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Community Health and Wellness Group, Fort Erie, Ontario

I Introduction

As in the rest of Ontario, in recent years the healthcare system has been a key issue for Fort Erie's residents. Early in 2002, this concern became a catalyst for community action when the town's entire healthcare system was threatened. The result? In a short period of time, Fort Erie has become one of the most progressive lower-tier municipalities in the province with respect to exploring their own health and wellness. Through the Community Health and Wellness Group Fort Erie, validated social science has been infused into town policy and culture. The 100-member volunteer group is studying and working to improve the town's health and wellness.

II Fort Erie Is Unique

From a health perspective, Fort Erie is unique in many ways:

* 26% of Fort Erie's population has an income lower than $20,000/year.

* The town is saturated with single and semi-detached (low density) units but has too few medium and high-density units.

* Fort Erie has a large number of seasonal homes, 81% of which are owned by Americans.

* The community is Canada's largest source of refugee claimants (7,000 to 8,000 per year). A significant number of these refugees stay in the town.

* Fort Erie has 660 self-identified, off-reserve Aboriginal people who have specific health and wellness needs.

* Geographically, the town is concentrated around five distinct and separate neighbourhoods.

* The town has the largest percentage of woodlot cover of any municipality in the Golden Horseshoe.

* The town has solid historical, tourist and cultural facilities.

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III A Unique Source of Funding

Through an arrangement with the Alcohol and Gaming Commission of Ontario, the town oversees a substantial portion of the revenues generated through the town's bingo and gaming facilities. These funds are allocated to a variety of local social service agencies. Although the provincial government provides guidelines about how the funds may be used, the town has considerable ability to allocate them based on community needs.

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IV The Group's History

Fort Erie's primary health care infrastructure needed a lifeline. For more than a year, only eight physicians served the community of 29,000. For the last five years, there have been no local physicians available for new residents. Most have been forced to retain their out-of-town physicians, use the emergency department of the local hospital, or visit drop-in clinics located twenty miles away in Niagara Falls.

While the town's hospital, Douglas Memorial Hospital, does not intentionally provide primary health care services, last year the emergency room had nearly 2,000 non-urgent visits (11% of total visits). One month, visits to the emergency department increased by 300 patients, after a local physicians' practice was restricted due to an Ontario College of Physicians investigation.

The town began taking steps to improve access to primary care several years ago through the creation of a committee to recruit physicians. However, the need for strong community action became obvious early in 2002, when the Niagara Health System (NHS), the organization that oversees hospital operations in Niagara, considered closing or reducing services of the hospital.

After presenting signatures from more than 10,000 residents to the NHS, Fort Erie's mayor, Wayne Redekop, and the town council struck a second citizens' committee to provide leadership and action in community health. They integrated this with the physician committee group and allocated $100,000 for making community health a reality.

At the same time, the town reviewed a proposal from the chair of the Community Health and Wellness Group to create a volunteer group to help understand and describe the community's needs around health and wellness. The plan, based on the precede/proceed model, was accepted.

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V Getting Started

During the summer of 2002, two public consultations designed to gather input about community health and wellness showed the extent of the community's support, when more than 150 residents turned out.

The volunteer group, consisting of community leaders, councillors and health experts, formed sub-committees around eight determinants of health including access to healthcare, education and literacy, the environment, housing, health of older adults, health of youth, family and child health and mental health. Each sub-group was charged with creating a picture of the town's health with respect to their specific determinant. The team members helped with finding and localizing existing research and providing insight into the town's needs.

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VI Notable Support

The group has received positive feedback, both from within the region and across Canada:

* In November 2002, Maude Barlow, volunteer chairperson of the Council of Canadians, met with the group to discuss the initiative. Ms. Barlow made a special stop in Fort Erie, outside of her official schedule, while raising awareness about the perils of for-profit health care. She heard about the group's innovative approach and the town's effort to infuse health and wellness into the official plan through community engagement. She told the crowd of seventy-five people, "What you are doing here is the future of healthcare. You are doing what citizens are supposed to do."

* Canadian environmentalist Dr. David Suzuki has also followed the work of the Community Health and Wellness Group. About the project, he has stated, "I strongly believe the future of the environmental movement will be in communities like Fort Erie. That is where the action is going to take place and I commend your community for getting involved".

* Other noted supporters of the project include Dr. Trevor Hancock and Jane Jacobs. The Regional Niagara Public Health Department has also been very positive towards the initiative.

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VII Next Steps

Social Capital Survey and Comprehensive Health Study: The group is currently partnering with Brock University to study more than 350 Fort Erie households to better understand the town's social capital around health and wellness. This will be followed by outreach, where all citizens will be invited to provide their insight and opinions.

Community Consultation and Presentation of Recommendations: In the spring of 2003, a final report with recommendations will be presented at a community forum to seek input and assistance in prioritizing. These findings will be provided to council. Council will use the information to infuse health and wellness into the town's official plan.

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VIII Results

While quantitative data are being compiled and strategies to augment the official plan are under development, there have already been some significant successes:

* Cooperation and Partnerships: Some residents feel that gaming funds are both an opportunity and a challenge. The challenge is that they may create dependence by local agencies on municipal funding instead of regional, provincial or federal funding that sustains similar programs in other towns. A related concern is that local organizations have not been motivated to build relationships with regional or provincial partners to the extent that groups in other municipalities have. This issue is outside the scope of the group's existing mandate, however stakeholders have identified the project as an effective approach in beginning to address these issues.

* Creating Positive Public Opinion: One of the key successes in the first phase of the project has been changing public opinion about health and wellness. This has occurred through the development of relationships with local newspaper editors and reporters, elected officials, town staff and community leaders. They have helped to shape thinking and generate dialogue around the concept of multiple determinants of health and social capital. Numerous articles and letters to the editors in local daily papers are injecting these concepts into the community.

* Changing Public Policy: Community Health and Wellness Fort Erie has helped convince Mayor Redekop and the town council about the power that public policy can have in creating community health. These individuals have been extremely supportive and visionary and are key participants in sub-committees.

* A Vehicle For Community Action: During her visit, Maude Barlow commented that Fort Erie is an example of intentional citizenship. According to Ms. Barlow, intentional citizenship -- taking action when faced with a challenge or adversity -- is one of the responsibilities of a democratic society. One of the dominant feelings of this group is empowerment. Volunteers are fighting to make the community healthier using science (e.g., the Early Years Study) to create viable solutions. The group has found that sustained action in the community must be based on enhancing people's quality of life.

* A Move From Economic To Human Development: This project has helped build an understanding about the relationship between health and public policy. Fort Erie now understands the need to move from an economic focus to a human development focus. Society has generally considered economic performance the most important indicator of a community's progress. However, in recent years, some have realized that economic performance alone is not always beneficial. Working with a community to enhance its social capital enhances social prosperity and creates sustainable economic activity while preserving ecological, social and human capital.

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IX Summary

Through a committed volunteer base forming Community Health and Wellness Fort Erie, the town has become the province's first lower-tier municipality with a mandate to influence its own determinants of health. Through its unique approach in harnessing its own social "fabric," Fort Erie hopes to realize a measurable positive effect in the community's health. Using its own infrastructure to devise unique solutions and strategies, the town is confident that its citizens needs can be met.

The group has also challenged citizens to re-think their understanding of health and wellness and how these may be achieved and maintained in the community. While not a current objective of the initiative, this shift in thinking could become a movement towards making human development the primary focus of municipal planning and delivery of health services.