VANCOUVER CITYWIDE SUMMARY

A health and social profile

SUMMER 2013

GEORGIA DRAKE

HASTINGS BURRARD

CLARK

UBC ALMA BROADWAY

NANAIMO

16 AVE CAMBIE

MCDONALD

BLANCA 25 AVE OAK

DUNBAR 41 AVE MARINE DR

GRANVILLE

57 AVE MAIN

BOUNDARY

ANGUS ANGUS

© Vancouver Coastal Health COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Contents

Introduction...... 3

Population in focus...... 3

Demographic composition...... 3 Population estimates and projections...... 3 Social determinants of health...... 3 Diversity...... 3 Education and healthy childhood development...... 3 Employment and income...... 3 Household characteristics...... 3 Housing costs...... 3 Living costs...... 3 Getting around...... 3 Community belonging...... 3

Health status...... 3 Life expectancy...... 3 Births...... 3 Mortality...... 3 Chronic disease...... 3 Communicable disease...... 3 Health related behaviour...... 3 School immunization coverage...... 3

Health service utilization...... 3 Acute care services...... 3 Home and community care services...... 3 Primary health care...... 3

Appendices...... 3 Appendix 1: 2011 Population Estimates...... 3 Appendix 2: Demographic Composition...... 3 Appendix 3: Health Status...... 3 Appendix 4. Health Service Utilization...... 3

Glossary of terms...... 3

References...... 34

A Health and Social Profile Vancouver Coastal Health 2 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Health is where we live, learn, work and play

We are pleased to present this package of Health and Social Profiles for the six Community Health Areas (CHAs) in Vancouver. The full package includes Health and Social Profiles for CHA 1 (City Centre), CHA 2 (Mid-East), CHA 3 (North East), CHA 4 (Westside), CHA 5 (Midtown) CHA 6 (South Vancouver), as well as a Citywide Summary.

These profiles were prepared by Vancouver Coastal Health (VCH). They were compiled by Nerissa Tai, a student in the Master of Public Health Program at Simon Fraser University, with guidance from the Community Developers in Vancouver; Charito Gailling, Katie Hume, Jazmin Miranda, Lisa McCune, Lycia Rodrigues and Nicole Latham, as well as Dr. Jat Sandhu and Eleni Kefalas at the VCH Public Health Surveillance Unit.

Vancouver Coastal Health (VCH) is the A population health approach regional Health Authority responsible for aims to improve the health of providing public health services to over 1 the entire population. million people in British Columbia. We serve the residents of Vancouver, Richmond, the North Shore and Coast Garibaldi, Sea-to- Sky, Sunshine Coast, Powell River, Bella Bella and Bella Coola. We operate 13 hospitals and also provide primary care, mental health and addiction services, community-based residential and home health care, and more. To deliver public health services in Vancouver, VCH divides the city into six geographical areas called “Community Health Areas” (CHAs). CHAs are roughly similar in population size and are each comprised of three to eight neighbourhoods.

While hospital care and clinical services are an important part of the health care system, Vancouver Coastal Health also uses a population health approach to address the determinants that influence the health of a population. A population health approach aims to improve the health of the entire population and to reduce health inequities among population groups.

In these Health and Social profiles we report on some of the factors that influence the health of individuals and populations in Vancouver. These factors are called the “social determinants of health.” In each profile we include population-level data about income, housing, education, employment and child development. We also report on health indicators such as life expectancy, birth rates, standardized mortality ratios and we include information about how health services are used and key community resources.

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Purpose: Addressing the social determinants of health can improve the health of the whole population and reduce health inequities. But Vancouver Coastal Health cannot do it alone. We need to work in partnership across sectors and with communities to address local issues, create access to services and strengthen the environments in which people live, learn, work and play. We hope that these profiles will help VCH staff and our partners in community to identify emerging needs, undertake strategic planning, and implement supportive health initiatives.

Data Sources: The majority of the information presented in these profiles comes from BC Vital Statistics Agency, BC Stats, the 2006 Statistic Canada Census and Vancouver Coastal Health databases (see the References for a complete list of data sources.)

Where possible, we have included information obtained through the 2011 Canada Census. However, at the time of publication, only limited data from the 2011 Census has been released. For that reason, where data was unavailable for 2011, we have used information from the 2006 Census. Nevertheless, the 2006 Census remains a valuable source of information about populations in Vancouver because it contains details collected through the mandatory long- form Census, which was discontinued prior to the 2011 Census.

We also consulted with community groups, public organizations and VCH staff to better inform the profiles and to share local knowledge about unique neighbourhood characteristics and emerging trends.

We hope that this will be a useful and stimulating document. Any comments or feedback is welcome at: [email protected]

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Acknowledgements

We would like to thank the following people for their contributions to the Vancouver Health and Social Profiles.

Participants in community consultation about the profile design: Diane Ash, Westside Family Place Adrian Archambault, Grandview Woodlands Community Policing Centre Madeline Boscoe, REACH Sharon Babu, South Family Place Donna Clarke, Renfrew-Collingwood Seniors Centre Terri Corcoran, David Thompson Secondary School Kayo Devcic, Vancouver Coastal Health Agata Feetham, Gordon Neighbourhood House Christine Gillespie, Vancouver Coastal Health Clemencia Gomez, South Granville Seniors Centre Barb Kirby, BC Community Response Networks Sandra Menzer, Vancouver Society of Children’s Centres Ken Paquette, The Kettle Friendship Society Wei-Wei Siew, South Vancouver Neighbourhood House Sanja Sladojevic, Little Mountain Neighbourhood House Chelan Wallace, South Vancouver Neighbourhood House Marla States, Helping Spirit Lodge Society Ethel Whitty, Carnegie Centre

Authors of the introductions for each profile: Joel Bronstein, Executive Director, Little Mountain Neighbourhood House Michelle Fortin, Executive Director, Watari Youth, Family & Community Services Jennifer Gray-Grant, Executive Director, Collingwood Neighbourhood House Kate Hodgson, Executive Director, Network of Inner City Community Services Society Eric Kowalski, Executive Director, West End Seniors Network Karen Larcombe, Executive Director, South Vancouver Neighbourhood House Emily Palmer, Director of Community Programs, Kitsilano Neighbourhood House

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Organizations that provided data: British Columbia Centre for Excellence in HIV/AIDS City of Vancouver Human Early Learning Partnership Vancouver School Board Cover map created by Patient Health Education Materials Program, VCH Centre for Patients and Families, May 2102.

Reviewers: Dr. John Carsley, Medical Health Officer, Vancouver Coastal Health Dr. Meena Dawar, Medical Health Officer, Vancouver Coastal Health Ken Hawkins, Advisor, Decision Support, Vancouver Coastal Health Dr. Jat Sandhu, Regional Director, PHSU, Vancouver Coastal Health

Additional Assistance: Lianne Carley, Policy Consultant, Vancouver Coastal Health Belinda Boyd, Leader, Community Engagement, Vancouver Coastal Health Susan Richter, Leader, Community Engagement, Vancouver Coastal Health Andi Cuddington, Leader, Community Engagement, Vancouver Coastal Health Margreth Tolson, Leader, Community Engagement, Vancouver Coastal Health Elizabeth Holliday, Health Systems Planning Adviser

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INTRODUCTION BY VANCOUVER COMMUNITY HEALTH

e are pleased to introduce the 2013 Health and Social Profiles for Vancouver and to write the introduction to this Vancouver Summary. These profiles paint a detailed and comprehensive picture of life in each of Vancouver’s six Community Health Areas (CHAs). They highlight information about community demographics (such as education and housing), health status (such as life expectancy and communicable diseases) and health care utilization.

From reading these profiles we have learned a lot about the residents of Vancouver. Overall we are a healthy bunch: our life expectancy is on the rise and our residents are less likely than other British Columbians to be obese. Vancouverites are also less likely than other British Columbians to die from cardiovascular disease, chronic pulmonary disease and transport accidents.

