United Way Seniors Vulnerability Report - The Province

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United WaySeniors VulnerabilityReportAging with Dignity Making it Happen for Everyone2011

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Table of contentsAcknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Investment for seniors is a United Way priority . . . . . . . . . . . . . . . . . . . . . . . . . 6Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Multiple dimensions of vulnerability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Seniors population projections and socio-demographic overview . . . . . . . . . . 14Economic security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Mental and physical health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Emotional wellbeing and living arrangements . . . . . . . . . . . . . . . . . . . . . . . . . 28Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Transportation, transit and walkability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Physical mobility and the built environment . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Recommended strategic directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423

AcknowledgementsThis report could not have been possible without the support and guidance of thefollowing advisors: Aileen Murphy (City of Surrey) Beverley Pitman (United Way of the Lower Mainland) John Stark (City of New Westminster) Mariam Larson (Voices of Burnaby Seniors and New Westminster Seniors Network) Margaret Manifold (City of Burnaby) Neil Spicer (Metro Vancouver) Tucker Doud (United Way of the Lower Mainland) Viv Christison (North Shore Seniors Planning Table)We also thank the following experts for their insightful discussions of topics relevantto vulnerability among seniors in Metro Vancouver and the Sea to Sky corridor. A kber Mithani (Clinical Associate Professor, Department of Psychiatry, UBC andVice President, Centre of Innovation, Providence Health) Andrea Procyk (Project Coordinator, School of Community and Regional Planning,UBC) Jean-Francois Kozak (Co-Director, Primary Care of the Elderly Research Group,Department of Family and Community Medicine, Providence Health Care) Lawrence Frank (Professor, School of Community and Regional Planning andBombardier Chair in Sustainable Transportation, UBC) Karen Kobayashi (Associate Professor, Sociology and Research Affiliate, Centre inAging, UVic) Maureen Ashe (Assistant Professor, Department of Family Practice and Investigator,Centre for Hip Health and Mobility, UBC)In addition, we thank Eric Hertzman for his technical expertise in producing thehighly informative and visually striking maps for this important project.We gratefully acknowledge the ongoing activities of Statistics Canada and, inparticular, its valuable work with the long form census.Finally, we are especially grateful to the Social Planning and Research Council ofBritish Columbia (SPARC BC) for leading and coordinating the research and analysiswork for this project.4

IntroductionThis report focuses on vulnerable seniorsin Metro Vancouver and the Sea to Skycorridor. 1 It recognizes multiple dimensions of vulnerability in order to graspthe situation of at-risk seniors and identify ways to improve their quality of life.The contents of this report are basedon a review of relevant statistics andsecondary literature pertaining to thequality of life of vulnerable seniors inour region, as discussed in a series ofdiscussion papers authored by scholarsand researchers from post-secondaryinstitutions and public interest researchorganizations in BC.The report is divided into severalsections, each of which features key factsand discussion points. Throughout thereport, maps are presented regardingconditions affecting seniors which inturn identify ‘hot spots’ or clusters ofat-risk seniors in Metro Vancouver andwhere possible the Sea to Sky corridor.Socio-demographic indicators are presented after this introduction, which isfollowed by a discussion of economicsecurity issues affecting seniors. Mentaland physical health matters negatively affecting seniors are explored next.The living arrangements and emotional well-being of seniors are discussedin the subsequent section, which isfollowed by a review of key housingfacts and trends contributing to seniors’vulnerability. Transportation, transit and issues of walkability for seniorsconstitutes the next section. The second last section focuses on physicalmobility and related considerationsfor the built environment. Strategicdirections for research, services/programs and policy pertaining to vulnerable seniors are described in the finalsection in an effort to advance the dialogueand action leading toward improved wellbeing for all seniors in our region.The report is accompanied by sixdiscussion papers, each of which elaborateson one dimension of vulnerability. Ninecommunity information bulletins serveas additional companions to this report,providing analysis of key socio-demographic and economic indicators formunicipalities in the region. The bulletinsare intended for use at the municipal leveland by seniors’ community planning tables.1 Seniorsare defined as people aged 65 or older unless otherwise stated. For more on this definition, see: Turcotte, M., & Schellenberg, G. (2007).Catalogue no. 89-519-XIE. A Portrait of Seniors in Canada. Produced for Statistics Canada: Social and Aboriginal Statistics Division. Retrieved onJuly 22, 2011. www.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno 89-519-XIE&lang eng.5

