And Surrounding Area Health And Well-Being Needs Assessment, 2011

Prepared For The

Oromocto And Surrounding Area Health Care Advisory Committee

Community Health Program, , , Department Of Health

Prepared By

Verlé Harrop, PhD ISBN 978- 0-9780873-2-6 Oromocto and Surrounding Area Health and Well-being Needs Assessment, 2011

July 2011

All Rights Reserved

Authored by Verlé Harrop, PhD

59 Battery Road, St. John’s NL A1A 1A4 [email protected]

Prepared for the Oromocto and Surrounding Area Health Care Advisory Committee. The Oromocto and Surrounding Area Health Care Advisory Committee can be contacted by emailing: [email protected]

For additional copies please contact: Bruce MacPherson, RSW, Director, Community Health Program, Horizon Health Network, Fredericton and surrounding area (506) 447-4219 [email protected] www.HorizonNB.ca “Volunteering, interestingly, in addition to all the good work we may do, is associated with better health for the volunteer as well. Why? Health is more than merely the absence of disease or the presence of physical well-being. It is about having those basic, solid foundations for life and society in place, and ensuring we have community, connections, friendship, control over our lives and infl uence over our destinies. ……Our health is infl uenced by the type of society we choose to create. We all have a role to play in creating the physical, economic, social and cultural conditions that are the foundation of good health. And what we do, even in small ways, can make a difference.”1

Dr. David Butler-Jones, ’s Chief Public Health Offi cer, 2008

“The major risk factors for chronic disease are an unhealthy diet, physical inactivity, and tobacco use.”2 “If the major risk factors for chronic disease were eliminated, at least 80% of heart disease, stroke and type 2 diabetes would be prevented; and 40% of cancer would be prevented.”3

World Health Organization, Ten Facts About Chronic Disease, 2005

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ACKNOWLEDGEMENTS

This report would not have been possible without Tony Ratliffe, the enthusiastic participation of the following Member of Gagetown & Area Health Services organizations and individuals: Association Inc., Bill Jarratt, The people of Oromocto and Surrounding Area Acting Director Leisure Services & Tourism, Town (O&SA), especially those who participated in the of Oromocto (replacing Jim Arbeau); town hall meeting and an extensive program of focus Susan Allen, Public Health Nurse, Healthy Learners School groups and key informant interviews; The Town of Program, School District 17; Oromocto and Mayor Tidd who graciously hosted Kayla Giesecke, the Town Hall Meeting; and The Oromocto Public Learning Specialist, School District 17; Hospital (OPH) which provided the monthly meeting Francis Hill, After-Hour Duty Chaplain and Volunteer space for the O&SA Health Advisory Committee; Member of the Spiritual and Religious Care Advisory Committee, OPH; The O&SA Health Care Advisory Committee: Constable Marc Trioreau, Public Community Beverly Greene, Relations Offi cer – Oromocto, District 2; Consultant, Department of Health; Carol Rankin, Communications, Horizon Health Bronwyn Davies, Network; Director, Primary Care Unit, Department of Pam Moxon, Admin. Assistant, Community Health Health; Program, Horizon Health Network; Nicole Tupper, Executive Director, Dr. Everett Chalmers Bruce MacPherson, Director, Community Health Program, Horizon Health Network; Regional Hospital/OPH Darline Cogswell, Emergency Room Nurse Manager/Facility The many individuals and organizations involved Manager, OPH in gathering local and health systems data for this Margaret Paul, report and in particular Bev Green who facilitated Health Director, Wel-A-Mook-Took Health the data collection process within the health Centre Oromocto First Nation system; Margaret Paul for conceptualizing the Dr. Bea Sainz, Determinants of Health Needs Assessment Tool; Family Physician, Under-Graduate Medical Darline Cogswell who played a major role in Education Representative for Fredericton and surrounding area, organizing the focus groups and key informant Medical Director of Palliative Care Services OPH; interviews; editor Hilary Harrop Archibald; Amy Janet Weber, Watling who compiled the references; Andrea Pike Nurse Practitioner, Canadian Forces for the data analysis; and Bruce MacPherson and Base Gagetown; his Administrative Assistant Pam Moxon, whose Beth Corey, combined tireless assistance with every aspect of Executive Director, Military Family Resource Centre; the needs assessment made this fi nal report Major Jonathan Daniels, possible. Gagetown (replacing Major Marcel LeBlanc and subsequently Major Rob Dunn);

