Cover

The road to a healthy life

The comprehensive second ranking includes the suburbs, and finds their prosperous residents have access to the best health services

Jennifer Hunter June 5 2000
Cover

The road to a healthy life

The comprehensive second ranking includes the suburbs, and finds their prosperous residents have access to the best health services

Jennifer Hunter June 5 2000

The North Shore Health Region embraces one of the most impressive locales in Canada, hugging the base of the cedar-crowned Coast Mountains like a ribbon wrapping a beautiful gift. Houses, buildings and roads built into the sides of Cypress Mountain, Grouse Mountain and Mount Seymour snootily look down, south across the Burrard Inlet, to the more prosaic Vancouver skyline. But remarkable scenery is not the areas only blessing. The North Shore region—including West Vancouver, North Vancouver, Bowen Island and Lions Bay—tops the Maclean’s ranking of the availability of health-care services. “It is a recognition that we are trying to do the right things,” says a proud Bruce Harber, North Shores chief executive officer.

The region, with its population of 200,000, ranks among the leaders in five of the 13 specific ranking categories—life expectancy, low birth weights, preventable admissions to hospital, availability of hip-replacement operations and low rates of hip fractures. It also placed among the top 10 communities in averting hospitalizations for flu and pneumonia and producing babies with healthy birth weights. “We have affluence, high levels of education and the climate to support people who want to exercise more and eat better,” says Harber.


Wealth and education are primary requisites for a healthy population and the North Shore is blessed with both: the average family income for the area is $73,000. West Vancouver, which makes up one-third of the region, is one of the richest neighborhoods in Canada, with an average family income of $97,000. Fifty-eight per cent of the region’s adult population has had some post-secondary education. And fitness, in a climate where it rarely snows beneath the mountain peaks, is a ubiquitous activity: cross-country and alpine skiing; bicycling, walking and jogging along miles of paths; swimming and Windsurfing at the beaches. The multitude of outdoor activities helps to pull neighbors together. “There is a strong sense of community here,” Harber says.

Amalgamating community health services into regional administrations, instituted four years ago, has helped knit the community’s once disparate services together. The combined region has one acute-care hospital, eight long-term care facilities and three community health centers. The regional board has instituted six programs focusing on seniors, maternal-child-youth, mental health, community and population health, medicine and surgery. In addition, the board takes guidance from six citizens groups. “We reach out to the community,” says Ellen Pekeles, the region’s vice-president of programs. “There is not a lot of bureaucracy here and it is easy to get things done.”

Harber and his staff recognize more work needs to be done in one area of the ranking: decreasing the length of hospital stays. “I’m not surprised at the results,” Harber says. “The North Shore region has been through some fairly turbulent times.” Two years ago, the province fired all 12 members on the region’s board—their relations with local doctors had irreparably broken down. With his new team, Harber is building bridges. “We’re engaging the community and physicians in a way that never happened before,” he says.

One means of providing more effective service was to contract a private clinic to perform cataract operations. “It decreased our waiting list from five months to three,” says Pekeles. With 15 per cent of the population over 64, there is a strong focus on support services for the elderly. The region has set up education programs for families and spouses who act as caregivers. The moderate climate and high level of physical activity definitely help in one category: the region has a low hip-fracture rate among the elderly. “You should see all the seniors walking along the seawall,” says Pekeles. In addition, the region encourages flu shots and inoculations against pneumonia. Served by the highest number of doctors per capita in the country, residents have no trouble getting their shots.


The top regions sit right next door to two major centers of medical training


In other areas of health care, the region is tracking births by caesarean section in an attempt to lower its high rate. Not only would lower numbers be better health policy, says Harber, but they would save the region a lot of money. “With every percentage drop in c-sections,” he adds, “we would save $100,000.” Harber says the goal of the North Shore Region is to become the healthiest community in North America. “The Maclean’s rating is a seal of approval for us,” he says, “evidence that we are making progress.” Jennifer Hunter


MISSISSAUGA: Regional growing pains

For Steve Isaak, success, ironically, arises from being stretched almost to the breaking point. As executive director of the district health council in bustling Halton-Peel region on the west side of Toronto, Isaak has presided over health-services planning during a time of rapid population growth and budget cutbacks—a combination that he says “has forced us to be as efficient as possible.” That, combined with other key demographic factors, gives Halton-Peel second place overall in the Maclean’s ranking of available services. In a region that has become a magnet for high-tech industries, the people of Mississauga, Brampton, Oakville, Burlington and other burgeoning towns and subdivisions generally have high levels of income and education—advantages directly connected to better health. “Our people are in good shape,” says Isaak. “But they still get sick and have to be treated. And our resources have been badly stretched. At times, it’s been very difficult to keep up with the demands on the system.”

