Ottawa Wellbeing Report – Healthy Populations This is part of a series of reports that provide a snapshot of education in Ottawa. Following the Canadian Index of Wellbeing framework, each report presents data from the eight domains of wellbeing. These domains are: Community Vitality, Democratic Engagement, Education, Environment, Healthy Populations, Leisure and Culture, Living Standards, and Time Use. Due to data availability, data are presented on only five of the eight domains and on selected indicators within each domain. In this report, the data are presented for the Ontario part of the Ottawa-Gatineau census metropolitan area (CMA), unless otherwise specified. Where possible, data for Ottawa are compared to those for Ontario and/or Canada. Key Messages •
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More Ottawa residents rate their health as being excellent or very good compared to Ontario and Canada. Within Ottawa, the lowest proportion reporting excellent or very good health is found in residents aged 65 years and over. Life expectancies at birth and at age 65 in Ottawa are similar to the estimates observed for Ontario and Canada. Health-adjusted life expectancy is a composite measure that represents both quantity and quality of life. In Ottawa, females at the age 65 spend a greater portion of their life in an unhealthy state compared to their male counterparts. In Ottawa, diabetes shows age and gender disparities. Diabetes is more prevalent in seniors aged 65 years and over. In addition, higher mortality rates and hospital utilization rates are observed among males. A higher proportion of Ottawa residents are affected by mood disorders, including depression, compared to the general Canadian population. Despite awareness among Ottawa youth about the harm caused by smoking, this behavioural risk factor continues to be a public health concern for this population. Immunization rates are one way to measure the ability of a public health system in preventing illness and death. A higher influenza immunization rate among seniors aged 65 and over is observed in Ottawa compared to Ontario and Canada.
The World Health Organization defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (World Health Organization, 2003). Consistent with this definition, the Canadian Index of Wellbeing describes health status along the dimensions of life expectancy, personal well-being, functional health, physical health, and mental health (Labonte et al., 2010). In addition, proximal factors that influence health such as lifestyle choices, health care services, and public health are also included in this domain. This report presents selected indicators from the Healthy Populations domain of the Canadian Index of Wellbeing for Ottawa (refer to Table A1 of the Appendix for a list of indicators).
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What is the current data telling us? Self-rated health Self-rated health or self-perceived health is a measure of an individual’s perception of their global wellbeing. It has been found consistently in many studies to be a predictor of an individual’s health status (Idler & Benyamini, 1997). It is, thus, commonly used in health surveys as a complement to other health status indicators (Employment and Social Development Canada, 2014a). In addition to being a measure of general health, self-rated health also reflects aspects of health that are not captured in other measures, such as early stage disease, disease severity, aspects of positive health status, physiological and psychological reserves, and social and mental function (Statistics Canada, 2007). Results of the Canadian Community Health Survey showed that in 2011/12, 63.3% of the Ottawa population aged 12 and over perceived their health as being excellent or very good (Statistics Canada, 2013). The 2009/10 estimate was similar at 63.6% (see Figure 1). The Ottawa rate in 2011/12 was higher than the rates observed in Ontario and Canada (60.4% and 59.9%, respectively). Across the different age groups, the highest proportion reporting excellent or very good health in Ottawa was among teens aged 12 to 19 years (70.1%) while the lowest proportion was found among those aged 65 years and over (48.6%) (Statistics Canada, 2013). Figure 1. Self-rated health1 among population aged 12 years and over, Ottawa, Ontario, and Canada, 2009/10–2011/12.
Percent of population (%)
66 64 62 60 58 56 54 52 50
Ottawa
Ontario
Canada
2009/2010
63.6
61.0
60.3
2011/2012
63.3
60.4
59.9
1
Based on Canadian Community Health Survey data, population aged 12 and over who reported perceiving their own health status as being either excellent or very good. Perceived health refers to the perception of a person's health in general, either by the person himself or herself, or, in the case of proxy response, by the person responding.
