Provincial Health Indicators Work Group

Provincial Health Indicators Work Group

Minutes

Thursday, July 16, 1998
10:00 am - 3:00 p.m.
North York Civic Centre
Committee Room #1

Present: Mary-Anne Pietrusiak, Durham Regional Health Unit (Chair)
                Patrick Seliske, Waterloo Regional Community Health Department
                Vic Sahai, Northern Health Information Partnership
                Ruth Sanderson, Sudbury and District Health Unit
                Hyewon Lee-Han, Population Health Service, Public Health Branch
                Ian Johnson, Toronto Public Health, North York Office
                Jessie Wong, IPE Branch, Ministry of Health
                Nam Bains, Health Information Partnership, Eastern Ontario Region

Others: Anna Goral, Toronto Public Health, North York Office
Jill Mallon, Toronto Public Health, North York Office

Corresponding Member: Dr. Vivek Goel, ICES

Regrets: Julie Stratton, Perth District Health Unit
                Terry Delmore, Halton Regional Health Department
                Carol Paul, IPE Branch, Ministry of Health
                Jo-Anne Peterson, Kingston, Frontenac- Lennox and Addington Health Unit
                Doug Manuel, Federal Field Epidemiologist, Ministry of Health

1.0 Introduction

2.0 Provincial Health Status Report Update

The working group is progressing steadily. Most databases are ready to be sent out for analysis. However, OHS 96 is problematic. The Ministry of Health has received the file, but has not received sufficient documentation from Stats Canada to release the data.

RDIS: Hyewon, Ian and Anna had a meeting with Monika Naus and will be receiving RDIS data from 1991-1996 shortly.

Institute for Work and Health: Ian met with Don Cole (Acting Director of Research). Don is committed to work on this project and has offered his assistance with drafting the chapter on work and health.

Cancer Incidence: Ian spoke to the program analyst from Cancer Care Ontario to discuss verifying the CCO data analysis.

Other Issues surrounding analysis: Ministry of Health is undergoing restructuring and is redefining the existing 5 Ontario Health Regions into 7 new Health Regions. The regions of North, East and Southwest will remain the same, but Central East and Central West will be divided into four new regions. Since this is proposed to be implemented in 1999, the Working Group has decided to analyze the data by the 7 new regions in addition to analysis by the previous 5 regions.

Purchase of a CD writer: The new CD writer has been purchased and has been installed. This will be used for distributing data sets for analysis.

3.0 Moving through the Framework

The group continued their discussion on which indicators should be included as a core set of indicators. In-depth discussions, including limitations and definitions of the indicators for Physical Environment and Health, Social Environment and Health, Sexual Health, Child Health, and Injury.

4.0 Environment and Health

(see handout distributed by Vic Sahai)

Air Quality Index - It was decided that the air quality index would be included as a core indicator even though the information is not available at all health units because not all areas have monitors.
UV index - needs to be further investigated

Discussion centered around the operational definition of this indicator. The group suggested looking at the maximum daily UV readings in terms of the number of hours of sun exposure over certain level per month.
* Ian to call Environment Canada on index values

Number of times that Interim Maximum Acceptable Concentration (IMAC) is exceeded (this indicator was previously titled, "Trihalomethanes levels in drinking water"

* Vic to investigate this indicator further

Number of times that water quality exceeds Maximum Acceptable Concentrations (MAC) - this indicator was previously titled AFrequency of poor water quality@.

* Vic will review which key health parameters the group will use. There are approximately 180 parameters measured in drinking water

Seasonal Posting of Beaches [ (total number of posting days for all beaches) / (# of beaches x number of days monitored) ] x100

Motor Vehicle Rate This is a complex indicator that raised many issues in its interpretation; the group decided to drop it as a core indicator

Future Indicators the group suggested additional indicators that might be useful once consistent data are available:
- Green Space
- Motor Vehicle Ratio
- Bicycle Pathways

5.0 Social Environment and Health

(See handout distributed by Hyewon Lee-Han)

Unemployment rate from Census, including youth unemployment for 18-24 year olds.
Incidence of Low Income the Ministry will be purchasing a special tabulation from Stats Canada that will provide the incidence of low income by age group for people in private households by census sub-division. The age breakdown is: <15, <6, 6-9, 10-14, 15-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-69, 70+. The Ministry will also be receiving incidence of low income by different type of family. From this the following indicators will be derived:

