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 (PHAC)
   3. Canadian Institutes of Health Research (CIHR)
   4. Canadian Food Inspection Agency (CFIA)
   5. Patented Medicine Prices Review Board
   6. Financials from the Health Portfolio
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. Indigenous/federal/provincial/territorial relations
   1. Overview of IFPT roles and relations in health and Indigenous 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
6. Relationships with the international community
   1. Overview of the Health Minister's role in the international community and portfolio engagement (global health and Canada-US)
7. Commitments and priorities overview
   1. Budget 2024 – Health Portfolio summary note
   2. Fall economic statement 2024
8. Issues for early attention
   • Health care system
   • Health workforce
   • Medical assistance in dying
   • Pharmacare
   • Dental Care
   • Overdose crisis response, including Canada's border plan
   • Mental health
   • G7 and the World Health Assembly
9. Upcoming tablings and appointments
   1. Reports to be tabled in Parliament
   2. Governor in council appointments

1. Health Portfolio overview

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

Health Portfolio at a glance

Responsible for helping Canadians maintain and improve their health

Under your direct purview

Health Canada (HC)

Helps make Canada's population among the healthiest in the world. As a partner in health, HC protects Canadians from unsafe food, health and consumer products, supports Canada's health care system through administration of the Canada Health Act, informs Canadians so they can make healthy choices, and works with partners, including provinces and territories, on priority issues such as mental health, substance use, oral health, and pharmacare.

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. The overall administration of CFIA including food safety is under Minister of Health, while supporting Canadian agriculture and agri-food businesses as they compete, innovate and grow in domestic and global markets is under Minister of Agriculture and Agri-food).

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.

Roles and partners of the Health Portfolio

1. Supporting Canada's health care system
   • Although health care delivery is primarily under provincial and territorial jurisdiction, the Canada Health Act (CHA) sets national standards through the use of the federal spending power.
   • Health Canada administers the Act by 1) monitoring PT compliance, 2) reporting annually to Parliament, 3) recommending appropriate action to address non-compliance, and 4) interpreting the CHA as the health care system evolves.
   • The Department of Finance provides Canada health transfer payments directly to PTs, giving them the flexibility to use the funds to meet their individual priorities.
   • HC also plays a leadership and convening role in cooperation with PTs on health system improvements and innovation.
2. Enabling access to safe and effective health products
   1. Assessing, regulating, and enforcing compliance of health products to ensure their safety, effectiveness and quality (e.g., regulatory oversight of drugs, medical devices, and natural health products).
   2. Modernizing regulatory regimes to increase timely access to safe and effective treatment options for Canadians.
   3. Help prevent and mitigate health product shortages.
   4. Monitoring health product safety and communicating to Canadians.
3. Managing risks to health
   • Managing food-related health risks through strong food safety regulations, surveillance and enforcement.
   • Setting health and safety standards and regulating a variety of products through pre- and/or post-market risk assessments based on level of risk.
   • Implementing comprehensive approaches to minimize the health risks associated with legal and illegal substances (e.g., overseeing the legal cannabis framework).
   • Reducing environmental risks, including regulating pest control products.
4. Supporting Canadians in making safe and healthy choices
   • Promoting the health and well-being of Canadians by addressing risk factors and underlying determinants of health and health inequities.
   • Promoting healthy behaviours and practices to improve health through public education and awareness initiatives.
   • Supporting Canadians in making better food choices, such as through the Canada Food Guide.
   • Informing Canadians by being a trusted source of information.
5. Supporting health research and science
   • Funding research that generates new knowledge, improves health or health services, informs decision-making and supports health innovation.
   • Investing in knowledge mobilization and the dissemination of research evidence and data to improve health of Canadians.
   • Strengthening surveillance, risk analysis and risk intelligence research and public education on chronic and emerging infectious diseases including zoonotic diseases.
   • Improving diagnostic, risk identification and analysis, and scientific capacity through national labs, to detect serious and emerging diseases.
   • Supporting Indigenous health research, knowledge mobilization and capacity-building.
6. Responding to public health emergencies
   • Developing health security measures and preparing for and responding to health emergencies, including managing the national emergency strategic stockpile.
   • Responding to the threat posed by antimicrobial resistance, leading the federal nuclear emergency plan – coordinating government response to a radiological or nuclear emergency —and responding to foodborne illness outbreaks.
   • Investing in research on prevention, response and preparedness.

Federal-provincial-territorial (FPT) partners

• PTs are responsible for the management, organization and delivery of health care services for their residents.
• FPT governments collaborate to advance key health priorities for Canadians.

Indigenous partners

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

Federal government departments

• The Health Portfolio works with other government departments and agencies (e.g., Indigenous Services Canada; Public Safety, Environment and Climate Change Canada; Employment and Social Development Canada).

Health stakeholders

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

International partners

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

B. The Health Portfolio: a partner in health for all Canadians

Health Portfolio overview

The Health Portfolio is responsible for maintaining and improving the health of Canadians.

The Health Portfolio consists of:

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

There are approximately 20,000 employees and an annual budget of over $13 billion working to help Canadians maintain and improve their health.

Health Portfolio's role

The Health Portfolio consists of five science-based organizations, each playing a unique and important role in the health and safety of Canadians.

The Health Portfolio's main activities include:

1. Supporting Canada's health care system, including administering the Canada Health Act
2. Enabling access to quality, safe and effective health products
3. Managing risks to health
4. Supporting the health and wellbeing of Canadians and promoting safe and healthy choices
5. Responding to public health emergencies
6. Supporting health research and science

Under your direct purview

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

Arm's-length organizations

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

Health Portfolio mandates

Health Canada

• Upholds the public health care system, expands access to health services, helps to reduce health risks, and supports Canadians in making informed health decisions.
• Total authorities (based on 2024-25 main estimates): $9,536M and 9,072 FTEs.

Public Health Agency of Canada

• Improve the health of all people and communities in Canada by addressing public health priorities through science, innovation, service delivery and collaborative action.
• Total authorities (based on 2024-25 main estimates): $2,191M and 4,038 FTEs.

Canadian Food Inspection Agency

• Dedicated to safeguarding food, animals and plants, which enhances the health and well-being of Canada's people, environment and economy.
• Total authorities (based on 2024-25 main estimates): $1,064M and 6,643 FTEs.

Canadian Institutes of Health Research

• 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
• Total authorities (based on 2024-25 main estimates): $1,369.6M and 589 FTE.

Patented Medicine Prices Review Board

• Protects and informs Canadian consumers by reviewing the prices of patented medicines sold in Canada, and by reporting on pharmaceutical trends.
• Total authorities (based on 2024-25 main estimates): $17.75M and 81 FTEs.

1. Supporting Canada's health care system

• Health Canada administers the Canada Health Act (CHA) by monitoring PT compliance, reporting annually to Parliament, recommending appropriate action to address non-compliance, and interpreting the CHA as the health system evolves.
• Health Canada also acts as a national convenor helping to bring together key health care partners, researchers, and experts for national approaches and conversations on key and emerging issues and innovations.
  • Shared priorities include expanding access to family health services, supporting health workforce, access to mental health and substance use services, modernizing health care system (e.g., digital health).
• To drive progress on cross-cutting health care priorities, the department also invests in pan-Canadian health organizations and manages grants and contributions programs to support health care and public health innovation and priorities.
• The Canada health transfer (CHT) is the largest federal transfer to provinces and territories ($54.7 billion cash in 2025-26, with previously transferred tax points adding approximately $26 billion). (Finance Canada).
• The federal government also provides targeted funding to PTs through bilateral agreements, in priority areas such as primary care, mental health, home care and long-term care (Health Canada).
• The government allocates significant direct funding for health care through its responsibility for health protection and promotion including regulation, public health, research, and delivery of health care to specific groups, such as Indigenous peoples and veterans (PHAC, CIHR, Indigenous Services Canada, Veterans Affairs Canada).
• Further assistance is provided to individuals and businesses through the federal tax system and other federal programs and initiatives, including the Canadian dental care plan (CDCP) and pharmacare (Health Canada).
• Oral health: the Canadian dental care plan is helping make cost of dental care more affordable for eligible Canadian residents. Since its launch, 3.2 million seniors, children and adults with disabilities have enrolled in the CDCP and, as of Jan 2025, 1.45 million members have already received care. The oral health fund aims to expand access to oral health care by supporting projects that reduce or remove non-financial barriers to accessing oral health care for targeted populations.

2. Enabling access to safe and effective health products

• Assessing, regulating, and enforcing compliance of health products to ensure their safety, effectiveness and quality (e.g., regulatory oversight of drugs, medical devices, and natural health products).
• Modernizing regulatory regimes to increase timely access to safe and effective treatment options for Canadians.
• Help prevent and mitigate health product shortages.
• Monitoring health product safety and adverse events arising from use and communicating risks to Canadians.

Health Canada regulates:

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

PHAC regulates:

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

CFIA conducts:

• Approximately 2,806 food safety investigations and an average of 161 recall incidents and 306 total recalls each year.

Regulatory oversight process from pre-market to post-market

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

3. Managing risks to health

• Managing food-related health risks through strong food safety regulations, surveillance and enforcement.
• Assessing and managing the health risks of consumer products and cosmetics.
• Implementing comprehensive approaches to minimize the health risks associated with legal and illegal substances (e.g., overseeing the legal cannabis framework).
• Reducing environmental health risks (e.g., lead in paint, exposure to radiation sources).
• Regulating pest control products.

Health Portfolio's role in ensuring food safety

Municipal, provincial and territorial agencies

• Primary health responsibility
• Monitor outbreaks
• Interventions

CFIA

• Regulatory compliance and enforcement
• Food safety investigations
• Risk assessment
• Recall warnings
• Effectiveness checks

Health Canada

• Develop health policies and standards
• Conduct health risk assessments

PHAC

• Monitoring outbreaks and interventions
• Investigations related to human health
• Laboratory tests
• Coordination and communication

Chemical management plan: thematic work areas

• Theme 1: chemical risk assessments
• Theme 2: chemical risk management, compliance, promotion and enforcement
• Theme 3: science-based decision making
• Theme 4: collaboration, outreach and engagement

4. Supporting the health and wellbeing of Canadians and promoting safe and healthy choices

• Promoting the health and well-being of Canadians by addressing risk factors and underlying determinants of health and health inequities.
• Promoting healthy behaviours and practices to improve physical health, and protecting and improving mental health (e.g., 9-8-8 suicide crisis helpline).
• Supporting Canadians in making better food choices, including through front-of-package labelling.
• Informing and engaging Canadians by being a trusted source of information on health and safety.

A social determinants of health approach to improve health

An individual's health is determined by the social determinants of health – a broad range of personal, social, economic and environmental factors – such as income, housing, education, physical environment, gender and culture. The Health Portfolio takes a comprehensive approach to help Canadians make safe and healthy choices. For example, the Health Portfolio worked to ensure the needs of at-risk populations were considered and incorporated in pandemic responses.

5. Responding to public health emergencies

• Developing health security measures and preparing for and responding to health emergencies (e.g., overdose crisis, natural and human-induced disasters, infectious disease outbreaks and pandemics), including managing the national emergency strategic stockpile.
• Supporting border and travel health.
• Providing domestic and international health security leadership.
• Protecting against vaccine-preventable diseases.
• Responding to the threat posed by antimicrobial resistance, leading the federal nuclear emergency plan – coordinating government response to a radiological or nuclear emergency – and responding to a foodborne illness outbreak.
• Investing in academic research on prevention, response, preparedness and recovery, and strengthening international collaboration (e.g., CIHR centre for research on pandemic preparedness and health emergencies, Canada's biomanufacturing and life science strategy, health emergency readiness Canada).

The national microbiology laboratory (NML)

• The NML works with public health partners in Canada and internationally to prevent the spread of infectious disease. It is the only "level 4 Lab" in Canada, meaning it is able to work with the world's most dangerous pathogens.
• The NML enables informed public health action through the delivery of innovative approaches to advance laboratory science, testing services, lab-based surveillance, outbreak response and national public health laboratory leadership.

Canada's border plan

Health Canada plays a critical role in supporting Canadian law and border enforcement in their activities to counter the global synthetic drug threat, including fentanyl. Canada's $1.3 billion border plan includes:

• Creating a Canadian drug analysis centre,
• A new precursor risk management unit, and
• Strengthen regulatory oversight for precursor chemicals.

6. Supporting health research and science

• Funding research that generates new knowledge, improves health or health services, informs decision-making and supports health innovation.
• Funding national collaborating centres that promote the use of evidence by public health practitioners and policy makers.
• Strengthening surveillance, evidence and public education on chronic and infectious disease.

CIHR and research

• The primary research arm of the Health Portfolio is CIHR, which invests over $1.4 billion annually to support world-class research conducted in Canadian post-secondary institutions and their affiliated hospitals and research institutes.
• CIHR is comprised of 13 research institutes dedicated to exploring a range of health topics (e.g., aging, cancer, genetics, infection and immunity, Indigenous peoples' health etc.). Budget 2024 proposed significant investments to bolster research in Canada, including investments in core grant funding, scholarships and fellowships and Indigenous participation in research.

Modernization of the federal research support system

• The advisory panel on the federal research support system made 21 recommendations on key themes: structural change, strategic and independent advice, modernized and integrated programming, new paradigm to support Canada's major research facilities, re-investment in research and talent to bolster success.
• Budget 2024 announced the government's intention to create a new capstone research funding organization to support better coordination across the federally funded research ecosystem.

Our investments help fund research across four primary pillars:

• Biomedical research – understanding how the body works to better prevent, diagnose, and treat disease.
• Clinical research – exploring how to improve patient care and overall quality of life.
• Health services research – finding ways to strengthen the effectiveness and efficiency of our health care system.
• Social, cultural, environmental and population health research – understanding how social, cultural and environmental factors affect our health.

Partnerships and collaboration

Federal-provincial-territorial (FPT)

• At the federal level, the Health Portfolio works collaboratively with a number of other government departments and agencies (e.g., public safety on opioids crisis).
• PTs are responsible for the management, organization and delivery of health care services for their residents.
• Ongoing FPT collaboration is maintained through well-developed formal structures including:
  • FPT health ministers' meeting;
  • Conference of deputy ministers of health;
  • Pan-Canadian public health network;
  • Collaborative work with FPT partners through engagement and leadership on several committees.
• The Jan 2025 health ministers' meeting discussed issues related to Canada Health Act, health workforce, digital health and health data, mental health and substance use, pharmaceuticals management, and public health.

Indigenous organizations and governments:

• Indigenous Services Canada (ISC) funds or directly provides services for First Nations and Inuit that supplement PT services.
• Engagement by the Health Portfolio is often done in collaboration with other federal departments, such as ISC and Crown-Indigenous Relations and Northern Affairs Canada.
• The Health Portfolio works with other Indigenous health system partners to close gaps in health outcomes and address systemic barriers to accessing safe and equitable health services (e.g., Indigenous Physicians Association of Canada, First Nations Health Authority).
• The Portfolio also contributes to whole-of-government efforts to advance reconciliation with Indigenous peoples by implementing the Truth and Reconciliation Commission's calls to action and supporting the federal response to the national inquiry into missing and murdered Indigenous women and girls.

International partners

• You will typically engage multilaterally by leading Canada's delegation at international and political fora, and bilaterally with key counterparts from other countries or regional partners:
  • World Health Organization
  • Organisation for Economic Co-operation and Development
  • G7 and G20 Health Ministers
• You will also engage with counterparts from other countries or regions to advance bilateral collaboration on health issues of common concern.
• The United States is a key bilateral partner, given joint regulatory work and inter-connected supply chain.
  • Health Canada shared information and expertise with international regulatory counterparts to support the review and post-market monitoring of COVID-19 health products.

2. Health Portfolio organizations

A. Health Canada

Health Canada's vision is to help make Canada's population among the healthiest in the world.

From coast to coast to coast, Health Canada employees - scientists and researchers, inspectors, doctors and nurses, policy analysts, administrative professionals, and many others - are working to help Canadians maintain and improve their health.

As a partner in health, Health Canada:

• Protects Canadians from unsafe food, health and consumer products;
• Promotes innovation in health care;
• Informs Canadians so they can make healthy choices; and
• Expands access to oral health care.

In addition to working closely with provincial and territorial governments, we also work with partners in the Health Portfolio, other federal departments and agencies, non-governmental organizations, Indigenous partners, other countries, and the private sector.

Health Canada's roles

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

How the federal government can act in health:

• Legislation and regulation
• Leadership/convening power
• Research, surveillance, and monitoring
• Policy development, engagement and advice
• Public awareness and engagement
• Program and service delivery
• Funding

Health Canada's roles: supporting Canada's health care system

• Administers and ensures compliance with the Canada Health Act (e.g., public administration, comprehensiveness, universality, portability, accessibility, and no patient charges).
• Works with provinces and territories to improve Canada's health care system and oversees bilateral funding agreements (e.g., working together to improve health care for Canadians, supporting health workforce, improving access to family health services, helping Canadians age with dignity and closer to home, Improving access to mental health and substance use services, modernizing the health care system with standardized health data and digital tools).
• Ensures that Canadians have access to appropriate and effective health services, including delivering a national dental care program (e.g., supporting access to dental care services, medical assistance in dying, improving access to sexual and reproductive health services, supporting organs, tissues and blood program).
• Advances the affordability, accessibility, and appropriate use of prescription drugs, including working towards national pharmacare.
• Provides advice and leads pan-Canadian initiatives on system innovation and quality improvements in new and emerging areas of health care (e.g., funding eight pan-Canadian health organizations), including manages federal health grants and contributions programs supporting health system innovation/priorities and minority official language communities.

Health Canada's roles: enabling access to safe and effective health products

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

Health Canada's roles: managing risks to health

• Sets health and safety standards and regulates a variety of products through pre- and/or post-market risk assessments based on level of risk for items such as cosmetics, health products, food, chemicals, radiation, and pesticides.
• Takes compliance and enforcement action related to Acts and regulations administered by Health Canada.
• In 2024, more than 1,000 recalls were posted to raise awareness with Canadians about unsafe products.
• Provides information to Canadians to make informed decisions on their health (e.g., food safety practices, recalls, product seizures, rules for clear and legible product labels, mandated health warnings and information on tobacco and vaping products, and drug shortages).
• Conducts research, monitoring and surveillance on environmental health and the health impacts of extreme weather events (e.g., lead in paint, exposure to radiation sources).
• Oversees the legal cannabis regime (e.g., grants licences for production, coordinates with FPT partners, and monitors and enforces compliance).
• Develops and implements approaches to address the harms associated with certain products and substances (e.g., tobacco, alcohol, cannabis and opioids).
• Maintains readiness to respond to public health threats and emergencies (e.g., federal nuclear emergency plan, extreme weather events, chemical safety).

Health Canada's roles: supporting Canadians in making safe and healthy choices

• Works with domestic and international partners to assess, manage and communicate the regulation of health products and benefits associated with various products (e.g. cosmetics, food, chemicals, radiation, pesticides, cannabis, controlled substances, and environmental factors).
• Build public education and awareness on health topics such as substance use, overdose crisis, mental health, cannabis use, smoking cessation, vaping and childhood vaccination through creative advertising and marketing campaigns to minimize health and safety risks (e.g., in 2023-2024, we ran 18 campaigns that received a combined 1.14 billion views).
• Supports Canadians in making healthier food choices through the Canada Food Guide and other healthy eating initiatives.
• Informs and engages Canadians as a trusted source of information on health and safety (e.g., operating 12 social media accounts across various platforms that have more than 2 million followers combined; air quality index).
• Works with FPT partners to ensure workers have the right safety information to protect themselves when using workplace hazardous products.