2
Source: Statistics Canada. (2013). Table 105-0592 - Health indicator profile, two-year period estimates, by age group and sex, Canada, provinces, territories, census metropolitan areas and influence zones, occasional (number unless otherwise noted), CANSIM (database). Retrieved from http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1050592
Life expectancy Life expectancy is the expected average number of years of life remaining at a given age and is reflective of the mortality conditions of the observation period (Ottawa Public Health, 2012). Life expectancy at birth is used worldwide as an indicator of a population’s state of health (Employment and Social Development Canada, 2014b). In 2007, life expectancy at birth for was 83.6 years for females and 79.6 years for males in the City of Ottawa (Ottawa Public Health, 2012). For both sexes, life expectancy increased since 2002, where the estimates were 82.3 years for females and 78.6 years for males. Life expectancy at birth estimates for Ottawa are similar to those observed for Ontario (83.4 for females and 79.0 for males) and Canada (83.1 for females and 78.5 for males) for the period 2006-2008 (Statistics Canada, 2012). In Ottawa, life expectancy at age 65 was 21.5 years for females and 18.6 years for males in 2007 (Ottawa Public Health, 2012). These are also similar to life expectancies at age 65 observed provincially and nationally. For the period 2006-2008, life expectancy at age 65 for Ontario was 21.6 years for females and 18.5 for males (Statistics Canada, 2012). For Canada, the estimates were 21.5 years for females and 18.3 for males for the same period (Statistics Canada, 2012).
Health Adjusted Life Expectancy (HALE) Health-adjusted life expectancy (HALE) is the expected average number of years expected to be lived in full health, based on the current health status of the population (Ottawa Public Health, 2012). The health status of the population is measured using the Health Utilities Index, a health indicator based on sensory, mobility, emotion, cognition, dexterity and pain attributes (Ottawa Public Health, 2012). HALE is a composite measure that includes both mortality and morbidity experience to give an indication of the quantity as well as quality of life (Labonte et al., 2012; Ottawa Public Health, 2012). In 2007, females living in Ottawa were expected to live another 16.3 years in good health and males were expected to live another 14.7 years in good health, as measured by HALE (Ottawa, Public Health, 2012). The difference between life expectancy and HALE can be viewed as an indication of the burden of ill health in a population (Ottawa Public Health, 2012). At age 65, this difference is 5.2 years for females and 3.9 years for males. Females at the age of 65 spent a greater portion of their remaining years in ill health (24.2% or 5.2/21.5) than males at the same age (21.0% or 3.9/18.6).
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Diabetes prevalence Diabetes has been identified as a growing public health concern in Canada, not only due to its health impact but also because of its close link to other health problems, including obesity, heart disease, blindness, and kidney failure (Labonte et al., 2012). More importantly, type 2 diabetes is largely preventable through lifestyle factors, such as improved nutrition, exercise, and a healthy weight (Labonte et al., 2012). In Ottawa, diabetes has been among the leading causes of death since 2003 (Ottawa Public Health, 2012). In 2007, it was the 9th leading cause of death, accounting for 2.4% of all deaths in the city (Ottawa Public Health, 2012). In 2011/2012, 5.4% of Ottawa residents aged 12 years and over reported that they have been diagnosed with diabetes (see Figure 2). Diabetes prevalence in Ottawa was similar to the prevalence observed in Ontario (6.6%) and Canada (6.3%) (Statistics Canada, 2013). In Ottawa, diabetes was most commonly reported among seniors aged 65 and over (17.5%) (Statistics Canada, 2013). The city’s administrative data showed that deaths from diabetes as well as hospitalization rates due to diabetes were higher among Ottawa males than females (Ottawa Public Health, 2012). Figure 2. Diabetes prevalence1 among population aged 12 years and over, Ottawa, Ontario, and Canada, 2009/10–2011/12.
