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Analysis Of Program Activities By Strategic Outcome

Strategic Outcome: Accessible and Sustainable Health System Responsive to the Health Needs of Canadians

Under this program activity, we strive to develop effective policy responses to a range of priority, emerging and cross-cutting issues that impact the health of Canadians. There are many governmental and non-governmental organizations working towards improved health outcomes in Canada, including provincial and territorial departments of health, professional organizations, research organizations, the program branches of Health Canada, and the agencies within the federal Health Portfolio. Our objective is to promote the national coordination and development of a strong, shared knowledge base to address health and health care priorities for all Canadians. We also aim to facilitate health system adaptation to changes in technology, society, industry, and the environment, so that Canadians will continue to be protected from heath risks, have access to quality health care, and gain positive health benefits from information and innovation.

Serving as a regulator, a trustee, a partner, an enabler, an innovator, a knowledge broker, and a proponent of transparency, we help support the sustainability of Canada's health system. To Canadians, sustainability means the availability, maintenance and advancement of key attributes of Canada's publicly funded health care system such as accessibility, efficiency and effectiveness. In the face of shifting and growing health system demands, we develop policies to respond to these changes in supporting a sustainable health system for Canadians.

The following program activities help support the Strategic Outcome entitled "Accessible and sustainable health system responsive to the health needs of Canadians":

• Canadian Health System
• Canadian Assisted Human Reproduction
• International Health Affairs

Program Activity - Canadian Health System

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Net expenditures	272.2	306.3	304.9	291.7
FTEs	415	415	414	412
Notes: The increase in forecast/planned expenditures from 2007-08 to 2008-09 is due mainly to the reprofile of funding for the Canadian Strategy for Cancer Control as well as an increase in the funding level for the establishment of the Mental Health Commission and the implementation of the Patient Wait Times Guarantee Pilot Project Fund. The decrease in planned expenditures from 2009-10 to 2010-11 is mainly due to the sunset of the Patient Wait Times Guarantee Pilot Project Fund. Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

Under this program activity, we provide strategic policy advice on health care issues such as improved access, quality and integration of health care services to better meet the health needs of Canadians wherever they live or whatever their financial circumstances. This objective is pursued mindful of long-term equity, sustainability and affordability considerations and in close collaboration with provinces and territories, health professionals, administrators, other key stakeholders, and citizens.

We are achieving this objective by investing in the health system and in health system renewal. This includes: working with provinces and territories to reduce wait times for essential services and ensure that the principles of the Canada Health Act are respected, developing health information and health measures for Canadians, and meeting the health and health access needs of specific groups including women and official language minority communities.

Expected Results

Performance Indicators

Improved health care system planning and performance Enhanced capacity of governments and stakeholders to support health system planning Awareness and understanding among health sector decision-makers and the public of the factors affecting accessibility, quality and sustainability of Canada's health-care system and the health of Canadians

Reports and analyses related to issues such as wait times reduction, health human resources planning, and provision of chronic, palliative and continuing care are used to improve the health care system Governmental and stakeholder engagement activities (e.g. meetings, workshops, conferences, program and policy proposals) Publication of information that raises awareness and understanding of the factors affecting accessibility, quality and sustainability of Canada's health-care system and the health of Canadians

 

Key Program/Service - Health System Renewal

Description: Through this program, Health Canada helps shape policy and programs related to health care renewal that benefit all Canadians through better access to quality health care services. We provide policy leadership on issues related to broader health care system renewal, such as improving access to quality health care, increasing the supply and improving the mix of health care professionals, reforming primary health care and enhancing the accountability of the health care system to Canadians. In the area of Pharmaceuticals Management, we identify the key policy issues, trends and implications with respect to pharmaceuticals access, affordability and equity; safety, effectiveness and appropriate prescribing and utilization, as well as drug prices, and the appropriate role of pharmaceuticals in health care. With provincial and territorial (P/T) partners, we work to advance federal, provincial and territorial (F/P/T) policy and mechanisms for better pharmaceuticals management. In 2008-09, Health Canada will advance federal initiatives and continue to foster the improved management and use of pharmaceuticals in the health care system, in collaboration with P/T governments where appropriate. Health Canada will continue to assist the implementation of Patient Wait Times Guarantees (PWTGs), including a $30 million PWTG Pilot Project Fund to support provinces and territories in the testing, advancement and establishment of PWTGs and facilitate best outcomes for patients through innovation and shared best practices by 2010. There are also four ongoing federal PWTG pilot projects. Three of these projects address diabetes and prenatal care in selected First Nations communities and one addresses wait times for paediatric surgery. Through the Health Human Resources (HHR) Strategy, we are focusing on securing and maintaining a stable and optimal health workforce in Canada and supporting overall health care renewal. Health Canada is working closely with the provinces and territories to develop priority objectives for the Pan-Canadian HHR Strategy for 2008-2013, based on the Action Plan from the Framework for Collaborative Pan-Canadian HHR Planning. For more information on the HHR Strategy, see: http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/index_e.html
Expected Results			Performance Indicators
Pharmaceuticals Management Continued collaboration with P/Ts to develop and actualize shared approaches to pharmaceuticals management policy, including a strengthened F/P/T Common Drug Review Enhanced integration of pharmaceuticals policy analysis, advice and program delivery across the federal Health Portfolio Developmental work towards improving the generation, assessment and dissemination of evidence on the safety and effectiveness of medicines once they reach the market Further development of international linkages to leverage resources and knowledge to enhance ability to optimize domestic pharmaceutical policy Patient Wait Times Guarantees (PWTGs) Identification of policy and operational issues associated with the implementation of guarantees Exchange and adoption of best practices Number of collaborative agreements among health providers Improved patient care pathways Identified access protocols Health Human Resources Strategy Improved jurisdictional capacity to plan for the optimal number, mix and distribution of health care providers based on system design, service delivery models and population health needs Enhanced jurisdictional capacity to work closely with employers and the education system to develop a health workforce that has the skills and competencies to provide safe, high-quality care, work in innovative environments and respond to changing health care system and population health needs Enhanced jurisdictional capacity to achieve the appropriate mix of health providers and deploy them in service delivery models that make full use of their skills Enhanced jurisdictional capacity to build and maintain a sustainable workforce in healthy, safe work environments			Pharmaceuticals Management Scope and effectiveness of F/P/T collaborative pharmaceuticals management activities Identification of best practices for enhanced listing and reimbursement decision-making by public drug plans Number of pharmaceuticals policy and program areas and activities characterized by horizontal, collective and/or collaborative efforts Steps toward establishment of an appropriate instrument for enhanced post-market surveillance of real-world drug safety and effectiveness Increased international engagement measured by the number, type and quality of international dialogues, meetings and conferences Patient Wait Times Guarantees (PWTGs) Degree of increase in the level of awareness among stakeholders of tools and approaches to the establishment of PWTGs Extent to which there is improved collaboration and transfer of knowledge among provinces and territories Changes in the level of awareness and understanding among jurisdictions of policy and operational issues associated with the establishment of PWTGs Health Human Resources Strategy Project dissemination and evaluation Number and type of collaborative networks of policy makers, researchers and other stakeholders Number and type of research reports, databases, tools, and strategies Number of projects on new approaches, models and best practices Increased flexibility of health service delivery models to meet the changing needs of the population
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
181.5	239	180.3	238	167.0	237

 

Key Program/Service - Health Information

Description: Through this activity, Health Canada provides timely research, analysis and information about priority health and health care issues to increase awareness and understanding of the factors affecting the accessibility, quality and sustainability of Canada's health care system and the health of Canadians among health sector decision-makers and the public. We will address two key areas in 2008-09, including: exploring health care cost drivers and researching the expected health impacts of climate change. These activities will provide a sound evidence base to inform decisions and debates on health care policies, performance and programs. We also make health policy research and analysis data available to the larger health research community both inside and outside of government by supporting data collection, accessibility and use.
Expected Results			Performance Indicators
Research and information related to priority health and health care system issues are available			Identification and collection of relevant and timely information on priority health and health care system issues
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
90.1	84	90.0	84	90.0	84

Program Activity - Canadian Assisted Human Reproduction

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Net expenditures	2.2	2.1	2.1	2.1
FTEs	14	13	13	13
Notes: Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

Health Canada is responsible for developing the licensing framework and regulations (laboratory and clinical) that will ensure the health, safety, dignity, and human rights of the Canadians who access the services of the Assisted Human Reproduction (AHR) sector and of the children born from the use of AHR technologies. Because the science of AHR evolves rapidly, we must engage stakeholders on an ongoing basis to find a balance between the needs of patients who use these technologies to help them build their families, the children born from these technologies, and the providers of these services - with health and safety as overriding goals. The goal of these policies and regulations is to develop a responsive regulatory regime that is a leader both domestically and in the international AHR community reflecting the objectives set forth in the AHR Act. We also gather input from stakeholders, including the provinces, to ensure a pan-Canadian approach.

We have completed public consultations on the first series of regulatory initiatives under the AHR Act and are drafting regulations in areas such as licensing administration, requirements for clinical and laboratory activities (i.e., in vitro fertilization procedures using one's own gametes), and health reporting information. These regulations will be pre-published in the Canada Gazette in 2008.

In addition, we will reviewthe Processing and Distribution of Semen for Conception Regulations, presently under the Food and Drugs Act, to incorporate these regulations under the AHR Act. We will continue developing regulatory policy and gathering input from stakeholders on the following issues: the use of donated gametes (semen, ovum and embryos), undertaking preimplantation genetic diagnosis, research, and manipulation of human reproductive materials. We intend to bring the new regulations into force over the next five years.

Expected Results

Performance Indicators

Increased input of Canadian stakeholders on AHR technologies Increased knowledge of the application of AHR procedures in Canada Increased number of AHR regulations to protect the health and safety, dignity, and rights of Canadians using AHR technologies Health and safety risks related to AHR technologies addressed

Stakeholder and advisory panel involvement and engagement of provinces and territories and online consultations Collection of relevant and timely information in AHR practices including, the number of stakeholders in AHR sector and details of their activities Number of proposed regulations related to AHR activities using own gametes published in Canada Gazette, Part I Reports of relevant issues addressed through a number of regulations and other instruments developed to enforce the AHR Act

Program Activity - International Health Affairs

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Net expenditures	29.8	28.7	28.4	28.2
FTEs	80	80	81	80
Notes: Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

Health Canada works internationally through leadership, partnerships and collaboration to fulfill its federal mandate of striving to make Canada's population among the healthiest in the world. The Health Policy Branch serves as the department's focal point to initiate, coordinate and monitor departmental policies, strategies and activities that help promote Canadian priorities and values on the international health agenda. International collaboration on global health issues is important because the health of Canadians is influenced significantly by public health risks originating in other countries. Global issues such as pandemic influenza preparedness, HIV/AIDS strategies and global health security are critical initiatives about which we consult with key external health partners such as the World Health Organization (WHO) and the Pan-American Health Organization (PAHO).

Health Canada will focus on three major activities/programs during fiscal year 2008-09: the Government of Canada's Americas Strategy, the development of a WHO framework and the Global Health Security Initiative.

