Proceedings of the Subcommittee on Population Health
Issue 6 - Evidence, May 20, 2008 - Morning
ST. JOHN'S, Tuesday, May 20, 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: We are delighted to be here, and I am delighted to be back in St. John's. I like the current Fairmont, but I think I liked the old Hotel Newfoundland better. I spent a week in Hotel Newfoundland many years ago when I was a visiting professor at Memorial University, and it just happened to coincide with St. Patrick's Day, and I never heard so much good music in all my life.
In any event, we deeply appreciate your joining us. As you know, the Subcommittee on Population Health is addressing the determinants of health, particularly in Canada, and particularly addressing the health disparities and what can be done to correct them. We are very interested in what you have been doing here in Newfoundland and look forward to hearing from you.
We have this morning from the Department of Finance, Alton Hollett, who is the Assistant Deputy Minister, Economics & Statistics Branch; from Memorial University, Dr. Roy West, Professor Emeritus of Epidemiology — our paths have crossed before in life; and from the Department of Finance, Robert Reid, Senior Manager, Community Accounts, Economics & Statistics Branch.
Without further ado, we will begin with Mr. Hollett.
Alton Hollett, Assistant Deputy Minister, Economics & Statistics Branch, Department of Finance, Government of Newfoundland and Labrador: Good morning. I should first welcome Newfoundlanders home, and non-Newfoundlanders, well, we are really glad you are here and we certainly appreciate your interest in our work. In reading your papers and your documents, I realized that we have a great deal in common. I find it interesting that we have been in some sense walking parallel paths for a long time, I expect. I am not quite sure of the history of your group, but we have been soldiering away doing what we consider to be God's work for quite a few years.
We began our work in Community Accounts around 1998, which goes back some time. I would like to tell you a little about the Community Accounts, where they came from and what we are trying to achieve, and I also wanted to talk a bit about the conceptual framework we are using. Not that I can tell anybody in this room much about the determinants of health or the determinants of well-being, but I can tell you how we think about it, and I would like to talk a bit about it and show you how our thinking is structured around these various determinants of well-being and determinants of health.
I will illustrate what we believe has been a major innovation in developing community interests and usage of the Community Accounts. Towards the end I will summarize by telling you about the path that we have travelled, which I think is what I called it on the slide, and about where we are planning to go in the future. That is the structure of what I will say. I will not get into anything in huge depth or detail, but I would be happy to answer any questions that I can.
I am very pleased that Dr. Roy West is with me this morning. He has been a great colleague with us for many years, and he and his colleague, Dr. Segovia, have worked for many years to develop community-level data around health to inform around the health status of individuals and families in the province. One reason I am so pleased to have Dr. West here is that he knows many things that I do not, and I feel a little bit disarmed here in a way this morning without my other colleague, Doug May, who is the conceptual architect of the conceptual framework of the Community Accounts. He is always overjoyed to answer any questions he is asked, and the more questions he is asked, the more overjoyed he becomes. Sadly, he is in Stockholm today at a conference of the Organisation for Economic Co-operation and Development, OECD, that he and I were both supposed to attend, but we decided that we should share our efforts; I would say here and he would go over there. I think he is probably a lot smarter than I am because I am here and he is over there, not that I am not overjoyed myself to be here with you this morning. I will take you through what hopefully will be of some interest and some help in your learning about the Community Accounts.
The origins of the Community Accounts for us went back a long way. There has always been a keen interest in local area data in Newfoundland and Labrador. Citizens of Newfoundland and Labrador and people who have ever had much interaction with local politicians and with our political leaders would testify or support the position that what Newfoundlanders and Labradorians are most interested in is seeing things about their own communities. Coming to the Newfoundland & Labrador Statistics Agency, to Statistics Canada, or to Human Resources and Social Development Canada and getting a string of numbers that one has to be able to write a query for is not, we have seen over the years, very appealing to people. There has been very keen interest, but that sort of approach definitely does not work well for most people. It is fine for academics, and we at statistics agencies do not worry about them because we feel they can look after themselves. They will ask us for complex data and we will give it to them, and they can do their business; but people in communities, community groups, community leaders and citizens in general need special products for the information to be useful to them.
Doug May and I first began working around developing data at low levels of geography back in 1985 when we both worked for the Newfoundland Royal Commission on Employment and Unemployment, and we were asking ourselves a question that we were supposed to answer for the commission: If we are trying to solve the high levels of unemployment in Newfoundland and Labrador, where did they come from? If we do not know where they come from, how do we know what we are rolling back or that we are moving forward from a perspective of improvement?
It was that particular time that we became, I would say, almost obsessed with local area data, because we really felt deficient at the time that there were inadequate data to answer many of the questions, and we began what has turned into a near lifelong crusade to try to address those deficiencies. We do feel that we have had some progress.
In the early 1990s, an economic commission was set up here. That was a time of considerable difficulty in our economy. We had tremendous out-migration, the collapse of the ground fishery and our share of the Canadian recession, and we were going through some extremely difficult times. It was a time of great stress and uncertainty for our residents, and what came out of it was a consultation where people looked at the situation we faced and made recommendations to our government with regards to what they thought was a social and economic vision for our province that would guide the government in what it does and where it is going. They talked to the people, and I was totally impressed by this; people went all across the province, the island and Labrador, and they talked to people. When they came back, they came back with a vision; and the vision was for healthy, educated, self-reliant people living in sustainable communities. There were a few other things in there too, but we do not have too much time, so I left out the ones I find less interesting. I thought it was very encouraging that people had been focused enough on their life situation that they could clearly articulate a vision for the future that they thought would actually give a better quality of life and a better level of well-being.
Out of this, of course, came a call for evidence-based decision making and policy approaches; again I was very impressed by that because it was coming from people from a wide variety of backgrounds. There was a desire that government would use the best information and knowledge that it had at its disposal to do things that would be in the best interests of the citizens. There was also a belief or a call to make sure that government should do this, and, of course, I do not have to tell you that that opened the door for the province's statistics agency. It was like Christmas for us. We actually received attention, and people were interested in the things that we love to do. It brought us into the game, and it made a lot of the work that we had done previously for the royal commission and the economic commission very relevant to what people were asking for. We greatly appreciated being relevant, because I think many people would agree that most statistics agencies tend to be black boxes that nobody really understands very well unless they are part of that organization and culture. We do not adhere to that ourselves. Even if we had some tendencies to think or to feel that way because of the culture that we inherited over the years, certainly our learning has told us that that is not the way of the future.
In terms of building the Community Accounts, very quickly I formed a partnership with Doug May, who was at the time the head of the economics department at the university. I think it was around then that Dr. West and I became acquainted, because Mr. May and Dr. West had been good colleagues for a number of years. We all put our heads together and we built a prototype based upon our vision of knowledge and upon the potential knowledge base of users, the types of people that we anticipated would be there and their needs.
I should say that I am very sensitive to dust, and I find whenever I go into a room early in the morning, and my office is worst of all, for the first 10 or 15 minutes I am gasping. However, I will be quite okay; I will not die, but I am allergic to dust. Some of you do not realize it, but you are being showered as much as I am, so I could be in some sense, I suppose, a canary in the mine, but if you hear me gasping, that is what it is about. Mr. Reid is quite used to that. He waits until the gasping is over. Sometimes he uses my gasping phase to make his points too, I should add.
We formed a partnership and began to build a prototype, and we shaped our data by extending the process through collaboration, partnering, engagement with citizens, officials, and experts in a variety of areas. We did not just go in there and do our own thing as we saw it. We really did try to engage with people who could help us and who were experts.
Two things served us very well. One is we had support from the premier at the time. That is very important, especially as I look at it retrospectively. The other thing, of course, is that we realized up front that it was very important to engage with people and make sure that we were doing things that would be relevant.
We also realized at that point that the majority of the people we would be providing data to were not technically strong. We knew our clientele, and we had a pretty good idea what kind of people potentially were on the receiving end, especially as we were interested in helping people in communities. As I said a few minutes ago, we have always felt that people like us at statistics agencies, professional economists, statisticians and other researchers who rely upon technical skills can use the data quite effectively if we provide it to them. They can do a very good job at what is needed to be done. Therefore, our focus has been citizens. We always believed that Newfoundlanders are smart, capable, resilient people who can face anything and survive. When I first took over the statistics agency, I told Ivan Fellegi I thought the one thing that we had possibly omitted bringing into the development equation was good, solid evidence and information so that we knew what we were playing around with. I guess, in some sense, Doug May, Roy West, myself, and Robert Reid, and our friends and colleagues with whom we worked for many years, set out in that quest to try to put data in people's hands that meant something to them. I will make a few comments as I go to reflect my belief that it has worked out fairly successfully.
We did realize that in providing huge amounts of data, there was a high likelihood that we would overwhelm people. When you talk about building a better mouse trap, when I think of it in the context of economic theory, our experience certainly has been that a better mouse trap is no guarantee that we are going to see a big up-tick in GDP. Simply put, there is a big gap between creating a useful product that has potential and getting it to the point that it is being used and being useful to people. I think that is probably the biggest learning experience we have had.
The principles upon which we did our work were that we believed that users have to readily identify the topics that they are interested in, and helping people to know themselves and their community better is a key objective of the data that we provide. We also used what some people refer to as "knowledge translation." We sometimes refer to it as "knowledge management," but I think it is all pretty close to the same thing. The way we see it is that data are numbers; information is numbers that are organized; and knowledge is data and information that are organized and that we work with on the basis of input from citizens, whom we respect as experts in their knowledge areas, so that we can make products that are useful to people. As you will see as I go through our presentation this morning, our approach to Community Accounts is very much a knowledge-building approach.
Out of the economic and social plans that were put in place back in the early 1990s came the idea of evidence-based decision making. We began to feel that the work we were doing was building a very good foundation for evidence- based decision making. At the top of our list of priorities was sharing data. We believed that if government collects data, and people like us have it and we understand it, that we really should get it out there and have it in people's hands so that it can help them. People who have heard me say that are often surprised, but we really believe that there is a large role for data and statistics to help people, and that is where our minds and our hearts are as we do these things. We do our best to help government departments, and they are big users of our products, but they have capacity that communities do not have. We feel that the gap there is community, and we try very hard to think about the communities.
