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Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 1
By
Mamawetan Churchill River Health RegiongNOR-MAN Health Region
Saskatchewan Ministry of Health Manitoba Ministry of Health and Healthy Living
Saskatchewan Cancer AgencyCancerCare Manitoba
1
Dr. James Irvine, Medical Health Officer Medical Health Officer,
Mamawetan Churchill River Health Region
Dr. Lawrence Elliott, Medical Officer of Health,NOR-MAN Health Region
Dr. Susan RobereckiDeputy Chief Medical Health OfficerManitoba Health and Healthy Living
2
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 2
Provide a overall health status assessment of the populations of Creighton and FlinFlon (FF/CR)
Compare with Manitoba, Saskatchewan and NOR-MAN Health Region and Mamawetan Churchill River Health Mamawetan Churchill River Health Region
3
Combined Compared to:Combined• Creighton, SK• Flin Flon, SK• Flin Flon, MB
Compared to:• Manitoba• Saskatchewan• NOR-MAN Health Region• Mamawetan Churchill
River Health Region
4
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 3
To provide information that will complement the work of the Human Health Risk Assessment (HHRA)
Does not replace the need for the HHRA
5
Community health status assessment is an assessment of the overall health of the an assessment of the overall health of the population
Human Health Risk Assessment is an assessment of the risk to human health from a particular contaminant or combination of contaminants
6
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 4
Vital Statistics Agency, Manitoba g y,Vital Statistics Registry, SaskatchewanSaskatchewan Cancer RegistryManitoba Cancer RegistryCanadian Community Health Survey, y y,Statistics CanadaCensus Canada, Statistics Canada
7
95% confidence intervals (CI) were calculated where appropriatepp p
CI give information on the range in which result will most likely be found
For survey information, only a sample of the population is surveyed. By chance the people selected may not reflect the whole population selected may not reflect the whole population perfectly accurately.
The CI shows the range that the whole population answers will be true 95% of the time. (i.e. correct 19 times out of 20)
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Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 5
95% confidence intervals (CI) were used for vital statistics and cancer incidence in order to compare the rates between populations
Rates of illness in smaller populations (especially for uncommon or rare events) can jump up and down overtime. Calculating an j p p gaverage rate with confidence intervals allows one to be ‘confident’ that the rate is somewhere within that CI
9
The larger the population studied the less The larger the population studied, the less variability there is by chance (the CI are narrow or tight)
The smaller the population, the wider the CI reflecting that rates can go up and down
dil b hreadily by chance
For less common events, the rates can go up and down more readily than common events, and CI will be wider for less common events
10
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 6
For the following slide:For the following slide:
• The percentage of smokers in NorthSask is not significantly different than NOR-MAN (the error bars ‘overlap’)
• The percentage of smokers in North Sask is greater than in Saskatchewan (the lower part of the error bar for in Saskatchewan (the lower part of the error bar for NorthSask is greater than the upper part of the error bar for Sask
• The percentage of smokers in NOR-MAN is greater than in Manitoba and Canada
11
Example of confidence intervals (CI)Occasional or Daily Smokers, aged 12 years and over,
off‐reserve, Northern Regions, 200760
rting
er
21.922.4
32.4
25.9
38.4
20
30
40
50
n aged
12 an
d over re
por
aily or ocassion
al smoke
0
10
20
Canada Man NOR‐MAN Sask NorthSask
% pop
ulation
being a d
Source: StatsCan 2007 (CCHS), Prepared by PHU June 2008 (Error Bars = 95% CI's)12
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 7
HHRA Human Health Risk AssessmentCR Creighton SaskatchewanCR Creighton, SaskatchewanFF Flin FlonFF, Man Flin Flon, ManitobaFF, Sask Flin Flon, SaskatchewanFF/CR Combined FF Man, FF Sask and CRCR FF Sask Combined CR and FF SaskatchewanSask SaskatchewanMan ManitobaNOR-MAN NOR-MAN Health RegionMCRHR Mamawetan Churchill River Health RegionHR Health RegionAge-Std Age-Standardized
13
14
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 8
15
When comparing health status between groups, the population age structure can make a difference
Populations with younger age structures would be expected to have lower rates of some illness such as cancer and chronic some illness such as cancer and chronic conditions (diabetes and heart disease) than populations with older age structures.