Health Canada will contribute to the Government of Canada's Americas Strategy by: 1) supporting ongoing governance of PAHO and expanding engagement with other multilateral institutions; 2) encouraging bilateral and trilateral relations with key countries on health policy; and 3) promoting and using Canadian technical expertise to improve health outcomes in the Americas. This will result in a more focussed approach to health by the federal government and its partners in the region by advancing good governance, ensuring economic development and maintaining health security in the hemisphere.

We are also working to provide greater strategic direction on key global health and governance issues involving WHO. We are developing a framework that will provide a common set of principles and priorities for the activities of all Government of Canada departments and agencies and contribute to an effective and coherent Canadian approach to WHO. The framework will be finalized in 2008-09 and will be implemented thereafter.

The Global Health Security Initiative (GHSI) is an informal, international partnership to strengthen global public health preparedness and response to chemical, biological, radiological, and nuclear (CBRN) threats, as well as pandemic influenza. Member countries/organizations include the G7 countries, Mexico, the European Commission, and the WHO as a technical advisor. Health Canada leads the GHSI and plays an active role within the Initiative. In 2008-09, Health Canada will work with GHSI members to strengthen networks that: 1) facilitate improved preparedness and response to CBRN threats and pandemic influenza; and 2) increase dialogue and exchange on emerging health security issues to allow for cross-national learning.

Expected Results	Performance Indicators
Enhance knowledge base and intersectoral collaboration on global health issues Influencing the global health agenda for the benefit of Canadians Global health policies for the benefit of Canadians	Short term Program Evaluation results Number of resolutions passed at multilateral organizations Number of multilateral fora in which Health Canada participates Number of foreign delegations hosted Relevant policy advice, papers and positions

Strategic Outcome: Access to Safe and Effective Health Products and Food and Information for Healthy Choices

Under this strategic outcome, Health Canada is committed to promoting and protecting the health and safety of Canadians. The Department achieves this outcome by continuing to work towards reducing health risks to Canadians from health products and food and providing information so that Canadians can make informed decisions and adopt healthy choices.

In 2008-09, the key activities that will contribute towards achieving results under this strategic outcome are mainly outlined in the Blueprint for Renewal II1 policy framework and Canada's Food and Consumer Safety Action Plan2 as announced in December 2007. The action plan reflects the need to modernize the health products and food's regulatory system. As part of its Comprehensive Review of resources and programs, Health Canada will determine the level of activities as well as resources the programs need to meet the Department's regulatory responsibilities, including the need for baselines, performance indicators and targets and program costs.

Scientific and technical expertise are of critical importance to the activities of this strategic outcome. They are used on a daily basis for policy development, the evaluation of health products and foods, risk assessments, compliance testing, and nutrition and contaminant surveillance to research on food pathogens and pharmacogenomics. We carry out research in support of regulatory activities and related activities that contribute to evidence-based decision making to protect the health and safety of Canadians.

As part of our new initiatives, we are preparing the first-ever comprehensive strategic science plan for health products and food. This plan includes the identification of current scientific practice, changes in the key methods for the generation and analysis of evidence, and the evolution of science and technology as it affects the nature of the products that fall within the health products and food mandate. The plan will guide our future work and support us in building science partnerships across the Health Portfolio and with the national and international community.

We anticipate that over the next three to five years, there will be major pressures on our science and operational infrastructure, and that we will need to adapt our practices as operational needs and related applied science changes. For example, nanotechnology is adding a new dimension to our fundamental understanding of the physical nature of the world around us. Maintaining and modernizing regulatory and analytical tools, process and practices also continue to drive our investment requirements. Strategies and frameworks to address infrastructure challenges are being developed and will serve as the basis for planning, investment, engagement, partnership, consultation, and communication.

Assessing and understanding the current and future human resources needs is key to ensure the right mix of skills and expertise is in place to deliver on our priorities. As we move forward, we will need to address the challenges in attracting and retaining highly qualified talent resulting from a highly competitive demand-driven environment. In addition, the potential retirement of 21% of the Health Products and Food Branch workforce within the next five years requires an aggressive strategy to address succession management, learning development and knowledge transfer to ensure management stability across the organization. We will implement succession planning strategies and knowledge transfer initiatives that are aligned with our business needs.

Health Canada will implement its Consumer Information Strategy and the Policy on Public Input in the review of regulated products to improve the way the department communicates information to consumers and to increase openness, transparency and accountability, thereby maintaining public confidence in the regulatory system for health products. As part of the Blueprint for Renewal II, Health Canada will conduct strategic outreach and consultations to increase consumer product safety. The department will collaborate with stakeholders and the public to seek input on product review, policy programming and legislative and regulatory proposals that will enhance the overall quality of decision-making and improve the safety of products for Canadians.

Health Canada is working with federal science and technology partners to promote and protect the health and safety of Canadians. Some of our work includes collaborating directly with Agriculture and Agri-food Canada (AAFC), Environment Canada (EC), the Public Health Agency of Canada (PHAC), and the Canadian Food Inspection Agency (CFIA).

Health Canada's regional offices develop and deliver key programs and services, including monitoring the risks of health products and the safety of food, and the investigation and inspection associated with the import, sale and manufacture of health products. They work with regional stakeholders and provincial and municipal governments to promote collaboration, participate in the monitoring of adverse reactions and assist in developing policy responses in areas including: food safety, nutrition, natural health products, antimicrobial resistance, and the efficacy of health products. As part of the national laboratory network, Health Canada's regional laboratories are key contributors to our work of developing and managing food safety research and surveillance projects on foodborne pathogens, persistent organic pollutants, natural toxins, genetically modified food, food allergen detection, and nutrition.

Internationally, Health Canada is working with the World Health Organization (WHO), other multilateral organizations and other governments on health products and food safety issues to strengthen and promote broader regulatory cooperation and encourage technical information exchange. Our partnerships enable Health Canada to ensure that its efforts meet the needs of all Canadians.  

The following program activities help support the Health Products and Food's Strategic Outcome:

• Health Products
• Food and Nutrition

Program Activity - Health Products

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Gross expenditures Less: Expected respendable revenues	266.7 39.9	226.3 39.9	224.0 39.9	220.7 39.9
Net expenditures	226.8	186.5	184.1	180.9
FTEs	2,211	2,038	2,021	2,007
Notes: The decrease in forecast/planned expenditures from 2007-08 to 2008-09 is due in part to one-year funding received in 2007-08 for Natural Health Products, funding from the Department's operational budget carry-forward and a decrease in the funding level for the Therapeutic Access Strategy. The decrease in planned expenditures from 2008-09 to 2009-10 is mainly due to the sunset of Health Canada's Response to Bovine Spongiform Encephalopathy. The decrease is partially offset by an increase in the funding level for Protecting Canadians and the Environment from Toxic Substances through a Chemicals Management Plan. Figures for 2007-08 have been restated due to the change in the Program Activity Architecture for 2008-09. Figures include an amount for other departmental and regional infrastructure costs supporting program delivery.

The Health Products program activity is responsible for a broad range of health protection and promotion activities that affect the everyday lives of Canadians. As the federal authority responsible for the regulation of health products, the program activity evaluates and monitors the safety, quality

and effectiveness of drugs (human and animal), biologics, medical devices, and natural health products, under the authority of the Food and Drugs Act and Regulations, as well as the Department of Health Act.

The program activity also provides timely, evidence-based and authoritative information to key stakeholders (including but not limited to: health care professionals such as physicians, pharmacists and practitioners such as herbalists, naturopathic doctors, Traditional Chinese Medicine (TCM) practitioners) and members of the public to enable them to make informed decisions and healthy choices.

In its November 2006 report3, the Auditor General of Canada has identified a number of gaps in the regulatory system and questioned whether Health Canada has adequate tools and resources to fulfill its regulatory responsibilities and protect the health and safety of Canadians.

Although the current regulatory system has served Canadians well over the past decades, it needs to be modernized to address emerging health and safety risks, help ensure timely access to innovative health products, and reduce adverse effects. Pharmaceuticals, non-prescription medicines, vaccines, blood products, gene therapies, tissues, and medical devices all offer benefits to Canadians, but they also carry risks. Today, most of our efforts are spent on pre-market assessment. As part of Canada's Food and Consumer Safety Action Plan, a new legislation is being considered to better protect Canadians from unsafe health products by:

• Taking a life-cycle approach to regulation by keeping watch and gathering information on products like pharmaceuticals both before and after they are approved for sale. This would allow the most rapid action possible to address the health risks of products that don't come to light until they are on the market;
• Gaining new authorities to order needed changes to health product labels to provide product information to consumers and recall health products as soon as a safety problem is identified; as well as to compel manufacturing to conduct post-market studies and issue risk communication;
• In cooperation with provinces and territories, acquiring the power to make it mandatory for hospitals to report on serious adverse drug reactions, so dangers can be identified more effectively to inform corrective action as early as possible; and
• Raising fines to levels comparable with other industrial countries.

These measures under the new legislation will help Health Canada address some of our regulatory gaps. In addition, Health Canada will work on the next phases of the Blueprint initiatives, which will be guided by recommendations that resulted from stakeholder consultations. More of what will be accomplished in 2008-09 is described in the key programs below.

Expected Results	Performance Indicators
Increased regulatory system response to health product-related health risks Increased awareness and/or knowledge of health products issues	Timeliness and appropriateness of regulatory actions (recalls, health advisories) for approved health products Proportion of incidents/investigations (by type) addressed/closed Number and type of publications disseminated and used by the public to make informed decisions

 

Key Program/Service - Pharmaceutical Human Drugs

Description: The Pharmaceutical Human Drugs program is significant in supporting the strategic outcome and the program activity for health products. This key program regulates pharmaceutical drugs for human use under the authority of the Food and Drugs Act and Regulations. Prior to receiving market authorization, a manufacturer must present substantive scientific evidence of a product's safety, effectiveness and quality as required by the Food and Drug Regulations. Drug products regulated include prescription and non-prescription pharmaceuticals, disinfectants and sanitizers with disinfectant claims. The key program also provides key stakeholders and members of the public with timely, evidence-based and authoritative information to make informed decisions and healthy choices. It is under this key program that we will accomplish work related to the modernization of the regulatory framework for pharmaceuticals and biologics (Progressive Licensing), which aims to address emerging health risks related to human drugs. This new modernized framework will support the strategic outcome by contributing to timely access to innovative drugs and mechanisms to address safety risks. In addition, counterfeit health products have become a significant problem in many developing countries and have been identified as an emerging issue for many developed countries. Recent incidents have revealed the presence of counterfeit health products in the Canadian supply chain. In 2008-09, Health Canada will establish an Anti-Counterfeiting Approach for Health Products that will focus on compliance verification and investigation, compliance monitoring, and laboratory analysis. The approach will also outline an education function for Health Canada, promote partnerships and encourage the use of emerging technology. As part of this approach, we will develop tools and regulations that will address many of the risks posed by counterfeit health products. Since the coming into force of Division 5 of the Food and Drug Regulations, "Drugs For Clinical Trials Involving Human Subjects" in September 2001, the number of compliance verifications related to clinical trials has augmented moderately. However, Canada is not meeting the internationally comparable best practice target for inspections of 2% of sites annually. In 2008-09, Health Canada plans to carry out approximately 80 inspections of clinical trials to meet this benchmark.
Expected Results			Performance Indicators
Improved Health Canada's ability to conduct ongoing evaluation of drugs over the product's life-cycle Updated counterfeit strategy that is based on sound science and risk management Achievement of international benchmark of 2% of all clinical trials inspections conducted annually  Collect more and better information on the safety of health products that are on the market			Extent to which legislation, regulations and new guidances are published in Canada Gazette II and implemented Number and type of new tools and regulations developed (to address counterfeit-related risks) Number of clinical trials inspections conducted annually Number of adverse reaction reports received
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
61.6	673.3	60.8	667.7	59.8	663.0
Total net of revenue in the amount of $27.4M