Health Canada's key partners

Health Canada operates in a complex and dynamic environment where many health challenges – such as sustainability of health care system and the opioid overdose crisis – require a multi-jurisdictional approach.

The department works collaboratively and collectively with federal partners, provinces and territories (P/Ts), Indigenous organizations, industry, and international regulators.

Health Portfolio partners

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

Provincial and territorial governments

• Multilateral and bilateral engagement (including annual FPT health ministers' meetings and the pan-Canadian public health network)

Health system partners

• Eight pan-Canadian health organizations (e.g., Canadian Institute for Health Information)
• National non-governmental organizations (health professional associations, regulatory and accreditation authorities, disease-specific organizations)

Industry / consumer groups

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

Indigenous partners

• National and regional First Nations, Inuit and Métis partners
• Indigenous health professional organizations

Federal departments and agencies

• Environment and Climate Change Canada
• Innovation, Science and Economic Development Canada
• Agriculture and Agri-Food Canada
• Public Safety/Canada Border Services Agency/Department of Justice
• Indigenous Services Canada
• Employment and Social Development of Canada/Immigration, Refugees and Citizenship Canada /Global Affairs Canada
• Finance Canada/Treasury Board

International partners

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

Health Canada organizational chart

• Deputy Minister of Health
  Greg Orencsak
• Associate Deputy Minister of Health
  Eric Costen
• Health Policy Branch (HPB)
  Jocelyne Voisin, Senior ADM
  Sarah Lawley, ADM
• Controlled Substances and Cannabis Branch (CSCB)
  Kendal Weber, ADM
  Jen Saxe, Associate ADM
• Regulatory Operations and Enforcement Branch (ROEB)
  Linsey Hollett, ADM
• Chief Financial Officer Branch (CFOB)
  Serena Francis, ADM and Chief Financial Officer
• Oral Health Branch (OHB)
  Lynne Réné de Côtret, ADM
• Pest Management Regulatory Agency (PMRA)
  Manon Bombardier, ADM
• Health Products and Food Branch (HPFB)
  Pamela Aung-Thin, ADM
  Celia Lourenco, Associate ADM
• Healthy Environments and Consumer Safety Branch (HECSB)
  Matthew Jones, ADM
• Chief Medical Officer
  Supriya Sharma
• Departmental Science Advisor
  Valerie Taylor
• Health Portfolio shared services
• Legal Services
  François Nadeau, Executive Director and Senior General Counsel
• Corporate Services Branch (CSB)
  Nadine Huggins, ADM
• Digital Transformation Branch (DTB)
  Shaifa Kanji, ADM and Chief Digital Transformation Officer
• Office of International Affairs for the Health Portfolio (OIA)*
  Christine Harmston, Branch Head
• Centre for Ombuds, Resolution and Ethics (CORE)
  Sylvie Richard, A/Ombud and Executive Director
• Office of Evaluation & Audit (OAE)*
  Amanda Hayne-Farrell, A/ Audit and Evaluation Executive
  *Shared service supported by PHAC
• Communications and Public Affairs Branch (CPAB)
  Cathy Allison, ADM

B. Public Health Agency of Canada (PHAC)

PHAC mission

Improve the health of all people and communities in Canada by addressing public health priorities through science, innovation, service delivery, and collaborative action.

PHAC focuses on responding to public health threats and emergency management, preventing disease and injuries, promoting good physical and mental health, and providing information to support informed decision making.

The Agency was established in 2004 through enabling legislation, the Public Health Agency of Canada Act (S.C. 2006), and is led by a President (deputy head) and a chief public health officer of Canada (CPHO) working collaboratively.

Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, communities and individuals.

How we work

To deliver its mandate, PHAC has programs, policies and services, to help protect and promote the health of Canadians. Core functions include:

• Promote health and well-being
• Prevent and control chronic diseases and injuries
• Prepare for and respond to public health emergencies
• Prevent and control infectious diseases
• Drive national approaches to public health policy and planning
• Strengthen public health collaboration between governments and jurisdictions
• Apply international research and development to Canada's public health programs
• Central point for international partnerships and sharing Canada's expertise with the world

Federal government public health levers

• Legislation and regulation
• Leadership/convening power
• Research, surveillance, and monitoring
• Policy development, engagement and advice
• Public awareness and engagement
• Program and service delivery
• Funding

Core responsibilities

Health security

• Prepare for and respond to public health events and emergencies (e.g., infectious disease outbreaks such as COVID-19); address health and safety risks associated with the use of pathogens and toxins; and address travel-related public health risks.

Infectious disease prevention and control

• Protect Canadians from infectious diseases by predicting, detecting, assessing, and responding to outbreaks and new threats; and contribute to the prevention, control, and reduction of the spread of infectious disease among Canadians.

Health promotion and chronic disease prevention

• Promote the health and well-being of Canadians of all ages by conducting surveillance and public health research and supporting community-based projects which address the root causes of health inequities and the common risk and protective factors that are important to promoting better health and preventing chronic disease. 

Roles

Health security

Public health risks associated with the use of pathogens and toxins are reduced

• Enhancing PHAC's oversight and engagement with Canadian laboratories working or intending to work with human pathogens and toxins.
• Advancing global health security priorities in biosafety and biosecurity. 
• PHAC serves as the national focal point for Canada's obligations under the WHO international health regulations.

Public health events and emergencies are prepared for and responded to effectively

• Maintaining a national emergency strategic stockpile of essential medical supplies.
• Coordinating Canada's national response by liaising with domestic and international partners.
• Leveraging expert science and public health advice.
• Lead the coordination of national response to public health events and emergencies, and support federal response to natural disasters (e.g., floods, wildfires).

Public health risks associated with travel are reduced

• Strengthening border operations and quarantine services.
• Identifying and mitigating public health risks related to travel.
• Providing subject-matter expertise and surge support to public health and health system partners.

Infectious disease prevention and control

Infectious diseases are prevented and controlled

• Developing immunization guidance and policy to support provincial/territorial immunization programs.
• Advancing studies on vaccine safety and effectiveness.
• Reducing the emergence and spread of antimicrobial resistance (AMR) and use [of antibiotics].
• Reducing the health impacts of sexually transmitted and blood-borne infections (STBBIs).
• Advancing public health research through collaboration on public health data systems and interoperability.
• Developing guidance to support healthcare professionals in preventing and treating infectious diseases for Canadians when they travel.

Infectious disease outbreaks are prepared for and responded to effectively

• Expanding technical and data infrastructure to address public health threats.
• Expanding existing disease surveillance operations to support outbreak detection and response.
• Leveraging innovations and building on scientific advancements.
• Advancing and leveraging laboratory science and leadership, including wastewater monitoring and genomics.
• Advancing work to mitigate the impacts of climate sensitive infectious diseases (e.g., tick and mosquito-borne diseases).
• Reducing the impact of foodborne illness outbreaks.
• Reducing the incidence of tuberculosis while addressing its impact.
• Preparing for and responding to infectious disease outbreaks and pandemics.

Health promotion and chronic disease prevention

Canadians have improved physical and mental health

• Supporting the mental health of people in Canada.
• Strengthening suicide prevention measures (i.e.988: suicide crisis helpline).
• Supporting physical activity initiatives and partnerships.
• Supporting those affected by dementia, advancing prevention efforts and supporting healthy aging.
• Supporting individuals with autism spectrum disorder (ASD), their families and caregivers.

Canadians have improved health behaviours

• Improving the understanding and prevention of substance-related harms.
• Supporting tobacco cessation and prevention for people in Canada.
• Advancing concussion prevention, detection and management.
• Fostering positive early development and stronger beginnings for people in Canada.
• Investing in Indigenous early learning and childcare.
• Preventing and addressing family and gender-based violence (FGBV)

Chronic diseases are prevented

• Addressing Post COVID-19 condition.
• Monitoring risk factors and reporting on chronic disease.
• Helping people living in Canada prevent diabetes.
• Encouraging healthy living behaviours: physical activity and healthy eating.

A changing public health environment

Climate change

• The average annual temperature in Canada has increased by 1.7°C since 1948, which is approximately twice the global rate, linked to pre-mature deaths, economic impacts and climate-related illnesses.
• Climate change led to a more than a 17-fold increase in lyme disease (2009 and 2019).
• The 2023 wildfire season was the worst fire season in Canadian history with over 15M hectares burned. This is more than double the previous record and six times more than the 10-year season average.
• Each year in Canada, 15,300 premature deaths and health impacts valued at $114 billion are linked to current levels of air pollution.

Population health

• The country's life expectancy has been decreasing over the past three years for the first time in decades due to the opioid crisis.
• Mental health is declining, costing $50B/year in health care and productivity.
• From 2015 to 2021, the proportion of Canadians meeting physical activity & nutrition guidelines declined from 56.9% to 53.9%.
• The senior population (65+) is growing and over one-third experience two or more chronic conditions, contributing to declining life expectancy.
• Almost half of Canadians live with chronic disease (2021).

Public health emergencies

• The probability of observing pandemics, like COVID-19 in a lifetime is 38%. This figure could double to 76%, fueled by trends in globalization, inter-regional travel, urbanization and climate.
• Historical evidence suggests that influenza pandemics occur three to four times per century. We are currently monitoring the current avian influenza A(H5N1) situation in Canada and globally.
• Since 2011, there have been over 1200 outbreaks of epidemic-prone diseases in 188 countries.
• Increase in emergency frequency and intensity requires a whole-of-government approach, intersectoral collaboration and a focus on resilience to prevent, mitigate, and prepare.

Vaccination and re-emerging diseases

• Inequity in access to vaccination contributes to disparities in vaccine coverage. In 2021, children at 2 years of age who lived in remote areas had lower overall vaccine coverage for routine vaccinations than those living in less remote locations.
• Misinformation can undermine vaccination efforts, leading to lower vaccine coverage, posing risks to individuals and communities.
• Canada is seeing an increase in measles activity compared to 2023, with 175 cases of measles reported in Canada as of February 28, 2025.

Socio-economic factors

• High housing costs, rising food insecurity and increasing climate-related emergencies are creating greater health inequalities.
• In 2022, 18% of Canadian families reported experiencing food insecurity in the past 12 months.
• The global movement patterns of people is impacting public health influenced by economic, health, social, and environmental factors.
• For example, people born outside of Canada account for 74.5% of active cases of tuberculosis in Canada.

Key Partners

Health portfolio partners

• Health Canada – promotes public health via regulation and public education.
• Canadian Institute of Health Research (CIHR) – supports research, knowledge translation/transfer activities, and builds research capacity.
• Canadian Food Inspection Agency (CFIA) – manages food safety risks, contributes to consumer protection and mitigates transmission of diseases from animal to humans.

Other government departments

• Complementary federal levers to address social determinants of health (e.g., ESDC, IRCC, CMHC, WAGE, GAC, PCH).
• Supports funding in sectors that impact public health (e.g., Finance Canada, NRC, ISED).
• Emergency management (e.g., Public Safety, CBSA, RCMP).
• Collects and communicates evidence on factors influencing health (StatsCan)
• Apply health-in-all-policies approach and intersectoral action.

Indigenous partners

• Indigenous health is a shared responsibility between FPTI governments, including ISC, working with national Indigenous organizations (NIOs) and regional/local partners to improve health outcomes, address social determinants and build capacity for Indigenous-led PH actions and research in line with international commitments.

Provinces and territories

• PTs – setting public health standards and delivery of programs and functions.
• Public Health Network Council (PHNC) –key governance mechanism for intergovernmental collaboration.

International partners

• Key multilateral, regional, and bilateral partners to strategically advance global health priorities in support of Canada's domestic health policy and foreign policy objectives (i.e. World Health Organization, Pan American Health Organization, etc.).

Academic stakeholders

• Collaboration with institutions to conduct research, develop evidence-based interventions, and train future professionals.

Non-governmental stakeholders

• Share information, mobilize evidence and collaborate (e.g., health professionals, non-profit, private sector, local associations, people with lived experience).

Major milestones in public health (2004-2024)

The number of public health emergencies have persisted year after year and are becoming more frequent and complex. PHAC must continue to demonstrate strong leadership through rapid mobilization, adaptation, and resiliency.

• 2003 – SARS outbreak
• 2004 – Public Health Agency of Canada established
• 2005 – Pan-Canadian public health network established
• 2007 – Health Infobase launched
• 2008 – listeriosis outbreak response
• 2009 – H1N1 influenza pandemic response
• 2013 – MERS CoV outbreak response
• 2013-2014 – ebola outbreak in West Africa: key role in developing vaccine
• 2015 – PHAC support resettlement of Syrian refugees
• 2016 – zika outbreak response
• 2017 – onset and response to the epidemic of opioid overdoses
• 2019 – Canada's dementia strategy released
• 2020-2023 – COVID-19 pandemic response
• 2021 – support resettlement of Afghan and Ukrainian refugees
• 2022 – Mpox outbreak Canada response
• 2023 – 9-8-8 suicide crisis help line established
• 2023 – wildfires response
• 2024 – HPAI (highly pathogenic avian influenza) response
• 2024 – launch of youth substance use prevention program

PHAC organizational structure

• President
  Heather Jeffrey
• Executive Vice-President
  Nancy Hamzawi
• Chief Public Health Officer
  Dr.Theresa Tam
• Regulatory Operations and Emergency Management Branch (ROEMB)
  Stephen Bent, Vice President
• Infectious Diseases and Vaccination Programs Branch (IDVPB)
  Dr. Kerry Robinson, A/Vice President
• Health Promotion and Chronic Disease Prevention Branch (HPCDPB)
  Michael Collins, Vice President
• Strategic Policy Branch (SPB)
  David Creasey, A/Vice President
• National Microbiology Laboratory Branch (NML)
  Dr.Jean Longtin, Vice President
• Chief Financial Officer and Corporate Management Branch (CFOCMB)
  Rod Greenough, Vice President and Chief Financial Officer
• Data, Surveillance, and Foresight Branch (DSFB) and Office of the Chief Science Advisor (OSCO)
  Dr.Sarah Viehbeck, Vice President and Chief Science Officer
  Dr.Howard Njoo, Deputy Chief Public Health Officer

Shared services supported by PHAC

• Office of Audit and Evaluation (OAE)
  Amanda Hayne-Farrell, A/Director General Evaluations and Chief Audit Executive
• Office of International Affairs for the Health Portfolio (OIA)
  Christine Harmston, Branch Head

Shared services supported by Health Canada

• Accounting Operations and Material Management
  Serena Francis, Chief Financial Officer (HC)
• Centre for Ombuds and Resolution (COR)
  Sylvie Richard, Ombuds and Executive Director
• Digital Transformation Branch (DTB)
  Shaifa Kanji, Assistant Deputy Minister and Chief Information Officer
• Communications and Public Affairs Branch (CPAB)
  Cathy Allison, Assistant Deputy Minister
• Corporate Services Branch (CSB)
  Nadine Huggins, Assistant Deputy Minister
• Legal Services
  Francois Nadeau, Executive Director and Senior General Counsel

Annex A: state of public health in Canada

Every year, the Chief Public Health Officer (CPHO) reports on the state of public health in Canada. These reports summarize evidence on high-priority public health issues and provide a way forward to improve the health of Canadians.

• Realizing the Future of Vaccination for Public Health (2024)
• Mobilizing Public Health Action on Climate Change in Canada (2022)
• Creating the Conditions for Resilient Communities: A Public Health Approach to Emergencies (2023)
• A Vision to Transform Canada's Public Health System (2021)

Annex B: FPT collaboration

Public health in Canada is a shared responsibility between the federal government and PTs. To advance collaboration for shared FPT public health priorities, PHAC:

• Convenes and leads the Pan-Canadian Public Health Network (PHN), co-led by the CPHO, and serves as the governance structure for collaboration between senior public health officials including Council of Chief Medical Officers of Health (CCMOH) and PHN steering committees.
• Convenes and supports strategic and technical tables that address a wide range of public health issues, including the Canadian immunization committee, the FPT steering committee on antimicrobial resistance, FPT coordinating committee on dementia, and the FPT sport, physical activity and recreation (SPAR) tables (together with Sport Canada).
• Fosters collaboration and senior public health decision-making and public health perspectives on health system business at the conference of deputy ministers of health (CDMH) and FPT health ministers meetings (HMM), working with and convened by Health Canada.
• Seeks to help reconcile jurisdictional differences by building regional public health capacity, mobilizing knowledge and intelligence and leading on regional Indigenous relations.
• Fosters relationships with provincial medical officers of health, Indigenous partners, and additional key stakeholders who also shape the FPT health system and public health landscape.

C. Canadian Institutes of Health Research (CIHR)

CIHR overview

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

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".

A brief overview of CIHR

• Invests over $1.4 billion annually to support over 16,000 world-class researchers and trainees.
• Funds the creation of new knowledge, builds research capacity, and promotes the dissemination of research results in order to improve the health of Canadians and make our health care system more efficient.
• Plays a catalyst role in collaborating with international and domestic partners, including the other federal research granting agencies (i.e., the Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities Research Council) to support and mobilize Canada's research enterprise.
• Offers the Minister of Health tools and resources to:
  • develop evidence-based policies and programs;
  • demonstrate leadership in health innovation; and
  • engage positively with provinces and territories.

CIHR Institutes

• A unique model for health research, CIHR Institutes share the responsibility for fulfilling its mandate.
• Each institute is led by an internationally renowned scientist and represents a network of researchers brought together to support a broad spectrum of research in its topic areas.
• The model enables optimal use of existing knowledge to fill research gaps in priority areas, maximize cooperation and minimize duplication.

Areas of responsibility

• Population and public health;
• Aging;
• Cancer research;
• Circulatory and respiratory health;
• Gender and health;
• Genetics;
• Health services and policy research;
• Human development, child and youth health;
• Indigenous peoples' health;
• Infection and immunity;
• Musculoskeletal health and arthritis;
• Neurosciences, mental health and addiction; and
• Nutrition, metabolism and diabetes.

How CIHR supports research

Two approaches drive research:

Investigator

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

Health priorities

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

Process

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

Key business lines

Health research

• Contribute to improved disease diagnoses, more effective options for treatment, and a strengthened health care system overall by investing in research across four main pillars:
  • Biomedical;
  • Clinical;
  • health systems services; and
  • social, cultural, environmental, and population health.
• Works with its domestic and international partners to optimize the impact of CIHR-funded research so that health outcomes are improved, and health care systems are more effective, safe and efficient.

Federal priorities

• Collaborating with the Health Portfolio and other government partners.
• Provide research evidence needed to develop sound, evidence-based policies on health priorities (e.g., pandemic preparedness and health emergencies, opioid crisis, mental health, suicide prevention, women's health, AMR action plan, national dementia strategy, diabetes, national strategy on high-cost drugs for rare diseases).
• Contribute to improved health care and health outcomes for all Canadians by supporting patient-oriented research and strengthening the clinical trials ecosystem in Canada.
• Inform the implementation of investments and measures announced in budget 2024, including those related to the modernization of the federal research funding ecosystem (e.g., capstone organization and Advisory Council on Science and Innovation).