16
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 9
Total Population by Age Group, Flin FlonManitoba, NOR‐MAN & Manitoba, 2006
20
FF Man NORMAN MAN
8
10
12
14
16
18
20
total pop
ulation
0
2
4
6
0‐9 10‐19 20‐29 30‐39 40‐49 50‐59 60‐69 70+
% of
Age (yrs)Source: Manitoba Health 2006, Prepared by PHU April 2008
17
Total Population by Age Group, Creighton ‐Flin Flon Saskatchewan, MCRHR &
Saskatchewan, 2006
25
CR FF Sask MCR Sask
10
15
20
25
total pop
ulation
0
5
0‐9 10‐19 20‐29 30‐39 40‐49 50‐59 60‐69 70+
% of t
Age (yrs)Source: SaskHealth 2006, Prepared by PHU April 2008
18
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 10
The population age structure of Creighton and Flin Flon is different than the other four comparison populations
Appropriate statistical adjustments are required in order to compare these populations (called ‘age-standardization)populations (called age-standardization)
Its like comparing ‘as if’ all the populations’ age structures are the same
19
Population by 5‐yr Age Group, Flin Flon Manitoba, 2001‐2006
700
8002006 2001
200
300
400
500
600
700
# individu
als
0
100
Age (yrs)Source: Manitoba Health 2001‐6, Prepared by PHU April 2008
20
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 11
Population by 5‐yr Age Group, Creighton ‐Flin Flon Saskatchewan, 2001‐2006
250
2006 2001
100
150
200
# individu
als
2006 2001
0
50
Age (yrs)Source: SaskHealth 2001‐6, Prepared by PHU April 2008
21
The population of Creighton and Flin Flon:• Since 2001, there has been:
A small decrease in the number of children and adolescents as well 35-45 year oldsThere is an increase in the number of 45 to 60 year olds
22
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 12
Total Population Change, Flin Flon Manitoba and Creighton/Flin Flon Saskatchewan,
1996‐2006
23
Total Population Change, Creighton, Flin Flon and Associated Areas, 2001‐2006
FF‐Man NORMAN Man FF/CR‐Sask MCR Sask
2.2
5.0
2 1‐2
0
2
4
6
in Total Pop
ulation
‐7.1
‐2.7
‐5.5
‐2.1
‐8
‐6
‐4
FF‐Man NORMAN Man FF/CR‐Sask MCR Sask
% cha
nge
Source: Manitoba & SaskHealth 2006, Prepared by PHU April 200824
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 13
Change in Population Aged 75 and Over, Creighton, Flin Flon and Associated Areas,
2001‐20063.0 Sask
4.8
16.5
6.9
Man
CR FF Sask
MCR
‐8.8
‐3.9
‐15 ‐10 ‐5 0 5 10 15 20
FF Man
NORMAN
% change in population aged 75+ 25
The population of Flin Flon and Creighton has been decreasing between 2001 – 2006
The population of those aged 75 years or older has increased from 2001-2006 in Creighton (16 5% increase) and Creighton (16.5% increase) and decreased in Flin Flon (8.8% decrease)
26
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 14
Population Aged 5yrs and Over that have Moved in the Past 5 Years, Creighton, Flin Flon
and Associated Areas, 2006 50
hat
39.736.2 36.6 36.1
33.3 31.7
20
30
40
on aged 5 yrs an
d over th
noved in past 5
years
0
10
FF Man NOR‐MAN Man Sask MCR CR FF Sask
% pop
ulatio
have n
Source: Census 2006, Prepared by PHU August 2008 27
Creighton and Flin Flon have similar proportions of Aboriginal people in their population to Manitoba and Saskatchewan and a lower proportion compared to NOR-MAN and MCR Health Regions.g
28
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 15
Population Declaring Aboriginal Identity, Creighton, Flin Flon & Associated Areas,
2006
29
30
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 16
The things that determine or influence our health
31
Incomes & social status
Ed tiEducation
Employment
EnvironmentHuman-madeNatural ecosystem
Social supports
Early childhood development
Health services
Health behaviours Source:: Saskatchewan Provincial Health Council, 1996
32
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 17
Education: Population Aged 15 and Over with No Certificate, Diploma or Degree, 2006
33
Male Employment Rate, Creighton, Flin Flon and Associated Areas, 2006
34
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 18
Female Employment Rate, Creighton, Flin Flon and Associated Areas, 2006
35
Median After Tax Income, Population Aged 15 and Over, Northern Region, 2005
36
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 19
Population Less than 18 yrs of Age in Low Income After Tax, Northern Regions, 2005
30
tax
18.9
13.7
15.9
12.5
24.2
10.010
15
20
25
< 18yrs in lo
w income after
0
5
10
FF‐Man NOR‐MAN Manitoba Sask MCR Creighton
% pop
ulation <
Source: Census 2006, Prepared by PHU August 200837
Occupied Private Dwelling Characteristics Creighton, Flin Flon and Associated Areas, 2006
38
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 20
Creighton and Flin Flon communities have similar (or slightly higher) education, employment, and income compared to Manitoba and Saskatchewan populations.
