Ministerial briefing volume I: Overview of the Health Portfolio

Table of contents

1. Health Portfolio overview
   1. Placemat: Overview of the Health Portfolio and federal role in health
   2. The Health Portfolio: a partner in health for all Canadians
2. Health Portfolio organizations
   1. Health Canada
   2. Public Health Agency of Canada
   3. Canadian Institutes of Health Research
   4. Canadian Food Inspection Agency
   5. Patented Medicine Prices Review Board
3. Legislation and decision-making in the Health Portfolio
   1. Key Legislation
   2. Overview of legislative and regulatory responsibilities
   3. Regulatory oversight of products
4. Federal/provincial/territorial relations
   1. Overview of FPT roles and relations in health
   2. List of provincial and territorial ministers responsible for health
5. Relationships with health system players
   1. An overview of Pan-Canadian health organizations
   2. Other key players and stakeholders in health
6. Relationships wit the international community
   1. Overview of the Health Minister's role in the international community and portfolio engagement

A. Health Portfolio overview

Placemat: Overview of the Health Portfolio and federal role in health

Under your direct purview

Health Canada (HC)

Promotes and helps protect the health and safety of Canadians by regulating products such as drugs, medical devices, consumer products, cosmetics, food and managing the health risks of substances. HC supports universally accessible, publicly funded health care for Canadians through stewardship of the Canada Health Act, leadership on issues such as mental health, substance use and digital health and collaboration with provinces and territories on health system improvements.

Public Health Agency of Canada (PHAC)

Promotes and protects public health and health equity in Canada by preparing for and responding to public health issues and emergencies through national leadership, science, policy, programs and partnerships. Its activities focus on the prevention of disease and injury and the promotion of physical and mental health and wellbeing for all. PHAC facilitates a national approach to public health policy and planning and serves as a central point for sharing Canada's health expertise both within Canada and with international partners.

Canadian Food Inspection Agency (CFIA)

Protects Canada and Canadians from food, plant, and animal health risks inherent in the modern environment, while supporting Canadian agriculture and agri-food businesses as they compete, innovate and grow in domestic and global markets (Minister of Agriculture and Agri-food), while the overall administration of CFIA including food safety, remains under the Minister of Health.

Arm's-length organizations

Canadian Institutes of Health Research (CIHR)

Canada's federal funding agency for health research. Composed of 13 institutes, CIHR collaborates with national and international partners to support discoveries and innovations that improve Canadians' health and strengthen Canada's health care system. CIHR is a source of scientific evidence to inform the Government's decisions.

Patented Medicine Prices Review Board (PMPRB)

Quasi-judicial body that protects consumers and contributes to health care by ensuring that the prices of patented medicines sold in Canada are not excessive. The PMPRB also informs Canadians by reporting on pharmaceutical trends.

Role of the health portfolio

Managing risks to health

• Maintaining readiness and responding to public health threats and emergencies (e.g. COVID-19 pandemic), such as providing domestic and international health security leadership, pandemic preparedness, border and travel health, supporting rapid research mobilization and nuclear emergencies (PHAC, HC, CIHR, CFIA).
• Assessing, managing, and supporting research on health risks of controlled substances, alcohol, antimicrobial resistance, consumer products, cosmetics, chemicals, radiation, pesticides, climate change and addressing population harms of tobacco, in collaboration with partners and Indigenous Peoples (HC, PHAC, CIHR, CFIA).
• Managing food-related health risks through strong food safety regulations, surveillance, research and enforcement (HC, PHAC, CFIA, CIHR).
• Promoting mental health and well-being for Canadians (HC, PHAC, CIHR) and providing mental and occupational health advice and services to the federal public service (HC).
• Overseeing the legal cannabis regime, including administering the Cannabis Act, granting licences for production, and monitoring compliance with regulations (HC, CFIA).
• Taking compliance and enforcement actions in relation to relevant acts and regulations (HC).

Supporting health research and science, data collection and surveillance capacity

• Funding research to generate knowledge, improve health and health services, inform government priorities and decision-making, and support health innovation (CIHR).
• Investing in knowledge mobilization and the dissemination of research evidence and data to improve the health care system and the health of Canadians (CIHR).
• Building research capacity in under-developed areas, and training the next generation of health researchers (CIHR).
• Promoting equity, diversity and inclusion (EDI) in the research system and the incorporation of EDI in research design and activities.
• Supporting Indigenous health research, knowledge mobilization and capacity-building (CIHR).
• Strengthening surveillance, risk analysis and risk intelligence research and public education on chronic and emerging infectious diseases (PHAC).
• Improving diagnostic, risk identification and analysis, and scientific capacity through national labs, to detect serious and emerging diseases (PHAC, CFIA).
• Reporting on pharmaceutical trends of all medicines, and research and development spending by patentees (PMPRB).
• Conducting research, monitoring and surveillance on health impacts of environmental contaminants, climate change and substances (HC).

Enabling access to safe and effective health products

• Assessing, and regulating health products, including vaccines, to ensure their safety, effectiveness and quality, through a world class, modern regulatory regime (HC).
• Monitoring health product safety and communicating risks to Canadians (HC).
• Funding and overseeing clinical trials to ensure the integrity of the data and participants (HC, CIHR).
• Working with stakeholders to mitigate shortages of therapeutic products (HC).

Strengthening Canada's universal health care system

• Stewardship of universally accessible, publicly-funded health care for Canadians through administration of the Canada Health Act (HC).
• Providing leadership for working together with provinces and territories to improve health care for Canadians and providing leadership on emerging issues such as mental health, substance use, and digital health (HC).
• Investing in Pan-Canadian Health Organizations to drive progress on health system priorities (HC).
• Advancing dental care for all Canadians, and a Pharmacare Act (HC).
• Ensuring access to sexual and reproductive health (SRH) services.
• Expediting work to create a world-class health data and digital system that is timely, usable, open-by-default, connected and comprehensive.
• Enhancing the affordability, accessibility and appropriate use of prescription drugs (HC, PMPRB).
• Improving cultural safety, humility and responsiveness in the health system to improve Indigenous health and address racism (HC).

Supporting Canadians in making safe and healthy choices

• Informing and engaging Canadians by being a trusted source of information on health and safety (HC, PHAC, CFIA), including:
  • The COVID-19 global pandemic (PHAC, HC);
  • The opioid overdose crisis (HC, PHAC); and
  • A range of health and safety issues, such as food and alcohol choices, health products, smoking prevention and cessation, youth vaping, cannabis use, concussion treatment, consumer product safety, safe food practices, and the safe use of hazardous products (HC,PHAC).
• Addressing root causes of health inequalities and common risks that are important in preventing and avoiding disease, including disease surveillance, creating environments that support healthy choices, reduce chronic diseases, and support healthy aging (PHAC, HC, CIHR).

Provincial/territorial (PT) partners

• PTs administer public health insurance plans for medically necessary services; plan and finance hospital care, physician and allied health services; deliver other services (drug plans, home care, etc.) on a discretionary basis; administer aspects of public health; collect and manage data critical for PH reporting and decision-making; and negotiate fee schedules for health professionals.
• FPT governments must often collaborate to advance key health priorities for Canadians.

Indigenous partners

• Engage with First Nations, Inuit and Métis to improve health outcomes and work to address inequities experienced by Indigenous Peoples.

Federal government departments

• Work collaboratively with other government departments on areas of shared priority/responsibility.

Health partners / industry / community stakeholders

• Work with health stakeholders, including professional associations, regulatory bodies, standards development organizations, the research community, patient groups, communities with a stake in public health, social media influencers/risk communicators and industry to ensure responsive approaches to Canadians' health needs.

International partners

• Engage internationally to protect and advance Canadian health interests.
• Participate in multilateral fora, particularly the World Health Organization, World Organization for Animal Health, and Food and Agriculture Organization of the United Nations.
• Foster bilateral relationships with key partners and regions.
• Partner on health research that affects Canadians and the global community, and position Canadian researchers as leaders.

The Health Portfolio: a partner in health for all Canadians

The Health of Canadians – the COVID-19 pandemic

• The impacts of the COVID-19 pandemic, and the response to it, profoundly affected Canadians. Not only did the pandemic lead to fundamental changes in our daily lives, but many Canadians experienced its tragic consequences including the suffering and loss of loved ones, lost jobs and livelihoods, reduced social connections and increased isolation.
• From the beginning, the Health Portfolio has been at the centre of efforts to respond to the pandemic.
• 4.6 million reported cases of COVID-19 in Canada since the start of the pandemic.
• 53,000 deaths due to COVID-19 in Canada since the start of the pandemic.
• 32 million Canadians received at least one dose of vaccine, or 83.2% of total population.
• The Chief Public Health Officer of Canada (CPHO) advises you, as the Minister of Health, on public health related matters, and provides leadership by communicating with other levels of government, voluntary organizations, the private sector and Canadians on public health issues.
• The CPHO has played a key role in the COVID response providing evidence-based, public health advice to the government, and working with PT counterparts to support Canadians.

State of the health system following COVID-19

The COVID-19 pandemic exacerbated longstanding health disparities and put significant strain on Canada's health systems.

• Backlogs: From March 2020 to September 2022, approximately 937,000 (14%) fewer surgeries were performed in Canada compared with before the pandemic.^{Reference 1}
• Family Health Services: 14.5% of Canadians aged 12 and older – roughly 4.6 million people – reported that they did not have a regular health care provider.^{Reference 2}
• Health Workforce: Canada's health care sector continues to see high levels of job vacancies, with 95,200 unfilled positions in health occupations in the first quarter of 2023.^{Reference 3}
• Mental Health and Substance Use: 1 in 5 Canadians will experience a mental illness or substance use problem. Nearly half of Canadians reported that their mental health worsened during the pandemic.
• Aging with Dignity: Long-term care failures during the pandemic have led to significant concerns about how and where Canadians who need care can be protected and supported.
• Health Data and Digital Health: Only 31.6% of Canadians report that they have been able to access their personal health information electronically.^{Reference 4}
• Health Inequalities: Key groups, such as Indigenous Peoples, communities that are racialized, women, people living with lower income, and people experiencing homelessness were disproportionately affected by both the direct and indirect consequences of the pandemic.^{Reference 5}

The health of Canadians

Canadians generally experience good health.

• Canada ranks among the top and middle third performers among Organization for Economic Cooperation and Development (OECD) member states for most health indicators.
• Public health efforts across Canada's health systems, including vaccination programs, have reduced the risks of infectious diseases considerably.
• Efforts are underway to address systemic health inequities especially for Indigenous, racialized and marginalized populations (e.g., new immigrant, low-income, 2SLGBTQQIA+).
• Canada's health care system is a source of pride for many Canadians and one of the reasons for the overall good health Canadians enjoy. However, it faces a number of challenges.

The health of Canadians – key challenges

• Health System - expanding access to family health services, supporting health workers and reducing backlogs, improving access to quality mental health and substance use services and modernizing the health care system with standardized health data and digital tools are critical for improving the health system.
• Infectious disease - rates of HIV and hepatitis C are slow to decrease, while rates of other sexually transmitted infections have increased exponentially. For example, infectious syphilis rates doubled, and congenital syphilis rates increased 13-fold between 2016 and 2020.
• Mental health - while many Canadians live with positive mental health, 1 in 3 have, or will have had, a mental illness by the time they reach 40 years of age. In 2021, 52% of Canadians reported their perceived mental health to be "very good" or "excellent," a decrease from 60% in 2020.
• Opioid overdose crisis - during the first year of the pandemic, the number of apparent opioid toxicity deaths nearly doubled compared to the year before. From January 2016 to December 2022, there was a total of 36,442 apparent opioid toxicity deaths in Canada.
• Chronic disease - chronic diseases such as cancer, heart disease and diabetes continue to be the greatest cause of disease burden in Canada. While Canadians are generally healthy, 44% of adults 20+ have at least 1 of 10 common chronic diseases, and over 4 out of 5 have at least one preventable risk factor.
• Alcohol, tobacco and vaping – while smoking rates in Canada are at their lowest level in decades, rates of youth vaping are high. While vaping may be less harmful than smoking for those who switch completely, it is not harmless, and the long-term health effects of vaping remain unknown. Alcohol is the most prevalent substance used in Canada and results in significant public health harms.
• Antimicrobial resistance (AMR) – antibiotics are rapidly becoming ineffective because the bacteria they are designed to eliminate are becoming resistant to these drugs. In Canada, AMR was estimated to have caused 5,400 deaths, cost the healthcare system about $1.4 billion, and reduced GDP by $2 billion in 2018.
• Climate change - Canadians are already experiencing health impacts from changes to Canada's climate such as increased injury and fatalities related to extreme weather events, including wildfires, mental health challenges, heat and food-related illness, increased food insecurity, and the spread of infectious and vector-borne diseases such as Lyme disease.
• Health inequalities - significant health inequities continue to exist in Canada between Canadians with different socioeconomic status and certain populations including Indigenous Peoples. Relative to the non-Indigenous population, First Nations life expectancy is shorter by five years.

The health system – national health expenditures

• As health needs and approaches to delivering care have changed, so too has the focus of spending. The proportion of spending going toward hospitals has declined over time, while spending on drugs and other spending – such as on other institutions and home and community care – have increased.^{Reference 6}
• Spending for hospitals decreased from 45% in 1975 to 24% in 2022.
• Spending for physicians decreased from 15% in 1975 to 14% in 2022.
• Spending for drugs increased from 9% in 1975 to 14% in 2022.
• Spending in other areas increased from 31% in 1975 to 44% in 2022.

Roles and Responsibilities of the Health Portfolio

• As Minister of Health, you are responsible for five dynamic, science-based organizations, each playing a unique and important role in the health and safety of Canadians.

Under your direct purview:

• Health Canada (HC);
• Public Health Agency of Canada (PHAC);
• Canadian Food Inspection Agency (CFIA);

Arm's-length organizations:

• Canadian Institutes of Health Research (CIHR);
• Patented Medicine Prices Review Board (PMPRB);

The Health Portfolio's main activities include:

• Responding to public health emergencies, including the current COVID-19 pandemic;
• Strengthening Canada's universal health care system;
• Enabling access to quality, safe and effective health products/regulatory role;
• Managing risks to health;
• Supporting Canadians in making safe and healthy choices; and
• Supporting health research and science, knowledge mobilization, data collection and surveillance capacity.

Roles and Responsibilities – responding to public health emergencies, including the COVID-19 pandemic

• Developing health security measures / preparing for and responding to health emergencies.
• Supporting border and travel health.
• Providing domestic and international health security leadership.
• Protecting against vaccine-preventable diseases.
• Responding to the threat posed by antimicrobial resistance.
• Investing in academic research on prevention, response, preparedness and recovery, and strengthening international collaboration (e.g., CIHR Centre for Research on Pandemic Preparedness and Health Emergencies).
• The NML works with public health partners in Canada and internationally to prevent the spread of infectious disease. It is the only "Level 4 Lab" in Canada, meaning it is able to work with the world's most dangerous pathogens.
• The NML enables informed public health action through delivery of innovative approaches to advance laboratory science, testing services, lab-based surveillance, outbreak response and national public health laboratory leadership.

Roles and responsibilities – strengthening Canada's universal health care system

• Stewardship of universally accessible, publicly funded health care for Canadians through administration of the Canada Health Act.
• Providing leadership on emerging issues and working multilaterally and bilaterally with provinces and territories on system improvements, including health workers, digital health and health data.
• Enhancing the affordability, accessibility and appropriate use of prescription drugs, including working towards national pharmacare.
• Investing in Pan-Canadian Health Organizations to drive progress on health priorities (see Annex 1).
• Managing federal grants and contributions programs to support health care and public health innovation and priorities.

Working Together to Improve Health Care for Canadians

• In February 2023, the Government of Canada announced an investment of nearly $200 billion over 10 years, including $46.2 billion in new funding, to improve health care services for Canadians.
• Agreements are being negotiated with provinces and territories that outline how funds will be spent and how progress will be measured.

Roles and responsibilities – enabling access to safe and effective health products

• Assessing, regulating, and enforcing compliance of health products to ensure their safety, effectiveness and quality, such as strengthening regulatory oversight of natural health products.
• Modernizing regulatory regimes to increase access to safe and effective treatment options for Canadians.
• Playing a leadership role to help prevent and mitigate health product shortages
• Monitoring health product safety and adverse events arising from use and communicating risks to Canadians.

Regulatory oversight process from pre-market to post-market:

• Pre-clinical trials;
• Clinical trials;
• Regulatory product submission;
• Submission review;
• Market authorization decision;
• Public access; and
• Safety, monitoring, surveillance, inspection, compliance, verification, enforcement.

Health Portfolio regulatory responsibilities

Health Canada regulates:

• More than 14,000 prescription and non-prescription drugs;
• More than 1,500 veterinary drugs and over 3,000 low-risk veterinary health products;
• More than 190,000 natural health products; and
• More than 35,000 medical devices.

PHAC regulates:

• More than 1,000 facilities that handle human pathogens and toxins.

CFIA conducts:

• Approximately 2,845 food safety investigations and an average of 164 recall incidents and 326 total recalls each year.

Roles and responsibilities - managing risks to health

In addition to maintaining readiness to respond to public health threats and emergencies, the Health Portfolio plays a number of other important roles in managing risks to health.

• Managing food-related health risks through strong food safety regulations, surveillance and enforcement.
• Assessing and managing the health risks of consumer products and cosmetics, including the recent ban of cosmetic testing on animals.
• Implementing comprehensive approaches to minimize the health risks associated with legal and illegal substances.
• Overseeing the legal cannabis framework.
• Investing in academic research to better understand risks to health.
• Reducing environmental health risks.

Health Portfolio role in food labelling

• Consumers are increasingly knowledgeable about food labels, and labelling is one of the most important and direct ways for the industry to share information. All food sold in Canada must be properly labelled in a way that is not false or misleading, including origin indications.
• The Canadian Food Inspection Agency (CFIA) is seeking feedback from stakeholders, including consumers, on labelling of the origin of imported foods when the food originates from a contested geographical area or territory.

Roles and Responsibilities – supporting canadians in making safe and healthy choices

• Promoting the health and well-being of Canadians by addressing risk factors and underlying determinants of health and health inequities.
• Promoting healthy behaviours and practices to improve health.
• Building protective factors and addressing health equity.
• Supporting Canadians in making better food choices, particularly with work to introduce front-of-package labelling and address Marketing to Kids.
• Informing and engaging Canadians by being a trusted source of information on health and safety.

A social determinants of health approach to improve health for at-risk groups

• An individual's health is determined by the social determinants of health – a broad range of personal, social, economic and environmental factors – such as income, housing, education, physical environment, gender and culture.
• The Health Portfolio analyzed the impact of the pandemic on at-risk populations, which highlighted how disproportionately these groups had been affected. Recommendations were made to reduce or close the gap, such as ramping up efforts in visible minority communities to reduce vaccine hesitancy. The Health Portfolio also worked to ensure the needs of at-risk populations were considered and incorporated in pandemic responses.

Front-of-package labelling regulations

• On July 20, 2022, Health Canada published the regulations to amend the Food and Drug Regulations (FDR) to add a new requirement for front-of-package (FOP) nutrition symbol labelling (FOP labelling) for most prepackaged products containing nutrients of public health concern (saturated fat, sugars and/or sodium) at or above specified thresholds. The FOP nutrition symbol (the symbol) will help Canadians to more easily identify foods high in these nutrients. Avoiding excess consumption of these nutrients can help reduce associated health risks.

Roles and responsibilities - supporting health research and science, data collection and surveillance capacity

• Funding research that generates new knowledge, improves health or health services, informs decision-making and supports health innovation.
• Funding National Collaborating Centres that promote the use of evidence by public health practitioners and policy makers.
• Strengthening surveillance, evidence and public education on chronic and infectious disease.
• The primary research arm of the Health Portfolio is CIHR, which invests over $1.4 billion annually to support world-class research conducted in Canadian post-secondary institutions and their affiliated hospitals and research institutes, as well as, develop the next generation of leaders within and beyond health research enterprise.

