A3 B The CIW Framework and Community-Based Survey

The CIW Framework and Community-Based Survey: Helping us better understand the health and wellbeing of residents in communities across Canada Bryan Smale, Ph.D. Director, Canadian Index of Wellbeing AOHC CONFERENCE, JUNE 5, 2013

The CIW is rooted in Canadian values fairness, diversity, equity, inclusion, health, safety, economic security, democracy, sustainability “Values provide us with a sense of connectedness and stability that enables us to deal with an everchanging world. … It begins with the belief that our cornerstone value as Canadians is the principle of ‘shared destiny’ – that our society is often best shaped through collective action; that there is a limit to how much can be achieved by individuals acting alone; that the sum of a good society and what it can achieve is greater than the remarkably diverse parts which constitute it.”

The Honourable Roy J. Romanow CIW Advisory Board Co-Chair

CIW Vision

CIW Vision To enable all Canadians to share in the highest wellbeing status by identifying, developing, and publicising statistical measures that offer clear, valid, and regular reporting on progress toward wellbeing outcomes Canadians seek as a nation.

AOHC Vision The best possible health and wellbeing for everyone. Our ultimate goal is for all people living in Ontario to live the healthiest, safest, and most prosperous lives as possible. CHCs’ and AHACs’ commitment is to work with each other, and with our partners in communities across this province, to make Ontario the healthiest place on earth.

Network of Ontario’s Community Health Centres and Aboriginal Health Access Centres Model of Health and Wellbeing Charter May 2013

AOHC Model of Health and Wellbeing The model is based on two core principles adapted from the World Health Organization (WHO): • enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.

• health is a state of complete physical, mental, social, and spiritual well-being and not merely the absence of disease or infirmity.

Network of Ontario’s Community Health Centres and Aboriginal Health Access Centres Model of Health and Wellbeing Charter May 2013

Wellbeing as a basic human right “People are much more than the goods and services they produce! Their health and quality of life come from the conditions of their daily living – the circumstances in which they are born, grow, live, work, and age.”

The Honourable Monique Bégin CIW Advisory Board Co-Chair Former Canadian Commissioner WHO Commission on Social Determinants of Health

“Poor social policies, unfair economics and bad politics are killing people on a grand scale.”

WHO Commission on Social Determinants of Health Final Report, August 2008

The presence of the highest possible quality of life in its full breadth of expression, focused on but not necessarily exclusive to:  good living standards

 vital communities

 robust health

 an educated populace

 a sustainable environment

 balanced time use

 high levels of democratic participation

 access to and participation in leisure and culture

CIW Indicators Approach

The Development of the CIW Indicators and Composite Index

CIW Framework 8 Domains

8 Indicators in each domain

CIW Composite Index 64 indicators consolidated into a single CIW average

CIW Composite Index The composite index gives a quick snapshot of whether the overall quality of life of Canadians is getting better or worse.

Do our governments truly respond to the needs and values of everyday Canadians?

Trends in the Canadian Index of Wellbeing with Eight Domains and Compared with GDP, 1994-2010

Trends in Community Vitality 1994-2010

Trends in Healthy Populations 1994-2010 Teen smoking

Flu shot Hlth. services rating Life expectancy Depression Years good health Self-rated health

Incidence of diabetes

Wellbeing is more than just health…

“The persistence of significant health gaps suggests both the need for health interventions tailored to socially excluded groups and the potential health benefits of initiatives outside the health field.”

CIW Healthy Populations Report September 2010

“What good does it do to treat people’s illnesses ... then send them back to the conditions that made them sick?”

