ARCHIVED - RPP 2007-2008
Public Health Agency of Canada

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Section II - Analysis of Program
Activities by Strategic Outcome

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.

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 disabilities each year; the related economic burden is estimated at $70 billion 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, cardiovascular disease and diabetes, and in so doing reduce the numbers of Canadians waiting for care and treatment to manage these diseases.

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

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 cannot be avoided, it can be caught early and managed so that people can live better with disease and avoid complications.

Program Activity - Health Promotion

Financial Resources (in millions of dollars)
2007-2008	2008-2009	2009-2010
186.5	187.2	187.2

Human Resources (FTEs)
2007-2008	2008-2009	2009-2010
416	425	424

Health promotion is the process of enabling people to increase control over their health and its determinants and thereby improve their health. At the same time, the population health approach emphasizes the broader determinants of health and related interventions to address root causes of health, and factors for addressing health inequities. The Agency's health promotion activities take a population health approach, recognizing that health promotion must address broader determinants if it is to have an impact in improving Canadians' health outcomes. Over the past 30 years and more, Canada has continued to play a role internationally in developing a comprehensive understanding of health promotion.

The enhancement of partnerships is a central part of the work in health promotion. There are constant efforts to develop instruments that will further leverage partnerships and resources, such as grants and contributions. Collaboration has also become a way of working with various stakeholders at varying levels. There are ongoing efforts to strengthen the knowledge infrastructure to enhance the knowledge development cycle of research, policy and practice, as evidence provides the foundation for effective public policy and health promotion.

In 2007-2008, the Agency will continue to promote health through multi-sectoral and multijurisdictional approaches to evidence-based decision-making, both domestically and internationally.

Health Promotion Initiatives

Agency's Priorities

Health promotion initiatives contribute to these Agency RPP priorities:

• Priority 2: Develop, enhance and implement integrated and disease- or condition-specific strategies and programs within the Health Portfolio to promote health and prevent and control chronic disease and injury;
• Priority 4: Strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity; and
• Priority 5: Lead several government-wide efforts to advance action on the determinants of health.

Healthy Living and Healthy Eating

The Agency will continue to work across the Health Portfolio, with other federal departments and agencies and in collaboration with a range of stakeholders to promote the health of Canadians, reduce the impact of chronic disease in Canada and address the key determinants of health.

The collaborative strategy, which includes disease-specific initiatives, will focus on three pillars:

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 Healthy Living and Chronic Disease initiative 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 diseasespecific strategies. Integration involves working with and networking the expertise of diverse partners and stakeholders involved in health promotion, chronic disease prevention and risk factors.

The Agency will also undertake the following healthy living/healthy eating 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 2007-2008, funding will be provided through contribution agreements to support and engage the voluntary sector, and to build partnerships and permit collaborative action among governments, nongovernmental organizations and other agencies (e.g. the dissemination and an ongoing assessment of Canada's Physical Activity Guide to Healthy, Active Living for children, youth, adults and older adults and their supplementary resources).
• The Intersectoral Healthy Living Network will continue to foster collaboration and improve information exchange among sectors and across jurisdictions.
• The Physical Activity Benchmarks/Monitoring Program will provide important knowledge for decision makers to help understand the health of the population and to measure progress in affecting health outcomes.
• As a member of the Joint Consortium for School Health, the Agency will continue working with provinces and territories to facilitate a comprehensive and coordinated approach to school health by building the capacity of the health and education sectors to work together.

In summary, this approach to health promotion 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 patient wait times.

Childhood and Adolescence
Over the planning period, the Agency will continue to promote evidence-based practice and practice-based evidence through the design and support of community interventions including the Canada Prenatal Nutrition Program, the Community Action Program for Children and 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.

The Fetal Alcohol Spectrum Disorder Initiative will continue to partner across the Health Portfolio, other sectors and jurisdictions to build capacity among stakeholders to prevent alcoholaffected births and mitigate the impact on those affected through professional awareness and education, the development of tools and resources, and collaboration on standards and guidelines. The Agency will host a roundtable meeting to develop an economic impact model of fetal alcohol syndrome disorder (FASD), and invite a second round of proposals for projects to be funded under the FASD National Strategic Projects Fund.

The Centres of Excellence for Children's Well-Being Program consists of four centres that generate and disseminate the latest knowledge on children's well-being to a broad network of audiences. The Centres will continue to translate knowledge into practical tools for parents and into evidence-based advice for service providers and policy makers from all levels of government, for various government departments, as well as for international organizations to improve the health and well-being of children.

On behalf of the Minister of Health, the Agency co-leads, with the Department of Justice, the federal government's efforts on matters concerning the United Nations Convention on the Rights of the Child. Through its collaboration with the Inter-American Children's Institute - a special institute of the Organization of American States - the Agency will continue to work with the Canadian International Development Agency 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 Health Behaviour in School-Aged Children Study - a cross-national, school-based survey conducted in collaboration with the World Health Organization's Regional Office for Europe. The survey will continue to monitor patterns in factors that influence the health of youth, as well as selected trends in their health behaviours.

In 2007-2008, the Agency will also work with the World Health Organization to develop a Policy Framework for the Prevention of Chronic Diseases in Schools. Member states would use the Framework to develop policies and programs that promote healthy eating, increase levels of physical activity and prevent tobacco use among children and youth in schools.

Injury and Violence
Preventing injuries contributes to a healthier society, reduces health care utilization and shortens wait times. The Agency will continue to work with injury and violence prevention stakeholders on a range of activities to address this important public health issue.

The Agency will continue to conduct surveillance of unintentional injury (with a focus on children) and child maltreatment. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), which is carried out in partnership with 14 hospitals across the country, collects data on the nature and circumstances of the injuries that are seen in emergency departments.

• In 2007-2008 CHIRPP will complete its program modernization and will release an annual report.

The Agency will also continue its planning for the third cycle of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008). The CIS provides estimates of the national incidence of child maltreatment investigated by child welfare services and information about the circumstances of the affected children and their families, using the population health approach. Other efforts include the continuation of an interactive Web site that provides current Canadian injury data, entitled Injury Surveillance On-Line
(http://dsol-smed.hc-sc.gc.ca/dsol-smed/is-sb/index-eng.html).

In addition, the Agency will continue to lead and coordinate the Family Violence Initiative (FVI), a partnership of 15 federal departments, agencies and Crown corporations and to operate the National Clearinghouse on Family Violence on behalf of the Initiative. The FVI works on issues such as child maltreatment, intimate partner violence and the abuse of older adults. Over the three-year planning period, the Agency will continue to play a central role in knowledge and policy development, research, education and information dissemination in this area.

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 will also be closely involved with work of the National Seniors Council reporting to the Minister of Human Resources and Social Development and the Minister of Health. In addition, collaborative work on the four priorities of healthy aging falls prevention, seniors' mental health, and emergency preparedness will contribute to knowledge and capacity development, both nationally and internationally.

The Agency is working towards integrating more fully the needs of seniors into emergency management. This initiative, which is being coordinated with federal, provincial and territorial governments as well as the World Health Organization and other key stakeholders, will strengthen policies and operational protocols aimed at maintaining the health and safety of older people in emergencies of all types. Emergencies planned for will include infectious disease outbreaks as well as extreme weather events associated with climate change.

Focus for RPP Reporting Period:

• Achieve a common understanding of current evidence and on the status of seniors with regard to emergency planning activities in Canada and internationally.
• Identify key policy options to address gaps and encourage use of better practices.
• Identify opportunities for further collaborative action across jurisdictions.
• Provide a vulnerability/resiliency framework to address the needs of other vulnerable groups such as persons with disabilities, children and youth.

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 review the Standing Senate Committee on Social Affairs, Science and Technology's final report and recommendations on mental health and mental illness in Canada - particularly those recommendations related to mental health promotion, mental illness prevention and surveillance efforts - and work to advance mental health issues across government.

Canadian Health Network
The Canadian Health Network is an Agency-led health information and promotion tool that informs Canadians about health promotion and chronic disease prevention and enables them to make healthy choices. The Canadian Health Network and its network of networks support the Agency's work in helping to build healthy communities.

Program Activity - Disease Prevention and Control

Financial Resources (in millions of dollars)
2007-2008	2008-2009	2009-2010
311.8	285.2	331.6

Human Resources (FTEs)
2007-2008	2008-2009	2009-2010
1.282	1.326	1.336

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.

In the long term, the Agency expects the following results from its activities:

• A decrease in the proportion of Canadians who develop or contract disease;
• Maintenance and enhancement of quality of life, with fewer complications and premature deaths in those with disease;
• A decrease in the personal, social and economic burden of disease for individuals and society; and
• Stronger management of disease in Canada.

Agency Priorities
The majority of the Agency's work on infectious disease falls under Priority 1: To develop, enhance and implement integrated and disease-specific strategies and programs for the prevention and control of infectious disease.

The Agency's work on chronic disease falls under the following priorities:

• Priority 2: Develop, enhance and implement integrated and disease- or condition-specific strategies and programs within the Health Portfolio to promote health and prevent and control chronic disease and injury; and
• Priority 4: Strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity.

Important contributions are also made toward:

• Priority 5: Lead several government-wide efforts to advance action on the determinants of health; and
• Priority 6: Develop and enhance the Agency's internal capacity to meet its mandate.

Context for Chronic Disease Prevention and Control

Studies show the following risks and challenges:

• 72% of Canadians aged 12 and over have reported one or more risk factors for chronic disease.²
• Chronic disease and injury account for more than 75% of deaths and 87% of disabilities each year.³
• The associated economic burden to Canada is estimated at $70 billion per year or about 62% of direct health care costs.⁴
• Two in five Canadian males and one in three Canadian females face a cancer diagnosis in their lifetimes.⁵
• When overweight and obesity are considered together, 65% of men and 53% of women have excess weight, with the most dramatic increases among children and adolescents.6 As an individual's body mass index increases, so does the likelihood of developing high blood pressure, diabetes, and heart disease.

