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Determining the Big Picture The Results of the Discovery Zone Community Health Needs Assessment


Determining the Big Picture The Results of the Discovery Zone Community Health Needs Assessment


The Results of the Discovery Zone Community Health Needs Assessment

Acknowledgements Many thanks to the people of the Discovery Region and Eastern Health staff, physicians and volunteers for their participation in the needs assessment process. In particular, we acknowledge: • Advisory Commiee – Lisa Browne (facilitator), Bernice Clements, Cal Cole, Janet Fisher, Gerald Giles, Barbara Ann Humby, Susan Khaladkar, Wayne Miller, Camilla O’Shea, Daphne Smith, Rev. Don Stiles • Steering Commiee – Michelle Abbo, Lisa Browne (chair), Pat Coish-Snow, Tammy Greening, Joan Linthorne, Wayne Miller, Natalie Moody, John Picke, Mona Romaine-Ellio, Collee Smith, Evelyn Tilley • Facilitators and Recorder – Lisa Browne, Pauline Chatman, Janet Fisher, Troy Mitchell • Administrative Support – Pauline Chatman • Photography – Cynthia Farrell, Janet Fisher • Graphic Design – Angela Lawrence

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Determining the Big Picture

Executive Summary Eastern Health Eastern Health is the largest health services organization in the province of Newfoundland and Labrador and provides the full continuum of health services, including community, acute and long-term care. It has both regional and provincial responsibilities. The organization has approximately 13,500 employees, over 700 medical staff and 2,000 volunteers. Community Health Needs Assessment As per the Government of Newfoundland and Labrador’s Regional Health Authorities Act and the Board of Trustees’ Strategic Plan, Eastern Health has been assessing the health needs of its geographic catchment. A community health needs assessment gathers information about the health of a particular area from both a factual and an opinion perspective. The Discovery Zone The area assessed for this report is referred to as the Discovery Zone, named aer John Cabot’s discovery of the New World. The zone has a population of 28,300 and includes the area from Bonavista to Port Blandford to Swi Current to Chapel Arm. The assessment was launched in January 2010. The Determinants of Health A number of influences and their interaction have major impacts on the health and well-being of a population. These determinants, such as social, economic, cultural and physical environment play a role -for beer or worse- in the health of a community. Determining the Big Picture looks at the health of the Discovery Zone from a determinants of health perspective, and paints a picture of the health of the people in the area.

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The Results of the Discovery Zone Community Health Needs Assessment

Methodology A Steering Commiee, made up of Eastern Health sta, oversaw the needs assessment process, and an Advisory Commiee, made up of people in the community who applied to sit on the commiee, provided guidance and support on the process. It is through the Advisory Commiee that this report tells the story of the people of the Discovery Zone. To ensure a wide variety of opinions and aitudes regarding the health needs of the area, a number of primary research methodologies were used: telephone survey, focus groups, key informant interviews and wrien submissions. Feedback was received from February to August 2010. This information was supplemented by existing secondary and utilization information. A blog and Facebook site were used to communicate information about the needs assessment process. Hurricane Igor On September 21, 2010, Hurricane Igor hit the province of Newfoundland and Labrador. It had a major impact on the communities within the Discovery Zone, the area covered by this community health needs assessment. While it is likely that the impact of Hurricane Igor will be felt for a long time, it is impossible to be able to speculate on what that impact will be in this report. All primary research and ďŹ ndings related to this needs assessment were completed prior to Hurricane Igor. Summary of Findings Within the Discovery Zone, there is a strong sense of place and volunteerism and community groups are lauded for their contributions to

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Determining the Big Picture

society. The region is one of disparity with some parts of the region doing quite well economically and others doing quite poorly. The lack of employment and consequently, lack of income, impacts on people’s ability to afford healthy food, appropriate housing and transportation. This in turn impacts on mental health and well-being of people and communities. People are very interested in health promotion activities, particularly for school aged children. People want to see increased personal responsibility for one’s own health but want to be supported through education sessions. The navigation of the health system continues to be a challenge, particularly for those with lower education and literacy levels. The lack of child care options is a problem for many families. People worry about youth and the isolation of living in aging communities and the impact of technology. From a health services perspective, the main themes were around health promotion, intervention and prevention, the primary health services, mental health and addictions, secondary health services and healthy aging. Recommendations The recommendations developed to address the issues that have arisen during the needs assessment process are: Health Promotion, Intervention and Prevention 1) Communicate the results of this assessment to members of the Eastern Region Wellness Coalition to discuss the findings of the needs assessment. As part of this commitment, the organization

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The Results of the Discovery Zone Community Health Needs Assessment

will also develop a practical handbook for community groups to outline how they can address some of the issues, such as transportation barriers, raised in the needs assessment. 2) Develop a communications plan for Eastern Health. This plan will include topics brought up in the ďŹ ndings, including promotion of local clinics and hospitalists, taking personal responsibility for your health, customer service training for front-line employees and developing a listing of credible sources of internet health information. 3) Work with the existing Eastern Health-Eastern School District Liaison Commiee to strengthen the relationship between the two entities at a local level. 4) Work in consultation with the Eastern School District to communicate to the public the contribution schools have made and continue to make in the promotion of health and wellness among the school population. Mental Health and Addictions 1) Develop a local community advisory commiee to review the identiďŹ ed mental health issues and develop an action plan to address same.

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Determining the Big Picture

Primary Health Care 1) Organize a symposium in the Discovery Zone to discuss physician recruitment and retention issues with key partners. This symposium will provide a comprehensive look at the challenges around recruitment in the Discovery Zone and provide an indication of what eorts have worked in other parts of the province. 2) Establish an annual meeting between family physicians and Eastern Health. This meeting will help to provide an opportunity to share information about Eastern Health services. 3) Implement fully the Client Centred Waitlist Management Strategy of Eastern Health as per the Northeast Avalon Community Health Needs Assessment (See Appendix III). 4) Initiate mechanisms to electronically track Emergency Department wait times in Clarenville and Bonavista. 5) Develop a handout regarding ambulance services for patients detailing the costs and use of the service. 6) Develop a strategy aimed at increasing interest and awareness of health and community services sector careers to high school students.

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The Results of the Discovery Zone Community Health Needs Assessment

Healthy Aging 1) Initiate the age-friendly concept throughout the organization. Emphasizing this concept throughout the organization will increase awareness of the needs of that population (e.g. the issue of oral health as raised in the primary research). As part of this initiative, Eastern Health will develop a guide/manual around preparing to be admied to a long-term care home. 2) Review the number of long-term care and protective care beds in the area to determine appropriateness of bed numbers. 3) Conduct an assessment on Golden Heights Manor to determine any security issues. 4) Establish a Working Group to co-ordinate palliative care services for the Peninsulas region with the newly appointed Coordinator for Palliative Care. 5) Work with partner agencies and government to build on communication messages regarding elder abuse and how to report it. Build Regional Capacity 1) Work with partner organizations to enhance collaboration and discussion of issues of mutual concern. These include: a. the Eastern School District to advocate for a Community School Model; b. Municipalities Newfoundland & Labrador (MNL) to discuss the health and well-being of communities; c. the Department of Tourism, Culture and Recreation to build

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Determining the Big Picture

regional capacity and identify opportunities to address physical activity and recreation, healthy eating and tobacco control; d. the Family Resource Centres to advocate for increased child care services in the area; e. the local detachment of the RCMP to focus on mental health and addictions issues; f. the Pharmacists Association of Newfoundland & Labrador to build relationship as a resource in the community. Conclusion When reviewing the determinants of health, it is clear that improving the health and well-being of a population is not solely one organization’s responsibility. Eastern Health values its work and collaboration with many community partners and individuals. We hope that this report and the information it contains will be used by many people to beneďŹ t the well-being of the people in the Discovery Zone.

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The Results of the Discovery Zone Community Health Needs Assessment

Table of Contents Eastern Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Needs Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 The Discovery Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 The Determinants of Health and The Advisory Commiee . . . . . . .4 What We Heard: Income and Social Status . . . . . . . . . . . . . . . . . . . . .7 What We Heard: Employment and Working Conditions . . . . . . . .10 What We Heard: Physical Environment . . . . . . . . . . . . . . . . . . . . . . .13 What We Heard: Education and Literacy . . . . . . . . . . . . . . . . . . . . . .16 What We Heard: Social Support Networks . . . . . . . . . . . . . . . . . . . .19 What We Heard: Social Environment . . . . . . . . . . . . . . . . . . . . . . . . .22 What We Heard: Healthy Child Development . . . . . . . . . . . . . . . . .25 What We Heard: Personal Health Practices and Coping Skills . . . .29 What We Heard: Gender and Culture . . . . . . . . . . . . . . . . . . . . . . . .33 What We Heard: Biology and Genetic Endowment . . . . . . . . . . . . .37 What We Heard: Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Health Promotion, Intervention and Prevention . . . . . . . . . . . . . . . . . . 41 School Based Programs and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Mental Health and Addictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

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Primary Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Family Physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Emergency Departments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Ambulance Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Oral Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Pharmacy Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Allied Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Recruitment and Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Secondary Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Healthy Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Long-Term Care and Protective Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Home Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Seniors Day Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Respite and Palliative Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Recommendations and Implementation . . . . . . . . . . . . . . . . . . . . . .70 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Appendix I: Primary Research Methodology Summary . . . . . . . . .76 Appendix II: Population and Communities in Each of the Three Areas Assessed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Appendix III: Backgrounder - Client Centred Waitlist Management Strategy for Eastern Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82

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The Results of the Discovery Zone Community Health Needs Assessment

Table of Figures Figure 1:

Map of Eastern Health . . . . . . . . . . . . . . . . . . . . . . . . . .1

Figure 2:

Areas within the Discovery Zone . . . . . . . . . . . . . . . . .3

Figure 3:

Income Support Assistance Indicator, 2008 by Areas within the Discovery Zone . . . . . . . . . . . . . . . . . . . . . . .8

Figure 4:

Employment Insurance Indicator and Average Weeks Worked Indicator by Areas in the Discovery Zone . .11

Figure 5:

Cervical Screening Rates by Community, Females 12+ years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Figure 6:

Body Mass Index, Overweight or Obese, Youth and Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

Figure 7:

Self-Rated Health Status of Telephone Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Figure 8:

Telephone Survey Responses: Level of Satisfaction with Health and Community Services . . . . . . . . . . . .39

Figure 10:

Wait List for Addictions Services – November 2010 .47

Figure 11:

People Reporting Having a Family Physician by Needs Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

Figure 12:

People Who Report Having a Family Physician by Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

Figure 13:

Wait Times to Get Family Physician Appointment by Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Figure 14:

Incidence of Diabetes, Cancer and Heart Disease . . .52

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Figure 15:

Number of visits to Emergency Room in Past 12 Months by Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

Figure 16:

Satisfaction Levels with Emergency Rooms . . . . . . .56

Figure 17:

Incidence of Visiting a Dentist . . . . . . . . . . . . . . . . . . .59

Figure 18:

Specialist Positions at the Dr. G. B. Cross Memorial Hospital as of November 20, 2010 . . . . . . . . . . . . . . . .63

Figure 19:

Long-Term Care Wait List . . . . . . . . . . . . . . . . . . . . . .66

Figure 20:

Personal Care Homes in the Discovery Zone, Vacancy Rate, August 31, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . .67


The Results of the Discovery Zone Community Health Needs Assessment

Eastern Health Eastern Health provides the full continuum of health services, including community, acute and long-term care. It is the largest health services organization in the province of Newfoundland and Labrador and has both regional and provincial responsibilities. As seen in the figure below, the Eastern Health region extends west from St. John’s to Port Blandford and includes all communities on the Avalon, Burin and Bonavista peninsulas, a population of 293,795 (Census, 2006) dispersed throughout 20,000 square kilometres. Figure 1:

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Map of Eastern Health

The organization has approximately 13,500 employees, over 700 medical staff and 2,000 volunteers. It has 28 health service facilities (acute care facilities, community health centres, longterm care facilities, provincial cancer care and provincial rehabilitation centres) and community-based offices in 30 communities. Within its facilities, the organization operates 925 acute care beds, 87 critical care beds and 1,722 long-term care beds (as of March 31, 2010). Eastern Health has the provincial responsibility for providing tertiary level health services, which are offered through its academic healthcare facilities, and provincial programs such as the Provincial Organ Procurement Program and the Provincial Post-Adoptions Program.

