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Section I – Overview

Message from the Minister of Health

It is with pleasure that I present the Public Health Agency of Canada’s 2008-2009 Report on Plans and Priorities, the Agency’s third such report on its corporate direction.

Canada is a great country with limitless potential, and Canadians have worked hard to create a solid foundation for our society and create a safe, healthy and prosperous nation for our children. Public health contributes to this foundation in many ways and is helping our Government deliver on its priorities for building a better Canada.

The Government of Canada is concerned with improving the quality and safety of our environment, not only the air that we breathe and the water we drink, but also ensuring that food for our families and the products we buy for our workplaces and homes are safe. The Agency supports the Government’s priorities through its expertise and networks on the surveillance of health outcomes. By highlighting links between exposure and illness, this work allows us to direct interventions where needed, and to in turn measure their effectiveness.

The Public Health Agency of Canada will also continue to lead the Government of Canada’s efforts, at home and internationally, on preparation and planning for a potential influenza pandemic and for any other emerging infectious disease that could threaten the health of our collective well-being. Through continued vigilance, the Agency works to ensure that early identification of and fast response to outbreaks will help reduce the impact of a pandemic on the health of Canadians.

An important step in reinforcing public health in Canada was the passing into law of the Public Health Agency of Canada Act in December 2006. The Act formally establishes the position of the Chief Public Health Officer of Canada and recognizes his unique dual role both as deputy head of the Agency and the Government of Canada’s lead health professional.  The Agency also has recently released its five-year Strategic Plan that sets its direction and key priorities.

This is indeed a country of which we can be very proud. By working to improve and protect the health of Canadians, the Public Health Agency of Canada continues to play a key role in Canada’s enduring prosperity.

Tony Clement
Minister of Health

Message from the Chief Public Health Officer

It has been over three years since the Public Health Agency of Canada was created to assist the federal government in protecting and promoting the health of the population. Emerging from the lessons of SARS we look back with some pride on the accomplishments of these first years as we work to address the fundamental factors that impact on health.

Public Health is the first public good addressed by governments in health as we recognized the powerful relationship between economic, social and individual health and wellbeing.

Whether it is protecting from emerging or well known infections, preventing and managing chronic disease and injury, planning for and responding to emergencies, preparing for a pandemic, enhancing public health capacity, studying and addressing determinants of health, or conducting research and surveillance, public health inevitably touches all aspects of our lives. Sound public health is a solid foundation that supports all else in society.

Looking ahead, the current pace of change within our borders and around the world poses both challenges and opportunities for Canadians, from changing demographics, environmental impacts, rising obesity and chronic disease rates, to a growing awareness of the interconnectedness of the world and the accelerating pace of scientific and technological innovation. It is ironic testimony to our technical success that despite our advances we have neglected the basics of health and this generation of children may be the first to have a shorter life expectancy than their parents.

In facing these challenges and embracing these opportunities, the Public Health Agency’s vision remains constant and relevant: healthy Canadians and communities in a healthier world. The Agency will continue to develop, enhance and implement strategies and programs for the prevention of infectious disease, for the promotion of health, and for the prevention and control of chronic disease and injury. We will continue to strengthen Canada’s preparedness for emergencies and disasters, while increasing public health capacity and enhancing our national and international collaborations. The Agency remains the government-wide lead on efforts to study and address determinants of health.

Our new, first ever Strategic Plan articulates the Agency’s objectives and will guide us forward over the coming years.

New with this 2008-2009 Report on Plans and Priorities is a revised strategic outcome for the Agency: healthier Canadians, reduced health disparities and a stronger public health capacity. By specifically stating the goal of reducing health disparities, we emphasize one of our greatest public health challenges. Health inequalities in Canada will be the focus of the upcoming inaugural Chief Public Health Officer’s Report on the State of Public Health in Canada.

We look forward to the challenges ahead as we work together towards achieving “healthy Canadians and communities in a healthier world”.