One of the Agency's key functions is risk assessment, which involves identifying, generating, collecting, evaluating, synthesizing, translating and sharing evidence on established and emerging risk factors, protective factors and determinants for chronic diseases. This work includes conducting research on key risk factors and their measures of risks, with a focus on preventable behavioural and environmental risk factors and social determinants of health, both at the individual and community levels.

The Agency also continues to actively monitor and respond to emerging issues in public health and chronic disease, e.g. obesity, respiratory diseases, mental illness, and models for chronic disease management. In part, this is facilitated by the Agency's enhanced, overarching surveillance approach to chronic disease in general which also focuses on disease-specific surveillance activities for diabetes, cancer, and cardiovascular disease.

Collectively, the Agency informs the development of policies, programs and strategies by policy makers and health practitioners who are working to prevent chronic disease and assist in the management and reduction of its burden on the health of Canadians. To support this work, the Agency focuses on the following programs for chronic disease prevention and control.

Key Programs

1. Engagement and Network Management for Chronic Disease Prevention and Control
   Improved inter-organizational, inter- and intra-sectoral, and multi-jurisdictional engagement is crucial to achieving expected results. This program supports internal coordinating structures, broader coordination across the Health Portfolio, and linkages between the federal, provincial and territorial governments. There is a particular focus on the Chronic Disease and Injury Prevention and Control Expert Group of the Pan-Canadian Public Health Network, which reports to the Conference of Federal-Provincial-Territorial Deputy Ministers of Health.

   Focus for RPP Reporting Period:

   • Enhance internal coordination, management and accountability mechanisms to implement the Healthy Living and Chronic Disease initiative.
   • Enhance networks within the Health Portfolio, with other government departments and agencies and across sectors and organizations.
   • Engage chronic disease stakeholder organizations such as the Chronic Disease Prevention Alliance of Canada (CDPAC) and expert groups such as the Chronic Disease and Injury Prevention and Control Expert Group.

2. Observatory of Best Practices in Chronic Disease Prevention
   In collaboration with experts and stakeholders from the research, policy and practice communities, the Agency continues to develop the Observatory of Best Practices to more effectively produce and disseminate information on best practices for chronic disease interventions. The Canadian Best Practices System (http://cbpp-pcpe.phac-aspc.gc.ca/system/index_e.cfm) has evolved to address three purposes: to facilitate knowledge exchange about best practices among decision makers in research, policy development and practice; to build consensus about best practices approaches; and to provide a centralized access point with respect to these approaches. The Canadian Best Practices Portal, launched in November 2006, offers an online database of evidence-based best practices for health promotion and chronic disease prevention. The Portal's content focuses on community interventions addressing cardiovascular disease, cancer, diabetes and their key risk factors as well as healthy living promotion.

   The Agency continues to support the revitalization of the Canadian Task Force on Preventive Health Care (http://www.ctfphc.org) and combine this renewal with broader efforts for knowledge development and exchange. The creation of a new infrastructure for the Task Force will lead to increased capacity of health professionals and the community for evidence-based practice, and healthier public policy.

   Focus for RPP Reporting Period:

   • Increase capacity for practice-based research and policy uptake, e.g. knowledge development and translation of best practices.
   • Develop cost-impact and cost-effectiveness economic models for various policy options, e.g. explore the cost-effectiveness of specific screening strategies for preventing type 2 diabetes among high-risk, pre-diabetic target groups as well as screening options regarding early detection and interventions for hypertension.

3. Demonstration Projects on Chronic Disease Prevention
   The capacity to generate and use practice-based evidence to support chronic disease prevention and healthy living interventions at the population level is needed throughout the country. A series of demonstration projects enhance provincial and territorial capacity for and activities in the area of knowledge development and exchange for chronic disease prevention and healthy living promotion; and identify the optimal methods to implement interventions identified as (but not limited to) best practices. Each project is required to set targets and apply standard scientific assessment techniques to evaluate progress. The first phase of the demonstration projects is currently being supported in Manitoba. As knowledge from this initial pilot is developed and disseminated, new sites planned for 2007 will build on existing systems, infrastructure and program successes.

   Focus for RPP Reporting Period:

   • Expand demonstration projects to other provinces and territories, using information from the initial pilot (Manitoba's Chronic Disease Prevention Initiative).

4. Enhanced Surveillance for Chronic Disease
   Surveillance information on chronic diseases, their risk factors and determinants, and their impact and outcomes, is needed to guide programs, policies and services. In response to the Auditor General of Canada's recommendation to increase capacity for the surveillance of chronic disease and to increase its ability to work with international, federal, provincial and territorial partners (http://www.oag-bvg.gc.ca/domino/reports.nsf/html/20020902ce.html), the Agency is developing an enhanced approach to chronic disease surveillance which will increase access to and use of surveillance information, expand data sources, and improve the planning, coordination and evaluation of surveillance activities.

   This approach supports evidence-based decision-making on health promotion and chronic disease prevention and control, along with a disease-specific focus on diabetes, cancer and cardiovascular disease, as well as risk factors. Surveillance gaps in the areas of chronic respiratory disease, arthritis and musculoskeletal disease, and mental illness will also be addressed.

   Focus for RPP Reporting Period:

   • Provide ongoing and timely health statistics and indicators by updating the Agency's dissemination tools and resources and including the Agency's Web site and chronic disease indicator reports.
   • Develop and publish a chronic disease supplement to Statistics Canada's Canadian Community Health Survey.
   • Advance policy development on cardiovascular disease, respiratory disease, arthritis and mental illness through the Surveillance Advisory Committee.
   • Develop new sources of data for mental illness surveillance with non-governmental organizations and industry.
   • Explore new areas for surveillance initiatives, including autism, arthritis and other chronic diseases.

5. Diabetes
   Approximately 2 million Canadians of all ages live with diabetes, and one in three of them are unaware of having the disease. The proportion of the Canadian population who reported having type 2 diabetes has increased by 27% between 1994 and 2000. As the Canadian population ages and rates of obesity rise, this trend is expected to continue. Type 2 diabetes rates are three to five times higher in Aboriginal communities than in the general population.

   The evidence shows that a substantial proportion of cases of type 2 diabetes, which is the predominant type, can be prevented or delayed through targeted and sustained lifestyle modification efforts among high-risk populations. Diabetes is largely fuelled by obesity, poor diet and physical inactivity.

   Since 1999, the Government of Canada has led the Canadian Diabetes Strategy (CDS), a federal initiative targeting the prevention and control of diabetes in partnership with the provinces and territories and a range of organizations such as the Canadian Diabetes Association. The CDS has raised awareness of diabetes and its risk factors and created the National Diabetes Surveillance System (NDSS), which reports national data on diabetes incidence, prevalence, mortality and comorbidity and projection data. The CDS has also contributed to the development of a national framework to address diabetes.

   Focus for RPP Reporting Period:

   • The expansion of the National Diabetes Surveillance System to: increase knowledge about diabetes through the collection of aggregate data and analysis; conduct data quality assurance and validation; and expand the Aboriginal component of the Canadian Diabetes Strategy in partnership with Health Canada with First Nations, Métis and Inuit participation.
   • Through partnerships with provinces, territories and stakeholders, continue to provide grants and contributions for community-based programs that target those at high risk of developing diabetes.
   • Through partnerships with provinces, territories and stakeholders, focus on at-risk populations, especially those who are overweight or obese or have pre-diabetes, through diabetes knowledge development and exchange activities.
   • Begin planning for the International Diabetes Federation 20th World Diabetes Congress to be held in Montréal in 2009.
   • Foster broader linkages across the Health Portfolio and the diabetes community, particularly those involving Health Canada, the Canadian Institutes of Health Research (research activities) and partner organizations such as the Canadian Diabetes Association, The Kidney Foundation of Canada and the Canadian National Institute for the Blind.
   • Work with key stakeholders to undertake a value-for-money review of the CDS. The review will examine current status, determine lessons learned and plan for future directions.

6. Cancer
   It is estimated that more than 153,100 Canadians were diagnosed with cancer and 70,400 died from the disease in 2006. By 2020, population aging is expected to contribute to more than double the number of new cases of cancer in Canada. Better cancer survival rates due to advances in cancer screening and treatment mean that a greater proportion of the adult population is living with the burden of cancer. Prevention activities targeting high-risk individuals can significantly impact on the number of new cases of cancer, although risk factors, detection, and management issues specific to this disease remain.

   Breast Cancer
   One in 9 women in Canada will develop breast cancer in her lifetime, and one in 27 will die from it ⁷. It is the most frequently diagnosed type of cancer in Canadian women. By monitoring and evaluating organized breast cancer screening programs in the country, it is possible to promote high-quality screening, leading to reductions in breast cancer mortality and morbidity, while keeping the potential harm of screening to a minimum.

   Childhood Cancer
   Close to 1,300 children and adolescents are diagnosed with cancer every year in Canada, of which nearly 300 die from their disease.

   Focus for RPP Reporting Period:

   • Work with the new Canadian Partnership Against Cancer Corporation (CPACC), announced in November 2006, to implement the Canadian Strategy for Cancer Control (CSCC). As a knowledge translation platform, CPACC will coordinate communities of practice to reduce the number of new cases of cancer, improve the quality of life of those living with cancer, and reduce the number of deaths from cancer. Eight strategic priorities (primary prevention; screening and early detection; standards; clinical practice guidelines; rebalancing the focus; health human resources; research; and surveillance and analysis) will provide the knowledge platform for cancer control.
   • Work to link the Agency's other cancer programs and efforts to CPACC's efforts on the CSCC and with international organizations such as the World Health Organization.
   • Work with CPACC, stakeholders, and provinces and territories to develop an enhanced national cancer surveillance system. The Agency and CPACC will provide national leadership in this endeavour.
   • Continue to work with the National Cancer Institute of Canada (NCIC), the Canadian Cancer Society (CCS) and Statistics Canada to publish Canadian Cancer Statistics, an annual publication distributed across the country.
   • As part of the Canadian Childhood Cancer Surveillance and Control Program, produce a report entitled Treatment and Outcomes for Childhood Cancer in Canada, 1995 to 2000 (winter 2008), and revise the on-line data management and entry system for the national surveillance study (winter 2007).
   • Continue funding the Canadian Breast Cancer Initiative (CBCI) by providing $7 million annually for research, care and treatment, professional education, early detection programs, and access to information. Also, on behalf of the CBCI, continue to manage and maintain the Canadian Breast Cancer Screening Database, which facilitates the monitoring and evaluation of organized breast cancer screening programs across Canada, and publish the associated biannual national performance report (winter 2008).
   • Work with stakeholders through the Cervical Cancer Prevention and Control Network on issues such as vaccination, prevention and control of sexually transmitted infections, and population screening to reduce the morbidity and mortality related to cervical cancer.

