Botwood Cottage H ospital, built in 1946, served the people ofBotwood and surrounding area
until its closure in 1989. It operated under the governance ofthe Provincial D epartment of
H ealth. Many changes in the health care system led to the construction and opening ofthe D r.
H ugh Twomey H ealth Care Centre, now named the D r. H ugh Twomey H ealth Centre, which
replaced the cottage hospital and came under the governance ofthe Central W est H ealth
Corporation with headquarters in Grand Falls-W indsor. The new centre opened in June 1989
and housed a modern outpatient/emergency clinic, diagnostics, long term care, including a
specialized protective care unit, respite and palliative care services and medical services
provided by four physicians. At this time, public health and continuing care nurses were also
accommodated in the same building and provided service to all areas covered by this report
except Bishop’s Falls. This arrangement continued to the mid 90's when due to space
allocations, the Community H ealth Services moved to another location and for a period of
about 6 years, services were accessed from three separate locations in the Botwood area.
Primary health care services were provided to the people ofBishop’s Falls by two fee for
service physicians, one continuing care nurse and a public health nurse. Until N ovember 2003,
these community based nurses were located in an office in Bishop’s Falls, however with the
opening ofthe new community health building in Botwood, services were consolidated and
nurses were relocated, with caseloads assigned on a geographical basis.
Physician/medical services were provided in Point Leamington by two physicians out ofGrand
Falls-W indsor with a clinic two days/week. W ith the closure ofthis clinic, many residents
continue to receive medical care from these physicians, traveling to Grand Falls-W indsor to
access same.
In 1994, Community H ealth Boards were brought about by legislation following a
comprehensive review ofhealth services governance models. The amalgamation ofthe
Gander and D istrict Continuing Care Program, Regional Public H ealth Units, and the Alcohol
and D rug Addictions Commission became the new Community H ealth Board mandate.
Until 1997, social programs were the responsibility ofthe former D epartment ofH uman
Resources. H owever, further integration saw the new Central Regional H ealth and Community
Service Board encompass these social programs: Family and Rehabilitative Services, Child
W elfare and Community Corrections. These services remained housed in the former Provincial
Building/Courthouse in Botwood until 2003. A new building constructed that year became
“home” to all community-based services in the Exploits area and this physical integration was
instrumental in consolidating the organizational mandate in place for several years.
9
H istory cont’d.
O n April 1, 2005, a single regional integrated health authority was born, bringing together
health and community, long term care and institutional services. A provincial directive to
reduce to four governing bodies saw the amalgamation ofH ealth and Community Services
Central, Central W est H ealth Corporation and Central East H ealth Care Institutions Board to
become the new Central Regional H ealth Authority, known to most citizens as Central H ealth.
This most recent merger now has the mandate for public health, early learning and child care;
addictions; mental health; community support services; acute and long term care services; and
primary health care services. The D epartment ofChild, Youth and Family Services (CYFS)
transitioned from Central H ealth into their own provincial department in July 2012. Staffofthe
new CYFS department in Exploits remains housed with all other Central H ealth employees
within CRH A’s owed and leased locations and facilities.
2.2 G eographic Profile
Bay ofExploits is located in the Central N orth Eastern portion ofN ewfoundland with Economic
Zone 12 also known as Exploits Valley Economic D evelopment Corporation. Economic Zone 12
encompasses a large geographic area east to N orris Arm, south to Grand Falls-W indsor, west to
Buchans and north to Cottrell’s Cove and Leading Tickles.
For purposes ofthis report, we will focus on the communities ofBishop’s Falls,B otw ood,
Peterview ,N orthern A rm ,Point Leam ington,Leading Tickles,Point of Bay and the Local
Service D istricts (LSD ) of Phillip’s H ead,Cottrell’s Cove,Fortune H arbour and G lover’s
H arb our. The combined area ofLSD is known as D iv.N o.8 Sub E.
All communities in this region are connected by road. The greatest distance between any two
communities in the region is 32kms (Cottrell’s Cove to Point ofBay). The farthest distance
between all communities in the area is 75kms - Bishop’s Falls to Leading Tickles. The greatest
distance for any person to access primary health care services is approximately 57 kilometers
(Leading Tickles to Botwood).
10
2.3 Population
The following table was constructed utilizing information from Statistics Canada (2011/2006
census). Figures may not add to total due to random rounding offigures.
Table 1: Population (by Sex): 2011/2006
Com m unity
Males (2011)
Fem ales
(2011)
Total -2011
Total -2006
Bishop’s Falls
1650
1690
3340
3399
Peterview
430
380
810
807
Botwood
1455
1555
3010
3052
N orthern Arm
190
205
395
385
Point Leamington
295
325
620
649
Leading Tickles
170
165
335
407
Point ofBay
80
80
163
169
D iv. N o. 8 Sub E:
Phillip’s H ead
Cottrell’s Cove
Fortune H arbour
Glover’s H arbour
280
255
535
698
4550
4655
9208
9566
Total:
The population was approximately 9208 in Exploits according to 2011 census. For the same
period the population for the Central H ealth Authority was 93,906. The population has a
relatively even distribution between sexes with the greatest variation ofapproximately 100
more females than males in Botwood.
The follow table shows population comparisons (2011) for Central H ealth, other Regional
H ealth Authorities, Province and Canada.
G eographical A rea
Central H ealth
Eastern H ealth
W estern H ealth
Labrador - Grenfell
Province
Canada
Population (2011)
93,906
303,253
77,983
36,394
514,535
33,476,700
11
Population cont’d.
Com m unity
0-4
yrs
5-14
yrs
15-19
yrs
20-24
yrs
25-44
yrs
45-54
yrs
55-64
yrs
65-74
yrs
75-84
yrs
85+
Median
A ge*
Bishops
Falls
120
315
190
180
685
615
605
375
215
35
48.2
Peterview
40
120
55
40
200
115
115
75
30
5
40.9
Botwood
105
285
180
85
595
480
570
395
220
105
50.5
N orthern
Arm
Point
Leamington
Leading
Tickles
15
40
15
10
85
60
95
55
20
5
51.5
15
60
30
20
110
135
120
90
40
15
51.8
10
30
15
15
65
70
70
40
30
10
51.3
Point ofBay
5
10
10
5
20
30
30
30
5
5
53.6
D iv N o. 8
Sub E*
15
45
30
20
90
110
115
75
30
5
51.8
Totals
325
905
525
375
1850
1615
1720
1135
590
185
% of
Population
4.0%
10%
6.0%
4.0%
20.0%
18.0%
19.0%
12.0%
6.0%
2.0%
Population A ge Range – 2011
*Includes Phillip’s H ead, Cottrell’s Cove, Fortune H arbour and Glover’s H arbour
Median
This refers to the middle number in a group ofnumbers. W here a median income, for
example, is given as $26,000, it means that exactly halfofthe incomes reported are
greater than or equal to $26,000, and that the other halfare less than or equal to the
median amount. Median incomes in the data tables are rounded to the nearest
hundred dollars. W ith the exception of"Total Income", zero values are not included in
the calculation ofmedians for individuals, but are included in the calculation of
medians for families.
The median age for the province is 44.0, with the median age for the EH SA area ranging from
40.9 in Peterview to 53.6 in Point ofBay.
A common trend is visible - in each community the smallest age group is the 0-4 year age
group, comprising 4.0% ofthe total population.
12
The majority ofthe population in the catchment area is 25-44 year group (20.0%) and the 5564 year group (19.0%) and this is seen consistently in each community profiled. As declining
birth rates and out migration from rural areas results in an aging population, some factors that
must be considered in planning for the health ofthe population include:
• less younger people/family members for support
• declining workforce
• increase in chronic illnesses/conditions
• shift in the services required/location ofservices/access to services
• impact on school enrollment
Population Change Exploits PHC Area 2006-2011
2500
2000
1500
1000
500
0
0-4
4-14
15-19 20-24 25-44
2006
45-54 55-64 65-74 75-84
85+
2011
Source: Statistics Canada
As shown in the graph above the percentage decline in population is true for all age groups up
to age 55 with the largest decline in the 25- 44 year old group. Anecdotally we are aware ofa
significant number in the young workforce moving away for employment. Figure 1 also
reflects an increase in persons aged 55 and older in the catchment area. W ithin this
geographic region, in 2001 there were two large long term care facilities and four personal
care homes for seniors and this might account for some ofthe increase in number ofpeople in
this age group. W hile it has been difficult to capture numbers, there is certainly a perception
ofmany ‘young retirees’, under the age of60, moving back to the area.
13
The following table shows the 2006 to 2011 population change (%) comparisons for Central
H ealth, province and Canada.
G eographical A rea
Central H ealth
Province
Canada
Population Change (%) 2006 - 2011
-1.6%
1.8%
5.9%
2.4 Migration
Migration data reflect interprovincial and international movements as well as intraprovincial
moves between census metropolitan areas or census divisions. Moves across town or across
the street are excluded.
Migration Population Changes 1996-2006
Com m unity
2001
2006
% change (0106)
2011
% change (06-11)
Bishop’s Falls
3688
3399
-7.8%
3340
-1.7%
Peterview
811
807
-0.5%
810
0.2%
Botwood
3221
3 052
-5.2%
3010
-1.4%
N orthern Arm
375
385
+ 2.7%
395
3.1%
Point
Leamington
685
649
-5.3%
620
-4.6%
Leading Tickles
453
407
-10.2%
335
-17.2%
Point ofBay
169
163
-3.6%
163
-2.5%
D iv N o. 8 Sub E
692
698
+ 0.9%
535
-23.1%
Central H ealth
99,865
95,460
-4.4%
93,906
-1.6%
Province
512,930
505,470
-14.5%
514,535
1.8%
For the period of2006 – 2011, migration based on population for Central H ealth was a
decrease of1.6%, while N ewfoundland and Labrador and Canada had an increase of1.8%.
14
Migration cont’d.
Migration Changes Males/Fem ales 2006-2011
Males
%
Com m unity
2006
2011
Change
Bishop’s Falls
1655
1650
-0.3%
Peterview
415
430
3.6%
Botwood
1495
1455
-2.7%
N orthern Arm
190
190
0%
Point
320
295
-7.8%
Leamington
Leading Tickles
210
170
-19%
Point ofBay
80
75
-6.3%
D iv. N o 8 Sub E
360
280
-13.9%
Region*
11765
12134
3.1%
Province
245735
250570
2%
Fem ales
2006
2011
1745
390
1,560
195
1690
380
1550
205
%
Change
-3.2%
-2.6%
-0.6%
5%
330
325
-1.5%
200
80
345
12610
259735
165
80
255
12915
263970
-18%
0%
-26%
2.4%
1.6%
For the period 2006-2011: Most communities observed a decline in the population with the
exception ofN orthern Arm who experienced a growth of5% in the female population while
the males remained unchanged.
2.5 Live B irth Trends
Birth rates and death rates must be considered in any discussion ofpopulation change. The
Following table reflects the number oflive births between 2007- 2012 for the EH SA.
N um ber and Rate of Live Births for EH SA area,2007- 2012.
Y ear
N um b er of Births
Population
2007
67
9141
2008
72
9125
2009
75
9170
2010
65
9201
2011
63
9207
2012
60
Total
402
Rate per 1,000
7.3
7.9
8.2
7.1
6.8
In 2007, there were 67 births recorded for the EH SA area compared to 60 births in 2012. For the
six years beginning in 2007, the average number ofbirths for this region has been 67.1, for a
cumulative total of402. In 2011 there were 670 births reported within Central H ealth. In 2012
Exploits had 60 births with an even split of30 males and 30 females.
15
Live B irth Trends cont’d.
N um ber of deaths and Mortality Rate for EH SA area,2007-2011
Y ear
N um ber of D eaths
Population
Rate per 1,000
2007
92
9141
10.1
2008
98
9125
10.7
2009
106
9170
11.6
2010
109
9201
11.8
2011
88
9207
9.6
Total
493
In reviewing death rates, there has been an average of98.6 deaths per year in the EH SA
catchment area. Between 2007- 2011, there was a total of493 deaths in the PCH area. The
natural increase ofa population is the difference in the number ofbirths and the number of
deaths for a given period oftime. Based on the number ofbirths and deaths for the PCH
catchment area between 2007 and 2011 the natural increase for this area was -151. It should
be noted that the natural increase does not reflect immigration and therefore does not show
the total population change.
2.6 Section Sum m ary
•
•
•
•
•
•
•
•
•
•
From 2006 to 2011 the population ofthe EH SA decreased by 358.
There are 105 more females than males in 2011.
Population has declined in most communities with D iv. 8 Sub E seeing the most
significant decrease by 163.
43% ofthe population is under 45 years ofage while 57% is 45 + .
The average median age ofcitizens in 2011 is 50 compared to 45 in 2006.
All age groups from 0 – 54 have seen a decrease in population from20016 – 2011 while
all age groups from 55 and over increased.
There is significant out migration in the smaller communities ofLeading Tickles and
D iv. N o 8, Sub E (Phillips H ead, Cottrell’s Cove, Fortune H arbour and Glovers H arbour.
This could be a direct result ofa downturn in the local fishery and forestry leading to an
increase in the population migrating to employment areas within and outside the
province.
N orthern Arm has seen an increase in their population which could account for those
who returned home to retire and new retires who are attracted to the area.
The birth rate from 2007 – 2012 has been relatively stable with 60 born in 2012.
The death rate is also stable for the same period with 88 recorded in 2011.
16
3. The D eterm inants of H ealth
D eterminants ofhealth are factors that together contribute to the state ofhealth and wellbeing ofa population or individuals. These are factors such as: income and social status, social
support network, education, health services, employment and working conditions, physical
environment, biology and genetic endowment, personal health practices and coping skills,
and child health and development (Federal, Provincial, and Territorial Advisory Committee on
Population H ealth, 1994).
3.1 Education
Education throughout the Exploits H ealth Service Area can be obtained from 3 elementary
schools (two – K – 6 and one K – 3), 3 high schools (7 – 12) and 2 all grade schools. The Adult
Basic Education (ABE) program is offered at the D iscovery Centre located in Botwood. Post
secondary education (trade school, colleges and university) is available outside the PH C site at
a reasonable driving distance ofapproximately 30 minutes in the communities ofGrand
Falls/W indsor and Lewisporte.
3.1.1 Level of Education
According to H ealth Canada, Statistical Report on the H ealth ofCanadians, educational
attainment is positively associated with economic status and health outcomes including
health lifestyles and behaviors. Education increases the opportunity for employment and
income and contributes to selfworth and control. The following table shows education
attainment levels among the communities ofExploits including regional comparisons.
17
Level of Education cont’d
B otw ood*
Point
Leam ingto
n
Leading
Tickles
Point of
B ay
Cottrell’s
Cove
Central
H ealth
Province
Canada
32%
78.6%
34.9%
19.4%
62.8%
29.6%
70.4%
33.6%
25.1%
15.8
%
25%
10.7%
27.6%
39.8%
18.6%
22.2%
14.8%
24.2%
23.8%
14.4%
1.9%
13.5%
16.5%
4.7%
14.8%
7.4%
14.1%
13.5%
22.7%
8.7%
15.1%
18.4%
9.3%
22.2%
--
17.7%
20.7%
B ishop’s
Falls
Peterview
H ighest Level of Schooling per PH C site’s com m unities and regions – 18-64 age groups
(2006)
N o H igh School
D iplom a
H igh School
D iplom a
A pprenticeship
/Trades
College or N onU niversity
Certificate/
D iplom a
U niversity
Certificate,
D iplom a or
D egree
5.4%
--
8.9%
6.8%
4.7%
7.4%
14.8%
10.4%
16.9%
27.3
%
11.5
%
19.7
%
25.7
%
* Botwood includes Charles Brook, Fortune H arbour, N orthern Arm, Philip’s H ead and
Pleasantview.
W ithin PH C site - Exploits, the level ofundereducated, with no high school diploma ranges
from a low of19.4% in Point Leamington to a high of78.6% in Peterview. The percentage of
adults ages 18 - 64 (2006 data) with a high school diploma as the highest education level
ranges from 10.7% in Peterview to a 39.8% in Point Leamington. Based on the average all
communities throughout the Exploits H ealth Service Area 46.8% ofthe population aged 18 –
64 do not have a high school diploma. It’s important to note that approximately 70% ofthe
citizens in Exploits reside in the two largest communities ofBishop’s Falls and Botwood where
the percentage ofpeople who do not have a high school diploma is averaged at 33.4% This is
comparable with Central H ealth’s average of33.6% for the same reporting period.
3.1.2 School Enrollm ent and G raduation Rate
The number ofschools in the EH SA in 2013 is 7, reduced from 11 in 1996. There were a number
offactors to account for these changes, including declining birth rate, out-migration of
families and the dissolution ofdenominational school boards in 1998 which all contributed to
the number and location ofschools.
18
School Enrollm ent and G raduation Rate cont’d.
School enrollment in the Grand Falls-W indsor - Point Leamington area (referred to as the local
region 43) has decreased from 3709 in school year 2005-06 to 3,250 in school year 2012-13.
This has been a steady annual decline and according to the D ept ofEducation Fast Facts,
enrollment is predicted to decline about 4% annually to 2010 within the province. School
enrollment in local region 43 declined at a rate of3.5% from 2011 -12 to 2012-13 W ithin the
PH C catchment area, school enrollment in March of2007 was 1435 students a decline of259
with the enrollment of1176 in 2013. There has been an 18% decrease in school enrollment
since 2007. The following table shows current schools in the PH C catchment area, including
grade span, enrollment and bussing patterns.
Schools in PH C A rea: 2006-2013
School
Com m unity G rade
06-07
Span Enrolm ent
09-10
H elen Tulk
Elementary
Leo Burke
Academy
Botwood
Collegiate
Bishop’s
Falls
Bishop’s
Falls
Botwood
K-6
251
232
11-121112B ussin
g
228
7-12
292
222
226
216
In-town
7-12
339
341
343
312
Memorial
Academy
Botwood
K-6
363
339
321
310
Cottrell’s
Cove
Academy
Point
Leamington
Academy
Cottrell’s
Cove
K-12
33
27
25
23
Peterview
N orthern
Arm
Phillip’s
H ead
Point ofBay
Peterview
N orthern
Arm
Phillip’s
H ead
Point ofBay
Fortune
H arbour
Point
Leamington
K-12
139
106
85
91
Leading
Tickles
Elementary
Totals
Leading
Tickles
K-3
18
12
11
13
1435
1279
1239
1176
-12-13
B ussing
211
In-town
Grades 4-12:
Glover’s
H arbour
Leading
Tickles
Grades K-12:
Pleasantview
Glover’s
H arbour
19
School Enrollm ent and G raduation Rate cont’d.
All schools in the Exploits H ealth Service Area are currently governed by The N ova Central
School D istrict (N CSD ) which has its regional headquarters located in Gander, N L.
3.1.3 School Environm ent
In June 2006, a provincial initiative entitled H ealthy Students/H ealthy Schools was introduced
to provide direction for schools to create healthy environments, in collaboration with health
guidelines. This is an excellent example ofcollaboration with students, teachers, parents,
school councils, food service providers, administrators, authorities and government partnering
to improve the health ofour children.
All schools in the PH C area have breakfast programs which are supported by community
groups, volunteers and grants from the Kids Eat Smart program.
In addition to healthy eating, there are provincial initiatives to increase the level ofphysical
activity in all schools. As part ofthe Active Schools project ofN L, teachers in the PH C area have
been trained for Q D PA- Q uality D aily Physical Activity- a program designed for Grades K-6 to
incorporate 20 minutes ofnon competitive, physical activity into daily curriculums. H ealth
promotion initiatives in the schools are coordinated by Susannah Rodgers – School H ealth
Promotion Liaison Consultant, Gander. sussahrodgers@ ncsd.ca (709) 256-2547.
In the spring of 2013, Provincial Government released its 2013 budget plan. In this budget,
major changes in education sector resulted in a proposed reduction of provincial school
boards to a total oftwo boards – one English-language board and one French-language board.
This will result in an amalgamation of the four current English-language school boards in the
province. Provincial Government reports that since school board administration was last
consolidated in 2004, school enrollment has declined by almost 14,000 students, or 17%.
3.1.4 Education Sum m ary
•
•
•
•
46.8% ofthe population in EH SA does not have a high school diploma.
Communities ofPeterview, Cottrell’s Cove and Leading Tickles are among the highest
rates with no high school diploma while Bishop’s Falls and Botwood have the lowest
rates.
The community ofPoint Leamington has the highest combined level ofeducation in
the EH SA while Peterview has the lowest level.
There is an 18% decrease in school enrollment since 2007.
20
3.2 Em ploym ent & W orking Conditions
Unemployment, underemployment, and conditions of employment have been associated
with poorer health outcomes. People are healthier when they have a job. They are healthiest
when they feel that the work they do is important, when their job is secure, and when their
workplace is safe and healthy (Circle of H ealth: Prince Edward Island’s H ealth Promotion
Framework, 1996).
3.2.1 Local Industry
As shown in Figure 2, ofthose employed in the Local Area 43 (Grand Falls-W indsor Pt Leamington), the most commonly reported occupation was in the sales and service
industry, followed by construction and related occupations and office and related
occupations. D ata for Exploits H ealth Service Area communities was unavailable.
W orker
Type and
O ccupation
W orker Type and O ccupation- G rand Falls- Point Leam ingto n
(2001-2006)
11,555
11,300
All O ccupations
3,295
3,190
2,100
2,140
1,710
1,530
815
885
750
820
735
815
570
660
471
460
Sales and Serv ice
Occupation
Construction and related
O ffice and related
Managem ent
H ealth
Prim ary
P rocessing and m anufa ctu ring
Education
0
2000
4000
6000
8000
10000 12000 14000
Number
2001
2006
This shows some change from the 2001 Community Accounts data for the same area with a
decrease in those reporting employment in the Service Industry and increases in those
reporting employment in Primary Industry and Manufacturing and Construction.
W hile the number ofpeople working in the industry remains relatively stable, one significant
change to note is the shift within the labour market that provides 50+ weeks ofwork/ year in
2006, compared to 2001.
21
Local Industry cont’d.
As shown in chart below, 6.4% were employed in primary industry, 23.1% were employed in
manufacturing and construction and the largest sector was the service industry with 61% of
the labour force. Primary includes: fishing, logging, mining and agriculture. Service includes:
transportation, communication/utilities, wholesale/retail, business service, government,
education and health. Construction and manufacturing includes: construction, equipment
operators, laborers, mechanics, fish plant workers etc. This shows some change from the 2001
Community Accounts data for the same area with a decrease in those reporting employment
in the Service Industry and increases in those reporting employment in Primary Industry and
Manufacturing and Construction.
Main Industry (2001- 2006)
Main Industry 2001
Main Industry 2006
6.40%
5.70%
19.40%
Primary
industry
Manufacturing
/ Construction
Service
Industry
23.10%
61%
Primary
industry
Manufacturing
/ Construction
Service
Industry
75%
W orker Type and O ccupations 15 and over regional com parisons – 2006 –
Com m unity A ccounts
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
h
alt
He
Region
Central Health
Province
Canada
a ti
uc
d
E
on
im
Pr
ary
&
les
Sa
rv
Se
g
nt
t ed
t ed
rin
me
ela
tu
ela
e
c
R
g
R
a
e
na
uf
on
fic
an
Ma
c ti
Of
u
M
r
t
g&
ns
Co
s in
s
e
oc
Pr
ice
W hile the number ofpeople working in the industry remains relatively stable, one significant
change to note is the shift within the labour market that provides 50+ weeks ofwork/ year in
2006, compared to 2001. The table below shows comparisons from 2001 – 2006.
22
Local Industry cont’d.
Percentage Changes in W orkforce -2001- 2006
50+ W eeks
Industry
(2001)
Primary Industry
1.3%
Manufacturing/Construction
18.6%
Service Industry
80.1%
50+ W eeks
(2006)
3.1%
12.4%
84.5%
% Change
+ 1.8%
-6.0%
+4.4%
According to 2006 Census D ata, 47.6% ofthose employed (that is reported employment for at
least one week ofthe year) reported working for 50+ weeks ofthe year compared to 47.7%
for 2001. That would indicate that approximately 52% ofthe workforce worked less than the
full year, and 10% worked less than 12 weeks, the minimum requirement to qualify for EI
benefits. From the information above, in 2006, 3.1% ofthose working in primary industry
worked equivalent full time (50+ weeks), an increase from 2001 where only 1.3% ofprimary
industry worked 50+ weeks. W ithin the manufacturing/construction industry, the 6.0%
decrease may reflect the number ofpeople that have moved away for higher paying jobs, but
many ofwhom work for shorter periods and return home for parts ofthe year. The service
industry registers a gain of4.4% reporting full time employment from 2001 to 2006
3.2.2 Em ploym ent Rates
The labour force consists of people who are currently employed and people who are
unemployed but were available to work in the reference period and had looked for work in
the past 4 weeks. The unemployment rate is a traditional measure of the economy.
Unemployed people tend to experience more health problems.
The following table shows employment rates per community for the Exploits H ealth Service
Area (EH SA) 18-64 year old age group. D ata was provided by Community Accounts 2006
census. The employment rate is based on the entire year of2005 while the unemployment
rate and participation rates are based on a 7 day period – one week prior to census day. D ata
for Cottrell’s Cove was unavailable.
Em ploym ent Rate - The employment rate is the number ofpersons who are employed
expressed as a percentage ofthe total population.
U nem ploym ent Rate - The unemployment rate is the number ofunemployed persons
expressed as a percentage ofthe labour force.
Participation Rate - The participation rate is the labour force during the reference week
divided by the total population 15 and over. (Community Accounts – 2011)
23
Em ploym ent Rates cont’d.
Pleasantview.
B ishop’s Botw ood* Peterview Point
Point
Leading
Falls
Leam ington of B ay Tickles
70.2%
63.5%
41.7%
67%
59.3%
69.8%
Em ploym ent
Rate
30.7%
48.6%
53.8%
57.9%
44.4%
U nem ploym ent 24.7%
Rate
68.8%
61.1%
35.9%
63.1%
70.4%
62.8%
Participation
Rate
The unemployment rate for Central H ealth was 17% compared to 12.7% in N ewfoundland
and Labrador (Labour Force Survey, Statistics Canada, 2011). The average employment rate in
2005 based on available data for the Exploits H ealth Service Area was 61.9% which is
significantly less than the Region at 70.8%, Central H ealth at 73.6%, and province at 76.7%
and Canada at 82.6. It’s important to note that 70% ofthe EH SA population resides in the two
largest communities of Bishop’s Falls and Botwood where the employment rate is 66.8%. The
highest employment rate in the EH SA is Bishop’s Falls 70.2% and the lowest is in Peterview at
41.7%. In 2006 the provincial employment rate of 78% was slightly above the employment
rate for Central Region, 76%.
The following chart shows rate comparisons (2006 census) between communities in the
Exploits H ealth Service Area (EH SA) with the Region (Grand Falls - Point Leamington Area,
plus Badger, Grand Falls-W indsor, Sandy Point and W ooddale) Central H ealth, Province and
Canada. (Community Accounts – 2006 Census)
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Bi
sh
op
’
s
Fa
lls
Bo
tw
oo
d*
Pe
Po
te
in
rv
tL
ie
ea
w
m
in
gt
Po
on
in
t
Le
of
ad
Ba
in
y
g
Ti
ck
le
s
Re
Ce
gi
on
nt
ra
lH
ea
lth
Pr
ov
in
ce
Ca
na
da
Em ploym ent
R ate
U nem ploym ent
R ate
Participation
R ate
24
3.2.3 Y outh Em ploym ent Rates
Youth Unemployment Rates Stats Canada 2011
40.00%
30.00%
32.10%
20.90%
20.00%
14.20%
Unemployment Rate
10.00%
0.00%
Central
Health
Province
Canada
Youth aged 15 - 24
Youth unemployment rates were unavailable for communities in the Exploits H ealth Service
area.
