HNHB LHIN Health Atlas · The HNHB LHIN uses a population-based approach to health services planning to gain a comprehensive understanding of the health status of LHIN residents and

HNHB LHIN Health Atlas

December 2009

1 Hamilton Niagara Haldimand Brant Local Health Integration Network Health Atlas – June 2009 L:\C. Initiatives (Operations)\P - I (IHSP)\Decision Support\Health Atlas\Health Atlas documents for Web\Health Atlas - For Web.doc

Table of Contents

EXECUTIVE SUMMARY....................................................................................................3

I. INTRODUCTION.............................................................................................................6

1.1 Framework for HNHB LHIN Health Atlas ...........................................................8

1.2 Population Health Approach ..............................................................................9

Key Elements of a Population Health Approach......................................................9

2. Summary of Key Findings ............................................................................................11

2.1 Population Characteristics and Determinants of Health ..................................12

2.2 Population Health Status .................................................................................15

2.3 Health System Utilization and Capacity ...........................................................17

2.4 Health Care System Performance ...................................................................20

3. Health Atlas Data and Information...............................................................................22

3.1. Population Characteristics and Determinants Of Health ......................................22

3.1.1 Geography....................................................................................................23

3.1.2 HNHB LHIN Population ................................................................................24

3.1.3 Sub-LHIN Population Estimates for 2006 .....................................................28

3.1.4 Sub-LHIN Population Projections .................................................................33

3.1.5 Socio-Economic Status.................................................................................36

3.1.6 Language......................................................................................................42

3.1.7 Aboriginal Population....................................................................................45

3.1.8 Immigrants....................................................................................................48

3.1.9 Lifestyle Behaviours .....................................................................................51

3.1.10 Preventive Care.........................................................................................54


3.2. Population Health Status..........................................................................................57

3.2.1 Well-being and Personal Resources ............................................................58

3.2.2 Chronic conditions ........................................................................................61

3.2.3. Activity limitation ..........................................................................................64

3.2.5 Life expectancy.............................................................................................69

3.2.6 Deaths and Leading Causes ........................................................................72

3.2.7 Potential years of life lost..............................................................................75

3.3. Health System Utilization and Capacity....................................................................78

3.3.1 Health Care System Utilization .....................................................................79

3.3.2 Health Care System Capacity.......................................................................86

3.4. Health Care System Performance............................................................................90

ENDNOTES .....................................................................................................................91


or formal e.4

EXECUTIVE SUMMARY The mandate of the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) is to mandate to plan, integrate, and fund a specific range of health care services located in Hamilton, Niagara, Haldimand, Brant, Burlington, and Norfolk (i.e., community support services, Community Health Centres, Community Care Access Centres, mental health and addictions services, long term care homes, and hospitals). The HNHB LHIN uses a population-based approach to health services planning to gain a comprehensive understanding of the health status of LHIN residents and their current and future health care needs. Evidence-based decision making including both quantitative and qualitative information guides HNHB LHIN decisions regarding the allocation of resources across the continuum of health care, with a goal of optimizing access to quality care. On an ongoing basis, the HNHB LHIN monitors key indicators of population health status and health system performance to ensure the system continues to respond effectively to the evolving health care needs of its residents. Research has shown that lifestyle behaviours, followed by genetic predisposition and social circumstances (i.e., education, housing, income, social isolation) have the greatest influence on the health status of an individual, and that access to health care and environmental factors have a comparatively smaller influence on individual health.1 Health service utilization statistics demonstrate that the need for health care increases with age. The health care system in the HNHB LHIN is challenged by the volume, range, and complexity of health care needs of a population with 15.7% over the age of 65 and the largest number of seniors of all Ontario LHIN’s. Given projections, health care needs are expected to escalate. Thus, a thorough knowledge of the demographic and socio-economic characteristics of the communities that comprise the LHIN area is key to understanding the barriers and opportunities for improving both the health status of the population and the population’s access to health services across this LHIN. Strong associations between the health status and socio-economic characteristics of the population have been demonstrated in research literature.2 Compared to the provincial average, the HNHB LHIN population has higher percentages of lone parent families and seniors living alone and a lower percent of adults with postsecondary education. Research illustrates that the prevalence of preventable health conditions, chronic illness, and disability is higher among lower socio-economic groups and the elderly.3 More specifically, seniors living alone may be at greater risk of social isolation. The lack of social support among the elderly contributes to poor health status and the need fand institutional car Research indicates that personal behaviour is the single greatest opportunity to improve health and reduce premature death with smoking, obesity, and physical inactivity identified as the leading behaviours.5 Relative to the province, a higher percentage of people in the


to a

HNHB LHIN smoke daily or occasionally, drink heavily, and are obese. These rates are also well above the provincial targets set for 2020 by the Canadian Cancer Society.6 Many chronic conditions share the same underlying risk factors. For example, smoking has been associated with many chronic conditions, such as lung cancer, heart disease, stroke,and chronic obstructive pulmonary disease.7,8 Chronic conditions can be related combination of multiple risk factors. For example, the World Health Organization estimates that in high income countries, such as Canada, about three-quarters of deaths related to diabetes can be attributed to the joint effects of smoking, physical inactivity, obesity, and alcohol use.9 HNHB LHIN residents have significantly higher rates of arthritis/rheumatism, high blood pressure, and asthma compared to the province as a whole. Local health promotion initiatives aim to address the lifestyle behaviors underlying these chronic conditions within the population.10 Access to timely and appropriate health care is also an essential means of managing these conditions in order to prevent premature morbidity, disability and mortality due to chronic diseases, such as cardiovascular disease, cancer and end-stage renal disease. For example, an Ontario study found substantial excess emergency department use and avoidable hospital admissions among people with chronic health conditions who did not have a regular primary care doctor.11 Diabetes rates for the HNHB LHIN are not significantly different than provincial rates; however rates are higher in specific populations, such as Aboriginal peoples. While data that specifically describes the Aboriginal population in the HNHB LHIN are not available, Canadian studies have consistently shown reduced life expectancy and poor health status for Aboriginal peoples compared to the general Canadian population and higher rates of chronic conditions which has implications for utilization of health services.12 Hospitalization and emergency department visit rates are higher in the HNHB LHIN compared to the province. Patterns of health service utilization are influenced by a combination of factors such as the availability of primary care and community supports, health status, lifestyle behaviours, use of preventive health care services, and socio-economic characteristics of the population. Having regular access to a family physician can reduce the need to access hospital emergency departments for primary care and also reduce the likelihood of admission to hospital. The rate of family physicians per population is significantly lower in the HNHB LHIN compared to the province. Variation is also seen within the HNHB LHIN with the lowest rates of family physicians per population in Haldimand, Norfolk, and Niagara. With the exception of Hamilton, communities within the HNHB LHIN are designated as having family physician vacancies by the Underserviced Area Program (UAP) of the Ontario Ministry of Health and Long-Term Care. In addition, actual availability of HNHB family physicians that provide primary care may be overestimated. For example, Hamilton area is home to Academic Health Science Centres and family physicians involved in either teaching or research may be less available to provide patient care. A study by the Institute


for Clinical and Evaluative Sciences found that 8.5% of active general and family practitioners in the HNHB LHIN were “quasi-specialists” (i.e., have more than 50% of their billings in one focused area of practice such as obstetrics, psychotherapy, or surgery) and thus are not available to provide the full range of primary care services.13

Financial and non-financial measures or metrics are used to define and evaluate the success of an organization, typically in terms of making progress towards its long-term organizational goals. Developed by Robert S. Kaplan & David P. Norton, the Balanced Scorecard is a framework, characterized as a “strategic management system” and is a management/ measurement tool that translates the organization’s strategy into tangible objectives and measures.14 The HNHB LHIN Scorecard reports performance across the following four domains that are cornerstones of the LHIN’s mission and vision:

o System Integration – Focus is on measures that report how well the system integrates (connects) care along the continuum of clients’ interaction with the health care system.

o Client Access and Outcomes - Focus is on measures that report clients’ abilities to access health care services in a timely manner and outcomes.

o Financial Health and System Sustainability - Focus is on measures that report how well the health care organizations and managers of health care handle health care resources in a fiscally prudent fashion.

o Organizational Health: Focus is on measures that report how well the health care organization manages its internal resources (i.e., heath human resources).

The percentage of ‘Alternate Level of Care’ (ALC) days is an example of an indicator of system integration for clients across the care continuum. Following the acute phase of hospitalization a relatively large proportion of patients in the HNHB LHIN are designated ALC, compared to the provincial average. Many patients are waiting for a long-term care bed or another level of care, such as inpatient rehabilitation (active and slow-paced) or palliative care. Long waiting times, particularly for rehabilitation, can have a permanent, detrimental impact on a patient's ability to regain function and independence. Refer to HNHB LHIN Scorecard at www.hnhblhin.on.ca for current and additional details about health care system performance.

Additional coordination and planning of resources, both human and financial, are needed in the HNHB LHIN to adequately address outstanding health care needs and to ensure programs are in place to meet the evolving and growing demand for health services. Just as essential as resources, however, is a readiness among local health care and human service sector stakeholders to share information, plan in a collaborative manner and identify opportunities to improve the accessibility of services.

http://www.hnhblhin.on.ca/


I. INTRODUCTION Health and health care are fundamental issues for individuals and communities. Therefore, population health status and factors that impact health combined with health system characteristics and performance are priorities. This report from the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) identifies and outlines a broad set of health indicators that offer multiple opportunities for application and benefit. The purpose of the report is to provide context for planning, monitoring and evaluating health system performance within the context of local population health needs. More specifically:

The Health Atlas utilizes a population health framework adapted from the Canadian Institute for Health Information and the Public Health Agency of Canada. This framework is a consistent approach that allows for comparisons of health experience with other health jurisdictions, with the potential for gaining insights into special needs, best practice, and benchmarks.

The Health Atlas is a compendium of information that can be used to shape the future health system agenda. These indicators can be monitored over time to identify and provide evidence of health issues that require attention.

The Health Atlas is a single source of reference data for population health for residents of the HNHB LHIN that can be used as a basis for broader consultation. While the current collection of indicators is broad, it does not represent a comprehensive picture of our health system. For example, more detailed information is needed on community-based health services and programs. International experience with performance improvement indicates that indicator development is an on-going, iterative process that requires continuous improvement and revision given new information needs, as well as changes and advances in availability and access to data.

The Health Atlas uses the following framework to answer four questions:

1. What factors affect the health of HNHB LHIN residents?

2. How healthy are people in the HNHB LHIN?

3. What do we know about the health system in the HNHB LHIN?

4. How well is the health system in the HNHB LHIN performing?


These questions correspond to the following categories of indicators, which are organized and reported in the following Sections and follow the framework outlined on the following page:

1. Population characteristics and determinants of health

2. Population health status

3. Health system utilization and capacity

4. Health care system performance


1.1 Framework for HNHB LHIN Health Atlas

Population Characteristics and the Determinants of Health What factors affect the health of HNHB LHIN residents?

