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Physical Health & Development
Healthy Lifestyle & Behaviours
Health Checks
Health Status & Disease
Pregnancy, Births & Early Development
Physical Health & Development
Children are born healthy, and reach their optimal physical health and development.
Defining health
The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The Ottawa Charter for Health Promotion states that, in order to be healthy, “an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment”. In this way, health is seen as a resource or an asset that helps us lead our everyday lives.
Healthy births
A healthy birth for every child in Toronto is an important goal because a healthy birth is a significant predictor of future health, development and overall well-being. A healthy birth is closely linked to the health of the mother (starting from before conception), which is affected by many social and material factors.
Physical health and development
Physical health and development, mental health, and social and emotional development are all intrinsically linked. The exercise of breaking well-being into separate outcomes poses inherent challenges because all aspects of well-being are so connected. Separating the Physical Health & Development Outcome from the Mental Health & Social Development Outcome ensures that each outcome can be measured in a manageable and appropriate way.
Screen time
What is it?
Screen time is based on TDSB students (grades 4 to 8) who reported how much time they spent watching TV or videos or playing computer/video games on a school day. “Less than 2 hours per day” includes students who responded “none”, “less that 1 hour per day”, and “1-2 hours per day” and “More than 2 hours per day” includes “2-3 hours per day” and “More than 3 hours per day”.
Limitations
This indicator is not able to identify beneficial screen time such as a computer game that helps students advance math skills or an educational video that may be assigned for homework.
Active transportation to school
What is it?
Active transportation to school is based on the precentage of TDSB students (grades 4 to 8) who reported walking or biking to school.
Limitations:
This indicator asks children to identify how they get to and from school from a selection of transportation modes. There are some active transportation modes that may not be represented in the results such as using a scooter or a skateboard to get to or from school.
Physical Exercise
What is it?
Physical exercise is based on the percentage of TDSB students (grades 4 to 8) who reported how often in a regular school week they exercised or took part in a sport that caused them to sweat or breath harder.
Limitations
This indicator only accounts for physical activities that cause sweat or heavy breathing (aerobic activity), leaving out other forms of excercise (e.g. resistance training, flexibility training) that are equally beneficial to well-being. Furthermore, it only accounts for frequency, and not intensity of physical activity.
Hours of sleep
What is it?
Hours of sleep is based on the percentage of TDSB students (grades 7 to 8) who reported average hours of sleep on a school night. “Less than 8 hours” includes students who responded “Less than 5 hours”, “5 hours”, “6 hours” or “7 hours” responses and “8 or more hours” includes “8 hours”, “9 hours” or “More than 9 hours”.
Limitations
This indicator does not take into account sleep quality. Frequently interrupted sleep could impact overall health. There are also various guidelines and studies that show that grade 7 and 8 may have different recommended hours of sleep. Canadian 24-hour movement guidelines recommends that for grade 7 students (predominantly 13 year olds) the minimum recommended hours of sleep is 9 hours and for grade 8 students (predominantly 14 year olds), the minimum recommended hours of sleep is 8 hours. Centers for Disease Control and prevention (CDC) recommends minimum of 8 hours of sleep per day for 13-18 years.
Tiredness
What is it?
Tiredness is based on the percentage of parents of TDSB students (JK to grade 6) who reported how often their child seemed tired in the morning.
Limitations
This indicator does not account for whether a parent is actually present to see their child wake up in the morning. It also does not elaborate on the multitude of reasons why a child may experience tiredness in the morning including: circadian rhythm, morning/evening extracurricular activities, anxiety preventing sleep, problems at home preventing sleep, differences in school start times, etc.
Unhealthy Eating
What is it?
Unhealthy eating is based on the percentage of TDSB students (grades 4 to 8) who reported how often during a regular school week they ate fast food or soft drinks. “Often” includes “Every day” or “Most days” responses and “Sometimes” includes students who responded “1-2 days”.
Limitations
This indicator does not include the full range of unhealthy eating choices that students could make. For some students, unhealthy food choices may be due to socioeconomic constraints or the unavailability of healthier eating options close to where they live.
Healthy Eating
What is it?
Healthy eating is based on the percentage of TDSB students (Grades 4-8) who reported how often during a regular school week they ate vegetables, fruits, or dairy products/alternatives. “Often” includes “Every day” or “Most days” responses and “Sometimes” includes students who responded “1-2 days”.
Limitations:
This indicator does not include the full range of healthy eating choices that students could make (i.e. there may be healthy food or drink items not captured in the question.) Students may not remember the frequency that they ate healthy foods or may not know that a healthy food product was part of something they had consumed (i.e. within a smoothie). Students may have different access to healthy foods due to income, food insecurity, where they live and more.
Physical health check-up
What is it?
Physical health check-up is based on TDSB students (grades 7 to 8) who reported how often do they usually go to a doctor for a physical health check-up.”Yearly” includes students who responded “Once a year or more” and “Once every few years or Once” includes “Once every few years” or “Once”.
