An Overview of the Health of Our Population · An Overview of the Health of Our Population Capital...

An Overview of the Health of Our PopulationCapital Health, 2013

Understanding Communities Unit Public Health Services

Lead Author: Holly D’Angelo-Scott, PhD

May 2014

Part 1

C A P I TA L H E A LT H • P O P U L A T I O N H E A L T H S T A T U S R E P O R T

This first population health status report for Public Health Services, Capital Health, would not have been possible withoutthe knowledge, insight, and sharing of numerous partners. We thank the following organizations and individuals who greatly contributed to the development of this report:

P O P U L A T I O N H E A L T H S T A T U S R E P O R T • C A P I TA L H E A LT H

Acknowledgementsi

Capital Health Community Health Board members

Capital Health Library Services

Capital Health Mental Health and Addictions

Capital Health Primary Care

Capital Health Public Health Services

(Current and former staff)

Kimberlee BarroValerie BlairNancy ChapmanCarolyn DohooNicole Druhan-McGinnKeely FraserHolly GillisPaulette HawksworthRita MacAulayAmy MacDonald Sarah MacDonaldSharon MacIntosh

Dalhousie University

Daniel Rainham, PhDMikiko Terashima, PhDSara Kirk, PhD

Halifax Regional Police Department

Bill MooreSean Greenough

Carmen MacKenzieHeather McPeakeSarah MelansonSusan MogaeHeather MonahanShannon O’NeillNadine RomainePatryk SimonMorgane StockerDr. Robin TaylorKristine Webber

Kira AbelsohnMarilyn BarrettKimberlee BarroKaren BeckermannTed Bruce David BuckeridgeConnie ClementsHolly D’Angelo-ScottDoug DoverLesley DyckJoy EdwardsChristopher GreenMargaret Haworth-Brockman

National Collaborating Centres for the Determinants of Health, Learning Circle Members and the Advisory Committee, and the external reviewers of the PopulationHealth Status Report

Ken HoffmanDoug MayHannah MoffattLara MurphyKaren HohenadelFay PikePatricia PlouffeMelissa PotestioRuth SandersonCristina UgoliniDr. Gaynor Watson-Creed


LETTER FROM THE MEDICAL OFFICER OF HEALTH

Welcome to our first population health status report. When we were first asked by the Capital Health Board to begin the work

of describing the health status of our population, we were excited – and a little worried. We knew that describing a populations’

health well – at least well enough to inform policy directions to improve health status – was no easy task. We have been

preceded by our sister cities across Canada – Winnipeg, Saskatoon, Montreal, Toronto, Vancouver – in this work and so have

had the benefit of learning from those organizations around the process of health status reporting. It is with this wisdom and

precedent in mind that we set out to produce our first population health status report.

What you will find in this report is a description of how our health is influenced by where we live. The report is based on the

premise that where we live matters to our health. We have used in this report the Institut national du santé publique du

Quebec (INSPQ) deprivation index to describe our communities and what underlying socioeconomic and material strengths

and limitations they may have that ultimately hold some of us back from being as healthy as the rest of us. It is our hope that

you will find that story in these pages, and that it will provoke you to ask the question “why”? Why are some communities

healthier than others?

This report marks the end of our journey of reporting in some ways, but the beginning in many others. From this technical

report will come a series of much smaller and more digestible knowledge translation products that we hope will spread our

findings further afield and stimulate more community dialogue. And we will take our lessons learned from this – our first

attempt at population health status reporting – and continue on to the production of our next report. We are grateful to our

colleagues at the National Collaborating Centre for Determinants of Health for making this report possible, through the creation

of a Learning Circle of experts that guided our work, and through coaching, collaboration, and encouragement.

And so here it is…our first report. We hope you find enough here to compel you to thumb through it and begin to ask yourself

that “why” question…but in the meantime…

Enjoy the read!

Gaynor Watson-Creed, MSc, MD, CCFP, FRCPC

Medical Officer of Health, Capital District


Welcomei i



Contentsi i i

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .i

Letter from the Medical Officer of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ii

Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii

Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ivTables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

About Health Status Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

About Public Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

1. Analysis of Capital Health as a Whole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62. Calculation of Deprivation for Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73. Determination of Health Outcomes (Obesity, Alcohol Use, and Mental Health) From the CCHS Data . . . . . . . . . .84. Analysis of Independent Individual Variables (Health Behaviours and Risk Factors) . . . . . . . . . . . . . . . . . . . . . .95. Analysis of Additional “Community Factors” (Social Determinants of Health) Contributing to . . . . . . . . . . . . . . .10

Risk Independent Variables and Health Outcomes6. Data Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

1. Selected Demographic Variables: Who is Capital Health? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

1.1 Age Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151.2 Immigration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161.3 Visible Minority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171.4 Aboriginal Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171.5 Dependency Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181.6 Life Expectancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191.7 Population density . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191.8 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

2. Selected Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

2.1 Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222.2 Injury Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .232.3 Suicide and Self-Inflicted Injury Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

C A P I TA L H E A LT H • P O P U L A T I O N H E A L T H S T A T U S R E P O R Ti v

2.4 Infant Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242.5 Birth and Fertility Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252.6 Low Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272.7 Morbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .282.8 Health-Adjusted Life Expectancy at Birth (HALE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292.9 Potential Years of Life Lost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302.10 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

3. Selected Health Outcomes of Interest – Obesity, Alcohol Use, and Mental Health . . . . . . . . . . . . . . . . . . . . . .31

3.1 Deprivation and Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .333.1.1 Material Deprivation in Capital Heath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .363.1.2 Social Deprivation in Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

3.2 Obesity and Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .423.2.1 Deprivation and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .443.2.2 Fruit and Vegetable Consumption and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .473.2.3 Physical Activity and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

3.3 Alcohol and Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .533.3.1 Deprivation and Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

3.4 Mental Health and Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .593.4.1 Deprivation and Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .613.4.2 Other Factors Associated with Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Our Lessons Learned Regarding our First Population Health Status Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89

Appendix A. Summary Tables of Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90

Contents

P O P U L A T I O N H E A L T H S T A T U S R E P O R T • C A P I TA L H E A LT H v

Appendix B: Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99

Appendix C. University and College Institutions in Halifax Peninsula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105

Appendix D. Summary of Demographic Indicators for Capital Health, Community Health Boards and Communities .106

Appendix E. Ranking of Capital Health against Peer Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110

Appendix F. Summary of the Literature for the Health Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114

Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116

Contents

FIGURES

Figure 1 Flow Diagram of the Determination of the Final Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Figure 2 Community Health Boards in Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Figure 3 Population of Capital Health by Sex and Age Group, 2001, 2006, and 2011 . . . . . . . . . . . . . . . . . . . . . .15Figure 4 Proportion of the Population With Asthma, by Sex, Capital Health, NS, and Canada, 2007- 2012 . . . . . . .29Figure 5 Total Deprivation by Communities in Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34Figure 6 Total Deprivation by Dissemination Areas in Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36Figure 7 Material Deprivation by Dissemination Areas in Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38Figure 8 Social Deprivation by Dissemination Areas in Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41Figure 9 Conceptual Diagram for Factors Associated with Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43Figure 10 Percent of Adults with Self-Reported Body Mass Index of Normal or Underweight, Overweight or . . . . . . .43

Obese, by Community Health Board, Aged 18 and Over, Capital Health, 2009/10 (n = 1709)Figure 11 Percent of Adults with Self-Reported Body Mass Index of Normal or Underweight, Overweight or . . . . . . .44

Obese, by Total Deprivation, Aged 18 and Over, Capital Health, 2009/10 (n = 1709)Figure 12 The Odds of Having a Body Mass Index of Overweight or Obese Based on Total Deprivation, . . . . . . . . . .44

Adults Aged 18 and Over, Capital Health, 2009/10 (n = 1720)Figure 13 Percent of Adults with Self-Reported Body Mass Index of Normal or Underweight, Overweight or . . . . . . .45

Obese, by Material Deprivation, Aged 18 and Over, Capital Health, 2009/10, (n = 1707)Figure 14 The Odds of Having a Body Mass Index of Overweight or Obese Based on Material Deprivation, . . . . . . . .46

Adults Aged 18 and Over, Capital Health, 2009/10, (n = 1720)Figure 15 Percent of Adults with Self-Reported Body Mass Index of Normal or Underweight, Overweight or . . . . . . .46

Obese, by Social Deprivation, Aged 18 and Over, Capital Health, 2009/10 (n = 1707)Figure 16 The Odds of Having a Body Mass Index of Overweight or Obese Based on Social Deprivation, . . . . . . . . .47

Adults Aged 18 and Over, Capital Health, 2009/10 (n = 1720)Figure 17 The Odds of Consuming Less Than the Recommended Guidelines for Fruit and Vegetable Consumption .48

Based on Total Deprivation Among Adults Aged 18 and Over, Capital Health, 2009/10 (n = 1737) Figure 18 Density of Fast Food Locations and Grocery Store Locations Per 100,000 Population by Community . . . .49Figure 19 The Odds of Being Physically Inactive Based on Total Deprivation Among Adults Aged 18 and . . . . . . . . .51

Over, Capital Health, 2009/10 (n = 1814)


Contentsvi

Figure 20 The Odds of Being Physically Inactive Based on Material and Social Deprivation Among Adults . . . . . . . . .51Aged 18 and Over, Capital Health, 2009/10 (n = 1814)

Figure 21 Parks, Park Features and Trails in Halifax Regional Municipality (Excludes West Hants) . . . . . . . . . . . . . .52Figure 22 Conceptual Diagram for Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54Figure 23 Percent of Adults Who Reported Having 5 or More Drinks on One Occasion at Least Once a Month . . . . .55

by Community Health Board, Aged 15 and Over, Capital Health, 2009/10 (n = 1238)Figure 24 Percent of Adults with Self-Reported Drinking by Total Deprivation, Aged 15 and Over, . . . . . . . . . . . . . .55

Capital Health, 2009/10 (n = 794)Figure 25 The Odds of Heavy Drinking Based on Total Deprivation, Persons Aged 15 and Over, . . . . . . . . . . . . . . . .56

Capital Health, 2009/10 (n = 794)Figure 26 Percent of Adults with Self-Reported Drinking by Material Deprivation, Aged 15 and Over, . . . . . . . . . . . .56

Capital Health, 2009/10 (n = 794)Figure 27 The Odds of Heavy Drinking Based on Material Deprivation, Persons Aged 15 and Over, . . . . . . . . . . . . .57

Capital Health, 2009/10 (n = 794)Figure 28 Number of Establishments for Alcohol Purchase by Community Health Board . . . . . . . . . . . . . . . . . . . . .58Figure 29 Liquor Stores and Agencies by Deprivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58Figure 30 Conceptual Diagram for Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60Figure 31 Self-Rated Mental Health by Community Health Board, Capital Health, CCHS 2009/10 . . . . . . . . . . . . . .61Figure 32 The Odds of Reporting Negative Mental Health Based on Total Deprivation Among Adults . . . . . . . . . . . . .62

Aged 15 and Over, Capital Health, 2009/10Figure 33 The Odds of Reporting Negative Mental Health Based on Material Deprivation Among Adults Aged 15 . . .63

and Over, Capital Health, 2009/10Figure 34 The Odds of Reporting Negative Mental Health Based on Social Deprivation Among Adults . . . . . . . . . . . .64

Aged 15 and Over, Capital Health, 2009/10 (n = 1503)Figure 35 The Odds of Reporting a Weak Sense of Belonging Based on Material and Social Deprivation, . . . . . . . . .65

Adults Aged 15 and over, Capital Health, 2009/10Figure 36 Trend in Selected Crime Categories in Capital Health (Excluding West Hants), 2008 to 2012 . . . . . . . . . .67Figure 37 Density of Selected Crimes per 1,000 Population in Capital Health (Excluding West Hants), 2008-2012 . .68

TABLES

Table 1 Health Units in Peer Groups A by Province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Table 2 Categories of Crimes, Capital Health, 2008 to 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Table 3 Proportion of Immigrants by Geography and Age Group, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Table 4 Proportion of Indiviudals of a Visible Minority, By Geography and Sex, 2011 . . . . . . . . . . . . . . . . . . . . . .17Table 5 Number Rate (per 1,000 Persons), and Percent of People Idetifying with at Least One . . . . . . . . . . . . . . .18

Aboriginal Group, by Community Health BoardTable 6 Changes in Population Density of Community Health Boards over Time, Capital Health . . . . . . . . . . . . . .19Table 7 Selected Variables Describing Capital Health and the CHBs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Table 8 Mortality Data (Deaths per 100,000 Population) for Capital Health, NS, and Canada, by Sex (2005/2007) .23Table 9 Unintentional Injury Mortality (per 100,000 Population), by Sex, 2005/2007 . . . . . . . . . . . . . . . . . . . . . .24Table 10 Suicide and Self-inflicted Injury Mortality (per 100,000 Population), by Sex, 2005/2007 . . . . . . . . . . . . .24Table 11 Infant Mortality Rate (per 1,000 Live Births), CHB, Capital Health, Nova Scotia, and Canada . . . . . . . . . . .25Table 12 Age-specific Fertlity Rates, Nova Scotia and Canada, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Table 13 Age-specific Fertlity Rate and Crude Birth Rate, Capital Health and CHBs, 2011 . . . . . . . . . . . . . . . . . . .26


Contents / Abbrviationsvi i

Table 14 Proportion of all Live Births where the Birth Weight was Less than 2,500 Grams, . . . . . . . . . . . . . . . . . .27Community Health Board, 2011