Investment for seniors is aUnited Way priority“It is a priority for United Way of theLower Mainland to work together withpartners to support an active agingagenda and ensure that seniors have theopportunity to live well and contribute tothe community.”United Way has been supporting servicesfor seniors in the Metro Vancouver/Sea toSky area for decades.Research demonstrates that by focusingon the following issues faced by seniors,we can strengthen our community in away that benefits us all.With one in five seniors living in poverty– and with seniors soon to outnumberchildren in many Lower Mainland communities – we face a growing risk of senior vulnerability and isolation. Ignoringtheir needs today means tough challengestomorrow, as the impact of demographicchange quickens and the implications ofan aging society is felt by all of us. Whenolder people are lonely and isolated, pooror homeless, we all lose.United Way is helping seniors to agewell – in their own homes and communities, surrounded by friends, families andcaregivers. Our goal is independent andengaged seniors who contribute fully tosociety. By providing seniors with thesupport they need, United Way preventsisolation, loneliness, and related healthproblems. We can change the future byhelping seniors live independently for aslong as possible.Today, United Way of the Lower Mainlandis a catalyst for action by organizationsand individuals devoted to strengtheningour community. For example, United Wayhelped to establish and is now funding10 seniors community planning tablesthroughout the region and in 2011, aregional senior community planning tablewas launched.We prevent problems by:United Way brings together the resourcesneeded to improve lives and strengthencommunities. We invest in preventativesocial services throughout 23 communities, from Pemberton to Langley. Together,with a network of community partners,we’re building a healthy, caring andinclusive community.We build partnerships by:United Way of the Lower Mainland doesmore than raise and distribute funds tothe community.6 Focusing on underlying causes; Engaging in community-basedplanning solutions; and, Strengthening community capacityto help those who are vulnerable. Identifying shared goals forcommunity change; Providing the foundation forcommunities to work together;and, Supporting the most comprehensivesocial service collaboration in BC.

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Executive summaryThis report focuses on key socio-demographic and economic facts pertaining tovulnerable seniors in Metro Vancouverand the Sea to Sky corridor. Specialattention is paid to analyzing anddiscussing primary data and relatedissues that affect older adults who areat-risk in various ways.The purpose of this report is to reviewfactors facing vulnerable seniors in orderto build a vision for how the United Wayof the Lower Mainland (UWLM) can targetinvestments and work with community partners to create supportive,age-friendly communities. The reportbuilds on the good work already going on in communities and adds important insights about how to tacklethe social, economic, cultural andbuilt environment-related conditionsthat have the greatest detrimental impacton the lives of older adults. The mapsfeatured throughout the report highlightareas of the region where concentrationsof at-risk seniors reside and where themost work needs to be done.This summary provides a snapshot ofthe key facts and discussion pointspresented in the body of the report.Key socio-demographichighlights In 2010, there were an estimated677,770 seniors in British Columbia.In Metro Vancouver, 2 there were316,972 seniors (13 percent of thetotal population). The SquamishLillooet Regional District 3 had 3,152seniors (8 percent of the total population). The first baby boomers (born between 1947 and 1956) are turning 65this year. The total number of 55 to64 year olds in Metro Vancouver in2006 was almost as large as the totalnumber of seniors 65 in the sameyear. We are on the verge of a majordemographic shift as baby boomershit their senior years: by 2036,Metro Vancouver’s 65 populationis expected to more than double –close to 1 in 4 people will qualify asa ‘senior.’ Women comprise 56.1 percent ofall seniors in the Lower Mainland(2006). Among seniors 85 , womenoutnumber men by more than 2 to 1. Over half of all Metro Vancouverseniors in 2006 immigrated toCanada with 77 percent arrivingin 1990 or before. Recent immigrant2 Note:In Metro Vancouver,projections suggest the 85 population will increase by200 percent by 2036 from2006 levels, growing from35,700 to 108,300.seniors arriving in 2001 or aftertotaled 5,900 in Metro Vancouverin 2006, making up just 2 percent ofall seniors. Almost one third of seniors in MetroVancouver consider themselvesmembers of a visible minority group.This is the highest incidence ofvisible minority seniors in anymetropolitan area in Canada. Metro Vancouver has a large numberof seniors and older adults withdifferent mother tongues. Fifteenpercent speak neither English orFrench.Key findings on seniors’economic security S ome groupsmore likely tobefore tax low(LICOs)4 , andof seniors arefall below theincome cut-offsthus are moreStatistical information for ‘Metro Vancouver’ is utilized to describe circumstances for the Lower Mainland. The ‘Metro Vancouver’ area ispopulated by residents of the following 21 municipalities: Anmore, Belcarra, Bowen Island, Burnaby, Coquitlam, Delta, Langley (City and DistrictMunicipality), Lions Bay, Maple Ridge, New Westminster, North Vancouver (City and District Municipality), Pitt Meadows, Port Coquitlam,Port Moody, Richmond, Surrey, Vancouver, West Vancouver, White Rock, Electoral Area A and the Greater Vancouver Regional District (GVRD).Data for Abbotsford, Chilliwack and Mission are not included in this report.3 The Squamish-Lillooet Regional District (SLRD) is comprised of four member municipalities - Squamish, Whistler, Pemberton and Lillooet – andfour Electoral Areas – A, B, C, and D. Wherever possible, this report focuses only on Pemberton, Whistler and Squamish since these communitiesare served by the United Way of the Lower Mainland.8

