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Health literacy among ethnocultural populations

: Data from the 2001 Census on visible minority groups show that Chinese community – 9.4% of total pop of BC SA com – 5.4% In the Vancouver CMA, these communities are substantially larger, where Chinese 17.4% of the population SA 8.4% -in this presentation we will be looking at focus group findings which are part of a larger evaluation of the BC HealthGuide Program

: Since the focus groups were conducted in English, we asked participants to give their thoughts and perspectives of their community’s needs and experiences.

: There were demographic differences between participants in the two focus groups. Chinese participants were older and had lived in Canada longer. There were also differences between the two groups in health information sources. South Asians relied more on health professionals, followed by their informal social networks versus Chinese participants – who used a broader range of info sources including the Internet and the media.

: There may be cultural differences in acquiring health information. SA participants spoke about being receiving and seeking health information from their families, friends and community members rather than only seeking information.

: The primary barrier to accessing health information is language.

: For people lacking literacy in their first language, they are unable to access health information in written form.

: Another formidable barrier to accessing health information is resettlement when newcomers are busy meeting their basic needs to live – like finding a job, housing, schools for their children, etc.

: South Asian participants mentioned social isolation as a barrier to health information in particular for recent newcomers and seniors.

: Lack of social networks impacts on access to health information and knowledge of the health care system

: Participants stressed the special needs of the elderly in accessing health information, since they encounter multiple barriers and have fewer resources to overcome those barriers. -cultural values of duty and respect for elders can create dependence on family members

: For elderly who are dependent on family members for translation, they do not have confidentiality when seeking health information. Because of this issue, some elderly may be hesitant to discuss these issues through their family members or not ask at all.

: Another barrier mentioned was not having a computer or lacking computer skills that hinders accessing information on the Internet.

: So how do we increase access to health information? The key strategy being providing good quality translation. Some participants discussed the poor quality of translated materials they encountered. Since it is poor quality people who do not know English could receive incorrect information that impacts on their access to information and services.

: Another strategy that participants discussed was providing information on where to access health information and services once newcomers have settled and acclimatized to their new community. it would be important to determine with communities when the appropriate time would be to introduce or reintroduce information with newcomers

: A third strategy mentioned was increasing the availability of health information in places where people routinely go such as Doctors’ offices, temples, community centres. This would help to overcome transportation issues for those with limited mobility.

: Thus, cultural differences in seeking information can impact on the barriers experienced trying to access health information. South Asian participants mentioned many more barriers to accessing health info than Chinese participants – this may be due to cultural preferences to seeking info within their social networks -since Chinese participants used a broader array of info sources, it may be one reason why they were less likely to experience barriers to health info -these cultural differences will also impact on the strategies used to increase access to health information among and within communities

: It is obvious from the focus groups that the Chinese and South Asian communities are not homogenous but rather consist of multiple communities Thus it is crucial to target subgroups within diverse communities based on their health info needs. Group 1 – the key strategy would be to increase awareness of existing information sources and health services Group 2 – provide good quality translation of needed health information (which should be decided in consultation with the communities) Group 3 – use oral forms of communication, including videos, TV and radio

: This publication comes from the Public Health Association of BC web site. http://www.phabc.org

The ActNow BC Healthy Choices in Pregnancy Initiative

What is ActNowBC?

Act Now BC is a chronic disease prevention strategy focusing on common risk factors.

An integrated, partnership-based platform of programs and services.

Led by the Ministry of Health; we are the “coach”.

All ministries contribute to ActNow BC’s goals and objectives.

Programs are designed and delivered in cooperation with more than 70 partners from other levels of government, non-government organizations, industry associations, and the private sector.

Pillars of ActNowBC

The ActNowBC platform to improve the health of British Columbians is supported by 4 pillars:

Increasing Physical Activity

Encouraging Health Eating

Reducing Tobacco Use

Promoting Healthy Choices in Pregnancy

Healthy Choices in Pregnancy

Focuses on

Alcohol

Smoking

and

Integrated with other pillars (nutrition, physical activity)

Why Support Healthy Choices in Pregnancy?