3.2.4 Em ploym ent Insurance Incidence
The employment insurance incidence reflects the number of people receiving employment
insurance benefits in the year divided by the total number of people in the labor force. The
labor force is defined as the number of people who received employment income or
employment insurance within the year. The chart below shows the employment insurance
comparisons for 2004, 2008 and 2011 for the EH SA communities, Local Area 43 (Grand Falls Point Leamington Area, plus Badger, Grand Falls-W indsor, Sandy Point and W ooddale) and
the province of N ewfoundland and Labrador. The average benefits for those individuals
collecting Employment Insurance in Local Area 43: Grand Falls-Point Leamington Area in 2011
was $8,100 while the average benefits in 1992 were $6,100. In comparison, the provincial
average benefits in 2011 were $8,400. The average benefits for those individuals collecting
Employment Insurance in Central H ealth Authority in 2011 were $9,000 while the average
benefits in 1992 were $6,800. D ata collected from Community Accounts Profiles.
25
Em ploym ent Insurance Incidence cont’d.
Em ploym ent Insurance Incidence (2004,2008,2011)
32.7
33
36
36.8
33
37
31.3
34
37
39.5
Local A rea 43
B ishop's Falls
Community
Province
B otw ood*
45
45
52.9
56
Peterview
52.7 58
57
Point Leam ington
35.7
Point ofB ay
50
63
58
70
Leading Tickles
61.1
Cotterll's Cove
68
0
10
20
30
40
50
60
70
73
81
75
80
90
P ercen t
2004
2008
2011
It is a widely known fact that many workers are in seasonal employment, short-term
employment in and out ofthe province, in sales/service, transport and equipment operators
and construction related industry. This is supported by the data. Two communities reporting
the highest percentage ofEI incidence, Leading Tickles and Cottrell’s Cove also report the
highest number ofclaims in fishing and primary industry such as logging
The employment insurance incidence for Central H ealth in 2011 was 44.1%, which is higher
than the provincial rate (31.3%) and the highest among the four regional health authorities.
Since 1992, the employment insurance incidence in Central had dropped by 17%. H owever,
Central has consistently had a higher rate of employment insurance incidence compared to
the province and the regional health authorities.
26
3.2.5 Em ploym ent and W orking Conditions Sum m ary
•
•
•
•
•
Sales and service industry followed by construction and manufacturing is the leading
occupation type among citizens living in local region 43.
There is a slight increase in those who receive 50+ weeks ofwork per year from 2001 –
2006 in the sales and service and primary industry while a decrease exist in the
construction and manufacturing industry.
The employment rate ranges from 70% in Bishop’s Falls to 41% in Peterview.
Leading Tickles has the highest rate of employment insurance incidence for 2011 in
comparison to all other communities in the Exploits H ealth Service Area.
The largest communities ofBishop’s Falls and Botwood are less reliant on employment
insurance compared to all smaller communities. This could indicate that the citizens in
smaller communities rely heavily on seasonal employment for their livelihood.
3.3 Incom e and Personal Status
This is the single most important determinant ofhealth. Many studies show that health status
improves at each step up the income and social hierarchy. Income determines living
conditions such as safe housing and ability to buy sufficient nutritious food. The healthiest
populations are those in societies which are prosperous and have an equitable distribution of
wealth, regardless ofhow much they spend on health care.
3.3.1 Personal Incom e Per Capita
Personal income per capita is defined as income from all sources received by an individual
and includes employment as well as government transfers, such as Canada Pension, O ld Age
Security, EI and Social Assistance. The following chart shows personal income per capita of
the EH SA communities, Local Area 43, province, Central H ealth and Canada from 2001 – 2010.
D ata for some communities was unavailable. Community Accounts 2011 Census
27
Personal Incom e Per Capita cont’d.
Personal Incom e Per Capita (2001- 2010)
Canada
23800
19800
15700
Com m unity
Province
21,200
16,900
Bishop's Falls
14,900
Point Leamington
18,400
13,900
12,000
Leading Tickles
8,500
0
22,400
21,800
31600
24,700
28 ,900
25,400
23,700
21,900
22,400
16,700
16,100
15,100
13,100
Peterview
18,900
25,100
23,300
20,000
15,500
23800
27,700
22,800
18,100
31000
28900
18,300
14,400
12,400
13,600
10,900
18,200
13,200
5,000 10,000 15,000 20,000 25,000 30,000 35,000
Incom e
2001
2006
2009
2010
Personal income per capita is slightly lower in Local Area 43 ($25400) than the provincial
average of($28900) for 2010. The above chart depicts the comparison throughout the
Exploits H ealth Service Area from a low ($13,200) in Peterview to a high of($23,700) in
Bishop’s Falls.
The majority ofcommunities in the EH SA have shown consistent annual increases in personal
income per capita between 2001- 2010 with the exception ofBotwood which seen a slight
decrease from 2009 – 2010. The closer ofthe paper mill in Grand Falls W indsor in 2009 would
have most likely contributed to this decline. O nly two communities, Point ofBay and Leading
Tickles, experienced small decreases in personal income per capita between 2005 and 2006.
Point Leamington has shown the largest increase in the past 10 years with personal income
per capita at $13,900 in 2001, increasing to $22,400 in 2010. D ata (2010) for the communities
ofLeading Tickles, Point ofBay and Cottrell’s Cove is currently unavailable.
28
3.3.2 Self Reliance
A Community’s level ofselfreliance is an indicator ofthe ability to earn income independent
ofgovernment transfers, such as Canada Pension, O ld Age Security, Employment Insurance
and Social Assistance. The higher the level ofself-reliance, the lower is the dependence on
government transfers. According to Statistics Canada, reporting on 2006 data, government
transfers accounted for 20.4% ofall reported income for the province. Government transfers
include Canada Pension, O ld Age Security, Employment Insurance and Social Assistance and
any payments without providing goods and services in return.
The following graph shows the economic self-reliance ratio in communities covered by this
report and ranges from 49.6% (2010) in Peterview to 73.6% in Bishop’s Falls compared to a
regional ratio of75.2 %, Central H ealth 72.5% and the Province and Canada at 80.1% and
87.2% respectively. 2010 data was unavailable for Cottrell’s Cove.
Self Reliance R atio (2001-2010)
Canada
88.3
Central Health
69.9
Province
79
78
Local Area 43
Community
71.1
74
Botwood*
70
68
Point Leamington
64
66
Point ofBay
51
Peterview
45
Leading Tickles
10
20
30
2001
40
72.5
79.6
74.7
75
80.1
75.2
73.6
66.4
64
63.6
62.7
61.8
52.2
55
49.6
48.2
49
51.9
48
0
71.9
87.2
68.2
59 58
Cotterll's Cove
87.4
75.9
76 76
Bishop's Falls
88.4
50
46
60
Percent
2006 2009
70
80
90
100
2010
29
Self Reliance Cont’d.
The figure for Botwood is based on data for Botwood and Surrounding area which includes
Fortune H arbour, Glover’s H arbour, N orthern Arm, Phillip’s H ead and Pleasantview.
** Local Area 43 denotes the Grand Falls- Point Leamington Region, which includes Leading
Tickles W est. Separate 2009 data for Leading Tickles is currently unavailable.
3.3.3 Incom e Support A ssistance Status
Income Support Assistance, formerly known as social assistance, is the number ofpeople
receiving income support assistance during the year (including dependents). The following
chart shows the Income Support Assistance Incidence rate from 2001 – 2011 for the
communities in the Exploits H ealth Service Area, Region 43, Central H ealth and the Province.
Incom e Support A ssistance Incidence (2001-2011)
13.8 11
Province
13.6
9.0
8.8
1.9
9.7
Local Area 43
Community
9.7
Central H ealth
13.6
11.4
Point Leamington
Leading Tickles
10
24.3
9.6
16.3
13.9
Cottrell's Cove
13.3
15.7
15.8
Bishop's Falls
12.4
Point ofBay
10.0
11.9
15.4
19.0
16.7
Botwood*
12.3
6
20.7
33
Peterview
56.1
40.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Percent
2001 2006 2011
W ithin the Exploits H ealth Service Area the range is from a low of1.9% (Leading Tickles) to a
high of33% (Peterview). Between 2001 and 2011, all communities have shown a consistent
decrease in the incidence ofIncome Support assistance. Although Peterview has the highest
incidence in 2011, there has been a significant decrease since 1996 when the Income Support
Assistance incidence was greater than 70%.
30
Incom e Support A ssistance Status cont’d.
Pleasantview. ** The Region denotes the Grand Falls- Point Leamington Region
In 2011, the number ofindividuals within the Central H ealth region who received Income
Support Assistance at some point was 9,270. The average benefits for those people collecting
Income Support Assistance in the Central H ealth Authority in 2011 was $7,000, provincially
the average benefit was $7,100. The total number ofchildren ages 0 to 17 in Central H ealth
Authority who were in families receiving Income Support Assistance in 2011 was 2,315.
The average duration or the average number ofmonths people were collecting Income
Support Assistance in the Central H ealth Authority was 9.1 months, provincially the average
was 9.3 months.
In 2011, 9.7% ofthe Central H ealth population received income support, which is the second
highest among the four health authorities and is slightly higher than the provincial average of
9.6%.
The incidence ofIncome Support in this Region is slightly higher at 12.3% (2010) than the
provincial incidence at 9.6%. W ithin the Exploits H ealth Service Area the range is from a low of
1.9% (Leading Tickles) to a high of33% (Peterview). Between 2001 and 2011, all communities
have shown a consistent decrease in the incidence ofIncome Support assistance. Although
Peterview has the highest incidence in 2011, there has been a significant decrease since 1996
when the Income Support Assistance incidence was greater than 70%.
Local knowledge ofthe area confirms that attitudes are changing and cites examples ofthird
and fourth generation income support recipients breaking out ofthe cycle, making life
changes.
“Today, more N ewfoundlanders and Labradorians are working than ever before and income
support numbers are at an historic low – clear evidence ofour growing prosperity,” said the
H onorable Joan Shea, Minister ofAdvanced Education and Skills. “The numbers show that our
three-pronged approach in poverty reduction, which includes preventing people from living
in poverty, reducing the number ofpeople living in poverty, and alleviating the poverty
experienced by vulnerable people, is working.”
In addition to a record decline in the percentage ofthe population receiving income support,
the total number ofincome support cases in the province dropped to 23,592 in June and the
lowest level since 1992. The number offamilies with children in receipt ofincome support has
also continued to trend downward, with the percentage falling from 18.3 per cent in 1997 to
10.1 per cent in 2013. http://www.releases.gov.nl.ca/releases/2013/exec/0809n03.htm
31
3.3.4 Incom e and Personal Status Sum m ary
•
•
•
There are considerable gaps ofpersonal income between citizens in some smaller as
compared to larger communities in the Exploits H ealth Service Area. Personal income of
citizens in Peterview in 2011 is 44% less then the personal income ofcitizens in Bishop’s Falls.
From the period of2001 – 2010 smaller communities have become a little less reliant on
government transfers while the largest communities are slighter more reliant.
From 2006 – 2011 all citizens/communities have become less dependant on income support
while some communities particularly Point ofBay and Peterview have seen a decrease in
dependence by 15% and 23% respectively.
3.4 H ealthy Child D evelopm ent
Prenatal and early childhood experiences have a powerful effect on subsequent health, well-being,
coping skills and competence. Increasing evidence shows there are critical stages where intervention
has the greatest potential to positively influence health. These stages are the period before birth,
early infancy, the beginning ofschool and the transitions to adolescence and to adulthood.
3.4.1 N um ber of Children and A ge Range
The following table shows the number ofchildren per age group for the communities in the EH SA for
the last two censuses 2006 and 2011. In 2006, the Central H ealth Authority had 20,150 children in
the 0-19 year old age group. More recent statistics are not available at this time for this health
authority. D iv. 8 Sub. E includes the communities ofPhillip’s H ead, Cottrell’s Cove, Fortune H arbour
and Glover’s H arbour. W hile most communities experienced some changes in the numbers of
children per age group from the 5 year period from 2006 – 2011 the most notable changes occurred
in the 5 – 14 and 15 – 19 year age group in Bishop’s Falls a decrease of65 and 55 children
respectively. The closure ofthe paper mill in Grand falls/ W indsor in 2009 may have had an impact
on this decrease as families may have re-located to other parts ofthe province and beyond in search
ofemployment.
Age Group
Census Year
Bishop’s Falls
Peterview
Botwood
N orthern Arm
Point Leamington
Leading Tickles
Point ofBay
D iv. 8 Sub E*
Total
Province
0–4
2006
2011
135
120
40
40
130
100
10
15
25
15
10
10
5
5
20
15
375
320
22,865
24,495
5 – 14
2006
2011
380
315
130
120
325
280
20
40
55
60
40
30
30
10
70
45
1050
900
55,360
52,140
15 - 19
2006
2011
245
190
60
55
185
180
30
15
45
30
30
15
15
10
35
30
645
525
34,105
29,590
32
3.4.2 Lone Parent Fam ilies and Incom e
Lone parent families are males and females living alone with one or more children. The following
chart show lone parent families in the PH C site’s communities for the two census year of2006 and
2011. D ata collected from Statistic Canada Census. D iv. 8 Sub. E includes the communities ofPhillip’s
H ead, Cottrell’s Cove, Fortune H arbour and Glover’s H arbour.
175
160
125
115
45
20
015
45
30
3020
25
10
05
2006
2011
B
ot
Bi
w
o
sh
op od
’s
Fa
l ls
Pe
t
No erv
ie
rth
w
er
n
Ar
Po
m
Po
in
to
in
fB
tL
ea
ay
m
Le
in
ad
gt
on
in
g
Ti
ck
D
le
iv
s
.8
Su
bE
200
180
160
140
120
100
80
60
40
20
0
In 2010 the median* income for lone parent families with one child for Central H ealth was $28,300,
Local Area 43 - $27900 and N ewfoundland and Labrador was $31,000.
*Median - Refers to the middle number in a group ofnumbers. W here a median income, for example,
is given as $26,000, it means that exactly halfofthe incomes reported are greater than or equal to
$26,000, and that the other halfare less than or equal to the median amount. Median incomes in the
data tables are rounded to the nearest hundred dollars. W ith the exception of"Total Income", zero
values are not included in the calculation ofmedians for individuals, but are included in the
calculation ofmedians for families.
3.4.3 Prenatal Care
Limited information is available in Canada on prenatal care. Prenatal care can impact infant
morbidity and mortality. N ova Scotia D epartment ofH ealth, (2002) recommends that women have
visits for prenatal care every four to six weeks up to the 7th month ofpregnancy, every two to three
weeks in the 7th and 8th month, and every one to two weeks thereafter. This is the guideline followed
by the province ofN ewfoundland and Labrador for prenatal care policy and best practice as well.
Prenatal care can reduce risks, detect early complications and promote healthier pregnancies.
33
3.4.4 Early Childhood Learning and Child Care Services
Prenatal and early childhood experiences have a powerful effect on subsequent health, well-being,
coping skills and competence. Increasing evidence shows there are critical stages where intervention
has the greatest potential to positively influence health. These stages include the period before birth,
early infancy, the beginning ofschool and the transition from adolescence to adulthood.
The following organizations and agencies in Exploits offer programs and services that support early
child development and child care services:
The B otw ood A nchor Fam ily Resource Centre,a division ofthe Exploits Valley Community
Coalition offers programs for young children from birth to six years, as well as their parents and
caregivers. All programs are free ofcharge, nutritious snacks are provided, and are offered on a
weekly or monthly basis depending on the time ofyear. Programs include: Tender Times (0-1 years),
D rop in Play (0-6 years), Theme Kits (2-6 years), Pre-K Programs (4 years), Little Chefs (3-6 years),
Parent Education Programs, H ealthy Baby Club, and Car Seat Installation & Inspection Clinics. The
centre also operates the W ee Care D aycare in Peterview and a satellite service in Cottrell’s Cove
Exploit’s Public H ealth N urses provide direct support and assistance with many programs and
services offered by the centre. For more information contact 709 257-3657 or email
evcc@ nf.sympatico.ca
The Botw ood Boys and G irls Club , a division ofthe Child Youth N etwork (CYN ) offers children a safe
place to participate in activities which encourage personal growth, learning, community
involvement, and healthy living. Through this network all youth have equal opportunity for success.
In the province ofN ewfoundland and Labrador there are 23 hub sites and 13 satellite sites. O fthese,
8 are within the Central H ealth region. Programming offered to children ages 5-18. Programs include
homework assistance and tutoring, learning and literacy games, health and fitness. For more
information contact 709 257-3191 or email colleenhaytor@ nf.aibn.com
N ew foundland and Lab rador Public Lib raries offer services and programs for children ages 3 – 5.
Some ofthese programs include Story Time (rhymes, stories, counting, singing, plays and puppets,
dancing and social time. Story time is designed to provide children with the tools and skills essential
to success. O ther programs may include seasonal events and special activities. There are 3 public
library locations in the PH C site: Botw ood – 709 257- 2091 or email pcoates@ nlpl.ca , Bishop’s Falls
709 258-6244 or email ejohn@ nlpl.ca , Point Leam ington – 709 484-3541 or email bwarford@ nlpl.ca.
There are 96 public libraries located throughout N ewfoundland and Labrador and most offer
preschool programs (Province ofN L, D ept ofEducation, 2013).
Little Stepping Stones D aycare in B ishop’s Falls provides daycare services to parents and families
with toddlers, pre-school, and school aged children. D aily activities promote healthy child
development. For more information contact the daycare at 790 258-6030.
The Child, Youth and Family Services (CYFS) D epartment describes a child care centre as a place
where care is provided for up to 60 children on either a part-time or full-time basis. Child care centers
must be licensed before they can open (Province ofN ewfoundland and Labrador, 2012). According
to CYFS, there are 27 licensed daycare centers in the Central H ealth region. In the province as a
whole, this number totals 191 centers.
34
Early Childhood Learning and Child Care Services cont’d.
D epartm ent of Education – K inder Start is a school transition program offered in the year prior to
Kindergarten entry. The program consists offive to ten one-hour orientation sessions organized and
promoted at the school level for children and their parents/caregivers. The sessions support
children’s adjustment to the school environment, and provide parents/caregivers with information
on how to support their children’s learning at home (D epartment ofEducation, 2013).
The D epartm ent of Child,Y outh and Fam ily Services is a new provincial department dedicated to
helping ensure the protection and well-being ofchildren and youth in N ewfoundland and Labrador.
This will be accomplished through the provision and development ofprograms, policies, standards
and services primarily related to the following Acts: Children and Youth Care and Protection Act,
Adoption Act, Child Care Services Act, Youth Criminal Justice Act , Young Persons O ffences Act.
There are currently 4 CYFS Social W orkers located at the Exploits Community H ealth Centre in
Botwood who provide care for children throughout the Exploits H ealth Service Area. For more
information on Child Youth and Family Services contact 709 651-6261 or visit their website at
http://www.gov.nl.ca/cyfs/department/contact.html
3.4.5 Live B irths and Low B irth W eight
The following chart shows the number oflive births from 2007 - 2012 in the PH C site. . There was 1
low birth weight infant for 2011 and 1 for 2012 in the EH SA.
N um ber and Rate of Live B irths for EH SA area,2007- 2012
Y ear
2007
2008
2009
2010
2011
2012
Total
N um b er of Births
67
72
75
65
63
60
402
Population
9141
9125
9170
9201
9207
Rate per 1,000
7.3
7.9
8.2
7.1
6.8
Live B irths b y A ge of Mother,2011
A ge G roup
TO TA L
Under 15 yrs
15 – 19 yrs
20 – 24 yrs
25 - 29 yrs
30 - 39 yrs
40+ yrs
Age not stated
Canada
377,636
99
13,436
53,478
113,628
184,005
12,915
75
N ew foundland Central H ealth
and Lab rador
A uthority
4,465*
670*
5
0
250
55
810
160
1,335
190
2,070
255
85
15
* N umbers may not add to total due to rounding
* Botwood includes Charles Brook, Fortune H arbour, N orthern Arm, Philip’s H ead and Pleasantview.
35
Live B irths and Low B irth W eight cont’d.
The total birth rate for 2011 for the Central H ealth Authority was 7.0. The total birth rate is the ratio of
live births to the population expressed per 1,000. The total birth rate for the province in 2011 was
8.8. In 2011 there were 670 births in Central H ealth Authority. This is a 13.0% decrease since 2010
when there were 770 births.
Starting in January of2008, residents ofthe province who gave birth to a baby were given a $1,000
lump sum payment under the Progressive Family Growth Benefit. At this time parents also received
$100 per month for the first 12 months after a child was born under the Parental Support Benefit.
Low B irth Rates
Low birth weight is an indicator ofthe general health ofnewborns, and a key determinant ofinfant
survival, health and development. Low birth weight infants are at a greater risk ofdying during the
first year oflife, and ofdeveloping chronic health problems.
Low birth weight is defined as weight at birth less than 2,500 grams. Risk factors for low birth weight
include low BMI (<18.5) ofthe mother, multiple births, maternal age over 35 years, alcohol
consumption, physical abuse, and/or smoking during pregnancy, as well as low income (Eastern
H ealth, H ealth Status Report, 2012).
N ewfoundland and Labrador had low birth weight rates above the national average at 6.7% in 2010.
The national rate was 6.2%. In Canada overall, there were 23,317 low birth weight babies born in
2010.
3.4.6 Child,Youth and Fam ily Services
Child Youth and Family Services is a new provincial department dedicated to helping ensure the
protection and well-being ofchildren and youth in N ewfoundland and Labrador. This will be
accomplished through the provision and development ofprograms, policies, standards and services
primarily related to the following Acts: Children and Youth Care and Protection Act, Adoption Act,
Child Care Services Act, Youth Criminal Justice Act , Young Persons O ffences Act. There are
currently 4 CYFS Social W orkers located at the Exploits Community H ealth Centre in Botwood who
provide care for children throughout the Exploits H ealth Service Area. For more information on Child
Youth and Family Services contact 709 651-6261 or visit their website at
http://www.gov.nl.ca/cyfs/department/contact.html
36
3.4.7 H ealthy Child D evelopm ent Sum m ary
•
In 2011 there were 2270 children aged 0 -19 in the Exploits H ealth Service Area, a reduction
200 children since 2006.
•
The 5 – 14 age group which is the largest at 900 in 2011 represents 40% ofthe entire children
population. All age groups have seen decreases since 2006.
•
The 4 communities ofBishop’s Falls, Peterview, N orthern Arm and Point ofBay have seen an
increase in lone parent families, from 2006 – 2011. All other communities in the EH SA where
data was available have reported a decrease.
•
There are a good variety services and programs throughout the EH SA that supports healthy
child development.
•
There were 60 births in 2012 compared to 63 in 2011. There has been a slight gradual decline
in births since 2010.
3.5 Physical and Social Environm ent
The physical environment is an important determinant ofhealth. At certain levels ofexposure,
contaminants in our air, water, food and soil can cause a variety ofadverse health effects, including
cancer, birth defects, respiratory illness and gastrointestinal ailments. In the built environment,
factors related to housing, indoor air quality, and the design ofcommunities and transportation
systems can significantly influence our physical and psychological well-being.
The importance ofsocial support also extends to the broader community. A society’s values and
norms contribute to the health ofits members. Risks to good health are lessened in communities
where social stability, recognition ofdiversity, safety and cohesion exists.
3.5.1 H ousing
Appropriate and affordable housing has been raised as a concern anecdotally throughout this
research project, especially for clients with physical or mental challenges, as well as for youth
requiring supervision. Although subsidized and low rental housing is available, a spokesperson for
N LH C confirmed that many existing housing units do not meet the needs ofclients, e.g. many units
are 2/3 bedroom, multilevel units while clients are needing 1 bedroom, single storey and wheelchair
accessible housing
In 2007, construction began on a new 10 unit, wheelchair accessible housing project in Peterview.
This project was completed in 2010. Another example ofcollaboration and cooperation, this project
will be realized with a donation ofland from the town, funding through N LH C, creating local
employment and providing subsidized and affordable housing for seniors and/or disabled persons.
37
H ousing cont’d.
An informal observation regarding the number ofsubsidized housing units located in Bishop’s Falls
was confirmed to be the highest proportion in the EH SA ofthis report: Bishop’s Falls (63), Botwood
(42), Point Leamington (10), Peterview (9), N orthern Arm (1), Point ofBay (1), and D ivision 8, Subdivision E (1). The following information attempts to provide a context for this information.The
following table shows the composition ofhousing throughout the Exploits H ealth Service Area. D ata
was collected from Community Accounts 2006 Census.
Total
D w ellings
O w ned
Rented
D etached
A partm ent
O ther
O ne Fam ily
Multi
Fam ily
N on Fam ily
Constructed
B efore 1971
Constructed
A fter 1971
B ishop’s Botw ood* Peterview
Falls
1370
1605
255
Point
Leading
Leam ington Tickles
285
130
Cottrell’s
Cove
85
Point
of Bay
65
1095
275
1130
10
225
1100
20
1300
305
1430
15
160
1210
50
165
90
230
245
35
250
80
10
85
10
60
30
210
25
35
215
120
80
245
595
345
750
25
65
65
75
10
40
40
25
770
860
190
195
95
35
45
115
15
125
10
60
5
Regional Sum m ary – H ousing Com position
2006 – Com m unity
A ccounts
Total D w ellings
O w ned
Rented
B and H ousing
D etached Type
A partm ent Type
O ther
O ne Fam ily D w elling
Multi Fam ily
D w elling
N on Fam ily
Constructed Before
1971
Constructed A fter
1971
Exploits
Central H ealth
2006 - Census
Province
2006
Canada
2006
3795
3060
735
3250
45
495
3430
95
37,340
31,325
6055
50
31,725
1,500
4,115
29,700
685
208,845
155,195
41,670
320
155,295
12,080
41,470
151,735
3,785
13,320,600
8,509,780
3,878,500
49,180
7329,150
3,632,330
2,359,140
8,835,900
268,060
690
1565
6,950
15,905
53,325
77,020
4,216,650
5,161,020
2145
21,430
120,160
7,276,450
38
H ousing cont’d.
The average owner’s major payment* for the EH SA is $527.00, Central H ealth ($520), N L ($645) and
Canada ($1000). The average gross rent for same is $486.25, CH ($530), N L (%570) and Can. ($730)
* Average O wner’s Major Payment - Average monthly total ofall shelter expenses paid by
households that own their dwelling. The owner's major payments include, for example, the
mortgage payment and the costs ofelectricity, heat and municipal services.
55 Plus H ousing
Given that approximately 39% ofthe EH SA population is 55 years ofage and older and the demand
for appropriate housing is on the rise it’s important to look at the composition ofhousing for this age
group. It’s also important to point out that approximately 42% ofoccupied dwellings in the PH C site
were constructed prior to 1971 which would indicate that a vast majority ofcitizens 55 and older are
living in older homes that are probably in need ofappropriate renovations and/or modernization to
accommodate the challenges ofaging. For those existing dwellings that cannot be modernized or
for those who chose not to, there will be an apparent need for citizens to have access to new
affordable housing. The following table shows total dwellings occupied and those that are owned
and rented for the PH C site, Central H ealth, Region and the province respectively. H ousing: Persons
in Private O ccupied D wellings by Age Groups 55 and O ver – Community Accounts, 2006 Census.
