Appendix C: The Chief Public Health Officer's Report on the State of Public Health in Canada 2013 – Definitions and data sources for indicators

Appendix C: Definitions and Data Sources for Indicators

A-Z

– A –

Aboriginal people(s) (2011) ^{Footnote 104}

This is a collective name for the original peoples of North America and their descendants. The Constitution Act (1982) recognizes three groups of Aboriginal peoples–Indians, Inuit and Métis.

Data Source
Table B.1: Statistics Canada. (2013). Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. (Ottawa: Statistics Canada).

First Nations (single identity) (2011) ^{Footnote 104}

A term commonly used beginning in the 1970s to replace Indian. Although the term First Nation is widely used, no legal definition of it exists. Among its uses, the term 'First Nations peoples' refers generally to the Indian peoples in Canada, both Status and Non-Status. Single identity refers to those persons who reported identifying with First Nations identity only.

Data Source
Table B.1: Statistics Canada. (2013). Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. (Ottawa: Statistics Canada).

Inuit (single identity) (2011) ^{Footnote 104}

Inuit are the Aboriginal People of Arctic Canada who live primarily in Nunavut, the Northwest Territories and northern parts of Labrador and Quebec. Single identity refers to those persons who reported identifying with an Inuit identity only.

Data Source
Table B.1: Statistics Canada. (2013). Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. (Ottawa: Statistics Canada).

Métis (single identity) (2011) ^{Footnote 104}

A term which is used broadly to describe people with mixed First Nations and European ancestry who identify themselves as Métis, distinct from Indian people, Inuit or non-Aboriginal people. Single identity refers to those persons who reported identifying with a Métis identity only.

Data Source
Table B.1: Statistics Canada. (2013). Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. (Ottawa: Statistics Canada).

Multiple Aboriginal identity (2011) ^{Footnote 2}

Includes persons who reported more than one Aboriginal identity group.

Data Source
Table B.1: Statistics Canada. (2013). Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. (Ottawa: Statistics Canada).

Other Aboriginal identities (2011) ^{Footnote 2}

Includes persons who reported being Registered Indians and/or band members without reporting an Aboriginal identity.

Data Source
Table B.1: Statistics Canada. (2013). Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. (Ottawa: Statistics Canada).

Alcohol dependence (2002) ^{Footnote 39}

Alcohol dependence is defined as tolerance, withdrawal, loss of control or social or physical problems related to alcohol use. This measure was estimated using the Alcohol Dependence Scale (Short Form Score) based on a subset of items from the Composite International Diagnostic Interview developed by Kessler and Mroczek for those aged 15 years and older.

Data Source
Table B.3: Government of Canada. (2006). The Human Face of Mental Health and Mental Illness in Canada.

Alzheimer's disease and other dementias (2008)Footnote 105

The DSM-III-R criteria were used to classify people as demented or not. Differential diagnoses used the NINCDS-ADRDA and DSM-IV criteria for Alzheimer's disease; the ICD-10 and the NINDS-AIREN criteria were used to define vascular dementia; operational criteria for Lewy body dementia were taken from McKeith et al. (1996). Those without dementia were classified as cognitively impaired but not demented (CIND), or as cognitively normal. Reisberg's Global Deterioration Scale was used for rating cognitive and functional capacity in all diagnoses.

Data Source
Table B.3: Smetanin, P., Kobak, P., Briante, C., Stiff, D. et al. (2009). Rising Tide: The Impact of Dementia in Canada 2008 to 2038. (RiskAnalytica).

Anxiety disorders (2011) ^{Footnote 14, Footnote 39}

Individuals with anxiety disorders experience excessive anxiety, fear or worry, causing them to either avoid situations that might precipitate the anxiety or develop compulsive rituals that lessen the anxiety. This measure was estimated as the population who reported that they have been diagnosed by a health professional as having a phobia, obsessive-compulsive disorder or a panic disorder.

