Proceedings of the Subcommittee on Population Health
Issue 6 - Evidence, May 21, 2008
ST. JOHN'S, Wednesday, May 21, 2008
The Subcommittee on Population Health of the Standing Senate Committee on Social Affairs, Science and Technology met this day at 9 a.m. to examine and report on the impact of the multiple factors and conditions that contribute to the health of Canada's population — known collectively as the social determinants of health.
Senator Wilbert J. Keon (Chair) in the chair.
[English]
The Chair: Good morning, honourable senators and guests. Welcome, everybody. We have an outstanding panel this morning. We look forward to hearing from everyone. Our time will be a little short, because we have to finish just a bit before noon, but I am sure we are going to learn a great deal.
We are very excited about what we heard yesterday. We came here feeling this was a model that we were going to incorporate into our report and advocate implementation of, either this model or something very similar across the country. We are more convinced than ever, so we look forward to what you all have to say this morning.
Starting from left to right on the panel, we have Joy Maddigan, Assistant Deputy Minister with the Department of Health and Community Services. Then we have Aisling Gogan — who is making her third appearance before the committee — who is the Director, Poverty Reduction Strategy, Department of Labour, Human Resources and Employment.
We also have with us Gerald Crane from the Rural Secretariat, Executive Council; Sergeant Doug Ross, a Non-Commissioned Officer in charge of RCMP Corporate Planning and Client Services Foundation in Newfoundland; Lisa Browne, who is the deputy mayor of Clarenville and from Eastern Health; Susan Green from the Kids Eat Smart Foundation; and Christine Snow from Capital Coast Development Alliance. I hope I got all of your connections correct.
We will begin with you, Joy, if you are agreeable.
Joy Maddigan, Assistant Deputy Minister, Department of Health and Community Services, Government of Newfoundland and Labrador: I do want to you thank you for the opportunity to be here today. My remarks will be brief.
My brief is entitled, "Community Accounts: A Resource to Strengthen Population Health in Newfoundland and Labrador." If I were to pinpoint one place where I really see Community Accounts, CAs, rising out of the ashes in the health system, it would be in relation to population health. Community Accounts is an information system, albeit a very interesting one with great value, no question.
In order to really appreciate the value and the impact of Community Accounts on the health and community services system, it is important that I put the health system in some context in relation to Community Accounts because it is the support that it brings to the system that I really want to stress today.
I have been in the health system for 30-plus years, so it is something I have thought a lot about and studied a lot about, that is for sure. One of the things that I have seen an enormous increase in over my career is the amount of health planning that we currently do in the health system.
There are a couple of factors that really have pushed that along. Certainly, as the system gets more complex, which we all know it will, the need to do well-thought-out thorough planning will be extremely important. Again, CAs have has been one of the cornerstones of health planning in our province, I would say, certainly in the last five to eight years, that is for sure.
The other thing that has really pushed the need to look at systems like CAs is the fact that, in the health system, the generation of data is becoming fairly significant and finding appropriate and effective ways to use that data is extremely important — there is no doubt about that.
In order to prepare for this today, I did an informal survey across our four regional health authorities as well as through the policy branch of my department. About 12 people gave me some kind of informal information about Community Accounts in their world. One of the things that came out most strongly, the strongest feedback that I received from all, is that the aspects related to planning is where Community Accounts really shows itself. It is not the only place where Community Accounts really shows itself, but certainly one of the primary places right now in the health system.
From demographic factors to health outcomes, CAs data is used in a variety and a range of different ways. It guides program decisions. It helps with research proposal development and certainly contributes to any number of policy development initiatives, which I will touch on in a little while.
I think, without doubt, all the regional health authorities and certainly our own department identified both strategic planning and operational planning as really having been enhanced or facilitated by the use of Community Accounts. In order to really appreciate, I believe, what Community Accounts has to offer, I would like to take a minute and step back, if you will, to put a little more context around it.
I recently came across a really interesting article that talked about how a health system can achieve a kind of quality and high value for its citizens, for its residents. This process was described by Berwick, Nolan and Whittington and is a 2008 article. It says that for the health system to thrive we really need to pay attention to three interlocking goals. I love them because they are so simple. I am always looking for ways to describe things in the health system in a very pragmatic and down-to-earth way.
You cannot look at the three goals separately. Berwick, Nolan and Whittington stress that the goals are interlocking. The first one they talk about is improving the individual experience of care. As a health professional, that is extremely important to me.
The second goal, and I thought it was quite appropriate for the group today, is about improving the health of the population. The third goal is to reduce the per capita cost of care. As someone who has been sitting in a health department for a number of years, those three goals had real resonance for me. Even more telling is that in order to reach those three goals a health system needs to have three pre-conditions, and it is the pre-conditions, I think, where we really see the value of Community Accounts.
The three necessary pre-conditions for the effective accomplishment of what is termed "The Triple Aim" — those three goals — are, first, the recognition of a population as a unit of concern. The second is to have sort of the parameters of your intervention or your program well defined, so externally supplied policy constraints and frameworks. We are talking about best practices and things like that here. Third, and I think this resonates again with many people, is the existence of some mechanism, some person, some vehicle that allows an integration across the full system of care, so that the population can achieve positive results on the three goals of the health system: their individual experience, their health as a group, as well as sustainability, a system that is affordable and effective.
When I looked at those three pre-conditions, understanding the population of concern is where Community Accounts has proven to be such a bonus and benefit to us. This is where it plays probably its most vital role right now in the health system. As we know, a population of concern does not have to be a geographic one, although Community Accounts very much helps us with a catchment area and geographic boundaries for sure. We can understand a system and we can understand a population, when we think about the notion of enrolment. Our registries that track people over time really help us understand the population of concern and know their characteristics.
In a sense, Community Accounts gives us a little bit of that registry for communities and for populations in our province, and it really helps us track and understand the various things that happen over time. Without a doubt that is how we can begin to know our population. If we know them well, then we can help improve the health of the group as well as understand how to make costs a little more acceptable in the system.
The main point I would make in terms of Community Accounts and the work that we have done in Newfoundland is that it has allowed us to understand the population that we serve in a much more thorough and important way. Given that that is one of the three pre-conditions to how we build a better health system, it is pretty clear how important Community Accounts can be and has been to the work that we do.
I do not want to take up much time, but I do want to touch on a couple of initiatives, if you will, in the health system. The one that I look to most clearly is primary health care reform. We have as a province worked hard to bring about change in that first level of our health system. I will not pretend to you at all that we have been wildly successful at this point in time. We have a vision. We know where we want to go, but certainly the journey has not been as fast as I know I and others would like. Nonetheless, we see primary health care reform as a critical foundation to building a strong health system.
As you know, primary health care refers to both a philosophy and a way of organizing team-based services that targets a defined population and provides a broad range of programs and services from prevention and promotion right through to rehabilitation, supportive care and palliation.
As we also know but do not address properly, I do not think, is that about 70 per cent to 80 per cent of the health system is primary health care. Hence, I try to remember that when I get frustrated with the slow pace of change. Even though we can describe primary health care fairly succinctly, I think, bringing the change about for primary health care certainly has not been succinct in that way. Primary health care illustrates most clearly how knowing our population really influences how the health system responds and acts.
As we get to know our population, which is one of the pre-conditions of the Triple Aim, rather than take a reactive approach to the problems that present to us at the door, which we will always do, we are in a much better position to take a proactive or upstream approach to how to make the health system less important in the lives of Canadians. I do not mean to minimize the importance of the system, but I think for all us, and I know for me, being healthy means you do not have to interact with the health system, other than in a preventive and promotive way. That is where I would like to see most of our citizens, that is for sure.
As a province, we have tried to develop primary health care by looking at particular geographic areas and determining the number of providers and types of health providers that are needed, as well as what are the priority health problems or conditions that that group of residents presents to us. Community Accounts has enabled to us to get very good descriptions and understandings of small populations within our province.
Some of our primary health care team areas have populations of only 6,000 or 7,000 people. Hence, when people in the health regions looked at developing primary health care teams, they were really able to understand the kinds of conditions that people in that region had. We have used Community Accounts in every one of those community assessments in primary health care, and right now we have 11 active team areas and certainly many more that are waiting to be active.
As I said, Community Accounts has proven invaluable in helping us to take a forward-looking approach to health and community services. Not only has it been of great value to the professionals and providers in the system, but each of the primary health care team areas also have a community advisory committee made up of citizens in that catchment area who have an interest in health and have some willingness to participate in working to make the health of Newfoundlanders and Labradorians better. Community Accounts has proven to be such a great resource for those people, to set some of their own priorities in their areas and to determine what kinds of things they want to tackle. We have had community advisory committees who have looked at snowmobile safety, for instance, and have done some great campaigns in their region about keeping people safe when using those kinds of vehicles. Smoking awareness and weight initiatives are other examples. When they have looked at the data of Community Accounts, it has really helped them determine where they want to focus as a community.
I do not want to leave you with the impression that it is only for planning that we use Community Accounts, because, while that may be right now the primary place for it, it is used in a whole lot of different ways. We certainly use CAs in evaluations of our programs and services. Public health nursing has used Community Accounts to look at potential workloads in various districts based on the health profile of that group. We certainly use it to obtain baseline measures and indicators, the kind of things we want to track and measure. It provides some context for us many times. For example, when we have a budget request or a budget ask, we can use that data to really make a compelling case for why we want to move in certain areas. The development of grant proposals and research proposals has also benefitted much from the Community Accounts system.
Most of the divisions within the policy branch use Community Accounts for various things. We have developed a number of provincial policies in the last number of years. We have a major healthy aging policy that use Community Accounts extensively, a major mental health and addictions policy that was very much enhanced by Community Accounts. As well, we bring Community Accounts to our FPT work across the country. In particular, our division of Aging and Seniors has used CAs information to help with some of the major public awareness nationally that is being done.
One of the things that has also been of great benefit to us is the fact that Community Accounts will help us build our infrastructure maps. For example, we recently did a fairly extensive presentation to cabinet about the health system, and one of the most compelling things in that presentation was a series of maps that showed our four health regions, over which we were able to lay the location of our major hospitals and health centres, as well as the location of our clinics and long-term care homes. By the time we had finished laying onto those maps the location of our services and what we provided, people had a little more respect, if you will, for some of our struggles and concerns within the health system. It was quite overwhelming to some to see the extent of where the health system is, which is pretty well in every nook and cranny of the province.
I will conclude by saying that one of the reasons that Community Accounts has been as effective as it is has to do with the Community Accounts staff and the stats agency in and of itself. Not only have they built a system that is really fun and ready to use, but you get something out of it almost immediately as you sit down. So all those needs for instant gratification are met by Community Accounts, which is a real seller if you want to keep people involved in it. What has been the real success of Community Accounts is the open and collaborative relationship people who have developed that system have with the users of that system. It really has been, in my opinion, such a collaborative effort to ensure that the data that is there are the data that are needed by the health system.
I will finish by saying that Community Accounts has been wholeheartedly endorsed by Health and Community Services, and for many reasons other than what I have been able to describe to you today as well. It really is a fantastic and well-used system.
The Chair: Thank you very much, Joy.
We will go next to Aisling Gogan.
Aisling Gogan, Director, Poverty Reduction Strategy, Department of Human Resources, Labour and Employment, Government of Newfoundland and Labrador: Thank you. I am not sure this statistics agency is used to being described as providing "instant gratification," but I am sure they will be pleased by that description.
I am very pleased to be here again today as well. In follow-up to the discussion yesterday with Minister Skinner and my Assistant Deputy Minister, Lynn Vivian-Book, I want to highlight the value of Community Accounts to the work of the Poverty Reduction Strategy. As Joy just described, it is an incredibly valuable tool in terms of being able to provide information instantly.
