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

Supporting health research and science, data collection and surveillance capacity

Enabling access to safe and effective health products

Strengthening Canada's universal health care system

Supporting Canadians in making safe and healthy choices

Provincial/territorial (PT) partners

Indigenous partners

Federal government departments

Health partners / industry / community stakeholders

International partners

The Health Portfolio: a partner in health for all Canadians

The Health of Canadians – the COVID-19 pandemic

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.

The health of Canadians

Canadians generally experience good health.

The health of Canadians – key challenges

The health system – national health expenditures

Roles and Responsibilities of the Health Portfolio

Under your direct purview:

Arm's-length organizations:

The Health Portfolio's main activities include:

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

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

Working Together to Improve Health Care for Canadians

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

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

Health Portfolio regulatory responsibilities

Health Canada regulates:

PHAC regulates:

CFIA conducts:

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.

Health Portfolio role in food labelling

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

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

Front-of-package labelling regulations

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

Modernization of the federal research support system

Partnerships and collaboration - FPT context

FPTI collaboration on Indigenous priorities

Partnerships and collaboration – Indigenous organizations and governments

Indigenous health equity funding

Network environments for Indigenous health research

Partnerships and collaboration - international partners

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

B. Health Portfolio Organizations

Health Canada

Health Canada's mandate and vision

Health Canada's core business lines

How the federal government can act in health

Core business lines - strengthening Canada's health care system

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

Core business lines – managing risks to health

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

COVID-19 response

Departmental Actions during the COVID-19 Response

Vaccines and therapeutics

Testing & tracing

Support to PTs

Communications and public engagement

Public service

Health Canada's key partners

Health Portfolio partners

Provincial and territorial governments

Health system partners

Industry / consumer groups

Indigenous partners

Federal departments and agencies

International partners

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:

Health protection and promotion:

Internal services:

Budget by vote

Vote 1 operating:

Vote 5 capital:

Vote 10 transfer payments (grants and contributions):

B. Health Portfolio organizations

Public Health Agency of Canada (PHAC)

PHAC's mandate:

PHAC was created in 2004 in order to:

Delivering on public health functions




Leadership during a public health emergency

PHAC during the COVID-19 response

Examples of activities during the COVID-19 response

Lessons learrned landscape

PHAC-focused Reports (internal):

PHAC-focused Reports (external):

Public Health System Reports:

International Reports:

Key lessons learned

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

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:

PHAC renewal (stabilization) – phase 1 [REDACTION]


PHAC financial overview

Budget (in millions)

Budget by Core Responsibility

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


PHAC organizational structure

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:

Collaboration with other partners

Minister's Role


Federal departments and agencies

Other partners

Agency's role


Federal departments and agencies

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

Other partners

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

A brief overview of CIHR

Our institutes

Areas of responsibility

How CIHR Supports Research

Two approaches drive research:


Health priorities


Key business lines

Health research – advancing CIHR's renewed vision

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

CIHR financial overview

Budget 2022-23 by category

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:

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

CIHR organizational structure

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

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:

The CIHR President is responsible to:

CIHR's Science Council is responsible for:

CIHR's Senior Leadership Committee is responsible for:

*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:

Research and Technology Organization:

Federal Agency:

Federal Department:

Canadian Food Inspection Agency (CFIA)

Legislative mandate

Develop and deliver inspection and other services to:

Division of responsibilities between Ministers

Minister of Health

Responsible for:

Food safety:

Minister of Agriculture and Agri-food

Responsible for:

Core responsibilities

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

Food safety

Safeguard Canada's food supply :

Minimize health and safety risks to Canadians by:

Contributes to consumer protection by:

Plant Health

Protect Canada's plant resource base:

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

Animal Health

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

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

International Trade

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

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

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

Corporate services

Both corporate services and delivery of CFIA mandate

Shared services with Agriculture and Agri-Food Canada

CFIA national presence

Area and Regional Offices

Atlantic Area:

Quebec Area:

Ontario Area:

Western Area:

NCR Area:

CFIA resources

Planned spending by core business 2022-23:

Planned spending by type of expenditures 2022-23:

CFIA Partners

International partners

Provincial, territorial and municipal governments

Federal departments and agencies



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

Patented Medicine Prices Review Board (PMPRB)

PMPRB mandate, jurisdiction and legislation


Jurisdiction and legislation

Responsibilities of the Minister

The Patent Act authorizes the Minister of Health to:

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

Core business lines

Regulatory mandate

Reporting mandate

Key files – modernizing the regulatory framework

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:

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:

PMPRB organizational structure

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:

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

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

C. Legislation and decision-making in the Health Portfolio

Health Portfolio legislative mandates at a glance


Enabling Statutes

Assigned Statutes

Overview of legislative and regulatory responsibilities in the Health Portfolio


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:

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.

  1. 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:

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.


  • Does surveillance (e.g. vaccine-related adverse event surveillance).


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.


  • 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.


  • 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).


  • 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.


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).


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

Provinces / territories (PTs)

Federal / provincial / territorial

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:

These investments are available to PTs through two bilateral agreements:

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 16th. 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:

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 7th 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 24th, 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)

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

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

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

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

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)

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)

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)

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

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

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

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

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

No separate Minister for Mental Health and Addictions

Northwest Territories
No separate Minister for Mental Health and Addictions

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)

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

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

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

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

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)

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

Pan-Canadian health organizations (PCHOs)

Health equity & community-based stakeholders

National and regional Indigenous organizations

International partners

Health system stakeholders

Research & academic stakeholders

Industry stakeholders

Public health stakeholders

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

Non-binding agreements

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

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:

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

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:

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.


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.

Caribbean Public Health Agency (CARPHA)

Other bilateral engagement

The Health Portfolio also supports Canada's engagement with:

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 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 5th 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:

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."

Reference 1

Canadian Institute for Health Information. "Surgeries impacted by COVID-19: An update on volumes and wait times" (March 2023).

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Reference 2

Statistics Canada. "Primary health care providers, 2019" (October 2020).

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Reference 3

Statistics Canada. "Job vacancies, first quarter 2023," The Daily (June 2023).

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Reference 4

Canada Health Infoway. "Virtual Care Use." 2021 Canadian Digital Health Survey (2021).

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Reference 5

Chief Public Health Officer of Canada's Report on the State of Public Health in Canada 2022: Mobilizing Public Health Action on Climate Change in Canada.

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Reference 6

"Other" includes long-term care institutions and other professionals such as dentists and optometrists. Drugs include prescription and non-prescription medications and do not include drugs dispensed in hospital.

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