Significant injury results from prenatal alcohol exposure – FAS, partial FAS, Alcohol-related birth defects, Alcohol-related neurodevelopmental disorder

Smoking during pregnancy associated with many adverse outcomes

Why Support, cont’d

Estimated prevalence: 3.5 cases of FAS per 1000 children and 9.1 cases of FASD per 1000 children. (Public Health Agency of Canada 2004)

The most recent, Canadian evidence clearly demonstrates that the cost burden of fetal alcohol spectrum disorder (FASD) is profound.

$14,342 = The total adjusted annual costs associated with FASD per child.

$344,208,000 = Cost of FASD annually to Canada of those 1 to 21 years of age (JFAS Int 2006; 4: e5 Feb 2006)

Why Support, cont’d

Rates of smoking vary widely by factors such as age, socioeconomic status, education, home environment and region.

Smoking during pregnancy is a self-reported measure, and thereby has the potential to be under-reported.

The most recent B.C. STATS survey indicated that from women surveyed:

7% were currently pregnant or have been pregnant within the last year. 24% were smokers.

2% were currently trying to become pregnant. 16% were smokers. (BC STATS, CHESS Twelve month average, surveyed monthly Apr’05-Mar’06)

Goals of Healthy Choices in Pregnancy

To increase by 50% the number of women counseled regarding alcohol use in pregnancy.

For each Health Authority to have developed an focused FASD prevention strategy.

Actions to Support Healthy Choices in Pregnancy

Enhancing pregnancy programs and services.

Funding allocated to health authorities to enhance current and develop additional pregnancy programs.

Pregnancy programs included HA led or contracted pregnancy outreach programs.

Actions, cont’d

Educate perinatal service providers on best practices for counseling women on alcohol and tobacco use during the perinatal period.

Funding provided to Provincial Health Services Authority to lead the development and provision of education for providers such as physicians, midwives, public health nurses, pregnancy outreach staff, mental health and addictions.

Encourage the evidence based resources to become Provincial standards of practice.

Actions, cont’d

Develop FASD prevention material.

Create evidence-based resources and material regarding the harm of using alcohol in pregnancy.

This includes: The BCRCP Guidelines for Alcohol Use in the Perinatal Period and FASD, HealthFiles and other material.

Actions, cont’d

Develop tobacco resources which target women of childbearing age and pregnant and postpartum women.

The “Training Needs Survey Report: Survey of the BC Prenatal Providers in Support of ActNow Planning. Fall, 2005” identified the need for best evidence resources to assist service providers in support women who are pregnant to reduce and/or quit smoking.

Guidelines for Tobacco Use in the Perinatal Period.

Additional resources for women who want, or do not want to quit, are currently being field tested.

The ActNowBC Incentive Fund

Encourages all ministries to undertake initiatives that build upon existing efforts or create new opportunities for partnerships and alliances among ministries and non-governmental organizations, agencies, business, and industry that contribute to the ActNow BC targets for 2010.

Provides matching funds for approved projects that support the goals of ActNowBC.

ActNowBC Incentive Project: FASD Awareness

The Liquor Distribution Branch accessed the incentive fund and lead a project to create FASD prevention signage to increase public awareness regarding alcohol use in pregnancy.

These resources are an example of a cross-ministry initiate and included partnerships with:
Ministries of Child and Family Development, Public Safety and Solicitor General, Health; Liquor Distribution Branch; BC Centre of Excellence on Women’s Health; Centre for Addictions Research of BC; Centre for Social Responsibility.

Healthy Choices in Pregnancy: Role of the MoH

Provide strategic facilitation and cross-government coordination.

Encourage sustainable education for service providers across the Province.

Provide advice and support in developing ActNow initiatives and policy.

Monitor the health outcomes of mothers and infants in BC.