Table 15 Proportion of all Live Births Where the Birth Weight was Less Than 2,500 Grams, by Sex, . . . . . . . . . . . .27Capital Health, Nova Scotia, and Canada, 2005/2007

Table 16 Proportion of the Population Reporting High Blood Pressure, by Sex, Capital Health, Nova Scotia, . . . . . . .28and Canada, 2009/10

Table 17 Proportion of the Population who Reported having Diabetes, Cancer, or Heart Disease, . . . . . . . . . . . . . .28by Sex, Capital Health, Nova Scotia, and Canada, 2009/10

Table 18 Rates of PYLL (per 100,000 Population), by Sex, Capital Health, Nova Scotia, and Canada, 2005/2007 . .30Table 19 Summary of Age Group and Sex for the Sample Population, Capital Health (n = 1896) . . . . . . . . . . . . . .31Table 20 Summary of the Deprivation Index Scores of Dissemination Areas by Deprivation Category, . . . . . . . . . . .32

Capital Health (n = 1896)Table 21 Variance Between Participants with Complete and Incomplete Postal Codes . . . . . . . . . . . . . . . . . . . . . .32Table 22 Total, Material and Social Deprivation Categories for Communities, Capital Health . . . . . . . . . . . . . . . . . .35Table 23 Proportion of the Poulation, Aged 20 Years and Over, with No Certificate, Diploma or Degree, . . . . . . . . . .37

Including High School Certificate or Equivalent, by Community Health Board and Capital Health, 2006Table 24 Average and Median Incomes for the Capital Health Population, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . .37Table 25 Number and Percent of Persons in Private Households Living Alone, by CHB, 2006 . . . . . . . . . . . . . . . . .39Table 26 Number and Percent of Lone-Parent Families, by CHB, 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40Table 27 Number and Percent of Population Aged 15 Years and Over who are Separated, Widowed . . . . . . . . . . . .40

or Divorced, by CHB, 2006Table 28 Density of Grocery Locations and Fast Food Locations per 100,000 Population by Community . . . . . . . . .48Table 29 Liquor Store Density per 100,000 Population and Sales per Person, by Community Health . . . . . . . . . . .59

Board, 2006 - 2011Table 30 Self-Rated Mental Health Among Adults Aged 15 and Over, by Total Deprivation, Capital Health, . . . . . . . .61

2009/10Table 31 Self-Rated Mental Health Among Adults Aged 15 Years and Over, by Material . . . . . . . . . . . . . . . . . . . . .61

Deprivation, 2009/10Table 32 Self-Rated Mental Health Among Adults Aged 15 Years and Over, by Social Deprivation, . . . . . . . . . . . . .63

2009/10Table 33 Perception of the Severity of Community Issues, Capital Health, 2009/10 . . . . . . . . . . . . . . . . . . . . . . . .66

ABBREVIATIONS

BMI Body Mass Index

CCHS Canadian Community Health Survey

CHB Community Health Board

CI Confidence Interval

DA Dissemination Area

OR Odds Ratio

p-value Probability Value

UCU Understanding Communities Unit


This population health status report is based on a single premise: the premise that geography matters, i.e. where we live,work, and play influences our physical, mental and emotional health. In fact, both space and place are important health determinants. Space can be defined as the physical location and physical features, both built and natural, of an environment.Place refers to the political, social, cultural and historical meanings attached to a location (University of Victoria, 2012). Healthdeterminants vary across both space and place.

With that in mind, then, the report has sought to test two important hypotheses:

1) That variations in health outcomes can be seen between different geographic units (dissemination areas, communities, and Community Health Boards) within the overall Capital Health boundary, and;

2) That these variations can be explained, at least in part, by underlying variations in the social determinants of health in those same geographic units.

This population health status report is a cross-sectional study using secondary data retrieved primarily from the oversampleof the Canadian Community Health Survey (CCHS) that was conducted for Capital Health in 2009/2010. The report includesan overall description of health outcome and risk factor trends for Capital Health as a district and for individual Capital Healthcommunities, as well as a more in depth analysis of three major health issues: obesity, alcohol use, and mental health. Additional units of geographic analysis used in this report include dissemination area, community, and Community HealthBoard (CHB).

Geography and deprivation were shown in the report to relate to health outcomes in the following ways:

• Variations in several demographic and health outcomes were seen across community health boards, communities,and deprivation areas (Tables 3-7, 11, 13, 14; Appendix D).

• Capital Health was demonstrated to have communities experiencing the full range of deprivation (Tables 22, 23, 25, 27).

• With increasing total and material deprivation, there was an associated increase in being overweight or obese (Section 3.2).

• Heavy drinking was more likely among individuals residing in areas with higher total and material deprivation (Section 3.3).

• Significant variations in mental health status with deprivation were not found in this report (Section 3.4).

Further work is needed to determine if additional subregional (dissemination area or community level) variations in outcomes(and health risk factors or community conditions) exist, particularly for denser parts of the district. Elucidation of measuressuch as mortality rates, life expectancy, and quality adjusted measures of health status (PYLL, HALE) at the community levelshould be considered for future reports.


Executive Summaryv i i i


ABOUT HEALTH STATUS REPORTING

Knowledge that can be gained from attempts to understand the health status of a population can contribute to the developmentof effective public policies that a community’s health needs and that reduce health disparities 1. Population health status reporting attempts to use the best available sources of routinely collected data, health indicators and local knowledge to describe the health of a population.

This population health status report is based on a single premise: the premise that geography matters, i.e. where we live,work, and play influences our physical, mental and emotional health. In fact, both space and place are important health determinants. Space can be defined as the physical location and physical features, both built and natural, of an environment.Place refers to the political, social, cultural and historical meanings attached to a location (University of Victoria, 2012). Healthdeterminants vary across both space and place. With that in mind, then, the report has sought to test two important hypotheses:

1) That variations in health outcomes can be seen between different geographic units (dissemination areas, communities, and Community Health Boards) within the overall Capital Health District boundary, and

2) That these variations can be explained, at least in part, by underlying variations in the social determinants of health in those same geographic units.

The contribution of social determinants of health to health outcomes is already well described in the literature. In particular,economic and social factors have been shown to influence health outcomes significantly. Economic factors such as income,employment, and education, may result in food insecurity, inadequate housing, unsafe transportation routes (both active andmotorized), neighborhood instability, and increased financial and life stress (Public Health Agency of Canada [PHAC], 2008).Social factors such as social connectedness and social support also influence long-term physical and mental health. This influence is partly experienced as the ways in which social and economic environments impact and contribute to individualbehaviours such as smoking, physical activity, healthy eating and alcohol consumption (PHAC, 2008).

The Capital Health Population Health Status Report (PHSR) presents health disparities within the geography of CapitalHealth, and applies research, surveillance, and other local data to the purpose of examining why such disparities might exist.Health disparities are differences in health status among distinct segments of the population that may or may not be healthinequities (Pan-American Health Organization, 1999). Health inequities are differences in health status among groups thatare considered unfair, unjust, or preventable as well as socially produced and systematic in their distribution across the population (Commission on Social Determinants of Health, 2008). We hope that the information presented in this report willspur much needed discussion regarding where health disparities come from, and why. This population health status reportis the first of its kind in Capital Health. It reflects our commitment to the core functions of public health, including the functionsof surveillance and population health assessment, and to the purpose statement for the Nova Scotia public health system(Nova Scotia Public Health, 2010).


Introduction1

1 Definitions for italicized terms can be found in Appendix B.

C A P I TA L H E A LT H • P O P U L A T I O N H E A L T H S T A T U S R E P O R T2

ABOUT PUBLIC HEALTH SERVICES

Public Health Services (PHS) is a team of approximately 120 health professionals charged with monitoring the health ofthe population overall, mitigating disease trends, and reducing health disparities, and ultimately health inequities, by workingwith partners to create the conditions for good health within communities. As such, much of Public Health’s work occurs well outside of the formal health care system, as the large systemic social determinants of health are found in other sectors(education, justice, finance, community services, etc.).

Public Health does this work as part of a provincial public health system, and the work is reflected in the provincial purposestatement for public health:

“Public Health works to understand the health of our communities, and acts with others to improve health.” (2011)

The five core functions of public health, as outlined by the 2003 Naylor report (post SARS, The National Advisory Committeeon SARS and Public Health, 2003) are reflected in the work of public health services in Capital Health today: population healthassessment, surveillance, health promotion, prevention, and health protection/emergency preparedness. Public Health’steams reflect these core functions and the provincial purpose statement in their orientation.


Introduction (Cont’d)

3


This population health status report is a cross-sectional study using secondary data retrieved primarily from the oversampleof the Canadian Community Health Survey (CCHS) that was conducted for Capital Health in 2009/2010. The report includesan overall description of health outcome and risk factor trends for Capital Health as a district and for individual Capital Healthcommunities, as well as a more in depth analysis of three major health issues: obesity, alcohol use, and mental health. Additional units of geographic analysis used in this report include dissemination area, community, and Community HealthBoard (CHB).


Methodology5

1 ANALYSIS OF CDHA AS A WHOLE

The 2009/10 CCHS data used for this population health status report provided the most complete and current data set whichcaptures the variables of interest. The total sample size used for this analysis was 2819, with equal representation of allseven CHBs.

Health risk factor data for Capital Health and for the CHBs was obtained from Community Counts (Government of Nova Scotia,2013). For variables of interest that were not available from Community Counts, Statistics Canada was used as the sourceof data. For the purpose of comparing the Capital Health population to other similar populations, information for CapitalHealth’s peer group was obtained from Statistics Canada (2013). A Peer Group is composed of health regions with similarcharacteristics, determined by Statistics Canada through the comparison of 24 sociodemographic variables and geographicfactors. Peer Group A includes Capital Health and 34 other health districts throughout Canada (refer to Table 1).


Methodology6

Health Units in Peer Group A by ProvinceTable 1

Province Health Units

Alberta South Zone

British Columbia Central Vancouver Island Health Service Delivery AreaFraser East Health Service Delivery AreaNorth Vancouver Island Health Service Delivery AreaOkanagan Health Service Delivery AreaSouth Vancouver Island Health Service Delivery AreaThompson/Cariboo Health Service Delivery Area

Manitoba Brandon Regional Health AuthorityWinnipeg Regional Health Authority

Nova Scotia Capital Health

Ontario Brant County Health UnitCity of Hamilton Health UnitEastern Ontario Health UnitElgin – St. Thomas Health UnitHaldimand – Norfolk Health UnitHaliburton, Kawartha, Pine Ridge District Health UnitHastings and Prince Edward Counties Health UnitKingston, Frontenac and Lennox and Addington Health UnitLambton Health UnitLeeds, Grenville and Lanark District Health UnitMiddlesex-London Health UnitNiagara Regional Area Health UnitOxford County Health UnitPeterborough County – City Health UnitWindsor-Essex County Health Unit

Prince Edward Island Prince Edward Island

2 CALCULATION OF DEPRIVATION FOR CAPITAL HEALTH

Capital Health is the largest health district in Nova Scotiaserving a population of approximately 400,000 people. Thedistrict is divided into seven CHBs which represent 65 communities and 1896 dissemination areas (DA). The DAcomprises one or more neighbouring blocks of homes representing a population of 400 to 700 persons. DAs in aregion can be amalgamated to describe a more completecommunity or neighborhood when necessary. In order tomeasure the degree to which social and material factorsthat could affect health might differ between disseminationareas, and so between communities, the Institut national du santé publique du Quebec (INSPQ) deprivation index(Pampalon & Raymond, 2000) for dissemination area wasapplied to the CCHS sample described above.


Methodology7

Province Health Units

Quebec Région de l’EstrieRégion de l’OutaouaisRégion de la Capital-NationaleRégion de la MontérégieRégion de LanaudièreRégion de LavalRégion des Laurentides

Saskatchewan Regina Qu’Appelle Regional Health AuthoritySaskatoon Regional Health Authority

Deprivation by Dissemination Area and Community

A deprivation index is a proxy measure of the health status of a population based on the aggregation of a number of variablesrepresenting the determinants of health. The index is intended for the surveillance of social inequalities in health (Gamache,Pampalon, & Hamel, 2010). The INSPQ tool measures total deprivation by describing its two distinct components: materialand social deprivation. Material deprivation is determined from three factors: 1) the proportion of persons without a highschool degree; 2) the ratio of employment to population; and 3) average personal income. Social deprivation is determinedfrom an additional three factors: 1) the proportion of persons living alone; 2) the proportion of single-parent families; and 3) the proportion of persons who are widowed, separated or divorced. Scores are generated for each of the six factors, andthen aggregated to define social, material, and total deprivation for a given geographical region. The deprivation scores (total,material, and social) for each DA were provided by the Canadian Institute of Health Information (CIHI, n.d.), and sorted inquintiles. The quintiles themselves were ordered to represent a range of lowest deprivation (1) to highest deprivation (5). Forthe purposes of this report, we were able to assign each individual in the CCHS sample to a DA, using the complete six character postal code of each included participant using ArcGIS 10.1. We were then able to assign a deprivation score (total,material, and social) to each included participant.

