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Section II – Analysis by Strategic Outcome and Key Program

Analysis by Strategic Outcome

Strategic Outcome:
A Healthier Population by Promoting Health and Preventing Disease and Injury

Program Activity Name: Population and Public Health

Financial Resources

Planned Spending	Total Authorities	Actual Spending
$629.7 million	$536.2 million*	$510.8 million**

    * The $93.5 million difference between planned spending and authorities is mainly due to the deferment of $44 million in funding for Avian and Pandemic Influenza Preparedness to subsequent fiscal years, and expected funding of $51 million for Canadian Strategy for Cancer Control not flowing through the Agency.

  ** Actual spending was $25.4 million lower than total authorities primarily due to capacity and technical constraints which impeded the full utilization of approved resources. Of the $25.4 million figure, operating expenditure totalled $20.5 million and transfer payments totalled $4.9 million.

Human Resources (Full-Time Equivalents*)

Planned	Actual	Difference
2,119	2,050	69

*To properly include persons employed for part of the year and/or employed part time in a measure showing average employment over the year, 'full-time equivalent' is calculated based on days worked . The Agency began the fiscal year with approximately 1,968 employees and ended it with approximately 2,157.

In collaboration with partners, the Agency leads federal efforts and mobilizes pan-Canadian actions to promote and protect national and international public health. These actions include anticipating, preparing for, responding to and recovering from threats to public health; and monitoring, researching and reporting on diseases, injuries, other preventable health risks and their determinants, and the general state of public health in Canada and internationally. These activities are designed to support effective disease prevention and health promotion, and building and sustaining a public health network with stakeholders. The Agency uses the best available knowledge and evidence to inform and engage Canadian and international public health stakeholders on various aspects of public health activities and to provide public health information, advice and leadership.

This Program Activity supports all six Priorities in the 2006-07 Report on Plans and Priorities.

Analysis by Key Program

Emergency Preparedness and Response

Canada must be prepared to respond to the public health risks posed by all natural and human-caused disasters, such as infectious disease outbreaks, natural disasters and criminal or terrorist acts such as explosions and the release of toxins or biological agents. Major preparedness challenges include planning to effectively deal with all possible hazards, providing training to health responders, coordinating among all levels of government, and holding sufficient emergency supplies across the country.

Emergency Preparedness Capacity

Planned ($M)	Authorities ($M)	Actual ($M)
13.9	13.7	12.9*

    * Actual spending was $0.8 million lower than authorities due to capacity and technical constraints.

What was planned

In 2006-07, the Agency planned to:

• Provide accurate and timely information on national and global public health events to Canadian and World Health Organization (WHO) officials through the Global Public Health Intelligence Network;
•  Develop regulations, policies, procedures and training for the updated Quarantine Act; and
•  Support and strengthen its nationwide quarantine service.

What was achieved

The Agency completed these plans, other than developing regulations for the updated Quarantine act, with some achievements going beyond expectations.

The Global Public Health Intelligence Network (GPHIN) anticipates and tracks infectious disease outbreaks using software which monitors large volumes of worldwide news reports. During 2006-07 GPHIN added the capability of monitoring in Portuguese, and provided a team of analysts to cover the evening and night shift to provide 24/7 analytical coverage to meet the needs of stakeholders such as WHO and other users worldwide for accurate and timely information.

Using GPHIN, the Agency provided support to mass gathering events by monitoring for potential public health threats during the entire event. GPHIN worked closely with the Caribbean Epidemiology Centre (CAREC) to provide support during the Cricket World Cup games held in Trinidad and Tobago and its neighbouring Caribbean countries in March 2007.

A new Quarantine Act came into force on December 12th, 2006. It replaced the existing Quarantine Act and Quarantine Regulations with new and modern authorities to better protect Canadians from the introduction and spread of foreign communicable diseases. The Agency developed necessary implementation tools, which included: training key federal officials including Quarantine and Environmental Health Officers; developing standard operating procedures; and educating federal, provincial, and territorial partners on the new legislation.

The Quarantine Act contains authority to make regulations on a variety of topics. Work began on the assessment of needs so that the Agency will be able to develop regulations in accordance with their priority.

The development of a National Marine Quarantine Protocol was undertaken to strengthen the delivery of quarantine services to marine ports. This Agency-led initiative provided guidance for departments and agencies with responsibilities related to quarantine issues at sea and in Canadian ports.

The Agency delayed development of new regulations for the new Quarantine Act owing to a major policy issue that was eventually resolved through Bill C42, but was otherwise able to complete all other plans, with some achievements going beyond expectations. Development of new regulations was rescheduled.

Working collaboratively with partners and stakeholders under the Treasury Board’s Public Safety and Anti-Terrorism initiative , the Agency developed and delivered Chemical, Biological, Radiological and Nuclear (CBRN) training courses such as Tier 1 Laboratory Bioterrorism Recognition and the five-partner CBRN First Responder training led by Public Safety Canada. Additionally, the Agency coordinated development and pilot implementation of Emergency Social Services, Emergency Health Services, and Disaster Behavioural Health for Health Care Professionals courses. The Agency will be putting both new and existing programs on-line in order to facilitate effective delivery of the courses for Canadians who require or desire this training.

The 2006 National Forum on Emergency Preparedness and Response, held in Vancouver in December, brought more than 250 emergency management stakeholders from around Canada to address the issue of building more disaster-resilient communities in Canada. This has laid the foundation for the development of a more comprehensive vulnerability/resiliency framework to reduce the risks of emergencies to Canadians. The Agency and PSC co-hosted and funded the forum.

The Agency developed and conducted the first of a series of monthly tabletop exercises to more clearly define processes, operating concepts and procedures, and roles & responsibilities for each of the functional groups within the newly redeveloped Emergency Response Structure.

In 2006-07, the Agency led the development of a pandemic influenza exercise named Coherence Trecedim II, a Tabletop Exercise for the 2006 National Forum on Emergency Preparedness and Response. Over two hundred stakeholders from the provinces, territories, non-governmental organizations and the federal government took part. The exercise provided insight into the Agency’s capacity to communicate with our partners and stakeholders, and with the general public, during a pandemic. This exercise focused, in part, on gaps identified during the 2005 National Forum exercise.

A series of consultations and workshops were held on emergency preparedness and at-risk groups, such as seniors, persons with disabilities, and children, to develop a more coordinated mechanism to address their needs in emergencies. This included collaboration with the World Health Organization on the organization of two international workshops focusing on older persons in disasters. Additionally, the Agency and the Canadian Psychological Association co-hosted a roundtable of key psychosocial and disaster mental health planning to identify key issues and priorities for preparing to manage the emotional and behavioural impacts of emergencies.

The Agency supported the development of the Voluntary Sector Framework for Health Emergencies and the formation of the Council of Emergency Voluntary Sector Directors comprised mainly of the major NGOs and voluntary organizations. This is intended to enhance coordination of preparedness, response and recovery activities across the non-government and voluntary health sector.

Emergency Response Capacity

Planned ($M)	Authorities ($M)	Actual ($M)
9.1	14.0	12.0*

    * Actual spending was $2.0 million lower than authorities due to capacity and technical constraints.

What was planned

In 2006-07, the Agency committed to:

• Maintain its 24-hour/7-day response capability and the ability to deliver supplies from the National Emergency Stockpile System (NESS) anywhere in Canada within 24 hours.
• Improve its laboratory response operations in both its first laboratory and its mobile response units and develop enhanced field-usable techniques for the identification of potential bacterial bioterrorism agents. Testing capacity at the Agency’s Canadian laboratories will also be enhanced;
• Contribute directly to Canada’s participation in the Global Health Security Initiative, an international Partnership established to address the threats of chemical, biological, radiological and nuclear terrorism as well as pandemic influenza;
• Take steps to ensure that yellow fever vaccine is dispensed in Canada in accordance with national standards;
• Work in collaboration with the Pan-Canadian Public Health Network toward the establishment of a federal, provincial and territorial Public Health Mutual Aid Agreement; and
• Staff, train and supply one Health Emergency Response Team (HERT) that would assist the provinces and territories to create surge capacity in the event of public health emergencies.
• Further connect the Emergency Operations Centre (EOC) to provincial, territorial and international networks
• Define the federal, provincial and territorial components of the National Health Emergency Management System;
• Collaborate with provincial and territorial government emergency preparedness authorities to refine region-specific planning and act as a liaison with other federal government departments;
• Create a permanent executive liaison function with the National Emergency Response System.

What was achieved

The Agency maintained its 24/7 response capability and 24-hour delivery commitment for its National Emergency Stockpile System (NESS). To remain able to respond to new and emerging threats, the Agency completely reviewed NESS holdings using an up-to-date Risk and Threat Assessment. The Agency, in collaboration with the provinces and territories, continued to build an effective stockpile of critical supplies including anti-viral drugs in order to respond to pandemic and other public health emergencies. By modernizing NESS, and by supporting and facilitating the national dialogue on emergency measures under an all-hazardous approach, the Agency continued to improve its pandemic influenza preparedness in 2006-07.

In support of Canada’s participation in the Global Health Security Initiative’s Global Health Security Action Group Laboratory Network, the Agency started developing an Environmental Sampling Framework for use after a bioterrorist event.

The Agency provided training to the Health Portfolio for the Transportation of Dangerous Goods, including infectious substances, hazardous chemical and radioactive substances. The Agency also developed and offered train-the-trainer courses on this topic.

The Agency assisted the Department of Foreign Affairs and International Trade with the Canadian implementation of the Biological Toxins and Weapons Convention. The Agency was a member of the Canadian delegation to the United Nations where significant progress was made to improve international participation in the annual Confidence Building Measures report process.

Canada chaired a lab network (GHSAG-LN) of the G7 countries plus Mexico. In this forum the Agency contributed to significant progress, including exchange of critical testing protocols for situations of suspected bioterrorism.

Public health security was enhanced by the Agency through the provision of essential up-to-date information on international public health to Canadian travellers and front-line health care workers. To be effective, the program utilized tools such as the Global Public Health Intelligence Network (GPHIN), which anticipates and tracks infectious diseases using software to monitor large volumes of worldwide news related to infectious and chronic disease, natural disasters, environmental and agricultural concerns that might affect the health of Canadian travellers.

Canadian traveller health was further protected as the Agency’s Travel Medicine Program dispensed yellow fever vaccine in accordance with national standards in 2006-07. A review of the program, initiated to ensure that the program would meet Canada's yellow fever vaccination obligations under the revised International Health Regulations (2005), highlighted the need for further collaboration with the provinces and territories to modernize vaccine delivery.

The Agency continued to provide the official federal representation as well as secretariat, policy, technical, and financial support to the Emergency Preparedness and Response Expert Group of the Pan-Canadian Public Health Network. This Expert Group’s role is to enhance emergency preparedness and response capacity across Canada through the development of evidence-based frameworks and practices that encompass the full spectrum of emergency management including mitigation, preparedness, response, and recovery from a federal, provincial and territorial context.

The Agency played a key role in the development of the Federal, Provincial, and Territorial Memorandum of Understanding on the Provision of Mutual Aid in Relation to Health Resources during an Emergency. This work, which was tasked to the Expert Group on Emergency Preparedness and Response by the Pan-Canadian Public Health Network, was completed and the agreement was ready for sign off by the Federal, Provincial, and Territorial Ministers of Health.

The Agency was not able to field the first Health Emergency Response Team (HERT) as had been planned. The National Office of Health Emergency Response Teams continued to address all aspects of establishing these teams of health professionals from outside the federal government who will provide medical surge capacity. A draft operational framework was developed, and the Agency completed 80% of the procurement of equipment for the first HERT Unit. Work was initiated with Central Agencies on mechanisms to engage HERT volunteers, and with the Federation of Medical Regulatory Authorities of Canada on cross-border Provincial, and Territorial licensure. Revised timelines for HERT include commissioning an Ottawa team in 2007, Vancouver and Halifax teams during 2008 and a Winnipeg team by 2009.

