2014 Community Health Assessment

Chapter 1: Introduction to -Eastern RHA and Community Health Assessment

CHAPTER 1 TABLE OF CONTENTS

1. Introduction to Interlake-Eastern Regional Health Authority Community Health Assessment

1.1 KEY FINDINGS ...... 7 1.2 COMMUNITY HEALTH ASSESSMENT PROCESS ...... 9 1.3 INTERLAKE-EASTERN REGIONAL HEALTH AUTHORITY AMALGAMATION ...... 12 1.3.1 Interlake-Eastern Regional Health Authority ...... 13 1.3.2 Interlake-Eastern RHA Board Vision, Mission, Values and Strategic Focus ...... 15 1.4 PROGRAMS AND SERVICES ...... 21 1.5 GEOGRAPHY AND PEOPLE ...... 23 1.5.1 Districts Descriptions...... 25 1.5.2 Community Descriptions ...... 26 1.5.3 French Language Communities and Associated Services ...... 33 1.5.4 Community Populations ...... 38 1.5.5 Population Density ...... 40 1.6 DEMOGRAPHICS...... 41 1.6.1 Population ...... 41 1.6.2 Aboriginal Population ...... 43 1.6.3 Dependency Ratio ...... 44 1.6.4 Changes in Population Over Time ...... 46 1.6.5 Population Projections ...... 48 1.7 CENSUS INDICATORS ...... 50 1.7.1 Marital Status and Family Structure ...... 50 1.7.2 Language ...... 52 1.7.3 Internal/External Migration ...... 54 1.7.4 Mobility Status ...... 56 REFERENCES ...... 58

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List of Tables TABLE 1-1. INTERLAKE-EASTERN RHA ORGANIZATION CHART, 2014...... 20 TABLE 1- 2. INTERLAKE-EASTERN RHA LIST OF COMMUNITIES BY DISTRICT AND ZONE ...... 25 TABLE 1-3. INTERLAKE-EASTERN RHA FRENCH LANGUAGE COMMUNITIES...... 34 TABLE 1-4. INTERLAKE-EASTERN RHA FRENCH LANGUAGE EDUCATION OPTIONS...... 35 TABLE 1-5. INTERLAKE-EASTERN RHA POPULATION BY COMMUNITY, 2013...... 39 TABLE 1-6. COMPARISON OF REGIONAL POPULATION DENSITIES, 2011...... 40 TABLE 1-7. INTERLAKE-EASTERN RHA NON-FIRST NATION COMMUNITY POPULATIONS, 2013...... 45 TABLE 1-8. POPULATION PROJECTIONS (IN THOUSANDS) BY RHA, SEVEN SCENARIOS TO 2042...... 48 TABLE 1-9. POPULATION PROJECTION AVERAGE ANNUAL GROWTH RATE (%) BY RHA FOR SEVEN PROJECTION SCENARIOS, TO 2042...... 49 TABLE 1-10. MARITAL STATUS AND FAMILY INDICATORS, 2011...... 51 TABLE 1-11. LANGUAGE BY INTERLAKE-EASTERN RHA RESIDENTS AND , 2011...... 53 TABLE 1-12. INTERNAL/EXTERNAL MIGRATION STATUS, 2011...... 54 TABLE 1-13. NEW IMMIGRANTS, MOST COMMON COUNTRIES OF ORIGIN, 2011...... 55 TABLE 1-14. MOBILITY STATUS, 2011...... 56

List of Figures FIGURE 1-1. INTERLAKE-EASTERN RHA MAP...... 24 FIGURE 1-2. INTERLAKE-EASTERN RHA (IERHA) POPULATION, JUNE 1, 2014...... 41 FIGURE 1-3. INTERLAKE-EASTERN RHA AND MANITOBA POPULATION DISTRIBUTION COMPARISON, JUNE 1, 2014...... 42 FIGURE 1-4. INTERLAKE-EASTERN RHA ABORIGINAL POPULATION, 2011...... 43 FIGURE 1-5. INTERLAKE-EASTERN RHA DEPENDENCY RATIO, BY REGION, JUNE 1, 2014...... 44 FIGURE 1-6. INTERLAKE-EASTERN RHA CHANGE IN POPULATION OVER TIME, 2000-2014...... 46 FIGURE 1-7. INTERLAKE-EASTERN RHA CHANGE IN POPULATION OVER TIME, 2000-2014...... 47 FIGURE 1-8. LONE-PARENT FAMILIES, BY REGION, 2011...... 52 FIGURE 1-9. YEAR AND 5 YEAR INTERNAL MIGRANTS, BY REGION, 2011...... 57

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1. Introduction to Interlake-Eastern Regional Health Authority Community Health Assessment

How healthy are we? What makes us sick? What factors play a role in determining how healthy we are? How do we use the services that are offered when we become ill?

Let us start by defining what is meant by a Community Health Assessment (CHA):

Community may refer to more than just a geographic location. There are communities of interest, or groups of people who share common ideas or characteristics. People who are of a certain cultural or ethnic group or people who have diabetes could be considered a community. Most of the information presented in this report is at a regional level and where possible data are also presented at a sub-regional level called “zones” and “districts”.

Health is defined by the World Health Organization as:

“The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities’. Thus, health refers to the ability to maintain homeostasis and recover from insults. Mental, intellectual, emotional, and social health refer to a person’s ability to handle stress, to acquire skills, to maintain relationships, all of which form resources for resiliency and independent living1.”

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It is a resource for everyday life – and not the objective for living. It is also a joint societal responsibility – and not only that of the formal health sector. Assessment in this report refers to a process of examining the factors that affect our health (determinants of health), the health of the people who live and work in the region, and the use of the health care system delivered by Interlake-Eastern RHA and the physicians in the region. We believe this should be an ongoing process of assessing health and all of its determinants in order to direct programming and planning, and address the health needs of the population.

Through review of our data and consultation with our staff and community members, this Community Health Assessment provides the RHA with a clearer picture of the health beliefs of residents, how these beliefs affect health and which determinants of health are the most significant predictors of health outcomes in the region.

The information collected through this process will be used:

 To inform RHA strategic planning process  To inform RHA communities and stakeholders  To inform Manitoba Health strategic planning and performance deliverable processes  To inform consultants/liaisons about the region  To inform evidence-based decision making

A comprehensive Community Health Assessment (CHA) must be undertaken by the Regional Health Authorities (RHAs) in Manitoba every five years and these are some of the questions that are explored. This is the fourth comprehensive CHA required by Manitoba Health but it is the first report for Interlake-Eastern RHA (amalgamation of Interlake RHA (IRHA) and North Eastman Health Association (NEHA). The first CHA was published in 1997, the second in 2004 and the third in 2009. While these reports cannot provide information about all health issues, they serve to highlight the important and relevant issues to be addressed by the RHA, our partners, and the community at large.

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This document will also indicate which priority issues need to be further explored, and act as a baseline and focus for future reports. For the first CHA of Interlake-Eastern RHA, we will try to present time trends, referring to the 2009 CHA document key findings from each of the former RHAs as a reference point for where we are todayi. That said, the focus will be on where the RHA is today and how this new set of baseline data can inform us as we move forward in strategic planning and prioritizing services for the region.

This document covers:

 Introduction to the CHA (Chapter 1)  What Keeps Us Healthy? (Chapter 2)  How Healthy Are We? (Chapter 3)  How Well Does the Health System Meet the Needs of the Population? (Chapter 4)  What Does the Health System Look Like? (Chapter 5)  Aboriginal Health (Chapter 6)  Key Findings (Chapter 7)

Beausejour, MB

i Note that when referring to “2009 findings” throughout the document, the reference is to the publication year of 2009 and not implying that all data are from 2009. Details of data years from the 2009 CHA are found in each document. In addition, although the formal names of the former regions are Interlake RHA (IRHA) and North Eastman Health Association (NEHA), for ease of narrative, in many cases these are referred to as “the former Interlake and North Eastman regions.”

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In addition, the Appendices provide further details about data collection, data sources and how to interpret the graphs in this document. Details and summary reports are also provided about the community consultation process that was undertaken to inform this process. All indicators presented in this document are also provided in “at a glance” data tables at both regional and zone levels (where data are available) in the Appendices. The appendices include the following information:

Appendix A – Interlake-Eastern RHA 2014 Data Sources and Tips on How to Read This Report Appendix B – Indicators at a Glance – Region and Manitoba (where available) Appendix C – Indicators at a Glance – Zones and Districts (where available) Appendix D – Interlake-Eastern RHA Community Consultation Methodology, Tool Kit, including survey tools Appendix E – Interlake-Eastern RHA 2014 Community Consultation Key Themes Appendix F – Interlake-Eastern RHA Client Health Services Experience Summary of Survey Results

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1.1 Key Findings 2015 Community Health Assessment

CHA Process Programs & Services

 Mandated by Manitoba Health  10 hospitals Chapter 1: Introduction to  5 year cycle  16 Personal Care Homes Interlake-Eastern Regional  12 Clinics Interlake-Eastern  Health Authority 6 Primary Health Care Centres Amalgamation  1 Crisis Stabilization Unit &  18 Emergency Medical Service  2013-2016 Strategic Plan Community Health Assessment Stations developed by the Board  16 Community Health Offices o Building for Tomorrow  Wide range of hospital o Innovation procedures and services to Chapter Details: o Learning & Growth community-based Community Health Assessment o Keeping it Going programming within a primary provides a clearer idea of the o Expanding Opportunities health care model o The Best We Can be people in the region,  Settings include hospitals, o Getting Better, Staying Healthy their beliefs and how this clinics, personal care homes

affects their health.  Regional Values include: and primary health care o Collaboration The focus of this assessment is centres o Accessibility where this region is today with o Respect Geography & People respect to health and health o Excellence services and how it proceeds o Innovation  Large, diverse geographic area o Quality Customer Service  Population increases in summer What is important in this  Numerous lakes, parks chapter?  Farming, mining, forestry, hydroelectric power, tourism We are a large region with a are key economic sectors growing and aging population  20 communities between 1,000-3,000 people and 8 with 5,000 or more.  17 First Nation communities

