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Section II – Analysis of Program Activities by Strategic Outcome

Health Promotion and Chronic Disease Prevention and Control

Efforts are being made to improve the health of all Canadians, in order to reduce or manage risk factors, such as physical inactivity, unhealthy eating, and unhealthy weights, that can often prevent or delay the onset of chronic diseases, such as cancer, cardiovascular disease and diabetes, and so reduce the number of Canadians waiting for treatment for these diseases. However, a balanced approach must be taken from health promotion, through chronic disease prevention, to early detection and effective chronic disease management, if the overall burden on the health system is to be reduced. Within this balanced approach, significant effort needs to be directed towards addressing the underlying societal factors that contribute to health and impede progress on the major preventable chronic diseases and conditions, for example, obesity. Intervention at multiple entry points and levels is needed to address the complexity and underlying determinants of these public health issues, to slow and reverse chronic disease trends in Canada.

Program Activity – Health Promotion

Financial Resources (in millions of dollars)

2008-09	2009-10	2010-11
203.5	200.8	197.3

Human Resources (FTEs)

2008-09	2009-10	2010-11
543	542	530

The decrease of $2.7 million between 2008-2009 and 2009-2010 reflects the end of the 2008 advertising plan.

The decrease of $3.4 million between 2009-2010 and 2010-2011 is mainly due to the sunsetting of five-year funding received for the First Nations and Inuit Health Programming (-$4.9M), offset by the end of the agreement with Western Economic Diversification Canada for the InterVac project ($1.2M);

Health promotion is the process of enabling people to increase control over their health and its determinants, thereby improving their health. In its health promotion activities, the Agency takes a population health approach, recognizing that health promotion must address broader determinants if it is to have an impact on improving Canadians’ health outcomes. The Agency’s health promotion activities focus on: the expansion of knowledge and evidence, including surveillance activities; policy leadership; the provision of relevant public information; increasing national and international community capacity; and fostering collaboration among sectors and across jurisdictions. The Population Health Promotion Expert Group, which reports to the F/P/T Public Health Network Council, is an important collaborative mechanism that will continue to be utilized to deliver on the Agency’s health promotion priorities.

The Agency’s Priorities

• Health promotion initiatives contribute to these Agency priorities 2, 4 and 5 (see Section I – Overview – The Agency’s Priorities).  

Healthy Living

The Agency’s healthy living activities are focused on promoting physical activity, healthy eating and healthy weights. Physical inactivity, poor nutrition and their adverse health effects represent a growing global health crisis and an increasing burden on public health systems in Canada and worldwide. Due to its prevalence, physical inactivity is the largest contributor to ill health and chronic disease in Canada.

The framework for the Agency’s work on healthy living is the Healthy Living and Chronic Disease initiative, which among other objectives, provides the federal contribution to the delivery of the Federal, Provincial, Territorial (F/P/T) Integrated Pan-Canadian Healthy Living Strategy. The vision of the federal Healthy Living and Chronic Disease initiative is to promote a comprehensive approach across a range of public health activities including the promotion of health, and the prevention, management and control of chronic health problems, with a view to building a healthier nation, decreasing health disparities, and contributing to the sustainability of the health system in Canada.

Focus for the RPP Reporting Period:

• National policy leadership: The Agency will continue to lead the development and implementation of evidence-based policy that promotes physical activity and healthy eating, working collaboratively with federal partners, provinces and territories and a range of other stakeholders.
• Knowledge development and exchange: The Agency will continue to develop knowledge and undertake relevant assessment activities, including best practices assessment, pilot and demonstration projects and evaluation protocols. Existing initiatives include the F/P/T Physical Activity Benchmarking and Monitoring Program, including Canada’s first-ever national effort to objectively measure physical activity levels and patterns among children and youth, labeled the CAN PLAY survey. It also includes building the capacity of the Canadian Community Health Survey (Cycle 2.2 of the report) to focus on gathering information about Canadians’ nutrition habits, and supporting a comprehensive literature review of nutrition policies, programs and strategies. In addition, the Agency will partner with the scientific community to support a comprehensive review of national physical activity guidelines, including recommendations for updating them to reflect emerging knowledge of how much physical activity is required to achieve health benefits.
• Engaging national stakeholders and provincial and territorial governments: In 2007, the Government of Canada announced a federal investment of $5.4 million over two years for 14 projects to be undertaken by non-government organizations. During the reporting period, these projects will provide innovative approaches to increasing physical activity and healthy living among Canadians including youth, families, and individuals with disabilities.  In 2008-2009, funding will also be provided to build partnerships through collaborative action on issues of common interest among F/P/T governments. Collaboration among these governments and their partners will continue to be facilitated by the Healthy Living Issue Group within the Public Health Network. In addition, as a member of the Joint Consortium for School Health, the Agency will continue working with provinces and territories to facilitate a comprehensive and coordinated approach to school health.
• Promoting and communicating the benefits of healthy living:  The Agency will continue to support ParticipACTION’s national public awareness campaign which targets all Canadians, with an emphasis on parents and youth, inspiring them to move more. Through the Summer Active and Winter Active Programs, the Agency and its P/T partners will continue to provide Canadians with tips, tools and information about physical activity and healthy lifestyles.

Childhood and Adolescence

The Agency’s efforts aimed at supporting improved health outcomes for children and youth in Canada will continue to focus on the following key areas:

• National health surveillance: The Agency manages national collaborative surveillance programs that are critical to building evidence on and increasing understanding of maternal and child health in Canada. In 2008, the Agency will release the 2008 edition of the Canadian Perinatal Surveillance System’s Canadian Perinatal Health Report, a comprehensive report on 29 indicators of maternal, fetal and infant health. The analysis of the first-ever Canadian Maternity Experiences Survey will be finalized and released. The Agency will continue its work with national Aboriginal organizations, Health Canada and other partners to improve First Nations, Inuit and Métis infant mortality data for Canada. The Agency will continue to collaborate with the Canadian Paediatric Society on the Canadian Paediatric Surveillance Program to monitor and report on childhood health conditions that are relatively rare but are nevertheless of public health importance. Through the Health Behaviour in School-Aged Children Study, the Agency will continue to develop knowledge regarding the health of children and adolescents. This Study is an international, school-based survey conducted in collaboration with the World Health Organization’s (WHO) Regional Office for Europe. Conducted every four years, the survey will continue to monitor changes in health behaviours of youth aged 11 to 15 years, as well as the impact that certain settings and conditions may have on risk-taking behaviours and health outcomes.
• Community support and capacity building: The Agency will continue to advance the use of evidence-based practice and the generation of practice-based evidence through the design and support of community interventions, including the Canada Prenatal Nutrition Program, the Community Action Program for Children and Aboriginal Head Start in Urban and Northern Communities. These programs are aimed at addressing the complex factors experienced by vulnerable children and families living in conditions of risk and include efforts to enhance the readiness of Aboriginal children to learn; the health of pregnant women and their infants; and  the parental capacity of those with children experiencing social, emotional or behavioural problems, for example.
• Disease prevention and control: Through the Fetal Alcohol Spectrum Disorder Initiative, the Agency will continue to work to prevent future births of those affected by alcohol and to improve outcomes for individuals and families already affected. This work includes collaboration with health professionals, partners across the federal government and other jurisdictions, and involves developing tools and resources for screening, diagnosis and intervention, as part of a surveillance platform. In 2008-2009, the Agency will also work collaboratively with the WHO to develop a Policy Framework for the Prevention of Chronic Diseases in Schools. The Framework is meant to assist member states in developing policies and programs that promote healthy eating and increase levels of physical activity among children and youth in the school setting.
• Promotion of children’s rights: On behalf of the Minister of Health, the Agency co-leads, with the Department of Justice, the federal government’s efforts on matters concerning the United Nations Convention on the Rights of the Child. Through its collaboration with the Inter-American Children’s Institute, a special institute of the Organization of American States, the Agency will continue to work with the Canadian International Development Agency to contribute to the implementation of the Convention throughout the Americas.

Injury Prevention

Preventing injuries contributes to a healthier society, reduces health care utilization and therefore contributes to shorter wait times. The Agency will continue to work with injury and violence prevention stakeholders on a range of activities to address this important public health issue as well as continue to conduct surveillance of unintentional child injury and child abuse and neglect. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), which the Agency carries out in partnership with 14 hospitals across the country, will maintain data collection and dissemination of information to support child injury prevention and safety promotion. The Agency will enter into the pre-data collection phase for the third cycle of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008). The CIS provides estimates of the national incidence of child maltreatment investigated by child welfare services and information about the circumstances of the affected children and their families, using the population health approach. Other surveillance efforts include the continuation of an interactive Web site that provides current Canadian injury data, entitled Injury Surveillance On-Line (http://dsol-smed.hc-sc.gc.ca/dsol-smed/is-sb/index_e.html).

In addition, the Agency will continue to lead and coordinate the Family Violence Initiative (FVI), a partnership of 15 federal departments, agencies and crown corporations and to operate the National Clearinghouse on Family Violence on behalf of the Initiative (www.phac-aspc.gc.ca). Through the National Clearinghouse and other mechanisms, the FVI develops knowledge and promotes public awareness of the risk factors of family violence, fosters collaboration and provides opportunities for the joint action to address issues, such as child maltreatment, intimate partner violence and the abuse of older adults. Over the three-year planning period, the Agency will continue to play a central role in knowledge and policy development, research and information dissemination in this area.

Aging and Seniors

The aging of the Canadian population has serious public health implications. Evidence shows that health promotion and disease prevention strategies can help those who are aging well, those with chronic conditions and those who are at risk for serious problems even very late in life. The Agency is the federal government’s centre of expertise and focal point on seniors’ health, and provides leadership through policy development, knowledge development and exchange, and community-based interventions and partnerships.  Its efforts are focused on four main areas: emergency preparedness, active aging, injury prevention, and mental health. During the reporting period, the Agency will also continue to identify key policy options to address gaps and encourage use of better practices and opportunities for further collaborative action across jurisdictions.

Focus for the RPP Reporting Period:

• Support to the National Seniors Council: Collaborate with and bring a public health lens to the work of the National Seniors Council, which was established to advise the Government of Canada on all matters related to the health, well-being and quality of life of seniors, and to report to the Minister of Human Resources and Social Development and the Minister of Health.
• Enhancement of emergency management: Work to more fully integrate the needs of seniors into emergency management, including, developing a common understanding of current evidence and the status of seniors with regard to emergency planning activities in Canada and internationally.  This work, which is being coordinated with F/P/T governments, as well as the WHO and other key stakeholders, will strengthen policies and operational protocols aimed at maintaining the health and safety of older people in emergencies of all types, including specifically infectious disease outbreaks and extreme weather events associated with climate change. Work in this area can be used by others to develop a framework on resiliency to address the needs of other vulnerable groups such as persons with disabilities and children and youth.
• Promotion of Age-Friendly Communities: Advance the application of the Age-Friendly Communities guides. These guides, recently developed by the Agency and its partners, are practical tools based on concrete indicators of age-friendly communities designed to increase awareness of local needs and gaps and provide suggestions for improvements to catalyze community development leading to more age-friendly environments.

Emerging Priorities

Mental Health

Mental illness is considered one of the most significant public health challenges of the 21st century.  According to the WHO, depression will rank second only to heart disease as the leading cause of disability worldwide by 2020.  One in five Canadians will experience a mental illness in their lifetime, while nearly one million live with a severe or persistent mental illness.  During the planning period, the Agency will continue to advance mental health promotion, mental illness prevention and related issues including supporting the work of the Mental Health Commission, collaborating across governments and examining the workplace as a key venue for addressing mental health and mental illness. 

