Canada Health Survey should provide
useful information if carefully used
DAVID WOODS
What if somebody did a survey of Ca- partment of National Health and Wel- vey was conducted over a 12-month
nadians' health status? Not one of those fare concerning itself mainly with the period.
empirical things where we're told we're "whats" of the survey, and Statistics As Thomas Stephens, PhD, director
too fat, or pop too many pills, or where Canada with the "hows". of the new survey's content and anal-
that infuriating 60-year-old Swede Decisions about content of the survey ysis division, puts it: "A fundamental
who's fitter than a 30-year-old Cana- have come about through consultation theme of (CHS) planning has been to
dian is again trotted out for our ad- with health officials, and the topics are focus on collecting useful information
miration, but a really hard, statistical wide-ranging and relevant. So far as and in making it available to users."
analysis of the nation's health. method is concerned, the idea is to con- Not that Stephens dismisses the par-
Well, it's under way. duct 40 000 interviews each year "pro- ent survey.
Operating out of appropriately Spar- portional to the square root of provin- "The CSS," he says, "had credibility
tan quarters in the Ottawa suburbs cial populations." and usefulness ... people still quote
is something called Canada Health Sur- their findings.
vey, Enqu&e Sante Canada. A joint Peterborough trial But what's become clear since those
venture of the Department of National findings were made available, he be-
Health and Welfare, which funds it to A trial run of the survey was con- lieves, and even more so since publica-
the tune of $700 000 a year and of ducted last July and August in Peter- tion of federal Health and Welfare Min-
Statistics Canada which (presumably borough Ont, that "average", "typical" ister Marc Lalonde's "A New Perspec-
preferring to deal in even rounder num- Canadian city which has become a tive on the Health of Canadians", is
bers) contributes $1 million, CHS is mecca for market testers and whose that there's a crying need for hard data
already analysing the results of a pre- citizens must surely have yielded up about health; that's one reason why the
test of health status conducted in Peter- more of their facts and fancies to anal- CHS will be interviewing people in
borough last year. ytical scrutiny than any others any- their own homes rather than simply
By next year, a huge sampling will where in the world. flipping through medicare records.
have been undertaken of the national In any event, the response rate of Such records, says Stephens, obvious-
population's health status, and the re- 86% from 262 households in the CHS
pretest was creditable and provided the ly show only those people who have
sults should have considerable impact actively sought out medical care. The
on future health care planning and surveyors with helpful insights. Next CHS, he says, will be measuring such
delivery. month another stage of the survey, in- hard-to-define factors as fitness and
volving 744 households in three prov-
inces, will begin. psychological wellbeing; moreover, he
Better data The last time a comparable national points out, the continuous nature of the
How did this seemingly ambitious project was undertaken was the Cana- new survey will allow for comparisons
project come about? dian Sickness Survey in 1951. The very over time: are we as a nation getting
The reasons put forward in a CHS name of this new venture - Canada healthier or less healthy?
overview appear compelling enough: Health Survey - indicates its differ- Naturally, the 35 people from a vari-
"Response to widespread demands for ence in approach and emphasis. ety of disciplines who make up the
better data on health status, especially While the 1951 survey looked at ill CHS working team would hope that the
on self-limiting and self-treated condi- health, disease care patterns, and ex- information they collect will translate
tions and their consequences. Health penditures (well before the advent of eventually into improved health for
status data now available have been universal medicare in Canada) on hos- Canadians - although they are not
termed inadequate in coverage and con- pital and other health services, the CHS noticeably evangelic about the work
tent as existing methods have tended will examine both positive and nega- they're doing.
to focus on collecting data on treated tive aspects of health. The Canada But if they are able to uncover
problems rather than untreated mor- Health Survey will, for example, con- worthwhile information about the vari-
bidity, positive health parameters or cern itself with risk factors, with health ous kinds of health risks, and about
risk exposure among the population at status of well people and with patterns how those risk factors are distributed
large... of use of the health care system. throughout the population, appropriate
Development work began in Novem- Further, the CHS will be a continu- preventive measures should be initiated
ber 1975 with, appropriately, the De- ous, open-ended project; the CSS sur- not only by individuals, but by com-
1302 CMA JOURNAL/JUNE 4, 1977/VOL. 116
munities, provinces and perhaps na- to changing informational needs, to Peterborough, where the CMA saw to
tionally. add and subtract information and to it that the local medical profession was
Returning to the trial run in Peter- survey subsections of the main ques- briefed about what was going on there."
borough, Tom Stephens says that this tionnaire, providing details on, say, Before cooperating with the CHS,
was really an attempt to get the ma- cardiovascular risk. the CMA understandably wanted to
chinery of the survey in working order. Eventually, says statistician and sur- satisfy itself about certain questions.