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Determining the Big Picture

2

Needs Assessments As per the Regional Health Authorities Act and the Board of Trustees’ Strategic Plan, Eastern Health has been assessing the health needs of its geographic catchment. Assessments of the Burin Peninsula, Southern Avalon, Bell Island and Northeast Avalon have been completed. This current community health needs assessment is of the Discovery Zone (Bonavista to Port Blandford to Swi Current to Chapel Arm), a population of 28,300. A community health needs assessment gathers information about the health of a particular area from both a factual and an opinion perspective. A community health needs assessment helps to continue dialogue with individuals and groups in an area and helps to increase public participation and engagement in the health of communities. Through an assessment, issues are identified and recommended actions to address the issues are identified and implemented. 1 A Steering Commiee, made up of Eastern Health staff, oversaw the needs assessment process, and an Advisory Commiee, made up of people in the community who applied to sit on the commiee, provided guidance and support to the process. Part of a needs assessment involves asking people about their opinions and aitudes. For this needs assessment, a telephone survey, focus group sessions, key informant interviews and request for submissions formed the basis of opinions. An overview of the primary research is in Appendix I. As a way to solicit feedback and to communicate with people in the area, a blog ( www.discoveryneedsassessment.blogspot.com) and a Facebook site (Discovery Needs Assessment) were established. Additional secondary information such as utilization information was used to validate findings.

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The Results of the Discovery Zone Community Health Needs Assessment

The Discovery Zone On June 24, 1497, an Italian explorer sailing under the British flag for King Henry VII, made landfall in the New World. "O Buona Vista," Giovani Caboto was said to Figure 2: Areas within the Discovery Zone exclaim aer nearly two months at sea. News of the existence BBonavista of this New Found Kings Cove Little Catalina Land - and the riches of the Grand Bank fishery Plate Cove West Catalina Port Rexton Charlottetownn Port Union - spread throughout Summerville-PrincetonTrinity Southern Bay Europe aer Cabot's Musgravetown Lethbridge g Bonavista Area return journey across Trouty Population 9,140 Morley’s Siding Clarenville the Atlantic. Clarenville Area Hickman’s Harbour

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Population 13,955 Arnold’s Cove Area

Population 5,610 The Discovery Zone, Swift Current Little Heart’s Ease Goobies named aer John Come by Chance Cabot’s discovery, Chance Cove covers the area from Arnold’s Cove Bellevue Bonavista to Port Southern Harbour Long Cove Blandford to Swi Fair Haven Current to Chapel Arm. Chapel Arm The zone has a population of 28,300. To help with the analysis of the primary research, the zone was divided into three areas: the Bonavista Area; the Clarenville Area; and, the Arnold’s Cove Area (Figure 2). See Appendix I for a listing of communities in each of the three areas.

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Determining the Big Picture

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The Determinants of Health and The Advisory Committee Health is defined as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. 2 Achieving Health for All: A Framework for Health Promotion (Epp, 1986) helped to focus society on the underlying prerequisites or determinants of health and illness. It suggested that a number of influences and their interaction had major impacts on the health and well-being of a population. Factors such as social, economic, cultural and physical environment play a role -for beer or worse- in the health of a community. This means that making improvements in the health and well-being of Canadians must go beyond delivery of health care services and include action on the broad determinants of health. 3 These determinants are: • Income and social status – Incomes are related to beer health. People can afford beer housing, food, clothing and other necessities. Income also increases your opportunities and choices and provides people with a sense of control over their lives. • Employment and working conditions – Employment provides income. It also can impact your health in terms of levels of stress, work overload, sense of satisfaction and opportunities to have control over your life. • Social support networks – Having friends to support you plays an important role in your health and well-being. People need to be in contact with others in order to have good health.

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The Results of the Discovery Zone Community Health Needs Assessment

• Social environments - In addition to social supports, it is important for support to be available in the broader community. The values of a society influence health. • Education – Education provides people with greater access to information. It also helps problem solving skills and provides beer opportunities for employment. • Physical environments – The physical environment around us, such as pollution, water quality and road designs can have an impact on our health. • Personal health practices and coping skills – Each one of us do things which impact our health. Personal health practices such as diet, exercise, smoking and drinking affect our health. How we cope with stresses also has a role to play. • Healthy child development – Providing a positive environment for a child can influence the health of that child for the rest of his/her life. • Biology and endowment – How our bodies work and how we age impacts our health. Some genetic endowments affect your likelihood to develop some diseases such as heart disease and diabetes. • Gender - Gender refers to the array of society-determined roles, personality traits, aitudes, behaviours, values, relative power and influence that society gives to the two genders. • Culture – Some people may have their health impacted due to cultural practices and values.

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Determining the Big Picture

• Health services – Health services help to take care of our mind and body. 4 There are two key beliefs for working with the determinants of health: 1) Communities have the strengths, knowledge and skills necessary to originate programs which influence the determinants of health and which promote a healthy lifestyle. 2) Individuals have an important role to play in making communities a healthier place to live. 5 To help provide guidance and support during the needs assessment process, people of the Discovery Zone were invited to apply to sit on an Advisory Commiee, and people were asked to join based on the determinants of health in which they have experience and knowledge. Advisory Commiee members were: Lisa Browne (Chair - Eastern Health staff), Cal Cole, Bernice Clements, Janet Fisher (Eastern Health staff), Gerald Giles, Barbara Ann Humby, Daphne Smith, Rev. Don Stiles, Susan Khaladkar, Wayne Miller (Eastern Health staff). It is through them that this report will tell the story of the Discovery Zone and the health and well-being of people in this region.

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The Results of the Discovery Zone Community Health Needs Assessment

What We Heard: Income and Social Status arbara Ann (Barb) Humby lives in Port Union. When she saw an advertisement inviting people to sit on the Advisory Commiee for a community health needs assessment, she knew right away that she would submit her name. “I know the impact that income can have on your health,” says Barb. Barb works at the OCI plant in Catalina as a forkli operator, and sees the struggles that people have to ensure they are as healthy as possible.

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“In this area, there is a lot of seasonal work both in the fishery and in tourism,” says Barb. “This can really have an impact on your health in a number of ways. From a very basic need, you need employment to have income. Your income can dictate the food you can afford to buy; the house you can afford to live in; whether or not you can afford your medication.” Barb’s comments reflect those that Eastern Health heard throughout the needs assessment. In the Bonavista Area, income was referenced as the most challenging determinant of health in discussions with people. In other areas of the region, income levels are viewed very positively, particularly with the growth of industry in the Arnold’s Cove Area and the Clarenville Area. Figure 3 provides an indication of income support assistance for local areas within the Discovery Zone. 7


Determining the Big Picture

Figure 3:

Income Support Assistance Indicator, 2008 by Areas within the Discovery Zone

Indicator

Income Support Assistance Incidence, 2008

Provincial rate: 10.0%

Area

Number

Bonavista Area 6

13.80%

Blackhead Bay 7

9.80%

Catalina Area 8

14.40%

Chandlers Reach 9

6.80%

Smith Sound – Random Island 10

7.60%

South West Arm Area 11

6.00%

Placentia Bay North West 12

3.30%

Isthmus of Avalon 13

7.10%

Some people worry about the increasing disparity of income in the region, and they believe that this disparity is going to become even more marked. Many people interviewed expressed concern about the social impact of future developments, such as Hebron, on the region, particularly increased highway traffic and social concerns such as increased drugs and violence. Barb notes that people have to make choices when money is tight. “You know that milk is healthier for your children than so drinks but when you look at the price difference, sometimes your income dictates that you buy so drinks.” The Newfoundland Nutritious Food Basket Survey provides information about the cost of healthy eating in Newfoundland and Labrador. In the rural Eastern Health Region (Rural Avalon and

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The Results of the Discovery Zone Community Health Needs Assessment

Peninsulas), the average weekly cost of the Nutritious Food Basket in June 2009 was $165.93 for a family of four.14 Another challenge people talked about is the lack of affordable housing. In some areas, the cost of housing has increased dramatically. A number of dual-income families indicated that while they have good salaries, they could not afford to live in Clarenville due to the high cost of housing. Many people wondered, given how difficult it was for dual-income families, how the unemployed, single parents or those with disabilities were coping. Income was also referenced as a barrier to receiving health services; whether it is the cost of medications or the cost of transportation for appointments. Not being able to provide for the family causes a great deal of stress. Many people throughout the needs assessment commented on self-esteem and depression as outcomes of low or no income.

At a Glance:

• • • •

Lack of year-round reliable income is a big challenge, particularly in the Bonavista Area. There is a great deal of disparity in the Discovery Zone around income. Income impacts health in terms of being able to afford healthy food and appropriate housing. Lack of income can have an impact on peoples’ mental health and wellbeing.

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Determining the Big Picture

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What We Heard: Employment and Working Conditions ncome and employment are very closely linked, and so employment was a very hot topic during the needs assessment. Many people interviewed talked about securing long-term, stable employment as the biggest challenge in the area. This was particularly true of the Bonavista Area, where the fishery is facing enormous challenges.

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Many people commented on the potential of tourism as a growing strength throughout the Discovery Zone but also noted the importance of long-term, permanent income rather than seasonal income. Camilla O’Shea of Clarenville has been involved in leadership roles with the Ability Employment Corporation for 16 years. Through her work, she sees the impact and importance of employment on people, not only for the income it provides and the ability to secure housing and food, but also for the impact on self-esteem and social support networks. “Not having a job can impact on mental health and well-being and increase isolation,” says Camilla. “Having a job, being able to support yourself or your family is extremely important. But imagine if you have other challenges like a disability, employment can become even more challenging,” she continued.

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The Results of the Discovery Zone Community Health Needs Assessment

The comments of needs assessment participants can be validated quantitatively through the Government of Newfoundland and Labrador’s Community Accounts, an information system that provides users with community, regional and provincial data. Figure 4 indicates that rates of Employment Insurance vary quite a bit in the region with the Catalina area at 67.5% while the provincial rate of employment insurance is 34%. The seasonal nature of many jobs on the Bonavista Peninsula is reflected in the average weeks worked, ranging from a low of 26 weeks worked to 41.1 weeks worked. Figure 4:

Employment Insurance Indicator and Average Weeks Worked Indicator by Areas in the Discovery Zone Indicator

Indicator

Employment Insurance Indicator, 2008 Provincial rate: 34.0%

25-54 years of age. All Occupations, 2005 Average weeks worked: 39.7%

Bonavista Area

59.0%

29.1%

Blackhead Bay

64.3%

26.0%

Catalina Area

67.5%

27.7%

Chandlers Reach

58.0%

34.6%

Smith Sound – Random Island

31.5%

41.1%

South West Arm Area

54.3%

35.4%

Placentia Bay North West

45.0%

36.3%

Isthmus of Avalon

53.1%

32.4%

Area

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Determining the Big Picture

For some people, the answer to no or limited employment is outmigration. Since the 1970s, a higher number of people have le the province on an annual basis than the number of people who came here. Net migration peaked at 9,490 in 1997-98 but has been decreasing since with a net migration of 1,877 in 2008-091. It is still prevalent in rural communities such as the Bonavista area. “People commented that outmigration means people may not be as invested in their communities as they once were,” says Camilla. “They told us that working away from families is difficult, and when they get back to their home communities, they have lile time or energy for volunteer activities within their communities.” We heard that in some areas of the region, it is a challenge for youth to get summer or aer-school jobs. There were concerns about the lack of apprentice trades positions in the region and the implications of having to move away to get an apprenticeship.

At a Glance:

• • • •

Getting long-term, consistent employment is a challenge, particularly in the Bonavista Area. Employment has a major impact on people’s mental health and well-being. Dealing with employment through outmigration impacts on the family unit as well as community engagement. Employment is particularly challenging for people with disabilities and those who face other barriers.