Focus for the RPP Reporting Period:

• Knowledge Development and Exchange: Continue to improve the understanding of underlying risk factors surrounding mental health and mental illness and prevalence levels in various settings, recognizing that knowledge development and exchange is the foundation for the development of effective services and resources for Canadians leading to improved mental health outcomes.
• Influencing policy and demonstrating federal leadership: Support the work of the F/P/T Advisory Network on Mental Health and build linkages between this group, the Mental Health Commission of Canada and the Joint Consortium on School Health.
• Promoting and communicating the benefits of positive mental health: Continue to increase awareness and understanding of the benefits of positive mental health for Canadians of all ages and in all spheres of life, including work, play, learning and living generally.

Leadership on the Determinants of Health

The Agency will continue to lead national efforts to advance action on the determinants of health. Taking leadership means strengthening the Agency’s work in the area of reducing health inequalities, enhancing partnerships within and across other government departments, jurisdictions, and sectors (including non-government organizations and the private sector) to address the underlying determinants of health. Such action is critical to achieving health gains and reducing the social and economic impacts of health inequalities. Through the development of new knowledge, strategic partnerships and intersectoral policy initiatives, the Agency is contributing to a better understanding of the ways in which the determinants of health can be more effectively addressed within and outside of the health sector.

The Agency has made an effective contribution to the WHO Commission on Social Determinants of Health (CSDH). Canada’s support for knowledge networks on early child development, the impact of globalization on health and health systems has successfully advanced global knowledge in these areas. In addition, the new knowledge and evidence produced by the Commission overall will be instrumental in advancing policy and action to address the Social Determinants of Health in Canada.  A key component of the Agency’s work with the WHO CSDH is providing leadership and support to the Canadian Reference Group on Social Determinants of Health (CRG), with its mandate to provide advice, facilitate initiatives that fill gaps, and engage non-government stakeholders.

Focus for the RPP Reporting Period:

• The Agency will finalize development of a strategic action plan to guide the Health Portfolio in an intersectoral federal government approach to address the determinants of health. To support this work, partnerships and initiatives with the Canadian Institutes of Health Research (CIHR) and other governmental and non-governmental stakeholders will be strengthened, with the objective of significantly advancing knowledge on evidence-based and innovative approaches to address health inequalities.
• The Agency will also further its engagement with the Conference Board of Canada’s Roundtable on Socio-Economic Determinants of Health, which serves as a forum for collaborative efforts with the private sector, other federal departments, provincial health and non-health ministries and NGOs.
• The Agency will ensure appropriate follow-up to the report and recommendations of the WHO CSDH, within Canada and multi-laterally. 
• The Agency will continue to lead and facilitate the work of the CRG, including efforts to engage with civil society organizations, collaborate with Aboriginal organizations to identify the specific determinants of Aboriginal Peoples’ health, to disseminate its analysis of case studies on intersectoral action in Canada, and to explore the economic impacts of investments in the social determinants of health.
• The Agency is partnering with the WHO on global initiatives to explore intersectoral action and integrated policy mechanisms for health. The experience of 20 countries will be analyzed to identify learnings and considerations to ensure effective approaches in working across sectors to improve health outcomes by addressing the determinants of health.

• The Agency will also continue to work with other partners in WHO countries such as the public health institutions in the United Kingdom, Sweden, Chile and Brazil, and international organizations such as the European Commission and the Organization for Economic Cooperation and Development (OECD) to better understand the economic consequences of health inequalities and to collaborate in policy analysis and reviews on issues of common concern.
• The Agency has created an Innovations and Learnings Strategy (ILS) that will:

Strategic Issues

Overweight and Obesity

Obesity has emerged as a significant public health challenge with major health, economic and social implications. At present, approximately 25 percent of all children and youth and more than half of all adults in Canada are classified as overweight or obese.  Moreover, overweight and obesity incidence and prevalence rates are projected to escalate in coming years.  To date, federal health promotion and disease prevention approaches with obesity-related elements have not been effective in counteracting the complex societal conditions that have contributed to escalating overweight and obesity trends.

A new comprehensive approach will comprise multi-sectoral policies and interventions that address the underlying societal causes of overweight and obesity, as well as approaches to enhance treatment and support options for Canadians who are overweight and obese.  In addition, a framework will be developed to support a coherent and complementary approach with existing obesity-related health promotion and chronic disease prevention strategies and initiatives. 

Focus for the RPP Reporting Period:

• Building a Federal Plan of Action on Overweight and Obesity will initiate a process of incremental change founded on an evidence-based policy approach for sustainable, long-term action to address the underlying causes of overweight and obesity in Canadian society.
• The Federal Plan will be structured around a set of strategic actions that will be initiated in the following areas:

• To address the challenge and complexity of obesity, the Agency will work with key stakeholders to show federal leadership in developing a comprehensive policy approach, aimed initially to continue action toward containing, and ultimately reversing, the rising overweight and obesity rates in Canada.
• The Public Health Agency of Canada will engage other federal government departments (e.g. Finance Canada, Transport Canada, Infrastructure Canada, Canada Mortgage and Housing Corporation, Agriculture and Agri-Food Canada, Human Resources and Social Development Canada, and Indian and Northern Affairs Canada) with the objective of harnessing the range of policy levers and capacity available at the federal level.

Stakeholder engagement strategies will reach beyond the federal family to establish partnerships with, and facilitate action by, other levels of government, the private-sector, and international and non-governmental organizations.

Program Activity – Chronic Disease Prevention and Control

Financial Resources (in millions of dollars)

2008-09	2009-10	2010-11
69.0	69.0	69.0

Human Resources (FTEs)

2008-09	2009-10	2010-11
288	288	288

Working in cooperation with regional, P/T, national and international governments and stakeholders (including NGOs), the Agency provides national population health assessment and surveillance in relation to chronic diseases. It also provides leadership and expertise in the development and implementation of pan-Canadian chronic disease prevention and control strategies.  Chronic diseases are among the most common, preventable and costly health problems facing Canadians.

The Agency’s Priorities:

• Chronic Disease Prevention and Control initiatives contribute to priorities 2 and 4 (see Section I – Overview – The Agency’s Priorities).

Platforms for Chronic Disease Prevention, Early Detection and Management

The Agency provides leadership, expertise and support to develop and implement pan-Canadian chronic disease prevention and control initiatives. By creating public health platforms that engage and support provinces, territories and stakeholders, the Agency promotes health, contributes to chronic disease prevention and risk reduction, and facilitates efforts to improve early detection and management of chronic disease.

Chronic disease and risk factor surveillance support the Minister’s responsibility to be vigilant of the health of Canadians and contribute to Canada’s capacity to measure progress on chronic disease prevention and control. Knowledge Development, Exchange and Transfer (KDET) support public health practitioners and decision makers by making known “what works best” so that it can be put into practice.  Through international collaboration, effective public health solutions are understood and shared globally.

Enhanced Surveillance for Chronic Disease

Surveillance information on chronic diseases, their risk factors and determinants, and their impact and outcomes, is needed to plan, implement, and assess chronic disease prevention and control programs, policies and services.  Surveillance is the tracking and forecasting of health events through the ongoing collection, integration, analysis, and interpretation of data, and the dissemination of information to public health planners and policy makers resulting in public health action.

The Agency is working with F/P/T partners to enhance chronic disease surveillance, which will increase access to and use of surveillance information, expand data sources, and improve the planning, coordination and evaluation of surveillance activities.  This approach supports evidence-based decision-making on health promotion and chronic disease prevention and control.

Focus for the RPP Reporting Period:

• Build on existing web-based surveillance tools in order to support ongoing and timely access by public health professionals and planners to chronic disease health statistics and indicators.
• Develop methodologies for sentinel surveillance of chronic diseases in clinical or primary care settings in order to use local data to estimate potentially broader national chronic disease trends.
• Determine approaches to regional risk factor surveillance that could potentially be used for national risk factor surveillance.
• Complete the next step in the expansion of the National Diabetes Surveillance System, by determining case definitions and compiling preliminary P/T health administrative data on one or more chronic diseases, such as hypertension, cardiovascular disease, respiratory disease, arthritis and mental illness.

Observatory of Best Practices in Chronic Disease Prevention and Health Promotion

The Agency continues to develop the Observatory of Best Practices to identify best practices for population-based chronic disease interventions and disseminate this information. The Canadian Best Practices Portal, launched in November 2006, offers an online database of evidence-based best practices for health promotion and chronic disease prevention (http://cbpp-pcpe.phac-aspc.gc.ca/). The Agency continues to support the revitalization of the Canadian Task Force on Preventive Health Care (http://www.ctfphc.org) and to combine this renewal with broader efforts for knowledge development, exchange and transfer.

Focus for the RPP Reporting Period:

• Develop the methodology for determining “promising practices” (interventions which have positive results, but do not have the same level of evidence as best practices) and begin establishing a promising practices collection.
• Populate the Best Practices Portal with new best practice interventions in priority areas including mental health, obesity, determinants of health, and interventions that utilize multiple approaches.

Demonstration Projects for Chronic Disease Prevention

Knowledge development and exchange support the application in practice of effective chronic disease prevention approaches.  The Agency is facilitating provinces and territories in their efforts to enhance this capacity in their chronic disease programs by supporting and assessing the demonstration site components of P/T Chronic disease prevention initiatives.

By applying standard scientific assessment techniques to each provincial or territorial project, program comparisons will advance understanding of the factors that result in greatest impact.

Focus for the RPP Reporting Period:

• Initiate at least three new demonstration projects. 
• Work with provinces and territories to collaboratively develop improved common assessment mechanisms so they can learn from each other.

International Initiatives

Through its WHO Collaborating Centre on Chronic, Non-communicable Disease (CNCD) Policy, the Agency contributes to the strengthening of the global response to chronic diseases and to the development and implementation of chronic disease prevention policy in Canada, the Americas and Europe. The WHO Collaborating Centre maintains an ongoing commitment of technical support for CNCD policy analysis to the WHO Country-wide Integrated Non-Communicable Disease Intervention (CINDI) program in Canada and Europe, and to the PAHO-CARMEN program, its equivalent in the Americas. The Collaborating Centre is co-sponsoring, with the Pan-American Health Organization (PAHO), the development of a Chronic, Non-Communicable Disease Observatory of Policy Development and Implementation Processes in Latin America.

Focus for the RPP Reporting Period:

• Continue to coordinate an international policy working group on non-communicable disease policy. In this regard, it is providing technical support to the uptake of the European Strategy for the Prevention and Control of Chronic Disease as well as PAHO Regional Strategy and Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Disease.
• Support the development of consultations and case studies on chronic disease policy in a number of countries in Europe and in the Americas that are participating in the WHO regional networks of CARMEN and CINDI.
• Provide technical assistance to PAHO and heads of government of the Caribbean region in their effort to address their growing burden of chronic disease, by facilitating the implementation of some of the elements of the Declaration of Port-Of-Spain (September 2007) and in developing a model based on their experience, which could be used by other sub-regions in the Americas.

Diabetes

Through the Healthy Living and Chronic Disease initiative, the Canadian Diabetes Strategy focuses on preventing diabetes and its implications through action on risk factors, early detection and management of diabetes.

Approximately 2 million Canadians of all ages live with either type 1 or 2 diabetes and many more adults are unaware that they have the disease. As the Canadian population ages and rates of obesity rise, the prevalence of type 2 diabetes is expected to continue to increase. The evidence shows that a substantial proportion of cases of type 2 diabetes, the predominant type, can be prevented or delayed through targeted and sustained efforts to improve lifestyles among high-risk populations. Obesity, poor diet and physical inactivity are significant risks for diabetes.

The Canadian Diabetes Strategy targets populations at higher risk of developing diabetes, especially those who are overweight, obese or have pre-diabetes. Other target populations include individuals who are over age 40, have high blood pressure and high cholesterol or other fats in the blood (e.g. triglycerides), have a family history of diabetes, or are members of high-risk ethnic populations.

One of the priorities for this period will be the Diabetes Policy Review announced in October 2006. The review of the Canadian Diabetes Strategy will help ensure that government policies and programs meet the needs of Canadians living with diabetes and those at risk of developing the disease.