economically vulnerable. Thesegroups include senior women 75 ,both male and female unattachedseniors, visible minority seniors,Aboriginal seniors, recent immigrant seniors, and seniors without acertificate, degree, or diploma. Older seniors (75 ) are more likelyto be living in economic insecurity:23 percent – almost 1 in 4 – of individuals aged 75 in Vancouver fellbelow the before-tax LICO in 2006. Areas of UWLM’s region that are“hotspots” for low-income seniorsinclude: Maillardville/Burquitlam,South Burnaby/New Westminster,Richmond City Centre area, and theDowntown Eastside/Downtown/Mount Pleasant areas of Vancouver. Similar to Canada as a whole, MetroVancouver and Sea to Sky corridorhave witnessed a large improvementin the economic insecurity of seniorsover the past three decades. Since2007, however, this trend seems tobe reversing for Metro Vancouverseniors.Key findings on seniors’mental and physical health There is a correlation between life expectancy and socio-economic status.Seniors in the region’s wealthierneighbourhoods are more likely tolive longer lives than those in poorerareas. Seniors and older adults in BC dealwith the impacts of chronic diseasedaily. In BC, 27 percent of seniors living at home and 38 percent of seniorsin care homes experience chronicpain every day. In Richmond,41 percent of seniors report sufferingfrom arthritis. In Metro Vancouver, 5 to 13 percentof seniors perceive themselves to beliving with ‘a lot of stress.’ Almost half of all seniors in BC havea disability, with rates being higherfor women than men. Residents in Metro Vancouver andSea to Sky corridor are living longerlives than ever before. In MetroVancouver, overall life expectancyranges from 79 to 85 years.Key findings on emotionalwellbeing and livingarrangements for seniors Older adults who live alone andhave small social networks are oftenbelieved to be vulnerable to decreased emotional well-being due totheir limited social connections. In BC, 27 percent of seniors 65 livealone. In 2006, the proportion of seniors aged 75 living along in MetroVancouver and Sea to Sky corridorranged from 16 percent of seniors inWhistler to 53 percent of seniors inthe City of Langley. Other communi-ties with large proportions (40 percent or more) of live-alone seniorsare Bowen Island, the City of NorthVancouver, New Westminster, WestVancouver and White Rock. Women are much more likely thanmen to live on their own. In BC’s 65 population, 36 percent of womenand 17 percent of men live alone.Living alone is also influenced byage, ethnicity, immigration status,and place of residence. Social isolation is more common inwomen than men, especially amongthose who are widowed, amongworking class older adults, andamong those who are in poor healthand have mobility limitations. Noteveryone living alone characterizesthemselves as vulnerable due tosocial isolation. Some value time aloneas solitude while other experiencepainful loneliness. Studies link large supportive socialnetworks to improved healthoutcomes in later life; whereas havinga small unsupportive network increases one’s risk for poor physicaland mental health. The highest proportion of olderadults in Metro Vancouver whoperceive themselves as having a lotof stress live in the more affluentareas of West and North Vancouver.4 Low-income cutoffs (LICOs) “represent an income threshold where a family is likely to spend 20 percent more of its income on food, shelter and clothingthan the average family, leaving less income available for other expenses such as health, education, transportation and recreation. LICOs arecalculated for families and communities of different sizes” (Statistics Canada 2008).9

