The History of the Core Indicators for Public Health in Ontario

Public health epidemiologists in Ontario have long felt the need for a consistent set of health indicator definitions. In February 1998, a group of epidemiologists met at the urging of the Institute for Clinical Evaluative Sciences (ICES) to discuss systematically defining health indicators. As a result, the Association of Public Health Epidemiologists in Ontario (APHEO) created the Provincial Health Indicators Work Group (PHIWG). PHIWG brought together epidemiologists from across the province, together with staff from health intelligence units (HIUs), the Public Health Resources Education and Development (PHRED) Program, the Institute for Clinical Evaluative Sciences (ICES), two branches of the Ontario Ministry of Health and Long Term Care (MOHLTC), and Health Canada. A list of the numerous members of PHIWG through the years is available at Members.

PHIWG built the indicators on the work of the past, most notably the Community Health Profile, produced in 1994 by the MOHLTC, the User’s Guide to 40 Community Health Indicators from 1992, and the Central East (CE) Collaboration Project. The CE Collaboration Project started as a Metropolitan Toronto initiative but expanded. It brought together public health units and district health councils in Central East Region to design a chart book of health indicators. The chart book pages were produced by the Central East Health Information Partnership (CEHIP). Other HIUs also had similar projects.

PHIWG met 12 times during 1998 and 1999 (see Minutes ). During 1998, PHIWG worked closely with the PHRED team producing the Report on the Health Status of the Residents of Ontario to ensure consistency between the two projects. The Core Indicators are organized in a similar framework as this Ontario Health Status Report. PHIWG’s work finally culminated in a draft report produced in November 1999 entitled Core Population Health Indicators for Ontario. The report was distributed in a binder to all public health units in Ontario and was available to everyone on the APHEO website. Feedback on the indicators was obtained from a variety of users.

In January 2001, PHIWG began Round 2 to revise and expand the first draft. New members revitalized PHIWG and took on the arduous role of adding new material to the indicators as an add-on to their busy regular jobs. The goal was to develop a website that could really showcase the indicators and the newly developed resources and be readily accessible and easily updated on a continuous basis. As well, the web environment allows for linkages with other resources on the Internet and can easily coordinate redundant information such as notes on data sources. During the summer of 2002, a Seneca student created a searchable website for the Core Indicators with funding from the Central East Health Information Partnership. The website was launched at APHEO’s 2002 Conference in Grand Bend.

In February 2006 the work group began a third round of revisions to the indicators and officially changed their name to the Core Indicators Work Group. In-depth review was planned for three sections of the indicators: Reproductive Health; Cancer Incidence and Early Detection of Cancer; and Infectious Diseases. A review of leading causes of mortality and hospitalization was added. Five sub-groups were formed to complete these reviews. General review is ongoing for all other indicators and resources. 

Key Milestones

  • Feb 1998: Inaugural meeting at the Institute for Clinical Evaluative Sciences
  • 1999: CPHA presentation, OPHA presentation, PHERO article
  • Nov 1999: Binder of draft "Core Population Health Indicators for Ontario” sent to all public health units
  • Feb 2000: Release of Ontario Health Status Report which used the Core Indicators as a basis for their work
  • Jan 2001: Revision and expansion of the first draft of Core Indicators begins
  • Summer 2001: Student hired by the Central East Health Information Partnership to create the Core Indicators website
  • Fall 2001: Core Indicators website launched at APHEO conference
  • 2005: Completion of indicators
  • Feb 2006: Formation of four subgroups: 1) Cancer and Risk Factors, 2) Reproductive Health, 3) Infectious Diseases,  4) Leading Causes
  • March 2007: Cancer and Risk Factors sub-group split to form the Cancer, Smoking & Sun Safety Sub-Group, and Healthy Eating and Active Living (HEAL) Sub-Group
  • June 2007: Funding application to the Public Health Agency of Canada (PHAC)
  • May 2008: APHEO website converted to wiki style
  • July 2008: Project Manager of PHAC project begins to revise and create indicators and resources for chronic disease and risk factors
  • Nov 2008: OPHS & the Population Health Assessment and Surveillance (PHAS) protocol released. The PHAS protocol refers to the Core Indicators
  • Dec 2008: Core Indicators Strategic Directions session held
  • Jan 2009: Formation of Built Environment Sub-Group
  • July 2009: Core Indicators PHAC project completed
  • Sep/Oct 2009: Formation of Injury & Substance Misuse Sub-Group, and Social Determinants of Health Sub-Group
  • Jan 2010: APHEO contingent approaches OAHPP for Core Indicators funding


"I just wanted to say (Though you've heard a million times) - how great the revisions of the indicators are - we have been using them a lot & they have helped point out some fixes that need to be made to our RRFSS data dictionary pages."
APHEO member, July 2009 

"I was on the site yesterday and am very impressed. People who worked on these did a tremendous job. This is a wonderful resource, particularly the table at the bottom that reflected the changes and the link to the standards makes it easier for us to apply the data."
APHEO member, July 2009 

"What an incredible project you and your colleagues continue to develop. The APHEO indicators site is a veritable gold mine of information, guide and HELP for those of us who are particularly scientifically challenged. My thanks to you and all your colleagues for this most useful web-site!"
District Health Council Planner, November 2004

"I must say congratulations on an informative and useful web site for the population health indicators. I have just started searching for others that are working in the area of performance measures for public health and I received wonderful information at this site!"
Department of Health and Wellness, New Brunswick, January 2001