Now, with the budget squeezes and hospital closures of Ontario’s sweeping health-care restructuring mostly in the past, Halton-Peel’s five hospitals and its long-term care services are embarking on an estimated $900-million expansion program that will add thousands of beds to hospitals and long-term facilities in the region within four years. “I think we’ve been pretty successful,” says Isaak, “in persuading the provincial government that we need to pump money into the system to keep up with our tremendous rate of growth.”

Stretching 60 km from Toronto’s western border to the fringes of Hamilton, and north into the rolling farm country around Caledon and Georgetown, Halton-Peel is booming. Its population of 1.3 million is growing by about 30,000 a year as information technology, manufacturing and service companies flock to the area. Until recently, provincial healthcare funding has not kept up with the regions hectic growth. As in other parts of the country, patients face long waits for MRI scans to detect cancer and other diseases. Some Halton-Peel residents found a way to jump the months-long queue: provincial officials are investigating whether one Brampton hospital broke the law by charging patients $875 to have an MRI done quickly on a privately funded scanner.

Mississauga’s Credit Valley Hospital is typical in many ways of the district’s approach to health care. The 15-year-old, 366-bed community hospital has a light and airy lobby designed to put patients at ease. Wayne Fyffe, Credit Valley’s CEO, points with pride to a state-of-the-art computer system that delivers laboratory test results, X-rays and other diagnostic data and medical records to hospital personnel at the touch of a few keys. The busy hospital has 60,000 emergency-room visits a year, more than a third involving children, and handles a large number of trauma cases, many from accidents on the network of highways lacing the area.

The hospital also operates regional genetic screening and kidney dialysis programs. Its follow-up services for discharged patients include one that connects the elderly and disabled with support services in the community. Fyffe says there is an emphasis on self-improvement at the hospital. “We constantly look at the way we do things,” he adds, “and try to find ways of doing them better.”

A five-year, $ 197-million expansion program should help. Credit Valley will get 119 new beds and become a regional center for more specialties, including cancer and pediatrics. In Halton-Peel as a whole, expansion will add 300 hospital beds to the current inventory of 2,400 and more than 3,800 long-term care beds in at least 20 new centers to help cope with the districts rapidly growing population of people 65 and over. “This is a big expansion,” says Isaak. But given the frantic rate of growth, it likely wont be long before the region has to expand its services again. Mark Nichols

VICTORIA: Special efforts for the elderly

Along the sidewalks and streets of Victoria, vibrant sprays of fluorescent paint capture the eye. “Our city is a veritable feast of color,” notes Elaine Gallagher, a professor of nursing at the University of Victoria. It is not the work of enthusiastic graffiti artists. Instead, municipal workers are wielding the spray cans to help senior citizens avoid hip fractures. Their splashes of color identify dangerous cracks and potholes that cannot immediately be repaired. The paint sprays are part of a public safety program that the UVic nursing school established five years ago in conjunction with Victoria, Saanich and Sidney, the urban areas that make up the Capital Health Region. Thanks to that program and other initiatives, the district at the south end of Vancouver Island does an excellent job of preventing hip fractures, one indicator used in Maclean’s national ranking of the availability of health services.

Besides the spray painting, municipal workers repair sidewalk cracks and holes much quicker than in the past. “They are actually rethinking the way they build their sidewalks,” says Gallagher. The safety program also encourages seniors to participate in f ai chi exercises to improve co-ordination and prevent falls. And it has helped Victoria score high marks for life expectancy and prevention of pneumonia and flu. “A boy born in the region can expect to live to the age of 77 and a girl to 81.7 years,” says Patricia Coward, acting chief executive officer for the region. Those excellent showings have vaulted Victoria to third place overall this year, up from seventh last year. Coward attributes the improvements to the creation three years ago of health regions grouping hospitals and other community health facilities into a single administration. That reorganization, she says, is just beginning to show 1 its benefits in the 1997-to-1999 data used in % the ranking. “Regionalization,” says Coward, I “has allowed us to put more money and re! sources into the delivery of care.”

