Full report: Working Together to Thrive: Well-Being and Public Health

The Chief Public Health Officer of Canada's Report on the State of Public Health in Canada 2025

On this page

• Message from the Chief Public Health Officer of Canada
• About this report
  • Orientation of the report
  • Health of people in Canada dashboard
• Executive summary
• Introduction
• Section 1: Well-being concepts and approaches
  • Origins of international well-being initiatives
  • Well-being frameworks, dimensions, and indicators
  • Well-being approaches
  • First Nations, Inuit, and Métis Peoples' concepts of well-being
  • Indigenous wellness teachings through art
• Section 2: Contributions of well-being to public health
  • A positive and strengths-based lens
  • A focus on future generations and the planet
  • A catalyst for intersectoral action
• Section 3: Roles for public health in well-being initiatives
  • Public health frameworks to understand structural determinants of well-being
  • Public health data and evidence to measure well-being inequalities
  • Public health as a champion for intersectoral action
  • Public health's roles and responsibilities in implementing Indigenous rights
• Way forward
  • Applying well-being approaches to public health
  • Contributing to well-being through public health
• Appendix A: Key examples of well-being initiatives
• Appendix B: Methodology
• Acknowledgements
• References

Message from the Chief Public Health Officer of Canada

Well-being matters to everyone. In order to thrive and be productive, we need to have health, quality housing, decent work, strong connections to our family and community, and a sense of hope for the future.

While many people in Canada have a high quality of life overall, recent years have brought significant challenges to our collective well-being. Climate change, the toxic drug crisis, economic pressures, and infectious diseases have affected our daily lives in many ways. The COVID-19 pandemic taught us that how we respond to challenges can also affect core aspects of well-being, like mental and physical health, education, financial security, and social connection.

But the impacts of these challenges have not been the same for everyone. Some communities have been harder hit because they do not have the things they need to enjoy good health and well-being. This is partly because racism, discrimination, and other unfair treatment are still common in our systems and institutions, which can affect many different aspects of daily life and access to opportunities.

Increasingly, and especially for today's youth, the places in which we live, work, and play are now also digital ones that are evolving in real time. We must find ways to harness the benefits of the digital evolution for all, while addressing potential harms to well-being as they arise.

No single community, government, or sector can meet these complex challenges alone. We need to reimagine how we work together for change. This is why my report is calling for attention to well-being as a unifying goal for collaborative action.

In Canada and around the world, we are seeing people come together to promote positive conditions for human and planetary thriving. Many communities in Canada are working to transform local environments to improve their quality of life and resilience. The Quality of Life Framework for Canada aims to measure what matters most to people in Canada, to help drive evidence-based budgeting and decision-making at the federal level. First Nations, Inuit, and Métis Peoples are demonstrating how to nurture the relational well-being of people, animals, the land, and future generations through Indigenous-led and self-determined research, programming, and governance. In this report, Indigenous wellness teachings are powerfully illustrated through the artwork of Dr. Lisa Boivin.

Well-being is also gaining traction internationally as an impetus for societal change. It includes but moves beyond economic indicators as a measure of how we are doing. This is important because we have seen that economic indicators, like gross domestic product (GDP), have risen while some other aspects of well-being have remained unchanged or even worsened. The World Health Organization (WHO) has been promoting whole-of-society action towards well-being as a new chapter for public health, recognizing the potential of this work to achieve health for all. This is anchored in the values and practice of health promotion, an integral part of public health since the Ottawa Charter.

Prioritizing well-being means focusing on the big picture and advancing health, social, economic, and environmental priorities together. It requires multidisciplinary research to understand how all policies and initiatives can impact the things that matter most to people in their lives. With a seat at the table, health leaders can contribute to a range of well-being policies by connecting data to decision making, including insights on health equity and emerging determinants of health, such as digital and commercial. In communities, public health professionals can work with local leaders and across sectors to exchange knowledge, combine resources, and take action on shared goals. Innovation and creativity will come if we learn from and collaborate with the many diverse populations and communities who are experts in their own well-being. We have to do more to understand how racism is built into our systems, institutions, and decision-making, and support the leadership of Black, Indigenous, and other racialized populations who are working for real change. We also need to co-develop ways to thrive with today's youth, who are the leaders of tomorrow. Across the health system, we must build renewed relationships with Indigenous leaders, organizations, and communities to promote holistic well-being, advance reconciliation, and protect Indigenous rights.

This is a transformative task, and not an easy one. Breaking down silos, building trusting relationships, transforming conditions, and evaluating the impacts will take time and unwavering commitment. Future generations are relying on us to stand up to this challenge.

Dr. Theresa Tam
Canada's Chief Public Health Officer

About this report

The annual report of the Chief Public Health Officer of Canada (CPHO) provides an opportunity to examine important issues influencing the state of public health in Canada. These reports are intended to spark discussion and support action to improve population health and the conditions for health. This year's report explores the momentum surrounding well-being as an intersectoral policy goal and approach, and how public health systems can both learn from and contribute to this work to improve the health and well-being of people in Canada. The primary audience for the report is public health professionals, policy makers, and other actors across the many institutions, organizations, groups, and communities that make up public health systems across Canada. However, it is also relevant for professionals from other sectors whose work impacts the determinants of health and well-being.

The report builds on themes from previous CPHO reports, including social and structural determinants of health, intersectoral action, and health equity. In particular, it speaks to the overall purpose of public health to achieve optimal health and well-being for all people in Canada.

Orientation of the report

Section 1 briefly describes the emergence and importance of well-being as a goal and approach among communities and governments in Canada and around the world. It introduces common dimensions and outcomes associated with well-being frameworks, highlights key features of well-being approaches, and showcases First Nations, Inuit, and Métis Knowledges and concepts of well-being.

Section 2 explores opportunities associated with applying a well-being approach in public health, including the benefits afforded by a positive and strengths-based lens, a focus on future generations and the planet, as well as the potential for well-being to be a catalyst for intersectoral action to concurrently advance health, social, economic, and environmental priorities.

Section 3 details proposed roles for public health within broader well-being efforts, including contributing to understanding the structural determinants of health, evidence and data on inequities, championing intersectoral action, and implementing First Nations, Inuit, and Métis rights.

Applied examples are used throughout the report to illustrate how well-being initiatives are supporting the health and well-being of people living in Canada, and to highlight roles for public health.

The Way Forward offers opportunities for public health practitioners, policy makers, and researchers to apply key features of well-being approaches to their work, and to leverage and strengthen public health knowledge and practice for intersectoral well-being initiatives.

Appendix A provides more details on well-being initiatives in Canada and around the world as context on the range of well-being activities undertaken by communities and governments.

Appendix B summarizes report methods, consultations, and engagements with public health and well-being leaders on report development, and limitations.

Note: The hyphenated spelling of "well-being", rather than "wellbeing", is used throughout the report, unless the latter spelling is used in the official title of an organization or initiative.

Health of people in Canada dashboard

Key indicators on the health of people living in Canada can be found in an interactive online dashboard. The CPHO message that accompanies this resource provides a high-level overview of relevant population health data trends. All dashboard information is periodically updated.

Executive summary

Well-being is gaining momentum globally as a shared policy goal and approach, focused on creating the conditions for current and future generations to thrive on a healthy planet. This approach balances health, social, economic, and environmental priorities through whole-of-society action. In Canada, people are facing multiple challenges to their well-being, including extreme weather related to climate change, infectious diseases threats, the toxic drug crisis, rising costs of living, and fast-changing digital environments. A well-being lens recognizes that coordinated work across sectors is needed to address these complex issues and support individual and collective well-being, now and into the future.

Well-being is also used as a measure of societal success, arising from an awareness that economic indicators, like gross domestic product (GDP), cannot fully capture how society is doing. Several groups have developed well-being measurement frameworks (e.g., Canada's Quality of Life Framework, the Organization for Economic Cooperation and Development's Better Life Index). These frameworks track multiple dimensions of well-being, such as income, housing, employment, environment, education, health, social cohesion, and life satisfaction. Since these dimensions are interconnected, improving overall well-being requires collaboration across sectors.

Indigenous Peoples around the world have long been leaders in advancing holistic approaches to well-being that are relational, strengths-based, and rooted in connections to the land and nature. First Nations, Inuit, and Métis Peoples' diverse well-being knowledge systems are complex and dynamic, with a deep history that holds significant value for well-being approaches. The World Health Organization defines well-being as "a positive state experienced by individuals and societies. Similar to health, it is a resource for daily life and is determined by social, economic, and environmental conditions." Since health and well-being are closely connected, creating the conditions that support well-being can also improve population health and health equity. Well-being approaches are well aligned with key aspects of public health practice, including health promotion and a focus on upstream intersectoral action on the determinants of health. This report explores ways to bring the strengths of public health and well-being together to advance shared goals, showcasing both Western and Indigenous well-being frameworks, as well as examples of initiatives led by governments, organizations, and communities.

Building further connections between public health and well-being is explored throughout the report, culminating in a Way Forward section that highlights opportunities for future action by public health professionals to promote the well-being of people and planet.

Well-being approaches and frameworks can support public health priorities in the following ways:

• Well-being offers a positive vision of thriving, resilient populations that are able to reach their full potential. This strengths-based lens helps mobilize action by emphasizing the capacities and necessary resources for communities to promote and maintain health and well-being. It also recognizes that well-being is a resource that can be fostered for everyone, and aligns with Indigenous well-being Knowledges.
• A well-being lens considers both current and future generations while acknowledging the intertwined well-being of humans, animals, and the planet. This perspective can support balancing a concurrent focus on these priorities within public health practice, policy, and research. Indigenous Peoples have long advocated for changes to systems that harm the land and undermine well-being across generations.
• Well-being frameworks facilitate intersectoral action by identifying how a broad collection of health, social, economic, and environmental factors contribute to quality of life. They showcase interconnections across these factors, and how improvements in societal conditions in one area can create positive effects in others. In this way, well-being offers a shared goal that bridges priorities across different sectors.

Public health systems can draw on their strengths and essential functions to support well-being initiatives. Relevant areas of action include:

• Public health research on the structural determinants of health examines how societal, economic, ecological, and political mechanisms drive the inequitable distribution of power and resources, affecting daily living conditions that influence health outcomes. Understanding these factors, including colonization and systemic racism, digital transformation, and the influence of commercial practices, can support well-being initiatives in addressing the structural drivers of well-being inequities.
• Public health professionals' expertise in monitoring health inequalities could also be leveraged to enable the measurement of well-being inequalities. This requires collecting disaggregated data, applying an equity and intersectionality lens, and addressing long-standing data challenges, such as the need for better cross-sector linkage of datasets. Public health systems can also continue to champion community engagement in data stewardship and strengthening support for Indigenous data sovereignty.
• Public health practitioners have knowledge and experience with intersectoral action for health, including work to bring partners together, embed collaboration within funding models, and offer ongoing support to help sustain initiatives. These strengths are closely aligned with health promotion approaches and can contribute to well-being initiatives. Public health can also follow First Nations, Inuit, and Métis leadership in building relationships across sectors.
• Supporting Indigenous well-being by advancing reconciliation, cultural safety, self-determination, sovereignty, and Indigenous rights in a context of sustained and reciprocal relationship-building is a key role for public health systems. Public health practitioners in Canada can engage in respectful dialogue with First Nations, Inuit, and Métis Peoples as thought leaders, scholars, and sovereign Nations to advance well-being approaches that draw on both Indigenous and Western ways of knowing.

Introduction

In Canada and around the world, a focus on well-being has emerged as a policy goal and approach that can foster thriving societies on a healthy planet, now and into the future. Well-being initiatives build conditions for resilient individuals and societies that can respond to current and emerging challenges. They also support a high quality of life that enables people and communities to contribute to the world with a sense of meaning and purpose.^{Footnote 1}

Well-being is defined and understood in different ways across different communities and contexts (see the text box "Uses of the term well-being"). The World Health Organization (WHO) defines well-being as "a positive state experienced by individuals and societies. Similar to health, it is a resource for daily life and is determined by social, economic, and environmental conditions".^{Footnote 2} The WHO definition describes well-being as both an individual and collective state, recognizing that societal well-being is more than the sum of individual well-being. This definition both aligns with and extends beyond similar concepts and approaches in public health, including the social determinants of health, health promotion, and Health in All Policies (HiAP).^{Footnote 2Footnote 3Footnote 4}

Health and well-being are inherently connected. Good health contributes to overall well-being, and the societal conditions that support well-being are also the conditions for population health and health equity.^{Footnote 5} The WHO's Agenda on Well-Being emphasizes the potential of a well-being approach to break down siloes and foster whole-of-society approaches to meeting societal challenges (see quote below).^{Footnote 5} People in Canada, and around the world, are facing a number of concurrent challenges to their well-being, including extreme weather events linked to climate change, new and re-emergent infectious diseases, cost of living increases, polarization and social conflict, and the potential harms associated with rapidly evolving digital environments.^{Footnote 6Footnote 7} As a goal for policy and programming, a focus on well-being can help foster coordinated ways of working together across all sectors of society to meet these challenges.^{Footnote 5} This work is intended to build on collective strengths to improve community conditions for resilience and thriving now and into the future.^{Footnote 7}

"The well-being agenda strives to create social, economic, and environmental conditions that support individual and collective health, quality of life, ability to thrive, the equitable distribution of resources, and planetary sustainability. Societies that centre on this idea of well-being intentionally create resilient, empowered communities, prepared to transcend challenges." (WHO, 2021. Towards Developing WHO's Agenda on Well-Being)

Many of the most important conditions for health and well-being, including social, economic, and environmental factors, lie outside of the health sector. Fast-paced societal changes are increasingly shaping these factors, with important implications for health. One key example is the profound digital transformation experienced in recent years. Digital determinants of health include any factor rooted in or contingent on the digital world that may directly or indirectly influence health or well-being.^{Footnote 8Footnote 9} The increasing reach of digital tools into many aspects of everyday life means that digital determinants are embedded across societal, political, and economic processes that impact health.^{Footnote 8Footnote 9Footnote 10} For instance, digital determinants are connected to the commercial determinants of health, which are the systems, practices, and pathways through which the private sector positively or negatively affect health outcomes.^{Footnote 11Footnote 12Footnote 13} Online platforms are one way people interact with corporate actors and therefore with products, services, and marketing that may enhance or compromise health and well-being.^{Footnote 8Footnote 9} The momentum around well-being as a goal for intersectoral policy action creates new opportunities for public health to collaborate on addressing this and other interconnected determinants of health and well-being.