 

Key Program/Service - Medical Devices

Description: The Medical Devices program sub-activity regulates medical devices for human use. Prior to being given market authorization, a manufacturer must present substantive scientific evidence of a medical device's safety, effectiveness and quality as required by the Medical Devices Regulations. Medical devices cover a wide range of health or medical instruments used in the treatment, mitigation, diagnosis, or prevention of a disease or abnormal physical conditions. The program sub-activity also provides key stakeholders and members of the public with timely, evidence-based and authoritative information to make informed decisions and healthy choices. Post-market surveillance for medical devices is a key element contributing to safe and effective medical devices by Canadians. The 2004 Office of the Auditor General's Report4 revealed major gaps in the medical device program, noting the need to take strong action against unapproved devices on the market, as well as the need for an effective inspection program. In response to the report, Health Canada has started to implement an inspection program for medical device establishment licence holders. In order to achieve the desired inspection cycle of 3 years as per the Medical Devices Regulations, Health Canada sets a target every year to conduct a certain amount of medical devices inspections. The targeted number for 2008-09 is to conduct an estimated 211 Medical Devices Establishment inspections, which will help reduce the inspection cycle to 7 years by March 2009. The Cost-Recovery Initiative which will be implemented in 2008-09 will be a key contributor to supporting the hiring of qualified personnel to increase the number of inspections conducted for medical devices.
Expected Results			Performance Indicators
Increased rate of compliance by industry with the Medical Devices Regulations Reduction of the inspection cycle of medical devices to 7 years by March 2009			Percentage of non-compliance observations by regulations type Number of medical devices inspections conducted annually
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
27.2	297.0	26.8	294.5	26.4	292.5
Total net of revenue in the amount of $7.6M

 

Program Activity - Food and Nutrition

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Gross expenditures Less: Expected respendable revenues	84.7 1.3	79.3 1.3	77.6 1.3	77.4 1.3
Net expenditures	83.4	77.9	76.3	76.0
FTEs	699	706	695	692
Notes: The decrease in forecast/planned expenditures from 2007-08 to 2008-09 is mainly due to the sunset of the Agriculture Policy Framework. The decrease in planned expenditures from 2008-09 to 2009-10 is mainly due to the sunset of Health Canada's Response to Bovine Spongiform Encephalopathy. Figures for 2007-08 have been restated due to the change in the Program Activity Architecture for 2008-09. Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

Planned Spending and Full-Time Equivalents (FTEs)

The Food and Nutrition program activity establishes policies, regulations and standards related to the safety and nutritional quality of food. Food safety standards-quality are enforced by the Canadian Food Inspection Agency (CFIA). The legislative framework for food is found in the Food and Drugs Act and Regulations, the Canadian Food Inspection Agency Act and the Department of Health Act.

The program activity also promotes the nutritional health and well-being of Canadians by collaboratively defining, promoting and implementing evidence-based nutrition policies and standards. As the focal point and authoritative source for nutrition and healthy eating policy and promotion, the program activity disseminates timely, evidence-based and authoritative information to Canadians and stakeholders to enable them to make informed decisions and healthy choices.

Health Canada's activities to strengthen food safety are key parts of Canada's Food and Consumer Safety Action Plan. As part of the action plan, Health Canada will modernize its food safety system through an integrated and proactive approach. Health Canada will conduct legislative amendments to the Food and Drugs Act, which would help streamline and provide more consistent regulatory tools across all sectors and better position Health Canada to achieve its food safety mandate.

More specifically, Health Canada addresses the mitigation of risks to human health associated with foods that contain environmental contaminants (e.g. mercury in fish), chemicals resulting from food processing (e.g. furan and acrylamide in food), chemicals resulting from industrial (e.g. heavy metals, Persistent Organic Pollutants (POPs), and agricultural (veterinary drugs and pesticides) uses. Health Canada identifies and assesses potentially harmful health effects of these contaminants and determines appropriate ways for Canadians to reduce their exposure to them, while at the same time considering the benefits of consuming particular foods that may contain such contaminants.

In the area of nutrition, controlling the addition of vitamins and minerals to our foods (a process known as fortification) is one way that Health Canada ensures that Canadians receive the nutrients they need but are not exposed to levels that are dangerously high. With the increasing marketing of certain newly fortified foods (beverages) and highly fortified foods in other jurisdictions, Health Canada has an obligation to ensure the safety and safe use of some of these products. Currently, other jurisdictions such as Australia and New Zealand, and the Commission of European Communities, are in the process of developing policies on voluntary fortification of foods.

Healthy eating plays a vital role in promoting health and reducing the risk of obesity and other nutrition-related chronic diseases. Changes in social and physical environments are resulting in increasingly complex and influential forces affecting the eating practices of Canadians. Activities to advance knowledge about what Canadians are eating, the determinants of eating behaviour and effective strategies to promote healthy eating are essential to the development of meaningful and effective policies and programs to improve the nutritional health and well-being of Canadians.

To address some of these pressures, Health Canada plans to put in place a number of initiatives and measures, which are described in key programs below.

Expected Results	Performance Indicators
Reduction of the exposure to disease-causing food- borne micro-organisms and environmental agrochemical contaminants, food allergens  Increased level of informed choices/healthy decisions related to food quality and food safety	Incidence rate of illness/diseases related to food products Number of educational documents published (i.e., Codes of Practice, policies, Internet postings)

 

Key Program/Service - Food Borne Pathogens

Description: The Foodborne Pathogens program sub-activity regulates the mitigation of risks to human health associated with emerging (new and re-emerging) pathogens along the food chain, as required under the Food and Drug Regulations. The program sub-activity contributes to the reduction of human exposure to disease-causing, foodborne microorganisms, thereby lowering the incidence of foodborne illnesses in Canada. The program sub-activity is responsible for the investigation of the prevalence of pathogens and the associated risks in food, and for the communication of appropriate intervention strategies. It also provides timely, evidence-based and authoritative information to Canadians and stakeholders about the risks of pathogens in food to enable them to make informed decisions and healthy choices. Complete control of foodborne pathogens is very difficult as microorganisms may be introduced to foods at all stages of the food chain and may survive food processing. In addition, foods may become contaminated later during preparation, cooking and storage. Health Canada has the responsibility for developing appropriate intervention strategies to combat disease-causing foodborne micro-organisms in all food consumed in Canada. Reducing the exposure to foodborne microorganisms will result in lowering the incidence of foodborne illnesses in Canada. Health Canada will undertake extensive communication/education efforts to increase the awareness and knowledge of consumers6. In addition, the Department will improve its science-based advice, guidelines, policies, and regulations to contribute to improved food production and handling practices. In 2008-09, we will conduct education campaigns for raw meat, poultry and unpasteurized juice, complete and implement regulations for safe handling and labelling of raw ground meat, develop policy and regulatory proposals for unpasteurized juice, conduct a research project to address current knowledge gaps in E. coli in produce and launch a consumer communication campaign as a joint produce package and include information on leafy greens, sprouts, unpasteurized juices, and other fresh fruits and vegetables.
Expected Results			Performance Indicators
Increased consumer awareness and knowledge of proper ways to combat disease-causing foodborne micro-organisms Enhance food production and handling practices to reduce exposure to disease-causing foodborne micro-organisms			Consumer campaigns conducted for raw meat, poultry and unpasteurized juice Complete and implement regulations for safe handling and labelling of raw ground meat
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
16.1	146.2	15.8	143.9	15.7	143.3

 

Key Program/Service - Food Borne Chemical Contaminants

Description: The Foodborne Chemical Contaminants program sub-activity regulates the mitigation of risks to human health associated with foods that contain environmental contaminants and chemicals resulting from industrial and agricultural uses; mitigation of human health effects associated with food allergies in vulnerable populations; identification, assessment, and determination of harmful health effects associated with food-borne natural toxicants and the development of intervention strategies to limit human exposure to these chemicals; and identification, assessment and mitigation of risks to human health associated with chemicals resulting from food processing operations, including intentional additives, packaging, and incidental formation induced by heating, fermentation, and irradiation, as required under the Food and Drug Regulations. The program sub-activity is responsible for the investigation of the prevalence of chemical contaminants in foods available for sale in Canada and the associated risks in food, and for the communication of appropriate intervention strategies. The program sub-activity also provides timely, evidence-based and authoritative information to Canadians and stakeholders about the risks of chemical contaminants in food to enable them to make informed decisions and healthy choices. Health Canada also identifies and assesses the potentially harmful health effects of a number of food borne chemical contaminants and determines appropriate ways for Canadians to reduce their exposure to them. In 2008-09, Health Canada will implement a risk communication plan on risks to mercury in fish and benefits of fish consumption (target population at risk: women of child-bearing age and young children); develop an integrated Food Chemical Surveillance plan through Health Canada's Food Chemical Safety Laboratory Network; generate, publish and provide guidance on data resulting from its food chemical surveillance activities, for example vis-à-vis the occurrence of recently reported chemicals in foods (e.g. furan, acrylamide in foods available in Canada).
Expected Results			Performance Indicators
Limited exposure of Canadians to selected chemicals in food			Mercury Risk communication strategy: Number of publications/communications written by Health Canada Number of new standards limiting the occurrence of chemicals in food sold in Canada Number of publications related to Health Canada's food chemical surveillance activities and associated actions taken (standard setting, risk assessment/management)
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
33.6	304.8	32.9	300.0	32.8	298.7

 

Key Program/Service - Novel Foods

Description: The Novel Foods program sub-activity assesses the safety of all genetically-modified and other novel foods proposed for sale in Canada. Before such foods can be sold in Canada, companies must submit detailed scientific data for review and approval, as required under the Food and Drug Regulations. Novel foods are foods resulting from a process not previously used for food products that do not have a history of safe use as a food and foods that have been modified by genetic manipulation, also known as genetically modified (GM) foods, genetically engineered foods or biotechnology-derived foods. The program sub-activity also provides timely, evidence-based and authoritative information to Canadians and stakeholders on the safety of novel foods to enable them to make informed decisions and healthy choices. Health Canada will improve the transparency and process for review of pre-market submission for novel foods7. Activities related to this commitment, will improve the predictability, credibility and consistency of Health Canada's approach to the regulation and safety assessment of novel foods. In 2008-09, we will implement quality management practices, and develop standard operating procedures for novelty determination.
Expected Results			Performance Indicators
Improved transparency and process for review of pre-market submissions for novel foods			Number and type of quality management practices implemented and standard operating procedures produced for novelty determination.
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
4.9	44.6	4.8	43.9	4.8	43.7

