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Minister’s Message

I am pleased to present the 2008-09 Departmental Performance Report for the Public Health Agency of Canada. Working collaboratively with federal, provincial, territorial and international partners, the Agency played a vital role in promoting and protecting the health of Canadians and creating a stronger public health capacity.

The Agency worked to protect the health of Canadians by strengthening Canada’s emergency preparedness, including planning for pandemic influenza. Through the Agency’s work, supported by its surveillance systems, nationwide quarantine service and emergency response protocols, Canada improved its position to respond to disease outbreaks, food-borne illness and other emergencies that impact human health. The magnitude of the 2008 listeriosis outbreak, a rare occurrence in Canada, required a multi-jurisdictional emergency response in which the Agency was one of many participants. The Agency coordinated and analyzed all laboratory data, and provided analyses and interpretation of genetic “fingerprints” which established the connection between cases of Listeriosis and the source of the food contamination. The Agency’s work helped to mitigate the outbreak and the impacts on the health and well-being of Canadians. By continuing to learn from this experience, from an internal review, and from the  Report of the Independent Investigator into the 2008 Listeriosis Outbreak, the Agency is moving ahead in enhancing the food safety system from a public health perspective.

With a focus on prevention, the Agency worked to promote good health practices among Canadians and eliminate barriers to healthy behaviours. For example, the Canadian Prenatal Nutrition Program provided funding to community groups to develop or enhance programs for vulnerable pregnant women with the aim to improve the health of both infant and mother through nutritional guidance, food supplements, and education/counselling on health and lifestyle issues. The Agency also entered into bilateral agreements with every province and territory to help address the challenges of physical inactivity and unhealthy eating. Many of the projects funded through these agreements support healthy lifestyles among youth.

Immunization programs across Canada continued to mitigate infectious diseases, including life threatening diseases such as meningococcal meningitis and infectious agents of chronic diseases like cervical cancer. These programs fostered federal, provincial and territorial cooperation to provide Canadians with equitable access to immunization protection across the country. Also, to enable Canadian travellers to make informed decisions, the Agency jointly published with Foreign Affairs and International Trade Canada, Well on Your Way, A Canadian’s Guide to Healthy Travel Abroad.

With the Agency’s support, a set of core competencies for public health professionals - the essential knowledge, skills and attitudes necessary for the practice of public health – were developed for use by provinces, territories, local jurisdictions and other federal departments and agencies.

In support of a stronger public health system in Canada and around the world, I am proud to report on the significant achievements made by the Agency during 2008-09.

 

_____________________________________
The Honourable Leona Aglukkaq
Minister of Health
Government of Canada

Message from the Chief Public Health Officer

Today, there is a clear recognition of the importance of public health activities to Canada’s overall well-being, and of the valuable role played by the Public Health Agency of Canada in improving and protecting the health of Canadians.

I take satisfaction in presenting this performance report, which provides an accounting of how the Agency’s dedicated staff across the country made progress in fulfilling our vision of healthy Canadians and communities in a healthier world.

Public health is a combination of programs, services and policies that protect and promote the health of all Canadians. It involves the organized efforts of all three levels of government in collaboration with a wide variety of stakeholders and communities across the country and around the world. The Agency leads the federal government’s work on promoting health, preventing and controlling chronic and infectious diseases, and preparing for and responding to human health disasters and emergencies.

One of my legislated responsibilities as Chief Public Health Officer is to report annually on the State of Public Health in Canada – it is a means of highlighting certain pressing public health issues with Canadians and Parliamentarians, and encouraging thought on possible solutions. In June 2008, my Report on the State of Public Health in Canada provided a broad look at the overall health of Canadians as well as disparities in health and other issues. This first report had a special focus on health inequalities intended to start a discussion among all Canadians on how we can move forward to build on Canada’s successes in addressing health inequalities.

The Agency continued improving Canada’s pandemic influenza readiness through the development of Canada’s pandemic preparedness plan, purchasing and distributing antiviral drugs and planning for the rapid production of a vaccine. The preparatory work done during 2008-09 and previous years was put to the test in the recent H1N1 outbreak.