It is often said that population-level statistics obscure the daily struggles faced by individuals. It is true that, while the Vancouver Health and Social Profiles paint a picture of the general populations that reside in the city’s six Community Health Areas, we are unable to report detailed local data for specific populations that experience unique health issues, such as people who identify as lesbian, gay, bisexual, transgender, queer, and two-spirit (LGBTQ2S), refugees, Aboriginal people and sex workers. This city wide summary includes short sections that discuss some of the health issues faced by these populations.

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Further, by including information on median incomes and the cost of housing, child care and a nutritious food basket, the profiles make it clear that the cost of living in Vancouver can be prohibitive. For example, Vancouver residents (regardless of where they live) are more likely than other British Columbians to spend more than 30% of income on housing costs. This means that some Vancouver residents have less money available for healthy food, access to recreation and other things that help keep us well.

In addition to reporting on the demographics, health status and health service utilization, these profiles highlight several community-based assets in Vancouver that address some of our core needs. While housing costs are high in the city, 25,306 units (about 8.4% of total housing stock) are available at non- market rents. While 28.8% of seniors in Vancouver live alone, there are several seniors-services organizations and adult day centres throughout the city that endeavour to serve their needs.

We would like to thank those who made these profiles possible: practicum student Nerissa Tai, the Community Developers in Vancouver, the VCH Public Health Surveillance Unit, and all of our community partners who shared data and reviewed drafts.

We hope you find these profiles as enlightening and useful as we have. Happy reading.

Mary Ackenhusen Chief Operating Officer Vancouver Coastal Health

Dr. John Carsley Medical Health Officer Vancouver Coastal Health

Dr. Meena Dawar Medical Health Officer Vancouver Coastal Health

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Population in focus

• Aborginal • Refugees • Sex trade workers • LGBTQ2S

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POPULATION IN FOCUS Aboriginal peoples As home to 40,310 people who identify as Aboriginal (First Nations/Indian, Inuit and/or Métis), the City of Vancouver is home to the third-highest urban Aboriginal population in Canada. Aboriginal people in Vancouver account for 21% of the overall Aboriginal population in BC but comprise only 6% of the city’s overall population. Approximately half of the Aboriginal population in Vancouver is made up of children and youth under the age of 24.

The City of Vancouver is located on unceded territory of the Coast Salish peoples. Colonization has shaped the experiences of Aboriginal people who live in Vancouver and this population as a whole faces challenges well in excess of the non-Aboriginal population. Data shows that Aboriginal people in Vancouver, in general, have lower education levels, higher unemployment rates, lower income levels, poorer health status, and higher rates of homelessness than other non-Aboriginals. Vancouverites. Aboriginal people are also overrepresented in the criminal justice system, both as victims and offenders.

AN URBAN ABORIGINAL LIFE. The 2005 indicators report on the quality of life of Aboriginal people living in the Greater Vancouver region

Vancouver Residents Aboriginal Non-Aboriginal Population in Vancouver 40,310 2,056,655 Life expectancy (male and female) 68.9 years 81.4 years Rate of diabetes (% of total population) 7.4% 3.6% New HIV diagnoses in BC as of 2011 14.9% 51.9% (51.9% of cases were Caucasian, 14.9% were Aboriginal, and 11.4% Asian) High school graduation rate (2003/2004) 35% 82% Incarceration rate (percent of total incarcerated population) 21.8% 78.92% Unemployment rate 15% 7% Social Assistance (% of total income) 16.8% 9.6% Homeless rate (% of Vancouver homeless) 30% 70%

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Over the past few decades the health status of Aboriginal peoples in Vancouver has improved, particularly in the areas of infant mortality, unintentional injuries and suicide. These improvements can be attributed to changes in the social determinants of health, improved access to health care services and greater emphasis on cultural teachings. Participants at the 2011 Forum for Aboriginal Elders identified many positive impacts that result from preserving Aboriginal cultural traditions. A number of community organizations operate in Vancouver to meet the needs of urban Aboriginal people. These include the Vancouver Aboriginal Council, the Vancouver Aboriginal Friendship Centre, the Urban Native Youth Association, and the Aboriginal Mother Centre Society.

References

Miles, R. (March 2012). A report on the Strengthening Relationships Urban Aboriginal Partners event. Native Courtworkers and Counselling Association of BC (2011). The forum for Aboriginal elders. Cardinal, N. (2006). An urban Aboriginal life: the 2005 indicators report on the quality of life of Aboriginal people living in the Greater Vancouver region. Mccallum, K. and D. Isaac (July 2011). Feeling home: Culturally responsive approaches to Aboriginal homelessness. Swinkels, H. (January 2008). Aboriginal health status profile, Vancouver Coastal Health. BC Centre for Disease Control. (2012). HIV in British Columbia: Annual Surveillance Report 2011. Retrieved from http://www.bccdc.ca/util/about/annreport/default.htm

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POPULATION IN FOCUS Government assisted refugees A refugee is a person that has been forced to flee her/his home because of persecution due to race, religion, nationality, political affiliation, sexual preference or gender identity. According to the United Nations High Commission on Refugees, in 2007 there were approximately 9 million refugees and 24 million internally displaced persons around the world. Refugees are categorized into three distinct groups: Asylum Seekers are refugees who apply for refugee status once they are in their destination country; Sponsored Refugees are usually brought to Canada by faith-based organizations; and Government Assisted Refugees (GARs). The only group that is possible to track is the GARs. Asylum Seekers and Sponsored Refugees are much more difficult to accurately count due to high mobility and fear of deportation.

Between 2005 and 2009, 93% of the 4,026 GARs destined to BC settled in Metro Vancouver and 16% of those refugees (about 599) settled in the City of Vancouver. In 2010 the Immigrant Services Society of BC (ISS of BC) reported that most refugees who settle in Vancouver settle in the east side neighbourhoods of Kensington-Cedar cottage and Victoria-Fraserview. The top source countries of refugees settling in the city are people from Vietnam (197), Myanmar (127), Colombia (41) and Iran (39).

Once in Canada there are many issues that affect settlement for refugees, particularly due to financial challenges caused by multiple barriers to employment and low Income Assistance rates. According to the ISS of BC, half of GARs spend between 51 and 75 percent of their income on housing as did 41.9 per cent of all refugee claimants. In addition, the Government of Canada requires that all GARs repay the cost of their travel to Canada through an interest-bearing loan starting one year after arrival in Canada. Given these expenses, many refugees have limited resources available for other basic necessities like food and transportation.

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POPULATION IN FOCUS Sex trade workers Sex workers live and work throughout Metro Vancouver and yet remain mostly invisible to policy makers and care providers. The quasi-criminalized status and stigma attached to sex work mean that sex workers typically do not disclose their employment in sex work. As a result, there is no definitive number of people engaged in sex work in Vancouver. However, it is clear from research and program evaluation that:

• Women, men and transgender people of all socioeconomic backgrounds are engaged in sex work in Vancouver.

• The majority of women engaged in sex work in Canada begin between the ages of 16 and 18. The AESHA Project, a longitudinal study of women and transwomen sex workers in Metro Vancouver shows the median age of sex workers to be 33.

• Vancouver sex workers across all genders are primarily Caucasian or Aboriginal. However, there are also a number of women immigrants, migrants and those who have been illegally trafficked working in sex work in Vancouver, particularly in massage parlours across the city.

• Lesbian, Gay, Bisexual, Transgender, Queer and Two-Spirit people are over-represented in sex work in Vancouver.

Sex work is often commonly associated with street-level prostitution. However, street-level prostitution is estimated to only account for about 20% of prostitution in Canada. Sex work more commonly occurs indoors via escort services, massage parlours, brothels and strip clubs. Service providers in Vancouver have also seen a shift in the last ten years towards sex workers employing web-based social media, chat rooms, dating sites and text messaging to connect with customers, particularly youth. This trend has increased the invisibility of sex work and sex workers.

Sex workers are at particular risk for health concerns associated with having multiple sexual partners. Street-level sex workers in particular may also be at increased risk of violence and/or have histories of trauma. Despite their potentially vulnerable health status, research in Metro Vancouver has shown that the stigma attached to sex work is a primary barrier to accessing health services for this population. Many vulnerable migrant or trafficked women are unable to access health and support services due to lack of English language skills and/or tenuous immigration status.