B ishop’s
Falls
1050
Total
O w ned 995
(95%)
Rented 95
(9%)
Subsid 63
ized
U nits*
B otw ood
*
Peterview
Point
Leam ington
Point Cottrell’s
of B ay Cove
Central
H ealth
1350
1200
(89%)
150
(11%)
44
140
100
(71%)
40
(29%)
9
225
200
(89%)
25
(11%)
10
35
35
28710
25895
(90%)
2815
(10%)
45
40
(89%)
Local
A rea
43
7150
6105
(85%)
1045
(15%)
NL
134105
117420
(88%)
16680
(12%)
1
* The Local Area 43 denotes the Grand Falls- Point Leamington Region, which includes Leading
Tickles W est. Separate 2006 data for Leading Tickles is currently unavailable.
* Subsidized units are units owned and managed by the N L and Lab H ousing Corporation.
39
H ousing cont’d.
The following chart shows the percentage ofoccupied dwellings by 55 plus age group for the PH C
site, Central H ealth and the province respectively.
Community Accounts 2006 Census
100%
76%
80%
77%
64%
60%
40%
Percentage of Total
Dwellings occupied by
55 Plus Age Group
20%
0%
EHSA
Central Health
Province
Personal Care H om es
Personal care homes are assisted living arrangements that provide a combination ofservices for
those who are disabled or are otherwise unable to care for themselves. It can include assistance with
personal care, activities ofdaily living and the preparation and provision ofmeals. There are currently
70 people (as ofJune 2013`) living in three personal care homes in the PH C catchment area.
According to the Long Term Care and Community Support Services Strategy 2012 there are currently
4370 licensee personal care beds in the province ofN ewfoundland and Labrador The following
outlines the personal care homes indicating present occupancy and capacity information.
Killick Retirement H ome – Botwood
occupancy - 44 capacity – 58 - (June 2013)
Islandside Manor – Leading Tickles
occupancy – 6 capacity – 24 ( June 2013)
Exploits Manor – Bishop’s Falls
occupancy - 20 capacity – 30 ( June 2013)
Long Term Care H om e
O wned and operated by Central H ealth the D r. H ugh Twomey H ealth Centre in Botwood provides
the only long term care services in the PH C site. There are approximately 80 beds at the facility.
Central H ealth has a total of518 long term care beds throughout the region compared to 2814 beds
for the entire province. (Long Term Care and Community Support Services Strategy 2012)
40
3.5.2 W ater Q uality
Canadian drinking water supplies are generally ofexcellent quality. H owever, water in nature is never
"pure." It picks up bits and pieces ofeverything it comes into contact with, including minerals, silt,
vegetation, fertilizers, and agricultural run-off. W hile most ofthese substances are harmless, some
may pose a health risk. To address this risk, H ealth Canada works with the provincial and territorial
governments to develop guidelines that set out the maximum acceptable concentrations ofthese
substances in drinking water. These drinking water guidelines are designed to protect the health of
the most vulnerable members ofsociety, such as children and the elderly. The guidelines set out the
basic parameters that every water system should strive to achieve in order to provide the cleanest,
safest and most reliable drinking water possible. http://www.hc-sc.gc.ca/ewh-semt/water-eau/drinkpotab/guide/index-eng.php
All communities except Bishop’s Falls and Botwood have a combination oftown water system and
private well system for water supply. The communalities ofN orthern Arm and Point ofBay have just
recently received major improvement to their existing water and sewer systems. Since 2006 the
following communities have been issued Boil O rder Advisories for the province:
•
•
•
•
Leading Tickles - July 12, 2013 – Coliforms* detected
N orthern Arm – June11, 2013 – W ater discoloration due to regular maintenance
Cottrell’s Cove- issued August 27, 2009 – Coliforms detected
Phillip’s H ead- issued July 28, 2006 – Coliforms detected.
D ata collected from the Boil W ater Advisories for Public W ater Supplies in N ewfoundland and
Labrador, D epartment ofEnvironmental Services, Government ofN ewfoundland and Labrador, Aug.
2013
*Coliforms are a broad class ofbacteria found in our environment, including the feces ofman and
other warm-blooded animals. The presence ofcoliform bacteria in drinking water may indicate a
possible presence ofharmful, disease-causing organisms.
Pat Murray (Regional Environmental H ealth Manager, Gander) confirmed that rural communities with
small tax bases are often challenged with maintaining and upgrading infrastructure such as pipes
and equipment to meet safe levels ofdrinking water. The Regional W ater Committee with
representatives from health, environment, municipal affairs and government affairs meet bimonthly
to review these reports and offer recommendations to resolve issues.
A ir Q uality
Air quality, especially in schools, has been a growing public concern in recent years. The school in
Leading Tickles was closed and subsequently replaced with a new building in 2006.
41
3.5.3 Roads
72
53
57
46
67
92
38
33
39
21
25
14
35
60
5
72
54
58
47
26
47
29
33
22
N orthern Arm
Point Leamington
Leading Tickles
Phillip’s H ead
34
16
20
9
30
55
26
7
11
Botwood
77
59
63
52
73
98
44
39
6
Peterview
Bishop’s Falls
Botwood
Peterview
N orthern Arm
Point Leamington
Leading Tickles
Phillip’s H ead
Point ofBay
Cottrell’s Cove
Point ofBay
D istance in K ilom eters
Cottrell’s Cove
PH C Site
Com m unities
Fortune H arbour
All communities in the PH C site are accessible by paved roads which are maintained by both
municipal and provincial governments. In 2011-12 the N L government spent 202 million on
construction, rehabilitation and maintenance ofroads and bridges. (N L Transportation and W orks
Annual Report 2011-2012) The greatest distance between two communities in the EH SA is 98
kilometers, Fortune H arbour to Leading Tickles. The following table shows the distances between
communities in kilometers. D ata for this chart is collected from the N ewfoundland and Labrador
Statistics Agency – D epartment ofFinance. http://www.stats.gov.nl.ca/D ataTools/RoadD B/D istance/
21
8
22
D istance to other major centers from the largest community in the PH C site – Bishop’s Falls.
D istance in
K ilom eters
Bishop’s
Falls
Grand Falls -W indsor
15
D eer Lake
227
Corner Brook
277
Stephenville
357
Port aux Basques
491
Gander
81
Clarenville
226
St. John’s
408
42
3.5.4 Transportation
Motor vehicle is the primary mode oftransportation throughout the PH C Site and beyond. According
to Statistics Canada 2006 Census 74% ofN ewfoundlanders and Labradoreans commute to work as
drivers ofa van, car or truck. This compares to 73% for Canadian commuters. According to Statistics
Canada there were 556,154 vehicles* in 2010 registered in N ewfoundland, in Canada there were
29,697,797 registered. In 2012 there were 33,606 new vehicles( cars, vans, trucks and SUVs)
purchased in N ewfoundland and Labrador. This is an increase ofapproximately 9% form 2011. The
following table shows all modes oftransportations comparing N ewfoundland and Labrador with
Canada. D ata is based on the Statistics Canada Census 2006. D ata for PH C site is currently
unavailable.
* Vehicles are defined as cars, vans, SUV, buses, trucks and all off-road vehicles.
Mode of Transportation - 2006 Census
74%73%
NL
th
er
O
Ta
xi
or
cy
cl
e
Canada
C
ar
,T
M
ot
B
ic
yc
le
8%
6% 0.20% 0.05% 0.40% 3.20%
1.30% 0.10% 0.20%
0.80%
k
11%
2%
W
al
13%
8%
ru
ck
,V
an
C
ar
as
,T
D
ru
riv
ck
er
,V
an
as
P.
..
Pu
bl
ic
Tr
an
si
t
80%
70%
60%
50%
40%
30%
20%
10%
0%
O ther sources oftransportation air and marine are available outside the site within an approximate
driving time from 1 – 5 hours from the largest community ofBishop’s Falls. The nearest air travel
service is available at the Gander International Airport which is approximately 84 km with a travel
time of58 minutes. The nearest marine travel service is located in Argentia at Marine Atlantic which
is a driving distance of371km and an approximate 4 hour drive. The following list shows all available
out ofprovince air and marine services with distances and travel times from Bishop’s Falls.
Marine Services
Argentia to N orth Sydney, N S – 371km (4 hour drive)
Port aux Basques to N orth Sydney, N S – 491 km (5 hour drive)
A ir Travel
St. John’s International Airport - 415km (4:19 hh/mm)
Gander International Airport – 84 km (1 hour)
D eer Lake Regional Airport – 225km (2:20 hh/mm)
Stephenville International Airport – 354 km (3:47 hh/mm)
43
Transportation Cont’d.
Inter- provincial marine and air travel is also available in the province. D etails on route and schedules
can be obtained from the provincial website: http://www.tw.gov.nl.ca/department/contact.html or
by calling 1 709 729-2300. The province is also responsible for 13 community airstrips in coastal
Labrador and eight on the Island portion ofthe Province. O ne ofwhich is located in the PH C site off
Route 350 approximately 6 km from Bishop’s Falls.
TaxiServices
W ithin the PH C site there are 3 private taxi services, 1 located in Bishop’s Falls (N GR Cabs – (709 2582947) and 2 in Botwood (CJ’s Taxi & Freight 709 257-1125) and (Bayside Taxi 709 257-3767).
The lack ofpublic transportation and wheelchair accessible transportation remains a challenge.
Many care providers site transportation as a deterrent to service, where clients do not have their own
vehicle, do not have family members or care providers to provide transportation or do not have the
resources to access the service. W hile some clients in the area own private wheelchair accessible
vehicles, many more have to rely on ambulance transport to access services and this can be very
expensive.
3.5.5 Safety
Feeling safe in the community and environment is critical to maintaining and enhancing one’s health
and well being. According to the Survey ofAttitudes Towards Violence (2002): Personal Safety &
Violence in Society (Community Accounts) 98.4% ofCentral H ealth’s citizens indicated they thought
their community was a safe place to live. This is comparable to what was reported by the province at
98.3%. The following table shows more selfperceived responses on safety as it relates to violence
and personal safety.
Self perceived responses
(Survey of A ttitudes Tow ards V iolence – 2002)
1. I think my community is a safe place to live.
2. I consider personal safety before I go out to public places.
3. I feel safe when I am at work.
4. I feel safe when I am at home.
Central
H ealth
98.4%
69%
77.6%
99.3
NL
98.3%
69%
81.4%
99.3%
3.5.6 Sense of B elonging to the Local Com m unity
According the Canadian Community H ealth Survey 2009-2010, 83.3% ofthose surveyed in Central
H ealth reported that they feel a sense ofbelonging to the local community. The province and
Canada reported 80.1% and 65.4% respectively.
Sense of Com m unity Belonging - Population aged 12 and over who reported their sense of
belonging to their local community as being very strong or somewhat strong. Research
shows a high correlation ofsense ofcommunity-belonging with physical and mental health.
44
Sense of B elonging to the Local Com m unity cont’d.
Life satisfaction,satisfied or very satisfied - Population aged 12 and over who reported
being satisfied or very satisfied with their life in general. Starting in 2009, this indicator is
based on a grouped variable. In 2009, the question was changed from 5-point answer
category to an 11-point scale. The concordance between the two scales was found to be
good.
The following chart shows both sense ofcommunity belonging and life satisfaction comparing
Central H ealth with N ewfoundland and Labrador and Canada. D ata was unavailable for the PH C Site.
Sence o f b elo nging to lo cal co m m u nity
100.00%
92.10%
83.30%
O verall life statisfactio n
91.70%
80.10%
80.00%
92.10%
65.40%
60.00%
40.00%
20.00%
0.00%
Central H ealth
N ew foundland &
Labrador
Canada
3.5.7 Exposure to Second H and Sm oke
Many ofus breathe in second-hand smoke – whether we’re aware ofit or not – in public places,
around doorways ofbuildings and at work. Second-hand smoke has the same chemicals in it as the
tobacco smoke breathed in by a smoker. So ifyou’re sitting beside someone who’s smoking, you and
everyone else around you are smoking too.
W hat is second-hand sm oke?
Second-hand smoke is what smokers breathe out. They breathe smoke into their lungs, but then
they breathe it out into the air around you. And the smoke from a burning cigarette, pipe or cigar –
that’s second-hand smoke too. (Canadian Cancer Society - http://www.cancer.ca/en/prevention-andscreening/live-well/smoking-and-tobacco/second-hand-smoke-is-dangerous/?region= nl)
According to the Canadian Cancer Society second hand smoke can cause cancer and it is harmful to
babies, children adults and pets. The following chart shows exposure to second hand smoke as per
data collected from the Canadian Community H ealth Survey 2009/2010. The data was collected from
the non smoking population 12 and over who reported being exposed to second-hand smoke in
private vehicles and/or public places on every day or almost every day in the past month during the
survey period. Smoking includes cigarettes, cigars and pipes.
45
Exposure to Second H and Sm oke cont’d.
Percentage ofpopulation 12 and over who were exposed to second-hand smoke in Canada,
N ewfoundland and Labrador and Central H ealth. 2009/2010 Canadian Community H ealth Survey.
14.80%
Canada Work and Public
Canada Home
6.00%
13.40%
Province Work and Public
Province Home
7.20%
Central Health Second hand
smoke – w ork and public areas
Central Health Second hand
sm oke - hom e
15.30%
6.30%
0.00 5.00 10.0 15.0 20.0
%
%
0% 0% 0%
The province ofN ewfoundland and Labrador continues its battle with second hand smoke as the
most recent ban came into effect on July 1, 2011. This ban makes it illegal to smoke in a motor
vehicle when a person under the age of16 is present. N ewfoundland and Labrador is the ninth
Provincial/Territorial jurisdiction in Canada to ban smoking in motor vehicles. Violators can face fines
from $50 - $500. O ther recent provincial smoking bans include:
•
2011 – D SR – designated smoke rooms no longer permitted in workplaces.
•
2009 – Central H ealth becomes smoke free.
•
2005 – Licensed Liquor Establishments and Bingo H alls
•
2004 - Public places such as day cares, schools, taxis, hospitals, retail stores, and
recreational facilities.
3.5.8 – Physical and Social Environm ent Sum m ary
•
•
•
•
•
There are 3795 total dwellings in the EH SA with approximately 80% being owned versus
rented.
41% ofdwellings are 42 years ofage or older.
88% ofthose 55 years ofage and older live in owned and/or financially supported dwellings.
EH SA has 3 personal care homes with a total capacity of112 and 1 long term care home with
a capacity of80.
Although there has been some isolated incidences with water and air quality in recent years;
for the most part citizens enjoy safe drink water and clean air.
46
Physical and Social Environm ent Sum m ary cont’d.
•
•
•
•
•
•
All communities within the EH SA are connected by paved roads and the furthest distance
between two communities within the EH SA is 98 kms.
Motor vehicle is the primary source oftransportation for citizens in the EH SA and there is a
variety ofprivate transportation services available. There is no public transportation system
available in the EH SA.
O ther sources oftransportation like air and marine are available outside the EH SA within an
acceptable driving distance.
Citizens within the geography ofCentral H ealth feel a sense ofsafety in their communities, at
home and at wok.
Citizens also feel a strong sense ofcommunity belonging within Central H ealth.
Citizens in Exploits are still exposed to second hand smoke and although recent legislation
strategies have help over 15% and 6% of those12 and older are exposed to second hand
smoke at work, public and at home respectively.
3.6 Personal H ealth Practices and Coping Skills
Personal health practices and coping skills refers to those actions by which individuals can prevent
diseases, promote self-care, cope with challenges, develop self-reliance, solve problems and make
choices that enhance health. Although individuals can choose to behave in ways that promote
health, it must be recognized that the social environments in which they live also influence
individual life choices.
3.6.1 Sm oking
Research suggests that tobacco use is responsible for the majority ofcases oflung cancer and
contributes to other types ofcancer. It is also the number one risk factor for developing CO PD (a
chronic respiratory condition) CIH I. The following table shows data on current occasional and daily
smokers from The Canadian Community H ealth Survey 2009/2010. D ata specific to the Exploits
H ealth Service Area is currently unavailable.
Percentage of 12 and over w ho reported b eing a current sm oker – CCH S – 2009/2010.
2009/2010
H ealth Profile
Current Sm oker
D aily or O ccasionally*
Current Sm oker
D aily*
Total
22.5
20.1
Central H ealth
Male
Fem ale
24.0
21.1
22.5
17.9
T
23.1
18.6
Province
M
F
25.8
20.5
20.4
16.9
T
20.4
Canada
M
F
23.4
17.6
15.6
17.8
* O ccasional Smoker refers to those (12 and over who reported being a current smoker) who
reported smoking cigarettes occasionally. This includes former daily smokers who now smoke
occasionally.
13.4
47
Sm oking cont’d.
* D aily Smoker refers to those (12 and over who reported being a current smoker) who reported
smoking cigarettes every day. This does not take into account the number ofcigarettes smoked.
According to the Canadian Tobacco Use Monitoring Survey (CTUMS), conducted from February
through D ecember 2011, the smoking prevalence has statistically significantly decreased to 17%
(about 4.9 million smokers). In 2011, 14% reported smoking daily, while 4% reported smoking
occasionally. More males (20%) reported smoking than females (15%). D aily smokers smoked an
average of14.4 cigarettes per day.
Y outh Sm oking
In 2011, current smoking among youth aged 15 to 19 years was 12% (approximately 256,000 teens).
W hile it is unchanged from the 12% reported in 2010, it is the lowest rate ofcurrent smoking
recorded for this age group since H ealth Canada first reported smoking prevalence and it is
significantly different than the rate reported in 2001 (22%). Six percent (6%) ofyouth reported
smoking daily, and consumed an average of11.7 cigarettes per day, while 6% ofyouth reported
smoking occasionally. There was no difference in the percentage ofmale (13%) and female (11%)
youth who were current smokers. (H ealth Canada W ebsite, Annual Summary, 2011, Canadian
Tobacco Use Monitoring Survey)
In N ewfoundland and Labrador it was revealed through the Youth Smoking Survey (YSS) 2010/2011
– N ewfoundland Profile that 11% ofN L students (grades 6 – 12) were smokers, 14% were males and
8% were females. In the 2008-2009 YSS 10% ofthe student populations were smokers with males
representing 12% and females at 9%.
http://www.yss.uwaterloo.ca/results/yss10_EN _Provincial%20Report_N ewfoundland%20and%20La
brador_20120514.pdf
Another interesting fact from 2010-2011 is that 23% ofsmokers surveyed said that they had no
restrictions in place against smoking at home. O ther facts ofthe most recent survey where
education can be targeted include:
•
85% ofsmokers start by the age of19.
•
The average age at which youth in grade 12 smoked their first cigarette is 14 years.
•
72% ofcurrent smokers are in grades 9 – 12.
•
83% ofcurrent smokers in grades 6 – 8 obtain cigarettes from family and friends.
•
33% ofnon smoking youth reported riding in a vehicle with a smoker. The national average is
23%.
•
Research has linked smoking to students achieving lower grades and being at risk of
dropping out ofschool. (43% ofcurrent smokers achieve A’s and B’s compared to 77% ofnon
smokers)
•
86% ofcurrent smokers have had a drink ofalcohol in the past 12 months ofthe survey
compared to 40% ofnon smokers.
48
Sm oking cont’d
•
71% ofsmokers have tried marijuana compared to 14% ofnon smokers.
•
Research has shown that students with a higher Body Mass Index (BMI) are more likely to
smoke. BMI = weight (kg)/height (m)2
•
Canada’s food Guides recommends 6-8 servings offruit and vegetables per day for children
aged 9 – 18. The YSS reported that 41% ofsmokers consume 3-5 servings per day compared
to 54% ofnon smokers.
•
Eating a regular healthy breakfast is associated with a healthy BMI, better nutrition, improved
memory function, academic performance and increased attendance. The YSS reported that
32% ofsmokers eat breakfast 6-7 days per week compared to 58% ofnon smokers.
Smoking cessation programs, like Kick the N ic, and the Smoker’s H elp Line, continue to provide
support for those who chose to quit smoking. According to the information provided by the
Smokers H elpline – N L there were 594 calls to the helpline during the period of2010 - 2012 from
Central N ewfoundland (Central H ealth) with 92 (15%) ofthose calls coming from the Exploits H ealth
Service Area. H ealth care professionals are the primary source ofclient referrals with nurses leading
the way followed by doctors. The following chart shows the source and percentages oftotal care
referrals from 2010 – 2012 throughout Central H ealth. Total referrals to SH L for the province was
3133, Central H ealth’s total was 480 (15%). Information provided by Smokers H elpline, N L.
Source ofCare Referrals to Sm okers H elpline
2010-2012
15%
Central H ealth
4%
W ork
Schools
O ther H ealth
0%
2%
3%
Social W orkers
R espiratory Therapists
Pharm acists
0.60%
1%
69%
N urses
30%
D octors
3%
D ietitians
D ental
0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
49
Sm oking cont’d
The source ofreferrals is selfreported by callers to the SML and the low numbers does not
necessarily show the lack ofeffort to inform clients. W hat the data does show is that smokers are
more receptive to follow up on the advice from nurses and doctors.
3.6.2 A lcohol U se
In many parts ofthe world drinking alcoholic beverages is a common feature ofsocial gatherings.
N evertheless, the consumption ofalcohol carries a risk ofadverse health and social consequences
related to its intoxicating, toxic and dependence-producing properties.
In addition to the chronic diseases that may develop in those who drink large amounts ofalcohol
over a number ofyears, alcohol use is also associated with an increased risk ofacute health
conditions, such as injuries, including from traffic accidents. (W orld H ealth O rganization – 2013)
The following charts show those 12 and over who reported drinking alcohol at least once in the past
12 months and consuming 5 or more drinks (2 – 3 times per month) in the past year. D ata specific to
the EH SA was unavailable. CCH S 2009/2010 – Community Accounts.
2 or 3 times per month consuming 5 or more
drinks on one occasion
Drank alcohol in the past 12 months
Total
100%
80%
73%
66%
60%
60%
Male
Female
76%79%73%
Total
77%81%73%
15%
10%
40%
Male
Female
14%
12%
10%
10%
7%
6%
7%
9%
4%
5%
20%
0%
0%
Central Health
Newfoundland
Canada
Central Health
Newfoundland
Canada
According the CCH S 2009/2010 heavy drinking refers to having consumed five or more drinks, per
occasion, at least once a month during the past year. This level ofalcohol consumption can have
serious health and social consequences, especially when combined with other behaviors such as
driving while intoxicated. The following table shows heavy drinking data comparing Central H ealth
with N ewfoundland and Canada.
CCH S 2009/2010
Central H ealth
N ew foundland
Canada
Stats Canada
Total
Male
Female Total
Male
Female Total
Male
Female
H eavy D rinking
21.4%
33.0%
10.4%
37.4%
12.2%
24.8%
10.0%
24.5%
17.3%
50
A lcohol U se cont’d.
H eavy drinking is dominant among the male population within N ewfoundland at 37.4% which is
slightly higher than Central H ealth at 33% and significantly higher than the national average at
24.8%. This drinking behavior is also an issue among the province’s student population. According to
the Youth Smoking Survey (YSS) 2010/2011 binge drinking among N L students at a frequency of1 -3
times per month is higher than the national average and slightly higher than what was reported in
the 2008 survey. Binge drinking is the same as heavy drinking, having consumed 5 or more drinks on
one occasion. The following chart shows binge drinking data from the YSS 2010-2011.
Once per month
Once or more per week
50%
45%
45%
40%
40%
1 – 3 times per month
44%
43%
31%
35%
30%
25%
26%
25%
25%
16%
20%
15%
10%
5%
0%
NL Students 2010
Canada Students 2010
NL Students 2008
3.6.3 D rug U se
Illicit drug use in a non medical, non sanctioned manner can be harmful and hazardous to ones
health and wellbeing. This type ofdrug use is linked to personal health, and societal problems and
concerns. Illicit drugs can be defined as drugs banned by the government and could include:
• cannabis (marijuana, hashish)
• opiates ( heroin)
• stimulants for (cocaine and amphetamines)
• hallucinogens ( LSD )
• anabolic steroids
According to the Canadian Community H ealth (Mental H ealth and well Being) 2002 it was reported
that 13% ofparticipants used illicit drugs in the past year ofthe survey. Furthermore 10% used
cannabis, and 25 used the other drugs such as cocaine ecstasy, and other hallucinogens. Young
adults aged 20 – 24 are the highest users ofillicit drugs and teens from 15 – 19 are the second
highest users. Males are the biggest users.
According the Youth Smoking Survey (2010/2011) 47% ofN L youth (grade 7 and above) use
marijuana once or more per week. The following charts show frequency patterns ofmarijuana use as
per YSS 2010/2011. D ata representing the EH SA is currently unavailable.
51
D rug U se cont’d.
Frequency of Marijuana U se - N L Y outh grades 7 - 12
47%
50%
46%
45%
41%
40%
35%
30%
33%
22%
33%
33%
once per m onth
25%
25%
21%
20%
1 – 3 tim es per m onth
O nce or m ore per w eek
15%
10%
5%
0%
N L youth 2010 Canada 2010 N L youth 2008
There are other substance abuse issues among youth beyond alcohol, and marijuana. The following
table shows the percentage ofyouth in N L and Canada who have used other illicit drugs in the past
year ofthe study for the purpose ofgetting high. (YSS 2010/2011)
O ther sub stances used to get
high
Illicit drugs used to get high
(excluding marijuana)
Prescription and other over-the
–counter drugs to get high
% ofyouth in N ewfoundland
and Labrador
8
9
% ofyouth in Canada
7
7
In 2008 the Royal Canadian Mounted Police – Grand Falls/W indsor, region had 60 drug enforcement
actual occurrences. An actual occurrence is a call for service where an actual offence occurred. 83%
ofthe occurrences involved marijuana.
3.6.4 G am bling
Problem gambling can impact ones health and personal relationships with family, friends and coworkers. In Canada gambling operates exclusively under the control ofthe provincial and territorial
governments. According to Statistics Canada in 2008 total net revenue from government run
lotteries (video lottery terminals (VLTs), casinos and slot machines not in casinos) was $13.67 billion
dollars compared to $2.73 billion in 1992. According to a report by W ood. R.T. & W illiam s,R.J. (2009,
January) Internet gam bling:Prevalence,patterns,problem s,and policy options,final report forthe
O ntario Problem G am bling Research Centre;Guelph, O ntario, 3.2% ofCanadian adults are affected by
moderate to severe problem gambling and 2.2% ofyouth aged 14 -24 are affected by moderate risk
or problem gambling.
52
G am bling cont’d.
In the province ofN ewfoundland and Labrador there are approximately 10,000 at risk gamblers,
according to the N L and lab Gambling Prevalence Study – 2009. It was also revealed in the study that
77% ofrespondents gambled at least once in the last 12 months. In 2009 the province profited 108
million dollars from gambling a 61% increase from 1992. Canada profited over 6.6 billion in 2009.
O ther facts and data collected in the study include:
•
•
•
•
•
•
•
72% ofrespondents from Central N L gambled at least once in the past 12 months.
68% N L gamblers are regular gamblers (at least once per month)
35% ofN L gamblers are aged 35-54.
61% chose lottery gambling which is the participated gambling activity.
there are currently 2274 VLT machines in N L, a reduction of263 since 2005 study
There are 505 VLT sites (bars, lounges, nightclubs, etc) in N L
VLT’s is the game ofchoice for 72% ofN L gambling addicts.
http://www.health.gov.nl.ca/health/publications/2009_gambling_study.pdf
Youth gambling is also an area ofconcern according to the 2007 N L and Lab Student D rug Use
Survey. In 2007 61.6% ofstudents in N L participated in at least one gambling activity at least once in
the past 12 months. The most common gambling activity among students is scratch tabs with both
males and females equally likely to participate. Males are more likely to participate in other forms of
gambling and are at higher risks ofbecoming problem gamblers than females. The following chart
shows gambling activities among the student respondents from the 2007 study.