3 DETERMINATION OF HEALTH OUTCOMES (OBESITY, ALCOHOL USE, AND MENTAL HEALTH) FROM THE CCHS DATA


Methodology8

Flow Diagram of the Determination of the Final SampleFigure 1

Total sample of CCHS participantsN = 2819 (100%)

CCHS participants not in Capital Health orcould not be geocoded (n = 60, 2.13%)

CCHS participants with incompletepostal codes (n = 863, 30.6%)

CCHS participantsn = 2759 (97.9%)

Final sample of CCHS participantsn = 1896 (67.3%)

Deprivation by community was calculated using data provided by Dr. M. Terashima, Dalhousie University. Using the INSPQindex factors, Terashima (2011) determined the scores for material and social deprivation for all communities within NovaScotia. The scores for communities within Capital Health were extracted and sorted into quintiles which were ordered to represent a range of lowest deprivation (1) to highest deprivation (5) for material, social and total deprivation. Data for the sixfactors comprising material and social deprivation was 2006 census data. Community boundaries were defined by NovaScotia Community Counts (Government of Nova Scotia, 2013).

The inclusion of the deprivation index as a variable for analysis required the exclusion of participants with incomplete postalcodes (n = 863) and those who did not reside in Capital Health or could not be geocoded (n = 60). The final sample for theexploration of the association between the three main topics and the deprivation index was 1896 (refer to Figure 1).

Obesity was derived from calculated Body Mass Index (BMI),based on self-reported weight and height, with underweightbeing a BMI of under 18 kg/m2, normal being a BMI of 18-24.9 kg/m2, overweight being a BMI or 25 – 29.9 kg/m2,and obese being a BMI of 30 kg/m2 and over. For the purposes of this report, the categories of BMI were dichotomized into underweight/normal and overweight/obese. Individuals who were younger than 18 years were excluded from the dataset as the BMI categories are not appropriate for this age group. The final sample for the analysis of this outcome was 1707 with a BMI category notavailable for 92 survey participants aged 18 years or older.There were 607 (35.5%) participants with a BMI category ofnormal/underweight and 1101 (64.4%) participants with aBMI category of overweight/obese (661 (38.7%) with a BMIcategory of overweight and 440 (25.7%) with a BMI categoryof obese). The BMI categories of normal and underweightwere combined due to the small number of survey participantswith a BMI of underweight (n = 21).

4 ANALYSIS OF INDEPENDENT INDIVIDUAL VARIABLES (HEALTH BEHAVIOURSAND RISK FACTORS)


Methodology9

A number of individual variables which could impact the health outcomes were considered in the population health report,including age, sex, self-reported physical health, sense of belonging, smoking, self-reported oral health, fruit and vegetableconsumption, stress in daily life, stress at work, and physical activity. Fruit and vegetable data was drawn the CCHS (2009/10)and categorized as either meeting or above the recommended guidelines or below the recommended guidelines. Throughconsultation with Understanding Communities Unit (UCU) team members and partners, several other possible independentvariables were identified. A literature review was done to explore the association between each of the identified possible independent indicators, the three health outcomes and the deprivation index.

Using a backwards progression from the health outcomes to the predictor variable, the deprivation index, the literature reviewwas organized to first highlight the connection between deprivation (total, material, and social) and the health outcome variables. To gather information on the health outcomes, general searches for “obesity”; “overweight”; “excessive alcoholuse”; “heavy drinking”; binge drinking”; “mental health”; “life satisfaction”; and “mood disorders” were conducted usingonline electronic databases, specifically www.google.ca, and multiple resources, such as the Journal of American MedicineAssociation, Academic SearchTM, Medline, PubMed Central, and CINAHL Plus as well as the Cochrane Library. A search forprimary articles and systematic reviews published from 2004 to July 2013 was conducted. Combinations of the search termsfor outcomes and deprivation including “deprivation”; “total deprivation”; “material deprivation”; “social deprivation”;

Alcohol use was based on the responses to the question:“How often in the past 12 months have you had 5 or moredrinks on one occasion?” The responses were dichoto-mised into heavy drinking (5 or more drinks on at least oneoccasion once a month or more) and no heavy drinking (5or more drinks on one occasion less than once a month).Participants who never drank alcohol (n = 698) and who responded with don’t know or refused to respond (n = 7)were excluded from the sample. There were 380 partici-pants who had missing information on this survey question.The final sample of 811 survey participants was composedof 398 (49.1%) participants with no heavy drinking and 413(50.9%) survey participants with heavy drinking.

Mental health was derived from one CCHS question pertaining to self-rated mental health: “In general, would you say yourmental health is: excellent, very good, good, fair or poor?”, and dichotomized into positive (excellent, very good, or good)mental health and negative (fair or poor) mental health. The final sample for this indicator was 1894 survey participants with1785 (94.1%) participants reporting positive mental health and 109 (5.8%) reporting negative mental health. There were 2missing responses.

In addition to self-rated mental health, two other variables which have been used to describe mental health, namely self-reported mood disorders and life satisfaction, were explored. Both variables were derived from the applicable CCHS questions.For self-reported mood disorders, the sample size was 1889 with 184 (9.7%) reporting that they had a mood disorder and1706 (90.0%) reporting they did not have a mood disorder. For life satisfaction, the final sample was 1889 participants with1710 (90.2%) reporting being satisfied with life and 180 (9.5%) being neither or unsatisfied with life. The analyses findingsfor mood disorders and life satisfaction have been included in Appendix A; however, discussion of mental health was limitedto self-reported negative mental health.

5 ANALYSIS OF ADDITIONAL “COMMUNITY FACTORS” (SOCIAL DETERMINANTSOF HEALTH) CONTRIBUTING TO RISK INDEPENDENT VARIABLES AND HEALTH OUTCOMES

“socioeconomic status”; “single parent family”; “income”; “education”; “employment”; “living alone”; “separated”; “divorced”;and “widowed” were used to gather literature on the association between deprivation and the health outcomes.

A search was then conducted for primary articles and systematic reviews, using the aforementioned databases, to gather information on the connection between the health outcomes and the independent individual factors. For this search,combinations of the search terms for the outcomes and the independent individual factors including “age”; “sex”; “life satisfaction”; “substance use”; “oral health”; “fruit and vegetable consumption”; “stress”; “smoking”; “tobacco”; “physicalactivity”; “food security”; and “food insecurity” were used. Finally, the search terms for the independent individual factorswere combined with the deprivation search terms to gather information on the association between deprivation and the independent individual factors. In total, the search strategy resulted in the retrieval of 233 articles of which 152 articles wereconsidered appropriate for the population health status report (note the number of articles include those associated withcommunity factors).


Methodology10

Through consultation with Understanding Communities Unit (UCU) team members and partners, community factors, representing the social determinants of health that could be influencing individual independent variables and health outcomes,were identified. Evidence for the association between the community factors and each of the outcomes was provided througha review of literature and the inclusion of the community factor was contingent on the availability of data.

Using the same methodology as noted in the previous section, a search for primary articles and systematic reviews published from 2004 to July 2013 was conducted.Combinations of the search terms for the health outcomesand community factors including “crime”; “crime density”;“crime rates”; “liquor store density”; “recreation areas”;“park”; “trails”; “park features”; “fast food density”; “builtenvironment”; “sense of belonging”; “social support”; “socialconnectedness”; “belonging”; and “grocery store density”were used to gather literature on the association betweencommunity factors and the health outcomes.

For the health outcome of obesity, the community factors that were considered included the distribution of grocery stores,fast food sites, parks and park features, and trails. The data was provided by a number of sources with the grocery storesand fast food locations provided by Dr. S. Kirk, Dalhousie University, and the parks and park features and trails provided byHalifax Open Data. For this population health status report, grocery stores included locations where groceries could beobtained including grocery store chains, markets, specialty food stores, and bakeries (n = 217). Fast food sites included fastfood chains (n = 228), independent fast food retailers (n = 274), and locations where snacks could be purchased (n = 442).Restaurants were also considered when exploring the health outcomes of obesity (n = 377).

For the health outcome of alcohol use, the community factors examined were Nova Scotia Liquor Corporation (NSLC) locationsincluding agencies and specialty stores (n = 51) that were present during the period of 2006 to 2011. It is important to notethat two of the NSLC locations ceased operation in 2009 while four locations opened in 2011. The postal codes for each ofthe included locations were retrieved from the NSLC website, geocoded, and mapped using ArcGIS 10.1. Breweries and

6 DATA ANALYSES

‘make your own’ locations as well as licensed restaurants were not included in this population health status report. The information for liquor sales was also retrieved from the NLSC website for the period of 2006 to 2011.


Methodology11

Community factors for the outcome of mental health considered statistics for a number of crimes, including assaults, break and enters, and thefts from, or of, a vehicle.The data was provided by the Halifax Regional Police for the period of 2008 to 2012 (Halifax Regional Police, 2013).Data for West Hants were not available. After removing 518 crimes which were not reported in 2008 to 2012, thedata were separated by year and by category (refer to Table2). Geocoding of the locations of the crimes allowed for thelinking of crimes to dissemination areas and communitiesusing ArcGIS 10.1.

Categories of Crimes, Capital Health, 2008 to 2012Table 2

Category Crimes Included in Category

Homicide Homicide, manslaughter, and attempted homicide

Assaults Assaults

Arson Arson

Break and Enter Break and enter (home/business/other)

Theft over$5000 Theft over $5000

Theft under $5000 Theft under $5000

Possession of stolen goods Possession and trafficking of stolen goods

Fraud Fraud and identity theft

Mischief Mischief including hate crime, graffiti, and property damage

Drugs Drug possession, trafficking, production and import

Youth Complaint Youth complaint and crime data

Impaired Vehicle Impaired operation (alcohol and drugs) of motor vehicle and boat

Traffic Offences Traffic offences

For all health outcomes, the association between total, material and social deprivation, and health outcome was measuredusing logistic regression. The association between individual variables and health outcome, and individual variables and total, material, and social deprivation was also measured using logistic regression. The results of the regression analyses arepresented as odds ratios with 95% confidence intervals. Associations were considered to be significant if the level of significance, or p-value, was ≤ .05. Analyses were carried out using SPSS (version 21.0), while mapping of community factorsand deprivation by dissemination area and community was done using ArcGIS 10.1.

Minimal analyses of the CHB level data were done: however, a two-sample test of proportions using Stata was conducted todetermine whether the proportion of low birth weight births between CHBs was significantly different compared to the proportion in Dartmouth. Limited analyses of Capital Health level data were conducted for this population health status report.



Results13

1 SELECTED DEMOGRAPHIC VARIABLES: WHO IS CAPITAL HEALTH?

Capital Health is the largest health district in Nova Scotia, with a population of over 412,000 in 2011, representing 44% ofthe provincial population. The 6,883 square kilometer territory covered by Capital Health is separated into seven CommunityHealth Boards (CHBs) (Figure 2). Generally speaking, the Halifax Peninsula and Dartmouth CHBs are considered to be hometo Capital Health’s urban population, and represent 34.5% proportion of the population, while Eastern Shore Musquodoboitand West Hants are more rural in nature (11.3% of the population). The remaining CHBs constitute largely suburban populations. In accordance with Statistics Canada (2012b), urban areas are those with a population density greater than 400persons per km2 while rural areas are those with a population density of less than 400 persons per km2 (Statistics Canada,2012b). While there are numerous approaches to differentiate between urban and suburban populations, for this report,suburban is defined as peripheral communities some distance from the centre core (Turcotte, 2008). Suburban areas do nothave a specific population density but are generally residential districts typically surrounding a city.


Results14

• Capital Health region population: 412,000 (2011) representing 44% of the provincial population

• Population density: 59.9 persons per km2 (2011)

• Median age: 40 years (2011)

• Largest proportion of population in 2011: Individuals aged 45 to 49 years

• Population under the age of 20 years: 21.4% (2011)

• Population over the age of 65 years: 13.3% (2011)

• Life expectancy at birth: 80.1 years (2007/2009)

• Life expectancy at 65 years: 19.4 years (2007/2009)

Community Health Boards in Capital HealthFigure 2

Community Health Boards

H D’Agelo-Scott, PhD, ROH UCU, Public Health, Capital Health ArcGIS 10.2

September 22, 2013

1.1 AGE DISTRIBUTION

Variables of interest in describing the overall population of Capital Health have been summarized in Table 7. A few selectedvariables describing Capital Health and the CHBs are presented in the following paragraphs. Additional variables for CapitalHealth, CHBs and communities within each CHB as well as comparison of CCapital Health to health units in the same PeerGroup can be found in Appendices D and E.

The population under the age of 20 years in Capital Health was 21.5% in 2011; this percentage is similar to that for all ofNova Scotia. The distribution of the population within the Halifax Peninsula is unusual when compared to the other CHBs;this CHB is home to the largest proportion of citizens aged 20 to 29 years. This is likely a result of the high density of universityand college institutions (refer to Appendix C) located in this particular CHB as compared to the others.


Results15

The 2011 population in Capital Health had a median age ofapproximately 40 years, which was about 3 years youngerthan the median age (43.1 years) for all of Nova Scotia andwas similar to that of the entire Canadian population (39.9years). When looking at the age distribution (see Figure 3), the largest proportion of the population in 2011 is represented by individuals aged 45 to 49 years, followed by individuals aged 50 to 54 years and 20 to 24 years. A comparison of the 2011 population distribution to the 2001 and 2006 population distributions indicates that the Capital Health population is increasing in age.

Population of Capital Health by Sex and Age Group, 2001, 2006, and 2011Figure 3

Note. Data from Statistics Canada (2013b).

Age (yea

rs)

Population Count (n)

20000 15000 10000 5000 0 5000 15000 2000010000

85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-14

5-90-4

2006 2001

1.2 IMMIGRATION

Persons aged 65 and older represented 13.3% of the total Capital Health population in 2011. Compared to the rest of NovaScotia and Canada, the percentage of the Capital Health population aged 65 years and older is lower. However, the distributionis not uniform across Capital Health; higher proportions of people aged 65 years and older reside in Dartmouth, EasternShore – Musquodoboit and West Hants than in the other CHBs.

