1. Census Geography Uses by the Ministry of Health and Long-Term Care Health System Information Management and Investment Division & Public Health Division, Ministry of Health and Long-Term Care

2. Outline Geographic hierarchy of the Census Examples of Census geography in action

3. Hierarchy of Standard Geographic Units, Census 2006

4. Source: “Boundaries Files, Reference Guide – Census 2006, 3 rd Edition”, catalogue no. 92-160-GIE, Statistics Canada.

5. Source: “The Geographic Structure, 2006 Census”, presented by Kevin Taylor on April 18, 2008.

6. How the Ministry of Health and Long-Term Care (MOHLTC) Uses Statistics Canada (StatCan) Geographic Products

7. Geographic Products from Statistics Canada Census data Public access Ministry access Geographic boundary files for administrative units for statistics units for Ministry of Health and Long Term Care’s health regions Others, e.g. road network file Correspondence files 2001 Census to 2006 Census Statistics Canada geography to Ontario Ministry of Health and Long Term Care’s health regions Postal Code Conversion files (PCCF) PCCF PCCF+

8. How MOHLTC uses StatCan Geographic Products Census data Available by MOHLTC health regions as well as by census geographies Examples of use: Demographic analysis / needs assessment Denominators for prevalence calculations Geographic boundary files Available for various census geographies Uses include mapping and spatial analysis Correspondence files Drill down from a higher to a lower geographic level Create crosswalks between StatCan and MOHLTC geographies Postal Code Conversion files Assigning postal code based data to different geographies as needed Create crosswalks between postal code and StatCan or MOHLTC geographies

9. How MOHLTC Uses StatCan Geographic Products - Examples

10. Mapping Demographic Characteristics by StatCan and MOHLTC Geographies

11. Assess and Re-Develop MOHLTC Geographic Boundaries

12. Defining Health Region Boundaries Using StatCan Geographies

13. Examples of Census Geography in Policy and Planning

14. Health Authorities and Geography Ontario has 2 types of regional structures for delivering health- services Local Health Integration Networks (LHINs) Public Health Units (PHUs) LHINs organize the delivery of health services, while health units directly provide public health protection and prevention as well as health promotion services There are 14 LHINs and 36 PHUs These boundaries do not necessarily correspond to the Census geography

15. LHINs and public health units at a glance* * Details in Appendix 1

16. Census geography and public health planning Under the Ontario Public Health Standards, public health units are required to analyses Census data by person, place and time CSDs are used to put these analyses together at the PHU level Most CSDs do not cross phu boundaries-1 exception in the current Census 2006 (more common in earlier Census cycles) Also under the Ontario Public Health Standards are the principles of Partnership and Collaboration-phu should work together with their partner agencies, including LHINs

17. Census geography and public health funding Funding to public health units is based on a 75:25 % cost-sharing with municipalities Funding formulas in 2008 also accounted for up to 5% additional funding based on 3% universal funding to all 36 phu and up-to an additional 2% funding based on Census indicators Population growth: funding was provided based on phu share of the province’s increase in population size between 2001 and 2007, based on population estimates from Statistics Canada that corresponded to the phu geography. Low-income population: funding was provided to phu based on their share of the province’s total population with family/individual income at or below the low income cut-offs in the 2006 census. Low-income population refers to families/individuals that spend 55% or more of their income on food, shelter and clothing. Provincial health services are under the provision of provinces, with the exceptions of First Nations which falls under the services provided by the Federal government Funding considerations: Unorganized territories First Nations (Akwesasne example) * *Appendix 2

18. Akwesasne Ontario’s Aboriginal census data provides useful information at the census sub-division level including details on: Reserves and Indian settlements; Aboriginal population estimates; First Nation population estimates; Populations living on/off reserve; and Reserves that are incompletely enumerated Information can be further adjusted to reflect Public Health Unit boundaries in order to inform future public health planning efforts. The ability to access to this level of data is important when dealing with Aboriginal communities that cross multiple jurisdictions and may signal the need for multi-jurisdictional discussions within public health planning for that community (i.e. Akwesasne).