Some programs within the Agency focus on identified health needs of specific populations. For example, the Agency’s Aboriginal Head Start Program is helping to address the spiritual, physical, nutritional, emotional and intellectual needs of thousands of young Aboriginal children living in urban centres and northern communities by employing strategies developed and managed by Aboriginal people by focusing on culture and language, education, health promotion, social support and parental involvement.

I am proud of everything the Agency continues to accomplish. It is through its many achievements and exceptional work that the Agency continues to be a world leader in public health.

 

________________________________________
David Butler-Jones, M.D.
Chief Public Health Officer

Section I – Overview

Raison d’être

Public health involves the organized efforts of society to keep people healthy and to prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians. In Canada, public health is a responsibility that is shared by the three levels of government, the private sector, non-government organizations, health professionals and the public.

In September 2004, the  Public Health Agency of Canada (Agency) was created within the federal Health Portfolio to deliver on the Government of Canada’s commitment to help protect the health and safety of all Canadians, to increase its focus on public health, and to contribute to improving health and strengthening the health care system. Its activities focus on promoting health, preventing and controlling chronic and infectious diseases, preventing injuries and preparing for and responding to public health emergencies.

Responsibilities

The Agency has the responsibility to:

• contribute to the prevention of disease and injury, and the promotion of health;
• provide federal leadership and accountability in managing public health emergencies;
• serve as a central point for sharing Canada’s expertise with the rest of the world and applying international research and development to Canada’s public health programs; and
• strengthen intergovernmental collaboration on public health and facilitate national approaches to public health policy and planning.

In December 2006, the  Public Health Agency of Canada Act came into force, giving the Agency the statutory basis to continue fulfilling these roles.

Strategic Outcome and Program Activity Architecture (PAA)

In order to effectively pursue its mandate, the Agency aims to achieve a single strategic outcome of healthier Canadians, reduced health disparities, and a stronger public health capacity supported by its Program Activity Architecture (PAA) depicted in the following figure. In fiscal year 2008-09, the Agency initiated the renewal of the Agency’s existing PAA to address Management Accountability Framework (MAF) Round V assessment results and address conditions as part of the 2009 Strategic Review approval letter. The 2010-11 PAA and supporting Performance Measurement Framework (PMF) were subsequently approved by Treasury Board in Spring-Summer 2009.

Summary of Performance

2008-09 Financial Resources ($ millions)

Planned Spending	Total Authorities	Actual Spending
590.6	632.4	582.9

2008-09 Human Resources (FTEs)

Planned	Actual	Difference
2,452	2,338	114

Significant progress was made during the year on staffing; however, Full-Time Equivalents still fell short by 114 due to delays in the staffing process given difficulties in finding highly skilled and technically qualified candidates.

Performance Summary

Strategic Outcome: Healthier Canadians, reduced health disparities and a stronger public health capacity

Performance Indicators	Targets	2008-09 Performance
Health-adjusted life expectancy (HALE) at birth	Baseline data	68.3 years (males); 70.8 years (females)*
The difference, in years, in HALE at birth between the top-third and bottom-third income groups	Baseline data	4.7 years (males); 3.2 years (females)*

* 2001 data are the most recent available. The feasibility of developing these performance indicators for use on an ongoing basis nationally is under consideration, with the intention of establishing new baselines and targets by 2010-11.

($ millions)

Program Activity	2007-08 Actual Spending	2008-09				Alignment to Government of Canada Outcomes
		Main Estimates	Planned Spending	Total Authorities	Actual Spending
Health Promotion	192.1	203.6	203.5	217.4	200.8	Healthy Canadians
Chronic Disease Prevention and Control1	41.2	69.0	69.0	62.4	52.9	Healthy Canadians
Infectious Disease Prevention and Control1	199.3	234.9	234.9	273.4	256.1	Healthy Canadians
Emergency Preparedness and Response	121.3	39.0	39.1	34.5	30.9	Safe and Secure Canada*
Strengthen Public Health Capacity	53.0	44.1	44.1	44.8	42.1	Healthy Canadians
Total	606.9	590.5	590.6	632.4	582.9

Note: Total excludes cost of services received without charge. Due to rounding, there may be insignificant variances.

