Dr. hasselback's presentation gneyp research event

1. Putting Nanaimo’s Children First:
Using routinely collected information
to build momentum for addressing
children’s issues
Paul Hasselback MD MSc FRCPC
Medical Health Officer
Central Vancouver Island

2. Data Driven Action
• Information as a catalyst for change.
• Positive examples from peer organizations in
BC.
• Data empowers people.
• Data enables decision makers to improve the
quality of their decisions.
– Data may dissuade poorer decisions.

3. Quality Improvement Cycle

9. Why?
• Children are our future.
• Efforts to improve child wellbeing result in
improvements in community health and
vitality.
• Thriving communities = Healthy people.
• Personal passion for the wellbeing of children.

10. Why
• Early Years Network in Nanaimo for over a decade.
‒ Strong foundation to build from.
• Draft city strategic plan with minimal emphasis on
families and scarce reference to children.
• Island Health services having room for improvement
in coordination.
‒ Also with scarce emphasis on children and families
• Public Health and Children’s Health “bounced”
between portfolios.

12. Greater Nanaimo Early Years
Partnership
• Success by Six parent survey 2012 (276
respondents).
– Parenting information
• 80% friends
• 73% family
• 42% internet
• 22% professional

14. Why
• A sense of decreasing success of children.
• Need for a documentation of a foundation of
benchmarks.
• A stepping stone for moving forward.
• Increasing awareness of the current state of
children in the community.

15. Method
• Greater Nanaimo and Ladysmith Early Years
Partnership members were asked to contribute their
indicators and information.
• Mostly existing sources of information were utilized.
• Released in conjunction with the International
Children’s Day, November 20 – a celebration of the
UN Rights of the Child 1989 (and previous
declaration of 1958).

16. Key Notes
• Data are presented without comparison and without time
trends.
– Some trend information is available.
• Agency specific information is available annually, often
with 1-3 year lag times.
• Used 2006 census information, 2011 census and national
household survey now available.
• Used wave 4 of the Early Development Index, wave 5
available.
• Used 2008 McCreary information, 2013 now being
released.

17. Key Points - Socioeconomic
• 19.0% of children living in poverty.
– 7.7 at less than $20,000
– 11.3% additional below LICO
• 6% of children in families receiving income
assistance.
• 21% of homeowners spending >30% on housing.
• 1.2% of children in need of protection.
• 1.5% of children in care.

18. Key Points – Aboriginal Children
• At least 6.4% of region is of Aboriginal
ancestry.
• 2040 Aboriginal students in School District.
– Proportion increasing

19. Key Points – Pre and Post Natal
• 44% of first time mothers received prenatal
education.
• Smoking in pregnancy below 14%
• Low birth weight rate 3.8%
• Breastfeeding initiation 84%
– Sustaining to 6 months 47%
• Audiology program a huge success.

20. Key Points – Toddler Health
• 86% of kindergarten students had no visible
tooth decay.
• Fully immunized rates are only 61% for two
year olds and 55% for 7 year olds.
• Minimal activity levels are achieved by only
54%.

21. 2 – Year Immunization Coverage
• Decreasing ~1/2-1% absolute per year.
• Island Health on par with province.
• Central Island 5-10% less than both North
and South Island on all vaccines.
• Nanaimo rates below Central Island
average.

22. 7 Year Old
• 68% coverage for DaPTP
‒ lowest on Island
‒ 7% less than province
‒ is dropping about 1% absolute per year
• 88% coverage for measles (MR similar)
‒ Stable
‒ On par for province, but 2% less than Central Island and North
Island.
• 90% Varicella protection
• 91% Meningococcal C coverage

23. Grade 6 and 9 Immunization
• Hepatitis B and Meningococcal coverage near 90.
‒ Central Island 1-3% below province and Island.
• HPV coverage 72% and increasing each year.
‒ Nanaimo – slightly better than other Central Island areas.
‒ Central island above Island average and near province.
• Grade 9 TdaP booster
‒ ~ 80%
‒ 4 % less than provincial average.

24. He finally did It

25. Key Points – Early Learning
• EDI vulnerability levels looked like they were
improving, but re-released data shows a
different trend.
• Access to child care is tight.

26. Key Points – Children’s
Environment
• Library use.
• Low cost recreation access.
• Development policies on park and playground
access.
• Aboriginal culture of support to children.

27. Birth Statistics
-10 -5 0 5 10 15 20 25 30
Preterm
Teen Mother
Live Birth
Low Birth Weight
Cesarean
Mother Greater than 35
Stillbirth
Percentage Variation from Island Health Rate 2013 2012 2011

28. 0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
Lone-Parent Rate for Island Health, 2013
Island Health BC

29. Child Health
-20 -15 -10 -5 0 5 10 15 20
Preshool Physical Development Vulnerabilty
Maternal Smoking
Infant Mortality
Preterm Births
Low Birth Weight
Respiratory Diseases Hospitalizations
Injury and Poisoning Hospitalizations
Percentage Variation from Island Health Rate 2013 2012 2011

30. Healthy Development

31. -220 -195 -170 -145 -120 -95 -70 -45 -20 5 30 55 80
Alberni
VI North
Cowichan
Nanaimo
Ladysmith
Sooke
VIHA
Greater Victoria
Courtenay
CRVI
Lake Cowichan
Saanich
Qualicum
Gulf Islands
Percentage Variation from BC Rate
Children in Care Island Health 2010 - 2011
2011 2010

