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Volume 4, Issue 3 Fall 2014
CARRFS eNews
Canadian Alliance for Regional Risk Factor Surveillance - Quarterly eNewsletter
CARRFS Feature
Mental HEALTH & Risk Factor Surveilance
CARRFS Interview
Public Health Data Dr. Robert J. Kyle Medical Officer of Health, Durham Region, Ontario
CARRFS Profile
Ruth Sanderson Manager, Ontario Public Health
CARRFS eNews
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Volume 4, Issue 3, Fall 2014
CONTENTS in this Issue... Mental Health & Risk Factor Surveillance 7 CARRFS eNews examines mental health and its implication for risk factor surveillance. By PAUL WEBSTER
Public Health in the North 12 CARRFS eNews visits Sudbury & District Public Health Unit to learn about health issues related to the North. By JOSTEIN ALGROY
CARRFS Interview 16 Dr. Robert J. Kyle, Medical Officer of Health, Durham Region talks to CARRFS eNews about local public health and the importance of local data for risk factor surveillance. By JOSTEIN ALGROY
Surveillance Facts 20 Dr. Bernard Choi, Public Health Agency of Canada, provides Part VII of his series on the evolution of Public Health Surveillance. By BERNARD CHOI
CARRFS Profile 23 The CARRFS Member Profile: Ruth Sanderson, Manger, Public Health Ontario. By JOSTEIN ALGROY
CONTRIBUTORS Jostein Algroy, Editor-in-Chief Steven Frei, Senior Copy Editor Paul Webster, Health Science Writer Dr. Bernard Choi, Science Writer Mary Lou Decou, Senior Writer Betty Reid-White, Canadian Coordination Committee, Chair Ahalya Mahendra, Tools & Resources Working Group Chair Michelina Mancuso, Surveillance Innovation Task Group Chair Li Rita Zhang, Population and Health Program, Provincial Health Services Authority, BC
PAN-CANADIAN EDITORIAL ADVISORY BOARD Jostein Algroy, Editor in Chief Paul Webster, Health Science Writer Anne Simard, Chief Public Affairs Officer, Public Health Ontario Mary Lou Decou, Epidemiologist, Public Health Agency of Canada Dr. Bernard Choi, Senior Research Scientist, Public Health Agency of Canada Dr. Elizabeth Rael, Senior Epidemiologist, Ontario Ministry of Health and Long-Term Care Larry Svenson, Director, Alberta Ministry of Health Dr. Drona Rasali, Director, British Columbia Provincial Health Services Authority
SECRETARIAT SUPPORT Public Health Agency of Canada Mary Lou Decou
Table of Contents From the Editor ................................................................. page 3 News & Trends Canada .................................................... page 4
PUBLICATION CARRFS eNews is a Quarterly Newsletter for the Canadian Alliance for Regional Risk Factor Surveillance (CARRFS) and is published in Winter, Spring, Summer, and Fall.
News & Trends International ............................................. page 5 CARRFS eNews Review ................................................... page 6 Mental Health and Risk Factor Surveillance ...................... page 7
CARRFS WEBSITE URL: www.carrfs-acsrfr.ca
Ontario Mental Health Report ............................................ page 11 Public Health in the North .................................................. page 12 CARRFS Interview: Dr. Robert J. Kyle ............................... page 16 Surveillance Facts .............................................................. page 20 Chair’s Message ................................................................ page 22 CARRFS Profile ................................................................. page 23 Updates from Working Groups ........................................ page 25 Hello & Goodbye ................................................................. page 26
Photo Credits:
Cover Photo: iStock_000038901958
Photo page 7: iStock_000011027866
Disclaimer: CARRFS is a pan-Canadian network of public stakeholders across Canada, working together to enhance the capacity of Regional Risk Factor Surveillance in Canada. CARRFS is supported by the Public Health Agency of Canada (PHAC). The content in the CARRFS eNews does not necessarily reflect the official view of PHAC, Health Canada, the Government of Canada or the employer of its contributors.
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From the Editor
As CARRFS eNews evolves to deliver better insights and to serve the Canadian risk factor surveillance community better, we’re focusing on key themes in public health. In this issue, we take a closer look at Mental Health and Substance Misuse. In 2014 the issue of mental health moved to centre stage in the Canadian health care debate. In any given year, one in five Canadians experiences some form of mental health problem or illness, according to the Mental Health Commission of Canada (MHCC). Not only does this exact a huge toll from individuals, families and communities across the country who are affected by mental illness, it also costs the Canadian economy up to $50 billion annually, according to the Commission. In this issue of CARRFS eNews, we explore issues and opportunities surrounding mental health and the public health surveillance community. As the MHCC notes in a recent study of mental health surveillance data, Canada has no clear vision for mental health information as a whole. Worrying! But it also provides an organization such as CARRFS an excellent opportunity to work together with the Commission and other federal and provincial entities in developing a risk factor surveillance framework for mental health. In this issue we also explore the implications that mental health has for local public health authorities. Last year, the Sudbury & District Health Unit in Northern Ontario released a report called “Opportunity for All: The Path to Health Equity.” By exploring the relationship between health equity and social and economic environments in the City of Greater Sudbury, the report identifies 15 health indicators that significantly differed between the most and the least deprived areas of the City. Some of the findings are quite profound: The annual number of emergency department visits for mental health problems by residents of Greater Sudbury’s most deprived areas was 341% higher than that for residents of the least deprived areas. Annual hospitalizations for mental health episodes in the Greater Sudbury’s most deprived areas were likewise 288% higher than in the least deprived areas. There is no question that economic conditions drive mental health impacts.
Also in this issue, Dr. Robert J. Kyle, Medical Officer of Health for Durham Region Health Department in Ontario, shows how data that illuminate local conditions are crucial to the effectiveness of public health programs. In an interview with CARRFS eNews, Dr. Kyle explains how Durham’s Health Neighbourhood Project - which defines 50 neighbourhoods, each with a unique social profile and health information - is providing data to guide planning, development and delivery of health programs in Durham region. CARRFS eNews welcomes feedback from readers and dialogue on public health surveillance topics. In this issue we hear from Li Rita Zhang, Population and Public Health Program, BC Provincial Health Services Authority, on the Public Health Agency of Canada’s Chronic Disease Indicator Framework. Finally, in our ongoing effort to improve the quality of the newsletter we have also engaged a professional copy editor, Steven Frei, who works in both official languages. Welcome Steven! Jostein Algroy Editor-in-Chief
Volunteers for CARRFS eNews CARRFS eNews needs volunteers to help with specific sections of the newsletter. We need reviewers who would like to review “Epi” reports and share the information with the network. We are looking for a person who can write up a few blurbs about News & Trends taking place in the “Epi” community – nationally and internationally. If you are interested please contact jostein@sympatico.ca.