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In Vancouver, a handful of small organizations and programs exist to support sex workers and may be able to provide education to health care providers on providing competent care to this population. Some of these include: Boys R Us and Hustle (for men and transmen), WISH and PACE (women and transwomen) and SWAN (immigrant, migrant and trafficked sex workers).

References

Cool, J. (September 1, 2004). Prostitution in Canada: An Overview. Library of Parliament. Accessed July 26, 2012 from http://publications.gc.ca/collections/ Collection-R/LoPBdP/PRB-e/PRB0443-e.pdf Hustle: Men on the Move (2012). Netreach Report. Lazarus, L. et al (2011). Occupational stigma as a primary barrier to health care for street-based sex workers in Canada. Culture, Health & Sexuality: An International Journal for Research, Intervention and Care 14:2, 139-150 K. Shannon, personal communication, July 31, 2012.

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POPULATION IN FOCUS Lesbian, Gay, Bisexual, Transgender, Queer, and Two-Spirit (LGBTQ2S) People who are LGBTQ2S (Lesbian, Gay, Bisexual, Transgender, Queer or Two-spirit) are some of Vancouver’s most vulnerable residents. But because one’s sexual and gender identity can’t be separated from other aspects of self (e.g. being indigenous or a refugee) it is challenging to identify health needs that are related specifically to the experience of being LGBTQ2S. Furthermore, local (Vancouver) information about LGBTQ2S communities is limited.

Still, there are some health issues that are common to many LGBTQ2S populations. These include depression and anxiety (associated with social exclusion), substance use (a common strategy for coping with emotional distress) and sexual and physical trauma. Health issues may be compounded because LGBTQ2S people often postpone accessing health care services out of fear of discrimination or misunderstanding.

Specific populations within the LGBTQ2S umbrella experience unique health concerns. For example, Vancouver’s gay male population is estimated to be about 20,000 people. Surveys of this population have shown the HIV prevalence to be about 14-15% (about 1 in 6), with about 2.5% (1 in 40) unaware of their status as HIV positive. Also, rates of breast cancer are higher among lesbian women than among heterosexual women, which may be related to having fewer pregnancies or having children later in life, heavier substance use, and/or lesbian women’s reluctance to access health care services due to fear of discrimination or heterosexist bias. People who are transgendered report financial and other barriers to accessing health services associated with gender reassignment. In 2010, gay bashings accounted for 30 of the 117 reported hate crimes in Vancouver.

In Vancouver, a number of health and social services exist to support the LGBQ2S population. A broad social service organization, QMUNITY offers specific programs for LGBTQ2S youth, adults and seniors, and people living with substance use and chronic health conditions. Vancouver Coastal Health’s Transgender Health Program regularly trains Health Authority staff to work with LGBTQ2S clients.

References Ristock, J., Zoccole, A., and Passante, L. (2010). Aboriginal Two-Spirit and LGBTQ Migration, Mobility and Health Research Project: Winnipeg, Final Report, November 2010. Tjepkema, Michael. (2008). “Health care use among gay, lesbian and bisexual Canadians”. Statistics Canada Health Reports, Vol. 19, No. 1, March 2008. Retrieved online at www.statcan.gc.ca, July 2012. Trussler, Terry, Rick Marchand and Mark Gilbert. (2006). Numbers Rising: Challenges for Gay Men’s Health. Retrieved online at http://cbrc.net/sexnow/numbersrising, July 2012 Trussler, T., Banks, P., Marchand, R., Robert, W., Gustafson, R., Hogg, R., Gilbert, M., and the ManCount Survey Team. (2010). ManCount Sizes-up the Gaps: a sexual health survey of gay men in Vancouver. Vancouver Coastal Health: Vancouver. Retrieved online at www.mancount.ca, July 2012 Hainsworth, Jeremy. (May 2012) “Stats Canada: Vancouver first again in reported gaybashings”. XTra! Canada’s Gay and Lesbian News. Vancouver. Retrieved online at www.xtra.ca, July 2012

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Demographic composition

This section brings attention to a multitude of demographic variables (e.g. total population, population change, age, gender and household income).

Population estimates and projections provide social agencies, government and other service providers with an opportunity to plan for emerging trends.

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Population estimates and projections

TABLE 1. Population Estimates. Community Health Areas, Vancouver, and British Columbia, 2011.

Population Count 0-19 years 20-39 years 40-64 years 65+ years CHA 1 121,165 8.5% 49.3% 31.9% 10.3% CHA 2 71,358 14.5% 35.4% 40.1% 10.0% CHA 3 106,364 20.0% 30.7% 36.1% 13.1% CHA 4 137,666 20.5% 33.1% 34.1% 12.2% CHA 5 95,928 20.1% 33.1% 36.6% 10.2% CHA 6 136,209 19.9% 29.5% 36.8% 13.8% Vancouver 668,690 17.4% 35.2% 35.6% 11.8% BC 4,573,321 21.1% 27.3% 36.3% 15.3%

Source: BC Stats, Population Estimates (P.E.O.P.L.E. 35) (2012, March)

The 2011 Vancouver population was 668,690, with Vancouver comprising 57.4%

of the VCH region’s total population and 14.3% of BC’s total population. 1

Within Vancouver, CHA 4 has the highest percentage of children and youth (persons aged 19 years and under), CHA 1 has the highest percentage of persons aged 20-39 years, while CHA 6 has the highest percentage of seniors aged 65 years and over.

For more information about Population Estimates in Vancouver, VCH and BC see Appendix 1 and 2

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FIGURE 1. Population distribution (%) by sex and age group. Vancouver HSDA, 2006, 2011 & 2036 projections

Source: BC Stats (2012, March)

Figure 1 illustrates in more detail the age and sex distribution of Vancouver residents in 2006 (black line), 2011 (bars), and projections for 2036 (red dashed line). Between 2006 and 2011, the age and gender distribution for Vancouver has remained relatively stable. Although the number of seniors aged 65 years and over increased between 2006 and 2011, the proportion of seniors in the population has decreased slightly over this time period (from 12.6% of Vancouver’s population in 2006 to 11.8% in 2011).

The red dotted line on the figure shows the projected distribution of the 2036 population. By 2036, the Vancouver population is projected to increase by 23.9% to 828,780, with a greater proportion of persons aged 50 or older (41.3%) as compared to 2011.

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Diversity Aboriginal people make up 2.0% of the Vancouver population. Six percent of the total BC Aboriginal population lives in the urban centre of Vancouver. CHA 2 is home to the highest percentage of Aboriginals living in Vancouver at 8.5% of the CHA 2 population.

Vancouver has a high immigrant population (45.6% of residents) compared to the rest of BC (27.5%). In fact, immigrants make up the majority of the population in CHA 6 (60.0%) and in CHA 3 (55.6%). Of those immigrants who have recently immigrated to Canada (2001-2006), 36.5% were born in China, 11.7% were born in the Philippines, and 4.7% were born in India.

Vancouver also has a higher percentage of visible minorities (51.1%) compared to the provincial number (24.8%), with the greatest proportion identifying as either Chinese (29.4%), South Asian (5.6%), or Filipino (4.9%). Visible minorities make up the majority of the CHA 3 and CHA 6 populations at 70.8% and 74.3%, respectively. CHA 3 is home to Vancouver’s largest Chinese population and CHA 6 is home to Vancouver’s largest South Asian population.

Less than half (48%) of Vancouver residents report English as their mother tongue. That percentage is even lower in CHA 6 and CHA 3, where 29.7% of residents in CHA 6 and 31.9% of residents in CHA 3 report English as their mother tongue. Instead 24.9% of Vancouverites report Chinese as their mother tongue, which is much higher than the provincial rate of 8.2%.

Between 2005 and 2009, 4,026 government assisted refugees (GARs) settled in Metro Vancouver with 617 (16%) settling within Vancouver (Figure 2) (Immigrant Service Society of British Columbia, 2010). They mostly settled throughout East Vancouver, especially in CHA 3 and CHA 6. The top five source countries included Vietnam (197), Myanmar (127), Colombia (41), Iran (39), and the Democratic Republic of Congo (33).