Focus for the RPP Reporting Period:

• Support P/T and stakeholder efforts through grants and contributions for:

• Publish an annual diabetes highlights report including the addition of 10 year forecasts for the prevalence of diabetes;
• Plan for the 2009 International Diabetes Federation 20th World Diabetes Congress to be held in Montreal;
• Support the work of the Diabetes Policy Review independent expert panel;
• Support activities linked to the prevention of obesity, a main risk factor for diabetes;
• Conduct synthesis of evidence and development related to marketing to children; and
• Enhance the ability to track obesity risk in infants and young children, support the revision of the 2004 Canadian Growth Monitoring guidelines in light of the new 2006 WHO Growth Standards for infants and children, through the work of an advisory committee composed of key partners.

Cancer

The Agency’s cancer program includes the Healthy Living and Chronic Disease Initiative cancer component, the Canadian Breast Cancer Initiative, and the Canadian Strategy for Cancer Control. The Healthy Living and Chronic Disease initiative supports cancer surveillance, screening, risk analysis and community-based programming. The Canadian Breast Cancer Initiative supports breast cancer research, prevention, early detection and quality screening, surveillance and monitoring, treatment and care enhancements, and community capacity building.

In November 2006, the Government announced the creation of the Canadian Partnership Against Cancer (CPAC), an independent, not-for-profit corporation which brings together cancer survivors, experts and government representatives from across the country. Of the $260 million/five years budgeted for the Canadian Strategy for Cancer Control, the Agency will receive $1 million per year over five years. This will be used to support links between the CPAC’s knowledge translation activities and other cancer portfolio members, and to promote international activities and federal leadership on cancer.

It is estimated that more than 159 900 Canadians were diagnosed with cancer and 72 700 died from the disease in 20071. The increased number of new cases of cancer is primarily due to a growing and aging population. By 2020, population aging is expected to contribute to more than double the number of new cases of cancer in Canada. Mortality rates have declined for all cancers combined and for most types of cancer in both sexes since 1994. Exceptions are lung cancer in females and liver cancer in males.

In Canada, 1 in 9 women will develop breast cancer in her lifetime, and 1 in 27 will die from it.2 Breast cancer is the most frequently diagnosed type of cancer in Canadian women. By monitoring and evaluating organized breast cancer screening programs in the country, it is possible to promote high-quality screening, leading to reductions in breast cancer mortality and morbidity.

Close to 1 300 children and adolescents are diagnosed with cancer every year in Canada, of which 210 die from their disease.3   Prevention activities targeting high-risk individuals can significantly reduce the number of new cases of cancer, although risk factors, detection, and management issues specific to this disease remain.

1  Canadian Cancer Society and National Cancer Institute of Canada. Canadian Cancer Statistics 2007, p. 12.
2  Canadian Cancer Society and National Cancer Institute of Canada. Canadian Cancer Statistics 2007, p. 70.
3  Canadian Cancer Society and National Cancer Institute of Canada. Canadian Cancer Statistics 2007, p. 67

Focus for the RPP Reporting Period:

• Work with the new CPAC to implement the Canadian Strategy for Cancer Control (CSCC), in particular, collaborate on cancer surveillance.
• Work to link the Agency’s other cancer programs to CPAC’s efforts on the CSCC and with international organizations, such as the WHO, Pan-American Health Organization (PAHO), and the International Cancer Control Congress.
• Work with the National Cancer Institute of Canada (NCIC), the Canadian Cancer Society and Statistics Canada to publish Canadian Cancer Statistics, an annual publication distributed across the country.
• Work with P/T cancer registry staff to include data on cancer stage and benign brain tumours in each cancer registry and work with the Métis Nation in Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia to establish a linkage between the Métis Nation cancer data and the P/T administrative health databases (e.g. hospitalization, physician billing).
• As part of the Canadian Childhood Cancer Surveillance and Control Program, produce a report entitled Treatment and Outcomes for Childhood Cancer in Canada, 1995 to 2000 (winter/spring 2008), and revise the on-line data management and entry system for national childhood cancer surveillance.
• Continue risk assessment and knowledge transfer in the areas of risk factors and determinants, lifestyle, environment and socio-demographic factors associated with cancer.
• Enhance and develop cancer community-based programming and capacity building among Aboriginal, seniors, and childhood cancer organizations.
• Work with stakeholders through the Cervical Cancer Prevention and Control Network on issues such as prevention of Human Papilloma Virus (HPV) infection, and population screening to reduce the morbidity and mortality related to cervical cancer.
• Support the ongoing work of the Canadian Breast Cancer Initiative (CBCI) including professional education, early detection programs, and access to information. Support the Canadian Breast Cancer Research Alliance in its new strategic alignment, as the research component of CBCI.  Also, continue to manage and maintain the Canadian Breast Cancer Screening Database, which facilitates the monitoring and evaluation of organized breast cancer screening programs across Canada, and publish the associated biannual national performance report.

Cardiovascular Disease

Through the Healthy Living and Chronic Disease initiatives, Cardiovascular disease (CVD) investments focus on a pan-Canadian cardiovascular policy framework in collaboration with stakeholders.

Cardiovascular disease is the leading cause of death in Canada.  Heart disease and stroke also put the greatest economic burden on our health care system, accounting for over $20 billion annually in direct and indirect costs ($12 billion among men and $8.2 billion among women). Cardiovascular disease is linked to several risk factors including hypertension, diabetes, obesity and tobacco use.  Out of 10 Canadians, 8 have at least one risk factor for cardiovascular disease, and 1 in 10 has three risk factors or more.

In October 2006, the Health Minister announced the creation of a Canadian Heart Health Strategy and Action Plan (CHHS-AP) to develop a comprehensive plan for the prevention and treatment of heart disease.

In 2008-2009, a priority will be to continue supporting the development of the Pan-Canadian cardiovascular disease policy framework in collaboration with stakeholders. The policy framework and action plan will inform both integrated and cardiovascular disease-specific future federal investments. Until collaborative priority setting is undertaken through the CHHS-AP development process, federal cardiovascular investments will focus on hypertension, a recognized cardiovascular risk factor and the development of cardiovascular disease surveillance. Subsequently, implementation in other areas, informed by the collaborative action plan, will begin.

Focus for the RPP Reporting Period:

• Support development of the CHHS-AP.
• Disseminate and promote an updated comprehensive surveillance report on cardiovascular disease in Canada.
• Develop the methodology for a national survey on hypertension and pilot a survey module, in collaboration with Statistics Canada, who will collect data on, for example, knowledge, attitudes and behaviours, and compliance with lifestyle and medication advice.
• Participate with the Agency’s partners such as Blood Pressure Canada and the Heart and Stroke Foundation, in measures to reduce sodium intake and hypertension in Canada.
• Work with Blood Pressure Canada, the Canadian Hypertension Education Program, the Heart and Stroke Foundation of Canada and the Canadian Hypertension Society to support projects that facilitate blood pressure reduction strategies through surveillance, knowledge development, exchange and transfer, and evaluation of blood pressure and sodium reduction best practices.

Emerging Priorities in Chronic Disease Prevention and Control

The Agency monitors and responds to emerging priorities related to public health and chronic diseases, such as obesity and respiratory diseases.  In 2008-2009, the Agency’s focus for emerging priorities will be:

Respiratory Disease/Lung Health

Over 3 million Canadians are affected by five serious respiratory diseases - asthma, Chronic Obstructive Pulmonary Disease (COPD), lung cancer, tuberculosis and cystic fibrosis.  Respiratory diseases, including lung cancer, are the third leading cause of death, responsible for 17.6% of deaths among men and 15.3% of deaths in women. 

In Canada, it is now estimated that one in five people has a breathing problem.  In particular, we are seeing increased prevalence of asthma – 2.7 million Canadians now have this disease, which affects over 15% of children and over 8% of adults. 

The Agency is collaborating with the Canadian Lung Association and stakeholders from across Canada to develop a coordinated action plan – the National Lung Health Framework – to help prevent and manage respiratory diseases.

Focus for the RPP Reporting Period:

• In 2008-2009, the Agency’s focus for Lung Health will be to finalize the Lung Health Framework.

Arthritis/Musculoskeletal

From 2000 to 2005, the number of Canadians diagnosed with arthritis increased from 3.9 to 4.4 million;  60% of cases were women and three out of five Canadians with arthritis were under 65 years of age. Arthritis ranks second and third among the most commonly reported chronic conditions in women and men, respectively.  In 1998, musculoskeletal conditions, including arthritis, were the category of diseases with the second highest estimated economic burden in Canada at $16.4 billion.

Focus for the RPP Reporting Period:

• In 2008-2009, the Agency will produce, disseminate, and promote a comprehensive surveillance report on arthritis incorporating the most recent data on the disease burden, risk factors, disability and quality of life impacts, mortality, hospitalization, joint replacements, waiting times for joint replacements, as well as disease disability.

Obesity/Overweight

The overarching framework being built around the federal plan of action on overweight and obesity, referred to in the Health Promotion Program Activity, will support a coherent and complementary approach to addressing the issue by ensuring the links between comprehensive policy development, new approaches, and existing obesity-related health promotion and chronic disease prevention actions, strategies and initiatives. Intervention at multiple entry points and levels is needed to address the complexity of the issue and continue action towards slowing and reversing overweight and obesity trends in Canada.

The Agency’s ongoing obesity surveillance and knowledge, development, exchange and transfer activities aim to support the reduction of the preventable chronic disease burden in Canada by advancing knowledge of the underlying societal determinants of obesity and informing the understanding of promising interventions.

Surveillance of Chronic Diseases of Increasing Importance

The impact of some common chronic diseases is growing and putting an increasing strain on the health care system.  In order to better understand and plan for future disease prevention and management, the Agency will explore approaches to gaps in the surveillance of chronic diseases such as autism.  This will include collaboration with Statistics Canada to develop a supplement to the Canadian Community Health Survey to survey chronic respiratory disease, arthritis and musculoskeletal disease, mental illness and neurological conditions.

Program Activity - Infectious Disease Prevention and Control

Financial Resources (in millions of dollars)

2008-09	2009-10	2010-11
234.9	275.6	239.0

Human Resources (FTEs)

2008-09	2009-10	2010-11
1 101	1 109	1 107

The increase of $40.7 million between 2008-2009 and 2009-2010 is mainly due to funding received for the Hepatitis C Health Care Services Program and the Canadian HIV Vaccine Initiative; offset by incremental funding for Preparedness for Avian and Pandemic Influenza.

The decrease of $36.6 million between 2009-2010 and 2010-2011 is mainly due to the sunsetting of funding received for Hepatitis C Health Care Services Program offset by incremental funding for the Ward (Logan) Laboratory project in Winnipeg.

The program promotes improved health for Canadians in the area of infectious diseases through public health actions including surveillance and epidemiology, risk management, public health policy development, and prevention and care programs. This program is necessary as infectious diseases require national attention and national efforts given their current and potential impact on the health of Canadians and the Canadian health care system, and also because new, existing, or re-emerging infectious diseases can pose a serious threat to the health and socio-economic well-being of Canadians.

The Agency’s Priorities:

• Infectious Disease Prevention and Control initiatives contribute to the following Agency priorities 1, 3 and 4 (see Section I – Overview – The Agency’s Priorities).

HIV/AIDS

The program promotes prevention and access to diagnosis, care, treatment and support for those populations most affected by the HIV/AIDS epidemic in Canada - people living with HIV/AIDS, gay men, Aboriginal people, people who use injection drugs, inmates, youth, women, and people from countries where HIV is endemic.  It also supports multi-sectoral partnerships to address the determinants of health. The program includes surveillance, knowledge development, partnership and community programming, laboratory sciences, health promotion, capacity building, policy development, leadership and coordination, social marketing and HIV vaccine development.

