2011-12 Report on Plans and Priorities

2011-12 Report on Plans and Priorities
2011-12 Report on Plans and Priorities
Table of Contents
MINISTER’S MESSAGE
1
MESSAGE FROM THE CHIEF PUBLIC HEALTH OFFICER
3
SECTION I – OVERVIEW
5
1.1
Summary Information ........................................................................................................................................ 5
Raison d’être and Responsibilities .................................................................................................................... 5
Contribution to the Federal Sustainable Development Strategy (FSDS) .......................................................... 5
Strategic Outcome and Program Activity Architecture (PAA)............................................................................ 6
1.2
Planning Summary ............................................................................................................................................ 7
Financial Resources ($M) ................................................................................................................................. 7
Human Resources (Full-time Equivalent – FTE) ............................................................................................... 7
Planning Summary Table .................................................................................................................................. 7
Contribution of Priorities to the Strategic Outcome ........................................................................................... 9
Risk Analysis ................................................................................................................................................... 10
Expenditure Profile .......................................................................................................................................... 13
Estimates by Vote ........................................................................................................................................... 14
SECTION II – ANALYSIS OF PROGRAM ACTIVITIES
2.1
15
Strategic Outcome........................................................................................................................................... 15
Program Activity 1.1 – Science and Technology for Public Health ................................................................. 15
Program Activity 1.2 – Surveillance and Population Health Assessment........................................................ 17
Program Activity 1.3 – Public Health Preparedness and Capacity.................................................................. 19
Program Activity 1.4 – Health Promotion ........................................................................................................ 21
Program Activity 1.5 – Disease and Injury Prevention and Mitigation ............................................................. 23
Program Activity 1.6 – Regulatory Enforcement and Emergency Response .................................................. 26
Program Activity 2.1 – Internal Services ......................................................................................................... 28
SECTION III – SUPPLEMENTARY INFORMATION
31
3.1
Financial Highlights ......................................................................................................................................... 31
3.2
List of Supplementary Information Tables ....................................................................................................... 34
SECTION IV – OTHER ITEMS OF INTEREST
35
Sustainable Development at the Agency ........................................................................................................ 35
Additional Web Links ....................................................................................................................................... 35
2011-12 Report on Plans and Priorities
Minister’s Message
I am pleased to present the Public Health Agency of Canada’s 2011-12
Report on Plans and Priorities. The Agency plays an important role in the
health and safety of Canadians by monitoring public health in Canada,
promoting healthy lifestyles, and protecting Canadians from adverse
public health events.
The H1N1 pandemic influenza outbreak underscored the value of having
effective emergency preparedness and response plans. While the Agency
successfully responded to this public health emergency, a number of
lessons learned reviews have noted areas for improvement. The Agency
will work with its federal, provincial and territorial partners to strengthen
Canada’s capacity to prepare for and respond to a public health event.
Internationally, the Agency will continue to support the World Health
Organization’s implementation of the International Health Regulations by
2012.
In September 2010, I announced, along with my provincial and territorial
colleagues, the Declaration on Prevention and Promotion, including the
release of Curbing Childhood Obesity: A Federal, Provincial and
Territorial Framework for Action to Promote Healthy Weights. Instilling the importance of a healthy lifestyle in children is
essential to preventing illness in later life. To that end, the Agency will work with partners to advance a number of
initiatives to promote healthy living by children and youth, including achieving and maintaining healthy weights and
avoiding injury.
Comprehensive and timely surveillance information is fundamental in strengthening public health in Canada. The
Agency will leverage this information to develop, in concert with provinces, territories and other key stakeholders,
targeted prevention, mitigation and control strategies for infectious and chronic diseases. Particular focus will be placed
on our most vulnerable populations including children, Aboriginal Peoples, and those living in rural, remote, and
Northern communities.
There is much to be accomplished. I have confidence in the Agency’s ability to deliver on the priorities in this report and
to continue promoting and protecting the health of Canadians.
_____________________________
Leona Aglukkaq, P.C., M.P.
Minister of Health
Report on Plans and Priorities 2011-12
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Report on Plans and Priorities 2011-12
Message from the Chief Public Health Officer
The Agency is recognized globally as a leader in the area of public health.
Recent successes such as our response to the H1N1 pandemic influenza
outbreak and development of the Declaration on Prevention and
Promotion with our provincial and territorial partners have underscored
that leadership. To continue promoting and protecting the health and
safety of Canadians, the Agency must maintain public confidence in its
activities, guidance and advice, and be seen as a valued contributor by
national and international partners. As a result, the Agency will focus its
efforts in 2011-12 on building on these successes.
Science and research underpin the Agency’s work and provide the strong
evidence base for our programs and activities. The Agency will publish a
Science and Research Strategic Plan that will provide an overarching
framework for our science and research activities, bring greater cohesion
to our initiatives and provide overall direction to our efforts. Improving how
we communicate science to all Canadians will form an important part of
these efforts.
As Chief Public Health Officer, I will work closely with my provincial and territorial colleagues to ensure a co-ordinated,
pan-Canadian approach to public health issues. The finalization of an agreement on the sharing of surveillance
information is a key priority, as it will improve our ability to prevent and respond to adverse public health events. I will
also continue to work with my federal, provincial and territorial colleagues to strengthen Canada's overall emergency
preparedness and response.
Sharing knowledge, information and resources, and continuing successful programs and policies for important issues
such as infectious and chronic diseases, injuries, and childhood obesity will be high priorities in 2011-12. Additionally,
as with previous years, I will update Canadians on the state of public health in Canada through my annual report.
Given the Agency’s vital and broad mission and its direct impact on the health and safety of Canadians, its employees
are its most valuable resource. To continue providing world class science and evidence-based products, we need to
continue to develop and retain a dedicated, knowledgeable, professional and diverse workforce that values excellence,
leadership, employee engagement, and workplace well-being. Consequently, strengthened human resources planning
will be a key management priority this year.
This 2011-12 Report on Plans and Priorities outlines activities the Agency will undertake to promote and protect the
health of Canadians.
________________________________________
David Butler-Jones, M.D.
Chief Public Health Officer
Report on Plans and Priorities 2011-12
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Report on Plans and Priorities 2011-12
Section I – Overview
1.1
Summary Information
Raison d’être and Responsibilities
Public health involves the organized efforts of society to keep people healthy and to prevent injury, illness and
premature death. It includes programs, services and policies that protect and promote the health of all Canadians. In
Canada, public health is a responsibility that is shared by the three levels of government, the private sector, nongovernment organizations, health professionals and the public.
In September 2004, the Public Health Agency of Canada (the Agency) was created within the federal Health
Portfolio to deliver on the Government of Canada’s commitment to increase its focus on public health in order to help
protect and improve the health and safety of all Canadians and to contribute to strengthening the health care system.
The Agency has the responsibility to:
x
Contribute to the prevention of disease and injury, and to the promotion of health;
x
Enhance the quality and quantity of surveillance data and expand the knowledge of disease and injury in
Canada;
x
Provide federal leadership and accountability in managing public health emergencies;
x
Serve as a central point for sharing Canada’s expertise with the rest of the world and for applying
international research and development to Canada’s public health programs; and
x
Strengthen intergovernmental collaboration on public health and facilitate national approaches to public
health policy and planning.
Contribution to the Federal Sustainable Development Strategy (FSDS)
The Agency is a participant in the Federal Sustainable Development Strategy (FSDS).1 The FSDS represents a
major step forward for the Government of Canada by including environmental sustainability and strategic
environmental assessment as an integral part of its decision-making processes. The new FSDS sets clear federal
direction for environmental sustainability and common goals and targets across government.
PHAC contributes to Theme IV: Shrinking the Environmental Footprint – Beginning with Government of the FSDS.
Contributions to the FSDS are further explained in Section II as part of the Internal Services Program Activity (2.1) and
electronically in Section III in the Greening Government Operations supplementary information table. Additional details
are available on PHAC’s Departmental Sustainable Development Strategy Web site.2
1
2
Federal Sustainable Development Strategy (FSDS) Web site: http://www.ec.gc.ca/dd-sd/default.asp?lang=EN&n=C2844D2D-1.
PHAC Web site: http://www.phac-aspc.gc.ca/sd-dd/index-eng.php.
Report on Plans and Priorities 2011-12
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Strategic Outcome and Program Activity Architecture (PAA)
To effectively pursue its mandate, the Agency aims to achieve a single Strategic Outcome supported by the Program
Activity Architecture (PAA) summarized below.
Strategic Outcome: Canada is able to promote health, reduce health inequalities,
and prevent and mitigate disease and injury
1.1
Science and
Technology for
Public Health
1.2
Surveillance
and Population
Health
Assessment
1.3
Public Health
Preparedness
and Capacity
1.4
Health
Promotion
1.5
Disease and
Injury
Prevention and
Mitigation
1.2.1
Public Health
Surveillance
1.3.1
Public Health
Capacity
1.4.1
Healthy
Communities
1.5.1
1.6.1
Chronic Disease Regulatory
Prevention and Enforcement
Mitigation
2.1.1
Governance and
Management
Support
1.2.2
Population
Health
Assessment
1.3.2
Preparedness
1.4.2
Emerging
Priorities and
Innovation in
Health
Promotion
1.5.2
Injury
Prevention and
Mitigation
1.6.2
Emergency
Operations
2.1.2
1.4.3
Childhood and
Adolescence
Programs
1.5.3
Infectious
Disease
Prevention and
Control
1.6.3
Emergency
Stockpile
2.1.3
Asset
Management
Services
1.3.3
Public Health
Networks
1.6
2.1
Regulatory
Enforcement
Internal
and Emergency Services
Response
Resource
Management
Services
1.4.4
Aging and
Seniors
In 2010-11, the Agency continued its work on the implementation of the Management, Resources and Results
Structure Policy that included the revision of the Agency’s Performance Measurement Framework (PMF). The objective
of this revision is to continue to improve a PMF that will provide more detailed, objective performance measurement
information to support the review, assessment and continuous improvement of programs.
