Population Growth and Demographic Changes in Halton-Peel. Phase I Report: Demographic Analysis
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1 Population Growth and Demographic Changes in Halton-Peel Phase I Report: Demographic Analysis September 2000
2 1.0 Background and Purpose District Health Councils are the local voice for health system planning. Made up of people who use and deliver health and related social services, the Council works in partnership to provide advice to the Minister of Health and Long-Term Care on local health planning needs and the development and implementation of a balanced and integrated health system. There are 16 District Health Councils representing 16 health planning districts in the province of Ontario, each of which as its own unique set of characteristics and population based needs. With knowledge of ministry policy directions, local provider capacities, and health needs of the population, District Health Councils are uniquely positioned to help shape the local health care service delivery system in order to best meet the needs of the population. In the Fall of 1999, the District Health Council initiated a multi-phased project aimed at gaining a better understanding of population growth and demographic changes and their potential impact on future utilization of health care services. This report summarizes the findings of the first phase of this project and is focused on understanding the population growth and demographic changes in Halton and Peel set in the context of the province of Ontario. Future reports will summarize additional phases of work, which will focus on projections of utilization for hospitals, projections of utilization for community services and future service models. Other District Health Council projects will use this baseline data to outline needs in specific areas such as physician and health human resources, long term care, mental health, etc. The purpose of this series of reports is both to educate and inform/guide ourselves as we undertake to plan for the health care needs of the population; for the providers of health care in Halton and Peel to use and incorporate into their own internal planning; and for the government in setting policy and allocating funds to meet the needs of the population. 2.0 Methods Population estimates and projections were obtained from the Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database for comparative data at the provincial and district health council level. Halton and Peel Regional Municipality Planning Departments provided population projections at the municipal level that more accurately reflected local population planning issues. Demographic characteristics including ethnicity, immigration, language, income and education were obtained from the 1996 Statistics Canada Census. Census data were analyzed at the county level (Halton and Peel) and also included Ontario data for comparison purposes. 1
3 Figure 1. District Health Councils Southwest Region 1 - Essex, Kent and Lambton DHC 2 - Thames Valley DHC 3 - Grey Bruce Huron Perth DHC 7 - Waterloo Region, Wellington Dufferin DHC 8 - Halton Peel DHC 9 - Toronto DHC 10 - Simcoe North York Region DHC 11 - Durham, Haliburton, Kawartha and Pine Ridge DHC East Region 12 - Southeastern Ontario DHC 13 - Champlain DHC Central South Region 4 - Grand River DHC 5 - Niagara DHC 6 - Hamilton-Wentworth DHC 14 - Northern Shores DHC 15 - Algoma, Cochrane, Manitoulin and Sudbury DHC 16 - Northwestern Ontario DHC Central West Region 2
4 Figure 2. Halton-Peel District Health Council Caledon Halton Hills Brampton Milton Mississauga Oakville Burlington 3
5 3.0 Findings 3.1 Population Growth In 1996, there were almost 1.3 million people living in Halton and Peel Regions, representing the second largest planning district in the Province, on a population basis (Figure 3). In 2016, the population of Halton-Peel planning district is projected to be almost 2 million. Figure 3. Halton-Peel Total Population Growth, ,500,000 2,000,000 1,500,000 1,000, , Source: Ministry of Health and Long-Term Care Provincial Health Planning Database; Queen s Printer for Ontario,
6 From 1996 to 2016, the Halton-Peel planning district is projected to experience a growth rate of approximately 57%, compared to a provincial average of approximately 25% (Figure 4). This projected population growth will result in an increase of over 50% in the size of the population, which will approach 2 million people in Although Halton-Peel shares the distinction of having the highest growth rates in the province with the Simcoe-York planning district, in absolute numbers, there will be significantly more people in Halton-Peel. Figure 4. Population Growth Rates by District Health Council and Ontario, % 60.0% 57.4% 66.6% 50.0% 40.0% 30.0% 30.4% 35.5% 24.9% 20.0% 13.4% 14.3% 14.1% 12.6% 9.7% 10.0% 6.0% 0.0% Essex Kent Lambton Grey Bruce Huron Perth Thames Valley Grand River Hamilton Wentworth Niagara Waterloo Wellington Dufferin Durham HKPR Halton Peel 17.8% 15.7% 10.2% 7.9% 2.1% -1.6% Toronto Simcoe York Champlain South Eastern Algoma Cochrane Manitoulin Sudbury Northern Shores Northwestern Ontario Ontario Source: Ministry of Health and Long-Term Care Provincial Health Planning Database; Queen s Printer for Ontario,
