ARCHIVED - RPP 2006-2007
Public Health Agency of Canada

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Section II - Analysis of Program Activities by Strategic Outcome

Analysis by Program Activity

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

Program Activity Name: Population and Public Health

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

1 The number of Full Time Equivalents (FTEs) corresponds to the salary allocation identified in the Agency's Main Estimates.
Human Resources (FTEs)1
2006-2007	2007-2008	2008-2009
2,119	2,118	2,153

The Public Health Agency of Canada is currently organized under one Strategic Outcome and one Program Activity.

Program Activity Description

In collaboration with its 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;
• 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 to support effective actions in 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, advise and engage Canadian and international public health stakeholders on goals, policies, strategies for action, tools, practices and community-based capacity; and to provide public health information, advice and leadership to Canadians and stakeholders.

Key Programs and Services

The Agency's key programs and services fall into five broad categories:

• Emergency Preparedness and Response;
• Infectious Disease Prevention and Control;
• Health Promotion and Chronic Disease Prevention and Control;
• Public Health Tools and Practice; and
• Strategic and Developmental Initiatives.

These programs and services are delivered at the headquarters offices located in the National Capital Region and Winnipeg, and at its regional offices. The remainder of this section describes the key programs and services related to these categories, and their contribution to delivering on the Agency's priorities.

Emergency Preparedness and Response
(http://www.phac-aspc.gc.ca/cepr-cmiu/index.html)

The Public Health Agency of Canada partners with Health Canada, other federal departments, the provinces and territories, international organizations and the voluntary sector to identify, develop and implement preparedness planning priorities and to develop public health emergency response plans.

The Agency's emergency preparedness and response activities are guided by the federal, provincial and territorial Expert Group on Emergency Preparedness and Response (formerly known as the Network on Emergency Preparedness and Response), which is based on the Minister of Health's Special Task Force on Emergency Preparedness and Response.

These activities are consistent with the recently completed National Framework for Health Emergency Management. This framework sets out a consistent, inter-operational approach to health emergencies that respects each jurisdiction's specific characteristics and priorities, and supports the Government of Canada's national readiness and response system.

The Agency's work on emergency preparedness and response capacity supports RPP Priority 3, "to increase Canada's preparedness for and ability to respond to public health emergencies, including pandemic influenza".

Emergency Preparedness Capacity
(http://www.phac-aspc.gc.ca/ep-mu/index.html)

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
13.9	13.8	13.8

The Agency provides training on emergency preparedness and helps its partners to develop their own emergency training capacity. As well, the Agency plans, coordinates and carries out various exercises to test existing operational plans and enhance preparedness (http://www.phac-aspc.gc.ca/cepr-cmiu/oeppt-dmupf/index.html). These activities contribute directly to Canada's readiness to respond to all emergencies involving hazards that threaten the public's health.

The Agency is responsible for activating the National Emergency Response Assistance Plan when necessary, and for compliance with the Transportation of Dangerous Goods Act in the matter of responses to inadvertent spills of dangerous pathogens during transport. To maintain response readiness, it also equips and coordinates 15 national response teams and regularly conducts national training sessions for federal, provincial and territorial participants.

The Agency administers a hazardous waste management program in the National Capital Region, and monitors the Health Portfolio's progress on laboratory safety.

The Agency has created Emergency Preparedness and Response Regional Coordinator positions across the country. These coordinators collaborate with provincial and territorial emergency preparedness authorities to refine region-specific planning and act as liaisons with federal departments.

Over the planning period, the Agency will continue 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 (GPHIN - http://www.phac-aspc.gc.ca/media/nr-rp/2004/2004_gphin-rmispbk-eng.html). GPHIN is a secure, Internet-based "early warning" system that tracks events such as disease outbreaks in humans and animals; plant diseases; contamination of food and water; chemical, radiological and nuclear incidents; natural disasters; and issues related to unsafe products, including drugs and medical devices. This system gathers relevant information by monitoring media sources throughout the world and makes this information available to governments and non-governmental organizations, which can then quickly react to public health emergencies.

The updated Quarantine Act received Royal Assent in May 2005 and is expected to come into force in the spring of 2006 during the planning period. This new quarantine legislation will further protect public health and will foster better emergency preparedness and response capacity at Canada's ports of entry and departure. In 2006-2007, the Agency will develop supporting regulations, policies, procedures and training.

In addition, the Agency will support and strengthen its nationwide quarantine service over the two fiscal years starting in 2006-2007, using well-trained, knowledgeable quarantine officers at six international airports accounting for 94% of international travel into Canada. This will allow the Agency to act quickly to protect the health of Canadians in the event of a global communicable disease outbreak. The Agency will respond to all reports of passengers whose presence aboard vessels constitutes a risk factor, and will assist all ports of entry in developing their respective emergency response protocols.

The Agency's enhancement of emergency preparedness capacity ensures that Canadians will benefit from a more efficient and effective response that reduces the effects of health-related emergencies.

Emergency Response Capacity

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
9.1	9.0	9.0

In order to link the health sector's emergency preparedness and response activities within the Government of Canada's National Emergency Management Framework, the Agency is directly linked to Public Safety and Emergency Preparedness Canada. This important liaison function will be enhanced to include operational links with the Agency's Emergency Operations Centre system. In 2006-2007, the Agency will create a permanent executive liaison function to strengthen the policy, program and emergency response linkage between the National Health Emergency Management System and the Government's National Emergency Response System.

The Agency also contributes 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.

The Agency issues permits for the importation of human pathogens, and inspects high risk (Level 3 and 4) biocontainment facilities that import human pathogens, in accordance with the Human Pathogens Importation Regulations . Agency and Health Canada laboratories meet all requirements set out in the Transportation of Dangerous Goods Act and Regulations with respect to the handling of radioactive materials and the transportation of dangerous goods and hazardous materials (including toxic waste and other chemical and toxic substances). Through the development and application of national biosafety policies and guidelines, the Agency provides national and international expertise and leadership in biosafety and biosecurity.

The Agency, the Royal Canadian Mounted Police and the Department of National Defence are members of the National Capital Region's Joint Chemical, Biological, Radiological and Nuclear Response Team (CBRN - http://www.phac-aspc.gc.ca/cepr- cmiu/ophs-bssp/links_index-eng.html). The CBRN Team provides expertise, specialized equipment, facilities and scientific support in response to threatened, perceived or actual incidents involving biological weapons or agents. The Agency provides on-site mobile detection and response capability; during 2006-2007, it will continue to improve its laboratory response operations in both its first response laboratory and its mobile response units.