Limitations:
This indicator is based on the student’s memory of visiting their doctor. It may be difficult to accurately remember when and how many times they visited.
Dental check-up
What is it?
Dental check-up is based on TDSB students (grades 4 to 8) who reported how often do they usually go to a dentist to have their teeth checked. “Yearly” includes students who responded “Once a year or more” and “Once every few years or Once” includes “Once every few years” or “Once”.
Limitations:
This indicator is based on the student’s memory of visiting their dentist. It may be difficult to accurately remember when and how many times they visited.
Hearing test
What is it?
Hearing test is based on TDSB students (grades 4 to 8) who reported how often do they usually go to a doctor for an hearing test. “Yearly” includes students who responded “Once a year or more” and “Once every few years or Once” includes “Once every few years” or “Once”.
Limitations:
This indicator is based on the student’s memory of visiting their doctor. It may be difficult to accurately remember when and how many times they visited. Hearing tests may only be done once a problem with hearing is identified.
Eyesight Test
What is it?
Eyesight test is based on TDSB students (grades 4 to 8) who reported how often they usually go to a doctor for an eye test. “Yearly” includes students who responded “Once a year or more” and “Once every few years or Once” includes “Once every few years” or “Once”.
Limitations:
This Indicator is based on the student’s memory of visiting an eye doctor. It may be difficult to accurately remember when and how many times they visited. There may also be cases where the student did not realize they were receiving an eyesight test.
18-month Well Baby Visit
What is it?
The 18-month well baby visits is the percentage of one-year old children who completed an 18-month well baby visit check-up and are registered for health care. The indicator is calculated using physician billing claims data from the Ontario Health Insurance Plan (OHIP).
Limitations:
This indicator is only able to capture visits that are recorded using the appropriate physician billing code. Increase in rates over time could reflect an increase in the uptake of billing code, rather than the visit itself. Moreover, the 18-month well baby visit is not the only avenue to assess developmental progress and needs.
Immunization compliance
What is it?
Immunization Compliance is based on the percentage of students who were compliant with Ontario’s Routine Immunization Schedule. Under the Immunization of School Pupils Act, Toronto Public Health is responsible for the collection and assessment of student immunization records.
Limitations:
Given restriction in how data is captured, further analysis by income or other socio-demographic characteristics is not currently available.
Self-rated physical health
What is it?
Self-rated physical health is based on the percentage of TDSB students (Grades 7 to 8) who rated their physical health as either “Good,” “Very Good,” or “Excellent” and those who rated their physical health as “Poor,” “Fair,” or “Average.”
Limitations:
This indicator is highly subjective and relies heavily on students’ understandings and/or perceptions of physical health. Understandings of physical health are impacted by a variety of factors including culture, education etc. and thus, may vary drastically from person to person.
Physical health & well-being
What is it?
Physical health and well-being is based on the percentage of kindergarten children who scored on-track, at-risk and vulnerable based on 13 questions in areas of physical development (i.e. gross and fine motor skills, energy levels, independence in looking after own needs, and daily living skills.) The vulnerability cut-off for this domain is 7.3 out of 10 and the at-risk cut-off for this domain is 8.1 out of 10.
Limitations:
Children’s physical development can occur at different times. Children who are younger are more likely to score lower in this domain. The range of results in the EDI physical development domain has tended to be quite small, which means the scores of vulnerable children on this domain are not necessarily much lower than non-vulnerable children.
Breastfeeding
What is it?
Breastfeeding is measured by two indicators. Intention to breastfeed measures the percentage of women who indicated (during their pregnancy or at the time of birth) that they intended to breastfeed their infant(s). Infant feeding measures the percentage of infants who were being breastfed exclusively (breast milk only) or non-exclusively (e.g. combination of breast milk and substitute). Infant feeding was measured at different points in time such as at the hospital after giving birth or two to six months after birth.
Limitations:
The breastfeeding indicator should be interpreted with caution due to high missing responses for this indicator. Information about breastfeeding at other time points, such as at 6-months, is currently not available. Intention to breastfeed data from BORN and infant feeding data from the 2017 IFSP is self-reported, and thus may be subject to social desirability bias. It is likely that breastfeeding decreases after mothers leave the hospital.
Low Birth Weight
What is it?
Low birth weight is defined as a birth weight of less than 2,500 grams (5.5 pounds), regardless of gestational age. Low birth weight refers to the number of babies born low birth weight, expressed as a percentage of all live births.
Limitations:
This indicator does not consider gestational age (weeks of the pregnancy) or ethnicity, which are known confounders of low birth weight. Birth weight is only one dimension of a healthy birth and pregnancy.
Smoking During Pregnancy
What is it?
Smoking during pregnancy is based on the percentage of mothers who reported smoking at any time during pregnancy. Any smoking refers to smoking any amount of cigarettes during pregnancy, including those who did not know how many cigarettes were smoked.
Limitations
Smoking during pregnancy may be underreported, in part due to diminished social acceptance of this behaviour. As such, these rates could underestimate the true rate.