CIHR organizational structure

• Paul C. Hébert: Deputy Head/President
• Catherine MacLeod: Executive Vice-President
• Vacant: Vice-President Research Programs
• Tammy J. Clifford: Vice-President Research and Learning Health Systems
• Jeff Moore: Associate Vice-President Government and External Relations
• Adrian Mota: Associate Vice- President Research Programs Operations
• Rhonda Kropp: Associate Vice-President Research Strategy

CIHR governance structure

The CIHR governing council is responsible to:

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

The CIHR President is responsible to:

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

CIHR's Science Council is responsible for:

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

CIHR's Senior Leadership Committee is responsible for:

• Leadership on corporate policy and management.

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

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

Canada research coordinating committee members:

• Canadian Institutes of Health Research ($1361M), Natural Sciences and Engineering Research Council ($1318M), Social Sciences and Humanities Research Council ($1162M), Canada Foundation for Innovation ($509M).

Research and technology organization:

• National Research Council ($1548M).

Federal agency:

• Natural Resources Canada ($1075M), Canadian Spacy Agency ($492M).

Federal department:

• Environment and Climate Change Canada ($1266M), Innovation, Science and Economic Development ($996M), Global Affairs Canada ($831M), National Defence ($682M), Statistics Canada ($652M), Health Canada ($578M), Agriculture and Agri-Food Canada ($547M), Fisheries and Oceans ($445M).

D. Canadian Food Inspection Agency (CFIA)

Three main roles:

• Regulatory – enforcement and compliance with regulations upholding food safety and protecting plant and animal health;
• Facilitating trade – supporting market access for Canadian agriculture and agrifood products; and
• Preparing for, and responding to, emergencies – managing and mitigating the impacts of disease or pest outbreaks impacting food, plants and animals.

The agency has a national footprint and works in offices, laboratories, factories in all regions of Canada. Of our 7,200 employees:

• 32% are front-line inspectors in meat plants and food processing facilities;
• 8% are veterinarians;
• 15% work in scientific testing; and
• Remaining 45% work across policy, programs, international affairs and corporate enabling functions

Legislative authorities

The Agency is part of the Health Canada portfolio and key partner of Agriculture and Agri-Food Canada.

• The Minister of Health provides the overall direction of the Agency and for everything related to food safety and is responsible for:
  • Food and Drugs Act
  • Safe Food for Canadians Act
• The Minister of Agriculture and Agri-Food is responsible for non-food safety legislation, such as animal health, plant protection, and market access and trade, under the following:
  • Fertilizers Act
  • Seed Act
  • Plant Protection Act
  • Plant Breeders' Rights Act
  • Feeds Act
  • Health of Animals Act
  • Food and Drugs Act
  • Safe Food for Canadians Act

Operating context

• Growing demand for services and increased diversity of trade markets. The CFIA regulates over 20,000 entities licenced under the safe food for Canadian regulations (SFCR). The SFCR includes manufactured foods which were previously not regulated by the CFIA.
• High expectations of Canadian public that food will be safe. The CFIA issues an average of 240 food recalls annually ranging from serious food safety issues to allergens and undeclared ingredients.
• Continuing need to respond to existing emergencies in Canada. Responsible for a range of animal and plant diseases that presently need to be managed (e.g., avian influenza, potato wart, MSX/dermo).
• Increasing need to prevent foreign diseases from entering. It's crucial to mitigate risks that could impact our food supply and economy. For example:
  • African swine fever poses a threat of $5.9B to the pork sector.
  • Foot and mouth disease could endanger Canada's $14.9B beef industry.
• Increasing complex trade environment that can make it difficult to access certain foreign markets.
• Wide array of stakeholders with varying demands on government (e.g. access to new plant material, faster review of vaccines and feed approval, and online digital harmonization with trading partners).

Front line operations

• Inspectors ensure food safety, protect plant and animal health and support trade by:
  • Verifying compliance with legislative requirements by conducting inspection activities: sample collection;
  • Promoting compliance through education and taking enforcement actions in cases of non-compliance;
  • Conducting food safety investigations and addressing food quality complaints; and
  • Issuing permissions for export, import or domestic purposes.
• Inspectors work onsite full time at slaughter establishments; inspect meat processing establishments, egg producers, fish and seafood establishments, imported food, plants and animals, and inspects lumber, animal handling facilities, greenhouses and grain shipments.
• A total of 13 CFIA laboratories across Canada support day-to-day operations of inspectors by performing diagnostic testing to identify hazards or diseases of Canada's food system as well as any diseases or pests that can risk the country's animal and plant resources. These laboratories also support testing requirements for meeting trading partner standards to access their market.

Compliance and enforcement

The CFIA promotes and verifies compliance with legislation, regulations and policy through:

• Compliance promotion - consultation, communication, information, tools and processes to help regulated parties understand and comply with regulatory requirements;
• Compliance verification - CFIA assessment of regulated party compliance by conducting inspections, taking samples, testing, etc., to verify that requirements are being met;
• Regulatory response - taking corrective and enforcement actions such as detaining or recalling product, suspending licence, issuing administrative monetary penalties (AMPs), prosecution, refusing entry; or quarantine, depopulation in cases of animal disease outbreak; and
• Recourse and feedback mechanisms - regulated party recourse and feedback mechanisms including ministerial reviews, Canada Agricultural Review Tribunal decisions, legal recourse.

The CFIA makes public all licence suspensions, AMPs and prosecution actions. This promotes confidence in the CFIA, demonstrates transparency and serves as a deterrent to Industry non-compliance.

International trade

Supporting market access for Canadian agriculture and agri-food products, through:

• Issuing export certificates, import permits, and conducting inspections and lab testing for imports and exports;
• Influencing development of international rules and standards for plant protection, animal health and food safety at international standard-setting bodies;
• Negotiating import/export conditions, free trade agreements (sanitary/phytosanitary measures) and standards;
• Strengthening international and regulatory cooperation and delivering technical assistance; and
• Working in collaboration with Agriculture and Agri-Food Canada and Global Affairs Canada.

CFIA is the sole competent authority in Canada responsible for administering and enforcing regulations for the import and export of food, animal and plant products.

Canada exports more than 50% of the agri-food and seafood products it produces, valued at $102B in 2024:

Top five export destinations include United States (62%), China (9%), Japan (5%) EU (5%) and Mexico (2%). Key products include:

• Canola (seed, oil, meal) – $14.6B (US 52%; China 33%; Japan 5%)
• Wheat – $10.3B (US 9%; Indonesia 9%; China 8%; Japan 8%; Italy 6%)
• Fish and Seafood – $8.2B (US 67%; China 15%; Japan 3%; UK 2%)
• Beef – $4.9B (US 79%; Japan 7%; Mexico 5%; Korea 3%)
• Swine – $5.4B (US 33%; Japan 27%; Mexico 9%; China 9%; Korea 7%)

Canada's imports of agri-food and seafood products is valued at $75B in 2024.

Canada's top five imports sources include US (52%), EU (12%), Mexico (6%), China (3%), Brazil (3%).

Key issue – listeria outbreak (plant-based beverages)

Background

• In July 2024 it was determined that Silk brand beverages were the likely source of listeria that had resulted in three deaths and multiple illnesses across three provinces.
• The CFIA worked with Danone (the brand owner) and Joriki Inc (the manufacturer) to recall the product and investigated the source and food safety as well as the manufacturing practices at Joriki Inc.
• The food safety investigation revealed that Joriki was not complying with Health Canada's listeria policy. Joriki Inc is no longer operational and has filed for bankruptcy protection.
• The CFIA assesses the risk profile of SFCR licence holders based on a range of factors and uses this to determine the inspection frequency. Based on the risk level assigned to Joriki, the agency should have inspected annually.
• The SFCR came into force in 2018 using a phased approach with manufactured foods like those produced by Joriki being regulated in 2022. Manufactured foods had not been regulated by the CFIA prior to the SFC Act.
• No inspection had taken place, however the agency responded to a number of food quality complaints over the years including on-site visits, all of which were resolved with Joriki.
• In 2022, the CFIA completed a three-year survey of plant-based milk alternatives and found them to be generally safe, with no listeria monocytogenes found in the samples taken.
• While listeria monocytogenes has typically been linked to products like ready-to-eat meats and unpasteurized dairy products, this is the first time plant-based beverages have been linked to illness in Canada.

Action plan

The President of the CFIA mandated the CFIA's inspector general to undertake:

• A verification of plant-based food manufacturers to determine compliance – in cases of non-compliance the CFIA took immediate action to ensure compliance.
• To review the complaints process and determine whether the CFIA was integrating this into risk assessments.
• To ensure that the CFIA put in place a plan to inspect the 2,700 manufactured food establishments licensed under the SFCR but not yet inspected.

The CFIA is also undertaking several actions to ensure the integrity of the food safety system:

• Making more information mandatory as part of the licence application process.
• Increasing Compliance promotion activities to ensure licence holders understand their obligations under the SFCR (including the HC listeria policy).
• Reviewing the risk assessment tools and processes to ensure is adequately reflects the science on listeria.
• Refining the planning process to maximize risk-based inspection coverage within current resources.

Media Attention

• The outbreak and food safety investigation garnered significant media attention.
• It is expected that the release of the IG's report will attract further attention.

Key issue – highly pathogenic avian influenza

• Highly pathogenic avian influenza (HPAI) is a viral infection that affects birds (chicken, ducks, turkeys, etc), and poses a risk to human health and is disrupting the global food supply. The CFIA "stamps out" infected domestic poultry infected to prevent further transmission by depopulating infected and exposed birds, disposing of birds and contaminated material, and disinfecting the premises. The poultry industry understands requirements and collaborates with the CFIA.
• The CFIA compensates owners for the costs of the birds and costs associated with depopulation and disposal. The latest outbreak in Canada began in 2021. 14M+ birds have been destroyed so far, resulting in $266.6M in compensation paid to industry from the consolidated revenue fund to date.
• This harms Canada's poultry industry. In 2023, the industry contributed $6.9B in farm cash receipts. The outbreaks have led to 40 countries refusing to import Canadian poultry.
• The virus is evolving and infecting new species. The US is managing an outbreak of H5N1 in dairy cows - Canada is guarding against this through pre-entry testing). Canada recently reported its first domestic human case of H5N1.
• An ostrich farm in B.C. that was ordered to destroy its birds in December 2024 refuses to cooperate, and sought an injunction to halt the application to dispose with a request for a judicial review.
  • The injunction was granted by the courts on January 31, 2025.
  • An expedited judicial review and a decision is anticipated in mid-April 2025 regarding the CFIA order to depopulate.
  • This infected premise has garnered significant media attention and is likely to continue after a decision is rendered.

Key issue – bovine tuberculosis

• Bovine tuberculosis (TB) is a highly contagious bacterial disease affecting cattle and wildlife – and which can also infect humans.
• Canada regularly detects and manages cases of bovine TB. There are concerning indications that the number of affected herds and animals may be expanding.
• Late 2024, a case was detected in Saskatchewan, with three positive cases subsequently identified in the cattle herd of 2,055 animals. The herd was declared infected, and infected animals ordered destroyed.

The Agency will:

• Continue tracing animals that may be affected with the disease (Note: we do this in collaboration with Canadian Cattle Association, the producer, and provincial governments, noting that this may take a few years to ensure that all cattle having been in contact with the infected heard are identified;
• Work with affected producers who could be compensated for their losses;
• Confirm affected premises are disinfected and when quarantines can be lifted; and
• Host industry briefings and update stakeholders.

Key issue – foot and mouth disease (FMD)

• FMD is a severe, highly contagious viral disease of cattle, swine, sheep, and other cloven-hoofed animals.
• FMD was last detected in Canada in 1952 but is endemic in much of the world. Recent outbreaks in Asia and Africa have increased the risk of global spread. It has recently been reported in Germany and Hungary.
• In the event of an FMD outbreak, the Agency will need to eradicate the disease using a stamping out response and re-establish Canada's disease-free status as quickly as possible.
• Budget 2023 provided $57.5M over five years, starting in 2023-24, and $5.6M ongoing, to the CFIA to establish a FMD vaccine bank for Canada and develop response plans. The procurement process for a supplier of concentrated FMD vaccine is underway, with two bids received. Public Service and Procurement Canada is responsible for the contract and it is estimated to be completed in April 2025.

The agency will continue:

• Developing response plans
• Securing a strategic reserve of FMD vaccines; and
• Pursuing a cost-sharing arrangement with the provinces and territories for previous two measures.

Key issue – African swine fever

• African swine fever (ASF) is a contagious viral disease that infects pigs but not humans. ASF has never been found in Canada but has spread to over 40 countries since 2018.
• Canada is world's 7th largest pork producer, and 4th largest pork exporter.
• In the event of ASF detection in Canada, all pork and live-hog exports would halt, and some export markets may remain closed for months, crippling the $5.3B Canadian swine industry.
• Since 2022, federal, provincial governments, and industry have collaborated to implement the pan-Canadian ASF action plan.

Key issue – MSX and dermo in oysters

• MSX and dermo are parasitic diseases that infect oysters but not humans, with death rates for infected oysters up to 95%. There are no known treatment or preventative measures.
• Outbreaks had been detected in PEI (July 2024), New Brunswick (November 2024), and Nova Scotia (November 2024).
• In January 2025, CFIA declared PEI as a declared infected area (DIA) for MSX. The DIA does not permit movement of oysters outside PEI, unless they have been processed for human consumption. Not every oyster population in PEI has MSX – but containing movement helps contain disease spread, by restricting growing oysters, and the equipment used, to already infected areas.
• Federal and provincial governments are collaborating on containment and emergency response plans. Work is ongoing to determine the disease status for NB and NS, informed by investigation and sampling. The federal government is developing a plan for additional DIAs based on disease presence and risk of spread.
• Should the mortality continue to rise, it could have a devastating impact on the industry. In 2022, the oyster aquaculture in Canada was valued at $63M – the highest of any shellfish in Canada.

Considerations and opportunities

Areas of consideration:

• Forging relationships with US colleagues in light of trade dynamics.
• Working with partners (e.g., AUS, NZ, the UK and the EU) to diversify and facilitate trade.
• Ongoing emergencies (e.g., TB, HPAI, potato wart, etc.) will create pressures for the Agency.
• Litigious files (e.g., ostrich review decision, honey-bees litigation) may draw some media attention.
• Advancing food program renewal efforts resulting from publication of the IG report on Joriki investigation.

Opportunities:

• Opportunity to visit facilities.
• Early meeting with stakeholders (e.g. associations, provincial and territorial partners).

CFIA Acts and regulations

As a regulator, the Agency is responsible for the full or partial administration and enforcement of the following acts and regulations:

• Agriculture and Agri-Food Administrative Monetary Penalties Act
  • Agriculture and Agri-Food Administrative Monetary Penalties Regulations
• Canadian Food Inspection Agency Act
  • Canadian Food Inspection Agency Fees Notice
• Feeds Act
  • Feeds Regulations, 2024
• Fertilizers Act
  • Fertilizers Regulations
• Food and Drugs Act
  • Food and Drug Regulations
• Health of Animals Act
  • Compensation for Certain Birds Destroyed in British Columbia (Avian Influenza) Regulations
  • Compensation for Destroyed Animals and Things Regulations
  • Export Inspection & Certification Exemption Regulations
  • Health of Animals Regulations
  • Reportable Diseases Regulations
• Plant Breeders' Rights Act
  • Plant Breeders' Rights Regulations
• Plant Protection Act
  • Eggplants and Tomatoes Production (Central Saanich) Restriction Regulations
  • Golden Nematode Order
  • Asian Long-horned Beetle Compensation Regulations
  • Plant Protection Regulations
  • Plum Pox Virus Compensation Regulations
  • Potato Production and Sale (Central Saanich) Restriction Regulations
  • Potato Wart Compensation Regulations
• Safe Food for Canadians Act
  • Safe Food for Canadians Regulations
• Seeds Act
  • Seeds Regulations
  • Weed Seeds Order

Organizational chart

• President
  Paul MacKinnon
• Executive Vice President
  Jean-Guy Forgeron
• Chief of Staff
  Linda Nguyen
• Operations Branch
  Debbie Beresford-Green, Vice President
  Vacant, Associate Vice President
• Science Branch
  Dr. David Nanang, Vice President
• Policy and Programs Branch
  Robert Ianiro, Vice President
  Diane Allan, Associate Vice President
• Communications and Public Affairs Branch
  Jane Hazel, Vice President
• Human Resources
  Raman Srivastava, Vice President
• Corporate Management Branch
  Stanley Xu, Vice President and Chief Financial Officer
• International Affairs Branch
  Kathleen Donohue, Assistant Deputy Minister
• Ombuds
  César Kagame
• Audit and Evaluation Branch
  Martin Rubenstein, Chief
• Legal Services
  Kristine Allen, Executive Director and Senior General Counsel
• Digital Services Branch
  Todd Cain, Digital Services Chief, Information and Innovation Officer
• Inspector General
  Scott Rattray

CFIA across Canada

Atlantic area:

• New Brunswick (Moncton)
• New Brunswick (Fredericton)
• Prince Edward Island (Charlottetown)
• Newfoundland and Labrador (St. John's)
• FTE: 825

Quebec area:

• Montreal East
• Montreal West
• Hyacinthe
• Foy
• FTE: 1,117

Ontario area:

• Northeast (Barrie)
• Toronto (Downsview)
• Central (Guelph)
• Southwest (London)
• FTE: 1,161

Western area:

• Manitoba (Winnipeg)
• Alberta South (Calgary)
• Alberta North - Saskatchewan (Edmonton)
• British Columbia (Burnaby)
• FTE: 1,702

NCR area:

• FTE: 1,848

Laboratories:

• Atlantic – 2
• Québec – 2
• Ontario – 3
• Western -6

E. Patented Medicine Prices Review Board

PMPRB mandate, jurisdiction and legislation

Mandate

• Price review: to monitor the prices of patented medicines to ensure that they are not excessive.
• Reporting: to report on trends in pharmaceutical sales and pricing for all medicines and on research and development (R&D) spending by patentees.

Jurisdiction and legislation

• The PMPRB's powers and obligations are set out in ss. 79-103 of the Patent Act and associated patented medicines regulations and rules of practice and procedure. The Patent Act establishes the PMPRB as an independent, quasi-judicial body.
• The PMPRB can hold price hearings to determine whether a price is excessive. It can also publish non-binding guidelines.
• While the PMPRB is part of the Health Portfolio, it carries out its regulatory mandate at arm's length (i.e. independently) from the Minister of Health, due to its quasi-judicial nature.
• Currently, approximately 1,146 patented medicines (by drug identification number), corresponding to approximately $20 billion in annual sales, are under the PMPRB's jurisdiction.

Responsibilities of the Minister

The Patent Act authorizes the Minister of Health to:

• Table the annual report prepared by the PMPRB before Parliament;
• Recommend new or amended regulations to the governor in council; and
• Refer matters to the PMPRB for inquiry.

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

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

Core business lines

Price review mandate

• The PMPRB can only conclusively determine whether a price is excessive within the context of a public pricing hearing.
• The PMPRB issues non-binding guidelines which set out the price review processes performed by PMPRB staff when preparing recommendations on whether the PMPRB should hold a public pricing hearing. The chairperson of the PMPRB makes the final decision to commence a public pricing hearing.
• At a hearing, a panel composed of board members acts as a neutral arbiter between staff and the right holder. If a panel finds that the price of a patented medicine is excessive, it can order:
  • the price be reduced to a non-excessive level.
  • the right holder to make a monetary payment to the Government of Canada to offset the excess revenues earned. In cases where the panel determines there has been a policy of excessive pricing, it can double the amount of the monetary payment.