Rather than getting into huge detail, I always like at this point when I am talking about the Community Accounts to make it clear to people what the Community Accounts are. In essence, the Community Accounts are data for 400 communities. We have got 215 neighbourhood areas, which we released a few months ago. I believe some people think that we do not have neighbourhood-level data. I have heard that on a couple of occasions, but that is not correct. Anybody who thinks that needs to go back and look at our products because they change every day as we share more and more. There are data and indicators from many geographies. In essence, then, the Community Accounts are a set of data, a set of indicators, and they cross the social and the economic domains.
I will talk to you a little bit about the conceptual framework and how we organize it and what that does, and then Mr. Reid will give you a better sense of the depth of the data and the indicators.
When we first began with the Community Accounts, as I said earlier, we were coming from a call to report on the people of Newfoundland and Labrador from the perspective of their being healthy, educated, prosperous and sustainable. When we talk about sustainable, we talk about demographics and a wide variety of key things. Our thinking went also to the structure concept that these things contribute to well-being. Therefore, we looked at what we do as a well-being framework.
This fell directly out of an element of government policy back a number of years ago, a strategic social plan that was in use that called for these things. When we were trying to provide quantitative data for the strategic social plan, we looked at what was being called for and then we said, okay, how could we reflect these ideals in statistics. For example, in terms of prosperous, you might think of income; in terms of healthy, you might think of health; in terms of sustainable, you might think of demographics, and so on. That is where our original structure came from.
When we went into this, we did not have truckloads of brilliance to be unloaded and brought in from the back of the building. When we started to do things, we followed our instincts; we drew upon our knowledge of what we felt worked and did not work in the past, and we created what we thought would be useful to people and would respond to citizens and policy-makers in an intuitive and sensible way, so that when people looked at what we had, they could see themselves in it and not see just a query that did not make any sense to them, that the numbers would be something that stood between them and what they actually needed.
Looking at this slide, you can see how these areas or domains would be familiar to you because they are mostly the ones that are also thought of in the population health model. A key difference in our way of thinking as we developed this model is that our focus is more or less on well-being, whereas the population health thinking is more focused on health and that particular outcome. We would see health as contributing to one of the variables affecting our domains that contribute to well-being.
We have arrows there to reflect relationships between domains. We do not use this diagram anymore because we have moved on, which I will tell you about. The reason we put the arrows there was to remind people that all these things are linked and interact together. These factors are related, and it is the interactions and their outcomes that contribute to well-being as we observe it, whether that is more or less.
We actually won the IPAC award from the Institute of Public Administration of Canada a few years ago for knowledge management, and after that event, a professor from the Université de Montréal called wanting me to talk about what the innovation was. He said that governments are not known for being innovative, but he wanted to talk to us because what we had done was seen as innovative.
I realized that the innovation was not the data we were providing them, and it was not the use of computer software, because anybody with some money could use the computer software that we use. Likewise, building the data requires effort and skills, but it is achievable; you do not need a magic wand to do it, you just need a little bit of money and a lot of patience. The innovation, in my mind, retrospectively, was actually bringing in that conceptual framework. We organized our data so that if someone wants data on income, they will hit that little box that says income; if they want something on health, they will hit that little box on health. However, when they look at the topics that we are saying we will report on, people can literally see themselves in it.
Doug May and I have had that experience, in particular when we talk to municipalities and do presentations. There was a fear at first within some quarters of our government that when these data were going to be out there, bad things would happen, the media would descend upon us and it would be terrible. People were worried that the clerk would have to spend a lot of time trying to help the politicians deal with all the terrible things our data were going to say that government had not done. We have never seen that. I am not saying it cannot happen, but what we have seen with the media is what we have seen with mayors in municipalities and other leaders: when they look at the data and they realize what we have there, that it is information about their community, they become most intrigued by what they see. They become keenly interested.
For example, a few years in Arnold's Cove we showed the Community Accounts to members of the Chamber of Commerce. They asked eight or ten questions, got it straight in their minds what we had there, and then they went into a discussion. They said they had not thought it was like that. They asked how it looked compared to Sunnyside. They wondered about Southern Harbour and the local area. They said they have got to revisit what they were thinking of doing, because that is not what they thought was there.
People see their community's health situation and the things that are contributing, and they find it very useful. I received an email one night when I was working at home from a mayor out on the west coast of Newfoundland. He wrote, "Dear Mr. Hollett, I just finished using the Community Accounts. I thought it would be very unfair if I did not take a minute to email you and say thanks very much, and please do not stop what you are doing." He said, "If we did not have the results of the Community Accounts, we would not be able to afford the data to know our communities as well as we do. By the way, it allows us a platform for all of us mayors to talk to each other and to understand on a common basis."
I must say that was both reflective of what we often see and also very encouraging, because when you are using modern technology — I always tell people this when they ask who is using our data — it is something like serving a buffet from behind a screen; you are passing out all this food that you have put great effort into preparing and it sure looks good and smells good, and you think that you have got a wonderful product, but then you are passing it out and you do not know whether the people are taking Gravol or if they are just walking away saying, "Why did they do that to us?"
It is very encouraging when we get that kind of feedback, but that has been our experience. I would argue that if we had not taken the approach that we took, which is organizing our data in a way that reflects the lives of people, I would not be here talking to you this morning. You could talk to anybody else across Canada in a similar business, in the statistics business, and he or she would have a product that is only marginally different from what we would have produced, and you could have saved yourself airline tickets, time, and all of the rest of it, and the Newfoundlanders would not have had a chance to step onto their native soil. We would not have had a story to tell that is of great interest to you.
Doug May and I have debated this endlessly, and I have been pushing him to get all his thoughts written up before he tires of it all, to tell his story in terms of the connections, the relationships, the indicators. I truly believe that showing people themselves is the innovation. Anybody could do it as well as we have; it is just that most people have not, and I do not quite understand that.
I refer to this next slide as the system of Community Accounts, and I say that because when we get to the information that I will go through now, when we get to the point that we are with the information that remains here, the concept of the system of Community Accounts reflects that our thinking has changed significantly. Before we had various domains that talked about different aspects of life, but as time passed we looked at the way things were moving across the world, the thinking on the subject matter, what people needed, and some of the conceptual deficiencies out there. Dr. May put a lot of effort into trying to bring it all together, and we now see the Community Accounts as a complete system that relates social and economic factors to the environment, to our natural resources and to how these things contribute to well-being.
I found your report very interesting. It was the first time I had seen those statistics, and it was satisfying to read what you said about the impacts of the various health outcomes, where the health care system contributes 25 per cent; broad genetic endowment, 15 per cent; and then social and economic environment, 15 per cent. Only a third of Canadians recognized these important links. Dr. May and I talked so many times about the same thing, that people are unaware of these relationships. They look at income separate from poverty, or they look at crime separate from poverty, and they look at poverty separate from health.
I am a founding member of the Atlantic Summer Institute on Healthy and Safe Communities, and we promote the population health way of thinking. I always preach or lecture that a big thing that needs to be achieved is that the average person in the street really needs to begin to understand these things. I know this is probably an academic ideal, but I do not see it that way. I do think that we have got an awful long way to go there.
I will skim through the actual framework that has evolved over time, bearing in mind what we started from, those few boxes that were tied to the vision, values and goals of the strategic social plan. Our focus is on well-being, and we have adjusted some of the domains from the earlier piece over time. It will be obvious to this group that there are large overlaps between the concept of well-being and the concept of population health. For example, we would tend to see population health as contributing to overall well-being. A key difference, besides a couple of other things I will mention quickly, between the population health model and the well-being model as we have it here is more focus and the degree of disaggregation and where we put things.
One thing I really like about our conceptual framework relative to any other I have seen anywhere else in the world — and we do have a good network and are fairly well informed, as best one can be in a small province located in a small corner of a big world — is that we brought in the production economy. Our initial framework was right along here, which is very close to a population health way of thinking, but with the well-being focus. Then we brought in our ecosystem, our natural resources, knowledge capital, capitalized patents and that sort of thing. The American statistics bureau breaks it that way, and we liked it, so we said we would do that too.
Basically, we are bringing in the production side of our economies where we are talking about the infrastructure used for production, and we have begun to relate these various pieces that relate to the production processes. We believe that that is very important, because of course these are all integral to the well-being and the health of our society and population. The simplest way to put it, I suppose, is that if we go into a massive recession, and there are some worries that the United States might, and if production declines significantly, you will see that feeding back in many ways, everything from incomes, to stress, to possibly even demographic impacts.
However, I did not come here to trace you through all these linkages. The main point here is that we have brought in the production economy, our natural resources, and the ecosystem, which is a big step forward from where we actually began.
A small point here is that we do think of these things in terms of the multiplicity of potential dimensions. We look at our data over time, and we look at it geographically, as I mentioned before, but we look at the various groups: children, youth, seniors, women, immigrants, Aboriginals, people with disabilities, and others that are relevant as time passes.
This one here is very important. Many of you have probably heard people comment that gross domestic product does not really reflect well-being, and I think that is a legitimate case to make. One of the most frequently used examples is that we could have a war and we could have gross domestic product going through the roof, but that does not necessarily reflect an improved well-being of the population. I think most people would agree with that.
There are a couple of points to be made about this issue. First, gross domestic product was never intended to measure well-being. It was designed to measure the output of the economy; that is its focus. Second, the people who designed the various national accounts that were developed to support the measurement of gross domestic product also envisaged the implementation of social accounts, which is in the direction, I guess, that we have been making some contribution. However, after we brought in the production economy, we wanted to remind people who said that gross domestic product does not measure well-being that, in spite of the differences there and divergences in concepts and in terms of impacts and outcomes, if you actually look at the economic equation — which you will find in any economics textbook, and I am sure anybody in this room who has ever done economics will recognize that gross domestic product is equal to the sum of consumption, investment, government expenditure, exports minus imports — you can see here that our income relates to consumption, that investment relates back to the infrastructure that goes into the production process, and you can see government expenditures on education and on health. The point is simply that all these factors are tied together, and we cannot throw away the production economy because people have not come to describe the health of a population on the basis of what is happening in that when they look at the other domains.
