Isles of Notre Dame Health Service Area
Twillingate-New World Island
Community Profile
Fall 2013
Prepared by:
Allison Scott, Primary Health Care Facilitator & Jessica Boyd, Community Development Public Health Nurse
Acknowledgements
We would like to thank the people of the Twillingate-New World Island area and Central Health Staff for their
participation in the community profile process. In particular, the Community Advisory Committee along with
the Primary Health Care Lead Team provided valuable support and information to ensure that this profile is
a document complete with rich data from both qualitative and quantitative sources. We look forward to
partnering with others in our area and within Central Health to follow through with our developed action
plans and make a difference in Primary Health Care in our communities.
Index of Acronyms
Many acronyms are used throughout this document. To make it easier to read, a list of commonly used
acronyms is listed below.
NDBMHC: Notre Dame Bay Memorial Health Centre
NWICHC: New World Island Community Health Clinic
JPRMHC: James Paton Regional Memorial Health Centre
CNRHC: Central Newfoundland Regional Health Centre
TWNWI: Twillingate-New World Island
NWI: New World Island
CRIHA: Central Region Integrated Health Authority
PHC: Primary Health Care
PHCLT: Primary Health Care Lead Team
CAC: Community Advisory Committee
EI: Employment Insurance
PHN: Public Health Nurse
BMI: Body Mass Index
LTC: Long Term Care
PCH: Personal Care Home
CYFS: Child, Youth and Family Services
CCHS: Canadian Community Health Survey
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Table of Contents
1. Introduction
1.1 What is a Community Needs Assessment?
1.2 Where did the information come from?
1.3 Data presentation & Interpretation
1.4 Central Health
2. Twillingate-New World Island, Isles of Notre Dame Health Services area
2.1 History
2.2 Geographic Profile
2.3 Population
2.4 Migration
2.5 Live Birth Trends
2.6 Section Highlights
3. Determinants of Health
3.1 Education
3.1.1 Level of Education
3.1.2 School Enrolment/Graduation Rate
3.1.3 School Environment
3.1.4 Section Highlights
3.2 Employment and Working Conditions
3.2.1 Local Industry
3.2.2 Employment Rate
3.2.3 Youth Employment Rate
3.2.4 Employment Insurance Incidence
3.2.5 Section Highlights
3.3 Income and Personal Status
3.3.1 Personal Income per Capita
3.3.2 Self Reliance
3.3.3 Income Support Assistance Status
3.3.4 Section Highlights
3.4 Healthy Child Development
3.4.1 Number of Children & Age Range
3.4.2 Lone Parent Families & Income
3.4.3 Prenatal Care
3.4.4 Early Childhood Learning and Child Care Services
3.4.5 Live Births and Birth Weight
3.4.6 Child, Youth and Family Services
3.4.7 Section Highlights
3.5 Physical Environment
3.5.1 Housing
3.5.2 Water Quality
3.5.3 Roads
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3.5.4 Transportation
3.5.5 Safety
3.5.6 Sense of Belonging to the Local Community
3.5.7 Exposure to Second Hand Smoke
3.5.8 Section Highlights
3.6 Personal Health Practices and Coping Skills
3.6.1 Smoking
3.6.2 Alcohol Use
3.6.3 Drug Use
3.6.4 Gambling
3.6.5 Physical Activity
3.6.6 Mammography
3.6.7 Cervical Screening
3.6.8 Prostate Screening
3.6.9 Colorectal Cancer Screening
3.6.10 Sexually Transmitted Infections
3.6.11 Immunizations
3.6.12 Oral Hygiene
3.6.13 Fruit & Vegetable Consumption
3.6.14 Section Highlights
3.7 Health Services
3.7.1 Primary Health Care Provider Profile
3.7.2 General Practitioner Profile
3.7.3 Service Profile
3.7.4 Regional Services
3.7.5 Non-Central Health
3.7.6 Secondary Services
3.7.7 Adjacency to Secondary Services
3.7.8 Migration Patterns
3.7.9 Access to Family Physician/PHC provider
3.7.10 Satisfaction with Health Care
3.7.11 Primary Reason for use of Emergency Department
3.7.12 Section Highlights
4. Health Outcomes or Status
4.1 Self Perception of Health
4.2 Self Perception of Mental Health
4.3 Life Stress Status
4.4 Overweight/Obesity
4.5 Underweight
4.6 Chronic Disease Rates
4.6.1 Diabetes
4.6.2 Cardiovascular Disease
4.6.2.1 High Blood Pressure
4.6.2.2 Acute Myocardial Infraction
4.6.2.3 Stroke
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4.6.3 Arthritis
4.6.4 Asthma
4.6.5 Chronic Obstructive Pulmonary Disease
4.6.6 Cancer
4.6.7 Mood Disorder
4.7 Chronic Pain
4.7.1 Pain or Discomfort, Moderate or Severe
4.7.2 Pain or Discomfort that Prevents Activities
4.8 Dementia
4.9 Participation and Activity Limitation
4.10 Section Highlights
5. Morbidity and Mortality
5.1 Hospital Morbidity
5.2 Mortality
5.2.1 Total Mortality Rates
5.2.2 Infant Mortality Rates
5.2.3 Potential Years of Life Lost
5.2.4 Potentially Avoidable Mortality
5.2.5 Avoidable Mortality from Preventable Causes
5.2.6 Avoidable Mortality from Treatable Causes
5.2.7 Unintentional Injury Deaths
5.2.8 Intentional Injury Deaths
5.29 Leading Causes of Death
5.3 Section Highlights
6. Community Assets
7. Health Priorities
7.1 We Learned
7.2 Recommendations
8. Next Steps
8.1 Action/Implementation Plan
8.2 Primary Health Care Model
8.3 Strengths, Challenges, Opportunities
9. References
Appendix A
Appendix B
Appendix C
Appendix D
Appendix E
Appendix F
Community Advisory Committee Consultation
Primary Health Care Lead Team Consultation
Consultation with Community Supports Staff
Community Youth Network and Early Outreach Worker Consultation
Clergy Consultation
Primary Health Care Action Plan
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Introduction
1.1 WHAT IS A COMMUNITY NEEDS ASSESSMENT?
One of the responsibilities of a health authority within the provincial Regional
Health Authorities Act is to assess health and community services needs in its
region on an ongoing basis.
A Community Health Assessment (CHA) is a dynamic, ongoing process
undertaken to identify the strengths and needs of the population, to enable
community-wide establishment of health priorities, and facilitate collaborative
action planning directed at improving community health status and quality of life.
The purpose of a community health assessment is to collect, analyze and
present information so that the health of the population can be understood and
improved, and to provide evidence to inform health service planning. It provides
baseline information about the health status of community residents, encourages
collaboration with community members, stakeholders, and a wide variety of
partners involved in decision-making processes within the health care system,
tracks health outcomes over time, and helps to identify opportunities for disease
prevention, health promotion and health protection (Community Health
Assessment Guidelines, Manitoba, 2009).
Understanding the communities it serves will ultimately provide Central Health
with evidence based knowledge to help it work towards its vision of Healthy
People, Healthy Communities.
1.2 WHERE DID THE INFORMATION COME FROM?
Information for this profile was gathered from a variety of sources and included
data from primary and secondary qualitative and quantitative sources. Part of the
process included validating findings and asking people from their own
perspective what they know. For this profile, consultations were carried out with
the Community Advisory Committee (CAC), the Primary Health Care Lead Team
(PHCLT) as well as with specific groups of individuals that could provide
information to fill in identified gaps in information. Consultation notes are included
in the appendix of this document.
1.3 DATA PRESENTATION AND INTERPRETATION
The Isles of Notre Dame Primary Health Care (PHC) facilitator and Community
Development Public Health Nurse took a lead role in collecting, presenting and
interpreting the data. Assistance from others was obtained as necessary. Data is
presented in this document in what is hoped to be a clear and usable fashion.
1.4 ABOUT CENTRAL HEALTH
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Central Health is the second largest health region in Newfoundland and
Labrador, serving a population of approximately 95,000 and offering a full
continuum of health care services that are dispersed throughout the region. As
seen in the figure below, the Central Health region extends from Charlottetown in
the east, Fogo Island in the northeast, Harbour Breton in the south to Baie Verte
in the west. Central Health is challenged by its rural land mass as the
geographical area encompasses more than half of the total land mass of the
island.
The organization has approximately 3,000 employees including salaried
physicians and over 900 volunteers. Within the region there is a diverse array of
primary, secondary, long term care, community health and some enhanced
secondary services. These services are provided through a number of health
centers, long term care (LTC) facilities and two regional referral centers. There
are 842 beds throughout the Central region comprised of 264 acute care, 518
LTC, 32 residential units and 28 bassinets. Central Health is also responsible for
the licensing and monitoring of personal care homes and approval of home
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support agencies within the region. The organization partners with the
Miawpukek First Nation to support health services delivery in Conne River.
Twillingate-New World Island (TWNWI), Isles of Notre Dame
Health Services Area
2.1 HISTORY
The TWNWI area has been involved in Primary Health Care since 1998 with it’s
participation in the federally and provincially funded PHC enhancement project
and post project initiatives.
There are two health care facilities owned by Central Health located in the
TWNWI area. Notre Dame Bay Memorial Health Centre (NDBMHC), located in
Twillingate, which opened in 1976 and New World Island Community Health
Centre (NWICHC), located in Summerford which opened in 1974. Along with
many previous changes, in April 2005, a provincial directive saw the
amalgamation of Health and Community Services Central, Central West Health
Care Corporation and Central East Health Care Institutions Board to become the
new Central Regional Integrated Health Authority (CRIHA, now known as Central
Health. NDBMHC and NWICHC both continue to operate under the Central
Health board.
Central Health adopted PHC as its service delivery model upon this
amalgamation and has established formal PHC sites in 6 different areas. One of
these areas continues to be the TWNWI PHC site. As a result of this formal
establishment, TWNWI has a PHC facilitator position, an established CAC and a
PHCLT. The CAC and PHCLT are the two main teams that lead the way in this
health service area for PHC development.
2.2 GEOGRAPHIC PROFILE
Twillingate is an island community located on Newfoundland’s Northeast coast,
just at the entrance of Notre Dame Bay and is made up of two islands joined by a
bridge - the North and South Twillingate Islands.Twillingate Island consists of two
municipalities (Twillingate and Crow Head ) and one Local Service District
(Purcell’s Hr). It is one of Newfoundland'
s oldest seaports and during the 1800'
s
was the most active and prosperous community in northeastern Newfoundland.
New World Island (NWI) is an island in Notre Dame Bay consisting of 19
separate communities. NWI extends from Indian Cove to Summerford. The
greatest distance between any two communities on New World Island is 41km
(Tizzard’s Hr-TooGood Arm). In NWI there are 13 Local Service Districts and two
municipalities (Summerford and Cottlesville).
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The TWNWI Area is part of the Isles of Notre Dame Health Service area which
includes all of Fogo Island, Change Islands, Twillingate, New World Island and
Boyd’s Cove. This community needs assessment covers the Twillingate and New
World Island area. The Boyd’s Cove area information was limited and is captured
in this profile when available.
Twillingate and New World Island are connected by causeways to the mainland
with the first community on the mainland being Boyd’s Cove. This community has
a Local Service District. Boyd’s Cove is 73km from Gander and 51km from
Lewisporte.
.
2.3 POPULATION
The population in Central Region for 2011 was 93,906. This represents
approximately 18% of the total provincial population for 2011. The Central
Region was second only to the Eastern Health Authority with a 2011 population
of 303,253 or 59% of the total population (Community Accounts).
Total population by Health Authority for 2011
Health Authority
Populationi
Central
93, 906
Eastern
303, 253
Western
77, 983
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Labrador – Grenfell
Province
TWNWI
Twillingate
New World Island
Boyd’s Cove
36, 394
514, 535
5,880
2,683
3,168
240
The population has decreased in TWNWI area from 6,340 in 2006 to 5,880 in
2011. The population in Boyd’s Cove also decreased from 305 in 2006 to 240 in
2011.
Based on the Census 2011 data, the median age for TWNWI ranged from 48.2 in
Summerford and 53.4 in Crow Head. The overall median age for this area was
50 years. The province’s median age was 44.
2.4 MIGRATION
Out-migration has increased and birth rates have declined, resulting in an aging
population. When planning for the health of an aging population these factors
must be considered:
- less young people/family members available for support
- declining workforce
- increase in chronic illnesses/conditions
- shift in the services required/location of services access to services
- impact school environment
Population Change 2006-2011
Region
2001
2006
Central
99,865
95,460
Change %
-4.4%
2011
93,906
Change %
-1.6%
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Province
TWNWI
Boyd’s
Cove
512,930
6,580
275
505,470
6,340
305
-1.5%
-3.8%
+10.9%
514,535
5,880
240
1.8%
-7.8%
-21.3%
Between 2006-2011, the population decreased for the TWNWI area by 7.8%.
The biggest decrease in population within the area was in the community of
Boyd’s Cove at 21.3%. The total population in the province has increased from
2006-2011 by 1.8%.
2.5 LIVE BIRTH TRENDS
The number of births and deaths must be considered in any discussion of
population change. In 2006, there were 50 births recorded for TWNWI compared
to 35 births recorded in 2011. Over a six year period (2006-2011) the total
number of births was 220. The total number of deaths for this same time period
was 340.
Twillingate
New World Island
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2.6 SECTION HIGHLIGHTS
The population in our local, regional and provincial area is aging. There are more
individuals in this local area within the 50+ age range than below 50 years of age.
There are more individuals dying than being born each year. This has an impact
on the community overall and our health service delivery.
The Determinants of Health
The 1986 report Achieving Health for All: A Framework for Health Promotion
focused on the underlying prerequisites or determinants of health and illness. It
suggested that a number of influences and their interaction had major impacts on
the health and well-being of a population. Factors such as social, economic,
cultural and physical environment play a role-for better or worse-in the health of a
community. This means that making improvements in the health and well-being
of Canadians must go beyond delivery of health care services and include action
on the broad determinants of health. The determinants covered in this report are:
• Income and Social Status
• Employment and Working Conditions
• Physical Environments
• Social Support Networks
• Social Environments
• Education
• Health Child Development
• Personal Health Practices and Coping Skills
• Biology and Genetic Environment
• Gender
• Culture
• Health Services
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These determinants of health, as they exist in the TWNWI area and the impact
they are having on the health of the region, will be examined in this section of the
report.
3.1 EDUCATION
Education is an important determinant of health that provides individuals with the
skills needed to be productive members in their communities and in their field of
work. Education enables individuals to make healthy choices, promotes job
stability and security, and offers control over life circumstances.
According to the Health Canada Statistics Report on the Health of Canadians,
educational attainment is positively associated with the economic status and
health outcomes including healthy lifestyles and behaviors. Education increases
the opportunity for employment and income, and contributes to self worth and
control.
3.1.1 Level of Education
Census 2006 reported 30% of people age 18 -64 in the Central Health Region do
not have a high school diploma compared to 22% in the province. This rate is
much higher in the NWI area at approximately 53% and in Twillingate at 38%. In
this area 11% had a University degree compared to 19% in the province.
Educational Comparisons age 18-64, 2006
Without Highschool Certificate
High School Certificate Only
Apprenticeship/Trades
College or Non-University
University
0% 10% 20% 30% 40% 50% 60%
Province
CH Region
NWI
Twillingate
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For Boyd’s Cove, for the same age range and year, 0% had University, 12.5%
had College or Non-University, 37.5% had Trades, 18.8% had High School only
training, and 31.3% did not have a High School certificate.
*More recent data could not be obtained for this section.
3.1.2 School Enrolment Graduation Rate
Up until recently, the schools in the Isles of Notre Dame Health Service area
were under the direction of the Nova Central School District (NCSD). In the
spring of 2013, the provincial government released its 2013 budget plan
changing the division of school boards into two main boards the Newfoundland
and Labrador English School Board (NLESB) and the Conseil Scolaire
Francophone (CSFP).
The provincial government reports that since school board administration was
last consolidated in 2004, school enrollment has declined by almost 14,000
students, or 17%. (Department of Education, NL, 2013).
In Central Region, 11,915 students were enrolled in the school system for the
2012-2013 school year. This is the second highest enrolment by Regional Health
Authority following Eastern Health Authority with 41,275 students.
Furthermore, the Central Region experienced a kindergarten enrolment of 840
students and a grade 12 enrolment of 955 for 2012-2013. This represents fewer
students entering the school system as opposed to those leaving.
The graduation rate for the Nova Central School District in 2011-12 was 91.15%.
Which corresponded to the 834 graduates out of 915 potential graduates
Nova Central School District Enrollment 2003-2013
There are three schools in the TWNWI area. New World Island Academy
(NWIA), a K-12 school located in Summerford, J.M.Olds Collegiate, a high school
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located in Twillingate and Twillingate Island Elementary (TIE) school in
Twillingate for grades K-6.
The enrolment for Twillingate Island (including both schools) has gradually
decreased over the last 20+ years but the rate but has shown little change over
the last couple of years. This is also true for New World Island.
School Year
1989-1990
Total Students 695
Primary
205
Elementary 145
Junior High 160
Senior High 165
20112012
282
20122013
275
65
55
70
85
School Year 1989-1990 2011-2012 2012-2013
Total Students 1,425
399
385
Primary
335
90
Elementary 255
85
Junior High 435
90
Senior High 385
120
For 2011-2012 the graduation rate at J.M.Olds was 96.7% (29 out of 30 eligible
graduates). The rate for NWIA was 97.4% (38 out of 39 eligible graduates).
During that year, 24.1% graduated with honours at J.M.Olds and 21.1%
graduated with honours at NWIA. This graduation with honors rate is lower than
the district and provincial rate at 24.3% and 26.2% respectively. (Department of
Education, NL, 2012-2013). The graduation rate for the 2013 school year for
J.M.Olds was 100% with all 24 students graduating and 100% at NWIA with all
40 students graduating.
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3.1.3 School Environment
The schools in the Isles of Notre Dame Health Service Area are considered
healthy active schools. This means they are following the school food guidelines,
they offer daily physical activity to their students on non physical education days,
and they have a smoke free grounds policy.
The Healthy Students Healthy Schools Initiative started in 2006-2007 as a
component of the Government of Newfoundland and Labrador’s Provincial
Wellness Plan. Intended to take place over five consecutive years, there were a
number of key initiatives implemented to provide direction for schools to create
healthy environments. In collaboration with health professionals, school food
guidelines were introduced and updated, and additional cafeteria equipment for
schools and professional development for caterers was provided (Provincial
Wellness Plan Annual Report, 2011).
The School Food Guidelines outlines a selection of food and beverages that
should be served in school cafeterias, canteens, and vending machines. These
guidelines ensure students are provided with healthy food choices and are given
quality information to promote health and wellness.
In addition to healthy eating, there are provincial initiatives to increase the level of
physical activity in all schools. As part of the Active Schools Project, teachers
have been trained in Quality Daily Physical Activity (QDPA) - a program designed
for grades kindergarten to six to incorporate 20 minutes of non competitive,
physical activity into daily curriculums. For the junior and senior high levels,
students rely more on physical education courses and sports teams within their
schedules and after school for their daily physical activity.
In recent consultations, options for and amount of physical activity within school
time was noted as a concern.
The "Safe and Caring Schools Policy" was launched in September 2006. The
policy defines the roles of school districts, school communities, teachers, and
administrators to ensure a respectful learning environment. Since its
implementation, awareness has been raised as to the serious effects of bullying
and harassment. Several aspects were included in the initiative, including:
granting of awards to schools for successful projects undertaken in schools and
communities; providing senior high school students with tuition vouchers for
demonstrations of safe and caring actions; producing and distributing brochures
on the Safe and Caring Schools program to parents; delivering teacher in service
on supporting the elimination of violence and harassment in schools; and
collaborating with other organizations, such as the Women’s Policy Office to
support and foster awareness and education at all levels of society (Department
of Education, 2012).
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Both NWIA and T.I.E. have been running the Roots of Empathy program in their
schools. This program is offered to children in elementary grades with the
intention of encouraging empathy and reducing aggressive behaviour. Youth
participating in this program have indicated great interest and participation has
been high.
The PARTY (Preventing Alcohol and Risk related Trauma in Youth) program is
offered annually to grade 10 students in both high schools in the area.