Seniors living aloneand older adults are moreprecariously housed. Basedon the available 2006 data,approximately 60 percentof unattached senior renterswere spending 30 percentor more of their income onhousing while 26 percentwere spending 50 percentor more.Key findings on seniors’housing In Metro Vancouver, the number ofsenior led households in core housing need 5 has increased since 1996.In the Sea to Sky corridor, there hasbeen a small year over year increasein the number of senior led households in core housing need. Approximately 36 percent of allsenior-led economic families inMetro Vancouver who rented in 2006were spending 30 percent or moreof their income on housing costs,while 12 percent were spending50 percent or more. A significant share of seniors livingalone are precariously housed. Approximately 60 percent of unattached senior renters were spending30 percent or more of their income5 Aon housing while 26 percent werespending 50 percent or more.seniors (80 ) in the shelter systemfor the first time. In Metro Vancouver 6,990 seniorrenter households are in ‘worst caseneed.’ These are households that arespending more than 50 percent oftheir income on their housing costsand are considered to be at extremerisk of becoming homeless. Seniors social housing units are concentrated in Vancouver and Burnaby.As of 2011, there were 2,312 seniorson BC Housing’s Applicant Registrywaitlist, up from 1,946 in 2010. The number of seniors living onthe streets or staying in emergencyshelters is on the rise. Local planningtables and senior service organizations across the region have recentlyreported the presence of frail, olderKey findings on seniors’transportation, transitand walkability As we age, the world we get aroundin shrinks. The travel behaviour ofseniors 65 is considerably differenthousehold is considered to be in core housing need if they are unable to find housing in their community that is suitable in size or in goodrepair without spending 30 percent or more of their income on housing costs.10

than that of other age cohorts. Olderadults take fewer trips out of thehome and for different reasons.Vulnerable seniors, such as olderadults with health concerns, mobilityimpairments or low-incomes, leavetheir homes the least. Older drivers depend on privatevehicles to make the majority oftheir trips. Older adults’ ability tooperate a car, however, can changequickly and those living in cardependent environments canexperience a sudden loss of independence. Older adults who do notdrive are reported to make only halfthe number of trips as their olderdriving counterparts. Wide streets, limited railings andwalkways, fast cars and a dizzyingpace of life can contribute toinsecurity about navigating thecommunity. A mix of land uses (i.e.having a variety of destinationswithin a close proximity) and higherdensity neighbourhoods with wellconnected streets encourage increasedlevels of physical activity as seniorscan walk to close by amenities. Walkability in Metro Vancouvervaries by region. Delta, Langley, PittMeadows, South Surrey and WestVancouver are areas with low walkability and high concentrations ofolder adults. Delta, Maple Ridge,Pitt Meadows, South Surrey andWest Vancouver are also areas withlimited access to transit.Key findings on seniors’personal physical mobilityand the built environment Approximately 134,645 seniors inMetro Vancouver experience activity limitations. The number ofactivity limited male seniors (65 )falling below LICO (before tax)rose between 2001 and 2006, from9,355 individuals in 2001 to 10,610individuals in 2006. The numberof activity limited female seniorsfalling below the LICO (before tax)also rose between 2001 and 2006,from 19,940 individuals in 2001 to20,590 individuals in 2006. Sidewalks – their presence, location,material and condition – can play animportant role in the life of an olderadult. This is especially true forthose older adults who have physicalimpairments. The presence and location of level, unobstructed pathways encourage physical activity. Alack of adequate curb cuts, as wellas cracks and disruptions caused bytree roots are a falls safety hazard. Getting outside has benefits forquality of life and longevity. Vulnerable older adults and seniors withreduced mobility may be at higherrisk of poor physical and mentalhealth.Key overall findingsVulnerabilities in our seniors’ populationare concentrated in certain groups of65 individuals in the Metro Vancouverand the Sea to Sky corridor.Groups most affected include: The “oldest old” women (85 ); Unattached, single-income seniors; Visible minority seniors; Aboriginal seniors; Recent immigrant seniors; Seniors without a certificate, degree,or diploma; and, Seniors with mobility limitationsand/or chronic illnesses.We know that vulnerable older adultsare often concentrated in certain neighbourhoods in our region.As we continue our work together withpartners to support an active agingagenda, the United Way of the LowerMainland will pay increasing attentionto these epicenters of need to helpensure that all older people – andespecially the most vulnerable – have theopportunity to both live independentlyas long as possible and participate intheir communities to reap the positivebenefits of being included.11