The Agency monitors the accidental release of biological materials from certified and non-certified facilities and instances of laboratory-acquired infections. It also participates in the administration of the Biological and Toxin Weapons Convention in Canada. When required, the Agency will activate the Emergency Response Assistance Plan for national transportation emergencies involving Risk Group 4 human pathogens, or the National Capital Region plan for on-scene response to reports of suspicious packages and other bioterrorism events. In addition, it will conduct scientific research in support of CBRN response decision-making, provide support to the Convention verification program, and offer guidance and assistance on biosafety and biosecurity to other government departments.

The Agency maintains three mobile laboratories that can be deployed anywhere in the world. Their technically advanced equipment allows for rapid diagnoses, yet is rugged enough to work in field conditions. During 2006-2007, the Agency will 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.

The Emergency Operations Centre (EOC) system is the Agency's and Health Canada's central emergency response unit. Equipped with state-of-the-art emergency management software and a geospatial information system for advanced video/telecommunications, data sharing and event management, it enables central direction, control and coordination during emergencies.

The EOC consists of a national hub in Ottawa, a public health laboratory operations centre in Winnipeg, and a back-up facility. These three EOC units are well connected to their federal, provincial, territorial and external counterparts, such as the US Department of Health and Human Services Command Center, the Centers for Disease Control and Prevention (CDC) in the United States, and the WHO. During the planning period the Agency will further connect them to provincial, territorial, and international networks.

The Agency's National Emergency Stockpile System (NESS) maintains emergency supplies in a robust and versatile system. Items stored range from small backpack trauma kits to complete 200-bed emergency hospitals. They are kept at a central depot in Ottawa, eight federal warehouses located strategically across the country, and approximately 1,300 storage sites under federal, provincial and territorial care. During the planning period, the Agency will increase the storage capacity as well as the stock of supplies. NESS will continue to have the capability to respond 24 hours a day, 7 days a week, and to deliver needed supplies anywhere in Canada within 24 hours of receiving a request for assistance. By modernizing NESS, and by supporting and facilitating the national dialogue on emergency measures under an all-hazards approach, the Agency will continue to improve its influenza pandemic preparedness in 2006-2007.

The National Office of Health Emergency Response Teams (NOHERT - http:// www.phac-aspc.gc.ca/cepr-cmiu/ophs-bssp/nohert-eng.html) was established in December 2001. It is mandated with developing Health Emergency Response Teams (HERTs) to assist the provinces and territories in creating surge capacity for emergency situations. Located in major centres across Canada, these teams will include medical, nursing and other personnel that will collaborate with provincial and territorial counterparts to assess and coordinate needed interventions. In 2006-2007, one HERT will be staffed, trained and provided with supplies. Three additional teams will be established by 2008.

The Agency helps to coordinate emergency health and social services through the Council of Health Emergency Management Directors and the Council of Emergency Social Services Directors (http://www.phac-aspc.gc.ca/emergency-urgence/index-eng.html).

Over the three-year planning period, the Agency will continue to coordinate the activities of key emergency preparedness stakeholders; promote evidence-based emergency preparedness practices across the country; and develop policies and strategies to establish a more integrated and comprehensive approach to managing health emergencies (including pandemic influenza). This will strengthen federal, provincial and territorial capacity to prepare for, respond to, and recover from public health emergencies.

In 2006-2007, the Agency will also:

• work in collaboration with the Pan-Canadian Public Health Network toward the establishment of a federal, provincial and territorial Public Health Mutual Aid Agreement;
• continue working with Canada's Pandemic Influenza Committee to operationalize the Pandemic Influenza Plan;
• further develop a national health incident management system; and
• define the federal, provincial and territorial components of the National Health Emergency Management System.

In 2006-2007, the Agency's Travel Medicine Program will take steps to ensure that yellow fever vaccine is dispensed in Canada in accordance with national standards.

Infectious Disease Prevention and Control

The Agency plays a leadership role in identifying and addressing emerging threats to the health and safety of Canadians through activities related to surveillance, risk analysis and risk management. It also participates in provincial, territorial and international investigations of disease outbreaks, as requested.

Specifically in 2006-2007 the Agency will look to provide an enhanced national capacity to conduct policy development, program response, surveillance, investigation and research on: tuberculosis and other respiratory infections; HIV/AIDS and other sexually transmitted infections; hepatitis B and hepatitis C; foodborne and waterborne infections; pandemic influenza; health-care acquired infections; and animal-borne diseases that pose a risk to humans.

Through the development of knowledge; inter-sectoral and international collaborations and capacity building; and public and professional education, the Agency will support changes in attitudes, behaviours and public health practices to prevent or slow down the spread of infectious diseases.

Additionally, the Agency has identified some specific priorities for 2006-2007:

The Agency will collaborate with its partners on the development of disease-specific and comprehensive strategies to combat the threat of infectious diseases within and beyond Canada's borders. Links will be established to other nationally-led public health initiatives and a focus on inter-sectoral collaboration, coordination and partnerships in infectious disease management.

The Agency will focus on health promotion, prevention, early detection and preparedness, and response and recovery while building on existing partnerships with other levels of government and with industry, academia and civil society to better protect the health of Canadians at home and abroad.

The Agency will continue its collaboration with regional health authorities across Canada in the implementation of the Canadian Network of Public Health Intelligence (CNPHI) which will be expanded to provide additional Web-based resources, including outbreak summaries of foodborne and waterborne disease, syndromic surveillance, infectious disease modelling tools and West Nile virus surveillance. A special data-extraction method will be 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 will also be 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.

Agency laboratories will continue to perform expert microbiological reference testing and carry out innovative research to improve Canada's capacity for identifying viruses and bacteria, often used to support surveillance and outbreak investigation. This relies 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.

Through the Agency's Laboratory for Foodborne Zoonoses in Guelph and units in St. Hyacinthe and Lethbridge (http://www.phac-aspc.gc.ca/lfz-llczoa/index-eng.html), the Agency will continue 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. Over the next three years, the Agency plans to work with federal, provincial and territorial counterparts, academia, industry partners and stakeholders to coordinate a Canadian Integrated Program for Antimicrobial Resistance Surveillance.

The Agency will, through the National Enteric Surveillance Program (NESP), continue to collect, and disseminate weekly, laboratory-based data on human gastrointestinal pathogens (bacterial, viral and parasitic) to facilitate timely outbreak detection, response and emergency preparedness. In 2006-2007, NESP will be further improved through the development and implementation of real-time, Web-based tools. Collaboration with partners such as the World Health Organization, the Pan American Health Organization and the Centers for Disease Control and Prevention strengthens international epidemiological and laboratory capacity.

