1. Health Statistics Information on STC website
Calgary–DLI training–Dec 2003
The following presentation will briefly describe the Health Indicators project, the health region geography, as well as present the features of our health indicators’ electronic publication (e-pub), our latest issue released this past December.
I’ll wrap up with some of our future challenges on the project, and hopefully leave enough time for any questions.
Health Indicators is a joint project with the Canadian Institute for Health Information (CIHI) and falls under the larger scope of the Health Information Roadmap initiative.
Michel B. Séguin, Statistics Canada,

2. Health information on the Internet
When talking about Health information over the pass 3 to 4 years
TIME

3. Health information on the Internet
Accessibility
We have better accessibility by loading the information on the Internet site and CANSIM
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4. Health information on the Internet
Availability
Accessibility
About 4 years ago, we had some publications, that were changed to Shelf Tables not catalogue to catalogue shelf tables and now, we have about 75% of our information on Internet site available in CANSIM through Internet publications. This is a big achievement and in about a year or so, we should have all our publications on the CANSIM which will complete our plan of making the health information available free on Internet.
But the Statistics Canada’s site not being a health site, and with some products that we have created, in some cases we have created some confusion
TIME

5. Health information on the Internet
Confusion H E A L T I N F O
Availability
Accessibility
Hopefully, this workshop will help reduce the confusion and help you understand where the information can be found and sort out some of the confusion between some of the products or what we make available and CIHI make available.
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6. Presentation outline Population Health Surveys Health Indicators
National Population Health Survey (NPHS)
Canadian Community Health Survey (CCHS)
Canadian Health Examination Survey (CHES)
Health Indicators
Health indicators
Comparable Health Indicators
Cancer
Vital Statistics
Residential Care Facilities
Analysis
Health Reports
Annual Reports
Canadian Institute for Health Information
This is what we will talk about today.
CHES is a new survey we are starting to plan. Even the name may change because the French translation is awful. I just wanted to mention this survey as being worked on at this point and you will hear about it in the near future.
I will have some comments on what information CIHI makes available as I go through the presentation because some products are jointly produced by CIHI and STC and will add a bit more at the end.

7. Population Health Surveys
Understand the determinants of healths
Collect data on the economic, social, demographic,
Occupational and environmental correlates of health
Aid in the development of public policy;
This is what we will talk about today.
I will have some comments on what information CIHI makes available as I go through the presentation because some products are jointly produced by CIHI and STC and will add a bit more at the end.

8. Population Health Surveys
Since 2000
NPHS:
PUMF for Households and Institutions
National Population Health Survey Overview
PUMF for Households and Institutions as well as user’s guide
PUMF for Households
User’s guide for PUMF
Since 2000, NPHS is only longitudinal
Products:
PUMFs
Tables in Health Indicators products
Analysis through the Health Reports and Annual Reports that we will talk about later on.
CCHS is Cross-sectional and includes North
Products for CCHS:
Health Indicators product
Comparable Health Indicators
Other products that we will see later
Analysis through Health Reports and Annual Reports that we will talk about later on. 

9. Canadian Community Health Survey
Created to collect data at the Health Region Level
Cross-sectional survey

10. Canadian Community Health Survey (CCHS)
Year 1
100,000+ respondents
stratified by Health Region
Questionnaire content
common content
optional content
sub-sample content
Estimates for Health Regions, Provinces, Terrritories and Canada
Year 2
30,000 respondents
Stratified by province
Questionnaire content
focus content
general content
60+ minutes
Estimates for Provinces and Canada (excluding territories)

11. Canadian Community Health Survey
Cycle 1.1: Large sample
Cycle 1.2: Mental Health
Cycle 2.1: Large sample
Cycle 2.2: Nutrition
Cycle 3.1: Large sample
Cycle 3.2: Aging population (TBD)
Let’s look at how the data is made available
1st: Public Use Microdata

12. Health Indicators Product Background
May consensus conference
Spring 2000 – published in STC/CIHI annual reports
December first e-pub release
Total of 7 releases – last in Nov. 2003
Next release is June 2004
ongoing consultations and data releases
project launched at a national consensus conference held in May Attendees included representatives from federal health organizations, provincial health ministries, local authorities and other people from the medical community.
outcome of this conference was a core set of indicators and a framework, in which these indicators are organized. (next slide)
One of the criteria for indicator selection, was the possibility of data at the health region level. We had to develop the methods and geographic infrastructure to code our data sources to health regions.
This development work was done in our pilot phase - during the first year of the project.
As health region level data have been produced, we have involved our contacts in the provincial and territorial ministries of health as well as regional authorities across Canada in the final data verification prior to each release. This has really helped to make visible our efforts and more importantly the input received has helped refine methods and ensure data validity and comparability.
The project is also committed to ongoing formal consultations to remain relevant to user needs.
Another consensus conference is planned for this fall.

13. What are Health Indicators?
measures of health status, the health system, and factors which influence health
based on comparable definitions and methods
broadly available – disseminated electronically at the national, provincial and regional level
Health indicators are general measures of the state of health of a population (health status), measures of health system performance and factors which influence health (determinants)
- used to report on (or monitor) the health of a population and evaluate (or assess) the performance of the health system.
The Roadmap Health Indicators are:
- based on standard and comparable definitions and methods
- broadly available in electronic format at the health region, provincial and national level.

