Supplementary Information Tables 2021-2022 Departmental Results Report: Health Canada

Table of Contents

• Reporting on Green Procurement
• Details on Transfer Payment Programs
  • Transfer Payment Programs of $5 Million or More
    • Addressing Racism and Discrimination in Canada's Health Systems Program
    • Canada Brain Research Fund Program
    • Canadian Thalidomide Survivors Support Program
    • Contribution to Canada Health Infoway
    • Contribution to Improve Health Care Quality and Patient Safety
    • Contribution to the Canadian Agency for Drugs and Technologies in Health
    • Contribution to the Canadian Institute for Health Information
    • Contribution to the Canadian Partnership Against Cancer
    • Contribution to the Canadian Foundation for Healthcare Improvement
    • Contribution to the Canadian Patient Safety Institute
    • COVID-19 Safe Restart Agreements Program
    • Health Care Policy and Strategies Program
    • Mental Health Commission of Canada Contribution Program.
    • Official Languages Health Program
    • Organs, Tissues and Blood Program
    • Strengthening Canada's Home and Community Care and Mental Health and Addiction Services Initiative
    • Substance Use and Addictions Program
    • Territorial Health Investment Fund
  • Transfer Payment Programs under $5 Million
    • Climate Change and Health Adaptation Capacity Building Program
    • Improving Affordable Access to Prescription Drugs Program
    • Innovative Solutions Canada
    • Radon Outreach Contribution Program
• Gender-Based Analysis Plus
  • Section 1: Institutional GBA Plus Capacity
  • Section 2: Gender and Diversity Impacts, by Program
    • Definitions
    • Core Responsibility 1: Health Care Systems
      • Program Name: Access, Affordability, and Appropriate Use of Drugs and Medical Devices
      • Program Name: Brain Research
      • Program Name: Canada Health Act
      • Program Name: Cancer Control
      • Program Name: Digital Health
      • Program Name: Health Care Systems Analysis and Policy
      • Program Name: Health Information
      • Program Name: Home, Community and Palliative Care
      • Program Name: Medical Assistance in Dying
      • Program Name: Mental Health
      • Program Name: Organs, Tissues and Blood
      • Program Name: Patient Safety
      • Program Name: Promoting Minority Official Languages in the Health Care Systems
      • Program Name: Thalidomide
      • Program Name: The Territorial Health Investment Fund (THIF)
    • Core Responsibility 2: Health Protection and Promotion
      • Program Name: Air Quality
      • Program Name: Biologic and Radiopharmaceutical Drugs
      • Program Name: Cannabis
      • Program Name: Climate Change
      • Program Name: Consumer Product Safety
      • Program Name: Controlled Substances
      • Program Name: Food and Nutrition
      • Program Name: Health Impacts of Chemicals
      • Program Name: Medical Devices
      • Program Name: Natural Health Products
      • Program Name: Pesticides
      • Program Name: Pharmaceutical Drugs
      • Program Name: Radiation Protection
      • Program Name: Specialized Health Services and Internationally Protected Persons Program
      • Program Name: Tobacco Control
      • Program Name: Water Quality
      • Program Name: Workplace Hazardous Products
• Horizontal Initiatives
  • Addressing the Opioid Crisis
  • Canadian Drugs and Substances Strategy
  • Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis
• Response to parliamentary committees and external audits
  • Response to parliamentary committees
  • Response to audits conducted by the Office of the Auditor General of Canada (including audits conducted by the Commissioner of the Environment and Sustainable Development)
  • Response to audits conducted by the Public Service Commission of Canada or the Office of the Commissioner of Official Languages
• Up-front multi-year funding
  • Canadian Foundation for Healthcare Improvement
  • Canada Health Infoway

Reporting on Green Procurement

This supplementary information table supports reporting on green procurement activities in accordance with the Policy on Green Procurement.

Health Canada is bound by the Federal Sustainable Development Act and was required to develop a 2020 to 2023 Departmental Sustainable Development Strategy (DSDS). Health Canada has developed its corresponding 2021-22 DSDS Report, including applicable reporting on green procurement activities. This report can be found on Health Canada's website.

Details on Transfer Payment Programs

Transfer Payment Programs of $5 Million or More

Addressing Racism and Discrimination in Canada's Health Systems Program

General information

Name of transfer payment program

Addressing Racism and Discrimination in Canada's Health Systems Program

Start date

January 28, 2022

End date

March 31, 2024

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2021-22

Link to the departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 1: Health Care Systems Analysis and Policy

Purpose and objectives of transfer payment program

The Addressing Racism and Discrimination in Canada's Health Systems Program aims to address systemic racism and discrimination in Canada's health systems to advance Health Canada's overall mandate to help everyone in Canada maintain and improve their health by striving to ensure high quality health services are efficient and accessible, and by reducing health inequalities.

The objectives of the Program are to address systemic racism and discrimination and advance health equity for racialized and marginalized populations in Canada's health systems. To achieve its objectives, the Program will provide support to eligible organizations through two distinct streams of funding:

1. Project stream: To improve the safety, accessibility, equity, quality, sustainability, and accountability of Canada's health systems, investments will be made in systems-level projects that address racism and discrimination perpetrated against racialized and/or marginalized populations.
2. Engagement stream: To maintain strong and effective publicly funded health systems through the development of policies and strategies that address evolving health priorities, investments will be made to build capacity within racialized and/or marginalized communities and organizations that serve racialized and/or marginalized populations to enable them to meaningfully engage on their health priorities to ensure that their priorities and perspectives are adequately considered by health-decision makers.

Results achieved

Health Canada established this Program in January 2022 and will be launching the inaugural Call for Proposals in 2022-23.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The timing for the evaluation will be determined during the development of a future Departmental Evaluation Plan.

Initiatives to engage applicants and recipients

Health Canada launched the call for proposals on April 4, 2022 through an online solicitation and with information located on a Canada.ca web page. At the same time, officials sent an email blast to a broad range of stakeholders and potential applicants to inform them of the launch. The call for proposals was initially open for six weeks and set to close on May 15, 2022. However, based on feedback from potential applicants the deadline was extended to May 25, 2022. Officials are currently assessing the applications and reaching out to applicants where information is missing or additional information is needed in order to properly assess the application.

Canada Brain Research Fund Program

General information

Name of transfer payment program

Canada Brain Research Fund Program

Start date

April 1, 2011

End date

March 31, 2026

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2021-22

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care systems

Link to the department's Program Inventory

Program 13: Brain Research

Purpose and objectives of transfer payment program

Through Budgets 2011, 2016, and 2019, and a subsequent funding renewal in 2021, the Government of Canada committed up to $200 million, to be matched by non-federal government donors, for the Canada Brain Research Fund Program. The Program provides funding for the Brain Canada Foundation (Brain Canada) which fundraises to match the federal contribution with donations from its private and charitable-sector donors and partners. The Government of Canada's objectives in funding the Canada Brain Research Fund are: 1) to serve as a focal point for private investment in brain research by attracting private and charitable donations to match federal funding; and, 2) to support research that advances knowledge of the brain through grants to researchers.

Results achieved

The Canada Brain Research Fund continued to support research with the greatest potential to lead to scientific discoveries that improve the health and quality of life of Canadians at risk of, or affected by, brain health conditions. Brain Canada, the sole recipient of the fund, works in partnership with a range of donors from across the private and charitable sectors, to provide competitively awarded funding for research across Canada. In 2021-22, despite the challenges posed by the COVID-19 pandemic, Brain Canada collaborated with institutions, health charities and donors, research networks, provincial agencies, and corporations to raise $8 million in funds, completing their obligation to match $36 million in federal funding from 2020 to 2022. Brain Canada also disbursed $25 million in support of 110 research grants and awards, including matched funds.

In 2021-22, Brain Canada launched 13 research competitions to support basic, clinical, and implementation research. These included targeted competitions focusing on mental health, Alzheimer's, and ALS, and open competitions that allowed researchers to propose innovative and original ideas to address a range of brain and neurological diseases, disorders, illnesses, and other brain health conditions. During the same period, Brain Canada supported 48 new research projects resulting from competitions launched over the past two years. Of these, 42% were supported through team grants, which brought together scientists from different disciplines to advance collaborative research on the brain and brain health; 2% were platform grants, which sustained or enhanced centralized shared research resources to promote efficient sharing of equipment, expertise, data, and protocols across research networks; and 13% were knowledge translation awards. The remaining 44% of projects were funded through capacity building grants to provide salary support, training, and mentoring to develop the next generation of Canadian brain researchers.

Over the past year, in partnership with the Women's Brain Health Initiative, Brain Canada introduced the Brain Canada-WBHI Expansion Grants: Considering Sex and Gender Program. With a total budget of $630,000, this program enabled previously successful research applicants to use additional resources either to add or enhance a sex and/or gender component as part of their research project. This new program reflects an increasing awareness across the research community of the differences between the sexes when it comes to their risk of developing diseases, and how they respond to treatment. For example, Gillian Einstein of the University of Toronto is examining the brain and cognitive effects of long-term gender affirming hormone therapy among aging Trans women.

A decade since its inception, the Canada Brain Research Fund is beginning to yield transformative results. In the last year, four more patents resulted from funded projects, increasing the total to 52 since 2011. One of these projects involved the development of the world's first blood test for Alzheimer's disease, as well as MRI brain scan techniques to support doctors in determining a prognosis.

Brain Canada continued convening the research community on key brain health priorities in 2021-22. To this end, it engaged over 100 neuroscience research stakeholders to ensure that their own five-year strategic plan, to be released in 2022-23, is aligned with the needs of the broader brain science ecosystem. Projects undertaken between 2011 and 2022 have connected more than 1,127 researchers from 115 institutions across Canada and resulted in more than 62,000 citations in Canada and internationally.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: Evaluation of the Canada Brain Research Fund Program 2016-17 to 2020-21.

Summary of Findings:

The evaluation found that the Program, through Brain Canada, addresses research and policy priorities identified by brain research stakeholders either as a shared priority or by engaging with research partners to support research on specific priorities of interest. Brain Canada adds value to the brain research ecosystem through its matching funding model, which doubles the federal investment in brain research and expertise in the brain health sector and has helped build capacity. Challenges identified were minor, and Health Canada has committed to engaging stakeholders to identify appropriate measures to modify the funding agreement to increase the Program's focus on and support for knowledge translation as well to revise the Performance Measurement Strategy.

Planned: Not applicable

Engagement of applicants and recipients in 2021–22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with Brain Canada staff and senior management to discuss progress. In addition, Health Canada continued to monitor the recipient's compliance with the contribution agreement, performance and results through analysis and follow-up on progress, performance and financial reporting.

Canadian Thalidomide Survivors Support Program

General information

Name of transfer payment program

Canadian Thalidomide Survivors Support Program

Start date

March 21, 2019

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 14: Thalidomide

Purpose and objectives of transfer payment program

The Program objectives are to ensure that, for the remainder of their lives, eligible thalidomide survivors:

• Receive ongoing tax-free payments based on their level of disability; and
• Have transparent and timely access to the Extraordinary Medical Assistance Fund.

Results achieved

The Canadian Thalidomide Survivors Support Program (CTSSP) supported 123 confirmed survivors as of March 31, 2022.

Ongoing tax-free payments were distributed to all known thalidomide survivors and 100% of payments were made before the end of April 2021, as per the service standard set by the independent third-party program administrator.

The Program administrator processed 44 Extraordinary Medical Assistance Fund (EMAF) applications. The EMAF assists survivors with costs related to extraordinary health support needs such as specialized surgeries, home or vehicle adaptations and some ongoing costs such as chiropractic care, physiotherapy and attendant services, among others. Based on needs identified in the annual outreach survey of survivors in April 2021, a new application process for requesting annual reassessment of disability levels was implemented. This resulted in a 92% increase in uptake over the previous year. A total of 32 health reassessments were submitted by phone with the assistance of the administrator's health care professional.

In 2021-22, a total of 41 new applications were submitted to the CTSSP and are at various stages of the assessment process. The CTSSP welcomed four new thalidomide survivors in 2021-22, who were confirmed using the 3-step probability based medical assessment process. The application period for the CTSSP will remain open until June 3, 2024.

Outreach data for 2021-22 showed that 96% of thalidomide survivors who responded to the survey said that the CTSSP is helping them age with dignity and 74% reported a better ability to access care, treatment and support, which aligns with the purpose of the Program.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2024-25.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with the third party administrator of the Canadian Thalidomide Survivors Support Program to discuss the Program progress. In addition, Health Canada provided information about the Program to individual Thalidomide survivors, and individuals who believe they are survivors of Thalidomide, and the general public through direct correspondence and online communication.

Contribution to Canada Health Infoway

General information

Name of transfer payment program

Contribution to Canada Health Infoway

Start date

April 1, 2016

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2021-22

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care systems

Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

Program 5: Digital Health

Purpose and objectives of transfer payment program

Canada Health Infoway (Infoway) is an independent, not-for-profit corporation that is federally funded to work with jurisdictions and other stakeholders to support the development and adoption of digital health technologies across Canada. Between 2001 and 2010, the Government of Canada invested $2.1 billion in Infoway, through grants or up-front multi-year funding, to focus on electronic health records and other priorities in digital health. Budget 2016 allocated $50 million over two years to Infoway to support digital health activities in e-prescribing and telehomecare, with the funds flowing through a Contribution Agreement. Budget 2017 allocated $300 million over five years to Infoway to expand e-prescribing and virtual care initiatives, support the continued adoption and use of electronic medical records, help patients to access their own health records electronically, and better link electronic health record systems to improve access by all providers and institutions. In addition, Budget 2019 provided $36.5 million over five years with $5 million per year ongoing, for Infoway and the Canadian Institute for Health Information to support the creation of a pan-Canadian data and performance reporting system for Organ Donation and Transplantation. Finally, in 2020, Infoway was allocated $50 million over two years to support provinces, and territories to expand virtual health services to Canadians. These funds flow as a contribution agreement.

Results achieved

• In 2021-22, PrescribeIT continued to equip Canadian providers with e-prescribing technologies that aided in delivering more efficient and high quality health care. All 13 jurisdictions have formally signed a Memoranda of Understanding agreeing to participate in the PrescribeIT program. As of March 31st, 2022, PrescribeIT^® was live in six jurisdictions (Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick, and Newfoundland and Labrador), with 10,507 prescribers and 6,048 pharmacies enrolled.
• Infoway continued to support provinces, territories and other stakeholders in furthering Canadians' access to virtual care and digital health tools, managed collective procurement processes with vendors for provinces and territories and advanced work on pan-Canadian standards to support interoperable digital health records.
• In collaboration with provincial, territorial and national agencies, patients, families, clinicians and researchers, Infoway and the Canadian Institute for Health Information co-led a project to modernize data management solutions for organ donation and transplantation. This multi-year project will result in more equitable and timely access to transplantation services for Canadians.
• Infoway also recently led the multi-jurisdictional procurement of a deceased donation management solution, which involved extensive collaboration with organ donation clinicians and specialists from seven participating jurisdictions.
• Infoway collaborated with the Canadian Healthcare Innovation Community to accelerate the adoption of new digital technologies that will improve access to care, quality of care, equity and health outcomes. This work included developing a Continuous Innovation Framework to identify, forecast and advance the most impactful and timely innovations for Canadians and publishing the state of health care innovation in Canada, and a toolkit for health care organizations beginning their journey with artificial intelligence (AI).

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2023-24.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with Infoway staff and senior management to discuss progress. In addition, Health Canada monitored the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Contribution to Improve Health Care Quality and Patient Safety

General information

Name of transfer payment program

Contribution to Improve Health Care Quality and Patient Safety

Start date

March 31, 2021

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care systems

Link to the department's Program Inventory

Program 1: Health Care Systems Analysis and Policy

Program 10: Patient Safety

Purpose and objectives of transfer payment program

In late 2020, the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute amalgamated their organizations, now called Healthcare Excellence Canada (HEC). The Department's annual funding to each organization has been combined and is flowing to the Program to improve health care quality and patient safety.

The Program supports the federal government's interest in achieving an accessible, high quality, sustainable and accountable health system adaptable to the needs of Canadians. It is designed to: find and promote innovators and innovations, drive the rapid adoptions and spread of quality and safety innovations, build capabilities to enable excellence in healthcare and catalyze policy change. HEC will focus its work on care of older adults with health and social needs, care that is closer to home and community with safe transitions, and pandemic recovery and resilience.

Results achieved

In 2021-22, HEC continued to support improvements in health care delivery by working with health care leaders, governments, policy-makers and other leaders. Examples of results achieved in 2021-22 included:

• Through its Long Term Care Plus (LTC+) program, HEC worked to support over 1,500 long-term care and retirement homes, as well as 40 shelters for people experiencing homelessness and residential substance use treatment facilities. Early evaluation results show that:
  • 53% of respondents reported that participation in LTC+ led to improvements in residents' health.
  • 58% indicated that it led to improvements in resident and/or family experience of care and.
  • 53% reported that joining the LTC+ program led to improvements in the work life of health care providers.
• Supported 24 teams to test and refine supports needed to implement safe virtual care, in partnership with Canada Health Infoway, as part of the Clinician Change Management project.
• Launched Essential Together, to help healthcare organizations safely re-integrate, welcome and engage essential care partners as part of care teams during COVID-19 and beyond. Essential Together is based on co-created policy guidance that can be applied to all health and care settings in Canada, regardless of their pandemic status.
• Supported 34 leaders through 9 improvement projects across Canada as part of the Executive Training for Research Application (EXTRA) program. Examples of innovative projects undertaken included: improving efficiency and effectiveness of the kidney transplant process, strengthening medical-administrative leadership to better serve the patient, enhancing quality of care by improving practice support for nurse practitioners in primary health care, and establishing a service offer and a center of expertise in crisis intervention throughout Montérégie-Est.

Findings of audits completed in 2021-22

Completed: No audit completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation completed in 2021-22.

Planned: The next evaluation is scheduled for 2023-24.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with HEC staff and senior management to discuss progress. In addition, Health Canada continued to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Contribution to the Canadian Agency for Drugs and Technologies in Health

General information

Name of transfer payment program

Contribution to the Canadian Agency for Drugs and Technologies in Health

Start date

April 1, 2008

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care systems

Link to the department's Program Inventory

Program 2: Access, Affordability, and Appropriate Use of Drugs and Medical Devices

Purpose and objectives of transfer payment program

The Canadian Agency for Drugs and Technologies in Health (CADTH) is an independent, not-for-profit agency funded by Canadian federal, provincial, and territorial governments to provide credible, impartial and evidence-based information about the clinical/cost-effectiveness and optimal use of drugs and other health technologies to Canadian health care decision makers.

The purpose of the contribution agreement is to provide financial support for CADTH's core business activities, namely, pharmaceutical Reimbursement Reviews, Health Technology Assessments and Optimal Use Projects. Through these activities, CADTH is able to create and disseminate evidence-based information enabling health system partners to make informed decisions on the adoption and appropriate utilization of drugs and non-drug technologies, in terms of both effectiveness and cost.

Results achieved

In 2021-22 CADTH responded to health system priorities by providing evidence, advice, implementation support, and recommendations on COVID-19 therapies, infection prevention and control, screening and testing for the Canadian health care system through its core business activities.

To support ongoing work on the foundational elements of national pharmacare, CADTH created an advisory panel to establish a recommended framework for developing a potential pan-Canadian prescription drug list, or formulary. Following public consultations this winter, the panel's final report and recommendations was submitted to Health Canada and made publicly available in June 2022.

CADTH was selected to become the host for a renewed Drug Safety and Effectiveness Network following an evaluation recommendation to identify a new model for the program. CADTH submitted a proposal to Health Canada for its new Post-Market Drug Evaluation program in November 2021 and a new contribution agreement was signed in March 2022, taking effect on April 1, 2022.

An independent evaluation of CADTH was completed in December 2021 to inform the renewal of Health Canada's contribution agreement with CADTH in April 2023. The findings of the evaluation were delivered to Health Canada and CADTH's CEO.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2023-24.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CADTH Program staff and senior management to discuss Program progress. In addition, Health Canada continued to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Contribution to the Canadian Institute for Health Information

General information

Name of transfer payment program

Contribution to the Canadian Institute for Health Information (CIHI)

Start date

April 1, 1999

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 6: Health Information

Purpose and objectives of transfer payment program

CIHI receives federal funding to provide comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada. CIHI's broad range of health system databases, measurements and standards, together with its evidence-based reports and analyses, are widely used by stakeholders in their decision-making processes. Further, CIHI protects the privacy of Canadians by ensuring the confidentiality and integrity of its health care information.

• Between 1994 and 2018, the Government of Canada allocated approximately $1.232 billion to CIHI through a series of contribution agreements. Over the past five years (2017-18 to 2021-22), CIHI received over $373.3 million under the current agreement, including targeted funding such as: the federal government committing $53 million over 5 years, starting in 2017-18, to address health data gaps and support improved decision-making on health system priorities;
• $140,000 in February 2019 to undertake an environmental scan of data gaps for addiction treatment services;
• $500,000 in December 2019 to initiate a collaborative pan-Canadian Organ Donation and Transplantation (ODT) Data and Performance Reporting System ($200,000 of this funding was subsequently allocated to Canada Health Infoway to enable joint work);
  • $3.4 million in October 2020 to advance the second year of the ODT Data and Performance Reporting System ($1.9 million of this funding was subsequently allocated to Canada Health Infoway);
• $3.7 million in March 2021 advance year three of the ODT Data and Performance Reporting project, including the development of indicators and standards, a data repository, and expanded reporting and tools to access data;
• $3.5 million to meet priority data needs for public health data management during the pandemic as part of the Safe Restart Agreement in 2020-21.

Health Canada funds approximately 81% of CIHI's total budget, while the provincial and territorial governments contribute 17%. The remaining funds are generated largely through product sales.

Results achieved

In 2021-22, CIHI continued to make progress towards producing more and better data, more relevant and actionable analysis, and improved client understanding and use of CIHI data and information products.

Key accomplishments include:

In 2017, federal, provincial and territorial (FPT) governments endorsed, A Common Statement of Principles on Shared Health Priorities^{Footnote 1}, accompanied by an $11 billion federal investment (Budget 2017) over 10 years, to improve Canadians' access to home and community care, and mental health and addictions services. To help inform progress, CIHI is working with provincial and territorial governments, Health Canada, Statistics Canada, and sector stakeholders, on a set of 12 pan-Canadian performance indicators.

To date, annual reporting is occurring for 6 of the 12 indicators and in May 2021, inaugural data was released for 3 new indicators:

• Wait Times for Community Mental Health Counselling;
• Wait Times for Home Care Services; and
• Home Care Services Helped the Recipient Stay at Home.

Results were accompanied by the release of the companion report, Common Challenges, Shared Priorities: Measuring Access to Home and Community Care and to Mental Health and Substance Use Services in Canada, which provided additional information on the indicator findings released to date and an update on progress on indicator development. CIHI continues to work with FPT governments across Canada and is on track to publish data on all 12 indicators by the end of fiscal year 2022-23.

In 2019, CIHI, in partnership with Canada Health Infoway, developed a comprehensive data and performance system to improve organ donation and transplantation (ODT) in Canada. CIHI is implementing this work with the ODT Collaborative (the Collaborative)^{Footnote 2}, which includes provinces and territories, organ donation organizations, transplant programs, research bodies, regulators, ethicists, and patient/advocacy bodies. CIHI and Canada Health Infoway are continuing to make progress in moving forward with this project. In particular, CIHI has conducted extensive stakeholder engagement, completed work on the development of data standards and prioritization of indicators and measures, and continues work on the development of a data repository, and enabling reporting and access. Achieving better data can further inform decision-making to increase the number of donors, decrease the number of missed opportunities in the system and increase access to transplantation for those who need it.

To close priority data gaps, CIHI also continued work on the collection of more comprehensive pan-Canadian data in key areas, including: virtual and primary health care; long term care; home care; community mental health and addictions; palliative care; pharmaceuticals; patient-reported outcomes; organ donation and transplantation; and, the health of Indigenous populations. CIHI also continued to report on cost estimates for COVID-19 hospitalizations, and meet other priority data needs related to hospitalizations and Intensive Care Unit (ICU) and Emergency Room (ER) admissions during the pandemic, including establishing estimated costs. This data provides insight into the financial impact of COVID-19 on Canada's health care systems.

Findings of audits completed in 2021-22

Completed: No audit completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2023-24.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CIHI staff and senior management to discuss progress. In addition, Health Canada continued to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Contribution to the Canadian Partnership Against Cancer

General information

Name of transfer payment program

Contribution to the Canadian Partnership Against Cancer

Start date

April 1, 2007

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

Program 9: Cancer Control

Purpose and objectives of transfer payment program

The Canadian Partnership Against Cancer (CPAC) is an independent, not-for-profit corporation established to implement the Canadian Strategy for Cancer Control (CSCC). The CSCC was developed in consultation with Canadians, including cancer experts and stakeholders with the following objectives:

• Reducing the expected number of new cases of cancer among Canadians.
• Enhancing the quality of life of those living with cancer.
• Lessening the likelihood of Canadians dying from cancer.

Health Canada is responsible for managing the funding to the corporation. CPAC was eligible to receive $250 million from the federal government for its first five-year term (2007 to 2012) and $241 million for its second five-year term (2012 to 2017). Budget 2016 confirmed ongoing funding for CPAC for $237.5 million.

The COVID-19 pandemic impacted all of CPAC's partners with many needing to pause, defer, and reprioritize work as staff were redeployed to address the pandemic. In-person consultations, research and training were restricted. Given these delays, CPAC was granted a one-year extension to its 2017-22 Contribution Agreement with Health Canada, to March 31, 2023, to complete work that was planned but unable to be completed. Despite the impact of the COVID-19 pandemic, progress was made towards all planned outcomes

Results achieved

In 2021-22, CPAC continued to accelerate the uptake of new knowledge and coordinating approaches to advance cancer control in Canada. Notable achievements included:

• Supported partners to implement the Action Plan for the Elimination of Cervical Cancer in Canada with a suite of knowledge products focused on HPV primary screening and abnormal screen follow-up.
• Ongoing implementation of lung cancer screening programs for people at high-risk across Canada. New and planned programs in British Columbia and Quebec will position Canada as a world-leader in lung cancer screening and will ultimately reduce cancer deaths.
• Released Equity-focused interventions to increase colorectal cancer screening: Program pack to provide cancer-screening programs with evidence-based interventions about colorectal screening programs and inform program decision-making.
• Released a Model of Care Toolkit to support jurisdictions and key partners in implementing and evaluating innovative models of care designed to enhance the efficiency, quality and equity of cancer care delivery.
• Released the Canadian Interdisciplinary Palliative Care Competency Framework to ensure health-care professionals have the necessary skills and knowledge to meet the growing need for palliative care services.
• Continued to fund and support 29 partners in all 13 provinces and territories to develop or implement cancer plans to improve the cancer journey and cancer outcomes for First Nations, Inuit and Métis.
• Supported partners in six jurisdictions to conclude initiatives to train paramedics to provide palliative care at home and to expand the use of patient-reported outcomes to identify patients who would benefit from palliative care earlier.
• Collaborated with the international modelling community and leveraging the OncoSim tool to estimate the impact of cancer care service interruption and delays during the COVID-19 pandemic.
• Created the Partnership's diversity, equity and inclusion multi-year strategic implementation roadmap.

Findings of audits completed in 2021-22

Completed: No audit completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2023-24.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CPAC staff and senior management to discuss progress. In addition, Health Canada continued to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Contribution to the Canadian Foundation for Healthcare Improvement

In late 2020, the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute amalgamated their organizations. The Department's annual funding to each organization has been combined and is flowing to the new amalgamated organization. For detailed information, please refer to the "Contribution to improve health care quality and patient safety".

Contribution to the Canadian Patient Safety Institute

In late 2020, the Canadian Patient Safety Institute and the Canadian Foundation for Healthcare Improvement amalgamated their organizations. The Department's annual funding to each organization has been combined and is flowing to the new amalgamated organization. For detailed information, please refer to the "Contribution to improve health care quality and patient safety".

COVID-19 Safe Restart Agreements Program

General information

Name of transfer payment program

COVID-19 Safe Restart Agreements Program

Start date

February 4, 2021

End date

March 31, 2023

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canadians have modern and sustainable health care systems

Link to the department's Program Inventory

Program 1: Health Care Systems Analysis and Policy

Purpose and objectives of transfer payment program

The purpose of the COVID-19 Safe Restart Agreements Program is to enhance Canadian testing, contact tracing and data management/sharing for COVID-19 to manage the pandemic.

The objectives of the Program are to:

• Testing Stream: Spread and scale evidence-based approaches to national testing, screening and surveillance capacity to help contain the virus and support economic restart.
• Contact Tracing Stream: Enhance the capacity to perform contact tracing and advance the implementation of tools and approaches to slow virus transmission, including the COVID Alert exposure notification app to reduce strain on tracing.
• Data Management Stream: Modernize health data management to enhance the sharing of relevant public health and health data and information across all orders of governments.

Results achieved

This program supports provincial and territorial efforts to conduct more testing, perform more contact tracing, and improve the sharing of data to slow the transmission of COVID-19.

In 2020-21, stakeholders, provinces and territories were engaged in health care improvements in priority areas of testing and screening, contact tracing, and data management. Specifically all provinces and territories:

• Submitted data on all key variables on 100% of their case reports in the National COVID-19 Case Dataset.
• Initiated COVID-19 contact tracing following the identification of a positive case within 24 hours.
• Expanded their testing capacity.

Recipients worked towards reducing the number of national COVID-19 cases through interventions in testing and screening, shortening COVID-19 contact tracing turnaround time between positive case determination and when tracing began, and making sustainable improvements to health and public health data systems.

While most of the projects funded by this Program in 2021-22 are still underway, investments provided in 2021-22 have enabled the:

• Implementation of 10 wastewater testing programs in various municipalities and regions across Canada.
• Conduct of 4 rapid test clinical trials.
• Creative Destruction Lab Consortium to support to Canadian workplaces in implementing their voluntary rapid testing programs by providing advice, guidance, best practices and tools to Canadian businesses and organizations.
• Provision of contact tracing surge capacity to provinces and territories.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The timing for the evaluation will be determined during the development of a future Departmental Evaluation Plan.

Engagement of applicants and recipients in 2021-22

Applicants continued to be engaged by requests for funding through an exchange of letters between Ministers of Health or by submitting a formal proposal using a standard application form.

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and/or knowledge transfer activities) with successful recipients. As well, Health Canada continued to monitor their compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting requirements.

Health Care Policy and Strategies Program

General information

Name of transfer payment program

Health Care Policy and Strategies Program

Start date

September 24, 2002

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2021-22

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canadians have modern and sustainable health care systems

Result 2: Canadians have access to appropriate and effective health services.

Link to the department's Program Inventory

Program 1: Health Care Systems Analysis and Policy

Purpose and objectives of transfer payment program

The Health Care Policy and Strategies Program, provides up to $25.7 million per fiscal year in time-limited contribution funding to support investments in emerging and demonstrated innovations in areas of priority for health care systems, including mental health care, home and community care, palliative and end-of-life care, and other federal, provincial-territorial and emerging priorities. Through the implementation of contribution agreements and a variety of stakeholder engagement activities, Health Canada contributes to the development and application of effective approaches to support sustainable improvements to health care systems.

Results achieved

The Program supported a wide range of projects designed to contribute to improvements and transformations in health care systems across Canada. For example, health care innovation projects supported activities that develop, implement and evaluate tools, models, and practices that address identified health care systems priorities. Other projects produced knowledge products and resources that enabled health care providers to maximize their roles in a range of settings; provided system managers and decision-makers with data and decision-making tools to enhance system planning and performance; and engaged key stakeholders in collaborative efforts that contribute to specific health care systems improvements relevant to Program priorities.

In 2021-22, the Health Care Policy and Strategies Program directed funding toward disseminating, exchanging and implementing knowledge to support innovation and best practices in areas such as: palliative and end-of-life care, home and community care, mental health care, and other federal, provincial, territorial and emerging priorities (such as, the COVID-19 pandemic). The Program also supported projects that contributed to improving access to health care services for all Canadians. Specific examples included:

• The Pallium Foundation of Canada's project Extension for Community Healthcare Outcomes connected local health care providers with palliative care specialists and learning materials to build local health care system capacity and improve access to needed palliative care services.
• The Canadian Home Care Association's project Partners in Care's Preparing Family Caregivers in Supporting Patients of Home Restorative Program provided home care professionals with the skills to empower family caregivers with increased knowledge and confidence in delivering home-based care to frail seniors transitioning from hospital or respite to the home environment.
• Unity Health Toronto's project Choosing Wisely Canada encouraged clinicians and patients across Canada to engage in conversations about unnecessary tests, treatments and procedures as well as made recommendations related to pediatric rheumatology, trauma, cardiology, gastroenterology, and hospital density.
• Accreditation Canada Global's project Peer Support to Help Small Mental Health and Addictions Organizations Develop their Competency in Quality and Accountability prepared materials and recruited participants from small public and private mental health and addictions organizations for coaching sessions that will build capacity in self-assessment and action planning around quality improvement, and help them better prepare for reporting and accountability.
• William Osler Health System's project Remote Self-Reporting of Symptoms by Patients with Palliative Care Needs explored a proof-of-concept web-based software program that allows for remote self-reporting of symptoms by patients with palliative care needs to their healthcare providers.
• The Organ Donation and Transplantation Collaborative initiative with provinces and territories (except Québec), Canadian Blood Services, patients, families, clinical and administrative stakeholders and researchers. This initiative aims to improve governance of organ and transplantation and policies related to inter-provincial organ sharing.
• Projects that responded to emerging pressures, such as the COVID-19 pandemic and the need to address health inequalities experienced by Indigenous peoples in Canada. Specific examples included a project that focuses on hand hygiene, respiratory hygiene, and the appropriate use of personal protective equipment and one that aims to support reforming physician education and advancing culturally safe health care delivery.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.^{Footnote 3}

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2023-24.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with staff and senior management of the various recipient groups to discuss progress. In addition, Health Canada continued to monitor the recipients' compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Mental Health Commission of Canada Contribution Program

General information

Name of transfer payment program

Mental Health Commission of Canada Contribution Program

Start date

2000 as a Grant, but as of April 1, 2017 it has become a Contribution.

End date

March 31, 2027

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2021-22

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 4: Mental Health

Purpose and objectives of transfer payment program

The Mental Health Commission of Canada (MHCC), an arm's length, not-for-profit organization, was established in March 2007 with a ten-year mandate to improve health and social outcomes for people and their families living with mental illness. Between 2007 and 2017, the Government of Canada invested $130 million in the MHCC through a grant, to develop a mental health strategy for Canada, conduct an anti-stigma campaign and create a knowledge exchange centre. In 2016, the MHCC's mandate was renewed for a ten-year period, from 2017-18 to 2026-27 to advance work on mental health priorities in four areas: the integration of mental health and substance use, suicide prevention, at-risk populations and engagement with diverse stakeholders to do this. The government of Canada provides $14.25 million per year contribution towards this end.

The MHCC is also receiving $10 million over five years (until March 31, 2023) through the Substance Use and Addictions Program to support an improved understanding of the impact of cannabis use on mental health.

Results achieved

In 2021-22, notable achievements included:

• Continued to assess gaps and develop operational guidelines to ensure an integrated mental health and substance use care approach at the service delivery levels in the area of mental health and substance use integration.
• Advanced the work on the evaluation, replication, and scale-up of opioid-related stigma reduction interventions and delivered two presentations on the Issues of Substance Conference related to this.
• Extended the agreement with the Fraser Health Authority to scale up their Trauma and Resiliency Informed Practice program.
• Worked with the Centre for Addiction and Mental Health to support the continuation of their Reducing Stigma and Promoting Recovery for Opioid Use course.
• Continued expanding the Roots of Hope community-based suicide prevention initiative by launching the Early Adopters Program and encouraging 11 new communities to join the program, an estimated impact on more than 3 million Canadians.
• Hosted webinar on the Mental Health Promotion Programs for Elementary School Children and Suicide Risk Assessment and released key fact sheets such as alcohol use and suicide, agriculture and suicide, rural and remote suicide, youth suicide, and public health and suicide.
• Continued to work with the National Collaborative for Suicide Prevention, in support of the development and implementation of the National Suicide Prevention Action Plan developed by the Public Health Agency of Canada.
• Continued to deliver training programs to support mental health and resilience of targeted groups at risk, which included youth, post secondary students, older adults, and first responders.
• Continued to convene key stakeholders to discuss opportunities, share best practices, and to brainstorm solutions to challenges in the space of e-mental health, including the development of an E-Mental Health Strategy for Canada.
• Supporting a new flexible system of mental health care with open access to a range of resources and services (the Stepped Care 2.0 model), across Newfoundland and Labrador, and into Nova Scotia and Northwest Territories with an Implementation Guide Book for Stepped Care and an Evaluation Toolkit.
• Continued championing implementation of the Standard on Mental Health and Wellbeing for Post Secondary Students with 47 post-secondary institutions implementing the Standard and 22 preparing to do so.
• Continued to coordinate the Provincial/Territorial Advisory Group on Mental Health and Substance Use to share information, align priorities, find opportunities for collaboration, and create action plans (joint or individual).
• Released a series of policy briefs in response to the COVID-19 pandemic, including COVID-19 and People Living With Serious Mental Illness; COVID-19 and Early Childhood Mental Health: Fostering Systems Change and Resilience; COVID-19 Mental Health and Substance Use in Correctional Settings: Considerations for Addressing Systemic Vulnerabilities, and COVID-19: Mental Wellness, and the Homelessness Workforce.

Findings of audits completed in 2021-22

Completed: No audit completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The funding for the Mental Health Commission of Canada will be evaluated as part of three separate evaluations. The first two are scheduled for 2022-23 and the third is scheduled for 2023-24.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with MHCC staff and senior management to discuss progress. In addition, Health Canada continued to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Official Languages Health Program

General information

Name of transfer payment program

Official Languages Health Program

Start date

June 18, 2003

End date

March 31, 2022 (Grant)

Ongoing (Contribution)

Type of transfer payment

Grants and Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 12: Promoting Minority Official Languages in the Health Care Systems

Purpose and objectives of transfer payment program

The Official Languages Health Program has a total budget of $191.2 million over five years (2018-2023), and $38.46 million per year ongoing after 2023. The Program supports the federal government's commitment to maintain a strong and effective publicly funded health care system by ensuring that official language minority communities (OLMCs) have access to health services in the official language of their choice. Through the implementation of contribution agreements and micro-grants, Health Canada supports investments that improve access to health care services for OLMCs, in the language of their choice through training and retention bilingual health care providers, networking activities and innovative projects in priority areas, such as home care, mental health, palliative and end-of-life care.