Demographic and Socio-economic Characteristics

Lifestyle Behaviours and Preventive Care

Geography LHIN population Sub-LHIN population estimates Sub-LHIN population projections Socio-economic status Language Aboriginal population Immigrant population

Smoking Exposure to second-hand smoke Diet Heavy drinking Physical activity Immunization Mammography Pap tests

Population Health Status How healthy are people in the HNHB LHIN?

Well-being and Personal Resources

Health Conditions and Human Function

Deaths

Life stress Self-rated general

health Self-rated mental

health

Chronic conditions Activity limitation Low birth weight

Life expectancy Deaths & leading causes Infant mortality rate Potential years of life lost

Health System Utilization and Capacity What do we know about the health system in the HNHB LHIN?

Health Care System Utilization Health Care System Capacity

Acute inpatient hospitalizations Day surgery & emergency department

visits Mental health hospitalizations Complex continuing care hospitalizations Inpatient rehabilitation hospitalizations Use of community care access centre

services Patient flow: In and Out of HNHB LHIN

Health service providers Supply of beds in hospital and long term

care homes Physicians

Health Care System Performance How well is the health system in the HNHB LHIN performing?

HNHB LHIN Scorecard


1.2 Population Health Approach

The HNHB LHIN Profile utilizes a population health framework that has been adapted from the Canadian Institute for Health Information and the Public Health Agency of Canada. The purpose of the framework is to guide and categorize a selection of indicators which help describe the population within the HNHB LHIN in terms of the demographic, social, economic and environmental factors which can influence population health, as well as the lifestyle behaviours and health care practices which directly impact health status. The framework also includes indicators that describe the characteristics, capacity and effectiveness of the health care system to respond to population health care needs.

The population health approach considers the entire spectrum from prevention and promotion to health protection, diagnosis, treatment, and care.

Key Elements of a Population Health Approach 15

1. Address Determinants of Health Recognizing That They Are Complex and Interrelated—The entire range of individual and collective factors and conditions and their interactions that have been shown to be correlated with health status need to be examined. These factors are commonly referred to as the "determinants of health" (e.g., income, social status, social support networks, education, working conditions, social and physical environments, personal health practices and coping skills, health services, and culture). A population health approach reflects the evidence that factors outside the health care sector significantly affect health.

2. Focus on the Health of Populations—The focus is on improving the health status of the population. Action is directed at the health of an entire population, or sub-population, rather than individuals. Focusing on the health of populations also necessitates the reduction in inequalities in health status between population groups. The outcomes or benefits of a population health approach extend beyond improved population health outcomes to include a sustainable and integrated health system, increased growth and productivity, and strengthened social cohesion and citizen engagement.

3. Invest Upstream—Efforts and investments in a population health approach are directed at root causes to increase potential benefits for health outcomes and are guided by parameters based on evidence about what makes and keeps people healthy.

4. Base Decisions on Evidence—A population health approach uses evidence-based decision making. A combination of quantitative and qualitative evidence is used to identify priorities and strategies to improve health.

5. Apply Multiple Strategies to Act on the Determinants of Health—The complex interplay between the determinants of health and a variety of strategies and


settings are considered to act on the health determinants in partnership with sectors outside the traditional health sector. Innovative and interconnected strategies that give due consideration to the full spectrum of social, economic and environmental health determinants are called for.

6. Collaborate Across Levels and Sectors—A population health approach recognizes that improving health is a shared responsibility and intersectoral collaboration is required. A population health approach calls for shared responsibility and accountability for health outcomes with groups not normally associated with health, but whose activities may have an impact on health or the factors known to influence it.

7. Employ Mechanisms to Engage Citizens—Participation in developing strategies to improve health is promoted. The approach ensures appropriate opportunities for people to have meaningful input.

8. Increase Accountability for Health Outcomes—A population health approach calls for an increased focus on health outcomes (as opposed to inputs, processes and products). Changes are examined in health status, determinants of health, and health status inequities between population sub-groups. Regular and timely reporting of results and sharing of information is an integral part.


2. Summary of Key Findings

Key findings of the Health Atlas are divided into four sections:

1. Population characteristics and determinants of health

2. Population health status

3. Health system utilization and capacity

4. Health care system performance

Additional information about each section is provided in Appendices A-D.


2.1 Population Characteristics and Determinants of Health

Demographic and Socio-Economic Characteristics

The HNHB LHIN covers 6,600 km2 and encompasses Brant, Burlington, Haldimand, Hamilton, Niagara and most of Norfolk.

The HNHB LHIN is home to approximately 1.4 million people, the third largest population of all 14 LHINs in Ontario. Over 70% of the population in the HNHB LHIN resides in Hamilton and Niagara. First Nations co-located in the HNHB LHIN represent approximately 1% of the population; the third largest population after the North East and North West LHIN’s.

Between 2009 and 2019, the HNHB LHIN population is projected to grow by about 9.6% to over 1.5 million people. This growth rate is is slower than the Ontario rate of 12.1%. Growth within the HNHB LHIN varies by community. Burlington is projected to grow the fastest and Niagara is projected to grow the slowest.

The HNHB LHIN’s population is aging. Over the next 10 years, the largest population growth will be among people ages 65-74 (growing by 43.5%) and over 84 (growing by 28.5%).

Over 200,000 seniors live in the HNHB LHIN which is the largest number of seniors of all Ontario LHINs. As of 2009, seniors 65 years of age and older represent 15.7% of the total HNHB LHIN population, compared to 13.6% for all of Ontario. Based on projections for 2019, seniors will represent 18.7% of the HNHB LHIN population compared to 16.7% for the province as a whole.

The age structure of the LHIN population varies by community. For example, seniors (over the age of 65) account for approximately 6.1% of the Aboriginal population in the HNHB LHIN compared to 10% of the total population of West Lincoln, 21% of Port Colborne, 24% of Niagara-on-the-Lake, and 15.7% of the total population of the HNHB LHIN.

The HNHB LHIN has a diverse population. For 18% of HNHB residents, English or French is not their first language. Francophones, First Nations, and urban and rural Aboriginal people are recognized populations in the HNHB LHIN. There are two reserves within the HNHB LHIN, Six Nations and Mississaugas of the New Credit. Approximately half of the First Nations population co-located in the HNHB LHIN live on reserve. The age structure of the on reserve population is younger than off reserve. According to data from Indian and Northern Affairs Canada, the age distribution of Aboriginal peoples who live on reserve is considerably younger. Seniors account for approximately 6.1% of the Aboriginal population who live on reserve in First Nations co-located in the HNHB LHIN compared to 12.7% for Off Reserve and 15.8% for LHIN as a whole.

Compared to the Ontario average, the HNHB LHIN has higher percentages of lone parent families and seniors living alone and a lower percent of adults with postsecondary education. Socio-economic characteristics vary across the LHIN. For example, Hamilton has 18.1% of its


population living in low income which is considerably higher than the 8.0% for Haldimand. In Burlington 63.4% of the population has completed post-secondary education compared to 48.1% for Halidmand and Norfolk.



Relative to the province, more people in the HNHB LHIN smoke daily or occasionally, drink heavily, and are obese. In 2007, 25.1% of residents of the HNHB LHIN were daily or occasional smokers, 27.0% consumed five or more drinks on one occasion, at least once a month within the last year, and 52.8% were active or moderately active. In addition, 32.2% of the adult HNHB LHIN population was considered overweight and 19.3% were obese.

Differences in lifestyle behaviours are seen for men and women. As compared to the province, the HNHB LHIN has a significantly higher percent of:

o women who are daily or occasional smokers

o both men and women who drink heavily

o men who are physically active

o women who are obese

Within the last three years, 71.7% of women in the HNHB LHIN had a pap smear (for cervical cancer screening), 54.5% of women received a routine mammogram in the previous two years, and 36.9% had a flu shot in the past year. None of these preventive health indicators are significantly different from Ontario as a whole.


2.2 Population Health Status

Well-being, Personal Resources, Health Conditions, and Human Function

Similar to the provincial rates, over 60% of HNHB residents rate their health as ‘excellent’ or ‘very good’.

A significantly higher percentage of HNHB LHIN residents reported they are limited in activities because of a physical or mental condition, or health problem compared to the province.

HNHB LHIN residents have significantly higher rates of arthritis/rheumatism, high blood pressure, and asthma compared to the province as a whole. Diabetes rates are slightly, but not significantly, lower than provincial rates.

Differences in chronic conditions are seen for men and women. As compared to the province, the HNHB LHIN has a significantly higher percent of:

o both men and women who have arthritis/rheumatism

o women who have high blood pressure

o men who have asthma

In the HNHB LHIN as of 2006, the rate of low birth weight babies was 5.97 per 100 live births compared to 6.10 per 100 live births for Ontario.


Deaths

As of 2005, life expectancy at birth was 79.9 years in the HNHB LHIN compared to 80.7 years for the province. Life expectancy is longer for females (81.9 years for females and 77.7 years for males in the HNHB LHIN).

The overall death rate for all causes of mortality is significantly higher in the HNHB LHIN compared to the province as a whole. Within the LHIN, the death rate in Brant is significantly higher than the HNHB LHIN rate and the death rate in Burlington is significantly lower.

The infant mortality rate in the HNHB LHIN is 4.98 per 1,000 live births which is lower than the provincial rate of 5.40 per 1,000 live births (2003-2005 average).

Potential years of life lost are useful for measuring the number of years of life “lost” from deaths that occur “prematurely” (i.e., before age 75). In 2005, there were over 66,000 potential years of life lost among residents of the HNHB LHIN. Heart disease, lung cancer, suicide, and motor vehicle collisions account for the most potential years of life lost. The rate of potential years of life lost is higher in the HNHB LHIN compared to the province and variation is seen within the LHIN.


2.3 Health System Utilization and Capacity

Health Care System Utilization

The acute care hospitalization rate for residents of the HNHB LHIN was significantly higher than the provincial rate. In 2007-08, over 96,000 HNHB residents stayed in an acute care hospital, accounting for over 125,000 stays. The most common diagnoses responsible for acute hospitalization include childbirth and complications of pregnancy, labour and delivery, acute myocardial infarction (heart attacks), chronic obstructive pulmonary disease, and heart failure.

Hospital utilization patterns vary by socio-demographic characteristics. For example, seniors in the HNHB LHIN account for about 38% of acute hospital stays and represent about 16% of the population.

HNHB LHIN residents use hospitals within the HNHB LHIN for most of their hospital care. Overall, less than 7% of acute care hospitalizations for HNHB LHIN residents occurred at hospitals outside of the LHIN. In contrast, about 6% of acute stays at hospitals within the HNHB LHIN were from residents who did not live in the HNHB LHIN. There is variation across the LHIN. For example, in 2007-08 approximately 22% of acute hospital stays among residents of Burlington occurred at hospitals outside of the HNHB LHIN compared to 3% of Hamilton residents who were admitted to a hospital outside of the LHIN.

