Genuine Progress Index for Atlantic Canada Indice de progrs vritable Atlantique Measuring Community

1
Genuine Progress Index for Atlantic CanadaIndice
de progrès véritable - AtlantiqueMeasuring
CommunityHealth and WellbeingAtlantic Network
for Prevention Research White Point, 26 October,
2005
2

Community GPI is based on simple question
What kind of community are we leaving our
children?
3
What kind of community are we leaving our
children?

• Step 1 Community consultations to translate
  measurement into experience and language of
  ordinary Nova Scotians
• Basic satisfaction with QOL
• Materially better off
• But, some disturbing signs

4
Uncertain Answers Better off in a Poorer Natural
World?

• Natural resource depletion, species loss
• Less fish, condition of forests, soils
• Global warming
• Stress, obesity, asthma, environmental illness
• Insecurity, inequality, child poverty
• Decline of volunteerism

5
Step 2 Education Why we need better measures of
progress

• Crime, sickness, pollution, resource depletion
  make economy grow
• GDP can grow even as poverty and inequality
  increase.
• More work hours make economy grow free time has
  no value.
• GDP ignores work that contributes directly to
  community health (volunteers, work in home).

6
We Need Better Indicators of Progress Wellbeing
- In GPI

• Health, livelihood security, free time, unpaid
  work, natural resource, education have value
• Sickness, crime, disasters, pollution are costs
• Reductions in crime, poverty, greenhouse gas,
  ecological footprint are progress
• Growing equity signals progress

7
Step 3 Partnerships to Create Community GPI

• Initiative came from community groups. Many
  community partnerships include
• NS Citizens for Community Development Society
  community health boards, regional public health
  authorities, Cape Breton Wellness Centre,
  Atlantic Centre of Excellence for Womens Health
• CB regional police, Glace Bay Citizens Service
  League, Rotary Clubs, Kings and Cape Breton
  Community Economic Development Agencies

8
Community-Government-University Partnerships

• Federal Canadian Population Health Initiative,
  National Crime Prevention Centre, ACOA, Health
  Canada, HRDC, Canadian Rural Partnership, Rural
  Secretariat, Statistics Canada
• Dalhousie Univ. Population Health Research Unit
  St. Marys University Time Use Research Program
  University College of Cape Breton, Acadia U.

9
Goals and Objectives

• Community vision, learn, mobilize, act
• Vision - community indicator selection
• Learning about ourselves
• Mobilize communities - common goals
• Turn new-found knowledge into action

10
Research Goals

• Identifying strengths and weaknesses of 2 very
  different communities
• Understand determinants of health
• Community learning about itself, insights,
  understanding relationships among variables - eg
  volunteerism, time use and health
• Turning knowledge into action keeping track -
  measuring genuine progress

11
Process as Result

• Indicator selection, creating survey
• E.g. Farmers exchanging information
• Report releases in Sheffield Mills, Jeddore -
  farmers, fishermen present
• New ideas e.g. restorative justice
• Results bring disparate groups together

12
The Means

• 3,600 surveys - random, 15, confidential
• CI 95 /- 3 2 cross-tabulations
• Detailed 2 hrs Glace Bay 82 response
• Survey includes health, care-giving, time use,
  voluntary work, security, income employment,
  environmental issues
• Data entry cleaning, access guidelines

13
Whats in the Glace Bay and Kings County GPI
Surveys?1) Demographics Employment

• Age, sex, household, marital, education, income
• Employment, unemployment, out of work
• Job characteristics - types of jobs (p-t, f-t,
  etc), benefits, work from home, occupation
• Work schedule, hours, shifts, job security,
  underemployment, job sharing - work reduction

14
2) Health and Community

• Core values, caregiving, volunteer work,
  community service
• Stress, mental health, social supports,
  childrens health
• Weight, smoking, physical activity, screening
  (Pap, mammogram, blood pressure)
• Pain, disability, disease, medications, health
  care use

15
3) Peace and Security

• Victimization and costs of crime
• Neighbourhood safety, fear, self-protection
• Opinions about police, courts, prisons
• Identify community problems - drinking? bullying?
  domestic violence? drugs? Etc.