Boasting scenic beauty and a moderate climate with just half the rain in Vancouver, Victoria has long been a destination for retirees. About 20 per cent of the population is over 64. The same factors have drawn many doctors, giving Victoria high marks in physicians per capita. “Doctors are attracted here because ifs a really nice place to live and work,” says Coward. The region ranges from the southern Gulf Islands on the east to Port Renfrew on the west coast of Vancouver Island. Its facilities include four acute-care hospitals and more than 30 other sites providing long-term care, children’s rehabilitation, and mental-health facilities. The population of 337,000 is affluent and well-educated.

Coward allows that some problems remain in the delivery of hospital services. Average lengths of stay in hospital, for instance, are too long, reflecting a lack of alternative-care facilities in the community. “We need more places outside hospitals where people can spend time recovering from surgery,” Coward explains. “That’s something we are going to focus on next year.” The region is also addressing its high rate of births by caesarean section, trying to determine if the risky procedure could be avoided in some cases. The rankings also show that it is relatively hard to get a hip or knee replacement in Victoria. “The ministry of health decides how many we can do,” says Coward. “We are not doing as many as we should.”

But, like the top-ranking North Shore region across the Strait of Georgia, the Capital region has good inoculation programs in place to minimize flu and pneumonia. “We also provide immunization for our hospital staff so they don’t pass bugs to the patients,” Coward explains. Average birth weights are also at a healthy level. Coward cites the availability of a perinatologist—a specialist in care before and after birth—as a benefit to women with high-risk pregnancies. The region is proud as well of its program to educate parents not to shake their babies, and the training it provides for foster parents caring for babies addicted to narcotics. “We are doing some wonderful things in terms of child care,” says Coward. And setting a standard for other regions. Jennifer Hunter



