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Placing health and wellbeing on par with economic performance: A Quality of Life Framework for Canada
Canada
World Health Organization | 30 Oct 2023
In Canada, a Quality of Life Framework combines health data with economic, social, governance, and environmental indicators in a holistic approach to measuring well-being. Developed through close collaboration across multiple government departments, the Framework has been integrated into the federal budgeting process and supports government decision-making and reporting. It offers a multisectoral perspective on the complex determinants of health, equity and wellbeing.
About one in three adults in Canada live with at least one of five major noncommunicable diseases (NCDs) and mental health conditions, including cancer, diabetes, cardiovascular diseases, chronic respiratory diseases, and mood or anxiety disorders. People experiencing social and economic disadvantages are reportedly at even greater risk.
The risk factors and determinants associated with NCDs and mental health challenges are often complex, spanning, for example, physical inactivity or unhealthy diets, as well as economic, social and environmental determinants. In addition, good health and wellbeing are not experienced equally by all people living in Canada. Promoting health equity, preventing diseases, and protecting peoples’ physical and mental health therefore require multisectoral interventions that reach beyond the health sector.
In 2019, the Canadian Prime Minister called upon the Minister of Middle Class Prosperity and Associate Minister of Finance to better incorporate quality of life measurements into government decision-making and budgeting, and to partner with the Minister of Families, Children and Social Development and the Minister of Innovation, Science and Industry, responsible for Statistics Canada. Finance Canada took the strategic lead in developing the multisectoral Quality of Life framework, while Statistics Canada led the data management and indicator development.
"The focus on quality of life and wellbeing and the formal leadership through ministerial mandate letters gave the initiative a strong boost and a clear multisectoral and interdisciplinary direction from the very beginning."
- Nancy Gehlen, Public Health Agency of Canada (PHAC) Health Equity Policy Division -
After the official release of the Quality of Life Framework in early 2021, mandate letters ensured whole-of-government commitment and directed all Ministers to apply the quality of life indicators into federal decision-making. A subsequent mandate letter then transferred leadership from the Minister of Middle Class Prosperity and Associate Minister of Finance to the President of the Treasury Board to support government-wide implementation of the Framework later that year.
“The focus on quality of life and wellbeing and the formal leadership through ministerial mandate letters gave the initiative a strong boost and a clear multisectoral and interdisciplinary direction from the very beginning”, said Nancy Gehlen, an analyst in the Public Health Agency of Canada’s (PHAC) Health Equity Policy Division.
Strong collaboration across sectors was also instrumental in getting the Framework across the finish line. To develop the Framework, Finance Canada and Statistics Canada took a consultative approach through interdepartmental discussions, constructive dialogues and transparent communication activities. The process involved over 20 collaborating federal departments and agencies, as well as with provincial and territorial officials, domestic and international subject matter experts within academia and the not-for-profit sector, and National Indigenous Organizations. Multilevel workshops in several departments, for example, helped to develop and finetune indicators with technical expertise and cross-sectoral thinking, and directly engaged staff from working level analysts to senior management.
“The initiative was explicitly framed as an umbrella framework that harmonizes Canada’s advanced portfolio of existing cross-sectoral initiatives, including the Sustainable Development Goals agenda, action on climate change and Health in All Policies. This allowed the Framework to build off of existing activities and indicator frameworks rather than to duplicate them and helped create buy-in across departments. Everyone could see their interests and priorities reflected in the Framework.”, explained Rachel Ma with PHAC’s Health Equity Policy Division.
Source: Quality of Life Hub (Statistics Canada)
The Framework includes 84 indicators across five domains of prosperity, health, society, environment and good governance, spanning from employment and job quality to health-adjusted life expectancy and self-reported mental health, social cohesion and connections, and air and water quality. There are also two cross-cutting lenses: Fairness and Inclusion, aimed at providing greater insight into how wellbeing is experienced by different groups of people, and Sustainability and Resiliency ensuring a long-term perspective on quality of life. People’s subjective wellbeing experience is also reflected with two measures of life satisfaction and sense of meaning and purpose.
Since 2021, the Framework has been formalized in Canada’s federal budget cycle and is part of the annual federal budget impact report. To facilitate knowledge translation and uptake of the indicators, Statistics Canada has published an online Quality of Life Hub, making key indicators and data analysis available publicly.
“As part of the budget cycle, the Quality of Life Framework first and foremost supports decision-making by placing physical and mental health alongside social and environmental determinants on par with more traditional economic performance indicators,” added Nancy Gehlen. “This is a significant shift to improving what matters most to Canadians. Now, when decision-makers are considering strategies for an issue such as climate change, they are explicitly prompted to make links across sectors and leverage evidence on how things like mental health, social connections, safety concerns, or economic status may be impacted” she explained.
"As part of the budget cycle, the Quality of Life Framework first and foremost supports decision-making by placing physical and mental health alongside social and environmental determinants on par with more traditional economic performance indicators. This is a significant shift to improving what matters most to Canadians."
- Nancy Gehlen, Public Health Agency of Canada (PHAC) Health Equity Policy Division -
The Framework’s initial implementation strengthens consideration of health in decision-making and opportunities for collaboration across government departments. Indicators from the health domain, for example, are now frequently cited for budget proposals by other departments, signalling a positive shift towards a sustainable whole-of-government strategy to tackle wellbeing priorities, including NCDs and mental health conditions.
Country story series & digital repository on multisectoral action.
This feature story is part of a series compiling country experiences in leveraging multisectoral action for improved NCD and mental health policies and programmes. Read more on the key role of whole-of-government-approaches to tackle NCDs and mental health conditions in the global mapping report, or visit the digital repository on multisectoral action to explore further country experiences.
This country story is also available as a detailed country case study in the WHO Compendium report on multisectoral actions for the prevention and control of noncommunicable diseases and mental health conditions. Read the full report or directly access the country story via below link.
The Public Health Agency of Canada has developed a series of factsheets to highlight multisectoral action as a strategic policy approach to advance action on the social determinants of health and health equity:
