Priorities.
All of the network priorities are interrelated and overlap. For example, when we look at root causes of housing insecurity and seniors wellness we see poverty as a major contributor. Rather than being seen separately the priorities need to be seen as a whole affecting the health of people in the Comox Valley. Our overarching goal is to support actions that focus on shifting root causes of issues and are preventative in nature.
The following is a short description of each priority that includes what people at the March 2018 Network Forum told us as well as what people in the 2018 Vital Signs Survey told us. Some local data has been included that informs our goals and actions.
Housing
People at the March 2018 Network Forum identified the need for affordable housing for multiple age groups and situations. They stated barriers such as supply of affordable housing, zoning restrictions, stigma and lack of understanding of the housing crisis needed to be addressed through collaboration. The top priority related to housing in the Comox Valley Vital Signs Report (2018) was to increase efforts to reduce homelessness, followed by the priority to create more subsidized housing units (1). Rental housing is “affordable” when rent and utility fees are 30% or less than a household’s pre-tax income. 2016 census data showed that 45.4% of renter households in the Comox Valley spend 30% or more of their income on housing and 20% of renter households spend 50% or more of their income on housing (1). The 2018 Point in Time count done by the Comox Valley Coalition to End Homelessness found that a minimum of 117 people experienced homelessness in the Comox Valley(2).
To increase affordable housing across the continuum of housing the Network has formed a relationship with the Comox Valley Coalition to End Homelessness to support them as they take action to address housing affordability in the Comox Valley.
Children, Youth & Families
People at the March 2018 Network Forum told us that the early years is where we build our foundation. Addressing all the determinants of health contributes to the health of children, youth and families. Collecting data over multiple years allows for an improved understanding of children’s development. The latest data shows that 40% of Comox Valley children entering kindergarten are vulnerable on one or more of the five Early Development Instrument (EDI) scale. This has increased gradually from 34% between 2004-2007 to 40% between 2013-2016 (1). In addition, availability of quality child care is almost non-existent in the Comox Valley with most child care providers having long wait lists.
The Network has partnered with the Comox Valley Early Years Collaborative to reduce childhood vulnerability, as measured by the EDI, to 25% by the year 2025 (3) and address child care planning. The Early Years Collaborative and the Network is participating in a Regional District wide initiative to assess the need for child care and plan new child care spaces with the goal of applying for funds to increase quality child care availability.
For a visual snapshot of families in the Comox Valley, check out this document from the Social Planning and Resource Council of BC.
Mental Health & Wellness
People at the March 2018 Network Forum told us that one of the major barriers to mental health and wellness was the lack of collaboration and coordination of services and that people did not know how to get support for their mental health. They told us to use a trauma-informed holistic approach to action and to include people with lived experience in planning solutions. The most common chronic health conditions experienced by people over the age of 12 in the Comox Valley are Mood and Anxiety Disorders at 29.9% of the population, higher than the BC rate at 26.7% and Depression at 25.5% of the population, higher than the BC rate of 21.9%. (1)
The majority of youth (grades 7-12) on the North Island report having good or excellent mental health. However, there is a gender inequality with females reporting higher levels of poor or frail mental health (21% versus 13%) and more females than males reported having a mental health condition (26% versus 20%). Youth most commonly reported the following mental health issues: Depression, Anxiety Disorder, Attention Deficit Disorder, and/or addiction to alcohol and/or drugs (1).
In the Comox Valley alcohol-related deaths were 30 people per 100,000, higher than the provincial rate of 26 people per 100,000 in BC. Illicit drug overdose deaths in the Comox Valley went from 7.5 people per 100,000 to 24.2 people per 100,000 in 2017, only slightly lower than BC rates. (1)
Healthy Environment
Ensuring environmental sustainability is essential for human health and well-being. We all require access to clean air, and drinking water, healthy foods and ecosystems in order to survive and to enjoy a high quality of life. The top priorities related to environment and sustainability identified by the community in the CV Vital Signs Report (2018) are:
o Improved health and protection of local rivers, streams and lakes
o Improved air quality
o Limited deforestation
o Options for alternate energy (1).