Modernization of the federal research support system

• The Advisory Panel on the Federal Research Support System was launched to provide advice on modernizing the system to maximize the impact of federal investments and position Canada's researchers for success.
• The Panel made 21 recommendations on key themes (Bouchard Report): structural change, strategic and independent advice, modernized and integrated programming, new paradigm to support Canada's Major Research Facilities, re-investment in research and talent to bolster success.
• Health Canada is working with Innovation, Science and Economic Development Canada to develop a response to the report.

Partnerships and collaboration - FPT context

• At the federal level, the Health Portfolio works collaboratively with a number of other government departments and agencies.
• Ongoing FPT collaboration is maintained through well-developed formal structures including:
  • FPT Health Ministers' Meeting (HMM);
  • Conference of Deputy Ministers of Health (CDM);
  • Pan-Canadian Public Health Network (PHN); and
  • Collaborative work with FPT partners through engagement and leadership on several committees.

FPTI collaboration on Indigenous priorities

• Health Canada is holding trilateral discussions with Indigenous leaders to help facilitate discussion on ways the new health system funding can improve Indigenous access to quality and culturally safe health services. As of July 24^th, trilateral meetings have taken place with British Columbia, Ontario, Newfoundland and Labrador, and Prince Edward Island.

Partnerships and collaboration – Indigenous organizations and governments

• Indigenous Services Canada (ISC) funds or directly provides services for First Nations and Inuit that supplement PT services.
• Engagement is often done in collaboration with other federal departments, such as ISC and Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC).
• The Health Portfolio works with other Indigenous health system partners to close gaps in health outcomes for Indigenous Peoples and address systemic barriers to accessing safe and equitable health services. Examples of partners include the Indigenous Physicians Association of Canada (IPAC), Canadian Indigenous Nurses Association (CINA), First Nations Health Authority (FNHA), National Consortium for Indigenous Medical Education, and National Aboriginal Council of Midwives (NACM), among others.
• The Portfolio also contributes to whole-of-government efforts to advance reconciliation with Indigenous Peoples by implementing the Truth and Reconciliation Commission's Calls to Action and supporting the federal response to the National Inquiry into Missing and Murdered Indigenous Women and Girls.

Indigenous health equity funding

• A $2 billion over 10 years Indigenous-specific funding stream will be distributed on a distinctions basis through a health equity fund. The Portfolio is working with the Minister of Indigenous Services, the Minister of Crown-Indigenous Relations, and the Minister of Northern Affairs to prioritize investments.

Network environments for Indigenous health research

• Through the leadership of its Institute of Indigenous Peoples' Health, CIHR supports NEIHR Program, which represents a $100.8 million investment over 16 years to build capacity in Canada for Indigenous health research. Through the NEIHR program, CIHR has established nine centres in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Atlantic Canada, Nunavut, and the Northwest Territories.

Partnerships and collaboration - international partners

• As Minister of Health, you will typically engage multilaterally by leading Canada's delegation at international and political fora, and bilaterally with key counterparts from other countries or regional partners. For example, World Health Organization (WHO), Organisation for Economic Co-operation and Development (OECD), G7 and G20 Health Ministers meetings.
• As Minister of Health, you will also engage with counterparts from other countries or regions to advance bilateral collaboration on health issues of common concern. For example, Health Canada shared information and expertise with international regulatory counterparts to support the review and post-market monitoring of COVID-19 health products.
• 2023 UN General Assembly – health related dialogue has dramatically increased since the beginning of the pandemic. With three major High-Level meetings related to health to health occurring during UNGA in 2023: Universal Health Coverage, Pandemic Preparedness, Prevention and Response, and Tuberculosis, this will be an important opportunity for Canada to play a leadership role to advance key domestic health priorities.

Annex 1 – list and mandate of the pan-canadian health organizations (PCHOs)

• The Canadian Institute for Health Information (CIHI) is the main national body charged with collecting, analyzing and reporting health data (e.g., wait times, quality of care and outcomes, health expenditures, allocation of health professionals). CIHI data and information supports health system improvements, and is used by Canadian governments, policy-makers and health system managers in making health policy decisions and in supporting effective health system management. CIHI relies heavily on PTs for collection of health data.
• The Canadian Agency for Drugs and Technologies in Health (CADTH) provides decision-makers with evidence and advice to help provincial/territorial health ministries and federal- provincial/territorial (FPT) drug plans make informed decisions about the effectiveness and efficiency of drugs, medical devices and other health technologies. CADTH's Reimbursement Reviews make recommendations to governments on drugs that are included on public drug plan formularies.
• Canada Health Infoway (Infoway) works with PTs, health care providers and other partners to accelerate the development and adoption of electronic health information systems with compatible standards on a pan-Canadian basis. Infoway is currently focused on pan-Canadian initiatives including virtual care, patient access to digital records, and an electronic prescribing system.
• Healthcare Excellence Canada is the newly amalgamated organization of the Canadian Patient Safety Institute and the Canadian Foundation for Healthcare Improvement. It works with patients and other partners to share proven innovations and best practices that lead to lasting improvements in patient safety and healthcare quality (most recently, its 'LTC+' program provided seed funding and programming support to long-term care and retirement homes to strengthen their pandemic preparedness and response).
• The Canadian Partnership Against Cancer (CPAC) provides national leadership on the implementation of the Canadian Strategy for Cancer Control (which addresses primary cancer prevention, screening and early detection, standards and cancer guidelines, the cancer journey, health human resources, research, and surveillance), and coordinates efforts of PTs, cancer experts and stakeholder groups. CPAC recently led a refresh of the Strategy, released in June 2019.
• The Mental Health Commission of Canada (MHCC) acts as a catalyst for improving the mental health system and changing the attitudes and behaviours of Canadians around mental health issues (for example, by reducing the stigma associated with mental health illness and treatment). Its work focuses on four priority areas: population-based initiatives, suicide prevention, the integration of mental health and substance use, and engagement with Canadians.
• The Canadian Centre on Substance Use and Addiction (CCSA) provides research, effective knowledge exchange and expertise for the substance use field, promotes increased awareness among Canadians and health system stakeholders about substance use and addiction, convenes stakeholders across sectors (including those with lived and living experience) to reduce the harms of substance use, and promotes the use of programs shown to be effective in combating problematic substance use. CCSA is the only PCHO created by federal legislation.

B. Health Portfolio Organizations

Health Canada

Health Canada's mandate and vision

• Health Canada is the federal department responsible for helping the people of Canada maintain and improve their health.
• 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.
• As a regulator, service provider, promoter of innovation, and trusted source of information, we are a partner in health for all Canadians.

Health Canada's core business lines

• Strengthening Canada's health care system - supporting universally accessible, publicly funded health care for Canadians through administration of the Canada Health Act, leadership on emerging issues, and cooperation with provinces and territories on system improvements.
• Enabling access to safe and effective health products - enabling access to safe and effective health products by assessing and regulating health products, such as drugs and medical devices, to ensure their quality, safety, and effectiveness.
• Managing risks to health - managing the health risks of health products, food, harmful substances, cannabis, tobacco, controlled substances, consumer products, cosmetics, chemicals, radiation and pesticides, and reducing environmental health risks such as climate change.
• Supporting Canadians in making safe and healthy choices - supporting Canadians in making safe and healthy choices through public education and awareness campaigns to communicate health and safety information.

How the federal government can act in health

• Legislation and regulation;
• Funding;
• Research, surveillance, and monitoring;
• Policy development, engagement and advice;
• Communication;
• Program and service delivery; and
• Leadership and convening power.

Core business lines - strengthening Canada's health care system

• Health Canada acts as the steward of medicare for Canadians and provides leadership and support for Canada's public health care system.
• Administers and ensures compliance with the Canada Health Act e.g. public administration, comprehensiveness, universality, portability, accessibility, and no patient charges.
• Works multilaterally and bilaterally with provinces and territories to improve Canada's health care system, and oversees bilateral funding agreements e.g. Working Together to Improve Health Care for Canadians, Supporting Health Workforce, Improving access to family health services, Helping Canadians age with dignity and closer to home, Improving access to mental health and substance use services, working towards a modern, connected, world-class health system.
• Canadians have access to appropriate and effective health services g. Supporting access to dental care services, expanding access to mental health and substance use services, Medical Assistance in Dying, Improving access to sexual and reproductive health services, Supporting organs, tissues and blood program, combating cancer.
• Advances the affordability, accessibility, and appropriate use of prescription drugs, including working towards national pharmacare.
• Manages federal health grants and contributions programs supporting health system innovation/priorities and minority official language communities.
• Partners with and funds seven Pan-Canadian Health Organizations to catalyze system innovation and improvements in priority areas e.g. cancer, mental health, substance use, healthcare quality and patient safety, assessment of drugs and health technologies, health information, and digitization.
• Provides advice and leads pan-Canadian initiatives on system innovation and quality improvements in new and emerging areas of health care e.g., organ donation and transplantation, medical assistance in dying, and virtual care.
• Improves cultural safety, humility and responsiveness in the health care system to address systemic barriers and improve Indigenous health outcomes.

Core business lines – enabling access to safe and effective health products

• Health Canada is the science-based regulator that ensures the safety, effectiveness and quality of health products.
• Provides regulatory oversight through pre-market review and authorization, and post-market risk assessments e.g. vaccines, drugs, biologics, medical devices, and veterinary drugs.
• Ensures that appropriate regulatory pathways are available to bring treatment options to Canadians e.g., Special Access Programs for critical drugs not sold in Canada.
• Leads scientific and technical analysis of health product submissions to ensure the safety, efficacy and quality of approved drugs.
• Oversees clinical trials conducted by industry and academics to ensure the protection of participants and the integrity of the data.
• Monitors health product safety and adverse events arising from real-world use and communicates risks to Canadians.
• Optimizes the use of real world evidence for regulatory decision-making to improve the extent and rate of access to medical products in Canada.
• Works in collaboration with stakeholders to mitigate and prevent shortages of therapeutic products.

Core business lines – managing risks to health

• Health Canada helps Canadians manage the health risks of consumer products, cosmetics, chemicals, radiation, pesticides, cannabis and other harmful substances.
• Sets health and safety standards and regulates a variety of products through pre- and/or post-market risk assessments e.g. cosmetics, health products, food, chemicals, radiation, and pesticides.
• Takes compliance and enforcement action in relation to acts and regulations administered by Health Canada.
• Implements a departmental data strategy to support evidence-based decision making and transparency.
• Provides information to Canadians to make informed decisions on their health e.g., recalls, product seizures, rules for clear and legible product labels, mandated health warnings and information on tobacco and vaping products, and drug shortages.
• Conducts research, monitoring and surveillance on environmental health and the health impacts of climate change.
• Oversees the legal cannabis regime e.g. grants licences for production, coordinates with FPT partners, and monitors and enforces compliance with the Act and its regulations.
• Develops and implements approaches to address the harms associated with certain products and substances e.g. tobacco, alcohol, cannabis and opioids.
• Maintains readiness to respond to public health threats and emergencies.
• Provides assistance services and occupational health advice to employees of the federal public service.

Core business lines – supporting Canadians in making safe and healthy choices

• Health Canada assesses, manages and communicates health and safety risks and benefits to support Canadians in making safe and healthy choices.
• Works with domestic and international partners to assess, manage and communicate the health and safety risks and benefits associated with various products, food, health and consumer products, substances, radiation, climate change, and the environment e.g. cosmetics, food, chemicals, radiation, pesticides, cannabis, controlled substances, environmental factors, and climate change.
• Conducts public awareness campaigns to educate Canadians on safe food practices and consumer products safety.
• Supports Canadians in making healthier food choices through the Canada Food Guide and other healthy eating initiatives.
• Informs and engages Canadians as a trusted source of information on health and safety.
• Conducts public education and awareness on the overdose crisis, chronic pain, and how to reduce harm while working to reduce use stigma.
• Develops and promotes public education and awareness activities, to provide information to Canadians with the information they need to make informed decisions and minimize health and safety harms associated with cannabis use.
• Provides public education resources, information and programming on prevention and smoking cessation, to reduce tobacco-related diseases and deaths, and to minimize health and safety harms associated with vaping.
• Works with FPT partners to ensure workers have the right safety information to protect themselves when using workplace hazardous products.

COVID-19 response

• Since the beginning of the COVID-19 pandemic, Health Canada has taken a leadership role to address the health impacts of the virus and protect Canadians.
• The magnitude of the COVID-19 pandemic required strategic and wide-ranging collaboration with all of Health Canada's partners in health – other federal government departments and agencies, provinces and territories, municipalities, Indigenous communities, academic and science and tech organizations, private sector companies, frontline workers and other stakeholders.
• Health Canada provided Portfolio, Government-wide and FPT coordination and leadership on the pandemic responses, and established a COVID-19 Taskforce to coordinate the department's response and provide leadership on health issues, including Personal Protective Equipment, Testing and Vaccines. It is now focused on gathering lessons learned and preparing for future pandemics.
• Many COVID-19-related exceptional measures and programs have concluded as Health Canada's pandemic posture adapts to meet Canada's needs in the current context. Many functions are transitioning to pre-pandemic operations and more sustainable management while applying lessons learned to the department's core functions.
• The COVID-19 outlook has improved in Canada. We remain ready for a range of COVID-19 scenarios.

Departmental Actions during the COVID-19 Response

Vaccines and therapeutics

• Implemented innovative and agile regulatory measures to authorize vaccines, as well as treatments and therapies.
• Co-Led work on expert advice and investments in research, vaccines, and treatments.

Testing & tracing

• Developed COVID Alert, a notification apps that alerted Canadians on risk of exposure to minimise the outbreak.
• Scaled up testing and contact tracing and established an emergency reserve of rapid tests.

Support to PTs

• Purchased PPE and supplies; developed PPE supply and demand model.
• Enhanced healthcare capacity.
• Mobilized resources to provide surge capacity and support.
• Launched digital tools to support mental health of Canadians (Wellness Together Canada).

Communications and public engagement

• Provided timely, trusted, and evidence-based pandemic information to Canadians.

Public service

• Reinforced comprehensive strategies to protect public servants' mental health and wellness.

Health Canada's key partners

• Health Canada operates in a complex and dynamic environment where many health challenges – such as the COVID-19 pandemic and the opioid overdose crisis – require a multi-jurisdictional approach.
• The Department works collaboratively and collectively with federal partners, provinces and territories (P/Ts), Indigenous organizations, industry, and international regulators.

Health Portfolio partners

• Public Health Agency of Canada;
• Canadian Food Inspection Agency;
• Canadian Institutes of Health Research; and
• Patented Medicine Prices Review Board.

Provincial and territorial governments

• Multilateral and bilateral machinery (including annual FPT Health Ministers' Meetings and the Pan-Canadian Public Health Network).

Health system partners

• Seven Pan-Canadian Health Organizations (e.g., Canadian Institute for Health Information);
• National Non-governmental organizations (health professional associations, regulatory and accreditation authorities, disease-specific organizations);
• Hospitals and patient safety organizations; and
• Advocacy groups.

Industry / consumer groups

• Private sector enterprises (including manufacturers, distributors, and retailers);
• Industry associations;
• Consumer groups; and
• Standards development organizations (e.g., CSA Group).

Indigenous partners

• National and regional First Nations, Inuit and Métis partners; and
• Indigenous Health Professional Organizations.

Federal departments and agencies

• Environment and Climate Change Canada;
• Innovation, Science and Economic Development Canada;
• Agriculture and Agri-Food Canada;
• Public Safety/Canada Border Services Agency;
• Indigenous Services Canada;
• Women and Gender Equality Canada;
• Department of Justice;
• Global Affairs Canada; and
• Finance Canada/Treasury Board;

International partners

• Multilateral fora (e.g., World Health Organization, Pan-American Health Organization, United Nations); and
• Bilateral relationships with key partners and regions (e.g., U.S. Food and Drug Administration, European Medicines Agency, and Australian Therapeutic Goods Administration).

Health Canada organizational structure

Deputy Minister of Health
Dr. Stephen Lucas

Associate Deputy Minister
Eric Costen

Strategic Policy Branch (SPB)
Jocelyne Voisin, ADM
Eric Bélair, Associate ADM
Lynne Tomson, Associate ADM / Dental Task Force
Susan Fitzpatrick, Head of the Canadian Drug Agency Transition Office

Health Products and Food Branch (HPFB)
Pamela Aung-Thin, ADM
Celia Lourenco, A/Associate ADM

Controlled Substances and Cannabis Branch (CSCB)
Kendal Weber, ADM
Shannon Nix, Associate ADM

Regulatory Operations and Enforcement Branch (ROEB)
Linsey Hollett, ADM

Healthy Environments and Consumer Safety Branch (HECSB)
Matthew Jones, ADM

Pest Management Regulatory Agency (PMRA)
Manon Bombardier, ADM (PMRA transformation)
Frederic Bissonnette, A/Executive Director

COVID and Pandemic Response Secretariat (CPRS)
Cameron MacDonald, ADM

Drug Shortages Taskforce
Stefania Trombetti, ADM

Chief Financial Officer Branch (CFOB)
Serena Francis, ADM and Chief Financial Officer

Health Portfolio shared services

Legal Services
Christian Roy, Executive Director and Senior General Counsel

Corporate Services Branch (CSB)
Debbie Beresford-Green, ADM

Communications and Public Affairs Branch (CPAB)
Sarah Lawley, ADM
Cathy Allison, A/Associate ADM

Digital Transformation Branch (DTB)
Luc Gagnon, ADM and Chief Digital Transformation Officer

Centre for Ombuds, Resolution and Ethics (CORE)
Sylvie Richard, A/Ombud and Executive Diretor

Office of International Affairs for the Health Portfolio (OIA)*
Christine Harmston, Branch Head

Office of Evaluation & Audit (OAE)*
Shelley Borys, Chief Audit and Evaluation Executive
*Shared service supported by PHAC

Health Canada 2023-24 financial overview

Budget by core responsibility

Health care systems:

• 83% of total;
• $5.5B;
• 385 FTEs.

Health protection and promotion:

• 12% of total;
• $834.1M;
• 6,371 FTEs.

Internal services:

• 5% of total;
• $307.9M;
• 2,083 FTEs.

Budget by vote

Vote 1 operating:

• 16% ot total;
• $1.03B.

Vote 5 capital:

• 0% of total;
• $28.0M.

Vote 10 transfer payments (grants and contributions):

• 84% of total;
• $5.5B.

B. Health Portfolio organizations

Public Health Agency of Canada (PHAC)

PHAC's mandate:

PHAC was created in 2004 in order to:

• Promote health, well-being, and equity;
• Protect against health emergencies and mitigate the impacts;
• Prevent and reduce disease, injury, and disability;
• The Agency was created through enabling legislation and is led by a President (Deputy Head) and a Chief Public Health Officer of Canada (CPHO) working collaboratively:
  • The President is the Deputy Head, accountable for the Agency including policy, programs, management of the Agency operations and staff, and leads Agency support for the Minister of Health in meeting his or her responsibilities and accountability to Parliament. The President is supported by the Executive Vice President;
  • The role of the CPHO is to advise the Minister of Health and President on public health matters, and communicate with public health authorities, stakeholders and the general public (see slide 10 for additional information);
• PHAC advances its mandate through collaboration with a wide range of partners and stakeholders, including provinces and territories, Indigenous and International partners, other federal departments and agencies, private/non-profit sectors, and municipalities.

Delivering on public health functions

• Public health is the organized efforts of society to achieve optimal health and well-being for all people in Canada.

Functions

• Emergency preparedness and response;
• Disease and injury prevention;
• Health surveillance;
• Population health assessment;
• Health protection; and
• Health promotion.