Overall, the percentage of females in the Capital Health population is higher than that of males (51.6% vs. 48.4%). However,the distribution of males and females across the age groups is different. There are more males than females at ages below25 years and more females than males at ages from 25 and older.

The people of Capital Health are diverse with immigrantsrepresenting approximately 7.9% of the population in 2011 (refer to Table 3). The highest proportions of the immigrant population live in Chebucto West and HalifaxPeninsula. The rural CHBs are those in which we see the smallest proportions of immigrants (Eastern Shore-Musquodoboit and West Hants). When compared to the immigrant population in Nova Scotia, Capital Health has ahigher proportion of immigrants. The distribution of the ageof the immigrant population in the CHBs and Capital Healthis reflective of that within Nova Scotia and Canada.


Results16

Proportion of Immigrants by Geography and Age Group, 2011Table 3

Chebucto West 10.7 0.7 1.3 1.4 4.3 0.5

Cobequid 6.0 0.3 0.7 0.6 2.0 0.2

Dartmouth 5.9 0.5 0.5 0.6 1.8 0.1

Eastern Shore – Musquodoboit 2.5 0.1 0.0 0.3 0.5 0.0

Halifax Peninsula 11.9 0.4 0.9 1.3 4.3 0.2

Southeastern Dartmouth 4.1 0.2 0.1 0.2 0.8 0.0

West Hants 2.8 0.3 0.5 0.6 1.0 0.1

Capital Health 7.9 1.1 1.5 1.6 3.1 0.5

NS 5.3 0.8 1.0 1.1 2.0 0.4

Canada 20.6 2.0 3.6 4.7 8.4 1.9

ImmigrantPopulation

45 years and over0 to 4 Years 5 to 14 Years 15 to 24 Years 25 to 44 Years

(%) (%) (%) (%) (%) (%)

Note. Data from Government of Nova Scotia (2013) and is based on the National Household Survey (Statistics Canada, 2013b.) The highest and lowest proportionsamong the CHBs are bolded.

1.3 VISIBLE MINORITY

1.4 ABORIGINAL POPULATION

Within Capital Health, the proportion of people who belong to a visible minority was 8.8% for both males and females, with9.2% of the visible minority population being male and 8.3% being female. Comparatively, in NS the proportion was lower at5.2% for both males and females, but higher nationally at 19.1% for males and females. When looking at the CommunityHealth Boards, the proportion of people who belong to a visible minority ranged from 1.5% in Eastern Shore – Musquodoboitto 15.1% in Halifax Peninsula. This same variance was seen for both males and females (refer to Table 4).

According to the 2011 National Household Survey, therewere 33,850 people in NS who identified as Aboriginal. This represents 3.7% of the total provincial population (Government of Nova Scotia, 2013). The proportion of thepopulation who identified as Aboriginal in Capital Health(n=10,073, 2.5%) was lower than the provincial estimate.Both the province and district were lower than the nationalestimate (n=1,400,685; 4.3%).

When comparing the CHBs (refer to Table 5), it can be seenthat the proportion of Aboriginal population is greatest inEastern Shore - Musquodoboit (n = 630, 2.6%) and lowestin Halifax Peninsula (n = 845, 1.2%).


Results17

Proportion of Individuals of a Visible Minority, by Geography and Sex, 2011Table 4

Note. Data from Government of Nova Scotia (2013) and is based on the National Household Survey (Statistics Canada, 2013b). The highest and lowest proportionsamong the CHBs are bolded.

Chebucto West 9.9 9.8 9.0

Cobequid 4.8 4.1 4.1

Dartmouth 8.1 7.0 6.6

Eastern Shore – Musquodoboit 1.5 0.8 0.9

Halifax Peninsula 15.1 14.8 12.3

Southeastern Dartmouth 8.3 7.5 7.3

West Hants 2.5 2.5 2.3

Capital Health 8.8 9.2 8.3

NS 5.2 5.5 5.0

Canada 19.1 18.8 19.3

Visable Minority Male Female

(%) (%) (%)

1.5 DEPENDENCY RATIO

The dependency ratio is the number of dependents (childrenand youth aged 0 to 19 years and seniors aged 65 yearsand above) relative to the working age population (adultsaged 20 to 64 years). The ratio is usually presented as thenumber of dependents for every 100 people in the workingage population (Association of Public Health Epidemiologistof Ontario, 2012). The importance of the dependency ratiois that it indicates the pressure on the productive portionof our population, or those who are of working age. It is theorized that the higher the dependency ratio the morepressure there will be on social supports such as healthcare, social security and education.


Results18

Number Rate (per 1,000 Persons), and Percent of People Identifying with at Least One Aboriginal Group.

Table 5

Note. Data from Government of Nova Scotia (2013) and is based on Statistics Canada (2013a). The highest and lowest proportions among the CHBs are bolded.

Chebucto West 1195 13.4 1.3

Cobequid 1,696 19.3 1.9

Dartmouth 1,526 22.7 2.3

Eastern Shore-Musquodoboit 630 25.7 2.6

Halifax Peninsula 845 11.7 1.2

Southeastern Dartmouth 918 21.1 2.1

Hants West 432 20.0 2.0

Capital Health 10073 24.8 2.5

NS 33850 37.4 3.7

Canada 1,400,685 42.6 4.3

Number Rate (per 1,000 persons) Percent of Population (%)

The number of dependents per 100 people aged 20 to 64 years ranged from 54.4 to 66.7 in all CHBs with the exception ofHalifax Peninsula. At 38.8, the total dependency ratio is much lower in this Community Health Board, as there are a higherproportion of people aged 20 to 34 years living in Halifax Peninsula. This higher proportion of younger (and likely independent)people reduces the dependency ratio. In Capital Health overall, there are approximately 51 dependent persons relative to100 persons aged 20 to 64 years. Comparatively, this is lower than the dependency ratios for the entire province of NS (dependency ratio = 59.6) or nationally for Canada (dependency ratio = 59.1), based on 2011 population estimates (Government of Nova Scotia, 2013; Statistics Canada, 2013f).

1.6 LIFE EXPECTANCY

Life expectancy at birth is the number of years a personwould be expected to live, starting from birth, if trends in mortality remain unchanged. In 2007/2009, the life expectancy at birth for Capital Health was 80.6 years (Statistics Canada, 2012f). This is similar to the life expectancy at birth for Nova Scotia and 0.5 years lower thanthe estimate for Canada. Life expectancy at 65 years is thenumber of years a person would be expected to live, startingage 65 if trends in mortality remain unchanged. The life expectancy in Capital Health at 65 years in 2007/2009 was19.4 years, which is similar to Nova Scotia and 0.8 yearslower than the estimate for Canada (Statistics Canada, 2012f).Data for life expectancy was not available by CHB or communityat the time of this report.

1.7 POPULATION DENSITY

The population density of an area is reported as the number of residents per square kilometer of land area. While densitycalculations can give a description of how urban or how rural a population is, density is of population health interest also because appropriately increased density in urban areas can have many positive effects, including reduction of urban sprawl,decreased reliance on motorized transport, increased use of active transportation, decreased air pollution, and several otherbenefits (Brownstone & Golob, 2009; Clean Air Partnership, 2010; Clifton & Dill, 2005; Gauvin, et al., 2008; Hess, Moudon,Snyder, & Stanilov, 1999; Saelens, Sallis & Frank, 2003; Toronto Public Health, 2012).

Trending over time from 2001 to 2011 show that the population density within Capital Health has increased 8.4% from 55 per-sons per km2 to 59.6 persons per km2 (refer to Table 6) The district shows marked regional differences in population density, with theurban areas of Halifax Peninsula and Dartmouth being the most densely populated and the more rural areas of Eastern Shore– Musquodoboit and West Hants being the least densely populated CHBs. Differences can also be seen in the rate of densi-fication between urban, rural and suburban areas. The greatest percent change in population density over the 10 year period of 2001 to2011 was found in the suburban areas, while Halifax Peninsula, an urban area, had the smallest percent change in population density.


Results19

Changes in Population Density of Community Health Boards over Time, Capital HealthTable 6

Note. Data from Government of Nova Scotia (2013). The highest and lowest proportions among the CHBs are bolded.

Chebucto West 86.6 95.2 101.0 16.7

Cobequid 131.6 140.4 153.0 16.2

Dartmouth 919.6 911.3 942.7 2.5

Eastern Shore-Musquodoboit 6.4 6.7 6.6 2.7

Halifax Peninsula 3295.1 3202.3 3317.8 0.7

Southeastern Dartmouth 232.3 240.9 242.0 4.2

West Hants 15.1 15.1 15.4 2.5

Capital Health 55.0 57.0 59.6 8.4

Percent Change2001-2011 (%)20062001 2011


Results20

Selected Variables Describing Capital Health and the CHBsTable 7

Popu

lationa

Popu

lation De

nsity

a

Age Grou

psa(Years) (% of total)

Visib

le M

inorities

b(%

of total)

Aboriginal Id

entityb

(% of total)

Citizen

ship & Im

migrationb

(% of total)

Family Stru

cturea

(% all familie

s)

Lang

uage

a(%

of total)

Total (n)

Person

s Pe

r Km

2

Unde

r 20

20 - 29

30 - 39

40 - 49

50 - 64

65 and

Older

Total R

eportin

gVisib

le M

inorities

Male

Female

Black

Arab

/West As

ian

Chinese/Ko

rean

/Jap

anese

South As

ian

Othe

rTotal R

eportin

gAb

original Id

entity

Total R

eportin

gCa

nadian

Citizen

Non-Ca

nadian

Born in

NS

Born Outsid

e NS

Immigrants

Non-Pe

rman

ent R

esiden

tsMarrie

dCo

mmon

-Law

Lone

Paren

tTotal R

eportin

gEn

glish

Lang

uage

Spo

ken at Hom

e Fren

chBo

thEn

glish

Mothe

r Ton

gue

Fren

chBo

th

412,51

859

.221

.514

.913

.415

.621

.313

.340

6,29

08.8

9.2

8.3

3.5

1.7

1.4

0.2

2.0

406,29

62.5

406,29

096

.23.8

67.4

23.6

7.9

1.2

67.9

15.4

16.6

408,29

294

.80.9

0.2

90.6

2.5

0.4

Commun

ity Hea

lth Boa

rd

Chebucto West

Cobequid

Dartmouth

Eastern ShoreMusquodoboit

Halifax Peninsula

SE Dartmouth

West Hants

Capital Health

90,932

101.0

20.6

13.9

13.8

15.4

21.6

14.6

89,276

9.9

9.8

9.0

1.9

2.6

1.0

0.2

4.2

89,357

1.3

89,362

94.9

4.5

67.2

20.7

10.7

0.7

68.0

15.7

16.2

89,960

93.0

0.7

0.2

88.1

2.3

0.4

88,396

153.0

26.8

10.1

13.6

18.4

21.1

10.3

87,944

4.8

4.1

4.1

1.3

0.9

0.8

0.1

1.7

87,928

1.9

87,929

97.4

2.1

67.8

25.3

6.0

0.2

75.1

11.5

13.4

88,053

96.6

0.9

0.2

93.0

2.5

0.3

68,210

942.7

19.8

13.8

12.9

15.3

22.8

15.5

67,202

8.1

7.0

6.6

3.9

0.3

0.3

0.2

3.4

67,229

2.3

67,277

97.9

1.4

67.6

25.3

5.9

0.1

62.4

15.9

21.4

67,609

95.

1.26 0.2

91.8

3.0

0.4

24,598

6.6

21.9

9.1

12.1

16.3

25.1

15.3

24,509

1.5

0.8

0.9

0.7

0.4

0.1

0.0

0.3

24,499

2.6

24,494

99.0

0.4

79.7

17.4

2.5

0.0

71.7

14.4

14.0

24,527

98.8

0.6

0.1

96.4

2.0

0.2

73,295

3317

.815

.128

.813

.811

.817

.812

.972

,157

15.1

14.8

12.3

3.8

2.9

2.5

0.1

5.8

72,161

1.2

72,151

91.3

8.1

57.3

26.2

11.9

3.7

57.6

23.4

19.2

72,290

90.2

0.9

0.2

84.2

2.5

0.4

43,593

242.0

25.4

11.7

13.6

17.1

22.0

10.0

43,385

8.3

7.5

7.3

6.3

0.2

0.3

0.0

1.5

43,433

2.1

43,385

98.8

0.4

68.4

27.0

4.1

0.1

70.4

12.5

16.8

43,388

97.0

1.6

0.3

93.4

3.7

0.4

22,078

15.4

22.5

9.1

11.7

15.5

23.6

17.5

21,571

2.5

2.5

2.3

1.7

0.0

0.2

0.0

0.6

21,571

2.0

21,574

99.0

0.9

82.9

14.0

2.8

0.1

69.7

15.9

14.4

21,740

98.9

0.3

0.1

97.0

1.2

1.0

Note.a

– 20

11 Cen

sus an

d ad

ministra

tive da

ta m

odeled

by NS

Com

mun

ity Cou

nts, b

– 20

11 Nationa

l Hou

seho

ld Survey da

ta m

odeled

by NS

Com

mun

ity Cou

nts, c

– 20

06 Cen

sus da

ta m

odeled

by NS

Com

mun

ity Cou

nts


Results21

Selected Variables Describing Capital Health and the CHBs (Cont’d)Table 7Incomec

(in $)

Depe

nden

cy Ratio

a

Educationa

l Atta

inmen

tc

Househ

olds

c

Labo

urb(%

of total pop

ulation)