As fields of work, public health and well-being are connected but distinct. Though they share many goals and priorities, they have unique contributions to make in improving the lives of people living in Canada. The report will explore both the ways that well-being approaches can contribute to public health (Section 2), as well as the ways that public health professionals can contribute to the well-being initiatives led by others (Section 3). The report also acknowledges the many knowledge systems and the strong leadership of First Nations, Inuit, and Métis Peoples in advancing well-being approaches. Indigenous well-being Knowledges and sciences are rooted in a deep history and hold significant value for understanding and meeting contemporary challenges to well-being.

Section 1: Well-being concepts and approaches

Well-being has been a successful catalyst for collaborative action in part because it speaks to the different goals of a variety of communities and sectors of society.^{Footnote 4Footnote 5} As a concept, well-being encompasses health, social, economic, and environmental dimensions, bringing key indicators from different sectors together. In doing so, the concept of well-being encapsulates diverse priorities and showcases their interconnectedness, creating a shared platform for intersectoral action.

Communities and societies around the world have different concepts of well-being.^{Footnote 14Footnote 15Footnote 16} Many of these concepts and approaches have a long history and a range of contemporary applications. While they cannot be fully explored within the scope of this report, this section will briefly discuss the origins of the current momentum around well-being as a goal for societies, as well as some of the ways well-being approaches are described, measured, and applied by leading well-being organizations in Canada and abroad. This section also discusses First Nations, Inuit, and Métis well-being knowledge systems and approaches, which pre-date the current field of well-being by millennia and provide a robust foundation for collaborative well-being action in Canada.^{Footnote 17Footnote 18}

"Well-being speaks to feeling physically healthy and mentally well, feeling stable from a social and financial point of view and having resiliency to respond to your life's challenges... As public health professionals, we want to help create those environments that support people to achieve well-being."

– Interview participant (public health professional)

Origins of international well-being initiatives

Much of the current momentum around well-being as a concept and as a policy goal was sparked by the severe and interconnected crises facing societies worldwide. There is a growing recognition that whole-of-society responses are needed to address these complex challenges.^{Footnote 4} Populations are more able to prevent, withstand, recover from, and transform in the wake of crises when the conditions for individual and community well-being are improved.^{Footnote 23Footnote 24}

While well-being is an important resource for resilience, it may also encompass a longer-term vision for positive change. As a policy goal, well-being can help redefine how societal success is measured and understood in times of crisis and beyond.^{Footnote 25} As a measure of the status of society, well-being has gained prominence in part due to the "beyond GDP" movement, which emphasizes the limits of using gross domestic product (GDP) and similar economic indicators to understand and track how a society is doing.^{Footnote 25Footnote 26} For instance, GDP does not incorporate non-market activities (e.g., unpaid domestic work, informal caregiving, volunteering) or take into account the inequitable distribution of economic resources.^{Footnote 26Footnote 27Footnote 28} GDP also does not capture social infrastructure, like community development, nor does it include the potential costs of economic growth to society, health outcomes, and the environment.^{Footnote 26Footnote 29}

Several initiatives intended to better measure, or drive policy action on, societal well-being have emerged from the "beyond GDP" movement. This includes the Canadian Index of Wellbeing and Canada's Quality of Life Framework.^{Footnote 30Footnote 31} Internationally, the WHO and the Organisation for Economic Co-operation and Development (OECD) have prioritized well-being, recognizing its potential as both a goal and an approach to improving societal conditions.^{Footnote 4Footnote 5} The United Nations' sustainable development goals that call on policy makers to safeguard ecosystems, promote equity, and prioritize long-term, inclusive development, are also aligned with well-being approaches.^{Footnote 32} Well-being has been explicitly prioritized at the WHO through the 2021 Geneva Charter for Well-being, which emphasized the importance of building "well-being societies" focused on health equity and a healthy planet, for current and future generations.^{Footnote 3} In these initiatives, well-being can be seen as a collection of outcomes to work towards (i.e., dimensions of well-being) as well as a conceptual structure to guide a process towards well-being (i.e., well-being approaches). Core to these initiatives is the recognition that all sectors play a role in creating the conditions necessary for societal well-being.^{Footnote 3Footnote 5Footnote 33}

Well-being frameworks, dimensions, and indicators

Well-being is commonly understood as a comprehensive concept, with multiple dimensions that each include a mix of well-being outcomes and/or drivers. Communities, organizations, and governments have developed a variety of well-being frameworks, tailored to local contexts and priorities.^{Footnote 30Footnote 31Footnote 33Footnote 34} These frameworks serve many different purposes, such as elaborating on a locally-defined concept of well-being, providing structures to measure and monitor well-being indicators, or catalyzing or evaluating intersectoral action on the conditions for well-being.

Although the specifics of frameworks vary, there are often common elements that represent the conditions required for individuals and communities to thrive.^{Footnote 16} This includes adequate income and housing, quality employment and education, positive physical and mental health, strong social cohesion and connectedness, reliable safety and security, work-life balance, and democracy and justice.^{Footnote 16Footnote 33Footnote 35} A well-being orientation also encompasses the necessities for immediate and long-term human and planetary survival, such as safe air, water, and food, as well as environmental protections and sustainability.^{Footnote 16Footnote 33Footnote 35} Both determinants and outcomes may be included in well-being frameworks, since some factors both influence well-being and are themselves important well-being outcomes (e.g., employment, housing).^{Footnote 35}

Well-being indicator frameworks focus on measurable aspects of well-being outcomes and determinants. They generally capture subjective reporting on perceived quality of life as well as objective measures of the determinants of well-being. While life satisfaction is sometimes used as a proxy for overall well-being, policy initiatives generally include it as one of a wide variety of indicators.^{Footnote 5Footnote 35} Subjective measures are oriented towards personal or individual well-being, whereas an assessment of societal well-being requires a broad look across health, social, economic, and environmental dimensions as well as other factors, such as equity, planetary sustainability, and future generations.^{Footnote 5Footnote 16} This comprehensive approach recognizes that societal well-being is more than the sum of the well-being of individuals.^{Footnote 5} A focus on who has access to the conditions of well-being is also often a component of well-being frameworks.^{Footnote 16} This could include assessing well-being inequities, and how the conditions for well-being differ across populations.^{Footnote 35Footnote 36}

Two relevant examples of well-being frameworks include Canada's Quality of Life Framework and the OECD's Better Life Index.^{Footnote 35Footnote 37}

Canada's Quality of Life Framework

Canada's Quality of Life Framework was designed to measure what matters most to people in Canada.^{Footnote 35} It assesses dimensions of well-being using 91 indicators spread across 5 domains and 3 central indicators (life satisfaction, sense of meaning and purpose, and future outlook). The variety of domains and sub-domains covered by this framework can be seen in Figure 1 along with the 2 cross-cutting lenses (fairness and inclusion, and sustainability and resilience).^{Footnote 31Footnote 35} See the text box "Well-being indicator data from Canada's Quality of Life Framework" for an illustrative selection of subjective and objective well-being indicator data from the Quality of Life Hub. More information on the development and use of the Framework, and its use in federal budgeting and decision making, is included in Appendix A.

Figure 1: Text description

Quality of Life Framework for Canada

• Central indicators: Life satisfaction, sense of meaning and purpose, and future outlook.
• Prosperity: Household income; employment; youth not in employment, training, or education; core housing need; acceptable housing; poverty; and making ends meet.
• Good governance: Perceptions of neighbourhood safety after dark; confidence in institutions; and discrimination and unfair treatment.
• Health: Perceived mental health; and perceived health.
• Society: Sense of belonging to local community; someone to count on; trust in others; and satisfaction with time use.
• Environment: Air quality; drinking water; greenhouse gas emissions; and conserved areas.
• Cross-cutting lenses: Fairness and inclusion; and sustainability and resilience.

Many of the indicators align with those traditionally considered in population health monitoring, but some, such as hopefulness about the future or confidence in public institutions, may be less common in public health practice.^{Footnote 56} These data can provide valuable insights into national trends in well-being dimensions. While people in Canada generally live long healthy lives, the recent declines in life satisfaction, hopefulness, self-reported mental health, and ability to afford day-to-day expenses demonstrate the need to work across sectors to understand the drivers and consequences of these trends.^{Footnote 38Footnote 39Footnote 41Footnote 57} Data can also be integrated across domains to understand connections between key indicators. For instance, from 2021 to 2024, 59% of those with no financial difficulties had high levels of life satisfaction compared with 29% of those experiencing financial hardships.^{Footnote 58} Analyses of these indicators further reveal inequities in well-being outcomes. For example, combining 9 indicators from the Quality of Life Framework to form an overall perceived well-being score showed that older adults, people without a long-term condition, and non-2SLGBTQI+ people reported higher perceived well-being in 2021 and 2022 compared to other age groups, people with a long-term condition, and 2SLGBTQI+ people, respectively.^{Footnote 59}

OECD Better Life Index

The OECD launched their well-being framework in 2011, emphasizing the need for well-being economies.^{Footnote 60} A well-being economy is an economy that prioritizes human, social, planetary, and economic well-being by expanding opportunities for people to improve their lives, reducing inequities, and fostering environmental and social sustainability.^{Footnote 61Footnote 62} The OECD's Better Life Index uses 24 indicators to measure 11 well-being topics for member countries.^{Footnote 37} According to the 2024 results, Canada ranks above the OECD average in 7 of the 11 well-being dimensions.^{Footnote 63} Notably, 89% of people in Canada reported their health to be "good" or "very good", one of the highest scores across OECD countries.^{Footnote 63} The OECD supports research and policy action on well-being through their Centre on Well-Being, Inclusion, Sustainability, and Equal Opportunity, and the Knowledge Exchange Platform on Well-being Metrics and Policy Practice.^{Footnote 64Footnote 65}

Well-being approaches

While well-being indicator frameworks focus on well-being as a multidimensional outcome, there is also recognition that new intersectoral approaches are necessary to achieve it. Accordingly, a focus on well-being is not just a goal, but also a different way of working together. While well-being initiatives vary, there are a number of characteristics that frequently emerge, including:

• A positive vision of health, encompassing physical, mental, spiritual, and social dimensions;
• Balancing health, social, economic, and environmental priorities, for both current and future generations; and,
• Intersectoral action across dimensions, with a focus on co-benefits across sectors.^{Footnote 4Footnote 5Footnote 27Footnote 66Footnote 67}

Well-being approaches have been applied across Canada and around the world, including initiatives led by different levels of government. A number of central governments, such as those in Wales, Finland, and Scotland, have integrated well-being into governance approaches, including transformations to legislation, policy development, and budgeting processes (more detail on the challenges and opportunities associated with these approaches is provided in Appendix A).^{Footnote 34} For example, a well-being budget emphasizes quality of life and the well-being of people and the planet as a central goal of governments' economic and fiscal policies.^{Footnote 68Footnote 69} These initiatives are intended to bring sectors together to collectively prioritize population and planetary well-being in government decision-making.^{Footnote 34} A focus on well-being has also driven new approaches among municipal governments. The text box "What we heard from municipal well-being initiatives across Canada" describes different ways municipalities have taken up well-being as a shared goal to mobilize intersectoral action and generate community-based solutions. Public health professionals can explore opportunities to support and contribute to municipal action on the local conditions that influence health and well-being. A number of local initiatives are featured in the report and detailed in Appendix A.

"We often hear municipalities say: 'Of course, sidewalks and infrastructure are important, but we also want to care about the people who walk on our sidewalks'."

– Interview participant (well-being initiative)

"Sometimes you co-lead the strategy… sometimes you're an expert participant. It's going to vary based on the municipal government… As public health people, we're there to support the local government to be successful."