16
4) Time Use Diary

• Work Household work, paid work, voluntary work,
  caregiving, education
• How we spend free time - TV, reading,
  socializing, spiritual practice, sport, exercise
• Travel, personal activities, child care
• Window on quality of life

17
5) Environment

• Energy use
• Transportation patterns
• Water quality
• Recycling and waste
• Food consumption - food diary and nutrition

18
Community Action

• Community access to results - special software
  packages, news stories, etc.
• Meet to discuss results and identify policy
  priorities / actions
• Community prioritizes indicators for annual
  benchmarks of progress
• Community training adaptations
• Community ownership creation of Kings and Glace
  Bay GPI Societies

19
Emphasis on practical action - e.g.

• Teenage smoking overweight exercise - e.g.
  promote school-based programs
• Screening rates - mammography, pap smears --
  notify health officials of needs
• Identify counselling needs - employment, domestic
  violence, mental health
• Education - nutrition, recycling, energy use

20
New directions for the future

• New solutions e.g. work-life balance
• Model for other communities - template for
  adaptation - community / province
• Balance community-based research with
  methodological rigour, Statistics Canada
  oversight, advice, review
• Improve methods, indicators, survey tools, data
  sources - never a final product

21
Examining tobacco use and health in Glace Bay and
Kings County, Nova ScotiaSimilar results in
survey for obesity, physical activity, nutrition,
screening, etc.
22
Natl/Prov. Comparisons
Glace Bay daily smoking above average, Kings below
23
At the present time do you smoke?
Numbers represent
24
Have you ever smoked cigarettes at all? Good
News
25
Self-reported health of smokers and non-smokers
26
Nicotine dependency How soon after you first
wake up do you smoke your 1st cigarette?
27
GB Characteristics of smokers

• 39 of unemployed cf 29 employed
• Low income groups have highest rates of smoking
  Under 10K 44 10-15K 37 15-20K 35 cf
  60K 21
• 47 primary industries cf 15 in management,
  24 social science, govt
• Grade 9-12 (32), community college (34 2x
  smoking rate cf university grads (17)
• Separated/divorced 45 cf married 29

28
Employment status of those smoking daily
29
Education level and daily smoking Kings County
30
Smoking by age group
31
Does anyone in your household smoke regularly?
32
Does anyone in your household smoke inside the
home?
33
Age of smoking initiation -
34
Smoking chronic conditions1st time local
correlations with

• Cancer, heart disease, stroke, diabetes
• Asthma, bronchitis, sinusitis, allergies.
• Smokers drink more coffee, exercise less, and
  visit their doctors more frequently
• Having local-level results makes issues
  immediate, direct rouses action

35
Second-hand smoke and children

• 78 of daily smokers (GB) and 76 (Kings) have
  children in the home
• Children who grow up in smoking households have
  poorer health and are more likely to be on
  medications
• GB 66 of smokers rated their childs health as
  excellent, vs. 80 of non-smokers Kings 58
  of smokers cf 63 of non-smokers

36
Ritalin or ADD medication among children
37
Quitting evidence shows

• Factors that influence readiness to quit after
  diagnosis
• if a family member smokes at home the person will
  be less likely to quit
• Level of nicotine dependence
• Awareness of the benefits of quitting
• Level of emotional distress
• Fatalistic outlook, why bother
• Cost of cigarettes other health costs

38
Applied research needs-E.g

• Much research exists on what influences healthy
  to quit smoking. Very little research on why
  people with chronic diseases quit or do not quit
  smoking. Needed to develop smoking cessation
  programs for people with chronic diseases.
• Kings County has higher quit rates than Glace
  Bay. This lifestyle difference needs further
  research, with potential to use successful Kings
  County experiences as models for smoking
  reduction programs in Glace Bay.