Send us your Story We urge all members of CARRFS to send us articles and ideas for upcoming issues. Please submit your idea or story to jostein@sympatico.ca.
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C A N A D A
News & Trends
CARRFS eNews
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Volume 4, Issue 3, Fall 2014
BC Community Health Profile BC’s Provincial Health Services Authority, in partnership with BC’s Ministry of Health, five regional health authorities, Union of BC Municipalities, and BC Healthy Communities Society, has developed the BC Community Health Profiles.. The profiles are intended to support community health planning through collaborative partnerships among health authorities, local governments, and other stakeholders. Using a standard provincial format, the profiles present community health data at a municipal level whenever possible. It will not replace the comprehensive Local Health Area profiles that are developed by regional health authorities. The profiles for 130 incorporated municipalities are found at http://www.phsa.ca/ HealthProfessionals/Population-Public-Health/community-health-data/ community-health-profiles.htm
Adapting to a Changing World The Ontario Public Health Convention (TOPOC) is holding a conference from March 25 to 27, 2015 in Toronto. The Conference is hosted jointly by Public Health Ontario, the Ontario Public Health Association (OPHA), and the Association of Local Public Health Agencies (alPHa). The topic of the conference “Adapting to a changing world” explores how public health practices can anticipate, implement, and respond to changes in ourselves and others, in our environment, and in technology. The topic explores the intersection between three themes: discussing the impact of the changing environment on public health practice; how changes in the population and society are affecting public health; and identifying the challenges and opportunities for public health arising from technological advances. More information can be found at: http://www.tophc.ca/ Pages/home.aspx
Measuring your Health System The Canadian Institute for Health Information (CIHI) has launched a new website that allows Canadian hospitals, health regions, provinces and territories to compare how they measure up on 37 indicators. These relate to access, quality of care, patient safety and emerging health trends across Canada. The tool provides comparable and interactive data so that hospitals, regions, and the provinces and territories can compare themselves with peer groups and the pan-Canadian average. The data sets include Social Determinants, Health Status, Appropriateness and Effectiveness, Safety and Access. This data should help health systems work more efficiently, safely and transparently. The website can be found at: http://yourhealthsystem.cihi.ca
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News & Trends International
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WHO Noncommunicable Disease Country Profile WHO has just released their second set of Noncommunicable Diseases (NCD) Country Profiles highlighting NCD status for each WHO Member State. The report provides country data on NCD mortality, risk factors and national systems capacity to prevent and control NCDs. The profiles include the number, rates and causes of deaths from NCDs and trends in NCD mortality since 2000; the prevalence of selected risk factors; and information describing current national responses to prevention and control of NCDs. The report can be found at http://www.who.int/nmh/ publications/ncd-profiles-2014/en/
The 2015 WARFS Global Conference in Antigua and Barbuda The 2015 WARFS (World Alliance for Risk Factor Surveillance) Global Conference will be held in Antigua and Barbuda (Caribbean) in October or November 2015. The dates have not yet been fixed. WARFS is the Global Working Group on Surveillance under the International Union for Health Promotion and Education (IUHPE). It supports the development of behavioural risk factor surveillance (BRFS) as a tool for evidence-based public health, acknowledging the importance of this information source to inform, monitor and evaluate disease prevention and health promotion policies, services and interventions. Dr. Bernard Choi and Dr. Susan Bondy, both CARRFS members, have been appointed members of the WARFS International Scientific Committee to plan the program of the 2015 WARFS Global Conference. For further information please visit the WARFS website http://www.warfs.info/. The WARFS website also has a hot link to the CARRFS website. http://www.warfs.info/ links.html
by Bernard Choi
Mapping our lives: the importance of lifelong health studies This summer Google X - the secretive research arm of Google announced the launch of a longitudinal study branded as “the most ambitious and difficult science project ever”. This baseline study will collect genetic and molecular data from thousands of individuals over the course of their lifetimes with the purpose of creating the cellular-level “fingerprint” of a healthy human being. After conducting a pilot study this summer with 175 people, Google X, working with academics from Duke and Stanford Universities, now aims to recruit thousands more volunteers.
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CARRFS eNews Review As CARRFS eNews evolves we encourage readers to provide feedback to articles in the newsletter or other published health reports. In this issue, Ms. Li Rita Zhang, Population and Health Program, Provincial Health Services Authority, BC has, from a regional perspective, reviewed the article “Monitoring chronic diseases in Canada: the Chronic Disease Indicator Framework“ in the Chronic Diseases and Injuries in Canada, Volume 34, Supplement 1, Spring 2014. The Public Health Agency of Canada (PHAC) has developed a Chronic Disease Indicator Framework that focuses on systematic and integrated chronic disease surveillance and provides the basis for consistent and reliable reporting on chronic diseases and their determinants. This comprehensive and focused panCanadian indicator framework for surveillance of chronic diseases and their determinants has been much anticipated to provide guiding principles for informing, planning, implementing, and monitoring regional chronic disease surveillance and prevention strategies. This article briefly reviews the Framework as published by PHAC, with some regional perspectives. Developed through a structured, iterative, and consultative approach, the Framework and indicators are envisioned to contribute to an “early warning system” that could inform trends and become important resources for evidence-informed decision making in Canada. The indicators in the Framework cover much breadth in chronic diseases, including their determinants and outcomes, and for different stages of life. The set of 41 indicators is organized into six core domains: Social and environmental determinants (5 indicators); Early life/ childhood risk and protective factors (3 indicators); Behavioural risk and protective factors (9 indicators); Risk conditions (5 indicators); Disease prevention practices (7 indicators); and Health outcomes/status (12 indicators). Indicators for birth weight, breastfeeding, and exposure to second-hand smoke are currently included in the “Early life/childhood risk and protective factors” domain. Many additional early experiences - including those in schools - help children and youth develop important life skills, including health practices that continue into adulthood. These can have tremendous impacts on health in later years. Therefore, early childhood development and youth health are two areas that merit further consideration to enhance the Framework and the indicator suite.
Examples of regional applications of the Framework include: highlighting areas requiring public health attention and action; monitoring progress of prevention and mitigation strategies; and maintaining some consistency in these processes. One drawback, however, is that while some indicator data sources may allow reporting at the regional/local level, some of the national databases from which other indicators in the Framework were developed do not allow geographic disaggregation below the provincial/territorial level. This may limit the Framework’s usefulness as an “early warning system” because emerging trends often first surface at the sub-provincial level. It is therefore recognized that identifying or creating coordinated and innovative data collection methods is key to regional applications of the Framework. Furthermore, as the related products of the Framework including data outputs, continue to develop, local and regional public health practitioners and policy makers may play increasingly important roles - providing input into the presentation of data that will inform meaningful interpretation of the results at the regional/local level. In conclusion, the Framework is a welcome step towards integrated and enhanced regional/local level chronic disease surveillance, provided that further enhancements and regional adaptations are considered. It has the potential to inform a variety of projects and ultimately contribute to a comprehensive approach to chronic disease surveillance and upstream prevention in Canada. The gaps (including gaps in data and gaps in indicators) identified during the framework and indicator development process present ample opportunities for increasing collaboration among regional/local, provincial/ territorial, and federal public health agencies, and strengthening chronic disease prevention capacity and infrastructure across the country. Reference: Betancourt M.T., Roberts, K.C., Bennett, T-L., Driscoll E.R., Jayaraman G., and Pelletier L. Spring 2014. Monitoring chronic diseases in Canada: the Chronic Disease Indicator Framework. Chronic Diseases in Canada. 34:Supplement.