I will discuss some challenges with it later because some of the questions that were asked yesterday during the session on the Poverty Reduction Strategy did relate to some challenges with the Community Accounts. I will try to answer some of those questions in my remarks and, certainly, you can obviously ask more questions at the end.
In terms of thinking about poverty reduction — and I know this came out a little bit yesterday — Community Accounts to date has been an incredibly valuable tool for engaging our community partners and, indeed, I think, for allowing them to engage us for having that two-way dialogue. It is very important that we are speaking about individuals in their communities and not just those that are connected in some way to a bigger organization. It gives our community partners, as well as just individuals out in the communities, access to evidence from what has been accepted as a neutral source. That has been really important in terms of sharing knowledge and power.
In our consultations and our ongoing dialogue with our community partners and with individuals, I have had information from Community Accounts being used in a number of different ways, and that has included information on income levels, information on Income Support use, EI use, health status, demographic characteristics, all different things that have been provided.
You do not have to go back very far — and it would have been unimaginable for even us as government officials to have had that kind of information at our fingertips, let alone to have been able to provide to our community partners. It is a significant step forward in terms of allowing us all to make decisions based on evidence and have a shared understanding. That has been really critical in terms of the level of dialogue that we have had around poverty reduction and our ability to set priorities and come to an agreement with our community partners on what the priorities are. We all have the same information and it gives a really good starting place.
In addition to it being unimaginable to have been able to provide that information in the past — first of all community groups would have needed to know what they wanted to know, which is difficult to know if you do not know what is there. Then they would have had to request it. We probably would not have had the capacity to put it together. Even if we did, we would not have been making those connections between the different data sets that you see on Community Accounts, and I think that is part of what Joy was talking about. When you see the way it is laid out, it makes sense to people. It is as easy to understand as this stuff is ever going to be. It is complicated, but it makes it as easy to understand as it can be and, certainly, I know that is of great value to our community partners.
I have also found that our community partners and other individuals have used CAs as a vehicle to be able to indicate what other information they would like to have. As we have been able to share information, they have been able to come forward and say that they are looking at a particular problem and do not have enough information. This came up yesterday in terms of some of the information that is being added to Community Accounts. There is the Community Crime and Social Vitality account and the work currently under way with community partners to start looking at how to measure risk of homelessness. I am going to talk about this a little bit more, but that is connected to our work on the Newfoundland and Labrador Market Basket Measure. These have come from community coming forward and saying, "This is great information. It would be great if we also had this other information. It would really allow us to help with planning."
It allows community groups to take an evidence-based approach and a more integrated approach. It also gives them the power to hold government accountable for doing the same thing, because we have the same information, and I think that is very important.
One of the main values of Community Accounts is that we all have access to the same information, allowing us to work collaboratively in a way that was more difficult in the past.
Another important value of Community Accounts to poverty reduction is that it allows us to fill what we see as a serious information gap in understanding poverty in our province. Right now, when we look at overall measures of poverty, we have a variety of measures of low income that are produced by Statistics Canada, and those are national measures. They do not really tell us anything about poverty at the community level. They give an overall view of the province and how we compare to other provinces. They do not allow us to do any kind of analysis in terms of who exactly in our province is living in poverty. They do not allow us to look at any smaller geographic areas, only the province as a whole.
You can look at some things around the St. John's CMA — census metropolitan area — perhaps, but beyond that you cannot. You cannot look at any sub-groups because we are dealing with sample-size issues and reliability problems with the data.
We can look at other proxies, and that is what we have been doing, and that has been useful. It has allowed us to make decisions based on evidence. However, it has limited our ability to understand all aspects of the problem and to ensure that we are developing the most appropriate responses.
As we move forward in implementing our strategy and further refining it, it will be important for us to understand what is working in different areas of the province, what is working in different types of communities in the province and what the challenges and, indeed, the strengths are. Community Accounts allows us to look at both, but this new measure will allow us to look at a measure of poverty at the community level.
The past work of Community Accounts has set the stage and built the capacity in government to allow us to develop the Newfoundland and Labrador Market Basket Measure. It is going to be released later this year on Community Accounts. It is really important, I think, that we have the vehicle of Community Accounts to release it because it immediately puts it out there where our community partners also have access to it. They can also look at their own communities, look at their own areas of the province and look at the province as a whole in a more detailed way.
We do have to recognize that, in particular, talking about people living in poverty and vulnerable to poverty, a lot of them do not have access to the web. Anyone who has access to the web will have access to this way of looking at poverty, and I think it will move forward our understanding both in terms of the analysis that we can undertake within government and also what community can do. Both are equally important because we have different perspectives and different abilities to look at the problem. We will be able to look at this information at the community level by family type, by refined age breakdowns, by gender, by different characteristics that will give us the understanding that we need.
I wish to give you a little bit of detail about the Newfoundland and Labrador Market Basket Measure. It takes the HRSDC definition of a basic basket of goods and services, that is the sort of things that everyone should be able to purchase to have a minimally acceptable standard of living. That can be debated forever — and it has already been debated. We have taken the definition that was agreed to at the federal-provincial-territorial level of terms of what should be in the basket, and we have applied it specifically to Newfoundland and Labrador.
There are a number of innovations that the Newfoundland and Labrador Statistics Agency has been able to put in place in doing this, and I think the most important is that it does not use survey data, but rather tax filer data. That is why it gives us this ability to look at the community level and to look at different sub-populations. We do not have to worry about the issue of sample error or small sample size.
Also, the costing more accurately reflects costs in this province than the national measure, which just has sort of regional costs and does not allow for most cost differences within our province. We know there are significant differences in terms of what things cost if you consider the coast of Labrador or St. John's versus some of our other communities. This is going to allow us on Community Accounts to eventually present data on incidence, depth and severity as well as persistence of poverty at the community level by these different sub-populations. It will be an important tool in terms of providing evidence for work, and it will also greatly enhance our ability to report on progress. So I see it as a really important development in Community Accounts and a really important tool for the Poverty Reduction Strategy. Without Community Accounts, we would not have been able to develop this measure and we would not have a vehicle to be able to share it with our community partners.
I wish to deal with some of the comments that were made yesterday in terms of how Community Accounts has led to priorities being set in government as well as the role it has played in the development of different strategies. In poverty reduction, wellness was mentioned. I know you had a presentation from Eleanor after-hours.
Speaking specifically of poverty, the commitment to tackle poverty was an election promise by the Progressive Conservative Party in the 2003 election campaign. Specifically, the party committed that, if elected, they would, over a 10-year period, transform Newfoundland and Labrador from a province with the most poverty to one with the least. It did not actually come out of Community Accounts.
That being said, the same understanding that has shaped the development of Community Accounts in terms of the way it is presented has also shaped the approach that we have been taking to poverty reduction, namely, one that recognizes the interconnectedness of the different elements — which is really important. It is an underlying understanding that is shaping all of our work.
Joy described how Community Accounts is being used regularly in terms of program and policy development by departmental staff. The same is certainly true of the Poverty Reduction Strategy Division as well as all the partner departments, and Health and Community Services is certainly one of those departments.
In our division, we would use Community Accounts as a quick way to scope out the problem and do some exploratory work. We would usually end up going back to the original source of data, just so that we can have the most recent data possible. For example, if we were looking at Income Support and we wanted to look at single parents on Income Support, we might quickly use Community Accounts to look at how that looked in different communities. In Community Accounts, I think we are looking at 2006 Income Support data now, whereas in my department I can get last month's Income Support data from an administrative source.
The reason I am using this example is that it leads me to the question Senator Cook asked yesterday about challenges and issues encountered in terms of data availability and related things. Certainly, timeliness of data is one of those, and in some cases it is completely unavoidable.
For example, anything based on tax filer data, you are always looking at a year and a half lag time at least, and that is just the nature of the income tax system. You have until the following April to file your income tax and then it has to be processed and put in a format that people can use.
Similar delays exist for census data and survey data. Statistics Canada, for example, just the week before last, released the 2006 Low Income Cut-offs, LICOs. Until just a couple of weeks ago, we were dealing with 2005 data, and here we are in 2008. It is not a unique problem to Community Accounts. In our province, we are in such a period of rapid change in terms of our economy and other social factors that, in looking at 2005 and even 2006 data, things look quite different. Some of the census data available is 2001 census data. We are in a pretty different place than we were in 2001.
Hence, one of the real challenges in terms of using Community Accounts is that sometimes the data are just old. They no longer reflect our current reality. It is something we always struggle with. We are looking for the best evidence available. We want to be sharing the evidence and we want us all to be using the same evidence, whether we are inside government or without. That is sometimes not possible, though, because we need to be using the most current information possible.
Another challenge is cost. We have to pay Statistics Canada for data and, for confidentiality reasons, sometimes we also have to pay them to do extra work on the data. For example, when I think of the Newfoundland and Labrador Market Basket Measure, every year we will be paying Statistics Canada for that data. Every year, we will be paying them to run it and provide it to us by community, because, for confidentiality reasons, we cannot do that ourselves. That is a matching that has to be done within Statistics Canada, and for good reason.
As we look at other information that we want to see on Community Accounts, ongoing costs are an issue because it is not like these are one-time costs. It is something we have to pay for every year. The more things we add the more cost there will be. That is an important element to be aware of as there is consideration for how to apply this model more broadly, because there are other things I would certainly like to see on Community Accounts, but there is cost. In addition to data purchase cost, there is the time of our own staff among other things through the Newfoundland and Labrador Statistics Agency to be able to do this work.
Another issue for a small province such as ours is the survey sample size for national surveys. I alluded to that earlier, but it is particularly true when we are relying on general population surveys to look at a specific sub- population, and this is true of all of Statistics Canada's measures of low income. They all use a general population survey and then they pull out the people that are living in low income, and that is who we want to look at. When you look at a province like ours even though Survey of Labour and Income Dynamics, which is the survey that is used, has a robust sample, even if you say that 20 per cent of the population are on low income and then you start to try and divide them up by their family status or whatever, you just run out of people and it is no longer representative. It is another challenge in terms of our ability to use the evidence that is out there.
Just one other point I wanted to mention in terms of a challenge, one that Minister Skinner raised yesterday, and that is Internet access here in the province. There are communities in Newfoundland and Labrador that only have dial- up Internet access, which is too slow for Community Accounts. Even if dial-up were not slow, it is a very expensive way to have to access the Internet. We must be mindful of the fact that not everyone can access this tool. Even in areas where there is Internet access, even here in St. John's, there are lots of people who either cannot have access or due to low levels of education and those sorts of things, the usual challenges, are not comfortable with computers. We still have to make sure we are finding other ways to communicate and share information.
I should like to finish on a positive note, though, now that I have gone through some challenges. Community Accounts and the expertise and the capacity that have been developed in the Newfoundland and Labrador Statistics Agency provide an excellent means for responding to information gaps. The Newfoundland and Labrador Market Basket Measure is an excellent example of this. This tool goes beyond anything available anywhere in the world in terms of community-level data on poverty, that can be looked at by almost any sub-population you like, that will have the richness to be able to consider depth and severity and persistence, when we get it all out there.
Through sharing this information widely — Community Accounts is the best vehicle for doing that; despite its limitations and its challenges, there is no better way — I know we will continue to refine the measure and we will continue to increase our understanding of poverty in this province and find new and creative solutions as a result. I see this innovation as a really important development in Community Accounts and also a really important tool as we continue our work to prevent, reduce and alleviate poverty.