Results achieved

Program funding supported the training and retention of additional bilingual health professionals, health networking and innovative projects to improve access to health services for OLMCs. These activities increased access to bilingual health professionals in OLMCs, as well as, the offer of health services to OLMCs.

In 2020-21, under the Action Plan for Official Languages 2018–2023: Investing in Our Future, Health Canada supported a range of programs and projects through the OLHP. The impacts of these initiatives included: increased availability of bilingual health service providers to meet the needs of OLMCs, enhanced mechanisms for providing effective health services for these communities, and improved understanding and measurement of health issues and challenges.

Through the Official Languages Health Program, Health Canada continued to provide financial support to community organizations and training institutions (e.g., the Société Santé en français (SSF), the Association des collèges et universités de la francophonie canadienne (ACUFC)-Consortium national de formation en santé (CNFS), McGill University, the Community Health and Social Services Network (CHSSN)), recipients of funding resulting from an open call for proposals launched in 2019 as well as micro-grants. These organizations implemented various initiatives to improve access to health services for OLMCs.

Training and retention of bilingual health professionals:

• For Francophones outside Quebec, the 16 member institutions of the ACUFC – CNFS recorded 838 additional graduates from 104 health training programs. In addition, according to surveys conducted in 2021, 95% of graduate health professionals surveyed were employed in OLMCs, which increased the number of health human resources available to meet the needs of Francophone minority communities. It should also be noted that 97% of health professionals who have been trained in ACUFC-CNFS affiliated institutions and who work in the health system report offering services in French in their workplace.
• For English-speaking residents of Quebec, McGill University has, as part of the Dialogue McGill initiative, enrolled over 1,700 health and social service professionals in English language training. A total of 1,477 (85%) health professionals have completed their English courses. In addition, 130 (93%) Anglophone students from Quebec post-secondary institutions/organizations registered for Dialogue McGill French training courses. The completion rate for the previous two semesters was 93%. This helped improve English language skills for participants in order to better serve English-speaking patients. The French language training helped Anglophone professionals in the health care system improve their French language skills. Lastly, as part of the Recruitment and Retention Program, McGill University allocated bursaries and internships to bilingual students in health and who agree to return or stay in a region of Quebec for a minimum of one year in a public health services establishment. A total of 78 bursary applications were received and 66 candidates received the bursaries and internship support.

Strengthening and improving local health networking capacity in OLMCs:

• In 2021-2022, SSF and CHSSN received funding to support networking initiatives that mobilize health system and partners, including provincial and territorial governments, to improve access to health services for OLMCs in their official language of choice. A total of 39 Health Networks across Canada have collaborated with various health sector stakeholders to provide support, resources and tools to inform the planning, development and implementation of initiatives to meet the needs of Francophones outside Quebec and Anglophones in Quebec and to strengthen the efficiency of the entire health care system in Canada. For example, through its activities and partnerships:
  • In Quebec, the CHSSN continued to actively represent the Anglophone community's needs in a number of local and regional tables on senior services, youth services, and early childhood development. The CHSSN also contributed to increase the offer of health services in OLMCs and health institutions by producing a broad range of health information products, organising/ coordinating conferences to disseminate knowledge and share good practices.
  • Outside Quebec, the SSF collaborated with policy decision-makers and health stakeholders to influence the planning of local health networks to better serve Francophone minority communities. For example, the SSF supported two organizations that provide mental health services in Nunavut and Ontario. These services included Remotely Delivered Mental Health and Wellness programs and the Accès EQUITY virtual platform to improve the range of healthcare services available in French.

Projects to improve access to health services for OLMC:

In 2021-22, Health Canada funded innovative projects to improve the availability of bilingual health professionals to address the needs of OLMCs. For example:

• In Quebec, the Montérégie-Centre Integrated Health and Social Services Center produced tools (i.e. videos, pamphlets and a microsite) to ensure that English-speaking seniors and their caregivers are able to identify aging-related health issues and risks in their environment. Six short videos were produced. The objective of these videos is to inform people with loss of autonomy as well as their caregivers about information, resources and services available in their community. The information presented in these videos is also available in a leaflet and through a website with related relevant information.
• In Saskatchewan, the Saskatchewan Health Authority in partnership with TAO Tel-Aide launched its empathetic listening and assistance line for the Fransaskois community, to allow better access to up-stream mental health services along with the continuum of care (in French) for all Francophone minority communities living in the province.

Micro-grants to mobilize different actors in the promotion of access to services for OLMCs:

• In addition, in 2021-2022, the Official Languages Health Program launched a call for micro-grants to mobilize different actors in the promotion of access to services for OLMCs. A total of 18 proposals were received in 2021-2022, of which 15 met the eligibility criteria and the applicants received $1,000 each in grants. These initiatives aim to improve access to health services that take into account the specific needs and priorities of patients living in OLMCs in Canada. An example of these initiatives include:
  • In Nova Scotia, the Association francophone de la Vallée, as part of the initiative entitled "Bienvenue et santé!" collected contact information of health care workers who provide services in French and then developed a web page and brochures that list these providers. It then distributed these brochures and information to French-speaking residents of "Rexpo – Bienvenue à l'Escadre". Access to health services in French will consequently be improved by facilitating understanding of the new provincial system and giving new members of the community the confidence to request services in French.

Findings of audits completed in 2021-22

Completed: No audit completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: Evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2022-23.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with recipients to discuss progress. In addition, Health Canada continued to monitor the recipients' compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Organs, Tissues and Blood Program

General information

Name of transfer payment program

Organs, Tissues and Blood Program

Start date

April 1, 2000

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2021-2022

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 11: Organs, Tissues and Blood

Purpose and objectives of transfer payment program

The Organs, Tissues, and Blood Program provides support for safe, effective, accessible and responsive organ, tissue and blood systems that will improve and extend the quality of the lives of Canadians while respecting federal, provincial, and territorial scopes of authority. In 2020-21, it was combined to replace two existing separate programs: the Canadian Blood Services (CBS) – Organ and Tissue Donation and Transplantation (OTDT) Program and the CBS – Blood Research and Development (R and D) Program.

Results achieved

The Program generated numerous knowledge products and learning events. It played a role in public education, engagement and awareness. The Program also played a significant role in training highly qualified people in important areas such as basic and applied research. The Program developed collaborative arrangements, established partnerships and identified areas of emergent interests as well as responded to emerging issues and needs relating to organ, tissue and blood systems.

In addition, various stakeholders, including Health Canada, used the knowledge generated by blood research and development projects and organ donation and transplantation projects to inform changes to practices and standards. This contributed to greater safety, effectiveness, accessibility and responsiveness of the organ, tissue and blood systems to improve and extend the quality of lives of Canadians.

Organ and Tissue Donation and Transplantation

The Program continued to support Canadian Blood Services to work with partners and stakeholders in order to influence and improve system performance through development and implementation of leading practices, professional and public education, engagement and awareness, data and analytics services and system performance reporting.

Blood Research and Development

In this context, "blood" includes whole blood and blood products, plasma and plasma products and their respective artificial and substitute products under its blood research and development component, the Program continued its research to inform the deferral period for gay men and men who have sex with men (MSM) on blood and plasma donations.

With Health Canada investments, Canadian Blood Services, in collaboration with Héma-Québec, funded MSM blood and plasma projects to build evidence on relevant stakeholder attitudes and MSM screening and testing. This work informed further evolution of eligibility criteria for blood donation. Results from the funded "SAFE" study informed the United Kingdom's proposed change to blood donor eligibility criteria, which was implemented in June 2021. In April 2022, Health Canada authorized a submission from Canadian Blood Services to implement sexual behaviour-based screening questions for all donors. With this change, the MSM questions, which have been used on Canadian Blood Services donor screening questionnaire since the 1980s, will be removed.

Canadian Blood Services generated numerous outputs and supported many activities including but not limited to fostering research in transfusion science and bone marrow transplant, blood products, stem cells, and transfusion medicine. Approximately 41 research projects were funded in 2021-2022, including an international collaboration between Canadian Blood Services and research partners at the McMaster Centre for Transfusion Research and the University of Toronto QUEST transfusion research program. The CONCOR-1 study was the world's largest clinical trial on convalescent plasma and COVID-19. Researchers made key discoveries through this study at a crucial time in the pandemic that would influence treatment of patients with COVID-19. Projects were also initiated to study ABO blood group and COVID-19 severity; freeze-dried COVID-19 convalescent plasma; COVID-19 effects on endothelial cells; extended storage of red blood cells; and long tubing for transfusion.

Canadian Blood Services' research and education network published 206 peer-reviewed and 70 non peer-reviewed publications, an increase over the prior year. Network members delivered 360 conference presentations to local, national and international audiences. The average h-index, a measure demonstrating the significance and impact of published work, was 32 for Canadian Blood Services research staff, over three times the average h-index (10.6) for Canadian academic science authors. Canadian Blood Services led or delivered in partnership with more than 30 education events for specialists in transfusion science and medicine and attracted 4,019 professionals. Various stakeholders used the knowledge generated by research and development projects to inform changes to practices and standards in blood.

Organ and Tissue Donation and Transplantation

Canadian Blood Services is a member of the Organ Donation and Transplantation Collaborative, and continued to support various projects focussed on the priorities identified by the Collaborative that advance transformative, system-level improvements in organ donation and transplantation by 2024.

In 2021-2022, Canadian Blood Services supported the development of 40 knowledge products and 147 learning opportunities for professionals, strengthening the foundations of the system and contributing to overall system performance both now and in the future. Examples include:

• Creating the COVID-19 Impact Dashboard, which informed the Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic.
• Hosting monthly national and international teleconferences in response to the pandemic, creating a forum for stakeholders from across the country to identify, discuss and resolve challenges created by the pandemic.
• Collaborating with Ontario's Trillium Gift of Life Network and the Canadian Donation and Transplantation Research Program to host the Deceased Donation Stream at the Critical Care Canada Forum. Sessions were lead by national and international experts and attended by donation physicians, coordinators, and program administrators.

In order to disseminate and promote awareness in 2021-2022, Canadian Blood Services supported the development of 54 knowledge products and 20 learning opportunities for the public. The public education and awareness activities aim to change donation culture in Canada, and in partnership with provincial campaigns, contribute to increased donation rates over time. Examples include:

• Launched a public education strategy to promote the national education and learning resource portal for teachers, students and parents.
• Led a number of activities that commemorated Green Shirt Day (April 7, 2021) and National Organ and Tissue Donation Awareness Week (April 18–24, 2021) including multimedia stories featuring patients and donors, media outreach, social media posts and a paid social media ad campaign and virtual community events.
• Developed innovative public awareness and education materials, in both official languages, to support living kidney donation. This included including My Transplant Coach, an online, video-based decision aid for patients with kidney failure; My Paired Donation Coach, a series of animated videos developed for patients, their friends and family, and potential donors to learn about the national Kidney Paired Donation program; a digital library of video stories of people sharing their living donor kidney transplant experiences; and, an advocacy tool kit.
• Launched the Organs and Tissues For Life Education Portal was launched in collaboration with system partners to encourage teachers, students and families to talk about organ donation by making available age-appropriate learning resources in French and English.

Findings of audits completed in 2021-22

Completed: No audit completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021–22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2022-23 (Blood Safety (Blood Research and Development Program and PHAC Blood Safety Program)) and 2025-26 (Organ and Tissue Donation and Transplantation Program).

Engagement of applicants and recipients in 2021–22

Health Canada officials undertook numerous exchanges (virtual meetings, phone calls, e-mails) with Canadian Blood Services' staff and senior management to discuss progress. In addition, Health Canada continued to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Strengthening Canada's Home and Community Care and Mental Health and Addiction Services Initiative

General information

Name of transfer payment program

Strengthening Canada's Home and Community Care and Mental Health and Addiction Services Initiative and Virtual Care Services Initiative

Start date

November 9, 2017

End date

March 31, 2027

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18 and amended in 2021-22

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 1: Health Care Systems Analysis and Policy

Program 3: Home, Community and Palliative Care

Program 4: Mental Health

Purpose and objectives of transfer payment program

The Government of Canada is investing $11 billion over ten years (from 2017 to 2027) to support provinces and territories (PTs) to improve access to home and community care ($6 billion) and mental health and addictions ($5 billion) services in their jurisdictions, in accordance with the Common Statement of Principles for Shared Health Priorities (CSoP), which was jointly agreed to by federal, provincial and territorial (FPT) Ministers of Health (with the exception of Quebec) in August 2017.

Governments agreed to common objectives in each of home and community care and mental health and addiction services, and in particular to improving access to mental health and addictions through one or more of the following areas of action:

• Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders.
• Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services.
• Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.

Similarly, on home and community care, FPT governments agreed to work together to improve access to services through one or more of the following areas of action:

• Spreading and scaling evidence-based models of home and community care that are more integrated and connected to primary health care.
• Enhancing access to palliative and end-of-life care at home or in hospices;
• Increasing support for caregivers.
• Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community based service delivery.

By endorsing the CSoP, PTs fulfilled the conditions set out in the Budget Implementation Act, 2017 to receive funding for fiscal year 2017-18 through a statutory appropriation ($300 million). The remaining nine years of funding ($10.7 billion) will be provided through bilateral funding agreements. Following the 2017 federal, provincial and territorial agreement on the Common Statement of Principles, the federal government negotiated and signed bilateral agreements with each province and territory in which each jurisdiction outlines how it will invest the federal funding for the first five years of the ten year commitment, based on the priority areas of action agreed to by FPT Ministers of Health in August 2017. Renewal discussions for the remaining $6 billion over five years (2022-23 – 2026-27) will occur in 2022-23. Furthermore, the 2020 Fall Economic Statement committed $1 billion to provinces and territories through the Safe Long-term Care Fund.

In 2021-22, the Government of Canada and provinces and territories amended the existing bilateral agreements to support greater infection prevention and control in long-term care facilities and seniors' residences providing continuing care services through Safe Long Term Care funding. As part of the CSoP, all governments also agreed to develop a focused set of common indicators to measure progress on the priority areas of home and community care and mental health and addiction services. The Canadian Institute for Health Information (CIHI) led a collaborative process which culminated in May 2018 when federal, provincial and territorial Ministers of Health endorsed a suite of 12 common indicators to be implemented over the coming years. For Safe Long-Term Care funding, provinces and territories identified, in an action plan annexed to the agreement, performance measures, targets and outcomes, and will report on these through updates to the action plan in 2022-23.

Additionally on May 3, 2020, the Prime Minister announced an investment of $240.5 million to accelerate the use of virtual tools and digital approaches to support Canadians. Of this, $150 million was allocated to provinces and territories to assist them to accelerate efforts to meet health care needs through virtual tools and approaches. Provinces and territories used these funds to support five shared priority areas, identified by federal provincial and territorial officials, for investments in technology and infrastructure:

• Secure messaging and information-sharing platforms or supports for end-to-end messaging.
• Secure video-conferencing technology.
• Remote patient monitoring tools.
• Patient access to COVID-19 and other lab results.
• Back-end supports for integration of new platforms and supports, including needed hardware.

To enable Canadians to assess progress, the Canadian Institute for Health Information will report the results of this work, based on jurisdiction-specific performance measures, by spring 2023.

Results achieved

In keeping with the bilateral agreements, federal funding was used to improve access to home and community care and mental health and addiction services. Action plans annexed to the bilateral agreements allow Canadians to see the plan for how the targeted federal funds were to be invested in each province and territory.

Pursuant to a shared commitment to report on results under the 2017 Common Statement of Principles on Shared Health Priorities, in 2018 FPT Ministers of Health agreed to 12 common indicators to report on progress. Since then, provinces and territories are progressively reporting indicators, with new indicators released nationally each year by CIHI.

Over time, these indicators will give Canadians more information about access to home and community care and to mental health and addictions services in their province or territory. Results for 9 indicators are now available on CIHI's Shared Health Priorities website, with three new indictors released in 2021:

• Wait Times for Community Mental Health Counselling.
• Wait Times for Home Care Services.
• Home Care Services Helped the Recipient Stay at Home.

These investments to strengthen home and community care and access to mental health and addiction services are leading to better health outcomes and a more sustainable health care system, as care is shifted from expensive hospital care to home and community-based service delivery.

Canadians can look for improvements in the availability and quality of services in their communities and at home, and investments have for example:

• Enabled patients to receive greater access to a wider range of multidisciplinary or coordinated teams, and to support better transitions in care.
• Enhanced infrastructure through new technology and digitally integrated clinical assessment tools, to better plan and coordinate care for patients.
• Supported caregivers with more educational and navigational supports, expanded respite services, and the use of innovative technology to support caregivers.
• Improved access to palliative and end-of-life supports, such as greater hospice resources.

Additionally, PTs have been using the safe long-term care funding to invest in priority areas exacerbated by the COVID-19 Pandemic. Funds have been used to help protect long-term care residents and staff by supporting infection prevention and control measure and hiring additional staff, or topping up wages. Specifically examples of areas where targeted investments have been made include:

• Infrastructure renovations and improvements, including updating heating, ventilation and air conditioning units, increasing bed availability, and installing outdoor recreation spaces to improve the quality visitations.
• Providing enhanced infection prevention and control educational resources and standardizing policies and procedures across long-term care facilities.
• Procuring personal protective equipment for staff and visitors, purchasing cleaning and medical.

PTs have taken steps to improve access to mental health and addiction services. Many took an integrated approach to delivery of these services that recognizes the need to provide people-centred care that was coordinated across the health care system. Specifically, investments in these areas:

• Provided children and youth programs, including integrated services that enhance provider collaboration and improve transitions between levels of care are aimed at reducing wait times for youth to access services.
• Expand community-based services are aimed at reducing the number of individuals with unmet mental health and addiction services needs.
• Expanded access to better-integrated care pathways, specialized services, and follow-up from emergent crisis situations to improve outcomes.
• supported the mental health needs of Indigenous populations with the development of implementation of culturally appropriate tools and practices, more integrated services, and more cultural competency training for health professionals.

PTs have also taken steps to use digital technologies to support patient-provider, and provider-provider interactions in order to enable Canadians to safely access the health services they need since the onset of the COVID-19 pandemic. Virtual care service investments have:

• Improved access to health services through adoption of secure video-conferencing technologies, including primary care in nursing homes (New Brunswick), e-mental health and addiction services (Nova Scotia, Manitoba), and chronic disease management (Nunavut, Quebec).
• Quickly transitioned health systems to use secure messaging and file-transfer platforms (away from a reliance on physical mail and fax services) to share information, request consultations, and submit referrals.
• Facilitated remote patient monitoring to allow chronic disease and post-surgical patients, as well as those recovering from COVID-19 (e.g., Saskatchewan ad British Columbia), to be monitored from their homes to improve their health outcomes.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: No evaluation is planned as evaluations will be completed by the P/Ts as per the various funding agreements.

Engagement of applicants and recipients in 2021-22

Health Canada officials have engaged in numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with Provinces and Territories to discuss progress. In addition, Health Canada monitored the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Substance Use and Addictions Program

General information

Name of transfer payment program

Substance Use and Addictions Program (SUAP)

Start date

December 4, 2014

End date

March 31, 2022 (Grant)

Ongoing (Contribution)

Type of transfer payment

Grants and Contributions

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to departmental result(s)

Core Responsibility 2: Health Protection and Promotion

Result 4: Canadians are protected from unsafe consumer and commercial products and substances

Result 5: Canadians make healthy choices

Link to the department's Program Inventory

Program 27: Tobacco Control

Program 28: Controlled Substances

Program 29: Cannabis

Purpose and objectives of transfer payment program

The Substance Use and Addictions Program (SUAP) provides funding for a wide range of evidence-informed and innovative substance use prevention, harm reduction and treatment initiatives across Canada at the community, regional and national levels. These public education, capacity building, research, best practices/standards and service delivery initiatives target a range of controlled drugs and substances, including opioids, stimulants, cannabis, alcohol, tobacco and vaping products.

Results achieved

In 2021-2022, SUAP invested over $85 million towards 180 projects which contributed to individual capacity and organizational, system and community level program, policy and practice change. Projects aimed to prevent and reduce harms related to substance use; facilitate treatment and related system enhancements; and, improve awareness, knowledge, skills and competencies of targeted stakeholders and Canadians.

From April 1, 2021 to October 31, 2021, SUAP-funded projects delivered a total of almost 48,000 knowledge products/learning opportunities, which were accessed approximately 80 million times. This included: adults and youth (who use drugs and/or who are at-risk, peers, Indigenous Peoples, LGBTQ2++, racialized, FASD, low-income); front-line care teams and healthcare professionals (Physicians/Nurses/Pharmacists); Federal/Provincial/Territorial, Regional/Municipal governments; school boards/trustees; community partners (public safety, veterans); non-profit organizations; program designers; policy makers; and the general public.

Tobacco

In support of Canada's Tobacco Strategy, SUAP funded nine projects focused on prevention, protection and/or cessation of use of tobacco and vaping products. Projects informed Canadians about harms and risk of tobacco and vaping products, including projects designing cessation interventions for people who smoke as well as youth who vape.

These SUAP initiatives produced 334 knowledge products (such as standards/guidelines, tools, toolkits, and reports), delivered 128 learning opportunities (such as training, presentations, and webinars) and reached approximately 35,000 individuals. These Canadians intend to use the new knowledge and skills to make positive changes to behaviour as well as improvements to substance use policies, programs and clinical practices.

Controlled Substances

One hundred and thirty nine projects addressed a variety of needs including improving access to harm reduction and treatment; naloxone training and distribution; identifying best practices for medication-assisted treatments; improving access to different types of treatment; identifying innovative models for opioid replacement therapy; and reducing harms for those who use alcohol. In the first six months of 2021-22 (April to October 2021), these projects delivered over 44,000 knowledge products and learning opportunities, reaching over 5.5 million Canadians/stakeholders.

These projects included the following:

• 38 new projects responding to substance use issues, including those providing frontline services in a COVID-19 context. Additional SUAP funding supporting the distribution of naloxone kits and opioid overdose response training to support communities particularly hard hit by the opioid overdose crisis.
• 18 safer supply projects in British Columbia, Ontario, Quebec and New Brunswick.
• 13 projects exploring new approaches to addressing methamphetamine use.

Cannabis

In 2021-22, SUAP funded 32 projects aimed at providing public education to Canadians on cannabis and its health effects, with a focus on reaching youth and young adults, Indigenous populations, health professionals and educators and other at risk groups. Projects focused on public education, awareness and community engagement across Canada, as well as targeting rural and remote areas. Together, these projects reached over 74 million individuals through 2,600 cannabis-related knowledge products and learning opportunities, such as posters, videos, campaigns, networks, youth events, webinars and training sessions.

Canadian Centre of Substance Use and Addictions

SUAP also directed $11 million core funding to the Canadian Centre on Substance Use and Addiction (CCSA) to address problematic substance use in Canada. With this funding, CCSA has advanced work in key areas contributing to federal priorities in the broader scope of substance use:

• Helped to address the opioid crisis by bringing together partners and stakeholders and creating resources, guidelines and toolkits to support young men in the trades and youth and their families impacted by opioid use.
• Contributed to national evidence and information sharing on emerging drug trends and risks, and substance use costs and harms.
• Updating Canada's Low-Risk Drinking Guidelines.
• Updated nationwide guidelines for the substance use workforce including an interactive webpage featuring 56 guides, tools and videos.
• In partnership with MHCC, released data on the impact of COVID-19 on mental health and substance use.
• Held the 2021 Issues of Substance Conference with approximately 750 participants.
• Engaged people who have experience with drugs through the Stigma Ends with Me campaign.
• In partnership with Inuit Tapiriit Kanatami, co-developed resources to address suicide risk among Inuit and delivered learning sessions to the Nishnawbe Aski Nation's youth, crisis coordinators and mental health workers.

The Program funded an additional $2.3 million to CCSA for cannabis research to build evidence needed to inform policy development. In 2021-22, CCSA released 8 knowledge products, co-authored 3 articles published in peer-reviewed journals, delivered 2 presentations, and hosted 3 webinars in the Emerging Research and Implications of Cannabis series.

Mental Health Commission of Canada

In 2021-22, SUAP directed $3,262,000 in cannabis funding to the Mental Health Commission of Canada (MHCC) to continue to inform current and future research; build an evidence-base, and mobilize knowledge regarding the impact of cannabis use on mental health in a legalized and regulated environment. In 2021-22, MHCC released 20 knowledge products such as reports, webinar recordings, and toolkits; and delivered 21 learning opportunities such as webinars, roundtables/dialogues, conference presentations and workshops.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: No planned audits.

Findings of evaluations completed in 2021-22

Completed: Evaluation of the Health Portfolio Tobacco and Vaping Activities.

Summary of Findings:

In relation to SUAP funding focused on tobacco and vaping, the evaluation found that Health Canada funded a variety of tobacco and vaping prevention and cessation projects. Available evidence on mature projects demonstrate that these projects have supported participants to quit smoking.

Planned: The next evaluation is scheduled for 2022-23 (Canadian Drugs and Substances Strategy and Cannabis) and 2025-26 (Health Portfolio's Tobacco and Vaping activities).

Engagement of applicants and recipients in 2021-22

SUAP applicants and recipients include not-for-profit organizations, provinces and territories, municipalities, Indigenous organizations, people with lived and living experience of substance use, universities and many other groups. These groups are engaged through various methods, including stakeholder outreach, solicitation processes, project development discussions, and performance reporting and monitoring tools, processes and activities. Health Canada also supports knowledge translation and exchange opportunities between SUAP projects and other partners and stakeholders.

Health Canada engaged SUAP applicants on funding applications and worked closely with successful organizations to shape their initiatives, monitor contribution agreements and obtain required performance measurement and evaluation reports. Of note, the department is also developing theme-based Communities of Practice (e.g. cannabis, safer supply, chronic pain, etc.) with partners within and external to the federal government.

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with SUAP recipient groups to discuss progress. In addition, Health Canada will continue to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Territorial Health Investment Fund

General information

Name of transfer payment program

Territorial Health Investment Fund

Start date

April 1, 2014

End date

March 31, 2023

Type of transfer payment

Grant

Type of appropriation

Estimates

Fiscal year for terms and conditions

2021-22

Link to the departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 15: The Territorial Health Investment Fund

Purpose and objectives of transfer payment program

Building on an initial investment of $70 million in contribution funding (2014-15 to 2017-18), the Territorial Health Investment Fund (THIF) was renewed as a grant Program in 2017-18 with an additional $108 million over four years (2017-18 to 2020-21) and then extended in 2021-22 with an additional $54 million over two years. Over 2021-22 and 2022-23, $12.8 million will be allocated to the Yukon, $14.2 million to the Northwest Territories, and $27 million to Nunavut. This funding will enable each territory to continue pursuing innovative activities in support of strong, sustainable health systems and to offset costs associated with medical travel to support Northerners' access to the health care they need.

Results achieved

The THIF supported territorial efforts to innovate and transform their health care systems and help offset costs associated with medical travel.

Funding provided through the THIF in 2021-22 continued to offset the medical transportation costs experienced by territorial governments and supported the development and implementation of innovative activities intended to transform territorial health systems. For example:

• The Northwest Territories developed projects, and began the first of two years of work to implement a System Sustainability Plan, with a goal of strengthening health care service delivery in the territory.
• Yukon developed new cultural safety and humility training, continued to work towards the launch of integrated and collaborative health service delivery models, and continued its rollout of the Yukon's integrated electronic health record system. It also continued to focus on implementing the transformative recommendations set out in Putting People First (the report of the Independent Expert Panel on the comprehensive review of health and social services in the Yukon).
• Nunavut supported work in its priority areas of health human resources and capacity building, including initiatives to support the participation of Nunavut Inuit paraprofessionals within the health workforce. It also continued to focus on its tuberculosis program, and the further implementation of the community oral health program.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2023-24.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with Territories to discuss progress. In addition, Health Canada continued to monitor the recipients' compliance with the grant agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Transfer Payment Programs under $5 Million

Climate Change and Health Adaptation Capacity Building Program

General information

Name of transfer payment program

Climate Change and Health Adaptation Capacity Building Program

Start date

April 1, 2018

End date

March 31, 2022

Type of transfer payment

Grant and Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2017-18

Link to departmental result(s)

Core Responsibility 2: Health Protection and Promotion

Result 4: Canadians are protected from unsafe consumer and commercial products and substances

Link to the department's Program Inventory

Program 22: Climate Change

Purpose and objectives of transfer payment program

The purpose of the Program is to protect and improve the health of Canadians in a changing climate through better understanding of risks and effective adaptation measures, and by building needed capacity to implement them.

Results achieved

The expected result is:

Health system actors take adaptation measures to reduce the health effects of climate change.

This expected result will be measured by the following indicator:

Percentage of funded health system actors that have taken evidence-based adaptation measures to reduce the health effects of climate change

Target: 80% by March 31, 2022

The Climate Change and Health Adaptation Capacity Building Program (HealthADAPT) funds projects to help health system actors (including provincial, territorial and regional health stakeholders) to prepare, prevent, and respond to impacts of climate change. Funding recipients included ten health authorities across five provinces and territories (British Columbia, Ontario, Quebec, New Brunswick, and the Northwest Territories).

In 2021-22, 100% (10/10) of funding recipients continue to make progress on their projects and have taken evidence-based measures to adapt to the health impacts of climate change.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2025-26.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with recipient groups to discuss progress. In addition, Health Canada continued to monitor the recipients' compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

The Health Canada HealthADAPT team regularly meets with funding recipients to provide guidance and support for projects and to facilitate knowledge exchange among funding recipients who provide peer support. The team also provides information on climate and health related training, webinars, and other materials.

The HealthADAPT team also held its fourth annual virtual meeting in February 2022. Officials from the ten funded health authorities across Canada, as well as guests from the World Health Organization, Pan American Health Organization, and the United States Center for Disease Control participated. The meeting provided the opportunity for participants to engage in knowledge exchange and meaningful dialogue and allowed funding recipients to share novel information on their respective HealthADAPT projects, along with project approaches, challenges faced, lessons learned, and recommendations for other health authorities.

Improving Affordable Access to Prescription Drugs Program

General information

Name of transfer payment program

Improving Affordable Access to Prescription Drugs Program

Start date

August 11, 2021

End date

March 31, 2025

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2021-2022

Link to the departmental result(s)

Core Responsibility 1: Health Care Systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 2: Access, Affordability, and Appropriate Use of Drugs and Medical Devices

Purpose and objectives of transfer payment program

The purpose is to expand Prince Edward Island's public formulary and improve the affordability of its public drug plans to levels more comparable to those of other provinces and territories. Insights and lessons learned from this initiative may be used to inform the future implementation of national pharmacare.

Results achieved

In 2021-22, Prince Edward Island (PEI) initiated a comprehensive review of its existing formulary and public drug programs to identify the gaps that exist between prescription drug coverage on PEI and the rest of the Atlantic region. This will help inform how the drug formulary and public drug programs can better serve Islanders and to improve the access and affordability of prescription drugs.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The timing for the evaluation will be determined during the development of a future Departmental Evaluation Plan.

Initiatives to engage applicants and recipients

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with the responsible PEI staff and senior management to discuss progress. In addition, Health Canada continued to monitor the recipient's compliance with the funding agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Innovative Solutions Canada

General information

Name of transfer payment program

Innovative Solutions Canada

Start date

August 23, 2019

End date

March 31, 2023

Type of transfer payment

Grant

Type of appropriation

Estimates

Fiscal year for terms and conditions

2019-20

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care systems

Result 2: Canadians have access to appropriate and effective health services

Link to the department's Program Inventory

Program 1: Health Care System Analysis and Policy

Purpose and objectives of transfer payment program

Innovative Solutions Canada is a horizontal Government of Canada initiative, coordinated by Innovation Science and Economic Development Canada, in which participating departments and agencies can issue challenges to Canadian businesses to develop solutions for operational or sector-specific issues and fund the early stage research and development of these innovations. Health Canada's participation will enable innovators and entrepreneurs to generate novel solutions to help Canadians maintain and improve their health.

Results achieved

Health Canada funded two Phase I grant challenges, designed to help address the oversubscription of antibiotics and improve the success of organ transplantation. These challenges resulted in Phase 1 funding of eight companies in spring 2020. To accommodate delays resulting from the COVID-19 pandemic, the time available for funding recipients to demonstrate proof of concept was extended to early 2021. Phase 1 was completed with solutions from seven companies demonstrating proof of concept and submitting proposals for Phase 2 funding. Of these submissions, four companies (two for each challenge) are being supported with Phase 2 funding of up to $1 million each over two years.

Health Canada also sponsored the testing of projects within the Canadian health system under the Innovations Solutions Canada Testing Stream. Respectively, these were aimed at developing environmentally safer, compostable face pieces to replace surgical masks, improving communication mental health care settings for enhanced patient care, and improving triage capacity in hospital emergency departments through AI-enabled digital solutions for improved efficiency and care. Sponsored last year but continuing into FY 22-23, Health Canada is sponsoring the testing of a patient-facing mobile application that supports continuity of care and provides health resources for Canadians living in rural and remote regions.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation completed 2021-22.

Planned: The timing for next evaluation will be determined during the development of a future Departmental Evaluation Plan.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with Innovative Solutions Canada to discuss progress. In addition, Health Canada continued to monitor the recipients' compliance with the grant agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Radon Outreach Contribution Program

General information

Name of transfer payment program

Radon Outreach Contribution

Start date

April 1, 2018

End date

Ongoing

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to departmental result(s)

Core Responsibility 2: Health Protection and Promotion

Result 4: Canadians are protected from unsafe consumer and commercial products and substances

Link to the department's Program Inventory

Program 30: Radiation Protection

Purpose and objectives of transfer payment program

The purpose of this Program is to protect and improve human health and well-being in Canada from the impacts of indoor radon exposure, by aiding in the education of Canadians about the importance of testing their homes, schools and workplaces for radon and reducing radon levels where necessary.

Results achieved

The expected results are:

• Canadians and stakeholders are aware of strategies and tools to reduce exposure to radon.
• Canadians and stakeholders are enabled to manage risk from exposure to radiation.

These expected results will be measured by the following indicators:

Percentage of Canadians surveyed who are knowledgeable about radon

Target: 65% by March 31, 2023

Percentage of Canadian homeowners surveyed who have tested their homes for radon

Target: 10% by March 31, 2026

Health Canada continued to increase awareness on the risks, health impacts and mitigation strategies related to radon gas – the leading cause of lung cancer for non-smokers.

Since the establishment of the Radon Outreach Contribution Program in 2018, 25 proposals have been funded. The funded projects are focused on innovative ways of motivating action and behaviour change to reduce radon exposure, particularly in populations that have been identified as at-risk, such as those in areas with high radon, smokers, residents of social housing, First Nation communities, schools, childcare facilities, young families, and lung cancer patients.

Measures/Indicators:

Indictor 1: The 2019 Households and the Environment Survey showed that 63% of Canadians surveyed are knowledgeable about radon. Note: these are the most recent available results. This survey is conducted every two years; results from the 2021 survey will be available in 2023.

Indicator 2: The 2019 Households and the Environment Survey showed that 6% of Canadian homeowners surveyed had tested their homes for radon. Note: these are the most recent available results. This survey is conducted every two years; results from the 2021 survey will be available in 2023.

Findings of audits completed in 2021-22

Completed: No audit was completed in 2021-22.

Planned: Not applicable.

Findings of evaluations completed in 2021-22

Completed: No evaluation was completed in 2021-22.

Planned: The next evaluation is scheduled for 2024-25.

Engagement of applicants and recipients in 2021-22

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with recipient groups to discuss progress. In addition, Health Canada continued to monitor the recipient's compliance with the contribution agreement, performance and results through the analysis and follow-up of progress, performance and financial reporting.

Gender-Based Analysis Plus

Section 1: Institutional GBA Plus Capacity

In 2021-22, the renewal of both the Health Portfolio SGBA Plus Policy (Policy) and Health Canada's Sex- and Gender-Based Analysis Plus (SGBA Plus^{Footnote 4}) Action Plan (Action Plan) supports greater integration of equity, diversity and inclusion into all Health Canada initiatives, departmental culture and operations. This 4-year Action Plan (2022-26) demonstrates Health Canada's continued commitment to advance equity and improve its approaches to diversity and inclusion. Specifically, it provides a framework to implement the Health Portfolio Policy while strengthening the integration of sex, gender and other intersectional factors (such as age, race and income level) in the externally and internally facing work of the Department. Priorities were established based on the results of an evaluation of the Sex and Gender Action Plan 2017-2020 and the corresponding Management Response and Action Plan (MRAP) in 2021. Priorities include:

• Increase governance, accountability and transparency in the integration of SGBA Plus in the Department's decision-making;
• Strengthen Departmental knowledge and capacity to apply SGBA Plus using an intersectional approach;
• Collaborate with internal and external partners to strengthen the Department's sex, gender and diversity-related evidence base and expertise;
• Enable the collection and use of disaggregated data for rigour in intersectional analysis;
• Enhance communications, guidelines, tools and resources with clarity on SGBA Plus and intersectionality.

Key 2021-22 initiatives in support of SGBA Plus integration included:

Health Canada's Centre of Excellence on SGBA Plus – In 2021, the Gender and Health Unit was renamed the SGBA Plus Centre of Excellence (SCOE). In addition to renewing the Action Plan as described above, the SCOE supported the evaluation of the 2017-2020 Action Plan and used the evaluation findings to strengthen Health Canada's SGBA Plus governance and reporting structure, support the integration of SGBA Plus into organizational processes, and address knowledge gaps through the development of tools and training. Activities included the following:

• Provided targeted advice and guidance to Health Canada employees on incorporating sex, gender and diversity considerations into research, policies, legislation, regulations, services and program development. This included reviewing and tracking the use and quality of SGBA Plus in policy proposals, Cabinet documents and documents designed to assess the performance of Health Canada's programs.
• Updated and improved SGBA Plus training, tools, resources and guidance to support Health Canada programs in integrating SGBA Plus into decision-making processes. This included: Program management training and integrating SGBA Plus with knowledge translation and performance measurement; customized training for Health Canada's programs; and integrating SGBA Plus into research through Health Canada's Science Forum. Events and training sessions were well attended by program experts seeking to better understand how to apply SGBA Plus in their work.
• Led the consultation and revision process of the Health Portfolio SGBA Plus Policy to better reflect an intersectional approach that integrates anti-racism, accessibility and Indigenous lenses in the development and delivery of programs and initiatives. The Policy also outlines responsibilities at all levels to fully integrate SGBA Plus into the work of the Health Portfolio.
• Established a new senior-level accountability structure to improve departmental SGBA Plus governance. This included creating a departmental SGBA Plus Integration Network to facilitate the integration of SGBA Plus into all areas and functions of the Department.
• Revitalized the Health Canada SGBA Plus Community of Practice to share best practices and approaches for integrating SGBA Plus into the work of the Department.

