ARCHIVED - RPP 2006-2007
Public Health Agency of Canada

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Section I - Overview

Message from the Minister

Improving health and access to health care remains one of the highest priorities of Canada's new government. As Minister of Health, I recognize the important role played by the Public Health Agency of Canada and the Chief Public Health Officer in helping to promote and protect the health of all Canadians.

Within this government's first 100 days in office it tabled in the House of Commons Bill C-5, An Act respecting the establishment of the Public Health Agency of Canada . Now before the Senate, Bill C-5 is expected to come into force this fall. This legislation not only confirms the Public Health Agency of Canada as a federal focal point for addressing public health issues, but it also allows the Agency to continue in supporting a strengthened public health system in Canada.

Our government has made it a priority to guarantee patient wait times. One of the best ways to do so is to reduce pressure on our health care system and increase its sustainability by enhancing the overall public health. Chronic diseases such as cancer, cardiovascular disease and diabetes are leading causes of death and disability in Canada. By placing greater emphasis on disease prevention and promotion of healthy living, the Public Health Agency of Canada fulfils its mission and furthers its vision of helping Canadians become the world's healthiest people.

With respect to the Canadian Strategy for Cancer Control, the Budget confirmed this government's commitment to do its part to implement the Strategy. An investment of $260 million over the next five years will allow the Public Health Agency of Canada and Health Canada to work with partners on implementation. This funding will help improve cancer screening, research and prevention activities and to help coordinate efforts with the provinces and with cancer care advocacy groups.

Since its inception in the fall of 2004, the Public Health Agency of Canada has firmly established itself as a world leader in pandemic preparedness. Canada's Pandemic Influenza Plan developed in collaboration with provinces and territories is recognized by the World Health Organization as one of the most comprehensive in the world.

To further enhance Canada's pandemic preparedness, this Government announced $1 billion over 5 years in the 2006 federal Budget to further improve Canada's pandemic preparedness - $600 million to be allocated to departments and agencies and $400 million to be set aside as a contingency. This investment will build on the Canadian Pandemic Influenza Plan and enhance initiatives already underway in relation to both avian and pandemic influenza preparedness. The Public Health Agency of Canada leads portfolio collaboration with the Canadian Food Inspection Agency and Public Safety and Emergency Preparedness Canada on a variety of pandemic preparedness activities. This includes the purchase of additional anti-virals, animal health guidelines and surveillance for wild birds and commercial poultry, laboratory enhancements and research, and improvements in vaccine readiness and emergency management preparedness.

The Public Health Agency of Canada also supports this government's direction on accountability through its ongoing review of grants and contributions to community groups and non-governmental organizations. The Agency has been recognized for its steps to ensure reporting on performance and value for money.

I am confident that the plans, priorities and programs outlined in this report will provide concrete advancements toward the Public Health Agency of Canada's goal of creating healthier Canadians and communities in a healthier world.

Tony Clement
Minister of Health

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Message from the Chief Public Health Officer

The Public Health Agency of Canada has become a key component of Canada's health system. As the organization responsible for leading federal efforts to promote and advance public health in Canada, the Agency has had a significant impact on the way that health professionals approach their work, and how Canadians view public health issues.

As the Chief Public Health Officer of Canada, and Deputy Head of the Public Health Agency, I report to and advise the Minister of Health on the daily operations of the Agency and advise the Minister on public health matters. It is also my job to communicate directly to Canadians on key issues of public health. This dual role will be confirmed once Bill C-5, the enabling legislation for the Agency is in force.

In terms of the 2006-07 planning period, the Public Health Agency looks to support the Minister's key priorities in a number of ways.

To become a healthier nation we must address the root causes of chronic diseases such as cancer, cardiovascular disease and diabetes that are the leading cause of death and serious illness in Canada. The Agency is moving forward on the healthy living initiative, which focuses on helping Canadians improve nutrition and physical activity - the underlying factors for many different diseases. This will support the government's commitment to reduce wait times, by helping to alleviate pressures on the Canadian health system.

