ARCHIVED - RPP 2007-2008
Public Health Agency of Canada

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Section I - Overview

Message from the Minister of Health

I am pleased to present the Public Health Agency of Canada's 2007-2008 Report on Plans and Priorities, an outline of the organization's corporate direction for the coming year. Health and access to a strong and effective health care system continue to be among the highest priorities for Canadians. These are priorities that are shared by Canada's New Government, and they continue to be my paramount concerns as Minister of Health.

In this role, I recognize the key contributions of the Public Health Agency of Canada and the Chief Public Health Officer to improving health and strengthening the health care system. This is why my first piece of federal legislation was the introduction of Bill C-5, The Public Health Agency of Canada Act. I was proud to see the Act approved by Parliament and entered into force in December 2006, as it reaffirmed the Government of Canada's commitment to public health. The Agency not only enhances the federal government's ability to plan for and respond to public health emergencies, such as SARS or pandemic influenza, but it ensures ongoing leadership in, and a strengthening of, the public health infrastructure in Canada.

Guaranteeing patient wait times remains one of our government's highest priorities. Reducing the burden on the health care system by improving overall public health continues to be one of the most effective ways of achieving this goal. Because major chronic diseases share common risk factors, Canada's New Government, with the support of the Public Health Agency and in collaboration with the provinces, territories and key stakeholders, is working to address health promotion and chronic disease prevention and control through a combination of integrated and disease specific strategies and programs.

The Public Health Agency is also helping our government provide Canadians with safe and secure communities by effectively reducing the threat of infectious diseases and chemical and biological agents. In particular, the Canadian Pandemic Influenza Plan for the Health Sector, developed by federal, provincial and territorial governments, provides guidance regarding the measures and systems that will be needed to respond to a pandemic. Drawing on an investment of $1 billion from the 2006 Budget, the Public Health Agency and its federal partner departments will continue to build on the plan and enhance other initiatives already underway.

While leading on federal efforts to prevent disease and injury and to promote and protect national and international public health, the Public Health Agency of Canada will continue to support this government's vision and direction on accountability and efficiency in all government operations and initiatives.

In support of a stronger public health system in Canada and around the world, and in moving forward on fulfilling our government's priority of improving health and access to health care for Canadians, I am proud to report on the plans and priorities of the Public Health Agency of Canada.

Tony Clement
Minister of Health

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Message from the Chief Public Health Officer

Public health is truly the foundation of a prosperous society. It is the vital role of the Public Health Agency of Canada to help create and assure the conditions that strengthen this foundation by ensuring that we, as a society, are constantly moving to eliminate the disparities and inequalities in our health and health status. This is one way in which we are fulfilling our mission of promoting and protecting the health of all Canadians.

As Canada's Chief Public Health Officer, it is my role to report on matters relating to public health and to share information and best practices with governments, public health authorities and others in the health field, both within Canada and internationally. It is also the Chief Public Health Officer's responsibility to speak to Canadians as a credible and trusted voice on public health issues, and to advise the Minister of Health on matters of public health and on the operations of the Public Health Agency.

This role of the Chief Public Health Officer and the status of the Public health Agency of Canada as a separate entity in the health portfolio were approved by Parliament in the Public Health Agency of Canada Act which entered into force on December 15, 2006. This legislation will allow the Agency to continue with its mandate to assist the Minister of Health in fulfilling his public health responsibilities while it builds on its many concrete achievements since its creation in 2004.

Public health often receives its greatest attention during times of crisis, and one of the Public Health Agency's highest priorities is to prepare and plan for such events, including pandemic influenza. The federal, provincial and territorial governments have worked together to develop the Canadian Pandemic Influenza Plan for the Health Sector, and the recent $1 billion investment in pandemic preparedness announced in Budget 2006 will enable the Public Health Agency to continue to work closely with its partners to build on our collective success.