Gambling Activities NL Students 2007
80.00%
60.00%
40.00%
61.60%
38.80%
38.10%
20.00%
30% 22.50%
19.50%
8%
0.00%
7.80%
0.50%
P layed any of the activities
Scratch tab s
Cards fo r m oney
Played break opens
B ingo for m o ney
Bet on sports
P layed VLTs
Played Sports Select lottery
P layed lottery other than Sports select
53
3.6.5 Physical A ctivity
The lack ofphysical activity is directly linked to rising rates ofobesity. H ealthy eating and physical
activity are essential for health and well-being.
According to the CCH S (2009), 48.2% ofthe population age 12 and over rate themselves as
moderately physically active or active, a small increase from 42.4% in 2005. Furthermore, 51.8% of
the population age 12 and over rate themselves as physically inactive, which represents a decline
from 57.6 in 2005.
In the 12-19 year age group, 29.5% rate themselves as physically inactive, with females more active
than males. This represents an increase from 22.0% in 2005.In the 65 and over age group, 59.2% rate
themselves as physically inactive a decrease from 67.6% in 2005. Males in the 65 and over age group
were much more likely to rate themselves as moderately active or active (56.2%) than females
(26.4%).
Literature supports the correlation between physical activity and the promotion ofhealth and wellbeing. In recent years, communities and community groups have taken the initiative to develop
walking trails - Botwood, N orthern Arm, Point Leamington, Leading Tickles and Fortune H arbour - all
ofwhich appear to be well used. The following is a list ofknown activities, initiatives, equipment and
facilities throughout the EH SA that directly support physical activities and exercise.
•
•
•
•
•
•
•
•
•
•
•
Leading Tickles, under the direction ofthe Recreation Committee, offers a fitness centre with
exercise equipment. There are also series ofwalking trails throughout the community.
Point Leamington maintains a walking trail to Rowsell’s H ill and the 50 + Club operates a
fitness program for their members.
The Community Youth N etwork (Botwood) coordinates grants and corporate sponsored
programs, e.g., Jumpstart, to fund sports/recreation opportunities for children and youth.
Point ofBay has an Active Living Group where citizens can participate in structured physical
activities and health education session.
Recreation facilities, stadiums, ball fields, running tracks, and gymnasiums are available in
several communities. There are several indoor walking programs in the Exploits H ealth
Service Area, one in Botwood (Botwood Collegiate Gymnasium) and one in Bishop’s Falls
(Pentecostal Church Gymnasium) and others are coordinated by local church groups.
The stadiums in Botwood and Bishop’s Falls have undergone major renovations and
enhancements that have improved operational efficiency and help sustain and enhance sport
and recreational opportunities for the two communities.
The community ofBishop’s Falls renovated an existing playground at H elen Tulk Elementary
and constructed a new one in the west end oftown in August 2010 with the support ofthe
community and the Let Them Be Kids Foundation.
At Your Pace Fitness Centre in Botwood presently has approximately 130 active members and
recently moved to a larger facility.
The Recreation Committee in Philip’s H ead has raised in excess of$4000 and constructed a
playground and basketball court for the town.
The Botwood Playground is currently being updated over a 3 year plan involving the Town of
Botwood and other community partners.
Licensed childcare programs emphasize physical activity and healthy eating as a part oftheir
program.
54
Physical A ctivity cont’d.
•
•
School curriculum now mandates physical activity as a requirement with the Q uality D aily
Physical Activity Initiative.
Schools, community groups, church groups and local organizations in the EH SA are
supported with resources and funds through provincial and regional sources to initiative and
sustain programs and activities that support physical activities and health and wellness
projects.
3.6.6 Mam m ography
According to Public H ealth Agency Canada (2011) one of the most common forms of cancer for
women is breast cancer. Research studies indicate measures women can initiate to aid in reducing
the likelihood of developing this disease or dying from it including minimizing lifestyles and
environmental risk factors and proper screening.
According to the Canadian Community H ealth Survey (CCH S) from 2007-2008, 74.6% of women in
the Central H ealth were screened using mammography compared to the CCH S 2009-2010 where
67.7% per cent of women aged 35 and over in the Central H ealth region reported having had a
mammogram at least once in their life time. This was a decrease in the number of screenings.
Central H ealth’s 2009-2010 data is slightly lower than the provincial rate of 69.7%; this is also lower
than the national rate of72.3%.
In April 2012 N ewfoundland and Labrador broadened their screening program to lower the initial
screening age to 40.
3.6.7 Cervical Screening
A simple Pap test will detect early cell changes that are precursors to cervical cancer. W omen who
are, or have ever been sexually active are encouraged to see their regular health care provider for
screening. In N ewfoundland and Labrador approximately 85,000 women are screened and 8,000
women will have an abnormal pap test each year. Unfortunately, that leaves about 14,000 women
not screened (Central H ealth, 2008).
The Cervical Screening Initiatives Program for Central N ewfoundland was launched in June 2003,
with the goal to increase screening rates in the region. In this province, the mortality rate attributed
to cervical cancer is 2.5 times greater than the Canadian rate. Early detection and treatment is
considered to be effective in reducing mortality from this disease according to Central H ealth’s
Cervical Screening Initiative Program (2010).
The following table reflects the percentage ofwomen in the PH C area screened between 2007 and
2012. (Information obtained from Valerie Fagan, Cervical Screening Initiatives Coordinator, Gander)
O ther factors not considered in the calculations may be those women who have pap smears in other
locations, especially out ofprovince, and hysterectomy status. W ithin Central H ealth there has been a
very small increase in the actual percentage ofeligible women screened: from 31% in 2004 to 33% in
2009. In Bishop’s Falls D istrict, the percentage ofwomen screened increased from 33% in 2004 to
39% in 2009.
55
Cervical Screening cont’d.
Cervical Screening Rates for the Exploits H ealth Service A rea
Community
Bishop’s Falls
Peterview
N orthern Arm
Botwood
Pt. Leamington
Leading Tickles
Point ofBay
D iv 8, Sub D iv E¤
2007
40%
32%
0%
43%
30%
33%
31%
12%
2008
35%
31%
2%
40%
33%
34%
40%
16%
2009
39%
31%
2%
46%
30%
36%
35%
15%
2010
39%
43%
1%
51%
33%
32%
43%
16%
2011*
38%
43%
2%
53%
39%
42%
38%
15%
2012*
32%
29%
1%
44%
33%
34%
40%
11%
2010-2012*
80%
86%
2%
100%**
82%
69%
88%
30%
¤ D iv. 8 Sub D iv E includes Cottrell’s Cove, Fortune H arbour, Phillip’s H ead, Ritters Arm
Please N ote:
* These numbers are for women 20-69 years ofage only as per the new screening guidelines
implemented in 2011!Previous years the screening rates have been based on all women 15+ years.
** The 100% screening rate for the community ofBotwood is believed to include pap results for
women who live in the smaller outlying communities in the Botwood area.
2010-2012 Screening Rates are based on women 20-69 Years ofage who have had at least 1 Pap in
the last 3 Years. This will be the reporting formula for screening from this year forward.
The regional rate (Central H ealth) for 2012 is 32% while the new screening formula (2010 – 2012, 1
pap in 3 years) is 71% in comparison to the provincial rate of69%.
There is no formal recall system in place for Bishop’s Falls or Botwood, however the chart tag system
is used, receptionists have been involved with patient reminders as they present for any clinic visit
and the N urse Practitioner and Public H ealth N urses are involved in awareness and a publicity blitz
with organized Pap Smear Clinics in O ctober ofeach year. H owever with the alarming mortality rate
for this province attributed to cervical cancer, combined with the low rate ofscreening, this is an
obvious area offocus for primary health care.
3.6.8 Prostate Screening
For Canadian men, prostate cancer is one ofthe most commonly diagnosed cancers. Prostate cancer
incidence increases almost exponentially with age, most cases are diagnosed in men ages 60 years or
older (Public H ealth Agency ofCanada, 2011).
According to the Canadian Community H ealth Survey (2009-2010) 57% ofthe male population in
Central H ealth had prostate specific antigen test (PSA) completed which is on par with the CCH S
2007-2008 report of57.3%. The provincial rate for 2009-2010 was 56.9%.
56
Prostate Screening cont’d.
In terms ofstatistics on digital rectal exams (D RE), there was a drop in the number ofmen screened in
Central H ealth from 60.1% (CCH S 2007-2008) to 53.5% in the CCH S 2009-2010 report. The provincial
rate has stayed constant for the two reports at 52.2%.
3.6.9 Colorectal Cancer Screening
The N ational Cancer Institute (2011) defines colorectal cancer as a disease in which cells in the colon
or rectum become abnormal and divide without control, forming a mass called a tumor.
According to Canadian Community H ealth Survey - CCH S (2010) 33.4% ofthe population aged 35
years and older in the Central H ealth region have had a fecal occult blood test completed. This is
higher than the provincial rate at 26.0%. The following chart shows colorectal screening rates
comparing Central H ealth with provincial and national rates. (CCH S 92009 -2010)
34.60% 34.40%
32%
30.60% 30.10%
30.30%
35.00%
Colorectal Screening Rates
(Sigm oidoscopy & Colonoscopy)
2009-2010
27.10% 29.80%
30.00%
26.50%
CCH S
25.00%
20.00%
Central H ealth
15.00%
Prov incial
10.00%
N ational
5.00%
0.00%
Male
Female
Total
As can be seen, the Central H ealth’s total rates are slightly higher than the province and the nation.
3.6.10 Sexually Transm itted Infections
The W orld H ealth O rganization (2012) defines Sexually Transmitted Infections (STI’s) as infections
that are spread primarily from person-to-person by sexual contact. There are more than 30 different
sexually transmissible bacteria, viruses and parasites. The following table shows STI cases reported
from 2007 – 2012 - N L Communicable D isease Surveillance Reports – Updated February 27, 2013
Provincial and Central H ealth Statistics
Sexually Transm itted Infections
Total Cases Reported 2007-2012
Year
2007-2009
2010-2012
H epatitis C
CH
NL
9
279
12
189
H IV
CH
0
1
NL
9
15
Chlamydia
CH
NL
161
1643
189
2192
Gonorrhoea
CH
NL
3
41
1
54
H epatitis B
CH
NL
8
78
7
65
Syphilis*
CH
NL
4
24
1
37
57
Sexually Transm itted Infections cont’d.
CH – Central H ealth
N L – N ewfoundland and Labrador
The most common form ofan STI in the Central H ealth region and for the province is Chlamydia. In
the last 6 years there have been 350 cases in the Central H ealth region and 3835 cases in the
province.
3.6.11 Im m unization
Public H ealth N urses in the Central Region provide/administer routine childhood immunizations and
the rates are among the highest in the province and the country (consistently greater than 96%).
Immunizations are an important part ofmaintaining your health. The successful use ofvaccines in
preventing disease means that most parents ofyoung children in Canada today have never seen a
life-threatening case ofdiphtheria (a disease that affects primarily the upper respiratory system and
is caused by the bacterium Corynebacterium diphtheria) or polio (can attack the central nervous
system and destroy the nerve cells that activate muscles) (H ealth Canada, 2011).
Im m unization Status at A ge 2 Exploits H ealth Service A rea,B irth Y ear 2010
Im m unization
D Tap-IPV -H ib (4 doses)
MMR (2 doses)
Pneum ococcal (4 doses)
V aricella (1 dose)
Men-C (1 dose)
# eligib le
75
75
75
75
75
# that Received Im m unization
75
75
75
75
75
EH SA School Im m unizations for 2012-2013
Im m unization
D Tap-IPV
Men C (A ,C,Y ,W -135)
H epatitis B
H PV
Tdap
# eligib le
75
74
87
37
100
# that Received Im m unization
73
70
82
34
93
D Tap-IPV- immunization administered prior to Kindergarten.
Men C (A,C,Y,W , 135)- immunization administered to Grade 4 students.
H epatitis B- immunization administered to Grade 6 & requires 2 doses.
H PV- immunization administered to Grades 6 females & requires 3 doses.
Tdap- immunization administered to Grade 9 students.
Influenza vaccination is an important step in maintaining the health ofour population and
government provides the influenza vaccine for all individuals age 6-59 months, the 60+ population,
as well as adults under age 60 with chronic illness in the at risk population. Influenza vaccines are
58
Im m unization cont’d.
also provided free ofcharge for all health professionals and other populations deemed as essential
workers or caregivers. In 2012 / 2013 there were in excess of1590 influenza vaccines administered in
the Exploits PH C area. The following table provides a breakdown ofvaccines administered by group.
This total shows a slight increase from 2011-2012 with 1563 influenza vaccines administered.
Influenza V accine B reakdow n,2012 - 2013.
Category
6-59 months 1 and 2nd dose
> 60 yrs ofage
< 60 yrs with chronic illness
Essential Community W orkers
Pregnant W omen
H ousehold Contacts
# of V accines A dm inistered
37
934
289
76
0
200
st
D uring the 2012-2013 Influenza Campaign, the Pneumococcal-P-23 vaccine was also offered to those
over 65 years ofage or to those who were considered high at risk for pneumococcal disease which is
caused by a bacterial infection with Streptococcus pneumonia. A total of78 Pneum ovax-23
vaccines were administered during the 2012-2013 campaign.
Influenza Cam paign 2011-2012 vs. 2012-2013
Flu Vaccines Administered
Pneumovax -23 Administered
Total
2011-2012
1542
21
1563
2012-2013
1593
78
1593
3.6.12 O ral H ygiene
According to Canadian Community H ealth Survey - CCH S (2010) 43.3% ofthe Central H ealth region’s
population visited the dentist within the last year. This is below the provincial average of54.1%. The
most recent information specific to the Exploits H ealth Service Area is available from the CCH S 20072008. This survey evaluated individuals aged 12 and over. This survey states that 44.1% selfperceived
their oral health as very good compared to the Central Region which rated at 34.9% and the province
at 37.9%. In terms ofdental visits, 26.2% from the EH SA visited the dentist more than once a year in
comparison to the Central Region at 22.3% and the province at 28% (CCH S 2007-2008).
According to the D epartment ofH ealth and Community Services, there has been an unprecedented
uptake ofthe expanded Adult D ental Program since being implemented in January 2012. As a result
ofthis uptake a prior approval process was established in April 1, 2013. "The prior approval process
will approve clients up to the limit ofthe existing budget, minus funding specifically allocated for
exceptional or emergency cases throughout the year" (H ealth and Community Services, 2013). This
59
O ral H ygiene cont’d.
process demonstrates an effort by government to ensure the continuation ofthis program. In order
to offer appropriate dental services to the residents ofthe province, the government also increased
the per person cap to $150.00 for basic dental services and $750.00 for dentures per year (H ealth and
Community Services).
3.6.13 Fruit and V egetable Consum ption
According to the W orld H ealth O rganization (2012) sufficient intake offruit and vegetables can help
eliminate about 14% ofgastrointestinal cancer deaths, about 11% ofischemic heart disease deaths,
and about 9% ofstroke deaths. O nly 18.9% ofthose living within the Central H ealth region reported
eating fruits and vegetables at least 5 times or more per day. This was lower than the provincial
average of27.4 % (CCH S 2009-2010). N o statistics were available specific to the Exploits H ealth
Service Area.
3.6.14 Personal H ealth Practices and Coping Skills Sum m ary
•
•
•
•
•
•
•
•
•
•
•
•
•
Although smoking has decreased in recent years, citizens in Central H ealth smoke slightly
more then the provincial and national average, with males smoking more then females.
11% ofN L youth students or current smokers with males smoking twice as much as females.
Research indicates that smokers or more likely to do drugs, alcohol, gambling than nonsmokers.
H eavy drinking continues to be a concern among citizens within Central H ealth including
youth, with males drinking significantly more than females.
47% ofN L youth use marijuana once or more per week, 8% use illicit drugs and 9% use
prescription drugs to get high.
Video lottery gambling is the game ofchoice among N L gambling addicts.
There are 505 video lottery sites and 2274 VLT machines in N ewfoundland and Labrador.
The gambling game ofchoice among N L youth is scratch tabs with both males and females
equally likely to participate.
D espite the availability ofexisting physical activity opportunities in the EH SA and the
emergence ofnew ones, over 50% ofCentral H ealth citizens remain inactive.
There was a slight decline in the screening rates using mammography among Central H ealth
females from 2009/2010 compared to 2007/2008 reported data.
The cervical screening rates among females in the EH SA are slightly higher in most
communities compared to the regional rates. D iv. 8 Sub. D iv. E has the lowest rate
percentage. This area could be targeted to receive more education and awareness.
Prostate screening rates among men in Central H ealth have been fairly consistent at 57 %
which is slightly higher then the current provincial rate.
Colorectal screening rates among Central H ealth citizens are currently higher than the
provincials and national rates.
60
Personal H ealth Practices and Coping Skills Sum m ary cont’d.
•
•
•
•
There is a 17% increase in the most common sexually transmitted infection, Chlamydia,
among citizens in Central health since 2007. The province has seen a 33% increase for the
same period.
There was a slight increase (3%) offlu vaccines and a significant increase (73%) ofPneumovax
vaccines administered to citizens in the EH SA in 2012-13 compared to 2011-2012.
43% ofCentral H ealth citizens visited their dentist at least once in the last year as compared
to provincial rate of54%.
Citizens in Central H ealth are not eating enough fruits and vegetables.
4. H ealth Services
H ealth services, particularly those designed to maintain and promote health, to prevent disease, and
to restore health and function contribute to population health.
4.1 Prim ary H ealth Care Provider Profile
The citizens ofthe Exploits area receive Primary H ealth Care services from health professionals ofthe
Central Regional H ealth Authority as well as private practice providers. A profile ofproviders
employed by Central H ealth is highlighted in the following table, and includes type ofprovider,
number, age range, years ofservice and applicable collective agreements governing provision of
service.
Information was provided by H uman Resources D ivision ofCentral H ealth 2014
Prim ary H ealth care Provider Profile – D r. H ugh Tw om ey H ealth Centre
Prim ary H ealth Care
Provider
N um b er
Collective
A greem ent
A ge Range*
Yrs of
Service**
D irector ofH ealth Services
1
Mgmt H L
B
B
Manager ofPH C
1
Mgmt H L
B
B
Social W orker
1
AAH P
C
C
Physicians
6
MO U 2005
A (4), B (1), C (1)
A (5) B(1)
N urse Practitioner
1
N LN U 32
C
B
Registered N urses
23
N LN U 28
A (2), B (9), C (12)
A (9), B (8), C (6)
Lab Tech II
1
N APE LX
C
C
61
Lab Tech I
1
N APE LX
A
A
Lab Assistant
1
N APE LX
C
A
N APE LX
C (1)
C
D iagnostic Imaging
Clinical D ietitian
1
N U/N M
A
A
LPN s
44
N APE
A (9), B (12), C
(23)
A(18 ), B (17), C
(9)
PCAs
34
N APE
A (7), B (11), C
(16)
A (25) B (6)
C (3)
Clerical
4
N APE
B (4)
A (2), B (2)
Manager ofLong Term
Care
1
Mgmt H L
C
B
N APE H P
B
B
Primary H ealth Care
1
Facilitator
*
A = <36, B = 36-45 and C = > 45
**
A = <10, B = 11-20 and C = > 20
Prim ary H ealth Care Provider Profile* - Exploits Com m unity H ealth Centre
Prim ary H ealth
Care Provider
N um b er
Collective
A greem ent
A ge
Range**
Yrs of
Service***
CCN C
4:
~1- Bishop’s Falls
~3- Botwood and Area
N LN U 30
A (1), B (1)
C (2)
B (2), C (2)
PH N
4:
~1- Bishop’s Falls
~2- Botwood and Area
~1- Community
D evelopment/ H ealth
Promotions
N LN U 30
A (1), B (1)
C (2)
B (2), C (2)
Social W ork
3:
~3- Community
Supports****
N APE H P
A (1), C (2)
A (3), B (1),
C (1)
BMS
1
N APE
B (1)
B (1)
Clerical
1.6
N APE
C (1) B (1)
C (1) A (1)
62
Prim ary H ealth Care Provider Profile cont’d.
* All services providers listed are located in Botwood and provide service to the EH SA area as well as
additional areas in some cases.
** A = <36, B = 36-45 and C = > 45
*** A = <10, B = 11-20 and C = >20
**** Provides services within the region on a shared geographical distribution.
All services are not clearly distributed by geographic area. Some services are assigned by program,
alphabetical client listing, special circumstances, etc.
W ithin the Exploits H ealth Service area, there has been a noticeable movement ofstaffin frontline
positions, especially community based nursing and social work positions. W ith a younger, mobile
workforce, factors such as childcare, temporary vs. permanent status, employment opportunities
created by new positions and personal choice all impact on staffretention. This level ofactivity can
impact the continuity ofprogram and service delivery, increase costs to the organization for
orientation and training and may decrease the sense oflong term commitment.
4.2 G eneral Practitioner Profile
Currently there are seven physicians providing medical services to citizens in the Exploits H ealth
Service Area. The D r. H ugh Twomey H ealth Centre has two fee-for-service and three salaried
physicians and the Bishop’s Falls Medical Clinic has two fee-for-service physicians. Physicians at the
D r. H ugh Twomey H ealth Centre provide regular primary health care services Monday-Friday and
share on-call duties for 24/7 emergent/urgent care. Physicians receive benefits in accordance with
the Memorandum ofUnderstanding 2010.
All physicians provide and share responsibility for medical care for the long-term care residents of
the D r. H ugh Twomey H ealth Centre. The physician group is represented on many in house and
regional committees including: multidisciplinary, interdisciplinary committees and the PH C
leadership team. They provide ad hoc representation for accreditation and disaster planning. The
physician group in Botwood meets monthly to share staffand professional issues and educational
opportunities.
Physicians also provide medical services utilizing the local ambulance service or provincial air
ambulance. Coverage for short-term leave such as vacation and education is usually covered
internally with schedule changes and additional call. The senior staffphysician has been in position
for 10 + years.
The Senior Medical O fficer fulfills the role ofproviding coordination oflocal services, including
administration and orientation for all physicians, collaborating physician for the nurse practitioner,
medical control for community based ambulance service, teaching and supervising medical/nurse
practitioner students. The current Senior Medical O fficer Physician has an appointment with
Memorial University ofN ewfoundland and is a Clinical Associate with the D epartment ofFamily
Medicine.
The local Medical Advisory Committee meets regularly to discuss site level issues, with VP Medical
and VP Rural available for consultation upon request. The Senior Medical O fficer together with the
63
G eneral Practitioner Profile cont’d
D irector ofH ealth Services represents the area on the Rural Medical Advisory Committee. This
committee is chaired by a Rural SMO and includes all rural SMO ’s, D H S’s, VP Rural H ealth and VP
Medical Affairs.
The Bishop’s Falls Medical Clinic offers an office based clinic service 5 days per week. The senior
physician also completes regular rotations at the Central N ewfoundland Regional H ealth Centre with
ambulatory care services, O R assist and maternity/delivery obstetrical coverage. There is no formal
liaison with the physician group in Botwood.
4.3 Prim ary H ealth Care Services:
The provision and delivery ofhealth services, designed to maintain and promote health, prevent
disease and restore health and function - all contribute to population health. The D r. H ugh Twomey
H ealth Centre, located in Botwood, offers primary health care services to the PH C area, with the
majority ofcommunity based services housed in a separate location in Botwood at the Exploits
Community H ealth Centre. Primary care is available to the residents ofBishop’s Falls at the Bishop’s
Falls Medical Clinic.
4.3.1 The D r H ugh Tw om ey H ealth Centre - 709 257- 2874 (B otw ood)
This facility offers and coordinates the following services:
• Long Term Care- 36 nursing care, 28 protective care, 12 Veteran’s Affairs Canada, priority
status, 2 respite care, 1 special/assessment, and 1 palliative care.
• 24 hour emergency service with 2 holding beds for stabilization/observation
• Pre-assessment clinic (clients do not have to travel to Grand Falls-W indsor for preoperative
preparation.
• After hour general practitioner clinics during the fall – spring seasons.
• D ietitian services for inpatient/outpatient and community development
• D iabetic clinic biweekly (½ day) by dietitian and nurse practitioner
• Recreation therapy ( 1- Recreation D evelopment Specialists and 2 Recreation Therapy
W orkers).
• Rehabilitative services (physiotherapy, O T, and speech-language) are provided by regional
visiting professionals to residents oflong term care only. Physiotherapist visits 2 days/month,
others on an ad hoc basis.
• D iagnostic services (laboratory and X-Ray) to all clients in the area, not limited to those who
access care in Botwood.
• Foot Care provided to LTC residents by staffnurses and LPN s
64
4.3.2 Exploits Com m unity H ealth Centre - B otw ood 709 257- 4900
This facility offers and coordinates the following community base services:
• Public H ealth N ursing (school , child and adult health and community development nursing)
• Continuing Care N ursing Services
• Community Supports Social W ork
• Behavioral Management
• Primary H ealth Care Facilitation
• Child, Youth and Family Services Social W ork Services – N on Central H ealth Service.
4.3.3 B ishop’s Falls Medical Clinic - B ishop’s Falls 709 258-5555
This private medical clinic offers medical services provided by two family physicians - N on Central
H ealth service.
4.3.4 Chronic D isease Prevention/Managem ent
Programs and services in this area involve prevention (primary) and management (secondary) of
chronic diseases contributing to premature mortality (e.g. diabetes, heart disease, stroke and cancer).
D iabetes clinics are offered at the D r. H ugh Twomey H ealth Centre jointly by the N urse Practitioner
and D ietitian in collaboration with family physicians. The clinics are held 2 days per week. Urgent
referrals are accommodated outside the regular diabetes clinic. Clients are seen mostly by referral
from the PH C provider and a plan ofcare guides the follow-up. The dietitian also accepts self
referrals.
4.3.5 Chronic D isease Self Managem ent Program
This free program is for any adult with or is at a risk ofchronic health condition. O ngoing health
problems or chronic conditions are health problems that you usually have for the rest ofyour life.
People who have chronic health conditions share similar challenges every day. Since 2011 there have
been six, 6 week workshops completed in Exploits in the communities ofBotwood, Bishop’s Falls and
Point ofBay and Point Leamington. There are 5 workshops being planned for Exploits for 2013/2014.
To date there are approximately 65 client graduates ofthe program and there are 5 community
workshop leaders and 1 master trainer for the Exploits H ealth Service Area.
4.3.6 Evening Physician Clinics – D r. H ugh Tw om ey H ealth Centre
Three family physicians have been providing evening clinics to clients at the D r. H ugh
Twomey H ealth Centre during the fall and winter months; one has been in operation since
2010. The clinics are all pre-booked and most clients must meet the criteria as determined by
the attending physician. O ne physician allows their clients to access the evening schedule
65
Prim ary H ealth Care Services cont’d.
when day clinic are fully booked. Since September of2013 there have been 30 evening
clients offered in total. O ne physician averages 15 client visits per clinic while the other two
average 7 and 6 per clinic. The average clinic time is 3 hours in duration and administrative
support is provided by scheduled O ut Patients D epartment staff. The predetermined client
criteria for 2 ofthe evening clinics include:
•
•
•
•
Students – high school and post secondary
W orking class with no paid leave benefits
D aytime care providers (children and other)
Clients with no chronic conditions
The evening clinic service offered at the D r. H ugh Twomey H ealth Centre promote accessibility for
clients to receive services without having to incur extra cost such as lost days ofwork or school and
potential monetary cost for caregivers. Seeing the benefit ofthe service all physicians are currently
considering offering evening clinics as a compliment to their daily practice.