Levers

• Legal and regulatory - acts or regulations that define areas of responsibility for public health and establish enforceable requirements (e.g., Quarantine Act, Human Pathogens and Toxins Act);
• Program Funding - public expenditure, public ownership, contracts, grants and contributions;
• Policy - standards and guidelines, policies, frameworks, strategies or guidance documents;
• Information and education - communications, education campaigns (e.g., combating misinformation), supports to implementation;
• Partnerships - formal/informal public health networks (e.g., Pan-Canadian Public Health Network), community-based and academic partnerships (e.g., Council of Canadian Academies, National Collaborating Centres), international cooperation (e.g. G7, G20); and
• Science - open and collaborative networks (e.g. Canadian Public Health Laboratory Network), Detection and monitoring of diseases through surveillance.

Timeline

• Since 2004, PHAC evolved while making significant contributions to public health, including:
  • 2004 – Establishment of the Public Health Agency of Canada;
  • 2005 – Establishment of the Pan-Canadian Public Health Network;
  • 2008 – Response to Listeriosis outbreak;
  • 2009 – Response to h2N1 influenza outbreak;
  • 2013-14 – Ebola outbreak in West Africa; National Microbiology Laboratory plays key role in developing Ebola vaccine;
  • 2015 – PHAC supports resettlement of Syrian refugees;
  • 2017 – Present – Response to the epidemic of opioid overdoses;
  • 2020 – Present – Response to COVID-19 global pandemic;
  • 2021 – Present – supports resettlement of Afghan/Ukrainian refugees;
  • 2022 – present – response to mpox outbreak in Canada;
• PHAC advances this work through leadership, partnerships, innovation, preparedness, and action in public health, both at the domestic and global level.

Leadership during a public health emergency

• In the event of a public health emergency, PHAC is at the centre of the federal response and must pivot its resources to meet the challenge. Specific responsibilities include:
  • coordinating Canada's national response;
  • liaising with domestic and international partners;
  • leading Canada's border and travel health measures;
  • leveraging expert science and public health advice;
  • developing national public health guidance;
  • providing subject-matter expertise and surge support to public health and health system partners;
  • providing surveillance, epidemiological, diagnostic and other scientific and technical leadership and support; and
  • communicating risk and public health advice to the public in a highly evolving context.
• PHAC leads the Health Portfolio Emergency Operations Centre with 24/7 capacity to monitor and respond to new and evolving threats and to connect with whole of Government responses.

PHAC during the COVID-19 response

• While emergency preparedness and response has always been a key part of PHAC's mandate, COVID-19 has stretched the Agency in unprecedented ways.
• The Agency rapidly scaled up existing operations and entered into new areas to support Canada's COVID-19 response (e.g., National Microbiology Laboratory (NML) supporting PT labs to scale up for COVID-19 testing).
• While some of this expansion is temporary, certain elements are likely to require PHAC to play an ongoing role in both the short and long term (e.g., enhanced border measures, and national vaccine strategy).

Examples of activities during the COVID-19 response

• Securing and distributing essential PPE, medical equipment, and supplies. Purchased 3.5B items to date, from N95 masks to syringes.
• Delivered millions of vaccines to provinces, territories and Indigenous partners and provided guidance on their use (through the National Advisory Committee on Immunization and PHAC experts), for the largest immunization program in Canada's history.
• Communicating and advancing science: modelling, epidemiology, vaccines, testing and therapeutics and making real-time information available to Canadians through public health guidance and updates.
• Borders and quarantine: Set policy and operate border systems to enhance public health at 35 points of entry (e.g., test and quarantine travellers).
• Surge Response: Through the Health Portfolio Operations Centre (HPOC), PHAC provides a single portfolio window to coordinate federal health supplies and health human resource responses to provincial requests during pandemic surges.
• Increasing engagement with domestic and international partners to support enhanced coordination on public health policy, guidance and communications.

Lessons learrned landscape

• COVID-19 had significant and complex health, social and economic impacts on society. The response demanded an exceptionally robust and responsive public health infrastructure to tackle the evolving nature of the pandemic in real time.
• Canada sought expert advice throughout the pandemic, standing up independent reviews (GPHIN), expanding Expert Advisory Bodies (NACI), undergoing formal audits (OAG), studies (HESA/PACP), and internal reviews that informed our adaptive response. These showed that while the Agency was successful on many fronts, the pandemic revealed critical weaknesses and gaps in Canada's emergency preparedness and management posture.
• A preliminary analysis of key reports and studies identified key themes, which point to areas of improvement to strengthen our future emergency preparedness and response efforts.

PHAC-focused Reports (internal):

• Over 21 relevant internal PHAC audits, evaluations and reports; and
• Topics Covered: g. vaccines and therapeutics; borders, health promotion; communications; engagement and outreach; rapid testing.

PHAC-focused Reports (external):

• GPHIN, 4 OAG Audits since 2021 and 4 PACP reports; and
• Topics Covered: e.g. preparedness, PPE, vaccines, quarantine and testing, vaccine equity, GPHIN.

Public Health System Reports:

• Over 22 reports of interest from CIHR, CPHA, Royal Society of Canada; and
• Topics covered: e.g. PH system, CIRN, science, advice, borders, NESS, COVID response, equity, health data, surveillance, FPT SAC.

International Reports:

• Enhanced and growing international work, including from the Lancet Commission, WHO's Independent Panel, NAPAPI and IANPHI; and
• Topics covered: lessons from COVID-19, the role of national public health institutes.

Key lessons learned

Six themes capturing key lessons learned and areas of improvement emerged from preliminary analysis:

• Governance and Collaboration: It is critical to ensure partnerships with a range of experts, and establish clear and well understood roles, responsibilities and accountabilities during public health emergencies.
• Surge Capacity & PH Workforce: Highlighted the need for tools and systems to rapidly mobilize resources and processes to support resiliency and well-being. Prioritization can help scale up and sustain surge capacity, support resilience and agility, focussing the organization where additional efforts are needed.
• Science and Technology: Investments in technologies, skills and science infrastructure (e.g., lab, genomics, and modelling) are essential to support future responses.
• Health Equity: There is a need to better integrate health equity approaches, reaching vulnerable and harder to reach populations, into the core of future pandemic preparedness, response, and recovery.
• Surveillance, data sharing and interoperability: embracing new sources of information and addressing challenges of darta sharing and disaggregation, technological infrastructure, and timeliness are critical. Work is needed with partners to support effective decision-making, research, and to embrace tranditional/non-traditional sources of information.
• Communication, Engagement, and Public Trust: Transparent and timely risk communications about activities and evolving science, along with targeted engagement and community partnerships to support the uptake of public health guidance to help build trust and mitigate mis- and disinformation.
• Lessons learned have contributed to PHAC's adaptive response throughout the pandemic. We will need to continue to monitor and address areas for improvement in order to be well-positioned for future health events.

Addressing complex public health challenges

The Agency oversees a range of complex public health issues and leads various initiatives to promote and protect the health and wellbeing of people living in Canada. Some examples include:

• Substance use: Collaborating and engaging across sectors to improve the understanding of substance use and supporting the prevention of substance-related harms in Canada, including those related to the use of cannabis, opioids, and vaping products.
• Mental health: Advancing suicide prevention efforts that include promoting safe messaging and responsible ways to communicate and report on suicide, improving data and developing a national suicide prevention action plan, and reporting on federal actions and progress under the Federal Framework for Suicide Prevention.
• Outbreaks: Supporting surveillance and monitoring of infectious diseases, risk assessments, modelling, and laboratory diagnostics as well as health professional education and public awareness activities through effective knowledge translation efforts.
• Climate change: Supporting climate change adaptation through monitoring activities and providing access to education to equip communities with the information to protect and improve health from climate-sensitive infectious diseases, as well as impacts of climate-related emergencies such as heat, wildfires/smoke, floods and storms.
• Antimicrobial resistance (AMR): Reducing the emergence and spread of AMR through increased monitoring of trends and analysis of interventions, and strengthening collaboration with international networks to address AMR using a One Health approach.
• Healthy living: Supporting healthy living and chronic disease prevention by encouraging all sectors of society to participate in supporting healthy living and bringing together partners to help Canadians lead more active lifestyles, eat healthier, and not smoke.
• Health inequity: Contributing to government-wide initiatives that seek to promote health equity and address the social and structural determinants of health, including a Federal 2SLGBTQI+ Action Plan, Health in All Policies approaches, Quality of Life indicators, and Canada's Anti-Racism Strategy.
• Health security: Encouraging continued collaboration at all levels of government to advance global health priorities and strengthen public health infrastructure, pathogen and biosecurity, border health and emergency management.

PHAC renewal (stabilization) – phase 1 [REDACTION]

[REDACTED]

PHAC financial overview

Budget (in millions)

• O&M: $4,309.9 million which represents 78% of the total budget;
• Gs&Cs: $519.3 million which represents 9% of the total budget;
• Salaries: $417.6 million which represents 8% of the total budget;
• Capital: $51.3 million which represents 1% of the total budget;
• Statutory: $244.7 million which represents 4% of the total budget.

Budget by Core Responsibility

• Infectious Disease Prevention and Control: $4402.8 million which represents 79% of the total budget;
• Health Security: $419.2 million which represents 8% of the total budget;
• Health Promotion and Chronic Disease Prevention: $505.8 million which represents 9% of the total budget;
• Internal Services: $214.9 million which represents 4% of the total budget.

Total Authorities 2016-17 to 2025-26 (in millions as of July 4, 2023)

• 2020-21 Authorities include $11.5B in authorities that are re-profiled to 2021-22 and beyond;
• 2021-22 Authorities include $3.6B in authorities that are re-profiled to 2022-23 and beyond;
• 2022-23 Authorities include $913.5M in authorities that are re-profiled to 2023-24 and beyond;
• COVID-19 funding ($3,471.3M) makes up more than 60% of PHAC's total 2023-24 budget ($5,542.8M).

Notes:

• Budgets based on 2023-24 Main Estimates plus Supplementary Estimates A, PHAC Renewal, 988 line, OBCF/CBCF and Budget 2023 cuts.
• Totals may not add due to rounding.

PHAC organizational structure

President
Heather Jeffrey

Senior Executive Advisor to the President
Fraser Valentine

Executive Vice-President
Nancy Hamzawi

Chief Science Advisor
Dr.Sarah Viehbeck

Chief Public Health Officer
Dr. Theresa Tam

Emergency Management Branch (EMB)
Cindy Evans, Vice President

Health Security and Regional Operations Branch (HSROB)
Jennifer Lutfallah, Vice President

National Microbiology Laboratory Branch (NML)
Dr. Guillaume Poliquin, Vice President

Infectious Diseases and Vaccination Programs Branch (IDVPB)
Dr.Donald Sheppard, Vice President

Strategic Policy Branch (SPB)
Stephen Bent, Vice President

Health Promotion and Chronic Disease Prevention Branch (HPCDPB) Vice President
Michael Collins, A/Vice President

Corporate Data and Surveillance Branch (CDSB)
Dr.Steven Hoffman, Vice President

Chief Financial Officer and Corporate Management Branch (CFOCMB)
Martin Krumins, Vice President and Chief Financial Officer

Shared Services Supported by PHAC

Office of Audit and Evaluation (OAE)
Shelley Borys, Director General Evaluations and Chief Audit Executive

Office of International Affairs for the Health Portfolio (OIAHP)
Christine Harmston, Branch Head

Digital Transformation Office
Luc Gagnon, ADM and Chief Digital Transformation Officer

Shared Services Supported by Health Canada

Communications and Public Affairs Branch (CPAB)
Sarah Lawley, Assistant Deputy Minister
Cathy Allison, Acting Associate Assistant Deputy Minister

Corporate Services Branch (CSB)
Debbie Beresford-Green, Assistant Deputy Minister

Legal Services
Christian Roy, Senior General Counsel

Accounting Operations and Material Management
Hongchao Wang, Director General and Deputy Chief Financial Officer

Centre for Ombuds, Resolution and Ethics
Sylvie Richard, Ombuds and Executive Director

Chief Public Health Officer approach and priorities

Every year, the Chief Public Health Officer of Canada (CPHO) is mandated to provide the Minister of Health with an independent report on the health of Canadians.

The 2022 report "Mobilizing Public Health Action on Climate Change" examines the impacts of climate change on the physical and mental health of people in Canada, and the role that public health systems can play to prevent and reduce these impacts across the country.

Overall, the reports raise the profile of public health issues and stimulate dialogue. They can also lead to action on improving and protecting the health of Canadians.

The 2022 CPHO report lays out a roadmap for the broader public health system in Canada to organize and mobilize around climate-health action. It provides concrete direction on how we can use our existing tools and knowledge, while also expanding them to meet new challenges that will come along with a changing climate.

The CPHO is targeting to release her annual report [REDACTED] in fall 2023.

Key federal roles

The federal government holds key responsibilities in areas such as protecting health and safety, emergency preparedness and response, Indigenous health, and health promotion/disease prevention, while PTs are responsible for setting public health standards and delivering public health functions and programming.

To advance shared FPT public health priorities, PHAC:

• Fosters collaboration and senior public health decision-making and public health perspectives on health system business at the Conference of Deputy Ministers of Health (CDMH) and FPT Health Ministers Meetings (HMM), working with and convened by Health Canada.
• Convenes and leads the Pan-Canadian Public Health Network (PHN), co-led by Canada's Chief Public Health Officer, which serves as the governance structure for collaboration between senior public health officials including Council of Chief Medical Officers of Health and PHN steering committees.
• Convenes and supports strategic and technical tables that address a wide range of public health issues, including the Canadian Immunization Committee, the FPT Steering Committee on Antimicrobial Resistance, FPT Coordinating Committee on Dementia, and the FPT Sport, Physical Activity and Recreation tables (together with Sport Canada).
• Fosters relationships with local medical officers of health, key stakeholders and Indigenous partners who also shape the FPT health system and public health landscape.
• [REDACTED] by building regional public health capacity, mobilizing knowledge and intelligence and leading on regional Indigenous relations and Science in French.

Collaboration with other partners

Minister's Role

International

• Plays a leading role in international activities related to public health by advancing priorities at various fora (e.g., G7 and G20 Health Ministerial Meetings, World Health Assembly; and United Nations General Assembly) and bilaterally with counterparts in other countries to advance key health priorities.

Federal departments and agencies

• Works with Cabinet colleagues and bilaterally with counterparts on key public health priorities: Minister of Seniors (e.g., dementia); Minister of Crown-Indigenous Relations and Minister of Indigenous Services (e.g., Indigenous health); Minister of Public Safety and Emergency Preparedness (e.g., Post-Traumatic Stress Injuries, emergency management).

Other partners

• Ministerial Advisory Bodies: the Dementia Advisory Board and the National Seniors Council (with Minister of ESDC). The Minister is also a member of Federal-Indigenous Permanent Bilateral Mechanisms with First Nations. Inuit, and Metis.

Agency's role

International

• Works closely with multilateral partners (World Health Organization [WHO], Pan American Health Organization [PAHO], G7, G20, Five Eyes, and key bilateral/ regional partners (U.S., Mexico, UK, the Caribbean Public Health Agency).
• Acts as Canada's focal point for International Health Regulations (IHR) and leads Canada's negotiations on over 300 proposed amendments.
• Leads development, analysis, and negotiation of Canadian positions and political declarations to shape global health policies.
• Manages the International Health Grants Program to facilitate funding for international projects and payment of Canada's assessed and voluntary contributions.
• Supports health working group/committee work.
• Hosts the WHO Collaborating Centre on Non Communicable Disease Policy and the WHO Collaborating Centre for Biosafety and Biosecurity.
• Participates on the Intergovernmental Negotiating Body to reflect Canadian priorities in the development of a new international pandemic instrument that aims to create a stronger and better coordinated global health security architecture for disease outbreaks.

Federal departments and agencies

Works closely with a number of departments and agencies responsible for ensuring healthy lives and promoting well-being including:

• Health Portfolio Partners;
• Crown-Indigenous Relations and Northern Affairs Canada;
• Indigenous Services Canada;
• Employment and Social Development Canada;
• Canadian Heritage;
• Public Safety Canada;
• Canada Border Services Agency;
• Global Affairs Canada;
• Innovation, Science and Economic Development;
• Correctional Services Canada;
• Immigration, Refugees and Citizenship Canada;
• Public Services and Procurement Canada; and
• Transport Canada.

Other partners

• Works with Indigenous partners to advance reconciliation and Indigenous public health priorities.
• Collaborates and works with national health organizations (e.g., health professional organizations, NGOs, academia, community based organizations), innovative partners from outside of the health sector and people with lived and living experience on science, guidance, programs and policy to support public health outcomes.

Canadian Institutes of Health Research (CIHR)

CIHR mandate

As stated in the CIHR Act (2000), the objective of CIHR is to "excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system".

CIHR overview

• As Canada's federal funding agency for health research and member of the Health Portfolio, CIHR is using the power of research to improve the health of Canadians, solve health challenges and make our health care system more efficient and effective.
• Working with international and domestic partners to set research priorities and support health research, CIHR is investing in world-class research conducted in Canadian post-secondary institutions and their affiliated hospitals and research institutes.

A brief overview of CIHR

• Invests over $1.4 billion annually to support over 15,000 world-class researchers and trainees.
• Funds the creation of new knowledge, builds research capacity, and promotes the dissemination of research results in order to improve the health of Canadians and make our health care system more efficient.
• Plays a catalyst role in collaborating with international and domestic partners, including the other federal research granting agencies (i.e., the Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities Research Council) to support and mobilize Canada's research enterprise.
• Offers the Minister of Health tools and resources to:
  • develop evidence-based policies and programs;
  • demonstrate leadership in health innovation; and
  • engage positively with provinces and territories.

Our institutes

Areas of responsibility

• Population and Public Health;
• Aging;
• Cancer Research;
• Circulatory and Respiratory Health;
• Gender and Health;
• Genetics;
• Health Services and Policy Research;
• Human Development, Child and Youth Health;
• Indigenous Peoples' Health;
• Infection and Immunity;
• Musculoskeletal Health and Arthritis;
• Neurosciences, Mental Health and Addiction; and
• Nutrition, Metabolism and Diabetes;

How CIHR Supports Research

Two approaches drive research:

Investigator

• Support the best research ideas proposed by researchers and trainees;
• We call this investigator-initiated research.

Health priorities

• Address the changing health needs and priorities of Canadians;
• We call this priority-driven research.

Process

• Researchers apply for funding;
• CIHR receives applications;
• Applications are evaluated by independent experts;
• CIHR makes final funding decision and releases funds;
• Researchers conduct research;
• Knowledge mobilization.

Key business lines

Health research – advancing CIHR's renewed vision

• Implementing CIHR's new Strategic Plan (2021-2031) – A Vision for a Healthier Future to support a vibrant health research community and improve the health of Canadians by:
  • Advancing research excellence in all its diversity;
  • Strengthening Canadian health research capacity;
  • Accelerating the self-determination of Indigenous Peoples in health research;
  • Pursuing health equity through research; and
  • Integrating evidence in health decisions.
• CIHR's Global Health Research Framework will guide strategic investments and activities in global health research from 2021-2026, positioning Canada as a world leader in leveraging the power of research to accelerate global health equity for all.

Federal priorities – collaborating with the Health Portfolio and other government partners

• Provide research evidence needed to develop sound, evidence-based policies on health priorities (e.g., emergency preparedness, long-term effects of COVID-19, opioid crisis, mental health, suicide prevention, climate change, AMR action plan, national dementia strategy, diabetes, post-traumatic stress disorder, national strategy on high-cost drugs for rare diseases).
• Work as a member of the Canada Research Coordinating Committee to improve the coordination efforts of Canada's research granting agencies (CIHR, Social Science and Humanities Research Council, Natural Science and Engineering Research Council) in priority areas, including research security.

CIHR financial overview

• CIHR's annual budget has remained relatively stable between $1 and $1.4 billion for the last 10 years.
• CIHR's operating budget is approximately 6.16% of its total budget, and CIHR faces increasing pressure to deliver CIHR's expanding health research priorities.

Budget 2022-23 by category

• Total authorities available: $1.362.3M;
• Total anticipated full-time equivalents: 590.