Creighton and Flin Flon have fairly Creighton and Flin Flon have fairly similar housing conditions in terms of crowding compared to Saskatchewan and Manitoba.
39
For some of the non-medical health determinants, current information is not available specifically for Creighton and Flin Flon but is available for the MCR and NOR-MAN Health Regions.
40
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 21
Population aged 18 and over, off‐reserve, classified as Overweight or Obese, 2007
41
Heavy Drinkers, aged 12 years and over, off‐reserve, 2007
42
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 22
Occasional or Daily Smokers, aged 12 years and over, off‐reserve, 2007
43
Occasional or Daily Smokers, aged 12 years & over, off‐reserve, 2000/1‐2007
g
Canada Manitoba NOR‐MAN Sask NorthSask
20
30
40
50
ed 12 an
d over re
porting
or occassion
al smoker
0
10
2000/1 2003 2005 2007% Pop
ulation age
being a da
ily o
Source: Statistics Canada (CCHS), Prepared by PHU, August 2008 44
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 23
Non‐smoking Population aged 12 and over, off‐reserve, Exposed to Second Hand Smoke in the
Home, 2005
45
Population aged 12 and over, off‐reserve, Physically Active or Moderately Active,
Northern Regions, 2007
46
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 24
Consuming Fruits & Vegetables 5 or more per Day,
Population aged 12 and over, off‐reserve, 2007
47
For off-reserve populations in NOR-MAN and MCR Health Regions, there are higher rates of people who are overweight and obese, are heavy drinkers, and are more exposed to second hand smoke compared to the general population in Saskatchewan g p pand Manitoba residents but the differences are not statistically significant.
48
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 25
Rates of smoking in MCR Health Region are significantly higher than in Saskatchewan and in NOR-MAN Health Region compared to Manitoba.
49
Based on population and health determinants indicators, the Manitoba population most closely resembles the Flin Flon / Creighton population followed by Saskatchewan, and then NOR-MAN Health Regiong
50
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 26
51
For all causes of death combined, the death rate in FF/CR is lower than the death rates in NOR-MAN and slightly lower than in Manitoba and Saskatchewan.
52
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 27
Total Mortality Rates, by Region, Average, 1996‐2005
(Age‐standardized per 100,000)
53
Age‐Specific Mortality Rate, by Region, Average 1996‐2005(Per 100,000)
54
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 28
In assessing death rates at various ages:
• There is little difference between groups for most age groups
• Rates in Flin Flon / Creighton are lower than MCRHR in the 20-35 year age group and lower than NORMAN HR , Manitoba and Saskatchewan in the 35-65 year
age group.
• For over 65 years of age, rates in Flin Flon / Creighton are less than those in NOR-MAN and higher than in MCRHR and roughly the same as Manitoba and Saskatchewan.