The number of Canadians living with HIV was estimated to be 58 000 in 2005, an increase of 16% from 2002 estimates. About 27% of these individuals were unaware of their infection at the end of 2005. This means that at the end of 2005 there were an estimated 15 800 infected individuals who had not had the opportunity to take advantage of available treatment strategies or appropriate counseling to prevent the further spread of HIV. 

The Agency has the lead for federal action on the prevention of HIV/AIDS in Canada with key partners as outlined in “Leading Together: Canada Takes Action on HIV/AIDS (2005-2010)”.  The Agency is responsible for overall coordination of the Federal Initiative to Address HIV/AIDS in Canada, a framework for renewing and strengthening the federal role in the Canadian response to HIV/AIDS, and for the Canadian HIV Vaccine Initiative (CHVI).

The Federal Initiative is a partnership among the Public Health Agency of Canada, Health Canada, the CIHR and Correctional Service Canada. Through the Federal Initiative, the Agency supports activities that will prevent new HIV infections, slow the progression of HIV/AIDS, improve the quality of life for affected people, reduce the social and economic impact of the disease, and contribute to the global efforts against the epidemic.

The Canadian HIV Vaccine Initiative is a collaborative undertaking between the Government of Canada and the Bill and Melinda Gates Foundation to contribute to the global effort to develop a safe, effective, affordable and globally accessible HIV vaccine. Participating federal departments and agencies include the Public Health Agency of Canada, Industry Canada, Health Canada, the Canadian Institutes of Health Research, and the Canadian International Development Agency.  In support of the CHVI, the Agency supports activities that increase pilot scale manufacturing capacity for HIV vaccine clinical trial lots, strengthens policy approaches for HIV vaccines and promotes the community and social aspects of HIV vaccine research and delivery, and ensures horizontal collaboration within the CHVI and with domestic and international stakeholders.

What’s New:

Over the next three years, the Agency will work towards delivering on key policy and program initiatives to further the new Canadian HIV/AIDS Vaccine Initiative by:

• Conducting an open and transparent selection process for a not-for-profit corporation to build and operate a pilot scale HIV vaccines manufacturing facility for clinical trial lots in Canada as well as begin construction of the facility.  This initiative will strengthen the global capacity to manufacture promising HIV vaccines candidates;
• Convening international policy dialogues addressing barriers to HIV vaccines research and development.  This initiative will improve domestic and international policy development models, capacity and tools to address HIV vaccine related issues; and
• Developing and implementing a new HIV Vaccine Community Engagement Funding Program in partnership with Health Canada.  This initiative will engage communities meaningfully in all aspects of HIV vaccines on all aspects of the HIV vaccine continuum.

As well, the Agency will provide secretariat support services to ensure an integrated delivery of CHVI policies, programs and initiatives with domestic and international linkages, including:

• Managing and supporting the CHVI governance and accountability structures, including the CHVI Director General Steering Committee and multi-stakeholder advisory committees/expert working groups;
• Coordinating day-to-day communications for the CHVI including the establishment and maintenance of a website;
• Liaising with domestic and international stakeholders; and
• Leading the evaluation process design and conducting a mid-term evaluation of the CHVI in 2009-2010.

Focus for the RPP Reporting Period:

Through the ongoing Federal Initiative to Address HIV/AIDS in Canada, the Agency will:

• Advance knowledge of the factors that contribute to the spread of HIV infection through:

• Increase evidence-based public health action on HIV/AIDS through:

• Continue to support its existing committees on:

• Support programs that focus on HIV prevention, and improve access to more effective care, treatment and support for people living with HIV/AIDS;
• Increase public awareness of HIV/AIDS and factors that fuel the epidemic, such as discrimination, through support for targeted social marketing campaigns for populations most affected by HIV/AIDS;
• Engage other federal departments in addressing factors that influence the determinants of health, such as housing and poverty;
• Provide policy and technical expertise to increase Canadian participation in the global response to HIV/AIDS; and
• Integrate, when appropriate, HIV/AIDS programs and services with those addressing other related diseases, such as sexually transmitted infections (STIs) and Hepatitis B and C (HBV and HCV).

Pandemic and Avian Influenza Preparedness and Response

The program provides avian and pandemic influenza preparedness and response measures to help ensure the health and safety of Canadians, to assist in mitigating potential social and economic disruption, and to support large-scale improvements to the Canadian public health system. Activities include the maintenance of the Canadian Pandemic Influenza Plan for the Health Sector (CPIP); developing and maintaining domestic pandemic vaccine production capacity; production and testing of a prototype pandemic vaccine; establishing an adequate reserve of antiviral medication; monitoring, detecting, and reporting unusual respiratory illnesses; strengthening collaboration with P/T and international governments, pandemic influenza research activities; providing technical support and expertise on human health issues related to avian influenza; and partnership with national and international organizations to strengthen surveillance, laboratory capacity, emergency preparedness and communications.

What’s New:

To ensure a timely, efficient and appropriate response by the Government of Canada during a pandemic, the following measures are part of a $1 billion initiative to address significant pandemic issues.  These issues include:

• An improved federal capacity for mathematical modelling, statistical analysis, and operations research on pandemic influenza issues will allow a better understanding of the spread of influenza and the effect of epidemics or pandemics on Canadians.  This will allow for more timely and evidence-based decision making on public health responses. 
• Enhanced surveillance for avian influenza virus in live and dead wild birds. 
• Continue current monitoring and emergency planning for avian influenza in partnership with Canadian Food Inspection Agency (CFIA) and P/T partners.
• Ensuring the safety of the blood supply and blood availability during a pandemic by developing an overall blood related “surveillance strategy” that will entail the management of a variety of information systems into a coherent, integrated, and coordinated approach. 
• Identifying research priorities along with the mechanism to rapidly generate research findings and promote access to new knowledge.
• Ensuring continual human surveillance during a pandemic through the development of an updated and integrated electronic data management system for influenza surveillance over the next 2-5 years. There will also be an initiation of surveillance for severe respiratory infections in patients within hospitals participating in the Canadian Nosocomial Infections Surveillance Program.
• An antiviral reserve beyond the national antiviral stockpile will give the Government of Canada the flexibility to support the initial containment of a potential pandemic influenza outbreak and with a surge capacity to support P/T efforts against an outbreak or to provide appropriate protection to designated essential federal employees, therefore ensuring a more timely and effective response to a pandemic situation and better protection of Canadians.
• Advance the Public Health Agency of Canada’s pandemic influenza risk communications strategy, which is built on seven pillars: research, public involvement, stakeholder outreach, public information/social marketing, web, media relations and internal communications.
• Support the development and testing of a coordinated North American approach on travel health advisories at all stages of the pandemic phase and monitor the distribution of travel health book­lets in collaboration with the Department of Foreign Affairs and International Trade (DFAIT).

Through the Canadian Public Health Laboratory Network (CPHLN):

• Facilitate the coordination of laboratory infectious disease diagnosis and standardization best practices and processes among federal and provincial member laboratories; and
• Coordinate preparedness for bio-terror events in Canada, including the creation of the Canadian Laboratory Response Network, based on the United States LRN model.

Through work coordinated at the National Microbiology Laboratory (NML) and together with other federal and provincial public health laboratories, the Agency is demonstrating its continuing commitment to its pandemic preparedness by:

• Contributing to the overall prevention and control of influenza viruses;
• Enhancing national capacity for the detection and control of pandemic influenza viruses; and
• Limiting the emergence and transmission of drug-resistant influenza viruses.

Focus for the RPP Reporting Period:

• Provide updated, evidence-based recommendations on an ongoing basis to prevent, limit, contain, and/or control the spread of pandemic influenza in health care settings, including the revision of several annexes of the Canadian Pandemic Influenza Plan for the Health Sector as necessary.
• In December 2006, a revised version of the CPIP was published on the Agency’s website. Revision of Annex F (Infection Control and Occupational Health Guidelines during Pandemic Influenza in Traditional and Non-Traditional Health Care Settings), is slated for publication in the spring of 2008.
• To ensure updated, evidence-based recommendations on an ongoing basis to prevent, limit, contain, and/or control the spread of pandemic influenza in health care settings, the Agency will work with expert representatives from occupational health and safety, public health and infection control communities to revise Annex F. The Agency will also work towards evaluating and assessing recommendations on best personal protective equipment - work that is endorsed by the Public Health Network Council.  In addition, the Infection Control Guideline Steering Committee issued an interim statement in May 2007, on the use of surgical masks and respirators (e.g. N95 NIOSH-approved respirator, appropriately fit-tested and fit-checked) for aerosol generating medical procedures performed on patients with suspected or known influenza caused by the pandemic strain.
• The NML will initiate a vaccine program dedicated to the development and testing of new influenza vaccines employing different platforms including one that was successfully utilized at NML for the development of highly promising candidate vaccines for Ebola, Marburg and Lassa hemorrhagic fever viruses.
• With respect to clinical trials on a H5N1 mock vaccine, using a pandemic vaccine produced in Canada, there are discussions underway with the manufacturer GlaxoSmithKline (GSK).
• As well, the Agency supports work on real-time vaccine safety and effectiveness through pilot studies during the regular annual influenza season to increase our capacity to gather knowledge and evidence for use during a pandemic. Results of the pilot studies in 2007-2008 will be available later in 2008.
• Construction has begun on the state-of-the art InterVac facility, in Saskatoon, Saskatchewan, designed for high-containment vaccine research.
• The national antiviral stockpile will be diversified to allow for antivirals for pregnant women and children. Antivirals are currently available in the stockpile for pregnant women, and pediatric antivirals will be available in 2008-2009.
• There will be an increase in the national antiviral stockpile to 55 million doses by 2008-2009, sufficient to treat 5.5 million Canadians (17.5% of the population) who could become ill during a pandemic.

The NML, through the CPHLN, is strengthening nation-wide public health laboratory capacity during a pandemic via the creation of the Pandemic Influenza Laboratory Preparedness Network (PILPN) which will:

• Identify and work to address gaps in public health capabilities, capacities, role clarification and collaborative opportunities as well as evaluating human resource capacities and pandemic testing methodologies; and
• Coordinate the deployment of federal Laboratory Liaison Technical Officers (LLTO) to the majority of P/T public health laboratories along with addressing issues of stockpiling emergency testing supplies and equipment.

With respect to the diagnosis and pathogenesis of respiratory viruses, the NML will:

• Further develop and validate new diagnostic tests for rapid molecular and serological typing of influenza A viruses;
• Carry out newly developed in-house testing to monitor emerging strains for resistance to current antiviral drugs;
• Evaluate and assist in influenza surveillance proficiency testing to support national quality assurance efforts; and
• Host additional influenza diagnostic laboratory training workshops for P/T clients, as demand requires.

The Emergency preparedness and response program aims at developing exercises to evaluate the capacity to respond to emergency situations. It provides appropriate ongoing training to public health emergency response personnel and procures supplies to adequately respond to emergencies including potential influenza pandemic.

Focus for the RPP Reporting Period:

• Plan, coordinate and carry out various exercises to test existing operational plans and enhance preparedness plans including the pandemic influenza plan.
• Procurement of supplies and expansion of antiviral including critical supplies (e.g. masks, gowns, body bags, pharmaceuticals, medical devices, etc.) will continue to be acquired.

Immunization and Respiratory Infections

The program seeks to reduce or eliminate vaccine-preventable diseases excluding pandemic influenza, reduce the negative impact of emerging and re-emerging respiratory infectious diseases and adverse events following immunization, and maintain public and professional confidence in immunization programs. This includes nationally coordinated surveillance, epidemiology, and research for vaccine-preventable and respiratory infectious diseases, implementation of the National Immunization Strategy (NIS), including immunization registry development, national goals and objectives, vaccine supply, vaccine safety, and public and professional education, enhancing preparedness, national and international collaboration, and developing guidelines and protocols.

