B11 Achieving Community Wellbeing in Oxford County by Working Tgoether_Lynne Beath and Cate Melito

Achieving Community Wellbeing in Oxford County

By Working Together Lynn Beath, Director/CEO, Oxford County Public Health and Emergency Services Cate Melito, Executive Director Woodstock and Area Community Health Centre

Goals for Session Introductions Canadian Index of Wellbeing Partnering in Oxford Community Governed Primary Care & Public Health Sectors as partners • Moving Forward • • • •

Oxford County

Oxford County • Located in the heart of southwestern Ontario, Oxford County has a population of approximately 109,000 people across eight municipalities that are “growing stronger together” through a partnership-oriented, two-tier municipal government incorporated as the County of Oxford.

• One of Ontario’s richest areas for farmland, Oxford County also boasts a rapidly expanding commercial and industrial sector that is bolstered by its choice location at the crossing of Highways 401 and 403. The County is home to a thriving local arts, culture and culinary community, as well as conservation parks, natural areas and more than 100 kilometres of scenic trails.

Oxford County • From 1991 – 20011 the % of population aged 55+ increased from 23% - 29%. (larger in proportion and increased at slightly higher rate than the Ontario average) This age group is expected to continue to increase.

• Home to the largest cultural community of non-immunizers.

Working in Partnership on Prevention • A partnership involving Oxford Public Health and Emergency Services, the Woodstock and Area Community Health Centre (WACHC), United Way of Oxford, Social Planning Council of Oxford, Children’s Aid Society of Oxford, Canadian Mental Health Association of Oxford and others has been engaging people of Oxford County in discussions about community wellbeing.

The Canadian Index of Wellbeing (CIW) • a resource that assists people in understanding the factors at a federal, provincial and local level that affect their wellbeing. • a way of broadening the conversation from to include governments, economic development officers, communities

When applying the 8 CIW domains in Oxford County you can begin some interesting conversations, for instance: Average voter turn out for municipal elections in Oxford in the most recent municipal election was 38.6%

In 2011/2012, a statistically significantly higher proportion of Oxford County adults were current smokers in comparison to Ontario adults. (higher % of men than women reported being a current smoker) Findings from the 2012/2013 Oxford County Youth Health Survey indicated: 12% of respondents were current smokers, and 32% of respondents who had never smoked felt they were susceptible to smoking.

In 2011/2012, approximately 60% of Oxford County residents (12+) reported having very good or excellent health, while 12% reported having fair or poor health. ( rates consistent with 2009/2010, and most recent provincial estimates)

58% of Oxford County adults (18+) reported being overweight or obese

(rates consistent with 2009/2010, and provincial estimates).

Statistically significantly higher proportion of males (68%) reported being overweight in comparison to Ontario males (60%).

From 2010-2012 in Oxford County major crimes decreased 2.5% from 2010 to 2013 there was a decrease in violent crimes in Woodstock

In 2009, 48.2% of Oxford County residents participated in physical activity lasting over 15 minutes

13% of 25-64 year olds report having a university certificate, diploma, or degree at the bachelor level or above.

Oxford County (16%) had a statistically significantly higher proportion of residents aged 25-64 years old that had no certificate, diploma or degree in comparison with Ontario (11%) residents of the same age. (2011 NHS)

Drinking water in Oxford County is all ground water sourced through municipal or private wells. There are areas throughout the County that have higher levels of naturally occurring Fluoride and Sodium.

Private vehicles are the primary mode of transportation. Two major highways intersect within the County. Agriculture.

In 2010, the median after-tax household income for Oxford County was $56,250. In comparison, Ontario’s median after-tax income was $58,717.

(2011 NHS) Oxford County had a statistically significantly lower number of households earning less than $20,000 in comparison to Ontario in 2010.

The unemployment rate for Oxford County (6.1%) was statistically significantly lower than Ontario (8.1%).

In 2006, 18.8% of people aged 15 years and older reported doing unpaid work caring for seniors.

Discussion Question 1: How would the Canadian Index of Wellbeing framework fit with the work you do in your communities.

Social Determinant of Health Model

Source: Dahlgren, G. and Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Futures Studies

CIW /SDoH

Working Together in Oxford County

Oxford: Working in Partnership • A presentation to Social Planning Council of Oxford about CIW •A “Working Better Together” agency barbeque where many downtown agencies that serve the same people were invited…

•Public Health participated in activities during Community Health and Wellbeing Week.

•A large community event was planned for September 2013 to promote a discussion about achieving wellbeing

Achieving Community Wellbeing

Working in Partnership • Held an event “Achieving Community Wellbeing: A Panel and Discussion” provided information about CIW and the Guelph Wellbeing Community Initiative.

• 140 agency representatives, municipal and county reps and Oxford County residents attended.

• Participants confirmed their interest in continuing to work on Community Vitality and specifically Community Belonging as an area of focus for Oxford County moving forward.

Working in Partnership • The CIW was confirmed as a common resource, language and approach to community wellbeing for WACHC, United Way of Oxford, Children’s Aid Society of Oxford, Canadian Mental Health Association of Oxford, Public Health and Emergency Services of Oxford, Social Planning Council of Oxford.