4.3.7 Telehealth Services
Citizens in Exploits now have the opportunity to see specialist utilizing a technology called
telehealth or video communication/ conferencing where client’s can participate in scheduled
appointments in the presence ofa health professional. This service is available at the D r. H ugh
Twomey H ealth Centre in Botwood and over the past few years it has resulted in huge saving oftime
and money for clients who would traditionally have to travel great distances to places like St. John’s
for routine follow –up appointments. According to Central H ealth’s Telehealth Coordinator – Jessica
Ruth, a large majority ofthe telehealth sessions throughout central have been with O ncology
Specialists for follow-up appointments for clients undergoing cancer treatment. The following
chart shows the number oftelehealth sessions held in Exploits at the D r. H ugh Twomey H ealth
Centre in Botwood from 2010 – 2013.
Year
2010
2011
2012
2013
N umber of
Appointments
16
63
42
16
In 2012 Central H ealth conducted 2945 telehealth appointments averaging approximately 245
sessions per month. According to Central H ealth’s Telehealth Coordinator the monthly average had
increased to 276 by May 2013 and average usage is increasing by 16% per year. Central H ealth’s
usage oftelehealth technology is second to Eastern H ealth followed by Labrador and W estern H ealth
respectively.
66
4.3.8 Com m unity Support Services
Community support services includes a mix ofhealth, social and supportive services to maintain, and
where possible, to improve the quality oflife ofindividuals. Services include assessment and
placement; nursing services; social work services; home supports and coordination; delegation of
function to support/alternate care givers; personal care home licensing and monitoring; alternate
family care home approvals and monitoring; individual living arrangements; cooperative apartments;
specialized board and lodging and other residential alternatives; palliative care; respite care; and
community behavioral services program. Pending financial eligibility and other criteria, these
services are available to seniors and individuals with physical and /or developmental disabilities.
O ther services may include special assistance for supplies and equipment; drug card and medical
transportation; and limited assistance program for support ofpersons dealing with chronic health
conditions; investigations ofallegations ofneglect and administration ofthe N eglected Adults Act;
and temporary home support following hospital discharge, including drugs, equipment, supplies
and palliative care.
4.3.9 Rehabilitative Services
Physiotherapy, O ccupational Therapy, Audiology and Speech-Language are regional primary health
care services based at the regional sites in Grand Falls-W indsor and Gander and offer a preventative
and curative focus. H owever, due to resource allocations, clients must travel to Grand Falls-W indsor
to access these services and for many clients; this is not achievable due to scheduling, transportation
and costs. A limited traveling service is available to clients ofthe long-term care facility in Botwood
and a home-based assessment may be arranged for homebound clients in special circumstances.
Physiotherapy and O ccupational Therapy services are also private based in Grand Falls-W indsor.
Many ofthe services are congruent with prevention and early intervention approach to individuals,
families and communities.
4.3.10 H ealth Protection
This program area assists in the identification, reduction and elimination ofhazards and risks to the
health ofindividuals in the community. Programs include disease control with monitoring,
monitoring ofpublic water supplies and surveillance ofpublic buildings and institutions. This
program is based in Gander and provides service to the Exploits H ealth Service Area as apart ofits
mandate.
4.3.11 Mental H ealth and A ddictions Services
This program area provides mainly outpatient based counseling services to individuals, families and
groups with mental health/illness issues, substance use and/or gambling issues. H ealth promotion,
education, prevention and early intervention services is also available to individuals, families and
communities. Specialized services within Mental H ealth and Addictions Services includes Regional
Early Psychosis Case M anagem ent Program , which is available to individuals with first episode of
67
Prim ary H ealth Care Services cont’d.
psychosis; Inpatient Psychiatric Treatm ent, individuals are admitted via psychiatrist to Central
N ewfoundland Regional H ealth Centre (CN RH C) located in Grand Falls-W indsor and; Assertive
Com m unity Treatm ent Team (ACTT), provide intensive long-term services to individuals with complex
severe and persistent mental illness. In the Exploits PH C area Central H ealth offers the following
Mental H ealth and Addictions Services Program:
Com m unity Mental H ealth & A ddictions Services
O ffers outpatient based counseling services to individuals, families and groups experiencing mental
health, mental illness, substance use and/or gambling issues. All referrals are screened daily and
processed based on client needs. Referrals are accepted by various service providers both internal
and external to Central H ealth. Selfreferrals are encouraged and accepted. Staffinclude: Addictions
Counselors, Mental H ealth Social W orkers, Mental H ealth Psychologists, Mental H ealth N urses and a
Mental H ealth O ccupational Therapist. The Grand Falls-W indsor O ffice is responsible for the Exploits
area. For further information, please contact the office at 489-8180.
Regional Early Psychosis Case Managem ent Program
O ffers services to individuals aged 16-45 years who are experiencing symptoms ofpsychosis for the
first time and who are in their first 6 months oftreatment . This is a home based program that works
closely with families/caregivers and collaborative providers. Referrals are accepted by psychiatrist
only. The Early Psychosis Case Management Program is a regional program that is available to
individuals living in any community within the Central H ealth area. The Early Psychosis Case
Manager is located in Grand Falls-W indsor.
A ssertive Com m unity Treatm ent Team (A CTT)
ACTT provides intensive, long term services to individuals with severe and persistent mental illness
to individuals living in the Bishop’s Falls, Botwood, Peterview and N orthern Arm communities within
the Exploits PH C area. Services focus on improving clients mental health symptoms that interfere
with their ability to achieve personal meaningful goals. This is a home and community based
program that works closely with families/caregivers and collaborative providers. Referrals are
accepted by existing mental health and addictions provider and/or the client’s psychiatrist. Staff
include: Addictions Counselor, Social W orkers, N urses, O ccupational Therapists, Community Mental
H ealth and Peer Support staff. The ACTT office is located in Grand Falls-W indsor.
Inpatient Psychiatric Treatm ent
O ffers a hospital based services at the Central Regional H ealth Care Centre (2E Unit) for individuals
requiring a higher level ofmental health care. Admission occurs following an assessment and
referral by psychiatry. An interdisciplinary team comprised ofpharmacy, dietician, recreational
therapy, social work, psychology, occupational therapy and psychiatry, acts as the care team for each
patient/client. This unit is the regional facility for individuals detained under certification under the
Mental H ealth Care and Treatment Act.
68
4.3.12 Parent and Child H ealth Program
This program is responsible for licensing; monitoring and supporting group child care centers and
family based child care; administering a subsidy program for child care fees and transportation.
D irect home services are provided to children with developmental delays and support services,
including ABA therapy, which is provided to children with Autism.
Special child welfare allowance programs offers services to children 0-18 years with disabilities. If
eligible, the child may qualify for transportation, respite hours and drug cards. A SCW A Social W orker
based in Lewisporte provides social work support to these clients in the Exploits area.
Service agreements are in place with both Federal and Provincial governmental agencies to support
Family Resource Centres in providing a variety ofcommunity-based activities and resources for
children and families that emphasize early childhood development and parenting support. Programs
are offered that reflect the needs ofthe families who are participating and the communities in which
they are located. Types ofprograms might include everything from drop-in playgroups, parenting
workshops, clothing exchanges and toy-lending libraries, to community kitchens, community
gardening, healthy lifestyle sessions and H ealthy Baby Clubs: a prenatal nutrition support program
offered through Family Resource Centres for eligible women who may need extra support during
and after their pregnancy. The Family Resource Centres in the Exploits area are located in Grand Falls,
Botwood, Peterview and Bishop’s Falls with satellite site capabilities in Cottrell’s Cove, all which
provide a place for families to gather in a friendly and informal setting.
Child Care Services are located in Peterview (YMCA) -26 spaces, Botwood (Exploits Valley H ealth
Coalition - Early Learning Center)-24 spaces and Bishop’s Falls (private)-28 spaces.
Botwood Early Learning Center operates 5 days /week with 24 licensed spaces offering halfday
programming for age 3-4 years and all spaces are filled, with a waitlist for next year.
Bishop’s Falls Little Stepping Stones operates 5 days/week with 28 licensed spaces for ages 2 - up to
school age (25-69 months). There are currently 4 vacant spaces with no waitlist and 14 children not
returning in September as they begin school. O fthose currently attending, 20 children receive
subsidized registration. Anecdotally, there may be as many as 6 private homes offering child care
services in the community and this may be affecting attendance at the licensed center.
H ealthy Baby Club (prenatal to infancy) can accommodate up to 21 participants and includes
initiatives and education such as nutrition supplements, car seat safety training, breastfeeding, infant
care, immunizations, prenatal nutrition and post partum care, clothing exchange and social supports.
Participation varies depending on the number ofprenatal clients at any time, but the spaces are
often all filled with a waitlist.
69
4.4 Regional Services
In addition to those services provided locally, there is a network ofproviders who provide clinical or
consultative services on a regional basis:
• Reproductive H ealth N urse
• Communicable D isease Control N urse
• Primary H ealth Care Consultant
• Cervical Screening Initiatives Coordinator
• Regional N utritionist
• Environmental H ealth Services Coordinator
• Genetics Counselor
• Lactation Consultants
• Parent and Child H ealth Coordinator
• W ound Care Consultant/Enterostomal Therapist
• Financial Assessors
• Child Care Services Consultant
• Respiratory Therapist
• Medical O fficer ofH ealth
• Acute Care H ome Supports Coordinator
• Asthma Care Clinic
• Palliation and End ofLife Care
• Regional Chronic D isease Selfmanagement Coordinator
• Telehealth Coordinator
4.5 N on Central H ealth
Primary health care services are also provided to the PH C area by various organizations and
individuals in private practice. These include but are not limited to:
4.5.1 Child,Youth and Fam ily Services (CYFS) D ivision
This program focuses on promoting the safety, well-being and protection ofchildren and youth
while supporting the capacity offamilies and communities. Included in the services provided by the
Child, Youth and Family Services D ivision are the following programs: Protective Intervention, Family
Services, In-Care and Adoptions, Community Youth Corrections and Youth Services. CYFS staffis
located at the Exploits Community H ealth Centre in Botwood. The following are services provided by
CYFS.
Protective Intervention Program (CY FS)
In the Protective Intervention Program, social workers assess the risk ofharm to a child up to age 16
when there is concern ofchild maltreatment by a parent or caregiver. The social worker, together
with the family, develops a plan to reduce the identified risk.
70
Child,Youth and Fam ily Services (CYFS) D ivision cont’d
Fam ily Services Program (CY FS)
Through the Family Services Program, early intervention services are can be implemented to
promote the safety, health and well being ofa child, promote strengths in families and reduce the
risk ofmaltreatment, improve parenting, prevent removal ofa child from his/her parent, and support
communities to meet the needs ofchildren and families. The program consists ofthe Child W elfare
Allow ance Program ,Fam ily Support Services and Voluntary Care Agreem ents.
In Care Program (CYFS)
W hen a child cannot live in the family home because ofmaltreatment, the In-Care program offers the
provision ofa safe alternate living arrangement. Sometimes parents voluntarily transfer the care ofa
child to a D irector ofChild, Youth and Family Services (CYFS) or the court may make a legal finding
that a child is in need ofprotective intervention and place a child in a D irector’s temporary or
continuous custody. The In-Care program is also responsible for the recruitment, assessment,
training and support offoster parents.
A doptions Program (CY FS)
The Adoption Services program finds permanent homes for children available for adoption. Social
workers match children relinquished for adoption or who are in the continuous custody ofthe
D irector ofChild, Youth and Family Services with adoptive parents. The program also approves
applications to adopt a child from other Canadian provinces and territories and foreign countries.
Com m unity Y outh Corrections Program (CY FS)
The Community Youth Corrections program is mandated to provide services to youth who come into
conflict or are at risk ofcoming into conflict with the law between their 12th and 18th birthdays.
Some ofthe services provided by this program are: supervision ofyouth serving a variety ofcourtordered sentences; preparation ofcourt reports to assist in the decisions ofthe Youth Justice Court;
service planning, individual, family and group counseling; and program development and
community mobilization.
Y outh Services Program (CY FS)
The Youth Services program is a voluntary program whose goal is to assist at-risk young people, age
16 and 17, make a successful transition to adulthood. Social work intervention and services may be
provided to youth and their families and can be either non-residential or residential. N on-residential
services are provided to young people living in their family home to address issues which could
affect their safety and development, including maltreatment and neglect, as well as mental health
and addiction issues. These services are offered in an effort to keep the family together and avoid out
ofhome placements. Residential services can be offered ifa youth is at risk ofmaltreatment in
his/her family or has no parent willing or able to provide care to the youth. In circumstances assessed
on an individual basis by a social worker, youth may continue to receive services through the youth
services program until the age of21.
71
4.5.2 H ealthLine
H ealthLine, the nurse staffed health advice telephone service, operates from 3 sites in the province,
St. Anthony, Stephenville and Corner Brook and according to a H ealthLine Report from September
2012 to February 2013, Exploits H ealth Service Area there were a total of256 service calls made for
which 1 was related to administration, 58 for information, 4 for referrals and 189 were triage based
calls. O nly 13% ofthe triage calls were referred to the ER D epartment while 43% were referred to
their primary care provider.
The majority oftotal callers range in ages from 20 – 64 which represents 52% ofall callers with
females being the dominate users ofthe service representing 62% verses 38% ofmales callers. The
following 2 charts show the Top 10 Adult and Pediatric Protocols Accessed for the reporting period
from September 2012 – February 2013.
Top 10 Protocols – Adult
H igh Blood Pressure
Chest pain
N ausea
Vaginal Bleeding – Abnormal
Cough - Acute Productive
D iabetes – H igh Blood Sugar
H eadaches
N eurologic D eficit
Pregnancy – Abdominal Pain GT 20 W eeks EGA
Pregnancy – Abdominal Pain LT 20W eeks EGA
Calls
10
7
5
5
4
4
4
4
4
4
Top 10 Protocols – Pediatric
Cough
Vomiting W ithout D iarrhea
Sore Throat
Colds
Earache
Poisoning
Trauma – H ead
Chest Pain
Ear D ischarge
Ear Infection Follow-up Call
Calls
7
7
4
3
3
3
3
2
2
2
From the period ofMarch – August 2014 Central H ealth recorded a total of2130 H ealthLine calls and
were third among all Regional H ealth Authorities with Eastern H ealth leading the way followed by
W estern, Central and Labrador. The majority ofCentral H ealth’s calls were triage based at 78%
followed by the request for information at 19%. The total calls reported for the province for the same
period was 17,306.
72
H ealthLine cont’d.
In 45% ofthese calls, the nurse operator was able to help callers with their need. O nly 15% ofcallers
were referred to an ER department. In a special report compiled for the Central Regional H ealth
Authority, for reporting period from O ctober 2006 – March 2007, there were a total of2880 calls for
information and or direction. O fthese calls, 66 were directed to 911/ambulance, 398 were directed to
the Emergency D epartment, 1068 were directed to physician services, 798 were self-care.
4.5.3 A lternate Fam ily Care H om es
An Alternate Family Care H ome is a private residence which provides room and board, supervision,
personal care, emotional & social support to individuals with Intellectual D isabilities. As part ofthe
Alternate Family Care H ome program various supports and services are available to care providers.
These include:
1. An enhanced board and lodging payment ofup to $1226 per month.
2. H ome support services are available based on the needs ofthe individual and the
circumstances ofthe care provider
3. Residential Respite, up to 54 days per year, may be utilized for the purpose ofvacation and/or
weekend respite.
4. Community access funding may be available to assist the client with participating in
community activities.
Currently there are 15 Alternate Family Care H omes in the catchment area ofBotwood, N orthern
Arm, and Bishops Falls, housing 12 clients. Information obtained from Greg McGrath, Coordinator of
Residential Services (adults), (Jan. 2011)
4.5.4 Supportive Services
Supportive services such as home care, alternate family care and respite care for primary caregivers
have made it possible for many clients/seniors to stay at home, supported in their own communities.
Information from the community accounts reports that 85.2% ofindividuals in the Central H ealth
Area report (CCH S, 2003) a strong or very strong sense ofcommunity belonging and this has been
supported anecdotally throughout the region. A discussion paper on healthy aging released in
March 2006 reports a strong sense ofcommunity within the province and identifies that 84% of
seniors in this province reside in their own homes.
In D ecember 2010 there were 190 clients (includes seniors and adults with disabilities) receiving
home support services in the Exploits Area. (Information obtained from Karen Ropson, Manager of
H ome Support Services, CRH A, January 2011). Although there are five H ome Support Agencies
providing service to the PH C area, service providers indicate that there is sometimes a challenge to
recruit qualified home support workers, especially for clients presenting with challenging needs or
residing in rural/remote communities
73
Supportive Services cont’d.
W hile home support services are invaluable, the maximum number ofhours provided for seniors
under existing H ome Support Provincial O perational Standards 2005 is up to a m axim um of5
hours/day ifprovided by a H ome Support Agency and a m axim um of6.5 ifSelf-Managed care. The
m axim um provided for an adult with a disability (under the age of65) is approximately 7 hours per
day ifprovided by a H ome Support Agency and 9.5 hours per day ifSelf-Managed care. H ours are
determined base on assessed need through the completion ofa professional Assessment and family
members are responsible for the remaining care; therefore the potential for caregiver stress and
burnout is high. The utilization rate for respite care beds indicate there is potential to enhance this
service, possibly through more awareness ofthe service, improved coordination ofassessment and
planning for clients in the community requiring complex care. Information provided by Karen
Ropson, Manager ofH ome Support Services – Central H ealth, 2011.
A m bulance Service
Three providers provide emergency transportation and planned medical transport to the area.
H ospital based (CN RH C) ambulance provides emergency service from the Bishop’s Falls area to
CN H RC. Freake’s Ambulance, a private operator, has two vehicles based in Botwood and provides
emergency transport from Peterview, Botwood and all communities to Fortune H arbour to Botwood
for initial assessment. Point Leamington Ambulance, a community based non-profit service with one
paid position and volunteer drivers, provides emergency transport from that area to Botwood for
initial assessment according to provincial regulations. All subsequent transfers to the referral site are
then carried out by Freake’s Ambulance as well as referrals for tertiary care.. All ambulance personnel
are required to meet/maintain minimum provincial standards for training and this poses another
challenge-to retain qualified personnel to provide a 24/7 operation.
A udiology
This service is available at the referral center in Grand Falls-W indsor but there is also one audiologist
in full time private practice with travel clinics held throughout the region/province.
Foot Care
There are three certified foot care nurses providing services in the Exploits H ealth Service Area with
home based or in-home service.
D ental
Basic dental service is available in Botwood on a part time basis, provided from two private practice
clinics based in Grand Falls –W indsor.
Pharm acy
Community based pharmacists in Botwood (3) and in Bishop’s Falls (2) provide a valuable service to
the communities. O ne community-based pharmacist in Botwood is a certified D iabetes Educator.
This is a resource that should be integrated into the chronic disease management process for clients
in the EH SA.
74
4.6 Secondary H ealth Care Services
Central H ealth is responsible for the provision ofhealth care services to the citizens ofExploits. The
majority ofsecondary care services are available from the Central N ewfoundland Regional H ealth
Centre (CN RH C) in Grand Falls-W indsor. Services accessed at the CN RH C include surgery, internal
medicine, ophthalmology, psychiatry/psychology, urology, respiratory technology,
obstetrics/gynecology, neurology, dialysis, pediatrics, dermatology, audiology, speech language
pathology, otolaryngology, nephrology and oncology. O rthopedics is available from James Paton
Memorial H ospital in Gander.
In cases ofemergency, the majority ofclients will access primary care at the D r. H ugh Twomey H ealth
Centre in Botwood for assessment and stabilization before being transferred to the appropriate
secondary care centre. Provincial regulations require all non-routine clients being transported by
ambulance must access services at the nearest available service provider, e.g. D r. H ugh Twomey
H ealth Centre for the Exploits area.
4.7 A djacency to Secondary H ealth Care Services
Grand Falls-W indsor is located 36kms from Botwood so to access secondary health care services, the
population ofFortune H arbour and Leading Tickles must travel approximately 90kms. Secondary
health care services (orthopedics) provided in Gander requires a distance ofapproximately 149kms
from Fortune H arbour and Leading Tickles.
4.8 Migration Patterns
Specific information on the migration patterns for residents ofthe Exploits area receiving primary
health care services is difficult to obtain, as there is no current rostering ofpatients, and some clinics
do not have electronic registration or cannot retrieve the information by geography. It is a known
fact that many residents in the EH SA area access primary care through Grand Falls-W indsor based
physicians, but it is difficult to categorize. In an effort to provide an overview the following
information has been obtained informally from the medical clinics servicing the area, through a oneday random sample, and suggests that more than one third ofthe PH C population access services
outside the PH C area.
D r. H ugh Twomey H ealth Care Centre: (5 doctors + 1 N urse Practitioner)
Total Patients seen:
134
Lab and/or X-ray only:
36
Total Patients seen/telephone advice:
96
Bishop’s Falls Medical Clinic (2 doctors)
Total patients seen:
N on-resident ofBishop’s Falls:
62
1
75
Migration Patterns cont’d.
Grand Falls-W indsor Clinics:
Medical Centre
Medical Arts
Family Practice
W indsor Clinic
Total Patients
66
154
166
87
Patients seen
from Exploits
area
21
29
32
14
2
5
6
3
N umber of
Physicians
4.9 A ccess to Fam ily Physician/PH C Provider
According to Statistics Canada H ealth Profile (2011/2012) 86.9% ofthose within Central H ealth aged
12 and over reported having a regular medical doctor. This rate is slightly lower than the provincial
rate at 91.3% and higher than the national rate at 84.9%. D ata for the EH SA is currently unavailable.
Client’s first point ofcontact with the health care system is often through their family doctor. Being
without a regular doctor is associated with fewer visits to general practitioners or specialists, who
play a vital role in early screening and treatment ofmedical conditions.
4.10 Satisfaction w ith H ealth Care
A community consultation session was held in N ovember 2013 in Exploits and 71% ofparticipants
indicated that the EH SA has adequate health care facilities, services and programs. Furthermore,
according to the CCH S (2010), 87.9% ofindividuals aged 15 years and older living in N ewfoundland
reported being satisfied with the way health care services were provided. 87.0% were satisfied with
the way the hospital services were provided, and 94.3% were satisfied with the way physician care
was provided. This was higher than the national average of86.5%, 81.9%, 90.8% for health
care services, hospital services, and physician services, respectively.
4.11 Prim ary Reason for U se of Em ergency D epartm ent
The Emergency D epartment at the D r. H ugh Twomey H ealth Centre provides 24 hour services to the
Exploits region. The department is staffed by a registered nurse and a physician. After hours and on
weekends a physician provides on call coverage.
D uring the period April 2013 – April 2014 the department received 9845 visits, the age group 35-64
year olds comprised 43% ofthe visits. The following table shows the number and percentage of
visits per age group.
76
Prim ary Reason for U se of Em ergency D epartm ent cont’d.
Age Groups
0 – 24
15-34
35-64
> 65
N umber/Percentage ofVisits
1241 (13%)
1881 (19%)
4199 (43%)
2524 (26%)
Efficient management ofan Emergency D epartment requires a team ofproviders capable of
correctly identifying patients needs, setting priorities and implementing appropriate treatment,
investigation and disposition. This is achieved utilizing a 5 level scale called the Canadian Triage
Acuity Scale (CTAS). The CTAS levels are designed such that level 1 represents the sickest patients
and level 5 represents the least ill group ofpatients. Explanation and examples ofcases which would
fall under each category are listed below.
Level 1 - Resuscitation
Conditions that are threats to life or limb (or imminent risk ofdeterioration) requiring immediate
aggressive interventions. Examples oftypes ofconditions that would be Level 1are:
Cardiac/Respiratory arrest, major trauma, shock states, unconscious patients, severe respiratory
distress.
Level 2 - Em ergent
Conditions that are a potential threat to life, limb or function, requiring rapid medical intervention or
delegated acts. Examples oftypes ofconditions which would be Level 2 are altered mental states,
head injury, severe trauma, neonates, acute coronary syndrome, overdose and stoke.
Level 3 - U rgent
Conditions that could potentially progress to a serious problem requiring emergency intervention
are associated with significant discomfort or affecting ability to function at work or activities ofdaily
living. Examples oftypes ofconditions which would be Level 3 are moderate trauma, asthma, GI
bleed, vaginal bleeding and pregnancy, acute psychosis and/or suicidal thoughts and acute pain.
Level 4 - Less U rgent (Sem iurgent)
Conditions that are related to patient age, distress, or potential for deterioration or complications
would benefit from intervention or reassurance within 1-2 hours). Examples oftypes ofconditions
which would be Level 4 are headache, corneal foreign body and chronic back pain.
Level 5 - N on U rgent
Conditions that may be acute but non-urgent as well as conditions which may be part ofa chronic
problem with or without evidence ofdeterioration. The investigation or interventions for some of
these illnesses or injuries could be delayed or even referred to other areas ofthe hospital or health
care system. Examples oftypes ofconditions which would be Level 5 are sore throat, URI, mild
abdominal pain which is chronic or recurring, with normal vital signs, vomiting alone and diarrhea
alone.
77
Prim ary Reason for U se of Em ergency D epartm ent cont’d.
For the period April 2013 – April 2014 only 8% ofthe documented visits at the D .H .T.H .C.C.
Emergency D epartment were level 1 – 3. The remaining visits were triaged at level 4 – 5. A
documented ER visit is one that met the triage requirements as stated in the CTAS levels. O nly 31%
ofthe total ER visits for the reporting period was documented and triaged. This could indicate that a
vast majority ofthe ER visits (69%) are ofa non emergency nature which may include visits
pertaining to reasons such as: prescription refill request, test results, dressing changes, personal, etc.
The following chart shows the number ofdocumented/triaged visits to D .H .T.H .C. Emergency
D epartment from April 2013 – April 2014 as per CTAS N ational Guidelines.
2000
1795
1500
995
1000
500
0
Canadain Traige and
Acuity Scale
231
3
22
Level 1
Level 2
Level 3
Level 4
Level 5
4.12 H ealth Service Sum m ary
• Citizens in Exploits have direct access to a variety ofquality health services and programs
•
•
•
•
within the PH C site that focus on both prevention and treatment. The furthest driving
distance for citizens to access these services is no greater than 59 kilometers.
There is a wide variety ofCentral H ealth regional services accessible to citizens within a
reasonable travel distance at the two regional health centers in Grand Falls-W indsor and
Gander.
The current compliment ofhealth providers available to provide health programs and
services supports consistency and stability particularly with the physician team currently at 6
members and the recent hiring ofa nurse practitioner.
There is a good balance ofhealth staffin Exploits with respect to age groups, skills and work
experience.
Citizens and health providers in Exploits share a sense ofpride in their health facilities and
services and are satisfied with the availability and access ofsame.
5. H eath O utcom es or Status
H ealth status is the level ofhealth ofthe individual, group, or population as subjectively assessed by
the individual or by more objective measures. H ow individuals feel about their health is usually a
reflection oftheir physical, mental and social well being.