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Population IERHA Males 64,207 75+  126,674 residents in 2014 70-74  Low population density below 2 65-69 people/square km 60-64  Slightly younger population than 55-59 provincial average 50-54  24.7% self-identify as Aboriginal 45-49 40-44  62.6% of residents are married 35-39  14.2% of residents are lone-parent 30-34 families 25-29 20-24 Growth 15-19 10-14  11% population growth between 5-9 2000 and 2014 1-4  Age 50-54 years and older has shown <1 the most considerable increase and 6% 4% 2% 0% 2% 4% 6% growth of older population will impact needs for services and long term care Source: Manitoba Health June 1, 2014 Population Report  Population expected to grow between 0.4% and 1.03% annually to 2042 to a high of 169,500 residents

Language 12,000 2000 2014  English is mother tongue for 84% of 10,000 residents and 93.4% most often 8,000 speak English at home 6,000 Mobility Status 4,000 2,000  5.5% of residents are immigrants  Over half of immigrants came from 0 UK, Germany or United States age  71.9% of residents lived at the same Sources: Manitoba Health June 1, 2000 Population Report address for 5 years Manitoba Health June 1, 2014 Population Report  16.4% of residents moved within the region in the past 5 years

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1.2 Community Health Assessment Process

This Community Health Assessment was led by Doreen Fey, Vice President Primary Care and Chief Administrative Officer (West). Ongoing assistance in data collection, graphing and editing was provided by Inga Bjarnason. Tamara Johnston provided editing, writing and formatting support. The work to compile the data and write this report was contracted to Cynthia Carr of EPI Research Inc.

In the spring of 2013, the CHA steering committee was formed to meet as needed to provide feedback and direction on proposed approaches, to assist with community consultations, provide stories and additional information for this document. The committee is comprised of:

 Doreen Fey, Vice President Primary Care and Chief Administrative Officer (West)  Brenda Martinussen, Regional Manager Allied Health  Connie Nixon, Public Health Clinical Team Manager  Dianne Mestdagh, Regional Director Surgery & MDR  Don Condie, EMS Manager  Jo-Ann Welham, Regional Manager Quality & Risk  Dr. Karen Robinson, Medical Officer of Health  Kelly-Lynn Bekar, Nurse Practitioner  Lauralou Cicierski, Regional Manager Communications  Leana Smith, Regional Manager Community Wellness  Leona Wright, Mental Health Clinical Team Manager  Lynette Klein, Regional Manager  Sharlene Thompson, Primary Health Care Nurse  Suzanne Dick, Project Manager Clinical Programs  Tammie-Lee Rogowski, Clinical Team Manager Palliative Care & Home Care Nursing  Wendy Sofranuik, Clinical Team Manager  Inga Bjarnason, Decision Support Clerk

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A core committee was established from the steering committee and is comprised of:  Doreen Fey, Vice President Primary Care and Chief Administrative Officer (West)  Suzanne Dick, Project Manager, Clinical Programs  Dr. Karen Robinson, Medical Officer of Health  Lynette Klein, Regional Manager, First Nation and Métis Health  Tracey Dowson, Primary Care Connector  Leana Smith, Regional Manager, Community Wellness & Chronic Disease Prevention  Inga Bjarnason, Decision Support Clerk

Suzanne Dick worked with staff and managers on an on-going basis to collect data and complete "reality checks" to ensure that data findings were in accord with direct staff experiences.

Leana Smith and her staff were instrumental in planning all of the community consultation logistics and conducting the focus groups.

Lynette Klein was successful in working with our First Nations communities and receiving approval to collect and include health status information about First Nation residents living on reserve in the region, for all but one community.

One formal meeting and focus group was held with the Interlake-Eastern RHA board to communicate about the CHA plan and ask for feedback regarding timelines and process. A second meeting with the board was held on March 25, 2015, to present the CHA key findings for utilization in the strategic planning process.

For this CHA, Manitoba Health required that each RHA report on a "core" set of approximately 81 indicators. These indicators are identified in Appendix A and Appendix B. Beyond this core set of indicators, each RHA could choose from many other important indicators based on their unique needs and priority areas. The indicators are presented throughout this document and summarized in “at a glance” data tables in Appendix B and Appendix C.

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It is important to note the information in this report is NOT limited to services and utilization only within the region - for example, if a resident of Gimli travelled to to give birth, the baby would still be captured as an "Interlake-Eastern RHA birth" but the actual birth would count towards the number of deliveries at the Winnipeg hospital (that is where there is a difference in counting numbers of events that occurred to a regional resident as opposed to counting the number of services provided within the region to residents). This is the case for all hospital and physician encounters for people living both on and off reserve as long as the encounter is captured through Manitoba Health billing data. In addition, it is also important to note that although the Interlake-Eastern RHA was established in 2012, historical data from the former Interlake Regional Health Authority and North Eastman Health Association has been combined form many indicators so that trends over time can be presented.

We note that 29,335 Interlake-Eastern RHA residents (24.7%) self-identified as Aboriginal (Aboriginal is defined as Inuit, Métis or First Nation) in the 2011 Census.ii We have devoted a chapter (chapter 6) to address what we currently know about risk factors and health status among Aboriginal residents.

Data from the Canadian Community Health Survey is used primarily in chapters 2 and 3. One of the limitations of the data is that Aboriginal residents living on reserve are not represented. Manitoba Health does not collect ethnicity data with its health, hospital or utilization information. Ethnicity data from these sources are limited to geography and to whether an individual lives "on" or "off" reserve.

ii Aboriginal people are defined as those who report being First Nations (North American Indian), Métis or Inuk (Inuit) and/or those who reported Registered or Treaty Indian status or membership in a First Nation or Indian Band.

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1.3 Interlake-Eastern Regional Health Authority Amalgamation

In April 2012, the Government of Manitoba introduced amendments to the Regional Health Authorities Act which reduced the number of regional health authorities in Manitoba from eleven (11) to five (5). The Minister of Health indicated that these amendments were introduced in order to improve financial accountability and community involvement. Savings generated from the merger would be re-directed to frontline care.2 For example, in the case of Interlake-Eastern RHA, two senior positions were removed from the RHA. All Manitoba regional health authority (RHA) boards voted to approve the government’s proposal to reduce the number of health authorities which included the merger of Interlake RHA and North Eastman Health Association into Interlake-Eastern RHA.

The current chief executive officer (CEO) of Interlake-Eastern Regional Health Authority (Interlake-Eastern RHA) is Ron Van Denakker. Oral Johnston is the current appointed chair of Interlake-Eastern RHA’s board of directors. The Board is composed of 15 appointed members, representing the broad diversity of the region.

The board of directors created a structure and processes within which the board of Interlake-Eastern RHA would operate. The process included electing a secretary and treasurer to the Executive Committee as well as electing chairs to the standing committees of policy and planning, finance, audit and quality and patient safety. Directors also identified and adopted bylaws and policies to guide board governance. Directors developed, in consultation with staff, the new region’s vision, mission and values.

The 2013-2016 Strategic Plan was developed by the Interlake-Eastern RHA board and shared with staff and the public. This plan used Manitoba Health’s priorities and goals as its basis for guidance, tailored to meet the needs in the region. The region’s annual health plan is developed by Interlake-Eastern RHA staff, guided by the priorities developed in the strategic plan. The process to integrate services across the new region is well underway with program

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evaluations being conducted in order to integrate services. The new Interlake-Eastern RHA Board has helped to guide this process toward a regional approach to planning and priority setting, considering overall regional impact first and to strategically assess where best to focus financial and human resources.

1.3.1 Interlake-Eastern Regional Health Authority

Interlake-Eastern Regional Health Authority (Interlake-Eastern RHA) is responsible for the operation and administration of facility and community- based health programs and services at a regional level within the Interlake and Eastern regions of Manitoba (see Figure 1). Within the context of broad provincial policy direction, Interlake-Eastern RHA assesses and prioritizes services and programs based on evidence-based needs and develops and manages an integrated approach to health care delivery. Interlake-Eastern RHA has developed an operational plan framework for 2013-2015. The priority areas are in finance, public relations, community service and allied health, acute care, and medicine. The objectives are to develop a standardized, best practice approach to health care delivery in the region with a particular emphasis on client-focused service.

The Board of Directors provides leadership, oversight and governance to Interlake-Eastern RHA. Part of their responsibility is to set goals and strategies and monitor the progress made toward achieving them. As identified in the 2013-2016 Strategic Plan, the region is focused on improving access to primary care, improved workplace culture and enhancing public health programming. Collaboration with community groups and a sustained commitment to creating integrated and accessible health care services were viewed as key contributors to the achievement of strategic priorities within the region. The CEO for the region liaises regularly with community health care committees and consults with a number of committees including the East Area Health Committee (includes elected representatives from , Beausejour, Lac du Bonnet and the RMs of Brokenhead, Reynolds, Springfield and Lac du Bonnet), the Health Advisory Committee and the

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Arborg-Bifrost Community Development Corporation. In addition, the CEO has met with RMs, town councils and First Nations communities to discuss health care.

