The Flin Flon area is one of the healthiest regions in a surprisingly unhealthy northern Manitoba.
That’s among the findings of The 2013 RHA Indicators Atlas, a compilation of health statistics assembled by the University of Manitoba’s Manitoba Centre for Health Policy.
Based on the latest data, the Flin Flon area – defined as Flin Flon, Cranberry Portage, Snow Lake and Sherridon – had a premature mortality rate considered statistically similar to that of Manitoba as a whole.
“Those numbers for premature mortality are quite close to the provincial average,” said Dr. Michael Isaac, medical officer of health for the Northern Health Region, as he reviewed the figures.
Indicator
Isaac said premature mortality rate, or PMR, is the best indicator of the overall health of a population. It reflects the age- and sex-adjusted annual death rate among people under the age of 75.
For 2007-11, the Flin Flon area had a PMR of about 3.5 for every 1,000 residents compared to a provincial rate of about 3.1. Since this difference is not considered statistically significant, it may stem from chance or a combination of health factors.
In northern Manitoba, only the Gillam-Fox Lake Cree Nation area had a lower PMR, and the difference with the Flin Flon area was minimal.
All other areas of northern Manitoba, and the region as a whole, had a significantly higher PMR when compared to the rest of the province.
Besides PMR, in recent years the Flin Flon area has also seen slightly above-average rates of hypertension, arthritis and osteoporosis, and marginally lower life expectancies, but again none of these were considered statistically significant.
In some more welcome findings, for 2009-12 the Flin Flon area had the lowest diabetes rate in northern Manitoba at about nine per cent, just below the provincial average.
There was a more dramatic – and statistically significant – difference in terms of mood and anxiety disorders. Here, the prevalence rate in the Flin Flon area was roughly 18 per cent for 2007-12, about five per cent lower than the province at large.
Also statistically significant was the variance in dementia prevalence for the same time period. The Flin Flon area’s rate was roughly seven per cent whereas the Manitoba average stood at about 10.5 per cent.
Good or bad?
Some of the statistical variations are difficult to classify as good or bad.
In 2011-12, for instance, about 75 per cent of this area’s residents visited a doctor at least once compared to almost 80 per cent of all Manitobans. It’s not clear whether that reflected a reduced need for care among area residents or an inability to see a physician.
That said, almost eight per cent of area residents had at least one in-patient hospital stay in 2011-12 versus about six per cent of all Manitobans. And in terms of hospital readmission within 30 days of discharge, this area’s rate was identical to that of Manitoba: about 8.5 per cent.
The Flin Flon area was also essentially on par with Manitoba in terms of prescription drug use, with about 65 per cent of people having at least one prescription in 2011-12.
Rates for Flin Flon alone are unknown since its statistics were combined with those of Cranberry Portage, Snow Lake and Sherridon; however, Flin Flon has about 80 per cent of the population in the area.
Overall, the figures indicate that the Flin Flon and Gillam-Fox Lake areas are much healthier than the other areas of northern Manitoba, which as a region has by far the highest mortality rate in the province.
A chart compiled by Manitoba’s Southern Health Region showed that for 2007-11, the Northern Health Region recorded a mortality rate of about 13 per 1,000 people.
The Manitoba average was about 8.5, and no other health region in Manitoba exceeded this rate.
Isaac, the medical officer of health, said the high northern mortality rate is largely the product of social factors affecting an Indigenous population that makes up most of the region.
“First Nations, Métis and Inuit populations, as we know, have poorer health status than other parts of the population because of certain factors such as colonization as well as the affects of the residential school system,” Isaac said.
But it’s also true that a key component in the North’s mortality rate is a high number of fatal motor vehicle accidents. This is not necessarily related to socioeconomic factors, as Dr. Michael Routledge points out.
“I don’t know that we have the data to suggest, for example, drinking and driving is more of an issue,” said Routledge, Manitoba’s chief provisional public health officer. “I think what we do know is that there’s a higher rate of death from motor vehicle collisions and…that could be from all sorts of causes. It could be from poor roads, it could be a lack of education and sort of driver training programs.”
Across Canada, Routledge said, vehicular accidents are one of the main causes, if not the main cause, of death in younger populations.
Given that the North has a relatively young population, “it wouldn’t be surprising that you have more motor vehicle deaths,” Routledge said.
As the pervasiveness of vehicular deaths illustrates, many influences behind the North’s mortality rate lay outside the dominion of the health care system.
Routledge points out that the medical system’s impact on a population’s health is thought to amount to 25 per cent. About 60 per cent is influenced by social determinants.
Isaac said that while there are challenges, such as health care accessibility in remote locations, overall the health system is serving northern Manitoba well.
As evidence of that, Isaac cites the North’s above-average in-patient hospitalization rate.
“What that is telling us is that the system is working well in responding to demand,” Isaac said. “We know that people up north are probably going to need to be hospitalized [more often] because, on average, they’re more likely to have certain health conditions, and the system is responding to that. So that’s a good thing.”
Building more hospitals and ERs across the region would not yield major improvements in mortality numbers, in Isaac’s view.
“Really the way to get at those factors is looking at the social things, and that takes time,” Isaac said. “That’s not something you can change overnight.”
Routledge agreed and shared his hope that more people will begin paying attention to the social determinants of health.
“If we want to get better at having better population health, and in fact actually being able to manage our health care system and have a sustainable health care system,” Routledge said, “we really need to start to have more conversations about how we can address the factors that cause people to have poor health in the first place.”
When asked about the high northern mortality rate, Helga Bryant, CEO of the Northern Health Region, gave additional examples of the social determinants of health, such as diminished access to housing, healthy food and social supports.
But Bryant also cited fewer health care resources and the vast distances some people must travel to receive medical care.
On that front, Sharon Blady, Manitoba’s minister of healthy living and seniors, said the province is working to improve health care access in the North with the establishment of renal health centres and other services in certain First Nations communities.
Blady said the province also operates programs to boost access to healthy foods and prevent chronic disease. There is as well a plan to give every Manitoban access to a family physician by next year.
“It’s about a holistic package,” said Blady. “So, yes, we want to make those investments in doctors and health-care practitioners, but we also want to make sure that people have access to healthy foods and healthy lifestyles.”
For her part, Bryant said the Northern Health Region continues to strive to achieve its oft-stated goal of “Healthy People in a Healthy North.”
“That includes education and prevention activities, along with good public health, a harm-reduction strategy and lobbying all levels of government to improve the controllable social determinants of health,” Bryant said. “At the same time, we will continue to work diligently to deliver on the promise of our mission to provide quality, accessible and compassionate health services for all.”
The complete 2013 RHA Indicators Atlas is available online by Googling the title of the document.
