ARCHIVED - Public Health Agency of Canada

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Minister’s Message

I am pleased to present the 2007-08 Performance Report for the Public Health Agency of Canada. The Agency continues to play a vital role in contributing to the Government of Canada’s ability to promote and protect the health of Canadians.

The Agency is the third largest federal organization with programs and initiatives contributing to the health of Canadians. It enhances the Government of Canada’s ability to improve and maintain the health of Canadian families by delivering new and ongoing public health information programs. These included activities such as the healthy pregnancy initiative, partnering on the World Health Organization’s groundbreaking Age-Friendly Cities Guide, and updating Canada’s Physical Activity Guides with versions for children, youth, adults and seniors.

The Agency also works to enhance Canada’s emergency preparedness, which includes planning for pandemic influenza. While we cannot always predict the timing of emergencies and pandemics, we can be as prepared as possible. Through the Agency’s work, and supported by its surveillance systems, nationwide quarantine service and effective emergency response protocols, we are in a better position than ever to protect Canadians and respond to outbreaks of infectious disease and foodborne illness, as well as other emergencies that impact human health.

As demonstrated in this Performance Report, the Agency has been key to this Government’s ability to take concrete action on public health issues and to deliver on its commitments to achieve healthier Canadians and a stronger public health capacity. We continue to build on the expertise of our officials as well as our many partners and stakeholders, because health protection and promotion are most successful when all sectors of society are involved.

In support of a stronger public health system in Canada and around the world, I am proud to report on the significant achievements made by the Agency during its third full year of operation.

The Honourable Leona Aglukkaq
Minister of Health
Government of Canada

Chief Public Health Officer’s Message

Created in 2004, the Public Health Agency of Canada has, in a relatively short period, made real progress in strengthening public health in Canada. This is in large part due to how we have brought a collection of programs, activities and expectations together into an effective and unified federal entity charged with protecting and promoting the well-being of Canadians.

There is today a recognition across Canada of the very clear need for the Agency to exist as the federal partner in a system designed to improve and protect the public’s health. While emergency preparedness and response is a key responsibility, the Agency addresses the totality of the population’s health. We protect against and respond to outbreaks and emergencies, but we also strive to prevent the basic things that kill and disable Canadians every day.

In 2007-08, we continued to work with our partners and stakeholders on health promotion and the prevention and control of chronic diseases. This included launching a second national healthy pregnancy advertising campaign, and work on healthy aging that led to international recognition of Canada's Minister of Health’s leadership role in seniors’ health issues.

Of course, one of our highest priorities as an Agency continues to be to prepare for public health emergencies, including a potential influenza pandemic. This Performance Report reviews key steps taken during the 2007-08 fiscal year on emergency preparedness and response, including building surge capacity and negotiating how different governments and stakeholders will work together to detect and respond to public health emergencies.

Most public health activities involve broad collaboration across a range of actors. This creates challenges for performance measurement, as positive health outcomes and trends usually reflect the success of joint efforts by multiple partners. For instance, in many of its activities the Agency works closely with the other members of the Health Portfolio as well as many other federal departments and agencies whose work has an impact on public health. Our collaboration with provinces, territories and other countries in how we face current and future threats to public health is key to our success.

Now, almost four years since it was established, the Agency finds itself turning a corner. We have in place programs, activities, communications strategies, and agreements that together prepare us for the range of threats to the health of the population. We work not in isolation, but in concert with our many partners, in a public health system that is one of the best in the world. With all of this in place, we have a tremendous opportunity to move forward and make real and lasting change to the well-being of our communities and population.

I am pleased to take part in this accounting to Parliament and to all Canadians, and am proud of our dedicated staff across the country who continue to make progress in fulfilling our vision of healthy Canadians and communities in a healthier world.

Dr. David Butler-Jones, M.D.
Chief Public Health Officer

SECTION I – OVERVIEW

Summary Information

Reason for Existence

Public health involves the organized efforts of society to keep people healthy and to prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians. In Canada, public health is a responsibility that is shared by the three levels of government, the private sector, non-government organizations, health professionals and the public. In 2003, the emergence of the Severe Acute Respiratory Syndrome (SARS) demonstrated the need for a national focal point for public health issues. In response to this need, the  Health Portfolio to deliver on the Government of Canada's commitment to help protect the health and safety of all Canadians. Its activities focus on preventing chronic diseases, like cancer and heart disease, preventing injuries and responding to public health emergencies and infectious disease outbreaks.