We do talk about that, because that challenge needs to be confronted by many people across this country. We have excellent colleagues all across the country for whom we have a great deal of respect, and some of them talk a lot about the deficiencies of GDP, but they do not talk about where it fits in the overall well-being or population health equation, and we brought that in. I mention that this morning because our framework brings it all together in that way.
Another point that I wanted to make, and I have only a few more, is that we see the Community Accounts framework as a determinants of determinants sort of a model. By taking well-being, we got ourselves into discussing subjective material, things that are not as easily measured, but through the approach that we have taken here, we are beginning to take qualitative subject matter — or what has historically been more subjective matter and is becoming less so now, but it has been that way for some years — and turning it into a more qualitative way of thinking. When we think, for example, of population health, we would think of the various determinants of health. We think of health as being a determinant of well-being, and then the determinants of health are a determinant of health, so we think of it as determinants of determinants in the system that we have here. This is how Dr. May has illustrated our determinants of population health. Again I think you will see clearly that in the differences between our thinking there and the thinking of this particular group, the domains are not radically different.
When we began this work back in the late 1990s, we were considered a bit odd talking about well-being. Most people in the business provided statistics, and that was pretty much the long and the short of it. We also noted recently that about 66 per cent of all articles written on well-being have been there since 2002, and I commented when we were at the IPAC session when we won the award that it reminded me a lot of Elvis Presley's song lyric about a whole lot of talk and not too much action. When we talked to our skilled and learned colleagues across North America, we saw that people were asking where you would get the data, and then after a while they became interested in what would be the right indicator. However, at that time nobody was talking about well-being, and I think they thought of us as a bunch of touchy-feely types who did not fit into good science. We were never daunted, and we always had the luxury of coming back to Newfoundland where there were not too many of those people, so we could get a break from that. We did not drop our ideas and we have been happy, but what has moved us from happiness to joy now is to see that so many other people across the world are going the same way that we went. They have not discovered us, but we have discovered them. I should say many of them have not discovered us. I note that a Sarkozy task force in France is taking a well-being approach, and there are many other groups. We have also done a lot of work with the Canadian Index of Wellbeing, and much of our thinking fits well into what they do. A big difference between what they are doing and what we are doing, of course, is that we want to drive the information factors out down to the community level and in a great deal more detail. We actually prefer to stay away from indexes ourselves.
Indexes are spooky to a lot of people, even though they are not without their merit. Mr. Reid will show you how we display our data. We have had citizens tell us that they want ways to look at this data and they want to understand it in such a way that they are not suspicious that we have used technical hocus-pocus to give them something that we tell them is such and such when they do not have the skills to know for sure that we are giving them the real thing or to know what it really means, because by the time they work the math through it does not really mean what they think it means; so they said no hocus-pocus.
In the Community Accounts, besides creating clean data, in other words getting rid of the anomalies and the noise, the Community Accounts data truly is straightforward. The vast majority of it can be understood quite easily by people with low levels of statistics and mathematical skills, and that means that it can be used and understood by people who probably do not have any but who have enough interest that they will put the energy into actually using what we give them.
I was very glad to see your statistics there, because I thought that what you saw in population health, we see in well- being. There is a very thin line, I think, between the two.
I will show you the headline indicators, which we use in the interest of making things understandable. Mr. Reid and his staff put in data across the various domains, and if somebody wants to know what is going on in Corner Brook, where Mr. Reid comes from, or Arnold's Cove, where some of my family come from, or Port Au Port, where Senator Cochrane comes from, and when Senator Cook was with us, we looked as best we could, given the deficiencies of postal codes, at where she came from, she does not have to get in there and dig around with a calculator and an Excel spreadsheet and do all sorts of additions to try to figure out what is happening there. She can get the bird's eye view just by looking at the headline indicators. They are the tip of the iceberg. They can give you a good idea what your data are telling you, and if you want to know more, and if you have the intestinal fortitude, you can always click on to the data tables and then, of course, the world shall be enlightened. There is all sorts of things there, but the important thing is the bird's eye view.
I cannot go past this without taking a minute to mention Dr. Jorge Segovia. Dr. Segovia worked with Dr. West. Dr. Segovia has since passed away, but he was a wonderful colleague of ours. He was a great visionary in many ways and certainly in terms of the contribution that he made to help create useful data in Newfoundland and Labrador. He created a set of data for Newfoundland that goes back to the 1980s and a couple of times in the 1990s, and then we picked it up in 2000, and Dr. West and I have been working hard to try to inspire other people now to bring it up to date so that we will have a comprehensive set of data that can look at things at the community level. Dr. Segovia was working with samples of 12,000 for Newfoundland and Labrador, which is quite large. You can do very good work with that. My point about Dr. Segovia is that he thought about people and he was determined and dedicated throughout his life to put good data in people's hands that would allow us to understand things.
One day we were at a meeting when we were working on the survey. Dr. West and Dr. May were late, so there were Dr. Segovia, myself and a couple of other people. Dr. Segovia was about 75 years old, but he was a handsome gentleman. He looked like Zorro; he had a pointed beard, and he was a vigorous man. He was an impressive man. What he said illustrated his concern about people, and I think that concern is what drove him to do the things he did, which inspired us, because he put all this data here at low levels so that we could get it out there so that people in communities could know it. He said, "I was at the mall this weekend and I noticed that many of the young children now, young girls especially, are wearing these really short shirts." He said, "What horrifies me about it are the bellies we see." He said there are so many overweight children, and "They have no idea what they are going to be facing in 30 or 40 years time — the implications of their diets and what they are doing right now." That reflected his tremendous concern about trying to put information out there. He knew that it probably would not be used effectively in his lifetime, but he knew that we as citizens needed to understand the implications of what is happening. I thought I should mention that because he and Dr. West, in their quest for providing data at low levels of geography, have been a real inspiration to us, and we have certainly absorbed that into the Community Accounts.
I showed Dr. May my slides this morning, and he said he would not have done it this way but he guessed it would be suitable for the needs of the Senate committee. That was one of his more well-stated corrective comments. I told Dr. May when I first saw what he had done here that I really like it because we hear so much about the health care system, but I do not think we do a good job of showing people what is there. We are talking about hospitals, pharmacies, a whole system that is inherently infrastructure but that is broken down into components that people can think about, and then, of course, we relate that once again to people. He would not have put it there because he would have said, "Here is our health account structure; now let us talk about the headline indicators."
However, I wanted to make the simple point in the end that the structure of our health account, along with the data that we will build up over the years to reflect these things, gives people a way of breaking down what otherwise they probably would not think of or would not be able to break down because they would not have the knowledge or the patience, and it gives them a way of thinking about what is out there that affects their lives from a health care perspective.
We do this sort of thing across all our various domains. Our beginning framework I saw as an innovation. The continuation of that innovation is that we continue to drive these pieces down into smaller and smaller elements so that they are easier to understand and they come much closer to describing people's lives. That is what will get people interested.
Lastly, I want to mention the road we have travelled. When we started, we started with the income accounts, which were totally a point of curiosity for us. We saw an opportunity there to prepare income data down at the community level. We thought it was useful. The strategic social plan came on stream, so we directed our work from what was pure economic work and working with Statistics Canada to take in social variables.
We realized early on that our work would have no credibility if we could not get good exposure across Canada. Even then, the assistant deputy minister would go to the minister responsible for the project we were working on and tell her, "Minister, you should see what Mr. Hollett and Dr. May have done; it is wonderful, and you should look at it." The minister would say, "but what about the Genuine Progress Indicator." There was a feeling that we could do this but that the real heavy lifting would have to be done somewhere else. I told Dr. May Doug it is like starting a band. You have to play the roughest old places first and pay your dues, work your way along and build your credibility. When people think that you might have something there that is worth listening to, you get to where there are others who know more and are better and you can have a true exchange of knowledge. You will get there, and you will develop the credibility as you go. I said, "Until our deputy ministers and our leaders can go to the mainland and hear that something is good is being said about the work in Newfoundland, they will always be wondering whether there is something better out there."
We went across Canada at least three times, working our way through the conferences. Nova Scotia asked us to help them implement a version for themselves, which we did. They have a working version. They changed the name, which I did not appreciate. They told me they would not, but they did, and I have to live with it; still, it is basically our system. We are currently working with the Prince Edward Island government. It was announced in the speech from the throne that Prince Edward Island wants to adopt the Newfoundland and Labrador Community Accounts for its purposes and to support its engagement policies. In recent years there has been a lot of interest in our work from the Australians. Dr. May and I were there for twelve days. They worked us like dogs. They had us in just about every meeting room in Australia talking about it, but it was good. From that, we connected with the OECD, and they have been very keen. As I mentioned earlier, Dr. May is speaking in Stockholm today.
We find now that the interest in our work is at much higher levels of government. Before it used to be people in departments, an analyst or some official would look at our work and think if we had this for Saskatchewan or for British Columbia we could do some good things here, so they would call us, but they would end up failing in frustration because you really need the pull from the top. Now we are getting calls from clerks of executive councils, and so on.
I mention that because maybe one of the few things that people can learn from us is what happens if you try to do this — not so much how to do it, but what happens as you travel the road, taking something that looks like curiosity where everybody is looking at you and wondering how hard you will fall and carrying it through, and that is the pathway there.