Plans to establish a permanent executive liaison function to Public Safety Canada (PSC) were held in abeyance while the Agency worked to establish the necessary conditions. However, the Agency continued working with PSC and other federal departments within the Government of Canada’s National Emergency Management framework.

With its work on the National Health Emergency Management System, the Agency made significant progress toward completing the main mapping document of the System’s federal, provincial and territorial components, and this work will continue.

The Agency continued to maintain the Emergency Operations Centre (EOC) system for the federal Health Portfolio. The EOC provides the platform from which the Agency and Health Canada will respond to any public health emergency. Development of new emergency management software that integrates geo-spatial technology continued during the year. The Agency also participated in an interdepartmental pilot project to enable easier, more efficient sharing of information and data among federal, provincial, and territorial partners and stakeholders in routine and emergency situations.

The Agency hosted, in Ottawa, the first international meeting of Regulators of the Contained Use of Human Pathogens. This saw the participation of representatives from the US (the Centres for Disease Control and Prevention), Switzerland, UK, Australia, Japan, and Singapore as well as the World Health Organization.

In summary, the Agency accomplished all emergency response capacity activities planned in the 2006-07 Report on Plans and Priorities, with the exception of establishing the complete Health Emergency Response Team (HERT) and creating a permanent executive liaison function with the National Emergency Response System.

Infectious Disease Prevention and Control

Despite recent advancements in prevention, treatment and control, the number of Canadians dying from or living with infectious diseases has been climbing since the 1980s, due in part to HIV/AIDS. An estimated 58,000 Canadian residents are living with HIV, and approximately one quarter of them are unaware of their condition.

The unpredictability and dynamic evolution of disease causing biological agents (pathogens), the animal origins of emerging and re-emerging infectious diseases and the spread of antimicrobial-resistant organisms and hospital acquired infections are creating formidable challenges for the prevention and control of infectious diseases.

In addition, the potential for co-infection by multiple micro-organisms with common risk factors, vulnerable populations and modes of transmission increases the need for comprehensive national approaches across groups of infectious diseases.

Communicable Disease Control Expert Group The Agency continued to provide the official federal representation as well as secretariat, policy, technical, and financial support to the Communicable Disease Control Expert Group of the Public Health Network. The Expert Group’s role is to provide strong leadership in communicable disease prevention and control through the development, recommendation and implementation of national policies, practices, guidelines and standards from a federal, provincial and territorial context.

Pandemic Influenza Preparedness

Planned Spending ($M)	Total Authorities ($M)	Actual Spending ($M)
92.6	36.7*	30.9**

    * The $55.9 million difference between the planned spending and total authorities is due mainly to funding being reprofiled to subsequent fiscal years and distributed to other programs to support their pandemic related initiatives.

  ** Actual spending was $5.8 million lower than authorities due to capacity and technical constraints. $2.2 million occurred because reprofiling was denied for vaccine readiness and surveillance tools, and $1.2 million stemmed from an uncontrollable delay in contracting for work on a Winnipeg laboratory expansion project.

What was planned

Recognizing that an influenza pandemic has the potential to be the largest public health infectious disease emergency in Canadian history, the Agency planned to take a leadership role in the publication of the updated Canadian Pandemic Influenza Plan for the Health Sector, and in promoting implementation of the update by all levels of government.

The Plan includes ensuring that there is an adequate domestic capacity to produce appropriate pandemic influenza vaccine. The Agency also made it a priority to appropriately increase and diversify the stock of antivirals for treatment.

What was achieved

The Agency took a leadership role in updating and publishing the updated Canadian Pandemic Influenza Plan for the Health Sector in December 2006, in collaboration with the provinces and territories. The Agency also promoted that the updated plan be adopted by all levels of government.

The Agency took steps to strengthen Canada’s capacity to prepare for and respond to the threat of avian and pandemic influenza in seven major areas:

• prevention and early warning;
• vaccines and antivirals;
• coordination capacity;
• emergency preparedness;
• critical science;
• risk communications; and
• federal/provincial/territorial and international collaboration.

Prevention and Early Warning

Effective and timely surveillance is critical to the ability of the government to accurately detect, monitor and respond to an emerging infectious disease. The Agency continued to support the integrated public health information system (iPHIS) and undertook necessary enhancements such as the improved capability to extract pertinent data thereby ensuring that the system is ready if called upon for responding to potential outbreaks and health emergencies.

Vaccines and Antivirals

Immunization is an important element of an effective response to pandemic influenza. Canada is now better prepared to develop and deliver a pandemic influenza vaccine. The Agency continued to administer a 10-year contract between ID Biomedical Corporation (operating as GlaxoSmithKline Biologicals North America) and the Government of Canada to develop and maintain domestic pandemic vaccine production capacity. The Agency also continued to administer a 2005 amendment to that contract for production and testing of a prototype pandemic vaccine, including conducting clinical trials, which will build upon current, company sponsored, trials and which will address issues of specific concern to Canada.

The Agency continued discussions with the vaccine manufacturer, GlaxoSmithKline, concerning enhanced pandemic readiness through access to expanded production capacity, potential regional projects for adverse event reporting, and strengthening adverse event surveillance and reporting.

A component of the preparation for an influenza pandemic is establishing a reserve of antiviral medication. During 2006-07 the National Antiviral Stockpile (NAS) for early treatment of pandemic influenza was expanded to 51 million doses, as approximately 21 million additional doses were delivered to provinces and territories. This initiative was funded through a cost sharing arrangement between the Agency and provincial & territorial governments. Also during 2006-07, in collaboration with the provinces and territories, the Agency led the development of a national policy recommendation on the advisability of stockpiling antivirals for prevention during a pandemic; this is to be submitted to federal, provincial, and territorial Ministers of Health later during 2007.

Coordination Capacity

With the increasing profile of pandemic influenza issues, there was an urgent need to strengthen the Agency’s capacity for strategic policy to support federal, provincial, and territorial relations, executive support and corporate correspondence. A Pandemic Preparedness Secretariat, led by a Director General, was established and began to provide a focal point for Agency participation in federal, provincial, territorial, cross-sectoral and international work to improve Canada’s avian and pandemic influenza preparedness.

Emergency Preparedness

Emergency preparedness activities are critical in order to adequately prepare for, respond to, and recover from the public health implications of avian or pandemic influenza.

The Agency worked with Public Safety Canada (PSC) on establishing an interdepartmental protocol for early notification and liaison and also continued developing the National Health Incident Management System (NHIMS) with provinces and territories to facilitate the coordination of planning and response mechanisms both within and across jurisdictions during emergencies.

The Agency, with Public Safety Canada, the Department of Foreign Affairs and International Trade and the Canadian Food Inspection Agency, co-developed a North American Avian and Pandemic Influenza Plan with the United States and Mexico to 1) detect, contain and control an avian influenza outbreak and prevent transmission to humans; 2) prevent or slow the entry of a novel strain of human influenza to North America; 3) coordinate emergency management and communications; 4) minimize unwarranted disruptions to the flow of people, goods and services at the borders and 5)sustain critical infrastructure.

Agency Success Across Canada: Pandemic and Avian Influenza Planning In 2006-07 the Agency collaborated with partners from federal and provincial governments, as well as essential partners from the non-government and private sectors, in planning for pandemic influenza and avian influenza emergencies. The Agency’s Manitoba/Saskatchewan Office was instrumental in building strategic partnerships with the development of the Joint Federal – Provincial H5N1 Avian Influenza Planning Group, whose members represent several federal and provincial departments, non government organizations and the poultry industry. This group is now developing an intersectoral plan for coordinated management of an avian influenza emergency in Manitoba, and the Agency led federal participation during preparatory exercises testing the Groups operational effectiveness. Also, the Agency provided essential training in emergency management and pandemic influenza planning to participants. In Atlantic Canada the Agency and Public Safety Canada (PSC) co-sponsored a meeting on June 8, 2006 of representatives of key provincial and federal departments and agencies to discuss emergency pandemic influenza planning. Representatives from the four Atlantic provinces’ Departments of Health, Emergency Measures Organizations, and Health Emergency Management organizations attended along with regional representatives of the Agency, Health Canada and PSC. The meeting provided an opportunity to share information, clarify roles and responsibilities and identify common issues and themes with the objective of facilitating ongoing collaboration and coordination in the region - an important first step in emergency pandemic influenza preparedness.

Critical Science

The Agency’s National Microbiology Laboratory (NML) conducts scientific research and development in a wide range of areas related to viral, bacterial and prion infectious agents. As Canada’s leading laboratory with high-containment facilities (Levels 3 and 4), NML is uniquely positioned to rapidly isolate, identify and characterize novel agents (e.g., new strains of influenza virus) as they arise periodically, using a variety of advanced technology applications built on genomics, proteomics and biocomputing. NML is also in the forefront in development of these modern public health technologies, applying them to diagnostics, vaccines, and molecular epidemiology.

On a less specialized level, NML’s scientists work continuously to collect laboratory data on infectious agents and diseases of importance both in Canada and internationally. These data are translated by regulators (e.g., Health Canada, Canadian Food Inspection Agency) and federal, provincial, and territorial public-health stakeholders into risk assessments, decisions, policies and guidelines for disease prevention, treatment, control and management. Internationally as well, NML’s contribution is increasingly valued by collaborating organizations such as the World Health Organization. Through NML, the Agency’s reach has been extended globally through its capacity to transfer and deploy its expertise to other countries, and through its support for professional interchange.

Examples of active areas for structured public health intervention based on laboratory data are food safety (enteric pathogens, BSE); blood safety (hepatitis viruses, variant Creutzfeldt-Jakob disease); zoonotic diseases (West Nile Virus, influenza virus); hospital infection control (antimicrobial-resistant bacteria); and travel and quarantine (drug-resistant tuberculosis). In a less direct way, safer community environments are also promoted, by using laboratory data to reduce the impact of community-acquired diseases such as pneumonia, tuberculosis and sexually transmitted infections, particularly in vulnerable populations such as those in day-care centres and long-term care facilities.

NML operated at full capacity during the year. To help keep laboratory capacity and scientific activity commensurate with public health needs, during 2006-07 the Agency successfully brought forward a plan for the purchase of a provincially-owned laboratory facility (the Logan Lab); purchased necessary equipment and began migration of selected administrative services which had been housed at NML to an office building in the downtown area.

Risk Communications

Risk communications has been recognized as a vitally important public health intervention. The Agency conducted public consultations and public opinion research on key issues related to pandemic influenza that will inform both the Agency’s policy development and communications planning. Public information materials, including two posters and a brochure, were produced, translated into multiple languages and distributed to key stakeholders. Public service announcements that would offer Canadians information about pandemic influenza and how they can protect themselves were produced for radio, Web and print media, in preparation for a pandemic.

The Agency also continued to strengthen its networks with provincial and territorial counterparts, as well as with international partners, in the area of communications.

Federal, Provincial, and Territorial and International Collaboration

To address the shortages which limit the ability of provinces and territories and local public health authorities to meet the Agency's priorities for surveillance and response, the Agency established the Public Health Service Program. The Agency engaged core staff and undertook initial consultation for internal collaboration among field staff programs and completed the first round of consultations with provincial and territorial governments. This formed the basis for a second round of talks with provinces and territories and the establishment of official agreements to deploy Public Health Officers in the next fiscal year.

The Agency provided a $1 million grant to support the implementation of the WHO Global Action Plan to increase global pandemic influenza vaccine supply.

Immunization

Planned ($M)	Authorities ($M)	Actual ($M)
10.0	9.9	8.6*

* Actual spending was $1.3 million lower than authorities due to capacity and technical constraints.

