Public Health in Simcoe Muskoka Source: Simcoe.com Bradford Carrot Fest http://www.simcoe.com/whatson-story/5747578-17th-annual-bradford-carrot-fest-just-around-corner/ Scott Warnock, Board of Health Chair Barry Ward, Board of Health Vice Chair Charles Gardner, Medical Officer of Health March, 2017

Healthy People–Our Shared Goal Our Vision The people who live, work and play in Simcoe Muskoka lead healthy, fulfilling and productive lives. Our Mission As champions of health for all, the Simcoe Muskoka District Health Unit works with individuals, families, agencies and communities to promote and protect health, and to prevent disease and injury. We Value: EXCELLENCE in promoting and protecting health, and providing quality programs and services. ACCOUNTABILITY for our individual and collective actions and outcomes, and for the responsible and effective use of public funds and resources. RESPECT for all people and their right to be treated fairly and with dignity. WORKING IN PARTNERSHIP and collaborating with governments, agencies, communities, families and individuals. A POSITIVE WORKING ENVIRONMENT where employees are engaged, and encouraged to exchange ideas, communicate openly, be innovative, and practice work-life balance. EQUAL OPPORTUNITY for health. http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&BillID=4054   Local Health System Integration Act, 2006 Consultations    14.1  (4)  A local health integration network shall engage and seek advice from each board of health for any health unit located in whole or in part within the geographic area of the network in developing its integrated health service plan. Section 67 of the Health Protection and Promotion Act is amended by adding the following subsections: Engagement with LHIN    (5)  The medical officer of health of a board of health shall engage on issues relating to local health system planning, funding and service delivery with the chief executive officer or chief executive officers of the local health integration network or networks whose geographic area or areas cover the health unit served by the board of health. Delegation    (6)  A medical officer of health may only delegate his or her responsibilities under subsection (5) to another medical officer of health for a health unit within the relevant local health integration network, with the agreement of that other medical officer of health.

Transformation Together (5)  The medical officer of health of a board of health shall engage on issues relating to local health system planning, funding and service delivery with the chief executive officer or chief executive officers of the local health integration network or networks whose geographic area or areas cover the health unit served by the board of health.

Our Shared Territory South Simcoe Population (2016 Census): nearly 81,000 Growth from 2011 to 2016: 13.1% Of the 232 Ontario municipalities with populations of 5,000+, South Simcoe Sub Region ranks in the top 70 fastest growing areas in Ontario Higher growth rate than Barrie (3.9%), Innisfil (11.7%), Markham (9%), East Gwillimbury (6.8%), Vaughan (6.2%), Newmarket (5.3%), Richmond Hill (5.1%), Georgina (4.4%) and Aurora (4.2%)

Health Challenges in South Simcoe Indicator South Simcoe Ontario Comparisons Current Smoker (Adults 20+) 20% (16%-25%) 20% (19.8%-20.6%) Same as Ontario Higher-Risk Drinking (Adults 19+) 36% (30%-42%) 28% (27.4%-28.3%) Significantly Higher than Ontario <5/Day Fruits & Vegetables (12+) 57% (51%-62%) 60% (59.2%-60.1%) Physically Inactive Leisure-Time (12+) 47% (39%-55%) 48% (47.2%-48.1%) Obese (Adults 18+) 32% (26%-38%) 25% (24.4%-25.2%) Household Food Insecurity (Any) 7% (5.1%-10.6%) 8% (6.6%-9.1%) Unintentional Injury ER Visit Rate (All) 111 per 1,000 95 per 1,000 MVC Injury ER Visit Rate (All) 7 per 1,000 6 per 1,000 Preventable Mortality Rate (<75 year) 1 per 1,000 IHD Mortality Rate

what Determines Health? CMA infographic, based on: Canadian institute for advanced research – Estimated impact of DOH on population health status

