3.0 Health Status
The health status of Brant County residents is extensively documented in the 2001 Brant County Health Status Report. Summary indicators including premature loss of life, life expectancy, and overall age standardized rates of mortality indicate that the health status of Brant County residents is poorer that that of Ontario residents in general.
Overall Health Status: Self-Rating
The first question of the Health Component in the 1996/97 Ontario Health Survey asked: “Generally, how would you say your health is?” Respondents were given five choices for a response, ranging from ‘poor’ to ‘excellent’. The results indicated that over 60% of people, in Brant-Haldimand-Norfolk (BHN) and in Ontario, reported their health to be ‘very good or excellent’. There were no statistically significant differences between Brant-Haldimand-Norfolk and Ontario in the self-reported health status for either males or females. However, in Ontario, the proportion of females rating their health as ‘poor/fair’ was statistically significantly higher than the proportion of males, even though the difference between the two sexes was small. There were no other significant sex-specific differences in either Ontario or Brant-Haldimand-Norfolk.
As could be expected, the proportion of individuals rating their health as ‘poor/fair’ increased with age, while the proportion rating their health as ‘very good/excellent’ decreased with age
Another measure of health status is the Health Utility Index, which was also measured in the Ontario Health Survey 1996/97. The Health Utility Index (HUI) is a generic health status index that is able to combine both quantitative and qualitative aspects of health. It provides a description of an individual's overall functional health, based on eight characteristics: vision, hearing, speech, mobility (ability to get around), dexterity (use of hands and fingers), cognition (memory and thinking), emotion (feelings), and pain and discomfort.
Consistent with self-reported health status, there was no statistically significant difference in the Health Utility Index scores between Brant-Haldimand-Norfolk and Ontario. Nor were there differences between males and females in Brant-Haldimand-Norfolk or Ontario.
Premature mortality and life expectancy
Between 1994 and 1996, the average annual life expectancy for males and females for most ages was lower in Brant County than in Ontario. On average, life expectancy from birth was 75 years for males and 81 years for females. Males and females that reached 75 and 80 years of age, respectively, had an additional life expectancy of approximately 9 years.
Approximately 80% of all deaths in Brant County, between 1993 and 1997, were attributed to four broad categories of causes: diseases of the circulatory system, cancer, diseases of the respiratory system, and injuries and poisonings. Between 1993 and 1997 in Brant County there was little change among the crude mortality rates for each of these categories.
In 1997 there were fewer than five deaths among youth aged 10-19 in Brant County, accounting for less than 0.5% of all deaths in Brant County in that year. Between 1993 and 1997, injuries were the leading category of death among youth aged 10 to 19 in Brant County, accounting for 15 of the total 26 deaths in this age group. More than two-thirds of the deaths from injuries affected male youths. Among the 15 injury-related deaths, 10 resulted from motor vehicle collisions.
In Ontario in 1997, there were 450 deaths among youth aged 10-19 (305 males and 145 females), which accounted for 0.6% of all deaths in Ontario in that year. Approximately 60% of these deaths in Ontario were attributed to injuries (half of which resulted from motor vehicle collisions and a quarter of which resulted from suicide). Additionally, 11% of Ontario deaths among youths in 1997 were attributed to cancers of various types.
In 1997, in Brant County, there were 50 deaths among adults aged 20 to 44 (36 males and 14 females), which accounted for approximately 5% of all deaths in Brant County in that year. Injuries were the leading category of death among Brant County adults in this age group accounting for 40% (20 deaths) of all deaths in this age group. Nearly all of the deaths from injuries occurred among males; eight from injuries involving motor vehicles and seven were attributed to suicide. Cancer was the second leading category of deaths among this age group, accounting for 16 deaths (9 males and 7 females).
