Report to: Chair and members of the Board of Health
Meeting Date: January 4, 2017
Report Number: BH.01.JAN0417.R02
Prepared by: Andrea Roberts, Director, Family Health; Rita Sethi, Director, Community Health and Wellness
Approved by: Dr. Nicola J. Mercer
Submitted by: Dr. Nicola J. Mercer, MD, MBA, MPH, FRCPC; Medical Officer of Health & CEO
It is recommended that the Board of Health::
- Receive this report for information.
Onward Willow (OW) is one of eight priority populations in Wellington-Dufferin-Guelph (WDG) where health disparities are seen.
Since the greatest gains in improving health can be made in vulnerable and marginalized sub-groups of our population, it is important to undertake activities supporting specific efforts in these areas.
Shelldale Centre is located in the OW neighbourhood as a multi-agency facility which brings together a number of health and social service providers to work collaboratively with Shelldale staff and OW residents to address health disparities in that population.
Wellington-Dufferin-Guelph Public Health (WDGPH) staff offer a comprehensive array of programs and services at the Shelldale location including clinical services, oral health, prenatal education, breastfeeding clinics, parenting supports and speech and language assessments.
The Social Determinants of Health
Social determinants of health are the socio-economic, cultural, and environmental conditions of our lives that impact overall health. Social determinants of health refer to a specific group of socio-economic factors within the broader determinants of health that relate to an individual’s place in society, such as income, education or employment. Social determinants of health are the conditions in which people are born, grow, live, play, work, and age, including the healthcare system. These conditions are shaped by the distribution of power and resources.1
Social determinants of health are seen as key contributors to the existence of health inequalities and health inequities. While not all health inequalities are avoidable and preventable, such as biological factors, some of them emerge as a result of a different experience in society. Gaps in population health refer to the absolute and relative differences in the health status between the most and least advantaged groups in a population.2 Health inequities are systematic differences in one or more aspects of health across socially, demographically, or geographically-defined populations or population subgroups. Unlike the health gaps that result from biological factors, health inequities are the product of social inequity and disadvantage, and are created in a social context; therefore, they are potentially remediable by policy changes.3
A publication from the Health Council of Canada, Stepping it Up: Moving the Focus from Health Care in Canada to a Healthier Canada, confirms that Canadians with the lowest incomes are more likely to suffer from chronic conditions such as diabetes, arthritis, and heart disease; to live with a disability; and to be hospitalized for a variety of health problems.4 They are twice as likely to use health care services as those with the highest incomes.
Since the greatest gains in improving health can be made in vulnerable and marginalized sub-groups of our population, it is important to undertake activities supporting specific efforts in these areas.
Onward Willow Population
NOTE: all data are from the 2011 National Health Survey and 2011 Census
OW is a neighbourhood located in the northwest part of Guelph with a population of 7,460 residents. In the WDGPH report “Addressing Social Determinants of Health in Wellington-Dufferin-Guelph”, OW was identified as one of eight priority neighbourhoods in the service region based on analysis/ranking of evidence-based indicators known to determine areas of health inequities within communities.5 There are a number of unique characteristics in this neighbourhood:
- OW is a multi-cultural neighbourhood with 27% of residents born outside of Canada (as compared to 16% in WDG). Because of this, neither English nor French is the first language for 26% of the neighbourhood residents.
2. A comparatively high rate of OW residents did not complete a high school education (as compared to the City of Guelph (17%) and WDG (20%).
3. There is a high rate of low income households in OW (as measured by the Low Income Measure, after tax (LIM-AT)).
4. More than half (56%) of OW residents rent, rather than own their homes. Comparatively, less than a quarter (22%) of all WDG residents rent their homes.
5. Slightly more than half (51%) of OW residents work in sales and service, or manufacturing and utilities occupations, as compared to 29% of WDG residents.
A comprehensive profile of the neighbourhood is attached as Appendix A: Neighbourhood Profiles in Wellington-Dufferin-Guelph.