Regarding the future, Community Accounts provide a huge amount of evidence, and we will continue developing our data. A major exercise that you will probably hear more about today when you speak to my friends and colleagues from the Poverty Reduction Strategy is that we have been working hard to bring a stronger evidence base in Newfoundland to the poverty reduction strategy. A key element of that is that we build a market basket measure of low income. We will be able to look at where in Newfoundland and Labrador the number of people by low income by different family types are found, the depth of poverty, how long people have been in poverty, what are the worse cases, and so on. We know from our current data that they tend to be certain groups of seniors. Anyway, we are building this and we are waiting now for ministerial direction to release it hopefully in June.
I expect this will get a lot of national interest. It is innovative. We have taken the national methodology and put Newfoundland data in there. It has been acknowledged by Statistics Canada, which did the methodology for the national model that one of the major deficiencies in the market basket measure of low income is that it does not do well with a deficit of Newfoundland-specific data. We saw this as an opportunity to take it down to our communities and neighbourhoods so that we can look closely at what is happening. With that particular exercise, there is tremendous opportunity to begin to understand the kind of things that are happening in communities and potential solutions.
We are also working with homeless groups and the National Homelessness Initiative as a spin off from our market basket measure data to develop measures of at risk of homeless. I do not know whether anybody has done this before, but our work is progressing quite well. Another major project that Mr. Reid and his staff are working on these days is crime and community safety data and indicators. The National Crime Prevention Strategy has given us a little bit of funding.
This year we are also working with our provincial libraries. There are 95 libraries across the province, and we have begun to train the librarians about the Community Accounts, what they are, and how they can use them, so that our librarians will be able to talk to school kids and educators and make sure that the Community Accounts data are out there. As people learn about their communities, they will be able to learn about it with their own data. We are hoping at some point to develop school textbooks with local data, so that instead of seeing information about the United States in a science class, for example, kids can see information for Fogo or for the Burin Peninsula.
Our underlying belief here is that if you know enough about a problem and the context, it brings you a lot closer to implementing a solution that might be successful.
I am never at a loss for words, but I will stop there. I think I have said enough, and I do not want to push anybody else off their spot. If there are any questions I can answer, I would be only too happy. I hope they are not too hard.
The Chair: That was truly an insightful presentation. We thought we were going to hear something special this morning. We have been aware for quite some time of what has been going on here. We do think you have got it right, and we are anxious to carry this to a higher level, which we will discuss later.
Robert Reid, Senior Manager, Community Accounts, Economics and Statistics Branch, Government of Newfoundland and Labrador: I will actually be demonstrating the system, and you can follow along on the computer screen.
As Mr. Hollett mentioned about the geographies that we provide information for, the system is organized in two ways. The first way is by geography, so we do provide quite a bit of information for different levels of geography. As you can see here, we have community level, we have economic zones, we have rural secretariat region. I like to describe it as almost a pyramid structure with the communities as the base. From communities, we have a build up. We call these local areas. We have about 400 community-level geographies. We have 80 local areas and 20 economic zones. You can think of this as a pyramid: the communities at the base, a build up of communities or local areas, economic zones, rural secretariat regions, and the province as a whole. The idea is that if you cannot find information for your community, you can actually select a local area that contains your community. In some cases, the communities are quite small. Due to sample size restrictions, we cannot display a community itself, but we can give you information for the local area that contains the community.
I will select the communities as our focus for this demonstration. Our basic building block for geography is a postal code. When we developed the system, we looked at a number of different data sources, including Statistics Canada census data or income tax data as well as administrative data from our own departments in the provincial and federal governments. The postal code seemed to be the most consistent, so we decided that if we were going to use a building block we would use the postal code for consistent geography across the data sources.
The postal code does provide some challenges in the province. In some cases, communities have a number of postal codes which need to be combined. In other cases, communities share postal codes, and we would identify that with a footnote.
I will select Corner Brook as the geography we will look at this morning, which is no surprise to some of my colleagues here. Whenever I demonstrate, I usually select Corner Brook. I am from Corner Brook, so I can answer some of those questions.
As I said, our system is organized in two ways. The first is by geography and the second is by account, and we have our conceptual framework. I will not go into detail as that was explained earlier, but I want to reiterate that the focus here is well-being, which you see at the centre. From well-being, lines connect the various accounts, and these talk about relationships and about the interconnected pieces.
Take education, for example. We would say that education levels affect the type of jobs that you would get; jobs affect income; and all these things together contribute to well-being. The main point here is that you cannot look at one of these elements in isolation. You cannot look at income and tell anything about well-being. You have to look at them all together.
Before I go too far, I want to talk about some of our sources of information. On the left side, you see a link to our data sources. When we demonstrate this system, many people ask up front what kind of data we have; they want to know whether this data is reliable. Obviously, if they are going to use this system to make decisions, they want to know its reliability.
We have a vast amount of information. Initially we concentrated on some of the readily available information sources, such as census data and information that Statistics Canada produces. Those data readily available at a community level. Since then, we have moved to looking more at administrative data. By the way, we are live on the site for this demonstration, so anything you see here you can go and look at yourself later. We have concentrated on a lot of administrative data. We get information from our government departments; we get income support data from our government departments. We get some health information through hospital records, and we get morbidity data, birth information and death information. We get some information from HRSDC looking at employment insurance. We also get information from our adult health survey, which we are shared with Memorial University. Thus, while we began with readily available Statistics Canada sources, we have moved to a number of other sources of information.
Given that we have so much information, we cater to a number of different users. We have some experienced data users and some novice data users.
We have developed profiles, very quick snapshots of what is happening in a particular community or region. If you select your community and you want to know something quickly about that community, we have the profile link, which pulls information from the various accounts. You do not have to dive into each of those accounts to pull out that information. The profile is a nice, quick snapshot for that. The profile begins with infrastructure. I can click and get infrastructure information for that area.
Here we have a map of the infrastructure for the region Corner Brook is in. Each of these icons represents a different type of infrastructure, and for each community we identify what infrastructure is included in the community. Corner Brook is seen as a service centre. It has a number of public infrastructure pieces: health care services, school services, public libraries. If you look at some of the smaller communities as you go up the Northern Peninsula, you will see a smaller number of infrastructure pieces. Corner Brook would be considered one of the service centres in this province.
Going back to the profile, we begin by looking at demographic information, so we show how the population has been changing overall. We also show the age structure. We show a population pyramid that indicates the number of males by each cohort and the number of females for the latest year available. Moving down, we show income information. We show the income information for people as well as for family structure. We show where their information is coming from, whether from market income or from government sources. From a determinants of health perspective, we know that income is related to health status or health of a population. We also show information on housing, including what the value is of the housing in Corner Brook. As we go through the profile, we also provide provincial comparisons so that people can see how their community relates to the province. You will notice that each of these sections is related to the accounts, so we are pulling information from each of the accounts.
For employment and working conditions, we show the number of people that are employed and the number of people unemployed. Employment working conditions is another determinant of health, and I am sure you are all are familiar with that. Here is information from our provincial government sources through our income support assistance, and you will see that this information has a very nice time series. It begins in 1991 and goes up to 2006.
We are pulling in the latest health information, and in the case of health status that comes from the Canadian Community Health Survey, CCHS. The CCHS sample size for Newfoundland and Labrador is about 4,000. That does not allow us to get information down to a community level. That is a definite gap in terms of looking at health data. When we have to get information from surveys with a small sample size, we cannot provide much information at a community level. I expect Dr. West will probably mention that in 1995, Memorial University produced an adult health survey with a sample size of about 12,000. In 2001, in a follow-up survey, the sample size was about 8,000. For the 1995 survey, we were able to get quite a number of community-level indicators based on the sample size of 12,000. However, with a sample size of 4,000 from CCHS, we are not at a community level.
Therefore, with the profile we are providing information at a regional level for the area that a community belongs to, to give an idea of what the health status would be, including smoking. We do have the information from hospital admittances at a community level. This is the morbidity data. We have aggregated five years of hospital admittances data so that we can produce community-level information so that people will understand that over this time frame, these are the reasons people were going into the hospital.
The last section is on education. Again, education is one of the major determinants of health, and we would say it is a major determinant of well-being as well.
With our profile for each of these sections, if the user wants more information on a particular topic, they can move into the accounts. The profile is a gateway into some of the other information. I will select the demographic accounts from here, and now we will move into the demographic account and I will show you some of the information here.
We are still in the community of Corner Brook, and the accounts are structured similarly. We are moving towards the information or structures Mr. Hollett mentioned in his presentation. We do have a number of data tables, which you can look at.
This is the detailed information for Corner Brook. You can look at some charting and also at some mapping. In our demonstrations, we have found that more and more people want to go the mapping route. They want to see the information mapped because seeing it visually makes more sense to them. When we designed this information, we tried to keep in mind how people learn. Some people like to look at data tables, while others like to look at charts and maps. We have tried to provide that information as we could in order to cater to as many users as possible.
Looking at the information here, I can see the median age, for example. Median age has often been talked about as a measure of how old a community or a region is. I can actually look at the median age in terms of the map, and hopefully you can see that. The scale here shows me that each of these dots represents a community. The communities in yellow are the youngest communities; the communities in red are the oldest, with a median age of about 47 to 65 years. Corner Brook is in the orange section, while Daniel's Harbour is in the red section. Daniel's Harbour is a bit older than the community of Corner Brook.
The question is what other information we can provide that will show exactly what is happening in those particular communities. We have a charting option here, which you saw in the profile. It is actually a population pyramid, and that will show you how the community has been changing over time. There is an animated display. The base of the population pyramid shows you the younger cohorts. On the left side are the males and on the right, the females. The top of the pyramid shows you the older cohorts; the bottom of the pyramid shows you the younger cohorts. We are actually moving through time. We are starting in 1996 and moving ahead each five year period. You are seeing that over this time frame, the bottom of the pyramid is shrinking, which means there has been a smaller number of births or there has been some migration. The top of the pyramid is getting bigger, which means that the cohorts are aging, and there are more people in the older cohorts than in the younger cohorts.