¹ The former Program Activity Disease Prevention and Control, 2007-08 actual spending has been pro-rated between Chronic Disease Prevention and Control and Infectious Disease Prevention and Control based on 2008-09 Actual Spending.

Funding received for the operating budget carry-forward from 2007-08, collective bargaining agreements, and non-controllable salary costs were the main reasons for the $41.8 million difference between Planned Spending and Total Authorities.

Funding re-profiles required to better align funding with anticipated expenditures such as Vaccine Readiness Fee and National Antiviral Strategy; the recent federal election, which caused delays in Grants and Contributions solicitations as well as in procurements; and difficulties in finding highly skilled and technically qualified candidates, resulted in Actual Spending being $49.5 million lower than Total Authorities.

* Formerly “Safe and Secure Communities”.

Contribution of Priorities to Strategic Outcome

Operational Priorities	Type	Status	Links to Strategic Outcome
To develop, enhance and implement integrated and disease-specific strategies and programs for the prevention and control of infectious disease	Ongoing	Mostly Met	The Agency contributed to healthier Canadians by collaborating both domestically and internationally on immunization and vaccine-preventable diseases; took a leadership role in the Federal Initiative to Address HIV/AIDS in Canada; and provided surveillance for infectious diseases.
To develop, enhance and implement integrated and disease -or condition- specific strategies and programs to promote health and prevent and control chronic disease and injury	Ongoing	Mostly Met	The Agency contributed to healthier Canadians through initiatives aimed at improved overall health for Canadians, a lower number of Canadians who develop chronic diseases, and a better quality of life and fewer complications for Canadians living with chronic diseases, using an appropriate mix of interventions.
To increase Canada’s preparedness for, and ability to respond to, public health emergencies, including pandemic influenza	Ongoing	Mostly Met	The Agency contributed to a stronger public health capacity by engaging in emergency preparedness and response planning with federal, provincial and territorial departments and agencies, and non-governmental organizations to identify emerging priorities, establish work plans and coordinate activities. The Agency responded to challenges and risks related to globalization, infectious disease surveillance, food-borne hazards and zoonotic incidents. A health portfolio mass gathering plan was developed. These program activities enhanced the Agency’s readiness capacity to mitigate public health risks and emergencies of national and international significance and ensure the health, safety, and security of Canadians.
To strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity	Ongoing	Mostly Met	The Agency contributed to stronger public health capacity by cultivating a sustainable, highly skilled workforce; by fostering the development of tools, frameworks and collaborative networks to increase and share public health information; and by supporting the development and application of legal and ethical strategies, tools and best practices to improve the understanding of the implications of public health interventions. Further improvements will be achieved as these activities become established and are modified in response to public health events.
To lead several government-wide efforts to advance action on the determinants of health	Ongoing	Mostly Met	The engagement of other federal departments, whose policy and initiatives have a significant impact on determinants of health, is a critical first step in taking action to reduce health inequalities. Several departments have been actively engaged on key issues such as: income and health -building an economic case for action; health as a determinant of productivity; the private sector role; and follow-up to the  May 2008 Report by the Senate Subcommittee on Population Health. This initial engagement will lead to further collaborative action to increase federal policy coherence and contribute to the reduction of health inequalities.

Management Priorities	Type	Status	Links to Strategic Outcome(s)
To develop and enhance the Agency’s internal capacity to meet its mandate	Ongoing	Mostly Met	The Agency’s Management, Results and Resources Structure (MRRS) was renewed and received Treasury Board approval on May 28, 2009. The renewed MRRS is an improved depiction of the Agency’s mandate and is articulated at a sufficient level of materiality to reflect how the organization allocates and manages its resources. This supports improved results-based management practices, demonstrates value for money, and provides key stakeholders with the information necessary to support decision-making. The Agency launched its first comprehensive 2009-10 Integrated Operational Planning process in support of Public Service Renewal to translate commitments into tangible, effective operational program delivery, program support and management activities for the following year. The Agency underwent a Strategic Review to identify areas for reallocation in support of the Government of Canada’s renewal of the Expenditure Management System. The Agency participated in the MAF assessment which identified areas of improvement such as business continuity planning, information, asset and project management, procurement and citizen-focused service. In addition, the Agency developed an Integrated Risk Management Framework as a tool to support its work, including the MAF.

