Performance Report Health Canada TES ESTIMA

Performance Report Health Canada TES ESTIMA
E S T I M AT E S
Health Canada
Performance Report
For the period ending
March 31, 2002
The Estimates Documents
Each year, the government prepares Estimates in support of its request to Parliament for
authority to spend public monies. This request is formalized through the tabling of
appropriation bills in Parliament.
The Estimates of the Government of Canada are structured in several parts. Beginning with an
overview of total government spending in Part I, the documents become increasingly more
specific. Part II outlines spending according to departments, agencies and programs and
contains the proposed wording of the conditions governing spending which Parliament will be
asked to approve.
The Report on Plans and Priorities provides additional detail on each department and its
programs primarily in terms of more strategically oriented planning and results information
with a focus on outcomes.
The Departmental Performance Report provides a focus on results-based accountability
by reporting on accomplishments achieved against the performance expectations and results
commitments as set out in the spring Report on Plans and Priorities.
The Estimates, along with the Minister of Finance’s Budget, reflect the government’s annual
budget planning and resource allocation priorities. In combination with the subsequent
reporting of financial results in the Public Accounts and of accomplishments achieved in
Departmental Performance Reports, this material helps Parliament hold the government to
account for the allocation and management of funds.
©Minister of Public Works and Government Services Canada — 2002
Available in Canada through your local bookseller or by mail from
Canadian Government Publishing — PWGSC
Ottawa, Canada K1A 0S9
Catalogue No. BT31-4/42-2002
ISBN 0-660-62114-2
Treasury Board of Canada Secretariat
Departmental Performance Reports 2002
Foreword
In the spring of 2000, the President of the Treasury Board tabled in Parliament the document
“Results for Canadians: A Management Framework for the Government of Canada”. This
document sets a clear agenda for improving and modernising management practices in federal
departments and agencies.
Four key management commitments form the basis for this vision of how the Government will
deliver their services and benefits to Canadians in the new millennium. In this vision,
departments and agencies recognise that they exist to serve Canadians and that a “citizen focus”
shapes all activities, programs and services. This vision commits the Government of Canada to
manage its business by the highest public service values. Responsible spending means spending
wisely on the things that matter to Canadians. And finally, this vision sets a clear focus on
results – the impact and effects of programs.
Departmental performance reports play a key role in the cycle of planning, monitoring,
evaluating, and reporting of results through ministers to Parliament and citizens. Departments
and agencies are encouraged to prepare their reports following certain principles. Based on these
principles, an effective report provides a coherent and balanced picture of performance that is
brief and to the point. It focuses on outcomes - benefits to Canadians and Canadian society - and
describes the contribution the organisation has made toward those outcomes. It sets the
department’s performance in context and discusses risks and challenges faced by the
organisation in delivering its commitments. The report also associates performance with earlier
commitments as well as achievements realised in partnership with other governmental and
non-governmental organisations. Supporting the need for responsible spending, it links resources
to results. Finally, the report is credible because it substantiates the performance information
with appropriate methodologies and relevant data.
In performance reports, departments and agencies strive to respond to the ongoing and evolving
information needs of parliamentarians and Canadians. The input of parliamentarians and other
readers can do much to improve these reports over time. The reader is encouraged to assess the
performance of the organisation according to the principles outlined above, and provide
comments to the department or agency that will help it in the next cycle of planning and
reporting.
This report is accessible electronically from the Treasury Board of Canada Secretariat Internet site:
http://www.tbs-sct.gc.ca/rma/dpr/dpre.asp
Comments or questions can be directed to:
Results-based Management Directorate
Treasury Board of Canada Secretariat
L’Esplanade Laurier
Ottawa, Ontario K1A OR5
OR to this Internet address: [email protected]
Health Canada
Departmental
Performance
Report
For the period ending
March 31, 2002
A. Anne McLellan
Minister of Health
READER FEEDBACK
Health Canada’s 2001-2002 Departmental Performance Report
We would like to hear from Canadians who read this report. Your comments
will help ensure that we provide relevant information that is easily
understood. Please send your completed questionnaire or comments to the
mail, e-mail address or fax number shown below.
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If no, what information were you looking for?
yes
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2) a) What parts of the document did you find most useful?
b) the least useful?
3) Would you recommend this report to others?
If no, why not?
4) Are there any other comments you would like to make regarding this
report?
Send your completed questionnaire or comments:
By mail:
Planning, Analysis and Reporting Division
Corporate Services Branch
0905D, Brooke Claxton Building
Tunney’s Pasture
Ottawa ON K1A 0K9
Thank you for your cooperation
By fax:
(613) 952-7328
By e-mail:
[email protected]
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Table of Contents
Section I: Minister’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Section II: Departmental Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
About Health Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Our Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Mission Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
In Concert with Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Flexibility for a Changing Environment . . . . . . . . . . . . . . . . . . . . . . . 17
Health Canada Organization, 2001-2002 . . . . . . . . . . . . . . . . . . . . . . . . . 18
Strategic Outcomes at Health Canada: Accountability
and Actual Spending, 2001-2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Section III: Departmental Performance by Strategic Outcome . . . 21
Chart of Strategic Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Access to Quality Health Care Services for Canadians . . . . . . . . . . . . . . 26
Improved Well-Being Through Health Promotion
and Illness Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Safer Health Products and Food for Canadians . . . . . . . . . . . . . . . . . . . . 39
Healthier Environments and Safer Products for Canadians . . . . . . . . . . 46
Sustainable Pest Management and Programs for Canadians . . . . . . . . . 52
Sustainable Health Services and Programs for First Nations
and Inuit Communities so Their People May Attain a Level
of Health Comparable with that of Other Canadians . . . . . . . . . . . . . 58
Better Health Outcomes through Information and Communication
Technologies and Evidence-Based Decision-Making . . . . . . . . . . . . . . 69
Effective Support for the Delivery of Health Canada’s Programs . . . . . . 76
Section IV: Reporting on Government Themes
and Management Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Modernizing Comptrollership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Sustainable Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Service Improvement Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Government On-Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Health System Performance Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Alternative Service Delivery - Foundations . . . . . . . . . . . . . . . . . . . . . . . 92
Section V: Financial Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Financial Performance Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Financial Summary Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Financial Table 1: Summary of Voted Appropriations Authorities
for 2001-2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Financial Table 2: Comparison of Total Planned Spending
to Actual Spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Financial Table 3: Historical Comparison of Total Planned Spending
to Actual Spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Financial Table 4: Crosswalk between Strategic Outcomes
and Business Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Financial Table 5: Revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Financial Table 6: Statutory Payments . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Financial Table 7: Transfer Payments . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Financial Table 8: Resource Requirements by Organization
and Business Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Financial Table 9: Details of Financial Information
by Business Lines and Service Lines . . . . . . . . . . . . . . . . . . . . . . . . . 104
Financial Table 10: Contingent Liabilities . . . . . . . . . . . . . . . . . . . . . . . 109
Section VI: Other Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Departmental Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Appendices
Appendix A: Measuring Health in Canada - more results relating to the
Health Status of Canadians . . . . . . . . . . . . . . . . . . . . . . . . 118
Appendix B: Executive Summary: Response to the Public Accounts
Committee - First Nations Health: Follow-Up . . . . . . . . . 136
Appendix C: Executive Summary: Response to the Public Accounts
Committee - Human Resources . . . . . . . . . . . . . . . . . . . . . 141
The following electronic Annexes are available on the Health Canada
Website at http://www.hc-sc.gc.ca/english/care/estimates/index.htm.
Annex A:
Regulatory Initiatives and Statutes and Regulations.
Annex B:
Details on Transfer Payments, 2001-2002 Actual Spending.
Annex C:
Health Canada’s 2000 Sustainable Development Strategy:
Sustaining Our Health.
Annex D:
Response to the Public Accounts Committee - First Nations
Health: Follow-Up.
Section I:
Minister’s Message
I am pleased to
present Health
Canada’s 2001-2002
Departmental Performance Report.
Health Canada
promotes and protects the health of
Canadians
in
many ways. The
Department provides leadership in
establishing, monitoring and enforcing
national criteria in the delivery of
health care under the Canada Health
Act. Health Canada helps to prevent
and reduce risks to health and the
environment by ensuring the safety of
health products, food, workplaces, and
many consumer products and by
protecting Canadians against current
and emerging risks to health. Health
Canada also makes valuable contributions to global health, and is committed
to supporting health research and the
development of health information.
By providing information and advocating healthy lifestyle choices, Health
Canada helps Canadians to make
informed decisions about their health
and the health of their families.
Working in partnership on issues such
as healthy living, reduction of tobacco
use, helping Canadians to identify
health risk factors, as well as our focus
Minister’s Message
on health priorities such as diabetes,
fetal alcohol syndrome and HIV/AIDS,
we are helping Canadians to lead
healthier lives.
Improving the health of First
Nations and Inuit and reducing health
inequalities between them and other
Canadians are priorities for Health
Canada. Consistent with overall government commitments, we are moving
on these priorities through a renewed
relationship with First Nations and
Inuit. Health Canada, along with First
Nations and Inuit, has developed and
implemented long-term strategies and
activities that are encouraging community responsibility for the design,
delivery and management of health
programs and services. These efforts
build on improvements in First
Nations and Inuit health status.
In addition to the Department’s
ongoing responsibilities, 2001-2002
included key steps forward in important areas.
Working collaboratively with the
provinces and territories, significant
progress has been made in implementing the commitments of the September
2000 First Ministers Meeting and the
Social Union Framework Agreement to
improve reporting and measuring
performance. As a result, for the first
time in this country’s history, in
11
September 2002 all jurisdictions will
begin to report on indicators of health
outcomes, health status and quality of
services. The reports will provide
consistent and comparable information to Canadians, including health
policy and program decision-makers.
Working with our provincial and
territorial colleagues, we developed a
dispute avoidance and resolution process that will help to avoid disagreements over interpretations of the
Canada Health Act, and resolve those
that occur. The process is based on
collaboration, negotiation and the
advice of third-party panels, where
needed, while respecting and maintaining federal authority to interpret and
enforce the Canada Health Act.
On behalf of the Government of
Canada, I introduced a proposed new
Pest Control Products Act in Parliament. The new Act seeks to protect the
health of Canadians, especially children, and the environment from risks
posed by pesticides, while helping to
ensure a safe and abundant food
supply. It sets out a stronger and
modernized process for pesticide regulation and makes the registration
system more transparent.
I also introduced comprehensive
legislation in Parliament to protect the
health, safety and privacy of those
Canadians who turn to assisted human
reproduction (AHR), and their children. This legislation addresses some
very complex and important issues.
Canadians have made it clear that they
want safe AHR procedures and the
benefit of important medical discoveries, but not at any cost. This proposed
Act clarifies what we, as a society, find
acceptable.
12
As we work to renew our health care
system and ensure that Canadians
have access to high-quality health care,
the Government of Canada is looking
forward to the Final Report of the
Commission on the Future of Health
Care in Canada, chaired by the former
Premier of Saskatchewan, Roy
Romanow.
At times, events occur that demonstrate the fundamental importance of
the services and programs we provide.
The tragedy of September 11, 2001 was
one of these. Health Canada employees
from across Canada responded to the
challenge, notably by providing materiel
and support to local authorities to
accommodate more than 10,000
stranded travellers in the Atlantic
provinces. Our experience during that
challenging and uncertain time has
allowed us to strengthen and improve
our capacity to prepare for emergencies
of all kinds that may occur in the
future.
In these and many other ways, this
Departmental Performance Report
confirms Health Canada’s commitment to maintaining and improving
the health of Canadians. It demonstrates our determination to identify
emerging needs and initiate responses
and partnerships that help to meet
them.
A. Anne McLellan
Minister of Health
Health Canada
Section II:
Departmental Overview
Departmental Overview
13
Our Mission
To help the people of
Canada maintain and
improve their health.
About Health
Canada
Our Vision
Good health is a fundamental goal
of all Canadians. Canada benefits
socially and economically when everyone enjoys the best possible health. In
order to meet that goal, the Government of Canada has given Health
Canada and the Minister a broad
mandate. Working with its partners,
Health Canada provides Canadians
with leadership in the following areas:
• Access to quality health
services for Canadians;
Mission Statement
To help the people of Canada
maintain and improve their health.
care
• Improved well-being through health
promotion and illness prevention;
• Safer health products and food;
• Healthier environments and safer
products for Canadians;
• Sustainable pest management and
programs;
• Sustainable health services and
programs for First Nations and
Inuit communities so their people
may attain a level of health
comparable with that of other
Canadians; and
• Better health outcomes through
information and communications
technologies and evidence-based
decision making.
The Department’s formal mandate
is spelled out in the Department of
Health Act while the Minister of Health
is responsible for the direct administration of another 18 laws. Through policy
development and the delivery of
specific programs and services, Health
Canada touches the lives of all
Canadians.
Departmental Overview
Health Canada is committed to
improving the lives of all of Canada’s
people and to making this country’s
population among the healthiest in the
world as measured by longevity,
lifestyle and effective use of the public
health care system.
Objectives
Health Canada works with many
partners to fulfil its mission. This
objective is met in many different ways,
by:
• Preventing and reducing risks to
individual health and the overall
environment;
• Promoting healthier lifestyles;
• Ensuring high quality health services that are efficient and accessible;
• Integrating renewal of the health
care system with longer term plans
in the areas of prevention, health
promotion and protection;
• Reducing health inequalities in
Canadian society;
• Providing health information to
help Canadians make informed
decision.
Health Canada seeks to ensure
Canadians enjoy the best possible
health outcomes. This is a challenge
given the ever expanding and complex
range of needs, demands and available
interventions. Through a network of
15
regional offices and its numerous
partnerships, the Department helps to
maintain effective and sustainable
systems for health that allow the
greatest number of Canadians to enjoy
good health throughout their lives. The
Department strives to reduce inequalities in health status, particularly
among children, youth, the elderly, and
First Nations people and Inuit.
The circumstances and behaviours
of Canadians vary. So, in order to
successfully achieve the objectives,
Health Canada strives to improve
community capacity to deal with health
issues while assisting Canadians in
making informed choices about their
health. It is through research, surveillance, and information sharing that
Health Canada works to inform the
development of policies by others who
support health.
Along with its partners, Health
Canada takes a comprehensive view of
health, arrives at priorities through
careful studies including science and
research and evidence-based decisions,
and decides how those decisions can
best be put into practice. The results
are effective policies, regulations and
programs that help anticipate and
meet future needs and challenges to
the health of Canadians.
Roles
Health Canada plays many roles in
order to achieve its objectives. Overall,
the Department leads and partners
with others in both health protection
and promotion.
Leader/Partner - Health Canada
is the national leader on health matters
with responsibility for administering
16
the Canada Health Act, the cornerstone of Medicare in Canada. The
Department develops policies to help
the health care system adapt to
evolving realities, identifies and addresses the determinants of health,
and seeks to contribute to the
government’s innovation agenda.
Funder - The federal government
is a major contributor to health care
funding through the Canada Health
and Social Transfer (CHST). There are
additional
improvements
and
modernizations realized through other
programs. Health Canada transfers
funds to First Nations and Inuit
organizations to help them provide
community health services. In addition, grants and contributions to
various organizations reinforce the
Department’s health objectives.
Guardian/Regulator - The Department protects the health of
Canadians by managing product related risks and providing information
to enable Canadians to make informed
decisions about health products available to them. Health Canada strives to
minimize health risk factors to Canadians and maximize the safety of health
products and food. The regulatory
system covers pesticides, toxic substances, pharmaceuticals, biologics,
medical devices, cosmetics, consumer
products, chemicals and natural health
products. The Department delivers a
range of programs and services in
environmental health and protection.
Other responsibilities include the
areas of substance abuse, tobacco
policy, workplace health and the safety
of consumer products. The Department monitors and tracks diseases and
takes action, where required.
Health Canada
Service Provider - Health Canada
provides supplementary health benefits to 700,000 First Nations people
and Inuit. Services available to these
communities include prevention, promotion, primary care, and addiction
services. In addition, the Department
provides occupational health and safety
services to all federal employees and in
all federal facilities
and territories, First Nations and Inuit
communities, professional associations,
consumer groups, universities and
research institutes, international organizations, volunteers, and other
federal departments and agencies.
Information Provider - Health
Canada’s high-quality science and
research supports the development of
new policies, regulations, services,
information and management that are
essential elements in maintaining
Canada’s world-class health care system. Through research and surveillance, the Department supplies
information that Canadians can use to
maintain and improve their health. It
also supports research across Canada
to expand the scientific and technical
knowledge base. As a key national
provider of health information, the
Department emphasizes both positive
health activities and illness prevention
measures.
Health Canada is keenly aware of
the forces that shape public health,
with a number of factors constantly
changing the environment:
In Concert with Others
Health Canada works with the
people of Canada through consultation
and public involvement. This includes
working with our partners: provinces
Departmental Overview
Flexibility for a
Changing Environment
• increased public preoccupation with
health matters and the accompanying demands for quick access to
services and information;
• shifting demographic patterns that
put pressure on health care services;
• rapid scientific advances that create
both health benefits and pressures;
• growing world migration, travel,
and business patterns that create
additional health challenges, and;
• a need for transparency in decision
making and accountability.
In the face of this constant
evolution, Health Canada remains
flexible in its operations, its allocation
of limited resources, and its response to
these forces.
17
Minister
Deputy Minister
Associate Deputy Minister
Pest
Management
Regulatory
Agency
Office
of the
Chief
Scientist
Audit
and
Accountability
Bureau
Corporate
Services
Branches
Health
Policy
and
Communications
Population
and
Public Health
Health
Products
and
Food
Healthy
Environments
and
Consumer
Safety
First Nations
and
Inuit Health
Information,
Analysis
and
Connectivity
Alberta
and
Northwest
Territories
Manitoba
and
Saskatchewan
Ontario
and
Nunavut
Quebec
Atlantic
Regions
Health Canada
British
Columbia
and
Yukon
Health Canada Organization, 2001-2002
18
Health Canada Organization, 2001-2002
Strategic Outcomes at Health Canada:
Accountability
and Actual
Spending,
2001-2002
Strategic
Outcomes
at Health
Canada:
Accountability
andAccountability
Actual Spending,
2001-2002
Strategic Outcomes
Actual
2001-2002
(under the Deputy Minister
$ million
and the Associate Deputy
Minister)
Full-Time
Equivalents
Access to quality health care
services for Canadians
Assistant Deputy Minister
(ADM), Health Policy and
Communications Branch
FTEs:
$107.1
375
Improved well-being through
health promotion and illness
prevention
ADM, Population and Public
Health Branch
FTEs:
$395.3
1,071
Safer health products and food for
Canadians
ADM, Health Products and
Food Branch
FTEs:
$128.2
1,472
Healthier environments and safer
products for Canadians
ADM, Healthy Environments
and Consumer Safety Branch
FTEs:
$194.5
1,076
Sustainable pest management and
programs for Canadians
Executive Director, Pest
Management Regulatory
Agency
FTEs:
$25.0
332
Sustainable health services and
programs for First Nations and
Inuit communities so their people
may attain a level of health
comparable with that of other
Canadians
ADM, First Nations and Inuit
Health Branch
FTEs:
$1,339.1
1,555
Better health outcomes through
information and communication
technologies and evidence-based
decision-making
ADM, Information, Analysis
and Connectivity Branch
FTEs:
$281.3
690
Effective support for the delivery of
Health Canada’s programs
ADM, Corporate Services
Branch
Regional Directors General
Executive Director General,
Audit and Accountability
Bureau
Chief Scientist
Executive Offices
FTEs:
$208.6
1,392
Total
Departmental Overview
$2,679.1
FTEs: 7,963
19
20
Health Canada
Section III:
Departmental
Performance by
Strategic Outcome
This section of the Report highlights the Department’s milestone
accomplishments in achieving our
Strategic Outcomes. As outcomes may
take many years to be realized, where
possible we have identified activities
and outputs and attempted to link
them to the final outcomes.
The Strategic Outcomes are based
on Business/Service Line objectives
and are aligned with our approved
Planning, Reporting and Accountability Structure. A crosswalk between the
Strategic Outcomes and the Department’s Business/Service Lines can be
found in Section V - Table 4 of the
Financial Tables.
This year, we have incorporated as
Appendix A: Measuring Health in
Canada - more results relating to the
Health Status of Canadians (see page
118). This Appendix provides information on the health status and health
determinants of Canadians and highlights health outcomes as they relate to
Health Canada.
More information on the Department and its activities can be found on
our website at http://www.hc-sc.gc.ca.
Departmental Performance by Strategic Outcome
21
Chart of Strategic Outcomes
This table of Strategic Outcomes reflects continuing efforts to articulate
Health Canada’s performance expectations and measurement techniques.
Chart of Strategic Outcomes
Strategic Outcomes*
Performance Expectations**
Access to quality health
care services for
Canadians
Publicly-funded hospital and physician
services consistent with the principles of the
Canada Health Act (CHA).
Initiatives and approaches that strengthen
the Canadian health care system.
Partnerships among federal, provincial and
territorial governments, key stakeholders,
Canadians and international organizations.
International initiatives which support
departmental priorities.
Improved well-being
through health
promotion and illness
prevention
Public knowledge about the determinants of
health and actions to take to maintain and
improve health; access to tools to improve
health; and enhanced community capacity
to deal with individual and collective health
issues.
Foster collaborations that help Canadians
maintain and improve their health.
Preventative initiatives and practices that
have enabled the reduction of illness,
disability, injury and/or death.
Improved surveillance capacity, emergency
preparedness and response strategies.
* Strategic Outcomes are based on Business/Service Line objectives.
** Performance Expectations were identified as Sub-Key Results Commitments in the 2001-2002 RPP.
22
Health Canada
Chart of Strategic Outcomes (continued)
Strategic Outcomes*
Performance Expectations**
Safer health products
and food for Canadians
Protection of Canadians against risk factors
related to health products and food.
Integrated management of health
determinants and risks to health associated
with health products and food.
Canadians better informed to make
decisions about their health through
promotion of health behaviours and
provision of information and tools.
Healthier environments
and safer products for
Canadians
Reduced risks to health and safety, and
improved protection against harm
associated with workplace and
environmental hazards, consumer products
(including cosmetics), radiation emitting
devices, new chemical substances and
products of biotechnology.
Reduced health and safety risks associated
with tobacco consumption and the abuse of
drugs, alcohol, and other substances.
Sustainable pest
management and
programs for Canadians
Safe and effective pest control products.
Compliance with the Pest Control Products
Act and Regulations.
Sustainable pest management practices that
reduce reliance on the use of pesticides.
* Strategic Outcomes are based on Business/Service Line objectives.
** Performance Expectations were identified as Sub-Key Results Commitments in the 2001-2002 RPP.
Departmental Performance by Strategic Outcome
23
Chart of Strategic Outcomes (continued)
Strategic Outcomes*
Performance Expectations**
Sustainable health
services and programs
for First Nations and
Inuit communities so
their people may attain
a level of health
comparable with that of
other Canadians
Improvements in First Nations and Inuit
peoples’ health and a reduction in health
inequalities between them and other
Canadians.
A First Nations and Inuit population that is
informed and aware of the factors that
affect health and what actions can be taken
to improve health.
Effective health care services available and
accessible to First Nations and Inuit people
that are integrated with provinces’ and
territories’ health services.
Improved management and accountability
in partnership with First Nations and Inuit
for health care services and the NonInsured Health Benefits Program.
Better health outcomes
through information
and communication
technologies and
evidence-based
decision-making
A well-functioning national health
information infrastructure which respects
privacy but shares information in support of
decision-making and public accountability.
Evidence-based (both data and analysis)
health policy decision-making including a
better understanding of the fundamental
issues relating to health care.
Accountability for, and effectiveness of,
Health Canada’s programs, policies and
functions.
* Strategic Outcomes are based on Business/Service Line objectives.
** Performance Expectations were identified as Sub-Key Results Commitments in the 2001-2002 RPP.
24
Health Canada
Chart of Strategic Outcomes (continued)
Strategic Outcomes*
Performance Expectations**
Effective support for
the delivery of Health
Canada’s programs
Continuous improvement in the provision of
timely and quality corporate administrative
services and in the promotion of sound
management practices, including modern
comptrollership.
Integrated health research and continual
improvements in bringing that research
into decision-making.
* Strategic Outcomes are based on Business/Service Line objectives.
** Performance Expectations were identified as Sub-Key Results Commitments in the 2001-2002 RPP.
Departmental Performance by Strategic Outcome
25
Access to Quality
Health Care
Services for
Canadians
Health Care Policy
implement this vision, we have defined
four key performance expectations:
Health Canada’s overarching vision
for health care is to ensure the longterm sustainability of our system,
which provides Canadians with comparable access to quality services based
on their health needs, regardless of
where they live or work. To help
• Publicly-funded hospital and physician services consistent with the
principles of the Canada Health Act
(CHA).
26
• Initiatives and approaches that
strengthen the Canadian health
care system.
Objective
Description
To provide a leadership role in
collaboration with provinces/territories, health professionals, administrators and other key
stakeholders, focussed on developing a shared vision for Canada’s
health system and identifying key
priorities and implementation approaches to achieve needed
changes that will improve the
timeliness of access, and the
quality and integration of health
services (including primary, acute,
home, community and long-term
care) to better meet the health
needs of Canadians wherever they
live or whatever their financial
circumstances.
Health Care Policy supports policy
development, analysis and communications related to leadership
in all areas of Canada’s health
system, with emphasis on ensuring the viability and accessibility of
Medicare; and collaborative efforts, with provinces/territories,
and other stakeholders, to
strengthen, modernise and sustain
Canada’s health system.
Actual Spending 2001-2002
(millions of dollars)
Gross
Revenues
Net
$107.1
N/A
$107.1
Health Canada
• Partnerships among federal, provincial and territorial governments,
key stakeholders, Canadians and
international organizations.
• International initiatives which support departmental priorities.
During this past year, our Department had three major priorities toward
this objective:
• Modernization of our health care
system.
• Uphold the Canada Health Act and
work with the provinces and
territories to ensure that all
governments fulfill their commitment to the principles of Medicare.
• Improve knowledge base on health
care system issues to support
evidence-based decision-making.
Health Care Expenditures as Percentage of
GDP, International Comparison, 2000
UK
7.3
Japan
7.8
Italy
8.1
Canada
9.1
France
9.5
10.6
Germany
USA
13
0
2
4
6
8
10
12
14
Percentage of national GDP
Source: Organization for Economic Co-Operation and Development
Modernization of our
health care system
On April 4, 2001, the Prime
Minister and the federal Minister of
Health announced the creation of the
Commission on the Future of Health
Care in Canada. The Commission has
been asked to recommend policies and
measures to ensure, over the long-
term, the sustainability of a universally
accessible health care system which
offers quality services to Canadians.
The Commission’s final report is
expected in November 2002.
The work of the Commission builds
on the common vision for health care
that was reached in September 2000 by
First Ministers when all jurisdictions
agreed to work together to address key
priorities to renew Canada’s health
care system. It is from this basis that
Health Canada has engaged in much
collaborative federal, provincial and
territorial work during the 2001-2002
fiscal year to implement commitments
made by First Ministers. Here are a few
examples of progress made to date in
implementing the vision.
Better Management of
Pharmaceuticals
Because increasing drug costs are a
shared concern, we worked with
provinces and territories to improve
the management of pharmaceuticals,
including the development of a single,
common drug review process to assess
drugs for potential inclusion in government drug plans. As part of this, an
interim shared drug review process
was implemented in March 2002 and a
National Prescription Drug Utilization
Information System was developed
that will provide accurate information
on prescription drug use and sources of
cost increases.
Improving Accountability for
Health System Performance
We helped design, in collaboration
with provinces and territories, a
reporting framework that will provide
consistent and comparable information across jurisdictions to Canadians
Departmental Performance by Strategic Outcome
27
and decision-makers. This framework
addresses health status, health outcomes and quality of services.
Addressing Health Human
Resources Issues
We were active in work to address
growing concerns over human resources issues facing various health
professions. As a result, a three year
study began to assess physician human
resources issues. Similarly, we have
been helping to implement the Nursing
Strategy for Canada. These are both
expected to help ensure that Canada
has the health professionals needed for
an effective health care system.
Health Canada is also playing a
leadership role in encouraging key
stakeholders to support easier integration of foreign trained physicians into
the health care system.
Accelerating Primary Health
Care Reform
The Government of Canada has
committed $800 million over four years
to accelerate and broaden health care
reform initiatives focused on the first
point-of-service for Canadians. During
the year, the provincial/territorial
guidelines for this Primary Health
Care Transition Fund, which we
administer, were completed and the
provinces and territories began to
submit proposals for funding.
28
Uphold the Canada
Health Act and work
with the provinces and
territories to ensure that
all governments fulfill
their commitment to the
principles of Medicare
Health Canada continues its efforts
to ensure that all eligible residents of
Canada have reasonable access to
medically necessary hospital and physician services on uniform terms and
conditions. We are responsible for
ongoing work related to administration of the Canada Health Act (CHA),
including the analysis and resolution of
compliance issues with provinces and
territories.
To make this process work as
collaboratively as possible, the federal
Minister of Health gained the agreement of the provinces and territories
(with the exception of Quebec) on a
new CHA dispute avoidance and
resolution process. This will help
address issues related to differences in
interpretation of the Act.
Increased use of private payment
options for high-technology diagnostic
services such as Magnetic Resonance
Imaging (MRI) and Computed Tomography (CT) are creating accessibility
and availability concerns. Ongoing
collaboration with the provinces and
territories on this priority issue has
helped strengthen the ability of
jurisdictions to deliver these services in
a fiscally and socially responsible
manner, and in a manner that is
consistent with Canadians’ values and
expectations of appropriate and timely
Health Canada
access to publicly-funded health care
services.
Improve knowledge base
on health care system
issues to support
evidence-based decisionmaking
Health Canada participates in
various analytical initiatives and
projects to track, understand and
provide evidence-based policy advice
on current and emerging issues that
relate to health care. Our Department
also continues to generate and disseminate evidence on new approaches to
health care delivery. Here are a few
examples of how Health Canada
supports evidence-based decision-making in health care policy:
• For a health professional, promoting self-care is an effective way of
helping patients participate in
decisions about their own and their
communities’ health. To support
health professionals in their efforts
to promote self-care, Health Canada
has funded and worked in collaboration with national health organizations to implement the program
Supporting Self-Care: A Shared
Initiative. The collaborative report
of this initiative was published by
the Canadian Nurses Association in
the spring of 2002. We also
developed a network for the purpose of facilitating information
sharing, support and connections
among health professionals and
interested users. The components
of this network include an electronic directory, a discussion mail-
Departmental Performance by Strategic Outcome
ing list, a quarterly newsletter and a
website.
• Health Canada undertook various
studies in collaboration with nursing associations, provinces and
territories to better understand the
challenges facing the nursing profession and the related impacts on
the quality of services received by
patients. A compelling body of
evidence is suggesting that more
nurses, and more satisfied nurses,
are associated with healthier and
more satisfied patients.
• From 1997 to 2001, our Department’s $150 million Health Transition Fund (HTF) supported projects
across Canada to test and evaluate
innovative ways to deliver health
care services. A total of 138 projects
have been successfully completed
and several have paved the way to
effective improvements in service
delivery. Syntheses of the projects
were prepared across 10 themes.
The HTF’s national dissemination
strategy included support to individual projects to disseminate
results to target audiences and five
regional workshops in the spring
of 2001. For more information,
http://www.hc-sc.gc.ca/
consult:
htf-fass/english/.
• As part of its ongoing departmental
business activities, Health Canada
facilitated increased capacity of
women’s organizations and local,
provincial and national stakeholders
in support of the holistic and
disease-specific approach to women’s health. Through the Women’s
Health Contribution Program, our
Department supported a National
Think Tank on Gender and Unpaid
Caregiving, informing gender im29
plications of home and community
care. In addition, several projects
were undertaken through the
Centers of Excellence for Women’s
Health and the Canadian Women’s
Health Network, including research and consultation resulting
in new regional guidelines for
mental health service intake of
women who are victims of domestic
abuse and the establishment of a
new Aboriginal Women’s Health
Network.
30
• In November 2001, Health Canada
hosted a major Organization for
Economic Cooperation and Development (OECD) conference, which
was attended by 450 participants
from 30 countries. The conference
offered participants the chance to
learn about best practices in health
system performance measurement
and to share experiences about how
citizens, providers, governments
and managers can best use performance measures to improve health
systems within the OECD.
Health Canada
Improved WellBeing Through
Health Promotion
and Illness
Prevention
Population and Public
Health
Healthy, active, engaged citizens
build strong, vibrant communities. The
Government of Canada recognizes the
importance of helping Canadians maintain and improve their health through
the many health promotion and illness
prevention activities accomplished under Health Canada’s leadership.
Objective
Promote health, and prevent and
control injury and disease.
Description
Population and Public Health
includes responsibility for policies,
programs and research relating to
disease surveillance, prevention
and control, health promotion, and
community action.
Actual Spending 2001-2002
(millions of dollars)
Gross
Revenues
Net
$395.4
$(0.1)
$395.3
The Department seeks to understand what makes people healthy or
sick and, based on this knowledge,
develops interventions that improve
the health status of individuals,
particular groups and the population as
a whole. Through our research and our
interventions, we know that five
factors influence health: genetic, biophysical, socio-economic and behavioural, in addition to the quality and
accessibility of the health care system.
The Department achieves its health
promotion and protection objectives
through leadership and partnerships in
health promotion, protection and
illness prevention and control, by
creating and disseminating knowledge
based on sound science, research and
surveillance data and by funding
community health projects. Through
our work with provinces and territories, we also translate our public health
knowledge into practices and actions
aimed at safeguarding the health of
Canadians.
To achieve its objectives, the
Department defined four key performance expectations for 2001-2002:
Departmental Performance by Strategic Outcome
31
• Public knowledge about the determinants of health and actions to
take to maintain and improve
health; access to tools to improve
their health; and enhanced community capacity to deal with individual
and collective health issues.
• Foster collaborations that help
Canadians maintain and improve
their health.
• Preventative initiatives and practices that have enabled a reduction
of illness, disability, injury and/or
death.
• Improved health surveillance, emergency preparedness and response
strategies.
The health policies of the federal
government recognize that an overall
health strategy builds on both a quality
and accessible health care system and
interventions that address the factors
that help determine the health of
Canadians. During this past year, our
Department had four major priorities
toward this objective:
• Protect Canadians against the
health implications of disasters.
• Promote healthy living.
• Prevent illness.
• Protect the health of Canadians
through surveillance and laboratory research.
Protect Canadians
against the health
implications of disasters
Protecting Canadians from the
health hazards of natural and manmade disasters is a key responsibility of
the Department. This capacity was
32
tested to its fullest on September 11,
2001 when we immediately mobilized
to provide public health assistance,
most notably, to more than 47,000
people whose flights to the United
States were diverted to Canada and to
other stranded passengers. And in the
weeks following the discovery, in the
United States, of letters contaminated
with anthrax, Health Canada collected
and analyzed hundreds of suspicious
packages.
In the months since, contingency
plans have been renewed and will
continue to be revitalized to adapt to
rapid changes in the public health
security environment.
As part of the overall government
response to the new security situation,
$7.94 million was allocated to the
National Emergency Stockpile System
to expand Canada’s existing pharmaceuticals stockpile to treat victims of
infectious disease outbreaks, chemical
attacks and exposure to chemical
agents. This complements the stockpile of supplies available to treat
trauma-related injuries.
We also accelerated staffing, budgetary and business planning activities
within our Centre for Emergency
Response and Preparedness to ensure
that the necessary resources would be
in place to operate effectively in this
new environment. Consistent with
these investments, we introduced a
mobile first-response laboratory which
can be quickly deployed in the field.
Because it is a Level 4 laboratory, it has
the capacity and security to deal with
possible cases involving the world’s
most dangerous chemical and biologic
agents.
Health Canada
Promote healthy living
Fetal Alcohol Syndrome/Fetal
Alcohol Effects
Encouraging Healthier Children
(FAS/FAE) is 100% preventable.
Significant health and social services costs are saved every time a
FAS birth is prevented through the
work of community-based programming funded by Health
Canada. Through regional initiatives, we are supplementing CAPC
and CPNP projects to incorporate
FAS/FAE components. For example, through telehealth distance
learning technology, 180 front line
community-based workers in Manitoba and Saskatchewan were
provided with skill development
training to assist in early detection
and appropriate intervention with
pregnant women who may be at
risk. For more information on FAS/
FAE, please consult: http://www.hcsc.gc.ca/hppb/childhood-youth/
cyfh/fas/.
Early childhood development is
critical to the health of our communities. For example, through investments of $59.5 million in the
Community Action Program for Children (CAPC) and $30.8 million in the
Canada Prenatal Nutrition Program
(CPNP), mothers’, children and families’ well-being are enhanced through
the transfer of good parenting skills,
early childhood intervention and community programs.
Evaluations of the benefits of CAPC
and CPNP programs demonstrate that
these programs are successful in
reaching people living in disadvantaged conditions. Regional CAPC
evaluation findings indicate that parents involved in caregiver and childfocused programs report improvements
in their children’s social behaviour.
Data collected from CPNP participants
between 1996 and 2001 reveals a low
birth weight rate of 6.9 percent. While
higher than the national rate of 5.9
percent, it is lower than rates for
similar at-risk populations (8.7 to 20
percent). Breast-feeding initiation rates
among CPNP participants were 78.5
percent, exceeding the national rate of
76.7 percent.
In partnership with the provinces
and territories, the Department is
developing a shared reporting framework for Early Childhood Development
expenditures and activities, and identifying common child health and wellbeing indicators, such as immunization
and healthy birth weight as a gauge of
physical health. Starting in September
2002, the information generated by
these tools will help inform program
and policy decisions across all levels of
governments.
Further guidance for policies and
programs regarding children is being
developed by the five Centres of
Excellence for Children’s Well-Being.
Through a five year, $20 million
commitment from the Government of
Canada, the Centres are creating and
disseminating knowledge concerning
child welfare, communities, early
childhood development, special needs,
and youth engagement issues.
We have learned from our experiences with campaigns promoting
healthy living practices. For example,
we encourage women of childbearing
age to take folic acid supplementation
to prevent spina bifida and other
Departmental Performance by Strategic Outcome
33
development. In 2000-2001, an average
of 40 percent of females and 33 percent
of males aged 12-24 indicated they lead
inactive lifestyles.
Physical Inactivity, by Age and Sex,
Canada, 2000/01
70
60
Percentage
neural tube defects in their children.
Because of the low impact of previous
campaigns that targeted health professionals, we shifted to directing the
information at women of childbearing
age. In this manner, women take an
active role in speaking to their health
professionals about folic acid supplementation. For more information on
this campaign, consult: http://www.hcsc.gc.ca/english/folicacid/index.html.
Males
Females
50
40
30
20
10
0
12-14
Promote Healthy Aging
A November 2001 workshop on
Healthy Aging provided experts
and stakeholder groups with an
opportunity to highlight strategic
directions for Health Canada
regarding key issues contributing
to healthy aging. Four issues
papers were developed: (1) physical activity and elders; (2) tobacco
use and smoking cessation among
seniors; (3) nutrition and healthy
aging; (4) prevention of unintentional injuries among seniors. We
are reviewing these four documents to help determine future
federal action regarding the health
of seniors. For more information on
seniors’ health issues, consult:
http://www.hc-sc.gc.ca/english/
for_you/seniors.html.
More Integrated Approaches to
Healthy Living
Between 1981 and 1996, the
prevalence of overweight doubled and
obesity tripled for both boys and girls.
Research has shown that more than
half of Canadian children are not
active enough for optimal growth and
34
15-24
25-44
45-64
65+
Age group
Source: Canadian Community Health Survey, 2000/01
In light of the proven health
benefits, and consistent with our longstanding support for increased physical
activity, we published the first ever
national guidelines for young people –
Canada’s Physical Activity Guide for
Children and Youth (http://www.hcsc.gc.ca/hppb/paguide/youth.html) and
a guide encouraging workplaces to
support physical activity–Active Living
at Work (http://www.hc-sc.gc.ca/hppb/
fitness/work/).
As physical inactivity and unhealthy weights are risk factors for
many health-related ailments, we
continue to integrate physical activity
into our broader health strategies. For
example, 85 percent of the 96 Canadian
Diabetes Strategy community-based
projects funded to date promote
physical activity because this can
reduce the incidence of diabetes.
Health Canada
Strengthening the Health of our
Communities
The January 2001 Speech from the
Throne highlighted the importance of
community-based health promotion
and disease prevention measures. This
builds on our ongoing role in the
regions to mobilize partnerships with
other levels of government,
stakeholders and citizens towards
common objectives. For example, the
Department continues to work with its
partners to help people living with
hepatitis C and breast cancer, to
further our knowledge on mental
health and to disseminate information
on family violence.
The two-year Mobilizing a Population Health Approach evaluation which analyzed a case study in
each of Health Canada’s six
regions has provided valuable new
knowledge on how the Department
can lead and partner in diverse
ways according to situational
requirements when it works with
other sectors and organizations
around various determinants of
health. For more information,
consult:
http://www.hc-sc.gc.ca/hppb/
phdd/case_studies/index.html.
To meet commitments outlined in
the 1999 and 2001 Speeches from the
Throne, the Government of Canada
launched the Voluntary Sector Initiative (VSI) to strengthen the voluntary
sector’s capacity to meet the challenges
of the future and its ability to serve
Canadians and enhance its relationship with the federal government.
As a key department in VSI, we are
investing $6.1 million for projects
enhancing the voluntary health sector’s capacity to contribute to Health
Canada’s policy development in Aboriginal health, seniors and housing,
mental health, chronic disease prevention and multiculturalism.
Rural and Remote Health
Through an $11 million grants and
contributions program, the Department is addressing the health
concerns of Canadians living in
rural, remote and northern areas of
the country. The program was
designed to promote the integration and accessibility of health
services in rural and remote areas
and to explore ways to address
health work force issues. The
program was developed in close
collaboration with the provinces
and territories. An evaluation of this
program is scheduled to be
completed in 2002.
Prevent illness
Building Innovative Responses to
Chronic Diseases
More than half of Canadians live
with chronic disease which puts strain
on individuals, families, and the health
care system.
The Department is increasingly
recognizing and promoting the advantages of better integration of prevention and promotion efforts to address
risk factors that are common to many
chronic diseases (tobacco, unhealthy
eating and physical inactivity). Integration will capitalize on existing
investments in disease-specific approaches and move us towards the
Departmental Performance by Strategic Outcome
35
Commonality of Risk Factors
and Chronic Diseases
BEHAVIOURS/ RISK
FACTORS
MAJOR CHRONIC
DISEASE
DIABETES
SMOKING
UNHEALTHY
DIET
OVERWEIGHT
SEDENTARY
LIFESTYLE
CANCER
CARDIOVASCULAR
DISEASE
CHRONIC
RESPIRATORY
CONDITIONS
ALCOHOL
ABUSE
PSYCHOSOCIAL
STRESS
MENTAL
ILL-HEALTH
critical mass of preventative effort
required to improve health outcomes.
Avenues for disease interventions
are also being discovered through our
surveillance activities, which can identify disease patterns and provide new
insights into risk factors. For example,
our research has demonstrated that
physical activity helps to protect
against cognitive impairment and
dementia. The Alzheimer’s Society of
Canada has incorporated this knowledge in its information/dissemination
strategies.
Canadian
(CDS)
Diabetes
Strategy
Early results of the process
evaluation of the prevention and
promotion projects under the CDS
demonstrate the elements of
successful community-based programming such as evidencebased approaches and community
participation. Further evaluations
to measure the impact of these
projects will follow. For more
information, please consult: http://
www.hc-sc.gc.ca/hppb/ahi/diabetes/english/index.html.
36
The 15-year Canadian Heart Health
Initiative is a population health
approach to implementing a policy on
heart health at the national, provincial
and community levels. The recent
process evaluation of the Initiative is
supporting the implementation of
heart health programming across the
country. Other evaluative work has
identified clear directions for future
policy and research to further enhance
heart health promotion such as the
need to pool and share best practices
for cardiovascular disease prevention.
Tracking and Responding to
Infectious Disease Threats
In collaboration with international
organizations, provinces and territories, we have an important role in
tracking the progression of infectious
diseases across Canada and internationally, as these represent significant
health risks if they cannot be quickly
identified and addressed.
We have coordinated Canada’s
pandemic influenza contingency planning efforts. Our new agreement with
the provinces and territories ensures
the security of supply of a pandemic
influenza vaccine and will lead to an
improved capacity to respond to the
next pandemic.
With the growing threats of emerging diseases, the health surveillance
system ensures that information rapidly reaches people who protect the
health of Canadians. We paid particular attention to West Nile virus (WNv),
which was first identified in Canada in
2001 in birds in southern Ontario.
While most people infected with WNv
show no or only mild flu-like symptoms, people with weaker immune
Health Canada
systems are at greater risk as they can
develop severe illnesses (meningitis or
encephalitis). In collaboration with
other federal and provincial partners
and stakeholders we led the development of a WNv plan. The result is that
confirmed cases of WNv in birds trigger
local level public health actions to
protect the population from infection.
The Canadian Strategy on HIV/
AIDS (CSHA) provides $10 million per
year in funding to community groups
and national non-government organizations and $4.75 million to fund
community-based care, treatment and
support programs. In 2001-2002, Health
Canada focused on improving the
management, planning, accountability
and communications aspects of this
work. For example, the CSHA Annual
Report was expanded to include
stakeholder perspectives and thereby
provide a more comprehensive picture
of HIV/AIDS in Canada and the
response of both governmental and
non-governmental actors to the epidemic.
Protect the health of
Canadians through
surveillance and
laboratory research
Health surveillance can be defined
as the tracking and forecasting of any
health event or health determinant
through the continuous collection of
health data. The integration, analysis
and interpretation of this data are then
collated into surveillance products,
which can be disseminated to those
who need them.
The establishment of strong, sustainable national surveillance net-
The Geographic Information System (GIS) demonstrates the
benefits of health surveillance
through the conversion of population health data gathered by
surveillance activities into graphic
representations (maps, charts,
graphs). Public health officials can
use this type of information in their
work to improve population health
and reduce the risk of disease
outbreaks or negative environmental impact.
works depends on the full participation
of data collectors. Through its leadership in health surveillance, the Department is working with provincial and
territorial partners to ensure that
surveillance networks are compatible
across the country. The Department
recognizes the need for full provincial
and territorial participation if the
surveillance networks it manages are
to provide health professionals, scientists and policy officers the data they
need to safeguard Canadians’ health.
Laboratory research carried out by
the Department is also contributing to
building the evidence base that guides
policy and program development.
Research is ongoing into infectious
diseases transmitted through blood,
food and water and the resistance of
these infections to antibiotics. For
example, Health Canada’s research to
track the development of drug-resistant HIV strains has improved our
understanding of the persistence of
drug-resistant mutations in individuals infected with HIV. This information will be useful in the development
of more effective treatments.
Departmental Performance by Strategic Outcome
37
Important research is also being
conducted into the transference of
disease-causing agents from animals to
humans, through the food chain or the
environment. Through this type of
As a partner in the Oldman River
Basin Water Quality Initiative the
Department has been looking at
the risks to health associated with
human/animal interface and water
consumption in an area of high
cattle density (namely the prevalence of E. coli O157:H7 and
Salmonella in water).
38
research, the Department can identify
risks and propose corrective measures
(e.g. new regulations, guidelines) to
prevent such incidents.
Population and Public Health
Branch
http://www.hc-sc.gc.ca/pphbdgspsp/new_e.html
Health Canada
Safer Health
Products and Food
for Canadians
Health Products and
Food
The safety and efficacy of health
products and food is of considerable
interest to Canadians, and is seen as a
critical component in accomplishing
the government-wide objective of a
healthier population. Health Canada’s
contribution to achieving this objective
is through its responsibility for the
regulations, policies, standards and
programs relating to the safety of
health products and food.
The three key performance expectations involved in this work are:
Objective
Description
The safety of food, and the safety
and efficacy of drugs, natural
health products, medical devices,
biologics and related biotechnology products in the Canadian
marketplace and health system,
through the development and
implementation of policies, legislation and regulatory frameworks,
the promotion of good nutrition
and the informed use of drugs,
medical devices, food and natural
health products.
Health Products and Food is
responsible for the policies, standards and programs relating to:
Actual Spending 2001-2002
(millions of dollars)
Gross
Revenues
Net
• the safety and nutritional
quality of food, the safety and
efficacy of drugs, medical
devices, natural health products, biologics and related
biotechnology products in the
Canadian marketplace and
health system;
• the promotion of good nutrition and the informed use of
pharmaceuticals, medical devices, biologics, food and
natural health products.
$163.7
$(35.5)
$128.2
Departmental Performance by Strategic Outcome
39
• Protection of Canadians against
risk factors related to health
products and food.
Risk factors related to
health products and food
• Integrated management of health
determinants and risks to health
associated with health products and
food.
To minimize risk factors, existing
processes have been improved and new
processes have been put in place. In the
accomplishments below, we have acknowledged, where appropriate, partnerships with our stakeholders, other
government departments, international
organizations, the United States,
European Union and Canadian public.
• Canadians better informed to make
decisions about their health through
promotion of health behaviours and
provision of information and tools.
Highlights of significant
accomplishments:
Canadians have high expectations
with respect to their ability to access
safe and effective health products and
food. In order to continue to effectively
carry out our mandate to deliver on
that expectation, Health Canada has
placed a major emphasis on continuously improving the knowledge base
and processes we use to make health
products and foods safer and to
promote health.
For example, we have established a
focus on post-approval and assessment
of marketed health products to enhance our ability to monitor risks and
benefits of products once they are on
the market. As well, we have obtained
the International Standards Organization (ISO) accreditation for our
Inspectorate Laboratory Program,
which provides chemical, physical and
microbiological analytical support to
inspection, investigation and surveillance activities of the Inspectorate. The
ISO accreditation is a recognition of
the Laboratory’s high standard and
quality of work and services to
Canadians.
40
Working to Provide Timely Access
to High Quality Health Products
Canada is recognized internationally as providing consistently high
quality health products including
drugs and medical devices to its
citizens and we continue to seek out
new and improved ways of meeting
these high standards. We have, therefore, placed considerable emphasis on
improvements to both our submission
review and decision-making processes.
As a result, during the past year, the
Department processed over 7,600
submissions to assess the safety of
biological and pharmaceutical products, an increase of 18.5 percent over
the past two years.
The effectiveness of our national
compliance and enforcement program
has been strengthened by employing
the consistent and disciplined approach embodied in Health Canada’s
Decision-Making Framework, risk management principles and by employing
the best science available.
Significant progress has been made
in carrying out an inspection function
for clinical trials to comply with new
regulations. As a result we processed
about 20 percent more clinical trials
Health Canada
(from 800 in 1999 to 950 in 2001). The
trials included sponsors, researchers,
patient groups, associations and others.
Resources have been invested to
develop and implement surveillance
mechanisms to gather much-needed
data and to track antibiotic resistance
and antibiotic use in order to control
the spread of resistant bacteria from
animals to humans.
Surveillance, policy and science
disciplines were brought together to
develop the most appropriate strategic
action to control and mitigate the
threat to health of the growth and
proliferation of undesirable microorganisms and of antibiotic resistance in
humans.
We made progress on backlogs: an
80 percent reduction in the backlog for
short-term submissions in the Clinical
Evaluation Division; elimination of the
backlog on corporate name changes on
New Drug Submissions (NDS); a 40
percent reduction in the manufacturing review backlog of NDSs; and a 70
percent reduction on Experimental
Studies Certificates.
Negotiations were conducted pertaining to the implementation of
Mutual Recognition Agreements between Canada and Switzerland for
Drug Good Manufacturing Practices.
We are finalizing confidence building
exercises with the European Union and
Australia. The Mutual Recognition
Agreement approach is an effective
way to ensure the participation of
Health Canada in enhancing international regulatory cooperation and
maintaining high standards of product
safety and quality, while facilitating
the reduction of the regulatory burden
for industries.