Supporting Prevention in Primary Care – BC’s Prevention Support Project

Honouring Our Health

Working together to improve food security: Community Food Action Initiative

: Canadian Community Health Survey – 2000/01 Food security is emerging as an area of concern within the health sector – seen as critical to a healthy population and has been identified as a core program for public health by the Ministry of Health. Rising trends in obesity and chronic disease, the correlation between diet and health, and the further connection with socio-economic status has led to a growing interest in the potential for community based food security projects to serve as interventions to address these issues. Promotion of healthy eating and ensuring access to nutritious foods is seen to have important implications for improving the health of populations

: Alliance of four health professional councils recently formed to provide leadership on food security in the province of BC (PHN, MHO, CN and Environmental Health and Protection) • Were 34 key informant interviews – represented a variety of health professionals, agencies, community groups, networks and coalitions ( BC Food Systems Network), different ministries, Aboriginal voice, PHAC – comprehensive • Collective efforts within the context of both ActNow BC and the core functions in public health

: To make British Columbia the healthiest jurisdictions to host the Olympic and Paralympic Games. To build community capacity to create healthier, more sustainable and economically viable communities. To improve the health of British Columbians by reducing tobacco use, eating healthy foods, being more active, and making healthy choices during pregnancy. To reduce demand on the health care system.

: Food security is emerging as an area of concern within the health sector – seen as critical to a healthy population and has been identified as a core program for public health by the Ministry of Health. Rising trends in obesity and chronic disease, the correlation between diet and health, and the further connection with socio-economic status has led to a growing interest in the potential for community based food security projects to serve as interventions to address these issues. Promotion of healthy eating and ensuring access to nutritious foods is seen to have important implications for improving the health of populations The orientation towards community capacity building and social capital development are important population health aspects of CFS activities.

: Community Food Security refers to the capacity of a community to provide for the food security of its members. Unit of analysis is the community Health is conceptualized as a capacity within a population health framework, similarly community food security is conceptualized as a capacity within a community food security framework Capacity within a health framework can be understood as “a general increase in community groups’ abilities to define, assess, analyze and act on health concerns of importance to their members” Labonte, 2001 “a situation in which all community residents obtain a safe, culturally acceptable, nutritionally adequate diet through a sustainable food system that maximizes self-reliance and social justice”. Hamm and Bellows, 2003

: Community food security, like population health, is a conceptual model for thinking about the health of a community. It uses a systems approach for analysis and action on a range of determinants impacting on food and nutrition, and supports collaboration across a range of sectors.

: In BC defined three stages of community food security • Community Nutritionist Council Discussion paper that was integral to identifying food security as a core public health program The orientation towards community capacity building and social capital development are important population health aspects of CFS activities.

: In BC defined three stages of community food security • Community Nutritionist Council Discussion paper that was integral to identifying food security as a core public health program The orientation towards community capacity building and social capital development are important population health aspects of CFS activities.

: Province-wide coordination, support and evaluation Regional coordination and management Community coordination and implementation Intent is to create an infrastructure and a system to support communities to achieve food security benefits for the long term. Manage the initiative at the regional level Provide funding to promote integrated solutions to community needs Establish an inter-sectoral Regional Food Security Committee Undertake assessment of needs Monitor and be involved in evaluation Provide representation to the Provincial CFAI Advisory Committee

: Role and Mandate 1. Corporate Governance and Management – governing, managing and funding agencies/programs that provide province-wide services such as BC Cancer Agency, Children’s and Women’s Hospitals, Riverview and Forensics, Renal, BCCDC and Transplant Services. 2. Planning and Coordinating specified programs and services such as Cardiac, Emergency, Trauma, Surgical, Telehealth, Thoracic Surgery and Centre for Excellence in HIV/AIDS. Supporting the work of the Ministry of Health and the Regional Health Authorities through knowledge brokering and facilitating province wide dialogue. Prevention, Promotion, Protection Strategic Direction Expand PHSA’s role as “knowledge resource” for the province by creating capacity to link and use evidence and health information to decrease the burden of chronic disease and to support policy development Collaborate with other Ministries, municipalities, voluntary and private sectors and the regional Health Authorities to promote active healthy living and healthy public policy Continue to increase the emphasis on prevention, promotion and protection to reduce the burden of disease