Putting Nanaimo's Children First: Using Routinely Collected Information to Build Momentum for Addressing Children's Issues by Dr. Paul Hasselback

1. VIU – February 16, 2015
Putting Nanaimo’s Children First:
Using routinely collected information
to build momentum for addressing
children’s issues
Paul Hasselback MD MSc FRCPC
Medical Health Officer
Central Vancouver Island

2. Data Driven Action
• Informa(on
as
a
catalyst
for
change.
• Posi(ve
examples
from
peer
organiza(ons
in
BC.
• Data
empowers
people.
• Data
enables
decision
makers
to
improve
the
quality
of
their
decisions.
– Data
may
dissuade
poorer
decisions.

3. Quality Improvement Cycle

5. Heart
Cancer
Lung
Stroke
Arthri(s
Depression
Diseases Risk factors Determinants
Tobacco
Alcohol
Diet
Physical
Fitness
Social
Fitness
Economic
status
Educa(on
Work
life
Environment
Social
support
Gene(cs
Gender
Child
life
Culture
Lifestyles
and
coping
Health
Services
Determinants of Health

7. Poverty and Health
• Income
and
income
distribu(on
is
a
determinant
of
health.
• Most
diseases
have
a
correla(on
between
higher
rates
of
illness
and
lower
income.
Examples
-­‐
Childhood
respiratory
illnesses
-­‐
Diabetes
rates
-­‐
Lung
cancer
rates
• A
simple
rule,
is
that
disease
rates
are
oNen
1.5
to
2
(mes
higher
in
the
lowest
economic
quin(le
compared
to
the
highest.

8. Self-reported Health by Household Income
72% 69%
62%
46%
$80,000 + $50,000-$79,999 $30,000-$49,999 < $30, 000
Total Household Income
VeryGoodorExcellent
Health
Canadian Community Health Survey

13. A Personal Why?
• Children
are
our
future.
• Efforts
to
improve
child
wellbeing
result
in
improvements
in
community
health
and
vitality.
• Thriving
communi(es
=
Healthy
people.
• Personal
passion
for
the
success
of
children.

14. Why
• Early
Years
Network
in
Nanaimo
for
over
a
decade.
‒ Strong
founda(on
to
build
from.
• DraN
city
strategic
plan
with
minimal
emphasis
on
families
and
scarce
reference
to
children.
• Island
Health
services
having
room
for
improvement
in
coordina(on.
‒ Also
with
scarce
emphasis
on
children
and
families.
• Public
Health
and
Children’s
Health
“bounced”
between
porZolios.

16. Greater Nanaimo Early Years
Partnership
• Success
by
Six
parent
survey
2012
(276
respondents).
– Paren(ng
informa(on
• 80%
friends
• 73%
family
• 42%
internet
• 22%
professional

18. Why the Report
• A
sense
of
decreasing
success
of
children.
• Need
for
a
documenta(on
of
a
founda(on
of
benchmarks.
• A
stepping
stone
for
moving
forward.
• Increasing
awareness
of
the
current
state
of
children
in
the
community.
• Successful
example
elsewhere
(best
prac(ce).

19. Key Notes
• Data
are
presented
without
comparison
and
without
(me
trends.
– Some
trend
informa(on
is
available.
• Agency
specific
informa(on
is
available
annually,
oNen
with
1-­‐3
year
lag
(mes.
• Used
2006
census
informa(on,
2011
census
and
na(onal
household
survey
now
available.
• Used
wave
4
of
the
Early
Development
Index,
wave
5
available.
• Used
2008
McCreary
informa(on,
2013
now
being
released.

20. Key Points - Socioeconomic
• 19.0%
of
children
living
in
poverty
(2011
21.3%).
– 7.7%
at
less
than
$20,000
– 11.3%
addi(onal
below
LICO
• 6%
of
children
in
families
receiving
income
assistance.
• 21%
of
homeowners
spending
>30%
on
housing.
• 1.2%
of
children
in
need
of
protec(on.
• 1.5%
of
children
in
care.

