Provincial Health Indicators Work Group

Monday, May 11, 1998
10:00 am - 4:30 pm
Committee Room #2, North York Civic Centre

Present: Mary-Anne Pietrusiak, Durham Regional Health Unit (Chair)
                Patrick Seliske, Waterloo Region Community Health Department
                Hyewon Lee-Han, Population Health Service, Public Health Branch
                Vic Sahai, Northern Health Information Partnership
                Jessie Wong, IPE Branch, Ministry of Health
                Carol Paul, IPE Branch, Ministry of Health
                Ruth Sanderson, Bruce-Grey-Owen Sound Health Unit
                Jo-Anne Peterson, Kingston, Frontenac and Lennox and Addington Health Unit
                Nam Bains, Health Information Partnership, Eastern Ontario Region
                Terry Delmore, Halton Regional Health Department
                Julie Stratton, Perth District Health Unit (recorder)
                Ian Johnson, Toronto Public Health, North York Office

Corresponding Member: Vivek Goel, ICES

Regrets: Doug Manuel, Federal Field Epidemiologist
Others:   Kinga David, MHSc Student, North York Office
                Karen Lee, Community Medicine Resident, North York Office
                Darshara Daflany, MHSc Student, Durham Regional Health Unit

1.0 Introductions

2.0 Provincial Health Status Report Update (Ian Johnson and Hyewon Lee-Han)

Ian and Hyewon updated the group on the Provincial Health Status Report.
The Provincial Health Status Report has been approved and there are five deliverables:

• a general report
• a francophone report
• focus reports on OHS topics
• a popular report for the public (Chief MOH report to be released in March 1999)
• updating summary data for HELPS at the Ontario level

The PHREDs will be giving some time to assist with the data analysis for the report.

An advisory committee for the Provincial Health Status Report has also been struck and will be meeting over the next few weeks.

3.0 Ministry of Health, Health Indicators Project (Carol Paul)

The Ministry of Health is devising some indicators and targets to be used as outcome measures as part of their business plan. Some of what we are doing with PHIWG can feed back into this Ministry project.

4.0 Structure of Indicators

The group discussed the framework of the indicators using the Central East Collaboration Project as an example. The group felt there were two main issues concerning the structure of the indicators:

• to identify indicator gaps from the mandatory programs.
• to select a core set of indicators for local level health units to use until the HIU chart books are prepared.

• A definition of what the indicator means was identified as something that might be of some use since not everyone understands the issues (i.e., what SMRs are).
• Be clear with the described limitations.
• Add calculations in to the chart page and be explicit as possible.

5.0 Framework of the Provincial Health Status Report

The framework of the Provincial Health Status Report was distributed previously through e-mail to all members of the group. No comments about the framework were made at this time.

6.0 Moving through the Indicator Framework

The group discussed which indicators should be included as part of the core set of indicators. There was not a lot of discussion about limitations or definitions at this meeting. Each member led the discussion for their section of the framework.

There were several general issues discussed regarding population indicators:

• which denominator to use and when; estimates, projections or the census.
• which denominator to use when presenting trends over time.

Recommendations:

• use population estimates from 1986-1996 based on the 1991 census.
• when using numerators from the census data, use population counts from the census as the denominator.
• use population estimates based on the 1996 census once they become available.
• for areas with unstable or small numbers, present data as grouped (i.e., 1991-1995) instead of trend over time.

The indicators identified as being part of a core set are as follows:

• population by age and sex (population pyramid)
• use percent as the label on the x-axis, but present table with actual population as an appendix.
• use 5 year age groupings up to age 80-84, followed by 85+.
• age dependency ratio
• male/female sex ratio
• population growth rate
• present every 5 years, i.e., 1986, 1991, 1996
• population projections
• present as a percent of the population
• trend with population pyramid?
• proportion of immigrants?
• useful indicator as it ties into where immigrants come from
• total immigrants not as useful, recent immigrants is more useful indicator
• ethnicity
• mother tongue
• home language
• % allophones
• % not permanent residents

6.2 4a Social Environment and Health (Hyewon Lee-Han)

• unemployment rate
• proportion of the population living below the low-income cut-off point
• proportion of the population on social assistance
• problems with accessibility
• problems with workfare
• definition may change over time
• questions about denominator (total population or population aged <65)
• proportion of single parent families with children
• definition needs to be checked (age of children)
• education level of population aged 15 years and older
• presented as a distribution
• determine the breakdown of the education levels (i.e., college, college + university?)
• proportion of households paying 30% or more of income on housing

6.3 4b Physical Environment and Health (Vic Sahai)

• ultra violet (UV) index
• tri-halo-methane (THM) levels in drinking water?
• frequency of poor water quality
• seasonal closing of beaches
• issues regarding collection methods
• public green space?