The rate of emergency department utilization is higher among residents of the HNHB LHIN compared to the province. Within the HNHB LHIN, rates of emergency department utilization vary greatly. Residents of Burlington had the lowest rate and residents of Haldimand County had the highest rate of emergency department visits.

There are over 590,000 visits to an emergency department among residents of the HNHB LHIN. While the number of emergency department visits has increased over the past four years, the age-adjusted rate of emergency department utilization has remained stable.

The greatest contributor to the higher rates of emergency department utilization by HNHB LHIN residents was the high rate of emergency department visits per population for less urgent or non-urgent cases.

In 2006-07, HNHB LHIN residents had 2,971 complex continuing care (CCC) admissions, the highest volume of CCC admissions among the 14 LHINs and representing 15.6% of the total CCC admissions at Ontario hospitals. The utilization rate of CCC for residents of the HNHB LHIN was well above Ontario average. In particular, the highest age-adjusted rates were for residents of Brant and Niagara.

In 2007-08, there were over 2,900 inpatient rehabilitation admissions among residents of the HNHB LHIN. The age-adjusted rate for HNHB LHIN residents was significantly lower than the


Ontario rate. Within the HNHB LHIN, admission rates for inpatient rehabilitation vary. The lowest age-standardized rates were for residents of Niagara, Haldimand, and Norfolk.

Orthopedic conditions, stroke, and medically complex patients were the most common groups of rehabilitation admission. In 2007-08 among residents of the HNHB LHIN, orthopaedic conditions accounted for 39% of all inpatient rehabilitation admissions compared to 51% for the province. In contrast, stroke accounted for 16% of all inpatient rehabilitation admissions among residents of the HNHB LHIN compared to 13% for the province as a whole.

In 2006-07, there were over 50,000 admissions to home care among residents of the HNHB LHIN. In-home acute and in-home rehabilitation were the most common services.


Health Care System Capacity

There are 244 health service provider agencies in the HNHB LHIN who deliver a wide range of health services. As of June 2009, there were:

o 10 Hospital Corporations

o 88 Long-Term Care Homes

o 1 Community Care Access Centre

o 88 Community Support Services: 64 Community Support Services (CSS) Programs, 3 Acquired Brain Injury Programs, 21 Assisted Living Services Supportive Housing (ALSSH) Programs

o 50 Community Mental Health and Substance Abuse: 18 Addictions Programs, 32 Mental Health Programs

o 7 Community Health Centres

As of 2007-08, there were 3,573 hospital beds staffed and in operation within the HNHB LHIN, including: 2,127 acute, 382 mental health, 793 complex continuing care, and 271 general and specialized rehabilitation.

The HNHB LHIN has more long-term care beds than any other LHIN.

Physician-to-population ratios vary across the HNHB LHIN area. As of 2007, there were 76 family physicians per 100,000 population in the HNHB LHIN, significantly lower than the provincial rate of 85 family physicians per 100,000 population. Within the HNHB LHIN, the lowest rates are seen in Haldimand, Norfolk, and Niagara.

In spite of the low ratio of family physicians per population in the HNHB LHIN, according to the 2007 Canadian Community Health Survey, 92.7% of HNHB LHIN residents reported that they had a regular medical doctor. This reported rate was above the Ontario average (90.4%). According the Primary Care Access Survey, approximately 4.2% of people 16+ years in the HNHB LHIN are unattached in regards to primary care, representing approximately 47,000 people. The percent of unattached patients for the province as a whole was estimated at 7.0%.

With the exception of Hamilton, communities within the HNHB LHIN are designated as having family physician vacancies by the Underserviced Area Program (UAP) of the Ontario Ministry of Health and Long-Term Care. As of March 2009, there were 119 general practitioner/family physician vacancies in the LHIN with the highest number of vacancies in Niagara (81 vacancies).


2.4 Health Care System Performance

The HNHB LHIN uses a balanced scorecard to report on performance across four domains. These domains are cornerstones of the HNHB LHIN’s mission and vision:

o System Integration – Focus is on measures that report how well the system is integrating (connecting) care along the continuum of clients’ interaction with the health care system.

o Client Access and Outcomes - Focus is on measures that report clients’ abilities to access health care services in a timely manner and outcomes.

o Financial Health and System Sustainability - Focus is on measures that report how well the health care organizations and managers of health care are managing health care resources in a fiscally prudent manor.

o Organizational Health - Focus is on measures that report how well the health care organization is managing its internal resources (i.e., heath human resources).

An example of an indicator included on the HNHB LHIN scorecard is % ‘Alternate Level of Care’ (ALC) days. Following the acute phase of hospitalization a relatively large proportion of patients in the HNHB LHIN are designated ALC, compared to the provincial average. ALC days are an indicator of system integration. Many patients are waiting for a long-term care bed or another level of care such as inpatient rehabilitation (active and slow-paced) or palliative care.

Refer to HNHB LHIN Scorecard at www.hnhblhin.on.ca for current and additional details about health care system performance.

.




3. Health Atlas Data and Information

3.1. Population Characteristics and Determinants Of Health

Population Characteristics and the Determinants of Health What factors affect the health of HNHB LHIN residents?

Demographic and Socio-economic Characteristics


Geography

LHIN population

Sub-LHIN population estimates

Sub-LHIN population projections

Socio-economic status

Language

Aboriginal population

Immigrant population

Smoking

Exposure to second-hand smoke

Diet

Heavy drinking

Physical activity

Immunization

Mammography

Pap tests

Demographic and Socio-economic Characteristics 3.1.1 Geography

Key Findings

The HNHB LHIN stretches from Fort Erie to Turkey Point and Paris to Lowville and covers approximately 6,600 square kilometres.

The HNHB LHIN encompasses Brant, Burlington, Haldimand, Hamilton, Niagara, and most of Norfolk.

The geography includes 18 municipalities, two regional governments, two federal reserves, 18 mayors, 12 Ontario MPPs, and 13 Federal MPs.



3.1.2 HNHB LHIN Population

Definition:

HNHB LHIN population projections for 2009 and 2019 by age and sex. Population projections are forecasts of future growth. These forecasts assume varying degrees of change within three major factors of fertility, mortality, and migration.

Significance/Uses:

To estimate future changes in the age and sex composition of the population.

To assess future health needs of the population.

A growth rate of zero does not mean that there are no changes in the population but that the net difference between births, deaths, and migration is zero.

Data Source:

Pop Proj Summary LHIN, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.

Notes:

Population projections from the Ontario Ministry of Finance are based on many assumptions (past and future) which are subject to change and uncertainty. As a result, projections may not reflect true population counts.

The discrepancy between projections and actual population figures may become more pronounced for projections that are further into the future. Fertility and mortality are considered to be more predictable components of the projection model than migration, as migration is affected by policy changes and social or economic conditions.

Greater variation in population projections is expected with smaller geographic areas.


Key Findings

The HNHB LHIN is home to about 1.4 million people, the third largest population of all 14 LHIN’s in Ontario.

Between 2009 and 2019, the HNHB LHIN population is projected to grow by about 9.6% to over 1.5 million people.

The HNHB LHIN population as a whole is not expected to grow as quickly as the provincial population over the next 10 years (12.1% population growth is projected from 2009 to 2019 for Ontario compared to 9.6% for the HNHB LHIN).

The largest percentage change in the population over the next ten years is expected among people 65-74 years (growing by 43.5%) and 85 years and older (growing by 28.5%). For both males and females, the largest percent change is expected among these age groups.

Over 200,000 seniors live in the HNHB LHIN. This represents the largest number of seniors of all Ontario LHIN’s.

As of 2009, females account for 56% of the population 65 years of age and older and 67% of the population 85 years and older in the HNHB LHIN. While females 65 years and over will continue to represent a larger percent of the population the senior male population is expected to grow at a faster rate than the female population (e.g., 39.6% percent growth in males 85+ years from 2009 to 2019 compared to 23.0% for females).

The HNHB LHIN population is aging. In 2009, seniors 65 years of age and older represent 15.7% of the total HNHB LHIN population, compared to 13.6% for all of Ontario. Based on projections for 2019, seniors will represent 18.7% of the HNHB LHIN population compared to 16.7% for the province as a whole.

Figure 1: HNHB LHIN Projected 2009 and 2019 Populations by Age Group and Sex

80,000 60,000 40,000 20,000 0 20,000 40,000 60,000 80,000

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89

90+A

ge

gro

up

Population

Bars= 2009 population Lines= 2019 population

Table 1: Change in HNHB LHIN and Ontario Population by Age Group from 2009 to 2019


HNHB LHIN Population Projections by Year Change from 2009 to 2019

Age group

2009 2019 Number % <15 227,996 234,850 6,854 3.0 15-44 559,856 575,881 16,025 2.9 45-64 390,005 434,759 44,754 11.5 65-74 111,790 160,376 48,586 43.5 75-84 78,200 87,996 9,796 12.5 85+ 30,202 38,805 8,603 28.5 Total 1,398,049 1,532,667 134,618 9.6

Ontario Population Projections by Year Change from 2009 to 2019

Age group

2009 2019 Number % <15 2,211,249 2,309,898 98,649 4.5 15-44 5,493,571 5,803,488 309,917 5.6 45-64 3,575,363 4,074,161 498,798 14.0 65-74 932,899 1,397,872 464,973 49.8 75-84 609,516 727,232 117,716 19.3 85+ 228,156 312,420 84,264 36.9 Total 13,050,754 14,625,071 1,574,317 12.1


Table 2: Change in HNHB LHIN Population by Age Group and Sex from 2009 to 2019 Male Female

Population Projections by Year

Change from 2009 to 2019

Population Projections by Year

Change from 2009 to 2019

Age group

2009 2019 Number % 2009 2019 Number % <15 116,951 120,930 3,979 3.4 111,045 113,920 2,875 2.6 15-44 282,739 290,125 7,386 2.6 277,117 285,756 8,639 3.1 45-64 192,444 215,673 23,229 12.1 197,561 219,086 21,525 10.9 65-74 52,973 76,400 23,427 44.2 58,817 83,976 25,159 42.8 75-84 33,481 39,385 5,904 17.6 44,719 48,611 3,892 8.7 85+ 9,946 13,883 3,937 39.6 20,256 24,922 4,666 23.0 Total 688,534 756,396 67,862 9.9 709,515 776,271 66,756 9.4


3.1.3 Sub-LHIN Population Estimates for 2006

Definition:

Population estimates of sub-LHIN areas by age and sex for 2006.

Significance/Uses:

To assess variations in the population across the HNHB LHIN by age, sex, and geography.

The population structure of the HNHB LHIN is shown at one point in time. The population structure can be combined with health data to estimate the population health needs and future needs.

Data Sources:

Profile for Canada, Provinces, Territories, Census Divisions, Census Subdivisions and Dissemination Areas, 2006 Census. Statistics Canada 94-581-XCB2006002.

Indian and Northern Affairs Canada First Nation Profiles and Registered Indian Population by Sex, Age Group, and Residence, 2006.

Notes:

There are a number of sources of error in the Canadian Census. Coverage errors occur when dwellings or members of dwellings are not included in the census counts. Undercoverage is more common than overcoverage or double-counting and occurs more frequently for certain population groups. For example, because of incomplete enumeration on reserves (due to non-participation of some communities, and low participation rates in others), there is undercoverage of the Aboriginal population (First Nations Peoples in Ontario: A Demographic Portrait. Ministry of Health and Long-Term Care, Health System Information Management and Investment Division. Health Analytics Branch, January 2009).

There are reporting lags between life events and entry into the Indian Registry System at Indian and Northern Affairs Canada. Births that occur in a calendar year, for instance, may not be recorded prior to the December 31st reporting date for each year’s data (First Nations Peoples in Ontario: A Demographic Portrait. Ministry of Health and Long-Term Care, Health System Information Management and Investment Division. Health Analytics Branch, January 2009).


Key Findings

As of 2006, approximately 39% of the HNHB LHIN population resided in Hamilton, 32% in Niagara, 12% in Burlington, 9% in Brant, 4% in Norfolk, and 3% in Haldimand, and 1% in First Nations.

Hamilton and Niagara are each home to over 73,000 seniors, and together represent 72% of the total LHIN population 65 years of age and older.

Data from the 2006 Census are not available for either New Credit or Six Nations because of incomplete enumeration. A major source of population data for First Nations people is Indian and Northern Affairs Canada (INAC) which maintains the Indian Registry System (IRS). Data are available from INAC for Mississaugas of the New Credit and Six Nations of the Grand River. Six Nations of the Grand River is comprised of 13 First Nations. Since membership in the INAC profiles is by First Nation and not by Reserve, these totals include Six Nations (Part) 40 and Glebe Farm 40B. The on reserve and on crown land registered population for the First Nations co-located in the HNHB LHIN was 11,929 for 2006.

The age structure of the population varies by sub-LHIN geography. For example, while Hamilton and Niagara have the highest number of seniors in the HNHB LHIN, Norfolk and Niagara have the highest proportion of seniors (17.9% of the population of Norfolk is 65+ years of age compared to 14.9% for Hamilton).

According to data from INAC, the age distribution of Aboriginal peoples who live on reserve is considerably younger. Seniors account for approximately 6.1% of the Aboriginal population who live on reserve in First Nations co-located in the HNHB LHIN.

Within geographic areas there is also variation. For example, differences are seen the proportion of seniors within Niagara. In Niagara, seniors represented 10.0% of residents of West Lincoln compared to 21.3% for Port Colborne and 24.1% for Niagara-on-the-Lake (based on 2006 data).

Figure 2: Percent of Total HNHB LHIN Population by Geography, 2006

Niagara32%

First Nations

1%

Burlington12%

Haldimand3%

Brant9%

Norfolk4%

Hamilton39%

Figure 3: Percent of HNHB LHIN Senior (65+ years) Population by Geography, 2006

Niagara35%

First Nations

1%

Burlington12%

Haldimand3%

Brant9%

Norfolk4%

Hamilton36%



Table 3: Population Estimates by Geography in the HNHB LHIN by Age Group, 2006

Age group County/Municipality <15 15-44 45-64 65+ Total

Hamilton 89,895 206,225 133,055 75,390 504,565 Niagara 71,980 163,345 117,960 74,160 427,445

Niagara Falls 13,755 31,960 22,425 14,045 82,185 Port Colborne 2,805 6,530 5,300 3,965 18,600 St. Catharines 21,385 51,440 35,345 23,810 131,980 Welland 8,425 19,560 13,895 8,455 50,335 Fort Erie 4,970 10,990 8,600 5,360 29,920 Grimsby 4,315 9,200 6,745 3,680 23,940 Lincoln 4,185 8,205 5,535 3,790 21,715 Niagara-on-the-Lake 2,030 4,445 4,610 3,515 14,600 Pelham 2,745 5,625 5,105 2,690 16,165 Thorold 3,195 7,440 4,960 2,625 18,220 Wainfleet 1,150 2,460 2,080 910 6,600 West Lincoln 3,020 5,490 3,360 1,315 13,185

Haldimand 8,800 17,375 12,925 6,095 45,195 Brant 23,300 49,600 33,540 18,165 124,605

Brantford 16,865 36,480 23,675 13,185 90,205 Brant 6,435 13,120 9,865 4,980 34,400

First Nations 2,819* 5,553* 2,708* 849* 11,929* New Credit 242* 374* 181* 56* 853* Six Nations 2,577* 5,179* 2,527* 793* 11,076*

Burlington 29,780 65,770 43,475 25,360 164,385 Norfolk 7,870 17,425 15,210 8,820 49,325

*Data from the 2006 Census are not available for either New Credit or Six Nations because of incomplete enumeration. First Nations data are from INAC. The INAC count is the total First Nations registered population On Reserve and Crown Land for 2006.


Table 4: Distribution of Population Estimates by Geography in the HNHB LHIN by Age Group, 2006 Age group Municipality

<15 15-44 45-64 65+ Total Percent of Row Total Hamilton 17.8 40.9 26.4 14.9 100.0 Niagara 16.8 38.2 27.6 17.3 100.0

Niagara Falls 16.7 38.9 27.3 17.1 100.0 Port Colborne 15.1 35.1 28.5 21.3 100.0 St. Catharines 16.2 39.0 26.8 18.0 100.0 Welland 16.7 38.9 27.6 16.8 100.0 Fort Erie 16.6 36.7 28.7 17.9 100.0 Grimsby 18.0 38.4 28.2 15.4 100.0 Lincoln 19.3 37.8 25.5 17.5 100.0 Niagara-on-the-Lake 13.9 30.4 31.6 24.1 100.0 Pelham 17.0 34.8 31.6 16.6 100.0 Thorold 17.5 40.8 27.2 14.4 100.0 Wainfleet 17.4 37.3 31.5 13.8 100.0 West Lincoln 22.9 41.6 25.5 10.0 100.0

Haldimand 19.5 38.4 28.6 13.5 100.0 Brant 18.7 39.8 26.9 14.6 100.0

Brantford 18.7 40.4 26.2 14.6 100.0 Brant 18.7 38.1 28.7 14.5 100.0

First Nations 23.6* 46.6* 22.8* 7.1* 100.0* New Credit 28.4* 43.8* 21.2* 6.6* 100.0* Six Nations 23.3* 46.8* 22.8* 7.2* 100.0*

Burlington 18.1 40.0 26.4 15.4 100.0 Norfolk 16.0 35.3 30.8 17.9 100.0 HNHB LHIN Total 17.6 39.5 27.1 15.8 100.0

*Data from the 2006 Census are not available for either New Credit or Six Nations because of incomplete enumeration. First Nations data are from INAC. The INAC count is the total First Nations registered population On Reserve and Crown Land for 2006.


3.1.4 Sub-LHIN Population Projections

Definition:

Population projections of sub-LHIN areas for 2009 and 2019 by age and sex. Population projections are forecasts of future growth. These forecasts assume varying degrees of change within three major factors of fertility, mortality, and migration.

Significance/Uses:

To estimate future changes in the age and sex composition of sub-LHIN areas.

To be used as a component of assessing the future health needs of the population.

Data Source:

Pop Proj Summary County, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.

Notes:

Based on population projections from the Ontario Ministry of Finance, the lowest level of data available by geography is by county. County level data does not sum to the HNHB LHIN total as counties do not directly map to the HNHB LHIN boundaries. For example, data for Burlington is included in the population projections for Halton and all of Norfolk County is included in the projections for Haldimand and Norfolk.

Population projections are not available specifically for the Aboriginal population co-located in the HNHB LHIN but some information is available nationally and provincially. There are a number of considerations for projections for Aboriginal peoples. For example, the younger age structure of the registered First Nation population in Ontario indicates the potential for greater population growth in the future. Fertility is almost exclusively the source of population growth for Aboriginal peoples in Ontario. Although minimal information is directly available on Aboriginal fertility in Canada, INAC reported a total fertility rate of 2.9 children in 2000 for Registered Indian women which was approximately double the rate for Canadian women as a whole at 1.5 children (Hull J. Aboriginal women: A profile from the 2001 Census. Women’s Issues and Gender Equality Directorate, Indian and Northern Affairs Canada. February, 2006. Available at: http://www.aincinac.gc.ca/pr/pub/abw/abw_e.pdf).

Population projections from the Ontario Ministry of Finance are based on many assumptions (past and future) which are subject to change and uncertainty. As a result, projections may not reflect true population counts.

The discrepancy between projections and actual population figures may become more pronounced for projections that are further into the future. Fertility and mortality are considered to be more predictable components of the projection model than migration, as migration is affected by policy changes and social or economic conditions. Greater variation is expected with smaller geographic areas.

http://www.aincinac.gc.ca/pr/pub/abw/abw_e.pdf


Key Findings

Growth of the HNHB LHIN population varies by sub-LHIN geography. The population of Halton, which includes Burlington, is expected to grow the fastest (25.6% from 2009 to 2019).

In all areas with the exception of Halton, the largest growth in terms of number of people and percent change in the population over the next ten years will be among people 65-74 years of age. For Halton, the largest growth in terms of number of people is expected among the 45-64 year age group and the largest percent change in the population is expected for the 85+ year age group.


Table 5: Projected Population Counts by Census Division and Age Group from 2009 to 2019 Hamilton Niagara Haldimand &

Norfolk Brant Halton Age

group 2009 2019 2009 2019 2009 2019 2009 2019 2009 2019

<15 85,320 84,126 66,929 65,067 18,893 18,459 24,872 26,416 91,056 106,714 15-44 217,754 224,678 165,993 160,353 42,355 41,553 56,632 59,875 207,099 240,922 45-64 145,513 160,854 125,188 131,771 34,050 35,379 37,759 41,537 132,576 179,459 65-74 38,578 55,613 39,455 54,716 9,841 14,960 10,226 16,077 32,916 50,436 75-84 28,391 30,365 27,357 30,388 6,061 7,168 6,717 7,937 21,624 28,732 85+ 10,704 13,710 11,131 13,271 2,282 2,900 2,509 2,992 7,969 13,056 Total 526,260 569,346 436,053 455,566 113,482 120,419 138,715 154,834 493,240 619,319

Table 6: Change in Population by Census Division and Age Group from 2009 to 2019 Hamilton Niagara Haldimand &

Norfolk Brant Halton Age group

Number % Number % Number % Number % Number % <15 -1,194 -1.4 -1,862 -2.8 -434 -2.3 1,544 6.2 15,658 17.2 15-44 6,924 3.2 -5,640 -3.4 -802 -1.9 3,243 5.7 33,823 16.3 45-64 15,341 10.5 6,583 5.3 1,329 3.9 3,778 10.0 46,883 35.4 65-74 17,035 44.2 15,261 38.7 5,119 52.0 5,851 57.2 17,520 53.2 75-84 1,974 7.0 3,031 11.1 1,107 18.3 1,220 18.2 7,108 32.9 85+ 3,006 28.1 2,140 19.2 618 27.1 483 19.3 5,087 63.8 Total 43,086 8.2 19,513 4.5 6,937 6.1 16,119 11.6 126,079 25.6


3.1.5 Socio-Economic Status

Labour Force Characteristics

Definitions:

The labour force participation rate is the percent of the population in the labour force. This value is calculated for the population 15+ and for youth defined as 15-24 years of age.