Roles and Responsibilities

The Agency has the responsibility to:

• lead the prevention of disease and injury, and the promotion of health;
• provide a clear focal point for federal leadership and accountability in managing public health emergencies;
• serve as a central point for sharing Canada’s expertise with the rest of the world and applying international research and development to Canada’s public health programs; and
• strengthen intergovernmental collaboration on public health and facilitate national approaches to public health policy and planning. 

In December 2006, the Public Health Agency of Canada Act came into force, giving the Agency the statutory basis to continue fulfilling these roles. The Agency delivers on its mandate by:

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

Operations across Canada

To carry out these roles and responsibilities, the Agency has developed a strong presence throughout the country, so that it can connect with provincial and territorial governments, federal departments, academia, voluntary organizations and citizens.

The Agency is supported by two pillars of expertise in Winnipeg, Manitoba and Ottawa, Ontario. The rest of the Agency's Canada-wide infrastructure consists of 16 locations in six Regions. Under an interdepartmental agreement, some programs are also delivered to the Yukon, Nunavut and the Northwest Territories through Health Canada's Northern Region office. In addition, the Agency operates specialized research laboratories across Canada. These laboratories play a key role in identification, control and prevention of infectious diseases.

Overall Agency Performance

Program Activity Architecture

The chart below illustrates the Agency’s framework of program activities and program sub-activities which contributed directly to progress toward a single Agency Strategic Outcome: Healthier Canadians and a stronger public health capacity. Collectively, they contributed to the Government of Canada outcome of healthy Canadians and indirectly to other outcomes such as safe and secure communities; a fair and secure marketplace; and a safe and secure world through international cooperation.

Expenditure Profile

The Agency’s actual spending for 2007-08 was $606.9 million. Over the past three years, spending increased by $130 million (or 27%) mainly due to funding announced in Budget 2006 for Preparedness for Avian and Pandemic Influenza and in Budget 2005 for the Integrated Strategy on Healthy Living and Chronic Disease. Growth was partly offset by incremental Expenditure Review Committee reductions flowing from Budget 2004 and 2005.

2007-08 Actual Spending Comparison

The increase in planned spending in 2009-10 is mainly due to funding approved for the hepatitis C Health Care Services Program. The decrease in planned spending in 2010-11 is mainly due to one-time funding that was previously provided for certain Avian and Pandemic Influenza Preparedness activities.  In addition, spending associated with the Aboriginal Head Start in Urban and Northern Communities (AHSUNC) program has been reduced in fiscal year 2010-11, to account for the sunsetting of the Program (the program’s terms and conditions are set to expire in 2010-11).

Financial Resources ($ millions)
Planned Spending	Total Authorities	Actual Spending
669.8	684.1*	606.9**
*The $14.3 million difference between planned spending and authorities is due to:  (a) increase of $1.3 million for items in Supplementary Estimates (A) not included in Planned Spending; (b)decrease of $1.5 million for transfers to other departments in Supplementary Estimates (B); (c) increase of $20.3 million for transfers from Treasury Board votes for the operating budget carry-forward from 2006-07 ($14.8 million), and to cover other operational requirements such as Collective agreements ($1.5 million), uncontrollable salary costs ($4.0 million); and (d) decrease of $5.8 million due to reduction in Employee Benefit Plan costs. ** Actual spending was $77.2 million lower than total authorities due to the deferment of funding to subsequent fiscal years ($35.6 million in operating expenditures and $4.6 million in transfer payments); capacity and technical restraints which impeded the full utilization of approved resources ($28.4 million in operating expenditures);  and delays in the approval and solicitation process in addition to transitions to the new Innovation Learning Strategy and to the Canadian Strategy for Cancer Control ($8.6 million in transfer payments).
Human Resources (Full-Time Equivalents*)
Planned	Actual	Difference
2376	2165	211**
* Full-Time Equivalents are calculated based on days worked, in order to properly include persons employed for part of the year and/or employed part time in a measure showing average employment over the year. ** The difference of 211 Full-Time Equivalents is due to:  (a) delays in the staffing process; (b) difficulty in finding qualified personnel because of low labour market availability for positions requiring unique public health specialization; and (c) constraints due to shortage of accommodation space.