- Child poverty (under age 18) - cross-referenced with child health section
- Senior poverty (age 65+) - cross-referenced with seniors health section
- Family poverty - Low income among unattached individuals (from standard data, not part of special request)

Proportion of Single Parent Families with Children
Education level of the Population 15+ - categories to be used:

- Less than grade 9
- Grades 9 to 13 without graduation certificate
- Grades 9 to 13 with graduation certificate
- Trades certificate or diploma + other non-university education (whether completed or not)
- University (whether completed or not)

Proportion of Households paying 30% or more household income on housing
Proportion of population on social assistance Hyewon found it difficult to determine what information is available from the Ministry of Community and Social Services. She will submit a request and see what happens.

6.0 Sexual Health

(See handout distributed by Ruth Sanderson)

Age of sexual debut - age groups to be decided
Percent of people aged 15-59 with 2 or more partners in the past year
Percent of sexually active people who use of condoms always or usually

- sexually active to be replaced with definition consistent with skip patterns in OHS 96.

Percent of sexually active people who used condoms the last time they had sexual intercourse

- sexually active to be replaced with definition consistent with skip patterns in OHS 96.

Percent of 15 to 19 year olds who have ever had sexual intercourse

The group suggested that we look at the global picture of sexual health including prevalence of STDs (listed in OHS 96), but self-reporting may not provide accurate information due to bias. RDIS is more accurate in terms of incidence data but does not include demographic information and risk factors. General snapshot of STD prevalence could be beneficial not only to health units but other health agencies.

Before we can use OHS data, we need to check the completeness of responses. If they are satisfactory, we can recommend OHS data in estimating the STD prevalence. If more detailed information is needed, RDIS can be used. At this point, the information will not be part of the core indicators except incidence data through RDIS.

7.0 Child Health

(See Handout distributed by Ruth Sanderson)

Title will be changed from Child Health toChild and Adolescent Health

The group decided to use the following age categories:
-less than 1 (infant)
-1 to 4, 5 to 9 (child)
-10-14, 15-19 (adolescent)

Selected causes of death in children aged 1 to 9 - age-specific rates using ICD-9 chapters (likely selected causes) for <1, 1-4, 5-9, 10-14, 15-19.
Selected causes of hospital separations in children aged 1-9, same age breakdown
Breast feeding initiation - from OHS 96
Breast feeding duration - from OHS 96
Total number of teeth decaying, missing or filled/ total number of tooth surfaces examined (Dental Index) for children at school entry (approx. 5 years old), 1993/94 and 1997/98
Carries Immune (or Carries resistant) - percent of children at school entry who have never had cavities/total population of children

8.0 Injury Prevention

(see handout sent by Terry Delmore)

E-Codes to be included:

External causes of injuries (E800 - E999)
Motor vehicle traffic crashes (E810 - E819)
Motor vehicle pedestrian injuries (E814)
Non traffic accident involving motor-driven snow vehicle (E820)
Non traffic accident involving off-road motor vehicle (E821)
Cycling injuries and deaths (E810 - E825 (selecting those with .6)), + E826*
Drownings (E830+ E832, E910)
Falls (E880 - E888)
Choking (E911 - E915)
Self- inflicted injury (E950 - E959) - to be included in mental health section
Homicide and Injury purposely inflicted by other persons (E960-E969)

* Needs to be investigated further by Terry

9.0 Other Issues (Mary-Anne Pietrusiak)

Add oral cancer to list of selected cause of deaths and hospital separations because it is in the Mandatory Programs
Add crude death rate to the Mortality section
Add number of animal rabies as an indicator to the rabies section
Consider breast cancer screening rates from Ontario Breast Cancer Screening Program because it is in the Mandatory Programs

10.0 Review of indicator format (for Submission)

The general format for the indicator listings was decided. The group will use the layout from the sample indicators created by Mary-Anne with a minor change under the specification section: include the indicator type, and how it relates to the Mandatory Programs.

The final document should include a clear statement of copyright, i.e., where some of the information was obtained. We will welcome people to use and copy the report but to acknowledge the source. The groups should also decide on a way to index the references for the indicator list.

August 17, 1998 is the deadline for submitting indicators in this new format to Mary-Anne.

Next Meeting:
Tuesday, September 8, 1998
10:00 am - 3:00 p.m.
North York Civic Centre
Committee Room # 1