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Minister’s Message

I am pleased to present the Public Health Agency of Canada’s 2011-12 Report on Plans and Priorities. The Agency plays an important role in the health and safety of Canadians by monitoring public health in Canada, promoting healthy lifestyles, and protecting Canadians from adverse public health events.

The H1N1 pandemic influenza outbreak underscored the value of having effective emergency preparedness and response plans. While the Agency successfully responded to this public health emergency, a number of lessons learned reviews have noted areas for improvement. The Agency will work with its federal, provincial and territorial partners to strengthen Canada’s capacity to prepare for and respond to a public health event. Internationally, the Agency will continue to support the World Health Organization’s implementation of the International Health Regulations by 2012.

In September 2010, I announced, along with my provincial and territorial colleagues, the Declaration on Prevention and Promotion, including the release of  Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights. Instilling the importance of a healthy lifestyle in children is essential to preventing illness in later life. To that end, the Agency will work with partners to advance a number of initiatives to promote healthy living by children and youth, including achieving and maintaining healthy weights and avoiding injury.

Comprehensive and timely surveillance information is fundamental in strengthening public health in Canada. The Agency will leverage this information to develop, in concert with provinces, territories and other key stakeholders, targeted prevention, mitigation and control strategies for infectious and chronic diseases. Particular focus will be placed on our most vulnerable populations including children, Aboriginal Peoples, and those living in rural, remote, and Northern communities.

There is much to be accomplished. I have confidence in the Agency’s ability to deliver on the priorities in this report and to continue promoting and protecting the health of Canadians.

 

Message from the Chief Public Health Officer

The Agency is recognized globally as a leader in the area of public health. Recent successes such as our response to the H1N1 pandemic influenza outbreak and development of the Declaration on Prevention and Promotion with our provincial and territorial partners have underscored that leadership. To continue promoting and protecting the health and safety of Canadians, the Agency must maintain public confidence in its activities, guidance and advice, and be seen as a valued contributor by national and international partners. As a result, the Agency will focus its efforts in 2011-12 on building on these successes.

Science and research underpin the Agency’s work and provide the strong evidence base for our programs and activities. The Agency will publish a Science and Research Strategic Plan that will provide an overarching framework for our science and research activities, bring greater cohesion to our initiatives and provide overall direction to our efforts. Improving how we communicate science to all Canadians will form an important part of these efforts.

As Chief Public Health Officer, I will work closely with my provincial and territorial colleagues to ensure a co-ordinated, pan-Canadian approach to public health issues. The finalization of an agreement on the sharing of surveillance information is a key priority, as it will improve our ability to prevent and respond to adverse public health events. I will also continue to work with my federal, provincial and territorial colleagues to strengthen Canada's overall emergency preparedness and response.

Sharing knowledge, information and resources, and continuing successful programs and policies for important issues such as infectious and chronic diseases, injuries, and childhood obesity will be high priorities in 2011-12. Additionally, as with previous years, I will update Canadians on the state of public health in Canada through my annual report.

Given the Agency’s vital and broad mission and its direct impact on the health and safety of Canadians, its employees are its most valuable resource. To continue providing world class science and evidence-based products, we need to continue to develop and retain a dedicated, knowledgeable, professional and diverse workforce that values excellence, leadership, employee engagement, and workplace well-being. Consequently, strengthened human resources planning will be a key management priority this year.

This 2011-12 Report on Plans and Priorities outlines activities the Agency will undertake to promote and protect the health of Canadians.

 

Section I – Overview

1.1 Summary Information

Raison d’être and Responsibilities

Public health involves the organized efforts of society to keep people healthy and to prevent injury, illness and premature death. It includes 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 (the Agency) was created within the federal  Health Portfolio to deliver on the Government of Canada’s commitment to increase its focus on public health in order to help protect and improve the health and safety of all Canadians and to contribute to strengthening the health care system.

The Agency has the responsibility to:

• Contribute to the prevention of disease and injury, and to the promotion of health;
• Enhance the quality and quantity of surveillance data and expand the knowledge of disease and injury in Canada;
• 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 for 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.

Contribution to the Federal Sustainable Development Strategy (FSDS)

The Agency is a participant in the  Federal Sustainable Development Strategy (FSDS).¹ The FSDS represents a major step forward for the Government of Canada by including environmental sustainability and strategic environmental assessment as an integral part of its decision-making processes. The new FSDS sets clear federal direction for environmental sustainability and common goals and targets across government.