Improve integrated
management of risks and
benefits to health
Developing New Safety
Regulations
New regulations, which included a
definition of Good Clinical Practices,
went into effect to improve the
approach to clinical trials. Our efforts
to build science capacity in this area
have been significant, with an increase
in the number of staff from 130 to 180.
We have also reduced the time for
decisions on acceptance for clinical
trials from the 60 day default to 30
days, thereby improving timely access
to clinical trials for experimental
drugs.
Development has begun on regulations for natural health products that
are distinct from, but consistent with,
the Food and Drug Regulations to
provide Canadians with increased
access to safe and effective natural
health products, with enhanced information on their use, while respecting
freedom of choice and philosophical
and cultural diversity.
Work began on the development of
regulatory amendments for nutrition
labelling of prepackaged foods to
ensure the nutrition content and
health claims are accurate. This will
facilitate the ability of Canadians to
select healthy diets and thus reduce the
risk of illness and premature death due
to diet-related chronic diseases.
Reducing Risks related to Foods
A number of activities were undertaken to effectively reduce levels of
food-borne illnesses in Canada. As the
Departmental Performance by Strategic Outcome
41
chart below shows, we have had
continued success and the incidence of
food-borne illness is decreasing over
the years.
safe. Currently, the only foods permitted to be irradiated and sold in Canada
are: wheat, flour, whole wheat flour,
potatoes, onions, whole and ground
spices and dehydrated seasoning preparations.
Incidence of Food-Borne Illness,
Canada, 1987-1999
A strategy to reduce the risk of
contamination of unpasteurized juice
and cider by harmful microorganisms
such as E.coli 0157:H7 and Salmonella
was developed and implemented. Working in partnership with the Canadian
Food Inspection Agency (CFIA), we
have launched an ongoing education
campaign by distributing pamphlets to
Canadian daycares and seniors centres, elementary schools and school
boards. Health Canada continues to
work with CFIA to collect data in
readiness for the performance evaluation of the policy.
Rate per 100,000
60
50
Campylobacteriosis
40
Giardiasis
30
Salmonellosis
20
Verotoxigenic E.
coli
10
0
1987 1989 1991 1993 1995 1997 1999
Year
Source: Population and Public Health Branch, Health Canada
Increasing consumer awareness of microbial hazards
To reduce food-borne illnesses,
(the majority of about 30,000
cases reported in Canada yearly
are due to the microbial contamination of raw foods of animal
origin), we have distributed:
250,000 refrigerator magnets with
food safety messages to retail
outlets selling ground beef across
Canada; about 5 million newspaper supplements carrying Health
Canada’s food safety messages to
homes advising on the need to
cook hamburgers to an internal
temperature of 710 Celsius.
We have initiated an ongoing
evaluation of industry submissions to
apply food irradiation to certain foods
(mangoes, shrimp, poultry, and ground
beef) to ensure that proposed irradiation processes for food are effective and
42
An action plan was developed to
further refine the approach to safety
assessment of foods derived from
biotechnology to address Canadians’
concern over the safety of genetically
modified foods. At the same time, we
are working closely with the Canadian
General Standards Board to develop
standards for industry to voluntarily
label foods derived from biotechnology.
This is expected to provide Canadians
more information on which foods have
been genetically modified (GM) or have
GM ingredients in them.
Building an Excellent Science
Capacity
Our science capacity has been
increased enabling us do a better job as
demonstrated in the following examples.
• Strategies to understand the scientific and industrial trends in health
Health Canada
related biotechnologies were developed, as well as new expertise in
evaluating and regulating new
biotechnology products such as
therapeutics, recombinant vaccines,
microbial pesticides, human and
animal pathogen diagnostics, and
safety of genetically modified foods.
• We began to manage three streams
of federal funds allocated to the
Genomics Research and Development Fund ($10 million for
1999-2002); Biotechnology Regulatory Fund ($46.5 million for
2000-2003); and the Canadian
Biotechnology Strategy Fund
($1.6 million for 1999-2002). These
programs have resulted in the
enhanced scientific knowledge required for the Department’s regulatory mandate and have allowed us
to increase the transparency of our
regulatory activities and the international harmonization of our
standards for human foods and
animal feeds.
• Surveillance of marketed health
products was improved and staff
was increased from 33 to 55, with a
particular focus on building capacity for scientific evaluator positions.
Enable Canadians to
make healthy choices
and informed decisions
about their health
Promoting the Nutritional
Health and Well-being of
Canadians
We supported nutrition and healthy
eating in Canada through a combination of initiatives.
• A Network on Healthy Eating was
established to enhance collaboration and alignment of efforts; key
messages were developed to support the nutrition labelling education initiative.
• An Expert Working Group was
established to advise Health Canada
on the development of updated
Healthy Weight Guidelines to be
used by health professionals to
monitor health risks associated
with weight in populations and
provide Canadians with a screening
tool to relate their weight to their
health status.
Enhancing Communications with
Canadians and Increased Public
Participation in our DecisionMaking Process
Information was provided on compliance and enforcement, and, on an
ongoing basis, warnings, safety alerts,
news releases, product recalls, and
other notices from industry were
Many aspects of our communications have been enhanced to enable
Canadians to make healthy choices and
informed decisions about their health.
Departmental Performance by Strategic Outcome
Improved Adverse Drug Reaction Reporting
We have introduced new health
professional and consumer tollfree telephone and fax numbers to
report adverse drug reactions
(ADRs). Calls are automatically
routed to the appropriate regional
ADR centre.
43
issued as a service to health professionals, consumers, and other interested
parties. In addition, we created a new
web posting “Advisories for Health
Professionals or Consumers”.
A series of public information and
consultation sessions on food irradiation was conducted in several Canadian
centres to provide consumers with
appropriate information and educational materials to make informed
choices.
Canadians and our stakeholders,
about 260 groups in seven cities across
Canada, were consulted to obtain their
input on: i) future priority areas for the
food safety and nutrition needs of
Canadians ii) the proposed regulatory
amendments on nutrition labelling of
prepackaged foods.
Health Canada’s Science and Technology Highlights: Investing in Excellence, 1996-2001, a Report on Federal
Science and Technology was published
to provide Canadians with information
on the role of science and technology in
Canada’s Innovation Strategy and
economic growth.
Challenges to our 2001
performance
Challenges to our performance over
the last three years have revolved
around recruitment, building infrastructure to support program objectives, building knowledge and expertise,
developing information products, and
knowledge management.
As a science-based organization, we
continually need to increase our
scientific expertise and knowledge
base. For example, we need scientific
evaluators in order to meet our
44
mandate and to ensure we provide
effective and efficient services in our
programs. To address this challenge we
initiated staff training and a development program to enhance quality
management objectives. This has
increased the expertise and knowledge
base required to provide essential
quality services to Canadians.
We continue to experience new
challenges such as the need to keep up
with the rapid pace of new technology
and the continued exponential increases in science and technology
developments. For example, a 500 fold
increase is expected in the number of
new health and biotechnology products
on the market in the next 10 years.
Next steps
We anticipate the completion by
December 2002 of work on national
standards in the area of biologics and
genetic therapies, specifically, new
standards-based regulatory frameworks
for cells, tissues, and organs, including
reproductive tissues.
Regulations on nutrition labelling
are expected to be published in the fall
of 2002.
It is also anticipated that the
regulations on natural health products
will go to Canada Gazette, Part II by
the end of December 2002 and come
into force shortly after.
By the end of 2002-2003, Health
Canada intends to have information on
its website that details the many steps
and factors considered in the biotechnology products approval process.
Health Canada
Health Products
Branch
and
Food
http://www.hc-sc.gc.ca/hpfbdgpsa
Departmental Performance by Strategic Outcome
45
Healthier
Environments and
Safer Products for
Canadians
Healthy Environments
and Consumer Safety
The Government of Canada and
Objective
Promote healthy living, working
and recreational environments,
and ensure the safety and efficacy
of producer and consumer products in the Canadian marketplace.
Description
• promotes healthy and safe
living, working and recreational environments;
• assesses and reduces health
risks posed by environmental
factors;
• regulates the safety of commercial and consumer chemicals and products, and
promotes their safe use;
• regulates tobacco and controlled substances and promotes initiatives that reduce or
prevent the harm associated
with these substances and
alcohol;
46
Health Canada recognize the importance of promoting healthy behaviours,
developing and applying harm reduction and prevention methods, and
• provides expert advice and
drug analysis services to law
enforcement agencies across
the country;
• establishes workplace health
and safety policies and provides services to protect the
health of the public sector, the
travelling public and dignitaries visiting Canada;
• is responsible for public health
measures designed to prevent
the entry and spread of
communicable diseases in
Canada;
• is responsible for coordinating
the implementation and monitoring of Health Canada’s
Sustainable Development
Strategy.
Actual Spending 2001-2002
(millions of dollars)
Gross
Revenues
Net
$201.9
$(7.4)
$194.5
Health Canada
enforcing health protection legislation
and regulations. To achieve this
objective, two key performance expectations were identified:
• Reduced risks to health and safety,
and improved protection against
harm associated with workplace
and environmental hazards, consumer products (including cosmetics), radiation emitting devices, new
chemical substances and products
of biotechnology;
• Reduced risks to health and safety
associated with tobacco consumption and the abuse of drugs, alcohol,
and other controlled substances.
The planned results from the
2001-2002 Report on Plans and
Priorities are expressed in the following high-level priorities:
• Enhancing health, safety, and wellbeing through evidence-based research.
• Improving health through collaboration and coordination activities.
• Supporting informed decision-making through awareness activities.
Highlights
The key results arising from five
distinct programmes (Drug Strategy
and Controlled Substances, Product
Safety, Safe Environments, Tobacco
Control, and Workplace Health and
Public Safety) established to address
the objective are described below.
Important contributions were made
towards the improvement of the
health, safety and well-being of Canadians through risk reduction activities in
response to legislated mandates and
identified needs.
Enhance health, safety
and well-being through
evidence-based research
Sharing Best Practices
Best practice studies on smoking
prevention and cessation targeting
youth, pregnant and post-partum
women (http://www.gosmokefree.ca)
were conducted, and national training
sessions for enforcement personnel to
improve the application of legislation
and regulations were undertaken to
reduce health risks associated with
smoking. Through joint efforts with
our partners across the country, a
smoking prevalence of 22 percent
among those aged 15 years and over
was achieved, down two percent from
the previous year. (Source: Canadian
Tobacco Use Monitoring Survey, Statistics Canada).
Health Canada also developed and
circulated best practices concerning
the prevention of substance abuse
through the identification of innovations and provision of evidence-based
research to more than 54,000 front line
health and social services providers in
response to needs identified by the
provinces and territories. These practices contribute to the prevention of
substance abuse among young people
(http://www.hc-sc.gc.ca/hppb/cds-sca/
cds/pdf/substanceyoungpeople.pdf) and
concurrent mental health and substance use disorders (http://www.hcsc.gc.ca/hppb/cds-sca/cds/pdf/concurrentbest
practice.pdf). The report entitled Reducing the Harm Associated with Injection
Drug Use in Canada (http://www.hcsc.gc.ca/hppb/cds-sca/cds/pdf/
injectiondrug_e.pdf) indicated the seriousness of injection drug use as a public
Departmental Performance by Strategic Outcome
47
health and social problem in Canada.
Feedback received from related workshops on these issues has been very
positive, indicating the importance
of the best practices in these
communities.
Red Book III “A healthy population is the
foundation of a smart country.”
Reducing Radiation and
Environmental Risks
In addition to regulatory audits of
inspection programs (e.g. X-ray equipment at airports), radiation safety
courses, and the development of Safety
Codes (e.g. for small radiological
facilities), we targeted our resources
towards inspections of ultrasound
therapy devices from manufacturers
and evaluated over 30 new radiation
emitting devices for compliance with
the Radiation Emitting Devices Act
because of the potential hazards
associated with these devices. We
developed guidelines on machinery
noise measurement to educate Canadians on the prevention of hearing loss
and published updated Guidelines for
the Safe Use of Diagnostic Ultrasound
Devices.
Health Canada’s participation in a
global network to detect radiation
releases worldwide provided data to
enable accurate health assessments
and risk reduction for the protection of
Canadians. Additionally, we offered a
quality assurance program to over 200
Canadian employers concerning radiation reduction in hospitals and other
workplaces. As well, the collection of
more than 600,000 new records from
48
Canadian workers enabled monitoring
and risk assessments of the effects of
radiation on human health. Risk
assessments to determine the relationship between radiation (including
noise) and cardiovascular diseases
produced a better understanding of
public health issues and the preventative measures required to minimize
these risks.
In response to increasing demands,
Health Canada processed 155 project
notifications from other federal departments and undertook environmental
assessments for 20 of its own projects
pursuant to the Canadian Environmental Assessment Act (CEAA). Advice
was provided to mitigate health
concerns and potential adverse health
effects of physical, chemical, biological,
and radiological agents, prior to
implementation of these development
projects (such as nuclear waste management, hydro-electric, and mining).
In fulfilment of the commitment
made in the 2001 Speech from the
Throne, Health Canada devoted more
resources towards increasing its knowledge of the effects of toxic and
environmental substances on human
health. We collaborated with the
private sector and academia to complete 99 research projects to enhance
the understanding of risks posed by
these substances. Some pollutants,
metals in the environment, chemicals,
and urban air quality can alter or
disrupt hormonal or endocrine systems
(e.g. birth defects, thyroid cancer) .
Exposure to airborne pollutants has
been linked to a variety of respiratory
and cardiac health effects. As such, this
research will enhance our ability to
better understand risks posed by
toxins and to manage toxic substances.
Health Canada
Improve health through
collaboration and
coordination activities
Access and Availability
Health Canada issued 3,977 import/
export permits to allow legitimate
trade in controlled drugs and substances for medical and scientific
purposes. This is a 38 percent increase
from the previous year due to additions
to the list of controlled drugs in
September 2000. Shipments are validated by the Canada Customs and
Revenue Agency for compliance with
the Controlled Drugs and Substances
Act.
Health Canada issued 1,392
exemptions to the Controlled
Drugs and Substances Act to
enable access to controlled drugs.
This allows researchers to advance scientific knowledge, and
physicians to prescribe controlled
drugs (such as methadone and
medical marijuana). Health
Canada also provided access to
medical marijuana to 255 seriously ill patients for the alleviation
of certain conditions.
request of the governments of Ontario
and Saskatchewan, Health Canada
assisted in the Walkerton and North
Battleford epidemiological investigations. Subsequently, all jurisdictions in
Canada have examined their drinking
water regulations, guidelines and
policies. Activities of this nature enable
actions to be taken to decrease the
prevalence of contaminants and byproducts, thereby reducing the incidence of illness.
Guidelines and voluntary compliance programs for the inspection of
food, water and sanitation services
aboard various modes of transportation (e.g. airplanes, trains, and cruise
ships) are the product of partnership
activities with industry, the United
States, and the World Health Organization. The resulting health outcomes
include reduced passenger illness,
higher sanitation practices, and increased food and water safety for more
than 80 million travellers annually.
Health Canada collaborated with
health care professionals and
industry to implement healthy
workplaces by assessing needs,
and introducing policies and
strategies to enhance productivity
and competitiveness and minimize
associated health care costs by
reducing work-related diseases,
accidents, disabilities, and absenteeism.
Enhancing Health, Safety, and
Health Security
In partnership with the provinces,
territories and municipal governments, Health Canada revised recreational and drinking water guidelines,
published research results concerning
water disinfectants and methods of
dealing with parasites, and reviewed
health impacts arising from chlorination disinfection by-products. At the
Health Canada completed 85,750
analyses of seized drugs for prosecution. This represents an eight percent
increase over the previous year due to
increased enforcement activity. In
addition, we dismantled 40 clandestine
Departmental Performance by Strategic Outcome
49
laboratories which produce illicit drugs
(such as ecstasy) and pose significant
hazards to public health and safety and
to the environment. An audit confirmed that we are providing an
objective, high-quality service to the
criminal justice system. Two factors
are expected to contribute to increased
workload: (1) aftermath of September
11 (2) Precursor (i.e. chemicals used to
manufacture illicit drugs) Control
Regulations. These regulations concern the manufacture and movement
of illicit drugs (e.g. ecstasy and GHB/
date rape drug) that pose public health,
environmental and security hazards to
Canadians.
Health Canada invested $14M in
the Alcohol and Drug Treatment
and Rehabilitation (ADTR) Program to improve access to
treatment and rehabilitation services among women and youth.
Through joint projects with the
International Atomic Energy Agency,
Health Canada provided expertise to
37 other countries which improved
radiation protection for their workers.
Following the events of September 11,
we received $2 million in funding to
further enhance the security and
preparedness for radio-nuclear emergencies.
Support informed
decision-making through
awareness activities
Informing Public Decisionmaking
Because of the recognized need to
address smoking cessation, Health
Canada engaged youth in the development of anti-smoking advertisements,
television productions, and educational environmental tobacco smoke
(ETS) resource kits. The distribution
of these kits encouraged the implementation of smoke-free policies in schools
and communities. Along with three
major media campaigns, these initiatives contributed to improved health of
Canadians by educating and informing,
and providing enabling tools to reduce
health care burdens.
Health Canada, in partnership with
Environment Canada, participated
in the Sun Savvy Club which
educated children about safe sun
behaviour. For more information,
please consult: http://www.hcsc.gc.ca/ehp/ehd/catalogue/
rpb_pubs/00ehd241.htm.
New Consumer Chemicals and
Containers Regulations were introduced to improve the labelling and
packaging requirements for consumer
chemicals. They will assist in reducing
the number of deaths, injuries and
associated health care costs due to
unintentional exposures involving hazardous consumer chemical products.
Lab evaluation methodologies for
flame projection and flashback of
50
Health Canada
consumer products packaged in aerosol
containers have also been updated to
(1) ensure analytical support for
enforcement of the new regulations,
and (2) inform consumers of the safe
handling of these products. The result
of these efforts is a reduced number of
hazardous products on the market,
thereby protecting the health and
safety of Canadians.
Healthy Environments and Consumer Safety Branch
http://www.hc-sc.gc.ca/hecs-sesc/
hecs/dscs.htm
http://www.hc-sc.gc.ca/psp
http://www.hc-sc.gc.ca/hecs-sesc/
hecs/sep/index.htm
http://www.hc-sc.gc.ca/hecs-sesc/
tobacco
http://www.hc-sc.gc.ca/hecs-sesc/
whpsp
Flame projection and flashback testing of aerosol containers
Departmental Performance by Strategic Outcome
51
Sustainable Pest
Management and
Programs for
Canadians
Pest Management
Regulation
The Pest Management Regulatory
Agency (PMRA) was established in
1995 to improve the regulation of
pesticides in Canada. The mandate of
the PMRA is to protect human health
and the environment by minimizing
the risks associated with pesticides,
while enabling access to pest manage-
Objective
To protect human health and the
environment by minimizing the
risks associated with pest control
products.
Description
• New product evaluation including regulatory decisions
within specified performance
standards on applications for
the registration of new pest
control products.
• Registered product evaluation
where registered products are
re-evaluated against current
standards;
52
ment tools and sustainable pest
management strategies. To meet our
mandate we established three strategic
objectives for the period 1998 - 2003:
• Protect health, safety and the
environment from the risks of
pesticides through the use of sound,
progressive science, including innovative approaches to sustainable
pest management.
• Compliance enforcement under the Pest Control Products
Act (PCPA) and Regulations
through investigations and
inspections;
• Development and implementation of sustainable pest
management policies and programs to integrate sustainable
pest management in registration decisions.
Actual Spending 2001-2002
(millions of dollars)
Gross
Revenues
Net
$31.9
$(6.9)
$25.0
Health Canada
• Meet the needs of Canadians for an
open, transparent and participatory process and for timely access to
new, safer pest control products.
• Effectively manage human and
financial resources.
Since then, we have implemented a
range of strategies, activities, regulations and guidelines to help us reach
these goals. PMRA has established a
joint review program with the United
States Environmental Protection
Agency (EPA) to speed up access to
reduced-risk products, and established
a number of integrated pest management strategies to complement sustainable pest management. We also
solicit public input on major regulatory
decisions and invite stakeholder and
provincial and territorial participation
in regulatory development to help us
achieve transparency in the pest
management regulatory process.
PMRA has three key performance
expectations:
• Safe and effective pest control
products.
• Compliance with the Pest Control
Products Act and Regulations.
• Sustainable pest management practices that reduce reliance on the use
of pesticides.
Safe and effective pest
control products
Re-evaluating Older Pesticides
Re-evaluation is the review of
pesticide active ingredients and their
end-use products on the basis of
updated data and information to
determine whether, and under what
conditions, their continued registration is acceptable. At the time of their
registration, these pesticides were
considered acceptable, but the scientific knowledge that forms the underpinning of these assessments is
continually evolving and new methodologies and tools are being integrated
into regulatory risk assessments. The
re-evaluation of older pesticides can
also take into consideration the full
extent of the use patterns of the active
ingredients, the diversity of their enduse products, and their market penetration.
PMRA implemented a re-evaluation program in 2000. Our reevaluation of organophosphate
pesticides (OP’s) resulted in the
discontinuation of four more OP’s; to
date PMRA has re-evaluated seven
OP’s. OP products are mainly insecticides and cover a broad variety of uses,
such as greenhouse food and non-food
crops, livestock, seed treatments,
oilseed and fibre crops, stored food and
feed, and terrestrial feed and food
crops. We also began to re-evaluate
lawn and turf insecticides and herbicides in response to increased public
interest, to ensure they meet health
and environmental safety standards.
We facilitated the development of an
agreement with the Canadian manufacturers of chromated copper arsenate
(CCA) to discontinue the use of arseniccontaining preservatives on wood for
consumer use by December 31, 2003.
CCA treated wood is commonly used in
decking, fencing and play structures in
a residential setting. This agreement
was reached by giving priority review
to replacement wood-treatment products for CCA. A decision on the
Departmental Performance by Strategic Outcome
53
industrial use of CCA treated wood is
still pending.
The re-evaluation of food use
products helps maintain our stringent
health based safety standards for
pesticide residues in food, by establishing or reassessing maximum residue
limits. It also ensures the continued
protection of health and environmental safety from risks of pesticides
registered for use in Canada by
eliminating the exposure to pesticides
that no longer meet our safety
standards. For more information,
please consult:
http://www.hc-sc.gc.ca/pmra-arla/
english/pdf/dir/dir2001-03-e.pdf.
Formulants
Formulants are any substance or
group of substances other than the
active ingredient that is intentionally
added to a pest control product to
improve its physical characteristics
(e.g. spray ability, solubility,
spreadability and stability). These
formulants, much like the active
ingredient in a pesticide, can pose
toxicological concerns with respect to
the environment and health. List 1
formulants have been identified as
being of significant concern with
respect to their potential adverse
effects on health and the environment.
These are to be phased out of pesticide
products by December 31, 2002.
As a result of our actions, all
registrants with List 1 formulants in
their products have been contacted and
most registrants have communicated
intent to remove List 1 formulants. To
date, approximately 33 percent of the
products have been discontinued.
54
Therefore, pest control products in
Canada now pose less risk to human
health and the environment. For more
information, please consult:
http://www.hc-sc.gc.ca/pmra-arla/
english/pdf/pro/pro2000-04-e.pdf.
A New Pest Control Products Act
We supported the parliamentary
process for Bill C-53, the proposed new
Pest Control Products Act, which was
introduced in the House of Commons
on March 21, 2002. The Pest Control
Products Act (PCPA) is the primary
federal legislation to control the
import, manufacture, sale and use of all
pesticides in Canada.
The new Act would safeguard
Canadians, especially children, and
help ensure a safe and abundant food
supply. New pesticide legislation would
strengthen Canada’s rigorous safeguards against the risks to people and
the environment from the use of
pesticides. Canadians would have
access to more information and new
opportunities for input into major
pesticide registration decisions. A
modernized, strengthened and clarified law on pesticide regulation would
provide the solid legislative foundation
needed to reduce risks posed by
pesticides and facilitate the availability
of newer, safer products and the
removal of older products that might
pose greater risks. For more information, please consult:
http://www.hc-sc.gc.ca/pmra-arla/
english/legis/pcpa-e.html.
Improving product labelling
We prepared amendments to the
Pest Control Products Regulations to
require mandatory bilingual labelling
Health Canada
on all pest control products. This will
ensure that all users of pesticides in
Canada have access to complete label
information in both official languages,
to strengthen the protection of health,
safety and the environment. The
requirements for bilingual labelling
will be phased in over a five year period
beginning January 1, 2003.
We introduced a directive on a label
improvement program aimed at reducing the potential for misuse of
pesticides used on companion animals
“We met our performance standard for review of pesticide application more than 85 percent of the
time. This means quicker access to
new pesticides for Canadians.”
and at safeguarding animal and human
health. The initiative addresses pesticides that are applied dermally to
companion animals (products administered via other routes such as by mouth
or to the eye are regulated as
veterinary drugs). Labels will now
provide more details, including the
type of animal the product is intended
for, reapplication frequency, rate and
method of application, and minimum
age of animals. For more information,
please consult:
http://www.hc-sc.gc.ca/pmra-arla/
english/pdf/dir/dir2002-01-e.pdf.
Increased efficiencies
We continued our work to reduce
regulatory duplication. For example,
the regulation of disinfectants is now
consolidated under the Food and
Drugs Act, while use of pesticides in a
swimming pool or spa or use as a
preservative or slimicide will still be
covered under the PCPA. We also
helped reduce the regulatory burden
on registrants by listing the PCPA and
its regulations in a schedule under the
new Canadian Environmental Protection Act (CEPA). This exempts registrants from having to have their new
products officially notified and assessed for risks to human and
environmental health under CEPA, as
well as under PCPA.
The reduction in duplication will
help reduce the cost to industry of
registering a product and to Canadian
taxpayers by assuring similar risk
assessments of products do not need to
be done by two separate departments.
New risk assessment/risk
management techniques
We adopted three new risk assessment/risk management policies and
guidelines as part of our commitment
within NAFTA to harmonize dietary
risk assessment procedures for determination of the safety of pesticide
residues in domestic and imported
treated foods.
Such policies play an increasingly
important role in the evaluation and
assessment of risks posed by pesticides,
and improve the regulator’s ability to
make decisions that fully protect public
health and sensitive subpopulations.
PMRA’s goal is to make exposure and
risk assessments as accurate and
realistic as possible, so that the entire
population, including infants and
children, is fully protected.
Departmental Performance by Strategic Outcome
55
Compliance with the
Pest Control Products
Act and Regulations
Administrative Monetary
Penalties
This fiscal year marked the first full
year of use of Administrative Monetary
Penalties (AMPs) as a compliance tool.
AMPs provide an enforcement option
that can be imposed when an individual
or company has contravened the
PCPA, rather than pursuing prosecution under the Act itself and can be
imposed instead of or in addition to
other sanctions available under the
PCPA and Regulations.
AMPs allow us to be more strategic
and proactive in our enforcement
approach. Since the PMRA has full
authority to decide when to issue a
monetary penalty, PMRA officials can
act on non-compliance situations more
efficiently. Where non-compliance is
identified, action can be taken immediately. AMPs provide the PMRA with a
broader array of options to determine
an appropriate enforcement response
when non-compliance occurs. The
experience of other agencies administering similar penalties shows that this
approach is very effective in increasing
compliance.
In our first full year using AMPs,
Notices of Violations were issued for
four AMPs cases and 20 other AMPs
case files were commenced during the
fiscal year. These will be completed
during 2002-2003. We also successfully
completed six prosecutions for violations that included the illegal use of a
pesticide on raspberries and the sale of
an unregistered control product. Crimi-
56
nal prosecution is pursued in cases
where a company or an individual has
acted wilfully or with negligence and
the violation poses a significant health
and safety or environmental risk or
constitutes significant fraud. From
1995 to 2001, the Agency has conducted 32 successful prosecutions,
thereby reducing risks to Canadians
from improper/unlawful use of pesticides.
Sustainable pest
management practices
that reduce reliance on
the use of pesticides
Healthy Lawns
We continued implementation of
the Action Plan for Urban
Use Pesticides including the
Healthy Lawns Strategy (http://
www.healthylawns.net). This strategy
has the objective of reducing Canadians’ reliance on pesticides for lawn care
by developing educational material for
homeowners, improving pesticide product labelling, assessing types of pesticide products available to homeowners,
revising classification of pesticide
products and increasing the knowledge
of landscape service providers as well
as re-evaluation of the most commonly available insecticides and herbicides to ensure that they meet current
day standards.
National Pesticide Sales
Database
PMRA completed the pesticide
database framework and electronic
data entry system for registrants.
Work is in progress to improve
Health Canada
technical aspects of the data collection.
As well, work continued on the
development of regulations to require
mandatory reporting of sales data. The
pesticide sales database will be used to
track the amounts and types of
pesticides sold in Canada. This information can then help estimate risks to
health and the environment and may
also be used to help set priorities for reevaluation or to determine the extent
of use of reduced-risk pesticides.
Reduced-Risk Pesticides
The PMRA and the U.S. EPA, in cooperation
with
Mexico’s
CICOPLAFEST, established a joint
review process for pest control products that contain conventional chemical pesticides (1996) and a joint review
process for pest control products in
which the active ingredient is a
microbial
or
an
arthropod
semiochemical (1997). These reviews
increase the efficiency of the registration process, facilitate simultaneous
registration in participating countries
and increase access to new pest
management tools. Results of these
programs give Canadian growers access to new and better technologies at
the same time as their U.S. counterparts, and the access to new lower risk
technology helps reduce the risk to
Canadians from pesticides.
This year the NAFTA Joint Review
Program registered one reduced-risk
pesticide, and started review on three
other reduced-risk chemical pesticides
and two microbial pesticides. To date,
23 registrations have been granted
under the Joint Review / Workshare
programs. This includes 10 traditional
chemicals, nine reduced-risk chemicals, two microbials and two
pheromones (active ingredients and
end-use products). Currently, there are
31 submissions undergoing joint review or workshare reviews, of which 11
are traditional chemicals, 13 are
reduced-risk products, six are
microbials and one is a pilot minor use
product. For more information, please
consult:
http://www.hc-sc.gc.ca/pmra-arla/
english/pdf/dir/dir2002-02-e.pdf.
Departmental Performance by Strategic Outcome
57
Sustainable Health
Services and Programs for
First Nations and Inuit
Communities so Their
People May Attain a Level
of Health Comparable
with that of Other
Canadians
First Nations and Inuit
Health
We have implemented a range of
long-term strategies and activities that
are expanding First Nations and Inuit
Objective
Sustainable health services and
programs for First Nations and
Inuit communities and people that
address health inequalities and
disease threats so that they may
attain a level of health comparable
with that of other Canadians, within
a context of First Nations and Inuit
autonomy and control and in
collaboration with the provinces
and territories.
Description
First Nations and Inuit Health
carries out its mandate through:
• provision of community-based
health promotion and prevention programs on-reserve and
in Inuit communities;
• provision of Non-Insured
Health Benefits to First Nations
and Inuit people regardless of
58
community responsibility for the design, delivery, priority-setting and
management of health programs and
services. Our actions are helping to
build on gains in First Nations and
Inuit health status. For example,
infant mortality has dropped by half
location
Canada;
of
residence
in
• provision of primary care and
emergency services on-reserve in remote and isolated
areas where no provincial
services are readily available.
Health Canada also supports the
transition to increased control and
management of these health
services, based on a renewed
relationship with First Nations and
the Inuit and a refocused federal
role. Health Canada participates in
government policy development
on Aboriginal issues.
Actual Spending 2001-2002
(millions of dollars)
Gross
Revenues
Net
$1,346.0
$(6.9)
$1,339.1
Health Canada
and life expectancy has risen by
10 years since 1979.
Life Expectancy at Birth by Sex,
Registered First Nations and General Population,
Canada, 1975-2000
85
Graph:
80
Life Expectancy at Birth
FN Male
Cdn Male
FN Female
by
Sex,
Registered
First
65
Cdn Female
60 Nations and General Popula55
50 tion
75
70
1975
1980
1985
1990
1995
2000
First Nations are classified as Registered Indians both on and off-reserve.
Year 2000 life expectancy is an estimate.
Source: Population Projections of Registered Indians,
1998-2008, DIAND, 1999
renewed relationship with First Nations and Inuit and a refocused federal
role. Building on existing funding, the
2000 Budget announced additional
allocations for First Nations and Inuit
Health in the amount of $50 million for
2001-2002. This new investment will
assist in the sustainability of our
community health programs and address the cost pressures in the NonInsured Health Benefits (NIHB)
Program. To help achieve our goals, we
have defined four key performance
expectations for 2001-2002:
At the same time, we face the
pressures that affect other health care
providers such as nursing shortages,
rapidly rising drug costs and expensive
new technology. These are in addition
to the specific challenges posed by
factors that particularly affect our
management of First Nations and Inuit
health services, such as the remoteness
and isolation of many communities we
serve, the lower health status of First
Nations people and Inuit and the
implications of a projected on-reserve
population increase that was 2.9
percent just in 2001-2002 alone. We
have had to address the reality of a
growing seniors population in these
communities that is 40 percent higher
than among Canadians in general. We
are also challenged by the aging and
maintenance of our 691 hospitals,
addiction treatment centres, nursing
stations and other facilities.
• Improvements in First Nations and
Inuit peoples’ health and a reduction in health inequalities between
them and other Canadians.
• A First Nations and Inuit population that is informed and aware of
the factors that affect health and
what actions can be taken to
improve health.
• Effective health care services available and accessible to First Nations
and Inuit that are integrated with
provinces’ and territories’ health
services.
• Improved management and accountability in partnership with
First Nations and Inuit for health
care services and the NIHB Program.
Health Canada recognizes as a
priority improving the health of First
Nations and Inuit people and reducing
health inequalities between them and
other Canadians. Consistent with
overall government commitments, we
are moving on this priority through a
Departmental Performance by Strategic Outcome
59
Improvements in First
Nations and Inuit
peoples’ health and a
reduction in health
inequalities between
them and other
Canadians
We worked with approximately 630
First Nations and Inuit communities to
provide a range of primary public
health and community care services.
These services focus on communicable
disease prevention, diabetes prevention and health promotion, environmental health and water safety,
addiction services and extended health
Launching Action Plans on HIV/
AIDS
Because of the impact of HIV/AIDS
on First Nations and Inuit communities, we supported the development of
HIV/AIDS regional action plans to
increase awareness through education
and prevention initiatives. They also
focus on treatment, care and support in
partnership with First Nations and
Inuit. At the national level, we
supported a national implementation
plan by the Assembly of First Nations
and the development of a comprehensive National Aboriginal Strategy for
HIV/AIDS which is being coordinated
by the Canadian Aboriginal AIDS
Network through a national working
group.
Reducing the Impact of Diabetes
Almost 6,500 First Nations children living on reserves benefited
from 314 Aboriginal Head Start
projects that feature early intervention strategies to help their
development.
benefits. We funded some 800 nursing
positions and 700 community health
workers to deliver our programs. These
programs and services focused on
decreasing the gaps in health care
between First Nations and Inuit
communities and the general population.
During the year, we paid particular
attention to the following key health
challenges.
60
One of the major chronic diseases
affecting First Nations and Inuit
communities is diabetes, which is three
to five times higher than the rate in the
general population. In response, we
had previously worked with Aboriginal
peoples to create the Aboriginal
Diabetes Initiative. It increases prevention and treatment and enhances
access to culturally appropriate diabetes programs for Aboriginal peoples.
During 2001-2002, the Initiative was at
work in 580 First Nations and Inuit
communities, resulting in increased
awareness of diabetes, strengthened
community based participation in
programs, and better access to prevention, health promotion, care and
treatment services. Additionally, 39
Metis programs have been funded to
create culturally appropriate primary
prevention and health promotion for
Metis and urban Aboriginal peoples.
Health Canada
Addressing Environmental
Health Challenges
We responded to the health threats
facing some First Nations and Inuit
communities due to local environmental hazards. As a key priority was to
enhance drinking water monitoring,
we provided bacteriological water and
chemical test kits to communities. We
also trained local Environmental Health
Officers in ensuring appropriate air
quality in housing and provided
refresher courses on the safe transportation of dangerous goods. These
measures helped to decrease adverse
health effects caused by unsafe water,
waste disposal and environmental
contaminants; increased the number of
facilities on-reserve that meet health
and safety standards; and ensured the
proper disposal of hazardous goods.
Promoting Mental Health
We completed a National Mental
Health Framework in consultation
with front line community mental
health workers and created an advisory
group on suicide prevention. A report
with recommendations on Aboriginal
mental health will be provided to the
National Chief of the Assembly of First
Nations in the upcoming year to begin
the process of developing strategies to
combat mental health issues within
First Nations communities.
A First Nations and Inuit
population that is
informed and aware of
the factors that affect
health and actions that
can improve their health
Meeting the Needs of Children,
Youth and Families
An increased awareness of health
issues improves the development and
good health of First Nations and Inuit
children and their families. An informed community is able to make
decisions about programs and services
that will result in better health. To
ensure a better quality of life for First
Nations and Inuit families, we implemented programs that focus on early
interventions in a child’s life and
developed awareness campaigns to
highlight the conditions that threaten
the health of families. The Department’s administration of programs and
initiatives that focus on improvement
of health status for First Nations and
Inuit children and families has produced a steady decrease in infant
mortality rates over the past 20 years.
Infant Mortality Rates, First Nations and
Canada, 1979 - 1999
Deaths per 1,000 live
births
To access more information on this
program, please consult: http://www.hcsc.gc.ca/fnihb/cp/adi/index.htm.
First
Nations
Canada
30
25
Break in data from
1994 to 1998
20
15
10
Graph:
5
Infant Mortality Rates, First
1982 1985 1988 1991 1994 1997
Year
Nations and Canada,
1979-1999
0
1979
Source: Statistics Canada; Health Canada, First Nations and Inuit Branch
(formerly Medical Services Branch),
Trends in First Nations Mortality 1979 -1993
- Rates include all births under 500 grams
- Data were unavailable for the First Nations population for the years
1994-1998.
- Current data may not be directly comparable to previous years due to
different data collection methods.
Departmental Performance by Strategic Outcome
61
Sharing Best Aboriginal Head
Start Practices
The Aboriginal Head Start OnReserve (AHSOR) program is designed
to prepare young First Nations children for their school years by providing
for their emotional, social, health,
nutritional and psychological needs.
The program encourages the development of locally controlled projects
covering the program components in
First Nations communities that strive
to instill a sense of pride and desire to
learn, strengthen parenting skills,
foster emotional and social development, increase self-confidence and
improve family relationships.
In December 2001, we sponsored
the annual training workshop for AHS
coordinators enabling them to share
their experience and knowledge and
then to pass on what they had learned
to other community members. The
conference and Final Report produced
helped to build skills and strengthen
the capacity of community-based Aboriginal Head Start coordinators.
To access more information on this
program, please consult: http://www.hcsc.gc.ca/fnihb/cp/fnhsor/index.htm.
Updating the Canada Prenatal
Nutrition Program(CPNP)
the program in the first trimester of
pregnancy. Preliminary evidence demonstrates a positive impact of CPNP on
some key indicators of maternal and
child health. Breast-feeding duration
rates, in particular, appear to be
extended with participation in CPNP.
As well, more than 500 front line health
workers participated in regionally
based training events that support
our commitment to build capacity
in program design, delivery and
evaluation.
Meeting the Fetal Alcohol
Syndrome/Fetal Alcohol
Effects(FAS/E) Challenge
The 2001 Speech from the Throne
committed the government to cooperative efforts to reduce the number of
newborns affected by fetal alcohol
syndrome. To enhance FAS/E prevention knowledge, we supported
the development and initial distribution of awareness materials to First
Nations and Inuit communities. These
were complemented by efforts to build
local capacity to deal with FAS/E issues
and training workshops on awareness,
prevention and parenting skills were
delivered in several regions. We also
developed a FAS/E evaluation framework.
The First Nations and Inuit
component of CPNP is designed to
improve the nutrition of pregnant
women who face conditions of risk that
threaten their health and the development of their babies. We have extended
the reach and depth of programming to
First Nations and Inuit women and
infants. Approximately 90 percent of
eligible women participate in the
program and more than one third enter
62
Health Canada
Effective health care
services available and
accessible to First
Nations and Inuit that
are integrated with
provinces’ and
territories’ health
services
We have worked with First Nations
and Inuit partners to define shared
health priorities in a renewed health
care system. The provision of effective
and accessible health care services to
First Nations and Inuit communities
requires long-range strategies to address sustainability of health services
and programs. Integral to this are
improvements in evidence-based decision-making by, for example, enhancing the First Nations and Inuit Health
Information System (FNIHIS).
Combatting Alcohol and Drug
Abuse
Alcohol and drug abuse are serious
concerns for First Nations and Inuit
communities. We worked with communities to provide treatment, prevention
and intervention through the National
Native Alcohol and Drug Abuse
Program (NNADAP).
Capacity at the community level
has increased and First Nations and
Inuit people now manage 96 percent of
the NNADAP resources through contribution agreements and through
eight regional addiction partnership
groups working with the National
Native Addictions Partnership Foundation (NNAPF).
During 2001-2002, 48 NNADAP
Treatment Centres offered 695 inpa-
tient treatment beds. In addition, the
nine Solvent Addiction Treatment
Centres, housing 120 beds, provided
treatment to approximately 321 clients. Also, there are over 550 community-based programs served by
approximately 734 field workers. The
ongoing inpatient treatment and community programs are designed to
increase quality of life of those seeking
treatment and enhance treatment
availability.
Another priority during the year
was to improve the quality of care and
20 centres have received full accreditation for treatment standards under
NNADAP. To improve access to
addictions information, we designed a
new addictions information system
and selected sites have begun pilot
testing of the new system.
To access more information on
NNADAP, please consult: http://
www.hc-sc.gc.ca/fnihb/cp/nnadap/
index.htm.
Expanding Home and Community
Care
We are committed to assisting First
Nations and Inuit people living with
chronic and acute illness to maintain
optimum health, well-being and independence in their home and community. The program ensures that a
universal set of essential services in
home and community care is in place to
assist clients. In collaboration with
First Nations and Inuit, the First
Nations and Inuit Home and Community Care (FNIHCC) Program was
developed and rolled out. As of 20012002, 96 percent of First Nations and
Inuit communities have the resources
available to prepare for service delivery
and there has been a growth of 51
Departmental Performance by Strategic Outcome
63
percent in communities which now
have access to FNIHCC services. To
ensure program effectiveness, we
developed a results-based management
and accountability framework for the
program, a service delivery handbook,
as well as accountability tools.
To access more information on this
program, please consult: http://www.hcsc.gc.ca/fnihb/phcph/fnihccp/index.htm.
Enhancing the First Nations and
Inuit Health Information System
(FNIHIS)
Improved health information and
technology are essential to gathering
and managing the data needed to
understand First Nations and Inuit
health issues and to ensure system
effectiveness. This is critical for
effective service delivery, better management and to predict health care
needs. Accordingly, we have expanded
the FNIHIS. By the end of 2001-2002,
we implemented the system in approximately 65 percent of communities. In
April 1999, 190 sites served 275
communities and in March 2002, 360
sites served 437 communities.
A major FNIHIS priority is integration with provincial public health
information systems. For example, we
have piloted data exchange projects
with British Columbia’s Centre for
Disease Control. We also began
projects aimed at coordinating information on home and community care
and diabetes. These are expected to
improve patient care by identifying
potential conflicts in treatment therapies.
64
Expanding Telehealth Access
Because many First Nations and
Inuit communities are in remote areas,
telehealth services promise to be a
valuable way to link these communities
with specialized health experts, improving access to services and reducing
transportation costs. To explore this,
we implemented and completed
telehealth research projects in La
Romaine, QC, Berens River, MB,
Southend, SK, Fort Chipewyan, AB
and Anahim Lake, BC. We also
implemented telehealth services in 41
Alberta First Nations communities
with the Alberta government, Telus
and Blue Quills First Nations College.
Residents are now linked to mental
health and diabetes education, teleelectrocardiogram and tele-rehabilitation services.
For more information on telehealth,
please consult:
http://www.hc-sc.gc.ca/fnihb/phcph/
telehealth/index.htm.
Surveillance Indicators
We improved our ability to report
on and analyze First Nations and Inuit
health and to develop comparisons to
the general Canadian population by
expanding health surveillance indicators. As part of this, we obtained
information on communicable diseases
and routine immunization data for
First Nations and Inuit from all
provinces and territories. This information enabled us to review new
vaccines, plan disease interventions
and investigate relationships between
environmental factors and the spread
of infectious diseases. We also broadened the set of surveillance indicators
Health Canada
to include chronic conditions, for
example, cancer, diabetes and injury.
Non-Insured Health Benefits
The NIHB Program complements
community-based programs and services and provides a range of medically
necessary goods and services to Status
Indians and recognized Inuit and Innu
that supplement benefits provided
through other private or provincial/
territorial programs. The program
largely contributes to the achievement
of an overall health care coverage for
First Nations and Inuit. Benefits
include drugs, dental care, vision care,
medical supplies and equipment, shortterm mental health services, and
transportation to access medical services and medical premiums in selected
provinces. These benefits are provided
by health professionals, consistent
with the best practices of health
services delivery and evidence-based
standards of care.
Building Partnerships
We established a joint committee
with the Assembly of First Nations and
the Inuit Tapiriit Kanatami (ITK) for a
partnership on renewal. The goal of
this partnership is to develop a
renewed First Nations and Inuit health
system by examining issues of integration, accountability, sustainability, and
capacity building and to develop a
framework to support that relationship. The committee is exploring ways
of improving health outcomes and
access to quality health services for
First Nations and Inuit through
control of their own health programs.
We also developed and implemented the Territorial Wellness Strategy in partnership with territorial
governments and First Nations and
Inuit groups. This strategy will improve dialogue, understanding and cooperation between federal, territorial
and community levels, as well as
improving synergy, efficiency and costeffectiveness, reducing the administrative burden and improving policy
decisions.
Improved management
and accountability for
health care services and
the Non-Insured Health
Benefits (NIHB)
Ensuring Sustainable and
Accountable Programming
Focus was placed on improving
accountability in order to enhance
program design and delivery while
keeping First Nations, Inuit and other
Canadians well informed of the
efficiency and effectiveness of programs and public funds spending.
Health Canada works in partnership
with First Nations and Inuit towards
sustainable and accountable programming. A special focus is the transfer of
knowledge and increased capacity on
management and control issues.
Improving Management
Accountability for Community
Health Programs
To improve accountability and
strengthen management practices, we
have streamlined 16 contribution
agreements into seven new standardized contribution agreements. The
agreements clarify and define roles and
responsibilities of all parties involved.
New clauses were added or amended to
Departmental Performance by Strategic Outcome
65
improve risk management and to
respond to recommendations made by
the Auditor General. They also allow
the Department and First Nations and
Inuit communities to better reflect
accountability to the public for the
prudent use of public funds. We have
published a comprehensive Guide for
the Standard Agreements, and a new
Intervention Policy Framework was
introduced. Our own internal accountability was strengthened with a new
routing process, and the implementation of a contribution agreement
monitoring system.
Response to the Public Accounts
Committee
The Public Accounts Committee
(PAC) followed-up the 2000 Report by
the Auditor General. Its December
2001 recommendations require Health
Canada to implement and report on
improvements to our accountability
and management activities.
Several important milestones were
reached in 2001-2002 as we worked to
implement corrective measures. For
instance, new program accountability
frameworks were introduced, comprehensive standard agreements were
developed and implemented and a
single contracts and contributions
management system was implemented
to enhance reporting, monitoring and
auditing.
The follow-up actions taken in
response to the PAC recommendations
and a copy of the Government
Response to the PAC Report can be
found in the electronic Annex D at:
http://www.hc-sc.gc.ca/english/care/estimates/index.htm. We also developed
a summary report of our follow-up
actions that is included as Appendix B.
66
Effective Management of NonInsured Health Benefits (NIHB)
During the year we addressed
specific service needs and built on
previous work to improve management
of NIHB to enhance the quality of
services to First Nations and Inuit and
better address cost pressures. To
better manage the cost of transportation, we have renegotiated fees with
taxi companies and ambulance providers servicing First Nations and Inuit
communities in some regions; implemented NIHB medical transportation
schedules for new standard contribution agreements with First Nations
and Inuit communities; developed the
medical transportation audit framework which will allow for greater
ability to detect billing irregularities
and recover overpayments; and developed an electronic web-based medical
transportation reporting system to be
implemented in July 2002.
We have made significant progress
in cost management through the
implementation of a number of efficiency measures. These measures were
very successful and the rate of growth
in program expenditures declined over
the past 10 years from 22.9 percent in
1990-1991 to 5.7 percent in 2000-2001.
Despite the cost management strategies adopted, projections indicate that
continued increases are likely in
program expenditures. For instance,
the drug benefit expenditures alone
grew by 25 percent between 1995-1996
and 1999-2000. Although this compares favourably to the six provincial
benefits plans that experienced over a
50 percent increase in drug costs
during the same period, spiralling drug
costs represent a significant burden to
overall NIHB Program sustainability.
Health Canada
We also enhanced the management
of medical supplies and equipment by
implementing a framework to provide
guidelines for approving benefits;
establishing provider qualification requirements to best meet the needs of
clients, by ensuring proper assessment
of providers to dispense medical
supplies and equipment; and setting up
an initiative to reuse medical equipment. This generated a total cost
savings in medical supplies and
equipment for 2001-2002 of 19.8
percent.
Improved services in the NIHB
Drug Exception Centre have ensured
that First Nations and Inuit clients
have equal access to prescription drugs
and that a fair and consistent approach
to approvals is provided at all times.
Constant streamlining of procedures
and systems within the Centre has
resulted in improved customer service
and timely handling of approvals.
A particular focus was placed on
improved dental health services. We
implemented changes to the dental
component of the Health Information
and Claims Processing System which
meant that both the dental and
pharmacy components were delivered
by the same sub-contractor. Using one
uniform system has streamlined the
processing of all claims. It also
increased system response time for
claims processors, toll-free inquiry,
and dental submission predetermination in the regions. The enhancement
of the ad hoc reporting system tool has
improved reporting turnaround times.
Adding Capacity through
Comprehensive Community
Health Plans
Internal and external capacity was
identified as key to achieving successful accountability. We have already
engaged discussions with First Nations, Inuit and with other federal
government departments on capacity
building. And to support our clients, we
have developed internal capacity plans
focusing on planning, monitoring and
reporting.
Health Canada has taken a lead role
in establishing an Interdepartmental
Committee on Capacity Building. This
committee provides a forum for
government departments to share
information and best practices on
capacity building initiatives, and to
identify possible linkages and
commonalities within their respective
responsibilities.
To respond to particular community health needs, comprehensive
Community Health Plans are being
developed and tested in four First
Nations communities: Kitselas Band
Council in Pacific Region; Bigstone
Cree First Nation in Alberta; Little
Grand Rapids First Nation in Manitoba Region and Eagle Village First
Nation (Kipawa) in Quebec. Training,
templates and guidelines were provided to the communities to assist with
the development of their health plans.
These Community Health Plans will
improve First Nations and Inuit
capacity to prioritize their health needs
and resources, improve the management and integration of programs and
services; and streamline financial and
human resources while improving data
collection and reporting. We developed
a First Nations and Inuit Program
Departmental Performance by Strategic Outcome
67
Compendium which allows communities to have the information needed to
select the appropriate programs for
their Community Health Plans. It
details all programs that are available
to First Nations and Inuit communities. The Compendium forms the basis
by which First Nations and Inuit will
select the programs that will best serve
their communities, and informs them
of reporting requirements for each
program.
Integrating Sustainable
Development Principles
We have established a permanent
function under the First Nations and
Inuit Health Business Line in order to
integrate sustainable development and
environmental management principles
into our programs and activities. We
have developed an environmental
management system that is used for
training and for tracking the activities
that we have undertaken to minimize
negative impacts on the environment,
such as non-hazardous waste and
water audits of our hospitals.
2001-2002 we received final reports on
all 10 projects tested including an
integrated overview report. Three of
the pilots continued and the others
have reverted to contribution agreements. To address issues around
economies of scale and sustainability,
all pilots that continued will have to
take on all benefits and all members/
clients by October 2002.
Health Canada has also developed a
three-part performance measurement
strategy for community-based programs. Annual program updates will
provide short-term outcome information generated through a core set of
program indicators (i.e. client information, program function, capacity/education and financial management).
Intermediate national program evaluations will provide a more comprehensive and risk-based program
assessment. Health surveillance activities will monitor health change over
the long-term. We will test this
performance strategy through the
Community Health Plan demonstration sites.
Evaluation of our Programs
We completed evaluations of the
pilot projects supporting transfer of the
NIHB. These evaluations provide
evidence-based guidance for development of further pilot projects. During
68
First Nations and Inuit Health
Branch
http://www.hc-sc.gc.ca/fnihb/
index.htm
Health Canada
Better Health
Outcomes through
Information and
Communication
Technologies and
Evidence-Based
Decision-Making
Information and
Knowledge Management
Improved health service delivery
and better informed decision-making
each contribute to better health
outcomes for Canadians.
A total of 49 percent of departmental spending in this area funds the
operations of essential departmental
information and knowledge management and information technology
systems. This includes mission critical
computer operations, telecommunica-
Objective
A health system that delivers better
health outcomes through more
effective use of information technologies; more and better health
research; and the effective use of a
base of timely, accessible and
reliable health information and
analysis for evidence-based decision-making and better public
accountability.
Description
Information and Knowledge Management is responsible for improving the evidence base (both
information and analysis) for decision-making and public accountability; updating the long-range
strategic framework and policies
that establish, direct and redirect
Departmental Performance by Strategic Outcome
the involvement of the federal
government in health research
policy; developing the creative use
of modern information and communications technologies (including the Information Highway) in the
health sector; and, in cooperation
with the provinces and territories,
the private sector and international
partners, providing advice, expertise and assistance with respect to
information management and information technology, planning
and operations.
Actual Spending 2001-2002
(millions of dollars)
Gross
Revenues
Net
$281.3
N/A
$281.3
69
tions, software application development, and information management
systems and services that support
national health programs and services
for Canadians as well as support the
more than 8,000 departmental employees across the country. The remaining
51 percent supports the achievement of
better health outcomes through innovations and implementation of information
and
communication
technologies and through evidencebased decision-making.
To help reach our objective, we have
defined three performance expectations:
• A well-functioning national health
information infrastructure which
respects privacy and shares information in support of decisionmaking and public accountability.
• Evidence-based health policy decision-making including a better
understanding of the issues relating to health care.
• Accountability for, and effectiveness of, Health Canada’s programs,
policies and functions.
Working with the provinces and
territories, our health sector clients
and other partners, we have implemented a range of strategies and
activities over time to help reach these
objectives. For 2001-2002, Health
Canada had four major priorities to
meet these objectives:
• Make significant progress on key
priorities for a pan-Canadian Health
Infostructure.
• Demonstrate the potential for
measurable improvements in the
quality, accessibility and efficiency
of health systems and services,
70
through the use of information and
communications technology.
• Increase data and analysis on the
health of Canadians and the
performance of the health care
system.
• Increase the capacity of Health
Canada to monitor, report on and
improve the performance of its
major programs.
Significant progress on
key priorities for a panCanadian Health
Infostructure
An ambitious, long-term undertaking, the development of a health
infostructure in Canada will help our
health care system meet the challenges
of the 21st century.
The term “health infostructure”
refers to modern information and
communications technologies, such as
electronic health records. The
infostructure will allow the general
public, patients and caregivers, as well
as health professionals to obtain and
provide information and data faster,
thus facilitating more informed and
timely decisions about one’s health,
medical interventions, or health services.
One of the challenges of implementing a national health information
infostructure is identifying and addressing the gaps in research concerning information and communications
technologies and health. Due to other
priorities within the Department,
funding of 15 projects planned for
2001-2002 to address various gaps was
delayed but is now under way.
Health Canada
An effective national health information infostructure also requires
working with our partners to develop
national strategies to enhance the use
of information, and information and
communications technologies, in the
health sector. Collaborative efforts
with our partners can reduce duplication and unnecessary expense and
ensure different systems can communicate with each other. Examples of
such collaboration are highlighted
below.
More Focused Work with an
Updated Tactical Plan
A Tactical Plan to assist all health
jurisdictions make planning and funding decisions for establishing a national
health infostructure was updated in
2001 in collaboration with provincial
and territorial jurisdictions. The Plan
has led to more focused activity across
jurisdictions. For example, a consortium of western provinces and territories is working on the recommendations
of the Plan dealing with the “building
blocks” of a pan-Canadian health
infostructure; those elements are
inter-operable, on-line client and provider registries, and pharmacy and
laboratory systems. The Atlantic provinces are also engaged in similar
activities intended to allow both interoperability and integration of electronic health services. These initiatives
are expected to lead to improved access
to health care services and consequently, to improved health status.
Implementing Health Canada
Pan-Canadian Health
Infostructure Initiatives
Our Department has three core
initiatives: the Canadian Health Net-
work, the National Health Surveillance Infostructure and the First
Nations and Inuit Health Information
System.
The Canadian Health Network
(CHN) is an Internet-based health
information service built collaboratively by government and non-government organizations across Canada. It
offers Canadians an on-line gateway to
credible, relevant, up-to-date information in four key areas: health promotion, disease prevention, self-care, and
performance of the health care system.
Through collaboration with major
health organizations across the country, we expanded and promoted the
CHN. In March 2002, a study found
that the CHN is the third most visited
health or medical-related website by
Canadians. As a result, Canadians have
better access to timely, credible and
comprehensive information on health
promotion and disease prevention.
Sixty-six percent of respondents to the
first CHN on-line survey indicated
satisfaction with the information
provided. For further information,
please consult:
http://www.canadian-healthnetwork.ca/.
The National Health Surveillance Infostructure initiative continues to provide information important
to health professionals and decisionmakers in making public health
decisions. The initiative is guided by a
partnership of people representing the
health surveillance interests of local,
provincial, territorial and national
governments, non-government organizations, First Nations, and universities.
As a result of activities undertaken
or completed in 2001-2002, 95 public
Departmental Performance by Strategic Outcome
71
health practitioners such as medical
officers of health, epidemiologists,
researchers and planners are able to
produce detailed maps of disease
incidence and trends, tailored specifically to their needs. For example,
Health Canada researchers discovered
a link between health events in
southern Ontario and a census of
agriculture data by overlaying E. coli
health event data with census boundaries. The system was also used to
monitor the impact of the Walkerton
outbreak and the West Nile virus on
the health of Canadians.
other federal departments to support
the Canadian Standards Association
model code as a basis for protecting
personal health information. This
agreement sets the foundation for
ensuring that major health providers
support the same privacy principles
and standards for handling the personal health information of all Canadians and ensures that work on a
Canadian health infostructure, including the implementation of electronic
health records and telehealth solutions, can effectively continue.
The First Nations and Inuit
Health Information System provides accurate and timely data to First
Nations and Inuit for case management, health planning and evaluation.
It provides First Nations and Inuit
communities with access to health
information not previously available
through provincial, territorial or federal databases.
Demonstration of the
potential for measurable
improvements in the
quality, accessibility and
efficiency of health
systems and services,
through the use of
information and
communications
technology
Approximately 65 percent of First
Nations communities are now being
served by the system, an increase of
24 percent from 1999 when 275 communities were served. These include
the 41 Alberta First Nations communities which have access to mental health
and tele-electrocardiogram telehealth
services. For more information, please
see page 64.
Protection of Personal Health
Information
Canadians care deeply about the
privacy of their health care information. As a result of the work on the
Personal Information Protection and
Electronic Documents Act, agreement
was reached with national health
associations, provinces, territories and
72
Just as Canadians expect that their
personal health information will be
protected, surveys also show that they
want simplified access to health
information and services. We have
addressed this in many ways.
Canada Health Infostructure
Partnerships Program (CHIPP)
During the year, Health Canada
funded innovative projects under the
Canada Health Infostructure Partnerships Program, an $80 million program
that tests and applies new technologies
to improve health service delivery,
especially to people in remote areas.
Health Canada
For example, the Central BC and
Yukon Telehealth project launched the
Picture Archiving Communications
System (PACS) at the Royal Inland
Hospital in Kamloops, British Columbia, and satellite equipment was placed
at two other hospitals in British
Columbia and the Yukon. The PACS
enables doctors in these regions to
instantly access patient X-rays and
other images related to a patient’s
chart thereby increasing the speed of
diagnosis and treatment. Once the
infrastructure is fully in place, the
network will serve as a model for the
delivery of other telemedicine applications.
As well, the Government of Nunavut
started the expansion of a pioneering
telehealth network, called the Ikajuruti
Inungnik Ungasiktumi (IIU) Network,
in order to link more communities to
more services and more clinical
expertise within and outside the
northern territory. The CHIPP funds
enable the IIU Network to improve
access to health care for the people of
Nunavut including social services,
public health, education and administration.
Of the 29 CHIPP projects with
anticipated completion of implementation by March 31, 2003, a few were
delayed and will not be completed until
2003-2004.
Simplified Access to Health
Information and Services
We partnered with other federal
departments to develop the Canada
Health Portal (CHP) as part of the
larger Government of Canada On-Line
initiative. The CHP is an Internet site
providing Canadians with single-window access to trusted and credible
health information from many sources,
including Health Canada and the
Canadian Health Network. The portal
now links the public to current healthrelated information from across the
federal government and agencies as
well as to provincial and territorial
departments of health. This initial
effort is expected to serve as a base
from which we can expand partnerships and integrate more content in
order to achieve the most user-friendly
site possible.
Increased data and
analysis on the health of
Canadians and the
performance of the
health care system
As the discussion in the Health
Care Policy section of this report notes,
our partners look to Health Canada for
information that can be applied for
better evidence-based health policy
decision-making.
To respond to this need, we
published three issues of a new Health
Policy Research Bulletin and five
Policy Research Working Papers. In
addition to serving policy makers in
Health Canada, the publications were
distributed to policy makers and
analysts in other government departments, non-government organizations,
academic institutions, interested citizens and international organizations.
The Bulletin received excellent reviews, with 5,000 additional copies of
an issue on genetic testing reprinted in
response to demand. The Policy
Research Publications Program brings
information to both health professionals and Canadians, enabling them to
Departmental Performance by Strategic Outcome
73
certainty what works well and what
could work better. Progress to date in
enhancing such information is noted
below.
Improving Departmental
Performance Reporting and
Helping Meet Accountability and
Reporting Commitments
learn about the policy research that
underpins the decisions taken by
Health Canada. The publications help
to educate the public about complex
issues and promote the concept of
building health policy on a credible
evidence base. In the coming year we
will survey users to determine the
extent to which the research and
analysis made available through the
Policy Research Publications Program
is influencing program and policy
decision-making.
Increased capacity of
Health Canada to
monitor, report on and
improve the
performance of its major
programs
A key element in achieving better
health outcomes is knowing with some
74
As noted under the Health Care
Policy section of this report, we worked
with our provincial and territorial
counterparts to fulfill the commitments in the First Ministers’ September 2000 Communiqué on Health to
develop a framework for comparable
reporting. All jurisdictions will begin
this reporting in September 2002,
using a framework that includes
indicators of health outcomes, health
status and quality of services. The
reports will provide consistent and
comparable information to Canadians
and decision-makers. We began to
reflect this type of information in the
quantitative Annex to our Departmental Performance Report in 2000-2001.
For further information, please consult:
http://www.hc-sc.gc.ca/english/pdf/
estimates/HCDPR%202001-FinalEN.pdf.
Improving Performance
Measurement
We concluded a three year pilot
Performance Measurement Development Project that developed and
implemented accountability frameworks in key departmental areas to
improve performance management
and measurement. For example, a First
Nations and Inuit Health Program
Compendium was developed which
details all First Nations and Inuit
Health Branch programs that are
Health Canada
available to those communities. It
enables First Nations and Inuit
communities to select the programs
that best serve their communities, and
informs them of reporting requirements for each program.
In addition, more than 150 departmental employees participated in
performance measurement training.
Home and Community Care. The
frameworks clarify performance expectations and are expected to lead to
improved program outcomes once the
necessary data collection and analysis
process begins. They will form a base as
we examine new or updated performance frameworks for other programs.
As well, we worked with
stakeholders as we developed performance measurement frameworks for
more than 20 of our programs. These
covered activities such as our Hepatitis
C Prevention, Support and Research
Program and First Nations and Inuit
Departmental Performance by Strategic Outcome
Information, Analysis and Connectivity Branch
http://www.hc-sc.gc.ca/iacbdgiac/english/iacb/branch
index.html
75
Effective Support
for the Delivery of
Health Canada’s
Programs
Departmental
Management and
Administration
provincial and territorial governments
and other organizations. To help
achieve our goals, we have set out these
commitments:
Our Department achieves many of
its objectives due to core services that
support the activities and operations of
all branches. We also have an extensive
regional structure that is increasingly
called on to deliver Health Canada’s
programs and ensure the best possible
collaboration with our partners in
Objective
To provide effective support for the
delivery of Health Canada’s programs and for sound management
practices across the Department.
• Continuous improvement in the
provision of timely and quality
corporate administrative services
and in the promotion of sound
management practices, including
modern comptrollership.
• Integrated health research and
continual improvements in bringing that research into decisionmaking.
During 2001-2002, in addition to
our ongoing responsibilities we achieved
important progress in improved management through a number of major
initiatives.
Description
Responsible for providing administrative services to the Department.
Modernizing
Management Practices
Actual Spending 2001-2002
(millions of dollars)
As part of the government-wide
modern comptrollership initiative, we
developed and acted on a strategy
document to implement modern management practices in Health Canada.
Health Canada’s vision of modern
Gross
Revenues
Net
76
$209.0
$(0.4)
$208.6
Health Canada
comptrollership is an organization,
which focuses at every level on the
effective management of resources for
the achievement of results in a manner
consistent with clearly defined and
commonly accepted values and ethics.
streamline processes in response to
requests from funding recipients.
Our new Centre for Workplace
Ethics worked with more than 700
employees and managers to raise
awareness of values and ethics issues in
our workplaces, as well as how to
operationalize these core values into
day to day business
Recruitment of skilled young people
was a major human resource focus,
which saw us marketing and promoting the Department through career
and job fairs, on-campus recruitment
at universities and student employment programs. This enabled us to
attract qualified candidates for jobs.
We also worked with the Department
of Canadian Heritage on a guide of
suggestions that managers are now
using to identify and select diverse
candidates, develop talent and create
an inclusive workplace. For further
information regarding the staffing
environment pertaining to regulatory
and surveillance programs refer to
Appendix C.
A Departmental Workplace Health
Initiative was established and an Office
of Workplace Health created to make
Health Canada a workplace that values
and actively promotes employees’
health and well-being and supports
their ability to fulfill Health Canada’s
mission.
A key departmental initiative being
championed is making Health Canada
a “True Learning Organization”. The
Learning and Development Policy is
under revision and a Continuing
Education Council has been created as
part of our investment in learning and
development opportunities for our
employees.
We introduced new control frameworks that strengthen accountability
in the areas of grants and contributions, contracting and financial management. We support this work with
training and tools for managers.
We improved our ability to ensure
effective management of resources
through new standard agreements for
our grant and contribution programs.
The new agreements reflect Treasury
Board policy, respond to recommendations made by the Auditor General and
Recruitment at Health
Canada
Health Canada continues to place
emphasis on, and make good progress
in, its creation of a diversified work
force.
Development of French
and English Language
Minority Communities
Part VII of the Official Languages
Act mandates us to support the
development of French and English
language minority communities, which
we did through support to the work of
Consultative Committees that are
addressing the health-related priorities of both groups. Agreement has
been reached on implementing a
networking initiative that will provide
a foundation from which to develop
Departmental Performance by Strategic Outcome
77
better access to health services for such
minority communities. In addition to
our involvement in interdepartmental
responses through the Interdepartmental Partnership with the Official
Language Communities initiative, we
provided direct funding for specific
initiatives of importance to official
language minority communities such
as the “Santé en français” national
forum held in Moncton and the
“Building on our Strengths” initiative
in Quebec.
Office Expansion in the
National Capital Region
In order to address the Department’s rapid growth and subsequent
shortage of departmental office space
within the National Capital Region, we
accommodated over 900 new employees, through our Departmental Accommodation Plan.
Enhancements in
Security Post
September 11
A number of security elements have
been implemented to protect employees, information and other valuable
assets following the events of September 11, such as, enhanced access
controls and emergency response
capability, a national security review
and threat and risk assessments at
major facilities.
Role of the Chief
Scientist
The Department’s Office of the
Chief Scientist has played an impor78
tant role in strengthening our departmental links to the science community
and fostering more research that
improves the quality of our decisions
and programming. During the year, it
strengthened its research relationship
with the Canadian Institutes of Health
Research (CIHR). This improved the
Department’s capacity to guide and
draw on the health research we require
for evidence-based decisions. We also
took part in joint research initiatives in
areas such as bioterrorism, children’s
health and the environment, and
gender and health.
Regional
Accomplishments
Our regional operations continued
to be the focal point for the delivery of
many of the programs and services that
are described throughout this Report.
For example, our Regional Offices
continued to network with their
provincial and territorial government
counterparts in the development of
provincial primary health care initiatives; the expansion of multi-jurisdictional funding, e.g. Primary Health
Care Transition Fund; action on
northern health issues through collaboration with territorial governments; and improvements in the
delivery of our program and services to
communities and First Nations and
Inuit people.
Regions also worked together on
common issues. For example, the
regions responsible for program delivery in Nunavut, the Northwest Territories and the Yukon worked with
those territorial governments and the
Northern Secretariat to develop the
Territorial Wellness Initiative. This
Health Canada
initiative is a response to territorial
requests for a focal point within Health
Canada to provide easier and more
equitable access to programs and
funding for people living in the North.
A key step towards this provision of
single-window services to territorial
residents was taken through the
transfer of the Population and Public
Health Branch and First Nations and
Inuit Health Branch programs in the
three territories to the Northern
Secretariat. Health Canada manages
its program delivery in the territories
by working collaboratively with the
territorial governments, First Nations
and Inuit organizations, and other
voluntary sector organizations.
Regional offices for Alberta/Northwest Territories and Manitoba/Saskatchewan worked with Environment
Canada and over 80 other federal
government managers and scientists at
the Winnipeg Prairie Water Quality
Workshop to craft an interdepartmental resolution. The resolution recommended that a regional water
framework be developed as a basis for a
cohesive federal strategy to address
prairie water quality issues.
Each region has identified some
specific accomplishments for 20012002. Regions also contribute actively
to all departmental program outcomes.
Atlantic Region
Health Canada launched a formal
partnership with the four Atlantic
provincial health departments to share
information, determine joint priorities
and develop a common approach to
wellness in Atlantic Canada.
Chronic health risk assessments
were completed for residents living
near the contaminated Sydney Tar
Ponds site. This new information
helped to determine future options for
the local residents based on actual
levels of risk.
Québec Region
The success of Aboriginal Head
Start pilot projects in Kuujjuak and
Inukjuak demonstrated the value of
the program for young Inuit children.
As a result, we collaborated with le
Ministère de la famille et de l’enfance
du Québec, le Secrétariat des affaires
autochtones du Québec, les Fonds de la
Convention de la Baie-James, Human
Resources Development Canada and
local groups to establish similar
projects in 14 Inuit villages in the
Nunavik.
The Ambassador Program was
launched to enable Québec Region
employees to learn about our full range
of health programs and services so they
can draw on that information to
provide higher quality service.
Ontario/Nunavut Region
Recognizing the value of enabling
project sponsors to learn from each
other, the Ontario and Nunavut
Region designed a webboard to connect
sponsors of Health Canada-funded
children’s projects. During 2001-2002,
we worked with the Ontario government to expand the webboard to
include provincial children’s programs,
which created an interactive learning
environment for all major agencies in
Ontario that offer children’s services.
Ontario and Nunavut Region participated on the Ontario Hospital
Association’s Task Force on Supply
Departmental Performance by Strategic Outcome
79
Chain Management along with representatives from hospitals, suppliers,
group purchasing organizations, government agencies and industry consultants. In its report, Improving
Supply Chain Management for Better
Health Care released in November
2001, the Task Force reported its
finding that Ontario hospitals could
achieve significant savings (approximately $320 million annually) and
improve patient safety through a more
efficient supply chain.
The Ontario and Nunavut Regional
Office, in collaboration with Environment Canada, formed a secretariat to
follow the Walkerton Inquiry. This
group monitored proceedings and
analyzed findings in order to identify
any scientific or technical issues for
consideration in the development of
federal policy and programs.
Manitoba/Saskatchewan
Region
In Manitoba and Saskatchewan, we
helped to launch Federal-Provincial
Senior Officials Committees on Early
Childhood Development. These are
encouraging better communication
and collaboration on children’s health
policy and program development,
implementation and evaluation.
A regional public health capacity
pilot project was completed that
identified ways to increase interdepartmental and stakeholder collaboration
and coordination on water-borne diseases, tobacco use, Aboriginal public
health issues, regional research priorities and regional public health needs
assessments.
80
A model report on grants and
contributions and official languages
minority communities was completed
and distributed in order to assist
clients in applying for assistance under
our programs.
Alberta/Northwest
Territories Region
The Alberta/Northwest Territories
Region took steps to strengthen the
effective use of their resources through
a pilot project involving a service level
agreement between its regional
branches and their finance unit.
Through better definition of
accountabilities and responsibilities,
efficiencies are being realized and the
public will receive more streamlined
and effective regional program delivery.
Preparations for the protection of
public health and safety for the June
2002 G8 Summit in Kananaskis
involved intensive work on the part of
Alberta/Northwest Territories Region
in collaboration with a diverse group of
external and internal stakeholders.
Key among the external stakeholders
were Alberta Health and Wellness,
Calgary and Headwaters Regional
Health Authorities, the towns of
Cochrane and Canmore, the Stoney
First Nation and the Kananaskis
Improvement District. Internal
stakeholders were the Summit Management Office (Foreign Affairs and
International Trade), the Solicitor
General’s Department, and Treasury
Board, as well as Health Canada
Corporate and Legal Services, and
Cabinet Affairs and International
Programs within the Healthy Environments and Consumer Safety Branch.
Health Canada
British Columbia/Yukon
Region
Our Regional Office sought feedback on health issues of local concern
through five health round tables held
in local communities.
We also partnered with Simon
Fraser University to deliver two policy
forums: New Reproductive Technologies and Alternative Medicine. These
allowed us to gain stakeholder feedback and provide Health Canada
positions to participants.
We explored new approaches to
prenatal services with the Mount
Currie Indian Band. The use of
prenatal coupons exchangeable for
food at Band and local area grocery
stores, and access to prenatal classes,
community kitchens and baby clinics,
has been effective in the promotion of
healthy birth weights, encouraging
early access to prenatal care, increasing breast-feeding rates and duration,
and promoting nutrition education
among pregnant women.
Through the Vancouver Agreement, an initiative involving three
levels of government, we are contributing to the efforts of multiple sectors to
address drug-related problems in
Vancouver’s Downtown Eastside. The
opening of the Health Contact Centre
in January 2002, in combination with
enforcement efforts, has visibly decreased the open drug scene and
provided treatment options that were
formerly unavailable. Efforts to include diverse communities in the
implementation of Vancouver Agreement initiatives are helping to build
community acceptance of innovative
solutions to long-standing and complex
problems.
Departmental Performance by Strategic Outcome
81
82
Health Canada
Section IV:
Reporting on
Government Themes and
Management Issues
Modernizing
Comptrollership
Health Canada achieved significant
milestones over the past year in
relation to implementing modern
management practices.
A modern comptrollership capacity
self-assessment was completed.
An internal governance structure
was established with the creation of a
Departmental Executive Sub-Committee on Operations to oversee the
modern comptrollership initiative and
provide a champion for support and
leadership in all activities related to
the initiative.
A strategy document entitled,
A Modern Management Strategy Implementing Modern Comptrollership
in Health Canada, which included an
action plan, was developed and distributed to internal and external
stakeholders. The Strategy presents
Health Canada’s vision of a modern
comptrollership organization, describes
the elements of modern comptrollership
being addressed through initiatives
under way within the Department, and
provides opportunities and actions for
improvement, including planned activities to maintain the momentum.
In conducting the capacity assessment and developing the Modern
Management Strategy, awareness of
the concepts of modern comptrollership
was increased and inculcated into the
departmental culture.
In particular, a number of management practices were implemented
which further enhanced the Department’s management framework,
such as:
• creation of a Centre for Workplace
Ethics responsible for the conduct
of a dialogue on values and
ethics. This initiative defined,
described and communicated to
over 700 employees and managers a
number of core departmental values of importance to employees of
Health Canada;
Reporting on Government Themes and Management Issues
83
• development of accountability
frameworks in the areas of grants
and contributions and contracting,
including action plans for improving the Department’s practices and
procedures and training for all
managers;
• creation of a financial management
control framework which documents essential requirements and
control objectives, and produces
practical and maintainable tools for
managers and functional specialists
to better understand their roles and
responsibilities in relation to controls;
for Results” aimed at increasing
managers’ awareness and knowledge through the provision of a
comprehensive orientation on the
administrative processes of management within Health Canada.
Health Canada has recognized the
need to improve the management of its
procurement and contracting activities
by implementing more effective control practices and managing risk to
acceptable levels of exposure. These
improvements are part of the Department’s overall approach to enhancing
its management practices.
• successful piloting of a new course
for managers entitled “Managing
84
Health Canada
Procurement and Contracting
1. Role played by procurement
and contracting in
delivering programs.
Procurement and contracting play an
integral role in the support of program
delivery in this Department. The aim of
procurement and contracting is to
provide materiel and services in
conjunction with program activities
aimed at achieving departmental goals
and objectives.
2. Overview of the contracting
management processes and
strategy within the
Department.
As part of overall efforts to strengthen
its management practices and processes,
Health Canada launched a management
review of its contracting function. As a
result, consistent with modern
comptrollership, Health Canada has
prepared a Contract Management
Framework and Action Plan for
implementation of the recommended
improvement opportunities. The Action
Plan deals with four major themes:
responsibility, accountability, oversight
and monitoring, and audit. Health
Canada senior management is
committed to rigorous contract
management practices across the
Department.
3. Progress and new
initiatives enabling
effective and efficient
procurement practices.
See 2 above.
4. Internet links and/or
website addresses.
Health Canada does not have an
Internet/Intranet site on procurement
and contracting. Health Canada does,
however, have a departmental policy
centre database on Materiel
Management in Lotus Notes.
Reporting on Government Themes and Management Issues
85
Materiel Management
1. Has there been an assessment
and/or inventory of resources?
A complete inventory was taken of all
capital assets in the fall of 2000. This inventory
listing is maintained on an ongoing basis.
2. What is the basis of the
assessment and the Department's
level of confidence in the
outcomes?
All assets that have a value in excess of
$1,000 or that are considered to be of an
attractive nature valued at less than
$1,000 were inventoried. This inventory
was verified in each program area.
3. Have the life-cycle costs for
mission critical assets been
identified?
Yes, as part of the Long-Term Capital
Plan (LTCP).
4. Has a plan been developed for
life-cycle, mission critical assets?
A Long-Term Capital Plan was submitted and
noted by the Treasury Board on February 12,
2002. A Part II update is being developed for
submission with the Annual Reference Level
Update (fall 2002).
5. What progress has been made to
identify these assets and their
operational cost?
All such assets have been inventoried and their
operational cost identified.
6. Have any serious concerns or
problem areas been identified?
The LTCP has identified gaps in O&M and
capital funding for the maintenance and upkeep
of assets.
7. Have risk management
assessments been made on
mission critical assets and if so,
has the financial impact on
operational capabilities been
determined?
Construction projects undergo a review by the
Labour Canada, Fire Commissioner's Office,
during the architectural plan preparation as well
as a final inspection prior to move-in to ensure
all newly constructed or renovated facilities
comply with appropriate building codes and
regulations. Additionally, building condition
reports are periodically undertaken on facilities
to identify any potentially hazardous situations
or health and safety concerns. Annual
inspections of facilities are also completed by
regional maintenance staff and a repair and
replacement budget prepared to address any
outstanding issues requiring attention. The
financial impact identified is a shortfall in O&M
and capital funding for the maintenance and
sustainability of assets.
86
Health Canada
Sustainable
Development
Health Canada’s final report on its
first sustainable development strategy, Sustaining Our Health (1997),
was completed this past year. The
Department originally reported in the
2000-2001 Departmental Performance
Report, that approximately 75 percent
of the strategy targets were completed.
In fact, the final target completion is
81 percent, and a full analysis of lapsed
targets has taken place resulting in a
corrective action plan to ensure that all
outstanding targets are addressed.
Health Canada’s Sustainable Development Strategy 2000 (SDS 2000)
has been under way for a full year.
Long-Term Targets for SDS 2000
44%
56%
Complete
Not Complete
This second departmental sustainable development strategy builds on
the lessons learned from the implementation and evaluation of the first,
and provides an outcome oriented
action plan for the three years of the
Strategy (April 2001 - March 2004). In
SDS 2000, the Department has focused
its sustainable development commitments on three priority areas, or
themes:
• Helping to create healthy social and
physical environments.
• Integrating sustainable development into departmental decisionmaking and management processes.
• Minimizing the environmental
health effects of the Department’s
physical operations and activities.
Within these three theme areas, the
specific commitments of SDS 2000 are
organized into Objectives and Targets.
Objectives are the overall directions
arising under each sustainable development theme, while Targets are the
detailed performance requirements
that the Department has set out to
achieve. Long-Term Targets have been
further organized into specific ShortTerm Targets that are outcome
oriented, measurable, time limited and
directly related to the eight federal
themes for sustainable development.
For the SDS 1997 Final Report and
an Annual Report for SDS 2000, please
consult: http://www.hc-sc.gc.ca/
susdevdur.
It is clear that many of Health
Canada’s programs and activities are
supportive of an integrative approach
to environmental, economic, and social/cultural issues, as is the underlying
principle of sustainable development.
The departmental SDS provides an
opportunity to focus beyond these
programs, and establish specific sustainable development objectives where
significant and concrete advances can
be made.
Reporting on Government Themes and Management Issues
87
Business Line Sustainable Development highlights for 2001-2002
include:
Health Promotion and
Protection Business Line
Long-Term Target (LTT):
Incorporated the principles of
sustainable development and
population health into public
education and awareness campaigns.
• Launched three public awareness
campaigns that promote healthy
lifestyles.
• Disseminated information about
best practices in five areas to health
care and other professionals working in the field of family violence
prevention.
LTT: Supported projects, research and initiatives to improve
community capacity to take action on health and healthy environments.
• Enhanced the health of communities and their capacity to take action
on health and healthy environments in all six Health Canada
regions.
LTT: Provided information to
Canadians so that they can make
more informed decisions about
their exposure to products and
environmental hazards.
• Provided callers to the Pest Management Regulatory Agency’s
(PMRA) information services with
information on non-pesticidal ways
to control home and garden pests,
as well as on pesticides.
88
LTT: Reduce risks from selected products and environmental hazards by improving risk
assessment and risk management
processes.
• Announced the discontinuation of
four of the 27 organophosphate
pesticides in use in Canada (in
consultation with industry
stakeholders and the U.S. Environmental Protection Agency). For
more information, please consult:
http://www.hc-sc.gc.ca/pmra-arla/
english/pubs/pubs-e.html.
First Nations and Inuit
Health Business Line
Long-Term Target (LTT):
Reduced the health inequities
between Canada’s First Nations
and Inuit and the general population for selected health problems.
• Developed action plans for targeted
priority notifiable diseases, such as
tuberculosis, and an integrated
communicable disease control program at the national, regional and
community levels in partnership
with First Nations.
LTT: Strengthened the NonInsured Health Benefits Program
(NIHB) that provides for medically necessary health-related
goods and services for First
Nations and Inuit that are not
provided through other private or
provincial/territorial health insurance plans.
• Implemented a pharmacy, medical
supplies and medical equipment
and dental provider audit plan.
Health Canada
• Established a mechanism to identify and address policy and financial
risks to the NIHB.
LTT: Increased home and community care capacity in First
Nations and Inuit communities.
• Implemented the development
phase of the First Nations and Inuit
Home and Community Care Program. The goal is to make it
accessible to a minimum of 75 percent of First Nations living onreserve and Inuit by the end of
2002-2003, with specific focus on
services to the chronically ill,
disabled and on post-hospital care.
LTT: Controlled risks to health
and the environment through
environmentally-responsible land
and facilities management.
• In total, nine out of 37 of the
assessed First Nations and Inuit
Health Branch’s fuel contaminated
sites have undergone complete
remediation and work is under way
to decontaminate another 17 sites.
Departmental
Management and
Administration Business
Line
Health Canada has incorporated
the targets outlined in the Sustainable
Development in Government Operations (SDGO) document into the 2000
Sustainable Development Strategy.
Progress on the SDGO targets is
highlighted in our Annual Report.
Long-Term Targets (LTT):
Implemented a Department-wide
Environmental Management System, consistent with ISO 14001.
• Implemented a process for ongoing
annual reporting on the status of
the Departmental Environmental
Management System (EMS).
• Inaugurated Building Performance
Reviews at all Health Canada
laboratories on an annual basis.
LTT: Increased water conservation and efficient wastewater
management.
• Conducted water audits to investigate water saving initiatives at
Health Canada laboratories.
Service
Improvement
Initiative
Results for Canadians commits the
Government of Canada to a “citizen
focus” and “citizen-centered service
delivery”. In May 2000, the Treasury
Board approved the Service Improvement Initiative (SII), which contributes to achieving this commitment by
identifying citizen expectations and
priorities for service improvement, and
implementing a program towards
progressively improving client satisfaction with key services.
Because the Citizens First 2000
national survey indicated that Health
Canada’s information services were a
priority, five key information services
became the initial focus for departmental service improvement efforts:
• It’s Your Health publications - A
client survey of distributors and
users of It’s Your Health publications identified opportunities to
improve distribution, including pro-
Reporting on Government Themes and Management Issues
89
motion of the on-line version and
updating database lists.
• Pest management 1-800 information system - A client satisfaction
survey was designed for implementation in June 2002.
• Canadian Health Network (CHN) A pilot website survey found that
29 percent of users who replied
were very satisfied with the CHN
site, with the majority of respondents being females (63 percent),
from Ontario and Quebec (25 and
20 percent respectively).
• Non-Insured Health Benefits Drug
Exception Centre - A random
sample survey of 1000 pharmacists
who need to request approval of
certain drugs for Status Indian and
Inuit clients was completed in June
2002, using toll-free fax technology.
The Drug Exception Centre responded to comments received from
the pharmacists and adjustments
were made.
• Health Canada’s general enquiries
1-800 lines - A six-month regional
pilot project to improve services
through the General Enquiries
Centre in Toronto is set to begin in
September 2002.
A sixth project, a 24/7 Emergency
Call Management System, was added
later to assess implementation of a
special 1-800 number to provide better
coordination of, and access to, timely
health information for the professional
community in the case of a health
emergency/crisis.
90
Government OnLine
Health Canada made significant
progress on three Government OnLine (GOL) projects with funding from
Treasury Board in the amount of $6.9
million:
• Canada Health Portal (CHP):
Health Canada partnered with
several other federal departments
to develop the CHP: http://www.chppcs.gc.ca, as part of the larger
Government of Canada On-Line
initiative. The CHP is an Internet
site providing Canadians with
single-window access to trusted and
credible health information from
multiple sources such as the
Canadian Health Network. The
portal links the public to current
health-related information from
across the federal government as
well as to the homepages of the
provincial and territorial departments of health. The focus will now
be on expanding the partnership
base and integrating more content
into an increasingly user-friendly
site.
• Provincial-Federal First Nations
and Inuit Telehealth Project: Initial
phases of this project involved the
development and rollout of the
technical infrastructure for 41 First
Nations communities, enabling
them to access health care through
telehealth programs. The Telehealth
Project also allows for increased
access to health care information
through a web-based health document repository. For further information, please refer to page 64.
Health Canada
• First Nations and Inuit Primary
Care Electronic Health Record
Project: This project accelerated
the development of the First
Nations and Inuit Health Information System (FNIHIS) from a case
management tool used by public
health nurses in First Nations and
Inuit communities to an integrated,
primary care Electronic Health
Record (EHR) used by all community health providers and linked to
provincial/territorial EHRs. Experience was gained in cross-jurisdictional GOL initiatives with First
Nations and Inuit. For further
information, please refer to page 64.
As a result of efforts made this fiscal
year, Canadians will also benefit when
the National Dosimetry Services goes
on-line with the measurement, analysis and reporting of radiation exposure
results, improving service delivery for
its 95,000 clients.
Work is also under way at Health
Canada to develop procedures for the
creation, publication and management
“Yahoo Health” and the Health
Canada site are the most commonly visited websites, followed
by the Canadian Health Network.
EKOS Research Associates
of web information and services, in
accordance with the Treasury Board
requirement for departments to meet
Common Look and Feel (CLF) and
other standards for their websites by
December 2002. At the same time,
Health Canada is taking steps to
ensure that its website continues to be
a reliable and trustworthy source of
health information for Canadians.
These activities support the role of
Health Canada as a provider of
information to Canadians as well as the
Government On-Line goal of making
information and services accessible
on-line.
Health System
Performance
Reporting
The Department continued its
work with provincial and territorial
government counterparts to realize the
commitments in the Social Union
Framework Agreement (SUFA) to
improved performance measuring and
reporting and in the First Ministers’
September 2000 Communiqué on
Health to develop a framework for
comparable reporting. As a result, in
September 2002 all jurisdictions will
begin to report on indicators of health
outcomes, health status and quality of
services. The reports will provide
consistent and comparable information to Canadians, including health
policy and program decision-makers.
We began to reflect this approach in
the quantitative Annex that we
included in the electronic version of the
Departmental Performance Report for
2000-2001 and in Appendix A of this
Report. This information indicates a
broad level of outcomes that cannot
normally be ascribed to the actions of
one Department or jurisdiction.
Health Canada has also been
working with Treasury Board and a
number of federal departments to
Reporting on Government Themes and Management Issues
91
promote the principles embedded in
the Social Union Framework Agreement in program delivery. For further
details, please consult the SUFA
Accountability Templates at:
http://www.tbs-sct.gc.ca/rma/account/sufa_e.asp.
Alternative Service
Delivery Foundations
In general, while departments
continue to play an important role in
service delivery, a growing need for
flexibility, interdependence and innovation has produced an increasing
diversity of organizational forms and
service delivery arrangements to provide more responsive service to Canadians. With respect to improving the
delivery of health programs and
services, two foundations have been
created to meet specific needs.
Improving Canada’s
health statistics system
In support of better decisionmaking and public accountability, the
Government of Canada has been
making a major financial contribution
to improving Canada’s health statistics
system. In the December 2001 Budget,
the Government committed a further
$95 million for the Health Information
Roadmap project. This will help the
Canadian Institute for Health
Information (CIHI) and Statistics
Canada carry on with activities begun
with the $95 million Roadmap funding
(over four years) of the 1999 Budget.
92
This funding has enabled new reports
on the health of Canadians and the
health of our health care system and
new data sources, especially a major
new survey of population health in 133
different regions that was designed and
mounted in the last three years, with
first results published in May 2002.
Roadmap data is being used in the
reports on health system performance
that federal/provincial/territorial governments will publish this September
and in the analysis of the Commissi
on on the Future of Health Care in
Canada. Roadmap funding is in
addition to ongoing funding of
$2.2 million provided by Health Canada
to CIHI to support core CIHI programs
and activities.
Accelerating the
development of
electronic health record
solutions in the health
sector
As a result of the First Ministers’
Agreement on Health of September
2000, the federal government provided
an initial investment of $500 million in
March 2001 for the creation of an
independent not-for-profit corporation
mandated to accelerate the development and adoption of modern health
systems of information and communications technology. Canada Health
Infoway Inc. (Infoway) is that
corporation. The corporation’s membership consists of the Deputy Ministers of Health from the federal,
provincial and territorial governments
(to date, the Quebec Deputy Minister
has chosen not to participate). Infoway’s
immediate priority is to foster and
Health Canada
accelerate the development of
inter-operable electronic health record
solutions on a pan-Canadian basis in a
cost-effective manner to support
improved quality of care. Infoway
is expected to publish its annual
report and business plan this year.
For further information, please
consult: http://www.ca nadahealth
infoway.ca/.
Reporting on Government Themes and Management Issues
93
94
Health Canada
Section V:
Financial Performance
Financial Performance Overview
The following financial summary
tables are presented to provide an
overview of Health Canada’s 2001-2002
resource utilization along with prior
years’ comparative information. Again
this year, Health Canada has strived to
utilize resources in the most effective
and efficient way possible, in an effort
to ensure Canadians receive value for
resources expended.
Financial Performance
Overall in 2001-2002, Health
Canada did not have significant lapses.
A surplus of $56.5 million or two
percent of the authorities in operating
and grants and contributions resources
did occur. This was primarily attributable to delays encountered during the
year in specific activities some of which
will be completed in 2002-2003, a
frozen allotment, and other small
operating lapses.
95
Financial Summary Tables
Financial Table 1:
Financial
Table 1: Summary of Voted
Summary of Voted Appropriations
Appropriations
Authorities for 2001-2002
Authorities for 2001-2002
This table reflects the break down of Health
Canada’s resources by Voted Appropriations.
Health Canada at present has two votes: Vote 1 for
Operating Expenditures and Vote 5 for Grants and
Contributions.
Actual spending for Vote 1 is $38.7 million lower
than authorities, mainly resulting from delays in
some activities which will be carried out in 20022003, a frozen allotment, and other small operating
lapses. The total authorities for Vote 1 are $153.7
million higher than the planned spending mainly
due to newly approved resources of several
initiatives such as Federal Tobacco Control, Public
Security and Anti-Terrorism and Program Integrity
initiatives.
Actual spending for Vote 5 is $17.8 million lower
than authorities, mainly caused by delays in
receiving proposals for Primary Health Care
Transition Fund (PHCTF). The total authorities for
Vote 5 are $71.2 million lower than the planned
spending mainly resulting from a change to the
funding profile related to PHCTF and the
reprofiling of resources to future years related to
Hepatitis C - Health Care Services,
Lookback/Traceback and the Canada Health
Infostructure Partnerships Program (CHIPP).
Financial Requirements by Authority (millions of dollars)
Vote
Planned
Spending1
2001-2002
Total
Authorities2
Actual
Spending2
Health Canada
1
Operating expenditures
1,355.3
1,509.0
1,470.3
5
Grants and Contributions
1,211.4
1,140.2
1,122.4
(S)
Minister of Health Salary and motor car allowance
-
0.1
0.1
(S)
Contributions to employee benefit plans
79.5
82.4
82.4
(S)
Spending of proceeds from the disposal
of surplus Crown assets
-
0.8
0.5
Refunds of amounts credited to
revenues in previous years
-
3.7
3.7
Payments for insured health services
and extended health care services
-
(0.3)
(0.3)
(S)
(S)
Total Department
2,646.2
2,735.9
2,679.1
Total Authorities are Main Estimates plus Supplementary Estimates plus other authorities.
1) from the 2001-2002 Report on Plans and Priorities
2) from the 2001-2002 Public Accounts
96
Health Canada
Financial Table 2:
Comparison
of Total
Planned Spending
to
Financial
Table
2: Comparison
of Total
Actual Spending
Planned Spending to Actual Spending
This table reflects how resources are used
within Health Canada by appropriation and by
business line. Explanations of variances by business
line can be found in Table 9: Details of Financial
Information by Business Lines and Service Lines.
Further details for non-respendable revenues
can be found in Table 5: Revenue. Cost of services
provided by other departments includes
accommodation, workers’ compensation coverage,
legal services, and employee insurance plans.
Departmental Planned versus Actual Spending 2001-2002 by Business Line
(millions of dollars)
Business Lines
Health Care Policy
(Planned spending)
(Total authorities)
(Actual spending)
FullTotal
Less:
Total
Time
Grants &
Gross Respendable Net
Equivalents Operating Capital Contributions Expenditures Revenues Expenditures
353
341
375
90.5
82.5
76.5
204.7
46.6
30.6
295.2
129.1
107.1
Health Promotion and Protection
(Planned spending)
4,169
(Total authorities)
4,128
(Actual spending)
3,951
474.3
549.6
533.5
309.0
260.0
258.2
783.3
810.8
792.9
(39.7)
(52.9)
(49.9)
743.6
757.9
743.0
First Nations and Inuit Health
(Planned spending)
1,414
(Total authorities)
1,443
(Actual spending)
1,555
705.1
711.2
709.0
627.6
637.0
637.0
1,332.7
1,348.2
1,346.0
(9.1)
(9.1)
(6.9)
1,323.6
1,339.1
1,339.1
Information & Knowledge Management
(Planned spending)
635
(Total authorities)
669
(Actual spending)
690
119.3
143.7
137.1
52.8
144.2
144.2
172.1
287.9
281.3
1.2
1.2
295.2
129.1
107.1
172.1
287.9
281.3
Departmental Management & Administration
(Planned spending)
747
91.2
(Total authorities)
1,165
154.7
(Actual spending)
1,392
141.1
3.9
15.8
15.8
17.3
52.1
52.1
112.4
222.6
209.0
(0.7)
(0.7)
(0.4)
111.7
221.9
208.6
Total
(Planned spending)
(Total authorities)
(Actual spending)
3.9
17.0
17.0
1,211.4
1,139.9
1,122.1
2,695.7
2,798.6
2,736.3
(49.5)
(62.7)
(57.2)
2,646.2
2,735.9
2,679.1
7,318
7,746
7,963
1,480.4
1,641.7
1,597.2
Other Revenues and Expenditures
Non-Respendable Revenues
(Planned spending)
(Total authorities)
(Actual spending)
Cost of services provided by other departments
(Planned spending)
(Total authorities)
(Actual spending)
Net Cost of the Program
(Planned spending)
(Total authorities)
(Actual spending)
Financial Performance
(7.8)
(7.8)
(32.5)
58.6
58.6
70.3
2,697.0
2,786.7
2,716.9
97
Financial Table 3:
Historical Comparison
of Total Planned
Financial
Table 3: Historical
Comparison
Spending to Actual Spending
ofThis
Total
Planned Spending
to Actual
table shows the trend of expenditures over
Some funding announcements were for one
time by business line. Large variances are mainly
year only, as was the case in Information &
Spending
the result of new initiatives announced in recent
Knowledge Management in 2001-2002 (e.g.
Budget speeches, reprofiling of resources, or
sunsetting of initiatives.
Canadian Institute for Health Information).
Departmental Planned versus Actual Spending by Business Line
(millions of dollars)
Business Lines
1999-2000
2000-2001
Actual
Spending
Actual
Spending
2001-2002
Planned
Spending
Total
Authorities
Actual
Spending
Health Care Policy
128.4
112.6
295.2
129.1
107.1
Health Promotion
and Protection
1,401.41
634.4
743.6
757.9
743.0
First Nations and
Inuit Health
1,128.1
1,266.5
1,323.6
1,339.1
1,339.1
Information &
Knowledge
Management
88.7
126.7
172.1
287.9
281.3
Departmental
Management &
Administration
148.7
180.3
111.7
221.9
208.6
2,895.3
2,320.5
2,646.2
2,735.9
2,679.1
Total
Total Authorities are Main Estimates plus Supplementary Estimates plus other authorities.
1) 1999-2000 Actual Spending for Health Promotion and Protection includes $855.3 million for a onetime court-ordered payment.
98
Health Canada
Total Planned Spending and Actual Spending 2001-2002 (millions of dollars)
Business Lines
Health
Care
Policy
Strategic Outcomes
Access to quality health care
Health
Promotion &
Protection
First Nations
&
Inuit Health
Financial Table 4: Crosswalk between
Strategic Outcomes and Business Lines
Financial Performance
Financial Table 4:
Crosswalk between Strategic Outcomes and
Business Lines
Business Lines
Information &
Knowledge
Management
Departmental
Management &
Administration
Total
($)
% of Total
FTEs
295.2
107.1
11.2%
4.0%
353
375
services for Canadians
(Planned spending)
(Actual spending)
Improved well-being through health
promotion and illness prevention
(Planned spending)
(Actual spending)
438.6
395.3
438.6
395.3
16.6%
14.7%
1,150
1,071
Safer health products
and food for Canadians
(Planned spending)
(Actual spending)
144.3
128.2
144.3
128.2
5.4%
4.8%
1,684
1,472
Healthier environments and
safer products for Canadians
(Planned spending)
(Actual spending)
139.3
194.5
139.3
194.5
5.3%
7.3%
1,051
1,076
Sustainable pest management
and programs for Canadians
(Planned spending)
(Actual spending)
21.4
25.0
21.4
25.0
0.8%
0.9%
284
332
1,323.6
1,339.1
50.0%
50.0%
1,414
1,555
172.1
281.3
6.5%
10.5%
635
690
111.7
208.6
111.7
208.6
4.2%
7.8%
747
1,392
2,646.2
2,679.1
295.2
107.1
Sustainable health services and programs
for First Nations and Inuit communities
so their people may attain a level
of health comparable with
(Planned spending)
that of other Canadians
(Actual spending)
1,323.6
1,339.1
99
Better health outcomes through
information and communication
technologies and evidence-based
decision-making
(Planned spending)
(Actual spending)
Effective support for the delivery
of Health Canada’s programs
(Planned spending)
(Actual spending)
Strategic Outcomes
(Planned spending)
(Actual spending)
295.2
107.1
743.6
743.0
1,323.6
1,339.1
172.1
281.3
111.7
208.6
% of Total
(Planned spending)
(Actual spending)
11.2%
4.0%
28.1%
27.7%
50.0%
50.0%
6.5%
10.5%
4.2%
7.8%
Full-Time Equivalents (FTEs)
(Planned spending)
(Actual spending)
353
375
4,169
3,951
1,414
1,555
635
690
747
1,392
172.1
281.3
Note: Due to rounding, figures may not add up to totals shown.
100.0%
100.0%
7,318
7,963
Financial Table 5: Revenue
Reflected in this table is the collection of
respendable revenues by business line/service line
and of non-respendable revenues by classification
and source. Non-respendable revenues are shown by
source in order to reflect the information in a useful
format.
A variety of respendable revenues are collected
which include Medical Devices, Radiation
Dosimetry, Drug Submission Evaluation, Veterinary
Drugs, Pest Management Regulation and Product
Safety.
Financial Table 5: Revenue
Revenues (millions of dollars)
1999-2000
2000-2001
Actual
Actual
Planned
Total
Actual
Revenues
Revenues
Revenues
Authorities1
Revenues
0.0
0.0
0.1
36.0
36.0
35.5
3.5
9.9
7.4
0.2
7.0
6.9
9.1
9.1
6.9
0.7
0.7
0.4
49.5
62.7
57.2
-
-
-
11.6
1.7
0.2
2.8
0.2
2.8
-
3.6
3.6
0.8
-
-
8.5
1.2
1.2
15.6
22.8
78.7
7.8
57.3
7.8
70.5
32.5
89.7
Respendable Revenues
2001-2002
2
Business Lines/Service Lines
Health Promotion and Protection
Population and
Public Health
0.1
0.0
Health Products
and Food
39.8
34.5
Healthy Environments
and Consumer Safety
6.6
6.9
Pest Management
Regulation
7.3
7.0
First Nations and Inuit Health
First Nations and
Inuit Health
6.8
7.2
Departmental Management and Administration
Corporate Services
0.4
0.3
Total Respendable
Revenues2
61.0
55.9
Non-Respendable Revenues
Main Classification and Source
Tax revenues:
Goods and services tax
0.3
Non-tax revenues:
Food and drug analysis fees
Refunds of expenditures
5.2
Service fees
1.9
Pharmacy and
dietary revenues
Proceeds from the
disposal of surplus
Crown assets
0.6
Miscellaneous
non-tax revenues
6.6
Total
Non-Respendable
Revenues
14.6
Total Revenues
75.6
1)
2)
100
0.2
14.5
1.8
0.6
Total Authorities are Main Estimates plus Supplementary Estimates plus other authorities.