Cancer is clearly a priority for government - evidenced by the commitment at the recent First Ministers' meeting to reduce cancer waiting times, and the commitment and planning support given to building the Canadian Strategy for Cancer Control. The Public Health Agency of Canada has been working with provinces and territories and other partners to help achieve this goal. Cancer will be one of the major chronic diseases addressed in the Pan-Canadian Public Health Strategy to be developed by the Agency in consultation with many partners.

With the latest $1 billion investment in pandemic preparedness announced in the Budget, the Public Health Agency will be able to work closely with provinces, territories and other government departments to build on our collective successes. The Agency continues to demonstrate its commitment to working collaboratively with our provincial, territorial and international partners to improve public health outcomes for Canadians and those in need beyond our borders.

Over the next three years, the Agency will build on its early successes and move forward on the priorities outlined in this report. It will do so by working in concert with the provinces and territories to further build public health human resources capacity and to respond to major information challenges facing the public health system.

With the help of a dedicated staff, I look forward to continuing the progress toward making the Public Health Agency of Canada an agent of positive change in the health of Canadians.

Dr. David Butler-Jones
Chief Public Health Officer

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Management Representation Statement

I submit for tabling in Parliament, the 2006-2007 Report on Plans and Priorities (RPP) for the Public Health Agency of Canada.

This document has been prepared based on the reporting principles contained in Guide for the Preparation of 2006-2007 Part III of the Estimates: Reports on Plans and Priorities and Departmental Performance Reports :

• It adheres to the specific reporting requirements outlined in the TBS guidance;
• It is based on the Agency's approved Program Activity Architecture structure as reflected in its Management Results and Reporting Structure (MRRS);
• It presents consistent, comprehensive, balanced and accurate information;
• It provides a basis of accountability for the results achieved with the resources and authorities entrusted to it; and
• It reports finances based on approved planned spending numbers from the Treasury Board Secretariat in the RPP.

Dr. David Butler-Jones
Chief Public Health Officer

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Summary Information

Our Vision - Healthy Canadians and communities in a healthier world

Our Mission - To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health.

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
629.7	677.1	624.5

Human Resources (FTEs)
2006-2007	2007-2008	2008-2009
2,119	2,118	2,153

Departmental Priorities by Strategic Outcome (in millions of dollars)
Priority	Type	Planned Spending
		2006-2007	2007-2008	2008-2009
Strategic Outcome: Healthier Population by Promoting Health and Preventing   Disease and Injury
Priority #1:   Develop, enhance and implement integrated and disease-specific strategies and programs for the prevention and control of infectious disease	Ongoing	169.6	172.9	167.0
Priority #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	179.9	188.3	196.1
Priority #3 :   Increase Canada's preparedness for and ability to respond to public health emergencies, including pandemic influenza	Ongoing	55.9	77.1	26.5
Priority #4:   Strengthen public health within   Canada and internationally by facilitating public health collaboration and enhancing public health capacity	Ongoing	83.8	107.6	98.2
Priority #5:   Lead several government-wide efforts to advance action on the determinants of health	New	70.6	73.3	76.3
Priority #6:   Develop and enhance the Agency's internal capacity to meet its mandate	Previously Committed	56.0	54.7	56.4

Operating Environment

Public Health Context

Canadians continue to put health at the top of any list of their key issues and concerns. Health remains a high-profile issue, both as a reflection of Canadian values and as a contribution to Canadians' sense of national identity. Individual citizens can relate to health and health care through their own experiences and those of their families and friends. In this context, Canadians have become increasingly aware of the importance of public health as a key component of our health system.