39
Peace and Security Issues in Glace Bay Kings
County
40
Kings 78 more likely be victims of crime
(14.6) than Glace Bay (8.2)Were you a victim
of crime in past 5 yrs?-
41
Victimization rates
Crime victims are more likely to protect
themselves 2 ½ times more likely to avoid
places than non victims, 2-4 times more likely to
obtain a gun, twice as likely to carry something
to defend themselves, and over 6 times more
likely to move their residence
42
Sex differences 55 crime victims in Kings
female cf 46 Glace Bay
43
Crime worries in each area

• GLACE BAY
• Top 3 concerns
• Underage drinking
• Drug use/trafficking
• Vandalism
• Bottom concerns
• Child abuse
• Fighting among groups

• KINGS COUNTY
• Top 3 concerns
• Drinking and driving
• Drug use/trafficking
• Underage drinking
• Bottom concern
• Violence against spouses

44
The most important role of the criminal justice
system is
Crime prevention should be the priority of the
criminal justice system, according to both groups
45
More and better youth programs would help reduce
crime
Respondents in both regions feel strongly about
this issue
46
What level of crime do you think your
neighbourhood has compared to the rest of Canada?
Both regions feel that crime in their area is
less than in rest of Canada
47
Satisfaction with personal safety from crime
48
In the past 5 years has the level of crime in
your neighbourhood increased, decreased, or
stayed the same?
49
FEAR OF CRIME How safe do you feel alone
walking after dark in your area?
50
How safe do you feel when alone in your home at
night?
51
Was your business victimized by crime in the past
12 months?

• In Kings County theft was the biggest problem for
  business owners, while in Glace Bay vandalism
  caused the biggest loss.

52
Business Losses

• Was the crime to your business reported to the
  police?
• yes no
• Kings 66.7 33.3
• Glace Bay 69.6 30.4
• Was your loss compensated by insurance?
• yes no
• Kings 6.7 93.3
• Glace Bay 6.1 93.9
• Was any of your stock, money, property recovered?
• yes no
• Kings 6.6 93.4
• Glace Bay 6.5 93.5

53
Communities offer solutions E.g.

• Develop programs that combat risk factors and
  social problems, i.e. unemployment and drug use
• Strengthen community networks develop
  partnerships
• Citizens need to be made aware of community
  programs and support networks through promotion
  and advertising
• Community beautification projects cleaning,
  painting
• More better youth programs created by youth
  for youth
• Employment and recreation initiatives are
  essential

54
Preliminary conclusions

• Solutions developed by communities may be
  stronger, longer lasting than punitive solutions
  through criminal justice system. Can increase the
  capacity of communities to handle new problems.
• By strengthening connections to the community
  obligations are created that act as both a
  deterrent and rehabilitative measure.
• Restorative justice, increased recreation, and
  new community programs and other specific
  solutions

55
Education and Health
56
Kings more highly educated ve employment
prospects.
57
Better educated better health
58
Low education more activity limitations
59
More education more stress
NB Comm coll smoking
60
Income and Health
61
Glace Bay lower incomes than Kings
62
Higher income better health (The substantially
higher rate of poor/fair health in lowest income
Kings residents requires further investigation.)
63
Lower income more activity limitations
64
Lowest highest incomes highest stress
Middle-income groups lowest stress (Statcan,
Jap. studies equity Dutch model)
65
Low income low life satisfaction
66
Unemployment
67
Unemployed persons Glace Bay 3x Kings
68
Unemployed males GB 4x Kings
69
Unemployed females GB 2.4x Kings
70
Reasons for unemployment GB more likely layoff,
no suitable work
71
Glace Bay unemployed less optimistic re finding
job in next six months, unemployed for longer
durations, higher stress re future lay-offs.
72
Employment Health Status
73
Job characteristics and Health Outcomes

• After controlling for age, gender, location
• Those with non-permanent jobs more likely to
  report lower life satisfaction than those with
  permanent jobs (13 vs 6)
• Shift-workers were more likely to report lower
  levels of life satisfaction (10 vs 5) and were
  more likely to report a functional limitation
  (25 vs 9) than those on regular schedules

74
Job characteristics Job security

• Persons who reported stress re possibility of
  future layoffs were significantly more likely to
  report
• Poor/fair health status
• Activity Limitations
• Disabilities
• Moderate/high stress
• Lower levels of life-satisfaction
• Less control over decisions affecting their lives

75
Unemployment and health status
Unemployed persons are significantly more likely
than employed persons to report - Poor/fair
health status - An activity limitation - A
disability - Lower levels of life-satisfaction
- Less control over decisions
76
Unemployment and health status
77
Health Status Comparisons
78
Disabilities higher in GB,Stress higher in Kings

