We Are All The Same | Pamela Rojas | 2010 | Details from mural on exterior of Kitchener-Waterloo Multicultural Centre

Photo by Selina Vesely.

As the Chief Executive Officer of the Waterloo Wellington Local Health Integration Network, I spend most of my time working with health-care leaders and front-line health professionals to improve the health care local residents receive. I also spend a significant amount of time with community leaders and residents discussing the need for a “whole-of-community” approach to health. 

As a result, I am often asked two questions: what is a Local Health Integration Network (LHIN)? And why is the leader of the health-care system talking about things like high school graduation rates and early childhood development? 

Most of the time, the first one is easy. The second, I’ll explain in a moment.

LHINs were created in Ontario in 2006 with the idea that no one knows better what services are needed in a community than the people who live, work, receive and provide health-care services there. 

Today, the network covering Waterloo Region, Guelph and Wellington County is among 14 LHINs across the province. 

The “local” in LHIN is the foundation of who we are. We are a group of local health and business professionals – doctors, nurses, allied health professionals, planners, accountants, technology experts, etc. – tasked with planning, funding and integrating services in the local health-care system, from those delivered by hospitals to mental health and additions to community-support agencies. 

A crucial part of our role is community engagement. We work with residents, families, health-service providers, community organizations, local government and other community partners to build a better health-care system. We are passionate about putting residents first in everything we do. We listen, we build partnerships, we act and we lead – and we do it all together with dedicated professionals across the system.

When developing our most recent strategic plan, we also updated our mission, vision and values. As a result of engaging with our community and examining the characteristics of the highest performing health systems in the world, we realized we needed to look at more than just health care to improve the health of our community. We launched a single core value: to act in the best interest of our residents’ health and well-being. That led us on a journey to get to the root causes of poor health outcomes.

The high costs of leaving school early.
Source: Waterloo Wellington LHIN Community Report 2015-16.


Determinants of health

While the health-care system is an important contributor to overall health, the reality is that it only impacts a person’s overall health by about 25 percent. A person’s biology is another 15 percent. But income, education, employment, housing and community belonging have the biggest impact. 

Take income for example. Research has shown that, overall, in a given population, individuals in the lower income category have an increased risk of engaging in unhealthy behaviours, including a more sedentary lifestyle, lower consumption of fresh fruits and vegetables, and higher rates of smoking. With this come higher rates of chronic diseases and lower rates of adherence to care plans to effectively manage illnesses. Those with lower incomes are also less likely to feel a sense of belonging and connectedness to their community. Overall, they are almost twice as likely to visit an emergency department for mental health and addictions concerns. 

In looking at this data, we must be cautious not to stigmatize. There are individuals in all income groups who have these risks and many in the lower income group who do not. But overall, a higher proportion of risk exists in the low-income population. 

While we have increased funding to help people who get sick – health-care funding in our community alone has increased by more than $300 million in the last nine years – wouldn’t we be better off in the long run to tackle those things that impact what makes you sick in the first place?

Belonging and health 

So, what can we do about this?

Because we have better data, we’re better able to understand why some individuals and some groups have certain health outcomes. A number of factors can be traced to early childhood circumstances, rather than recent events. Factors such as growing up in poverty, having less-than-optimal childhood development, a less-than-optimal sense of community belonging, and limited access to high-quality food and regular meals can play a large role in a person’s health down the road. 

Locally, 11.5 percent of the population lives with low-income. That’s more than 82,000 people. 

The good news is that there are many things communities can do to get upstream and support these individuals to improve their health today and for the future. For example, Ontario’s Chief Medical Officer of Health has indicated that women with low income and educational levels are more likely to have low-birth weight babies. So through effective public health strategies – encouraging healthy eating, breastfeeding and non-smoking – plus good access to primary care, we can better support families before children are even born.

Connecting women with supportive networks and a strong sense of community belonging is also crucial for their mental health in what can be a challenging and stressful time.