Dr. David Butler-Jones
Chief Public Health Officer

Management Representation Statement

I submit for tabling in Parliament, the 2008-2009 Report on Plans and Priorities (RPP) for the Public Health Agency of Canada.

This document has been prepared based on the reporting principles contained in the Guide for the Preparation of Part III of the 2008-2009 Estimates: Reports on Plans and Priorities and Departmental Performance Reports:

• It adheres to the specific reporting requirements outlined in the Treasury Board Secretariat guidance;
• It is based on the Agency’s Strategic Outcome and program activities that were approved by the Treasury Board;
• It presents consistent, comprehensive, balanced and reliable information;
• It provides a basis of accountability for the results achieved with the resources and authorities entrusted to it; and
• It reports finances based on approved planned spending numbers from the Treasury Board of Canada Secretariat.

Dr. David Butler-Jones
Chief Public Health Officer

The Agency’s Reason for Existence

Health Portfolio Overview The Minister of Health is responsible for maintaining and improving the health of Canadians. This is supported by the Health Portfolio which comprises the Public Health Agency of Canada, Health Canada, the Canadian Institutes of Health Research, the Hazardous Materials Information Review Commission, the Patented Medicine Prices Review Board and Assisted Human Reproduction Canada.  Each member of the Portfolio prepares its own Report on Plans and Priorities. The Health Portfolio consists of approximately 11 400 employees and an annual budget of over $4.5 billion.

In September 2004, the Public Health Agency of Canada 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 and to increase its focus on public health. The Agency’s role is to help build an effective public health system in Canada – one that allows Canadians to achieve better health and well-being in their daily lives, while protecting them from threats to their health security.

Events like the emergence of severe acute respiratory syndrome (SARS) in 2003 demonstrated the need for Canada to have a national point of focus for public health issues. In response, the Public Health Agency of Canada was established on September 24, 2004, and Dr. David Butler-Jones was appointed as the country’s first Chief Public Health Officer (CPHO). The creation of the Agency marked the beginning of a new approach to federal leadership, and to collaboration with the provinces and territories in the Government’s efforts to renew the public health system in Canada.

On December 15, 2006, the Public Health Agency of Canada Act came into force. The Actcontinues the strong tradition of cooperation and collaboration that has been a part of Canada’s approach to public health for decades. The Act formally establishes the position of the Chief Public Health Officer and recognizes his unique dual role as deputy head of the Agency and as the Government of Canada’s lead public health professional.

Dual Role of the Chief Public Health Officer:

• As Deputy Head of the Agency, the Chief Public Health Officer (CPHO) is accountable to the Minister of Health for the daily operations of the Agency, and advises the Minister on public health matters. The CPHO can engage other federal departments to mobilize the resources of the Agency to meet threats to the health of Canadians.
• In addition to his role as deputy head, the Public Health Agency of Canada Act also recognizes that the CPHO is the lead health professional of the Government of Canada, with demonstrated expertise and leadership in this field. As such, the CPHO has the legislated authority to communicate directly with Canadians and to prepare and publish reports on any public health issue. He is also required to submit to the Minister of Health an annual report on the state of public health in Canada, which is tabled in Parliament.

Role of the Public Health Agency of Canada

The role of the Public Health Agency of Canada can be summed up as follows:

• To be a leader in the prevention of disease and injury and the promotion of health;
• To provide a clear focal point for federal leadership and accountability in managing public health emergencies;
• To 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
• To strengthen intergovernmental collaboration on public health and facilitate national approaches to public health policy and planning. 

Organizational Information

The Agency is mandated to work in collaboration with its partners to lead federal efforts and to mobilize pan-Canadian action in preventing disease and injury, and to promote and protect national and international public health by:

• Anticipating, preparing for, responding to and recovering from threats to public health;
• Carrying out surveillance of, monitoring, researching, investigating and reporting on diseases, injuries, other preventable health risks and their determinants, and the general state of public health in Canada and internationally;
• Using the best available evidence and tools to advise and support public health stakeholders nationally and internationally as they work to enhance the health of their communities;
• Providing public health information, advice and leadership to Canadians and stakeholders; and
• Building and sustaining a public health network with stakeholders. 