Just to bring it back in terms of yesterday's discussion, that is taking a population health approach. When we talk about poverty reduction, we are talking about social determinants of health, and this tool will very much allow us to do that with the best evidence available.
The Chair: Thank you, Aisling.
Gerald?
Gerald Crane, Director of Partnership Research and Analysis, Rural Secretariat, Executive Council: I want to just take 30 seconds at the beginning to tell you what our organization does and why I am here this morning.
The Rural Secretariat is a relatively new entity in government. It was formed in 2004 following the election of Premier Williams in 2003. There is a lot written about us, but our role in one sentence is to seek to ensure that the needs of regions and rural areas in the province and the impacts on those areas, what they are facing, are considered in policy and program decisions of government in the infrastructure and other investments that government make, and in major government initiatives such as the Poverty Reduction Strategy, a broadband strategy that we are doing, and various other strategies of government.
We do this in two broad ways. We do this internally through working with other government departments, such as the Property Reduction Strategy and many others, and we do it externally through citizen engagement. What I want to talk about this morning is the citizen engagement part. Basically, I want in my remarks to speak to the benefits of the Community Accounts to citizens of the province, particularly those in rural areas.
We engage with citizens and stakeholder groups and various other interest groups to build their capacity to contribute to the public dialogue of government and to help them provide input and advice to government and its decision-making processes. That sounds easy to say; it is quite a challenge to do. It is a long-term task. It requires a lot of patience, a lot of energy and a lot of time. It also requires that trust be built with citizens.
We have taken a path to build that capacity and trust in citizens and through citizens in a very quantitative way by telling them about themselves in a way that they can relate to. Community Accounts has been a primary way by which we have been able to do that, and I can say that our work would not be nearly as effective without the Community Accounts and various other data tools that the Newfoundland and Labrador Statistics Agency and others provide.
Everyone in this province, be they from rural areas, urban areas, wherever, has been impacted by ongoing economic, labour market, demographic and social change — and probably in that order for many people. The reasons for this change are well know, and I will not go into them here this morning. It will not come at as a surprise to you if I said this change will likely continue and rural areas, in particular, will probably continue to be impacted.
The key for us is how to describe this change, how to talk about this change in a way that people can relate to. We use the accounts to talk about drivers of change on regions, communities, interest groups, firms, citizens and every other stakeholder out there. In a way, we use the same data that Joy uses; we use the same data that Aisling uses. The difference here is not what we use. The difference is how we use it and where we put emphasis.
The point that I want to make here for citizens is that the accounts can be used for a multitude of ways. Population health is one way, and I will just list a couple of ways later on in my presentation. The Community Accounts have a very broad application in a very broad number of ways.
Why are we doing this, why are taking this quantitative route, and why are we investing the time and energy here? At its core, citizens implicitly know that change is happening. Many of them need a reason to embrace the change. People generally do not like change, they tend to reject change. What we want to do is try to get them to embrace it. We use words like to lead change, to react to change, to understand change, to adapt to it, to benefit from change. Why do this? We see it as a good thing to assist citizens and to help citizens to inform the decision-making processes of government. I mentioned this earlier and I think it is very important. We want to give citizens a voice to allow them to provide input to government. Right now, a lot of citizens do not feel they have that voice.
I want to make a couple of remarks on that. I am going to talk in very general terms here, and I do not mean to stereotype individuals versus groups or anyone else. My experience with stakeholder groups is that generally they have more capacity, more funding, more expertise and more ability to understand, to contribute and to participate in the decision-making processes of government. They bring a position to government; they have the ability to do that.
Individual citizens, the people on the street, generally have less ability to participate. Why is this? They tend to be more passive. They do not have the time. They do not often contribute to the same extent as stakeholders, but the decisions that government make equally impacts them as much as it does stakeholder groups. They need advice in order to contribute to the process.
What we are dealing with then is almost a knowledge gap, and what we need to do is fill that knowledge gap to level the playing field. We see Community Accounts and use the Community Accounts as a means to level the playing field. As I said earlier, I do not think we would be nearly as effective in our work without this tool.
I want to make three points this morning in my brief remarks regarding the accounts. The first one is this: The Community Accounts platform and the technology that is used are vital to the process, but not sufficient. Joy referenced this as well in her notes. Equally important to the process here is the human element, the ability of the staff of the Statistics Agency, the trained users, the ability of our staff and other staff, other users in government and outside government, to take data and make it real to people, to take it and to bring it to life, to interpret the data for them. Without this element, in my view the Community Account would not have had the impact they have had over the past decade.
Government too benefits from this whole process. A supportive citizen base and a knowledgeable citizen base that understand the context of decisions also allow for better decision-making processes to be put in place and better decisions to be made.
There is one additional benefit that comes from this, and that is my second point — that is, the ability of the accounts to allow for cross-pollination of data. What Al Hollett and his staff would say is that users in one field can learn and gain knowledge by looking at data in other fields. A couple of quick examples: Educators can look at health data, or health users such as Joy can look at education data. Municipal administrators can look at income data. Local economic developers can look at demographics or other data sources. I believe we have a person who will speak to this later. The RCMP and others can look at education data, health data, income data and so on. The ability of users in one field, experts in one field, to be able to take that data and apply it to various other fields is vital to the success of the accounts. I suspect in some cases that this was incidental, probably was not planned, but it has been a very valuable outcome from the use of the Community Accounts.
One phrase that is quite often used in regard to data dissemination tools is the "data to information to knowledge" phrase. It sounds powerful. It is a simple phrase. One of the questions that always come to us is this: What does that mean? Who is its target and what is the outcome of that phrase?
This is a totally wrong statement in my view, but a lot of people can look at the accounts as a simple way of putting data on a website from 15 or 20 or 30 data domains and 50 data sets and 5,000 numbers and expecting the ordinary citizen, the individual person, to look at it and make sense of it and to interpret it. That is a very simplistic view and a wrong view, in my mind. The key thing for me and for our organization is how we stimulate individual citizens' interest in the data. Aisling spoke about some of this in her remarks. How, essentially, do we want to stimulate citizens' interest to look at data?
The third and last point I want to raise is that we need to give citizens a reason to look at numbers, to look at data and to be able to interpret the data and to take the time and energy to do it. We, as do many others, use conceptual frameworks here. What we want to do is put in place a very simple way to go out and talk to citizens and tell them that this is important, that it makes sense, impacts their lives, and is a way that we think they can influence and impact the decision-making processes of government. Here are the numbers that back this up. Here is the evidence. Here is how we think you can use the numbers. These frameworks are pivotal in allowing citizens to understand why data is important and why decisions are made, and I think that point as well should not be lost.
I want to briefly touch on the conceptual framework that we use because it does not really address the needs or apply to population health at one level, but yet it does at various other levels. In a very simple statement, we try to talk to citizens and say to them that they have assets on the ground, what we regional assets. How do you take those assets and turn them into opportunities that will give you equal choice to live in small community "X" or small community "Y" versus St. John's or Toronto or Fort McMurray. As I said, a lot of the data is the same as the population health model, but the emphasis is different in terms of where we talk to citizens.
At the top of our model, we say there are three policy objectives for our work, what citizens want and what citizens have told us. They want sustainability for their regions. They want the ability to live there 5, 10, 15 years from now, be it a small community as I said or a larger community. Economic activity, jobs and income are vital to that process. Demographic stability — and anyone who knows our province knows that we are facing rapid demographic change — is important.
At the other end is the regional assets, and that is basically what people have on the ground that they can use. Regional assets entail things like physical capital or infrastructure, human capital, financial capital, natural capital or natural resources and the social capital that is out there. The challenge for us and for citizens is how to take those five regional assets and turn them into opportunities that give people the choice to live, to work and to raise families in their community.
In our work with citizens, and some of the people that we work with are here today, there are five broad policy themes that are used to turn assets into opportunities. The five policy themes are as follows: to stimulate labour demand or to create jobs, to enhance the labour supply in terms of skills, to provide high quality public programs and infrastructure investments, to do appropriate municipal governance — not to suggest that municipal governance is inappropriate right now — and to build leadership in communities. Across all of that, of course, there is a thread that goes through there that youth is important to these communities, given our rapid demographic change.
This is a very simple model. For those senators that have the written presentation, there is the graphic form in the presentation. It looks simple. It is not intuitively challenging. It can get challenging in a hurry. It can get complex in a hurry. You can draw a lot more boxes on a model. You can draw a lot of lines going left, right and centre. The point that we want to make is that do not make a model complicated. Do not make the process complicated. Keep it simple. Build a model that resonates with citizens out there. Allow them to see the issues that are important to them in their regions and then populate that model with data. Populate the model with things and quantitative information that allows them to see themselves in it and allows them to see a role for themselves for their communities and for government to assist them.
How does Community Accounts help us with this? If you look at the five policy themes that I spoke about — jobs, skills, public programs, municipal governance, and community leadership — Community Accounts has data on all these. It allows individuals to see for their community, for their region, in some cases for their neighbourhood, where they fare, how they compare comparatively to other communities, how they compare over time.
Why is this all important and why am I talking about this? I want to borrow a phrase that Al Hollett uses periodically. This is Community Accounts in one sentence. "It allows us to debate the issues with citizens out there, not to debate the numbers." Quite often, as Aisling reference earlier, we used to debate numbers with citizens. Who has the right number? Who has the wrong number? Energies, time, everything was taken up trying to figure out whether the number was "X" or "Y". We do not have that problem anymore in many cases, because of the accounts. Right now, we debate the issues; we do not debate the numbers.
I want to let the other panellists speak, but I just want to go through very briefly some of the case examples. I will not go into detail with these. A lot of local users that we work with in the province use Community Accounts for a variety of reasons other than population health and looking at the determinants of health, which is important. They look at CAs for understanding local or regional labour market shortages. They look at CAs for understanding labour market behaviours out there, seasonal employment and so on, changing labour market dynamics. They look at CAs for understanding demographic shifts. One of the ones coming to the fore lately is understanding municipal governance and regional planning in a municipal context. That one, I suspect, will take on a life of its own over the next few years.
The last one I want to talk about is a vital one, and I want to reference it, that is, understanding the changing demand for public services given changing demographics at regional levels. Quite often, what we are seeing now in many cases is a dramatic shift from providing K to Grade 12 education to providing health care for seniors. That is a simple statement, and there are many complexities that go around that, but the process by which we do that, building citizens' knowledge and allowing them to understand and to support that, is vital as we move forward.
I want to conclude by summarizing the three points that I raised.
First, the data comes alive because of the human element, and I work with data quite a lot. Data is dry. Data are numbers. The key is not to look at numbers. The key is to interpret numbers and make the data come to life, and the human element here is vital to that process.
Second, the cross-pollination of data, as I refer to it, breeds learning and breeds knowledge. As I said, in some cases that was incidental, but it has become valuable over time. The third point is, of course, that simple conceptual frameworks that resonate with citizens are powerful. Give citizens a reason to look at data. Allow them to see themselves in the data and the process will become a lot more powerful.
My last point is this. Community Accounts have allowed us to engage with citizens to challenge their perceptions and the presumptions about government, about what is going on around them, in a very honest and forthright manner. What we are engaged in here is a cultural shift in how we as a government think, how citizens think and how we engage with citizens and work with citizens as a government. I think over the long term, be it 5 years, 10 years from now, there will be a benefit from the Community Accounts in terms of decision-making processes, but this cultural shift is going to be a broad societal change that will, hopefully, bring us a lot further in rural areas and urban areas.
The Chair: Thank you very much, Gerald.
Sergeant Ross.