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CARRFS Feature...
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Mental Health
& Risk Factor
Surveillance 7
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CARRFS Feature...
Mental HEALTH & Risk Factor Sur veillance
Paul Webster explores a range of issues associated with Mental Health and its implications on Risk Factor Surveillance. After decades in the shadows of Canadian healthcare, mental health is suddenly centre stage. And with good reason: According to the Mental Health Commission of Canada (MHCC), one in five Canadians suffers from some form of mental illness. The toll on individuals, families and society, the Commission emphasizes, is vast. So too are the economic costs - as high as $50 billion annually. To face these challenges, warns the Commission, which was established with federal funding in 2007, urgent national action is needed to raise awareness, expand treatment and “reduce disparities in risk factors and access to mental health services.” But identifying – let alone mitigating - the key risk factors that propel mental illnesses is a tricky and controversial task. Beyond a handful of well-known factors, explains Scott Patten, a University of Calgary specialist in mental health epidemiology, there is little expert consensus on what creates and propels mental illnesses. In large part, says Patten, this is because mental health surveillance “lags behind other chronic disease surveillance, and far behind infectious disease surveillance.” The MHCC agrees: In a recently-released study of mental health surveillance data, the Commission warned that “there is no clear vision for mental health information as a whole” in Canada, and “no single organization at the national level dedicated to gathering and reporting on all mental health services and policies.” Defining a core set of risk factors for mental illness is a key priority for the MHCC. In its 2012 Mental Health Strategy for Canada, which the Commission described as a landmark document intended to guide national action well into the future, the Commission shortlisted a dozen risk factors: >> 8
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CARRFS Feature... CARRFS Feature (cont’d)
poverty, genetics, childhood trauma, sexual abuse, social isolation, substance use problems, racism, bullying, stigma, domestic violence, overcrowded housing, and having a parent who lives with a mental illness. It’s a list that could easily be expanded. But before that can happen, the Commission warned, “there is a long way to go before we have the data that are needed.” To broaden the consensus on mental health risk factors, massive reams of disparate data from scores of provincial and national sources will have to be compiled and distilled, says Elliot Goldner, a Simon Fraser University epidemiologist recruited by the MHCC to forge a comprehensive risk factor list. “That process is now well underway,” he says. If all goes well, Goldner and his team will be ready to publish a comprehensive list of the main risk factors for mental illness in early 2015. Complementary efforts are underway at the Public Health Agency of Canada (PHAC), where extensive expert consultations were recently completed on a forthcoming “Positive Mental Health Indicator Framework”. As part of the leadup to this effort, last spring, PHAC published a Chronic Disease Indicator Framework in which three of 41 key risk factors identified for chronic diseases sit squarely within the mental health domain. These factors include exposure to chronic stress, barriers to access to primary health care, and associations between mental health problems and chronic diseases. “Mental health problems, especially depression and anxiety, frequently precede chronic disease development,” PHAC concluded. “People with long-term chronic diseases [also] have an increased risk of developing mental health problems and report high levels of distress.” The efforts by the MHCC and PHAC to fashion evidence-based indicator frameworks both for mental illness and for mental health are longawaited and much-needed, says Alain Lesage of the Université de Montréal Department of
Psychiatry. “This will be a good start in helping to expedite action,” Lesage believes. Action is especially needed on suicide prevention, he argues. “Suicide is a huge cause of death but still gets far less attention than many infectious and non– infectious diseases which are far less significant causes of mortality. There’s a lack of focus and energy. We need better information about the risk factors, and better surveillance of those risk factors.” The Mental Health Commission and PHAC aren’t the only federally-funded bodies interested in mental health risk factors. In recent years the Canadian Institute for Health Information and Statistics Canada have jointly produced a series of surveys of mental health indicators including mood disorders, heavy drinking, perceived life stress, and life satisfaction. In 2013, they added “perceived need for mental health care” and “generalized anxiety disorder” to the list of risk factors worth monitoring. In September, a StatsCan study added chronic pain, age, marital status, and religiousness to the lengthening list of potentially important factors influencing mental health. Provincial public health agencies also show growing interest in probing and identifying risk factors relevant to mental health. In 2012, Public Health Ontario (PHO) and the Toronto-based Institute for Clinical Evaluative Sciences released a report estimating that the burden of mental illness and addictions in Ontario is more than 1.5 times that of all cancers, and more than seven times that of all infectious diseases. “As our understanding of the burden of mental illness and addictions comes into focus,” the report argued “the case for a broad mental health promotion and mental illness and addictions prevention strategy becomes stronger.” A first step in this process, the report concluded, would be to develop “key indicators of mental health and its determinants”. >>
“...mental health surveillance “lags behind other chronic disease surveillance, and far behind infectious disease surveillance.”
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Heather Manson, PHO’s Chief of Health Promotion, Chronic Disease and Injury Prevention, says the burden of mental disease study revealed a strong role for childhood experience in the development of mental illness. “There’s very little data on child mental health,” says Manson, “but the treatment of infants and children obviously plays a huge role in the development of mental illness. We need to examine the factors that lead to more and less maternal attachment, and how factors that promote mother-child attachment protect against mental illness.” Gustavo Turecki, Director of the McGill University Group for Suicide Studies in Montreal, agrees. “Childhood maltreatment is an extremely important risk factor for negative mental health outcomes,” he argues. “I think a lot more work is necessary for life adversity surveillance.” A new study headed by Tracie Afifi, a mental trauma specialist at the University of Manitoba, reports that 32% of the adult population has experienced physical abuse, sexual abuse and/or exposure to intimate partner violence in childhood. All of which “were associated with all types of interview-diagnosed mental disorders, self-reported mental conditions, suicidal ideation and suicide attempts in models adjusting for socio demographic variables.” Corporate Canada is also stepping-up action on mental illness risk factors through initiatives like the Canadian Alliance on Mental Illness and Mental Health. Since 2010, Bell Canada alone has committed more than $62 million to mental healthrelated initiatives in Canada, focussing strongly on anti-stigma, community care and access, and workplace mental health. Heather Stuart, who holds the Bell Canada Mental Health and AntiStigma Research Chair at Queen’s University, says stigmatization of mental illness is an important risk factor.