Public health focuses on the entire population rather than the individual. It encompasses a range of activities delivered by all three levels of government in collaboration with stakeholders and communities. Public health comes to the forefront in times of crisis, such as during outbreaks of SARS (Severe Acute Respiratory Syndrome), BSE (commonly referred to as "mad cow disease"), West Nile virus or avian influenza. However, it also includes day-to-day activities (such as immunization campaigns, nutrition counselling and restaurant inspections) that require scientific and analytical support (e.g. laboratory research and analysis, epidemiology, surveillance). Along with provincial, territorial and local governments, the federal government has a key role to play in public health. This role is based on its responsibility for issues of national concern and its direct mandate for infectious disease control at international borders (i.e. quarantine).

The Public Health Agency of Canada

The Public Health Agency of Canada was created within the federal Health Portfolio to deliver on the Government of Canada's commitment to help protect the health and safety of all Canadians and to increase its focus on public health.The Agency's role is to help build an effective public health system in Canada - one that allows Canadians to achieve better health and well-being in their daily lives, while protecting them from threats to their health security. Bill C-5, An Act respecting the establishment of PHAC is before the Senate and expected to come into force this fall. Bill C-5 continues the strong tradition of cooperation and collaboration that has been a part of Canada's approach to public health for decades. It formally establishes the position of the Chief Public Health Officer and recognizes his unique dual role.

The Government of Canada's Health Portfolio consists of the following organizations: Health Canada; the Public Health Agency of Canada; the Canadian Institutes of Health Research; the Hazardous Materials Information Review Commission; the Patented Medicine Prices Review Board; and the Assisted Human Reproduction Agency of Canada. For more information see: http://www.hc-sc.gc.ca/ahc-asc/minist/health-sante/portfolio/index-eng.html.

Dual Role of Chief Public Health Officer

As Deputy Head of the Agency, the Chief Public Health Officer (CPHO) is accountable to the Minister of Health for the daily operations of the Agency, and advises the Minister on public health matters. The CPHO can engage other federal departments to mobilize the resources of the Agency to meet threats to the health of Canadians. In addition to his role as deputy head, the legislation also recognizes that the CPHO will be Canada's lead public health professional, with demonstrated expertise and leadership in the field. As such, the CPHO will have the legislated authority to communicate directly with Canadians and to prepare and publish reports on any public health issue. He will also be required to submit to the Minister of Health, for tabling in Parliament, an annual report on the state of public health in Canada. Stakeholders have made it clear that they want the CPHO to be a credible and trusted voice. Providing the CPHO with authority to speak out on public health matters and ensuring that the CPHO has qualifications in the field of public health will confirm this credibility with stakeholders and with Canadians.

Organization Structure

The following outlines the various components that make up the Public Health Agency of Canada (PHAC).

Display full size graphic

The Agency's Mandate

In collaboration with our partners, lead federal efforts and mobilize Pan-Canadian action in preventing disease and injury, and promoting and protecting national and international public health through the following:

• Anticipate, prepare for, respond to and recover from threats to public health;
• Carry out surveillance, monitor, research, investigate and report on diseases, injuries, other preventable health risks and their determinants, and the general state of public health in Canada and internationally;
• Use 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;
• Provide public health information, advice and leadership to Canadians and stakeholders; and
• Build and sustain a public health network with stakeholders.

Key Areas of Focus

The Agency's activities contribute to four key elements of Canada's Performance, as explained below.

Canada's Performance 2005 - Public Health Agency of Canada's Contribution   The Public Health Agency of Canada contributes primarily to the following Government of Canada outcome noted in Canada's Performance 2005:   Theme Government of   Canada Outcome   Department   Strategic Outcome   Program Activity Canada's Social   Foundations Healthy Canadians with access to quality health care Healthier Population by Promoting Health and Preventing   Disease and Injury Population and   Public Health As health is a state of complete physical, mental and social well-being and not merely the absence of disease, the Agency focuses on promoting health and minimizing the extent and impact of infectious and chronic diseases, injuries and emergencies. The Agency also seeks to better understand and address the underlying factors leading to health disparities among Canadians. A healthy population and the prevention of disease are requirements for a strong and productive labour force and for reduced pressures on the health care system.   The Agency also has an influence on other Government of Canada outcomes as follows:   Safe and secure communities - The Agency plays an important role in reducing the threat of infectious diseases and chemical and biological agents, and accordingly contributes to the safety of Canadian communities.   A fair and secure marketplace - Events such as a SARS outbreak can impair economic activity by affecting production, trade and travel. The Agency's leadership in reducing the likelihood and potential impact of public health emergencies helps protect and sustain Canada's economy.   A safe and secure world through international cooperation - The Agency is committed to strengthening global health security in collaboration with its international partners. To support Canada's participation in the Global Health Security Initiative, the Agency advances pandemic influenza preparedness, moves forward to prepare against chemical and biological threats, and leads the Global Health Security Action Group Laboratory Network.