Respendable Revenues: These revenues were formerly called "Revenues Credited to the Vote" and are
available for spending by the Department.
Health Canada
Financial Table 6:
Statutory Payments
Health Canada's only statutory payment in to individuals infected with Hepatitis C through the
Financial
6: Statutory
Payments
recent years was for aTable
one-time court-ordered
blood supply between
January 1, 1986 and July 1,
payment of $855.3 million providing compensation
1990.
Statutory Payments by Business Line (millions of dollars)
Business Line
1999-2000
2000-2001
Actual
Spending
Actual
Spending
2001-2002
Planned
Spending
Total
1
Authorities
Actual
Spending
Health Promotion
and Protection
855.3
0.0
0.0
0.0
0.0
Total Statutory
Payments
855.3
0.0
0.0
0.0
0.0
1) Total Authorities are Main Estimates plus Supplementary Estimates plus other authorities.
Financial Performance
101
Financial Table 7:
Transfer Payments
Financial
Table 7: Transfer
Payments
Care Transition Fund) and the reprofiling
This table reflects the break down of Transfer
Payments (Grants, Contributions, and Other
Transfer Payments) by Business Line. Large
variances are mainly the result of new initiatives
announced in recent Budget speeches (e.g. Canada
Prenatal Nutrition Program, Canadian Diabetes
Strategy, Sustaining the Health Protection Capacity,
Federal Tobacco Control Strategy, Primary Health
of
resources (e.g. Hepatitis C Health Care Services and
Lookback/Traceback). Some funding
announcements were for one year only, as was the
case in Information & Knowledge Management in
2001-2002 (e.g. Canadian Institute for Health
Information).
Transfer Payments by Business Line (millions of dollars)
Business Lines
1999-2000
2000-2001
Actual
Spending
Actual
Spending
2001-2002
Planned
Spending
Total
1
Authorities
Actual
Spending
Grants
Health Care Policy
11.9
11.9
0.9
1.1
1.1
Health Promotion
and Protection
54.9
23.7
28.4
23.3
23.3
0.0
0.0
0.0
95.0
95.0
66.8
35.6
29.3
119.4
119.4
Health Care Policy
49.3
43.0
203.8
45.5
29.5
Health Promotion
and Protection
157.8
172.6
209.6
180.9
179.1
First Nations and
Inuit Health
545.9
589.1
627.6
637.0
637.0
Information and
Knowledge
Management
12.5
20.8
52.8
49.2
49.2
Departmental
Management
and Administration
32.2
41.0
17.3
52.1
52.1
Total Contributions 797.7
866.5
1,111.1
964.7
946.9
Information and
Knowledge
Management
Total Grants
Contributions
Other Transfer Payments
Health Promotion
and Protection
0.0
29.6
71.0
55.8
55.8
Total Other
Transfer Payments
0.0
29.6
71.0
55.8
55.8
864.5
931.7
1,211.4
1,139.9
1,122.1
Total Transfer
Payments
1) Total Authorities are Main Estimates plus Supplementary Estimates plus other authorities.
102
Health Canada
Financial Table 8:
Resource Requirements by Organization and
Financial
Table 8: Resource
Business Lines
Requirements
by Organization and
Comparison of 2001-2002 (RPP) planned spending and total authorities to actual
spending
by organization
and business line.
Business
Lines
Explanations of variances by business line can be found in Table 9: Details of
Financial Information by Business Lines and Service Lines (millions of dollars)
Organization
Health Care
Policy
Health Policy and
Communications
(Planned spending)
295.2
(Total authorities)
129.1
(Actual Spending)
107.1
Population and Public Health
(Planned spending)
(Total authorities)
(Actual Spending)
Health Products and Food
(Planned spending)
(Total authorities)
(Actual Spending)
Healthy Environments and
Consumer Safety
(Planned spending)
(Total authorities)
(Actual Spending)
Pest Management
Regulatory Agency
(Planned spending)
(Total authorities)
(Actual Spending)
First Nations and
Inuit Health
(Planned spending)
(Total authorities)
(Actual Spending)
Information, Analysis
and Connectivity
(Planned spending)
(Total authorities)
(Actual Spending)
Corporate Services
(Planned spending)
(Total authorities)
(Actual Spending)
Departmental Executive
(Planned spending)
(Total authorities)
(Actual Spending)
Total
(Planned spending)
295.2
(Total authorities)
129.1
(Actual Spending)
107.1
% of Total
4.0%
Health
Promotion
and Protection
Business Lines
First Nations
and Inuit
Health
Information
and Knowledge
Management
Departmental
Management and
Administration
Total
295.2
129.1
107.1
438.6
395.4
395.3
438.6
395.4
395.3
144.3
138.4
128.2
144.3
138.4
128.2
139.3
199.1
194.5
139.3
199.1
194.5
21.4
25.0
25.0
21.4
25.0
25.0
1,323.6
1,339.1
1,339.1
1,323.6
1,339.1
1,339.1
172.1
287.9
281.3
743.6
757.9
743.0
27.7%
1,323.6
1,339.1
1,339.1
50.0%
172.1
287.9
281.3
10.5%
172.1
287.9
281.3
90.8
103.7
101.6
90.8
103.7
101.6
20.9
118.2
107.0
20.9
118.2
107.0
111.7
221.9
208.6
7.8%
2,646.2
2,735.9
2,679.1
100.0%
Numbers in italics denote Total Authorities for 2001-2002 (Main and Supplementary Estimates and
other authorities).
Financial Performance
103
Financial Table 9:
Details of Financial Information by Business
Financial
Table 9:
Details of Financial
Lines and Service
Lines
Information by Business Lines and
Business Line 1: Health Care Policy
Service
Lines
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
295.2
N/A
129.1
N/A
107.1
N/A
Net expenditures
295.2
129.1
107.1*
* This represents 4.0 percent of the Department's actual spending.
Decrease between planned spending versus authorities is mainly due to a change in the funding profile of the
Primary Health Care Transition Fund (PHCTF).
Variance between authorities and actual spending is also mainly caused by delays in receiving proposals for
the PHCTF.
Business Line 2: Health Promotion and Protection
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
783.3
(39.7)
810.8
(52.9)
792.9
(49.9)
Net expenditures
743.6
757.9
743.0*
* This represents 27.7 percent of the Department's actual spending.
Refer to Service Lines for explanations of variances.
104
Health Canada
Financial Table 9: Details of Financial Information by Business Lines
and Service Lines (continued)
Service Line 1: Population and Public Health
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
438.6
0.0
395.4
0.0
395.4
(0.1)
Net expenditures
438.6
395.4
395.3*
* This represents 53.1 percent of the Health Promotion and Protection actual spending.
Variances between planned spending versus total authorities and actual spending are mainly due to
reprofiling of resources to future years of Hepatitis C - Health Care Services and Lookback/Traceback
initiatives.
Service Line 2: Health Products and Food
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
180.3
(36.0)
174.4
(36.0)
163.7
(35.5)
Net expenditures
144.3
138.4
128.2*
* This represents 17.3 percent of the Health Promotion and Protection actual spending.
The actual spending is $10.2 million lower than total authorities. This is the result of delays in various
activities throughout this service line as well as some reduced program requirements. Revenues collected in
excess of forecast also contributed to the lapse.
Resources will be carried forward to 2002-2003 when delayed activities will be carried out.
Financial Performance
105
Financial Table 9: Details of Financial Information by Business Lines
and Service Lines (continued)
Service Line 3: Healthy Environments and Consumer Safety
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
142.8
(3.5)
209.0
(9.9)
201.9
(7.4)
Net expenditures
139.3
199.1
194.5*
* This represents 26.2 percent of the Health Promotion and Protection actual spending.
Variances between planned spending and total authorities are due to the approval of the Workplace Health
and Public Safety Program (WHPSP) vote netting authority, and funding for the Federal Tobacco Control
Strategy and the Canadian Environmental Protection Act (CEPA) and Public Security and Anti-Terrorism
(PSAT).
Variances between total authorities and actual spending for revenues are mainly due to less revenues than
anticipated collected by the Workplace Health and Public Safety Program.
The actual spending is $4.6 million lower than total authorities mainly resulting from delays in some
activities related to the areas of Tobacco Control, Drug Strategy and Controlled Substances, and
Environmental Assessment.
Resources will be carried forward to 2002-2003 when delayed activities will be carried out.
Service Line 4: Pest Management Regulation
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
21.6
(0.2)
32.0
(7.0)
31.9
(6.9)
Net expenditures
21.4
25.0
25.0*
* This represents 3.4 percent of the Health Promotion and Protection actual spending.
Variances between planned spending and total authorities are mainly due to the approval of Pest
Management Regulatory Agency vote netting authority.
106
Health Canada
Financial Table 9: Details of Financial Information by Business Lines
and Service Lines (continued)
Business Line 3: First Nations and Inuit Health
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
1,332.7
(9.1)
1,348.2
(9.1)
1,346.0
(6.9)
Net expenditures
1,323.6
1,339.1
1,339.1*
* This represents 50.0 percent of the Department's actual spending.
Variances between planned spending versus total authorities and actual spending are mainly due to:
-
funding for First Nations’ construction and restoration of on-reserve facilities being shown in the
Departmental Management and Administration business line;
-
newly approved funding (i.e. not in planned spending) to maintain the sustainability of the
Program.
Business Line 4: Information and Knowledge Management
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
172.1
N/A
287.9
N/A
281.3
N/A
Net expenditures
172.1
287.9
281.3*
* This represents 10.5 percent of the Department's actual spending.
The variance between planned spending and authorities is mainly due to:
-
the approval of a one-time grant of $95 million to the Canadian Institute for Health Information
(CIHI);
-
Program Integrity funding for IM/IT Implementation;
-
the reprofiling to future years of the Canada Health Infostructure Partnerships Program (CHIPP)
The actual spending is $6.6 million lower than total authorities mainly resulting from delays in the
implementation of a new platform for the Canadian Health Network.
Resources will be carried forward to 2002-2003 when delayed activities will be carried out.
Financial Performance
107
Financial Table 9: Details of Financial Information by Business Lines
and Service Lines (continued)
Business Line 5: Departmental Management and Administration
(millions of dollars)
Planned
Spending
2001-2002
Total
Authorities
2001-2002
Actual
Spending
2001-2002
Gross expenditures
Revenues
112.4
(0.7)
222.6
(0.7)
209.0
(0.4)
Net expenditures
111.7
221.9
208.6*
* This represents 7.8 percent of the Department's actual spending.
Variances between planned spending versus total authorities and actual spending are mainly due to newly
approved resources for several initiatives such as Capital Rust-Out, as well as funding related to the support
for First Nations’ construction/restoration of on-reserve facilities and other functions that were realigned to
this business line during the year.
The actual spending is $13.3 million lower than total authorities mainly resulting from the setting aside of
funds to cover the increased costs of the employee benefit plan and other departmentally-supported costs.
108
Health Canada
Financial Table 10:
Contingent Liabilities
There are a number of individual
and class action suits against the
Government involving allegations of
negligence related to its role in the
regulation of medical devices, blood
and drug products. Because of the
Financial Performance
complexity of the claims and the early
stage of the litigation in these cases,
any estimation of contingent liability
at this point would be highly speculative and could not be said to be a
reasoned evaluation.
109
110
Health Canada
Section VI:
Other Information
Other Information
111
Departmental Contacts
Regional Offices
Atlantic
Manitoba and Saskatchewan
Maritime Centre, Suite 1918
1505 Barrington Street
Halifax, Nova Scotia B3J 3Y6
Telephone: (902) 426-9564
Facsimile: (902) 426-6659
437-391 York Avenue
Winnipeg, Manitoba R3C 0P4
Telephone: (204) 983-4764
Facsimile: (204) 983-5325
Quebec
Alberta and
Northwest Territories
Complexe Guy Favreau, East Tower
Suite 202
200 René Lévesque Blvd. West
Montreal, Quebec H2Z 1X4
Telephone: (514) 283-5186
Facsimile: (514) 283-1364
Canada Place, Room 710
9700 Jasper Avenue
Edmonton, Alberta T5J 4C3
Telephone: (780) 495-5172
Facsimile: (780) 495-5551
Ontario and Nunavut
British Columbia and Yukon
4th Floor, 25 St. Clair Avenue East
Toronto, Ontario M4T 1M2
Telephone: (416) 954-3593
Facsimile: (416) 954-3599
757 West Hastings St., Room 405
Vancouver, British Columbia
V6C 1A1
Telephone: (604) 666-2083
Facsimile: (604) 666-2258
Headquarters
Telephone: (613) 957-2991
Facsimile: (613) 941-5366
Website: http://www.hc-sc.gc.ca
or write to:
Health Canada
0900C2 Podium Level,
Brooke Claxton Building
Ottawa, Ontario, CANADA
K1A 0K9
112
Health Canada
References
Selected Health Canada Publications
Best Practices: Concurrent Mental Health and Substance Use Disorders
Best Practices: Fetal Alcohol Syndrome/Fetal Alcohol Effects and the Effects of
Other Substance Use During Pregnancy
Best Practices: Treatment and Rehabilitation for Women with Substance Use
Problems
Best Practices: Treatment and Rehabilitation for Youth with Substance Use
Problems
Bringing Up Baby
Canada’s Physical Activity Guide for Healthy Active Living for Older Adults
Child Health Record
Healthy Development of Children and Youth: The Role of the Determinants of
Health
It Helps to Talk: How to Get the Most from a Visit to your Doctor. Patient’s Guide
It Helps to Talk: The 5-minute Guide to better Communication. Doctor’s Guide
Nutrition for Healthy Term Infants
Perspectives on Complementary and Alternative Health Care
Profile - Substance Abuse Treatment and Rehabilitation in Canada
Second Report on the Health of Canadians: Toward a Healthy Future
Trends in the Health of Canadian Youth
Why All Women Who Could Become Pregnant Should be Taking Folic Acid
Documents can be ordered from:
Publications
Health Canada
Ottawa, Ontario
K1A 0K9
Telephone: (613) 954-5995
Facsimile: (613) 941-5366
Telecommunication Device for the Deaf: 1-800-267-1245
Other Information
113
Index
A
Aboriginal/Indian/First Nations and Inuit
11, 18, 19, 24, 35, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68,
71, 72, 74, 75, 78, 79, 80, 88, 89, 90, 91, 97, 98, 99, 100, 102, 103, 107, 108,
118, 119, 122, 123, 125, 128, 136, 137, 138, 139, 140
Aboriginal Diabetes Initiative 60
Aboriginal Head Start 60, 62, 79, 139
Aboriginal Women's Health Network 30
Community Health Plans/Programs 60, 67, 68, 136, 137, 139
First Nations and Inuit Health Information System 63, 64, 71, 72, 91
First Nations and Inuit Home and Community Care Program 63, 89
First Nations and Inuit Telehealth Project 90
National Aboriginal Strategy for HIV/AIDS 60
National Native Addictions Partnership Foundation 63
National Native Alcohol and Drug Abuse Program 63
Non-Insured Health Benefits Program
24, 58, 59, 65, 66, 67, 68, 88, 89, 90, 136, 139, 140
Acts
Canada Health Act 11, 12, 22, 26, 27, 28
Canadian Environmental Assessment Act 48
Canadian Environmental Protection Act 55, 106
Controlled Drugs and Substances Act 49
Food and Drugs Act 55
Official Languages Act 77
Personal Information Protection and Electronic Documents Act 72
Pest Control Products Act 12, 23, 52, 53, 54, 55, 56
Radiation Emitting Devices Act 48
air pollution/quality 48, 61
alcohol/drinking 23, 36, 46, 47, 63
Alcohol and Drug Treatment and Rehabilitation Program 50
fetal alcohol syndrome/effects 11, 33, 62, 113
antibiotics 37, 41
B
biologics/biologic agents/biological products 32, 39, 40, 44, 48, 141, 142
biotechnology 23, 39, 42, 43, 44, 47
Biotechnology Regulatory Fund 43
Canadian Biotechnology Strategy Fund 43
blood 37, 101, 109, 141
C
Canada Health Infostructure Partnership Program 72, 73, 96, 107
Canada Health Infoway Inc. 92, 93
114
Health Canada
Canada Health Portal 73, 90
Canadian Health Network 71, 73, 90, 91, 107
Canadian Institute for Health Information 92, 98, 102, 107
Canadian Institutes of Health Research 78
chemicals/chemical substances/agents 23, 32, 40, 46, 47, 48, 50, 57, 61
children/youth 12, 33, 34, 47, 50, 54, 55, 60, 61, 62, 78, 79, 80, 113
Centres of Excellence for Children's Well-Being 33
Community Action Program for Children 33
Early Childhood Development 33, 80
clinical trials 40, 41
Commission on the Future of Health Care in Canada 12, 27, 92
D
dental care 65, 67, 88
diagnostic devices/services 28, 48, 73
disease(s) 29, 31, 37, 38, 46, 49, 58, 60, 63, 71, 72, 80, 88, 119
cancer 35, 36, 65, 119, 126, 127, 128
chronic 35, 36, 41, 63, 65, 79, 89, 119, 126, 128, 133
diabetes 11, 34, 36, 60, 64, 65, 102, 128, 133
heart/cardiovascular 36, 48, 126, 127, 128, 133
hepatitis C 35, 75, 96, 101, 102, 105
HIV/AIDS 11, 37, 60, 119, 130, 139
infectious/communicable 32, 36, 37, 64, 88
respiratory 36, 48, 126
tuberculosis 88, 129
drugs/pharmaceuticals
23, 27, 32, 37, 39, 40, 41, 43, 46, 47, 49, 50, 59, 63, 65, 66, 67, 81,
90, 106, 109, 139, 140
marijuana 49
National Emergency Stockpile System 32
National Prescription Drug Utilization Information System 27
E
electronic health records 70, 72, 90, 92
emergency services/preparedness/response/emergencies
12, 22, 32, 50, 58, 78, 90
F
family violence/domestic abuse 35, 88
First Ministers' Agreement on Health/September 2000 Meeting
11, 27, 74, 91, 92, 118
food(s) 11, 12, 18, 19, 23, 37, 38, 39, 40, 41, 42, 43, 44, 49, 53, 54, 55,
99, 100, 103, 105, 119, 130, 135, 142
G
genetics 31, 43, 44, 73, 142
Genomics Research and Development Fund 43
Other Information
115
Geographic Information System 37
H
Health Information Roadmap 92
Health Transition Fund 29
home and community care 26, 30, 59, 60, 63, 64, 65, 75, 89
I
irradiation 42, 44
M
Medicare 26, 27, 28
mental health 30, 35, 36, 47, 61, 64, 65, 72, 113
N
National Health Surveillance Infostructure 71
natural health products 39, 41, 44
nursing/nurses 28, 29, 59, 60, 91
nutrition 34, 39, 41, 43, 44, 62, 81, 113
Canada Prenatal Nutrition Program 33, 62, 102, 139
P
pest control products/pesticides 12, 23, 43, 52, 53, 54, 56, 57, 88
Action Plan for Urban Use Pesticides 56
Pest Management Regulatory Agency
18, 19, 52, 53, 55, 56, 57, 88, 103, 106
physical activity/inactivity 34, 35, 120, 133
primary care 26, 58, 60, 78, 91
Primary Health Care Transition Fund 28, 78, 96, 102, 104
privacy 12, 24, 70, 72
R
radiation 23, 47, 50, 91
Regulations
Consumer Chemicals and Containers 50
Food and Drug 41
Pest Control Products 53, 54
Precursor Control 50
remote and rural areas 35, 58, 59, 64, 72
reproductive health/technologies/assisted human reproduction 12, 44, 81
S
seniors/older adults/aging 34, 35, 59, 113, 128
Social Union Framework Agreement 11, 91, 118
T
telehealth 33, 64, 72, 90
116
Health Canada
tobacco/smoking
11, 23, 34, 35, 36, 46, 47, 50, 80, 96, 102, 106, 119, 120, 131, 132
V
vaccines/immunization/inoculation 36, 43, 64, 119, 120, 129, 133
Voluntary Sector Initiative 35
W
water 37, 38, 49, 60, 61, 68, 79, 80, 89, 130
weight/obesity 33, 34, 36, 43, 81, 119, 120, 124, 134, 135
West Nile virus 36, 37, 72
women 29, 30, 33, 34, 47, 50, 62, 113, 121, 125, 135
Canadian Women's Health Network 30
Centres of Excellence for Women's Health 30
pregnant/pregnancy 33, 47, 62, 81, 113
Women's Health Contribution Program 29
wood-treatment products 53
Other Information
117
Appendix A:
Measuring Health in Canada more results relating to the
Health Status of Canadians
Measuring Health in Canada provides information on the health status
and health determinants of Canadians,
with a particular emphasis on the
health of the First Nations. International comparisons have been made on
these topics whenever available. Where
possible, a standard subset of nations
was used for these comparisons;
however, data restrictions limit this for
some indicators.
regular public reporting on health
programs and services they deliver, on
health system performance, and on
progress on key priorities. Jurisdictions released their reports in September 2002. The Federal Report on
Comparable Health Indicators may be
found at:
Measuring Health in Canada is
organized around the three major
topics for health system performance
reporting identified in the First
Ministers’ Communiqué on Health of
September 2000. These are: 1) health
status; 2) health outcomes; and 3)
quality of service. At that time, First
Ministers reaffirmed their commitment in the 1999 Social Union
Framework Agreement to report regularly to constituents. Governments
agreed to provide comprehensive and
In Measuring Health in Canada, we
have, wherever possible, used indicators and definitions agreed to in the
First Ministers’ process. However, the
charts that have been included in this
Appendix place more emphasis on
areas specific to Health Canada’s
programs and activities and present a
slightly different look at the underlying
data by profiling health trends, and
highlighting health outcomes as they
relate to Health Canada.
118
http://www.hc-sc.gc.ca/iacb-dgiac/araddraa/english/accountability/
indicators.html
Health Canada
Measuring Health in Canada provides information on:
1. Health Status
Life Expectancy at Birth by Sex, Canada, 1979 - 1999 . . . . . . . . . . . . . . 121
Life Expectancy at Birth by Sex, International Comparisons, 1999 . . . 121
Life Expectancy at Birth by Sex, Registered First Nations
and General Population, 1975 - 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Infant Mortality Rates, Canada, 1988 - 1999 . . . . . . . . . . . . . . . . . . . . . 122
Infant Mortality Rates, International Comparisons, 1999 . . . . . . . . . . . 123
Infant Mortality Rates, First Nations and Canada, 1979 - 1999 . . . . . . 123
Prevalence of Low Birth Weight, Canada, 1979 - 1999 . . . . . . . . . . . . . 124
Self-Reported Health Status, Canada, 1994/95-2000/01 . . . . . . . . . . . . 124
Self-Reported Health Status, International Comparisons, 1998 . . . . . . 125
Self-Reported Health Status, First Nations, by Age and Sex, 1999 . . . . 125
2. Health Outcomes
Age-Standardized Mortality for Chronic Conditions,
Canada, 1996 - 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Age-Standardized Mortality for Selected Causes,
International Comparisons, 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Potential Years of Life Lost, Selected Causes of Death,
Canada, 1979 - 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Potential Years of Life Lost, Selected Cancers, Canada, 1979 - 1999 . . 127
Self-Assessed Prevalence of Chronic Conditions,
Canada, 1994/95-2000/01 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Prevalence of Chronic Conditions, First Nations/Labrador Inuit
and General Population, Canada, 1998/1999 . . . . . . . . . . . . . . . . . . . . . 128
Incidence of Selected Vaccine-Preventable Diseases,
Canada, 1987 - 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Incidence of Selected Notifiable Diseases, Canada, 1990 - 1999 . . . . . . 129
Incidence of Food-Borne Illness, Canada, 1987 - 1999 . . . . . . . . . . . . . . 130
Incidence of HIV and AIDS per 100,000, Canada, 1995 - 1999 . . . . . . . 130
3. Quality of Service
Exposure to Cigarette Smoke in the Home, Canada, 1994/95 - 2000/01 131
Current Smoker Rate, Age 12+, Canada, 1994/95 - 2000/01 . . . . . . . . . 131
Current Smoker Rate, Age 12-19, Canada, 1994/95 - 2000/01 . . . . . . . . 132
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
119
Prevalence of Daily Smoking, Age 15+,
International Comparisons, 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Influenza Inoculation in Past Year, by Age, Canada, 2000/01 . . . . . . . . 133
Physical Inactivity, by Age and Sex, Canada, 2000/01 . . . . . . . . . . . . . . 133
Overweight/Obesity Prevalence, by Sex, Canada, 1994/95 - 2000/01 . . 134
Obesity Prevalence, by Sex, Canada, 1994/95 - 2000/01 . . . . . . . . . . . . . 134
Obesity by Sex, International Comparisons, 1999 . . . . . . . . . . . . . . . . . 135
Daily Fruit and Vegetable Consumption of Five or More Servings,
by Age and Sex, Canada, 2000/01 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
120
Health Canada
Health Status
Life Expectancy at Birth by Sex,
Canada, 1979-1999
84
82
80
years
78
76
74
72
Females
Males
70
68
66
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
Source: Statistics Canada, Canadian Vital Statistics, Birth and Death
Databases, and Demography Division (population estimates)
Life expectancy at birth has increased steadily over the 20th century, even in recent decades. In
1999, life expectancy was 81.7 for women and 76.3 for men. While women in general live longer
than men, the gap between the sexes has decreased from 6.3 in 1990 to 5.4 in 1999.
Life Expectancy at Birth by Sex,
International Comparisons, 1999
86
Females
Males
84
82
80
years
78
76
74
72
70
68
66
Japan
France
Australia
Canada
New
Germany United
Zealand
Kingdom
United
States
Mexico
Source: OECD Health Data 2002
Life expectancy of Canadians is higher than in most countries. Life expectancy across the
countries listed ranges, for both men and women, from a low in Mexico (males 72.8 and females
77.3) to a high in Japan (males 77.1 and females 84.0).