Sergeant Doug Ross, Non-Commissioned Officer in Charge, RCMP Corporate Planning and Client Services, Newfoundland and Labrador: Mr. Chair, senators, thank you very much for inviting me to come here today and participate in this forum. I have been a member of the Royal Canadian Mounted Police for 15 years, the first 11 of which has been on providing front-line services throughout this province as well as three years in the province of Nova Scotia. For the past four years, I have worked as a planning analyst responsible for strategic planning in client services duties for the RCMP within the province of Newfoundland and Labrador. In this capacity, I have had an opportunity to observe presentation from Newfoundland and Labrador Statistics Agency in relation to a project they were working on called Community Accounts.
As you know, Community Accounts is an innovative information system which provides citizens and policy-makers with a single comprehensive source of key social, economic and health data and indicators that would not otherwise be readily available. The agency was interested in expanding their project to include a justice and safety component. I immediately realized the potential for a mutually beneficial relationship. Adding a justice component would allow employees, the public and the government to retrieve the various data sets and indicators along with crime- and justice- related statistics according to a number of different boundaries for the 400 communities, including the 80 census subdivisions, 20 economic development zones and the province as a whole.
Information currently retrievable at the level of Rural Secretariat regions, health authorities, school districts and Human Resource Development Canada regions would also now be available, based on our policing districts and jurisdictions.
On behalf of the RCMP Newfoundland and Labrador, I worked with the Newfoundland and Labrador Statistics Agency to develop a MOU that allowed the data-sharing relationship with the agency. I worked with the agency providing rationale and a supporting document and participated in a series of meetings and teleconferences that culminated in the agency receiving funding under the National Crime Prevention Initiative. Based on this funding, the agency hired data-entry staff and worked with the RCMP to convert our data for a two-year period for 2003 and 2004 into a usable format. They took, basically, all of our crime data for the province right down to the community level, to what we refer to as the zone level, which could be as small as a neighbourhood, and converted that data to usable data that they could use on their website.
Although some of the data remains on the agency's developmental server, through a collaborative effort we have been able to move the initiative forward, and we are hoping that the remaining data will eventually become accessible on the public server. Recognizing the potential benefit and opportunities of this sort of comprehensive tool in assessing and planning for police and public safety needs and recognizing the potential role it could play nationally, I brought the tool to the attention of the RCMP National Client Service Enhancement Project team and the national aboriginal strategic priority working group. Representatives of these groups have examined the Community Accounts tool and have found it very impressive. Considering aboriginal requirements within the RCMP, the national priority working group has identified a need for a comprehensive community-assessment tool at the front end of aboriginal service planning in order to determine the policing and public safety needs, while also accounting for what resources and supports are available to draw upon for approximately the 600 aboriginal communities the RCMP police throughout the country. The only way to know where our greatest needs and demands are is to compare each community to other communities.
Representatives of the national priority working group have attended the training session with Community Accounts here in St. John's. This session was followed by a series of meetings in relation to options for using this as a national tool in support of the national aboriginal policing strategic priority.
A number of weeks ago, I was asked to participate in this discussion. It is like one of those commercials for a cell phone. I was on a cell phone talking to Alton, but I did not quite get all of the details, and I agreed to speak to the committee. I was very excited and passionate about the project and the benefits for both, our communities as well as the RCMP in this province. I readily accepted, without too many questions, to appear before the group.
It was not until I actually received the correspondence from staff of this committee that I realized that I in fact agreed to speak before a subcommittee on population health. I was a little surprised when I realized the topic of the meeting, considering my background is solely in policing and police planning. In preparation for the meeting today, I did some research on the committee, as well as its role and some of the various people who had appeared before the committee.
What became very clear to me through that research were the similarities between crime prevention and disease prevention. I wrote out a little parable that I was going to speak about today, but instead of reading it I will just speak to it. I suspect a lot of you have probably heard it before. It is what I call The River Story; perhaps you have heard it before. I have used this, interestingly enough, when I am doing presentations at the community levels to try to explain to communities the importance of getting involved in community policing initiatives to prevent crime.
Basically, the parable goes something like this: I was out walking one day and came upon a river, and there was someone floating by in the river. They were screaming for help so I swam out and I grabbed the person and I swam to shore. I was trying to do CPR on the person when I noticed another person floating by in the river. Of course, I stopped doing CPR and I swam out and grabbed that person and swam to shore and started CPR. All of a sudden, another person started swimming by, so some other people started coming over and helping me. This continued for a period of time. Then I decided that I needed to go upstream to see exactly what was going on and determine where these were people coming from. I started to go upstream, but some of the people who were there trying to provide CPR asked where I was going. I said that I was going upstream. They replied that all of these people need help, that there are more people coming down the river and we have to save these people. As hard as it was to step away from those people who needed my help, I went upstream. I found that there was someone up there throwing people in the river.
Of course, in the process of going upstream, as a policeman I was able to deal with this person who was throwing people in the river, but some people happened to float by during the process.
Just to bring it back to the context at hand, it certainly relates both to disease prevention and crime prevention. We get so focused on dealing with the treatment of the result of the issue that it is very difficult for us to head upstream. That did a couple of things. It allowed me to relate the significant similarities between disease prevention and crime prevention, but also I think it allowed me to reflect back upon Community Accounts and the significant role it plays in relation to trying to move upstream. I believe that Community Accounts are a tool that can help us move upstream and attempt to ascertain the root causes and subsequently target the communities with the greatest needs and demands, consequently ensuring the most significant and effective impacts, based on the resources that are available.
Just to add to some comments that some of the previous speakers have made — and I made some notes here. It is great to come to functions like this because you can leave with all kinds of great ideas. If I do not leave you with any great ideas that I have spoken about today, it has not been a waste of my time because I have all kinds of great ideas that I written down here from the previous speakers.
I would like to make some comments in relation to Ms. Maddigan's comments on the mapping issue. Through Community Accounts, we have achieved a lot of benefits. They have mapped out all of our boundaries for us and because of that we are able to take all the existing data sets that they have and now draw upon that data and format it based on our boundaries and our policing jurisdictions. Also, we have been able to get an idea of what sort of infrastructure is available, what sort of partners are available, what sort of support features are available at every level, right from our small rural communities up to the larger areas that we police.
Also, to add to the comment in relation to the staff at Community Accounts, as planning analysts we sometimes have a tendency to maybe over-complicate things. One of the great things that Alton and his staff bring to the table, I find, is a very pragmatic and common-sense approach, one that is very appealing not only to the public but also to the senior managers to whom I have to deliver some of this data.
As well, Ms. Gogan made some comments in relation to baskets of goods and some issues in relation to levels of remoteness. These are factors that have a significant impact on our organization. I have worked with Community Accounts in relation to some of their remoteness indicators to help us in relation to some of the unique challenges we have in staffing some of our remote locations and tying in compensation for employees based on levels of remoteness. So again, as a neutral outside agency they can provide a somewhat non-biased perspective on some of those things that are going to be tied into compensation for employees.
Also, some comments in relation to Mr. Crane's presentation. There are some unique challenges in providing services to some rural communities. This is exacerbated to some degree by the fact that there is a tendency for resources, particularly incremental resources, to focus on larger centres, and that is a challenge that we face in policing a vast majority of rural communities in this province. So a tool like this really helps us to explain our challenges to the provincial government, to whom we provide contract policing services.
One of the other advantages, from my experience from presentations I have made to the provincial government and to a provincial cabinet finance committee, is that if it is our data, they have tendency to question that, as it can be somewhat self-serving on occasion. However, if I footnote data from Community Accounts, it is really instantaneously accepted by the target audience that we are delivering the presentation to.
In closing, I want to thank everyone for the opportunity to be here. I am very passionate about our relationship with Community Accounts. My only reservation is that, probably because of our capacity on the RCMP side to commit more resources to it, it has not moved as far forward as both myself and Alton would have liked it to have gone.
The Chair: Thank you very much, indeed. It really is so very simple if collectively we could just get there. Getting people through the human lifecycle, and I will use the expression from Community Accounts, in a state of well-being is the goal. Before I came here, I would be saying in a state of good health, but good health is a little too narrow; they have to be in a state of well-being. There is the old saying about it taking a village to raise a child; however, we have lost our villages in Canada. Canada now has six huge metropolises, and a number of slightly smaller ones, causing you, in the police world, all kinds of headaches — including these huge schools that are out of control and all of this stuff. We have to find a way of getting back to the ground. As Joy mentioned in her opening remarks, we have to find a way of combining primary health care with community services and social services and so forth, but more important than that, we have to get the community to own it and take pride in it, to build it on their own. This is the exciting thing about this data pool, this methodology.
I did not want to take time out here for a sermon, but I am trying to get all of you people to tell us what we need to know.
We will move now to Lisa Browne from Clarenville.
Lisa Browne, Planning Specialist, Eastern Health: I have no parables or sermons, but I thought what I would do today — first, thank you very much for the opportunity. I am thrilled to be here; particularly, it is always nice to talk about something that is so positive. We often do not get to do that, so thank you.
I thought I would take a little bit of time to talk about how I have used Community Accounts in my role as a planning specialist with Eastern Health and also from a municipal governance perspective. I will also highlight some of the reasons why I think Community Accounts is so successful and outline a couple of the challenges that it faces.
Eastern Health is a regional health authority that offers the full continuum of health, from community health to primary and secondary health services, and tertiary services in our case. As a planning specialist, I can barely imagine doing my job without Community Accounts. It is that valuable and important to my role.
Let me give you just a couple of examples. One is the community health needs assessments. We have just completed two community health needs assessments in two different areas of the region. We took a determinants-of-health perspective to look at those needs assessments. We took each of the determinants, used mostly the information available in Community Accounts, and supplemented that with our own primary research through key informant interviews and focus groups and telephone survey. As you can imagine, we came up with a very rich comprehensive document that talks about the needs of that particular area.
The Burin Peninsula, for example, was one of the areas. If you look at Community Accounts, then you know that the Burin Peninsula is in the lower half of the nine Rural Secretariat regions in the province in terms of per capita income, and it is the second most reliant Rural Secretariat region on government transfers. Given that a very important determinant of health is income and social status, that sort of information is necessary in order to determine what interventions might work best for that community.
Joy mentioned strategic planning and operational planning. The health boards must submit a strategic plan to government every three years and certainly the demographic information available in Community Accounts is very rich and very appropriate for them.
Our organization's directors also submit a departmental operational plan. As an example, if we take a look at the Clarenville-Bonavista Rural Secretariat Region, which has a director, we can tell them, for example, that the school- age population in this area, which is the 5- to 19-year-old age group has declined by 56 percent from 1986 to 2007 and that the seniors population, 65-plus, has increased by 20 percent from 1986 to 2007. Clearly, this has major implications for health care planning and services that we offer. So you might consider your long-term care programs versus what is it that you do in terms of child care programs, that sort of thing.
What I really like about Community Accounts is that it adds that quantitative aspect to the qualitative part that we may or may not know. It provides that evidence that we need to know.
In addition to having an impact on programming, of course, statistics like the ones I just gave you also have an impact on human resource management as well as facility and infrastructure management. Long-term care facilities, for example, personal care homes, would certainly be required given the population trends that we see.
One of the things that Community Accounts offers, as well, is population projections — something that I really like. If you go to consulting firms, that can be rather expensive to get, depending on the model that you use. Hence, to be able to have population projects, I think, is very positive.
In term of health promotion, we have recently finished a regional health promotion plan and the information provided in terms of the determinants of health is very important from that perspective.