Throughout 2006/2007, the Agency's National Studies on Acute Gastrointestinal Illness initiative will continue to study the incidence, burden, cost and risk factors, and the phenomenon of under-reporting, of infectious gastrointestinal illness in Canada.

The Agency will also take 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.

These planned activities will enable the Agency to meet RPP Priority 1, "to develop, enhance and implement integrated and disease-specific strategies and programs for the prevention and control of infectious disease".

Pandemic Influenza

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
92.6	137.6	70.6

Pandemic influenza is a serious health threat faced by Canada and the global community. While inevitable, influenza pandemics are unpredictable; preparedness is critical to minimizing their human and societal disruption. The Agency plays a leading role in Canada's pandemic preparedness, as it links provincial, territorial and local efforts with the activities of international organizations.

The 2006 Budget provides significant new funding to protect and promote the health of Canadians including $1 billion over five years to improve pandemic preparedness. This investment will enhance initiatives already underway in relation to both avian and pandemic influenza preparedness.

The Agency and members of Canada's Pandemic Influenza Committee have held extensive consultations to develop the Canadian Pandemic Influenza Plan. An updated version of this framework to guide public health actions will be published in 2006; it will reflect advances in scientific information since the first edition was released in 2004.

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 administers a 10-year contract between GlaxoSmithKline and the Government of Canada to develop and maintain domestic pandemic vaccine production capacity. The Agency will also continue to administer a 2005 contract to produce and test a prototype pandemic vaccine and conduct clinical trials. Future plans for expanded operations could result in faster production of necessary doses as a result of increased capacity and/or technological advancement. These activities will contribute to the improvement of Canada's preparedness.

Part of the preparation for an influenza pandemic is establishing an adequate reserve of antiviral medication. The Agency and the provinces and territories have contributed to the creation of a national stockpile of 16 million doses of antivirals for use during a pandemic which is to be increased to 55 million doses over the planning period. Some provinces and territories have purchased additional stock, which would result in an even greater total Canadian supply. The Agency is committed to optimizing the amount and composition of the national stockpile, and in 2006-2007, has made it a priority to appropriately increase and diversify the stock of antivirals for treatment.

Monitoring, detecting and reporting unusual respiratory illnesses are important. Canada has improved its surveillance activities and collaborates regularly with international partners to ensure optimal results. The Agency will continue surveillance, research and knowledge translation related to preparedness. Over the three-year planning period, the Agency's ongoing pandemic research activities will include the evaluation of influenza immunization programs in Canada. As well, the Agency will develop public involvement activities to respond to immediate needs for increased information.

Canada provides technical support and expertise on avian influenza to affected countries. The Agency will partner with the Canadian International Development Agency (CIDA) in implementing the Canada-Asia Regional Emerging Infectious Diseases (CAREID) project over a five-year period. The Agency's contribution will account for up to $5 million of the $15 million initiative. CAREID strengthens surveillance, laboratory capacity, emergency preparedness and communications in Southeast Asia and China, and increases the capacity of countries in this area to respond to emerging infectious diseases, including pandemic influenza. Canada collaborates on avian influenza with international partners, including the WHO, in various forums such as the Global Health Security Action Group, the Security and Prosperity Partnership and APEC (the Asia-Pacific Economic Cooperation).

Immunization

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
10.0	10.0	10.1

Immunization has proven to be one of the most effective types of public health intervention.

The National Immunization Strategy accepted by the Conference of Federal, Provincial and Territorial Deputy Ministers of Health in 2003 sets out a joint approach to strengthen Canada's immunization capacity to reduce the incidence of vaccine-preventable diseases.

Under the Strategy, the Agency facilitates ongoing discussions with the key stakeholders and provides scientific, program, policy, information dissemination, coordination and administrative support to the federal, provincial and territorial Canadian Immunization Committee, and the National Advisory Committee on Immunization under the auspices of the Pan-Canadian Public Health Network. The Agency also collaborates internationally on issues related to immunization and vaccine-preventable infectious diseases.

Bloodborne Diseases and Sexually Transmitted Infections

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
52.8	57.7	65.5

The Agency undertakes activities, and provides pan-Canadian coordination related to: the reduction of the spread of bloodborne diseases and sexually transmitted infections (STIs), including the Federal Initiative to Address HIV/AIDS in Canada, core surveillance and initiatives to address sexually transmitted infections, as well as initiatives to reduce infections through injection drug use, transfusion and transplantation.

The number of Canadian HIV-positive test reports has increased by 20% over the past five years. About 30% of the individuals concerned are unaware of their infection. This "hidden" aspect of the epidemic means that in total, an estimated 17,000 infected individuals cannot access treatment, support or prevention services.

In January 2005, the launch of the Federal Initiative to Address HIV/AIDS in Canada signalled a renewed and strengthened federal role in the Canadian response to the disease, building on on-going Government of Canada action since 1983. The Federal Initiative is a partnership among the Public Health Agency of Canada,

Health Canada, the Canadian Institutes of Health Research and Correctional Service Canada. Through this initiative, the Agency will continually aim 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. In 2006-2007, an approach with efforts aimed at discrete population groups will be put in place to address the shared needs of e.g. gay men, women and people from countries where HIV/AIDS is endemic. This work will subsequently be extended to include the other priority population groups, with a target date for completion in 2008-2009.

In 2006-2007 the Agency will also continue 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 this period the Agency will follow-up and expand on its efforts to support services and programs that help Canadians improve and maintain their sexual health. This will include an examination of the Agency's national guidelines on sexual health education, in collaboration with provinces and territories, non-governmental organizations and academia, to identify "best practice" models of school-based curricula and research on sexual health promotion. The Agency will also continue current projects including behavioural research and plans to distribute a new series of national STI guidelines in 2006 to health care practitioners and clinics across Canada.

Plans for 2006-2007 also include monitoring the infection rates of a wide range of sexually transmitted and bloodborne infections, and using the Enhanced Surveillance of Canadian Street Youth to provide a comprehensive picture of the health of Canadian street youth including undertaking, surveillance related to risk factors. This will help in developing appropriate, innovative services and prevention programs

Health Care Acquired Infections

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
3.7	3.7	3.7

It is estimated that about 5% to 10% of all patients who enter a Canadian health facility will develop a health care acquired (nosocomial) infection. The Agency’s Nosocomial Infections Program works in collaboration with the provinces and territories and their health care institutions develop and evaluate guidelines, using statistics from the Canadian Nosocomial Infection Surveillance Program (CNISP), a collaboration between the Agency and 30 major teaching hospitals.