Health Canada's response to COVID-19 – In response to the pandemic, Health Canada put forth a number of enhanced post-market surveillance activities for monitoring the safety profile of COVID-19 vaccines and conducted expedited safety assessments that included SGBA Plus such as:

• Analyzing spontaneous safety reports each week and disaggregating them by sex to identify adverse events associated with vaccines (in collaboration with the Public Health Agency of Canada).
• Requiring vaccine manufacturers to collect additional data specific to pregnant and breastfeeding persons and to study the outcomes further in the same population.
• Requiring vaccine manufacturers to submit monthly safety reports that include data disaggregated by patient characteristics, including by sex.

Health products – Health Canada sought advice from its Scientific Advisory Committee on Health Products for Women on SGBA Plus considerations for medical device scientific reviewers. The Department also incorporated the Committee's input into a draft guidance document on "Clinical evidence requirement for medical devices"; a breast implant patient checklist; a medical device triage tool; and Medical Device Incident Reporting Templates. Advice provided by the Committee on the guidance related to SGBA Plus considerations were integrated throughout the guidance document prior to public consultation.

Healthy eating – When promoting Canada's food guide, Health Canada continued to develop targeted healthy eating resources and worked with stakeholders to reach Canadians across various settings, ages, and population groups. For example, Health Canada:

• Created a user-centric food-guide recipe gallery that includes culturally diverse recipes and articles.
• Hired an organization that represents a diverse group of chefs and food advocates from minority communities to review Canada's food guide content through a lens of multiculturalism and diversity and to challenge assumptions and biases. This input informed updates and new content in the food guide's consumer-facing webpages.
• Continued working with diverse groups of youth and young adults to inform the development of new resources and tools, including social media campaigns and experiential marketing modules, as well as to promote peer-to-peer engagement on healthy eating.
• Evaluated its monthly food guide newsletter, in part to determine whether it is reaching a diverse audience. The Department will use the results of the evaluation to develop strategies to broaden the reach of the newsletter in the coming fiscal year.

Cannabis – Health Canada continued to integrate SGBA Plus into its public opinion research on cannabis. Since the establishment of the Canadian Cannabis Survey in 2017, additional demographic questions were added annually to improve data quality. Questions on gender, educational attainment, and household income were included with the addition, in 2018, of a question about sex at birth. In 2019, questions on sexual orientation and place of birth were added. In 2020, additional questions on race and Indigenous identity were added, with some adjustments in 2021.

Expanding Access to Mental Health and Substance Use Services – Health Canada signed an agreement with the Standards Council of Canada to develop an integrated suite of standards for mental health and substance use services in priority areas that align with the Common Statement of Principles on Shared Health Priorities: primary health service integration; children and youth; and people with complex health needs. A diverse range of interested parties will be engaged to inform this work, including provinces and territories, Indigenous partners, health organizations and people with lived and living experience. The Department also funded the Mental Health Commission of Canada to advance specific priorities in mental health and substance use and suicide prevention through engagement with a diverse set of stakeholders. The organization continued to provide mental health education and training for targeted populations on addressing stigma and e-mental health.

Chemicals Management Plan – Health Canada completed two pilot projects to develop and introduce tools and training materials to strengthen and more systematically apply SGBA Plus considerations within its chemicals management activities, including risk assessment, risk management, engagement and outreach and air and water quality. The Department also published a new online Risk Assessment Fact Sheet outlining how various sub-populations are considered in chemical risk assessments. This document highlights the importance of SGBA Plus in identifying sub-populations that may be disproportionately impacted by chemical exposure in order to assess how the needs of these populations can be addressed.

Environmental Health Outreach – The Department continued to refine its environmental health outreach materials to support inclusive outcomes for all Canadians with inclusive images and text, described video, and selected images to challenge stereotypes.

A national survey of Canadians aged 18 years and older was conducted to determine their awareness and understanding of and behaviours towards chemicals and pollutants found in and around the home. The survey provides data for various sub-populations including parents/guardians of children under six, pregnant persons, seniors, and newcomers to Canada.

A new 3-year Healthy Home marketing strategy was developed to reach parents with young children and pregnant persons, and populations that may be disproportionately impacted by chemical exposure, including seniors, people with health conditions and new Canadians, as well as homeowners and renters. A campaign leveraging 20 social media influencers was launched late in the year to deliver key messages related to children and pregnant persons' health and safety, as well as the importance of ventilation, radon testing and chemical safety around the home. Additional marketing activities will continue through to 2024.

For additional information on SGBA Plus implementation within Health Canada, please refer to the 2021-22 Departmental Results Report: Key Results, Sex- and Gender-Based Analysis Plus.

Section 2: Gender and Diversity Impacts, by Program

The data presented in the tables below reflect SGBA Plus indicators from 2021-22 (or if unavailable, 2020-21 data or earlier) as monitored through Health Canada program Performance Information Profiles as well as external sources (e.g., contribution agreement recipients, the Canadian Institute for Health Information, Statistics Canada, etc.). The Department is committed to evidence-based decision-making, through the implementation of SGBA Plus, and to continuous improvement of its indicators and outputs to ensure programs meet the needs of all Canadians. Subject to program scope and data availability, the Distribution of Benefits section presents the aggregated (total) impact of each Program's activity streams on gender, age and/or income groups. The Key Impacts sections present quantitative and qualitative information on SGBA plus Program impacts by sex, gender and/or other diversity factors. The GBA Plus Data Collection Plan section highlights how the program plans to collect and use new or additional sources of SGBA Plus data for future analysis.

Definitions:

Target Population: See Finance Canada definition of Target Group in the following document: User Instructions for the GBA Plus Departmental Summary – Budget 2020 – Canada.ca

Gender Scale:^{Footnote 5}

• First group: Predominantly men (e.g. 80 per cent or more men)
• Second group: 60 per cent - 79 per cent men
• Third group: Broadly gender-balanced
• Fourth group: 60 per cent - 79 per cent women
• Fifth group: Predominantly women (e.g. 80 per cent or more women)

Income Level Scale:

• First group: Strongly benefits low income individuals (Strongly progressive)
• Second group: Somewhat benefits low income individuals (Somewhat progressive)
• Third group: No significant distributional impacts
• Fourth group: Somewhat benefits high income individuals (Somewhat regressive)
• Fifth group: Strongly benefits high income individuals (Strongly regressive)

Age Group Scale:

• First group: Primarily benefits youth, children and/or future generations
• Second group: No significant inter-generational impacts or impacts generation between youth and seniors
• Third group: Primarily benefits seniors or the baby boom generation

Gender Results Framework Pillars: see definitions at the following page: Gender Results Framework - Women and Gender Equality Canada)

Quality of Life Domains: See definitions in Annex-5-eng.pdf (budget.canada.ca)

Core Responsibility 1: Health Care Systems

Program Name: Access, Affordability, and Appropriate Use of Drugs and Medical Devices

This program supports the federal government's interest in achieving an accessible, high quality, sustainable and accountable health system that is adaptable to the needs of Canadians by advancing the accessibility, affordability and appropriate use of drugs and medical devices.

Infographic for Access, Affordability, and Appropriate Use of Drugs and Medical Devices

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Cost related non-adherence (CRNA) to prescription by sex	Female: 6.5% Male: 4.5%	Canadian Community Health Survey (2015-16) Law et al. 2018	Females have experienced higher rates of CRNA than males.
CRNA to prescription by income	<20k: 11.14% $20,000-39,999: 9.44% $40,000-59,999: 7.03% $60,000-79,999: 5.56% >$80,000: 4.81%	Canadian Community Health Survey (2015-16) Law et al. 2018	Lower household income is associated with higher rates of CRNA.
CRNA to prescription by age	12 to 34: 5:84% 35 to 44: 7.65% 45 to 65: 5.30% >65: 4.19%	Canadian Community Health Survey (2015-16) Law et al. 2018	The >65 age group consistently had the lowest rates of CRNA over time, likely due to specialized drug coverage programs provided to this age group. The 35-44 age group had the highest rates of CRNA.
Table a3.1 - Footnote * 2021-22 or most recent Return to Table a3.1 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Data gaps are particularly present for visible minority groups and, in many studies, researchers are not able to disaggregate by race or income status. The limited clinical and administrative data available that is disaggregated on gender, age, and race indicates that Canada's current pharmaceutical management system disproportionality impacts women, seniors, Indigenous peoples and visible minorities, who experience higher rates of CRNA (not taking medications due to cost) along with other health and social barriers based on biological sex, gender, age, or ethnicity.

GBA Plus Data Collection Plan:

An SGBA Plus perspective is regularly applied as part of policy and program decisions to improve access, affordability and appropriate use of drugs and medical devices. Since Health Canada engages provinces and territories (P/Ts), and other health system partners to support the effective management of health products, the Department relies on data collected and reported by data owners external to the Health Portfolio, which can result in SGBA Plus considerations to be incorporated to varying degrees. Various health-data initiatives are underway that will seek to improve the collection of disaggregated data with an emphasis on at-risk populations where possible. For example, updated disaggregated data on CRNA, among other pharmaceutical indicators, are expected to be available from Statistics Canada in 2023.

Health Canada plays an active role to ensure access for all Canadians to appropriate and effective drugs and health care products while strengthening the integration of sex, gender and other intersectional factors (such as age, race and income level) in the externally- and internally-facing work of the Department. Hence, Health Canada will continue to work with recipients that receive federal funding through this program to impress a shared value of SGBA Plus amongst funded projects and pan-Canadian Health Organizations. This includes improving incorporating SGBA Plus considerations into recipient's data collection plans and designing impactful SGBA Plus indicators for performance measurement and reporting. For example, Health Canada's 2021 evaluation of the Canadian Agency for Drugs and Technology in health (CADTH) recommended improving the performance indicators on its products and services, with a particular focus on improving the application of SGBA Plus considerations in its work. The evaluation also recommended that CADTH improve its engagement with Indigenous Peoples, as well as other marginalized communities, while recognizing the history of discrimination and abuse that these groups have faced in the Canadian health care system. Advancing these recommendations are a feature of CADTH's 2022-25 Strategic Plan and will be a key focus of work between Health Canada and CADTH as part of a renewed contribution agreement expected to take effect in the 2023-24 fiscal year.

Program Name: Brain Research

The Brain Research program contributes to research and innovation through understanding underlying mechanisms across various brain diseases/disorders. Specifically, Health Canada provides funding for the Brain Canada Foundation (Brain Canada) which fundraises to match the federal contribution with donations from its private and charitable-sector donors and partners.

Infographic for Brain Research

Target Population: Individual Canadians (People with brain and neurological health conditions, diseases and disorders, and their families and caregivers)

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of research programs with sex, gender or diversity component	Brain Canada-led programs: 100% Total programs: 93% Total programs includes competitions led by Brain Canada's funding partners.	Brain Canada Foundation (Brain Canada) (2021)	Over the years, Brain Canada has demonstrated its commitment to advancing sex, gender and diversity as part of research by incorporating relevant components in research competitions. While it can take decades for fundamental research to translate to intellectual property and clinical applications, considering sex, gender and diversity in the design of research competitions and projects helps to ensure that findings will benefit diverse populations. Brain Canada has less direct control in the context of research competitions led by their funding partners, but has nevertheless worked with partners to increase the consideration of sex, gender and diversity.
Sex distribution of highly-qualified personnel (HQP) at the PhD or Postdoctoral level given capacity building opportunities	Total: 629 Male: 31% Female: 32% Information not available/not disclosed by: 31%	Annual Scientific Reports submitted by researchers to Brain Canada captured and tracked through performance reporting	Brain Canada aims to equitably provide capacity-building opportunities for researchers who are women and men, and have put measures in place as part of their research selection processes to mitigate unconscious bias and monitor trends related to diversity considerations over time. Data includes HQP supported through projects beginning in 2012-13 up until the most recent collection of data in March 2022. Information from 37% of HQP (233 out of 629) was unavailable because there was no requirement from Health Canada to collect sex disaggregated data prior to 2016-17. While Brain Canada voluntarily collected some of this information prior to 2016-17, it did not include input by some funding partners. Some researchers also opted out of disclosure.
Percentage of research applicants in receipt of funding, by gender	Male: 36% Female: 18% Gender not disclosed: 46%	2021-22 Applications to Brain Canada's research competitions	New indicator – data collection began in 2021. Data is limited to grant recipients who received funding beginning in April 2020 or later. 44 of 78 recipients completed a self-identification questionnaire between April 2021 and March 2022.
Percentage of research applicants in receipt of funding, by equity groups	Person with a disability: 3% Visible minority: 17% Indigenous identity: 1%	2021-22 Applications to Brain Canada's research competitions	New indicator – data collection began in 2021. Data is limited to grant recipients who received funding beginning in April 2020 or later. 44 of 78 recipients completed a self-identification questionnaire between April 2021 and March 2022.
Percentage of research projects focussed on diverse groups including women, men and gender-diverse people; Indigenous people; visible minorities; and people in various age groups	Diversity as consideration: 91 Sex/Gender as primary focus: 11% Absence of diversity element: 9%	2021-22 Applications to Brain Canada's research competitions Canada's funding recipients	New indicator - data collection began in 2021 and reflects grants awarded in 2021 and 2022 If researchers do not consider diversity as part of their work, they are required to provide justification for this decision as part of their funding application.
Table a3.2 - Footnote * 2021-22 or most recent Return to Table a3.2 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Research projects funded by Brain Canada have generated evidence to better inform prevention, diagnosis and care for population groups that have traditionally been marginalized in research. These include women and Indigenous people, among others. As part of research competitions, Brain Canada requires applicants to consider how a range of diversity factors including gender, age, ethnicity, and education may influence their research questions. These considerations encourage the researchers to examine disease mechanisms and the development of new therapeutics using novel perspectives as well as enhancing scientific rigour and reproducibility.

Select research projects are specifically geared to examine sex and gender differences, and/or advance knowledge to improve health outcomes for people in diverse groups. A study completed in 2021-22 examined how hormone therapy may affect brain development among adolescents. The findings highlighted the importance of age-related changes in brain structure, and of considering diversity factors including gender identity and sexual orientation in studies on brain development. Foundational knowledge generated from this relatively new area of research has the potential to inform future research on mental health among transgender youth. Another project currently underway is examining the impact of exercise among male and female participants over the age of 65 with mild cognitive impairment. The study, which began in 2018 and will be completed in fall 2022, is expected to help guide the design of sex-specific exercise interventions to reduce Alzheimer's risk.

Supplementary Information Sources:

Effects of Sex Hormone Therapy on Brain Development in Adolescents Experiencing Gender Dysphoria: A Magnetic Resonance Imaging Study

Sex differences in exercise efficacy: Possible role of BDNF and stress axis

GBA Plus Data Collection Plan:

In 2021-22, Health Canada, in collaboration with Brain Canada, advanced and refined a strategy for collecting SGBA Plus data disaggregated by sex, gender and other diversity factors as it relates to research projects funded by Brain Canada. As a result, Brain Canada began collecting data on the percentage of projects focused on diverse groups, as well as the percentage of applicants in diverse groups receiving funding. Lessons learned from the first round of data collection will inform future improvements. For example, optional self-identification among researchers resulted in low response rates. Thus Brain Canada is considering making self-identification a mandatory component of grant applications in the future. In 2022-23, further consideration will be given to indicators that build on/improve existing parameters for the collection of SGBA Plus data.

Program Name: Canada Health Act

The Canada Health Act (CHA or the Act) is Canada's federal legislation for publicly funded health care insurance. The aim of the Act is to facilitate reasonable access to insured health care services without financial or other barriers.

Infographic for Canada Health Act

Target Population: All Canadians

Other Key Program Impacts on Gender and Diversity:

The CHA is Canada's federal legislation for publicly funded health care insurance. The Act sets out the primary objective of Canadian health care policy, which is "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. The CHA establishes criteria and conditions related to insured health services and extended health care services that the P/Ts must fulfill to receive the full federal cash contribution under the Canada Health Transfer. The aim of the CHA is to ensure that all eligible residents of Canada have reasonable access to insured health services on a prepaid basis, without direct charges at the point of service.

Health Canada monitors the operations of P/T health care insurance plans in order to provide advice to the Minister of Health on possible non-compliance with the CHA. Sources for this information include: P/T government correspondence and publications; non-governmental organizations; media reports; and correspondence received from the public. The results of monitoring efforts have identified compliance issues and potential compliance issues pertaining to specific SGBA Plus cohorts including pregnant persons and individuals seeking abortions in New Brunswick and Ontario as well as Indigenous peoples.

Abortion:

• Active monitoring of abortion service issues identified patient charges for abortion services in New Brunswick and Ontario. Both provinces were subject to mandatory deductions to their Canada Health Transfer Deductions in 2021 ($65,850 to New Brunswick and $13,905 to Ontario).
• In December 2021, Ontario submitted a Reimbursement Action Plan to Health Canada, and has committed to revisit the current framework for the funding of insured surgical abortion services in the province. Health Canada continues to engage with Ontario as it works to implement its plan. Health Canada has reminded New Brunswick of the Reimbursement Policy under the Act.

Anti-Indigenous Racism:

• Media and web monitoring identified qualitative information on anti-indigenous racism in the Canadian health care system.
• While the delivery of health care is P/T jurisdiction, P/Ts are reminded of their obligations under the accessibility criterion of the Act to ensure barrier-free access to insured health services, with specific regards to anti-indigenous discrimination and racism in the Canadian health care system.
• No barriers to access, as defined by the Act, were identified in 2021-22.

GBA Plus Data Collection Plan:

Health Canada will continue to actively monitor P/T compliance with the Act, including SGBA Plus related issues (e.g., barriers to abortion services, anti-Indigenous racism at the plan level), through analysis of available information including: correspondence with P/Ts, publications from P/Ts and non-governmental organizations, media reports and grievances received from the public (related to access issues). When issues of non-compliance are suspected, the Department will encourage P/Ts to share detailed information including the number of patients affected and costs. The data will be used to understand the size and scope of the issues and potentially apply deduction amounts to P/T Canada Health Transfer payments when issues cannot be resolved through collaboration.

Program Name: Cancer Control

Through the Canadian Partnership Against Cancer, Health Canada seeks to accelerate action on cancer control for all Canadians by augmenting, building upon and implementing the multi-tiered Canadian Strategy for Cancer Control.

Infographic for Cancer Control

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	N/A	Somewhat benefits high income individuals (Somewhat regressive)	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of cancer patients satisfied with access to care, by sex and provincial jurisdiction	BC: Male: 70.1% Female: 69.5% AB: Male: 74.2% Female: 74.4% SK: Male: 73.8% Female: 73.0% MB: Male: 74.4% Female: 73.8% ON: Male: 72.4% Female: 70.4 % QC: Male: 70.3% Female: 66.2% NS: -- PE: Male: 72.7% Female: 73.4% NL: Male: 72.6% Female: 76.2% NB: --	Ambulatory Oncology Patient Satisfaction Survey (2019)	Data is collected every 2 years. This data is from June 2019. No updates are yet available as jurisdictions did not administer the Ambulatory Oncology Patient Satisfaction Survey in 2021 and the next iteration has not yet been announced.
Smoking prevalence in cancer patients by household income quintile	First Quintile: 21.0% Second Quintile: 16.7% Third Quintile: 15.0% Fourth Quintile: 13.9% Fifth Quintile: 11.3%	Canadian Community Health Survey (CCHS) (2019)	First Quintile represents the lowest income and Fifth Quintile the highest income. Data is collected every 2 years. This data is from 2019 and excludes the Territories because the 2019 CCHS did not cover the entire population of the Territories.
Table a3.3 - Footnote * 2021-22 or most recent Return to Table a3.4 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The federal government recognizes the burden of cancer both at the personal and societal level. Health Canada is supporting cancer control through the Canadian Partnership Against Cancer (CPAC). Established in 2007, CPAC is an independent, not-for-profit organization with a mandate of reducing the number of cancer cases in Canada, minimizing the number of cancer-related deaths, and improving patient quality of life. CPAC seeks to accelerate action on cancer control for all Canadians by augmenting, building upon, and implementing the multi-tiered Canadian Strategy for Cancer Control.

Reducing disparities in access to care and outcomes between jurisdictions, communities, and population groups is a key outcome for CPAC. Efforts are designed to respond to long-standing and pervasive disparities, historically meaning that not all Canadians have benefitted equally from the efforts to implement the Strategy for Cancer Control. The first indicator above measures the extent to which patients across Canada are satisfied with access to care. The data is stratified by jurisdiction and sex and/or gender, which allows for a more comprehensive understanding of patient satisfaction across the country. An increase in patient reported access to services demonstrates an increase in one dimension of quality of life for cancer patients.

Healthy populations require fewer health care treatments. Accelerating the uptake of cancer prevention strategies and policies and adopting evidence-based interventions improves population health. CPAC has defined its role within broader cancer prevention efforts in Canada to focus on key cancer-specific risk factors such as tobacco and radon. CPAC has also focused on integrating prevention with better and earlier diagnosis and screening for underserved populations, such as rural, remote and low-income populations, as well as First Nations, Inuit, and Métis peoples.

Another key outcome for CPAC is that Canadians have access to appropriate and effective health services. The second indicator above is tied to CPAC's prevention program which includes developing and implementing national prevention programs and policies. Smoking prevalence in cancer patients by household income quintile has decreased in all except the fourth quintile.

GBA Plus Data Collection Plan:

The CPAC measures progress and performance on an ongoing basis. This includes: performance measurement planning; regularly collecting data on output and outcome indicators; analyzing and/or synthesizing the data; and using the data to inform decision-making to continually improve implementation. As part of CPAC's contribution agreement with Health Canada, the organization submits a Performance Measurement Strategy every January 31st along with a corporate plan. Sufficient SGBA Plus data is being collected through the Performance Measurement Strategy.

The Performance Measurement Strategy consists of the Canadian Strategy for Cancer Control, the logic model, the previous year's inventory of outcomes and indicators and the planned outputs and outcomes for the upcoming year. CPAC is committed to addressing the diagnostic and treatment needs of men and women, girls and boys, and gender diverse Canadians in its SGBA Plus data collection plans and activities. This includes the application of SGBA Plus and strengthening and promoting the collection of sex and gender disaggregated data in Performance Measurement Strategy in the new 5 year term (beginning in 2022-23).

Program Name: Digital Health

This program supports pan-Canadian collaboration on health innovation to encourage the adoption of new digital health technology to improve access, increase efficiency and improve outcomes for patients.

Infographic for Digital Health

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	N/A	60 per cent - 79 per cent women	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	Somewhat benefits low income individuals (Somewhat progressive)	N/A	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	N/A	Primarily benefits seniors or the baby boom generation	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Canadians access to a telephone consultation with a health care provider, by age group	16-17: 33% 18-34: 41% 35-49: 45% 50-64: 48% 65+: 51%	Canadian Digital Health Survey 2021: What Canadians Think	In 2021, older age groups had telephone visits with their health care professional, while younger age groups used more video and messaging consultations. The telephone was still the most common modality of Virtual Care across age groups
Canadians access to video, consultation with a health care provider, by age group	16-17: 12% 18-34: 20% 35-49: 20% 50-64: 15% 65+: 12%	Canadian Digital Health Survey 2021: What Canadians Think	N/A
Canadians access to secure messaging with a health care provider, by age group	16-17: 4% 18-34: 15% 35-49: 13% 50-64: 10% 65+: 10%	Canadian Digital Health Survey 2021: What Canadians Think	N/A
Canadians access to telephone, video and secure messaging by sex	Female: 57% Male: 46%	Canadian Digital Health Survey 2021: What Canadians Think	N/A
Canadians access to personal health information (PHI), by sex	Females: 83% Males: 76%	Canada Digital Health Survey 2021: What Canadians Think	N/A
Canadians that have accessed own personal health information electronically, by sex	Females: 35% Males: 28%	Canadian Digital Health Survey 2021: What Canadians Think	N/A
Table a3.5 - Footnote * 2021-22 or most recent Return to Table a3.5 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The federal government recognizes the importance of improving health care systems through the implementation of digital health technologies. The policy advice provided by Health Canada is instrumental in advancing the uptake of innovative health solutions. Since 2001, the Government of Canada has invested a total of $2.45 billion in Canada Health Infoway (Infoway) to accelerate the development, adoption and effective use of digital health care across Canada.

This funding will advance pan-Canadian collaboration on health innovation to encourage the adoption of new digital health technology to improve access, increase efficiency and improve outcomes for patients. Infoway works with P/T governments, health care organizations, health professional associations, retail pharmacies, technology vendors, patients and caregivers to advance digital health priorities. Infoway's expected outcomes contribute to supporting the Health Care Systems Core Responsibility.

Improved access to comprehensive primary care services enabled by digital health has the potential to enable better continuity of care, enhanced patient communication with their regular provider and more convenient access to care. This would allow Canadians to better maintain their health and to prevent health problems through early detection. In turn, better upstream management of health issues would reduce acute care interventions. Taken together, the proliferation of digital health tools creates new data points that provide insights into health care functioning and management, including opportunities to improve health service delivery to accommodate the needs of diverse populations. The ultimate outcome is that a strong primary care system will enable better long-term health outcomes for Canadians.

Digital health literacy is an important aspect of health equity, especially for marginalized and vulnerable populations. Factors that affect the digital health literacy of surveyed Canadians include education, household income, and age. Health Canada's work on digital health includes fostering public trust and health data literacy through meaningful engagement to understand Canadians' needs. Furthermore, ongoing efforts in collaboration with F/P/T Governments to accelerate the use of equitable, high-quality and continuous digital health can help ensure that all Canadians have the digital literacy skills and confidence necessary to reap the benefits of digital health while taking concurrent steps to ensure the utmost privacy and security in the collection, sharing, and use of health data.

Supplementary Information Sources:

Canadian Digital Health Survey 2021: What Canadians Think

GBA Plus Data Collection Plan:

There is a lack of research on virtual care services that incorporates an SGBA Plus lens, there is a need to better understand possible inequities in virtual care, especially for underserved populations such as women and 2SLGBTQI+ patients. However, in 2021, Infoway assessed the links between equity and access to electronically enabled health services (Digital Health Equity Analysis: Access to Electronically-Enabled Health Services). Findings suggested that young women were more likely to experience barriers to accessing virtual care during the pandemic compared to older women and men due to a range of issues, such as a lack of health literacy. Evidence also demonstrates that a wide digital divide exists, especially for underserved populations. These results are being used to inform Infoway's initiatives in the 2022-23 fiscal year, and improve SGBA Plus data collection, measurement and analysis of equity issues in access to electronically enabled health services. Health Canada will continue to consult with relevant stakeholders and patient bodies to ensure digital health strategy incorporates the unique needs of sub-populations.

Program Name: Health Care Systems Analysis and Policy

Health Canada works in close collaboration with the P/Ts, health professionals, pan-Canadian organizations and other key stakeholders to undertake health care systems analysis and policy development along with providing funding support towards current and future health care systems challenges. Health care systems analysis and policy activities address issues related to broader health care systems renewal, such as the implementation of the Common Statement of Principles on Shared Health Priorities (CSoP), bilateral agreements with P/Ts, health care financing, governance and accountability, and the roles and interface of the public and private sectors. The work undertaken via the bilateral agreements with P/Ts, the Canadian Institute for Health Information (CIHI) led process on common shared health priority indicators, the Health Care Policy Strategies Program (HCPSP), and Healthcare Excellence Canada (HEC) generates valuable insights that supports the Department's analysis and policy on the health care system

Infographic for Health Care Systems Analysis and Policy

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Gender distribution of healthcare leaders who reported knowledge acquisition in quality improvement because of participating in Healthcare Excellence Canada programming	Number of males: 317/364 Number of females: 51/57 Not known/not disclosed: 113/132	Healthcare Excellence Canada 2020-21 annual report	Gender results may not tally to total result since not all respondents provided responses to the gender element.
Table a3.6 - Footnote * 2021-22 or most recent Return to Table a3.6 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Healthcare Excellence Canada (HEC):

In 2021-22, HEC continued to work towards new policies and ways of organizing and providing services that improve outcomes for older adults by better integrating health and social care. This included programming in long term care (LTC) and frailty care, which based on Canadian demographics, would have the potential to positively benefit seniors, and specifically senior women. Through HEC's "LTC+" program, LTC and retirement homes worked together to improve the health of 170,000 LTC patients/residents in addition to strengthening pandemic preparedness, resilience and recovery in over 1,500 homes. Its "Advancing Frailty Care in the Community" collaborative improved capability and capacity in primary care and home settings to implement, spread and sustain frailty-related improvements (involving over 200 healthcare leaders and approximately 5,000 patients across the country).

The federal government has engaged with P/Ts to address key health care priorities by providing funding through bilateral agreements. Like other federal actions also undertaken in home and community care, and mental health and substance use, the bilateral agreements target areas of the health system where change is most needed. These agreements set out details of how each jurisdiction is investing the first 5 years of the federal funding of $11 billion over 10 years to improve access to home and community care and mental health and addiction services, which includes initiatives that support the integration of sex, gender and diversity in their programs. CIHI has worked closely with F/P/T governments to develop a set of common indicators. In June 2018, the F/P/T health ministers (except Quebec) approved 12 indicators in these priority areas, and 8 indicators are now available in CIHI's Your Health System. These data are disaggregated by sex and/or gender and/or age as appropriate.

Provinces continue to assist women and 2SLGBTQI+ and diverse communities in Canada using federal funding under the Home and Community Care and Mental Health and Addictions Services bilateral agreements. For example:

• British Columbia increased access to community-based mother-baby care services for pregnant persons who use substances. British Columbia's primary care intervention for children and youth provided mental health and addiction prevention services in school-based settings, recognizing diversity, including Indigenous, 2SLGBTQI+ immigrant, refugee, and newcomer student communities.
• Alberta increased housing- and home-based support to assist recovery for people with addiction and mental health needs, including the addition of housing supports for chronically homeless in the North Zone and women in the sex trade in the Edmonton Zone.
• Manitoba implemented a pregnancy and infant loss program improving support to assist women and families experiencing post-partum depression.
• Ontario enhanced their community-based core mental health and addictions services by expanding programs for priority populations, including new Canadians, French-speaking, and 2SLGBTQI+. Ontario also implemented a new province-wide Eating Disorders Early Intervention Program to address body image, disordered eating and early-stage eating disorders. A Canadian study found that lesbian, gay, and bisexual youth are significantly more likely to engage in disordered eating than their heterosexual peers.

Specifics on investments can be found online.

Health Care Policy and Strategies Program (HCPSP):

A number of projects funded by the HCPSP in 2021-22 ensured the needs of diverse populations were considered and incorporated in programming, specifically women, seniors, Indigenous peoples, youth, 2SLGBTQI+ communities, racialized communities, and/or people living in rural/remote areas. Examples include:

• The Heart and Stroke Foundation of Canada's project Advancing Women's Heart Health supported targeted research on heart disease and stroke in women; promoted collaboration between research institutions; and invested in female and Indigenous researchers. In addition, the Foundation provided opportunities for researchers to learn about SGBA Plus and research, and how to apply it in order to increase capacity for SGBA Plus in cardiovascular research.
• The Children's Hospital of Eastern Ontario hosted training sessions to support the adoption of the Aaniish Naa Gegii: the Children's Health and Well‐being Measure in communities and organizations that support First Nation, Inuit, and Metis children and youth. This culturally-appropriate application collects self-reported health and wellness data and screens the data for mental health challenges to identify children at risk. The application also gives Indigenous children and youth a safe space to talk about wellness.
• In 2019-20, Providence Health Care Research Institute worked with patients and community partners to develop and test interventions to improve access to living donor kidney transplants for South Asian, African, Caribbean, and Black Canadians with kidney failure. In 2021-22, the organization published best practices and recommendations for increasing access to and equity in Canadian organ transplantation. Next steps include implementing and evaluating culturally competent support services.

GBA Plus Data Collection Plan:

Home and Community Care and Mental Health and Addiction Services Bilateral Agreements:

CIHI publishes data on the shared health priorities annually through Your Health System including new gender-disaggregated data on hospital stays and self-harm made available in spring/summer 2022.

Health Care Policy Strategies Program:

Health Canada integrates SGBA Plus at all stages of the project cycle. All applicants are required to describe their approach to SGBA Plus in their funding proposal and to work with Health Canada after the contribution agreement is signed to develop a tailored performance measurement plan that includes relevant SGBA Plus results data appropriate to the project. Health Canada collects and analyzes data reported by the funding recipients at the end of each fiscal year, including the disaggregation of data by SGBA Plus factors. The results of this data analysis are included in the Program's results reporting. The results measure the performance of funded projects to demonstrate how these projects are improving the health care system to better meet the needs of underserved populations across Canada.

For instance, all of the output-level indicators measure some aspect of diversity, including: the identification of underserved groups that project resources/activities are targeted to; whether a resource is gender-specific; the geographic location of resources, activities, and collaborative arrangements; and the language of products and activities. The collection of data along these factors provides a deeper understanding of the performance results and enables the HCPSP to report an inclusive performance story at the program level. In 2021-22, Health Canada strove to better understand the impacts of funded initiatives, specifically focusing on projects that targeted women and Indigenous researchers, as well as cultural and linguistic minorities (Chinese and South Asian communities in British Columbia), to illustrate some of the ways in which funding supports diversity and inclusion in the health care sector. The case studies identify some best practices to support effective integration of SGBA Plus into project activities and outputs, such as leveraging diverse expertise, including those with lived experience in content development processes, and, taking deliberate actions to make new resources accessible to the targeted audiences (e.g., by using low-barrier online platforms, using relevant language and cultural versions of materials).

Health Canada has also developed questionnaires which will be administered to Health Canada program/policy leads at the completion of funded initiatives, starting with projects that ended in the 2021-22 fiscal year. The questionnaires are intended to gather an additional layer of qualitative data regarding the success of the HCPSP projects, and include a section on best practices and lessons learned related to SGBA Plus.

The results of monitoring efforts have identified compliance issues and potential compliance issues pertaining to specific SGBA Plus cohorts including pregnant persons and individuals seeking abortions in New Brunswick and Ontario as well as Indigenous peoples.

Program Name: Health Information

Health Canada acknowledges the importance of enhancing health care systems by providing health care information that improves the health of Canadians. The Health Information program supports the provision of comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada under its present mandate.

Infographic for Health Information

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Number of CIHI databases with the variable Sex	17 databases with available data 6 databases with partial data availability (i.e., data element has significant data quality and/or coverage limitations) 9 databases with no data availability	CIHI's Equity Stratifier Inventory	It may not be relevant to collect data by sex for some of CIHI's databases. For instance, the National Health Expenditures Database is focused exclusively on financial information.
Number of CIHI databases with the variable Gender	8 databases with available data 7 databases with partial data availability (i.e., data element has significant data quality and/or coverage limitations) 17 databases with no data availability	CIHI's Equity Stratifier Inventory	It may not be relevant to collect data by gender for some of CIHI's databases. For instance, the National Health Expenditures Database is focused exclusively on financial information.
Table a3.7 - Footnote * 2021-22 or most recent Return to Table a3.7 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The Canadian Institute for Health Information (CIHI) is an independent not-for-profit organization that provides comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada. Its stakeholders use CIHI's broad range of health system databases, measurements and standards, together with its evidence-based reports and analyses, to support health system decision-making processes. In 2021-22, CIHI received over $101.3 million (about 81% of its total funding) from Health Canada.

Historically, many databases of the CIHI have included data by sex and some have included information on sexual orientation, where applicable. Sex and gender data in the health sector is undergoing a paradigm change, evolving from capturing "male and female" to more broadly reflecting population gender diversity. Data within the acute care hospital sector has largely reflected biological sex rather than gender, as such information is usually linked to health card registration, which historically captured biological sex at birth. Sex and gender concepts and collection practices are continuing to evolve in the health care sector, and it may be a few years before there is a common cross jurisdictional standard adopted for collecting both sex and gender. The availability of acute care/hospital data on both sex and gender is slowly increasing, as individuals are provided opportunities to update this information.

The CIHI continues to establish common definitions and data standards, and works to promote the collection of SGBA Plus data as demonstrated by the 2018 report "In Pursuit of Health Equity: Defining Stratifiers for Measuring Health Inequality A Focus on Age, Sex, Gender, Income, Education and Geographic Location." The goal of this report was to facilitate and encourage the use of standard equity stratifiers in data collection, performance measurement and reporting initiatives, enabling comparisons across Canada. The definitions are part of a broader program of work under way at CIHI to harmonize and strengthen the measurement of health inequalities in Canada. CIHI supports implementing common coding standards and encourages their use within P/T health systems, with P/Ts gradually adopting the proposed standards in their collection systems e and voluntarily submitting data to CIHI. CIHI continued to work with jurisdictions on establishing common definitions and data standards in 2021-22 through holding regular forums and meetings of CIHI's Database Advisory Committees.

CIHI's Measuring Health Inequalities: A Toolkit — Equity Stratifier Inventory was developed to help assess the availability of embedded and area-level equity stratifiers (socio-demographic variables) when planning an analysis to measure health inequalities using selected CIHI and Statistics Canada data sources. The capture of sex and gender data elements at CIHI is described and updated regularly in the Equity Stratifier Inventory. Further, in 2020 CIHI developed pan-Canadian standards for collecting race-based and Indigenous identity data in health systems. These data standards map to existing Statistics Canada's national standards, so information can be integrated and compared with other data sources.

GBA Plus Data Collection Plan:

Although CIHI does not collect primary data and has no direct authority over what data is collected, it establishes pan-Canadian standards for data submitted by jurisdictions, actively promoting the use and adoption of standardized identifiers for gender and ethnicity within the P/T data sources. This enables expanded data collection in support of SGBA Plus. It is anticipated that richer data will become available once P/Ts consistently adopt the proposed standards in their health care data collection systems. The Canadian Health Information Forum with participation from F/P/T government officials and health system stakeholders, including CIHI, provides a venue for sharing and discussing pan-Canadian health information issues, including broadening the collection of SGBA Plus data.