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“We have seen instances where youth who were described by their families as healthy and happy have become depressed and suicidal after being cyber bullied and ostracized,” Stuart observes while noting that public health surveillance of stigmatization is entirely possible through tools such as the ‘Mental Health Experiences Module’ recently adopted within Statistics Canada’s Canadian Community Health Survey - Mental Health. “People who have experienced stigma tell us that it is worse than the illness itself,” Stuart emphasises. “We know that stress can trigger repeat episodes of an illness. We don't have systematic data on this, but could if studies were funded to address this problem.” <>
“A new study headed by Tracie Afifi, a mental trauma specialist at the University of Manitoba, reports that 32% of the adult population has experienced physical abuse, sexual abuse and/or exposure to intimate partner violence in childhood.”
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Ontario Mental Health Report 2012
Opening Eyes, Opening Minds The report “OPENING EYES, OPENING MINDS: The Ontario Burden of Mental Illness and Addictions Report” published in October 2012 by the Institute for Clinical Evaluative Sciences (ICES) and Public Health Ontario (PHO) maps out the impact of mental illnesses and addictions on life expectancy, quality of life and health care utilization. The results are staggering. Below are some of the findings quoted from the report: •
200,000
204,463 •
168,834
HALYs
•
The burden of mental illness and addictions in Ontario is more than 1.5 times that of all cancers, and more than seven times that of all infectious diseases.
disorder, alcohol use disorders, social phobia and schizophrenia.
The nine conditions identified in this report contributed to the loss of more than 600,000 health-adjusted life years (HALYs), a combination of years lived with less than full function and years lost to early death in Ontario.
•
Depression is the most burdensome condition, with twice the impact of bipolar disorder, the next highest condition. The burden of depression alone is more than the combined burden of lung, colorectal, breast and prostate cancers.
•
In terms of deaths, alcohol use disorders contributed to 88% of the total number of deaths attributed to these conditions and 91% of the years of life lost to dying early.
Five conditions have the highest impact on the life and health of Ontarians: depression, bipolar
116,921
100,000 84,119 75,368
62,796
Number of Incident Cases
55,196
25,351 19,235 12,277
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Health-adjusted life years (HALYs) lost for selected mental illnesses and addictions in Ontario, by (a) years of life lost
due to premature mortality (YLL) and (b) year-equivalents of reduced functioning (YERF), and number of incident cases.
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Public Health in the North Sudbury & District Public Health Unit On a spectacular summer day CARRFS eNews traveled to Sudbury to discuss public health surveillance with some of the leaders of the Sudbury & District Health Unit (SDHU). Sudbury is a 4 hour drive north of Toronto and the city is beautifully situated around Ramsey Lake. The SDHU is located on Paris Street which leads into the magnificent Bridge of Nations, featuring the flags of all nations registered by the United Nations. 12
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Renée St. Onge, Sandra Laclé, and Marc Lefebvre
S
udbury is surrounded with smaller, sparselypopulated suburbs and settlements. This uneven population distribution provides some tremendous challenges in terms of collecting and measuring health data. The Health Unit has done an extensive job obtaining health related data for all the communities it serves by combining data from Statistic Canada’s Canadian Community Health Survey (CCHS) in combination with the Ontario Rapid Risk Factor Surveillance System (RRFSS) alongside various over samplings for specific targeted populations. The result is a series of comprehensive health profiles for each of the local communities within the district. In a recently-published report “Opportunity for All: The Path to Health Equity” (2013), the Health Unit explored the relationship between health indicators and social and economic environments in the City of Greater Sudbury. In this report, says co-author Marc Lefebvre, Manager, Population Health >>
Data: Sudbury & District Health Unit The Sudbury & District Health Unit (SDHU) has offices in Sudbury, Chapleau, Espanola, Mindemoya, and St. Charles. The SDHU has a mandate to deliver provincially-legislated public health programs and services to almost 200,000 people in an areathat spans 46,475 square kilometres on the northern shore of Georgian Bay. The area includes the City of Greater Sudbury, and the Sudbur y and Manitoulin distr icts . Approximately 82% of the population lives within Greater Sudbury. The rest is spread over the Sudbury District which accounts for 86% of the land area and the Manitoulin District. The population density outside the Greater Sudbury is quite low, as it is in most of Northern Ontario. A quarter of the population is French speaking, while there is also a relatively large Aboriginal population in the district. 13
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(cont’d)
Assessment and Surveillance, “in order to compare socioeconomic disadvantage in various Table 1. Health Indicators in Most Deprived Areas Where Differences Are Statistically Significant communities we used the Deprivation Index by the Institut national de santé publique du Québec Health indicator Level in most deprived areas relative to least deprived areas (INSPQ). By using this well-proven method, we identified 15 (see table) out of a total of 42 1. Self-rated health (excellent /very good) 20% lower or 0.2 times lower indicators in which there is a significant difference 2. Premature mortality (dying before age 75) 86% higher or 1.9 times higher between the least and most deprived areas of the City. For the remaining 27 indicators we 3. Infant mortality 139% higher or 2.4 times higher didn’t find significant differences between the 4. Teen births (% of all live births born to adolescent mothers) 205% higher or 3.1 times higher areas.” The report’s results are profound - not only for 5. Injury and poisoning emergency department (ED) visits 44% higher or 1.4 times higher Sudbury, but across the country. Here are a few 25% higher or 1.3 times higher examples from the report (see table 1 with all 15 6. Injury and poisoning ED visits (children and youth) listed health indicators): 7. Injury and poisoning hospitalizations 24% higher or 1.2 times higher
• The annual rate of emergency department
visits for mental health episodes in the City of Greater Sudbury’s most deprived areas was 341% (or 4.4 times) higher than that for residents in the least deprived areas. • The annual rate of infant mortality in the City of Greater Sudbury’s most deprived areas was 139% (or 2.4 times) higher than for residents in the City’s least deprived areas. • The prevalence rate of obesity in residents of the City of Greater Sudbury’s most deprived areas was 102% (or 2.0 times) higher than that for residents of the City’s least deprived areas.