Selkirk & District General Hospital, Selkirk, MB

Did you know? The 2013/14 year saw the first program modifications and restructuring to reflect the new, amalgamated region. These changes have resulted in more consistent and reliable care across all program and service areas, particularly in the home care program, information technology supports and in the planning and delivery of food services to long term care residents and hospital in-patients. Service coordination in the maintenance, construction and building management department was improved. Clinical team leaders are better connected through improved communications, planning and problem solving processes and this has resulted in improved care for our clients and patients.

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1.3.2 Interlake-Eastern RHA Board Vision, Mission, Values and Strategic Focus

The vision of Interlake-Eastern RHA is: connecting people and communities to excellent health services - Today and Tomorrow. The mission of the organization is: In partnership with our communities and through a culture of quality customer service, we are dedicated to delivering health services in a timely, reliable and accessible manner. We achieve our success through an engaged and empowered staff.

The two crescent shapes in the Interlake-Eastern logo represent two responsibilities for health care – the responsibility of individuals and communities and the responsibility of the RHA. When the two crescents merge, they create a whole person, in recognition that our care of people’s health is the foundation of the work we do at Interlake-Eastern RHA.

The values of Interlake-Eastern RHA are the following:

 Collaboration - We will maintain the highest degree of integrity, accountability and transparency with our communities, health partners and our staff.

“We need to stop being individual sticks trying to stand on their own and become a bundle of sticks that are stronger because they are wrapped together as one thing.” (Interlake-Eastern RHA senior leadership team member)

 Accessibility - We will ensure timely and reasonable access to appropriate health programs and services.

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”I can guarantee you that if patients experienced shorter wait times for surgery, if it was easier to refill routine prescriptions, if we could get into see our family doctor without having to wait months for an open appointment, and if we had an overall excellent customer service experience when we interacted with the health system – then no one would be complaining about how much we are spending on health care.” (Interlake-Eastern RHA senior leadership team member)

 Respect - We are committed to a health care environment that treats all clients, patients, staff and communities with compassion, empathy and understanding.

“[Health care is] about people working together to provide the best care possible with whatever resources are at our disposal. It’s about taking the time to talk with clients and patients. It’s about remembering that being human is about more than just being alive.” (Interlake-Eastern RHA senior leadership team member)

 Excellence - We are committed to excellence in all of our programs, services, and initiatives built on a foundation of client, patient and staff safety.

“Let’s be the kind of organization that tries to get it done rather than the kind that finds why we can’t.” (Interlake-Eastern RHA senior leadership team member)

 Innovation - We will lead based on best practice evidence and have the courage to address challenges with honesty and creativity.

“Let's be fixers and problem solvers, not problem makers and idea blockers.” (Interlake-Eastern RHA senior leadership team member)

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 Quality Customer Service - We will cultivate and support a culture of quality customer service committed to providing a positive experience for clients, patients, staff and other stakeholders.

“Let’s be enemies of unnecessary red tape and find the common sense in the complicated.” (Interlake-Eastern RHA senior leadership team member)

Gimli Community Health Centre, Gimli, MB

The Interlake-Eastern RHA board has identified the following elements for their strategic focus as identified in the 2013-2016 Strategic Plan:

 Building for Tomorrow: We are committed to making the most of our human and financial resources to ensure that we are in the best position possible to serve our communities today and into the future. All decisions are based on evidence, ethics and efficiency.

“[We] need more flexibility in working in engaging First Nation practitioners to work in our facilities.” (Interlake-Eastern RHA board member)

 Innovation, Learning and Growth: We embrace new ideas, explore opportunities, focus on innovation, and build and strengthen partnerships.

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“[We will have a more connected system] when physicians are working in a more inter-connected way across the region.” (Interlake-Eastern RHA board member)

 Keeping It Going: We will meet the needs of our clients and patients by sustaining our current levels of care and service delivery. We will choose wisely, have the courage to address challenges, focus on our priorities and take action to provide the best care possible.

“We are moving towards our vision when patients choose services from throughout the region rather than driving to Winnipeg.” (Interlake-Eastern RHA board member)

 Expanding Opportunities: We welcome all people we serve with approachable, accessible and appropriate care and services by providing the right care, in the right place, and at the right time. We want to contribute to the vibrancy and health of the communities we serve.

“[We] need to review current service models to ensure the best care in the best place at the best time.” (Interlake-Eastern RHA board member)

 The Best We Can Be: Each health care experience is as unique as the person being cared for. We will deliver quality and safe care by doing it right and doing it well through a person-centered experience. We will be accountable for using human and financial resources wisely.

“[We know we are more client/community focused when] the community expresses confidence that the system is working as it should and is meeting their needs.” (Interlake-Eastern RHA board member)

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 Getting Better, Staying Healthy: Challenges related to education, income, culture, and social factors can make it harder to stay healthy. It is important to us to work with everyone to improve their health. We plan to do this through strong partnerships and by working together to find new ways to improve the health and well- being of everyone we serve. We will create a legacy of health and wellness for generations to come.

“[I want] services that are available that help me take responsibility for my health and that of my family.” (Interlake-Eastern RHA board member)

Ashern Personal Care Home, , MB

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Table 1-1. Interlake-Eastern RHA Organization Chart, 2014.

Board of Directors Local Health Involvement Groups (LHIG)

Chief Executive Officer Regional Manager Corporate Administration-Executive Assistant to CEO Executive Director Human Resources

Medical Officers of Health Regional Manager Communications & Public Communications & Communications & Public Relations Relations Associate Public Relations Assistant

VP Finance VP Corp Services VP Acute Care & VP Community VP Primary Care & VP Medical & & CFO & CAO East Chief Nursing Officer Services & CAHO CAO West CMO

Regional Director Regional Director Capital Regional Director Regional Director Personal Care Regional Director Associate Financial Services Planning & Facilities Acute Care-Emergency Home Programs Mental Health & Crisis Services VP Medical Management Department/Cancer Regional Director Services/Acute Care Regional Director Home Care/ Regional Director Regional Manager Information Technology Regional Director Education Palliative Care/Seniors Housing PHC Planning & Development Physician Services Support Services Regional Director Regional Director Regional Manager Regional Director Health Information Regional Manager Acute Care Medicine Allied Health Public Health Services Disaster Management Regional Community Development Regional Director Acute Care Regional Manager Regional Director Officer Regional Director Surgery/MDR/Obstetrics/ Community Wellness & Chronic Project Management Materials Management Renal Health Disease Prevention

Project Manager Clinical Programs Regional Director Regional Director Regional Manager First Nations Quality, Risk & Patient Diagnostics Services Regional Director Acute Care & Métis Health Safety Manitoba (DSM) Patient Experience FLS Coordinator – St. Laurent

Regional Manager Regional Director EMS PHC Clinical Services FLS Coordinator – St. Georges

Regional Director Pharmacy

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1.4 Programs and Services

Interlake-Eastern RHA delivers a broad range of services in a variety of facilities throughout the region. The region has:

 10 Hospitals (Arborg, Ashern, Beausejour, Eriksdale, Gimli, Pinawa, Pine Falls, Selkirk, Stonewall, )

 16 Primary Health Care Clinics (Arborg, Ashern, Beausejour, Eriksdale, Fisher Branch, Gimli, Lac du Bonnet, , Oakbank, Pinawa, Pine Falls, Riverton, St. Laurent, Selkirk, Teulon, Whitemouth)

 16 Personal Care Home Sitesiii (Arborg, Ashern, Beausejour, Eriksdale, Fisher Branch, Gimli, Lac du Bonnet, Lundar, Oakbank, Pine Falls, Selkirk (3), Stonewall, Teulon, Whitemouth)

 1 Crisis Stabilization Unit (Selkirk)

 18 Emergency Medical Service Stations (Arborg, Ashern, Beausejour, Bissett, Fisher Branch, Gimli, , Lac du Bonnet, Lundar, Pinawa, Pine Falls, Riverton, Selkirk, Springfield, Stonewall, Teulon, West St. Paul, Whitemouth)

 16 Community Health Offices (Arborg, Ashern, Beausejour, Eriksdale, Fisher Branch, Gimli, Lac du Bonnet, Lundar, Oakbank, Pinawa, Pine Falls, Riverton, Selkirk, St. Laurent, Teulon, Whitemouth)

iii Includes privately-run and Interlake-Eastern RHA facilities. Of the 16 PCHs in the region, four are private including the Betel PCH in Gimli and the Red River Place, Betel PCH and Tudor House PCH in Selkirk.

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Through these facilities, the region offers a broad range of health programs and services. For example:

 In patient services – medical,  Mobile crisis services (teams for youth surgical and adults) Community wellness  Renal care (dialysis)  Chronic disease prevention and management  Community cancer programs  Family doctor finder  Cancer navigation services  FASD diagnostics clinics  Diagnostic services  Hearing/audiology  Obstetrics  Children’s speech language pathology  Surgical services (general,  Home care gynecological, urology)  Physiotherapy  Physicians  Occupational therapy  Nurse practitioners  Services to older adults  Public health  Palliative care  Dietitians  Spiritual care  Mental health services for children, adults and older adults  Crisis stabilization unit (CSU)

Elizabeth M. Crowe Memorial Hospital, Eriksdale, MB

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1.5 Geography and People

The special characteristics of the region in which we live have a significant impact on how healthy we are, and our ability to manage our own health. This chapter examines the geography and governance of the region, its demographic features, including the make-up of our population, the structure of our families, and our socio-economic situation.

