2 Carlton Street, Suite 1306 , Ontario M5B 1J3 Tel: (416) 595-0006 Fax: (416) 595-0030 E-mail: [email protected]

Ted Hsu November 7, 2014 Member of Parliament alPHa’s members are the 36 public health for Kingston and the Islands (Ontario) units in Ontario. House of Commons Ottawa, Ontario Canada K1A 0A6 alPHa Sections: Dear Mr. Hsu, Boards of Health Section Re: Bill C-626, an Act to amend the Statistics Act (appointment of Chief Statistician and long-form census) Council of Ontario Medical Officers of Health (COMOH) On behalf of member Medical Officers of Health, Boards of Health and Affiliate organizations of the Association of Local Public Health Agencies (alPHa), I am writing today to express our strong support for your Private Member’s Bill, C-626, which calls Affiliate for the appointment of a Chief Statistician and the reinstatement of the mandatory Organizations: Long-Form Census. ANDSOOHA - Public Health Nursing Along with many other organizations, we expressed grave concerns about the Management cancellation of the mandatory Long-Form Census at the time the decision was made, Association of Ontario and I am pleased to enclose a related resolution that was passed by our members just Public Health Business this year as well as two letters that we have sent to your federal colleagues on the Administrators subject.

Association of Public Health Please consider these documents an expression of support from alPHa for your Bill. Epidemiologists in Ontario Sincerely,

Association of Supervisors of Public Health Inspectors of Ontario

Health Promotion Ontario Penny Sutcliffe, President Ontario Association of Public Health Dentistry Copy: Rt. Hon Stephen Harper, Ontario Society of Hon James Moore, Minister of Industry Nutrition Professionals Hon Minister of Health in Public Health Hon Tom Mulcair, NDP Leader

Justin Trudeau, Liberal Leader Libby Davies, NDP Critic, Health Peggy Nash, NDP Critic, Industry , Liberal Critic, Health , Liberal Critic, Industry Hon Eric Hoskins, Minister of Health and Long Term Care (Ontario) Dr. Peter Donnelly, President and CEO, Public Health Ontario Pegeen Walsh, Executive Director, Ontario Public Health Association Cameron McDermaid, President, Association of Public Health Epidemiologists

www.alphaweb.org Providing Leadership in Public Health Management 2 Carlton Street, Suite 1306 Toronto, Ontario M5B 1J3 Tel: (416) 595-0006 Fax: (416) 595-0030 E-mail: [email protected]

September 4, 2014

alPHa’s members are Wayne Smith the public health units Chief Statistician of Canada in Ontario. Office of the Chief Statistician of Canada 150 Tunney's Pasture Driveway Ottawa, Ontario K1A 0T6 alPHa Sections:

Boards of Health Dear Mr. Smith, Section Re: alPHa RESOLUTION A14-1 - Request for Provision of Population Data from Council of Ontario Medical Officers of Administrative Sources and Changes in Practice Related to the National Household Health (COMOH) Survey

Affiliate On behalf of member Medical Officers of Health, Boards of Health and Affiliate Organizations: organizations of the Association of Local Public Health Agencies (alPHa), I am writing today to introduce the attached resolution that was passed by the Association at its ANDSOOHA - Public June 2014 Annual General Meeting for your support and action. Health Nursing Management As you are aware, the voluntary National Household Survey (NHS) replaced Canada’s Association of Ontario Mandatory Long-Form Census in 2010. We expressed significant concerns about this Public Health Business decision at the time, chief among them being the predictable compromise of Administrators previously reliable data due to potentially low response rates both overall and within Association of selected populations. With the release of the results of the 2011 NHS, these concerns Public Health appear to have been valid. Epidemiologists in Ontario Non-response creates significant bias in the data, which is magnified when applied to Association of small areas and smaller populations, especially where these populations can be Supervisors of Public identified (e.g. aboriginal, immigrants, low education, low income etc.). This bias has Health Inspectors of made it difficult if not impossible to compare estimates with previous censuses or Ontario other sources. Health Promotion Ontario Our members count on reliable information about populations both large and small in order to do effective population health planning at the local level. The data from the Ontario Association of Public Health Dentistry NSA appears to be reliable enough to do broad-spectrum planning, but we have grave concerns about its reliability for the purposes of planning in areas with small Ontario Society of populations as well as for identifiable vulnerable populations. The latter is an Nutrition Professionals especially important area of focus for our members, as it is a requirement of the in Public Health Ontario Public Health Standards, mandated in the Ontario Health Protection and Promotion Act.

We have already called on the to reinstate the Mandatory Long-Form Census (please see the letter attached). In the interim, we are asking Statistics Canada to release supplementary data sets that will help us better identify and deal with the gaps created by the voluntary nature of the NHS, especially in the areas of aboriginal identity, ethnic origin, education, income, mobility, language, and housing to support decision makers in small areas and smaller populations. Page 1 of 2 www.alphaweb.org Providing Leadership in Public Health Management Wayne Smith Page 2 of 2 August 27, 2014

We look forward to working with the Statistics Canada and the Federal Government to resolve this issue, which will contribute to the improvement of health and wellbeing for all Canadians.