Further financial information

In 2022-23, CIHR invested a total of $1,258.4B in Grants and Awards broken down into discretionary investments, non-discretionary investments, and statutory authorities.
Discretionary investments totaled $804.7M and included:

• Training and Career Support ($19.4M). The majority of CIHR support for training is provided indirectly, through grants to researchers reported in the other categories;
• Research in Priority Areas - Institute and Corporate-led Initiatives ($130.2M);
• Investigator-Initiated Research - Project & Foundation Grants ($631.2M).

Non-discretionary investments totaled of $453.7M and included:

• Government of Canada Priorities - Ring-fenced Initiatives ($222.6M);
• Tri-agency Programs - Separately listed grants ($231.1M).

CIHR organizational structure

CIHR consists of a single head office in Ottawa, under the lead of the following senior executives:

• Michael J. Strong: Deputy Head/President
• Catherine MacLeod: Executive Vice-President
• Dwayne Martins : Chief Enterprise Corporate Priorities
• Christian Baron: Vice-President Research Programs
• Tammy J. Clifford: Vice-President Learning Health Systems
• Jeff Moore: Associate Vice-President Government and External Relations
• Adrian Mota: Associate Vice- President Research Programs Operations
• Rhonda Kropp: Associate Vice-President Research Strategy

CIHR governance structure

The CIHR governance structure describes the roles and responsibilities that each governance area oversees. At the top of CIHR's governance structure is Parliament and the Minister of Health. Directly under the Minister of Health is CIHR Governing Council (GC), then the CIHR President, and a Science Council (SC) and a Senior Leadership Committee (SLC) that report to the CIHR President.

The CIHR Governing Council is responsible to:

• Develop strategic directions, goals and policies;
• Evaluate performance/appointments of scientific directors;
• Approve budget/by-laws; and
• Establish, maintain, terminate and provide mandates for CIHR's institutes.

The CIHR President is responsible to:

• Day-to-day management of CIHR;
• Approve funding for research; and
• Provide advice to the Minister of Health.

CIHR's Science Council is responsible for:

• Leadership on research and knowledge;
• Translation strategy; and
• Leadership on funding for CIHR.

CIHR's Senior Leadership Committee is responsible for:

• Leadership on corporate policy and management.

*As a Government of Canada agency within the Health Portfolio, CIHR reports to Parliament (e.g., Departmental Results Report), advises the Minister of Health in respect of any matter relating to health research or health policy, and supports federal government policy directions (e.g., participate in parliamentary committee hearings).

Annex: a key player in the Government of Canada's science and technology structure

Numerous key players are involved in the Government of Canada's Science and Technology Structure.

At the top of the Government of Canada's Science and Technology Structure is the Prime Minister of Canada. Under the Prime Minister is the Minister of Health, the Minister of Innovation, Science and Industry, and other Cabinet Ministers.

Those reporting to the Minister of Health are Health Canada, the Public Health Agency of Canada, the Canadian Food Inspection Agency, and the Canadian Institutes of Health research.

Those reporting to the Minister of Innovation, Science and Industry are Innovation, Science and Economic Development Canada, the National Research Council, the Canadian Space Agency, Statistics Canada, the Natural Sciences and Engineering Research Council, and the Social Sciences and Humanities Research Council.

Other Cabinet Ministers include National Resources Canada, Global Affairs Canada, National Defence, Defence Research and Development Canada, Fisheries and Oceans Canada, Transport Canada, Public Safety Canada, and Environment and Climate Change Canada.

Of the above list, the following are departments with national laboratories: Health Canada, Innovation, Science and Economic Canada, National Resources Canada, Global Affairs Canada, National Defence, Fisheries and Oceans Canada, Transport Canada, Public Safety Canada, and Environment and Climate Change Canada.

The following are federal agencies conducting research: the Public Health Agency of Canada, the Canadian Food Inspection Agency, National Research Council, the Canadian Space Agency, Statistics Canada, and Defence Research and Development Canada.

The following research funding agencies: the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council, and the Social Sciences and Humanities Research Council.

Annex: a key player in federal science and technology investments (2022-23)

Numerous key players invest in Federal Science and Technology. Below is a list of federal committees, organizations, departments & agencies along with their investments in science and technology for 2022-2023.

Canada Research Coordinating Committee members:

• Canadian Institutes of Health Research ($1352M), Natural Sciences and Engineering Research Council ($1324M), Social Sciences and Humanities Research Council ($1073M), Canada Foundation for Innovation ($478M).

Research and Technology Organization:

• National Research Council ($1442M).

Federal Agency:

• Canadian Spacy Agency ($348M), Natural Resources Canada ($788M).

Federal Department:

• Statistics Canada ($733M), Global Affairs Canada ($1104M), Environment and Climate Change Canada ($1216M), Fisheries and Oceans ($468M), National Defence ($626M), Innovation, Science and Economic Development ($899M), Agriculture and Agri-Food Canada ($557M), Health Canada ($568M).

Canadian Food Inspection Agency (CFIA)

Legislative mandate

Develop and deliver inspection and other services to:

• Prevent and manage food safety risks (e.g., food recalls);
• Protect plant resources from pests, diseases, and invasive species (e.g., emerald ash borer);
• Prevent and manage animal diseases (e.g., African swine fever (ASF), bovine spongiform encephalopathy (BSE), chronic wasting disease (CWD), etc.), which sometime also threatens human health (e.g., Avian influenza);
• Contribute to consumer protection (e.g., labelling claims);
• Facilitate market access for Canada's food, plants, and animals; and
• Conduct innovative research to make science-based decisions.

Division of responsibilities between Ministers

Minister of Health

Responsible for:

• Overall direction of the CFIA; and
• Establishing policies and standards relating to the safety and nutritional quality of food sold in Canada and assessing the effectiveness of the Agency's activities related to food safety.

Food safety:

• Food and Drugs Act; and
• Safe Food for Canadians Act.

Minister of Agriculture and Agri-food

Responsible for:

• The non-food safety legislation administered and enforced by the CFIA, including the facilitation of market access, animal health and plant protection.
• The Agency is responsible for the administration and enforcement of the Agriculture and Agri-Food Administrative Monetary Penalties Act and the following:
  • Plants: Fertilizers Act, Plant Protection Act, Seeds Act and Plant Breeders' Rights Act;
  • Animals: Feeds Act and Health of Animals Act; and
  • Non-food safety: Safe Food for Canadians Act and Food and Drugs Act.

Core responsibilities

Food safety, plant health, animal health, and international trade:

• A regulator: to enforce food, animal and plant-related Acts and regulations set by Health Canada and Agriculture and Agri-Food Canada;
• A risk manager: to mitigate diverse public risks related to public health, economics and environment; and
• A facilitator: to improve the regulatory interface with industry and trading partners.

Food safety

Safeguard Canada's food supply :

• Includes health and safety and labelling;
• Administering and enforcing Safe Food for Canadians Regulations, Food and Drugs Act, and Food and Drug Regulations (as it relates to food safety) that Health Canada establishes; and
• Shared responsibility between CFIA, industry, international partners, Public Health Agency of Canada, Health Canada and municipal, provincial and territorial authorities.

Minimize health and safety risks to Canadians by:

• Protecting Canadians from preventable food safety hazards; and
• Managing food safety investigations and recalls effectively.

Contributes to consumer protection by:

• Verifying information provided to Canadian consumers through labels and advertising is truthful and not misleading

Plant Health

Protect Canada's plant resource base:

• Includes crops, horticulture, nurseries, forest resources and products, greenhouses, seeds, fertilizers, plants with novel traits.

Protect Canada's plant resource base, environment and plant-related industries by:

• Preventing the introduction and spread of pests that could damage Canadian production and the income of Canadian producers;
• Verifying farmers have access to safe, effective and innovative agricultural inputs (e.g., seed, fertilizer) that support environmental sustainability;
• Fostering innovation through protection of intellectual property (i.e., plant breeders' rights); and
• Maintaining the reputation of Canadian agricultural products in the global marketplace as being high-quality, pest free and safe.

Animal Health

Protect Canada's animal resource base and Canadians from diseases :

• Includes livestock, poultry, animal feeds, vaccines and fish and seafood.

Minimize risks to Canada's terrestrial and aquatic animal resource base, and ensure the safety of animal feeds, products and vaccines by:

• Protecting Canada's animals, including aquatic animals, from diseases;
• Managing animal disease incidents and emergencies (e.g., ASF, BSE, CWD, etc.), including diseases that also threatens human health (e.g., Avian influenza, coronaviruses, etc.);
• Promoting and regulating animal welfare, in transportation and in slaughter; and
• Verifying that animal feeds and vaccines are safe and effective.

International Trade

Facilitate market access for Canada's plants, animals, and food

Contribute to market access for Canadian agriculture and agri-food by:

• Issuing export certificates, import permits, and conducting inspection and lab testing for imports and exports;
• Influencing the development of international rules and standards for plant protection, animal health, and food safety through international standard-setting bodies;
  • World Organisation for Animal Health (WOAH)
  • Codex Alimentarius Commission (CODEX) (Food)
  • International Plant Protection Convention (IPPC)
• Engaging trading partners to negotiate import/export conditions and technical agreements and standards; and
• Working in collaboration with Agriculture and Agri-Food Canada and Global Affairs Canada.

Organizational structure

CFIA's organizational structure is led by two (2) senior executives. The President, Dr. Harpreet S. Kochhar, and the Executive Vice-President Jean-Guy Forgeron. Under the 2 senior executives are 11 executives that oversee different sections of CFIA.

Delivery of CFIA mandate

• Diane Allan, A/Vice-President of Policy and Programs, provides strategic policy advice and sets out program policies and procedures.
• Jagvinder Dhanda, A/Vice-President of the Operations Branch, provides scientific leadership, advice and laboratory services to contribute to an effective science-based regulatory agency.
• David Nanang, Associate Vice-President of Operations, delivers inspection programs and takes compliance and enforcement action.
• Kathleen Donohue, Assistant Deputy Minister of the International Affairs Branch, leads on market access and international regulatory trade issues.
• Scott Ratray, A/Associate Vice President of Operations, delivers inspection programs and takes compliance and enforcement action.

Corporate services

• Raman Srivastava, Vice-President of Human Resources, enables talent identification, acquisition and mobilization.
• Stanley Xu, Vice-President of Corporate Management and Chief Financial Officer, provides oversight of financial management and assets and security management.
• Martin Rubenstein, Chief Audit Executive and Head of Audit and Evaluation, provides evidence-based advice and assurance to senior management.
• Jane Hazel, Vice-President of Communications and Public Affairs, delivers internal and external communication services.

Both corporate services and delivery of CFIA mandate

• Todd Cain, Chief Innovation and Information Officer, delivers on major projects and priority change initiatives and enables information and information technology.

Shared services with Agriculture and Agri-Food Canada

• Kristine Allen, Executive Director and Senior General Counsel, Legal Services, provides legal services to the CFIA and Agriculture and Agri-Food Canada (AAFC).

CFIA national presence

Area and Regional Offices

Atlantic Area:

• New Brunswick (Moncton);
• New Brunswick (Fredericton);
• Prince Edward Island (Charlottetown);
• Newfoundland and Labrador (St. John's);
• FTE: 936.

Quebec Area:

• Montreal East;
• Montreal West;
• Hyacinthe;
• Quebec City;
• FTE: 1,197.

Ontario Area:

• Northeast (Barrie);
• Toronto (Downsview);
• Central (Guelph);
• Southwest (London);
• FTE: 1,331.

Western Area:

• Manitoba (Winnipeg);
• Alberta South (Calgary);
• Alberta North - Saskatchewan (Edmonton);
• British Columbia (Burnaby);
• FTE: 1,945.

NCR Area:

• FTE: 2,095.

CFIA resources

Planned spending by core business 2022-23:

• 45% is for safe food and has a budget of $373 million;
• 20% is for internal services has a budget of $171 million;
• 18% is for animal health and has a budget of $148M;
• 15% is for plant health and has a budget of $129M; and
• 2% is for international and has a budget of $17M.

Planned spending by type of expenditures 2022-23:

• Operating expenditures: totals $645 million and 77% of the total;
• Other statutory: totals $97 million and 12% of the total;
• Statutory revenue: totals $53 million and 6% of the total; and
• Capital expenditures: totals $43 million and 5% of the total.

CFIA Partners

International partners

• Set import requirements and verify export requirements.
• Comparability and acceptance of relevant systems (e.g., inspection).
• Develop international science-based rules, standards, etc.

Provincial, territorial and municipal governments

• Enforce jurisdictional food safety, plant and animal health requirements.
• Collaborate in responding to food safety incidents.
• Prevent and manage plant and animal health emergencies.

Federal departments and agencies

• Health Portfolio;
• Agriculture and Agri-Food Canada Portfolio;
• Global Affairs Canada;
• Canada Border Services Agency;
• Fisheries and Oceans Canada;
• Environment and Climate Change Canada;
• Natural Resources Canada;
• Crown-Indigenous Relations, and Northern Affairs Canada;
• Innovation, Science and Economic Development; and
• Public Service and Procurement Canada.

Industry

• Production of safe food;
• Comply with regulatory requirements; and
• Develop and implement best management practices.

Consumers

• Safe food handling and preparation; and
• Awareness of plant and animal risks (e.g., transporting infested firewood);

Note: CFIA also works with Indigenous Groups to support Indigenous reconciliation.

Patented Medicine Prices Review Board (PMPRB)

PMPRB mandate, jurisdiction and legislation

Mandate

• Regulatory: to take action against patented medicines with excessive prices.
  • The Board does not have general price regulatory authority for all drugs but supports other F/P/T bodies such as CADTH and pCPA.
• Reporting: to report on trends in pharmaceutical sales and pricing for all medicines and on research and development (R&D) spending by patentees.

Jurisdiction and legislation

• The PMPRB's powers and obligations are set out in ss. 79-103 of the Patent Act and associated Patented Medicines Regulations and Rules of Practice and Procedure.
• The PMPRB also publishes non-binding Guidelines intended to provide transparency and predictability to right holders.
• The Patent Act establishes the PMPRB as an independent, quasi-judicial body.
• While the PMPRB is part of the Health Portfolio, it carries out its regulatory mandate at arm's length (i.e., independently) from the Minister of Health, due to its quasi-judicial nature.

Responsibilities of the Minister

The Patent Act authorizes the Minister of Health to:

• Table the Annual Report prepared by the PMPRB before Parliament;
• Recommend new or amended regulations to the Governor in Council; and
• Refer matters to the PMPRB for inquiry.

The Minister of Health may (but is not obligated to):

• Participate as a party in a hearing before the PMPRB;
• Convene meetings with the PMPRB;
• Participate in PMPRB guideline consultations and designate representatives of consumer groups and of the pharmaceutical industry as participants in such consultations;
• Enter into agreements with provinces respecting the distribution of excess revenues collected by the PMPRB from pharmaceutical patentees; and
• Under section 90 of the Act, make inquiries to the Board, which in turn is required to report to the Minister at the time and in accordance with the terms of reference established by the Minister.

Core business lines

Regulatory mandate

• The Guidelines set out the circumstances which trigger a review by PMPRB staff into the price of a patented medicine. Once an investigation is commenced, it may be:
  • closed upon further review;
  • closed as a result of the patentee volunteering to lower its price and/or refund its potential excess revenues through a Voluntary Compliance Undertaking (VCU); or
  • lead the Chairperson to refer the matter to a public hearing.
• At a hearing, a panel composed of Board members acts as a neutral arbiter between Staff and the rights holder. If a panel finds that the price of a patented medicine is excessive, it can order:
  • the price be reduced to a non-excessive level;
  • the right holder to make a monetary payment to the Government of Canada to offset the excess revenues earned. In cases where the panel determines there has been a policy of excessive pricing, it can double the amount of the monetary payment.

Reporting mandate

• As required by the Act, the PMPRB reports annually to Parliament through the Minister of Health on its price review activities, the prices of patented medicines and price trends of all prescription medicines, and on the research and development expenditures reported by pharmaceutical patentees.
• Pursuant to an agreement by the F/P/T Ministers of Health in 2001, and at the request of the Minister of Health, pursuant to section 90 of the Act, the PMPRB conducts critical analyses of price, utilization and cost trends for patented and non-patented prescription medicines under the National Prescription Drug Utilization Information System (NPDUIS). This program provides F/P/T governments and other interested stakeholders with a centralized, objective and credible source of information on pharmaceutical trends.
• Among other initiatives under its reporting mandate, the PMPRB also hosts various forums, such as webinars, research forums and information sessions, with academics and policy experts to discuss and disseminate research on emerging areas for study on pharmaceutical trends in Canada and internationally.

Key files – modernizing the regulatory framework

• On April 14, 2022, the Minister of Health issued a statement announcing Health Canada's intention to move forward with the implementation of the new basket of comparator countries and reduced reporting requirements for those medicines at lowest risk of excessive pricing. These regulations came into force on July 1, 2022.
• On August 18, 2022, the PMPRB announced Interim Guidance conducting interim price reviews while consulting stakeholders on new guidelines.
• On October 6, 2022, the PMPRB commenced a consultation on new Guidelines. Stakeholders were overwhelmingly opposed to the proposed approach. Ultimately, the 2022 draft Guidelines were not adopted, and the Interim Guidance remained in effect.
• On June 20, 2023, the PMPRB launched a 60-day Notice and Comment on changes to the Interim Guidance as the interim period has been extended beyond its anticipated length.
• The PMPRB intends to re-engage its stakeholders in the coming months and consult on a new set of guidelines, which are anticipated to be finalized in 2024.

PMPRB budget by operational priorities 2023-24

Budget 2023-24 by category (in millions)

Operational priorities budget (in millions) for each branch within PMPRB. The PMPRB has six branches: Executive Director, Board Secretariat, Corporate Services, Regulatory Affairs and Outreach, Policy and Economic Analysis, and Legal Services. The total resources are 81 Full-Time Equivalent (FTEs) and a budget of approximately $17.09 million.

The budgets for each branch are as follows:

• Executive Director has a budget of $0.95M;
• Board Secretariat has a budget of $2.05M;
• Corporate Services has a budget of $2.96M;
• Regulatory Affairs and Outreach has a budget of $3.43M;
• Policy and Economic Analysis has a budget of $3.58M; and
• Legal Services has a budget of $4.12M.

The department's Core Responsibility is to regulate patented medicine prices and the Departmental Result is affordable patented medicine prices. The Department Budget is directed towards two priorities:

• Strategic Outcomes, which accounts for $13.93 million of the budget; and
• Internal Services, which accounts for $3.16 million of the budget.

PMPRB organizational structure

• The Board consists of up to five part-time Governor in Council-appointed members, including a Chairperson and a Vice-Chairperson.
• The Chairperson is designated under the Patent Act as the Chief Executive Officer of the PMPRB, with the authority and responsibility to supervise and direct its work.
• The Executive Director is responsible for the day-to-day administration of the PMPRB and oversight of its approximately 80 public servants staff.

The organizational structure lists the senior management of PMPRB. At the top of PMPRB is the chairperson, Thomas Digby.

Under the chairperson, we find the vice-chairperson (vacant) and three members of the Council:

• Carolyn Kobernick;
• Vacant; and
• Vacant.

The three senior staff of the PMPRB act under the direction of the Board:

• Executive Director, Guillaume Couillard;
• Director of the Board Secretariat, Mélissa Lyonnais; and
• General Counsel, Isabel Jaen Raasch.

The Executive Director oversees the Directors of the PMPRB's three other directorates:

• Director of Policy and Economic Analysis, Tanya Potashnik;
• Director of Regulatory Affairs and Outreach, Theresa Morrison; and
• Director of Corporate Services and CFO, Devon Menard.

C. Legislation and decision-making in the Health Portfolio

Health Portfolio legislative mandates at a glance

Portfolios

• Health Canada;
• Public Health Agency of Canada;
• Canadian Food Inspection Agency;
• Canadian Institutes of Health Research; and
• Patented Medicine Prices Review Board.

Enabling Statutes

• Department of Health Act;
• Public Health Agency of Canada Act;
• Canadian Food Inspection Agency Act;
• Canadian Institutes of Health Research Act; and
• Patent Act.

