Quality of Life Index
Quality of Life Index for Persons with Disabilities
In 2022, the Nova Scotia Accessibility Directorate provided funding to the Nova Scotia League for Equal Opportunities (NSLEO) to lead the development of a Quality of Life Index (QOLI) for people with disabilities as well as a baseline report. This report is the first step in developing the Quality of Life Index that will be used by disability organizations, the Nova Scotia Government, Prescribed Public Sector Bodies, and other stakeholders to monitor the protection of human rights of people with disabilities and the implementation of the Nova Scotia Accessibility Act. Extensive work has already been done by Engage Nova Scotia to develop a Quality of Life Index for Nova Scotians. This current project recognizes the need to enhance that index while also establishing baseline indicators for measuring progress under Nova Scotia’s Accessibility Act. Central to this work is a rights-based approach that considers human rights obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD), to which Canada is a signatory.
Quality of Life Domains
Quality of life indicators are used to measure progress on well-being and quality of life of a population. Governments often use survey data to measure quality of life indictors in order to collect evidence that will inform policy and funding decisions (Statistics Canada, 2023). Some indicators can be objectively measured by a third party while subjective indicators depend upon the point of view from which they are measured. Both are necessary for understanding quality of life.
In developing the proposed indicators, an analysis of several key documents was undertaken. These documents included, but were not limited to, Engage Nova Scotia’s Quality of Life Index report, Access by Design 2030 which identifies a roadmap for meeting obligations under Nova Scotia’s Accessibility Act, Committee recommendations made under obligations of the Nova Scotia Accessibility Act, the UN Convention on the Rights of Persons with Disabilities, and the Canadian Survey on Disability. The proposed domains and Indicators are:
Domain 1: Education. The Convention on the Rights of Persons with Disabilities (UNCRPD) recognizes the right to education for persons with disabilities on an equal basis with others (United Nations, 2008). Indicators in this area span the lifetime and are concerned with accessibility and inclusion. This domain outlines 14 indicators that measure opportunities to access education; accessible navigation and communication related to supports and services; recruitment and application procedures; the learning environment; learning resources; diverse inclusive and accessible instruction; accommodations; language access; appropriate assessments; transition planning; family involvement; completion rates; non-discrimination; and transportation.
Domain 2: Built Environment. This includes indicators specific to the built environment, but additional indicators in this area may intersect other sections outlined in this index. This domain measures accessibility of the built environment across six areas; public places; outdoor pathways; public housing; transit stops; indoor spaces; and emergency access,
Domain 3: Employment. Access to employment is a significant social determinant of health and has a notable impact on the quality of life of people with disabilities. While closely related to section 13 on Economic Security, it is distinct due to the various components of employment that need to be considered beyond income levels. There are eight employment related indicators; accessible recruitment; quality of work; employment accommodations; inclusion in the workplace; career development; return to work; emergency preparedness; and time spent on daily commute to and from work.
Domain 4: Goods and Services. This domain pertains to the delivery and reception of goods and services in the province. How service providers interact with people with disabilities, how people with disabilities access goods and services and how they access assistive devices all fall within this domain. Specifically, four indicators are access to goods and services; access to assistive aids, devices or technologies; accessible ICT and telephone services; and attendant support.
Domain 5: Information and Communication. This area aims to ensure that all Nova Scotians have equal access to information. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) (United Nations, 2008), makes it clear that people with disabilities have a right to information and indicates that information should be received in accessible formats, in a timely manner and without additional costs. The six indicators in this area are equitable access to Information; timely access to information and communication; privacy maintained when ICT is offered in alternative formats; access to visual, audible, speech, and closed function ICT; service navigation; and time spent on accessing information.
Domain 6: Public Transportation and Transportation Infrastructure. Standards for public transportation and transportation infrastructure are important for enabling all Nova Scotians to travel more easily in urban and rural areas across the province (Province of Nova Scotia, 2018). Transportation affects all areas of life; education, work, health, social, access to goods and services. It includes bus, train, and air travels. The six indicators in this area are access to accessibility Information and general service information; accessible transportation; service Interruptions; equitable fares; qualifying for and accessing accessible specialized transportation; and time spent accessing transportation and making daily commutes.
Domain 7: Community Vitality. Strong communities and community engagement are important for individual well-being. The COVID-19 pandemic has taught us the importance of socialization and connection to others. Resilient communities and our sense of belonging to community impact our quality of life. To this extent, we need to understand the extent to which communities in Nova Scotia are welcoming of people with disabilities. Six indicators in this area are sense of belonging to community; ability to live independently in the community; virtual access; community safety; access to volunteer activities; and time spent in community and with friends and/or family.
