Embedding health equity strategically within built environments.

BACKGROUND: Population health approaches are visible among multidisciplinary methods used in urban design and planning, but attention to health equity is not always an explicit focus. Population and Public Health-Saskatoon Health Region recognized the need for frameworks to prioritize, integrate and measure health equity within local built environments. SETTING: A cross-department healthy built environment (HBE) initiative coordinated activities involving Health Promotion, Environmental Public Health, Public Health Observatory, and Medical Health Officers engaged with municipal, academic and community partners in Saskatoon, Saskatchewan. INTERVENTIONS: The HBE team conducted evidence reviews and consulted with partners to identify common health equity issues in built environments and best and leading practices to address them. The HBE team then prioritized and undertook projects to model a health equity approach. OUTCOMES: Projects included the following: (1) developing a Health Equity in Healthy Built Environment Framework; (2) engaging in a partner campaign highlighting built environment and health equity during a municipal election; (3) producing a Health Equity Impact Assessment (HEIA) report on the City of Saskatoon's growth plan; and (4) developing a monitoring and evaluation framework for health equity outcomes. Other outputs include making new connections between local HBE and poverty reduction efforts and promoting social inclusion guidelines in consultation processes. IMPLICATIONS: Within a population health approach to HBE, an explicit focus on health equity can be a catalyst for engaging partners in cross-sectoral action for building inclusive physical and social environments.

Home care clients in the last year of life: is material deprivation associated with service characteristics?

OBJECTIVES: To compare demographic, social, medical, and health care characteristics of home care clients in the last year of life by quintile of deprivation and examine associations between material deprivation and service characteristics. METHOD: This retrospective study used administrative data for 700 clients who died while receiving home care services. Outcome measures were the receipt of supportive or palliative home care. Associations were assessed using multiple logistic regression. RESULT: Material deprivation was not associated with either the hours of home care received or the receipt of supportive home care services. Clients with dementia or stroke, those were older than 80 years and those who were single were less likely to receive palliative care services than other groups. DISCUSSION: Inequalities in allocation of home care services based on age, diagnosis, and marital status, but not material deprivation, suggest the need to carefully match service with need at the end of life.

Effect of bodychecking on injury rates among minor ice hockey players.

BACKGROUND: In 2002, Hockey Canada changed the age classifications for minor ice hockey. Previously, 10- and 11-year-old children played at the Atom level (no bodychecking), and 12- and 13-year-old children played at the Peewee level (bodychecking allowed). After the policy change, 11-year-old players were placed in the Peewee division with 12-year-old players; the Atom division included 9- and 10-year-old players. The objective of this study was to examine the effect that the policy change had on injuries to 11-year-old players and compare this information with injury trends among 10- and 12-year-old players. METHODS: The study location was the Capital Health region, which serves the greater Edmonton area in Alberta. Capital Health maintains a database of all emergency department visits in the region. A search of the database identified 10-, 11- and 12-year-old players admitted to 7 emergency departments with hockey-related injuries during the 2 years before and the 2 years after the policy change. We also conducted a chart review for the 11-year-old players, extracting detailed information on the nature and circumstances of their injuries for the same period. RESULTS: The rate of injuries sustained by 11-year-old children playing at the Peewee level (with bodychecking) increased significantly compared with the rate among 11-year-old players at the Atom level (rate ratio [RR] 1.9, 95% confidence interval [CI] 1.4-2.4). The rate of severe injuries was more than 2 times greater among 11-year-old Peewee players than among 11-year-old Atom players (RR 2.4, 95% CI 1.6-3.6). Injury rates among the 10-year-old players (bodychecking never allowed) and the 12-year-old players (bodychecking always allowed) changed little over the study period. INTERPRETATION: The introduction of bodychecking to 11-year-old players was associated with a large increase in injury rates. From a public health perspective, the age at which bodychecking is introduced in minor hockey should be raised.