Participation rates and engagement with the youth is high in this program.
Evaluation of this program indicates that this program is a great success.
All three schools in TWNWI area have breakfast programs, with the most recent
program set up at J.M.Olds two years ago. All programs depend on the help of
volunteers and provide breakfast 5 days/week to students who wish to avail of
the program.
The Early Youth Outreach worker and Public Health Nurse with Central Health
along with community partners such as RCMP and Fire Departments offer
various programs in the schools on a regular basis to support healthy living,
safety and positive development in youth.
3.1.4 SECTION HIGHLIGHTS
School enrollment has been decreasing within this local area over the past
couple of decades however enrolment appears to have stabilized over the last
couple of years and in one local school the enrolment number increased slightly
in this school year. Graduation rates are high, at 100% in the last school year.
There have been many efforts in increasing opportunities for healthy lifestyles for
the children within schools in this area. However, recent concerns regarding a
decrease in physical education time as well as lack of healthy food options, along
with consistency with the options brought into the schools have been noted.
3.2 EMPLOYMENT AND WORKING CONDITIONS
Unemployment, underemployment, and conditions of employment are associated
with poorer health outcomes. People are healthier when they have a job. They
are healthiest when they feel that the work they do is important, when their job is
secure, and when their workplace is safe and healthy (Circle of Health, 1996).
3.2.1 Local Industry
The leading industry in Central Health is sales and service followed by
manufacturing construction and primary industry, 26%, 23%, 13% respectively
(Census, 2006).
The primary sector includes:
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fishers
loggers
miners
farmers
etc.
The construction and manufacturing sector includes:
construction
mechanics
equipment operators
labourers
fish plant workers
etc.
The sales and service sector includes:
health professionals and providers
teachers and others employed in the education department
sales and service industry, such as retail works, food and beverage
workers, etc.
office staff and other related positions
etc.
As per the last profile the leading industry in 2006 was manufacturing and
construction (31%), followed by Sales and Service (27%) (TWNWI Profile 20092010). It was noted in consultations that the Tourism Industry in Twillingate has
been steadily increasing over the past few years. No other change in industry
was noted and there is no up to date data available.
3.2.2 Employment Rates
The labour force consists of people who are currently employed and people who
are unemployed but were available to work in the reference period and had
looked for work in the past 4 weeks. The unemployment rate is a traditional
measure of the economy. Unemployed people tend to experience more health
problems. The unemployment rate for Central Region was 17% compared to
12.7% in Newfoundland and Labrador (Labour Force Survey, Statistics Canada,
2011).
In 2005 the provincial employment rate of 76.7% was slightly above the
employment rate for Central Region (73.6%). In 2005 for Twillingate Island the
employment rates for the entire year was 79.6%. For New World Island, 2005,
the rate was 71.7% and for Boyd’s Cove the rate was 81.3%.(Community
Accounts). There is no up to date data available for this area.
3.2.3 Youth Employment Rates
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According to Statistics Canada Health Profile, October 2011, 28.3% of the youth
aged 15 - 24 are employed within the Central Region. This is higher than the
provincial rate of 21.5%.
In consultation with the Community Youth Network (CYN) coordinator, it was
noted that within this local area there is limited opportunity for employment for
youth. The majority of employment opportunities for youth are through the
Summer Employment grant programs in the area.
3.2.4 Employment Insurance (EI) Incidence
The EI incidence reflects the number of people receiving employment insurance
benefits in the year divided by the total number of people in the labor force. The
labor force is defined as the number of people who received employment income
or employment insurance within the year.
The EI incidence for Central Region in 2011 was 44.1%, which is higher than the
provincial rate (31.3%) and the highest among the four regions. Since 1992, the
EI incidence in Central has dropped by 17%. However, Central has consistently
had a higher rate of EI incidence compared to the province and the regions.
The EI Incidence for TWNWI has changed very little in the past 10+ years. The
percentage of people in the labor force in NWI who collected EI at some point
during 2011 was 67.4% and in 1992 it was 77.8%. The percentage of people in
the labor force in Twillingate who collected EI at some point during 2011 was
54.7%, in 1992 it was 67.3%. The percentage in Boyd’s Cove was 72.7%, in
1992 it was 86.7%. The provincial rate in 2011 was 31.3%.
Employment Insurance Incidence, New World Island
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Employment Insurance Incidence, Twillingate
Geography
Employment Insurance incidence 2011
Newfoundland and Labrador
31.3%
Cottlesville
63.3%
Moreton’s Hr
56.3%
Summerford
67.6%
Valleypond
66.7%
Boyd’s Cove
72.7%
Bridgeport
75.0%
Herring Neck-Cobb’s Arm –Newville*
65.7%
Twillingate Island
54.7%
Data was not available for all communities in the TWNWI area.
The average total EI benefits increased substantially in 2009, partly due to the
federal government'
s Economic Action Plan that temporarily increased the
maximum number of eligible weeks of benefits from 45 to 50.
The average benefits for those individuals collecting EI in NWI (2011) was
$9,700 and for Twillingate Island it was $9,500 compared to $6,800 for both
areas in 1992. For Boyd’s Cove (2011) the average benefits was $9,400 in
comparison to 1992 when it was $7,200. In comparison, the provincial average
benefits (2011) was $8,400 (Community Accounts).
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Average Employment Insurance benefits received, New World Island
Average Employment Insurance Benefits Received, Twillingate
3.2.5 SECTION HIGHLIGHTS
Seasonal employment is very common for the TWNWI area with the fishing
industry and tourism industry being major employers. It is therefore not surprising
that the EI Incidence rate in all the communities of TWNWI is significantly higher
than that of the province. There is some difference between the areas with
Twillingate having the lowest incidence rate at 54.7% and Bridgeport having the
highest incidence rate at 75.0%.
3.3. INCOME AND PERSONAL STATUS
Research indicates that income and personal status is the single most important
determinant of health. Studies show that health status improves at each step up
the income and social hierarchy (Public Health Agency of Canada, June 2003).
3.3.1 Personal Income Per Capita
Personal income per capita is defined as income from all sources received by an
individual and includes employment as well as government transfers, such as
Canada Pension, Old Age Security, EI and Social Assistance.
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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21
Within Central Region, the gross personal income for 2010 was $24,700, which
was the lowest among the four regional health authorities, lower than the
province ($28,900) and even lower than the country ($31,600). The rate in
Twillingate was $23,100 and for New World Island it was lower still at $19,300.
New World Island Personal Income Per Capita
Twillingate Personal Income Per Capita
3.3.2 Self Reliance
A community’s level of self-reliance is an indicator of the ability to earn income
independent of government transfers, such as Canada Pension, Old Age
Security, Employment Insurance and Social Assistance. The higher the level of
self-reliance, the lower the dependence on government transfers.
In 2010, the self reliance ratio for Central Region was 72.5%, which is the lowest
among the four regional health authorities, the province (80.1%) and the country
(87.2%). Twillingate and New World Island had a lower self reliance ratio at
66.1% and 57.5% respectively.
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Food Bank/Community Kitchen/Other Resources
There are two food banks in the TWNWI area, located in Summerford and
Twillingate. There are more people accessing the NWI food bank than the one
located in Twillingate. Approximately 60 individuals/families regularly access the
NWI food bank and 14-20 accessing in Twillingate.
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A community kitchen was initiated in the summer of 2013 by community partners,
offered at the United Church in Newville. Six individuals participated in this
program and future planning is in place.
3.3.3 Income Support Assistance Status
In 2011, the number of individuals within Central Region who received Income
Support Assistance at some point was 9,270. In Newfoundland, it is noted that
the rate of income support assistance is at a historic low. In 2013 the rate was
7% (Govt. of NL Website).
In 2011, 9.7% of the Central Region population received income support, which
is the second highest among the four health authorities and is slightly higher than
the provincial average of 9.6%. While the rate for New World Island has been
declining since 1992 (21.8%) it was significantly higher than the Province in 2011
at 12.4%. For Twillingate the rate of Income Support Assistance has also been
declining since 1992 (13.5%) and was lower than the province, the health region
and New World Island in 2011 at 7.6% (Community Accounts).
New World Island, 2011
Twillingate, 2011
In the TWNWI area the community with the highest rate of income support
assistance was Virgin Arm-Carter’s Cove-Chanceport area with a rate of 22.5%
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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in 2011, followed by Summerford at 13.4%. The area with the lowest rate of
income support assistance was Boyd’s Cove at 7.3%.
For New World Island, 2011, the average benefits of those collecting income
support assistance was $7,300, up from the 1991 rate of $3,500. For Twillingate,
2011, the average benefits was $6,500 and in 1991 it was $3,500. For Boyd’s
Cove, 2011, the average benefits of those collecting income support assistance
was $5,200, up from the 1991 rate of $2,500. The average benefits for those
people collecting Income Support Assistance in the Central Health Authority in
2011 was $7,000, provincially the average benefit was $7,100.
The total number of children ages 0-17 in NWI who were in families receiving
Income Support Assistance in 2011 was 95, lower than that in 1991 at 465. The
total number of children in Twillingate was 50, a decline from 1991 number of
180.
In 2011, the average duration or the average number of months people were
collecting Income Support Assistance in the Central Health Authority was 9.1
months, provincially the average was 9.3 months. For New World Island the
average was 9.4 months, in Twillingate it was 9.3 and in Boyd’s Cove 7.7
(Community Accounts).
3.3.4 SECTION HIGHLIGHTS
While there appears to be improvements in the overall income status of people
overall in the province, region and local area, there is still a significant difference
in most categories of income in comparing the Twillingate and NWI areas with
indication that NWI overall is faring worse than Twillingate within this category.
3.4 HEALTHY CHILD DEVELOPMENT
“Healthy child and youth development begins long before birth and is one of the
key determinants for health and well-being throughout life. A healthy child is one
who thrives through each developmental stage and is positioned to reach his or
her potential in adulthood. The capacity for a child to develop in a healthy
manner depends greatly on the environment in which he or she is raised”
(Department of Health and Community Services, 2011).
There is strong evidence that prenatal and early childhood experience influence
coping skills, resistance to health problems and overall well being for the rest of
one’s life. Children born to low-income families are more likely than those born to
high-income families to have low birth weights, to eat less nutritious food, and to
have more difficulty in school.
3.4.1 Number of Children and Age Range
Population of Children in 2011 (Statistics Canada, 2011)
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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Age
Group
0 - 19 yrs
0 - 4 yrs
5 – 9 yrs
10 – 14
yrs
15-19 yrs
Canada
Newfoundland
and Labrador
7,785480 106,225
1,877,095
24,495
1,809,895
25,105
1,920,355
27,035
Central
Health
18,450
4,036
4,256
5,062
Twillingate
Island
400
75
75
120
New World
Island
530
110
110
150
2,178,135
5,096
130
160
29,590
In 2006, the Central Health Authority had 20,150 children in the 0-19 year old
age group. This decreased to 18,450 in 2011.
The total number of children ages 0-19yrs for the TWNWI area has decreased
from 1205 in 2006 to 930 in 2011. The largest group of children in all TWNWI
was those ages 15-19yrs with a total of 290.
3.4.2 Lone-Parent Families and Income
In Newfoundland, the total number of lone parent families in 2011 was 24,420.
In 2006, New World Island had 115 lone parent families and in Twillingate there
were 115. In 2011, the total lone parent families for NWI remained the same at
115 and in Twillingate it decreased to 105. For Twillingate, 80 of these families
were female-led and 25 were male led. For New World Island, 75 were led by
female and 40 were led by male (Community Accounts).
Half of the lone parent families in the Central Region had incomes of more than
$27,100 in 2009. Half of the lone parent families in the province had incomes of
more than $29,800, the average income for Twillingate area was $28,500 and for
New World Island it was $25,100. The national value was $36,100 (Community
Accounts).
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Incidence of Low Income: All Lone Parent Families
In Twillingate, the incidence of low income in lone parent families increased in
2004 at 51.2% from 44.8% in 2003, but steadily decreased after that to 33.9% in
2009. The incidence for New World Island has been steadily decreasing since
2003 (48.7%) to 42.7% in 2009. The province’s incidence rate in 2009 was 35%.
By comparison, for couple families, the incidence rate of low income is much
less.
For New World Island in 2009 the rate was 9.4%. For Twillingate in 2009, the
couple families low income incidence rate was 5.8%. (Community Accounts)
3.4.3 Prenatal Care
Limited information is available in Canada on prenatal care. Prenatal care can
impact infant morbidity and mortality. Nova Scotia Department of Health, (2002)
recommends that women have visits for prenatal care every four to six weeks up
to the 7th month of pregnancy, every two to three weeks in the 7th and 8th month,
and every one to two weeks thereafter. This is the guideline followed by the
province of Newfoundland and Labrador for prenatal care policy and best
practice as well (Public Health New Life Series). Prenatal care can reduce risks,
detect early complications and promote healthier pregnancies
In 2012 the total number of referrals received by the public health nurse (PHN)
for prenatal care remained the same as the 2011 number at 19 prenatal (9,
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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Twillingate, 10, NWI). The number of referrals increased in 2013 with 23 referrals
already received as of August 2013 (14 from Twillingate, 9 from NWI). Most of
these referrals are received for women in their first trimester of pregnancy. All
PHN prenatal referrals are contacted and screened to determine their education
and support needs. The screening is usually done in an individual session and
then plans made for follow-up in prenatal classes or individual session (Public
Health Program, Central Health, 2013).
3.4.4 Early Childhood Learning and Child Care Services
Prenatal and early childhood experiences have a powerful effect on subsequent
health, well-being, coping skills and competence. Increasing evidence shows
there are critical stages where intervention has the greatest potential to positively
influence health. These stages include the period before birth, early infancy, the
beginning of school and the transition from adolescence to adulthood.
There are many early learning programs that serve children from birth to age six
and their families. These include regulated full-time or part-time child care
centres, family childcare homes, family resource centre programs, school-based
pre-Kindergarten programs, and early literacy programs such as those offered by
public libraries and community centres. There are 96 public libraries located
throughout Newfoundland and Labrador and most offer preschool programs
(Dept of Education, NL, 2013).
Licensed Childcare Centres
The Child Youth and Family Services (CYFS) Department describes a child care
centre as a place where care is provided for up to 60 children on either a parttime or full-time basis. Child care centres must be licensed before they can open
(Department of Health & Community Services, 2012). According to CYFS, there
are 27 licensed daycare centres in the Central Region. In the province as a
whole, this number totals 191 centres.
In TWNWI there are two licensed child care centres, one located in Summerford
and one located in Twillingate both operating within the two local schools by the
YMCA. These two centres are filled to capacity most of the time with 14 spaces
for children in Twillingate and 13 spaces for children in New World Island. The
centre in Twillingate expanded in 2013 to include an afterschool program for
children ages 5-12.
Family Resource Centre (FRC)
FRCs provide a variety of community-based activities and resources for children
from birth to 6 years of age and their families. These resource centres emphasize
early childhood development and parenting support. They provide a place for
families to gather in a friendly and informal setting. A variety of programs are
offered that reflect the needs of the families who are participating and the
communities in which they are located. Types of programs might include drop-in
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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playgroups, Baby and Me groups, parenting workshops, clothing exchanges, toylending libraries, community kitchens and healthy lifestyle sessions (CYFS,
Strategic Plan, 2013). According to CYFS, there are 8 FRC hub sites in the
Central Region and 29 within the province. It is important to note that many of
these hub sites have several satellite sites as well.
There is no FRC in the TWNWI area. It has been noted that FRC programming
would be of great value to parents and children in this local area. This was of
particular concern for NWI.
BURPS (Baby’s growth and development, Understanding role changes,
Resources, Parenting, Support)
BURPS is offered to moms and babies up to the age of 12 months at
NDBMMHC. In 2012 there was a total of 23 BURPS sessions offered with 28
new visits by parents and babies and 180 repeated visits, with an average of 9 in
attendance. As of August 2013 there has been 12 BURPS sessions with an
average of 6 moms and babies in attendance. The majority of those attending
this program are from Twillingate.
Healthy Beginnings Long Term Program (HBLT)
Support is offered from birth until kindergarten entry through the Healthy
Beginnings Long Term Program to newborns, children and their families who,
based on assessed criteria, have potential for poor developmental outcomes.
The numbers for the HBLT program vary from month to month because of
admissions or discharges, the numbers are an average. As well, the assessment
is done based on three categories:
A- Children with known disability
B- Developmental Factors
C- Family Interaction Factors
Twillingate district (2012) (Twillingate district includes the communities of
Indian Cove, Herring Neck, Cobbs Arm, Pikes Arm)
A-1
B- 3
C-5
NWI district (2012) (New World Island district includes communities from
Newville to Boyd’s Cove).
A-3
B-12
C- 15
KinderStart
Kinderstart is a school transition program offered in the year prior to kindergarten
entry. The program consists of five to ten one-hour orientation sessions
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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organized and promoted at the school level for children and their
parents/caregivers. The sessions support children’s adjustment to the school
environment, and provide parents/caregivers with information on how to support
their children’s learning at home (Department of Education, NL, 2013). Funding is
available to parents if transportation is an issue.
Kinderstart attendance at NWIA and Twillingate Island Elementary is close to
100% with usually only a couple of students not attending.
Community Youth Networks(CYN)
Research indicates that one of the prime characteristics of a healthy community
for youth is a rich array of structured opportunities for children and adolescents.
A community youth network (CYN) aims to enhance opportunities by engaging
youth and providing learning, employment, community-building, recreational
activities and supportive services.
The CYN focuses on the assets and needs of youth to assist in the development
of healthy families and communities. Through this network, all youth have equal
opportunity for success. In the province of Newfoundland and Labrador there are
23 hub sites and 13 satellite sites. Of these, 8 are within the Central Region.
The CYN, Isles of Notre Dame is located in Summerford and provides youth
programming to the TWNWI area. Some programs include those related to
music, cooking, sports, and other topics that youth have identified as of interest
to them. There has been great success noted in the CYN of this area based on
the number of youth participating in programs. A total of 86 youth ages 12-18 are
registered as members with this CYN and 25 future club members are registered.
For the period of June 2012-June 2013 there were 1006 drop ins with 40 new
clients in attendance. While the CYN provides programming for all the TWNWI
area it has been noted that the vast majority of youth who are involved in
programming are youth from NWI.
The CYN sponsors and manages the Linkages Program (helping youth attain
their employment goals) for TWNWI. A total of four participants were approved
and placed in businesses under the linkages program in 2012-13. All of these
participants went on to enroll in post secondary education programs.
The CYN also manages the Jumpstart program for the Isles of Notre Dame
(enabling more children to join sports teams by providing financial assistance).
The Jumpstart program for the area processed 38 applications in 2012 and as of
October 2013, 36 applications were received for 2013.
Library Programs for Preschoolers
The Twillingate Public Library offers an early literacy program for preschoolers in
the area and attendance by preschoolers and moms is high and has warranted
an expansion of the program (offered more frequently). The Summerford Public
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Library has offered similar early literacy programs however there was very little
attendance and therefore is not a regularly scheduled program.
MOPS (Mothers of Preschoolers)
MOPS is a community-based group that meets on a bi-weekly basis. The role of
MOPS is to encourage, equip and develop mothers of preschoolers to realize the
potential to share healthy habits for children at a very young age while providing
an opportunity for the child to engage in social and physical activities. In this local
area, a MOPS program is established, with an average of 23 mothers and
children meeting together twice/month.
3.4.5 Live Births and Birth Weight
Births
The total number of births in the Central Region for 2011 was 670; 350 (52%) of
these were male and 320 (48%) were females. This is a 13% decrease since
2010 when there were 770 births. In the province in 2011, there were 4,465 live
births compared to 4,860 in the previous year.
Birth Trends by Health Authority for 2011
Health Authority Males
Females
Totali
Central
350
320
670
Eastern
1,405
1,370
2,775
Western
310
305
615
Labrador
– 210
200
405
Grenfell
Province
2,270
2,190
4,465
i) Numbers may not add to total due to rounding (Community Accounts)
The crude birth rate is the ratio of live births to the population expressed per
1,000. In 2011 the total crude birth rate for Central Health was 7.0. Among the
four health authorities, Central Health had the lowest birth rate. The birth rate for
the province for the same period was 8.8.