What’s New:

• Collaborative efforts with P/T governments, vaccine manufacturers, the public health community, and key stakeholders in the areas of immunizations and vaccines. 
• Continue contributing to national and international efforts in reducing incidences or maintain elimination of viruses causing rash illnesses.
• Address gaps in surveillance of sexually-transmitted and vaccine-preventable diseases through improved diagnostic and detection methods as well as through expanded surveillance quality assurance and training programs.

Focus for the RPP Reporting Period:

Continue to strengthen Canada’s ability to manage and respond to emerging and re-emerging infectious diseases and respiratory infections through the prevention, reduction or elimination of vaccine-preventable and infectious respiratory diseases.  In addition, the Agency will continue to reduce the negative impact of these respiratory infections, and maintain public and professional confidence in immunization programs in Canada.

• In collaboration with P/T, develop national scientific and programmatic recommendations on new vaccines approved for use in Canada.
• The National Advisory Committee on Immunization will review and update the Canadian Immunization Guide.
• Ongoing evaluation of the NIS, including a plan for implementation of mid-term evaluation recommendations and ongoing monitoring of the components of the strategy.
• Review of international models for immunization programs to facilitate information exchange between Canadian (F/P/T) governments and other countries.
• Continue to work with Canada Health Infoway and the “Panorama” public health surveillance system to ensure that new and existing national standards for immunization registries are incorporated into the design of the system.
• In support of PAHO’s Rubella Elimination Goal by 2010, establish a national Rubella Elimination Plan with a goal of strengthening policy and activities to maintain Canada’s rubella and Congenital Rubella Syndrome elimination status. This will occur in 2008-2009.
• Continue to collaborate with P/Ts and government services to facilitate the purchase and distribution of vaccine while working towards a secure supply of vaccine in Canada. 
• Continue regular nationally coordinated public education and communication strategies for reliable information on immunization. Develop multi-faceted education and training strategies for immunization providers to enhance knowledge and skills in immunization delivery.
• Enhancements to the Canadian Adverse Events Following Immunization Surveillance System through the F/P/T Vaccine Safety Network to enhance vigilance with monitoring and reporting of adverse events following immunization. Enhance vaccine safety capacity through a variety of mechanisms, such as harmonized and routine reporting mechanisms, networks and committees and improved communications.
• Enhance vaccine-preventable disease surveillance capacity; strengthen and coordinate surveillance systems and reporting mechanisms.
• Over the planning period, the Agency will be collaborating with internal and external partners to translate scientific and evidence-based knowledge on the HPV vaccine into a cervical cancer prevention program and policy recommendations.

Communicable Diseases and Infection Control

The program includes prevention, control, support and research activities aimed at addressing communicable diseases that can be acquired within the community or within health care settings, and any associated health risks and determinants. A specific component addresses communicable diseases at large, from an international and migration health perspective, as a cross-cutting issue for the Agency. Diseases include sexually transmitted diseases (STIs) or blood-borne infections (e.g. Hepatitis B and C, excluding HIV), tuberculosis, Creutzfeldt-Jakob, C. difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and issues such as anti-microbial resistance, transplantation/transfusion transmitted injuries/ infections, and blood safety.

What’s New:

• Modernize the Yellow Fever vaccination program in collaboration with provinces and territories in order to meet one of Canada’s obligations under the revised International Health Regulations.
• Strengthen travel health communications and provide improved travel health information.
• Collaborate with WHO, PAHO and the Agency’s technical program areas to monitor and assess global events that may impact the health of Canadians in order to provide timely travel health advisories.
• Work with other government departments, provinces and territories to implement a shared work plan to minimize the health risk to Canadians and newcomers related to immigration.
• Development of a sentinel surveillance system to measure the burden of HPV infection and baseline epidemiology as the HPV vaccine is introduced in Canada.
• Develop and implement standardized methods to electronically extract data from a sentinel network of primary care physicians and hospital emergency departments in diverse urban and rural locations.
• Develop an enhanced public health network for human prion diseases in Canada, incorporating the Canadian Creutzfeldt-Jakob Disease Surveillance System.
• Enhance surveillance capacity for Extreme Drug-Resistant Tuberculosis (XDR-TB) and work toward development of rapid testing methods.
• Contribute to the surveillance, detection and prevention of HPV infection through enhanced surveillance, detection and research activities.

Focus for the RPP Reporting Period:

• The Agency will continue efforts to support and facilitate the development, implementation and evaluation of strategies, programs, resources and tools that help Canadians to improve and maintain their sexual and reproductive health, including an STI pamphlet.
• Over the planning period - the re-development and re-launch of the Agency’s Canadian Guidelines for Sexual Health Education will occur so that they can continue to be used as an up-to-date resource for health and educational organizations in developing new programs and curriculum or evaluating existing programs and curriculum.
• Develop an assessment model that incorporates a comprehensive set of sexual health indicators that will be used to assess the sexual health of Canadians across their lifespan.
• Identify “best practice” models of school-based curricula and research on sexual health promotion and the dissemination of these models to educators and policy makers.
• Educate the general public and health and education professionals on HPV, its associated diseases and vaccine, facilitated by consistent messaging with a national focus.
• Develop and disseminate policy documents that address sexual and reproductive health issues identified through the Enhanced Surveillance of Canadian Street Youth Study.
• Continue to work towards strengthening the knowledge and capacity of health care professionals for the prevention, diagnosis, and treatment of STIs.
• Continue to work in collaboration with the National Collaborating Centre for Infectious Diseases on initiatives for the promotion of sexual health.
• Ongoing collaborative efforts with F/P/T and regional government and non-governmental partners in the areas of STI surveillance and prevention in federal correctional facilities and behavioural research, and efforts to increase Canada’s participation in sexual health promotion internationally.
• Continued monitoring of rates of a wide range of sexually transmitted and blood-borne infections through routine and enhanced surveillance, and continued work on the initiation of the sentinel surveillance projects for both HPV and antimicrobial resistant gonorrhea.
• Continued improvements to the quality and timeliness of existing routine surveillance systems with the development of national data standards for reportable STIs and Hepatitis B and C. 
• Enhanced Surveillance of Canadian Street Youth will continue to provide a comprehensive picture of the health of Canadian street youth, including through surveillance related to risk factors for STIs and other determinants of health in this population.

To further assist the Agency in the area of communicable diseases, the NML will:

• Provide advanced laboratory reference services for hepatitis viruses and develop laboratory assays for identifying emerging pathogens with blood-borne potential. These include developing drug and vaccine resistant strains of Hepatitis B virus and ensuring that current test methods are able to detect potentially new mutant strains.
• Carry out phylogenetic analysis of strains of Hepatitis viruses (A, B, C, D) strains to track and determine the source of outbreaks and facilitate preventative interventions.
• Monitor the currently circulating strains of Hepatitis B and C viruses for the emergence of drug resistance, and monitor Hepatitis B viruses for immune resistance to vaccination and gamma-globulin therapy.
• Conduct research on the molecular identification and characterization of Hepatitis virus strains and carry out basic research into the pathogenesis and chronic persistence of Hepatitis C virus infections in order to understand how chronic infection leads to liver diseases, and to develop improved prevention or treatment therapies.

In addition the Agency will:

• Continue collaboration with the First Nations and Inuit Health Branch (Health Canada), Correctional Service Canada and the Canadian Institutes of Health Research.
• Engage and support the Agency’s regional offices to strengthen and coordinate program activities.
• Support enhanced research and surveillance activities among vulnerable and at-risk populations in partnership with P/T governments.
• Promote peer-based education and awareness among at-risk and vulnerable populations.

Enhanced Hepatitis Strain Surveillance System and Canadian Needle Stick Surveillance Network

• Over the planning period, recruitment of additional sites to further strengthen data produced by Enhanced Hepatitis Strain Surveillance System (EHSSS) and Canadian Needle Stick Surveillance Network (CNSSN) and its use for infectious disease prevention and control activities. Data produced from the EHSSS and CNSSN will continue to be used to protect public health and for a number of regulatory (Health Canada)/public health policy (Agency) purposes.
• There will be ongoing identification of risks associated with specific technical/medical procedures, such as possible transmission of various infectious diseases. The Agency will also work to further advance information sharing and knowledge transfer for better scenario analysis and option development, to help risk assessment and risk communication as part of a sound risk management approach.
• Data from EHSSS and CNSSN will continue to be published in scientific journals and posted on the Agency’s website.
• Due to the variability in the prevalence and incidence of HBV infection across Canada among the different subpopulations (e.g. immigrants and Aboriginals), HBV public health policy needs to be modified on an ongoing basis.
• Strategies such as risk reduction counselling and services for reducing or eliminating high-risk behaviours within the injection drug users and Aboriginal populations need to be more widely implemented.

Canadian Blood and Marrow Transplant Surveillance System Database

• The Agency will continue collecting data through its Canadian Blood and Marrow Transplant Surveillance System (CBMTSS) database, and from 2009-2011, will work towards converting the current system into a Web-base database.
• Data collected through CBMTSS and stored at NML’s specimen repository will be used jointly by the participating centres, with the principal aim of improving patient safety and public health.

Blood-borne Pathogens Surveillance Project

• Continue with providing comprehensive surveillance on patients with hemophilia or other blood related diseases, such as sickle cell, in order to quickly gain knowledge of the outcomes of treatment with blood products through the Blood-borne Pathogens Surveillance Project (BBPSP).  
• Ongoing support to maintain a secure bank of blood samples from these high-risk patients to be available for testing for newly emerging pathogens. 

National Transfusion Transmitted Injuries Surveillance System and Transfusion Error Surveillance System

• National Transfusion Transmitted Injuries Surveillance System (TTISS) will continue to be upgraded and there will be ongoing capacity building with provinces and territories for adverse event reporting including new Transfusion Related Acute Lung Injury (TRALI) definition; development of standardized guidelines for the investigation of bacterial contamination cases; and reconciliation of data with Heath Canada’s regulatory Marketed Health Products Directorate (MHPD), Canadian Blood Services (CBS), and Héma-Québec. The TTISS will be upgraded to a web-based application that will be more user-friendly and will enable real time reporting.
• In 2008-2009, there will be continuous development of TESS Pilot sites.  The TESS data will be collected with initial analysis completed.
• Reports and a synopsis from both TTISS 2004-2005 and the Transfusion Error Surveillance System (TESS) 2005-2006 will be drafted for scientific publication.

Cell, Tissue and Organ Surveillance System

• Develop a Cell, Tissue and Organ Surveillance System (CTOSS) for the adverse events resulting from the transplantation of cells, tissues and organs (CTOs). The Agency will establish initial contact with key stakeholders and potential pilot sites.

Health Care Acquired Infections

Canadian Nosocomial Infection Surveillance Program

• Continue to oversee Canadian Nosocomial Infection Surveillance Program (CNISP) activities, with 30 participating members in 9 provinces. The Agency will also work to expand health-care acquired infection surveillance beyond acute care hospitals to health care situations in the broader community.
• The Agency will pursue with provision of reports, and related scientific articles on the Agency website, on the incidence of key, emerging infectious agents that cause health care acquired infections, including MRSA, VRE and C. difficile.
• The Infection Control Guideline Series will continue to be regularly updated and posted in a timely manner on the Agency website, with relevant science-based information to help prevent, limit, contain and/or control health care acquired infections.
• Maintain support to the Infection Control Steering Committee by providing Secretariat support and advisory role as well as organizing meetings. This Committee is responsible for drafting the Infection Control Guideline Series, which also provide expert advice in matters of health care acquired infections issues to the Communicable Disease Committee Expert Group (CDCEG) reporting to the Pan-Canadian Public Health Network (PHN).
• The Agency will continue providing assistance (upon request) to P/Ts and their health care agencies on health care acquired infection issues such as when an outbreak occurs, including MRSA, CA-MRSA, and C. difficile.