8. Obesity
102% higher or 2.0 times higher
9. ED visits (all causes)
71% higher or 1.7 times higher
10. Hospitalizations (all causes)
20% higher or 1.2 times higher
11. Access to a regular medical doctor
11% lower or 0.1 times lower
12. Intentional self-harm ED visits
226% higher or 3.3 times higher
13. Intentional self-harm hospitalizations
242% higher or 3.4 times higher
14. Mental health episodes ED visits
341% higher or 4.4 times higher
15. Mental health episodes hospitalizations higher
288% or 3.9 times higher
The report reveals potentially great health improvements in Sudbury. If, for example, everyone in the City of Greater Sudbury experienced the same opportunities for health as those in the least deprived areas, each year there would be:
• 14,077 fewer emergency department visits for all causes in the City of Greater Sudbury
• 1,783 fewer hospitalizations for all causes in the City of Greater Sudbury
Alongside the health benefits, the financial savings would be significant. And if one stretched this finding to represent Canada as a whole, and not just one city, the budget savings would be staggering. There are of course limits to what any health unit can do by itself, so what is SDHU doing to follow up on its findings? “We always share our knowledge products and reports that we produce with our Board of Health,” says Renée St. Onge, Director of the Resources, Research, Evaluation and Development Division, SSHU.
“The Board of Health is made up of representatives from the 19 municipalities that we serve. We make sure that they have access to that information as timely as possible,” adds St. Onge, and “we also try to connect as much as possible with our local community partners. As a public health organization we are linked to a number of local groups, committees, and agencies that are not necessarily only within the health sector but are also in a number of other sectors. When we produced the “Opportunity for All” report we shared the results with the City Council and we produced ward profiles so each ward councillor would have access to information about the neighbourhoods they represent.” How do these findings filter down to the program level? “The community of Sudbury has created a committee called Partnership for Children and Youth (PCY)”, says Sandra Laclé, Director Health Promotion Division. “This was established to coordinate planning, prevention, and shared action on child and youth issues and initiatives that cross individual agency mandates. The PCY does this by identifying gaps, aligning >>
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efforts, acting “cross-sectorally” for the well-being of children and youth. One initiative of the committee is the adaption of the Positive Parenting Program - the Triple-P parenting program. All agencies, school boards, municipalities and the health unit realized the need for a common parenting platform to support healthy child development and resiliency. Triple P is a one-stop access point for parents. No matter where they go they get referred into a seamless system and get the one-on-one advice or the group advice or the resources they need.” “The biggest priority we have today as the Resources, Research, Evaluation and Development Division is to meet the Foundational Standard set out by the provincial government; we spend most of our time as a Division to fulfill this obligation of population health assessment, surveillance, research, evaluation, and knowledge exchange,” St. Onge explains. “If we had more resources we’d have more time for additional research to further understand the effectiveness of some of the interventions we do, as well as understand “the causes of the causes” relating to health inequity. With that information we’d be that much more effective.” <> By Jostein Algroy
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CARRFS Interview...
Local Public Health Data Collection
Dr. Robert J. Kyle Medical Officer of Health, Durham Region
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CARRFS Interview... What are the key factors that have led to changes in Public Health over the last 10 to 20 years? I think the main reason is SARS in 2003. SARS led to changes in the mandate of Public Health, together with the publication of the Ontario Public Health Standards, 2008, and protocols. It also led to the creation of new structures such as Public Health Ontario, the Provincial Infectious Diseases Advisory Committee (PIDAC), the Regional Infection Control Networks, and the Emergency Management Branch in the Public Health Division of the Ontario Ministry of Health and Long-Term Care. Legislative changes to the Health Protection and Promotion Act improved and enhanced the emergency powers of the Chief Medical Officer of Health.
days where one tackles particularly complex issues, such as obesity prevention, or injury prevention, in isolation – working in silos or with one agency owning a particular issue – are long gone. Today, there is an expectation to tackle problems more holistically and to form partnerships. New professions have come into play such as epidemiologists – how do you see the role of epidemiologists changing over the next 10 years? If you simplify their role, it is about collecting data, analyzing data and translating data into user-friendly products. These may include, for example, info-graphics, and interactive local health neighbourhoods maps. In addition to translating data into useful information, I think that there is an increasing need, driven by colleagues and by the community, that epidemiologists (and public health units in general) need to connect with their audiences in order to assure that the data products produced are userfriendly, and used as much as possible. In terms of knowledge translation, I think when you are looking at a data set, rather than crunching the numbers and then thinking through your knowledge translation strategy, this must come in the beginning of the process. Maybe this is already becoming bred into the DNA of epidemiologists. When we are planning our products we need to address: What is your knowledge translation plan – who, what, where, when and why? I suspect this is common across the public health sector. With the rise of social media, peoples’ attention spans have lessened – they want information to be as simplified as possible. With respect to the medical community, I know that if we can’t get our message on one page, it is unlikely that our message will be heard. This differs radically from earlier, when local health status reports were always massive documents including tons of data and data analyses, and so forth, which nobody read. Today, I think one really needs to think about one’s audience’s >>
“I think that there is an increasing need, driven by colleagues and by the community, that epidemiologists need to connect with their audiences in order to assure that the data products produced are user-friendly, and used as much as possible.”
What tasks does the Public Health system face that didn’t exist 20 years ago? I have worked in Durham Region for about 20 years. If I look at the system as a whole, I think that the main changes centre on a more consistent approach to the management of infectious diseases through the Ontario Public Health Standards and protocols. Health promotion was coming to the fore in the late 1980s and early 90s. Lately, the focus of Public Health has broadened to include broader prerequisites of health and the social determinants of health. There is also an increased focus on research and knowledge exchange. New Public Health disciplines have emerged such as public health librarians. And of course, something we often forget, 20 years ago we didn’t have the Internet – information technology has had a huge impact on Public Health. Looking back, I think Public Health has become more complex. I think there are new disciplines, new players, far more community partners, and we are way more interconnected than before. Even though the Public Health focus is a local one, certainly one has to see the big picture with respect, for example, to multi-jurisdictional outbreaks. The Ontario Public Health Standards and protocols speak to this. The
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CARRFS Interview (cont’d)
attention span. It has been shortening in part because there is so much information out there, and I think that the social media and the way information is being portrayed has helped feed that kind of expectation. What do you think are critical factors for success in public health in general, and for Durham specifically? I think you need to be locally relevant and performance-driven. You need to develop sound plans, robust performance indicators and targets, and you need to evaluate your programs. I think there is an expectation among ourselves as well as in the broader community that we are evidence-informed. Particularly in the age of the Internet, everybody has an opinion and you can get a whole lot of misinformation not formed with sound evidence. We have been trying to train our staff on what steps need to be followed with regard to evidence-informed decision making. Additionally, you need to be passionate, at times a risk-taker, and you need at all times to understand that you are the steward of public funds. You are working in the public’s interest, and you need to be proud of what you do day in and day out, and strive for excellence.
for us in terms of developing new programs on a number of fronts relating to drug and alcohol use and other risky behaviours. We have developed an Infant Feeding Surveillance System that has been in place since 2007 and we have data from about 5,000 clients who have received support from us. Most recently, we have spent a lot of time and effort on mapping a range of data that we can access in what we call the Health Neighbourhood Project. We defined Durham Region into 50 neighbourhoods. Each neighbourhood has a special social profile and has been mapped with health information. This data has been on our Intranet site for a couple of years, and we are planning to go live on the Internet this November. These are examples of local surveillance systems that we have put in place to supplement other data that is out there on Durham Region. We did this because the program staff has identified a strong need for more local data sets. All of these information products can be found on the Health Statistics in Durham Region tab of our website.