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Statistics Canada, Demography Division.


The Results of the Discovery Zone Community Health Needs Assessment

What We Heard: Physical Environment s a Councillor with the Town of Sunnyside, Susan Khaladkar recognizes the impact the physical environment has on health. Throughout the region, Easten Health heard concerns about municipal infrastructure either being insufficient or nonexistent. A lack of sidewalks and street lights means that people must walk on a road or not at all. In other communities, speeding cars on highways that run through the towns are a big concern.

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“We live in aging communities,” says Susan, “and that is having an impact on all of society.” Many people Eastern Health talked to throughout the needs assessment process thought that individuals and organizations need to become more age-friendly. For some communities, water quality is an issue. Trinity Bay North has been on a boil water order for years, yet people still cook and clean with that water. “Some people in the area indicated that they cook vegetables and the water changes the colour of the vegetables, and they wash clothes and the colour of the clothes changes because of the water,” says Susan. “They are wondering about health implications.”

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Determining the Big Picture

’m concerned about water quality. We have been on a boil order for years. I’m concerned about showering, brushing my teeth and cooking food in the water.

I

—Focus group participant “One of the most common themes we heard about was transportation,” says Susan, “particularly as it relates to youth and seniors.” People talked about challenges driving to appointments where there are no public or private transportation options. Challenges regarding road conditions, snow-clearing and moose were all brought up as barriers. Transportation challenges stop people from participating in recreation activities and some cancel medical appointments due to the lack of transportation or the associated costs. People are concerned about seniors who have to drive for services and the impact it has on them -

1 4


The Results of the Discovery Zone Community Health Needs Assessment

they go without care, have increased stress levels and sometimes are forced to move closer to services. For youth, while transportation was cited as a barrier, they also noted that having a driver’s licence and access to a car impacted their wellness because they walked significantly less. While people expressed pleasure with the jobs that industry provides, there were a number of questions about industry links to cancer rates. This particularly came up in the Arnold’s Cove-Sunnyside-Come-ByChance Area and Norman’s Cove Area.

At a Glance:

• • • •

Many towns lack basic municipal infrastructure which may impact wellbeing. Water quality is a big concern for some communities. Transportation is a major barrier for accessing services, particularly for youth and seniors. People wonder about the impact of industry on cancer rates in the area.

1 5


Determining the Big Picture

8

What We Heard: Education and Literacy s someone who has spent 30 years as a teacher, principal and administrator, it’s no wonder that Advisory Commiee member Gerald Giles believes that education is a lifelong process. And the people of the Discovery Zone seem to agree.

A

“Many focus group and key informant participants indicated a desire for education on lifestyle and wellness issues,” says Gerald. “In particular, they want education opportunities in their own community to help address barriers such as transportation and intimidation of going into Eastern Health facilities.” People also want education on healthy foods and eating. There is a sense that there are a lot of mixed messages about nutrition-related topics in particular. “People stressed the importance of health promotion activities in the schools in order to increase awareness and education of health and well being,” says Gerald. “We heard that not only should students be educated about healthy lifestyles, but so too should their parents.”

1 6


The Results of the Discovery Zone Community Health Needs Assessment

e need to create opportunities to link local health professionals to community groups. The population needs an understanding of what services are available and how they are accessed.

W

—Focus Group Participant Eastern Health also heard about the challenge of literacy and the impact that it has on people’s health. “People can sometimes misread or misunderstand medical information or prescription information,” says Gerald. Literacy and education levels also play a key role when navigating the health and community services system. People spoke about confusion in trying to access services, not knowing what services are available and general frustrations with how to get help navigating the system. This was referenced a number of times in relation to certain services, such as long-term care, palliative care and respite care.

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Determining the Big Picture

Throughout the needs assessment, a number of people spoke about the importance of interactions with health care workers. Interactions with front line receptionists and clerical employees were viewed as extremely important to help people feel comfortable and to assist them in navigating the system. Throughout the process, people emphasized the importance of having a family member or friend to navigate through the system and to ensure that people receive the appropriate care. In particular, people worried about those without someone to assist them, such as those with mental health and addictions issues, with disabilities or without family in the area. Youth also indicated they do not always know how to access assistance or guidance on health-related issues. They referenced their reliance on the internet.

At a Glance:

• • • •

1 8

People want education about lifestyle and wellness issues. People feel it is critical to teach young people about healthy living at a very early age. Navigation of the health and community services system is often described as a barrier to accessing services. People worry about those without friends and family and how they navigate through the health and community services system without assistance.


The Results of the Discovery Zone Community Health Needs Assessment

What We Heard: Social Support Networks aphne Smith of Norman’s Cove is a retired community health nurse. “Having someone you can talk to or have fun with is very important for your health,” Daphne says. “For 30 years, I have been meeting with a group of women at a local restaurant. The servers call us the Salad Ladies! It was something I so looked forward to every week. Not only was it a time to get out of the house, but we shared so much in common; working outside the home, life cycles of our children, school activities, even our own life cycles, supporting one another through our networking and friendship. The people who aend have changed over the years, but I have found it to be a great support network.”

D

9

Throughout discussions, people spoke about the importance of having social support networks such as friends or being part of a community group. “In this region, I wasn’t surprised to hear that most people thought that one of the greatest strengths of this region is volunteers,” says Daphne. “Many people commented that our communities can certainly pull together in times of need.”

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Determining the Big Picture

While people spoke positively about volunteers, they wondered about the impact of aging communities on volunteerism, the difficulties in recruiting volunteers and who would be coming behind to take the place of today’s volunteers. Aging communities also brought out another concern, that of isolation. “In some smaller communities,” says Daphne, “we heard about people wondering if seniors and youth feel isolated. This can have an impact on people’s mental health. Everyone needs a friend.” The issue of seniors’ isolation oen came up due to family members moving away. Conversations with youth indicated they felt there were a lot of services for seniors and that youth not actively involved in sports or music at school would probably feel isolated. Throughout the primary research process, people talked about the importance of seniors having someone to help them get the services they need from the health system. As communities age and young families move away, they worry about those who have no one to assist them.

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The Results of the Discovery Zone Community Health Needs Assessment

eople know their neighbours. There is a strong sense of community ownership.

P

—Focus group participants People also stressed the need to be close to their loved ones in long-term care facilities. A number of people commented on the importance of engaging youth in the community in a meaningful way, not just to have a token youth representative. There were also references to elder abuse. Key informants and focus group participants referenced the wide spectrum of elder abuse, from neglect to stealing to violence. People are concerned about such instances and are not always sure how to go about reporting elder abuse.

At a Glance:

• • • •

Aging communities are having an impact on social support networks and isolation of youth and seniors. Volunteerism is strong in the region, but people are wondering who will replace our aging volunteers. Youth need to be meaningfully engaged in their communities. Elder abuse is a concern of people in the region.

2 1


Determining the Big Picture

10

What We Heard: Social Environment al Cole enjoys being a part of many community groups in his hometown of Clarenville. “By being involved in groups such as Crime Prevention and the ALS Society, I have made some great friends,” says Cal, “and I also have the satisfaction of helping others in the community.”

C

Throughout the needs assessment, many people commented positively on the numerous community groups that exist, from the 50+ Clubs to church groups, and the important role that they play in the region. Many of those groups, however, felt that they spend too much time trying to secure grant money in order to operate. They also lamented the restrictions that exist around grants (i.e. funding is available for trail development but not labour, etc.). A number of community groups spoke about the challenge of having buildings and not being able to afford to heat or insure them. Other groups did not have a building to access.

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The Results of the Discovery Zone Community Health Needs Assessment

here is a community depression. There’s a prevailing sense that young people are moving away, businesses are closing, church aendance is down; these losses affect the mood of the whole community.

T

—Focus group participant In focus groups, people remarked on feeling safe living in their communities and indicated they did not worry about personal safety; this was particularly true of youth. With key informants, however, violence was raised as an issue in relation to the lack of a shelter for victims of violence in the region and the importance of stressing that healthy relationships do not include violence. Personal safety of residents was raised as an issue, particularly in communities where highways go through towns (i.e. Swi Current) and due to a lack of municipal infrastructure (i.e. lack of sidewalks and street lights). See also the section What We Heard: Physical Environment.

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Determining the Big Picture

“Collaboration and cooperation were words we heard a lot,” says Cal. A number of focus group participants and key informants commented on the need for community groups to work together for the benefit of the whole community. People particularly noted the importance of communities to work together. There were a number of positive examples of communities working together, such as the merger of a number of municipalities into the one municipality of Trinity Bay North. However, there were also concerns expressed about a lack of cooperation. For example, it was noted a number of times that within the towns of Clarenville, Arnold’s Cove and Come-By-Chance, there are three separate physician recruitment and retention commiees. With aging communities and declining numbers of young people, some focus group participants referenced a “community depression”. People felt that their communities were dying, and they didn’t hold out a lot of hope for their future sustainability.

At a Glance:

• • •

2 4

Community groups do great work, but chasing after grant money is exhausting. Communities are starting to work together, but more of this is required. Many people feel safe in their communities although some were concerned about speeding, lack of sidewalks and street lights.


The Results of the Discovery Zone Community Health Needs Assessment

What We Heard: Healthy Child Development s a mother and grandmother, Bernice Clements of Bonavista, like many people in the Discovery Zone, believes that healthy child development is extremely important.

A

11

“My daughter works at a family resource centre, and so I certainly understand the role of the centres and the impact that they have,” says Bernice, “and I was very pleased to see that the participants in the needs assessment thought the same thing.” People who participated in focus groups and key informant interviews see family resource centres as having a positive impact on the health of children and families. There is a desire to see their hours extended to evenings and weekends and more centres/programming established throughout the region. A number of participants referenced the lack of child care in the region. People talked about the stress of trying to find child care, the impact it has on families in terms of employment and even the impact it is having on people as they decide to have additional children. Both the Neighbourhood of Friends Family Resource Centre (Clarenville) and the Vista Family Resource Centre (Bonavista) have commissioned feasibility

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Determining the Big Picture

he lack of childcare in this region is extremely stressful. I would like to have another child but if I do I will lose my current childcare arrangements. I know couples who arrange to work at dierent times so that they have child care covered. It really stresses relationships.

T

—Focus group participant studies/needs assessments about early learning and child care needs in the area. Both reports indicate a need to build child care capacity in the region. Community Youth Networks (CYNs) is a youth driven service agency designed to engage youth aged 12-18. They are viewed as positive resources within the region. There are currently two in this region (with bases in Bonavista and Clarenville).

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The Results of the Discovery Zone Community Health Needs Assessment

“One of the common themes we heard,” says Bernice, “was the changes in lifestyle of youth.” Many people felt that technology (e.g. video games, the internet, texting) is resulting in children who have less social skills and are less physically active. People wonder about the impact of this on the self-esteem and social skills of children. Linked to lack of physical activity are concerns about nutrition. These concerns range from children and youth who don’t eat enough to those who eat too much. In focus groups, youth themselves indicated that only healthy food is served in the schools but noted that most schools are surrounded by fast food outlets. There is concern with long wait times for services for children, particularly Speech Language Pathology. As with all age groups, there is concern about wait times to get a family physician appointment. Participants in youth focus groups indicated they were less likely to seek help given the long wait times to see a physician. Some participants felt that while sexual health was a topic covered within the school system, the teachers’ comfort level with the topic influenced the degree to which it was discussed.

2 7


Determining the Big Picture

Educators feel they are dealing with more and more complex health issues than ever before. In particular, mental health issues were seen as increasingly challenging. Other health issues such as autism, allergies, diabetes pumps, disabilities and asthma are causing a lot of stress within the classroom seing. Teachers feel that they need additional support in dealing with these issues. See also What We Heard: Health Services - School Health Program. There was some sense that there is a lack of support for parents who are dealing with complex issues with youth, particularly addiction issues and discipline issues.

At a Glance:

• • • •

2 8

The lack of child care in the area is causing problems for many families. Technology is seen as changing youth behaviour, and people expressed concerns about obesity, social skills and isolation issues with youth. There is concern about wait times for services for children. Educators feel they are dealing with complex health issues in the school system and want more support.