7. Cardiovascular Disease
   Cardiovascular disease (CVD) is the leading cause of death in Canada, responsible for 32% of deaths in men and 34% of deaths in women, and is the country's most costly disease. It is linked to such risk factors as hypertension, tobacco use, stress, obesity, and diabetes. Symptoms can be absent which poses a significant challenge for early diagnosis and long-term control.

   Focus for RPP Reporting Period:

   • Continue to develop the pan-Canadian Heart Health Strategy, announced in October 2006 by the Minister of Health (http://www.phac-aspc.gc.ca/media/nr-rp/2006/2006_09-eng.html). Key partners (e.g. Canadian Institutes of Health Research, Health Canada, Heart and Stroke Foundation of Canada, Canadian Cardiovascular Society) are engaged in this process, which will be coordinated with other national initiatives related to cardiovascular health such as stroke and diabetes strategies. Initial activities are to:
     • Develop a strategic framework and an action plan for CVD, in collaboration with provinces, territories and stakeholders;
     • Establish a steering committee, eight thematic working groups, and a secretariat housed in the Heart and Stroke Foundation's office in Ottawa; and
     • Provide a CVD action plan and recommendations to the Minister (by fall 2008).
   • As part of the development of a comprehensive approach for cardiovascular health surveillance for Canada, develop collaborative surveillance on hypertension to define and evaluate special strategies and target populations. In addition, the Expert Advisory Committee on Hypertension advises the Agency on modifications to diagnosis and management guidelines.
   • Publish the sixth report on heart disease and stroke in Canada, which will have a new chapter on hypertension and stroke.

Infectious Disease Prevention and Control

Avian/Pandemic Influenza
The federal government made significant investments (December 2006) in preparedness and response capacity activities in anticipation of a potential influenza pandemic. The Agency has the lead for the prevention and control of infectious diseases as well as public health emergencies in Canada, and it therefore leads the Health Portfolio's pandemic influenza preparedness activities. Preparedness for avian and pandemic influenza is being managed as a horizontal initiative for which the Public Health Agency of Canada (PHAC) is establishing an appropriate governance framework in collaboration with Health Canada, the Canadian Institutes of Health Research (CIHR) and the Canadian Food Inspection Agency (CFIA).

The Agency established a Pandemic Preparedness Secretariat which provides a focal point for the Agency, the Health Portfolio and the Government of Canada on human health aspects of avian and pandemic influenza, domestically and internationally.

The Canadian Pandemic Influenza Plan for Health Sector (www.influenza.gc.ca) was developed as a collaborative effort between federal, provincial and territorial public health officials, as well as, in consultation with the non-governmental organizations, external technical experts, local governments, emergency planners and bioethicists. The Plan maps out how the health sector is preparing for and will respond to pandemic influenza in Canada, by outlining the actions that should be taken during the different phases of a pandemic and by clarifying the roles and responsibilities of the health sector at all levels of governments. First released in 2004, the Plan was updated in December 2006 and remains an evergreen document.

Focus for RPP Reporting Period:

• Continue to use the latest scientific literature, international trends and policy decisions to update the Canadian Pandemic Influenza Plan for the Health Sector and technical annexes.
• Publish an updated Plan and annexes as needed, using the latest scientific information.
• Review and publish Annex F of the Plan, the Infection Control and Occupational Health Guidelines during Pandemic Influenza in Traditional and Non-Traditional Health Care Settings, which addresses the broad components of infection control practices during a pandemic.
• Establish a process to evaluate and make recommendations on personal protective equipment and on existing and new scientific literature and expert information.

Key public health interventions to mitigate the impact of a pandemic include immunization with a pandemic influenza vaccine and the use of antiviral drugs to treat those who need them in addition to general community-based and individual infection control measures.

Strengthening Vaccine Research and Development Capacity in Canada
The Agency is working with a domestic pandemic vaccine supplier to increase production capacity in order to immunize the entire Canadian population against pandemic influenza in the shortest time possible. Prior to a pandemic, development of a prototype or «mock» vaccine allows us to gain scientific knowledge and experience in rapid vaccine development, testing and approval of new technologies for rapid vaccine production.

Canada's vaccine capacity will be increased, with the aim of reducing its reliance on foreign laboratories and the private sector, by establishing a rapid vaccine development and testing service. During the reporting period, the National Microbiology Laboratory (NML) will begin a program dedicated to the development and testing of new influenza vaccines using different vaccine platforms, including one that the NML has already successfully employed in the development of highly promising candidate vaccines for Ebola, Marburg and Lassa hemorrhagic fevers.

The Agency spearheaded an additional federal investment in Intervac of $25 million in reallocation from the Agency, Agriculture and Agri-Food Canada and the Canadian Food Inspection Agency over 5 years. InterVac is a project to build high containment vaccine research labs at the University of Saskatchewan. InterVac will enhance domestic capacity for the development of vaccines. The unique value of InterVac is in its focus on pathogens of both, animal and humans as well as its unique capacity for experimentation in large animal models. Investment in this project is also linked to pandemic influenza, since influenza is one of the key infectious disease threats that affect both animals and humans.

Focus for RPP Reporting Period:

• Clinical trials on a H5N1 mock vaccine will begin in 2007-2008, using a pandemic vaccine produced in Canada. This work will provide needed evidence on pandemic influenza vaccines, before a pandemic occurs.
• Real-time vaccine safety and effectiveness pilot studies during the regular annual influenza season to increase our capacity to gather knowledge and evidence for use during a pandemic.
• Ground breaking of the Intervac project to build high-containment vaccine research laboratories at the University of Saskatchewan will begin and continue well over the reporting period.

Antivirals: A component of the preparation for an influenza pandemic is establishing an adequate reserve of antiviral medications. The Agency and the provinces and territories have contributed to the creation of a national antiviral stockpile, which was recently increased to a target of 55 million doses to provide early treatment for Canadians in need. The stockpile will be diversified to include 2 drugs and will include formulations to treat children and pregnant women.

The Agency is also active on the issues of avian and pandemic influenza from an emergency preparedness perspective. The National Emergency Stockpile System will be augmented with additional antivirals and other supplies such as gowns and masks. These supplies will provide for a response capacity where current supplies fall short and additional resources are needed. This capacity reflects the fact that an outbreak may affect different areas to different degrees.

Focus for RPP Reporting Period:

• Complete public and professional consultations on the use of antivirals for prophylaxis (prevention).
• Complete the work of the Task Group on antiviral prophylaxis that is currently developing recommendations, for the Public Health Network Council and the federal, provincial and territorial (F/P/T) Deputy Ministers of Health, regarding the use of antivirals for prophylaxis.
• Conduct F/P/T stakeholder meetings to facilitate the development of an operational strategy for the distribution of antiviral medication to the public in the event of an influenza pandemic.
• Increase the national antiviral stockpile to 55 million doses.

Emergency Preparedness
The quarantine program will be further supported through the posting of quarantine officers at major marine ports. This will strengthen the current system, which operates primarily at hightraffic air entry points. In conjunction with the recently revised Quarantine Act, this measure will improve Canada's ability to deal with the very mobile populations that travel wide distances.

Additional activities include: adding engineering support to increase the capacity of the laboratory certification process; strengthening F/P/T coordination and involving Health Canada's First Nations and Inuit Health Branch, in part through a series of table-top and command post exercises; and improving the videoconferencing capability of the Emergency Operations Centre. An office will also be established to support the development of a national incident command system.

Research: A priority of the Agency is to strengthen influenza research through the following three elements: establishing a national research priority-setting and coordination mechanism; creation of an influenza research network that is rapidly accessible for investigating questions of importance to public health; and building a comprehensive public health research program in partnership with CIHR and other key stakeholders.

Focus for RPP Reporting Period:

• Establish a Research Advisory Council to identify influenza research priorities.
• Support intra-mural and extra-mural research projects based on knowledge gaps identified at the September 2005 Influenza Research Priorities Workshop, through the Canadian Institutes of Health Research's Pandemic Preparedness Strategic Research Initiative, and the Research Advisory Council.
• Establish an influenza research network to conduct applied influenza research as directed by the Agency.
• Undertake knowledge management and translation activities to ensure that research findings are used to improve decision-making related to public health policies, programs and practices.

Surveillance: The Agency is supporting activities to better prepare front-line physicians and public health professionals to rapidly detect and respond to suspected cases of influenza, and it will work with an expanded influenza surveillance network (which includes First Nations and Inuit communities) to conduct real-time surveillance of hospitalizations and deaths. In addition, the Agency will initiate appropriate dialogue with responsible F/P/T agencies and with the blood regulators and manufacturers in order to assess the impact of human, avian and pandemic influenza on blood safety.

Focus for RPP Reporting Period:

• Develop training materials for front-line physicians and public health professionals to assist in rapid detection and response.
• Strengthen real-time data reporting and analysis, risk assessments and communication of results.
• Evaluate and improve seasonal influenza surveillance through ongoing and timely reports, and continuous coordination at the F/P/T and international levels.
• Enhance response capacity through the placement of surveillance officers in local jurisdictions.
• Improve linkages between epidemiological and laboratory data.
• Assess the effectiveness of public health actions in managing the spread of disease.
• Set up surveillance of the transmission of influenza for clients/patients in acute care hospitals.
• Conduct training for front-line physicians and public health professionals to assist in rapid detection and response.
• Continue with regular surveillance reporting (e.g. FluWatch) and Web site information for professionals and the public.

