Abstract
Background: Health varies by geography and is influenced by factors including demographics, socio-economic status, and the built environment. Mapping health indicators by neighbourhood can identify disparities within the community and allow for focused integrated interventions. While community health maps have been developed using primary care, public health, or municipal data, none to our knowledge, have brought together all three data sources in a single platform in the Canadian context.
Healthy Barrie is a collaborative, community-based partnership that brings together primary care, public health, academic researchers and municipal government to improve health in the City of Barrie, Canada (population 141,434). A founding partner is the Barrie and Community Family Health Team (BCFHT), which has over 95 family physicians working on a shared electronic medical record (EMR) system. 83% of Barrie’s census population is captured in the EMR. Leveraging the power of this data, the collaborative set out to identify and map relevant health indicators. The result is the Healthy Barrie Community Snapshot.
Approach: A working group including physicians, public health, community members and data experts was formed to identify indicators, gather data and map these to appropriate geographies.
Indicators: Each partner organization compiled potential indicators based on available data. Indicators were reviewed and then ranked using an indicator prioritization tool.
Data: EMR data was abstracted for health markers using Canadian Primary Care Sentinel Surveillance Network case definitions and data recorded in the EMR cumulative patient profile. The Simcoe Muskoka District Health Unit (SMDHU) provided data from Canadian Census, Vital Statistics, the Canadian Community Health Survey and the Hedgehog Classic Database. The City of Barrie provided data on city services and publicly available data on the built environment and neighbourhood characteristics.
Geographies: The City was divided into 6 neighbourhoods using results from a principal component analysis with criteria including population size <25,000, physical geography, municipal boundaries and homogeneity of socioeconomic variables. Data was mapped by postal code.
Results: Eighty potential indicators were considered. After iterative rounds of discussion and ranking, 29 health indicators were included in the Community Snapshot. These have been grouped into four themes: i) health outcomes; ii) health behaviours; iii) service utilization and neighbourhood characteristics; and iv) demographics and social determinants of health. Thirteen indicators come from public health, eight from primary care, and eight from the municipality.
The indicators are mapped in an interactive web-based Geographic Information System environment. The algorithms used to pull data have been used to see how the neighbourhood indicators change with time. They have been used for regression analysis of correlations between neighbourhood characteristics and health outcomes to inform clinical initiatives for comprehensive patient care.
Implications: The Healthy Barrie Snapshot is one of the first Canadian platforms that collaboratively combines EMR data with public health and municipal data to map health across neighbourhoods. The inclusion of municipal data is unique and informs local policy and health promotion activities. The working group is now leveraging these data to plan social prescribing for food security and physical activity in neighbourhoods identified at risk.