In Ontario, in 1997, there were 3,750 deaths among adults aged 20-44 (2,517 males and 1,233 females), which accounted for approximately 5% of all deaths in Ontario in that year. Approximately 34% of these deaths in Ontario were attributed to injuries (more than one-third were attributed to suicide and more than one-quarter were attributed to motor vehicle collisions). Additionally, 23% of Ontario deaths among these adults were attributed to cancers of various types, and 12% were attributed to diseases of the circulatory system.
Hospital Admissions
In 1998/99 in Brant County, there were 634 hospital admissions for youth aged 10-19 – 51% or 325 of these were for females. In addition, there were 158 hospital admissions attributed to ‘Complications of Pregnancy, Childbirth and the Puerperium’. These accounted for 20% of the overall total hospital admissions for youth aged 10-19 and, specifically, 32.7% of the female hospital admissions in this age group. The leading category for females in this age group (not including pregnancy and childbirth) was ‘Mental Disorders’ followed by ‘Diseases of the Digestive System’ and ‘Injury and Poisoning’. For females, the leading specific causes of hospital admissions were mainly attributed to: ‘neurotic and personality disorders’, schizophrenic psychoses and asthma. For males in this age group, ‘Injury and Poisoning’ was the leading category followed by ‘Diseases of the Digestive System’ and ‘Mental Disorders’. For males in this age group, the leading specific causes included: ‘neurotic and personality disorders’, ‘intracranial injury’ and appendicitis.
Sexual, reproductive health and teen pregnancy
Between 1993 and 1997, in Brant County, the overall pregnancy rate for women aged 15 to 44 was consistently below the provincial rate (Fig. 2.1). Between 1993 and 1996, Brant County had substantially higher teen (aged 15 to 19) pregnancy rates than Ontario (Fig. 2.4). In Brant County, teen pregnancy rates rose in the middle 1990s, increasing from 57/1,000 in 1993 to 59/1,000 in 1996 (Fig. 2.4). The Brant County teen pregnancy rate was 17% higher than the provincial rate in 1993, and 28% higher in 1996. Furthermore, the teen pregnancy rate in Brant County was higher than any of the other Health Unit Areas in Central Western Ontario in 1996, including: Niagara Region, Waterloo Region, Haldimand-Norfolk Region, Halton Region, Hamilton-Wentworth Region, and Wellington-Dufferin (Central West Health Planning Information Network, 1999). In fact, teen pregnancy rates were higher in Brant County despite the fact that overall pregnancy rates (women aged 15 to 44) were lower than the Ontario average (Fig. 2.1) during these years.
- Sum of live births, therapeutic abortions, stillbirths, miscarriages, and ectopic pregnancies. Brant County excludes Six Nations and New Credit residents except for therapeutic abortions. Miscarriages and ectopic pregnancies estimated for first third of 1993. Sources: Ontario Reproductive Outcomes and Population Databases, Ontario Ministry of Health and Long Term Care, 1999/2000; and Provincial Health Planning Database - Inpatient and Day Surgery Data, 1999.
There are several reasons for concern regarding the incidence of teen pregnancies:
Teen mothers are more likely to have low birth weight babies, who are at greater risk for a wide variety of chronic illnesses and who are at greater risk of death during the first year of life. In 1997, eight percent of teens had a low birth weight baby, compared to six percent low birth weight overall in Brant County.
- A teen may delay getting prenatal care and because she is still growing herself, is at risk for becoming undernourished.
- Teenagers are less likely to have a permanent partner. In 1997, 6% of teenage mothers in Brant County were married, compared to 72% of all mothers. Approximately, 95% of teenage mothers were single, compared to 28% of all Brant County mothers who gave birth in 1997.
- Both young mothers and fathers are still in the midst of their formative years, in the middle of their secondary school education, and at a stage in their life when they are just beginning to develop their own sense of independence. If their education is interrupted and/or if they do not have adequate social supports, they run the increased risk of ending up in lower paying jobs or being unemployed, setting the stage for a lifetime of poverty.
- Sum of live births, therapeutic abortions, stillbirths, miscarriages, and ectopic pregnancies. Brant County excludes Six Nations and New Credit residents except for therapeutic abortions.