Research has shown there are cumulative effects of health disparities.6 Disadvantaged individuals find themselves trapped in a cycle where being disadvantaged in one area (such as low education) leads to a greater disadvantage in another area (such as low income employment) which leads to yet greater disadvantage in another area (e.g. lack of medical/dental benefits or paid time to address medical concerns.
The Shelldale Centre is a multi-unit facility located at 20 Shelldale Crescent in the west end of Guelph and accommodates a number of health and social service agency tenants including WDGPH, Family & Children’s Services of Guelph and Wellington County (F&CS), Waterloo-Wellington Canadian Mental Health Association (WWCMHA), Guelph Community Health Centre (GCHC), Play Sense, Better Beginnings, Better Futures (BBBF) and Upper Grand District School Board (UGDSB). All of these organizations offer agency-specific programs and services that are open to the general population of the City of Guelph with the exception of BBBF which provides services to residents of the OW neighbourhood only. The various agencies work collaboratively, with the support of a Shelldale Centre Coordinating Committee, to support the residents of OW. The Shelldale Centre is owned and operated by Kindle Communities Inc. (Kindle) and was opened in 2001.
WDGPH Services at Shelldale Centre
To align with the distinct needs of this priority population, WDGPH provides unique and specialized services out of the Shelldale Centre location within a context and perspective of targeted universalism. WDGPH uses the Shelldale space as a service only site and offers a number of programs/services at that location:
A full range of clinical services, including sexual health, sexually transmitted infection management, birth control education/dispensing, and immunization, with the exception of those for travel, is offered at this site on a weekly basis. These services include physician-led clinics with a focus on high risk populations. In December 2016, Clinical Services launched a high risk clinic to address the needs of sex workers in this area. The highest rate of Hepatitis B cases are found in the OW area which makes Shelldale the most appropriate location to provide Hepatitis B case management.7
In 2015, Clinical Services saw 956 clients at the Shelldale site with 535 clients seeking healthcare around sexually transmitted infection management. Also, 372 clients came to receive birth control counselling and receive low to no cost birth control medication. These two areas of clinical services were primarily targeted to clients under the age of 25 and many were new immigrants with English as their second language.
2.Oral Health Services
The Oral Health program currently provides preventive services (cleanings, pit and fissure sealants and fluoride varnish applications) to children/youth under the age of 18, two days per week at the Shelldale clinic. The team also offers dental screenings to identify urgent needs and assist families with enrollment into the Healthy Smiles Ontario (HSO) program. In 2016, 33% of children/youth seen for dental screenings at the Shelldale Centre presented with urgent needs.
Shelldale is a unique facility as many service providers are housed in one building, offering the opportunity for collaboration between agencies and programs, and the Oral Health team leverages this regularly. For example, many oral health referrals are made directly from the GCHC, Young Parenting Education Program (YPEP), Baby Days program, OW Breakfast Club, etc. Oral Health staff allocate time to programs within the Shelldale Centre on a regular basis to build relationships and promote oral health services.
Shelldale is situated in a priority community that presents with language, accessibility and financial barriers. Many families who reside in this area have established a comfort level and community support within this community hub. Operating a dental clinic at the Shelldale location addresses several barriers to accessing care. For example, several families have expressed the inability to access care at Chancellor’s Way due to transportation and financial barriers. On a regular basis, families walk in to speak to WDGPH staff one-on-one to book appointments. This is a more effective form of communication due to language considerations, as it is more difficult to book appointments over the phone when English is not a first language.
The Shelldale Centre is the site for WDGPH in-person prenatal classes in Guelph. In-person prenatal education is a universal program offered to all expectant individuals across WDG. The classes draw participants from all across Guelph and some other areas of Wellington and Dufferin. The majority of in-person prenatal classes are offered at the Shelldale location based on population distribution. Using a health equity approach, fees ($90) for in-person prenatal classes are waived for clients who face financial hardship.
4. Wee Talk: Speech and Language
All preschool children entering Wee Talk, the speech and language system in WDG are initially assessed by a speech and language pathologist (SLP) at WDGPH. Depending on the results of the child’s assessment, families may be provided with home programming, monitoring, parent training and/or the child may be referred to Wee Talk partner providers to receive individual or group therapy as determined by the child’s needs.