Assigned Statutes

• Assisted Human Reproduction Act;
• Canada Health Act;
• Canada Consumer Product Safety Act;
• Canadian Environmental Protection Act, 1999 (with Minister of Environment);
• Cannabis Act;
• Comprehensive Nuclear Test-Ban Treaty Implementation Act (Section 12(1));
• Controlled Drugs and Substances Act;
• Criminal Code (section 241.31, regulations re medical assistance in dying);
• Emergency Management Act (supports Minister of Public Safety & Emergency Preparedness);
• Food and Drugs Act;
• Framework on Palliative Care in Canada Act;
• Hazardous Materials Information Review Act;
• Hazardous Products Act;
• Agriculture and Agri-Food Administrative Monetary Penalties Act (as it relates to pest control products);
• Patent Act [Patented Medicines (Notice of Compliance) Regulations];
• Pest Control Products Act;
• Pesticide Residue Compensation Act;
• Radiation Emitting Devices Act;
• Tobacco and Vaping Products Act;
• Department of Health Act;
• Emergencies Act;
• Federal Framework on Lyme Disease Act;
• Federal Framework on Post-Traumatic Stress Disorder Act;
• Federal Framework for Suicide Prevention Act;
• Health of Animals Act;
• Human Pathogens and Toxins Act;
• National Strategy for Alzheimer's Disease and Other Dementias Act;
• Quarantine Act;
• International Health Regulations;
• National Framework for Diabetes Act;
• Agriculture and Agri-Food Administrative Monetary Penalties Act;
• Feeds Act;
• Fertilizers Act;
• Food and Drugs Act (as it relates to food);
• Health of Animals Act;
• Plant Breeders' Rights Act;
• Plant Protection Act;
• Safe Food for Canadians Act;
• Seeds Act;
• Canadian Institutes of Health Research Act; and
• Patent Act (Industry Canada).

Overview of legislative and regulatory responsibilities in the Health Portfolio

Introduction

In Canada, health is an area of shared jurisdiction. Under the Constitution Act, 1867, provincial responsibilities include the establishment, maintenance and management of hospitals, local matters, and property and civil rights. Over time, courts have interpreted these constitutional provisions to mean that provinces and territories (PTs) are primarily responsible for health care delivery, the administration of provincial health insurance plans, and the regulation of health professions.

Federal authorities in health are grounded in the federal government's constitutional responsibilities for criminal law and taxation, and the federal spending power. These responsibilities provide the basis for helping to protect the health and safety of Canadians through the regulation of drugs, food, medical devices, controlled substances, cannabis, tobacco and vaping products, consumer products and cosmetics, pest control products, and medical assistance in dying.

Parliament also has the authority to spend money raised through taxation, and to attach terms and conditions to the authorized spending. Accordingly, the Canada Health Act establishes the criteria and conditions PT health insurance plans must meet to receive their full cash entitlement under the Canada Health Transfer.

Rooted in the "peace, order and good government" provisions of the Constitution, the federal government also has key functions in relation to national health emergencies, and where public health matters are issues of national concern. Since the 1970s, federal power in public health has been interpreted to also include efforts in health research and promotion, disease prevention and health information.

Several other federal responsibilities include health elements, not all of which fall within the purview of the Health Portfolio. This includes economic powers related to trade; commerce and patents, which apply to drugs; medical devices and technologies; responsibilities in foreign affairs and immigration that relate to migration health (e.g., admission of foreign nationals with international credentials, and relations with international bodies and foreign governments); and supplementary benefits and health services for certain populations (First Nations and Inuit, refugees, the military).

Health portfolio legislation and regulation

There is a range of legislative mechanisms that the government can use to meet its desired objectives. Legislative tools include Acts (statutes), Regulations, and Orders in Council, all of which are relevant in the Health Portfolio context. While Acts are laws enacted by Parliament, regulations also have legally binding effects. Normally, the power to make regulations is conferred by Parliament to the Governor in Council (Cabinet), a Minister, or, occasionally, an agency.

The Minister of Health is responsible for the administration and enforcement of aspects of approximately 40 Acts (and their associated regulations) that have a direct impact on the health and safety of Canadians.

Three of the Acts are enabling statutes, for which the Minister is responsible for; that is, they create and provide the basis of the activities of the three largest Portfolio organizations – Health Canada, the Public Health Agency of Canada, and the Canadian Food Inspection Agency.

These Acts set out specific responsibilities carried out by these organizations in relation to the Minister's statutory responsibilities. These include: the promotion of the physical, social, and mental well-being of Canadians (Department of Health Act); taking public health measures, identifying and reducing public health risk factors, and supporting national readiness for public health threats (Public Health Agency of Canada Act); and setting safety standards for food sold in Canada, as well as enforcing the food provisions of the Food and Drugs Act (Canadian Food Inspection Agency Act and the Public Service Rearrangement and Transfer of Duties Act). In addition, the Patent Act provides the legislative basis for the establishment and functioning of the Patented Medicine Prices Review Board. As well, the Canadian Institutes of Health Research Act created in 2000 the Canadian Institutes of Health Research (CIHR), an arm's-length agency that is under the management responsibility of its Governing Council and that reports to Parliament via the Minister of Health. The objective of the CIHR is to excel in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system.

The Minister also has important responsibilities in relation to the administration of the Canada Health Act (CHA), Canada's federal legislation on insured health services. The CHA defines the national principles that govern the Canadian health care system and aims to "… protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers." It establishes the criteria and conditions provincial and territorial health insurance plans must meet to receive their full cash entitlements under the Canada Health Transfer.

The Public Health Agency of Canada Act mandates the Public Health Agency of Canada and the Chief Public Health Officer to assist the Minister of Health "in exercising or performing the Minister's powers, duties and functions of public health", which includes public health emergency preparedness and response. Under the Emergency Management Act, the Minister of Health has specific responsibilities to identify risks pertinent to his or her mandate and develop plans to address these risks. The Chief Public Health Officer also has explicit responsibilities in the Emergency legislation. Emergency plans have been developed by the Health Portfolio that address a variety of public health risks (for example, pandemic influenza and foodborne illness).

To prevent the introduction and spread of communicable diseases in Canada, the Quarantine Act gives the Minister (and other designated officials) the power to take comprehensive public health measures. Since the very beginning of the COVID-19 pandemic in early 2020, those powers were relied upon to support the COVID-19 response, for instance by designating quarantine facilities. The Quarantine Act also provides the Governor in Council the authority to issue emergency orders prohibiting or imposing conditions on travelers entering Canada.

Between February 2020, and February 2023, 82 emergency orders were made under the Quarantine Act to minimize the risk of exposure to COVID-19, to reduce the risk of its importation from other countries, to repatriate Canadians, and to strengthen measures at the border. There is still one emergency order currently in effect, expiring on April 5, 2023, which imposes pre-arrival testing requirements on travelers arriving from certain countries, with limited exceptions.

Under the Food and Drugs Act and the Pest Control Products Act, the Minister also has the authority to issue Interim Orders (IO) if immediate action is required to deal with a significant risk, direct or indirect, to health, safety, or the environment. During the COVID-19 pandemic, IOs were used to expedite access to important COVID-19 drugs, vaccines, disinfectants, and medical devices.

To help respond to COVID-19 related restrictions, which impacted access to prescription medications containing controlled substances, an exemption to certain restrictions under the Controlled Drugs and Substances Act was issued (e.g. permitting pharmacists to extend, renew and transfer prescriptions and allowing practitioners to verbally prescribe such medications).

The Cannabis Regulations were also amended to extend the validity of medical documents whereby health care practitioners authorize their patients to access cannabis for medical purposes.

In addition to enabling statutes, there are several statutes that assign the Minister of Health as the Minister responsible for that statute. There are assigned statutes that establish federal frameworks (e.g., palliative care, Lyme disease, post-traumatic stress disorder) or national strategies (e.g., dementia), which confer specific responsibilities on the Minister of Health.

The balance of the assigned statutes relevant to the Health Portfolio set out responsibilities to be carried out by the Minister of Health in the context of regulating food, pharmaceutical drugs, controlled substances, tobacco and vaping products, pest control products, medical devices, biologics, human toxins and pathogens, radiation-emitting devices, and consumer products and cosmetics.

There are significant differences in the nature of these various regulatory regimes. However, some principles of decision-making are common to many of the Acts for which the Minister of Health is identified as exercising a role. The following section sets out some key principles.

"Powers, duties and functions" in legislation

Most Acts of Parliament and associated regulations are administered by individual Ministers, and this responsibility can include a variety of powers, duties, and functions. Depending on the legislation (or regulations), the responsible Minister can be named in the Act itself or designated by the Governor in Council (i.e., Cabinet).

Typically, the various powers, duties and functions set out in an Act or regulations are assigned to the responsible Minister. However, in some circumstances, specific authorities are assigned to other identified individuals or groups of individuals. For example, powers to make regulations and amend Schedules to an Act are often assigned to the Governor in Council. In all cases, the Minister of Health would still be involved in setting overall policy direction for regulatory programs, developing regulations, and approving regulations recommended to the Governor in Council.

Who makes regulatory decisions?

Depending on the legislation, the authority to make decisions may be specifically assigned to the Minister, to other individuals (such as designated inspectors), or, occasionally, to the Governor in Council. The following section explains how these different types of decision-making authorities work.

A. The Minister of Health

1. Decisions made by the Minister or on the Minister's Behalf

Decision-making authority in legislation often resides with the Minister. In the Health Portfolio context, this authority encompasses many possible kinds of regulatory decisions, and on any given day, many of these decisions are made. Accordingly, the majority of decisions are made by governmental officials. This has four important advantages:

• Given the volume of regulatory decisions required, it is not practical for a Minister to personally exercise all of his or her authorities;
• The risk of perceived political interference in evidence-based decision-making is minimized;
• Many regulatory decisions are highly technical in nature and require a specialized (often scientific) expertise; and
• In the event a decision is challenged in a court of law (subject to judicial review), the person who makes the decision may need to give evidence.

At all times, where the decision-making authority in legislation resides with the Minister, the responsible Minister retains the authority to personally make those decisions. However, the practice of allowing officials to exercise regulatory decision-making powers that are appropriate to their functions is common to all regulatory departments and agencies.

Regulatory decisions can be scrutinized by industry, the media, the public, and the judiciary. Therefore, it is essential that the Minister – or appropriately-placed officials in the Health Portfolio who make those decisions on behalf of the Minister – are able to demonstrate integrity in their decision-making processes. It is important to demonstrate that each decision is the result of an objective – and, as applicable, science-based – assessment of all the information available to the regulator.

While routine and uncontroversial regulatory decisions are made every day by officials, if a decision is particularly sensitive in nature, additional background information may be provided so that the Minister is aware of the context and basis for a decision.

2. Ministerial Decision-Making Authority where a Delegation Order is Required

In some specific instances, legislation may include specific provisions that allow the Minister, as head of the institution, to make an order delegating particular powers, duties and functions to officers or employees of the institution (or to another institution within the Portfolio). Relevant examples in the context of the Health Portfolio include the Access to Information Act and the Privacy Act.

Some examples of the decision-making authorities assigned to the Minister of Health include the power to:

• issue a "Notice of Compliance" permitting the sale of a new drug in Canada (Food and Drug Regulations);
• order the recall of a drug or medical device if the Minister believes it presents a serious or imminent risk of injury to health (Food and Drugs Act);
• issue a registration permitting the sale and use of a pest control product in Canada (Pest Control Products Act);
• issue authorizations for access to controlled substances (Controlled Drugs and Substances Act);
• order a stop sale or stop the import of a non-compliant hazardous product (Hazardous Products Act);
• order a recall of a consumer product that is a danger to human health or safety (Canada Consumer Product Safety Act);
• order the recall of a food, animal or plant product that poses a health risk (Canadian Food Inspection Agency Act);
• establish a quarantine station and designate a quarantine facility at any place in Canada (Quarantine Act); and
• issue an Interim Order Under the Food and Drugs Act or the Pest Control Products Act if it is believed that immediate action is required to deal with a significant risk, direct or indirect, to health, safety, or the environment.

B. Other officials

Many Acts confer decision-making powers explicitly on individuals other than the Minister. For example, inspection powers (such as entry, examination of records, detention of substances, etc.) can only be exercised by a designated "inspector" in the Food and Drugs Act, the Controlled Drugs and Substances Act, and the Human Pathogens and Toxins Act, to name but a few. Under the Quarantine Act, a "quarantine officer" decides whether to require health assessments of individuals suspected of carrying a communicable disease. The Chief Public Health Officer is responsible for making certain decisions under the Emergency Orders issued under the Quarantine Act, including granting exemptions for essential workers and taking immediate public health measures to minimize the risk of introduction or spread of COVID-19 by imposing conditions on exempt persons.

In these instances, the Minister may request a briefing in relation to the decision-making process and discuss the decision with officials, but may not make, nor is directly involved in, the decision itself.

C. Independent tribunals

Some statutes create tribunals that operate independently of a minister. One such example in the Health Portfolio is the Patented Medicine Prices Review Board (PMPRB). The PMPRB is an independent, quasi-judicial body established under the Patent Act. The Board determines whether the patented drug price set by the manufacturer is excessive and, if so, the Board can order price reductions and/or the offset of excess revenues. Further, the Board has the authority to issue non-binding guidelines regarding the administration of the Board. However, before issuing any such Guidelines, the Board is required to consult with the Minister of Health, as well as other stakeholders.

Although the PMPRB carries out its mandate at arms-length from the Minister of Health and is independent of Health Canada, the Patent Act sets out several roles for the Minister of Health in relation to the PMPRB. This includes recommending new/amending regulations to the Governor in Council in relation to the PMPRB regime, and entering into agreements with any province to disburse funds collected by the PMPRB.

D. Governor in council (Cabinet)

Legislation can expressly provide that the Governor in Council will exercise the decision-making power. An example of this is in the Health Portfolio is the emergency orders that can be made by the Governor in Council under the Quarantine Act, which prohibit or impose conditions on persons entering Canada. This can be done, for example, if they are coming from a country that has an outbreak of a communicable disease that could pose a threat to Canadians and no reasonable alternatives to prevent the introduction or spread of the disease are available. Since February 2020, the Governor in Council has exercised this authority to create prohibitions on entry into Canada and to impose mandatory isolation and quarantine on travelers to prevent the introduction and spread of COVID-19.

Another example is under the Pest Control Products Act, where the Governor in Council may make an order cancelling or amending the registration of a pest control product if considered necessary to implement an international agreement. Neither the Minister nor departmental officials may make these types of decisions on Cabinet's behalf.

Regulatory Oversight of Products

Hundreds of new products are introduced by industry every year in Canada. Any health or consumer product, chemical, radiation emitting device, pesticide or food sold on the Canadian market must meet strict regulatory standards set by Health Canada. The Health Portfolio works to help Canadians lead healthier lives by providing access to products such as pharmaceuticals to improve their health, and by helping to protect them from products that are unsafe or high risk to their health (e.g. illegal opioids, tobacco). The Portfolio regulates tens of thousands of products and monitors them through the administration and enforcement of over 160 regulations in more than 40 Acts.

A number of regulatory tools are used to review, assess and monitor products (see table below). The extent of the review of a given product generally depends on its risk level. For example, while health products and pesticides are subject to pre-market oversight (e.g., clinical trials for drugs, exposure modelling for pesticides) as well as post-market measures (e.g. safety monitoring, recalls), consumer products (such as toys and appliances) are managed through a robust post-market regime that includes the development of guidelines and outreach activities for industry, the development of national and international voluntary safety standards, and proactive testing and inspections to support regulatory compliance.

The Health Portfolio also regulates to protect Canadians from threats posed by infectious diseases. Risks posed by human pathogens and toxins to human health and safety are also mitigated through the regulation and licensing of facilities working with human pathogens and toxins.

Products	"Pre-market": before a product is on the market	"Post-market": once a product is already on the market
Prescription drugs (human and veterinary use)	Health Canada conducts scientific reviews of drugs for: Safety; Quality; and Efficacy.	Health Canada: Monitors adverse events; Inspects facilities where the drug is produced; Investigates complaints; Conducts enforcement activities; Does surveillance; and Orders a recall when necessary.
Non-prescription drugs (human and veterinary use)	Health Canada conducts scientific reviews of drugs for: Safety; Quality; and Efficacy.	Health Canada: Monitors adverse events; Inspects facilities where the drug is produced; Investigates complaints; Conducts enforcement activities; and Orders a recall when necessary.
Natural health products	Health Canada reviews products on a risk basis for: Safety; Quality; and Efficacy.	Health Canada: Monitors adverse events; Investigates complaints; Conducts enforcement activities; and Orders a recall when necessary.
Medical devices	Health Canada reviews devices on a risk basis for: Safety; Quality; and Effectiveness.	Health Canada: Monitors the safety of devices; Inspects facilities where devices are produced; Orders a recall when necessary; and Conducts enforcement activities.
Biologics and radiopharmaceuticals	Health Canada reviews biologics and radiopharmaceuticals for: Safety; Quality; and Effectiveness.	Health Canada: Monitors ongoing drug safety and effectiveness; Monitors adverse events; Inspects manufacturing plants where the drug is produced; Investigates complaints; Does surveillance; Conducts enforcement activities; and Orders a recall when necessary. PHAC: Does surveillance (e.g. vaccine-related adverse event surveillance).
Food	Health Canada: Conducts pre-market assessments of food additives, novel foods, infant formulas, certain types of health claims and nutrient content claims; and Provides opinions, upon request by manufactures, on the chemical safety of food packaging materials, food processing aids and incidental additives. PHAC: Monitors trends in antimicrobial use and antimicrobial resistance in selected bacterial organisms from healthy animals on farm and at slaughter through the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). Links antimicrobials used in food-animals with the associated health impact.	CFIA: Enforces legislation for food safety and consumer protection; Inspects regulated parties that trade inter-provincially and internationally; Inspects foods and their labels to ensure compliance with Canadian food regulations; Investigates complaints; Manages food recalls; Tests food products for safety, including contaminants and pathogen testing; and Conducts research to develop and enhance methods used for testing of food. Health Canada: Provides regulatory oversight post-market through establishment of food standards, policies and guidelines; Conducts health risk assessments and provides the results to the CFIA for appropriate follow-up/risk management action; Undertakes studies/research to identify and assess risks from chemical and microbial hazards as well as nutrition adequacy; Provides national reference services for foodborne pathogens; Collects food and human biomonitoring contaminant data and food consumption information, in order to assess; and Canadians' exposure to contaminants (e.g., Canadian Community Health Survey, Canadian Health Measures Survey, Total Diet Study). PHAC: Monitors and enforces food safety and the potability of water on passenger conveyances (e.g., airplanes, cruise ships, passenger trains); Conducts surveillance of enteric diseases through the National Enteric Surveillance Program and PulseNet (detection and investigation of foodborne illnesses), and through FoodNet Canada to identify risks in the food chain; Supports provinces in transitioning to Whole Genome Sequencing to improve detection of outbreaks and characterization of pathogens; and Monitors trends in antimicrobial use and antimicrobial resistance in selected bacterial organisms from human, animal and food sources across Canada through CIPARS.
Consumer products and cosmetics	Health Canada: No pre-market regulatory oversight.	Health Canada: Reviews cosmetic notifications to verify whether prohibited or restricted ingredients are being used in cosmetics; Monitors and tests products on the market for safety and compliance with regulations; Oversees recalls on products deemed unsafe; and Monitors and assesses safety incidents associated with consumer products and cosmetics.
Chemical substances	Health Canada and Environment and Climate Change Canada: Assess the potential human health and environmental impacts of new chemical substances; Introduce control measures as appropriate.	Health Canada and Environment and Climate Change Canada: Assess the risks of existing chemical substances; and Take appropriate risk management action when warranted.
Pesticides	Health Canada: Evaluates whether a pesticide can be used safely and effectively for its intended use without harming human health or the environment; Pre-market Product Reviews: Scientific assessments are conducted to help ensure risks to the health of Canadians and the environment are acceptable and that the product has value (e.g., will meet a need to control a pest problem); and Pesticides must be registered or otherwise authorized before they can be sold or used in Canada.	Health Canada: Re-evaluation: To ensure that pesticides meet modern standards for protection of health and the environment, all pesticides must have re-evaluations initiated on a 15-year cycle; Special reviews: Special reviews must be initiated if there are reasonable grounds to believe that the health and environmental risks posed by the product may no longer be acceptable; Conducts compliance and enforcement activities; and Incident Reporting and Sales Data Reporting: Pesticide manufacturers are required to report an incident involving the possible use of their products, new scientific studies identifying new risks, and volumes of products sold in Canada.
Controlled substances	Health Canada: Inspects licensed dealers of controlled substances and precursor chemicals to ensure they meet security and other requirements prior to receiving a licence.	Health Canada: Monitors adverse events; Inspects licensed dealers and pharmacies; Monitors reported loss and theft; Monitors reported suspicious transactions; Compliance promotion of regulations; Investigates complaints; Issues warning letters; and Manages recalls; and Conducts enforcement activities including suspending or revoking licenses, permits or exemptions.
Tobacco and vaping products	Health Canada: No pre-market regulatory oversight	Health Canada: Monitors and assesses safety incidents associated with vaping products; and Conducts compliance and enforcement activities, which includes inspections to verify compliance with the TVPA-including labelling and packaging requirements, restrictions on access, promotion, the ban on selected additives, the presence of child-resistance closures & limits on the concentration of nicotine, the ignition propensity standard (cigarettes only), reporting requirements, and nicotine concentration limits (vaping products only).
Cannabis	Health Canada: Requires cannabis licence applicants to meet good production practices, physical security and personnel security requirements prior to operating; and Requires cannabis licence holders to meet good production practices prior to cannabis edible/extract/topical product sales.	Health Canada: Safeguards the integrity of the supply chain (e.g., Cannabis Tracking and Licensing System, inventory controls); Inspects cannabis licence holders; Monitors serious adverse events; Conducts complaint reviews and follow ups; and Conducts compliance and enforcement activities.
Workplace hazardous products	Health Canada: Receives applications, which include Safety and Data Sheets for all workplace hazardous products for which Confidential Business Information protection is requested; and Determines the validity of Confidential Business Information claims.	Health Canada: Works with federal and provincial/territorial regulatory partners to monitor health and safety concerns, as well as compliance with labelling and Safety Data Sheet requirements; and Determines the compliance of Safety Data Sheets, selected by risk-based triage, that accompany applications for the protection of Confidential Business Information.
Radiation emitting devices	Health Canada: No pre-market regulatory oversight.	Health Canada: Regulates the importation, lease and sale of radiation emitting devices, including labelling, packaging, advertising, construction and performance; Monitors and tests products on the market for safety and compliance with regulations; and Monitors incident reports from manufacturers.