PHAC contributes to Theme IV: Shrinking the Environmental Footprint – Beginning with Government of the FSDS. Contributions to the FSDS are further explained in Section II as part of the Internal Services Program Activity (2.1) and electronically in Section III in the Greening Government Operations supplementary information table. Additional details are available on PHAC’s  Departmental Sustainable Development Strategy Web site.²

Strategic Outcome and Program Activity Architecture (PAA)

To effectively pursue its mandate, the Agency aims to achieve a single Strategic Outcome supported by the Program Activity Architecture (PAA) summarized below.

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In 2010-11, the Agency continued its work on the implementation of the Management, Resources and Results Structure Policy that included the revision of the Agency’s Performance Measurement Framework (PMF). The objective of this revision is to continue to improve a PMF that will provide more detailed, objective performance measurement information to support the review, assessment and continuous improvement of programs.

Tag Legend:

	Theme I: Addressing Climate Change and Air Quality
	Theme II: Maintaining Water Quality and Availability
	Theme III: Protecting Nature
	Theme IV: Shrinking the Environmental Footprint – Beginning with Government

1.2 Planning Summary

Financial Resources ($M)

2011–12	2012–13	2013–14
622.7	592.1	579.2

Note: Additional information on expenditures at the Agency level is provided in Section I’s Expenditure Profile and at the Program Activity level in Section II.

Human Resources (Full-time Equivalent – FTE)

2011–12	2012–13	2013–14
2,768	2,729	2,729

Planning Summary Table

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and prevent and mitigate disease and injury.

Performance Indicators	Targets
Health-adjusted life expectancy (HALE)3 at birth	Maintain or exceed Canada’s 2001 HALE at birth as reported by Statistics Canada.4 • Overall - 69.6 • Women - 70.8 • Men  - 68.3
HALE by income; the difference, in years, in HALE at birth between the top-third and bottom-third income groups	Maintain or reduce the difference in years. • Women - 3.2 • Men  - 4.7

Program Activity	Forecast Spending 2010–11	Planned Spending			Alignment to Government of Canada Outcomes
		2011–12	2012–13	2013–14
1.1 Science and Technology for Public Health	87.1	60.7	55.0	48.9	Healthy Canadians
1.2 Surveillance and Population Health Assessment	60.6	60.1	58.5	58.5	Healthy Canadians
1.3 Public Health Preparedness and Capacity	83.0	94.6	75.3	72.4	Healthy Canadians
1.4 Health Promotion	182.9	182.2	182.2	182.2	Healthy Canadians
1.5 Disease and Injury Prevention and Mitigation	104.1	107.3	102.5	98.6	Healthy Canadians
1.6 Regulatory Enforcement and Emergency Response	30.2	26.0	24.7	24.7	Safe and Secure Canada
Total Planned Spending	547.9	530.9	498.2	485.3

Note: All figures are rounded

Internal Services

Internal Services	Forecast Spending 2010–11	Planned Spending
		2011–12	2012–13	2013–14
	110.3	91.8	93.9	93.9

Contribution of Priorities to the Strategic Outcome

The following table outlines three operational and two management priorities and their links to the PAA and Agency plans.

Risk Analysis

The Agency’s risk analysis is a synthesis of environmental scans, trend analysis, and the Corporate Risk Profile. This information plays an important role in helping the Agency determine priorities and plans over the short, medium and long terms. The analysis incorporates the risks and mitigation strategies as well as the context.

Context and Infrastructure

The Agency seeks to mitigate risks by increasing public health capacity among Canadians and the public health system through fostering proactive partnerships with key stakeholders and other governments. This collaboration is key to developing strategies that assess and address gaps in public health capacity in order to enhance our ability to take action on major health issues and respond to potential public health emergencies. The main vehicles used to increase capacity are disease and injury prevention and mitigation activities, health promotion activities, emergency preparedness and response, knowledge translation, and domestic and international collaboration.

Similar to many public service organizations, the Agency also identified in its Corporate Risk Profile management risks. To address these risks, the Agency will develop and implement a talent management strategy and professional development and recruitment programs; strengthen integrated planning, reporting and decision activities through enhanced horizontal communication and coordination; implement an Agency Information Management Operational Plan; and strengthen the governance of information technology service agreements.

To ensure that the Agency will recruit and retain the required public service talent, the Agency will foster a people-oriented workplace in support of Public Service Renewal by developing and implementing a comprehensive Human Resources (HR) policy framework and an HR Management Framework over the three-year planning horizon. The Agency is also committed to strengthening public health capacity to meet the needs of Canadians by working with national and international partners.

Public Health Emergencies

A key part of the Agency’s mandate is to prepare for, and respond to, public health emergencies. This requires the coordination of federal, provincial, territorial, regional and local health authorities, as well as foreign governments and multi-lateral organizations. The unpredictability of public health emergencies, and the fact that they are addressed within multi-jurisdictional and multi-party domains, creates both opportunities and challenges.