Agency Priorities

#	Priority	Type	Performance Status	Explanation of Performance
1	Develop, enhance and implement integrated and disease-specific strategies and programs for the prevention and control of infectious disease	Ongoing	Successfully Met	The Agency collaborated both domestically and internationally on immunization and vaccine-preventable diseases; took a leadership role in the Federal Initiative to Address HIV/AIDS in Canada; and provided surveillance for infectious diseases.
2	Develop, enhance and implement integrated and disease- or condition-specific strategies and programs within the health portfolio to promote health and prevent and control chronic disease and injury	Ongoing	Successfully Met	The Agency worked with multiple domestic and international partners and stakeholders to mobilize efforts across various levels and sectors to promote the health of Canadians. As well, the Agency prevented and controlled chronic disease and injury by identifying and responding to key risk factors.
3	Increase Canada's preparedness for and ability to respond to public health emergencies, including pandemic influenza	Ongoing	Successfully Met	The Agency engaged in emergency preparedness and response planning with federal/provincial/ territorial departments and agencies, and non-governmental organizations to identify emerging priorities, establish work plans and coordinate activities.
4	Strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity	Ongoing	Successfully Met	The Agency provided resources and tools to facilitate public health work done by all levels of government and institutions across Canada in order to develop a seamless, comprehensive and sustainable public health system. Through partnerships and joint initiatives, the Agency led and supported public health professionals and stakeholders in their efforts to keep pace with rapidly evolving conditions, knowledge and practices.
5	Lead several government-wide efforts to advance action on the determinants of health	Ongoing	Successfully Met	The Agency has brought together Canadian government and non-government stakeholders to share promising approaches such as those outlined in a global study on intersectoral action. The Agency has also collaborated with several departments to advance action on the determinants of health, such as health literacy in Canada.
6	Develop and enhance the Agency's internal capacity to meet its mandate	Previously committed	Partially met	The Agency initiated strategic and business planning processes that addressed capacity issues, including expansion of laboratories and further development of the Winnipeg headquarters and regional offices. However, neither a Performance Measurement Framework nor an Evaluation Plan were finalized in 2007-08. As well, more work needs to be done on developing risk management strategies within the Corporate Risk Profile. The Management Accountability Framework assessment by the Treasury Board Secretariat has identified four areas where improvement is necessary (i.e., managing organizational change; effectiveness of information management; effective project management; and effective management of security and business continuity). Together, these issues provide a critical path for the Agency’s improvement agenda over the next year.

Program Activities by Strategic Outcome

Strategic Outcome: Healthier Canadians and a Stronger Public Health Capacity
Program Activity	Expected Results	Performance Status	2007-08		Contributes to Priority #	Alignment to Government of Canada Outcomes
			Planned Spending  ($ millions)	Actual Spending ($ millions)
Health Promotion	Improved health and well-being Improved health behaviours Reduced health disparities	Successfully met	186.5	192.1	2, 4 and 5	Healthy Canadians
Disease Prevention and Control	Decreased proportion of Canadians who develop or acquire disease Maintained and enhanced quality of life; fewer complications and premature deaths in those with disease Decreased personal, social and economic burden of disease for individuals and society Strengthened response to managing diseases in Canada	Partially met	311.8	240.5	1, 2 and 4	Healthy Canadians
Emergency Prepared­ness and Response	Canada is one of the countries best prepared to respond to the public health risk posed by natural and human-caused disasters, such as infectious disease outbreaks, hurricanes, floods, earthquakes, and criminal or terrorist acts such as explosions and the release of toxins	Successfully met	115.9	121.3	3	Healthy Canadians
Strengthen Public Health Capacity	Strengthened public health capacity in Canada through enhancements to the public health workforce, public health information and knowledge systems, and public health law and ethics	Successfully met	55.6	53.0	4	Healthy Canadians

Strategic Context, Operating Environment and Risk Analysis

PHAC facts... As highlighted in the  2007 Speech from the Throne, there is a strong link between health and the environment. Growing populations are placing an increased pressure on the global environment while, in Canada, greater urbanization brings increased concentrations of toxins and pollutants, as well as increased demands for energy, land and other resources. Changes in Canadian society have also resulted in shifts in behavioural patterns (e.g., unhealthy eating and physical inactivity) and in living and working conditions. All of these changes could lead to a higher risk of chronic disease incidence and additional costs on the health care system and the economy.