Reporting mandate

• Annual report: as required by the Act, the PMPRB reports annually to Parliament through the Minister of Health on its price review activities, the prices of patented medicines and price trends of all prescription medicines, and on the research and development expenditures reported by pharmaceutical patentees.
• Reports to the Minister: pursuant to section 90 of the Act, at the request of the Minister of Health, the PMPRB's national prescription drug utilization information system (NPDUIS) group conducts critical analyses of price, utilization and cost trends for patented and non-patented prescription medicines. The reports are provided to the Minister and published on the PMPRB's website.

Key files – modernizing the regulatory framework

• The amendments to the patented medicines regulations ("regulations"), published in the Canada Gazette, Part II, came into force on July 1, 2022, and resulted in an updated schedule of 11 countries for which rights holders must file prices with the PMPRB (the "PMPRB11") and reduced reporting requirements for medicines believed to be at the lowest risk of excessive pricing.
• On August 18, 2022, the PMPRB announced its approach for reviewing the prices of patented medicines for an interim period (the "interim guidance") to allow for time to consult on new pricing guidelines.
• On September 27, 2023, the PMPRB announced changes to the interim guidance to move forward with implementing the updated basket of comparator countries, with the aim to provide early guidance and greater predictability to certain new medicines.
• In November 2023, the PMPRB launched the first phase of a three-phase consultation process on new guidelines with the release of a scoping paper to encourage a productive conversation between stakeholders and the PMPRB.
• In December 2023, the PMPRB hosted a two-day policy roundtable inviting stakeholders to present their feedback in person. The written feedback can be read on the PMPRB website, and a summary of the in-person feedback can be reviewed in the What We Learned Report.
• In June 2024, the PMPRB launched the second phase of the consultation on new guidelines with the release of the discussion guide. The Guide provides a proposed framework that indicates a direction on certain issues and provides a range of options on others.
• The board published new draft guidelines on December 19, 2024 after considering the feedback received on the two previous phases. These guidelines are open for a notice and comment period before finalization and implementation, which is anticipated in 2025, unless further consultation on an amended draft is necessary.

PMPRB organizational structure

The board consists of up to five part-time governor in council-appointed members, including a chairperson and a vice-chairperson.

The chairperson is designated under the Patent Act as the chief executive officer of the PMPRB, with the authority and responsibility to supervise and direct its work.

The director general is responsible for the day-to-day administration of the PMPRB and oversight of its approximately 80 public servants staff.

• Chairperson
  Vacant
• Acting Chairperson
  Anie Perrault
• Board Members
  Dr.Emily Reynen
  Peter Moreland Giraldeau
  Sharoon Blady
• Director General
  Guillaume Couillard
• Senior Director, Regulatory Affairs and Outreach
  Stéphanie Plouffe
• A/Senior Director, Policy and Economic Analysis
  Kevin Pothier
• Senior Director, Corporate Services and Chief Financial Officer
  Manon Souligny
• Director and General Counsel
  Isabel Jaen Raasch
• Director and Board Secretariat
  Mélissa Lyonnais

F. Financials from the Health Portfolio

Health Canada financial overview 2024-25

Budget by core responsibility

• Health care systems – $8,329 M; 570 FTEs
• Health protection and promotion –$878 M; 6,430 FTEs
• Internal services - $419 M; 2,072 FTEs

Budget by vote

• Vote 1 – operating $3,395 M
• Vote 5 – capital $31.1 M
• Vote 10 – transfer payments (grants and contributions) $5,818 M
• Statutory – $292 M

Total resources: $9,536 M

Notes:

• The above 2024-25 budgets are up to and including supplementary estimates 'B' (includes statutory items and excludes SSC and accommodation costs).
• Internal services includes corporate services, communications, finance, legal services, and departmental reserve containing the OBCF/CBCF funding.
• Totals may not add due to rounding.

Public Health Agency of Canada financial overview 2024-25

Budget by core responsibility

• Health promotion and chronic disease prevention – $432 M; 636 FTEs
• Health security – $366 M; 756 FTEs
• Infectious disease prevention and control – $1,211 M; 2,025 FTEs
• Internal services – $182 M; 621 FTEs

Budget by vote

• Vote 1 – operating $1, 576 M
• Vote 5 – capital $30 M
• Vote 10 – transfer payments (grants and contributions) $418 M
• Statutory – $174 M

Total resources: 4,038 FTEs and budget of approximately $2,191M. With term employment concluding on March 31, 2025, FTE resources will be reduced to ~3,025 as of April 1, 2025. The agency's financial overview going forward will account for funding decisions related to the long-term approach to renewal of PHAC, as well as refocusing government spending initiatives.

Notes:

• The above 2024-25 budgets are up to and including supplementary estimates 'B' (includes statutory items and excludes SSC and accommodation costs).
• Statutory includes PVC transfer to PTs, rapid test kits, EBP, stat revenue, and revenue from sale of crown assets.
• Totals may not add due to rounding.

Canadian Food Inspection Agency financial overview 2024-25

Budget by core responsibility

• Safe food – $381 M
• Animal health – $150 M
• Plant health – $130 M
• International – $23 M
• Internal services – $172 M

Budget by vote

• Operating $672 M
• Other statutory $93 M
• Statutory revenue – $53 M
• Capital expenditures $38 M

Canadian Institute for Health Research financial overview 2024-25

Discretionary

• Investigator–initiated research – $654.7 M
• Research in priority areas – $132.2 M
• Training and career support – $21.9 M

Non-discretionary

• Separately listed grants – $238.8 M
• Ring-fenced initiatives – $210.8M

Notes:

• CIHR's annual budget has remained relatively stable between $1 and $1.4 billion for the last 10 years.
• CIHR's operating budget is approximately 6.2% of its total budget, and CIHR faces increasing pressure to deliver on expanding health research priorities.
• Total authorities – $1,369.6 M.
• Total FTEs – 589.

Patented Medicine Prices Review Board financial overview 2024-25

Budget by branch

• Director general – $0.38 M
• Board secretariat – $2.73 M
• Corporate services – $3.19 M
• Legal services – $4.12 M
• Policy and economic analysis – $3.85 M
• Regulatory affairs and outreach – $3.48 M

Budget by core responsibility

• Strategic outcomes – $14.32 M
• Internal services – $3.43 M

Total resources:

• 81 FTEs and budget of approximately $17.75 M

3. Legislation and decision-making in the Health Portfolio

A. Key legislation

B. Overview of legislative and regulatory responsibilities

Introduction

In Canada, health is an area of shared jurisdiction. Under the Constitution Act, 1867, provincial responsibilities include the establishment, maintenance and management of hospitals, local matters, and property and civil rights. Over time, courts have interpreted these constitutional provisions to mean that provinces and territories (PTs) are primarily responsible for health care delivery, administration of provincial health insurance plans, and 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, patents, and drugs; ensuring a robust and economically strong pharmaceutical, medical devices and technologies sector; 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, military).

Health Portfolio legislation and regulation

There are legislative mechanisms that the government can use to meet its desired objectives, including Acts (statutes), regulations, and orders in council, all of which are relevant in the Health Portfolio context.

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

Enabling Statutes

Five of the Acts are enabling statutes, for which the Minister is responsible. They create and provide the basis of the activities of the portfolio organizations:

• Department of Health Act (Health Canada): promotion of the physical, social, and mental well-being of Canadians.
• Public Health Agency of Canada Act (Public Health Agency of Canada): taking public health measures, identifying and reducing public health risk factors, and supporting national readiness for public health threats.
  • This 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.
• Canadian Food Inspection Agency Act (Canadian Food Inspection Agency): setting safety standards for food sold in Canada, as well as enforcing the food provisions of the Food and Drugs Act.
• Canadian Institutes of Health Research Act (Canadian Institutes of Health Research): 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.
• Patent Act (Patented Medicine Prices Review Board): regulates the pricing of patented drugs.

Assigned Statutes

In addition to the enabling statutes, the Minister of Health is responsible for several assigned statutes that provide further legislative frameworks, national strategies, and regulatory controls for the Health Portfolio. Some key assigned statutes include:

• Canada Health Act: Canada's federal legislation on insured health services, which 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.
• Emergency Management Act: under this Act, the Minister of Health has specific responsibilities to identify risks pertinent to their mandate and to develop plans to address these risks. The chief public health officer also has explicit responsibilities in the emergency management legislation. Emergency plans have been developed by the Health Portfolio that address a variety of public health risks (e.g., pandemic influenza, foodborne illness, nuclear disasters).
• Quarantine Act: to prevent the introduction and spread of communicable diseases in Canada, the Quarantine Act gives the Minister (and designated officials) the power to take comprehensive public health measures. The Quarantine Act also provides the governor in council the authority to issue emergency orders prohibiting or imposing conditions on travelers entering Canada.
• Controlled Drugs and Substances Act: governs the control of substances such as narcotics and controlled drugs, including licensing, inspections, and compliance enforcement related to these substances.

There are also 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, 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). 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.

The Department of Health Act provides that the Minister "has the management and direction of the department" and must "coordinate the activities of, and establish strategic priorities for, any board or agency for which the Minister is responsible and may, subject to any terms and conditions that the Minister considers appropriate, delegate those powers, duties and functions to the deputy minister of Health".

"Powers, duties and functions" of the deputy minister of health

The deputy minister of health is appointed by the governor in council on the Prime Minister's recommendation and holds office pursuant to s. 3 of the Department of Health Act. The deputy minister acts under the direction of the Minister, who maintains responsibility for the overall management and control of the Department of Health. The powers, duties and functions of the deputy minister are derived from four main sources of law:

1. The general and implicit power to act on behalf of the Minister

According to s. 24 of the Interpretation Act, words in legislation directing or empowering a Minister of the Crown to do an act or thing include the deputy minister and appropriately situated departmental officials. This authority recognizes that a Minister is not required to exercise all of their statutory powers personally but is assisted by departmental officials for that purpose.

2. Powers delegated by the Minister to the deputy head through legislation

Many powers and responsibilities are delegated to the deputy minister by the Minister through specific provisions in various pieces of legislation. For instance, s. 34 of the Financial Administration Act requires that the Minister authorize the person or positions who are responsible for the payment, certification and verification of financial expenditures in the department. Other legislation such as the Privacy Act (s. 71) or the Access to Information Act (s. 73) provides that the Minister may delegate powers to the deputy head.

3. Powers directly vested in deputy heads by legislation

As a deputy head, the deputy minister of health has specific powers and responsibilities that stem directly from legislation. For instance, the Financial Administration Act imposes specific obligations for commitment control (s. 32), maintenance of adequate records in relation to public property (s. 62) and ensuring appropriate internal audit capacity (s. 16.1).

A deputy head also has numerous direct powers and responsibilities in human resources management stemming from the Financial Administration Act, the Federal Public Sector Labour Relations Act and the Public Service Employment Act.

4. Powers delegated to the Deputy Minister by others

The authority to appoint under the Public Service Employment Act belongs to the Public Service Commission, but has been delegated to the deputy minister for positions within the Department of Health (s. 15 of the Public Service Employment Act). Order in council (P.C. 1991/1695) provides that Treasury Board may authorize deputy heads to make ex gratia payments. As such, the deputy minister may do so for the Department of Health.

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

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 as part of administering the department's programs. Accordingly, the majority of decisions are made by governmental officials. This has four important advantages:

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

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

Regulatory decisions can be scrutinized by industry, media, the judiciary, and the public. Therefore, it is essential that the Minister, or appropriately-designated officials, are able to demonstrate integrity in their decision-making processes. It is important to show that each decision is the result of an objective 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.

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

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

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.

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.

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 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 communicable diseases 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 PMPRB determines whether the patented drug price set by the manufacturer is excessive and if so, can order price reductions and/or the offset of excess revenues. PMPRB also has the authority to issue non-binding guidelines regarding its administration, however, before issuing any such guidelines, it 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 regulations or 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 allows the governor in council to exercise decision-making power. An example of this in the Health Portfolio are 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 a person arrives from a country that has an outbreak of a communicable disease that could pose a threat to Canadians, and there are no reasonable alternatives to prevent the introduction or spread of the disease. Under the Pest Control Products Act, the governor in council may establish an order to cancel or amend 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.

C. Regulatory oversight of products

Hundreds of new products are introduced every year in 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 pose a high risk to their health (e.g. illegal opioids, tobacco).

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 regulates tens of thousands of products and monitors them through the administration and enforcement of wide range of Acts and regulations.

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.

The extent of the review of a given product generally depends on its risk level. For example, while health products, some food and pesticides are subject to pre-market oversight (e.g., clinical trials for drugs, infant formula, supplemental ingredients, exposure modelling for pesticides) as well as post-market measures (e.g. safety monitoring, recalls), consumer products (such as toys and appliances) and the vast majority of food are managed through a robust post-market regime that includes the development of guidelines and outreach activities for industry, consumers and other stakeholders, the development of national and international safety standards (voluntary and mandatory), and proactive testing and inspections to support regulatory compliance and support enforcement activities.

An overview of the regulatory tools that are used to review, assess and monitor products is outlined below:

Item #1

Regulatory tool:

Prescription drugs and non-prescription products (human and veterinary use)

Pre-market:

Health Canada conducts scientific reviews of drugs for:

• Safety
• Quality
• Efficacy

Post-market:

Health Canada:

• Monitors ongoing drug safety and efficacy
• Monitors adverse events
• Inspects facilities where the drug is produced
• Investigates complaints
• Conducts enforcement activities
• Surveillance
• Orders a recall when necessary

Item #2

Regulatory tool:

Natural health products

Pre-market:

Health Canada reviews products on a risk basis for:

• Safety
• Quality
• Efficacy

Post-market:

Health Canada:

• Monitors adverse events
• Investigates complaints
• Conducts enforcement activities
• Orders a recall when necessary

Item #3

Regulatory tool:

Medical devices

Pre-market:

Health Canada reviews devices on a risk basis for:

• Safety
• Quality
• Efficacy

Post-market:

Health Canada:

• Monitors the safety of devices
• Inspects facilities where devices are produced
• Orders a recall when necessary
• Conducts enforcement activities
• Investigates complaints

Item #4

Regulatory tool:

Biologics and radiopharmaceuticals

Pre-market:

Health Canada reviews biologics and radiopharmaceuticals for:

• Safety
• Quality
• Efficacy

Post-market:

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
• Orders a recall when necessary

Public Health Agency of Canada (PHAC):

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

Item #5

Regulatory tool:

Pathogens and toxins

Pre-market:

PHAC:

• Licences and inspects facilities working with higher risk microorganisms and toxins for safety, security, and compliance with regulations
• Can include manufacturing facilities storing precursor drug materials as well as research facilities.

Health Canada:

• Premarket oversight starts when the pathogen or toxin is part of an authorized drug formulation or clinical trial drug active ingredient.

Post-market:

Health Canada:

• Oversight applies post-market dependent on the final product under development (e.g. authorized biologic drug, food, pesticide, medical device, pharmaceutical drug, etc.)

Item #6

Regulatory tool:

Food

Pre-market:

Health Canada:

• Conducts pre-market assessments of food additives, novel foods, infant formula, human milk fortifiers and new supplemented food categories and ingredients
• Provides opinions, upon request by manufactures, on the chemical safety of food packaging materials, food processing aids and incidental additives

PHAC:

• Monitors trends in antimicrobial use and antimicrobial resistance in selected bacterial organisms from healthy animals on farm and at slaughter through the Canadian integrated program for antimicrobial resistance surveillance (CIPARS). Links antimicrobials used in food-animals with the associated health impact

Post-market:

Canadian Food Inspection Agency (CFIA):

• Enforces legislation for food safety and consumer protection
• Inspects regulated parties that trade inter-provincially and internationally
• Inspects foods and their labels to ensure compliance with Canadian food regulations, including front-of-package labeling
• Investigates complaints
• Manages food recalls
• Tests food products for safety, including contaminants and pathogen testing
• 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 data on food consumption and containment levels to support risk analysis, research and standard setting activities
• Assesses Canadians' exposure to contaminants (e.g., Canadian community health survey, Canadian health measures survey, total diet study)

Public Health Agency of Canada (PHAC):

• Monitors and enforces food safety and the potability of water on passenger conveyances (e.g., airplanes, cruise ships, passenger trains)
• Conducts surveillance of enteric diseases through the national enteric surveillance program and PulseNet Canada (detection and investigation of foodborne illnesses), and through FoodNet Canada to identify risks to the health of Canadians through the food chain
• Supports provinces in transitioning to whole genome sequencing to improve detection of outbreaks and characterization of pathogens
• Monitors trends in antimicrobial use and antimicrobial resistance in selected bacterial organisms from human, animal and food sources across Canada through CIPARS

Item #7

Regulatory tool:

Consumer products and cosmetics

Pre-market:

Health Canada:

• No pre-market regulatory oversight

Post-market:

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
• Authorizes recalls on products deemed unsafe
• Monitors and assesses safety incidents associated with consumer products and cosmetics
• Conducts enforcement activities

Item #8

Regulatory tool:

Chemical substances

Pre-market:

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

PHAC

• Supports assessments for pathogens and toxins

Post-market:

Health Canada and Environment and Climate Change Canada:

• Assess the risks of existing chemical substances
• Take appropriate risk management action when warranted

Item #9

Regulatory tool:

Pesticides

Pre-market:

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)
• Pesticides must be registered or otherwise authorized before they can be sold or used in Canada

Post-market:

Health Canada:

• Initiates special reviews 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
• 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
• 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

Item #10

Regulatory tool:

Controlled substances

Pre-market:

Health Canada:

• Administers licences for registered dealers (i.e. businesses authorized to handle controlled substances)
• Issues import and export permits for controlled substances or products containing controlled substances
• Inspects licensed dealers to ensure compliance with security and other requirements
• Administers exemptions allowing controlled substances to be used for scientific or medical purposes, or in the public interest

Post-market:

Health Canada:

• Inspects licensed dealers and pharmacies
• Monitors reported loss, theft, and suspicious transactions
• Promotes compliance with regulations
• Reviews and addresses complaints
• Issues warning letters
• Conducts enforcement activities including, suspending or revoking licences, permits or exemptions

Item #11

Regulatory tool:

Precursor chemicals

Pre-market:

Health Canada:

• Administers licences and registrations for Class A licensed dealers and Class B registered dealers
• Issues import and export permits for Class A precursor chemicals or products containing them
• Inspects licensed dealers to ensure compliance with security and other requirements prior to receiving a licence and also during the time they hold a licence

Post-market:

Health Canada:

• Inspects licensed dealers
• Monitors reported loss, theft and suspicious transactions
• Compliance promotion of regulations
• Reviews and addresses complaints
• Issues warning letters
• Conducts enforcement activities including suspending or revoking licences, permits or registrations

Item #12

Regulatory tool:

Tobacco and vaping products

Pre-market:

Health Canada:

• No pre-market regulatory oversight

Post-market:

Health Canada:

• Monitors and assesses safety incidents associated with vaping products
• Conducts compliance and enforcement activities, which includes inspections to verify compliance with the Tobacco and Vaping Products Act (TVPA) and its regulations. For example, labelling and packaging requirements for tobacco and vaping products, nicotine concentration limits for vaping.
• Ensures compliance with the Canadian Consumer Product Safety Act (CCPSA) (for example, requirement for child-resistant closures for vaping products, ignition propensity standard for cigarettes)

Item #13

Regulatory tool:

Cannabis

Pre-market:

Health Canada:

• Requires cannabis licence holders to meet good production practices for cannabis products, physical security and personnel security requirements prior to operating
• Requires cannabis licence holders to notify the department at least 60 calendar days before selling a new cannabis product not previously sold in Canada, excluding cannabis plants or seeds
• Requires industrial hemp licence holders to commercially cultivate only hemp varieties found on the list of approved cultivars
• Issues import and export permits for cannabis and industrial hemp under the Cannabis Act

Post-market:

Health Canada:

• Safeguards the integrity of the supply chain (e.g., cannabis tracking and licensing system, inventory controls)
• Monitors regulated parties to ensure adherence to the Cannabis Act and its regulations, with a focus on preventing non-compliance. This includes gathering and analyzing data, conducting compliance verifications, and collaborating with relevant regulatory agencies.
• Conducts inspections of cannabis licence holders.
• Reviews and follows up on complaints from the public and industry to address emerging issues
• Takes targeted enforcement actions, when necessary, including:
  • Issuing warning letters and public advisories
  • Seizing or detaining products
  • Refusing, suspending, or revoking authorizations, including licences or permits
  • Imposing administrative monetary penalties of up to $1 million
  • Issuing ministerial orders for product recalls, testing, or other corrective measures
• Collaborates with law enforcement to address illegal cannabis activities, safeguard the integrity of the licensing system, and ensure compliance with security and regulatory provisions, referring suspected illegal activities for further action

Item #14

Regulatory tool:

Workplace hazardous products

Pre-market:

Health Canada:

• Receives applications, which include safety and data sheets for all workplace hazardous products for which confidential business information protection is requested
• Determines the validity of confidential business information claims

Post-market:

Health Canada:

• Works with federal and provincial/territorial regulatory partners to monitor health and safety concerns, as well as compliance with labelling and safety and data sheet requirements
• Determines the compliance of safety data sheets, selected by risk-based triage, that accompany applications for the protection of confidential business information

Item #15

Regulatory tool:

Radiation emitting devices

Pre-market:

Health Canada:

• No pre-market regulatory oversight

Post-market:

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
• Monitors incident reports from manufacturers

4. Indigenous/federal/provincial/territorial relations

A. Overview of IFPT roles and relations in health and Indigenous health

• Health is an area of shared responsibility among federal, provincial, and territorial (FPT) governments as well as Indigenous governments.
• PTs have primary jurisdiction for the planning, organization, and management of their health systems and services to all residents, including Indigenous peoples.
• The federal government supports publicly funded health care through transfer payments to provinces and territories, delivers some national programs to Canadians (e.g., dental care), and provides direct health services to certain populations (First Nations on reserve, Inuit, Canadian forces members, federal inmates, refugees). Health Canada also has an important role protecting national health and safety and emergency response.
• Ongoing IFPT collaboration enables all orders of government to work together to address a range of health priorities, particularly where responsibilities intersect (e.g., funding health care initiatives, responding to public health emergencies, preventing chronic disease and the spread of infectious and communicable diseases).
• The Health Portfolio supports this collaboration through well-established formal structures, including: first ministers meetings (PM and premiers), FPT health ministers' meetings (HMM) and bilateral and trilateral engagement with Indigenous partners, including national Indigenous organizations (NIOs).

Health Portfolio funding

• The federal government supports health systems through financial contributions to PTs, and Indigenous communities, primarily via direct transfers and bilateral funding agreements.
  • The Canada health transfer (CHT) is the largest federal transfer to PTs. It provides long-term, predictable funding to support universally accessible, publicly funded health care and supports the Canada Health Act, which sets out requirements PTs must meet to receive their full CHT allocation.
  • Bilateral agreements have been used to provide targeted funding in priority areas. Recent examples include working together bilateral agreements, aging with dignity, and home and community care and mental health and addiction services.
  • PTs frequently express preference for unconditional funding through the CHT and have expressed concerns about the prescriptive nature of targeted federal funding and the administrative burden of bilateral agreements.
• The federal government also plays a role in funding or directly providing services for certain populations, including primary care for Canadian Armed Forces, inmates in federal penitentiaries, refugees.
• Indigenous Services Canada (ISC) also funds or directly provides services for First Nations and Inuit communities that supplement those provided by provinces and territories. The Public Health Agency of Canada (PHAC) and Health Canada provide funding to community organizations that support, in part, Indigenous peoples who live in urban, rural and remote communities.
• Health Canada also provides coverage under the Canadian dental care plan (CDCP) to all eligible Canadians.

Health Portfolio role – convening

• Collaboration among IFPT partners on health is maintained through well-established formal structures at multiple levels, including regular multilateral meetings and bilateral engagements with PTs, other federal departments/agencies, and national/regional Indigenous organizations.
• Central to this collaboration are FPT health ministers' meetings (HMM) and FPT Ministers responsible for mental health and substance use meetings, through which ministers discuss and provide collective direction on priority issues and advance collaborative work.
  • Ministers are supported by the FPT conference of deputy ministers of health (CDM), a network of assistant deputy minister-level committees, senior public health officials via the pan-Canadian Public Health Network (PHN), and a range of FPT working groups.
  • PTs also have their own tables, where they discuss issues without the federal government in attendance (i.e., council of the federation at the premiers' level and PT health ministers).
  • Additional FPT work throughout the Portfolio is facilitated through committees on issues such as cannabis, food safety, antimicrobial resistance, health data, dementia, health workforce issues, health and environment, water quality, medical assistance in dying, drug shortages, and interprovincial health insurance agreements.
  • FPT governments also work closely with several federally-funded, arm's length pan-Canadian Health Organizations (e.g., such as Canada's Drug Agency (CDA), Canadian Institute for Health Information (CIHI), Canada Health Infoway).

Health Portfolio role – health, safety and emergency response

• Additional federal responsibilities in health include protecting health and safety through legislation, health security and emergency preparedness and response; health promotion and chronic disease prevention; infectious disease prevention and control; and health research.
  • Some of these responsibilities are shared with PTs – with both the Health Portfolio and PTs having levers that support common objectives (i.e., surveillance, infectious disease prevention and control, health promotion and chronic disease prevention, and health security and emergency preparedness – including coordinating emergency response 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.
• FPT emergency response coordination is supported by FPT response plans (e.g., FPT public health response plan for biological events), federal response plans (e.g., Health Portfolio emergency response plan) as well as established emergency response governance mechanisms (i.e., activation of an FPT special advisory committees in response to a public health emergency).

Health Portfolio role – Indigenous relations

• The Health Portfolio engages with Indigenous partners, including NIOs, regional partners, and other organizations, on a regular basis at all levels, to ensure policies and programs reflect Indigenous rights, needs, and perspectives.
• The Health Portfolio has begun meeting trilaterally with Indigenous partners and PTs.
  • In 2023-24, HC and ISC ministers held 17 trilateral discussions with all PTs (except QC) and regional Indigenous partners to discuss priorities under the working together bilateral agreements. Further trilaterals were convened in January 2025.
  • These distinction-based meetings allowed for a more tripartite approach on Indigenous health priorities to be reflected in PT bilateral agreement action plans. Some PTs (e.g., AB) have indicated interest in continued trilateral engagements going forward.
• Some FPT committees operate as FPTI committees, with Indigenous representation and participation in committee decision-making.
• There is not FPT concurrence on the participation of Indigenous partners at FPT tables. At the January 30, 2025, FPT HMM, ministers agreed to further discuss the issue of greater Indigenous engagement in intergovernmental work at a future meeting.

Key issues / current state

• FPT collaboration takes place within the broader FPT relations landscape, which has included calls by the Council of the Federation to increase the Canada health transfer, and the need to avoid federal overreach into PT jurisdiction.
  • In July 2024, the council of the federation issued a communique stating that in recent years, "federal actions have repeatedly encroached on provincial/territorial jurisdiction without adequate consultation, collaboration, or funding."
• Individual PT collaboration with the Health Portfolio can vary based on priorities, governments, and historical precedents.
  • Quebec has historically requested asymmetrical federal funding agreements. Quebec and Alberta have legislation requiring provincial approval before public institutions (e.g., universities, municipalities) can receive federal funding.
• The pace and intensity of multilateral and bilateral engagement with PTs over the past five years have fluctuated significantly – from very frequent during the pandemic, to bi-annual health ministers meeting in the last two years.
• At their January 29, 2025 health ministers meeting, PT ministers tasked "senior officials to examine the current intergovernmental health landscape and develop strategic options for future federal-provincial-territorial engagement" with a priority focus on strengthening collaboration to achieve health outcomes through respective PT jurisdictions.
• Recently, the Prime Minister has held regular first ministers' meetings to respond to the US threat of tariffs.

Key partners and stakeholders

• Provinces and territories (PTs) – PTs hold primary jurisdiction over the administration and delivery of their health systems. The Health Portfolio works with PTs at all levels to advance shared health objectives.
• Indigenous partners – partners include NIOs, regional partners, modern treaty and self-government agreement holders, Indigenous health authorities, and non-governmental organizations.
• Other federal areas – the Health Portfolio also frequently acts as a focal point for other sector engagement with PTs on health-related issues, supporting a whole-of-government approach (e.g. Indigenous Services Canada, Immigration, Refugees and Citizenship Canada; Transport Canada; Canada Border Services Agency, and Department of National Defence).
• Other PT ministries – while the primary counterparts of the Minister of Health and Minister of Mental Health and Addictions are PT ministers in the health and mental health sectors, they also engage with PT counterparts in other sectors (e.g., seniors, long-term care) based on organizational mandates.
• Pan-Canadian health organizations (PCHOs) – the Health Portfolio and PTs work closely with PCHOs to advance priorities, including in areas of pharmaceuticals management, mental health and substance use, data and digital health, among others.

Key points – Indigenous health

• Indigenous peoples are included in the per capita allocations of funding from the Canada health transfer to PTs and are entitled to access insured provincial and territorial health services as residents of a PT.
• In addition, Indigenous Services Canada (ISC) funds or directly provides services for First Nations on reserve and Inuit that supplement those provided by PTs, including primary health care, health promotion and supplementary health benefits.
• ISC also funds non-insured health benefits to eligible First Nations and Inuit regardless of where they live in Canada. For Métis, off-reserve First Nations and non-status First Nations, services and benefits are primarily provided for by PTs.
• Indigenous partners advocate for self-determination and recognition of treaty rights which includes control over their own health priorities. They are also seeking more stable funding options to improve health outcomes and address inequities for Indigenous communities.
• The federal government is supportive of Indigenous communities managing their own health systems; the First Nations Health Authority in BC, established in 2013, is a significant step and an example of one model for this.

Key Indigenous partners and priorities

• Indigenous governments and organizations have an active interest in designing and delivering health services, asserting self-determination in healthcare.
  • Some Indigenous nations have established their own health governance models, such as the First Nations Health Authority in British Columbia and the Nishnawbe Aski Nation Health Authority in Ontario.
  • The Health Portfolio and other federal partners regularly engage organizations like the Assembly of First Nations (AFN), Métis National Council (MNC), and Inuit Tapiriit Kanatami (ITK) who advocate for improved healthcare access and funding.
  • Many Indigenous communities negotiate self-government agreements that include control over healthcare services and funding.
• Priorities for Indigenous partners include:
  • Self-determination at the nation or community level, implementation of treaty rights to health, and a holistic approach to health.
  • Preventative approaches to health, including the social determinants of health, including housing, food and water security, on the land infrastructure as well as the prevention of chronic diseases (e.g., TB).
  • Access to mental health and substance use services.
  • Developing the Indigenous health workforce, improving primary care close to communities, and reducing the reliance on medical travel.

Background and current status

Indigenous health care in Canada has evolved significantly over time, transitioning from a system that was largely under the shared jurisdiction of FPT governments to one where Indigenous peoples are gaining greater control and input. The Health Portfolio supports the following legal and policy commitments that directly relate to reconciliation efforts, such as:

• The UN Declaration Act: the United Nations Declaration on the Rights of Indigenous Peoples Act (UNDA; 2021) requires all federal departments and agencies to implement Section 5, 6, and 7. Within the UNDA action plan co-developed in 2023, the Health Portfolio leads or co-leads 8 action plan measures.
• Modern treaties: the Cabinet directive on the federal approach to modern treaty implementation (2015) and Canada's collaborative modern treaty implementation policy (2023).
• Truth and Reconciliation Commission's (TRC) calls to action: the TRC published a set of 94 calls to action (CTA) that would contribute to further reconciliation between Canadians and Indigenous peoples. The Health Portfolio plays a supporting role for ten CTAs.
• Missing and murdered Indigenous women, girls and 2SLGBTQI+ people: in response to the national inquiry into national inquiry into missing and murdered Indigenous women, girls and 2SLGBTQI+ people the government of Canada created the federal pathway. The Health Portfolio jointly leads on 1 call for justice priority and supports on 16 other call for justice priorities.
• Inuit Nunangat policy: the Inuit Nunangat policy (2022) applies to all federal departments and agencies, which sets out guidance for initiatives that apply to the Inuit Nunangat and/or benefit Inuit.

Disparities in health care access and treatment for Indigenous populations

• Indigenous populations face greater challenges in accessing health care compared to non-Indigenous individuals^{Footnote 1}
  • A higher proportion of First Nations people living off reserve (20.3%), Métis (17.9%), and Inuit (56.5%) reported not having a regular health care provider, compared to 14.5% of the non-Indigenous population.
  • This is exacerbated for those living in very remote areas or those with two or more chronic conditions.
• When Indigenous people do receive care, many report facing systemic discrimination ^{Footnote 2}
  • Approximately 20% of Indigenous individuals have experienced unfair treatment, racism, or discrimination from a health care professional.
• Differences in self-rated mental health highlight ongoing disparities ^{Footnote 3}
  • Self-rated excellent or very good mental health between 2020-2022 with close to 60% of non-Indigenous individuals, compared to 48% of First Nations off reserve, 51% of Métis, and 50% of Inuit.

Health Portfolio role for Indigenous health

• Implements national and community-based public health programming for Indigenous communities and peoples and health funding for the north through the territorial health investment fund.
• Assesses, manages, and supports research on health risks (controlled substances, pesticides, etc.), and on addressing population harms (tobacco), in collaboration with Indigenous peoples.
• Supports Indigenous health research, knowledge mobilization and capacity-building.
• Works in collaboration with other federal departments, in particular ISC and CIRNA as well as other Indigenous health system partners, to close gaps in health outcomes for Indigenous peoples and address barriers to accessing safe and equitable health services.
• Contributes to whole-of-government efforts to advance reconciliation with Indigenous peoples by implementing several federal commitments.

Current engagement and initiatives

Engaging Indigenous peoples, other government departments and PTs on health priorities is complex:

• Diversity amongst Indigenous partners, including across distinctions (First Nations, Inuit and Métis) is considerable in terms of geography, composition, governance and engagement protocol.
• Effective engagement with Indigenous peoples requires strategies that align with Indigenous self-determination and community-led solutions to support create equitable, culturally safe, and sustainable health systems.

Recent Health Portfolio investments in Indigenous-led initiatives:

Bilateral funding agreements with PTs

• Held trilateral discussions with Indigenous leaders across the country to help facilitate discussion on ways the new health system funding can improve Indigenous access to quality and culturally safe health services.
• CIHI is working with Indigenous partners to improve availability of disaggregated data and common indicators for First Nations, Inuit, Métis.

Mental health and substance use

• The emergency treatment fund allocated approximately 20-25% to Indigenous communities annually, the youth mental health fund has allocated $125M to Indigenous communities.
• The substance use and addictions program (SUAP) funded 74 projects, including projects focused or led by Indigenous groups and communities, following a call for proposals in November 2023.
• PHAC released Canada's first national suicide prevention action plan on May 2024, and complements existing Indigenous-led suicide prevention work underway, including the national Inuit suicide prevention strategy.

Infectious disease prevention

• PHAC contributes directly to support ITK with the Inuit tuberculosis elimination framework as a joint commitment by ITK and the Government of Canada to reduce and eliminate TB across the country by 2035.

B. List of provincial and territorial ministers responsible for health

• British Columbia, Josie Osborne
  Minister of Health (appointed November 18, 2024)
• Alberta, Adriana LaGrange
  Minister of Health (appointed June 9, 2023)
• Saskatchewan, Jeremy Cockrill
  Minister of Health (appointed November 7, 2024)
• Manitoba, Uzoma Asagwara
  Minister of Health, Seniors and Long-Term Care (appointed October 18, 2023)
• Ontario, Sylvia Jones
  Minister of Health / Deputy Premier (appointed June 24, 2022)
• Québec, Christian Dubé
  Minister of Health (appointed October 20, 2022)
• New Brunswick, John Dornan
  Minister of Health (appointed November 2, 2024)
• 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, John Hogan
  Minister of Health and Community Services / Attorney General and Government House Leader (appointed July 19, 2024)
• Yukon, Tracy-Anne McPhee
  Minister of Health and Social Services / Minister of Justice (appointed May 3, 2021)
• Northwest Territories, Lesa Semmler
  Minister of Health and Social Services / Minister Responsible for Seniors / Minister Responsible for Persons with Disabilities (appointed December 12, 2023)
• Nunavut, John Main
  Minister of Health / Minister Responsible for Suicide Prevention / Minster Responsible for Qulliq Energy Corporation (appointed November 19, 2021)

List of provincial/territorial ministers responsible for mental health

• British Columbia, Jennifer Whiteside
  No separate Minister
• Alberta, Dan Williams
  Minister of Mental Health and Addiction (appointed June 9, 2023)
• Saskatchewan, Lori Carr
  Minister of Mental Health and Addictions / Seniors and Rural and Remote Health (appointed November 7, 2024)
• Manitoba, Bernadette Smith
  Minister of Housing, Addictions and Homelessness / Minister Responsible for Mental Health (appointed October 18, 2023)
• Ontario, Michael Tibollo
  Associate Minister of Mental Health and Addictions (appointed June 20, 2019)
• Québec, Lionel Carmant
  Ministre responsable des Services Sociaux (appointed October 18, 2018)
• New Brunswick, Rob McKee
  Minister of Justice / Attorney General / Minister responsible for Addictions and Mental Health Services (appointed November 2, 2024)
• Nova Scotia, Brian Comer
  Minister of Addictions and Mental Health (appointed August 31, 2021)
• Prince Edward Island
  No separate Minister for Mental Health and Addictions
• Newfoundland and Labrador, John Abbott
  Minister of Housing / Minister of Mental Health and Addictions (appointed July 19, 2024)
• Yukon
  No separate Minister for Mental Health and Addictions
• Northwest Territories
  No separate Minister for Mental Health and Addictions
• Nunavut
  No separate Minister for Mental Health and Addictions

Supplementary contacts

• British Columbia, Sheila Malcolmson
  Minister of Social Development and Poverty Reduction (appointed December 7, 2022)
• Alberta, Jason Nixon
  Minister of Seniors, Community and Social Services (appointed June 9, 2023)
• Ontario, Raymond Cho
  Minister for Seniors and Accessibility (appointed June 29, 2018)
• Québec, Sonia Bélanger
  Ministre déléguée à la Santé et aux Aînés (nommé au portefeuille 20 octobre 2022)
• Nova Scotia, Barbara Adams
  Minister of Seniors and Long-Term Care (appointed August 31, 2021)
• New Brunswick, Lyne Chantal Boudreau
  Minister for Seniors (appointed November 2, 2024)
• Newfoundland and Labrador, Paul Pike
  Minister of Children, Seniors and Social Development / Minister Responsible for the Status of Persons with Disabilities / Minister Responsible for the Community Sector (appointed June 14, 2023)
• Prince Edward Island, Barb Ramsay
  Minister of Social Development and Seniors (appointed April 14, 2023)

5. Relationships with health system players

A. An overview of pan-Canadian health organizations

Key points – pan-Canadian health organizations

• Health Canada funds eight pan-Canadian health organizations (PCHOs) who work with provinces, territories, and other partners to advance shared health priorities. First established in 1988, the PCHOs are self-governed, non-profit organizations. Although the federal government shapes their mandates and provides most of their funding, they operate as arm's-length bodies.
• Their arms-length nature allows PCHOs to engage more directly than the federal government with provinces, territories, and other entities on shared priorities in provincial jurisdiction. In Canada's decentralized health care delivery system, they help advance key priorities on a pan-Canadian scale.
• Each PCHO has a specific mandate, focusing on priorities such as cancer, mental health, substance use and addiction, health data, digital health, drugs, patient safety, and health workforce.
• Rapid changes driven by COVID-19, opioid-related deaths, and innovations in technology have been significant in the Canadian health care context and drive the priorities and activities of the PCHOs.

