Public Health in the North

On a spectacular summer day CARRFS eNews traveled to Sudbury to discuss public health surveillance with some of the leaders of the Sudbury & District Health Unit (SDHU). Sudbury is a 4 hour drive north of Toronto and the city is beautifully situated around Ramsey Lake. The SDHU is located on Paris Street which leads into the magnificent Bridge of Nations, featuring the flags of all nations registered by the United Nations.

Sudbury is surrounded with smaller, sparsely-populated suburbs and settlements. This uneven population distribution provides some tremendous challenges in terms of collecting and measuring health data. 

The Health Unit has done an extensive job obtaining health related data for all the communities it serves by combining data from Statistic Canada’s Canadian Community Health Survey (CCHS) in combination with the Ontario Rapid Risk Factor Surveillance System (RRFSS) alongside various over samplings for specific targeted populations. The result is a series of comprehensive health profiles for each of the local communities within the district. 

In a recently-published report “Opportunity for All: The Path to Health Equity” (2013), the Health Unit explored the relationship between health indicators and social and economic environments in the City of Greater Sudbury. In this report, says co-author Marc Lefebvre, Manager, Population Health Assessment and Surveillance, “in order to compare socioeconomic disadvantage in various communities we used the Deprivation Index by the Institut national de santé publique du Québec (INSPQ). By using this well-proven method, we identified 15 (see table) out of a total of 42 indicators in which there is a significant difference between the least and most deprived areas of the City. For the remaining 27 indicators we didn’t find significant differences between the areas.”  

The report’s results are profound - not only for Sudbury, but across the country. Here are a few examples from the report (see table 1 with all 15 listed health indicators):

  • The annual rate of emergency department visits for mental health episodes in the City of Greater Sudbury’s most deprived areas was 341% (or 4.4 times) higher than that for residents in the least deprived areas. 
  • The annual rate of infant mortality in the City of Greater Sudbury’s most deprived areas was 139% (or 2.4 times) higher than for residents in the City’s least deprived areas. 
  • The prevalence rate of obesity in residents of the City of Greater Sudbury’s most deprived areas was 102% (or 2.0 times) higher than that for residents of the City’s least deprived areas.

The report reveals potentially great health improvements in Sudbury. If, for example, everyone in the City of Greater Sudbury experienced the same opportunities for health as those in the least deprived areas, each year there would be:

  • 14,077 fewer emergency department visits for all causes in the City of Greater Sudbury
  • 1,783 fewer hospitalizations for all causes in the City of Greater Sudbury

Alongside the health benefits, the financial savings would be significant. And if one stretched this finding to represent Canada as a whole, and not just one city, the budget savings would be staggering. 

There are of course limits to what any health unit can do by itself, so what is SDHU doing to follow up on its findings? 

“We always share our knowledge products and reports that we produce with our Board of Health,” says Renée St. Onge, Director of the Resources, Research, Evaluation and Development Division, SSHU.

“The Board of Health is made up of representatives from the 19 municipalities that we serve. We make sure that they have access to that information as timely as possible,” adds St. Onge, and “we also try to connect as much as possible with our local community partners. As a public health organization we are linked to a number of local groups, committees, and agencies that are not necessarily only within the health sector but are also in a number of other sectors. When we produced the “Opportunity for All” report we shared the results with the City Council and we produced ward profiles so each ward councillor would have access to information about the neighbourhoods they represent.”

How do these findings filter down to the program level? 

“The community of Sudbury has created a committee called Partnership for Children and Youth (PCY)”, says Sandra Laclé, Director Health Promotion Division. “This was established to coordinate planning, prevention, and shared action on child and youth issues and initiatives that cross individual agency mandates. The PCY does this by identifying gaps, aligning efforts, acting “cross-sectorally” for the well-being of children and youth. One initiative of the committee is the adaption of the Positive Parenting Program - the Triple-P parenting program. All agencies, school boards, municipalities and the health unit realized the need for a common parenting platform to support healthy child development and resiliency. Triple P is a one-stop access point for parents. No matter where they go they get referred into a seamless system and get the one-on-one advice or the group advice or the resources they need.” 

 “The biggest priority we have today as the Resources, Research, Evaluation and Development Division is to meet the Foundational Standard set out by the provincial government; we spend most of our time as a Division to fulfill this obligation of population health assessment, surveillance, research, evaluation, and knowledge exchange,” St. Onge explains. “If we had more resources we’d have more time for additional research to further understand the effectiveness of some of the interventions we do, as well as understand “the causes of the causes” relating to health inequity. With that information we’d be that much more effective.” <>

             By Jostein Algroy

Data: Sudbury & District Health Unit

The Sudbury & District Health Unit (SDHU) has offices in Sudbury, Chapleau, Espanola, Mindemoya, and St. Charles. The SDHU has a mandate to deliver provincially-legislated public health programs and services to almost 200,000 people in an areathat spans 46,475 square kilometres on the northern shore of Georgian Bay. The area includes the City of Greater Sudbury, and the Sudbury and Manitoulin districts. Approximately 82% of the population lives within Greater Sudbury. The rest is spread over the Sudbury District which accounts for 86% of the land area and the Manitoulin District. The population density outside the Greater Sudbury is quite low, as it is in most of Northern Ontario. A quarter of the population is French speaking, while there is also a relatively large Aboriginal population in the district.