 

Key Program/Service - Nutrition

Description: The Nutrition program sub-activity promotes the nutritional health and well-being of Canadians by collaboratively defining, promoting and implementing evidence-based nutrition policies and standards. The program sub-activity maintains and improves the nutritional quality and safety of the food supply to help ensure that it meets the needs of the general population; ensures that infant formula and foods for special medical purposes (e.g. formulated liquid diets) are safe and nutritionally adequate for their indicated uses; and establishes requirements and guidelines for factual, consistent, and understandable information on food labels about the nutrient content of food. In addition, the program sub-activity ensures that nutrition claims and health claims are consistent, not misleading or deceptive, and based on recognized health and scientific criteria. The program sub-activity ensures, to the extent possible, that products promoted by these claims are safe and nutritious. The program sub-activity also makes available information about the nutrient composition of food to Canadians and stakeholders to enable them to make informed decisions and healthy choices. In 2008-09, Health Canada will continue with the monitoring of the trans fat levels of prepackaged and restaurant foods. The results of this assessment will be used to develop strategies to reduce the presence of trans fatty acids8 in Canadian diets to the lowest possible levels, consistent with the recommendations of the Trans Fat Task Force. Also in 2008-09, Health Canada will put in place a working group to oversee a strategy for reducing sodium intake; establish clear and consistent policies for health claims, including aligned policies for the management of the food/natural health product interface; and conduct consumer research to find out about consumers' perceptions of foods that carry health claims and the benefits that these foods might provide. Health Canada will also continue work to provide for safe levels of nutrient intakes for Canadians in the context of the whole diet, and ensure an appropriate level of health protection. This will be accomplished through the development of policy decisions and regulations on fortification for restoration, mandatory fortification, discretionary addition of vitamins and minerals to foods, and for special purpose foods, while broadening the number of fortified food products. In 2008-09, we will publish regulatory amendments in Canada Gazette, Part I; develop proposals for a regulatory amendment; develop a contract with the US Institute of Medicine, and the National Academies of Science, to launch a review of Vitamin D, and continue the work of the new Government of Canada federal steering committee on Dietary Reference Intakes (DRI). In 2008-09, Health Canada will work with Canadian and U.S. federal government partners, and the United States' Food and Nutrition Board of the Institute of Medicine (FNB/IOM) to contribute to the refinement of the framework for the next review of the Dietary Reference Intakes (DRIs), which form the scientific basis for the development of national nutrition policies and standards. Health Canada will develop a contract with the IOM to launch a review of Vitamin D and related nutrients. We will also publish and disseminate revised recommendations on nutrition and healthy eating during pregnancy9. To help build research capacity and inform nutrition policies, we will release a report on vegetable and fruit consumption, and the third Volume of summary data tables on Nutrient Intakes from Food, both based on the Canadian Community Health Survey 2.2, Nutrition Focus8. To assist Canadians to make informed food choices, nutrition labelling10 information will be included in healthy eating awareness initiatives and will continue to be profiled through distribution of the revised Food Guide11.
Expected Results			Performance Indicators
Reduced presence of trans fatty acids in Canadian diets to the lowest possible levels: Limit the trans fat content of vegetable oils and soft, spreadable margarines to 2% of the total fat content; and limit the trans fat content for all other foods to 5% of the total fat content, including ingredients sold to restaurants Increased consumer confidence in the nutrition claims and health claims Amended Food and Drug Regulations including provisions for the discretionary fortification of foods Increased level of awareness, knowledge and informed choices/healthy decisions related to nutrition and healthy eating Strategy on sodium intake reduction developed Improved transparency and process for review			Percentage of stakeholders who are aware of trans fatty acids Number of foods or food groups falling below recommended limits Percentage of Canadians who are confident in nutrition claims and health claims Number and type of regulations and policies developed and published Percentage of stakeholders who have used information to make healthy food choices Percentage of stakeholders who are knowledgeable about nutrition and information to make healthy food choices Number and type of reports, information (e.g. educational tools and research publications produced and disseminated) Working group on sodium intake established Number and type of quality management practices implemented and standard operating procedures produced for novelty determination
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
23.2	210.5	22.7	207.2	22.7	206.3

Endnotes

1.Blueprint for Renewal policy framework
http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/hpfb-dgpsa/blueprint-plan/blueprint-plan_ll_intro_e.html

2.The Government of Canada's Food and Consumer Safety Action Plan
http://healthycanadians.ca/pr-rp/plan_e.html

3.The Auditor General Report of November 2006 - Chapter 8
http://www.cbc.ca/news/background/auditorgeneral/report200611.html

4.The Auditor General Report of 2004
http://www.oag-bvg.gc.ca/domino/reports.nsf/html/20040302ce.html

5.Cabinet Directive on Streamlining Regulation
http://www.regulation.gc.ca/cdsr-dcrr_e.pdf

6.Food-related health advisories, warnings and other food safety information
http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2007/2007_08_e.html
http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2007/2007_58_e.html
http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2007/2007_142_e.html 
http://www.hc-sc.gc.ca/fn-an/securit/handl-manipul/index_e.html

7.Novel foods (or also known as Genetically Modified Foods)
http://www.hc-sc.gc.ca/fn-an/gmf-agm/index_e.html
http://www.hc-sc.gc.ca/fn-an/gmf-agm/appro/index_e.html
http://www.hc-sc.gc.ca/fn-an/legislation/acts-lois/index_e.html

8.The Canadian Community Health Survey 2.2, Nutrition Focus
http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/index_e.html

9.Nutrition and healthy eating during pregnancy
http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/index_e.html

10.Nutrition labelling
http://www.hc-sc.gc.ca/fn-an/label-etiquet/index_e.html

11.Food Guide
http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index_e.html

Strategic Outcome: Reduced Health and Environmental Risks from Products and Substances, and Healthy, Sustainable Living and Working Environments

Program activities touch many aspects of Canadians' daily lives. These include: drinking water safety; air quality; chemicals in the workplace and the environment; substance use and abuse; tobacco and secondhand smoke; consumer product safety (including cosmetics); radiation exposure; workplace health; and, pest control products. Other health and safety related activities include: the Government's public safety and anti-terrorism initiative; chemical and nuclear emergency preparedness; inspection of food and potable water for the travelling public; and, health contingency planning for visiting dignitaries. Much of this work is governed through legislation including the Canadian Environmental Protection Act (CEPA), the Controlled Drugs and Substances Act, the Hazardous Products Act, the Tobacco Act, the Food and Drugs Act, the Radiation Emitting Devices Act, the Quarantine Act, the Pest Control Products Act, and others.

Health Canada will continue to advance science and use strong evidence-based research to formulate our healthy and safe living promotion and harm prevention programs, policies and regulations. Our experts work closely with colleagues in the federal government and beyond (e.g. academia) in the areas of both research and development and related scientific activities. Anticipatory, applied and novel research provide the evidence of emerging health issues through investigations along the continuum from exposure and hazard assessment, to mechanism of action and population studies, to contribute to the design and implementation of policies, regulations and legislation, as well as to decision making, aiming at protecting the health and safety of Canadians. In our role as a regulator, we extend our scientific research by contributing to the generation, dissemination and application of scientific and technological knowledge, including the assessment of products and processes for the purpose of regulation, as well as surveillance, testing and collection of information. In addition to our internal activities related to scientific research, health surveillance and foresight in the safe use of emerging and merging technologies (such as biotechnology and nanotechnology), we will also use the science conducted by external organizations to help identify risks to human health, and assess and manage these risks.

In response to the 2006 report of the Auditor General, a Comprehensive Review of programs was launched to determine the full costs of regulatory programs and identify opportunities to improve management and efficiency. An integrated change strategy will detail the actions to be undertaken immediately and over the coming years to address any gaps, risks, opportunities, and challenges identified by the Review. The findings of the Review will also be leveraged to support the development of an Integrated Planning and Reporting Strategy that will bring together planning tools and software, finances, risks, results, and performance indicators to improve business intelligence for management decision making and provide greater rigour, structure and integration to planning and accountability.

Activities within this strategic outcome require sustained partnerships with other federal government departments as well as provinces and territories, non-governmental organizations, academia, and the international community. We work closely, for example, with all branches of Health Canada as well as Environment Canada, Natural Resources Canada, the Public Health Agency of Canada, the Canadian Institute for Health Information, and others on health and environment issues. Through the Government's National Anti-drug Strategy aimed at tackling illegal drug use and associated crime, we are working with Justice Canada, Public Safety Canada, the Royal Canadian Mounted Police, and the Canada Border Services Agency. We are also engaged in the Government's public safety and anti-terrorism initiatives. In addition, we collaborate with provinces and territories through various committees to develop guidelines on issues such as tobacco cessation and safe drinking water, and to coordinate nuclear emergency preparedness activities. Our work with international partners allows us to better respond to domestic health and safety issues, meet our obligations and commitments, share best practices, and promote Canadian leadership globally.

The contributions of Health Canada's regional offices are integral to program delivery. They include: playing a leadership role on key national initiatives; conducting inspection, surveillance and educational activities related to consumer products, tobacco, controlled drugs and substances; conducting risk assessments and evaluations; and providing health advice to federal employees, provinces and municipalities related to chemical contaminants and exposure levels, and work environments.

The following program activities help support the Strategic Outcome:

• Sustainable Environmental Health
• Consumer Products
• Workplace Health
• Substance Use and Abuse
• Pesticide Regulation

Program Activity - Sustainable Environmental Health

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Gross expenditures	152.1	166.8	181.3	179.0
Less: Expected respendable revenues	1.4	1.4	1.4	1.4
Net expenditures	150.7	165.4	179.9	177.6
FTEs	966	1,056	1,092	1,071
Notes: The increase in forecast/planned expenditures from 2007-08 to 2008-09 is due mainly to an increase in the funding level for protecting Canadians and the environment from toxic substances through the Chemicals Management Plan. The increase in planned expenditures from 2008-09 to 2009-10 is due mainly to an increase in the funding level for the Chemicals Management Plan and for the implementation of the Clean Air Regulatory Agenda. Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

The environment continues to be a key determinant of health for all Canadians. This program activity promotes and protects the health of Canadians, including vulnerable populations such as children, by identifying, assessing and managing health risks posed by environmental factors in living, working and recreational environments. The scope of activities includes: research on drinking water quality, air quality, contaminated sites, toxicology and climate change; clean air programming and regulatory activities; risk assessment and management of environmental contaminants, including new and existing chemical substances, environmental noise, environmental electromagnetic frequencies, products of biotechnology and products of other new and emerging technologies (including nanotechnology); solar ultraviolet radiation; preparedness for nuclear and environmental disasters as well as working with the passenger conveyance industry to protect the travelling public.

