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Nova Scotia Health Atlas

Nova Scotia Health Atlas

Exploring health and wellbeing across Nova Scotia

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Frequently Asked Questions

Frequently Asked Questions

The Nova Scotia Health Atlas (NS Health Atlas) is an interactive, online visualization tool designed to show spatial variation in population demographics, health determinants, behaviours, and outcomes across several geographic scales.

A main aim of the Nova Scotia Health Atlas is to inform decisions focused on improving the health of Nova Scotians. Ideally, decisions on the allocation of resources to improve health and prevent disease are based on rigorous evidence. The NS Health Atlas is also used to translate insights from empirical health research towards policy change and actions to improve population health. By transforming complex data into relatable stories, we engage users with new experiences and meaningful insights.

The NS Health Atlas is housed by the Centre for Planetary Health and Sustainable Care and maintained by Drs. Nathalie Saint-Jacques and Daniel Rainham. Dr. Cindy Feng in the Department of Community Health and Epidemiology at Dalhousie University serves as a project advisor. Geospatial support and storytelling is made possible with support from Ms. Hannah Freeman.

The How to Use page includes a tutorial explaining navigation and how to interpret key messages.

The NS Health Atlas displays most data at four geographic scales: health management zone (4 areas), health networks (14 areas), community clusters (54 areas), and the community environs (301 areas). Think of Russian nesting dolls (Matryoshka) where each of these geographic boundaries are nested within another. You can find definitions for each of these geographic units in the atlas tool by hovering your cursor over the geography of interest. We endeavor to make data available for each geographic scale used in the atlas; however, this is not always possible so we urge users to be aware that some datasets are only available at specific geographic scales.

Data in the atlas come from several sources. Population demographics and several data sets associated with the determinants of health are derived from Canadian Census data. Indices of socioeconomic conditions (e.g., material security score), community connectedness and diversity are derived from statistical models using data from the Canadian Census. Data on environmental exposures  are sourced from relevant provincial departments (e.g., radon and well-water quality) or from the analysis of satellite-based observations (e.g. air quality and greenness). Data on health behaviours and outcomes are derived from completed research projects that employ statistical models to determine the spatial and temporal variation of prevalence, or disease rates typically from health registries, administrative data or surveys.

There are two main reasons: data privacy and statistical stability.

Data privacy means protecting the identity of the individuals included in the data.

Statistical stability refers to the way statistics naturally fluctuate when they’re based on small numbers of records. The smaller the number, the more the results bounce around.

Both issues matter most in small geographic areas, such as community environs. Modelled estimates help solve this problem. They can reveal the real differences in health behaviours and outcomes between areas, all while keeping individuals’ information private.

Census data are released for research purposes typically 1-2 years after data collection. There are no fixed schedules for other data at this time.

We show rates by sex because biological sex and gender roles deeply influence how illnesses start, progress, and present in the body. Tracking these rates helps with improving prevention, early detection, and targeted treatments for patients.

Differences in rates are due to several reasons, including biological differences (genes, hormones, immune response), social and behavioural factors (employment status, health behaviours, social context, stress), environmental factors (air and water quality, chemical exposures), differences in healthcare (diagnosis, treatment), and the success of public health initiatives.

Yes — the older you are, the more likely you are to get cancer. When we compare cancer rates across different areas, we adjust for age. This means if one area has mostly younger people and another has mostly older people, we account for that difference. So when the maps show that one area has higher cancer rates than another, it is not simply because that area has more older people.

To make sense of the numbers, we compare each area to the Nova Scotia average. On its own, a cancer rate for one area does not tell you much and you need another rate for comparison. The NS Health Atlas shows whether each area’s cancer rate is higher or lower than the Nova Scotia average.

Health behaviour and outcomes data in Nova Scotia typically include a person’s home postal code at the time they participate in a survey or are diagnosed . Each postal code is geocoded or converted to a specific geographic location and then linked to a defined area on the map. This allows us to calculate rates at different geographic scales.

