1 GAT context: Primary health care is a recognized gap in Thorncliffe - PDF document

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GAT context: Primary health care is a recognized gap in Thorncliffe Park (TP) that impacts access and health outcomes. Various separate partnerships have been created in response to specific challenges. Proposals have been made to address the most pressing gaps (e.g., TNO’s submission for FHT, SRCHC’s proposal for post ‐ partum depression service expansion). However, there has been no overall coordinated health/primary health care plan for TP involving all players to guide priority setting and system integration. TC LHIN convened key stakeholders serving TP in December 2013 to initiate a collaborative planning process focused on primary health care. To inform this process, Flemingdon Health Centre (FHC) in collaboration with Thorncliffe Neighborhood Office (TNO) and South Riverdale CHC (SRCHC) conducted a health care current state and gap analysis, emphasizing primary health care in TP. 2

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History and Geography – A Contained community Thorncliffe Park was a planned suburban community. It was contemplated during the construction of the Don Valley Parkway (DVP) when it was assumed that eventually everyone would own a vehicle. The nearby Parkway, the Don Valley ravine to the south and east and the CN rail line to the north restrict access to and from Thorncliffe Park resulting in an isolated and cloistered micro community with only four entry/exit points. The only way south or east out of the community require crossing two high bridges designed primarily for cars. The bridges are difficult and dangerous to walk, and a safety concern for pedestrians. This photo shows the length and height of the bridges ‐ two of Thorncliffe Park's only four entry/exit points. http://spacing.ca/toronto/2013/07/25/concrete ‐ toronto ‐ the ‐ don ‐ valley ‐ parkway ‐ and ‐ suburban ‐ growth/ 7

People “Today’s TP, Tomorrow’s Canada” Population size (2011) = 19,250 according to census. TP is a top newcomer receiver community with a young population that is undergoing acculturation and has strong cultural ties. The population is relatively educated but also under/unemployed. Many intergenerational families live together in the apartments. While TP apartments are older and fairly large 2 ‐ 3 bedroom units, families and friends are doubling up because of lack of access to housing and affordability which is causing overcrowded living conditions. http://spacing.ca/toronto/2008/05/08/walking ‐ thorncliffe ‐ park/ Other key population characteristics: Politically active (high voting rate), high level of involvement in grassroots, faith groups and large multi ‐ • service agency (TNO). 8

Sizable undocumented/uninsured population with a variety of circumstances (exact • numbers not available). The following key sub ‐ populations were the focus of our analysis: newcomers; women; young families and children; youth; seniors; refugees/non ‐ insured. 8

Demographics, Language, Immigration and Ethno ‐ Racial Diversity, Socio ‐ economic Status ‐ highlights City of Toronto released its new methodology for identifying priority neighbourhoods in March 2014. The Urban Heart Matrix looks at a combination of economic opportunity, social and human development, governance, physical environment & infrastructure indicators. Each neighbourhood is given an equity score based on comparative results to the Toronto rate. The neighbourhoods with the 10 lowest equity scores have been designated at Neighbourhood Improvement Areas. Thorncliffe Park has the 9 th lowest equity score in Toronto. Other neighbourhoods include South Parkdale, Regent Park, Oakridge, Mount Dennis and Black Creek. The Top 10 neighbourhoods will be the focus for City of Toronto coordinated service planning and resource allocation. What Urban Heart Matrix tells us about TP population: Comparably high levels of unemployment and social assistance and low income levels. Education levels are • higher than comparable neighborhoods and on par with Toronto, and the community is civically engaged. The high rate of diabetes and hospitalization due to preventable causes in TP point to the need for accessible • and comprehensive primary health care in the community. For GAT we selected the following neighbourhoods as comparators to Thorncliffe Park: Crescent Town, Flemingdon Park, Oakridge, North St. James Town because they are all newcomer, high density/high rise communities with similar diversity and socioeconomic profiles. 9

