Tip of the Iceberg

1
Tip of the Iceberg

• Effects of Forestry Closures
• On Health in
• Northwestern Ontario

Hill, Pugliese, Park, Minore, Gray, and
Russell Northern Health Research Conference May
29-30, 2009
2
Research Team

• Mary Ellen Hill, Irene Pugliese Jungwee
  Park, Bruce Minore
• Centre for Rural and Northern Health Research
• Lakehead University
• Heather Gray, Cory Russell
• North West Local Health Integration Network

3
Objectives

• Study commissioned by the NW LHIN to
  determine whether, and to what extent, recent
  restructuring in the forestry industry has
  affected the health of people living in
  Northwestern Ontario

4
Model

• Murray Report (2005), examined the health and
  socioeconomic impacts of the cod moratorium on
  Newfoundland communities
• Although not directly comparable, we used the
  Murray report and similar studies of industry
  closures to inform our study of NWO forestry
  downturn

5
Mixed Methods Study

• Quantitative Data (Identify affected communities
  and examine changes in health status and social
  well being using CCHS data)
• Qualitative Data (Interviews with 15 health care
  administrators and front-line providers to
  determine more widespread effects)

6
Affected Communities

• Defined as affected by forestry downturn if
  community
• Experienced forestry operations closures in past
  5 years (Canadian Forestry Service Database)
• Lost at least 10 of labour force in
  resource-related sectors (Statistics Canada 2001
  2006 census)

7
Affected Communities

• Dorion
• Dryden
• Greenstone
• Ignace
• Kenora
• Machin
• Manitouwadge
• Marathon

• Nipigon
• Oliver Paipoonge
• Red Rock
• Schreiber
• Terrace Bay
• Kenora Unorg
• Rainy River Unorg

• Thunder Bay, large population and diverse
  economy, treated as separate case

8
Health Data (CCHS 3.1)

• 2005 data (telephone survey, self-report data)
• Sample based on 2001 census (20 sample,
  collected January through December)
• Aggregate analysis (compares affected communities
  to City of Thunder Bay and Ontario)

9
Chronic Conditions

• 75 of residents in affected communities had at
  least one chronic condition
• Rates of stroke (3) much higher than provincial
  rates (1.1)
• Heart disease rate (7) also higher than province
  (4.8)
• High blood pressure exceeded provincial rates
  (18 vs. 15.2)

10
Negative Self-Perceived Health

• Fair or poor health reported by 1 in 6 residents
  of affected communities (16.4) and Thunder Bay
  (15.9), much higher than province (11.0)

• No differences in mental health, stress or work
  stress rates

11
Risk Factors
12
Diet and Physical Activity
13
Associations Between Poor Health and Risk Factors

• Daily smokers about 5 times more likely to report
  fair or poor physical health
• Smoking also associated with chronic conditions
  and poor mental health
• People in food insecure households most likely to
  have poor health and unmet needs

14
Mental Health and Suicide

• Poor mental health associated with daily smoking
  and heavy drinking
• Heavy drinkers almost 6 times more likely than
  others to seriously consider committing suicide

15
Access to Services

• More than 1 in 4 from affected communities had no
  regular doctor
• More than 1 in 2 said no doctors available in
  area or none taking new patients
• Residents of affected communities also less
  likely to see specialists or dentists

16
Qualitative Analysis - Themes

• Unemployment as Determinant of Health
• Physical Health and Unemployment
• Mental Health Effects of Unemployment
• Family Health Unemployment
• Effects on Health Care Utilization
• Community Well-Being Policy Implications

17
Providers Were Seeing More Physical Health
Problems

• High blood pressure (especially younger
  individuals)
• Injuries (people accepting more risky jobs to
  support families)
• Weight gain (people cannot afford to eat healthy
  diets or participate in usual recreational
  activities)

18
More Mental Health Problems

• More clients with sleep disorders and depression,
  seeking medication
• More people resuming smoking or other risky
  behaviours
• Unemployed facing chronic stress, exacerbated
  when retraining
• Older unemployed workers often expressing
  suicidal thoughts

19
Widespread Family Health Effects

• Spouses stressed by partners heading west for
  employment, involuntary separations, marital
  problems
• Children, youth anxious about pressures of having
  to relocate and leave friends behind
• Seniors worried about loss of family supports
  when families have to relocate

20
Changing Healthcare Utilization

• Seeing more walk-in clients with mental health
  issues in primary care clinics, mental health
  services and ERs
• Difficulties with transportation, affect ability
  to access appointments
• Loss of benefits creates difficulties paying for
  prescriptions, so people skip medications,
  conditions poorly controlled

21
Community and Policy Effects

• Consensus effects observed were just tip of the
  iceberg
• Quality of life will decline as communities
  cannot support services
• More difficulty recruiting and retaining
  professionals
• Must revisit issues to understand full effects

22
Thank you!

• We wish to thank the North West LHIN for
  commissioning and funding this study
• If you would like copy of the report, please
  contact Dr. Mary Ellen Hill at the Centre for
  Rural and Northern Health Research (Lakehead
  University) [phone] or
  maryellen.hill_at_lakeheadu.ca

The Centre for Rural and Northern Health Research
is an academic and applied health research centre
funded through the Ontario Ministry of Health and
Long-Term Care