Health Disparities in Saskatoon Health Region: Measurement, - - PowerPoint PPT Presentation

Health Disparities in Saskatoon Health Region: Measurement, Community Engagement and Intersectoral Action

• Dr. Cory Neudorf

Chief Medical Health Officer

• Dr. Mark Lemstra

Population Health Research Lead

What’s Our Story?

Saskatoon Health Region Our Intersectoral Journey

• 1996…member of the Regional Intersectoral Committee to

participate in planning and policy making

• 1999…invested in development of the CCIS
• 2000…produced locally relevant reports for our partners to

use with us to effect change

• 2005…Health Disparities Study
• 2005 to 2006…community/stakeholder meetings, public

survey, CIHR health disparity grant

• 2006 to 2008…study published, news release, start of action

plan announced, expansion to other Canadian cities

• 2007…School Health Survey

What’s Our Story?

Community Engagement Intersectoral Partnerships & Action Programs & Services for most Vulnerable Advocacy for Policy Change Measurement

Measurement

Initial Study: Health Disparity by Neighbourhood Income

• Substantial disparity in all health outcomes between

low and high income neighbourhoods

• Examples:

– Infant mortality – 448% higher – Suicide attempts – 1458% higher – Chlamydia – 1389% higher

• www.saskatoonhealthregion.ca/your_health/ps_public

_health_profinfo.htm

Saskatoon neighbourhood analysis boundaries, excluding industrial and development areas, 2005

Legend

Affluent neighbourhoods Rest of Saskatoon Low income neighbourhoods

Source: Saskatoon Health Region, Public Health Sevices

More Research – Examples

• CCHS Data Merge (n = 5,948)

– Multiple health and behaviour outcomes

• Saskatoon School Health Survey (n = 4,093)

– Prospective, longitudinal cohort

• CCHS Data Linkage with Health Records (n = 3,433)
• Systematic Literature Reviews
• First Nations Regional (Saskatoon) Longitudinal

Health Survey

Main Findings

• CCHS

– Age and income have the strongest associations with disease/disorder prevalence

• SSHS

– Aboriginal cultural status has more limited association with poor health outcomes and risk behaviours

Knowledge Transfer & Community Consultations

• Regional and Provincial Government
• Community Groups
• Community Agencies
• Low Income Residents

Meetings occurred with community groups including:

• Saskatoon Tribal Council
• Central Urban Metis Federation
• Saskatoon Indian and Metis Friendship Center
• Whitecap First Nation
• White Buffalo Youth Lodge and
• Community Association Presidents

Elder Circle Direct interviews with core neighbourhood children and adults

SHR Leadership Response to Evidence

• Responsible release of the evidence
• Baseline data on awareness, attitudes & willingness to

change

• Community engagement & intersectoral action is key
• Communication plan
• An action plan to announce with the evidence
• Ongoing study and evaluation plans

Community Engagement

Reaction to Evidence

Human service workers and general public

• Shock
• Denial to acceptance
• Anger
• Motivation

Inner city community & workers

• Less shock
• Anger and despair
• Action!
• Willingness to partner
• Many ideas

Communication Strategy

• Share data widely
• Meet with media under embargo
• Work with journal to coordinate release date
• Branding of issue focused on solutions

(Building Health Equity)

“Health Disparity Knowledge & Support for Intervention in Saskatoon”

• Baseline survey to:

– Measure public and staff awareness – Gauge public receptiveness

• Repeat survey

• Telephone survey
• Random sample of 5000
• 62% response rate
• Representative sample
• 83% of people believe something can be done to

address this disparity

“Health Disparity Knowledge & Support for Intervention in Saskatoon”

“Health Disparity Knowledge & Support for Intervention in Saskatoon”

• 80% of people agree that the poor have poorer health
• Most believe that there should be 0% difference in

health outcomes by income status

• Most support for interventions:

– Work earning supplements (84.1%) – Strengthen early intervention (83.8%)

How has this changed the Health Region, so far?

2007 to 2010 Strategic Plan – Partnering for Improved Health for Aboriginal people – Year 1 priority - reducing health disparities – Aboriginal health strategy (in progress) – Replicating the study in rural context

Program Initiatives

• Transferred $1 Million of resources to 6 low

income neighbourhoods

• 80% due to reallocation with Public Health

Services

• New investment of $150,000 to support

infrastructure

• Development of interdisciplinary team
• Leasing property within core

neighbourhood

Branding…Building Health Equity Team

• All Departments to consider the need to change practice

– Awareness and accountability – Balance between treatment and prevention – Taking services to clients in need

Other Health Region Departments

Other Health Region Departments

– Cultural appropriateness – People Strategies initiatives (representative workforce) – Recognize the need for assisting people to navigate a complex system – Can we impact determinants of health by our hiring practices, interactions with clients, and advocacy on social justice issues?

Intersectoral Action

How has this changed others, so far?

• College of Medicine

– Paediatricians in 2 schools

• Government of Saskatchewan

– $40 million for low income subsidized housing

• City of Saskatoon

– Doubled the budget for affordable housing

• United Way and Health Region

– $80,000 annually for after school programs

• Saskatoon Tribal Council & Health Region

– Immunization clinic, HIV clinic & joint research

2006 Saskatoon Regional Intersectoral Committee (SRIC) endorsed health disparities as a key priority Coalition formed to brainstorm action plan 2007 SRIC commissioned the document “Health Disparity in Saskatoon: Analysis to Interaction” (Consultations in progress, May, 2008)

Intersectoral Planning

Examples of Intersectoral Action

Services: Immunization clinic Nursing services Paediatrician “Doctor in the House” Partners: W.P Bate Community School U of S Saskatoon Tribal Council Health Region

Examples of Intersectoral Action

Services: Agility Clinic Paediatrician Clinic Nursing Services Immunization Clinic Partners:

• St. Mary’s

Community School U of S Saskatoon Tribal Council Health Region

Where are we going next?

Ongoing Study and Evaluation

• Regular progress reports
• Advisory meetings with community agencies

and members

• Repeat surveys
• CIHR grant ($787,000 over 5 years) to fund

further study and evaluation

Ongoing Study and Evaluation

• Other intervention research grants

– CIHR Urban Aboriginal grant for $300,000 over 3 years to improve immunization coverage in inner city – Aboriginal Health Transition Fund for HIV for $715,000 for 3 years

• National & International initiatives
• Urban Public Health Network
• National report on Poverty and Health from CPHI (Nov 2008)
• International links with UK Population Health Observatories
• Regular reporting on progress
• Other topical reports

In closing ……..

Measurement

• Tested an assumption
• Discovery of the extent of health disparity
• Impetus for change

Community Engagement

• Respectful approach to community residents
• Testing policy change ideas on the general public
• Taking the pulse of policy makers

Intersectoral Action

• Infrastructure such as a Regional Intersectoral

Committee

• Coalition building to advocate for public policy changes

across sectors

• Leveraging regionalization to influence change within

the health system

Thank You!