Seven societal investments for health


By Margaret Angus


Where should we invest to create a healthier society? Dr. John Frank, director of the Scottish Collaboration for Public Health Research and Policy, says most of our most important and influential investments for better health are not in the health care system.


Dr. Frank, who completed his training in Medicine and Community Medicine at the University of Toronto and in Family Medicine at McMaster University and now holds a chair in public health at the University of Edinburgh, hosted a public talk on Oct. 26 at the Halifax Central Library. The event was sponsored by the National Collaborating Centre for Determinants of Health, IWK Health Centre, Atlantic Health Promotion Research Centre and Dalhousie University.  

There are seven societal investments can we can make to create a healthier population across socioeconomic levels, said Frank.

Investments in early life

  1. Universally accessible free, strongly promoted and high-quality ‎family planning, pre- and perinatal care, including breastfeeding promotion and support.
  2. Lifting all parents of young children out of poverty through tax breaks and transfers. “There are permanent consequences of being raised in poverty from living under constant stress,” said Frank.
  3. Universally accessible, high-quality development/education program, located in every neighbourhood. Frank says universally accessible day care doesn’t go far enough if there’s not a focus on stimulation and education.
  4.  Systematic support to achieve universal female and male secondary/subsequent education. 

Investments in adult life

  1. Accessible, sustainable, high quality and free point-of-care primary and secondary health care - with strong public health services for health promotion, disease and injury prevention and health protection. While Frank acknowledges Canada’s strength in having a universal health care system, he points to the gaps left by not having universal dental care and drug coverage.
  2. ‎Strong economic and marketing controls on tobacco, alcohol, unhealthy foods, gambling and similar hazards.
  3. Green policies for sustainable, equitable economic development, including full, meaningful employment


Rob Strang, Nova Scotia’s medical officer of health, joined Dr. Frank at the event to provide a Nova Scotian context. Strang said we need to start by talking about “What kind of communities and society do we want?” Impacts on health will follow.

Strang also pointed to the recent One Nova Scotia Coalition report, Now or Never: An Urgent Call to Action for Nova Scotians, which provides recommendations for building our economy.

“These (factors) all have huge impacts on the economy,” says Strang. “We can't afford not to have every Nova Scotian contributing to society. We have an opportunity to bring some of these issues to the fore.”

How do we do that? “We need to be talking much, much more about health and not about health care,” said Strang. He advised that with every decision we make within the health system, we need to ask, “Where is the evidence that this is going to be better for the collective?”

Strang pointed to Nova Scotia Health Authority’s (NSHA) Talk about health initiative as an important opportunity for changing how we think about health and health care. As part of its public engagement strategy, Talk about health, NSHA will be hosting online and face-to-face conversations along with partners in many other sectors, including many of its 37 Community Health Boards across the province. These conversations will help provide direction for a healthier way forward. To learn more about what’s driving Talk about health, read Nova Scotia Health Authority invites Nova Scotians to Talk about health. To join the conversation, visit