Multiple dimensions of vulnerabilityThis report and accompanying information (e.g., discussion papers and community information bulletins) are focusedon vulnerable seniors living in MetroVancouver and the Sea to Sky corridor.Population groups defined as vulnerable,in general, identify with some type ofbarrier to accessing a good quality of life.Dimensions of vulnerability referred to inthis report and accompanying information include but are not limited to: Economic insecurity Social isolation Inadequate and unaffordablehousing Poor mental and physical health Inaccessible transportationand built environments Food insecurity Physical mobility limitations Marginalized identities andcultures Barriers to multi-lingualcommunication and lack ofmulti-lingual servicesBelow we define each dimension ofvulnerability based on points raised inthe companion discussion papers.12 Economic insecurity: Seniors areconsidered to be economically insecurewhen their household does not haveavailable money to buy healthy food,afford appropriate housing, pay forutilities and services, enroll in recreational activities or cover medical anddental costs. In this report we utilizeStatistics Canada’s before tax lowincome cut-offs (LICOs) to measureeconomic insecurity. Statistics Canadaexplains that LICOs “represent anincome threshold where a family islikely to spend 20 percent more of itsincome on food, shelter and clothingthan the average family, leaving less income available for other expenses suchas health, education, transportationand recreation. LICOs are calculatedfor families and communities ofdifferent sizes.” Individuals can havea low income but not live in ‘poverty’because they have financial assets andsavings that may help them throughhard times. Social Isolation: Seniors are generallythought to be socially isolated whentheir social networks are small,weak,or lacking altogether. Having a smallunsupportive network increasedone’s risk for poor physical andmental health. Not all older adultswho live alone consider themselvesto be vulnerable because of theirsolitary lifestyle. Inadequate and unaffordablehousing: Generally, any householdthat is experiencing inadequate andunaffordable housing is said to bein core housing need. To be in corehousing need is to be unable to findhousing in one’s community thatis suitable in size or in good repairwithout spending 30 percent or moreof one’s income on housing costswith available resources. Poor mental and physical health:Physical and mental health is acomplex interplay of biology andgenes, the social, cultural and physical environments that we live in, thehealth services accessible to us andthat we actually receive, and ourown individual behavior. To havereal or perceived poor health is acommon condition for many seniorsin our region and limited availablelocal data makes it difficult to knowmuch about the health trends of ourseniors. Inaccessible transportation andbuilt environments: Older adultswho experience transportation andother services as inaccessible livein households where these thingsare difficult to reach for some reason. They may have physical mobility limitations, live in a (suburban)household without a car, live too faraway from a bus stop, or lack the resources to use public transit. Or theymay live in a neighbourhood without services, like grocery stores, andlack a car to overcome the distancesinvolved. Food insecurity: A lack of foodsecurity is the absence of reliable