Risk Analysis

The Agency operates within changing socio-economic, cultural and environmental conditions that may positively or adversely affect the public health of Canadians. The Agency responded to challenges and risks related to the surveillance of infectious diseases, globalization, food-borne hazards and zoonotic outbreaks/incidents, demographic trends, public preparedness and response during mass gatherings.

PHAC facts... In September 2008, Federal, Provincial and Territorial Ministers approved a multi-lateral F/P/T Memorandum of Understanding on Information Sharing During a Public Health Emergency. Development of information sharing agreements continued within the pan-Canadian Public Health Network to cover the broad scope of information sharing needed for public health. Information sharing agreements are complex intergovernmental documents that require extensive consultation which includes: identification of needs and required resources, development of mandates, clarification of roles and responsibilities and careful drafting and review by all parties before approval.

In May 2008, the Auditor General of Canada (OAG) submitted to Parliament a report that focused on  May 2009 Committee Report, the Agency will provide an interim status report to the Public Accounts Committee on its progress in implementing the OAG recommendations by September 30, 2009, and annual status reports until the recommendations are fully implemented.

PHAC facts... The International Health Regulations are a set of rules and procedures agreed upon by 193 countries aimed at reducing threats to global health by governing key elements in the prevention and control of infectious disease. The Agency has the mandate to coordinate IHR implementation efforts in Canada across federal, provincial/territorial and local authorities, and is working jointly with Health Canada to achieve this end.

Globalization has resulted in higher international migration for commerce and travel. This trend increases the likelihood of an infectious disease outbreak and the speed of its transmission within Canada. To mitigate public health risks associated with increased international travel, Canada committed to complying with the  International Health Regulations (IHRs) by 2012. In addition, the Agency established stringent made in Canada requirements.

PHAC facts... The Agency provided expertise on food-borne, waterborne, and zoonotic diseases to the provinces, the Canadian Food Inspection Agency and Health Canada. The Agency supported 52 investigations, coordinated 11 multijurisdictional investigations, and collaborated on 18 international investigations of outbreaks.

Global food supply chains and increasing consumer demand for convenience have significantly changed the way in which food is produced, processed, packaged, distributed and sold around the world. In addition, increased demand for greater diversity in imported ethnic foods means that food may enter Canada from countries that may not be as strictly regulated. Canada may fail to detect, track and/or mitigate food-borne pathogens, toxins, chemical contaminants and other food-borne hazards both of domestic and international origin that could pose a public heath risk to Canadians. In 2008-09, the Emergency Operations Centre was activated within 24 hours for a Listeriosis outbreak linked to ready-to-eat meats and for Melamine contamination in food. The Agency released a  Canadian Food Inspection Agency (CFIA), the Agency is now working in closer cooperation with provincial and territorial health authorities to protect the public from these outbreaks. In April 2008, the three departments signed a Memorandum of Understanding to support collaboration and coordination for issues involving zoonotic diseases and the potential impacts on human and animal health. In May 2008, the Agency and CFIA signed a Letter of Agreement to establish a collaborative integrated process for the development of surveillance and risk assessment mechanisms to anticipate and prepare for potential non-food-borne zoonotic diseases.

PHAC facts... The increasing incidence of chronic diseases is a significant challenge since 81% of all Canadian deaths are caused by major chronic diseases. Chronic diseases such as cancer, cardiovascular diseases, diabetes, lung diseases and arthritis result in four out of five deaths in Canada (Public Health Agency of Canada, 2009, using Statistics Canada  Vital Statistics).