Laboratory Capacity
The National Microbiology Laboratory (NML) houses and supports the Secretariat for the Canadian Public Health Laboratory Network (CPHLN - http://www.cphln.ca/CPHLN/src), a national forum of public health laboratories that provides a unified federal, provincial and territorial response to naturally occurring infections through the promotion of standardized laboratory procedures and quality assurance methods and facilitates training to improve laboratory protocols, best practices and emerging technologies.

Focus for RPP Reporting Period:

• During 2007-2008, CPHLN will develop a process to identify and address gaps in laboratory capability and capacity through the creation of the Pandemic Influenza Laboratory Preparedness Network (PILPN). This network will coordinate and operationalize laboratory preparedness for pandemic influenza in support of the Canadian Pandemic Influenza Plan for the Health Sector and will assist Canadian public health laboratories in delivering consistent, effective and coordinated diagnostics, results, surveillance and communication during an influenza pandemic.
• CPHLN will also use this preparedness work to build common templates and processes for other public health emergencies requiring a national laboratory response.

The NML carries out fundamental and applied research relating to the diagnosis and pathogenesis of respiratory viruses, including the influenza virus. It conducts surveillance and develops and evaluates methods for the diagnosis, prevention and effective management of viral respiratory diseases. A designated WHO influenza reference centre, the NML participates in global surveillance of influenza viruses.

Focus for RPP Reporting Period:

• During 2007-2008, the NML will further develop and validate new diagnostic tests for rapid molecular and serological typing of influenza A viruses.
• The NML will continue antigenic and molecular surveillance of circulating influenza A and B strains in Canada as well as carrying out newly developed in-house testing to monitor emerging strains for resistance to both classes of antiviral drugs licensed for use against influenza in Canada.
• The NML will continue to develop additional recombinant reagents for rapid detection of novel influenza strains, such as H5N1 and H7N3 subtypes, as well as candidate vaccine vectors in addition to providing proficiency and reference services to public health laboratories for molecular typing of influenza A viruses.
• The NML will also host additional influenza diagnostic laboratory training workshops for provincial and territorial clients.

The national capacity to identify and respond to novel influenza viruses will be enhanced by establishing a federal-provincial laboratory network for influenza surveillance, detection, and diagnosis. Under the direction of the NML, the Agency's Laboratory Liaison Technical Officers will be placed within federal and provincial laboratories or regional hospitals (where appropriate) to provide decentralized, coordinated, standardized surveillance and diagnostic capability and capacity. This approach will increase local expertise, support integration of laboratory and epidemiological information, and provide a system of coordinated and networked operations for performing influenza diagnostics. While this approach is being developed for influenza diagnostics, it will also support other Agency/NML national surveillance activities.

Immunization
The Agency has been providing federal leadership on the National Immunization Strategy (NIS), which was accepted by the Conference of Federal, Provincial and Territorial Deputy Ministers of Health in 2003 to strengthen Canada's immunization capacity. The NIS is a means for governments and other key stakeholders to work in partnership to address immunization issues with a national perspective. The main objectives of the NIS are to work with provincial and territorial partners to:

• Ensure equitable and timely access to recommended vaccines;
• Optimize program safety and effectiveness;
• Improve the coordination and cost-effectiveness of immunization programs;
• Ensure the security of the vaccine supply;
• Provide rapid and effective national interventions in emergency situations and in response to international requests when required; and
• Promote professional and public acceptance of recommended programs.

There has been a great deal of progress on the NIS over the past three years, and work continues through F/P/T committees and working groups to assess, evaluate, and improve our activities.

The Agency will continue to strengthen Canada's ability to manage and respond to emerging and re-emerging infectious diseases and respiratory infections through the prevention, reduction or elimination of vaccine-preventable and infectious respiratory diseases. In addition, the Agency will continue to reduce the negative impact of emerging and re-emerging respiratory infections, and maintain public and professional confidence in immunization programs in Canada. In collaboration with provincial and territorial counterparts, the Public Health Agency of Canada undertakes key initiatives in immunization.

Focus for RPP Reporting Period:

• Develop national scientific and programmatic recommendations on three new vaccines approved for use in Canada: human papillomavirus (HPV); rotavirus; and meningoccal disease (i.e. Menactra).
• Release of the Canadian Immunization Guide (7^th edition) and the Canadian Report on Immunization.
• Evaluation of the National Immunization Strategy (NIS).
• In partnership with the provinces and territories, development of a model for ongoing support of new immunization programs to ensure continued harmonization of programs and equitable access to vaccines for all Canadians.
• Continue to work toward the establishment of a network of immunization registries through the Canadian Immunization Registry Network and Canada Health Infoway.
• Progress toward establishing national public health research priorities, in partnership with the Canadian Institutes of Health Research, the Canadian Association for Immunization Research and Evaluation and other research partners.
• Endorsement of national vaccine-preventable disease reduction goals and objectives for six vaccine-preventable diseases (rubella, varicella, pertussis, invasive pneumococcal disease, invasive meningococcal disease, influenza) and implementation of strategies to realize the goals.
• Through the F/P/T Vaccine Supply Working Group, the Agency will establish a National Vaccine Supply strategy to enhance the security of vaccine supply in Canada. The purpose of such a strategy is to avoid or mitigate the potential effect of vaccine supply problems, such as vaccine shortages, delays, and other issues that may affect the production and delivery of vaccines.
• Through the F/P/T public and professional education working groups, emphasis on improving professional and public immunization awareness through:
  • Completing core competency definitions for the education of health professionals and working toward their integration into core curricula;
  • Facilitating the development of Web-based continuing education modules for health professionals and other providers;
  • Organizing the bi-annual Canadian Immunization Conference (2008); and
  • Conducting multi-faceted public education campaigns including national social marketing strategies.
• Enhancements to the Canadian Adverse Events Following Immunization Surveillance System through the F/T/P Vaccine Safety Network to enhance vigilance with monitoring and reporting of adverse events following immunization.
• Enhance vaccine-preventable disease surveillance capacity; improve surveillance systems and the coordination of surveillance systems and reporting mechanisms.

HIV/AIDS
The Agency has the lead for federal action in the prevention of HIV/AIDS in Canada. The number of Canadians living with HIV was estimated to be 58,000 in 2005, an increase of 16% from 2002 estimates. About 27% of these individuals were unaware of their infection at the end of 2005. This «hidden» aspect of the epidemic means that at the end of 2005 there were an estimated 15,800 infected individuals who had not had the opportunity to access treatment, support or prevention services.

The Federal Initiative to Address HIV/AIDS in Canada is a partnership among the Public Health Agency of Canada, Health Canada, the Canadian Institutes of Health Research and Correctional Service Canada. Through the Federal Initiative, the Agency supports activities that will prevent new HIV 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.

Over the planning period, the Agency will:

• Advance knowledge of the factors that contribute to the spread of HIV infection through:
  • Augmented HIV and risk behaviour surveillance;
  • Targeted epidemiologic studies and development of programs for at-risk populations;
  • Enhanced HIV laboratory reference services;
  • Improved knowledge and characterization of the transmission of drug-resistant HIV in Canada; and
  • Interdepartmental collaborations to advance the research and development of HIV vaccines.
• Develop HIV/AIDS status reports to provide an overview of current surveillance data, research and current responses and identify emerging issues and gaps for Aboriginal peoples, gay men, people who use injection drugs, youth, women at risk, people living with HIV/AIDS, people from countries where HIV/AIDS is endemic and prisoners. These reports will guide research, policy development and front-line interventions.
• Further develop and implement a national HIV/AIDS social marketing campaign to expand and improve Canadian's knowledge of HIV/AIDS , to address community and societal attitudes, and to reduce stigma and discrimination.
• Conduct an implementation evaluation of the roll-out of the Federal Initiative in 2007- 2008, and an impact evaluation of the Federal Initiative in 2008-2009.

In collaboration with provinces and territories, the Agency will:

• Develop a framework that will assist all jurisdictions in making decisions regarding HIV testing policies. This framework will be based on informed consent, counselling, and confidentiality. It will address a range of issues, such as testing during pregnancy, testing of marginalized groups, ethical and human rights considerations and ways to increase the proportion of people who know their HIV status.

The Agency recognizes the strategic importance of collaboration and engagement with civil society, stakeholders from other sectors and government as crucial to achieving expected results. The Federal Initiative supports internal coordinating structures, broader coordination across the Health Portfolio, and linkages across the federal, provincial and territorial governments.

The Agency will also continue to support its existing committees on:

• The Federal/Provincial/Territorial Advisory Committee on AIDS;
• The Government of Canada Assistant Deputy Ministers Committee on HIV/AIDS;
• The National Aboriginal Council on HIV/AIDS (NACHA); and
• The Ministerial Council on HIV/AIDS.

Through national and regional funding programs, the Agency will:

• Support programs that focus on HIV prevention, and improve access to more effective care, treatment and support for people living with HIV/AIDS;
• Develop a knowledge exchange service to strengthen the response of organizations delivering front-line services, and work with its partners to develop a knowledge exchange framework;
• Increase public awareness of HIV/AIDS and factors that fuel the epidemic, such as stigma and discrimination;
• Engage other federal departments in addressing factors that influence the determinants of health, such as housing and poverty;
• Provide policy and technical expertise to increase Canadian participation in the global response to HIV/AIDS; and
• Integrate, when appropriate, HIV/AIDS programs and services with those addressing other related diseases, such as sexually transmitted infections.

Sexually Transmitted Infections (STIs) and Blood-Related Issues, Health Care Acquired Infections and Foodborne, Waterborne and Zoonotic Diseases
The Agency undertakes research, surveillance, policy and national coordination activities on sexually transmitted infections (STIs) and other blood-related issues, health care acquired infections and zoonotic diseases. These issues will remain significant infectious disease priorities for the Agency over the planning period.