access to nutritious food. Food securityis generally understood as thedevelopment of community foodsystems in which food production,processing, distribution and consumption are integrated to enhancethe environmental, economic, socialand nutritional health of a specificplace. Food security is increasinglyframed as a social determinant ofhealth, where weaknesses in the foodsystem can present barriers to accessing healthy local food which can inturn lead to public health problems. 6 Physical mobility limitations:Personal mobility is a key determinantof independence and quality of life.Defined as the capacity of individualsto physically move through theirenvironment, good mobility contributes to a dynamic, independent life,and is fundamental to healthy aging.When a person loses their ability tomove and navigate their environment,their world shrinks dramatically andis often accompanied with negativehealth impacts. B arriers to multi-lingual communication and lack of multi-lingualservices: Older adults who facelinguistic barriers generally do notpossess either English or Frenchlanguage skills and are not able toaccess services in their mothertongue. This may be because they aresimply not available or not availableat costs they can afford.Seniors that identify with any one orcombination of these dimensions ofvulnerability may be less able than othersto meet and safeguard their own needs andinterests. Where groups of older adultsexperience multiple dimensions of vulnerability, and live in such circumstances overextended periods of time, the outcome isoften troubling and persistent disparitieswithin and across our communities.The data in this report suggest thatdisparities within the 65 population arequite common in our region. They are notinevitable, however. Many disparities arethe result of social practices, public policypriorities and a combination of actiontaken without the needs of older membersof the population in mind.To facilitate the identification of neededresearch, programs and policy in MetroVancouver and Sea to Sky corridor regarding seniors’ health and well being, thisreport concentrates on a selection of keydimensions of vulnerability experiencedby many seniors in our region. Throughthese foci, we provide an evidence-basedpicture of what contemporary issues affectthe lives of older adults as well as a lensthrough which we can look into a futurethat we have the ability to shape today. Marginalized identities, culturesand histories: Older adults whoseidentities, cultures or histories are marginalized find themselves relegatedto the fringes of society. Excludedfrom meaningful participation in thelarger society, they are isolated bothindividually and as members oftheir socio-cultural group – in ethnicenclaves, for example. Material deprivation is a common result.6 Although food insecurity is not addressed in this report, the community information bulletins do include some reference to the location of grocery storesand their spatial relation to where concentrations of vulnerable seniors are living in our cities. For more information on food security in the BC context,see: BC Provincial Health Officer. (2006). Food, health and well-being in British Columbia: Provincial Health Officer’s Annual Report 2005. Victoria, B.C.13

Seniors population projections andsocio-demographic overviewIn 2010, there were an estimated 677,770seniors 65 in BC making up 15 percentof the total provincial population. InMetro Vancouver there were 316,972seniors (or 13 percent of the region’s population). In the Squamish Lillooet Regional District (SLRD) there were 3,152 seniors(8 percent of the region’s population). 7We are on the verge of a major demographic shift as baby boomers hit theirsenior years (the first baby boomersturned 65 this year). Projections indicatethat by 2036 Canada’s population ofseniors will be double its 2006 figure,growing from 14 to 25 percent of thecountry’s total population. Close to 1 in 4people will qualify as a ‘senior.’Seniors aged 85 , referred to as the “oldestold”, are the fastest growing segmentof seniors. In Metro Vancouver, the totalnumber of 55 to 64 year olds in 2006was almost as large as the total numberof seniors in the same year. 8By 2036 Metro Vancouver’s 85 population is to increase 300 percent (from35,700 in 2006 to 108,300). Figure 1shows the projected growth of olderadults by age category from 1976 to2036. Note the gradual leveling of the55-64 group.Figure 1: Projected number of adults 55 , by gender and age groups, Metro Vancouver, 1976-2036Source: BC Stats. (2010). Regional Population Estimates and Projections. Retrieved August 24, pulationStatistics/SelectRegionType.asp?category Census7 BCStatistics (2010). Regional Population Estimates. Retrieved August 24, pulationStatistics/Query.asp?category Census&type RD&top

The 'Metro Vancouver' area is populated by residents of the following 21 municipalities: Anmore, Belcarra, Bowen Island, Burnaby, Coquitlam, Delta, Langley (City and District

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