The unemployment rate is the percent of the population who is unemployed. This value is calculated for the population 15+ and for youth defined as 15-24 years of age.

Data Source:

2006 Census, Statistics Canada.

Significance/Uses:

Unemployment is an indicator of social disadvantage.

Unemployed persons tend to experience more health issues.

Long term unemployment may extend one’s susceptibility to poor health.

Comparisons can be made between geographic areas.

Notes:

As very broad indicators of risk conditions for poor health status, this information should only be used in conjunction with relevant information regarding population risk factor prevalence and the availability of social, health, and economic support services in the local community.

The data represents a snapshot as of 2006.

Data are not available for First Nations due to incomplete enumeration.


Income

Definitions:

The percent of the population spending over 30% of income on housing.

The percent of the population who live below the low income cutoff. According to the 2006 Canadian Census the low income cutoff is defined as income levels at which families or unattached individuals spend 20% or more on food, shelter or clothing.

Data Source:


Significance/Uses:

Along with education, income is one of the main indicators of socio-economic status. Research evidence show that low socio-economic status is associated with low-skilled jobs, high unemployment rates, unfavourable lifestyle and living conditions, and a greater prevalence of disability and health problems.

Lower income is associated with higher risk of health issues.

Lower income is an indicator of socio-economically disadvantaged populations and lower quality of life.

Income inequalities in the population may lead to inequities in health outcomes.


Notes:

Income is self-reported and thus may be subject to reporting bias.



Certain sub-groups are not accurately represented in the Canadian Census (e.g., young adults and the homeless).

While comparative measures of housing affordability are important for describing the population potentially at risk of poor health status, it is also necessary to consider the availability of social supports in a community, such as affordable housing and community support services.


Family and Living Characteristics

Definitions:

Percent of families with children that are headed by a lone-parent.

Percent of the population 65+ years who live alone.

Data Source:


Significance/Uses:

An indicator of social isolation.


Notes:




Education

Definitions:

The percent of the population 25 years of age and older that does not have a certificate, degree, or diploma.

The percent of the population 25 years of age and older that have completed post-secondary education.

Data Source:


Significance/Uses:

Education is an indicator of socio-economic status. Studies have demonstrated a relationship between lower levels of education and the following conditions: unskilled jobs, high unemployment, unfavourable living conditions, and greater prevalence of disability and health conditions.

People with lower education have reduced access to health information.

Information about education is useful in assessing the reading level required for preparation of educational materials.


Notes:

Education levels vary by age group. An older population may show a higher percentage of lower education than a younger population.




Key Findings

In 2006, unemployment rates in the HNHB LHIN were lower than provincial rates but within the HNHB LHIN the rates vary. Norfolk and Hamilton had the highest adult unemployment rates.

Compared to the province the HNHB LHIN has a lower percentage of the population living below the low income cutoff. Within the HNHB LHIN, Hamilton has the highest number and percent of its population living in low income.

The HNHB LHIN has a higher percent of lone parent families compared to the province as a whole. Within the HNHB LHIN, Hamilton and Niagara have the highest percentages of lone parent families.

A higher percentage of seniors live alone in the HNHB LHIN compared to the Ontario average. More specifically, Hamilton, Brant, and Niagara have the highest percentages of seniors living alone (all ≥28%).

In the HNHB LHIN, a higher proportion of the population 25 years of age and older is without a certificate, degree or diploma and a lower proportion has a university education, compared to all Ontario. Burlington has the highest percentage of the population with completed post secondary education and Norfolk and Brant have the lowest percentages.


Table 7: Characteristics of Employment, Income, Family Composition, Education for the HNHB LHIN, Ontario, and Range for all LHINs, 2006 Characteristic HNHB

LHIN Ontario Range for all

14 LHINs Labour force participation rate (age 15+) 65.7% 67.1% 60.1%-71.5% Unemployment rate (age 15+) 6.0% 6.4% 5.2%-8.4% Youth labour force participation rate (age 15-24) 70.0% 65.2% 58.2%-72.1% Youth unemployment rate (age 15-24) 13.2% 14.5% 11.5%-18.6% % population living in low income 13.7% 14.7% 9.6%-24.0% % families (with children) headed by a lone parent 26.1% 24.5% 20.0%-30.9% % seniors (age 65+) living alone 27.7% 25.7% 15.2%-34.0% % population (age 25+) without certificate, degree, diploma 20.8% 18.7% 13.0%-25.9% % population (age 25+) with completed post-secondary education 52.9% 56.8% 50.3%-64.7%

Table 8: Characteristics of Employment, Income, Family Composition, Education for the HNHB LHIN, by sub-LHIN Geography, 2006 Characteristic Hamilton Niagara Haldimand Brant Burlington Norfolk

Unemployment (age 15+) Number who are unemployed 17,255 13,740 1,190 4,055 4,305 1,755 Unemployment rate 6.5% 6.1% 4.8% 6.0% 4.6% 6.7% Income Population living in low income 89,677 50,288 3,558 14,259 15,409 4,311 % of population living in low income 18.1% 12.0% 8.0% 11.6% 9.5% 9.0% Households spending ≥30% of income on housing

53,035 42,640 3,420 11,085 14,725 4,110

% households spending ≥30% of income on housing

27.3% 25.3% 21.6% 23.4% 23.3% 21.6%

Lone parent families Number of lone parent families 25,085 20,200 1,495 5,875 6,340 1,800 % of families headed by lone parent 27.3% 27.3% 18.9% 26.3% 21.6% 22.6% Seniors living alone (age 65+) Number of seniors living alone 19,815 19,215 1,325 4,745 6,055 2,085 % of seniors living alone 28.5% 28.0% 24.0% 28.3% 25.6% 25.6% Education (age 25+ years) Population without certificate, degree, or diploma

74,520 61,415 6,945 20,860 12,930 8,830

% without certificate, degree, diploma

22.0% 20.9% 23.3% 25.2% 11.4% 25.8%

Population with completed post-secondary

179,400 149,995 14,825 39,920 71,800 16,480

% with completed post-secondary 53.0% 51.0% 49.8% 48.1% 63.4% 48.1%


3.1.6 Language

Definitions:

Percent of the population by who include English and French as 'Mother Tongue', i.e., the language first learned and still understood.

Percent of the population with knowledge of official languages. Refers to the ability to conduct a conversation in English only, in French only, in both English and French, or in neither of the official languages of Canada.

Data Source:


Significance/Uses:

People who do not know either English or French may have reduced access to health information and services.

Useful in identifying the people most in need of translation or cultural interpreter services.

Useful in planning for population-based services.

Useful for preparation of educational materials.


Notes:

Knowledge of official languages is self-reported and thus may be inaccurate. It is based on the respondent’s assessment of this or her ability to speak the official languages.



Welland, Port Colborne, and Hamilton are designated areas under the French Language Services Act. A detailed report on the needs of the Francophone population is available at: www.hnhblhin.on.ca


Key Findings

Compared to the provincial average, the HNHB LHIN has a higher percentage of population with English as mother tongue and lower percentages of population with French as mother tongue and without knowledge of English or French.

Niagara has both the highest number and percent of population with French as mother tongue.

No knowledge of official languages is highest in Hamilton in terms of both numbers and percent of population.


Table 9: Language Characteristics for the HNHB LHIN, Ontario, and Range for all LHINs, 2006 Characteristic HNHB LHIN Ontario Range for all

14 LHINs % with English as mother tongue 80.1% 69.8% 51.5%-91.5% % with French as mother tongue 2.2% 4.4% 1.0%-23.9% % with knowledge of neither English nor French 1.0% 2.2% 0.2%-2.2%

Table 10: Language Characteristics for the HNHB LHIN by sub-LHIN Geography, 2006 Characteristic Hamilton Niagara Haldimand Brant Burlington Norfolk

English as mother tongue Population with English as mother tongue

369,010

342,770

41,260

108,425

134,330

43,645

% with English as mother tongue 74.2% 81.3% 92.3% 88.3% 82.7% 90.0% French as mother tongue Population with French as mother tongue

7,635

15,175

510

1,460

3,375

520

% with French as mother tongue 1.5% 3.6% 1.1% 1.2% 2.1% 1.1% Knowledge of official languages Population with knowledge of neither English nor French

8,500

2,570

15

545

835

250

% with knowledge of neither English nor French

1.7% 0.6% <0.1% 0.4% 0.5% 0.5%


3.1.7 Aboriginal Population

Definitions:

Percent of the population reporting Aboriginal identity. Aboriginal identity refers to the respondent’s affiliation with an Aboriginal population and reflects their current self-definition.

Number of and percent of Aboriginal people who live on reserve and off-reserve.

Data Sources:


Indian and Northern Affairs Canada (INAC) First Nation Profiles and Registered Indian Population by Sex, Age Group, and Residence, 2006.

First Nations Peoples in Ontario: A Demographic Portrait. Ministry of Health and Long-Term Care, Health System Information Management and Investment Division. Health Analytics Branch, January 2009

Significance/Uses:

The use of multiple data sources provides a more complete profile of Aboriginal populations.

Consideration should be given to whether the focus is on Aboriginality or on specific Aboriginal groups, and to determine whether on and off reserve populations should be differentiated for First Nations analyses.

Notes:

The definition of Aboriginality used in the Census of Canada is more expansive than INAC’s administrative definitions. Since the 1996 Canadian Census, the long form has included questions on Aboriginal self-identity, band membership and whether an individual is a Registered Indian in addition to having Aboriginal ancestry. Each concept results in different population counts.

Census data undercount Aboriginal peoples in Ontario.

Because INAC data are based on registrations, it does not include Métis, Inuit or non-registered First Nations peoples.

For INAC off reserve populations, these totals represent the number of people who do not live on reserve who are registered with a First Nations co-located with that particular LHIN. No information is available on where these off reserve individuals may live. They may reside within the LHIN, in other LHINs, or outside of the province.


Key Findings

The demographic profile of First Nations people in Ontario differs substantially from the non-First Nations population. The First Nations population has a younger age structure, higher fertility rates, and is more mobile.

According to 2006 data from the Canadian Census, over 21,000 people or 1.7% of the population reported Aboriginal identity in the HNHB LHIN compared to 2.0% for the province as a whole. Hamilton had the highest number of people that reported Aboriginal identity (7,625) and Brantford had the highest percent of the population with Aboriginal identity (3.9%).