In 2006-2007 the Agency will expand the scope of its Infection Control Guidelines Series. These guidelines are widely used by health care providers, governments and other institutions best-practice information on the prevention and control of infections and encompass acute care, long-term care, office and outpatient care, and home care.

In 2006-2007, the Agency also plans to use survey information related to infection prevention and control practices to revise the existing Infection Control Guideline on "Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care."

As well, the Agency plans to update the Infection Control and Occupational Health Guidelines for pandemic influenza in traditional and non-traditional health care settings, as part of the Canadian Pandemic Influenza Plan.

One particular nosocomial bacterium, Clostridium difficile (see http://www. phac-aspc.gc.ca/c-difficile/index.html), is the most common cause of infectious diarrhoea in hospitals in the industrialized world. During 2006-2007, the Agency plans to complete its analysis of a previously conducted C. difficile survey and to publish a report.

Over the next three years, CNISP will increase its number of active surveillance projects and policy activities related to critical health care acquired infections. It will also establish ongoing surveillance in intensive care units in the 30 CNISP-affiliated hospitals across Canada. The Agency will begin the expansion of the CNISP network to community hospitals and long-term care agencies. In addition, it will establish a surveillance system for bloodstream infections within the CNISP-network hospitals. Ongoing surveillance activities will focus on C. difficile-associated diarrhoea, antibiotic-resistant organisms, cardiac surgery site infections and severe respiratory conditions.

A specialized unit at the National Microbiology Laboratory (NML) in Winnipeg works closely with the CNISP and other surveillance programs to fingerprint antimicrobial-resistant strains of common nosocomial pathogens to track the spread of these organisms. The unit acts as a resource for hospital or provincial public health laboratories.

The above national surveillance efforts are complemented by program support to the provinces, territories and health care organizations for investigating outbreaks of nosocomial infections (such as SARS and avian influenza) and infections resulting from the emerging resistance of infectious organisms to antibiotics. The Agency assists the provinces, territories and health care institutions in analyzing infectious disease outbreaks and in developing contingency plans for emerging infectious agents in health care environments.

Animal-to-Human (Zoonotic) Diseases

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
20.7	18.8	15.9

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.

Agency Centres and Laboratories conduct surveillance of specific zoonotic diseases and participates in related outbreak response and management. It provides technical expertise, information and advice on the public health risks linked to zoonotic and emerging diseases.

The Agency leads the federal government's response to West Nile virus through the National West Nile Virus Surveillance Program. It 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. During the three-year planning period, the Agency will continue to collaborate with Canada's blood agencies in an effort to minimize the risks posed by West Nile virus to Canada's blood supply.

Lyme disease has become increasingly recognized as an ongoing public health issue. There is a need to better understand the risk factors associated with Lyme disease and other tick-borne diseases, including the impact of future climate variability and climate change. The Agency will continue to be active in research and knowledge transfer on this issue, and in 2006-2007 will update existing guidelines and host a national conference to assess the impact of Lyme disease.

As an important step towards the establishment of a pan-Canadian rabies program, the Agency plans to lead the development of a national contingency plan for raccoon rabies.

At the NML, 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.

Over the planning period, the Agency activities for infectious disease prevention and control will include:

• carrying out selected field studies to define the activity of disease agents such as leptospirosis and tularemia;
• providing a mobile laboratory emergency response to zoonotic disease outbreaks (e.g. Ebola and Marburg viruses);
• training technicians, students and visiting scientists;
• undertaking prevention-related activities as official spokespersons on different zoonotic diseases, by participating in committees and by giving presentations to special interest groups who face potential risks, for example, hydro workers, and members of wildlife associations; and
• conducting a strong research program on topics ranging from the mechanisms of pathogenesis to studies on antiviral drugs and vaccines.

Health Promotion and Chronic Disease Prevention and Control

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
284.7	291.8	304.1

The Agency's ongoing work in promoting health and preventing and controlling chronic diseases has recently been extended through a new integrated initiative that is profiled below.

Approaches to Health Promotion and Chronic Disease Prevention and Control

Health is determined by a number of factors including conditions in society, personal health practices and behaviours. Each person has factors that determine their risk of chronic disease. Some of these, such as genetics, age and gender, cannot be changed. More and more Canadians, however, have one or more risk factors like smoking, unhealthy eating and physical inactivity that often lead to the major chronic diseases: heart disease and stroke, cancer, diabetes and respiratory disease.

The economic burden of chronic disease in Canada is estimated to be $70.0 billion per year.

Fortunately, two-thirds of death and disability could be avoided. Most Canadians, up to 80%, have at least one health behaviour they could change to improve their health.

Still, chronic disease remains the leading cause of death and disability in Canada. One in every two Canadians has a chronic disease. Chronic disease and injury account for more than 75% of deaths and 87% of disability each year and the related economic burden is estimated at $70B per year or about 62% of direct health care costs and 79% of the indirect costs of illness (e.g. loss of productivity).

Regrettably, the burden of preventable death and disease has been growing, reducing quality of life and increasing wait times for care and challenging the sustainability of the health system. Health promotion and efforts to reduce the risks of chronic diseases, can prevent diseases such as cancer, heart disease and stroke, and diabetes, and in so doing reduce the numbers of Canadians waiting for care and treatment to manage these diseases.

As identified by major national reviews like the Kirby and Naylor reports, there is a need for balancing investments in health promotion and chronic disease prevention in order to make a difference in reducing the burden on the health care system. Lessons learned indicate that upstream investments in health promotion and prevention are needed to reverse current trends and address unhealthy lifestyles.

When chronic disease can't be avoided, it can be caught early and managed so that people can live better with disease and avoid complications.

Healthy Living and Chronic Disease Strategy

To address the growing burden of chronic disease in Canada, the Agency will 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, reduce the impact of chronic disease in Canada and address the key determinants of health.

The collaborative strategy, that includes disease specific initiatives, will focus on three pillars, including:

1. promoting health by addressing the conditions that lead to unhealthy eating, physical inactivity and unhealthy weight;
2. preventing chronic diseases; and
3. supporting early detection and management of chronic diseases

The vision of the Integrated Strategy on Healthy Living and Chronic Disease is to promote a comprehensive approach across a range of public health activities including the promotion of health, and the prevention, management and control of chronic health problems, with a view to building a healthier nation, decreasing health disparities, and contributing to the sustainability of the health system in Canada.