The Canadian Environmental Protection Act,1999, in concert with other federal statutes such as the Hazardous Products Act, the Food and Drugs Act, and the Pest Control Products Act, provide assessment and protection regimes for a variety of substances and products. Under the New Substances Notification Regulations of CEPA, 1999, new substances undergo a rigorous health and environmental risk assessment before they can be used in Canada. Under the Chemicals Management Plan, Health Canada and Environment Canada have used the results of the categorization of the 23,000 existing substances in Canada as of the mid-1980s to determine priority chemicals for assessment and then management of the risks associated with those substances deemed to pose a possible risk to human health and the environment. Other activities include: implementing a national bio-monitoring system; developing risk management performance agreements with industry sectors; and, strengthening the assessment and management of environmental health risks, including those posed by pharmaceuticals, personal care products, cosmetics, and food. Finally, enhanced communications and outreach activities allow Canadians to make better informed decisions about limiting their exposure to potential environmental hazards.

Expected Results	Performance Indicators
Timely regulatory system response to new and emerging health risks related to toxic chemicals and environmental risks to health New and emerging health risks related to toxic chemical substances are identified, assessed and managed Canadians are knowledgeable and aware of environmental health issues	Proportion of regulatory activities addressed within service standards/target Time period within which serious health risks are brought into a risk management regime % of target population aware of environmental health issues

Key Program/Service - Air Quality

Description: Under the 2007 Regulatory Framework for Air Emissions, Health Canada supports and improves risk management actions to address both indoor and outdoor air quality risks to health. Using valuation tools and strategies, the health impacts of proposed regulatory options will be evaluated. Health Canada and Environment Canada will establish air quality objectives for particulate matter and ozone, two important constituents of smog. The Air Quality Health Index will also be introduced to help Canadians make informed decisions about reducing their health risks. In addition, Health Canada will develop indoor air guidelines, awareness and prevention programs, and source product regulations to reduce exposure to indoor contaminants. Health Canada will also build awareness related to radon in indoor air.
Expected Results			Performance Indicators
Risk assessments leading to improved risk management strategies to reduce overall human exposure to air pollutants Increased public awareness of the impacts of reduced indoor and outdoor air pollution and the protective measures that can be taken			Number of assessments and strategies in support of regulations, standards, and practices Application of the Air Quality Benefits Assessment Tool to estimate health benefits of air pollution reductions % of target population that have access to the Air Quality Health Index
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
50.9	242	51.2	248	51.9	251

 

Key Program/Service - Water Quality

Description: Health Canada provides leadership and scientific expertise to better protect human health against health risks from drinking and recreational water. For 2008-09, up to 5 Guidelines for Canadian Drinking Water Quality will be developed and submitted for approval through the federal, provincial and territorial (F/P/T) process. The new edition of the Guidelines for Canadian Recreational Water Quality will be posted for consultation, and the Guidelines for Household Reclaimed Water are expected to be finalized and published. Health Canada will continue to work with partners to prioritize and develop strategies to improve the safety of small community drinking water supplies.
Expected Results			Performance Indicators
F/P/T policies incorporate health-based requirements for drinking and recreational water quality to reduce risks to the health of Canadians Provinces adopt a common set of strategies to address current gaps specific to small drinking water systems, leading to improved drinking water quality, particularly in rural and remote communities			Number of Guidelines for Canadian Drinking Water Quality approved by F/P/T committees Successful completion of pilot projects or strategies to address current gaps specific to small systems
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
23.7	154	23.2	151	23.1	149

 

Key Program/Service - Chemical Management

Description: The Chemicals Management Plan will enable Health Canada and Environment Canada to protect the health of Canadians and the environment from risks associated with chemical substances. The chemical substances will be assessed over a three year time frame and, every three months, batches of 15 to 30 chemical assessments will be released to industry and stakeholder groups for a 6-month comment period. Health Canada and Environment Canada will integrate chemical substances activities across federal laws and significantly strengthen and accelerate the risk assessment and risk management of new and existing substances. The monitoring, research, and reporting needed to measure the success of Health Canada and Environment Canada in protecting Canadians' health and the environment from risks due to chemical substances will be established. In addition, Health Canada and Environment Canada will work with stakeholders to develop and implement a regulatory framework that will provide for appropriate environmental assessments of substances found in commodities regulated under the Food and Drugs Act.
Expected Results			Performance Indicators
Increase level of Canadian public awareness of chemical management issues and actions being taken Risk assessments are conducted and risk management objectives are met for regulations and other control instruments for substances and the products of biotechnology Declining trends in levels of risk, adverse reactions, illnesses, and injuries from toxic chemical substances in the environment and their use and/or the risk of exposure to Canadians Enhanced knowledge of environmental hazards and evidence on which regulatory decisions are based Timely regulatory system response to new and emerging health risks related to new substances and the products of biotechnology			Level of awareness of Chemicals Management Plan and action being taken % completion of plans within service standards/targets to assess and reduce release of, or uses of, the highest priority chemicals Number of incidents of illnesses/injury due to toxic chemical substances, levels of priority contaminants in humans, and levels of priority contaminants in environmental media Number of peer reviewed posters, publications, workshops, advice given Proportion of risk assessments and regulatory activities addressed within service standards/targets
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
61.5	406	76.6	442	81.6	461

 

Key Program/Service - Passenger Conveyances

Description: As mandated by the Department of Health Act, Health Canada conducts inspection activities for the protection of public health on conveyances including railways, ships and aircraft as well as their ancillary services (i.e., flight kitchens). Health Canada plays a critical role in preventing the introduction and spread of communicable diseases in Canada, including pandemics. Work is currently underway to address risk areas and to meet our commitments under the World Health Organization's International Health Regulations. In the interim, Health Canada continues to improve its program in consultation with the conveyance industries, including expanding its water management plans to trains and ferries and initiating discussions with airport and seaport operators. These activities will supplement the current voluntary program on a transitional basis until the legislative framework is in place. In addition, Health Canada will develop and implement a risk-based inspection framework, including an assessment tool to determine the types and frequency of inspections that are required. This will be a core feature of the transitional activities and the proposed new framework.
Expected Results			Performance Indicators
Improved public health prevention measures in relation to conveyances and ancillary services Declining trends in levels of passengers with gastro-intestinal disease Adherence to Potable Water Guidelines for Common Carriers			Proportion of inspection activities conducted within service standards/targets % of passengers reported having gastro Intestinal disease # of inspection/audit reports that confirm adherence to Potable Water Guidelines
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
1.4	24	1.3	24	1.2	23

 

Key Program/Service - Emergency Preparedness

Description: Health Canada provides physical and psycho-social emergency preparedness and response services to Government employees across Canada, including the provision of trained staff, personal protective equipment, analytical equipment to conduct on-site inspections in emergency situations, response vehicles, and communication devices. Health Canada also ensures the psycho-social health of public servants and that those employed by the Government of Canada are protected and supported prior, during, and following emergencies in order to maintain the delivery of services to the Canadian public. Plans are currently underway to increase the number of emergency response locations, develop a Programme Emergency Response Plan which will be consistent with the Health Portfolio Emergency Response Plan, expand Emergency Preparedness and Response training and exercises, and validate decontamination methodologies to allow re-occupancy of federal workplaces contaminated by infectious bio-agents. Health Canada also coordinates Government of Canada preparedness and response activities relating to radio-nuclear emergencies, maintains and provides technical and scientific capability in support of health impact assessment in the event of a radio-nuclear emergency, discharges Canadian and international obligations and liaison for radio-nuclear emergencies, and enhances the preparedness and response capacity of the Health Portfolio with respect to Chemical Emergencies. Health Canada also leads multi-agency federal technical and scientific research and development projects, maintains a national radiological laboratory and surveillance networks, and is involved in emergency responder training and exercises in support of Canada's chemical, biological, radiological, and nuclear national security initiatives. The Federal Nuclear Emergency Plan will be updated and linked to the Federal Emergency Response Plan being developed by Public Safety by March 2010. The description of Emergency Preparedness includes Healthy Environments and Consumer Safety Branch activities only.
Expected Results			Performance Indicators
Timely regulatory system response to radio-nuclear emergencies Health Canada is ready to provide support for chemical emergencies Business continuity is managed during and after a workplace critical incident affecting the federal public service			Proportion of Health Canada's planned activities that are ready to respond to radio-nuclear emergencies addressed within service standards/targets Proportion of Health Canada's planned activities that are ready to respond to chemical emergencies within service standards/targets % of employees able to remain at work through and/or return to work following a critical incident Hazard-specific plan developed The plan is followed Deficiencies in plan are identified
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
9.4	82	9.3	81	9.0	80

The financial information for Emergency Preparedness includes Healthy Environments and Consumer Safety Branch activities only.

Program Activity - Consumer Products

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Gross expenditures	25.8	24.6	25.1	27.1
Less: Expected respendable revenues	0.5	0.5	0.5	0.5
Net expenditures	25.3	24.2	24.6	26.6
FTEs	195	203	208	216
Notes: Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

Health Canada identifies, assesses, manages, and communicates to Canadians the health and safety risks associated with consumer products (including domestic, industrial and clinical use products), cosmetics and radiation emitting devices. This is achieved through research, risk assessments and the development of risk management strategies to minimize the exposure of Canadians to potentially hazardous products. Also included are regulatory monitoring and compliance activities as well as information, education and guidance aimed at both industry and the public. Relevant acts include: Hazardous Products Act, Food and Drugs Act (cosmetics), and Radiation Emitting Devices Act.

Expected Results	Performance Indicators
Declining trends in levels of risk, adverse reactions, illnesses, and injuries from hazardous products, substances, cosmetic products, and radiation emitting devices Adherence to Acts and Regulations Canadians are knowledgeable/aware of the health risks of exposure to hazardous products, substances, cosmetic products, and radiation emitting devices	Number of incidents of illnesses/injury from hazardous products, substances, cosmetic products, and radiation emitting devices % of inspected registrants/firms/users that are compliant/non compliant % of public that is knowledgeable/aware of the risks of exposure to hazardous products, substances, cosmetic products, and radiation emitting devices

 

Key Program/Service - Consumer Product Safety

Description: Recent events such as lead in children's jewellery and ingestible magnets in children's toys have called into question the safety of consumer products on the market. In the Speech from the Throne, the Government committed to "introduce measures on food and product safety to ensure that families have confidence in the quality and safety of what they buy". In support of this commitment, Health Canada worked with other key federal departments to develop Canada's new Food and Consumer Safety Action Plan, with three key action areas. The Action Plan aims to prevent health and safety problems, by providing further guidance to industry and better information to empower consumers in making informed decisions. The Action Plan also targets the highest risks by keeping a vigilant eye on products that pose the greatest hazard potential to the public. Finally, the Action Plan proposes new legislation that will enable the government to respond faster to protect the public when a problem occurs. The proposed legislation would emphasize industry's responsibilities for the safety of the consumer products they put into the marketplace, and provide stronger and more flexible regulatory backstops such as mandatory reporting of injuries, illnesses and defects, and mandatory product recalls. Health Canada will also work with key trading partners (and other countries) to strengthen cooperation and dialogue on issues related to consumer products (including cosmetics) and radiation emitting devices. A 30-day consultation period was held to seek the views of the provincial and territorial governments, industry, non-governmental organizations, consumer groups, and the general public. It is anticipated that the proposed new legislation will be tabled before the House of Commons in early 2008. Health Canada will also work with key trading partners (and other countries) to strengthen cooperation and dialogue on issues related to consumer products (including cosmetics) and radiation emitting devices. For example, a Memorandum of Understanding between Canada and China was signed in November 2007, which will see the establishment of technical working groups on consumer product safety issues of interest and other mechanisms to facilitate information exchange, including conducting urgent consultations on significant consumer product safety concerns.
Expected Results			Performance Indicators
Declining trends in levels of risks, adverse reactions, illnesses, and injuries from consumer products Adherence to Acts and Regulations Canadians are knowledgeable/aware of the health risks related to consumer products			Number of incidents of illnesses/injury related to consumer products % of inspected registrants/firms/users that are compliant/non compliant % of public that is knowledgeable/aware of the risks associated with consumer products
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
14.8	124	15.1	127	17.3	134

