Multilevel models of health: A comparison between British Columbia and Newfoundland

As part of MHST 601, both writers of this blog posting paired up to compare obesity with respect to levels of health and continuum between British Columbia and Newfoundland. Obesity is rated as one of the top determinants of health in Newfoundland, with statistics showing that 38% of the population are obese, comparable to 27% in Canada as a whole for 2017 (Statscan, 2018). British Columbia is rated as the lowest province with respect to obesity rates, coming in at 22% of the population being obese (Statscan, 2017).

British Columbia

In order to address the growing problem of obesity, BC created a continuum, which involved planning, partnership, and action between multiple sectors, and at multiple levels (Bradbury, Day, & Scarr, 2015). The continuum includes population health, prevention, identification, early intervention, weight management and specialized treatment (Bradbury et al., 2015).

Each part of the continuum has a goal and then initiatives to help achieve that goal. The continuum is summarized below.

Population Health - Goal: to improve social environments so that they support healthy eating and active lifestyles. Lessening health disparities and vulnerabilities (Bradbury et al., 2015).

‘Plan H’ seeks to initiate partnerships across many sectors, including health authorities and local governments (Bradbury et al., 2015). The aim is to improve communities through policy changes, plans and collective action (Bradbury et al., 2015). Plan H is focused on creating healthy people, societies, and environments (Bradbury et al., 2015). More specifically, improving the air we breathe, housing we live in, food we can access, green space availability and safety of our neighborhoods (Bradbury et al., 2015). 

Community Food Action Initiative (CFAI) is partnered between five different health authorities as well as the ministry of health. The initiative seeks to improve food security through support for local food production, community gardens, farmers markets, healthy food availability in public buildings, and community planning to name a few (Bradbury et al., 2015). 

Prevention – educating people about making healthy choices, and creating environments that encourage physical activity, healthy eating and mental well-being (Bradbury et al., 2015). 

Healthy Families BC is B.C.’s chronic disease prevention and promotion strategy. It provides a framework for promoting and improving health, and encourages action throughout the province at every level (Bradbury et al., 2015). Some of the initiatives currently underway are the following:

‘Farm to School’ is a program that is carried out by the Public Health Association of BC. Schools can be connected with local farmers so that fresh produce is available for them to eat in school during the day. The program also helps to educate youth and children about local farming (Bradbury et al., 2015). 

‘LIVE 5-2-1-0’ is an evidence-based initiative endorsed by the Canadian Pediatric Society. The simple rule is:

-eat 5 or more fruits and vegetables in the day, 

-no more than 2 hours of screen time

-1 hour of activity

-zero sweetened drinks

Prevention initiatives have mainly focused on environmental factors thus far, however there are other complex factors that can influence obesity and physical health. For example, mental health, social isolation and depression can influence obesity (Bradbury et al., 2015). In addition, recent research has shown that cultural, social and economic factors can also influence health. That being said, a multi-pronged approach is needed to address the rates of obesity in BC (Bradbury et al., 2015).

Identification- Identifying weight related issues in the early phases, so that interventions can be made early, and there is a better chance of a healthy outcome (Bradbury et al., 2015).

BC is the first province to use growth charts for monitoring weight and identifying children who are leaving their optimal weight trajectory (Bradbury et al., 2015). These charts were developed by World Health Organization. The point of this identification is so that these children can be referred to programs early on (Bradbury et al., 2015).

Early Intervention: the goal is to provide early interventions so that long-term outcomes are more successful.

'Mend' is a program that is a partnership between the BC Minister of Health and the Childhood Obesity program (Bradbury et al., 2015). It is available through the YMCA and BC Recreation and Parks Association. The program provides education in regards to healthy lifestyles, and plans activities for families and kids (Bradbury et al., 2015).

Weight Management- setting goals at the individual and family level, so that long- term impairments are minimized (Bradbury et al., 2015).

ShapeDown BC is a program developed for kids age 6-17 that need more intensive psychological support to remove challenges and barriers related to eating habits and activity (Bradbury et al., 2015).

Specialized Treatment: Managing specific comorbidities in a way that minimizes long- term impairment (Bradbury et al., 2015).

Initiatives for specialized treatment include minimizing long-term impacts by referring to endocrinologists, sleep specialists, geneticists, and gastroenterologists for specific interventions (Bradbury et al., 2015).

Newfoundland

Newfoundland has a similar plan of action to that of BC for addressing the health and well-being of the population, however there is currently not a specific plan in place to address obesity alone. The Government of Newfoundland and Labrador is continuing its commitment to improve the health and wellness of the people of the province. The provincial wellness plan has been developed which focuses on improving the health of the population at the front end of the health spectrum: the goal is to keep people healthy through the promotion of initiatives and support for people and communities. It builds on the foundation of partner policies, programs and resources and reflects forward thinking needed to effect change in people, communities and policies within a supportive environment (NL, 2018). The health of individuals is not influenced solely by access to health care services, but by a variety of variables of the social ecological model that include individual characteristics (genetics, personnel behavior patterns), environmental characteristics (workplace, school, home, pollution, water quality) and social characteristics of a society (government policy, income equality and access to employment and education opportunities) (Twells, 2005). While BC's plan mainly addresses environmental factors, what about social characteristics of society?

Newfoundland has an active strategy in addressing income equality and access to healthy nutrition and services. The provincial Wellness Plan is closely linked to the poverty reduction strategy (2006) which provides a comprehensive and practical approach to prevent, reduce and alleviate poverty to further strengthen the ability of Newfoundlanders and Labradorians to participate in their communities and lead healthier lives. Annual funding of $1.09 million to the Kids Eat Smart Foundation to provide healthy meals and snacks for school age children is an example of an initiative making a real difference by increasing access to healthy food for the children of our province (NL, 2018). This program is comparable to the 'farm to school' program offered in BC.

The Province of Newfoundland and Labrador has some of the poorest lifestyle practices and health indicators in the country (Eastern Health, 2018). In comparison, British Columbia is said to be the healthiest province in Canada, in that they are more physically active and are active participants in healthy lifestyle behaviors (Bradbury et al., 2015). As a result of Newfoundland's poor lifestyle practices, the provinces primary healthcare organization, Eastern Health, has incorporated this focus as part of the 2017-2020 strategic plan (Eastern Health, 2018). As part of this focus, Eastern Health will look to engage with communities as partners to determine appropriate initiatives to improve the health of the population (Eastern Health, 2018).

References

Bradbury, J., Day, M., & Scarr, J. (2015). British Columbia’s Continuum for the Prevention, Management, and Treatment of Health Issues Related to Overweight and Obesity in Children and Youth. Retrieved on October 24, 2018 from http://www.childhealthbc.ca/sites/default/files/15%2012%2018%20Healthy%20Weights%20Continuiim.pdf

Eastern Health (2018). Population Health. Retrieved from http://www.easternhealth.ca/WebInWeb.aspx?d=2&id=2380&p=2377

Newfoundland and Labrador (2018). Health promotion and wellness. Retrieved from https://www.health.gov.nl.ca/health/wellnesshealthyliving/index.html.

Statistics Canada (2017). Obesity in Canadian adults, 2016-2017. Retreived from https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2018033-eng.htm.

Twells, L. (2005). Obesity in Newfoundland and Labrador. Retrieved from https://www.researchgate.net/publication/251307563_Obesity_in_Newfoundland_and_Labrador.