According to 2006 data from the Indian Register at INAC, there were 22,648 registered people for Six Nations and 1,735 for New Credit. Approximately half of the registered population lives off reserve.


Table 11: Indian Register Population for Six Nations and New Credit, 2006 Six Nations New Credit Total Register Population 22,649 1,735 Number On Reserve 11,076 853 % On Reserve 48.9% 49.2% Off Reserve 11,573 882 % Off Reserve 51.1% 50.8%


3.1.8 Immigrants

Definitions:

Percent of the population who are immigrants and the percent of the population who arrived within 5 years. Immigrants refer to people who have been granted the right to live in Canada permanently by immigration authorities. Many are Canadian citizens. The category excludes non-permanent residents (e.g., refugee claimants and holders of employment authorizations, student visas, or Minister’s permits and their families). Non-immigrants are people who are Canadian citizens by birth.

Percent of the population who are visible minorities. Refers to the visible minority group to which the respondent belongs. The Employment Equity Act defines visible minorities as 'persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour'.

Data Source:


Significance/Uses:

Some immigrants have resided in Canada for a number of years, while others are recent arrivals. New immigrants may have different health care needs and levels of utilization of health care services from those who lived in Canada longer.

Period of immigration may be an indication of acculturation into mainstream culture.

Useful in planning culturally sensitive services for communities with diverse ethnic groups.

Cultural values and beliefs greatly influence people’s health seeking behaviors and utilization of health services.

Notes:




Key Findings

About 20% of the population of the HNHB LHIN were immigrants and 2% were recent immigrants. These percentages are lower than the provincial rates. Hamilton has the highest numbers and percent of immigrant and recent immigrant populations.

The percent of the HNHB LHIN population who are visible minorities is lower than the provincial average. Hamilton has both the highest numbers and percent of visible minority populations in the HNHB LHIN.


Table 12: Immigration and Visible Minority Characteristics for the HNHB LHIN, Ontario, and Range for all LHINs, 2006 Characteristic HNHB LHIN Ontario Range for all 14

LHINs % who are immigrants 20.3% 28.3% 6.3%-47.9% % who arrived within 5 years 2.3% 4.8% 0.3%-9.5% % who are visible minorities 9.1% 22.8% 1.4%-50.3%

Table 13: Immigration and Visible Minority for the HNHB LHIN by sub-LHIN Geography, 2006 Characteristic Hamilton Niagara Haldimand Brant Burlington Norfolk

Immigrants Population who are immigrants 126,485 75,835 4,025 15,930 36,280 5,190 % who are immigrants 25.4% 18.0% 9.0% 13.0% 22.3% 10.7% Population who arrived within 5 years

16,560

7,875

135

1,190

4,020

195

% who arrived within 5 years 3.3% 1.9% 0.3% 1.0% 2.5% 0.4% Visible minorities Population who are visible minorities 67,845 26,405 575 6,715 15,690 885 % who are visible minorities 13.6% 6.3% 1.3% 5.5% 9.7% 1.8%


3.1.9 Lifestyle Behaviours

Definitions:

Percent of the population aged 12+ who smoke on a daily or occasional basis.

Percent of the population aged 12+ who are exposed to second-hand smoke at home.

Percent of the population aged 12+ who reported drinking 5+ drinks on one occasion.

Percent of the population aged 12+ who reported being active or moderately physically active in response to questions about the frequency, duration and intensity of their participation in leisure-time physical activity.

Percent of the population aged 12+ who were overweight or obese, based on Body Mass Index (BMI).

Percent of the population aged 12+ who reported consuming fruits and vegetables 5+ times per day.

Data Source:

2007 Canadian Community Health Survey, Statistics Canada.

Significance/Uses:

Useful in estimating the size of the population at risk of developing chronic health conditions.

Notes:

A number of potential biases should be considered when interpreting the results such as whether or not the results are representative of the population (e.g., non-respondents to a survey often differ from respondents), social desirability, and did the questions measure what they intended to measure.

Reluctance to self-report unhealthy lifestyle behaviour may underestimate the population at risk of chronic disease due to lifestyle related risk factors.

Survey does not include homeless persons or persons living in institutions.

Physical activity may not reflect year-round activity levels.

Smoking measure does not account for intensity of tobacco use.


Key Findings

Poor health practices are known to be related to increased risk of chronic disease, mortality and

disability. Relative to the province, there is a higher prevalence of daily or occasional smoking, heavy drinking, physical activity, and obesity in the HNHB LHIN.

In 2007, 25.1% of residents of the HNHB LHIN reported being daily or occasional smokers, 27.0% consumed five or more drinks on one occasion, at least once a month within the last year. Based on Body Mass Index, 32.2% of the adult HNHB LHIN population was considered overweight and 19.3% were obese.

Differences in lifestyle behaviours are seen for men and women. As compared to the province, the HNHB LHIN has a significantly higher percent of:

o women who are daily or occasional smokers

o both men and women who drink heavily

o men who are physically active

o women who are obese

Figure 4: Health Practices in the HNHB LHIN and Ontario, Population Age 12+, 2007

39.9

16.1

33.1

48.8

21.1

5.7

20.6

42.0

19.3

32.2

52.8

27.0

6.7

25.1

0 20 40 60

Consume 5+ fruits and vegetablesper day

Obese (age 18 +)

Overweight (age 18+)

Physical activity, active ormoderately active

5 or more drinks on one occasion

Exposed to second-hand smoke athome

Smoking, daily or occasional

Percentage

HNHB LHIN

Ontario

*

*

*

*

* Significantly different from provincial average.



3.1.10 Preventive Care

Definitions:

Percent of the females aged 18-69 who have had a pap smear within the past three years.

Percent of the females aged 50-69 who received a routine mammogram within the last two years.

Percent of the population who had influenza immunization less than one year ago.

Data Source:

2005 and 2007 Canadian Community Health Survey, Statistics Canada.

Significance/Uses:

Useful in estimating use of preventive health services.

The use of preventive health care services can lead to early detection of disease, which ultimately results in reduced morbidity and mortality.

Notes:




Key Findings

Of the selected preventive health indicators, none are significantly different from Ontario as a whole. Within the last three years, 71.7% of women in the HNHB LHIN had a Pap smear (for cervical cancer screening), 54.5% of women received a routine mammogram in the previous two years, and 36.9% had a flu shot in the past year.

Figure 5: Use of Preventive Care in the HNHB LHIN and Ontario

35.7

53

72.9

36.9

54.5

71.7

0 20 40 60 80

Influenza immunization, less than oneyear ago (2007 data)

Received routine screeningmammogram within the last 2 years (50

to 69 years, 2005 data)

Pap smear, within the last 3 years (18 to69 years, 2005 data)

Percentage

HNHB LHIN

Ontario



3.2. Population Health Status

Population Health Status How healthy are people in the HNHB LHIN?

Well-being and Personal Resources


Deaths

Life stress

Self-rated general health

Self-rated mental health

Chronic conditions

Activity limitation

Low birth weight

Life expectancy

Deaths & leading causes

Infant mortality rate

Potential years of life lost


3.2.1 Well-being and Personal Resources

Definitions:

Percent of the population aged 12+ who rate their own health status as being very good or excellent compared to good, fair, or poor.

Percent of the population aged 12+ who rate their own mental health status as being very good or excellent compared to good, fair, or poor.

Percent of the population 15+ who report having quite a lot of life stress.

Data Source:


Significance/Uses:

Self-reported health, an indicator of overall health status, can reflect aspects of health not captured in other measures, such as disease severity, aspects of positive health status, physiological and psychological reserves and social and mental function.

Useful in estimating the size of the population in need of mental health and other services.

Identifies populations at risk for poor health.

Notes:




Key Findings

About 21% of the population 15+ in the HNHB LHIN report having ‘quite a lot” of life stress. This rate is not significantly different than the provincial average.

Approximately 60% of the HNHB LHIN population 12+ years report being in ‘very good’ or ‘excellent; health and about 74% perceive their mental health as ‘very good’ or ‘excellent.’ The proportion of HNHB LHIN that rate their overall health and mental health as ‘excellent’ or ‘very good’ is similar to Ontario as a whole.

Figure 6: Life Stress and Perceived Health for the HNHB LHIN and Ontario, Population Age 12+, 2007

72.6

60.0

22.1

73.8

60.2

21.4

0 20 40 60

Perceived mentalhealth, very good or

excellent

Perceived health,very good or

excellent

Life stress, quite a lot(age 15+)

Percentage

80

HNHB LHIN

Ontario




3.2.2 Chronic conditions

Definitions:

Percent of the population aged 12+ who reported being diagnosed by a health professional as having arthritis or rheumatism.

Percent of the population aged 12+ who reported being diagnosed by a health professional as having high blood pressure.

Percent of the population 12+ who reported being diagnosed by a health professional as having asthma.

Percent of the population 12+ who reported being diagnosed by a health professional as having diabetes.

Data Source:


Significance/Uses:

Useful in estimating the capacity requirements for programs/services designed to help people better manage their chronic health conditions in order to prevent or delay the onset of chronic disease and to improve the quality of life.

Notes:


The prevalence of chronic health conditions may be underestimated if a proportion of the population has undetected conditions due to inadequate access to primary care.



Key Findings

HNHB LHIN residents have significantly higher rates of arthritis/rheumatism, high blood pressure, and asthma compared to the province as a whole. Diabetes rates are slightly, but not significantly, lower than provincial rates.

Differences in chronic conditions are seen for men and women. As compared to the province, the HNHB LHIN has a significantly higher percent of:

o both men and women who have arthritis/rheumatism

o women who have high blood pressure

o men who have asthma

Figure 7: Prevalence of Selected Chronic Conditions in the HNHB LHIN and Ontario, Population Age 12+, 2007

6.1

8.1

16.4

16.2

5.1

9.6

18.4

20.1

0 5 10 15 20 25

Diabetes

Asthma

High bloodpressure

Arthritis orrheumatism

Percentage

HNHB LHIN

Ontario

*

*

*




3.2.3. Activity limitation

Definitions:

Percent of the population aged 12+ who reported being limited in activities because of a physical condition, mental condition or health problem which has lasted or is expected to last 6 months or longer.

Percent of the population aged 12+ who reported having pain or discomfort that prevents them from doing their normal activities.

Data Source:


Significance/Uses:

Useful in estimating activity limitations. Activity limitations are related to health.

Notes:




Key Findings

Compared to Ontario as a whole, a significantly higher proportion of HNHB LHIN residents reported being limited in activities because of a physical condition, mental condition or health problem which has lasted or is expected to last 6 months or longer.

Figure 8: Activity Limitations HNHB LHIN and Ontario, Population Age 12+, 2007

13.0

33.1

13.3

37.0

0 20 40 60

Pain or discomfortthat prevents

activities

Activity limitation

Percentage

80

HNHB LHIN

Ontario

*




3.2.4 Low birth weight

Definition:

Rate of live births under 2,500 grams (singleton only) per 100 live births (excluding multiple births focusing only on singletons).