– Interview participant (public health professional)

Indigenous Peoples around the world have long been leaders in advancing holistic approaches to well-being. These approaches are anchored in Indigenous knowledge systems that emphasize environmental stewardship and preserve and promote relationships with the land and nature. For example, the Indigenous Andean concept of Buen Vivir ("living well together") has been integrated into the Ecuadorian constitution and national development plans, with the goal of centring the well-being of people and nature.^{Footnote 74} First Nations, Inuit, and Métis Peoples in Canada have also made significant gains in applying Indigenous Knowledges to well-being promotion across communities and contexts (see Appendix A for a description of select Indigenous-led well-being approaches in Canada, alongside a number of examples in sections below). Indigenous well-being knowledge systems have been developed over millennia and often differ from Western well-being frameworks and approaches.^{Footnote 22} When Western-designed initiatives do not reflect Indigenous priorities and approaches, they risk perpetuating harm by deepening systemic inequities.^{Footnote 17} However, there are also points of potential alignment between Western and Indigenous well-being concepts and approaches. These offer opportunities for dialogue and collaboration on well-being promotion at the interface between knowledge systems.^{Footnote 17}

First Nations, Inuit, and Métis Peoples' concepts of well-being

First Nations, Inuit, and Métis Peoples' well-being knowledge systems are complex and dynamic. They have a deep history and hold significant value for understanding and meeting contemporary challenges to well-being.^{Footnote 21Footnote 75Footnote 76Footnote 77Footnote 78}

There are many Indigenous populations and Nations across the country, each with distinct cultures, languages, geographies, histories, politics, governments, experiences, and priorities that shape well-being knowledges and practices.^{Footnote 22} There are also commonalities among these diverse Indigenous well-being concepts, including a holistic and strengths-based lens, and an understanding of well-being as collective and relational.^{Footnote 20Footnote 79Footnote 80} Well-being is often understood as a balance across interconnected mental, emotional, spiritual, and physical dimensions.^{Footnote 81} Indigenous well-being models are grounded in the understanding that individual well-being is inseparable from the well-being of family, community, society, and the land and nature.^{Footnote 82} The relational nature of Indigenous well-being also encompasses both a life course and an intergenerational perspective, embedded in a deep respect for ancestors and future generations.^{Footnote 83Footnote 84Footnote 85} Food sharing is one example of how the collective worldview is practiced. Sharing traditional or country foods promotes food security, health and well-being, and cultural connectedness, while presenting opportunities for environmental stewardship and protection.^{Footnote 86Footnote 87}

For many Indigenous Peoples, land, culture, and language are at the heart of well-being, both as the source of extensive knowledge systems and teachings around how to live well, as well as determinants of well-being in themselves. Indigenous cultures and systems of knowledge are often place-based, rooted in deep relationships and responsibilities to the land and waters.^{Footnote 22Footnote 88} For many, land is foundational to all other dimensions of well-being, as the source of culture, language, and identity, and as a relation whose well-being is inseparable from the well-being of Indigenous Peoples.^{Footnote 22Footnote 82} Access to relatively intact land that allows for participation in on-the-land cultural activities, stewardship of the environment, and sustainability for future generations are essential to Indigenous well-being.^{Footnote 22}

Indigenous languages are central to the health, identity, and self-determination of Indigenous Peoples.^{Footnote 89Footnote 90} There are more than 70 Indigenous languages spoken across Canada, representing a rich diversity of cultures, Knowledges, and worldviews.^{Footnote 91} Rooted in verbs, actions, and strengths, such languages often do not use deficit-based terms.^{Footnote 92Footnote 93} More than just communication, these linguistic frameworks are a means for expressing laws, principles, roles, responsibilities, and rights, and connect people to their lands and their ancestors.^{Footnote 77Footnote 92} Indigenous languages support an understanding of core well-being concepts and principles that are not directly translatable into English or French. The words influence thinking and lay a foundation for Indigenous well-being research, policy, and programming.^{Footnote 94Footnote 95}

A number of Indigenous languages have unique terms for expressing the collective nature of well-being. For example, the 2025 CPHO report's Indigenous Working Group shared the following terms (see Appendix B for a description of the Working Group):

• kaa-wiichihitoyaahk: A word inMichif that means "We take care of each other"
• Piliriqatiginniq ᐱᓕᕆᖃᑎᒋᓐᓂ: A word in Inuktitut that loosely translates to "Working for the common good or for the benefit of the collective"
• Mino Bimaadiziwin: An Anishinaabe word and philosophical concept that describes a collective sense of well-being and "living the good life" ^{Footnote 96Footnote 97Footnote 98}
• Aama didils: A word for well-being or to live a good life in the Nisga'a language

Indigenous ways of knowing, echoed by Western research, have identified knowledge of language, cultural connections, a strong sense of cultural identity, a sense of belonging, connection to the land, family and community connectedness, and a positive self-image as important determinants of Indigenous health and well-being.^{Footnote 82Footnote 99Footnote 100Footnote 101Footnote 102Footnote 103Footnote 104Footnote 105Footnote 106Footnote 107} Reconciliation, self-determination, and sovereignty have been described as pathways to Indigenous well-being that can be supported by the implementation of Indigenous rights.^{Footnote 22Footnote 108} Indigenous sovereignty refers to the inherent authority and right of Indigenous Peoples to govern themselves, make decisions about their lands, cultures, and resources, and exercise self-determination without external interference.^{Footnote 109Footnote 110} In Canada, the implementation of Indigenous rights is enshrined in the Constitution, most notably under Section 35 of the Constitution Act, 1982, which addresses Aboriginal and treaty rights. Indigenous rights are also implemented by legal frameworks such as the United Nations Declaration on the Rights of Indigenous Peoples Act, which is further discussed in Section 3.^{Footnote 111} In addition to these obligations, all people in Canada have a responsibility to contribute to broader processes of reconciliation, with a focus on building renewed relationships with First Nations, Inuit, and Métis Peoples based on the recognition of rights, respect, and partnership.^{Footnote 112}

Indigenous Peoples have actively resisted colonization, dispossession of Indigenous lands and cultures, systemic racism, and the exclusion of Indigenous leadership and Knowledges from decision-making processes. Through this resistance, Indigenous Peoples have preserved and transmitted Indigenous well-being Knowledges across the generations.^{Footnote 21Footnote 22Footnote 113} Indigenous leaders are actively reclaiming, revitalizing, advancing, and applying these relational worldviews through innovative and transformative approaches to governance, policy, service provision, data, and research among First Nations, Inuit, and Métis communities in Canada (see Section 2 and Appendix A for examples of Indigenous-led well-being initiatives).

Indigenous art and storytelling are central to the creation and transmission of well-being values and Knowledges over time. The following section "Indigenous wellness teachings through art" contains a gallery of original artworks by Dr. Lisa Boivin depicting Indigenous wellness teachings.

Indigenous wellness teachings through art

First Nations, Inuit, and Métis well-being Knowledges and teachings have immeasurable value both to guide Indigenous well-being promotion and to enrich our collective vision for well-being in Canada. The following section explores both Western and Indigenous well-being frameworks and approaches, highlighting the contributions they can make to contemporary public health practice.

Section 2: Contributions of well-being to public health

As a measurement framework and policy goal, a focus on well-being may help advance public health priorities through its positive and strengths-based lens, its attention to future generations and the planet, and as a catalyst for intersectoral action.

A positive and strengths-based lens

Well-being offers a positive vision of thriving and resilient populations that are able to achieve their full potential.^{Footnote 3Footnote 4} While a positive lens has long been recognized in public health, particularly related to health promotion, its application in practice has varied.^{Footnote 67Footnote 114} For example, surveillance often focuses on measuring and monitoring trends or inequalities in disease risk over time. While this work remains vitally important to detect and respond to differential outcomes, it offers an incomplete picture of how individuals and communities are doing. It can also contribute to stigma by reinforcing harmful stereotypes or framing a community as inherently "high risk", if structural inequities are unexplored.^{Footnote 115Footnote 116Footnote 117} As a complement to inequalities data, positive and strengths-based approaches to understanding and measuring well-being may help highlight community capacity and resources that promote health and well-being.^{Footnote 118Footnote 119Footnote 120}

"I think that public health, with this population-based vision, [has the] ability to mobilize the community around a common cause and then develop a common vision together, this ability to identify needs and then also strengths on a collective scale. Because I think you really have to balance the 2 levels if you want to be able to maintain mobilization, otherwise you're just telling people they have problems, and that's not very mobilizing."

– Interview participant (public health professional)

Health, social, economic, and planetary well-being, which serve as "well-being capitals", are essential for thriving, resilient, and equitable societies over multiple future generations.^{Footnote 25} This positive framing of well-being goes beyond preventing or treating illness, recognizing that well-being is a resource that can be fostered for everyone.^{Footnote 25} This is evident in how positive well-being frameworks have been applied to specific public health priorities, such as mental health.

Taking a well-being approach to mental health means shifting the focus from mental illness prevention alone toward a more positive and holistic vision for emotional, psychological, and social well-being. This approach is embedded in the concept of "positive mental health", which is defined as a state of well-being that allows people to feel, think, and act in ways that enhance their ability to enjoy life and deal with the challenges they face.^{Footnote 120Footnote 121} Importantly, positive mental health can exist at the same time as mental illness, meaning everyone can be supported to experience positive mental health even in difficult circumstances.^{Footnote 120} One example of a well-being approach to mental health surveillance is the Government of Canada's Positive Mental Health Surveillance Indicator Framework (see text box "A strengths-based approach to monitoring positive mental health").^{Footnote 121} This example can serve as inspiration for public health data stewards looking to explore how a well-being approach could enable a broader lens in the surveillance of priority public health issues.

Attention to positive and strengths-based methods can also align with Indigenous well-being Knowledges and approaches.^{Footnote 80Footnote 124} Several Indigenous researchers and organizations across the country have articulated strengths-based well-being frameworks and indicators that draw from the rich Knowledges, values, and priorities of distinct Indigenous communities. One example is described in the text box "The First Nations Mental Wellness Continuum Framework: Developing a strengths-based system of care".^{Footnote 21}

Source: Thunderbird Partnership Foundation. First Nations Mental Wellness Continuum Framework Summary Report; 2015.

Figure 2: Text description

Legend (from centre to outer ring):

• Four directions (outcomes): Purpose; hope; belonging; and meaning.
• Community: community; clan; Elders; and kinship.
• Populations: Individuals in transition and away from reserve; infants and children; youth; adults; gender: men, fathers, and grandfathers; gender: women, mothers, and grandmothers; health care providers; community workers; Two-Spirit and LGBTQ people; Northern communities; remote and isolate communities; and families and communities.
• Specific population needs: Crisis; people with unique needs; intergenerational impacts of colonization and assimilation; people involved with care systems and institutional systems; individuals with process addictions; individuals with communicable and chronic diseases; individuals with co-occurring mental health and addictions issues; and individuals with acute mental health concerns.
• Continuum of essential services: Health promotion, prevention, community development, and education; early identification and intervention; crisis response; coordination of care/care planning; detox; trauma-informed treatment; and support and aftercare.
• Supporting elements: Governance; research; education; workforce development; change management and risk management; self-determination; and performance measurement.
• Partners in implementation: Communities; nations; regional entities; federal government; provincial and territorial government; non-governmental organizations; and private industry.
• Indigenous social determinants of health: Health care; housing; environmental stewardship; social services; justice; education and lifelong learning; language, heritage, and culture; urban and rural; land and resources; and economic development; employment.
• Culture as foundation: Language; practices; ceremonies; knowledge; land and values; Elders; cultural practices; and kinship relations.
• Key themes for mental wellness: Community development, ownership, and capacity building; quality care system and competent service delivery; collaboration with partners; and enhanced flexible funding.

Public health professionals can learn from and follow the leadership of First Nations, Inuit, and Métis well-being initiatives. This includes ensuring Indigenous Knowledges and self-determination are centered in well-being policies and approaches that serve Indigenous Peoples. It also means supporting initiatives that are community-based, intersectoral, and focused on strengths-based outcomes such as hope, belonging, meaning, and purpose.

A focus on future generations and the planet

Well-being frameworks encompass the well-being of current and future generations, as well as the health of the planet.^{Footnote 5Footnote 16Footnote 35Footnote 127} While these factors are important for public health outcomes, they may not be covered by existing public health frameworks.^{Footnote 128Footnote 129Footnote 130} A focus on well-being can encourage public health professionals to look more closely at these dimensions, and their connection to existing public health priorities.

"[Well-being] expands the notion of what health is and it is also a way of encompassing the things that we know that we should be working on."