• The CIW has also been included in the terms of reference for the Oxford Health Service Provider Committee and has become a strategic priority for the work of this committee moving forward

Use the Canadian Index of Well-Being to guide our work and measure impact • All members will have working knowledge of the CIW • Use the CIW framework to assess the work of the Oversight Table – Become – they key table to participate at • Priorities for CIW work will be selected for the next year

Focus on System Improvement & Advocacy • Rigorously oversee the hub ensuring the development of each level (front line, core, and OVERSIGHT) through leadership and coordination – Commit to the hub pilot to ensure people at high risk receive timely quality care

• Address privacy/consent concerns – resolve issues around privacy that create barriers to quality care. Create an agreement for all parties to sign • Develop and implement communication/engagement plan to link with other existing system partners (CIW) • Ensure we are harvesting the data from the hub in order to identify trends associated with barriers to care with the focus of removing barriers at the integrated system level (get to the root cause) and document success/best practice • Create a system approach to advocacy – talk about failure, take the blame off of the patient and make ourselves accountable for a quality outcome • Ensure the model we build includes the voice of the client (experience based design). Make sure the story unfolds to get at all the issues; not just the obvious (e.g. gender)

Working in Partnership •The findings of the United Way Lived Experience focus groups about Community Belonging/Engagement were presented to the community •Support for the release of the Ontario Wellbeing Report and community discussion about the Ontario report and a local report

Working in Partnership • Live a Day in My Shoes event was hosted by the Oxford Poverty Coalition.

Working Together on Poverty Oxford Poverty Action Coalition

Policy Watch

Oral Health

Food Security

Community Voices

Working in Partnership A Community Belonging event was held in scheduled for May to deepen the community discussion on Community Belonging and to develop a community and agency action plan.

Working in Partnership • Oral Health Advocacy

Working in Partnership- cont’d • Rainbow Coalition

Discussion Question 2: What attributes do Public Health and Community Governed Primary Care Share that contribute to being Partners?

Community Governed Primary Health Care Organizations embrace the Model of Health and Wellbeing

Community Governed Primary Health Care • Population needs based approach • Use a community development approach • Serve populations at risk and work to maintain and improve their health - trusting relationships in place • Provide holistic care with referral to support programs • Based on the social determinants of health • Committed to social justice and health equity; address barriers of income, accessibility, language, literacy, transportation • Trained in anti-oppression and cultural safety

Public Health • Bring expertise in population health • Data access and epidemiological analytical capacity to enable quality improvement and population health.

• Have expertise on health behaviour and socioenvironmental factors such as nutrition, physical activity, alcohol, drug and tobacco reduction, injury avoidance that contribute to the prevention of chronic conditions • Expertise in community engagement and capacity building and have close ties with municipal governments, education and others

Together

Discussion Question 3: What barriers/challenges exist that may need to be overcome before Public Health and Community Governed Primary Care Share can work as Partners?

Discussion Question 4: How will the Community Governed Primary Care sector and Public Health sector continue the journey that has started here at the conference?

Thank You Lynn & Cate

NOTES

NOTES question 1 Benefits of The Canadian Index of Wellbeing

•The CIW has provided a common way to define Wellbeing and an opportunity for partners to work toward the common goal of Community Wellbeing and Belonging •Strengthened relationships •A shared commitment to the wellbeing/belonging of Oxford County residents.

•A shared commitment to engaging people in discussion about wellbeing.

•A shared understanding with the community that Community Belonging is an area where we can make a difference by working together •A shared plan to start to take action on Community Belonging with people in Oxford.

Working in Partnership • Creating community dialogue about wellbeing and what contributes or detracts from wellbeing in Oxford County • Lets Talk sessions co-hosted by WACHC and the SPCO in three local communities • Focus on the results of the Ontario CIW report and local CIW data • Promote ways to become involved in local action: Oxford Poverty Coalition, Community Belonging, upcoming provincial election

NOTES: question 2 Ideas from Discussion • Common values: focused on broad issues of improving the overall health of communities/population, reducing inequities and the Social Economic Determinants of Health and social justice issues • Leadership skills and ability: public health and community governed primary health care leaders advocate for issues of public policy ( ie. Poverty, hunger, homelessness) that are essential for improving population health and reducing inequities

Notes #2 Ideas from Discussion • Both have health promotion expertise in empowering individuals, groups and communities to take a more active role in crating conditions that improve health, address the social and economic determinants of health and reduce inequities • Both have training and skills in community engagement and capacity building

Question #3 Barriers • Turf protection: concerns about decreased to meet the increasing demands of acute services • Inertia and vested interests • Lack of time, resources and structures that facilitate innovation through collaborative ventures • Lack of shared vision, goals and effective leadership

Question 4: Moving Forward • Leadership: meet regularly to exchange info on local poverty/health issues. Explore opportunities to work together • Work together and with other like minded organizations in existing local poverty reduction networks • Speak out publicly together for policy change to improve health outcomes: social assistance, minimum wage, housing, public drug and dental programs

Examples of collaboration at local level with Public Health • S Riverdale CHC partners with Toronto Public Health on: programs for ‘at risk’ new mums; peer- based Diabetes Prevention; and Harm Reduction Services.

• Kitchener CHC & Waterloo Public Health offer peer based programs to support breastfeeding • Guelph CHC partnering with Public Health on Nurturing Neighbourhoods supporting ‘at risk’ kids

Question 4: By working in partnership the following outcomes can be achieved moving forward:

•Development of a plan of community action that engages and involves residents of Oxford to be part of strengthening Oxford Counties vitality and experience of belonging in Woodstock, Ingersoll, Tillsonburg and Mount Elgin •Development of CHC pre and post measurement tools to measure Belonging as a performance indicator within the CHC sector and possibly with partner agencies.

•Increase opportunities for partnering and collaboration between Public Health & WACHC