What was planned

Immunization has proven to be one of the most effective types of public health intervention. Consistent with the National Immunization Strategy, which was accepted by the Conference of Federal, Provincial and Territorial Deputy Ministers of Health in 2003, the Agency planned to provide scientific, program, policy, information dissemination, coordination and administrative support to the federal, provincial and territorial Canadian Immunization Committee (CIC), and the National Advisory Committee on Immunization under the auspices of the Pan-Canadian Public Health Network, and to collaborate internationally on issues related to immunization and vaccine-preventable infectious diseases.

What was achieved

The planned initiatives were met and in some cases exceeded.

The Agency provided scientific, program, policy, information dissemination, coordination and administrative support to the federal, provincial and territorial Canadian Immunization Committee (NACI), and the National Advisory Committee on Immunization under the auspices of the Pan-Canadian Public Health Network.

With Agency participation and administrative support, NACI published the 7th edition of the Canadian Immunization Guide and distributed approximately 40,000 copies nationally. Also with Agency participation and administrative support NACI released its public health recommendations for the human papillomavirus (HPV) vaccine, the first vaccine approved for use in Canada to protect women and girls against cervical cancer. In order to facilitate timely and equitable access across Canada, Budget 2007 provided $300 million over three years to provinces and territories to launch HPV vaccine programs. The Agency took the leadership role in coordinating Canada’s first collaborative immunization program planning exercise. Both national committees, CIC and NACI, formed a joint task force to evaluate options and provide evidence to inform immunization programming planning decisions focussing on this vaccine.

The CIC approved the national cold chain guidelines for publications, received approval from the Pan-Canadian Public Health Network, to adopt the national goal for eliminating rubella and congenital rubella syndrome, and approved national goals and recommendations for five vaccine preventable diseases: influenza, invasive pneumococcal disease, invasive menningococcal disease, varicella and rubella. Under the guidance of the CIC an external consultant evaluated the National Immunization Strategy three years into its mandate.

The Agency published the Canadian National Report on Immunization, including information on vaccine preventable disease epidemiology, vaccine coverage, vaccine safety/adverse events, and progress with the National Immunization Strategy. Also published were:

• Guidelines for Prevention and Control of Invasive Group A Streptococcal Disease; and
• Data on Enhanced Surveillance of Invasive Meningococcal Disease (2002-2003).

To collaborate internationally on issues related to immunization and vaccine-preventable infectious diseases, the Agency worked with international agencies such as the World Health Organization and the Pan American Health Organization, continuing to provide technical leadership and advice for vaccine-preventable disease elimination and eradication globally. The Agency also participated in the International Circumpolar Surveillance Initiative in order to better understand the epidemiology of a variety of invasive bacterial diseases above the 60th parallel.

In collaboration with the Canadian Paediatric Society and the Canadian Association for Immunization Research and Evaluation, the Agency organized a Canadian Immunization Conference, which took place December 3-6, 2006, in Winnipeg, Manitoba, and drew more than 1,000 participants. The exchange of ideas and expertise at this conference is expected to help stimulate both the development and application of new scientific and technological advances.

Bloodborne Disease and Sexually Transmitted Infections

Planned ($M)	Authorities ($M)	Actual ($M)
52.8	52.8	52.8

There has been a steep increase in sexually transmitted infections over the last decade, and rising co-infections of HIV with diseases such as tuberculosis,hepatitis C and syphilis.

What was planned

In 2006-07 the Agency planned:

• to lead the Federal Initiative to Address HIV/AIDS in Canada;
• to put in place an approach to address the shared needs of discrete population groups at-risk of HIV/AIDS;
• to distribute national STI guidelines to health care practitioners and clinics across Canada;
• to monitor the infection rates of a wide range of sexually transmitted and bloodborne infections; and
• to use the Enhanced Surveillance of Canadian Street Youth to provide a comprehensive picture of the health of Canadian street youth including risk factors;
• to identify "best practice" models of school-based sexual health promotion.

What was achieved

All these plans were accomplished during 2006-07.

The Agency continued to lead the Federal Initiative to Address HIV/AIDS in Canada. The Federal Initiative is a partnership among the Agency, Health Canada, the Canadian Institutes of Health Research and Correctional Service Canada. Its aim is to prevent new infections, slow the progression of HIV/AIDS, improve the quality of life for affected people, reduce the social and economic impact of the disease, and contribute to the global efforts against the epidemic. Through this initiative, the Agency continued its efforts to strengthen the knowledge of HIV/AIDS to provide better information on prevention, care, treatment and support programs; increase public awareness of HIV/AIDS and factors that fuel the epidemic, such as stigma and discrimination; integrate, when appropriate, HIV/AIDS programs and services with those addressing other related diseases, such as STIs; engage federal departments in addressing factors that influence health, such as housing and poverty; increase Canadian participation in the global response to HIV/AIDS; and support partners to implement effective interventions to address HIV/AIDS.

During 2006-07, the Agency worked with national and international partners to update the estimates of national HIV incidence and prevalence in Canada for 2005. The new estimates were released prior to the International AIDS Conference in Toronto in August 2006 and are now being used to guide program and policy actions. The Agency also continued to develop Canada’s second-generation HIV surveillance program for monitoring HIV and related risk behaviours among groups at high risk for HIV infection. The monitoring program for people who use injection drugs now has sites from Quebec to British Columbia, while the program for men who have sex with men completed its first round of surveys in Montreal and in Ontario. A similar pilot study for people from countries where HIV is endemic was started in the Montreal Haitian community.

As part of its efforts to contribute to the global response, the Agency supported the Canadian HIV Vaccine Initiative, announced by the Prime Minister in February 2007, to develop safe and effective HIV vaccines. The Agency’s partners in this Initiative include Health Canada, the Canadian Institutes of Health Research, the Canadian International Development Agency (CIDA), Industry Canada, and the Bill & Melinda Gates Foundation. Also, the Agency supported the establishment of an effective second-generation HIV/AIDS surveillance system in Pakistan, which is being funded by CIDA. The information acquired through this system will be used by the Government of Pakistan to monitor the epidemic and to plan, implement and evaluate an expanded response.

The HIV Genetics Research Program continued its work in the field of molecular epidemiology, allowing researchers to use the genetic code of HIV sub-types to assist public health efforts by identifying clusters of infections, supporting outbreak investigations and informing prevention efforts for specific target groups.

The Agency worked with EKOS Research Associates to produce the HIV/AIDS Attitudinal Tracking Survey of 2006, and in partnership with Health Canada, First Nations and Inuit Health Branch (FNIHB), to produce the first HIV/AIDS Aboriginal Attitudinal Survey 2006. These surveys offered an overall picture of knowledge, attitudes and behaviours related to HIV/AIDS in Canada, and insight into the extent and causes of HIV/AIDS related stigma and discrimination, providing the foundation towards the development of the first national Agency-led HIV/AIDS social marketing campaign.

The Agency participated in a multi-stakeholder project to create a Canadian HIV Vaccines Plan which outlines a wide range of recommended actions for researchers, government, community and international organizations. This plan has been recognized internationally as one of the first country wide HIV vaccine plans that promotes a comprehensive strategy for vaccine, advocacy and funding. The Canadian HIV Vaccines Plan can be found at: http://www.phac-aspc.gc.ca/aids-sida/pdf/publications/vaccplan_e.pdf.

Through the AIDS Community Action Program, the Agency continued to fund community-based organizations to support the delivery of HIV/AIDS prevention education, to create supportive environments for those infected with and affected by HIV/AIDS, and to increase the capacity of people living with HIV/AIDS to manage their condition through 148 projects across Canada.

During 2006-07, steps were taken to address the shared needs of discrete populations at risk of HIV infection by launching the new Specific Populations HIV/AIDS Initiative Fund. Experts and stakeholders were engaged to assist the development of Population-Specific HIV/AIDS Status Reports for gay men, for women, for Aboriginal people, and for people from countries where HIV is endemic.

Success Stories In 2006-07, the Agency’s Quebec Region provided financial support for the Refugee Project (Projet pour les réfugiées), to develop mechanisms for collaborative action adapted to refugees’ particular health needs. With partners including Royal Victoria Hospital, St Justine’s Hospital, the Centre Social d'Aide aux Immigrants, the Service d'Aide aux Réfugiés et Immigrants, and Maison Plein Coeur the project is designed to provide people living with HIV/AIDS who have applied for, or been granted refugee status, access to health services and support to develop social and community networks that will further their integration into society. Reducing social isolation is viewed as key to improving the health status of this population, and project benefits have already been noted at the local, regional and national levels. The Agency’s Ontario/Nunavut Region developed and distributed the first annual Ontario Community HIV/AIDS Reporting Tool (OCHART) reporttitled The View from the Front Lines. This report provides a summary and analysis of data collected by the Ontario Ministry of Health and Long-term Care and from four years of Agency-funded projects using a tool jointly developed by both levels of government. The analysis was designed to provide a general picture of HIV/AIDS prevention, care and support activity in Ontario. The report provides invaluable intelligence to the AIDS Bureau, the Agency and the funded agencies helping to understand the demand for services, identify any shifts and changes in trends and provides an evidence base for future research and prevention projects. The OCHART report may be viewed at the following link: https://www.ochart.ca/OCHART Report March (Final 2006-03-19).PDF. The Agency’s Ontario/Nunavut Region commissioned the Youth Engagement Research Unit at the University of Toronto Centre for Health Promotion to carry out an environmental scan of youth engagement activities in Ontario. Interviews were conducted with youth organizations in urban, rural and remote communities to identify existing activities and networks, with a focus on hepatitis C, HIV and sexually-transmitted infections and the determinants of health. A final report identified gaps, opportunities, successes and challenges of youth engagement activities, and provided recommendations for the development of a regional youth network. For more information see: http://www.youthvoices.ca.

The 2006 Canadian Guidelines on Sexually Transmitted Infections, which represents the most current available knowledge on the management of sexually transmitted infections, was made available to health care professionals on the Agency website. Agency officials participated in the expert working group which developed these guidelines.

The Agency continued to monitor the infection rates of a wide range of sexually transmitted and bloodborne infections, and to undertake blood safety surveillance including building the necessary leadership, scientific expertise and infrastructure to support its ongoing core surveillance projects directed towards the collection of detailed information on:

• Risk factors on blood-borne pathogens like hepatitis B, C viruses and HIV in the general population as well as in occupational settings. This included projects like the Enhanced Hepatitis Strain Surveillance System (EHSSS) and the Canadian Needle Stick Surveillance System (CNSSN).
• Incidence of adverse transfusion events and transfusion errors. This included projects such as the Transfusion Transmitted Injuries Surveillance System (TTISS) and the Transfusion Error Surveillance System (TESS).

The Agency has also undertaken efforts to broaden networks and increase knowledge transfer activity to better manage public health risks across Canada. As examples, the Agency is in the process of assessing data from Canadian hospitals related to accurate and ongoing neonatal/ paediatric transfusions as well as blood conservation for transfusion purposes. The aim is to develop better approaches, relevant risk evaluations and equations, and the development of options to better protect Canadians from existing, emerging and re-emerging infectious diseases.

The Agency used the Enhanced Surveillance of Canadian Street Youth (E-SYS) system to provide a comprehensive picture of the health of Canadian street youth. Based on data from the Enhanced Surveillance of Canadian Street Youth system, several reports were released on rates of sexually transmitted infections and blood-borne infections, risk behaviours and health determinants in this population. This surveillance pilot project, undertaken in collaboration with external stakeholders, led to the development of more effective mechanisms to reach street youth and provide testing and care for HIV, sexually transmitted infections and related infections.

Work was also conducted towards the development of data standards for sexually transmitted and bloodborne infections in order to improve national data quality and timeliness.