Data Source
Table B.3: Statistics Canada. Canadian Community Health Survey, 2011: Annual [Share Microdata File]. Ottawa, Ontario: Statistics Canada. All computations on these microdata were prepared by the Public Health Agency of Canada and the responsibility for the use and interpretation of these data is entirely that of the author(s).

Arthritis (2011) ^{Footnote 10}

Population who reported having arthritis, including rheumatoid arthritis and osteoarthritis, but excluding fibromyalgia, as diagnosed by a health professional.

Data Source
Table B.3: Statistics Canada. (2012-06-18). Table 105-0501 - Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2011 boundaries) and peer groups, occasional, CANSIM (database) [Data File].

Asthma (2011) ^{Footnote 10}

Population who reported having asthma as diagnosed by a health professional.

Data Source
Table B.3: Statistics Canada. (2012-06-18). Table 105-0501 - Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2011 boundaries) and peer groups, occasional, CANSIM (database) [Data File].

– C –

Cancer incidence (2012) ^{Footnote 22}

Estimated number of new cancer cases diagnosed in a given population during a specific period of time.

Data Source
Table B.3: Canadian Cancer Society's Steering Committee on Cancer Statistics. (2012). Canadian Cancer Statistics 2012. (Toronto: Canadian Cancer Society).

Cancers (2009) ^{Footnote 42}

Deaths associated with malignant cancers (ICD-10 C00-C97).

Data Source Table B.3: Statistics Canada. (2012-05-30). Table 102-0522 - Deaths, by cause, Chapter II: Neoplasms (C00 to D48), age group and sex, Canada, annual (number), CANSIM (database) [Data File] and; Statistics Canada. (2011-09-27). Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted), CANSIM (database) [Data File].

Chlamydia (2010) ^{Footnote 23}

Estimated rate per 100,000 population, where chlamydia (Chlamydia trachomatis) was reported to the Public Health Agency of Canada by provinces and territories.

Data Source
Table B.3: Public Health Agency of Canada. (2012). Report on Sexually Transmitted Infections in Canada: 2010. (Ottawa: Public Health Agency of Canada).

Chronic obstructive pulmonary disease (2011) ^{Footnote 14}

Respondents who reported having chronic obstructive pulmonary disease, chronic bronchitis or emphysema.

Data Source
Table B.3: Statistics Canada. Canadian Community Health Survey, 2011: Annual [Share Microdata File]. Ottawa, Ontario: Statistics Canada. All computations on these microdata were prepared by the Public Health Agency of Canada and the responsibility for the use and interpretation of these data is entirely that of the author(s).

Circulatory diseases (2009) ^{Footnote 43}

Deaths associated with circulatory diseases (ICD-10 I00-I99).

Data Source Table B.3: Statistics Canada. (2012-05-30). Table 102-0529 - Deaths, by cause, Chapter IX: Diseases of the circulatory system (I00 to I99), age group and sex, Canada, annual (number), CANSIM (database) [Data File] and; Statistics Canada. (2011-09-27). Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted), CANSIM (database) [Data File].

Contact with dental professional (2011) ^{Footnote 14}

Persons who have consulted with a dental professional (dentist, dental hygienist or orthodontist) in the past 12 months.

Data Source
Table B.4: Statistics Canada. Canadian Community Health Survey, 2011: Annual [Share Microdata File]. Ottawa, Ontario: Statistics Canada. All computations on these microdata were prepared by the Public Health Agency of Canada and the responsibility for the use and interpretation of these data is entirely that of the author(s).