55
Mortality Rates per 100,000, < 1‐yr, Average 1996‐2005
56
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 29
Mortality Rates per 100,000, 0‐9‐yrs, Average 1996‐2005
57
Mortality Rates per 100,000, 10‐19‐yrs, Average 1996‐2005
58
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 30
Mortality Rates per 100,000, 20‐34‐yrs, Average 1996‐2005
59
Mortality Rates per 100,000, 35‐64‐yrs, Average 1996‐2005
60
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 31
Mortality Rates per 100,000, 65+ yrs, Average 1996‐2005
61
Death rates for circulatory disease (e.g. y ( gheart disease and stroke ) are lower in FF/CR compared to NOR-MAN, Saskatchewan and Manitoba
Death rates for cancers are lower in FF/CR d t NOR MAN d M it bcompared to NOR-MAN and Manitoba.
62
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 32
Death rates for respiratory diseases are higher in FF/CR than in Manitoba and Saskatchewan but lower than in NOR-MAN Health Region Death rates for injuries and violent deaths are higher than in Manitoba and deaths are higher than in Manitoba and Saskatchewan but lower than NOR-MAN and MCR HR.
63
Mortality Rates by Major Cause, Average, 1996‐2005(Age‐standardized per 100,000)
64
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 33
Male Mortality Rates by Major Cause, Average, 1996‐2005(Age‐standardized per 100,000)
65
Female Mortality Rates by Major Cause, Average, 1996‐2005(Age‐standardized per 100,000)
66
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 34
Premature death rates (PYLL) for males and ( )females combined are lower in FF/CR than in Manitoba, NOR-MAN and MCRHR
67
Potential Years of Life Lost (PYLL) Rates by Sex, Average, 1996‐2005
(A reflection of ‘premature deaths’ or deaths occurring before 75 years of age)
68
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 35
The most common causes of premature deaths in FF/CR NOR MAN and MCRHR are deaths in FF/CR, NOR-MAN and MCRHR are injuries followed by cancer and circulatory disease.Premature death rates for injuries are higher in FF/CR than Manitoba and SaskatchewanPremature deaths (PYLL) from respiratory disease are lower in FF/CR than in NOR-MAN, MCRHR, Manitoba and Saskatchewan.
69
Potential Years of Life Lost Rates, by Cause, Average, 1996‐2005
(a reflection of the rate of ‘premature deaths’ before age 75 years)
70
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 36
PotentialYears of Life Lost
Condition FF/CR lower than: FF/CR same as: FF/CR higher than:
Injury NORMAN
MCRHR
Manitoba
Saskatchewan
Circulatory NORMAN Manitoba
MCRHR
Saskatchewan
MCRHR
Cancers NORMAN
Manitoba
Saskatchewan
MCRHR
Respiratory Manitoba
Saskatchewan
NORMAN
MCRHRMCRHR
Endocrine Manitoba
Saskatchewan
MCRHR
NORMAN
Nervous System
MCRHRNORMAN
Saskatchewan
Manitoba
71
Premature deaths (PYLL) from respiratory ( ) p ydisease are lower in FF/CR than other groupsDeath rate from respiratory disease are higher in FF/CRR i t d th t d t b f Respiratory deaths tend to be more of an issue in FF/CR for the oldest age groups in comparison to the other groups
72
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 37
73
Cancer has multiple causes or ‘risk factors’p
Tobacco, diet and obesity are thought to cause about 60% of the cancer causing death in developed countries.
This study of cancer incidence cannot determine the cause of specific types of cancers seen in Creighton and Flin Flon
74
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 38
Percent of Cancer Deaths Attributed to Various Risk Factors in Developed Countries
75
76
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 39
There is no significant difference in the cancer rate for females in FF/CR compared to those in Manitoba, NOR-MAN HR or MCRHR.
There is no significant difference in the t f l i FF/CR d cancer rate for males in FF/CR compared
to those in Manitoba, Saskatchewan or NORMAN HR.
77
Total Cancer Incidence Rate, by Sex and Region, 1996‐2005
(Other than non‐melanoma skin: Age‐Standardized Rate per 100,000)
78
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 40
Cancer Site NumberIn assessing cancers in
ll l ti Cancer Site Number
Lung 67
Female Breast 43
Colorectal 40
Prostate 39
Bladder 17
Non-H Lymphoma 17
small populations especially for uncommon events, small changes can have a large impact on the rate (so the y p
Kidney 14
Leukemia 13
Brain Less than 5
on the rate (so the Confidence Intervals or ‘error bars’ will be large).