Tag Legend:
Theme I: Addressing Climate Change and Air Quality
Theme II: Maintaining Water Quality and Availability
Theme III: Protecting Nature
Theme IV: Shrinking the Environmental Footprint – Beginning with Government
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Report on Plans and Priorities 2011-12
1.2
Planning Summary
Financial Resources ($M)
2011-12
2012-13
2013-14
622.7
592.1
579.2
Note: Additional information on expenditures at the Agency level is provided in Section I’s Expenditure Profile and at the Program
Activity level in Section II.
Human Resources (Full-time Equivalent – FTE)
2011-12
2012-13
2013-14
2,768
2,729
2,729
Planning Summary Table
Strategic Outcome: Canada is able to promote health, reduce health inequalities, and prevent and
mitigate disease and injury.
Performance Indicators
Targets
Maintain or exceed Canada’s 2001 HALE at birth as
reported by Statistics Canada.4
Health-adjusted life expectancy (HALE)3 at birth
Overall - 69.6
Women - 70.8
Men - 68.3
HALE by income; the difference, in years, in HALE at birth
between the top-third and bottom-third income groups
Maintain or reduce the difference in years.
Women - 3.2
Men - 4.7
3
HALE is an indicator of overall population health that combines measures of both age- and sex-specific health status, and ageand sex-specific mortality into a single statistic. It represents the number of expected years of life equivalent to years lived in full
health, based on the average experience in a population.
* Report on the State of Public Health in Canada 2010
4 Statistics Canada. CANSIM Table 102-0121 and Catalogue no. 82-221-X.
Report on Plans and Priorities 2011-12
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Planned Spending
Forecast
Spending
2010-11
2011-12
2012-13
2013-14
Alignment to
Government of Canada
Outcomes
1.1 Science and Technology
for Public Health
87.1
60.7
55.0
48.9
Healthy Canadians
1.2 Surveillance and
Population Health
Assessment
60.6
60.1
58.5
58.5
Healthy Canadians
1.3 Public Health
Preparedness and Capacity
83.0
94.6
75.3
72.4
Healthy Canadians
1.4 Health Promotion
182.9
182.2
182.2
182.2
Healthy Canadians
1.5 Disease and Injury
Prevention and Mitigation
104.1
107.3
102.5
98.6
Healthy Canadians
30.2
26.0
24.7
24.7
Safe and Secure Canada
547.9
530.9
498.2
485.3
Program Activity
1.6 Regulatory Enforcement
and Emergency Response
Total Planned Spending
Note: All figures are rounded
Internal Services
Forecast Spending
2010-11
110.3
8
Planned Spending
2011-12
2012-13
2013-14
91.8
93.9
93.9
Report on Plans and Priorities 2011-12
Contribution of Priorities to the Strategic Outcome
The following table outlines three operational and two management priorities and their links to the PAA and Agency
plans.
A. Operational Priorities
A1. Managing Public Health Risks to
Canadians
Type: Ongoing
Link to Program Activities (PAs):
1.1, 1.2, 1.3, 1.5, 1.6
Why is this a priority?
x Strengthening the Agency’s ability to anticipate and respond to both real and potential public health risks will
help prevent and mitigate disease.
Plans for meeting the priority
x Integrate expertise and information acquired through the management and review of the federal responses to
public health events.
x Enhance ability to prevent and control infectious diseases.
x Enhance preparedness to respond to emerging infectious diseases and other public health events.
x Strengthen chronic disease prevention initiatives to reduce common risk factors.
x Strengthen the capacity for public health surveillance.
x Strengthen the regulatory approach to aspects of public health.
x Enhance public health initiatives related to food safety.
A2. Promoting the Health of Vulnerable
Populations in Canada
Type: Ongoing
Link to Program Activities (PAs):
1.2, 1.3, 1.4, 1.5
Why is this a priority?
x Improving the health status of key disadvantaged and vulnerable populations in Canada by means of more
strategic and focused policies and interventions will help reduce health inequalities.
Plans for meeting the priority
x Strengthen initiatives to advance the health and well-being of children and youth.
x Engage other sectors and government departments to influence and develop healthy public policies and related
investments.
x Support the design, implementation and assessment of innovative policies and interventions. This includes
systematic knowledge sharing for broader benefits to Canadians.
A3. Enhancing Public Health Capacity
Type: Ongoing
Link to Program Activities (PAs):
1.2, 1.3, 1.4, 1.5, 1.6
Why is this a priority?
x Enhancing pan-Canadian and Agency capacity will build a stronger public health system and, in turn, promote
health, reduce health inequalities, and prevent and mitigate disease and injury.
Plans for meeting the priority
x Strengthen the capacity of the public health workforce.
x Build public health capacity in the North.
x Improve systematic knowledge sharing and use of best practices in public health.
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B. Management Priorities
B1. Achieving Business Excellence
Type: Previously committed
Link to Program Activities (PAs):
2.1
Why is this a priority?
x Strengthening the management and administrative infrastructure will enable the Agency to better serve the
public health interests and needs of Canadians.
Plans for meeting the priority
x Provide strategic and policy support for the Agency’s operational goals and for Ministerial priorities, with an
emphasis on evidence-based decision-making.
x Adopt stable, forward-looking management tools.
B2. Focussing on People
Type: New
Link to Program Activities (PAs):
2.1
Why is this a priority?
x Instill and support a workplace that values excellence, leadership, employee engagement, and workplace wellbeing in support of the delivery of the Agency’s programs and priorities.
Plans for meeting the priority
x Implement recommendations from the review of service delivery and strategic human resource management in
support of Agency priorities and mandate, within a three-year planning horizon.
x Establish a People Management Framework over the three-year planning horizon to support Public Service
Renewal.
x Develop a Human Resources resourcing strategy aimed at attracting, developing and retaining a dedicated,
knowledgeable and professional workforce.
Risk Analysis
The Agency’s risk analysis is a synthesis of environmental scans, trend analysis, and the Corporate Risk Profile. This
information plays an important role in helping the Agency determine priorities and plans over the short, medium and
long terms. The analysis incorporates the risks and mitigation strategies as well as the context.
Context and Infrastructure
The Agency seeks to mitigate risks by increasing public health capacity among Canadians and the public health
system through fostering proactive partnerships with key stakeholders and other governments. This collaboration is key
to developing strategies that assess and address gaps in public health capacity in order to enhance our ability to take
action on major health issues and respond to potential public health emergencies. The main vehicles used to increase
capacity are disease and injury prevention and mitigation activities, health promotion activities, emergency
preparedness and response, knowledge translation, and domestic and international collaboration.
Similar to many public service organizations, the Agency also identified in its Corporate Risk Profile management risks.
To address these risks, the Agency will develop and implement a talent management strategy and professional
development and recruitment programs; strengthen integrated planning, reporting and decision activities through
enhanced horizontal communication and coordination; implement an Agency Information Management Operational
Plan; and strengthen the governance of information technology service agreements.
To ensure that the Agency will recruit and retain the required public service talent, the Agency will foster a peopleoriented workplace in support of Public Service Renewal by developing and implementing a comprehensive Human
Resources (HR) policy framework and an HR Management Framework over the three-year planning horizon. The
Agency is also committed to strengthening public health capacity to meet the needs of Canadians by working with
national and international partners.
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Report on Plans and Priorities 2011-12
Public Health Emergencies
A key part of the Agency’s mandate is to prepare for, and respond to, public health emergencies. This requires the
coordination of federal, provincial, territorial, regional and local health authorities, as well as foreign governments and
multi-lateral organizations. The unpredictability of public health emergencies, and the fact that they are addressed
within multi-jurisdictional and multi-party domains, creates both opportunities and challenges.
Acting on the recommendations of a June 2010 internal Audit Report on Emergency Preparedness and Response, the
Agency will, among other things, create internal surge capacity by developing a reserve of personnel within the
Agency; participate in exercises to clarify and reinforce roles and responsibilities during emergencies; and synthesize
and apply lessons learned from reviews and evaluations of past events, such as H1N1.
Globalization
Countries worldwide are more dependent on one another, which has resulted in higher international migration,
commerce and travel. Globalization presents opportunities, in the form of expanded opportunities to share best
practices with other countries, and improved communications to address public health events. It also presents threats,
however, as globalization increases the likelihood and transmission speed of an infectious disease outbreak. The
Agency's experience in responding to the H1N1 pandemic in Canada will provide knowledge and tools to
strengthen surveillance, and further improve planning, preparedness and response for future pandemics.
One element of globalization is the worldwide movement of products and services, including food. Global food supply
chains and demand for lower costs result in food products that are sourced from many different countries, not all of
which have robust regulatory systems to protect the public from food-borne illnesses. Coordination and capacity among
federal, provincial, territorial, regional and local health authorities are of the utmost importance to enable effective
management and response to multi-jurisdictional food-borne illness and infectious disease outbreaks. The Agency will
continue to coordinate through strategies that include addressing systemic challenges in leadership, preparedness,
planning and communication of food safety issues. Lessons learned from the H1N1 flu outbreak will also provide
insight for continued improvements.
