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2016

Prevention System

Quality Index Monitoring Ontario’s Efforts in Cancer Prevention

Introduction 2016 Prevention System Quality Index

Acknowledgements

• Population Health and

Prevention Unit and

Occupational Cancer

Research Centre, Prevention

and Cancer Control, Cancer

Care Ontario

• Prevention System Quality

Index Advisory Committee

• Prevention System Quality

Index Expert Panels

Maria Chu, Alison Rothwell,

Penney Kirby, Mohammad Haque,

Marcia Bassier-Paltoo,

Corinne Hodgson, Victoria Nadalin,

Sargam Rana, Catherine Slavik,

Amanda Veglia, Elisa Candido,

Rebecca Truscott, Julie Klein-

Geltink, Wolodymyr Lewyckyj and

Alice Peter

Representatives from:

• Public health units

• Non-governmental organizations

• Academic institutions

2


2016 Prevention System Quality Index (PSQI)

• 21 indicators of system-level policies and programs that

can reduce cancer risk factors and exposures in the

population

• Policies and programs: various levels of government in

several sectors

• Evidence and data to help governments, non-

governmental organizations and public health units

implement cancer prevention initiatives in Ontario

3


Background

4


Percentage of adults in Ontario with selected modifiable risk factors, 2003–2014

Source: Canadian Community Health Survey, 2003, 2005, 2007–2014 (Statistics Canada)

Note: Estimates are adjusted to the age distribution of the 2011 Canadian population.

5


Changes from 2015

• Added occupational exposures and infectious agents

and omitted cancer screening

• Removed, refined or added indicators (13 new

indicators)

• Provided greater contextualization of indicators

• Descriptive sections where no indicators available

• Note where improved measurement is required

6


Types of PSQI indicators

• PSQI indicators measure:

• the resources dedicated to policies or programs;

• the process by which the policies or programs are

implemented;

• products that result from the policies or programs;

or

• outcomes of policies or programs.

7


Areas of focus for today

• Overview of indicators

• Brief comparison of 2015 PSQI and 2016 PSQI findings

• Focus on the evidence, findings and opportunities for

five indicators:

• Food literacy development in secondary schools

• Active transportation to work and school

• Shade policies in local municipalities

• Radon levels in residences

8

Tobacco Tax as a percentage of tobacco retail price Exposure to second-hand smoke Long-term smoking cessation

Tobacco 2016 Prevention System Quality Index

Tobacco

• As of April 2016, taxes

were 65% of average

retail price

• In 2014, 14.2% of

adults and 25.6% of

adolescents were

exposed to second-

hand smoke in public

places

Alcohol Minimum retail price of alcohol sold in off-premises alcohol outlets Private off-premises alcohol outlets Alcohol outlet density (on- and off-premises)

Alcohol 2016 Prevention System Quality Index

Alcohol

• In 2015, 75.9% of off-

premises alcohol outlets

were privately owned

• In 2015, density of on-

and off-premises

alcohol outlets was 17.2

for every 10,000 people

Healthy eating

Household food insecurity Food literacy development in secondary schools

Healthy eating 2016 Prevention System Quality Index

Healthy eating

14

• In 2014, 11.9 per cent of

Ontario households

experienced food

insecurity

Physical activity Use of active transportation to or from work and school Health and physical education specialist teachers in schools Enrolment in health and physical education

Physical activity 2016 Prevention System Quality Index

Physical activity

16

• In 2013/14, 19.7% of

elementary and 21.7%

of secondary schools

had specialist teachers

• In 2013/14, 88.6 per

cent of Grade 9

students earned one or

more HPE credits,

compared to 26.0% of

Grade 12 students

Ultraviolet radiation

Shade policies in local municipalities

Environmental carcinogens

Radon levels in residences Fine particulate matter (PM2.5) concentrations in outdoor air

Occupational carcinogens

Industrial formaldehyde use and employment in industries using formaldehyde Industrial nickel use and employment in industries using nickel

Infectious agents

School-based HPV vaccination coverage School-based hepatitis B vaccination coverage


Food literacy development in schools Evidence:

• Enhancing food literacy can increase the consumption of

healthy foods

• Childhood and adolescence may be critical periods for

food literacy development

Findings:

• One-third of students who entered Grade 9 from 2005/06

to 2009/10 took at least one food literacy course during

high school

Policy opportunity:

• Include at least one compulsory credit in a course that

focuses on food literacy. 21


Percentage of students in publicly funded secondary schools in Ontario who earned at least one credit in a course that included a food literacy component during their secondary school education, 2005/06 to 2009/10 cohort

Source: Ontario School Information System, 2005/06–2013/14 (Ministry of Education)

Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention), based on analytic results provided by the Dissemination and

Reporting Unit, Ministry of Education

Note: Cohort year refers to the school year a student begins Grade 9.