At 61,000 square kilometres, Interlake-Eastern RHA represents approximately one-tenth of Manitoba’s area. The Interlake-Eastern region is a geographical area which extends east to the border, north to the 53rd parallel, and west to . A large northern area of the region is defined as unorganized territories, which tends to be largely unpopulated.

The region includes a wide variety of geographical features such as natural lake borders as part of the to agricultural and parklands to beaches and marshlands. The population more than doubles in the summer with vacationers and cottage owners enjoying properties along and Lake Manitoba as well as the Hecla/Grindstone, Whiteshell, Nopiming and Atikaki Provincial Parks and resort communities.

The economy of the region is diverse and includes farming, mining, forestry, and hydroelectric power. Recreation and tourism have a significant role in the economy with a highly developed network of seasonal recreational activities including snowmobiling, ice fishing, cross country skiing and boating. There are a large number of seasonal and all-season cottages. The tourism and recreational activity has a direct impact on the demand for health care services in the region. Potential for significant increases in demand for emergency services, physician services and hospital care exists during these peak tourist seasons. The north eastern portion of the region is accessible only by air, water or a winter road system. This area is home to a large First Nations and Métis population. Areas such as the RMs of Springfield and Brokenhead enjoy a close proximity to Winnipeg and residents of these communities can easily commute to the city for employment.

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FigureFigure 1-1 .1 Interlake. -Eastern RHA Map.

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1.5.1 Districts Descriptions

The region has been divided into six zones (Selkirk, South, North, East, West, Northern Remote) and 15 districts (see Table 1- 2). These zones and districts were organized to facilitate and co‐ordinate the planning and provision of health services in the region. Table 1- 2. Interlake-Eastern RHA List of Communities by District and Zone District # Selkirk Zone District # West Zone 1 Selkirk Selkirk City 9 Gimli Gimli Town District # South Zone 10 Arborg/ Bifrost RM Riverton 2 Stonewall/ Stonewall Town Arborg Town Teulon Teulon Town Riverton Village Rockwood RM Hecla Rosser RM 11 St. Laurent Armstrong RM Woodlands RM Coldwell RM 3 Winnipeg St. Andrews RM St. Laurent RM Beach/St. Dunnottar Village District # North Zone Andrews Town 12 Powerview- Sagkeeng FN Pine Falls 4 St. Brokenhead Ojibway Powerview-Pine Falls Clements Nation St. Clements RM Black River FN 5 Springfield Springfield (Oakbank) RM Hollow Water FN District # East Zone 13 Fisher/ Fisher RM Peguis 6 Beausejour Brokenhead RM Unorganized Territories Beausejour Town Peguis FN 7 Pinawa/Lac Lac du Bonnet RM Fisher River Cree Nation du Bonnet Lac du Bonnet Town Kinonjeoshtegon FN Alexander RM Dauphin River FN Victoria Beach RM 14 Eriksdale/ Grahamdale RM Ashern Pinawa LGD Fairford FN 8 Whiteshell Whitemouth RM Little Saskatchewan FN Reynolds RM Lake St. Martin FN Siglunes RM Lake Manitoba FN Eriksdale RM District # Northern Remote Zone 15 Northern Berens River FN Remote Bloodvein FN Little Grand Rapids FN Pauingassi FN Poplar River FN Source: Interlake-Eastern RHA

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1.5.2 Community Descriptions

The following provides a description of the major regional centres in the Interlake-Eastern RHA region.

Selkirk Zone

Selkirk Selkirk is located about 22 kilometres north east of Winnipeg on the Red River. The city was named in honour of Scotsman Thomas Douglas, 5th Earl of Selkirk, who obtained the grant to first establish a colony in the Red River area. The mainstays of the local economy are tourism, a local steel mill and the Selkirk Mental Health Centre, the largest mental health facility in the province that is also a major employer in the city. Gerdau, owned by the Brazilian company Gerdau S.A. of Porto Alegre, operates a steel mill in Selkirk. Selkirk is known as the Catfish Capital of the World, due to the large amounts of catfish in the nearby Red River. Selkirk is also home to Chuck the Channel Cat, a fiberglass representation of a catfish which honours local sport fisherman Chuck Norquay. The Marine Museum of Manitoba which houses a collection of historical marine artifacts of Lake Winnipeg and the Red River area is located in Selkirk. Selkirk is also the site of a Canadian Coast Guard base. 3 To learn more about this community, please visit: http://www.cityofselkirk.com

South Zone

Stonewall Stonewall is located along Highway 67 and is 25 kilometres north of Winnipeg. Stonewall was founded in 1878 and was officially incorporated in 1908. Stonewall was a major limestone production centre and the town still has many limestone buildings such as the post office/library and the town hall. The abandoned limestone quarry has been developed into Stonewall Quarry Park. Although the need for limestone has diminished, Stonewall has evolved into a supply and service centre for the local agricultural community.4 To learn more about this community, please visit: http://www.stonewall.ca/main.asp?cat_ID=4.

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Teulon Teulon is a town located approximately 59 kilometres north of Winnipeg on Highway 7. It is located between Stonewall and Gimli, surrounded by the RM of Rockwood. It is commonly referred as "The Gateway to the Interlake." Teulon was founded in 1919, as a settlement for immigrant farmers by Charles Castle. The community was named after Castle’s wife's maiden name, "Teulon.” The agricultural and construction industries are key driving forces of the local economy. Contractors provide a range of services including building, electrical, construction, renovation and agriculture-related work.5 To learn more about this community, please visit: http://www.teulon.ca.

East Zone

Beausejour Beausejour is a town in the RM of Brokenhead, 46 kilometres north east of Winnipeg. Beausejour means "beautiful place to live" in French. Prior to the incorporation of Beausejour in 1912, Manitoba Glass Works was established as a glass container factory, aided by a nearby deposit of high quality sand. It employed up to 350 workers, but eventually relocated to Alberta in 1913. Beausejour's current economy is based on agriculture (grain production) and tourism. It serves as an access point to Whiteshell Provincial Park as well as a commercial centre for farmers and residents of the surrounding area.6 The town is home to the Canadian Power Toboggan Championships, the Double B Agricultural Festival and the annual Brokenhead River Agricultural Conference. Beausejour is also known for its annual "Shades of the Past" car show on the last Sunday of August. To learn more about this community, please visit: http://www.ourhomeyourhome.ca.

Lac du Bonnet Lac du Bonnet is located 115 kilometres north east of Winnipeg on the west shore of Winnipeg River. It is surrounded by the Rural Municipality of Lac du Bonnet. Pierre Gaultier de La Verendrye, an explorer, having surveyed the topography of the area, decided that the surrounding water reminded him of a bonnet and named the area Lac du Bonnet. The Town of Lac du Bonnet acts as a service centre for the surrounding municipalities. Agriculture remains the

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primary industry of the local economy with hydroelectric power generation, mining, harvesting of trees for lumber, pulp and paper and tourism as other important components of the local economy.7 To learn more about this community, please visit: http://www.lacdubonnet.com/

Pinawa Pinawa is located in southeastern Manitoba, 110 kilometres north east of Winnipeg. The town is located on Canadian Shield within Whiteshell Provincial Park near the Manitoba-Ontario border. Administratively, the town includes the surrounding area and is officially the Local Government District of Pinawa. WikiMiniAtlas

The community of Pinawa was originally established in 1901 to support the operation of an early hydroelectric generating station which was shut down in 1951. Pinawa was re-established about 10 kilometres from the original hydro town in 1963 when Atomic Energy of Limited (AECL) built Whiteshell Laboratories nuclear research facility. Pinawa was chosen as the site for the research station because of the seismic stability of the area. AECL began decommissioning Whiteshell Laboratories in 1998. Pinawa has since diversified its economy more with a number of environmental science firms in the area. 8 To learn more about this community, please visit: http://pinawa.com.

Whitemouth Located on Highway 44, Whitemouth is approximately 100 kilometres east of Winnipeg and on the way to Whiteshell Provincial Park. The RM was incorporated on March 1, 1905. The community of Whitemouth is located in the municipality. It also contains small parts of Manitoba's Agassiz Provincial Forest and Whiteshell Provincial Forest (in its north east corner). The area’s economy is primarily in agriculture with dairy, grain, hog, and poultry as the mainstay of the region.9 Tourism and recreation are also an important aspect to the local economy with camping facilities at Cooks Falls. Seven Sisters also offers great fishing opportunities. To learn more about this community, please visit: http://rmwhitemouth.com.

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West Zone

Arborg Arborg is located in the RM of Bifrost in the north , 103 kilometres north of Winnipeg. The town was settled in 1908 along the Icelandic River. Its first postal address was Ardal but in 1910 when the Canadian Pacific Railway reached the settlement, the name of the town was changed to Arborg (meaning "River Town").10 Icelanders first established homesteads in the area along with Polish and Ukrainian settlers. The arrival of the railroad brought large numbers of Ukrainians who settled throughout the district along with other European immigrants. This mixture gave Arborg a rich cultural diversity and its own distinct cultural mix as evidenced by the many different churches, ethnic foods and social activities in the town. The town has recently created an Arborg & District Multicultural Heritage Village that includes an interpretive centre that aims to preserve and highlight the multicultural and agricultural history of the area. To learn more about this community, please visit: http://www.townofarborg.com.