Migration and International Health

• Collaborate with DFAIT to print and distribute a travel health booklet for the general public to promote safe and healthy international travel. As well, the Agency will distribute new International Certificates of Vaccination or Prophylaxis and provide guidance on its completion to designated yellow fever vaccination centres in order to meet one of Canada’s obligations under the revised International Health Regulations.

Infection Control

The Agency will work towards developing initiatives on infection control to improve prevention, early detection, containment and response capacity across Canada. These initiatives could address diseases such as XDR TB and MRSA which has moved beyond the limits of the hospital setting and has become established in localized vulnerable populations and communities. For example, CA-MRSA outbreaks are occurring in various localities across Canada with the most recent being in Nunavut. As such, the Agency is exploring the establishment of a survey to identify the prevalence of CA-MRSA in Canadian communities.

Human Papilloma Virus Vaccine

With federal funding provided to the P/Ts for the HPV vaccine and with the implementation of publicly funded vaccine programs within the P/Ts there has been a need to undertake surveillance and education activities to support the P/Ts and monitor the virus. The Agency has initiated surveillance and education activities and will need to continue and expand current efforts in anticipation of the approval of other HPV vaccines, new formulations and expanded indications, such as the immunization of males.

Foodborne, Waterborne and Zoonotic Diseases

The program includes surveillance, research, risk analysis and response to address the incidence and mitigate the burden of, foodborne, waterborne, and zoonotic illness in Canada; investigation and coordination of outbreak response, population and targeted research; and establishment of national surveillance capacity through consultation and coordination. The program strengthens public health capacity through technology and training, investigation of burden of disease and risk factors for infections, and development of national guidelines relating to risk reduction and prevention. Diseases being addressed include E. coli, Salmonella, Campylobacter, Hepatitis A, Norovirus, West Nile Virus, Lyme disease, rabies, and other emerging and re-emerging risks resulting from changes to behaviour, the climate, the environment and other factors.

What’s New:

• Expand and explore opportunities for capture and reporting of antimicrobial use data from major food animal species which are used for the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) program.
• Contribute to studies to further the understanding of disease prevalence and transmission through molecular and serological surveillance and epidemiological investigations.
• Participate in Global Laboratory Directory Map (GLaDMAP), a new WHO project that will focus on activities in the Asia-Pacific region to ensure laboratory capacity to respond to cholera, anthrax, dengue hemorrhagic fever and other pathogens that pose national and international public health threats.
• Contribute to improved animal health surveillance for early detection of emerging infectious disease risks.
• Contribute towards the provision of support in reducing the incidence and impact of antimicrobial resistance and hospital-acquired outbreaks in Canada.
• Develop strategic plans to support and enhance systems such as Web accessible National Enteric Surveillance Program (WebNESP), Canadian Laboratory Surveillance Network-PulseNet (CLSN-PulseNet), Laboratory Information Management System (LIMS) and PulseNet Canada BioNumerics.
• Work with federal partners (e.g. Health Canada, Agriculture and Agri-Food Canada and the Canadian Food Inspection Agency) on a joint federal working group on toxin-producing E. coli to develop and implement surveillance methods through the Canadian food safety continuum (“farm to fork”).
• Reduce the threat posed to Canadians by emerging pathogens through collaborative research with national and international governmental, industrial and academic researchers to enhance surveillance capabilities and improve vaccines and diagnostic procedures.
• Develop strategies to support recognition and response to infectious gastrointestinal illness affecting new immigrants, refugees and other migrant populations entering Canada.

Focus for the RPP Reporting Period:

• Continue to provide leadership in the coordination of multi-provincial outbreaks and content expertise to the provinces, the Canadian Food Inspection Agency and Health Canada as requested.
• Continue to liaise with international partners in the investigation of international foodborne disease outbreaks.
• Launch a new tool for collecting summary data on food-borne and waterborne illness outbreaks - tool is near completion, launch and training plan is being developed.
• Enhance focus on waterborne disease and other environment related risks for enteric and zoonotic diseases.  Specifically, the Waterborne Disease Summary Report (2007) will be linking meteorological data through C-EnterNet water and human endemic case data.
• Conduct a population survey to better understand the economic costs and origins of acute gastroenteritis in the community - Pilot surveys complete - planning for Aetiology Study.
• Continue to collect, and disseminate weekly, laboratory data on human gastrointestinal pathogens (bacterial, viral and parasitic) to facilitate timely outbreak detection, response and emergency preparedness through the National Enteric Surveillance Program (NESP).
• Continue development and application criteria to prioritize potential additions to the list of pathogens under surveillance in the NESP. Specifically, a background discussion document has been drafted.
• Continue to coordinate antimicrobial resistance (AMR) surveillance data under CIPARS.  
• Continue implementing targeted studies examining AMR in enteric pathogens (Salmonella Heidelberg, S. Typhi and S. Paratyphi and Campylobacter spp.) and antimicrobial use data validation. 
• Continue coordination of C-EnterNet, a program for sentinel surveillance program of foodborne and waterborne pathogens across the food chain and in the environment including determining the feasibility of launching new sentinel sites.
• Ensure that epidemiological findings from disease surveillance, research and outbreak investigations are used to inform food safety policy.
• Complete a study on barriers to enteric disease outbreak prevention in childcare settings.  Consultation is planned for spring 2008.
• Contribute to strategies to reduce risks of infection from raw produce. Raw fruits and vegetables have become an important source of key enteric pathogens, causing widespread disease outbreaks.
• Complete national guidelines on the management of enteric pathogen shedders; and animal exhibitions, to reduce the risk of human infection.  Specifically, the Shedder Guideline draft is completed and will be reviewed more broadly.
• Continue to support Health Canada and the CFIA in risk assessment related to product recall actions.
• Continue to contribute to F/P/T, national and international fora on food safety. 
• Collaborate in studies of foodborne and waterborne illnesses in northern Aboriginal communities and the impact of climate change on these illnesses. 
• Carry out a study of toxoplasmosis in the Arctic and sub-Arctic regions, to understand toxoplasmosis risk from both ecological and public health perspectives.
• Continue to support the implementation of Arctic initiatives on the impact of zoonotic infections.  To that end, the Agency will review articles on current knowledge, and research into the risk of zoonotic infections for Inuit communities in Canada.  As such, the outcome is a multi-disciplinary approach to understanding zoonotic disease risk from both ecological and public health perspectives.
• Initiate a process to identify and prioritize potential effects of climate change on a wide range of pathogens, including vector-borne, foodborne and waterborne pathogens, to guide research efforts.
• Focus on identification of climate related risks and risk mitigation strategies for vulnerable groups (e.g. Seniors, First Nation communities), including continuation of projects underway in First Nations communities
• Continue the current surveillance program for West Nile virus, including Dead Bird Surveillance, Core Program Activities and Research, contingency funding for emerging issues, and assistance to the NML to obtain specimens for broad screening for zoonotic pathogens. 
• Complete a diagnostic guidance document for Lyme disease and facilitate the development of clinical guidelines with F/P/T partners.
• Expand disease modeling efforts for a variety of vector-borne infections, including Lyme disease.
• Facilitate the development of national coordination for a response to rabies in Canada.

Science and Innovation

The program generates and translates knowledge into effective national public health policy and actions.   This includes the development of unique capabilities as a national resource, with a focus on infectious disease prevention and control, the application of biotechnologies and genomics to population health, and mitigation of human illnesses arising from the interface between humans, animals, and the environment.  Projects undertaken by the National Microbiology Laboratory (NML) and the Laboratory for Foodborne Zoonoses (LFZ) strengthen public health capacity through research, reference services, development of innovations such as the Canadian Network for Public Health Intelligence (CNPHI) and the Global Public Health Intelligence Network (GPHIN), emergency research capacity, health risk modeling, and management of intellectual assets to improve public health and better respond to emerging health risks in Canada and internationally.

What’s New:

• Advance the NML mobile lab unit as a national and international public health resource in support of infectious disease control and bioterrorism / biowarfare preparedness, which will include supporting national security operations for special events such as the 2010 Olympics.
• Contribute to Canadian and global preparedness against bioterrorism / biowarfare through scientific research, including projects relating to detection and treatment for threat agents.
• Develop and strengthen relationships with bilateral and multilateral partners and institutions, including the WHO, the Food and Agricultural Organization (FAO) and the PAHO in order to develop science-based risk management practices.
• Develop mechanisms to link surveillance data to prudent use policies and clinical practice guidelines for antimicrobial agents used in animal production.
• Continue to gain knowledge about antimicrobial use patterns in agriculture and factors affecting antimicrobial use and the potential linkage between exposure and antimicrobial resistance and pathogen virulence in the food chain.
• Continue integrating CNPHI with F/P/T and regional public health databases as part of the Agency’s national, real-time alerting and strategic intelligence distribution system. This includes developing an Encephalitis Collaborating Group (ECG) surveillance application, the Measles and Rubella Surveillance (MARS) pilot, and the Canadian Animal Health Surveillance Network to detect emerging animal disease.
• Advance the bio-risk (bio-safety, bio-security and bio-containment) management agenda for the Agency which includes the development of a national and international bio-risk management strategy.

Focus for the RPP Reporting Period:

• Develop best-evidence synthesis, research, methodology and evidence-based policy advice, including risk management on targeted food policy and zoonotic public health policy issues.
• Using the latest molecular and cellular techniques to:

• Develop agro-environment decision making tools by:

• Work to develop a Biotechnology, Genomic and Population Health (BGPH) Program by:

As part of the continued development of CNPHI web-based applications the Agency will:

• Consider the feasibility of continuing a nation-wide, web-based surveillance system for over-the-counter pharmaceutical sales put in place using the Canadian Early Warning System (CEWS).
• Continue developing web-based resources, including a prototype for electronic dynamic event management (dynaEvent) to support the Incident Command System structure, an outbreak summaries reporting system for enteric and respiratory disease, and applications for electronic quality control monitoring and electronic proficiency testing.
• Continue expansion to encompass more F/P/T and regional government departments, including: the development of a surveillance system to integrate health data and information from multiple points of care; a national framework to support animal health surveillance; a collaboration between public health and radio-nuclear communities providing general alerts of nuclear events; and establishment of a collaboration centre to promote online collaboration between P/T  laboratories.

Program Activity - Emergency Preparedness and Response

Financial Resources* (in millions of dollars)

2008-09	2009-10	2010-11
39.1	42.4	39.0

Human Resources (FTEs)

2008-09	2009-10	2010-11
271	271	271

* Additional funding of $0.1M for 2008-2009 and $3.4M for 2009-2010 are planned for increased security measures at the 2010 Vancouver Winter Olympics.

A series of domestic and international public health safety and security threats associated with natural and human-caused disasters confront the health safety and security of Canadians. These threats have been particularly evident by the emergence of Severe Acute Respiratory Syndrome (SARS), Avian Influenza, the Asian tsunami and Hurricane Katrina. These events and numerous other natural and man-made disasters are occurring in a global public health environment shaped by complex social, economic and environmental factors.

On the domestic front, demographic challenges such as aging and vulnerable populations as well as health and income disparities among population groups pose serious ongoing challenges in the development of uniform and robust emergency preparedness and response capacities across a vast and sparsely populated country.

This complex interplay of domestic and international health factors requires a comprehensive and highly collaborative approach to disaster preparedness, response and mitigation on the part of the Public Health Agency of Canada. With this in mind, the Agency takes a proactive “all hazards” approach to emergency management, working with emergency preparedness and response (EPR) partners and stakeholders across Canada to prepare for and respond to natural and human-caused health emergencies at anytime, anywhere across the country.

The Agency’s Priority:

• The Emergency preparedness and response capacity supports Agency priority 3 (see Section I – Overview – The Agency’s Priorities).