The Agency at a Glance

Type of Organization	Federal Agency funded by Parliament
Mission	To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health
Vision	Healthy Canadians and communities in a healthier world
Strategic Outcome	Healthier Canadians, reduced health disparities, and a stronger public health capacity
Government of Canada Outcomes Directly Supported	Healthy Canadians Safe and secure communities
Enabling legislation	Public Health Agency of Canada Act
Acts and Regulations Administered	The Quarantine Act The Importation of Human Pathogen Regulations
Program Activities	Health Promotion Chronic Disease Prevention and Control Infectious Disease Prevention and Control Emergency Preparedness and Response Strengthen Public Health Capacity
Reporting to Parliament	The Agency reports to Parliament through the Minister of Health The CPHO is to submit a report to the Minister on the state of public health in Canada

Organizational Structure

The following organization chart depicts how the Agency is structured within the Federal Health Portfolio.

Operations Across Canada

To maintain the knowledge and skills needed to develop and deliver the public health advice and tools required by Canadians, the Agency calls upon the efforts of public health professionals, scientists, researchers, technicians, communicators, administrators, and policy analysts and planners. These employees work across Canada in a wide range of operational, scientific, technical and administrative positions.

The largest concentration of employees is in the National Capital Region. The head office in Winnipeg forms a second pillar of expertise. In times of a national health emergency, the Emergency Operations Centres (EOC), based both in Ottawa and Winnipeg, can be utilized to manage the crisis.

The Public Health Agency of Canada recognizes the need to have a strong presence throughout the country to connect with Provincial Territorial (P/T) governments, federal departments, academia, voluntary organizations and citizens. Outside of Winnipeg and the National Capital Region, the Agency’s Canada-wide infrastructure consists of sixteen locations in six Regions: British Columbia and Yukon, Alberta and Northwest Territories, Manitoba and Saskatchewan, Ontario and Nunavut, Quebec, and Atlantic. Some Agency programs are delivered to the Yukon, Nunavut and the Northwest Territories through Health Canada’s Northern Region office under an interdepartmental agreement.

The Agency operates specialized research laboratories in several locations across Canada. The Canadian Science Centre for Human and Animal Health in Winnipeg houses the Agency’s state-of-the-art National Microbiology Laboratory which is one of the world’s high containment research laboratories. The Agency’s Laboratory for Foodborne Zoonoses, which studies the risks to human health from diseases arising from the interface between animals, humans and the environment, is headquartered in Guelph, Ontario and maintains units in Saint Hyacinthe, Quebec and Lethbridge, Alberta.

The following map shows where the Agency’s staff, offices and laboratories are located (employee numbers are as of March 31, 2007):

Evolution of the Agency’s Strategic Outcome and Program Activity Architecture

A government-wide process to facilitate the full implementation of the Government of Canada’s Management, Resources and Results Structure Policy took place starting in 2006-2007 and continued in 2007-2008.  As part of this process the Agency reviewed and restructured its Program Activity Architecture (PAA). Changes to the Strategic Outcome (SO) and Program Activity Architecture were approved by the Treasury Board on May 31, 2007, and come into effect on April 1, 2008.

Strategic Outcome and Program Activity Architecture Crosswalk

	2007-08	2008-09
Strategic Outcome (SO)	Healthier Canadians and a stronger public health capacity	Healthier Canadians, reduced health disparities, and a stronger public health capacity
Program Activities (PA)	Health Promotion	Health Promotion
	Disease Prevention and Control	Chronic Disease Prevention and Control Infectious Disease Prevention and Control
	Emergency Preparedness and Response	Emergency Preparedness and Response
	Strengthen Public Health Capacity	Strengthen Public Health Capacity
	Program Management and Support	Internal Services
Sub and Sub Sub Activities (SA and SSA)	18 Sub Activities   0 Sub Sub Activities	22 Sub Activities   6 Sub Sub Activities

Notable changes include:

• The Strategic Outcome is now Healthier Canadians, reduced health disparities, and a stronger public health capacity. The phrase “reduced disparities” was added to reflect the potential benefits to all Canadians by addressing disparities in health. 
• For greater accountability, the Disease Prevention and Control Program Activity (PA) was divided into a PA for Chronic Disease Prevention and Control and a PA for Infectious Disease Prevention and Control.  
• Refinements were also made to the sub activity andsub sub-activity levels of the Program Activity Architecture.  Also, the name of the PA for Program Management and Supportwas changed to Internal Services to be consistent with Treasury Board guidelines. 