7 In fact, the proportion of total Ontario growth will be highest in Halton-Peel. From 1996 to 2016, 2,760,000 new people will live in Ontario (this refers to net growth, including all in/out migration, births and deaths). Out of the 2,760,000 new Ontario residents, over 25% will reside in the Halton-Peel planning district, representing an additional 707,000 people (Figure 5). In absolute numbers, this is significantly more than any other area of the province and is equivalent to adding a population greater than the current City of Mississauga. Figure 5. Proportion of Total Provincial Growth by District Health Council, Other DHCs 13.8% Waterloo Wellington Dufferin 7.1% Durham HKPR 9.9% Champlain 6.7% Halton Peel 25.6% Simcoe York 23.0% Toronto 14.0% (100% = 2,760,000 persons) Source: Ministry of Health and Long-Term Care Provincial Health Planning Database; Queen s Printer for Ontario,
8 Figure 6 demonstrates where the growth is projected to occur in Halton and Peel by municipality. Growth is projected to occur in all municipalities across the planning district. However, Mississauga and Brampton will have the largest absolute growth. It is important to note that Brampton, Milton and Caledon are all projected to double in size. Figure 6. Halton-Peel Population Growth by Municipality, , , , ,000 0 Mississauga Brampton Caledon Oakville Burlington Milton Halton Hills Source: Regional Municipalities of Halton and Peel,
9 The proportion of total Halton-Peel growth will be highest in Brampton. Over the next 20 years, over 232,000 new people are projected to reside in Brampton (Figure 7). Figure 7. Proportion of Total Halton-Peel Growth by Municipality, Mississauga 22.2% Halton Hills 3.6% Milton 8.7% Brampton 39.3% Burlington 6.4% Oakville 14.0% Caledon 5.9% (100% = 591,000 persons) Source: Regional Municipalities of Halton and Peel, 2000 In summary, given the absolute numbers and rate of growth anticipated for the Halton-Peel district, planning for additional infrastructure must take place now. This includes all infrastructure services, such as roads, utilities, schools, and health care services. 8
10 3.2 Changing Demographics Not only is the Halton-Peel population growing, but the demographic profile is changing in two significant ways. First, the population is aging faster than other parts of Ontario and, second, the population represents one of the most culturally diverse in the province Aging Population pyramids are a useful graphical representation of the changes in age and sex composition of the population. The horizontal bars on a population pyramid represent the percentage of each age and sex group relative to the total population. Figure 8 shows the population pyramid for Halton-Peel and its change from 1996 to In absolute terms, the shape of the pyramid changes significantly above the age group. Although the population of Halton-Peel is frequently referred to as a young population, this analysis clearly demonstrates that over the next 20 years we will see a significant change. Figure 8. Halton-Peel Age and Sex Distribution, 1996 and Males Females Percentage 1996 (total population: 1,232,000) 2016 (total population: 1,939,000) Source: Ministry of Health and Long-Term Care Provincial Health Planning Database; Queen s Printer for Ontario,
11 The population aged 65 and older is growing at the fastest rate in the province. Figure 9 shows the top five fastest growing planning districts among aged 65 and older in the province. Figure 9. Population Aged 65+ Growth Rates by District Health Council and Ontario, (by 5-year time period) 35.0% 30.0% Halton Peel 25.0% Simcoe York 20.0% 15.0% 10.0% 5.0% 0.0% Waterloo Wellington Dufferin Champlain Durham HKPR Ontario Source: Ministry of Health and Long-Term Care Provincial Health Planning Database; Queen s Printer for Ontario,
12 Figure 10 shows the growth in the population aged 65 and older in the top five largest planning districts in the province by population aged 65 and older. In 2006, Halton-Peel is projected to have the second largest population aged 65 and older in Ontario. Figure 10. Total Population Aged 65+ by District Health Council, , , , ,000 Toronto Halton Peel Simcoe York Champlain Durham HKPR 100, Source: Ministry of Health and Long-Term Care Provincial Health Planning Database; Queen s Printer for Ontario,