Lundar Lundar is located in the Rural Municipality of Coldwell, in Manitoba's Interlake Region, 99 kilometres north of Winnipeg on Highway 6. Lundar was founded by Icelandic settlers. Nearby attractions are Lake Manitoba and Lundar Provincial Park. The community is a regional service centre supporting the agricultural, fishing, recreation and tourism industries. The area is known for excellent fishing and hunting opportunities as well as for wildlife management areas including marsh bird nesting and Canada geese.11To learn more about this community, please visit: http://www.lundar.ca.

Gimli Gimli is a community located on the west side of Lake Winnipeg. It was settled first by Canadian Icelanders and later by Icelandic immigrants. The region became known as New Iceland and has preserved its Icelandic culture and language. Since 1874, Gimli has celebrated this heritage with the Icelandic Festival (Islendingadagurinn) which hosts several thousand tourists

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for three days each year during the August long weekend. Gimli also holds a five-day summer film festival, during which films are shown on a screen in the lake to audiences on the beach.

Fishing and tourism are major economic sectors in the Gimli area during the spring and summer months. There are over 100 commercial fisheries in Gimli, catching a variety of fish including white fish and pickerel. Thousands of summer cottagers fill the town of Gimli with its hotels, restaurants and stores that cater to these summer visitors. Two of the largest employers in Gimli are the Diageo Canada distillery and Faroex (a division of Sigma Industries). The Gimli distillery, operated by Diageo Canada, opened in 1968. The operation is situated on two quarters of land and comprises a production building, barrel filling and dumping, and 46 warehouses to store the maturing whiskies. This plant produces Crown Royal whisky. Faroex produces composite components for use in the agricultural, automotive, consumer and military supply industries.

In 1983, Gimli Industrial Park Airport became famous when an Air Canada Boeing 767 ran out of fuel over and successfully glided to a landing at Gimli Motorsport Park. The aircraft in that incident became known as the Gimli Glider.12 To learn more about this community, please visit: http://www.gimli.ca.

Riverton The Village of Riverton is located approximately 110 kilometres north of Winnipeg. It is within the Rural Municipality of Bifrost. A Canadian Pacific Railway train conductor is said to have named the community. Riverton has a small population of around 600 people. The main economy is fishing. Freshwater Fish Marketing Corporation operates a fish-packing factory on the banks of the Icelandic River, which passes through the centre of Riverton. Other industries include agriculture and the service sector. The community also services northern communities via a winter road across Lake Winnipeg.13 To learn more about this community, please visit: http://www.rivertoncanada.com.

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St. Laurent The Rural Municipality of St. Laurent is 85 kilometres north west of Winnipeg on Highway 6. It was first incorporated in 1881 and includes the communities of Harperville, St. Laurent and Oak Point. The largest concentration of French- speaking population per capita in Interlake-Eastern Regional Health Authority, lives in this area.

St. Laurent was established in 1824 by French-speaking Métis, and is today the community with the largest concentration of Métis in Manitoba and in North America².

The eastern portion of the municipality is bordered by Shoal Lakes. Agricultural land in the municipality is used primarily for cattle grazing. The shore of Lake Manitoba makes up the western edge of the municipality. A commercial fishery exists on Lake Manitoba in which local fishermen catch species such as carp, perch and pickerel. The western portion of the municipality also has a strong contingent of seasonal cottagers and permanent residents on the shores of Lake Manitoba.14 To learn more about this community, please visit: http://www.rmofstlaurent.ca.

North Zone

Ashern Ashern is in the RM of Siglunes in the Interlake Region. It was incorporated in 1917 and named after A. S. Hern, a timekeeper for a railway construction company that served the western Interlake. Ashern and surrounding area support agricultural, fishing, mineral extraction, recreation and tourism industries. The community of Ashern is the largest community in the RM and is a regional service centre.15 To learn more about this community, please visit: http://www.ashern.ca/.

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Eriksdale Eriksdale is near the eastern shore of Lake Manitoba, approximately 118 kilometres north of Winnipeg. It is part of the surrounding RM of Eriksdale. The first white settlers in the area were from Sweden and began arriving in 1905. The RM of Eriksdale was incorporated in 1918. The community was named Eriksdale after the Jonas Erikson family who had owned land where Eriksdale was built.16

Agriculture and its related businesses continue to be the major economic activity in the area. The production of cattle is perhaps the most important agricultural sector in this area. Commercial fishing on Lake Manitoba is also a key sector in the area. Eriksdale serves as a commercial centre for the surrounding area with a Consumers Co-op selling groceries, hardware, clothing, farm supplies and fuel. To learn more about this community, please visit: http://www.eriksdale.com.

Fisher Branch Fisher Branch is a village in the RM of Fisher, located on Highway 17 in the north Interlake Region. Fisher Branch was originally named Wasoo, but was later changed to Fisher Branch because it was beside a branch of the Fisher River. Fisher Branch was first settled in the early 20th century. In 1914, the Canadian Railway came into town and with it the station building. This building was a gathering, receiving and shipping place for people residing in the area, helping many to become prosperous. The primary industry of Fisher Branch today is agriculture. The area is primarily fertile agricultural farmland and parkland. It boasts lakes, forests, nature trails and native wildlife.17To learn more about this community, please visit: http://www.rmoffisher.com/fisherbranch.asp.

Powerview-Pine Falls Powerview-Pine Falls is located 132 kilometres north east of Winnipeg. Powerview and Pine Falls were initially communities located on Highway 11 on the banks of Winnipeg River. In 1926, the Manitoba Paper Company was formed in Pine Falls. In 1951, the community of Powerview was developed and became a separate entity in 1951.

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Tembec Industries purchased the Pine Falls paper mill in 1998, announcing that the town would need to become self-sufficient. Pine Falls opted to amalgamate with Powerview in May 2005. World famous fishing, beaches, water sports, hiking and cross-country skiing attract people to this area. The Edgewater region is a great place for business. Forestry, agriculture, mining and tourism are key industries in the area. In addition, the region has many hydro generating stations supplying both domestic and international markets with power.18 To learn more about this community, please visit: http://www.powerview-pinefalls.com.

St. Georges St-Georges is among one of the largest communities in the RM of Alexander with a population of well over 400 residents. It is primarily a Francophone community that originated in 1882 when Father Jaochim Allard, an Oblate missionary, wanted to establish a French-Canadian parish on Winnipeg River. In 1903, after the construction of a chapel, St. Georges officially became a parish with Abbé Charles Poirier as its first resident priest. It continues to be a French speaking community with a bilingual library and St. Georges Community School that is Francophone. 19 To learn more about this community, please visit: http://www.villagestgeorges.ca/en.

1.5.3 French Language Communities and Associated Services

Interlake-Eastern RHA undertakes to provide health care services in French to its French-speaking population. The regional French language services committee develops and supports the implementation of the regional French language services plan as per the Government of Manitoba French Language Services Policy. The committee’s goal is to ensure people and communities within the RHA are able to connect, in the official language of their choice, to excellent health services, today and tomorrow.

There are three main community areas designated as French speaking within the region. Table 1-3 lists the communities along with associated French speaking population.

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Table 1-3. Interlake-Eastern RHA French Language Communities. Rural Total Identifying as Bilingual French as Mother Municipality population (knowledge of both Tongue (includes official languages) multiple responses) Number % of total Number % of total i Alexander RM 2,983 540 18.1 365 12.2 St. Laurent RM 1300 435 33.5 315 24.2

Powerview-Pine 1314 245 18.6 145 11.0 Falls

Source: Statistics Canada. 2012. Alexander, Manitoba (Code 4601071); St. Laurent, Manitoba (Code 4618040), Powerview-Pine Falls, Manitoba (Code 4601075). Census Profile. 2011 Census. Statistics Canada Catalogue no. 98-316-XWE. Ottawa. Released October 24, 2012. http://www12.statcan.gc.ca/census-recensement/2011/dp-pd/prof/index.cfm?Lang=E (accessed January 28, 2013). i. Population numbers for the RM of Alexander are different when compared provincially and federally.

The Province has designated two health care facilities within Interlake- Eastern RHA as bilingual, meaning the facility delivers its services in both English and French and the primary language of operation is English.

