2012 Community Health Check-Up

Message from the Commissioner & Medical Officer of Health

The Health Department continues to make a difference in the lives of Durham residents. I am proud to present Check-Up 2012, which complements our 2012 Performance Report, 2012 Annual Health Statistics and 2013 Health Plan. We're here to help and support you with healthy living. I encourage you to contact us, browse our website, 'Like' us on Facebook and 'Follow' us on Twitter. Here's to your good health and well-being!

Dr. Robert Kyle


In this issue...

Health Department awarded 3-year accreditation certificate

Durham Region Health Department (DRHD) received a three-year accreditation certificate from the Ontario Council on Community Health Accreditation (OCCHA). The award was presented by OCCHA to Durham Regional Council, the Health Department’s Board of Health, in November 2012.

OCCHA is an independent agency directed by a Board whose members are appointed by professional associations involved in public health. OCCHA’s mission is to promote accountability and excellence in public health. The accreditation process provides an independent, voluntary, peer evaluation of the administrative and operational aspects of local public health agencies, including a review of program planning, implementation, monitoring and evaluation.

The Health Department was commended for its program planning and evaluation, staff education and training, and policies and procedures stewardship. This is DRHD’s fourth, unconditional three-year award received from OCCHA.

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Emergency Medical Services commended during service review; paramedics receive advanced certification

In April 2012, the Ontario Ministry of Health and Long-Term Care (MOHLTC) awarded Durham Region Emergency Medical Services (EMS) with a three-year, unconditional operating certificate during the MOHLTC’s Land Ambulance Service Review. This represents Durham Region EMS’ fifth consecutive three-year award, the highest level possible for a land ambulance service.

The MOHLTC review team found that Durham Region EMS met all certification criteria and legislated requirements, while commending the service for its clean and well equipped emergency vehicles, community involvement and engagement, and its well organized employee files.

In keeping with the recognition of providing excellent service for the Durham Region community, 11 full-time primary care paramedics (PCP) completed the preceptorship and final consolidation phases of the advanced care paramedic (ACP) training program. As a result, these paramedics have now received full and unrestricted ACP certification from the Central East Pre-hospital Care Program.

The addition of these new advanced care paramedics will allow Durham Region EMS to maintain the best possible deployment of one ACP and one PCP on each ambulance that operates 24-hours a day.

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Giving area residents a Snapshot on Asthma

The Snapshot on Asthma report provides local information on the prevalence of asthma in Durham Region. The report shows that one in 10 Durham Region residents 12 and older has asthma, with rates higher in youth 12 to 19-years old and in females.

While the prevalence of asthma has remained stable since 2001, the burden is evident in the over 2,300 asthma-related emergency room visits and 190 hospitalizations in Durham Region residents in 2010. The highest rates of asthma-related emergency room visits and hospitalizations occurred in male children from birth to four years old; higher rates of asthma in male children is likely a result of their smaller airway size. However, for adults, emergency room visits and hospitalization rates were higher in females.

Asthma prevalence and other measures of asthma control, such as recent asthma symptoms/attacks or using asthma medication, were higher in individuals with lower socioeconomic status, non-immigrants and among Aboriginal people. Rates were also more common in smokers and those exposed to environmental tobacco smoke.

The effectiveness of asthma self-management education is supported through research into such programs. The Public Health School Asthma Program is a school-based asthma education program developed to create asthma friendly and supportive school environments, and to teach children how to manage their asthma.

In addition to initiatives such as the school asthma program, DRHD has joined with many other jurisdictions across Canada in promoting the Air Quality Health Index (AQHI). The AQHI is a tool that provides individuals, including those living with asthma, with advice on how to protect their health during air quality levels associated with low, moderate, high and very high health risks.

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Evaluation of Health Department population survey pilot project

The Rapid Risk Factor Surveillance System (RRFSS) is an ongoing telephone survey that has been used by DRHD and a number of Ontario public health units (PHU) since 2001. RRFSS is used to gather information on key public health indicators, monitor public opinion on public health concerns, and collect information on emerging issues of importance to public health from a local geographic perspective.

While the information gathered through RRFSS has provided valuable findings for each participating PHU, it has been consistently noted that the lack of a province-wide sample group is a key limitation of the information compiled through the survey. As a result, in 2011, a provincial sample pilot project (PSPP) was implemented to collect data from a provincial sample group which would include survey participants from all 36 health unit areas in Ontario. Data from the provincial sample were collected by the Institute for Social Research at York University, the same organization that collects RRFSS data for local PHUs.

To help review the pilot, an evaluation of the PSPP was undertaken and supported by funding from Public Health Ontario Locally Driven Collaborative Projects. DRHD was the lead applicant for the funding, with support from co-applicant health units and collaborating organizations.