WDGPH offers Wee Talk assessments at five sites across WDG which includes two days per week at the Shelldale Centre. If a child requires therapy, parents are referred for service through our Wee Talk partner agency, St. Joseph’s Health Centre, which is also located in close proximity to the OW neighbourhood.
Prior to the individual or group treatment with an SLP, parents attend a parent orientation session where they learn what to expect for both child and parental participation as their child receives services. SLPs at WDGPH deliver this parent orientation at all sites including the Shelldale Centre.
5. Parenting Programs
5.1 Pregnancy to Parenting (P2P)
P2P (formerly known as Canada Prenatal Nutrition Program) is an accessible, culturally appropriate, community-based program that supports vulnerable pregnant women to reduce the incidence of unhealthy birth weights, improve the health of both infants and mothers and encourage breastfeeding.
P2P is a 100% federally-funded program. There are 276 P2P projects in 2,000 communities that have been running for the past 20 years. There has been no additional projects funded since that time. WDGPH receives funding to run two programs in Guelph, one of which is focused on new immigrant families (at Shelldale) and the other on young mothers (at OEYC in Guelph). While there are no federal funds supporting a program in Dufferin, WDGPH does offer a prenatal program with similar supports to young pregnant and parenting teens in Orangeville.
A public health nurse (PHN) and registered dietitian staff the program. Each weekly session includes a social and an educational component. Topics covered include nutrition, healthy pregnancy, birth preparation, parenting, infant growth and development, breastfeeding support, and support for the new family. Participants are provided with grocery gift cards to supplement food to support pregnancy, prenatal vitamins and vitamin D for breastfed infants, bus tickets, child minding and interpreters.
P2P is a women-only program where pregnant women can ask questions and share their experiences with other women who are at a similar stage in their lives. WDGPH staff are able to refer women to public health programs and services such as Healthy Babies, Healthy Children, breastfeeding clinics, sexual health clinics and dental services. Participants also learn about other community resources such as the Ontario Early Years Centre, breastfeeding cafes and peer support, parenting programs and the Garden Fresh Box program.
WDGPH is the sponsoring agency for P2P and works collaboratively with Shelldale BBBF and GCHC who provide in-kind contributions to P2P. Funding is provided by the Public Health Agency of Canada.
In 2016, 81 new women joined P2P while the program had an average weekly attendance of 20 women.
5.2 Young Parents Education Program through UGDSB
This specialized school program run by UGDSB is located at the Shelldale Centre for students under 21 years of age, who are pregnant or have young children. Led by a teacher from UGDSB, students complete at least one credit as a class and can also complete credit recovery, independent or eLearning courses. A PHN from the WDGPH Family Health Division attends the program periodically throughout the school year to deliver information and support related to pregnancy and parenting. PHN participation varies according to
attendance which can fluctuate over the school year. Topics included nutrition, safety, taking care of a sick child, community supports, self-care, sleep routines and other common parenting concerns. In November 2016, the PHN in collaboration with the YM/YWCA Teenage Parent Program initiated a seven-week parenting program, “Nobody’s Perfect”, which is an evidenced based low literacy program to support high risk parents.
5.3 Baby Days Program
Baby Days is a weekly program offered by Shelldale BBBF for parents and children up to the age of 18 months. A PHN attends Baby Days with the objective of:
- Promoting public health services such as P2P, Healthy Babies Healthy Children, speech and language services etc.; and
- Leading group discussions on topics of interest to parents.
Typical parenting topics addressed include building resiliency, the importance of role modeling, dressing for Canadian weather, play and parenting in the context of cultures. Many of the participants are familiar with the PHN assigned either through previous involvement with P2P or other parenting programs that have been offered by WDGPH in conjunction with BBBF and other community agencies. The BBBF coordinator has indicated that this relationship and type of ongoing support increases the comfort level for parents to share and be open to supportive suggestions.