Program Activity - Workplace Health

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Gross expenditures	62.0	48.9	48.2	46.4
Less: Expected respendable revenues	13.8	14.1	14.1	14.1
Net expenditures	48.2	34.8	34.1	32.2
FTEs	463	437	436	434
Notes: The decrease in forecast/planned expenditures from 2007-08 to 2008-09 is due largely to the one-year funding received in 2007-08 for the Public Service Health Program. Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

This program activity provides services to protect the health and safety of the federal public sector, visiting dignitaries, and others. Specific programs include: the provision of occupational health services to federal employees; delivery of the Employee Assistance Program; emergency health services to Internationally Protected Persons; dosimetry services (the measurement of personal, occupational exposure to radiation); and, Workplace Hazardous Materials Information System (WHMIS) a national hazard communication standard, including worker education, inspector training and standards for cautionary labels

Expected Results	Performance Indicators
Timely system response to public service employees with psycho-social problems  Internationally Protected Persons and Canadian Public Servants are protected during visits and events from work-related and other risks to their health and safety Adherence to Acts, Regulations, and Guidelines	% of public service employee clients' psycho-social problems dealt with within service standards % of visits/events without serious health-related incidents for Internationally Protected Persons or for Canadian Public Servants % of federal departments that are purveyors of water, that are in compliance with the Canadian Guidelines on Drinking Water Quality

 

Key Program/Service - Public Service Health

Description: Through the Public Service Health Program, Health Canada provides occupational health and safety services to federal employees working in Canada and overseas. The Public Service Health Program has undertaken two studies aimed at revitalizing and modernizing the Program. The first study is looking at the financial management practices of the Program and will be making recommendations related to linkages between operational planning, performance measurement and resource allocation. The second study will include a review of the operational performance of the program, a client needs analysis, review of best practices, market analysis, and a gap analysis which will lead to the presentation of costed options for the renewal of the Program.
Expected Results			Performance Indicators
Federal departments that are purveyors of water are in compliance with the Canadian Guidelines on Drinking Water Quality  The health and well-being of Canadian Public Servants abroad including dependents and locally engaged staff is maintained			Number of federal departments that are contributing to the development of a "safe drinking water in area of federal jurisdiction" document Number of incidents of illnesses/injury of Canadian Public Servants while abroad Number of times advice and guidance is provided to maintain the health of Canadian Public Servants abroad
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
25.6	265	25.3	265	25.3	266

 

Key Program/Service - Workplace Hazardous Materials Information System

Description: Health Canada, through collaboration of its National WHMIS Office with all federal, provincial and territorial occupational health and safety regulatory authorities, is reviewing WHMIS to, among other things, be consistent with the Globally Harmonized System of Classification and Labelling of Chemicals, while maintaining WHMIS standards, improving the overall communication of hazards in Canadian workplaces and facilitating international trade in chemicals.
Expected Results			Performance Indicators
Stakeholders and the public have confidence and trust in the regulatory system			% of stakeholders and public that have confidence and trust in the regulatory system
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
2.5	18	2.5	20	2.5	20

 

Key Program/Service - Dosimetry Services

Description: The National Dosimetry Services (NDS) protect Canadians who are potentially exposed to ionizing radiation in the workplace by providing accurate, reliable and timely monitoring and reporting of exposures. This information allows workers to modify their methods and practices to reduce the health risks associated with ionizing radiation. The Canadian Nuclear Safety Commission requires that some workers have their radiation dose monitored and the NDS ensures that this service is available to Canadian workers. NDS also supports the Federal Nuclear Emergency Plan by providing response personnel with dosimetry capabilities in the event of a radiological emergency.
Expected Results			Performance Indicators
Timely response to requests for radiation exposure data for workers			% of radiation exposure reports received by workers within service standards % of clients satisfied with the service they receive
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
1.4	69	1.4	70	1.4	70

Program Activity - Substance Use and Abuse

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Net expenditures	142.3	152.9	151.5	148.2
FTEs	555	575	586	586
Notes: The difference between forecast and planned spending is due to a reprofile of funding from 2007-08 for the Drug Strategy Community Initiative Fund to 2008-09 and 2009-10 as well as an increase in funding for the National Anti-Drug Strategy which decreases slightly in 2010-11. Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

Through regulatory, programming and educational activities, Health Canada seeks to improve health outcomes by reducing and preventing tobacco consumption and combatting alcohol and drug abuse.

Through the Tobacco Act and its regulations, Health Canada regulates the manufacture and sale of tobacco. Health Canada also leads the Federal Tobacco Control Strategy.

Health Canada administers the Controlled Drugs and Substances Act (CDSA) and its regulations. Through four regional labs, Health Canada provides expert scientific advice and drug analysis services to law enforcement agencies. The Marihuana Medical Access Regulations and related programs control the authorization for use and cultivation of marihuana by those suffering from grave and debilitating illnesses. Health Canada is a partner in the National Anti-Drug Strategy which includes: prevention programming aimed at youth; facilitating access to treatment programs; compliance and enforcement activities related to controlled substances and precursor chemicals; and, increased resources to drug analysis services commensurate with the increase in law enforcement resources; and the need to enhance the safety of procedures used in the dismantling of clandestine laboratories.

Expected Results	Performance Indicators
Reduced tobacco consumption Reduced abuse of drugs, alcohol, and other controlled substances	Smoking prevalence rate in % of the Canadian population Prevalence (in %) rates of illicit drugs, alcohol, and pharmaceuticals

 

Key Program/Service - Tobacco

Description: Health Canada will continue to work in support of its commitment to contributing to the improvement of the health of Canadians by reducing tobacco-related disease and death in Canada. Through the Federal Tobacco Control Strategy 2007-2011, Health Canada is committed to moving forward with a number of tobacco control initiatives including: increasing the number of smokers who quit, updating the health warning messaging on tobacco packaging, and enforcing product labelling requirements. The goal of the Federal Tobacco Control Strategy is to reduce overall smoking prevalence from 19% (2005) to 12% by 2011.
Expected Results			Performance Indicators
Declining number of Canadians who choose to smoke Declining number of Canadians who are exposed to second-hand smoke Adherence to Acts and Regulations restricting Canadian youth's access to tobacco			Smoking prevalence rates % Canadians exposed daily to second-hand smoke Number of incidents of illnesses/injury related to second-hand smoke % of inspected retailers complying with   prohibitions on the sale of tobacco to youth
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
59.9	209	59.6	210	59.4	209

 

Key Program/Service - Alcohol

Description: Health Canada is developing national alcohol drinking guidelines to support Canada's move toward a culture of moderation where alcohol is used sensibly. The guidelines aim to help Canadians reduce the risks associated with drinking.
Expected Results			Performance Indicators
Increased awareness of responsible drinking practices			% of the population aware of National Alcohol Drinking Guidelines
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
9.3	37	9.2	38	8.9	38

 

Key Program/Service - Controlled Substances

Description: The National Anti-Drug Strategy puts forth the Government of Canada's strategic approach to address key concerns surrounding the presence and use of illicit drugs in Canada. Under the Strategy, Health Canada will focus on reducing drug use among Canadians, particularly vulnerable groups; supporting effective approaches to treatment for drug dependencies; and supporting enforcement activities through enhanced compliance, particularly for precursor chemicals used in illicit drug production, and enhanced safety in the dismantling of clandestine laboratories.
Expected Results			Performance Indicators
Increased awareness and understanding of illicit drugs and harmful health and social effects associated with illicit drug use Illegal drug operations are dismantled in a safe manner Industry and sites comply with legislation and regulations			% of youth aware about harmful health and   social effects associated with illicit drug use Ratio of clandestine laboratories safely dismantled in relation to the total number of labs dismantled by the Drug Analysis Service. Safety is defined as no injuries to investigation officers and no additional risk to the environment % of inspected registrants/firms/users that are compliant/non compliant
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
83.8	329	82.8	339	80.0	339

Program Activity - Pesticide Regulation

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Gross expenditures Less: Expected respendable revenues	68.3 7.0	67.5 7.0	68.2 7.0	68.3 7.0
Net expenditures	61.3	60.5	61.2	61.3
FTEs	702	707	715	712
Notes: Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

To help prevent unacceptable risks to people and the environment, and facilitate access to sustainable pest management tools, Health Canada, through the Pest Management Regulatory Agency (PMRA), regulates the importation, sale and use of pesticides under the federal authority of the Pest Control Products Act (PCPA) and Regulations.

Protecting human health and the environment is an important priority for Health Canada and science is the foundation for Health Canada's activities related to the PCPA and its Regulations. We conduct assessments of risks to human health and the environment arising from exposure to chemical and biological pesticides as well as assessments of the value of these products. In support of this work, we develop assessment methodologies, pesticide testing protocols, risk reduction strategies, and risk management tools. Scientific expertise is in place in the following areas: toxicology, environmental toxicology, analytical chemistry, environmental fate and chemistry, biochemistry, endocrinology, ecology, crop science, plant pathology, entomology, occupational and bystander risk assessment, and aggregate and cumulative risk assessment.

The PMRA will work closely with other Health Canada branches and Health Portfolio members over the next fiscal year on a variety of initiatives. We will collaborate with Health Canada and Environment Canada to achieve re-evaluation targets established through the Government of Canada's Chemicals Management Plan. We will continue to work horizontally with Agriculture and Agri-Food Canada (AAFC) through our joint Pesticide Risk Reduction Program. This year, the program will focus on finding sustainable solutions to key areas of pesticide risk associated with grower identified pest management issues. Health Canada's National Pesticide Compliance Program (NPCP) will continue to work with national partners to promote, verify and enforce compliance with the PCPA. Compliance strategies, programs and activities will be modernized to align with new priorities and to improve transparency of the program and results to Canadians.

The PMRA co-chairs a multi-departmental working group known as the '6NR', involving six federal science-based departments and agencies (Agriculture and Agri-food Canada, the Canadian Food Inspection Agency, Environment Canada, Fisheries and Oceans Canada, Health Canada, and Natural Resources Canada). Over the next fiscal year, the 6NR will complete the summative evaluation of the Horizontal Initiative: Building Public Confidence in Pesticide Regulation and Improving Access to Pest Management Products (also referred to as the BPC Initiative). Further information can be found at: http:// www.pmra-arla.gc.ca/english/pdf/ plansandreports/evaluation_bpcinitiative-e.pdf.
(BPC Initiative)

Expected Results	Performance Indicators
Declining trends in levels of risk from regulated pest control products Increased stakeholder awareness of risks and confidence in regulatory activities	Level of risks based on exposure and hazard % of the target population aware/engaged/ confident

Human resources capacity to respond to the PMRA's needs continues to be an ongoing challenge. This requires that the PMRA continually re-prioritize work plans.