The evaluation included an online survey of Ontario public health units, interviews with key informants and a comparative analysis of the PSPP provincial data with Census information, the Canadian Community Health Survey and RRFSS data from the public health units.

Results of the pilot indicate that there is a perceived value in having a provincial sample as an ongoing part of RRFSS, to provide a provincial comparison for local RRFSS data, and to measure and monitor emerging public health issues at the provincial level. The evaluation report also recommends developing further options for funding and maintaining a provincial sample as part of RRFSS.

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Health Department works with community partners to promote road safety message

Addressing the issue of risky driving behaviours among youth was a key Health Department message for 2012 with the implementation of the Think and Drive…a second is all it takes road safety campaign. Partnering with Durham Regional Police Service, the Ontario Provincial Police and the Ontario Ministry of Transportation, DRHD launched this campaign at Durham College/University of Ontario Institute of Technology as a way to broaden the reach for the target audience of this campaign.

The goal of the Think and Drive campaign is to increase awareness of three driving behaviours leading to motor vehicle collisions: speeding, distracted and impaired driving. As part of the campaign launch, social media marketing, including Facebook and Twitter posts, were used to help promote this initiative. DRHD and its community partners also worked with faculty and students of the college and university to encourage youth participation.

Motor vehicle traffic collisions rank first among all causes of death for individuals 15 to 24-years old. Statistics from 2007 to 2009 found that rates of emergency room visits for motor vehicle collisions was higher for this age group in Durham Region than was found in corresponding Ontario rates.

The campus event, held during the police Festive Ride initiative, attracted 375 students and included presentations and displays addressing the personal and social costs of drinking and driving. A survey of students attending the event indicated that 81 per cent felt they were provided with information that would encourage them to take personal responsibility for making themselves and others safer on the roads.

One of the main components of the campaign was the Road Safety Challenge, an online quiz that allows individuals to assess their driving behaviours, focusing on speeding, distracted and impaired driving. From September to December 2012, approximately 500 area residents completed the quiz, with 63 per cent of respondents representing the target age group of 15 to 24-years old.

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Helping to create healthy school environments

The concept of creating healthy school environments is a holistic approach to school health that addresses the areas of curriculum, supportive social and healthy physical environments, and community partnerships. The Health Department works with area schools to help create a healthy school environment and develop strategies to build healthier schools using this comprehensive approach.

To help achieve the creation of healthy school environments, DRHD encourages schools to establish healthy school action teams and provides support for these teams through the implementation of health promotion initiatives. Each school in Durham Region has an assigned DRHD public health nurse who works with schools to promote and assist with the implementation of healthy schools initiatives.

Research shows that schools are uniquely position to create these supportive environments, as school-aged children spend about half of their waking hours at school. Curriculum taught in the classroom such as healthy eating, physical activity, sun safety and tobacco-free living, filters down into the school environment at large and then out into the broader community, including the home environment.

Throughout 2012, DRHD staff utilized a number of strategies to support healthy schools in Durham Region such as:

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Encouraging physical activity with the Grade 5 Action Pass

The Grade 5 Action Pass helps to increase students’ access to recreation activities by providing free, unlimited access to swimming, skating and some drop-in programs at participating recreation facilities for a student’s entire grade 5 year.

Available to Durham Region residents for the past five years, the Grade 5 Action Pass provides students with more opportunities to participate in fun physical activities each day, with the intention of creating an interest in physical activity that may carry on in the future. DRHD promotes the Grade 5 Action Pass by distributing promotional postcards and posters to local elementary schools, and also posts information about the pass on Durham Region’s website.

Canada’s Physical Activity Guidelines recommend that children and youth five to 17-years old should participate in at least 60-minutes of moderate to vigorous physical activity each day to achieve health benefits. However, statistics show that 93 per cent of children and youth in Canada are not meeting this recommendation.

The number of students that have obtained a Grade 5 Action Pass has increased each year, with a total of 2,124 grade 5 students obtaining a pass during the 2011-2012 school year. This represents a 20 per cent increase from 2010-2011 and is double the number of students that participated in 2008-2009 – the first time the pass was offered.

For the current school year, approximately 9,454 postcards and 416 posters were distributed to area elementary schools and recreation facilities, resulting in 1,354 students obtaining the pass to date.

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New infection prevention and control resource for day nurseries

Under the Ontario Public Health Standards, all public health units are required to provide educational resources to licensed day nurseries on appropriate infection prevention and control (IPAC) policies and practices.

Currently, IPAC education is provided to day nurseries by DRHD staff through a one-hour workshop session during routine inspections of the day nursery facility. However, with the increasing number of day nurseries in Durham Region, Health Department staff has found it increasingly challenging to provide these sessions to meet operators’ needs. As a result, the idea of an online educational resource is being developed to meet the growing need for basic IPAC education for area day nurseries.