Rank by region

Rank last year / Overall Scores / Overall ranking

1 North/West Vancouver: --- / 87.6 / 1

2 Mississauga/Brampton/Burlington, Ont.: --- / 85.6 / 2

3 Victoria: 7 / 85.5 / 3

4 Kitchener/Waterioo, Ont.: --- / 83.6 / 7

5 Lévis/Thetford-Mines, Que.: --- / 82.6 / 12

6 Markham/Richmond Hill, Ont.: --- / 82.2 / 14

7 St. Catharines/Niagara, Ont.: --- / 81.4 / 19

8 Laval, Que.: --- / 81.3 / 20

9 Burnaby, B.C.: --- / 81 / 21

10 Brantford, Ont.: --- / 80.6 / 23

11 Windsor, Ont.: --- 79.9 / 25*

12 Regina: 11 / 79.7 / 27

13 Surrey, B.C.: --- / 79.5 / 28

14 Peterborough, Ont.: --- / 78.8 / 32

15 Granby/St-Hyacinthe, Que.: --- / 78.1 / 33*

16 Joliette, Que.: --- / 77.3 / 36

17 Chilliwack, B.C.: --- / 76.9 / 37*

18 St-Jérôme/Ste-Thérèse, Que.: --- / 76.6 / 40

19 Chicoutimi, Que.: --- / 76 / 42

20 St. John’s, Nfld.: 14 / 75.9 / 43

* Indicates a tie


OUTCOMES

Life expectancy

1 North/West Vancouver: 1

2 Mississauga/Brampton/Burlington, Ont.: 2

3 Victoria: 5

4 Kitchener/Waterioo, Ont.: 11

5 Lévis/Thetford-Mines, Que.: 22

6 Markham/Richmond Hill, Ont.: 3*

7 St. Catharines/Niagara, Ont.: 17

8 Laval, Que.: 13*

9 Burnaby, B.C.: 7

10 Brantford, Ont.: 28*

11 Windsor, Ont.: 28*

12 Regina: 23*

13 Surrey, B.C.:15

14 Peterborough, Ont.: 16

15 Granby/St-Hyacinthe, Que.: 18*

16 Joliette, Que.: 40

17 Chilliwack, B.C.: 44*

18 St-Jérôme/Ste-Thérèse, Que.: 42

19 Chicoutimi, Que.: 48

20 St. John’s, Nfld.: 38

* Indicates a tie

PRENATAL CARE

Low birth weight / Caesarean section / Births after c-section

1 North/West Vancouver: 5* / 38 / 40*

2 Mississauga/Brampton/Burlington, Ont.: 28* / 28 / 24*

3 Victoria: 3 / 50 / 14*

4 Kitchener/Waterioo, Ont.: 8* / 15* / 14*

5 Lévis/Thetford-Mines, Que.: 19* / 19* / 23

6 Markham/Richmond Hill, Ont.: 28* / 36 / 35*

7 St. Catharines/Niagara, Ont.: 19* / 23* / 32*

8 Laval, Que.: 28* / 12 / 28*

9 Burnaby, B.C.: 38* / 34 / 30*

10 Brantford, Ont.: 11* / 17 / 20*

11 Windsor, Ont.: 28* / 21 / 10*

12 Regina: 44* / 4* / 20*

13 Surrey, B.C.: 25* / 45 / 37

14 Peterborough, Ont.: 15* / 39 / 40*

15 Granby/St-Hyacinthe, Que.: 34* / 13* / 14*

16 Joliette, Que.: 19* / 4* / 4

17 Chilliwack, B.C.: 5* / 43* / 40*

18 St-Jérôme/Ste-Thérèse, Que.: 34* / 2 / 14*

19 Chicoutimi, Que.: 15* / 10 / 9

20 St. John’s, Nfld.: 44* / 42 / 46

* Indicates a tie



COMMUNITY HEALTH

Hip fractures / Pneumonia and flu

1 North/West Vancouver: 3* / 9

2 Mississauga/Brampton/Burlington, Ont.: 9 / 12

3 Victoria: 2 / 7

4 Kitchener/Waterioo, Ont.: 36 / 21

5 Lévis/Thetford-Mines, Que.: 5 / 2

6 Markham/Richmond Hill, Ont.: 46 / 25

7 St. Catharines/Niagara, Ont.: 21 / 10

8 Laval, Que.: 10 / 3

9 Burnaby, B.C.: 48 / 32*

10 Brantford, Ont.: 31* / 31*

11 Windsor, Ont.: 27 / 15

12 Regina: 29 / 27

13 Surrey, B.C.: 40* / 23

14 Peterborough, Ont.: 47 / 36

15 Granby/St-Hyacinthe, Que.: 24 / 34

16 Joliette, Que.: 3* / 40

17 Chilliwack, B.C.: 20 / 41

18 St-Jérôme/Ste-Thérèse, Que.: 8 / 26

19 Chicoutimi, Que.: 13 / 30

20 St. John’s, Nfld.: 22* / 1

* Indicates a tie




ELDERLY SERVICES

Hip replacements / Knee replacements / Possible patients

1 North/West Vancouver: 7 / 42/ 11

2 Mississauga/Brampton/Burlington, Ont.: 32 / 22 / 6

3 Victoria: 26 / 36 / 33*

4 Kitchener/Waterioo, Ont.: 19 / 28 / 5

5 Lévis/Thetford-Mines, Que.: 38 / 38 / ---

6 Markham/Richmond Hill, Ont.: 34 / 20 / 16*

7 St. Catharines/Niagara, Ont.: 20 / 18 / 14*

8 Laval, Que.: 44* / 47 / ---

9 Burnaby, B.C.: 27* / 29 / 20*

10 Brantford, Ont.: 12* / 13 / 2*

11 Windsor, Ont.: 17 / 1 / 29

12 Regina: 29 / 25 / 25*

13 Surrey, B.C.: 31 / 34 / 9*

14 Peterborough, Ont.: 10 / 17 / 16*

15 Granby/St-Hyacinthe, Que.: 43 / 43 / ---

16 Joliette, Que.: 50 / 49 / ---

17 Chilliwack, B.C.: 22* / 24 / 23*

18 St-Jérôme/Ste-Thérèse, Que.: 49 / 50 / ---

19 Chicoutimi, Que.: 47 / 37 / ---

20 St. John’s, Nfld.: 46 / 44 / 38

* Indicates a tie