Percent of population (%)
8 7 6 5 4 3 2 1 0
Ottawa
Ontario
Canada
2009/2010
5.9
6.8
6.2
2011/2012
5.4
6.6
6.3
1
Based on Canadian Community Health Survey data, population aged 12 and over who reported that they have been diagnosed by a health professional as having Type 1 or Type 2 diabetes. Diabetes includes females 15 and over who reported that they have been diagnosed with gestational diabetes. Source: Statistics Canada. (2013). Table 105-0592 - Health indicator profile, two-year period estimates, by age group and sex, Canada, provinces, territories, census metropolitan areas and influence zones, occasional (number unless otherwise noted), CANSIM (database). Retrieved from http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1050592
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Prevalence of mood disorders Depression and other mental illnesses account for significant disease burden and is increasingly threatening the lives of children in Canada (Labonte, 2012; CMHA, 2014). According to the Canadian Mental Health Association (2014), one in five Canadians will personally experience a mental illness in their lifetime. Depression can affect every aspect of life, including emotions, physical health, relationships, and work (CMHA, 2014). Moreover, it has been estimated that depression poses a greater impact on job performance than chronic conditions such as arthritis, hypertension, back problems, and diabetes (Statistics Canada, 2009). In 2011/2012, 9.0% of Ottawa’s residents aged 12 years and over reported that they have been diagnosed with a mood disorder, including depression, bipolar disorder, mania, or dysthymia (see Figure 3). This was higher compared to 7.1% of the Canadian population aged 12 years and over reporting a mood disorder (Statistics Canada, 2013). In Ontario, this percentage was 7.6% for the same period (Statistics Canada, 2013). Figure 3. Prevalence of mood disorders1 among population aged 12 years and over, Ottawa, Ontario, and Canada, 2009/10–2011/12.
Percent of population (%)
10 8 6 4 2 0
Ottawa
Ontario
Canada
2009/2010
7.8
6.8
6.4
2011/2012
9.0
7.6
7.1
1
Based on Canadian Community Health Survey data, population aged 12 and over who reported that they have been diagnosed by a health professional as having a mood disorder, such as depression, bipolar disorder, mania or dysthymia. Source: Statistics Canada. (2013). Table 105-0592 - Health indicator profile, two-year period estimates, by age group and sex, Canada, provinces, territories, census metropolitan areas and influence zones, occasional (number unless otherwise noted), CANSIM (database). Retrieved from http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1050592
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Teen smoking rate Smoking is a lifestyle behaviour that has been shown to show negative effects on an individual’s health. It is a leading preventable cause of disease and premature death in Canada (PHAC, 2013; Ottawa Public Health). Despite considerable progress made in reducing the prevalence of smoking through health promotion programs and policies, such as bans on smoking in public places, smoking is still a major public health concern for Canadians (Labonte et al., 2010; Ottawa Public Health). Teen smoking is of particular public health interest because regular smoking habits are typically initiated by the age of 18 (Labonte et al., 2010). Moreover, smoking prevalence in Canada is highest among young adults aged 20 to 24 years (PHAC, 2013). The prevalence of smoking (daily and occasional smokers) among Ottawa residents aged 12 to 19 years was 3.9% * in 2011/2012. In 2009/2010, the prevalence was 10.7%* (see Figure 4). The 2011/2012 prevalence of teen smoking for Ontario and Canada were 9.3% and 6.4%, respectively (Statistics Canada, 2013). At all three levels of geography, smoking prevalence was the highest among individuals aged 20 to 34 years (Statistics Canada, 2013). The 2011/2012 estimate for the 20 to 34 age group was 22.8% in Ottawa, 26.2% in Ontario, and 27.0% in Canada (Statistics Canada, 2013). Figure 4. Prevalence of smoking1 among population aged 12 to 19 years, Ottawa, Ontario, and Canada, 2009/2010-2011/2012.
Percent of teen population (%)
12 10
*
8 6
*
4 2 0
Ottawa
Ontario
Canada
2009/2010
10.7
8.8
11.2
2011/2012
3.9
6.4
9.3
*Interpret with caution due to high sampling variability. 1
Based on Canadian Community Health Survey data, population aged 12 to 19 who reported being a current smoker (daily and occasional). Daily smoker refers to those who reported smoking cigarettes every day. Occasional smoker refers to those who reported smoking cigarettes occasionally. This includes former daily smokers who now smoke occasionally. Does not take into account the number of cigarettes smoked.