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
121
Health Status
Life Expectancy at Birth by Sex,
Registered First Nations and General Population, 1975 – 2000
85
80
years
75
70
65
60
FN Male
Cdn Male
FN Female
55
Cdn Female
50
1975
1980
1985
1990
1995
2000
Source: Population Projections of Registered Indians, 1998-2008,
Department of Indian Affairs and Northern Development, 1999
Life expectancy for Registered Indian males and females has been increasing steadily since
1975, at a pace such that the gap with the general population continues to steadily decrease.
Note:
First Nations are classified as Registered Indians both on and off-reserve. Year 2000 life expectancy is an
estimate.
Infant Mortality Rates, Canada,
1988 – 1999
8
Deaths per 1,000 live births
7
6
5
4
3
1988
1990
1992
1994
1996
1998
Source: Statistics Canada, Birth and Death Databases
Canada’s infant mortality rate has decreased steadily, with gains even since the late 1980s.
Note:
122
Infant Mortality Rate is defined as number of infants who die in the first year of life (i.e. from time of birth to
first birthday), expressed as a rate per 1,000 live births.
Health Canada
Health Status
Infant Mortality Rates, International
Comparisons, 1999
Sweden
3.4
Japan
3.4
France
4.3
Germany
4.5
Italy
5.1
Canada
5.3
Australia
5.7
United Kingdom
5.8
United States
7.1
0
1
2
3
4
5
6
7
8
Deaths per 1,000 live births
Source: OECD Health Data 2002
Canada has one of the best infant mortality rates in the world, at 5.3 deaths per 1,000 live births.
Japan and Sweden had the lowest infant mortality rate in 1999 at 3.4 per 1,000 live births.
Infant Mortality Rates, First Nations and
Canada, 1979 – 1999
Deaths per 1,000 live births
30
First Nations
Canada
25
20
Break in data from 1994 to 1998
15
10
5
0
1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999
Year
Source: Statistics Canada; Health Canada, First Nations and Inuit Branch (formerly Medical Services Branch),
Trends in First Nations Mortality 1979 -1993
The First Nations infant mortality rate has been declining steadily since the mid 1980s.
Historically, infant mortality in First Nations has been higher than in the general population, but
the gap is narrowing.
Notes:
Rates include all births under 500 grams. Data were unavailable for the First Nations population for the
years 1994-1998. Current data may not be directly comparable to previous years due to different data
collection methods.
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
123
Health Status
Prevalence of Low Birth Weight,
Canada, 1979 – 1999
10
Percentage of all live births
9
8
7
6
5
4
3
2
1
0
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
Source: Statistics Canada, Canadian Vital Statistics, Birth Database
Infants born with low birth weight are more likely to experience complications. The rate for low
birth weight (i.e. less than 2,500 grams) in Canada has been relatively stable for the past two
decades, and is down significantly from the 1960s.
Self-Reported Health Status,
Canada, 1994/95 – 2000/01
45
1994/95
1996/97
1998/99
2000/01
40
35
Percentage
30
25
20
15
10
5
0
Excellent
Very good
Good
Fair
Poor
Source: National Population Health Survey 1994/95 – 1998/99,
Canadian Community Health Survey 2000/01
In 2000/01, approximately 88% of Canadians rated their health as good, very good or excellent.
However, the number of Canadians who reported their health as fair or poor increased slightly
between 1994/95 and 2000/01.
124
Health Canada
Health Status
Percentage reporting health as "good" or better
Self-Reported Health Status,
International Comparisons, 1998
100
90
Males
Females
80
70
60
50
40
30
20
10
0
United States
Canada
Sweden
United
Kingdom
Germany
Japan
Source: OECD Health Data 2002
Self-reported health status of Canadians is virtually the same as that of Americans. The two
countries have significantly higher rates of good health than other industrialized countries.
Self-Reported Health Status,
First Nations, by Age and Sex, 1999
Very good to excellent
Poor to fair
80
Males
Females
70
Percentage
60
50
40
30
20
10
0
15-29
30-54
55+
15-29
30-54
55+
Source: First Nations and Inuit Regional Health Survey, National Report 1999
In younger age groups, more First Nations men than women report very good to excellent
health status. In the age group 15-29, only 57% of women report their health status as very good
to excellent.
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
125
Health Outcomes
Age-Standardized Mortality for Chronic
Conditions, Canada, 1996, 1999
Ischemic heart disease
Cerebrovascular disease
Lung cancer
Breast cancer
1996
1999
Prostate cancer
Respiratory
0
20
40
60
80
100
120
140
160
Deaths per 100,000 Canadians
Source: Statistics Canada Health Indicators 2002 (1996 data),
Statistics Canada Deaths Shelf Tables, 1999 (1999 data)
Heart disease continues to be the leading cause of death in the Canadian population, with 121.7
deaths per 100,000 Canadians in 1999. Among the causes listed, respiratory disease is the next
most common cause (62.3 deaths per 100,000 in 1999), while lung cancer has overtaken stroke
as the third leading cause (50.0 deaths per 100,000 in 1999).
Note:
Prostate cancer figures are for males only; breast cancer figures are for females only.
Age-Standardized Mortality for Selected Causes,
International Comparisons, 1999
Japan
Respiratory
Circulatory
Cancer
Australia
Canada
United Kingdom
Germany
0
50
100
150
200
250
300
350
Deaths per 100,000 population
Source: OECD Health Data 2002
Age-standardized mortality rates in Canada for cancer and respiratory and circulatory diseases
are comparable to other OECD countries.
126
Health Canada
Health Outcomes
Potential Years of Life Lost, Selected Causes of Death,
Canada, 1979 – 1999
2000
Acute myocardial infarction
(AMI)
All stroke
PYLLs per 100,000 population
1800
1600
Unintentional injuries
1400
Suicides
1200
1000
800
600
400
200
0
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
Source: Statistics Canada Health Indicators 2002
Potential years of life lost to acute myocardial infarction (heart attack) have decreased steadily in
the past two decades. PYLLs due to unintentional injury have also decreased significantly.
Note:
Potential years of life lost (PYLL) is the number of years of life "lost" when a person dies "prematurely" from
any cause before age 75.
Potential Years of Life Lost, Selected
Cancers, Canada, 1979 – 1999
500
PYLLs per 100,000 population
450
400
350
Colorectal cancer
Lung cancer
Prostate cancer
Breast cancer
300
250
200
150
100
50
0
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
Source: Statistics Canada Health Indicators 2002
Lung cancer costs Canadians more potential years of life than any other form of cancer.
Potential years of life lost to breast cancer have dropped since 1994.
Note:
Prostate cancer figures are for males only; breast cancer figures are for females only.
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
127
Health Outcomes
Self-Assessed Prevalence of Chronic
Conditions, Canada, 1994/95 – 2000/01
20
1994/95
2000/01
Percentage
15
10
5
0
Arthritis /
rheumatism
Heart disease
Diabetes
Asthma
High blood
pressure
Cancer
Source: National Population Health Survey 1994/95, Canadian Community Health Survey 2000/01
The number of Canadians who have had a chronic condition diagnosed by a health professional
has increased for all major chronic conditions since 1994/95. This may be reflective of an aging
population.
Note:
Question asked whether respondent had a condition which had lasted or would last for 6 months,
diagnosed by a health professional.
Prevalence of Chronic Conditions, First Nations/Labrador
Inuit and General Population, Canada, 1998/99
First Nations &
Labrador Inuit
General
Population
Heart Disease
Diabetes
Arthritis
Hypertension
0%
5%
10%
15%
20%
25%
Source: National Population Health Survey (1998/99), Statistics Canada.
First Nations and Inuit Regional Health Survey (1999), Assembly of First Nations
Heart disease, diabetes, arthritis and hypertension are all more prevalent among the First
Nations and Labrador Inuit people than in the general population.
128
Health Canada
Health Outcomes
Incidence of Selected Vaccine-Preventable Diseases,
Canada, 1987 – 1999
45
40
Measles
Haemophilus influenzae B
Meningococcal Infections
Rate per 100,000
35
30
25
20
15
10
5
0
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
Source: Population and Public Health Branch, Health Canada
Vaccine-preventable diseases are, by definition, diseases whose burden can be reduced by
effective uses of health system resources. Incidence rates for vaccine-preventable diseases
have diminished since 1987.
Incidence of Selected Notifiable Diseases,
Canada, 1990-1999
200
180
Rate per 100,000
160
140
120
100
80
Chlamydia, Genital
Tuberculosis
60
40
20
0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
Source: Population and Public Health Branch, Health Canada
The incidence rate for chlamydia, a sexually transmitted disease, has decreased 23.3% since
1991; however, there is an increase from its low in 1997. Incidence of tuberculosis remained
consistently low for the entire decade.
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
129
Health Outcomes
Incidence of Food-Borne Illness,
Canada, 1987 – 1999
60
Rate per 100,000
50
40
30
Campylobacteriosis
20
Giardiasis
Salmonellosis
Verotoxigenic E. coli
10
0
1987
1988
1989
1990
1991
1992
1993
Year
1994
1995
1996
1997
1998
1999
Source: Population and Public Health Branch, Health Canada
Reported incidence of food- and water-borne illnesses shown here has diminished since 1987.
Incidence of salmonellosis has shown the greatest decline in that period (58.4%).
Incidence of HIV and AIDS per 100,000,
Canada, 1995 – 1999
12
Rate per 100,000
10
8
6
AIDS
HIV
4
2
0
1995
1996
1997
1998
1999
Year
Source: Population and Public Health Branch, Health Canada
The incidence of both HIV and AIDS has declined significantly since 1991. New reported cases
of AIDS have decreased from 5.38 cases per 100,000 Canadians in 1995 to 1.36 per 100,000 in
1999, a decrease of 74.7%. New incidences of HIV have declined from 10.2 to 7.3 cases per
100,000 Canadians in that same period, for a decrease of 28.4%.
130
Health Canada
Quality of Service
Exposure to Cigarette Smoke in the Home,
Canada, 1994/95 – 2000/01
40
Percentage
35
30
25
20
1994/95
1996/97
1998/99
2000/01
Source: National Population Health Survey 1994/95 – 1998/99,
Canadian Community Health Survey 2000/01
The percentage of Canadians who reported being in the same household as a smoker has
decreased steadily since 1994/95.
Current Smoker Rate, Age 12+, Canada,
1994/95 – 2000/01
40
Percentage
35
30
25
20
1994/95
1996/97
1998/99
2000/01
Source: National Population Health Survey 1994/95 – 1998/99,
Canadian Community Health Survey 2000/01
Canada’s smoking rate has decreased in the last decade, from 29.3% in 1994/95 to 26.0% in
2000/01.
Note:
Current smoker is defined as someone who is either a daily smoker or an occasional smoker.
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
131
Quality of Service
Current Smoker Rate, Age 12-19, Canada,
1994/95 - 2000/01
22
Percentage
21
20
19
18
17
1994/95
1996/97
1998/99
2000/01
Source: National Population Health Survey 1994/95 – 1998/99,
Canadian Community Health Survey 2000/01
Similarly, prevalence of smoking among young Canadians has declined. The smoking rate
among Canadians aged 12-19 has decreased 13.8% since 1996/97.
Note:
Current smoker is defined as someone who is either a daily smoker or an occasional smoker.
Prevalence of Daily Smoking, Age 15+,
International Comparisons, 2000
60
Males
Females
50
Percentage
40
30
20
10
0
Japan
Italy
United
Kingdom
New
Zealand
Canada
United
States
Sweden
Source: OECD Health Data 2002
Canada’s smoking rates for both sexes are similar to those of the OECD countries shown.
132
Health Canada
Quality of Service
Influenza Inoculation in Past Year, by Age,
Canada, 2000/01
70
Had flu shot in past year (%)
60
50
40
30
20
10
0
12-24
25-44
45-64
65+
Age group
Source: Canadian Community Health Survey 2000/01
The likelihood of Canadians having been inoculated against influenza in the past year increases
with age, to a high of 65.5% for Canadians aged 65 or over.
Physical Inactivity, by Age and Sex,
Canada, 2000/01
70
60
Males
Females
Percentage
50
40
30
20
10
0
12-14
15-24
25-44
45-64
65+
Age group
Source: Canadian Community Health Survey 2000/01
Physical inactivity is one of the prime risk factors for many chronic conditions, including heart
disease, stroke and diabetes.
Canadians tend to be less active as they grow older. Males tend to be more active than females
across all age groups.
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
133
Quality of Service
Overweight/Obesity Prevalence, by Sex,
Canada, 1994/95 – 2000/01
70
60
Percentage
50
40
30
20
Males
Females
10
0
1994/95
1996/97
1998/99
2000/01
Source: National Population Health Survey 1994/95 – 1998/99,
Canadian Community Health Survey 2000/01
Prevalence of overweight/obesity has remained relatively stable since 1994/95, for both males and
females.
Obesity Prevalence, by Sex,
Canada, 1994/95 – 2000/01
20
Percentage
15
10
Males
Females
5
0
1994/95
1996/97
1998/99
2000/01
Source: National Population Health Survey 1994/95 – 1998/99,
Canadian Community Health Survey 2000/01
Prevalence of obesity (body mass index greater than 30) has increased for both sexes since 1994/95.
134
Health Canada
Quality of Service
Obesity by Sex,
International Comparisons, 1999
25
Male
Female
Percentage
20
15
10
5
0
Australia
United
Kingdom
Canada
Germany
Italy
Japan
Source: OECD Health Data 2002 (Canadian data obtained from 1998/99 National Population Health Survey,
American data obtained from National Center for Chronic Disease Prevention and Health Promotion)
Rates of obesity in Canada in 1999 (15.4% for males, 14.4% for females) were in the middle of
other OECD countries, for both males and females.
Daily Fruit and Vegetable Consumption of Five or More
Servings, by Age and Sex, Canada, 2000/01
60
Male
Female
50
Percentage
40
30
20
10
0
12-18
19-44
45-64
65+
Age group
Source: Canadian Community Health Survey, 2000/01
According to the Canada Food Guide, the recommended amount of fruit and vegetable
consumption is 5-10 servings per day. Only 37.4% of Canadians consume at least five servings
of fruit and vegetables each day. Women are more likely to consume fruits and vegetables than
men, regardless of age.
Appendix A: Measuring Health in Canada –
more results relating to the Health Status of Canadians
135
Appendix B:
Executive Summary:
Response to the Public
Accounts Committee - First
Nations Health: Follow-Up
Response to the Public
Accounts Committee
Tenth Report on the
Auditor General’s
Report, October 2000
(Health Canada – First
Nations follow-up)
Introduction
The Public Accounts Committee
(PAC) as a follow-up to the 2000
Auditor General’s report, tabled recommendations in December 2001
requiring Health Canada to implement
and report on improvements to its
accountability and management activities. Health Canada agrees with the
Standing Committee and the Auditor
General (OAG) that health programs
for First Nations and Inuit must be
well managed and accountable. This
document highlights some of the
progress made by the Department
since the release of the PAC/OAG
report. Our progress on actions taken
towards Auditor General and Public
Accounts Committee recommendations is fully reported in the electronic
136
Annex D of the Departmental Performance Report 2001-2002. The continuing need for additional reporting will be
reviewed with the Auditor General
after three years of reporting. A copy of
the Government Response to the PAC
Report is also part of the comprehensive electronic Annex D of the
Departmental Performance Report
(http://www.hc-sc.gc.ca/english/care/estimates/index.htm).
Health Canada has chosen to
respond to the 26 recommendations by
grouping information under five
themes:
• Reporting to Parliament on progress
• Community Health
(CHP) accountability
Programs
• Supporting capacity development
• Measuring performances, outcomes
achievement, and managing information
• Non-Insured Health Benefits
(NIHB) control and prevention
measures
Several important milestones were
reached in 2001-2002 as Health
Canada worked to implement a strong
Health Canada
accountable management regime. New
program accountability frameworks
were introduced, comprehensive standard agreements were developed and
implemented, a single contracts and
contributions management system was
implemented to enhance reporting,
monitoring and auditing and an
Intervention Policy was introduced to
guide our actions in communities
which have been unable or unwilling to
address problem areas.
Recommendations and
follow-up actions
Reporting to Parliament on
progress. The major recommendation
under this theme is that Health
Canada inform Parliament of the
progress it is making in implementing
the recommendations contained in
chapter 13 of the 1997 Report and
chapter 15 of the 2000 Report of the
Auditor General of Canada and in the
Committee’s 5th Report (36th Parliament, 1st Session). This information
must make specific reference to
progress in implementing each recommendation and be provided annually in
Health Canada’s Performance Reports, beginning with the Report for
the period ending March 31, 2002.
Key actions taken
To respond to this Recommendation as well as Recommendations 5, 9,
11, 16, 19, 23 and 24, we will be
reporting with a web-based link to
Departmental Performance Reports.
Paper copies will be available upon
request. The ongoing need for this
special reporting requirement will be
reassessed with the Auditor General in
three years, after her next audit on
First Nations and Inuit health programs. An initial PAC reporting Annex
was prepared for the Departmental
Performance Report 2001-2002 and
full reporting will begin in 2002-2003.
Community Health Programs
(CHP) accountability. Greater focus
is being placed by the Department on
providing accountable and sustainable
programs and services for First
Nations and Inuit. We are implementing measures to better manage internally and externally to deliver the best
possible service to First Nations and
Inuit communities.
Key actions taken
To address the recommendations
regarding accountability and respond
to the need for a nationwide standardized system for monitoring contribution agreements, First Nations and
Inuit Health Branch (FNIHB) developed and implemented the Monitoring
Contract and Contribution System
(MCCS). This is one of the ways we will
address the need for risk-based monitoring in our accountability documents. We will also conduct an MCCS
Quality Assurance Review during the
course of 2002-2003.
FNIHB is developing a comprehensive reporting handbook for Community Health Programs with Program
Reporting Guidelines.
• A draft of the Financial Reporting
Guidelines for the handbook was
developed and reviewed by a
working group.
• A quality assurance review of the
reporting process is being planned
and will be done once results of the
OAG First Nations Reporting Study
is undertaken.
Appendix B: Executive Summary: Response to the Public Accounts Committee First Nations Health: Follow-Up
137
An Intervention Policy was developed to address problem situations
that may arise under health funding
arrangements. A handbook to assist in
implementing the policy was approved
and distributed.
• A communication
developed.
plan
was
• A review of the Intervention Policy
will take place in three years.
Supporting capacity development. Health Canada shares the
Public Accounts Committee’s belief
that capacity development is a priority.
The Government recognizes that a
participatory approach contributes to
community capacity development. The
Transfer Policy (1988) and the Integrated Community-Based Health Services Approach (1999) allow Health
Canada to engage First Nations and
Inuit in arrangements that permit
various levels of control ranging from
general and integrated contribution
agreements to transfer contribution
agreements.
Actions taken
We have developed Health Plan
Demonstration Sites that will improve
our capacity to manage health programs and services; improve capacity
to identify community health needs
and resources; improve management
coordination; integrated health programs and services; improve financial
and human resources allocation processes; and enhance programs and
services management information and
reporting.
FNIHB is looking at adapting some
of the tools developed or being
developed for the Health Plan Demonstration Projects for First Nations and
Inuit communities interested in pursu138
ing transfer activities. As of June 30,
2002, there are seven demonstration
sites for the health planning process
across Canada. These are: Pacific
Region - Kitselas Band Council;
Alberta Region - Bigstone Cree First
Nation and Blood Tribe; Saskatchewan
Region - Gordon First Nation; Manitoba Region - Little Grand Rapids First
Nation; Quebec Region - Eagle Village
First Nation (Kipawa); and Yukon
Region - Liard First Nation.
In addition, to improve internal
capacity, FNIHB is holding two
regional training sessions - in August
and fall 2002. We will provide
refreshers for existing staff and
training for new staff on the authorities, accountability requirements, policies, guidelines and procedures for all
new and renewal transfer agreements.
Measuring performances, outcomes achievement, and managing information. Health Canada is
committed to effective management of
its programs by making important
decisions with relevant data. Collecting
good performance information is a
priority of the Department.
Key actions taken
FNIHB is planning to work with
Statistics Canada and the National
Aboriginal Health Organization
(NAHO) to support the First Nations
Regional Longitudinal Survey to provide health information about onreserve populations.
• Three questionnaires for the survey
have been finalized and translated
into French.
• The sampling plan, training materials, and field manuals are complete.
Health Canada
• NAHO and FNIHB are developing
a License to Use Data Agreement
which will be finalized in September 2002.
First Nations and Inuit Health
Branch will report on the data collected
to demonstrate the health outcomes
achieved by Community Health Programs and the Non-Insured Health
Benefits Program in the Annex to the
Departmental Performance Report
beginning with the 2003-2004 Report.
FNIHB is currently developing its
multi-year evaluation plan in the
context of its contribution programs
authority renewal initiative. In accordance with the Transfer Payment
Policy, all terms and conditions of
contributions programs must be renewed by March 31, 2005. The
authority renewal submission must be
supported by program evaluation
information and a Result-Based Management Accountability Framework
must be defined for each of the
programs. The evaluation strategy will
be finalized in the fall of 2002. Program
evaluations for the Canada Prenatal
Nutrition Program, Aboriginal Head
Start for First Nations On-Reserve,
and the Canadian Strategy on HIV/
AIDS for First Nations On-Reserve will
be undertaken by March 31, 2003 and
evaluation results will be available
by 2004.
Non-Insured Health Benefits
(NIHB) control and prevention
measures The Public Accounts Committee recommended that Health
Canada enhance the quality of management of services provided to First
Nations and Inuit. The Department is
committed to progress and has taken
steps to improve the management
of NIHB.
Key actions taken
The PAC recommended that Health
Canada immediately upgrade the
Point-of-Sale system for pharmacies
under the NIHB Program so that the
system provides the dates, quantities,
and drugs prescribed of at least a
client’s last three prescriptions and
information on doctors visited. The
Point-of-Sale system or Pharmacy
Electronic Communication Standard
(PECS) Version 3 is the current
industry standard. Currently over 99
percent of providers on the NIHB
Program are utilizing this system.
• A technical advisory group representing the Canadian Pharmacists
Association and a broad spectrum
of users including FNIHB has been
tasked with developing enhancements to Version 3.
• Once implemented, the enhanced
standard will streamline claims
administration, facilitate efficient
coordination of benefits, improve
access to patient medication history
(including Drug Utilization Review
data) and provide interactive communication with other health professionals.
FNIHB will continue to ensure that
the analysis of pharmacists’ overrides
of warnings is done, and will conduct
audits on providers and continue
generating quarterly reports on the
number of Drug Utilization Review
(DUR) claims submitted, accepted and
rejected. These actions will be reported
in the annual Departmental Performance Report beginning with 2002-2003.
The PAC/OAG also recommended
that Health Canada develop a policy to
guide its response in cases where it is
unable to obtain the consent of
Appendix B: Executive Summary: Response to the Public Accounts Committee First Nations Health: Follow-Up
139
recipients of Non-Insured Health
Benefits to share information on their
use of pharmaceuticals with health
care professionals and that the Department make that policy known prior to
the implementation of a client consent
arrangement under the NIHB Program. In July 2002, the NIHB Program
conducted the national rollout of the
consent initiative and developed a
communication package outlining the
consent initiative. The campaign outlined the purpose of consent, the
options for giving consent and how the
information will be used, collected and
disclosed. If the recipient does not sign
the general consent form, covering all
benefit areas in conjunction with the
140
consent campaign, the recipient must
complete an NIHB Program reimbursement form in order for benefits to
be provided.
Summary
The Department is committed to
reporting on actions taken on the
Public Accounts Committee and Auditor General recommendations. We will
implement greater measures to improve on our management of First
Nations and Inuit programs and
services. We will report on progress
made in the annual Departmental
Performance Report.
Health Canada
Appendix C:
Executive Summary:
Response to the Public
Accounts Committee - Human
Resources
Response to the Public
Accounts Committee
Tenth Report on the
Auditor General’s
Report, October 2000
(Health Canada Vacancies in regulatory
and surveillance
programs)
Introduction
The Public Accounts Committee
(PAC) as a follow-up to the 2000
Auditor General’s report, tabled recommendations requiring Health
Canada to fill outstanding vacancies in
its regulatory and surveillance programs for related biologics and to
report progress on these initiatives.
Recommendation 26.41 states that
“Health Canada should take measures
to ensure authorized positions are
staffed.” This recommendation is in
the context of funding received to
strengthen the regulatory side of
Health Canada’s Blood Safety Program
and is tied to recommendations by the
Public Accounts Committee in their
Seventeenth Report, as follows.
Recommendation 11
That Health Canada undertake all
the necessary measures to fill outstanding vacancies in its regulatory
and surveillance programs for related
biologics and report the progress of
these initiatives in its annual Performance Report to Parliament for the
period ending March 31, 2003.
Recommendation 12
That Health Canada include in its
annual Performance Report a section
containing the number of technical and
scientific vacancies in its regulatory
and surveillance programs at each year
end with the length of time each
position has been vacant.
Actions and current status
Several organizational changes have
taken place over the past two years
in an effort to strengthen both
the regulation and surveillance of
biological products within the Health
Appendix C: Executive Summary: Response to the Public Accounts Committee Human Resources
141
Products and Food Branch (HPFB).
These include the creation of the
Biologics and Genetic Therapies Directorate (BGTD), the Marketed Health
Products Directorate (MHPD) and the
Inspectorate.
Management recently approved a
special Human Resources Initiative to
accelerate recruitment. The project
will focus internally on the retention of
the highly qualified staff needed to
deliver the program and externally on
attracting and recruiting highly specialized staff to fill the numerous
vacancies in a timely fashion.
During 2001-2002, BGTD has
grown from 130 to 180 filled positions.
Specific focus continues to be paid to
staffing to address attrition and
142
internal movement, as well as gaps in
expertise.
In MHPD, priorities for staffing will
concentrate on Medical Officers and
management staff in the short-term.
Staff within the Biologics Division of
MHPD has grown from approximately
12 to 23. Staffing over the past year has
become more efficient through hiring
from Scientific Job Fairs. Operational
planning for the current year combined
with three year strategic planning will
be conducted in the near future now
that stable funding has been secured.
The HPFB Inspectorate’s 17 positions assigned to biologics have been
staffed and the planned projects
implemented.
Health Canada
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