14. Health Indicators framework
This is the framework that was established at the concensus conference. It is sometimes referred to as the Roadmap framework and is becoming a standard template for organising health indicators.
To give you an idea of indicators which fall under each heading:
Health Status - body mass index BMI, and life expectancy
Determinants of Health include health behaviours eg. physical activity as well as living conditions such as income and unemployment rate
Health System indicators include measures of efficiency such as expected compared to actual stay and hip fracture hospitalizations
Community and Health System Characteristics - Immigrant population, hip/knee replacement and health expenditures
Although the framework has not changed since the project began, the actual list of indicators has evolved over the past two years. There are currently ____ indicators. (see handout)

15. Health Indicators - integrating many data sources
Canadian Institute for Health Information:
provincial health ministries,
Health Canada
hospital morbidity database
discharge abstract database,
other
Statistics Canada:
vital statistics and cancer registry (admin. data)
health surveys: NPHS, CCHS, other
Census
labour force survey
crime statistics
other
This is a project which brings together several sources.
Administrative data
Surveys (both cross-sectional and longitudinal)
Derived data from multiple sources - e.g., disability-free life expectancy
(uses Census data, population estimates and mortality d
various techniques were developed to link these data to health regions.

16. Health Indicators - sub-provincial focus
Priority on health region level data
defined provincially
administrative areas
inconsistent in size and composition
population size, land area and characteristics very different
peer groups defined
boundaries change – major challenge
The key focus of the Health Indicators project is to provide data at the Health Region level.
Benefits:
useful information at geographic level relevant to decision-makers, planners
reveals disparities (potentially hidden at the province level)
positive : encourage investigation into successful programs and practices
negative : may target action in problem areas where health or health care utilization is affected
Challenges:
problem of small numbers and high variability from year to year
different geo-coding methods for different sources
quality of data source - e.g., inconsistent hospital coding
interpretation issues - e.g., c-section rate - regional comparisons may not be useful
changing boundaries / time series
comparability across data sources

17. Here is a map of health regions in Canada
There are 139 health regions in Canada - counting the territories and including the 37 PHUs of Ontario.
Coding system developed in HSD which recognizes (where possible) the standard codes used by the provinces

18. Some maps of health regions from a selection of provinces - these are general reference maps to show the boundaries and names and location of CA and CMAs (red dots)

20. Peer groups need to compare health region data with ‘like’ regions
grouping of HRs with similar socio-economic characteristics
concept based on 24 variables
working paper available
new peer groups based on 2001 Census available in November 2003
Heatlh regions are not all the same - as I have said. In order to compare health regions to other similar health regions, a classification has been developed to group regions into peer groups.
We have defined a peer group simply as ‘ a grouping of health regions that have similar social and economic characteristics’.

22. Health Indicators E-pub releases to date
free electronic publication
catalogue no XIE/F
available on STC & CIHI web-sites
integrated and dynamic product
accumulating content
‘seamless’ links between sites
next release : June 2004
December 2001: Fully integrated Health Indicators electronic product update, with ‘seamless’ links between STC and CIHI websites
We also have already introduced health regions into the Community Profiles at Statistics Canada, where the public can access basic census data at the health region level.

25. Comparable Health Indicators
Following the First Ministers’ Meeting in 2000
Agreed that all Provinces and Territories would report on Health in September 2002
Identified 14 areas of comparable health status and health system performance indicators

26. Health status Health outcomes Quality of service Life expectancy
Infant mortality
Low birth rate
Self-reported health
Health outcomes
Change in life expectancy
Improved quality of life
Reduced burden of disease, illness and injury
Quality of service
Waiting times for key diagnostic and treatment services
Patient satisfaction
Hospital re-admission for selected conditions
Access to 24/7 first contact health services
Home and community care services
Public health surveillance and protection
Health promotion and disease prevention

35. Residential Care Facilities
No data released since 1999
Requests dealt through custom tabulations
Next release on the Internet and CANSIM planned for early summer 2004
Will provide historical data
Work being done with Census in defining Residential Care Facilities

36. Analysis Health Reports Annual Reports (STC) CIHI Annual Reports
Still available as a quarterly report
Uses many sources as input to research
Still have to subscribe but available through Depositary Services Program
Annual Reports (STC)
Supplement to the Annual Reports
Free on the Internet site
Made available by article and the full publication is released after
Different theme each year
CIHI Annual Reports

37. Other products and services
Custom Products
Remote Access
Research Data Centres
Health information on the Community profiles
Health Information on Canadian Statistics
Vital Statistics Shelf Tables will be transferred to CANSIM and Electronic Publications over the next year

38. HOW TO ACCESS HEALT INFO ON STC SITE
Go to
On the first page, click on “Our products and services”
Under “Browse our Internet Publications”, click on FREE
Click on “Health” or “Population and Demography” for Vital Statistics information

39. Health information on CIHI Site
URL for CIHI Internet Site