5.4 Positive Parenting Support
WDGPH offers Triple P, an evidence-based, group parenting support program, in collaboration with BBBF. A PHN leads this program; BBBF refers appropriate families and provides child care services and refreshments during the sessions with parents. This partnership has allowed WDGPH to support “vulnerable populations” who might face issues such as lower literacy, poverty, transportation and language/newcomer barriers. BBBF has recently asked WDGPH to provide more tailored parenting support for new families from Africa and Nepal who have recently moved into the Guelph community. BBBF is also committed to working with WDGPH to offer a lower literacy parenting program such as Nobody’s Perfect to that group.
In addition, the Family Health PHN currently assigned to provide P2P, Baby Days, YPEP and other positive parenting programs at Shelldale, often acts as a bridge between Shelldale and WDGPH staff which increases awareness and access to a broad range of public health programs and services.
5.5 Breastfeeding Clinic
The Shelldale breastfeeding clinic runs two afternoons per week as a drop-in clinic. While the clinic is open to all residents of Guelph, this location increases access for many new families who do not have transportation.
One of the objectives of Family Health is to increase breastfeeding rates in populations with lower rates of breastfeeding; those being young mothers, mothers with lower income and education, single mothers, mothers with fewer support systems, mothers who smoke, mothers in poor health, and mothers with less confidence. Through successful breastfeeding, women gain confidence and are empowered to improve their health and the health of their children.
The breastfeeding clinic is run by two PHNs and provides assessment and support to breastfeeding mothers with questions or concerns. Clients are seen on an individual basis by a PHN who assesses feeding, infant weight gain and hydration as well as mothers’ physical, social, and emotional status including the availability and effectiveness of support systems. A feeding is observed, and support, education, and resources are provided. Referrals to primary care providers, Healthy Babies Healthy Children program and peer supports in the community are made as needed. In addition, electric breast pumps are loaned to clients who face financial barriers and are unable to afford to rent a pump if needed. Other breastfeeding supplies are available for purchase at cost or provided free at the PHN’s discretion.
In 2015, 235 mothers attended the Shelldale breastfeeding clinic and 170 of those mothers returned to the clinic for follow-up and further support for a total of 405 visits. For the first 11 months of 2016, 221 mothers attended the clinic with 165 returning for follow-up, for a total of 386 visits.
The Shelldale Centre is a multi-unit facility, located in the neighbourhood of OW, offering a variety of programs and services by a number of co-located health and social service agencies who are accessible by the priority population who live in that area.
OW is a neighbourhood located in the northwest part of Guelph with a population of 7,460 residents. In the WDGPH report “Addressing Social Determinants of Health in Wellington-Dufferin-Guelph”, OW is identified as one of eight priority neighbourhoods in the service region based on analysis/ranking of evidence-based indicators known to determine areas of health inequities within communities.5
Some of the characteristics of OW which it make it a unique community include:
- It is a multi-cultural neighbourhood with 27% of residents born outside of Canada (as compared to 16% in WDG) so that neither English nor French is the first language for 26% of the neighbourhood residents.
- A comparatively high number of OW residents did not complete a high school education.
- There is a high incidence of low income households in OW.
- More than half of OW residents rent, rather than own their homes, while, comparatively, less than a quarter (22%) of all WDG residents rent their homes.
- Slightly more than half (51%) of OW residents work in typically lower paying jobs such as sales and service, or manufacturing and utilities occupations, as compared to 29% of WDG residents.
Ontario Public Health Standards
Reproductive Health Standard
Goal: To enable individuals and families to achieve optimal preconception health, experience a healthy pregnancy, have the healthiest newborn(s) possible, and be prepared for parenthood.
Requirement #6: The board of health shall provide, in collaboration with community partners, outreach to priority populations to link them to information, programs, and services.
Child Health Standard
Goal: To enable all children to attain and sustain optimal health and developmental potential.
Requirement# 5: The board of health shall increase public awareness of:
- Positive parenting;
- Healthy family dynamics;
- Healthy eating, healthy weights, and physical activity;
- Growth and development; and
- Oral health
Requirement #6: The board of health shall provide, in collaboration with community partners, parenting programs, services and supports, which include:
- Consultation, assessment and referral; and
- Group sessions.