Government Assisted Refugees (GARs) are a highly mobile population and the April 2012 GAR Bulletin provided the most recent snapshot of this population. Between January and March 2012, 97 individuals (in 59 family units) settled in BC. Of those 97 individuals, 7% settled within Vancouver.

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Social determinants of health The primary factors that shape the health of residents are not medical but the social and economic conditions in which they live. The distribution of money, power, and resources is responsible for producing health inequities- or the unfair and avoidable differences in health status we see within the Vancouver population. Education and healthy childhood development A vast body of research has demonstrated that early learning and childcare has significant educational, social, and emotional benefits for children. Canada does not have a comprehensive early learning and childcare plan, so access to these services varies by province and region.

Across the country, fewer than 20% of children ages 0 to 6 years find a place in a regulated child care service (compared to France 69% and UK 60%) (Vancouver Coastal Health, 2009).

BC has licensed child care spaces for only about 20 per cent of children. In Vancouver, the number of licensed group child care spaces for children age 30 months to school age ranges from 9.5 spaces for every 100 children in CHA 3 to 23.5 spaces for every 100 children in CHA 1 (Vancouver Coastal Health, 2009). Access to after-school childcare is equally limited. In CHA 5 only about 8 out of every 100 children ages 5-12 have access to regulated childcare during after- school hours (Vancouver Coastal Health, 2009).

The Early Development Instrument (EDI) measures Kindergarten children’s development in five core domains: physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge overall (University of British Columbia, Human Learning Partnership, 2011). Children are considered to be “vulnerable” when the EDI shows them to be at increased risk of encountering difficulties in the school years and beyond. When compared across the city, children in CHA 2 are most vulnerable overall while children in CHA 4 are the least vulnerable overall. Across Vancouver in all the CHAs, children are particularly vulnerable in the domain of communication skills and general knowledge as compared to BC. Further detail about children’s vulnerability is included in each profile. For more information, see http://earlylearning.ubc.ca/.

Reflecting Vancouver’s high newcomer population, 29.6% of students enrolled in the Vancouver School Board are English language learners (Vancouver School Board, 2011). An average 11.0% of students enrolled in the Vancouver School Board have a special needs designation.

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Among high school students in Vancouver, CHA 2 has the most Grade 4 and 7 students who scored below the average on the Foundation Skills Assessment (FSA) reading tests (23.8%) (BC Stats, 2011). This does not reflect all Grade 4 and 7 students as many parents have opted their children out from writing the FSA due to controversy over its meaningfulness and misuse of data. CHA 2 also has the highest percentage of 18 year olds who did not graduate from high school their first time eligible (62.4%) though many students take an extra year to graduate if they are, for example, a newcomer or have a special- needs designation (BC Stats, 2011). Students in CHA 4 are the least likely to score below average in the FSA reading tests.

A high number of Vancouver residents have postsecondary-level education (47.1%, compared to 30.2% provincially), with the greatest number residing in CHA 4 (66.5%). CHA 2 and CHA 3 have the highest percentages of residents with “no certificate” or whose highest level of education is high school Employment and income The average family income in Vancouver is higher than in BC overall. Vancouver’s average family income after-tax is $72,680 (10% higher than the BC average) and average individual income is $28,662 (5% higher than the BC average). Average income in Vancouver is influenced by the high family and individual income of residents in CHA 1 and CHA 4.

Men continue to earn more than women, with men earning 21.3% ($4,249) and 49.2% ($9,321) more than women in Vancouver and BC, respectively, in 2005. The largest gendered income discrepancy is found within CHA 4.

Across Vancouver, recent immigrants (2001-2006) experience a disadvantage in the labour force, earning on average $17,933 less than the average Canadian- born worker and experiencing higher rates of unemployment (9.5% for recent immigrants vs. 5.1% for Canadian born workers).

It is estimated that an average Canadian individual or family spends about 50% of their total income on food, shelter and clothing. Individuals or families that earn an income that would likely mean they are spending 70% or more of their income on basic necessities are considered to be “low income.” At 21.6%, Vancouver is home to more people who are considered low income than BC overall (13.1%), with the greatest percentage found in CHA 2 (25.6%). Vancouver also has a higher proportion of children under age six (20.1%) and seniors aged 65 years and over (16.6%) living in low-income conditions compared to BC, with the highest percentage of both found in CHA 2 (29.2% of children under six and 42.2% of seniors).

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Household characteristics Vancouver has an average of 2.2 people per household with an average of 1 child per family. The largest households are found within CHA 3 and CHA 6 at an average of 2.8 people per household and an average of 1.2 children per family.

The proportion of lone parent families in Vancouver is slightly higher (16.2%) than in BC overall (15.1%), with the overwhelming majority being female-led (81.6%). Lone-parent families represent 11.3% of families who live in CHA 1 and 22.4% of families who live in CHA 2.

28.8% of seniors in Vancouver live alone while another 7.7% live with a relative. More than half (52.1%) of seniors who live in CHA 1 live alone. CHA 3 (11.5%) and CHA 6 (11.7%) have the most seniors living with a relative. Further, immigrant seniors are more likely than non-immigrant seniors to live with a relative (Citizenship and Immigration Canada, 2005).

Vancouver is home to a highly mobile population, with 50.7% of residents having changed addresses within the last five years. This rate is highest in CHA 1 (where 67.3% of residents have changed addresses within the last five years). This highly mobile population is also more likely to rent (rather than own) their primary residence. In fact, the majority of Vancouver dwellings (52.1%) are rental units, higher than the BC average of 30.4%.

Secondary suites, involving the use of basements or separate floors of houses to provide additional accommodation, have played an increasingly important role in meeting the rental housing demand in Vancouver. They are also thought to facilitate home ownership by providing additional income to homeowners so they can qualify and pay for mortgages. In 2009, the City of Vancouver estimated that there were approximately 25,000 secondary suites, both legal and illegal, in the city (City of Vancouver, 2009b). Overall, there are significantly more secondary suites in the east side areas of Vancouver than in west side areas. Further detail about secondary suites is available in the Community Health Area Profiles for CHA 3, 4 and 6.

A Health and Social Profile Vancouver Coastal Health 22 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Housing costs Both renters and owners in Vancouver spend a significant proportion of their income on housing costs. A household paying more than 30% of total annual income on housing costs is considered to be living in unaffordable conditions, where the cost burden makes it difficult to pay for other necessities such as food, clothing, education, transportation, and health care. In Vancouver, 37.4%, of renters and homeowners spend 30% or more their income on housing costs, indicative of Vancouver’s increasingly unaffordable housing. In CHA 2, 46.2% of renters and homeowners spend 30% or more their income on housing costs. This is higher than in the rest of BC, where 29% of renters and owners spend more than 30% of their income on housing costs.

In Vancouver, the average gross rent is $901, which is 8.8% higher relative to BC. The average owner monthly payment is $1,243, which is 17.4% higher relative to BC. The highest rental and owner monthly payment housing costs are found in CHA 4 ($1,109 and $1,449, respectively).

Non-market housing provides housing mainly for those who cannot afford to pay market rents. It is housing owned by a government agency, a non-profit organization, or co-operative society where rents are determined not by the market but by the resident’s ability to pay (City of Vancouver, 2010c). In 2010, non-market housing accounted for 8.4% of Vancouver’s total housing stock (City of Vancouver, 2010b): 491 complexes with 25,306 units (City of Vancouver, 2012a). Most 40% of the non-market housing facilities are located within CHA 2 (City of Vancouver, 2012a). Within Vancouver, 117 complexes are housing co-operatives, 92 are for seniors, 52 are for families, 43 are for low income families or singles, 27 are for Aboriginal people, 24 are for people with a mental illness, and 21 are for people with a disability (City of Vancouver, 2012a).

Over the past decade, the number of homeless people has risen from 629 to 1,602 to comprise 2% of Vancouver’s total population (City of Vancouver, 2012b).