– Interview participant (public health professional)

While many traditional public health frameworks emphasize human health as the central priority, well-being offers a more relational approach. Well-being frameworks recognize that the well-being of humans, animals, and the planet cannot be disentangled.^{Footnote 4Footnote 5} Such approaches are aligned with One Health, which emphasizes intersectoral action to foster and balance human, animal, and planetary health.^{Footnote 4Footnote 6} Recognizing interdependence is important to understand and resolve tensions across these connections, particularly since activities undertaken to promote human well-being could negatively impact animals and the environment, now and into the future.^{Footnote 131} By explicitly including a focus on planetary health and future generations, a comprehensive well-being lens can help advance and balance a concurrent focus on these priorities. This is central to many definitions or interpretations of well-being, including the WHO's Geneva Charter for Well-being and the OECD's Well-Being Framework.^{Footnote 3Footnote 127} A focus on the future, especially in the context of digital transformation, has also been emphasized by the United Nations, who recently released a Pact for the Future that includes a Global Digital Compact and a Declaration on Future Generations. This international agreement covers the design, use, and governance of technology for the benefit of all as well as concrete steps to account for generations to come in decision-making.^{Footnote 132}

Indigenous Peoples have long advocated for changes to societal systems and processes that harm the land and compromise the well-being of current and future generations. Access to and relationships with the land is a determinant of Indigenous well-being, both in rural and urban contexts.^{Footnote 88} As highlighted in the 2022 CPHO report, the strong leadership and deep Knowledges of Indigenous Peoples around ecological stewardship and the relationships between people, animals, and nature are indispensable for collective efforts to promote the well-being of people and planet.^{Footnote 51}

"Indigenous Peoples in Canada are diverse, but we share many perspectives on our relationship with the environment. Many Indigenous Peoples have nurtured relationships with their surrounding environment for generations upon generations. Intimate knowledge of place— inclusive of land, water, animals, and plants—can be developed and shared over the life course. These relationships and this knowledge can support emotional, physical, mental, and spiritual health and reinforce that everything is connected. As Indigenous Peoples, we have responsibility to, and are in reciprocity with, both the beings around us now and those who will comprise future generations."

– Dr. Shannon Waters, Medical Health Officer for the Cowichan Valley Region at Island Health – Vancouver Island Health Authority, from "Visioning the Future: First Nations, Inuit, & Métis Population and Public Health"

A concurrent focus on human and planetary health, now and for future generations, fosters both individual and societal well-being. One such approach to well-being promotion can be seen in the Cittaslow movement.^{Footnote 133} Originating from Italy in 1999, Cittaslow promotes "well-living" through several core principles, such as the philosophy of slow living, supporting local economy, heritage and traditions, and protecting the environment through renewable energy, waste reduction, and green space preservation.^{Footnote 133} There are 4 Cittaslow towns in Canada: Naramata and Cowichan Bay in British Columbia, Wolfville in Nova Scotia, and Lac-Mégantic in Quebec.^{Footnote 134} Lac-Mégantic undertook a holistic reflection on the future and reconstruction of its downtown following a devastating train accident in 2013 (see text box "'Well-living' and the Cittaslow Movement: The example of Lac-Mégantic, Quebec").^{Footnote 135} This example illustrates how public health can draw on well-being approaches by promoting collective action across sectors and applying population health assessments to tailor solutions to community strengths and assets.

A deep commitment to the well-being of future generations is a feature of many Indigenous well-being concepts and practices. As one example, the Seven Generations Teaching is shared across a number of Indigenous Nations and communities, and is a central component of Anishnaabe knowledge systems.^{Footnote 140} This teaching highlights the impacts that individual and collective choices will have on the next 7 generations, as well as the importance of connection to ancestors, the past 7 generations. This teaching can support well-being action that is forward looking and sustainable. It is central to contemporary efforts to transform systems of care for Indigenous Peoples. For instance, in 2019 the Assembly of First Nations' Chiefs-in-Assembly passed the resolution Developing a Seven Generations Continuum of Care for First Nations, by First Nations of Health, Economic, and Social Services.^{Footnote 141} This resolution calls for coordination of care across sectors and across the life course, with a focus on sustainable systems change that will benefit generations to come.^{Footnote 142}

Indigenous research and science anchored in holistic, relational, and future-oriented concepts of well-being are essential to inform systems change and program development. The text box "Strengthening Inuit youth well-being through the Eight Ujarait/Rocks Model" showcases a youth well-being intervention model based on Inuit terminology, philosophy, and societal values that puts an expanded view of youth well-being into action. Public health can both learn from and strengthen support for Indigenous-led well-being approaches that promote cultural transmission, connection to land and community, and self-determination for current and future generations.

A catalyst for intersectoral action

Well-being elevates multidimensional and holistic frameworks

Well-being approaches support holistic measurement of the status of individuals, communities, and societies, including inequities and emerging trends.^{Footnote 127Footnote 145Footnote 146} Well-being frameworks often include dimensions related to happiness and life satisfaction, health, employment, income, housing, education, environmental quality and sustainability, personal safety, and civic engagement and social cohesion.^{Footnote 16Footnote 33Footnote 35} This comprehensive lens implicates other sectors to engage in well-being activities, the governance structures required to implement them, and the associated shared benefits.

A more comprehensive scope of measurement can help identify areas for intersectoral action. This approach has been used by Engage Nova Scotia, an organization that measures multidimensional well-being indicators and uses that data to help facilitate community discussions on well-being in Nova Scotia (see text box "Engage Nova Scotia: Quality of Life Initiative").

In well-being frameworks, well-being is often conceptualized as a combination of interconnected dimensions spanning health, social, economic, and environmental contexts.^{Footnote 150} Recognizing these interdependencies helps showcase how interventions in one dimension can have cascading effects across others.

Well-being provides a shared goal to mobilize collective action

In the context of well-being as a policy goal, health is not just an outcome, but also a determinant. Positive health outcomes can be seen as important contributors to the success of other sectors, enabling economic productivity, labour supply, innovation, educational attainment, civic engagement, and environmental sustainability.^{Footnote 151}

Despite the benefits to other sectors, emphasizing health goals alone may be insufficient to drive intersectoral action.^{Footnote 152Footnote 153Footnote 154Footnote 155Footnote 156Footnote 157} It can be difficult for non-health sectors to integrate health considerations if it is not clear how their own priorities may be aligned.^{Footnote 151Footnote 158Footnote 159Footnote 160Footnote 161Footnote 162Footnote 163} Centring well-being, rather than health, as a primary goal could help. Research suggests that framing shared priorities using language other than health, such as well-being, may be more accepted as a collective aim by intersectoral partners.^{Footnote 161Footnote 164} Well-being offers a goal that resonates with partners and encompasses priorities across sectors.^{Footnote 114} Language and conceptual framing used to describe goals are important because they influence how these goals are developed, who should lead or contribute, and who is held accountable.^{Footnote 165}

"The holistic understanding of health and well-being as a framework for social sustainability really continues to resonate with different sectors in the community. We have never had a challenge with people not being able to see themselves in the strategy, and that has been a really important success."

– Interview participant (well-being initiative)

Attention to the multidimensional nature of well-being may also foster an intersectoral focus on structural determinants of health. This is because the other sectors implicated in well-being frameworks are also those responsible for policy levers that influence key determinants. For example, financial strain is influenced by a number of structural factors (e.g., macroeconomic systems, as well as education, housing, and employment policies that influence income and cost of living).^{Footnote 166} However, interventions frequently target individual-level financial knowledge and behaviour, which are unlikely to influence income inequities since they do not address the systemic barriers that impact financial circumstances.^{Footnote 166} This is of consequence to public health because financial strain impacts physical and mental health, with effects accumulating over the life course and across generations.^{Footnote 167Footnote 168Footnote 169Footnote 170} Bringing a broader and multidimensional well-being lens to addressing the structural factors impacting financial stability can facilitate intersectoral collaborations among players with economic, health, or other goals.^{Footnote 166} The text box "An expanded view of financial well-being to support intersectoral action for health equity" illustrates how a well-being approach can expand our understanding of a key social determinant of health and highlight entry points for equity-promoting intersectoral action.

Well-being emphasizes co-benefits of intersectoral action

In addition to supporting intersectoral action on shared goals, a well-being approach may specifically enable a focus on co-benefits across sectors. This idea that multiple goals across sectors could be influenced by one action has many names, including win-win or multiple impacts, all recognizing that the interconnected nature of policy involves inevitable spillover effects.^{Footnote 173} For example, improving access to green space can reduce greenhouse gas emissions, in part by encouraging active modes of transportation. Moreover, the co-benefits of more green space include better air quality, increased physical activity, reduced all-cause mortality, flood mitigation, and better mental health.^{Footnote 174Footnote 175Footnote 176Footnote 177}

When decisions are made in silos, co-benefits are often neither identified nor measured, leading to their exclusion from investment analyses and budgetary decisions.^{Footnote 178} Deliberately considering co-benefits can help to break down these siloes and promote policy coherence. Centring co-benefits can facilitate coalition building by emphasizing multiple potential beneficiaries of policy action and incentivizing policy-makers to collaborate outside of their core responsibilities.^{Footnote 151} By supporting multiple goals, co-benefits help move past a zero-sum policy model where finite resources are perceived to be offered to one sector at the expense of another.^{Footnote 151}

Co-benefits are the focus of the WHO European Region's Finding Common Ground initiative, which intends to create new modelling tools for central banks and ministries of finance to better understand how fiscal and economic policies can concurrently support economic and health outcomes.^{Footnote 179} Future plans include creating proposals on how to integrate well-being and equity into economic analyses, identifying win-win policies, and working to strengthen the investment case for initiatives that concurrently prioritize healthier economies, populations, and societies.^{Footnote 179} The WHO European Region has represented the domains of human, social, economic, and planetary well-being as overlapping "capitals" that are essential for thriving societies (see Figure 3).^{Footnote 178} This overlap illustrates opportunities for actions in one area to influence actions in another.

Source: World Health Organization. Harnessing the Benefits of Well-Being Policies and Investments for Health. World Health Organization; 2023.

Figure 3: Text description

• Policy and governance
• Planetary well-being: Good air and water quality; health and sustainable living environment; sustainable public transport and active travel; access to safe green space; stable climate; biodiversity and natural capital; and circular economy and green technology.
• Human well-being: Healthy life expectancy; mental health and well-being; ability to carry out daily activities free from illness; universal health coverage; quality and on-discriminatory health and social care; universal policies for housing, food, and fuel security; early childhood development; lifelong learning and literacy; and safe, orderly, and regular migration.
• Economic well-being: Living wage; universal social protection through the life course; decent, psychologically safe work; gender-responsive employment; social dialogue and collective bargaining; and economic cohesion and balanced development.
• Social well-being: Living in safety and free from violence; sense of belonging ("Mattering"); social cohesion and embracing diversity; perceived ability to influence politics and decisions ("Agency"); social support and protection; building trust in others and institutions; public spending on communities; and participation in volunteering.

Co-benefits also contributed to intersectoral action on well-being in Newfoundland and Labrador (NL). A provincial commitment to well-being emerged in the province through the process of developing the 2022 Health Accord NL.^{Footnote 180} In the Accord, well-being is a guiding principle, defined as a way of expressing a sense of feeling happy, healthy, socially connected, and purposeful.^{Footnote 180Footnote 181} The Accord recognizes the shared responsibility of health and social systems together with health educational institutions, municipalities, community organizations, and the private sector to improve health outcomes and health equity.^{Footnote 181} It promotes a vision of better population health that explicitly builds on existing public policies, including the Poverty Reduction Strategy adopted in 2006, a climate action plan, mental health and addictions initiatives, and education programs.^{Footnote 182} See the text box "Identifying co-benefits to advance well-being in Newfoundland and Labrador" for a description of how the concept of co-benefits mobilized intersectoral action on well-being in the province.