In recent years, the Government of Canada has identified several priorities in the Speech from the Throne and the Federal Budget ranging from health threats to children and seniors, to enhancing laboratory safety. Responding to these priorities has presented both challenges and opportunities to the Agency.

Globalization

Societies and economies are becoming increasingly interdependent. The increased volume and speed of trade and travel has brought significant economic benefits and challenges to Canadians. Keeping pace with the demands of a global economy has meant greater time pressures for families. With less time, families consume more convenience foods and are less physically active which translates into risks such as obesity. Higher mobility of people also raises the risk of infectious disease outbreak.

Population

Canada has the highest rate of population growth among the eight economically-leading countries. Given Canada’s dependence on immigration to support economic growth, there is a need to focus attention on immigrants’ health issues who are more likely than those born in Canada to rate their health as fair or poor health. The health of immigrants (measured by diagnosed chronic disease) becomes progressively worse with increasing length of residence in Canada. Innovative approaches to understanding, assessing and addressing non-medical determinants of health are also being developed in collaboration with domestic and international partners. These approaches will inform more effective interventions to reduce health disparities borne by Canada’s vulnerable populations including First Nations, Inuit and Metis people, children, seniors, and people living in rural and remote areas.

Diseases

PHAC facts... Obesity is a significant risk factor for a range of health issues.  a study published in 2000 by the Canadian Medical Association estimated that a ten percent increase in the proportion of Canadians who are physically active could save $150 million annually in health care costs for coronary heart disease, stroke, type 2 diabetes, colon cancer, breast cancer and osteoporosis.

Although chronic disease is the leading cause of death in Canada, the impact of an uncontrolled outbreak of an infectious disease would be immense. As seen with SARS, even the perception that an infectious disease is out of control can cause major social and economic disruptions. Climate change and the growing global population increase the risk of a new disease – and an outbreak anywhere in the world can swiftly appear in Canada. The challenges associated with such infectious diseases as avian influenza and “superbugs” often mean that national and international approaches are required to address disease transmission and control.

Sexually-transmitted infections, blood-borne infections (e.g., hepatitis) and Tuberculosis collectively represent over 50 percent of all reportable infections/diseases in Canada. It is also estimated that 250 000 Canadians develop healthcare- associated infections and 8000 die as a result each year. The cost of healthcare associated infections to the Canadian healthcare system is estimated to be between $453 million and $1 billion annually while the costs associated with hepatitis C virus alone is projected to cost Canada $1 billion annually by 2010. With increasing incidence of antimicrobial resistant forms of these diseases, the healthcare, economic and personal burdens will continue to grow.

Science and Technology

The rate of scientific discovery and technological innovation has increased dramatically in the past decade. By providing new approaches for improving health and preventing disease, these innovations can mitigate pressures on the health system. Advances in public health genomics – an emerging field that assesses the impact of the interaction between genes and the environment on population health – creates research that can be applied to prevent disease and improve the health of Canadians.

Partnerships and Stakeholders

The Agency depends greatly on partners and stakeholders to achieve long-term expected results for Canadians. For example, actions the Agency has taken to support disease prevention and control are primarily in surveillance and knowledge transfer in keeping with our federal role. The Agency engages stakeholders through national-level bodies to develop and achieve consensus on standards; develop surveillance systems; identify best practices; and so on. As well, the Agency’s community-based chronic disease prevention activities are only funded in the area of diabetes. An external diabetes policy review has advised that even these activities should focus more on knowledge development and on pilot projects that will test promising practices. In addition, emergency preparedness activities rely on collaboration across national and international jurisdictions in order to ensure timely and effective risk management.

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