In addition to its role in preparing and planning for emergencies, the Public Health Agency also works to improve the overall health and quality of life of Canadians through programs such as healthy eating and physical activity, thereby reducing the health, social and economic burden of chronic disease in Canada. Ultimately, this will be a vital contribution to the Government's commitment to achieving meaningful reductions in patient wait times.

Public health is complex, and success requires a comprehensive team approach that brings in partners from across all sectors of society. Therefore the Public Health Agency will continue to actively engage its many partners, including Health Canada and the rest of the health portfolio, other federal departments, the provinces and territories, stakeholders, and non-governmental organizations. And through the plans, priorities and programs outlined in this report, I know we will make real progress in achieving the unified vision of the Minister of Health, the Government of Canada, and the Public Health Agency, of healthier Canadians and communities in a healthier world.

Dr. David Butler-Jones
Chief Public Health Officer

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Management Representation Statement

I submit for tabling in Parliament, the 2007-2008 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 the Guide for the Preparation of Part III of the 2007-2008 Estimates: Reports on Plans and Priorities and Departmental Performance Reports:

• It adheres to the specific reporting requirements outlined in the Treasury Board Secretariat guidance;

• It is based on the Agency's Strategic Outcome and Program Activity Architecture that were approved by the Treasury Board;

• It presents consistent, comprehensive, balanced and reliable 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.

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Program Activity Architecture (PAA) Crosswalk

In 2005-2006, the Agency had a single strategic outcome and a single program activity. An enhanced Program Activity Architecture (PAA), to take effect in fiscal year 2007-2008, has been developed to reflect the Agency's responsibilities, and to enable more detailed reporting on accomplishments and resource use. The following tables present the new strategic outcome and program activities, as well as the previous structure. Additional layers of the activity architecture have also been developed.

CROSSWALK
	Approved (June 22, 2006)	Previous
Strategic Outcome	Healthier Canadians and a Stronger Public Health Capacity	Healthier Population by Promoting Health and Preventing Disease and Injury Population and Public Health
Program Activities	Health Promotion Disease Prevention and Control Emergency Preparedness and Response Strengthen Public Health Capacity Program Management and Support	Population and Public Health

The Public Health Agency of Canada (PHAC) required amendments to the previously approved PAA to reflect structural changes which followed the Agency's creation as a separate government entity. The amendment to the Strategic Outcome (SO) better reflects the enduring benefits to Canadians of the Agency's expanded mission and role, by adding wording that identifies the benefit of increased public health capacity. At the Program Activity level, the existing Program Activity (PA) is split into five PAs. These changes, together, provide parliamentarians and the Canadian public with a clearer picture of the scope of the Agency's work, and support better accountability. The proposed five PAs provide the best possible framework by which expected results and performance measures can be linked to each activity and at all levels, and against which actual results and financial information can be reported.