Program Name: Home, Community and Palliative Care

The Government of Canada is committed to supporting P/Ts to enhance access to quality home, community and palliative care services for Canadians by spreading and scaling integrated models of care; enhancing access to palliative care; increasing support for caregivers; and enhancing home care infrastructure.

Infographic for Home, Community and Palliative Care

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	N/A	60 per cent - 79 per cent women	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	Somewhat benefits low income individuals (Somewhat progressive)	N/A	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	N/A	Primarily benefits seniors or the baby boom generation	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Gender distribution of Canadians (age 18+) who have expressed an unmet need for home care services	Female: 2.1% Male: 1.1%	Statistics Canada 2015/2016 Canadian Community Health Survey	A larger proportion of females than males have unmet home care needs in Canada.
Number of days Canadians waited for home care services, from the initial referral to the day when the first home care service was received by sex	Female: 4 days or longer Male: 3 days or longer	Canadian Institute for Health Information (2021)	Females were more likely to be referred for home care services than males, with half of females waiting 4 days or longer, compared with 3 days or longer for males.
Gender distribution of new long-term care residents who potentially could have been cared for at home	Women: 63% Men: 37%	Canadian Institute for Health Information (2021)	In 2018-19, of all new long-term care residents who potentially could have been cared for at home, about 63% were women and 37% were men. The age and sex profiles of these residents were not significantly different from those of other newly admitted long-term care residents.
Gender distribution of senior caregivers reporting distress	Women: 39% Men: 26%	Statistics Canada 2018 General Social Survey (Caregiving and Care Receiving)	One-third of senior caregivers reported that their caregiving responsibilities were stressful or very stressful. Among senior caregivers, women reported higher levels of stress than men.
Access to palliative care, by sex and age	For those who died at home: 19 to 44, 47%; 45 to 64, 46%; 65 to 74, 46% 75 to 84, 40%; 85 and older, 29%. For those who died in acute care: 19 to 44, 18%; 45 to 64, 29%; 65 to 74, 29%; 75 to 84, 25%; 85 and older, 22%.	Access to Palliative Care in Canada	Access to palliative care did not appear to differ by sex or income level. However, some groups were more likely than others to receive palliative care at home or in hospital settings, including: people with a cancer diagnosis; younger seniors and adults; and those who lived in rural and remote areas. Access to palliative care by 2SLGBTQI+ community members was not reported.
Caregiving for someone at the end of life	Canadians 15 years or older who reported providing end-of-life care to a friend or family member at some point in their lives: 13% Female: 63% Age 45 to 64: 51%	Statistics Canada, 2012 General Social Survey, Caregiving	Caregivers who had provided end-of-life care were primarily female (63%), married (54%), age 45 to 64 (51%) and 63% had a household income of less than $100,000 a year. These characteristics were similar to the profiles of Canadian caregivers more generally.
Table a3.8 - Footnote * 2021-22 or most recent Return to Table a3.8 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Age is a significant factor for care received at home and at end of life. More than 87% of assessed home care clients were aged 65 years and older, and 18% died while receiving home care (Profile of Clients in Home Care, 2020–21. Ottawa, ON: CIHI; 2022).

Both age and gender differences are present in the unmet needs of caregivers:

• In 2018, about one-third of caregivers who received support said that there was another kind of support that they would have liked to receive in the past year.
• Female caregivers were more likely to report unmet needs (32%) than male caregivers (28%).
• A higher proportion of caregivers between the ages of 35 and 64 reported having unmet caregiving support needs (34%) than young caregivers aged 34 and younger (25%) and senior caregivers aged 65 and older (28%). Caregivers born outside Canada were also more likely to report unmet needs.
• Unmet caregiving support needs are associated with lower life satisfaction, more daily stress and worse self-reported mental health.

Health Canada will continue to consider SGBA plus data in the development of policy and programs to support Canadians aging at home, and will continue to encourage P/Ts to address SGBA plus considerations in collaborative initiatives.

Supplementary Information Sources:

2018 General Social Survey: Caregiving and Care Receiving

Home and community care indicators available through the CIHI led process on shared health priorities: Your Health System | CIHI

Statistics Canada Data: Census 2016 Labour Data: Occupation, Employment Income Statistics, Immigrant Status and Period of Immigration, Work Activity During the Reference Year, Age and Sex

Access to Palliative Care in Canada

Gender and Palliative Care: A Call to Arms

Framework on Palliative Care in Canada

Action Plan on Palliative Care

Two-Spirit and LGBTQ+: Proud, Prepared and Protected

GBA Plus Data Collection Plan:

Through the CIHI-led process on shared health priorities, common indicators for home and community care will be updated and released annually through Your Health System | CIHI and will be disaggregated by gender and/or age as appropriate. Launched in 2013, Your Health System is an interactive application provided through CIHI that compiles data from close to 1,300 long-term care organizations and 600 Canadian hospitals. This data allows for the comparison of person-centeredness and health care; health care access, efficiency, appropriateness and effectiveness; social determinants of health; health care safety; and health status. Over the next 5 years, these indicators will tell a clearer story about access to care across the country, identify where there are gaps in services and help to make meaningful changes in order to improve the experiences of Canadian patients and their families.

Program Name: Medical Assistance in Dying

Health Canada monitors Medical Assistance in Dying (MAID) implementation and provides policy support to increase the evidence base about how MAID is being delivered in Canada and to support consistent access for eligible Canadians. Health Canada engages and collaborates with P/Ts, key stakeholders, and practitioners and pharmacists involved in MAID to facilitate consistent application of the regulations and data collection, and shares this information through federal reports, guidance and policy work.

Infographic for Medical Assistance in Dying

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	N/A	Primarily benefits seniors or the baby boom generation	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Distribution of MAID recipients by sex	Total number of MAID recipients for 2020: 7,595 Male: 51.9% Female: 48.1%	2nd Annual Report on Medical Assistance in Dying in Canada (data collected from calendar year of 2020)	Sex difference is slightly greater than in 2019 (Total number of MAID recipients was 5,660 - 50.9% males and 49.1% females). Findings are consistent across jurisdictions with the exception of Manitoba where the proportion of females receiving MAID was slightly higher.
Distribution of MAID recipients by age and sex	Average age of recipients at the time of MAID: 75.3 Average age of male recipients at the time of MAID: 75.0 Average age of female recipients at the time of MAID: 75.5	2nd Annual Report on Medical Assistance in Dying in Canada (data collected from calendar year of 2020)	The greatest number of MAID deaths occur in the age range of 56 to 90. 94.5% of MAID cases occurred at age 56 and older and 80.3% of MAID cases at age 65 and older.
Distribution of MAID recipients by main condition	Cancer: 69.1% Cardiovascular conditions: 13.8% Chronic respiratory conditions: 11.8% Neurological conditions: 8.7%	2nd Annual Report on Medical Assistance in Dying in Canada (data collected from calendar year of 2020)	There were no significant differences between men and women in the reported main condition. These trends are similar to those seen in 2019 and are consistent with the leading causes of death in Canada (i.e., cancer and diseases of the heart at number 1 and 2 respectively).
Table a3.9 - Footnote * 2021-22 or most recent Return to Table a3.9 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The federal legislation for MAID sets out the legal framework for the lawful provision of MAID by establishing eligibility criteria, safeguards for its application and Criminal Code exemptions for those who deliver MAID in accordance with the framework. The law also requires the Government to implement a monitoring regime to collect information from practitioners about persons who request and receive MAID. Using the data collected in accordance with the Regulations for the Monitoring of Medical Assistance in Dying, Health Canada has produced 2 Annual Reports on MAID in Canada (2019, 2020).

On March 17, 2021 new federal legislation on MAID was passed, expanding eligibility to persons whose natural death is not in the foreseeable future but who are suffering intolerably. While current data shows that MAID recipients are almost equally split between men and women, and typically fall into older age groups (i.e. 70 years and older), the expansion of eligibility will potentially broaden MAID to newer populations such as persons with disabilities and with complex chronic non-terminal conditions which may impact current trends. Data collection and reporting will play a key role in identifying and monitoring changes in who is requesting and receiving MAID, and whether there exist any individual or systemic inequalities or disadvantages with respect to MAID.

Supplementary Information Sources:

Second Annual Report on Medical Assistance in Dying in Canada 2020

GBA Plus Data Collection Plan:

The Regulations for the Monitoring of MAID support the collection of information on persons who request and receive MAID and require the Department to publish a report at least once a year using the information collected under this federal monitoring system. These reports aim to provide a full understanding of the circumstances under which MAID is sought and administered and the application of the eligibility criteria and safeguards.

Since data is collected quarterly, with final quarter data being received and vetted early in the following calendar year, annual reports on MAID are released in the summers of the following year the data was collected. Recent changes to MAID legislation will require the collection of data about persons who request MAID who are not facing a reasonably foreseeable natural death. The new law also requires the collection of additional data on race, disability, and Indigenous identity to help determine any individual or systemic inequality or disadvantage with respect to MAID. Health Canada is amending the Regulations to reflect these. A consultation process is underway and will inform the expanded data collection as part of the MAID monitoring regime. Amended Regulations are expected to come into force on January 1, 2023 with new data starting in 2023 and published in 2024.

Program Name: Mental Health

The Government of Canada is committed to improving the health care systems by enhancing access to quality mental health services for Canadians by expanding access to community-based services for children and youth; spreading evidence-based models of community mental health care and culturally-appropriate interventions; and expanding availability of integrated community-based services for people with complex health needs.

Infographic for Mental Health

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	N/A	60 per cent - 79 per cent women	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	Somewhat benefits low income individuals (Somewhat progressive)	N/A	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Sex distribution of Canadians (aged 15 and over) with a self-reported chronic mood or anxiety disorder, who reported feeling that their needs were unmet or only partially met	Female: 25.07% Male: 24.15%	Statistics Canada (2020)	N/A
Sex distribution of Canadians (aged 12 and over) who reported perceiving their own mental health status as being excellent or very good	Female: 61.1% Male: 69.1%	Statistics Canada (2020) Table 13-10-0096-01 Health characteristics, annual estimates	N/A
Age distribution of Canadians (aged 12 and over) who reported perceiving their own mental health status as being excellent or very good	Aged 12 to 17: 68.6% Aged 18 to 34: 59.0% Aged 35 to 49: 64.2% Aged 50 to 64: 66.5% Aged 65 and older: 71.0%	Statistics Canada (2020) Table 13-10-0096-01 Health characteristics, annual estimates	N/A
Distribution of Canadians (aged 12 and over) who reported perceiving their own mental health status as being excellent or very good by household income	First quintile: 57.5% Second quintile: 63.4% Third quintile: 65.8% Fourth quintile: 67.4% Fifth quintile: 70.9%	Statistics Canada (2020) Health Characteristics, annual estimates, by household income quintile and highest level of education	Indicator results are positively correlated with income quintile.
Crude rate of children and youth (ages 5-24) who visited the emergency department for mental disorders by sex	Female: 1,809 crude rate per 100,000 population Male: 1,407 crude rate per 100,000 population	Canadian Institute for Health Information Data tables: Care for Children and Youth With Mental Disorders (XLXS) (2018-19)	N/A
Distribution of targeted Canadians who reported taking positive actions with regards to improving their mental health and wellness and that of others as a result of training (e.g., seek support, provide support) by type of training and official language	Mental Health First Aid (MHFA) Course: English: 74% French: 65% The Working Mind – First Responders (TWMFR): English: 56% French: No data available The Working Mind (TWM) Program: English: 67% French: Sample size too small for reporting	Mental Health Commission of Canada (MHCC) Core Performance Report (2021-22 fiscal) (data from October 1 – March 31, 2022)	Data with less than 20 responses are not reported. Official Language distribution not reported in data for this indicator from April 1- September 30, 2021.
Sex distribution of participants in mental health training programs	Female: 72.34% Male: 24.48% Non-binary: 0.34% Unknown: 2.84%	MHCC Core performance report (2021-22) (data from April 1- September 30 2021), and MHCC Core performance report (2021-22) (data from October 1 – March 31, 2022)	Aggregation of participation across all mental health training programs.
Distribution of participants who reported they strengthened capacity (knowledge) in mental health and wellness, by training or campaign event and by official language	MHFA English: 94%Footnote * MHFA French: 92%Footnote * TWMFR English: 76%Footnote * TWMFR French: No Data Available TWM English: 94%Footnote * TWM French: 94%Footnote *	MHCC Core performance report (2021-22) (data from April 1- September 20, 2021), and MHCC Core performance report (2021-22) (data from October 1 – March 31, 2022)	Not all participants responded to the survey. The percentages represent a voluntary sample of the participant group.
Approximate sex distribution of Wellness Together Canada site visitors	Female: 61.9% Male: 38.1%	Wellness Together Canada (WTC) reporting ( data from March 1, 2021 to April 30, 2022)	Distribution of male and female site visitors is approximate, as values are based on Google analytics, and may not be representative of all users.
Table a3.10 - Footnote * 2021-22 or most recent Return to Table a3.10 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Self-reported perceived mental health status has been analyzed by Statistics Canada and has been reported by education level, gender and sexual orientation, geographical region, visible minority status, Indigeneity, and immigration status.

In 2021-22, the Mental Health Commission of Canada (MHCC), funded by Health Canada, continued to strengthen competencies among staff by applying an SGBA Plus lens through ongoing SGBA Plus training and by utilizing its established Community of Practice to promote the application of SGBA Plus tools and methodologies throughout the project development life-cycle. For example, an SGBA Plus lens was applied to the development and refinement of course materials to ensure training programs were responsive to the needs of different populations and to consider questions of intersecting identities.

Similarly, SGBA Plus was used to identify health and social inequities for policy and research purposes. For instance, the MHCC used SGBA Plus to better understand suicide and suicide risk among men and the need for tailored interventions. In addition, the MHCC incorporated SGBA Plus into the literature review for the Operational Guidelines for Integrated Mental Health and Substance Use project to better understand the unique need of diverse populations.

MHCC also applies an intersectional approach to program evaluation and analysis to ensure responsiveness to the needs of different genders and equity seeking groups.

The Mental Health Program also supported specific policy initiatives in the area of mental health through the Health Care Policy and Strategies Program.

Supplementary Information Sources:

Mental health indicators available through the CIHI led process on shared health priorities: Your Health System | CIHI

GBA Plus Data Collection Plan:

Through the CIHI-led process on shared health priorities, common indicators for mental health will be updated and released annually through Your Health System | CIHI and will be disaggregated by gender and/or age as appropriate. Over time, these indicators will tell a clearer story about access to mental health supports across the country, identify where there are gaps in services and help to make meaningful changes in order to improve the experiences of Canadian patients and their families.

SGBA Plus data is not collected from users on the Wellness Together Canada portal to respect privacy requirements and reduce barriers to access. However, some SGBA Plus information is available via Google analytics and user feedback surveys. In 2021-22, Health Canada continued to work with the Consortium responsible for the Wellness Together Canada portal to engage diverse stakeholders to ensure the portal continues to align with Canadians' needs. The portal strives to promote an inclusive experience using an equity, diversity, accessibility, and inclusivity approach - particularly for persons with lived experience in mental health and substance use, and diverse and at-risk populations (e.g., youth, 2SLGBTQI+, racialized Canadians, Indigenous persons).

Health Canada now requires MHCC to describe the SGBA Plus work undertaken in each semi-annual reporting period. The MHCC continues to conduct targeted consultations and stakeholder engagement, as well as engage its communities of practice which are comprised of individuals from different populations and with lived experience, to ensure diverse representation and that diverse perspectives inform its work.

Program Name: Organs, Tissues and Blood

The Organs, Tissues and Blood Program supports research that contributes to a safe and effective supply of blood and blood products for Canadians, and by supporting activities that contribute to Canadians' access to safe, effective donations and transplantations of organs and tissues.

Infographic for Organs, Tissues and Blood

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Number of organ donors, by sex	Male: 600 Female: 610	CIHI (2019)	N/A
Percentage of deceased donors, by sex	Male: 61% Female: 39%	CIHI (2019)	N/A
Percentage of living donors, by sex	Male: 38% Female: 62%	CIHI (2019)	N/A
Table a3.11 - Footnote * 2021-22 or most recent Return to Table a3.11 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The collection of SGBA Plus data as it pertains to organ donation falls under P/T jurisdictions which present limitations in data collection as data comes from multiple sources under different formats that are not easily comparable. By way of contribution funding to Canadian Blood Services (CBS), Health Canada aims to improve access for all Canadian patients to health information and services related to organs, tissues and blood, no matter the geography or income level of individuals and their families.

As a general principle, ethical and equitable listing and allocation practices are embedded within current donation and transplantation practices in Canada. Data on biological sex is a variable collected and available routinely as part of provincial data collection. The Canadian Organ Replacement Register currently captures patient data by sex and provides some sex-based analyses for donors, transplants by organ type, and incident end-stage kidney disease patients by volume and rate.

CBS has continued to raise awareness about the need for all genders and those of diverse heritage to register their intent to donate and have discussions with their families about their decision. Awareness campaigns have taken a more focused approach on targeting underrepresented groups. For example, in the development of guidelines, CBS involves members of the 2SLGBTQI+ community for topics where this perspective is needed.

Additionally, the Blood Research and Development component intersects with issues in gender and diversity. CBS continued to consider sex and gender in all research projects, including pre-clinical studies. These considerations are applied whenever a call for applications for any research and training programs is issued. For example, the research related to the Men who have Sex with Men (MSM) Plasma initiative provided evidence for CBS to implement plasma donation behavioural-based screening criteria, regardless of gender and sexuality. Final results from the research projects that were published in peer-reviewed journals and disseminated continued to inform CBS's efforts in expanding eligibility criteria for whole blood donation by MSM in Canada. Also under this program, CBS is exploring gender and cultural appropriateness of the donor questionnaire from the perspectives of African, Caribbean and Black men who have sex with men (cisgender and transgender). This project is ongoing and ends in December 2022.

CBS has implemented the following initiatives:

• Collected diversity-related data regarding staff via employee surveys
• Created the Diversity, Equity, and Inclusion program
• Created a Chief Diversity Officer position
• Expanded their recruitment and career development programs to better reflect the needs and foster the potential of diverse team members
• Committed to the federal government's 50-30 Challenge to promote diversity in corporate Canada.

Supplementary Information Sources:

Organ replacement in Canada: CORR annual statistics

GBA Plus Data Collection Plan:

Health Canada is working with CBS to strengthen the collection of SGBA Plus data, as well as to strengthen the diversity and inclusion data. A more exhaustive approach is considered at the time of contribution agreement renewals (e.g., more comprehensive collection of socio-demographic data elements related to donors with annual public report on these elements).

The Canadian Institute for Health Information and Canada Health Infoway, both funded by Health Canada, are co-leading a multi-year project to develop a modernized and integrated pan-Canadian data and performance system to address current data limitations and facilitate understanding of which population subgroups may be experiencing barriers for accessing high-quality organs and transplant services. The system is expected to be released in April 2024 and will collect appropriate standardized data from both donors and recipients across the country, including standard socio-demographic variables.

Program Name: Patient Safety

Health Canada provides and synthesizes broad policy advice that helps to advance patient safety in health care systems. The contribution to Healthcare Excellence Canada (HEC) supported the federal government's interest in achieving an accessible, high quality, sustainable and accountable health system adaptable to the needs of Canadians.

Infographic for Patient Safety

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	N/A	Primarily benefits seniors or the baby boom generation	Senior

Other Key Program Impacts on Gender and Diversity:

HEC seeks out and includes the perspectives of patients, seniors, and diverse groups in the design of its programs and projects to improve patient safety to ensure it is response to and reflective of the needs of its various programming beneficiaries. Examples of these initiatives include:

• Patients for Patient Safety Canada is a patient led program of HEC and is the Canadian arm of the World Health Organization's Patients for Patient Safety global network. Every member of the program has experienced harm in healthcare, and now provides patient perspectives to healthcare providers, policymakers and other patients to ensure that care is safe for all.
• Long Term Care Plus (LTC+), which has a focus on patient, resident and family experience.
• The Virtual Care Together Design Collaborative, which supports community-based primary care providers and teams in-care transformation to improve equitable, safe, and high-quality virtual care for people across the country.

GBA Plus Data Collection Plan:

HEC has developed a new performance measurement framework to accompany its 2021-26 Contribution Agreement. It includes two metrics that will specifically be broken down by sex and/or gender: (1) leaders reached by HEC offerings, and (2) leaders reporting increased preparedness to lead health care improvement efforts as a result of their engagement with HEC. Reporting against these metrics has begun in 2022-23 and will assist HEC as it continues to look for ways to support higher quality, safer care, and better outcomes for diverse populations.

Program Name: Promoting Minority Official Languages in the Health Care Systems

This program is designed to support the federal obligation to foster the full recognition and use of both English and French in Canada. It also includes the Official Languages Health Contribution Program, which fosters collaboration and innovation in the areas of recruitment, training, retention, networking, research, organization and support to the delivery of health services to French-speaking communities in P/Ts other than Quebec and to English-speaking communities in the province of Quebec.

Infographic for Promoting Minority Official Languages in the Health Care Systems

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	N/A	60 per cent - 79 per cent women	N/A	Women

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Gender distribution of funded French-language postsecondary training graduates	Male: 17.3% Female: 82.2% Other: 0.5%	« Consortium National de formation en santé » data base (2021-22)	N/A
Gender distribution of funded French-language postsecondary training graduates	Male: 18% Female: 81.3% Other: 0.7%	« Consortium National de formation en santé » data base (2021-22)	N/A
Gender distribution of funded health professional and intake staff graduating who report acquiring academic and professional knowledge and skills to work in Official Language Minority Communities (OLMCs)	Male: 12% Female: 88% Other: 0.4%	« Consortium National de formation en santé » data base (2020-21)	Updated data on this key impact will be available in late 2022, through recipients' performance reports, as required through their funding agreements.
Gender distribution of funded postsecondary trained health graduates who offer services in OLMCs	Male: 11% Female: 88% Other: 0.5%	« Consortium National de formation en santé » data base (2020-21)	Updated data on this key impact will be available in late 2022, through recipients' performance reports, as required through their funding agreements
Gender distribution of health placements in OLMCs 2 years after graduation	Male: 13% Female: 87% Other: 0.3%	« Consortium National de formation en santé » data base (2020-21)	Updated data on this key impact will be available in late 2022, through recipients' performance reports, as required through their funding agreements
Gender distribution of funded Language Training Program Students (Dialogue McGill)	Male: 10.7% Female: 89% Other: 0.2%	McGill University data base (2021-22)	N/A
Gender distribution Recruitment and Retention Program (Dialogue McGill)	Male: 11% Female: 89% Other: 0%	McGill University data base (2021-22)	N/A
Table a3.13 - Footnote * 2021-22 or most recent Return to Table a3.13 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Historically, women have represented the majority of health human resources. Men and gender diverse individuals represent less than 20% of the students who enrolled in training programs supported by Health Canada's Official Languages Health Program.

GBA Plus Data Collection Plan:

In 2022-23, Health Canada is reviewing its current performance measurement tools to expand the capacity to measure and assess the impacts of this Program on gender and diversity in the future. This review will aim to enhance the integration of sex, gender and diversity considerations, improve the monitoring and analysis of progress made by recipients towards achieving targets and ensure adequate implementation of measures and policies that take into account SGBA Plus. The revised tools will also be used by the Program recipients (the Société Santé en français, the Association des collèges et universités de la francophonie canadienne - Consortium national de formation en santé, the Community Health Social Services Network and McGill University) to monitor and collect disaggregated data on sex and gender and report (annually or as required) on progress on achieving expected results.

Program Name: Thalidomide

The Canadian Thalidomide Survivors Support Program (CTSSP) is intended to contribute to meeting the lifetime needs of Canadian thalidomide survivors so that they may age with dignity.

Infographic for Thalidomide

Target Population: A particular demographic group

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	N/A	Primarily benefits seniors or the baby boom generation	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Clients who reported the ability to age with dignity by gender	Male: 98% Female: 96%	2021-22 Recipient Progress Report (Q3/Q4)	Statistics reported are based on Annual Outreach Survey distributed by the third-party administrator for the CTSSP.
Clients who reported the ability to access care and treatment by gender	Male: 73% Female: 77%	2021-22 Recipient Progress Report (Q3/Q4)	Statistics reported are based on Annual Outreach Survey distributed by the third-party administrator for the CTSSP.
Table a3.14 - Footnote * 2021-22 or most recent Return to Table a3.14 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The CTSSP is equally accessible to men and women given that thalidomide is the cause of their injuries and given that the drug is known to have affected both sexes. While sex and gender data is collected under the CTSSP, it is difficult to assess impacts due to the relatively small population of thalidomide survivors and limited data available. Of the 123 known Canadian thalidomide survivors receiving financial support under the CTSSP in 2021-22, there are slightly more women than men (58% women compared to 42% men).

The Extraordinary Medical Assistance Fund is intended to help cover the costs of extraordinary health supports such as specialized surgery, home or vehicle adaptations not otherwise provided in P/T health care plans and some ongoing costs, including physiotherapy, chiropractic care and attendant services. Access to the Fund is based on survivors' need, regardless of sex or gender.

While the number of applications submitted over the years has increased, the proportion of men and women who accessed the Fund in 2021-22 remains largely unchanged at 36% and 64% respectively. The administrator of the program is taking proactive steps to encourage more men to apply by reaching out to individuals directly to raise awareness of the Fund and how it could help them.

GBA Plus Data Collection Plan:

The SGBA Plus data collection plan for the CTSSP currently captures data based on sex and gender. Program impacts will continue to be assessed and analyzed to better understand survivor needs using an Annual Outreach survey. This will allow CTSSP to enhance improve communication strategies and processes based on sex and gender. The current collection plan will remain as is to ensure consistency when analyzing the data collected.

Program Name: The Territorial Health Investment Fund (THIF)

The objective of the Territorial Health Investment Fund is to improve Northerners' access to health services to meet their health care needs and to improve their health status.

Infographic for Territorial Health Investment Fund

Target Population: All Canadians

Other Key Program Impacts on Gender and Diversity:

Men, women, and children experience health disparities that may lead to increased need for health system innovations that the THIF can help achieve. Territories are aware of their populations' diverse needs and barriers to health and take these into account when determining the allocation of the THIF. Certain territorial programs supported through the THIF are dedicated to addressing the most pressing needs among territorial residents. For example, tuberculosis (TB) rates in Nunavut are far higher than the national rate. With support from the THIF, Nunavut's TB Program Development is working to reduce these disparities through community and mobilization efforts to better access residents, capacity building and enhancing human resources, and the adoption of new technologies to better treat latent TB, among other actions.

Another example is Yukon's 1Health initiative. The territory's new electronic health record system, which is supported by the THIF, may benefit residents with chronic illnesses such as cancer and diabetes, who are disproportionately represented in the territories. The system uses a single integrated electronic health record network to allow for immediate and seamless exchange of health information between care centres, facilitating the scheduling of appointments and medication tracking which may be burdensome for residents with chronic illnesses. As another example, the Yukon is using its THIF funding to develop and launch new integrated primary health care services, including midwifery services, which will increase the availability of this type of holistic pre- and post-natal care for pregnant people in the Yukon.

The Northwest Territories is using THIF funding to support a primary health care reform initiative and demonstration projects, which includes a community-led effort to enhance access, quality and continuity of prenatal, maternal/child, and perinatal health care supports for remote communities through proactive virtual outreach. Other demonstration projects will focus on mental health and chronic disease management.

As another example, the oral health of children in the territories is below that of other Canadian children. Taking this into account, the territories have implemented oral health initiatives targeted specifically to children that have been or are currently funded by the THIF. Such initiatives may help alleviate some of the disparity in children's oral health.

GBA Plus Data Collection Plan:

Key health indicators can be disaggregated by sex (for example, percentage of adults aged 18 and over reporting their health as excellent or very good and rate of potentially avoidable deaths).

However, capturing territorial data is challenging to start with and disaggregating by gender and diversity even more so. Territorial efforts are dependent on available data from, for example, Statistics Canada and CIHI, which is often outside of their control.

Health Canada will continue to encourage the territories to implement sex and gender considerations in the design of their THIF activities, as well as in the development of project-specific indicators (where data is or can be made available). Health Canada will continue to monitor progress on indicators for compliance.

Core Responsibility 2: Health Protection and Promotion

Program Name: Air Quality

The Air Quality Program supports actions to improve air quality and health for all Canadians. Key activities include research on exposure of Canadians to air pollution and the health impacts of air pollution; assessments of the health risks from air pollutants and pollutant sources; and quantification of the health benefits from actions to improve air quality. This information is made available to stakeholders including governments, industry, health professionals and directly to the public.

Infographic for Air Quality

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	Primarily benefits youth, children and/or future generations	N/A	Primarily benefits seniors or the baby boom generation	Senior

Other Key Program Impacts on Gender and Diversity:

Health Canada's Air Quality Program benefits all Canadians by supporting actions to improve air quality and health. Some individuals have a higher risk of health problems from exposure to air pollution (e.g., children, seniors, and people with existing illness or chronic health conditions, such as those affecting the lungs and heart). Others may have higher risk from exposure because of where they live, their occupation, and other factors. Health Canada has targeted initiatives to better understand and address the needs of these higher-risk individuals, and strives to identify and assess these health risks through its science, research, and assessment work.

Program activities are primarily driven by the need to protect sub-populations who may be more susceptible or highly exposed from air pollution. For example, Health Canada calculated the health impacts of air quality beyond deaths (e.g., asthma symptom days), set guidelines, conducted risk assessments, and communicated health risks to Canadians, including outreach to sub-populations who may be more susceptible or highly exposed, through the Air Quality Health Index (AQHI).

Health Canada conducted research on exposure to, and the health effects of, air pollution which considered sex and gender throughout the research process, including the planning phase. These research studies frequently report on sex, socioeconomic, regional, or other differences in exposure to air pollution or the health effects of air pollution. For example, a study published in 2021-22 of fine particulate matter air pollution and incidence of COVID-19 in 140 neighborhoods in Toronto showed that the numbers of COVID-19 cases were higher in areas where the particulate matter had a higher potential to cause oxidative stress. The increase in COVID-19 cases was more strongly associated with males, in neighborhoods with more Black residents, and in neighborhoods with lower socioeconomic status. These findings highlight the importance of considering demographic and neighborhood characteristics when undertaking studies of health effects of localized air pollution.

In terms of measuring key impacts, Health Canada monitored the proportion of deaths that can be attributed to two major air pollutants: ground-level ozone (O₃) and fine particulate matter (PM_2.5), by age, sex and region.

Key results showed the following:

• There are no substantial differences in mortality attributable to air pollutants for people aged 65 years or older when compared with the general population.
• Both males and females show increasing trends in deaths attributable to O₃, while females show a decreasing trend for PM_2.5. There is no known explanation for sex differences in deaths due to air pollution.
• Ontario shows fewer deaths attributable to O₃, whereas Western Canada shows fewer deaths attributable to PM_2.5.

Supplementary Information Sources:

Air Health Trends

Within-City Variation in Reactive Oxygen Species from Fine Particle Air Pollution and COVID-19 | American Journal of Respiratory and Critical Care Medicine

GBA Plus Data Collection Plan:

Health Canada will continue to collect data on, study, and assess health effects attributable to air pollution, including sex- and gender-specific health endpoints, most notably with a significant focus on studying the impacts on pregnant persons and birth outcomes. Health Canada will also continue to collect data on, study, and assess who is reached by the AQHI and how the associated health messaging is used, particularly amongst sub-populations who may be more susceptible or highly exposed. As part of the AQHI public opinion research planned for 2025-26, Health Canada will prioritize collecting data on AQHI usage amongst different populations as part of ongoing efforts to improve awareness of the tool so that Canadians can better protect themselves from the health risks of air pollution.

Program Name: Biologic and Radiopharmaceutical Drugs

The Biologic and Radiopharmaceutical Drugs Program ensures that biologic and radiopharmaceutical drugs sold in Canada are safe, effective and of high quality through regulatory activities and the provision of relevant information to Canadians and health professionals.

Infographic for Biologic & Radiopharmaceutical Drugs

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage increase in Adverse Drug Reaction reports being submitted to Health Canada by healthcare institutions for biologic and radiopharmaceutical drugs collected by sex	Percentage increase: 19% Total number of mandatory ADRs for biologics By sex: Male: 255 (51%) Female: 234 (46%) Not Specified: 15 (3%) Total number of mandatory ADRs for radiopharmaceutical drugs By sex: Male: 72 (32%) Female: 150 (67%) Not Specified: 3 (1%)	Canada Vigilance Database (2021-22)	N/A
Table a3.17 - Footnote * 2021-22 or most recent Return to Table a3.17 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

In collaboration with CIHR, Health Canada established research-policy partnerships that support researchers who have both subject matter and SGBA plus expertise, to engage with departmental staff on priority Health Canada initiatives. This includes the study "Risk Reviewed: Integrating sex and gender into the lifecycle management of prescription drugs", focusing on the application of an SGBA Plus lens on the lifecycle management of drugs, making recommendations for how SGBA Plus considerations from the clinical trial stage to the post-market monitoring of drugs. The report was finalized in late 2021 and will support the implementation of Health Canada's SGBA Plus work by identifying areas where Health Canada can increase the application of SGBA Plus considerations throughout the regulation of drugs.

Since Health Canada modified its Drug Safety and Effectiveness Network query submission forms in 2020, research teams were reminded to ensure that all SGBA Plus considerations were adequately considered for queries in 2021-22. Thus Health Canada and CIHR ensured that SGBA plus considerations were taken into account during the development of each query and that they will be reflected in the research questions being posed. For example, research may look into a specific population such as pregnant persons, pediatrics, people who inject drugs, etc., or other SGBA plus factors that could impact the use of a certain drug. A case in point: hormone therapy could be used by cisgender or transgender individuals. This helps us to provide insights on specific population impacts depending on the issue under investigation and can result in targeting certain populations as a result through risk management activities. This could include activities such as advising health care providers that one population may be more at risk than another.

Throughout COVID-19 vaccine development, Health Canada asked sponsors to be inclusive in their recruitment strategies for COVID-19 vaccine trials to ensure that COVID-19 safety and efficacy data would be produced for diverse populations (e.g., sex, age, race, ethnicity, comorbidities, etc.). For example, the Pfizer vaccine and the Moderna vaccine, there were:

• Close to equal numbers of males and females included in the clinical trials
• A higher than usual proportion of trial participants who had co-morbidities
• A higher than usual proportion of trial participants who identified as racialized minorities

Health Canada scientific reviewers took special care in applying SGBA Plus considerations when reviewing submissions, and any missing data were identified and targeted for post-market studies (i.e., studies in children and studies in pregnant and breastfeeding persons).

In response to the pandemic, Health Canada implemented a number of enhanced post-market surveillance activities for monitoring the safety profile of COVID-19 vaccines and conducted expedited safety assessments. These included:

• Gender-based analyses, with weekly analysis of spontaneous safety reports (in collaboration with PHAC) for adverse events
• Manufacturers of COVID-19 vaccines submit risk management plans which list use in pregnant and breastfeeding persons
• Manufacturers of COVID-19 vaccines are required to submit monthly safety reports that include patient characteristics, such as sex.

Health Canada is also building on this work to implement procedures and tools to easily retrieve disaggregated data from submissions for drug approval, which will lead to increased public reporting on the diversity of clinical trial participants. Parallel to this, Health Canada will be working with international regulators and stakeholder organizations in an attempt to increase the diversity of clinical trial participants across the health product development ecosystem.

GBA Plus Data Collection Plan:

In the drug lifecycle, sponsors seek authorization to sell health products in the Canadian market by submitting clinical trial data to Health Canada (and other international health regulators). Health Canada scientific reviewers then assess the trial data submissions when considering authorization. However, specific subpopulations continue to be under-represented in drug clinical trials. Transgender, intersex, and pregnant persons are generally excluded while women, racialized, Indigenous, pediatric, and geriatric populations are under-represented. Factors such as implicit bias, cost, language barriers, fear and mistrust, health literacy levels, recruitment methods and patient inclusion and exclusion criteria can pose barriers to achieving representative sample groups in trials. Limited patient data is collected and/or reported to Health Canada, and data is not always disaggregated into relevant groups.

To address these and other issues, Health Canada developed an SGBA Plus Action Plan for Health Products and Food in June 2021, which outlines measures that will be taken over a period of 5-10 years. The Department is working to ensure that individuals in Canada have access to information to support informed decision-making regarding their treatment options based on safety and efficacy profiles of people like them. Specifically, Health Canada is looking to work with relevant stakeholders nationally and internationally to: 1) improve the SGBA Plus data submitted to Health Canada; 2) Enhance the way SGBA Plus data is analyzed and reported on by Health Canada; and 3) Increase the SGBA Plus information available to the users of the data to build trust and transparency. These measures will be implemented over the next several years, as there is a need to work with international regulators and stakeholder organizations to effect change at a global level.

As part of this work, Health Canada will develop publication timelines to ensure that required information is collected and reported transparently. Health Canada is also exploring how to compel sponsors to submit disaggregated data when applying for regulatory approval of health products. Other activities include creating guidance documents for industry around developing inclusive trials to increase trial diversity and the inclusion of pregnant and breastfeeding persons in trials as well as working with international partners to ensure harmonized, systematic change in the larger global context for drug development. This work will take place over the next several years, given the need to consult broadly – both nationally and internationally.

Program Name: Cannabis

The Cannabis Program supports the Government of Canada in the administration of the Cannabis Act and associated regulations, which strictly regulates activities with cannabis, including its production, sale, import/export and possession.

Infographic for Cannabis

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of Canadians (aged 15-24) who have used cannabis in the last 12 months by sex and age	Overall: 33.6% By sex: Male: 33.7% Female: 33.5% By age: 15-17: 9.5% 18-24: 43.7%	Canadian Alcohol and Drugs Survey (CADS) (2019)	As the data collection frequency for this indicator varies, most recent year of data has been reported.
Table a3.18 - Footnote * 2021-22 or most recent Return to Table a3.18 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

In 2021-22, Health Canada integrated SGBA Plus information in the 2021 Canadian Cannabis Survey and collected demographic variables including sex, gender, sexual orientation, age group and Indigenous status to better understand cannabis use and priority populations. Health Canada also took steps to increase diversity in the regulated cannabis industry, and to better understand barriers to participation. Health Canada continued to offer a dedicated Indigenous Navigator service, with the purpose of helping and supporting Indigenous-affiliated applicants throughout the federal commercial cannabis licensing process (from application through to licence amendments and post licensing changes) and better support Indigenous communities' participation in the industry. Health Canada also surveyed commercial cannabis licence holders to better understand the diversity of those occupying leadership positions in the licensed industry, and to identify barriers to applicants and ways to address them. Lastly, Health Canada continued to work to enable a diverse, competitive cannabis industry comprised of small and large businesses, and increase the participation of Indigenous, Black and other racialized communities in the cannabis industry.

