Genuine Progress Index for Atlantic Canada Indice de progrès véritable - Atlantique Measuring Community Wellbeing & Development JAG, Sydney, 6 June, 2003

Community GPI based on simple questions: How healthy is our community? What kind of community are we leaving our children?

Uncertain Answers: More possessions, growth, but…. Stress, obesity, asthma, environmental illness Insecurity, inequality, unemployment, child poverty Decline of volunteerism Natural resource depletion, species loss Less fish, condition of forests, soils Global warming

E.g.: Cape Breton in CCHS – causes for concern High unemployment and low-income rates Much higher incidence of chronic illness, disability, and premature death than Halifax Highest age-standardized mortality rate in Maritimes Highest death rate from circulatory disease, heart disease in Maritimes – 30% above nat.av.

Of 21 Atlantic health districts, Cape Breton has highest rates of: Cancer death (231.8 per 100,000) – 25% higher than the national average, lung cancer Deaths due to bronchitis, emphysema, and asthma (9.2 per 100,000) –50%+ higher than the national average High blood pressure– 21.7%, (24.3% women 19% men = 72% higher than the Canadian rate.

Cape Breton = highest: Arthritis and rheumatism: 31% of women, 23% of men Activity limitation (34%) Life expectancy: 72.8 years for men, and 79.4 for women. (Canada: 75.4 years - men and 81.2 years -women

Disability-free life expectancy Cape Bretoners have an average disability-free life expectancy of only 61.8 years, seven fewer than the national average, and the lowest of all the 139 health regions in Canada. This means that Cape Bretoners can expect to live considerably more years with a disability than other Canadians.

Potential years of life lost highest number of potential years of life lost due to both cancer and circulatory diseases Cape Bretoners lose 2,261.9 potential years of life per 100,000 population due to cancer – 41% higher than the national average of 1,603.7 and they lose 1,684 potential years of life per 100,000 population due to circulatory diseases – 65% higher than the national average of 1,020.7

Cape Breton = lowest mammogram screening, highest breast cancer rate

Conventional measures of social progress & wellbeing send the wrong message:  Sickness, crime, pollution, resource depletion, long work hours (stress) make economy grow – which in turn means we are “better off”??  GDP can grow as poverty, inequality increase. GDP ignores work that contributes directly to community health (volunteers, work in home)  We need better indicators of health & wellbeing: GPI values health and its determinants – equity, livelihood security, education, environment, unpaid work, etc.

Community GPI Initiative came from community groups. Many community partnerships include: Cape Breton Wellness Centre, community health boards, regional public health authorities, Atlantic Centre of Excellence for Women’s Health, NS Citizens for Community Development Society CB regional police, Glace Bay Citizens Service League, Rotary Clubs, Kings and Cape Breton Community Economic Development Agencies

Community-Government- University Partnerships: Federal: Canadian Population Health Initiative, National Crime Prevention Centre, HRDC, Health Canada (PPHB Atlantic), Canadian Rural Partnership, Rural Secretariat, Statistics Canada University College of Cape Breton, Acadia U. Dalhousie Univ. Population Health Research Unit; St. Mary’s University Time Use Research Program

Tool for community health and wellbeing - Goals: Community: vision, mobilize, learn, act, assess: Vision - community indicator selection Mobilize communities - common goals “Learning about ourselves” – relationships among variables = unique database Turn new-found knowledge into action Track progress

Process as Result Indicator selection, creating survey Results and report releases bring together stakeholders and disparate groups Scan existing programs, identify gaps New ideas: e.g. restorative justice, family-friendly work arrangements

The Means: 3,600 surveys - random, 15+, confidential CI 95% +/- 3%; 2 cross-tabulations Detailed: 2 hrs; Glace Bay: 82% response Survey includes health, care-giving, time use, voluntary work, security, income employment, environmental issues Data entry & cleaning, access guidelines

Balance community-based research with methodological rigour Statistics Canada oversight, advice, review Frame questions to compare results with provincial & national averages Improve methods, indicators, survey tools, data sources - never a final product Model for other communities (e.g. Sydney, Whitney Pier) - template for adaptation

What’s in the Glace Bay and Kings County GPI Surveys? 1) Demographics & Employment Age, sex, household, marital, education, income Employment, unemployment, out of work Job characteristics - types of jobs (p-t, f-t, etc), benefits, work from home, occupation Work schedule, hours, shifts, job security, underemployment, job sharing - work reduction

2) Health and Community Core values, caregiving, volunteer work, community service Stress, mental health, social supports, children’s health Weight, smoking, physical activity, screening (Pap, mammogram, blood pressure) Pain, disability, disease, medications, health care use

3) Peace and Security Victimization and costs of crime Neighbourhood safety, fear, self- protection Opinions about police, courts, prisons Identify community problems - drinking? bullying? domestic violence? drugs? Etc.

4) Time Use Diary Work: Household work, paid work, voluntary work, caregiving, education How we spend free time - TV, reading, socializing, spiritual practice, sport, exercise Travel, personal activities, child care Window on quality of life

5) Environment Energy use Transportation patterns Water quality Recycling and waste Food consumption - food diary and nutrition

Community Action Community access to results - special software packages, news stories, etc. Meet to discuss results and identify policy priorities / actions Community prioritizes indicators for annual benchmarks of progress Community training - adaptations

Emphasis on practical action - E.g: Teenage smoking; overweight; exercise - e.g. promote school-based programs Screening rates - mammography, pap smears - - notify health officials of needs Identify counselling needs - employment, domestic violence, mental health Education - nutrition, recycling, energy use Glace Bay police inspector – vandalism focus

Present Smoking Habits (Non-smokers include both those who quit smoking and those who never smoked)

Current smokers by employment status

Daily Cigarette Consumption and Employment Status