Management, Resources and Results Structure
SO and PA Changes Affecting 2007-2008 Estimates, Future Year Estimates and Public Accounts Displays as Well as Reference Levels for 2008-2009 and for Future Years
Ministry	Department	Changed Strategic Outcomes	Changed Program Activities	Changed Program Descriptions
Health Canada	Public Health Agency of Canada	Healthier Canadians and a Stronger Public Health Capacity	Health Promotion	In collaboration with partners, the Public Health Agency of Canada supports effective actions to promote healthy living and address the key determinants of health and major risk factors for chronic disease, by contributing to knowledge development, fostering collaboration and improving information exchange among sectors and across jurisdictions.
			Disease Prevention and Control	In collaboration with its partners, the Agency leads federal efforts and mobilizes domestic efforts to protect national and international public health. These include: monitoring, researching and reporting on diseases, injuries, health risks and the general state of public health in Canada and internationally; and supporting the development of knowledge; intersectoral and international collaboration; and developing policies and programs to prevent, control and reduce the impact of disease and injury
			Emergency Preparedness and Response	The Public Health Agency of Canada provides a national focal point for anticipating, preparing for, responding to and facilitating recovery from threats to public health and/or the public health complications of natural disasters or humancaused emergencies. The Agency applies the legislative and regulatory provisions of the Quarantine Act. It collaborates with international partners to identify emerging disease outbreaks around the globe. Providing leadership in identifying and addressing emerging threats to the health and safety of Canadians through surveillance, risk analysis and risk management activities, the Agency partners with Health Canada, other federal departments, the provinces and territories, international organizations and the voluntary sector to identify, develop and implement preparedness priorities. The Public Health Agency of Canada manages and supports the development of health-related emergency response plans for natural and human-caused disasters, including the Canadian Pandemic Influenza Plan for the Health Sector. The Agency is actively engaged in developing and sponsoring training in emergency preparedness, and coordinates counter-terrorism preparations to respond to accidents or suspected terrorist activities involving hazardous substances. The Agency is a leader on biosafety-related issues. It stands ready to provide emergency health and social services and manages the National Emergency Stockpile System with holdings ranging from trauma kits to complete 200-bed emergency hospitals.
			Strengthen Public Health Capacity	Working with national and international partners, the Agency develops and provides tools, applications, practices, programs and understandings that support and develop the capabilities of front-line public health practitioners across Canada. The Agency facilitates and sustains networks with provinces, territories, and other partners and stakeholders to achieve public health objectives. The Agency's work improves public health practice, increases cross-jurisdictional human resources capacity, contributes to effective knowledge and information systems, and supports a public health law and policy system that evolves in response to changes in public needs and expectations.
			Program Management and Support

Summary Information

Financial Resources (in millions of dollars)
2007-2008	2008-2009	2009-2010
669.8	582.9	633.1

Human Resources (FTEs)
2007-2008	2008-2009	2009-2010
2,376	2,415	2,428

Departmental Priorities
Priority	Type
1. To develop, enhance and implement integrated and diseasespecific strategies and programs for the prevention and control of infectious disease	On-going
2. To develop, enhance and implement integrated and diseaseor condition-specific strategies and programs within the Health Portfolio to promote health and prevent and control chronic disease and injury	On-going
3. To increase Canada's preparedness for, and ability to respond to, public health emergencies, including pandemic influenza	On-going
4. To strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity	On-going
5. To lead several government-wide efforts to advance action on the determinants of health	On-going
6. To develop and enhance the Agency's internal capacity to meet its mandate	Previously committed

Program Activities by Strategic Outcome
	Expected Results	Planned Spending (in millions of dollars)			Contributes to the following priority
		2006-2007	2007-2008	2008-2009
Strategic Outcome:	Healthier Canadians and a Stronger Public Health Capacity
Health Promotion	Improved health and wellbeing. Improved health behaviours. Reduced health disparities.	186.5	187.2	187.2	Priorities 2, 4 and 5
Disease Prevention and Control	Decreased proportion of Canadians who develop or acquire disease. Maintained and enhanced quality of life; fewer complications and premature deaths in those with disease. Decreased personal, social and economic burden of disease for individuals and society. Strengthened response to managing diseases in Canada.	311.8	285.2	331.6	Priority 1,2 and 4
Emergency Preparedness and Response	Canada is one of the countries best prepared to respond to the public health risk posed by natural and human-caused disasters, such as infectious disease outbreaks, hurricanes, floods, earthquakes, and criminal or terrorist acts such as explosions and the release of toxins.	115.9	54.7	57.9	Priority 3
Strengthen Public Health Capacity	Strengthened public health capacity in Canada through enhancements to the public health workforce, public health information and knowledge systems, and public health law and ethics.	55.6	55.8	56.4	Priority 4

