MHLU - Health Status Resource

Self-Rated Health

Self-Rated Health

Key Findings: 

Aspects of self-rated health such as self-perceived health, self-perceived mental health and community belonging are important overall predictors of wellbeing, disability, ill health and death. These general health indicators can help health planners and policy makers identify over-all priority populations at increased risk of poor health outcomes.1

The majority of residents of Middlesex-London reported positive health and even more reported positive mental health. Of concern is the 10% of the population aged 12 and older that rated their general health as poor or fair in 2015/16, suggesting that they are potentially vulnerable to illness and premature death.

Self-perceived health significantly declined with age, though neither self-perceived mental health nor community belonging showed this same decline by age group in Middlesex-London. There were no overall differences by sex or between Middlesex-London, Ontario and the Peer Group on the three self-rated health indicators in 2015/16.

There were significant differences by sub-groups within Middlesex-London for self-perceived health and mental health, specifically by income group, employment status and urban/rural region of residence in 2015/16. The biggest absolute difference (33.2%) was in the proportion that reported very good or excellent self perceived health between the highest and the lowest household income groups. Unlike self-perceived health and mental health, there was little variation by sub-group in community belonging. Self perceived health and mental health within urban Indigenous adults is reported elsewhere, and showed vast differences from the general population in self-rated health. Only a quarter of urban Indigenous adults reported excellent or very good self-perceived health (25%) and just under a third reported very good or excellent mental health (31%) in 2016.2

Perceived health Community belonging
Perceived mental health  

Perceived Health

Generally, Middlesex-London residents consider themselves to be healthy. Six out of every 10 residents aged 12 and older rated their health as very good (36.6%) or excellent (23.4%) in 2015/16 and approximately one in ten rated their health as fair 6.6%) or poor (3.4%) (Figure 3.1.1).

Very good or excellent self-perceived health was the same for Middlesex-London, Ontario and the Peer Group. (Figure 3.1.2).

Self-perceived health decreased with age. A significantly higher percent of those aged 12 to 19 rated their health as very good or excellent (81.1%) compared with those aged 45-64 (55.8%) or those 65 and older (49.4%) (Figure 3.1.3).

Self-perceived health differed by residents’ household income and employment status and whether or not they lived in an urban population centre or rural area.

A significantly higher percent of residents aged 12 and older in the highest household income group (Quintile 5) rated their health as very good or excellent (77.6%) compared with residents in the other income groups (Figure 3.1.4).

A significantly higher percent of residents aged 15 to 75 that had a job rated their health as very good or excellent (64.8%) as compared to those that did not have a job (47.6%) (Figure 3.1.5).

A significantly higher percent of residents aged 12 and older that lived in rural areas (72.5%) as compared to those that lived in urban population centres (58.5%) rated their health as very good or excellent (Figure 3.1.6).

A similar percent of females (59.2%) and males (60.8%) aged 12 and older rated their health as very good or excellent in Middlesex-London (not shown). Similarly, there was little variation by education level in self-perceived health.

Interpretation
The self-rated health indicator measures an individual's perception of his or her overall health. It refers to a person's health in general—not only the absence of disease or injury but also the presence of physical, mental and social well-being. Good-to-excellent self-reported health status correlates with lower risk of mortality and use of health services. Fair or poor self-reported health status is a good predictor of subsequent illness and premature death.3

Overall, Middlesex-London residents are healthy. However, given the results, approximately 1 in 10 residents of Middlesex-London aged 12 and older rated their health as fair or poor (9.9%) and are at higher risk for illness and mortality; this increases to almost 2 in 10 among those aged 65 and older (17.5%) (data not shown). Furthermore, this risk is higher among sub-groups that may be considered priority populations for public health interventions including lower household income groups, those who are unemployed and urban dwellers.

Perceived Mental Health

Most Middlesex-London residents aged 12 and older (70.2%) reported having positive mental health in 2015/16 (very good, 34.3% or excellent, 35.9%). A small percent rated their mental health as fair or poor (7.5%) in 2015/16 (Figure 3.1.7).