D. Federal/provincial/territorial relations

Overview of federal, provincial, territorial roles and relations in health

Roles and responsibilities

Health is an area of shared responsibility among the federal, provincial, and territorial (FPT) governments. The delivery of health services, administration of provincial and territorial (PT) health care insurance plans, and the regulation of health professions fall within PT jurisdiction.

The federal government supports universally accessible, publicly funded health care for Canadians through transfer payments to PTs via the Canada Health Transfer (CHT) and the administration of the Canada Health Act (CHA). The CHA establishes the requirements that PT health care insurance plans must meet to receive their full cash contributions under the CHT. As the largest major transfer to PTs, the CHT is intended to provide long-term, predictable funding.

Federal responsibilities include protecting health and safety through regulation, health security and emergency preparedness and response, health promotion and chronic disease prevention, infectious disease prevention and control, as well as support for health research and innovation.

While PTs must provide all residents with universally insured health services, the federal government is also responsible for the financing and administration of a range of health benefits and services for federal populations (i.e., primary health care services for members of the Canadian Armed Forces, inmates in federal penitentiaries, and refugee claimants; and supplementary benefits for registered/Status First Nations and recognized Inuit, the Royal Canadian Mounted Police, and veterans).

Additional areas of responsibility where both federal and PT levers can support common objectives include, amongst others, all aspects of public health such as surveillance, infectious disease prevention and control, health promotion and chronic disease prevention, as well as health security and emergency preparedness (including coordinating pandemic response efforts). Federal environmental health guidelines and regulations also provide guidance for provincial/territorial implementation and stewardship efforts. Both orders of government and their respective health organizations share responsibility for the collection and analysis of health information, and for funding research and innovation initiatives.

The diagram below summarizes the roles and responsibilities of FPT governments, including areas of overlap:

Federal government

• Stewardship of Canadian Medicare;
• Administration of the Canada Health Act (CHA);
• Uses "spending power" to provide financial support to PTs tied to CHA principles;
• Supports health care improvement and innovation;
• Regulates market access for health products including drugs, medical devices, controlled substances, consumer and pest control products;
• Regulates patented drug prices.;
• Provides funding and/or delivers some health care programs/services to federal populations such as First Nations and Inuit, federal inmates, military, and refugee claimants;
• Coordinates national responses to public health emergencies and national public health surveillance; and
• Administers Canada Dental Benefit and upcoming Canadian Dental Care Plan.

Provinces / territories (PTs)

• Administer PT health insurance plans and other health care programs (e.g., drugs);
• Deliver health services;
• Determine organization and governance of the system;
• Regulate health care facilities and professionals (e.g., physicians, nurses);
• Regulate private health insurance;
• Manage capital investments; and
• Negotiate drug purchasing and pricing for their drug plans.

Federal / provincial / territorial

• Fund health care and public health;
• Support health research and innovation;
• Prevent, control and reduce infectious and chronic diseases;
• Promote the health and well-being of Canadians;
• Prepare for and respond to public health events and emergencies;
• Collect and analyze health data and information;
• Develop science-based public health advice;
• Communicate risk and public health advice; and
• Fund health care for eligible First Nations and Inuit.

FPT collaboration

Canada's health system has been shaped by key FPT legislative activities and policies spanning decades, and it has evolved to respond to changing population needs and fiscal capacity. Ongoing FPT collaboration is crucial, as both orders of government must work together to address a whole range of health priorities. This is especially true in areas where responsibilities intersect, such as funding healthcare services, responding to public health emergencies, preventing chronic disease and the spread of infectious and communicable diseases, and health promotion, amongst others.

FPT governments continue to collaborate on a number of high-profile priorities, including concluding new bilateral healthcare funding agreements, expanding access to family health services, reducing backlogs and supporting health care workers, improving access to quality mental health and substance use services, modernizing health systems with health data and digital tools, medical assistance in dying, drug supply disruptions and shortages, the affordability and accessibility of prescription drugs, and antimicrobial resistance, to name a few. Many of these areas require ongoing and robust FPT engagement with other sectors (e.g., ESDC, agriculture, justice, and public safety). The Health Portfolio also frequently acts as a focal point for other sectors' engagement with PTs on health-related issues (e.g., Indigenous Services Canada, Immigration, Refugees and Citizenship Canada)

The level of FPT collaboration during the COVID-19 pandemic was unprecedented and helped ensure a pan-Canadian response to the pandemic. Areas of collaboration focused on procurement and distribution of personal protective equipment; vaccines; public health and clinical guidance; communications and education; testing and screening, surveillance and national reporting; border measures; and health system capacity. Considerable federal funding, programs and procurement backed these efforts, including health-related investments through the Safe Restart Agreement, and federal surge support made available through PHAC's single-window to assist jurisdictions with health workforce, physical assets and supplies, and vaccination and epidemiological support, among others.

[REDACTED] The February 7, 2023 working meeting between the Prime Minister and PT Premiers marked a significant shift as the federal government announced its plan on Working Together on Shared Health Priorities, providing almost $200 billion over 10 years, including an increase to the CHT and $25B over 10 years in bilateral funding to support the priorities of:

• expanding access to family health services;
• reducing backlogs and supporting health care workers;
• improving access to mental health and substance use services; and,
• modernizing health systems with health data and digital tools.

These investments are available to PTs through two bilateral agreements:

• The first agreement will centre on the four new shared health priorities, as well as the final four years of funding for mental health and addictions services from the 2017 commitments made under the Common Statement of Principles on Shared Health Priorities. It will begin with a three-year agreement, supported by action plans for the same length of time;
• The second agreement will focus on Aging with Dignity and includes the remaining four years of funding for home and community care from the 2017 commitment made under the Common Statement of Principles on Shared Health Priorities and the remaining funding for long-term care from Budget 2021.

In addition, the federal government will also provide $1.7B over five fiscal years (2023-23 to 2027-28) to improve wages and the support conditions of personal support workers and related new professions.

The CoF publicly announced their acceptance of the federal funding on February 13, 2023 including a formal letter on February 16^th. Following bilateral engagement at the Ministerial level, all PTs except QC have provided their agreement in principle with the federal funding offer. Bilateral engagement with all jurisdictions, including QC, continues to take place at the ministerial and officials' level to develop bilateral agreements and action plans to flow funding, as well as to establish common indicators through a process led by the Canadian Institute of Health Information (CIHI).

This federal funding plan builds on past joint FPT work, including collaboration that resulted in the Common Statement of Principles (CSOP) on Shared Health Priorities, signed in August 2018. The CSOP was supported by federal targeted investments ($11B over 10 years) in home and community care, and, mental health and addictions services. Following adoption of the CSOP, the federal government negotiated and signed bilateral agreements with each PT that set out details on how each jurisdiction will use federal funding to improve access to home and community care, and, mental health and addiction services.

Additional bilateral health agreements have been used to advance other common health objectives including:

• $150M Emergency Treatment Fund (2018) to support PTs in responding to the opioid crisis;
• $150M Virtual Care Bilateral Agreements to support PTs acceleration of virtual care during the pandemic (2021); and
• $1B for the Safe Long-term care Fund (2021) (via amendments to the home care/mental health bilateral agreements).

Health Canada is also engaging in other key areas, including bilaterally at the ADM-level on federal commitments on dental care, particularly the Canadian Dental Care Program (CDCP), with a focus on validating information about existing PT programming, developing a Terms of Reference for a new FPT ADM Committee on Dental Care, and confirming intent of PTs to opt out of federal delivery for the CDCP (only QC has consistently expressed a desire to opt out).

The department is also engaging with PTs at the ADM-level on implementation of the National Strategy on Drugs for Rare Diseases, including the allocation of $1.4B over three years through bilateral agreements. On March 30, 2023, CDM tasked the FPT Pharmaceutical Executive Group to advance work on developing the bilateral agreements, as well as a list of new and emerging drugs for rare diseases to be cost-shared and covered consistently across the country. Separate discussions are underway with QC, as they indicated their desire not to participate in this work.

FPT machinery

Core FPT Health Machinery

Ongoing collaboration is maintained through well-developed formal structures including: FPT Health Ministers' Meetings (HMM), meetings of Deputy Ministers (known as the Conference of FPT Deputy Ministers of Health, or CDM), and the Pan-Canadian Public Health Network (PHN).

The HMM forum is the key intergovernmental table through which FPT Ministers of Health discuss and provide collective direction on priority health issues and advance collaborative FPT work. The federal Health Minister is the co-chair of the HMM, and the Deputy Minister of Health Canada acts as co-chair of the CDM. Provincial/territorial co-chairs are nominated at the provincial/territorial level, and usually rotate annually following the annual in-person HMM. A network of committees (standing and ad hoc) supports the CDM and HMM on various files. In 2023, PEI formally assumed the co-chair role from BC. During their co-chair tenure, BC hosted the first in-person HMM since the onset of the pandemic, November 7-8, 2022 in Vancouver. The next face-to-face HMM is anticipated to be held in Charlottetown, PEI on October 11-12.

FPT Ministers responsible for Mental Health and Substance Use have also been collaborating through dedicated meetings (MHSU HMM), supported by Deputies and a newly established FPT ADM Committee on Mental Health and Substance Use. Along with the federal Minister of Mental Health and Addictions, 7 PTs have separate, dedicated Ministers in this space.

Throughout the pandemic, engagement at the CDM and HMM level was at an all-time high with weekly HMM teleconferences, and daily CDM calls during 2020, to ensure coordination and sharing of information at the most senior levels. Engagement at these tables remains frequent, though is beginning to normalize to a more regular pace (e.g., monthly CDM calls).

Regular collaboration on public health occurs through the PHN structure and its network of supporting committees. Through the PHN, jurisdictions work collaboratively on a broad range of issues to strengthen public health in Canada, including health promotion, chronic disease prevention, public health infrastructure, emergency preparedness and response, and infectious diseases. PHN is currently focused on renewal of its governance structure and priorities. It has confirmed priorities in building public health workforce capacity,, preventing infectious and vaccine-preventable diseases, advancing digital and data systems; strengthening pandemic preparedness by examining lessons learned, and Indigenous rights and reconciliation. The PHN renewal work will confirm priorities (including those in chronic disease prevention) and governance changes by January 2024.

The 17-member PHN Council (comprised of ADM-level FPT government officials responsible for public health) is accountable to the CDM, which provides direction and approves public health policy priorities for Canada. The Council of Chief Medical Officers of Health (CCMOH), which includes Chief Medical Officers of Health from all jurisdictions, is also responsible for technical collaboration and public health expert and scientific advice on technical issues and falls under the PHN. Health Canada's representative on the PHN Council and CCMOH is Dr. Supriya Sharma, Chief Medical Advisor.

In January 2020, as a time-limited emergency mechanism under the PHN, the FPT Special Advisory Committee (SAC) was activated to advise the CDM and provide public health leadership to support a pan-Canadian, coordinated public health approach to the COVID-19 response. SAC on COVID-19 members comprised the Chief Medical Officers of Health from all PTs, the Chief Public Health Officer of Canada, and Chief Medical Officers from key federal departments, along with ADMs of public health from jurisdictions. The Committee is chaired by the Co-Chairs of the PHN Council, Dr. Theresa Tam, Canada's Chief Public Health Officer, and the current PT co-chair, New Brunswick's Chief Medical Health Officer, Dr. Jennifer Russell. The SAC on COVID-19 was deactivated on July 6, 2023, following the re-establishment of the Communicable and Infectious Disease Steering Committee (CIDSC) as part of efforts to integrate COVID-19 into respiratory disease planning and return to normal operations. A separate SAC on Opioids continues to address the epidemic of the opioid crisis. A SAC on Monkeypox was de-activated in December 2022.

Additional FPT machinery

The federal Minister of Health, supported by the Public Health Agency of Canada (PHAC), also co-chairs the FPT Ministers of Sport, Physical Activity and Recreation (SPAR) table, alongside the Minister of Heritage and a PT co-chair (currently PEI). The SPAR table is comprised of three distinct, but interrelated sectors: sport, physical activity and recreation. PHAC's President is one of three co-chairs of the FPT Conference of Deputy Ministers of SPAR, with responsibility for physical activity items.

The President of the Canadian Food Inspection Agency (CFIA) participates at the FPT Ministers and Deputy Ministers of Agriculture meetings on matters pertaining to food safety, plant and animal health as well as trade and market access for the agriculture sector.

The FPT Food Safety Committee, on which Health Canada and CFIA participate, provides federal and provincial/territorial government leadership and partnership in food safety.

Additional FPT Committees have been established to address the overdose crisis, cannabis legalization and regulation, problematic substance use and harms, antimicrobial resistance, health data, dementia, health workforce issues, medical assistance in dying, drug shortages, and interprovincial health insurance agreements, among others.

Indigenous Health

The provision of health services to Indigenous Peoples is an area of shared responsibility between FPT governments and Indigenous partners. Provincial/territorial governments provide universally accessible and publicly insured health services to all residents, including Indigenous Peoples.

Indigenous Services Canada (ISC) funds or directly provides supplemental health programs and services for registered/Status First Nations (primarily on-reserve) and recognized Inuit in addition to what is provided by PTs. Indigenous Services Canada administers the Non-Insured Health Benefits program, which provides eligible First Nations and Inuit clients, regardless of where they reside with a range of health benefits such as prescription drugs, vision and dental care and medical supplies and equipment and medical transportation to access health services. (In BC, the First Nations Health Authority delivers these supplemental health programs and services to Indigenous people living in the province.) PHAC delivers off-reserve programs, such as early learning priorities including the Aboriginal Head Start in Urban and Northern Communities Program and works with Indigenous organizations on key priorities including suicide prevention and mental health promotion, sexually transmitted and blood borne infections, and tuberculosis.

Further, Indigenous governments and communities may be involved in directing, managing and delivering a range of health programs and services, which vary by PT.

The Health Portfolio is also involved in a range of activities, in collaboration with Indigenous, federal and provincial/territorial partners, to improve Indigenous health outcomes. For example, Health Canada is working closely with Indigenous Services Canada on advancing the $2 billion over ten years Indigenous Health Equity Fund that was part of the February 7^th health funding announcement by the Prime Minister. The Fund would support First Nation, Inuit, and Metis partners in helping to address health care gaps faced by Indigenous Peoples. Health Canada is also working closely with ISC to help ensure that PTs are working closely with regional Indigenous partners to advance their action plans to support new healthcare funding. The CSOP on Shared Health Priorities also committed FPT governments (except QC) to work together to ensure that health care systems continue to respond to the needs of Indigenous Peoples living in Canada, and these same principles will be applied in the new health care bilateral agreements. Other priority files that Health Canada is supporting ISC on includes the co-development of Indigenous health legislation and addressing anti-Indigenous racism in Canada's health systems.

In addition, the Canadian Institutes of Health Research (CIHR) works to accelerate the self-determination of Indigenous Peoples in health research by supporting research that is driven by, and grounded in, Indigenous communities and that addresses the health challenges and inequities experienced by Indigenous Peoples, including racism within Canada's health care systems.

Recognizing the significant disparities in Indigenous health outcomes compared to the non-Indigenous population, federal departments are committed to working with PTs to ensure First Nations, Inuit and Métis partners are included in discussions to improve access to health services and health outcomes of Indigenous Peoples and discuss progress in these areas.

FPTI engagement on federal funding plan

The February 7, 2023 plan for Working Together on Shared Health Priorities set out that PTs would "agree to continue engaging with Indigenous peoples, organizations, and governments to ensure their right to fair and equitable access to quality and culturally safe health services free from racism and discrimination anywhere in Canada."

The letter from Ministers Duclos and Bennett to PTs on February 15, 2023 also stated that "PT governments will also be encouraged to work in partnership with Indigenous organizations within their jurisdiction to support culturally-safe and appropriate care for Indigenous peoples and leverage opportunities to align projects with the $2 billion Indigenous Health Equity Fund."

To support these efforts, Minister Duclos and Minister Hajdu (ISC) sent a joint letter to all jurisdictions (except QC) inviting them to participate in trilateral discussions with Indigenous leaders to help facilitate discussion on ways the funding can improve Indigenous access to quality and culturally safe health services. As of July 24^th, trilateral meetings have taken place with BC, ON, NL, and PEI.

Health research and innovation

The Canadian Institutes of Health Research (CIHR) works closely with members of the National Alliance of Provincial Health Research Organizations as key partners in the Canadian health research ecosystem.

Canada's Strategy for Patient-Oriented Research (SPOR) is a national coalition of stakeholders, dedicated to the integration of research into patient care, led by CIHR at the federal level, in close collaboration with PT partners. SPOR-funded health research and platforms provide a collaborative, co-led and co-funded FPT mechanism to address jurisdictional and national priorities, improving the health of Canadians and the FPT health care systems, including their cost-effectiveness. For example, CIHR has established partnerships with every province, the Yukon, and the Northwest Territories for the creation of SPOR SUPPORT Units — provincial and territorial-based centres that provide access to health data, apply knowledge generated through research to improve health care practices, provide training on conducting and using patient-oriented research, and engage patients as active partners throughout the research process. CIHR continues to work with its partners in Nunavut on the launch of a SUPPORT Unit in that territory. CIHR is currently looking to deepen its relationship with partners on this joint venture and is in the process of forming a short-term Steering Committee to guide a Pan-Canadian engagement process to gather widespread input on SPOR needs for the future.