Operating Environment

Public Health Context
Canadians continue to place health at the top of their list of 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. Within 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 at both the individual and the community level. It encompasses a range of activities performed by all three levels of government in collaboration with a wide variety of stakeholders and communities across the country. Public health is brought to the forefront in times of crisis, as was observed during the outbreak of SARS (Severe Acute Respiratory Syndrome), and plays a key role in preparedness and planning for crises such as an influenza pandemic. It also includes day-to-day activities (such as immunization campaigns, nutrition counselling and restaurant inspections) that require policy, scientific and analytical support (e.g. laboratory research and analysis, epidemiology, surveillance, knowledge translation). The federal government plays a key role in public health, in conjunction with provincial, territorial and local governments. Federal interests which help to define the federal role in public health include a safe public, equity and solidarity, economic performance and advantage, global citizenship and strengthening federalism. The federal role is based on its responsibility for public health issues (and their causal factors) of national concern and for certain populations, including certain First Nations and Inuit populations, and its direct mandate for infectious disease control at international borders (e.g. quarantine).

The Public Health Agency of Canada
In September 2004, 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. On December 15, 2006, the Public Health Agency of Canada Act came into force. The Act continues the strong tradition of cooperation and collaboration that has been a part of Canada's approach to public health for decades. The Act formally establishes the position of the Chief Public Health Officer (CPHO) and recognizes his unique dual role as deputy head of the Agency and as Canada's lead public health professional.

Dual Role of Chief Public Health Officer
As the deputy head of the Agency, the 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 and mobilize the resources of the Agency to meet threats to the health of Canadians. In addition to his role as deputy head, the Public Health Agency of Canada Act also recognizes that the CPHO is Canada's lead public health professional, with demonstrated expertise and leadership in this field. As such, the CPHO has the legislated authority to communicate directly with Canadians and to prepare and publish reports on any public health issue. He is also 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.

The Minister of Health, through the work of the Health Portfolio, is responsible for maintaining and improving the health of Canadians. The Health Portfolio consists of approximately 11,400 employees and an annual budget of over $4.5 billion.

The Public Health Agency of Canada is a key component of the Government of Canada's Health Portfolio which 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.

The following chart illustrates the various components that make up the Health Portfolio:

click on the image to enlarge

The Public Health Agency of Canada's Mandate
The Agency's primary role is to lead in collaboration with its partners, 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.

Links to the Government of Canada Outcome Areas
The Agency's activities contribute to four key elements of Canada's Performance, as explained below:

Canada's Performance 2006 - The Public Health Agency of Canada's Contribution

The Public Health Agency of Canada contributes to the following Government of Canada outcomes noted in Canada's Performance 2006:

Theme	Government of Canada Outcome	Department Strategic Outcome	Program Activities
Social Affairs	Healthy Canadians	Healthier Canadians and a Stronger Public Health Capacity	Health Promotion Disease Prevention and Control Emergency Preparedness and Response Strengthen Public Health Capacity Program Management and Support

In a manner consistent with the World Health Organization's definition of health as 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 inhibit 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 is a relatively new organization, it is quickly becoming a leader in global health efforts and a centre for expertise and knowledge development 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.

The Agency has made significant progress on a number of fronts, including the role of the updated Canadian Pandemic Influenza Plan for the Health Sector, the National Immunization Strategy and the development of comprehensive, disease-specific approaches to address chronic disease, particularly the Canadian Strategy for Cancer Control. The Agency has also established, with the provinces and territories, the Pan-Canadian Public Health Network as a key mechanism for inter-jurisdictional collaboration and coordination and has 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 conducting 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 promising vaccine against Ebola, Marburg and Lassa fevers. Recent studies have demonstrated the effectiveness of the Marburg vaccine as a post-exposure treatment.

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.

Infectious Disease Factors
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 over the past five years. Since many of the infected 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. The spread of the virus in birds has raised concerns about a possible human influenza pandemic.

• In addition, several emerging or rare diseases have appeared or reappeared in the world in recent years, including West Nile virus and Lyme disease.

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. Events such as the December 2004 Indian Ocean tsunami and Hurricane Katrina in 2005 have highlighted the need for Canada's public health system to anticipate emergencies and to be prepared to respond effectively when needed. To address the health impacts of such events, public health strategies require an all-hazards approach using robust measures coordinated with provinces and territories, including their Chief Medical Officers of Health. The Agency will continue to make progress towards collaborative, pan-Canadian surveillance and emergency response and will work with international partners to strengthen global collaboration on these issues. The Agency supports an integrated approach to the prevention and control of infectious diseases, associated risk factors and health determinants through the development of evidence-based interventions and public policies.