Core housing need (2006) ^{Footnote 106}

A household is in core housing need if it does not meet one or more of the adequacy, suitability or affordability standards and it would have to spend 30 per cent or more of its before-tax income to pay the median rent (including utility costs) of alternative local market housing that meets all three standards:

Adequate housing does not require any major repairs, according to residents. Major repairs include defective plumbing or electrical wiring, or structural repairs to walls, floors or ceilings.
Suitable housing has enough bedrooms for the size and make-up of resident households according to National Occupancy Standard requirements. Enough bedrooms based on NOS requirements means one bedroom for each cohabiting adult couple; unattached household member 18 years of age and over; same-sex pair of children under age 18; and additional boy or girl in the family, unless there are two opposite sex children under 5 years of age, in which case they are expected to share a bedroom. A household of one individual can occupy a bachelor unit (i.e. a unit with no bedroom).
Affordable housing costs less than 30 per cent of before-tax household income. For renters, shelter costs include rent and any payments for electricity, fuel, water and other municipal services. For owners, shelter costs include mortgage payments (principal and interest), property taxes, and any condominium fees, along with payments for electricity, fuel, water and other municipal services.

Data Source
Table B.4: Canada Mortgage and Housing Corporation. (2009). 2006 Census Housing Series: Issue 3 – The Adequacy, Suitability, and Affordability of Canadian Housing, 1991-2006. (Canada: Canada Mortgage and Housing Corporation).

Current smoker (2011) ^{Footnote 81}

Respondents who have identified themselves as daily smokers and non-daily smokers (also known as occasional smokers).

Data Source
Table B.4: Health Canada. (2012-09-19). Table 1. Smoking status and average number of cigarettes smoked per day, by age group and sex, age 15+ years, Canada 2011 [Data File].

– D –

Diabetes prevalence (2008–2009)Footnote 19

The proportion of individuals that are affected by diabetes at a given point in time.

Data Source
Table B.3: Public Health Agency of Canada. (2011). Diabetes in Canada: Facts and figures from a public health perspective. (Ottawa: Public Health Agency of Canada).

– E –

Engaged in leisure-time physical activity, moderately active or active (2011) ^{Footnote 10}

Population who reported a level of physical activity, based on their responses to questions about the nature, frequency and duration of their participation in leisure-time physical activity. Respondents are classified as active, moderately active or inactive based on an index of average daily physical activity over the past three months. For each leisure-time physical activity engaged in by the respondent, average daily energy expenditure is calculated by multiplying the number of times the activity was performed by the average duration of the activity by the energy cost (kilocalories per kilogram of body weight per hour) of the activity. The index is calculated as the sum of the average daily energy expenditures of all activities. Respondents are classified as follows:

3.0 kcal/kg/day or more = physically active
1.5 to 2.9 kcal/kg/day = moderately active
less than 1.5 kcal/kg/day = inactive

Data Source
Table B.4: Statistics Canada. (2012-06-18). Table 105-0501 - Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2011 boundaries) and peer groups, occasional, CANSIM (database) [Data File].

Exceeds long-term low-risk drinking guidelines (2011) ^{Footnote 82}

Population who consume in excess of 10 drinks a week for women, with more than 2 drinks a day most days; and 15 drinks a week for men, with more than 3 drinks a day most days.

Data Source
Table B.4: Health Canada. (2012-07-03). Canadian Alcohol and Drug Use Monitoring Survey. Summary of Results for 2011.

Exceeds short-term low-risk drinking guidelines (2011) ^{Footnote 82}

Population who consume more than 3 drinks for women and 4 drinks for men on any single occasion.

Data Source
Table B.4: Health Canada. (2012-07-03). Canadian Alcohol and Drug Use Monitoring Survey. Summary of Results for 2011.

– F –

Fine particulate matter concentrations (2010) ^{Footnote 107}

This national PM_2.5 indicator uses the warm seasonal (April 1 to September 30) average of 24-hour daily average concentrations, which is population-weighted to calculate trends and averages across 66 monitoring stations located throughout the country.

Data Source
Table B.4: Environment Canada. (2013-07-12). Ground-Level Ozone and Fine Particulate Matter Air Quality Indicators Data [Data File].

First Nations (2011)

See Aboriginal people(s).

Fruit and vegetable consumption (2011) ^{Footnote 10}

Indicates the usual number of times (frequency) per day a person reported eating fruits and vegetables. Measure does not take into account the amount consumed.

Data Source
Table B.4: Statistics Canada. (2012-06-18). Table 105-0501 - Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2011 boundaries) and peer groups, occasional, CANSIM (database) [Data File].

