On May 1, 2026, Dr. Kate Linden, co-stream lead for Economics and Well-Being traveled to Saint Mary’s University in Halifax for the Workshop on Policy Impact Assessment. Hosted by the Sobey School of Business, the event gathered academic experts and federal policy leaders from Innovation, Science and Economic Development Canada (ISED) and the Treasury Board of Canada Secretariat to discuss the evolving landscape of evidence-based policy evaluation.  

The Challenge of Rural Invisibility 

Dr. Linden’s presentation focused on a critical gap in current provincial health assessments: the Centralization Paradox. While standard models often prioritize urban administrative efficiency, they can unintentionally externalize costs in rural areas. This improves a provincial balance sheet while diminishing social determinants of health for patients such as proximity to care and social isolation.  

Dr. Linden introduced the room to the Economic and Well-Being stream’s concept of Liminal Care Infrastructure (LCI). This term, developed by Dr. Linden and her co-stream lead Dr. Martin Sers, refers to the hidden economy of rural Nova Scotia which includes the informal, non-monetized networks built on decades of trust. Whether it is a neighbor checking the curtains or a retired nurse providing informal guidance, this infrastructure is what currently keeps many seniors out of long-term care. However, because this care is invisible to standard spreadsheets, it is often dismantled by policies that treat these communities as service-deficient rather than resource-rich.  

An Ecosystem Approach 

To address this, Dr. Linden and Dr. Sers are developing the Ecosystem Approach to Rural Aging (EARA). This framework moves beyond treating aging-in-place as a narrow healthcare problem. Instead, it views community health as an emergent property of eight interdependent domains such as transportation and informal driver networks, social check-ins like the local post office or coffee shop table, and physical environment, acknowledging the land as a relational partner in Atlantic Canada.  

The EARA framework is designed to trigger a cascade logic so that we recognize that when one domain fails (such as the closure of a local post office), it destabilizes adjacent ones, leading to health deterioration and community out-migration.  

Toward a Unified SROI 

The workshop provided an invaluable opportunity to stress-test the Econ & Well-Being team’s methodology for a unified Social Return on Investment (SROI) ratio. Their goal is to combine hard financial savings (using CIHI patient cost estimators) with monetized and non-monetized well-being values defined by rural Nova Scotians themselves through participatory based community research.  

Dr. Linden’s presentation sparked a robust dialogue among federal and provincial policy practitioners. Attendees highlighted the urgent need for rigorous yet participatory data that can convince analysts to invest in the social patchwork of rural life. The feedback from discussion confirmed that the Economics and Well-Being stream’s methodology is addressing a major policy translation problem. As we continue our data collection through the Spring of 2026, we remain committed to building a defensible, community-validated model that ensures the retired nurse down the road is finally recognized as a cornerstone of the healthcare system. 

A working paper on this topic is available by contacting Dr. Linden: kate_linden@cbu.ca