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Developing Meaningful Indicators to Measure Population Health and Health Equity in Health Systems

It is critical for health systems to invest in a population health approach to function optimally and ensure system sustainability. Where health systems remain vulnerable to competing priorities and fiscal constraints, the implications of health service and delivery systems not investing in population health cannot go ignored. In Canada, socioeconomic health inequalities results in $6.2 billion of direct health care costs annually (representing 14% of acute care costs in the form of inpatient hospital admissions, prescription drug costs, and physician consultation services); furthermore, 60% of these direct costs are attributed to persons within the lowest income group. 


Inequities in health that arise due to the social determinants of health are a global killer requiring urgent, intersectoral, whole-of-government attention and action; adopting an upstream approach within the health system is recognized to make the most meaningful impact on population health.

Nova Scotia is confronted with significant health system challenges that coincide with poor health in the population and health inequities. The Nova Scotia Health Authority (NSHA) – the legislated provincial health service and delivery system for Nova Scotia-undergoing rapid transformation and provides an opportunity to be a test case to generate evidence within an emerging area of health services and policy research. In order to achieve full system impact and transformation, measurement is key. Health system decision makers and stakeholders must be equipped with meaningful indicators, related tools and metrics to assess progress in system transformation and impact around population health and health equity action.

Read our snapshot on this topic here.

Flagship Project Co-Leads


Dr. Mohammad Hajizadeh

Faculty of Health

Dr. Katherine Fierlbeck

Department of Political Science

Flagship Project Community Lead:

Dr. Nathalie Saint- Jacques


Translating Research into Action

Roundtable Discussion
November 18, 2022

In honour of National Child Day, Dalhousie University's Healthy Populations Institute, in partnership with the IWK Mental Health & Addictions, and the Nova Scotia College of Social Workers (NSCSW), hosted a 'Fishbowl Conversation'  event featuring a collective of passionate advocates for a critical conversation on child and youth well-being in Nova Scotia and the formation of a provincial Child and Youth Commission. The event was an in-person panel discussion with almost 200 attendees held on Dalhousie Campus with an online audience, to facilitate a critical conversation that highlights recent, relevant and multi-faceted reports on child and youth rights and well-being. A report of this critical conversation was published and  will be a joint submission to the newly announced Nova Scotia Child and Youth Commission Steering Committee.

August 2023

Flagship Project Community Lead Nathalie Saint-Jacques published a new article in Science Direct on the Nova Scotia Community Cancer Matrix. he Nova Scotia Community Cancer Matrix (NS-Matrix) study was established in Nova Scotia (NS), a small province in Eastern Canada with a population of 1 million. The study integrates small-area profiles of cancer incidence with cancer risk factors and socioeconomic conditions, to inform locally relevant and equitable cancer prevention strategies. The NS-Matrix Study includes over 99,000 incident cancers diagnosed in NS between 2001 and 2017, georeferenced to small-area communities. Read the article here and the corresponding community snapshots here. 



42 snapshot reports providing socio-economic profile on communities throughout NS now available on cancer care website

July 2022

The Healthy Populations Institute (HPI) at Dalhousie has been supporting this initiative for over a year, working with a research team at the Cancer Care Program, led by Dr. Nathalie Saint-Jacques. The snapshots are the first knowledge products released from a study aiming to profile community-level cancer risk and how it relates to the social and material conditions in which people live.  The shift to knowledge translation efforts is the basis of HPI’s five year strategic plan. 


The information provided in these snapshots is key to informing the development of an effective, equitable and sustainable cancer prevention strategy. It will also inform the Cancer Care Program, the larger heath system including chronic disease partners, government and communities as we work together to improve the health of all Nova Scotians. More information is provided below.

Check out the snapshots here.



May 2022

Hosted in partnership with the MacEachen Institute for Public Policy and Governance, HPI brought together thought leaders and youth representatives to engage with the findings from the recent One Chance Report. Panelists highlighted the most pressing issues facing young people in Nova Scotia which undermine their well-being and discussed policy shifts which could result in their experiencing the benefits of rights  during their one chance to be a child. This event generated. great interest with 110 registrants and 54 participants. Watch the event here. 



April 2022

A new report on child and youth well-being in Nova Scotia, led by Dalhousie University’s Department of Pediatrics and the Healthy Populations Institute, is providing the first comprehensive snapshot of child and youth well-being in the province. The One Chance to Be a Child data profile represents the work of a multidisciplinary team of service providers, academics and community leaders across Nova Scotia, and is aligned with HPI’s flagship project “Designing Supportive Environments for Chronic Disease Prevention”. 


Using data from national and provincial surveys, the data profile is based upon the Canadian Index of Child and Youth Well-being produced by UNICEF Canada, and uses a child rights lens that included the voices of young people in what matters to their health and well-being. The report has six key recommendations that address broad issues like racism, discrimination and poverty, with 12 specific actions, including investing in a system to collect and monitor key data about children, using child rights impact assessments when making key decisions and passing legislation to keep the issue of child poverty reduction on the agenda of future governments.


Read the report here

Watch the 3 minute whiteboard animation on the report here.

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Co-Lead Dr. Hajizadeh investigated factors underlying the difference in psychological distress and suicidal behaviours between non-Indigenous and Indigenous populations living off-reserve in Canada.
Read the paper here.
March 8, 2021

The HPI "Indicators" Flagship Team has released a commentary exploring Public Health investment in Nova Scotia. They analyzed Nova Scotia Department of Health and Wellness budgets from 2015−2016 to 2019–2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5–6% of healthcare funding be spent on public health.

Read the full article here.
February 24, 2021

January 2021

Co-Lead Dr. Fierlbeck provides input on why she thinks that this Flagship Project is so valuable and why she is a member of HPI. Read her interview here.

Check out Dr. Fierlbeck's Book, "Boundaries of Medicare: Public Health Beyond the Canadian Health Act" here.

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