Background

Canada's eight PCHOs have been created over the past 37 years to address cross-cutting priorities in the health care system.

• 1988 – Canadian Centre on Substance Use and Addiction (CCSA): addresses issues around substance use by providing national leadership and coordinating action through partnerships. (HC funding: $11.0 million)
• 1994 – Canadian Institute for Health Information (CIHI): collects, analyses, and reports on health data to deliver comparable and actionable information to accelerate improvements in health care, health system performance and population health across the continuum of care. (HC funding: $127.6 million)
• 2001 – Canada Health Infoway (Infoway): works with partners to accelerate the development, adoption, and effective use of digital health solutions. (HC funding: $75.6 million)
• 2006 – Canadian Partnership Against Cancer (CPAC): accelerates action on cancer control by working with provincial and territorial cancer agencies and other stakeholders. (HC funding: $47.5 million)
• 2007 – Mental Health Commission of Canada (MHCC): leads the development and dissemination of programs and tools to support the mental health and wellness of Canadians. (HC funding: $14.25 million)
• 2021 – Healthcare Excellence Canada (HEC): works with partners to spread innovations, build capability and catalyze policy changes so that everyone in Canada has safe and high-quality healthcare. Established from amalgamation of 2 historical PCHOs. (HC funding: $25.1 million)
• 2023 – Health Workforce Canada (HWC): supports key partners in addressing the current health workforce challenges and critical long-term planning. (HC funding: $5.5 million)
• 2024 – Canada Drug Agency (CDA)^{Footnote *}: provides evidence and advice to help PTs and public drug plans make informed decisions about the effectiveness and efficiency of drugs, medical devices and other health technologies. (HC funding: $38.7 million)

Health Portfolio role

The Health Portfolio supports PCHOs in the following ways:

1. Funding and oversight:

• Health Canada provides majority funding to PCHOs to support federal health priorities (~$360 projected million in 2025-2026; PTs also provide funding to some PCHOs).
• This enables the department to set expectations and performance targets for these organizations through contribution agreements.
• While PCHOs operate at arm's length, governed by an independent board of directors, Health Canada is also represented as a federal appointee and a full voting member and/or ex-officio member. Several PTs also nominate representatives to certain PCHOs (e.g., CIHI, Infoway, CPAC).

2. Policy and strategic guidance

• Health Portfolio partners regularly liaise with PCHO leadership and staff through a series of formal and informal mechanisms.
• This relationship has resulted in the PCHOs having greater clarity on federal priorities, and increased information sharing between the PCHOs and the Health Portfolio, which helps the PCHOs better deliver on their mandates while ensuring alignment with federal priorities.

3. Collaboration and knowledge sharing

• Health Portfolio works with PCHOs to facilitate national data collection, evidence-based decision-making, and best practice sharing.
• PCHOs often leverage the Health Portfolio's various FPT Tables to engage PTs on shared priorities.

Current status – PCHOs are advancing key health priorities

• Health data: CIHI reports on health system performance, including shared FPT health indicators. CPAC is advancing pan-Canadian cancer data strategy to enhance collection, integration and use of cancer data.
• Digital health: Infoway is advancing health system interoperability, supporting adoption of digital health technologies (e.g., AI scribes) and maintains a national e-prescribing service (i.e., PrescribeIT) to support a connected health care system, including access to electronic health information across points of care.
• Health workforce: HWC is advancing access to enhanced health workforce data and information through its data dashboards, catalyzing capacity for health workforce modelling and forecasting, and sharing what works on health workforce innovations and leading practices.
• Mental health and substance use: MHCC is training health care providers to increase mental health literacy and implementing national standards (e.g., psychological safety in workplace, well-being of post-secondary students). CCSA updated guidance on alcohol and health, and leads Canadian substance use cost and harms study.
• Pharmacare: the CDA provides reimbursement recommendations to public drug plans and under the Pharmacare Act, the CDA is developing advice on a list of essential prescription drugs and a national bulk purchasing strategy.
• Others: CPAC is supporting PTs to implement lung cancer screening programs for people at high risk and working with PHAC on breast cancer screening and prevention action plan. HEC is improving care of older adults (e.g., enabling aging in place program), supporting health workforce retention (e.g., health workforce innovation challenge) and strengthening primary care in northern, rural and remote communities.

Stakeholders

PCHOs are generally valued by their key partners, including other PCHOs.

• The 2018 fit for purpose external review and a 2024 evaluation of the PCHOs acknowledged the important role PCHOs play in Canada's health care systems and provided recommendations to improve governance, structure and coherence between PCHOs.

Provinces and territories

• Provincial and territorial governments value the PCHOs for their expertise and ability to drive collaboration on pan-Canadian priorities.
• PCHOs also fill capacity gaps in smaller or lower-capacity provinces and territories where these functions do not exist, either by providing national leadership or by funding specific initiatives at the regional level.

Indigenous organizations

• PCHOs value their engagement with Indigenous organizations, and work at maintaining or strengthening their relationships. Several PCHOs (e.g., CIHI, CPAC) have strong approaches in place to advance reconciliation.

Health stakeholders

• PCHOs are generally well regarded by health stakeholders. Stakeholders have noted that PCHOs act as a "convener" of key stakeholders and the federal government, bringing together partners within their networks to address important issues in Canada's health systems through a multidisciplinary and pan-Canadian approach.

Annex A: Health Canada funding to PCHOs

Other key players and stakeholders 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

• e.g., Pan-Canadian public health network, regional authorities, P/T occupational health and safety organizations, and in specific cases, local health services

Pan-Canadian health organizations (PCHOs)

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

Health equity & community-based stakeholders

• e.g., community health organizations (e.g., racialized communities, religious communities, communities of practice, immigrants, older adults and youth-based organizations, 2SLGBTQ2+, etc.), social media influencers / risk influencers / risk communicators

Indigenous partners

• e.g., national and regional organizations such as the Assembly of First Nations, Inuit Tapiriit Kanatami, Métis National Council, modern treaty holders, Native Women's Association of Canada, Pauktuutit Women of Canada, Manitoba Métis Federation, Les Femmes Michif Otipemisiwak, Congress of Aboriginal Peoples, National Association of Friendship Centres

International partners

• e.g., United States Food and Drug Administration, United States Environmental Protection Agency, European Medicines Agency, World Health Organization, Pan-American Health Organization, United Nations Office on Drugs and Crime, Multilateral Regulatory Fora, International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, Global Research Collaboration for Infectious Disease Preparedness, Organisation for Economic Co-operation and Development

Health system stakeholders

• Health professionals (e.g., Canadian Medical Association, Canadian Nurses Association, Nurse Practitioners Association of Canada, Canadian Doctors for Medicare, Canadian Pharmacists Association, Local Medical Officers of Health, Canadian Dental Association, Canadian Dental Hygienists Association, Denturist Association of Canada, Canadian Pediatric Society)
• Health institutions (e.g., hospitals)
• Patient groups (e.g., Institute of Safe Medicine Practices Canada, Patients Canada, Children's Healthcare Canada)
• Health sector labour unions (e.g., Canadian Labour Congress, Professional Institute of the Public Service of Canada)

Research & academic stakeholders

• Universities and academic organizations (e.g., Association of Faculties of Medicine of Canada, Association of Faculties of Pharmacy of Canada, U15 Group of Canadian Research Universities, Universities Canada, Canadian Academy of Health Sciences, Canadian Black Scientists Network)
• Hospital-based research institutions (e.g., SickKids)
• Think tanks (e.g., Conference Board of Canada, Public Policy Forum)
• Health charities and research foundations (e.g., Juvenile Diabetes Research Foundation, Multiple Sclerosis Society, Gairdner Foundation)
• International research agencies (e.g., National Institutes of Health, European Commission)
• Provincial health research organizations: (e.g., The National Alliance of Provincial Health Research Organizations

Industry stakeholders

• Pharmaceutical and biologics (e.g., Innovative Medicines Canada, Canadian Generic Pharmaceutical Association, Group Purchasing Organizations, and distributors)
• Medical devices (e.g., Medtech Canada)
• Natural health products and non-prescription drugs (e.g., Canadian Health Food Association, Consumer Health Products Canada)
• Food products (e.g., Canadian Supply Chain Food Safety Coalition, Dairy of Farmers of Canada, Canadian Beverage Association)
• Pesticides (e.g., CropLife Canada)
• Cannabis (e.g. Cannabis Council of Canada, Canada Hemp Trade Alliance)
• Consumer products and cosmetics (e.g., Retail Council of Canada, Cosmetics Alliance Canada)
• Workplace hazardous products (e.g., Canadian Consumer Specialty Products Association, Canadian Paint and Coatings Association, Responsible Distribution Canada)
• Health insurance companies (e.g., Canadian Life and Health Insurance Association)
• E-health vendors (e.g., Maple, Telus)

Public health stakeholders

• Service providers (e.g., Center for Addiction and Mental Health, Kids Help Phone, Hope for Wellness)
• Non-governmental organizations and health charities (e.g., Canadian Red Cross, Health Charities Coalition of Canada, disease specific – Alzheimer Society of Canada, Heart & Stroke)
• National public health associations (e.g., Canadian Public Health Association, National Collaborating Centres on Public Health)
• Disease-based advocacy groups (e.g., Canadian Organization for Rare Disorders, Pain Canada)
• Disease prevention/health promotion (e.g., Canadian AIDS Society, YMCA Canada, ParticipACTION)
• People with lived and living experience (e.g., Canadian Association of People who Use Drugs, Community Addictions Peer Support Association, Black Health Education Collaborative)

6. Relationships with the international community

A. Overview of the Health Minister's role in the international community and portfolio engagement (global health and Canada-US)

Key points – global health

• Health is global. Infectious diseases and other health threats (e.g., air pollution, mosquito-borne diseases) don't stop at borders. Heart disease, diabetes, cancer, mental illness (to name a few) are serious concerns for high, middle, and low-income countries alike, impacting both health and the economy.
• Canada's efforts to manage health threats and mitigate health risks include important cooperation with other countries, international health organizations, and within the United Nations system where common challenges are shared. Canada also has important international treaty obligations to adhere to - the international health regulations and the framework convention on tobacco control – both held with the World Health Organization.
• Engagement in global health allows Canada to exercise leadership and build alliances through its scientific, regulatory, trade, and policy expertise in health care and public health. It also offers opportunities for Ministerial-level leadership to engage with key counterparts to influence health agendas and strengthen cooperation that has mutual benefit domestically and globally.

Health portfolio role

Engagement with multilateral, bilateral and regional partners supports the Portfolio's capacity to protect the health of Canadians, advance Canada's interests and benefit from cooperation and pooled resources, while acting to prevent, prepare and respond to emerging health threats.

• Maintain international commitments via joint initiatives, formal agreements, trade agreements and other mechanisms (e.g. global action plans, leader/ministerial declarations) with other countries and international organizations (see annex for active commitments)
• Maintain important membership in United Nations health fora (e.g., World Health Organization, Pan-American Health Organization)
• Maintain a diverse set of technical and policy dialogues & relationships with international counterparts (scientific, regulatory, trade and policy experts)
• Lead the Global Health Security Initiative's (GHSI) secretariat to facilitate real-time intelligence-sharing with G7 partners on a diverse range of public health outbreaks and biologic and chemical health threats; lead Canada's participation on the Pan-American Health Organization executive committee until 2026.
• Lead coordination of the Government of Canada's health-related G7 activities for the 2025 presidency and chair the G7 + group for the pandemic agreement negotiations.

Current status

• Global health cooperation is being significantly impacted by geo-political dynamics including current decisions being taken by President Trump's administration; by conflict (Ukraine, Middle East), and by regional power dynamics (China's growing influence). These factors are challenging the advancements of strengthening health systems globally and threatening global health security (e.g. risk of increased epidemics/pandemics).
• Through the work of the Health Portfolio, Canada is:
  • fostering an ongoing work program of international health cooperation by way of Canada's 2025 G7 presidency; while there are no new or specific health deliverables, working level health meetings are continuing;
  • cooperating via formal health agreements with other countries (e.g. Denmark, Taiwan, European Union, and South Africa — see annex A) and a diversity of international arrangements in regulatory and scientific domains;
  • pursuing domestic implementation of amendments to the international health regulations (2005) and engaging in the ongoing intergovernmental negotiating body (INB) to develop a new pandemic agreement to further bolster health security; and
  • defending and/or pursuing opportunities to strengthen domestic health interests via Government of Canada international trade negotiations including via the upcoming re-negotiations of Canada United States Mexico Agreement (CUSMA).

Key partners and stakeholders

Canada engages a wide range of domestic and international partners to manage threats and mitigate risks to our health security as well as to facilitate technical exchanges to strengthen health systems strengthening:

• Core United Nations (UN) - UN General Assembly
• UN agencies, funds, and programs - World Health Organization, Pan American Health Organization, United Nations Development Programme, Food and Agricultural Organization, UN Agency for HIV/AIDS
• Multilateral organizations - World Trade Organization, World Bank Group, Organisation for Economic Co-operation and Development
• Regional organizations - European Union, Caribbean Public Health Agency, Africa Centre for Disease Control
• Bilateral - United States [Health and Human Services, Federal Drug Administration, Environmental Protection Agency, Centres for Disease Control, National Institutes of Health], United Kingdom, France, Brazil, Australia, Japan, Denmark, Taiwan, South Africa
• Intergovernmental initiatives - Global Health Security Initiative, Global Health Security Agenda
• Intergovernmental political forums - Group of 7 (G7), Group of 20 (G20), Five Eyes (U.S., UK, New Zealand, Australia), Asia-Pacific Economic Cooperation
• Global public / private partnerships - Global Fund, Gavi, the Vaccine Alliance, Coalition for Epidemic Preparedness Innovation
• Philanthropic organizations - Bill and Melinda Gates Foundation, Wellcome Trust, Rockefeller Foundation, Grand Challenges Canada
• Civil society organizations - Médecins Sans Frontières, CANWACH, Global Strategy Lab, Action Canada for Sexual Health and Rights, Red Cross, Canadian Association for Global Health, Academic bodies
• Professional associations - International Association for National Public Health Institutes
• Domestic partners - Provinces and territories, Indigenous partners

Key milestones

Annex A – active bilateral agreements

Canada – U.S. health engagement

• The United States is Canada's most important bilateral partner in the health domain – a product of Canada's shared geography, deeply integrated economies, populations and health ecosystems, and asymmetric relations.
• For decades, close collaboration between Canada and the United States on health and public health – through data sharing, information exchange, regulatory and research synergies, technical cooperation and operational responses – has been critical to protecting domestic Canadian interests and advancing Health Portfolio priorities.
• The HP maintains relations with the U.S. Department of Health and Human Services (HHS) and its agencies.
• Since the pandemic, health cooperation with the U.S. has served Canada's domestic objectives in several critical areas, including the opioids epidemic, health emergencies, medical supply chains, health product and food regulation, and a range of global health priorities.
• The new Trump administration – bolstered by republican control of Congress – is pursuing policy directions and administrative reforms expected to impact Canadian interests and priorities in areas of HP responsibility.

Health Portfolio role

• The Health Portfolio fosters and maintains relationships with departments and agencies across the U.S. government – both within and beyond Human Health Services – on a range of health, public health, regulatory and other areas with significant impacts on health outcomes in Canada.
  • These connections are advanced through a combination of high-level engagement, policy alignment, program cooperation, and coordinated research, technical and operational activities.
• With leadership and direction from ministers, and in keeping with shared priorities (or irritants) raised with/by the Secretary of HHS, leads from across the Health Portfolio engage directly with U.S. counterparts to advance Canadian interests and priorities.
  • This includes extensive cooperation and sharing of information between Health Canada regulators and the Food and Drug Administration; Public Health Agency of Canada (PHAC) and the Centers for Disease Control and Prevention (CDC) on infectious disease; Canadian Food Inspection Agency and the U.S. Department of Agriculture on animal and plant health; and Canadian Institute of Health Research and the National Institutes of Health on research collaboration – among many other points of connection (see annex B for more illustrative examples).
• The pandemic accelerated Canada-U.S. cooperation in various areas of public health; it also raised the profile of HP files in the context of broader relations. For example, since 2021, PHAC exchanges with CDC on parallel efforts at post-COVID public health renewal have been especially active.

Background and current status

• Several executive actions have provided a clearer picture of directions likely to impact Canadian interests and HP mandates, including:
  • Tariffs / opioids epidemic: two executive orders linking 25% goods tariff with Canadian actions related to fentanyl, and a presidential memo ordering recommendations of "appropriate trade and national security measures to resolve that emergency [of unlawful fentanyl flows]" by April 1, 2025.
  • Global health: an executive order confirming the intention of the U.S. to withdraw from the World Health Organization (WHO) and cessation of negotiations on the WHO Pandemic Agreement and amendments to the international health regulations.
  • Chronic disease: an executive order creating the President's make America healthy again (MAHA) commission instructing departments and agencies that address health to focus on reversing chronic disease, and prioritizing recommendations from the new council on how to address the childhood chronic disease crisis.
• As further U.S. actions relevant to Canada's interests emerge, the Health Portfolio will continue to validate top risk areas (and mitigations), opportunities (and cooperation options) and related ongoing activities in support of ministerial-and senior-level engagement.

Why it matters to Canadians

• In the context of overall Canada-U.S. relations, health rarely receives the same attention as other portfolios (e.g. trade, border security, immigration); however, health and public health engagement and responsiveness can prove critical to Canadian interests within the wider bilateral context.
• Moreover, major shifts expanding U.S. executive powers and reforming HHS capacities and architecture may produce new risks, the impacts of which will require ongoing monitoring, assessment and response by the Health Portfolio.

Preparing for tariffs

• In preparation for a 25% goods tariff and retaliatory measures by Canada, the Health Portfolio has accelerated its assessment of health product and medical countermeasure (MCM) vulnerabilities and its development of mitigations including supply levers and contributions to an ISED-led "Buy Canadian" strategy.
• Stakeholders have underscored the fragility of the health product supply chain and the risk of increased costs and shortages on both sides of the border if tariffs are imposed.

Addressing the U.S. rationale

• To address the U.S. identification of illegal drug dynamics as the basis of the tariff threat, Health Canada is progressing on elements of the 2024 border plan that address U.S. concerns, including enhanced collaboration with the U.S. by the Canadian drug analysis centre.