Financial Crosswalk of Program Activities

Main Estimates 2007-08
(millions)	(New) Health Promotion	(New) Chronic Disease Prevention and Control	(New) Infectious Disease Prevention and Control	(New) Emergency Preparedness and Response	(New) Strengthen Public Health Capacity	Total
(Old) Health Promotion	186.4	-	-	-	-	186.4
(Old) Disease Prevention and Control	-	70.8	229.7	-	-	300.5
(Old) Emergency Preparedness and Response	-	-	-	115.8	-	115.8
(Old) Strengthen Public Health Capacity	-	-	-	-	55.6	55.6
Total	186.4	70.8	229.7	115.8	55.6	658.3

Voted and Statutory Items displayed in the Main Estimates (in millions of dollars)

Vote or Statutory Item	Truncated Vote or Statutory Wording	2008-09 Main Estimates	2007-08 Main Estimates
40*	Operating expenditures	360.5	438.4
45*	Grants and contributions	199.6	189.3
(S)	Contributions to employee benefit plans	30.4	30.6
	Total – Agency	590.5	658.3

* In 2007-2008, Vote 40 and Vote 45 were numbered Vote 35 and Vote 40 respectively.

The decrease of $77.9 million in Vote 40 between the 2007-2008 and the 2008-2009 Main Estimates is mainly attributable to reduced requirements for preparedness for avian and pandemic influenza (-$82.8M) offset by funding received for the renewal of the Hepatitis C Prevention, Support and Research Program ($4.7M) and incremental funding in support of the Integrated Strategy on Healthy Living and Chronic Disease ($4.7M), and the Federal Initiative to address HIV/AIDS in Canada ($3.9M), the Expenditure Review Committee (ERC) reduction announced in Budget 2007 (-$2.9M) and the transfer to Western Economic Diversification Canada (WEDC) for the InterVac project in Saskatoon (-$3.0M).

The increase of $10.3 million in Vote 45 is mainly attributable to the renewal of the Hepatitis C Prevention, Support and Research Program ($4.9M) and incremental funding in support of the Integrated Strategy on Healthy Living and Chronic Disease ($3.8M), and the Federal Initiative to address HIV/AIDS in Canada ($3.6M).

Refer to the table on “Departmental Planned Spending and Full-Time Equivalents” for additional details regarding variances in planned spending.