I can also do a comparison quickly. If I select Daniel's Harbour again, we can see that there is a difference between Corner Brook and Daniel's Harbour in how their age structure has been changing. Daniel's Harbour is on the Northern Peninsula, and you will see some dramatic shifts in terms of population change in Daniel's Harbour. The overall pyramid itself is shrinking; not only that, but each of the cohorts is shrinking dramatically. We see that in a number of communities. Typically, in the communities in the larger urban areas the population is fairly stable, but in the outlying areas and in many rural areas there are dramatic population shifts.
I want to look at some of our health information. The health account is structured similarly to the demographic accounts. I will go back to Corner Brook, and you can see as I am demonstrating that it is very easy to switch and do comparisons with these communities. The menu system is there. You can also change your geography to look at a different community region. You can also change an account and look at an account quickly. You can switch between accounts, and you are always maintaining the community you are focused on.
The health accounts are similar to the demographic accounts. I can see maps here. We have obesity maps, and this is Canadian Community Health Survey regional data. We have also worked with a cervical screening group that wants to do some mapping of their information. They gave us their administrative data, and they wanted us to use our demographic information to determine what the rates of screening are amongst communities in the province. Looking at Western Newfoundland, we provided them with maps showing participation broken down into groups. They wanted to see across communities where the highest and the lowest participation rates are so that they can focus their efforts. If they want to increase screening in particular areas, they know exactly which communities to target.
I cannot go through a demonstration without showing at least one table. We are still looking at the city of Corner Brook. We have information from the hospital morbidity separation data, and in this table I get information for two time periods and can see the changes over this time frame. We have the period from 1994 to 1999 and the more recently period from 2000 to 2004. This information is based on the International Classification of Diseases. Right now we are providing a count of the number of times people have gone into hospital for these particular diseases.
In order to do some further analysis, up on the left side there are some options. We provide these options for users to do some analysis on this data. They can actually view some percentages. Instead of making users pull the information out to an Excel spreadsheet and do the calculations, as much as we can we provide these options. For example, in this particular area, 11.8 per cent of the time females went into hospital it was for diseases of the circulatory system. We can also do ratios for the province that compare this particular community to what is being done at a provincial level. When it is above 1, it means that the community is higher than the province; when it is below 1, it means that the community's rates are less than the provincial rates.
Those are some of the major categories, but we can also show more detailed information and do subcategories. I have circulatory system broken down, and we have a heart disease category. Under digestive system, we have intestine and perineum; we have diseases of the gall bladder. It is a way to drill down to get the more detailed information if you want to look at that.
I want to look at some of the Canadian Community Health Survey data. As I mentioned earlier, this information is available at a regional level as opposed to a community level. You will see that the information we have has check marks. The check marks indicate whether or not the information is available for the geography you are looking at. As you can see, we do have some information for Corner Brook based on the adult health survey from 1995, but if I click the health practices table for the Canadian Community Health Survey, I get a note telling me that the CCHS information is not available for this geography and I need to change my geography. The menu system will let me know that I can select a region, and once I select the region that Corner Brook is in, I get the information for that region. Included in this we get smoking, for example. This is the health practices table. We get the number of current daily smokers and when they began smoking. We get the drinking, we get the information on body mass index. We are always talking about obesity. Overweight is a very important health issue. We also provide the margin of error on this information, because if you are looking at how this compares from one region to another you need to know what the error margin is on those numbers in order to know whether or not there is a real change.
One option I will go into is the ability to do some quick comparisons. We call it our community comparison tool, but we can also use it for regional comparisons. If I wanted to know across regions in the province where the highest rates of current daily smokers are, I can click current daily smokers. Incidentally, this information is also available for provinces. You can do a comparison between regions in Newfoundland as opposed to provincial comparisons as well. If I select economic zones, this nice little tool will actually give me the information for each of the economic zones in this province. I can order this information, and it will let me know the lowest rates in the province to the highest rates in the province. You will notice that there are still gaps here. This is information obviously due to small sample sizes. We try to maintain a 95 per cent confidence integral. When we fall outside of that margin, then we do not provide that information.
From here, I want to go in and look at well-being. As has been discussed, well-being is our focus. I cannot go through a demonstration without showing some of the well-being information. Again I will go back and switch to Corner Brook. The well-being account is structured is a bit differently than the other accounts. We pull in information from the various accounts, because we are talking about well-being in an integrated approach and you want to look at different factors. We pull information in from the various accounts. We pull in education information, demographic information, income information, self-reliance, and health information to start to measure well-being. We provide the value and the ranking for the community.
I will focus on population change. Here is Corner Brook. It had a population change of 1.5 per cent over this time frame. It ranked 61 in the province. I can click that and it gives me the value for all the communities in the province, from the community with the highest population increase, which was Benton, to the community with the highest population decline, 28 per cent. You can see there is quite a variation in the province. If I scroll up, Corner Brook is highlighted and ranked 61. I can see which communities rank higher and which rank lower.
The other way to show this information is by charting it. This chart came about through a lot of discussion with a number of clients who wanted to be able to quickly see how their communities ranked relative to everyone else. The table was one way to do it, but this is another way to organize that information. The chart shows the same information the table shows. The community at the bottom here is Bridgeport, and you see a population decline of 28 per cent, and on the other end is Benton at 44 per cent. We have lined up all the communities from the lowest to the highest. Here is where Corner Brook ranks on this scale.
We have tried to provide this information so that people can understand it quickly. We have broken it up into ranges. This is the bottom 25 per cent community; this is the red range. The top 25 per cent of communities are in this range, and the middle 50 per cent are in this range. This is basically a distribution of this particular indicator. Here is Corner Brook. If I wanted to do a comparison to another community and I selected Arnold's Cove, here is where Arnold's Cove ranks. We see that Arnold's Cove had a population decline, so it ranks lower than Corner Brook. That is a quick way to do those two comparisons. I can compare communities one to one quickly that way.
We can also compare all the communities on that particular indicator by way of maps. If I click the mapping option, we are still looking at population change, and in terms of change, we are still looking at the same colour scheme. The red areas, which are the bottom 25 percent, are the communities that have the highest population losses, and the communities in the yellow are the communities that have the highest population increases.
Some options here I can change. I can look at Labrador. This is the island portion of the province. We have separate information for Labrador. I can select the roads. The system will provide the road network for me, and I can look at each community. I see Corner Brook in the yellow area. When I click it, it brings me back to the chart. I can also look at communities on the Northern Peninsula, and I can see quickly which communities are in the red. Here I see Port au Choix, and it tells me that the population decline is 13 per cent. I can look at any of these communities, and I can easily scan across the province and see which communities are in the red and which are in the yellow. This is a very quick way to compare all the communities on one particular indicator.
Let us return to our well-being account. As we start presenting this information, obviously there is another question to be answered. You can compare one indicator for all the communities: Can you compare all the indicators for all the communities? In fact, we have developed a tool to do that. We call it our indicator summary table.
The indicator summary table shows me all the information for all the indicators, and I can do a comparison across a number of communities. I will select the region that contains Corner Brook, and we will do a comparison across all the communities. Across the top are the indicators for well-being. The colour again represents the scheme. The top 25 per cent are in yellow and the bottom 25 per cent are in red, and we have provided an overall score here. We have added a little feature that allows people to summarize this information. We will add in the number of times a community is in the yellow, and we will subtract the number of times a community is in the red. We will do the number of yellows minus the number of reds, and we will provide an overall score. This is an indication of which communities seem to be doing better or worse on this particular number of indicators, and I can sort the information by the overall score. Scrolling down, I see that the community at the top with the lowest score is Lark Harbour, and you can see which indicators it falls in the bottom 25 per cent on. The communities at the top are Corner Brook and Pasadena with overall indicator scores of 10 and 11.
This is a nice way to help organize what is happening in a particular region. You can do the same thing for all the communities in the province. You can select a province option that will give you all the communities, and you can rank them from lowest to highest.
We have to keep in mind that this is based on these particular indicators. Our intention is always to add more indicators for well-being so that we actually start to round out this picture a little more. For example, at present we do not have any environmental indicators. We need to add those in.
I want to show you some of our neighbourhood information. Keep in mind that with a population of 25,000, Corner Brook is one of the province's larger communities. When we start showing this information to people in these areas, it is understood that Corner Brook as a whole seems to be doing well on these indicators. But what about areas within Corner Brook? I am from Corner Brook myself, and I know that some areas in Corner Brook are very different than other parts with respect to social and economic status.
Along with groups in the regions, we have developed neighbourhood areas. I guess initially it started with the Strategic Social Plan where people in each of these regions initiated the connection with the communities to help us to define some of these neighbourhoods. A couple of months ago we released information for neighbourhood areas, and a listing of the neighbourhood areas in this case shows some of our larger communities. We have neighbourhoods for Carbonear, Conception Bay South, Corner Brook, Gander, Grand Falls, Happy Valley, Labrador City, Mount Pearl, St. John's, Stephenville and Torbay. Those are some of the larger communities. To demonstrate what information we have at a neighbourhood level, I will select Corner Brook again. This is the Corner Brook area, and this time it is for the city as a whole. I can move in, and as I zoom in farther, I can actually see the streets within the city, and I can select one of the neighbourhoods.
Once I have selected a neighbourhood in Corner Brook, I am brought back again to the diagram. I can get a profile for the neighbourhood just as I can for the community, but now we are talking about a neighbourhood area, and you can see that the description is very detailed. It tells me which streets are included within that neighbourhood. I get the demographic information and income information, but you will notice that a lot of the information is not as detailed as we have at a community level. This is where our further development is going. We are moving in that direction.
I want to show you one piece of information. I want to show a little tool we have to see some indicator information at a neighbourhood level, and we will look at personal income per capita. Here is a map of personal income per capita for Carbonear. In this case, as opposed to the map we saw at the provincial level, we are actually doing comparisons across all neighbourhoods. On this scale, the red area shows the areas that had the lowest personal income per capita. The green area show the areas that had the highest personal income per capita. We have to keep in mind that we are comparing all neighbourhoods. In some cases, particular communities may not have all of the range of colours. In this case, Carbonear does not. There is a little arrow at the top here. I can do some fairly quick comparisons across communities and looking down at a neighbourhood level. Here is Conception Bay South, and here is Corner Brook. As I was saying, although Corner Brook does rank fairly high in terms of personal income on a provincial scale, community by community some neighbourhoods in Corner Brook have lower personal incomes than others. You can see that in other indicators as well.