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EXECUTIVE SUMMARY

Introduction health disparities. Their use effected a shift away Oromocto and Surrounding Area (O&SA) is from a sole focus on Health Services and back to comprised of the Town of Oromocto, Oromocto what David Butler-Jones refers to as “a whole of First Nation (OFN), Canadian Forces Base (CFB) society response” wherein “Canadians’ health is a Gagetown, and a number of small rural villages and shared responsibility and individuals, communities, crossroads. According to the Canadian Census 2006, public, private and not-for-profi t sectors all have a the total population of O&SA, including military role to play.”4 Implicit throughout the course of the personnel, is 30,020. The geographic area for the needs assessment was the understanding that any needs assessment extended as far north as Youngs new or additional health care services would have Cove, east to Codys, south to Wirral, and west to to benefi t the population of O&SA as a whole. Beaverdam. There are 18 governance jurisdictions in O&SA serving approximately 45 communities. Methodology The needs assessment followed a mixed In 2009, the Director of the Community Health quantitative and qualitative design. PHAC’s 12 Program, Horizon Health Network, Fredericton Determinants of Health Framework was used to and surrounding area, worked with the broader structure the needs assessment process, the data health care community to establish a Health Care collection and the writing of the report. There Advisory Committee representative of O&SA. was one town hall meeting, six focus groups and This stakeholder group was tasked with overseeing 20 key informant interviews. Relevant cycles of a participatory, community-based health and well- the Canadian Community Health Survey (CCHS) being needs assessment. and a customized, extended O&SA Canadian Census 2006 profi le were obtained from Statistics The needs assessment had three complementary Canada. Complementary systems-level data were objectives: 1. identify O&SA’s health and well- acquired from Health Services, the NB Cancer being priorities; 2. develop strategies for realizing Registry, the Population Health – Offi ce of the O&SA’s health and well-being priorities in keeping Chief Medical Offi cer of Health, Elections Canada, with its needs and resources; and 3. align the the New Brunswick Liquor Corporation, provision of health services with O&SA’s resources Lottery Corporation (ALC) and CFB Gagetown. and health and well-being concerns. From the onset, Qualitative and quantitative data were analyzed for the Advisory Committee understood that their health disparities across O&SA and amongst seven modus operandi was to fi nd effi ciencies and leverage communities within the area identifi ed (Town of resources through inter-sectoral collaboration with Oromocto; Burton Parish (Greater Geary Area); community and institutional partners. Village of Cambridge Narrows; OFN; Village of Gagetown; Village of and Background CFB Gagetown’s military spouses and dependants). Three conceptual underpinnings endorsed by the Where appropriate, O&SA data were compared to Word Health Organization (WHO), Health Canada Fredericton and surrounding area and the province and the Public Health Agency of Canada (PHAC) of NB as a whole. informed the needs assessment process, namely: population health; determinants of health; and

6 There were a number of limitations. As evidenced one year ago or fi ve years ago; less likely to have in the methodology chapter, local data collection participated in the 2006 provincial election; more and analysis posed many challenges as most likely to be exposed to second-hand smoke both standardized data collection tools are designed at home and in vehicles; less likely to have had for regional rather than small area collection a routine pap smear; more likely to report “quite and analysis. The Community Health Program’s a lot of stress”; less likely to be “moderately decision not to include a survey component meant active” or “active” in their leisure time; much less there was no self-reported data and emergent themes likely to speak both offi cial languages and more or perceived barriers to health and well-being could likely to have an overweight or obese Body not be quantifi ed. Mass Index (BMI). According to the 2007-2008 CCHS, in O&SA 72.0% of adults over age 18 Findings according to the numbers (excluding pregnant females) self-reported an The comparative data analysis of O&SA, overweight or obese BMI compared with 60.8% Fredericton and surrounding area, and the province in Fredericton and surrounding area and 61.0% as a whole, indicated that O&SA is doing better than in the province as a whole. As well, 20.6% of the comparison groups. According to the 2007-2008 the O&SA population age 12 and over has high 5 Canadian Community Health Survey (CCHS) and blood pressure. 2006 Statistics Canada Census, the New Brunswick Cancer Registry, the Offi ce of the Chief Medical Although O&SA’s overall picture was positive, Offi cer of Health, Elections New Brunswick, and except for extant gender disparities, the subsequent Elections Canada, citizens in O&SA enjoy higher comparative data analysis of the seven representative median incomes, with a lower percentage of the O&SA communities revealed signifi cant health population living below the Low Income Cut Off disparities in terms of income, social status, (LICO). They spend less disposable income on aboriginal identity, and geography. Moreover, there rent and are more likely to own their own homes. was compelling evidence of poor social cohesion, O&SA has fewer children living in poverty. Fewer social exclusion, marginalization, and pockets of senior citizens live alone, and there are fewer lone marked child poverty. These disparities were found parent families. More O&SA citizens voted in the both within and between the seven representative last election. More citizens received their infl uenza O&SA communities profi led. immunization, are more likely to have a doctor, while, interestingly, males have lower rates of Findings according to the people cancer than their Fredericton and surrounding area Working with the qualitative data from the focus and provincial cohorts. There are fewer accidental groups and key informant interviews, the top ten deaths. And, O&SA has a greater proportion of the health and well-being priority areas for action that population “from away” who have settled in the emerged are: area. • Access to public transportation: Fear of liability On the negative side of the balance sheet, when has virtually shut down the volunteer driver sector, compared with Fredericton and surrounding which in the past enabled urban and in particular area and the province as a whole, O&SA citizens rural seniors, youth and young families to socialize, are: less likely to have a university certifi cate or carry out activities of daily living and get to medical degree; less likely to have a sense of community appointments. belonging; less likely to have lived in the province