The Results of the Discovery Zone Community Health Needs Assessment

What We Heard: Personal Health Practices and Coping Skills s a member of the clergy, Reverend Don Stiles of Arnold’s Cove is very aware of the importance of listening and providing comfort to people. “For some people, clergy and the church are a comfort and can serve as a coping mechanism as they go through life’s challenges,” says Don.

A

12

Coping skills are very individualized, and people have different kinds of coping mechanisms. For many people, for example, having strong social support networks is an important coping mechanism. In many cases, coping skills are influenced by the other determinants of health. For example, income levels can impact on whether someone from a small, rural community can afford to travel to a service centre. Throughout this needs assessment, participants referenced the importance of people taking personal responsibility for their health. People recognized the importance of health services but also stressed that individuals need to take responsibility through exercise, healthy eating and other health interventions.

2 9


Determining the Big Picture

“While people emphasized the importance of personal responsibility,” says Don, “there is confusion about conflicting messages.” For example, on the one hand people understand they should see their family physician if they have a health issue or concern, but people indicated it is difficult to get an appointment. This can mean they go to the Emergency Room for a non-urgent issue where they are asked why they didn’t go to see their family physician. “Some people even indicated that they felt embarrassed at having to go to the Emergency Room,” says Don. They feel the health system sends the message that early intervention is important, however, long waiting times, either to see a family physician or at the Emergency Department, discourages some people from pursuing care until more serious symptoms develop. There is a desire to have education sessions available to people to assist with wellness, (healthy eating habits, cooking techniques, grocery shopping on a tight budget, etc.) and to support people in order to change behaviour. In addition to physical activity, many participants focused on the importance of socialization and coming together as an important part of good mental health. People also stressed the importance of education sessions within their own communities.

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The Results of the Discovery Zone Community Health Needs Assessment

eople are beginning to take more ownership of their health and that’s a positive thing. A health board can’t do the work for us. We must be commied to our own health.

P

—Focus group participant Mobile resources are seen as important from a preventative health perspective and a way to overcome the transportation barrier. School gyms are viewed as a valuable resource, but the ability to use them depends on the personnel at the school. Schools were seen as hard to access when teachers teach in one community but live in another. People are supportive of recreation directors/ community liaisons as champions for physical activity. They spoke about the importance of physical activity and in particular, they were concerned about the lack of physical activity of children and youth. In fact, one participant

3 1


Determining the Big Picture

even declared that if you want to punish your child, force him/her to play outside! See also the section What We Heard: Healthy Child Development. Throughout the interviews and focus groups, people expressed concerns about drug use and addictions. Youth acknowledged the use of drugs at the high school level as a fact of life. Many people indicated that the internet is a major resource for them when trying to find out information about health issues. In the telephone survey, when asked “if you needed a health service for yourself or someone else, how would you get the information you needed,” 35% indicated they would ask their family doctor, 29% indicated they would call a hospital or clinic while 12% said they would use the internet. For youth, their first response was to use the internet. Depending on the source used, there can be credibility issues associated with the information.

At a Glance:

• • • •

3 2

People want to see increased personal responsibility for one’s own health but want to be supported through education sessions. The lack of physical activity of children and youth is very concerning. People of the area are concerned about drug use. The internet is a major source of information about health and well-being, particularly for youth.


The Results of the Discovery Zone Community Health Needs Assessment

What We Heard: Gender and Culture anet Fisher is a Primary Health Care Manager with Eastern Health in Bonavista and served on both the Advisory Commiee and Steering Commiee for the needs assessment. “Two determinants of health are gender and culture,” says Janet. “Gender can impact our health due to various aitudes, behaviours, values and relative power that society gives to the two genders,” says Janet. Many health issues are a function of gender-based social status or roles.

J

13

Women and men have different health issues and can be impacted by the same issues in different ways. Heart disease, for example, affects men and women differently, including diagnosis and treatment. Some issues are gender specific. For example, cervical screening for women is an important tool to help detect cancer. For the Discovery Zone area (defined for this purpose as the area from Chance Cove to Bonavista) the screening rate for 2009 was 30%. Figure 5 provides a visual of the cervical screening rates in this area.

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Determining the Big Picture

Figure 5:

Cervical Screening Rates by Community, Females 12+ years

Community Level Rates of Cervical Screening Females Age 15+, Eastern Newfoundland & Labrador 2008 Percentage of Participation

Population

0% to 10.0%

< 250

10.1% to 20.0%

251 - 1000

20.1% to 40.0% Heart's Content

Inset

1001 - 1500

40.1% to 60.0%

Kingston

Heart's Desire

1500+

60.1% to 97.0%

Perry's Cove

Salmon Cove

0

Victoria

Heart's DelightIslington

30

Freshwater

60

Kilometers

Carbonear Cavendish

Bonavista

Green's Harbour New Harbour

Chapel Arm

Wabana Upper Island Cove

Bishop's Cove Spaniard's Bay Bay Roberts

Keels Duntara

Paradise Cupids Conception Bay Brigus South h ac Georgetown Be River e's South Dildo Clark SouthRoaches Marysvale Makinsons Line Colliers Blaketown Harbour Main - Chapel Conception Harbour Cove - Lakeview

Avondale Holyrood

Brigus Junction

Little Catalina

Plate Cove East and West

Lance Cove

North River

Whitbourne

Newman's Cove

Open Hall-Red Cliffe

Freshwater

Port de Grave Bareneed

Hopeall

Dildo

Old Shop

Elliston

Bryant's Cove

Harbour Grace

Whiteway

Trinity Bay North

Sweet Bay

Cannings Cove Musgravetown Bunyan's Cove Bloomfield Port Blandford

Port Rexton Champney's East Trinity English Harbour Charleston Trouty Lethbridge New Bonaventure Old Bonaventure George's Brook Harcourt-Monroe-Waterville Grates Cove Milton Burgoynes Cove Clarenville Lower Lance Cove

Old Perlican

Deep Bight Caplin CoveSouthport Hillview-Adeytown Hant's Harbour North West Brook-Ivany's Cove Winterton Queen's Cove Long Beach New Perlican Goobies North Swift Current Harbour Sunnyside

Red Head Cove

Bay de Verde Caplin Cove Lower Island Cove Job's Cove

Ochre Pit Cove Western Bay Pouch Cove

Garden Cove

Come by Chance

Flatrock

Arnold's Cove

Torbay

Southern Harbour Chance Cove Grand le Pierre Little Harbour Terrenceville English Harbour East Bellevue Beach Norman's Cove-Long Cove Harbour Mille-Little Harbour East Monkstown Fair Haven Little Bay East St. Bernard's-Jacques Fontaine Long Harbour-Mount Arlington Heights Boat Harbour

Petit Forte

Parker's Cove Rushoon

See Inset

Petty HarbourMaddox Cove Bay Bulls

Ship Harbour Southeast Bight

Red Harbour

Fox Harbour

Jean de Baie Spanish Room Rock Harbour Beau Bois Grand Beach ook Fox Cove-Mortier Grand Bank Tides Br Cove 's Burin in w Le Fortune Epworth-Great Salmonier Point May

Lawn Lord's Cove

Marystown

St. Lawrence Lamaline

Point au Gaul

Witless Bay

Colinet

Tors Cove

Harricott Little Barasway

Cape Broyle

Big Barasway Ship Cove Patrick's CoveAngels Cove Cuslett

St. Joseph's

O'Donnells Admiral's Beach

Riverhead

Mall Bay

St. Bride's Little St. Lawrence

Markland

Placentia Point Verde

Garnish Frenchman's Cove

St. John's Mount Pearl

Branch Point Lance

Calvert Aquaforte Fermeuse

Mobile

Brigus South Admiral's Cove Ferryland Port Kirwan

Renews-Cappahayden St. Mary's Gaskiers-Point La Haye St. Vincent's-St. Stephen's-Peter's River Trepassey

Biscay Bay Portugal Cove South

St. Shott's

Department of Finance Newfoundland & Labrador Statistics Agency

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The Results of the Discovery Zone Community Health Needs Assessment

“Our culture can also impact our health,” says Janet, “because our environment is largely determined by dominant cultural values.” For example, traditionally, Newfoundlanders and Labradorians have eaten a diet that is very high in salt. Eating food such as salt cod, scrunchins and salt beef is a part of the culture and can be difficult to break. This has impacted on people’s health. For example, the Discovery Zone has a diabetes rate of 7.4% compared with the province’s rate of 6.8% and the country’s rate of 4.9%. Similarly, the Eastern Health region, and the province as a whole, has very high rates of obesity. As seen in Figure 6, the Eastern Health region has self-reported Body Mass Index (BMI) rate of overweight or obese of 60.7% compared with 51.1% for the country. For youth, that number is 32.1% compared with the national rate of 19.3%. Low socio-economic status can be linked to high rates of obesity as people struggle to purchase healthy foods on low income.

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Determining the Big Picture

Figure 6:

Body Mass Index, Overweight or Obese, Youth and Adults

Indicator

Eastern Health

Province

Canada

Adult Body Mass Index, Self-Reported, Age 18+, Overweight or Obese, 2008 18

60.7%

63.5%

51.1%

Youth Body Mass Index, Overweight or Obese, Age 12-17, 2008 19

32.1%

34.8%

19.3%

At a Glance:

• • •

3 6

Women and men have different health issues and can be impacted by the same issues in different ways. Traditional eating habits can impact on people’s health and well-being. The province has very high rates of diabetes and obesity.


The Results of the Discovery Zone Community Health Needs Assessment

What We Heard: Biology and Genetic Endowment asic biology and organic make-up of the human body is a fundamental determinant of health. Genetic endowment provides an inherited predisposition to a wide range of individual response that aďŹ&#x20AC;ects health status.

B

14

In the telephone survey, respondents were asked to rate their own health. As Figure 7 indicates, 46.6% of respondents rated their health as excellent or very good. Figure 7:

Self-Rated Health Status of Telephone Survey Respondents

45 Region 40 Bonavista

35 30

Clarenville

25 Arnold's Cove 20 15 10 5 0

Poor

Fair

Good

Very Good

Excellent

Poor

Fair

Good

Very Good

Excellent

0

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Determining the Big Picture

15

What We Heard: Health Services ayne Miller is Eastern Health’s Vice-President of Quality, Patient Safety and Planning. In this capacity, he served on the Advisory Commiee. “Health Services, another determinant of health, very clearly contributes to population health,” says Wayne. Health services are designed to maintain and promote health, prevent disease and restore health and function.

W

“The determinant of Health Services makes up the bulk of this report,” says Wayne. “A number of themes were very clearly heard throughout the process: Health Promotion, Intervention and Prevention; Mental Health and Addictions; Primary Health Services; Secondary Health Care; Healthy Aging and Recruitment and Retention. In general, needs assessment participants were pleased with the number and variety of health and community services offered in the Discovery Zone,” says Wayne. There were many comments received about knowledgeable and responsive Eastern Health

3 8

This section will be divided into five sub-sections, aligning with the themes most often heard.

1

Health Promotion, Intervention and Prevention • School-Based Programs and Services

2

Mental Health and Addictions

Primary Health Services • Family Physicians • Emergency Departments • Ambulance Services • Oral Health • Pharmacy Services • Allied Health Services • Recruitment and Retention

3 4

Secondary Health Care

Healthy Aging • Long-Term Care and Protective Care • Home Care • Seniors Day Care • Respite and Palliative Care

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The Results of the Discovery Zone Community Health Needs Assessment

staff and people expressed gratitude for being able to avail of services locally. This was particularly true of staff that go into communities and schools. In the telephone survey, people were asked: Based on your own experience, how satisfied or dissatisfied are you with health and community services? As Figure 8 indicates, 74.5% indicated they were very satisfied or satisfied. Figure 8:

Telephone Survey Responses: Level of Satisfaction with Health and Community Services

60 Region 50

Bonavista Area

40

Clarenville Area

30

Arnold's Cove

wonK t'noD Don't Know

yreV deifsitassiD Very Dissatisfied

deifitassiD Dissatified

rehtieN Neither

10

deifsitaS

0

Satisfied

0

yreV deifsitaS

10

Very Satisfied

20

20

30

Arnold's Cove

Clarenville Area

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Determining the Big Picture

here are great Eastern Health staďŹ&#x20AC;. All I have to do is phone and they immediately respond.

T

â&#x20AC;&#x201D;Key Informant Interview When asked if health and community service in your area is geing beer, worse or staying the same, 63% of telephone respondents indicated it was staying the same while 14.9% thought it was geing worse, 13.7% thought it was geing beer and 8.4% had no opinion. There was reference in the focus groups and key informant interviews to the need to celebrate the positive aspects of health care.

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The Results of the Discovery Zone Community Health Needs Assessment

Health Promotion, Intervention and Prevention Eastern Health implements measures that promote and protect population health and help prevent disease or injury. In general, needs assessment participants greatly recognize the value of health promotion, intervention and prevention. Throughout the region, people spoke about the importance of promoting self-care initiatives and engaging communities to support communitybased health programming. There was some reference to the importance of community recreation directors and the role they can play in terms of activity-based programming. Participants spoke enthusiastically about health promotion activities that are ongoing within the region but would like to see more education sessions. See also the section What We Heard: Personal Health Practices and Coping Skills. There were many suggestions that health education sessions should be oďŹ&#x20AC;ered in communities throughout the region. Transportation and intimidation of travelling into Eastern Health facilities were seen as barriers that could be addressed by oďŹ&#x20AC;ering education sessions in communities. Sessions such as those on healthy eating, nutrition and parenting were most frequently referenced.

School-Based Programs and Services Over the years, the school has been an important seing for programs and services oďŹ&#x20AC;ered by Eastern Health. Working in partnership with schools and the Eastern School District, Eastern Health supports a variety of individual client and population health based programs and services.

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Determining the Big Picture

In the Discovery Zone, Eastern Health has established School Teams; multidisciplinary teams that provide support for individual client and population health programs and services. Eastern Health has also partnered with the Eastern School District to implement the Healthy Students Healthy Schools initiative. This provincial initiative aims to create a school environment that supports healthy living for children and youth and to foster a healthy lifestyle that will continue throughout life. There are two School Health Promotion Liaison Consultants working in partnership with Eastern Health staff and other community partners. One consultant services the Vista School District (which includes the Discovery Zone). Several initiatives have been undertaken in partnership over the past two years including the implementation of the School Food Guidelines and Eastern School District’s Nutrition policy; development and delivery of Healthy Living workshop with teachers, principals, parents and Eastern Health staff; implementation of the Eastern Health Health Promoting Schools Grant program; Living Healthy Commotions; development and distribution of the Living Healthy News quarterly newsleer.

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The Results of the Discovery Zone Community Health Needs Assessment

would like to see more community-based programs, especially in smaller communities.

I

—Focus Group Participant As discussed in the Healthy Child Development section, special aention was paid to the school system through focus groups with school administrators, principals and youth. A number of themes arose. The H1N1 response was cited by many in the education sector as a true collaboration between the education and the health systems. A number of educators also commented very positively on the work done by some Eastern Health employees within the school system, particularly in the area of mental health and addictions. Some people in the school system, however, feel that Eastern Health is perceived as “nurses with needles” and to some degree, have pulled out of the schools as compared to past activities. Similarly, some Eastern Health staff have expressed concern that it is difficult to get into schools. They both want each other’s assistance, and they want the same outcome healthy children - but current systems are not seen as working to the degree that both parties want. There is a sense that services are available, but there is a lack of true meaningful collaboration. Eastern Health and the Eastern School District have a Liaison Commiee that focuses on high level policy directions, but there is room for more local connections.

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Determining the Big Picture

In terms of nutrition, there were references to the difficulties in policing the existing nutrition policy within the school system; the challenge of schools surrounded by fast food outlets; the difficulty in interpreting food value; the profitability of junk food versus healthy food and the lack of support for caterers. In response to these challenges, Eastern Health has offered catering workshops and made available a food list and nutritionists to assist with menu development. A number of people in the education system thought that offering education sessions regarding health issues to parents would help cement messages that were being given to their children (e.g. school system holds education sessions for parents on the new math system and something similar could be held regarding health-related issues).

At a Glance:

• •

• •

4 4

People value health promotion activities and are thankful for Eastern Health’s professional and helpful staff. People recognize the importance of health promotion, intervention and prevention and would like to see more education sessions offered within their communities to deal with barriers such as transportation. The school system is viewed as a critical part of Eastern Health’s focus to ensure children and youth are well versed in health and wellness. People would like to see enhanced linkages and collaboration between the school system and the health and community services system.


The Results of the Discovery Zone Community Health Needs Assessment

Mental Health and Addictions Mental health was a major theme throughout the needs assessments at almost every focus group and key informant interview. Participants identiďŹ ed increased needs of mental health resources and referenced long wait lists as a major concern. People worried that those who required assistance would not bother to wait for an appointment that is six weeks away. This was particularly a concern for certain client groups such as those with addictions or those involved in the justice system. As Figure 9 indicates, as of November 2010, mental health services in Bonavista and Clarenville had 113 people on the wait list for services. The majority of people on the wait list were referred for mood disorders and anxiety disorders. This equates to a waiting time of six to eight months. All referrals are seen for intake assessment within two weeks of referral and all are prioritized. Urgent referrals are seen as soon as possible.

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Determining the Big Picture

Figure 9:

Wait List for Mental Health Services â&#x20AC;&#x201C; November 2010

Mental Health

Clarenville

Bonavista

TOTALS

Children

10

0

10

Youth

20

9

29

Adult

54

16

70

Senior

4

0

4

88

25

113

Total number waiting

In terms of addiction services, as of November 2010, there were 34 people on the addictions wait list, as indicated in Figure 10. The main reasons for referral were for street drug use and alcohol. This equates to a waiting time of three to six months. All referrals are prioritized, and urgent referrals are seen as soon as possible. Figure 10:

Wait List for Addictions Services â&#x20AC;&#x201C; November 2010

Addictions

Clarenville

Bonavista

TOTALS

Children

0

0

0

Youth

3

0

3

Adult

11

6

17

Senior

0

1

1

14

7

21

Total number waiting

4 6


The Results of the Discovery Zone Community Health Needs Assessment

Participants also referenced the stigma associated with mental health and addictions. This received particular mention in Bonavista where those services can only be accessed in the basement of the Bonavista Peninsula Health Centre. In the telephone survey, people were asked about satisfaction levels of a number of health services. Forty-one per cent of respondents who had used mental health services in the past year indicated they were very satisfied with mental health services while 21.8% indicated they were very dissatisfied mostly due to long wait times. People commented on the excellent service received but worried about the wait times to receive services.

At a Glance:

• • •

The efforts of mental health and addictions staff who go into communities and schools are very much appreciated. Concerns about mental health and addictions came up in almost every focus group and key informant interview. People think the wait times for mental health services is excessive and results in people not bothering to wait for assistance.

4 7


Determining the Big Picture

Primary Health Services Eastern Health investigates, treats, rehabilitates and cares for individuals with illness or injury. Primary Health Care is the ďŹ rst point of contact for all patients. The most common references made under this theme were around family physicians, emergency departments, ambulance services, chronic diseases, oral health, pharmacy services and allied health services.

Family Physicians The most common concern expressed in the qualitative research (focus groups and key informant interviews) was the lack of access to family physicians. There is a sense throughout the region that there are not enough family physicians in the area; that there are many residents in the region without a family physician; and those with a family physician must wait a long time for an appointment. However, in the telephone survey, when respondents were asked if they had a family physician, 89.4% said yes. This is consistent with Eastern Healthâ&#x20AC;&#x2122;s other rural needs assessment results where respondents of the Burin Peninsula and the Southern Avalon had 88% of respondents with a family physician but lower than the Northeast Avalon needs assessment results with 97.3%, as seen in Figure 11.

4 8


The Results of the Discovery Zone Community Health Needs Assessment

Figure 11:

People Reporting Having a Family Physician by Needs Assessment No Family Doctor

With Family Doctor

Burin Peninsula

Southern Avalon

Northeast Avalon

Discovery

Burin Peninsula

Southern Avalon

Northeast Avalon

Discovery

Within the three areas of the Discovery Zone, there were some diďŹ&#x20AC;erences in terms of people who reported having a family doctor as seen in Figure 12 where 94.3% of respondents in the Arnoldâ&#x20AC;&#x2122;s Cove Area have a family doctor; 90.1% in the Clarenville Area and 84.4% in the Bonavista Area.

Figure 12:

People Who Report Having a Family Physician by Area Yes

No

Arnold's Cove

Clarenville

Bonavista

Arnold's Cove Area

Clarenville Area

Bonavista Area

4 9


Determining the Big Picture

In the Discovery Zone, of those who had a family physician, 73.6% have been seeing the same physicians for ďŹ ve years or more. Half of those with family physicians travel up to 10 minutes from their home to their family physician oďŹ&#x192;ce and 23.4% travel more than 31 minutes. While the percentage of those with family physicians is similar to other rural results, the waiting times to see a family physician are longer in the Discovery Zone than other areas assessed. In terms of wait times to get an appointment for a non-urgent maer, 37.8% can get an appointment within a week while 19.1% wait 1-2 weeks, 13.6% wait 2-3 weeks and 15.9% wait more than 3 weeks. In comparison, the Northeast Avalon and Southern Avalon 20 indicate shorter wait times as seen in Figure 13. Figure 13:

Wait Times to Get Family Physician Appointment by Area

160 Discovery Zone 140 North East Avalon 120 Southern Avalon

100 80

60

5 0

80

2 ot 1 skeew

3 ot 2 skeew

1 to 2 weeks

2 to 3 weeks

more than 3 weeks

nihtiw keew a within a week

40

yad txeN

0 20

Next day

0

yad emaS

20

Same day

40

naht erom skeew 3

60


The Results of the Discovery Zone Community Health Needs Assessment

In the Bonavista Area, people felt that the turnover of family physicians was excessive; however, a review of tenures of family physicians indicates that there has been stability in the area. Of the ďŹ ve contracted physicians at the Bonavista Peninsula Health Centre, three have been working there between three and 12 years with two working for less than one year. In addition, there are three fee-per-service physicians in the area who have been working from between four and 35 years. People also expressed concern over the likelihood of physicians retiring in the near future and the added stress that would cause. In the Clarenville Area, people were concerned with the lack of availability of family physicians during evenings, weekends or Friday aernoons and the lack of walk-in clinics. During discussions with family physicians, they noted this area as aracting seniors as a place to retire. This, combined with the aging population in general, means that acuity and complexity of their patients is increasing, particularly as it relates to chronic disease management. Chronic disease management, particularly diabetes, cancer and heart disease, is a concern for people. As Figure 14 indicates, the incidence of these diseases is high compared with national averages. The community family physicians indicated that it is very diďŹ&#x192;cult if not impossible for them to focus on health promotion.

5 1


Determining the Big Picture

Figure 14:

Incidence of Diabetes, Cancer and Heart Disease

Eastern Health Rate (Confidence Level)

Newfoundland & Labrador Rate (Confidence Level)

Canada Rate (Confidence Level)

Chronic Conditions – Diabetes, Age 12 +), 2008 21

8.1% (6.0-10.2)

8.8% (7.3-10.4)

5.9% (5.6-6.2)

Chronic Conditions – High Blood Pressure, Age 12+, 2008 22

18.5% (15.9-21.1)

20.2% (18.3-22.1)

16.4% (16.0-16.8)

Mental Health

Participants in focus groups also referenced the importance of family physicians as sources of information for the general public. During Eastern Health staff focus groups, in particular, participants stressed the importance of consistent communications with family physicians regarding new services available and to keep them informed about general wait times for services. This was validated in the telephone survey. When asked how they would get information about health services, 34.7% of respondents indicated they would ask their family doctor. In particular, Eastern Health staff felt that family physicians needed to be kept apprised of new services so that referrals could be made locally, rather than sending patients outside of the area unnecessarily. Family physicians in the Clarenville and Arnold’s Cove Areas spoke about a lack of relationship with the Dr. G. B. Cross Memorial Hospital and Eastern Health and seem to want to strengthen ties for the benefit of patients.