Supplementary Information Sources:

Sex, Gender and Cannabis Report

Understanding Youth and Young Adults' Interest in, and Usage of, Flavoured Cannabis Vaping Products

2021 Canadian Cannabis Survey (CCS)

2019 Canadian Alcohol and Drugs Survey (CADS)

Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS)

GBA Plus Data Collection Plan:

Health Canada applies SGBA Plus to its data collection tools and analysis to help inform cannabis related policy and regulatory decisions and the development of more targeted public education campaigns. SGBA Plus data collection plans include the assessment of key aspects of cannabis use through population health surveys, such as:

• The Canadian Cannabis Survey gathers detailed information about the knowledge, attitudes and behaviours (i.e., including high-risk behaviours such as cannabis use and driving, frequent cannabis use, etc.), product preferences and purchasing habits and sources of cannabis amongst Canadians aged 16 and over who use cannabis, including cannabis for medical purposes. It also collects information on sex, gender, age, sexual orientation, household income and ethnicity.
• The Canadian Alcohol and Drugs Survey is a biennial general population survey of cannabis, alcohol and drug use among Canadians aged 15 years and older. It collects information on sex, gender, Indigenous status and age group, where possible. Due to data quality/sample size, Health Canada may not be able to report on some SGBA disaggregated data.

The Canadian Student Tobacco, Alcohol, and Drugs Survey is a biennial national survey conducted with students in grades 7-12 (Secondary I – Secondary V in Quebec). The survey captures information related to the use of tobacco and vaping products and smoking status, cannabis, as well as the use of alcohol and drugs among students and other areas identified by schools as priorities. The Survey also collects information on sex, gender and grouped grade, where possible.

Program Name: Climate Change

The purpose of the Climate Change Program is to increase the knowledge, capacity, and tools on climate change and health risks available to healthcare and public health professionals, emergency preparedness officials and provincial and local decision-makers across Canada, as well as by increasing the level of awareness among Canadians of extreme heat health risks.

Infographic for Climate Change

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Number of heat-related health impacts in Canada (per 100,000 people) by sex, age and region	Heat-related illness By sex: Male: 7.0 Female: 4.3 By age: 0 to 4 years: 3.5 5 to 14 years: 6.3 15 to 64 years: 7.2 65 to 74 years: 7.1 75 years and older:13.0 By region: Atlantic: 1.3 Quebec: 0.4 Ontario: 9.8 Prairies: 6.6 BC: 3.8 Territories: 3.5 Heat-related deaths By sex: Male: 0.08 Female: 0.04 By age: 0 to 4 years: 0.03 5 to 14 years: 0.00 15 to 64 years: 0.04 65 to 74 years: 0.16 75 years and older: 0.29 By region: Atlantic: 0.01 Quebec: 0.09 Ontario: 0.03 Prairies: 0.02 BC: 0.01 Territories: 0.00	The Canadian Institute for Health Information's National Ambulatory Care Reporting System (Emergency Department visits) and Hospital Morbidity Database (hospitalizations) Quebec's MED-ÉCHO database (hospital admissions) Statistics Canada's Vital Statistics Database and Canadian Census	Results related to illnesses are based on data collected from 2005-21. Results related to deaths are based on data collected from 2000-20.
Percentage change in the incidence of priority climate-related health impacts (per 100,000 people) by sex	% change in the number of Lyme disease cases: 3.2 % change in the number of Melanoma cases (excluding Quebec): 18.1 Male: 19.6 Female: 16.6	The Canadian Institute for Health Information's National Ambulatory Care Reporting System (Emergency Department visits) and Hospital Morbidity Database (hospitalizations) Quebec's MED-ÉCHO database (hospital admissions) Statistics Canada's Vital Statistics Database and Canadian Census	Results reflect the baseline that was established in 2021-22. Subsequent results reported will reflect the percentage change compared to this baseline. Results related to Lyme disease are based on data from 2009-19. Results related to melanoma are based on data from 2000-18.
Table a3.19 - Footnote * 2021-22 or most recent Return to Table a3.19 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The Climate Change Program benefits all Canadians by developing resources to increase awareness of climate change and health risks, as well as strategies to adapt and protect health, which supports climate change resiliency. In 2021-22, Health Canada published Health of Canadians in a Changing Climate: Advancing our Knowledge for Action. This report provided an assessment of the risks of climate change to the health of Canadians and to the health care system as well as a chapter on health equity. Health Canada continued to explore mechanisms to better integrate health equity considerations into its Climate Change Program activities to better recognize health inequalities and tailor activities to future programming to protect at-risk populations.

GBA Plus Data Collection Plan:

The Department conducts public opinion research to collect data on the level of awareness and the use of evidence-based measures to reduce the health impacts of climate change every five years. The next survey results will be available in 2022-23, including disaggregated results by certain sub-populations (e.g., by gender and Indigeneity). Health Canada will continue to collect and assess data on the health effects attributable to climate change impacts and collaborate with federal partners to identify ways to enhance these considerations, including SGBA Plus -specific health endpoints.

Program Name: Consumer Product Safety

The Consumer Product Safety Program's objective is to manage the potential health and safety risks posed by consumer products and cosmetics in the Canadian marketplace. The Program identifies, assesses, manages and communicates health or safety risks associated with consumer products and cosmetics to Canadians.

Infographic for Consumer Product Safety

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of Canadians who indicate they are aware of the information that Health Canada provides about consumer products and cosmetics by sex and primary language	By sex: Male: 64% Female: 58% By primary language: English as primary language: 62% French as primary language: 56%	Fact-based Survey on Consumer Products and Cosmetics (September – October 2020)	Survey was conducted by Prairie Research Associates Inc., on behalf of Health Canada. In total, 1,000 residents answered the survey using a weighted sample to ensure a survey representative of the Canadian population. Age, education, income and employment status disaggregates not reported as there were no significant differences. Note: The survey is completed every 2 years. New data is expected in late 2022 or early 2023.
Percentage of Canadians who indicate they use the information that Health Canada provides about consumer products and cosmetics by sex, primary language, age, educational attainment, employment status, and income level	By sex: Male: 35% Female: 29% By primary language: English as primary language: 34% French as primary language: 23% By age: Under 45 years of age: 40% Over 45 years of age: 25% By educational attainment: Obtained at least a university bachelor's degree: 38% Education lower than a university bachelor's degree: 28% By employment status: Employed: 37% Unemployed: 26% By income level: Earn over $60,000 per year: 35% Earn less than $60,000 per year: 30%	Fact-based Survey on Consumer Products and Cosmetics (September – October 2020)	Survey was conducted by Prairie Research Associates Inc., on behalf of Health Canada. In total, 1,000 residents answered the survey using a weighted sample to ensure a survey representative of the Canadian population.
Number of domestic incident reports of a child ingesting an e-liquid	320	Domestic incident reports that the Program received from consumers and industry (calendar year 2021) Data from hospitals (e.g., Canadian Hospitals Injury Reporting and Prevention Program) (calendar year 2021) Data from Canadian poison control centres (calendar year 2021)	E-liquid is the mixture used in vaping products such as e-cigarettes and generally consists of propylene glycol, glycerin, water, nicotine and flavourings. It is not always known if the e-liquid involved in reports contains nicotine, cannabis, or neither substance. Reports involve e-liquids, either as a stand-alone product or as part of a vaping device. To align with external data sources used for this indicator, results are reported by calendar year. The reported result is likely an over-estimation as it includes all reports received from poison control centres involving a child being exposed to an e-liquid. Data are not available to assess how many of these reports involved the ingestion of e-liquid. The result may also include double-counting of incidents as the same incident could be included in more than one data source.
Table a3.20 - Footnote * 2021-22 or most recent Return to Table a3.21 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The Consumer Product Safety Program benefits all Canadians by helping to protect them from the potential health and safety risks posed by consumer products and cosmetics in the Canadian marketplace. In terms of measuring key impacts, Health Canada examined case studies to demonstrate how risk management actions taken by the Department mitigated risks to human health or safety.

In 2021 Health Canada worked with industry to post consumer product recalls for two distinct types of popular infant products: one type being a glider/rocker and the other a newborn lounger. Infants who were unrestrained in these products were later found on their stomachs which poses a risk of suffocation. The recalls advised to immediately stop using the products and contact the company for a refund. Over 80,000 units of the two types of products were sold in Canada. Although no suffocation incidents were reported in Canada, there were several infant fatalities while using these products in the United States.

In addition to posting the recalls on the Healthy Canadians Recall and Safety Alert website, Health Canada shared information with numerous media outlets and used social media to communicate the risks associated with these products to Canadians. In addition, Health Canada inspected retail outlets across Canada to verify that the products had been removed from store shelves and were no longer available to Canadians.

By working with industry to protect Canadians before a reported infant mortality in Canada, Health Canada was able to mitigate the risk to infant health and safety.

GBA Plus Data Collection Plan:

In 2021-22, Health Canada's Consumer Product Safety Program established an Anti-Racism Science Working Group to identify areas of potential racial bias within Program activities. This awareness will support informed data collection strategies and support an anti-racism review of templates, guidance, operating procedures and decision-making processes. For example, planning began in 2021-22 for a multi-year toxicology project to be initiated in 2022-23 on identifying racial bias in skin pigmentation for assessment of irritation. Health Canada will continue to explore the potential for additional SGBA Plus data collection opportunities to better assess the Program's impact.

Program Name: Controlled Substances

The Controlled Substances Program authorizes legitimate activities with controlled substances and precursor chemicals, while managing the risks of diversion and associated harms that could affect public health and safety. The Program regulates manufacturing, medical, and scientific industries on the possession, production, provision and disposition of controlled substances and precursor chemicals.

Infographic for Controlled Substances

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of Canadians (aged 15+) who engaged in problematic use of legal drugs in the past 12 months by sex and age	Overall: 1.6% By sex: Male: 1.7% Female: 1.5% By age: 15-19: 1.3% 20-24: 5.5% 25+: 1.3%	Canadian Alcohol and Drugs Survey (2019)	Baseline (2016-17): Overall: 0.5% Male: 0.5% Female: 0.4% Moderate sampling variability, interpret with caution
Percentage of males who reported having 5 or more drinks, or women who reported having 4 or more drinks, on one occasion, at least once a month in the past year (Heavy Drinking)	Overall: 17.5% By sex: Male: 22% Female: 13%	Canadian Community Health Survey (2021)	Baseline (2015): Overall: 19.2% Male: 24.1% Female: 14.5%
Table a3.21 - Footnote * 2021-22 or most recent Return to Table a3.21 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Health Canada continued to apply SGBA Plus while reviewing and developing policies and initiatives related to controlled substances, including treatment and harm reduction services and initiatives to reduce stigma associated with drug and substance use. Health Canada applied SGBA Plus in its work by drawing on disaggregated data to define issues and inform policies and programs related to the opioid crisis and substance use more broadly. Disaggregated data has been used to identify trends in men and women who use substances such as alcohol and legal drugs.

Applying an SGBA Plus lens to disaggregated data has made it possible to determine how opioid-related harms and deaths are experienced at a greater rate among specific sub-populations (e.g., young and middle-aged men were identified as a higher risk group). As a result, in 2021-22, Health Canada continued to address the stigma around addiction and substance use by developing a targeted marketing campaign to reach men in physically demanding occupations. Additionally, based on this SGBA Plus knowledge, which highlighted the potential generational impacts of substance use, Health Canada continued to implement prevention measures with the KNOW MORE National Tour in 2021-22, sharing information about opioid use with thousands of young people across Canada.

Supplementary Information Sources:

Canadian Community Health Survey

Health Infobase Canada

Canadian Alcohol and Drugs Survey

Canadian Student Tobacco, Alcohol and Drugs Survey

GBA Plus Data Collection Plan:

Health Canada collects SGBA Plus data and information from a variety of sources including general and targeted population surveys, reports from supervised consumption sites, and recipients of Substance Use and Addictions Program (SUAP) funding. Data is also collected through bi-annual Performance and Progress Reports submitted by recipients funded through SUAP. Data is aggregated/rolled-up by Health Canada: indicator data is disaggregated by demographics such as sex, gender, and language, and by target population factors such as Indigenous, 2SLGBTQI+ and racialized people/communities.

To improve Health Canada's capacity for collecting and reporting on SGBA Plus data and to support funding recipients, the Department is proposing to undertake the following:

• Collect aggregate project-level data (e.g., diversity and ethnicity demographics) of the front-end of a project's life cycle (current and ongoing).
• Provide a demographic data collection guide that supports the collection of relevant SGBA Plus data. This guide will include examples of SGBA Plus data collection tools (2022-23).
• Provide information sessions for funding recipients on collecting SGBA Plus data (2022-23).

Program Name: Food and Nutrition

The Food and Nutrition Program is responsible for establishing regulations, guidelines, standards and policies pertaining to food safety, nutrition and healthy eating.

Infographic for Food and Nutrition

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of Canadians who report eating fruit and vegetables 5 or more times per day by sex and age	Total: 25.4% By sex: Male: 20.3% Female: 30.2% By age: 12 to 17: 24.1% 18 to 34: 22.4% 35 to 49: 27.0% 50 to 64: 24.4% ≥ 65r: 29.0%	2020 Canadian Community Health Survey Annual Component	Respondents aged 12 years and older
Percentage of Canadians who use dietary guidance provided by Health Canada by sex and age	Total: 44.3% By sex: Male: 34.5% Female: 53.7% By age: 12 to 18: 47.9% 19 to 30: 44.4% 31 to 50: 46.3% 51 to 70: 44.3% ≥71: 35.9%	2020 Canadian Community Health Survey Annual Component	Respondents aged 12 years and older
Table a3.22 - Footnote * 2021-22 or most recent Return to Table a3.22 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Culture, language, religion, ethnic origin, and socioeconomic status each play an important role in food and nutrition. Health Canada recognizes that these social and cultural factors influence people's diets. This includes people's norms, values, and views around food. They determine the cultural traditions and family practices that are conveyed, such as recipes and food preparation knowledge, eating practices (e.g., eating together), and more. Ethnic origin, socioeconomic status are also associated with economic access to food, which affects food purchasing and consumption. The department integrates these considerations into its policy analysis, regulations and education and awareness activities.

One important area of the Program's progress is with respect to integrating health literacy the ability to make use of nutrition information in ways that promote health and wellbeing. Health literacy is associated with health inequities, and has been shown to be disproportionately lower in racial and ethnic minorities. The recent systematic integration of these considerations into the social and behavioural science informing food and nutrition policies and regulations is helping the Department to better meet the needs of the increasingly diverse Canadian population. The recent regulations for (1) front-of-package labelling on foods high in nutrients of public health concern and (2) a risk-based multi-component labelling approach for supplemented foods were informed by research that took into consideration those disadvantaged by risks of marginal health literacy, who face challenges in accessing, understanding, and evaluating nutrition labelling information when making food choices.

Canada's food guide, the key source of evidence-based healthy eating information in Canada, has also been updated to reflect the increasingly diverse Canadian population. Updates to current resources and the development of new resources, tools and initiatives to promote healthy eating include:

• The development of social media campaigns and experiential marketing modules informed by diverse groups of teens and young adults;
• The development and implementation of a new user-centric Canada's food-guide recipe gallery with culturally diverse recipes and articles;
• New content development and updates to the consumer-facing webpages for Canada's food guide, informed by a diverse group of chefs and food advocates from minority groups, to help meet the goal of increasing relevance to all people in Canada, as well as to identify and address gaps and biases; and
• An evaluation of the monthly Canada's food guide newsletter to develop strategies to broaden the reach to a more diverse population of people living in Canada.

While an important component of health promotion, knowledge about healthy eating and food skills alone do not always translate into healthy diets. Societal and environmental factors have a large effect on access to nutritious foods, and as with health literacy, culture, ethnicity and socioeconomic status come into play. Health Canada is working with stakeholders to stimulate changes to food environments, with a particular focus on settings with populations vulnerable to food insecurity.

Another priority for Health Canada is monitoring children's exposure to food marketing. This is an important determinant of healthy eating and may contribute to health disparities affecting youth. Results of a recent study suggest that there are gender differences in teen engagement with food brands on social media, which may explain gender differences in their consumption patterns. This reinforces the importance of continued gender-based considerations in monitoring of food marketing in Canada.

Supplementary Information Sources:

Integrating a Health Literacy Lens into Nutrition Labelling Policy in Canada

Household food insecurity in Canada

GBA Plus Data Collection Plan:

Health Canada contracted researchers to develop 3 questionnaires: (1) to assess food literacy which will build the Department's understanding of food knowledge, skills, behaviours and attitudes, (2) to assess the food choices guidance from Canada's food guide (what people eat), and (3) to assess guidance on food habits (how people eat). All questionnaires were tested and validated among English and French speaking Canadians via an online platform to reach diverse populations from various locations. Efforts were made to ensure different sex and cultural groups were recruited based on the percentages outlined in Canadian census data. Once finalized, the questionnaires will allow for collection of SGBA Plus data to provide information related to areas for improvement and future policy development related to healthy eating across diverse groups in the Canadian population. Health Canada plans to collect data using these short questionnaires in collaboration with Statistic Canada in 2023-24.

Program Name: Health Impacts of Chemicals

The Health Impacts of Chemicals Program aims to protect the health of Canadians, through the assessment and management of health risks associated with environmental contaminants.

Infographic for Health Impacts of Chemicals

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Other Key Program Impacts on Gender and Diversity:

Health Canada assesses the extent to which its risk management activities have reduced the potential for exposure to harmful substances. When Health Canada identifies a particular risk to a sub-population (e.g., infants or pregnant people), risk management actions are put in place to address those risks, and then examines the extent to which the potential exposure has been reduced for this identified sub-population. For example, Health Canada's risk management performance evaluation of Bisphenol A (BPA) found that the Government of Canada's risk management activities lead to a 96% decrease in exposure to BPA between 2008 and 2014 for infants who were bottle-fed formula. These studies are conducted once sufficient time has passed to reasonably expect to see the effects of risk management activities.

Health Canada considers sex and gender when researching and monitoring the health effects of exposure to chemicals in humans. This begins in the planning phase, where all proposals are required to consider SGBA Plus in their design. Study results frequently report on sex, socioeconomic, regional, or other differences in exposure to chemicals or the health effects of chemicals.

In 2021-22, Health Canada released eight biomonitoring fact sheets bringing together results of monitoring and surveillance and research activities to report on trends in the Canadian population, including sex, age and regional differences. For example, in the lead biomonitoring fact sheet, comparisons between men and women in the general Canadian population showed that males had higher blood lead levels than females, that older adults (especially those over age 60) had higher blood lead levels than younger Canadians (children, adolescents and young adults). Blood lead levels were higher in Inuit populations in Canada, while First Nations on-reserve populations had similar blood lead levels, compared to the general Canadian population.

In the context of chemicals management, Health Canada recognizes that there are a groups of individuals within the Canadian population who, due to greater susceptibility or greater exposure, may be at an increased risk of experiencing adverse health effects from exposure to substances. This greater susceptibility may be due to factors such as age/life stage, sex and pre-existing health conditions, Greater exposure may be experienced due to factors such as behaviour (for example infant mouthing), culture (for example unique diet or product use) and geography (for example, living near industrial facilities). In 2021-22, Health Canada created an internal technical team on the topic of chemicals management and sub-populations who may be more susceptible or highly exposed to determine how to better communicate considerations of these sub-populations in risk assessment and to create consistent internal guidance on this communication. A new section was added to the Chemicals Management Plan information sheet webpage summary to achieve this improved communication, capturing SGBA Plus information when available. A fact sheet on how various sub-populations are considered in risk assessment that speaks to SGBA Plus was also drafted for future publication.

Health Canada also completed a pilot project in 2021-22 to develop and introduce tools and training materials to strengthen and more systematically apply SGBA Plus considerations within its chemicals management activities, including risk assessment, risk management, engagement and outreach, and water and air quality activities.

Supplementary Information Sources:

Individual Fact Sheets:

Arsenic in Canadians

Cadmium in Canadians

Lead in Canadians

Mercury in Canadians

Per- and polyfluoroalkyl substances (PFAS) in Canadians

Di(2-ethylhexyl) phthalate (DEHP) in Canadians

Bisphenol A (BPA) in Canadians

Parabens in Canadians

GBA Plus Data Collection Plan:

Public opinion research completed in 2021-22 collected data that will help to determine the awareness, knowledge, and behaviours of Canadians regarding chemicals and pollutants in and around the home. These data are disaggregated by sub-populations such as gender groups to enable more effectively tailored engagement and outreach activities. In 2022-23, these data are being used to establish a baseline to measure outreach performance.

Health Canada will continue to collect data on, study and assess health effects attributable to toxic substances, including sex- and gender-specific health endpoints with a significant focus on studying the impacts on pregnant people and birth outcomes. Health Canada has started to implement a work plan to advance progress on addressing the needs of sub-populations who may be more susceptible or highly exposed in the context of chemicals management and SGBA Plus. Activities include developing targeted guidance for risk assessors, exploring data needs and additional opportunities for acquisition of data in this area.

Program Name: Medical Devices

The Medical Devices Program ensures that medical devices sold in Canada are safe, effective and of high quality through regulatory activities and the provision of relevant information to Canadians and health professionals.

Infographic for Medical Devices

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Other Key Program Impacts on Gender and Diversity:

Due to the potential for differential impacts of medical devices, Health Canada recognizes the importance of designs taking into account SGBA Plus considerations related to the unique anatomical and physiological characteristics of different sex and gender groups through an intersectional lens.

Health Canada is committed to incorporating SGBA Plus in its medical devices programming. Under the Medical Devices Action Plan, Health Canada committed to reviewing its evidence requirements related to higher-risk medical devices with a view to strengthening the evidence requirements for devices based on previously authorized versions. Health Canada has developed a draft Guidance Document on Clinical Evidence Requirements for medical devices. The document provides guidance to Class III and IV medical device manufacturers and regulatory representatives on when clinical data and evidence is required, common methods to generate clinical data, and how to appropriately compare devices. This Guidance has benefitted from commentary received from the Scientific Advisory Committee on Health Products for Women, established in 2019. The Guidance, to be available in late fall 2022, includes an SGBA Plus section regarding clinical trial data on sex, gender, under-represented populations, and pediatric populations.

The Committee also provided guidance on Health Canada's breast implant patient checklist as well as on incorporating SGBA Plus in the Medical Device Incident Reporting Templates with respect to post-market surveillance.

In 2020-21, a report was developed to apply an SGBA Plus lens to medical device regulations (see Health Canada-CIHR SGBA plus Health Policy-Research Partnerships). This led to the development of an implementation plan of key recommendations in the area of medical devices. These include SGBA Plus considerations in pre-market and post-market activities and regulatory processes. Health Canada is advancing its implementation, including incorporating SGBA Plus recommendations into guidance, regulations and training.

In addition, Health Canada is further advancing this work by collaborating with the Department of Women and Gender Equality (WAGE) and the Canadian Institutes of Health Research to plan a WAGE-led Best Brains Exchange on the Best practices for a breast implant registry anticipated to take place in fall 2022.

Supplementary Information Sources:

Consultation: Guidance on clinical evidence requirement for medical devices

Guidance on clinical evidence requirements for medical devices

Examples of clinical evidence requirements for medical devices

GBA Plus Data Collection Plan:

An SGBA Plus lens applied to medical devices can help in determining the differential impacts when assessing safety and effectiveness of medical devices. Under the Medical Device Regulations, Health Canada expects that clinical data referred to or used by manufacturers adequately represent the Canadian population and clinical practice. Any clinical data used by the manufacturer to demonstrate a device's safety and effectiveness should reflect the population for whom the device is intended.

In 2021-22, Health Canada developed internal review templates for staff that include sex, gender and other equity considerations to support post-market risk assessments. When these assessments are conducted, the templates offer a guide for all scientific reviewers to assess sub-populations and identify when there is a need to seek out additional data, where possible.

In addition to applying the SGBA Plus lens to the post-market risk assessment, work on the draft Guidance Document on Clinical Evidence Requirements for medical devices continues. This document will provide guidance on Health Canada's expectations for clinical data, such that clinical data used by manufacturers adequately represents Canada's diverse population and clinical practice. More specifically, guidance is provided on:

• When clinical data/evidence may be required as part of a pre-market licence application
• The types and quality of clinical evidence that may be required to support the safety and effectiveness of a medical device
• The use of clinical evidence from comparator devices for the purpose of a pre-market application
• The various ways that clinical data may be generated
• The various ways identity factors such as sex, gender, race and/ or ethnicity may be integrated
• When clinical data/evidence may be required as part of a post-market obligation

Health Canada is also developing a guidance document for machine learning-enabled medical devices where SGBA Plus considerations will be included. This guidance will outline supporting information to consider when manufacturers are demonstrating the safety and effectiveness of such a device for the purposes of applying for or amending a medical device licence; or at any other point in the device lifecycle.

Taken together, these tools will help Health Canada to better assess the safety and effectiveness of medical devices that enters the Canadian market throughout their lifecycle. It will also enhance the way that SGBA Plus data is analysed and reported on by Health Canada with the goal to better inform the public about medical devices benefits and risks.

Program Name: Natural Health Products

The Natural Health Products Program is responsible for administering an efficient and transparent regulatory system that enhances consumer safety, reduces regulatory burden, fosters innovation and accountability, and helps deliver health options to Canadians.

Infographic for Natural Health Products

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	N/A	60 per cent - 79 per cent women	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	N/A	Somewhat benefits high income individuals (Somewhat regressive)	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	N/A	Primarily benefits seniors or the baby boom generation	Senior

Other Key Program Impacts on Gender and Diversity:

73% of Canadians use natural health products. According to the 2016 Consumer Health Products Survey, women are more likely than men to use these products. Canadians 55 years or older are significantly more likely than Canadians 18 to 54 years of age to frequently use natural health products such as vitamins. Canadians under 55 or with a university degree are more likely to frequently use traditional natural health products and homeopathic products.

In August 2021, Health Canada examined the role of sex and gender in the knowledge, attitudes and practices of consumers related to self-care products including natural health products and non-prescription drugs (see Health Canada-CIHR SGBA Plus Health Policy-Research Partnerships).

The Department found that most consumers are more likely to read the labels on self-care products regularly when not familiar with products they are purchasing and when labels are well designed (e.g., large font and good contrast). No appreciable differences between men and women were identified. Men and women had comparable levels of knowledge about natural health products and non-prescription drugs. In general, both men and women had a poor understanding of potential adverse reactions of these products. This research informed draft regulations to improve the labelling of natural health products which included requirements to improve font and contrast on natural health product labels and to make warnings, including allergen warnings clearer. The work also helped to inform the final regulations published in July 2022.

Supplementary Information Sources:

Natural Health Product Tracking Survey 2010 Final Report.

Consumer Health Products Survey 2016

GBA Plus Data Collection Plan:

Health Canada developed and finalized an SGBA Plus toolbox in 2021 to promote the significance of considering sex, gender, and other identity factors when collecting consumer data. This toolbox provides important resources on gender concepts and definitions, key words to use in a literature search, data analysis tools, description of the methodology of gender analysis, and references to publications that have used SGBA Plus. In 2022-23, the SGBA Plus toolbox is helping to guide data collection on sex and gender, enhancing the Department's ability to further integrate SGBA Plus in its decision-making.

Program Name: Pesticides

The objective of the Pesticides Program is to protect the health and safety of Canadians and the environment relating to the use of pesticides.

Infographic for Pesticides

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of Canadians indicating that they use Health Canada information to make decisions about the products they buy, and how they use them (by gender, age, region, education level, area of residence, income	By gender: Male: 48% Female: 51% Prefer not to Disclose: 1% By age: 18-34: 27% 35-54: 34% ≥55: 39% By region: BC: 14% AB: 11% SK: 3% MB: 4% ON: 38% QC: 23% Atlantic: 7% By education level: Less than High School: 4% High School: 24% Post-Secondary: 39% University Graduate: 32% Prefer not to Answer: 1% By area of residence: Urban: 42% Suburban: 35% Rural: 23% By income: <$40,000: 27% $40,000 - <$60,000: 17% $60,000 - <$100,000: 27% >$100,000: 18% Prefer not to Answer: 11%	2020 Public Opinion Research	N/A
Table a3.26 - Footnote * 2021-22 or most recent Return to Table a3.26 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

When a pesticide is being evaluated for its potential risks to human health, the Pest Control Products Act requires Health Canada to take into account greater risks that chemicals may pose to groups based on differences in biology and behaviour (e.g., differences due to sex, gender, age and occupation). If the health and environmental risks of a pesticide cannot be mitigated, the product will not be registered for use in Canada. Consideration of at-risk groups, including sex, gender, age, and occupation factors are a requirement of the Pest Control Products Act. The Considerations of Sex and Gender in Pesticide Risk Assessments Infographic outlines SGBA Plus metrics considered by Health Canada. The Sex- and Gender-based Considerations in the Scientific Risk Assessment of Pesticides in Canada Factsheet provides additional details on how the Department considers SGBA Plus within its operations and forward plans.

In addition to the above, Health Canada surveys Canadians every four years to measure the impact of outreach and awareness activities impact on the public. In total, 2,209 respondents completed the survey in 2020, and weighting was applied to the sample to ensure that the final data reflects the adult population of Canada by region, age, and gender according to the 2016 Census. The key program impacts on gender and diversity statistic profiled above is one example of research that tracks SGBA Plus metrics. SGBA Plus metrics provide insight into whether variances exist between these groups regarding outreach and awareness activities and can inform future program strategies.

Health Canada will continue to evaluate inclusion of other SGBA Plus factors with emphasis on intersectionality, where appropriate.

Supplementary Information Sources:

Pests and Pesticides Management Reports and Publications

GBA Plus Data Collection Plan:

Companies applying to register a pesticide must provide Health Canada with substantial toxicology data from health and environmental studies in accordance with internationally accepted scientific standards. Health Canada scientists evaluate potential risks to human health and the environment based on the data provided, which includes consideration to SGBA Plus factors such as sex, gender, and age. Health Canada requests additional information from the applicant if necessary. Health Canada will continue to evaluate feasibility and requirements regarding additional SGBA Plus data metrics with emphasis on intersectionality, where appropriate.

Program Name: Pharmaceutical Drugs

The Pharmaceutical Drugs Program ensures that pharmaceutical drugs sold in Canada are safe, effective and of high quality through regulatory activities and the provision of relevant information to Canadians and health professionals.

Infographic for Pharmaceutical Drugs

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage increase in Adverse Drug Reaction Reports (ADR) being submitted to Health Canada by healthcare institutions for pharmaceutical drugs collected by sex	Percentage increase: -18% Total number of mandatory ADRs for pharmaceutical drugs By sex: Male: 2439 (48%) Female: 2497 (51%) Not Specified: 31 (1%)	Canada Vigilance Database (2021-22)	N/A
Table a3.27 - Footnote * 2021-22 or most recent Return to Table a3.27 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

Health Canada established the Scientific Advisory Committee on Health Products for Women in 2019 to provide timely patient-centered, scientific, technical, medical and clinical advice on current and emerging issues regarding women's health and the regulation of drugs.

In 2021-22, the Committee provided advice on several relevant topics including (but not limited to):

• Mandatory SGBA Plus training for Health Canada staff;
• Ongoing SGBA Plus initiatives which are aimed at better integrating SGBA Plus considerations across the drug lifecycles;
• The development of an SGBA Plus Action Plan specific to Health Canada's initiatives on health products and food;
• Guidance documents for industry on integrating equity, diversity and SGBA Plus considerations in drug development and post-market activities.

Health Canada participated in the development of an international guidance document (ICH E8 (R1): General Considerations for Clinical Studies) which emphasizes that the design of a clinical study should reflect the population for which the drug is intended.

As noted under the "Biologic and Radiopharmaceutical Drugs" section, work has also continued in including an SGBA Plus lens to Drug Safety and Effectiveness Network queries for drugs.

Health Canada scientific reviewers take into consideration SGBA Plus factors when reviewing submissions, and work with the sponsor to obtain safety information for different populations, such as children, pregnant and breastfeeding persons. In response to the pandemic, Health Canada has put forth a number of enhanced post-market surveillance activities for monitoring the safety profile of COVID-19 treatments and conducted expedited safety assessments. For example, in January 2022, Health Canada authorized the combination of two antiviral drugs, nirmatrelvir and ritonavir (brand name PAXLOVIDTM) for the treatment of COVID-19 in adults. Two post-authorisation safety studies for PAXLOVIDTM are planned as additional pharmacovigilance activities in the Risk Management Plan (RMP), on pregnant and breastfeeding/lactating persons. Routine pharmacovigilance activities included pregnancy follow-up questionnaires and data capture aids about the safety of PAXLOVIDTM use during lactation.

GBA Plus Data Collection Plan:

Health Canada assesses data from clinical trials and other studies that are part of drug submissions by sponsors seeking authorization to access the Canadian market. These data are assessed by regulatory staff as part of the regulatory authorization of therapeutic drug products and associated labelling information for patients. Generally, sex is included in the methodology and analysis of any drug treatment in a clinical setting. Phase II or III studies conducted by manufacturers and other researchers are most typically designed with disaggregation by sex, unless the disease is sex-specific (e.g., ovarian or prostate cancer) where all participants will be either one sex or the other.

Health Canada plans to develop guidance documents for industry around developing inclusive trials to encourage greater diversity of trial participants, as well as the inclusion of pregnant and breastfeeding persons in clinical trials, where it makes sense to do so. Additionally, the SGBA Plus analysis that was developed for the Clinical Trials Modernization framework showed that certain elements of the proposed framework will help to encourage greater diversity among participants and researchers of clinical trials through the reduction of systemic barriers to participation. This will be mainly accomplished through the enabling and promotion of the conduct of decentralized trials in Canada by the modernized framework. Health Canada's SGBA Plus Data Strategy and SGBA Plus Action Plan specific to Health Products and Food is designed to promote greater subpopulation specific considerations and SGBA Plus data collection among industry^{Footnote 6}.

Program Name: Radiation Protection

The objectives of the Radiation Protection Program are to inform and advise Canadians and Canadian government departments and stakeholders (P/Ts, health professionals and associations, industry, etc.) about the health risks associated with radiation, and strategies to manage those risks. The key activities of the Program are monitoring environmental and occupational radiation; collaborating with international partners; managing federal nuclear emergency preparedness and response (including plans, procedures and training) for nuclear emergencies that require a coordinated federal response; educating Canadians and stakeholders on the health risks of radon and on risk mitigation strategies; conducting radiation-related research; and regulating radiation emitting devices. In addition, the program is licensed under the Nuclear Safety and Control Act to deliver the National Dosimetry Service, which provides cost-recovered occupational radiation monitoring services to clients.

Infographic for Radiation Protection

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of Canadians who indicated that they use the information on radiation emitting devices provided by Health Canada by sex, primary language, age, educational attainment, employment status, and income level	By sex: Male: 27% Female: 23% By primary language: English as primary language: 24% French as primary language: 31% By age: < 45: 36% > 45: 14% By educational attainment: Obtained at least a university bachelor's degree or higher: 28%: Education lower than a university bachelor's degree: 23% By employment status: Employed: 30% Unemployed: 16% By income level: Earn over $60,000 per year: 24% Earn less than $60,000 per year: 28%	Fact-based survey on Consumer Products and Cosmetics (September 28-October 6, 2020)	Survey was conducted by Prairie Research Associates Inc., on behalf of Health Canada. In total, 1,000 residents answered the survey using a weighted sample to ensure a survey representative of the Canadian population.
Table a3.28 - Footnote * 2021-22 or most recent Return to Table a3.28 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The Radiation Protection Program benefits all Canadians by helping to reduce the health risks associated with radiation exposure. In terms of measuring the key impacts of the Program, efforts are underway to collect data related to certain types of radiation exposure as case studies. For example, Health Canada assessed Canadians' use of tanning equipment and the prevalence of injuries in the 2019 Canadian Community Health Survey. The survey found that an estimated three percent of Canadians had used indoor tanning equipment in the past year, and 71% of users were female. Females aged 18 to 34 were significantly more prevalent users compared to females aged 45 or older; indoor tanning was higher among people without a university degree; and there were no differences in prevalence by household income or region.

Supplementary Information Sources:

Prevalence of tanning equipment use among Canadians

GBA Plus Data Collection Plan:

Health Canada conducted public opinion research in 2021-22 to collect data on attitudes, knowledge, and expectations about radiation risk from exposure to radiation emitting devices. Disaggregated data will be available in 2022-23 to support SGBA Plus considerations.

Health Canada is planning a fact-based survey in 2023-24 to determine Canadians' awareness and use of information regarding radiation emitting devices and will be collecting disaggregated data to help inform better-targeted outreach activities and determine additional opportunities for incorporation of SGBA Plus considerations into future work. Health Canada will report on disaggregated results by certain sub-groups (e.g., by sex, age, language, etc.).

Program Name: Specialized Health Services and Internationally Protected Persons Program

The Specialized Health Services consists of the Employee Assistance Services (EAS), which delivers the Employee Assistance Program (EAP) through a network of contracted mental health professionals; and the Public Service Occupational Health Program (PSOHP), which provides occupational health services and occupational hygiene consultative services to Government of Canada departments and agencies. The Internationally Protected Persons (IPP) Program helps fulfill the Government of Canada's international legal obligations by protecting the health of IPPs (e.g., the Royal Family, heads of state, and other dignitaries) visiting Canada.

Infographic for Specialized Health Services

Target Population: A particular demographic group (eligible federal employees and veterans [and immediate family members] and internationally protected persons)

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	N/A	60 per cent - 79 per cent women	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Other Key Program Impacts on Gender and Diversity:

The Health Canada Specialized Health Services and Internationally Protected Persons Program consists of three sub-programs:

• The EAS delivers the EAP through a network of contracted mental health professionals. In 2021-22 Health Canada's EAP applied a SGBA Plus lens to its policies, procedures, and services. Using this lens, EAP identified key improvement activities, including technology-based service delivery, communications and outreach, data collection and evaluation, and training and recruitment of mental health professionals. Research has confirmed that a one-size-fits-all approach is not sufficient to address the wellness needs of a diverse client base.
• EAP uses an enhanced capacity building approach to invest in tools and training to benefit groups underutilizing EAP (such as men, youth and the 2SLGBTQI+ community). Examples of these enhancements in 2021-22 included:
  • Full roll-out of chat intake to all EAP client departments. Chat seeks to eliminate barriers for those hesitant to access the service by phone (this is monitored via usage stats and client feedback);
  • Continued delivery of 2SLGBTQI+ training to EAP's mental health service providers in order to ensure an open, welcoming, and affirming environment when clients of this community access EAP. To date, over 200 counsellors have received this training and EAP will continue to offer it in fiscal year 2022-23;
  • Focused recruitment of network counsellors, including adding 20 Black counsellors to the network in 2021-22, thereby improving EAP's ability to meet client requests for a Black counsellor, and;
  • Continued expansion of the Lifespeak digital library of expert-led content focusing on diversity and inclusion (e.g., modules on addressing systemic racism; the 2SLGBTQI+ community).
• PSOHP provides occupational health services and occupational hygiene consultative services to Government of Canada departments and agencies.
• The IPP Program's mandate is to coordinate the development of health contingency plans for visiting IPPs to Canada. As a result of the global restrictions on international travel due to the pandemic during the 2021-22 fiscal year, Health Canada's IPP Program only processed fourteen (14) health plans for five (5) visits to Canada by internationally protected visitors

Supplementary Information Sources:

Infographic for Health Canada

GBA Plus Data Collection Plan:

While the EAP collects sufficient data to enable it to monitor and/or report program impacts by gender and diversity, PSOHP and the IPP Program are currently unable to report on program impacts by gender and diversity.

• EAP incorporates an SGBA Plus lens in a telephonic client survey (950 persons selected at random from approximately 4,000 clients who had used EAP services). Data is disaggregated by gender, age, region, language, sexual orientation, and employment equity.
• Health Canada is currently unable to collect disaggregated data on the delivery of the PSOHP due to a delay in the implementation of its new National Occupational Health Information System (NOHIS), and limitations with its existing Activity Tracking System. However, NOHIS will capture data on client populations to support the use of SGBA Plus in monitoring and reporting on program impacts, as informed by the SGBA Plus currently underway. It is anticipated this new system will be operational in early 2023. Health Canada will ensure best practices in SGBA Plus data collection plans for its EAP are applied to the new information system.
• The IPP Program supports the Government of Canada's international obligations under customary International Law by ensuring the health protection of IPPs visiting Canada.
• IPPs are Heads of State and dignitaries from foreign countries visiting Canada for official government purposes or for personal reasons. Official visits for IPPs are at the request of government officials, such as the Prime Minister. IPP's program partners in Global Affairs Canada, Heritage Canada, the RCMP and the Department of National Defence serve as hosts for IPP visits and lead all planning activities.
• The IPP Program supports IPP visits and major events attended by multiple IPPs by ensuring appropriate measures are in place in the event of a medical emergency. The Program develops contingency health plans that identify medical service providers as well as processes and procedures in the event of a medical need by an IPP during a visit to Canada. Diplomatic considerations preclude requesting non-medically relevant information from IPPs.
• For these reasons, the IPP Program is not collecting SGBA Plus data this year but will continue to explore ways to incorporate SGBA Plus data collection into its program activities.

Program Name: Tobacco Control

The objective of Canada's Tobacco Strategy, led by Tobacco Control Program, is to reduce tobacco use in Canada to less than 5% by 2035 through efforts to prevent the uptake of tobacco use and to help smokers quit. The Program also addresses the health risks associated with vaping product use and works to prevent usage among youth and non-smokers.

Infographic for Tobacco Control

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Key Program Impacts on Gender and Diversity

Statistics	Observed ResultsFootnote *	Data Source	Comment
Percentage of Canadian students (grades 7-12) who have used a vaping product (e-cigarettes only) in the past 30 days by sex	Overall: 20% By sex: Male: 21% Female: 19%	Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS,) (2018-19)	Next available CSTADS data will be in March 2023. Baseline (CSTADS, 2016-17) Overall: 10% Male: 12% Female: 8%
Percentage of Canadian students (grades 7-12) who have used any tobacco product (including cigarettes) in the past 30 days by sex	Overall: 8% By sex: Male: 9% Female: 7%	Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS, (2018-19)	Next available CSTADS data will be in March 2023. Baseline (CSTADS, 2016-17): Overall: 10% Male: 12% Female: 8%
Prevalence of Canadians (aged 15+) who are current cigarette smokers by sex, age, sexual orientation, educational attainment, socio-economic status and diagnosis of anxiety and/or mood disorder	Overall: 13% By sex: Male: 16% Female: 11% By age: 15-19: 6% 20-24: 13% 25-44: 16% > 45: 13% By sexual orientation: Heterosexual: 13% Homosexual: 22% Bisexual: 20% By educational attainment: Less than secondary school graduation: 18% Secondary school graduation, no post-secondary education: 16% Post-secondary certificate/diploma: 15% University degree or more: 7% By socio-economic status Income Quintile 1: 20% Income Quintile 2: 16% Income Quintile 3: 16% Income Quintile 4: 11% Income Quintile 5: 9% Diagnosis of a mood and/or anxiety disorder: Yes: 21% No: 12%	Canadian Community Health Survey (CCHS) - Annual Share (2020)	Full-year 2021 data is not yet available. The observed results reported in 2021-22 are based on data collected in 2020 (CCHS 2020). Baseline Overall: 15% Male: 20% Female: 12% (Source: CCHS, 2016) Baseline data disaggregated by age, sexual orientation, education, socio-economic status and mental-health condition is not yet available. Note: income quintile 1 is the lowest and 5 is the highest.
Table a3.30 - Footnote * 2021-22 or most recent Return to Table a3.30 Footnote * referrer

Other Key Program Impacts on Gender and Diversity:

The Tobacco Control Program continues to monitor smoking and vaping trends based on socio-demographic characteristics and considers targeted measures to address high prevalence rates amongst population groups as appropriate. For example, the Program works to address concerns regarding youth vaping and aims to protect youth and non-users of tobacco products from nicotine addiction.

In 2021-22, Canada's Tobacco Strategy, led by the Tobacco Control program continued to support Health Canada's core responsibility of health protection and promotion by minimizing risks to the health of Canadians resulting from the use of tobacco and vaping products. Health Canada also continued to address the health risks and potential benefits associated with the use of vaping products and worked to prevent the use of vaping products among youth and non-smokers.

Supplementary Information Sources:

Health Fact Sheets, Smoking 2019

Canadian Tobacco and Nicotine Survey: Summary of results for 2020

GBA Plus Data Collection Plan:

The Department's SGBA Plus data collection plans include collaborating with Statistics Canada to assess key aspects of tobacco use through population health surveys, such as the Canadian Community Health Survey and the Canadian Tobacco and Nicotine Survey.

Recently, the Tobacco Control program began to move to using data from the Canadian Community Health Survey (CCHS) as the data source for monitoring the primary indicator of prevalence of cigarette smoking and of tobacco use among Canadians. The CCHS collects information related to health status, health care utilization and health determinants for the Canadian population, including age and socio-demographic characteristics. The CCHS uses the two-step sex and gender approach to separate the concepts of sex and gender, which allows for examination of diverse gender identities. Information on sexual orientation is also captured. A key strength of the CCHS is its examination of socio-demographic characteristics and identity factors including province, region (urban/rural), education, household income, industry group, country of birth, cultural/racial background, and Indigeneity.

The CTNS collects demographic information such as age and gender. These surveillance tools allow Health Canada to analyze the distribution of smoking and vaping behaviours among the Canadian population, including the identification of subgroups with high prevalence rates.

Program Name: Water Quality

The objective of the Water Quality Program is to help manage potential risks to the health of Canadians associated with water quality. Specifically, the Program works with other federal government departments and agencies, P/Ts to establish the Guidelines for Canadian Drinking Water Quality. These guidelines are endorsed through a federal, provincial and territorial (F/P/T) collaborative process, and are used by all F/P/T jurisdictions in Canada as the basis for establishing their drinking water quality requirements.

Infographic for Water Quality

Target Population: All Canadians

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Other Key Program Impacts on Gender and Diversity:

The provision of safe drinking water in Canada is the responsibility of P/Ts and other federal government departments and agencies (e.g., Correctional Service Canada), as applicable. Indigenous Services Canada administers the Government of Canada's role related to safe drinking water on First Nations reserves. Health Canada's Water Quality Program generally benefits all Canadians by developing guidelines that are used by the federal government and P/Ts to set regulations and policies for drinking water quality in their respective jurisdictions.

When reviewing the existing scientific evidence during guideline development, Health Canada considers health endpoints related to sub-populations who may be disproportionately impacted by poor drinking water quality, such as pregnant persons and infants. Health Canada highlights any population differences in the guidelines.

GBA Plus Data Collection Plan:

Data collection is part of the development of the Canadian Drinking Water Quality Guidelines. Health Canada collects existing scientific evidence and analyzes SGBA Plus data, such as those related to sex, gender, age, and/or geography. Using all information gathered, Health Canada identifies critical health endpoints affecting human health from water contaminants, including the determination of whether certain sub-populations may be particularly vulnerable to exposure or effects of exposure, to inform a protective concentration level.

Program Name: Workplace Hazardous Products

The objective of the Workplace Hazardous Products Program is to ensure that suppliers provide critical health and safety information on hazardous chemicals to workers, the target population for the program. It therefore helps Canadian workers who come into contact with workplace chemicals have the information they need to protect themselves.

Infographic for Workplace Hazardous Products

Target Population: A particular demographic group

Distribution of benefits by gender

By gender	First group	Second group	Third group	Fourth group	Fifth group	By gender
Men	N/A	N/A	Broadly gender-balanced	N/A	N/A	Women

Distribution of benefits by income level

By income level	First group	Second group	Third group	Fourth group	Fifth group	By income level
Low	N/A	N/A	No significant distributional impacts	N/A	N/A	High

Distribution of benefits by age group

By age group	First group	Second group	Third group	By age group
Youth	N/A	No significant inter-generational impacts or impacts generation between youth and seniors	N/A	Senior

Other Key Program Impacts on Gender and Diversity:

As part of the Globally Harmonized System of Classification and Labelling of Chemicals, workplace hazardous products in Canada display hazard and safety information on labels and safety data sheets that include potential acute and chronic effects (such as cancer) from short- and long-term exposures. This system also includes identification of chemicals that may cause adverse effects on sexual function and fertility in adult men and women as well as developmental toxicity in children, including via lactation. This allows workers to take measures to protect themselves when using these products by following the precautionary statements in the safety data sheets.

Informing workers on the safe use of workplace hazardous chemicals is intended to reduce the number of injuries or illnesses at work, which is also anticipated to have secondary impacts for the workers' families and communities. SGBA Plus considerations are included for each cost-benefit assessment that is completed for regulatory proposals. Health Canada also considered whether certain demographics would be impacted differently than others in the development of educational and compliance promotion activities.

Supplementary Information Sources:

Precarious Employment and Vulnerable Workers

GBA Plus Data Collection Plan:

Health Canada is increasing its collection of SGBA Plus data through consultations with partners, stakeholders, and the public in order to inform policy and decision-making as it relates to workplace hazardous products. Furthermore, Health Canada has been considering extending hazard communication requirements to consumer products used in workplaces. As Health Canada continues to explore this issue in 2022-23, SGBA Plus-related information will be included in the analysis.

Health Canada is also exploring the protection of vulnerable workers. In this context, vulnerable workers may include young, new, aging, migrant/immigrant workers and workers who have precarious employment. These workers are likely disproportionately employed in physically demanding or hazardous jobs, which puts them at higher risk for workplace injuries and illnesses. Work is underway to qualify and quantify economic impacts for certain injuries and illnesses and to identify the potential relationship between these injuries and illnesses and the use of chemical products at work. These data will be disaggregated to the extent possible along SGBA Plus lines to enable a better understanding of workplace illness and injury among various demographic groups. This work will serve to inform compliance promotion and enforcement of accurate hazard communication to workers in vulnerable sectors. Early results are expected in 2023-24.

Horizontal initiatives

Addressing the Opioid Crisis

General information

Name of horizontal initiative

Addressing the Opioid Crisis

Lead department

Health Canada

Federal partner organization(s)

• Canada Border Services Agency
• Public Health Agency of Canada
• Public Safety Canada
• Statistics Canada

Note: Other government departments (e.g., Correctional Service Canada) are supporting the federal response to the overdose crisis. However, they are not captured in this Horizontal Initiative table as they have not received funding through the Treasury Board Submission "Addressing the Opioid Crisis."

Start Date

April 1, 2018

End Date

March 31, 2023 and ongoing

Description

Illegal drugs and substance use have always presented health and safety challenges in Canada and around the world. Recently, however, there has been a dramatic rise in the number of opioid-related overdoses and deaths with those most affected in this crisis being young to middle-aged individuals, particularly men. Most deaths are accidental and largely due to the contamination of the illegal drug supply with highly toxic fentanyl and/or fentanyl analogues. Fentanyl continues to be a low-cost way for drug dealers to make street drugs more powerful. Just a few grains contribute to the high rates of overdoses and overdose-related deaths.

The federal government's actions to address the overdose crisis are guided by the Canadian Drugs and Substances Strategy^{Footnote 7}, which takes a comprehensive, collaborative, and compassionate approach to substance use issues using a public health lens. The federal government is deeply concerned about the number of overdoses and overdose-related deaths and is taking significant actions in areas of federal jurisdiction to address the crisis. However, despite significant efforts to date, the overdose crisis in Canada continues. According to data from the Public Health Agency of Canada, 30,843 people lost their lives in Canada between January 2016 and March 2022 to apparent opioid toxicity deaths. In addition, it is estimated that approximately 250,000 Canadians do not have access to treatment when seeking help from substance use services.^{Footnote 8} Since people who use drugs have traditionally been stigmatized, Canadians struggling with a substance use disorder often encounter barriers when accessing health, medical and social services. Tragically, the COVID-19 pandemic has also exacerbated long-standing challenges regarding substance use and has contributed to the worsening overdose crisis with some communities reporting record high numbers of overdose deaths, hospitalizations, and emergency medical service responses.

While the Government of Canada is taking a number of actions to respond to the overdose crisis, this horizontal initiative is specific to measures announced in Budget 2018 to:

• support additional prevention and treatment interventions through an expansion of the Substance Use and Addictions Program (SUAP);
• address the stigma surrounding people who use drugs, which creates barriers for those seeking treatment, through a public education campaign and training for law enforcement;
• enhance capacity to identify and intercept illegal substances at the border by equipping border agents with additional tools at ports of entry; and,
• improve the availability of and access to public health data by expanding public health surveillance, conducting special studies, and redesigning the Canadian Coroner and Medical Examiner Database (CCMED).

Ultimately, these complementary activities are intended to contribute to a reduction in overdose harms and deaths in Canada.

Governance structures

The Government of Canada has put in place a robust governance structure to facilitate whole-of-government coordination in implementing a comprehensive, collaborative federal response to the overdose crisis. Each department and agency is responsible for leading its respective initiatives and providing updates to the interdepartmental Assistant Deputy Minister (ADM)-level Working Group on Opioids. This working group is used as a forum for information and consultation on next steps. Updates and decisions from this working group feed into the federal, interdepartmental Deputy Ministers Task Force on the Opioid Crisis as required. This Task Force, chaired by the Deputy Minister of Health Canada, serves as a time-limited forum to provide leadership and oversight of federal initiatives to respond to the overdose crisis. The Task Force will remain an established committee until such time that the public environment no longer requires it.

The Government is committed to ongoing collaboration and consultation with provincial and territorial (P/T) partners. Departments and agencies will provide updates to and consult with P/T colleagues as required through the federal/provincial/territorial (F/P/T) ADM-level Committee on Substance Use (CSU). Formerly known as the Problematic Substance Use and Harms Committee, the CSU is co-chaired by Health Canada and officials from the province of British Columbia. It is comprised of ADMs responsible for drug policy in their respective jurisdictions. The CSU also provides updates to and consults with P/T colleagues as required through the F/P/T Special Advisory Committee on the Epidemic of Opioid Overdoses (SAC) co-chaired by the Chief Public Health Officer of Canada and New Brunswick's Chief Medical Officer of Health and comprising Chief Medical Officers of Health from each jurisdiction. The CSU is an established committee intended as a long-term forum for drug policy discussions. The SAC was created specifically as a mechanism for public health collaboration and information sharing between jurisdictions related to the overdose crisis in Canada.

Total federal funding allocated from start to end date (dollars)

$108,794,405 (includes existing funding)

Total federal funding planned spending to date (dollars)

$91,945,446

Total federal actual spending to date (dollars)

$83,754,784

Date of last renewal of initiative

Not applicable

Total federal funding allocated at the last renewal and source of funding (dollars)

Not applicable

Additional federal funding received after last renewal (dollars)

Not applicable

Total planned spending since last renewal

Not applicable

Total actual spending since last renewal

Not applicable

Fiscal year of planned completion of next evaluation

2022-23

Performance highlights

All federal partners work collaboratively to address the overdose crisis in a comprehensive, robust, and effective manner. The work of federal partners to address the overdose crisis includes initiatives that span the continuum from gathering data and evidence to better understand the crisis to conducting public education and awareness activities, to supporting prevention and treatment projects, and enhancing enforcement capabilities.

Key achievements in 2021-2022 include:

• ongoing monitoring and support of 15 prevention and treatment projects funded under the SUAP to improve prevention and treatment efforts;
• continued the Know More Opioids virtual session into the 2021-22 school year, allowing for greater reach to rural and remote schools across Canada. The tour has had over 168,000 interactions with youth since its launch in 2018, visiting 770 schools (in-person and virtually), 43 festivals and 68 campuses and has engaged with students in sessions in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick, Nova, Scotia, Prince Edward Island, Newfoundland and Labrador, Yukon and the Northwest Territories;
• launched a Stigma Gallery on HealthCanadaExperiences.ca comprised of shared stories from people with living or lived experience to educate visitors about the harms of substance use;
• conducted phase five of a national advertising campaign featuring advertisements on the impacts of stigma surrounding people who use drugs and the Good Samaritan Drug Overdose Act, surpassing minimum targets with 98.9 million ad impressions and increasing opioid-related web traffic on Canada.ca by 60%;
• continued to socialize, amend, and promote the uptake of Public Safety Canada's online Drug Stigma Awareness Training amongst the law enforcement community to ensure that they are mindful of the negative impacts of stigma when interacting with people with substance use disorder;
• enhanced the detector dog service team's training and evaluation methodologies and integrated detector dogs into postal operations;
• established new Designated Safe Examination Areas (DSEAs) and regional screening facilities to conduct safe examinations of goods suspected of containing opioids at ports of entry, including three fully operational Regional Screening facilities, located at the highest risk ports for encountering opioids and synthetic opioids such as fentanyl and fentanyl analogues;
• implemented 70 DSEAs to-date remaining on track to deliver a total of 81 DSEA by the end of fiscal year 2022-23;
• led national epidemiologic studies to better understand how the overdose crisis affects sub-populations of Canadians, including who is affected, risk factors, substances involved, and circumstances surrounding overdose events;
• continued to monitor and support 16 P/T substance-related harms surveillance capacity building initiatives funded through PHAC;
• continued to deploy substance-related harms Public Health Officers to P/Ts to support overdose surveillance and response;
• continued to collaborate with P/Ts to support quarterly data collection and reporting on substance-related harms, and to collaborate with P/Ts and key federal partners to strengthen and co-ordinate new and more timely data analysis and insights, as well as to enhance the monitoring and surveillance activities associated with overdose death data via the Canadian Coroners and Medical Examiners Database (CCMED);
• collaborated with P/Ts on the redesign of the CCMED, which includes the addition of an overdose module to capture more detailed information and incorporate machine learning techniques to improve the analytical capacity of the CCMED; and,
• continued to support and fund P/T surveillance capacity building initiatives with dissemination of knowledge generated and lessons learned to national partners.

Health Canada

The department continued ongoing monitoring and support of 22 opioid-related projects funded through SUAP (for the period covering 2018-19 through 2023-24) targeting prevention and treatment interventions. Funded projects located across the country included activities such as: developing curricula, tools and supports related to safe prescribing as well as resources and networks that support health and social service professionals to offer addictions services; increasing access to opioid agonist treatment (OAT) across the country, including training and performance measurement activities; and research activities including the development of best practices in OAT.

Health Canada also launched phase five of a national advertising campaign to address the stigma surrounding people who use drugs and inform Canadians about harm reduction measures. This phase included content on opioid awareness, stigma, and the Good Samaritan Drug Overdose Act. It built on previous campaigns implemented between Fall 2018 and Winter 2021.

Public Safety Canada

Public Safety Canada hosted the fifth Law Enforcement Roundtable on Drugs in September and October of 2021 that brought together experts from P/Ts, police services, national organizations, Indigenous communities and academia, to engage in discussions on current and emerging drug threats. Due to ongoing COVID-19 pandemic travel restrictions, this event was held virtually. It featured 20 presenters over four two-hour sessions with approximately 150 participants per session. While previous roundtables focused on a specific region within Canada, this roundtable leveraged the virtual platform to host a pan-Canadian conversation regarding the increasing importation of precursor chemicals, their subsequent impact on the domestic production of synthetic drugs, and the increasing prevalence of illegal drug trafficking via the surface web.

Public Safety Canada launched its Drug Stigma Awareness training in September 2020. This online training module provides members of the law enforcement community with tools and reference material that they can refer to when engaging with individual suffering from a substance use disorder and their families. Since its launch, 7.9% of frontline law enforcement members across Canada have completed the training.^{Footnote 9} The Department continues to promote uptake of the training amongst the law enforcement community, including through creating and sharing a bilingual video of testimonials of the course's usefulness in the field. The video will support future engagement and communication activities with policing agencies. The Department expects that these efforts will contribute to making stronger progress toward meeting the target for uptake of the training before March 31, 2023.

Finally, the Department continued to work with portfolio partners to advance its illegal drug supply reduction efforts. This included undertaking research on the scope of trafficking of opioids, synthetic opioids, and other illicit drugs on the web in support of developing disruption mechanisms, and exploring measures to strengthen the postal system against drug trafficking.

Canada Border Services Agency

The Canada Border Services Agency (CBSA) has implemented 70 Designated Safe Examination Areas (DSEAs) and is on track to implement another eleven by the end of fiscal 2022-23. This will result in a total of 81 DSEAs implemented. As well, all Border Services Officers are required to complete a regimen of training before they conduct exams within the DSEA.

The CBSA also succeeded in implementing three Regional Screening facilities that are fully operational. These three screening facilities are located at the highest risk ports for encountering opioids and synthetic opioids, such as fentanyl and fentanyl analogues, and have been highly successful at detecting associated precursor chemicals.

In addition, detector dog teams have been integrated into the postal operations and have demonstrated great success.

Work continued to progress through fully-staffed Intel and Targeting teams, who are producing excellent results. The teams have exceeded their targets and products are being produced which contribute to CBSA's ability to stem the flow of contraband from entering the country.

Public Health Agency of Canada

The PHAC released a total of 21 evidence products from April 1, 2021 through March 31, 2022. These included 12 national surveillance reports on apparent opioid-related deaths and harms, four updates of a joint brief with Health Canada on federal actions on opioids, three brief reports on opioid-related hospitalizations and harms, and two releases of modelling opioid-related deaths during COVID-19.

Funding and support for P/T substance-related harms surveillance capacity building initiatives were also renewed with expanded focus on alcohol-related surveillance activities for jurisdictions with a high need to put in place best practices of engaging peers in the development of harm-reduction strategies at the community level.

In addition, PHAC has staffed 11 of the 14 Substance-related harms Public Health Officer positions on a full-time basis over the course of the fiscal year.

Statistics Canada

Statistics Canada continued its work in modernizing and enhancing the CCMED. Together with a new partner, Public Safety Canada, Statistics Canada worked on a feasibility analysis of drug-involved driver deaths. Statistics Canada also worked collaboratively with PHAC and the P/T chief coroners and chief medical examiners to agree on a set of opioids and stimulant toxicity deaths to make the data more comparable at a national level. Statistics Canada also provided funding to the province of Newfoundland and Labrador to improve its electronic case management capacity thereby allowing for more complete data collection in the CCMED. Statistics Canada also began to explore how to develop a drug toxicity module in the CCMED.

Two additional key developments of the CCMED pertain to continued improvements around timeliness and comprehensiveness. Statistics Canada continued to release data from the CCMED twice per year and will be annually updating linkages of these data to the central data repository to allow for data integration to other datasets such as census, tax, hospital data and additional social domain data. These integrated datasets will allow for a more complete picture of the decedent providing further insights to the circumstances surrounding deaths, including overdose deaths. Statistics Canada is also leveraging machine learning expertise within the organization, including extending topic modelling techniques to all P/Ts, to look at changes to trends in the unstructured text narrative reports for each death investigation, and to classify information from these free text fields into coded variables for more efficient analysis.

Contact information

Jennifer Novak
Executive Director, Opioid Response Team
Controlled Substances and Cannabis Branch
jennifer.novak@hc.sc.gc.ca
613-816-6478

Performance information

Theme horizontal initiative activities

Comments on Variances

Health Canada

The variance between actual and planned spending is due to the reallocation of funds from other initiatives to address the opioid crisis in Canada.

CBSA

The variance between actual and planned spending is due to previous carry forwards and re-profiles required as a result of delays in procurement and execution due to COVID, supply chain issues, and additional indirect costs.

Public Health Agency Canada

The variance between actual and planned spending is due COVID-19 which significantly restricted anticipated in-person training, conferences, meetings and travel.

Public Safety

The variance between actual and planned spending is due to COVID-19 travel restrictions, which directly impacted actual spending.

Statistics Canada

The variance between actual and planned spending is mainly due to a reprofile of funds from 2020-21 to 2021-22 for planned work with the province of Newfoundland and Labrador on the CCMED. This resulted in planned spending for StatCan in 2021-22 of $404,446. Actual spending in 2021-22 for StatCan was $427,093, which represents a variance of 5.6% relative to the revised budget.

Theme 1: Supporting Additional Prevention and Treatment Interventions

Expected results

Health Canada

ER 1.1.1 Targeted stakeholders and Canadians are equipped with the capacity (knowledge, skills and supports) to inform their decisions and actions related to opioid use

ER 1.1.2 Targeted stakeholders use evidence-informed information on opioid use to change policies, programs, and practice

Performance indicators

Health Canada

PI 1.1.1 Percentage of funding recipients who met their targets set for targeted Stakeholders/Canadians who intend to use knowledge/skills related to substance use they have acquired through SUAP funded projects^{Footnote 10}

Targets

Health Canada

T 1.1.1 65%

Health Canada

AR 1.1.1 69% (as of March 31, 2022)

Theme 2: Addressing Stigma

Expected results

Health Canada

ER 2.1.1 Increased sympathy among Canadians for people using opioids^{Footnote 11}

ER 2.1.2 Increased perception among Canadians of drug use as a public health issue

Public Safety Canada

ER 2.2 Increased awareness of the impacts of stigma and support for people who use substances amongst law enforcement community about de-stigmatization of people who use opioids

Performance indicators

Health Canada

PI 2.1.1 Percentage of Canadians who have sympathy for people using opioids

PI 2.1.2 Percentage of Canadians who believe that opioid-related substance use disorder is a disease

Public Safety Canada

PI 2.2 Percentage of police service members who completed the online course

Targets

Health Canada

T 2.1.1 Increase by 5 percentage points^{Footnote 12}

T 2.1.2 Increase by 5 percentage points^{Footnote 13}

Public Safety Canada

T 2.2 25% of eligible police service members

Actual results

Health Canada

AR 2.1.1 24%

AR 2.1.2 65%

Public Safety Canada

AR 2.2 7.9% of frontline law enforcement members

Theme 3: Taking Action at Canada's Borders

Expected results

Public Safety Canada

ER 3.1 Increased knowledge generation and sharing of information on targeted issues related to reducing the illegal supply of opioids in Canada

Canada Border Services Agency

ER 3.2.1 Increased capacity to identify high-risk goods at ports of entry

ER 3.2.2 Increased ability to risk assess and identify high risk shipments

ER 3.2.3 Increased communications related to threat assessment information and intelligence provided to personnel and partnering agencies

ER 3.2.4 Enhanced capability^{Footnote 14} to interdict illegal cross-border movement of drugs, such as opioids, at postal locations

Performance indicators

Public Safety Canada

PI 3.1 Percentage of completed planned engagement activities with law enforcement community, stakeholders and partners to address policy issues related with the illegal supply of opioids that are completed

Canada Border Services Agency

PI 3.2.1.1 Number of designated safe examination areas, allowing ports of entry to be equipped to identify, detect, and interdict opioids

PI 3.2.1.2 Percentage of CBSA officers at ports of entry identified for safe examinations training that have completed the required training

PI 3.2.1.3 Number of items per year of suspected opioid-containing packages sampled and identified at safe sampling areas (outside of the laboratory)

PI 3.2.2 Number of streams/risk rules supporting advanced risk assessment

PI 3.2.3 Number of intelligence products produced by the CBSA

PI 3.2.4.1 Percentage of interdictions of drugs, including opioids, using detector dogs (compared to random resultant rate)

PI 3.2.4.2 Percentage of interdictions of drugs, including opioids, resulting from targeted examinations (compared to random resultant rate)

Targets

Public Safety Canada

T 3.1 100%

Canada Border Services Agency

T 3.2.1.1 70

T 3.2.1.2 100%^{Footnote 15}

T 3.2.1.3 1,000^{Footnote 16}

T 3.2.2 Increase by 10%

T 3.2.3 5

T 3.2.4.1 2.5%^{Footnote 17}

T 3.2.4.2 TBD

Actual results

Public Safety Canada

AR 3.1 Hosted the 5^th Law Enforcement Roundtable on Drugs

Canada Border Security Agency

AR 3.2.1.1 70

AR 3.2.1.2 100%

AR 3.2.1.3 4730

AR 3.2.2 100% increase

AR 3.2.3 137

AR 3.2.4.1 4.27%

AR 3.2.4.2 The KPI is currently under review and subject to change. The plan is to review, refine and adjust the KPI as the initiative proceeds to fine the best metric to measure progress. The PI for this indicator is a duplicate and is mentioned in the Theme 3 Details. It therefore should be removed from CTB Enhancement of Detector Dog Program.

Theme 4: Enhancing the Evidence Base

Expected results

Public Health Agency of Canada

ER 4.1 Enhanced quality surveillance data is available

Statistics Canada

ER 4.2 Increased use and relevance of CCMED among stakeholders

Performance indicators

Public Health Agency of Canada

PI 4.1 Number of opioid-related evidence products^{Footnote 18} disseminated publicly

Statistics Canada

PI 4.2 Percentage of clients satisfied with statistical information from CCMED

Targets

Public Health Agency of Canada

T 4.1 11

Statistics Canada

T 4.2 Overall client satisfaction target: 80%

Actual results

Public Health Agency of Canada

AR 4.1 21

AR 4.2 84%

Canadian Drugs and Substances Strategy

General information

Name of horizontal initiative

Canadian Drugs and Substances Strategy

Lead department

Health Canada

Federal partner organization(s)

• Canada Border Services Agency
• Canada Revenue Agency
• Canadian Institutes of Health Research
• Correctional Service Canada
• Department of Justice Canada
• Financial Transactions and Reports Analysis Centre of Canada
• Global Affairs Canada
• Indigenous Services Canada
• Parole Board of Canada
• Public Health Agency of Canada
• Public Prosecution Service of Canada
• Public Safety Canada
• Public Services and Procurement Canada
• Royal Canadian Mounted Police

Start date

April 1, 2017

End Date

March 31, 2022 and ongoing

Description

The Canadian Drugs and Substances Strategy (CDSS) is the Government of Canada's comprehensive, collaborative, compassionate and evidence-based approach to drug policy, which uses a public health lens when considering and addressing substance use. The CDSS is led by the Minister of Mental Health and Addictions and Associate Minister of Health, supported by Health Canada and 14 other federal departments and agencies. The CDSS covers a broad range of legal and illegal substances, including cannabis^{Footnote 19}, alcohol, opioids^{Footnote 20} and other substances. The goal of the strategy is to protect the health and safety of all Canadians by minimizing harms from substance use for individuals, families, and communities.

The CDSS takes a 4-pillar approach to substance use-related harms (prevention, treatment, harm reduction, and enforcement), supported by a strong evidence base. The public health focus of the CDSS, along with the inclusion of harm reduction as a core pillar of the strategy, enables the Government to address the current overdose crisis.

The CDSS recognizes that a national approach to substance use requires strong collaboration and coordination amongst all levels of government, working in their respective areas of jurisdiction. It also recognizes the critical importance of working closely with a wide range of stakeholders on an ongoing basis, including people with lived and living experience with substance use. Reducing the stigma experienced by people who use drugs is also integral to the CDSS, and an ongoing priority for the Government of Canada.

Governance structure

The CDSS is led by the Minister of Mental Health and Addictions and Associate Minister of Health. The Strategy is coordinated through a Director General (DG) level steering committee that reports to Assistant Deputy Ministers (ADMs).

The DG Steering Committee is designed to reflect and support the CDSS's comprehensive approach to substance use. The committee is composed of DGs from federal departments/agencies whose mandates are relevant to drug and substance use across the four pillars of prevention, treatment, harm reduction and enforcement. The Committee meets on a quarterly basis, with additional ad hoc meetings as required, and is supported by Working Groups and/or short-term task specific groups, as needed. Secretariat support for the CDSS is provided by Health Canada.

Current federal/provincial/territorial (F/P/T) engagement is achieved through a number of F/P/T mechanisms, including the F/P/T Committee on Problematic Substance Use and Harms that is co-chaired by Health Canada and a provincial Co-Chair.

Total federal funding allocated from 2017-18 to 2021-22 (dollars)

$641,823,968^{Footnote 21}

Total federal funding planned spending to March 31, 2022 (dollars)

$129,283,572

Total federal actual spending to March 31, 2022 (dollars)

$166,920,795

Date of last renewal of initiative

Not applicable

Total federal funding allocated at the last renewal and source of funding (dollars)

Not applicable

Additional federal funding received after last renewal (dollars)

Not applicable

Total planned spending since last renewal

Not applicable

Total actual spending since last renewal

Not applicable

Fiscal year of planned completion of next evaluation

2022-23

Performance highlights

In 2021-22, substance-related harms continued to cause devastating health and social effects on Canadians. For many people, the COVID-19 pandemic exacerbated these trends, particularly around overdose-related harms and deaths, heavy drinking, and co-occurring mental health conditions. Evidence shows that substance-related hospitalizations and deaths increased in Canada during the pandemic compared to the same period in 2019. From January–December 2021, apparent opioid toxicity claimed the lives of 7,560 Canadians, making 2021 the worst year on record. This amounted to 21 deaths per day, bringing Canada to a total of 30,843 apparent opioid-toxicity deaths between January 2016 and March 2022^{Footnote 22}. In comparison, pre-pandemic levels ranged from 7 (in 2016) to 12 (in 2018) deaths per day^{Footnote 23}. Contributing factors include increased feelings of isolation, stress and anxiety, and limited availability or accessibility of services for those who used drugs during the pandemic.

The COVID-19 pandemic has also had profound impacts on mental wellness in Indigenous communities in particular, magnifying existing mental health and substance use harms and inequities. Recent First Nations-specific data from British Columbia, Alberta, Saskatchewan, and Ontario show that Indigenous communities in Canada have recorded large increases in opioid toxicity deaths during the COVID-19 pandemic, and are overrepresented in instances of opioid overdose deaths compared to their share of Canada's population. For instance, in British Columbia, the number of First Nations people who died of toxic drugs from January to June 2021 increased by 25.7% compared to the same period in 2020. Additionally, there was a 119% increase in overdose deaths in 2020 over the previous year.

People who use drugs are experiencing higher risks related to an increasingly toxic illegal drug supply, which is intensifying due to the presence of fentanyl and other substances. Fentanyl and its analogues comprise the largest share of opioids submitted for analysis by law enforcement. Of all accidental apparent opioid toxicity deaths between January–December 2021, 86% involved fentanyl and 82% involved opioids that were only non-pharmaceutical. More than half (61%) of accidental apparent opioid toxicity deaths in 2021 (January–December) also involved a stimulant, reflecting the polysubstance nature of this crisis. Of the accidental apparent stimulant toxicity deaths in 2021 (January–December), 64% involved cocaine, while 53% involved methamphetamines.

In 2021-22, Health Canada, working with its other federal partners under the CDSS, continued to support efforts to: improve access to treatment and harm reduction services; strengthen enforcement to help reduce the toxic illegal drug supply; increase awareness and prevention efforts; and build the evidence base through federal investments in research and surveillance. In 2021, the Expert Task Force on Substance Use delivered 2 reports to Health Canada with its recommendations on the federal government's drug policy, the CDSS, and potential alternatives to criminal penalties for the simple possession of controlled substances. In 2021-22, Health Canada has continued its work to update the CDSS to reflect the advice of the Expert Task Force on Substance Use, lessons and feedback from public consultations in 2018 on drug policy, ministerial outreach to stakeholders, the Canadian Pain Task Force, and other important advice, to strengthen Canada's approach.

Cross-cutting actions undertaken as part of the CDSS in 2021-22 include the funding of an estimated 138 community organizations through the Substance Use and Addictions Program (SUAP). The program has funded pilot projects for a variety of initiatives, including safer supply, drug checking, supervised consumption sites, overdose prevention, stigma reduction, and capacity building. These programs have led to the creation of new best practices and have saved lives.

Health Canada conducted ongoing surveillance and monitoring through its various national surveys. Results were released for the 2019 Canadian Alcohol and Drugs Survey (CADS). It showed that overall prevalence of psychoactive pharmaceutical^{Footnote 24} use among Canadians aged 15 years and older was 23%, nearly unchanged from 2017 (22%). The prevalence of past-year psychoactive pharmaceutical use in 2019 was higher among females (27%) than males (19%) and was lower among youth aged 15 to 19 (15%) than among young adults aged 20 to 24 (27%) and adults aged 25 years and older (23%). Data collection was initiated for the 2021 Canadian Postsecondary Education Alcohol and Drug Use Survey and for the 2020-2021 Canadian Student Tobacco, Alcohol and Drug Use Survey. In addition, Health Canada and the Public Health Agency of Canada released quarterly reports on opioid and stimulant-related harms in Canada. These quarterly reports provide the latest available data on overdoses hospitalizations and deaths involving opioids and/or stimulants dating back to January 2016.

In addition to these actions, CDSS partners continued to work to address substance-related harms in Canada in 2021-22. Ongoing key activities included project funding for harm reduction efforts, reducing stigma, the review of evidence in drug use and policy, and the continuation of international collaboration on drug trafficking.

Specific actions under the four pillars of the CDSS are outlined below:

Prevention

The goal of the prevention pillar is to prevent, reduce or delay substance use and its associated harms, with a particular focus on youth. In 2021-22, key prevention activities included public education resources and campaigns, supporting research, developing guidelines and other tools, and funding a range of community-based prevention programs. Additionally, prevention activities worked to reduce substance related harms by addressing social determinants of health and risk and protective factors, such as poverty reduction, self-esteem, and housing supports. The Government of Canada continued its ongoing "Know More" Awareness Campaign, which is an interactive campaign that engages and informs Canadian high school, university and college students about opioids. Other important awareness campaigns included "Consider the Consequences of Vaping - Canada.ca" and "Pursue Your Passion" which aim to educate youth about the risks associated with vaping and cannabis use.

In 2021-22, Health Canada participated in the consultation process to develop the Global Alcohol Action Plan 2022-30 GAAP) to strengthen the implementation of the Global Strategy to Reduce the Harmful Use of Alcohol. The final draft of the GAAP was approved during the WHO 175th Executive Board meeting in January 2022.

Treatment

In 2021-22, the Government of Canada worked with P/T governments and other partners to help make evidence-based treatment more accessible and better tailored to the needs of patients. This has included support for a wide range of services, including psychological and behavioural therapies, and also medication-assisted treatment options, such as methadone and buprenorphine, which are used to treat opioid use disorder. Health Canada supported research into new and more effective treatment approaches, and the development of clinical guidelines to manage and treat substance use disorders. In April 2021, Canada continued to advance and promote Canadian drug policy priorities at the international level by tabling a resolution, adopted by the 64th session of the United Nations Commission on Narcotic Drugs entitled "Facilitating access to comprehensive, scientific evidence-based drug demand reduction services and related measures, including for people impacted by social marginalization"^{Footnote 25}.

Since the beginning of the COVID-19 pandemic, Health Canada has implemented critical and timely measures to enable support to the health system to address the needs of people who use substances and those at risk of overdose. For example, Health Canada extended, until September 2026, the class exemption to allow health practitioners, including nurse practitioners, to verbally prescribe controlled substances, and authorized pharmacists to prescribe, sell, or provide (including the transfer of prescriptions) controlled substances in limited circumstances. This exemption is helping get substances to people who need them in their communities. The department facilitated access to medications necessary for opioid agonist treatment (e.g., suboxone and methadone). It has also targeted initiatives such as the capacity to deliver injectable opioid agonist treatment (iOAT), health professional capacity building via training and education, and improving retention in care via OAT programs with wrap-around supports. For example, in 2021-22, the Government of Canada supported 72 OAT sites in First Nations and Inuit communities.

On January 5, 2022, regulatory amendments were made to reverse regulatory changes made in 2013 to the Food and Drug Regulations and the Narcotic Control Regulations that prohibited access to restricted drugs through Health Canada's Special Access Program and added unauthorized products containing cocaine to the definition of a restricted drug. With these changes, health care practitioners can now request access to restricted drugs, such as psilocybin and MDMA, for emergency treatment of patients with serious or life-threatening conditions when other therapies have failed, are unsuitable, or are not available in Canada, and when there is sufficient data to support the safety and efficacy of the drug for the specific condition of the patient. Health Canada also published a Controlled Drugs and Substances Act (section 56) class exemption to enable health care practitioners and certain other professionals to legally conduct certain activities with MDMA and psilocybin when those substances have been authorized for sale through the Special Access Program.

Harm Reduction

Harm reduction is an evidence-based, public health approach that respects the rights of people who use drugs including through the recognition that not everyone needs, wants, or is ready for treatment for their substance use. It includes policies and programs that aim to reduce the negative health, social, and economic impacts of substance use on individuals and communities, without requiring or promoting abstinence. In 2021-22, Canada continued to facilitate harm reduction services such as supervised consumption sites, drug checking technologies, and safer supply programs.

Supervised consumption sites help save the lives of Canadians. These sites have had over 3.8 million visits, reversed over 42,000 overdoses without a single death. Site staff have made over 208,000 client referrals to health and social services. These sites reduce risk of overdose death and of transmission of infection. In addition, they provide access to other health and social services for people who use drugs, including opportunities to access treatment.

Another harm reduction measure includes drug checking, which can be used inside or separately from supervised consumption sites and services to provide people who use drugs and health workers with information on the contents of street drugs, including whether they contain fentanyl or benzodiazepines. This gives people who use drugs the opportunity to make informed decisions that may reduce their risk of overdose. To help the community of people who use drugs, and those who support them, to make more informed decisions based on the composition of a drug and to reduce harm, Health Canada and Impact Canada launched a challenge in 2018 in order to accelerate the availability, accuracy and reliability of drug checking technology. Scatr Inc. was announced as the winner of the Canada's Drug Checking Technology Challenge in 2021 for their innovative technology that quickly and accurately identifies the contents of potentially toxic illegal drugs and helps prevent overdoses.

Overdose deaths are being driven by a highly unpredictable and toxic illegal drug supply. Many stakeholders are calling for greater access to pharmaceutical-grade medications as an alternative to the toxic illegal drug supply to help prevent overdoses and save lives, and as part of a continuum of care that may include other substance use treatment and harm reduction services. Health Canada supports safer supply as a potential intervention to help reduce overdose deaths. In fiscal year 2021-22, Health Canada supported 18 safer supply pilot projects with over $20 million in funding through SUAP. This includes supporting a range of service delivery projects in British Columbia, Ontario, Quebec and New Brunswick, and a National Safer Supply Community of Practice to help share knowledge amongst stakeholders. To help build the evidence around safer supply, Health Canada supported a preliminary qualitative assessment of 10 safer supply projects, conducted by an independent contractor. This assessment found that program clients and staff reported improvements across a number of health and socioeconomic outcomes, such as improved health, wellbeing, and quality of life, improved stability, and becoming housed and employed. The assessment also emphasized the importance of wraparound care, peer involvement and external partnerships and outlined key design and implementation considerations.

Health Canada extended a number of regulatory exemptions to the Controlled Drugs and Substances Act to support P/T, municipalities and community organizations to enable jurisdictions to establish overdose prevention sites to address urgent public health needs in a variety of locations, including in temporary community shelters.

Actions from the PHAC included efforts through the Harm Reduction Fund to reduce instances of sexually transmitted and blood-borne infections (STBBIs) among groups with high levels of drug use, including through the sharing of drug use equipment. In 2021-22, PHAC recommended 40 program proposals for funding in the 2022-23 fiscal year. In 2021-22, PHAC also developed an accredited learning module with the University of British Columbia to help public health professionals provide STBBI services.

PHAC published several studies throughout 2021-22, including the National Report: Findings from the Survey on the impact of COVID-19 on the delivery of STBBI prevention, testing and treatment including harm reduction services in Canada. This report found that nearly two-thirds (64.5%) of harm reduction, substance use and treatment service providers reported a strong increase in the number of drug use-related negative outcomes including overdoses. Additionally, it published The Hepatitis C Epidemic in Canada, which presented changing epidemiological trends on hepatitis C from drug injection both before and after the COVID-19 pandemic.

Enforcement

Priorities under the enforcement pillar of the CDSS focus on addressing trans-national serious and organized crime networks, both domestically and internationally, and working with relevant stakeholders to continue strengthening the regulation of controlled substances so they are used only for authorized purposes. In 2021-22, Health Canada promoted, monitored, verified and enforced compliance with the Controlled Drugs and Substances Act (CDSA) using a risk based approach to oversee the supply chain and address gaps of potential diversion at licenced dealers and pharmacies. Activities included 166 licensed dealer inspections completed and 19 compliance verifications received to follow up with licensed dealers where there was potential risk of diversion identified. In addition, 89 pharmacy inspections were completed and 217 compliance verifications received for follow up with pharmacies. The Department has developed a pharmacy compliance promotion strategy to expand it's reach and promote compliance with requirements.

The Government of Canada has continued to explore alternatives to criminal penalties for personal possession of small amounts of controlled substances, including consideration of requests for exemptions from the CDSA from jurisdictions to allow for personal possession of controlled substances. The Minister of Justice and Attorney General of Canada introduced Bill C-5: An Act to amend the Criminal Code and the CDSA. If enacted, this Bill would reform sentencing measures for certain offences, repeal mandatory minimum penalties for certain offences, increase the availability of conditional sentence orders where appropriate, and encourage greater use of diversion programs to reinforce the Government's commitment to address problematic substance use as a health issue.

The Government of Canada has continued to engage with international partners through bilateral and multilateral fora to advance policy responses to various drug threats, including the flow of illegal drugs and their precursor chemicals from source and transit countries. Through the Canada-US Action Plan on Opioids, federal partners worked closely with U.S. counterparts to develop new projects and advance implementation of the ongoing projects under the law enforcement and border security working groups. For example, Canada Post and the United States Postal Inspection Service formalized an agreement to support coordination and communication efforts, held joint training workshops on investigations and a session on detection technology best practices to improve the targeting of illegal drug trafficking in the postal streams. Similarly, Public Safety Canada and federal partners worked with counterparts in Mexico and the U.S. to advance common priorities. As part of these efforts, in February 2022, Public Safety Canada participated in the Fifth North American Drug Dialogue to review progress to address the production and trafficking of illegal drugs, the public health harms associated with drug use and overdoses, and illegal finance.

Contact information

Health Canada

Jennifer Saxe
Director General
Controlled Substances Directorate
Controlled Substances and Cannabis Branch
jennifer.saxe@hc-sc.gc.ca
613-816-1739

Horizontal initiative framework: departmental funding by theme (dollars)^{Footnote 26}

Horizontal initiative: Canadian Drugs and Substances Strategy

Shared outcomes:

1. Problematic substance use is addressed as a health and social issue by governments, communities, stakeholders and Canadian society.
2. Rates of problematic substance use in Canada are minimized, especially for youth and those most at risk of harm, including preventing, reducing and/or delaying the use of drugs and other substances.
3. Canadians and their communities are supported with evidence-based tools, programs and services to be safer, healthier and more resilient.

Performance information

Theme horizontal initiative activities

Comments on Variances

Health Canada

The variance between planned and actual spending is mainly due to an internal reallocation of funding to CDSS to support targeted activities such as improved access to treatment and harm reduction measures; as well as, regulatory actions to authorize supervised consumption sites and urgent public health need sites across Canada.

Canada Revenue Agency

The variance between planned and actual spending is attributable to an additional two resources required to carry out the CDSS work.

Correctional Services Canada

The variance between planned spending and actual spending is mainly due to a reduction in the number of provincial offenders being supervised and requiring community-based accommodation services. The pandemic has led to a decrease in admissions, available capacity, and concerted efforts to divert offenders away from congregate living arrangements (community-based residential facilities) where safe to do so, which resulted in decreased costs.

Department of Justice

After Budget 2021 announced additional funding for the Drug Treatment Court Funding Program (DTCFP), agreements with provinces and territories were amended to allocate the additional funding available for fiscal year 2021-2022. The variance between actual and planned spending is mainly due to an internal reallocation of funds from another program (the Contraventions Act Fund) to increase and amend agreements in 2021-22 with provinces and territories for the Drug Treatment Court Funding Program.

Financial Transaction and Reports Analysis Centre of Canada (FINTRAC)

FINTRAC is an unfunded partner within CDSS. FINTRAC continues to work with law enforcement and intelligence agencies to ensure they receive financial intelligence related to drug production and distribution that is useful for further actions.

Indigenous Services Canada

The variance between planned spending and actual spending is mainly due to regional variations in community needs and priorities and a commitment to making decisions in partnership which resulted in regional variations to activities.

Parole Board of Canada

The variance between planned and actual spending is due to the estimated number of reviews not materializing.

Public Health Agency of Canada

The variance between planned and actual spending is mainly due to a reallocation of funds from CDSS Communicable Diseases and Infections Control to the HIV and Hepatitis C Community Action Fund due to delayed project solicitations and cancelled projects relating to COVID challenges.

Public Prosecution Service of Canada

The variance between actual and planned spending is mainly due to internal allocations to support this initiative.

Public Safety Canada

The variance between planned and actual spending is mainly due to the inability to spend all funding on operational activities as per COVID restrictions.

Theme 1: Prevention

Expected results

Health Canada

ER 1.1.1 Targeted stakeholders and Canadians are equipped with the capacity (knowledge, skills and supports) to inform their decisions and actions related to substance use.

ER 1.1.2 Targeted stakeholders use evidence-informed information on substance use to change policies, programs, and practice.

ER 1.1.3 Increased compliance and reduced risk of diversion of controlled substances, prescription drugs and precursor chemicals.

Royal Canadian Mounted Police

ER 1.2 The RCMP will increase awareness of drugs and illegal substances among stakeholders by developing education products, supporting outreach and engagement efforts, and building new partnerships.

Performance indicators

Health Canada

PI 1.1.1 Percentage of funding recipients who met their targets set for targeted Stakeholders/Canadians intend to use knowledge/skills related to substance use they have acquired through SUAP funded projects.^{Footnote 27}

PI 1.1.2 Percentage of pharmacies inspected that are deemed to be compliant with the Controlled Drugs and Substances Act (CDSA) and its regulations.

Royal Canadian Mounted Police

PI 1.2.1 Number of awareness products.

PI 1.2.2 Number of stakeholders reached.

PI 1.2.3 Percentage of partners and stakeholders who demonstrate an increase in awareness of illegal drugs.

PI 1.2.4 Number of partnerships and collaborations.

PI 1.2.5 Number of new engagement opportunities identified.

Targets

Health Canada

T 1.1.1 65%

T 1.1.2 80%

Royal Canadian Mounted Police

T 1.2.1 5 illegal drug related awareness products will be produced and/or updated.

T 1.2.2 Approximately 1000 stakeholders will be reached (stakeholders include Police, Public/Youth, and Industry/other stakeholders).

T 1.2.3 50% of partners and stakeholders agree that Federal Policing contributed to an increased awareness/understanding of illegal drugs.

T 1.2.4 At least 3 partnerships/collaborations.

T 1.2.5 5 At least 5 new engagement opportunities.

Actual Results

Health Canada

AR 1.1.1 54% (as of March 31, 2022)

AR 1.1.2 83%

Royal Canadian Mounted Police

AR 1.2.1 4^{Footnote 28}

AR 1.2.2 1203^{Footnote 29}

AR 1.2.3 38%

AR 1.2.4 3 partnerships/collaborations.

AR 1.2.5 1^{Footnote 30}

Theme 2: Treatment

Expected results

Canadian Institutes of Health Research

ER 2.1 Support for research in priority areas.

Department of Justice Canada

ER 2.2.1 The criminal justice system supports alternative ways of responding to the causes and consequences of offending.

ER 2.2.2 Increased availability of, and access to, drug treatment services and programs for youth involved in the justice system.

Performance indicators

Canadian Institutes of Health Research

PI 2.1 Percentage of funded research projects with a nature and scope that support CDSS' goals.

Department of Justice Canada

PI 2.2.1 Percentage of Drug Treatment Court participants retained for 6 months or longer in the court-monitored treatment program.

PI 2.2.2 Number of active projects funded under Youth Justice Fund's Drug Treatment component per fiscal year.

Targets

Canadian Institutes of Health Research

T 2.1 100%

Department of Justice Canada

T 2.2.1 50% of participants are retained for six months in federally funded Drug Treatment programs.

T 2.2.2 5 active projects

Actual Results

Canadian Institutes of Health Research

AR 2.1 100%

Department of Justice Canada

AR 2.2.1 68.97% of participants were retained for more than six months in federally funded Drug Treatment Court programs.^{Footnote 31}

AR 2.2. 26 active projects

Theme 3: Harm reduction

Expected results

Health Canada

ER 3.1 Increased availability of harm reduction services.

Public Health Agency of Canada

ER 3.3 Reduction in risk-taking behaviour among drug or substances users.

Performance indicators

Health Canada

PI 3.1 Percentage of applications for an exemption to operate a Supervised Consumption Site that received a decision within the service standard by the time the review is complete.^{Footnote 32}

Public Health Agency of Canada

PI 3.3 Percentage decrease in the number of people who use drugs who report sharing drug use equipment.^{Footnote 33}

Targets

Health Canada

T 3.1.1 90%

Public Health Agency of Canada

T 3.3 10% decrease

Actual Results

Health Canada

AR 3.1 not applicable^{Footnote 34}

Public Health Agency of Canada

AR 3.3 not applicable^{Footnote 35}

Theme 4: Enforcement

Expected results

Health Canada

ER 4.1.1 Authorizations to perform legitimate activities with controlled substances and precursor chemicals are processed in a timely manner.

ER 4.1.2 Increased compliance and reduced risk of diversion of controlled substances, prescription drugs and precursor chemicals.

ER 4.1.3 Increased effectiveness in drug analysis.

ER 4.1.4 Data and research evidence on drugs and emerging drug trends are used by members of the federal Health Portfolio and their partners.

Canada Border Services Agency

ER 4.2.1 Increase awareness and capacity to gather information and intelligence to maximize interdiction of illegal drugs (as defined in the CDSA) at the border.

ER 4.2.2 Continue to inform enforcement activities by providing intelligence and analytical support to the regions.

ER 4.2.3 Continue to work with CDSS partner agencies to identify opportunities for cooperation, share information, and conduct laboratory analysis related to illegal drugs and other goods (e.g., precursor chemicals) governed by the CDSA.

Canada Revenue Agency

ER 4.3 30 audits. Re- assessments of $2.0 million of federal taxes.

Correctional Services Canada

ER 4.4 Timely case preparation and supervision of provincial offenders with a drug offence (CDSA Schedule II).

Financial Transactions and Reports Analysis Centre of Canada

ER 4.5 Given the importance of the CDSS initiative, FINTRAC will continue to work with law enforcement and intelligence agencies to ensure they receive financial intelligence related to drug production and distribution that is useful for further actions.

Global Affairs Canada

ER 4.6 In 2020-2021, GAC will increase capacity of port officials in selected countries in the Americas to intercept and seize illegal drugs smuggled via legal maritime containerized cargo. GAC will also work to build the capacity law enforcement of OAS member states to share and disseminate information and early warning alerts on New Psychoactive Substances (NPS), opioids, and other emerging drug threats.

Parole Board of Canada

ER 4.7.1 Conditional release decisions contribute to keeping communities' safe.

ER 4.7.2 The timely exchange of relevant information with victims, offenders, observers, other components of the criminal justice system, and the general public.

Public Prosecution Service of Canada

ER 4.8.1 Provision of legal advice and litigation support, as well as the prosecution of drug offences in all provinces /territories regardless of which police agency investigates the offences, except Quebec and New Brunswick. In these provinces, the PPSC prosecutes only drug offences investigated by the RCMP.

ER 4.8.2 Provision of pre-charge legal advice and litigation support, as well as the prosecution of serious drug offences under the CDSA to which mandatory minimum penalties are applicable.^{Footnote 36}

Public Safety Canada

ER 4.9 Coordinated enforcement action to address illegal drugs and substances.

Public Services and Procurement Canada

ER 4.10 Assist law enforcement agencies and prosecutors by providing forensic accounting services and expertise. These services assist in determining whether the assets identified were derived from criminal activities, thereby allowing the Crown to seize the assets and remove the financial incentives from the crime.

Royal Canadian Mounted Police

ER 4.11 The RCMP will focus its efforts to undertake investigations and initiatives focussing on the highest threats related to organized crime networks including those involved in the importation and trafficking of illegal drugs, including illegal opioids.

Performance indicators

Health Canada

PI 4.1.1 Overall percentage of High-Volume Regulatory Authorizations for controlled substances processed within service standards.

PI 4.1.2 Percentage of licensed dealers inspected that are deemed to be compliant with the Controlled Drugs and Substances Act (CDSA) and its regulations.

PI 4.1.3 Percentage of drug notifications analyzed within service standards.

PI 4.1.4 Number of alerts issued to clients and to provincial and territorial health authorities on newly identified potent illegal drugs in communities.

Canada Border Services Agency

PI 4.2 Ratio of the average dollar value of drugs and their precursors seized attributed to Intelligence led investigations vs. the average dollar value drugs and their precursors seized not attributed to intelligence led investigations.

Canada Revenue Agency

PI 4.3 80% or more of audits resulting in a (re) assessment.

Correctional Services Canada

PI 4.4.1 Total number of provincial offenders convicted of a drug offence (CDSA Schedule II) supervised by CSC on a monthly basis during the year.

PI 4.4.2 Total number of provincial offenders convicted of a drug offence (CDSA Schedule II) with a residency requirement on a monthly basis during the year.

PI 4.4.3 Total number of case preparation reports (pre- and post-release) completed for all provincial offenders during the year.

Financial Transactions and Reports Analysis Centre of Canada

PI 4.5 Total number of FINTRAC disclosures of actionable financial intelligence made to regime partners, and the number of unique disclosures of actionable financial intelligence that relate to at least one drug-related offence.

Global Affairs Canada

PI 4.6.1 Number of illegal drug seizures made by GAC-financed/UNODC trained Port Control Units in beneficiary countries.

PI 4.6.2 Volume of illegal drug seized by GAC-financed/UNODC trained Port Control Units in beneficiary countries.

Parole Board of Canada

PI 4.7.1 Number and proportion of provincial offenders convicted of drug offences who successfully complete parole.

PI 4.7.2 Percentage of individuals (i.e., general public and victims) who are satisfied with the quality of the service.

Public Prosecution Service of Canada

PI 4.8.1.1 Number of litigation files related to the prosecution of drug offences under the CDSA referred to the PPSC during the fiscal year.

PI 4.8.1.2 Number of files for which legal advice was provided by PPSC counsel.

PI 4.8.2.1 Number of litigation files related to the prosecution of serious drug offences under the CDSA referred to the PPSC during the fiscal year to which mandatory minimum penalties are applicable.

PI 4.8.2.2 Number of files for which legal advice was provided by PPSC counsel where mandatory minimum penalties are applicable.

Public Safety Canada

PI 4.9 Timely sharing of evidence-based knowledge and intelligence to support law enforcement actions against illegal drugs and substances.

Public Services and Procurement Canada

PI 4.10.1 Number of active CDSS files where the services of a forensic accountant were required.

PI 4.10.2 Number of Forensic Accounting Reports produced during the fiscal year.

Royal Canadian Mounted Police

PI 4.11.1 Number and percentage of Federal Serious and Organized Crime (FSOC) investigations with a transnational nexus.

PI 4.11.2 Number of drug-related charges laid by FSOC units.

PI 4.11.3 Number of drug seizures made by FSOC units, including amount of drugs seized.

Targets

Health Canada

T 4.1.1 90%

T 4.1.2 TBD^{Footnote 37}

T 4.1.3 95% of certificates of analysis issued within service standards or negotiated date.

T 4.1.4 Demand driven

Canada Border Services Agency

T 4.2 9:1 ratio

Canada Revenue Agency

T 4.3 30 audits. Re-assessments of $2.0 million of federal taxes.

Correctional Services Canada

T 4.4.1 42 (approximately)

T 4.4.2 19 (approximately)

T 4.4.3 556 (approximately)

Financial Transactions and Reports Analysis Centre of Canada

T 4.5 FINTRAC seeks to closely align its financial intelligence products with the needs and priorities of its investigative partners. As such, the Centre does not set specific targets for the number or types of drug-related case disclosures it produces in any fiscal year.

Global Affairs Canada

T 4.6.1 Illegal drug seizures are made in all beneficiary countries benefiting from GAC-financed/UNODC trained port control units.

T 4.6.2 At least 20 tons

Parole Board of Canada

T 4.7.1 100% of provincial offenders serving sentences for drug offences who are on parole are not convicted of a violent offence during their supervision period.

T 4.7.2 89% of individuals are satisfied with the quality of service.^{Footnote 38}

Public Prosecution Service of Canada

T 4.8 Targets are not applicable owing to the nature of the PPSC's workload and mandate.

Public Safety Canada

T 4.9 100% completion of planned coordination activities based on an integrated law enforcement work plan.

Public Services and Procurement Canada

T 4.10 The files are dependent on the projects law enforcement assign to PSPC-FAMG and are based on the resource capacity of the three senior forensic accounts dedicated to work on CDSS files.

Royal Canadian Mounted Police

T 4.11 Targets are not applicable as these will vary by province/territory and is based on need.

Actual Results

Health Canada

AR 4.1.1 94%

AR 4.1.2 88%

AR 4.1.3 40%^{Footnote 39}

AR 4.1.4 179

Canada Border Services Agency

AR 4.2 The CBSA made 40,535 drug seizures, 1,475 of those were intelligence led. Since the total amount of intelligence-led seizures were larger and worth more money, the final result is that the ratio of intelligence led seizures compared to non-intelligence led seizures, in dollars, is 24:1.

Canada Revenue Agency

AR 4.3 18 cases resulting in $9.5M in Tax Earned by Audit (TEBA)

Correctional Services Canada

AR 4.4.1 19^{Footnote 40}

AR 4.4.2 11^{Footnote 41}

AR 4.4.3 388

Financial Transactions and Reports Analysis Centre of Canada

AR 4.5 2,292, including 748 unique disclosures^{Footnote 42}

Global Affairs Canada

AR 4.6.1 Target met.

AR 4.6.2 Target met.

Parole Board of Canada

AR 4.7.1 100%

AR 4.7.2 89.0%^{Footnote 43}

Public Prosecution Service of Canada

AR 4.8.1.1 During the 2021-2022 fiscal year, 7,546 litigation files related to the prosecution of drug offences under the CDSA had been referred to the PPSC.

AR 4.8.1.2 PPSC counsel provided legal advice on 831 files during the 2021-2022 fiscal year.

AR 4.8.2.1 During the 2021-2022 fiscal year, 164 litigation files related to the prosecution of serious drug offences under the CDSA to which mandatory minimum penalties are applicable had been referred to the PPSC.

AR 4.8.2.2 Legal advice was provided by PPSC counsel on 13 litigation files where mandatory minimum penalties are applicable.

Public Safety Canada

AR 4.9 Participated in domestic and international forums to share knowledge and advance best practices to reduce the illegal drug supply.^{Footnote 44}

Public Services and Procurement Canada

AR 4.10.1 78 open CDSS investigations in 2021-22 (opened with 77, added 28, closed 27)

AR 4.10.2 56 CDSS reports issued to clients in 2021-22

Royal Canadian Mounted Police

AR 4.11.1 835 (13.4%)^{Footnote 45}

AR 4.11.2 9439^{Footnote 46}

AR 4.11.3 8,652^{Footnote 47}

Theme 5: Evidence base

Expected results

Health Canada

ER 5.1 Increased availability of data and research evidence on drugs and substances.

Canadian Institutes of Health Research

ER 5.2 Increased availability of data and research evidence on drugs and substances.

Performance indicators

Health Canada

PI 5.1 Percentage of United Nations Annual Report Questionnaire completed with Canadian data.^{Footnote 48}

Canadian Institutes of Health Research

PI 5.2.1 Percentage of grant recipients producing policy-relevant knowledge products, such as research publications, policy briefs, guidelines for policies or practice, presentations to policy audiences, and media mentions.

PI 5.2.2 Percentage of health research publications related to substance use.

Targets

Health Canada

T 5.1 60.5%

Canadian Institutes of Health Research

T 5.2.1 75%

T 5.2.2 90%

Actual Results

Health Canada

AR 5.1 100% in 2020-21^{Footnote 49}; 100% in 2021-22

Canadian Institutes of Health Research

AR 5.2.1 100%

AR 5.2.2 85%

Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis

General information

Name of horizontal initiative

Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis

Lead department

Health Canada

Federal partner organization(s)

• Canada Border Services Agency
• Public Health Agency of Canada
• Public Safety Canada
• Royal Canadian Mounted Police

Note: Other government departments (e.g., the Department of Justice) are supporting the federal cannabis framework. However, they are not captured in this Horizontal Initiative table, as they have not received targeted funding to support this initiative, "Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis."

Start Date

April 1, 2017

End Date

March 31, 2022

Description

The objective of this horizontal initiative is to implement and administer the federal framework to legalize and strictly regulate cannabis. The Cannabis Act received Royal Assent on June 21, 2018, and came into force on October 17, 2018. The initiative is designed to follow through on the Government's key objectives of protecting public health, safety, and security. More specifically, the initiative aims to prevent young persons from accessing cannabis, to protect public health and public safety by establishing strict product safety and product quality requirements and to deter criminal activity by imposing serious criminal penalties for those operating outside the legal framework.

Federal partner organizations implement ongoing delivery of the regulatory framework including licensing; compliance and enforcement; surveillance; research; national public education and awareness activities; and framework support.

The initiative also supports law enforcement capacity to collect and assess intelligence on the evolution of organized crime involvement in the illicit cannabis market and other related criminal markets.

Activities are organized by five high-level themes:

1. Establish, implement and enforce the new legislative framework;
2. Provide Canadians with information needed to make informed decisions and minimize health and safety harms;
3. Build law enforcement knowledge and engage partners and stakeholders on public safety;
4. Provide criminal intelligence, enforcement and related training activities; and
5. Prevent and interdict prohibited cross-border movement of cannabis while maintaining the flow of legitimate travelers and goods.

Governance structures

The Government of Canada continues to support a robust governance structure to facilitate whole-of-government coordination in implementing and administering the federal framework to legalize and strictly regulate cannabis. At the federal level, this structure includes: an Assistant Deputy Minister Committee that serves as a forum for government-wide coordination of policy and implementation activities; a Directors General Committee that is responsible for coordinating policy, regulatory development, and implementation activities across federal departments and agencies; and, a Federal, Provincial, Territorial (F/P/T) Partners Cannabis Data Working Group to promote horizontal collaboration and support evidence-based policy and program development.

Health Canada assumes a central role in coordinating and tracking key project milestones and in reporting to its Ministers.

The federal government is committed to ongoing collaboration and consultation with provincial and territorial (P/T) partners. In May 2016, the F/P/T Senior Officials Working Group on Cannabis Legalization and Regulation was established to enable exchange of information between F/P/T governments on important issues about the legalization and regulation of cannabis throughout the consultation, design and implementation of the legislation, regulations, and non-regulatory activities. In addition, existing F/P/T bodies are also considering the implications of cannabis legalization and regulation, including F/P/T Deputy Ministers responsible for Justice and Public Safety and Finance, and F/P/T Ministers Responsible for Finance.

Total federal funding allocated from start to end date (dollars)

$546,807,456

Total federal funding planned spending to date (dollars)

$546,807,456

Total federal actual spending to date (dollars)

$508,554,096

Date of last renewal of initiative

Not applicable

Total federal funding allocated at the last renewal and source of funding (dollars)

Not applicable

Additional federal funding received after last renewal (dollars)

Not applicable

Total planned spending since last renewal

Not applicable

Total actual spending since last renewal

Not applicable

Fiscal year of planned completion of next evaluation

2022-23

Performance highlights

The federal government continued to support the effective implementation of the cannabis legislative framework in 2021-22, working with P/Ts, Indigenous governments, federal partners, regulated industry, municipalities, non-governmental organizations, academics, law enforcement, international partners, and communities to meet its objectives. The objectives of the Cannabis Act are to protect the public health and public safety of Canadians, particularly youth, while providing adults with legal access to regulated cannabis and reducing illicit activities.

More specifically, the following progress and achievements have been made in 2021-22:

Public Health

Public education and awareness is a fundamental component of the government's public health approach to reducing the harms associated with cannabis. Over the past fiscal year, Health Canada launched several campaigns and initiatives to help communicate important public education messaging about the health risks associated with cannabis, particularly for youth.

In May 2021, Health Canada hosted the fourth public education partnership symposium on Substance Use, which brought together a variety of stakeholders to discuss public education and awareness efforts relating to substance use. The event was a success, in that it provided a forum for important discussions around the intersection between the COVID-19 pandemic and substance use, as well as priorities for the year ahead.

In March 2022, Health Canada launched an updated Pursue Your Passion campaign. The teacher-led presentation and accompanying teacher's guide educates youth aged 13 to 15 about the physical and mental health effects of cannabis. This tool was included on the new Health Canada Experiences platform that brings all of Health Canada's experiential marketing campaigns together in one place to make it easier for teachers, students and other group leaders to access a diversity of marketing information from cannabis, vaping, and opioids, to Canada's food guide and more.

Furthermore, a new installment of the Cannabis Resource Series was released, which is a set of publicly available education resources designed to provide health and safety information related to cannabis. As part of this series, the Health Effects of Cannabis on Adults Over 55 and the "How to Read and Understand a Product Label" were published in March 2022 and promoted widely to stakeholders and partners.

Risk communication is fundamental to help ensure people in Canada have the information they need to make informed decisions about cannabis consumption, and to reduce the occurrence of preventable harms. In 2021-22, the Department issued a public advisory on illegal copycat edibles which aimed to raise awareness of, and to prevent future accidental pediatric poisonings linked to illicit cannabis products that look similar to popular candies and snacks. The advisory also included links to P/T authorized online retailers and retail stores.

In addition, Health Canada continued to proactively post social media messaging monthly to reduce health risks for those who consume cannabis, or those who are thinking about consuming cannabis. Communication themes included safe storage, brain development, consumption during COVID-19, identifying and choosing legal cannabis, cannabis use and pregnancy, cannabis for medical purposes, mental health, and edible cannabis.

Safe Cannabis Storage information was published in February 2022, and performed in line with other content published on departmental Twitter, Facebook and LinkedIn channels. By comparison, Cannabis and Brain Development content, published in March 2022, had over double the amount of average impressions on Facebook, likely due to the content's appeal to the parent demographic on that channel, seeking health information to protect their children. The Choose Legal Cannabis content published in May 2022 had a very high impression rate on Twitter and LinkedIn, but the highest performing content overall was the Cannabis Medical Access Safe Use, published in June 2022.

In addition to supporting the Chief Public Health Officer as a leading voice on public health, the Public Health Agency of Canada (PHAC) worked with partners and stakeholders on a variety of collaborative efforts to prevent substance-related harms. Focusing on priority populations, PHAC released a number of public education resources to support Canadians in making informed decisions about their substance use. PHAC also advanced best practices for preventing substance-related harms among youth, centered on upstream approaches that enhance resilience. As part of this work, PHAC released the Blueprint for Action: Preventing substance-related harms among youth through a Comprehensive School Health approach, a resource that combines evidence-based approaches for addressing substance use with an internationally recognized framework for building healthy school communities.

Health Canada continued to monitor the emerging scientific literature on the risks, harms and potential medical benefits of cannabis, provide scientific advice, monitor, assess and communicate cannabis adverse reactions (including vaping-associated lung injury), conduct health risk assessments, and conduct regulatory research. In 2021-22, Health Canada conducted 3 health risk assessments, more than 250 risk-related consultations/requests, and screened 142 unique cases of adverse reactions associated with cannabis products (20% of which resulted in hospitalization).

Health Canada continued to work towards strengthening the regulatory framework for cannabis. On June 19, 2021, Health Canada published the proposed Regulations Amending the Cannabis Regulations (Flavours in Cannabis Extracts) in the Canada Gazette, Part I, which initiated a 75-day consultation. This consultation sought feedback from Canadians on the following topics: new restrictions on flavours in inhaled cannabis extracts, other than the flavour of cannabis; proposed rules for flavouring agents used to produce an inhaled cannabis extract; and new restrictions on promoting or labelling an inhaled cannabis extract with a flavour, other than the flavour of cannabis to reduce the appeal to youth. Health Canada also published the proposed Regulations Amending Certain Regulations Concerning Cannabis Research and Testing and Cannabis Beverages in the Canada Gazette, Part I on March 12, 2022 that initiated a 45-day consultation. The consultation sought feedback from Canadians concerning non-therapeutic research on cannabis involving human participants, the dried cannabis equivalency/public possession limit for cannabis beverages, cannabis reference standards (i.e., cannabis used to calibrate analytical instruments and assess testing methods) and cannabis test kits, and the educational qualifications for the head of laboratory position required for an analytical testing licence holder.

The federally-regulated production of cannabis continued to expand and diversify in 2021-22. Health Canada granted an additional 256 licences for cultivating, processing, and selling cannabis for medical purposes, 151 research, analytical testing, and/or cannabis drug licences, and 157 industrial hemp licences. Overall, 82% of all submitted licence applications were processed within the service standards.

Health Canada continued to implement strategies aimed at promoting a diverse commercial cannabis industry. For example, a dedicated Indigenous Navigator service – a tool to help and support self-identified Indigenous-affiliated applicants throughout the federal commercial cannabis licensing process –continued to be in place to better support Indigenous communities' participation in the industry. From April 2021 to March 2022, there were an additional 20 Indigenous-owned or -affiliated licence holders located across Canada that received a Health Canada licence to cultivate or process cannabis, for a total of 48 Indigenous businesses licensed, including 6 located on a reserve. Over the course of the fiscal year, there were an additional 14 Indigenous-owned or -affiliated hemp licence holders located across Canada, for a total of 33.

As of June 2022, Health Canada officials have participated in more than 280 engagement sessions with First Nations, Inuit, and Métis governments, communities and organizations across Canada to better understand their perspectives and concerns regarding cannabis legalization and regulation, share information related to cannabis, and to provide details about the Act and its Regulations. Health Canada has held discussions with an increasing number of First Nations who are developing and implementing their own cannabis control measures. These discussions included exploring the possibility for First Nations to increase their oversight of cannabis activities, within the framework of the Cannabis Act. Such arrangements support a cooperative application of federal and local cannabis frameworks, consistent with the Act and its Regulations. To date, one agreement has been reached which is now serving as a model for others.

Health Canada continued to promote, monitor, verify and enforce regulatory compliance with legislative requirements. The Department is responsible for regulatory oversight of the legal industry, while law enforcement agencies are responsible for enforcing the criminal prohibitions associated with cannabis (such as the illegal production, distribution or sale or cannabis). In 2021-22, over 2,200 compliance promotion activities (webinars, calls, letters) were conducted. Health Canada reviewed a total of 25,587 notices of new cannabis products and followed up on 7% of them due to potential non-compliance with the regulations or potential quality concerns. Health Canada conducted 410 inspections with an overall industry compliance rate of 98%, and completed 173 compliance verifications, which included 11 critical and 343 major citations resulting in the issuance of 3 warning letters. Health Canada inspection teams undertook 317 compliance promotion sessions with licence holders focusing on key risk areas with the goal of educating industry and minimizing occurrences of future non-compliance.

Additionally, the Department collected 325 cannabis product samples for laboratory analysis to monitor and enforce compliance with legislative and regulatory requirements. The number of inspection activities have greatly increased over the previous fiscal year, and have been targeted on a wider range of industry activities including compliance monitoring projects related to cannabis vaping, cannabis extracts and edible cannabis products.

Health Canada is closely monitoring the impacts of cannabis legalization and regulation. Changes in knowledge, attitudes and behaviors on cannabis were published in 2021-22 in the 2021 Canadian Cannabis Survey as well as the 2019 Canadian Alcohol and Drugs Survey. Health Canada continued to work closely with the Canadian Institutes of Health Research, the Canadian Centre on Substance Use and Addiction (CCSA) and the Mental Health Commission of Canada to advance cannabis research priorities aimed at understanding the impacts of legalization and regulation. Health Canada also initiated planning for the mandated review of the administration and operation of the Cannabis Act. This review will help identify areas of strength and inform areas for improvement.

Public Safety

Health Canada continued to track the movement of cannabis throughout the supply chain and regularly published updated market data on its website to keep Canadians informed of industry trends. The proportion of household spending on cannabis in the legal market has grown from 9% in Q3 2018 to 67% in Q1 2022 (representing over $6 billion in annual legal spending from Q2 2021 through Q1 2022). This represents $11.8 billion in legal spending from Q3 2018 to Q1 2022.

Public Safety (PS) worked closely with F/P/T partners, Health Canada, Statistics Canada, Justice Canada, and the CCSA to displace the cannabis illicit market, including disrupting illicit online sales of cannabis. In 2021-22, PS continued to implement the Online Illicit Cannabis Sales Action Plan which included increasing information resources for law enforcement and working with third party entities. PS also worked with F/P/T partners to enhance data collection and monitoring activities to help measure the size and scope of the illicit cannabis market, including online. This work helped PS and law enforcement partners address emerging issues related to the illicit sales of cannabis, particularly online, and to disrupt illicit online activities.

In January 2022, PS and the CCSA held a virtual symposium to take stock of key public safety-related impacts of cannabis legalization and regulation. This symposium focused on changes in sourcing behaviors, the illegal online cannabis market, impacts on law enforcement and organized crime groups, as well as on drug-impaired driving. The event brought together more than 150 F/P/T officials, public safety and law enforcement community representatives, academics and other organizations. A report has been published on the CCSA website.

In addition, in 2021-22, PS undertook further research related to cannabis and illegal drugs. This included the following research projects:

• Promising Disruption Methods for Illicit Drug Markets: This research identified promising practices for countering the supply-side of both online and offline illicit drug markets, including the involvement of organized crime groups in illicit drug markets. It included: (1) an overview of existing measures used to disrupt illicit drug markets and an analysis of their effectiveness; and (2) identifying opportunities for exploring novel approaches to countering illicit drug markets and the impact of COVID-19 on these practices.
• Trends in Organized Crime Group (OCG) Operations in Licit and Illicit Cannabis Markets: This review of the literature examined how operation patterns among OCGs changed since cannabis legalization (i.e., production, sourcing, distribution, scope of involvement, role, methods of operation, price/volume available, etc.). The research also examined the impact of the COVID-19 pandemic on these operations.

PS delivered public education and awareness activities to support Canadians in making informed and lawful decisions around cannabis. For example, in 2021-22, PS implemented a new public-facing webpage entitled: Buying Legal Cannabis – What You Need To Know. This page informs consumers of the public health and public safety risks of illegal cannabis, including the dangers of online purchasing, how to identify what is legal and what is not, and connects individuals who wish to consume cannabis to legal products in all P/Ts via Health Canada's new Authorized Retailers page. In addition, PS developed and distributed an animated video and radio clip on buying legal cannabis, which garnered 8.215 million impressions.

PS also completed the final public opinion tracking survey on Drug-impaired Driving in January 2022 and some questions touched on cannabis laws. The results indicated that 53% of Canadians who have used cannabis in the past 12 months said they typically acquire it from a legal storefront (up from 31% in 2020), while 15% said they typically buy from a legal online source, a result relatively unchanged from 2020's (17%). These results are consistent with the findings from the 2021 Canadian Cannabis Survey. The PS tracking survey also revealed a small minority of Canadians feel they are aware of the laws around cannabis and the legal consequences of breaking cannabis laws. Just over one in ten (13%, down from 19% in 2020) are aware that an individual may face monetary fines or jail terms for breaking Canadian cannabis laws, while 53% say they are not aware and 30% are only somewhat aware. This result highlights an opportunity on which to focus future awareness efforts.

In 2021-22, the Royal Canadian Mounted Police (RCMP) delivered awareness and public education products on cannabis legalization and regulation, with an emphasis on possession, production, and distribution of cannabis for Indigenous and youth populations by undertaking the following select initiatives:

• Developed evidence-based awareness materials for youth audiences, including lesson plans, fact sheets, presentations, posters, brochures and online campaigns (such as Operation Think of Me) for use by RCMP School Resource Officers, Community Program Officers, school administrators and persons who work with youth on cannabis legalization and regulation. The RCMP Centre for Youth Crime Prevention received 157 cannabis related requests in fiscal year 2021-2022.
• Engaged youth nationally by hosting two interactive live discussions with their National Youth Advisory Committee; and delivered 'RCMP Talks' videoconferencing sessions, which connect Canadian youth for open and real-time conversations, and allow the RCMP to learn directly from youth on the impacts of cannabis.

The RCMP continued its efforts to support training and capacity development by updating online or in-class delivery based on training needs identified as part of the annual National Cannabis working group. In 2021-22, 65% of active RCMP members had received appropriate cannabis-related training as compared to 64% in 2020-21.

The RCMP continued to work with partners on various cannabis policy-related initiatives to identify, target, and disrupt criminal involvement in the Canadian cannabis market. The RCMP leveraged existing forums such as the Canadian Association Chiefs of Police to discuss and advance current or emerging policy initiatives. Criminal Intelligence Service Canada established a National Intelligence Working Group of federal, provincial and municipal law enforcement partners to enhance information sharing on organized crime group involvement in the illicit cannabis market. The meetings have increased the national level sharing of information and intelligence relating to illicit cannabis, and have led to an overall increase in reporting on the activities of organized crime groups throughout the annual CISC Integrated Threat Assessment Process. Early indications suggest that organized crime remains involved in the illicit cannabis market, despite the legalization of recreational cannabis in 2018. The RCMP also continued to employ a measured approach regarding enforcement of the Cannabis Act in Indigenous communities, while national-level discussions with Indigenous stakeholders and communities continue.

The RCMP continued to support Health Canada's decisions on security clearances required as part of the licensing regime for cannabis cultivators and processors, which included identifying criminality or associations to criminal organizations and verifying this information with the law enforcement organizations of jurisdiction. Of the 2,588 applicants verified, 24% required further investigation due to findings that had a nexus to criminality and criminal organizations. Information deemed to be relevant to security risk was identified on 5% of the total number of applicants.

In 2021-22, the Canada Border Services Agency (CBSA) continued to advance initiatives that support the identification and interception of high-risk people, goods and conveyances that pose a threat to the security of Canadians with respect to the illegitimate cross-border movement of cannabis. Overall, interdictions on import occur more frequently, are of smaller quantities, and can be largely attributed to unintentional violations, while interdictions on export are of significant quantities and represents the majority of all (60-90%) significant interceptions. The unauthorized movement of cannabis across Canada's borders remains a serious criminal offence under the Cannabis Act. As such, the CBSA continues to detect and combat the illicit and unauthorized cross-border movement of cannabis in accordance with CBSA program legislation and cannabis remains among the most frequently seized substance by the CBSA. Between fiscal years 2018-19 and 2021-22, the overall number of border interdictions (import and export) has increased 43% (16,016 to 22,945) and the quantity of cannabis interdicted has increased 417% (from 3,154 kg to 16,300 kg). Comparing the commercial and traveller streams, almost 75% of the cannabis interdictions occur in the commercial stream, with the majority taking place in postal shipments.^{Footnote 50}

The CBSA laboratory analyzed or partially analyzed 76% of suspect cannabis samples received from ports of entry of which 67% of the samples tested positive for cannabis.

In March 2021, the CBSA Personal Administrative Monetary Penalty (AMP) regime was implemented at the border and sets out financial penalties for cannabis-related contraventions of the Customs Act.^{Footnote 51} Over the fiscal year, a total of 278 monetary penalties were administered to travellers entering Canada with undeclared cannabis.

Also in 2021-22, to ensure that travellers and the import/export community have access to recourse mechanisms to challenge certain CBSA actions and decisions in a timely manner, the CBSA acknowledged 88% of appeals received within 10 calendar days and decided 97% of the Enforcement and Trusted Traveller appeals within 180 days.

In 2021-22, the federal government continued to support the effective implementation of the cannabis framework by ensuring a collaborative approach with partners and stakeholders to meet its shared objectives of keeping cannabis out of the hands of Canadian children and youth, and reducing criminal involvement in the illicit cannabis market.

Contact information

Health Canada

John Clare
Director General
Controlled Substances and Cannabis Branch
John.Clare@hc-sc.gc.ca
613-858-8492

Horizontal Initiative: Implementing a New Federal Framework for the Legalization and Strict Regulation of Cannabis

Shared Outcomes:

• SO 1: Cannabis is kept out of the hands of Canadian children and youth
• SO 2: Criminal involvement in the illicit cannabis market is reduced

Performance information

Theme horizontal initiative activities

Comments on Variances

Health Canada

The variance between actual and planned spending is due to COVID-19, staffing and contracting delays.

RCMP

The variance between actual and planned spending is due staffing delays, a reduced volume of Law Enforcement Record Checks requested by Health Canada, as well as the RCMP's shifted focus towards new activities in supporting a more mature Cannabis Act.

Theme 1: Establish, implement and enforce the new legislative framework

Expected results

Health Canada

ER 1.1.1 A federally licensed and regulated (non-medical) industry is established.

ER 1.1.2 The federally licensed industry understands the legislation and regulatory requirements.

ER 1.1.3 The federally licensed industry is found to be compliant with regulatory requirements.

Royal Canadian Mounted Police

ER 1.2 Law Enforcement Records Checks (LERCs) are conducted in support of Health Canada's security clearance decisions.

Performance indicators

Health Canada

PI 1.1.1.1 Number of licence applications decisions per year.

PI 1.1.1.2 Percentage of licensed applications reviewed within internal service standards.

PI 1.1.2 Percentage of federal licence holders who indicate they have access to information to help them understand the regulatory requirements.

PI 1.1.3 Percentage of federally licensed industry that is found to be compliant with regulatory requirements.

Royal Canadian Mounted Police

PI 1.2 Percentage of LERCs completed within negotiated service standards.

Targets

Health Canada

T 1.1.1.1 2,200

T 1.1.1.2 75%

T 1.1.2 80%

T 1.1.3 80%

Royal Canadian Mounted Police

T 1.2. 75%

Actual results

Health Canada

AR 1.1.1.1 1,863

AR 1.1.1.2 82%

AR 1.1.2 90%

AR 1.1.3 98%

Royal Canadian Mounted Police

AR 1.2 100%

Theme 2: Provide Canadians with information needed to make informed decisions and minimize health and safety harms

Expected results

Health Canada

ER 2.1.1 Canadian youth understand the potential health and safety risks associated with cannabis use.

ER 2.1.2 Canadians use information to make informed decisions about the potential health and safety risks associated with the use of cannabis.

Public Health Agency of Canada

ER 2.2.1 Health care and social service professionals and public health officials have access to high-quality public health information.

ER 2.2.2 Health care and social service professionals and public health officials use information, knowledge and data products related to the public health impacts of cannabis and interventions to address them.

Public Safety Canada

ER 2.3.1 Canadians are aware of the legal implications associated with cannabis use, and understand the laws associated with the new legislation.

ER 2.3.2 Canadians use information provided by the program to make informed, lawful decisions.

Performance indicators

Health Canada

PI 2.1.1 Percentage of youth (grades 7-12) who perceive that there is "no risk" in smoking cannabis on a regular basis.

PI 2.1.2 Percentage of Canadians who strongly agree or somewhat agree that they have access to enough trustworthy information about the health risks of cannabis to make informed decisions

Public Health Agency of Canada

PI 2.2.1 Number of health care and social service professionals and public health officials accessing high-quality public health information and data products developed.

PI 2.2.2 Percentage of Chief Public Health Officer's Health Professionals Forum member organizations using information, knowledge and data products to make informed decisions.

Public Safety Canada

PI 2.3.1 Percentage of Canadians who indicate that they are aware of the new legislation, and the consequences related to making certain decisions involving cannabis.

PI 2.3.2 Percentage of Canadians who have indicated that they have made informed, lawful decisions around cannabis that protected themselves, and the safety of others.

Targets

Health Canada

T 2.1.1 7%

T 2.1.2 74%

Public Health Agency of Canada

T 2.2.1 200,000

T 2.2.2 75%

Public Safety Canada

T 2.3.1 22%

T 2.3.2 51% of Canadians who have used cannabis in the past 12 months indicate they usually purchase cannabis from a legal storefront or legal online source

Actual results

Health Canada

AR 2.1.1 7%

AR 2.1.2 73%

Public Health Agency of Canada

AR 2.2.1 285,444

AR 2.2.2 Not available

Public Safety Canada

AR 2.3.1 13%

AR 2.3.2 68%

Theme 3: Build law enforcement knowledge and engage partners and stakeholders on public safety

Expected results

Public Safety Canada

ER 3.1.1 Law enforcement is well-informed to apply the new legislation.

ER 3.1.2 Evidence-based decision-making on organized crime and policing issues.

ER 3.1.3 Research projects related to cannabis and performance measurement implemented.

ER 3.1.4 Policy development and decision-making is informed by evidence and performance measurement.

Royal Canadian Mounted Police

ER 3.2.1 RCMP prevention and engagement activities support enhanced understanding among targeted partners and stakeholders, including youth and Indigenous communities.

ER 3.2.2 Enhanced capacity of target populations, including partners and stakeholders, youth and Indigenous communities, to respond to the new cannabis regime.

Performance indicators

Public Safety Canada

PI 3.1.1 Percentage of law enforcement knowledgeable about the changes to the new regime, and able to use the legislative framework as a result of the training materials.

PI 3.1.2.1 Percentage of stakeholders who indicate that the materials informed decision making.

PI 3.1.2.2 Number of working meetings and consultations with stakeholders held.

PI 3.1.2.3 Number of new initiatives considered for implementation.

PI 3.1.3 Percentage of research projects related to performance measurement completed and disseminated.

PI 3.1.4 Percentage of stakeholders indicating that policy development and decision making was based on performance measurement results and lessons learned.

Royal Canadian Mounted Police

PI 3.2.1.1 Percentage of targeted federal partners and stakeholders who strongly agree or agree with the statement "RCMP Federal Policing contributes to increased understanding specific to the new cannabis regime, organized crime, and the illicit cannabis market".

PI 3.2.1.2 Number of information inquiries responded to by the Centre for Youth Crime Prevention.

PI 3.2.2.1 Percentage of targeted partners/stakeholders who strongly agree or agree with the statement "RCMP Federal Policing contributes to an increased skills/ability to respond to the new cannabis regime".

PI 3.2.2.2 Percentage of youth resource officers who positively assessed the impact of training.

Targets

Public Safety Canada

T 3.1.1 33% of frontline police officers access materials 75% of officers with access to materials find the materials helpful.

T 3.1.2.1 75%

T 3.1.2.2 15

T 3.1.2.3 2

T 3.1.3 100%

T 3.1.4 50%

Royal Canadian Mounted Police

T 3.2.1.1 45%

T 3.2.1.2 150

T 3.2.2.1 30%

T 3.2.2.2 80%

Actual results

Public Safety Canada

AR 3.1.1 Achieved March 31, 2020

AR 3.1.2.1 75%

AR 3.1.2.2 45

AR 3.1.2.3 2

AR 3.1.3 100%

AR 3.1.4 78%

Royal Canadian Mounted Police

AR 3.2.1.1 35%

AR 3.2.1.2 157

AR 3.2.2.1 29%

AR 3.2.2.2 97%

Theme 4: Provide criminal intelligence, enforcement and related training activities

Expected results

Royal Canadian Mounted Police

ER 4.1.1 Information and intelligence products/advice related to illicit substances (including cannabis) are shared with Canadian law enforcement agencies and available to be used to target organized crime.

ER 4.1.2 Canadian law enforcement agencies have intelligence information to nationally coordinate activities to target organized crime groups involved in the Canadian cannabis market.

ER 4.1.3 RCMP staff have access to required training in regards to enforcement of the new cannabis regime.

ER 4.1.4 RCMP employees have an increased ability to enforce the new cannabis regime.

Performance indicators

Royal Canadian Mounted Police

PI 4.1.1 Percentage or number of RCMP information / intelligence products / advice incorporating organized crime groups' activities in the Canadian cannabis market shared with RCMP senior management, divisions, domestic partners (including Canadian law enforcement) or international partners.

PI 4.1.2.1 Number of organized crime groups involved in the illicit cannabis market for which there are intelligence gaps is reduced which will result in efficient and accurate targeting by the law enforcement community.

PI 4.1.2.2 Number or percentage of information and intelligence products that are used to guide enforcement against organized crime groups in the Canadian cannabis market.

PI 4.1.3 Percentage of target audience who have received the appropriate cannabis related training.

PI 4.1.4 Percentage of training participants who reported an increased level of knowledge and ability to enforce the new cannabis regime.

Targets

Royal Canadian Mounted Police

T 4.1.1 10

T 4.1.2.1 TBD by December 31, 2022

T 4.1.2.2 3

T 4.1.3 80%

T 4.1.4 90%

Actual results

Royal Canadian Mounted Police

AR 4.1.1 Not available

AR 4.1.2.1 10%

AR 4.1.2.2 4

AR 4.1.3 65.5%

AR 4.1.4 Not available

Theme 5: Prevent and interdict prohibited cross-border movement of cannabis while maintaining the flow of legitimate travellers and goods

Expected results

Canada Border Services Agency

ER 5.1.1 Travellers understand the requirements to declare cannabis and cannabis-related products when entering Canada.

ER 5.1.2 Travellers are provided a clear opportunity to declare cannabis in their possession at all primary inspection sites.

ER 5.1.3 CBSA has enhanced capacity to promote compliance and to enforce import-related laws.

ER 5.1.4 Prohibited cross border movement of cannabis is detected.

ER 5.1.5 Travellers and the import/export community have access to recourse mechanisms to challenge certain CBSA actions and decisions in a timely manner.

Performance indicators

Canada Border Services Agency

PI 5.1.1.1 Percentage of ports of entry with displayed signage on cannabis.

PI 5.1.1.2 CBSA awareness tools are in place to inform travelling public on prohibition of cross-border movement of cannabis.

PI 5.1.2 Percentage of relevant primary inspection kiosks, systems, training materials, operational guidelines and forms in all modes updated.

PI 5.1.3 Number of cannabis import interdictions at ports of entry.

PI 5.1.4 Percentage of referred cannabis samples analyzed within 30 days.

PI 5.1.5.1 Percentage of appeals received that are acknowledged within 10 calendar days.

PI 5.1.5.2 Percentage of Enforcement and Trusted Traveller appeals received that are decided within 180 calendar days.

PI 5.1.5.3 Percentage of Trade related appeals – Tariff Classification – that are decided within 365 calendars days (for cases never held in abeyance).

PI 5.1.5.4 Percentage of cannabis-related complaints for which the CBSA contact the complainant within 14 calendar days after a written complaint is received.

PI 5.1.5.5 Percentage of cannabis-related complaints for which CBSA provides a final written response to the complainant within 40 calendar days after a written complaint is received.

Targets

Canada Border Services Agency

T 5.1.1.1 75% of major ports and 100% of other priority ports.

T 5.1.1.2 100% of the digital strategy launched.

T 5.1.2 100%

T 5.1.3 10% reduction (+/- 5%) to baseline of 20,933

T 5.1.4 90%

T 5.1.5.1 85%

T 5.1.5.2 70%

T 5.1.5.3 70%

T 5.1.5.4 85%

T 5.1.5.5 90%

Actual results

Canada Border Services Agency

AR 5.1.1.1 100%

AR 5.1.1.2 100%

AR 5.1.2 100%

AR 5.1.3 18,039 Cannabis imports (14% reduction from 20,933)

AR 5.1.4 17.30%

AR 5.1.5.1 88%

AR 5.1.5.2 97%

AR 5.1.5.3 No trade-related appeals were received in 2021-22

AR 5.1.5.4 94%

AR 5.1.5.5 100%

Response to parliamentary committees and external audits

Response to parliamentary committees

Violence Faced by Health Care Workers in Hospitals, Long-term Care Facilities and in Home Care Settings

Brief Summary

Workplace violence is a pervasive problem in health care settings across Canada. Health care workers have a fourfold higher rate of workplace violence than any other profession. And yet, most of the violence experienced by health care workers goes unreported due to a culture of acceptance. The House of Commons Standing Committee on Health's report examines the scope and devastating impacts of workplace violence in health care settings. It also looks at its causal factors such as complex patient needs; staffing shortages; aging health care infrastructure; and inadequate security personnel and response systems. The Committee's report provides nine recommendations that outlines ways the federal government can collaborate with the provinces and territories and health care stakeholders to address this pressing issue.

Corrective Actions

Initiatives underway and recently announced in Budget 2021, such as significant investments in long-term care, mental health, infrastructure and research are aligned with the spirit of the Report's recommendations, and will help to address many of the root causes identified in the Report. The Government Response highlights the context of COVID-19 that has been the Government's and the health care sector's focus in the last years. It also highlights the federal initiatives underway and the new initiatives implemented in response to COVID-19 over the last year that will help to address factors associated with workplace violence and support the health workforce. The Response also emphasizes the importance of ongoing collaboration with provincial and territorial governments and stakeholders on these issues.

Diabetes Strategies in Canada and Abroad

Brief Summary

The Committee's recommendations are intended to help the Government of Canada find better ways to prevent people from getting type 2 diabetes and provide more support to people who have diabetes. One of the Committee's main recommendations is that the federal government work with the provinces and territories and key stakeholders to create a national plan to help prevent and manage diabetes in Canada.

Corrective Actions

The Government is undertaking a comprehensive range of multi-sectoral activities on diabetes, in partnership with provinces and territories. The Government Response addresses the 11 recommendations through five thematic areas: (1) diabetes prevention; (2) data collection and research; (3) tax relief; (4) access to medications, supplies and equipment; and (5) access to health services including in rural and remote communities.

Sports-Related Concussions in Canada

Brief Summary

The Subcommittee applauds the efforts of all stakeholders and makes 13 recommendations that focus on:

• legislation to establish a Concussion Awareness Week;
• continued support for the Federal-Provincial/Territorial Working Group on Concussion in Sport and organizations working on the issue;
• creating a Concussion Research Expert Advisory Board and increasing funding for concussion research; and
• enhancing collaboration with the provinces and territories to ensure a pan-Canadian approach to sports-related concussion.

Corrective Actions

The government response addresses the 13 recommendations through four thematic areas: (1) establish a concussion awareness week; (2) support for the Federal-Provincial/Territorial Working Group on Concussion in Sport and stakeholders; (3) concussion research; and (4) collaboration with the provinces and territories to ensure a pan-Canadian approach to sports-related concussion.

The Government recognizes that sport-related concussion remains a public health issue, including mental health, and agrees with the 13 recommendations. The government response highlights the Government's actions led by the Department of Canadian Heritage (Sport Canada) and the Public Health Agency of Canada given the shared mandate to implement a pan-Canadian concussion strategy. This work is done in partnership with provinces, territories and stakeholders.

M-206, Level of Fitness and Physical Activity of Youth in Canada

Brief Summary

A healthy lifestyle includes good eating habits, adequate physical activity and avoidance of unhealthy behaviours such as smoking and excessive alcohol consumption. With respect to physical activity, Canada's children and youth are spending too much time participating in sedentary activities, including spending time on screens, and too little time being active. Good habits established at a young age are likely to carry through to adulthood and senior years. This report makes six recommendations to the federal government on ways it can help to get Canadian youth sitting less and moving more, including the appointment of a Physical Activity Champion for Youth to oversee the implementation of a pan-Canadian approach on physical activity.

Corrective Actions

The Government is undertaking a comprehensive range of multi-sectoral activities in physical activity, including for youth, in partnership with provinces and territories. The Government Response addresses the six recommendations through five thematic areas: (1) policy initiatives; (2) engaging and informing Canadians; (3) Federal/Provincial/Territorial (FPT) governments; (4) non-governmental sectors; and (5) research and surveillance.

LGBTQ2 Health in Canada

Brief Summary

In its report, the Committee notes that a number of factors contribute to the health inequities experienced by LGBTQIA2 communities, including discrimination and stigmatization. The Committee also emphasizes that health inequities among LGBTQIA2 communities are exacerbated when other identity factors and determinants of health—such as age, ethnic origin, income and access to health care—intersect with gender identity and sexual orientation.

The Committee's report concludes by suggesting courses of action that could help reduce health inequities for LGBTQIA2 communities. The Committee recognizes that members of these communities know best how to improve their health and that they should be included in all related decision-making. The Committee recommends that the federal government include modules on gender and sexual diversity in training programs for health professionals and in sexual health education guidelines. The Committee further recommends that data collection be improved in order to obtain a more complete picture of the health of gender and sexual minorities in Canada; that gender and sexual minorities be consulted so that federal policies and programs include measures targeting these populations; and that funding for research on the health of LGBTQIA2 communities and funding for LGBTQIA2 organizations be improved.

Corrective Actions

The Government Response addresses the 23 recommendations through eleven thematic areas: awareness campaign, training and education; consultation; data collection; research funding; program funding; target LGBTQIA2 communities within existing public policies and programs; health of trans people; sexually transmitted and blood-borne infections; conversion therapy; intersex people; and blood, organ and tissue donation.

The government response provides an opportunity to demonstrate the government's commitment to promoting LGBTQIA2 equality, protecting LGBTQIA2 rights, and addressing discrimination against LGBTQIA2 communities as part of its priority to strengthen diversity and inclusion. It also presents the opportunity to highlight the wide range of the government's activities to help reduce health inequities among LGBTQIA2 Canadians.

Response to audits conducted by the Office of the Auditor General of Canada (including audits conducted by the Commissioner of the Environment and Sustainable Development)

2021 Report 2 of the Commissioner of the Environment and Sustainable Development

Natural Health Products

The Commissioner of the Environment and Sustainable Development (CESD) conducted an audit on natural health products available for sale in Canada.

The objective of this audit was to determine whether Health Canada ensured that natural health products offered to Canadians are safe and accurately represented on the basis of appropriate evidence.

The audit found that overall the natural health products available for sale in Canada are safe and accurately represented to consumers.

Recommendations:

CESD made five recommendations for Health Canada to action. These were:

1. Obtain sufficient evidence to verify that licensed sites follow good manufacturing practices;
2. Take a risk-based approach to ensure that product labels are readable, and monitor product labels and advertisement on natural health products on the market and internet;
3. Develop a risk-based monitoring and inspection program;
4. Develop a risk-based monitoring program to identify unlicensed products and take appropriate action so that they are not available for sale; and,
5. Obtain information, on products suspected of causing serious health risk, to verify and ensure that these products are not available for sale to consumers in Canada.

Health Canada's Response:

Health Canada has accepted the five recommendations made by the CESD and has prepared an action plan in response. Health Canada has committed to taking more steps to protect the health and safety of Canadians, such as:

• Establish fully costed options for a risk-based approach to quality oversight prior to the issuance or renewal of licences;
• Continue to pursue regulatory and policy changes to improve labelling;
• Implement a pilot program for inspecting the good manufacturing practices;
• Implement a risk-based approach to monitoring advertising; and
• Move forward with a proposal to extend to natural health products the use of powers under the Protecting Canadians from Unsafe Drugs Act (Vanessa's Law)

The report was tabled on April 22, 2021.

2021 Report 10 of the Auditor General of Canada to the Parliament of Canada

Securing Personal Protective Equipment and Medical Devices

The Office of the Auditor General (OAG) conducted an audit on personal protective equipment (PPE) and medical devices, which limit the spread of the coronavirus disease (COVID-19), protect frontline workers, and keep patients severely affected by COVID-19 alive. The OAG audited Health Canada, Public Health Agency of Canada, and Public Services and Procurement Canada.

The objective of this audit was to determine whether the Public Health Agency of Canada and Health Canada, before and during the COVID-19 pandemic, helped meet the needs of provincial and territorial governments for selected personal protective equipment and medical devices, and whether Public Services and Procurement Canada provided adequate procurement support.

Overall, the Public Health Agency of Canada, Health Canada, and Public Services and Procurement Canada helped to meet the needs of provincial and territorial governments for personal protective equipment (PPE) and medical devices during the pandemic. However, there were areas for improvement.

Recommendation:

Health Canada should determine whether respirators are appropriately classified given that Class I medical devices are not subject to a Health Canada review for safety and effectiveness.

Health Canada's Response:

Health Canada accepted the recommendation made by the OAG. Health Canada prepared an action plan in response. The Department currently regulates medical devices in accordance with a risk-based classification system but consideration could be given to providing greater pre-market oversight over some lower-risk devices. The Department will specifically review the classification of lower-risk devices and is committed to exploring options to evaluate the appropriate level of pre-market oversight of these devices.

The report was tabled on May 26, 2021.

2021 Report 6 of the Commissioner of the Environment and Sustainable Development to the Parliament of Canada

Departmental Progress in Implementing Sustainable Development Strategies – Healthy Coasts and Oceans, Pristine Lakes and Rivers, and Sustainable Food

This limited assurance report was prepared by the Commissioner of the Environment and Sustainable Development (CESD) on the contribution of departmental sustainable development strategies, as applicable to each organization, to the 2016–2019 Federal Sustainable Development Strategy's goals.

The objective of this review was to determine whether departments and agencies contributed to meeting the 2016–2019 Federal Sustainable Development Strategy goals of healthy coasts and oceans, pristine lakes and rivers, and sustainable food, as applicable to each entity.

Recommendation:

When reporting on progress, departments and agencies should clearly describe the extent to which they met the actions in their sustainable development strategies, using the relevant performance indicators.

Health Canada's Response:

Health Canada accepted the recommendation of the CESD. Health Canada is preparing an action plan in response. The Department will follow the appropriate guidance to help ensure that reporting on its sustainable development strategies clearly describes how actions were met, using relevant performance indicators and including targets and timelines to ensure progress can be measured.

This review was tabled on November 25, 2021.

Environmental Petitions Annual Report

This year's Annual Report of the Commissioner of the Environment and Sustainable Development indicates that 12 petitions, addressing a wide range of issues, were received between July 1, 2020 and June 30, 2021 and four of these were directed to Health Canada. Canadians petitioned Health Canada for information regarding their concerns related to nanosilver (one petition), federal funding of the Ontario Line (one petition), electromagnetic frequency (one petition) and pollinators (one petitions).

There were no recommendations in this report for HC.

The report was tabled on November 25, 2021.

Response to audits conducted by the Public Service Commission of Canada or the Office of the Commissioner of Official Languages

There were no audits in 2021–22 requiring a response.

Up-front multi-year funding

Canadian Foundation for Healthcare Improvement

General information

Recipient information

Healthcare Excellence Canada, an amalgamation of the Canadian Patient Safety Institute and the Canadian Foundation for Healthcare Improvement.

Start date

1996-97

End date

Not applicable

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care systems

Link to department's Program Inventory

Program 1: Health Care Systems Analysis and Policy

Purpose and objectives of transfer payment program

When the Canadian Health Services Research Foundation (CHSRF) was established as an independent organization, its priorities were to bring researchers and decision-makers together to identify gaps in applied health services research, fund the researchers who could investigate those gaps, and promote best practices of health services delivery and their outcomes. To reflect the evolution of its work, CHSRF was renamed the Canadian Foundation for Healthcare Improvement (CFHI) in 2012, with a new mandate to: find and promote health care innovators and innovations; drive rapid adoption of proven innovations; enable improvement-oriented systems; and, shape the future of healthcare. In 2020-21, CFHI amalgamated with the Canadian Patient Safety Institute, forming Healthcare Excellence Canada (HEC). The first year of HEC's new strategy was 2021-22, which focused on: finding and promoting innovators and innovations, driving rapid adoption and spread of quality and safety innovations, building capacity to enable excellence in healthcare and catalyzing policy change.

Up-front multi-year funding to HEC includes the original $66.5 million endowment to establish the Canadian Health Services Research Foundation along with the following grants:

• 1999: $25 million to support a ten-year program to develop capacity for research on nursing recruitment, retention, management, leadership and the issues emerging from health system restructuring (Nursing Research Fund).
• 1999: $35 million to support its participation in the Canadian Institutes of Health Research.
• 2003: $25 million to develop a program to equip health system managers and their organizations with the skills to find, assess, interpret and use research to better manage the Canadian health care system (Executive Training for Research Application or EXTRA).

Subsequent funding to HEC (and CFHI before it) has been delivered through contribution funding rather than upfront multi-year funding.

Audit findings by the recipient during 2021-22, and future plan

CFHI and now HEC's financial records are reviewed and audited annually by independent external auditors. The 2021-22 external financial and pension audits showed no major concerns. Independent external auditors will continue to perform audits on an annual basis.

Evaluation findings by the recipient during 2021-22, and future plan

CFHI and now HEC pursues ongoing internal evaluative and measurement work of its activities and reports its results through its website and annual reports. In 2019-20, HEC also undertook an independent 5-year corporate evaluation for the period from 2014 to 2019 to examine the relevance, effectiveness and efficiency of its work. The results were released in June 2020 and showed the organization demonstrated good alignment with the priorities and requirements of its stakeholders; it has greatly contributed to the acceleration of healthcare improvements in Canada and has achieved a high degree of success in achieving its outcomes; and it has a well-defined governance mechanism and policies in place at the Board of Directors level.

Summary of results achieved by the recipient

In 2021-22, HEC focused on: finding and promoting innovators and innovations, driving rapid adoption and spread of quality and safety innovations, building capacity to enable excellence in healthcare and catalyzing policy change. It will release an annual report covering 2021-22 in Fall 2022.

As its designated successor, Healthcare Excellence Canada has assumed ownership of the remaining up-front multi-year funding, which is being held in reserve to address potential staffing and pension liability costs, similar to its predecessor organization. There are no new results associated with the up-front multi-year funding to report for 2021-22.

With ongoing contribution funding now in place, most recently provided through a new agreement that provides annual funding from 2021-22 to 2025-26. HEC has been considering how to best use its remaining up-front multi-year funding (approximately $11 million).

Total funding approved (dollars)

$151,500,000

Total funding received (dollars)

$151,500,000

Financial information (dollars)

Canada Health Infoway

General information

Recipient information

Canada Health Infoway (Infoway)

Start date

March 31, 2001^{Footnote 52}

End date

March 31, 2015^{Footnote 53}

Link to departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care systems

Result 2: Canadians have access to appropriate and effective health services

Link to department's Program Inventory

Program 6: Digital Health

Purpose and objectives of transfer payment program

Canada Health Infoway Inc. is an independent, not-for-profit corporation established in 2001 to accelerate the development of electronic health technologies such as electronic health records (EHRs) and telehealth on a pan-Canadian basis.

Between 2001 and 2010, the Government of Canada committed $2.1 billion to Infoway in the form of grants and up-front multi-year funding consisting of: $500 million in 2001 to strengthen a Canada-wide health infostructure, with the EHR as a priority; $600 million in 2003 to accelerate implementation of the EHR and Telehealth; $100 million in 2004 to support the development of a pan-Canadian health surveillance system; $400 million in 2007 to support continued work on EHRs and wait time reductions; and $500 million in 2010 to support continued implementation of EHRs, implementation of electronic medical records (EMRs) in physicians' offices, and integration of points of service with the EHR system. Infoway invests in electronic health projects in collaboration with a range of partners, in particular provincial and territorial governments, typically on a cost-shared basis. Project payments are made based on the completion of pre-determined milestones.

It is anticipated that Infoway's approach, where federal, provincial and territorial governments participate toward a goal of modernizing electronic health information systems, will reduce costs and improve the quality of health care and patient safety in Canada through coordination of effort, avoidance of duplication and errors, and improved access to patient data.

Audit findings by the recipient during 2021-22, and future plan

The annual independent financial and compliance audits were conducted during the year, and both resulted in unqualified audit reports. There were no other audits scheduled or conducted during the year.

Evaluation findings by the recipient during 2021-22, and future plan

Infoway pursued ongoing internal evaluative and measurement work of its activities and reported its results through its website and annual reports.

Summary of results achieved by the recipient

With respect to Pan-Canadian Leadership in Digital Health Knowledge and Collaboration, Infoway:

• Continued to support jurisdictional partners as they implemented and enhanced virtual care and other digital health services to meet the needs of their citizens. They also made progress on several important initiatives, including national procurement of digital health solutions, the advancement of interoperability, clinician change management, and digital health literacy.
• Continued to refine their private sector engagement approach and supported a variety of activities, including facilitating networking during the Partnership Series and Conference, development and publication of podcasts and articles, and direct outreach to support Infoway-led initiatives (e.g., multi- jurisdictional procurements and research papers).
• Established a Cybersecurity Forum that includes jurisdictions, public and private sector organizations. This new and continuing forum will support knowledge exchange about security, as well as approaches for enabling secure interoperability and data sharing.

In regard to Virtual Care and Digital Health, Infoway:

• Continued to advance interoperability and projects to support access to digital health and virtual care;
• Continued to support all jurisdictions in advancing their digital health priorities through strategic investments that enabled them to accelerate the implementation of technologies such as virtual care and additional tools to support clinicians;
• Supported jurisdictions by streamlining procurement of digital health solutions through multi-jurisdictional pre-qualification processes for two services that jurisdictions identified as priorities—virtual visits and remote patient monitoring—and publishing a toolkit with curated requirements, including privacy and security requirements;
• Continued to evolve their approach to interoperability and led work with jurisdictions to develop a set of pan-Canadian data and technical requirements that enable different platforms and providers to exchange patient data. They successfully delivered and tested two modules.
• Collaborated with Healthcare Excellence Canada to develop a Clinician Change Virtual Care Toolkit to support care providers in their implementation and use of virtual care; and,
• Launched a Digital Health Learning Program to provide resources for Canadians, with a focus on minority, vulnerable and senior population groups, with the goal of improving digital health literacy and health equity for all Canadians.

Total funding approved (dollars)

$2,100,000,000

Total funding received (dollars)

$2,093,398,112^{Footnote 54}

Financial information (dollars)