Tran

sportationc

(% of total pop

ulation)

Individ

ual

Med

ian

Averag

e

Family

Med

ian

Averag

eLow Income Familie

s (%

)

20 Ye

ars an

d Ov

er with

Post-S

econ

dary Certifica

te,

Diplom

a, or D

egree (%

)

Own (%

)Re

nt (%

)Ne

ed Rep

airs (%

)Va

lue (%

)Mon

thly Mortgag

e Pa

ymen

ts (in $)

Mon

thly Re

nt (in $)

Employmen

t

>25

Years

15-24 Years

Vehicle

Public Tran

sitWalk to W

ork

28,291

36,387

66,019

77,052

9.9

51.3

84.0

64.9

35.1

35.6

209,32

497

474

565

.258

.376

.511

.39.9

Commun

ity Hea

lth Boa

rd

Chebucto West

Cobequid

Dartmouth

Eastern ShoreMusquodoboit

Halifax Peninsula

SE Dartmouth

West Hants

Capital Health

30,366

36,499

67,129

75,528

9.9

NA 85.2

60.8

39.2

32.4

206,37

295

563

165

.260

.482

.911

.43.7

33,798

41,434

79,317

87,410

6.7

NA 85.6

86.9

13.0

31.4

241,80

910

4340

271

.155

.588

.86.7

2.9

29,423

35,804

64,725

75,205

12.5

NA 82.6

56.1

43.6

36.5

171,60

783

857

162

.559

.972

.517

.67.2

26,589

31,788

59,206

64,635

7.6

NA 72.9

91.4

9.1

45.1

146,36

572

342

359

.346

.694

.60.8

2.5

25,543

34,986

68,054

80,119

15.7

NA 88.2

37.7

62.2

36.6

252,34

496

576

162

.262

.144

.616

.034

.2

32,095

36,347

71,133

75,531

6.1

NA 85.0

87.3

12.4

35.0

174,11

394

332

171

.056

.484

.011

.32.7

24,277

29,880

52,808

58,747

8.7

NA 72.3

82.1

17.8

42.6

145,81

971

458

256

.848

.291

.50.4

6.4

Note.a

– 20

11 Cen

sus an

d ad

ministra

tive da

ta m

odeled

by NS

Com

mun

ity Cou

nts, b

– 20

11 Nationa

l Hou

seho

ld Survey da

ta m

odeled

by NS

Com

mun

ity Cou

nts, c

– 20

06 Cen

sus da

ta m

odeled

by NS

Com

mun

ity Cou

nts

1.8 SUMMARY

2 SELECTED HEALTH INDICATORS

2.1 MORTALITY

In summary, 44% of the provincial population resides in Capital Health. When compared to the rest of Nova Scotia, our population is slightly younger with a smaller proportion of the population 65 years and older. Even so, there are higher proportions of people aged 65 years and older in our rural CHBs. We have a higher proportion of immigrants and visible minorities but a lower proportion of people who identified as Aboriginal. Our life expectancy in Capital Health is similar to thelife expectancy of all Nova Scotians. While the average population density is 59.9 persons per km2, the density varies from6.6 persons per km2 in Eastern Shore – Musquodoboit to 3317.8 persons per km2 in Halifax Peninsula.


Results22

This section describes the general health indicators more typically seen in estimates of population health status, such asmorbidity and mortality rates, chronic disease rates, and quality adjusted measures of health status. Data by CHB or communitywere not available for most variables reported in this section.

Mortality (death rate) can be measured as total mortality (all combined) or by selected cause of death. According to StatisticsCanada (2011b), Capital Health causes of death had a lower all-cause mortality rate, when compared to both NS and Canada(refer to Table 8). The rate is lower for males in Capital Health than provincial and national estimates. The rate for females in Capital Health is lower than the NS rate but slightly higher than the Canadian one (Capital Healthrate: 689.8/100,000;Canadian rate: 686.6/100,000).

As can be seen in Table 8, cancers and circulatory diseasesare the leading causes of mortality in Capital Health. However, the mortality rates for all cancers is lower in CapitalHealth than in NS, for males and females, and the rates forCapital Health are similar to those reported nationally, formales, females and overall. The male and female mortalityrates for circulatory diseases are lower in Capital Health thanin NS and Canada (refer to Table 8). The highest mortalityrates from circulatory disease in Capital Health are from ischemic heart disease. The mortality rates from respiratorydiseases are lower in Capital Health than in NS, for malesand females, and the rates for Capital Health are similar tothose reported nationally, for males, females and overall. Thehighest mortality rates related to respiratory disease in Capital Health resulted from pneumonia and influenza. Datafor analysis by CHB was not available at the time of this report.


Results23

2.2 INJURY MORTALITY

Unintentional injury mortality is the age-standardized rate of death per 100,000 population from external causes of deathsuch as transport accidents, falls, poisoning, drowning and fire. The rate excludes complications of medical and surgicalcare. All rates are calculated using the total population (all age groups) and are based on the average of three consecutiveyears of data. The injury data presented in Table 9 are the average estimates from the years 2005 through 2007 and allrates were calculated using the total population for those years (all age groups).

The rates of unintentional injury are higher among males than females in Capital Health, NS, and Canada (Statistics Canada,2011b). The rate of injury for females in both Capital Healthand NS is greater than the national average (Table 13) and therate of injury for males, in NS, is 37% higher than the national average (48.5 versus 35.5 per 100,000 population). ForCapital Health, the rate of unintentional injury among males is lower than the NS rate and is similar to the national rate.

Potential years of life lost (PYLL) is a measure of premature deaths. Specifically, PYLL is the number of years of potential life“lost” when a person dies prematurely (before the age of 75 years). For example, if a person dies at 55 years old due tocancer, 20 years of potential life have been lost. Numbers from deaths at a young age are weighted more heavily than thoseat an older age as a greater number of potential years of life have been lost (Region of Peel, 2008). This measure is importantas it indicates causes of death that are more common in younger people. The PYLL due to unintentional injuries for CapitalHealthreflects the higher mortality rate among males; in 2009, the PYLL from unintentional injury was 799.2 per 100,000population while for females it was 290.0 per 100,000 population. Exploration of the age groups most affected by unintentionalinjuries could not be conducted due to the lack of available data.

Mortality Data (Deaths per 100,000 population) for Capital Health, Nova Scotia and Canada, by Sex,2005/2007

Table 8

All Cause 689.2 688.5 689.8 871.0 896.6 846.8 699.3 712.2 686.6

All Cancers 207.1 221.7 193.3 258.6 286.6 232.1 207.2 220.0 194.6

Colorectal Cancer 21.8 23.2 20.5 25.1 27.6 22.7 22.6 24.5 20.8

Lung Cancer 56.1 61.1 51.4 72.6 85.7 60.2 55.4 63.2 47.7

Breast Cancer 14.2 n/a 27.5 16.8 n/a 32.7 15.1 n/a 29.9

Prostate Cancer 10.2 21.0 n/a 13.5 27.8 n/a 10.9 22.0 n/a

All Circulatory Diseases 205.9 202.2 209.3 272.7 274.8 270.7 212.2 212.5 212.0

Ischemic Heart Disease 99.0 111.4 87.2 137.7 156.6 119.8 113.1 125.5 100.8

Cerebrovascular Disease 41.3 29.6 52.3 54.5 44.8 63.8 42.2 35.0 49.2

All Other Circulatory Diseases 65.6 61.1 69.8 80.5 73.4 87.1 57.0 52.0 61.9

All Respiratory Diseases 60.7 57.8 63.5 82.3 81.6 83.0 60.5 61.8 59.2

Pneumonia & Influenza 16.9 14.2 19.4 23.1 18.9 27.1 16.5 14.8 18.2

Bronchitis 2.8 1.7 3.8 3.6 3.4 3.7 3.1 3.2 3.0

All Other Respiratory Diseases 41.1 41.8 40.3 55.6 59.2 52.2 40.8 43.8 37.9

Capaital Health NS Canada


Total Male Female Total Male Female Total Male Female

2.3 SUICIDE AND SELF-INFLICTED INJURY MORTALITY

Suicide and self-inflicted injury mortality is the age-standardized rate of death from suicide and self-harm per100,000 population. All rates are calculated using the totalpopulation (all age groups) and are calculated based on theaverage of three consecutive years of data. The rates of suicide and self-inflicted injury are numerically higheramong males than females, in Capital Health, NS, andCanada (Statistics Canada, 2011b). The rate of suicide andself-inflicted injury mortality for females in Capital Health issimilar to the Canadian rate, but higher than the NS rate(Table 10). Overall, the estimated rates for Capital Healthand NS were similar to, but slightly lower than, the nationalrate. Data for analysis by CHB was not available at the timeof the writing of this report.


Results24

Unintentional Injury Mortality (per 100,000 Population), by Sex, 2005/2007 Table 9


Total Female Male


NS 40.5 33.0 48.5

Canada 29.2 23.0 35.5

Suicide and Self-inflicted Injury Mortality (per 100,000 population), by Sex, 2005/2007Table 10



NS 9.8 3.6 16.3

Canada 10.9 5.1 16.7

Total Female Male

2.4 INFANT MORTALITY

Infant mortality describes the probability (chances) that a child will die before reaching the age of one (World Health Organization [WHO], 2011a) and is expressed as the number of deaths in children less than 1 year of age per 1,000 livebirths. The infant mortality data for NS and Canada are based on an average of three consecutive years of data (2005 to2007) (Statistics Canada, 2010c). The data for individual CHBs is from the Nova Scotia ATLEE Perinatal Database (NSAPD)(Reproductive Care Program of Nova Scotia, 2012). The NSAPD is administered by the Reproductive Care Program of NovaScotia and contains information for all pregnancies and births occurring in Nova Scotia.

The rate for infant mortality in Capital Health is lower than the provincial and national rates (refer to Table 11). Further exploration of the infant mortality rate by CHB demonstrates that the rate is highest in Eastern Shore – Musquodoboit (5.7per 1,000 live births); however, this number must be interpreted with caution, as the low birth rate in this CHB means thateven one or two infant deaths can significantly influence the infant mortality rate for a given year. CDHA, NS and Canadiandata for infant mortality by sex is listed in Table 11 but was not available by CHB at the time of this report.


Results25

2.5 BIRTH AND FERTILITY RATES

The fertility rate is the average number of children that would be born per woman if all women lived to the end oftheir child-bearing years and had children according to theage-specific fertility rates for that area and time period. A fertility rate of 2.1 children per woman is required to maintain current population levels in developing countries(Region of Peel, 2008). In 2011, the fertility rate for Canadawas 1.61 while for Nova Scotia, the rate was 1.47 (StatisticsCanada, 2013d). Among the 13 provinces and territories,Nova Scotia had the third lowest fertility rate.

Infant Mortality Rate (per 1,000 Live Births), CHB, Capital Health, Nova Scotia, and CanadaTable 11

Note. Data from Statistics Canada (2010c) and Reproductive Care Program of Nova Scotia (2012). The highest and lowest proportions among the CHBs are bolded.

Total Female Male

Chebucto West 1.0

Cobequid 1.8

Dartmouth 2.5

Eastern-Shore Musquodoboit 5.7

Halifax Peninsula 3.7

Southeastern Dartmouth 0.0

West Hants 0.0


NS 3.6 3.8 3.4

Canada 5.0 4.6 5.4

Age-specific fertility rate (ASFR) is the number of live births per 1,000 females in a specific age group compared to thenumber of females in the age group. Five-year age groups were used to prepare the calculations for this report (ranging from15 to 19 years to 45 to 49 years). The fertility rate in Nova Scotia and Canada gradually increases with age until it peaksamong women aged 30 to 34 years of age and then declines (refer to Table 12). When compared to Canada, women aged15 to 19 years and 20 to 24 years in Nova Scotia have higher fertility rates than their cohorts in other parts of Canada (Statistics Canada, 2013d).

The age-specific fertility rate varies between CHBs in Capital Health (refer to Table 13). The birth rate was highestamong women aged 25 to 29 years of age in Eastern Shore– Musquodoboit and West Hants. For the remaining CHBs,the birth rate was highest among women aged 30 to 34years. This data indicates that in the rural CHBs, the highest proportion of births occurs among younger women whencompared to the other CHBs. Crude birth rate is the ratio of total live births to the total population in an area over a specified period of time. As shown in Table 13, the birthrate is highest in Cobequid while the lowest crude birth rateis in Eastern Shore – Musquodoboit.


Results26

Age-specific Fertility Rates, Nova Scotia and Canada, 2010Table 12

15-19 years 17.9 13.5

20-24 years 52.8 48.0

25-29 years 86.3 96.4

30-34 years 93.0 105.7

35-39 years 37.2 51.6

40-44 years 7.0 9.9

45-49 years 0.2 0.4

Age-Specific Fertility Rate Per 1,000 Women

Age Group Nova Scotia Canada

Note. Data from Statistics Canada (2010d)

Note. Data from Statistics Canada (2013d).

Age-specific Fertility Rate and Crude Birth Rate, Capital Health and CHBs, 2011Table 13

Note. Data from Reproductive Care Program of Nova Scotia (2012) and Government of Nova Scotia (2013). Where numbers are too low, data have been suppressed(x). The highest proportions among the CHBs are bolded.