5 2


The Results of the Discovery Zone Community Health Needs Assessment

In the Bonavista Area, people referenced a lack of privacy and concerns about confidentiality at the Bonavista Community Health Centre when visiting family physicians. Participants, including youth and physicians themselves, commented on the combined use of clinic space and office space as well as the closeness of offices as barriers to privacy. A number of concerns were also brought up regarding the newly renovated blood collection area as not offering enough space for people to sit down and not having privacy. Clinics in the region, the Trinity Clinic and the Norman’s Cove Clinic, were referenced as not being used to their full capacity; and a number of participants did not realize that certain services (i.e. physician and nurse practitioner services) were even offered. There has been a decline in the number of clinics in Trinity from 63 offered in 2007-08 to 41 in 2008-09 and 40 in 2009-10. Nurse Practitioners were well received in the Bonavista and Clarenville Areas but not understood or seen as a partial solution in the Arnold’s Cove Area. When asked if they had seen a Nurse Practitioner in the past year, only 11.8% of telephone survey respondents indicated they had. The majority of those were in the Clarenville Area.

5 3


Determining the Big Picture

Emergency Departments People reported using an Emergency Department due to long waits for family physician appointments. As shown in Figure 15, in the telephone survey, 48.3% of respondents reported using an Emergency Room at least once over the past 12 months with 40% of those making 1-4 visits. Of the 48.3% of those that indicated they used an Emergency Room in the past 12 months, 67.1% of those went to the Emergency Department of the Dr. G.B. Cross Memorial Hospital. The least frequent users of the Emergency Room were in the Arnold’s Cove Area, the area with the highest percentage of those people reporting having a family doctor and the least waiting time to see a family doctor. Participants voiced concerns with using Emergency Departments for nonurgent issues but felt there was no other choice. They also voiced concern about confusing messages. For example, they are told to take a preventative approach to their health. When they can’t get a family physician appointment and must go to Emergency, they feel that they are not well received at that department and questioned as to why they are there. A number of people expressed frustration when, aer visiting an Emergency Room, they are told to see their family physician the next day when they felt that staff and physicians in the Emergency Room would know that this would not be possible.

5 4


The Results of the Discovery Zone Community Health Needs Assessment

Figure 15:

Number of visits to Emergency Room in Past 12 Months by Area

70 Region 60 Bonavista 50 Clarenville 40 Arnold's Cove 30

20

10 1-4 times

5-9 times

10+ times

Didn't visit

1-4 times

5-9 times

10+ times

Didn't visit

0 0

Of those that had used an Emergency Room, satisfaction levels were at the two ends of the spectrum. As indicated in Figure 16, 22.3% of telephone survey respondents rated their experience a 5 (very satisfied) while 21.3% rated it a 1 (very dissatisfied) with 25.3% at a 3 (neither satisfied nor dissatisfied). Those that indicated they were very dissatisfied with the Emergency Department mostly said it was because wait times were too long.

5 5


Determining the Big Picture

Figure 16:

Satisfaction Levels with Emergency Rooms

30 Discovery Zone 25

0

Arnold's Cove Area deifsitassid yreV - 5

5

deifsitaS - 2

10

deifsitas yreV - 1

15

Clarenville Area

deifsitassiD - 4

20

deifsitassid ro deifsitas rehtieN - 3

Bonavista Area

Very Dissatisfied

Dissatisfied

Neither

Satisfied

5

Very Satisfied

0

10

15

Discovery Zone

The Dr. G.B. Cross Memorial Hospital does not track wait times at the Arnold's Cove Area 20 Emergency Department as defined from the time a patient is triaged to the time he/she is seen by a physician. In an effort to address the wait times at the Emergency Department at the Dr. G.B. Cross Memorial Hospital and the lack of family physicians in the area, Eastern Health hired hospitalists. For the fiscal year 2009-10, 3,782 patients registered at the hospitalist clinic. From April 1, 2010, to September 14, 2010, that number was 1,864. In addition to family practice

5 6


The Results of the Discovery Zone Community Health Needs Assessment

clinics, hospitalists are also responsible for inpatients who do not have a family doctor, and as the Emergency Room gets busy, they see patients who have been triaged at the lowest levels of the acuity scale.

Ambulance Services Ambulance service was brought up a number of times during the needs assessment. The majority of concerns regarding ambulance service were around the practice of responding to a call by first picking up a second aendant and then going to the call. Community residents feel this slows response times. In the telephone survey, 26% of respondents indicated that they had used ambulance services in the past 12 months. This compares with 15% in the Southern Avalon needs assessment and 25% in the Northeast Avalon needs assessment. Of the 26% of telephone respondents who had used an ambulance, 60.9% of those said they were very satisfied with the service. Of those, 79.5% in the Clarenville Area were very satisfied while 50% of those in the Arnold’s Cove 2 Area and 53.6% of those in the Bonavista Area were very satisfied. People who said they were very dissatisfied were so mostly because of wait times.

_________________________________________________________ 2

An ambulance service based in Arnold’s Cove was announced by the Minister of Health and Community Services on August 31, 2010. 5 7


Determining the Big Picture

A conversation with a local ambulance provider indicates that response times are within the parameters set by the provincial government. The second point that arose regarding ambulance service is the lack of understanding of how the service works. Most people are unaware of the costs incurred with ambulance services, and there is confusion regarding who pays for the service. There is also some sense in the community that some people abuse ambulance services as a way to bypass waiting times at the Emergency Room. This has recently been addressed at the Dr. G. B. Cross Memorial Hospital so that patients arriving by ambulance are triaged if necessary prior to going into the department.

Oral Health Oral health is viewed as problematic in the Bonavista Area and Arnoldâ&#x20AC;&#x2122;s Cove Area where dental services are limited or non-existent. This is seen in Figure 17 where only 47% of respondents to the telephone survey indicated they had visited a dentist in the last 12 months. In the region, only 40% of respondents to the telephone survey indicated that they had dental insurance, ranging from a low of 33.9% in the Bonavista Area to a high of 47.4% in the Clarenville Area.

5 8


The Results of the Discovery Zone Community Health Needs Assessment

Figure 17:

Incidence of Visiting a Dentist

Yes

No

Overall

Arnold's Cove Area

Overall

Arnold's Cove Area

Clarenville Area

Clarenville Area

Bonavista Area

Bonavista Area

A number of family physicians also reported seeing increased cases of oral health issues. In the case of children’s oral health, there are two poles in the spectrum: children who are taken out of school for orthodontist appointments every couple of weeks and children who haven’t seen a dentist in years. There was also concern expressed with the dental care of residents of personal care and long-term care facilities. Dentists do not come into the facilities and geing residents of personal care homes or long-term care homes to a dentist’s office can be very challenging given mobility issues.

5 9


Determining the Big Picture

Pharmacy Services In the telephone survey, 85% of people reported having a prescription filled in the past 12 months and 97.9% of people said that they did not have any problem geing a prescription filled. Qualitatively, in the key informants and focus group sessions, a number of people commented on the helpfulness of pharmacists in the community but wondered if people used their knowledge base as much as they could. People also thought that pharmacists could be a great source of information regarding services available in the community. Some physicians referenced concerns about medications. In some instances, patients have been referred on to specialists who may provide a new prescription or change a prescription. Family physicians expressed concerns that, in some cases, when a patient goes to a community pharmacy to have the prescription refilled, a discontinued medication is filled because the pharmacy database has not noted that that medication has been discontinued.

6 0


The Results of the Discovery Zone Community Health Needs Assessment

Allied Health Services Qualitatively, a number of needs assessment participants referenced the wait times for allied health services such as physiotherapy, occupational therapy and speech language therapy. Some concern was expressed in the Bonavista area that speech language pathology visits from Clarenville no longer occurred. With the recent hiring of a third speech language pathologist at the Dr. G.B. Cross Memorial Hospital, these clinics are expected to resume.

Recruitment and Retention A number of people suggested that the health system should play a stronger role within the education system to promote health careers either through offering tours of health facilities or presenting at career fair opportunities. Several people made the point that educating rural students for careers in the health field may help to address challenges of recruitment and retention. There was also a call to increase the number of seats at the Faculty of Medicine at Memorial University of Newfoundland in order to help address recruitment and retention of physicians. In 2008, the provincial government announced an expansion in seats to 78 within five years, an increase of 30%.

6 1


Determining the Big Picture

• • •

At a Glance:

• • • • • • • • •

6 2

People in the Discovery Zone wait longer to get in to see their family physician than any other region assessed by Eastern Health to date. People are worried that physician turnover and future retirements will result in even longer wait times for appointments. Inability to get a timely appointment to see a family physician is resulting in visits to Emergency Departments for non-urgent matters and is impacting people’s ability to focus on health promotion and early intervention. Family physicians are key sources of information for people about health concerns and services available in the area. People do not have a clear understanding of how ambulance services work, particularly in terms of cost. Chronic diseases, such as diabetes, heart disease and cancer, are concerns for people. Both the lack of dentists in the region and the lack of dental insurance coverage are resulting in low uptake of dental visits. Pharmacists are seen as key members of the health care team and are key contacts to provide health information. There is concern by physicians regarding discontinued medications being refilled by pharmacies. Some health and community services and programs are not well known or understood and people do not always know how to access services. There is a feeling that more students should be accepted into Memorial University of Newfoundland’s Faculty of Medicine. More emphasis needs to be put on increasing awareness of careers in the health care field, particularly directed to high school students.


The Results of the Discovery Zone Community Health Needs Assessment

Secondary Health Care Secondary Health Care refers to the treatment received by a specialist from a primary health care referral. A number of people spoke about the importance of specialist services (secondary services) at the Dr. G.B. Cross Memorial Hospital. They emphasized the importance of having a full slate of specialists, not just to ensure appropriate care and reduce transportation for patients, but also to ensure that funding for those positions are maintained at the hospital. As indicated in Figure 18, recruitment eďŹ&#x20AC;orts have been successful and work continues in this area. Figure 18:

Specialist Positions at the Dr. G. B. Cross Memorial Hospital as of November 20, 2010

Discipline

General Surgeon

Current Positions Filled/ # of Positions

Notes

2.5 of 3

Obstetrician/Gynecologist

1 of 2

Second position hired; awaiting licensing and work permit processes

Psychiatrist

1 of 2

Second position hired; awaiting the licensing and work permit processes

Radiologist

2 of 2

One position will be vacant due to retirement December 2010.

Anesthesia

2 of 3

Pediatrics

2 of 2

Pathology

2 of 2

Internal Medicine

2 of 3

Related to the turnover of specialists is the confusion that results when patients are moved from one specialist to another. Patients are distressed if they need to go to the boom of a wait list when they need to change

6 3


Determining the Big Picture

specialists. Eastern Health’s Northeast Avalon Community Health Needs Assessment, Access: Charting the Course, focuses on wait lists for specialists extensively. Recommendations from that report are relevant to the findings in this report (see Appendix III). In the telephone survey, 63% of respondents reported accessing specialist services in the past year. Of those, 49% indicated they were very satisfied or satisfied with the service while 30.8% said they were very dissatisfied or dissatisfied and 20.2% were neither satisfied nor dissatisfied. The overwhelming majority of those who expressed dissatisfaction did so because of long wait times. People spoke about health services and clinics that are reduced without knowing the reason why (i.e. no more visiting specialists in Bonavista or no more speech language pathologist visits in Bonavista) and the sense that once these clinics/services stop, they will not be offered in the future. In most cases, clinics or services may not be able to be offered if there is a position vacancy. People are concerned about appointments provided early in the morning without regard for travel times.

At a Glance:

• • •

6 4

People want a commitment to ensure the full complement of specialists at the Dr. G. B. Cross Memorial Hospital. With specialist turnover, there is confusion about coordination of wait lists and test results. Barriers such as transportation should be considered when booking appointments.