"Best practice" models of school-based sexual health promotion were identified so that future initiatives could be more effective.

Health Care Acquired Infections

Planned ($M)	Authorities ($M)	Actual ($M)
3.7	3.6	3.6

What was planned

It is estimated that about 5% to 10% of all patients who enter a Canadian health care facility will develop a health care acquired (Nosocomial) infection. To address this, the Agency’s plans for 2006-07 were to:

• expand the scope of its Infection Control Guidelines, including using survey information to revise the Guideline on Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care;
• update the Infection Control and Occupational Health Guidelines During Pandemic Influenza In Traditional and Non-Traditional Health Care Settings, as part of the Canadian Pandemic Influenza Plan; and
• complete analysis of a previously conducted Clostridium difficile (C. difficile) survey and publish a report.

What was achieved

The Agency reviewed, revised, and expanded the scope of its the Infection Control Guideline Series, which are widely used by health care providers, governments and other institutions to provide best-practice information on the prevention and control of infections. These guidelines now have been adapted for the entire spectrum of Canadian health care providers, such as acute care and long-term care institutions, office and outpatient care, and home care. The Guidelines can be found at: http://www.phac-aspc.gc.ca/dpg_e.html#infection.

Revision of the Infection Control Guidelines was accomplished in collaboration with a national and multi-disciplinary steering committee, reporting to the Communicable Disease Control Expert Group (CDCEG) of the Pan-Canadian Public Health Network. The steering committee was established as an advisory and directing body to facilitate the development and maintenance of the Public Health Agency of Canada’s Infection Control Guideline Series.

The Agency advanced its work reviewing and revising, as part of the Canadian Pandemic Influenza Plan (CPIP), Annex F: the Infection Control and Occupation Health Guidelines during Pandemic Influenza in Traditional and Non-Traditional Health Care Settings. The work was accomplished in collaboration with a multi-disciplinary team from across Canada.

Clostridium difficile (C. difficile) is the most common cause of infectious diarrhea in hospitals in the industrialized world. During 2006-07, the Agency also completed its analysis of a previously conducted C. difficile survey, designed to identify the infection prevention and control practices that are in place in all Canadian acute care and long term care facilities. This study also determined if there were differences between infection control practices in larger or smaller hospitals as well as differences between acute care hospitals and long term care facilities. Results from the survey will allow inter-provincial/territorial comparisons of routine infection control practices and added precautions related to C. difficileassociated diarrhoea. Results will also enable single institutions to compare their infection control practices to those of similar institutions.

The Canadian Nosocomial Infection Surveillance Program (CNISP) represents a collaborative effort of the Agency and of the Canadian Hospital Epidemiology Committee (CHEC), a subcommittee of the Association of Medical Microbiologists and Infectious Diseases-Canada. The objectives of CNISP are to provide rates and trends on nosocomial infections at Canadian health care facilities thus enabling comparison of rates (benchmarks), and providing evidence-based data that can be used in the development of national guidelines. CNISP network expansion in major teaching hospitals is critical towards reaching community care and long-term care facilities, in order to develop a complete national health care-acquired infection surveillance program. During 2006-07, CNISP network of sentinel hospitals expanded to 49, so that the Agency’s plan was achieved.

In summary, the Agency accomplished all activities planned for Health Care Acquired Infections in the 2006-07 Report on Plans and Priorities with the exception of revising the Guideline on Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.

Animal-to-Human (Zoonotic) Diseases

Planned ($M)	Authorities ($M)	Actual ($M)
20.7	20.4	18.7*

    * Actual spending was $1.7 million lower than authorities due to capacity and technical constraints.

What was planned

The economic effects of diseases that can be transmitted between animals and humans (zoonotic diseases) range from lost productivity to restrictions on international trade and travel. With its specialized laboratories, the Agency is taking national leadership in addressing such diseases. During 2006-07 the Agency planned to:

• continue research on and surveillance of the West Nile virus in an effort to minimize the risk to Canada’s blood supply;
• update existing guidelines and host a national conference on Lyme disease;
• continue its collaboration with regional health authorities across Canada in the implementation of the Canadian Network for Public Health Intelligence (CNPHI)
• perform expert microbiological reference testing and carry out innovative research to improve Canada's capacity for identifying viruses and bacteria
• continue to generate, synthesize and communicate science-based information related to the prevention and control of public health risks associated with infectious gastrointestinal diseases at the human, animal and environmental interface;
• through the National Enteric Surveillance Program (NESP), continue to collect, and disseminate weekly, laboratory-based data on human gastrointestinal pathogens;
• continue to study the incidence, burden, cost and risk factors, and the phenomenon of under-reporting, of infectious gastrointestinal illness in Canada; and
• lead the development of a national contingency plan for raccoon rabies.

What was achieved

Through the Foodborne, Waterborne and Zoonotics Infections Division and the National Microbiology Laboratory, the Agency continued research on and surveillance of the West Nile virus. Through the National West Nile Virus Surveillance Program, the Agency continued to lead the federal government's response to West Nile virus. The program coordinates overall federal, provincial and territorial West Nile virus-related activities, including surveillance, public education and awareness, and research into the ecology, spread and risk factors of the disease. This work was done in collaboration with Canada’s blood agencies.

The Agency hosted a national conference on Lyme disease, as a first step toward providing recommendations for updating existing Lyme disease guidelines.

The Agency continued its collaboration with regional health authorities across Canada in the implementation of the Canadian Network of Public Health Intelligence (CNPHI) which was expanded to provide additional Web-based resources, including outbreak summaries of foodborne and waterborne disease, web-NESP (National Enteric Surveillance Program), syndromic surveillance data, infectious disease modelling tools and West Nile virus surveillance. A special data-extraction method was used to integrate CNPHI information with existing federal, provincial, and regional public health databases while maintaining the confidentiality of personal data and respecting jurisdictional responsibilities. CNPHI was also made available to other government departments with public health links, creating broader intergovernmental integration, to facilitate the necessary collection and processing of surveillance data, dissemination of strategic information, and coordination of responses necessary to meaningfully address these public health threats.

Performing expert microbiological reference testing and carry out innovative research to improve Canada's capacity for identifying viruses, prions, and bacteria relied on Agency expertise in laboratory biosafety, which is recognized worldwide, and on the high-level containment capacity of the Canadian Science Centre for Human and Animal Health in Winnipeg, which houses both the Agency's National Microbiology Laboratory (http://www.nml.ca/english/index.html) and the Canadian Food Inspection Agency's National Centre for Foreign Animal Disease.

Agency laboratories continued to perform such reference testing and research, which is often used to support surveillance and outbreak investigation. For example, the Agency provides routine and reference diagnostics for a wide range of zoonotic disease agents, many of which are not tested for at the provincial level. Laboratory-based surveillance documents the circulation within Canada of diseases such as Lyme disease, Q fever and hantavirus pulmonary syndrome.

Innovative research using genome-based tools was undertaken to develop methods for the rapid identification of disease agents (pathogens), for example, the use of microarrays for typing Salmonella.

Through the National Enteric Surveillance Program (NESP), the Agency continued to collect, and disseminate weekly, laboratory-based data on human gastrointestinal pathogens.

The Agency continued to study the incidence, burden, cost and risk factors, and the phenomenon of under-reporting, of infectious gastrointestinal illness in Canada.

The Agency also continued to generate, synthesize and communicate science-based information related to the prevention and control of public health risks associated with gastrointestinal infectious diseases at the human, animal and environmental interface. Significant advances were made in the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). Changes in data management allowed direct access to the most current data available for reporting purposes and global analysis for the stakeholders (CIPARS managers, Provincial Public Health Laboratories and Animal Health Laboratories participating in CIPARS). CIPARS surveillance findings were used as a successful policy lever whereby Quebec chicken industry groups banned the use of a specific antibiotic (ceftiofur) on hatching and day-old chicks; thus reducing drug resistance and retaining a treatment option for humans.

The Agency also continued to provide national coordination and support to the investigation and control of outbreaks of foodborne and waterborne diseases such as identification of outbreaks due to fresh produce (e.g. spinach) and their recall from retail sales.

In summary, the Agency accomplished all activities planned for Animal-to-Human (Zoonotic) Diseases in the 2006-07 Report on Plans and Priorities with the exception of leading the development of a national contingency plan for raccoon rabies and publishing fully updated guidelines on Lyme disease.

Success Story: Rift Valley Fever in Kenya In December 2006, Kenya experienced an outbreak of Rift Valley Fever (RVF) which affects humans and animals. Kenya’s Ministry of Health requested assistance from the World Health Organization (WHO), which in turn solicited diagnostic support in the form of a mobile laboratory from the Agency’s National Microbiology Laboratory. In January 2007, five scientists from the Agency were selected to participate in the mission and were deployed to Kenyas’s Garissa District - the epicentre of the outbreak. The Agency team provided guidance in carrying out health care facility-based, laboratory-based, and community-based surveillance for RVF. Support was also provided with surveillance data management, analysis, interpretation and dissemination. This work is part of the Agency's commitment to assist in public health emergencies anywhere in the world, and will help prepare Canada for similar national public health emergencies.

 

Canadian Public Health Laboratories Expert Group The Agency continued to provide the official federal representation as well as secretariat, policy, technical, and financial support to the Canadian Public Health Laboratories Expert Group of the Public Health Network. This Expert Group’s role is to provide strong leadership in public health laboratory functions through the development of a proactive Federal and Provincial network of public health laboratories, as well as strategic direction in public health laboratory science and diagnostics to protect the health of Canadians.

Other Activities Associated with Infectious Disease Prevention and Control

The Agency took steps to enhance programs in biotechnology, genomics and population health, through expanding capacity, base knowledge and technical expertise aimed at increasing response and action related to national public health threats.

Health Promotion and Chronic Disease Prevention

Planned ($M)	Authorities ($M)	Actual ($M)
284.7	222.6*	211.3**

    * The difference between planned spending and authorities represents the provision of $51 million in funding to Health Canada instead the Agency for the Canadian Strategy for Cancer Control, and other funding reallocations totalling $11.1 million.

  ** The $11.3 million difference between authorities and actual, approximately $8.0 million was due to constraints in accommodations, staffing, and contracting which impeded reaching budgeted staff and operating levels. (Of this, approximately $2.6 million was associated with the Integrated Strategy on Healthy Living and Chronic Disease.) Also, the Agency’s regional organization was unable to use $2.3 million as planned for supporting demonstration projects. Additionally $1.0 million in resources earmarked for launch of ParticipACTION could not be utilized for this purpose.

The Agency’s comprehensive approach to health promotion and chronic disease brings together non-governmental organizations, experts, provinces and territories, and communities to improve the health of Canadians, prevent injury, and reduce the incidence of major chronic diseases such as heart disease and stroke, cancer, diabetes, and respiratory disease.

The burden of preventable death and disease in Canada has been growing, reducing quality of life, increasing wait times for care, and challenging the sustainability of the health system. And while chronic disease remains the leading cause of death and disability in Canada, up to two-thirds of the death and disability that occur prematurely could be avoided. Health promotion and risk reduction initiatives can play an important role in reducing the impact of chronic disease.

Each person has factors that determine their risk of chronic disease. Some of these, such as genetics, age and gender, cannot be changed. However, up to 80 per cent of Canadians have at least one modifiable risk factor such as unhealthy eating, unhealthy weight, physical inactivity, or smoking which could be changed to improve their health and reduce their risk of chronic disease. Obesity is of particular concern: about 65 per cent of men and 53 per cent of women did not have healthy weights in 2004 and an estimated 26 per cent of children and youth between the ages of 2 and 17 were either overweight or obese.