Note: all homeless counts underestimate the number of homeless people at one time and do not take into account the mobility of this population). In 2011/2012, Vancouver had 680 “year round” and 436 temporary shelter spaces, most found within CHAs 1, 2, and 5. These service a sheltered homeless population of 1,296 people; however, there are another 306 homeless individuals scattered throughout Vancouver who are considered “street homeless” (people who routinely sleep outside, rather than in shelters). The proportion of homeless people who are Aboriginal remains disproportionately high- routinely greater than 30%.

A Health and Social Profile Vancouver Coastal Health 23 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Living costs The Living Wage for Families campaign has calculated the cost of living in Metro Vancouver for a family of four where both parents work full-time. Since it was first calculated in 2008, the living wage has been rising annually, along with the cost of consumer goods. In 2012, to cover only bare bone expenses such as food, shelter, clothing, and health care, each parent in a family of four has to earn at least $19.14 per hour (A Living Wage for Families, 2012). The provincial minimum wage is $10.25 per hour.

The cost of a basket of nutritious food is also more expensive in the Vancouver Coastal Health region relative to other areas in BC. In a 2011 report entitled “The Cost of Eating in British Columbia,” the Dietitians of Canada BC Region (2011) note that the average monthly cost of a nutritious food basket within BC in 2011 was $868.43. Of all health authority regions, the VCH region had the highest monthly food costs for a family of four, at $944.19.

According to Westcoast Child Care Resource Centre, in 2011, the average monthly child care fees in Vancouver were $1,196 for children aged 6 weeks to 18 months, $1,143 for children aged 19 months to 3 years, $801 for children aged 3 to 5 years, and $314 for after-school care. Getting around Within Vancouver, more people in the labour force aged 15+ years use public transit (24.9%) or walk to work (12.5%), compared to those who take transit (10.3% ) or walk (6.9%) in BC. Amongst the CHAs, cars are most widely utilized in CHA 6 (71.1%), while public transit is the least utilized in CHA 4 (20.1%). Maps of the public transportation system show that CHA 4 and CHA 6 are the least diversely serviced areas of Vancouver.

A Health and Social Profile Vancouver Coastal Health 24 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Community belonging A 2012 study commissioned by the Vancouver Foundation (2012) examined community belonging and engagement in Metro Vancouver. Through a telephone survey of 3,841 residents, the study looked at people’s personal friendships, connection to their neighbours and participation in their community.

Findings showed that most residents of Metro Vancouver feel a sense of belonging and engagement in their communities. For example: 43% of respondents reported having twenty or more friends, 83% reported visiting their local library or community centre, and 80% of respondents strongly agreed or agreed with the statement that they like living in metro Vancouver and feel like they belong here.

However, the research also points to some important gaps. For example, 31% of respondents reported that it is difficult to make new friends in metro Vancouver and 25% say they are alone more often than they would like to be. These same people are also likelier to experience poorer health, lower trust and a hardening of attitudes toward other community members.

While 74% of respondents know the names of at least two of their neighbours, 70% have not visited a neighbour’s home or invited a neighbour over. The most often-cited reason for not knowing neighbours is that people seldom see each other (46%). However, 32% reported having little interest in getting to know their neighbours or said that they prefer to keep to themselves.

In the past year, only 23% of respondents took part in a neighbourhood or community project, and only 33% reported volunteering more than once a month. The most often-cited reason for not participating in neighbourhood and community life is a feeling that they have little to offer.

From a health perspective, these findings are important to pay attention to because “social support networks” and “social environments” are key determinants of health. The Public Health Agency of Canada (2003) cites several US studies that demonstrate the link between connectedness and health, including one study that found that the more social contacts a person had, the lower their premature death rate. And another that found that high levels of trust and group membership were associated with reduced mortality rates.

A Health and Social Profile Vancouver Coastal Health 25 VANCOUVER CITYWIDE SUMMARY

Health status

This section details the type of data used to profile the health of communities and illustrates the interaction between the determinants of health, illness and injury.

Understanding the health status of a population provides an opportunity to evaluate current health programs and to be proactive in planning future health initiatives and tailor interventions to meet community needs.

A Health and Social Profile Vancouver Coastal Health 26 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Life expectancy

FIGURE 3. Life expectancy (years) for total population. Vancouver HSDA, Vancouver Coastal Health Region, and British Columbia, 1987-2011

Source: BC Stats, Vital Statistics, Ministry of Labour, Citizens’ Services, and Open Government (2012, February) Births From 1987 through to 2011, the birth rate has been steadily declining across Vancouver. The live birth rate is highest in CHA 5 at 11.8 per 1,000 population and lowest in CHA 2 at 7.9 per 1,000 population. The infant mortality rate within CHA 5 (7.9 per 1,000 live births) is significantly greater than the provincial value (3.6 per 1,000 live births).

Births to teenage mothers aged 15 to 19 years have also been steadily declining with Vancouver rates (8.3 per 1,000 live births) well below the provincial average (30.1 per 1,000 live births). The highest rates are found in CHA 2 (26.6 per 1,000 live births). A greater percentage of Vancouver women are having children at a later age, with 36.4% of new mothers aged 35 years or older as compared to 23.2% provincially.

Vancouver also has higher rates of low birth weight births (62.2 per 1,000 live births) relative to BC (55.5 per 1,000 live births); however, these rates have fluctuated over the years. From 2001 to 2010, the rate of low birth weights has been increasing in all the CHAs except CHA 2, with the highest rate found in CHA 6 (72.4 per 1,000 live births) and lowest in CHA 4 (52.1 per 1,000 live births).

A Health and Social Profile Vancouver Coastal Health 27 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Mortality

FIGURE 4. Standardized mortality ratio (SMR) by specific cause of death. Vancouver HSDA, 2007-2011

Source: BC Vital Statistics Agency (VISTA) (2011,July 28)

The potential years of life is an indicator of premature death and highlights the causes of death that occur at younger ages. It counts the number of years that people in a particular area “lose” when they die before the age of 75.

The PYLL index (PYLLI) is the ratio of the geographic area’s observed PYLL to its expected PYLL.

The black bars show the 95% confidence interval or range of accuracy of the PYLLI.

* where the observed PYLL is statistically significantly different from the expected PYLL Within Vancouver, significantly more people are dying from infectious disease (1.54), including HIV (2.80), and accidental poisonings (1.22), while significantly less people are dying from cancer (0.9), diabetes (0.77), cardiovascular disease (0.83), chronic pulmonary disease (0.76), and transport accidents (0.4) than what is expected based on provincial rates. CHA 2, encompassing the Downtown Eastside with its concentration of people who inject drugs, has the highest ratio of observed to expected deaths for infectious disease, HIV, accidental poisonings, and suicide. CHA 3 has the highest SMR for homicide. CHA 6 has the highest SMR for diabetes. This may be due to CHA 6’s large South Asian population. South Asians are at an increased risk of diabetes due to certain metabolic risk factors..

A Health and Social Profile Vancouver Coastal Health 28 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

FIGURE 5. Potential years of life lost (PYLL) index by specific cause of death. Vancouver HSDA, 2007-2011

Source: BC Vital Statistics Agency (VISTA) (2011, July 28)

The potential years of life is an indicator of premature death and highlights the causes of death that occur at younger ages. It counts the number of years that people in a particular area “lose” when they die before the age of 75.

The PYLL index (PYLLI) is the ratio of the geographic area’s observed PYLL to its expected PYLL.

The black bars show the 95% confidence interval or range of accuracy of the PYLLI.

* where the observed PYLL is statistically significantly different from the expected PYLL

In Vancouver, there are significantly more premature deaths related to infectious disease (7,499), including HIV (4,643), while there are significantly fewer premature deaths related to cancer (34,404) and transport collisions (3,077) than expected values based on provincial rates (Figure 4). CHA 2 has the highest PYLLI for infectious disease, including HIV, accidental poisoning, suicide, chronic pulmonary disease, cardiovascular disease, and cerebrovascular disease, while CHA 6 has the highest PYLLI for transport accidents.

Vancouver and BC have similar suicide rates and these have remained relatively stable from 2001-2005 to 2006-2010, saving a noticeable decrease in the suicide rates of those aged 85 years and over. The highest suicide rates are found within CHA 1 and CHA 2.