78
5.1 Self Perception of H ealth
W ithin the Central Region, 59.7% ofthe population aged 12 and over rated their own health status as
very good or excellent. According to the Canadian Community H ealth Survey (CCH S) 2009-10, 60.3%
ofthe population thought that their health was very good or excellent in the province. Specific data
to all communities in the PH C site was not available however according to the CCH S 2009-2010,*
Local Area 43( which includes all communities in the Exploits PH C site along with GFW , and Badger)
shows an assessment of64.2% for excellent & very good selfassessed health status. This evaluation is
higher than for both the province and the Central H ealth Region. According to the 2007-08 CCH S,
residents from the PH C site have increased their selfperception ofhealth from 61.1% in 07-08 to
64.2% on the most recent survey. The following table shows selfassessed health statues comparing
PH C site with Central H ealth and the province.
Self A ssessed H ealth Status
Profile
Exploits PH C
Central H ealth
Province
2007-08
61.1%
59.8%
61.8%
2009-10
64.2%
59.7%
60.3%
5.2 Self Perception of Mental H ealth
The W orld H ealth O rganization (2003) defines mental health as a “state ofwell-being in which the
individual realizes his or her own abilities, can cope with the normal stresses oflife, can work
productively and fruitfully, and is able to make a contribution to his or her community”.
Mental health is a crucial dimension ofoverall health and an essential resource for living. It influences
how we feel, perceive, think, communicate, and understand. W ithout good mental health, people
can be unable to fulfill their full potential or play an active part in everyday life. Mental health issues
can address many areas from enhancing our emotional well-being, treating and preventing severe
mental illness to the prevention ofsuicide” (H ealth Canada, 2009).
Looking at the Exploits PH C site (Local Area 43), 80.8% ofindividuals rate themselves as having an
excellent or very good mental health status compared to 72.5% in Central H ealth which rates mental
health as very good or excellent (age 12+ years) compared to the provincial rate of75%. (Canadian
Community H ealth Survey 2009-2010).
It is interesting to note that the mental health status ofExploits PH C site has increased from 77.5% in
the 07-08 CCH S report to 80.8% today. Central H ealth and Provincially, ratings have decreased
minimally (73.7% and 77.5% respectively). The following chart shows the comparisons in
percentages.
79
Self Perception ofMental H ealth cont’d.
Mental Health Status
82
80
78
76
74
72
70
68
77.5 77.5
73.7
80.8
72.5
75
2007- 08
Exploits
Central Health
Province
2009-10
5.3 Life Stress Status
Perceived life stress refers to the amount ofstress in the individual’s life, on most days and is
classified by asking respondents to rank their life stress into one ofthe five categories: N ot at all
stressful, not very stressful, a bit stressful, quite a bit stressful, or extremely stressful. Stress
contributes to heart disease, high blood pressure, strokes, and other illness in many individuals. It
also contributes to the development ofalcoholism, obesity, suicide, drug addiction, cigarette
addiction, and other harmful behaviors.
In Exploits PH C, (Local Area 43) 13.8% rated their stress level as extremely or quite a bit. This was a
little lower than Central H ealth 14.6% and lower than the province which was rated at 14.2%
(Canadian Community H ealth Survey 2009-10). Ifwe compare this to the 2007-08 CCH S, Exploits was
rated at 16.0%, Central H ealth at 12.1% and the province at 12.0%. Comparing the 2 surveys, Exploits
Life Stress Status appears to have decreased while the Central H ealth and the provinces have
increased.
5.4 O verw eight/O besity
O verweight is defined as having a Body Mass Index (BMI) between 25 -29.9. O besity is defined as
having a BMI or 30 or greater. BMI is calculated by dividing the individual’s body weight (kilograms)
by their height (meters) squared.
O besity is a risk factor in a number ofchronic diseases. The number ofCanadians who are overweight
or obese has increased dramatically over the past 25 years. The proportion ofchildren who are obese
in Canada has almost tripled in the past 25 years (H ealth Canada 2006).
In the 2009 -10 Canadian Community H ealth Survey (CCH S), 49.2% ofyouth in the Exploits (Local
Area 43) considered themselves to be overweight, in the Central H ealth region, 39.3% ofthe youth
population was considered overweight or obese. Provincially, 21.2% ofyouth were considered to be
overweight and 9.1% were considered to be obese (CCH S 2009-10).
80
O verw eight/O besity cont’d.
In 2010, 42.4% ofindividuals 18 and over in the Exploits H ealth Service Area(EH SA) considered
themselves overweight and approximately 70% ofindividuals aged 18 and older in Central H ealth
reported themselves to be overweight or obese. Reports ofoverweight and obesity were higher in
men at 80.8% than women at 59.6%. This rate in Central H eath is the highest among the regional
health authorities and higher than the overall provincial rate of64% (CCH S 2009-10).
In 2011 Canning, Courage, and Frizzell released a follow up report to previous studies on the
prevalence ofoverweight and obesity in preschool children in the province ofN ewfoundland and
Labrador. The results from this study indicated that the overall provincial rate ofcombined
overweight and obesity rose between 1988/89, 2001/02 and declined significantly by 2009/10.
The following table shows that in the Central H ealth region, the combined rate ofoverweight and
obesity increased significantly from 1988/89 to 2001/02 but decreased significantly between
2001/02 and 2009/10 In fact, the rate in 2009/10 no longer differs from that in1988/89.
Prevalence rates ofoverweight and obesity in preschool age children, as defined by the CD C, for the
Province and Central H ealth Region
Province
2009/10
2001/02
1988/89
Central
2009/10
2001/02
1988/89
N ormal
O verweight
O bese
Combined
61.7
61.5
69.4
16.7
18.0
14.3
16.6
18.0
10.8
33.3
36.0
25.1
65.0
60.0
66.7
10.3
16.5
15.4
15.0
20.5
11.0
25.4
37.0
26.4
For the Exploits PH C Site, the variety ofprograms available that promote physical activity may be a
contributing factor to this decrease.
5.5 U nderw eight
Underweight is defined as having a body mass index (BMI) below 18.5. Being underweight can
increase your risk ofosteoporosis, fertility problems, weaken your immune system, and cause other
health problems including mental health issues such as low self-confidence and low self-esteem
(Body & H ealth 2011).
In the Central H ealth Region, 2.8% considered themselves to be underweight compared to 2007-09
of3.8% (Canadian Community H ealth Survey (CCH S) 2009-10). According to the CCH S (2009-10) 1.0%
ofthe population 18 years and over in N L were underweight compared to 2.5% ofthe Canadian
population aged 18 years and over.
81
5.6 Chronic D isease Rates
The Center for D isease Control and Prevention (2009) defines chronic disease as illnesses that are
prolonged, do not resolve spontaneously, and are rarely cured completely. A chronic disease is
classified as one that has been present for three months or more. In the province 95% residents aged
65+ and 61% aged 12+ reports having at least one chronic condition. Central H ealth is moving
forward in the area ofChronic D isease Prevention and Management. The following chart indicates
the percentages ofselfreported chronic diseases nationally, provincially, and regionally as per
Community Accounts 2009 -10.
5.6.1 D iabetes
According to the Canadian D iabetes Association, there are three main types ofdiabetes. Type 1
diab etes, usually diagnosed in children and adolescents, occurs when the pancreas is unable to
produce insulin. Insulin is a hormone that controls the amount ofglucose in the blood.
Approximately 10% ofpeople with diabetes have type 1.
The remaining 90 % have type 2 diabetes, which occurs when the pancreas does not produce
enough insulin or when the body does not effectively use the insulin that is produced. Type 2
diabetes usually develops in adulthood, although increasing numbers ofchildren in high-risk
populations are being diagnosed.
A third type ofdiabetes, gestational diabetes, is a temporary condition that occurs during
pregnancy. It affects approximately 2 to 4% ofall pregnancies (in the non-Aboriginal population) and
involves an increased risk ofdeveloping diabetes for both mother and child.
Scientists believe that lifestyle changes can help prevent or delay the onset oftype 2 diabetes. A
healthy meal plan, weight control and physical activity are important prevention steps. 10% ofthe
population within Central H ealth have diabetes (this includes all three types ofthe disease). This is
the highest in N ewfoundland and higher than Canada overall. The following table compares rates
nationally, provincially and among the 4 Regional H ealth Authorities. (Source – Community Accounts
– CCH S 2009-2010)
82
D iabetes cont’d.
G eography
D iab etes
Canada
6.1%
N ewfoundland and Labrador
8.1%
Central H ealth Authority
10.0%
Eastern H ealth Authority
6.9%
Labrador-Grenfell H ealth Authority
6.1%
W estern H ealth Authority
8.8%
According to the Canadian Institute for H ealth Information (2007) health care services utilization is
higher among those with diabetes, than those without. More specifically, hospital stays are four
times as long, and the number ofphysician visits is twice as high among those with diabetes as
compared to those without diabetes.
W hile the percentage ofpeople with diabetes is the highest in Central H ealth, the rate has seen a
decrease from 2008 (12%) to the 2010 rate of10%.
According to (CCH S 2009-10), the rate ofdiagnosis ofdiabetes increases dramatically with age.
13.9% ofthe population within the Central H ealth ages 45-64, and 26.3% ofthe 65 years ofage or
older had a diagnosis ofdiabetes. The provincial rates are slightly lower at 9.8% and 22.3%
respectively.
5.6.2 H igh B lood Pressure
H igh blood pressure (hypertension) is a major risk for heart disease and stroke. H ypertension is a
condition that can be prevented and or controlled through healthy lifestyle options such as physical
activity and healthy eating.
The percentage ofpeople who self-report high blood pressure in Central H ealth is higher at 25.9%
than that ofCanada, 16.9% and N ewfoundland, 22.9% (Community Accounts – 2009-10). In the
Exploits H ealth Service Area, using Local Area 43 statistics from the Canadian Community H ealth
Survey (CCH S) 2009-2010, 18.8% report having hypertension. This is lower than Central H ealth and
the province but higher than Canada as a whole.
Again, when considering an older demographic, the rate ofhigh blood pressure increases
dramatically with 60.3% ofthe population within Central H ealth, age 65+ having been diagnosed
with the condition compared to the provincial rate of55%. The following chart shows the
percentages ofmale and females 65 and over within Central H ealth who have high blood pressure.
83
H igh B lood Pressure cont’d
H igh Pressure % b y sex 65 years and over,
Central H ealth,N L (CCH S 2009-10)
80
60
60.3
55
54.2
50.2
65.6 59.2
40
Central H ealth
NL
20
0
Total
Male
Fem ale
5.6.3 Cardiovascular D isease
Cardiovascular disease is a term that refers to more than one disease ofthe circulatory system
involving the heart and blood vessels. Cardiovascular disease involving blood vessels can affect the
lungs, the brain, kidneys or other parts ofthe body. Cardiovascular diseases are the leading cause of
death in adult Canadian men and women (Public H ealth Agency ofCanada, 2011).
In 2011, 8.0% of people age 12 years and older living in Central H ealth have heart disease compared
to 2008 which was 5.6%. The rate of cardiovascular disease in Central H ealth, 8.0% is higher than the
province (6.5%) and Canada (4.8%) (Community Accounts - 2011).
5.6.4 A rthritis
The term arthritis is used to describe more than 100 conditions that affect joints, the tissues which
surround joints, and other connective tissue. These conditions range from relatively mild forms of
tendonitis and bursitis to systemic illnesses, such as rheumatoid arthritis. Typically, arthritis
conditions are characterized by pain, stiffness and or deformity of the joints which can substantially
reduce the quality oflife.
Using data from Local Area 43 to represent the Exploits H ealth Serve Area, 20.2% of the population
report having arthritis. This is slightly higher than Central H ealth but lower than the provincial
statistics at 19.9% and 23.2% respectively. In Canada the rate is lower at 15.7%. W hile still lower than
the Province, the percentage of people living in Central H ealth with arthritis within the 65+ age
group is much higher at 42.3% and much higher in women than men (CCH S 2009-10). The following
table shows arthritis percentage by sex, 65 years and over for Central H ealth and the province of
N ewfoundland and Labrador (CCH A 2009-10).
84
A rthritis cont’d.
Central H ealth
N ew foundland
Total
42.3
47
Male
27.3
36.2
Fem ale
55.7
56.2
5.6.5 A sthm a
Asthma is a chronic health disorder affecting a substantial proportion ofchildren and adults
worldwide. It is a chronic inflammatory disorder ofthe airways characterized by coughing, shortness
ofbreath, chest tightness, and wheezing. Asthma symptoms and attacks (episodes ofmore severe
shortness ofbreath) usually occur after exercise, exposure to allergens, viral respiratory infections,
irritant fumes, or gases (Public H ealth Agency ofCanada, 2012). The percentage ofpeople diagnosed
with asthma in Central H ealth is 6.5% which is lower than the province and Canada at 8.4%
(Canadian Community H ealth Survey-CCH S, 2009-10).
5.6.6 Chronic O bstructive Pulm onary D isease
Chronic O bstructive Pulmonary D isease (CO PD ) includes such disorders as chronic bronchitis or
emphysema. In the 2009-2010 CCH S, within Central H ealth, 3.9% of the population aged 35 and
over were diagnosed as having CO PD , compared to 4.9% ofthe population in the province. The rate
in Canada was 4.2%. These rates showed very little change from what was reported in 2010.
5.6.7 Cancer
According to Statistics Canada (2011), cancer incidence has been on a steady rise in N ewfoundland
and Labrador for a number ofyears. The incidence rate per 100,000 population went from 412.1
(0.4%) in 2003, to 570.7(0.6%) in 2009. According to the Canadian Cancer Society (CCS) (2012) it is
estimated that there will be a total of3,150 new cases ofcancer in N L this year. O fthese, 1,750 will
occur in men, while the other 1,400 will occur in women. In addition approximately, 790 men and
630 women will die from cancer this year (CCS, 2012).
The most common types ofcancer in men are prostate (27%), lung (14%), and colorectal (13 %). The
most common types ofcancer in woman are breast (26%), lung, (13%), and colorectal (12%).
(Canadian Cancer Society, 2012)
Research has shown that you can reduce your chances ofgetting cancer by living a healthy lifestyle.
About halfofall cancers can be prevented through healthy living and policies that protect the health
ofCanadians (CCS, 2011).
According to the CCH S 2009 -10, there were 349.8 (0.35%) cases ofcancer per 100,000 people in
Central H ealth. W ithin the province in that year, there were 382.6 (0.4%) cases per 100,000. The
percentage ofpeople diagnosed with cancer in Central H ealth in 2010 was 1.8% which was in line
with the rate in the country at 1.9% and slightly lower than the provincial rate of2.1%
85
5.6.8 Mood D isorder
The percentage ofpeople reporting that they had been diagnosed by a health professional as having
a mood disorder, such as depression, bipolar disorder, mania or dysthymia in 2010 in the Central
H ealth was 4.6%. This is lower than the rates in the province (5.2%) and Canada (6.6%). There was a
noticeable difference in diagnosis based on gender with 8% ofthe female population diagnosed
with the disorder in Central H ealth and 0% in men.
5.6.9 Stroke
According to the Canadian Stroke N etwork, stroke is an interruption ofthe blood supply to the brain
or the rupture ofan artery causing bleeding into or around the brain (2011). Stroke is one ofthe
leading causes oflong-term disability and death. Measuring its occurrence in the population is
important for planning and evaluating ofpreventive strategies, allocating health resources and
estimating costs. From a disease surveillance perspective, there are three groups ofstrokes: fatal
events occurring out ofthe hospital, non-fatal strokes managed outside acute care hospitals and
non-fatal strokes admitted to an acute care facility. Although strokes admitted to a hospital do not
reflect all stroke events in the community, this information provides a useful and timely estimate of
the disease occurrence in the population (Statistics Canada H ealth Profile 2013). D uring 2008-2009
15% ofpatients admitted to a hospital in N L were cases related to a stroke event (The Q uality of
Stroke Care in Canada, 2011).
A stroke event can have serious implications for the individual, their family, and society as a whole.
Some ofthe side effects ofa stroke include permanent to partial paralysis, short term memory loss,
depression, pain and tiredness (H ealth Canada 2011). As indicated by the Canadian Stroke N etwork,
“7.1% ofCanadians between the ages of65 -74 are living with the effects ofa stroke” (2011). W ithin
Central H ealth, in 2012, there were 133 (0.13%) hospitalized stroke events per 100,000 ofthe
population. Provincially, the rate was 146 (0.15%) per 100,000 (D ischarge Abstract D atabase,
Canadian Institute for H ealth Information - CIH I).
5.7 Chronic Pain
The W orld H ealth O rganization defines chronic diseases as, “diseases oflong duration and generally
slow progression. In N ewfoundland and Labrador, the rates ofchronic disease are significant. O f
residents 12 years ofage and up, over half(approximately 61 per cent) report having at least one
chronic disease¹, and many have more than one. Chronic disease is the biggest threat to the health
ofthe population and to the sustainability ofthe health care system. It also poses a significant
challenge for communities and the labor force where good health is essential for the well-being of
individuals and the continued prosperity ofthe province. The human and economic costs ofchronic
disease cannot be ignored. (Improving H ealth Together – A Policy Framework for N ewfoundland and
Labrador – 2011)
86
5.7.1 Pain or D iscom fort,Moderate or Severe
According to Canadian Community H ealth Survey, Statistic Canada, (2011/2012) 15.5% the
population aged 12 and over in Central H ealth reported that they usually have pain or discomfort.
Provincially the rate is a little less at 15.3%. Females report having more pain than males. The
following is a table that shows comparisons between Central H ealth and the province.
Pain or D iscomfort
Total
Males
Female
Central H ealth
15.5%
15.3%
15.6%
N ewfoundland
15.3%
13.3%
17.1%
5.7.2 Pain or D iscom fort that Prevents A ctivities
14.3 % ofCentral H ealth’s population 12 and over reported having pain and discomfort that
prevents activities, females report 15.4% while males are 13.2%. The provincial numbers are
slightly different at 15.5% total, 17.6% females and 13.2% males.
5.8 Participation and A ctivity Lim itation
According to the Canadian Community H ealth Survey (2009-10) 30.3% ofthe population 12 years
and over in Central H ealth experience participation and activity limitations due to health issues. The
provincial rate is slightly lower at 31.2%. The rate increased with age with 46.1% ofthe population in
Central H ealth having this limitation sometimes or often.
5.9 D isability or D eath
The number ofpersons in N ewfoundland and Labrador aged 15 and over reporting disabilities in
2006 was approximately 14.9%, a slight increase from 14.0% in 2001. In the 65 and over age group
36% reported living with at least one disability in 2006, compared with 39.0% in 2001. In the 15 and
under age group 3.9% reported living with a disability, an increase from 3.3% in 2001. This rate is
now higher than the national rate of3.7% for children under 15. The Participation and Activity
Limitation Study (PALS), a national study designed to collect information on adults and children who
have a disability, that is, whose everyday activities are limited because ofa condition or health
problem, confirm that the disability rate increases with age.
87
D isability or D eath cont’d.
Using the communities (Bishop’s Falls, Botwood, N orthern Arm, Peterview, Point Leamington and
Leadings Tickles) to represent the EH SA there were 110 deaths reported in 2012. (Community
Accounts – General Profile 2012) D ata from other communities within the EH SA was unavailable.
For the same period Central H ealth had 960 deaths and the province reported 4590. The median age
ofdeath for Central H ealth is 79 and the province is 78 years old.
5.10 Morbidity and Mortality
H ospital morbidity refers to the number ofseparations from hospitals due to discharges, transfers
and deaths. It is based on the diagnosis most responsible for patient stay, including multiple
separations/re-admissions for the same individual. The following chart shows hospital
morbidity/separations by diagnosis for 2008/09 comparing the EH SA to Central H ealth and the
province. D ata is from Community Accounts General Profile.
Hospital Morbidity/Seperations 2008 - 09
18
15.6 15.5
16
14
12
10
8
7.7
9.5
7.6
6.8
6
5.9
5.6
6.5
6
5.2
9.9
11.6
9 .1
10.6
12.8
9.8
Local Area 43
Central Health
5.8
Newfoundland
4
2
0
Cancer
Injury &
P oisoning
Di sease of the Disease of the Disease of the Disease of the
Genitourinary
Respiratory
Digesti ve
Circu latory
System
System
System
System
Percent
Morbidity rates are influenced by the age structure ofthe population. The median age ofindividuals
diagnosed with diseases ofthe circulatory system in the Central H ealth region was 71 years ofage
(69 years for males and 75 years for females) and 76% ofthose admitted for disease ofthe circulator
system were over the age of60. In 2008-09, the median age ofall hospital admissions was 57 years
(61 years for males and 53 years for females), which was among the highest ofthe regional health
authorities and was higher than the provincial age of53 years. 39% ofhospital admissions occurred
in the 65+ age group, which was 5% higher than the province (34%). This is not surprising
considering that the Central H ealth region has an aging population.
88
Mortality
Information about mortality can be used to assess the health status ofthe population. Mortality
rates are often calculated for specific diseases or conditions and act as indicators ofpopulation
health. In 2010, the Central H ealth region had a total of925 deaths. 79% ofindividuals were aged 65
and older, which is comparable to the province (78%). See the pie graph for a breakdown ofdeaths
for age groups in Central. The bar graph reflects the number ofdeaths by sex in the Central H ealth
region from 2003-2010. In 2010, males in the region had a higher number ofdeaths (55%) than that
ofthe province (52%). Among the four health authorities, males in the Central H ealth had the
second highest number ofdeaths. As can be seen in the figure, males consistently have a higher
mortality rate than females.
U nder 20
20-49
50-64
65+
Males
Fem ales
2010
2009
2008
2007
2006
2005
2004
1,000
800
600
400
200
0
N um b er of D eaths b y Sex Central
Region
(2003-2010)
2003
# ofPersons
N u m b er o f D eaths b y A ge Central
R egion (2010)
Total
The crude mortality rate refers to the number ofdeaths per 1,000 individuals in a given year. In 2009,
the crude mortality rate was 9.67 per 1,000 people living within the Central H ealth region, which has
decreased slightly since 2006. Among the four regional health authorities, Central had the highest
mortality rate and was higher than the provincial rate of8.55. (Central H ealth Regional; Report 2012)
The number ofinfant deaths in the Central H ealth region was 19 in 2009 with an infant mortality rate
of7.8, which is higher than the provincial rate of6.1. See the graph below for comparisons between
the regional health authorities and the province from 2005-2009.
89
Prem ature Mortality
Premature deaths are those ofindividuals who are younger than age 75 expressed as the mortality
rate and potential years oflife lost (PYLL). PYLL is the number ofyears ofpotential life not lived when
a person dies before age 75. Premature mortality is an overall indicator ofpopulation health that
reflects deaths at younger ages. It can be used to guide efforts on health promotion and disease
prevention. For Central H ealth, the rate per 100,000 for 2006-2008 was 281. The rate for
N ewfoundland and Labrador was 307 and Canada was 259. The age-standardized PYLL per 100,000
was 4,811 for Central, 5,317 for N ewfoundland and 4,533 for Canada (Vital Statistics D eath D atabase,
Statistics Canada).
Potentially A voidab le Mortality
Potentially avoidable mortality is defined as deaths before age 75 that could potentially have been
avoided through all levels ofprevention (primary, secondary, tertiary). It refers to untimely deaths
that should not occur in the presence oftimely and effective healthcare or other public health
practices, programs and policy interventions. It serves to focus attention on the portion of
population health attainment that can potentially be influenced by the health system. For Central
H ealth, the rate per 100,000 for 2006-08 was 188, which was the lowest among the regional health
authorities, lower than the provincial rate (220) but slightly higher than the national rate (187). The
PYLL for Central was 3,287, which was also the lowest among the regional health authorities, the
province (3,967) and the country (3,428) (Vital Statistics D eath D atabase, Statistics Canada).
A voidab le Mortality from Preventab le Causes
Mortality from preventable causes is a subset ofpotentially avoidable mortality, representing deaths
before age 75 that could potentially have been prevented through primary prevention efforts. This
indicator informs efforts to reduce the number ofinitial cases (incidence reduction). Through these
efforts, deaths can be prevented by avoiding new cases altogether. For Central H ealth, the avoidable
mortality rate from preventable causes per 100,000 for 2006-08 was 114, which is lowest among the
regional health authorities and lower than the provincial rate (132) and national rate (120). The PYLL
for Central was 2,061 per 100,000, which was also among the lowest ofthe regional health
authorities and was lower than the province (2,285) and the country (2,141) (Vital Statistics D eath
D atabase, Statistics Canada).
A voidab le Mortality from Treatab le Causes
Mortality from treatable causes is a subset ofpotentially avoidable mortality, representing deaths
before the age of75 that could potentially have been avoided through secondary or tertiary
prevention. The indicator informs efforts aimed at reducing the number ofpeople who die once
they have the condition, or case-fatality reduction. For Central H ealth, the avoidable mortality rate
from treatable causes per 100,000 for 2006-08 was 74, which was among the lowest ofthe regional
health authorities, was lower than the provincial rate (88) and higher than the national rate (66). The
PYLL for Central was 1,200, the lowest among the region and lower than the provincial (1,682) and
national (1,286) rates (Vital Statistics D eath D atabase, Statistics Canada).
90
Leading Cause of D eath
The leading cause ofdeath in the Central region in 2006 was circulatory system diseases (36.3%)
which is down by 1.2 percent from the previous year. The second leading cause ofdeath was cancer
(26.3%) which is also down by 1.3 percent from the previous year and endocrine, nutritional and
metabolic diseases (6.8%), which is down by 2.5% from the previous year. The following graph
reflects the leading causes ofdeath for the region in 2006.
5.11 H ealth O utcom es Sum m ary
• W hile a high percentage ofcitizens rate their mental health statues as very good or
excellent there seems to be an increase in the request for awareness and education
and mental health issues in general are on the rise.
• O verweight, obesity and limited physical activity is a common concern for most all age
groups in Exploits.
• D espite our efforts our chronic disease rates in central N ewfoundland still remain
some the highest in Canada.
6. Com m unity A ssets
Primary H ealth Care is the first level contact with people taking action to improve health in a
community using a population health approach. This approach attempts to facilitate the integration
ofall services across the continuum. Many services already exist but may not be highly visible or
‘connected’. By attempting to identify all stakeholders in the Exploits area, this process will be more
effective in identifying gaps in service or underutilization ofexisting services.
91
Com m unity A ssets cont’d.
The W orld H ealth O rganization defines intersectoral collaboration as a recognized relationship
between sectors ofsociety to take action on an issue to achieve health outcomes in a way that is
more effective, efficient or sustainable than might be achieved by the health sector acting alone.1
A true primary health care model will have many stakeholders to bring into the delivery ofcare. The
following list excludes the primary health care providers already referenced.Stakeholders identified
in the Exploits area, excluding primary health care providers previously referenced, include but is not
limited to:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Ministerial Group
Exploits Community Advisory Committee
Local Church Groups
Seniors Resource Groups
Family Resource Centre
Senior’s H ousing Committee
Community Youth N etwork
Child Care Providers
Service clubs, e.g. Lion’s, Kinsmen
50 + and Seniors Clubs
Chamber ofCommerce
Municipalities and Local Service D istricts
Local Recreation Councils
Point Leamington Ambulance Service
Freake’s Ambulance Service
D epartment ofJustice/RCMP
Crime Prevention Committees
H uman Resources, Labour and Employment
N ova Central School D istrict
Central Regional W ellness Coalition
N ewfoundland and Labrador H ousing Corporation
Public Libraries Board
D epartment ofVeteran’s Affairs
Local Fire D epartments
Emergency Alert Foundation (Aliant)
H ome Care Agencies
Botwood Interfaith Goodwill Centre/Board and Grand Falls Food Bank
Botwood Boys and Girls Club
Your Strength is O ur Strength Club (Peterview)
Unions and Associations representing primary care providers, para health professionals and
other healthcare workers included by may not be limited to:
Association ofAllied H ealth Professionals
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
92
Association ofN L Psychologists
Association ofRegistered N urses ofN ewfoundland and Labrador
Canadian Association ofMedical Radiation Technologists
Canadian D iabetic Association
Canadian Society ofH ospital Pharmacists - N ewfoundland and Labrador Branch
Canadian Society ofMedical Laboratory Science
Council for Licensed Practical N urses
N L Association ofPublic and Private Employees
N L Board ofExaminers in Psychology
N ewfoundland and Labrador Massage Therapists’ Association
N ewfoundland and Labrador Association ofO ccupational Therapists
N ewfoundland and Labrador Association ofSocial W orkers
N ewfoundland and Labrador Association ofSpeech, Language Pathologists and Audiologists
N ewfoundland and Labrador College ofPhysiotherapists
N ewfoundland and Labrador D ental Association
N ewfoundland and Labrador Medical Association
N ewfoundland and Labrador N urses Union
N ewfoundland and Labrador Therapeutic recreation Association
N ewfoundland and Labrador Recreation Association
Central Regional W ellness Coalition
Society ofRural Physicians and Royal College ofPhysicians and Surgeons.