I will move to Labrador City. You can see how quickly the system allows you to do these comparisons. Here is Mount Pearl, which you can see has one area in the green and an area in the red.
The St. John's area really shows the variety of neighbourhoods. St. John's we had broken down into 95 neighbourhoods. When we define these neighbourhoods, we are looking for populations of about 1,000 people, because we want to avoid issues with suppression and confidentiality. Neighbourhood areas of about 1,000 people are larger than at least a third of the communities in the province.
We have been concentrating on doing a number of different mapping options. We began by doing a lot of static maps. Users want us to do more dynamic mapping, and we have done a lot of searching around where to go for doing dynamic mapping. We work with a geographic information system, GIS, group that advises us on many of these things. They suggest that we go the route of looking at Google; a lot of people understand Google, relate to Google, have used Google.
We have begun by producing our community infrastructure mapping system, which allows you to see where infrastructure is located in the province. There has been quite a lot of interest in mapping infrastructure in this province, whether it be health care centres, government service centres, or other types of infrastructure, and people want to be able to do it through a dynamic application.
For our demonstration, I have selected the health care centres. It shows me where in the province the health care centres are located, and since it is dynamic, I can zoom into a region. If I zoom in far enough, I can click on the satellite image and see right down to the front door of this hospital. In addition, we say what the facility is, and we also have a profile of the facility that tells me what services are in that particular facility. I know the number of acute beds and whether or not there is cardiac care. It also gives me links to the website for the facility.
We are moving in the direction of having users be able to do searches. For example, if I go back out to the provincial level and I select health care system, I am looking at the health care layer, but supposing I want only areas that have dialysis services, the system will show me only the health care centres that have that particular service. It is a nice way for users to identify where the services they want to look at are located in the province.
The Chair: Thank you very much indeed, Mr. Reid. That is very impressive.
We will now hear from Dr. Roy West.
Dr. Roy West, Professor Emeritus of Epidemiology, Memorial University of Newfoundland: Thank you, Mr. Chair. I could not resist having Mr. Reid put up this slide. It is not part of my presentation. I was going to say we have got a competitor in Newfoundland, but it is not on population health. This is the map that has been put together for tourists to Newfoundland to show that icebergs have been sighted in Newfoundland. If any of you will be doing any sightseeing, this tells you where the icebergs are, and you can see that there are quite a few. The bottom circle is where we might be going this evening for dinner out around Conception Bay, so with luck you will see some. Anyway, let us get to the serious business if we could.
I will be talking from a epidemiological perspective. It will be a mixture of some of the things we need to do from the point of view of research and also a bit from the point of view of health policy, and then I talk about some of the skills that are necessary in order to do Community Accounts.
This is not new to you, but I put it in to illustrate the importance of where we are going. You people know the population health wellness model as well as I do. This leads me to one way we are using Community Accounts: as a PhD public health professional teaching in a medical school, it is a constant battle to get across the concept of population health to undergraduate medical students. In fact, we are now able. Memorial University was in the lead in starting an interdisciplinary training program bringing nurses, physicians, pharmacists and social workers together for some courses. The Community Accounts are one of the tools we use for those groups when they are trying to identify projects. That is a small way we have started to introduce the population health model to those people. Unfortunately, those particularly in the medical school, with due respect to Dr. Keon, rapidly get switched back to the medical model for most of their training.
This slide is equally part of the lead in and is to remind us once again about the different determinants of health.
From the point of view of determinants of health, we want a healthy public policy. Ongoing information on the determinants of health is needed on a national, provincial, regional and community level. We have been hearing about our efforts, sometimes struggles, to take that on down to the community level, and this is the important issue for which we are all here today.
We are jumping around a bit with the slides, and I am sorry about that. They are not in the same order as the package you have. However, we will take them in the order they come.
We all work in a complex environment. I was very much taken by this picture of Canada, which was produced on a policy project of the Canadian Public Health Association in Ottawa. There are a few words on there that perhaps may not apply to population health and well-being, but indirectly everything on that map applies to population health and well-being, and this is the mix, if you like, in which we are working.
I think you have already seen this morning that an awful lot of the factors on that slide are already included in Community Accounts. You were looking at demographics from the point of view of urban growth or decline. You saw stuff with regards to age. As you can see, different places become an issue, as do Aboriginal peoples, diversity, education, and so on. I am rather taken with this map because it also fits in with Mr. Hollett's model that population health does not just take place on its own; it is in this bigger environment of demographics, geopolitics, technical innovation and globalization. We have to remember that when we are trying to put together all the initiatives that we believe should happen as far as population health in Canada.
I will talk a bit about how epidemiology and research using Community Accounts relate to policy and practice. You have probably seen this triangle before from others. I like this triangle, because from the point of view of setting policy, and the point of view of carrying out practice, if we are to be evidence-based, as we have talked about, we will always have to do research and we will always have to be on the leading edge. Equally, if the triangle had arrows, it would have double arrows, because coming out of research is evidence-based policy put into practice; it does not always work, and therefore it has to go back and there would be more research. Today we are here to put in perspective how Community Accounts can help us as we work our way through this triangle.
I will talk about the use of Community Accounts by each of the different points on that triangle. I have deliberately said "applied health researchers." I am not trying to demote other areas of health research, including basic science and clinical research, and often they may be developing some of the indicators that we need to use from the point of view of looking at the well-being or health of a community. However, Community Accounts are particularly pertinent to applied health researchers. From the surveillance point of view, they can give us trends in the determinants of health and some trends in health outcomes.
When I talk about trends, that raises the issue of ongoing surveys in order to measure change over time, and this is one of the areas we need to concentrate on a little more. Community accounts are made up of snapshots at various points in time of risk factors for health and well-being, but also they contain some data on outcomes. From that point of view, we can use them to be the generator of research questions. There are many, many research questions that the Community Accounts cannot answer, but they can be the generator of a research question for which the research then can be more specifically carried out.
For instance, I will take a simplistic example. If we had a community with a high rate of smoking on the one hand and a high rate of lung cancer on the other, it would seem obvious, based on our knowledge today, that those two are linked. However, if they were a risk factor and a health outcome for which we did not have the same level of knowledge, we would not be able to answer the total question of whether this caused that, but it would be a flag to researchers that they need to do studies into whether there is a link between the two.
From the point of view of research, the Community Accounts will be very useful as we go down the road. Also, as we go longer in time and we get more surveys done at the community level, we may get closer to being able to use the Community Accounts specifically to answer questions, because we will be able to bring the time factor in and look at environmental factors, risk, income, and so on and then look a number of years later to see whether those have changed. That is important from the point of view of improving health. It is not just setting up questions that we can research with regard to whether one thing causes another; it is whether some of the interventions that we make will be able to prevent people becoming ill. From that point of view, from a research point of view, from the point of view of using etiological research, then the Community Accounts are a very good generator of research. Moreover, from the point of view of health services research, if one carries out certain changes in health services in a community, one can then use the Community Accounts to examine whether those changes in health services are having any effect.
With regard to program evaluation that governments or health authorities put in place, the Community Accounts will not give you the cost information, but in this day and age you have got to have the source of the benefit, the source of the effectiveness of the information. The cost information, the researcher may need to get from elsewhere, but at least from the point of view of program evaluation, we do have some benefit or effectiveness outcome information.
Last, a major part of being a researcher in an academic environment is training the next generation of graduate students. In the community health division at Memorial University, we found Community Accounts invaluable for training the next generation of graduate students, whether they will work as researchers or take up positions in government.
The second point on the triangle is policy. We can get down to the regional level fairly easily. This point has been eloquently made by Mr. Reid and Mr. Hollett using the Canadian Community Health Survey. We have been in this fortunate position because of the work of Dr. Segovia and then jointly our work on the 2001 survey. We had a sample size in Newfoundland and Labrador large enough to get down to the community level, but we need to be able to keep the effort going.
Some of these examples are quite simplistic, but it is important to see that policy questions could be answered using Community Accounts. Over time we should be able to measure the well-being status of the population and the trends in the determinants of health in that population. You saw illustrations of this from Mr. Reid this morning. What are the main health problems in a population? Are determinants of health and health itself with the population becoming better or worse?
I am not trying to give you a lecture on policy-making, but there are four main steps, as you probably are aware. The first is to identify an issue and recognize that issue, and then obviously the question for government is whether it should do anything about that issue. Senator Keon said to me earlier today that the health system is running out of money. We have got to push more in the population health direction. We all know that we cannot do everything. Some in these four stages may need other information as well as Community Accounts, but I believe that the Community Accounts can be very useful from the point of view of helping government to decide whether it is a big enough problem and whether the government should put resources in that area. Policy formulation and what interventions are available may be a little outside of Community Accounts, but much of the demographic and other information in Community Accounts will help to determine to whom interventions should be directed.
From the point of view of implementation and monitoring and how government should decide which intervention should be implemented, once again perhaps in that area Community Accounts do not play such a large role, but there are times when you can link community account data with other data that can help.
Finally, in policy evaluation, we look at the questions of what is the overall impact on health and quality of life and how will the government know its new policies are successful. Obviously, there are limitations; we cannot do this in all areas, but I think that Community Accounts can be very useful to government for evaluation in many of the areas captured in Community Accounts. As a researcher and as somebody who previously worked in government, I will say that governments are not good at evaluation. We need to get better at evaluation. Perhaps one of the excuses in the past has been that data were not available. With Community Accounts, that excuse is starting to be removed.