“Particularly in the age of the Internet, everybody has an opinion and you can get a whole lot of misinformation not formed with sound evidence.”
Where do you focus your efforts in collecting Public Health data? There is a ton of data out there that we can access, so the challenge is to have relevant data at the municipal or sub-municipal level – in other words, to focus your effort. Regarding the Rapid Risk Factor Surveillance System (RRFSS), for example, we were one of the original partners when the system was established in the beginning of 1999. We still find RRFSS data relevant today. For us it is pure gold – certainly with respect to getting local data that can be translated into useful local products. For a number of years, we have had a partnership with the Centre for Addiction and Mental Health where we get an oversample of local data on student alcohol and drug use and related information. This again is pure gold
What made you focus on the neighbourhood level? I guess it was a belief that when you are planning a particular targeted programming, such as smoking cessation, we realized that focusing on the municipality as a whole was too big a population size, in the sense of appropriateness. Our program planning is driven by availability of data, technology that allows us to map this data, and an alignment with analysis that can be translated into effective implementation of programs and services. I should say that in north Durham we have three, fairly sparsely populated municipalities, and then along the lakeshore [Lake Ontario] we have five, fairly heavily populated municipalities. So of course you will have more health neighbourhoods in the south than in the north, because of their respective population densities. What are the challenges you face in collecting Public Health data, analyzing it and publishing the results? On one hand there really is a wealth of data – data that is available at the public health unit level. And >>
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CARRFS Interview (cont’d)
we are part of a municipal data consortium so we can access even more data. There is probably not a “set of data” out there that we cannot access. We are living in a time of abundance for data, and the major challenge we find is that despite the breath of available data, it needs to be synthesized into a very precise and easily accessed type of product. I think that the other challenge is to adapt social media in an appropriate way as a means of capturing a wider audience. How do you see the public health units (in general) evolving in the future and what kind of role do you see PHUs playing to improve the future health of the people of Ontario? I think that public health has been well served by the former Mandatory Health Programs and Services Guidelines and the current Ontario Public Health Standards and protocols. The Standards of course will be reviewed from time to time. Attached to the Standards are various protocols which were put in place to provide consistent practices among the PHUs across the province – in particular relating to the health protection side. In my opinion, that has been achieved more or less. I think that the mandate of Public Health will continue to evolve. There are gaps out there that I think were identified in the Ontario Public Health Sector’s 2013 Strategic Plan “Make No Little Plan”, – I am particularly thinking about more targeted programming in respect to early childhood development, built environment, and mental health programming. In addition to advancing the Public Health Sector’s Strategic Plan, Public Health will continue to have to respond to emerging issues – Ebola is happening as we speak - and that has already led to new management guidelines. Canada is a land of immigrants so I think cultural diversity will continue to play a role in public health programming. We are living in an age of austerity, with the expectation that tax increases are minimal, and governments are focused on growing the economy by cutting red tape and creating a more receptive business climate. All that will play out in terms of resources available for public health. I think in order to adapt to a changing world we need to stick to our knitting. We need to continue to be locally relevant, embrace new technologies in order to get to new audiences, look for opportunities for new programming, continue to reduce health inequity, and develop new tools and try to improve and develop staff on the new core competencies. <> By Jostein Algroy
Call for Interest Are you interested in and available to contribute to setting strategy for CARRFS ? Do you have time to volunteer? We are looking for members for the working groups (training, tools & resources, and surveillance innovation) and the coordinating committee. These are twoyear terms. Each group has a specific focus. The Training Working Group coordinates opportunities including bi-monthly e-Learning sessions and an e-Forum which will be informed by an updated needs assessment. The Tools and Resources Working Group identifies what tools and resources are out there and how to link those who “have” with those who “need”. They are looking at creative ways to make it easier to connect – including more use of our Twitter account and other networking options. The Surveillance Innovation Working Group is still in its initial stages, and there are opportunities to influence the direction that this group takes.The Coordinating Committee provides advice on the operation of CARRFS, and takes the lead in specific areas including the e-Newsletter and web presence. We have openings and would be pleased to hear from you if you want additional information, would like to nominate a colleague, or volunteer yourself.The strength of CARRFS lies in its membership:We encourage your contributions! <> 19
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Surveillance Facts
... Part VII in a series about the Past, Present and Future of Public Health Surveillance. Written by Dr. Bernard Choi, Senior Research Scientist, Chronic Disease Surveillance and Epidemiology Division, Public Health Agency of Canada and CARRFS eNews science writer. Past Surveillance efforts were used to develop legislation and social change as early as the 19th century. In 1834, the Poor Law was passed in England. The Act implemented recommendations made by Sir Edwin Chadwick, secretary of the Poor Law Commission in England, who used surveillance data to demonstrate the link between poverty and disease. The Pool Law Amendment Act, more commonly known as the New Poor Law, remained in force until 1948 and is considered to be one of the most farreaching pieces of legislation of the 19th century. William Farr (1807–1883) is recognized as the founder of the modern concept of surveillance. In 1836, the General Register Office was established in England and Wales to provide more accurate and complete mortality data. Medical certification of death and universal death registration was introduced in 1837. Farr was the first Compiler of Abstract (medical statistician) at the General Register Office. He began the practice of collecting and analysing vital statistics to describe the impact of diseases in various populations. From 1838 to 1879, he concentrated his efforts on collecting vital statistics, on assembling and evaluating those data, and on reporting his results to both the responsible authorities and to the general public and created a modern surveillance system. Present Epidemiologic Surveillance versus Public Health Surveillance. In 1965, the World Health Organization established the epidemiologic surveillance unit in the Division of Communicable Diseases. The Division director, Karel Raska, defined
surveillance to include “the epidemiological study of a disease as a dynamic process involving the ecology of the infectious agent, the host, the reservoirs, and the vectors, as well as the complex mechanisms concerned in the spread of infection and the extent to which this spread occurs”. The 1968 World Health Organization definition of surveillance includes “the use of epidemiologic information”. On the other hand, Thacker and Berkelman in 1988 proposed using the term “public health surveillance” and gave the following reasons: “the use of the term epidemiologic to modify surveillance is misleading. Epidemiology is a broad discipline that incorporates research and training that is distinct from a public health process that we call surveillance.” Surveillance Ending with Information Dissemination versus Surveillance Ending with Public Health Action. Langmuir in 1963 advocated limiting the use of the term surveillance to the collection, analysis, and dissemination of data. His construct of surveillance ended with “dissemination of data to those who need to know” and did not encompass direct responsibility for control activities. Others also felt that although data are important for informing policy making, they may not lead immediately to action. On the other hand, former WHO director Karel Raska in 1965 defined surveillance much more broadly than Langmuir. In the case of malaria, Raska saw surveillance as encompassing control and prevention activities. Indeed, the WHO definition of malaria surveillance included not only case detection, but also the obtaining of blood films, drug treatment, epidemiologic investigation, and followup. Former US CDC director William Foege also felt an essential relationship between information and action: “The reason for collecting, analyzing, and disseminating information on a disease is to control that disease. Collection and analysis should not be allowed to consume resources if action does not follow”.