In the medium-term trade context – e.g. CUSMA negotiations and 2026 review

• The HP serves as an advocate of Canadian interests with respect to, e.g. the protection of clinical data related to pharmaceuticals, limitation of patent terms, and barriers on low-risk drugs and natural health products – which implicate Canadians' privacy, drugs costs, and access to / quality of health products.

To prevent drug shortages – e.g. U.S. support for bulk imports of generics

• The HP is active bilaterally and domestically in response to U.S. actions supporting and sanctioning the development of state-level plans to import pharmaceuticals, which could contribute to shortages here.

On a responsive basis – e.g. August 2024 CDC dog import requirements:

• Working with CFIA, the HP helped coordinate high-level advocacy to prevent CDC's imposition of new dog importation requirements that would have impacted thousands of Canadians.

Annex A: presumptive Trump health appointees – pending senate confirmation

Robert F. Kennedy Jr.

• Secretary of the Department of Health and Human Services (HHS) – confirmed on February 13.
• Environmental lawyer and activist, known for vaccine skepticism, and desire to reshape public health and food policies.

Jim O'Neill

• Deputy Secretary of Health and Human Services (HHS).
• Investor and former HHS official known for advocating FDA reforms, freer healthcare markets, and advancing regenerative medicine.

Dr. Janette Nesheiwat

• U.S. Surgeon General
• Family and emergency medicine specialist and Fox News medical contributor known for public health advocacy, preventative care focus, and critiques of COVID-19 policies.

Dr. Martin (Marty) Adel Makary

• Commissioner of the Food and Drug Administration (FDA).
• Surgeon, public health professor, and author known for advocating lifestyle medicine, criticizing vaccine mandates, and promoting healthcare transparency.

Dr. David (Dave) Weldon

• Director for the Centers for Disease Control and Prevention (CDC).
• Physician, army veteran, and former congressman known for advocating vaccine safety reforms, fiscal responsibility, and social conservatism.

Dr. Jayanta (Jay) Bhattacharya

• Director of the National Institutes of Health (NIH).
• Professor and researcher of medicine, economics, and public health known for his work on COVID-19 policy and opposition to lockdowns.

Peter (Pete) Hoekstra

• U.S. Ambassador to Canada
• Former Michigan congressman and diplomat, known for his role as U.S. Ambassador to the Netherlands and Chair of the House Intelligence Committee.

Annex B: illustrative examples of Canada – U.S. health engagement

• Opioids and substance use: Health Canada with the White House Office of National Drug Control Policy (ONDCP)
• Regulatory cooperation: Health Canada with the U.S. Food and Drug Administration (FDA)
• Simultaneous reviews of oncology products (as part of project orbis) and veterinary drugs: Health Canada with the FDA
• Food safety: Health Canada and CFIA with the FDA and U.S. Department of Agriculture (USDA)
• Emerging and infectious diseases: PHAC with the Centers for Disease Control and Prevention (CDC)
• Health emergencies: PHAC with CDC and the U.S. Administration for Strategic Preparedness and Response (ASPR)
• Mental health: Health Canada with the Substance Abuse & Mental Health Services Administration (SAMHSA)
• Data collaboration: PHAC and CIHR with CDC and the U.S. National Institutes for Health Research
• Food inspection: CFIA with the FDA and U.S. Department of Agriculture (USDA)
• Environment and health: Health Canada with HHS and the U.S. Environmental Protection Agency (EPA)
• Global health diplomacy: Office of International Affairs for the HP (OIA) with HHS agencies, State Department

7. Commitments and priorities overview

A. Budget 2024 – Health Portfolio summary note

The Government of Canada presented budget 2024 in the House of Commons on April 16, 2024. In budget 2024, fairness for every generation, the Government of Canada is focusing on more affordable homes, lowering everyday costs such as groceries, economic growth, safer and healthier communities, a fair future for Indigenous peoples, protecting Canadians and defending democracy, and tax fairness.

A central theme of budget 2024 is "making life cost less" and "building a Canada that works for every generation". As part of this budget, health specific investment focus on enhancing health research system, strengthening health care (e.g., pharmacare, drug shortages, health workforce, opioid crisis, mental health) and protecting health and safety of Canadians (e.g., chemical management, pesticide safety). New programs to help with the cost of living include initiatives such as expanding loan forgiveness (e.g., dentists and pharmacists) and covering cost of contraceptives and insulin which are expected to strengthen Canada's social safety net. The budget also highlights achieving savings in federal public service through natural attrition while ensuring measures do not impact delivery of benefits to Canadians.

Implications for the Health Portfolio:

Budget 2024 announced a number of measures directly relevant to the Health Portfolio:

1. Health research investments (HC-SPB, CIHR)

Budget 2024 announced a total $2.5 billion over five years to strengthen research by Canada's granting councils. This includes:

• Increasing core research grant funding and supporting Canadian researchers through $1.8 billion over five years, with $748.3 million ongoing, to CIHR, NSERC, and SSCHRC;
• $825 million over five years, starting in 2024-25, with $199.8 million per year ongoing, to increase the annual value of student scholarships and fellowships;
• $26.9 million over five years and $6.6 million ongoing, with $26.6 million in remaining amortization, to the granting councils to establish an improved and harmonized grant management system;
• $30 million over three years to support Indigenous research and their communities, on a distinctions-basis;
• $45.5 million over five years, starting in 2024-25, to support the Arthur B. McDonald Canadian Astroparticle Physics Research Institute in its work in areas such as medical imaging;
• $30 million over three years, starting in 2024-25, to support the completion of the University of Saskatchewan's Centre for Pandemic Research. This investment will enable the study of high-risk pathogens to support vaccine and therapeutic development, a key pillar in Canada's biomanufacturing and life sciences strategy;
• $10 million for the Gairdner Foundation to support an endowment to increase prize values awarded by the Gairdner Foundation for excellence in health research; and
• $80 million over four years to Health Canada to support Brain Canada Foundation in its advancement of brain research.

In response to the recommendations of the advisory panel on the federal research support system, budget 2024 also highlighted the creation of the new capstone research funding organization.

• The granting councils will continue to exist within this new organization, and continue supporting excellence in investigator-driven research, including linkages with the Health portfolio. This new organization and structure will also help to advance internationally collaborative, multi-disciplinary, and mission-driven research. The government is delivering on the advisory panel's observation that more coordination is needed to maximize the impact of federal research support across Canada's research ecosystem.
• Further details of the new organization are expected in the Fall Economic Statement.

Budget 2024 also announced the establishment of an advisory council on science and innovation. This council will be made up of leaders from the academic, industry, and not-for-profit sectors, and be responsible for a national science and innovation strategy to guide priority setting and increase the impact of these significant federal investments.

2. Pharmacare (HC-SPB)

• $1.5 billion over five years to Health Canada, starting in 2024-25, to support the launch of the national pharmacare plan. This first phase will ensure the effective roll-out of pharmacare, while providing immediate support for health care needs of women (i.e., contraceptives), as well as people with diabetes.
  • The federal government will work towards implementing coverage of these essential medications through existing provincial and territorial pharmacare programs, following negotiations. New federal funding will expand and enhance, rather than replace, existing provincial and territorial spending on public drug benefit programs. This approach ensures that the unique needs and existing coverage plans of each province and territory are considered, advancing collaborative federalism where the federal, provincial, and territorial governments work together towards a common goal.
• Beyond support for diabetes medication, budget 2024 announced the federal government's plan to establish a fund to support access to diabetes devices and supplies. Further details regarding this fund will be announced following discussions with provincial and territorial partners, who will be essential to its roll-out.
• In addition to items that received funding, budget 2024 commits to making essential menstrual products more accessible through the work of the menstrual equity fund pilot project. This project helps food banks and other community organizations ensure women have the menstrual products they need. The government will announce further details in the 2024 Fall Economic Statement.

3. Drugs shortages (HC-ROEB)

• To mitigate the effects of health product shortages and expedite emergency responses when supply chain fails, budget 2024 announced $3.2 million over three years to upgrade Health Canada's supply management capacity for drugs and medical devices. Additional funding is to be re-allocated internally.

4. Health workforce - internationally-educated health professionals (HC-SPB)

• $77.1 million over four years, starting in 2025-2026 to effectively integrate internationally educated health care professionals into Canada's health workforce by creating 120 specific training positions, increasing assessment capacity and providing support to navigate credential recognition systems.

5. Ensuring continued access to the vaccine injury support program (PHAC)

• $36 million over 2 years, starting in 2024-2025, to the Public Health Agency of Canada.

6. Emergency treatment fund (HC-CSCB)

• $150 million over three years, starting in 2024-2025, to Health Canada, including $25 million for 2024-25 for an emergency treatment fund, open to municipalities and Indigenous communities to help provide rapid responses to emergent, critical needs related to the opioid crisis.

7. Kids help phone (PHAC)

• $7.5 million over three years, starting in 2024-25, to the Public Health Agency of Canada to support kids help phone in their work providing mental health, counselling, and crisis support to young people.

8. Youth mental health fund (HC/PHAC)

• $500 million over five years, starting 2024-2025 to launch a new youth mental health fund to help younger Canadians access mental health care. This includes $50 million for 2024-25.

9. Medical countermeasures facility (PHAC)

• $155 million over five years, plus $32 million last fiscal, to support ongoing research and preparedness for emerging public health threats. This is a reduction of funding based on a re-evaluation of the funding required to fulfill this commitment.

10. Sunsetters

Several programs that are sunsetting this fiscal year were extended, including:

• $39 million over two years to maintain the pesticides regulatory system and monitor and support sustainable pesticide use in Canada. This funding includes $32 million over two years to Health Canada (HC-PMRA)
• $190.9 million over two years for the chemical management plan, including $130 million over two years to Health Canada (HC-HECSB), to reduce human and environmental exposure to harmful chemicals.
• $23 million over three years for the public service occupational health program (PSOHP) to ensure federal organizations meet occupation health obligations under the Canada Labour Code (HC-CSB).
• $23 million over five years for the travelling public program to uphold sanitary standards on federally regulated passenger transportation (PHAC). $5 million of this is to be cost recovered.
• $49 million over two years to maintain the bovine spongiform encephalopathy (BSE) inspection program, including $1.6 million to the Public Health Agency of Canada and $2.3 million to Health Canada (CFIA-led).
• $4 million over two years, starting in 2024-25, to continue supporting initiatives through the mental health of Black Canadians fund that aim to increase health equity and address mental health and its determinants for Black Canadians (PHAC).

11. Other

The budget highlighted the bilateral agreements signed with provinces and territories under the working together plan, describing initiatives underway in each PT's action plan. (See annex). The budget also noted the projected growth of the Canada health transfer under the working together plan, as set out below.

Efforts to recognize foreign credentials for internationally-educated health professionals were also highlighted.

Additionally, the budget notes that government will work with health care professionals to lower administrative burden of obtaining a disability tax credit certificate.

Several initiatives led by the Health Portfolio were noted in the Budget even though they did not receive funding. These include:

• Introducing the Safe Long-Term Care Act to support new national long-term care standards to help ensure safe, reliable, and high-quality care, and improve infection prevention and control practices (HC-SPB)
• Canada's biosecurity oversight framework (PHAC/CFIA)
• The Canadian dental care plan roll-out (HC-OHB)

Legislative measures

In addition to funding, budget 2024 also noted several legislative amendments of interest to the Health Portfolio, including amendments to:

• The Federal-Provincial Fiscal Arrangements Act to implement the five per cent growth guarantee to the Canada health transfer for five years starting in 2023-24, for eligible jurisdictions (see image below for a year-over-year projection and breakdown);
• The Food and Drugs Act to:
  • provide the Minister of Health with the authority to exempt a person or product from certain requirements in the Food and Drugs Act and/or its regulations by ministerial order. This amendment would improve transparency when the minister chooses to exempt health products, such as infant formulas, from certain Canadian requirements to increase supply in the event of a shortage;
  • expand the governor-in-council regulation-making authority related to drug and medical device shortages to include foods for a special dietary purpose, such as infant formulas and human milk fortifiers;
  • provide the Minister of Health with the authority to rely on information or decisions of select foreign regulatory authorities in specific instances to satisfy requirements in the Food and Drugs Act and/or its regulations;
  • make the process of updating performance standards documents related to the remittance of fees more efficient and less labour intensive by ensuring the Act always refers to the latest version of performance standards documents incorporated by reference, rather than static documents only effective as of a certain date; and
  • address and prevent unintended and harmful uses of therapeutic products, such as preventing addictive nicotine replacement therapies from being marketed to youth.
• The Tobacco and Vaping Products Act to allow information sharing between government departments for the effective administration and enforcement of the forthcoming tobacco cost recovery framework;
• The Controlled Drugs and Substances Act to introduce amendments to streamline authorization of supervised consumption sites and drug checking services; and
• The Human Pathogens and Toxins Act to modernize the act and strengthen oversight of human pathogens and toxins.

Tax measures

Budget 2024 announced several tax measures related to health, including:

• adding psychotherapists and counselling therapists to the list of health care practitioners whose professional services rendered to individuals are exempt from the goods and services tax/harmonized sales tax (GST/HST);
• increasing the tobacco excise duty rate by $4 per carton of 200 cigarettes (i.e., for a total of $5.49 including the automatic inflationary adjustment of $1.49 per carton of 200 cigarettes that took effect on April 1, 2024), along with corresponding increases to the excise duty rates for other tobacco products;
• amending the Excise Tax Act to repeal the temporary zero-rating of certain face masks or respirators and certain face shields under the GST/HST. The temporary relief announced in the 2020 Fall Economic Statement was proposed to be in effect until the use of face coverings was no longer broadly recommended by public health officials for the COVID-19 pandemic. This measure would apply to supplies made on or after May 1, 2024;
• amending the Income Tax Act to extend eligibility for the CCB in respect of a child for six months after the child's death (the "extended period"), if the individual would have otherwise been eligible for the CCB in respect of that particular child. The extended period would also apply to the child disability benefit, which is paid with the CCB in respect of a child eligible for the disability tax credit; and
• an exemption from the AMT for trusts established under, or where the beneficiaries are any combination of the following persons or entities, including a registered charity or a non-profit organization that is organized and operated primarily for health, education, social welfare, or community improvement for the benefit of the members of an Indigenous group, community, or people that holds rights recognized and affirmed by section 35 of the Constitution Act, 1982.

Measures from other government departments of relevance to the Health Portfolio

In addition to the announcements made on internationally educated health professionals, budget 2024 announced two other initiatives to expand the reach to more health care and social services professionals:

• Budget 2024 proposes to provide $50 million over two years, starting in 2024-25, to Employment and Social Development Canada for the foreign credential recognition program. At least half of this amount will be to streamline foreign credential recognition in the construction sector to help skilled trades workers build more homes, and the remaining funding will support foreign credential recognition in the health sector.
• Budget 2024 announces the government's intent to introduce amendments to the Canada Student Financial Assistance Act and the Canada Student Loans Act to permanently expand the reach of the Canada student loan forgiveness program to more health care and social services professionals working in rural and remote communities. The cost of this measure is estimated to be $253.8 million over four years, starting in 2025-26, and $84.3 million ongoing. This is in addition to new student loan forgiveness for rural and remote early childhood educators, and recently expanded student loan forgiveness for doctors and nurses in rural and remote communities.
• Budget 2024 also proposes $281.3 million over five years, starting in 2024-25, with $216 million in future years, for DND for a new electronic health record platform for military health care.

Indigenous health

To ensure First Nations and Inuit across the country have fair and equal access to the health care they deserve, budget 2024 proposes to provide:

• Budget 2024 proposes to provide $167.5 million over two years, starting in 2023-24, to ensure Inuit children can access the health, social, and educational services they need, when they need them. The government continues to work with Inuit partners to advance the long-term vision of the Inuit child first initiative so that Inuit children will continue to receive timely, high-quality services;
• $60 million over two years, starting in 2024-25, to support friendship centres, across the country, which provide much-needed supports and services to members of their communities across a range of areas including health, housing, education, recreation, language, justice, employment, economic development, culture, and community wellness;
• $562.5 million in 2024-25 to support medically necessary services through the non-insured health benefits program, which supports a range of benefits for First Nations and Inuit people, including mental health services, medical travel, medications, and more;
• $390.4 million over four years, starting in 2024-25, to build or renovate health facilities, including to support the virtual health bub led by the Saskatchewan Indian Institute of Technologies. This funding will also improve the safety of primary care workers in remote and isolated on reserve First Nations communities;
• $104.9 million over five years, starting in 2024-25, for health transformation initiatives to support First Nations self-determination in the design and delivery of health services in their communities;
• $57.5 million over three years, starting in 2024-25, which builds on previous federal investments to construct a mercury care home in Grassy Narrows First Nation;
• $630.2 million over two years, starting in 2024-25, to support Indigenous people's access to mental health services, including through distinctions-based mental wellness strategies; and
• $167.6 million over five years, starting in 2024-25, to combat anti-Indigenous racism in health care to help ensure Indigenous peoples are treated with the respect and safety they deserve.

Artificial intelligence (AI)

To secure Canada's AI advantage, budget 2024 announces a monumental increase in targeted AI support of $2.4 billion, including $2 billion over five years, starting in 2024-25, to launch a new AI compute access fund and Canadian AI sovereign compute strategy, and $200 million over five years, starting in 2024-25, to boost AI start-ups to bring new technologies to market, and accelerate AI adoption in critical sectors, such as agriculture, clean technology, health care, and manufacturing. This support will be delivered through Canada's regional development agencies.

Supporting the care economy

• Budget 2024 proposes a sectoral table on the care economy that will consult and provide recommendations to the federal government on concrete actions to better support the care economy, including with regard to early learning and child care.
• Budget 2024 also announces the government's intention to launch consultations on the development of a national caregiving strategy.

Food insecurity

Budget 2024 announced several measures related to food insecurity, including:

• $23.2 million in 2024-25, to Crown-Indigenous Relations and Northern Affairs Canada for nutrition north Canada's subsidy program to lower the cost of nutritious food and other essential household items;
• $101.1 million over three years starting in 2024-25, to support the harvesters support grant and community food program fund and promote Indigenous communities in implementing culturally appropriate, local solutions to address food insecurity;
• the creation of a national school food program, which will provide $1 billion over five years to Employment and Social Development Canada, Crown-Indigenous Relations and Northern Affairs Canada, and Indigenous Services Canada, starting in 2024-25, to work with provinces, territories, and Indigenous partners to expand access to school food programs. This includes investments for First Nations, Inuit, and Métis communities as well as self-governing and modern treaty partners, many of whom have some of the highest rates of food insecurity in Canada.
• $62.9 million over three years, starting in 2024-25, to renew and expand the local food infrastructure fund to support community organizations across Canada to invest in local food infrastructure, with priority to be given to Indigenous and Black communities, along with other equity-deserving groups. Part of the expansion will support community organizations to improve infrastructure for school food programs as a complement to the national school food program.

Canada's action plan on combatting hate

Budget 2024 proposes to provide $273.6 million over six years, starting in 2024-25, with $29.3 million ongoing, for Canada's action plan on combatting hate to support community outreach and law enforcement reform, tackle the rise in hate crimes, enhance community security, counter radicalization, and increase support for victims.