One of the things that we are currently looking at is indicator development. Of course, many health organizations are looking at indicators, and this is something very positive that you can get out of Community Accounts. I just noticed — whether I just noticed it or whether it is new — the provincial indicators, where you can get a chart of the provincial indicators in some areas. We are now looking at developing our own indicator framework for Eastern Health and then comparing that to other regions, as well as to the province. There is very applicable information there.
Another of the things that I really like about Community Accounts is that, traditionally, in the past, we tended to look at the largest common denominator, if I could put it that way. We would look at information from a city or from a province. Community Accounts allows us to really get at rural areas and to neighbourhoods and communities. This is important because people want to see themselves reflected in policies and in strategies. If we expect community engagement and a buy-in, particularly in health promotion or people taking responsibility for their own health, they need to see themselves in the programs that we develop.
From a municipal governance perspective, Community Accounts has a number of applications; certainly from an economic development perspective, there is a comprehensive amount of economic development research available to businesses, should they want to set up shop in a particular community or a region.
It also allows us to get rich information at that basic local level. For example, within my own community of Clarenville, we often hear — and Senator Cochrane will certainly understand my reference to past the overpass. We often divide our province past the overpass, so the rural areas versus the St. John's area. We cannot forget the importance of recognizing that, while we might make general statements or stereotypical statements about how rural Newfoundland is dying or is aging or is this or that, Community Accounts allows you to take a look at particular areas of the province that buck that trend and cannot be put into that same basket. Clarenville would be one of those.
For example, within my community, we have very high literacy rates, more highly educated people than most areas of the province, and very high levels of income. The information can be used for a number of different reasons. For example, if you want an annual general meeting for your community, you might have a written document, depending on your literacy levels, or you might decide to have a community meeting. How you give information to your community can be guided by the information that you get in your Community Accounts.
Recreation is similar. You can look at Community Accounts and the level of physical activity within your community and perhaps try to gear some of your recreation activities around that. If the majority of your population is aging seniors but a well senior versus a senior that is in a personal care home, then what is it that you can do from that perspective?
Of course, there are implications for things like infrastructure development, such as the lighting of your streets and safe sidewalks and those sorts of things.
As well — and this was referenced earlier in terms of affordable housing — Community Accounts can provide information on the number of people living in a house and the cost of the residence, whether they rent or own their house, those sorts of things. Community Accounts can help municipal governments from a zoning perspective, as well.
From my perspective, there are a number of reasons for the success of Community Accounts. First, there are various ways to look at the data. It involves information not only at the provincial level, but also at the level of cities, communities and neighbourhoods. You can look at the information from the perspective of a health board or a school board, and that makes it very relevant. Hence, if you have information that pertains to your town of 5,200 versus an area of 20,000, you have much richer information that is more applicable.
The second reason is the user-friendliness and support of the system. The website is very user-friendly and intuitive, and that is extremely important. It is also supported by online tutorials and training sessions. I have used the "contact us" e-mail and somebody responded in a timely fashion, which is always a bonus.
The updates are also another reason for success. It seems to be regularly updated through additional data, as well as enhanced navigation and visual impact and new features. The infrastructure maps, the migration maps, the provincial indicators that I mentioned — all of these are really value-added aspects of the site.
In terms of some of the challenges — this was referenced in terms of the timeliness. It is like feeding the beast. When you feed the beast, it gets hungrier and hungrier. Once you are accustomed to getting such great information, and you know the census data is out, then you want it on your Community Accounts right away, so it can be very topical and timely.
The other challenge for me has to do with boundaries and how the boundaries are decided. I would assume that in the case of neighbourhoods and towns it is based on Statistics Canada definitions, perhaps. However, in the case of my town, for example — our population is almost 5,300 — when you go into the town of Clarenville, it also includes other local service districts, so the population is referenced as almost 7,500. That is a bit of a challenge for us in terms of how we can use that information.
In general, however, Community Accounts is a fantastic resource. I cannot imagine my job without it; nor can I imagine any other province not having it. Community Accounts provides outstanding information that is very user- friendly, and the data can be very easily transferred into knowledge to help us better the health of our communities.
The Chair: Thank you.
Senators, our next presenter is Susan Green.
Susan Green, Consultant, Kids Eat Smart Foundation: Thank you very much. I would like to thank you very much for inviting me to participate.
First, I wish to give an overview of the organization that I represent. Then I wish to talk about some of the determinants of health that we try to address and how Community Accounts has affected or facilitated the work that we do.
The Kids Eat Smart Foundation of Newfoundland and Labrador's vision is that every school-aged child in Newfoundland will attend school well nourished to be ready to learn. The chair said earlier that it takes a village to raise a child; we believe it takes a community to raise a child, certainly to ensure that that child is well nourished.
As a result, we work with community volunteers to start and sustain school-based breakfast, lunch and snack programs across the province. At present, we have approximately 180 programs. More than half of our schools now have programs. Although we are a funder, that is only a part of what we do. We are concerned with the health and well-being of school-aged children, and we are also concerned about the high rate of obesity and type 2 diabetes. We were involved in the Coalition for School Nutrition, which lobbied for the new school food guidelines that exist in the province.
As far as the determinants of health are concerned, we believe that we respond to several. With respect to income and social status, we believe that we respond by mitigating some of the impacts that result from this, specifically poor nutrition. Respecting education and literacy, we believe that we help children's ability to concentrate so that they can take advantage of their educational opportunity. In terms of healthy child development, we believe we assist through improved nutrition. With respect to personal health practices, we believe we are helping to establish good eating practices.
Community Accounts has been absolutely invaluable in the work that we do. First of all, they give us a snapshot of the community need. It helps identify areas for mobilization. I have heard some of the challenges about the timeliness of the information and whether it is up to date, but it is comparative. Even if it is only a snapshot in time, it is extremely useful as a tool for community organizations.
When we start a program, it helps us know what proportion of the children will be using that program on the basis of need. When a program starts, all children are welcome, as the program is non-stigmatizing. What we find, however, is that after a period of time, when the program is well established, the numbers that are attending the program decrease and we are left with approximately the number of children that are reflected in the needs, which you could find in the information in the Community Accounts. It is really important for us to have a sense of how many children will be participating so that we can make an assessment of how much funding they will need on an ongoing basis.
Our organization would be classified as a community partner. We are just starting this increasing trend, I think, where community groups are going to be delivering services on behalf of government. There is a huge amount of accountability. There is a tremendous sense of responsibility at receiving those public funds and utilizing them in the most equitable and effective way. It is a profound trust. It is important to have access to something such as the Community Accounts, because it does give you evidence-based information on which to make decisions, and I think it is absolutely crucial.
Community Accounts also gives us an indication of what the community resources might be. We partner with communities to deliver these programs. We allocate matching funds, so that as the community raises funds we will match what they raise. An area where we have found Community Accounts to be extremely useful is that of identifying the capacity in the community. In the past, we would allocate a certain amount of money in matching funds. It was beyond the capacity of the community to raise, which was very discouraging for them. They then felt they could not come back to us, and sometimes they did not have the resources to continue the program or to continue the program delivering the type of food that we would like. Community Accounts has given us extremely helpful information to be much more accurate as far as how we work with our communities.
One of the relatively new areas in Community Accounts is the demographic information. That demographic information has been extremely useful to us. We are an organization that mobilizes volunteers. As such, it is extremely important for us to know the potential pool of volunteers and their age range, so that we really know how to draw them in. That is another account that we use quite often.
One of the newer additions to Community Accounts is an assessment at the neighbourhood level. We have found that information to be absolutely invaluable, particularly in urban areas where we are working with a school to deliver a program. If you only have community information, you are looking at St. John's, which is a very homogenous community, but it does not give you the kind of information necessary to know the kind of resources a particular school might need, because it depends on the neighbourhood it is in and from where it draws its student population. Hence, neighbourhood accounts has really helped us get a sense of what the capacity is at that particular school community so that we can be a much more effective partner in helping to deliver the program.
When we started the Kids Eat Smart Foundation, we were asking people in a community who were applying to us for information about social assistance rates and unemployment rates in their community. This is information that these communities and these community volunteers did not have. It was information that we realized we would have to get. Until Community Accounts came along, as a small community-based organization, it was very difficult to get that information. We did not have the manpower. Sometimes, we did not have the expertise. Community Accounts gave us information that allowed us to make good evidence-based decisions. When you have a small community group that is overseen by a board of directors, it is crucial to ensure that they have a way to make evidence-based decisions and to ensure that they feel transparent and accountable.
Hence, we have used the Community Accounts extensively in much of our decision-making. It has helped us to be a much better partner with the community because we understand what is going on in the community that we are trying to partner with. We can, therefore, be much more effective in what we do. I cannot imagine how difficult our work would have been without Community Accounts.
When I talk to people who are doing this kind of work across the country, I recognize the difficulties they encounter trying to grant assessments without access to the kind of information we have. We have a tremendous advantage, a tremendous advantage that many of my colleagues across the country do envy. It is a transparent and accessible system that has been a benefit to us, and one that I think would be of benefit to similar organizations across the country.
The Chair: Thank you very much, Susan.
Our final presenter is Christine Snow.
Christine Snow, Executive Director, Capital Coast Development Alliance: Thank you, Mr. Chair.
I thought I would talk first about who Capital Coast Development Alliance is, what we do and, in particular, how we have used the Community Accounts to help us do our job in a much more productive fashion.
In brief, Capital Coast Development Alliance is one of 20 regional economic development boards across the province. We are a not-for-profit organization. We are governed by a volunteer elected board of directors that represents four major stakeholder groups, including business, labour, education and municipalities.
I can give you a full-page mandate, but in a synopsis version our mandate is to facilitate, promote and coordinate economic development in the Northeast Avalon Region, which is the region that I am responsible for. We are the smallest in terms of geography. We are home to 19 municipalities. We include the major urban core of St. John's, Mount Pearl, Conception Bay South and Paradise, as well as a number of rural communities, including Bell Island, Conception Harbour, Marysvale, some of the more rural parts of our region. We are the smallest in terms of geography. You can get anywhere within our region within 45 minutes, which is a bonus.
As well, we are the largest in terms of population. As of the 2006 census, we are the only region in the province to experience an in-migration of population. That comes with its own unique challenges. At this point, we are home to 37 per cent of the provincial population. If you look at some of the generic, economic and social characteristics, as a region we are economically doing very well, but we are a region of contrasts and that is the point where the Community Accounts has become very helpful to us. While we may have communities that have high income levels, high unemployment levels, we also have communities that have really low income levels, really low education levels, poverty levels and so forth, which means the actions we undertake have to address the both extremes of the economic mandate, if you like. I call it a region of contrast because we do have the best and the worst of what is going on.
How we accomplish our mandate is through the development and implementation of our strategic plan. We have been around for about 10 years. We have had two iterations of our strategic plans in process. We are into a third — which is very timely because of the significant change in the economic prosperity of the region. In going through the planning process, we all know we need to go through that whole environment scanning process to see what exactly is going on in our community. This is where the Community Accounts for us has proven invaluable. It has told us where our population is. We know the ages of our population. For example, we know there is a community within our region that has a significant number of seniors. In terms of business development opportunity identification, then, perhaps a business should be focusing on opportunities for seniors and limiting early childhood types of businesses. So that is how the age becomes important.
We need to know employment opportunities, and we need to know education levels. The standard today is post- secondary education. We have considerable numbers and considerable communities with less than grade nine education. That, therefore, indicates to us a course of action that we need to undertake as part of our planning exercise.
We need to know employment levels. We need to know where our labour force is. We are all hearing of labour shortages and so forth. We need to know in Zone 19, which is our region, where our labour force is because that becomes a key selling tool when we are trying to encourage and attract business development to our region. We have to know the structure of our business community. We need to know where our strengths are. We need to know where our challenges are. This is the type of information Community Accounts is providing to us.