Although the Public Health Agency of Canada has only existed since September 2004, it is quickly becoming a leader in global health efforts and a centre for expertise and research in public health. The World Health Organization (WHO) has commended the Agency for its collaborative approach to strengthening public health in Canada and has welcomed its continued support in helping to contain infectious diseases worldwide.

For its part, the Agency has made significant progress on the Canadian Pandemic Influenza Plan, the National Immunization Strategy and comprehensive, disease-specific approaches to address chronic disease. The Agency has also established the Pan-Canadian Public Health Network and provided financial support for the successful start-up of six National Collaborating Centres for Public Health.

The Agency's laboratories reinforce Canada's reputation for world-class research, particularly in microbiology and the control of infectious diseases. The Agency has earned praise for the excellent work of its researchers in developing a vaccine against Ebola, Marburg and Lassa fever.

Factors Affecting the Health of Canadians

Although Canadians are among the healthiest people in the world, there is still much work to do. Given the latest estimate of the economic burden of illness and injury in Canada - $217 billion in 2004 dollars - Canadians are facing significant public health challenges.

International Influences

Increasing globalization has profound and multiple implications for Canada:

• The increase in the speed and volume of global transportation places Canadians within 24 hours of almost any other place in the world. This is a shorter time frame than the incubation period of most communicable diseases, whose micro-organisms can be transported by individuals or in products such as food.
• Globally, HIV/AIDS and sexually transmitted infections continue to spread at an alarming rate, leaving a trail of suffering and premature death. In Canada, HIV rates have increased substantially over the past five years. Since many of the affected individuals are unaware of their condition, HIV/AIDS remains a hidden epidemic.
• Human cases of avian influenza A (H5N1 subtype), commonly known as "bird flu", have been reported in many parts of the world. This raises concerns about a possible human influenza pandemic.
• In addition, several previously unknown or rare diseases have appeared or reappeared in the world in recent years.

These factors highlight the need for the Agency to be involved in activities aimed at detecting and identifying potential sources of infectious disease outbreaks and at reducing and preventing the spread of infectious diseases.

Other factors such as climate change and international terrorism are challenging the health security of Canadians and increasing the risk of national disasters. Recent events such as the SARS outbreak and Hurricane Katrina have raised concerns about the ability of Canada's public health system to anticipate emergencies and to respond effectively when needed. To address the health impacts of such events, public health strategies require an all-hazards approach using robust and coordinated measures with provinces, territories and Chief Medical Officers of Health. The Agency will continue to make progress towards collaborative surveillance and emergency response.

Chronic Disease Burden

Globally, of the 58 million deaths in 2005, approximately 35 million are the result of chronic diseases. Chronic diseases are currently the major cause of death among adults in almost all countries and the toll is projected to increase by a further 17% in the next 10 years. At the same time, obesity along with type 2 diabetes is growing worldwide, leading to significant increases in heart disease and other major causes of death. The Agency, and its WHO Collaborating Centre on Chronic Disease Policy, support an integrated approach to the prevention and control of chronic diseases, their risk factors and associated health determinants through the development of evidence-based interventions and public policies.