79
Lung, breast, colorectal and prostate cancers were the most common cancers in FF/CR during this 10 year period.
This is similar to cancers in Canada, Manitoba, Saskatchewan, NOR-MAN and MCR Health RegionsMCR Health Regions.
80
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 41
Cancer Incidence Rate, by Site and Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
81
There is no significant difference in lung cancer rates in males and in females in FF/CR and MB, SK, NM and MCR HRs.
However, lung cancer rates for males are higher in NOR-MAN HR compared to MB and in MCRHR compared to SKand in MCRHR compared to SK.
82
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 42
Lung Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005 (Age‐Standardized Rate per 100,000)
83
Lung Cancer Incidence Rate, by Sex and Region, 1996‐2005
(Age‐Standardized Rate per 100,000)
84
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 43
Breast cancer incidence rates for women in FF/CR are lower than rates for women in Manitoba
85
Female Breast Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
86
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 44
Prostate cancer incidence rate in FF/CR males is lower than for males in Saskatchewan but similar to males in Manitoba and Canada.
87
Prostate Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
88
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 45
There is no significant difference in the cancer incidence rate for colorectal cancer for people in FF/CR compared to the other comparison groups.
89
Colorectal Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
90
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 46
There is no significant difference in the cancer incidence rate for non-Hodgkin’s lymphoma for people in FF/CR compared to the other comparison groups.
91
Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
Cancer Incidence by Site Non‐Hodgkin’s Lymphoma Incidence RateIncidence Rate
92
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 47
There is no significant difference in the cancer incidence rate for bladder cancer for people in FF/CR compared to the other comparison groups.
93
Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
Cancer Incidence by Site Bladder Cancer
Incidence RateIncidence Rate
94
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 48
There is no significant difference in the cancer incidence rate for kidney cancer for people in FF/CR compared to the other comparison groups.
95
Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
Cancer Incidence by Site Kidney Cancer Incidence Rate
96
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 49
There is no significant difference in the leukemia incidence rate for people in FF/CR compared to the other comparison groups.
97
Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
Cancer Incidence by Site Leukemia Incidence Rate
98
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 50
There is no significant difference in the cancer incidence rate for brain cancer for people in FF/CR compared to the other comparison groups.
99
Cancer Incidence Rate, by Region, 10 yr average, 1996‐2005
(Age‐Standardized Rate per 100,000)
Cancer Incidence by Site Brain Cancer Incidence Rate
100
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 51
The following graph shows the comparison in rates between FF/CR and Manitoba. Error bars overlapping the red line indicates no difference in rates between FF/CR and Manitoba.Breast caner rate is slightly higher in Manitoba than FF/CR (the lower end of the error bar is above the FF/CR rate)
101
Comparisons of Cancer Rates for Manitoba compared to Creighton and Flin Flon by Site,
1996‐2005(Standardized Rate Ratio)
102
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 52
Overall health status of the population of Creighton and Flin Flon is generally as good as or better than the provincial averages for most indicators studied
103
Premature deaths due to injuries in FF/CR are higher than in Manitoba and SaskatchewanDeath rates due to respiratory conditions are higher for the oldest age groups than in Manitoba and Saskatchewan. However, ,premature deaths due to respiratory conditions are lower in FF/CR than in Manitoba and Saskatchewan
104
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 53
Overall death rates and overall premature mortality rates are lower in FF/CR than in Manitoba and SaskatchewanOverall death rates for circulatory disease are lower in FF/CR than in Manitoba and SaskatchewanSaskatchewan
105
Premature deaths due to cancer are lower in FF/CR th i M it b d S k t hFF/CR than in Manitoba and SaskatchewanThere were no specific types of cancer determined to have significantly higher rates in FF/CR than in Manitoba or SaskatchewanBreast cancer rates are lower in FF/CR than M it bManitobaProstate cancer rates are lower in FF/CR than Saskatchewan
106
Community Health Status Assessment: Creighton and Flin Flon
November 19, 2008 54
The health indicator information from this report will also be used by the NOR-MAN and Mamawetan Churchill River Health Regions for their planning and review of community health services and health promotion strategies.p g
107