7. Strengths,Challenges and O pportunities
Primary H ealth Care is the first level essential care which includes promotion, preventative, curative,
rehabilitative and supportive services. The utilization ofthe primary health care model has been
based on the following principles:
Public Participation
Accessibility to health services
H ealth Promotion
Interdisciplinary/Intersectoral Collaboration
Appropriate Provider
Technology and Evidence based practice.
Based on the features ofthe Primary H ealth Care Framework D ocument, the following strengths,
challenges and opportunities have been identified in the PH C area in 2007 and updated in 2010.
Prim ary H ealth Care Team : Provides interdisciplinary services and work together to promote health
and wellness, provide comprehensive primary health care services; and within the available
resources, respond to the health needs ofthe population. W here teams operate from multiple sites,
coordination and communication is vital for effective delivering ofservices.
93
Strengths:
•
•
•
•
•
•
O ne governance board for health services
Majority ofdirect health care providers operate from two locations in Botwood.
O ne N urse Practitioner with a PH C focus as well as chronic disease management.
Staffand citizens in Exploits have a good understanding ofPH C, determinants of
health and the population health approach.
Staffcurrently collaborates to manage complex cases, palliative care, respite care and
PH C initiatives.
O ttawa N ursing Model implemented in long term care
Challenges:
• Understanding ofteam member roles.
• N ew management structure and operational review have created many changes to staffing
and operations.
• Current system focuses on illness, rather than prevention.
O pportunities:
• Focus on team building in the Exploits area, including roles and responsibilities, reporting
structures and communication.
• Public education targeted on injury and prevention and efficient use ofemergency services
Prim ary H ealth Care N etw ork: The Primary health care network consists ofa group ofservice
providers whose expertise is needed by the primary health care team, on a consulting basis, to
provide appropriate and comprehensive care. These service providers may be regional employees or
independent practitioners who provide service on a contractual basis.
Strengths:
•
•
•
•
Currently have many services available in the region, board employees or private, notfor-profit or volunteer based.
Strong involvement ofministerial/spiritual care group
Agreements with many professional/educational programs encourage rural
placements, creating a healthy awareness ofrural issues and a positive impact on
recruitment, i.e. Senior Medical O fficer Physician has an appointment with Memorial
University ofN ewfoundland and is a Clinical Associate with the D epartment ofFamily
Medicine.
Telehealth technology available to support the PH C network and practice. N urse
Practitioner dedicated to attend/coordinate appointments with oncology.
94
Challenges:
•
•
•
•
•
•
•
•
Limited understanding ofroles and responsibilities.
Limited physical space to accommodate visiting network members
Services available but not always integrated or consistent approach with all providers.
Limited discharge planning for complex care cases.
H igh turnover rate ofthe front line staffin some areas
O ften a crisis management approach to service delivery.
Providers currently working in “silos” or pockets to manage chronic disease.
Telehealth technology/network not fully utilized/ integrated with the local team.
O pportunities:
• Continue to educate all stakeholders and the public about PH C.
• To develop strategies to increase education/ awareness of, and access to, network
providers/services.
• Explore more opportunities for team building and role enhancement.
• Connect N urse Practitioner with Telehealth Coordinator for education purposes,
particular to enhancing services and better utilization ofsame.
A ccess: The goal outlined in the Provincial Primary H ealth Care Framework (2003) is that by 2007
95% ofthe population will be able to access 24/7 primary health care services within 60 minutes
travel time.
Strengths:
•
•
•
•
•
•
•
•
•
All residents in the catchment area can access PH C services within the 60-minute
travel time.
W ith the exception ofmedical clinic in Bishop’s Falls, all services are located in
Botwood.
D iabetes clinic services available in Botwood coordinated by D ietitian in collaboration
with N urse Practitioner
Pre Assessment clinic for pre-operative care is available in Botwood.
D iagnostic Services (Laboratory and X-ray) are available in Botwood
Three Personal Care H omes in PH C area.
Access to services provided through a complex H uman Resources Labour and
Employment structure is accessed through a 1-800 number and calls directed to the
appropriate service provider
Toll Free 24/7 Telehealth service (H ealthLine) available, providing initial contact with a
qualified health provider.
Utilization oftelehelth technology.
95
Challenges:
• Retention ofqualified ambulance personnel, especially community based service in Point
Leamington.
• N o rehabilitative/recreation programs for mental health clients
• N o registration ofthe population; rostering may be perceived as limiting choices.
• N o supported living arrangement for clients in situations where clients need more than the
available home supports but wish to remain at home.
• Limited public transportation/no public wheelchair transportation
• Bereavement Counseling and Support services are lacking in the area.
• N urse Practitioner available at the D .H .T.H .C.
• D ifficult to recruit/retain appropriate caregivers, especially for challenging needs cases in
more remote communities.
• Community based palliative care services available.
O pportunities:
• Advocate for home-based services, e.g. recreation, meals on wheels.
• Advocate for provision ofappropriate transportation for disabled clients.
• D evelop liaison with D isabilities Association to increase public awareness ofaccessibility
issues for all public areas.
• Explore options to expand the N urse Practitioner service.
Physician N etw orks: Primary care physicians are integral members ofthe Primary H ealth Care Team.
Strengths:
• Primary care physician has maintained practice in Bishop’s Falls for 20+ years.
• Currently complement offive physicians provide service at the D r. H ugh Twomey H ealth Care
Centre
• 24/7 on call services available at D H TH CC and at CN RH C
• Physicians in Bishop’s Falls have admitting privileges at CN RH C and are able to maintain
continuity ofcare.
• The current Senior Medical O fficer Physician has an appointment with Memorial University of
N ewfoundland and is a Clinical Associate with the D epartment ofFamily Medicine.
• The D .H .T.C. has created physical space to accommodate medical students and rotations at
both facilities including the E.C.H .C. This supports the ongoing recruitment efforts ofCentral
H ealth ofattracting GPs to practice at a rural setting.
96
Challenges:
•
•
•
•
•
Many residents ofarea routinely access physician services in Grand Falls-W indsor, but seek
after hours care in Botwood.
Recruitment and retention for the Bishop’s Falls clinic and Botwood
Physician (Bishop’s Falls) service has liaison with CN RH C (provides on call and O R assist
services) but no liaison with Botwood based providers, except public health and continuing
care nurses.
O ngoing challenge to maintain proficiency in emergency skills and interventions
Physicians based in Botwood do not have admitting privileges so must transfer care for
inpatients.
O pportunities:
• Explore opportunities to increase physician networking throughout the area to include all
providers.
• D evelop a general orientation that is inclusive to all providers including physicians to ensure
knowledge ofprimary health care delivery model and services available in the Exploits area.
• D evelop and implement a model for service delivery that facilitates a collaborative
environment, full scope ofpractice and enhances recruitment and retention.
Scope of Practice: Refers to the range ofactivities that a qualified practitioner may undertake. It
establishes the boundaries ofan occupation, especially in relation to other occupations where
activities may be shared. Scope ofpractice may be established through governing legislation or
internal regulations ofa regulatory body. (Glossary ofterms, H RD C, 2002) The intent ofPH C is to
encourage the most efficient use ofresources and one way is to promote team members to practice
full scope. This is fully supported by Central H ealth.
Strengths:
• All ambulance personnel, including community based, meet minimum practice level ofEMRII
• All institution based RN ’s have Advanced Cardiac Life Support Certification
• Community based nurses trained for venipuncture and provide service to housebound
clients.
• LPN s in LTC practice to their scope with medication administration, health assessments,
• O ttawa N ursing Model now in place in LTC.
• catheterization, suctioning, glucometers, wound care and enteral nutrition
• Selflearning modules are available to promote competencies required to meet the complex
care needs ofmany clients
• Base on ARN N L guidelines, community health staffdelegate nursing functions to family
members, home support workers, alternate care givers as deemed appropriate.
• Paramedics practice to their full scope ofpractice
• N P with advanced scope - chronic disease management e.g., diabetes clinic
• Program areas such as BMS and CYFS are exploring core competencies and developing
guidelines for most effective utilization ofservices.
97
Challenges:
• O ngoing challenge to obtain proficiency for advanced skills in a timely manner to keep
abreast ofclient requirements. e.g., the various direct access lines for chemotherapy.
• O ngoing challenge to maintain proficiency in all skills especially where limited practice
opportunities exist.
• Recent changes to some scopes ofpractice, e.g. N P’s, LPN s, so roles/responsibilities are not
always clearly understood.
• Limited opportunities for professional development
• Limited understanding ofroles/responsibilities resulting in fear ofjob loss or unclear
expectations ofsupervision and liability.
• Enhanced skills for clients in high acuity are increasing in the community, presenting a
challenge to balance with prevention and monitoring.
• Sometimes limited clerical support
O pportunities:
• Explore opportunities for team building, education and increased knowledge ofeach other’s
roles.
• Review the scope ofpractice and job descriptions ofall current providers to determine
appropriate skill mix and areas where enhanced scopes will facilitate more efficient and
effective service provision.
Em ergency Transportation: As an integral part ofthe primary health care team the ambulance
service must ensure an uninterrupted flow ofservice between the community, primary health care
sites and secondary and tertiary referral sites. Increased paramedic skills set facilitates earlier
assessment and intervention at first point ofcontact. Emergency transportation is regulated
provincially and services are available through three providers: hospital based, community based
and private service.
Strengths:
• Community based, non-profit ambulance service based in Point Leamington, fully supported
by community.
• Private operator - Freake’s Ambulance - service with 2 vehicles based in Botwood and
additional vehicles/staffavailable in Lewisporte ifneeded.
• H ospital based ambulance service available to Bishop’s Falls.
• Good relationship between all three ambulance provider systems.
• Radio communication between all three providers and base units.
• Air ambulance available and local airstrip can accommodate same.
• Provincial flight teams with specialized training reduces cost and demand on local resources.
• Ground search and rescue, RCMP and Fire D ept. Emergency vehicles can be deployed if
necessary.
• Community based service has up to date vehicle and pager system.
98
Challenges:
• Recruiting and retaining qualified personnel.
• W ages cannot compete with out ofprovince job opportunities
O pportunities:
• Strengthen partnerships to enhance communication, minimize conflict and ensure the most
efficient and effective deployment ofresources.
H ealth Prom otion and W ellness: The W orld H ealth O rganization (1984) adopted the following
definition ofhealth promotion: “H ealth Promotion is the process ofenabling individuals and
communities to increase control over the determinants ofhealth and thereby, improve their health.”
Primary health care promotes initiatives such as increasing knowledge and skills ofindividuals,
building healthy public policy and supporting resources to enhance self-help and social support.
Strengths:
• Schools have adopted H ealth School policies and Q uality School H ealth concepts, with goals
to improve school environments - healthy eating, increased physical activity.
• Many organizations have adopted “junk free” snacks and refreshments
• Several communities have applied for/accessed funds though Central Regional W ellness
Coalition to offer focused activities.
• Lifestyle clinics in throughout Exploits H ealth Service Area.
• Support at the provincial, regional and local level for health promotion
• W ell woman clinics offered annually involving community and facility based staff
• Strong liaison with community based groups/organizations e.g. Family Resource Centre.
• Several communities have seniors groups to encourage socialization and information sharing.
• D evelopment and ongoing work ofthe Chronic disease and Prevention Management
Leadership Team
• Some communities and organizations host annual health and wellness days and health
promotion events supported by local health staff.
• There are opportunities to support public engagement i.e. Exploits Community Advisory
Committee.
• Social media is not being utilized to communicate with citizens informing them ofhealth
promotion events and activities.
• There exist a greater awareness among community citizens and organizations oflocal
community health resources staffand expertise that can be utilized to help support local
health and wellness initiatives.
• Local CD PM Lead team has assumed a supportive/advisory role to community health
promotion.
• Exploits has a good understanding ofthe determinants ofhealth and the population health
approach.
• Community groups and volunteers are very supportive oflocal health promotion initiatives.
99
Challenges:
• Limited coordination in approach to health promotion.
• H igh cost associated with nutritious foods and organized sport/activities
• There is limited healthy eating and physical activity incorporated into the operation of
community/church groups and organizations.
• O ften difficult to encourage citizens to take advantage ofexisting health promotional events
and activities happening in their local communities.
O pportunities:
• Ensure a coordinated, collaborative approach to health, including health promotion
interventions.
• D evelop a mechanism to support and enhance partnerships between all sectors to address
issues that impact on health and well-being. e.g. transportation, housing and physical activity.
• N eed to identify gaps in services for adults/seniors to reflect the demographic shift and
determine the most effective use ofexisting resources, e.g. school buildings, recreation
facilities.
• Community/church groups and organization can be targeted for health initiatives based on
expressed interest and needs.
Com m unity Input and Capacity Building: one ofthe goals ofthe PH C Renewal Initiative is to
establish a Primary H ealth Care Advisory Committee to facilitate community and intersectoral
involvement, to help identify needs ofthe population, and the planning, implementation and
evaluation ofservices. Goals are based on the unique characteristics ofthe population, political
structures and geography.
Strengths:
• Exploits Community Advisory Committee established with 3 priorities selected for 2011.
• Communities show evidence ofcreative capacity building e.g., Leading Tickles with economic
development, Point Leamington with Youth/Recreation, Bishop’s Falls with Community
Profile, Philip’s H ead with Recreation Fundraising.
• PH C Facilitator and Community D evelopment N urse to coordinate and assist with community
capacity building activities.
• Several communities/groups have successfully obtained funding through the W ellness
Coalition to deliver health promotion activities in the community.
• Some community organizations have sustained their health initiatives long after the initial
funding.
• Exploits have developed a good understanding ofthe importance and necessity ofcreating
partnership as a means to achieve desired outcomes.
• Career development course in high school encourages youth volunteering.
• An annual 3 community partnership initiative that recognizes the contributions of
community volunteers and organizations.
100
Strengths cont’d
•
•
•
•
Strong sense ofcommunity and willingness to work collectively, e.g. H ockeyville and Let
Them Be Kids initiatives – Bishop’s Falls – 2010
The development and circulation ofthe primary health care newsletter – ECH O (Exploits
Community H ealth O utreach)
Community Youth N etwork partners with recreation, employment opportunities through
SW ASP and Linkages and other mentoring programs.
Community based Goodwill Centre/Food bank, managed and operated by volunteers, meets
the immediate needs offamilies and individuals.
Challenges:
• Volunteer base is strained in some areas especially with lack ofleadership.
• H igh turnover offront-line staffimpacts continuity ofservice
• Community Youth N etwork only available in Botwood.
• Engaging community input to ensure that programs /services are based on identified needs.
O pportunities:
• Explore opportunities for liaison/partnering with existing groups or organizations to expand
the volunteer base.
• Create public awareness ofvolunteer opportunities and benefits.
• Strengthen the partnership with existing networks to hear the concerns ofyouth.
• To develop/partner with Community Youth N etwork to enhance volunteering and
intergenerational awareness.
• Build an awareness ofvolunteer base through capacity building.
Inform ation and Com m unication Technology: It is well recognized that information and
communication technology is needed to support primary health care renewal. Ready access to
evidence based practice information, consistently updated research information and shared client
information will improve services and care, ifproperly utilized. N ew technology requires significant
funds and almost continuous upgrades to be efficient. This must be balanced against available
resources and many other demands.
Strengths:
• All institution staffhave access to meditech/internal communications
• H igh speed internet is available in most areas ofthe PH C catchment area.
• CAP sites available in Botwood, Bishop’s Falls, Point Leamington, Leading Tickles, Cottrell’s
Cove.
• EKG system transmission available at D r. H ugh Twomey H ealth Care Centre
• All community based staffhave access to CRMS and Groupwise
• PAC system in X-ray. (D igital imaging and transfer to referral site)
• Toll free 24/7 Telehealth service available throughout the province/region, providing initial
contact with a qualified health provider.
• Community based ambulance service has pager system
• Conference call systems and video conferencing equipment are utilized for meetings which
are more cost effective ways to conduct regional meetings.
101
Strengths cont’d
•
•
•
•
IT support available to all staff.
Electronic databases support continuity ofcare and have the capacity to retrieve information
and statistics
The utilization oftelehealth technology for specialty appointments at D H T.
The development ofan internal communication message board at D H T with plans to
additional units in O PD , Emergency and Patient waiting areas.
Challenges:
• Medical Clinic (Bishop’s Falls) not connected to Meditech
• CRMS and Meditech are not linked, resulting in duplication.
• Many clients not comfortable with automated phone system
• N o toll free numbers for clients to access local services.
• Lack ofelectronic health record
• Understanding the role ofthe new telehealth service and how it interfaces with current
providers
• Current internal/external service listings are not user friendly, making it difficult to access
appropriate provider or service.
O pportunities:
• Explore opportunities for communication. e.g. link between Groupwise and Meditech. ¤
• Encourage and support implementation ofall modules for Meditech and CRMS. ¤
• D evelop and implement an integrated electronic health record, accessible to all providers
• D evelop an integrated directory for all PH C providers ¤
• Ensure user-friendly public directory for service providers.
• Promote H ealthLine and Telehealth services .
8. Sum m ary
Community and health provider consultations took place in the fall of2013 and winter of2014. The
purpose ofconsultation is to engage both citizens and health providers in a process that involves
assessing the health ofthe community as whole by identifying current assets and strengths, gaps
and challenges and potential opportunities. This assessment will aid in developing local health
priorities that could help maintain and improve the current health and wellbeing ofcitizens in
Exploits.
Stakeholders from all communities, identified by the Exploits Community Advisory Committee, were
invited to attend representing groups in the areas of: municipalities, education, local service groups,
seniors, business industry, ministerial, community and youth organizations. Seventeen participants
attended the community consultation session in N orthern Arm on N ov. 14, 2013. Community
Consultation Session H ighlights 2013 is included in Appendix A.
102
Sum m ary cont’d
Similarly, a health provider consultation was conducted over the month ofFebruary 2014 in the
form ofa survey. Twenty five health providers completed the survey which included: 5 Physicians, N urse Practitioner, D ietitian, Community Supports Social W orker, Care Facilitator, 4 Licensed Practical N urse, Recreation Therapists ,Personal Care Attendant, Clinical N urse
Educator,4 -Public H ealth N urse, 2 -Continuing Care N urse, Client Care Manager, X-Ray
Technologist, LTC/ER N urse. The H ealth Provider session highlights is included in Appendix B.
The analysis ofboth consultations, community and health provider, revealed many similarities
and common themes and messages indicating that everyone shares a common vision ofour
current health statues in Exploits. Some ofthe more predominant themes and messages show
that there are many good supportive community assets and opportunities that exist to promote
health and wellness. Furthermore, citizens and health providers are very fortunate and pleased
to have and to provide access to quality primary health care services and programs within the
Exploits H ealth Service Area. There is also a shared understanding that there are many
challenges and opportunities that requires attention. Some ofthe more notable ones include:
the prevalence ofchronic disease, poor nutrition, physical inactivity and mental health issues. In
addition, there seems to be a culture that still exists where some citizens lack responsibility for
selfmanagement ofones health which can be verified by the low participation rate among
existing health and wellness programs and community initiatives. Another commonality
expressed in the consultations was, although we have access to quality health services and
programs within the Exploits H ealth Service Area, some can be utilized more efficiently and
effectively.
O fall the challenges, gaps and opportunities revealed there was one clear message that is
essential and applicable to all, and that is the continued need for health promotion and
education focusing on prevention. This message we so clear that on April 8, 2014 the Exploits
Community Advisory Committee decided to re-establish their local health priorities previously
developed in 2010. The CAC determined that the existing priorities were still very current and
relevant to the EH SA. The local health priorities for Exploits re-established in 2014 are as follows:
1. Improving H ealth and W ellness for the Citizens ofExploits.
2. Chronic D isease Prevention and Management.
3. Mental H ealth
103
Sum m ary cont’d
The Exploits Primary H ealth Care Leadership Team which includes: D irector ofH ealth Services,
N urse Practitioner, Client Care Service Managers, Senior Physician, Community D evelopment
N urse and Primary H ealth Care Facilitator are now tasked with reviewing the Exploits
Community Profile in its entirety. The review could involve identifying key areas ofthe profile
that may result in action planning pertaining to the following:
1. Continue to support existing community health and wellness projects and initiatives.
As well as the development ofnew ones based on needs identified in the profile.
2. Identify operational inefficiencies and in consultation and collaboration with
stakeholders, develop strategies and implement initiatives to enhance operations.
3. Ensure that the Exploits local health priorities and Central H ealth Strategic Issues are
communicated frequently and are at the focal point ofthe work in primary health
care over the next the next four years.
104
Reference List
Canadian Association ofEm ergency Physicians (CAEP) - http://caep.ca/resources/ctas 2014
Central Health Hum an Resources D epartm ent - 2014
Central Health Im m unization Reports (Influenza Vaccines Adm inistered in Exploits Region 20082014)
Central Regional Health Authority- 2014.
Central Screening Initiatives (2003-2013). Cervical Screening Statistical Inform ation forExploits.
Healthline Service Report forN L D epartm ent ofHealth and Com m unity Service:Special Report-CRHA.
2013.
D epartment ofH ealth and Community Services (2002). HealthierTogether:A Strategic Health Plan
forN ew foundland and Labrador. Government ofN ewfoundland and Labrador
D epartment ofH ealth and Community Services (2006). Healthy Aging forAll In The 21st CenturyD iscussion Paper. Government ofN ewfoundland and Labrador.
Exploits Com m unity/ProviderFocus G roup Session – 2013.
Exploits Health ProviderSurvey 2014
H ealth Canada, Canadian Tobacco Use Monitoring Survey (CTUMS) 2006-2008.
www.hc-sc.gc.ca/hl-va/tobac./research, March 20, 2007
Internet G am bling:Prevalence,patterns,problem s,and policy options,final report forthe O ntario
Problem G am bling Research Centre;Guelph, O ntario, W ood. R.T. & W illiam s,R.J. (2009,January)
Moving Forward Together: M obilizing Prim ary Health Care – Sept 2003
N ewfoundland and Labrador Centre for H ealth Information (2002 -2005). M y People W here:
Hospital Separations and Length ofStay by Region ofResidence,N ewfoundland and Labrador
2003-2004.
N ewfoundland and Labrador Statistics Agency. Road D istance D atabase. Government of
N ewfoundland and Labrador. www.stats.gov.nl.ca/datatools/roaddb/distance.default.asp
Statistics Canada Census (1996/2001/2006/2011). Com m unity Profiles. Government ofCanada.
www.statcan.ca/start.ht.html
Strategic Social Plan O ffice. Com m unity Accounts ofthe Strategic Plan. Government of
N ewfoundland and Labrador. www.communityaccounts.ca
105
Appendix A
Com m unity Consultation Session,N ovem ber14,2013.
O n N ov. 14, 2013 key citizens from all communities in Exploits were invited to a community
consultation session at the United Church H all in N orthern Arm. The 17 citizens in attendance
represented a variety ofsectors within our communities: municipal councils, youth, seniors,
service clubs, private business, church organizations and health care. Participants were given
a snapshot ofthe last 3 – 4 years ofour work and then they were engaged in discussions that
prepared them for answering a series ofquestions pertaining to their own health views and
the health status ofthe community as a whole. Turning Point Technology was utilized in this
session which allowed participants to vote following discussions on what was most important
to them. The following are slides from the session which show details ofthe snapshot review
and the questions with responses which was voted on by participants.
Exploits Com m unities
Bishop’s F alls
Botwood
Peterview N orthern Arm
Phillip’s H ead Point ofBay Cottrell’s Cove Fortune H arbour
Point Leamington Glover’s H arbour Leading Tickles
106
Agenda
1.
2.
3.
4.
5.
6.
7.
Community Health Assessment (CHA) Process.
Recent local health priorities – 2010
Current heath initiatives - Exploits
Environmental community profile scan of the Exploits
Health Service Area – demographics and health data
30 minutes
Induction to the CHA session and the technology .
Community health assessment session
Wrap up and evaluation
90 minutes
What is a Community Health
Assessment?
• Ongoing appraisal of community health.
• It helps to identify community assets,
strengths and challenges.
• It’s a guide that aids us in establishing
local health priorities to improve our health
status.
• Based on the population/determinants of
health approach.
107
What is Population Health?
• A way of looking at health and services
• It focuses on the needs of our entire
population.
• Based on the determinants of health.
Determinants of Health
Factors that contribute to the state of health and
well-being of a population and individuals.
108
Local Health Priorities
Established in 2010
• Improving health and wellness for children, youth
and families #1
• Chronic disease prevention and management #2
• Mental health #3
• Education and literacy – reaching out to adults
• Health promotion and education
• Improving accessibility and affordability of health
services
• Community safety, security and sustainability
• Reaching out to low income families and individuals
Health Initiatives 2010-2013
A collaborative Approach!
Food and Fun
Camps - Children
CDSM Program
Workshops
Indoor Walking
Programs
Diabetes Sessions Annual Healthy
ECHO Newsletters Living Seminars
Community
Kitchens programs
Community
Garden - Exploits
Community
Capacity Building
Community
Consultations
109
Health Initiatives
Oh by the Way!
We’re on
Face BookExploits
now! Flu
Info. Sharing/
Community
Networking
Health/Promotion Clinics
Healthy Eating
Promotion
Physical Activity
Projects
Volunteer
Recognition
Mental Health
Education
School Health
Projects
Grocery Store
Initiative
1.
2.
3.
4.
5.
6.
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110
Exploits Community Profile
Demographics
• 4% decrease in population from 2006 (9566) to
2011 (9208)
• All age groups from 0-54 have decreased. 55+
have increased by 28% from 2001 – 2011.
• Median (average) age of citizens in Exploits is
49.9. Median age in 2001 was 40.3.
• Birthrate is relatively stable with 60 births in
2012.
• The highest out migration exist in Leading
Tickles and Division 8 Subdivision E, 17% and
23% respectively.
Demographics
• Education levels in communities range from 19.4% 78.6% - who do not have a high school diploma. (2006)
• School enrollment (7 school in Exploits) is down by 18%
from 2006 – 2013.
• 61% of those employed work in the service
industry.(2006 census)
• Unemployment rate in communities ranges from 24.7%
to 57.9% (2006 census)
• Employment Insurance ranges from 37% - 70% (2011)
• Personal Income per capita ranges from $13,200 –
$23,700 – (2010).
• Income support ranges from 6% to 33% (2011). We are
less reliant than 2006 (9.7% - 56.1%)
111
Demographics
• Housing – 2006 there were 3795 dwellings in Exploits
(81% are owned and 19% are rented)
• 55+ Housing in 2006 87% owned and 14% rented.
