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HEALTHY BARRIE: A DATA-DRIVEN APPROACH TO BUILDING HEALTHIER COMMUNITIES
from 2023 Family Medicine Report
by Department of Family and Community Medicine at the University of Toronto
By Elaine Smith
Dr. Matthew Orava was a new family medicine resident at Royal Victoria Regional Health Centre (RVH) in Barrie when he was asked to take on the additional role of research lead for Healthy Barrie—an incipient citywide vehicle for innovative, collaborative efforts to improve community health.
The project aimed to use population health indicators to measure health and social well-being in local neighbourhoods and use that information to inform city policy and planning.
“Matt was a young rock star health care provider and leader,” says Dr. Stuart Murdoch, former chief of family medicine at RVH and the project’s original academic chief, who tapped Dr. Orava for the role.
Today, eight years later, Dr. Orava is a family physician, member of the Barrie & Community Family Health Team and faculty member with the University of Toronto’s Department of Family and Community Medicine (DFCM). He is not only responsible for training the U of T’s family medicine residents at RVH, but serves as Healthy Barrie’s primary care lead. He has been instrumental in ensuring the project meets its goals.
“Barrie seemed like an ideal place to think about initiating a better integration of community health, public health and family medicine with the assistance of the municipal government,” says Dr. Ross Upshur, a Professor at DFCM and U of T’s Dalla Lana School of Public Health (DLSPH). He worked with other U of T leaders, Dr. Adalsteinn Brown, Dean of DLSPH, and Dr. Murdoch, DFCM’s Director of post-graduate education, to get Healthy Barrie off the ground. “There was one large family health team, a health unit with a progressive medical officer of health and a mayor and council that wanted innovations in community health. It was an opportunity to engage in long-term thinking and undertaking a long-term project with impact,” Dr. Upshur says.
In 2020, representatives from the city, the Simcoe Muskoka District Health Unit, Simcoe County, the Barrie Police Service and RVH signed the Healthy Barrie Accord, formalizing support for projects like Healthy Barrie that started in 2015 and committing to collaborate on future planning for community wellness in the city.
As the project got underway, Dr. Orava and representatives for the other partners participated in a regular working group. Each organization agreed to provide data to allow for a more complete snapshot of the health of the community. “The health unit had access to anonymized data we could share and we received ethics approval this summer to share and study it,” Dr. Orava says.
Initially, each partner organization compiled potential indicators based on available data. The indicators were reviewed and then ranked using an indicator prioritization tool. After rounds of discussion and ranking, 29 health indicators were included in a 2018 Community Snapshot and these fell into the four theme categories: health behaviours, health outcomes, service utilization and neighbourhood characteristics, and social determinants of health.
Some of the many indicators available were statistics about: alcohol use, diabetes, life expectancy, traffic-related air pollution, frequency of primary care use, utilization of city recreation programs, median household income and food security.
To create the Community Snapshot, in accordance with the Healthy Barrie project charter, Dr. Orava and team were to map and describe the characteristics of Barrie neighbourhoods, which he did with the help of data from UTOPIAN, the U of T Practice-Based Research Network and the Simcoe Muskoka District Health Unit. The team analyzed the principal components of the data and aligned it with Statistics Canada census areas. Next, they worked with a geographic information specialist to create a series of maps visually illustrating how each area fared with regard to the indicators. For example, the colour-coded maps allow the viewer to see at a glance the prevalence of smoking in the city’s neighbourhoods or the median household income in these same neighbourhoods.
COVID slowed down the project. Dr. Orava has since re-run the data provided by the family health team, which will alter the snapshot. His next step will be to take all the data and conduct analyses to see if there are correlations between various indicators and whether those correlations have statistical significance. He plans to begin with diabetes or body mass index and correlate it with each area’s walkability, income level and availability of healthy food sources, taking care not to stigmatize individual neighbourhoods.
Community ‘snapshots’ like these show the relationship between a condition, like diabetes, and income level. This type of data can help municipal government and health system leaders with public health planning and developing service policy to help build healthier communities.
Community 'snapshots' like these show the relationship between a condition, like diabetes, and income level. This type of data can help municipal government and health system leaders with public health planning and developing service policy to help build healthier communities.
Meanwhile, Dr. Orava and his partners strengthened their own ties and built relationships with other organizations interested in the project and the information it can provide. The Dalla Lana School of Public Health has funded a project manager, Dr. Patrick Feng, and Dr. Orava has connected with the Upstream Lab at St. Michael’s Hospital in Toronto, run by DFCM’s Dr. Andrew Pinto, to tap into their expertise on urban health interventions. The Simcoe Muskoka District Health Unit continues to provide epidemiological and knowledge translation support. The Joannah and Brian Lawson Centre for Child Nutrition at U of T appointed Dr. Orava the Tristan Lawson Distinguished Fellow in Child Nutrition and Community Engagement to devote time to the project and the RVH Foundation funded a summer student to assist him.
Locally, the food bank has expressed interest in the data so it can make people aware of healthy food options, and Dr. Orava is hoping Barrie businesses and the city government will promote healthier choices that are available.
“There’s a strong culture of health change here, so we’re set up for success,” Dr. Orava says.
The project charter commits him to providing the data to Barrie’s mayor, council and health care administrators to inform service policy and public health planning and drive change that leads to a healthier population.
“Once we have the new maps, we can start making changes,” says Dr. Orava. “We can sit down with council and talk about what can be done in each ward and perhaps be proactive when new developments are planned, too.”
With a newly elected council, there may be a learning curve, but he is hopeful and has visions of expanding the program to include the entire Simcoe Muskoka region.
Dr. Upshur sees Healthy Barrie as a potential prototype for other cities to use.
“Healthy Barrie emerged out of trends in health system thinking,” he says. “It could be a real model for other communities to think about similar partnerships, since the rest of the province is more like Barrie than like Toronto in terms of system complexity. It makes sense for communities to take the long view and invest.”
