R E P O T Northern River Basins Human Health Monitoring Program March 1999 NORTHERN RIVER BASINS HUMAN HEALTH MONITORING PROGRAM ○ ○ ○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ Northern River Basins Human Health Monitoring Program ○ ○ ○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ For more information contact: Health Surveillance Alberta Health P.O. Box 1360 10025 Jasper Avenue Edmonton, Alberta T5J 2P4 Phone: 780-427-4518 Fax: 780-427-6663 Internet: www.heath.gov.ab.ca ISBN (0-7785-0197-3) NORTHERN RIVER BASINS HUMAN HEALTH MONITORING PROGRAM AAAACKNOWLEDGEMENTSCKNOWLEDGEMENTSCKNOWLEDGEMENTSCKNOWLEDGEMENTS AACKNOWLEDGEMENTSCKNOWLEDGEMENTS○ ○ ○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ This report is the result of the efforts of a number of individuals who collaborated to identify potential sources of information in available data sources, and to develop new approaches to analysis of that data. The process of analysis inevitably generated more questions than answers, but resulted also in new methods of comparing health care utilization across the province. The study was led by Dr. Stephan Gabos, Health Surveillance and coordinated by Susan Shaw, Health Surveillance. The analysis was carried out by a team of analysts including Health Surveillance staff: Fu- Lin Wang, Thu Ha Nguyen, Yan Jin, Xinjie Cui, and Jonathan Robb; and consultants Erik Ellehoj (Ellehoj-Redmond Consulting) and Dennis Prince (WaterWest Consulting). Desktop publishing provided by Drager Communications Services. Management Committee: l David Bougher, Alberta Health l Connie MacRae (Chair), Northern Lights Regional Health Authority l Sally Ulfsten (Vice-Chair), Non-Governmental Organizations l Marlene Poitras, Athabasca Tribal Council l Lucille Partington, Northern River Basin Study and Project Manager l Lucille Polukshko, Public-at-Large l Dennis Stokes, Alberta Environmental Protection l Dr. Stella Swanson, Pulp and Paper Industry Communication: l Irwin Huberman, Irwin Huberman Consulting Science Advisory Committee: l Dr. Steve Hrudy, Environmental Health Sciences Program, Public Health Sciences, University of Alberta l Dr. David Schindler, Biological Sciences, University of Alberta l Pierre Band, Biostatistics Division, Health Canada Administration: l Betty Collicut l Lucille Partington Financial Administration: l Mistahia Regional Health Authority ○ ○ ○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ NORTHERN RIVER BASINS HUMAN HEALTH MONITORING PROGRAM TTTTABLEABLEABLEABLE OOOOFFFF CCCCONTENTSONTENTSONTENTSONTENTS TTABLEABLE OOFF ○ ○ ○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ CCONTENTSONTENTS Executive Summary........................................................................................................................................1 Recommendations........................................................................................................................................5 Introduction...................................................................................................................................................9 Background.................................................................................................................................................11 Methods........................................................................................................................................................17 Sources Of Data...................................................................................................................................19 Exposure Data...........................................................................................................................19 Population Data........................................................................................................................21 Socioeconomic Indicators Data...................................................................................................22 Health Outcomes Data...............................................................................................................22 Measurement And Scale..................................................................................................................25 Rate Of Hospital Admissions....................................................................................................25 Rate Of Visits TO A Physician.....................................................................................................26 Cause-Specific Mortality Rate....................................................................................................26 Rate Of Health Care Utilization..................................................................................................26 Rate Estimation.........................................................................................................................27 Mapping......................................................................................................................................29 Analysis.............................................................................................................................31 The Natural Environment.................................................................................................................33 Water....................................................................................................................................33 Air........................................................................................................................................44 Soil......................................................................................................................................51 Food....................................................................................................................................54 The Human Environment..................................................................................................................57 Population Distribution......................................................................................................57 Age And Gender Distibution.......................................................................................................57 Marital Status..............................................................................................................................59 Size Of Household.....................................................................................................................59 Fertility Rate..............................................................................................................................59 Race......................................................................................................................................61 The Socioeconomic Environment.......................................................................................................63 Education..............................................................................................................................63 Household Income And Poverty..................................................................................................63 Unemployment....................................................................................................................64 Family Composition...................................................................................................................65 Dependency Ratio......................................................................................................................66 Health Indicators................................................................................................................................69 General Health Status................................................................................................................69 Life Expectancy.........................................................................................................................70 Infant Mortality.........................................................................................................................70 Low Birth Weight.........................................................................................................................70 Mortality Rate..............................................................................................................................72 Potential Years Of Life Lost...................................................................................................○ ○ ○ ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ .....73 Health Outcomes................................................................................................................................75 Major Causes Of Death...............................................................................................................75 Reproductive Systems Diseases.................................................................................................75 Stillbirth And Infant Death.........................................................................................................84 Congenital Anomalies................................................................................................................88 Respiratory Diseases..................................................................................................................94