15-19 years x x x x x x x x

20-24 years 40.0 48.7 51.8 63.3 67.9 13.1 45.3 83.7

25-29 years 74.2 78.7 122.0 94.6 85.6 29.0 104.4 93.8

30-34 years 101.4 93.2 158.8 98.5 71.4 66.9 108.7 69.4

35-39 years x 45.9 58.1 46.8 25.6 52.1 35.5 x



Crude Birth 10.1 10.5 12.3 11.6 7.1 7.3 10.0 7.9Rate Per 1000

Age Group Capital Health Chebucto West Cobequid Dartmouth Eastern Shore -Musquodoboit

HalifaxPeninsula

SoutheasternDartmouth West Hants

2.6 LOW BIRTH WEIGHT

Low birth weight is defined as infants born weighing lessthan 2,500 grams regardless of gestational age. Low birthweight is commonly used as a population health status indicator as it may indicate a variety of prenatal conditionsthat could negatively affect birth outcome, such as insuffi-cient prenatal care, young age of mother, poor nutrition,heart disease or environmental factors such as exposure totobacco smoke.

The low birth weight data for NS and Canada are based onthe average of three consecutive years of data (2005 to2007) (Statistics Canada, 2010b). The data for individualCHBs are from the ATLEE Perinatal Database, for 2011 (Reproductive Care Program of Nova Scotia, 2012). Although data for Eastern Shore – Musquodoboit and West Hants werenot available, it can still be seen that the proportion of babies with low birth weight varies between CHBs (refer to Table 14).The highest proportions are among births of women residing in Halifax Peninsula and Chebucto West, which have low birthweight rates higher than the district value.


Results27

Proportion of all Live Births where the Birth Weight was Less than 2,500 Grams, Community HealthBoard, 2011

Table 14

Note. Data from Reproductive Care Program of Nova Scotia (2012). Dartmouth was chosen as the reference group because it had the lowest reported proportionof low birth weight babies in 2011.Where numbers are too low, data have been suppressed (x). The highest and lowest proportions among the CHBs are bolded.

Chebucto West 6.6 0.07

Cobequid 5.3 0.49

Dartmouth 4.6 Ref

Eastern-Shore Musquodoboit x x

Halifax Peninsula 7.1 0.05

Southeastern Dartmouth 5.3 0.58

West Hants x x

Percentage p-Value

The proportion of babies with low birth weight in Capital Health and NS is similar to the Canadian rate. In Capital Health, NS andCanada, the proportion of children born less than 2,500 grams is higher for female infants than for males (refer to Table 15).

Proportion of all Live Births where the Birth Weight was Less than 2,500 Grams, Capital Health, NovaScotia and Canada, 2005/2007

Table 15

Note. Data from Statistics Canada (2010b) and the Reproductive Care Program of Nova Scotia (20120).

Ca[ital Health 6.2 7.0 5.5

NS 6.1 6.7 5.6

Canada 6.0 6.4 5.6

Percentage Female Male

2.7 MORBIDITY

Morbidity refers to the incidence of poor health and diseasein a population. Chronic health conditions have a significantimpact on health status and quality of life. For the purposesof this report, the chronic conditions of self-reported highblood pressure, heart disease, asthma, diabetes, and cancerwere summarized by geography and sex. All populations inCapital Health and NS, with the exception of males, hadhigher rates of self-reported high blood pressure comparedto national rates (refer to Table 16). Data for analysis by CHBwas not available at the time of the writing of this report.


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Proportion of the Population Reporting High Blood Pressure, by Sex, Capital Health, Nova Scotia, andCanada, 2009/10

Table 16

Source: Data from Public Health Agency of Canada (2012).


Nova Scotia 23.9 26.2 25.1

Canada 19.8 20.4 20.1

Male

Self-Reported High Blood Pressure (%)

Female Total

The estimates for self-reported diabetes rates for both NS and Capital Health are higher than the national rates for bothmales and females (refer to Table 17). Both men and women in Capital Health and NS report having a diagnosis of cancermore often than the rest of the Canadian population. The proportion of the population who reported ever having cancer is5.5% in Capital Health, 5.9% in NS, and 4.2% in Canada. The proportion of males and females reporting having heart diseaseis the lower in Capital Health, than in NS. The NS rate is higher than the national average.

Proportion of the Population who Reported having Diabetes, Cancer, or Heart Disease, by Sex, CapitalHealth, Nova Scotia and Canada, 2009/10.

Table 17

Diabetes Male 7.0 8.8 6.9

Female 5.8 7.2 5.4

Total 6.4 8.0 6.1

Cancer Male 4.9 4.8 3.2

Female 6.1 6.9 5.1

Total 5.5 5.9 4.2

Heart Disease Male 4.2 6.7 5.6

Female 3.7 4.6 4.0

Total 3.9 5.6 4.8

Capital Health Nova Scotia Canada

Note. Data from Public Health Agency of Canada (2012).

Figure 4 presents the population estimates for people (aged 12 years and older) who report having asthma (as diagnosed bya health professional). Based on data from the Canadian Community Health Survey (CCHS), the proportion of the populationwith asthma is higher in Capital Health than in NS, and is higher still than the Canadian rate for both males and females.However, the data suggests that the proportion of males and females in Capital Health with asthma has been slowly declining,while in Nova Scotia, there has been a slight increase. According to this data, more females than males consistently reporthaving asthma in Capital Health, NS and Canada.


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2.8 HEALTH-ADJUSTED LIFE EXPECTANCY AT BIRTH (HALE)

While life expectancy, as described earlier, tells us the expected length of life for our population, health-adjustedlife expectancy gives us a little more information on the quality of life lived. Health adjusted life expectancy (HALE)is the number of years in full health that an individual canexpect to live given the current morbidity and mortality conditions in a region (Statistics Canada, 2012e). As such,the HALE is a measure of both the quantity and quality of life.

Proportion of the Population With Asthma, by Sex, Capital Health, NS, and Canada, 2007-2012Figure 4

2007/2008 2011/20122009/2010

Percen

tage

(%) o

f Pop

ulation With

Asthm

a

16

14

12

10

8

6

4

2

0


Total Male Female Total Male Female Male FemaleTotal

2007/2008

2009/2010

2011/2012

12.1 9.3 14.6 10.3 8.2 12.4 8.2 7 9.4

10.7 8.7 12.6 9.3 7.4 11 8.3 6.9 9.6

9.8 7.4 11.9 9.6 8.1 11 8.3 7.1 9.6

Note. Data from Public Health Agency of Canada (2012)

The HALE for males in Canada is 68.9 years while for females, it is 71.2 years. According to Statistics Canada, the HALE forfemales in Nova Scotia is 69.4 years and for males, it is 66.6 years. This means that Nova Scotians can expect to have fewerthan average years in full health than other Canadians. These estimates are based on death data from the years 2005 through2007 (Statistics Canada, 2012e). Specific HALE data for Capital Health or CHB was not available at the time of this report.

2.9 POTENTIAL YEARS OF LIFE LOST


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For males in Capital Health, the most common causes of premature death were ischemic heart disease, lung cancer, and circulatory diseases (not including ischemic heart disease (IHD) or cerebrovascular disease (CVD)). While lung cancer andbreast cancer were the most common causes of premature death for females in Nova Scotia and Canada, PYLL from ischemicheart disease was higher than non-IHD non-CVD circulatory diseases. Data for PYLL by CHB was not available at the time ofthe writing of this report.

Potential years of life lost (PYLL) can be estimated for different disease entities to give some picture of how theymay each contribute to premature death. Table 18 presentsthe potential years of life lost (PYLL) data for Capital Health,Nova Scotia and Canada, by sex. All rates in this table are calculated using the population aged 0 to 74 and are based on the average of three consecutive years of data, specifically 2005 to 2007 (Statistics Canada, 2011b).As summarized in Table 18, the PYLL for all cancers and circulatory diseases based on the 2005-2007 data washigher for both Nova Scotia and Capital Health when compared to Canada. For all respiratory diseases, the PYLLwas higher for Nova Scotia but lower in Capital Health whencompared to Canada.

Rates of PYLL (per 100,000 Population), by Sex, Capital Health, Nova Scotia, and Canada, 2005/2007Table 18

All Cause Mortality 4,665.0 5,736.0 3,626.2 5,423.9 6,867.6 4,011.5 4,895.8 6,033.7 3,746.0

All Cancers 1,632.8 1,742.5 1,526.4 1,891.9 2,075.0 1,712.8 1,516.7 1,548.6 1,484.5

Colorectal Cancer 160.5 194.8 127.2 162.3 207.4 118.2 139.3 165.9 112.4

Lung Cancer 397.3 402.8 392.0 506.6 544.7 469.3 392.1 417.2 366.7

Breast Cancer 132.4 n/a 260.9 155.2 n/a 307.0 151.5 n/a 304.7

Prostate Cancer 28.3 57.4 n/a 31.7 64.1 n/a 23.8 47.4 n/a

All Circulatory Diseases 887.7 1244.3 541.9 1,030.8 1,452.8 618.0 775.6 1,099.4 448.4

Ischemic Heart Disease 490.2 780.9 208.2 604.5 949.7 266.7 449.1 699.4 196.2

Cerebrovascular Disease 109.6 109.5 109.7 134.9 156.9 113.4 114.6 127.4 101.6

All Other Circulatory Diseases 287.9 353.8 224.1 291.4 346.2 237.8 211.9 272.5 150.5

Respiratory Diseases 171.8 147.1 195.7 210.7 203.4 217.8 173.7 197.1 150.1

Pneumonia & Influenza 35.2 28.7 41.6 46.0 50.4 41.7 48.5 58.5 38.5

Bronchitis 17.4 13.7 21.0 13.1 9.3 16.8 15.1 15.8 14.3

All Other Respiratory Diseases 119.1 104.7 133.1 151.6 143.8 159.3 110.1 122.8 97.3



Total Male Female Total Male Female Total Male Female

2.10 SUMMARY

3 SELECTED HEALTH OUTCOMES OF INTEREST – OBESITY, ALCOHOL USE, AND MENTAL HEALTH

When looking at select health status indicators, it can be seen that there are a few differences between Capital Health, NS,and Canada. While the proportion of low birth infants is similar between those jurisdictions, infant mortality is lower in CapitalHealth, and there is some variation within Capital Health worthy of further examination. Death from unintentional injuries ishigher in Capital Health when compared to Canada. Death from suicide and self-inflicted injury is less prevalent in CapitalHealththan in NS and Canada. While the overall proportion of individuals with high blood pressure is gradually increasing, fe-males are more likely to report having high blood pressure. Females are also more likely to report having cancer in CapitalHealth while males are more likely to report having diabetes and heart disease. The potential years of life lost due to respiratorydisease were lower in Capital Health when compared to NS and Canada. Data at the district level was not available for anumber of the health indicators, including health-adjusted life expectancy.

As mentioned earlier, the data used for this population health status report was obtained from the Canadian Community Health Survey (CCHS) conducted in Capital District Health Authority (Capital Health) in 2009/2010 (Table19). The mean age of the sample population was 45.6 (95%CI 45.2 – 46.7) with an age range of 15 to 91 years and a median age of 47.0 years. The highest percentage of surveyparticipants was 35 to 54 years (38.5%) followed by 20 to 34 years (20.6%). The proportion of males and femaleswas equal in the sample.


Results31

Summary of Age Group and Sex for the Sample Population Capital Health (n = 1896)Table 19

Age group (years) 15 to 19 149 (7.8)

20 to 34 383 (20.6)

35 to 54 731 (38.5)

55 to 64 305 (16.0)

65+ 333 (17.5)

Sex Male 948 (50.0)

Female 948 (50.0)

Category Frequency (%)

As was described in the Methodology section, the INSPQ’s deprivation index was used to assign measures of socioeconomicstatus to neighborhoods and community health boards, within quintiles. Table 20 depicts the percentage of the sample population that was assigned to each quintile of total, material, and social deprivation. The sample size was fairly evenly distributed, with between 15 and 30 percent of the sample appearing in any of the quintiles for total, material and socialdeprivation.


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Summary of Deprivation Index Scores of Dissemination Areas by Deprivation Category, CapitalHealth (n = 1896).Table 20

1 20% least deprived 341 (18.0) 295 (15.6) 289 (15.2)

2 20 - 40% least deprived 308 (16.2) 304 (16.0) 444 (23.4)

3 Average deprivation 255 (13.4) 286 (15.1) 414 (21.8)

4 20 - 40% most deprived 526 (27.7) 430 (22.7) 288 (15.2)

5 20% most deprived 466 (24.6) 581 (30.6) 461 (24.3)

Social Deprivation, n (%)Material Deprivation, n (%)Total Deprivation, n (%)Deprivation Index ValueDeprivation Index Category

Prior to analysis, the sample was examined to determine ifthere was significant potential for skew in the analysis dueto the exclusion of respondents without postal codes (referto Table 21). Differences in the distributions of independentvariables (including health outcomes) by complete postalcode/incomplete postal code were tested with X2 tests andshowed that those with incomplete postal codes differed in sex, age group, sense of belonging, BMI category, oralhealth, and stress in daily life (p < .05). When compared tothe group with complete postal codes, the group withoutpostal codes were more often female (57.1% vs. 50.0%)and aged 20 to 34 (26.8% vs. 20.6%). There were no significant differences between the two groups in the othervariables.