The  2006 Census showed that Canada had the fastest-growing population among the G-8 countries between 2001 and 2006 mainly due to immigration. The population is also aging, with the number of Canadians aged 65 years and older almost doubling since 1970. This change has notable effects on the number of Canadians living with chronic diseases. Rates of chronic diseases (such as cancer, diabetes and cardiovascular diseases) are rising which creates increased burdens on health care systems, communities, families and individual Canadians. The Agency is working with provincial and territorial governments and non-governmental organizations to identify strategies to prevent chronic diseases and facilitate their implementation. In Canada, the Aboriginal population is relatively young, has a higher than average rate of injuries and disease, and is growing almost twice as fast as the country’s general population. While Canada is the second largest country in the world in terms of land mass with many rural and remote northern populated areas, at the same time it is one of the most urbanized. Research has demonstrated that economic factors, including rising unemployment, negatively impact population health. The growth in Canada’s vulnerable populations, together with increasing income inequality and economic uncertainty pose risks of higher health inequalities and growing chronic and infectious disease burdens associated with the economic, geographic and social inequalities. These trends are considered by the Agency in order to develop public health responses to reduce health inequalities and improve the health for all Canadians.

There is increasing recognition and expectation for public preparedness and response during mass gatherings such as the 2010 Winter Olympics in Vancouver, British Columbia. The Agency prepared a health portfolio mass gathering plan and conducted 2010 Winter Games Exercise Silver which involved federal, provincial, territorial and some US state government departments. The Agency actively participated in three scenarios which focused on an influenza outbreak, an unidentified illness and a chemical attack. Information from those exercises was used to strengthen capacity to address any possible health risks from natural disasters, disease outbreaks, accidents and potential criminal or terrorist threats.

To address challenges facing all levels of governments in Canada related to public health capacity and surge capacity, the Agency provided training opportunities, identified competencies and delivered distance learning for public health, provided scholarships and bursaries for research work and career advancement in public health, deployed human resources in support of surveillance and disease control as part of surge capacity in jurisdictions and began negotiating with Agency partners for these deployments across Canada.

The Agency had some human resource recruitment challenges that impacted its ability to meet all of its Report on Plans and Priorities (RPP) commitments. While Full Time Equivalents increased by 8% from the previous year, they remained 4.6% (114) below plan. Delays in staffing due to difficulties in recruiting staff with public health specialization, and a shortage of available office space for public servants are some of the factors that contributed to the complexity of recruiting and retaining of qualified personnel.

Expenditure Profile

The Agency received funding announced in Budget 2006 for Avian and Pandemic Influenza Preparedness. This initiative provided significant resources in 2007-08 to build national capacity to prepare for and respond to a pandemic event. Hence, significantly large expenses occurred in 2007-08 to purchase antivirals and personal protective equipment for building national stockpiles after which expenditures were expected to stabilize.

As previously noted, Actual Spending for 2008-09 was $49.5 million lower than Total Authorities primarily resulting from the re-profiling of the funding for Vaccine Readiness Fees and National Antiviral Strategy to future years to better align with the anticipated expenditure; the October 2008 federal election, which caused delays in Grants and Contributions solicitations as well as in procurements; and difficulties in finding highly skilled and technically qualified candidates.

Voted and Statutory Items
($ millions)

Vote # or Statutory Item (S)	Truncated Vote or Statutory Wording	2006-07 Actual Spending	2007-08 Actual Spending	2008-09 Main Estimates	2008-09 Actual Spending
40*	Operating expenditures	305.4	393.3	360.5	371.3
45*	Grants and Contributions	182.2	188.7	199.6	184.2
(S)	Contributions to employee benefit plans	23.2	24.9	30.4	27.3
Total		510.8	606.9	590.5	582.9

* In 2006-07 and 2007-08, Votes 40 and 45 were numbered Votes 35 and 40 respectively.

Actual Spending in Operating Expenditures is higher in 2007-08 than in 2008-09 mainly due to large purchases to build up the National Emergency Stockpile, which did not occur to the same degree in 2008-09.

Actual Spending in Grants and Contributions was lower in 2008-09 by $4.5 million as a result of delays in issuing solicitations for new projects during the 2008 federal election period.

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