21. Key Points – Aboriginal Children
• At
least
6.4%
of
region
is
of
Aboriginal
ancestry.
• 2040
Aboriginal
students
in
School
District.
– Propor(on
increasing

22. Key Points – Pre and Post Natal
• 44%
of
first
(me
mothers
received
prenatal
educa(on.
• Smoking
in
pregnancy
below
14%
• Low
birth
weight
rate
3.8%
• BreasZeeding
ini(a(on
84%
– Sustaining
to
6
months
47%
• Audiology
program
a
huge
success.

23. Key Points – Toddler Health
• 86%
of
kindergarten
students
had
no
visible
tooth
decay.
• Fully
immunized
rates
are
only
61%
for
two
year
olds
and
55%
for
7
year
olds.
• Minimal
ac(vity
levels
are
achieved
by
only
54%.

24. 2 – Year Immunization Coverage
• Decreasing
~1/2-­‐1%
absolute
per
year.
• Island
Health
on
par
with
province.
• Central
Island
5-­‐10%
less
than
both
North
and
South
Island
on
all
vaccines.
• Nanaimo
rates
below
Central
Island
average.

25. He Finally Did It

26. Key Points – Early Learning
• EDI
vulnerability
levels
looked
like
they
were
improving,
but
re-­‐released
data
shows
a
different
trend.
• Access
to
child
care
is
(ght.

27. Key Points – Children’s
Environment
• Library
use.
• Low
cost
recrea(on
access.
• Development
policies
on
park
and
playground
access.
• Aboriginal
culture
of
support
to
children.

28. Birth Statistics
-10 -5 0 5 10 15 20 25 30 35
Preterm
Teen Mother
Low Birth Weight
Live Birth
Cesarean
Mother Greater than 35
Stillbirth
Percentage Variation from Island Health Rate 2014 2013 2012 2011

29. 0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
Rate of children living in household with single parent for
Island Health, 2013
Island Health BC

30. % Lone Parent Families
About 50% of census families have children – all lone parent
families have children
0.0
5.0
10.0
15.0
20.0
25.0
30.0

31. -220 -195 -170 -145 -120 -95 -70 -45 -20 5 30 55 80
Alberni
VI North
Cowichan
Nanaimo
Ladysmith
Sooke
VIHA
Greater Victoria
Courtenay
CRVI
Lake Cowichan
Saanich
Qualicum
Gulf Islands
Percentage Variation from BC Rate
Children in Care Island Health 2010 - 2011
2011 2010

32. -340 -310 -280 -250 -220 -190 -160 -130 -100 -70 -40 -10 20 50
Lake Cowichan
Cowichan
Ladysmith
Alberni
VI North
VIHA
Nanaimo
Greater Victoria
Sooke
Qualicum
CRVI
Courtenay
Gulf Islands
Saanich
Percentage Variation from BC Rate
Children in Need of Protection Island Health 2010 - 2011
Children in Need of Protection 2011 Child Abuse 2010

33. 0
5
10
15
20
25
30
35
40
Percentage of Children less than 6 years Living in Low-
Income, 2011 Census

34. 0
5
10
15
20
25
30
35
Prevalence of Low-Income based on LIM (after tax) for
Population under 6 Living in Private Households

36. Measures of Education
Readiness and Success
-25 -20 -15 -10 -5 0 5 10
Grade 4 & 7 Below Standard in Reading
Preschool Language Development Vulnerabililty
Grade 4 & 7 Below Standard in Writing
18 Year Olds who Graduated
Grade 10 English Exam Completion Rate
Preschool Communication Skills Vulnerability
Percentage Variation from Island Health Rate 2014 2013 2012 2011

37. BC EDI Vulnerability on One or More
Scales
26
27
28
29
30
31
32
33
II III IV V
Any dimension

38. BC EDI Vulnerability on Specific
Dimensions
0
2
4
6
8
10
12
14
16
18
II III IV V
Physical
Social comp
Emotional mat
Lang & Cog
Communication

39. EDI Vulnerability by LHA
0
10
20
30
40
50
60
Vulnerability on One or More Scales, 2009 - 2013
w4
w5

41. Correlations
• Very
high
correla(ons
within
Nanaimo
area
between
EDI
and
– %
lone
parent
families
(0.71).
– Unemployment
(0.71).
– Low
income
families
(0.87).
– High
income
families
(-­‐0.83).
All
values
significant
at
p
<
0.05

43. From Hastings Street to Haida
Gwaii
Provincial
results
of
the
2013
BC
McCreary
Adolescent
Health
Survey.

44. Decrease in Serious Injuries
45%
39%
33%
30%
34%
29%
25% 24%
0%
25%
50%
1998 2003 2008 2013
Injured in the Past Year
Males Females
Note:
The
difference
for
females
between
2008
and
2013
was
not
sta(s(cally
significant.

