Supplementary Information Tables 2022-2023 Departmental Results Report: Health Canada

Table of Contents

• Details on Transfer Payment Programs
  • Transfer Payment Programs with total actual spending 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
    • COVID-19 Safe Restart Agreements Program
    • Health Care Policy and Strategies Program
    • Improving Affordable Access to Prescription Drugs 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
    • