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Section II – Analysis of Program Activities

2.1 Strategic Outcome

The Agency has one Strategic Outcome: Healthier Canadians, reduced health disparities, and a stronger public health capacity. The following section describes the six program activities through which the Agency works to achieve the Strategic Outcome, and, for each, identifies the expected results, performance indicators and targets. This section also explains how the Agency plans on achieving the expected results and presents the financial and human resources that will be dedicated to each program activity.

2.1.1 Program Activity – Health Promotion

Program Activity Summary: In collaboration with partners, the Agency supports effective actions to promote health, build healthy communities and address the key determinants of health, by contributing to knowledge development, fostering collaboration, and improving information exchange among sectors and across jurisdictions.

Program Activity Expected Results
Canadians have increased awareness and knowledge of health and well being, the factors that influence these, and how they can play a role in improving and maintaining their health and that of their families and communities. Canada has expert knowledge of the conditions that lead to inequalities in health among Canadians and has the infrastructure (e.g., policies, practices) to reduce them.

Performance Indicator(s)	Target(s)
Knowledge, practice and policy documents produced and distributed to improve the health and well being of vulnerable groups (e.g., seniors, children, aboriginal peoples) and/or support and inform healthy public policy and practice	Establish baseline by March 31, 2010
External cross-government and cross-sectoral collaborations to address health and public health, common determinants of health and/or social well-being	Establish baseline by March 31, 2011
Canadians participating in health promotion programs, activities and initiatives	Establish baseline by March 31, 2011

Financial Resources ($ millions)				Human Resources (Full-time Equivalents)
2009-10	2010-11	2011-12		2009-10	2010-11	2011-12
194.5	191.3	191.5		567.0	561.3	562.5

The main change from 2009-2010 and 2010-2011 is the reduction in spending associated with the Aboriginal Head Start Urban and Northern Communities program to account for the sunsetting of incremental funding provided to the program in Budget 2005 ($4.9M).

Planning Highlights

In order to achieve the expected results, the Agency plans to undertake the following activities:

• Support the development of targeted, evidence-based health promotion strategies and interventions with a special focus on:
  • seniors who are vulnerable to health risks and disparities (e.g., the frail, older women, ethno cultural minority seniors, those living in rural and remote areas, cognitively impaired),
  • healthy living,
  • injury prevention, and
  • reduction of family violence;
• Continue to support targeted and evidence-based health promotion strategies and interventions for vulnerable children and families, including Aboriginal Canadians by promoting research into children’s health, community-based programs and support mechanisms for Aboriginal Children, as well as disease prevention and the promotion of children’s rights and well-being in Canada and internationally;
• Develop and implement enhanced national child health surveillance for congenital anomalies, developmental disabilities and disorders and product-related injuries according to the undertakings of the 2008 Health and Environment Initiative and Consumer Safety Action Plan;
• Focusing on the underlying contributing factors, continue leading the development of a portfolio plan of action to counteract overweight and obesity in Canada. It is intended to foster health, social, physical and economic environments that support the attainment of good health and well being and ultimately reduce the incidence of chronic disease and health care pressures in Canada;
• Develop a framework to better understand the factors that lead to health inequalities and what can be done to support Canadians with poorer health status; and
• Support engagement and collaboration with other federal departments, provinces and territories, other levels of government, non-government organizations, professional groups, and the private sector to better align investments and ensure coordinated action on reducing health disparities and improving the overall health of Canadians.

Benefits for Canadians

Health promotion is the process of enabling people to increase control over and improve their health. This process is based on understanding the important influences that determinants of health (such as gender, income, and literacy) have on an individual. Health promotion activities move beyond health education and changes in personal behaviours to address social change, institutional change and community change. So, for example, the Agency’s Health Promotion work will positively affect the health of children and adolescents through community-based mechanisms supporting vulnerable Canadian families and children, collaboration with domestic and international partners on disseminating relevant health promotion knowledge and research, and the sharing of best- and promising-practices to improve the health of Canadians and address health disparities in Canadian children and their families.

By enabling Canadians to improve their health, and Canadian governments and institutions to better address the factors that influence and determine health and health disparities, the work done in the Health Promotion program activity will support progress toward the Agency Strategic Outcome of “Healthier Canadians, reduced health disparities and a stronger public health capacity”.

2.1.2 Program Activity – Chronic Disease Prevention and Control

Program Activity Summary

Working in cooperation with regional, provincial/territorial, national and international governments and stakeholders (including non-governmental organizations), the program provides national population health assessment and surveillance in relation to chronic diseases. It also provides and supports leadership and expertise in the development and implementation of pan-Canadian chronic disease prevention, control and management strategies. This program is necessary because chronic diseases are among the most common, preventable and costly health problems facing Canadians.

Program Activity Expected Results
Canadians have access to science-based, authoritative and timely information and tools to support informed decision-making on preventing chronic diseases and decreasing health risks.

Performance Indicator(s)	Target(s)
Diseases tracked and reported	Establish baseline by March 31, 2010
Chronic diseases for which risk factors are established	Establish baseline by March 31, 2010
Interventions listed on Canadian Best Practices Portal	300listed by March 31, 2010

Financial Resources ($ millions)				Human Resources (Full-time Equivalents)
2009-10	2010-11	2011-12		2009-10	2010-11	2011-12
60.3	60.4	60.4		237.4	237.2	237.2

Planning Highlights

The Agency works with stakeholders at all levels to provide pan-Canadian and international leadership in chronic disease prevention and control through integrated policy and program development, surveillance, and knowledge development and dissemination. Key steps planned for 2009-10 include:

• To avoid duplication and ensure high standards and comparable data across the country, lay the foundation for a comprehensive national chronic disease surveillance system that supports the development of tools and methods/models for the prevention of the major chronic diseases facing Canadians (e.g., cardiovascular disease, cancer and respiratory illnesses);
• Make surveillance system information including Canadian Cancer Statistics, Report on Chronic Diseases in Canada, Hypertension Highlights, and Diabetes in Canada readily accessible and useful for increased knowledge about chronic disease and their risk factors in Canada;
• Foster innovation in developing and assessing models for chronic disease prevention at national, provincial, territorial and community levels;
• Contribute to the improvement of health in Canada through a coordinated approach to the prevention of major chronic diseases (i.e., diabetes, cancer, cardiovascular and respiratory);  and
• Advance chronic disease prevention internationally through multilateral (i.e., World Health Organization and Pan American Health Organization) and bilateral fora.

Benefits for Canadians

Through its Chronic Disease prevention and control work the Agency will provide public health practitioners with data, analysis, web tools and technical advice that support policies, programs and public health interventions for chronic disease prevention. Public health decision/policy-makers and practitioners will be better informed about what works in the area of chronic disease prevention policies and programs to reduce the burden of chronic disease in Canada.

2.1.3 Program Activity – Infectious Disease Prevention and Control

Program Activity Summary

The program promotes improved health for Canadians in the area of infectious diseases through public health actions including surveillance and epidemiology, risk management, public health policy development, and prevention, care and awareness programs. This program is necessary as infectious diseases require national attention and national efforts given their current and potential impact on the health of Canadians and the Canadian health care system, and also because new, existing, or re-emerging infectious diseases can pose a serious threat to the health and socio-economic wellbeing of Canadians.

Program Activity Expected Result
Reduced incidence of infectious diseases of public health importance in Canada. Improved response to infectious disease outbreaks in Canada both in the health care and community settings.

Performance Indicator(s)	Target(s)
Incidence of tuberculosis, viral hepatitis, sexually transmitted infections, West Nile Virus, and HIV among Canadians	Establish baseline by March 31, 2011
Agreements with provinces and territories on information management during outbreaks where there is a federal role	40% of provinces and territories have agreements for improved information sharing by March 31, 2011

Financial Resources ($ millions)				Human Resources (Full-time Equivalents)
2009-10	2010-11	2011-12		2009-10	2010-11	2011-12
261.3	214.9	193.2		831.9	830.7	822.9

The decrease from 2009-10 to 2010-11 is mainly due to the requirement to pay $49.7 million in 2009-2010 to the provinces under the Hepatitis C Health Care Services Program. This program has been providing funding to the provinces every five years as compensation for the care of individuals infected with Hepatitis C. The final payments will occur in 2014-2015.

The decrease from 2010-11 to 2011-12 is mainly due to a reduction resulting from the phased funding approach for the Canadian HIV Vaccine Initiative ($8.2M).

Planning Highlights

In order to achieve the expected results, the Agency plans to undertake prevention, care and awareness, surveillance, outbreak preparedness and response and science and innovation activities during 2009-10. Key planned steps include:

Prevention, Care and Awareness

• Examination of the National Immunization Strategy with a view of strengthening it; options for a Pan-Canadian approach to vaccine evaluation and research; and a report on the current state of vaccine supply and supply security in Canada and globally;
• Continue to lead federal programs to address HIV, sexually transmitted and blood borne infections (including viral hepatitis) and tuberculosis. The focus of this work is on effective prevention initiatives, education and awareness activities, diagnosis, care, equitable access to treatments, and support of those persons in Canada infected with, affected by or vulnerable to infectious diseases;
• Continue to contribute toward global efforts to accelerate the development of safe, effective, affordable and globally accessible vaccines.  Focus includes continued collaboration between the Government of Canada and the Bill & Melinda Gates Foundation on the Canadian HIV Vaccine Initiative; programmatic investment; ongoing collaboration with the Canadian Institutes for Health Research in the research; and development of a hepatitis C vaccine; and
• Expand the implementation of counselling and other social support services and health promotion activities that are key to reducing high-risk behaviours within Canada’s most vulnerable populations and marginalized communities.

Surveillance

• Strengthen the Agency’s infectious diseases surveillance systems, particularly those focused on blood, tissues and organs;
• Enhance surveillance of vaccine preventable diseases, vaccine safety, respiratory infectious diseases and emerging respiratory infectious diseases; and
• Augment HIV and risk behaviour surveillance and report on current surveillance data, research, current responses, emerging issues and gaps for at risk populations.

Outbreak Preparedness and Response

• Strengthen national pandemic preparedness and response capacity by:
  • continuously reviewing the pandemic antiviral drug management and supply strategy;
  • completing the pandemic antiviral drug management and supply strategy;
  • strengthening early detection of novel influenza viruses and monitoring of severe morbidity/mortality during a pandemic; and
  • enhancing the federal, provincial and territorial pandemic governance model
• Improve capacity for modelling, statistical analysis and operations research to better understand the spread and effect of epidemics or pandemics on Canadians; and
• Advance the Agency’s pandemic influenza risk communications strategy.

Science and Innovation

• Continue surveillance, research, risk assessment, interventions, policy advice and programs on pathogens arising from animals and the environment;
• Develop innovative approaches to prevent infectious and chronic diseases based on the analysis of human genetic risk;
• Develop cutting-edge methods to identify and evaluate the public health risk of emerging pathogens; and
• Work to establish a more holistic approach to preventing disease and for maintaining ecosystem integrity for the benefit of humans and animals.

Benefits for Canadians

As a result of the Agency’s work in this Program Activity, Canadians will contribute to reducing the risk of acquiring infectious diseases in Canada, and a reduced burden of infectious disease. In the event of an infectious disease outbreak, the Agency’s surveillance and preparedness activities will enhance Canada’s ability to respond rapidly and effectively, and so to reduce the impacts of the outbreaks.

2.1.4 Program Activity – Emergency Preparedness and Response

Program Activity Summary

The Agency is a national focal point for anticipating, preparing for, responding to and facilitating recovery from public health consequences of natural disasters or human caused emergencies. The program applies the legislative and regulatory provisions of the Quarantine Act and aligns with the Emergency Management Act.

Partnering with Health Canada, other federal departments, the provinces and territories, international organizations and the voluntary sector, the Agency provides leadership in addressing emerging threats through surveillance, risk analysis, and risk management; and implements preparedness priorities.

The program manages and supports the development of health-related emergency response plans, including support for the Canadian Pandemic Influenza Plan. It develops and sponsors emergency preparedness training, and coordinates counter-terrorism preparations for incidents involving hazardous substances. It provides surge capacity support to provinces and territories on emergency health and social services, including management of the National Emergency Stockpile System. It also manages an Emergency Operations Centre that enables central direction, control and coordination during emergencies through its video/telecommunications, data sharing and event management capability.

Program Activity Expected Result
Canada is prepared to respond to public health risks caused by natural and human-caused emergencies including infectious disease outbreaks, hurricanes, floods, earthquakes, Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies and to recover from the aftermath of these emergencies.

Performance Indicator(s)	Target(s)
Extent of Canada’s preparedness and response gaps highlighted during an incident or exercise	Establish baseline by March 31, 2011
Percentage of implementation of the International Health Regulations in Canada	Meet compliance obligation 100% by 2012

Financial Resources ($ millions)				Human Resources (Full-time Equivalents)
2009-10	2010-11	2011-12		2009-10	2010-11	2011-12
32.3	31.2	32.0		200.2	219.0	224.2

Planning Highlights

In order to achieve the expected result, the Agency plans to undertake the following:

• Expand the operation of the Health Portfolio Operations Centre to 24/7. The Centre gathers daily public health information, monitors for and assesses risks and provides situational reports to the Agency. It will integrate and manage the Agency’s and Health Canada’s response to public health events of national or international concern and serve as a communication access point for stakeholders and triage centre for the Agency;
• Further develop Health Portfolio and national emergency preparedness and response plans using an all hazards approach;
• Exercise emergency response plans including the Pandemic Influenza Plan;
• Develop a plan for and coordinate the implementation of the International Health Regulations (IHRs) to achieve compliance by 2012. As well, support the World Health Organization in the development of its IHR training program that will build member states ability to meet the core capacity requirements of the IHRs;
• Implement the Pan-Canadian Health Incident Management System, a system intended to facilitate planning and communication across jurisdictions during emergencies;
• Support federal/provincial/territorial Health Emergency Response Networks, including emergency social services and psychosocial preparedness;
• Develop and deliver training for health and social service professionals. Train Agency and provincial/territorial first responders on public health emergency response including Chemical, Biological and Radio Nuclear Emergency. Conduct emergency exercises as part of training and readiness;
• Develop an implementation plan for Health Emergency Response Teams;
• Renew the stockpile of critical medical supplies (e.g., vaccines) in the National Emergency Stockpile System;
• Contribute to the security of special national and international events, including the 2010 Vancouver Winter Olympics, by developing a laboratory response plan for the National Microbiology Laboratory to address potential bioterrorism/bio-warfare events and equipping its mobile laboratories with essential equipment for operations;
• Finalize the Quarantine Service Framework for Cooperation agreement with provinces, territories and local health authorities;
• Develop a policy framework and implementation plan for biosafety of human pathogens and toxins including new legislation about the domestic acquisition of pathogens; and
• Continue active participation in the Global Health Security Action Group to provide an international response capacity for emerging disease outbreaks.

Benefits for Canadians

These activities will contribute to strengthening Canada’s emergency preparedness and response capacity, reducing the potential harm and increasing recovery speed.

2.1.5  Program Activity – Strengthen Public Health Capacity

Program Activity Summary

Working with national and international partners, the Agency develops and provides tools, applications, practices, programs and understandings that support and develop the capabilities of front-line public health practitioners across Canada. The Agency facilitates and sustains networks with provinces, territories, and other partners and stakeholders to achieve public health objectives. The Agency’s work improves public health practice, increases cross-jurisdictional human resources capacity, contributes to effective knowledge and information systems, and supports a public health law and policy system that evolves in response to changes in public needs and expectations.

Program Activity Expected Result
Canada has the public health workforce, information, laws and ethical frameworks needed to meet Canada’s public health needs.

Performance Indicator(s)	Target(s)
Public health capacity index	Establish baseline by March 31, 2012

Financial Resources ($ millions)				Human Resources (Full-time Equivalents)
2009-10	2010-11	2011-12		2009-10	2010-11	2011-12
31.1	31.2	32.0		222	222	222

Planning Highlights

In 2009-10, the Agency will continue to strengthen Public Health capacity. In particular, the Agency will:

• Implement a competency-based Learning Framework for the Agency;
• Conduct a formal review of the Field Epidemiology Program;
• Complete full establishment of the Canadian Public Health Service Program; and
• Continue to support the Public Health Human Resource Task Group and to respond to their priorities.

As the Agency has a number of surveillance systems capturing important information on public health, an overall surveillance strategy will provide the basis for an integrated approach to the associated information, knowledge and action in the Agency, in turn supporting action at the provincial and territorial level. In 2009-10, the Agency will:

• Continue to implement the components of its surveillance strategy;
• Continue to develop privacy impact assessments of its surveillance systems and information holdings;
• Play a leadership role in the federal, provincial and territorial governance and sustainment of Panorama, an electronic health surveillance tool that, once deployed in federal, provincial and territorial jurisdictions will improve the collection and analysis of health information and assist in the coordination of responses to infectious disease outbreaks; and
• Integrate Panorama into the existing surveillance systems within the Agency.

Sharing information during public health emergencies is a critical factor to safeguard the health of Canadians. In 2009-10, the Agency will work on concluding and implementing bilateral and multilateral information sharing agreements with provinces and territories.

The Agency strives to develop new knowledge to facilitate its public health decision making.  In 2009-10, the Agency will:

• Continue to support the National Collaborating Centres in their efforts to identify requirements for, and gaps in, knowledge and research in a variety of public health areas; and
• Enhance its approach to managing research ethics considerations within the Agency.

The Agency’s Chief Public Health Officer will present to Parliament his annual report on the state of public health in Canada in the fall 2009.

Other plans that support public health capacity include:

• Continue developing tools for federal, provincial and territorial partners through the Canadian Network for Public Health Intelligence to facilitate the dissemination of strategic intelligence and coordination of public health responses;
• Strengthen management of science within the Agency by developing a science plan for the Agency and identifying a range of models to improve the delivery of science advice and science programming;
• Increase Canada’s capacity to control and prevent infectious diseases through the National Microbiology Laboratory’s training program for Canadian and international research scientists and public health professionals and by delivering an internship program for post-doctoral fellows and graduate and undergraduate students; and
• Support front-line public health practitioners through Public Health Network Expert Groups that include the Canadian Public Health Laboratory Network. It facilitates the development of standards, protocols, case definitions and policies and the Laboratory Liaison Technical Officer Program. This will create a pan-Canadian network of qualified laboratory personnel in host provincial public health laboratories to enhance pandemic influenza and outbreak preparedness and response.

Benefits for Canadians

The Agency works in partnership with stakeholders and other governments to address gaps in public health capacity, both within the Agency and in other jurisdictions. The Agency is helping to build a public health workforce that has the skills and knowledge necessary to meet Canada’s public health needs. This will enhance Canada’s ability to detect and take action on major health issues and respond to potential public health emergencies.

Effective and timely surveillance is critical to Canada’s ability to accurately track, plan for and respond to diseases. As it comes into being, an integrated national surveillance system will employ cutting-edge technology to provide timely and accurate information to policy-makers, clinicians and laboratories. Due to the Agency’s work in this area, public health workers will be able to more effectively undertake public health action because of improved management of information and increased access to key data elements.

2.1.6 Program Activity – Internal Services

Internal Services groups respond to the needs of programs and fulfil other corporate obligations. These groups are: Management and Oversight Services; Communications Services; Legal Services; Human Resources Management Services; Financial Management Services; Information Management Services; Information Technology Services; Real Property Services; Materiel Services; Acquisition Services; and Travel and Other Administrative Services. Internal Services financial and human resources relate to activities provided for the benefit of the entire Agency.  When services are provided to only one program the associated costs and FTEs are allocated directly to that program.

Financial Resources ($ millions)				Human Resources (Full-time Equivalents)
2009-10	2010-11	2011-12		2009-10	2010-11	2011-12
74.0	76.5	75.9		376.4	376.4	376.4

Planning Highlights

• The Agency launched its first Strategic Plan 2007-2012 in September 2007. The Agency monitors and assesses its progress on the Strategic Plan priorities, and will report results to its Executive Committee twice a year;
• In 2009-10, the Agency will strengthen corporate risk management. This work will inform senior officials on the prevailing departmental perspective on risks inherent to the Agency’s mandate and risk emerging from the changing operating environment, and how these risks are to be mitigated, managed and communicated;
• The Agency developed a Strategic Risk Communications Framework and Handbook that provides a process and guiding principles on how to understand the perceptions and responses associated with decisions that involve risk. The Agency will promote the use of the Framework and Handbook to enable program managers, communicators, and all decision-makers to better understand how to manage and communicate risk with stakeholders;
• The Agency has developed a Public Involvement Framework that outlines the concepts and theory of public involvement, and its role in the work of the Agency. This will guide the Agency as it develops capacity, expertise, and leadership in this area. In 2009-10, the Agency will finalize the Framework and focus on its dissemination and adoption, through training, awareness building and development a toolkit;
• The Agency’s Business Continuity Plan allows critical services or products to be delivered to clients regardless of any major disruption in normal activities (e.g., due to a disaster). The Agency will review over 300 processes to identify those that are mission critical, and will develop a comprehensive set of recovery plans to address those. The Agency is committed to having a solid BCP program that responds to all hazards;
• The Agency will continue to improve and streamline Human Resource Strategies, policies and practices. To support Public Service Renewal, the Agency will develop a learning strategy and continue to provide support for the Agency’s workplace well-being initiative; and
• The Agency will continue establishing all the components of its Management, Resources and Results Structure.

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