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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Birth Rates, Twillingate- New World Island
2010
2011
TWNWI
29
32
2012
42
2013
35
In 2006, the number of babies born in the TWNWI area was 50. After that year,
the number of births decreased every year until 2010. In 2011 & 2012, an
increase has been noted.
Breastfeeding
Of the 42 babies born in 2012, 30 of them were breast fed. Of the 18 babies born
in TWNWI as of August 2013, 8 were breast fed.
Births by Age of Mother
Younger mothers and older mothers are at a higher risk of poorer pregnancy
outcomes (e.g. preterm delivery for younger mothers, caesarean section for older
mothers). While younger mothers are more likely to be underweight and smoke
during pregnancy, older mothers are at an increased risk of being obese or
having chronic medical conditions, such as hypertension or diabetes (Vaughan
DA, Cleary BJ, Murphy DJ., 2013).
Live Births by Age of Mother, 2011
Age Group
Canada
TOTAL
Under 15 yrs
15 – 19 yrs
20 – 24 yrs
25 - 29 yrs
30 - 39 yrs
40+ yrs
Age not stated
377,636
99
13,436
53,478
113,628
184,005
12,915
75
Newfoundland Central
and Labrador Health
Authority
4,465*
670*
5
0
250
55
810
160
1,335
190
2,070
255
85
15
Twillingate
New World
Island
10
0
0
0
5
5
0
25
0
0
10
5
10
0
*Numbers may not add to total due to rounding
The breakdown of children in the pre-school age group by community is noted
in the table below.
Number of children ages Newborn-Age 4 (as of Dec
2011)
TOTAL
Communities Serviced
45
Twillingate
19
Durrell
3
Crow Head
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Purcell'
s Harbour
Summerford
Cottlesville
Carter'
s Cove
Chanceport
Virgin Arm
Fair Bank
Hillgrade
Bridgeport
Newville
Moreton'
s Harbour
Valley Pond
Boyd'
s Cove
Herring Neck
Cobb'
s Arm
1
36
5
17
3
21
8
2
4
7
1
4
3
2
5
Rates of births to mothers 19yrs & under
In 2010, in Central Region, there were 40 women under the age of 18 giving
birth and in 2011 there were 35 women (Community Accounts).
Low Birth Weight Rates
Low birth weight is an indicator of the general health of newborns, and a key
determinant of infant survival, health and development. Low birth weight infants
are at a greater risk of dying during the first year of life, and of developing chronic
health problems.
Low birth weight is defined as weight at birth less than 5.5lbs. Risk factors for low
birth weight include low Body Mass Index (BMI) (<18.5) of the mother, multiple
births, maternal age over 35 years, alcohol consumption, physical abuse, and/or
smoking during pregnancy, as well as low income (Eastern Health, Health Status
Report, 2012)
Newfoundland and Labrador had low birth weight rates above the national
average at 6.7% in 2010. The national rate was 6.2%. There was no up to date
data available for the region or local area for this topic.
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Source: Statistics Canada. Live birth, by birth weight (less than 2,500 grams) and
sex, Canada, provinces and territories, annual (CANSIM Table 102-4005).
Ottawa: Statistics Canada, 2012.
High Birth Weight Rates
High birth weight babies are defined as birth weight above 9lb 14oz. High birth
weight is associated with a higher risk for complications for the mother and baby
at the time of birth. High birth weight may also be associated with increased risk
for childhood obesity (Reilly, 2005). In Canada, there were 6,521 high birth
weight babies born (Statistics Canada, 2012).
For 2005-07, the high birth weight rate for Central Health was 3.4%, which is
higher than the province at 3.1% and Canada at 1.9%. In all the provinces,
Newfoundland’s rate was the second to highest next to the Northwest Territories.
The Central Health rate represented an increase from 2000-02 when it was
2.2%. Newfoundland remained the same. Up to date data was unable to be
obtained for this topic.
3.4.6 Child, Youth and Family Services (CYFS)
Under the Provincial Budget 2009, the new, separate department of CYFS was
created. This department is dedicated to the protection of children and youth
from maltreatment by their parents and to the promotion of healthy development
of children and youth in Newfoundland and Labrador. The department of CYFS is
responsible for administering the following legislation:
• Child Youth Care and Protection Act
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•
•
•
•
Adoption Act
Child Care Services Act
Youth Criminal Justice Act
Young Persons Offences Act
(CYFS Strategic Plan, 2010-2014)
Foster care
In 2013, there were four foster children in the Twillingate-New World Island area.
There are three approved foster homes in the area with two more waiting to be
processed. Since the launch of the provincial Foster a Future campaign an
increase in the number of foster home applications provincially has been noted.
There is a great need for foster homes all over the province.
Child protection
In 2013, there were 10 families in the TWNWI area on the child protection
caseload. It was noted that a regional trend indicated a decrease in the number
of referrals for child protection (CYFS, 2013)
Youth Corrections
In 2013, in TWNWI, there were no youth corrections clients under the CYFS
program (CYFS, 2013).
Adoptions
For TWNWI, 2013, there are a number of adoption clients waiting for children
and one waiting to be processed. One infant adoption took place in this area in
2013.
For the TWNWI area, a trend has been noted that for this local area there has
been an increase in the number of family violence, mental heath and addictions
referrals under the CYFS program (CYFS, 2013).
3.4.7 SECTION HIGHLIGHTS
While the number of children has been decreasing in this local area over the
years, the trend appears to be changing with an increase noted in the
number/year in the last two years. This local area has a number of programs and
resources that support healthy child development and positive growth in youth
however, there are gaps noted. In looking at the HBLT program and comparing
the two areas, more resource development/support appears to be necessary for
NWI. In addition, this area does not have a FRC and our CYN is mainly accessed
by youth in NWI and very little by youth of the Twillingate area.
3.5 PHYSICAL ENVIRONMENT
Physical environment is an important determinant of health. At certain levels of
exposure, contaminants in our air, water, food and soil can cause a variety of
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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adverse health effects, including cancer, birth defects, respiratory illness and
gastrointestinal ailments. In the built environment, factors related to housing,
indoor air quality, and the design of communities and transportation systems can
significantly influence our physical and psychological well-being.
3.5.1 Housing
The table below indicates the number of dwellings in the TWNWI area. Dwellings
requiring repair information was unavailable for this area however through
consultations it was noted that most dwellings are in good condition and
generally necessary repairs are completed as needed.
Ownership of Dwellings, 2011.
Town
Total
Dwellings
Twillingate
1,446
Island
New
World 1,672
Island
Region*
2,320
Occupied by
usual
residents
(permanent
occupancy)
Total # of
people aged
65+ in
private
households
1,173
670
1,352
615
Dwellings
Requiring
Repair (%)
*Source: Statistics Canada, 2011.
Newfoundland and Labrador Housing Corporation (NLHC) offers a Rental
Housing Program that provides low income housing for individuals and families
that cannot obtain suitable and affordable rental housing on the private market.
NLHC owns and administers approximately 5,573 social housing units
throughout various regions of the province, with the greatest concentration of
units located in St. John’s (3,178) and Corner Brook (802). Low-income earners
are the beneficiaries of the program with rental rates based on 25 per cent of
monthly income. Approximately 23 per cent of units are occupied by pensioners.
There are an estimated 14,000 individuals housed in NLHC units under this
program. Through the Rental Housing Program we help households with low
income that cannot obtain suitable and affordable rental housing on the private
market (NLHC, 2013).
NL and Lab housing has 11 units within the TWNWI area. These are all single
family dwellings with 2-4 bedrooms each. All units are occupied. There is a
waitlist of 3 families in the Summerford area (Sept 2012). The breakdown of the
units is as follows:
Twillingate- 3 units
Summerford- 5 units
Cottlesville- 1 unit
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Virgin Arm/Carters Cove- 3 units
As of September 2013, there are two people on the waitlist for this type of
housing in the TWNWI area.
Subsidized apartments are available to people in the area at Evergreen Manor in
Summerford. This is noted to be a valuable resource for independently living
seniors and is filled to capacity with a waitlist. A rent subsidy is also available for
the seniors apartments located in the apartment complex in Cottlesville.
Funding from the Government of NL was received for the development of 10
units of affordable housing in the Twillingate area in 2012. These units have been
constructed and all are filled. Currently more units are under construction for this
purpose.
Individuals requiring placement or community support services such as home
supports require assessment of their level of functioning to determine what
options are available to meet their needs. This assessment determines the “level
of care” required with level one being the lowest and level four requiring the
highest level of care.
As reported by the personal care home coordinator in 2013, Central Health, the
regional vacancy rate for personal care homes has been in the 30% range over
the past couple of years. A trend was noted that vacancies tend to exist more in
the smaller, rural areas and that the facilities in larger centers are typically full.
There is one personal care home (PCH) in the TWNWI area located in
Twillingate with space for 23 individuals. This home is at maximum capacity most
of the time (there may be brief periods when there is a vacancy). This PCH is
licensed to provide care to level one assessed individuals. Individuals in the area
requiring PCH accommodations do access other personal care homes in nearby
areas such as Lewisporte, and Gander Bay which are licensed as level one and
level two.
According to the Regional Coordinator for facility placement, there are no
vacancies in any LTC unit across Central Region and there are a number of
people requiring this type of care that are currently in acute care beds on medical
discharge (2013).
There is one LTC facility in the TWNWI area located at NDBMHC in Twillingate.
This LTC facility has 31 beds, providing care to level three individuals and is at
full capacity.
3.5.2 Water Quality
In Newfoundland and Labrador, regular sampling of public water supplies is
carried out by Environmental Health officers. Boil water advisories (BWA) are
preventative measures and are issued when water sampling and testing detects
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that there may be higher than accepted amounts of bacteria or if there are
deficiencies with regard to chlorination or other forms of disinfection. There were
52 BWAs between 1989 and Sept 6th, 2012 in the Central Region.
As reported by the Department of Environment and Conservation, Newfoundland
& Labrador, there was a BWA issued for Purcell’s Harbour June 18th, 2013 that
was still in effect as of August 12th, 2013. The only other community in the area
with a BWA was Chanceport which was issued in 1989 due to no free chlorine
residual detected in the water destination system. The water supply in this
community is operated by the Local Service District that services a total
population of approximately 35 people.
3.5.3 Roads
No great concern has been noted regarding use of roads in this local area with
the exception of lack of shoulders or sidewalks for pedestrians. Higher levels of
traffic was noted as well as high speeds in areas such as school zones
(Consultation, 2013).
3.5.4 Transportation
Access to affordable, reliable transportation was noted as a priority issue through
the last profile process (2010).
As a result of this noted priority, grant funding was applied for and received for a
Community Wheels Project (CWP). After the success of phase 1, phase 2
funding was applied for and again received. Phase 1 of the project ran from
December 2011-January 2013. After a short break in service (waiting on
extended funding), Phase 2 funding was received in May 2013 for a period of 1
year. As of July 2013, a total of 51 individuals have accessed the bus through the
CWP (combined # for both phases). 28 of these passengers were seniors, 5
were young adults and the remaining were middle aged. All passengers had little
or no available transportation to them and accessed the bus for reasons
including medical appointments, grocery shopping and social events.
Transportation has been noted as a continued concern particularly for youth and
the younger adult population in the area. The community wheels project does not
provide service to anyone under the age of 19. Youth have indicated inability to
attend programs and events on NWI as a result of limited access to
transportation. Parents and service providers have indicated a concern regarding
access to transportation for youth/children to attend medical appointments.
A taxicab service is available in the local area but it is mainly used/accessible for
out of town travel.
3.5.5 Safety
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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38
The most up to date data on reported safety is 2002. Self-reported community
safety for Central Region was 98.4%, for Economic Zone 14, it was 98.7% and
for the province 98.3%.
Although generally the communities of TWNWI are considered to be safe, there
has been a noted increase in concern for safety in relation to theft, break and
enters, and the number of visitors/strangers in the area (Consultations, 2013).
For NWI, 81.3% (2010) consider their community to be safe. This overall data
statement was not available for Twillingate (Survey of Attitudes Towards
Violence, 2010).
The Survey of Attitudes Towards Violence completed in 2010 for the TWNWI
area indicated that safety was more of a concern for New World Island than
Twillingate and Central Region. Some survey question responses are recorded
below.
Survey Question
Twillingate
Responses
I feel safe walking outside alone
92.3%
I feel confident that if I was in personal
danger, strangers nearby would come to 80.8%
help me
New World
Island
Responses
81.3%
Central NL
Region
Responses
82.5%
75%
80.3%
3.5.6 Sense of Belonging to the Local Community
Overall in NL, 80.3% report having a very strong sense of belonging to the
community (ranked 2nd to Nunavut in all of Canada). For Central Region the rate
is 82.6%.
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
Region –
Newfoundland
Central Health & Labrador
Canada
Sense of Community Belonging – 2009/2010
Health Profile – Statistic Canada
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
39
67.2% of people in Twillingate report having a very strong or somewhat strong
sense of belonging to the community. The percentage for NWI is higher at 97.6%
(2009-2010).
Percentage of Population with a Very Strong or Somewhat Strong Sense of Belonging to a
Community, age 12+ (Multiple Year Comparison, with selectable Geographies)
3.5.7 Exposure to Second Hand Smoke
According to Statistics Canada the percentage of the population aged 12+ in
Central Region who reported being exposed to second hand smoke in their own
home on a daily basis decreased from 2009 to 2011 from 8.2 to 5.8%. The
provincial rate decreased as well from 8.0% in 2009 to 5.2% in 2011. Those who
reported being exposed to second hand smoke in vehicles and/or public places
changed very little in the province from 2009-2012. In Central Region there was a
decrease from 16.2% in 2009 to 10.2% in 2012.
Region
Second hand
smoke - home
6.3%
Region
Second hand
smoke – work
and public
areas
15.3%
Province
Home
7.2%
Province
Work and
Public
13.4%
Canada
Home
6.0%
Canada
Work and
Public
14.8%
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
40
*no local data available
In Newfoundland, children’s (aged 0-17) exposure to second hand smoke in the
home has declined significantly from 32% in 2000 to 3.8% in 2011. (Tobacco
Reduction Strategy, NL, 2013-2017)
As of July 1, 2011 it was illegal to smoke in a motor vehicle when a person
under the age of 16 is present. These new amendments also prohibited
designated smoking rooms in workplaces (Department of Health and Community
Services, NL).
3.5.8 SECTION HIGHLIGHTS
In general, housing, water quality and safety are of no big concern in this local
area. However, housing options for those who require a significant amount of
care is a recognized gap. There is no level two care available in this local area
and level three or higher care requiring long term care placement is not available
anywhere in the region as there are no beds available and many on medical
discharge waiting placement. While safety has not been noted as a great
concern, in consultations with various individuals concerns around safety are
greater than they have been in previous years.
3.6 PERSONAL HEALTH PRACTICES AND COPING SKILLS
Personal health practices and coping skills refers to those actions by which
individuals can prevent diseases and promote self-care, cope with challenges,
and develop self-reliance, solve problems and make choices that enhance
health. Although individuals can choose to behave in ways that promote health,
it must be recognized that the social environments in which they live also
influence individual life choices.
3.6.1 Smoking
Tobacco use is the leading cause of preventable illness, disability and premature
death in Canada and the leading cause of preventable death worldwide (Health
Canada & World Health Organization 2011). Tobacco reduction efforts have
been ongoing in Newfoundland and Labrador for several decades however over
81,000 people aged 15 years and over in the province continue to use tobacco
(Health Canada & World Health Organization, 2011).
Furthermore, the rates of tobacco use has not declined significantly since 2005
and continue to be much higher in certain groups such as those in lower
economic status groups, younger adults ages 20-24, those with mental illness,
and aboriginal populations. (Tobacco Reduction Strategy NL, 2013-2017) Also of
significance, 13-27% of women in the province use tobacco during pregnancy
and women under 25 are more likely to report that they smoke regularly while
pregnant.
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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41
Percentage of population who smoke daily, age 12+
.
The CCHS 2009-10 revealed that the rate of smoking among current daily
smokers 12 years of age and older in Central Region was approximately 17.7%.
The provincial rate was slightly higher at 18.6%. In Canada, the rate of smoking
(current daily smokers) for ages 12+ was 15.5%.
Since 2010 the percentage of the population who smoke daily in Central Region
has increased at 21.8% in 2012. In comparing across gender in Central Region,
the percentage of males who smoke daily is higher than females (24.5% males,
19.1 % females, 2012).
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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42
Tobacco use among youth has shown improvements. For youth ages 15-19 the
rate smoking in the province was reduced to half from 1999-2011 at 11%
(Tobacco Reduction Strategy NL, 2013-2017). While no local data was available,
it was noted during consultations that there appears to be a high number of youth
in the area who smoke.
The CARE (Community Action and Referral Effort) program includes a tool for
health care providers to refer their clients to the Smokers’ Helpline. In TWNWI,
health care professionals are continuing to refer patients to the Helpline. The
number of people referred has remained fairly stable over the past few years with
12 people being referred by HPs (11 of which were referred by a nurse, 1 by a
physician) and 2 self-referring in 2011. In 2008, there were a total of 11 referrals.
In 2012, a total of 9 referrals were received for information or support from the
TWNWI area, representing a slight decrease (Smokers’ Helpline, 2012). *This
data may not be completely accurate due to clients not completing the postal
code section on the form.
In 2012 for the Central Region, 143 total referrals were received for the CARE
program. This was a decrease from the 2011 number of referrals at 186.
Similarly, the number of referrals decreased across the province from 1,005 in
2011 to 834 in 2012.
3.6.2 Alcohol Use
Alcohol consumption impacts on health and in excess, can contribute to acute
challenges and chronic physical, psychological and behavioral problems. It is
important to note that Statistics Canada identifies that having 5 or more drinks on
one occasion at least once/month as heavy drinking.
The rate of heavy drinking has increased in Central Region from 27.4% in 200708 to 33.3% in 2009-2010. In Newfoundland the 2009-2010 rate of heavy
drinking is the same as in Central Region which was a slight increase from 200708. In Canada, the rate did not change (approximately 22%).
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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43
Percentage who are heavy drinkers (5 or more drinks on one occasion, 12 or more
times a year), age 12+. Only asked of those who stated they had at least one
drinking in the past year
As reported in the Cross Canada Report on Student Alcohol and Drug Use,
2011, Newfoundland has the one of the highest rates of drug and alcohol use by
youth in every category as compared to the rest of the provinces.
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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44
3.6.3 Drug Use
As reported in the Cross Canada Report on Student Alcohol and Drug Use,
2011, Newfoundland has the second highest percentage of daily or almost daily
cannabis use at 4.6%. The percentage of youth reporting use of cocaine/crack
within the last 12 months in Newfoundland was 5.3%, representing the highest
rate reported in the study.
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
45
For the period of April-June 2013 in TWNWI there were five drug enforcement
related files generated (RCMP, Quarterly Report, 2013). As a comparison, for a
three month period in 2012 the number of drug enforcement related files was the
same.
Through consultations with health providers, it was noted that there is a number
of individuals misusing prescription drugs and abuse was noted in the use of
narcotics.
3.6.4 Gambling
According to the Department of Health and Community Services, Government of
Newfoundland and Labrador (1998) signs of a problem gambler is an individual
who:
•
•
•
•
•
•
•
•
•
•
spends large amounts of time gambling
begins to place larger, and more frequent bets
has growing debt
pins hopes on the big win
promises to cut back on gambling
refuses to explain behaviours, or lies about it
feels frequent highs and lows
boast about winning
prefers gambling over a special family occasion
seeks new places to gamble close to home and away.
According to the Newfoundland and Labrador Student Drug Use Survey (2007),
61.6% of students in Newfoundland and Labrador participated in at least one
gambling activity. This represents a decrease from 65% in 2003 and 74% in
1998. Of students in this province 3.6% met the definition of at-risk gambling
whereas 1.7% met problem gambling criteria.
According to the 2009 Newfoundland and Labrador Gambling Prevalence Study,
gambling prevalence rates have declined to 72% in 2009, from 78% in 2005. Of
those surveyed, 65% were identified as non-problem gamblers. This study
showed a decrease in the prevalence of moderate risk gamblers, from 2.2% in
2005 to 1.1% in 2009; as well as problem gamblers (1.1% in 2005 to 0.1% in
2009). Finally, there was an decrease in the prevalence of low risk gamblers from
4.3% in 2005 to 5.1% in 2004.