What is Public Health? A 170 year old movement Strategies focused on populations To prevent disease, and protect and promote health Working with the determinants of health Source: Tottenham Bluegrass Festival 2014 http://www.simcoe.com/photogallery/4596178 In the Sanitary Report of 1842, Chadwick augmented his forceful advocacy with data, which he used well by the standards of policy debate of his times

The Potential for 7 more years of life Social determinants of health accounts for 60% of variation in health status Tobacco –16% of all deaths Diet/Inactivity – 14% of all deaths, 1/3 of all cancers avoidable with optimal diet Alcohol – 5% of all deaths Infections – 5% of all deaths Injuries – the leading cause of death for people aged 1 to 44 years; $14.7 billion annually in direct and indirect costs Others – Sexual behaviour, illicit drugs Source: SEVEN MORE YEARS: The impact of smoking, alcohol, diet, physical activity and stress on health and life expectancy in Ontario. Institute for Clinical Evaluative Sciences, Public Health Ontario

Health Care Costs prevented

Our Board of Health Scott Warnock County of Simcoe Chair Barry Ward,                                          Thomas Ambeau, Provincial Appointee Sandy Cairns, District of Muskoka Ralph Cipolla, City of Orillia Lynn Dollin, County of Simcoe Anita Dubeau, County of Simcoe Fred Hamelink, Provincial Appointee Stephen Kinsella, Provincial Appointee Betty Jo McCabe, Provincial Appointee Barry Ward, City of Barrie Vice Chair  Sergio Morales, City of Barrie Gail Mullen, Provincial Appointee Margaretta Papp-Belayneh, Provincial Appointee Terry Pilger, District of Muskoka Ben Rattelade, Provincial Appointee Brian Saunderson, County of Simcoe Peter Willmott, Provincial Appointee

Changing Public Health Standards

Determines where our organization is heading over the next few years and how we’re going to get there. Shapes and guides what the organization is, what it does, and why it does it. Requires the efforts of the whole health unit to accomplish the plan Management play a critical role in positioning, interpreting and championing the strategic plan with staff Purpose of the presentation is to provide managers with the information they need to play this critical role and with tools to engage staff in discussion of the new plan and what it means for them. With each component of the plan, ask yourself: How do the statements relate to our program/service mandate and the work of my team? What more do I need to help me engage my staff in living the mission, functioning in a manner that is consistent with the organizational values and moving the strategic directions forward? How would I measure success in relation to the strategic goals?

Climate Change- Human Health Impacts Flooding, wind damage and severe winter storm damage due to extreme weather events More extremely hot days Food safety & security Reduced air quality Increased risk of warm-climate diseases such as Lyme and West Nile diseases and malaria