Departmental Planned Spending Table and Full Time Equivalents

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Health Promotion	186.4	203.5	200.8	197.3
Chronic Disease Prevention and Control	70.8	69.0	69.0	69.0
Infectious Disease Prevention and Control	229.7	234.9	275.6	239.0
Emergency Preparedness and Response	115.9	39.1	39.1	39.1
Strengthen Public Health Capacity	55.6	44.1	44.8	45.2
Budgetary Main Estimates (gross)	658.4	590.6	629.3	589.6
Less: Respendable revenue	(0.1)	(0.1)	(0.1)	(0.1)
Total Main Estimates	658.3	590.5	629.2	589.5
Adjustments
Supplementary Estimates (A):
Funding related to the renewal of the Hepatitis C Prevention, Support and Research Program	9.7
Funding related to government advertising programs (horizontal item)	2.2
Funding to the Canadian MedicAlert Foundation to assist the “No Child Without” Program	2.0
Funding for risk assessments and targeted research in the area of Bovine Spongiform Encephalopathy (BSE)	0.8
Funding to prepare for Canada’s participation in International Polar Year 2007-2008, an extensive international research program in the Arctic and Antarctic (horizontal item)	0.4
Funding support of the Federal Accountability Act to evaluate all ongoing grant and contribution programs every five years (horizontal item)	0.2
Spending authorities available within the Vote	(0.3)
Transfer from Health – To adjust for the allocation of resources following the transfer of the control and supervision of the Population and Public Health Branch	0.6
Transfer from National Defence – For public security initiatives (horizontal item)	0.4
Transfer from Health – To support the Canadian Health Services Research Foundation’s Community Health Nursing Study	0.1
Transfer from the Royal Canadian Mounted Police – For the initial planning related to policing and security for the 2010 Olympic and Paralympic Winter Games	0.1
Transfer to Citizenship and Immigration – To support the Centres for Excellence in fostering and funding policy research related to immigration, integration and diversity (Metropolis Project)	(0.1)
Transfer to Human Resources and Skills Development – To support the development of an Atlas on Country Resources for Intellectual Disabilities	(0.1)
Transfer to the Canadian Institutes for Health Research – To fund health services and health population research relevant to the surveillance of diabetes	(0.2)
Transfer to the Canadian Institutes for Health Research – To fund influenza research to strengthen Canada’s pandemic preparedness capacity	(0.4)
Transfer to Western Economic Diversification – For the design and construction of the International Vaccine Centre’s (InterVac) Biosafety Level III Containment Facility in Saskatoon (horizontal item)	(3.0)
Total, Supplementary Estimates (A)	12.4
Supplementary Estimates (B):
Transfer to National Defence – To fund public security initiatives (horizontal item)	(0.3)
Transfer to Canadian Institutes for Health Research – To fund Hepatitis C specific inter-disciplinary training programs	(0.3)
Transfer to Health – To fund the Science Library Network	(0.3)
Transfer to Canadian Institutes for Health Research – To fund Pandemic Influenza Research	(0.6)
Total, Supplementary Estimates (B)	(1.5)
Other adjustments:
Expected year end lapse for funding reprofiled to subsequent years	(40.1)
Funds available internally from savings and other surpluses	(15.6)
Transfer from Treasury Board Vote 22 for Operating budget carry forward	14.8
Transfer from Treasury Board Vote 15 for collective bargaining agreement	1.5
Employee Benefit Plan (EBP)	1.0
Transfer from Treasury Board Vote 10 for allocation of ongoing incremental funding in support of the new requirements of the (2006) Policy on Internal Audit	0.3
2010 Vancouver Winter Olympics		0.1	3.4
Total, Other adjustments	(38.1)	0.1	3.4
Total Adjustments	(27.2)	0.1	3.4	0.0
Total Planned Spending	631.1	590.6	632.6	589.5
Plus: Cost of services received without charge (1)	25.8	28.7	27.9	27.5
Total Departmental Spending	656.9	619.3	660.5	617.0
Full-Time Equivalents	2 376	2 452	2 463	2 449

1. Services without charge include accommodations provided by Public Works and Government Services Canada, contributions concerning the employer’s share of employee’s insurance premiums and expenditures paid by Treasury Board of Canada Secretariat (TBS) and salary and associated expenditures of legal services provided by the Department of Justice Canada.

The planned spending for 2007-2008 mainly represents funding received in Main Estimates and in Supplementary Estimates (A) and (B), adjusted to include employee benefit plans and anticipated surpluses.

Supplementary Estimates (B) are anticipated to be tabled in Parliament in February 2008.

The net decrease of $40.5 million between the total planned spending for 2007-2008 and 2008-2009 is mainly due to: reduced requirements for Preparedness for Avian and Pandemic Influenza (-$57.5M);  funding received in 2007-2008 as a result of the 2006-2007 operating budget carry-forward exercise        (-$14.8M) and for a one-time grant to the Canadian MedicAlert Foundation (-$2.0M) not required in 2008-2009; the sunsetting of funding in support of five-year projects under the Agriculture Policy Framework (-$1.4M) and three-year Genomics Research and Development projects (-$1.5M); reduction in employee benefit plans (-$2.9M); and Expenditure Review Committee (ERC) reduction announced in Budget 2007 (-$2.9M).