Thorncliffe Park is experiencing rapid population growth. Between 2001 and 2011 the community grew by 2,500. That’s more than a 15% increase over the 2011 population estimate of 19,275. The current population size is likely underreported. It has been frequently reported that families and friends “double ‐ up” in apartments. TNO and others estimate that the population size is closer to 30,000. The greatest growth is amongst children. Thorncliffe Park has the highest fertility rate in the City by far. The three ‐ year average number of births/1000 women 15 ‐ 49 years of age was 84.7 in 2009 ‐ 11. The next highest fertility rate was Black Creek at 63.2/1000 women aged 15 ‐ 49. 71.6% more children 0 ‐ 14 years than the proportion of children in this age group in the City of Toronto. • Double the proportion of children aged 0 ‐ 4 in comparison to the City (10.6% vs 5.4%). The total number of • hospital births continues to increase over time. In 2011, 67.0% of private households had children and 18.2% of private households had 5+ persons. • The high fertility rate and the fact that over 90% of births are to mothers not born in Canada suggests a much higher need than other areas of the City for pre ‐ natal and post ‐ partum care and services for mothers and children – care that is accessible, culturally competent and well coordinated during pregnancy and throughout childhood. Seniors represent a relatively small proportion of TP (less than Toronto average by 28.6%) but what is unique is the large proportion of seniors who are medically complex AND living alone (40% living alone). Seniors over 75+ in TP had approximately 25% more ED visits than the Toronto average (2009/10). A majority of seniors in TP have a disability or activity limitation ‐ higher than TC LHIN and City averages

Thorncliffe Park has the highest ethnic concentration index score among Toronto neighbourhoods. This indicator is made up of two indicators – proportion of the population who are recent immigrants (5yr) and proportion of the population who self ‐ identify as visible minority. In 2011: The top 3 non ‐ official languages spoken in TP were Urdu (20.8%), Farsi (4.0%) and Gujarati • (3.7%). 7% of the community has no knowledge of either English or French. (2011 Stats Can NHS). The top 3 ethnic origins in TP were East Indian (25.9%), Pakistani (19.9%) and Filipino (7.6%). • The top 3 visible minority groups in TP were South Asian (64.5%), West Asian (9.8%) and • Filipino (7.1%) Given high level of mobility in community and changes in immigration patterns, the make up of TP is quite dynamic. From 2001 to 2011 there was an increase in the number of Afghani, Pakistani and East Indian immigrants, while the number of Filipino immigrants has decreased. This has implications for health care planning and service delivery in the neighbourhood., e.g, meeting needs of Afghani’s and others from conflict regions. The health system has not kept pace with the community’s changing needs. 11

Health Profile ‐ highlights Nearly 15% of TP residents had a physician visit involving mental health (MH) in 2007. This prevalence rate for MH is higher than the prevalence of diabetes in TP. Age ‐ adjusted rates are 18% higher than in the City and higher than TC LHIN. Rates of MH in TP are the highest amongst comparator neighbourhoods for the males and females 20+ years of age and even higher comparatively for the 20 ‐ 44 age groups and among the highest for the seniors’ population. MH visits are high despite the stigma associated with mental illness and addictions in the neighbourhood. Women have more MH visits than men in all age groups. Engagement: What we Heard All ages and groups affected. • Low awareness, under ‐ recognition and stigma among newcomers. Some TP residents prefer to leave • community to seek help for MHA. Lack of early identification, coordinated care management. Some get support only when in crisis. • No known psychiatrists, psychologists in TP. A few mental health counseling services in TP for some • populations, but not generally available. Some targeted programs are effective, could be replicated. Key MH issues identified by residents, primary health care providers, agencies: depression, anxiety, post ‐ • partum depression, PTSD. 12

Addictions – Hidden issue. Lack of reliable information. Anecdotally, issues include: • alcohol abuse among youth/young adults, women and prescription drugs (e.g., OxyContin), opium addiction. 12

Health Profile – highlights TEGH reported in consultations that women are arriving at the hospital in the third trimester or at the time of birth without having received pre ‐ natal care. Given that over 90% of women in TP were foreign born and the prevalence of post ‐ partum depression amongst immigrant women is 41% it can be anticipated that approximately 157 women in TP could be affected by post ‐ partum depression at any given time. (Collins, C.H, Zimmerman,C,Howard,L.M. Archives of Women's Mental Health (2011) 3 ‐ 11) 13