13 Figure 11 shows that by 2016 there will be 844,000 additional residents aged 65 and older in Ontario compared to The largest percentage of these additional persons aged 65 and older (20.0%) is projected to reside in Halton-Peel. Figure 11. Proportion of Total Provincial Growth Aged 65+ by District Health Council, Other DHCs 24.0% Waterloo Wellington Dufferin 5.9% Durham HKPR 7.8% Halton Peel 20.0% Champlain 9.6% Simcoe York 15.8% Toronto 16.8% (100% = 844,000 persons) Source: Ministry of Health and Long-Term Care Provincial Health Planning Database; Queen s Printer for Ontario, 2000 The prevalence of illness increases with age, as does the use of medical services. In 1993, persons aged 65 years and older, who represented 11.4% of the total Canadian population accounted for approximately 40% of total direct costs (Health Canada, Economic Burden of Illness in Canada, 1993). Direct costs included hospitalization, physician care and drug expenditures. However, a greater proportion of total direct costs on the population aged 65 and older may represent appropriate utilization for this age group. In addition, although population aging contributes to rising health care costs, it is important to recognize that other factors such as inflation and increasing drug costs also contribute to overall rising health care costs. 12
14 3.2.2 Cultural Diversity Cultural values and beliefs may influence health seeking behaviour and utilization of health care services. Identifying particular communities with diverse ethnic groups may help health system planning to reduce potential barriers for these populations. The Statistics Canada 1996 Census definition of ethnic origin refers to the ethnic or cultural groups to which the respondent s ancestors belong. However, reporting of ethnic origin may represent a limitation as ethnicity may be misinterpreted as citizenship, nationality or language. Furthermore, it is also important to recognize cultural variations and differences may exist within a single ethnic group. The Halton-Peel planning district represents a culturally diverse population. Figure 12 and Table 1 demonstrate that Peel is more culturally diverse than Halton, as measured by respondent ethnic origin. In 1996, approximately 50% of Peel residents indicated a single ethnic origin other than British or Canadian, compared to approximately 23% in Halton. Figure 12. Population by Ethnic Origin, Halton and Peel, 1996 Halton Peel East Indian 1.4% Polish 1.5% Portuguese 1.7% German 2.1% Dutch 2.2% French 1.3% Chinese 1.1% Other single origins 8.1% Multiple Origins 45.2% German 1.3% Filipino 2.3% Jamaican 2.8% Polish 3.2% Other single origins 17.6% Multiple origins 31.2% Italian 3.2% Chinese 3.9% Canadian 12.5% British 19.7% Portuguese 4.2% Italian 6.4% East Indian 7.8% Canadian 8.3% British 11.0% Source: Statistics Canada Census,
15 Table 1. Population by Ethnic Origin, Halton, Peel and Ontario, 1996 Halton Peel Ontario # % # % # % Total pop. by ethnic origin 337,440 Total pop. by ethnic origin 849, Total pop. by ethnic origin 10,642, Multiple Multiple Multiple origins 152, Single origins 184, origins 265, Single origins 583, origins 4,185, Single origins 6,457, Ranking of Single Origins Ranking of Single Origins Ranking of Single Origins British 66, British 93, British 1,478, Canadian 42, Canadian 70, Canadian 1,289, Italian 10, East Indian 65, Italian 482, Dutch 7, Italian 54, Chinese 365, German 6, Portuguese 36, French 301, Portuguese 5, Chinese 32, East Indian 242, Polish 5, Polish 27, German 234, East Indian 4, Jamaican 23, Portuguese 181, French 4, Filipino 19, Dutch 168, Chinese 3, German 10, Polish 164, Other single origins 27, Source: Statistics Canada Census, 1996 Other single origins 149, Other single origins 1,549,
16 Immigrants refer to individuals who have been granted the right to live in Canada permanently by immigration authorities. This category excludes non-permanent residents and nonimmigrants who are Canadian citizens by birth. Recent immigrants represent a population that may have different health care needs and different levels of health care utilization. Recent immigrants may also lack familiarity with the health care system and thus have less accessibility to health care. In 1996, 40% of the Peel population were immigrants as opposed to 23% in Halton and 26% in the province (Figure 13). Of those immigrants in Peel Region, 22% were recent immigrants (immigrated into Canada between ) (Table 2). Figure 13. Immigration Status, Halton, Peel and Ontario, 1996 Halton Peel Ontario 22.6% 25.6% 0.5% 40.0% 59.3% 0.7% 76.9% 0.7% 73.7% Non-immigrant population Non-permanent residents Total immigrant population Source: Statistics Canada Census, 1996 Table 2. Period of Immigration, Halton, Peel and Ontario, 1996 Period of Immigration Halton Peel Ontario # % # % # % Before , , , , , , , , , , , , , , , Total immigrant population 76, , ,724, Source: Statistics Canada Census,
17 Effective communication is essential in receiving health prevention messages and adequate health care. Residents who do not know either English or French language may have reduced access to health information and services and are at greater risk of social isolation. In 1996, 0.6% of Halton population and 3.1% of Peel Region population could not converse in either English or French (Table 3). Table 3. Knowledge of Official Languages, Halton, Peel and Ontario 1996 Halton Peel Ontario # % # % # % Neither English nor French 1, , , English and French 34, , ,234, English only 301, , ,116, French only , Total 337, , ,642, Source: Statistics Canada Census,