The Program manages and supports the development of health-related emergency response plans, including the Canadian Pandemic Influenza Plan (CPIP). It develops and sponsors emergency preparedness training, and coordinates counter-terrorism preparations for incidents involving hazardous substances. It provides emergency health and social services, and manages the National Emergency Stockpile System (NESS). Emergency preparedness and response activities are guided by the F/P/T Expert Group on Emergency Preparedness and Response, which is based on the Minister of Health’s Special Task Force on Emergency Preparedness and Response.

Emergency Preparedness 

The Program strengthens Pan-Canadian emergency preparedness through the development of emergency operations plans, processes, and planning tools that support improved interoperability and response capabilities during emergencies. 

The Program aims at protecting Canadians from geographical, biological and meteorological disasters that are either naturally occurring or human-made.  Development of events such as workshops, table-top and command-post exercises helps to evaluate the capacity to respond to emergency situations and the effectiveness of existing plans and planning tools. It provides appropriate ongoing training to F/P/T and regional public health emergency response personnel and prepares them to adequately respond to public health emergencies including potential influenza pandemics.

The Program undertakes and supports relevant research, in addition to activities that support the use of evidence from relevant research fields to inform practice and policy decisions impacting health through knowledge dissemination, exchange and transfer (KDET) which includes the collection, review, and synthesis of evidence, risk assessment, creation of networks for knowledge exchange, creation of accessible and usable products and formats to communicate evidence, and development of mechanisms for dissemination. 

The Program encompasses a range of public health intervention activities by which individuals, groups, and organizations improve their capacity and develop sustainable skills to identify, mobilize, and address public health problems. It includes activities such as community, institutional or professional based programming, workshops, and other educational events; the development of products, network development; and the provision of expertise. Emergency Preparedness develops plans and exercises that assist the Agency and its internal and external stakeholders to respond more efficiently and effectively during public health emergencies.

Emergency Preparedness develops training programs in health emergency management that permit all responders to respond to all types of emergencies.  This activity aims at developing methodologies, courses, electronic and other tools, and skill sets to enhance emergency preparedness and response training.

Focus for the RPP Reporting Period:

• Plan and coordinate with departmental, other federal governmental, and P/T partners preparations for public health threats, including pandemic influenza.
• Carry out various exercises with other federal governmental and P/T partners to test existing operational plans and enhance preparedness plans including the pandemic influenza plan.  Work also continues to support the Security and Prosperity Partnership initiative. 
• Develop training programs on emergency preparedness and help its health responders and health emergency response team (HERT) partners to develop their own emergency training capacity including the capacities of key federal organizations, P/Ts and municipal governments, as well as for the Program’s quarantine officers and Emergency Operations Centre (EOC) managers.
• Develop a Forensic Epidemiology online course to provide distance skills training and deployment.
• Strengthen and support programs to reduce vulnerabilities of at-risk populations during health emergencies (e.g. children, seniors, people with disabilities, etc.).
• Coordinate yearly national bio-safety and bio-containment training events, including the Canadian Bio-safety Symposium and the Containment Level 3 Facilities Design and Operations course, and develop bio-safety learning tools for laboratory workers to help minimize the risk from new and emerging dangerous pathogens.
• Manage the Transportation of Dangerous Goods (TDG) compliance and training program within the Health Portfolio through the development and the provision of training to ensure compliance with national and international TDG Regulations.
• Provide training to the Agency/Health Canada across Canada in the Workplace Hazardous Material Information System (WHMIS), Radiation Safety and Spill Response, including the development of new on-line TDG and WHMIS training tools.

Emergency Response

The Program maintains the National Emergency Stockpile System which provides reserves of medical supplies and equipment strategically located in 1,300 P/T sites, and nine federal warehouses to enable timely responses which limit the potential harm to Canada from natural and human-made disasters.  The Program also supports training of stakeholders to develop their capacities to deal with emergencies. The Program provides Health Emergency Response Teams (HERTs) to assist P/T and local authorities in providing emergency medical care during disasters. This program also coordinates with P/T and other federal authorities to manage population movement, medical assessment, and when necessary, medical isolation of travelers. Quarantine and other public health measures at entry and exit control points at major airports, including the provision of staff, protect against importation of infectious diseases of public health significance, safeguard the health of Canadian and international travelers, including visitors from falling prey to imported diseases.

The Program encompasses a range of public health intervention activities by which individuals, groups, and organizations improve their capacity and develop sustainable skills to identify and address public health problems. It includes community, institutional or professional based programming, workshops, and other educational events; the development of products; network development; and the provision of expertise.  The program supports provinces and territories in response to natural and man-made disasters by providing emergency medical supplies and equipment (NESS, Emergency Response Assistance Plan for Infectious Substances, RG4) and medical surge capacity consistent with the National Framework for Health Emergency Management -Guideline for Program Development (National Office of Health Emergency Response Teams).

The Program also includes activities related to the development and drafting of regulations and legislation. As well, it includes initiatives related to monitoring, compliance with regulations, and the evaluation of their impact. Emergency Response provides quarantine services at major points of entry across Canada by enforcing the Quarantine Act to prevent the introduction of communicable diseases into and out of Canada and to assist in mitigating potential social and economic disruption.

In order to link the health sector’s emergency preparedness and response activities within the Government of Canada’s National Emergency Management Framework, the Agency is directly linked to Public Safety Canada. An important liaison function enhances the operational links with the Agency’s Emergency Operations Management System (EOMS) and the Government’s National Emergency Response System (NERS).

Focus for the RPP Reporting Period:

• Create a robust 24/7 EOC for the health portfolio with a  “user-friendly” communication capacity including satellite, cellular, two-way radios, and land line telephone connections to facilitate communication anywhere with the capacity to divert incoming calls to crisis management centers.
• Create a permanent executive liaison function to strengthen the policy, program and emergency response linkage between the EOMS and NERS.
• Co-ordinate the management of the NESS with other federal agencies and include NESS in the NERS to ensure consistency with the National Framework for Health Emergency Management – Guidelines.
• Enhance the NESS’s state of readiness to respond effectively to emergencies within 24 hours of request in Canada.
• Perform a comprehensive analysis of the recommendations from the December 2006 NESS Strategic Review final report and develop a multi-year implementation plan to enhance the NESS based on an updated risk and threat analysis and with consideration of the specific emergency response needs of the provinces and territories.
• Acquire and maintain an effective stockpile system with sufficient medical supplies and equipment.
• Provide emergency medical equipment and supplies to support surge capacity for P/Ts affected by natural or human-caused disaster within 24 hours of request.
• Establish and operate the National Office of Health Emergency Response Teams (HERTs) by recruiting, training, and deploying HERTs throughout Canada.
• Improve inter-provincial emergency licensure for physicians, surgeons, nurses, and other health scientists towards rapid deployment.

Public Health Security

The Agency provides Pan-Canadian and international leadership through its surveillance, policy, and coordination of domestic and international efforts to ensure public health security. 

The Program provides accurate and timely national and global public health event information to Canadian and WHO officials through the GPHIN. The Program also manages an EOC to facilitate the Agency and Health Canada situation/crisis management.

The Agency monitors imported diseases and foreign health outbreaks with potential to harm Canada, Canadians, and international travelers; mobilizes the Agency’s EOC system in times of national or international health emergencies to facilitate a coordinated and effective response, ensures a ready supply of expertise for evidence-based bio-safety, bio-containment, and bio-security interventions for possible biological accidents, and provides training, published guidance, and the enforcement of the Human Pathogens Importation Regulations on movement and use of dangerous pathogens in Canadian laboratories.

The Program manages ongoing, systematic use of routinely-collected health data for tracking and forecasting health events or determinants.  Surveillance includes collection and storage of relevant data, data integration, analysis, and interpretation, production of tracking and forecasting products, publication and dissemination of those products, and provision of expertise to partners developing or contributing to surveillance systems.

The Program manages activities related to the development and drafting of legislation and regulations. It also manages initiatives related to monitoring, compliance with legislations and regulations, and the evaluation of policies and their impact. The program also manages the Health Portfolio’s Emergency Response Assistance Plan for Infectious Substances, RG4. The program prepares for transportation accidents involving RG4 materials. The plan includes Agency response personnel coordination of P/T response teams that respond to transport incidents anywhere in Canada.

The Program also verifies that Canadian Bio-containment laboratories are compliant with rigorous Canadian and international Bio-safety and Bio-security standards. The program minimizes the risk to Canadians from laboratories importing and working with highly dangerous pathogens for diagnostic, emergency preparedness and research purposes.

Focus for the RPP Reporting Period:

• Strengthen Canada’s role in the Global Health Security Initiative to improve public health preparedness and response to possible incidents of chemical, biological and radio-nuclear terrorism.
• Use GPHIN surveillance to gather information on health emergencies of national and international significance on a 24/7 basis. Continue to provide important and timely information on Pan Canadian and global public health events to Canadian and WHO officials.
• Ensure that emergency response activities provide quarantine services at major points of entry and exit across Canada by enforcing the Quarantine Act (which came into force in the fall of 2006) to prevent the introduction of communicable diseases of public health concern into and out of Canada.
• Develop supporting regulations, policies, procedures, and training to support its Pan-Canadian quarantine service, with quarantine officers at six international airports which account for 94% of international travelers into and out of Canada.
• Continue to work within the F/P/T Network on Emergency Preparedness and Response to strengthen the capacity in Canada to deal with health emergencies.
• Work within the F/P/T community to strengthen the Health Portfolio’s capacity to respond to a transportation emergency involving RG4 material anywhere in Canada.
• Provide leadership and collaboration with the international bio-safety community, as a WHO Collaborating Centre, to develop global approaches to bio-safety and bio-containment to protect the health and safety of Canadians.
• Develop a comprehensive legislative framework for bio-safety of human pathogens and toxins to protect the health and safety of Canadians and international visitors.
• Strengthen the new Canadian Bioterrorism Laboratory Response Network to ensure that local, P/F laboratories can quickly test and identify unknown agents.
• Represent the Agency’s national authority for bio-safety and its mission: to ensure effective, evidence-based bio-safety interventions on a national basis through regulatory control, surveillance, applied research and timely dissemination of information related to needs, priorities and strategies.
• Administer the current Importation of Human Pathogens Regulations, including issuing import permits in the certification of new and re-certification of existing Bio-containment facilities to ensure Canada’s response capacity to new and emerging dangerous pathogens.
• Provide a national leadership and co-ordination with P/Ts for the issuance of new Bio-safety Advisories for new and emerging dangerous pathogens.

Program Activity - Strengthen Public Health Capacity

Financial Resources (in millions of dollars)

2008-09	2009-10	2010-11
44.1	44.8	45.2

Human Resources (FTEs)

2008-09	2009-10	2010-11
249	253	253

Canada must ensure a stronger public health system to keep Canadians healthy in an environment that presents many increasing threats to their health from widening social and economic inequalities to an increasing prevalence of chronic and infectious diseases.  This public health system includes skilled public health practitioners, as well as the right information, knowledge and legal frameworks to support public health decisions. 

Public health threats are indeed increasing.  Global trade and personal mobility mean that viruses, contagious infections and foodborne illnesses can be transported from one continent to another in a matter of hours.  There is also a rising incidence of once dormant infections such as Tuberculosis and polio, which are becoming a renewed threat to the health of Canadians.  In addition, the persistent threat of a pandemic like Avian Influenza continues to loom. 

Moreover, our primary health care system is strained, while unhealthy living habits and chronic disease continue to increase the demands for health services.  Canadians facing social and economic challenges are also more likely to suffer health problems, and public health interventions must continue supporting targeted interventions for these populations.

The Public Health Agency of Canada is committed to strengthen and sustain its public health capacity to respond to the health needs of Canadians in their everyday lives and during a public health threat or emergency. The Agency will do that by focusing on building public health human resource capacity across Canada, establishing knowledge-based information systems and advancing its work in public health law and ethics. 

Working with its national and international partners, the Agency will provide tools, practices, programs and understandings that support the public health system. 

The Agency’s Priority:

• This activity will address Agency priority 4 (see Section I – Overview – The Agency’s Priorities).