This government sees integration as an ultimate result that will be achieved through disease-specific strategies. Integration involves working with and networking the expertise of diverse partners and stakeholders involved in health promotion, chronic disease prevention and risk factors.

Cardiovascular Disease

Cardiovascular disease is the most common cause of hospitalization and the leading cause of death in Canada for both men and women. It is the country's most costly disease and places the greatest burden on the Canadian healthcare system.

The Agency will continue to work across the Health Portfolio, in collaboration with provinces, territories and key stakeholders to establish a Pan-Canadian Cardiovascular Disease Strategy and action in Canada.

Canadian Diabetes Strategy

More than 5% of Canadian adults and children suffer from diabetes, and 60,000 new cases are diagnosed each year. These rates are expected to increase in the future.

The Agency provides leadership on the non-Aboriginal elements of the Canadian Diabetes Strategy, which has been in effect since 1999, and will be working with the Canadian Diabetes Association, provinces, territories and other partners on the future direction of the Canadian Diabetes Strategy.

The Agency will also undertake the following activities during the three-year planning period:

• The Healthy Living Fund will promote integrated approaches to healthy living by supporting knowledge development and exchange, and will strengthen capacity to achieve an impact at the regional, national and international levels. In 2006-2007, funding will be provided through contribution agreements to support and engage the voluntary sector, and to build partnerships and collaborative action among governments, non-governmental organizations and other agencies.
• The Intersectoral Healthy Living Network will continue to foster collaboration and improve information exchange among sectors and across jurisdictions.
• In 2006-2007, the Agency will participate in the Joint Consortium for School Health, a partnership between the federal government and provincial and territorial ministries of Health and Education to promote the health of children and youth in school settings.
• An assessment of risk factors for chronic disease, including behavioural, social and environmental factors, will continue to support the ongoing development of promotion, prevention and management interventions.
• Enhanced Surveillance of Chronic Disease is a key knowledge and management tool for decision-makers to understand the health of the population and to measure progress in affecting health outcomes. Funding for Enhanced Surveillance will provide on-going and timely information and indicators on the health of the population, the nature and scope of health problems, and the factors that need to be addressed in the population to improve health. Information on these factors will assist to inform evidence-based health-related decisions on policies, programs and services as a tool to evaluate progress in chronic disease prevention and control. The Agency will be working with stakeholders, the provinces and territories to implement shared priorities in chronic disease surveillance.
• The Agency will continue to work with a national consortium of governments and stakeholders to inventory health promotion and disease prevention interventions in order to identify and develop best practices; disseminate this information to researchers, policy makers and practitioners; and monitor adoption. The proposed Observatory of Best Practices would include a broad range of interventions from clinical preventative health care to community programs and to policies.
• The Agency's expertise in chronic disease policy development and analysis will be extended through the work of the Collaborating Centre on Non-Communicable Disease Policy, which it operates in conjunction with the World Health Organization.

In summary, this Strategy's approach to health promotion and chronic disease prevention and control supports the Agency's priorities by facilitating collaboration and capacity building. It also supports Agency leadership in government-wide efforts to advance action on the determinants of health. On another level, it also helps facilitate and is directly linked to one of the government's top priorities - reducing wait times.

Cancer

Cancer prevention and control is a priority for the Government of Canada. An estimated 149,000 new cases of cancer and 69,500 deaths from cancer will occur in Canada in 2005. Every year thousands of Canadians are diagnosed with or die of cancer. It affects not only those living with the disease, but also their families, friends and colleagues. As well, this disease affects all Canadians in terms of the economy and increased health care costs.

Cancer is expected to be the leading cause of death within the next several years, and population aging is expected to contribute to doubling the number of new cases of cancer in Canada by 2020.

Budget 2006 committed $260 million over five years towards the implementation of the Canadian Strategy for Cancer Control (CSCC) to help improve cancer screening, prevention and research activities, and to help coordinate efforts with the provinces, territories and cancer care advocacy groups.

The CSCC represents seven years of collaborative work by a 30-member Council who consulted with more than 700 stakeholders to develop a framework on how best to control cancer in Canada. The CSCC's main objectives are to reduce the number of new cases of cancer, to enhance the quality of life of those living with the disease and to reduce the number of premature deaths attributable to cancer.

The essence of the CSCC vision is knowledge translation, based on the notion that decision-makers at all levels no longer have the capacity to stay current with the exponential growth of new knowledge and breakthroughs in cancer prevention, diagnosis and treatment. The CSCC plan therefore proposes to develop and provide useful decision support mechanisms and tools to both policy makers and those on the front lines of cancer care.

In addition, through the Canadian Breast Cancer Initiative the Agency will continue to collaborate with stakeholders to address breast cancer issues ranging from prevention to palliative care. The Agency will also continue to participate in the Canadian Childhood Cancer Surveillance and Control Program, a partnership involving health care providers, researchers, consumers, provincial, territorial and federal governments, voluntary agencies, universities and organizations. This program will examine the implications of childhood cancer on Canada's health care system, and will address knowledge gaps affecting its control.

Other Health Promotion and Chronic Disease Prevention and Control Initiatives

Children and Adolescents

Over the planning period, the Agency will continue to deliver a wide range of community-based programs for women, children and families, including the Canada Prenatal Nutrition Program, the Community Action Program for Children and the Aboriginal Head Start in Urban and Northern Communities. These programs help to reduce the health disparities experienced by vulnerable children and families living in conditions of risk.

On behalf of the Minister of Health, the Agency co-leads, with the Department of Justice, federal government efforts on matters concerning the United Nations Convention on the Rights of the Child (the Convention). Through its collaboration with the Inter-American Children's Institute - a special institute of the Organization of American States - the Agency will continue to contribute to the implementation of the Convention throughout the Americas.

Other programs administered by the Agency will continue to contribute to the development and exchange of knowledge concerning the health of children and adolescents, including the Survey on the Health Behaviours of School-Aged Children and the Fetal Alcohol Spectrum Disorder Initiative. In addition, the Agency will continue to conduct national surveillance and epidemiologic analysis on elements of maternal and child health.

The Centres of Excellence for Children's Well-Being Program generates and disseminates the latest knowledge on children's well-being to a broad network of target audiences, including policy-makers, service providers and community groups and families. The program consists of four Centres - Early Childhood Development, Special Needs, Youth Engagement and Child Welfare. The Centres will continue to provide advice to all levels of government and international organizations to strengthen child-related policies and programs in Canada and abroad.