This process is not perfect. First, it\assumes that individuals’ home locations stay relatively stable over time. Second,  it depends on having accurate address information on file. Common challenges include postal codes that do not exist, correspond to a PO box or commercial address rather than a home address, or records where the address is incomplete or missing. Finally postal codes in rural Nova Scotia often cover larger areas than those in cities. This may make it harder to assign homes to their exact locations. This is especially important when reporting data over small areas, where location should be based on home’s civic address when that information is available.

Many chronic diseases, including cardiovascular diseases and cancers, share common risk factors and conditions. Some risk factors can’t be changed, like your age, sex, and genes. But many others can. With the right support, certain behaviors can be changed, such as what we eat or how much we exercise and whether we use alcohol or smoke. Changing these behaviors can also help with health problems like high blood pressure, extra weight, high blood fat levels, and prediabetes. The world around us matters too. Things like our income, the services and infrastructure in our community, and where we live can shape our behaviour. These conditions can also affect our health in direct and indirect ways.

The NS Health Atlas includes results from a study of smoking prevalence using data from the Canadian Community Health Survey between 2011-2020. Included are rates for current and former smokers, and those who are exposed to smoke from those smoking around them. The good news is that smoking prevalence has declined over time in Nova Scotia. However, as the rates are reported over small areas, we see that smoking has not declined at the same pace across all communities. Some areas continue to have smoking rates well above the latest national rate of about 11.5%, and far beyond the Canadian target of 5% by March 2035. 

The 10 cancer types included in the NS Health Atlas are those where prevention efforts can make a  difference in Nova Scotia. Cancer can affect men and women differently because of genetics, hormones, immune response, body composition, and lifestyle.  Some cancers such as bladder cancer are more common in men, and others like breast cancer are more common in women. Looking at data separately can help us see patterns that may be missed when results are combined and may help us understand possible causes and help guide health services and prevention efforts. 

All estimates for smoking behaviour, high-cost healthcare utilization and cancers are relative to the Nova Scotian average. A “higher” rate in an area means the average risk for people living there is likely higher than the provincial average. This does not mean every individual in that area has a higher risk.

Higher rates in an area may reflect the broader health, behaviours, and circumstances of people living there. This means there are opportunities to improve health not only through individual choices, but also through changes that make healthier choices easier for everyone. Communities can support better health by improving access to healthy, affordable food, creating safe and accessible opportunities for physical activity, reducing exposure to tobacco and harmful alcohol use, and ensuring people can access screening and preventive health services. Individuals can also reduce their own risk where possible by eating less processed food, choosing more plant-based foods, staying active, maintaining a healthy weight, reducing alcohol consumption, quitting smoking, and taking part in eligible screening programs. You can make a big difference by eliminating any one of these risks.

Technical

The Atlas incorporates the results from research that employs both frequentist (i.e. traditional) and Bayesian statistical methods to identify variation in rates of health behaviours and outcomes across the province.

The rates reported over small areas were all modeled using Bayesian  statistical methods best suited for measuring rare health outcomes in areas with small populations, such as Nova Scotia. The approach calculates a rate in a given location by ‘borrowing’ data from neighboring areas. Therefore, the rate in one area depends (i.e. is ‘conditional’) on the values of neighboring areas. This protects privacy while stabilizing the estimates and reducing the chances of incorrectly identifying an area as ‘high risk’ when its rate is similar to the provincial average. It assumes that people living closer to one another tend to be more alike than those further apart as they often share similar exposures, access to care, and risk factors. This type of modeling implies that we can gain information about a community from its neighbors.

To know more about the modeling of cancer rates, click  here.

To know more about the modelling of health behaviours from survey data, click here.