A Health and Social Profile Vancouver Coastal Health 29 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

TABLE 2. Lifestyle related deaths. Vancouver, 2006-2010

SMR PYLL PYLLI Alcohol-related 0.73* 14,918 0.67* Medically treatable 1.16 3,545 1.11 Drug induced 1.24* 11,182 1.13 Smoking attributable 0.87* 17,137 0.95

Source: BC Vital Statistics Agency (2011, March) *= statistically significant α<0.05

Within Vancouver, fewer people are dying from deaths related to alcohol and smoking, while more people are dying from deaths related to drugs than what is expected based on provincial values. Smoking accounts for the greatest number of premature deaths, while the observed potential years of life lost for alcohol- related deaths (14,918) is significantly lower than the expected value. Amongst the CHAs, CHA 2, encompassing the Downtown Eastside, has the highest ratio of expected to observed deaths for all four lifestyle related deaths. Chronic disease Chronic diseases are the leading cause of mortality across the world, representing 60% of all deaths (WHO, 2012). Vancouver has relatively low chronic disease incidence rates for arthritis, cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes as compared to the VCH region and provincially (BC Primary Health Care, 2011). Amongst the CHAs, CHA 6 has the highest rates for cardiovascular disease and diabetes. CHA 2 has the highest rates for arthritis and COPD. The lowest rates for arthritis, COPD and diabetes are found within CHA 4 and the lowest rate for cardiovascular disease is found within CHA 5. Vancouver has considerably lower rates of overweight or obese individuals at 31.7% compared to 44.7% provincially (Statistics Canada, 2012). Communicable disease

Communicable diseases are ones that can be passed between people through proximity, social contact, or intimate contact. From 2009-2011, Vancouver had higher incidence rates for both HIV and Hepatitis C compared to the VCH region (BC Centre for Disease Control, 2012). These rates have decreased by approximately 20% from the 2006-2008 to 2009-2011 period. The highest incidence rates for HIV are found within CHA 1, while the highest incidence rates for Hepatitis C are found within CHA 2. The lowest rates for both are found within CHA 4.

A Health and Social Profile Vancouver Coastal Health 30 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Health related behaviour Within Vancouver, 14.9% of the population are daily or occasional smokers and 15.1% are heavy drinkers, slightly lower than the provincial rates (16.7% and 15.8%, respectively) (Statistics Canada, 2012). School immunization coverage Immunization is one of the most effective methods to protect adults and children from communicable disease, illness or deaths. Widespread immunization reduces the number of susceptible people making it difficult for disease to spread from person to person. VCH is the public health agency in Vancouver responsible for providing these vaccines in the school setting. Within Vancouver, the Meningococcal C vaccine had been administered to 96.1% of Grade 6 students and the Tdap vaccine had been administered to 79.8% of Grade 9 students (Vancouver Coastal Health Public Health Surveillance Unit, 2011). The lowest rates of immunization are found within CHA 2 and CHA 4, while the

highest are found within CHA 6.2

For more information about health status see Appendix 3.

A Health and Social Profile Vancouver Coastal Health 31 VANCOUVER CITYWIDE SUMMARY

Health service utilization

This section presents data on health service utilization for the years 2007-2011 inclusive. Health care utilization has evolved as the population’s need for care has changed over time.

Factors which have influenced the population’s need for care include: aging, socio-demographic population shifts and changes in the prevalence and incidence of different diseases.

The prevalence of chronic health conditions has resulted in the emergence of both residential and community-based health services designed to promote functional independence and hence, keep people out of institutional settings.

Health service utilization data provides valuable insight into the health of a population and can be used to help determine the allocation of health prevention efforts and resources.

A Health and Social Profile Vancouver Coastal Health 32 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Acute care services When examining acute care hospital admissions (inpatients) by clinical category, pregnancy and childbirth (1,103.0 per 100,000 population) accounted for the highest admission rate across Vancouver and BC (1,185.0 per 100,000 population) in 2007/08 (BC Ministry of Health Services, Management Information Branch (Discharge Abstract Database), 2008).

Within Vancouver, admission rates related to the circulatory system, respiratory system, and significant trauma, injury, poisoning, and toxic effect of drugs are lower as compared to BC.

Admission rates for mental disease and disorders are slightly higher in Vancouver (645.8 per 100,000 population) as compared BC (645.2 per 100,000 population).

Amongst the CHAs, CHA 2 has the highest hospital admission rates related to the circulatory system, respiratory system, mental diseases and disorders, and significant trauma, injury, poisoning, and toxic effect of drugs. CHA 1 has the lowest hospital admission rates for all the clinical categories except for mental diseases and disorders, for which the lowest admission rates are in CHA 4.

Between 2008/09, in Vancouver there were 20,143. Emergency Room (ER) visits per 100,000 population (Vancouver Coastal Health, October 2010). This is lower than the rate in the VCH region (20,924.5 per 100,000 population). CHA 2 has the highest rate of ER visits (31,800.1 per 100,000 population), while CHA 3 has the lowest (12,118.1 per 100,000 population). Home and community care services People aged 65 years and older make up 11.8% of Vancouver’s population and this is expected to increase to 21.3% by 2036. One of the main goals of the health care system is to ensure that there is an adequate supply of home and community care services so that people do not have to resort to institutional care. Vancouver has slightly higher rates of utilization for adult day care, case management, community rehabilitation, home nursing, and home support services as compared to the VCH region. Vancouver has 603 publicly funded assisted living beds, 28 publicly funded hospice beds, and 3,886 residential care beds (BC Ministry of Health Services, Health Systems Planning Division, 2009).

A Health and Social Profile Vancouver Coastal Health 33 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Primary health care In 2008/09, Vancouver had 136.6 general and family physicians and 231.9 specialist physicians per 100,000 population (BC Ministry of Health Services, Health Systems Planning Division, 2009). This is the highest rate in BC. CHA 1 has the highest number of both general and specialist physicians (269.0 and 785.9 per 100,000 population), most likely due to the presence of large medical institutions such as Vancouver General Hospital and St. Paul’s Hospital. Among Vancouver CHAs, CHA 3 has the fewest general and specialist physicians per 100,000

population (53.1 and 19.3, respectively). 3

For more information about the Health Service Utilization see Appendix 4

A Health and Social Profile Vancouver Coastal Health 34 VANCOUVER CITYWIDE SUMMARY

Appendices

A Health and Social Profile Vancouver Coastal Health 35 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

APPENDIX 1: 2011 Population Estimates

Vancouver VCH BC 2011 Population Estimates* Total Population 668,690 1,153,753 4,573,321 Male (%) 49.7% 49.4% 49.6% Under 5 years (%) 4.7% 4.7% 5.1% 5 to 9 years (%) 4.3% 4.5% 5.1% 10 to 14 years (%) 4.3% 4.8% 5.4% 15 to 19 years (%) 5.0% 5.8% 6.4% 20 to 24 years (%) 7.0% 7.4% 7.5% 25 to 44 years (%) 36.7% 32.2% 27.2% 45 to 64 years (%) 27.3% 28.8% 29.0% 65 to 74 years (%) 5.6% 6.3% 8.1% 75+ years (%) 5.1% 5.4% 6.2% Female (%) 50.3% 50.6% 50.4% Under 5 years (%) 4.3% 4.3% 4.7% 5 to 9 years (%) 3.8% 4.1% 4.6% 10 to 14 years (%) 3.9% 4.3% 5.0% 15 to 19 years (%) 4.6% 5.3% 5.9% 20 to 24 years (%) 6.9% 7.0% 6.8% 25 to 44 years (%) 36.4% 32.1% 27.1% 45 to 64 years (%) 27.3% 28.9% 29.4% 65 to 74 years (%) 6.1% 6.7% 8.3% 75+ years (%) 6.9% 7.3% 8.1%

A Health and Social Profile Vancouver Coastal Health 36 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