The infection rates for the three nationally reportable STIs, (gonorrhea, genital chlamydia and infectious syphilis) declined in the early 1990s until reaching their lowest point in 1997. Since then, the rates have significantly increased and they continue to do so unabated. The reported chlamydia rate has seen an increase greater than 70% between 1997 and 2004. The reported rate of gonorrhea in 2004 had increased 94% from its lowest level 1997. Infectious syphilis, which was near the point of elimination in 1997 has also seen drastic increases over the same time period, with the national rate in 2004 increasing to almost 9 times the rate reported in 1997 (3.5 vs. 0.4 per 100,000).

The 2006 edition of the Canadian Guidelines on Sexually Transmitted Infections was released in the fall of 2006. It is an evidence-based, best practice guideline document, which is used by health care professionals across the country for the prevention, management and control of STIs.

Focus for RPP Reporting Period:

• Continue efforts to support and facilitate the development, implementation and evaluation of strategies, programs and resources that help Canadians to improve and maintain their sexual and reproductive health. This will include working with provinces, territories, nongovernmental organizations and academic institutions on a number of strategic initiatives.
• The redevelopment and re-launch of the Agency's Canadian Guidelines for Sexual Health Education so that they can continue to be used as an up-to-date resource for health and educational organizations in developing new programs and curriculum or evaluating existing programs and curriculum.
• The development of an assessment model that incorporates a comprehensive set of sexual health indicators that will be used to assess the sexual health of Canadians across their lifespan regardless of their demographic characteristics such as sex, ethnicity or education level.
• The identification of «best practice» models of school-based curricula and research on sexual health promotion and the dissemination of these models to educators and policy makers through continued participation in working groups and education symposiums.
• The development of tools to improve public awareness of STIs and factors that influence sexual health, including an STI pamphlet and anti-homophobia resources and campaigns.
• The education of the general public and health and education professionals on HPV, its associated diseases and vaccine, facilitated by consistent messaging with a national focus.
• The development and dissemination of policy documents that address sexual and reproductive health issues identified through the Enhanced Surveillance of Canadian Street Youth Study.
• Continue to work towards strengthening the knowledge and capacity of health care professionals for the prevention, diagnosis, and treatment of STIs. The Quick Reference Guide of the 2006 Canadian Guidelines on Sexually Transmitted Infections will be released in early 2007. The Agency will continue to work with other groups on the development and delivery of associated training and knowledge dissemination.
• Continue to work in collaboration with the National Collaborating Centre for Infectious Diseases on initiatives for the promotion of sexual health.
• Ongoing collaborative efforts with federal, provincial, and regional government and nongovernmental partners in the areas of STI surveillance and prevention in federal correctional facilities and behavioural research, and efforts to increase Canada's participation in sexual health promotion internationally. For example, the Agency's involvement in the World Association for Sexual Health, the World Congress on Sexual Health, and the International Symposium on School Sexual Health Education.
• Continued monitoring of rates of a wide range of sexually transmitted and bloodborne infections through routine and enhanced surveillance, including the initiation of sentinel surveillance projects for both HPV and antimicrobial-resistant gonorrhea.
• Continued improvements to the quality and timeliness of existing routine surveillance systems with the development of national data standards for reportable STIs and hepatitis B and C.
• Enhanced Surveillance of Canadian Street Youth will continue to provide a comprehensive picture of the health of Canadian street youth, including through surveillance related to risk factors for STIs and other determinants of health in this population. This will help in developing appropriate, innovative services and prevention programs in subsequent years.

The NML provides reference services for hepatitis A, B, C, D and E virus infections as well as consultation services on diagnostics issues. It also conducts research to address questions related to hepatitis infections in Canada and develops tests for the detection of other potential bloodborne pathogens.

Focus for RPP Reporting Period:

• During 2007-2008, the National Microbiology Laboratory (NML) will provide advanced laboratory reference services for hepatitis viruses and develop laboratory assays for identifying emerging pathogens with bloodborne potential.
• The NML will provide laboratory support for field investigations and molecular analysis of hepatitis virus strains associated with viral outbreaks in Canada.
• The NML will monitor the currently circulating strains of hepatitis B and C viruses currently in circulation for the emergence of drug resistance, and will monitor hepatitis B viruses for immune resistance to vaccination and gamma-globulin therapy.
• The NML will also conduct research on the molecular identification and characterization of hepatitis virus strains and carry out proteomic analysis to address questions related to the pathogenesis and chronic persistence of hepatitis C virus (HCV) infections.

During 2007-2008, the Agency will continue to foster meaningful citizen engagement and support services and programs that help Canadians infected and affected by the hepatitis C virus. Over the past few years, the scope of the epidemic has changed from those infected through the blood supply to vulnerable populations. This trend has required the Hepatitis C Prevention, Support and Research Program to shift its focus from care and treatment to prevention and awareness.

Focus for RPP Reporting Period:

• Continued collaboration with the First Nations and Inuit Health Branch (Health Canada), Correctional Service Canada and the Canadian Institutes of Health Research.
• Engage and support the Agency's regional offices to strengthen and coordinate program activities.
• Support enhanced research and surveillance activities among vulnerable and at-risk populations in partnership with provincial and territorial governments.
• Promote peer-based education and awareness among at-risk and vulnerable populations (e.g. youth).

Enhanced Hepatitis Strain Surveillance System (EHSSS)
With regard to hepatitis, additional plans for 2007-2008 involve intensifying the Agency's surveillance activities of hepatitis B virus (HBV) and hepatitis C virus (HCV) through the Enhanced Hepatitis Strain Surveillance System (EHSSS). EHSSS allows for the collection of detailed risk information on newly acquired viral hepatitis cases and provides evidence-based information for the development of hepatitis B and C prevention and control programs in Canada.

Focus for RPP Reporting Period:

• Data produced from the EHSSS will continue to be used for a number of public health policy purposes such as:
  • National hepatitis B vaccination guidelines and a blood safety program;
  • Modelling research (e.g. to project the future of hepatitis B and C infection) and risk assessment; and
  • Public information and education.
• Due to the variability in the prevalence and incidence of HBV infection across Canada among the different subpopulations (e.g. immigrants and Aboriginals), HBV public health policy needs to be modified on an ongoing basis.
• Moreover, in the absence of a hepatitis C vaccine, strategies such as risk reduction counselling and services for reducing or eliminating high-risk behaviours within the injection drug users and Aboriginal populations need to be more widely implemented.

Canadian Needle Stick Surveillance Network (CNSSN)
The Agency also plans to persist in its national activities to protect health care workers from bloodborne pathogen infections acquired by occupational exposures to blood or body fluids, through its Canadian Needle Stick Surveillance Network (CNSSN). The CNSSN, established in 2000, is collecting data on occupational exposures to blood, body fluids and bloodborne pathogens (including hepatitis B, hepatitis C and HIV) from 14 sentinel hospitals located in 10 provinces and territories. The CNSSN monitors heath care workers' seroconversions for these pathogens and data on morbidity and mortality to help understand which technical procedures put health care workers at greatest risk of exposure and the level of risk involved (low, moderate and high as an accidental needle stick injury from a hollow bore, blood-filled needle would constitute a higher risk than an accidental stick injury from needles used on an intravenous line for an injection). In the past six years, a number of reports have been produced, among them the Four-Year (2000-2004) Surveillance Report (released in March 2006).

Focus for RPP Reporting Period:

• Many articles are planned for publication in scientific journals over the planning period. The information is intended for use by stakeholders and hospitals for their targeted prevention activities aiming health care workers or provincial legislatures on safety devices to prevent needle stick injuries.
• Over the planning period, the identification of risk associated to specific technical procedure will:
  • o Allow hospitals to introduce safer products and implement safety policies and technical procedures; and
  • o Help private companies to lobby hospitals to buy their safety-engineered devices.

Canadian Blood and Marrow Transplant Surveillance System (CBMTSS) Database
Another very useful database, with respect to monitoring the safety and quality of the care provided to patients and donors, is the Canadian Blood and Marrow Transplant Surveillance System (CBMTSS) database. The CBMTSS, successfully installed in eleven transplant programs in Canada, is intended to provide surveillance information related to infectious and noninfectious complications as well as adverse events among recipients of bone-marrow transplants and their donors.

Focus for RPP Reporting Period:

• In 2007-2008, in addition to establishing a specimen repository at the National Microbiology Laboratory, the Agency will finalize the National Registry Database and continue to convert the current system into a Web-base database. This national database contains important epidemiological and clinical information on patients undergoing blood and marrow transplantation and on the donors.
• The database and repository of specimens will be used jointly by the participating centres, with the principal aim of improving patient care; this will be particularly useful when patients with rare illnesses can only be properly analyzed and when compared with other patients having similar illnesses.

Blood Borne Pathogens Surveillance Project (BBPSP) Hemophilic patients with HIV or hepatitis C resulting from treatment with blood products have informed the Canadian blood system of their status and continue to be at the forefront of innovative treatment.

Focus for RPP Reporting Period:

In 2007-2008, the Blood Borne Pathogens Surveillance Project (BBPSP) will contribute to:

• Providing comprehensive surveillance on hemophilic patients with HIV or hepatitis C in order to quickly gain knowledge of the outcomes of treatment with blood products; and
• Maintaining a secure bank of blood samples from these high-risk patients to be available for testing for newly emerging pathogens.

Safety of Blood and Cell, Tissues and Organs (CTOs)

National Transfusion Transmitted Injuries Surveillance System
Surveillance of transfusion transmitted injuries (TTIs), in all Canadian provinces and two territories,will continue in 2007-2008 through the strongly implemented National TTI Surveillance System (TTISS). To help sites, clinics, provinces and the Agency to capture data on moderate and serious adverse events related to the transfusion of blood, blood components and plasma derivatives, the Agency has created and developed an information system that has a number of key functions and features. TTISS produces information that enhances the ability of governments and the Agency to detect and prevent transfusion-associated adverse events and develop appropriate strategies to manage these risks.