*
Interpret with caution due to high sampling variability.
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Source: Statistics Canada. (2013). Table 105-0592 - Health indicator profile, two-year period estimates, by age group and sex, Canada, provinces, territories, census metropolitan areas and influence zones, occasional (number unless otherwise noted), CANSIM (database). Retrieved from http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1050592
The Ontario Student Drug Use and Health Survey (OSDHUS), conducted in Ottawa in 2008/2009 and 2010/2011 school years, examined behavioural risk factors, including smoking, among students in grades 7 through 12. Results of the OSDHUS for Ottawa showed that in 2010/2011, two-thirds (66%) of student smokers reported that they had begun smoking in secondary school (Ottawa Public Health). As much as 88% of student smokers reported they had acquired their last cigarette either from stores (46%) or from friends and family (42%). Three out of five students, or 60%, felt it would be fairly to very easy to obtain cigarettes, despite the fact that it is illegal for people under the age of 19 to purchase tobacco. More than one-third, or 34%, of students felt someone would be at ‘great risk’ and 36% reported ‘medium risk’ of harming themselves if they smoked one or two cigarettes per day. Finally, a great majority, or 93%, of students in Ottawa reported that they disapproved of adults smoking one or more packs of cigarettes a day. (Ottawa Public Health)
Influenza immunization rate Immunization rates are one way to measure the ability of a public health system in preventing illness and death (Labonte et al., 2010). The Canadian Index of Wellbeing selected immunization rates for the influenza virus as an indicator of public health care due to the significant disease burden caused by the virus, with increased mortality risk among the elderly and those with chronic conditions (Labonte et al., 2010). The World Health Assembly recommends that Member States aim to immunize at least 50% of elderly people by 2006 and 75% by 2010, as well as increasing coverage of all people at high risk (Labonte et al., 2010). In Ottawa, 76.6% of residents aged 65 and over reported they had been immunized against the influenza virus in the previous year (see Figure 5), indicating that Ottawa has reached the target of 75% recommended by the World Health Assembly. Furthermore, the Ottawa rate was higher than the rates found in Ontario (69.4%) and Canada (64.2%).
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Figure 5. Prevalence of past year influenza immunization1 among population aged 65 years and over, Ottawa, Ontario, and Canada, 2009/102–2011/12. 90
Percent of population (%)
80 70 60 50 40 30 20 10 0
Ottawa
Ontario
Canada
2009/2010
76.5
70.3
62.9
2011/2012
76.6
69.4
64.2
1
Based on Canadian Community Health Survey data, population aged 65 and over who reported when they had their last influenza immunization (flu shot).
2
The 2009 data on flu shots may include H1N1 vaccines received in the Fall of 2009. In 2010, the word "seasonal" was added to the questions in order to collect the two types of vaccines separately. After 2010, the separate module on H1N1 vaccines is not asked as the H1N1 flu shot is now given in combination with the seasonal flu vaccine.
