Academic journal article Canadian Journal of Public Health

Defining Needs-Based Urban Health Planning Areas Is Feasible and Desirable: A Population-Based Approach in Toronto, Ontario

Academic journal article Canadian Journal of Public Health

Defining Needs-Based Urban Health Planning Areas Is Feasible and Desirable: A Population-Based Approach in Toronto, Ontario

Article excerpt

ABSTRACT

Reporting health data for large urban areas presents numerous challenges. In the case of Toronto, Ontario, amalgamation in 1998 merged six census subdivisions into one mega-city, resulting in the disappearance of standard reporting units. A population-based approach was used to define new health planning areas. Census tracts were used as building blocks and combined according to residential income homogeneity, respecting natural and man-made boundaries, forward sortation areas and the City of Toronto's community neighbourhoods whenever possible. Correlations and maps were used to establish area boundaries. The city was divided into 5 major planning areas which were further subdivided creating 15 minor areas. Both major and minor areas showed significant differences in population characteristics, health status and health service utilization. This commentary demonstrates the feasibility and describes the outcomes of one method for establishing planning and reporting areas in large urban centres. Next steps include the further generation of health data for these areas, comparisons with other Canadian urban areas, and application of these methods to recently announced Ontario Local Health Integration Networks. These areas can be used for planning and evaluating health service delivery, comparison with other Canadian urban areas and ongoing monitoring of and advocacy for equity in health.

MeSH terms: Socioeconomic factors; urban population; health planning

Reporting of health-related information in urban areas tends to follow administrative or political boundaries that may not correspond well with the population characteristics that are important for health. When these boundaries include heterogeneous areas, important differences in population characteristics, health risks, health needs, health care utilization and health outcomes may be obscured.1 A few Canadian urban areas have established internal boundaries that correspond to some extent with health needs,2,3 but this is not the case for most cities.

Canada's largest city, Toronto, Ontario, lost its major internal political divisions, including its census subdivisions, with amalgamation of its six component cities in 1998. With a population of 2.5 million people (8% of Canada's total population), it became one large reporting unit in national surveys and in the Canadian census. Toronto health and social service agencies currently use a large number of different boundaries, but few of them correspond with the population characteristics that determine health needs.

Toronto's population is highly diverse in socio-demographic characteristics and cultural backgrounds. Significant disparities in health status and utilization of health services are apparent.4,5 Given its large size, high diversity, and lack of consistent and appropriate internal boundaries, there was a need for defining comprehensive units in Toronto that would facilitate the understanding of area differences in population health status and present a consistent way of reporting health information as well as planning and delivering health services. The purpose of this commentary is to demonstrate the feasibility and describe the outcomes of one method for establishing planning and reporting areas in a large urban centre. These new planning areas were not meant to rationalize health service areas or to define and replace catchment areas for health service agencies.

Iterative process

Several steps were used in developing the new health planning areas, including: deciding on population versus service-based approaches; identifying socio-demographic characteristics(s) that most relate to health needs; deciding whether planning areas should be contiguous or composed of scattered units across the city; selecting an appropriate building block that could be aggregated into new areas; using area characteristics to establish boundaries; and evaluating the new areas by examining area variation in socio-demographic characteristics and health indicators and holding community consultations with relevant stakeholders. …

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