Focus for RPP Reporting Period:

• TTISS will continue to be upgraded through:
  • A new definition of transfusion related lung injury (TRALI): TRALI is a transfusion-related adverse event; in 2004, Canadian Blood Services and Héma-Québec held a consensus conference on TRALI, entitled, Towards an Understanding of TRALI; the consensus panel statement of the conference recommended a change in the definition of TRALI;
  • The development of standardized guidelines for the investigation of bacterial contamination cases;
  • The reconciliation of its data with that of blood manufacturers and Health Canada's Marketed Health Products Directorate (MHPD), Health Canada; and
  • A move to a Web-based database that is currently being planned.

Transfusion Error Surveillance System
The Transfusion Error Surveillance System (TESS) pilot project is scheduled for completion by 2008. The system will capture errors related to the transfusion of blood, blood components and plasma derivatives. It is anticipated that it will evolve into a sentinel surveillance system to be used by hospitals for benchmarking.

Cell, Tissue and Organ Surveillance System
Over the planning period, the Agency will develop a surveillance system for the adverse events resulting from the transplantation of cells, tissues and organs (CTOs).

Other CTO Issues
Defining the respective roles and responsibilities between federal, provincial and territorial partners may become at stake when dealing with public health issues such as CTO recalls. As there is an increased focus on transplantation in Canada, improving national capacity to share this type of information will constitute a huge challenge in the coming years.

Health Care Acquired Infections
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.

Health care infection surveillance - including risk factors, impacts and outcomes - is needed to guide programs, policy, and services nationally, regionally and locally. The Agency is developing an enhanced approach to expand nosocomial infection surveillance beyond acute care hospitals to health care situations in the broader community, based on the successful, collaborative approach utilized within the Canadian Nosocomial Infections Surveillance Program (CNISP). This approach will continue to focus on key health care acquired infectious agents such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE) and Clostridium difficile; invasive medical practices that increase the risk of health care acquired infections (e.g. surgery, dialysis and bloodstream access); and evaluation of common infection control practices used to prevent nosocomial infections.

Evidence-based decision making on nosocomial infection control policy and practices are crucial to preventing, limiting, containing and or controlling these infections. The Agency will continue to revise and expand its Infection Control Guideline Series to provide evidence-based decisionmaking for government departments, agencies and professionals in Canada.

Focus for RPP Reporting Period:

• Provide reports, on the Agency Web site, on the incidence of key, emerging infectious agents that cause health care acquired infections (e.g. community-acquired MRSA, C. difficile, other antibiotic-resistant organisms, and severe respiratory infections caused by emerging viruses).
• Continue providing timely, relevant infection control guidelines on the Agency Web site, to prevent, limit, contain and/or control health care acquired infections. These include Infection Control Guidelines for:
  • The prevention of heath care-associated pneumonia;
  • Classic Creutzfeldt-Jakob disease in Canada (Quick Reference Guide);
  • Effective infection prevention and control programs;
  • Flexible gastrointestinal endoscopy and flexible bronchoscopy; and
  • Routine practice and additional precautions in health care.
• Expand health care acquired infections surveillance beyond acute care hospitals to health care situations in the broader community, based on the successful, collaborative approach utilized within the Canadian Nosocomial Infection Surveillance Program (CNISP).
• Provide updated, evidence-based recommendations on an ongoing basis to prevent, limit, contain and/or control the spread of pandemic influenza in health care settings, including recommendations to protect health care workers caring for patients infected with pandemic influenza (e.g. update Annex F of the Canadian Pandemic Influenza Plan for the Health Sector), with a special focus on modes of transmission and the use of respiratory protection for health care workers, visitors and families.
• Establish and support new networks with the provinces and territories on health care acquired infection issues.
• Provide assistance (upon request) to provinces and territories and their health care agencies when health care acquired infection outbreaks occur.
• Provide support, coordination, analysis and advice to the Agency's Communicable Disease Committee Expert Group.
• Continue to support and coordinate the Infection Control Group Steering Committee and the Canadian Nosocomial Infections Surveillance Program.

A multi drug-resistant strain of Acinetobacter baumannii associated with wound infections in soldiers returning from Iraq and Afghanistan has been reported to have caused outbreaks in hospitals in the United Kingdom and the United States. A number of wounded Canadian soldiers have been infected with this bacterium and transported to Canadian hospitals. The National Microbiology Laboratory is working with National Defence to alert Canadian hospitals accepting these patients to limit the spread of this organism.

Foodborne, Waterborne and Zoonotic Diseases
Canadians are at risk from the threat of infectious disease that can be transmitted through other animals, food, and water. Foodborne and waterborne diseases cause numerous outbreaks in the Canadian population; however, the nature and extent of such events are changing. There is an inherent potential for outbreaks in changing patterns of food production and consumption, including globalization of the food supply; increased exposure during international travel; new, re-emerging or drug-resistant disease agents; mass distribution of food; the demand for fresher produce; large scale production; processing and distribution chains; highly variable water systems; and the daily exposure to potentially contaminated produce. It is estimated that 11 million episodes of foodborne illness occur within Canada each year. There are over 30 million episodes of acute gastroenteritis per year, of which some sections of the population are at increased risk for these diseases, including the very young, seniors, and individuals with suppressed immunity.

In addition, waterborne disease outbreaks are frequent in Canada. From 1974 to 1996 (most recent data), over 200 outbreaks of infectious diseases associated with drinking water were reported, resulting in more than 8000 confirmed illnesses. Additionally, food and water are potential targets for intentional contamination and terrorist attacks, and through these consumables Canada is increasingly linked with the activities and standards of other countriesas a result of globalization.

The Agency plays a critical role in food and water safety through risk identification and management, horizontal integration and public health capacity. Key activities include enhancement of the national capacity to conduct surveillance; the investigation and coordination of foodborne and waterborne disease outbreaks; facilitation and coordination of risk identification, analysis and management activities; and the provision and coordination of population-based and targeted research focused surveillance activities related to antimicrobial resistance, travelers and vulnerable sectors of the community and First Nations. Diseases that are transmitted to humans from animals also pose significant risks to human health. Nationally and internationally, many previously unknown human infectious agents have emerged from animal reservoirs, such as hantavirus, human immunodeficiency virus (HIV) and Ebola, or have emerged in North America, for example Hantavirus, Lyme disease and West Nile virus. There is every reason to believe that these infectious diseases, many of which are of animal origin, will continue to emerge due to a variety of factors, including closer proximity between humans and animals, travel to exotic locations, changing climatic conditions, social and behavioural factors, an increasing popularity of exotic pets and increasing urbanization. The elderly and immunosuppressed populations are generally the most vulnerable to these diseases. As such, the Agency plays a key role in ensuring a consistent approach to address these issues of national concern, including activities related to national surveillance programs, guidelines development, international information sharing and emergency response, diagnostic testing and collaboration with local public health authorities and jurisdictions.

Foodborne and Waterborne Outbreak Response and Surveillance

Focus for RPP Reporting Period

• Continue to provide leadership in the coordination of multi-provincial outbreaks and content expertise to the provinces, the Canadian Food Inspection Agency and Health Canada as requested.
• Continue to liaise with international partners in the investigation of international foodborne disease outbreaks.
• Launch a new tool for collecting summary data on foodborne and waterborne illness outbreaks.
• Enhance focus on waterborne disease and other environment related risks for enteric and zoonotic diseases.
• Enhance surveillance for travel-associated enteric (gastrointestinal) illness outbreaks.
• Conduct a population survey to better understand the economic costs and origins of acute gastroenteritis in the community.
• Continue to collect, and disseminate weekly, laboratory data on human gastrointestinal pathogens (bacterial, viral and parasitic) to facilitate timely outbreak detection, response and emergency preparedness through the National Enteric Surveillance Program (NESP).
• Continue development and application criteria to prioritize potential additions to the list of pathogens under surveillance in the NESP.
• Continue to coordinate antimicrobial resistance (AMR) surveillance human data under the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS).
• Continue implementing several targeted studies examining AMR in enteric pathogens (Salmonella Heidelberg, Typhi and Paratyphi and Campylobacter spp.) and antimicrobial use data validation which are in planning or underway.
• Continue coordination of C-EnterNet, a program for sentinel surveillance program of foodborne and waterborne pathogens across the food chain and in the environment including determining the feasibility of launching new sentinel sites.
• Determine the feasibility of launching one or two new C-EntreNet sentinel sites.

Policy Development

Focus for RPP Reporting Period:

• Ensure that epidemiological findings from disease surveillance, research and outbreak investigations are used to inform food safety policy.
• Complete a study on barriers to enteric disease outbreak prevention in childcare settings. Hold a consensus meeting on best practices and develop guidelines for the prevention of enteric outbreaks in childcare facilities.
• Contribute to strategies to reduce risks of contamination from raw produce. Raw fruits and vegetables have become an important source of many pathogens, causing widespread disease outbreaks.
• Complete national guidelines on:
  • The management of enteric pathogen shedders; and
  • Animal exhibitions, to reduce the risk of human infection.
• Continue to support Health Canada and the Canadian Food Inspection Agency (CFIA) in risk assessment related to product recall actions.
• Continue to contribute to federal, provincial and territorial, national and international fora on food safety.
• Develop evidence synthesis, research and methodology on targeted food policy issues with public health implications.

Diseases in Aboriginal Communities

Focus for RPP Reporting Period:

• Collaborate in studies of foodborne and waterborne illnesses in northern Aboriginal communities and the impact of climate change on these illnesses.
• Carry out a study of toxoplasmosis in the Arctic and sub-Arctic regions.
• Continue to support the implementation of Arctic initiatives on the impact of zoonotic infections (e.g. ArcticNet network).

Health and the Environment

Over the planning period, the Agency will continue to provide accurate and timely information on national and global public health events to Canadian and 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 gathers preliminary reports of public health events of significance in seven languages (English, French, Chinese (simplified and traditional), Russian, Arabic and Spanish) on a realtime, 24 hour / 7 days a week basis. This system gathers and disseminates relevant information on disease outbreaks and other public health events by monitoring global media sources such as newswires and Web sites.