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
46
2009 Newfoundland and Labrador Gambling Prevalence Study
Department of Health and Community Services
Overall, 77% of respondents participated in at least one gambling activity over
the past 12 months, a decrease of 7% since 2005. Regionally, prevalence
rates ranged from 72% in Central to 79% in Eastern. All regions experienced
a decrease in gambling prevalence rates, with the exception of LabradorGrenfell (78%), where the prevalence rate has remained relatively stable.
*There was no local data available.
Provincially, the average number of hours spent gambling in a typical month
was 2.4, slightly higher than what was found in 2005 (2.0 hours), and ranged
from an average of 1.9 hours in Central to an average of 2.7 hours in Eastern.
In the past 12 months, the average overall amount spent on gambling
activities per year was $255.40 (~$21.28/month), similar to the amount
reported in 2005 ($249.64, ~$20.80/month).
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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47
There are two businesses located in this area that have Video Lottery Terminals
(VLTs) available for use by individuals. Use of VLTs was noted to be a concern in
this area with individuals using them frequently and for long periods of time
(Consultations, 2013)
3.6.5 Physical Activity
“Regular physical activity is associated with a reduced risk of cardiovascular
disease, some types of cancer, osteoporosis, diabetes, obesity, high blood
pressure, depression, stress and anxiety. As well, strong evidence suggests that
higher levels of physical activity are associated with health benefits. In fact, the
more activity, the greater the health benefit” (Coley, et al., 2011).
The percentage of the population who are physically inactive in the province has
been greater than the Canadian percentage since 1995 (oldest data available).
Percentage of population who are physically inactive, age 12+
In 2011, 52.4% of those aged 12+ in Central Region were physically inactive, the
highest percentage of all health authorities and higher than the provincial rate of
50.1%. In 2012, the rate of physical inactivity in Central Region increased to
61.2%, the highest it has been since 2008 (the oldest data available). The
provincial rate did not change much at 49.3%. The rate of physical inactivity in
those aged 12 and over in the Central Region has been consistently high over
the past several years (Statistics Canada, Health Profile, 2012).
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
48
As reported in the 2013 Active Healthy Kids Canada Report Card, only 5% of
youth aged 5-17 in Canada met the Canadian Physical Activity Guidelines
recommendation for children and youth. The rate in 2007 was 7%.
Parents from low income families report that their children’s opportunities for
physical activity at school do not meet their physical activity needs more so than
parents from high economic status (2013 Active Healthy Kids Canada Report
Card).
According to Kids can Play 2011 series, children and youth in Newfoundland and
Labrador take significantly fewer steps than the national average, at roughly
10,800 steps. Boys in Newfoundland and Labrador take more daily steps on
average than girls, this pattern is similar to that found nationally. Daily steps
decrease as age group increases. In Newfoundland and Labrador, this is
particularly evident when comparing younger children with older teens.
In Newfoundland and Labrador, children who participate in organized physical
activities and sport take on average 2,100 more daily steps than children who do
not participate in these types of activities.
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Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
49
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The percentage of individuals reporting being inactive during their leisure-time
has increased in Central Region since 2010, with Central Region now having the
highest percentage of inactivity compared to the other health authorities, the
province and country (Statistics Canada, 2013).
There has been a great deal of effort from various organizations and individuals
in this local area towards increasing and/or improving physical activity options
within our communities. Most all of the activities for recreation that were noted in
the last profile have continued. In addition to these options some of the new
opportunities are listed below. The recreation committees in the area, the CYN,
the Regional Recreation Director and others have certainly been leaders in this
area of development.
•
•
•
•
•
•
•
•
•
•
Two new playgrounds have been developed (Twillingate and Summerford)
A newly developed ball field has been completed (Summerford)
Use of the rink as well as other sports activities through the CYN
Activities with the NWI 50+ club through the support of the Recreation
Director. Including bowling, line dancing, etc
A Curves has opened in Twillingate
New walking and fitness programs
New World Island Active Kids program (summer 2011)
Kidkicks and other summer recreation programs in Twillingate for youth
Use and development of many walking trails in the area
Increase in afterschool programs for youth at NWIA through funding for
afterschool bussing and development of activities (2012)
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
50
3.6.6 Mammography
Breast cancer will affect 1 in 9 Canadian women during their lifetime. In 2011, it
is estimated that 23,400 women will be diagnosed with breast cancer nationally
(What You Should Know about Breast Cancer, 2011). In 2007, the breast cancer
incidence rate per 100,000 population for Central Health was 80.9 (Statistics
Canada, Canadian Cancer Registry 2007-2009).
Early detection provides more treatment options and increases chance of
survival. Early detection methods of breast cancer include a self breast exam,
physical examination, mammography and biopsy. It is recommended that women
become familiar with their own breasts and seek medical advice if changes are
noticed. Annual clinical breast exams are recommended for women 40 years and
older.
Screening mammography can find breast cancer 2-3 years before it can be felt.
In April 2012 Newfoundland broadened its screening program by recommending
screening for women every 2 years for healthy women 40 years and over. Prior
to this change it was recommended that healthy women 50 years of age and
over be screened. Those women 50 years of age and over with a family history
of cancer or a personal history of ovarian cancer should be referred for an annual
mammogram.
According to the CCHS 2009-10 92.7% of women aged 50-69 in Central Region
have had a mammogram done at least once in their lifetime. This is higher than
the province at 89%.
.
For the period of 2010-2012, a total of 686 appointments for breast screening
took place for women of the TWNWI area (Provincial Breast Screening Program).
3.6.7 Cervical Screening
A simple Pap test will detect early cell changes that are precursors to cervical
cancer. In Newfoundland and Labrador approximately 85,000 women are
screened and 8,000 women will have an abnormal Pap test each year.
Unfortunately that leaves about 14,000 women not screened (Central Health,
2008).
The Cervical Screening Initiatives (CSI) Program was implemented in 2003 to
decrease mortality and morbidity rates of cervical cancer by promoting Pap
participation on a regular basis to all eligible women in the Central Region. In this
province, the mortality rate attributed to cervical cancer is 2.5 times greater than
that of the Canadian rate. Early detection and treatment is considered to be
effective in reducing mortality from this disease.
Cervical screening recommendations have changed as of 2011. Routine
screening initiation begins at age 20 and ceases at age 70. Routine screening
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
51
has changed from annually to one Pap every 3 years after 3 consecutive
negative Pap tests. These recommendations do not apply to women with
abnormal Pap tests. Statistics for 2011 indicate a 73% screening rate for Central
Region, which was comparable to 72% for the province. The following figure
indicates the percentage of women across various age groups that have been
screened in the Central Region and the province in 2010.
Cervical Screening: Central Region vs. Province 2010
100%
80%
60%
61%
49%
67%
53%
46%
57%
40%
43%
45%
42%
41% 48% 43% 46% 40%
39% 40% 40%
40%
31%
29%
20%
0%
20-24 25-29
30-34
35-39 40-44
45-49
50-54
55-59
60-64
65-69
Age
Central Region
Province
In the fall of 2011, funding was applied for and received from the Access to
Service grant from the Cervical Screening program to offer regular Pap test
clinics and increase the screening rate in TWNWI. A nurse practitioner was hired
and regular Pap test clinics were offered and continue to be offered in the area.
Feedback from patients has been very positive with 24% saying they were very
satisfied with the service and 71% indicating they were satisfied. When asked
about the reasons for accessing the service, 89% stated that they attended
because it was more convenient. One respondent indicated they accessed this
service because it was a female provider and three women indicated it was
because they had no family doctor. 20% of the women who received this service
had been under screened. (Summary Report, 2013)
For 2012, the screening rate was 71% for Central Region, a slight decrease from
the 2011 rate.
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
52
Percentage of Women 20 – 69 years
Screened in Central Region
2012 vs 2010-12 (1 Pap in 3 Years)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
12
20
12
-20
10
0
2
Percentage of Women 20 – 69 years
Screened in Central Region
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
20102012
2010-2012
2010
2010
2011
2011
2012
2012
The cervical screening rate, in 2012, in Twillingate was 75% and for New World
Island the rate was lower at 65%. It is difficult to note on any change in the rate
for this local area due to the change in screening guidelines
3.6.8 Prostate Screening
For Canadian men, prostate cancer is one of the most commonly diagnosed
cancers. Prostate cancer incidence increases with age, most cases are
Twillingate-New World Island, Isles of Notre Dame Health Service Area
Primary Health Care Profile
53
diagnosed in men ages 60 years or older (Public Health Agency of Canada,
2011).
Prostate cancer is the most common cancer among Canadian men (excluding
non-melanoma skin cancer). In 2013, an estimated 23,600 men will be
diagnosed with prostate cancer and 3,900 will die of it. The death rate of men
with prostate cancer has been declining by almost 4% per year (between 20012009) as a result of improved testing and treatment options (Canadian Cancer
Society 2013).
For early detection of prostate cancer, the prostate blood test (PSA) and the
digital rectal exam (DRE) may be recommended for men depending on age and
medical/family history. According to the CCHS (2009), 57.3% of males in the
Central Region reported having had a PSA which was higher than the provincial
rate at 53.2%. In the Central Region from 2009-2010, 53.5% of the population
have had a DRE, with the majority (57.2%) having had them within less than one
year to 2 years. Provincially, 52.3% have confirmed having a DRE, with the
majority (55.9%) within less than one year to two years ago.
While no local rate of prostate screening was available, according to health
providers prostate screening is completed according to evidence based practice
with no issues noted in screening rates (Consultations, 2013).
3.6.9 Colorectal Cancer Screening
Colorectal cancer incidence rates have increased significantly among males in
Newfoundland and Labrador (by 2.1% per year) and a similar rate of increase is
noted for females (1.9% per year) but it is not statistically significant (Canadian
Cancer Society, 2011). The province has one of the highest rates of colorectal
cancer in Canada, which is the second leading cause of cancer related death in
both men and women.
Colorectal cancer screening checks for colorectal cancer as part of routine
medical care when there are no symptoms present. The Canadian Cancer
Society recommends men and women age 50 and over have a stool test (either
a fecal occult blood test (FOBT) or fecal immunochemical test (FIT)) at least
every 2 years. Stool tests help identify polyps before they become cancerous.
According to CCHS (2010), 33.4% of the population aged 35 years and older in
the Central Region has had a fecal occult blood test completed. This is higher
than the provincial rate at 26.0%.
Follow-up for a positive test could include a colonoscopy, double contrast barium
enema and sigmoidoscopy. Results from the 2009-10 CCHS revealed that only
32% adults aged 35 or older in the region have had a colonoscopy or
sigmoidoscopy at some point in their life. This is the highest among the health
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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54
authorities and is slightly higher than the provincial rate of 31% and the national
rate of 30%. For the New World Island area this rate was higher at 40.2%. Data
was not available for the Twillingate area.
The Bowel Wellness Committee launched a Bowel Health Initiative in 2005
aimed at promoting bowel health and increasing colorectal cancer screening
rates. Patients can pick up tests kits in three areas within the Central Region
(Green Bay, Buchans and Twillingate/New World Island). The overall goal of the
Bowel Cancer Screening Program is to increase awareness and improve
screening and detection rates of colorectal cancer and precancerous lesions.
Locally, in the period between 2008-2010, 439 kits were returned (return rate of
25%) with a total of 39 positive results. In 2011, another 53 kits were returned
with 3 positive results.
In partnership with the Newfoundland and Labrador Colon Cancer Screening
Program, Central Health launched a new screening program in the region in June
2013. The screening program is a population-based screening program that uses
an automated immunochemical test (FIT) to screen for colon cancer. The goal of
the program is to reduce mortality from bowel cancer among individuals 50-74
years who are at average risk. The program will replace the local program that
was initially set up in the TWNWI area.
3.6.10 Sexually Transmitted Infections (STIs)
The World Health Organization (2012) defines Sexually Transmitted Infections
(STIs) as infections that are spread primarily through person-to-person sexual
contact. There are more than 30 different sexually transmissible bacteria, viruses
and parasites. The most common form of STI in the Central Region and for the
province is Chlamydia.
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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From 2009-2011 in the Central Region, the rates of Hepatitis B and C had
increased by 6%, however this trend appears to have changed in 2012 with a
decrease noted. Chlamydia continues to increase in the province while the
regional rate has remained fairly constant.
3.6.11 Immunizations
In the last 50 years, immunization has saved more lives in Canada than any
other health intervention. Immunizations are safe and effective. Immunizations
are recommended through all stages of life (Immunize Canada, 2013).
Childhood Immunization Program
In the Central Region the childhood immunization program (all routine
immunizations from birth-grade 9) is delivered by PHNs. For Central Region,
immunization rates for all routine childhood vaccinations are between 90-100%.
For 2012-13, for the TWNWI area the rate of immunization under this program
ranged from 93-100% with the exception of the HPV vaccine at 78% in
Twillingate (this was a decrease from 2011 rate of 100% and represented two
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56
individuals). The HPV vaccine rate in NWI was 100%. These rates are in line with
region.
Influenza Vaccination
Influenza vaccination is an important step in maintaining the health of the
population. The provincial government provides the influenza vaccine for adults
and children with chronic conditions requiring regular medical follow-up, residents
of nursing homes and other chronic care facilities; persons age 60 years and
over; children age six months to 59 months; healthy pregnant women, particularly
those in the third trimester; Aboriginal people; healthcare workers in facilities and
community settings; household contacts of immunocompromised and other
persons at high risk of influenza complications; essential service workers and
individuals who work in the live poultry or swine industry. Influenza vaccines are
provided free of charge.
“In Canada, flu season usually runs from November-April and an estimated 1025% of Canadians may get the flu each year. Although most of these people
recover completely, an estimated 4000-8000 Canadians, mostly seniors, die
every year from pneumonia related to the flu and many others may die from other
serious complications of the flu” (Health Canada, 2006)
According to the 2011 CCHS, 25% of respondents age 12 and over from the
Central Region indicated they were immunized with the influenza vaccination
within the last year. This number has increased from 21.2% since the 2007
survey. The proportion for the province during the same time period was 28.4%.
According to the Central Health Influenza Report, 2011-2012 there were a total of
19,669 influenza vaccines administered by Public Health Nurses/Continuing Care
Nurse Coordinators, Occupational Health Nurses/Registered Nurses and
Physicians/Nurse Practitioners in Central Region. Below is a break down of
administrated vaccines.
Table 8
Influenza Vaccine Breakdown, 2011 – 2012.
Persons Administrated to
# of Administrated
Vaccines CRHA
6 mos – 4 yrs of age
60 years of age
Persons with chronic illness
Essential Community Workers
Household Contacts
Pregnant Women
Aboriginal People
Acute Care/LTC/Other
Staff
Total
360
10,106
3,954
975
1,613
29
372
600
1,660
19,669
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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57
The majority of influenza vaccine is administered by PHNs. In the TWNWI area
the total number of influenza vaccines administered by PHNs to the public in
2011-12 was 1,114. This increased to 1,187 in 2012-13. The physician group
administers a small percentage of influenza vaccine to the population of TWNWI
as well. The exact number is difficult to determine due to reporting discrepancies.
For Central Health staff in TWNWI (2011-2012), 28 out of 164 (17%) staff were
immunized. For 2012-13, the percentage increased to 35%. For Central Region
in 2012-13 the percentage was higher at 58%.
Pneumoccocal vaccine is offered to those with chronic illnesses or those 60+ and
is only administered once in a lifetime. 27 individuals received the pneumoccocal
vaccine in 2011-12 while 45 individuals received it in 2012-13.
3.6.12 Oral Hygiene
Having poor oral health can have significant impacts on other areas of the body
other than the mouth. Evidence now shows that poor oral health has been
connected to systematic diseases such as diabetes in people of all ages, and
respiratory diseases among the elderly. Further evidence also indicates a
correlation between poor oral health and heart disease and premature, low birth
weight in babies (Healthy Canada, 2009).
According to CCHS (2010) 43.3% of the Central Region'
s population visited the
dentist within the last year. This is below the provincial average of 54.1%.
In 2010, the Adult Dental Health Program expanded to make dental services
available once every 3 years to adults who are covered under certain
Newfoundland and Labrador Prescription Drug Program plans (Department of
Health and Community Services, 2011).
According to Health and Community Services, there has been an unprecedented
uptake of the expanded Adult Dental Program. As of result of this uptake a prior
approval process was established in April 1, 2013. "The prior approval process
will approve clients up to the limit of the existing budget, minus funding
specifically allocated for exceptional or emergency cases throughout the year"
(Department of Health and Community Services, 2013). This process
demonstrates an effort by government to ensure the continuation of this program.
In order to offer appropriate dental services to the residents of the province, the
government also increased the per person cap to $150.00 for basic dental
services and $750.00 for dentures per year (Department of Health and
Community Services, 2013).
In July 2011, dental services were re-established in the Twillingate area, located
within NDBMHC. As of October 2013, approximately 1,600 individuals
(approximately 27% of the total population) had received dental services from
this practice since opening. In January 2012, improvements in access to dental
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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58
care by the provincial government were in place. At that time, an increase in
persons receiving dental services in this practice was noted. The majority of
patients receiving services in this clinic are between the ages of 40-80, however
there are a number of patients attending this clinic across all age groups. In
comparing the two areas, approximately 865 patients of this clinic are from the
Twillingate area and 750 are from the New World Island area. 13 individuals from
Boyd’s cove also receive their dental care at this clinic(Twillingate Dental
Practice, 2011-2013).
A concern around proper dental care and poor oral hygiene has been noted,
through general observation by health providers who work with youth in the area.
3.6.13 Fruit and Vegetable Consumption
Statistics Canada identifies that a diet rich in fruits and vegetables may help to
prevent cardiovascular disease, certain cancers, and obesity. They have also
identified that women eat more fruit and vegetables compared to men. Eating
low amounts of fruits and vegetables has been found to be associated with other
health risk behaviors, like physical inactivity, smoking, obesity, and alcohol
dependence (Statistics Canada, Fruit and Vegetable Consumption, 2010).
In 2011, 40.4% of Canadians aged 12 and older reported that they consumed
fruit and vegetables five or more times per day in 2012 the rate was 40.6%. This
was down for the third year in a row from the peak of 45.6% in 2009. Females
were much more likely than males to consume fruit and vegetables. In 2011, in
the province, 29.9% of females (29.7% in 2012) consumed fruit and vegetables
five or more times daily, compared with 23.5% of males (20.2% in 2012) (CCHS,
2011).
For Newfoundland, the fruit and vegetable consumption rate is the lowest in
Canada at 25.1% in 2012 representing a steady decrease from 2008 at 32.6%.
The Central Region rate of consumption is lower than the average rate of
Newfoundland and the lowest of all health authorities at 17.2% in 2012. The
second lowest was the Labrador health authority 22.3% and Eastern Health was
the highest at 27.7% (CCHS, 2011).
3.6.14 SECTION HIGHLIGHTS
With regards to personal health practices and coping skills, data suggests that
generally, in Central Region overall, the region is not showing much improvement
and, in fact, in most categories such as smoking, drug use, alcohol use, fruit and
vegetable consumption and physical activity practices are worsening. Screening
rates for the area are difficult to obtain in most categories. Cervical screening
rates for the region are consistent with provincial screening rates and, within the
local area, the rate for Twillingate is higher than the region and in NWI the rate is
slightly lower than the region. Local efforts have been made in some areas to
promote improved personal health practices in areas of cervical and bowel
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59
screening. Improvements are also noted in options available for physical activity
in the area as well as access to dental service.
3.7 HEALTH SERVICES
Health services have a direct impact on the health of a community. Health
services, particularly those designed to maintain and promote health, to prevent
disease, and to restore health and function contribute to population health.
This section of the profile will discuss PHC services under the following themes:
provider profile, service profile and non- Central Health; regional services;
secondary services; adjacency to secondary services; and migration patterns;
population with access to a family physician/ PHC provider and satisfaction with
health care.
3.7.1 Primary Health Care Provider Profile
The citizens of the TWNWI receive PHC services from health professionals of
the CRIHA, as well as private practice providers. A profile of providers employed
by CRIHA is highlighted in the following table, and includes type of provider,
number(s) of provider(s), age range, years of service, and applicable collective
agreements governing provision of service, as displayed in Table 18.
