Discussion and Implications

What did the Survey Accomplish?

The Nova Scotia Health Survey 1995 was designed and implemented by Heart Health Nova Scotia in partnership with the Nova Scotia Department of Health. Other important contributors were the World Health Organization MONICA project, the Department of Community Health and Epidemiology, the Department of Psychology, and the Population Health Research Unit at Dalhousie University. Financial support was provided by Health Canada through the National Health Research and Development Program (NHRDP), the Nova Scotia Department of Health and the Heart and Stroke Foundation. The impetus for the survey came from the need to replicate the 1986 Nova Scotia Heart Health Survey, and to examine changes in the population's cardiovascular health. The survey was expanded to include a broader array of health measures including physiological, psychosocial, demographic, and behavioural variables, and in so doing became the first of its kind in Nova Scotia. The results have implications for maintaining and improving the health of Nova Scotians through comprehensive, integrated strategies and information systems designed to monitor those strategies. The NSHS95 had two goals: the first was to provide specific information that describes the health of Nova Scotians; the second was to replicate key elements of the 1986 Nova Scotia Heart Health Survey to estimate changes in risks for heart disease over the past ten years. These two goals were more clearly defined by the following objectives: 1) to estimate the prevalence of major health indicators and determinants of health; 2) to track population changes in these health indicators; 3) to provide health data for provincial and regional planning; and 4) to enable health regions to gain experience in population health research methods.

Prevalence data on a range of health indicators and determinants were collected and analysed. These data provide a comprehensive picture of the health of adult Nova Scotians that will be available to all Nova Scotians interested in managing and improving the health10 of the population. Scientific validity was ensured in the NSHS95 through a scientific review process. An expert panel of scientists reviewed the methods and the results of the survey and noted that "the methods were scientifically sound and they were implemented effectively. The findings are of great value and importance to the province, the country and the scientific community" (Report of the Scientific Review Panel for the 1995 Nova Scotia Health Survey, 1996). Excellent data on health status is now available for health planning in Nova Scotia, and we have a very clear picture of the changes that have occurred with respect to major risk factors for cardiovascular disease.

The survey results provide an excellent base from which to strengthen many public health policies and programs in Nova Scotia. These results aid in the identification and selection of priority health issues on a provincial, and ultimately, regional level. Based on these very important issues, relevant health indicators can be selected and monitored. The provincial government has identified several targets for healthier families and communities (Department of Finance, 1995) and the NSHS95 provides a timely contribution to the ongoing measurement of progress toward some of these targets. While the data presented in this highlights report allow analysis and decision-making on the provincial level, it is recognized that small area analysis needs to occur on specific data sets to assist Regional Health Boards in future planning.

The planning and implementation of this survey demonstrated a collaborative approach to health research. The collective effort of the partner groups achieved a product that will serve a large community of health professionals and public groups who are investing in the improvement of health for Nova Scotians. In the process of implementation, capacity to oversee and conduct research was enhanced within the Public Health Services system. The work of the public health nurses who collected and managed the data typifies the capacity that is being transferred to local levels; the ability to gather information and understand the role of research to monitor and maintain health.

Survey Implications

The NSHS95 provides a clear picture of progress toward improved health for some indicators and identifies areas where considerable individual and collective effort is still needed.

Although cardiovascular disease continues to be a key public health concern and is still the major cause of death in the province, progress has been made in some areas since 1986. There have been modest reductions in the prevalence of high blood pressure and elevated blood cholesterol. Smoking rates have declined considerably in younger age groups. The impact of these reductions on the incidence of CVD is likely to be quite significant. Since CVD is the cause of several hundred thousand hospital days per year in Nova Scotia, the impact of risk factor reduction on health care costs could be substantial if these trends continue (Nova Scotia Department of Health, 1996).

However, the survey results clearly show that the population has a number of health habits and lifestyle factors which contribute to ill health and disability. Too many Nova Scotians smoke, are overweight, are inactive, and have high levels of risk factors that promote the development of chronic diseases like CVD, cancer, diabetes, and chronic lung disease. In fact, 70% of Nova Scotians have one or more of the major risk factors for heart disease. The results show average weight (BMI) increased from 1986, and the percentage of the population classified as obese increased substantially. This increase is worrisome, and appears to be part of a societal trend which has been observed in other countries. Data on a number of current disease prevention programs such as cervical cancer screening, breast examinations, flu immunizations indicate that measures must be taken to enhance these practices in order to reach desired targets and appropriate populations. Another concern is the percentage of Nova Scotians, particularly young women, who are exhibiting symptoms of depression.

There is much that Nova Scotians can do individually and collectively to change this situation. Individuals can make personal choices, such as exercising on a regular basis, eating a healthy diet, choosing lower-fat foods more often, and smoking cessation to improve their health status. These choices need to be supported by comprehensive strategies to increase awareness, motivation and skills in targeted segments of the population. These strategies should be designed to help people increase control over their health and the conditions which determine their health. In addition, environments that are supportive of health will need to be developed. Governments at all levels have a responsibility to develop and support policies that make healthy choices the easier choices for Nova Scotians. Particular emphasis needs to be given to prevention and promotion programs that will ultimately change the broader environments which influence the health practices of the population. The level of risk currently existing in the adult population will only be improved in future generations if more emphasis is placed on the health needs of children and youth. Environments, policies, and programs which support positive health behaviours of this population are required.

Future Directions

A concerted effort by all Nova Scotians is needed to reduce the prevalence of illness and disability in the province. Clearly the problems identified in the survey require that individuals, communities, and a wide range of partners, such as non government organizations, the academic community, health professional groups, governments, and the private sector, be involved in an integrated and intersectorial approach to health promotion. Nova Scotia has experience in the implementation of a collaborative approach to health through Heart Health Nova Scotia. Jointly funded by the Nova Scotia Department of Health and Health Canada (NHRDP), this research project has demonstrated the feasibility and success of this approach. The Scientific Review panel acknowledged the value of this demonstration research project as a model for Nova Scotia and the larger research community.

This survey provides a wealth of data that can serve as a benchmark for future comparisons. As such, it should be viewed as the beginning of a future research and planning agenda. During the Scientific Review of the survey data the Canadian Cancer Society, the Heart and Stroke Foundation of Nova Scotia, Canadian Mental Health Association, and Smoke Free Nova Scotia pointed to key areas for program planning, policy development, and future research. These organizations and others will be significant partners and an integral part of Nova Scotia's health system as the current health challenges are addressed. This report presents key results, but there is much to be learned from the data that remains to be analysed. Beyond the current report and ongoing data analyses, research is needed on how to implement, in a sustainable way, community approaches to health promotion and disease prevention. This includes the development of information systems that will support monitoring and evaluation of community interventions.

Finally, these survey results are one source of information that can help Nova Scotians understand their health status. These findings will augment other data collection activities of government, academia, public, and private organizations and will support evidence-based decision making at all levels. A future challenge is the integration of existing sources of information for the purpose of effectively planning and developing policies, programs, and supportive environments to improve the health status of all Nova Scotians.

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