45. More Youth ate Breakfast
50%
53%
54%
18%
15%
13%
0%
20%
40%
60%
2003 2008 2013
Eating Breakfast on School Days
Always ate breakfast Never ate breakfast

46. Risky Sexual Behaviour
Decreased
Among
those
who
had
ever
had
sex:
• 3%
ever
had
an
STI
• 69%
used
a
condom
the
last
(me
they
had
sex.
• 5%
had
ever
been
pregnant
or
caused
a
pregnancy.
• 24%
used
drugs
or
alcohol
last
(me
they
had
sex.

47. Decreases in Substance Use
58%
54%
45%
37%
30%
26%34%
26%
21%
0%
35%
70%
2003 2008 2013
Ever Tried Different Substances
Alcohol Marijuana Tobacco

48. School Safety Increased
83%
63% 66%
85%
71%
56%
94%
88% 90%
96%
91%
87%
Classroom Washrooms Hallways Library Cafeteria Outside on
school
property
Always or Usually Felt Safe at School
2008 2013

49. Rise in Overweight and
Obesity Rates
Males Females
Healthy weight
Underweight
Overweight
Obese

50. 2011 NHS
• 52%
of
renters
spending
>30%
of
income
on
housing
c.f.
BC
45.3%.
• 23.8%
of
homeowners
spending
>30%
of
income
on
housing
(same
as
BC).
• Unemployment
rate
of
9.2%
c.f.
with
BC
7.8%.
• Educa(on
levels
of
25-­‐65
age
group
comparable.
• 6.6%
self
iden(fy
as
Aboriginal
c.f.
BC
5.4%.

51. BC Stats Socio-economic Index
-0.8-0.6-0.4-0.200.20.40.60.81
Alberni (9)
VI North (11)
Lake Cowichan (14)
Nanaimo (25)
CRVI
Cowichan
Ladysmith (44)
Greater Victoria (55)
Qualicum (62)
Courtenay
Sooke (67)
Gulf Islands (74)
Saanich (75)
Socio-Economic Index - 2012 BC Stats

52. So What?

54. What is Next?
• Data
can
drive
ac(on
‒ Bring
aoen(on
to
issues
some
consider
“unacceptable”.
‒ Fix
immediate
issues
iden(fied
by
the
data
and
within
scope
of
specific
group.
‒ Bring
similar
thinking
people
together
around
specific
issues
of
concern
to
plan.
-­‐ S(mulate
a
community
dialogue.
-­‐ Wet
the
appe(te
for
more
informa(on.
-­‐ Issue
specific
“data
dives”.
-­‐ Plan
for
a
second
report
on
State
of
the
Child
Nanaimo.

55. Thanks, Resources and
Questions
• Early
years
Table
partners
–
Greater
Nanaimo
• Amber
Bruner
–
Children
First
Early
Years
Coordinator
• Christal
Lawson
–
MHO
office,
Central
Island
• hop://www.uwcnvi.ca/web_documents/state_of_the_child_report_2013_-­‐_nanaimo-­‐ladysmith.pdf
• hop://www.mcs.bc.ca/ahs
• hop://www.nanaimofounda(on.com/vital-­‐signs/
• hop://earlylearning.ubc.ca/edi/
• hop://www.bcstats.gov.bc.ca/Sta(s(csBySubject/SocialSta(s(cs/SocioEconomicProfilesIndices/
SocioEconomicIndices/LHAReports.aspx

56. More resources
Campaign 2000 report card
Royal College statement on
ECD
http://drphealth.blogspot.ca/

57. Paul Hasselback MD MSc FRCPC
250.739.6304
paul.hasselback@viha.ca
@drphealth
http://drphealth.blogspot.ca/