In 2012, DRHD conducted an anonymous survey to determine the need for having additional IPAC education resources for day nursery operators. The survey was distributed to the operators by email with results indicating strong support for more IPAC education for day nursery staff, delivered in a way that provides easy and ready access when needed. Once the survey results were analyzed, DRHD staff reviewed the information currently provided to day nurseries on infection prevention and control, and researched current literature to help develop the content for a pilot online resource.

In October, the Health Department launched the pilot known as the Day Nursery Infection Prevention and Control Learning Online Module. A link to this pilot was emailed to Regional day nurseries and also a number of larger independent chain day nurseries operating throughout the community. Through feedback received from the pilot, revisions and modifications will be made to ensure that the module meets the needs of the day nursery community. It is expected that the module will be fully launched in spring 2013.

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Health Department tests knowledge of infection prevention and control practices

International Infection Control Week provided an opportunity for Health Department staff to feature the second annual DRHD Infection Prevention and Control Bootcamp, a fun, interactive event providing information about the importance of infection prevention and control.

Held at Durham Region Headquarters, the bootcamp invited both the public and staff from all Regional departments to test their knowledge of infection control at a number of information stations with messages promoting:

Upon entry to the bootcamp, each participant received a passport that was stamped at the completion of each station. All stations required the participant to take part in an activity that reinforced one of the key messages. Once all bootcamp stations were stamped as completed, the participant could complete a ballot for a chance to win a gift basket full of infection control products.

There is evidence that this bootcamp was an effective health promotion method and it is expected that this event will continue for 2013.

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Healthy Smiles Ontario gives area residents a reason to smile

In October 2010, the MOHLTC introduced Healthy Smiles Ontario (HSO), a new program to help young families across the province access oral health care for children 17 and under. HSO was designed to complement the existing Children in Need of Treatment (CINOT) program, which provides urgent care for children whose families cannot afford to obtain oral health treatment.

HSO provides routine dental care including preventive services, restorations and extractions. The goal of the program is to decrease the number of children who will require urgent dental care in the future. As part of the roll out of the program, the MOHLTC provided $500,000 to the Health Department to upgrade its Oral Health clinic.

HSO differs from the CINOT program as children receiving service under HSO do not require an urgent need to be eligible. However, unlike CINOT, families must provide proof of financial need to quality for HSO, having an adjusted net family income of $20,000 per year to access the program. Once eligibility is approved, families may access services from a dentist of their choice in the community, or receive service through the Health Department’s Oral Health clinic.

In Durham Region, there has been a steady increase in the number of children enrolled in HSO. Launched in the last three months of 2010, the program saw 47 children enrolled to receive service. In 2011, the number in children enrolled increased to 577 and over 870 were enrolled in 2012. Although over 870 children were enrolled in the program last year, only 626 children sought treatment – 463 received treatment from community dentists, while163 were seen in the Health Department clinic. To help ensure all eligible children receive treatment in future, public awareness activities will be streamlined to provide parents with a greater understanding of the need to take their children to a dental office in order to see long-term benefits from the program.

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Infant and Child Development staff volunteer to help at risk children in Jamaica

In April 2012, staff from the Health Department’s Infant and Child Development Services travelled to Jamaica as volunteers, along with 10 other specialists, to provide training sessions and share their skills for working with children at risk of development.

During the trip, DRHD staff visited an orphanage for children living with HIV/AIDS, a community and school for children living in an area built on a landfill site and a residential facility for children and young adults with special needs.

At the residential facility, there were 150 abandoned children and young adults with medical, mental and physical challenges. Health Department staff was part of a team that provided support and recommendations to approximately 80 staff and caregivers at the facility, while also working hands-on in the classrooms with children.

Training consisted of sessions on topics such as fine motor and cognitive activities for children, literacy and numeracy skills, art activities and workshops on autism.

In addition, DRHD staff also delivered over 200 pounds of donations and supplies for the children, families and staff that were donated by other Health Department programs and services. Health Department staff acknowledged that this was a life changing experience and that they would welcome the opportunity to visit again in future.

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2012 Financial Information

 Expenditures  Revenues
Chronic Diseases & Injuries $8,400,000 Region of Durham $32,148,142
Emergency Medical Services  38,035,000 Province of Ontario   50,381,358
Environmental Health & Emergency Preparedness    5,599,000 User/Program Fees         910,500
Family Health  12,844,000  
Infectious Diseases    8,824,000  
Professional & Administration Services    9,738,000  
  $83,440,000   $83,440,000

2012 Community Health Check-Up