Co-benefits at the local level

Opportunities for co-benefits may be particularly evident at local levels. Municipalities have access to levers for change that are directly linked to the conditions for community well-being, such as land use planning, infrastructure management, and providing essential services, like affordable housing, immigrant settlement, and childcare.^{Footnote 186Footnote 187Footnote 188} Municipalities are also closer to their communities than other levels of government, making them well-positioned to engage with residents, businesses, and community leaders to tailor policy and program solutions to their local needs and contexts.^{Footnote 186} The WHO's Healthy Cities initiative seeks to harness this potential by engaging with municipal governments to transform social, economic, and cultural agendas to better support the health and well-being of their residents. This work defines a healthy city as one that puts health, social well-being, equity, and sustainable development at the centre of local policies, strategies, and programmes.^{Footnote 189} In 2023, members of the WHO European Healthy Cities Network committed to championing a well-being economy with a focus on 12 action points across 4 key areas: planetary well-being, human well-being, economic well-being, and social well-being.^{Footnote 190} These action items include protecting and enhancing the environment, promoting workforce well-being, fostering participatory decision-making and community-led action, and embracing diversity and inclusion.^{Footnote 190} Pilot projects in 9 cities across Europe have been initiated to implement these action points.^{Footnote 190}

Similar thinking has been integrated in jurisdictions across Canada. For example, the City of Vancouver's Healthy City Strategy is a long-term, integrated plan that aims to enhance health and well-being in Vancouver through coordinated, intersectoral policy action supported by well-being frameworks and the monitoring of well-being indicators.^{Footnote 191} The initiative is co-led by the municipality and the local public health authority. Public health has built on and leveraged existing relationships while fostering trust and new partnerships. Public health has also provided valuable local and tailored data to support the municipality in understanding and implementing effective strategies.^{Footnote 191} As an example of the strategy in action, co-benefits for health equity and community development are being promoted through the City of Vancouver Community Benefits Agreement Policy. The policy provides opportunities for low-barrier local employment and economic benefits for residents, including populations facing inequities, through mandated agreements with developers.^{Footnote 192} Urban Indigenous community leaders in Vancouver also collaborated with the city to develop culturally relevant, strengths-based Indigenous well-being indicators to track progress on the implementation of the strategy from an urban Indigenous perspective.^{Footnote 193Footnote 194}

Indigenous relational well-being knowledges and approaches often stand in contrast to Western initiatives that divide responsibility for different well-being dimensions across sectors.^{Footnote 17} Even when not explicitly labelled as well-being initiatives, many Indigenous-led health promotion approaches already span multiple well-being dimensions in an integrated way by focusing on the relationships and balance between them.^{Footnote 140} One example of this holistic approach to health and social programming can be seen in the work of Indigenous Friendship Centres. These centers serve as hubs for promoting well-being and exercising self-determination among urban Indigenous communities. They address and mitigate the impacts of colonization through Indigenous-led health and social service provision, social infrastructure development to meet the diverse needs of urban Indigenous populations, programming that fosters cultural continuity and connections to community, and advocacy for cultural safety training and systems change in non-Indigenous services, particularly in health care.^{Footnote 195Footnote 196}

Section 3: Roles for public health in well-being initiatives

In addition to the potential contributions offered by well-being for public health, public health can draw on and strengthen essential functions and core competencies to support well-being initiatives led by others. Particularly relevant areas of action include sharing knowledge on the structural determinants of health, leveraging public health data and evidence, championing intersectoral action, and supporting the implementation of Indigenous rights.

"In my early days in public health, people thought of health promotion as telling people not to smoke, to exercise, and to eat healthy food. [But it's] really about giving people more control over their health by addressing some of those underlying physical, environmental, social, political determinants of health. It's a lot of the work we've been doing… to think about moving towards healthy public policy."

– Interview participant (public health professional)

Public health frameworks to understand structural determinants of well-being

There is considerable overlap between well-being dimensions and the social determinants of health, which are the conditions of daily life, the ones in which people are born, grow up, live, work, play, learn, and age.^{Footnote 11} To understand why these conditions are inequitably distributed across society, some public health practitioners have focused on exploring the structural determinants of health, which are the mechanisms (e.g., values, beliefs, norms, laws, policies, and institutional practices) that drive the inequitable distribution of power and resources and therefore influence daily living conditions.^{Footnote 5Footnote 11Footnote 155Footnote 197Footnote 198}

Structural determinants do not only influence health, but are also relevant across well-being dimensions. This is because they impact how societies are structured, with implications across health, social, economic, and environmental outcomes. Public health knowledge on structural determinants can be used to support well-being initiatives to understand and take action on the societal conditions that create and perpetuate well-being inequities.^{Footnote 199Footnote 200Footnote 201Footnote 202} This includes identifying structural determinants and understanding their impacts, which has been an area of growing attention in public health.^{Footnote 197}

Ongoing efforts to distinguish the structural determinants of health have resulted in distinct sub-categories, such as political, economic, and ecological determinants.^{Footnote 2Footnote 11} Within these categories, researchers can explore specific structural determinants like colonization and systemic racism, commercial practices, or digitalization and online environments. Each of these structural determinants has wide-ranging impacts across well-being dimensions, and it is important to explore and address the interconnections between them to promote equity in well-being.

Colonization and systemic racism as determinants of well-being

Colonization and racism are foundational determinants of well-being among Indigenous, Black, and other racialized populations in Canada.^{Footnote 11Footnote 199Footnote 203} They are intertwined, and the processes of colonization have led to ongoing and entrenched systemic racism. Systemic racism is embedded in systems, processes, and relationships, and operates to reinforce beliefs, prejudices, and stereotypes, as well as to normalize discriminatory practices that benefit the dominant group.^{Footnote 204} Systemic racism also interacts with other structural determinants to influence the everyday social, economic, ecological, and political conditions for health and well-being among diverse populations.^{Footnote 201}

The ongoing effects of systemic racism within and across multiple systems and structures in Canada can be seen in the lack of representation of Indigenous Peoples, Black Canadians, and other racialized populations in leadership positions, overrepresentation in the criminal justice and child welfare systems, and the unfair distribution of resources, such as quality housing, health care, clean water, education, employment, and social services.^{Footnote 202Footnote 205Footnote 206Footnote 207Footnote 208Footnote 209}

Colonization and systemic racism have distinct histories among population groups, with long lasting, wide-reaching, and intergenerational impacts.^{Footnote 142Footnote 210} For example, the well-being of diverse Black Canadian communities is affected by the specific health and social impacts of anti-Black racism, which is defined as prejudice, attitudes, beliefs, stereotyping, and discrimination that is directed at people of African descent.^{Footnote 211} Anti-Black racism is rooted in European colonization in Africa and the legacy of slavery, which was legal in British North America until 1834. It is deeply entrenched in Canadian institutions, policies, and practices and is often invisible to those who do not feel its effects. Black Canadians continue to experience inequities driven by processes of stigma and discrimination that stem from ideologies of anti-Black racism.^{Footnote 210}

Examples of colonial policies affecting Indigenous Peoples include the Manitoba Act of 1870 and subsequent land fraud that displaced Métis Peoples in the region, the Indian Act of 1876 and the residential school system, which did not fully end until 1996, and the forced relocation of Inuit populations in the 1950s into permanent settlements without adequate shelter and supplies.^{Footnote 212Footnote 213Footnote 214} These policies disrupted the fundamental roots of Indigenous well-being, including connection to land, language, culture, community, family, and identity.^{Footnote 214Footnote 215Footnote 216} This disconnection has been passed on as trauma from generation to generation, compounded further by the ongoing impacts of colonization.^{Footnote 217Footnote 218} Systems and processes of discrimination as well as social and political exclusion of Indigenous Peoples have carried forward and remain embedded in the fabric of Canadian society.^{Footnote 217Footnote 219} This is also visible in the devaluation and exclusion of Indigenous Knowledges and sciences from policy processes, programs, and services, leading to environments that may be discriminatory, culturally unsafe, and misaligned with the needs and priorities of communities.^{Footnote 220Footnote 221Footnote 222}

Commercial and digital determinants of health as emerging factors influencing well-being

The impact of some structural determinants on health and well-being are growing, particularly commercial and digital determinants. Public health research into these emerging determinants could support well-being initiatives that address the impacts of these societal-level factors.

Commercial determinants are shaped by policies, market forces, and regulatory conditions and include the production, marketing, and sale of goods and services.^{Footnote 11Footnote 12Footnote 13} In 2024, the WHO released a report detailing the significant impact of commercial determinants on noncommunicable diseases in Europe.^{Footnote 13} The report summarized the impacts of numerous commercial practices, including marketing of unhealthy products, labour practices that increase precarious employment, and opposition to regulations that would protect public health.^{Footnote 13} Of relevance to well-being initiatives, the report emphasized system-level actions to better safeguard public policy from commercial influences.^{Footnote 13} These actions span taxation, fiscal measures, regulatory reforms, marketing restrictions, mandatory labeling, and governance tools aimed at reducing the power and reach of commercial interests in public health policy.^{Footnote 13}

Digital determinants may impact health and well-being in both positive and negative ways, by either directly or indirectly influencing other determinants.^{Footnote 9Footnote 10Footnote 223Footnote 224} For instance, online accessibility of health information, virtual connection to healthcare providers, technological improvements in healthcare delivery and quality, and enhanced data and methodology for monitoring population health can be health-protective factors. At the same time, digitalization can create health risks, such as the spread of health mis- and disinformation and the erosion of trust in institutions, biases in the training and implementation of artificial intelligence, financial fraud, cyberbullying, exploitation, and harassment.^{Footnote 9Footnote 10Footnote 223Footnote 224Footnote 225} Commercial interests also influence the online environment, including through the development of addictive applications, and through digital marketing with targeted algorithms.^{Footnote 9Footnote 13} Digital transformation is also fundamentally altering living and working conditions, including education, employment, social connections, and media, with significant impacts on well-being.^{Footnote 9} Differential access to technology and digital literacy can mediate or reinforce these pathways, which can amplify existing disparities.^{Footnote 10Footnote 226}

These determinants are particularly consequential for children and youth.^{Footnote 227} Childhood and adolescence are crucial periods for brain development and identity formation, and young people today are more immersed in digital environments than any previous generation.^{Footnote 223Footnote 225Footnote 227} This age range is therefore most likely to be exposed to any harms associated with digital technologies.^{Footnote 225Footnote 228} The literature is inconclusive on the overall impact of digital and online environments on well-being, since potential benefits and risks may affect various groups differently. While these platforms offer opportunities for connection and learning, digital engagement can also contribute to stress, burnout, and social disconnection, underscoring the need for targeted interventions to support youth well-being.^{Footnote 227Footnote 229Footnote 230Footnote 231Footnote 232Footnote 233} These themes emerged during a conversation with the Prime Minister's Youth Council (see text box "Digital determinants of health and future generations: What we heard about youth well-being from the Prime Minister's Youth Council"). Public health can continue to promote well-being by supporting the intersectoral collaborations and research needed to understand and address the complex emerging challenges and opportunities presented by the digital determinants of health.^{Footnote 227Footnote 234Footnote 235}

Public health data and evidence to measure well-being inequalities

Historically, well-being indicators have been summarized and reported in aggregate or average formats at the population-level. Aggregate level indicators of well-being provide crucial information on the status of a population as a whole and are useful for international and regional comparisons. However, they do not convey insights about possible inequalities across population groups.^{Footnote 236} This requires both collecting disaggregated data to measure and monitor inequalities (e.g., by socioeconomic status or demographics) and applying equity and intersectionality lenses when possible to account for the diverse lived experiences and differential outcomes of populations affected by multiple and intersecting systems of power and oppression.^{Footnote 115Footnote 150Footnote 236} Improving data collection and analysis to identify and monitor health inequalities is a priority area for public health research and surveillance. This work could also contribute to measuring well-being inequalities. For example, in 2024, the WHO published a comprehensive guide to health inequality monitoring, recognizing that a detailed characterization of inequality trends is required to inform strategies to improve population health.^{Footnote 115}

"The epidemiological competency to me is the basic science of public health. I think that's where we can add value, that we can look at large data sets and interpret the data and understand the data in a way that others can't."

– Interview participant (public health professional)

To support the integration of equity considerations into well-being data and indicator initiatives, the National Collaborating Centres for Infectious Diseases and Determinants of Health developed a series of prompts to guide the development of equity-promoting processes, decision-making, and engagement activities (see text box "Public health equity prompts for implementing a well-being framework").

Addressing long-standing challenges in Canada's health data ecosystem can enable better well-being inequalities measurement and generate evidence for intersectoral interventions. This includes continuing work to improve the collection, sharing, and use of disaggregated data through respecting data sovereignty, strengthening partnerships across organizations, addressing data privacy concerns, and enhancing data quality and standardization.^{Footnote 237Footnote 238} Public health systems can also support better linkage of health data with information held by other sectors as well as work toward improved data access and interoperability.^{Footnote 239Footnote 240Footnote 241Footnote 242}

"[Local] level data is what's really valuable. A small enough geography, that's really meaningful to make a difference and that helps you identify health inequities too… It can also help you focus your work as a public health person, looking at what are the most important issues in this community."

– Interview participant (public health professional)

It is important for data stewards to engage with communities to co-develop solutions and prevent populations from being systematically underrepresented in datasets.^{Footnote 239Footnote 242Footnote 243Footnote 244} Community knowledge is essential for contextualizing and interpreting disaggregated data. This knowledge fosters an understanding of the structural inequities that drive differential outcomes, helping to reduce the stigma that can occur when data on negative outcomes is broken down by social groups.^{Footnote 114Footnote 245} Public health, especially at the local level, often has existing close relationships with communities that may assist with revealing relevant interactions across determinants.^{Footnote 246Footnote 247Footnote 248} Meaningful and deep engagement of communities in the early stages of intervention design has been identified as fundamental for addressing research-to-practice gaps, translating evidence into policy and practice, and evaluating initiative effectiveness.^{Footnote 249Footnote 250Footnote 251Footnote 252Footnote 253}

Communities across Canada have been leading efforts to address challenges in public health data, including Black and Indigenous communities. Black researchers, service providers, and community advocates in Canada have emphasized the need for better disaggregated and community-led data to identify the public health consequences of anti-Black racism, and to inform and evaluate interventions to improve health equity.^{Footnote 254Footnote 255Footnote 256} This includes the importance of Black data stewardship to lead data collection and analysis, as well as determining who has access to data and for what purposes.^{Footnote 254Footnote 255Footnote 256} One example of this work is the Engagement, Governance, Access, and Protection framework published by the Black Health Equity Working Group in 2021. This framework aims to ensure that data from Black communities is collected, protected, and used properly and with the goal of dismantling structural racism.^{Footnote 255}

Indigenous leadership in asserting data sovereignty is reshaping how public health addresses the harms of colonial data systems, representing a shift toward self-determination and structural change (see text box "Indigenous leadership in redressing the harms of deficit data in public health").