18 Population by home language also demonstrates the cultural diversity in Peel (Table 4). In Peel, 19.1% of single responses indicated a home language other than French or English. The top five languages spoken at home in Peel after English were Punjabi, Chinese, Polish, Portuguese, and Italian. Table 4. Population by Home Language, Halton, Peel and Ontario, 1996 Halton Peel Ontario # % # % # % Total pop. by home language 337,435 Total pop. by home language 849,305 Total pop. by home language 10,642, Multiple Multiple Multiple responses 4, responses 33, responses 258, Single responses 333,095 Single 98.7 responses 815, Single responses 10,384, English 313, English 649, English 8,773, French 2, French 4, French 287, Non-official Non-official Non-official languages 16, languages 162, languages 1,323, Ranking of non-official languages (single responses) Ranking of non-official languages (single responses) Ranking of non-official languages (single responses) Portuguese 2, Punjabi 28, Chinese 273, Polish 1, Chinese 22, Italian 136, Chinese 1, Polish 17, Portuguese 91, Italian 1, Portuguese 14, Polish 84, Croatian 1, Italian 10, Spanish 68, Punjabi 1, Spanish 7, Punjabi 58, German Tagalog 6, Tamil 47, Arabic Vietnamese 6, Arabic 44, Serbian Arabic 5, Vietnamese 44, Spanish Croatian 4, German 41, Other Other Other languages 4, languages 38, languages 432, Source: Statistics Canada Census,
19 3.2.3 Income and Education Studies have increasingly shown income to be an important determinant of health. Individuals with higher incomes have greater health (lower morbidity, greater life expectancy, fewer potential years life lost, higher self-rated health status) than those with lower incomes. Low income rates may help identify populations who have increased risk of illness and mortality, as well as increased utilization of health care services. In the 1996 Census, Statistics Canada set the low income cut-offs at 20% higher than what the average family spends on basic necessities (food, shelter and clothing). Low income cut-offs are updated annually by changes in the consumer price index and are set for unattached individuals, and for different sizes of families. In 1995, Halton and Peel Regions had a lower proportion of residents living below the low income cut-off point compared to Ontario (Table 5). Although, the proportion of residents classified as low income was greater in Peel relative to Halton. Table 5. Proportion of Low Income, Halton, Peel and Ontario, 1995 Halton Peel Ontario % % % Economic families* Unattached individuals Total population in private households * Economic families refers to a group of two or more persons who live in the same dwelling and are related to each other by blood, marriage, common-law or adoption. Source: Statistics Canada Census,
20 Education is also an important determinant of health. Evidence from the literature demonstrates that individuals with higher education are healthier than those with lower education. Although this effect is likely to be related to income, increased decision making skills, coping skills and locus of control which are all primarily associated with education are important determinants of health. In 1996, 4.9% of Halton residents and 8.0% of Peel residents reported having less than grade 9 education as opposed to 10.0% in the province of Ontario (Table 6). Table 6. Education Level of Population Aged 15+, Halton, Peel and Ontario, 1996 Education Level Halton Peel Ontario # % # % # % Less than grade 9 13, , , Grades 9 to 13 89, , ,170, Other* 81, , ,362, University 81, , ,050, Total 265, , ,429, * Other includes trades certificate or diploma and other non-university education. Source: Statistics Canada Census,
21 4.0 Conclusions At a population of approximately 1.3 million in 1996, Halton-Peel represents the second largest planning district in the province. Halton-Peel is projected to be one of the fastest growing planning districts in the province from 1996 to Halton-Peel s population is projected to increase by 707,000 from 1996 to Halton-Peel is projected to be the fastest growing planning district in the province among people aged 65 and over from 1996 to The Halton-Peel planning district includes a culturally diverse population. Halton and Peel Regions differ with respect to demographic and socio-economic indicators. Identifying demographic and socio-economic indicators is necessary for planning present and future health system needs. Further research should attempt to translate the projected population growth and changing demographics into the need for health services in the Halton-Peel planning district. 20
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