Domain 8: Democratic Engagement. Article 29 of the CRPD pertains to participation in political and public life. It states that, “States Parties shall guarantee to persons with disabilities political rights and the opportunity to enjoy them on an equal basis with others” (United Nations, 2008, p. 21). Historically, Nova Scotia saw regular increases in democratic engagement followed by decreases in more recent years. This domain should also include engagement in provincial and municipal elections and with government events such as town halls and other political events as desired. Specifically, two primary indicators in this area are engagement in federal, provincial and municipal elections; and knowledge and investment in political issues.
Domain 9: Healthy Populations. More than ever, our health care systems are facing a crisis. The CRPD addresses rights to health for people with disabilities in Articles 21 and 25. Healthy populations go beyond the healthcare system to social determinants of health addressed throughout this Index. Many areas of our daily life impact our health and health outcomes. This set of indicators is concerned with understanding the extent to which people with disabilities have access to what they need to live a healthy life and also how they rate their overall physical and mental health. Nine indicators in this area are; access to medical, specialist and physician services; access to medication; access to therapies and services; access to emergency services; access to quality food; physical Activity, recreation and fitness; physical and mental health status; the impact of the COVID 19 pandemic; and time spent on health-related activities.
Domain 10: Justice. For many people with disabilities, access to justice is hindered by barriers due to their disability. Confidence in the justice system and police has been captured in the first quality of life survey conducted by Engage Nova Scotia (2014) under the Community Vitality domain. Given the finding of systemic discrimination against people with disabilities found by the Nova Scotia Court of Appeals in 2021 (Disability Rights Coalition v. Nova Scotia (Attorney General), 2021), indicators in the area vital. Article 4 of the CRPD (United Nations, 2008) outlines commitments in this area. Four key indicators are awareness of rights and legal options; access to the justice system; trust in the justice system, and effective navigation of the justice system.
Domain 11: Leisure and Culture. Leisure and culture can include physical activity, parks, live events, and vacations. This domain also includes arts and cultural activities. For people with disabilities, their access to leisure and culture may be impacted by disability related barriers. It is important to capture the extent to which people with disabilities are engaging in leisure and cultural activities and to understand what barriers, if any, they are facing. Article 30 of the CRPD addresses the right to participation in cultural life, recreation, leisure and sport (United Nations, 2008). Four indicators in this area are accessibility of activities and Events; participation in and attendance at activities and events; time spent on activities and events; and volunteering.
Domain 12: The Natural Environment. According to Engage Nova Scotia (2014) “environmental protection involves the prevention of waste and damage while revitalizing our ecosystems and working towards the sustainability of all our resources” (p. 46) Environmental sustainability is becoming a growing concern as we experience more frequent weather events that impact our daily lives. Opportunities to contribute to environmental sustainability as well as the impact of weather events on people with disabilities needs to be carefully considered here. Three key indicators here are quality of the natural environment; access to opportunities to contribute to environmental sustainability; and safety during weather events.
Domain 13: Economic Security. One of the strongest social determinants of health, and by extension well-being, is income and income security. Income and income supports are required to meet basic needs, but they also impact health and health outcomes, housing security, access to education, transportation options, socialization decisions and all areas of life which impact our quality of life. Given the high rates of poverty among persons with disabilities, and the bi-directional link between poverty and disability economic security is one of the most important areas to consider in measuring well-being and quality of life for people with disabilities just as it is for those without disabilities. Without success in this area, all other areas will be affected. The impact of economic security is measured throughout this document particularly when measuring denial to access of services, supports, equipment, events, and locations due to financial barriers. Three key indicators are income or income supports; affordable and accessible housing, and the ability to save for the future.
Quality of Life Index for Persons with Disabilities
We have a working draft of the Quality of Life Index for Persons with Disabilities of the indicators open for you to review. There is a PDF version of the document. This document is being updated as more feedback and consultations are happening.
We are currently in the community consultation stage of the process which we welcome your feedback. Below is a Google Form to input your feedback and if you would like a through consultation for your membership.
If you have any questions or would like to reach out to someone on the Quality of Life Initiative, email firstname.lastname@example.org.