Primary Health Care
Provider
Director, Health
Services
Manager, Client Care
Services
Manager, Primary
Health Care
Manager, Support
Services
Number
Collective
Agreement
Age
Range*
Years of
Service**
1
MGMT
B
A
1
MGMT
C
C
1
MGMT
C
C
1
MGMT
B
B
Secretary II
1
Physicians
Primary Health Care
Facilitator
Nurse Practitioner
Clinical Nurse
Educator
Registered Nurse
6
Non UnionNon
Management
MOU 2005
1
NAPE HP
A
A
2
NLNU
C(2)
C(2)
1
NLNU
C
B
19
NLNU
A(2) B (2) C
(15)
A(2) B(5)
C(12)
3
NLNU
C (3)
C (3)
Nurse II
B
A
A(4) C(2)
A(5) C (1)
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CCNC
3
NLNU
B(2) C(1)
PHN
3
NLNU
A(2) C(1)
Primary Care
Paramedics
6
NAPE HS
A(4) C(2)
A(5) B(1)
Social Worker
3
NAPE HP
C(3)
C(3)
Occupational
Therapist
1
NAPE HP
A
A
Lab Technologist II
Lab Technologist I
Medical Lab Assistant
1
2
1
NAPE LX
NAPE LX
NAPE LX
X Ray Technologist
2
NAPE HS
LPN
22
NAPE HS
B
B (2)
B
A(1) Vacant
(1)
A(9) B(5)
C(8)
PCA
10
NAPE HS
Physiotherapist
Recreation Specialist
Physiotherapy Aide
Maintenance Repairer
Tradesworker
Laundry Worker I
Stores/Laundry
Worker
1
2
1
1
4
2
NAPE HS
NAPE HS
NAPE HS
NAPE HS
NAPE HS
NAPE HS
B
B (1) C(1)
C
A(1)
Vacant(1)
A(4) B(2)
C(16)
A(5) B(1)
C(4)
C
A(1) B(1)
C
C
B(1) C(3)
C(2)
1
NAPE HS
C
C
Domestic Worker
6
NAPE HS
Accounting Clerk I
1
NAPE HS
A(1) B(1)
C(4)
A
A
A(3) B(1)
C(2)
A
Clerk III
1
Stenographer II
3
Medical Records Tech
II
1
WPEO I
2
Cook
Food Operations
Supervisor
Food Service Worker I
2
NAPE HS
B(1) C(1)
B(2)
1
NAPE HS
B
B
5
NAPE HS
B(3) C(2)
B(4) A(1)
B(3)
NAPE HS
C
C(2)
B(3)
A(2) B(1)
A(8) C(2)
A(1) B(1)
B
A
A(2) B(2)
B(2)
A
B(3)
C
A(1) C(1)
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Food Service Worker
II
Cooks Helper
Switchboard Operator
Ward Clerk
Staffing Coordinator
1
NAPE HS
A
A
1
1
1
NAPE HS
NAPE HS
NAPE HS
Non UnionNon
Management
B
C
C
A
C
C
C
C
1
* A = <36, B = 36-45, C = >45
** A = <10, B = 11-20, C = >20
3.7.2 General Practitioner Profile
Having a regular family physician improves access to both routine and
preventative services. According to the Canadian Institute for Health Information,
in 2010 there were 116 general/family physicians per 100,000 in the Central
Health Region, which was the lowest among the health authorities and slightly
lower than the provincial rate of 118. The rate of specialists in the region was 66
per 100,000 which was lower than the provincial rate of 108. Physician to
population rates are useful indicators and are published by a variety of agencies
to support health resources planning (Scotts Medical Database, CIHI, 2010)
The 2009-10 CCHS revealed that 85% of individuals in the Central Region
reported having a family doctor. 21% of males said they didn’t have a regular
medical doctor compared to 10% of females. This value is up from 83% from the
2005 survey but is below the provincial rate of 88.4%. (Central Health Regional
Profile, 2012)
Currently, there are six physicians providing services to the TWNWI area. Four of
these physicians are fee for service and provide regular primary health care
services Monday through Friday. After hours emergency services are provided at
the NDBMHC on a rotation basis by five of these physicians. Physicians receive
all benefits in accordance with the Memorandum of Understanding (2010).
Five of these physicians provide and share responsibility for the care of patients
on the medical unit at NDBMHC. There is one dedicated physician to provide
medical care to the residents of Long Term Care at NDBMHC. One salaried
physician provides a clinic at NDBMHC and one salaried physician has
responsibility for providing regular primary health care services through MondayFriday clinics at NWICHC.
The senior staff physician fulfills the role of providing coordination of local
services, including administration and orientation for all physicians and
collaborating with the nurse practitioner.
There is a local Medical Advisory Committee with all physicians sitting on this
committee. The regional VP Medical Affairs is available on a consulting basis.
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The physicians are consulted by health care providers on an as needed basis.
3.7.3 Service Profile
PHC services will encourage and support individuals, families, communities and
populations as a whole, to make decisions or choices that prevent illness, and
achieve and maintain the best possible health. A full range of PHC services are
available to residents of the area, including: Continuing Care, Community
Support Services, Addiction Services, Mental Health, Health Promotion, Health
Protection, Early Learning and Childcare Services, Ambulatory Care and
Diagnostic Services. A description of these services follows.
The TWNWI area has two health center’s that provide primary health care
services.
1. Notre Dame Bay Memorial Health Centre
Long Term Care
Acute Care Inpatients
Acute Care Outpatients
Emergency Services
Laboratory Services
Physician Clinics
Nurse Practitioner Clinics
Diagnostic Imaging
Support Services (laundry, housekeeping, maintenance, dietary)
Mental Health and Addictions
Youth Outreach
Diabetes Education
Dietitian Services
Public Health Nursing Services
Continuing Care Nursing Services
Pharmacy
Mental Health and Addictions
Social Work Services
Palliative & Respite Services
Recreation Therapy
Physiotherapy
Occupational Therapy
Chronic Disease Prevention and Management
Restorative Care
2. New World Island Community Health Centre
Acute Outpatient Services
Chronic Disease Prevention and Management
Continuing Care Nursing Services
Public Health Nursing Services
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Nurse Practitioner Clinic
Physician Clinic
Mental Health Services
Social Work Services
Diabetes Education
Dietitian Clinic
Health Promotion (HP)
Health promotion is encouraged at all levels of front line service to best meet all
needs of the population. Specific HP programs and services are delivered
primarily by public health nurses in the region and programs aim to enable
people to increase control over, and improve their health- through healthy
choices and supportive environments.
Other programs are also available for nutrition, reproductive health,
environmental health, communicable diseases, dental hygiene, and other health
promotions areas. Within the Twillingate-New World Island area, there are three
public health nurses. One position has a focus on heath promotion, school
health, and travel. One position has a focus that centers on child health clinics,
pre/post natal follow up, BURPS and healthy beginnings programs. The other
position focuses on community development, mass immunizations, and influenza
vaccinations as well as emergency preparedness.
A Health Promotion Committee has been established in this area. The committee
consists of two of the public health nurses, the nurse educator, the primary health
care facilitator and the manager of primary health care. This committee focuses
on developing and implementing one community initiative that supports health
promotion and one staff initiative that supports health promotion at any given
time. The committee also organizes displays in the two health facilities and
ensures print materials are up to date and organized.
Chronic Disease and Prevention Management (CDPM)
CDPM includes programs involved with prevention (primary) and management
(secondary) of chronic diseases contributing to premature mortality (e.g.,
diabetes, heart disease, stroke, and cancer).
A diabetes education program is offered through a Dietitian and a Diabetes
Education Nurse who, following a self-management model, work closely with
people with diabetes in the TWNWI area, to help them understand how to control
their diabetes. Ongoing support and reinforcement is provided through individual
or group education sessions, face to face follow-up visits, telephone
consultations and referral to other providers as required. People with diabetes or
those at risk for diabetes can self refer to the program or be referred by their
health care provider. Within this program, promoting the prevention of diabetes
and increasing awareness of the seriousness of diabetes among health care
providers and the public alike is important.
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64
Furthermore, the local team is connected with provincial and regional efforts in
the management and prevention of chronic diseases in Newfoundland and
Labrador. The initiatives will focus on a self-management, prevention and
awareness, health care delivery, practice guidelines, information systems and
research, and community action approach. Within Central Health, there is an
increased importance placed on self management in dealing with chronic
diseases.
Alternate Family Care Homes
An Alternate Family Care Home (AFCH) is a private, approved family residence
that provides board and lodging, supervision, personal care and social supports
to unrelated adults with developmental disabilities. This provides a residential
option for adults with developmental disabilities who cannot live independently
due to presenting developmental or behavioral disabilities. An AFCH can provide
long term care or short term respite to families. There are currently two alternate
family care homes located in Summerford.
For individuals in the AFCH there is a community access funding program which
is established through a Behavioral Management Specialist who is assigned to
each individual case. This funding is available for eligible clients of AFCH and
provides them with a sum of money on a monthly basis to assist with
transportation to various community events, registration for community programs,
and anything else the client wishes to partake in to integrate into the community.
(Central Health’s Coordinator of Residential Service, March 2012).
Personal Care/Long Term Care/Respite Care
When supportive services are no longer able to meet the needs of clients at
home, individuals can be assessed to be placed in a PCHs or LTC facility. The
assessment will provide information on the level of care they require and it
ranges from level one-four. Within this area, there is one LTC unit that provides
care to level three assessed individuals and one PCH that provides care to level
one assessed individuals. There is no facility within this area providing care to
anyone assessed as level two.
There is one respite bed located in NDBMHC. With the current LTC bed shortage
and other situations that require this bed, the respite bed has not been an option
that has been reliable to families in the area which is a noted concern
(Consultations, Sept 2013).
Acute Care
The NDBMHC has a 12 bed acute care unit which includes one palliative care
bed. There are two beds that comprise a stabilization/observation unit (OSU) on
the unit for patients that require specialized nursing care.
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It has been noted that Palliative Care services are required often within this
facility with often more than one patient at a time requiring this type at any given
time.
Community Support Services
Community Supports Services includes a mix of health, social and supportive
services to maintain and, where possible, to improve the quality of life of
individuals. Services include assessment and placement, nursing services, social
work services, home supports and coordination, delegation of function to support
or alternate care givers, personal care home licensing and monitoring, alternate
family care home approvals and monitoring, individual living arrangements,
cooperative apartments, specialized board and lodging or other residential
alternatives, palliative care, respite care, and community behavioral services
programs. Pending financial eligibility and other criteria, these services are
available to seniors and individuals with physical and/or development disabilities.
Other services may include special assistance for supplies and equipment, drug
card and medical transportation, limited assistance program for support of
persons dealing with chronic health conditions, investigations regarding
allegations of neglect and administration of the Neglected Adults Act, and
temporary home support following hospital discharge, including drugs,
equipment, supplies and palliative care.
Support services that include home care, alternative family care, and respite care
for primary caregivers have made it possible for many clients and seniors to stay
at home, and be supported in their own communities. A discussion paper on
healthy aging released in March 2006 reports a strong sense of community within
the province and identified that 84% of seniors in this province reside in their own
homes.
While home support services are invaluable, the maximum number of hours
provided under existing guidelines is up to 11 hours per day. Family members
must then be responsible for the remaining hours of needed care. Therefore, the
potential for caregiver stress and burnout is high.
Within the TWNWI area we have two Community Supports social workers and
three Continuing Care nurses (two full time, one part time) that work together to
offer the services under the community supports program.
Under the current program there is no home support service for individuals who
are under the age of 65 and not within the category of 18-65 years old with an
intellectual disability. This has been noted as a gap in service that can cause
difficulties in the provision of adequate care for people who need it
(Consultations, 2013).
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Under the home supports program, certain areas within Central Health have the
Enhanced Care program available. This program involves palliative care
(available everywhere in Central Region), care for individuals for 14 days post
surgery through home support provision, and after hours care such as wound
care. The third noted category is not available in this local area. Individuals
requiring the after hours wound care receive this service through the after hours
outpatient/emergency department at NDBMHC.
Mental Health and Addictions Services
Geared to assist both adults and children with mental health issues, mental
health services include counseling and case management.
Child and youth mental health services are provided to individuals aged 19 years
and under and their family members. These services are provided using a team
approach, utilizing a psychologist, social workers, and psychiatrists. It is available
to children and youth experiencing emotional, behavioral, and social difficulties.
Individuals from the TWNWI who require mental health and addictions services
are assessed through the Mental Health Intake team, located in the Town of
Lewisporte, for a determination of where their needs will be best met. Reasons
for referrals include depression, family issues, behavioral issues, and anxiety.
Currently, referrals are made to CNRHC in Grand Falls-Windsor for individuals
seeking psychiatric services only.
It is difficult to determine the numbers of people requiring mental health services
from this area. From providers and community perspective, the number of people
who require mental health services is high however a number of people decline
service from the Mental Health program due to having to access this from outside
the local area. This was noted as a concern.
There is a social worker located at NDBMHC who has a caseload of mental
health referred clients and provides counseling, assessment and referral
services. This is not a full time mental health focused position as this position
also covers social work services in Long Term Care and Acute Care. Currently
plans are underway to have a traveling clinic offered by a Psychologist and
Addictions Counselor for people requiring this service in this area.
A Mental Health Case Manager provides support to individuals in the community
with mental illness that is “severe and persistent” with the goal of helping
individuals stay in their own homes living independently. This service is mainly
provided in the client’s home, but office visits can be arranged. A Mental Health
Case Manager provides services to the FICI and TWNWI area with a total
caseload of six clients at present.
Mental health was identified as the number one priority in the previous profile
process. Since that time a Mental Health Working Group has been established in
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67
the area consisting of both health professionals and community partners. This
working group has developed a mental health action plan with the following
goals:
• Increasing and improving upon resources available to support mental
health
• Reducing stigma associated with mental health/mental illness
• Enhancing supports to providers in the area of mental health service
delivery
• Enhancing supports to the community in the area of mental health
• Increasing awareness of mental health resources available with health
team and community
• Identifying root causes of mental health/illness in the community
The working group has had some success in building upon resources and
bringing support and education into the area and will continue in their work
towards these established goals.
Furthermore, there is a mental health crisis line offered through the Department
of Health and Community Services. Help is available 24/7 for people seeking
assistance with mental health and addictions issues, and can be reached at 1888-737-4668.
Special Child Welfare Allowance (SCWA)
The SCWA is a program available to financially eligible families who have a child
with a diagnosed developmental or physical disability. The program is designed
to assist with additional expenses incurred by families due to the child’s disability,
as well as utilized to enhance the developmental potential of a child with a
disability. This program is open to families with children from birth to age 18.
Autism Services
Autism services programs are offered by the Direct Home Services Program with
Central Health. This program provides home therapy to children with Autism
Spectrum Disorder, utilizing applied behavioral analysis (ABA) techniques and
specifically discrete trail teaching. Families are provided with funding to hire
home therapists to work with their children up to 30 hours per week until entering
kindergarten and 15 hours per week during the kindergarten year.
Ambulance Service
A hospital based ambulance service is provided at NDBMHC in Twillingate which
serves the Twillingate area and New World Island area as far as the NWI
highway depot. This service operates and responds to both routine and
emergency calls on a 24 hour basis and is staffed by paramedics employed by
Central Health. For the remainder of NWI, ambulance service is provided by
Mercer’s Ambulance.
3.7.4 Regional Services
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68
Rehabilitative Services
Physiotherapy, Occupational Therapy, and Speech-Language Pathology are
regional PHC services based at JPMRHC, as well as services based at CNRHC
and offer a preventative and curative focus either through professionals visiting
the area or through clients accessing services at the regional referral centers.
In consultations it was noted that wait times and access to services such as
Physiotherapy and Speech/Audiology services are long with patients (depending
on the condition) waiting for assessment and treatment for an extensive period of
time. With the addition of the Restorative Care unit to the area, wait times and
access to the services of an occupational therapist has improved (Consultations,
2013).
Restorative Care
Restorative Care, a five bed unit located at NDBMHC has been providing slow
stream rehabilitation to seniors of Central Health since March 2011. The program
consists of therapy that is offered daily and incorporates activities of daily living
(washing, dressing, grooming), exercise-programs and therapeutic recreation.
The therapy team includes an occupational therapist, physiotherapist,
physiotherapy support worker, recreation specialist, licensed practical nurses and
social workers who all collaborate around client goals and uphold the philosophy
of enablement.
Feedback from approximately 80 clients has been overwhelmingly positive with
97.5% agreeing they could not have made the same progress alone and every
client agreeing that they felt comfortable and at home during their stay. This unit
in Twillingate is the first of its kind in Newfoundland and has been used as a
template to develop a similar program in Western Health (On the Pulse, 2013).
Health Protection
Health protection assists in the identification, reduction and elimination of
hazards and risks to the health of the individuals in the community. Programs
include disease control with monitoring, monitoring of public water supplies and
surveillance of public buildings and institutions. This program is based in Gander
and provides service to the PHC area as a part of its mandate.
Other regional services include (list may not be all inclusive):
Cervical Screening Initiatives Coordinator-regional service that provides
screening program support.
Regional Nutritionist- there are two regional nutritionists located at the
community level in Gander. One provides childhood nutritional services,
and the other has mainly a school focus.
Environmental Health Services Coordinator
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69
Genetics Counselor- there are no scheduled visits from this discipline,
however, these services are available via referral from a family physician
and are provided at the secondary center.
Lactation Consultants- services are available through a community based
lactation consultant.
Wound Care Consultant/Enterostomal Therapist- there is regular
communication with the community based wound care consultant in
Gander through the Nurse II and CCNC in Lewisporte.
Respiratory Therapist
Medical Officer of Health
Acute Care Home Supports Coordinator
Asthma Care
3.7.5 Non-Central Health
PHC services are also provided to the TWNWI area by various organizations and
individuals in private practice. These include but are not limited to
Home Care Agency:
There is one government licensed home care agency operating in the TWNWI
area providing coordination of home supports through assessments, hiring of
home support workers, providing education and supervision, as well as fulfilling
an administrative role for the home support client and their workers.
Clergy:
There are a number of churches in the TWNWI with denominations including
Salvation Army, United Church, Pentecostal, Anglican, Full Gospel, Roman
Catholic. There is an active ministerial association as well as a pastoral care
committee.
Massage Therapy:
Massage therapy services is available in the area through one registered
massage therapist with a regular clinic offered in Summerford.
Optometry:
An eye clinic is located in the local area (Twillingate) providing optometry
services on a part time basis.
Pharmacy:
There are three pharmacies located in the TWNWI area. Pharmachoice located
in Twillingate and Summerford as well as a pharmacy located within Save Easy,
Twillingate.
Foot Care Service:
A foot care nurse is available to people in the area requiring this service. The foot
care nurse travels to Twillingate and NWI every six weeks to provide advanced
Twillingate-New World Island, Isles of Notre Dame Health Service Area
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70
foot care service to those in need. People living with diabetes, sight impairment,
circulation problems or mobility limitations or those taking blood thinning
medications may benefit from this service.
While the foot care nurse provides a valuable service to the area and many avail
of the service, this cost associated with foot care continues to be a concern. MCP
does not cover foot care and therefore it is not accessible to all (Consultations,
2013).
3.7.6 Secondary Services
Central Health is responsible for the provision of health care services to the
population of the region. Secondary care services are available from either
JPMRHC, or the CNRHC. Services include surgery, internal medicine,
ophthalmology, psychiatry/psychology, urology, respiratory technology,
obstetrics/gynecology, neurology, dialysis, pediatrics, dermatology, audiology,
speech language pathology, otolaryngology, nephrology, and oncology.
3.7.7 Adjacency to Secondary Services
People living in the Twillingate area are, on average, about 119 kilometers away
from James Paton Memorial Regional Health Centre. For those living in NWI this
ranges from 104km to 114km.
Telehealth
Consulting with a specialist or other health care provider no longer means a long
drive, often overnight, to a distant medical centre for residents of Central
Newfoundland. Patients can now ‘see’ medical specialists in their home
communities through the two-way video communication using Telehealth(TH)
mobile carts located in 14 clinics throughout the region.
In 2012, patients in the Central NL area participated in 2,945 telehealth
appointments with an average of over 245 appointments/month. This average
increased to 276 appointments/month as of May 2013 (The Beacon, 2013). It
was noted in 2013 by the provincial telehealth coordinator that there has been an
increase in telehealth usage in the province by approximately 16% every year.