We need accurate, reliable data, and I think a number of our panellists referred to the need to be able to have confidence in the data that you are using to making your decisions on. If you cannot trust the data, then you are really planning and implementing in a vacuum. Community Accounts helps to address that.
Community-level data is absolutely critical. I would even go so far as to say neighbour-level data that Susan had referenced is critical. Because of the extremes of wealth and extreme poverty in our region, you need to get at that community level. Otherwise, this particular region would be dismissed as a region requiring any types of supports and activity — because we do have those extremes within St. John's in particular.
If you look at the overall statistics, it is a very prosperous region, particularly in recent times. However, if you go to the neighbour-level data, there are pockets of communities within St. John's that have the same types of economic and social characteristics as some of the more rural communities that are really struggling to survive. So you have a community within a community that is really struggling to survive.
That is the type of information that Community Accounts allows us to get it. As we go down the road of developing our actions and our priorities, it gives us the information we need.
We have talked a lot about evidence-based research — and it is absolutely critical. Everything we do has to be based on a reason. There has to be a challenge, but more important, it allows us to establish our performance measures. We can track what it is we are doing — benchmarking. We can keep an eye on the success or lack thereof of an initiative that we are undertaking — and that is important, not only from a funding agency perspective. As a not-for-profit organization, we have to go through the proposal-writing process to access the resources to do our work. Accountability is critical. We have to be able to document why we are doing something — and also, more important, the success of what we are doing.
The other part of all of that is that we are governed by a volunteer board of directors. These are individuals that are devoting considerable amounts of time and energy to working on the economic prosperity of their region. They want to know that what they are doing is productive and valuable. Community Accounts allows them to be able to see the value of the free time they are putting in, because they are seeing results at the end of the day.
As part of that planning process, as I said, we use Community Accounts to identify our priorities as part of our business plan. I shall give you some examples of stuff that we have done over the years. We have undertaken work around career development because we have identified a number of industries that are providing us with opportunities. We have significant strengths, but when we look at the labour force side we know that we have limited numbers of people going into that industry. Hence, if we want to grow, we have to work on getting more young people into that industry to provide the labour force to allow it to grow. Community Accounts helps us to identify that.
We know we have had significant challenges in the past with the number of young people dropping out of school. Besides the economic and social consequences of doing that, there are real economic consequences. This is our future labour force we are talking about. If a significant percentage is not even in the labour force, then there are consequences we need to address.
One of the key challenges that the Community Accounts has identified to us — and you have heard about it at the national level as the perfect storm within the manufacturing sector. I call it the collapse of the manufacturing sector in our particular region. We have lost probably 20 per cent of our manufacturing businesses over the past number of years. Why that becomes important is that it is the manufacturing sector where innovation takes place. You get a lot of productivity and a lot exporting. We are a small region. We are a small province. The only way we are going to be able to create the wealth that we need is to look to exports. We know we have a significant challenge with a key sector of our economy. Now they are declining in numbers. That helps us to identify; we know we have got a challenge. Now we will start to put in place actions to try and deal with it.
We have talked about neighbour-level data, and that was an initiative back in 2000, I believe, when the province went through a strategic planning exercise. We really got into the neighbourhood-level data. It was important to get a better understanding of what is going at the sub-community level because there are many differences.
We have also used it for advocacy purposes. We were working with a lot of community organizations, particularly in the St. John's region. Many organizations were having difficulty accessing resources, because there were some misconceptions. They would hear, "Well, the region is doing well. You do not really need the support that you are asking for." So it helped to address that.
We have also used Community Accounts in our capacity-building work, working with a lot of local, not-for-profit, community-based organizations and helping them achieve their mandates. In a lot of cases, there is a lack of awareness of the Community Accounts. More important is the lack of understanding of how to use it. I think someone earlier said that data is data until you actually put it to use. In March 2006 — and I do apologize that I do not have it in a French version — we took some key characteristics from our region and put together a document that we distributed to all of our municipalities and our community-based organizations, interpreting the data, taking the data, showing how you can use it and how you can build it into proposals they were using to secure the resources to be able to undertake their initiatives.
That is something we did a couple of years ago, and it has proven to be very useful because it is taking the data and using it and interpreting it and looking at it and trying to compare yourself to what other regions and so forth are doing.
I do have copies to leave with you, just so that you can get an idea of some of the ways Community Accounts has helped us.
I am excited about a new initiative that we are working on with the Community Accounts. It involves the whole business development arena, which is what I am responsible for. We do a lot of investment attraction, trying to encourage local businesses from outside the region to locate here. Why? It brings with it wealth, employment and so forth.
We are now working on an investment-attraction database, if you like. When business are trying to decide on a location, a lot of the information they require relates to demographics, labour force and employment, which is already in the Community Accounts. A lot of it also centres on business infrastructure and what is out there. We are now working on expanding the Community Accounts. The first thing we are looking at is real estate because businesses need a place to locate. We are working on a system whereby through GPS you can go into any one of our municipalities and identify buildings of 25,000 square feet and over — including photos. Right now, we only have one done. You could be anywhere in the world and decide that to want to locate in the Northeast Avalon. Not only could you access all demographics, labour force and all that other kind of stuff, but you could actually see the community. You will be able to see the building. You will know the infrastructure on the inside of a building. It makes it easier for us to entice businesses to locate here. It is taking Community Accounts and expanding it beyond some of the social areas that we are talking about.
In terms of our experience with, I would like to call Community Accounts "data for dummies" — because it is really easy to use. The definitions are great. There are excellent charts — and I truly believe a picture is worth a thousand words. We are in the business of knowing data, but it is helpful when we are dealing with our stakeholder group because they can see it and it is easy to understand.
It also provides us with access to data we may not otherwise have known about. Government is this mysterious being that has all kinds of data being collected by all kinds of different departments, and you may or may not know it is in existence. What Community Accounts has been doing — because they are a part of that mysterious being — is accessing data that they put on the site, data that I may never have even known existed. Let me give you an example.
One of the things that we have been talking about with this investment attraction piece is municipal planning assessments, the value of real estate. There is a municipal planning assessment agency that gathers a lot of that data, so now we are trying to find a way to link what they are doing with what we are doing. That gives us access to the dollar value — which is something else that businesses are looking for. Community Accounts data is reliable, accurate and consistent because it is up to date. I do not have to worry about the definitions or comparing apples with oranges because it is already there. It makes my job a whole lot easier.
It is legal. When I say legal, I mean in the sense that now we are moving into some of this investment attraction stuff, all of the data that you see have to meet privacy regulations and so forth. You do not want to run into using some information and then getting a challenge from an organization for privacy purposes. A lot of that is being addressed for us, so we do not have to worry that we are going to be sued or hauled into court for improper use of data. We do not have a lot of money to cover that stuff.
Maintenance and the updating — I think somebody referenced it earlier. As the 2006 census data is coming out — it is not coming out fast enough, as I believe somebody said earlier — it allows us to keep as current as we possibly can from somebody else that has the expertise to do it.
Again, the economic and the social side uses. Community Accounts, where it is now, is only the tip of iceberg. Its potential to go into so many different areas, I think, is limitless, and moving into investment attraction is just really one of its many uses.
If I had to address a challenge, it has to do with the timeliness of the data. If anybody can convince Statistics Canada to let their census data out in a more timely fashion, that would be very helpful — because some of the demographics date back to 2001, and that is a challenge. It is that community neighbourhood-level stuff that is really important for the work that we do.
Thank you, Mr. Chair.
The Chair: Christine, as I was listening to you, I was wondering what your connectivity is, for example, to a little pocket of poverty and a non-productive community from an economic point of view. When you identify in what you are doing the cause of lack of productivity as a health problem, what is your move? What is your connectivity in the community?
Ms. Snow: A lot of our work is built on stakeholders, partnership building and so forth. I will give you an example. We did a lot of work a number of years ago in youth dropout rates, which had a lot of health consequences, justice issues and so forth. We, along with another partner organization in the city, pulled together what we called a coalition for educational opportunities. We, in partnership with the Community Youth Network, co-chaired the group. We brought together a number of key organizations that were involved in dealing with the issue to, first, determine whether this was just something we were experiencing, to see how broad they see the challenges, and then to develop an action plan from it. In particular, our CEO group has made great strides in pulling together this group of community organizations and putting a proposal in place to build an alternative school that would help address the needs of these young people who needs for some reason are not being met by the education system.
In cases like that, we tend to bring groups together. At some point, when we have done that, then we walk away and leave the group to move forward with it. We hand over the issue, once they have reached a certain stage. That is the process we follow when we run into those issues.
The Chair: Joy, how do you interface with Christine, because you are primarily concerned, I believe, as far as I can tell, with health?
Ms. Maddigan: That is right.
The Chair: You have got to get this whole infrastructure with all the dozen or so determinants to help you along to change the health status. So how do you connect with people like Christine?
Ms. Maddigan: We probably do it more at a regional level and a community level than maybe as a provincial government, certainly in my experience.
The Chair: I like that very much.
Ms. Maddigan: I can speak more clearly around the development of primary health care, and certainly that has been an approach that really does involve all different aspects and components of the community. Our community needs assessments would certainly address the kinds of things that Christine's board would be dealing with.
As well, to speak to Gerald's point as well around the Rural Secretariat, we work together in all the different places where community capacity and community issues are important to people. As regional health authorities, I would say that the connections are made most clearly there.
What you would find is that our provincial policies would support those kinds of directions. Built within those frameworks would be efforts to build those kinds of relationships and connections.
The Chair: Lisa, as a health planner, and probably more important as a deputy mayor, how do you interface with these two people to build your community?
Ms. Browne: A couple of people at break asked me how I managed to wear both hats, time-wise, I guess. The lines are surprisingly blurred, I would say. From a health planner perspective, we know now, and certainly my job is no longer the old-fashioned definition of health in terms of hospitals. It is everything. It is me driving two hours to get here. Transportation, for example, is an aspect of that. The lines are so blurred now, I find, whether it is an economic development agency or a health authority or a school. The lines are really blurred because we all want the same thing, and that is to be a healthy community. The only way we can do that is if all components, which are outlined in the determinants of health, come together to work on that.
Our municipality is just finishing off a strategic plan now, the first we have ever had. Sometimes you think that people have no idea what municipal governments do — and to some degree I think that is probably true. On the other hand, what they want is a health community, and if to them a health community is public transportation, then maybe we should look at doing something. We cannot have a Metrobus system like they have in St. John's, but can we have a weekly bus to go pick up seniors to go get their groceries, for example.
The linkages are very important, and I think we see some of it through council committees. For example, in our municipality, we have a councillor that sits on the board of Christine's counterpoint, the Discovery Regional Development Board. Those linkages are there, but I think we all want to get to the same point. It is just a matter of working together and perhaps getting rid of some of the traditional boundaries that we have had in the past.
The Chair: Susan, in terms of the healthy schools program — or I will call it healthy schools program — which we are so lacking across the country, you seem to have half the children of Newfoundland well fed in the schools now. Has that come mostly from philanthropy or is it government?
Ms. Green: I think like anything, it initially came from the community, but I have to say that government has been a partner for an extended period of time. To be successful, it is impossible to respond to the need in a comprehensive way if you are just dependent on philanthropy. It is essential that it is a partnership and that it includes everyone. So, yes, government is a partner with us and has been. I think our organization would be what Aisling would refer to as a community partner.
This is not the case across the country. There is no national policy. In some provinces, there is provincial funding, but in many provinces there is not and it is dependent on philanthropy. That is to the detriment of the well-being of the children of our country.