• Personal care home capacity 112 beds – occupancy rate
is 63%. (June 2013)
• Long Term Care beds 80 – occupancy rate 100%.
Health Data
• Dr. Hugh Towmey Health Centre
• Long term, respite, palliative and dementia care,
emergency, lab and X-ray, out patient services
• 5 family physicians, 1 Nurse Practitioner, 1
Dietitian.
• Exploits Community Health Centre
• Continuing Care and Public Health, and
Community Development Nursing (8)
• Community Support Social Work (2)
• Behavior Management Services (1)
• Child Youth and Family Services Social Work (5)
• Bishop’s Falls Medical Clinic
• 2 family physicians
112
Health Data
• We have the hig hest rate of diabetes in Canada. 10% of our
population in Central Health.
• 21.4 % of our drinkers are classified as heavy drinkers.
(Males – 33% , Females – 10.4%) – Central Health
• Marijuana is the drug of choice among our NL youth with 47%
of users reporting using 1 or more per week.
• Gambling – VLTs is the gambling preference of choice among
NL gambling addicts. There are 2274 VLTs in 505 sites in NL.
(NL Gambling Prevalence Study 2009)
• Smokers – 20% current Central Health smokers, smoke daily.
(Canadian Community Health Survey – 2009)
• Cardiovascular disease is still the number one cause of adult
deaths in Canada. The rates are increasing at Central Health
and we are slightly higher than the provincial rate and
significantly higher than the national rate.
Health Data
• High blood pressure 26% is the leading self reported
chronic illness followed by arthritis and diabetes. (CCHS –
2009/2010.
• Cancer is on the rise in NL and it is estimated that there will
be 3150 new cases this year. (CCS 2012)
• Our self reported mental health status, excellent – very
good – Exploits is 80%.
• Obesity is on the rise among our school children and adults
here in Exploits. Central Health has the highest obesity
rates compared to other health authorities and the
province.
• 48% of CH population 12 and over rated themselves as
being physically active (CCHS – 2009)
• 60% of the CH population rated their health status as very
good or excellent (CCHS – 2009)
• 83.3% of CH population reported that they feel a sense of
belong to the local community. (CCHS 2009)
•
______________________________
113
Health Data
• Nurses are leading the way in referring
smokers to the Smokers helpline.
• Flu vaccinations administered by public
health nurses in Exploits are up slightly
from last year with 1593 administered in
2012-13.
• We have seen some gains/improvements
in Central Health screening rates (cervical,
prostate, colorectal)
114
What does being healthy mean to you?
Select 3
Free from sickness & disease – 21%
Being physically healthy – 22%
Being mentally healthy – 22%
Being spiritually healthy – 14%
Able to function effectively – 22%
.
..
0%
rs
?
fe
th
e
to
fu
n
O
y
0 %
e
..
a.
.
ly
he
l th
0 %
on
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a
ir i
..
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a
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le
ss
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ly
ic
he
a
sp
ck
ta
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si
ys
ph
en
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ng
g
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n
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n
B
B
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e
0 %
ct
i
0%
Ab
1.
2.
3.
4.
5.
My community is healthy!
1.
2.
3.
4.
Strongly Agree Agree – 47%
Neutral – 35%
Disagree – 12%
5. Strongly Disagree
gr
ee
0% 0%
eu
N
A
0%
tr a
l
Di
sa
gr
ee
gly
Di
sa
gre
e
0%
St
ron
St
r
on
gl
yA
gre
e
0%
115
My Community is healthy because:
Select 3
.
.
.
.
e
.
t
a
0
s
0 %
%
0 %
0%
u
y
s
a
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t
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.
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.
.
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.
.
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1. Clean air, water and soil – 17%
2. Good governance and services – 6%
3. Opportunities for leisure and recreation
pursuits – 20%
4. Adequate healthcare services – 15%
5. Adequate education opportunities – 8%
6. My community is unhealthy -2%
7. Citizens Contributions – 21%
8. Volunteers – 12%
What is currently happening in my
community that keeps people healthy? What
is good here? Select 3. (DRV)
Safe environment – 25%
Active living – 12%
School and community spirit – 4%
Community sports facilities – 8%
Church programs – 9%
Service organizations – 4%
Volunteers – 6%
Safe clean water – 8%
Health care – 17%
Presence of healthy foods – 5%
An
s
we
r
Te
xt
0%
En
te
r
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
116
What is not so good here in my
community? Select 1 (DRV)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Not taking advantage of health and education session.
Limited access/knowledge of technology for seniors.
Cost to participate in sports
Limited cell phone services
Lack of alternate services
Lack of employment – 29%
Community protection – 18%
Substance abuse
Lack of services for youth
Bullying
Voted responses does not add up to 100% - Tech issues!
E
n
t
e
r
A
n
s
w
er
T
e
x
t
0%
What do you perceive to be your
community’s biggest health/ general
problems? Select 3, (DRV)
1.
2.
3.
Wait time to see family doctor – 13%
Gap between low income and booming economy – 15%
Wait time for referrals to follow-up appointments a nd
specialists. – 8%
4. education of how and where to access PHC services. –
0%
5. Cost of living – 7%
6. No continuity of care – 2%
7. Lack of police presence which creates fear among older
adults – 12%
8. Availability of hospital beds and overcrowding – 23%
9. Social Isolation – 14%
10. Lack of self awareness and self management of one’s
health issues. - 6%
E
n
t
e
rA
n
sw
e
r
T
e
x
t
0%
117
What is the biggest issue for you, your
family and your community? Select 1
(DRV)
5.
6.
7.
8.
n
sw
er
Te
xt
0%
nt
er
A
Fixed income – 31%
Long wait times – 13%
Lack of police protection 6%
Lack of prioritization of emergency.
Services – 6%
Lack of available specialists – 13%
High cost of dental services – 6%
Lack of mental health services - 6%
Lack of employment – 19%
E
1.
2.
3.
4.
What would help you and your family to
become healthier? Select 1 (DRV)
1.
2.
3.
Lower prices of fresh fruits and vegetables. – 47%
More policy to promote healthy living. 18%
More social programs. - 6%
4.
5.
6.
Increased employment opportunities. 18%
Increase the price of junk food. – 0%
Increased linkages to access services. – 12%
En
te
rA
ns
we
rT
ex
t
0%
118
What would you say are the greatest
strengths of the health system in your
area/region? Select 1
1. Leadership – 0%
2. Accessibility – 18%
3. Recruitment of HP – 6 %
4. Retention of HP – 6%
5. Adequate health facilities and services. – 71%
0%
0% 0%
0%
0%
.3R
1.
Le
ad
ers
2.A
hi
p
cce
ss
ecr
ib
ui
il it
tm
y
4.
e
R
5.A
et nt o
ent f H
de
io P
qu
no
ate
fH
h
P
eal
th
fac
6. i . .
O
the
rs
0%
Overall, what do you consider to be the
main health and community services
concerns and challenges of your area?
DRV. Select 1.
xt
e
rT
e
sw
Income penalties for homecare access – 6%
Wait times – 18%
n
6.
7.
A
Lack of diagnostic and medical equipment. 35%
Lack of palliative care services – 6%
er
4.
5.
0%
nt
2.
3.
Chronic diseases (diabetes, obesity, hypertension,
cancer) – 29%
Health education - 0 %
Travel distance to access services. – 0%
E
1.
119
In your opinion, how can these health
concerns be reduced or eliminated? DRV
Select 1!
1.
More funding for health care – 24%
2.
3.
4.
More efficient use of resources – 35%
Eliminate unnecessary test. – 0%
More emphasis on prevention. – 18%
5.
6.
Health education. – 0%
Centralized medical equipment – 24%
0%
ex
T
er
w
s
n
rA
e
nt
E
n
sw
e
r
Te
x
t
0 %
A
7.
er
5.
6.
t
4.
Education and awareness – 16%
Prevention and self management of health. – 22%
Holistic approach involving all sectors of society
focusing on early prevention.- 24%
Health education is schools ( healthy foods/eating
initiatives). – 12%
Appropriate medication education. – 3%
Emphasize health promotion – “my own
responsibility”. – 9%
Increase emphasis on health promotion in younger
population. – 15%
En
1.
2.
3.
t
Of all the strengths and challenges we
discussed here tonight, what do you think our
local priorities should be? DRV. Select 2
120
Appendix B
H ealth Provider Consultation Survey Results 2014
Exploits H ealth Provider Survey
D ear H ealth Providers:
It’s time again for us to complete our Community H ealth Assessment (CH A) for the Exploits
H ealth Service Area. Community H ealth Assessments are to be completed in each Primary
H ealth Care (PH C) site every three years, (2014, 2018, etc.) aligning with the development ofa
new three year Central H ealth Strategic Plan. The Community H ealth Assessment is an
ongoing appraisal ofcommunity health that involves the collection ofdata for the purpose of
action planning and local priority setting to improve and sustain the health ofour citizens
throughout Exploits. The key components ofthe CH A include:
1.
2.
3.
4.
Community Consultation – completed N ov. 14, 2013.
H ealth Provider Consultation - Survey
Action Planning and Local Priority Setting
Updated Community Profile.
To complete component 2 we have decided to target key health professionals (physicians,
nurses, social workers, etc.) within our site to complete a simple survey in which the collected
data will be categorized into main themes. Your input and the data collected from the
community consultation on N ov. 14, 2013 session will aide us in completing component 3 –
action planning and priority setting.
The following is a snapshot ofthe CH A back in 2010. Community consultation sessions were
held in several communities throughout Exploits and the data collected resulted in the
development ofthe following local priorities listed in order ofimportance as selected by the
Exploits Community Advisory Committee (CAC).
1. H ealth and wellness for children, youth and families
2. Chronic disease prevention and management
3. Mental health
121
Following the community consultations we engaged our health providers in a similar session
in N ov. 2010 and this is what providers said was important.
1. Improving accessibility ofhealth services and programs.
2. Improving and building on health promotion strategies and initiatives.
3. Employee wellness initiatives to address staffmorale, provider workload,
orientation, recruitment and retention.
4. Enhance recreation therapy services in long term care.
These priority directions and important areas offocus have guided our work in primary health
care over the past 3 – 4 years and have resulted in many ongoing great community initiatives
such as: indoor walking programs, healthy aging education seminars, healthy eating
education and programs for children youth and seniors, community gardening, community
kitchens, chronic disease selfmanagement workshops, active living groups, school health
initiatives, citizen engagement and community capacity building opportunities.
W e have also seen some significant improvements in our health services and programs at the
operation level in the areas of: increase stafffor therapeutic recreation department, current
compliment ofphysicians and nurse practitioner, evening clinic service, medical student
residency, improvements to health records, infrastructure and facility renovations and the roll
out ofthe new O ttawa N ursing Model.
Com m unity Consultation Session – N ov. 14,2013:
O n N ov. 14, 2013 key citizens from all communities in Exploits were invited to a community
consultation session at the United Church H all in N orthern Arm. D ata collected from this
session is included w ith your survey.
The 17 citizens in attendance represented a variety ofsectors within our communities:
municipal councils, youth, seniors, service clubs, private business, church organizations and
health care. Participants were given a snapshot ofthe last 3 – 4 years ofour work and then
they were engaged in discussions that prepared them for answering a series ofquestions
pertaining to their own health views and the health status ofthe community as a whole.
Turning Point Technology was utilized in this session which allowed participants to vote
following discussions on what was most important to them. To see the results ofeach
question please refer to the power point slides included w ith your survey. The evaluation
122
from the session was positive and all in attendance felt it was a worthwhile use oftheir
time and they would participate in similar sessions in the future.
N ow that we have the community data collected its time now to engage you - our providers
in answering similar questions about health and it’s statues in our community. O n the next
page there will be 8 questions to review and answer. Some questions have two or more parts
in one, but completing all ofthem should take only a few moments ofyour time. To help us
analyze and categorize the data in the most effective manner please keep in mind the
following points:
W rite clearly or type directly on the survey and then save it as a file on your com puter.
1. Form alize your thoughts b efore answ ering and w rite or type short
statem ents/responses. Please clarify your statem ents so that your thoughts can be
reported accurately.
2. Please don’t include personal inform ation in your answ ers like nam es,titles or
identifiable characteristics of sam e.
3. It’s not necessary to include your nam e on the survey only your position or title.
4. A dditional com m ents,elab orations,thoughts or ideas can b e added at the end.
25 health providers completed the survey which includes: 5- Physicians, N urse Practitioner,
D ietitian, Community Supports Social W orker, Care Facilitator, 4 - Licensed Practical N urse,
Recreation Therapists ,Personal Care Attendant, Clinical N urse Educator,4 -Public H ealth
N urse, 2 -Continuing Care N urse, Client Care Manager, X-Ray Technologist, LTC/ER N urse. The
sym b ol * represents the frequency ofthe same/similar responses by providers. The responses
to questions 3, 5(Gaps and D ifficulties with Access), and 7 were themed in categories to avoid
repetition.
123
Provider Consultation Q uestions and Responses
1. W hat does being healthy m ean to you? W rite in or click on the text box
and type.
Free from illness/pain******
Functioning, contributing to
oneselfand society****
Able to manage ones health
conditions**
Access to services
Selfawareness ofmind and
body
Participate in and enjoy life**
H olistic health - body, spirit,
mind*
Being smoke free
Taking on challenges,
realizing dreams and goals
Living a balanced lifestyle**
Contributing to the wellbeing
ofothers
Living well*
D eterminants ofhealth
Feeling good mentally**
physically***, socially*,
emotionally, spiritually
H ealthy; eating***, active
lifestyles**, exercising**
weight, sleeping and
laughing.
Being educated, employed
Life contentment and
fulfillment
Selfsatisfaction ofones health Environmental health
124
2. W ould you describe your com m unity as a “healthy com m unity”?
•
•
•
•
36% said community is healthy
24% said community is unhealthy
24% said somewhat (yes and no responses)
16% did not clearly answer
3. W hat w ould it take to m ake your com m unity healthier?
•
A targeted approach to health promotion and education for all ages particularly in the
areas of:
o healthy eating and nutrition
o physical activity
o selfmanagement ofchronic diseases
•
•
Increase opportunity for local employment
Increase community engagement and involvement in existing programs and local health
initiatives focused on healthy living.
4. W hat is currently happening in your com m unity that helps keep people
healthy?
•
•
•
•
•
•
•
•
•
•
•
•
Social supports – church**** families, youth organizations***, service clubs****, community
organizations**, schools
Good access to health services***
A good primary care system that’s evidence based, comprehensive, and provides continuity
ofcare**
Community volunteers*
Smoking cessation program*/smoker help line*
Environment – access to free space, wild food clean air, water and safety*
Community planned events i.e. winter carnivals
Support ofthe Central Regional W ellness Coalition*
Pharmacy support
O ngoing health education**
Support for community groups and volunteers
Full compliment ofphysicians and other H Ps*
125
5. In general,do you believe that residents/citizens in Exploits have
appropriate access to prim ary and em ergency health care? W hat are som e
of the gaps and difficulties w ith access?
•
•
•
•
•
•
84% responded yes
8% responded no
8% responded somewhat
O ur health facilities is a great asset to our citizens**
Community health takes services to the client homes
Being affiliated with the Mun School ofMedicine is an asset.
G aps and D ifficulties w ith A ccess
•
•
•
•
Mental health services particularly in the area ofaddictions support care and services.
Increased wait times to see family physicians
Timely access to long term care placement
Transportation to attend scheduled medical appointments
126
6. W hat do you perceive to be the m ajor health care services strengths in
our area?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Primary care***
Adequate health care facilities and services and access for same***
Access to community and continuing care services********
6 MD ’s****, N P*** , D ietitian/clinics**, Community D evelopment N urse
ER department********, Lab and X services** O PD , protective care, telehealth**, long term
care
Chronic disease selfmanagement program*
ECH O newsletter.
Palliation*
H ouse calls
Addictions medicine
Teaching site
Local control ofdecision making that affects our healthcare and infrastructure
Q ualified, dedicated and caring staff*
Access to ambulance services
O n call doctor on duty- daily
Patient N avigator – new position – cancer care
Good relationship between providers
W ell organized community vaccination program*
Excellent consultant services
Medical clinic in Bishop’s Falls
Fully staffed
Excellent community partners ( Community Advisory Committee)
Staffmorale
Community has good access to H CP’s for health education. H CP are very visible in the
community
Access to evening clinic
Full range ofservice within a 60 mile radius
127
7. In you opinion w hat are som e viable strategies that could m itigate
these gaps?
•
•
•
•
H ealth promotion and education
Explore viable transportation opportunities to improve access to and efficiencies ofmedical
appointments.
Improve access to out patient services by better utilization ofexisting resources.
Enhance internal communications and implement strategies focused on employee wellness.
Please subm it com pleted survey (hard copy and/or em ail) to one of the
follow ing:
D oug Prince – doug.prince@ centralhealth.nl.ca
Chad Langdon – chad.langdon@ centralhealth.nl.ca
Allison Champion - allison.champion@ centralhealth.nl.ca
Thank You!
Appendix C
128
G LO SSA RY O F TERMS
A ccountab ility
The ownership ofconferred responsibilities, combined with an obligation to
report to a higher authority on the discharge ofthese responsibilities and on the
results obtained (Treasury Board, Government ofN ewfoundland and Labrador
(2000). Achieving Excellence).
B est Practices
Approaches that have been shown to produce superior results, selected by a
systematic process, and judged as “exemplary”, “good ”, or “successfully”
demonstrated. They are then adapted to fit a particular organization (Canadian
Council on H ealth Services Accreditation (CCH SA) 2002 Achieving Im proved
M easurem ent (Glossary) O ttawa, O ntario).
Capacity B uilding
Capacity building involves enhancing the ability ofindividuals and groups to
mobilize and develop resources, skills and commitments needed to accomplish
shared goals (Canadian Mental H ealth Association (1999). M ental Health
Prom otion Tool Kit:A practical resource forcom m unity initiatives).
Com m unity Capacity
Community capacity refers to the ability ofcommunity members to use the assets
ofits residents, associations and institutions to improve quality oflife. Each
community’s collection ofassets will be unique, for it will reflect the specific
characteristics ofits population, its political structures and geography (Canadian
Mental H ealth Association (1999). M ental Health Prom otion Tool Kit:A
practical resource forcom m unity initiatives).
Com m unity D evelopm ent
A process involving a partnership with community members or groups to build
the community’s strengths, self-sufficiency, well-being, and to solve problems.
This process enables the community to make decisions, to plan, design, and
implement strategies to achieve better health (H aen, B. & Labonte, R., 1990).
Continuity
The provision ofunbroken services that is coordinated within and across
programs and organizations, as well as during the transition between levels of
services, across the continuum, over time (Canadian Council on H ealth Services
Accreditation (CCH SA) 2002 Achieving Im proved M easurem ent
(Glossary).O ttawa, O ntario).
129
Continuum of Care
A full range offlexible, effectively linked services, from institutional care to
home-based/community-based care (McGill University H ealth Centre. (1997) 21st
Century: A new vision for health care).
Continuum of Services
An integrated and seamless system ofsettings, services, service providers, and
service levels to meet the needs ofclients or defined populations. Elements ofthe
continuum are: self-care, prevention and promotion, short-term care and service,
continuing care and services, rehabilitation, and support (Canadian Council on
H ealth Services Accreditation (CCH SA) (2002) Achieving Im proved
M easurem ent (Glossary).O ttawa, O ntario).
Core Set of Services
A basic set ofhealth care services which would be common to each primary
health care site throughout the province. Services would include
individual/family health services, public health/population health services, and
social/community services (H ealthier Together: A Strategic H ealth Plan for
N ewfoundland and Labrador, 2002).
Moving Forward Together: Mobilizing Primary H ealth Care iv
Critical Mass
The optimum threshold for levels ofservice delivery, teaching, and research at
which resources are efficiently utilized (and under which resources would not be
efficiently utilized.) (McGill University H ealth Centre. (1997) 21st Century: A
new vision for health care).
D eterm inants of H ealth
Factors that together contribute to the state ofhealth and well-being ofa
population or individuals. These are factors such as: income and social status,
social support network, education, health services, employment and working
conditions, physical environment, biology and genetic endowment, personal
health practices and coping skills, and child health and development (Federal,
Provincial, and Territorial Advisory Committee on Population H ealth, 1994).
Evidence-B ased D ecision Making
Evidence-based decision making is the explicit, conscientious
and judicious consideration ofthe best available evidence in the provision of
health care (adapted from Canadian N urses Association. (1998) Policy Statement
on Evidence-based D ecision-making and nursing practice).
G overnance
The exercise ofauthority, direction and control (Treasury Board, Government of
N ewfoundland and Labrador (2000). Achieving Excellence).
130
H ealth Prom otion
Process ofactively supporting and enabling people to increase control over and
improve their health (W orld H ealth O rganization, 1998).Process ofenabling people to
increase control over, and to improve, their health. To reach a state ofcomplete physical,
mental and social well-being, an individual or group must be able to identify and to realize
aspirations, to satisfy needs, and to change or cope with the environment. H ealth is,
therefore, seen as a resource for everyday life, not the objective ofliving. H ealth is a positive
concept emphasizing social and personal resources, as well as physical capacities.
Therefore, health promotion is not just the responsibility ofthe health sector, but
goes beyond healthy life-styles to well-being (O ttawa Charter for H ealth
Promotion (1986). First International Conference on Health Prom otion,
O ttaw a). Concerned with maximizing the involvement ofindividuals and communities in
improving and protecting quality oflife and well-being. H ealth promotion aims to
address equity in health, the risks to health, sustainable environments conducive
to health, and the empowerment ofindividuals and communities by contributing
to healthy policy, advocating for health, enabling skills development and
education (Canadian Mental H ealth Association (1999). M ental Health
Prom otion Tool Kit:A practical resource forcom m unity initiatives).
Interdisciplinary Prim ary H ealth Care Model
An approach to primary health care delivery which emphasizes universally
accessible continuous, comprehensive, coordinated primary health care provision
for a defined population through the shared responsibility and accountability of
physicians and all other primary health care providers (adapted from the W orking
Group on Interdisciplinary Primary Care Models, Advisory Committee of
Interpersonal Practitioners (AGIP). Interdisciplinary Primary Care Models: Final
Report). Moving Forward Together: Mobilizing Primary H ealth Care v
Intersectoral Collaboration
A recognized relationship between part or parts ofdifferent sectors ofsociety
which have been formed to take action on an issue to achieve health outcom es in
a way which is more effective, efficient or sustainable than might be achieved by
the health sectoracting alone (W orld H ealth O rganization. 1998. H ealth
Promotion Glossary).
Leadership
Leadership is a process ofgiving meaningful direction to collective effort. It is
the influencing ofthe activities ofan organized group toward goal achievement.
(Jacobs and Jacques, 1990. Rauch and Behling, 1984).
Managem ent
The act, art or manner ofcontrolling or conducting affairs and the skillful use of
means to accomplish a defined purpose (Treasury Board, Government of
131
N etw ork
A grouping ofindividuals, organizations and agencies organized on a non
hierarchical basis around common issues or concerns, which are pursued
proactively and systematically, based on commitment and trust (W orld H ealth
O rganization. 1998. H ealth Promotion Glossary).
Patient/Client
W hen an individual enters the health care system, he/she is referred to as a patient
or client, depending on the health care provider seen (e.g., physicians typically
see patients, while social workers see clients). In community health, families,
groups or the community itselfcan be the client.
Perform ance Measurem ent
A systematic process which enables an organization to track, manage and report
progress toward its strategic goals and objectives. Performance measurement
focuses on the desired quantitative and qualitative outcomes required for an
organization to achieve its mission and goals and is a means ofdetermining an
organization’s planned versus achieved results (Treasury Board, Government of
Population H ealth A pproach
A way oflooking at health and services, and an approach to
managing them, that focuses on the needs ofa given group as a whole, and the
factors that contribute and determine health status. A population health approach
facilitates the integration ofservices across the continuum (Canadian Council on
H ealth Services Accreditation (CCH SA). (2002) Achieving Im proved
M easurem ent (Glossary).O ttawa, O ntario).
Prim ary Care
The first level ofcontact with the medical care system, provided primarily by
general practitioners (including office visits, emergency room visits and house
calls). Primary care operates inside the larger context ofprimary health care
(Report ofthe Primary Care Advisory Committee: The Family Physician’s Role
in a Continuum ofCare Framework for N ewfoundland and Labrador, 2001).
Prim ary H ealth Care
The first level contact with people taking action to improve health in a
community. Primary health care is essential heath care made accessible at a cost
which the country and community can afford, with methods that are practical,
scientifically sound and socially acceptable (W orld H ealth O rganization. 1998
(a/b) H ealth Promotion Glossary) Moving Forward Together: Mobilizing Primary H ealth Care vi
132
Prim ary H ealth Care Team
A group ofpersons who share a common health goal and common objectives
determined by community needs, to which achievement ofeach member ofthe
team contributes, in a co-ordinated manner, in accordance with his/her
competence and skills and respecting the functions ofothers. (W orld H ealth
O rganization, 1985).
Pub lic H ealth
Public health is a social and political concept aimed at improving health,
prolonging life and improving the quality oflife among whole populations
through health promotion, disease prevention and other forms ofhealth
intervention (W H O , 1998a).
Q uaternary Care
The provision ofhighly complex sub-specialty services. Centres delivering
quaternary care may act as provincial, national, and international resources, e.g.,
H ospital for Sick Children (Ministry ofH ealth and Long-Term Care, O ntario,
1998).
Regional H ealth A uthority/Board
The regional body that administers institutional and community healthcare
programs and services in a particular geographic region. Currently there are 14
regional boards in N ewfoundland and Labrador, eight institutional boards, four
community services boards, and two integrated boards that deliver both
institutional and community services.
Scope of Practice
The scope ofpractice for an occupation refers to the range ofactivities that a
qualified practitioner ofan occupation may undertake. It establishes the
boundaries ofan occupation, especially in relation to other occupations where
similar activities may be performed. The scope ofpractice for an occupation may
be established through governing legislation or through internal regulations
adopted by a regulatory body (Glossary ofTerms, H RD C, 2002).
Self-Care
The decisions and actions taken by someone who is facing a health
challenge/concern in order to cope with it and improve his or her health
(Enhancing H ealth Services In Remote and Rural Communities ofBritish
Columbia, 1999).
Secondary Care
Consists offirst level specialized care requiring more sophisticated and
complicated diagnostic procedures and treatment than provided at the primary
care level, normally delivered in hospitals (N ew Brunswick H ealth and
Community Services. H ealth Services Review: Report ofthe Committee, 1998).
133
Telehealth
Efforts ofhealth telecommunication, information technology and health
education to improve the efficiency and quality ofhealthcare (H ealth Canada,
Glossary 2001).
Telem edicine
Medical imaging technology and other provisions ofhealth care through use of
telecommunications technology (H ealth Canada, Glossary 2001).
Telephone Triage
The intervention ofa trained health professional who delivers expert advice over
a telephone help line. The location ofthe trained health professional is often
referred to as a call centre (First N ations Inuit H ealth Branch, H ealth Canada,
2000).
Tertiary Care
Sub-specialty care requiring a high level ofintensive hospital based care (N ew
Brunswick H ealth and Community Services. H ealth Services Review: Report of
the Committee, 1998).
Moving Forward Together: Mobilizing Primary H ealth Care vii
Triage
A method for prioritizing care delivered and guiding patients to proper services
by use ofan intermediary who gathers preliminary information regarding
patients’ conditions (H ealth Canada, Glossary 2001).
134

Exploits - Central Health

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