Ontario Public Health Standards (OPHS)

The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.

Outcomes Related to this Indicator

• Societal Outcome (Foundational Standard):  Population health needs are anticipated, identified, addressed, and evaluated.

• The board of health shall assess current health status, health behaviours, preventive health practices, health care utilization relevant to public health, and demographic indicators in accordance with the Population Health Assessment and Surveillance Protocol, 2008 (or as current) (Foundational Standard)
• The board of health shall conduct surveillance, including the ongoing collection, collation, analysis, and periodic reporting of population health indicators, as required by the Health Protection and Promotion Act and in accordance with the Population Health Assessment and Surveillance Protocol, 2008 (or as current) (Foundational Standard).

• The board of health shall collect or access the following types of population health data and information: Socio-demographics including population counts… (Population Health Assessment and Surveillance Protocol, Data Access, collection and management, 1b)  http://www.ontario.ca/publichealthstandards

Corresponding Health Indicator(s) from Statistics Canada and CIHI

The internet publication Health Indicators, produced jointly by Statistics Canada and the Canadian Institute for Health Information, provides over 80 indicators measuring the health of the Canadian population and the effectiveness of the health care system. Designed to provide comparable information at the health region and provincial/territorial levels, these data are produced from a wide range of the most recently available sources.  A pdf copy of the Health Indicators e-publication report can be found on CIHI’s website (http://www.cihi.ca) at http://www.cihiconferences.ca/indicators/2012/ind2012_e.html Corresponding Mandatory Objectives

• None

·         Low income cut-offs, before and after tax (2011).  Table 202-0801.  Available at: http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=2020801&pattern=2020801&searchTypeByValue=1&p2=35  

Available at:  http://www.statcan.gc.ca/pub/75f0002m/2010003/tbl/tbl02-eng.htm

Numerator & Denominator: Canadian Census, National Household Survey
Original source: Statistics Canada
Distributed by:
1. Health Planning Branch, Ontario MOHLTC
2. Statistics Canada
Suggested citation (see Data Citation Notes):
[year] Census, Statistics Canada[year] National Household Survey, Statistics Canada


Alternative Data Sources

• Health Indicators, Statistics Canada (see above).
• Survey of Labour and Income Dynamics

·         Low Income Cut-offs (LICOs), Low Income Measures (LIMs) and the Market Basket Measure (MBM) are available at: http://www.statcan.gc.ca/pub/75f0002m/2012002/tbl-eng.htm

·         Persons in Low Income Families. CANSIM Table 202-0802  Available at:  http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=2020802&paSer=&pattern=&stByVal=1&p1=1&p2=37&tabMode=dataTable&csid·         Persons in Low Income, by Economic Family Type. CANSIM Table 202-0804  Available at:  http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=2020804

# persons/families in low income (LI)
total population (persons or families) (TP)
{LI/TP}x100%

• “Persons in low income” should be interpreted as persons who are part of low income families (or households), including persons living alone whose income is below the cut-off.
•  “Children in low income” means “children who are living in low income families (or households)”. The low income rate for persons can be calculated as the number of persons in low income divided by the total population. The same can be done for various sub-groups of the population; for example, low income rates by age, sex, or province.
•  Low Income Rate for Economic Families: Proportion of economic families in a given classification below the low income cut-offs (LICOs). These incidence rates are calculated from un-rounded estimates of economic families. 
• Low Income Rate for Unattached Individuals: Proportion of unattached individuals in a given classification below the low income cut-offs (LICOs). These incidence rates are calculated from un-rounded estimates of unattached individuals 15 years of age and over. 
• Low Income Rate for All People in Private Households: Proportion of population in low-income households relative to the total population in private households. Proportion of population living under LICOs. 
• Children in Low Income Households (Child Poverty): Proportion of children < 18 years in low-income households relative to the total number of children < 18 years in private households. Proportion of children < 18 years living under LICOs. Information for school aged children in low income families is available at : http://www.statcan.gc.ca/pub/81-599-x/81-599-x2009004-eng.htm  
• Seniors in Low Income Households (Senior Poverty): Proportion of seniors 65+ years in low-income households relative to the total number of seniors 65+ years in private households. Proportion of seniors 65+ years living under LICOs.·         Population in private households – all ages, children: < 18 years, seniors: 65+ years 
• Never-married children are further broken down by age-groupings, for example, under 18 years of age, through a special tabulation from the Ministry of Health. Population in private households by age-groupings (under 15 years, under 6 years, 6-9, 10-14, 15-17,18-24, 25-34, 35-44, 45-54, 55-64, 65-69, 70+) and sex also through a special tabulation. 
• Sex: male, female 
• Available geographic areas: health planning region, public health unit, district health council, census division, and census sub-division.