Climate Change

Focus for RPP Reporting Period:

• Initiate a process to identify and prioritize potential effects of climate change on a wide range of pathogens, including vector-borne, foodborne and waterborne pathogens, to guide research efforts.
• Establish an internal committee on climate change that will examine the public health impacts of climate and environmental change.
• Focus on identification of climate related risks and risk mitigation strategies for vulnerable groups (e.g. Seniors, First Nation communities).

Zoonoses

Focus for RPP Reporting Period:

• Continue the current surveillance program for West Nile virus.
• Continue current monitoring and emergency planning for avian influenza in partnership with CFIA and provincial and territorial partners.
• Complete a diagnostic guidance document for Lyme disease and facilitate the development of clinical guidelines with F/P/T partners.
• Expand disease modelling efforts for a variety of vector-borne infections, including Lyme disease.
• Facilitate the development of national coordination for a response to rabies in Canada.
• Carry out national coordination of initiatives on zoonotic diseases.
• Expand national surveillance and response to zoonotic diseases.

Technologies

The different technologies developed and utilized by the Agency are critical for maintaining adequate knowledge of the spread of disease both in Canada and globally. These technologies allow the Agency to rapidly respond and to coordinate activities with provincial, territorial and local public health authorities if required.

Focus for RPP Reporting Period:

• Using the latest molecular and cellular techniques, continue to conduct innovative research on pathogenic determinants and host responses; rapid identification of enteric pathogens; and novel interventions for the prevention and control of enteric diseases.
• Develop high performance modelling tools, such as Geographic Information Systems (GIS) and multi-criteria decision making tools that will provide analysis and options for public health issues related to the agro-environment.
• Take steps to establish a program in biotechnology, genomics and population health, which can contribute to strategies to prevent disease and improve health status based on the genetic and biologic endowment of individuals and populations, and the application of new genomic knowledge, products and biotechnologies.

The Agency continues to develop various surveillance systems to facilitate its ongoing activities. Some of its emerging technologies are used by many different programs to monitor a variety of both infectious and non-infectious diseases.

The Agency will continue its collaboration with provincial, territorial and regional health authorities across Canada in the implementation of the Canadian Network for Public Health Intelligence (CNPHI). CNPHI has become Agency's primary information management and information technology (IM/IT) platform for collaboration, surveillance, alerting and response. For instance, the NESP and CIPARS (mentioned above) utilize the CNPHI platform. CNPHI is used daily by more than 2000 public health stakeholders from across the country to facilitate infectious disease management. To date, CNPHI has successfully piloted a suite of Web-based resources including, a pan-Canadian alerting system, collaboration resource centres in use by over 50 domestic and international working groups, national disease surveillance systems, and a pilot syndromic surveillance system for the City of Winnipeg.

Focus for RPP Reporting Period:

• The CNPHI team will implement a nation-wide, Web-based surveillance system for overthe- counter pharmaceutical sales.
• A proprietary data collation infrastructure has been developed and will be implemented to integrate CNPHI with existing federal, provincial, and regional public health databases and systems as well as a public health information system being developed through Canada Health Infoway.
• CNPHI will continue to be expanded to provide additional Web-based resources, including a dynamic event management system, an infectious disease outbreak summaries reporting system, infectious disease mapping, modelling and tracking tools, and a laboratory quality management system.
• Efforts are currently underway to make CNPHI available to other federal, provincial and territorial government departments with public health links, and fostering broader intergovernmental and cross-jurisdictional integration. This integration will facilitate the collection and processing of surveillance data, the dissemination of strategic information, and the coordination of responses necessary to meaningfully address potential health threats.

Program Activity - Emergency Preparedness and Response

Financial Resources (in millions of dollars)
2007-2008	2008-2009	2009-2010
115.5	54.7	57.9

Human Resources (FTEs)
2007-2008	2008-2009	2009-2010
367	328	328

(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 National Framework for Health Emergency Management. This framework sets out a consistent, interoperational 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: 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)

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 and validate 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 natural and human-caused emergencies involving hazards that threaten the health and safety of Canadians.

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 for the Health Portfolio in the National Capital Region, and monitors the Health Portfolio's progress on laboratory safety. It collaborates with the World Health Organization (WHO) in the promotion of biosafety, biocontainment and biosecurity on the international stage.

The Agency has created Emergency Preparedness and Response Regional Coordinator positions across the country. These coordinators facilitate coordinated planning within the Health Portfolio and among federal departments to strengthen provincial and territorial partnerships in the response community.

The updated Quarantine Act received Royal Assent in May 2005 and came into force on December 12, 2006. This new quarantine legislation will offer enhanced protection to Canadians by providing the Government of Canada with new authorities and modern tools to respond rapidly and effectively to the changing threat and risk environment in global public health at entry and departure ports in Canada.

Focus for RPP Reporting Period:

• Continue to support and strengthen its nationwide quarantine service 2007-2008, 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.
• Respond to all reports of passengers whose presence aboard conveyances constitutes a risk factor.
• Assist authorities at entry points in the development of their respective emergency response protocols.
• Enhancement of emergency preparedness capacity to ensure that Canadians benefit from a more efficient and effective response that reduces the effects of health-related emergencies.

Emergency Response Capacity
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.

Focus for RPP Reporting Period:

• Important liaison function will be enhanced to include operational links with the Agency's Emergency Operations Centre system.
• 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 (CBRN) 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. The Agency also publishes and maintains the Laboratory Biosafety Guidelines. The 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 National Microbiology Laboratory's Office of Biorisk Management advances the public health agenda by promoting biorisk management for national and international laboratories and facilities working with infectious diseases. In 2007-2008, the Office will continue conducting its internationally recognized High Containment Biosafety Workshops. It will also chair the European Committee for Standardization (CEN) workshops to work towards an international standard on laboratory 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 (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.

Focus for RPP reporting period:

• Continue to improve its laboratory response operations in both its first response laboratory and its mobile response units.
• The National Microbiology Laboratory will lead a CRTI exercise (BI-EX West). This exercise will allow municipal, provincial and federal agencies to engage in an integrated response to a simulated biological terrorist emergency event, thereby enhancing Canada's capability to secure Canadians against bioterrorist threats.
• Monitor the accidental release of biological materials from certified and non-certified facilities and instances of laboratory-acquired infections.
• 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.
• 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. These labs have advanced equipment which allows for rapid diagnoses and operations in rugged field conditions.

Focus for RPP Reporting Period:

• Develop enhanced field-usable techniques for the identification of potential bacterial bioterrorism agents.
• Enhance testing capacity at the Agency's Canadian laboratories.

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.

Focus for RPP Reporting Period:

• The Agency will further connect the three EOC units to provincial, territorial and international networks.
• Start implementing a modular Emergency Management Software call E-Team. It allows the Emergency Management Team to task users, develop and publicize action plans and supporting reference documents and facilitates users' ability to review the history, location and status of any incident, provided\ for the sharing of data with related groups, enable communications between and alerting of users and partner agencies and record all data of an event for future review. The E-Team software has been used internationally to manage planned events with heightened security threats such as the 2002 Winter Olympics, the Super Bowl and has been used to manage responses to unplanned events, including the 2003 power blackout that affected Southern Ontario and the North Eastern United States and Hurricanes Katrina and Rita.

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 165-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.

Focus for RPP Reporting Period:

• Increase the storage capacity as well as the inventory 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 2007-2008.

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 Ottawa, Vancouver, Halifax and Winnipeg, these units will include medical, nursing and other personnel that will collaborate with provincial and territorial counterparts to assess and coordinate needed interventions. In June 2007, the Ottawa HERT unit will be operational. This requires that:

• The Medical Response Teams (MRT) and Mission Support Teams (MST) for the Ottawa Unit fully recruited and contracted;
• Arrangements for benefits, indemnification and compensation;
• All HERT unit Ottawa equipment and supplies purchased and validated;
• Transportation and logistical support arrangements contracted and in place;
• Completion of the training plan development; and
• Implementation of an exercise program.

Other units to be operational will be Vancouver and Halifax in 2008 and Winnipeg HERT units in 2008-2009.

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).

Focus for RPP Reporting Period:

• 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.
• 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 Canadian Pandemic Influenza Plan for the Health Sector.
• Further develop a national health incident management system.
• Define the federal, provincial and territorial components of the National Health Emergency Management System.

In 2007-2008, the Agency's Travel Medicine Program will take steps to ensure that yellow fever vaccine is dispensed in Canada in accordance with national standards.

Global Health Security
The World Health Organization set up the Global Outbreak Alert and Response Network (GOARN) in April 2000 as a technical partnership to coordinate activities between existing institutions and networks in mobilizing and connecting global resources to control disease outbreaks. Canada, a founding member of GOARN, has deployed experts to be members of international teams assisting in dealing with various outbreaks of international concern. Agency experts participated in the assessment of affected areas to define needs before specific requests were issued for assistance to network partners.

Focus for RPP Reporting Period:

• Canada will continue to contribute (human) resources for GOARN activities and continue to be a strong supporter of this network.
• Canada will send experts to be members of international teams in response to GOARN requests for assistance in dealing with outbreaks of international concern.

Canada will work actively towards implementation of the International Health Regulations, which would see consistent measures applied around the globe with respect to issues surrounding the movement of people and goods. These standards would help enhance the standard of health security for people everywhere, by reducing or slowing the spread of disease.

Canada supports a four-year project entitled Canada-Asia Regional Emerging Infectious Disease (CAREID). This project is funded by the Canadian International Development Agency, whose minister (the Minister of International Cooperation), has selected the Public Health Agency of Canada as the Canadian Executing Agency. The Agency will provide short-term and long-term technical assistance and management services to implement the project in Southeast Asia and China. The project will support the Government of Canada priorities on public health security and will strengthen both regional collaboration and the capacity of selected national public health systems in the region to detect and respond to infectious disease emergencies.

The Agency is actively participating in a number of international initiatives on avian and pandemic preparedness, including collaboration with the World Health Organization (WHO) on the Global Action Plan to increase the supply of pandemic influenza vaccines; the provision of technical expertise to the Global Health Security Initiative (GHSI) involving the G7 countries plus Mexico; and participation in the development of a North American avian and pandemic influenza plan as well as other health-related pandemic activities under the Security and Prosperity Partnership of North America that links Canada, the United States and Mexico.