Future Improving Methods of Information Dissemination. A number of methodological research areas to improve information dissemination in the 21st century are: Methodology to alert health professionals and the general public about forthcoming health risks; Innovative and non-traditional methods for information dissemination; Methods to put our current knowledge of risk assessment and management into perspective so the general public knows what health risks to avoid and what healthy activities to pursue; Ongoing and timely information dissemination system; Survey of the general public for their regular and most effective channels of obtaining health information; Development of summary indicators for health, risk and intervention (e.g., for Canada, Canadian Health Index, Canadian Heart Health Index, Canadian Diet Index) in a way similar to the Consumer Price Index or stock market indices; Development of 365 health, risk, and intervention indicators for reporting to the general public after the evening television news, one indicator a day; Computer software to calculate probability of risks of selected diseases or overall health outcomes, based on input concerning personal lifestyle, demographics, diet, and smoking. Improving Use of Surveillance Information by Decision Makers. Perhaps most importantly, surveillance information should be used more by decision makers. It must, however, be recognized that while public health surveillance is the cornerstone of public health practice, it is not the only source of information for evidencebased public health, as surveillance is only one element in the package of evidence to influence healthy public policies. There are at least five tools/processes for decision makers on public health actions: metaanalysis, risk assessment, economic evaluation, public health surveillance, and expert panels/consensus conferences. <>
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> MESSAGE > PROFILE > UPDATE >
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Chairâ&#x20AC;&#x2122;s Message Betty Reid-White, Chair for the Canadian Coordination Committee, (CCC) gives a status update on CARRFS achievements over the last quarter and what is in store for CARRFS over the months ahead. Over the past several months the CARRFS Canadian Coordinating Committee (CCC) has been reviewing its work plan and is pleased to inform you of several focal initiatives. The Tools and Resources Working group will be working towards the development of a searchable database of subject matter experts on relevant risk factors for chronic disease surveillance in Canada. Once developed, this database will be accessible to all CARRFS members and will support the sharing of information and mobilizing knowledge to enhance regional risk factor surveillance across the country. The Surveillance and Innovation Task Group is currently in the process of producing a proof-ofconcept paper to supplement surveillance activities in relation to existing resources. This paper should identify ways to leverage and support innovation and learnings to energize surveillance and create opportunities for healthier Canadians.
As we continue to explore opportunities and methods to support the CARRFS membership and improve regional risk factor surveillance, we would ask for any ideas and suggestions you may have. Input from local and regional professionals will prove valuable as we move forward. It is only through volunteers like you that we can continue the work of CARRFS. If you would like to volunteer to be part of any of our committees or would like to support the ongoing work, please let us know. At this time I would like to thank Gail Butt and Riaz Alvi who have completed their terms on the CCC. These two individuals have spent years working with CARRFS and we truly appreciate all they have done to enhance surveillance, not only in their local areas but across Canada as well. Thank you Gail and Riaz. We wish you well in all your future endeavors. Betty Reid-White Chair, Canadian Coordination Committee, CCC
Work is continuing on the development of a CARRFS eNews website. This website will not only be a portal for CARRFS members to access current information, but will also provide a forum for communication through email, Twitter, etc.
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CARRFS Profile... To help build our community, the CARRFS eNews profiles a leading member in each issue. In this issue we profile Ruth Sanderson, Manager, Ontario Public Health.
What is your background? I have 20 years of experience in public health, primarily working as a public health epidemiologist in Ontario, with a master of science in Community Health and Epidemiology from Queen’s University. I’ve worked at the local level in many different settings including rural, northern and urban public health units, as well as within Ontario’s Ministry of Health and Long-Term Care. For the past five-and-a-half years I’ve been with Public Health Ontario (PHO), first as a chronic disease epidemiologist and more recently as the manager of Analytic Services.
What inspired you to become an epidemiologist? I wish I could say I always wanted to be a public health epidemiologist but it was really a confluence of disparate events that led me to learn about epidemiology, and, eventually, to work as a public health epidemiologist. Honestly, I had not heard of epidemiology until my third year as an undergraduate student at Trent University. I was studying biology and anthropology at the time and while I enjoyed learning about biology and its role in health, I was keenly interested in the influence of culture and society on a population’s health. My anthropology professor, Dr Joseph So, who recognized my interest, suggested I explore epidemiology as an approach to population health. In 1987, I finished my undergraduate program and was selected to participate in the World University Services of Canada’s (WUSC) International Research Seminar in Zimbabwe. The WUSC Seminar was a tremendous opportunity for me to witness the impact of a rapidly changing society, and the intricate influence of traditional culture and government policy, on the population’s health. My first real career-oriented job involved coordinating the local “practice” arm of an early policy, practice and research initiative aimed at improving the life chances of children in the Peterborough area. Dr Dan Offord, the developer of the Early Development Instrument, was the lead scientist for the research arm, so you can imagine the quality of the effort. Overnight the core funding for the organization that held the project’s funding ceased with the provincial government cut-backs in 1995. We moved the project to the local public health unit. At the end of the project, I knew much more about the formal public health system in Ontario and it seemed logical to transition into the role of public health epidemiologist. >>
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CARRFS Profile (cont’d)
What do you spend the most time on in your current position? As the manager of Analytic Services at the PHO, I work with a team of eleven specialists with skills in analytics, biostatistics, epidemiology and geospatial analysis. We play a key role in supporting PHO’s strategic efforts to accelerate integrated population health monitoring. This helps us deliver on our mandate to provide scientific and technical advice and support to clients working in government, public health, healthcare and related sectors. My work at PHO has involved finding ways to analyse and communicate the population health assessment and surveillance information that we already have in new and innovative ways. Last April we released a set of ten population health assessment stories on important public health topics as infographics, and we are currently preparing to release interactive web reports on the same topics. What was your motivation to become a member of the CARRFS? When I first heard about CARRFS in 2008 there was little doubt in my mind that I would join. One of the strengths of working as a public health epidemiologist in Ontario is the atmosphere of mutual learning through groups like the Association of Public Health Epidemiologists in Ontario (APHEO) and PHO. CARRFS offered an opportunity to learn about what was working related to regional risk factor assessment and surveillance from colleagues across Canada, and it really fosters an environment of mutual learning. How do you see the current role of the CARRFS in Canada today? CARRFS is uniquely positioned to connect public health professionals from across the country who understand that chronic disease risk factor surveillance is a tool to assist them in improving the health of their local communities. The CARRFS website provides a “go to” place for accumulated knowledge and other information sharing.