• leading causes of death
• by leading causes and by ICD-9 chapter
• standardization issues need to be worked out
• determine which codes / ICD-9 chapters
• potential years of life lost
• life expectancy

6.4 5b Leading Causes of Hospitalizations (Patrick Seliske)

• leading causes of hospitalizations
• by leading causes and by ICD-9 chapter
• standardization issues need to be worked out
• determine which codes / ICD-9 chapters

6.4 5c Leading Causes of Health Problems (Jo-Anne Peterson)

• proportion of population in good or excellent health (distribution)
• prevalence of selected chronic health problems
• move to chronic disease section?

6.5 6a Chronic Diseases (Jo-Anne Peterson)

• cervical cancer screening
• which guidelines to use for frequency of screening
• proportion of women who have had a mammogram
• proportion of women who have had a clinical breast exam
• proportion of women who have had breast self exam
• incidence of breast, lung, oral, skin, prostate and colon cancers
• morbidity from diabetes, hypertension, osteoporosis?

6.6 6b Injury Prevention including Substance Abuse Prevention (Terry Delmore)

• hospital morbidity due to injury
• drownings
• injuries caused by cycling crashes (lead to hospitalization)
• injures and deaths caused by MV crashes (lead to hospitalization)
• injuries and other substance related injures and deaths
• fall related injuries and deaths in the elderly (65+)
• proportion of population wearing seat belts
• standardization issues

6.7 6c Behaviour and Health (Jessie Wong)

• smoking prevalence (by youths, adults, and sex)
• proportion of current cigarette smokers
• proportion of tobacco convictions with sales to minors* (needs exploration)
• proportion of population consuming 15 or more alcoholic drinks per week* (explore)
• population distribution of binge drinking
• population distribution of physical activity
• needs standardization
• prevalence of overweight (BMI) - distribution

6.8 7a Family Health: Sexual Health (Ruth Sanderson)

• use of condoms as protection of STD=s (cross-tab with number of partners)

6.9 7b Family Health: Reproductive Health (Mary-Anne Pietrusiak)

• total fertility rate
• general fertility rate
• age specific fertility rate
• prevalence of low birth weight
• rate of neural tube defects
• therapeutic abortion rate / ratio
• infant mortality rate
• perinatal mortality rate
• neonatal mortality rate
• total pregnancy rate
• teenage pregnancy rate
• rate of multiple births
• M/F ratio of newborns
• stillbirth rate
• congenital anomaly rate

• leading causes of hospital separations and deaths in children aged 1-9
• dental indices (DMF, fluorosis, % edentulous)
• proportion of infants breast-fed up to 6 months

• proportion of population having contemplated suicide
• proportion of population satisfied with their social life?
• suicide rate
• issues include sources; general hospital versus psychiatric hospital

6.10 9 Infectious Diseases (Ian Johnson)

• see handout Ian distributed during meeting
• wastage of provincially funded vaccines not included

6.11 10 Consequences of Health Problems (Nam Bains)

• prevalence of long term disability
• measurement of severity, type, age groups
• average duration of compensation for occupational injuries?
• medical consultation rate?
• rate of days of hospitalization by cause?
• cesarean rate?
• coronary bypass rate?
• use of medication
• proportion of population having three or more medications in the past two days
• seniors

• proportion of seniors living alone
• move to population section?
• population projections for seniors
• Other selected populations ?

• no indicators identified for core set

• Francophone report will be produced

• no indicators identified for core set

Members of the workgroup were asked to draft descriptions of: definitions, significance/use, limitations and source of the indicators for the next meeting.

7.0 Next Meeting

May 25th, 1998, 10:00 am - 3:00 pm
North York Civic Centre
Committee Room #1