Walkable destination in Ontario Transportation Behaviors and Health Outcomes by Residential Density and Availability of Walkable Destinations. Figure 2 Transportation Behaviors and Health Outcomes by Residential Density and Availability of Walkable Destinations. These figures depict the interaction between density and destinations in relation to transportation behaviours and related health outcomes. The average daily number of trips per person by walking or bicycling, public transit, and automobile were derived from the Transportation Tomorrow Survey (2006) for residents age 11 years and older. Proportion of the population aged 30 to 64 years that were overweight and obese was derived from 2003–2008 Canadian Community Health Survey data. Age-sex adjusted prevalence of diabetes mellitus among adults aged 30 to 64 years was derived from the Ontario Diabetes Database, 2009. Residential density was calculated using data from the 2006 Canada Census and availability of walkable destinations was calculated using data from DMTI Spatial Inc. (2009), the City of Toronto (2009), and the Ministry of Education (2009). Density, Destinations or Both? A Comparison of Measures of Walkability in Relation to Transportation Behaviors, Obesity and Diabetes in Toronto, Canada Richard H. Glazier mail, * E-mail: rick.glazier@ices.on.ca Affiliations: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada X Maria I. Creatore, Affiliations: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Jonathan T. Weyman, Affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Ghazal Fazli, Affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Flora I. Matheson, Affiliations: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Peter Gozdyra, Affiliations: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Rahim Moineddin, Affiliations: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada Vered Kaufman Shriqui, Affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Gillian L. Booth Affiliations: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Department of Medicine, University of Toronto, Toronto, Ontario, Canada Published: January 14, 2014 DOI: 10.1371/journal.pone.0085295 Characteristics of the study area by walkability quintiles are shown in Table 1. There were few clear socio-demographic differences across quintiles apart from a higher proportion of children and seniors living in the least walkable areas, and a higher average household income, yet lower education, in the least walkable areas. The variation in walkability components between the highest and lowest walkability areas was approximately four-fold for population density (ratio of Q1:Q5 = 0.24), five-fold for residential density (Q1:Q5 = 0.18), three-fold for street connectivity (Q1:Q5 ratio 0.35) and twenty five-fold for destinations (Q1:Q5 = 0.04). As compared with individuals in the most walkable areas, those living in areas with the lowest walkability owned almost twice as many vehicles (Q1:Q5 ratio = 1.80, 95% CI: 1.25–2.34), were almost twice as likely to travel by automobile (Q1:Q5 ratio = 1.75, 95% CI: 1.20–2.30), were almost half as likely to use public transportation (Q1:Q5 ratio 0.58, 95% CI: 0.30–0.87) and roughly one-third as likely to walk or bicycle (Q1:Q5 ratio = 0.32, 95% CI: 0.0–0.71) (Table 2). These results were consistent and significant for population density, residential density and availability of destinations, and were in the same direction but less strong for street connectivity. Booth GL, Glazier RH, Creatore MI, Weyman JT, Fazli G, Matheson FI, et al. (2014) Density, Destinations or Both? A Comparison of Measures of Walkability in Relation to Transportation Behaviors, Obesity and Diabetes in Toronto, Canada. PLoS ONE 9(1): e85295 doi:10.1371/journal.pone.0085295

Health inequity in south simcoe In comparison to slide 18, the data in the south Simcoe sub-region is too small to allow us to calculate the DRR for other health conditions.

VULNERABLE POPULATIONS IN SOUTH SIMCOE The Ontario Marginalization Index (ON-Marg) uses census data from 2006 to illustrate levels of marginalization across the province. ON-Marg focuses on four dimensions that contribute to the process of marginalization: residential instability, material deprivation, dependency and ethnic concentration. ON-Marg makes this information available for various geographic units (like census tracts and dissemination areas), allowing you to examine levels of marginalization in specific areas.  Marginalization is the process by which individuals and groups are prevented from fully participating in society. Marginalized populations can experience barriers to accessing meaningful employment, adequate housing, education, recreation, clean water, health services and other social determinants of health. Both community and individual health are deeply impacted by marginalization. The following census variables are included in the calculation of the material deprivation index: Proportion of the population aged 25+ without a certificate, diploma or degree Proportion of families who are lone parent families Proportion of the population receiving government transfer payments Proportion of the population aged 15+ who are unemployed Proportion of the population considered low income Proportion of households living in dwellings that are in need of major repair Dissemination area - Small area composed of one or more neighbouring dissemination blocks, with a population of 400 to 700 persons. All of Canada is divided into dissemination areas.

Engaging with the community

…On social determinants of health Food Access Income Food Security Housing Alcohol Water Fluoridation Air Quality Transportation Poverty

Provincial Grant Freeze Grant freeze impacts in 2015 – 2016 (continuing): The loss of over 11 FTEs in staffing positions, including three management positions, The reorganization of the agency with a reduction of one department, The closure of the sexual health clinic in Alliston, Slimmed agency strategic plan, $90,000 in operational savings.

Provincial Accountability Agreements 2015 2014

Final Thoughts The Central LHIN and SMDHU share the same goal – improving health. People’s health has always been about their living conditions. Public health works to improve health through addressing the determinants of health. There are challenges and opportunities to population health in South Simcoe. The SMDHU Board of Health is committed to working with our communities for better health. Scott Warnock picture: Mary and Scott following the Cycle Camelot event in support of the Georgian Bay Cancer Support Centre this summer.