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? Measurement Intersectoral Community Partnerships & Engagement Action Programs Advocacy for & Services Policy Change for most Vulnerable
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 � Inner city community & and general public workers - Shock - Less shock - Denial to acceptance - Anger and despair - Anger - Action! - Motivation - 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
“Health Disparity Knowledge & Support for Intervention in Saskatoon” • 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” • 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
Other Health Region Departments • 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 – 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
Intersectoral Planning 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)
Examples of Intersectoral Action Partners: W.P Bate Community School U of S Saskatoon Tribal Council Services: Health Region Immunization clinic Nursing services Paediatrician “Doctor in the House”
Examples of Intersectoral Action Partners: St. Mary’s Community School Services: U of S Agility Clinic Saskatoon Tribal Paediatrician Council Clinic Health Region Nursing Services Immunization Clinic
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!
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