Pine Falls Health Complex St. Laurent Health Centre Pine Falls, MB St. Laurent, MB

Did you know? There are two Francophone schools located The RM of St. Laurent and the RM of within Interlake-Eastern Regional Health Alexander are both situated on the Authority, as well as several schools offering shores of Lake Manitoba and Lake French Immersion programming. The table below Winnipeg respectively. They experience outlines French language education options a large swell in population over the available to residents of the Interlake-Eastern summer months with cottage owners region. and vacationers, a significant number of whom are French-speaking. www.rmstlaurent.ca

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Table 1-4. Interlake-Eastern RHA French Language Education Options. School / Daycare* School Division* Location* Grades* Enrolment 2012** École communautaire Division scolaire St. Laurent K-S4 100 Aurèle Lemoine franco-manitobaine École Communautaire St- Division scolair St-Georges K-S4 48 Georges franco-manitobaine La Prématernelle N/A St. Laurent Pre-K 28 Les P‘tits Loups N/A St-Georges Pre-K 12 R. W. Bobby Bend School Interlake Stonewall K-4 360 École Centennial School Interlake Stonewall 5-8 282 École secondaire régionale Lord Selkirk School Lord Selkirk Regional Selkirk S2-S4 39 Division Secondary Lord Selkirk School École Selkirk Junior High Selkirk 7-S1 60 Division Lord Selkirk School École Bonaventure Selkirk K-6 286 Division École Dugald School Sunrise Dugald K-8 323 École Beausejour Early Sunrise Beausejour K-5 123 Years School École Edward Schreyer Sunrise Beausejour S1-S4 82 School Powerview- École Powerview School Sunrise K-S4 148 Pine Falls *Source: https://www.dsfm.mb.ca/ScriptorWeb/scripto.asp?resultat=103879 (accessed May 7, 2013) and http://www.edu.gov.mb.ca/k12/schools/fr_imm.html (accessed May 7, 2013) **Depicts enrolment as of May 2013. In the case of dual track schools, enrollment numbers reflect students enrolled in French Did you know? Immersion programming. In terms of numbers, the Francophone population of Alexander is concentrated primarily in the community La Prématernelle de Saint-Laurent Inc. of St-Georges, with smaller pockets also living in the is a French Language daycare that Albert Beach and Bird River areas. The community of offers pre-school programming. The St-Georges is considered the heart of the Blue Water community of St-Georges also has a Francophone community and is located just southeast Centre de la petite enfance et de la of Powerview-Pine Falls. www.rmofalexander.com famile (CPEF) which is located within www.powerview-pinefalls.com L’École communautaire Saint-Georges. www.villagestgeorges.ca

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Did you know? La Fédération des Parents du Manitoba (la FPM) and Pluri-elles are non-profit provincial organizations that support francophone parents, families and organizations. They offer many programs and supports to individuals and communities throughout the province,

including the communities of St. Laurent and St. Georges.

Services Interlake-Eastern RHA provides to residents in the RM of St. Laurent include public health, mental health, home care, community wellness, primary care nurse and nurse practitioner. These programs and services are housed at the Centre de santé communautaire de St. Laurent/St. Laurent Community Health Centre, which is a designated bilingual health facility.

The St. Laurent French language services coordinator is a registered nurse whose position links strongly to the primary health care program. Services may include direct provision of first-contact services and coordination function to ensure continuity of care responsive to community needs.

The Neil Gaudry Centre, also located in St. Laurent, is a five-bed supportive housing facility operated by the community. The Regional Health Authority provides health care services to its tenants via the home care program.

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French language services in the eastern part of the region are targeted to residents of the communities of Powerview-Pine Falls and St. Georges. Health services for the Blue Water Francophone community are primarily based at the Pine Falls Health Complex and include acute care, primary health care and long-term care. Community based services such as home care, mental health, public health and community wellness are available within the community. The Blue Water FLS coordinator position is directly integrated into the primary health care program via the community wellness program.

Interlake-Eastern RHA links to other regional and provincial bilingual partners such as HealthLinks – InfoSanté, Centre de Santé de Saint-Boniface, Manitoba Telehealth, and other designated RHAs to address service gaps that may be identified.

French in the Workplace Workshop - St. Laurent CHC

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1.5.4 Community Populations

For the most part, Interlake-Eastern RHA provides services to communities located outside of First Nations communities. The federal government provides most, if not all, services to residents living on reserve in First Nation communities. However, First Nation residents living on reserve do access regional hospitals and programs that are off reserve in the region. Many people move on and off reserve so the health status of all residents living in our geographic region must be included in the Community Health Assessment and in the regional health planning and service provision as much as possible.

Steep Rock, MB

Table 1-5 illustrates the wide range of community sizes throughout the region. More detail on First Nations community populations is provided in chapter 6.

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Table 1-5. Interlake-Eastern RHA Population by Community, 2013.

First Nation Communities within Communities within Interlake-Eastern RHA Interlake-Eastern RHA Proportion of Proportion of Interlake- Interlake- Community Population Community Population Eastern RHA Eastern RHA population population Berens River First Nation 732 0.6% Alexander RM 1,749 1.4% Black River First Nation 281 0.2% Arborg Town 2,081 1.7% Bloodvein First Nation 581 0.5% Armstrong RM 1,499 1.2% Brokenhead Ojibway Nation 224 0.2% Beausejour Town 5,804 4.6% Dauphin River First Nation 59 0.0% Bifrost RM 1,888 1.5% Fisher River Cree Nation 942 0.7% Brokenhead RM 3,024 2.4% Hollow Water First Nation 532 0.4% Coldwell RM 1,313 1.0% Kinonjeoshtegon First Nation 143 0.1% Dunnottar Village 97 0.1% Lake Manitoba First Nation 494 0.4% Eriksdale RM 918 0.7% Lake St. Martin First Nation 387 0.3% Fisher RM 2,575 2.0% Little Grand Rapids First 752 0.6% Gimli RM 5,922 4.7% Nation Little Saskatchewan First 274 0.2% Grahamdale RM 1,918 1.5% Nation Pauingassi First Nation 364 0.3% Lac du Bonnet RM 1,320 1.0% Peguis First Nation 2,245 1.8% Lac du Bonnet Town 2,991 2.4% Pinaymootang First Nation 866 0.7% Pinawa LGD 1,494 1.2% Poplar River First Nation 516 0.4% Pine Falls Village 2,140 1.7% 2,100 1.7% Reynolds RM 964 0.8% FN Sub-Total 11,492 9.1% Riverton Village 1,000 0.8% Rockwood RM 6,568 5.2% Rosser RM 1,290 1.0% Selkirk City 9,884 7.9% Siglunes RM 1,798 1.4% Springfield RM 13,808 11.0% St. Andrews RM 14,981 11.9% St. Clements RM 8,128 6.5% St. Laurent RM 1,381 1.1% Stonewall Town 5,818 4.6% Teulon Town 1,787 1.4% Unorganized 3,214 2.6% Victoria Beach RM 378 0.3% Whitemouth RM 1,725 1.4% Winnipeg Beach Town 1,484 1.2% Woodlands RM 3,412 2.7% Region Total Population: 125,845 Non-FN Sub-Total 114,353 90.9% Source: Manitoba Health June 1, 2013 Population Report

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1.5.5 Population Density

As Table 1-6 shows, the average population density in Manitoba is 2.19 persons per square kilometre which is higher than the regional population density of 1.51. Our region is the second least densely populated in the province which can make service provision challenging.

Within the region, there is a mixture of both low and high density population areas. For much of the landmass particularly in the north, the population density is low between 0-2 people per square kilometre. Greater population density is found along Lake Winnipeg and Highways 7, 8, 9, 12 and 44 with between 40 to 639 people per square kilometre. Areas closer to Winnipeg also have higher population densities.

Table 1-6. Comparison of Regional Population Densities, 2011. Name Density Interlake-Eastern Regional Health Authority 1.51 Northern 0.19 Manitoba 2.19 Prairie Mountain 2.49 Canada 3.73 Southern 6.49 Winnipeg 1,047.26 Source: Statistics Canada, 2011 Census

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1.6 Demographics

1.6.1 Population

According to Manitoba Health, the 2014 Interlake-Eastern population was 126,674 residents which is higher than the 2011 census report of 118,630iv. Overall, the region makes up about ten per cent of the Manitoba population. Population groups accounting for the highest proportions of regional residents include the 50-54 year old and 75 years and older age categories (see Figure 1-2). Figure 1-2. Interlake-Eastern RHA (IERHA) Population, June 1, 2014. IERHA Males 64,207 IERHA Females 62,467 75+ 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 1-4 <1

6% 4% 2% 0% 2% 4% 6% Source: Manitoba Health June 1, 2014 Population Report

iv Unless otherwise stated, the Manitoba Health population data will be used when calculating rates and referencing population sizes.

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The region has a very similar population profile (pyramid shape) to Manitoba overall, but appears to be slightly younger (see Figure 1-3). Small differences in comparing the age profile of Interlake-Eastern RHA to the province, include the proportion of the female population at 75 years and older which is higher in Manitoba overall. The provincial proportion of the female population is also higher at ages 20-24, 25-29, 30-34 and 35-39. Conversely, the Interlake- Eastern RHA proportion of the female population is higher at 45-49, 50-54, 55-59, 60-64 and 65-69 years of age. For males, the Manitoba proportion is higher at ages 25-29, 30-34 and 35-39 years.

Figure 1-3. Interlake-Eastern RHA and Manitoba Population Distribution Comparison, June 1, 2014.

MB Males 648,110 MB Females 658,198 IERHA Males 64,207 IERHA Females 62,467 75+ 4.0% 70-74 1.7% 65-69 2.4% 60-64 2.9% 55-59 3.3% 50-54 3.6% 45-49 3.3% 40-44 3.2% 35-39 3.2% 30-34 3.4% 25-29 3.5% 20-24 3.6% 15-19 3.2% 10-14 3.0% 5-9 3.1% 1-4 2.5% <1 0.6%

5% 4% 3% 2% 1% 0% 1% 2% 3% 4% 5%

Source: Manitoba Health June 1, 2014 Population Report

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1.6.2 Aboriginal Population

According to the 2011 Census, the self-identified Aboriginal population in the region is 29,335. “Aboriginal” includes residents who are First Nation (with or without “Status” at 17,415 residents), Métis (11,545 residents) and Inuit (60 residents)v. A small number of residents (325) self-identified under more than one Aboriginal group. Of those who self-identified as Aboriginal, 17,020 are “Registered or Treaty Indian”.