Building Public Health Human Resource Capacity

Needed public health capacity in Canada is not possible unless measures are taken to provide and maintain an adequate staff of highly qualified and motivated public health professionals.  Such measures require comprehensive planning and cooperation at all level of governments, as well, as a multi-dimensional, integrated approach to public health human resources. 

Working with its national and international partners, the Agency will deliver a wide range of programs covering the aspects of governance, programming, training, development and public health emergency support services.  The human resource capacity (adequate people in the right places and with the necessary competencies) within the Agency and across Canada is a requirement for the Agency to fully achieve its strategic objectives.

In 2008-2009, the Agency will continue to support the Public Health Human Resources (PHHR) Task Group of the Public Health Network.  The Task Group’s mandate was extended in November 2007 to address priorities identified for PHHR planning that were documented by the Advisory Committee on Health Delivery and Human Resources in the Pan-Canadian Framework for PHHR Planning:  Building the Public Health Workforce for the 21st Century.  Work will be undertaken in priority areas identified: Enumeration, Education and Core Competencies.

Focus for the RPP Reporting Period

The Enumeration Working Group established under the PHHR Task Group is responsible for proposing pan-Canadian standards to guide the development of an information infrastructure for needs-based, system-driven public health workforce planning.  The Enumeration Working Group anticipates:

• To propose Pan-Canadian enumeration standards (e.g. a working definition of the public health workforce, its organization, and minimum data required for planning);
• To assess the ability of national data agencies, jurisdictions, and disciplines to report data on the public health workforce (e.g. professionals working in public health positions); and
• To identify strategies to collect better data on the public health workforce. 

Ultimately, this will increase all jurisdictions’ capacity to plan for the optimal number, mix, and distribution of public health skills and workers.

The Education and Core Competencies working groups will:

• continue collaborative work with F/P/T partners, universities and professional associations to help develop an inter-professional public health workforce with the skills and competencies to fulfill public health functions and meet population health needs at the local, provincial, national and international levels; and 
• as part of this engagement, work will be undertaken with other working groups established to support the recommendations identified in the Pan-Canadian Framework for Public Health Human Resources Planning. 

Continuous enhancement of skills is core to improving performance and ensuring a more effective public health workforce, which ultimately benefits the health of all Canadians.  This is the focus of the Agency’s Skills Enhancement for Public Health Program, which offers an online continuing education environment for public health practitioners.  In 2008-2009, the program will add three online modules to the current suite, increasing the total number to thirteen. This continuing education initiative helps public health practitioners develop and strengthen the knowledge, skills and attitudes needed to meet the core competencies for public health.  The program will:

• develop tools to support the use of the core competencies for public health, and will undertake collaborative work to establish discipline-specific competencies; and
• do an evaluation on the effectiveness of the consultation and communication undertaken to develop and use the core competencies. 

Recent interest from international agencies has highlighted the potential of the program to help strengthen public health systems and workforce capacity globally.  The program will:

• collaborate with PAHO to assess the suitability of the program to support the Virtual Campus of Public Health, with a focus on the Caribbean countries. 

An adequate supply of qualified public health professionals entering practice is required to effectively support public health in Canada.  The Agency, through its Public Health Scholarship and Capacity Building Initiative, will:

• continue to work to increase the supply of public health professionals;
• enhance training and capacity building opportunities across Canada; and
• strengthen linkages between public health organizations and universities.

The Agency will work with the CIHR to award scholarships and fellowships to professionals with a focus on public health and to provide grants to support academic chairs in public health at a number of universities. These chairs will establish public health focused training opportunities, intervention research and linkages to local public health practice. 

Through contribution agreements, the Agency will also support public health organizations to create training products and tools, such as nursing manuals, which will help professionals improve their work practices.

In order to fully deliver on its commitments, the Agency itself must have a competent workforce and an integrated workplan for professional development covering both the science and policy aspects of program delivery.  Thus, the Agency will put in place the necessary measures to:

• move forward on its professional development plan, which will include a formalized governance structure and an implementation strategy, including learning needs analyses, curriculum development and delivery and other supports to learning, including, actively recruiting and developing new staff through a number of programs; and
• recruit and provide professional development of epidemiologists, policy and other analysts and program evaluators who will be supported through an expanded ES Recruitment and Development Program, which will provide collective recruitment and development to support programs across the Agency.

The Canadian Field Epidemiology Program (CFEP), now in its 33rd year, will continue to assign highly qualified staff to work with experienced epidemiologists, in order to broaden their skills. During their two-year training experience, Field Epidemiologists assist all jurisdictions and many institutions with outbreak investigation and control, cluster investigation and control, surveillance, risk assessment, evaluation, and other field epidemiology studies. The CFEP plays a major role in providing emergency public health service and response as these field epidemiologists are available and deployed both nationally and internationally as part of the Agency’s emergency response capacity.

The Agency’s new Canadian Public Health Service Program will hire a variety of public health professionals to address key gaps in provinces, territories, local jurisdictions and other public health organizations, as part of an expanded and strengthened public health work force.  Public Health Officers in this program will directly serve their host organizations, while having the benefit of individualized learning plans supported by the Agency. The Program provides participants the combination of career-positive professional development and field experience in order to help develop the next generation of practitioners. Typical assignments will focus on planning, evaluation, surveillance and the management of diseases, risks to health, and emergency response, including, but not limited to, Avian or Pandemic Influenza.

Knowledge-based Information System

Strengthened public health capacity requires robust knowledge-based information systems to support individuals and organizations in making decisions. Quite simply, it is critical that the collection, collation and distribution of information is meaningful (the right information), timely and efficient. This is one of the cornerstones of the Agency’s effort in strengthening public health capacity. Working with its F/P/T partners, the Agency makes tools, data, knowledge and best practices available to public health practitioners and strives to build consensus on common agreements for information sharing and for issues of mutual interest across jurisdictions.

The Agency’s GIS program is a recognized leader in its field due to its innovative virtual service delivery to public health practitioners. The geographic maps, charts and data available online to practitioners, assist them in fulfilling their public health responsibilities. Over the past several years, the Agency has seen a consistent increase in demand for these services. 

Focus for the RPP Reporting Period

Over the next three years, the Agency will:

• continue to operate and gradually expand its GIS services which will include the continual provision of tools such as the ‘online’ Public Health Map Generator;
• provide data, training and support to a growing community of public health GIS users; and
• plan and undertake necessary groundwork to develop an online training module for GIS users, as part of its commitment to excel.

Stronger public health requires an integrated multifaceted approach to develop, manage and sustain public health information systems. Canada Health Infoway was given a mandate to develop and implement a national surveillance system (Panorama) across all Canadian jurisdictions. The Agency’s Canadian Integrated Public Health Surveillance System (CIPHS) program will continue to support Panorama’s predecessor, the integrated Public Health Information Systems (iPHIS), in jurisdictions which are using it to carry on their relevant public health responsibilities, including public health emergency response. Jurisdictions require ongoing support for the iPHIS system until they can fully adopt and integrate Panorama.

The Agency’s Chief Public Health Officer (CPHO) will publish in 2008 the first annual report on the state of public health in Canada. This report will provide Canadians with a trusted source of information from Canada’s foremost officer responsible for the nation’s public health. Public health policy makers and program managers across Canada will see value in having a national perspective on public health issues.  As part of fulfilling the Agency’s legislated mandate to report to Parliament on the state of public health in Canada, it will establish the ongoing capacity to prepare future reports.

Knowledge about the economic burden of illness in Canada is needed by all levels of government. The Agency will continue to:

• research methods to improve the determination of the burden of illness; and
• provide estimates of the direct and indirect economic burden for the wide range of communicable and chronic diseases that affect Canadians.

The supply of public health information is critical to the success of the Agency.  Key suppliers for some data include Statistics Canada, the Canadian Institute for Health Information and private sector data suppliers. The Data Coordination and Access Program (DCAP) continues to work with these partners to ensure the data available meets the needs of the Agency and that Agency staff have access to critical information, while respecting formal stipulations set by data suppliers.  In 2008-2009 DCAP will continue these critical activities.

The Agency will continue working to strengthen the National Collaborating Centres for Public Health (NCCs).  They carry an overarching mission to “build on existing strengths and create and foster linkages among researchers, the public health community and other stakeholders to ensure the efficiency and effectiveness of Canada’s public health system”. The NCCs:

• facilitate a better understanding of current research and knowledge-based evidence in public health in key areas: aboriginal health, determinants of health, environmental health, healthy public policy, infectious diseases and methods and tools;
• disseminate important information using relevant, easy to use products and tools that can be readily accessed and applied at all levels of the Canadian public health system; and
• connect with public health policy and program specialists, practitioners, governmental and non-governmental groups, academia and researchers across Canada and internationally.

The Agency, with the NCCs’ National Advisory Council, will continue to provide guidance and financial support to the NCCs.

The Agency strives to support its actions through integrated information and knowledge functions.  Effective program delivery hinges on it. The Knowledge Translation Program aims to promote knowledge synthesis, transfer, exchange and application within the Agency and between the Agency and the public health system more generally. In 2008-2009, the program will:

• focus on improving knowledge translation within the Agency through collaboration and working groups;
• conduct internal and external consultations with key national and international organizations; and
• work with other parts of the Agency to develop an overall knowledge translation strategy to meet the knowledge translation strategic objective of the Agency.

Sharing of information during public health emergencies is a critical factor to safeguard the health of Canadians. An F/P/T Memorandum of Understanding (MOU) to this effect was developed by the Pan-Canadian Public Health Network Council. The Agency will continue to support the development and ratification of this MOU and to explore, review and undertake activities to determine the roles, processes and practices for sharing information between jurisdictions.

To support effective use of information systems, the Agency will:

• strengthen its project management services including capacity gap analysis, business analysis and, process mapping; and
• assist programs throughout the Agency in managing cross-cutting projects with internal and external partners.

A key activity in this regard will be to support an Agency-wide integrated surveillance strategy.

Public Health Law and Ethics

All public health authorities are concerned about new and re-emerging infectious and chronic diseases such as SARS, CA-MRSA,1 pandemic influenza, Types 1 and 2 diabetes and MDR-TB2. They remain equally concerned about refining jurisdictional roles and responsibilities and the need to ensure that the most modern legislative tools are available to protect public health. The Agency’s special role is to lead the response to these challenges specifically by enhancing public health preparedness through improving legal and ethical frameworks in collaboration with all relevant stakeholders.

In 2007, Canada’s Health Ministers identified Pan-Canadian collaboration on these issues as critical in meeting this challenge. At the forefront in these efforts, the Agency undertakes and facilitates activities to review, analyze and assess laws and regulations intended to protect health and safety in order to increase awareness and understanding of the law as a public health intervention tool, and the importance of ethics as underpinning effective public health decision-making.

1  Community Acquired Methicillin Resistant Staphylococcus Aureus
2  Multi-Drug Resistant Tuberculosis

Focus for the RPP Reporting Period

In 2008-2009, the Agency will continue to:

• conduct and support applied research in public health law and ethics; and
• organize workshops and meetings to help public health practitioners and policy makers keep current with legislative developments and their impact on public health practice.

Following the ground-breaking success of Canada’s first-ever Canadian Conference on the Public’s Health and the Law in 2006, the Agency will host a follow-up conference in 2009.  This will further support the activities of the Pan-Canadian Public Health Law Improvement Network, whose aim is to share information and assist with analysis in public health law and develop additional public health legal capacity.

Through the Public Health Ethics Working Group, the Agency will:

• continue supporting inter-professional and inter-sectoral linkages in public health ethics; and
• continue building on the success of the First National Roundtable on Public Health Ethics in November 2007, a collaborative effort between Health Canada, the CIHR, provincial and local public health authorities, and academia, and continue to collaborate with its stakeholders to develop tools to support the effective use and support of public health ethics for the public health community.

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