Indicator Comments

General Information

• Low income rates are defined in various ways; higher income is associated with better health.
•  The LIL indicators do not provide information about the duration of poverty.
• LIL’s not take into account the near-poor or low wage-earners who have incomes barely above the LICO and who have similar living conditions.
• One or more of the Low Income Line (LIL) indicators can be used.  Each provides a unique perspective on a facet of income related to expenses.  None of these capture low income, per se, as they do not capture a single low income threshold. 
• There is a contextual element in the criteria used to define low-income levels based on the amount spent on lodging, food and clothing. This level may vary from one region to another. 
• The family concept used is the economic family.  An economic family refers to a group of two or more persons who live in the same dwelling and are related to each other by blood, marriage, common-law or adoption. A couple may be of opposite or same sex. Foster children are included.
• In 2011, most information previously collected by the mandatory long-form census questionnaire was collected as part of the new voluntary National Household Survey (NHS). For differences between the two, please refer to the questionnaires⁶.  The first NHS data is due to be released on August 13, 2013.

Low Income Measure (LIM) 

• LIM is a fixed percentage (50%) of median adjusted household income, where “adjusted” indicates that household needs are taken into account. Adjustment for household sizes reflects the fact that a household’s needs increase as the number of members increases. 
• When using the LIM, the household is the appropriate unit for analysis. Low Income Cut-Offs (LICO)
• The LICOs represent levels of income where people spend disproportionate amounts of money for food, shelter, and clothing.
• LICO’s are income thresholds below which a family will likely devote a larger share of its income on the necessities of food, shelter and clothing than the average family. The approach is to estimate an income threshold at which families are expected to spend 20 percentage points more than the average family on food, shelter and clothing.  Cut-offs vary by seven family sizes and five different populations of the area of residence.
• When using the LICO, the economic family is the appropriate unit for analysis. 
• Statistics Canada produces two sets of low income cut-offs and their corresponding rates—those based on total income (i.e., income including government transfers, before the deduction of income taxes) and those based on after-tax income.  
• The LICO definition was based on national family expenditure data. These data indicated that Canadian families spent, on average, 42% in 1969, 38.5% in 1978, 36.2% in 1986 and 34.7% in 1992 of their income on basic necessities. By adding the original difference of 20% points to the basic level of expenditure on necessities, new low income cut-offs were set at income levels differentiated by family size and degree of urbanization. Since then, these cut-offs have been updated yearly by changes in the consumer price index. For example, the LICO is $34,572 for a family of four living in a city with a population of 500,000 or more vs. $23,892 in a rural area (for 2001 Census).  The LICOs were revised in early 2005 to incorporate revised weights from the 1992 Family Expenditure Survey, which were part of the 2003 Survey of Household Spending historical revision.
• LICOs are based on family and community size and are updated to account for changes in the Consumer Price Index (CPI). 
• LICO data exclude institutional residents and were not derived for economic families or unattached individuals in the territories or on Indian reserves.
• The LICO point is the amount necessary for material survival.  It is not an indicator of general welfare. 
• The choice of after-tax income, total income or market income depends on whether one wants to take into account the added spending power that a family gets from receiving government transfers or its reduced spending power after paying taxes. Some families in low income before taking taxes into account are relatively better off and not in low income on an after-tax basis. Statistics Canada prefers the use of the after-tax measure (see http://www.statcan.gc.ca/pub/75f0002m/2009002/s2-eng.htm). The before-tax rates only partly reflect the entire redistributive impact of Canada's tax/transfer system because they include the effect of transfers but not the effect of income taxes. Since the purchase of necessities is made with after-tax dollars, it is logical to use people's after-tax income to draw conclusions about their overall economic well-being. 
• The number of people falling below the cut-offs has been consistently lower on an after-tax basis than on a before-tax basis. Market Basket Measure (MBM)  
• MBM is based on the cost of a specific basket of goods and services representing a modest, basic standard of living. It includes the costs of food, clothing, footwear, transportation, shelter and other expenses for a reference family of two adults aged 25 to 49 and two children (aged 9 and 13). 
• The MBM provides thresholds for a finer geographic level than the low income cut-off (LICO).
•  When using the MBM, the economic family is the appropriate unit for analysis.