These reductions are offset by increases due to: forecasted internally generated savings ($15.6M), incremental funding for the Integrated Strategy on Healthy Living and Chronic Disease ($8.8M), and the Federal Initiative to address HIV/AIDS in Canada ($7.6M), the development and testing of a mock pandemic vaccine ($5.4M), the acquisition and retrofit of the Ward (Logan) Laboratory in Winnipeg ($3.5M), and the Canadian HIV Vaccine Initiative ($1.2M).

The increase of $42.0 million between the total planned spending from 2008-2009 and 2009-2010 is mainly due to funding received, which is to be transferred to provinces and territories under the Hepatitis C Health Care Services Program ($49.7M), for the Canadian HIV Vaccine Initiative ($8.5M), Preparedness for Avian and Pandemic Influenza ($4.3M), and for new funding related to the 2010 Vancouver Winter Olympics ($3.3M).  These increases are offset by reduced funding for the maintenance of the National Antiviral Stockpile (-$12.6M), Preparedness for Avian and Pandemic Influenza ($-6.4M), the Ward (Logan) laboratory Project in Winnipeg (-$2.0M), and the sunset of the 2008 advertising plan (-$2.7M).

The decrease of $43.1 million between the total planned spending from 2009-2010 to 2010-2011 is mainly due to reduced funding for the Hepatitis C Health Care Services Program (‑$49.7M), and the First Nations and Inuit Health Programming (-$4.9M), reduced funding related to the 2010 Vancouver Winter Olympics (-$3.4M), offset by increases related to the Ward Laboratory Project in Winnipeg ($10.7M), the end of a three-year agreement for the InterVac project in Saskatoon ($3.0M), and incremental funding for Preparedness for Avian and Pandemic Influenza ($0.9M) and the Canadian HIV Vaccines Initiative ($0.3M).

Summary Information

Financial Resources (in millions of dollars)

2008-09	2009-10	2010-11
590.6	632.6	589.5

Human Resources (FTEs)

2008-09	2009-10	2010-11
2 452	2 463	2 449

Plans and Priorities

Strategic Context

Public health focuses on the entire population at both the individual and the community level. It encompasses a range of activities performed by all three levels of government in collaboration with a wide variety of stakeholders and communities across the country. Public health plays a key role in preparedness and planning for crises such as an influenza pandemic. It also includes day-to-day activities, such as immunization campaigns, nutrition counselling and restaurant inspections, which require policy, scientific and analytical support (e.g. laboratory research and analysis, epidemiology, surveillance, and knowledge translation).

Demographics
Changing demographics are an important factor in Canada. As noted in the 2006 Census, Canada has the highest rate of population growth in the G8, with the majority of this growth coming from immigration. As well, due to a combination of low birth rates and longer life spans, the age of Canada’s population continues to increase. In the next 10 years, Canadians over age 65 will outnumber those under age 15. However, the exception to these demographics changes has been Canada’s Aboriginal peoples. While the majority of this population lives in urban settings, over a third still resides in isolated, poorly serviced communities with few economic opportunities. While the Aboriginal population is younger and faster growing than the rest of the Canadian population, it also faces a number of specific health problems. All of these changes will have significant impacts in the incidence and distribution of many diseases and injuries, and will place increasing pressures on Canada’s health system.

Environment
Canadians are increasingly recognizing the linkages between health and the environment, not only in areas such as the effects of toxins and pollutants, but also the impacts of climate change and the trade-offs involved in sustainable development. Growing populations are placing an increased pressure on the environment globally while, in Canada, greater urbanization brings with it increased demands for energy, land and other resources, as well as increased concentrations of toxins and pollutants.

Science and Technology
The rate of scientific discovery and technological innovation has increased dramatically in the past decade, but the impact on the health sector has been mixed. On one hand, advances in treat­ment and care offer new opportunities to address illness and improve health. On the other hand, these advances have increased the cost pressures on Canada’s already stressed health system.