32. -340 -310 -280 -250 -220 -190 -160 -130 -100 -70 -40 -10 20 50
Lake Cowichan
Cowichan
Ladysmith
Alberni
VI North
VIHA
Nanaimo
Greater Victoria
Sooke
Qualicum
CRVI
Courtenay
Gulf Islands
Saanich
Percentage Variation from BC Rate
Children in Need of Protection Island Health 2010 - 2011
Children in Need of Protection 2011 Child Abuse 2010

33. 0
5
10
15
20
25
30
35
40
Percentage of Children less than 6 years Living in Low-
Income, 2011 Census

35. Measures of Education
Readiness and Success

36. BC EDI Vulnerability on One or More Scales
26
27
28
29
30
31
32
33
II III IV V
Any Dimension
Any dimension

37. BC EDI Vulnerability on Specific
Dimensions
0
2
4
6
8
10
12
14
16
18
II III IV V
Physical
Social comp
Emotional mat
Lang & Cog
Communication

38. Nanaimo Early Development Index
2004-2013
0
10
20
30
40
50
60
2004-2007 2007-2009 2009-2011 2011-2013
Vulnerability on One or More Scales, 2004 to 2013
North Nanaimo
Nanaimo West
Cedar - Wellington -
Gabriola
Northfield - Diver Lake
Long Lake -
Departure Bay
SD 68
Townsite - Nanaimo
Downtown
South Nanaimo

40. 0
10
20
30
40
50
60
Vulnerability on One or More Scales, 2009 - 2013
w4
w5
EDI Vulnerability by LHA

42. From Hastings Street to Haida Gwaii
Provincial results of the 2013 BC
McCreary Adolescent Health Survey.

43. Decrease in Serious Injuries
45%
39%
33%
30%
34%
29%
25% 24%
0%
25%
50%
1998 2003 2008 2013
Injured in the Past Year
Males Females
Note: The difference for females between 2008 and 2013 was not statistically significant.

44. More Youth ate Breakfast
50%
53%
54%
18%
15%
13%
0%
20%
40%
60%
2003 2008 2013
Eating Breakfast on School Days
Always ate breakfast Never ate breakfast

45. Risky Sexual Behaviour
Decreased
Among those who had ever had sex:
• 3% ever had an STI
• 69% used a condom the last time they had
sex.
• 5% had ever been pregnant or caused a
pregnancy.
• 24% used drugs or alcohol last time they
had sex.

46. Decreases in Substance Use
58%
54%
45%
37%
30%
26%34%
26%
21%
0%
35%
70%
2003 2008 2013
Ever Tried Different Substances
Alcohol Marijuana Tobacco

47. School Safety Increased
83%
63% 66%
85%
71%
56%
94%
88% 90%
96%
91%
87%
Classroom Washrooms Hallways Library Cafeteria Outside on
school
property
Always or Usually Felt Safe at School
2008 2013

48. Ratings of Mental Health
3%
11%
38%
49%
6%
18%
43%
33%
Poor Fair Good Excellent
Males Females

49. Rise in Overweight and Obesity
Rates
Males Females
Healthy weight
Underweight
Overweight
Obese

50. 2011 National Household Survey
Mean Household Income
$32,095
$34,913 $35,649
$26,725
$28,425
$22,595
$27,510 $27,798 $27,825
$25,356
$28,339 $28,141 $27,428
$28,394
$30,063
$28,765
$-
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000

51. 2011 NHS
• 52% of renters spending >30% of income on
housing c.f. BC 45.3%.
• 23.8% of homeowners spending >30% of
income on housing (same as BC).
• Unemployment rate of 9.2% c.f. with BC 7.8%.
• Education levels of 25-65 age group
comparable.
• 6.6% self identify as Aboriginal c.f. BC 5.4%.

52. BC Stats Socio-economic Index
-0.8-0.6-0.4-0.200.20.40.60.81
Alberni (9)
VI North (11)
Lake Cowichan (14)
Nanaimo (25)
CRVI
Cowichan
Ladysmith (44)
Greater Victoria (55)
Qualicum (62)
Courtenay
Sooke (67)
Gulf Islands (74)
Saanich (75)
Socio-Economic Index - 2012 BC Stats

53. So What?

55. What is Next?
• Data can drive action
‒ Bring attention to issues some consider “unacceptable”.
‒ Fix immediate issues identified by the data and within
scope of specific group.
‒ Bring similar thinking people together around specific
issues of concern to plan.
‐ Stimulate a community dialogue.
‐ Wet the appetite for more information.
‐ Issue specific “data dives”.
‐ Plan for a second report on State of the Child Nanaimo.

56. Thanks, Resources and
Questions
• Early years Table partners – Greater Nanaimo
• Amber Bruner – Children First Early Years Coordinator
• Christal Lawson – MHO office, Central Island
• http://www.uwcnvi.ca/web_documents/state_of_the_child_report_2013_-_nanaimo-ladysmith.pdf
• http://www.mcs.bc.ca/ahs
• http://www.nanaimofoundation.com/vital-signs/
• http://earlylearning.ubc.ca/edi/
• http://www.bcstats.gov.bc.ca/StatisticsBySubject/SocialStatistics/SocioEconomicProfilesIndices/SocioEconomicI
ndices/LHAReports.aspx

57. More resources
Campaign 2000 report card
Royal College statement on
ECD
http://drphealth.blogspot.ca/

58. Paul Hasselback MD MSc FRCPC
250.739.6304
paul.hasselback@viha.ca