For this reason, the 262 households vey manager John Coombs, CHS will The association invited survey person-
were surveyed only for their occupants' conduct surveys in 1000 households a nel to make a presentation to its Coun-
physical condition and fitness readings month. Each will be in two phases: an cil on Community Health. Was this
and to iron out the whole business of interviewer-administered questionnaire just another government make-work
statistical validity. The more sophisti- on health matters and a self-adminis- project? How would the collected in-
cated testing involving lifestyle and tered one on lifestyle and behaviour formation be applied and who would
mental health data will be brought into patterns. At the second interview a have access to it? Then concern was ex-
the next phase of the survey beginning surveyor will collect the self-admin- pressed about how truthful the answers
this summer. istered questionnaire and, if it is from would be to such survey questions as
So the Peterborough survey, con- a designated household, conduct the "how much alcohol do you drink?"
ducted by local nurses, was mainly a various physical tests called for. While the CMA agreed that the
trial of survey procedures; even so, You might ask what all of this has Peterborough trial was a success in
the information gleaned about height to do with the practising physician; terms of response, the association has
and mass and blood pressure will have after all, if the survey points up that a residue of concern, says Dr. Bennett,
some relevance. we are indeed an overfed, overweight, about the use the data will be put to.
Relevance, Stephens emphasizes, is overmedicated, underexercised people, He hastens to point out that this stems
what the CHS is all about. While noting so what? Just having that information not from a feeling that there are Or-
that "we're just the people who collect (and we have it right now) is not going wellian Big Brother motives behind it
the information" he says that none the to change anything. all, but that there may be misuse of
less there is continuing contact with Tom Stephens says that MDs will the data or misinterpretation or over-
the health system planners ... getting become consumers of the CHS output. reaction to some of the findings.
them to say what they need to know They will be able to place the individual Asked if anything new is likely to
in order to do a better job. patient into an age/occupation/risk ca- emerge from the CHS, Bennett says,
With the lifestyle data for instance, tegory, to compare that patient's choles- "Who knows at this stage? But if any
it is going to be possible to find out terol level, say, with national levels and thing comes out it will be to show
not only who smokes, but what they to engage in preventive medicine by people they are unhealthy (as opposed
smoke and whether or not they in- education and motivation. to sick)."
hale; with medications, are they being Since each individual surveyed will He agrees with Tom Stephens that
taken independently or on a physician's get a readout of his own health status survey data will help the physician in
advice; who bothers to get his blood he will be able to go to his physician his educational work with patients and
pressure checked voluntarily? The data to take appropriate therapeutic or pre- give him some hard facts to work with.
that finally emerge will provide a geo- ventive action. "A massive annual "The MD," says Dr. Bennett, "will be
graphic, demographic breakdown for checkup for certain broad parameters on firmer ground in showing patients
study and for action. The "whos" and of health," is the way Stephens de- they will benefit from a change in life-
the "wheres" will be added to the scribes it. style, that inhaling clean air is better
"whats" and "hows" as it is discovered Dr. John Bennett, director of scienti- than breathing smoke-filled air or that
whether lifestyle patterns predominate fic councils for the CMA, says organ- cross-country skiing is preferable to
in men or women, rich or poor, Al- ized medicine's involvement in the CHS slumping in front of a television set."
bertans or Ontarians. began 2 years ago when the survey Dr. Bennett concludes that, with the
The Peterborough survey did not say people invited the association to nom- provinces being forced to pick up the
much about people's willingness to em- inate a medical adviser. The CMA health care tab, new ways will have to
bark on healthier lifestyles, but it spoke named Dr. Jack Kilgour, medical di- be found to reduce costs by focusing
volumes about wholehearted acceptance rector for the Metropolitan Life com- on preventive medicine.
of, and cooperation in, surveys of this pany. Despite its modest budget and its
kind; unless, of course, the burgers of "We at the CMA," says Bennett, modest offices, the Canada Health Sur-
Peterborough have given up all re- "gave our blessing to the CHS project, vey could very well achieve that far-
sistance to repeated enquiries about and Kilgour sat down wih the survey from-modest goal. And help us to
their various proclivities. In any event, people to help develop a protocol. He reach the healthy status of that 60-year-
only 5% of those asked actually re- also had a hand in the trial run at old Swede in the process.E
fused to take part. The remaining 13%
of nonrespondents were simply un-
available for questioning. CCHA REPORT they are to gain accreditation for 3
If the response rate is as strong na- continued from page 1300 years."
tionally, the CHS computers will in- The CCHA in 1976 conducted its
deed be able to produce what Stephens Kellogg Foundation, was completed first surveys of an ambulatory care
calls "quality information" not only to by the CCHA in 1976. centre for emotionally disturbed chil-
the people surveyed, but to health "This project has already had a ma- dren and of alcohol treatment centres.
workers, health planners and health jor impact on the health field in Cana- Also the largest surveyors' confer-
researchers; the latter, particularly, may dian hospitals," states the report. "Ef- ence ever was held in March, 1976.
be about to be offered a goldmine of fective for all surveys of general hos- The report explains the increased cost
statistical data to work with. pitals commencing in January, 1977, of conducting an improved surveyors'
Another virtue claimed for the CHS standards have been revised to require conference is included in the 1977 bud-
is its flexibility: if the survey continues that hospitals be able to show proof get and is one factor in the necessary
indefinitely - as present plans call that they have a well-structured system increases in fees to hospitals and mem-
for -it will be possible to tailor it of continuing patient care appraisal if ber associations. U
CMA JOURNAL/JUNE 4, 1977/VOL. 116 1303