Globalization
Globalization has already had a profound impact on public health in Canada. The vast increase in the volume and speed of trade and travel has brought significant economic benefits to Canadians, while making available a greater range of consumer products and foods.

However, there are challenges that exist. Over the past 30 years, health in Canada and in other migrant-receiving nations has been increasingly influenced by human migration. Migration represents one way in which globalization has meant a greater risk from infectious disease, increasing both the likelihood of an outbreak and the speed of its transmission. Keeping pace with the demands of a global economy has meant greater time pressures for Canadian families, along with a proliferation of convenience foods and reduced time for physical activity. As well, globalization has had a major effect in the area of health security, as the free movement of people and ideas has also facilitated the export of instability and violence, bringing threats to the health and safety of Canadians. And while the risk of a health emergency remains low, the impact of an event, whether natural or man-made, could be catastrophic.

Infectious Disease
In addition, globalization has had profound and multiple implications for Canada. The increase in the speed and volume of global transportation places Canadians within 24 hours of almost any other place in the world. Recent events have highlighted the precarious nature of the current infectious disease landscape, increasing the need for national approaches to the global issue of disease transmission and infection control, as evidenced by avian influenza outbreaks in various parts of the world, outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units, C. difficile in hospitals, and the development of extensively drug resistant tuberculosis and other infectious diseases in the community setting.

Trends and Burden of Chronic Diseases in Canada
The increasing burden of chronic diseases is significant, both globally and in Canada.  A number of specific trends are contributing to the incidence and prevalence of chronic diseases and the ability to address them through health promotion and chronic disease prevention efforts.

In 2004, 82% of all deaths in Canada were the result of chronic diseases, including cancer, cardiovascular disease and diabetes, with about 184 000 Canadians losing their lives to these diseases. At the same time, the rate of obesity, an important risk factor for diabetes, heart disease, stroke and some cancers, is growing worldwide, leading to significant increases in heart disease and other major causes of death. With respect to mental illness, 11% of (or 2.7 million) Canadians have mood disorder, anxiety disorder or substance dependence.  According to year 2000 data, the estimated economic burden of the major chronic diseases in Canada (diabetes, cancer, cardiovascular disease, musculoskeletal, neurodegenerative and respiratory diseases) was $108 billion.

Among the trends contributing to the overall growing social and economic burden of chronic disease are an ageing Canadian population, escalating rates of overweight and obesity among children, youth and adults, and increasing health inequalities, particularly among certain vulnerable or at-risk populations.

Determinants of Health and Health Inequalities
Decades of research demonstrates that for population health gains to be achieved, interventions must address the underlying factors and conditions that lead to poor health and health inequalities. At every stage of life, health is determined by complex interactions between the social, physical and economic environments in which people live.  Differences in how people experience these determinants of health lead to health inequalities.

Canadians have been among the healthiest people in the world, but if inequalities in health outcomes are not addressed, this status will be difficult to maintain in the future. Major health-related inequalities in Canada are related to factors such as socio-economic status, Aboriginal heritage, gender, immigrant status and geographic location.  To effectively address the root causes of health inequalities and the health issues to which they contribute, public health has a critical leadership role to play in coordinating the efforts of and collaborating with a range of other relevant sectors.

Public Health Capacity
One of the most significant challenges facing all governments is the traditionally weak and limited public health capacity in Canada. Gaps in this capacity have been identified by governments, and were highlighted by the events of the SARS outbreak of 2003. Although improvements have been made since that time, there remains a lack of qualified public health professionals across Canada, gaps in systems for communications and information-sharing, and uneven resources and capacity across jurisdictions.

These are only a few of the most significant issues that the Agency’s activities must be able to respond to while continuing to fulfill its mandate to promote and protect public health.