Changes in Canadian society have resulted in shifts in consumption patterns and in living and working conditions. These changes have the potential to intensify key risk factors for leading chronic diseases in Canada and to impose significant costs on the country's economy and society. The WHO estimates that in the last few years, 1.1 million Canadians have become obese - a significant risk factor for chronic disease.

Chronic diseases such as cardiovascular disease, cancer and diabetes account for two-thirds of all deaths in Canada. In 2005, their toll was approximately 160,000 lives. The WHO estimates that over the next 10 years, over 2 million people will die in Canada from a chronic disease, and it evaluates the economic cost of these premature deaths at more than $10 billion. In addition, an estimated 3% of Canadians suffer from severe and chronic mental disorders that can cause serious functional limitations and social and economic impairment. However, a significant portion of this disease burden can be prevented through public health interventions. For example, the Health Ministers have set a target to reduce obesity rates by 20% and an objective of increasing physical activity by monitoring health issues and leading effective action.

Determinants of Health and Risk Factors

Decades of research show that for gains to be achieved in addressing all of these threats to public health, interventions must go beyond merely treating and providing care for the ill. At every stage of life, health is determined by complex interactions between social and economic factors, the physical environment and individual behaviours. The determinants of health include economic and social status, social support networks, education and literacy, employment and working conditions, the social environment, the physical environment, personal health practices and coping skills, healthy child development, biology and genetics, health services, gender and culture. Addressing these determinants is essential, and public health has a key role to play in mobilizing efforts across sectors to this effect.

One of the research findings is that inequity is closely linked to health. Although Canadians are among the healthiest people in the world, some groups are not as healthy as others. There is agreement that disparities constitute a major health problem and that opportunities for future health gains lie in reducing these disparities through action on the determinants of health. Key health disparities in Canada are related to socio-economic status, Aboriginal heritage, gender and geographic location. In Northern Canada, climate change, contaminants, remoteness, the health system's capacity and the training and retention of health care professionals also impact on health outcomes.

Recent reports show that the country's performance is slipping in some areas that are critical to future health outcomes. Demonstrated changes to key indicators include infant mortality, childhood obesity, poverty and child poverty, road accidents, and the health and standard of living of Aboriginal people and visible minority immigrants. All First Ministers' accords in the past several years have expressed the need to reduce health disparities. Therefore, work to address health disparities and action on the determinants of health, in collaboration with other sectors and partners, is central to public health.

The Agency within the Public Health System

As a key federal organization responsible for public health issues, the Public Health Agency of Canada has a clear leadership role to play in developing and coordinating efforts to meet these challenges. 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.

Canadians expect engagement, discussion, and quick and effective problem solving. They also expect transparency and accountability, so that they can evaluate the effectiveness of public organizations in meeting their mandates.

The nature of the non-governmental elements of public health is evolving. While the Agency has forged stronger linkages and partnerships, it faces very high expectations. The dynamics of working with provincial and territorial governments pose both challenges and opportunities. The Agency has made significant strides in the establishment of the Pan-Canadian Public Health Network as a key mechanism for collaboration between federal, provincial and territorial governments. The Agency's efforts in 2006-2007 must ensure that this mechanism is optimized and ensure its ongoing capacity to be an effective vehicle for advancing a Canadian public health agenda.

The Auditor General of Canada recently called for better leadership and management in relation to horizontal issues. In that context, the Agency participates in a number of initiatives, notably Climate Change, the International Polar Year, the National Food Policy Framework, the Canadian Biotechnology Strategy, the National Health Security Policy and the Security and Prosperity Partnership. The federal government's sustainable development initiative furthers the concept of horizontality; it takes into account the economy, society and the environment in an integrated way. A broad, determinants-of-health approach to public health interventions fully supports this government-wide initiative as it works toward longer-term solutions. However, the Agency needs to further demonstrate the links between public health and sustainable development, as well as its commitment to the "greening" of its operations.

Looking to the future, the Agency is committed to ensuring that its programs are as efficient as possible; that overhead costs are minimized; and that its management and planning processes meet current standards and priorities as identified by the Clerk of the Privy Council.