Variance between Participants with Complete and Incomplete Postal CodesTable 21

Age (years) Mean (95% CI) 45.96 (45.18 -46.74) 44.15 (43.07-45.23)

Median 47.00 44.00

Range 15.00 -91.00 15.00 – 89.00

Age Group (Years, n (%)) 15 to 19 149 (7.8) 58 (6.8) 19.84* .001

20 to 34 383 (20.6) 231 (26.8)

35 to 54 731 (38.5) 350 (40.5)

55 to 64 305 (16.0) 120 (13.9)

65+ 333 (17.5) 103 (12.0)

Missing 0 1 (0.1)

Sex, n (%) Male 948 (50.0) 370 (42.9) 12.07* .001

Female 948 (50.0) 493 (57.1)

Physical Health, n (%) Positive 1643 761 (88.2) 1.17 .297

Negative 252 (13.3) 102 (11.8)

Missing 2 (0.1) 0

X 2 Test Value p-ValueIncomplete Postal Codes (n = 863)

Complete Postal Codes (n = 1896)ValueVariable

3.1 DEPRIVATION AND CAPITAL HEALTH

Total deprivation is composed of material deprivation and social deprivation, which can be considered together or as separatecomponents. As shown in Figures 5 and 6, the total deprivation varies by community and dissemination area with distinctareas ranging from the least deprived (represented in green) to areas with the highest total deprivation (represented in red).Although total deprivation considers both material and social components, it is important to understand how each of the twocomponents varies geographically.


Results33

Mental Health, n (%) Positive 1785 (94.1) 821 (95.1) 1.42 .233

Negative 109 (5.8) 40 (4.7)

Missing 2 (0.1) 2 (0.3)

Life Satisfaction, n (%) Satisfied 1710 (90.2) 792 (91.8) 1.20 .273

Neither or Not Satisfied 180 (9.5) 71 (8.2)

Missing 7 (0.3) 0

Senseof Belonging,n (%) Strong 1317 (69.5) 546 (63.2) 10.77* .001

Weak 558 (29.4) 308 (35.7)

Missing 21 (1.1) 9 (1.1)

Smoking, n (%) Daily or Occasional Smoker 1517 (80.0) 680 (78.8) 0.54 .462

Non-Smoker 379 (20.0) 183 (21.2)

Oral Health, n (%) Positive 1647 (86.9) 781 (90.4) 6.88* .009

Negative 228 (12.0) 75 (8.7)

Missing 21 (1.1) 8 (0.9)

Fruit and Vegetable Met/Above Daily Requirements 665 (35.0) 319 (36.9) 1.01 .315Consumption, n (%)

Below Daily Requirements 1144 (60.3) 503 (58.3)

Missing 88 (4.6) 41 (4.8)

Body Mass Index, n (%) Normal/Underweight 607 (32.0) 316 (36.6) 4.08* .043

Overweight or Obese 1100 (58.0) 479 (55.5)

Missing 189 (10.0) 68 (7.9)

Stress in Daily Life, n (%) Not Stressful 700 (36.9) 281 (32.6) 5.12* .023

Stressful 1191 (62.8) 582 (67.4)

Missing 5 (0.3) 0

Stress at Work, n (%) Not Stressful 377 (28.9) 182 (27.8) 0.27 .604

Stressful 928 (71.1) 476 (72.0)

Mood Disorder, n (%) No Mood Disorder 1706 (90.0) 76 (89.9) 0.01 .911

Have a Mood Disorder 184 (9.7) 85 (9.9)

MIssing 7 (0.3) 2 (0.3)

Physical Activity, n (%) Active or Moderate Activity 1085 (57.2) 472 (54.6) 1.63 .202

Inactive 811 (42.8) 392 (45.4)

Alcohol Use n (%) No Heavy Drinking 398 (21.0) 195 (22.6) 0.02 .899

Heavy Drinking 414 (21.8) 206 (23.9)

Missing 1084 (57.2) 462 (53.6)

X 2 Test Value p-ValueIncomplete Postal Codes (n = 863)

Complete Postal Codes (n = 1896)ValueVariable

(Excludes those who do not work.)

Although the deprivation for Capital Health and the CHBswas not available, the deprivation by community and dissemination area using the INSPQ deprivation index was.As shown in Figure 5 and Table 22, levels of deprivationamong communities vary within CDHA, with pockets of relative deprivation being interspersed throughout more affluent areas. More geographically condensed areas of relative deprivation are also seen, particularly in rural communities within the district.

When looking at material and social deprivation as separate components of total deprivation (refer to Table 22), it can beseen that the contribution of each component to the total deprivation varies between communities. For example, while thecommunities of Clayton Park and Upper Musquodoboit both have a total deprivation score of 4, the relative contributions ofmaterial and social deprivation are different. It was for this reason that material and social deprivation have been consideredseparately, as well as combined into total deprivation.


Results34

Total Deprivation by Communities in Capital HealthFigure 5

Total deprivation index values for communities in Capital Health developed and provided by Dr. M. Terashima (2011). The geographical data and mapping softwarewere provided by Dalhousie Geomatics Lab.

Total Deprivation Categories

1 (20% least deprived)

2

3

4

5 (20% most deprived)

H D’Agelo-Scott, PhD, ROH UCU Public Health, Capital Health ArcGIS 10.2July 31, 2014

DATA: 1) CDHA, 2006


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Figure 6 depicts deprivation maps for dissemination areaswithin Capital Health. It can be seen that between dissemi-nation areas within a CHB, there is variation in the levels of deprivation. For example, while the Halifax Peninsula com-munities had a total deprivation score of 4 (20 to 40% mostdeprived), it can be seen in the figure, that within that CHB,the entire range of deprivation scores is present and variesbetween the dissemination areas within the CHB. Under-standing of the levels of deprivation can permit analysis ofpublic health issues that allows for targeted interventions tobe delivered to the populations (for example, to geographicareas of relative deprivation) where they are needed most.

Total, Material, and Social Deprivation Categories for Communities, Capital HealthTable 22

Note. The names of the communities reflect the communities as defined and named by Nova Scotia’s Community Counts (Government of Nova Scotia, 2013).

Lawrencetown, Tantallon, Fall River, Hatchet Lake 1 1 1

Waverley, Cole Harbour 1 1 2

Hammonds Plains, Prospect 1 2 1

Lake Echo 1 2 2

Lantz, Peggy’s Cove 1 3 1

Beaver Bank 1 3 2

Timberlea, St. Margaret’s Bay, Herring Cove, Hacketts Cove 2 2 3

Enfield, Beaver Bank, Porters Lake 2 3 2

Elmsdale 2 3 3

Brooklyn, Falmouth 2 4 1

Sambro, Mount Uniacke 2 4 2

Bedford, Dartmouth East 3 1 4

Sackville South, Eastern Passage 3 2 4

Sackville North, Musquodoboit Harbour 3 3 3

Hubbards 3 3 4

Newport Corner 3 4 2

Jeddore 3 4 4

Smith’s Corner 3 5 2

Windsor Forks 3 5 3

Clayton Park, Halifax Chebucto, Armdale-Northwest Arm, Halifax Citadel 4 1 5

Fairview, Dartmouth South 4 2 5

Middle Musquodoboit 4 4 3

Hantsport, Chezzetcook 4 4 4

Upper Musquodoboit 4 5 1

Preston 4 5 2

Dartmouth North, Halifax Needham 5 3 5

Windsor, Spryfield 5 4 5

Terence Bay 5 5 1

Kempt Shore, Ship Harbour 5 5 3

Three Mile Plains, Sheet Harbour, Summerville 5 5 4

Moser River 5 5 5

TotalCommunity Material Social

Deprivation

3.1.1 MATERIAL DEPRIVATION IN CAPITAL HEALTH

Material deprivation, a component of total deprivation, is based on three variables: the proportion of persons without a highschool degree, the ratio of employment to population, and average personal income. Further exploration of each of thevariables is summarized as follows:


Results36

Total Deprivation by Dissemination Areas in Capital HealthFigure 6

Material and social deprivation indices for dissemination areas in Capital Health developed by Pampalon and Raymond (2000) and a 2006 version provided by CIHI(n.d.). The geographical data and mapping software were provided by Dalhousie Geomatics Lab.

a. High School Degree Completion: In Capital Health, theproportion of individuals aged 20 years and older without a high school degree was 16.0% in 2006. However, the percentage varies between Community Health Boards, withthe highest proportion of individuals without a high schooldegree in West Hants (27.8%) and the lowest in HalifaxPeninsula (11.7%) (refer to Table 23). A difference betweenmales and females is also noted, with males in CapitalHealth more likely to not have a high school degree. Whilethis was found for the majority of the Community HealthBoards, females in Dartmouth and Halifax Peninsula wereless likely to have a high school degree when compared tomales.

Total Deprivation


2

3

4



DATA: 1) CIHI, 2006

November 25, 2013

Missing Values


Results37

b. Average Personal Income: The average and medianincomes for families, households, and by gender for the population in Capital Health, Nova Scotia, and Canada, according to the 2006 Census, have been summarized in Table 24. It can be seen that both average and median incomes for individual females are substantially lower compared to those for individual males for Capital Health,Nova Scotia, and Canada. For the most part, the CapitalHealth incomes are comparable to the national estimatesand higher than the average and median incomes for NovaScotia.

c. Employment-Population Ratio: The employment – population ratio, also known as the employment rate, is the proportionof the population 15 years and older that is employed relative to the total population 15 years and older. In 2012, the employment – population ratio for Canada was 61.8% while for Nova Scotia, the ratio was 58.4%.

No Certificate, Diploma or Degree

Proportion of the Population, Aged 20 Years and Over, with No Certificate, Diploma or Degree, includingHigh School Certificate or Equivalent, by Community Health Board and Capital Health, 2006

Table 23

Note. Data from Government of Nova Scotia (2013). The highest and lowest proportions among CHBs are bolded.

Chebucto West 15.1 15.8 14.3

Cobequid 14.4 14.8 14.3

Dartmouth 17.3 16.0 18.2

Eastern Shore – Musquodoboit 27.7 28.9 26.2

Halifax Peninsula 11.7 11.2 12.0

Southeastern Dartmouth 15.0 16.0 14.1

West Hants 27.8 29.2 26.5


Total (%)Community Health Board Male (%) Female (%)

Average and Median Incomes for the Capital Health Population, 2006Table 24

Note. Data from Government of Nova Scotia (2013).

Individual 36,387 28,291 31,795 24,030 37,302 26,917

Male 44,227 35,085 38,556 30,916 45,580 33,622

Female 29,142 22,794 25,420 19,157 29,255 21,645

Families 77,052 66,019 66,032 55,412 79,738 63,866

Households 65,673 53,665 57,366 46,605 69,548 53,634

Average Income ($)

Median Income ($)

Average Income ($)

Median Income ($)

Average Income ($)

Median Income ($)



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The unemployment rate is the number of unemployed persons expressed as a percentage of the labour force. Thelabour force consists of people aged 15 years and over thatare currently employed and people who are unemployed butwere available to start work in the week prior to enumerationand looked for work in the past 4 weeks (APHEO, 2012). Thelabour force excludes persons living on reserves and otherAboriginal settlements in the provinces, full-time membersof the Canadian Armed Forces, and institutionalized populations.

In 2011, 68.7% of the population in Capital Health was part of the labour force. Sixty-three percent of the population wasemployed while 5.1% were unemployed (Government of Nova Scotia, 2013). In 2012, there was a 64.1% participation ratein the labour force in Nova Scotia, with 58.4% of the population being employed (employment – population ratio) and 9.0% unemployed (Statistics Canada, 2013l). Nationally, for the population aged 15 years and over, there was 66.7% of the population who participated in the workforce, with 61.8% of the population employed (employment – population ratio) and7.3% of the population unemployed (Statistics Canada, 2013l). So, when compared to provincial and national statistics, theemployment – population ratio was higher in Capital Health, with more people in the labour force and a smaller proportionof individuals who are employed in Nova Scotia.

When considering the three variables associated with material deprivation, an overview of the geographical distribution ofmaterial deprivation by dissemination area can be developed (refer to Figure 7). Areas with high material deprivation can befound in all of the Community Health Boards with a significant portion of both of the rural Community Health Boards identifiedas high material deprivation areas as compared to other Community Health Boards.

Material Deprivation by Dissemination Areas in Capital HealthFigure 7

Material deprivation indices for dissemination areas in Capital Health developed by Pampalon and Raymond (2000) and a 2006 version provided by CIHI (n.d.). The geographical data and mapping software were provided by Dalhousie Geomatics Lab.

Material Deprivation


2

3

4



DATA: 1) CIHI, 2006

November 28, 2013

All Other Values

3.1.2 SOCIAL DEPRIVATION IN CAPITAL HEALTH

The second component of total deprivation, social deprivation, includes persons living alone, single-parent families andpersons who are widowed, separated or divorced. An overview of each of the variables is presented as follows:


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a. Persons Living Alone: The first variable of the socialdeprivation index is the proportion of the population in private households who are living alone. According to NovaScotia Community Counts (Government of Nova Scotia,2013), the highest proportions of people living alone in 2006 resided in Halifax Peninsula (21.6%) and Dartmouth(14.0%), whereas on average, only 11.5% of the overallCDHA population is living alone (refer to Table 25). It is important to note that the proportion of people living alonein Halifax Peninsula may be significantly influenced by the number of individuals attending universities in the peninsula.

b. Single Parent Families: Single parent families are defined as the proportion of census families made up of one parentand one or more never married sons and daughters living in the same dwelling. This can be further defined as male singleparent families or female single parent families (APHEO, 2012). Table 26 presents the proportion of single parent families for Capital Health and its CHBs for the year 2006 (Government of Nova Scotia, 2013). It can be seen that the highest proportionof lone-parent families reside in Dartmouth (20.1%, 2006) followed by Halifax Peninsula (19.4%, 2006). There are also a substantially greater proportion of female lone-parent families (13.7% for Capital Health) compared to male lone-parent families (2.8% for Capital Health), in all Community Health Boards. The highest proportion of female lone-parent familiesreside in Dartmouth while the lowest proportions of male and female lone-parent families reside in Cobequid and EasternShore – Musquodoboit, respectively.