Building on Success

The Public Health Agency of Canada will continue to meet its responsibilities in providing federal leadership in public health, building domestic and international partnerships to improve health outcomes and building capacity and expertise to meet new challenges that threaten the health of Canadians. Recognizing that the public health system is a jigsaw puzzle where all of the pieces need to fit together, the Agency’s focus for the next three years will be on developing and delivering integrated approaches that cross sectors and jurisdictions. This will help to promote health, to prevent and control infectious and chronic diseases and injuries, to prepare for and respond to public health emergencies, and to develop public health capacity in a manner consistent with a shared understanding of the determinants of health and of the common factors that maintain health or lead to disease and injury.

The Agency’s Priorities

1. To develop, enhance and implement integrated and disease-specific strategies and programs for the prevention and control of infectious disease.
   
   The Agency will develop proposals to achieve a more integrated and coordinated approach to managing infectious disease and to improving the health status of those who become infected. This will be done by assessing national capacity to prevent, reduce and control infectious disease, greater integration of policy, research, surveillance and program interventions, and more effective and efficient use of resources expended to improve health outcomes.
2. 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.
   
   Promoting health and addressing the risk factors and underlying determinants leading to chronic disease will significantly change the health and well-being of Canadians over the long term. Planned initiatives aim at improved overall health for Canadians, a reduction of medical wait times, 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.
3. To increase Canada’s preparedness for, and ability to respond to, public health emergencies, including pandemic influenza.
   
   The Agency’s activities continue to take an all-hazards approach that encompasses emergency medical response to infectious disease outbreaks, natural disasters, explosions or chemical, biological or radiological/nuclear incidents. As a member of the Global Health Security Initiative, the Agency is committed to a resilient and effective national health emergency management system and to advancing work, globally and within Canada, on infectious disease outbreaks and pandemic influenza preparedness. Initiatives being put in place with P/T governments will facilitate mutual assistance and information exchanges during public health emergencies.
4. To strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity.
   
   Building on initial successes such as the establishment of the Pan-Canadian Public Health Network, the Agency will continue to work closely and cooperatively with all of its partners toward a seamless and comprehensive pan-Canadian public health system. Through partnerships and initiatives at the local, regional, national and international levels, and with the help of the National Collaborating Centres for Public Health, the Agency will support public health professionals and stakeholders in their efforts to keep pace with rapidly evolving conditions, knowledge and practices. The Agency will also assist in strengthening the public health workforce.
5. To lead several government-wide efforts to advance action on the determinants of health.
   
   While recognizing the many influences that lie within the purview of other departments, jurisdictions and sectors, the Agency, as a credible voice for public health, will continue to advocate for healthy public policy, using its knowledge and understanding of the factors that affect the health of communities and individuals. The Agency continues to strengthen its partnerships to help address the factors that lead to disparities in health status. The Agency will continue to take a broad, determinants-of-health approach in making tangible progress on the Health Goals for Canada.
6. To develop and enhance the Agency’s internal capacity to meet its mandate.
   
   Over the planning period, the Agency will create a framework for results, with a view to providing Canadians with the best guidance and information on what it is trying to achieve, as well as supporting the federal government’s sustainable development initiative. The Agency has reviewed its Program Activity Architecture and has developed a draft performance measurement framework and associated governance structure. The Agency continues work on its corporate risk profile, which will include risk mitigation and risk management strategies, and will respond to increasing requirements for transparency by undertaking strategic and integrated business and human resource planning processes. During the reporting period the Agency will continue to address capacity issues related to delivering on and supporting day-to-day business, clarifying its roles, further developing its Winnipeg headquarters and its vitally important network of regional offices, and expanding its world-class laboratory capacity.

In summary, these initiatives will further the ability of the Government of Canada to address Canadians’ concerns that their health system be adaptable, responsive to emerging threats, and able to meet their needs. The Public Health Agency of Canada will work toward meeting the demand for an integrated health system that places an emphasis on promotion and prevention over the full range of the determinants of health, while providing treatment and care. To this end, the Agency will work strategically with key partners – such as provinces, territories, international institutions and stakeholders within and beyond the health sector – whose cooperation is fundamental to the achievement of its mandate.

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