In 1997, teen pregnancy rates dropped throughout the province, and the decrease in Brant County surpassed the relative decrease in the provincial average, bringing the rates in Brant County closer to the provincial rates than they had been at any time throughout the mid 1990s. There is no well-established explanation for this drop in Brant County, and hospital discharge data suggests that rates may have started to rise again in 1999 (Central West Health Planning Information Network, draft December 2000). The Brant County rate was still above the provincial rate in 1997 (Fig. 2.4). Furthermore, in 1997 the teen pregnancy rate in Brant County was also higher than the objective in the Mandatory Health Programs and Service Guidelines, which is to reduce the teen pregnancy rate to 40/1,000 by the year 2005 (Table 2.1).
Among the reproductive outcomes that comprise teen (15-19 year old) pregnancies, between 1993 and 1996 in Brant County, for every three live births there were two therapeutic abortions. The rate of miscarriages, ectopic pregnancies and stillbirths remained low throughout the 1990’s among teenagers in Brant County.
Changes to Improve Health
There is evidence that people do change their behaviours and make their lifestyle healthier. Approximately 50% of the population aged 12 and older, in Brant-Haldimand-Norfolk (BHN) and Ontario as a whole in 1996/97, stated that they did something in the previous year to improve health. The most important change they made was to exercise more. However, a notable proportion lost weight and changed their eating habits; and a small proportion smoked less
Levels of Physical Activity
Physical activity has been shown to reduce the risk of premature morbidity and mortality, particularly in relation to cardiovascular disease, hypertension, osteoporosis, cancer and diabetes. Another benefit of physical activity is weight control. In addition, physical activity is associated with positive mental health and decreased stress, leading to increased self-confidence and an improved sense of well-being.
The Physical Activity Index is used to categorize energy expenditure, which is based on the types of leisure-time physical activity, the frequency of each activity, and the average duration of each activity. In 1996/97, there were no statistically significant differences overall between Brant-Haldimand-Norfolk (BHN) and Ontario in the physical activity index. Almost 60% of the population was found to be inactive
Weight, Nutritional Status and its Impact on Teens
A 2001 study on student health, carried out by the Brant County Health Unit, surveyed 789 Brant County students on 42 questions related to eating behaviours, alcohol use, gambling, smoking and sexual health. The survey revealed that, in Brant County, poor eating habits increase as students get older. By grade 11, almost 28% of those students surveyed reported their eating habits were less than good, compared to 6% in grade 5, 11% in grade 7 and 17% in grade 9.
The proportion of students feeling they needed to lose weight nearly doubled between grade 5 (27%) and grade 11 (50%). And, approximately one third of all students surveyed were concerned about the amount of fat in the foods they were eating.
Tobacco and Alcohol Use
Despite the general awareness that smoking is detrimental to health, a quarter of the population of Ontario aged 12 and older indicated that they smoked in 1996/97. There was no difference in the proportion of occasional smokers between Brant-Haldimand-Norfolk (BHN) and Ontario at that time. However, the proportion of daily smokers was statistically significantly higher in BHN (25%) than Ontario (21%) in 1996. In both BHN and Ontario in 1996/97, the proportion of daily smokers aged 12 and older was statistically significantly higher among males than females. In addition, the proportion of male daily smokers was statistically significantly higher in BHN than Ontario.
Excessive alcohol consumption may lead to serious social and health problems. Social problems associated with excessive alcohol consumption include unemployment, domestic violence, and mental health problems.
In 1996/97, more than 70% of the population aged 12 and older in Brant-Haldimand-Norfolk (BHN) and Ontario as a whole were ‘current drinkers’, reporting that they had at least one drink in the past year. In that year, approximately half of all Ontario residents aged 12 and older drank alcohol at least once per month, while approximately 18% drank more frequently than once per week. Over a quarter of BHN and Ontario residents were former drinkers or abstainers.