This next slide is about use of Community Accounts by the community. You will be hearing a lot about that this afternoon and tomorrow morning identifying health challenges within the community, and you have seen from Mr. Reid a better understanding of community demographics, determinants of health within the community, the health outcomes of the community. You heard from Mr. Hollett about his talks with mayors and other civic officials from the point of view of developing community-based programs. Communities are keen at the community level to institute simple programs they believe will help their population and help improve the well-being and health of that population. Some of those programs might be economic, providing good jobs for the people who live in their jurisdiction, but a number pertain directly to risk factors with regards to health. We have seen that over the years with the Heart Health Program across Canada. Some communities in Newfoundland have built trails and encourage members of their community to walk those trails every day, and that initially started under the Heart Health Program. It has since been picked up by some of the federal sponsorship programs to put jobs into communities. Community accounts can certainly help communities decide where they want to target specific activities within their own community to improve the health and well-being of the community.
Evaluating those programs at the community level is similar to doing it at the higher government level. From a methodological and a epidemiological point of view, I would stress that some programs at the community level are so modest in cost that if you are not careful, you can end up spending a fortune on evaluation, and even though as an epidemiologist I love evaluation, I would say quite frankly it is not worth the money. With many community-level programs, we should take the best-practice approach of saying, "We think this works; it does not cost us much money; let us put it in place." I think the Community Accounts are ideal for identifying those sorts of programs.
Here are a few issues, from my point of view as an epidemiologist, around developing the Community Accounts. The first issue is information on all the determinants of health. We heard from Mr. Hollett how gradually over time Newfoundland has got to the point that there are these different accounts. In the early days I used to ask Dr. May and Mr. Hollett what they meant by an "account." As an epidemiologist, I tended to think in terms of databases and words like that. It turns out that "account" is a word that economists use. Dr. May introduced the word, but from the point of view of the accounts, we had to start looking at where could we find data for the various accounts. As you heard from Mr. Hollett, they have done very good job on that.
We have talked about sample size and community-level data, and you have been told that Dr. Segovia's 1996 survey had 12,000 Newfoundlanders. I would add one piece — something that makes Newfoundland special as well — which is that in that study funded by the old National Health Research and Development Program, Dr. Segovia asked people for their permission to link their survey data to their use of the health system, through using the hospital database and the physician payment database. A number of people from across the country who reviewed that project said they would fund the project but they did not have too much hope; they thought the response rate would be very low. However, 88 per cent of those 12,000 people agreed to have their data linked to their health data. To me, that is a reflection of the different level of trust in researchers and the system in Newfoundland, as well as perhaps the sense of Newfoundlanders wanting to help each other. He had very good cooperation from that point of view.
The sample size is important if we are going to drive this down to the community level, whether it be here in Newfoundland or across the country. Quite frankly, I think Statistics Canada cannot afford to drive it that low all the way across the country. Moreover, as health is a provincial matter and as at the community level the majority of the benefit will be at the provincial level, then Statistics Canada may have an argument that provincial governments should pay.
Access to data and confidentiality and privacy issues all go together. As you have seen, Community Accounts are aggregated data and have no identifiers of individuals on those data. The only restriction from the confidentiality and privacy point of view is as Mr. Reid said, taking it down to too low a level, to too small a community. If there are only 10 people in a community, for example, then there is the risk that if you start talking about the data on the 10 people you can identify people. One has to be careful from that point of view.
To do research studies, we need to link some of the data that is going into the Community Accounts with other data, but that is a separate issue. In those issues, we have to go back to the original database. We have to follow all of the ethical guidelines and get permission to do a linkage at the identified level. We have also talked about the ongoing issue versus the cross-section of data. We have two slices now, 1996 and 2001. We would like to see that slice being done every five years.
I want to touch on a concept that I suspect you are well aware of: we need to measure health outcomes, not just health outputs. To me, a health output is the number and types of programs and services delivered, and using a population health example, health promotion programs put in place or a reduction in hospital waiting times. Health outcome is the actual effect on the health and well-being of the population or person, and obviously that takes us right back into Community Accounts. From a population health point of view, the example for health promotion is actual change in lifestyle risk behaviour — not just people getting the message, but people actually changing their lifestyle and their behaviour.
As a public health person I could not resist including this next point. We are seeing a lot of emphasis on waiting lists at the moment in Canada, and I wonder whether we are doing enough to show whether the interventions improve the quality of life or the life expectancy of people. We may be spending money to reduce waiting lists and we may not be having quite as much effect as we hoped. I just raise that question. That is a little outside of why I am here today.
We have talked about longitudinal community health surveys. In Canada, there is a need for ongoing information at all jurisdictional levels. We have talked about that. Statistics Canada provides it at the national and provincial levels and sometimes at the regional level but not always across the country. At the community level, to my knowledge, there are no routinely funded longitudinal surveys. We are not to the point where provinces, including Newfoundland, are doing what Statistics Canada is doing at the national, provincial, and regional levels. No province is yet to the point where we are doing it routinely at the community level. Mr. Hollett mentioned that we have done some thinking about this. We have had some discussion with colleagues in different levels of government; we are still working on it.
This next slide is an example; the numbers are approximate, so do not use them as the actual costs. In Newfoundland and Labrador, the estimated cost for a survey that is carried out every five years, over the next twenty years, in today's dollars, would be $2 million, roughly $500,000 a survey. The current Newfoundland and Labrador health budget is approximately $2 billion or $40 billion over 20 years. Therefore, the cost of collecting data for the Community Accounts from the health point of view — and I should have put in that qualification because, obviously, there are many other databases going into the Community Accounts — over the next 20 years, if we were able to do that, would be 0.005 per cent of the health budget. I often tell government when I am trying to get more research dollars from government that any business, from the research and development point of view, probably puts anything between 8 per cent and 10 per cent back into research and development to keep their business going. I use that argument to try to get more research dollars for the university, because we have got nowhere near that sort of level. Similarly, here is another activity we desperately need across the country, and the cost would be relatively small. As I said, these are just approximate figures, so do not hold me to this, but a magnitude of one or two would not change this 0.005 very much. It is pretty small.
This next slide shows the attributes needed for others to develop Community Accounts. I deliberately put these in order of priority. You need highly skilled staff. You saw this morning how skilled Mr. Reid is. In doing secondary research with databases, as a researcher, I know the questions I want to answer, but technologically I do not know what I can do and not do with those databases. You need a highly skilled person to help put your vision or your research into reality. We are fortunate here that through the staff in Mr. Hollett's division, people like Mr. Reid, we have those skills.
The worst thing that could happen is if we encouraged others across the country to build similar Community Accounts and they did not use the right people to bring the data together. I will hold back on the old adage "garbage in, garbage out," but there is a real problem because some instances it will not work, and if it does not work in some instances, that will create a problem for all of us. I do stress that you have got to have the right people.
You also have to have valid data, obviously, and you need to make sure not only about the sample size, but also that the questions being asked in any survey are giving you valid data that you can use. You need a total understanding of the structure of each data set. Once again that not only links back to the people who manage those data sets and do the computer technology on those data sets, but it also links to the next point, which is the identification of appropriate indicators to use in Community Accounts. Each of the databases that Mr. Hollett and his staff have linked in have literally hundreds of indicators, and it is a matter of identifying which are the best ones to reflect the health and well- being in those communities. That takes real skill. I remember the arguments just over the health accounts. I have been more involved obviously in the health side. I remember the arguments that Dr. May, Mr. Hollett, and I had over which health indicators, risk indicators, disease indicators and so on should go in as the best way of reflecting the well-being of that community. Obviously, you have got to have people from two levels. You have to have people from the health side, and I am talking specifically about the health account, who understand those data, but you also need people from the community to advise you on what they will understand best.
It is not easy, and that probably is my main message. From a methodological point of view, it looks so smooth and easy. Thanks to Mr. Hollett, his staff, Mr. Reid, I am absolutely amazed at the difference today and where we have been able to take this compared with where we were in 1998. If you had had a demonstration in 1998, it would have been very simple and not at all like what Mr. Reid was able to show you, but it was because we have the people and the databases and because we were able to identify the appropriate indicators. It is not easy, but as you have already heard, and it should not be me who is saying this, it should be Mr. Hollett saying it, Newfoundland is willing to share the lessons learned. You also heard about Mr. Hollett's experience with Nova Scotia. We would like to get a little bit of credit for what Newfoundland has done.
I will touch on two of the major next steps for Community Accounts. First is the study of long-term trends. We must recognize that we have to put in place the structures that will generate the data over the long haul so that we have five- year data. We had some discussion around that. In different jurisdictions, that length of time might need to change a little, but we felt that particularly if we were looking for change in risk factors, you probably would not get much cost benefit out of doing it every year. We decided that it would be good to do this every five years in Newfoundland.
The second point is to have all provinces and territories using Community Accounts constructed with a common methodology. Over the years I have worked in several provinces in Canada and in several areas of public health, and one of our biggest problems is that when we try to do comparisons between provinces, we end up getting snared by the fact that data has been collected in a different way almost in each of the ten provinces. That cuts down on our ability to do provincial comparisons. It also cuts down on our ability to roll that data up so that we can have a national picture as well. I will stop there.
The Chair: Thank you so much, all three of you. What an appropriate place to end. I wish we had more time for questions, but it was very important that we hear all three of you, and as a matter of fact, many of the questions I have I think will be answered this afternoon or tomorrow morning. It may be that this has been our best option.
One thing I would like to ask you reflects your last slide. It is almost certain that our report will recommend the implementation of this system across the country. It will recommend that the federal government get involved and quarterback this and finance it, but what we do not know and what we have come here to find out is just how that can be done without messing up the system as you have described it. I would like all three of you to address that. All the senators have a number of questions for you, so I would ask you to be as brief as you can so that they get to ask you some of their questions too.
How can we frame our recommendations to the federal government to implement a system like this across the country, or at least encourage the provinces to implement a system like this across the country? The federal government will have to play a leadership role to get the job done, but how can we frame our recommendations in such a way that we avoid its being badly done?
Mr. Hollett: I would like to ask a question for clarification before I can make any comment. Dr. Keon, when you say "badly done" or "messed up," what are you thinking there? Are you thinking of how to do it without having a major transformation to what we have, or are you just thinking about its coming out wrong?