APPENDIX 2: Demographic Composition

Vancouver VCH BC Demographic Composition† Aboriginal population (%) 2.0% 2.4% 4.8% Total immigrant population by select places of birth (%) Total immigrant population (%) 45.6% 43.2% 27.5% United States of America (%) 3.2% 3.3% 5.1% United Kingdom (%) 5.3% 7.5% 12.3% China, People’s Republic of (%) 26.3% 22.6% 13.0% Hong Kong, Special Administrative Region (%) 11.1% 12.5% 7.0% Philippines (%) 8.5% 8.0% 6.2% India (%) 4.9% 4.6% 10.7% All Other (%) 40.7% 41.5% 45.7 Total recent immigrants, 2001 to 2006, by select places of birth (%) United States of America (%) 3.9% 3.5% 4.6% United Kingdom (%) 2.4% 3.2% 3.7% China, People’s Republic of (%) 36.5% 35.1% 23.3% Hong Kong, Special Administrative Region (%) 2.5% 2.8% 1.7% Philippines (%) 11.7% 11.7% 9.9% India (%) 4.7% 4.3% 13.5% All Other (%) 38.4% 39.4% 43.4% Total population by visible minority group (%) Total visible minority population (%) 51.1% 45.0% 24.8% Chinese (%) 29.4% 25.5% 10.0% South Asian (%) 5.6% 5.3% 6.4% Filipino (%) 4.9% 4.2% 2.2% Southeast Asian (%) 2.6% 1.7% 1.0% Korean (%) 1.7% 1.6% 1.2% Japanese (%) 1.7% 1.6% 0.9% All Other (%) 54.1% 60.2% 78.3%

A Health and Social Profile Vancouver Coastal Health 37 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Vancouver VCH BC Select mother tongue (% of total population) English (%) 48.0% 53.4% 70.6% French (%) 1.6% 1.4% 1.3% Chinese (Mandarin, Cantonese, Chinese n.o.s.) (%) 24.8% 21.4% 8.2% Punjabi (Punjabi) (%) 2.7% 2.4% 3.9% Tagalog (Pilipino, Filipino) (%) 2.8% 2.4% 1.2% Vietnamese (%) 1.8% 1.1% 0.6% All Others (%) 18.3% 17.8% 14.2% Education Total population, 25 to 64, by highest level of education attained (%) University certificate, diploma or degree (%) 47.1% 44.6% 30.2% College or non-university certificate or diploma (%) 16.2% 17.5% 19.6% Apprenticeship or trades certificate (%) 6.6% 7.6% 12.0% High school certificate or equivalent (%) 20.0% 21.3% 25.9% No certificate, diploma, or degree (%) 10.0% 9.1% 12.4% Employment and Income Family income distribution of economic families, after-tax Under $10,000 (%) 4.9% 4.7% 3.4% $10,000 to $29,999 (%) 16.0% 14.8% 14.0% $30,000 to $79,999 (%) 48.9% 49.0% 54.5% $80,000 and over (%) 30.2% 31.5% 28.1% Median after-tax family income ($) $56,700 $58,521 $57,599 Average after-tax family income ($) $72,680 $74,207 $67,200 Composition of family income in 2005 economic families Employment income (%) 77.2% 77.5% 77.1% Government transfer payments (%) 7.6% 7.4% 9.6% Other (%) 15.2% 15.1% 13.4% Individual income distribution of persons (aged 15+ years) not in economic families, after-tax Under $10,000 (%) 20.4% 18.7% 16.1% $10,000 to $29,999 (%) 42.1% 42.7% 47.7% $30,000 to $49,999 (%) 23.6% 24.6% 24.5% $50,000 and over (%) 13.9% 14.1% 11.7% Median after-tax income ($) $22,647 $23,539 $22,832 Average after-tax income ($) $28,662 $29,076 $27,670

A Health and Social Profile Vancouver Coastal Health 38 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Vancouver VCH BC Composition of individual income in 2005 for persons (aged 15+ years) not in economic families Employment income (%) 74.8% 71.7% 66% Government transfer payments (%) 10% 11.3% 15.9% Other (%) 15.1% 17.1% 18.2% Median after-tax income of individuals, aged 15 years and over ($) Males $24,200 $25,739 $28,251 Females $19,951 $19,789 $18,930 Percent difference (%) 21.3% 30.1% 49.2% Prevalence of low income persons (%) 38.8% 35.6% 29.0% Males 39.2% 35.8% 28.8% Females 38.5% 35.5% 29.2% Children aged less than 6 years living in low income conditions, after 20.1% 18.6% 15.1% tax (%) Seniors aged 65 years and older living in low income conditions, after 16.6% 13.5% 7.3% tax (%) Recent immigrant employment income and unemployment rates (compared to Canadian-borns) Employment Income ($) $18,486 ($36,418) - $17,994 ($36,053) Unemployment rates (%) 9.5 % (5.1%) - 9.7% (4.8%) Housing and Household Characteristics Average number of persons in private households 2.2 2.4 2.5 Lone parent families (%) 16.2% 15.5% 15.1% Seniors living arrangements Living alone (%) 28.8% 27.9% 27.3% With relative (%) 7.7% 7.0% 5.3% Households Tenant occupied (%) 52.1% 41.8% 30.4% Average gross rent ($) 901 925 828 Owner occupied (%) 47.9% 58.2% 69.6% Average owner monthly payment ($) 1,243 1,232 1,059 % paying 30% or more of their income on housing costs 37.4% 35.0% 29.0% Mobility Status Moved within last year (%) 19.7% 18.0% 17.0% Moved within last 5 years (%) 50.7% 48.0% 46.6%

A Health and Social Profile Vancouver Coastal Health 39 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Vancouver VCH BC Mode of transportation of those in labour force (15+ years) to Work Car, truck, van, as driver (%) 51.3% 60.0% 71.6% Car, truck, van, as passenger (%) 6.1% 6.9% 7.7% Public transit (%) 24.9% 19.3% 10.3% Walked (%) 12.5% 9.7% 6.9% Bicycle (%) 3.8% 2.9% 2.0% Other (%) 1.3% 1.3% 1.5%

A Health and Social Profile Vancouver Coastal Health 40 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

APPENDIX 3: Health Status

Vancouver VCH BC Life Expectancy Life expectancy at birth (years), 2007-2011 Total 83.3 83.7 78.0 Male 80.9 81.6 79.8 Female 85.7 85.7 84.1 Life expectancy at birth (years), total population 1987-1991 77.2 77.9 78.0 1992-1996 77.5 78.6 78.6 1997-2001 79.6 80.3 83.7 2002-2006 81.6 79.7 80.8 2007-2011 83.3 83.7 82.0 Births Infant mortality rate per 1,000 live births, 2009-2011 4.0 3.4 3.6 Crude live birth rate per 1,000 live births, 2010 8.9 8.7 9.6 Low birth weight births per 1,000 live births (<2,500 g), 2010 65.5 58.4 54.5 Births by age of mother, 2010 Less than 20 years (%) 0.8% 1.2% 3.0% 20-34 years (%) 62.8% 63.4% 73.8% 35+ years (%) 36.4% 35.4% 23.2% Teenage mother births per 1,000 live births, 2010 8.3 11.5 30.1 Mortality Age specific suicide rates per 10,000 population 2006-2010 (2001-2005) Less than 24 years 1.5 (1.1) 1.5 (1.0) 1.6 (1.9) 25-44 years 1.1 (1.4) 1.1 (1.2) 1.2 (1.5) 45-64 years 1.8 (1.9) 1.5 (1.6) 1.4 (1.6) 65-84 years 1.2 (1.4) 1.1 (1.2) 1.2 (1.2) 85+ years 1.4 (2.4) 1.2 (2.0) 1.3 (1.8) Chronic and Communicable Disease Incidence Chronic disease incidence rate per 100,000 population, 2010/11 (compared to 2008/09 Arthritis (osteoarthritis and rheumatoid arthritis) 487.2 (447.6) 546.6 (498.5) 690.5 (642.8) Cardiovascular disease 358.5 (364.8) 363.9 (397.0) 421.7 (469.6) Chronic obstructive pulmonary disease (45+ years) 298.0 (476.1) 305.1 (495.1) 424.7(643.5) Diabetes 641.0 (561.3) 652.2 (582.0) 644.6 (650.4)