Source: Statistics Canada. (2013). Table 105-0592 - Health indicator profile, two-year period estimates, by age group and sex, Canada, provinces, territories, census metropolitan areas and influence zones, occasional (number unless otherwise noted), CANSIM (database). Retrieved from http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1050592
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References Canadian Mental Health Association (CMHA). (2014). Fast Facts about Mental Illness. Retrieved from http://www.cmha.ca/media/fast-facts-about-mental-illness/#.U1VgkPldVSM. Employment and Social Development Canada. (2014a). Health – Self-rated Health. Retrieved from http://www4.hrsdc.gc.ca/.3ndic.1t.4r@-eng.jsp?iid=10. Employment and Social Development Canada. (2014b). Health – Life Expectancy at Birth. Retrieved from http://www4.hrsdc.gc.ca/.3ndic.1t.4r@-eng.jsp?iid=3. Idler, E. L., & Benyamini, Y. (1997). Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies. J Health Soc Behav, 38(1):21-37. Labonte, R., Muhajarine, N., Winquist, B., & Quail, J. (2010). Healthy Populations – A report of the Canadian Index of Wellbeing (CIW). Waterloo: Canadian Index of Wellbeing. Ottawa Public Health. (2012). Mortality and Morbidity 2012. Ottawa (ON): Ottawa Public Health. Ottawa Public Health. Youth Tobacco Use – Results from the Ontario Student Drug Use and Health Survey 2009-2011. Ottawa (ON): Ottawa Public Health. Public Health Agency of Canada (PHAC). (2013). Risk Factor Atlas. Retrieved from http://www.phacaspc.gc.ca/cd-mc/atlas/index-eng.php. Statistics Canada. (2013). Table 105-0592 - Health indicator profile, two-year period estimates, by age group and sex, Canada, provinces, territories, census metropolitan areas and influence zones, occasional (number unless otherwise noted), CANSIM (database). Retrieved from http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1050592. Statistics Canada. (2012a). Canadian Vital Statistics, Birth and Death Databases and population estimates. The CANSIM table 102-0512 is an update of CANSIM table 102-0511. Retrieved from http://www5.statcan.gc.ca/cansim/a26. Statistics Canada. (2012b). Table 102-0122 - Health-adjusted life expectancy, at birth and at age 65, by sex and income, Canada and provinces, occasional (years), CANSIM (database). Retrieved from http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1020122&pattern=&csid=. Statistics Canada. (2009). Mood Disorders. Retrieved from http://www.statcan.gc.ca/pub/82-625x/2010002/article/11265-eng.htm. Statistics Canada. (2007). Health Indicators 2007. Volume 1 Number 1. Catalogue number 82-221-XIE. Ottawa. World Health Organization. (2003). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 9
1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
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Appendix Table A1. A comparison between deadline indicators from the Healthy Populations domain of the Canadian Index of Wellbeing and the indicators presented in this report. Domain Healthy Populations
Canadian Index of Wellbeing Headline Indicators Self-rated health – Percentage of population aged 12 and over who reported perceiving their own health status as being excellent or very good Life expectancy – Number of years a person would be expected to live, starting from birth (for life expectancy at birth) or at age 65 (for life expectancy at age 65), on the basis of the mortality statistics for a given observation period Health Adjusted Life Expectancy (HALE) – Average remaining years expected to be lived in good health Diabetes prevalence – Percentage of population aged 12 and over with selfreported diabetes Probable risk of depression – Percentage of population aged 12 and over who show symptoms of depression, based on their responses to a set of questions that establishes the probability of suffering a 'major depressive episode' is 0.9 or greater Teen smoking rate – Percentage of population aged 12 to 19 reporting they are current cigarette smokers (including daily or occasional) Influenza immunization rate – Percentage of population aged 12 and over getting influenza immunization Patient satisfaction with overall health services – Percentage of population aged 15 and over who rate themselves as either very satisfied or somewhat satisfied with the overall health care services received in the past 12 months
Indicators presented in this report Self-rated health – Percentage of population aged 12 and over who reported perceiving their own health status as being excellent or very good Life expectancy – Number of years a person would be expected to live, starting from birth (for life expectancy at birth) or at age 65 (for life expectancy at age 65), on the basis of the mortality statistics for a given observation period Health Adjusted Life Expectancy (HALE) – Average remaining years expected to be lived in good health at age 65 Diabetes prevalence – Percentage of population aged 12 and over with selfreported diabetes Prevalence of mood disorders – Percentage of population aged 12 and over with a mood disorder such as depression, bipolar disorder, mania or dysthymia, based on self-reporting Teen smoking rate – Percentage of population aged 12 to 19 reporting they are current cigarette smokers (including daily or occasional) Influenza immunization rate – Percentage of population aged 12 and over getting influenza immunization
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