As the Canadian population ages and if obesity rates continue to rise, increased rates of diabetes, cancer, and cardiovascular disease can be expected. Without focused and integrated action, these and other chronic diseases will continue to place extraordinary burdens on individual Canadians and on the Canadian health care system.

The Agency supports the development of tools and resources used by communities and professionals to improve health and prevent and control chronic disease. It facilitates collaboration, networking, capacity building, and leadership in government-wide efforts to advance action, with a view to building a healthier nation, decreasing health disparities, and contributing to the sustainability of the health care system in Canada. Since its inception in 2004, the Agency has had a positive impact on the growth of chronic disease knowledge in Canada, and has influenced a more cohesive and coordinated approach to health promotion and chronic disease control by decision-makers and health professionals.

Integrated Healthy Living and Chronic Disease Strategy

A. Chronic Disease

What was planned

The Agency planned to implement the Integrated Strategy on Healthy Living and Chronic Disease, using the $300 million over five years announced in September 2005, in collaboration with other members of the Health Portfolio, federal departments and agencies, and a range of stakeholders. To do so, the Agency planned to continue to develop and promote policies and programs which would improve the health of Canadians, reduce the impact of chronic disease, and address the key determinants of health. This included general and disease-specific approaches to address conditions that lead to unhealthy eating, physical inactivity and unhealthy weight; prevent chronic disease through concerted action on major chronic diseases and their risk factors; and support early detection and management of chronic disease.

As part of this process, the Agency planned to:

• Continue to work with stakeholders and experts to develop an Observatory of Best Practices which would include a broad range of interventions at the community level;
• Work with non-governmental organizations, experts, and provinces/territories to implement shared priorities in chronic disease surveillance, including indicators on the nature and scope of health problems, and factors to be addressed to improve the health of the Canadian population; and
• Assess risk factors for chronic disease, including behavioural, social and environmental factors, and to continue to support the ongoing development of health promotion and chronic disease prevention and management interventions.

What was achieved

All items planned in the 2006-07 were successfully achieved.

The Agency launched the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention in November 2006. Finding and using best practices is a key part of delivering effective initiatives. The Canadian Best Practices Portal (http://cbpp-pcpe.phac-aspc.gc.ca) provides an array of evidence-based best practices in health promotion and chronic disease prevention. The Portal supports decision-makers in practice, policy and research working at all levels across the country. Currently, the Portal focuses on community interventions addressing cardiovascular disease, cancer, diabetes and their key risk factors as well as the promotion of healthy living. Feedback from Portal users and participants at Portal awareness sessions and live demos has been very positive. The Portal received 12,200 unique visitors from its launch on November 16, 2006 to July 17, 2007. Users regularly submit nominations for best practices and suggestions regarding other resources for posting on the portal.

Tracking trends and statistics related to chronic disease in Canada supports policy makers and researchers in making more informed and more effective decisions about chronic disease prevention, control, and management. The Agency expanded its activities around the development of a national approach to chronic disease surveillance, including:

• Consulting with national stakeholder advisory groups to develop the Indicator Framework for Surveillance of Chronic Diseases (including mental illness, cardiovascular diseases, chronic respiratory disease, and arthritis);
• Completing five pilot projects which used provincial/territorial administrative databases (such as hospital discharge and physician billing records) for surveillance of mental illness, asthma, chronic obstructive pulmonary disorder, arthritis, and hypertension;
• Extending the Non-Communicable Diseases Surveillance Infobase, an internet web surveillance tool (http://www.cvdinfobase.ca) to include a broader range of diseases, and adding a component which enables analysis at the regional level. This provides stakeholders across all Canadian jurisdictions access to a larger statistical database on chronic disease; and
• Establishing a Task Group on Surveillance of Chronic Disease and Injury to focus on the gaps in available data to report on chronic disease and its determinants and the impact of policies, programs and services on the population's health.

The Agency provided grants for research on risk factors for diabetes, including the numbers of Canadians exposed to different types of risk factors. By enhancing knowledge of the impact of dietary factors, physical activity, and obesity not just on diabetes, but also on cancer and cardiovascular disease, such studies enable public health officials to plan effective interventions.

Agency scientific expertise supported federal efforts related to eating disorders and obesity, policy directions and priorities on food, health claims on food, the development of nutritional indicators, and the revision of Canadian growth monitoring standards. Together, these efforts ensured that policies, programs, information, and services related to monitoring and assessment of risk factors were informed by domestic and international policy and practices, and were responsive to the needs and concerns of Canadians. Also, the Agency collaborated with Health Canada on the revised Canada’s Food Guide, which identified the connection between healthy eating behaviours (portion size, healthy choices) and decreased risk for chronic disease.

The Agency published the report How Healthy are Rural Canadians; An Assessment of their Health Status and Health Determinants (http://www.phac-aspc.gc.ca/publicat/rural06/index.html) examined differences in health between rural and urban Canadians, and explored disadvantages and disparities facing rural communities in Canada. The Agency also released The Human Face of Mental Health and Mental Illness in Canada 2006 (http://www.phac-aspc.gc.ca/publicat/human-humain06/index.html) raising awareness and increasing knowledge and understanding about mental health and mental illness in Canada. This is an update to a 2002 report, with new chapters on mental health, problematic substance use, gambling, and hospitalization.

The Agency continued the development of an enhanced mental illness surveillance system. Pilot projects were completed in five centres across the country to develop case definitions for mental illness to be used with provincial and territorial administrative databases. Work was undertaken with the Canadian Psychological Association to develop an Internet-based surveillance method to collect data from psychologists in various clinical settings. Contacts were made with companies that manage disability programs and supplementary health benefits to provide data on prescriptions for mental illness, short and long-term disability claims for mental illness, and services to psychologists.

Chronic Disease and Injury Prevention and Control Expert Group The Agency continued to provide the official federal representation as well as secretariat, policy, technical, and financial support to the Chronic Disease and Injury Prevention and Control Expert Group of the Public Health Network. This Expert Group is responsible for providing strong leadership in chronic disease and injury prevention and control through the development, recommendation and implementation of national policies, practices, guidelines and standards from a federal, provincial and territorial context.

Cardiovascular Disease

Eight in ten Canadians have at least one risk factor (hypertension, smoking, stress, obesity, diabetes) for cardiovascular disease, and one in ten have three or more risk factors.

What was planned

In collaboration with other members of the Health Portfolio, and with provinces, territories, and key stakeholders, the Agency planned to work toward the establishment of a pan-Canadian Cardiovascular Disease Strategy and Action Plan.

What was achieved

In October, 2006, the Minister of Health announced funding to develop a heart health framework, and to address hypertension and cardiovascular disease surveillance in Canada. Development of the Canadian Heart Health Strategy and Action Plan was initiated, and common interest areas such as strengthening information systems, prevention and detection of major risk factors, timely access to care, knowledge development and translation into practice, intervention impacts and outcomes, and Aboriginal/indigenous cardiovascular health were identified. The Agency entered into a funding agreement that enabled the Heart and Stroke Foundation of Canada to provide administrative support to the Expert Group developing the Strategy and Action Plan.

An Expert Advisory Committee on Hypertension was established to provide scientific and expert advice to the Chief Public Health Officer. Funding was provided for a number of hypertension prevention and control projects endorsed by the Committee as making important contributions to heart health. To contribute to better consistency in the reporting of hypertension, the Agency completed several surveillance pilot projects designed to further develop and clarify case definitions.

Diabetes

Approximately 2 million Canadians live with diabetes, although as many as one third may not know they have it. Rates of type 2 diabetes, which account for approximately 90 per cent of all cases, increased by 27 per cent between 1994 and 2000. Evidence shows that type 2 diabetes can be prevented or delayed through lifestyle modification efforts to reduce weight, eat healthy food, and be physically active.

What was planned

The Agency planned to advance action on the non-aboriginal elements of the renewed Canadian Diabetes Strategy (http://www.phac-aspc.gc.ca/ccdpc-cpcmc/diabetes-diabete/english/strategy/index.html)by working with the Canadian Diabetes Association, provinces, territories and other national and international partners to maintain a coordinated approach to diabetes which maximizes impact and reduces duplication.

What was achieved

Ongoing commitments were made in the areas of partnership development, diabetes prevention and control, surveillance, research, community-based programming, and national coordination. Activities included:

• Continuing to build partnerships with the Canadian Diabetes Association, the Kidney Foundation of Canada, the Canadian National Institute for the Blind, the Juvenile Diabetes Research Foundation, and Diabète Quebec. With these groups, the following new directions and focus for the Canadian Diabetes Strategy were established: diabetes prevention among high risk populations; supporting approaches to enable earlier detection of type 2 diabetes; and decreasing complications experienced by those living with type 1and type 2 diabetes;
• Through the Public Health Network, establishing priorities with provincial and territorial members for diabetes community-based programs;
• Expanding the National Diabetes Surveillance System to track several conditions associated with diabetes such as renal failure, amputation, and cardiovascular disease, and increasing the involvement of First Nations populations in tracking Aboriginal diabetes data; and
• Approving and funding 52 projects with a wide range of objectives, including: building community capacity, knowledge, awareness, and education; conducting diabetes risk assessment; identifying and disseminating prevention and control interventions; and piloting screening studies among the general population and those at risk.

Success Story: Primer to Action An ongoing challenge in the field of health promotion is to develop programs which address the needs of marginalised populations and which consider barriers such as poverty and social isolation. With funding from the Agency’s Canadian Diabetes Strategy program, the Ontario Chronic Disease Prevention Alliance developed a document which will help public health stakeholders develop more effective programs and policies to address chronic disease. Primer to Action: Social Determinants of Health is a resource to help health professionals, lay workers, volunteers and activists explore how the social determinants of health impact on chronic disease and how they need to be considered in the design of programs and policies.

Cancer

Cancer is the leading cause of premature death in Canada In 2007, the number of new cases is estimated to be 159,900 and the number of deaths to be 72,700. This is an additional 6,800 new cases over the estimate for 2006.

What was planned

The Agency planned to lead the implementation of the Canadian Strategy for Cancer Control (CSCC) (http://www.cancer.ca/ccs/internet/standard/0,3182,3172_335265__langId-en,00.html) to help improve cancer screening, prevention and research activities, and to help coordinate efforts with provinces, territories and cancer care advocacy groups. The CSCC’s main objectives are to: reduce the number of new cases of cancer among Canadians; enhance the quality of life of those living with the disease; and lessen the likelihood of Canadians dying from cancer.

Other planned cancer activities included collaborating with stakeholders to address breast cancer issues ranging from prevention to palliative care through the Canadian Breast Cancer Initiative examining the implications of childhood cancer on Canada’s health care system, and addressing knowledge gaps through the Canadian Childhood Cancer Surveillance and Control Program.

What was achieved

The Agency was a key stakeholder in the development of the Canadian Strategy on Cancer Control (CSCC) and provided secretariat support to the CSCC’s Action Groups. In November 2006, the Prime Minister announced the creation of the Canadian Partnership Against Cancer (CPAC), an arms length, not-for-profit entity that would be responsible for implementation of the CSCC. The Agency continued to support the work of the Action Groups and facilitated the transition of responsibility for the CSCC to the new entity. As part of this transition the Agency provided funding to enable the National Aboriginal Organizations to develop their capacity to participate in the CSCC.

The Agency contributed substantially to the publication of Canadian Cancer Statistics 2007 in collaboration with the Canadian Cancer Society and Statistics Canada. It provides current information on cancer incidence and mortality, and monitors cancer trends. Cancer in Young Adults, published jointly by Cancer Care Ontario and the Agency, reported on issues related to the exposure of young adults to carcinogens. These knowledge-building reports were developed to stimulate research, assist decision-making, and contribute to health care planning.