22


Use of active transportation to or from work and school

Evidence:

• Those who use active transportation (walking and

bicycling) have higher physical activity levels

Findings:

• In 2011, active transportation was used in 21.6% of

trips to or from work and in 51.4% of trips to or from

school

Policy/program opportunities:

• Continue to develop and replicate successful provincial

and municipal policies, and community-wide programs

that increase active transportation

23


Percentage of trips taken to or from work by adults (age 19+) that included active transportation, Greater Golden Horseshoe regions in Ontario, 2011

Source: Transportation Tomorrow Survey, 2011 (Data Management Group,

University of Toronto)

Note: Active transportation: walking or cycling used as the only mode of

transportation to or from work, and to or from public transit.

24


Percentage of trips taken to or from school by youth (ages 11–18) that included active transportation, Greater Golden Horseshoe regions in Ontario, 2011

Source: Transportation Tomorrow Survey, 2011 (Data Management Group,

University of Toronto)

Note: Active transportation: walking or cycling used as the only mode of

transportation to or from school, and to or from public transit.

25

Ultraviolet radiation 2016 Prevention System Quality Index


Evidence:

• Shade provided by built structures and tree canopies

can protect people from UVR exposure more effectively

than sunscreen

Finding:

• Three municipalities with >100,000 people have strong

shade policies: Ajax, Kitchener and Waterloo

Policy opportunity:

• Broaden the scope and strengthen the requirement for

shade in municipal policies

26


• Guidelines that the municipality follows when evaluating

plans for developing or redeveloping sites state that

shade:

• should be provided for a broad range of

municipally and privately owned sites (Strong)

• should be provided for only a few types of

municipally and/or privately owned sites (Moderate)

• should be considered for one or more types of

municipally and/or privately owned sites, but it is not

essential (Limited)


27


Strength of shade policies in the planning policy documents of local municipalities in Ontario with populations of 100,000 or more, as of March 2016

Sources: Municipal planning policy documents (e.g., official plans, urban design guidelines, site plan control bylaws) posted on the web and/or additional documents sent via

email from the municipality for each of the 26 Ontario local municipalities with populations of 100,000 or greater, 2016

28

Environmental carcinogens 2016 Prevention System Quality Index

Radon levels in residences

Evidence:

• Reducing radon concentrations can reduce the risk of

lung cancer

Finding:

• From 2009-2013, 25.2% of homes had radon

concentrations higher than WHO recommended level

for remedial action (100 Bq/m3)

Policy opportunity:

• Amend the building code to include radon prevention

measures and test and remediate existing homes

29

Environmental carcinogens 2016 Prevention System Quality Index

Percentage of tested homes in Ontario with radon concentrations of 100 Bq/m³ or greater, by public health unit, 2009–2013

Source: Cross-Canada Survey of Radon

Concentrations in Homes, Final Ontario Dataset,

2013 (Health Canada)

Note: The minimum detection limit for a three-month

radon test is 15 Bq/m³ and for data points below

15 Bq/m³, a value of 8 Bq/m³ (roughly half the

detection limit) was substituted to allow calculation

of medians to be performed; a total of 662 homes

in Ontario (16.7% of all samples) had radon

concentrations below 15 Bq/m³.

30

Conclusion 2016 Prevention System Quality Index

Conclusion

• Opportunities exist to create healthier environments

and supports

• Comprehensive strategies with dedicated, sustained

funding, provincial coordination and a mix of policies

and programs are required

• Population health should be considered when

developing policies in all sectors

31

Conclusion 2016 Prevention System Quality Index

Contact information

For questions or comments, please contact:

Caroline Silverman

Lead, Prevention System Quality Index

Population Health and Prevention Unit

Prevention and Cancer Control

Cancer Care Ontario

416-971-9800 ext. 2803

[email protected]

32

Documents

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