• Violence: intentional behaviours that produce injuries, as well as the outcomes of these behaviours (the injuries themselves)
• Death and injury from violence results in physical, sexual, social, spiritual, and mental health problems
• In Canada, the most violent setting is the family; vulnerable groups include women, children, the elderly, and ethnic minorities
• Violence carries high social, emotional, and economic costs
PHYSICAL: air, water, soil, housing, climate, geography, heat, light, noise, debris, radiation, etc.
BIOLOGICAL: man, viruses, microbial agents, insects, rodents, animals and plants, etc.
PSYCHOSOCIAL: cultural values, customs, beliefs, habits, attitudes, morals, religion, education, lifestyles, community life, health services, social and political organization.
Health indicators are based upon conceptual models for what influences health status, based upon scientific research.
Models have evolved over time, as have definitions of health, but trace historical improvements in health, e.g., increases in life expectancy, declines in mortality due to infectious diseases.
Context is important: For example, in 1900 the leading causes of death were Pneumonia, Tuberculosis, and Diarrhea and Enteritis as compared to Heart Disease, Cancer, and Stroke in 2006.
Rate of healthcare spending is unsustainable, and, levels of spending not consistent with level of health. Ripe opportunities for increasing the return on investments in health through prevention.
Burden of chronic diseases (e.g., premature mortality, costs) and
Complex public health problems (e.g., violence, obesity, HIV), and health-related behaviors (e.g., smoking, diet, substance use)
The influence of social and environmental conditions on determining health outcomes, either directly or indirectly
Deep, persistent disparities in health
-Reports are compiled at every jurisdictional level
-Provincial and local level - Health departments, foundations and philanthropic organizations, businesses, educational, law enforcement, human services providers, and other civic leaders, faith organizations, universities, media.
-National - Federal government/private partnerships.
-International - OECD, WHO
The most common health indicators are those related to birth and death:
-Premature mortality (e.g., Years of Potential Life Lost or -YPLLs)
-Age-specific death rates (e.g., infants, teens)
-Cause specific deaths (e.g., lung, cervical cancer)
-Births to teens
-Very/Low birth weight
-Adequacy of prenatal care
-Social characteristics of parents (e.g, maternal educational attainment).
These are robust—high completeness of reporting, widely available through the Canadian Institute of Health Information (CIHI), and standardized so as to be are comparable across provinces and regions.
But, also limited.
-Health-related Quality of Life:
-Poor health days
-Self-rated health status
- Body Mass Index based on self-reported height and weight
-Diabetes, asthma, and other chronic diseases.
Area-based measures, e.g., income/poverty, population density
Access to public transportation, housing
Environmental pollution, e.g., air and water quality.
Education (e.g., high-school graduation rates, students reading/doing math at grade level)
Social support and connectedness.
Child and family focused:
Parental educational attainment
Parent practices (e.g., breastfeeding, reading to child, regular meal/bedtimes)
Access to services such as early developmental screening
Family social environment (e.g. parent stress, depression