Acting on the recommendations of a June 2010 internal Audit Report on Emergency Preparedness and Response, the Agency will, among other things, create internal surge capacity by developing a reserve of personnel within the Agency; participate in exercises to clarify and reinforce roles and responsibilities during emergencies; and synthesize and apply lessons learned from reviews and evaluations of past events, such as H1N1.

Globalization

Countries worldwide are more dependent on one another, which has resulted in higher international migration, commerce and travel. Globalization presents opportunities, in the form of expanded opportunities to share best practices with other countries, and improved communications to address public health events. It also presents threats, however, as globalization increases the likelihood and transmission speed of an infectious disease outbreak. The Agency's experience in responding to the  H1N1 pandemic in Canada will provide knowledge and tools to strengthen surveillance, and further improve planning, preparedness and response for future pandemics.

One element of globalization is the worldwide movement of products and services, including food. Global food supply chains and demand for lower costs result in food products that are sourced from many different countries, not all of which have robust regulatory systems to protect the public from food-borne illnesses. Coordination and capacity among federal, provincial, territorial, regional and local health authorities are of the utmost importance to enable effective management and response to multi-jurisdictional food-borne illness and infectious disease outbreaks. The Agency will continue to coordinate through strategies that include addressing systemic challenges in leadership, preparedness, planning and communication of food safety issues. Lessons learned from the H1N1 flu outbreak will also provide insight for continued improvements.

Prevention and Promotion

Canadians are increasingly facing challenges to their health caused by unhealthy lifestyles. Generally, Canadians eat too much, particularly foods high in sodium and refined sugars. Further, only 15% of Canadians are meeting the recommendations for physical activity,⁵ a core element of overall health and well-being. These two factors contribute to rising obesity rates and increase the chance of developing chronic diseases such as type 2 diabetes, osteoarthritis and some cancers. In 2005, nearly one-quarter of adult Canadians were obese and an additional 35% were overweight.⁶ Children are facing a similar picture; more than one-in-four children and youth in Canada are overweight or obese,⁷ increasing their risk of unhealthy outcomes in their adult life. As well, some 4.9 million Canadians are regularly using tobacco, putting them at higher risk of developing cardiovascular and respiratory diseases, and many cancers.⁸ Other vulnerable populations, such as Aboriginals or low-income Canadians, are particularly at risk for developing poor health outcomes.

PHAC has been responding to this challenge on a number of fronts. The Agency's primary program for the promotion of healthy living is the Integrated Strategy on Healthy Living and Chronic Disease. This program seeks to reduce common risk factors such as high blood pressure, and address specific diseases such as cardiovascular disease, cancer and diabetes in Canadians. Recently, federal, provincial, and territorial Ministers of Health and Healthy Living agreed on a framework to curb childhood obesity, which includes strategies to help children achieve healthy weights.

Canada’s Aging and Changing Population

Canada's population is aging, creating new demands on families and potentially greater costs for social programming and healthcare. Aging impacts our society in terms of economics, health care and services. Health promotion, injury prevention, and efforts to encourage and increase social participation and inclusion can save money, maintain and improve quality of life, and drive healthy economies.

Canada’s population is also changing. Two-thirds of Canada’s population growth between 2001 and 2006 was due to international migration.⁹ As well, the Aboriginal population in Canada is growing faster than the non-Aboriginal population. These demographic changes present challenges to public health. For example, there may be pressure on communication systems as there is a need to ensure that public health messages effectively reach these sectors of the population, especially during public health emergencies.

Responding to Canada’s aging and changing population will require on-going analysis of demographic trends and adaptable public health strategies to effectively capture the opportunities and respond to the challenges inherent in these changes.

Environmental Concerns

The environment influences public health policy and programming in some fundamental ways, from the need for clean air and water, to the need to limit human contact with harmful chemicals and pollutants. In the first days of public health policy, efforts were focussed on controlling and eliminating major public health threats, such as sewage and air pollution.

While Canada has had great success on these fronts, today’s challenges are no less important, specifically as related to climate change. The main threats to public health from climate change are related to disease prevention and control, in particular a warmer climate facilitating the rapid spread of new communicable diseases. As well, climate change could increase immigration to Canada due to displacement, adding to health care pressures; it could impact emergency preparedness owing to more extreme weather events; and it could have serious implications for food safety¹⁰ and food security as growing patterns change worldwide.

Environmental concerns as they relate to public health also extend to the built environment,¹¹ and the need to ensure that the physical environment is designed in a way that supports health and safety. Communities need to be designed to promote healthy living and mitigate risks to health sometimes posed by infrastructure design that does not encourage active lifestyles. Canada has played a leading role in creating friendly environments for seniors through an Age-Friendly Communities Initiative in which five provinces are engaged. Senior Canadians help in the planning and design within their own communities to create healthier and safer places for seniors to live and thrive.