Chronic Disease Burden
Health is determined by a number of factors, some of which include conditions in society and personal health practices and behaviours. Each person is influenced by 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, are directly associated with one or more risk factors such as smoking, unhealthy eating and physical inactivity that often lead to the major chronic diseases: cardiovascular disease, cancer, diabetes, and respiratory disease.

Over time, the burden of preventable death and disease in Canada has been growing, reducing quality of life, increasing wait times for care, and challenging the sustainability of the health system. Health promotion and associated efforts to reduce or manage risk factors can often prevent or delay the onset of chronic diseases such as cancer, cardiovascular disease and diabetes, and so reduce the number of Canadians waiting for treatment for these diseases.

As identified by the Kirby and Naylor reports on Canada's health system, there is a need to balance investments in traditional health care, health promotion, and chronic disease prevention if the overall burden on the health care system is to be reduced. Experience shows that early investments in health promotion and prevention are needed to control current upward trends and address unhealthy lifestyles. And, when chronic disease cannot be avoided, it can be caught early and managed so people can live better with their condition and avoid complications.

Globally, of the 58 million deaths in 2005, approximately 35 million were 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, the rate of obesity coupled with type 2 diabetes is growing worldwide, leading to significant increases in heart disease and other major causes of death. The Agency is home to a WHO Collaborating Centre on Chronic Disease Policy and supports 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 the leading chronic diseases in Canada and to impose significant costs on the country's economy and society. In 2004, 23.1% of Canadians aged 18 or older, or an estimated 5.5 million adults, were obese.¹ This is much higher than estimates compiled from self-reported data collected in 2003 and earlier.

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 and controlled through public health interventions and knowledge translation and transfer, e.g. by putting knowledge into action. For example, federal, provincial and territorial Health Ministers have set a target to reduce obesity rates by 20% and an objective of increasing physical activity through public health policies and effective action. As well, the Agency was represented on the Governing Council of the Canadian Strategy for Cancer Control (CSCC), and provided the secretariat support for the development and initial implementation of the CSCC. On November 24, 2006, the Prime Minister announced the creation of a not-for-profit organization, the Canadian Partnership Against Cancer Corporation (CPACC), which will implement the eight strategic priorities of the CSCC. The CPACC is a platform for knowledge development and transfer that is expected to provide evidence-based knowledge across the cancer continuum, e.g. from prevention to palliative care. With the creation of the Canadian Partnership Against Cancer Corporation (CPACC), the Agency's role in the CSCC will be to serve as a bridge between CPACC and other federal public health activities for chronic diseases.

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 treatment. 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 to the achievement of health gains, and public health has a key role to play in mobilizing efforts across sectors to this effect.

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 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 involve 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 the lead 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 field of public health is continually evolving and includes a wide variety of governments and stakeholders. 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 2007-2008 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 of horizontal issues. In that context, the Agency participates in a number of horizontal initiatives, such as Health and the Environment, the International Polar Year, the National Food Policy Framework, the Canadian Biotechnology Strategy, the National Health Security Policy, Pandemic Preparedness and Response, and the Security and Prosperity Partnership. Additionally, the federal government's sustainable development initiative furthers the concept of horizontality by taking 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 governmentwide initiative as it works toward longer-term solutions. However, the Agency needs to further develop 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 building capacity and expertise 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 and underlying determinants 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, a 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. The Agency has reviewed its Program Activity Architecture and will develop a performance measurement framework in 2007-2008. The Agency continues work on its corporate risk profile, which will include risk mitigation and risk management strategies, and will respond to increasing requirements for transparency by undertaking a strategic and integrated business and human resource planning processes. During the reporting period the Agency will continue to 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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