In addition to activities related to children and adolescents, during the three-year planning period, the Agency will continue its work on the following:

• Aging and Seniors - The Agency is the federal government's centre of expertise and focal point on seniors' health, and will continue to provide leadership on healthy aging through policy development, health promotion, research and education, partnerships and dissemination of information. The Agency also provides operational support to the National Advisory CouncilonAging.
• Mental Health and Mental Illness - Approximately 20% of Canadians will experience a mental illness during their lifetime, and the remaining 80% will be affected by mental illness in family members, friends or colleagues. The Agency will continue to work to advance mental health issues across government.
• Family Violence - The Agency leads the Family Violence Initiative, a partnership of 13 federal departments, agencies and Crown corporations. Over the three-year planning period, the Agency will continue to play a central role in increasing awareness and developing knowledge in this area.

As a key information service, the Canadian Health Network (CHN) and its "network of networks" will continue to support the Agency's work in helping to build healthy communities.

These other health promotion and chronic disease prevention and control initiatives also contribute to the Agency's RPP Priority 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".

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 contributes greatly to the training of public health workers. Health professionals at local public health departments and regional health authorities across Canada access its programs to increase their skills in the fields of epidemiology, surveillance and information management.

The Agency also contributes to improving public health care infrastructure by developing and providing tools, applications, practices and programs that support and develop the capabilities of front-line health care professionals.

These efforts to develop, improve and promote public health tools and practices support the Agency's RPP Priority 4, "to strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity".

Building Public Health Human Resource Capacity

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
10.9	12.5	12.5

In 2006-2007, in concert with the provinces and territories, the Agency will participate in the development of the Pan-Canadian Framework for Public Health Human Resources Planning, and will support the Public Health Human Resource Task Group of the Pan-Canadian Public Health Network. The Agency will leverage the subject matter expertise across Canada and hold consultations with them to address core public health and discipline-specific competency profiles.

During 2006-2007, the Agency will prepare a comprehensive professional development plan for its staff. In addition, it will work with the Canadian Institute for Health Information, Health Canada, Statistics Canada and other partners to develop administrative databases on public health human resources in order to quantify the current workforce in this field.

The Agency is a leader in field epidemiology, which is the application of epidemiological methods to unexpected health problems in situations where rapid, on-site investigation is necessary. In 2006-2007, it plans to significantly increase the number of placements available in the Canadian Field Epidemiology Program (http://www.phac-aspc.gc.ca/cfep-pcet/index.html).

The Skills Enhancement for Public Health Program (http://www.phac-aspc.gc.ca/csc-ccs/sehs-acss/index-eng.html) provides distance-learning opportunities to Canadian public health workers. Delivered through the collaborative efforts of the Agency, the provinces, the territories, professional associations and academic institutions, it provides professional development training in epidemiology, surveillance and health information management. During 2006-2007, the Agency plans to add and/or improve the program modules to enhance core competencies; to train on-line facilitators; to address the learning needs of front-line practitioners; and to continue to use and improve e-learning opportunities. Over the planning period, the Agency will strengthen its existing partnerships and seek new ones in federal, provincial, territorial and local jurisdictions.

In 2006-2007, the Agency will provide training award incentives to public health professionals and universities to promote education in applied public health. The Agency will collaborate with the Canadian Institute of Health Research (CIHR) on an awards program and will collaborate with universities on the development of guidelines for an applied masters program for public health.

By enhancing the skills, knowledge and capacity of public health human resources, the Agency supports its RPP Priority 4, "to strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity, as well as its RPP Priority 3, "to increase Canada's preparedness for and ability to respond to public health emergencies, including pandemic influenza".

Knowledge and Information Systems

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
6.1	6.9	6.9

To respond to the recognition that the public health surveillance system in Canada lacks a planned, coordinated national effort and that each jurisdiction is carrying out surveillance using different methodologies, different software and different standards and definitions, the Agency has established the Canadian Integrated Public Health Surveillance (CIPHS) program and the Geographic Information Systems (GIS) Infrastructure program.

The CIPHS program (http://www.ciphs.ca), in collaboration with Provincial and Territorial partners, has developed a web-enabled suite of integrated case management applications called the integrated Public Health Information System (iPHIS). iPHIS facilitates, as a by-product of public health practitioners' day to day work in client assessment and case management, the systematic collection, integration, analysis, interpretation and dissemination of public health surveillance data.

While iPHIS was due for a major redesign to upgrade it to new Electronic Health Record (EHR) architecture standards, Canada Health Infoway Inc. was allocated funds to develop and implement a Pan-Canadian Public Health Surveillance and Management Solution. Infoway is making use of the lessons learned, along with key design concepts and business rules of iPHIS, as well as working with public health professionals from across the country and the Public Health Agency in the design of this new system that will be fully compatible with the EHR. While awaiting completion and implementation of the new solution, the Agency will continue to maintain iPHIS and will continue to work with Infoway to help ensure that the new system meets both jurisdictional and federal surveillance program needs. The Agency will also ensure that iPHIS remains in a pandemic-ready state (with new modules for outbreak management being rolled out to users) and will work to ensure that the transition for existing iPHIS users when the Infoway solution becomes available is as seamless as possible.

The GIS Infrastructure program (http://www.phac-aspc.gc.ca/csc-ccs/gis-eng.html) includes the Public Health Map Generator for public health professionals across Canada at the federal, provincial, territorial and local levels. Maps created with this web-enabled generator will continue to be used to support evidence-based decision making in program planning and evaluation, disease outbreak investigation, disease and injury surveillance, emergency preparedness, resource allocation, intervention program implementation and evaluation, and public awareness and policy activities. The GIS infrastructure will also continue to support public health professionals through the provision of specialized data and mapping services.

An ongoing assessment of the state of the public's health will benefit the Agency and its partners in program development and delivery. This assessment will take the form of an Annual Report. In 2006-2007, the Agency will undertake the groundwork leading to the development of such an Annual Report.

Canada's six National Collaborating Centres for Public Health (NCCs) play an important role in promoting the use of evidence in public health practice. These non-government organizations provide national focal points to examine priority areas in public health. Their work contributes to the development of the Pan-Canadian Public Health Strategy. Each Centre specializes in a different priority area: environmental health (British Columbia); infectious diseases (Manitoba); public health methodologies and tools (Ontario); public policy and risk assessment (Quebec); determinants of health (Atlantic); and Aboriginal health (British Columbia).