Senator Pépin: What we have learned since we have been here is unbelievable. We had an eye-opening presentation yesterday. You have confirmed by your presentation today everything we were told yesterday. It is really wonderful. I hope, and I am sure that Senator Keon will agree with me, that we will mention Newfoundland in our report because what you are doing is really great.
Ms. Aisling, with respect to the Community Accounts, what are the things that you do not have right now that you would like to see?
Ms. Gogan: Christine mentioned some on the economic development side. There is more information about businesses and employees and that side of things that would be very useful, particularly at the community level. In considering poverty, we are looking at it broadly and including social and economic development. So it is important to be able to make the connections, and from a planning point of view, look at what businesses are there and what skills they need.
On the education side as well, there are some indicators, particularly in the K to 12 range, the scores on some of the national tests are there. From the census, there are high school completion rates and that sort of thing. There is not as much detail as you would like to see in terms of some of the post-secondary side, and again, there is some census information from that.
In terms of looking at the skill side, it is a real challenge. There has been some work done in the past in certain areas, like in the Placentia area and that kind of thing, on what skills are actually in the community and what skills are needed to look at matching. So that kind of piece would be interesting.
In terms of what resources are in the community around early childhood development programs, I think that would be an important piece. That is information we know, but it is not there matched with the other pieces in Community Accounts. It means our community partners do not have the same access to some of the information we can get, not that we will not share it with them, but it is not there or to an individual sitting in the community wondering about their own community and how it compares, in terms of capacity, in that area.
Those are some of the areas. I could certainly think of more.
Senator Pépin: I understand.
Mr. Crane, from all the information that you get, you said that people can plan where they are going to live, where they want to go and where they are going to work, but you also have demographic changes. If I am a new young family, depending on the information I am looking for, I can decide if I want to move depending on what I am looking for.
Mr. Crane: One of the things we are often challenged with, as an organization, is people ask us whether we are out there to save the rural areas of the province, and we say we are not. We say that we are out there to raise awareness and provide citizens with the knowledge and capacity to make decisions that are in their own best interests and in the interest of their communities and their regions.
We are also working internally with government in several ways on a variety of projects. One of our deputy ministers often says to us, "Right now, young people, families, do not think they have a choice but to move to urban areas or to move to other provinces." He says that the Rural Secretariat should seek to give people an equal opportunity to live in Deer Lake versus move to Red Deer, Alberta.
If you think about it, it gets at more of a philosophical discussion of what the framework conditions are that government should seek to pursue to give people an opportunity to stay in rural areas, if they choose, or to move to urban areas of the province, if they choose, or to move out of the province, if they choose. Right now, people do not feel they have a choice. What we are seeking to do is not only to create the framework conditions that give the choice, but also to raise awareness.
Senator Pépin: Ms. Snow, you said that you can do a comparative analysis. However, you get the statistics from Statistics Canada. How often are you able to do that? Is it every two years or every year? How regularly do you do your comparative analysis? The information you are getting from Statistics Canada is quite late. In 2006, it is for 2001 and 2003. How are you able to do that?
Ms. Snow: There are certain types of data that we can do the comparative analysis with. The business development side, for example, is as current as anything. They use the business register data, which is up to date as far as 2006, so in that particular area, we are pretty comfortable.
The Community Accounts also uses a number of other data sources, besides Statistics Canada, particularly data from within government, and that tends to be a little bit more current. While the demographic challenges are there, I have only now started to redo some demographic stuff as the 2006 is becoming available. Some of the other business development stuff is updated on a regular basis. That is where the comparison will come in.
Senator Pépin: I have a question regarding the First Nations. In our studies we have done, we have found out that we had a lack of information regarding the health of First Nations.
With respect to the Community Accounts, do you have special information regarding the First Nations who live in this province?
Ms. Gogan: We do not have very good information on aboriginal people in the province. We know that some communities are primarily aboriginal, so that sort of a proxy. It is not 100 per cent accurate. It works for some groups but not for others. We have not traditionally collected information based on aboriginal status here in the province.
I know there is some work going on. I am sure Alton Hollett or some of our colleagues from the statistics agency, I do not know, Gerald, if you know any more, could comment on that. The First Nations statistics agency is kind of getting off the ground. I know meetings have taken place with our statistics agency to look at the Community Accounts approach and that sort of thing.
There is always the concern of stigmatizing or how further information will be used. Obviously, historically, aboriginal people have good reason to not necessarily trust what we are doing or how we are going to use information. So whatever we do, we are trying to do in partnership.
Currently, when in looking at data for aboriginal people, we tend to look at communities. Here on the island we have one aboriginal reserve, the Conne River; we can also look at some communities in Labrador. However, it is a challenge that we do not have good data. We are looking at ways to work with our aboriginal partners and aboriginal people to see how to move that forward.
Mr. Crane: Just to add to Aisling's comments, she is right in that we can look at it on a community-by-community basis in Labrador, in particular.
A couple of our regional groups have asked us about the status or demographics of aboriginal groups that live in what I will call regular communities, that do not live primarily in aboriginal communities. In our case, in the Stephenville area, there is a significant Indian population. The Federation of Newfoundland Indians is negotiating a lands claim deal there. They are not in a specific aboriginal community. They are integrated throughout a range of communities in the region and to try to find characteristics on that group is very difficult because they are one in ten or one in twenty.
So the only point I would make is that it is easy to do it where there are large concentrations or where there is full communities. It is harder to do for us right now for those communities where one in twenty is an aboriginal person, for example.
Senator Pépin: I understand that.
Mr. Ross, you said that there was a link between sickness and crime, but I misunderstood. Can you explain that?
Mr. Ross: Crime and disease was the term I used, and I would go back to the prevention parable, the river story that I related. I have always used it for community policing. I never really made the connection to health. I accessed the Internet to do a bit of research and I searched the term prevention parable. I discovered that that same parable is used in the health environment, in the sense that it is about going upstream, finding the source of the issue, whether it be crime or health issues, finding a root cause and dealing with the root case, as opposed to trying to triage the symptoms of what the issue is.
So in the same sense, from a crime prevention perspective of policing, we have taken on the perspective of crime prevention through social development. By developing our communities and by intervention at an early age with root causes, the determinants of crime, we are able to hopefully influence people so that we will never have to deal with them as offenders or victims of crime down the road.
Senator Pépin: Since the start of the program in 2003, I think it was, there have been political changes, and the program survived. Do any of you wish to comment on how it worked then and how are you able to have everything flowing like this?
Mr. Crane: Perhaps I will take a stab at it, and others can add, if they wish.
I worked in the Department of Finance with Al and the other staff back there during some of the development stages of the Community Account, and I have worked in other line departments since the accounts were made public, I believe in 2002 or 2001. There may be two broad reasons why they survived political change, a philosophic approach and a pragmatic approach.
Philosophically, if I could put it that way, as a government — and federal government is no different — we are based in rigid silo structures. A lot of the issues we are facing today, such as poverty reduction or others, are more horizontal or cross-cutting. That necessitated bringing a lot of different players to the table, with different agendas and different backgrounds. The one common thread through all that that the community council was able to fill was to provide a common data set and common data understanding to allow issues to be addressed. There was some value in that, and people saw the value and government saw the value.
From a pragmatic point of view, I have three or four quick points. First, there was no political change during the development stage of it, which is important. Second, during the developmental stage, there was value seen internally. Before the accounts went public in 2002 — it may have been 2001 — the data was being used internally by senior management, by politicians, in some decision-making processes, and it began to become an institutional part of decision making in government, long before the accounts went public.
Building on that, the early winds, I guess, were important to the process. Once the accounts went live and government continued to make decisions, as governments do, politicians and senior managers in government realized that people began to understand this stuff. They began to really know what government was doing and began to understand what they were doing. Citizens knew more than we gave them credit for, and they really started to latch on to the data and understand it.
I just want to conclude by saying, and I would go back to my earlier points, that the human element is important here. The work that Al's staff and others have done to disseminate the accounts and to train users on the accounts is becoming more embedded in how people think and how government thinks, and it is becoming more of an institutional part of government, more so than a project of government.
Ms. Gogan: I would just add one comment. There is a general trend, not just our government, towards increased accountability and transparency. In the 2003 election, that was discussed a lot; there were promises on both sides around that. Community Accounts is a tool that used to encourage transparency and accountability. I think it would be difficult in the current climate for any government to not support Community Accounts.
The underlying value, again just to emphasize Gerald's point, was seen by all as well; it is an accepted part of the way government works. It was not seen as having represented the previous government. It was seen as being part of government apparatus, if you like. It was not seen in the way other things are seen as being attached to a previous government, something that is going to be changed. It was more just seen as part of government structure, permanent structure.
Senator Pépin: That is good.
Ms. Snow: If I could add just one final point, and just building on that, Community Accounts were never politically driven. It was driven by the bureaucracy and those at the grass roots who insisted that the information was needed to properly do their jobs. Because it was out of that political arena, it was allowed to grow and become the tool that it is today.
Ms. Maddigan: That was my point. We heard from a number of speakers that the data did not have self-interest attached to it, that it was free of the self-interest of health or whatever. That was alluded to by a number of us and I do think that has been a major factor in it.
Senator Cochrane: Government is really accepting this strategy. We heard yesterday and we are hearing from you people today — and it is very important that we hear from you. You are the people who have done the selling job. When you go to government or government ministers, whoever they are, you have convinced them that this is the way to go. You are the people who have sold the whole accounts system, and it is very good.
We want to commend you all for that, because I think it is wonderful, and not only wonderful for Newfoundland, but it will be wonderful right across Canada — trust me. You can pat yourselves on the back, something we do not do often enough.
Susan, did you have a problem with this strategy? Did you have make changes or did you have to add to this database? I know you are not involved in curriculum as such within schools, but my background is in teaching and if children have a healthy breakfast, they can accomplish much more with the curriculum than if they come to school hungry.
Did you have to make any changes in this strategy?
Ms. Green: I am not sure that I understand your question.
Senator Cochrane: You are promoting healthy breakfasts and things like that for the children. Has an assessment been done? Have the children improved as a result of a good breakfast, or have they not?
Ms. Green: That is a very valid question, and that is one of our challenges. We do not have the capacity within our organization to do credible analysis of that kind. We certainly do evaluations, and we have done anecdotal reports asking principals after a program has been initiated whether they have noticed any differences vis-à-vis attendance rates, ability to concentrate and performance. We certainly have captured all of that anecdotal information.
There have been some longitudinal studies done across the country in areas where school breakfast programs have been started, and they are beginning to show some results.
Dr. Susan Evers from the University of Guelph did some research, looking at whether or not if children who missed breakfast are able to eat enough through the day to compensate for that and her research shows that they do not. Nevertheless, research of this type needs to be done. It is not yet being done across the country and I think it is something that does need to be done in a comprehensive way.
Senator Cochrane: Is there anything in the Community Accounts that could help you measure the success of the breakfast program?
Ms. Green: Not at the moment. We do research and we have been doing research with Memorial University. We looked at some research around fruits and vegetables. We had an intervention that introduced fruits and vegetables for school-age children and we did some research to determine whether or not that changed their food choices on an ongoing basis. If that information were available, I think it would be a good addition to the Community Accounts.
When looking at well-being, food insecurity is looked at. When we talk about the market basket, we will get some useful information.
Senator Cochrane: I am pleased, then. We have Alton and Gerald here, and they have got the message, I think. Maybe they could look at that in a more substantial way.