As Figure 1-4 shows, about one in four residents of our region self-identified as Aboriginal to the 2011 Census. This is the second highest rate in the province and higher than the Manitoba average of 17 per cent.

Figure 1-4. Interlake-Eastern RHA Aboriginal Population, 2011.

Manitoba 17% 100%

80% 70.0%

60%

40% 24.7% 15.9% 20% 11.0% 11.9% 4.3% 0% Northern RHA Prairie Mountain Winnipeg RHA Southern RHA Canada Interlake-Eastern RHA RHA Source: Statistics Canada, 2011 Census

Overall, the Aboriginal population in the region is relatively young compared to other regional residents. Chapter 6 provides further details about the age distribution and other determinants of health related to this population.

v Note: individual numbers do not add up to the total of 29,335 as some respondents did not provide further information on Aboriginal identity.

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1.6.3 Dependency Ratio

The dependency ratio refers to the proportion of the population who are “outside the working age”, meaning either under the age of 15 or over the age of 65. In Interlake-Eastern RHA the dependency ratio is 34.3 per cent which is similar to the provincial average of 33.3 per cent (see Figure 1-5).

Figure 1-5. Interlake-Eastern RHA Dependency Ratio, by region, June 1, 2014.

Manitoba 33.3% 40% 36.6% 36.4% 35.8% 34.3% 31.5% 30%

20%

10%

0% Prairie Northern Southern Winnipeg Interlake- Mountain RHA RHA RHA EasternRHA RHA Source: Manitoba Health June 1, 2014 Population Report

Table 1-7 illustrates the dependency ratio by community. Dependency ratios of over 40 per cent were found in Gimli (41.1%), Victoria Beach (40.8%), Lac du Bonnet (40%), the Town of Arborg (40.8%), the Village of Dunnottar (60.2%) and the Pinawa LGD (40.8%). Those communities with the lowest dependency ratio include St. Andrews (29.3%), Rockwood (29.9%), Springfield (30.0%), Rosser (30.4%), and St. Clements (30.4%).

Within the region, the overall dependency ratio for First Nation communities is slightly higher than for our non-First Nation communities (37% compared to 33.8%). Chapter 6 presents further details of dependency ratio for each First Nation community.

Introduction to Interlake-Eastern RHA and Community Health Assessment Chapter 1, Page 44

Table 1-7. Interlake-Eastern RHA Non-First Nation Community Populations, 2013.

Community Total Under 15 65 and Dependency Population over Ratio Alexander RM 1749 226 409 36.3% Arborg Town 2081 567 294 41.4% Armstrong RM 1499 226 317 36.2% Beausejour Town 5804 954 1016 33.9% Bifrost RM 1888 324 339 35.1% Brokenhead RM 3024 571 451 33.8% Coldwell RM 1313 214 281 37.7% Dunnottar Village 97 6 49 56.7% Eriksdale RM 918 152 199 38.2% Fisher RM 2575 553 423 37.9% Gimli RM 5922 632 1830 41.6% Grahamdale RM 1918 353 319 35.0% Lac du Bonnet RM 1320 99 434 40.4% Lac du Bonnet Village 2991 376 723 36.7% Pinawa LGD 1494 152 496 43.4% Pine Falls Village 2140 495 266 35.6% Reynolds RM 964 112 188 31.1% Riverton Village 1000 190 163 35.3% Rockwood RM 6568 1022 961 30.2% Rosser RM 1290 211 185 30.7% Selkirk City 9884 1540 1992 35.7% Siglunes RM 1798 327 352 37.8% Springfield RM 13808 2479 1716 30.4% St Andrews RM 14981 2361 2116 29.9% St Clements RM 8128 1263 1231 30.7% St Laurent RM 1381 203 266 34.0% Stonewall Town 5818 1056 798 31.9% Teulon Town 1787 321 320 35.9% Unorganized Territories 3214 744 432 36.6% Victoria Beach RM 378 18 137 41.0% Whitemouth RM 1725 232 364 34.6% Winnipeg Beach Town 1484 164 369 35.9% Woodlands RM 3412 598 506 32.4% Non First Nations Total 114,353 18,741 19,942 33.8% Source: Manitoba Health, Population Report, June 1, 2013.

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1.6.4 Changes in Population Over Time

According to Manitoba Health, between 2000 and 2014, the regional population grew by 11 per cent from 114,158 to 126,674. In reviewing the population changes, it is noted that the population has aged and that considerable increases have occurred in 55-59, 60-64, and 65-69 age categories with increases also evident in the 50-54 and 75+ years of age categories. Despite the overall increase in population over the past 12 years, the largest decline has been in residents aged 35-39 years with smaller declines among residents 5-9, 10-14, 30-34 and 40-44 years of age (see Table 1-6 and Table 1-7).

Figure 1-6. Interlake-Eastern RHA Change in Population over Time, 2000-2014.

2000 2014 12,000

10,000

8,000

6,000

4,000

2,000

0

age Sources: Manitoba Health June 1, 2000 Population Report Manitoba Health June 1, 2014 Population Report

Introduction to Interlake-Eastern RHA and Community Health Assessment Chapter 1, Page 46

Figure 1-7. Interlake-Eastern RHA Change in Population over Time, 2000-2014.

75+

70-74

65-69

60-64

55-59

50-54

45-49

40-44 age 35-39

30-34

25-29

20-24

15-19

10-14

5-9

1-4

<1

-60% -40% -20% 0% 20% 40% 60% 80% Source: Manitoba Health June 1, 2000 Population Report Manitoba Health June 1, 2014 Population Report

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1.6.5 Population Projections

According to the population projections to 2042, the region is projected to have a population of between 140,600 and 169,500 with annual growth rates ranging between 0.4 and 1.03 per cent. Our projected growth rate is expected to be the second lowest among Manitoba RHAs.

Table 1-8 and Table 1-9 show seven projection scenarios. Each projection scenario is denoted by a three-letter combination of low (L), medium (M), and high (H) changes in fertility, mortality, and migration rates, in that order. As well, for migration, there is one condition of no inter-provincial migration (I). For example, the LLL scenario means low rates of change in fertility, mortality, and migration over time, while the LML scenario assumes a low rate of change in fertility, moderate rate of change in mortality, and low rate of change in migration over time.

Under the LLH, MMH and HHH projection scenario, the region has the lowest expected growth rate of all the RHAs. The RHA’s proportionate shares of the provincial population are expected to remain constant over the projection period.

Table 1-8. Population Projections (in thousands) by RHA, Seven Scenarios to 2042. 2012 MMI LLL HHL MMM LLH MMH HHH Interlake-Eastern RHA 124.7 150 140.6 150 154 159.3 164.7 169.5 Southern RHA 183.3 245.5 273.6 290.5 303.6 306.3 314.1 324.5 Winnipeg RHA 723.5 740.8 939.9 975.2 1070.3 1183.2 1195.3 1224.2 Prairie Mountain RHA 165.7 160.2 180 191.1 201 215.4 221.1 228 Northern RHA 74.2 87.9 86.7 94.8 93.6 95.8 99.9 104.3 Manitoba 1271.4 1384.4 1620.8 1701.6 1822.5 1960.0 1995.1 2050.5 Source: Manitoba Population Projection Report, May 2014

Introduction to Interlake-Eastern RHA and Community Health Assessment Chapter 1, Page 48

Table 1-9. Population Projection Average Annual Growth Rate (%) by RHA for Seven Projection Scenarios, to 2042. MMI LLL HHL MMM LLH MMH HHH Interlake-Eastern RHA 0.62 0.4 0.62 0.71 0.82 0.93 1.03 Southern RHA 0.98 1.34 1.55 1.7 1.73 1.81 1.92 Winnipeg RHA 0.08 0.88 1 1.31 1.65 1.69 1.77 Prairie Mountain RHA -0.11 0.28 0.48 0.65 0.88 0.97 1.07 Northern RHA 0.57 0.52 0.82 0.78 0.86 1 1.14 Manitoba 0.28 0.81 0.98 1.21 1.45 1.51 1.61 Source: Manitoba Population Projection Report, May 2014

Bird’s Hill Provincial Park

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1.7 Census Indicators

Beyond the breakdown of population figures by gender, community and age group, other census data on marital status, language, families, mobility and migration, provide additional key information to determine the kind of population in a given region and the health services and programs that will be necessary to serve communities.

1.7.1 Marital Status and Family Structure

 Census data from 2006 indicated that 55.2 per cent of residents from the former Interlake RHA (IRHA) reported being married which is above the provincial average of 50.2 per cent. In the former North Eastman Health Association (NEHA), 57.1 per cent of residents were married and only 5.8 per cent of residents reported being divorced.

 More recently, the 2011 census (see Table 1-10) indicates that almost two thirds (62.6%) of residents are either married or living with a common-law partner which is higher than the provincial average of 57.2 per cent. Almost three-quarters of families with children are headed by married couples while 14.2 per cent are headed by lone-parent families.