20. The Role GIS in the Surveillance Section, Public Health Protection and Prevention Branch Among our many goals and objectives we: Conduct geospatial analysis and visualization of disease data (using ESRI ArcGIS with extensions of Spatial Analyst, Tracking Analyst, and Geostatistical Analyst) - Licenses are issued through the Ministry of Natural Resources (MNR) Concurrent Use Network License Data/Data Sources Tabular data sources: - For all reportable disease information – integrated Public Health Information System (iPHIS) - Provincial Health Planning Database (PHPDB) - Telehealth for syndromic surveillance  link to spatial datasets Spatial data sources: - MNR through the Ontario Geospatial Data Exchange (OGDE), Public Health Agency of Canada (PHAC) GIS Infrastructure, Statistics Canada  For Ontario surveillance mapping we mostly use Public Health Unit boundaries, Local Health Integration Network boundaries, and Postal Codes

21. The Role GIS in the Surveillance Section, Public Health Protection and Prevention Branch Three main categories: mapping, spatial data requests, analysis - Mapping is always part of the whole – never stand-alone - Outputs are given to epidemiologists who include them in their analysis and reports - Requests come from epidemiologists and disease program areas within PHPPB, outside PHPPB, etc. General mapping Weekly mapping Seasonal mapping Outbreaks  Case trends/investigation/analysis support Year end summary reports Ad-hoc requests Analysis EXAMPLES…

22. General Map Requests Influenza - Weekly Influenza - Annual

23. Telehealth – Syndromic Surveillance Outbreak Mapping

24. Vector-Borne Diseases – LD Vector-Borne Diseases – WNV

25. Future Most project work has been focused on the visualization component of GIS Some projects involved in analysis, will get deeper into the analysis Lots of work to be done

26. Contact Information Elsa Ho Senior Health Analyst Health Analytics Branch Health System Information Management and Investment Division Ministry of Health and Long-Term Care 1075 Bay Street, 13th Floor Toronto, ON, M5S 2B1 Tel: (416) 326 – 6542 Fax: (416) 325 – 4083 Email: elsa.ho@ontario.ca Jeff Liu, PhD Geospatial Analyst Surveillance Section Public Health Protection and Prevention Branch Public Health Division Ministry of Health and Long-Term Care 5700 Yonge Street, 8th Floor Toronto, ON, M2M 4K5 Tel: (416) 326 – 1520 Fax: (416) 325 – 4083 Email: jeff.liu@ontario.ca Joanne Thanos Senior Epidemiologist Public Health Practice Branch Public Health Division Ministry of Health and Long-Term Care 1075 Bay Street, 8th Floor Toronto, ON, M5S 2B1 Tel: (416) 212 – 5219 Fax: (416) 314 – 2117 Email: joanne.thanos@ontario.ca

27. Appendix 1 Maps of Public Health Units and LHINs

32. Appendix 2 Incompletely enumerated First Nations in Census 2006 Incompletely enumerated Indian reserves and Indian settlements, 2001 and 1996 population counts

33. Province Incompletely enumerated Indian reserves and Indian settlements, 2006Population, 2001Population, 1996 ¶ incompletely enumerated Indian reserve or Indian settlement Sources: Statistics Canada, censuses of population, 1996, 2001 and 2006. QuebecGesgapegiag (formerly Gesgapegiag 2) 488442 Doncaster (formerly Doncaster 17) ¶0 Kanesatake ¶¶ Kahnawake (formerly Kahnawake 14) ¶¶ Akwesasne (formerly Akwesasne (Partie)) ¶¶ Lac-Rapide ¶228 Wendake 1,555¶ OntarioFort Severn 89 401362 Attawapiskat 91A 1,2931,258 Factory Island 1 1,4301,286 Bear Island 1 ¶153 Tyendinaga Mohawk Territory ¶¶ Wahta Mohawk Territory ¶¶ Six Nations (Part) 40 ¶¶ ¶¶ Oneida 41 ¶¶ Akwesasne (Part) 59 ¶¶ SaskatchewanBig Island Lake Cree Territory (formerly Big Head 124) ¶¶ AlbertaLittle Buffalo ¶¶ Saddle Lake 125 ¶¶ Tsuu T'ina Nation 145 (Sarcee 145) 1,9821,509 British ColumbiaEsquimalt ¶¶