Ms. Gogan: I just want to make a comment about that. Community Accounts is an incredibly valuable tool, but I think it is important to recognize that we need to go to other sources for evidence as well. Qualitative evidence and looking at best practices is equally important. We are not always going to have up-to-date quantitative information to show our success. However, we cannot ignore the whole body of literature that supports that — and I know you are not disputing that. There is a whole body of evidence that supports that children, if they are eating properly, can learn.
As someone who is not fit to look at until I eat breakfast, I certainly support that, from a personal preference as well.
We know that if children who are going off to school without a healthy breakfast have behavioural problems; they cannot learn. As a teacher, I am sure you have experienced this firsthand.
We cannot wait for quantitative evidence to act. Through the poverty reduction strategy, we are very careful on that. Yes, we are taking an evidence-based approach and we are looking at all the available evidence, but that includes best practices. It includes anecdotal evidence and qualitative information that is of quality, if you like. When everything points to the same direction, we are going to act, even if we do not have the kind of quantitative information we ideally might like to have.
Senator Cochrane: Okay, that is fine.
Let me go to Sergeant Ross. You say that you are using the community strategy quite effectively. Let me ask you then this: If we had had this before, would it have been possible to design our communities in a different way? I am thinking about Labrador. We have tried to move people from one community to another and another. When we did that, we did not have this community strategy, did we? Would it have been different had we had it? That might even be something people are thinking about in the future, about moving communities.
Mr. Ross: It is certainly a good question. I was not involved with the relocation of the community from Davis Inlet to Natuashish, which is what I assume you are referring to.
Senator Cochrane: Well, I was not going to mention names.
Mr. Ross: I certainly have been very involved in a number of the issues in the community, from a provincial level, not so much on the ground. In fact, I sit on the Innu Healing Strategy Committee as well.
There was some consideration given in relation to the structure of the community, certainly when the community was laid out. I do not know if I have just been led down a golden path or not, but I have been told — and I have flown over the community, but I have never really looked at it from this perspective — that the community is laid out as a footprint. From the air, it looks like a foot, to demonstrate that the community is moving forward.
Some efforts have been made in relation to the way the community has been laid out, to actually include some aspects of physical layout of the community in relation to crime prevention. I know there has been a move to do that in other communities in the country.
The issues in some of these communities — it has taken hundreds of years to get to the point we are at, and it is going to take a long time to move some of them forward, although there have been some very significant steps taken by the communities to address a number of issues at hand right now.
During the break, I spoke with Gerald in relation to the community's effort to establish a dry community in Natuashish. I am not sure if everyone at the table is aware of that, but the community took that initiative. The leadership moved forward and created a dry community in Natuashish. I do not know what impacts we have seen on the health side, but on the justice side, the impacts have been significant. For example, the crime rate in the community is down by half, I would say.
Senator Cochrane: Wow.
Mr. Ross: One of the indicators we tend to use in aboriginal communities for police workload is the number of prisoners that we would lodge into our cells. It is probably not a well known fact, but four or five of our busy detachments in Labrador would lodge more prisoners in their cells in a year than the St. John's lock up, which serves a population of probably 200,000 people. Our prisoner numbers in Natuashish, since the bylaw has been in force, are probably in half as well.
It is an indication of how a significant initiative — and a very challenging one to try to enforce dry community bylaws — of how a planned step can have a huge impact on outcomes. I do not know if anyone from the health side has looked at whether — obviously, they are related. Substance abuse, although it certainly lends strongly to criminal involvement and victimization, certainly has a huge impact on health.
The challenge for these communities is obtaining support, not necessarily financial, necessarily, but obtaining the required support from all levels involved, government, both provincial and federal, and the various agencies, to pursue the path they have decided to pursue. The outcomes will depend on what — a number of people have been charged in the community for violating the bylaw, and the outcome of that will be a huge factor.
That is an example of a community that used significant planning during the relocation. It has provided the basis for things like the dry community bylaw to be moved ahead by the community.
Senator Cochrane: What about the suicide rate? Has that gone down as well?
Mr. Ross: It has been a challenge in a number of communities in Labrador. We have tracked it fairly closely over the number of years. There has been a decrease in suicide numbers over the last year. However, more time is required in order to assess the impact.
Many significant social factors drive those rates. Although we have put some measures in place to educate the communities, and we have tried some intervention strategies in the communities, it takes time to assess the impact. Historically, the numbers have been higher for Labrador than they have been for the island portion of the province.
I was just looking the other night at our 2007 statistics and it is actually higher on the island portion than it in is Labrador. So it would appear, at least on the surface, that we are headed in the right direction. I do not know if I have answered your question.
Senator Cochrane: Yes, thank you.
Christine, you talked about a decline in exporting. Is the reason for that the same as Ontario? Is the decline because of the American dollar? Are our people with wonderful initiatives to start businesses and export gone?
Ms. Snow: I think it is more national. We are seeing here in this region the same circumstances that are being experienced by Ontario. The impact of China is a consideration. The high Canadian dollar is a consideration. There are low productivity levels. The same challenges that Ontario is facing are present here.
Senator Cochrane: You said that 37 per cent of the population is in your zone area, Zone 19. That is a lot. Do you have a lot more seniors in your zone? I am hearing that there are seniors moving from the rural areas into St. John's and this area. Did you see that?
Ms. Snow: Not so much in St. John's, but in the surrounding communities around St. John's.
Senator Cochrane: Moving there?
Ms. Snow: Moving there. For example, Holyrood, which you may be familiar with, is 20 to 25 minutes outside St. John's. It is close enough to the urban core, should you need medical services, but it is still far enough away and the weather is nicer. There is less congestion in Holyrood. We are finding that there tends to be younger families in the urban core and the seniors are in the surrounding areas. That is what we have been finding.
Senator Cook: I just want to say to you that I believe you have arrived at the place that you intended to go. When my researcher said to me that the Population Health Committee is going to Newfoundland and said we should look at Community Accounts, I said, "What is that?" Never one not to mess up waiting for an opportunity to serve my region, which is the prime region that I went to Ottawa, believing I could make a difference, I look for opportunities to represent my region. Each year that I have been at the Senate, as soon as the budgets and the throne speech come forward, I make a point to read them.
The Community Accounts concept intrigued me. I have problems with a vacuum cleaner, so the intrigue stayed. Pat comes once a year and we go through my schedule and look for opportunities. I went back into the Senate and I came back over and she said "sit down," and I did, and she had printed out a bunch of paper, and I said "That is St. Jacques Island. What are you doing with that?" St. Jacques Island happens to be where I was born and spent the first 15 to 16 year of my life. She showed me in five minutes what I needed to know in order to understand Community Accounts, and from then, it has been an incredible journey. I came and met Alton and his colleagues.
I went to my own colleagues and convinced them that maybe this was something that we needed to look at in our pursuit of population health and better health for Canadians. I am convinced that you have done it right. I hope we can take that vision further, because we hear a lot about the knowledge-based economy, but you are building a knowledge-based society, and I commend you all for it. You may work for government. People may see some of you as bureaucrats, but I think you are free spirits. You would not have arrived, notwithstanding what Alton has designed and given you, you would not have arrived if you had not been free spirited. I am glad I am a Newfoundlander, too, and that is all I need to say today.
Ms. Gogan, how much money goes Statistics Canada take from this government for its information?
Ms. Gogan: Alton would be better able to give you that.
Senator Cook: I need to know the answer to that question. How expensive is it to get, from my census form, in order to be of use for me and my people? Is it expensive?
Alton Hollett, Assistant Deputy Minister, Economics and Statistics Branch, Department of Finance, Government of Newfoundland and Labrador: I have been hoping for the opportunity to sit by Senator Cook all morning. It varies from year to year how much we spend, but I would say never less than $100,000 a year, some years $250,000. That is what we spent last year. Interestingly enough, 60 per cent of that would be for the privilege of sharing the data through the Community Accounts.
So if we spend, for example, $100,000 purchasing data, then we have to pay a 60 per cent fee on top of that to allow us to share it with everybody that we share it with.
Senator Cook: I thought Statistics Canada was designed to help the people of Canada. I now find out that it is a cost-recovery operation.
Mr. Hollett: It is like interpreting data. Different people interpret it different ways.
Senator Cook: I must confess to my fellow Newfoundlanders that I see things very differently than most people. We are on an incredible journey. I wish I were 20 or 30 years younger; I could probably walk it with you.
A long time ago, Susan and I walked it, because what is now her foundation had its beginning in my church basement. With one school, and some money — Lisa, I am a storyteller — that came from the Pelleys who owned the brick plant in Milton; they left a legacy to the United Church for children. We stretched the elastic and took $5,000 — which was a lot of money — and began an incredible journey for the children of this province, and Susan was there from the beginning. Between losing the church forks and the knives, the Kids Eat Smart Foundation has emerged into something incredible. Their journey has been incredible; and now you have moved to another place with incredible information. When I was young, we would say that if you do not know where you are going, you are going to end up somewhere else. You do know where you are going, and it cannot help but benefit our people. Your passion comes through. If I can leave you with one thought, do not let them lose their free spirit. Just give it to them and let them try their wings. Thank you very much.
The Chair: Thank you, Senator Cook.
Just before I say my final thank you, I just want you to know, we embarked on this because we felt that the health disparages in Canada are doing tremendous damage to our people, tremendous damage to our economy and resulting in a tremendous loss of opportunity for many people to live a productive life.
The pool of knowledge that exists now — and it is extensive, if we look at the global literature and our own Canadian literature and what you have taught us since we have come here — allows us to establish a population health platform of a dozen or so important factors. On top of that platform, I used to position the healthy society, but now you have convinced me to put well-being in there. I do not know how long it will stay there, but you have convinced me to do that.
Then we have to look at the full lifecycle. We have to look at parenting. We have to impress upon Canadians that the most responsible thing two individuals will ever do is parent a child, perhaps. To be responsible parents, they must be in a state of well-being when they make that decision.
The next thing is maternal health. We talk a lot about early child development — all this sophistication about neuroscience and psychology and psychiatry and education, involved in the developmental process of early childhood development. However, if the mother is unhealthy, the child is born unhealthy, the child is destined to die prematurely of something, cancer, health disease, whatever, probably diminished intellectual capacity throughout his or her life. It is a very small investment to produce healthy mothers all across our country, I believe.
We then have to move on to early childhood development and we have to move into adolescence and be sure that people do not fall off the wagon, and particularly in the native communities, where it becomes such a problem.
We will have to look at post-secondary education, where so many kids are getting discouraged, committing suicide and so forth, because the social safety net is not helping those who need the help.
We then have to look at the productive phase of life, the workforce and all its problems. Some people are being driven crazy by the jobs they are in, and so forth, and the lack of sensitivity in the workforce.
Finally, comes a phase that some of us are in, which is seniors — and then finally, hopefully, cycling through that, contributing while we are in there because of a state of well-being that has continued throughout the curve, and gracefully, at 105, dying in one's own bed.
I just want to thank you very, very much for sharing this with us. I really do think this is a tremendous tool. I have been a believer in community work for a very long time, even though my professional life was spent as a CEO of a $100-million-plus heart institute and as a heart surgeon. However, I knew very early on that the secret to good health lay in communities. We have to build communities with primary care, as Joy said, that is integrated with all of the social services and all the determinants of health and hopefully we can make a major contribution to that.
It is so wonderful to see that you are able to get to the ground with your measurement systems and your information systems. You already can close the loop and get the information back, which is wonderful, I think.
Thank you all so very much. I will be talking to Alton on the phone often before this report is finished. I may be talking to some of the rest of you as your testimony is looked at a little more closely.
I want to thank Pat West, who helped to put the program together here and helped make our time here so productive. God bless you all.
The committee adjourned.