• As part of this action plan, budget 2024 proposes to provide $7.3 million over six years, starting in 2024-25, with $1.1 million ongoing, to the Department of Canadian Heritage to support the special envoy on preserving holocaust remembrance and combatting antisemitism. This builds on previous funding in budget 2022 of $5.6 million over five years, starting in 2022-23, and $1.2 million ongoing.
• In addition, budget 2024 proposes to provide $7.3 million over six years, starting in 2024-25, with $1.1 million ongoing, to the Department of Canadian Heritage to support the special representative on combatting islamophobia. This builds on previous funding in budget 2022 of $5.6 million over five years, starting 2022-23, and $1.2 million ongoing.

Canada disability benefit

• Budget 2024 announced the creation of a new Canada disability benefit. The budget proposed funding of $6.1 billion over six years, beginning in 2024-25, and $1.4 billion per year ongoing, including costs to deliver the benefit.
• Payments will begin to be provided to eligible Canadians starting in July 2025, following successful completion of the regulatory process and consultations with persons with disabilities.
• To ensure access to the Canada disability benefit for eligible Canadians, and to address an anticipated significant financial barrier associated with benefit take-up, Budget 2024 further proposes funding of $243 million over six years, beginning in 2024-25, and $41 million per year ongoing, to cover the cost of the medical forms required to apply for the disability tax credit.

Governance

To implement the second phase of refocusing government spending, budget 2024 announces the government will seek to achieve savings primarily through natural attrition in the federal public service.

• Starting on April 1, 2025, federal public service organizations will be required to cover a portion of increased operating costs through their existing resources.
• Over the next four years, based on historical rates of natural attrition, the government expects the public service population to decline by approximately 5,000 full-time equivalent positions from an estimated population of roughly 368,000 as of March 31, 2024.
• Altogether, this will achieve the remaining savings of $4.2 billion over four years, starting in 2025-26, and $1.3 billion ongoing towards the refocusing government spending target.

Budget 2024 also noted funding to implement legislative amendments to the Canada Labour Code that would require employers in federally regulated sectors to establish a right to disconnect policy limiting work-related communication outside of scheduled working hours. This is expected to benefit up to 500,000 employees in federally regulated sectors.

B. Fall Economic Statement 2024

Overview

On December 16, 2024, the Government of Canada tabled the Federal Economic Statement (FES). The government highlighted its commitment to responsible fiscal management and outlined targeted investments to provide short-term relief, while laying the groundwork for a more productive economy in the years to come. The FES also included a number of investments related to health, including initiatives focused on Indigenous health, food safety and physical activity

Economic update

The FES states that Canada is well positioned, both economically and institutionally, to manage the current high global uncertainty and a complex geopolitical landscape.

The FES focused on four key pillars:

• making generational investments to equip Canadians for success in the workforce while reducing everyday costs;
• securing Canada's AI advantage;
• overcoming geopolitical risks and uncertainty, and adapting to a rapidly shifting global trade landscape; and
• ensuring Canada is leading in the global competition for capital needed for the industrial transition.

Health Portfolio highlights

In terms of items of interest to the Health Portfolio, the 2024 FES provides an update on the federal government's investments in:

Health workforce

• The government signalled its intent to consider a similar standard setting framework as the red seal trade program to enable the mobility of health care workers across the country.
• The FES states that provinces and territories have not agreed to bilateral deals to raise the wages of personal support workers, and therefore the federal government announced its intention to introduce a new refundable tax credit for personal support workers, potentially modelled on the design of the tax credit for volunteer firefighters. To implement this measure, the government intends to introduce legislation as soon as possible. Further details will be announced in due course.
• The federal government announced it is considering further measures to create a more nimble and resilient labour market, that supports newcomer integration into their chosen professions, including by removing the tax-exempt status of regulatory colleges that do not accelerate credential recognition and publishing a national credential recognition performance framework.

Health system

• Consistent with budget 2024, the Canda health transfer is projected to increase from $52.1 billion in 2024-25 to $65.3 billion in 2029-30, supported by the CHT growth guarantee of at least 5 per cent for five years (in effect from 2023-24 to 2027-28), after which it will grow in line with a three-year moving average of nominal GDP growth, with funding guaranteed to grow by at least 3 per cent per year.
• Protecting women's reproductive health, by providing $90 million over six years, with $20 million ongoing, to expand and make permanent the sexual and reproductive health fund, and $7.5 million over four years to run new surveys about sexual and reproductive health and rights.
• Health Canada to source from existing departmental resources to support Canada Health Infoway to launch a clinician adoption incentive program to encourage uptake of AI scribes.
• Establishing Canada's Black justice strategy, to help protect Black communities from prejudice, discrimination, and hatred. The 2024 fall economic statement proposes to provide $77.9 million over two years to reduce the injustices faced by Black Canadians. This includes $8.8 million over two years, starting in 2025-26, for Health Canada to expand culturally-appropriate mental health supports and substance use and addictions programming for Black Canadians.
• $30 million for the vital real-time health computing infrastructure for trials, artificial intelligence, and a learning health system (VITAL) to pilot a secure digital AI infrastructure to leverage Canadian health data.

Dental

• FES 2024 highlighted $165 million as administrative funding for the Canadian dental care plan in 2025-26 that was provided since budget 2024.

Public health

• Funding of $5 million in 2025-26 for the Public Health Agency of Canada (PHAC) to support ParticipACTION's promotion of physical activity for people of all ages and abilities.
• $2 million in 2025-2026 to PHAC to support AIDE Canada to connect members of the autism and intellectual disability community to information and resources.
• FES 2024 noted that the federal government expects to record $1.2 billion in 2023-24 for the write-down by PHAC of expired COVID-19 vaccines and therapeutics.

Modernizing federal research ecosystem

• While there were few additional details on the proposed capstone research funding organization, FES 2024 noted that a recent What We Heard report is informing the final stages of development of the new capstone research funding organization announced in budget 2024 and that further details will be announced in the coming months.
• FES 2024 also reaffirms a commitment to introduce legislation to legislate the role and mandate of the chief science advisor.

Environmental safety

• $3 million per year from 2025-2026 to 2028-2029 to Health Canada to support national framework on cancers linked to firefighting.

Indigenous health

• Funding to Indigenous Services Canada to support Weeneebayko Area Health Authority hospital redevelopment project in northern Ontario.

Food safety, agriculture and agri-food

• $27 million in 2024-2025 to the Canadian Food Inspection Agency (CFIA) to support response to avian influenza.
• $4.3 million over three years, starting in 2025-26, to the CFIA to advance mutual recognition in the agriculture and agri-food sector and support businesses in building capacity to meet federal regulations and expand trade across the country.
• Proposes to amend the Farm Credit Canada Act to require regular legislative reviews to ensure alignment with the needs of the agriculture and agri-food sector.

Regulatory red tape

• To reduce unnecessary barriers to innovation, productivity, and economic growth, and lower regulatory costs for Canadians and Canadian businesses, the 2024 Fall Economic Statement proposes to provide $27.8 million over five years, starting in 2025-26, for a new red tape reduction office, sourced from existing resources of the Treasury Board Secretariat. The red tape reduction office will prioritize work in key sectors including medicine and health.
• To cut red tape for growing businesses and help them to succeed, the 2024 Fall Economic Statement also announces the government's intent to explore a transition from cannabis excise duty stamps specific to each province and territory to a single, national stamp. This would make it easier for regulated cannabis producers to ignite new business opportunities in other provinces. More details will roll out in budget 2025.

Border safety, Canada-United States relations and international relations

• The FES proposes to provide a $1.3 billion comprehensive border security package to Public Safety Canada, the Canada Border Services Agency, the Communications Security Establishment, and the Royal Canadian Mounted Police.
• The immediate priorities will be to strengthen our deeply integrated trading relationship and to work collaboratively with the U.S. to continue to secure our shared border. Canada and the U.S. remain aligned in protecting workers from the effects of China's deliberate overcapacity strategy and ensuring supply chain resilience in response to China's use of non-market policies and practices to enhance its strategic position in global supply chains.

Health care support for asylum claimants and refugees

• The FES proposes to provide $233 million in 2024-25 and $584 million in 2025-26 to Immigration, Refugees and Citizenship Canada for health care support for asylum claimants and refugees.

Federal public service

• Launch of a strategic review of government operations and programs with a focus on expanding the use of AI in the public service to improve both efficiency and service delivery. The review will be led by the AI secretariat, and results will be announced in budget 2025.
• Budget 2024 announced the second phase of savings from refocusing government spending would be achieved primarily through natural attrition in the federal public service. This work will begin showing results in 2025-26.

Fiscal sustainability

In 2023-24, the government is projected to record significant unexpected expenses related to Indigenous contingent liabilities. Absent these expenses, and allowances for COVID-19 pandemic supports, the 2023-24 budgetary deficit would have been approximately $40.8 billion, compared to the budget 2024 projection of $40 billion. However, the higher-than-anticipated provisions for these two categories add accounting charges of $21.1 billion.

In the 2024 Fall Economic Statement, the government's sought to maintain the fiscal anchor and achieve the ongoing fiscal objective set out in budget 2024 to keep the deficit under 1 per cent of GDP in 2026-27 and future years. Specifically:

• The deficit-to-GDP ratio is expected to fall to under 1 per cent of GDP in 2026-27, consistent with the ongoing fiscal objective set out in budget 2024.
• The federal debt-to-GDP ratio in 2023-24 was 42.1 per cent, exactly as forecast in budget 2024, reflecting stronger than expected economic growth after historical revisions. This ratio for 2024-25 is forecast to decline to 41.9 per cent, also matching budget 2024 projections.
• Public debt charges as a share of the economy are expected to continue to remain near historically low levels.

Moving forward, the government will continue to focus on the objective of maintaining the deficit below 1 per cent of GDP beginning in 2026-27 and future years—in addition to its fiscal anchor.

The full text of the FES is available online, here: 2024 Fall Economic Statement

8. Issues for early attention

Officials are prepared to brief you on the following key issues which will require your early attention:

Health care system

Canada's health care system is under enormous strain. Over 6 million Canadians do not have access to a regular health care provider.

Provinces and territories (PTs) are responsible for delivering health care services to Canadians but the federal government has a key role in contributing long-term, predictable funding through the Canada health transfer and bilateral agreements to provinces and territories, funding pan-Canadian health organizations, and convening partners to help address key health system challenges.

Officials will brief you on the current state of Canada's health care system and options within the federal remit to address current challenges.

Health workforce

A well-supported health workforce is critical to the functioning of Canada's health care systems. Growing demand for care is outpacing the supply of available health workers. On top of that, the COVID-19 pandemic exacerbated job stress and burnout of health workers.

When Canadians can't access timely care, they turn to costly alternatives such as emergency rooms, which puts a greater strain on already overwhelmed acute care systems.

Officials will brief you on efforts underway, in collaboration with provinces and territories and key health partners, to help address health workforce challenges, including with respect to training and retention, labour mobility, foreign credential recognition, data, and planning.

Medical assistance in dying

Medical assistance in dying (MAID) is a health service delivered by PT health systems as part of end-of-life or complex care, and available to eligible Canadians suffering intolerably from a medical condition to end their life.

Health Canada works closely with PTs and stakeholders to support the safe and appropriate implementation of MAID in Canada. It also collects and reports on data on the number and circumstances of MAID requests and provisions annually.

PTs are currently working to prepare for the planned expansion of MAID eligibility for individuals whose sole underlying condition is mental illness, slated to take place in March 2027. At the same time, in October 2024, Quebec brought into force its provincial legislative framework for advance requests for MAID. An advance request is a request for MAID by an individual who still has capacity to make health care decisions but is not yet eligible for MAID. Their intent is that MAID be provided in the future after they have lost the capacity to consent but are eligible to receive MAID, and when certain conditions that they specify in their advance request are met. Under the current legal framework set out in the Criminal Code, the provision of MAID through an advance request is not permitted.

Canadians recently had an opportunity to share their perspectives on the issue of advance requests. Officials will brief you on outcomes from these conversations.

Pharmacare

An estimated 21% of Canadians lacked adequate coverage of prescription drugs in 2021, meaning they reported not having adequate insurance to cover the cost of prescription medications in the past 12 months.

The Pharmacare Act, which received royal assent on October 10, 2024, outlines an approach to future discussions on prescription drug coverage with PTs, Indigenous peoples, and other partners; information gathering; and a coverage standard for a range of diabetes and contraception drugs and devices. The Government of Canada has also reached agreements with Manitoba, British Columbia and Prince Edward Island to provide free, universal, single-payer access to a range of contraceptives and diabetes medications.

In addition, the government launched the national strategy for drugs for rare diseases, aimed at improving access to effective drugs for rare diseases (DRD), an essential element in providing treatment options and ensuring successful patient care for people suffering from rare medical conditions. The strategy is currently in the first year of full implementation with the recent signing of several FPT bilateral agreements.

Officials will brief you on current efforts to ensure Canadians can have access to the medications they need.

Dental care

Health Canada is administering oral health programming to Canadians, which consists of the Canadian dental care plan (CDCP) and the oral health access fund (OHAF).

The CDCP helps to ease financial barriers to accessing oral health care services and aims to make the cost of dental care more affordable for uninsured individuals with annual family net incomes under $90,000. As of January 28, 2025, 3.2 million Canadian residents have been enrolled for CDCP coverage.

The OHAF is a grants and contributions program that complements the CDCP by investing in targeted measures to address oral health gaps among vulnerable populations and helping to reduce non-financial barriers to accessing care, including in rural and remote communities.

Officials will brief you on current status of the CDCP and the OHAF.

Overdose crisis response, including Canada's border plan

Canada is facing the scourge of a drug overdose crisis. Over 49,000 people have died from opioid toxicities since 2016. In the last five years, 21 people died each day, on average, impacting families and communities across the country. The highly toxic illegal drug supply, including fentanyl and fentanyl analogues, continues to be a key driver of overdose deaths – both in Canada and the US.

Detecting and disrupting the fentanyl trade is a key component of Canada's border plan, including Health Canada's actions to better detect, analyze, monitor and control the movement of fentanyl, other illegal drugs and precursors.

The crisis has been exacerbated by an evolving mental health crisis, unmanaged pain, and housing instability and affordability. Lack of access to treatment, and fragmentation of substance use services means that Canadians often cannot get treatment where and when they are ready.

Officials will brief you on efforts underway to respond to the crisis with a wide range of actions, including public health as well as enforcement measures to combat both demand for as well as the illegal drug supply.

Mental health

Mental illness affects 1 in 5 Canadians annually, with 1 in 2 Canadians having experienced a mental health challenge by the age of 40. Young people, especially those aged 15-24, face the highest rates of mental health and substance use disorders.

The Health Portfolio plays a critical role to support effective and equitable mental health policy and practice, by providing funding to PTs and community organizations, supporting interjurisdictional collaboration and funding research.

Officials will brief you on federal efforts to support mental health in Canada.

G7 and the World Health Assembly

Canada assumed the presidency of the G7 on January 1, 2025. The G7 leaders' summit will be in Kananaskis, Alberta, from June 15 to 17, where Canada will work with G7 partners on common priorities, such as building economies that benefit everyone, fighting climate change, and managing rapidly evolving technologies.

Three Health Portfolio organizations provide health services and related security supports for international major events as part of their federally legislated authorities and delegated responsibilities. This includes ensuring 24-hour emergency medical services and food surveillance (Health Canada); emergency preparedness and response (Public Health Agency of Canada) and import requirements of products at points of entry (Canadian Food Inspection Agency).

The Health Portfolio is working closely with federal partners, the Government of Alberta, Indigenous partners, municipalities and local health partners. Officials will brief you on preparations to support the upcoming G7 meetings.

Additionally, the World Health Assembly (WHA) is scheduled to take place in May 2025. Canada's official delegation to the WHA is often headed at the Ministerial or deputy level. Officials will brief you on key Canadian priorities for the upcoming WHA.

9. Upcoming tablings and appointments

A. Reports to be tabled in Parliament

The Minister of Health must table reports and other documents in Parliament on a variety of subjects under his or her purview. Most often, this involves tabling annual reports related to key activities under the responsibility of the Health Portfolio and related organizations to inform Parliament and Canadians about areas of government activity or spending.

The requirement to table a report is typically found in statute or standing order of the House of Commons. In these cases, the report can be provided to Parliament through a "back-door tabling" (i.e. the department provides the report to Parliament via the clerks of the House of Commons and Senate). In other cases, the requirement is set out in a funding agreement or Treasury Board policy and must go through a "front-door tabling" (i.e. the minister must table the report in the House of Commons during routine proceedings).

The following table provides an overview of the reports that could be tabled in Parliament in spring 2025.

• House of Commons standing order 109 requires the government to table a comprehensive response to a report from a standing or special committee within 120 days of it being presented in the House of Commons (2 of the 3 reports below are government responses).
• Pursuant to House of Commons standing order 49, requests for documents that come from an order of the house do not die on prorogation. This provision applies to government responses to committee reports and to petitions.

Material will be provided to the Minister to seek approval of the following reports, and officials are ready to brief the Minister on the tabling process.

B. Governor in council (GIC) appointments

Decisions on governor in council appointments

The following document outlines the current governor in council vacancies where the appointments require Ministerial consideration in the next year. Officials are prepared to brief you on the following appointments and the appointment process, especially those requiring immediate attention.

1. Chief public health officer (CPHO), Public Health Agency of Canada (PHAC) – lead: Minister of Health

The CPHO plays a key leadership role in the achievement of PHAC's mandate and Canada's ability to effectively plan and respond to public health threats, outbreaks and emergencies. The chief public health officer advises the Minister of Health, the Minister of Mental Health and Addictions and the President of the Public Health Agency of Canada on health issues.

The incumbent's term will expire on June 20, 2025, and will not seek reappointment.

2. Canadian Centre on Substance Use and Addiction (CCSA) board of directors – lead: Minister of Mental Health and Addictions

A volunteer board of directors is responsible for governing CCSA. The directors meet face-to-face three to four times per year.

The governor in council appoints the chair and up to four additional board members may be appointed. These appointments come on the recommendation of the Minister of Health after the minister has consulted with the board.

There are three upcoming vacancies (the chair and two directors) in November/December 2025. They are not eligible for reappointment.

3. Patented Medicine Prices Review Board (PMPRB) – lead: Minister of Health

The members of the PMPRB, including the chairperson, are responsible collectively for the implementation of the applicable provisions of the Patent Act.

The chairperson stepped down from his role on March 6, 2025, to pursue other opportunities. The vice-chairperson has assumed the duties of acting chairperson until a permanent replacement is appointed by the governor in council.

4. Member, National Seniors Council (NSC) – co-lead: Minister of Health (with Minister of Seniors)

The National Seniors Council (NSC) was established in 2007 by an order in council to advise the government, through the Minister of Seniors and the Minister of Health, on matters related to the well-being and quality of life of seniors including opportunities arising from a rapidly growing and increasingly diverse aging population.

The NSC currently has one vacant member position, and the terms of six members will expire in the coming year. Options to address these vacancies will be provided to your office by the Minister of Seniors, via Employment and Social Development Canada (ESDC).

5. Members, Governing Council of the Canadian Institutes of Health Research (CIHR) – lead: Minister of Health

Governing council members develop the strategic directions, goals and policies of the CIHR; they evaluate the CIHR's overall performance, including with respect to the achievement of its objectives; approve the Institute's budget; and are responsible for establishing the mandate and evaluating the performance of the Institutes.

There is currently one vacant positions on the CIHR governing council. Options to fill this position will be provided to your office for consideration.