To address this, the PMRA has integrated Human Resources Planning within the Business Planning process and identified key priorities, including monitoring and reporting of these activities. The priorities are:

• Designation of Senior Manager Champion to develop a strategy with options/actions and monitoring and reporting;
• Working closely with Human Resources to build capacity; and,
• Continue to allocate funding to recruitment and staffing activities.

Key Program/Service - Evaluation of New Products

Description: Before a new pesticide can be registered for use in Canada, Health Canada conducts an extensive pre-market assessment. This includes assessments of human health risks, food residues, environmental risk, and value. Only pesticides whose use poses no unacceptable risk will be registered. To protect health and the environment as well as to maximize the efficiency of our regulatory process, the PMRA works closely with international partners. In 2008-09, the PMRA will continue to expand on progress made with the United States and Mexico under the North American Free Trade Agreement (NAFTA) on harmonizing many of the technical requirements and processes involved in new pesticide registration. We will also continue our work with the Organisation for Economic Development (OECD) countries with a focus to increase the number of global joint reviews and work sharing arrangements. International joint review and work sharing programs help the PMRA to address the technology gap that exists between Canada and the United States. To increase Canadians' confidence in our pesticide regulatory system, the PMRA will improve the transparency of our new product decision-making process and enhance our communications initiatives.
Expected Results			Performance Indicators
Timely regulatory system response to pre-market reviews Improve international regulatory cooperation Increase transparency and communications for the evaluation of new products			Proportion of regulatory actions addressed within service standards/targets Number of new registrations completed through joint review or work share programs % of target population aware and engaged
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
28.8	370	29.2	374	29.2	373
Total net of revenue in the amount of $3.4M

 

Key Program/Service - Re-evaluation of Older Products

Description: Health Canada re-evaluates older pesticides currently available on the market to determine if their continued use is acceptable in consideration of modern scientific approaches and standards. The PCPA requires older pesticides to be re-evaluated on a 15-year cycle to reduce risks to human health and the environment. The PMRA conducts joint reviews of older pesticides with international partners such as the United States, Mexico, and OECD countries to help facilitate timely decisions. In 2008-09, we will continue to work with the United States Environmental Protection Agency to develop joint re-evaluation work plans and processes, as well as to initiate two work sharing pilot projects. In addition to committing to meet the PMRA's re-evaluation targets, we will be working with Environment Canada and other Health Canada branches to meet ambitious re-evaluation goals established under the Government of Canada's Chemicals Management Plan. As part of our life cycle stewardship strategy, the PMRA will be working with growers to develop transition strategies for products under re-evaluation. As with our new product decision-making process, the PMRA will increase the transparency of our re-evaluation process and improve communications to our stakeholders and the Canadian public.
Expected Results			Performance Indicators
Timely regulatory response to post-market review Improve international regulatory cooperation Increase transparency and communications for the re-evaluation of older products			Proportion of regulatory actions addressed within service standards/targets Number of re-evaluations completed through joint review or work share programs % of target population aware and engaged
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
13.0	176	13.2	178	13.2	177
Total net of revenue in the amount of $1.9M

Strategic Outcome: Better Health Outcomes and Reduction of Health Inequalities Between First Nations and Inuit and Other Canadians

The objective of First Nations and Inuit health program activity is to improve health outcomes, by ensuring the availability of, and access to, quality health services, and by supporting greater control of the health system by First Nations and Inuit.

Health Canada works closely with our health partners and other federal departments to support First Nations and Inuit health. We support the Public Health Agency of Canada in its delivery of Children and Youth programming through the Aboriginal Head Start in Urban and Northern Communities program, as well as its work on a number of pan-Aboriginal programs and pandemic planning activities. We work closely with Indian and Northern Affairs Canada (INAC) through: the First Nations Water Management Strategy, to ensure that all First Nations communities across Canada have access to a safe and reliable water supply; the Home and Community Care program, to address the gaps in continuing care services available to First Nations and Inuit communities; and the Labrador Innu Comprehensive Healing Strategy, to support long term healing in the Labrador Innu communities. We also work with Indian Residential Schools Resolution Canada to ensure that eligible former students of Indian residential schools have access to mental health and emotional supports.

Program Activity - First Nations and Inuit Health Programming and Services

Planned Spending and Full-Time Equivalents (FTEs)

($ millions)	Forecast Spending 2007-08	Planned Spending 2008-09	Planned Spending 2009-10	Planned Spending 2010-11
Gross expenditures Less: Expected respendable revenues	2,217.1 5.4	2,161.5 5.5	2,215.1 5.5	2,048.3 5.5
Net expenditures	2,211.7	2,156.0	2,209.6	2,042.8
FTEs	2,879	2,876	2,880	2,728
Notes: The decrease in forecast/planned expenditures from 2007-08 to 2008-09 is due in part to the one-year funding received in 2007-08 to support the delivery of health services to First Nations and Inuit populations. The decrease is partially offset by an increase in the funding level for the Indian Residential Schools Resolution Health Support Program and the yearly growth for the Indian Envelope. The increase in planned expenditures from 2008-09 to 2009-10 is due mainly to an increase in the funding level for the Indian Residential Schools Resolution Health Support Program, the National Anti-Drug Strategy, and the yearly growth of the Indian Envelope. The decrease in planned expenditures from 2009-10 to 2010-11 is due largely to the sunset of funding for the Follow-up to the Special Meeting of Ministers and Aboriginal Leaders in September 2004 and for the Territorial Medical Travel and Health Access Funds. The decrease is partially offset by the yearly growth of the Indian Envelope. Figures include an amount for departmental and regional infrastructure costs in support of program delivery.

Health Canada delivers a range of health services to First Nations and Inuit. A series of primary health care services are provided in approximately 200 First Nations communities, largely in rural or remote areas where access to provincial health care services is limited. In addition, home and community care services are provided in approximately 600 First Nations communities. Health Canada supports a range of community-based health programs, focussing on children and youth, mental health and addictions, and chronic disease and injury prevention. We also deliver a range of public health programs with a focus on communicable disease control, including tuberculosis, HIV/AIDS and immunization, and environmental health and research. The Non-Insured Health Benefits (NIHB) Program provides approximately 800,000 eligible First Nations and Inuit with a limited range of medically necessary health-related goods and services not provided through private insurance plans, provincial/territorial health or social programs or other publicly funded programs. Health Canada also maintains healthcare infrastructure, including nursing stations, treatment centres and community health centres. To support greater First Nations and Inuit control over their health system, many health programs and services are provided in collaboration with First Nations and Inuit communities, and a number of communities deliver their own health services through Contribution Agreements with Health Canada. Health Canada also works closely with other health partners, including provinces and territories, to support and coordinate health programs and services for First Nations and Inuit.

Health Canada uses information from evaluations and review studies to support program improvement on a continual basis. We will continue to work on three integrated program cluster evaluations for the Children and Youth, Environmental Health and Research and Communicable Disease Control program areas and on an implementation/process evaluation for the Maternal Child Health program in 2008-09.

Expected Results	Performance Indicators
Strengthened community programs; better health protection; improved primary health care; and access to non-insured health benefits to contribute to improved health status of First Nations and Inuit individuals, families and communities	Life expectancy (at birth, on and off reserve) Birth weight NIHB client utilization rates

Human Resource Challenges:

The Department continues to experience challenges in recruiting nurses into First Nations and Inuit communities, especially in remote and isolated areas. Health Canada is particularly concerned with the impact that nursing shortages have on the provision of services and the health and well-being of First Nations and Inuit, and we are undertaking a number of activities to address this challenge. Through the Aboriginal Health Human Resource Initiative, Health Canada is supporting Aboriginal students to pursue health careers, and working to improve retention of existing health care workers in First Nations and Inuit communities. We will continue to support the recruitment and retention of nurses in First Nations communities by pursuing the integration of Nurse Practitioners and Licensed Practical Nurses for health program delivery in remote and isolated First Nations communities. We will continue an aggressive nurse recruitment campaign to include piloting a Nurse Practitioner Student Incentive program to attract Nurse Practitioner students to First Nations communities. We will also continue to work with the Canadian Association of Schools of Nursing and other stakeholders to provide appropriate education programs to meet mandatory training requirements.

Key priorities:

1. Continuing to provide health-related programs and services
2. Improving quality of and access to health-related programs and services
3. Promoting healthy living and disease prevention
4. Improving accountability and performance measurement

Key Programs and Services

In addition to the four priorities, the Department has identified five key program areas from the Program Activity and Architecture (PAA).

Key Program/Service - First Nations and Inuit Community Programs

Description: First Nations and Inuit Community Programs support a suite of community-based and community delivered programs, initiatives and strategies that collectively aim to improve the health outcomes and reduce health risks in three targeted areas: Children and Youth; Chronic Disease and Injury Prevention; and Mental Health and Addictions. In the area of children and youth, the primary objective is to improve the health of mothers, infants and families, as well as support the development of children in an effort to address the gap in life chances between Aboriginal and non-Aboriginal children. In the area of chronic disease and unintentional injury, the primary objective is to deliver services that reduce the rate of chronic diseases (such as type-2 diabetes) and injuries among Aboriginal people to levels consistent with other Canadians. Finally, in the area of mental health and addictions, the primary objective is to deliver direct prevention and promotion activities on reserves and in communities to improve physical, social, emotional, and spiritual well-being of Inuit and Aboriginal populations. Through these objectives, Community Programs support the overarching goal of supporting Aboriginal communities in becoming healthy, sustainable, culturally strong, and economically viable.
Expected Results			Performance Indicators
Improved continuum of programs and supports in First Nations and Inuit communities Increased participation of Aboriginal individuals, families, and communities in programs and supports			Number and percentage of communities with programs Number and type of participants in programs by program type
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
347.9	408.4	363.5	408.9	247.8	387.4

Health Canada will continue to invest in the Maternal Child Health Program. This program provides pregnant First Nations women and families with infants and young children living on-reserve with home visits by nurses and trained, experienced mothers in the community. The program also provides case management for families living with more complex needs. In the north, program funding will continue to enhance existing health promotion programs. Key plans for 2008-09 are to increase the number of trained nurses and home visitation workers and enhance existing health promotion programs in Nunavik, Nunatsiavut and the Territories.

Work to expand the Aboriginal Head Start on Reserve (AHSOR) program will continue through increased training of AHSOR staff and a study of the status of AHSOR capital facilities in communities to better define capital requirements. The goal of the AHSOR program is to support locally controlled and designed early childhood intervention strategies for on-reserve First Nations children. Outreach activities will be strengthened and expanded to serve small communities that do not have enough children to run a centre-based program. In 2008-09, the results of 17 demonstration projects undertaken to improve integration and coordination among AHSOR, Human Resources and Social Development Canada's First Nations and Inuit Child Care Initiative, and INAC funded daycares in Alberta and Ontario will be used to inform future work on key components of the interdepartmental early childhood development strategy.