The Agency has established a five-year contribution agreement spanning 2005-2009 under which it will provide guidance, advice and financial support to the NCCs, which will, in return, develop expertise in the synthesis, translation and exchange of knowledge with a variety of public health communities of practice. Through this work, over the three-year planning period, the NCCs will engage public health policy and program specialists and practitioners, governmental and non-governmental groups, academia and researchers in improving their capacity to communicate, collaborate and use public health research in their decision making within areas such as public health policies, practices and program development.

Public Health Law and Information Policy

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
3.3	3.6	3.6

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 to supporting Canada's capacity to respond to new and re-emerging public health threats and to meet greater requirements and expectations. To address this, in 2006-2007 the Agency's Public Health Law Program, working with federal, provincial and territorial stakeholders, will undertake activities such as specialized workshops and discussions for the dissemination of targeted research and analysis in public health law.

In 2006-2007, through research, collaboration and dissemination of research and analyses, the Agency will continue its efforts to improve understanding about how the law affects the prevention and control of diseases and injuries.

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. In June 2005, the Public Health Network Council identified as an urgent priority the development of public health information-sharing agreements. In 2006-2007, the Agency will continue to lead this information sharing initiative.

In the promotion and protection of public health, the Agency seeks to reconcile the value of privacy protection with the important need to access critical information. To this end, the Agency is playing an active role with its provincial and territorial partners in harmonizing legislation and developing and implementing 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. In 2006-2007 the Agency will continue to work to improve policies, practices and tools associated with the collection, use, retention and disclosure of sensitive personal information.

Strategic and Developmental Initiatives

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
12.9	12.8	12.8

Since its establishment on September 24, 2004, the Agency has undertaken a number of activities to take on its role as a voice for public health, to define its structural needs and develop the necessary elements, to build new and expanded relationships, and to explore new avenues for improving the public health system in Canada.

To move forward, it is imperative that the Agency work closely and cooperatively with all of its partners in the health system, as public health is a shared responsibility. With a view to maximizing efficiency and effectiveness, the Agency pays particular attention to creating the capacity for coordinated efforts with partners and stakeholders. In light of the lessons learned from the SARS crisis, strengthening relations among federal, provincial and territorial authorities in the public health field is vital. Within this context, the Agency works closely with the Canadian Public Health Association and its umbrella group, the Canadian Coalition of Public Health in the 21^st Century.

Recognizing the critical need for coordination and knowledge sharing, the Agency will continue to support the Pan-Canadian Public Health Network and its expert groups, establish intersectoral working groups in priority areas, establish linkages to key international organizations and networks, and further develop its capacity for generating knowledge and sharing information.

The Agency pursues strategic and developmental initiatives that support the achievement of its six priorities and advance the work of improving public health. The following strategic, cross-cutting and overarching actions are critical to the full achievement of the Agency's priorities for 2006-2007.

Surveillance

Health Surveillance is a key function of public health. It is the ongoing, systematic use of routinely collected health data to guide public health actions. Surveillance process includes data collection, collation, analysis, interpretation, and dissemination followed by action. These actions lead to disease prevention and help professionals manage outbreaks and threats in an effective and efficient manner. The information generated from surveillance systems in one jurisdiction can alert authorities to look for similar cases in their own jurisdictions. In 2006-2007, in collaboration with organizations such as the Canadian Health Institute for Health Information (CIHI) and the Canadian Population Health Initiative (CPHI) and many others, the Agency will continue to deliver surveillance programs that will help identify emerging disease trends, spot occurring outbreaks and recognize threats to the health of Canadians.

The table below gives examples of such programs (these have already been listed in detail in preceding sections):

National West Nile Virus Surveillance program National Enteric Surveillance Program (NESP) Canadian Nosocomial Infection Surveillance Program (CNISP) Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) Pandemic Influenza program HIV/AIDS Surveillance program

Pan-Canadian Public Health Strategy

In September 2004, under the Ten-Year Plan to Strengthen Health Care, the First Ministers committed to accelerate work on a Pan-Canadian Public Health Strategy. This strategy will provide a framework for existing public health approaches and initiatives; identify public health system gaps, vulnerabilities, and risks; and develop a strategic agenda to address them. It will oversee the federal directions and vision for public health within Canada, and will build on recent investments in public health.

Over the three-year planning period, the Agency will assist the Public Health Network to identify key areas of priority for action and develop a plan to move forward on the Public Health Strategy. In 2006-2007, the Agency will develop a profile and understanding of the public health environment in Canada to identify current initiatives, gaps and vulnerabilities. These activities will lead to a more organized, strategic and efficient approach to public health in Canada and will include fostering innovative domestic and international partnerships to respond to increasingly complex public health issues.

Health Goals for Canada

As part of the Ten-Year Plan to Strengthen Health Care, Canada's First Ministers committed to the development of "goals and targets for improving the health status of Canadians through a collaborative process". Subsequently, the Deputy Ministers of Health agreed to a two-step approach: Phase I, the development of broad goals; and Phase II, the setting of targets and indicators to measure progress. As a result, the Agency made the development of the Health Goals for Canada a corporate priority.

The Agency has engaged in a broad consultation process which has culminated in the drafting of health goal statements that were validated by governmental and non-governmental partners, public health experts and stakeholders. The Health Goals for Canada, approved by the Ministers of Health on October 23, 2005, provide a tool to guide further action on the determinants of health and help to strengthen the management of horizontal issues. The Health Goals provide key stakeholders in government with a vehicle within which they can work together on public health issues.

Moving forward through the three-year planning period, the Agency will be advancing the Health Goals for Canada by embarking on three streams of federal engagement:

• Federal family - working with federal departments and agencies to support collaboration aimed at aligning federal activities with the Health Goals; developing objectives and targets in areas of federal responsibility; and conducting research.
• Intergovernmental - examining international efforts to incorporate a population health perspective in public policy development; identifying opportunities to work with provinces and territories; identifying existing work in cities and communities to promote population health; and helping to develop a toolkit of best practices.
• Citizen engagement - developing communication products to engage Canadians in public health issues and liaising with professional associations and non-governmental organizations (NGOs) to facilitate the broadest utilization of the Health Goals.

Pan-Canadian Public Health Network

The 2005 launch of the Pan-Canadian Public Health Network was an important and strategic step in implementing the Ten-Year Plan and strengthening public health capacity across Canada. In establishing the Network, federal/provincial/ territorial Ministers created a mechanism for multilateral sharing and exchange among federal, provincial and territorial public health institutions and professionals. This new, more collaborative approach to public health is critical during public health emergencies, and will also assist Canada in gaining a coordinated approach to serious public health issues.