Data Source:

Ontario Live Births Data [2006], Provincial Health Planning Database (PHPDB) version 18.10 [extracted April 20, 2009], Health Data and Decision Support, Ontario MOHLTC.

Significance/Uses:

There is a potential that health reforms may have differential outcomes on birth weights of different population sub-groups, such as those with low income and recent immigrants.

Useful in planning comprehensive prenatal programs.

It is a predictor of an infant’s chance of survival. It is an important indicator of population health status in developed countries.

Notes:

Weight at birth is associated with prematurity. This effect can be eliminated by using only low birth weight infants carried to term (37 weeks of gestation or more).


Key Findings

In the HNHB LHIN as of 2006, the rate of low birth weight babies was 5.97 per 100 live births compared to 6.10 per 100 live births for Ontario.


Deaths

3.2.5 Life expectancy

Definition:

Life expectancy is reported in years and is calculated from birth.

Data Source:

[Deaths table, 2005], Ontario Ministry of Health and Long-Term Care, IntelliHealth.

Significance/Uses:

Indicator of population health and mortality conditions.

Notes:

Life expectancy does not measure quality of life.


Key Findings

As of 2005, life expectancy at birth was 79.9 years in the HNHB LHIN compared to 80.7 years for

the province.

Life expectancy is longer for females compared to males (81.9 years for females and 77.7 years for males in the HNHB LHIN).


Table 14: Life Expectancy at Birth for the HNHB LHIN and Ontario by sex, 2005 Sex HNHB LHIN Ontario Males 77.7 78.6 Females 81.9 82.7 Total 79.9 80.7


3.2.6 Deaths and Leading Causes

Definition:

Age-adjusted death rate for the HNHB LHIN, Ontario, and sub-LHIN per 100,000 population. Age-adjusted means the rate is adjusted for variations in population age distributions over time and place. Data Source:

2005 Death, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.

Significance/Uses:

Death rates reflect the overall health of the population. Lower death rates show success in preventing, detecting, and treating disease, and reducing suicide.

Allows for comparisons by geography.

Notes:

Death rates and causes of death vary by a range of factors such as age, sex, and socio-economic status.


Key Findings

The overall death rate for all causes of mortality is significantly higher in the HNHB LHIN

compared to the province as a whole. Within the HNHB LHIN, the death rate in Brant is significantly higher than the HNHB LHIN rate and the death rate in Burlington is significantly lower.

The leading causes of death among residents of the HNHB LHIN are:

o Ischemic heart disease (20%)

o Lung cancer (7%)

o Cerebrovascular disease (7%)

o Diabetes (4%)

o Chronic lower respiratory diseases (4%)

o Dementia/Alzheimer’s Disease (4%)

o Colon/rectal cancer (4%)

The infant mortality rate in the HNHB LHIN is 4.98 per 1,000 live births which is lower than the provincial rate of 5.40 per 1,000 live births (2003-2005 average).

Figure 9: Death Rate by Location of Residence

6 59 64 5589 58 8

490 45 4

576 5 39

0

1 00

2 00

3 00

4 00

5 00

6 00

7 00

Nor

folk

Brant

Ham

ilton

Niaga

ra

Haldi

man

d

Burlin

gton

HNHB L

HIN

Ont

ario

Rat

e pe

r 10

0,0

00 p

opul

atio

n

*

*

*

* Significantly different from HNHB LHIN rate.



3.2.7 Potential years of life lost

Definition:

Potential years of life lost is the number of life years lost due to premature mortality assuming all males/females live to a standard age of 75. The rate is calculated for the HNHB LHIN, Ontario, and sub-LHIN per 100,000 population. Data Source:

2005 Death, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.

Significance/Uses:

Provides a measure of the major causes of premature mortality. Most of the improvements in life expectancy come from the reductions in death rates at the older years. For comparisons over place and time, adjusted PYLL should be standardized for age, sex etc. Provides a measure of the major causes of premature death due to a particular cause. Allows for comparisons by geography.

Notes:

The number of years of life lost before the age limit (i.e. life expectancy) is overestimated since not all the deceased would have reached the age limit even if the cause of their death had been eliminated.


Key Findings

In 2005, there were over 66,000 potential years of life lost among residents of the HNHB LHIN.

Heart disease, lung cancer, suicide, and motor vehicle collisions account for the most potential years of life lost. The rate of potential years of life lost is higher in the HNHB LHIN compared to the province and variation is seen within the LHIN.

The leading causes of account for the most potential years of life lost among residents of the HNHB LHIN are: o Ischemic heart disease (11%) o Lung cancer (8%) o Suicide (5%) o Motor vehicle collisions (5%) o Perinatal conditions (4%) o Colon/rectal cancer (4%) o Lymph/blood cancer (3%) o Breast cancer (3%) o Diabetes (3%)

Figure 10: Potential Years of Life Lost Rate by Location of Residence

6,1805,626

5,146 4,908 4,601

3,216

4,8664,334

0

1000

2000

3000

4000

5000

6000

7000

Norfolk

Brant

Niagar

a

Ham

ilton

Haldim

and

Burlingto

n

HNHB L

HIN

Ont

ario

Ra

te p

er

100

,00

0 p

opu

lati

on



3.3. Health System Utilization and Capacity

Health System Utilization and Capacity What do we know about the health system in the HNHB LHIN?

Health Care System Utilization Health Care System Capacity

Acute inpatient hospitalizations

Day surgery & emergency department visits

Mental health hospitalizations

Complex continuing care hospitalizations

Inpatient rehabilitation hospitalizations

Use of community care access centre services

Patient flow: In and Out of HNHB LHIN

Health service providers

Supply of beds in hospital and long term care homes

Physicians


3.3.1 Health Care System Utilization

Definition:

Age-adjusted utilizations rate are provided for the HNHB LHIN, Ontario, and sub-LHIN per 100,000 population. Age-adjusted means the rate is adjusted for variations in population age distributions over time and place.

Inflow represents people who do not live in the HNHB LHIN but receive health services in the HNHB LHIN.

Outflow represents people who live in the HNHB LHIN but receive health services outside of the HNHB LHIN.

Data Source:

Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.

Significance/Uses:

Reflects utilization of health services in the HNHB LHIN.


Notes:

While the data displays utilization patterns, it does not necessarily reflect population needs.

Adjustments for factors such as age are required to allow for a fair comparison to other areas.


Key Findings

The acute care hospitalization rate for residents of the HNHB LHIN was significantly higher than the provincial rate. In 2007-08, over 96,000 HNHB residents stayed in an acute care hospital, accounting for over 125,000 stays.

Leading Reasons for acute care hospitalization (Most Responsible Diagnosis) among residents of the HNHB LHIN were:

o Live born infants (8%)

o Complications of pregnancy predominantly labour and delivery (6%)

o Complications of pregnancy predominantly antenatal (5%)

o Acute myocardial infarction (2%)

o Chronic obstructive pulmonary disease (2%)

o Heart failure (2%)

For residents of the HNHB LHIN the leading clinical area (Program Cluster Categories) based on number of separations were:

o Obstetrics (12%)

o Neonatology (12%)

o Cardiology (10%)

o General Surgery (8%)

o Gastro/Hepatobililary (8%)

o Orthopedics (7%)

o Pulmonary (7%)

o General Medicine (6%)

o Trauma (5%)

For residents of the HNHB LHIN the leading clinical area (Program Cluster Categories) based on number of inpatient days were:

o General Surgery (11%)

o General Medicine (10%)

o Cardiology (9%)

o Pulmonary (8%)

o Neonatology (7%)

o Orthopedics (7%)

o Gastro/Hepatobiliary (7%)


o Trauma (6%)

o Obstetrics (5%)

While obstetrics is the leading clinical area in terms of hospitalized cases, these patients account for fewer hospital days due to shorter lengths of stay compared to other clinical areas such as general surgery or general medicine.

Hospital utilization patterns vary by socio-demographic characteristics. For example, seniors in the HNHB LHIN account for about 38% of acute hospital stays and represent about 16% of the population.

HNHB LHIN residents use hospitals within the HNHB LHIN for most of their hospital care. Overall, less than 7% of acute care hospitalizations for HNHB LHIN residents occurred at hospitals outside of the LHIN. In contrast, about 6% of acute stays at hospitals within the HNHB LHIN were from residents who did not live in the HNHB LHIN. There is variation across the LHIN. For example, in 2007-08 approximately 22% of acute hospital stays among residents of Burlington occurred at hospitals outside of the HNHB LHIN compared to 3% of Hamilton residents who were admitted to a hospital outside of the LHIN.

The rate of emergency department utilization is higher among residents of the HNHB LHIN compared to the province. Within the HNHB LHIN, rates of emergency department utilization vary greatly. Residents of Burlington had the lowest rate and residents of Haldimand County had the highest rate of emergency department visits.

There are over 590,000 visits to an emergency department among residents of the HNHB LHIN. While the number of emergency department visits has increased over the past four years, the age-adjusted rate of emergency department utilization has remained stable.

The greatest contributor to the higher rates of ED utilization by HNHB LHIN residents was the high rate of ED visits per population for less urgent or non-urgent cases.

In 2006-07, HNHB LHIN residents had 2,971 complex continuing care (CCC) admissions, the highest volume of CCC admissions among the 14 LHINs and representing 15.6% of the total CCC admissions at Ontario hospitals. The utilization rate of CCC for residents of the HNHB LHIN was well above Ontario average. In particular, the highest age-adjusted rates were for residents of Brant and Niagara.

In 2007-08, there were over 2,900 inpatient rehabilitation admissions among residents of the HNHB LHIN. The age-adjusted rate for HNHB LHIN residents was significantly lower than the Ontario rate. Within the HNHB LHIN, admission rates for inpatient rehabilitation vary. The lowest age-standardized rates were for residents of Niagara, Haldimand, and Norfolk.

Orthopedic conditions, stroke, and medically complex patients were the most common groups of rehabilitation admission. In 2007-08 among residents of the HNHB LHIN, orthopaedic conditions accounted for 39% of all inpatient rehabilitation admissions compared to 51% for the province. In contrast, stroke accounted for 16% of all inpatient rehabilitation admissions among residents of the HNHB LHIN compared to 13% for the province as a whole.


In 2006-07, there were over 50,000 admissions to home care among residents of the HNHB LHIN. In-home acute and in-home rehabilitation were the most common services.