"The community has the best knowledge of what it needs. When we [organized] our collective reflection day... we took a positive approach. We started by mapping our assets... We don't just have problems, we have super strengths."

– Interview participant (public health professional)

Public health as a champion for intersectoral action

Public health has long recognized the role of other fields in influencing health, and the importance of intersectoral action to foster health and health equity by improving the determinants of health.^{Footnote 267Footnote 268} This commitment is evident in international health policy documents, from the 1978 Alma Ata declaration on primary health care to the 2021 Geneva Charter for Well-being.^{Footnote 3Footnote 269} Public health has also been active in leading and participating in intersectoral initiatives. For example, the efforts of Marmot Places (see text box "A public health approach to addressing health inequities: Marmot Places") demonstrate how public health can bring sectors together, share data, and support evidence-based policy to collaboratively address the social determinants of health and reduce inequities.^{Footnote 270} Convening partners, embedding intersectoral action within funding models, and acting as a sustainable facilitator are essential strengths of public health systems, closely aligned with health promotion approaches.

"When addressing complex, multi-factorial issues, like homelessness and other social crises, which involves multiple partners and intersectoral collaboration, and often seem to be everybody's and no-one's responsibility, perhaps public health has a crucial role to play, [for example] in documenting what is happening and analysing local needs."

– Interview participant (public health professional)

As an essential public health function, health promotion is focused on intersectoral action to improve a wide range of social, economic, and ecological factors. This means working collaboratively with communities and other sectors to understand and improve health through healthy public policies, community-based interventions, public participation, and advocacy or action on the underlying circumstances that shape health (e.g., determinants of health, like housing, income, and systemic racism).^{Footnote 275Footnote 276Footnote 277} Health promotion was proposed as a primary way to connect well-being and public health by the WHO in their report "Achieving well-being: A global framework for integrating well-being into public health utilizing a health promotion approach", which was adopted by member states at the 76^th World Health Assembly in May 2023.^{Footnote 4}

"Getting in there and developing relationships and understanding context and helping build capacity, that's the real work! That's where health promotion really shines and can really make a difference."

– Interview participant (public health professional)

Additionally, Health in All Policies (HiAP) is a policy approach that offers an avenue to intersectoral action and has relevance to well-being, particularly if adapted to prioritize co-benefits.^{Footnote 151} HiAP enables decision-makers to work across sectors to improve conditions for health, equity, and well-being, seek synergies in their initiatives, and avoid potential harms.^{Footnote 278Footnote 279} The strategies of HiAP may stimulate discussions to identify mutual goals, coordinate planned actions, leverage strengths of all partners, and maximize collective impact.^{Footnote 268Footnote 280} HiAP can also be expanded upon to recognize the co-benefits of action that concurrently advances the goals of health and non-health sectors. For example, this is the focus of work by the European Observatory on Health Systems and Policies, which has recommended a shift from "health in all policies" to "health for all policies".^{Footnote 151}

"We view Health in All Policies as an essential part of achieving well-being. In fact, I think we won't have well-being without it. We need to have all departments thinking about how policies and legislation impact well-being and focus on developing those that have a positive influence."

– Interview participant (public health professional)

Public health leaders have considerable experience with bringing sectors together for collective action. Research from public health has documented some of the challenges and facilitators of intersectoral action for health that could be of value to strengthen well-being initiatives. This includes the need for sustained funding and political leadership, clear accountability mechanisms, enabling environments and workforce capacity in cross-sectoral collaboration, and challenges to evaluation, such as the lag time between intervention and health outcomes.^{Footnote 162Footnote 281} Public health professionals also have recent experience from the COVID-19 pandemic that could help with balancing competing priorities and conflicting interests in well-being initiatives.^{Footnote 24Footnote 282Footnote 283Footnote 284} This is particularly important for well-being initiatives if an overemphasis on common priorities inadvertently limits collaboration to areas that are easier to implement and less contested.^{Footnote 151Footnote 285} Such attention could result in avoiding action in instances where the interests of different sectors do not clearly align, for example where there are tensions between environmental and economic priorities.^{Footnote 151Footnote 285} Drawing from these lessons in convening a variety of partners, there are ongoing discussions within public health practice about improving governance models for intersectoral action on population health and health equity.^{Footnote 286Footnote 287Footnote 288} One example of public health efforts to foster intersectoral action is the framework developed by the Institut national de santé publique du Québec (INSPQ) (see text box "Public health leadership in well-being: The INSPQ framework for supportive environments"). By providing structured, evidence-based frameworks and tools, public health can support local governments in designing and implementing effective intersectoral interventions that create positive environments for health equity and well-being.

Public health has also championed intersectoral action by building it into funding models, with lessons learned for well-being initiatives. PHAC's Mental Health Promotion Innovation Fund (MHP-IF) and Intersectoral Action Fund (ISAF) are 2 examples.^{Footnote 291Footnote 292} The MHP-IF invests in long-term community-based initiatives to promote mental health and well-being. It moves beyond behaviour change to deliver projects that promote sustained well-being at multiple levels (e.g., individual, family, community). Since 2019, the MHP-IF has supported community-based projects to develop partnerships across sectors, including health, education, food, and cultural sectors, with an internationally recognized approach to scaling up successful interventions in over 200 communities.^{Footnote 293Footnote 294} Similarly, the ISAF aims to enhance community capacity for intersectoral action on the social determinants of health.^{Footnote 295} The ISAF focuses on improving population health, reducing health inequities, and enhancing community resilience. These projects frame good health as a collective goal, engaging diverse collaborators to address cross-cutting issues that affect health and well-being.^{Footnote 292} For example, the Partnerships for Better Housing research project in Winnipeg, Manitoba, convened partners across sectors, as well as community members and those with lived experience, to complete a needs assessment that identified priority areas for collective action to improve housing for newcomers to Canada and create a Community Action Plan. ^{Footnote 292}

"[Funding projects] also comes with a responsibility to know what's being done, to know how to direct funding, and to find the balance between what we think should be done versus [what] communities [say they need]... because we have the power to say yes, we'll go that way, or no, we won't go that way."

– Interview participant (public health professional)

It is important that funding for community action on well-being be flexible and responsive to local contexts and priorities. Some funders have done so by adopting models that are not prescriptive in their definitions or outcomes. The First Nations Well-Being Fund (see text box "First Nations leadership in defining and promoting well-being in British Columbia: The First Nations Well-Being Fund") can serve as an example for public health funders looking to support community-defined and culturally responsive well-being interventions.^{Footnote 296} It also highlights the importance of Indigenous leadership and self-determination in both funding distribution and program development and implementation.

While communities are experts in the contexts and conditions that promote local well-being, they may need support to enhance the reach and sustainability of their initiatives. Public health actors can participate directly in local well-being initiatives, fostering community leadership on community priorities. Larger public health institutions may also provide infrastructural help to sustain local projects, facilitate planning and evaluation, and make connections and exchange knowledge across initiatives. The Tables de quartier (see text box "Leveraging Tables de quartier to support local intersectoral action and improve living conditions in Montreal's neighbourhoods") illustrate the role of public health in recognizing and amplifying the value of grassroots community action on the conditions for well-being and supporting them to grow and flourish over the long term.

Public health can also learn from and follow the leadership of First Nations, Inuit, and Métis Peoples in applying Indigenous collaboration approaches to build relationships across sectors.^{Footnote 17} For example, the M'Wikwedong Indigenous Friendship Centre in Owen Sound, Ontario, developed and implemented the Giiwe model for systems homelessness prevention, an Indigenous-led intersectoral action initiative that used ceremony, Indigenous Knowledges, discussion, and follow-up actions to increase access to services for First Nations, Inuit, and Métis Peoples. It was successful in strengthening relationships and coordination among over 20 organizations invested in preventing homelessness in the city, including public health organizations.^{Footnote 296Footnote 301}

Public health's roles and responsibilities in implementing Indigenous rights

A key role for public health is to support Indigenous well-being through the implementation of rights-based approaches. One important framework for rights-based action is the United Nations Declaration on the Rights of Indigenous Peoples (the UN Declaration). The UN Declaration affirms the human rights of Indigenous Peoples and establishes a universal framework of the minimum standards necessary for the survival, dignity, well-being, and rights of Indigenous Peoples globally.^{Footnote 302Footnote 303} It describes a standard for achievement related to the very foundations of Indigenous well-being described in Section 1, including the right to self-determination and self-government; the recognition of Treaties; access to and protection of lands, territories, and resources; protection and promotion of culture and language; economic and social rights; and participation in decision-making and strengthening Indigenous institutions. Implementation of the UN Declaration across jurisdictions and sectors would constitute powerful action on the structural drivers of inequities in well-being for Indigenous communities in Canada.

First Nations, Inuit, and Métis Peoples have worked to advance the implementation of the UN Declaration in Canada for over a decade.^{Footnote 304} In 2021, the Parliament of Canada passed the United Nations Declaration on the Rights of Indigenous Peoples Act (UNDA), which affirms the UN Declaration as a universal international human rights instrument with application under Canadian law and provides a framework for the Government of Canada's implementation of the UN Declaration.^{Footnote 111} Section 5 of the Act requires the federal government to take all measures necessary, in consultation and cooperation with Indigenous Peoples, to ensure that the laws of Canada are consistent with the UN Declaration. In 2023, after 2 years of consultation and cooperation with Indigenous Peoples, the federal government released the United Nations Declaration Act Action Plan.^{Footnote 305} The action plan provides a roadmap for Canada to implement the principles and rights set out in the UN Declaration in consultation and cooperation with Indigenous Peoples and to further advance reconciliation in a tangible way. It describes whole-of-government actions to support the right to participate in decision-making for relevant legislative, policy, and program initiatives. The action plan was informed by and builds upon the priorities of Indigenous partners and the recommendations made by the Royal Commission on Aboriginal Peoples, the Truth and Reconciliation Commission (TRC), and the National Inquiry into Missing and Murdered Indigenous Women and Girls.^{Footnote 306}

There are practical tools that can help those working in public health to implement rights-based considerations into organizational policies and practices. For example, the TRC has developed a guide to assist people or organizations in developing their own ReconciliACTION plans in response to the calls to action.^{Footnote 307} The Indigenous Gender Based Analysis Plus Toolkit provides questions and prompts to help organizations identify systemic barriers, centre Indigenous voices, and ensure meaningful inclusion of Indigenous women, girls, Two-Spirit, and gender-diverse individuals in public health policies, programs, and decision-making processes.^{Footnote 308}

In alignment with the UN Declaration principles of respect and self-determination, public health practitioners can partner with Indigenous Peoples directly as experts, collaborators, and service providers. The text box "How to support Indigenous rights in public health" describes prompts to guide public health organizations in reflecting on how to integrate Indigenous rights into their work.^{Footnote 142}

Public health is well-positioned to build on its strengths and contribute to intersectoral well-being initiatives by building and mobilizing evidence on the social and structural determinants of health; measuring and monitoring inequities in health, well-being, and their determinants; advancing intersectoral action; and partnering with First Nations, Inuit, and Métis Peoples to create conditions for Indigenous well-being.^{Footnote 92Footnote 214Footnote 217Footnote 302Footnote 307Footnote 309Footnote 310Footnote 311Footnote 312} Public health can also reflect on its own goals and approaches, and explore opportunities to strengthen well-being approaches within public health policy, practice, and research to help advance well-being in Canada.

Way forward

This report explores the strengths of bringing well-being and public health approaches together. Addressing the conditions that support well-being will also improve population health and health equity. Public health professionals and leaders of well-being initiatives can collaborate to transform these conditions and work toward co-benefits across sectors.

This section describes opportunities for public health professionals to:

• Prioritize key features of well-being approaches within public health practice, policy, and research; and,
• Leverage and strengthen public health knowledge and approaches that can contribute to intersectoral well-being initiatives.

The current momentum around well-being presents a new opportunity for public health to work with other sectors to improve the conditions for human and planetary health well-being, now and for future generations.

Applying well-being approaches to public health

Mobilizing intersectoral partnerships through well-being frameworks

Well-being frameworks show different entry points for intersectoral action on the health, social, economic, and environmental dimensions of well-being (e.g., urban green space, affordable housing, quality employment). By showing how dimensions interact, these frameworks can be used to promote a common language around complex challenges, achieve mutual goals, and recognize the co-benefits of collective action across sectors. Public health can explore opportunities to learn from and apply well-being frameworks to advance intersectoral action for health:

• Apply well-being frameworks to convene partners, catalyze collaborative action, and evaluate and track co-benefits for health and well-being over time (e.g., OECD Better Life Index, Canada's Quality of Life Framework, municipal, provincial, and territorial well-being strategies, First Nations, Inuit, and Métis frameworks).
• Build the competencies of public health professionals to engage with well-being approaches and intersectoral action, including cross-disciplinary training in finance, housing, social policy, and environment dimensions, as well as Indigenous well-being Knowledges and ways of knowing.
• Collaborate with other sectors to determine appropriate policy instruments to accomplish shared goals, pool resources including though shared financing mechanisms, develop enabling institutional environments, and co-develop sustainable and equitable programs and policies that improve the conditions for health and well-being.