• Glace Bay respondents were more likely to have
  activity limitations, disabilities, high blood
  pressure and diabetes
• Kings County respondents were more likely to
  report higher stress levels and little or no
  control over important decisions that affect
  their lives

79
(No Transcript)
80
(No Transcript)
81
Caregiving and Caregivers in Glace Bay
82
Unpaid Caregiving mostly for sick parent,
spouse or child

• Growing issue with de-institutionalization of
  health care highlighted by Romanow Report
• Affects livelihood, household income, ability to
  hold down job
• Impacts on health, mortality, risk behaviours and
  conditions, stress, inadequately researched
• Policy implications Needs for respite, EI
  benefits, community supports, employer policies

83
Key Findings

• Caregivers are more likely to be female, married,
  middle-aged (especially 45-54), unemployed, less
  educated, lower incomes
• Caregivers poorer emotional health status, more
  stress, more likely to report fair or poor health
  and activity limitation, more likely to visit
  doctors/ER often, use medications more often,
  smoke more, exercise less
• Caregivers have 2x incidence of migraine
  headaches and intestinal disorders, 3x bowel
  disorders

84
E.g. Glace Bay Age

85
Perceived Health Status
86
Activity Limitation
87
Pain reliever/anti-inflammatory
88
Anti-depressants
89
Blood Pressure Medication
90
Stomach Remedies
91
Life Stress
92
Not Accomplished What You Want
93
Constantly Stressed trying to Accomplish More
94
Physician Contacts
95
Visits to ER/OP
96
Exercise Patterns
97
Smoking
98
Volunteerism
99
Caregiving and Caregivers in Kings County
100
Perceived Health Status
101
Activity Limitations
102
Pain Relievers/Anti-inflammatory
103
Stomach Remedies
104
Time with Friends/Family
105
Constantly Stressed Trying to Accomplish More
106
No contact with Non-Live-in Family indicates
isolation
107
Examples of policy implications (1)

• Tobacco Wider adoption and use of school-based
  Smoke-Free for Life smoking prevention
  curriculum
• Community college interventions
• Supports for quitting free nicotine gum and
  patches as in Quebec

108
Policy Implications (2)

• Peace and Security Glace Bay focus on vandalism
  brought to attention of police
• Addressing social determinants of crime
  especially youth programs and activities
• Glace Bay lower victimization than Kings
  discovering a community strength, source of pride
  gt first release to press

109
Policy implications (3)

• Caregiving More respite services for caregivers
• EI and other income-support benefits for
  caregivers
• Employer policies that include supports or
  insurance for caregivers forced to give up their
  jobs to care for an ailing spouse, child, or
  parent
• Better community supports rather than caregiving
  being currently regarded as a personal, domestic
  issue

110
Policy implications (4)

• Employment Job creation emphasis in Glace Bay
  job security in Kings County
• Education employment links emphasized need
  for retraining in Glace Bay
• Stress at both ends of income spectrum and among
  highly educated discussed esp in Kings.
  Potential for job creation through work hours
  redistribution

111
Lessons learned - examples

• Community consultation process agreeing to all
  community requests led to survey that was too
  long. Experience shows it can be reduced by 2/3
• Balancing expertise and community participation.
  Emphasizing expertise in early stages coupling
  it with community leadership/technical training
• Sustaining effort through creation of community
  infrastructure researchers and community
  groups Kings and Glace Bay GPI Societies

112
New research on income-related health
inequalities using Community GPI

• Report will be released Nov. 17
• Dr. Sean Rogers, Dalhousie, with 5-university
  partnership Acadia, CBU, Memorial, SMU
• Wide gap in Atlantic Canada
• Single parenthood, unemployment less direct
  impacts on health than income implications of
  these determinants

113
Database is available to you unparalleled
resource

• For community-level research on determinants of
  health
• See www.gpiatlantic.org Community GPI -gt
  Publications bottom of page for surveys
• Simple data access guidelines available from
  Acadia and CBU. Go to Kings GPI and Glace Bay GPI
  web pages for Data Access

114

Measuring what we value to leave a better
community for our children
115
Genuine Progress Index for Atlantic CanadaIndice
de progrès véritable - Atlantique

• www.gpiatlantic.org