Figure 12: Rate of Acute Care Hospitalizations by Location of Residence

8,994 8,69510,087

9,433

7,202

9,9008,760 8,553

0

2000

4000

6000

8000

10000

12000

Hamilto

n

Niagara

Haldim

and

Brant

Burlin

gton

Norfolk

HNHB L

HIN

Onta

rio

Ra

te p

er

10

0,0

00

pop

ula

tio

n

Figure 13: Rate of Emergency Department Visits by Location of Residence

0

20000

40000

60000

80000

Hamilto

n

Nia

gara

Haldim

and

Brant

Burlingto

n

Norfolk

HNHB L

HIN

Onta

rio

Ra

te p

er

10

0,0

00

pop

ula

tio

n


Figure 14: Rate of Inpatient Rehabilitation by Location of Residence

0

100

200

300

400

Hamilt

on

Niagara

Hald

imand

Bran t

Burlingto

n

Norfolk

HNHB L

HIN

Onta

rio

Ra

te p

er

10

0,0

00

pop

ula

tio

n

Figure 15: Rate of Complex Continuing Care by Location of Residence

0

50

100

150

200

250

Hamilto

n

Nia

gara

Haldim

and

Brant

Burlingt

on

Norfolk

HNHB LHIN

Onta

rio

Ra

te p

er

10

0,0

00

po

pu

latio

n


Figure 16: Rate of Home Care Visits by Location of Residence

0

1000

2000

3000

4000

Hamilto

n

Niaga

ra

Haldim

and

Brant

Burlingto

n

Norfolk

HNHB LHIN

Ontario

Rat

e p

er

100

,000

po

pula

tion

Table 15: Initial Service Goal for Home Care, HNHB LHIN Residents


Initial service goal # admits % of admits

In-home − Acute 18,645 37%

In-home − Rehabilitation 11,661 23%

In-home − Maintenance 8,923 18%

Residential − Long Stay 6,598 13%

In-home − End Of Life 1,858 4%

In-home − Long-term Supportive 1,801 4%

Residential − Short Stay Respite 628 1%

Residential − Convalescent Care 367 1%

Residential − Long-term Care Placement 13 0%

Unknown 245 0%

Total 50,739 100%


3.3.2 Health Care System Capacity

Definition:

The number of hospital corporations, long-term care home, Community Care Access Centres, community support services, community mental health and substance abuse, community health centres in the HNHB LHIN.

The Ontario Physician Human Resources Data Centre (OPHRDC) maintains a registry of all active and licensed physicians practicing in Ontario. The Registry is compiled from a number of sources including RCPSC, CPSO, CFPC, OHIP, APPs, and an independent survey of physicians. Records of physicians passing the criteria for inclusion in the Active Physician Registry are appended with the specialty recorded by the College of Physicians and Surgeons (CPSO) for the most recent (sub)specialty of RCPSC certification. Certification data provided by the College of Family Physicians of Canada (CFPC) are used to identify Family Physicians and Family Physicians with special competency in Emergency Medicine. Remaining physicians shown to be billing OHIP in "general practice" are classified as General Practitioners (GP's). The unmatched remainder are included in the OPHRDC dynamic survey to clarify the specialty of actual practice. Note that physicians qualified in Emergency Medicine from the RCPSC are included under "specialists".

Significance/Uses:

Useful for examining the quantity of available services.

Can be used as a component of accessing equitable access to services.


Indicators of human resources as health care resources available to an area resident population.

Compare number to other estimates of supply, e.g., physicians billing OHIP

Useful for health human resources planning.

Notes:

Physician supply is measured using headcounts. These data do not capture all physician activity, such as - hours per week worked, or volume of patients seen.

These data may reflect a physician's last acquired specialty certificate rather than current field of practice, and multiple specialties of practice are not captured.

Individuals seeking care often use physicians whose activity is captured in another county, and likewise, physicians provide care to individuals who reside in a different county (inflow - outflow).

These data do not reflect the differences in time spent in clinical practice vs. academic or administrative responsibilities.


Key Findings

There are 244 health service provider agencies in the HNHB LHIN who deliver a wide range of health services. As of June 2009, there were:

o 10 Hospital Corporations

o 88 Long-Term Care Homes

o 1 Community Care Access Centre

o 88 Community Support Services: 64 Community Support Services (CSS) Programs, 3 Acquired Brain Injury Programs, 21 Assisted Living Services Supportive Housing (ALSSH) Programs

o 50 Community Mental Health and Substance Abuse: 18 Addictions Programs, 32 Mental Health Programs

o 7 Community Health Centres

As of 2007-08, there were 3,573 hospital beds staffed and in operation within the HNHB LHIN, including: 2,127 acute, 382 mental health, 793 complex continuing care, and 271 general and specialized rehabilitation.

The HNHB LHIN has more long-term care beds than any other LHIN.

Physician-to-population ratios vary across the HNHB LHIN area. As of 2007, there were 76 family physicians per 100,000 population in the HNHB LHIN, significantly lower than the provincial rate of 85 family physicians per 100,000 population. Within the HNHB LHIN, the lowest rates are seen in Haldimand, Norfolk, and Niagara.

In spite of the low ratio of family physicians per population in the HNHB LHIN, according to the 2007 Canadian Community Health Survey, 92.7% of HNHB LHIN residents reported that they had a regular medical doctor. This reported rate was above the Ontario average (90.4%). According the Primary Care Access Survey, approximately 4.2% of people 16+ years in the HNHB LHIN are unattached in regards to primary care, representing approximately 47,000 people. The percent of unattached patients for the province as a whole was estimated at 7.0%.

With the exception of Hamilton, communities within the HNHB LHIN are designated as having family physician vacancies by the Underserviced Area Program (UAP) of the Ontario Ministry of Health and Long-Term Care. As of March 2009, there were 119 general practitioner/family physician vacancies in the LHIN with the highest number of vacancies in Niagara (81 vacancies).


Table 16: HNHB LHIN Hospital Beds by Hospital Location, Acute and Mental Health

Location Medical Surgical Comb.

Med Surg ICU Obstet. Peds Psych Total

Hamilton 427 395 43 132 66 50 284 1,397

Niagara 197 123 134 57 40 26 58 635

Haldimand 0 0 16 0 4 2 0 22

Brant 41 54 31 15 22 20 24 207

Burlington 61 56 0 14 15 6 16 168

Norfolk 47 16 4 6 5 2 0 80

Total 773 644 228 224 152 106 382 2,509

Table 17: HNHB LHIN Hospital Beds by Hospital Location, Chronic and Rehabilitation

Location Chronic General Rehab Special Rehab

Hamilton 328 110 60

Niagara 288 37 0

Haldimand 13 0 0

Brant 73 25 0

Burlington 50 39 0

Norfolk 41 0 0

Total 793 211 60

Figure 17: Rate of family physicians in the HNHB LHIN, Ontario, and Sub-LHIN

85

67

58

75

81

56

76

86

0 20 40 60 80 100

Hamilton

Niagara

Haldimand

Brant

Burlington

Norfo lk

HNHB LHIN

O ntario

Rate of Family Physicians per 100,000 population



+

3.4. Health Care System Performance

Health Care System Performance How well is the health system in the HNHB LHIN performing?

HNHB LHIN Scorecard

Developed by Robert S. Kaplan & David P. Norton, the Balanced Scorecard is a framework, characterized as a “strategic management system” and is a management/ measurement tool that translates the organization’s strategy into tangible objectives and measures. Financial and non-financial measures or metrics used to help an organization define and evaluate how successful it is, typically in terms of making progress towards its long-term organizational goals. The HNHB LHIN Scorecard reports performance across four domains that are the cornerstones of the LHIN’s mission and vision.

o System Integration – Focus is on measures that report how well the system is integrating (connecting) care along the continuum of clients’ interaction with the health care system.

o Client Access and Outcomes - Focus is on measures that report clients’ abilities to access health care services in a timely manner and outcomes

o Financial Health and System Sustainability - Focus is on measures that report how well the health care organizations and managers of health care are managing health care resources in a fiscally prudent manor.

o Organizational Health: Focus is on measures that report how well the health care organization is managing its internal resources i.e. heath human resources.

Percent ‘Alternate Level of Care’ (ALC) days is an example of an indicator of system integration for clients across the care continuum. Following the acute phase of hospitalization a relatively large proportion of patients in the HNHB LHIN are designated ALC, compared to the provincial average. Many patients are waiting for a long-term care bed or another level of care such as inpatient rehabilitation (active and slow-paced) or palliative care. Long waiting times, particularly for rehabilitation, can have a permanent, detrimental impact on a patient's ability to regain function and independence. Refer to HNHB LHIN Scorecard at www.hnhblhin.on.ca for current and additional details about health care system performance.

Additional resources, both financial and human, are needed in the HNHB LHIN to adequately address outstanding health care needs and to ensure programs are in place to meet the evolving and growing demand for health services. Just as essential as resources, however, is a readiness among local health care and human service sector stakeholders to share information, plan in a collaborative manner and identify opportunities to improve the accessibility of services.



ENDNOTES

1 Schroder, S. We Can Do Better — Improving the Health of the American People. New England Journal of Medicine 2007;357:1221-1228 (adapted from McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21:78-93).

2 Adler NE, Ostrove JM. Socioeconomic status and health: what we know and what we don't. Ann N Y Acad Sci 1999;896:3-15.

3 Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood. 2002;21(2):60-76.

4 Tomaka J, Thompson S, Palacios R. The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. J Aging Health 2006;18(3):359-84.

5 Schroder S. We Can Do Better — Improving the Health of the American People. New England Journal of Medicine 2007;357:1221-1228 (adapted from Mokdad AH, Marks JS, Stroup JS, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291:1238-1245).

6 Canadian Cancer Society & Cancer Care Ontario. Targeting Cancer. An Action Plan for Cancer Prevention and Detection. Cancer 2020 Summary Report, 2003. Available at: www.cancer.ca.

7 Canadian Cancer Society, National Cancer Institute of Canada. Canadian Cancer Statistics. Toronto: CCS, 2005.

8 Australian Institute of Health and Welfare. Chronic diseases and associated risk factors in Australia (AIHW). Canberra: AIHW, 2001.

9 Ezzati M, Vander Hoorn S, Lopez AD et al. Comparative quantification of mortality and burden of disease attributable to selected risk factors. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, editors. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva: World Health Organization, 2004. p. 241-96.

10 Government of Ontario. Ontario Public Health Standards 2008. Available at: www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/pdfs/ophs_2008.pdf

11 Institute for Clinical and Evaluative Sciences (ICES). The Impact of Not Having a Primary Care Physician Among People with Chronic Conditions. ICES Investigative Report, July 2008.

12 Health Canada. A Statistical Profile on the Health of First Nations in Canada: Determinants of Health, 1999 to 2003. Minister of Health: Ottawa, 2009. Available at: http://www.hc-sc.gc.ca/fniah-spnia/pubs/aborig-autoch/index-eng.php


13 Institute for Clinical and Evaluative Sciences (ICES). Supply and Utilization of General Practitioner and Family Physician Services in Ontario. ICES Investigative Report, August 2005.

14 Kaplan RS, Norton DP. Balanced Scorecard: Translating Strategy into Action. Harvard Business School Press, 1996.

15 Public Health Agency of Canada. What is the Population Health Approach? 2004. Available at: http://www.phac-aspc.gc.ca/ph-sp/approach-approche/index-eng.php

Documents

HNHB LHIN Health Atlas · The HNHB LHIN uses a population-based approach to health services planning to gain a comprehensive understanding of the health status of LHIN residents and