Assessing Value in Upstream Health Interventions: A Case Study of the Dr. Paul Schwann Centre Cardiac Rehabilitation Program
type: CreativeWork
description: In the past several decades, a major ideological shift has occurred regarding the relative importance of broad socioeconomic factors as determinants of health over access to conventional health services. During this time, public health experts have continually re-emphasized the need to focus attention further “upstream” of disease, in order to prevent populations from developing poor health. While provincial health systems currently integrate some population and public health programming within the basket of services they offer, upstream health interventions represent only a very small proportion. While many factors can explain this pattern, one explanation is key; upstream health interventions must compete against conventional “downstream” services for a single funding pool, and in this evaluation process, three unique challenges arise. First, there must be a convincing argument that governments should intervene in these private markets to produce a socially optimal outcome. Second, there are unique challenges that arise in measuring the outcomes of upstream interventions, as upstream interventions tend to relate to broader social values that occur over the long-term rather than immediate, quantifiable improvements in health. Third, there have been structural challenges within the system of healthcare administration in Canada. As a result of these three challenges, upstream health interventions are often undervalued and can become subject to great financial instability. This is demonstrated by one upstream program in the Regina Qu’Appelle Health Region – the Dr. Paul Schwann Centre Cardiac Rehabilitation Program. This research investigates the policy problem of assessing value in upstream interventions through a case study of this upstream health intervention. Through a three-pronged analysis of program-level data, this thesis explores the question of how evidence in preventative health interventions can be synthesized with greater policy relevance to inform the re…
abstract: In the past several decades, a major ideological shift has occurred regarding the relative importance of broad socioeconomic factors as determinants of health over access to conventional health services. During this time, public health experts have continually re-emphasized the need to focus attention further “upstream” of disease, in order to prevent populations from developing poor health. While provincial health systems currently integrate some population and public health programming within the basket of services they offer, upstream health interventions represent only a very small proportion. While many factors can explain this pattern, one explanation is key; upstream health interventions must compete against conventional “downstream” services for a single funding pool, and in this evaluation process, three unique challenges arise. First, there must be a convincing argument that governments should intervene in these private markets to produce a socially optimal outcome. Second, there are unique challenges that arise in measuring the outcomes of upstream interventions, as upstream interventions tend to relate to broader social values that occur over the long-term rather than immediate, quantifiable improvements in health. Third, there have been structural challenges within the system of healthcare administration in Canada. As a result of these three challenges, upstream health interventions are often undervalued and can become subject to great financial instability. This is demonstrated by one upstream program in the Regina Qu’Appelle Health Region – the Dr. Paul Schwann Centre Cardiac Rehabilitation Program. This research investigates the policy problem of assessing value in upstream interventions through a case study of this upstream health intervention. Through a three-pronged analysis of program-level data, this thesis explores the question of how evidence in preventative health interventions can be synthesized with greater policy relevance to inform the re…
author: Beck, Caroline Anna
language: en
date published: 2015-07
date modified: 2026-07-24T04:03:29Z
provider: University of Regina
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Faculty of Graduate Studies and Research, University of Regina

PropertyValue
property ID: Handle
value: https://hdl.handle.net/10294/6558

PropertyValue
property ID: DOI
value: 10.82465/3876