The Agency developed and delivered provincial training modules related to the collection of cancer stage information for breast, prostate, colorectal, lung, head and neck cancers in provincial/territorial cancer registries. The training helped to increase reporting consistency across the country, led to a more accurate national picture regarding the stages of cancer, and contributed to increased provincial cancer registry staging capacity.

Wait times, quality of life, and use of health care services are priorities in Canadian health care planning. With collaborators, the Agency initiated and completed studies examining these topics in relation to children and adolescents with cancer.

While continuing to fund breast cancer projects, the Agency consulted with key stakeholders in the breast cancer community to ensure the ongoing relevancy, timeliness, and effectiveness of its community capacity-building activities. This process was integral to understanding the needs of the community-based organizations which provide breast cancer detection and management services to Canadians. To determine programming needs, the Agency gathered and assessed information on community needs and priorities for outreach support for diverse populations, developed sustaining partnerships for networks and coalitions, and coordinated information needs for those with advanced breast cancer.

The Canadian Breast Cancer Research Alliance (CBCRA), the largest portion of the Canadian Breast Cancer Initiative, successfully undertook an independent evaluation. The study, which was supplemented by an External Review Panel, was very positive about CBCRA's achievements.

International Non-Communicable Disease Policy

On the international front, the Agency houses the WHO Collaborating Centre on Non-Communicable (Chronic) Disease Policy (WHOCC), under the scientific leadership of the Deputy Chief Public Health Officer. As the only collaborating centre on non-communicable disease (NCD) policy in the Americas and Europe, the Agency’s WHO Collaborating Centre has become a global centre of excellence in the analysis of chronic disease policy development and implementation.

The WHOCC was also co-leading, with the Pan American Health Organization, in the development of the Chronic Non-Communicable Disease Policy Observatory. The purpose of the observatory is to support more effective NCD related policy formulation and implementation and to create strong international and multisectoral collaboration in NCD prevention on policy development and implementation. Over the past year, the observatory boosted the technical capacity of policy analysis in a number of countries of the Americas such as Costa Rica and Brazil, and in European countries such as Russia, Slovenia and Spain.

The WHOCC, through the Deputy Chief Public Health Officer, coordinates an international policy working group on non-communicable disease policy. In this regard, over the last year, it has provided technical support to the development of the European Regional Strategy and action plan on chronic disease as well as the PAHO regional action plan on chronic disease. It has also supported the development of policy consultations and case studies on chronic disease in a number of countries in Europe and in the Americas that are participating in the WHO regional network for chronic diseases such as the Conjunto do Acciones para la Reduccion Multifactorial de las Enfermedades No Tranmisibles (CARMEN) and the Countrywide Integrated Non-communicable Disease Intervention (CINDI).

WHOCC has played an integral role in the development and signing of a Framework for Cooperation on Chronic Diseases between the WHO and Canada, the objective being to promote joint actions aimed at strengthening the global response to chronic disease. The areas of cooperation were: policy development and evaluation, development and dissemination of best practices; implementation of the Global Strategy on Diet, Physical Activity and Health; Cancer prevention and control.

B. Healthy Living Strategies

Research has demonstrated that physical activity and healthy eating play a key role in improving health and preventing disease, disability and premature death. However, physical inactivity and unhealthy eating among Canadians have continued to rise, as have rates of obesity. Obesity exacerbates nearly all physical chronic conditions, significantly contributes to the incidence of chronic disease complications and can adversely affect mental health. By working collaboratively with partners and other levels of government, the Agency is committed to policies to improve the opportunities in physical activity and healthy eating and to help make healthy choices easier for all Canadians.

What was planned

In 2006-07, the Agency planned to work across the Health Portfolio, with other federal departments and agencies and in collaboration with a range of stakeholders to promote the health of Canadians by addressing the conditions that lead to unhealthy eating, physical inactivity and unhealthy weight by means of the following activities:

• Providing funding support to the voluntary sector to develop and exchange knowledge, and build capacity at regional, national and international levels;
• Participating in the Joint Consortium for School Health to promote the health of children and youth in school settings.
• Fostering collaboration and improved information exchange among sectors and across jurisdictions through the Intersectoral Healthy Living Network

What was achieved

In 2006-07, the Agency continued to advance its health promotion agenda in the area of healthy living through a range of initiatives:

• The Children’s Fitness Tax Credit (CFTC), which came into effect on January 1, 2007, establishes economic conditions that support regular physical activity. The Agency participated in a print and web advertising campaign which informed Canadians about the new CFTC, and promoted participation in physical activity and sport for children and youth.
• In 2006, the Agency announced renewed federal support to ParticipACTION, which will undertake marketing and communications activities to help advance federal communications objectives around physical activity and healthy eating. Canadian Heritage (Sport Canada) is also providing federal support to ParticipACTION.
• The Agency contributed funding to 14 non-governmental organizations to undertake enhanced evaluations of their initiatives to ensure that the programs are having the desired impact. The enhanced evaluations included activities such as evaluating basic performance data associated with the individual initiatives; identifying best practices for healthy living interventions; measuring changes in awareness and understanding of the relationship between physical activity and healthy growth and development, as well as uptake and on-going use of resources; and, identifying and measuring effective means for disseminating evidence-based research associated with physical activity, with the goal of developing user-friendly resources for use by grassroots practitioners and organizations.
• In 2006, the Agency also developed a framework for creating Bilateral Agreements on Physical Activity and Healthy Eating with provincial and territorial governments based on activities of mutual interest.
• Through the Canadian Fitness and Lifestyle Research Institute (CFLRI) (www.cflri.ca), the Agency supported the Physical Activity Benchmarks Program, which monitors changes in physical activity within the population, as well as the Institute’s analysis of the Canada Community Health Survey, which contains physical activity questions.
• Through Canada’s Physical Activity Guide to Healthy Active Living (http://www.phac-aspc.gc.ca/pau-uap/paguide/), the Agency continued to disseminate and promote national physical activity guidelines aimed at children, youth, adults, and older adults. Between April 2006 and March 2007, 2,751,446 copies of the Guides and related resources were distributed to Canadians and abroad.
• The Agency also partnered with the provinces and territories to deliver SummerActive (www.summeractive.org/en/) and WinterActive annual seasonal initiatives that raise awareness of how Canadians can take their first steps to improving their health and mobilize community actions that focus on local opportunities for physical activity, healthy eating and other healthy behaviours.
• The Agency participated in various working groups which oversaw health survey development, including the Canadian Community Health Survey, to ensure that surveys continued to maintain and develop content relevant to physical activity surveillance.
• The Agency created and executed a successful advertising campaign aimed at promoting a healthy lifestyle before and during pregnancy. Launched in February 2007, the campaign targeted women 18 to 29 years old and relied on out-of-home advertising tactics: posters in public transit, doctor’s offices, bars and restaurants, as well as internet banners. The advertisements encouraged women to seek more information on healthy pregnancy by calling 1 800 O-Canada or by visiting www.healthycanadians.ca—a single gateway to a variety of authoritative information on the subject. Although the campaign ran for only 6 weeks, according to survey results, it reached a substantial 28 per cent of the targeted audience. As part of the campaign, the Agency also created and distributed in print and electronic versions 230,000 copies of the Sensible Guide to a Healthy Pregnancy.

The Agency is responsible for co-chairing and providing secretariat support to the Healthy Living Issue Group (HLIG) which reports to the Council of the Public Health Network (Federal/Provincial/Territorial) through the Population Health Promotion Expert Group (to which the Agency also provides policy and secretariat support). The HLIG is tasked with reporting on progress in meeting the targets and outcomes contained in the Pan-Canadian Healthy Living Strategy. Both an Evaluation Working Group and a Disparities Working Group were struck in 2006 to support the work of the Issue Group.

The Issue Group continues to provide leadership for the Intersectoral Healthy Living Network and ensures that the purpose and guiding principles of the Pan-Canadian Healthy Living Strategy are upheld. The Intersectoral Healthy Living Network acts as a virtual network to bring together key players across sectors and jurisdictions on activities related to healthy living in order to advance the Pan-Canadian Healthy Living Strategy.

Through its association with the Joint Consortium for School Health (JCSH), the Agency continued to promote healthy eating and physical activity in the school setting. The JCSH provides leadership and facilitates a coordinated approach to school health by encouraging collaboration between the health and education sectors. In 2006-07, the JCSH developed draft knowledge summaries and quick scans on physical activity and nutrition to share with member provinces and territories. In addition, two national events took place: a National Conference on School Health and a national meeting on data and monitoring to discuss the need for regular, reliable and timely information for schools relating to programs, policies and the health of school-aged children.

Success Stories - Partnership Initiatives Promoting Public Health and Prevention One of the ways the Agency supports prevention program across the country is to facilitate effective evaluation and research processes with partner organizations. Some successful examples of these include the following: Supporting Evaluation of Nutrition Programs The Agency’s Alberta/Northwest Territories Region provided funding to Dieticians of Canada to review and compile a collection of reliable nutrition assessment and knowledge assessment instruments. This project will increase community practitioners’ access to high quality data collection instruments that can be used in measuring the impact of projects on nutrition knowledge and behaviours (e.g. food intake). The results of this project will be disseminated to evaluation networks in the Agency, other chronic disease related networks and to the Agency-funded projects. Affiliation of Multicultural Societies and Service Agencies The Promoting Healthy Living in BC's Multicultural Communities project was initiated and funded by the Agency to identify the public health needs and health status of multicultural communities. The project created tools, resources and directories to facilitate access to health information and services for these communities. Multicultural health fairs were held to bring professionals and members of public together to share and benefit from each other's resources and information on multicultural health. The project has partnerships with Provincial Ministries and health authorities; municipal governments; the private sector and numerous Non-Governmental Organizations. As a result of this project, Agencies in British Columbia will be better able to understand the health issues of the various cultural communities in this province and to develop more effective programs and policies. www.amssa.org/multiculturalhealthyliving/

Other Health Promotion Initiatives

Children and Adolescents

What was planned

The Agency planned to continue to provide leadership, contribute to knowledge development and exchange, and implement community-based programs through the following activities:

• Continuing to deliver a wide range of community-based programs for women, children, and families;
• Contributing to the implementation of the United Nations Convention on the Rights of the Child throughout the Americas; and
• Developing and exchanging knowledge on the health of children and adolescents.

What was achieved

In 2006-07, the Public Health Agency of Canada continued to successfully deliver health promotion programming to pregnant women, children and families at risk for poor health outcomes through three community-based programs:

• Through the Community Action Program for Children (CAPC), the Agency provided funding for community groups to deliver health promotion programs for at-risk children who are up to 6 years old;
• Through the Canada Prenatal Nutrition Program (CPNP), the Agency funded community agencies to increase access to health services and supports pregnant women living in conditions of risk. It served about 50,000 women, reaching an estimated 60% of low income pregnant women, 37% of pregnant Aboriginal women, and 40% of teenage mothers delivering live births in Canada.
• Through its Aboriginal Head Start in Urban and Northern Communities program the Agency continued to fund local Aboriginal organizations to provide health promotion programs for off-reserve children up to age 6.

On behalf of the Minister of Health, the Agency continued to co-lead with the Department of Justice, federal government work on matters concerning the United Nations Convention on the Rights of the Child. Through its collaboration with the Inter-American Children's Institute - a special institute of the Organization of American States – the Agency contributed to the implementation of the Convention throughout the Americas.

Through the Centres of Excellence for Children's Well-Being initiative, the Agency continued to generate and disseminate the latest knowledge on children's well-being to a broad network of target audiences, including families, service providers, community groups and policy-makers. The Agency developed practical health promotion tools and provided advice to all levels of government and international organizations on the issues of early childhood development, special needs, youth engagement and child welfare to strengthen child-related policies and programs in Canada and abroad.

The Agency’s Health Behaviours of School-aged Children (HBSC) survey continued to contribute to the development of knowledge concerning the health and health behaviours of Canada’s youth. It is the only national health promotion database for this age range in Canada.