Community Vitality Time Use

Democratic Engagement

Canadian Index of Wellbeing

Education

Environment

Leisure and Culture Healthy Populations

CIW Subjective Wellbeing Approach

The Development of the CIW Community Wellbeing Survey

Innovating to address community needs The survey asks residents of a community to indicate on a range of questions how they are really doing with respect to aspects of each of the domains of the CIW in addition to their wellbeing overall Most of the survey questions are standardised with some customisation to include questions on specific issues or to account for differences among large/small urban communities, rural/remote communities, and demographics of communities This ensures that the data collected reflect the complex interplay among domains and provide the opportunity for comparisons to be made among communities using a common set of measures

Potential benefits to communities • Provides a rich source of new data specific to your residents creating a broader understanding about the them and your community, with the opportunity to:

o Engage residents in discussions about those things that affect their health and wellbeing o Foster collaboration among community organisations working in various domains to enhance wellbeing o Create an action plan to better address unmet needs o Demonstrate leadership by sharing knowledge and best practices with other communities

• Potentially resulting in: o Greater efficiencies in programme and service delivery o Community residents with greater access to the full range of services and supports they need to stay well

Administering the survey in Guelph

What we learned‌ Overall Wellbeing of Guelph Residents

Average = 4.94

Level of Satisfaction

Overall wellbeing of Guelph residents by income

Level of Satisfaction

Percentage

Sense of belonging to community by income

Inability to pay for things at least once in past year by income

Percentage

Physical activity participation in previous month by Ward Team sports: 18.3% Indiv. sports: 23.4% Phys. activity: 53.7% Light exercise: 96.4%

Team sports: 21.6% Indiv. sports: 28.6% Phys. activity: 62.4% Light exercise: 92.8%

Team sports: 23.8% Indiv. sports: 35.2% Phys. activity: 61.6% Light exercise: 94.7%

Team sports: 16.5% Indiv. sports: 33.3% Phys. activity: 58.5% Light exercise: 94.9%

Team sports: 22.5% Indiv. sports: 27.8% Phys. activity: 57.5% Light exercise: 95.6% Team sports: 19.6% Indiv. sports: 25.0% Phys. activity: 59.1% Light exercise: 94.3%

Percentage

Self-reported physical and mental health

Self-reported physical and mental health by income Physical Health

Mental Health

Percentage

Health care services ratings on quality and accessibility as very good/excellent by Ward

Ward

CHC/AHAC Intake Survey

The CHC/AHAC Intake Survey

The Task – our collective challenge How do we replicate the success of our efforts system-wide?

How do we create coherent, coordinated health and wellbeing systems province-wide?

Informed by your existing work

The basics….

•

Survey design based on the CIW Framework as a guide to choose valid measures that CHCs/AHACs can act on

•

Informed by Health Promoter Working Group, demonstration sites, intake workers

•

Where? At least five sites each piloting about 50 surveys during Phase 1 of OTF grant

•

Who? New clients as they come on board at a Centre; clients can be re-surveyed to track progress

•

How? Site specific: (a) administered in person at a Centre; (b) handed out at a visit, completed at home, and (c) discussed at next visit

•

Completed surveys sent to CIW, where we will maintain a data repository for AOHC intake survey data

Potential benefits to CHCs and AHACs • Provides a rich source of new data specific to your clients creating a broader understanding about the complexities faced by the people that you serve, with the opportunity to:

o Engage clients in a discussion about those things beyond primary health that affect their health and wellbeing o Increase integration by better matching referrals to other staff, programmes, and other community supports, including those beyond primary health care o Share strengths, inform topics for education nights and programme development

• Potentially resulting in: o Greater efficiencies in programme and service delivery o Community residents with greater access to the full range of services and supports they need to stay well

Timeline Phase 2 (2014)

Phase 1 (2013)

May-June

Aug-Dec

Draft design, informed by working with CHCs/ AHAC/ AOHC groups

Pilot of intake survey in at least 5 CHCs/AHACs, minimum of 50 surveys per site

Phase 3 (2015)

Apr-Dec Role out to another group of CHCs/AHACs; follow-up with ‘pilot’ clients (Aug-Dec)

July

Jan-Mar

Jan-Dec

Share draft of survey with Health Promotion and Community Development group

Analysis of pilot survey data; revisions to survey questions if required

Analysis of phase two survey data; roll out system-wide

Bryan Smale, Ph.D. Director, Canadian Index of Wellbeing University of Waterloo smale@uwaterloo.ca

For more information: www.ciw.ca