Exploits - Central Health
Transcription
Exploits - Central Health
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 Exploits Primary Health Care 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 Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 7 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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). Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 12 Population cont’d. 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. Exploits Primary Health Care 13 Population cont’d. 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%. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care -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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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) Exploits Primary Health Care 23 Em ploym ent Rates cont’d. * Botwood includes Charles Brook, Fortune H arbour, N orthern Arm, Philip’s H ead and 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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%. Exploits Primary Health Care 30 Incom e Support A ssistance Status cont’d. * Botwood includes Charles Brook, Fortune H arbour, N orthern Arm, Philip’s H ead and 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 Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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 * Botwood includes Charles Brook, Fortune H arbour, N orthern Arm, Philip’s H ead and Pleasantview. 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 Exploits Primary Health Care 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 * Botwood includes Charles Brook, Fortune H arbour, N orthern Arm, Philip’s H ead and Pleasantview. * 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. Exploits Primary Health Care 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) Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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) Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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% Exploits Primary Health Care 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% Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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%. Exploits Primary Health Care 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 Exploits Primary Health Care 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 Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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) Exploits Primary Health Care 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 Exploits Primary Health Care 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 Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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). Exploits Primary Health Care 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. Exploits Primary Health Care 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) Exploits Primary Health Care 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. Exploits Primary Health Care 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). Exploits Primary Health Care 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% Exploits Primary Health Care 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) Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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). Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care • • • • • • • • • • • • • • • • • • • • • 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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. Exploits Primary Health Care 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 Exploits Primary Health Care 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. Search for Exploits Primary Health Care View our site Like it – click the like button! You will receive all future postings. You can comment and send messages for information. Please share our site and postings and invite your FB friends to like and share as well. Help us grow our network! 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 tu a ir i .. he a 0 % le ss ne al ly ic he a sp ck ta l ly si ys ph en B om m ei ng g g fr e ei n ei n B B Fr 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 n t u m t O e h h e u a a t u m o q d d c e e q o d p y M A A O G C l e o p a o n u r a t g ir o n , v it e w i e i e d t r a e e r a n te lt s i ? c h u i a % c n o r h e n s e 0 f r 0 % r % o 0 n c a e n l a d i s n . o . . . . . . i . l 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 N ewfoundland and Labrador (2000). Achieving Excellence). 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 N ewfoundland and Labrador (2000). Achieving Excellence). 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