Sincerely,

Linda Stewart, Executive Director

COPY: Rt. Hon Stephen Harper, Prime Minister of Canada Hon James Moore, Minister of Industry Hon Rona Ambrose Minister of Health Hon Tom Mulcair, NDP Leader , Liberal Leader Libby Davies, NDP Critic, Health Peggy Nash, NDP Critic, Industry Hedy Fry, Liberal Critic, Health Judy Sgro, Liberal Critic, Industry Hon Eric Hoskins, Minister of Health and Long Term Care (Ontario) George Pasut, Interim CEO, Public Health Ontario Pegeen Walsh, Executive Director, Ontario Public Health Association Cameron McDermaid, President, Association of Public Health Epidemiologists in Ontario

Encl.

The Association of Local Public Health Agencies (alPHa) is a non-profit organization that provides leadership to Ontario’s boards of health and public health units. The Association works with governments and other health organizations, to advocate for a strong and effective public health system in the province, as well as public health policies, programs and services that benefit all Ontarians.

alPHa RESOLUTION A14-1

TITLE: Request for Provision of Population Data from Administrative Sources and Changes in Practice Related to the National Household Survey SPONSOR: Association of Public Health Epidemiologists in Ontario (APHEO)

WHEREAS the National Household Survey (NHS) is intended to provide data for small geographic areas and small population groups; and WHEREAS the 2011 NHS was conducted as a voluntary national population survey; and WHEREAS non-response to the NHS has increased compared to the mandatory long form Census as result of the voluntary nature of the survey; and WHEREAS Statistics Canada supports the general reliability of the data at the national, provincial, territorial levels; and WHEREAS despite this support, Statistics Canada has identified possible effects of non-response in aboriginal identity, ethnic origin, education, income, mobility, language, and housing; and WHEREAS the risk of bias of such measures increases for small areas and smaller populations, the groups for which the NHS is intended to provide estimates; and WHEREAS the NHS surveys a different population than the long form census did: those living in communal settings and abroad are excluded; and WHEREAS the possible bias due to non-response and the change in population has made it difficult if not impossible to compare measures such as income with previous censuses or other sources; and WHEREAS no alternate information sources are readily available to inform decisions or validate NHS estimates based on aboriginal identity, ethnic origin, education, income, mobility, language, and housing at the health unit level; and WHEREAS supplemental data such as those derived from the annual tax file provided by the Canada Revenue Agency or citizenship and immigration statistics from Citizenship and Immigration Canada are available under the Data Liberation Initiative; and WHEREAS only institutional networks of Canadian postsecondary institutions participating in the Data Liberation Initiative currently have access to such data;

NOW THEREFORE BE IT RESOLVED that the Association of Local Public Health Agencies request Statistics Canada to make available and/or expedite access to supplemental information or their derivative products in the areas aboriginal identity, ethnic origin, education, income, mobility, language, and housing to support decision makers in small areas and smaller populations. This request will be copied to the Prime Minister’s office, Minister of Industry (as the originator of the Order in Council that altered the census), the Minister of Health, and the leaders of the opposition parties and their critics for these two ministries;

AND FURTHER that Statistics Canada and those who may influence decisions made by Statistics Canada be asked to reinstate a mandatory long form census and otherwise gather and make available information from administrative databases such data that may be influenced by non-response to the NHS at a small area or small population level;

AND FURTHER that the Association of Local Public Health Agencies encourage other stakeholder agencies such as the Ministry of Health and Long Term Care, Public Health Ontario, Ontario Public Health Association, etc. to support this resolution.

ACTION FROM CONFERENCE: Resolution CARRIED

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Providing leadership in public health management

Honourable Tony Clement July 21, 2010 Minister of Industry C.D. Howe Building 235 Queen Street Ottawa, Ontario K1A 0H5

Dear Minister Clement,

Re. Discontinuing the Mandatory Long-Form Census Questionnaire

On behalf of member Medical Officers of Health, Boards of Health and Affiliate organizations of the Association of Local Public Health Agencies (alPHa) I am writing to express our disagreement with your decision to discontinue the mandatory long-form Canadian Census questionnaire in favour of a voluntary National Household Survey during the 2011 census.

For longer than Canada has been a country, the census has provided high quality information about her residents and communities, which has aided policymakers at all governance levels to make well informed policy decisions that are for the good of the Canadian public. The rich data generated have long been used by researchers and analysts to examine societal trends, identify areas of need, inform policy interventions, and demonstrate value for money in the use of public resources.

Ontario’s public health units for example are mandated by the Ontario Public Health Standards to undertake population health assessments and surveillance and are specifically required to gather data on socio-demographics including population counts by age, sex, education, employment, income, housing, language, immigration, culture, ability/disability among others. The census is the sole source of much of this required information, and it is in turn applied to planning for effective and efficient delivery of programs and services.

It is widely accepted that the census data as reported through Statistics Canada are the gold standard for this type of information, as its mandatory responses and large sample size provide unassailable statistical reliability. This reliability will be severely compromised under a voluntary system, and so in turn will the ability to properly assess the best use of public resources or inform policy responses to address community public health needs.

This of course is not limited to public health. Compromising the richest and most reliable source of data we have on the characteristics of the Canadian population – from the national level right down to the individual census tract – compromises the very foundation for making sound decisions about how to best serve the public good at all levels.

We are therefore strongly urging you to reverse this short-sighted decision and reinstate the

mandatory long-form questionnaire as part of the 2011 Canadian Census.

Sincerely,

Valerie Sterling President Association of Local Public Health Agencies (alPHa)

Copy: Hon. Stephen Harper, Prime Minister of Canada Munir A. Sheikh, Chief Statistician of Canada