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Inner City Health Promotion Needs Assessment and Policy Recommendations to Support Delivery of Programs and Services Open Access


Other title
employment status
legal status
health needs
Drug Use Disorders Identification Test
health services delivery
health status
health system use
Brief COPE
problematic alcohol use
access to health information
avoidant coping
social supports
health care costs
Alcohol Use Disorders Identification Test
access to health services
housing first
problematic drug use
visual analogue scale
needs assessment
chronic disease
health services planning
Inner city
Charlson Comorbidity Index
active coping
ARC questionnaure
cultural identity
determinants of health
mortality risk
Type of item
Degree grantor
University of Alberta
Author or creator
Fung, Terry L
Supervisor and department
Dr. John Church, Department of Political Science (supervisor), University of Alberta
Examining committee member and department
Dr. Candace Nykiforuk, Centre for Health Promotion Studies, University of Alberta
Dr. Kathryn Dong, Faculty of Medicine and Dentistry, Department of Emergency Medicine, University of Alberta
Dr. Tom Noseworthy, Associate Chief Medical Officer for Strategic Clinical Networks, Alberta Health Services; and Professor, Health Policy and Management, Department of Community Health Sciences and O’Brien Institute, University of Calgary.
Dr. Ian Colman, Department of Epidemiology and Community Medicine, University of Ottawa
Centre for Health Promotion Studies

Date accepted
Graduation date
Master of Science
Degree level
Background: In Alberta, and across Canada, health care costs continue to rise at an unsustainable rate. Over the past five years, the cost of delivering healthcare has outpaced the annual rate of inflation by nearly four percent. Health services use is driven by health needs and characteristics associated with health status. Through the investigation of health status, characteristics associated with health status, types of health services and information available, and policies that support the delivery of programs and services to Edmonton’s vulnerable inner city residents. We looked at how, in a system with escalating costs, unnecessary use can be mitigated by having the right service in the right place at the right time. Methods: 110 vulnerable inner city adults were recruited from the Boyle Street Community Services drop-in program and the Boyle McCauley Health Centre, in downtown Edmonton, Alberta, between September 2011 and February 2012. Cross-sectional data was collected on health status, health determinants and access to care. Linear regression analysis was used to investigate the association between health status and age, gender, cultural identity, education, income level, social supports (being in a relationship/living alone/having children), legal status, employment status, quality of food consumed, housing status, problematic alcohol and drug use, strategies to cope with life stressors, chronic disease, and depression. Descriptive statistics and qualitative analysis was used to understand access to services and information to identify needs. Finally, a review of Canadian health promotion policy influences and evidence-based initiatives to support health promotion constructs and achievement of the pre-requisites for achieving better health, to generate healthy public policy recommendations suitable to the local and provincial context was completed. Results: Edmonton’s inner city residents experience a significantly compromised health status, where 72% have lower physical health and 69% have lower emotional well-being than men and women of similar age. Lower health status is most strongly associated with chronic disease, Emergency Department use, age, mental health (depression and coping), housing, and value of personal possessions. One protective factor for lower health status is having children. In Alberta 1% of the population account for 44% of healthcare expenditures and they have a 28% predicted 1-year mortality rate; which is similar to the 26% predicted mortality rate of Edmonton’s inner city residents whose health needs require significant program and service supports. Interpretation: In order to offset increasing fiscal pressures and improve the health of Edmonton’s inner city residents, an immediate investment in the following Alberta policy alternatives is required: - Expand the Alberta Human Services integrated housing and supports framework model; - Continue to build integrated Alberta Health Services mental health and addictions supports; - Expand the Alberta Health Services Community Health Centres model; - Improve service coordination through the Alberta Health Services, Royal Alexandra Hospital Inner City Health and Wellness Campaign, The Alex and CUPS; and - Invest in Alberta Primary Care Network programs.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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