Cross-References to Other Sections

• Low Income Measures - http://www.statcan.gc.ca/pub/75f0002m/2012002/lim-mfr-eng.htm  
• Market Basket Measure - http://www.statcan.gc.ca/pub/75f0002m/2012002/mbm-mpc-eng.htm  
• Low Income Cut Offs - http://www.statcan.gc.ca/pub/75f0002m/2012002/lico-sfr-eng.htm  
• Low Income Rate and Low Income Gap Ratio - http://www.statcan.gc.ca/pub/75f0002m/2012002/low-faible-eng.htm  
• Low Income Families - http://www5.statcan.gc.ca/subject-sujet/result-resultat.action?pid=20000&id=20007&lang=eng&type=ARRAY&pageNum=1&more=0 
• The Median Share of Income is a related indicator to Low Income Rate.  Information can be found in CANSIM Table 109-0300 (2006) and Table 109-0200 (2001). Available at:  http://www.statcan.gc.ca/pub/82-221-x/2012002/tblstructure/2nm/2lw/lw2mso-eng.htm
  

References

1. Statistics Canada. 2001 Census Dictionary. Ottawa, ON: Ministry of Industry, 2002. Available from: URL: http://www12.statcan.ca/english/census01/Products/Reference/dict/index.htm
2. Cotton C, St-Pierre Y, Webber M. (1999).  Should the low income cutoffs be updated? A discussion paper. Ottawa (ON): Statistics Canada, Income Research Paper Series, 75F0002MIE99009.
3. Picot G, Myles J. (1996). Children in low-income families. Canadian Social Trends, 42:15-19.
4. Income Statistics Division, Statistics Canada. Low Income Cut-offs for 2006 and Low Income Measures for 2005. Ottawa, ON: Ministry of Industry, 2007. Available from: URL: http://www.statcan.gc.ca/pub/75f0002m/75f0002m2007004-eng.pdf  
5. Statistics Canada. Overview of the Census: Census Year 2011. Ottawa, 2011. Catalogue number: 98-302-XIE. Available from: http://www12.statcan.gc.ca/census-recensement/2011/ref/overview-apercu/98-302-XIE.pdf.
6. Statistics Canada [homepage on the Internet]. Ottawa: Statistics Canada. 2011 Census - Census questionnaires. Available from: URL: http://www12.statcan.gc.ca/census-recensement/2011/ref/about-apropos/questions_guides-eng.cfm
7. Income Statistics Division, Statistics Canada. (2012). Low Income Lines, 2010 to 2011. Income Research Paper Series, Ottawa.  75F0002M Available from: URL: http://www.statcan.gc.ca/pub/75f0002m/75f0002m2012002-eng.pdf   

Changes Made