As part of a larger project on development of an ecosystem integrity and cumulative effects monitoring program for the Peace, Athabasca, and Slave River basins, this report reviews the concept of ecosystem health and cumulative effects assessment as well as the theoretical framework and practical objectives of these approaches. The report reviews the literature on existing individual, population-, and community-level approaches and associated measurements being used for the assessment of aquatic ecosystem health and cumulative effects. It also identifies the types of data required to assess and monitor aquatic ecosystem health and cumulative effects in large northern rivers. Finally, the report discusses the applicability of these approaches and associated measurements, and recommends approaches with potential for use in the Northern River Basins Study.