The telehealth coordinator for the region also noted an overall increase in
telehealth appointments in Central Region. Central Region had the 2nd highest
number of appointments (next to Eastern Health) for the period of April-July
2013.
Telehealth Appts/RHA 2013
Central
Eastern
Labrador
Western
Apr
274
438
261
215
May
281
423
241
190
Jun
259
364
215
187
Jul
281
408
260
174
Total
1,095
1,633
977
766
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Other
Total
1,188
1,135 1,025 1,123 4,471
At NDBMHC there was a slight decrease in appointments in 2012 (just by 2) but
it appears to be increasing again as of August 2013. The majority of the
telehealth appointments that took place at NDBMHC were for oncology purposes
(130 of the total 167 appointments) followed by Mental Health purposes (12
appointments in total).
We have one pharmacy technician position at NDBMHC. A telepharmacy project
began as a pilot in the region in this local area at NDBMHC. State of the art
telecommunications technology is used to connect a licensed pharmacist at one
of the two major referral centres and our local pharmacy technician to provide
pharmaceutical care to patients from a distance. This project was awarded a
leading practice certificate by Accreditation Canada in 2013. From the period of
April-August 2013, there were a total of 257 appointments for telepharmacy at
this site.
Healthline
Healthline is a toll free nurse telephone service that is available to residents of
Newfoundland and Labrador 24 hours/day, seven days/week. Healthline was
launched in 2006 as an alternate delivery model to improve access to services,
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to encourage self-care, and to reduce the number of inappropriate or
unnecessary visits to the emergency department and/or physicians. Services are
provided by registered nurses and provide assessment of non-urgent issues to
recommend a course of action, the provision of health information, and the
referral to emergency departments when necessary. (NL Healthline, 2013) The
number is 1-888-709-2929.
Evaluation of the Healthline indicated users are getting timely access to the
service, are overall satisfied with the service, and the majority would recommend
the service to others (NL Healthline, 2013).
For the period of March-August 2012, there were 2,130 calls received from the
Central Health region. This was the second lowest in all the health authorities
with Eastern Health being the highest at 10,538 calls. For the Isles of Notre
Dame health service area, for the period of September 2012-Feb 2013, 144 calls
to the healthline were received. The majority of these calls were for patients
between the ages 20-64 (87 calls). Those aged 60+ years are using the service
the least. In Central Health the number one reason for calls was for Chest Pain,
which differed from the local area that had Low Blood Pressure and Neurologic
Deficit as the number one reason.
Isles of Notre Dame Calls to Healthline, Top 10 Protocols(Adults)
Isles of Notre Dame Calls to Healthline, Top 10 Protocols (Pediatric)
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3.7.8 Migration Patterns
Migration patterns refer to where residents go to access primary care. For the
TWNWI area, the majority of the population access primary care at NDBMHC or
NWI Community Health Centre. For most services such as diagnostic imaging
and bloodwork, people in both Twillingate and New World Island come to
NDBMHC. Residents of NWI access family physician/NP services from both NWI
clinic and NDBMHC. Many residents of Boyd’s Cove also come to Twillingate or
NWI for their primary care. A recent change has also been noted that individuals
living in areas such as Birchy Bay and Stoneville are migrating to this local area
for their primary care as for reasons of good access to and consistency in a
family physician. A number in the area may access service in nearby health
centres such as Gander.
3.7.9 Access to Family Physician/PHC Provider
According to the Statistics Canada 2012 Health Profile, 82.2% of the Central
Health population aged 12 and over reported having contact with a medical
doctor in the past 12 months. For Central Health, 87.4% of the population
reported having a medical doctor.
3.7.10 Satisfaction with Health Care
According to the CCHS (2010), 87.9% of individuals aged 15 years and older
living in Newfoundland reported being satisfied with the way health care services
were provided. 87.0% were satisfied with the way the hospital services were
provided, and 94.3% were satisfied with the way physician care was provided.
This was higher than the national average of 86.5%, 81.9%, 90.8% for health
care services, hospital services, and physician services, respectively.
3.7.11 Primary Reason for Use of Emergency Department
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For a select period (November 2012, January 2013 and March 2013) data was
collected on the use of the emergency department at NDBMHC. The biggest
reason for use was symptom relief of pain (296 visits), followed by ENT (sore
throat, eye conditions, ear infection) (254 visits) and musculoskeletal (broken
bones, injuries to arms, legs, arthritis) (233 visits) (Health Records Dept.,
NDBMHC).
Appropriate use of the emergency department has been a concern in this local
area for a long time. Patients who are not in need of urgent or emergency care
continue to present to the emergency department after hours for assessment and
treatment.
3.7.12 SECTION HIGHLIGHTS
In this local area there is a variety of health services that both focus on treatment
and prevention. The compliment of physicians has improved for this area and the
physicians have established practices with access for patients improved. There
has been a number of new positions established in the area as well which as
improved our service delivery and our ability to engage in health promotion and
community development efforts. Service delivery to those requiring high levels of
care has been a challenge. The population is aging and demand for home
support and/or facility placement has increased. This is noted as a great concern
as many in the local area are awaiting placement in long term care without any
beds available in the region. Palliative care has also been noted as a concern
with more than one, at any given time, requiring palliative care within the acute
care facility with resources lacking to support this need. A need for more local
and accessible Mental Health Services has also been noted as a need for this
local area, however data is limited. Efforts to measure the need as well as
improve Mental Health service delivery are being initiated at the time of this
report. Restorative care has been a positive addition to the area with high
satisfaction and improved outcomes noted from clients of this program. There
have also been improvements noted in telehealth advancements to improve
access and service delivery in the area.
HEALTH OUTCOMES OR STATUS
Health status is the level of health of the individual, group, or population as
subjectively assessed by the individual or by more objective measures. How
individuals feel about their health is usually a reflection of their physical, mental
and social well being.
4.1 Self Perception of Health
Within the Central Region, 59.7% of the population aged 12 and over rated their
own health status as very good or excellent. According to the CCHS 2009-10,
60.3% of the population thought that their health was very good or excellent in
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the province. For Twillingate the percentage rating their health as very good or
excellent decreased from 70.9% in 2007 to 51.3% in 2010. For NWI it increased
slightly from 59.3% in 2007 to 62.3% in 2010.
Percentage of population with excellent or very good self-assessed health
status, age 12+
4.2 Self Perception of Mental Health
The World Health Organization (2003) defines mental health as a “state of wellbeing in which the individual realizes his or her own abilities, can cope with the
normal stresses of life, can work productively and fruitfully, and is able to make a
contribution to his or her community”.
Mental health is a crucial dimension of overall health and an essential resource
for living. It influences how we feel, perceive, think, communicate, and
understand. Without good mental health, people can be unable to fulfill their full
potential or play an active part in everyday life. Mental health issues can address
many areas from enhancing our emotional well-being, treating and preventing
severe mental illness to the prevention of suicide” (Health Canada, 2009).
72.5% in the Central Region rated their mental health as very good or excellent
(age 12+ years) compared to the provincial rate of 75%. (CCHS, 2009-10). For
New World Island the rate was 51.8%.This data was not available for Twillingate.
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Percentage of population with excellent or very good self-assessed mental health (age 12+)
80.00%
70.00%
60.00%
Percent
50.00%
40.00%
2009-2010
30.00%
20.00%
10.00%
0.00%
New World Island
Central Region
Newfoundland
Geography
4.3 Life Stress Status
Perceived life stress refers to the amount of stress in the individual’s life, on most
days and is classified by asking respondents to rank their life stress into one of
the five categories: Not at all stressful, not very stressful, a bit stressful, quite a
bit stressful, or extremely stressful. Stress contributes to heart disease, high
blood pressure, strokes, and other illness in many individuals. It also contributes
to the development of alcoholism, obesity, suicide, drug addiction, cigarette
addiction, and other harmful behaviors.
In Central Region, 14.6% rated their stress levels as quite a bit. This was on par
with the provincial average of 14.2% and lower than Canada at over 23%.
(CCHS 2009-2010). Data was not available for TWNWI.
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Percentage of population with life stress as extremely or quite a bit, age 15+
While no local data was available on this category, it was noted in consultation
that youth appear to have high levels of anxiety and stress and limited coping
skills and support.
4.4 Overweight/Obesity
Overweight is defined as having a Body Mass Index (BMI) between 25-29.9.
Obesity is defined as having a BMI of 30 or greater. BMI is calculated by dividing
the individual’s body weight (kilograms) by their height (meters) squared.
Obesity is a risk factor in a number of chronic diseases. The number of
Canadians who are overweight or obese has increased dramatically over the
past 30 years. (Health Canada 2006). Rates of overweight and obesity have
increased in both the region and the province as well.
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In 2010, approximately 70% of individuals aged 18 and older in Central Region
reported themselves to be overweight or obese. A trend suggests that this
percentage is decreasing with 2012 rates noted to be 66.2%. Reports of
overweight and obesity were higher in men at 82.4% then women at 60.1%. This
rate in Central Region is the highest among the regional health authorities and
higher than the overall provincial rate of 64% (CCHS 2009-10).
For NWI reports of overweight and obesity was 80.4% in 2009-10 representing a
decrease from 90% in 2007-08. The reports in Twillingate increased from 70% in
2007-08 to 87.9% in 2009-10.
Percentage of population, excluding pregnant women, with BMI 25 or greater, age
18+
.
Overweight and obesity has nearly tripled in Canada over the past 30 years in
youth ages 12-17 (Statistics Canada, 2012). Youth BMI is measured differently
than adult BMI as youth are considered to be still maturing. According to
Statistics Canada, the youth BMI rate is increasing in the province from 34.8% in
2008 to 39.2% in 2012. The rate, however, has decreased in Central Region
from 49.9% in 2009 to 41.8% in 2012.
4.5 Underweight
Underweight is defined as having a body mass index (BMI) below 18.5. Being
underweight can increase your risk of osteoporosis, fertility problems, weaken
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your immune system, and cause other health problems including mental health
issues such as low self-confidence and low self-esteem (Body & Health 2011).
In the Central Region, 2.8% considered themselves to be underweight compared
to 2007-09 of 3.8% (CCHS 2009-10).
4.6 Chronic Disease Rates
A chronic disease is classified as one that has been present for three months or
more. 95% of the province’s residents aged 65+ and 61% of residents aged 12+
report having at least one chronic condition. Central Health is moving forward in
the area of Chronic Disease Prevention and Management (Central Health
Regional Profile, 2012).
4.6.1 Diabetes
According to the Canadian Diabetes Association, there are three main types of
diabetes. Type 1 diabetes, usually diagnosed in children and adolescents,
occurs when the pancreas is unable to produce insulin. Insulin is a hormone that
controls the amount of glucose in the blood. Approximately 10 per cent of people
with diabetes have Type 1 diabetes.
The remaining 90 per cent have Type 2 diabetes, which occurs when the
pancreas does not produce enough insulin or when the body does not effectively
use the insulin that is produced. Type 2 diabetes usually develops in adulthood,
although increasing numbers of children in high-risk populations are being
diagnosed.
A third type of diabetes, gestational diabetes, is a temporary condition that
occurs during pregnancy. It affects approximately 2 to 4 per cent of all
pregnancies (in the non-Aboriginal population) and involves an increased risk of
developing diabetes for both mother and child.
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Scientists believe that lifestyle changes can help prevent or delay the onset of
Type 2 diabetes. A healthy meal plan, weight control and physical activity are
important prevention steps.
10% of the population in Central Region have diabetes (this includes all three
types of the disease). This is the highest in Newfoundland and higher than
Canada overall.
Geography
1
Canada
6.1%
Newfoundland and Labrador
8.1%
Central Health Authority
10.0%
Eastern Health Authority
6.9%
Labrador-Grenfell Health Authority
6.1%
Western Health Authority
8.8%
Diabetes
CCHS, 2009-2010
While the percentage of people with diabetes is the highest in Central Region,
the rate has seen a decrease from 2008 (12%) to the 2010 rate of 10%. This is
inline with the noticed trend in Canada but differs from the provincial rate which
has shown an increase over the same time period.
Prevalence of diabetes, age 12+
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The trend provincially appears to be changing with data from Statistics Canada
indicating that the percentage of people diagnosed with diabetes has decreased
in the Province in 2012 with a reported rate of 7.7%.
Data for Twillingate rates of diabetes is unavailable through Community Accounts
or any formal database but it is noted from our service providers and in the last
profile that the prevalence rate is high at between 10-13%. Data for NWI was
available for 2007-08 (CCHS) which showed a rate of 25.6% for those aged 12+
having been diagnosed with diabetes. Any more up to date data was not
available.
As illustrated in the graphs below (CCHS 2009-10), the rate of diagnosis of
diabetes increases dramatically with age. 13.9% of the population within the
Central Region ages 45-64, and 26.3% of the 65 years of age or older had a
diagnosis of diabetes.
Health Conditions: Diabetes (%) by sex, 65 years and over, Central Regional Integrated
Health Authority, Newfoundland and Labrador and Newfoundland and Labrador (CCHS,
2009-10)
Health Conditions: Diabetes (%) by sex, 45 to 64 years, Central Regional Integrated Health
Authority, Newfoundland and Labrador and Newfoundland and Labrador (CCHS 2009-10)
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In 2011, a Chronic Disease Prevention and Management (CDPM) Lead team
was formed for TWNWI. The team has been focused on improvements in
diabetes and has developed a Diabetes Action Plan to direct the work. The team
consists of a number of local health care providers, as well as a person with
diabetes and meets at least 4 times/year. The team is connected to the Regional
CDPM Consultant and the Regional CDPM committees within Central Health.
4.6.2 Cardiovascular Disease
Cardiovascular disease is a term that refers to more than one disease of the
circulatory system including the heart and blood vessels, whether the blood
vessels are affecting the lungs, the brain, kidneys or other parts of the body.
Cardiovascular diseases are the leading cause of death in adult Canadian men
and women (Public Health Agency of Canada, 2011).
8.0% of people age 12 years and older living in Central Region have a heart
disease which is an increase since 2008, 5.6%. This 2011 percentage is higher
than that reported in the province (6.5%) and Canada (4.8%) (Community
Accounts).
Congestive heart failure has been noted as very prevalent in this local area and
has been identified as an increasing concern (Consultations, 2013).
4.6.2.1 High Blood Pressure
High blood pressure (hypertension) is a major risk factor for heart disease and
stroke. Hypertension is a condition that can be prevented and or controlled
through healthy lifestyle options such as physical activity and healthy eating.
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The percentage of people who self-report high blood pressure in the Central
Region is higher at 25.9% than that of Canada (16.9%) and Newfoundland
(22.9%). For NWI 41.7% of the population self-reported high blood pressure and
in Twillingate the rate was 46.3%.(CCHS 2009-10).
Again, when considering an older demographic, the rate of high blood pressure
increases dramatically with 60.3% of the population within Central Region, age
65+ having been diagnosed with the condition.
Health Conditions: High blood pressure (%) by sex, 65 years and over, Central Regional
Integrated Health Authority, Newfoundland and Labrador and Newfoundland and Labrador
(CCHS 2009-10)
4.6.2.2 Acute Myocardial Infraction
Acute Myocardial Infarction (AMI) is one of the leading causes of morbidity and
death. This indicator is important for planning and evaluating preventative
strategies, allocating health resources and estimating costs. The rate of new
acute AMI events admitted to an acute care hospital age 20 and older in 2010-11
for Central Health was 364 per 100,000, which was the highest among the
regional health authorities, higher than the provincial rate (320) and higher than
the national rate (209) (Discharge Abstract Database, 2012).
4.6.2.3 Stroke
Stroke is one of the leading causes of long-term disability and death. This
indicator is also important for planning and evaluating preventative strategies,
allocating health resources and estimating costs.
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From a disease surveillance perspective, there are three groups of strokes: fatal
events occurring out of the hospital, non-fatal strokes managed outside acute
care hospitals and those admitted to an acute care facility. Although strokes
admitted to a hospital do not reflect all stroke events in the community, this
information provides a useful and timely estimate of the disease occurrence in
the population. (Statistics Canada, Health Profile, 2013).
Within the Central Region, in 2012 there were 133 hospitalized stroke events per
100,000 of the population. Provincially, the rate was 146 per 100,000 (Discharge
Abstract Database, 2012).
Health Conditions: Hospitalized stroke event rate (per 100,000 population) by sex, 12 years
and over, Central Regional Integrated Health Authority, Newfoundland and Labrador and
Newfoundland and Labrador
The number of deaths due to stroke in 2010-11 was 416 in the province (NL
Centre for Health Information, 2010).
4.6.3 Arthritis
The term arthritis is used to describe more than 100 conditions that affect joints,
the tissues which surround joints, and other connective tissue. These conditions
range from relatively mild forms of tendonitis and bursitis to systemic illnesses,
such as rheumatoid arthritis.
The percentage of people living with arthritis in Central Region increased from
2009-10 at a rate of 19.9% to 25.5% in 2012. The provincial rate remained the
same over this time period at 23.2%. When considering the 65+ age group the
percentage increases in the region to 42.3% and is much higher in women than
men (CCHS 2009-10).
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Health Conditions: Arthritis (%) by sex, 65 years and over, Central Regional Integrated
Health Authority, Newfoundland and Labrador and Newfoundland and Labrador (CCHS
2009-10)
4.6.4 Asthma
Asthma is a chronic health disorder affecting a substantial proportion of children
and adults worldwide. It is characterized by coughing, shortness of breath, chest
tightness, and wheezing. The percentage of people diagnosed with asthma in
Central (6.5%) is lower than that of both the province and Canada (both 8.4%)
(CCHS, 2009-10).
4.6.5 Chronic Obstructive Pulmonary Disease
COPD includes such disorders as chronic bronchitis or emphysema.
Within Central region, 3.9% of the population aged 35 and over was diagnosed
as having COPD, compared to 4.9% of the population in the province. The rate
in Canada, was 4.2%. These rates showed very little change from the rates
reported in 2010 (CCHS).
COPD is prevalent in this local area as well with an observed increase in the
number of people affected by this disease (Consultations, 2013)
4.6.6 Cancer
According to the CCHS 2009-10, there were 349.8 cases of cancer per 100,000
people in the Central Region population. Within the province in that year, there
were 382.6 cases per 100,000. The percentage of people diagnosed with cancer
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in Central in 2010 was 1.8% which was in line with the rate in the country at 1.9%
and slightly lower than the provincial rate of 2.1%
4.6.7 Mood Disorder
The percentage of people reporting that they had been diagnosed by a health
professional as having a mood disorder, such as depression, bipolar disorder,
mania or dysthymia in 2010 in the Central Region was 4.6%. This is lower than
the rates in the province (5.2%) and Canada (6.6%). There was a noticeable
difference in diagnosis based on gender with 8% of the female population
diagnosed with the disorder in Central and 0% in men.
Health Conditions: Mood disorder (%) by sex, 12 years and over, Central Regional
Integrated Health Authority, Newfoundland and Labrador and Newfoundland and Labrador
(CCHS. 2009-10)
4.7 Chronic Pain
Health and Welfare Canada considers chronic pain as pain that “persists
(beyond) the normal time of healing, is associated with protracted illness, or is a
severe symptom of a recurring condition”, and is of 3 months duration or more
(Ospmia & Harstall, 2002).
According to the Newfoundland and Labrador’s Improving Health Together
(2011), 17% of Newfoundland and Labrador’s population reported living with
Chronic Pain.
4.7.1 Pain or Discomfort, Moderate or Severe
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In Central Region, 12.1% (9% males, 15.1% females) of the population reported
pain or discomfort that was moderate or severe. This is on par with the provincial
rate of 12% (CCHS, 2009-10).
4.7.2 Pain or Discomfort that Prevents Activities
In 2009-10 in Central Region 12.7% were reported to have pain or discomfort
that prevents activities. The provincial rate was similar at 12.5%.
4.8 Dementia
Dementia describes a group of symptoms affecting thinking and social abilities
severely enough to interfere with daily functioning. Many causes of dementia
symptoms exist. Alzheimer'
s disease is the most common cause of a progressive
dementia.