Prevention and Promotion
Canadians are increasingly facing challenges to their health caused by unhealthy lifestyles. Generally, Canadians eat
too much, particularly foods high in sodium and refined sugars. Further, only 15% of Canadians are meeting the
recommendations for physical activity,5 a core element of overall health and well-being. These two factors contribute to
rising obesity rates and increase the chance of developing chronic diseases such as type 2 diabetes, osteoarthritis and
some cancers. In 2005, nearly one-quarter of adult Canadians were obese and an additional 35% were overweight.6
Children are facing a similar picture; more than one-in-four children and youth in Canada are overweight or obese,7
increasing their risk of unhealthy outcomes in their adult life. As well, some 4.9 million Canadians are regularly using
tobacco, putting them at higher risk of developing cardiovascular and respiratory diseases, and many cancers.8 Other
vulnerable populations, such as Aboriginals or low-income Canadians, are particularly at risk for developing poor health
outcomes.
PHAC has been responding to this challenge on a number of fronts. The Agency's primary program for the promotion
of healthy living is the Integrated Strategy on Healthy Living and Chronic Disease. This program seeks to reduce
common risk factors such as high blood pressure, and address specific diseases such as cardiovascular disease,
cancer and diabetes in Canadians. Recently, federal, provincial, and territorial Ministers of Health and Healthy Living
agreed on a framework to curb childhood obesity, which includes strategies to help children achieve healthy weights.
5 Colley, Rachel C. et al. Physical activity of Canadian adults: Accelerometer results from the 2007 to 2009 Canadian Health
Measures Survey. Statistics Canada, Catalogue no. 82-003-XPE, Health Reports, Vol. 22, no. 1, March 2011.
http://www.statcan.gc.ca/pub/82-003-x/2011001/article/11396-eng.pdf. [Accessed January 28, 2011].
6 Public Health Agency of Canada. 2009. Obesity in Canada – Snapshot. http://www.phac-aspc.gc.ca/publicat/2009/oc/indexeng.php. [Accessed February 2, 2011].
7 Curbing Childhood Obesity: A federal, Provincial and Territorial Framework for Action to Promote Healthy Weights. (September
2010) http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/framework-cadre/pdf/ccofw-eng.pdf. [Accessed February 2, 2011].
8 Statistics Canada. (September 27, 2010)The Daily. Canadian Tobacco Use Monitoring Survey. (previously released)
http://www.statcan.gc.ca/daily-quotidien/100927/dq100927c-eng.htm. [Accessed January 28, 2011].
Report on Plans and Priorities 2011-12
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Canada’s Aging and Changing Population
Canada's population is aging, creating new demands on families and potentially greater costs for social programming
and healthcare. Aging impacts our society in terms of economics, health care and services. Health promotion, injury
prevention, and efforts to encourage and increase social participation and inclusion can save money, maintain and
improve quality of life, and drive healthy economies.
Canada’s population is also changing. Two-thirds of Canada’s population growth between 2001 and 2006 was due to
international migration.9 As well, the Aboriginal population in Canada is growing faster than the non-Aboriginal
population. These demographic changes present challenges to public health. For example, there may be pressure on
communication systems as there is a need to ensure that public health messages effectively reach these sectors of the
population, especially during public health emergencies.
Responding to Canada’s aging and changing population will require on-going analysis of demographic trends and
adaptable public health strategies to effectively capture the opportunities and respond to the challenges inherent in
these changes.
Environmental Concerns
The environment influences public health policy and programming in some fundamental ways, from the need for clean
air and water, to the need to limit human contact with harmful chemicals and pollutants. In the first days of public health
policy, efforts were focussed on controlling and eliminating major public health threats, such as sewage and air
pollution.
While Canada has had great success on these fronts, today’s challenges are no less important, specifically as related
to climate change. The main threats to public health from climate change are related to disease prevention and control,
in particular a warmer climate facilitating the rapid spread of new communicable diseases. As well, climate change
could increase immigration to Canada due to displacement, adding to health care pressures; it could impact
emergency preparedness owing to more extreme weather events; and it could have serious implications for food
safety10 and food security as growing patterns change worldwide.
Environmental concerns as they relate to public health also extend to the built environment,11 and the need to ensure
that the physical environment is designed in a way that supports health and safety. Communities need to be designed
to promote healthy living and mitigate risks to health sometimes posed by infrastructure design that does not
encourage active lifestyles. Canada has played a leading role in creating friendly environments for seniors through an
Age-Friendly Communities Initiative in which five provinces are engaged. Senior Canadians help in the planning and
design within their own communities to create healthier and safer places for seniors to live and thrive.
Finally, poor air quality, indoors and outdoors, continues to have significant negative effects on public health and is
estimated to have large economic costs.12 Increasing urbanization, and the considerable periods of time people spend
in climate-controlled environments, may be factors impacting air quality. We need to continue monitoring and
researching environmental contaminants and their potential health effects.
9
Statistics Canada. 2007a. 2006 Census: Portrait of the Canadian Population in 2006: National portrait.
http://www12.statcan.ca/census-recensement/2006/as-sa/97-550/p2-eng.cfm [Accessed November 30, 2010].
10 Food and Agriculture Organization of the United Nations (FAO). 2008. Climate Change: Implications for food safety.
http://www.fao.org/docrep/010/i0195e/i0195e00.htm [Accessed December 7, 2010].
11 The built environment can be broadly defined as environments that have been created or modified by people such as:
neighbourhood designs; schools; homes; workplaces; recreation areas; location of stores; and the location and design of roads;
sidewalks, bike lanes and footpaths. It is a key determining factor to promote physical activity and prevent obesity.
12 Canadian Medical Association. No Breathing Room: National Illness Costs of Air Pollution. August 2008.
http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Office_Public_Health/ICAP/CMA_ICAP_sum_e.pdf [Accessed
December 6, 2010].
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Report on Plans and Priorities 2011-12
Science and Technology
Science and technology profoundly affects public health. For example, immunization has saved countless lives and
further advances in science and technology hold the promise of achieving more progress toward the Agency’s stated
vision of healthy Canadians and communities in a healthier world.
Information technology is one area that holds great promise. Internet usage among Canadians is increasing, and
Canadians are accessing the Internet more frequently. Searching for health information is now the second-most
common activity on the Internet next to email use. In fact, searching for health information on line was reported by 70%
of users in 2009, up from 59% in 2007.13 To mitigate the risk of Canadians indiscriminately searching for health
information anywhere on the Internet (where incorrect information can be found), PHAC must expand its profile as a
leader in delivering credible health information to Canadians. Further, as communication technologies are increasingly
important tools for sharing information, implementing the successful use of the most effective Internet-based
information delivery methods (social media, audio-visual, traditional Web page) could be fundamental to promoting
health and reducing health inequalities.
The growth of the internet in Canada and around the world also has implications for how public health information is
gathered and disseminated. For example, new generation surveillance tools will allow for more rapid collection and
sharing of public health information as well as the identification, confirmation and response to public health risks of
international importance.
Advances in public health science and technology (in areas such as vaccines, antibiotics, antivirals, and diagnostics)
and the effect that computing and networking has had on the collection and interpretation of surveillance data will also
change the way Canadians and public health practitioners address emerging issues in public health. For example, the
future development of new prophylactic and therapeutic vaccines could have the potential to prevent more infectious
and chronic diseases. As well, future advances in antibiotics (such as phage therapy, engineered antibodies, and the
use of probiotics) could one day help address the growing threats of antibiotic resistance, hospital acquired infections,
and new emerging infectious diseases.
Finally, technological advances will also continue to impact how conditions and diseases are diagnosed. Recent
advances in diagnostic technology have made it possible for Canadians to conduct self-testing to diagnose health
conditions (such as a pregnancy), monitor illness (such as blood sugar levels in people with diabetes), and screen for
an illness or disease. Moreover, the growing application of public health genomics — which looks at the ways in which
genes, behaviour, diet and the environment combine to impact health — may create new possibilities in the prevention
and control of infectious and chronic diseases.
Expenditure Profile
In 2009-10, Canada experienced an H1N1 pandemic from the Spring to the Fall which accounted for approximately
$310M of the additional $361.3M spending. This additional spending was related to the purchase of the H1N1 vaccine
and pandemic response activities such as communications, surveillance, and the procurement of ventilators. The
Agency also spent $49.7M on the Hepatitis C Health Care Services Program which provided funding to the provinces
to compensate for the care of individuals infected with Hepatitis C. This program provides payments every five years
until 2014-15.
As the items noted above were for one-time spending in 2009-10, forecasted spending was lower by approximately
$286M in 2010-11. However, this decrease was partially offset by $20.6M received to complete the final year of the
project to modernize the Canadian Science Centre for Human and Animal Health (CSCHAH) laboratory in Winnipeg,
Manitoba.
Starting in 2011-12, planned spending will gradually decline as several time-limited projects near completion. In 201112, funding will decrease for modernizing the CSCHAH ($20.6M). Other reductions stem from implementation of
13
Statistics Canada (May 10, 2010). The Daily. Canada Internet Usage Survey (previously released).
http://www.statcan.gc.ca/daily-quotidien/100510/dq100510a-eng.htm. [Accessed December 6, 2010].
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budget reallocations made in the 2008 Strategic Review process ($6.3M), a permanent transfer of the Canadian Breast
Cancer Research annual named grant to the Canadian Institutes for Health Research ($3M), as well as the planned
sunsetting of the Clean Air Agenda ($2.2M).
In 2012-13, reference levels will decline by approximately $30M mainly due to two items: one-time funding received to
implement the recommendations made in the Report of the Independent Investigator into the 2008 Listeriosis Outbreak
will end ($7.6M), and one-time funding for the installation of the new vaccine influenza fill line will decrease by $20.7M.
In 2013-14, PHAC funding declines by $12.9 M mainly as a result of the near completion of the Lung and Neurological
Diseases initiative ($4.9M) and reduced funding for the JC Wilt Laboratory ($6.1M).
Spending Trend ($ M)
1,000
900
944.2
800
700
600
500
658.3
582.9
622.7
592.1
579.2
2012-13
2013-14
400
300
2008-09
2009-10
Actual Spending
2010-11*
Forecast
Spending
2011-12
Planned Spending
*2010-11 is a forecast as of December 20, 2010.
Estimates by Vote
For information on the Agency’s organizational votes and/or statutory expenditures, please see the 2011-12 Main
Estimates publication. An electronic version of the Main Estimates is available at http://www.tbs-sct.gc.ca/estpre/2011-2012/me-bpd/info/info-eng.asp.
14
Report on Plans and Priorities 2011-12
Section II – Analysis of Program Activities
2.1
Strategic Outcome
The Agency’s Strategic Outcome is: Canada is able to promote health, reduce health inequalities, and prevent and
mitigate disease and injury. The following section describes the six Program Activities (PAs) through which the Agency
works to achieve the Strategic Outcome, and for each, identifies the expected results, performance indicators and
targets. This section also explains how the Agency plans to achieve the expected results and presents the financial
and human resources that will be dedicated to each Program Activity.
Program Activity 1.1 – Science and Technology for Public Health
Canada is able to promote health, reduce
health inequalities, and prevent and mitigate
disease and injury
1.1 Science and Technology
for Public Health
Human Resource (FTEs) and Planned Spending ($ M)
2011-12
2012-13
2013-14
FTEs
Planned
Spending
FTEs
Planned
Spending
FTEs
Planned
Spending
445
60.7
439
55.0
439
48.9
The current funding profile for JC Wilt Laboratory project is $5.7M less in 2012-13 than 2011-12. The anticipated construction
schedule of the JC Wilt Laboratory project is the main reason for the decrease of $6.1M from 2012-13 to 2013-14.
Expected Result(s)
Public health decisions and
interventions by public health
officials are supported by research,
timely and reliable reference service
tests*
Performance Indicator(s)
Target(s)
% of accredited reference service
tests within the various specified
turnaround times
80%
% of reference service testing
performed under acceptable
International Organization for
Standardization (ISO) accreditation
standards
100%
Research Publications Impact
Factors Rating**
2,000
*Reference testing performed by Agency laboratories includes specialized diagnostic testing, confirmatory testing and special
testing to characterize disease-causing agents. Such reference testing is carried out both routinely and in response to emergency
outbreaks.
**This rating is defined as the number of citations of PHAC laboratory research publications over the past three years. It may not
include all PHAC publications.
Report on Plans and Priorities 2011-12
15
PA Summary: This program deals with the development and application of leading edge national public health science
and innovative tools, the provision of specialized diagnostic laboratory testing and reference services, and the
mobilization of Canadian scientific capacity and networks to enable Canada to improve public health and better
respond to emerging health risks.
Planning Highlights: To achieve the expected result, the Agency will undertake the following activities:
x
Provide timely and reliable testing that complies with reference testing requirements, which include ensuring
that laboratories continue to expand the number of diagnostic tests meeting ISO/IEC 17025 standards and
maintain accreditation for tests that are currently ISO 17025 certified.
x
Develop integrated public health science and innovative tools and technologies that address emerging
infectious public health risks at the human-animal-environment interface.
x
Publish research findings from applied and discovery research14 on established and emerging infectious
diseases, including their characteristics, diagnosis, transmission, and treatment.
x
Develop and provide leading-edge molecular-based technology and expertise for research, surveillance, and
diagnostic testing on infectious diseases. Apply the latest generation of DNA sequencing technologies to
enhance the capacity to analyze and interpret whole genome sequences in molecular epidemiology.
x
Develop innovative approaches and integrated public health technologies for the prevention of infectious and
chronic diseases based on the analysis of risk and on current knowledge about the human genome in terms
of biological variability throughout the population.
Benefits for Canadians: Canadians will benefit from timely and reliable public health decisions and interventions and
advances in diagnostic techniques and knowledge related to public health risks. Canadians will also be able to make
personal health decisions that are based on advanced scientific knowledge. This will contribute to improved response
to emerging health issues and improved public health.
14
Discovery research is carried out to increase knowledge and understanding. This generates new scientific ideas, principles,
theories and ways of thinking. Applied research takes these new concepts and translates them into new methods, applications or
technologies. For example, discovery research may investigate how the human immune system works or how micro-organisms
interact with humans and cause disease, whereas applied research may investigate ways to diagnosis or prevent a specific disease,
such as developing a new vaccine.
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Report on Plans and Priorities 2011-12
Program Activity 1.2 – Surveillance and Population Health Assessment
1.2.1 Public Health
Surveillance
1.2 Surveillance and
Population Health
Assessment
Canada is able to promote health, reduce
health inequalities, and prevent and mitigate
disease and injury
1.2.2 Population Health
Assessment
Human Resource (FTEs) and Planned Spending ($ M)
2011-12
2012-13
2013-14
FTEs
Planned
Spending
FTEs
Planned
Spending
FTEs
Planned
Spending
408
60.1
402
58.5
402
58.5
One-time funding received to implement the recommendations made in the Report of the Independent Investigator into the 2008
Listeriosis Outbreak is planned to sunset in 2011-12. This will decrease planned spending in 2012-13 by $1.6M.
Expected Result(s)
Performance Indicator(s)
Federal, provincial, and territorial
jurisdictions, and health NGOs use
PHAC information to make informed
decisions*
% of federal, provincial, and
territorial jurisdictions, and health
NGO’s that indicate that PHAC's
surveillance and population health
assessment information is relevant
and accessible*
Key stakeholders use PHAC
surveillance information to support
chronic disease prevention action
and to monitor and evaluate the
impact of actions
% of key stakeholders using chronic
disease surveillance information
provided by PHAC, by type of use
Target(s)
70%*
Establish target by March 31, 2012
* The original expected result (Federal, provincial, territorial and local jurisdictions, health care providers and health NGOs use
PHAC information to make informed decisions), performance indicator (% of survey respondents [i.e., jurisdictions and stakeholders]
who indicate that PHAC’s surveillance and population health assessment information is relevant and accessible), and target (30%)
have been revised due to data accessibility. The target was revised upwards following a clarification of the key participating
jurisdictions.
PA Summary: This program facilitates ongoing, systematic analysis, use and sharing of routinely-collected data with
and among provinces, territories, local health authorities, and other federal departments and agencies so that they can
be in a better position to safeguard the health of Canadians. This program is necessary because of the continuous risk
to the health of Canadians from emerging infectious and chronic diseases as well as other population health risk
factors present. The program is geared towards working with federal departments and agencies, other levels of
government, health professionals, hospitals and laboratories across the country to facilitate the development of
surveillance systems and the sharing of information.
Report on Plans and Priorities 2011-12
17
Planning Highlights: To achieve the expected results, the Agency will undertake the following activities:
x
Develop a collaborative federal/provincial/territorial pilot project for respiratory virus surveillance to serve as a
model for a nationally coordinated surveillance system drawing on the experience of provincial/territorial
public health agencies and other existing centres of knowledge.
x
Continue to address recommendations from the May 2008 Report of the Auditor General by maintaining a
process to identify surveillance system priorities, ensuring mechanisms and tools are in place to maximize
effective partnerships, facilitating the sharing of data and information, and collaborating with partners on
surveillance activities.
x
Implement the Agency’s Surveillance Strategic Plan. Strengthen Canadian Public Health Surveillance
systems including those focused on obesity, mental illnesses, risk behaviours, chronic and infectious
diseases as well as population groups such as children, youth, and seniors. Moreover, systems focused on
HIV/AIDS, sexually-transmitted and bloodborne infections, vaccine safety, anti-microbial resistance, tissue
and organ safety, and tuberculosis will be enhanced. This will include developing plans to address
surveillance data gaps for chronic and infectious diseases; improving the effectiveness and efficiency of the
Canadian Notifiable Diseases Surveillance System data collection, validation and reporting process;
expanding the Canadian Chronic Disease Surveillance System (asthma, chronic obstructive pulmonary
disorder, heart diseases, osteoporosis, and arthritis); and enhancing the web-based query and analysis tools
to improve information accessibility for analysis and timely dissemination of results and adding
enhancements to vaccine safety surveillance through upgrades to the Canadian Adverse Events Following
Immunization Surveillance System.
x
Perform testing and research on diseases that afflict vulnerable populations (e.g., tuberculosis) and
participate in enhanced surveillance tracking studies of HIV and sexually transmitted infection prevalence in
vulnerable populations in conjunction with provincial public health labs.
x
Continue to develop and implement an integrated approach to human papillomavirus (HPV) surveillance to
evaluate the effectiveness of the HPV vaccine and HPV-related outcomes.
x
Use surveillance to detect, monitor and report on infectious disease sources and risk factors in order to
provide best evidence that can guide decision-making for interventions at the human-animal-environment
interface.
x
Initiate sentinel surveillance of hypertension, diabetes, chronic obstructive pulmonary disease (COPD),
depression and osteoarthritis in primary care settings using data from electronic medical records in
collaboration with the College of Family Physicians of Canada.
x
Conduct ongoing data collection, analysis and reporting on the rates, patterns and circumstances of injury of
Canadians, focusing on children and seniors. Contribute to the evidence base for policies, practices and
programs for injury prevention and control.
x
Increase capability to assess the health of the population through the development of population health
analyses on complex public health issues.
Benefits for Canadians: The Agency’s surveillance and population health assessment initiatives will contribute to the
timely and accurate information requirements of public health partners and stakeholders. They will also prepare the
health system to respond to infectious disease outbreaks, vaccine safety concerns, and address trends in the risk
factors leading to infectious and chronic diseases. Population Health Assessment activities increase capacity in
assessing the health of the population by strengthening the evidence base and contributing to the development of
public health policy. This ensures that Canadian decision-makers have information and tools to identify and address
priority public health issues.
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Report on Plans and Priorities 2011-12
Program Activity 1.3 – Public Health Preparedness and Capacity
1.3.1 Public Health
Capacity
Canada is able to promote health, reduce
health inequalities, and prevent and mitigate
disease and injury
1.3 Public Health
Preparedness and Capacity
1.3.2 Preparedness
1.3.3 Public Health
Networks
Human Resource (FTEs) and Planned Spending ($ M)
2011-12
2012-13
2013-14
FTEs
Planned
Spending
FTEs
Planned
Spending
FTEs
Planned
Spending
367
94.6
362
75.3
362
72.4
Planned spending is $19.3M higher in 2011-12 mainly as a result of expenditures related to the installation of a vaccine fill line
project. This project is scheduled for completion in 2013-14.
Expected Result(s)
Performance Indicator(s)
Target(s)
Canada has the capacity for public
health interventions including
emergency response
% completion of International Health
Regulations Action Plan for
addressing capacity gaps
75% (June 15, 2011)
100% (June 15, 2012)
Pan-Canadian and international
agencies have interoperability and
response capacity
% of capacity demonstrated in joint
exercises with partners
100%
Public health organizations have the
capacity to carry out their core public
health functions*
% federal, provincial, and territorial
jurisdictions that indicate that they
made progress in addressing
capacity gaps as a result of Agency
training and tools*
50%*
* The original expected result (public health organizations have the capacity to carry out their core public health functions),
performance indicator (% federal, provincial, territorial and local jurisdictions that indicate that they made progress in addressing
capacity gaps as a result of Agency training and tools), and target (90%) have been revised due to data accessibility. The target was
revised downwards following a clarification of the key participating jurisdictions.
PA Summary: This program increases Canada’s public health preparedness and capacity by: providing tools, training
and practices that enhance the capabilities of organizations and people who have a role in Canada’s public health
system; increasing public health human resource capacity; developing and maintaining Canada’s ability to prepare for
public health emergencies; and establishing/maintaining networks both within and outside Canada. The program is
necessary as public health skills, tools and networks are required to be able to keep Canadians healthy.
Report on Plans and Priorities 2011-12
19
Planning Highlights: To achieve the expected results, the Agency will undertake the following activities:
x
Develop an all hazards Threat and Risk Assessment with the health portfolio to identify the threats, hazards
and risks for decision makers regarding emergency preparedness planning and stockpile of supplies. This
will support Canada’s partnership activities such as the Global Health Security Initiative.
x
Develop and execute a trilateral action plan with the United States and Mexico for animal and pandemic
influenza, guided by the principles established in the 2011 North American Plan for Avian and Pandemic
Influenza.
x
Build on lessons learned from the Vancouver 2010 Olympic and Paralympic Winter Games and the G8/G20
Summits to inform and enhance mass gathering planning. In 2015, Canada will host the Pan/Parapan
American Games in Toronto, Ontario. The Agency will work with other government departments, and local
and provincial authorities to ensure that obligations are met.
x
Address key recommendations identified in the Lessons Learned Review: Public Health Agency of
Canada and Health Canada Response to the 2009 H1N1 Pandemic and the Standing Senate Committee
Report entitled Canada's Response to the 2009 H1N1 Influenza Pandemic.
x
Engage provincial/territorial jurisdictions and key national stakeholders to contribute to a comprehensive
review and revision of the Canadian Pandemic Influenza Plan, which will incorporate new information
including national and international experience gained during pandemic H1N1.
x
Maintain and update the all-hazards Health Portfolio Emergency Response Plan based on lessons learned
from exercises, real events and mass gatherings through the direction of the Joint Emergency Preparedness
Committee that oversees the coordination of emergency preparedness activities of the Health Portfolio.
x
Strengthen public health skills across Canada by continuing to provide a competency-based suite of
learning modules on core public health functions to enhance preparedness to respond and address risks to
Canadians. Review and update the modules to ensure that they meet the needs of stakeholders.
x
Continue to develop tools for federal, provincial and territorial (F/P/T) partners through the Canadian
Network for Public Health Intelligence to facilitate the dissemination of strategic intelligence and coordination
of public health responses.
x
Continue to develop the capacity to promote and improve the use of scientific research and other knowledge
to strengthen public health practice and policy in Canada by providing support for the activities of the
National Collaborating Centres for Public Health.
Benefits for Canadians: These activities will provide increased coordination and capacity among partners and assist
public health practitioners in performing public health roles that are critical to the effective preparation for public health
events and in addressing trends in the risk factors leading to chronic diseases. Evidence-based, ethical, timely, and
effective decision-making, coordination, and action are critical to minimizing the effects of adverse public health events
on Canadians.
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Report on Plans and Priorities 2011-12
Program Activity 1.4 – Health Promotion
1.4.1 Healthy
Communities
Canada is able to promote health, reduce
health inequalities, and prevent and mitigate
disease and injury
1.4.2 Emerging Priorities
and Innovation in Health
Promotion
1.4 Health Promotion
1.4.3 Childhood and
Adolescence Programs
1.4.4 Aging and Seniors
Human Resource (FTEs) and Planned Spending ($ M)
2011-12
2012-13
2013-14
FTEs
Planned
Spending
FTEs
Planned
Spending
FTEs
Planned
Spending
391
182.2
385
182.2
385
182.2
Expected Result(s)
Performance Indicator(s)
Target(s)
Supportive environments and
collaborative health promotion
policies are in place to reduce health
inequalities and enable Canadians to
maintain and improve their health
% of collaborations that result in joint
action having an objective of
influencing supportive environments
and health promoting policies
80%
# of communities reached
Establish baseline by March 2011
# by type of health promotion
initiatives
Establish baseline by March 2011
PA Summary: This program provides leadership and support in promoting health and reducing health inequalities
among Canadians. It supports Canadians in making healthy choices during all life stages through initiatives focussed
on, for example, child development, families, lifestyles, and aging. It also facilitates the conditions that support these
choices by working with and through others to address factors and determinants that influence health, such as health
literacy, food security, social support networks and the “built”15 environment.
15 The built environment can be broadly defined as environments that have been created or modified by people such as:
neighbourhood designs; schools; homes; workplaces; recreation areas; location of stores; and the location and design of roads;
sidewalks, bike lanes and footpaths. It is a key determining factor to promote physical activity and prevent obesity.
Report on Plans and Priorities 2011-12
21
Planning Highlights: To achieve the expected result, the Agency will support the development of targeted, evidencebased health promotion strategies and interventions with a special focus on:
x
Vulnerable children and families through collaboration and programs such as the Canada Prenatal
Nutrition Program, the Community Action Program for Children and Aboriginal Head Start in Urban
and Northern Communities. Strategic funding will be used to develop a cohesive Agency approach to child
health and strengthen the Agency’s leadership in advancing child and youth health priorities.
x
Adults in later life, specifically with regard to healthy aging and Public Health Security and other health
promotion interventions geared towards seniors.
x
Healthy Living, as it relates to the promotion of physical activity and healthy eating and their relationship
to healthy weights, in alignment with federal and collaborative actions identified in Curbing Childhood
Obesity: an F/P/T Framework for Action to Promote Healthy Weights. Instilling the importance of a healthy
lifestyle in children is essential to preventing illness in later life. PHAC will continue to develop the evidencebase and monitor and support research to supplement the existing information on physical activity. This in
turn will contribute to the development of additional tools and resources to help Canadians be more active
and live healthier lives. The Agency will also support community-based initiatives to promote physical activity
and healthy eating opportunities in the after-school time period.
x
Lead federal efforts to address family violence and provide an update of the Report on Seniors’ Falls in
Canada. The Agency will also participate in federal activities related to the Canadian Year of Road Safety
2011 and the start of the UN Decade of Road Safety.
x
Mental health promotion and mental illness prevention, including the identification and documentation of
effective and promising practices.
x
Health inequalities, in leading initiatives such as the development and application of tools including sex- and
gender-based analysis16 and health equity impact assessment to assess and more effectively reach
vulnerable populations through policy and program interventions.
x
Innovation in population health interventions, by designing, testing and evaluating new policies and initiatives
to fill evidence gaps on how to avert and mitigate inequalities among disadvantaged populations, e.g., for
mental health promotion and healthy weights via the Innovation Strategy.
Benefits for Canadians: Health promotion is the process of enabling people to increase control over and improve their
health. It is based on understanding the influence that determinants of health — such as healthy child development,
gender, income, literacy, and other factors — have on health status. The Agency’s health promotion activities are
moving beyond health education and personal behavioural change to address social, institutional, and community
change. By enabling individual Canadians to improve their health and enabling all levels of government and institutions
to better address the factors that influence and determine health and health inequalities, the Agency is supporting the
development of Healthy Canadians.
