HISTORY 

Public health epidemiologists in Ontario recognized the need for consistency among health reports. Therefore, the Core Indicators for Public Health began in February 1998, as an initiative of APHEO to systematically define and operationalize a core set of health indicators in Ontario. In fall 2001, the Core Indicators website was launched as part of APHEO’s website. The indicators were completed in 2005. In 2006 and 2007, five sub-groups were formed to revise the indicators: 1) Cancer, Smoking & Sun Safety, 2) Healthy Eating and Active Living, 3) Leading Causes, 4) Reproductive Health, and 5) Infectious Diseases. In 2009, three more sub-groups were added: the Built Environment; Injury and Substance Misuse; and Social Determinants of Health. The Core Indicators Working Group (CIWG) ensures that the Core Indicators for Public Health in Ontario are accurate, up-to-date and reflect the Ontario Public Health Standards (OPHS); they advocate for health unit access to good quality data in a timely manner and promote the use of the Core Indicators.

KEY MILESTONES

·    Feb 1998: Inaugural meeting at the Institute for Clinical Evaluative Sciences
·   1999: CPHA presentation, OPHA presentation, PHERO article
·    Nov 1999: Binder of draft “Core Population Health Indicators for Ontario” sent to all public health units
·    Feb 2000: Release of Ontario Health Status Report which used the Core Indicators as a basis for their work
·    Jan 2001: Revision and expansion of the first draft of Core Indicators begins
·    Summer 2001: Student hired by the Central East Health Information Partnership to create the Core Indicators website
·    Fall 2001: Core Indicators website launched at APHEO conference
·     2005: Completion of indicators
·     Feb 2006: Formation of four subgroups: 1) Cancer and Risk Factors, 2) Reproductive Health, 3) Infectious Diseases,  4) Leading Causes
·    March 2007: Cancer and Risk Factors sub-group split to form the Cancer, Smoking & Sun Safety Sub-Group, and Healthy Eating and Active Living (HEAL) Sub-Group
·    June 2007: Funding application to the Public Health Agency of Canada (PHAC)
·    May 2008: APHEO website converted to wiki style
·   July 2008: Project Manager of PHAC project begins to revise and create indicators and resources for chronic disease and risk factors
·    Nov 2008: OPHS & the Population Health Assessment and Surveillance (PHAS) protocol released. The PHAS protocol refers to the Core Indicators
·   Dec 2008: Core Indicators Strategic Directions session held
·   Jan 2009: Formation of Built Environment Sub-Group
·   July 2009: Core Indicators PHAC project completed
·    Sep/Oct 2009: Formation of Injury & Substance Misuse Sub-Group, and Social Determinants of Health Sub-Group
·    Jan 2010: APHEO contingent approaches OAHPP for Core Indicators funding

WHAT IS A CORE INDICATOR?

Health indicators, or core indicators, are measures of the health of individuals and their communities. They reflect complex concepts in a concrete, clearly defined way using standardized definitions and methods. The Core Indicators website contains definitions (but not data) for over 120 public health indicators to enhance accurate and standardized reporting of information across public health units in Ontario.

The following key Information is provided for each indicator:
·         Description
·         Specific Indicators 
·         Corresponding Outcome from the Draft Ontario Public Health Standards (OPHS)
·         Corresponding Health Indicator from Statistics Canada and CIHI 
·         Data Sources 
·         Survey Questions or ICD Codes (where applicable)
·         Alternative Data Source(s) 
·         Analysis Check List 
·         Method of Calculation 
·         Basic Categories 
·         Indicator Comments 
·         Cross-References to Other Sections 
·         References – Cited References and Other References
·         Changes Made 

CRITERIA FOR SELECTING CORE INDICATORS 

The criteria for selecting core indicators are based on the following requirements:

• Applicable to outcomes and requirements from the Ontario Public Health Standards, including the Population Health Assessment and Surveillance Protocol
• Data generally available and accessible to all or most public health units
•  Indicator has to be useful and meaningful
• Indicator has to be relevant to health
•  “Core” indicator important to public health
• Decision by consensus

• Ministry of Health and Long-Term Care
• Ministry of Health Promotion
• Statistics Canada
• Public Health Agency of Canada
• Cancer Care Ontario
• Ontario Tobacco Research Unit
• Institute for Clinical Evaluative Science
• University of Toronto
• The Ontario Agency for Health Protection and Promotion 
  
  Plus numerous other groups that are consulted as indicators are written and revised.  

1. Population
2. Environment and Health
    2A. Social Environment and Health
    2B. Physical Environment and Health
3. Mortality, Morbidity and Health-Related Quality of Life
4. Chronic Disease and Injuries
    4A. Chronic Diseases
   4B. Cancer Incidence and Early Detection of Cancer
   4C. Injury Prevention and Substance Abuse Prevention
5. Behaviour and Health
   5A. Smoking
   5B. Alcohol
   5C. Physical Activity
   5D. Nutrition and Healthy Weights
   5E. Ultraviolet Radiation Exposure
6. Family Health
   6A. Sexual Health
   6B. Reproductive Health
   6C. Child and Adolescent Health
7. Mental Health
8. Infectious Diseases
9. Use of Health Services

ORGANIZATIONAL STRUCTURE OF THE RESOURCES 

• References
• Data Sources
• Documentation
• Methodology
• Syntax Files  

The following Sub-Groups are currently revising and creating Core Indicators:
·         Built Environment
·         Healthy Eating and Active Living
·         Infectious Diseases
·         Injury and Substance Misuse
·         Reproductive Health
·         Social Determinants of Health 

Sub-groups are composed of public health epidemiologists across Ontario along with members from the Ministry of Health and Long-Term Care, Ministry of Health Promotion, Statistics Canada, Cancer Care Ontario, Ontario Tobacco Research Unit, Institute for Clinical Evaluative Sciences, universities and other organizations. Many more people are involved as reviewers, consultants, and users.  

For information and the CIWG and Sub-Groups, refer to:  http://www.apheo.ca/index.php?pid=50  

List of Indicators and Resources 
http://www.apheo.ca/index.php?pid=55  

Meeting Minutes 
http://www.apheo.ca/index.php?pid=53  

Membership of CIWG and Sub-Groups 
http://www.apheo.ca/index.php?pid=255  

Guide to Creating or Editing Core Indicator Pages 
http://www.apheo.ca/index.php?pid=125  

Terms of Reference, Policies & Procedures, Organizational Chart 
http://www.apheo.ca/index.php?pid=257

• Core Indicators Working Group Terms of Reference
• Core Indicators Sub-group Terms of Reference
• Core Indicators Organizational Chart
• Membership P&P   

Publications & Presentations 
http://www.apheo.ca/index.php?pid=48#Publications  

Ontario Public Health Standards & Protocols 
http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/ophsprotocols.html  

APHEO Core Indicators Project: Strategic Direction Session (Kim Bergeron, December 2008)
http://www.apheo.ca/resources/indicators/CIWG_December_5_Session_Report_2009_Final%20_.pdf 

Core Indicators PHAC Project Final Report (July 2009)
http://www.apheo.ca/resources/indicators/Core%20Indicators%20Project-%20Chronic%20Disease%20%20Risk%20Factors%20PHAC%20report%20FINAL.pdf