The Chair: I suppose having it come out wrong is what we would fear most, but I worry about what will happen as this works its way down through the system. I have had quite a lot of experience with sitting on committees to try to get provinces to introduce various kinds of uniform data collection and so forth, and it does not work. How can we make recommendations that will avoid tampering with the system, so to speak?
Mr. Hollett: I can make a few comments in response as it relates to the experience we have had. Other jurisdictions, probably 15 or 20 jurisdictions across the world, have come to us with great enthusiasm to look at the Community Accounts. They like them, and they want some. When that happens, what I see happening across Canada is that when there is a possibility of money flowing, that is when the forces coalesce. In my experience, whoever has the most sway in getting their hands on control of the money, or whoever has the most authoritative technical group, whether it be an appropriate entity or not, that is when the work that we have created becomes transformed. I have seen that over and over. Going back to Dr. West's point, I know sometimes that if we have a good day, we make it look simple; if we have a bad day, I am sure people look at us and say why in the name of God would they want to be working at that. For the most part, we do make it look a lot simpler than it is. Everything that Dr. West said is correct.
I do not want to go too far the other way and say that this is so difficult and so esoteric that it is formidable to take on. I truly do not believe that at all. I sort of feel that if we can do it, anybody can do it; but I also feel, and this is based on experience, that there is a fairly narrow margin within which you can operate where you have a high likelihood of success. What we have here seems to work well, and when I say that, I mean that I think our framework covers adequately major areas of interest to most of the people who have an interest in using this sort of information, and more especially that it has appeal to community. I think that is absolutely important.
Based on experience, my advice is that there has to be a clear articulation of what is being sought. There has to be a clear articulation of what is to be done, and there has to be a clear articulation that it needs to be done incrementally. The approach we have always taken is to focus on a deliverable. We have had opportunities on occasion when people have come to us with money, asking if we can take $2 million, for example. Generally speaking, in the context of the way that is presented, we would not be interested in that because in most cases you need money, you need time, and you have to be able to achieve what you are doing. In most cases, money and time do not come in a good mix. Usually when there is lots of money it is because somebody else does not have time to spend it. Large amounts of money also imply large amounts of deliverables, and if you have integrity and you are serious about getting a good value for the dollars, it tends not to work too well.
If I were to implement this across Canada it certainly could work, in my view. Newfoundland is so different from any other area in this country where groups of people are interested in the same subject matter that we cannot provide them information in this kind of a manner, if this is a manner that is will work for everybody, and I think it will. I am not saying that this is absolutely perfect because it is not, but it certainly has great potential for being built up. In my mind, you cannot go into a situation where you churn up all this whitewater with people waiting to get their hands on budgets and do this big thing. That becomes complicated. You have got to take it back into a black box and work on it there for ages and ages, because only a handful of people in the world are the right people to work on this. That is just the wrong way, and it is the way it usually happens. I could give you one example after another, but I will not because what I would have to say would not be fair to the people who are not here to join in the debate.
As I said, I would make clear what you are trying to achieve, what is to be done, that something is desired along the lines of the Community Accounts, that you want to see something for efforts in an orderly and a timely fashion, and that there is a vision underneath that we will build it as time passes. Based on our expedience, that is a good way to start. I think when you are doing something like this, you really need to start off with something that people can identify with, and you need to be able to show them that something can be done over a reasonable period of time. We have had discussions with First Nations, and First Nations are keenly interested in what Newfoundland has done. One reason they are so keenly interested is that they have the good sense to realize that with some modifications and patience, they can quickly have a product that will have an appeal to First Nations, because they feel that what we have reflects people. It is numbers that reflect people's lives, and they like that. They are trying to build an awareness of using good information within the First Nations groups, and they want to build confidence over a short period of time that something can be achieved that is useful to them. I think that is the way one has to approach this.
I know I have given you a lot of words, but I have not given you a big answer. If Michael Wilson were here, he would give you a much more sophisticated and complex answer, and you might not understand it, but it would sound a lot better. Then again, we have a system that people like. I think we need a sensible approach where we are keeping citizens in mind, because if we put a lot of time, effort, money, dedication, blood, sweat and tears into a system that only someone with a high level of skill can use, I think we have failed. The scientific community can get the data it needs. I think the real answer to the health care issues we are talking about is for people to understand the determinants, so that they start thinking that way and are able to see information that tells them about those determinants so that they can take action themselves.
Our steps forward have to embody that. Time after time people come to us, and their work takes on a life force of its own, and they basically end up stepping outside of the pathway that will lead to success, and it becomes something that citizens cannot understand. It becomes too costly to maintain. It becomes too complicated for most people to use. It is possible to do it, in my opinion, but it is very possible to fail miserably as well.
Senator Pépin: I agree with Senator Keon. The information you have given us this morning is fantastic. In our report, we want to talk about the Newfoundland experience as an example.
My question is for Mr. Reid. How regularly do you get updated information via the Internet? Is it easy and can we get that information on a regular basis?
Mr. Reid: It depends on the data source. The administrative data we receive from the provincial government or the federal government can be updated on a fairly regular basis. That is annual data. You will notice that our income support data, for example, is up to 2006, and we are in the process now of updating to 2007. It is an annual data source and we can update that fairly regular. The census information is updated every five years. We go through a process of scheduling updates based on the release of the census information. For example, in March, the release of labour market and education information from the census allows us to get that information from Statistics Canada so we can update our system.
In some cases, there is a lag in information. For example, we file income tax for our previous year. The information has to be compiled, so there is usually a two- to three-year lag before we can get that.
I will say that the information is as up-to-date as we can make it. Often the community-level information lags behind some of the more current provincial and regional information, but as we mentioned in the presentations, community is our focus, so we are always looking for the community-level information. We will provide links to provincial-level, more current information, but the focus is always the community level — and, no, it is never easy.
[Translation]
Senator Pépin: Is the information centralized and updated, or do the agencies concerned have the option of accessing the information themselves? Are participating groups able to access that information?
[English]
Mr. Reid: The information that is shared through our provincial departments they are actually collecting for their own program purposes, and they have their own databases. They use that information to administer their own programs. We have a sharing arrangement with them so that once they compile their information, they share their files with us. Then my team takes that information and disseminates it through the Community Accounts by community.
[Translation]
Senator Pépin: Mr. Hollett, can you give us some concrete examples of how databases have enabled the government to improve the quality of life in communities?
[English]
Mr. Hollett: As I said this morning, a large part of the work we do is the cook behind the screen providing the buffet. You might get better examples tomorrow when you have people come in who are more on the user end, but we have had people in community, as Mr. Reid said, using our data to look at the prevalence of breast cancer and different kinds of screening to see if there are disproportionate issues in their areas and to come to government and the health care system to actually get action taken on those findings. Medical doctors throughout the province use our demographic data for their community and their areas, buying medications they have to provide where there are not pharmacies locally and that sort of thing. We had people across the province who were developing businesses use our data to present strong evidence-based cases to our government to explain why they should get help and support or changes in policies. We did not mention this, but we have actually trained over 5,000 people in training sessions across the province to actually use the Community Accounts data. Many people are coming to government, and responses from government have certainly changed.
One story I could tell relates to our Department of Municipal Affairs which deals with the tax rates in communities. They said that before the Community Accounts came on the scene, they would fight over who had the numbers, but since the Community Accounts have come on the scene, they believe the numbers and now they fight over what has to be done. I think that is good progress.
Mr. Reid: I have an example from a community perspective. A number of years ago, one of the towns in the St. John's census metropolitan area, Conception Bay South, approached us looking for some of the information we had available for their town from census information. They were questioning some of the numbers that were coming through the census for their town. They wanted to partner with us to produce an enumeration for their area because they wanted to use more detailed information to do some strategic planning. We agreed to help them out with their enumeration and also to post the information in the Community Accounts. They identified a data gap for them, and we partnered with them, and now there is community and neighbourhood information in the Community Accounts for them to use and also for other people in their community.
Mr. Hollett: Also, over the years, the Community Accounts data and that approach are becoming a very large element of core business at our statistics agency. In a sense, that is a reflection of the high level of absorption that our Community Accounts data has come to have within government uses and community uses. The varieties of usages flow in all directions, and there are so many things happening that it is difficult to keep a fix on it.
I attended a session last year when the Wellness Coalition came to see you. There is a lady on Prince Edward Island some of you may know, Patsy Beatty-Huggan, and she has developed this circle of health, which is a population health way of thinking. I do not know if you have ever seen it. I was quite struck by it. They had a group together at a hotel here in St. John's. They said, "If here is a health issue, then here are the things that you need to think about." The circle says you should think about income, about education, about bunch of factors. Then they say, "Okay, now that we are thinking of it in this way, let us go to the Community Accounts to see what the data tell us."
All sorts of things are happening. The Community Accounts has matured significantly. My best example is this, and I say this not to trivialize your question at all, but it reminds me of when people call in sometimes to our statistics agency and say, "I was looking for some data to start a business," and we will say, "Yes, what would you like," and they will say, "Well, what have you got?" That is a very difficult question to answer.
The Chair: Dr. West, I would like to ask you one question and I would like you to answer it in 10 seconds. I know how closely aligned well-being and health status are. How do you differentiate well-being from health status?
Dr. West: The two-second answer is that I think Mr. Hollett has a greater differentiation than I do. From the point of view of health status, Community Accounts are using it for those traditional determinants of health, which came forward in the 1992 federal-provincial report on population health, whereas I think Mr. Hollett would argue he is putting well-being in the outer circle, which includes production and other things. I would go back to the World Health Organization definition of health which starts with the words, "the total well-being." I appreciate your question, because there is some real confusion around this issue, and I think that different people do have slightly different definitions.
The Chair: Thank you.
Senators, we will reconvene at one o'clock to hear form the Honourable Shawn Skinner, Minister of Human Resources, Labour and Employment.
The committee adjourned.