The Canadian Study of Health and Aging estimates that 364,000 Canadians over
age 65 have dementia, with 238,000 of them being diagnosed with Alzheimer
Disease. An estimated 5,300 individuals in this province are affected by
dementias. Based on provincial population estimates, the number of individuals
over the age of 65 with a form of dementia is expected to rise to over 10,000 by
2026 (Provincial Strategy for Alzheimer Disease and Other Dementias, 2002).
While we do not have numbers to indicate the percentage of individuals impacted
by dementias in our local area, it has been noted as an increasing concern. In
consultation with community supports local staff, the level of concern regarding
this population was tremendous. From their caseload perspective, dementia
appears to be on the rise and along with it, the resources required to support this
clientele and their families is not available. Individuals in the community with
dementia are being cared for by family members who are burdened with the
stress involved in this role. Adequate placement options are not available.
Capacity assessments wait times are lengthy. The respite bed option for these
individuals is no longer reliable and many are waitlisted for LTC without any
vacancies being available across all Central Region.
4.9 Participation and Activity Limitation
30.3% of the population in Central Region experience participation and activity
limitation sometimes or often. The provincial rate was 31.2%. This rate increases
with age with 46.1% of the population age 65+ in Central NL having this limitation
sometimes or often (CCHS 2009-10).
Percentage of population who sometimes or often have limitations in activities
due to health issues, age 12+.
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Human Function: Participation and activity limitation, sometimes or often (%) by sex, 65
years and over, Central Regional Integrated Health Authority, Newfoundland and Labrador
and Newfoundland and Labrador (2009-10).
4.10 SECTION HIGHLIGHTS
The rates of overweight and obesity as well as Type 2 Diabetes are very high in
this area with a noticed increase. This has been noted of great concern. Rates of
other chronic diseases are not available locally but thought by health providers to
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be in line with the region with high rates of individuals being diagnosed with high
blood pressure and cardiovascular disease. The number of individuals affected
with dementia and the impact on them and their families has been noted as a
great concern. Families are struggling to cope with demands and individuals are
having difficulty accessing the high level of care they require.
MORBIDITY AND MORTALITY
5.1 Hospital Morbidity
Hospital morbidity refers to the number of separations from hospitals due to
discharges, transfers and deaths. It is based on the diagnosis most responsible
for patient stay, including multiple separations/re-admissions for the same
individual.
Central Region has higher rates than the province for most categories except for
injury and poisoning. The highest hospital admissions from 2000-2009 was
attributed to diseases of the circulatory system (16%) which is higher than the
province (13%). Circulatory system rates were the highest category for
Twillingate at 17% as well as New World Island at 13%.
Morbidity rates are influenced by the age structure of the population. In 2008-09,
the median age of all hospital admissions was 57 years (61 years for males and
53 years for females), which was among the highest of the regional health
authorities and was higher than the provincial age of 53 years. 39% of hospital
admissions occurred in the 65+ age group which was 5% higher than the
province (34%).
Highest Hospital Morbidity/Separations:
(2008-09)
7%
Cancer
7%
4%
Injury and Poisoning
6%
8%
8%
Twillingate
7%
6%
4%
Diseases of the
Genitourinary System
6%
6%
New World Island
7%
Diseases of the
Respiratory System
Province
9%
Diseases of the
Digestive System
10%
Central Region
11%
10%
14%
10%
10%
11%
Diseases of the
Circulatory System
17%
13%
13%
0%
4%
8%
12%
16%
16%
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* The percentages in this graph does not equal 100% as there is a category of “other” that
is not included.
5.2 Mortality
5.2.1 Total Mortality Rates
Information about mortality can be used to assess the health status of the
population. Mortality rates are calculated for specific diseases or conditions and
act as indicators of population health. In 2010, the Central Region had a total of
925 deaths. 79% of individuals were aged 65 and older, which is comparable to
the province (78%). For the TWNWI area there was a total of 70 deaths in 2010
with 71% of these being individuals 65 years or older.
In 2010, males in the region had a higher number of deaths (55%) than that of
the province (52%). Among the four health authorities, males in the Central
Region had the second highest number of deaths. (Central Health Regional
Profile, 2012).
The crude mortality rate refers to the number of deaths per 1,000 individuals in a
given year. In Central Region in 2009, the crude mortality rate was 9.67 per
1,000 people. Central Region had the highest mortality rate of the four authorities
and was also higher than the provincial rate. (Central Health Regional Profile,
2012)
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5.2.2 Infant Mortality Rates
In 2009, the number of infant deaths in Central Region was 19 (an infant
mortality rate of 7.8) This rate was higher than the provincial rate of 6.1. (Infant is
defined as a child within the first year of life).
5.2.3 Potential Years of Life Lost (PYLL)
Potential years of life lost for total mortality is the number of years of life “lost”
when a person dies “prematurely” from any cause before the age of 75. A person
dying at age 25, for example, has lost 50 years of life.
In the Central Region the PYLL rate for 2009 (per 100,000 population) was
4919.5. Comparatively, within the province, the PYLL rate (per 100,000
population) for 2009 was 5293.0. (Newfoundland and Labrador, Centre for Health
Information, 2010).
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5.2.4 Potentially Avoidable Mortality
Potentially avoidable mortality is defined as deaths before age 75 that could
potentially have been avoided through all levels of prevention (primary,
secondary, tertiary). It refers to untimely deaths that should not occur in the
presence of timely and effective healthcare or other public health practices,
programs, and policy interventions. It serves to focus attention on the portion of
population health attainment that can potentially be influenced by the health
system (Central Health Regional Profile, 2012). For Central Region this rate was
lower than all health authorities and the province with a rate per 100,000 for
2006-08 of 188. The provincial rate was 220. (Vital Statistics Death Database,
2006-2008)
5.2.5 Avoidable Mortality from Preventable Causes
Mortality from preventable causes is a subcategory of potentially avoidable
mortality, representing deaths before age 75 that could potentially have been
prevented through primary prevention efforts such as lifestyle modifications or
population level interventions (e.g. vaccinations, injury prevention). This can
inform efforts to reduce the number of initial cases (incidence reduction). For
Central Region the avoidable mortality rate from preventable causes per 100,000
for 2006-08 was 114, which is lowest among the regional health authorities and
lower than the provincial rate (132). (Vital Statistics Death Database, Statistics
Canada).
5.2.6 Avoidable Mortality from Treatable Causes
Mortality from treatable causes is a subcategory of potentially avoidable
mortality, representing deaths before the age of 75 that could potentially have
been avoided through secondary or tertiary prevention. The indicator informs
efforts aimed at reducing the number of people who die once they have the
condition or case-fatality reduction. For Central Health, the avoidable mortality
rate from treatable causes per 100,000 for 2006-08 was 74, which was among
the lowest of regional health authorities, and was lower than the provincial rate of
88. (Vital Statistics Death Database, Statistics Canada).
5.2.7 Unintentional Injury Deaths
For Central Region (2005-2007) the rate of unintentional injury causing death
was 23.1 per 100,000 population. These injuries are related to transport
accidents, falls, poisoning, drowning and fires but not complications of medical
and surgical care (Statistics Canada).
According to the Social Determinants of Injury report by the Atlantic Collaborative
on Injury Prevention, injury rates have been declining in recent decades.
However, the report notes that there is a significant difference in injury rates
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according to socio-economic status (the poorest Canadians experience injury at
a rate 1.3 times higher than the wealthiest) and that seniors, children, and
adolescents are at a higher risk of injury than other age groups. Aboriginal
peoples also experience injury at a significantly higher rate. These trends and
differences should be considered when looking at prevention strategies.
5.2.8 Intentional Injury Deaths
For Central Region, there were 4.4 per 100,000 of the population suicides and
self-inflicted injuries causing deaths (Statistics Canada, 2005-2007). The overall
suicide rate among Newfoundlanders is still significantly lower than the Canadian
average (The Telegram, 2008).
5.2.9 Leading Causes of Death
The leading cause of death in Central Region in 2006 was circulatory diseases
(36.3%) which is down by 1.2 percent from the previous year. The second
leading cause of death was cancer (26.3%) which is also down by 1.3 percent
from the previous year.
5.3 SECTION HIGHLIGHTS
Most data for this section was regional as local data was difficult to obtain.
Through consultations in looking at this section nothing stood out as of great
concern and it was thought that local data would be consistent with regional
trends.
COMMUNITY ASSETS
A community asset is anything that can be used to improve the quality of
community life. It can be a person, a physical structure or place, and /or a
business that provides jobs and supports the local economy. (Community
Toolbox, 2013)
Some of the community assets identified in the TWNWI area, excluding primary
health care providers previously referenced, include the following:
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Local Employers
• Central Health
• Nova Central School District
• Fish Plants
• Cottles Island Lumber
• First Choice Vision Centre
• Seniors Complex’s
• Funeral Homes
• YMCA Child Care Centre
• Public LIbraries
• Fishing boats
• RCMP
• Construction companies
• There is an array of other businesses such has retail stores, restaurants,
hotels, tourism establishments, gas bars. etc.
Community Resources
• Minor Hockey Association
• Guiding Movement
• Community Youth Network
• Town Recreation Committees
• Food Banks
• 50+ Clubs
• Red Cross
• Caregiver Support Group
• Development Association
• Figure Skating Club
• Women’s Institute
• Sea Cadets
• Hospital Auxiliary
• Breast Cancer Support Group
• Fire Departments
• Kids Eat Smart Foundation
• Kinsmen
• Boyd’s Cove Interpretation Centre
• Ministerial Association
• MOPS group, NWI
• Lions/Lioness’ (Legion)
• Community Centres
• Indoor Walking Program
• Recreation/Sports Teams
There are a number of churches across this area. Also included in under these
churches are various groups associated within the churches. There is a Roman
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Catholic Church in nearby Boyd’s Cove. The Dominations include but are not
limited to
•
•
•
•
•
•
Pentecostal
Roman Catholic
Anglican
United
Salvation Army
Full Gospel
Town Councils
• Twillingate
• Summerford
• Cottlesville
• Crow Head
Local Service Districts
• Purcell’s Hr
• Virgin Arm-Carter’s Cove
• Chanceport
• Bridgeport
• Moreton’s Hr
• Valleypond
• Tizzard’s Hr
• Fairbank-Hilgrade
• Newville
• Cobb’s Arm
• Herring Neck
• Merritt’s Hr
• Indian Cove
Education Institutions
• New World Island Academy
• Twillingate Island Elementary
• J.M Olds Collegiate
Physical Space
• Local Playgrounds
• Hospital Pond walking trail and beach area
• Peyton’s Woods RV Park (La Scie)
• Dildo Run Provincial Park
• New World Island Ski Trail
• Outdoor Rink
• Ball Fields
• # of developed walking trails/signage
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Other
• George Hawkins Arena
• Community Centres
•
It is important to note that the above assets are not considered to be an all
inclusive list and are up to date only at the time of profile development.
HEALTH PRIORITIES
7.1 We Learned
The community profile process has been very informative of the needs and
strengths of the Twillingate-New World Island Primary Care area. The data that
was gathered through research, databases, and surveys was enhanced further
by consultations with health providers, other service delivery professionals as
well as many community members and leaders.
The final community consultation took place on November 26th, 2013 at the
Twillingate Lion’s Club. The following individuals attended the session:
Victor Shea, Director of Health Services
Gloria Bath, Manager Primary Health Care
Hilary Rice, Youth CAC member
David Regular, CAC Chairperson
Wanda Smith-Gillard, Community Supports Social Worker
Elaine Steele, Continuing Care Nurse
Vanessa Dove, Continuing Care Nurse
Jane Bath, Public Health Nurse
Cheryl Cassell, Early Youth Outreach Worker
Geena Anstey, Youth CAC member
Dr. Daniel Hewitt, Family Physician
Katherine Sansome, Manager, Client Care Services
Theresa King, Social Worker
Joanne Lodge, Public Health Nurse
Jean Link, Education CAC member
Grant White, Twillingate Recreation Committee
Tony Richards, Nurse Practitioner
Paula Mitchell, Nurse Unit Coordinator
Invitations were also extended to the following (unable to attend):
David Dove, CAC Board Trustee/Chair
Ross Gambin, Industry CAC member
Corporal Joe Young, RCMP CAC member
Victor Cassell, CAC member
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Gord Noseworthy, Town Council CAC member
Cynthia Coish, Local Service Group CAC member
Pastor Willie Angell, Clergy CAC member
Dr. Ravalia, Family Physician
Sharon Mercer, CYN coordinator
Capt Dwayne LeDrew, Clergy
Rev. Paula Gale, Clergy
Heather Saunders, Community Supports Social Worker
Holly Anstey, Recreation New World Island
Jessica Boyd, Community Development Public Health Nurse and Allison Scott,
Primary Health Care Facilitator led the discussion during this consultation. Seven
themes were presented based on the information gathered through this process.
The seven themes were as follows:
1. Options for Children, Youth and Families
(Need to examine what we have available to children, youth and families and
fill in the gaps in resources/support)
2. Supports for Seniors and their families
(Need more resources to support our increasing numbers and increasing
levels of care)
3. Transportation
(Need to examine if what we have is sufficient, identify gaps, build resources)
4. Healthy Lifestyles
(Need to make improvements in the lifestyle options available, access to the
options, and participation levels in healthy choices)
5. Mental Health
(Need to look at mental health needs versus resources and fill in the gaps)
6. Access to and Awareness of services
(Awareness of how and the ability to access services/supports outside the
local health provider team)
7. Chronic Disease
(Prevent chronic disease and support people affected by it)
Information was presented on each of the seven noted themes. Time was
allowed for clarification, questions, and comments around each of the individual
themes. Participants were given the opportunity to suggest if the facilitators had
missed any topics that should be included as a theme. While no themes were
added, a couple of points to consider when planning at a later stage were noted
including 1. That outmigration continues to be a factor for this area and it is worth
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considering the impact this has on this area, and 2. Employment issues around
the ability to recruit and retain qualified individuals to fill the vacancies and
requirements for service delivery in this local area.
Using Turning Point technology (response pads) participants were given the
opportunity to pick two themes that they would consider to be the top two
priorities for this local area. Individuals chose two themes on an individual,
anonymous basis. In making their selection, participants were asked to consider
the following:
•
•
•
•
•
Whether or not the theme affected a large number of people or a select
few
Whether or not the issues was already being addressed and well
underway
What would happen if we didn’t select the theme as a priority (what would
the impact be?)
Is the issue at a local, regional or provincial level?
The cost versus the value.
Through this process the priorities selected were as follows:
#1 Supports for Seniors and their Families (36%)
#2 Healthy Lifestyles (25%)
#3 Access to and Awareness of Services (17%)
#4 Chronic Disease & Options for Children and Youth (both at 8%)
#5 Mental Health (6%)
#6 Transportation (0%)
Results were provided to the participants instantaneously. Feedback suggested
that the results were not of any surprise and participants were satisfied with the
activity. It was noted, however, that the themes that were ranked very low were
still seen as very important but felt that the questions to consider while ranking
played a role in their decision making.
7.2 Recommendations
The results of this community profile process will be brought forward for detailed
discussion at the Community Advisory and Primary Health Care Lead Team
tables for action planning. All seven of the noted themes have potential action
items that these two teams will consider for inclusion in the 3 yr action and
implementation plan and partnerships with the Regional Health Board as well as
other stakeholders will be identified through this process.
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NEXT STEPS
8.1 Action/Implementation Plan
The priorities identified through this profile process will be included in the
Twillingate-New World Island Primary Health Care operational plan (Appendix
F). Action plans for specific priorities will be developed as needed. The PHCLT
and the CAC will use the operational and action plans as a guide for the PHC
work over the next three years and will partner with other community groups,
sectors, key stakeholders and individuals as needed to impact change.
8.2 Primary Health Care Model
Central Health has committed to a PHC model for service delivery. The primary
health care approach is a philosophy of health care, a strategy for organizing
health services and includes a range of health services. It extends beyond the
traditional health care system to include all services that play a part in health
such as income, housing, education, and environment.
Primary health care, as a strategy for organizing health services, is the first level
of contact in a well-integrated continuum of health services. It addresses the
main health concerns in a community, providing promotive, preventative,
curative, supportive, and rehabilitative services. It includes well defined and
effective linkages with health and community service programs, secondary and
tertiary levels of health services, in order to facilitate efficient and effective client
referral processes between the three levels of services.
Primary health care, as a level of health services, is the first point of contact with
the health services system. At the primary health care level, teams work in
collaborative partnership with clients/patients to determine the most appropriate
health service providers to meet their needs in the initial and continuing
team/client/patient relationship. Within this relationship, health service providers
will be supported and enabled to fully use their knowledge and skills, and
clients/patients will be enabled to take control of their own health. The
community, as a client, will be supported by the team in building capacity to
improve the health of the community population.
Primary health care, as a defined set of comprehensive services, will be
evidence-based, and cost-effective. It will provide a balance of services that
promote health, prevent illness/ injury, and diagnose/treat episodic and chronic
illness and injury. Primary health care services will encourage and support
individuals, families, communities, and populations as a whole, in making
decisions to prevent illness, and achieve and maintain the best health possible.
The Primary Health Care approached as described by the World Health
Organization (1978) is guided by the principles of accessibility, equity,
appropriate
technology,
intersectoral
collaboration,
interprofessional
collaboration, health promotion and public participation.
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8.3 Strengths, Challenges and Opportunities
The following are some of the identified strengths, challenges and opportunities
for the implementation of a PHC Model for service delivery in the TWNWI area.
Interprofessional Collaboration
The collaborative approach is about health care providers working together to
improve the continuity of care, reduce duplication and ensure individuals have
access to appropriate health professionals. Patient-centered care is a guiding
principle for interprofessional teams.
Our Team – Strengths
•
•
•
•
•
•
•
•
•
•
•
•
•
This area has been a part of Primary Health Care since 1999
The area has core teams set up with strong membership and leadership
The area has sub teams as needed to get the work accomplished
There is a good compliment of family physicians/nurse practitioners
New positions have been introduced recently
There is built in PHC education for all staff hired
There are opportunities for staff to become involved in PHC planning
There are regularly scheduled medical rounds with an education
component
Through leadership of our physician lead, a strong connection with MUN
school of Medicine exists with many medical students coming here for
internships. This has resulted in the recruitment of many of our physicians
now on staff.
Community health staff are physically located at NDBMHC and NWICHC.
Videoconferencing and teleconferencing is available to the team to
support their participation in education and/or regional meetings.
Our health care centres have excellent support services that enable the
facility to operate daily
Regional health care providers visit on prearranged clinic schedules to
offer service
Our Team- Challenges
•
•
•
•
Difficulty recruiting to some positions (e.g. X-Ray, Nursing, Physio)
Gaps identified in some service areas (e.g. Mental Health, Dietitian
services shared)
Difficult to retain employees (lacking competitive wages for skilled labor)
It can be difficult to be all inclusive of staff (especially shift workers) in
activities, education events, etc due to the nature of their position and
ability to take time to attend/participate
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•
•
•
Not all staff feel competent and comfortable using the technology that is
available to them
There is a lack of casual nursing staff available in this local area which
makes it difficult to provide staff with leave. This leads to staff burnout.
Changes around the nursing model are a challenge with the current
nursing compliment.
Our Team- Opportunities
•
•
•
•
Team social activities- recent increase in uptake- room for advancement
and growth
Support and further education for staff to utilize technology as a means to
connect with other staff members should be explored.
Continued education opportunity regarding the new nursing model
Build good connections with regional program to fill in service gaps
creatively (e.g. Mental Health & Addictions traveling clinics)
Health Promotion (HP) and Illness/Injury Prevention
Under a primary health care model there should be an increased emphasis on
promotion of wellness and the prevention of illness and injury. Health promotion
is the process for enabling people to increase their control over their own health
and make improvements to their overall well-being.
Health Promotion- Strengths
•
•
•
•
•
•
•
A team has been established to organize HP displays and print materials,
organize community health promotion events and avail of opportunities for
health promotion with staff.
Strong community leaders in area of health promotion are evident in the
recreation committees and the social groups there
Programs available in the area to support HP such as Chronic Disease
Self Management program.
Schools in the area utilizing health promotion strategies. For example,
Anti-Bullying, Kids Eat Smart, Quality Daily Physical Activity
Some positions have a focus on Health Promotion such as PHN and Early
Outreach Youth Worker and have done a large amount of work in this
area, particularly with youth.