In the NS Health Atlas, the rates are reported using a metric of ‘relative risk’ (RR). A RR greater than 1 means that the rate is higher than what we measured on average for Nova Scotia over a specific period of time (e.g. 16-year period (i.e. 2001-2017).  For example, a RR of 1.2 indicates that the rate is 20% higher. A RR of 0.8 means that the rate is 20% lower. To determine if the rate of cancer in a given area is significant, the Atlas uses ‘exceedance probability’.  Areas with a RR greater than 1 and an exceedance probability of 80% or higher (i.e., 0.8) are considered to have a significantly higher-than-average cancer rate; areas with RR smaller than 1 and an exceedance probability of 20% or lower (i.e. 0.2) are considered to have significantly lower-than-average cancer rate.

Health behaviours such as smoking are reported using a metric of ‘prevalence’ which is the percentage of people in a given area who for example, smoke either daily or occasionally (i.e. current smokers) or who have smoked in the past but have now quit (i.e. former smokers). Exceedance probabilities are again used as a measure of confidence to determine if prevalence is above or below the Nova Scotia average.

Every statistical estimate carries some degree of uncertainty. The greater this uncertainty, the less confidence we can have that the estimate reflects the true value. Even when health statistics are drawn from an entire population rather than a sample, counts still fluctuate from year to year and place to place. The smaller the number involved, the greater this natural variability tends to be.

By selecting layers options, you can view locations of all hospitals, and nursing and residential care locations. You can also overlay the boundaries of other geographic areas. For example, if you would like to know what the spatial variation of breast cancer looks like within a community cluster or health management zone then just add the boundary overlay. At this time we do not provide any summaries of variation within larger zones but aim, when possible, to provide data at all geographic scales. 

Yes, you can use the scroll wheel on your computer mouse or the “+” and “-” buttons on the atlas page to zoom in and out. You can also hover or click on an area to see values for the indicator(s) of interest. For more information on how to use the atlas, review the storymap on how to use the atlas.

Other

Nova Scotia Health Atlas  (https://healthatlas.ca/). Centre for Planetary Health and Sustainable Care. Version 06-2026. Accessed [access date]

Copyright notice: Materials were developed by researchers from Dalhousie University and the Nova Scotia Health Cancer Care Program using data from several sources. Enquiries: contact@healthatlas.ca

Permitted use. You may use this content without prior consent only if all of the following conditions are met:

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All other uses. Except as set out above, or as otherwise permitted under the Copyright Act (R.S.C. 1985, c. C-42) or other applicable law, this content may not be reproduced, adapted, published, distributed, stored, or transmitted in any form or by any means without the prior written consent of authors Dr. Daniel Rainham or Dr. Nathalie Saint-Jacques. The authors assert their moral rights in this content.

Disclaimer: Material on this website is provided for general information only. It is not legal, medical, health, or other professional advice, and no professional or advisory relationship is created by your use of it. You should obtain advice specific to your circumstances from a qualified professional before acting on anything you find here.

Opinions expressed on this site do not necessarily represent the views of the Centre for Planetary Health and Sustainable Care, Dr. Daniel Rainham, or Dr. Nathalie Saint-Jacques (together, the “Project Parties”).

While care has been taken in preparing this material, the Project Parties make no representation or warranty — express, implied, statutory, or otherwise — that the information is correct, accurate, complete, current, or fit for any particular purpose. If you rely on this material, you do so at your own risk and are responsible for independently verifying it.

To the fullest extent permitted by law, the Project Parties exclude all liability for any loss or damage (including direct, indirect, incidental, or consequential loss, and including loss arising from negligence) suffered as a result of accessing, using, or relying on this material. Where liability cannot lawfully be excluded but may be limited, the Project Parties’ liability is limited to supplying corrected information through an update to the Atlas.

Nothing in this disclaimer is intended to exclude, restrict, or modify any right, warranty, or remedy that applies to you under the Consumer Protection Act (Nova Scotia) or other applicable legislation and that cannot lawfully be excluded, restricted, or modified.

The Project Parties are not responsible for the content, accuracy, or availability of any third-party website linked from this site, and a link does not imply endorsement. Some material has been developed from data provided by third parties, whose accuracy the Project Parties are unable to verify.

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