Program Activity - Strengthen Public Health Capacity

Financial Resources (in millions of dollars)
2007-2008	2008-2009	2009-2010
55.6	55.8	56.4

Human Resources (FTEs)
2007-2008	2008-2009	2009-2010
311	336	340

A strong and sustainable public health system is necessary to keep Canadians healthy. Only such a system would respond effectively in situations of health threats and emergencies and protect Canadians from disease. It would have the public health capacity to handle challenges posed by the increasing incidence of existing as well as emerging diseases in the population.

The Agency's work under strengthening public health capacity involves working with national and international partners to develop and provide tools, applications, practices, programs and understandings that support the public health system, increase public health capacity 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.

Strengthening public health capacity means improved public health practice, increased crossjurisdictional human resources capacity, effective knowledge and information systems, and support of the development of public health laws and an ethics framework that evolve in response to changes in public needs and expectations.

Agency's Priorities
Strengthening public health capacity initiatives contribute to Priority 4: Strengthen public health within Canada and internationally by facilitating public health collaboration and enhancing public health capacity.

Strengthen Public Health Capacity Initiatives

Building Public Health Human Resource Capacity
An improved capacity in public health human resources is essential for a stronger public health system in Canada. A lack of such capacity across the country has been cited in a number of reports published after the severe acute respiratory syndrome (SARS) outbreak of 2003. There is a need for a comprehensive strategy, which should build on the existing programs and include new ones. To contribute to this, the Agency collaborates and partners with stakeholders and plays a lead role in strategy development and implementation. Over the three year planning period, the Agency will deliver a range of programs that will strengthen public health human resource capacity.

In 2007-2008, the Agency will:

• Continue to participate in the development and implementation of the Pan-Canadian Framework for Public Health Human Resources Planning. It will do so in association with its federal, provincial and territorial partners;
• Continue to support the Public Health Human Resource task group of the Pan-Canadian Public Health Network;
• Continue to work with the Canadian Institute for Health Information (CIHI), Health Canada and Statistics Canada on the administrative databases to quantify the current workforce in this field, to help solidify workforce planning.

A skilled workforce within the Agency is a must for the effective delivery of programs and services. In 2007-2008, the Agency will finalize a comprehensive professional development plan for its staff, based on the groundwork previously carried out.

There are concerns across the country about the national shortage of public health staff. To address this, the Agency will continue the establishment of the National Public Health Service Program in consultation with provincial health departments during 2007-2008. This program will recruit and deploy qualified staff into permanent positions across Canada. It is anticipated that these public health officers will handle tasks associated with surveillance and epidemiological work, and will be prepared to deal with broader public health issues as well as outbreak or pandemic duty needs, when required.

The Agency will continue to play a major role in training field epidemiologists in Canada. The Canadian Field Epidemiology Program (CFEP) will accept ten trainees for its 2007-2008 cohort. They will start their training in September 2007, as federal employees, and will be posted at public health organizations across Canada. They will receive hands-on training in their host organization and will assist it in activities such as disease outbreak investigation and program evaluation.

The Agency's Skills Enhancement for Public Health Program will continue to contribute to enhancing the skills status of public health practitioners by providing on-line training modules in public health. The program will add three modules to its current suite, increasing the total to ten. Through the Public Health Scholarships and Capacity Building Initiative, the Agency will:

• Improve readiness capacity in the public health system by increasing the capacity of people, systems and tools. This will be achieved by increasing the number and skills of public health professionals; enhancing relationships between university programs in public health and public health organizations; and developing public health training products and tools;
• Work with the Canadian Institutes of Health Research (CIHR) to provide grants to universities to develop and implement programs and courses that increase the number of graduates in the public health field. It will also award grants to health professionals who are willing to pursue their career in public health;
• Work with other partners in public health through a contribution program on tools for workforce development, including competency-based training.

Knowledge and Information Systems
Effective and efficient knowledge and information systems are required to strengthen public health capacity. Such systems are designed to help front-line public health stakeholders in obtaining the information required for public health practice in an effective manner. These systems help turn the data into useful knowledge in the shortest possible time through collection, compilation and presentation in a manner that is flexible and most suited to the user. The Agency works with its federal, provincial and territorial partners to develop information and knowledge management tools and products and to make them available to public health practitioners across Canada. As well, the Agency partners with its stakeholders to obtain consensus and common agreements on such tools and their use in practice.

Over the three year planning period, the Agency will:

• Deliver a range of programs that will strengthen knowledge and information systems. Building on the success of the last year;
• Continue to operate and maintain its Geographic Information Systems (GIS) program in 2007-2008. As the information technology becomes commonplace in public health, more practitioners will be able to access the GIS Infrastructure.

The program will continue to promote the use of a user-friendly, online tool for public health professionals called the Public Health Map Generator (PHMG). The PHMG will address current public health GIS needs for a cost-effective solution by providing a bilingual Web site for public health professionals to quickly and easily create their own maps. Public health professionals will map their health data using spatial data from an integrated data warehouse, with little or no previous GIS skills or knowledge required. The expedited output of the GIS products in the hands of front-line decision makers will accelerate response capacity.

Knowledge about the burden of illness in Canada is needed by all levels of government. In 2007- 2008 the Agency will continue to research methods to improve the determination of the burden of illness and will estimate the direct and indirect economic burden for the wide range of communicable and chronic diseases that affect Canadians.

Building on the groundwork undertaken in the previous year, in 2007-2008 the Agency will prepare the first Annual Report on the Public's Health. This assessment of the state of the public's health will benefit the Agency and its partners in program development and delivery.

In 2007-2008, the Agency will work to strengthen the six National Collaborating Centres for Public Health (NCCs), which were established with an overarching mission to "build on existing strengths and create and foster linkages among researchers, the public health community and other stakeholders to ensure the efficiency and effectiveness of Canada's public health system". The Agency provides guidance, advice and financial support to the NCCs; however, the latter are drawing on regional, national and international networks and expertise to collaborate on projects and activities with other organizations in the public health system.

Through their focus on the practice of public health, the NCCs are facilitating a better understanding of current research and knowledge-based evidence in public health and disseminating important information in the form of relevant, easy to use products and tools that can be readily accessed and applied at all levels of the Canadian public health system. Through this work the NCCs will connect with diverse audience of public health policy and program specialists, practitioners, governmental and non-governmental groups, academia and researchers. They will be engaged to listen to, collaborate on and respond to the needs and uses for methods and tools to make appropriate decisions within their respective areas of responsibility.

The Knowledge Translation Program aims to promote knowledge synthesis, transfer, exchange and application within the Agency specifically and between the Agency and the public health system more generally. The program will foster a focus on knowledge translation within the Agency through a seminar series held in conjunction with the University of Ottawa and the Canadian Institute for Health Information; a Public Health Agency of Canada evidence-based decision-making working group; the development of an organizational assessment of internal PHAC activities; internal and external consultations with key national and international organizations; and the development of an overall knowledge translation strategy.

Knowledge networks contribute to public health capacity. Such networks are spread across Canada but need to be better integrated. Strong performance of Canada's public health system requires that information systems be well-connected. The Agency will strengthen these networks through the Canadian Integrated Public Health Surveillance (CIPHS) program. This program will build bridges between Canadian jurisdictions and bring them together to discuss opportunities for coordination on the implementation of interoperable systems.

In 2007-2008, the Agency will be working, under the direction of the Surveillance and Information Expert Group (SIEG) of the Pan-Canadian Public Health Network, toward the ratification and implementation of memoranda of understanding pertaining to information sharing between and among jurisdictions during public health emergencies. As part of this work, the Agency will be participating in discussions concerning the policies and legal aspects of ownership, release and sharing across jurisdictions of individual records, while keeping in mind the need to balance individual interests and societal interests in protecting the public's health. In 2007-2008, the Agency will work to improve policies, practices and tools associated with the collection, use, retention and disclosure of information about individuals.

The Agency will also ensure its staff and affiliates have easy access to library resources to effectively support their roles as world-class researchers, leaders and advisors. During 2007- 2008, a pilot project will be undertaken by the National Microbiology Laboratory to make electronic databases, journals and other library resources available via a Web-based application, thereby ensuring 24/7 desktop access, irrespective of location.

Public Health Law and Ethics
Growing concerns about new and re-emerging diseases have prompted public health authorities to further clarify jurisdictional roles and responsibilities in the event that a disease like SARS or pandemic influenza should hit Canada. These concerns, raised in a number of reports from external advisory committees published after the SARS events of 2003, were reiterated by Canada's Health Ministers. The Agency is taking a lead federal role in collaborating with provinces and territories to address these concerns.

Modern and concise legislative and ethics frameworks are required to support improved population health and stronger public health practice. Combined to action of this front are efforts to review, analyze and assess laws and regulations intended to protect health and safety - which must reflect current scientific knowledge and best practices in fostering compliance. The Agency will conduct and support applied research in public health law and ethics and also organize workshops and meetings to help public health practitioners and policy makers keep abreast of legislative developments and their impacts on public health practice.

With the United Nations' Millennium Development Goals in mind, the Agency will also collaborate with the World Health Organization in developing public health legislative strategies and tools. Such strategies and tools, intended for tabling at the World Health Assembly in 2008, will serve to enhance public health through the development of consistent and interoperable legislation-based standards and approaches.

Building on the success of Canada's first ever Canadian Conference on the Public's Health and the Law in 2006, the Agency will plan for a follow-up conference in 2008, and continue to support the activities of the pan-Canadian Public Health Law Improvement Network.

Supported by its Public Health Ethics Working Group, the Agency will continue to foster interprofessional and intersectoral linkages in public health ethics. It will collaborate with Health Canada, the Canadian Institutes of Health Research, provincial and local public health authorities, and academia in planning and organizing a national roundtable on public health ethics in 2007. This event will bring together specialists from public health and research disciplines to identify issues and opportunities related to supporting the development of a national framework for public health ethics, and the development of methodologies and tools that enable prompt consideration of ethics in public health interventions.

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