Lastly, as outlined in the Working Together on Shared Health Priorities, CIHR is committed to working with Health Canada and PTs to improve access to mental health and substance use (MHSU) services. With strong support from all 13 PTs, there is both a grass roots and top-down momentum in developing Integrated Youth Services (IYS) for MHSU or expanding existing services across the country. IYS is an approach that provides a one-stop-shop for youth ages 12-25, that brings together service providers, youth and their families, and communities to address and deliver local and culturally relevant services. In several provinces IYS networks have been developing that enable research to understand and evaluate best practices in IYS in real time. CIHR has committed $15.15M over 5 years to all 13 PT and Indigenous IYS networks to further expand existing IYS networks (BC, AB, SK, MB, ON, QC, NB, NS, NL, Indigenous), or to explore and potentially develop IYS services/networks (YT, NT, NU, PE). Additionally, ongoing CIHR research investments ($1M over 1 year, started October 2022) are supporting work focused on the development of national mental health and substance use service standards for youth. These investments have been directed to three of the most established IYS networks in the country – Foundry (BC), Youth Wellness Hubs Ontario (ON), and Aire Ouverte (QC)– as well as to an Indigenous IYS network.

List of provincial / territorial Ministers responsible for health

British Columbia
Adrian Dix
Minister of Health / Minister Responsible for Francophone Affairs
(appointed July 18, 2017)

Alberta
Adriana LaGrange
Minister of Health
(appointed June 9, 2023)

Saskatchewan
Paul Merriman
Minister of Health
(appointed November 9, 2020)

Manitoba
Audrey Gordon
Minister of Health and Seniors Care / Minister of Mental Health, Wellness, and Recovery
(appointed January 5, 2021)

Ontario
Sylvia Jones
Minister of Health / Deputy Premier
(appointed June 24, 2022)

Québec
Christian Dubé
Minister of Health and Social Services
(appointed October 20, 2022)

New Brunswick
Bruce Fitch
Minister of Health
(appointed July 15, 2022)

Nova Scotia
Michelle Thompson
Minister of Health and Wellness / Minister Responsible for the Office of Healthcare Professionals Recruitment
(appointed August 31, 2021)

Prince Edward Island
Mark McLane
Minister of Health and Wellness
(appointed April 14, 2023)

Newfoundland and Labrador
Tom Osborne
Minister of Health and Community Services
(appointed July 6, 2022)

Yukon
Tracy-Anne McPhee
Minister of Health and Social Services
(appointed May 3, 2021)

Northwest Territories
Julie Green
Minister of Health and Social Services / Minister Responsible for Persons with Disabilities / Minister Responsible for Seniors
(appointed September 9, 2020)

Nunavut
John Main
Minister of Health / Minister Responsible for Suicide Prevention / Minster Responsible for Seniors
(appointed November 19, 2021)

List of provincial / territorial Ministers responsible for mental health and addictions

British Columbia
Jennifer Whiteside
Minister of Mental Health and Addictions
(appointed December 7, 2022)

Alberta
Dan Williams
Minister of Mental Health and Addictions
(appointed June 9, 2023)

Saskatchewan
Everett Hindley
Minister of Mental Health and Addictions / Minister for Rural and Remote Health / Minister Responsible for Seniors
(appointed November 9, 2020)

Manitoba
Janice Morley-Lecomte
Minister of Mental Health and Community Wellness
(appointed January 30, 2023)

Ontario
Michael Tibollo
Associate Minister of Mental Health and Addictions
(appointed June 20, 2019)

Québec
Lionel Carmant
Ministre responsible for Social Services
(appointed October 18, 2018)

New Brunswick
No separate Minister for Mental Health and Addictions

Nova Scotia
Brian Comer
Minister responsible for the Office of Mental Health, Youth and Communications
(appointed August 31, 2021)

Prince Edward Island
No separate Minister for Mental Health and Addictions

Newfoundland and Labrador
No separate Minister for Mental Health and Addictions

Yukon
No separate Minister for Mental Health and Addictions

Northwest Territories
No separate Minister for Mental Health and Addictions

Nunavut
No separate Minister for Mental Health and Addictions

Supplementary contacts

Jurisdictions with Ministers responsible for issue-specific Portfolios

British Columbia
Sheila Malcolmson
Minister of Social Development and Poverty Reduction
(appointed December 7, 2022)

Alberta
Jeremy Nixon
Minister of Senior, Community and Social Services
(appointed June 9, 2023)

Manitoba
Scott Johnston
Minister of Seniors and Long-Term Care
(appointed January 18, 2022)

Ontario
Raymond Cho
Minister for Seniors and Accessibility
(appointed June 29, 2018)

Ontario
Paul Calandra
Minister of Long-Term Care
(appointed January 14, 2022)

Québec
Sonia Bélanger
Ministre déléguée à la Santé et aux Aînés / Ministère de la Santé et des Services sociaux
(appointed October 20, 2022)

New Brunswick
Dorothy Shephard
Minister of Social Development / Minister Responsible for the Economic and Social Inclusion Corporation
(appointed August 23, 2022)

Prince Edward Island
Matthew MacKay
Minister of Social Development and Housing
(appointed: August 16, 2022)

Nova Scotia
Barbara Adams
Minister of Seniors and Long-Term Care
(appointed August 31, 2021)

Newfoundland and Labrador
John G. Abbott
Minister of Children, Seniors and Social Development / Minister Responsible for the Status of Persons with Disabilities / Minister Responsible for the Community Sector
(appointed April 8, 2021)

Nunavut
Joanna Quassa
Minister of Culture and Heritage / Minister Responsible for Qulliq Energy Corporation / Minister Responsible for Languages / Minister Responsible for Seniors
(appointed October 25, 2021)

E. Relationships with health system players

An overview of pan-canadian health organizations

At different points over more than thirty years, the Government of Canada created pan-Canadian health organizations (PCHOs) to address specific health care system needs and issues. There are now seven such organizations.

PCHOs were created to address priorities in the Canadian health care system, recognizing their potential to tackle issues in a more targeted, pan-Canadian and flexible way than the federal government - or any one PT - can do on its own or at intergovernmental tables, with diverse mandates and activities. For example, the Canadian Agency for Drugs and Technologies in Health (CADTH)'s Reimbursement Review program assesses the cost-effectiveness of drugs; Canada Health Infoway has directly supported provinces and territories (PTs) in the implementation of their virtual care and digital health needs; the Canadian Institute for Health Information (CIHI) reports on health system performance; and the Canadian Partnership Against Cancer and the Mental Health Commission of Canada have developed national strategies on pressing health issues (cancer control and mental health respectively). While most PCHOs were established exclusively through federal investment, two (CADTH and CIHI) were created in partnership with provincial/territorial governments.

The federal government remains the majority funder of all PCHOs accounting for about 60-100% of total individual PCHO budgets. Based on longstanding agreements, PTs provide financial support to CIHI (approximately 20% of its budget) and CADTH (approximately 15% of its budget), while Infoway cost-shares with PTs on some of the projects it funds.

As not-for-profit corporations, each PCHO is governed by a board of directors on which the federal government generally holds one seat, some voting and some as observers (and in a few cases also designates the board chair). A senior public servant from Health Canada typically serves as the federal representative and PTs generally have public servant representation on PCHO boards. Although PCHOs are operationally independent, they are accountable to their majority funder, the Government of Canada, for federal investments and related objectives, and so they have a vested interest in developing products and services that respond to the priorities of the federal government and their primary partners, the PTs.

Mandate and core activities

The Canadian Institute for Health Information (CIHI) is the main national body charged with collecting, analyzing and reporting health data (e.g., wait times, quality of care and outcomes, health expenditures, allocation of health professionals), including collaborating with PTs, StatsCan, and data partners to develop and use comparable indicators on priority topics. CIHI data and information supports health system improvements and is used by Canadian governments, policy-makers and health system managers in making health policy decisions and in supporting effective health system management. CIHI relies heavily on PTs for collection of health data.

The Canadian Agency for Drugs and Technologies in Health (CADTH) provides decision-makers with evidence and advice to help provincial/territorial health ministries and federal- provincial/territorial (FPT) drug plans make informed decisions about the effectiveness and efficiency of drugs, medical devices and other health technologies. The expert committees from CADTH's Reimbursement Review Program make non-binding recommendations to public drug plans that support formulary listing and reimbursement conditions decisions for new drugs.

Canada Health Infoway (Infoway) works with PTs, health care providers and other partners to accelerate the development and adoption of digital health technologies, drive health innovation, and improve health outcomes. Infoway is currently focused on leading the development of a pan-Canadian interoperability roadmap for supporting the secure access and exchange of health data between digital solutions, supporting the adoption of standardized digital health solutions, supporting the adoption of standardized digital health tools with PTs, and an electronic proscribing system.

Healthcare Excellence Canada is the newly amalgamated organization of the Canadian Patient Safety Institute and the Canadian Foundation for Healthcare Improvement. It works with patients and other partners to share proven innovations and best practices that lead to lasting improvements in patient safety and healthcare quality (over the pandemic, its 'LTC+' program provided seed funding and programming support to long-term care and retirement homes to strengthen their pandemic preparedness and response). Its current focus areas include: care closer to home and community with safe transitions; care of older adults with health and social needs; pandemic recovery and health system resilience.

The Canadian Partnership Against Cancer (CPAC) provides national leadership to mobilize partners, including governments and cancer experts, to reduce the burden of cancer through coordinated, system-level change through the implementation of the Canadian Strategy for Cancer Control (the Strategy). The Strategy is a framework for Canadian cancer control that reflects the views of cancer stakeholders, including all levels of government. It touches upon the full cancer control continuum from prevention, screening and early detection to treatment, standards and cancer guidelines through recovery and palliative care.

The Mental Health Commission of Canada (MHCC) acts as a catalyst for improving the mental health system and changing the attitudes and behaviours of Canadians around mental health issues (for example, by reducing the stigma associated with mental health illness and treatment). Its work focuses on four priority areas: population-based initiatives, suicide prevention, the integration of mental health and substance use, and engagement with Canadians.

The Canadian Centre on Substance Use and Addiction (CCSA) facilitates knowledge exchange and mobilizes research and expertise in the substance use field, promotes increased awareness among Canadians and health system stakeholders about substance use and addiction, convenes stakeholders across sectors (including those with lived and living experience) to reduce the harms of substance use, and promotes the use of programs shown to be effective in combating problematic substance use. CCSA is the only PCHO created by federal legislation.

Ministerial role and engagement

As PCHOs are operationally independent, the Minister of Health, the Minister of Mental Health and Addictions, and the Associate Minister of Health have no direct involvement in their day-to-day activities. The administration of contribution funding to each organization is delegated to Health Canada officials. The Minister of Health has ultimate oversight of federal investments in these organizations, including the use of federal funding to advance priorities and requests through Cabinet for new funding to support emerging federal or FPT priorities.

Most federal board appointments are the prerogative of the Deputy Minister. However, the Minister is charged with nominating a federal representative to the CPAC Board of Directors; the Chair and one additional federal representative to the MHCC Board of Directors; and recommends Governor in Council appointments for the Chair and up to four other representatives to the CCSA Board of Directors. Given the close relationship between the department and the organizations, the Minister can also expect PCHOs to seek direct engagement from time to time on matters of relevance to their respective organizations.

Key players in Health

The Health Portfolio works with a variety of key players in health, including provinces and territories, Indigenous partners, federally funded arm's-length health organizations, non-governmental organizations, professional associations, charities, international organizations, industry, the research community, other federal departments and agencies, foreign regulators and people living in Canada. This work includes partnering on research, surveillance, public consultation, collaborative policy and program development, sharing information to support health system improvement, best practice/knowledge sharing and engagement with people with lived and living experience.

Provincial / territorial health ministers & public health agencies

• g., Pan-Canadian Public Health Network, regional authorities, P/T occupational health and safety organizations, and in specific cases, local health services, e.g., BC First Nations Health Authority.

Pan-Canadian health organizations (PCHOs)

• g., Canadian Institute for Health Information, Mental Health Commission of Canada, Canada Health Infoway, Canadian Agency for Drugs and Technologies in Health, Canadian Centre on Substance Use and Addiction, Healthcare Excellence Canada, Canadian Partnership Against Cancer.

Health equity & community-based stakeholders

• g., community health organizations, communities with a stake in public health (e.g., Black communities, religious and racialized community groups, communities of practice, immigrants, senior and youth-based organizations, LGBTQ2+,, etc.), social media influencers / risk influencers / risk communicators.

National and regional Indigenous organizations

• Modern Treaty Holders, and Self Governments e.g., Assembly of First Nations, Native Women's Association of Canada, Inuit Tapiriit Kanatami, Pauktuutit Women of Canada, Métis National Council, Manitoba Métis Federation, Les Femmes Michif Otipemisiwak, Congress of Aboriginal Peoples, The National Association of Friendship Centres.

International partners

• g., US Food and Drug Administration, European Medicines Agency, World Health Organization, Multilateral Regulatory For a (ICMRA, ACCESS), Pan-American Health Organization, International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, Global Research Collaboration for Infectious Disease Preparedness (GloPID-R), Organisation for Economic Co-operation and Development (OECD), US Environmental Protection Agency, United Nations Office on Drugs and Crime.

Health system stakeholders

• Health Professionals (e.g., Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, Local Medical Officers of Health).
• Health Institutions (e.g., Hospitals, Children's Healthcare Canada, Canadian Pediatric Society).
• Patient Groups (e.g., Institute of Safe Medicine Practices Canada, Patients Canada).
• Health Sector Labour Unions (e.g., Canadian Labour Congress, Professional Instititute of the Public Service of Canada).

Research & academic stakeholders

• Universities and Academic Organizations (e.g., Association of Faculties of Medicines of Canada, Association of Faculties of Pharmacy of Canada, U15 Group, Universities Canada, Canadian Academy of Health Sciences, Canadian Black Scientists Network).
• Hospital-based Research Institutions (e.g., SickKids).
• Think Tanks (e.g, Conference Board of Canada, Public Policy Forum).
• Health Charities and Research Foundations (e.g., JDRF, MS Society, Gairdner Foundation).
• International Research Agencies (e.g., NIH, European Commission).
• Provincial Health Research Organizations: (e.g., The National Alliance of Provincial Health Research Organizations.
• International Research Agencies (e.g., NIH, European Commission).

Industry stakeholders

• Pharmaceutical and biologics (e.g., Innovative Medicines Canada, Canadian Generic Pharmaceutical Association, Group Purchasing Organizations, and distributors).
• Medical Devices (e.g., Medtech Canada).
• Natural Health Products and Non-prescription Drugs (e.g., Canadian Health Food Association, Consumer Health Products Canada).
• Food Products (e.g., Canadian Supply Chain Food Safety Coalition, Dairy of Farmers of Canada, Canadian Beverage Association).
• Pesticides (e.g., CropLife Canada).
• Cannabis (e.g. Cannabis Council of Canada, Canada Hemp Trade Alliance).
• Consumer Products and Cosmetics (e.g., Retail Council of Canada, Cosmetics Alliance Canada).
• Workplace Hazardous Products (e.g., Canadian Consumer Speciality Products Association, Canadian Paint and Coatings Association Responsible Distribution Canada).
• OGD tables with industry (e.g., National Cross Sector Forum).

Public health stakeholders

• Health Charities (e.g., Canadian Red Cross, Health Charities Coalition of Canada, Disease Specific - ALS, Alzheimers, Heart & Stroke, etc.).
• National Public Health Associations (e.g., Canadian Public Health Association, National Collaborating Centres on Public Health funded by PHAC).
• Disease-based Advocacy Groups (e.g., Canadian Organization for Rare Disorders, Pain Canada).
• Disease Prevention/Health Promotion NGOs (e.g., Canadian AIDS Society, YMCA Canada).
• People With Lived and Living Experience (e.g., Canadian Association of People who Use Drugs, Community Addictions Peer Support Association, Black Health Education Collaborative).

F. Relationships with the international community

COVID-19 has heightened the importance of global collective action to address mega-trends, and highlighted that health is not solely impacted by local factors. The pandemic exacerbated global health issues that have direct implications for the health of Canadians, especially those facing conditions of marginalization.

Now, more than ever before, it is vital to engage on health and safety issues in a way that reflects the interconnectedness of global and domestic health and safety priorities. Active international engagement to advance Canadian health priorities can serve to protect and promote the health and safety of Canadians while demonstrating global leadership on issues where we can make a difference.

The Ministers of Health and Mental Health and Addictions play leading roles internationally by engaging with bilateral, regional, and multilateral partners, which includes sharing Canadian experiences and good practices from across sectors and all levels of government with international partners.

International Obligations and Goals

Both binding international agreements and non-binding international policy frameworks govern Canada's international engagement on health and safety.

Binding agreements

• The World Health Organization Framework Convention on Tobacco Control (FCTC) requires Parties to develop and implement tobacco demand and supply reduction provisions.
• The International Health Regulations, 2005 (IHR) requires Member States to develop and maintain the capacity to detect, assess, report and respond to outbreaks and other public health events that can have a broader international impact on human health, thereby protecting global health security. Member States of the World Health Organization (WHO), including Canada, are currently engaged in a process to strengthen and modernize the IHR (2005) based on lessons learned from the COVID-19 pandemic and other health emergencies; a package of amendments is expected to be considered by the 77th World Health Assembly in May 2024.
• The Biological and Toxins Weapons Convention (BTWC) mandates the elimination of existing biological weapons and prohibits developing, stockpiling or using biological and toxic weapons. Domestic implementation of this Convention includes the Human Pathogens and Toxins Act and Regulations.

Non-binding agreements

• The United Nations Sustainable Development Goals (SDGs), a broad set of 17 non-binding international commitments adopted as part of the 2030 Agenda for Sustainable Development, to respond to a broad range of global health challenges

Multilateral Engagement

Engaging in multilateral fora allows Canada to advance domestic and international health and safety priorities; promote its values, including good governance, accountability and transparency; and advance broader foreign policy priorities beyond global health. Canada works with likeminded countries in multilateral fora to enhance its ability to respond to a broad range of global health challenges and to maintain situational awareness of emerging issues. Canada's strength comes from its reputation of being a convener and broker that facilitates agreements on key global health issues. Policies are driven through vehicles such as Memorandums of Understanding (MOU) between Canada and other countries, Letters of Intent, outcome documents, resolutions, and negotiation texts.

High Visibility Engagement Opportunities for the Health Portfolio

• G20 Health Minister's Meeting (India, August 18-19);
• United Nations General Assembly High Level Meetings (New York, September 2023);
• Global Mental Health Summit (Argentina, October 5-6);
• World Health Summit (Berlin, Germany November 2023);
• Organization for Economic Cooperation and Development (OECD) Health Ministerial (Paris, France January 2024); and
• World Health Assembly (Geneva, Switzerland, May 2024) – the preeminent global gathering of Health Ministers and the highest decision-making body of the WHO.

Whole-of-Government Approach

The Minister of Health works closely with the Ministers of Foreign Affairs and International Development to engage on health issues that have a predominant development focus (e.g., maternal and child health, HIV-AIDS, sexual and reproductive health and rights, gender equality, food systems, child and adolescents health and health human resources). Similarly, the Minister of Health works with the Ministers of Foreign Affairs and International Trade to support trade negotiations, in particular by advocating for the protection of Canada's right to regulate in support of legitimate health and safety objectives. Minister of Health also works closely with the Minister of Environment and Climate Change in support of binding multilateral environmental agreements (including Basel, Rotterdam, Stockholm and Minamata Conventions, the Plastic Treaty, the Paris Agreement) and voluntary frameworks (including International Sound Management of Chemicals).

United Nations (UN)

The Health Portfolio works with the UN, main bodies and specialized agencies on a significant and diverse number of health and safety issues. This includes liaising with GAC on the Canadian engagement related to the UN General Assembly, and contributing to the negotiations of health-related UN resolutions and key statements Canada delivers at the UN to ensure alignment with key positions and priorities of the Portfolio. In addition, the Health Portfolio provides a health lens and coordinates engagement, in close collaboration with other government departments, with specialized UN agencies such as the:

• Joint UN Programme on HIV/AIDS (UNAIDS);
• Food and Agriculture Organization (FAO);
• United Nations Environmental Program (UNEP);
• Comprehensive Nuclear-Test-Ban Treaty organization (CTBTO);
• International Atomic Energy Agency;
• United Nations Sub-Committee of Experts on Globally Harmonized System of classification and labelling of chemicals (UNSCEGHS);
• Convention on Biological Diversity (CBD);
• UN Framework Convention on Climate Change (UNFCCC);
• International Labour Organization (ILO);
• International Civil Aviation Organization (ICAO);
• the UN Human Rights Council (HRC); and
• High-level Political Forum on Sustainable Development (HLPF).

2023 UN General Assembly (UNGA78) – September 2023

Health-related dialogue has dramatically increased since the beginning of the pandemic. With three major High-Level Meetings related to health occurring during UNGA this year: Universal Health Coverage, Pandemic Preparedness, Prevention and Response, and Tuberculosis, this will be an important opportunity for Canada to play a leadership role to advance key domestic health priorities. It is also expected that related discussions on other upcoming HLMs will take place, including on AMR (2024), NCDs (2025) and HIV-AIDS (2026).

World Health Organization

The WHO is the specialized health agency of the UN system that provides leadership on global health matters, setting norms and standards, articulating evidence-based policy options, shaping the health research agenda, and monitoring and assessing health trends. This includes playing an important role in declaring, preparing for, and responding to global public health emergencies.

Canada is currently partway through its term on the WHO Executive Board (EB) (2022-2025). Canada's priorities deliverables include: advancing global health governance objectives on health equity and the determinants of health including environmental determinants of health; co-leading a WHO resolution that addresses health impact of chemicals, waste and pollution, and mobilizing global action to prevent, prepare for and respond to health emergencies.

Pandemic Treaty

• In December 2021, the 194 World Health Organization (WHO) Member States, including Canada, agreed to launch an intergovernmental negotiating body to develop a new WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response (often called a "pandemic instrument").
• The proposed negotiating mandate for the pandemic instrument aligns closely with the approved negotiating mandate for the amendments to the IHR (2005).
• Negotiations started in early 2023 and are progressing, albeit slowly. Key areas of contention between the Global North and South exist in areas related to intellectual property, the transfer of technology, the importance of a One Health approach, and the tying of providing access to pathogens to receiving benefits.
• In March 2023, the Health Portfolio held the Pandemic Instrument Stakeholder and Partner Forum which allowed federal, provincial and territorial representatives, Indigenous partners, academics and experts in a broad range of fields, civil society organizations, private sector and youth to provide important considerations for federal officials and help to inform the development of the Government of Canada's priorities and positions. Stakeholder engagement will continue throughout the negotiation process.
• Both the proposed text for the Pandemic Instrument and the proposed amendments to the IHR(2005) are expected to be considered at the 77th WHA in May 2024.

Pan American Health Organization (PAHO)

PAHO is the Regional Office of the WHO for the Americas and the specialized organization for health of the Organization of the American States (OAS) whose mission is to lead strategic collaborative efforts among Member States and other partners to promote equity in health, to combat disease, and to improve the quality of, and lengthen, the lives of the peoples of the Americas. Canada will rotate back onto PAHO's Executive Committee (EC) for a three-year term (2023-2026) in September 2023. While on the EC, Canada will have the opportunity to further advance its health and development priorities in the region, such as health equity, health security, sexual and reproductive health and rights (SRHR), and mental health and well-being.

Global Health Security Initiative (GHSI)/ Global Health Security Agenda (GHSA)

Canada is an active member of the GHSI, an informal international partnership among like-minded countries (G7 plus Mexico and the European Commission), which serves to strengthen global health preparedness and response to chemical, biological, and radio-nuclear (CBRN) and pandemic threats. The GHSI's goals are to address intentional, accidental and naturally-occurring events through technical and policy cooperation; strengthen partnerships through cross-sectorial collaboration; and promote awareness and dissemination of outcomes from GHSI activities. Canada is also an active member of the GHSA, launched in 2014 to support IHRs (2005) implementation and promote multi-sectoral action in support of global health security. The GHSA is a growing partnership of more than 70 nations, international organizations, and non-governmental stakeholders that seeks to strengthen global and national capacity to prevent, detect, and respond to human and animal infectious diseases threats, whether naturally occurring or accidentally or deliberately spread.

Other multilateral engagement

The Health Portfolio also supports Canada's engagement with:

• Asia-Pacific Economic Cooperation (APEC);
• Arctic Council;
• Commonwealth;
• North American Trade Organization (NATO);
• International Association of National Public Health Institutes (IANPHI);
• Organisation for Economic Co-operation and Development (OECD);
• Five Eyes;
• International Experts Group of Biosafety and Biosecurity Regulators;
• Caribbean Public Health Agency (CARPHA)/ The Caribbean Community and Common Market (CARICOM);
• European Union/European Centre for Disease Prevention and Control (ECDC);
• The Association of Southeast Asian Nations (ASEAN);
• The International Agency for Research on Cancer (IARC);
• Pharmaceutical Inspection Cooperation Scheme (PIC/s);
• International Coalition of Medicines Regulatory Authorities (ICMRA);
• International Atomic Energy Agency (IAEA);
• International Organization for Standardizations (ISO); and
• Global Alliance for Chronic Diseases (GACD).

Bilateral and Regional Engagement

In addition to multilateral engagement, the Minister of Health engages bilaterally with likeminded bilateral and regional partners who share common values and interests on a variety of global health issues. Policies are driven through vehicles such as Memorandums of Understanding (MOU) between Canada and other countries, Letters of Intent, outcome documents, resolutions, and negotiation texts.

G7/G20

The Health Portfolio leads Canada's health-related engagement in the G7 and G20 to build and maintain political momentum and commitment to action on priority health issues. The The Minister of Health attends Health Track meetings as the head of delegation to demonstrate Canada's commitment to addressing key global health threats and to endorse political commitments. The Health Portfolio also supports Canada's participation in other G7 and G20 tracks with implications for health, such as Finance, Agriculture, Environment, Development, and Transportation, and supports Canada's health interests at the Leader level. These fora provide a unique opportunity to promote work across sectors to address complex health issues in support of domestic policies and programs.

Canada will assume the G7 Presidency in 2025, taking the lead in shaping the agenda, determining the thematic key priorities and number of related thematic-based Ministerial meetings. There will be opportunities to scope out a health pillar proposal. Since 2015, health discussions at the G7 have moved from development-centred issues to global health challenges impacting both high-and low-and middle-income countries. Most recently since the start of the COVID-19 pandemic, global health has been closely tied to financing, with Joint G7 Finance and Health Ministerial Meetings taking place.

North American Partners

The U.S. is Canada's closest and most important ally in health and safety. Areas of collaboration include food, drug and medical device regulation, health security, health research, youth vaping, the opioid crisis, climate change and health, radiation safety, cosmetics, consumer and hazardous products safety, coordinating border policies based on science and public health criteria, sharing best practices on increasing vaccine acceptance and addressing food safety and chemicals management. Engagement with the U.S. Secretary of Health will provide an opportunity to discuss continued bilateral collaboration and areas for collaboration in multilateral fora.

• In January 2023, Prime Minister Trudeau travelled to Mexico City for the 10th Annual North American Leaders' Summit (NALS). While most of the focus was on the economy and migration, health made up one of the six pillars referenced in the joint statement. The health pillar centers on plans to update the North American Plan for Animal and Pandemic Influenza (NAPAPI), a platform that includes mechanisms for early notification, surveillance, and joint outbreak investigation.
• In March 2023, U.S. President Joe Biden had his first visit to Canada as U.S. President. The bilateral meeting focused largely on cross-border trade and supply chain issues, immigration, and security and commitments to address the opioid overdose crisis, in part by building a global coalition against synthetic drugs.

Caribbean Public Health Agency (CARPHA)

• Canada, who through the Health Portfolio was instrumental in its creation, shares the common goal with CARPHA of strengthening in-country capacity to prevent, detect and respond to current and emerging health threats. Post-COVID-19, PHAC is engaging with CARPHA to provide technical advice and support for long term governance, promote safe travel between Canada and the Caribbean and collaborate on emerging areas of interest such as climate change and health.

Other bilateral engagement

The Health Portfolio also supports Canada's engagement with:

• Caribbean and Latin American countries, in particular Brazil;
• European Union (EU) and other European countries, such as Denmark and the Netherlands;
• Commonwealth countries, specifically the United Kingdom (UK), Australia and New Zealand; and
• China remains a country of interest on health and safety given its increasingly important role on the global health and safety landscape as a main player and key contributor to multilateral for a.

Key areas of health portfolio engagement

Health security, emergency preparedness and response

The Health Portfolio works closely with the WHO, PAHO, and other regional partners to address threats to global health security and to strengthen emergency preparedness and response, particularly those that have an impact on Canada. The global community has been increasingly looking to the WHO to demonstrate more leadership and coordination, as seen with the modernization of the IHRs and the negotiations underway to develop a pandemic treaty.

International Health Regulations Implementation

Canada is committed to strengthening global and regional health security by building capacities and contributing to IHR monitoring and evaluation activities both domestically and internationally, and by helping to improve international collaboration to detect, assess, report and respond to public health events. As noted, Canada and Member States of the WHO are currently engaged in a process to strengthen and modernize the IHR (2005).

Global Outbreak Alert and Response Network (GOARN)

PHAC actively collaborates with GOARN, WHO and other international bodies such as TEPHINET (Training Programs in Epidemiology and Public Health Interventions Network) to bolster national and international capacity in training for applied public health, public health emergency management and public health response. This includes working collaboratively with partners to reduce work duplication and share training material in field epidemiology training, including with national training programs. From a response perspective, the WHO regularly issues requests for assistance through the GOARN network to help identify, coordinate, and deploy global technical expertise in support of disease outbreaks around the world. PHAC triages, assesses and provides recommendations to support these requests through the identification, the selection and the mobilization of PHAC public health specialists.

Global Health Security Initiative / Global Health Security Agenda

These two bodies work to enhance global capacity to prepare and respond to a wide range of chemical, biological, radiological, and nuclear threats through early detection, risk assessment and joint exercises. Linked to this work, Canada engages with the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (the GP) via GAC.

Global Research Collaboration for Infectious Disease Preparedness (GloPID-R)

Canada, through Canadian Institutes of Health Research (CIHR), is the current chair of the GloPID-R, an international initiative that brings together research funding organizations on a global scale to facilitate an effective and rapid research of a significant outbreak of a new or re-emerging infectious disease with epidemic and pandemic potential.

The QUAD

The QUAD is a long-standing, defense-led initiative comprised of members from Australia, Canada, the United Kingdom and the U.S. Of particular interest, Canada (via PHAC) is a regulator participants in a working group on Medical Countermeasures Consortium (MCMC). The MCMC meetings provide insight into research, development and acquisitions of medical countermeasures across the four countries, informing preparedness for potential chemical, biological, and radio-nuclear emergencies. This forum also enables participation in strategic discussions about medical countermeasure advancements and potential to leverage this network for coordinated and strategic procurement.

International Atomic Energy Agency (IAEA)

The IAEA works closely with the Agency to promote and improve nuclear emergency preparedness and response and radiation safety and security best practices. Canada is a signatory to the Convention on Nuclear Safety, the Convention on Early Notification of a Nuclear Accident and the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency (all administered through the IAEA). Canada actively participates on several standards setting committees at the IAEA including the Emergency Preparedness and Response Standards Committee.

Health equity

The COVID-19 pandemic has highlighted gaps in health equity that persist both domestically and globally, leading to the erosion of health outcomes in vulnerable and marginalized populations. The Health Portfolio maintains an equity-focused approach to all areas of engagement with international partners, particularly as the pandemic has underscored the cracks that exist in our health and social systems. Canada will continue championing health equity and action on the determinants of health, including ensuring that equity and gender equality are at the forefront of COVID-19. This aligns with Health Canada's Sex and Gender-Based Analysis Plus (SGBA Plus) Action Plan, the goal of which is to systemically integrate sex, gender and diversity considerations into all of Health Canada's research, legislation, policies, regulations, programs and services to advance equity, diversity and inclusion.

The Health Portfolio also remains committed to leveraging the power of research to accelerate global health equity for all. Through the CIHR and the release of its Framework for Action on Global Health Research, emphasis is being placed on equity, the forging of authentic partnerships, reciprocal learning, and transnational cooperation to tackle mutual health challenges. This work will continue contributing to cutting-edge science and improvements to the health of Canadians and citizens throughout the world.

Mental health and well-being

The COVID-19 pandemic has underscored the gaps that exist in our mental health systems and has exacerbated existing inequities. Canada continues to take a leadership role in mental health and well-being. The creation of the role of Minister of Mental Health and Addictions signaled Canada's commitment in this area. In recent years, the global community has also begun to shift with many countries now prioritizing mental health and wellbeing domestically and championing global efforts. Canada actively participates in the International Initiative for Mental Health Leadership (IIMHL), a network of government and non-government organizations in ten regions and countries dedicated to strengthening domestic and international leadership in mental health and suicide prevention through networking, collaboration, and the sharing of best practices. Furthermore, Canada is currently playing a leadership role in the 5^th annual Global Mental Health Summit, sitting on the Expert Panel. This role allows Canada to champion mental health promotion as well as improved mental health supports and services. Countries participating in the IIMHL network, including the United States and New Zealand, shared learnings which informed Canada's initiative to implement 9-8-8, a three-digit number for suicide prevention and emotional distress. Canada also has an opportunity to host the Global Mental Health Summit in 2024 and is exploring options.

Health promotion and chronic disease prevention

Chronic, non-communicable diseases (NCDs) such as cancer, diabetes, cardiovascular and respiratory diseases and their common underlying risk factors including tobacco, unhealthy eating, physical inactivity, and air pollution are an ongoing health concern. NCDs have been further exacerbated throughout the COVID-19 pandemic in part due to the disruption of NCD-related services. NCDs contribute to poor health resilience and worsens infectious/pandemic illness outcomes These impacts and insufficient global progress in addressing NCDs have contributed to renewed international interest to collaborate and coordinate research.

Canada hosts the WHO/PAHO Collaborating Centre on Non-communicable Disease Policy, and works to share knowledge and tools to prevent chronic disease. Through CIHR, Canada is a member of the Global Alliance for Chronic Diseases (GACD), an alliance of major research funders that supports global activities to address the prevention and treatment of chronic NCDs. GACD multi-country, multi-disciplinary research focuses on the needs of low- and middle-income countries (LMICs), and people living in situations of vulnerability in developed countries. CIHR's scientific director of the institute for cancer research is also Canada's representative on the International Agency for Research on Cancer (IARC) governing Council.

One Health

One Health is a multi-sectoral, cross-disciplinary approach to detect, prevent, understand, and respond to public health threats, recognizing the fundamental interconnection and interdependence between the health of humans, animals, plants and their shared environment. Canada recognizes the growing global discourse on the need to apply a One Health approach and is committed to a collaborative One Health approach to addressing health security threats that involves and mobilizes partners across human health, animal health, and environmental sectors. The COVID-19 pandemic and the current climate of increasing globalization and disease emergence and re-emergence means that now, more than ever, there is a need for strengthened local, regional, national and international collaboration across the human-animal-environment interface. Canada work collaboratively with international partners, including the Quadripartite Alliance on One Health to identify opportunities for collaboration and information-sharing, harmonize efforts and mitigate any potential for duplication to strengthen the One Health approach. Several international initiatives have been launched under the One Health banner, such as the WHO-FAO-OIE-UNEP One Health High Level Expert Panel and the PREZODE initiative.

Antimicrobial resistance (AMR)

Canada also actively contributes to cutting edge research to achieve better public health outcomes and to harmonize regulatory requirements. This includes founding and participating in the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)—a collaboration of 28 member states aimed at coordinating research in AMR to achieve long-term reductions in resistance levels and better public health outcomes.

In June 2023, PHAC became a member of the Antimicrobial Resistance Multi-Stakeholder Partnership Platform (Platform). The Platform is a new, international forum established by the Quadripartite (consisting of the Food and Agriculture Organization of the United Nations, the United Nations Environment Programme, the WHO and the World Organisation for Animal Health) that unites stakeholders from various sectors to address the threat of AMR from a One Health approach. It aims to engage various stakeholders across the human, animal, plant, and environment interface to co-create sustainable and innovative solutions to preserve antimicrobials and ensure their responsible use under a One Health approach. The Platform also seeks to raise awareness of the role organizations should play in tackling AMR and highlight the importance of a collaborative One Health approach.

Looking ahead, it is expected that AMR will feature prominently in multilateral and regional discussions, including in future G7 and G20 Presidencies, and as a HLM for the Un General Assembly in 2024.

Environment and climate change

Climate change and extreme weather are affecting lives in Canada. To ensure that global efforts to respond to environmental and climate change threats take into consideration Canada's domestic priorities and agendas, the Health Portfolio is actively engaged in a number of international discussions and bodies:

• Binding Multilateral Environmental Agreements on chemicals and waste such as the Basel, Rotterdam, Stockholm and Minamata Conventions, and on plastic pollution (hosting the fourth meeting of the Intergovernmental Negotiating Committee in early April 2024);
• As the National Focal Point for the Strategic Approach to International Chemicals Management (SAICM), HC will be leading negotiations for a new, ambitious global instrument for the sound management of chemicals and waste, to be finalized during the fifth session of the International Conference on Chemicals Management (ICCM5) in September 2023;
• Steering Committee for the WHO led Alliance for Transformative Action on Climate and Health (ATACH), Co-Chairs the Climate Resilient Health Systems working group;
• Global Heat Health Information Network (GHHIN);
• Commission for Environmental Cooperation (CEC);
• WHO Collaborating Centre on Environmental Health, focused on environmental determinants of health and environmental drivers of disease (e.g., air, water and soil pollution, hazardous chemicals and climate change; and
• Convention of Biological Diversity (CBD), as part of the post-2020 Global Biodiversity Framework, as well as the development of a CBD-led Global Action Plan on Biodiversity and Health.

Science and regulatory cooperation

Cooperation with international regulators

The Health Portfolio works with other jurisdictions (e.g. the U.S. Food and Drug Administration, Australia's Therapeutic Goods Administration, European Directorate for the Quality of Medicines and HealthCare, among others) to share information to inform regulatory decisions, harmonize standards, help prevent and mitigate health product shortages, and address current and emerging health regulatory challenges. In an era of complex international trade and global supply chains, this cooperation with trusted regulatory partners helps ensure the access to, and safety, quality and efficacy of the health products Canadians use and consume, and helps develop evidence-based risk mitigation approaches.

Food safety

The Health Portfolio engages in multilateral organizations, such as the Codex Alimentarius Commission, to adopt science-based international standards, guidelines and recommendations for food safety and quality to protect consumer health and promote fair practices in the food trade. From 2022-2024, Canada will be the North American Member on the Executive Committee for Codex, providing strategic advice and expertise to enhance the operation of the organization as a whole. In addition, the Health Portfolio works in the FAO, WHO, APEC Food Safety Cooperation Forum and other organizations to advance international and regional food safety initiatives. The Health Portfolio also works with bilateral partners such as the U.S., Australia, New Zealand, the E.U. and the UK to discuss and, where appropriate, align regulatory approaches and food inspection practices, the surveillance of foodborne disease outbreaks and to enhance and share technical and scientific information.

Health Research and Standard Development

The Health Portfolio lends scientific expertise to various international organizations, contributing to the development of recommendations and guidance and helping to establish international standards which are used by research institutions, industry, and regulatory bodies. The development, adoption and maintenance of high standards supports evidence-based policy options and helps protect public health and safety, as well as the environment. This engagement also supports alignment of Canada's domestic regulations and guidance documents with international standards."