– G –

Gonorrhea (2010) ^{Footnote 23}

Estimated rate per 100,000 population, where gonorrhea (Neisseria gonorrhoeae) was reported to the Public Health Agency of Canada by provinces and territories.

Data Source
Table B.3: Public Health Agency of Canada. (2012). Report on Sexually Transmitted Infections in Canada: 2010. (Ottawa: Public Health Agency of Canada).

Ground-level ozone concentrations (2010) ^{Footnote 107}

This indicator uses the warm seasonal (April 1 to September 30) average of daily eight-hour maximum average concentrations, which is population-weighted to calculate trends and averages across monitoring stations located throughout the country.

Data Source
Table B.4: Environment Canada. (2013-07-12). Ground-Level Ozone and Fine Particulate Matter Air Quality Indicators Data [Data File].

– H –

Health-adjusted life expectancy (2005-2007) ^{Footnote 12}

An indicator of overall population health that combines measures of both age- and sex-specific health status, and age- and sex-specific mortality into a single statistic. It represents the number of expected years of life equivalent to years lived in full health, based on the average experience in a population. Quebec, Nunavut and Northwest Territories are not represented.

Data Source
Table B.3: Statistics Canada. (2012-05-23). Table 102-0122 - Health-adjusted life expectancy, at birth and at age 65, by sex and income, Canada and provinces occasional (years), CANSIM (database) [Data File].

Heart disease (2011) ^{Footnote 14}

Respondents who reported having heart disease.

Data Source
Table B.3: Statistics Canada. Canadian Community Health Survey, 2011: Annual [Share Microdata File]. Ottawa, Ontario: Statistics Canada. All computations on these microdata were prepared by the Public Health Agency of Canada and the responsibility for the use and interpretation of these data is entirely that of the author(s).

High blood pressure (2011) ^{Footnote 14}

Respondents who reported having high blood pressure or having used blood pressure medication in the past month, excluding those who reported high blood pressure during pregnancy only.

Data Source
Table B.3: Statistics Canada. Canadian Community Health Survey, 2011: Annual [Share Microdata File]. Ottawa, Ontario: Statistics Canada. All computations on these microdata were prepared by the Public Health Agency of Canada and the responsibility for the use and interpretation of these data is entirely that of the author(s).

High school graduates (2012) ^{Footnote 100}

Persons who have received, at minimum, a high school diploma or, in Quebec, completed Secondary V or, in Newfoundland and Labrador, completed fourth year of secondary.

Data Source
Table B.4: Statistics Canada. (2013-01-03). Table 282-0004 - Labour force survey estimates (LFS), by educational attainment, sex and age group, annual (persons unless otherwise noted), CANSIM (database) [Data File].

HIV (2011) ^{Footnote 26}

The number of new HIV diagnoses in the population reported to the Public Health Agency of Canada during a specified time.

Data Source
Table B.3: Public Health Agency of Canada. (2012-11-22). At a Glance - HIV and AIDS in Canada: Surveillance Report to December 31^st, 2011.

Households reporting moderate to severe food insecurity (2011) ^{Footnote 108}

A situation that exists when people lack physical and economic access to sufficient amounts of safe and nutritious food for normal growth and development and an active and healthy life.

Data Source
Table B.4: Statistics Canada. Canadian Community Health Survey, 2011: Annual [Share Microdata File]. Ottawa, Ontario: Statistics Canada. All computations on these microdata were prepared by the Public Health Agency of Canada and the responsibility for the use and interpretation of these data is entirely that of the author(s).

– I –

Illicit drug use in the past year (2011) ^{Footnote 96}

Persons who reported using an illicit drug (cannabis, cocaine, speed, ecstasy, hallucinogens, salvia or heroin) in the 12 months preceding the interview.

Data Source
Table B.4: Health Canada. (2012-08-02). Table 1: Main 2011 CADUMS indicators by sex and by age - Drugs, CADUMS [Data File].