Implementation of the National Aboriginal Youth Suicide Prevention Strategy will continue with a focus on prevention, skills training, and the development of protocols to respond to suicide-related crises. Moreover, the Strategy will support greater awareness and knowledge through activities promoting mental wellness and resiliency among youth. Evaluation, data gathering and research initiatives will be undertaken to improve knowledge of effective Aboriginal youth suicide prevention activities and how suicide impacts Aboriginal youth living off reserve and in urban areas.

Health Canada and its partners have developed a strategic action plan for First Nations and Inuit mental wellness that aims to improve mental wellness through a coordinated continuum of mental health and addictions services respecting traditional, cultural and mainstream approaches to healing. Work with our partners, including the new Mental Health Commission of Canada, will continue in 2008-09 in order to validate and implement elements of the plan. In 2008-09, key aspects of the plan that can proceed within existing resource levels, such as raising awareness of the plan and aligning existing mental wellness activities with its objectives, will be implemented. The Department will also continue to offer a range of mental health and emotional support services to former students of residential schools and their families through the Indian Residential Schools Resolution Health Support Program.

Through Patient Wait Times Guarantees pilot projects in diabetes and prenatal care services on-reserve, Health Canada will test defined time frames and access to alternative care options if these time frames are exceeded. In 2008-09, pilot projects will begin data collection and testing of time frames.

Continuing work under the Aboriginal Diabetes Initiative will improve screening and care services and will strengthen community-based diabetes prevention and promotion activities through increased training and employment of community-based diabetes prevention workers. Participatory research will be undertaken to gather more data on pre-diabetes, diabetes and its complications, and to develop strategies to reduce the burden of the disease. Complementary activities to aid in diabetes prevention will also be undertaken including the continued promotion and dissemination of a Eating Well with Canada's Food Guide -- First Nations, Inuit, and Mé´©s, as well as ongoing partnerships with retailers in northern isolated communities to support healthy eating by increasing the availability, quality and promotion of healthy foods.

Key Program/Service - First Nations and Inuit Health Protection and Public Health

Description: Health Canada works with the provinces and First Nations communities to support a public health system on-reserve that includes basic services such as: communicable disease control and surveillance; prenatal education; immunization; environmental health services (drinking water testing, health inspections, etc.).
Expected Results			Performance Indicators
Improved access to communicable disease prevention and control programs for First Nations and Inuit individuals, families and communities Improved environmental health risk management			Number and percentage of communities with programs Number of communities with access to a trained Community-Based Water Monitor Number of communities equipped with water testing/sampling kits
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
47.6	388.3	47.7	388.8	46.7	368.3

Employing a team approach which focuses on building First Nations' capacity, Health Canada works with First Nations to ensure that all First Nations communities south of 60Ì? have access to safe and reliable drinking water. Health Canada raises awareness in First Nations communities of the importance of using safe drinking water best practices on-reserve for public health through targeted risk communication materials.

In 2008-09, Health Canada will begin implementation of a new policy to: address the drinking water quality in individual wells and wells with two to four connections on-reserve; focus on public awareness and education; enhance quality assurance/quality control monitoring for contaminants; and, develop waterborne illness procedures.

As part of Health Canada's efforts to ensure that its nursing stations and health centres meet appropriate environmental standards, we will undertake remediation activities in at least 9 of 19 remaining contaminated sites in 2008-09. Health Canada will also continue its work with First Nations and Inuit to help them improve their health and well-being by building and supporting their capacity to identify, understand and control the impact of exposure to environmental hazards. In 2008-09, we will provide a total of $2 million in funding to at least 10 First Nations and Inuit communities to develop community-based research projects dealing with health-related environmental issues. In addition, Health Canada will continue to conduct regionally-based traditional food safety workshops, bringing together First Nations communities to increase their knowledge of the nutritional benefits and risks of contaminants so they can make informed decisions on food choices.

Key Program/Service - First Nations and Inuit Primary Care

Description: Health Canada provides directly or funds the provision of 24/7 primary care treatment services in 76 nursing stations located in remote and isolated reserves, where there are no provincial services readily available, and funds or provides access to home and community care services such as nursing, personal care and respite in all First Nations and Inuit communities.
Expected Results			Performance Indicators
Improved access to primary health care programs and services for First Nations and Inuit individuals, families and communities			Number and percentage of communities with programs Number of treatment centres by type, in the communities
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
269.4	880.8	272.7	882.0	271.5	835.5

Key Program/Service - Non-Insured Health Benefits (Supplementary) for First Nations and Inuit

Description: The NIHB Program provides approximately 800,000 eligible First Nations and Inuit with a limited range of medically necessary health-related goods and services not provided through private insurance plans, provincial/territorial health or social programs or other publicly-funded programs. The benefits provided under the NIHB Program include prescription drugs, dental and vision care, medical supplies and equipment, short-term crisis intervention mental health services, medical transportation to access medical services not available on-reserve or in the community of residence, and health care premiums in Alberta and British Columbia.
Expected Results			Performance Indicators
Access by eligible clients to Non-Insured Health Benefits			Utilization rates for dental and pharmacy benefits (# and %)
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
963.3	631.3	989.5	632.2	1,004.3	598.8

Key Program/Service - Governance and Infrastructure Support to First Nations and Inuit Health System

Description: Health Governance and Infrastructure Support aims to increase First Nations and Inuit control over health programs, establish adequate First Nations and Inuit infrastructure and health services and improve capacity to generate and use health information. These activities include: health facilities; health planning and management; capacity building; consultation and liaison; integration and coordination of health services; stewardship and health research; knowledge and information management; health human resources; e-Health services; and health services accreditation.
Expected Results			Performance Indicators
Access to quality health services Increased capacity of First Nations and Inuit communities to manage and deliver health programs and services			# of health facilities and services accredited % of communities with community-based health systems under First Nations and Inuit control (transferred communities)
2008-09		2009-10		2010-11
($ millions)	FTEs	($ millions)	FTEs	($ millions)	FTEs
528.0	567.2	536.2	568.0	472.7	538.0

Health Canada will continue to work with our partners to support the development and implementation of quality improvement activities, including accreditation of First Nations and Inuit health organizations, and modernization and accreditation of addictions treatment centres. In 2008-09, $2.5 million will be invested in accreditation with an estimated 10% increase in the number of accredited treatment centres and health services.

By increasing the amount of bursary and scholarship funds available through the National Aboriginal Achievement Foundation and other Aboriginal organizations, we will exceed our target of doubling the numbers of First Nations, Inuit and Mé´©s students pursuing health career studies, and in the longer term, will increase the supply of Aboriginal health care workers. We will also continue to work with provinces, territories, colleges and universities to double the number of student support programs for First Nations, Inuit and Mé´©s health care students. Through work with health professional organizations and post-secondary school partners, health educational curricula will be adapted so that future health care workers have a better understanding of First Nations, Inuit and Mé´©s clients, leading to an improved quality of service to the clients and better health outcomes.

Health Canada supports the construction, operation, maintenance and environmental management of on-reserve health facilities and staff residences. In 2008-09, fourteen health facilities will be constructed or expanded, and recapitalization initiatives (repairs, replacements, upgrades) will improve the working environment of clients and staff, and enhance the quality of health care services offered at the community level. We will also invest $1.5 million in environmental audit, assessment and remediation activities to ensure operations of health facilities in First Nations communities meet environmental codes and requirements and are consistent with the Department's commitments to sustainable development.

The Aboriginal Health Transition Fund will continue to support federal, provincial and territorial governments, and Aboriginal communities and organizations, to improve the integration and adaptation of health services to better meet the needs of First Nations, Inuit and Mé´©s. Expected results for 2008-09 include the implementation of provincial and territorial plans and projects to better adapt health care services, and the continued implementation of Health Canada Regional plans and projects, to improve the integration and coordination of provincial, territorial and federal health programs and services. These projects, along with cross-jurisdictional First Nations, Inuit and Mé´©s projects supported by capacity funding, will contribute to improve partnerships between federal, provincial and territorial governments and Aboriginal peoples in the delivery of health programs and services for Aboriginal peoples. In addition, Health Canada will continue to pursue improvements to quality and accessibility of health services for First Nations through tripartite agreements with provincial governments, such as the First Nations Tripartite Health Plan with the Province of British Columbia and British Columbia First Nations Leadership Council.

In March 2004, the federal government directed Canada Health Infoway to facilitate the development of an electronic Pan-Canadian communicable disease management and public health surveillance system (now known as Panorama) in partnership with the provinces and territories. In 2008-09, plans will be completed and implementation begun to include First Nations health facilities and communities within the provincial implementations of Panorama.

Health Canada is developing plans for an enhanced and more effective use of information and communications technologies to support health care delivery and management. We will continue our collaborative work with various stakeholders towards the finalization of long-term Health Infostructure and e-Health strategy framework.

The First Nations Regional Longitudinal Health Survey is a national health survey of First Nations on-reserve. This survey collects information on medical and non-medical determinants of health and well-being of First Nations people living on reserves. Health Canada funds this survey and works collaboratively with the Assembly of First Nations on this project to build First Nations capacity and participation in health data collection and analysis. The data collection phase is expected to be completed in 2008-09.

First Nations and Inuit Programs and Services and Web Links

Non-Insured Health Benefits 2005/06 Annual Report
http://www.hc-sc.gc.ca/fnih-spni/pubs/nihb-ssna/2006_rpt/index_e.html

Non-insured Health Benefits Program
http://www.hc-sc.gc.ca/fnih-spni/nihb-ssna/index_e.html

Aboriginal Head Start On Reserve
http://www.hc-sc.gc.ca/fnih-spni/famil/develop/ahsor-papa_intro_e.html

Fetal Alcohol Spectrum Disorder
http://www.hc-sc.gc.ca/fnih-spni/famil/preg-gros/intro_e.html

Aboriginal Diabetes Initiative
http://www.hc-sc.gc.ca/fnih-spni/diseases-maladies/diabete/index_e.html

Injury Prevention
http://www.hc-sc.gc.ca/fnih-spni/promotion/injury-bless/index_e.html

Indian Residential Schools Resolution Health Support Program
http://www.hc-sc.gc.ca/fnih-spni/services/indiresident/index_e.html

National Native Alcohol and Drug Abuse Program
http://www.hc-sc.gc.ca/fnih-spni/substan/ads/nnadap-pnlaada_e.html

Drinking Water Quality
http://www.hc-sc.gc.ca/fnih-spni/promotion/water-eau/index_e.html

Immunization Schedule for Infants and Children
http://www.phac-aspc.gc.ca/im/is-cv/index.html

Targeted Immunization Strategy
http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni_e.html#immuni

e-Health
http://www.hc-sc.gc.ca/fnih-spni/services/ehealth-esante/index_e.html

Aboriginal Health Human Resources Initiative
http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni_e.html#ahhri-irrhs

New web-links to the Communicable Disease Control Division (CDCD)
http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/cdcd-dcmt_e.html

Contribution Agreements
http://www.hc-sc.gc.ca/fnih-spni/finance/agree-accord/index_e.html

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