16
Sex and Gender Based Analysis is an approach to research, programs and policies which systemically inquires about biological
(sex-based) and socio-cultural (gender-based) differences between women and men, boys and girls, without presuming that any
differences exist. The purpose of SGBA is to promote rigorous sex/gender-sensitive health research, policies and programs which
expand the understanding of health determinants in both sexes in order to provide knowledge which may result in improvements in
health and health care. http://www.hc-sc.gc.ca/hl-vs/pubs/women-femmes/sgba-policy-politique-ags-eng.php [accessed January
26, 2011]
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Report on Plans and Priorities 2011-12
Program Activity 1.5 – Disease and Injury Prevention and Mitigation
1.5.1 Chronic Disease
Prevention and Mitigation
Canada is able to promote health, reduce
health inequalities, and prevent and mitigate
disease and injury
1.5 Disease and Injury
Prevention and Mitigation
1.5.2 Injury Prevention
and Mitigation
1.5.3 Infectious Disease
Prevention and Control
Human Resource (FTEs) and Planned Spending ($ M)
2011-12
2012-13
2013-14
FTEs
Planned
Spending
FTEs
Planned
Spending
FTEs
Planned
Spending
348
107.3
343
102.5
343
98.6
Planned spending levels will decrease by $4.8M in 2012-13 and by $3.9M in 2013-14 mainly as a result of work on the Lung and
Neurological Diseases initiative nearing completion.
Expected Result(s)
Diseases and injury in Canada are
prevented and mitigated
Performance Indicator(s)
Target(s)
Rate of age-standardized new
diagnoses of major diseases during
a one-year period (incidence)17
x Diabetes
x Cancer
x Hypertension
x Asthma
x Chronic Obstructive Pulmonary
Disease (COPD)
Baselines identified:
x Diabetes: 6.7 per 1,000
population
x Cancer: 4 per 1,000 population
x Hypertension: 22.1 per 1,000
population
17 Diabetes, cancer, and hypertension are the only chronic diseases for which the Agency will have incidence data for in 2011-12.
Work is ongoing to develop baseline data for incidence of additional chronic diseases such as asthma and COPD over the next few
years.
Report on Plans and Priorities 2011-12
23
Unintentional and intentional injury
incidence rates over a one-year
period
Baselines identified:
All injuries (all ages):
x Deaths: 45.1 per 100,000
x Hospitalizations: 659 per
100,000
Unintentional Injuries (all ages):
x Deaths: 29.5 per 100,000
x Hospitalizations: 600.5 per
100,000
Rate of reported cases of infectious
diseases including health care
associated infections, during a oneyear period
Targets identified:
x Tuberculosis: 3.6 per 100,000
by 2015
Baselines identified (2007):
x Tuberculosis: 4.8 per 100,000
x HIV: 8.8 per 100,000
x Chlamydia: 224.0 per 100,000
x Gonorrhoea: 36.1 per 100,000
x Infectious syphilis: 3.7 per
100,000
x Acute hepatitis B: 0.69 per
100,000
x Acute hepatitis C incidence:
1.61 per 100,000
x MRSA (Methicillin-resistant
staphylococcus aureus): 7.62
per 1,000 patient admissions
x VRE (Vancomycin-resistant
enterococcus): 1.20 per 1,000
patient admissions
x C. difficile: 4.45 per 1,000
admissions
PA Summary: This program develops and implements strategies, undertakes prevention initiatives, and supports
stakeholders to prevent and mitigate chronic disease, injury, and prevent and control infectious disease. Federal
leadership and collaboration to mobilize domestic efforts characterize this program. This program is necessary given
the current and potential impact of injury and chronic and infectious disease on the health of Canadians and the
sustainability of the Canadian health care system.
Planning Highlights: To achieve the expected result, the Agency will undertake the following activities:
24
x
Continue to implement measures to address the recommendations made in the Report of the
Independent Investigator into the 2008 Listeriosis Outbreak by developing: a comprehensive national Foodborne Illness Incident Response Plan; an Incident Command Structure specifically tailored to food-borne
illness outbreaks; and a Pilot Infectious Disease Impact and Response System adapted to climate change
impacts.
x
Use decision-making tools such as risk assessment, systematic reviews, epidemiological investigations,
geospatial mapping and integrated public health technologies to identify and address public health risk
factors with a special focus on pathogens arising from the food chain and health conditions arising from the
agro-environment.
Report on Plans and Priorities 2011-12
x
Engage and collaborate with other federal departments, provinces, territories, NGOs, professional groups
and the private sector to determine how best to strengthen the effectiveness and efficiency of the National
Immunization Strategy (NIS).
x
Continue to work in close collaboration with provinces, territories, and other partners/stakeholders on the
finalization of the Canadian Tuberculosis Strategy.
x
Collaborate with key diabetes stakeholders to develop and disseminate tools and resources designed to
support self-management by Canadians living with or at risk of diabetes, a principal priority of the
Canadian Diabetes Strategy.
x
Continue to support the renewed Canadian HIV Vaccine Initiative (CHVI) through the establishment of a
new CHVI Research and Development Alliance.
x
Engage other governments, provincial/territorial partners, stakeholder groups and international partners to
explore strategies towards the development of a coordinated pan-Canadian approach and an effective,
cohesive response to address antimicrobial resistance (AMR) in the community and healthcare settings.
x
Build on the F/P/T Ministers’ of Health endorsement of the F/P/T Declaration on Prevention and Promotion to
enhance health promotion and chronic disease prevention by developing the evidence base for encouraging
healthier choices.
x
Work with other governments, stakeholders and international partners in expanding the work done to date
related to hypertension surveillance, prevention, treatment and control, including sodium reduction, as a
means of providing high quality analysis, tools and resources on cardiovascular health.
x
Continue to provide Canadians with information about their respiratory health learned from successful
models identified to date through work with lung health stakeholders.
x
Through collaboration with the Neurological Health Charities of Canada on the National Population Study
of Neurological Conditions, continue projects to enhance knowledge of the incidence, prevalence and risk
factors of neurological diseases which will inform policy and program development by governments,
practitioners and health related organizations.
x
Conduct risk analysis using expanded surveillance data for the prevention and control of consumer productrelated injuries to provide Canadian policy makers and health professionals with information to develop and
implement programs and policies in order to prevent and mitigate injuries.
x
Improve evidence and information available to public health practitioners, policy-makers and Canadians by
supporting the development and dissemination of clinical practice guidelines from the Canadian Task Force
on Preventive Health Care and by establishing an innovative knowledge exchange platform to highlight best
and promising practices in chronic disease prevention and control.
x
Lead the development of Canada’s position for the United Nations High-level Meeting on Prevention and
Control of Non-Communicable Diseases in September 2011.
Benefits for Canadians: Canada’s ability to prevent and manage diseases and injuries will be strengthened by these
activities. For example, enhanced national food-borne illness outbreak preparedness will contribute to the protection
and health and well-being of Canadians. Policies, programs and interventions will be enhanced by working in
collaboration with the health portfolio and domestic and international partners. Public health practitioners, policy
makers and Canadians will have information, guidelines and advice that foster prevention and management of disease
and injury in Canada.
Report on Plans and Priorities 2011-12
25
Program Activity 1.6 – Regulatory Enforcement and Emergency Response
1.6.1 Regulatory
Enforcement
Canada is able to promote health, reduce
health inequalities, and prevent and mitigate
disease and injury
1.6 Regulatory Enforcement
and Emergency Response
1.6.2 Emergency
Operations
1.6.3 Emergency
Stockpile
Human Resource (FTEs) and Planned Spending ($ M)
2011-12
2012-13
2013-14
FTEs
Planned
Spending
FTEs
Planned
Spending
FTEs
Planned
Spending
150
26.0
148
24.7
148
24.7
One-time funding received to implement the recommendations made in the Report of the Independent Investigator into the 2008
Listeriosis Outbreak is planned to sunset in 2011-12 resulting in a decrease in planned spending of $1.3M.
Expected Result(s)
Performance Indicator(s)
Canada has 24/7 public health
emergency response capability and
capacity
% of responses to national and
international public health
emergencies within time standards
Canada is compliant with World
Health Organization ( WHO)
International Health Regulations
(IHR)
% of Agency procedures which are
compliant with WHO IHR
PHAC responds to emergencies in a
timely and coordinated manner
% of response compliant with the
Health Portfolio Emergency
Response Plan
Target(s)
100%
100%
100%
PA Summary: The program is dedicated to protecting the health and safety of Canadians through the administration
and enforcement of the Human Pathogens Importation Regulations and select sections of the Human Pathogens and
Toxins Act (HPTA), and by developing new regulations under the HPTA to enhance the biosafety, biosecurity and
biocontainment of human pathogens and toxins across Canada. In addition, there will be increased protection from
infectious diseases at ports of entry to and from Canada and for participants in mass gatherings. Activities under this
program are designed to ensure that Canadians are protected against all hazards such as communicable diseases,
chemical, biological and radio-nuclear as well as environmental emergencies.
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Report on Plans and Priorities 2011-12
Planning Highlights: To achieve the expected results, the Agency will undertake the following activities:
x
Coordinate national input through a network of F/P/T IHR Champions for a submission to the WHO as part of
the annual IHR report. This report consists of measures taken to ensure Canada’s compliance with the IHRs
by June 2012.
x
Enhance emergency operations infrastructure by strengthening operational capacity within the Health
Portfolio Emergency Operations Centre (HP EOC) and by establishing a 24/7/365 Watch Officer program.
x
Implement a 24/7/365 contact link at the National Microbiology Laboratory to ensure a single point of initial
contact for all emergency scientific enquiries from private, regional, provincial, and federal health and safety
departments.
x
Engage, communicate and consult with stakeholders on the design and development of a risk-based and
new regulatory framework for the HPTA.
x
Establish a series of programs that will support HPTA implementation and an effective regulatory lifecycle.
x
Continue to enforce the Human Pathogens Importation Regulations through compliance inspections and
permit issuing processes, in order to effectively regulate Canadian laboratories handling imported human
pathogens and toxins.
x
Transform the original Health Emergency Response Team (HERT) to a deployable health professional
surge capacity by evaluating other relevant models and consulting with partners on the merits of a
roster/reserve model. The Agency will also test the Public Health Reserve Pilot Model to support PHAC’s
surge capacity.
x
In collaboration with F/P/Ts, automate the inventory system and develop a five-year strategic and operational
plan to renew pharmaceuticals, and medical supplies and equipment to align the National Emergency
Stockpile System with the recommendation of the internal Audit of Emergency Preparedness and Response
and the evaluation.
x
Develop an F/P/T Quarantine Framework to clarify roles and responsibilities during public health
emergencies, in addition to developing Standard Operational Procedures and standardized training of
Quarantine Officers.
x
Deploy the Microbiology Emergency Response Team (MERT)18 mobile laboratories, as required, to respond
to infectious disease emergencies and bioterrorism incidents in Canada and globally.
x
Provide genome sequencing of pathogens and modelling, as and when required, to support timely
epidemiology and rapid response research capacity for public health threats such as H1N1 and the cholera
outbreak in Haiti.
Benefits for Canadians: These planning highlights will provide increased coordination and capacity among partners
and assist public health practitioners in performing public health roles that are critical to the effective response to public
health events. Rapid response research will increase the capacity of public health authorities to manage outbreak
situations and optimize their evidence-based public health response. These efforts will also equip stakeholders with the
mechanisms to exchange information and expertise so that they can become more responsive to all public health
needs of their jurisdictions, and facilitate more rapid recovery from adverse public health events.
18
The Microbiology Emergency Response Team (MERT) is a mobile laboratory capacity that deploys on short notice to assist
around the world in public health crises. Staffed by the National Microbiology Laboratory, and working closely with the WHO, the
mobile lab capacity includes a range of options from state of the art portable lab equipment to the mobile lab-truck and lab-trailer.
MERT can be deployed prior to major international events to identify and process potential pathogens and enhance event security
as well as train staff in outbreak response and develop new diagnostic tests that can detect emerging infectious agents rapidly and
efficiently.
Report on Plans and Priorities 2011-12
27
Program Activity 2.1 – Internal Services
2.1.1 Governance and
Management Support
2.1 Internal Services
Canada is able to promote health, reduce
health inequalities, and prevent and mitigate
disease and injury
2.1.2 Resource
Management Services
2.1.3 Asset Management
Services
Human Resource (FTEs) and Planned Spending ($ M)
2011-12
2012-13
2013-14
FTEs
Planned
Spending
FTEs
Planned
Spending
FTEs
Planned
Spending
659
91.8
650
93.9
650
93.9
$2.1M of internal allocations to support Agency priorities is planned to sunset in 2011-12 and will be reallocated to other Agency
priorities in future years.
Expected Result(s)
The communications, service
operations and programs of the
Agency comply with applicable laws,
regulations, policies and/or plans
and meet the diverse needs of the
public
Strategic allocation and prudent use
of resources among programs,
processes and services
28
Performance Indicator(s)
Target(s)
Compliance with the statutory time
requirements of the Access to
Information Act and Privacy Act
(ATIP)*
“A” Rating (95% and above)
Compliance with the Government of
Canada Communications Policy
100%
Compliance with the Government of
Canada Official Languages Act, Part
IV, Communications with and
services to the public
100%
Compliance with the Government of
Canada Employment Equity Act**
Aboriginal people: 3.4%
Persons with disabilities: 4.3%
Visible minorities: exceed 12.7%
Women: 61.9%
Report on Plans and Priorities 2011-12
Maintain or increase number of
employees in critical shortage
occupational groups***
% Year-end Agency variance of
planned versus actual expenditures
Information technology that supports
government priorities and program
and service delivery
Compliance with Government of
Canada Common Look and Feel
(CLF) 2.0
Assets and material are managed
throughout their lifecycle in a
sustainable and financially
responsible manner which supports
Agency priorities and program
delivery
% of major capital assets**** with
completed asset condition reports to
assess physical condition and level
of criticality***** to program
operations
Acquisition services are timely and
meet client needs
Average time required for approval
of long-form contracts
Client satisfaction
Medicine (MD): 45
Veterinary medicine (VM): 24
Nursing (NU): 63
Senior Human Resources
(PE-04): 10
Senior Finance (FI-03): 9
Senior Finance (FI-04): 3
5% variance or less
100%
100%
15 days
85%
* Office of the Information Commissioner’s rating;
** Based on Workforce Availability 2006 census data;
***Growth will be measured based on baseline data as of April 1, 2010. Includes indeterminate and term employees >3 months;
**** Assets with an initial acquisition cost of $50,000 or more, excluding real property and related infrastructure;
***** “critical” rating high/medium/low.
PA Summary: Internal services support the Agency’s strategic outcome and all six PAs. Internal services are groups
of related activities and resources that are administered to support the needs of programs and other corporate
obligations of an organization. These groups are Management and Oversight Services, Communications Services,
Legal Services, Human Resources (HR) Management Services, Financial Management Services, Information
Management Services, Information Technology Services, Sustainable Development, Real Property Services, Materiel
Services, Acquisition Services, Security Services, and Travel and Other Administrative Services. Internal services
include only those activities and resources that apply across the Agency and not those provided specifically to a
program.
Planning Highlights: To achieve the expected results, the Agency will undertake the following activities:
x
Consistent with commitments made in the Strategic Plan (2007-2012), continue to strengthen evidenceinformed and science-based decision-making through environmental scanning, development of partnerships,
and development of the science and research plan.
x
Implement the Agency’s three-year strategic approach to People Management, with a focus on revising the
performance management process and developing an integrated approach to talent management for
executives and feeder groups.
x
Address strategic and operational HR issues through: 1) the initial implementation of a phased plan to
transform HR service delivery; 2) a resourcing strategy; and 3) a Staffing Monitoring Framework.
x
Continue to implement the Agency’s Values and Ethics Framework and Plan, including: the establishment of
a working group to serve as an advisory body on values and ethics, and the development of a PHAC Values
and Ethics Code.
Report on Plans and Priorities 2011-12
29
x
Support strategic policy development in collaboration with the Health Portfolio, other government
departments and key stakeholders.
x
Support the Federal Sustainable Development Strategy through the development and implementation of the
PHAC 2011-2014 Departmental Sustainable Development Strategy. Key commitments relating to green
buildings; surplus electronic and electrical equipment; printing units; and green procurement are identified in
the Greening Government Operations supplementary information table.
x
Continue to enhance integrated security services in compliance with the Policy on Government Security by
completing the Departmental Security Plan and associated Threat and Risk Assessments. Enhance the
Personnel Security Screening processes to safeguard the Agency’s intellectual property and asset
resources.
Benefits for Canadians:
The Agency will demonstrate sound resource management and continue to improve knowledge translation, information
management, and science-based decision-making systems. Canadians will have access to current public health
information to support knowledge development and informed decision-making for the well-being of themselves and
their families. The Agency will also be better prepared to protect Canadians and respond to public health emergencies.
30
Report on Plans and Priorities 2011-12
Section III – Supplementary Information
3.1
Financial Highlights
The future-oriented financial highlights presented in this report provide a general overview of the Agency’s financial
position and operations. Future-oriented Financial Statements are prepared on an annual basis to strengthen
accountability and improve transparency and financial management. The statements are located on the Agency’s Web
site at http://www.phac-aspc.gc.ca/rpp/2011-2012/fofs-erp-eng.php.
($ M)
% change
Future-oriented
2011-12
Future-oriented
2010-11
Total Expenses
7.0
678.9
634.2
Total Revenues
(33.0)
0.2
0.3
7.0
678.7
633.9
Future-oriented Condensed Statement of
Operations for the year ended March 31st
Net Cost of Operations
The Agency is forecasting $678.9M in expenses based on 2011-12 Main Estimates and accrued information. The
expenses are broken down as follows: salaries and wages $235.5M; transfer payments $196.5M; professional and
special services $96.6M; utilities, material and supplies $71.8M; accommodation $22.2M; travel and re-location
$14.8M; amortization $10.7M; other $10.6M; information $8.2M; communication $5.5M; purchase repair and
maintenance $5.0M; and rentals $1.7M.