The Network has initially focused on joint strategies and action in the following six public health areas: communicable disease control; emergency preparedness and response; public health laboratories; public health surveillance and information; non-communicable disease and injury prevention; and health promotion.

Over the planning period, the Agency will continue to capitalize on investments made in the Pan-Canadian Public Health Network. Key planned initiatives for the Network over this period include:

• the continued development of joint agreements on emergencies, information sharing, resources, facilities and personnel;
• action on common approaches to public health legislation across jurisdictions;
• the design and application of tools to support timely and efficient public health communications and links within the Pan-Canadian Public Health Network; and
• the pursuit of international cooperation and coordination agreements for public health laboratory networks; interchange with public health researchers; and further development of the National Health Emergency Management System.

Leadership on the Determinants of Health

The Agency intends to lead government efforts to advance action on the determinants of health. Such action is critical to achieving health gains and reducing health disparities. Leading by example through the development of new knowledge and intersectoral policy initiatives, the Agency seeks to contribute to a better understanding of the ways in which the determinants of health can be more effectively addressed to prevent disease and other health problems.

In a comprehensive health system, action is needed to prevent illness and injury, and to treat, cure or mitigate the burden of existing illness and disease. A comprehensive public health system works to prevent disease through such approaches as vaccination, legislative measures, awareness campaigns, and tax incentives for example for sports involvement.

Evidence increasingly shows that many efforts to influence behaviour are least effective with segments of the populations that are dealing with situations such as poor living conditions that compromise their health. Consequently, the underlying conditions which faciliate or hinder behaviour change are critical to consider and act upon.

Addressing the underlying factors and conditions which determine health, help us in key ways to achieve government objectives by:

1. Focusing on preventing disease by keeping people well  
2. Improving the health of those at risk of premature disease and death
3. Reducing pressures on the health care system
4. Contributing to productivity

Taking leadership on determinants of health means working with Health Canada and other government departments to identify ways to be more effective in creating conditions for good health for Canadians with lower socioeconomic status and groups exhibiting health disparities, for example Aboriginal Canadians. Taking such leadership will improve the effectiveness of preventative policies and strategies, which in turn, can reduce the pressure on health care systems, thus contributing to addressing issues underlying wait-times and timely access to quality care. In addition, a healthier population is linked to a more productive workforce. Productivity is also enhanced in workplaces that likewise create conditions supportive of good health.

During the planning period, the Agency in collaboration with Health Canada will further strengthen its partnership with the World Health Organization in support of the WHO's new Commission on the Social Determinants of Health (SDOH). Canada's contribution to the Commission includes supporting the Canadian Commissioners, participating in knowledge networks, acting as a core member of the Global Country Partners and ensuring that new knowledge from the Commission is disseminated and appropriately integrated into Canadian policy.

As a key component of this initiative, the Agency will provide leadership and support to the Canadian Reference Group on SDOH to help facilitate multidisciplinary action on the underlying factors that cause health disparities. The Reference Group involves key stakeholders in Canada, including other federal departments, provincial officials, NGOs, academics and others, all of whom will be critical to the success of the strategy in Canada.

The Agency will coordinate the establishment of a Health Portfolio plan to ensure an integrated approach with Health Canada and the Canadian Institutes of Health Research to advance an intersectoral federal government approach.

This plan will include engaging central agencies and key federal departments whose policies and programs have an impact on health through factors such as income, employment and working conditions, education, social development and inclusion, the affordability of housing and food security. To support this work, partnerships and initiatives with the Canadian Institutes of Health Research and other governmental and non-governmental stakeholders will be strengthened to advance the Canadian research agenda and related knowledge on health disparities. This includes facilitating effective dialogue between researchers and policy analysts or stakeholders to ensure better understanding and use of research findings.

In addition, the Agency intends to support the 2007 World Conference on Health Promotion and Education in Vancouver, and to facilitate a focused federal Health Portfolio participation in this event as a means of advancing action on the determinants of health.

International Strategic Framework

The Agency is committed to strengthening international links with key global public health players and increasing Canadian participation in international public health activities. During the planning period, the Agency will take a leadership role in supporting international initiatives that build capacity in key areas and influence global policies that are in the interests of public health in Canada.

The Government of Canada's 2005 International Policy Statement identifies health as a critical international issue with economic, security and development dimensions. It recognizes that public health is a key security issue, and that the health sector ranks highly on the international scene in terms of requests received by Canada for assistance to developing countries. International public health issues are also high on the agenda of top policy decision-making bodies such as the G8 and Asia-Pacific Economic Cooperation (APEC), where countries are collaborating to address health issues at the regional and international levels.

The Agency needs to be strategic in its approach to international roles and activities, and needs to ensure that such activities are aligned with Canada's domestic interests. This approach will strengthen Canada's links in the international public health arena, and would enable Canada to meet its international obligations and share more public health expertise with global partners.

In 2006-2007, the Agency will continue to develop an international strategic framework to achieve a coherence of efforts in international activities. In addition to supporting Canada's domestic public health goals, this investment creates the foundation for strategic international initiatives to strengthen global public health security; to strengthen international efforts to build capacity in public health systems; and to reduce the global burden of disease and global health disparities. The Agency's investments in 2006-2007 will expand its capacity to implement the strategic international framework and enhance international policy development and global partnerships.

During the planning period, the Agency will also continue to develop and strengthen relationships with bilateral and multilateral partners and institutions, such as the WHO, the Pan American Health Organization, the Organization for Economic Cooperation and Development (OECD) and the International Union for Health Promotion and Education. The resulting exchange of information will improve the Agency's work in the international arena, increase the Agency's capacity in the realm of international policy, and allow the best practices of other countries to be reflected in the development of Agency policies.

The Agency's work on its strategic and developmental initiatives specifically addresses RPP Priority 5, "to lead government-wide efforts to advance action on the determinants of health", and in general supports all of its other RPP priorities.

Other Programs and Services

Financial Resources (in millions of dollars)
2006-2007	2007-2008	2008-2009
109.0	98.9	96.0

Other Programs and Services consist primarily of corporate support and administration in the National Capital Region (NCR), Winnipeg and regional offices (Atlantic, Quebec, Ontario, Prairies, Alberta, British Columbia and Northern Secretariat). In 2006-2007 the planned expenditures include: $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. The funding for 2006-2007 also includes $10.4 million held in a frozen allotment pending approval for a one-year extension.

 

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