Self-perceived mental health was the same for Middlesex-London, Ontario and the Peer Group. Approximately seven out of every 10 residents aged 12 and older rated their mental health as very good or excellent in all three jurisdictions in 2015/16 (Figure 3.1.2).

Self-perceived mental health differed by residents’ household income, employment status and whether or not they lived in an urban population centre or rural area.

A significantly higher percent of residents aged 12 and older in the highest household income group (quintile 5) rated their mental health as very good or excellent (81.5%) compared with residents in the lowest income group (52.8%). The middle income groups were more like the highest income group and similar to each other (Figure 3.1.4). This pattern is different than in Ontario where there was an incremental and significant difference between each income quintile in positive mental health (Ontario Q1:59.9; Q2:66.1%; Q3:71.3; Q4:76.9; Q5:80.8) (not shown).

A significantly higher percent of residents aged 15 to 75 that had a job rated their mental health as very good or excellent (73.0%) as compared to those that did not have a job (57.8%) (Figure 3.1.5).

A significantly higher percent of residents aged 12 and older that lived in rural areas (79.7%) rated their mental health as very good or excellent as compared to those that lived in urban population centres (69.1%) (Figure 3.1.6)

A similar percent of females (66.9%) and males (73.7) aged 12 and older rated their mental health as very good or excellent in Middlesex-London (not shown). Also, a similar percent of each of the age groups rated their health as very good or excellent in Middlesex-London (not shown) and there was no clear pattern by education level (not shown).

Interpretation
Mental health is defined by the Public Health Agency of Canada as, “the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity.”4 Public health plays a key role in mental health promotion which is about, “fostering the development of positive mental health by supporting individual resilience, creating supportive environments and addressing the influence of the broader determinants of mental health.”5

Past assessments have indicated that a self-assessment of mental health corresponds to more complex assessments of mental health status.6

Overall, most Middlesex-London residents reported positive mental health. However, given the results, of concern is the 7.5% of residents of Middlesex-London aged 12 and older that rated their mental health as fair or poor. Risk of poorer mental health is higher among sub-groups including lower household income groups, unemployed and urban dwellers. They may be considered priority populations for public health intervention.

Community Belonging

Over 70% of Middlesex-London residents aged 12 and older are socially connected and have a sense of community belonging. Residents aged 12 and older indicated that their sense of community belonging was very strong (17.7%), somewhat strong (53.8%), somewhat weak (21.9%) or very weak (6.6 in 2015/16 (Figure 3.1.8).

Community belonging was similar for Middlesex-London, Ontario and Peer Group. Seven out of every 10 residents aged 12 and older indicated that their sense of community belonging was very or somewhat strong (Figure 3.1.2).

Community belonging was similar across all sub-groups by residents’ sex (not shown), age group (not shown), household income group (Figure 3.1.4), education level (not shown), employment status (Figure 3.1.5) and whether or not they lived in an urban population centre or rural area (Figure 3.1.6).

Interpretation
Sense of community belonging is a self-reported indicator that measures an aspect of residents’ personal resources. In the Ontario Chief Medical Officer’s recent report, “Connected Communities: Healthier together”, it was indicated that people with a strong sense of community belonging — regardless of their income — experience significant health benefits compared to those with a weak sense of connection; having a strong sense of connection makes both individuals and communities more resilient.7

Sense of community belonging embodies the social attachment of individuals and reflects social engagement and participation within communities. This type of indicator supports an "upstream" approach to preventing illness and promoting health. It has been associated with physical and mental health. 8,9

Overall, most Middlesex-London residents indicated that they are connected with their community. However, of concern is the approximately 1 in 4 residents aged 12 and older of Middlesex-London who indicated that their sense of community belonging was somewhat weak or weak.

How this Indicator was Calculated:

Self-perceived health

Self-perceived mental health – Percent of the population aged 12 and over who reported perceiving their own mental health status as excellent, very good, good, fair or poor (excluding don’t know responses).