Advisory Council Members
Shelley Adams, CNIB Foundation
Bernard Akuoko, Youth Representative
Rebecca Bourbonnais, March of Dimes Canada
Sherry Costa-Lorenz, Nova Scotia League for Equal Opportunities
Shelley Curtis-Thompson, Pictou County Women’s Resource and Sexual Assault Centre
Elizabeth Doull, Society of Deaf and Hard of Hearing Nova Scotians
Birgit Elssner, Nova Scotia Accessibility Advisory Board
Louise Gillis, Canadian Council of the Blind
Marcus Jamieson, Rob Casey, and Jonathan Hall, TEAM Work Cooperative
Linda Peters, Indigenous First Voice
Emily Roeding, Brain Injury Association of Nova Scotia
Miia Suokonautio, YWCA Halifax
Mike Townsend, Directions Council
Steve Trussoni, Tetra Society of North America
Sheila Wilderman, Human Rughts Expert, Dalhousie Schulich School of Law
Kristin Williams, Prudentia Institute
More Advisory Council members to come.
To make this intiative possible, we have the Accessibility Directorate and Engage Nova Scotia as non-voting members who provides insights and data to the Advisory Council. We would like to acknowledge Lisa Jacobs from the Accessibility Directorate and Danny Graham and Ryley Urban from Engage Nova Scotia for their contributions and knowledge to the project and meetings.
Below are the resources that were used by our researcher, Dr. Tammy Bernasky to develop the Quality of Life Indicators for Persons with Disabilities.
Accessibility for Ontarians with Disabilities Act (2012). Integrated regulation. Found at: https://www.aoda.ca/integrated/
Bernasky, T. (2022). Working to end gender-based violence in the disability community: international perspectives. Practical Action Publishing
Built Environment Standard Development Committee (2021). Recommendations on Accessibility Standard in the Built Environment: Phase 2. Found at https://novascotia.ca/accessibility/built-environment/built-environment-standards-phase-2-recommendations.pdf
Disability Rights Coalition v. Nova Scotia (Attorney General), 2021 NSCA 70 (CanLII), <https://canlii.ca/t/jjg28>, retrieved on 2023-09-10
Education Standard Development Committee (2023). Recommendations to the Minister of Justice on an Accessibility Standard in Education: Phase 2. Found at https://novascotia.ca/accessibility/education-committee/recommendations-education-accessibility-standards-phase-2-en.pdf
Employment and Social Development Canada (2023). Future information and communication technologies accessibility regulations: what we heard. https://www.canada.ca/en/employment-social-development/programs/accessible-canada/consultation-accessibility-regulations-information-communication-technologies/report-2023.html
Engage Nova Scotia (n.d.) Persons with Disabilities Spotlight. (Note: This information is from Engage Nova Scotia’s Wellbeing Analysis Tool which uses the data from the survey to show the big picture. Watch how CEO Danny Graham explain the tool in relation to persons with disabilties at our Access Awareness Week Nova Scotia 2023 event at https://www.youtube.com/watch?v=U3qhGOtRXcc.)
Engage Nova Scotia. (2014). Nova Scotia Quality of Life Index 1994-2014. Found at https://static1.squarespace.com/static/5d388a67fad33f0001679229/t/633493c9e9fbfb7acb9f91fe/1664390104859/EngageNS_NSQoLIndex_2018Jun25.pdf
European Telecommunications Standards Institute. (2021) EN 301 549 V3.2.1 (2021-03) Harmonized European Standard. https://www.etsi.org/deliver/etsi_en/301500_301599/301549/03.02.01_60/en_301549v030201p.pdf
Grabowska, I., Antczak, R., Zwierzchowski, J., & Panek, T. (2021). Individual quality of life and the environment – towards a concept of livable areas for persons with disabilities in Poland. BMC Public Health, 21(1), 740–15. https://doi.org/10.1186/s12889-021-10797-7
Government of Canada (2019). Accessible Canada Act. Minister of Justice. Found at https://laws-lois.justice.gc.ca/PDF/A-0.6.pdf
Michalos, A.C. (2014). Subjective Indicators. In: Michalos, A.C. (eds) Encyclopedia of Quality of Life and Well-Being Research. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0753-5_2899
Province of Nova Scotia (2023). Communities, Culture, Tourism and Heritage: Community funding and awards. Retrieved from https://cch.novascotia.ca/investing-our-future/community-funding-and-awards/community-access-ability-program
Province of Nova Scotia (2018). Access by Design 2030. Department of Justice. Found at https://novascotia.ca/accessibility/access-by-design/access-by-design-2030.pdf
Statistics Canada. (2023). Quality of Life Hub. Retrieved from: https://www160.statcan.gc.ca/index-eng.htm
Statistics Canada (2022). Canadian Survey on Disability. Retrieved from: https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&lang=en&Item_Id=1400719
United Nations. (2008). Convention on the Rights of Persons with Disabilities. https://social.desa.un.org/issues/disability/crpd/convention-on-the-rights-of-persons-with-disabilities-crpd