Immigrant (2011) ^{Footnote 3}

Applies to a person who is or has ever been a landed immigrant or permanent resident. This person has been granted the right to permanently live in Canada by immigration authorities. While it usually applies to persons born outside Canada, it may also apply to a small number of persons born inside Canada to parents who are foreign-born.

Data Source
Table B.1: Statistics Canada. (2013). Immigration and Ethnocultural Diversity in Canada. (Ottawa: Statistics Canada).

By birth place (2011) ^{Footnote 109}

Refers to the country of a respondent if born outside Canada. Respondents are to report their place of birth according to international boundaries in effect at the time of enumeration not at the time of birth.

Data Source
Table B.1: Statistics Canada. (2013-07-24). Citizenship, Place of Birth, Immigrant Status and Period of Immigration, Age Groups and Sex for the Population in Private Households of Canada, Provinces, Territories, Census Metropolitan Areas and Census Agglomerations, 2011 National Household Survey [Data File].

By years since immigration (2011) ^{Footnote 110}

Refers to the period in which the immigrant first obtained his or her landed immigrant/permanent resident status.

Data Source
Table B.1: Statistics Canada. (2013-07-24). Citizenship, Place of Birth, Immigrant Status and Period of Immigration, Age Groups and Sex for the Population in Private Households of Canada, Provinces, Territories, Census Metropolitan Areas and Census Agglomerations, 2011 National Household Survey [Data File].

Infant mortality rate (under one year) (2009) ^{Footnote 111}

Infant mortality rate is the number of infant deaths occurring within the first year of life during a given year per 1,000 live births in the same year.

Data Source
Table B.3: Statistics Canada. (2012-05-30). Table 102-0504 - Deaths and mortality rates, by age group and sex, Canada, provinces and territories, annual, CANSIM (database) [Data File].

Infectious syphilis (2010) ^{Footnote 23}

Estimated rate per 100,000 population, where infectious syphilis (including primary, secondary and early latent stages) was reported to the Public Health Agency of Canada by provinces and territories.

Data Source
Table B.3: Public Health Agency of Canada. (2012). Report on Sexually Transmitted Infections in Canada: 2010. (Ottawa: Public Health Agency of Canada).

Inuit (2011)

See Aboriginal people(s).

– L –

Life expectancy at birth (2007-2009) ^{Footnote 9}

Life expectancy is the number of years a person would be expected to live, starting at birth if the age- and sex-specific mortality rates for a given observation period (such as a calendar year) were held constant over his/her life span.

Data Source
Table B.1: Statistics Canada. (2012-05-30). Table 102-0512 - Life expectancy, at birth and at age 65, by sex, Canada, provinces and territories, annual (years), CANSIM (database) [Data File].

– M –

Major depression (2002) ^{Footnote 39, Footnote 112}

Persons who met all criteria for a major depressive episode in the 12 months prior to the interview. A major depressive episode is defined as at least two weeks of depressed mood and/or loss of interest in usual activities accompanied by at least four additional symptoms of depression:

depressed mood most of the day, nearly every day, as indicated by either subjective report (for example, feels sad or empty) or observation made by others (for example, appears tearful);
markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others);
significant weight loss when not dieting, or weight gain (for example, a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day;
insomnia or hypersomnia nearly every day;
psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down);
fatigue or loss of energy nearly every day;
feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick);
diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others); and
recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Data Source
Table B.3: Government of Canada. (2006). The Human Face of Mental Health and Mental Illness in Canada.

Métis (2011)

See Aboriginal people(s).

– O –

Obesity (2009-2011) ^{Footnote 113}

According to Health Canada guidelines, the index for body weight classification for the population aged 18 years and over, excluding pregnant females and persons less than 3 feet (0.914 metres) tall or greater than 6 feet 11 inches (2.108 metres) is: less than 18.50 (underweight); 18.5 to 24.9 (normal weight); 25.0 to 29.9 (overweight); 30.0 to 34.9 (obese, class I); 35.0 to 39.9 (obese, class II); 40.0 or greater (obese, class III). Body mass index (BMI) is calculated by dividing the respondent's body weight (in kilograms) by their height (in metres) squared.