Community belonging – Percent of the population aged 12 and over who describe their sense of belong as very strong, somewhat strong, somewhat weak or very weak (excluding don’t know responses). 

Interpretive Notes

These three indicators, self-perceived health, self-perceived mental health and community belonging come from the self-reported, cross-sectional, Canadian Community Health Survey 2015/16. Excluded from the survey's coverage are: persons living in First Nation Communities full-time members of the Canadian Forces; the institutionalized population, and children aged 12-17 that are living in foster care.

Tests of significance were used to establish significant differences between household income groups and between urban and rural regions.

Ontario Public Health Standard: 

Population Health Assessment and Surveillance Protocol, 2018

Ontario Public Health Standards: Requirements for Programs, Services, and, Accountability - Chronic Disease Prevention and Well-Being (page28)

Mental Health Promotion Guide, 2018 

References: 

1.  DeSalvo KB, Bloser N, Reynolds K, He J. Muntner P. Mortality prediction with a single general self-rated health question: a meta-analysis. J Gen Intern Med. 2006 Mar;21(3):267-75.

2.  Southwest Ontario Aboriginal Health Access Centre [Internet]. London, ON. Our health counts London, ca 2018 [cited 2018 Nov 27] Available from: http://soahac.on.ca/our-health-counts/

3.  CIHI’s Indicator Library [Internet]. Ottawa (ON): Canadian Institute for Health Information. 1996 - . [Part], Perceived health; [cited 2019 May 27]; [about 1 screen]. Available from: http://indicatorlibrary.cihi.ca/display/HSPIL/Perceived+Health

4.  Public Health Agency of Canada [Internet]. Ottawa (ON): Public Health Agency of Canada; [modified 2019 May 6]. Mental health promotion; [modified 2014 May 6; 2019 May 27]; [about 2 screens]. Available from: https://www.canada.ca/en/public-health/services/health-promotion/mental-...

5.  Canadian Institute for Health Information. Improving the health of Canadians: exploring positive mental health [Internet]. Ottawa (ON): Canadian Institute for Health Information; 2009 [cited 2019 May 27]. 103 p. Available from: https://cpa.ca/cpasite/UserFiles/Documents/Practice_Page/positive_mh_en.pdf

6.  Gilmour H. Positive mental health and mental illness. Health Rep [Internet]. 2014 Sep [cited 2019 May 27]; 25(9):3-9. Available from: https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2014009/article/14086-en...

7.  Ministry of Health and Long-Term Care, Office of the Chief Medical Officer of Health. Connected communities: healthier together - 2017 annual report of the chief medical officer of health of Ontario to the Legislated Assembly of Ontario [Internet]. Toronto (ON): Ministry of Health and Long-Term Care; 2019 Feb [cited 2019 May 27]. 38 p. Available from: http://health.gov.on.ca/en/common/ministry/publications/reports/cmoh_19/...

8.  Statistics Canada. Healthy people, healthy places [Internet]. Ottawa (ON): Statistics Canada; 2010. Community belonging; [cited 2019 May 27]; p. 79-82. Available from: https://www150.statcan.gc.ca/n1/en/pub/82-229-x/82-229-x2009001-eng.pdf?...

9.  Shields M. Community belonging and self-perceived health. Health Rep [Internet]. 2008 Jun [cited 2019 May 27]; 19(2):1-10. Available from: https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2008002/article/10552-en...

Last modified on: June 21, 2019

Jargon Explained

Self-perceived health 
Population aged 12 and over who rated their own health as either excellent or very good when asked, “In general, how would you say your health is: excellent, very good, good, fair or poor?”

Self-perceived mental health 
Population aged 12 and over who reported perceiving their own mental health status as being excellent or very good when asked, “In general, would you say your mental health is: excellent, very good, good, fair or poor?

Community belonging 
Population aged 12 and over who described their sense of belong as somewhat strong or very strong when asked, “How would you describe your sense of belonging to your local community? Would you say it is: very strong, somewhat strong, somewhat weak or very weak? “