Number and Percent of Persons in Private Households Living Alone, By CHB, 2006Table 25

Note. Data from Government of Nova Scotia (2013).

Chebucto West 83,201 9,501 11.4

Cobequid 83,228 4,567 5.5

Dartmouth 66,407 9,284 14.0

Eastern Shore – Musquodoboit 21,302 1,931 9.1

Halifax Peninsula 69,642 15,040 21.6

Southeastern Dartmouth 42,321 2,144 5.1

West Hants 21,048 1,877 8.9

Capital Health 389,163 44,917 11.5

Total Persons in Private Households Persons Living Alone (Number) Persons Living Alone (%)


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Number and Percent of Lone-Parent Families, by CHB, 2006Table 26

Note. Data from Government of Nova Scotia (2013). The lowest and highest proportions for CHBs are bolded.

Chebucto West 24,383 672 (2.8) 3,273 (13.4)

Cobequid 25,280 514 (2.0) 2,706 (10.7)

Dartmouth 18,938 467 (2.5) 3,307 (17.5)

Eastern Shore – Musquodoboit 6,623 222 (3.4) 615 (9.3)

Halifax Peninsula 16,499 438 (2.7) 2,812 (17.0)

Southeastern Dartmouth 12,964 418 (3.2) 1,592 (12.3)

West Hants 6,618 184 (2.8) 811 (12.3)

Capital Health 111,830 3,097 (2.8%) 15,266 (13.7%)

Lone-Parent Families, n (%)

Total Census Families Lone Male Parent Lone Female Parent

c. Separated, Widowed, or Divorced: The third variablefor social deprivation is the number of individuals aged 15 years and over who are separated from their partner, widowed, or legally divorced (Government of Nova Scotia,2013). In 2006, there were approximately 55,632 personswho were separated, widowed, or divorced among the330,751 persons aged 15 years and over in Capital Health.This represents approximately 17% of the population (referto Table 27). The proportions of people separated, widowed,or divorced does not vary greatly across the CHBs, with the highest percentage in Dartmouth and the lowest inCobequid. These rates have either remained the same or increased slightly, from 1996 to 2006, with the exception of Halifax Peninsula where there has been a decrease over time.In 2006, according to Statistics Canada, there were 32,649,482 people in Canada and 3,194,123 are widowed or divorced(9.8%). This does not include people who are legally married but separated and it also includes people in the populationbelow the age of 15 years.

Number and Percent of Population Age 15 Years and Over, Who are Separated, Widowed, or Divorced,by CHB, 2006

Table 27

Note. Data from Government of Nova Scotia (2013). The highest and lowest proportions for CHBs are bolded.

Chebucto West 71,358 12,318 (17.3)

Cobequid 66,534 9,088 (13.7)

Dartmouth 57,431 11,537 (20.1)

Eastern Shore – Musquodoboit 17,955 3,158 (17.6)

Halifax Peninsula 64,472 11,333 (17.7)

Southeastern Dartmouth 34,231 4,764 (13.9)

West Hants 18,029 3,315 (18.3)

Capital Health 330,751 55,632 (16.7)

Persons 15 Years and Over Persons Separated, Widowed, Divorced, n (%)


Results41

SUMMARY

When exploring the CCHS data, the primary data source for this population health report, we found the mean age ofthe survey participants to be 45.6 years (range of 15 to 91years; median 47.0 years). The highest percentage of surveyparticipants was 35 to 54 years (38.5%) followed by 20 to34 years (20.6%). There were an equal proportion of malesand females in the sample. Total deprivation varied betweencommunities within Capital Health with the contribution ofmaterial and social deprivation varying between urban andrural areas. Variation in deprivation was also noted within communities comprised of more than one disseminationarea, emphasizing the need to assess health determinantspotentially associated with health outcomes at the lowestlevel of geography.

Social Deprivation by Dissemination Areas in Capital HealthFigure 8

Social deprivation indices for dissemination areas in Capital Health developed by Pampalon and Raymond (2000) and a 2006 version provided by CIHI (n.d.). Thegeographical data and mapping software were provided by Dalhousie Geomatics Lab.

Figure 8 presents social deprivation by dissemination area for Capital Health. Similar to material deprivation, there is variationthrough the district with pockets of higher social deprivation noted in many communities. Areas with the highest social deprivation appear to be concentrated in the urban core areas of the district with rural areas being less socially deprived.

Social Deprivation


2

3

4



DATA: 1) CIHI, 2006

November 28, 2013

Missing Values

3.2 OBESITY AND CAPITAL HEALTH

In 2011/12, 57.3% (95% CI 53.3 – 61.2) of people aged12 years and older and living in Capital Health were overweight or obese, which is 5% higher than the nationalpercentage (52.3%, 95% CI 51.4 - 52.5, Statistics Canada,2013i). The results of the CCHS (2009/10) suggested thatan even higher percentage of adults aged 18 and over inCapital Health may be overweight or obese, with 63.2%being overweight or obese. In this report, we found thatmales were more likely to be overweight or obese whencompared to females (OR = 1.88, 95% CI 1.54 – 2.30).


Results42

• Variation in self-reported BMI between the Community Health Boards

• With increasing total deprivation, there was an associated increase in being overweight or obese

• With increasing material deprivation, there was an associated increase in being overweight or obese

• Males were more likely to be overweight or obese when compared to females

• With increasing age, there was an increased likelihood of being overweight or obese

• An increased likelihood of being obese but not overweight was linked to fruit and vegetable consumption

below the recommended guidelines. With increasing deprivation, there was an increased likelihood of fruit

and vegetable consumption below the recommended guidelines

• People who were overweight or obese were more likely to report negative physical health. Individuals with

higher deprivation were more likely to report negative physical health

• People who were overweight or obese were more likely to be inactive. Physical activity was not associated

with deprivation

• People who were overweight or obese were more likely to have a mood disorder. Having a mood disorder

was not linked to deprivation

Figure 9 presents the conceptual diagram that was used todescribe the many factors contributing to overweight/obesityas this report was being developed. Material and social deprivation are positioned in the diagram as the underlying context for both individual and community factors, and representthe many social determinants of health. It is important to note that this conceptual diagram for obesity is not complete asthere are many additional factors that contribute to an increased risk of being overweight or obese. The variables capturedin the conceptual diagram are some of the factors that were considered in this population health report.

The following sections discuss variables which were significantly associated with obesity and could be linked to deprivation;the complete results of our analysis can be found in Appendix A.

Using the BMI for each CCHS survey participant 18 years and older, the distribution of BMIs by residential Community HealthBoard was explored. As shown in Figure 10, the majority of participants in each CHB were overweight or obese with thehighest percentage of overweight or obese participants residing in Eastern Shore – Musquodoboit. Those residing in HalifaxPeninsula were less likely to have a BMI category of overweight or obese (OR = 0.44, 95% CI 0.45 - 0.81). It is important tonote that geographic variances of BMIs may be due to the differences in age distribution. For example, the lower likelihoodof being overweight or obesity among those residing in the Halifax Peninsula may be due, in part, to the population beingyounger in that CHB when compared to other CHBs.


Results43

Conceptual Diagram for Factors Associated with ObesityFigure 9

Note. This diagram does not capture all factors that have been associated with overweight or obesity.


Social Deprivation

OBESITY

Healthy Eating

Cost of Food

BreastfeedingInitiation

Level of Transportation

Level of Recreational

Activity

BreastfeedingDuration

Food Literacy

Density of Fast Food Establishments

Food Access

House Security Presence of Supermarkets

Fruit & VegetableConsumption

Fiber Intake

Safety of UnmotorizedTransport

Opportunity ofUnmotorizedTransport

Screen Time (T.V.,Computer, Video)

Cost for PhysicalExercise

Access to Opportunities forPhysical Activities

Physical Education

Pre-PregnancyBMI

GestationalWeight Gain

DiabetesPrevalence

High BloodPressure

Cancer

CardiovascularDisease

RespiratoryDisease

MaternalSmoking

Walkability

GreenSpaces

Sugar Intake

Portion Size

Physical Activity

Percentage of Adults With Self-Reported Body Mass Index of Normal or Underweight, Overweightor Obese, Aged 18 and Over, Capital Health, 2009/10 (n = 1709)Figure 10

Normal or Underweight Overweight or Obese

Self-

Repo

rted BM

I (%) 100.0%

80.0%

60.0%

40.0%

20.0%

0Chebucto West

(n = 363)Cobequid(n = 375)

Dartmouth(n = 362)

ES/Musquodoboit(n = 362)

Halifax Peninsula(n = 375)

SE Dartmouth(n = 361)

West Hants(n = 358)

Community Health Board

3.2.1 DEPRIVATION AND OBESITY

As a proxy measure for the determinants of health, the association between total, material and social deprivation,and obesity was examined. The percentages of self-reportedBMI within each category of total deprivation were first examined. As shown in Figure 11, more individuals in thetwo most deprived quintiles reported a BMI of overweight or obese than those in the two least deprived quintiles.


Results44

Percent of Adults With Self-Reported Body Mass Index of Normal or Underweight, Overweight or Obese,by Total Deprivation, Aged 18 and Over, Capital Health, 2009/10 (n = 1709)

Figure 11

Self-

Repo

rt BMI (%)

100.0%

80.0%

60.0%

40.0%

20.0%

0.0%

Total Deprivation

60.1% 55.1% 63.8% 69.8% 67.8%

1 (20% Least Deprived) 2 3 (Average Deprivation)


4 5 (20% Most Deprived)

The distribution of the self-reported BMIs reflects that individuals residing in areas with the highest total deprivation(categories 4 and 5) are the most likely to report a BMI of overweight or obese. The odds of a person in the highestdeprivation category being overweight or obese are 1.39 times greater than for a person in the lowest deprivation category(refer to Figure 12).

Note. The asterisk indicates a significant association between category of total deprivation and the odds of having a BMI of overweight or obese. The 20% leastdeprived category (1) was used as the reference category (odds ratio = 1), with all other categories of deprivation being compared to the reference category. Thetotal deprivation ranges from 20% least deprived (1) to 20% most deprived (5).

The Odds of Having a Body Mass Index of Overweight or Obese Based on Total Deprivation, AdultsAged 18 and Over, Capital Health, 2009/10 (n = 1720)

Figure 12

Odds

Ratio

2

1.5

1

0.5

0

Total Deprivation Index

1 2 3 4* 5*

As material and social deprivation may have different influences on the likelihood of being overweight or obese, each component of deprivation was explored. The proportion of individuals with a BMI of normal/underweight, and overweight/obeseby material deprivation categories are summarized in Figure 13. Among individuals residing in areas with the highest materialdeprivation, there are a higher proportion of self-reported BMIs that were overweight or obese. The lowest percentage ofself-reported BMIs of overweight or obese is among individuals residing in communities of the lowest materialdeprivation.


Results45

Percent of Adults With Self-Reported Body Mass Index of Normal or Underweight, Overweight or Obese,by Material Deprivation, Aged 18 and Over, Capital Health, 2009/10 (n = 1707).

Figure 13

Self-

Repo

rt BMI (%)

100.0%

90.0%

80.0%

70.0%

60.0%

50.0%

40.0%

30.0%

20.0%

10.0%

0.0%


57.2% 52.9% 68.1% 69.2% 69.1%




Further evidence of the association between material deprivation and BMI can be seen in Figure 14, which presents the odds ratio of having a BMI of overweight orobese by material deprivation category. The findings suggestthat with increasing material deprivation, the likelihood ofbeing overweight or obese increases. With the exception of those residing in areas with a material deprivation of category 2 (20 to 40% least deprived), individuals residingin areas with increasing material deprivation are more likely to be overweight or obese when compared to thoseresiding in areas with the lowest deprivation. The odds ofan individual in areas with the highest materialdeprivation being overweight or obese are 1.67 timesgreater (95% CI 1.23 – 2.27) when compared to thoseresiding in areas with the lowest material deprivation.

When looking at social deprivation and BMI, the findings are significantly different to what was seen for material deprivation(refer to Figure 15). Individuals who fell in the lowest social deprivation category are more likely to be overweight or obesethan those in the most socially deprived category. Furthermore, those who reside in areas with average social deprivation aremore likely to report being overweight or obese than those who were in the most deprived category.


Results46

Note. The asterisk indicates a significant association between category of material deprivation and the odds of having a BMI of overweight or obese. The 20% leastdeprived category was used as the reference category (odds ratio = 1), with all other categories of deprivation being compared to the reference category. The totaldeprivation ranges from 20% least deprived (1) to 20% most deprived (5).

The Odds of Having a Body Mass Index of Overweight or Obese Based on Material Deprivation, AdultsAged 18 and Over, Capital Health, 2009/10, (n = 1720)

Figure 14

Odds

Ratio

2.5

2

1.5

1

0.5

0

Material Deprivation Index

1 2 3* 4* 5*

Percent of Adults with Self-Reported Body Mass Index of Normal or Underweight, Overweight or Obese,by Social deprivation, aged 18 and over, Capital Health, 2009/10 (n = 1707).

Figure 15

Self-

Repo

rted

BMI (%)

100.0%

90.0%

80.0%

70.0%

60.0%

50.0%

40.0%

30.0%

20.0%

10.0%

0.0%

SocialDeprivation

64.7% 62.0% 67.7% 64.8% 63.3%




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