Data Source
Table B.3: Statistics Canada. Canadian Health Measures Survey, 2009: Cycle 1 [Share Microdata File]. Ottawa, Ontario: Statistics Canada. All computations on these microdata were prepared by the Public Health Agency of Canada and the responsibility for the use and interpretation of these data is entirely that of the author(s).

– P –

Perceived health, very good or excellent (2011) ^{Footnote 10}

Population who reported perceiving their own health status as being either excellent or very good. Perceived health refers to the perception of a person's health in general, either by the person himself or herself, or, in the case of a proxy response, by the person responding. Health means not only the absence of disease or injury but also physical, mental and social well-being.

Data Source
Table B.3: Statistics Canada. (2012-06-18). Table 105-0501 - Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2011 boundaries) and peer groups, occasional, CANSIM (database) [Data File].

Perceived mental health, very good or excellent (2011) ^{Footnote 10}

Population who reported perceiving their own mental health status as being either excellent or very good. Perceived mental health refers to the perception of a person's mental health in general. Perceived mental health provides a general indication of the population suffering from some form of mental disease, mental or emotional problems, or distress, not necessarily reflected in perceived health.

Data Source
Table B.3: Statistics Canada. (2012-06-18). Table 105-0501 - Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2011 boundaries) and peer groups, occasional, CANSIM (database) [Data File].

Persons living in low income (after tax) (2010) ^{Footnote 101}

The percentage of Canadian families who are likely to spend 20 percentage points more of their total post-tax income on necessities (food, clothing and footwear, and shelter) when compared to an average family of the same size, in the same broad community size. Low income is based on the consumption patterns for 1992 and adjusted for family size, community sizes and inflation based on the national Consumer Price Index. After-tax income is total income, which includes government transfers, less income tax (see Table C.1).

Data Source
Table B.4: Statistics Canada. (2012-06-15). Table 202-0801 - Low income cut-offs before and after tax by community and family size, 2010 constant dollars, annual (dollars), CANSIM (database) [Data File].

Population (2012) ^{Footnote 5}

Estimated population and population according to the census are both defined as being the number of Canadians whose usual place of residence is in that area, regardless of where they happened to be on Census Day. Also included are any Canadians staying in a dwelling in that area on Census Day and having no usual place of residence elsewhere in Canada, as well as those considered non-permanent residents.

Data Source
Table B.1: Statistics Canada. (2011-09-27). Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted), CANSIM (database) [Data File].

Population centre (2011) ^{Footnote 6}

A population centre has a minimum population concentration of 1,000 persons and a population density of at least 400 persons per square kilometre, based on the current census population count.

Data Source
Table B.1: Statistics Canada. (2013-01-30). Population and dwelling counts, for population centres, 2011 and 2006 censuses [Data File].

Post-secondary graduates (2012) ^{Footnote 100}

Persons who have completed a certificate (including a trade certificate) or diploma from an educational institution beyond the secondary level. This includes certificates from vocational schools, apprenticeship training, community colleges, Collège d'Enseignement Général et Professionnel (CEGEP) and schools of nursing, as well as certificates below a bachelor's degree obtained at a university.

Data Source
Table B.4: Statistics Canada. (2013-01-03). Table 282-0004 - Labour force survey estimates (LFS), by educational attainment, sex and age group, annual (persons unless otherwise noted), CANSIM (database) [Data File].

Potential years of life lost ^{Footnote 62}

Potential years of life lost are the number of years of life lost when a person dies prematurely from any cause - before age 75. A person dying at age 25, for example, has lost 50 years of life.

Premature mortality due to cancers (2009) ^{Footnote 62}

Potential years of life lost for all malignant neoplasms (ICD-10 C00-C97) is the number of years of life lost when a person dies prematurely from any cancer before age 75.