High air pollution from wood burning is associated with an increased risk of heart attack in people over 65 years of age. During cold season when residential wood burning is at its highest the risk of heart attack in Comox Valley residents over 65 increases by 19% (1).
In Canada, 200 plastic bags are used for every one of us annually (5). In the Comox Valley, that equals 132 tonnes of plastic each year that never goes away. Plastic bags are now one of the biggest threats to the marine environment and remain toxic as microplastics even after they have broken down. In a recent study, the Coastal Ocean Research Institute (2018) found up to 3,200 particles of microplastics per cubic meter of water in the Straight of Georgia.
Youth Environmental Action in the Comox Valley is advocating to local government to declare a state of climate emergency as many governments across the world have. Nurses (CV Nurses for Health and the Environment and CV Nurses and Nurse Practitioners of BC) are advocating for improved air quality, reduction of plastics in our oceans and waterways and increasing the use of electric vehicles. Delegations have been presented to all municipalities and the Regional District to request a plastic bag ban; most local governments are in support
Seniors Wellness
People at the March 2018 Network Forum identified lack of affordable housing, transportation, social isolation and ageism as barriers to senior’s health. They also told us to listen to the stories from seniors and to create opportunities for meaningful participation so solutions are planned by seniors themselves!
The 2018 Vital Signs Report tells us that 34% of people in the Comox Valley are over 60 and the median age of the Comox Valley population is 50.8 years (1). The projected increase of people over 65 from 2018-2038 is 35.5% (1). The greatest increase is in people 75 and above and is expected to double between 2017 and 2037 (4).
12.3% of seniors in the Comox Valley are considered to be low income, which is higher than the percentage across Island Health (iv). There are large differences by geographic region: Cumberland had the highest seniors poverty rate at 15.8% and Comox has the lowest at 6%. 29% of the 117 people identified as homeless in 2018 Point in Time Count (2) were seniors (over 55) up significantly from 2016.
Although not specifically seniors, in 2016 approximately 42% of Comox Valley residents had an activity limitation, which is much higher than BC rates. In 2018 there were 37,693 Handy Dart trips in the Comox Valley, an increase of almost 5% since 2016. (1)
Poverty Reduction
People at the March 2108 Network Forum told us that poverty was a major contributor to many of the other identified priorities. Employment and income have a direct impact on the health and well-being of individuals and communities. The top priorities in the Vital Signs Report related to the gap between the “rich and the poor” were more affordable housing, supports to transition from poverty to workforce, and more job creation initiatives. The overall poverty rate in the Comox Valley is 15.6 % but there are significant differences between local communities.
The poverty rate by community is:
Hornby Island (28.3%)
Denman Island (24.2%)
Union Bay (19.2%)
Cumberland (17.8%)
Courtenay (17.1%)
Fanny Bay (16.6%)
Black Creek (13.9%)
Royston (12.4%)
Comox (11.6%) (i)
21% of households in the Comox Valley are lone parent families (4). The Comox Valley child (age 0-17) poverty rate in a lone parent family is 55% (1). Lone parent family median income in 2016 census was $43,800 lower than the BC or Island Health median income and significantly lower than 2 parent families in Comox Valley (4). The highest rates of child poverty are on Denman (55.2%) and Hornby (42.7%) (1).
The 2019 living wage for Comox Valley is $15.28 per hour, down 8% from $16.59 in 2018. Living wage refers to basic costs for a family of two parents and two children, ages four and seven. This reduction is a result of the Province of BC’s recent investments in child care. Otherwise, the living wage would have increased to $20.75 per hour in 2019. Given the poverty rate in lone parent families and seniors this living wage needs to be applied to the context of two parent families only. (9)
One of the top priorities related to food security in the 2018 Vital Signs Report was more affordable healthy food choices (1). The monthly “Food Basket” cost for the North Island Health Service Delivery Area is $985, higher than the BC cost of $974 (1). Rising food costs have the biggest impact on those who earn low wages. Food insecurity affects physical, social, mental health and overall well-being. In 2018 it cost an average $1043/month to feed a family of 4, up $78 since 2015. There has been a 6% increase in cost of vegetables in 2019. (7, 8)