Canadian Health Measures Survey
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Policy makers, provincial health departments, researchers and health professionals from many fields have expressed a need for a national, comprehensive source of accurate health measures to assist them in addressing the health needs of all Canadians.
To address longstanding limitations within Canada’s health surveillance system, Health Canada has supported Statistics Canada in obtaining funding for a “direct measures” health survey. This support was announced in the 2003 federal budget as part of an extension of the Health Information Roadmap initiative.
The Canadian Health Measures Survey will collect key information relevant to the health of Canadians in the form of direct physical measurements such as blood pressure, height and weight, blood and urine sampling and physical fitness testing. Also, through questionnaires, it will gather information related to nutrition, smoking habits, alcohol use, medical history, current health status, sexual behaviour, lifestyle, physical fitness, as well as demographic and socioeconomic variables.
All this valuable information will help evaluate the extent of health problems associated with such major health concerns as diabetes, obesity, hypertension, cardiovascular disease, exposure to infectious diseases, and the extent of exposure to environmental contaminants.
It will serve to ascertain relationships among disease risk factors, health protection practices, and health status based on direct measures. The survey will also provide a platform to explore emerging public health issues and new measurement technologies.
In the last 35 years, some Canadian surveys have collected direct physical measures:
- Nutrition Canada Survey (1970-72)
- Canada Health Survey (1978)
- Canadian Heart Health Surveys (1988-92)
- Canadian Study of Health and Aging (1992)
- Canadian Community Health Survey 2.2 (2004)
Many countries have a long history of surveys including direct physical measures that have led to important findings.
In the United States, for example, the National Health and Nutrition Examination Survey has helped develop the standard growth charts for children.
The American survey’s biggest impact was probably its findings about the link between high cholesterol and heart disease in the 1960s. The same survey also gave the first evidence that Americans had too much lead in their blood. This pushed the government to phase out the use of lead as an additive in gasoline.
In Australia, a similar survey conducted from 1999 to 2001 found that for every known case of diabetes, there was one undiagnosed case. Furthermore, nearly 1 million Australians over the age of 25 have diabetes. The data collected will be important for national and regional public health education, health promotion programs and health care planning.
In New Zealand, the 1996-97 health and nutrition surveys have shown three key nutrition problems in population: obesity, food security and calcium inadequacy. These are all now priorities within the Ministry of Health for policy work.
All of these improvements would not have been made possible without the information gathered through measurements of physical characteristics.
The CHMS will collect health information on Canadians that cannot be captured, or may be inaccurately reported, through data gathered through self-report or health care records.
Several consultations have occurred to determine a list of high priority variables to be measured in the CHMS and discussions will continue with various stakeholders to finalize the exact survey content.
The following are some of the measures that the CHMS is considering:
- Anthropometry (height, sitting height, weight, waist circumference, skinfolds)
- Cardiovascular fitness (blood pressure, modified Canadian Aerobic Fitness Test)
- Musculoskeletal fitness (hand grip strength, sit and reach test, partial curl-ups)
- Physical activity (accelerometry)
- Oral health
Blood measures to assess
- Indicators of nutritional status
- Cardiovascular Disease, including cholesterol level
- Nutritional Status (vitamin D, iron, calcium, vitamin B12, folic acid)
- Environmental exposure to lead and mercury for example
- Infectious disease markers
- Indicators of diabetes and kidney disease
The CHMS is investigating the possibility of analysing some of the measures at a later date, when funds become available. This would likely involve the storage of biological samples. However, before decisions are made on storage, more research needs to be conducted into the issues of privacy, costs, research ethics, and others.
The CHMS will collect measures from 5,000 people representing 97% of the Canadian population aged 6-79 (including the territories). Survey development and testing are planned for 2003-2006, with the survey occurring in 2006-2008. Data dissemination is planned for late 2009. Although funding for the CHMS is one time only, it is hoped that the survey will become an ongoing part of Canada’s health information system.
Although the data collection logistics are still in development, collection will likely consist of a combination of personal household and individual interviews using computer-assisted interviewing software and a visit to a clinic (mobile examination centres) for the physical examination.
The survey will be conducted in 15 sites across the country, over a period of 24 months. The CHMS mobile examination centres will stay in each site for 6-8 weeks. Direct measures will be collected from approximately 350 respondents per site.
First step: interview at the household
The first contact with respondents will be made by a letter sent by mail telling the persons living at the sampled address that an interviewer will visit their home to collect some information about the household.
When visiting the home, the interviewer will list all the persons living at the address, randomly select a respondent, and conduct a health interview. The interview should last about 45 minutes. The interviewer will assist the respondent in setting an appointment for the physical measures at the CHMS clinic, where the measures will be taken by health professionals.
Second step: visit to the CHMS clinic
Statistics Canada is examining the possibility of using mobile examination centres for the clinic part of the survey. These centres have been used successfully for years by the U.S. health measures survey—the National Health and Nutrition Examination Survey (NHANES).
We are investigating using two sets of two trailers; in each pair, one trailer is to be used as an administration area and the other as a clinic. The two trailers in a set will be linked by an enclosed pedestrian walkway. Two trailers have been offered by NHANES for use in the CHMS. The inside dimensions of the trailers are 15.3 metres long (51 feet) by 2.4 metres wide (8 feet). The clinic area will be divided into smaller rooms accessed by a corridor, but the administration area will be divided in two sections, one for staff, and the other for respondents.
Respondents in the survey will first come through the administration trailer, which houses the office/staff convenience area, a reception area, and the blood pressure station. Respondents will enter the clinic into the reception area, and will be greeted and registered by the clinic receptionist. The respondent will be led to the first station in the administration area. Other scheduled respondents may enter the trailer and wait in the reception area.
After the first station, the respondent will be led to the other stations in the clinic area, the order determined by room availability and the measures to be taken. Each station in the clinic area serves a specific measure: blood draw, urine sample, oral health exam, and measures of anthropometry, cardiovascular fitness, muscular strength and flexibility. The clinic area also houses the laboratory.
For each respondent, the complete clinic experience should last less than 2 hours, depending on the measures to be taken.
If respondents agree, they will get a preliminary report of results at the clinic. A few months after the survey, laboratory test results will be returned to them.
Confidentiality and consent
The Canadian Health Measures Survey is conducted under the authority of the Statistics Act. Participation in this survey is voluntary. The respondents will be asked to give their written consent for all parts of the process.
For more information
For more information on the Canadian Health Measures Survey, please contact the Statistics Canada regional office nearest you or e-mail firstname.lastname@example.org.