Finally, poor air quality, indoors and outdoors, continues to have significant negative effects on public health and is estimated to have large economic costs.¹² Increasing urbanization, and the considerable periods of time people spend in climate-controlled environments, may be factors impacting air quality. We need to continue monitoring and researching environmental contaminants and their potential health effects.

Science and Technology

Science and technology profoundly affects public health. For example, immunization has saved countless lives and further advances in science and technology hold the promise of achieving more progress toward the Agency’s stated vision of healthy Canadians and communities in a healthier world.

Information technology is one area that holds great promise. Internet usage among Canadians is increasing, and Canadians are accessing the Internet more frequently. Searching for health information is now the second-most common activity on the Internet next to email use. In fact, searching for health information on line was reported by 70% of users in 2009, up from 59% in 2007.¹³ To mitigate the risk of Canadians indiscriminately searching for health information anywhere on the Internet (where incorrect information can be found), PHAC must expand its profile as a leader in delivering credible health information to Canadians. Further, as communication technologies are increasingly important tools for sharing information, implementing the successful use of the most effective Internet-based information delivery methods (social media, audio-visual, traditional Web page) could be fundamental to promoting health and reducing health inequalities.

The growth of the internet in Canada and around the world also has implications for how public health information is gathered and disseminated. For example, new generation surveillance tools will allow for more rapid collection and sharing of public health information as well as the identification, confirmation and response to public health risks of international importance.

Advances in public health science and technology (in areas such as vaccines, antibiotics, antivirals, and diagnostics) and the effect that computing and networking has had on the collection and interpretation of surveillance data will also change the way Canadians and public health practitioners address emerging issues in public health. For example, the future development of new prophylactic and therapeutic vaccines could have the potential to prevent more infectious and chronic diseases. As well, future advances in antibiotics (such as phage therapy, engineered antibodies, and the use of probiotics) could one day help address the growing threats of antibiotic resistance, hospital acquired infections, and new emerging infectious diseases.

Finally, technological advances will also continue to impact how conditions and diseases are diagnosed. Recent advances in diagnostic technology have made it possible for Canadians to conduct self-testing to diagnose health conditions (such as a pregnancy), monitor illness (such as blood sugar levels in people with diabetes), and screen for an illness or disease. Moreover, the growing application of public health genomics — which looks at the ways in which genes, behaviour, diet and the environment combine to impact health — may create new possibilities in the prevention and control of infectious and chronic diseases.

Expenditure Profile

In 2009-10, Canada experienced an H1N1 pandemic from the Spring to the Fall which accounted for approximately $310M of the additional $361.3M spending. This additional spending was related to the purchase of the H1N1 vaccine and pandemic response activities such as communications, surveillance, and the procurement of ventilators. The Agency also spent $49.7M on the Hepatitis C Health Care Services Program which provided funding to the provinces to compensate for the care of individuals infected with Hepatitis C. This program provides payments every five years until 2014-15.

As the items noted above were for one-time spending in 2009-10, forecasted spending was lower by approximately $286M in 2010-11. However, this decrease was partially offset by $20.6M received to complete the final year of the project to modernize the Canadian Science Centre for Human and Animal Health (CSCHAH) laboratory in Winnipeg, Manitoba.

Starting in 2011-12, planned spending will gradually decline as several time-limited projects near completion. In 2011-12, funding will decrease for modernizing the CSCHAH ($20.6M). Other reductions stem from implementation of budget reallocations made in the 2008 Strategic Review process ($6.3M), a permanent transfer of the Canadian Breast Cancer Research annual named grant to the Canadian Institutes for Health Research ($3M), as well as the planned sunsetting of the Clean Air Agenda ($2.2M).

In 2012-13, reference levels will decline by approximately $30M mainly due to two items: one-time funding received to implement the recommendations made in the Report of the Independent Investigator into the 2008 Listeriosis Outbreak will end ($7.6M), and one-time funding for the installation of the new vaccine influenza fill line will decrease by $20.7M.

In 2013-14, PHAC funding declines by $12.9 M mainly as a result of the near completion of the Lung and Neurological Diseases initiative ($4.9M) and reduced funding for the JC Wilt Laboratory ($6.1M).

*2010-11 is a forecast as of December 20, 2010.

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Estimates by Vote

For information on the Agency’s organizational votes and/or statutory expenditures, please see the 2011-12 Main Estimates publication. An electronic version of the Main Estimates is available at  http://www.tbs-sct.gc.ca/est-pre/2011-2012/me-bpd/info/info-eng.asp.

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