Building on Success

The Public Health Agency of Canada will continue to meet its responsibilities in providing federal leadership in public health, building domestic and international partnerships to improve health outcomes and rising to meet new challenges that threaten the health of Canadians.

Recognizing that the public health system is a jigsaw puzzle where all of the pieces need to fit together, the Agency's focus for the next three years will be on developing and delivering integrated approaches that cross sectors and jurisdictions to promote health, to prevent and control infectious and chronic diseases and injuries, to prepare for and respond to public health emergencies, and to develop public health capacity in a manner consistent with a shared understanding of the determinants of health and of the common factors that maintain health or lead to disease and injury.

The Agency's Priorities

1. To develop, enhance and implement integrated and disease-specific strategies and programs for the prevention and control of infectious disease

   The Agency will develop proposals to achieve a more integrated and coordinated approach to managing infectious disease and to improving the health status of those who become infected. This will be done by assessing national capacity to prevent, reduce and control infectious disease; greater integration of policy, research, surveillance and program interventions; and more effective and efficient use of resources expended to improve health outcomes.

2. To develop, enhance and implement integrated and disease or condition-specific strategies and programs within the health portfolio to promote health and prevent and control chronic disease and injury

   Promoting health and addressing the risk factors leading to chronic disease will significantly change the health and well-being of Canadians over the long term. Planned initiatives aim at improved overall health for Canadians, reduction of medical wait times, a lower number of Canadians who develop chronic diseases, and a better quality of life and fewer complications for Canadians living with chronic diseases using an appropriate mix of interventions.

3. To increase Canada's preparedness for, and ability to respond to, public health emergencies, including pandemic influenza

   The Agency's activities continue to take an all-hazards approach that encompasses emergency medical response to infectious disease outbreaks, natural disasters, explosions or chemical, biological or radiological/nuclear incidents. As a member of the Global Health Security Initiative, the Agency is committed to a resilient and effective national emergency management system and to advancing work, globally and within Canada, on infectious disease outbreaks and pandemic influenza preparedness. Initiatives being put in place with provincial and territorial governments will facilitate mutual assistance and information exchanges during public health emergencies.

4. To strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity

   Building on initial successes such as the establishment of the Pan-Canadian Public Health Network, the Agency will continue to work closely and cooperatively with all of its partners toward a seamless and comprehensive pan-Canadian public health system. Through partnerships and initiatives at the local, regional, national and international levels, and with the help of the National Collaborating Centres for Public Health, the Agency will support public health professionals and stakeholders in their efforts to keep pace with rapidly evolving conditions, knowledge and practices. The Agency will also assist in strengthening the public health workforce.

5. To lead several government-wide efforts to advance action on the determinants of health

   While recognizing the many influences that lie within the purview of other departments, jurisdictions and sectors, the Agency, as a credible voice for public health, will continue to advocate for healthy public policy, using its knowledge and understanding of the factors that affect the health of communities and individuals. The Agency continues to strengthen its partnerships to help address the factors that lead to disparities in health status. The Agency will continue to take a broad, determinants-of-health approach in making tangible progress on the Health Goals for Canada.

6. To develop and enhance the Agency's internal capacity to meet its mandate

   Over the next three years, the Agency will create a framework for results, with a view to providing Canadians with the best guidance and information on what it is trying to achieve, as well as supporting the federal government's sustainable development initiative. In 2006-2007, the Agency plans to review its Program Activity Architecture. The Agency will also complete its corporate risk profile, including risk mitigation and risk management strategies, and will respond to increasing requirements for transparency by undertaking a comprehensive strategic and integrated business and human resource planning process. Within its first business plan, during 2006-2007, the Agency will address capacity issues related to delivering on and supporting day-to-day business, clarifying its roles, further developing its Winnipeg headquarters and its vitally important network of regional offices, and expanding its world-class laboratory capacity.

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

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