PHC newsletter distributed regularly with a health promotion section. This
is delivered to every mailbox in the local area.
Falls prevention champions in this area (institution). Falls prevention
community education has taken place.
Health Promotion- Challenges
•
It is difficult to reach certain populations with HP messages.
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•
•
•
It is difficult to recruit participants for the organized HP sessions. Noshows is an ongoing issue.
It can be challenging to continue with programs such as Kids Eat Smart
due to the reliance on volunteers
Programs such a QDPA and Anti-Bullying require refreshers and
continued support
Health Promotion- Opportunities
•
•
•
•
Room for improvement in health promotion within the organized groups in
the area. Provision of healthy food options as well as physical activity
incorporated in events needs further consideration/implementation.
Build upon the Health Promotion is Everybody’s Business education (i.e.
having staff recognize and avail of opportunities for health promotion in all
client/patient interactions)
Further Falls Prevention education at community level
Ensure understanding of the roles of the different consultants within CH
and utilizing these consultations when applicable
Community Engagement
PHC’s approach is to promote health with input by the community in making
decisions regarding their own health, identifying the needs of the community and
then assisting in the planning and implementation of community health action
plans.
Our Community- Strengths
• CH has invested in a community development approach and has
designated Public Health Nurse positions to provide support to the
community.
• Examples of strong community development in the area include Caregiver
Support Group, Licensed Child Care, Playground development,
Community Wheels Project, Community Youth Network, Women’s Days.
• Funding has been availed of to support community development efforts.
Provincial government funding in the area of health promotion appears to
be growing.
Our Community- Challenges
• Although progress can be seen in some examples, there is a continued
division within the local area between the two islands of Twillingate and
New World Island that can pose a barrier to community capacity building.
• There is a declining volunteer base.
• Out-migration has resulted in a loss of many of the younger adult
population as well as community leaders.
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Our Community- Opportunities
• The community appears receptive to a community development approach
and therefore continued education with the community and with providers
can facilitate further capacity building.
• A common vision for the whole area (Twillingate and NWI) would help in
strategic planning and further teamwork/community building.
• Encourage youth/young adults to become active participants in their
communities by participating in teams and committees.
Access
Access, under a Primary Health Care model, involves more than wait times but
involves consideration of availability of services, geographic location of services,
how accommodating services are to the patients’ needs, and whether or not the
services are acceptable to what the patient requires.
Access- Strengths
•
•
•
•
•
•
•
Provincial Healthline is readily available and now promoted through the
local health centre phone line.
Telehealth is available and used by people in the community to connect
with regional/provincial specialists such as oncologists. This is expanding.
Community Wheels Project in place which enable individuals without
readily available transportation to attend medical appointments, get their
groceries, and further engage in the community.
With the current physician compliment, wait times to see a family
physician is generally reasonable.
Access to services such as dental and physiotherapy has improved.
Young families in the area access programs such as BURPS, MOPS to
support them in healthy child development
There is a PCH and LTC in this local area
Access- Challenges
• Appointment wait times for the female nurse practitioner has been noted
as a concern
• Awareness of and/or confidence in the Provincial Healthline is lacking
• Access to services such as Mental Health has been noted as a challenge
• There is a lack of formalized programming for young families to participant
in activities with their children (particularly with children ages 1- school
age)
• Access to high levels of care (level 2+) is a challenge in this local area
increasing the demands on the families
Access- Opportunities
•
Further education/awareness of the Healthline is warranted as well as
other provincial/regional helplines is warranted.
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•
•
Traveling clinics for Mental Health and Addictions has been introduced as
a pilot with the hope that this will continue as a part of our local service
delivery- support from our local team is essential.
Explore option for Family Resource Centre in the area.
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Active Healthy Kids Canada Report Card, 2013.
http://www.activehealthykids.ca/ReportCard/2013ReportCard.aspx
Body & Health, Underweight is a Problem Too, 2011.
http://bodyandhealth.canada.com/
Canadian Cancer Society, 2011-2013
Canadian Community Health Survey, 2009 -10
Canadian Diabetes Association, 2013
Canadian Study of Health and Aging
Census, Statistics Canada, local industry, 2006
Central Health, Cervical Screening Initiative Program, 2008-2013
Central Health, Coordinator of Residential Service, 2012-2013
Central Health Influenza Report, Hayley Cooze, CDCN, 2011-2012
Central Health, NL Colon Cancer Screening Program, 2013
Central Health Regional Profile, 2012
Circle of Health, Prince Edward Island’s Health Promotion Framework, 1996
Colley, C., Garriguet, D., Janssen, I., Craig, C., Clarke, J., and Tremblay, M.,
Physical activity of Canadian adults: Accelerometer results from the 2007
to 2009 Canadian Health Measures Survey, 2011
Community Accounts, 2005-2013
Community Health Assessment Guidelines, Manitoba, 2009
Community Tool Box, Identifying Community Assets and Resources, 2013.
http://ctb.ku.edu/
Consultations, 2013. Community Advisory Committee, Primary Health Care Lead
Team, Community Supports Staff, Clergy, Youth Services providers
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Cross Canada Report on Student Alcohol & Drug Use, 2011
CYFS Strategic Plan, 2010-2014
Department of Education, Newfoundland & Labrador, 2012-2013
Department of Environment and Conservation, Newfoundland & Labrador, 2013
Department of Health & Community Services, Newfoundland & Labrador, Adult
Dental Program, 2010-2013
Department of Health & Community Services Newfoundland & Labrador, Child
and Youth Development, 2011-2012
Department of Health & Community Services Newfoundland & Labrador,
Gambling, 1998
Department of Health & Community Services, Tobacco Control, 2011
Discharge Abstract Database, Canadian Institute for Health Information, 2012
Eastern Health, Health Status Report, Birth Weight, 2012
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Health Canada, Healthy Living: Oral Health, 2009
Health Canada, Mental Health, 2009
Health Canada, Overweight and Obesity, 2006
Health Canada, Seasonal Influenza, 2006
Health Canada & World Health Organization, Tobacco Use, 2011
Healthy Aging Discussion paper, March 2006
Immunize Canada, 2013. http://www.immunize.cpha.ca/en/default.aspx
Kids can Play series, Canadian Fitness & Lifestyle Research Institute, 2011
Newfoundland & Labrador Centre for Health Information, Mortality System &
Statistics, 2010
Newfoundland and Labrador Gambling Prevalence Survey, June 2009
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Newfoundland & Labrador Healthline, Evaluation: Phase II Report, March 2013
Newfoundland and Labrador Housing Corporation, 2013
Newfoundland and Labrador Student Drug Use Survey (NLSDUS), 2007
Nova Scotia Department of Health, Prenatal Care, 2002
On the Pulse, Nina Elliott, Restorative Care Program, 2013
Ospina, M., & Harstall, C., Prevalence of Chronic Pain: an overview. 2002
Personal communication with Central Health Coordinator of Residential ServicesAdults, 2013
Personal communication with Central Health Personal Care Home Coordinator,
2013
Provincial Breast Screening Program, NL
Provincial Strategy for Alzheimer’s Disease & other Dementias, 2002
Provincial Wellness Annual Report, 2011
Public Health Agency of Canada, 2003-2011
Public Health New Life Series
Public Health Program, Central Health, 2013
Reilly, Early Life Risk Factors for Obesity in Childhood, British Medical Journal,
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Scott’s Medical Database, Canadian Institute for Health Information, 2010
Smokers Helpline, NL, 2012
Social Determinants of Injury Report by Atlantic Collaborative on Injury
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Statistics Canada, Canadian Caner Registry, 2007-2009
Statistics Canada, Education, 2006
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Statistics Canada, Health Profile, 2012/ 2013
Statistics Canada, Labour Force Survey, 2011
Statistics Canada, Mortality, 2005-2007
Statistics Canada, Population of Children, 2011
Summary Report, Access to Service Grant Feedback Form, 2013
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The Beacon, Kevin Higgins, Video Healthcare Eases Family Members'Anxiety,
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The Telegram, 2008
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Vaughan DA, Cleary BJ, Murphy DJ., Delivery outcomes for nulliparous women
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Appendix A
Community Advisory Committee Consultation
Oct 1, 2013
TWNWI
Available:
Unavailable:
Geena Anstey
Hilary Rice
Gordon Noseworthy
Pastor Angell
Cpl. Joe Young
David Regular
Dave Dove
Ross Gambin
Jean Link
Victor Cassell
Cynthia Coish
Gloria.Bath
Allison Scott, Primary Health Care Facilitator, and Jessica Boyd, Community
Development Public Health Nurse facilitated this session to assess and validate
the information that had been collected for the community needs assessment.
Allison informed the group on the process that is followed and how data was
collected. The group was then guided through each of the data topic areas.
Population
- Older population in this area.
- Harder to get people for some employment older population not able to do
heavy work.
- We have seniors taking care of seniors.
- Different health services are needed for seniors vs. younger population.
Education
Employment
- EI rates not surprising with a small rural community, many people working
with fishery.
- Tourism is almost as big as the fishery in TW, NWI more fishing/logging
industry.
- Seems to be a higher number of people availing of “turnaround” positions.
Income & Personal Status
- Age is a factor in the decrease in Income support in the area, people are
moving to different government transfers?
- Poverty is not seen to be an issue in this area, a big difference noted in
the last 25 years.
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-
The senior population and the ”working poor” were said to be the two
populations most at risk for income problems.
Health Child Development
- Childcare is a disadvantage for lone parents.
- Not enough programming for youth age 15-18, CYN in NWI is used mostly
by younger teens and youth from TW do not attend
- Church youth groups and stadium only options for youth in TW.
Physical Environment
- Transportation not as much an issue, community bus is filling a gap. Taxis
are stating to be running a lot.
- Safety is noted to be a concern everywhere, even in smaller communities.
Some problems with locals and strangers causing problems.
- Fear of theft and intruders of noted concern.
- Roads are not safe for walking, no shoulders/sidewalks, higher speeds
and a lot of ATV use on roads.
- TW water quality noted to have improved over last few years.
Personal Health Practices and Coping
- New members to the community note that there are a lot of physical
activities to avail of.
- Fruit and vegetable consumption is low because of affordability not
because it is not available. Parents don’t enforce healthy eating with
children?
- Increase misuse of prescription drugs? Decrease in alcohol use (not as
many clubs open).
2nd meeting, Community Advisory Committee Consultation, Oct 29th, 2013
Available:
- Jean Link
- Ross Gambin
- Hilary Rice
- Dave Dove
- Cynthia Coish
- Pastor Angell
- Gloria Bath
- Gordon Noseworthy
- David Regular
- Cpl. Joe Young
Unavailable:
- Geena Anstey
- Victor.Cassell
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Health Services
- For most it does not seem to be an issue to access a physician or nurse
practitioner.
- Hard to get an appointment with only female professional in the area.
- Mental Health services seem to only be available in GFW, which as been
an issue for people accessing.
- Some people from NWI have to travel to TWI for doctor appointments.
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Appendix B
Primary Health Care Lead Team Consultation
Oct 1, 2013
TWNWI
Available:
Victor Shea
Tony Richards
Theresa King
Vanessa Dove
Jane Bath
Katherine Sansome
Julie Baggs
Unavailable:
Dr. D. Hewitt
Dr. M. Ravalia
Wanda Smith-Gillard
Paula Mitchell
Joanne Lodge
Gloria Bath
Allison Scott, Primary Health Care Facilitator, and Jessica Boyd, Community
Development Public Health Nurse facilitated this session to assess and validate
the information that had been collected for the community needs assessment.
Allison informed the group of the process that is followed and how data was
collected. The group was then guided through each of the data topic areas.
Population
- Not surprising that this area has an older population.
- Population mostly age 50 +.
- More issues with employment noted because most of the working class is
now in the older age range and no one to replace retirements.
- As population ages we need more resources in the area of health and
wellness.
- More LTC resources need, problem is only going to get worse.
Education
- Nothing surprising with level of education or enrolment rates.
Employment
- Many people are availing of employment opportunities out-of-province,
NWI considered to be more of this population than TW.
- Increasing number of home care workers in this area.
- Sometimes hard to find people to fill certain positions because they do not
have a grade 12 education ex. Hospital support staff.
- People in public service sector are generally do not feel secure in their
jobs.
Income & Personal Status
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Less people receiving income support assistance, not as much incentive
to receive it.
Household incomes are still low, many are considered to be “the working
poor”.
Low income drug program is available which many people avail of.
More food bank users in NWI vs. TW (60 NWI, 14-20 TW).
Healthy Child Development
- Need for FRC in area
- Not many programs available in NWI for children (TW has library program,
BURPS, Kidkicks, etc).
- Surprising that male led lone-parent families was so high (25 male led TW,
40 NWI).
- Daycare improvement in area, now available in evening until 6:30, better
for those with longer work hours.
- Lack of activities in winter (outside of hockey). No beavers/cubs, not much
for young boys, more opportunities noted for girls (guides, dancing, etc).
- It would be a huge gain if the pool was available year round.
- Not many activities for teens, end up being around younger children in
playground etc. ? good or not
- More youth groups within churches in both TWNWI.
Physical Environment
- Patients medically discharged in acute care beds increasing because of
lack of LTC beds. Many people in community are hanging by a thread and
should be receiving care within a facility.
- More care options are needed for level 2 and 3 care.
- Huge gap right across the province, only choice to go in a PCH or stay in
own home that can not meet their needs or be medically discharged in
hospital bed.
- Families in area are going through torture caring for those requiring more
care.
- Enhanced home care would improve these problems.
- Respite bed is being used as medically discharged bed, not proper
utilization.
- Gap noted in transportation for children and youth under 19. Not able to
avail of community bus. Issue of this population attending medical
appointments.
- Taxi company’s prices are increasing.
- No tele-health at NWI Clinic.
- Area not as safe as it used to be, more break-ins, thefts, more tourists in
area leave people feeling unsettled.
- No shoulder of roads or sidewalks for walking in the area.
Personal Health Practices and Coping
- People surprised that NL youth more inactive than youth in other areas
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Staff immunization rate for influenza low right now because it is a personal
choice, until it is mandatory it will continue to be low.
Fruit and vegetable consumption thought to be low because produce is
not available, bad quality and very costly. Not thought to be because there
are more fast food options.
Increase misuse of prescription drugs and narcotic abuse
More harsh drugs available.
Noted that people are lined up to use the VLT”S when building opens.
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Appendix C
Consultation with Community Supports Staff
TWI-NWI
September 4th & 20th, 2013
Housing
- Need for smaller cheaper, maintenance done independent living option. It
does not necessarily need to be an apartment complex. Guy’s seniors’
apartments are filling a gap.
- Seniors are finding it difficult to stay in larger homes, costs of heating
them, and difficulty doing ongoing maintenance/repair.
- Financially it is harder for seniors to maintain and heat larger homes
(wood heat is very difficult and oil/electric is very costly.
- The mindset of people not wanting to leave their homes is seen to be
changing, but people still want to live as independently as possible.
- The personal care home is not attractive to some seniors, they do not like
the idea of having to share a room with someone else and still want their
privacy.
- Most homes in the area are well maintained and this is seen to be
improved in the last few years.
There are residential options in NWI such as the Cottlesville Seniors
Complex and Evergreen Manor in Summerford that is filling a gap in
housing for many. These residences provide privacy of an individual
apartment while providing maintenance of property and a common living
space as well. These are usually full with a waitlist. Subsidies are
sometimes available and rent is regulated.
Alternate Family Care
- These homes are similar to foster care but they provide care to adults with
special needs. It gives these individuals a permanent home. Sometimes
these homes do have space for short term respite care.
- These homes are financially supported by the Gov.
- There are 2 homes in the area, both located in Summerford (individuals
currently residing in these homes are not from this local area)
- Most adults with special needs in the area stay at home with parents.
Transportation
- Positive feedback from the Community Wheels Project however
awareness of this service is still required and a change in mindset of
potential clients
Some need noted for level 2 care in area (none available here) Some individuals
are choosing to stay in their homes and others are moving to Lewisporte,
Gander, GFW, etc.
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Long Term Care is filled across the region and many medical beds are filled with
medically discharged patients.
Dementia has been noted as a problem and seems to be on the rise. Services
are not available for this people and issues are arising.
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Appendix D
Consultation with CYN Director and Early Outreach Youth Worker
Oct 17, 2013
TWNWI
Allison Scott, Primary Health Care Facilitator, and Jessica Boyd, Community
Development Public Health Nurse facilitated this session to assess and validate
the information that had been collected for the community needs assessment.
Allison informed the group on the process that is followed and how data was
collected. The group was then guided through each of the data topic areas.
Education
- There has been more awareness in schools around bullying.
- Violence and bullying in schools has still been noted as a concern among
youth, has been mentioned to CYN staff at times.
- A need for activities on self image and mental health programs for youth
was noted.
Employment
- Not many employment opportunities noted for youth.
- A better link is needed with the children who are in families that have no
plans on attending post secondary school or are having trouble accessing
employment after high school. These individuals need some
counseling/assistance before leaving high school because once they
leave they are much harder to reach.
Health Child Development
- It was noted that there are not many programs available, especially on
NWI, which provide information/support to children at young ages and
their parents. Such as FRC type programming.
Physical Environment
- Gap identified that transportation is an issue for youth. Where
communities are spaced so far apart on NWI parents have no way to bring
them to school/physical/social activities.
- Also noted that some children/teens that need to access doctor/nurse
services are not able to get to appointments, etc.
- Youth need to obtain volunteer hours to graduate and many can not get
them because they have no transportation to get to and from areas where
they can volunteer.
Personal Health Practices and Coping
- A lot of children already have these lifestyle behaviors in place before they
attend school and before they attend CYN programs.
- There has been an increase seen in the number of students out smoking
at school.
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A need for more education surrounding ATV/Skidoo safety and helmet
use.
There seems to be a general acceptance of drug and alcohol use among
youth.
With regards to physical activity it seems that those that are involved are
really involved and others do not participate in any activities.
Youth seem to have more anxiety/stress and to be overwhelmed with life
and they do not have the coping skills that they need.
Some kids and youth in area have been noted to have dental issues.
Dental care is free up to age 12 , but it seems some may not be availing of
this service.
Health Services
- Thought around the healthline-Can it be accessed by youth/teens? The
healthline may be a resource for those you do not want their parents to
know their concerns or those who have no transportation to health
services
- Mental Health – Kids who you think would not have any problems are
those that often do. Increase concerns in relation to: depression, suicidal
thoughts, relationship problems, and anxiety.
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Appendix E
Consultation with Clergy
Clergy members from the area were given the opportunity for consultation regarding this
profile. The following questions were asked with feedback from one clergy member
provided as per below.
From your perspective, how are families/individuals doing financially? i.e.
do you hear many concerns voiced around not being able to make ends
meet? Concerns around the cost of groceries, heating, housing?
It was noted that many seniors are doing better financially than in the past with
the financial resources they have available to them. It was noted, however, that
cost of heating homes and groceries has become a source of financial stress.
With regards to food bank utilization numbers are there any trends noted,
any increase/decrease in usage, monthly stats, any differences between
the two food banks, etc?
Food bank usage may be a challenge due to transportation to the foodbank,
particularly on NWI.
Community kitchen effort was a success with participants noting the need for this
program and actively participating. More of this initiative is planned.
Is transportation noted as a concern? Is the Community Wheels Project
filling the gap/need for transportation? Are there other gaps?
Many individuals rely on family support for transportation however it is
anticipated that transportation will become a bigger concern with the population
as it ages. Some indicate they are challenged in getting transportation but still do
not avail of the bus.
It appears that safety is becoming more of a concern in this area, do you
have anything to add to this?
As clergy, it is of concern that many seniors, especially those living at home, are
feeble, have many medications on hand, and have ++ finances kept in their
home. Potential abuse, home invasions etc is a concern.
From your perspective, are mental health issues a concern for many? Are
the concerns getting addressed? Are families/individuals experiencing
more “life stress”? What about youth? Etc…
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Mental health is a topic that we face regularly in our pastoral response to people.
There are many more people being diagnosed and the community trying to
figure out more about it and how to respond well and in a helpful way
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Appendix F
The Primary Health Care Action/ Operational Plan will be developed under the
leadership of the TWNWI management team and the PHC facilitator in conjunction
with the PHC lead team and the CAC. The action plan will be added here when
complete (March 2014).
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