7 • Increased access to services for mental health priority. and addiction: Priority populations include youth, rural communities and OFN. • Sustainable income, inclusion and health equity: O&SA is a highly varied constellation • Primary care and prevention to be delivered of approximately 45 communities with widely in the communities: Orphan patients, and in variant median incomes, backgrounds and cultures. particular transient military dependants, can be Strengthening tolerance, inclusion and social found throughout O&SA. There is great interest in cohesion within and between communities is a using Nurse Practitioners as primary care providers priority. These ‘healthy community’ characteristics particularly in rural areas, and in evolving a new go hand in hand with community capacity model of primary care practice generally. and resiliency. Access to reliable local data is foundational to addressing health inequities. • Ready access to recreational facilities accommodating all ages: Communities recognize • Inter-sectoral collaboration: Addressing the the need to embrace physical fi tness, active living broad determinants of health requires inter-sectoral and healthy eating. Making all schools fully collaboration. Health in All Policy (HiAP) and accessible community schools and complementing Health Impact Assessments (HIA) need to be them with local infrastructure (ball fi elds, rinks, taken up by all government departments and local recreation centres, and so on), is key. governance structures.

• Dramatic change in culture around obesity: • Volunteers: These often unsung heroes are Obesity in O&SA is an epidemic and the health care reported to be a dying breed. Volunteering needs to system, in its current confi guration, cannot address it be revived and securely embedded in the culture of alone. Successfully tackling obesity rates in O&SA NB. requires a “whole of society/government response”. Communities and citizens need to become engaged. Community Resources The seven communities profi led in Chapter 7 bring • Empowering governance structures and a wealth of skills, experience and leadership to the community infrastructure: As noted by Canada’s table including: experience with HiAP; an ability to Chief Public Health Offi cer, self-determination engage and mobilize communities and successfully and control are foundational to a community’s lobby government; a proven ability to leverage motivation to address the determinants of health and partnerships and existing resources; an ability to 6 advance health equity. A robust, community-based develop strong connections between people; an communication infrastructure is a pre-requisite. ability to leverage the expertise of outside partners like UNB; experience with integrated learning • Appropriate and enabling housing: An aging and childcare and taking up of the NB Curriculum population and concentration of seniors in rural Framework - English; expertise providing communities makes “healthy aging in place” a

8 community-based mental health and addiction to the successful implementation of the report’s services; extensive experience with Nurses and recommendations. Nurse Practitioners as primary care providers; an ability to create recreation facilities; expertise in The out-going Advisory Committee expects that physical fi tness; and fi nally, an ability to attract and the in-coming, elected Advisory Board will form retain volunteers and in the process build social working groups around the recommendations -- cohesion. Presently however, these community- most importantly around: transportation; mental based resources remain largely untapped and only health and addictions; primary care access; exist in isolated pockets across O&SA. obesity; and inter-sectoral collaboration.

Recommendations Conclusion The 61 recommendations are congruent with This community-based, participatory health and Canada’s Chief Public Health Offi cer’s priority well-being needs assessment has accomplished areas for action to address health inequalities, what it set out to do. The Advisory Committee namely: social investment, community capacity, has clearly identifi ed priority areas for action inter-sectoral action, knowledge infrastructure and namely, obesity, inactivity, inclusion, intersectoral leadership.6 Recommendations are grouped under collaboration, the integration of Nurse Practitioners O&SA’s espoused Top 10 Health Priority Areas as primary care providers and fi nally, increased For Action and are designed for implementation at access to services for mental health and addictions. the systems level, in communities and by citizens Moreover, the Advisory Committee has identifi ed and households. doable strategies for addressing these priority areas that are in keeping both with O&SA’s Inter-sectoral collaboration and partnerships with capacity and, for the most part, Health Services’ local schools, associations, municipal councils, existing resources. There is a signifi cant body of provincial government departments (Health work ahead but working together, Health Services, Services, Social Development, Education, its inter-sectoral peers and the communities that Justice, Transportation and Local Government) make up O&SA can do much to ameliorate the and other outside partners such as University of health inequities in their communities – leading to New Brunswick, CFB Gagetown, Service NB a better and more equitable quality of life for all. and the NB Health Council - are foundational

9 REFERENCES

1Marshall, H., Boyd, R. (2008). The Chief Public Health Offi cer’s report on the state of Public Health in Canada. Retrieved on February 1, 2011, from http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2008/pdf/ cpho-report-eng.pdf

2World Health Organization (2005). Geneva: Fact fi le: Ten facts about chronic disease. Retrieved February 28, 2011, from http://www.who.int/features/factfi les/chp/05_en.html

3Ibid.

4Marshall, H., Boyd, R. (2008). The Chief Public Health Offi cer’s report on the state of Public Health in Canada. Retrieved on February 1, 2011, from http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2008/pdf/ cpho-report-eng.pdf

5CCHS 2007-2008.

6Marshall, H., Boyd, R. (2008). The Chief Public Health Offi cer’s report on the state of Public Health in Canada. Retrieved on February 1, 2011, from http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2008/pdf/ cpho-report-eng.pdf

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