The Results of the Discovery Zone Community Health Needs Assessment

Healthy Aging Another major theme arising from the needs assessment focuses on seniors and health services, in particular, long-term care, protective care, home support, respite care and palliative care.

Long-Term Care and Protective Care A number of long-term care issues were mentioned during the primary research. These included the distance people must travel to see loved ones in long-term care or personal care homes, the diďŹ&#x192;culty in obtaining home care, the importance of allowing people to stay in their own homes as long as possible and the lack of protective care beds. People expressed concern that there are not enough longterm care beds in this region, resulting in seniors being forced to live in facilities far away from their homes and families. As indicated in Figure 19, the wait list for the Dr. Albert Oâ&#x20AC;&#x2122;Mahony Memorial Manor has consistently been in the 50s while the wait list for Golden Heights Manor has increased to 18 with the Protective Care Unit in Bonavista having a wait list of less than six in the time period March to August 2010.

6 5


Determining the Big Picture

Figure 19:

Long-Term Care Wait List *

Month/Year

Dr. A. O’Mahony Memorial Manor, Clarenville

Golden Heights Manor, Bonavista

Protective Care Unit, Bonavista

March 2010

56

10

3

April 2010

58

20

2

May 2010

56

21

2

June 2010

55 (33 awaiting transfer)

18 (4 awaiting transfer)

0

July 2010

53 (29 awaiting transfer)

20 (3 awaiting transfer)

0

August 2010

55 (34 awaiting transfer)

18 (2 awaiting transfer)

0

*Caution must be exercised when interpreting wait lists as some individuals are waitlisted for more than one facility. There was concern regarding Alzheimer’s care and the anticipated increased incidences of this disease as the population ages. The only protective care unit in the Discovery Zone is in Golden Heights Manor, Bonavista, with 12 protective care beds and one respite bed. This unit will be moving to a coage style unit with the same number of beds available. People believe that this will not be a sufficient number of beds in the region. The difficulty in accessing long-term care beds is also reflected in occupancy levels at the Dr. G.B. Cross Memorial Hospital. As of October 2010, 11 out of 21 medical-surgical beds at the Dr. G.B. Cross Memorial Hospital were filled with patients requiring Alternative Level of Care (ALC). ALC type patients do not require acute care services but they do

6 6


The Results of the Discovery Zone Community Health Needs Assessment

require either a lower level of care such as long-term care or transitional care, or they are awaiting home supports. When patients are designated as ALC they remain in the hospital until an alternate discharge plan is put in place or the appropriate bed in the appropriate care seing becomes available. In addition to impacting occupancy levels, this has a domino impact at the Emergency Room. For the 2009-10 fiscal year, patients waited an average of 11.38 hours from the time they were admied from the Emergency Department to the time that they received an inpatient bed at the Dr. G.B. Cross Memorial Hospital. By comparison, at the Burin Peninsula Health Care Centre, the wait was 4.48 hours. People expressed some concern about difficulty accessing personal care homes, although the vacancy rate at personal care homes in the Discovery Zone is about 33%, as seen in Figure 20 (as of August 31, 2010). Figure 20:

Personal Care Homes in the Discovery Zone, Vacancy Rate, August 31, 2010

Personal Care Home

Location

Number of Beds

Vacancy Rate

Luxury Estates

Bonavista

82

37%

Clarenville Retirement Home

Clarenville

90

27%

Cozy Quarters

Clarenville

30

3%

Shirley’s Haven

Catalina

50

32%

Musgravetown

20

55%

Hickman’s Harbour

20

25%

Arnold’s Cove

32

53%

Greenwood Rest Home MiraQuinn Hilltop Manor Hilltop Manor

6 7


Determining the Big Picture

ong-term care in Clarenville was already full when the new O’Mahony Manor opened. There are relatives all over the place.

L

—Focus group participant A number of people thought that recreational activities should be available for residents of personal care homes. Residents of personal care homes are typically in beer mental and physical health than residents in a long-term care facility yet recreational services are sometimes minimal and at the discretion of the personal care home owner. In general there is a lot of confusion about how to access services for seniors, particularly long-term care services. In particular, the financial assessment and ramifications of moving into a long-term care home are confusing for people. At Golden Heights Manor, there is concern that a person can walk in the building and go into a resident’s room without ever seeing a staff person. They worry about safety implications.

Home Care In general, participants spoke about the desire to allow people to age in their own homes and own communities for as long as possible. This

6 8


The Results of the Discovery Zone Community Health Needs Assessment

requires support of caregivers as well as access to home support workers whom people believe should be beer paid. The challenge of finding home support workers was referenced a number of times.

Seniors Day Care People also talked about the need for day care for seniors; a place where seniors could go during the day to socialize with others while providing a break for caregivers. People see this as an important component to healthy aging and a way to maintain social supports while also keeping busy.

Respite and Palliative Care A lack of information about certain services such as palliative care and respite care was referenced. People were unsure of what was available and where and how it could be accessed. Related to the difficulty navigating the health and community services system, people were confused with what services are available by self-referral, speaking once again to challenges around navigation.

At a Glance:

• • •

The process to apply to long-term care and personal care homes is not well known and people have difficulty accessing the information they need. People feel the number of long-term care beds and protective care beds in the area is inadequate. Seniors want to age in their homes but feel more home support workers are required and services such as seniors daycare would help to enable this. Services such as respite care and palliative care are not well known and are seen as difficult to navigate.

6 9


Determining the Big Picture

16

Recommendations and Implementation In some cases, operational issues have arisen during the community health needs assessment process and have been addressed as this process has been ongoing. A number of recommendations have been developed to address the issues that have arisen during the needs assessment process. In order to facilitate the movement of these recommendations, action plans will be developed for each. As with Eastern Healthâ&#x20AC;&#x2122;s previous needs assessments, the results of this report will be communicated with a public release of the ďŹ ndings and recommendations. To ensure accountability of the recommendations, the Board of Trustees of Eastern Health will receive a semi-annual wrien report on the progress of the implementation of the recommendations. Two years from the release of the report, a public report will be provided on the implementation of recommendations. Health Promotion, Intervention and Prevention The people of the Discovery Zone clearly see the importance of health promotion, intervention and prevention activities. To address the issues that arose, Eastern Health commits to the following recommendations: 1) Communicate the results of this assessment to members of the Eastern Region Wellness Coalition to discuss the ďŹ ndings of the needs assessment. As part of this commitment, the organization will also develop a practical handbook for community groups to outline how they can address some of the issues, such as transportation barriers, raised in the needs assessment.

7 0


The Results of the Discovery Zone Community Health Needs Assessment

2) Develop a communications plan for Eastern Health. This plan will include topics brought up in the ďŹ ndings, including promotion of local clinics and hospitalists, taking personal responsibility for your health, customer service training for front-line employees and developing a listing of credible sources of internet health information. 3) Work with the existing Eastern Health-Eastern School District Liaison Commiee to strengthen the relationship between the two entities at a local level. 4) Work in consultation with the Eastern School District to communicate to the public the contribution schools have made and continue to make in the promotion of health and wellness among the school population. Mental Health and Addictions People are eager to have a focus on mental health promotion and are particularly concerned about wait times for services. To address this issue, Eastern Health commits to the following recommendations: 1) Develop a local community advisory commiee to review the identiďŹ ed mental health issues and develop an action plan to address same. Primary Health Care People recognize the importance of timely access to primary health care services. Eastern Health commits to the following recommendations: 1) Organize a symposium in the Discovery Zone to discuss physician recruitment and retention issues with key partners.

7 1


Determining the Big Picture

This symposium will provide a comprehensive look at the challenges around recruitment in the Discovery Zone and provide an indication of what eďŹ&#x20AC;orts have worked in other parts of the province. 2) Establish an annual meeting between family physicians and Eastern Health. This meeting will help to provide an opportunity to formalize communication channels. 3) Implement fully the Client Centred Waitlist Management Strategy of Eastern Health as per the Northeast Avalon Community Health Needs Assessment (See Appendix III). 4) Initiate mechanisms to electronically track Emergency Department wait times in Clarenville and Bonavista. 5) Develop a handout regarding ambulance services for patients detailing the costs and use of the service. 6) Develop a strategy aimed at increasing interest and awareness of health and community services sector careers to high school students. Healthy Aging The needs of our aging population came out clearly in the ďŹ ndings of this needs assessment. To address the issues that arose, Eastern Health commits to the following recommendations: 1) Initiate the age-friendly concept throughout the organization. Emphasizing this concept throughout the organization will increase awareness of the needs of that population (e.g. the issue of oral health as raised in the primary research). As part

7 2


The Results of the Discovery Zone Community Health Needs Assessment

of this initiative, Eastern Health will develop a guide/manual around preparing to be admied to a long-term care home. 2) Review the number of long-term care and protective care beds in the area to determine appropriateness of bed numbers. 3) Conduct an assessment on Golden Heights Manor to determine any security issues. 4) Establish a Working Group to co-ordinate palliative care services for the Peninsulas region with the newly appointed Coordinator for Palliative Care. 5) Work with partner agencies and government to build on communication messages regarding elder abuse and how to report it. Build Regional Capacity Eastern Health values its work and collaboration with many community partners. It is important to share information and work together to beneďŹ t the well-being of the population. To further address the issues that arose in this needs assessment, Eastern Health commits to the following recommendation: 1) Work with partner organizations to enhance collaboration and discussion of issues of mutual concern. These include: a. the Eastern School District to advocate for a Community School Model; b. Municipalities Newfoundland & Labrador (MNL) to discuss the health and well-being of communities; c. the Department of Tourism, Culture and Recreation to build regional capacity and identify opportunities to address

7 3


Determining the Big Picture

physical activity and recreation, healthy eating and tobacco control; d. the Family Resource Centres to advocate for increased child care services in the area; e. the local detachment of the RCMP to focus on mental health and addictions issues; f. the Pharmacists Association of Newfoundland & Labrador to build relationship as a resource in the community.

7 4


The Results of the Discovery Zone Community Health Needs Assessment

Conclusion When reviewing the determinants of health, it is clear that improving the health and well-being of a population is not solely one organizationâ&#x20AC;&#x2122;s responsibility. Eastern Health values its work and collaboration with many community partners and individuals. We hope that this report and the information it contains will be used by many people to beneďŹ t the well-being of the people in the Discovery Zone

17

7 5


Determining the Big Picture

18

Appendix I: Primary Research Methodology Summary Telephone Survey Telelink Research was hired to conduct telephone interviews. Interviews were conducted using a Computer Assisted Telephone Interviewing (CATI) system and an automatic dialer. All listed residential telephone numbers for each of the three sampling areas (Arnoldâ&#x20AC;&#x2122;s Cove Area, Clarenville Area and Bonavista Area) were obtained from an electronic database and were randomized prior to being loaded into the automatic dialer. During the course of the survey, a total of 7,740 calls were made, resulting in 1,009 completed interviews. The collected data was imported into an SPSS (Statistical Package for the Social Sciences) computer program for analysis. Prior to analysis, the data was weighted by population, 19 years of age and older, in each region. The 1,009 completed interviews were distributed throughout the survey region as indicated in the table below. A sample size of 1,009 has a margin of error of +3.02 percentage points 19 times out of 20.

Number

Percent

Margin of Error (95% level of confidence)

Arnoldâ&#x20AC;&#x2122;s Cove Area

334

33.1%

+5.15 (19 times out of 20)

Clarenville Area

342

33.9%

+5.20 (19 times out of 20)

Bonavista Area

333

33.0%

+5.28 (19 times out of 20)

1,009

100%

+3.02 (19 times out of 20)

Sampling Area

Total

The results of the telephone survey in their entirety are available at  www.easternhealth.ca.

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The Results of the Discovery Zone Community Health Needs Assessment

Key Informant Interviews Key informant interviews were held with representatives of the following organizations: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.