The Waterloo Wellington Local Health Integration Network supports a population of almost 800,000.
Source: Waterloo Wellington LHIN Community Report 2015-16.

Next comes early-childhood development – programs through early learning centres, community centres and preschools. Research from the Council for Early Child Development underlines the importance of such programs: Fewer than five percent of children of every socio-economic level are born with clinically detectable limitation in their development but, by school age, vulnerability in developmental health has grown to more than 26 percent. And profound socio-economic inequalities in development emerge.

We know that early education, which leads to higher educational attainment, has been shown to improve the socialization of children and increase health literacy. 

Once children are in school, combating these socio-economic inequalities is vital. Our community foundations, municipalities and community organizations serve a key role through breakfast programs, literacy programs, community sports and more. 

Adding community hubs in schools and community centres – things like drop-in youth programming and subsidized sports and exercise classes – brings youth and families together to build that sense of belonging. It also contributes to an increased likelihood of staying in school, forming better habits around activity levels and healthy eating, and it builds a stronger community – benefiting health, economics and social services.

In high school, innovative initiatives to keep kids in school also make a big difference. Not every student is the same – a one-size-fits-all approach doesn’t always work. Students who live in poverty have greater barriers to graduating and need more flexibility and support. It’s hard to focus on your studies when you’re hungry, or you’re tired because you worked a night shift to help support your family. 

Some young people also struggle with mental health and addictions – issues that cannot be solved by any one sector, program or organization. They require a “whole-of-community” approach. This means mental health and addictions providers, educators, social workers, crime prevention professionals, municipalities, community supports, all need to come together to look at how to keep these kids in school. 

From an education perspective, we know that co-op programs, trades programs, alternative schools, programs such as Pathways to Education, and many others are all supporting young people who might otherwise leave school early. This is important, not just because it’s the right thing to do, but also from an economic perspective. Statistically, those who don’t graduate from high school can cost the Canadian health care system, on average, an additional $211,471 over a lifetime. That’s $10.2 billion in Waterloo Wellington alone. 

While we’re trying to have a greater impact earlier so that 10 and 20 years down the road we have a much healthier population, the reality is that we can’t go back in time. We have a number of residents today who grew up in poverty. Who didn’t graduate high school, had a less-than-optimal childhood, who don’t currently have a strong connection to their community. And they are in crisis. 

That’s why we have supported initiatives like Mobile Crisis Teams, which partner mental health nurses with police services to directly support these residents. We also have Connectivity Tables (see “Proactive Intervention, page 40) that bring front-line professionals from different organizations in policing, education, social services, municipal supports and health together every week to work directly with our most at-risk residents. 

Such initiatives make a huge difference today. They are also making a huge difference tomorrow as family members, especially young children, are connected to vital supports that will address the determinants of health – like belonging. These are models that are being looked at and adopted across the country as a result of innovations in Waterloo Region, Guelph and Wellington and other like-minded communities. 

The quality of your life is linked to your health and wellbeing.
Source: Waterloo Wellington LHIN Community Report 2015-16.


A call to action

Recently, Adrienne Clarkson, former Governor General of Canada, spoke in Waterloo about belonging. She shared her concern for the health of children in Waterloo Region as a result of the latest report on community well-being issued by the Kitchener-Waterloo Community Foundation. 

We, at the Waterloo Wellington LHIN, share that concern. We also share the belief that in order to have a sense of belonging, one must have a sense of ownership. No one person or organization is responsible for the health of our community. We all are.

We are blessed in Waterloo-Wellington. Municipalities, community foundations, crime prevention councils, breakfast programs, early literacy programs, neighbourhood groups, police services, faith groups, chambers of commerce and more all anchor their work in creating a welcoming, warm community where everyone has a better chance at a healthier, more prosperous life. 

We have had many successes over the years through partnership and I have no doubt that by working together we can also improve the sense of belonging and overall health of residents in our community.

Bruce Lauckner is CEO of the Waterloo Wellington Local Health Integration Network.

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