A Health and Social Profile Vancouver Coastal Health 41 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Vancouver VCH BC Communicable disease incidence rate per 100,000 population, 2009/11 (compared to 2006/08) HIV (males) 11.1 (24.9) 26.7 (31.5) N/A (27.1) Hepatitis C 37.7 (58.2) 45.4 (59.4) N/A (64.3) School Immunization Coverage, 2011 Meningococcal C- Grade 6 students (%) 86.1% 87.1% 87.7% Tdap- Grade 9 students (%) 79.8% 84.3%-

A Health and Social Profile Vancouver Coastal Health 42 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

APPENDIX 4: Health Service Utilization

Vancouver VCH BC Acute Care Acute care hospital admissions (inpatient) by clinical category per 100,000 population, 2007/08 Circulatory system 598.0 721.0 1049.5 Mental disease and disorders 645.8 570.7 645.2 Pregnancy and childbirth 1,102.0 1,059.9 1,184.9 Respiratory system 495.6 504.7 622.3 Significant trauma, injury, poisoning, and toxic effect of drugs 471.9 517.4 705.2 Emergency room (ER) visits, 2008-2009 average ER visits per years (n) 128,269 230,974 - ER visits per 100,000 population 20,141.2 20,924.6 - Home and Community Care Home and community care age utilization rate per 1,000 population, 2010/11 Adult Day Service 1.4 1.1 - Assisted Living Service 1.0 1.4 - Case Management Services 8.3 7.3 - Community Rehabilitation Services 10.2 9.8 - Home Nursing Services 8.6 8.5 - Home Support Services- Long-Term 7.9 6.7 - Home Support Services- Short-Term 2.6 2.1 - Residential Care Services 8.1 11.9 - Primary Care Medical practitioners, 2008/09 General practitioners (n) 861 1,369 4,899 General practitioners per 100,000 population 136.6 125.2 11.8 Specialists (n) 1,462 1,791 4,087 Specialists per 100,000 population 231.9 163.8 93.2

A Health and Social Profile Vancouver Coastal Health 43 COMMUNITY HEALTHVANCOUVER AREA 1 CITYWIDE CITY SUMMARY CENTRE

Glossary of terms4

Aboriginal population Persons who identify themselves with at least one Aboriginal group, that is, North American Indian, Métis or Inuit and/or those who report being a Treaty Indian or a Registered Indian, as defined by the Indian Act of Canada, and/or those who report they are members of an Indian band or First Nation.

Alcohol-related deaths Alcohol-related deaths include deaths where alcohol was a contributing factor (indirectly related) as well as those due to alcohol (directly related). Alcohol‐related and drug overdose deaths are the only cause of death categories that are not based entirely upon underlying causes of death.

Afte-tax income Refers to total income minus federal, provincial and territorial income taxes paid for calendar year 2005. Total income refers to income from all sources, including employment income, income from government programs, pension income, investment income and any other money income.

Average family income The average total income of all members of an economic family in the 2005 calendar year.

Composition of income The composition of the total income of a population group or a geographic area refers to the relative share of each income source or group of sources, expressed as a percentage of the aggregate total income of that group or area.

Drug-induced deaths Deaths due to drug-induced causes. This category of deaths excludes unintentional injuries, homicides, and other causes that could be indirectly related to drug use. Deaths directly due to alcohol are also excluded. The causes of death classified as being drug-induced are based on those used by the National Center for Health Statistics.

Economic family Refers to a group of two or more persons who live in the same dwelling and are related to each other by blood, marriage, common-law or adoption. A couple may be of opposite or same sex. For 2006, foster children are included.

Immigrant population Immigrant population is defined as persons who are, or who have been, landed immigrants in Canada, excluding non-permanent residents, who are persons in Canada on employment or student authorizations, or are refugee claimants and persons born outside Canada who are Canadian citizens by birth.

Recent immigrants Recent immigrants refer to landed immigrants who came to Canada up to five years prior to a given census year. For the 2006 Census, recent immigrants are landed immigrants who arrived in Canada between January 1, 2001 and Census Day, May 16, 2006.

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Life expectancy at birth Life expectancy at birth represents the mean number of years a birth cohort (persons born in the same year) may expect to live given the present mortality experience of a population. The life expectancy for a population is a summary measure that reflects the mortality rates for all ages combined, weighted in accordance with a life-table population structure. Life expectancy is an internationally accepted indicator of the health status of a population.

Lone-parent family Includes a parent of any marital status, with at least one child (without a spouse or children) living in the same dwelling.

Low income cut-offs after-tax Measures of low income known as low income cut-offs (LICOs) were first introduced in Canada in 1968 based on 1961 Census income data and 1959 family expenditure patterns. At that time, expenditure patterns indicated that Canadian families spent about 50% of their total income on food, shelter and clothing. It was arbitrarily estimated that families spending 70% or more of their income (20 percentage points more than the average) on these basic necessities would be in ‘straitened’ circumstances. With this assumption, low income cut-off points were set for five different sizes of families. Subsequent to these initial cut-offs, revised low income cut-offs were established based on national family expenditure data from 1969, 1978, 1986 and 1992. The initial LICOs were based upon the total income before tax of families and persons 15 years and over, not in economic families.

In a similar fashion to the derivation of low income cut-offs based upon total income, cut-offs are estimated independently for economic families and persons not in economic families based upon family expenditure and income after tax. Consequently the low income after-tax cut-offs are set at after-tax income levels, differentiated by size of family and area of residence, where families spend 20 percentage points more of their after-tax income than the average family on food, shelter and clothing.

Government Transfer Payments Refers to all transfer payments, excluding those covered as a separate income source (Child Benefits, Old Age Security pensions and Guaranteed Income Supplements, Canada or Quebec Pension Plan benefits and Employment Insurance benefits) received from federal, provincial, territorial or municipal programs during the 2005 calendar year.

Other money income Refers to regular cash income received during calendar year 2005 and not reported in any of the other ten sources listed on the questionnaire. For example, severance pay and retirement allowances, alimony, child support, periodic support from other persons not in the household, income from abroad (excluding dividends and interest), non-refundable scholarships, bursaries, fellowships and study grants, and artists’ project grants are included.

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Medically treatable deaths2 Medically treatable disease deaths are ones for which mortality could potentially have been avoided through appropriate medical intervention. The incidence of deaths from medically treatable diseases can be used by public health professionals as a way of monitoring the effect of health promotion programs.

Mobility status Information indicating whether the person lived in the same residence on Census Day (May 16, 2006), as he or she did one year before (May 16, 2005) or five years before (May 16, 2001). This means that we have ‘movers’ and ‘non-movers’. There are different types of ‘movers’: people who moved within the same city or town (non-migrants), people who moved to a different city or town (internal migrants), and people who came from another country to live in Canada (external migrants).

Non-market housing Non-market housing provides housing mainly for those who cannot afford to pay market rents. It is housing owned by government, a non-profit, or co-operative society. Rents are determined not by the market but by the resident’s ability to pay.

Prevalence of low income, after tax The prevalence of low income after tax is the proportion or percentage of economic families or persons not in economic families in a given classification below the low income after tax cut-offs. These prevalence rates are calculated from unrounded estimates of economic families and persons 15 years of age and over not in economic families.

Smoking attributable deaths2 The absence on death certifications of complete and reliable data on smoking requires the use of estimation techniques to approximate the extent of smoking-attributable deaths. Smoking- attributable deaths are derived by multiplying a smoking-attributable mortality percentage by the number of deaths aged 35+ years in specified cause of death categories including cancers, circulatory system diseases, and respiratory system diseases.

Teenage mother birth rate The number of live births to mothers less than 20 years of age divided by the number of live births and converted to a rate per 1,000 live births.

Unemployment rate The unemployment rate for a particular group (age, sex, marital status, geographic area, etc.) is the unemployed in that group, expressed as a percentage of the labour force in that group, in the week prior to enumeration.

Visible minority population Defined by the Federal Employment Equity Act as persons, other than Aboriginal peoples, who identify themselves as non-Caucasian in race or non-white in colour.

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