Requirement #8: The board of health shall provide, in collaboration with community partners, outreach to priority populations to link them to information, programs and services.
Sexual Health, Sexually Transmitted Infections, and Blood-borne Infections (including HIV) Standard
Goal: To prevent or reduce the burden of sexually transmitted infections and blood-borne infections; and to promote healthy sexuality.
Requirement # 7: The board of health shall provide clinical services for priority populations to address contraception, comprehensive pregnancy counselling, sexually transmitted infections, and blood-borne infections.
WDGPH Strategic Directions
|Health Equity: We will provide programs and services that integrate health equity principles to reduce or eliminate health differences between population groups.||YES|
|Organizational Capacity: We will improve our capacity to effectively deliver public health programs and services.||NO|
|Service Centred Approach: We are committed to providing excellent service to anyone interacting with Public Health.||YES|
|Building Healthy Communities: We will work with communities to support the health and well-being of everyone.||YES|
Health equity is the condition where everyone can attain their full health potential and are not disadvantaged due to their social position or other socially determined circumstances. In 2013, WDGPH released a report “Addressing the Social Determinants of Health in Wellington-Dufferin-Guelph: A public health perspective on local health, policy and programs” in which OW was identified as one of eight priority neighbourhoods across the service area and the highest priority neighbourhood in the City of Guelph.5 Some of the barriers commonly faced by residents of this neighbourhood include transportation, language, culture, low incomes, low education, social isolation, insecure housing and access to food.
Unlike the health gaps that result from biological factors, health inequities are the product of social inequity and disadvantage, and are created in a social context; therefore they are potentially remediable by policy changes.3 Generally policies and practices that can contribute to the reduction of health inequities include:
- Actions that aim at the reduction of poverty, marginalization, and exclusion;
- Provision of supportive and culturally appropriate social support and health care;
- A seamless continuum of services; and
- A system that is prepared to place the focus on the most disadvantaged individuals and population groups, through commitment to “upstream” interventions.8 The model of care and provision of service currently offered at the Shelldale Centre reflects many of these important characteristics.
Appendix A: Neighbourhood Profiles in Wellington-Dufferin-Guelph
- World Health Organization, 2011. Programs and projects: Social determinants of health. Retrieved from: http://www.who.int/social_determinants/en/
- Canadian Institute for Health Information, 2004. Canadian Population Health Initiative, improving the health of Canadians. Ottawa, ON: Author. Retrieved from http://dsp-psd.pwgsc.gc.ca/Collection/H118-14-2004-1E.pdf
- International Society for Equity in Health, 2011. International Society for Equity in Health. Retrieved from www.iseqh.org/workdef_en.htm
- Health Council of Canada, 2010. Stepping it up: Moving the focus from health care in Canada to healthier Canada. Toronto, ON: Author. Retrieved from: http://www.healthcouncilcanada.ca/tree/2.40-HCCpromoDec2010.pdf
- Wellington-Dufferin-Guelph Public Health, 2013. Addressing Social Determinants of Health in Wellington-Dufferin-Guelph. A public health perspective on local health, policy and program needs Retrieved from: www.wdgpublichealth.ca/reports
- Braveman, P., 2009. A health disparities perspective on obesity research. Preventing Chronic Disease, 6(3). Retrieved from: http://www.cdc.gov/pcd/issues/2009/jul/09_0012.htm.
- Davis, Andrew. Hepatitis B in Wellington-Dufferin-Guelph: 2006-2012 summary of reported cases. Wellington-Dufferin-Guelph Public Health. 2012.
- Sutcliffe, P. et al., 2007. Social inequities in health and Ontario public health: Background document. Document prepared for the January 15, 2007 meeting between the Ministries of Health Promotion, Health and Long-Term Care and Children and Youth Services and the Sudbury & District Health Unit, Northwestern Health Unit and Simcoe Muskoka District Health Unit. Retrieved from: http://www.ontla.on.ca/library/repository/mon16000/272021.pdf.
Neighbourhood Profiles in Wellington Dufferin Guelph