Rural Secretariat, Clarenville-Bonavista RCMP – Clarenville-Bonavista Detachment Provincial Age-Friendly Initiative Department of Human Resources Labour and Employment Communities Against Violence Eastern Region Wellness Coalition Ability Employment Corporation Homelessness & Affordable Housing Initiative College of the North Atlantic – Clarenville Campus Department of Industry Trade and Rural Development Eastern School District Members of the House of Assembly (MHAs) for the Region (4) Chamber of Commerce – Clarenville Area Community Youth Network – Clarenville Community Youth Network – Bonavista Discovery Regional Development Board Fewer’s Ambulance Victim Services, Department of Justice

Wrien Submissions • Healthy Aging - LTC and CS • Unable to Have Access to Test Results in time for Specialist Appointments • Dental Care for Long-Term Care Residents • Concerns About Health Care System • Health Issues Concerns in Bellevue Area • Health Concerns Re Seniors • Relationship Between Physicians and Specialists • Highlights of Seniors Issues

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Determining the Big Picture

Focus Group Sessions

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Area

Group

Regional

• • • •

Rural Secretariat Youth Protocol Committee School Principals Discovery Zone Advisory Committee

Bonavista Area

• • • • • • • •

Local Government Leaders Bonavista Primary Health Care Advisory Committee Bonavista Area Staff Bonavista Area GPs and NPs Ministerial Association Community Stakeholders Community Youth Network Ability Employment Corporation – Youth

Clarenville Area

• Local Government & Community Stakeholders • Community Youth Network • Health Providers (GPs/NPs) • Health Providers – Staff at Park Place, Laskey Place & DM Brown Building • Health Providers (Specialists) • Neighbourhood of Friends

Arnold’s Cove Area

• • • •

Local Government Health Providers (GPs) Community Stakeholders Ministerial Association


The Results of the Discovery Zone Community Health Needs Assessment

Appendix II: Population and Communities in Each of the Three Areas Assessed Area

Bonavista Area

Clarenville Area

Arnoldâ&#x20AC;&#x2122;s Cove Area

Population

19

Communities Included

9,140

Birchy Cove, Bonavista, Catalina, Champney's East, Champney's West , Charleston, Dunfield, Duntara, Elliston, English Harbour, Hodderville, Keels, King's Cove, Knights Cove, Little Catalina, Lower Amherst Cove, Melrose, Middle Amherst Cove, New Bonaventure, Newmans Cove, Old Bonaventure, Open Hall, Plate Cove East, Plate Cove West, Port Rexton, Port Union, Princeton, Red Cliff, Southern Bay, Spillerâ&#x20AC;&#x2122;s Cove, Stock Cove, Summerville, Sweet Bay, Tickle Cove, Trinity, Trinity East, Trouty, Upper Amherst Cove

13,955

Adeytown, Bloomfield, Brooklyn, Bunyan's Cove, Burgoynes Cove, Butter Cove, Cannings Cove, Caplin Cove, Charlottetown, Clarenville, Clifton, Deep Bight, Georges Brook, Gin Cove, Gooseberry Cove, Harcourt, Hatchet Cove, Hillview, Hodge's Cove, Ivany Cove, Jamestown, Lethbridge, Little Heart's Ease, Long Beach, Milton, Monroe, Muddy Brook, Musgravetown, North West Brook, Port Blandford, Portland, Queen's Cove, Southport, St. Jones Within, Terra Nova, Thorburn Lake, Waterville, Winter Brook, and all of Random Island.

5,610

Includes all communities from Goobies to Chapel Arm and Long Harbour-Mount Arlington Heights. Garden Cove, North Harbour, Swift Current and Woody Island 23

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Determining the Big Picture

20

Appendix III: Backgrounder - Client Centred Waitlist Management Strategy for Eastern Health The Clinical Efficiency department of Eastern Health, whose goal is to improve client access to health care services, has developed a Client Centred Waitlist Management Strategy for Eastern Health. This strategy is regional (i.e. applicable across all of the Eastern Health region) and can be implemented wherever patients must wait for services. Initially, the strategy was developed to address adult and pediatric surgical waitlists but has grown to include 15 waitlists at various stages of development within programs across the entire Eastern Health region: Rheumatology, Mental Health, Community Allied Health, Speech Language Pathology, Long Term Care, Gastroenterology, Ophthalmology (Janeway), Rehabilitation and Diagnostic Imaging. The strategy involves three main phases: • Pre-implementation phase which consists of: (1) an environmental scan (2) current processes and waitlist review, (3) developing baseline documents which include an urgency classification tool to facilitate prioritizing clients on the waitlist according to need, and defining measureable and appropriate wait time intervals. These documents form the basis for evaluation of the key performance indicators. • Implementation phase which consists of (1) implementing recommended changes to streamline processes, (2) electronically capturing client wait time information, (3) communicating changes to all stakeholders. Recommended changes, for example, may include development of a standardized referral form. The referral form is reviewed upon receipt by a clinician who determines referral appropriateness and client urgency (if not already assigned by the referring agent). The strategy also recommends that the referring agent be notified that their client’s referral has been received and the

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The Results of the Discovery Zone Community Health Needs Assessment

client has either been placed on the waitlist or given an appointment. If the referring agent wishes an earlier appointment they may make direct contact with the service provider. As well, inappropriate referrals are redirected as needed. Many of these streamlining recommendations are supported by the Patient Flow Study completed by Global Solutions Healthcare Consulting/Siemens Healthcare in 2009. This study was integral to the review and streamlining of current and future referral processes across Eastern Health. • Monitoring and evaluation phase which consists of (1) reporting our performance against the established key performance indicators identified at the strategy onset, (2) implementing measures to ensure data quality, (3) developing and/or strengthening wait time policies, (4) providing periodic review to ensure changes are effectively addressing issues of client access to service. Challenges to implementation: Implementing this strategy requires significant resources to improve wait time management in various specialty areas. This is complex, as there are presently many waitlists maintained within specialist offices within private practice, Eastern Health as well as Memorial University. Resources are required in multiple areas, especially in IT and Clinical Efficiency to support the implementation of the strategy within a timely manner. An additional challenge to implementation is the mandatory requirement of health professionals to exclusively use the centralized intake process.

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Determining the Big Picture

21

Endnotes 1

Sue Cavanagh and Keith Chadwick, Summary: Health Needs Assessments at a Glance (Health Development Agency, 2005). P. 6-9.

2

World Health Organization, WHO Definition of Health,  www.who.int/about/definition/en/.

3

Canadian Institute for Health Information, Canadian Population Health Initiative, About Population Health  www.secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=cphi_aboutph_e.

4

Public Health Agency of Canada, The Determinants of Health,  hp://www.phac-aspc.gc.ca/ph-sp/determinants/determinantseng.php#gender. Accessed November 24, 2010.

5

Developing Healthy Communities, 1998, Chinook Health Region.

6

As defined by the Government of Newfoundland and Labrador’s Community Accounts, Bonavista Area includes Bonavista and Spillars Cove.

7

As defined by the Government of Newfoundland and Labrador’s Community Accounts, Blackhead Bay Area includes the communities of Birchy Cove, Duntara, Hodderville, Keels, King's Cove, Knights Cove, Lower Amherst Cove, Middle Amherst Cove, Newmans Cove, Stock Cove and Upper Amherst Cove.

8

As defined by the Government of Newfoundland and Labrador’s Community Accounts, Catalina Area includes the communities of Catalina, Elliston, Lile Catalina, Melrose and Port Union.

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The Results of the Discovery Zone Community Health Needs Assessment

9

As defined by Government of Newfoundland and Labrador’s Community Accounts, Chandlers Reach includes the communities of Bloomfield, Brooklyn, Bunyan's Cove, Cannings Cove, Charloetown, Jamestown, Lethbridge, Muddy Brook, Musgravetown, Port Blandford, Portland, Terra Nova, Thorburn Lake and Winter Brook. For the purposes of this needs assessment, Portland, Terra Nova, Thorburn Lake and Winter Brook were not included. 10

As defined by Government of Newfoundland and Labrador’s Community Accounts, Smith Sound-Random Island includes the communities of Burgoynes Cove, Clarenville, Clion, Georges Brook, Gin Cove, Harcourt, Milton, Monroe, Waterville and all of Random Island.

11

As defined by Government of Newfoundland and Labrador’s Community Accounts, the communities included in South West Arm Area are Adeytown, Buer Cove, Caplin Cove, Deep Bight, Gooseberry Cove, Hatchet Cove, Hillview, Hodge's Cove, Ivany Cove, Lile Heart's Ease, Long Beach, North West Brook, Queen's Cove, Southport and St. Jones Within.

12

As defined by Government of Newfoundland and Labrador’s Community Accounts, Placentia Bay North West includes the communities of Garden Cove, North Harbour, Swi Current and Woody Island.

13

As defined by Government of Newfoundland and Labrador’s Community Accounts, the Isthmus of Avalon includes the communities from Goobies to Chapel Arm and Long Harbour-Mount Arlington Heights. Long Harbour-Mt. Arlington Heights was not considered in this needs assessment as it was covered in the Southern Avalon needs assessment. 8 3


Determining the Big Picture

14

The Newfoundland Nutritious Food Basket Survey provides information about the cost of healthy eating in Newfoundland and Labrador. In the Eastern Health Region – Rural Avalon and Peninsulas, the survey is conducted by the Regional Nutritionists with Eastern Health, in cooperation with the Department of Health and Community Services and the Newfoundland and Labrador Statistics Agency. During a designated 2-week period in June 2008, a “food basket” list of 63 basic food items is priced in six selected grocery stores in the region. Items in the food basket are priced at the lowest price available in the store in a specified purchase size, regardless of brand. The basket is not a recommended diet. It is a tool for monitoring the cost of healthy eating. It has the advantage of being based on food purchasing paerns and therefore has some similarity to the foods generally purchased in the province.

15

Understanding the Labour Market Landscape in Newfoundland and Labrador: A Baseline Report. P. 20, Department of Human Resources, Labour and Employment, Government of Newfoundland and Labrador.  hp://www.hrle.gov.nl.ca/hrle/publications/lmd/Baseline%20Report% 20Final.pdf. Accessed Oct 20, 2010.

16

Eastern Health has recently hired a third speech language pathologist at the Dr. G. B. Cross Memorial Hospital. This should help to address waitlists and result in visiting clinics in Bonavista.

17

Percentage of population with diabetes, age 12+, Canadian Community Health Survey, 2005.

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The Results of the Discovery Zone Community Health Needs Assessment

18

Body Mass Index is a method of classifying body weight according to health risk. It is calculated by dividing the respondent’s body weights (in kilograms) by their height (in metres) squared. This indicator is measured out of 18 years and over only. Proportion of household population age 18 and older with a body mass index of 30 or greater. According to the WHO and Health Canada guidelines, a BMA of 30 or greater is classified as obesity and is associated with high health risk. Statistics Canada, Canadian Community Health Survey, 2008.

19

Body Mass Index for youths is different from that of adults as they are still maturing. This indicator classifies children aged 12 to 17 (except female respondents aged 15 to 17 who were pregnant or did not answer the pregnancy question) as obese or overweight according to the age- and sex-specific BMI applied to the Canadian Community Health Survey since 2005 and are based on pooled international data for BMI and linked to the internationally accepted adult BMI cut-off points of 25 (overweight) and 30 (obese).

20

For the Burin Peninsula needs assessment, this question was asked a lile differently. When asked how quickly they were able to get an appointment with a particular family doctor, 29% of respondents with a regular family doctor indicated they were able to get an appointment within a day; 46% within the week; and 25% within two weeks or more.

21

Population aged 12 and over who reported being diagnosed by a health professional as having diabetes. Statistics Canada, Canadian Community Health Survey. Diabetes includes females 15 and over who reported that they have been diagnosed with gestational diabetes. 2008.

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Determining the Big Picture

22

Population age 12 and older who reported being diagnosed by a health professional as having high blood pressure. Statistics Canada, Canadian Community Health Survey, 2008.

23

For the purposes of the Discovery Zone needs assessment, Long Harbour-Mount Arlington Heights was not included in this assessment since it was part of Eastern Healthâ&#x20AC;&#x2122;s Southern Avalon Assessment.

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Determining the Big Picture The Results of the Discovery Zone Community Health Needs Assessment

www.easternhealth.ca


Discovery Zone Community Health Needs Assessment