Introduction to Interlake-Eastern RHA and Community Health Assessment Chapter 1, Page 50

Table 1-10. Marital Status and Family Indicators, 2011. Interlake-Eastern RHA Manitoba

Number Percentage Number Percentage

Total population 15 years and over 100,090 977,105

Married or living with a common-law partner 62,685 62.6% 558,510 57.2% Married (and not separated) 53,710 53.7% 480,140 49.1% Living common law 8,975 9.0% 78,370 8.0% Not married and not living with a common-law 37,400 37.4% 418,600 42.8% partner Single (never legally married) 24,645 24.6% 282,465 28.9% Total number of census families with children 35,680 327,875

Married couples 26,145 73.3% 232,635 71.0% Common-law couples 4,480 12.6% 39,055 11.9% Total lone-parent families by sex of parent 5,055 14.2% 56,190 17.1% and number of children Female lone-parent 3,770 74.6% 43,855 78.0% Male lone-parent 1,285 25.4% 12,330 21.9% Average number of children at home per 1.1 1.2 census family Source: Statistics Canada, 2011 Census

 Figure 1-8 presents the proportion of families that are lone-parent families. The regional rate of 14.2 per cent is among the lowest in the province. This is similar to 2006 Census findings where 13.8 per cent of families were single parent in the former IRHA and 13 per cent in former NEHA.

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Figure 1-8. Lone-Parent Families, by Region, 2011. Manitoba 17.1% 40%

30.0% 30%

18.8% 20% 16.3% 14.5% 14.2% 10.3% 10%

0% Northern Winnipeg Canada Prairie Southern Interlake- RHA RHA Mountain RHA RHA Eastern RHA Source: Statistics Canada, 2011 Census

1.7.2 Language

 In 2006, English was the “mother tongue” of 78.3 per cent of former NEHA residents and 84.4 per cent of former IRHA residents. Both regions were slightly higher than the provincial average of 74.0 per cent in 2006. The use of French in these regions was below the provincial average.

 English was also the predominant language spoken at home both in the former IRHA and NEHA regions at 95.6 and 92.4 per cent respectively, which were above the provincial average of 87.3 per cent in 2006.

 In the 2011 census, there was little change in language use with English as the “mother tongue” for just under 84 per cent of residents in the region compared to 73 per cent of Manitobans. Aboriginal languages are the “mother tongue” for three per cent of regional residents which is similar to the provincial average.

 By far, the most common Aboriginal language spoken in the home is Ojibway (2,105 of the 2,170 residents who speak an Aboriginal language in the home).

Introduction to Interlake-Eastern RHA and Community Health Assessment Chapter 1, Page 52

 There were similar findings for the language most spoken at home with more than nine out of ten (93.4%) Interlake-Eastern RHA residents indicating they spoke English most often at home with small percentages of residents indicating other languages (4.9%), French (0.6%) or Aboriginal languages (1.8%) (see Table 1-11).

Table 1-11. Language by Interlake-Eastern RHA Residents and Manitoba, 2011. Interlake-Eastern RHA Manitoba Number Percentage Number Percentage Mother tongue 121,500 1,193,095 English 101,875 83.8% 869,990 72.9% French 2,815 2.3% 42,090 3.5% Aboriginal languages 3,610 3.0% 34,605 2.9% Knowledge of official 121,495 1,193,095 languages English only 114,485 94.2% 1,074,335 90.0% French only 45 0.0% 1,490 0.1% Neither English nor French 385 0.3% 14,135 1.2% First official language spoken 121,495 1,193,095 English 118,580 97.6% 1,136,685 95.3% French 2,450 2.0% 39,995 3.4% Neither English nor French 375 0.3% 13,675 1.1% Language spoken most often 121,495 1,193,095 at home English 113,425 93.4% 1,007,325 84.4% French 695 0.6% 17,950 1.5% Non-official languages 6,005 4.9% 125,280 10.5% Aboriginal languages 2,170 1.8% 21,035 1.8% Source: Statistics Canada, 2011 Census

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1.7.3 Internal/External Migration

 The former Interlake region reported in 2006 that 94.2 per cent of its population was Canadian born with 5.6 per cent born outside of Canada. The proportion of Canadian born residents was higher than the provincial average of 87.0 per cent.

 The former North also reported a higher proportion of Canadian born residents at 93.4 per cent in 2006 with 6.3 per cent born outside of Canada.

 As Table 1-12 shows, similar results were found for the 2011 Census with 94.4 per cent Canadian born residents in Interlake-Eastern RHA and 5.5 per cent identified as immigrants.

Table 1-12. Internal/External Migration Status, 2011. Interlake-Eastern Manitoba Regional RHA Number Percentage Number Percentage

Total 118,630 1,174,345

Canadian Born Residents 111,945 94.4% 981,200 83.6% Immigrants 6,525 5.5% 184,505 15.7% Before 1971 2,850 43.7% 32,675 17.7% 1971 to 1980 995 15.2% 22,995 12.5% 1981 to 1990 700 10.7% 21,950 11.9% 1991 to 2000 750 11.5% 25,010 13.6% 2001 to 2011 1,230 18.9% 81,875 44.4% Non-permanent residents 160 0.1% 8,635 0.7% Source: Statistics Canada, 2011 Census.

 Of the 6,525 immigrants to the region, the most common countries of origin are presented in Table 1-13. Just over one in five new residents originated in the United Kingdom followed by Germany at 20 per cent and the United States at approximately one in ten new residents.

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Table 1-13. New Immigrants, Most Common Countries of Origin, 2011. Number Percentage United Kingdom 1,400 21.5% Germany 1,330 20.4% United States 645 9.9% Netherlands 490 7.5% Asia 290 4.4% Mexico 235 3.6% Poland 225 3.4% Africa 195 3.0% Russian Federation 180 2.8% Portugal 175 2.7% Ukraine 170 2.6% Philippines 150 2.3% South Africa 120 1.8% Jamaica 60 0.9% Italy 55 0.8% Trinidad and Tobago 50 0.8% Other 755 11.6% Total 6,525 Source Statistics Canada, 2011 Census.

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1.7.4 Mobility Status

 In 2006, 73.1 per cent of former Interlake region residents had lived at the same address for the past year which was higher than the provincial average of 58.2 per cent. Only 2.2 per cent of former Interlake region residents reported having lived in a different province or territory five years previously, below the Manitoba average of 3.4 per cent.

 The population of former NEHA was similarly stable with 74.8 per cent having lived at the same address for the past five years and only 2.2 per cent reporting within the time period that they had moved from a different province or territory.

 Similar high levels of stability were found in 2011 with over 9 out of 10 residents found to be living at the same address a year ago and 71.9 per cent at the same address five years ago which were both higher than the provincial averages (see Table 1-14).

Table 1-14. Mobility Status, 2011. Interlake-Eastern Manitoba RHA Lived at same address one year ago 91.9% 87.5% Lived at same address five years ago 71.9% 61.9% Moved from another community within province in 14.2% 7.2% past five years Lived in different province or territory five years ago 2.2% 3.4% Lived in a different country five years ago 0.5% 5.0% Source: Statistics Canada, 2011 Census

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Figure 1-9 illustrates both one and five year internal migrants by region. Internal migrant means the resident moved from their town/city/province but from within Canada. “Migrant” does not include people that moved homes but stayed in the same community. This shows that there is a fairly high rate of movement for residents of the region with 16.4 per cent of residents having changed communities within Canada within the past five years.

Figure 1-9. Year and 5 Year Internal Migrants, by Region, 2011.

1 year internal migrants 5 year internal migrants

Manitoba 1 year internal migrants Manitoba 5 year internal migrants 20% 17.5% 16.4% 15.5% 15% 13.9%

10.8% 10% 6.6% 5.1% 5.2% 4.8% 4.2% 5% 3.4% 2.1%

0% Northern RHA Prairie Mountain Winnipeg RHA Southern RHA Canada Interlake-Eastern RHA RHA Source: Statistics Canada, 2011 Census

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References

1 Association of Faculties of Medicine of Canada (AFMC): http://phprimer.afmc.ca/Part1- TheoryThinkingAboutHealth/ConceptsOfHealthAndIllness/DefinitionsofHealth 2 Manitoba Government News Release. http://news.gov.mb.ca/news/index.html?item=13793&posted=2012-04-20 3 http://en.wikipedia.org/wiki/Selkirk,_Manitoba 4 Town of Stonewall, Community Profile. http://www.stonewall.ca/main.asp?cat_ID=4 5 Town of Teulon, Location. http://www.teulon.ca/location.cfm 6 Town of Beausejour, History and Community Profile. http://www.ourhomeyourhome.ca/town- of-beausejour/community-profile/ 7 Lac du Bonnet, Our History. http://www.lacdubonnet.com/main.asp?fxoid=FXMenu,7&cat_ID=2&sub_ID=29 8 http://en.wikipedia.org/wiki/Pinawa,_Manitoba 9 RM of Whitemouth, Our Heritage. http://rmwhitemouth.com/community/our-heritage/ 10 Town of Arborg, History. http://www.townofarborg.com/index.asp?fxoid=FXMenu,6&cat_ID=44&sub_ID=210 11 Lundar Profile. http://www.lundar.ca/main.asp?cat_ID=4 12 Town of Gimli, Our History. http://www.gimli.ca/main.asp?fxoid=FXMenu,10&cat_ID=4&sub_ID=47&sub2_ID=44 13 Village of Riverton. http://www.rivertoncanada.com/village-riverton 14 RM of St. Laurent, Our Municipality. http://www.rmofstlaurent.ca/main.asp?cat_ID=1 15 Village of Ashern. http://www.ashern.ca/main.asp?cat_ID=19 16 http://en.wikipedia.org/wiki/Eriksdale,_Manitoba 17 Welcome to the RM of Fisher. http://www.rmoffisher.com/ 18 Town of Powerview-Pine Falls, Community Profile. http://www.powerview- pinefalls.com/main.asp?cat_ID=4 19 Village of St. Georges, History. http://www.villagestgeorges.ca/history

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