(1) Support workforce capacity: CARRFS is uniquely positioned to connect people interested in chronic disease risk factor surveillance, and advance the practice of assessment and surveillance generally across Canada. For example, surveys are the backbone of risk factor surveillance, yet most of us are concerned about the future of traditional surveys – even approaches using more than one mode of data collection (e.g., phone, cell phone, email and paper) may not keep the traditional population health survey approach viable in the longterm. CARRFS can foster innovation within its network to help risk factor surveillance embrace new approaches to monitoring, so that when game changing ideas come knocking we have receptor capacity to act quickly. (2) Focus on all components of the surveillance cycle: Data collection is a key component of risk factor surveillance but there are other components of the surveillance cycle that are in need of our collective attention such as analysis and dissemination. (3) Consider expanding risk factors across the spectrum of public health outcomes: Chronic disease risk factor surveillance embraces the idea that human behaviour has a great deal of impact on population health. This notion has successfully led public health to consider upstream action for chronic disease prevention. I think CARRFS can use this success to steer more public health surveillance efforts towards upstream exposure and risk factor surveillance. For example, large surveillance gaps exist for environmental health exposure data - and while infectious disease surveillance has a good system for tracking new cases, it could benefit from an increased focus on risk and protective factor surveillance. <> By Jostein Algroy
What are the future opportunities for the CARRFS? CARRFS has a chance to shine the light where the keys really are - that is to say with upstream risk factor surveillance. There are three broad opportunities that I would highlight for CARRFS:
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Update... Updates from each CARRFS Working Group Chair on recent activities. All working groups need members. Please get in touch with the Chair or a member of the working group and join! Surveillance Innovation Task Group
Tools and Resources Working Group
The Surveillance Innovation Task Group, chaired by Michelina Mancuso, is currently working on a proofof-concept paper that will describe innovative and non-traditional data sources, and their use for public health surveillance. The task group includes 11 CARRFS members from the western, central and eastern parts of Canada. Surveys have been the mainstay for collecting data related to behavioral risk factors of chronic diseases at the local, provincial and national levels. However, surveys represent an additional burden to respondents, are plagued with decreasing response rates, and are often cost prohibitive. They may therefore not be effective in collecting timely data on risk factors on an on-going basis. Identifying new surveillance data sources can lead to significant benefits to a population’s health as well as to decision-makers dealing with a significant burden in health system costs. The objective of this paper is to describe several innovative ideas on new emerging non-traditional data sources for use in public health surveillance. The task group has identified a number of new data sources including data from emerging information technology, remote sensing technology, pharmaco-surveillance, low-cost community data, and school health surveys. The first draft has been completed and the paper will go through several iterations in the upcoming months until its completion.
The next project of the Tools and Resources Working Group is to update the environmental scan that was initially done several years ago. This project would update currently available information across Canada for chronic disease regional risk factor surveillance and the key organizational contacts who can provide expertise and insight in their use. For updated information, please contact Ahalya Mahendra at ahalya.mahendra@phacaspc.gc.ca. In October we held an e-Learning session on the launch of the Economic Burden of Illness in Canada (EBIC) online tool. The tool allows users to access Canadian cost of illness estimates for all major diseases and injuries. The EBIC online tool provides 2005-2008 cost estimates for the following components: hospital care, drugs, physician care and lost production due to premature mortality. Hospital care and mortality cost estimates are also available for 2004. For additional information and cost totals for other EBIC components (e.g. morbidity) users can consult the EBIC 2005-2008 Methodology Report. You can access the EBIC online tool and Methodology Report at: http://ebic-femc.phacaspc.gc.ca/index.php
CARRFS Committees Canadian Coordination Committee (CCC)
Chair: Betty Reid-White Co-Chair: Ali Artaman
Tools and Resources Working Group (TRWG)
Chair: Ahalya Mahendra Co-Chair: Vacant
Training Working Group (TWG)
Surveillance Innovation Task Group (SWTG)
Chair: M. Nawal Lutfiyya Chair: Michelina Mancuso Co-Chair: Audrey Layes Co-Chair: Vacant
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Hello & Goodbye...
Volume 4, Issue 3, Fall 2014
This is the place to welcome new members to the CARRFS Steering Committee - The Canadian Coordination Committee (CCC) and honour those who have to leave the committee to pursue or fulfill other commitments. Gail Butt
Our previous chair Gail Butt, has retired. It is sad to see her leaving the Canadian Coordination Committee (CCC) which she has been an active part of since 2010. Gail became the second CARRFS Chair in 2011. As chair, Gail was also fully engaged as Associate Director of Hepatitis Services at the BC Centre for Disease Control and as Clinical Assistant Professor in the Nursing Faculty at the University of British Columbia. With a soft voice, Gail steadfastly guided CARRFS through some challenging times. She always took the long view and had a unique ability to find ways to craft a consensus that everybody could support. As a Co-Chair for CARRFS during the two years Gail served as Chair, I was always happy with our discussions and with Gail’s guidance and support. Gail dove full-heartedly into the tasks she gave herself - whether crafting the organization’s Terms of Reference, developing the strategic direction, or negotiating the terms and conditions under which CARRFS could flourish. Gail understood and never wavered in seeing CARRFS’s need to represent and serve the local surveillance communities across Canada. Gail’s contributions to CARRFS have been significant. On behalf of the CCC, I wish Gail all the best in her retirement. By Jostein Algroy
Riaz Alvi
The CCC would like to thank Riaz Alvi for the thoughtful input and direction that he has provided over the last several years. Riaz is the Provincial Leader, Epidemiology & Performance Measurement with the Saskatchewan Cancer Agency and he has provided valuable perspectives for CARRFS. Riaz began his term on the CCC in April 2010 and over the last four years his contributions have been significant. Again, Riaz, the CARRFS network appreciates your involvement on the CCC and we know your commitment to CARRFS will continue into the future. By Mary Lou Decou
MANDATE CARRFS is a network of Public Health stakeholders interested in working together to build capacity for regional/local area chronic disease risk factor surveillance in Canada that will be used for chronic disease prevention and control.
VISION
MISSION
A sustainable and effective regional/local collection, analysis, interpretation and use of risk factor data to inform program and policy decisions in Canada.
To build and strengthen the capacity for regional/ local risk factor surveillance in Canada.
Send us your Story We urge all members to send us articles for upcoming editions. Since we are promoting a bilingual newsletter, articles will be published in the language they are submitted - English or French. Please submit your story to the CARRFS eNews Editor-in-Chief at jostein@sympatico.ca 26