In addition, the Agency’s Fetal Alcohol Spectrum Disorder (FASD) initiative continued to develop and provide access to culturally appropriate knowledge for decision-making, as well as tools, resources, and expertise across the country. The program focuses on the prevention of future births affected by alcohol, and the improvement of outcomes for those individuals and families already affected, through: increasing public and professional capacity; developing capacities; creating effective screening, diagnosis and data reporting; expanding the knowledge base and information exchange; and increasing commitment to FASD reduction.

Success Stories: Projects Promoting the Health of Children In 2006-07, the Agency’s Quebec Region developed a bilingual online training module to promote child health and help prevent Fetal Alcohol Spectrum Disorder (FASD). Designed as accredited training, this professional development module provides physicians with resources to assist them in addressing the issue of alcohol use among women of childbearing age. Module objectives are to facilitate participants’ understanding of the consequences of fetal alcohol exposure and develop skill in assessing alcohol consumption in women before and during pregnancy. Memorial University in Newfoundland has established a partnership with Laval University in Quebec City for category 1 accreditation to encourage Quebec physicians to take part in the program. The Quebec Heart and Stroke Foundation’s En route, en coeur (On the Road to a Happy Heart) project, which receives financial support from the Agency’s Quebec Region office, targets school aged children. In 2006-07, the project developed an Internet education program for primary and secondary level pupils on healthy living habits and diabetes. The project also developed and produced materials for a large media campaign addressing Quebec’s English-speaking minority language communities, including the Aboriginal communities, most of whom lie in rural, remote or northern settings. All of the tools developed by the project have been tested, assessed and translated for the three cycles of primary school. The project is receiving special attention from education and health circles in connection with the Écoles en santé (healthy schools) program under the Quebec Department of Education.

Aging and Seniors

What was planned

The Agency planned to continue providing leadership on healthy aging through policy development, health promotion, research and education, partnerships and dissemination of information.

What was achieved

Canadian and global events have demonstrated the special risks faced by seniors as a vulnerable population during catastrophic events. The Agency organized the Winnipeg International Workshop on Seniors and Emergency Preparedness on February 6-9, 2007. More than 100 gerontology, emergency preparedness and health promotion experts from nine countries participated and planned future collaborative action. The workshop served to integrate seniors more fully into emergency preparedness policies and practices, and opened an important dialogue among experts, including seniors, to achieve a common understanding of the impacts of disasters on older people and the actions required to take their needs and potential contributions to the recovery of their communities into account. The Agency was presented with an international award for related efforts by Queen Elizabeth II in May 2006.

At this conference the Minister of Health announced financial support for a project from the World Health Organization titled Seniors in Emergencies: Engaging in Humanitarian Action. The funding will help further support international readiness in meeting the needs of seniors in emergency situations.

Also in collaboration with WHO, the Agency supported research on Age Friendly Cities in 32 cities around the world, four of which are in Canada (Saanich, British Columbia; Portage La Prairie, Manitoba; Sherbrooke, Québec; and Halifax, Nova Scotia). The Agency also initiated similar research with eight provinces in ten small rural communities (Alert Bay, British Columbia, Lumby, British Columbia, High Prairie, Alberta, Turtleford, Saskatchewan, Gimli, Manitoba, Township of Bonnechere Valley, Ontario, Town of Guysborough, Nova Scotia, Alberton, Prince Edward Island, Clarenville, Newfoundland and Labrador, Port Hope Simpson, Newfoundland and Labrador.

Mental Health

What was planned

The Agency planned to continue advancing mental health issues across government.

 What was achieved

In 2006-07, the Agency supported the work of the Interdepartmental Task Force on Mental Health to identify ways to improve the mental health status of those populations that fall within federal jurisdiction. The Agency also responded to the Kirby Senate Committee’s final report Out of the Shadows at Last: Transforming Mental Health, Mental Illness, and Addiction Services in Canadapublished in May 2006. In addition, the Agency continued to provide secretariat support to the Federal/Provincial-Territorial Advisory Network on Mental Health (ANMH) which provides an inter-governmental forum for national collaboration and intersectoral action on mental health and mental illness.

Family Violence

What was planned

In 2006-07, the Agency planned to continue playing a central role in increasing awareness and advancing knowledge in the area of family violence.

What was achieved

The Agency was responsible for leading and coordinating the Family Violence Initiative and for managing the National Clearinghouse on Family Violence on behalf of 15 federal departments, Crown corporations and agencies (http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence). The Initiative strengthens the criminal justice, housing and health systems’ response to family violence; promotes public awareness of the risk factors of family violence and the need for public involvement; and supports data collection, research and evaluation efforts.

Canadian Health Network

What was planned

The Agency planned to continue to providing the Canadian Health Network - a key information service which supports the Agency’s work in helping to build healthy communities.

 What was achieved

The Agency continued to fund 20 major Canadian health organizations to deliver the Canadian Health Network (CHN) program, resulting in sustained growth in reach and network size. As of March 31, 2007, there were more than 69,000 subscribers to the newsletter (HealthLink / Bulletin santé) compared to less than 27,000 one year prior. A total number of 3,106,870 visitors accessed the CHN website in 2006-07.

Additional Health Promotion Activities

Other examples of the Agency’s health promotion activities during 2006-07 include:

• Building on the success of its 2005-06 Healthy Lunches to Go pilot project, the Agency re-launched the social marketing project in January 2007 to correspond with the new 2007 Canada Food Guide, and included updated interactive tools, such as a webcast and daily nutrition tips sent by email or text message.
• Providing funding for the Canadian Fitness and Lifestyle Research Institute, a national non-governmental organization, for their efforts on the Benchmarks program. This information and analysis tool has been monitoring physical activity in Canada for a number of years. The program is also an example of federal-provincial/territorial partnership and collaboration.
• Negotiating Bilateral Agreements on physical activity and healthy eating with each of the provinces and territories. The Agreements will aim to reduce health disparities by focusing on vulnerable populations and related settings for action, and will reflect joint priorities between the federal and provincial/territorial governments. Along with joint priorities, the Agreements will include matched funding between the federal government and the province/territory.
• Playing a strategic role in the development of the World Health Organization (WHO) School Policy Framework, an important component of the WHO Global Strategy on Diet, Physical Activity, and Health. The Policy Framework will guide primarily policy makers in the development and implementation of policies that promote healthy eating and physical activity in the school setting through environmental, behaviour and education changes.
• The Agency began to explore the feasibility of initiating consultations as the first step towards potentially establishing a national surveillance system for autism.

Public Health Tools and Practice

A strong public health system requires a deep, cross-jurisdictional human resources capacity, effective dissemination of knowledge and information systems, and a public health law and policy system that evolves in response to changes in public needs and expectations. The Agency’s contributes to all these areas through the following key initiatives:

Building Public Health Human Resource Capacity

Planned ($M)	Authorities ($M)	Actual ($M)
10.9	10.8	10.4

What was planned

In 2006-07 the Agency intended to:

• support the Public Health Human Resource Task Group of the Pan-Canadian Public Health Network in steps to develop a Pan-Canadian Framework for Public Health Human Resources Planning;
• hold consultations with experts across Canada about public health competency profiles;
• work with partners to develop databases on public health human resources;
• significantly increase the number of placements available in the Canadian Field Epidemiology Program;
• add and/or improve the Skills Enhancement for Public Health program modules;
• provide training awards to promote education in applied public health;
• collaboratively with universities develop guidelines for applied public health masters programs; and
• prepare a comprehensive professional development plan for its staff.

What was achieved

In 2006-07, the Agency continued to support the Public Health Human Resource Task Group of the Pan-Canadian Public Health Network. An Enumeration Working Group was formed to address the limitations of public health workforce data reported at the regional, provincial, and national levels. Stakeholders including jurisdictions, disciplines, national data agencies, and federal partners agreed in principle to jointly work with the Agency and the Task Group to address these limitations.

Clear statements of core competencies for public health will enable Canadian jurisdictions to strengthen the public health workforce. In 2006-07, the Agency began to conduct consultations on these core competencies. Activities included an online survey, which had 1,606 respondents from across Canada. Regional consultations held with the public health community in British Columbia, Alberta, Saskatchewan and Manitoba helped to identify opportunities, challenges, and strategies for implementation; and identify roles and responsibilities. Work with public health discipline groups including nurses, health inspectors/environmental health officers, epidemiologists, medical officers, dentists/ dental hygienists, nutritionists/dieticians and health promoters/educators helped to focus on discipline-specific competencies.

In addition to expanding the intake from 13 in 2005-06 to 15 in 2006-07 the Canadian Field Epidemiology Program (CFEP) (http://www.phac-aspc.gc.ca/cfep-pcet/index.html) increased its offering of external seats for public health practitioners in its training modules. The program also successfully piloted a new module on Rapid Assessment for Complex Emergencies.

To address the learning needs of front-line public health practitioners the Agency launched two modules - Introduction to Public Health Surveillance and Applied Epidemiology: Injuries - bringing the number of modules in the Skills Enhancement for Public Health program to seven. Other new modules including Communicating Data Effectively, Basic Biostatistics, and Principles & Practices of Public Health, were piloted. Registration increased as new modules were added and awareness of the program grew - a total of 1456 participants completed at least 1 module in 2006-07. Also, thirty additional online facilitators were trained to further build capacity.

The Agency partnered with Canadian Institute of Health Research (CIHR) to provide grants to fifteen successful Doctoral Research and Fellowship applicants, and to fund 20 universities for Master's in Public Health programs.

To prepare a comprehensive professional development plan for its staff, a working group was formed to look at training needed to support public health practice done by the Agency. Through interviews and focus groups, training needs were identified for key professional groups. The Agency created a pilot Public Health Practice Learning Calendar offering competency based training and education to staff. An intranet site, Learning @PHAC, was launched to consolidate learning and training resources at the Agency.

In summary, the Agency accomplished all activities planned for Building Public Health Human Resource Capacity in the 2006-07 Report on Plans and Priorities with the exception of developing databases on public health human resources.

Knowledge and Information Systems

Planned ($M)	Authorities ($M)	Actual ($M)
6.1	15.1*	15.1

    * The difference between planned and authorities reflects the funding received for the National Collaborating Centres Contribution Program.

What was planned

The Agency planned to:

• keep the integrated Public Health Information System (iPHIS),in a pandemic-ready state, with new modules for outbreak management;
• work towards a seamless transition for users when the Infoway solution becomes available;
• promote the Public Health Map Generator (PHMG); and
• undertake the groundwork leading to the development of an annual report on the state of the public's health.

What was achieved

All these plans were fulfilled as the Agency develop information about public health knowledge and information systems, to increase and exchange knowledge in this area, and to leverage the information and knowledge into effective action.

The Agency continued to maintain and support the iPHIS product, and made the Outbreak Management module available to jurisdictions across Canada. The Agency also worked to investigate a data migration strategy for iPHIS-deployed jurisdictions to the planned successor (Infoway Panorama) solution.

Throughout 2006-07 the Agency provided expert resources to the Infoway Electronic Public Health System (now known as Panorama) project. By participating in forums including Design working groups, Pan-Canadian Standards Group, Implementation Working Group, Steering Committee, Product Management Committee, Joint Implementation Leads, the Agency transferred the knowledge gained by past work in the development of case management tools usage by Federal, Provincial, and territorial officials.

As of March 2007, the Agency’s GIS Infrastructure (http://www.phac-aspc.gc.ca/php-psp/gis_e.html) tools, data, services and training supported 361 public health professionals ("clients") from 141 public health organizations across Canada. All 361 clients were members of the online GIS community known as the Map and Data Exchange. The Agency continued to support a variety of initiatives across Canada through the provision of data and spatial services.

Surveillance and Information Expert Group The Agency continued to provide the official federal representation as well as secretariat, policy, technical, and financial support to the Surveillance and Information Expert Group of the Public Health Network. This Expert Group is responsible for providing coordination and leadership for public health surveillance, information collection, analysis and sharing, and knowledge dissemination across Canada from a federal, provincial and territorial context.

The Public Health Agency of Canada Act mandates the Chief Public Health Officer to submit a report to parliament on the State of Public Health in Canada, with the first Report to be tabled by or before January 2008. During 2006-07, the Agency established working groups responsible for consultations, compilation of information for the Report, and provision of technical advice. The Agency hosted consultative meetings on Storyline Development, Lessons Learned and Health Inequalities, with internal and external stakeholders. Background research, framing exercises and content development were initiated and extensive stakeholder consultations were undertaken

All six of the Agency-funded National Collaborating Centres (NCCs) for Public Health were in place:

NCC focus	Location
Environmental health	BC Centre for Disease Control, Vancouver
Aboriginal health	University of Northern British Columbia, Prince George
Infectious diseases	International Centre for Infectious Diseases, Winnipeg
Public health methods and tools	McMaster University, Hamilton
Healthy public policy	Institut national de santé publique du Québec, Montréal
Determinants of health	St. Francis Xavier University, Antigonish

The NCCs connected with public health policy-makers, researchers and practitioners through environmental scans of stakeholders in their respective priority areas, and participated in educational and research fora to determine the knowledge needs of frontline public health practitioners, identify knowledge gaps, and develop knowledge communities. The NCCs collaborated with each other and external partners to synthesize existing research, develop reports and tools for their user groups, and develop knowledge transfer approaches through participation in events such as Annual Canadian Public Health Conference and the 5th Annual Cochrane Symposium. As part of their mandate of transferring knowledge among public health stakeholders, the NCCs will hold their 2nd Annual Summer Institute in Nova Scotia, August 2007.

Public Health Law and Information Policy

Planned ($M)	Authorities ($M)	Actual ($M)
3.3	3.3	3.2

What was planned

Expert reports from the Naylor Commission (Learning from SARS: Renewal of Public Health in Canada) and the Kirby Commission (Reforming Health Protection and Promotion in Canada: Time to Act) urged federal, provincial and territorial stakeholders to collaborate on the development of agreements that would provide for effective surveillance through common standards and practices for information sharing and public health responses.

During 2006-07 the Agency planned to continue to take an active role with its provincial and territorial partners in harmonizing legislation and developing and implementing policies, practices and mechanisms that comply with privacy rights yet allow better collection, use and sharing of key health information for the prevention and control of communicable diseases and health emergencies.

The International Health Regulations, adopted in 2005, outlined the need for a strong legal foundation for public health practice at all levels of government. Having this in place is crucial for Canada's capacity to respond to new and re-emerging public health threats. To address this, the Agency planned to undertake activities such as specialized workshops and discussions for the dissemination of targeted research and analysis in public health law.

What was achieved

These plans were completed. The Agency developed information about public health law, and information policies, increased and exchanged knowledge in this area, and leveraged the information and knowledge into effective action.

In November 2006, the Agency played a major role in delivering the first Canadian Conference on the Public’s Health and the Law, which brought together some of the most respected Canadian and international public health law expertise to review progress and consider future challenges including planning for Pandemics. The conference strengthened public health capacity by promoting an enhanced understanding of the application of various legal and policy instruments in public health, and by fostering professional and linkages across disciplines.

The Agency held specialized workshops and discussions with key provincial, territorial and international agencies and stakeholders to collaborate on common challenges, identify common problems and disseminate the results of targeted research and analysis in public health law. The Agency also collaborated with leading researchers in public health law and shared the results of this research through the Public Health Law Improvement Network.

The Agency took an active role in enhancing the integration of ethical considerations into public health decision-making by collaborating and taking the first steps to facilitate a National Roundtable on Public Health and Ethics.

Strategic and Developmental Initiatives

Planned ($M)	Authorities ($M)	Actual ($M)
12.9	12.8	12.3*

    * Actual spending was $0.5 million lower than authorities due to capacity and technical constraints.

The Public Health Agency of Canada recognizes that strategic and developmental initiatives are required to support the achievement of its priorities and advance the work of improving public health.

What was planned

The Agency intended:

• in collaboration with other organizations including the Canadian Institute for Health Information (CIHI), to continue to deliver crucial surveillance programs;
• continue to support the Pan-Canadian Public Health Network, including establishment of intersectoral working groups in priority areas, and continued development of agreements for sharing of information, facilities, and personnel during health emergencies;
• to develop a profile of the public health environment in Canada, in preparation for collaborative development of a Pan-Canadian Public Health Strategy;
• to collaborate with Health Canada to further strengthen partnership with the World Health Organization in support of the WHO's new Commission on the Social Determinants of Health (SDOH);
• to coordinate the establishment of a Health Portfolio plan with Health Canada and the Canadian Institutes for Health Research to advance an intersectoral federal government approach; and
• to continue to develop an international strategic framework for coherence of efforts, and to expand the Agency’s capacity for international policy development and global partnerships.

What was achieved

All the planned initiatives were undertaken.

Health surveillance supports disease prevention, and enables public health professionals to manage outbreaks and threats. Public Health Surveillance – the ongoing, systematic use of routinely-collected health data to guide public health actions - has been identified as a priority area for the Agency in its Strategic Plan, and a senior multidisciplinary task group was launched during March 2007 to begin the review of the Agency’s surveillance infrastructure components.

The Agency continued to provide key surveillance programs during 2006-07. In collaboration with the Canadian Institute for Health Information and the Canadian Public Health Initiative and many other organizations, the Agency delivered surveillance programs including:

• Canadian Creutzfeldt-Jakob Disease Surveillance System (CJDSS)
• Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)
• Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)
• Canadian Laboratory Surveillance Network (PulseNet and other DNA fingerprinting outbreak surveillance systems)
• Canadian Nosocomial Infection Surveillance Program (CNISP)
• Canadian Nosocomial Infection Surveillance Program (CNISP)
• Canadian Tuberculosis Laboratory Surveillance System (CTBLSS/GRID)
• HIV/AIDS Surveillance program
• National Diabetes Surveillance System (NDSS)
• National Enteric Surveillance Program (NESP)
• National West Nile Virus Surveillance program
• Surveillance of Vaccine Escape mutants of Meningococci, H. influenzae and B. pertussis

The Agency continued to represent the Federal government in the Pan-Canadian Public Health Network and to provide secretariat, policy, technical, and financial support to it. The Network, whose creation was announced by the Federal-Provincial-Territorial Ministers of Health in April, 2005, was established to provide a new, more collaborative approach to public health. Improved communication and collaboration, particularly critical during public health emergencies such as SARS or pandemic influenza, will also assist Canada in addressing serious public health issues such as obesity and non-communicable disease.

The Agency’s Chief Public Health Officer is the federal co-chair of the Public Health Network’s governing Council. In addition, Agency personnel represent the federal government on each of the groups reporting to the Network.

In 2006-07 the Public Health Network focussed on three key areas:

• Preparing for and responding to emergencies and communicable disease control and prevention;
• Building public health infrastructure and organization; and
• Promoting health and healthy living.

The Public Health Network has proven to be a key mechanism for collaboration between federal, provincial and territorial governments, and an effective vehicle for advancing a Canadian public health agenda. Progress made during 2006-07 included:

• Agreement on recommended size, composition and use of the national antivirals stockpile to provide for early treatment of those with pandemic influenza;
• Release of the 2006 Canadian Pandemic Influenza Plan for the Health Sector;
• Analysis and refinement of the Network’s organizational structure to provide greater precision on the mandate and authority of the Public Health Network, resulting in improved linkages between groups within the Public Health Network and increased operational efficiency.

In addition, significant progress was made on development of joint agreements respecting roles and responsibilities in pandemic preparedness and response, information sharing, and the sharing of resources, facilities and personnel.

Actions to create a foundation for the development of a Pan-Canadian Public Health Strategy, to be overseen by the Pan-Canadian Public Health Network, included strengthening the policy base in the Agency’s regions to contribute to the intelligence cycle. The expanded regional work of gathering, analyzing and providing advice on public health information within the provincial and territorial jurisdictions allowed the Agency to develop an emerging profile and understanding of the public health environment in Canada, and contributed to the Agency's ability to identify current initiatives, gaps, and vulnerabilities.

The Agency strengthened its partnership with the World Health Organization (WHO) Commission on Social Determinants of Health through contributing knowledge and expertise that helped to shape the direction and recommendations to be contained in its Interim Statement and Final Report, and also by funding two Knowledge Networks to synthesize global evidence for policy and action. Further, the Agency collaborated with the Commission on the planning of the 8th WHO Commission meeting (to be held in Canada). The Agency contributed to Canada’s leadership role with WHO and member states on intersectoral action, reporting on cross-government and cross-sectoral approaches to advance policy and action on health inequalities, and also in engaging other countries and WHO in an initiative to examine the economic benefits of investing in the determinants of health.

The Agency supported the work of the Canadian Reference Group (CRG) to contribute to the WHO Commission’s plan of work and to advance related initiatives here in Canada. During 2006-07, the CRG has initiated work on Canadian case studies of effective intersectoral action, led the development of case studies in 23 other countries, and engaged with Civil Society on how to best address the social determinants of health.

As a step towards the establishment of a Health Portfolio Plan, the Agency developed a draft action framework to outline its leadership role in advancing federal action on the social determinants of health and the beginning of an integrated approach within the Health Portfolio. This work, when enhanced through the knowledge to be gained from the WHO Commission and Canadian Reference Group work, will lead to further interdepartmental collaboration. The Agency initiated working relationships and knowledge sharing with other departments, private sector partners and other levels of government through its participation in the Conference Board of Canada’s Roundtable on the Socio-Economic Determinants of Health.

The Agency supported preparations for the World Conference on Health Promotion and Education (to be held in Vancouver in June 2007). During 2006-07, the Agency coordinated the Health Portfolio’s lead role in this event and organized sessions and speakers to profile Canadian experiences with a global audience and learn from other countries.

The Agency continued developing an international strategic framework to support internationally focused initiatives to strengthen public health security, strengthen international efforts to build capacity in public health systems, and reduce the global burdens of disease and health disparity.

Other Programs and Services

Planned ($M)	Authorities ($M)	Actual ($M)
109.0	120.5*	119.0

    * The $11.5 million difference between planned and authorities represents primarily operating budget carry forward received in the Supplementary Estimates (A). The Agency was able to use of $11.0 million of this to address IM/IT infrastructure requirements, comply with mandatory government-wide IT security policy, and respond to a computer malware infection.

Other Agency programs and services consisted primarily of corporate support and administration in the National Capital Region, Winnipeg and the Agency’s regional offices (Atlantic, Quebec, Ontario & Nunavut, Manitoba & Saskatchewan, Alberta & Northwest Territories, British Columbia & Yukon). Under an interdepartmental agreement, Health Canada’s Northern Region office was also responsible for administering some of the Agency’s programs in Canada’s territories. Planned expenditures included $28.0 million for the facility services and the support of the National Microbiology Laboratory; $48.4 million for the corporate support in Human Resources, Communications, Legal, Finance, Real Property and Administration Services, Information Technology and Management; $4.3 million for support in Strategic Policy and Development and $17.9 million for regional support operations across Canada. Planned funding also included $10.4 million held in a frozen allotment pending approval for a one-year extension.

Actual expenditures included $37.1 million for the facility services and the support of the National Microbiology Laboratory; $69.3 million for the corporate support in Human Resources, Communications, Legal, Finance, Real Property and Administration Services, Information Technology and Management; and $11.1 million for regional support operations across Canada.

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