($ M)
Future-oriented Condensed Statement of
Financial Position for the year ended
March 31st
% change
Future-oriented
2011-12
Future-oriented
2010-11
Total Assets
6.8
208.7
195.5
Total Liabilities
(1.5)
144.0
146.2
Equity
31.0
64.7
49.4
6.8
208.7
195.5
Total Liabilities and Equity of Canada
Report on Plans and Priorities 2011-12
31
2011-12 Allocation of Net Cost of Operations by Program Activity
PA 1.1 Science and
Technology for Public Health
8%
14%
9%
PA 1.2 Surveillance and
Population Health Assessment
10%
15%
PA 1.3 Public Health
Preparedness and Capacity
PA 1.4 Health Promotion
17%
PA 1.5 Disease and Injury
Prevention and Mitigation
PA 1.6 Regulatory Enforcement
and Emergency Response
27%
PA 2.1 Internal Services
$ millions
Expenses - Where Funds Go
200
180
160
140
120
100
80
60
40
20
0
186.2 181.1
53.8
62.2
118.3
96.8 95.2
65.6
64.2 60.7
27.9
1.1
2011-12
Forecast
111.9
100.3 105.6
2010-11
Forecast
1.2
1.3
1.4
1.5
1.6
2.1
Program Activity
Breaking down the $678.9M of Agency expenses by Program Activity allocates: $53.8M to Science and Technology for
Public Health (PA 1.1); $64.2 to Surveillance and Population Health Assessment (PA 1.2); $100.3M to Public Health
Preparedness and Capacity (PA 1.3); $186.2M to Health Promotion (PA 1.4); $111.9M to Disease and Injury
Prevention (PA 1.5); $65.6M to Regulatory Enforcement and Emergency Response (PA 1.6); and $96.8M to Internal
Services (PA 2.1).
32
Report on Plans and Priorities 2011-12
Revenue - Where Funds Come From
80
76.0
$ thousands
60
64.0
56.0
50.0
40
31.0
29.0
20
35.0
37.0
34.0
26.0
21.0
23.0
17.0
16.0
-
1.1
2011-12
Forecast
1.2
2010-11
Forecast
1.3
1.4
1.5
1.6
2.1
Program Activity
The Public Health Agency of Canada is forecasting $225K in revenues based on 2011-12 Main Estimates and accrued
information. The revenues are broken down as follows: Services of a Non-Regulatory Nature $137K; Rights and
Privileges $18K, a decrease of $67K related to royalties; other $62K and interest $8K. The 2011-12 forecast figures
reflect the trend from previous years which included revenues from the sale of first aid kits and other royalty payments
received.
Assets by Type*
140
120
122.9
$ millions
100
80
82.4
60
40
20
3.4
0
Due from Consolidated
Revenue Fund
Accounts Receivable and
Advances
Tangible Capital Assets
*This is the first year PHAC has reported a statement of financial position; therefore, no comparative 2010-11 figures are available.
Total assets are forecast to be $208.7M for 2011-12, an increase of $13.1M over the 2010-11 forecast. The amount
due from the Consolidated Revenue Fund is forecast to be $82.4M. Accounts receivable is forecast to be
$3.4M. Capital assets are forecast to be $122.9M, an increase of $12.2M over the 2010-11 forecast.
Report on Plans and Priorities 2011-12
33
Liabilities by Type*
100
$ millions
80
82.9
60
48.5
40
20
10.1
2.5
0
Accounts Payable
and Accrued
Liabilities
Employee Severance Vacation Pay and
Benefits
Compensatory Leave
Other Liabilities
*This is the first year PHAC has reported a statement of financial position, therefore no comparative 2010-11 figures are available.
Total liabilities are forecast to be $144M for 2011-12, a net decrease of $2.2M over the 2010-11 forecast. The
breakdown of liabilities is as follows: accounts payable and accrued liabilities $83M; employee severance benefits
$48.5M; vacation pay and compensatory leave $10.1M and other liabilities $2.5M.
3.2
List of Supplementary Information Tables
All electronic Supplementary Information tables found in the 2011-12 Report on Plans and Priorities can be found on
the Treasury Board of Canada Secretariat’s Web site at http://www.tbs-sct.gc.ca/rpp/2011-2012/info/info-eng.asp.
x
Details on Transfer Payment Programs
x
Greening Government Operations
x
Horizontal Initiatives
x
Upcoming Internal Audits and Evaluations over the next three fiscal years
x
Sources of Respendable Revenue
x
Summary of Capital Spending by Program Activity
The following table is located on the Agency’s Web site:
Summary of Three-year Plan for Transfer Payment Programs
34
Report on Plans and Priorities 2011-12
Section IV – Other Items of Interest
Sustainable Development at the Agency
Based on the Federal Sustainable Development Strategy, the Public Health Agency of Canada commits to:
x
Providing more specific information on departmental sustainable development activities appropriate to the
department or agency’s mandate;
x
Strengthening the application of Strategic Environmental Assessments (SEAs) by ensuring that the
Government’s environmental goals are taken into account when pursuing social and economic goals; and
x
Pursuing best practices on reporting on summary information on the results of SEAs linked to the FSDS
goals and targets, in order to ensure that environmental decision-making is more transparent.
For additional details on the Agency’s activities to support sustainable development please see http://www.phacaspc.gc.ca/sd-dd/index-eng.php, and for complete details on the Federal Sustainable Development Strategy please
see http://www.ec.gc.ca/dd-sd/default.asp?lang=En&n=C2844D2D-1.
Additional Web Links
Aboriginal Head Start in Urban and Northern
Communities
http://www.phac-aspc.gc.ca/hp-ps/dca-dea/prog-ini/ahsuncpapacun/index-eng.php
Canada Prenatal Nutrition Program
http://www.phac-aspc.gc.ca/hp-ps/dca-dea/prog-ini/cpnppcnp/index-eng.php
Canada’s Response to the 2009 H1N1 Influenza
Pandemic
http://www.parl.gc.ca/40/3/parlbus/commbus/senate/com-e/socie/rep-e/rep15dec10-e.pdf
Canadian Adverse Events Following Immunization
Surveillance System
http://www.phac-aspc.gc.ca/im/vs-sv/caefiss-eng.php
Canadian Chronic Disease Surveillance System
http://www.phac-aspc.gc.ca/cd-mc/cvd-mcv/ccdss-snsmc2010/2-1-eng.php
Canadian Diabetes Strategy
http://www.phac-aspc.gc.ca/cd-mc/diabetesdiabete/diabetes_strategy-diabete_strategie-eng.php
Canadian HIV Vaccine Initiative
http://www.chvi-icvv.gc.ca/index-eng.html
Canadian Network for Public Health Intelligence
https://www.cnphi-rcrsp.ca/cnphi/index.jsp
Canadian Pandemic Influenza Plan for the Health
Sector
http://www.phac-aspc.gc.ca/cpip-pclcpi/index-eng.php
College of Family Physicians of Canada
http://www.cfpc.ca/Home/
Community Action Program for Children
http://www.phac-aspc.gc.ca/hp-ps/dca-dea/prog-ini/capcpace/index-eng.php
Core Competencies for Public Health in Canada
http://www.phac-aspc.gc.ca/ccph-cesp/index-eng.php
Report on Plans and Priorities 2011-12
35
Curbing Childhood Obesity: an F/P/T Framework
for Action to Promote Healthy Weights
http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/frameworkcadre/index-eng.php
Federal Sustainable Development Strategy
http://www.ec.gc.ca/dd-sd/default.asp?lang=EN&n=C2844D2D-1
Global Health Security Initiative
http://www.ghsi.ca/english/index.asp
Health Emergency Response Team
http://www.phac-aspc.gc.ca/media/nr-rp/2007/2007_14bk01eng.php
Health Portfolio
http://www.hc-sc.gc.ca/ahc-asc/minist/portfolio/index-eng.php
Healthy Aging
http://www.phac-aspc.gc.ca/seniors-aines/index-eng.php
Healthy Canadians
http://www.tbs-sct.gc.ca/ppg-cpr/descript-eng.aspx#bm02
Healthy Living
http://www.phac-aspc.gc.ca/media/nr-rp/2005/2005_37bk3eng.php
Injury Prevention
http://www.phac-aspc.gc.ca/inj-bles/index-eng.php
Innovation Strategy
http://www.phac-aspc.gc.ca/ph-sp/fund-fonds/index-eng.php
Lessons Learned Review: Public Health Agency of
Canada and Health Canada Response to the 2009
H1N1 Pandemic
http://www.phac-aspc.gc.ca/about_apropos/evaluation/reportsrapports/2010-2011/h1n1/pdf/h1n1-eng.pdf
May 2008 Report of the Auditor General
http://www.oagbvg.gc.ca/internet/English/parl_oag_200805_05_e_30701.html
Mental Health
http://www.phac-aspc.gc.ca/mh-sm/index-eng.php
National Collaborating Centres for Public Health
Contribution Program
http://www.phac-aspc.gc.ca/php-psp/ncc-eng.php
National Emergency Stockpile System
http://www.phac-aspc.gc.ca/ep-mu/ness-eng.php
National Immunization Strategy
http://www.phac-aspc.gc.ca/im/nis-sni/index-eng.php
National Population Study of Neurological
Conditions
http://www.phac-aspc.gc.ca/cd-mc/nc-mn/1-eng.php
PHAC Departmental Sustainable Development
Strategy
http://www.phac-aspc.gc.ca/sd-dd/index-eng.php
Physical Activity Guidelines
http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pag-gap/index-homeaccueil-eng.php
Public Health Agency of Canada
http://www.phac-aspc.gc.ca/index-eng.php
Public Health Agency of Canada Act
http://www2.parl.gc.ca/Sites/LOP/LegislativeSummaries/Bills_ls.
asp?lang=E&ls=c5&source=library_prb&Parl=39&Ses=1
Report of the Independent Investigator into the
2008 Listeriosis Outbreak
http://www.listeriosis-listeriose.investigationenquete.gc.ca/index_e.php?s1=rpt&page=tab
36
Report on Plans and Priorities 2011-12
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