Promoting positive outcomes through a strengths-based lens

Well-being approaches emphasize solutions that are strengths-based and build on community resources and leadership, alongside policy action to create positive societal conditions for thriving. Public health actors can build on and extend existing work to measure and monitor positive health and well-being, and promote these outcomes through strengths-based interventions:

• Advance the development and implementation of public health frameworks, indicators, research initiatives, and surveillance approaches that focus on positive health and well-being outcomes.
• Learn from and support communities in bringing strengths-based health and well-being data and research to policy and program decision-makers across different sectors to advocate for action on the conditions for community thriving.
• Provide sustained and culturally-responsive support, resources, and funding to community-led health and well-being initiatives that centre on community goals, knowledge, strengths, and assets.
• Support Indigenous-led and self-determined health and well-being approaches in a context of sustained, respectful, and reciprocal relationships with First Nations, Inuit, and Métis communities, leaders, and organizations.

Fostering the well-being of future generations and the planet

As emphasized by a One Health approach, the well-being of humans, animals, and the planet are inseparable. Striving for balance among people, animals, the lands and waters, the spirit, and future generations has always been at the core of Indigenous Knowledges and practices. Public health actors can learn from and explore diverse ways of understanding these connections while integrating consideration for the well-being of future generations and the planet into public health practice, policy, and research:

• Support the implementation and evaluation of future-oriented policies and planning by bolstering long-term data collection and modelling to explore health and well-being trends over time.
• Expand and implement transdisciplinary research and surveillance approaches (e.g., One Health) to inform public health policies and programs that respond to the dynamic interconnections between human, animal, and environmental health and well-being.
• Provide sustained funding and support for the continued development of First Nations, Inuit, and Métis Knowledges, sciences, and ways of knowing connected to relational health and well-being, in alignment with principles of Indigenous data sovereignty and research ethics.

Contributing to well-being through public health

Leveraging knowledge and evidence on the social and structural determinants of health and well-being

Well-being dimensions significantly overlap with the social and structural determinants of health. Leveraging and strengthening research and data on these determinants can support the development, implementation, and evaluation of well-being initiatives. In particular, better understanding the mechanisms by which structural determinants (e.g., commercial determinants, digital determinants, systemic racism and discrimination) influence well-being within and across populations, helps inform equitable and sustainable intersectoral action on the conditions for well-being. Public health actors can:

• Strengthen data and research on how emerging determinants, such as digital and commercial, are connected to well-being outcomes across the life course and intersect with other determinants.
• Leverage interdisciplinary knowledge and evidence on the social and structural determinants of health to support the development of policies and initiatives that address key drivers of inequities in the conditions for health and well-being, including systemic racism and discrimination.

Measuring and monitoring well-being inequities

Strengthening and sharing health equity data and research supports well-being initiatives and policies. Public health actors can also promote ethical and co-developed health and well-being data collection and analysis, where affected communities are enabled to contribute to decision-making throughout the data ecosystem, from identifying priority areas for research and surveillance, to interpreting and translating data into action. Opportunities include:

• Strengthen existing public health research and surveillance approaches to contribute to measuring, monitoring, and reporting on inequities and trends in well-being outcomes and determinants.
• Apply equity prompts to integrate health equity considerations into public health and well-being initiatives, including the collection and use of well-being data.
• Facilitate the collection and interpretation of data disaggregated by population groups and report on differential impacts on well-being in collaboration with community leaders.
• Contribute to data sharing and interoperability within public health and across sectors to facilitate analyses of the relationships between well-being dimensions, while respecting data privacy standards, Indigenous data sovereignty principles, and appropriate community data stewardship.
• Support communities to define, measure, and monitor well-being by improving access to existing public health data and facilitating community-led well-being research.

Advancing intersectoral action

Public health has long recognized the importance of engaging across sectors to improve the conditions for health. Building on this experience, public health professionals can support sustainable partnership-building and collaborative action among different sectors and communities in well-being initiatives. They can also seek out opportunities to contribute to existing well-being initiatives while exercising humility, flexibility, and adaptability. Opportunities include:

• Seek out roles in well-being initiatives, recognizing where public health can be most supportive (i.e., convening stakeholders, providing data and evidence, leveraging networks).
• Champion culturally safe engagement and collaboration opportunities for diverse communities to contribute their knowledge and expertise to well-being initiatives, including opportunities for youth to participate in decision making.
• Use intersectoral approaches (e.g., through health promotion, Health in All Policies, and One Health) to support the development and governance of strategic and sustainable partnership models and accountability mechanisms within well-being initiatives.
• Support interdisciplinary intervention research that can garner new insights into the outcomes and mechanisms of action for well-being initiatives, including analyses of co-benefits that resonate with the goals and priorities of all partners.

Collaborating with First Nations, Inuit, and Métis Peoples

First Nations, Inuit, and Métis Peoples have many diverse and sophisticated well-being knowledge systems and have taken a leadership role in advancing well-being approaches across the country. The implementation of Indigenous rights-based approaches supports reconciliation, cultural safety, self-determination, and sovereignty as pathways to Indigenous well-being. Public health has a responsibility to advance reconciliation and build renewed relationships with First Nations, Inuit, and Métis Peoples and communities based on the recognition of rights, respect, and partnership. Public health actors can:

• Engage in respectful and meaningful dialogue with First Nations, Inuit, and Métis Peoples, in a context of long-term relationship-building and with cultural humility, to strengthen our collective well-being knowledge by drawing on both Indigenous and Western ways of knowing.
• Create opportunities to partner with First Nations, Inuit, and Métis leaders, organizations, and communities to invest in and support Indigenous-led and self-determined well-being data, research, policies, and programming.
• Implement Indigenous rights-based approaches within public health systems and intersectoral partnerships to promote the well-being of current and future generations of First Nations, Inuit, and Métis Peoples.

Appendix A: Key examples of well-being initiatives

There are many examples of well-being policy and measurement initiatives at international, national, and local levels. A selection of examples is detailed below to provide context on the history and breadth of well-being approaches.

International central government well-being initiatives

In recent years, a number of governments have taken steps to transform legislation, policy development, and budgeting processes to advance population well-being.^{Footnote 34} This includes Finland and Scotland, who have both integrated well-being indicators into national budgeting processes to inform decision-making and long-term planning across departments.^{Footnote 34}

An example of a well-being policy supported by legislation is the Well-being of Future Generations Act in Wales, which sets national goals to improve the well-being of current and future generations. Notably, it encourages intersectoral action by legislating requirements for collaborative and integrated approaches across the public sector.^{Footnote 313} To support implementation of the Act, the Future Generations Framework was created to track well-being outcomes across environmental, social, cultural and economic domains. Public Health Wales has also contributed to the Wellbeing of Future Generations Act by collaborating with regional boards and conducting health impact assessments of public policies related to the Act.^{Footnote 314} In general, public health actors can play a critical role in providing leadership, coordination, data and research, consultation, and advocacy support to central government well-being initiatives.

While there have been important gains, central government well-being initiatives also face a number of challenges. These include the difficulties of coordinating across different departmental and sectoral priorities, contexts, and cultures; resource constraints and funding sustainability; and changes in political leadership or government priorities.^{Footnote 34Footnote 314Footnote 315} Public health leaders can play an important role in advancing and maintaining a focus on well-being over time.

Canadian well-being initiatives

In 2021, the Government of Canada released the Quality of Life Framework for Canada (introduced in Section 1). The Framework was designed to measure well-being, and integrate a focus on well-being into federal budgeting and decision-making.^{Footnote 35} Statistics Canada maintains a Qualify of Life Hub, including dashboards showing certain quality of life indicators at the municipal and census subdivision levels. Development of the framework was led by Finance Canada and Statistics Canada and revised through engagement with more than 20 federal departments and agencies (including the Public Health Agency of Canada), provincial and territorial officials, national Indigenous organizations, and domestic and international subject matter experts.^{Footnote 316} The framework has been integrated as a component of federal budgeting processes, with the Department of Finance reporting on the expected quality of life impacts of budget initiatives. Since December 2021, under the Treasury Board of Canada Secretariat's leadership, it has also been adopted in other areas of Cabinet decision-making, and departmental reporting to Parliament. Through integration in these government-wide processes, it can serve as a standardized approach to consider and incorporate benefits of proposed policies across sectors.^{Footnote 316}

Outside government, the Canadian Index of Wellbeing (CIW) was developed by the Atkinson Foundation and is now housed at the University of Waterloo. It is a composite index built from 64 indicators across 8 domains (community vitality, democratic engagement, education, environment, healthy populations, leisure and culture, living standards, and time use).^{Footnote 317} Results have been published since 2009.^{Footnote 317} At the time of writing this report, according to an upcoming publication on the CIW, between 1994 and 2022 Canada's GDP increased by 52.8% while the overall well-being index rose by 3.5%. Initial increases in the index were stalled by the 2008 economic recession and the COVID-19 pandemic that began in 2020. In particular, compared to 1994, the domains of community vitality, leisure and culture, healthy populations, and living standards, showed decreases in their respective 2022 indices.^{Footnote 318} The CIW has also produced indices for provincial and territorial partners (i.e., Ontario, Nova Scotia, Saskatchewan, Manitoba, and Yukon) that reflect regional variations in well-being. A survey measuring the subjective well-being of Canadians has additionally been developed, particularly to capture the experience of populations in smaller geographies, when local or regional data are not available. This survey has been used by a number of provinces and territories, municipalities, and organizations across the country in efforts to address well-being inequities for priority groups.^{Footnote 319}

Communities across Canada have been making progress towards measuring and tracking indicators of well-being to better capture lived experiences and historic inequities, and to inform change. For example, the Road to Economic Prosperity (REPP) is a 5-year intersectoral strategy developed and owned by the African Nova Scotian (ANS) community to address systemic issues, such as anti-Black racism, and improve the well-being of African Nova Scotians.^{Footnote 320} Launched in May 2024 as part of the implementation of the REPP, the African Nova Scotian Prosperity and Well-being Index uses the latest available data from multiple sources, including Engage Nova Scotia's Quality of Life Survey, to describe the ANS community's status across a range of topics, namely population, labour, income, education, housing, and subjective-well-being.^{Footnote 321} The index is an example of a community-led and owned well-being data development initiative that is designed to support collaborative equity action.

Many communities and municipalities across the country have led well-being policy, program, and data initiatives tailored to their local contexts and priorities. There are also a number of non-governmental organizations who provide leadership, coordination, capacity building, and support for local initiatives that seek to strengthen the conditions for well-being and health equity. For example, the Tamarack Institute's Networks for Change works with multi-sectoral, place-based collaboratives that are developing, implementing, and evaluating large scale initiatives aimed at ending poverty, building belonging and connection to community, improving outcomes with youth, and just climate transitions. They are supporting communities in more than 400 municipalities to map local assets, identify root causes, and explore strategies for action. The networks also provide guidance and support in building municipal capacity for engaging people with lived experience in efforts to address the root causes of well-being inequities. Public health plays a key role in this work, participating in multi-sectoral roundtables as partner, chair, or leader as well as providing technical support for measuring and monitoring well-being determinants and outcomes. Similarly, Espace MUNI is an organization comprising more than 400 municipalities and municipalités régionales de comté in Quebec who seek to offer a sustainable and inclusive local environment that allows citizens to develop their full potential. Espace MUNI provides funding support, tools, and inspiration to help municipalities build capacity in the areas of citizen participation, intersectorality, and public policy. Public health often contributes as a partner at the municipal level, and by leading health impact assessments.^{Footnote 322}

First Nations, Inuit, and Métis well-being initiatives

Indigenous communities, organizations, and governments across Canada have made significant gains in applying Indigenous well-being Knowledges to transform governance, programming, data systems, and services to strengthen the foundations of well-being across communities and contexts.

There are a number of examples of Indigenous-led well-being action at the policy level, visible in advancements in Indigenous self-government as well as through partnerships between Indigenous leaders and Western governments. For example, the Métis Nation's Métis Vision for Health, developed in 2017 through a collaborative engagement among Métis Governments (Ontario, Saskatchewan, Alberta, and British Columbia), defines health as holistic well-being that is influenced and shaped by larger social structures and Métis-specific determinants of health. These determinants include, but are not limited to, family and kinship ties, community, culture, and relationship to the land. The document puts forward a vision for Métis health and well-being to guide the development of Métis-specific health legislation.^{Footnote 323} Another example is the Nisg̱a'a Lisims Quality of Life Strategy and Framework. This framework is used by the Nisga'a Lisims government to inform actions that enhance the living conditions of Nisg̱a'a citizens. The strategy was developed through a participatory approach and includes key performance indicators that reflect how citizens view and describe the relationships among governance, public policy, and quality of life.^{Footnote 324} An example at the federal level, the Inuit Nunangat Policy was co-developed through the Inuit-Crown Partnership Committee to promote prosperity and support community and individual well-being throughout Inuit Nunangat with the goal of socio-economic and cultural equity between Inuit and other Canadians. The policy guides all government departments and agencies in advancing equitable resource allocation and collaboration with Inuit governments and organizations to strengthen self-determination and jurisdiction in designing and delivering policies, programs, and services that impact Inuit.^{Footnote 325}

Indigenous researchers and organizations have also developed and implemented novel indicator and measurement frameworks grounded in Indigenous Knowledges and principles of data sovereignty. Examples include the Regional Health Survey, a survey that measures the holistic health and well-being of First Nations children, youth, and adults living on reserves and in Northern communities and is carried out by the First Nations Information Governance Centre; or the Qanuippitaa? National Inuit Health Survey, which is an Inuit-led and -owned national health and well-being survey focused on measuring health and well-being, while taking into account Inuit values, strengths, and research priorities. In British Columbia, the First Nations Health Authority and BC's Provincial Health Officer have partnered to develop the Population Health and Wellness Agenda (PHWA), which is a report series that will monitor and report on the health and wellness of First Nations Peoples in British Columbia over a decade using 22 health and wellness indicators. Rooted in First Nations teachings, the PHWA takes a strengths-based approach, emphasizing resilience, self-determination, and Two-Eyed Seeing to integrate Indigenous and Western knowledge systems.^{Footnote 326}

Appendix B: Methodology

The 2025 Chief Public Health Officer of Canada (CPHO) Annual Report was drafted based on a review of the best available evidence, including research from academic, government, and non-governmental sources, as well as guidance from expert advisors and engagement with public health, First Nations, Inuit, Métis, and community experts.

The evidence was identified through the approaches summarized below.

Reviews of scientific evidence

• The Public Health Agency of Canada (PHAC) commissioned the National Collaborating Centre for Methods and Tools to complete a rapid evidence review to answer the research question: "What national or population-level interventions or policies that address the social determinants of mental health have an effect on mental health and well-being?"
• At the request of the Office of the CPHO (OCPHO), PHAC also commissioned updates to the following existing review:
  • Whole-of-Government Wellbeing Approaches: A Comparative Analysis of 4 Central Government Initiatives (updated by the National Collaborating Centre for Healthy Public Policy)
• Continuous literature searches by the OCPHO, completed by report sub-topics as needed in English and French, using online databases, such as MEDLINE and Scopus.

Public health reports and other grey literature

• Continuous literature searches completed by OCPHO to find grey literature and public health reports on well-being from key sources, such as public health organizations (e.g., World Health Organization) and government publications (e.g., federal, provincial/territorial, municipal, and Indigenous governments).
• Identification of applied public health examples and case studies through engagement with public health and well-being experts. These examples were selected to demonstrate the range of initiatives underway across Canada, with a focus on diverse geographies and communities.

Engagements and expert interviews

A targeted engagement process, completed by OCPHO, focused on:

• Promising practices and applied examples that have had success in bringing sectors together to promote health equity and influence community and population well-being;
• The role of public health in championing or supporting intersectoral action on community and population well-being;
• Challenges to the implementation, evaluation, and sustenance of well-being initiatives; and,
• First Nations, Inuit, and Métis perspectives and Knowledges on well-being and its determinants.

The engagement process included knowledge-sharing events, a series of contracted interviews with representatives from well-being initiatives across Canada, interviews with public health leaders and experts involved in well-being initiatives, as well as specific Indigenous engagements further described below.

Expert knowledge exchange event on well-being and public health

In June 2024, the OCPHO, along with the National Collaborating Centre for Healthy Public Policy hosted a virtual knowledge exchange event to capture diverse experiences and perspectives on well-being from a host of experts, including public health researchers, practitioners, and policy makers, as well as organizational leaders and community voices. Following stage-setting presentations, 4 break-out groups focused on one of 4 key topics, namely well-being policies, well-being and the public health system, well-being promotion in communities, and equity in well-being. This event informed the high-level framing for the 2025 CPHO report.

Prime Minister's Youth Council

In November 2024, the CPHO met with the Prime Minister's Youth Council to explore youth well-being and the societal factors that influence it. The Council provides youth perspectives on key issues affecting youth in Canada to the federal government. Members of the Council are from regions across Canada, including rural and urban areas, and reflect a range of educational, employment, and life experiences. The council also includes Indigenous and other racialized youth, as well as youth who identify as 2SLGBTQI+. Members engaged in a facilitated discussion around the following questions:

• What does the concept of well-being mean to you as a youth leader in Canada?
• A well-being approach, as described in the Geneva Charter, can provide the foundation for future generations to thrive on a healthy planet. From your perspective, what 3 things should we change now, so that future generations can thrive?
• What policies do you think are needed to advance a well-being approach?

Expert interviews

The OCPHO commissioned interviews with representatives from 11 well-being initiatives across the country. The initiatives selected met the following criteria:

• Had a focus on population well-being,
• Had an equity lens,
• Engaged with local communities; and,
• Took an intersectoral approach.

Other considerations included geographical and linguistic representation. The interview questions assessed the origin of the initiative, its organization and governance, successes and challenges in design and implementation, tangible results, partnerships across sectors, and how well-being was framed as part of the work.

The OCPHO conducted 4 complementary interviews with public health leaders and practitioners directly involved in well-being initiatives in Canada to hear more from a public health perspective about the existing and potential roles for public health to advance well-being in Canada.

The interviews were all conducted between June 2024 and March 2025, in French or in English.

Indigenous engagements

To learn from and reflect the considerable expertise of Indigenous leaders in well-being, OCPHO collaborated with a working group of Indigenous experts and leaders in well-being and wellness throughout the report's development. The 2025 CPHO report's Indigenous Working Group included First Nations, Inuit, and Métis experts as well as representation from the National Collaborating Centre for Indigenous Health. The Working Group provided advice and guidance on report content, framing, and engagement, and informed how to showcase Indigenous concepts of well-being and Indigenous-led initiatives.

As part of the annual Indigenous Wellbeing Gathering Conference held in October 2024 in Kelowna, British Columbia, members of the Indigenous Working Group hosted an interactive discussion with conference participants on Indigenous well-being and public health. Conference attendees were invited to share their insights, ideas, and knowledges by responding to the following key questions:

• How does culture contribute to wellness within your community?
• How do we counter the main obstacles to wellness?
• What personally has been most significant to your wellness?
• What do we need for community wellness?
• How can public health support our communities to be well?
• What outcomes would indicate community wellness?

Participants reacted to these questions through discussion and arts-based creation, such as drawing, writing, stickers, and collage. During the conference, Deninu Kųę́ First Nation artist Dr. Lisa Boivin hosted knowledge sharing workshops on the theme of Indigenous wellness. Her original artworks are included in this report.

This rich content, illustrating both shared understandings and distinct experiences and knowledges on what it means to be well and what is needed to support wellness, informed the writing team's thinking and the working group's discussions.

Additionally, the OCPHO led targeted engagements with the following organizations for report input and Indigenous-led examples: the Assembly of First Nations, Inuit Tapiriit Kanatami, the Métis National Council, the Manitoba Métis Federation, the Native Women's Association of Canada, the National Association of Friendship Centres, and the Ontario Federation of Indigenous Friendship Centres. The OCPHO is committed to improving opportunities and mechanisms for meaningful engagement with Indigenous leaders and organizations throughout report development in a spirit of ongoing learning, cultural humility, and relationship building.

Feedback and draft reviews

Report drafts were submitted for critical review to a variety of experts at different stages of report development, including selected domestic and international experts in public health and well-being, community experts, as well as Indigenous well-being experts and organizations.

Limitations

Scope and literature search

The 2025 CPHO Annual Report explores the momentum surrounding well-being as an intersectoral policy goal and approach, and how public health systems can learn from and contribute to this work to improve the health and well-being of people in Canada. Given the considerable breath of this topic, there are necessary restrictions on the level of detail provided in each section. Accordingly, the report does not represent an exhaustive evidence review, but rather a summary of select key literature. Only literature published in English and French was reviewed. A detailed assessment of study quality and risk of bias was not conducted in this review.

Language

To the extent possible, the report writers attempted to use standardized, inclusive, and culturally appropriate language when drawing on evidence related to different communities and their experiences of health and well-being. However, in some instances they relied on the terminology included in the source documents (e.g., seniors versus older adults), if this language had particular meaning or relevance in those materials.

Acknowledgements

Many people and organizations contributed to the development of this report.

I would like to express my gratitude to my annual report advisors for sharing their expertise and providing strategic guidance:

• Dr. Evan Adams, 2024–25 Canadian Harkness Fellow, University of Hawaiʻi at Mānoa; Deputy Chief Medical Officer, Public Health, First Nations Health Authority
• Dr. Margaret Barry, Established Chair in Health Promotion and Public Health, Head of the World Health Organization Collaborating Centre for Health Promotion Research, University of Galway (Ireland); Past President of the International Union for Health Promotion and Education
• Sir Michael Marmot, Professor of Epidemiology, University College London; Director, of the UCL Institute of Health Equity, London (Great Britain); Past President of the World Medical Association
• Dr. Cory Neudorf, Professor, Community Health and Epidemiology, University of Saskatchewan
• Dr. Candace Nykiforuk, Professor, School of Public Health, University of Alberta; Canada Research Chair in Community Environments and Public Policy for Well-Being
• Dr. Gaynor Watson-Creed, Associate Dean of Serving and Engaging Society, Assistant Professor, Community Health and Epidemiology, Faculty of Medicine, Dalhousie University

I extend my heartfelt thanks to the members of the 2025 Indigenous Working Group for their invaluable advice and insights:

• Dr. Evan Adams, 2024–25 Canadian Harkness Fellow, University of Hawaiʻi at Mānoa; Deputy Chief Medical Officer, Public Health, First Nations Health Authority
• Dr. Gwen Healey Akearok, Executive and Scientific Director, Qaujigiartiit Health Research Centre, Iqaluit, Nunavut; Assistant Professor, Division of Human Sciences, Northern Ontario School of Medicine
• Dr. Carol Hopkins, Chief Executive Officer, Thunderbird Partnership Foundation
• Dr. Gabrielle Legault, Assistant Professor in Indigenous Studies, Department of Community, Culture and Global Studies, University of British Columbia (Okanagan Campus)
• Dr. Deanna Nyce, President and CEO, Wilp Wilxo'oskwhl Nisga'a Institute; Advisory Committee Member, National Collaborating Centre for Indigenous Health 

I also want to acknowledge the contribution of Dr. Lisa Boivin, Deninu Kųę́ First Nation in Denendeh (Northwest Territories) and Indigenous Educator at University Health Network and The Center for Wise Practices in Indigenous Health's (Ganawishkadawe) at Women's College Hospital in Tkaronto (Toronto), for developing original artwork depicting Indigenous wellness teachings. I would like to thank Elder Parry Francois, Assembly of Manitoba Chiefs, for opening our expert knowledge exchange event in a good way and sharing his teachings and reflections on well-being.

My deep appreciation goes to experts from across Canada, including Medical Officers of Health, public health practitioners, researchers, non-governmental organizations, and community leaders who participated in conversations and interviews on the role of public health in achieving well-being in Canada.

I would like to thank the analysts and experts from the following Indigenous organizations who provided advice and reviewed report content: Assembly of First Nations, Inuit Tapiriit Kanatami, Métis National Council, Manitoba Métis Federation, Native Women's Association of Canada, National Association of Friendship Centres, and the Ontario Federation of Indigenous Friendship Centres.

I am grateful to the staff from the National Collaborating Centres for Public Health for their support and contributions. Sincere thanks to Dr. Ilona Kickbusch (Global Health Centre, Geneva Graduate Institute), Dr. Chris Barrington-Leigh (Canadian Wellbeing Knowledges Network), Danya Pasturszek (Tamarack Institute), Danny Graham (Engage Nova Scotia), Bryan Smale (Canadian Index of Wellbeing), and Drs. Ruediger Krech and Faten Ben Abdelaziz (Department of Health Promotion, World Health Organization) for reviewing this report.

Thank you to the many colleagues at the Public Health Agency of Canada, Health Canada, Indigenous Services Canada, Crown-Indigenous Relations and Northern Affairs Canada, Statistics Canada, Treasury Board Secretariat, and the Department of Justice who provided insights, guidance, and reviews of report drafts.

Finally, I am profoundly grateful to my Office members who supported the development and mobilization of this report. Special thanks to the Reports and Science Policy teams for their commitment and dedication from conception to publication: Fabienne Boursiquot, Dr. Marie Chia, Dr. Charlene Cook, Stephanie Cunningham-Reimann, Janis Ellis-Claypool, Elyse Fortier, Rhonda Fraser, Dr. Kimberly Girling, Dr. Kimberly Gray, Dr. David Grote, Tasha Lake, Jessica Lepage, Jennifer Lew, Sarah Maxwell, Danielle Noble, Batul Presswala, Saïdou Sabi Boun, Shauna Sanvido, Dr. Sarah Schwarz, and Ashley Shaw.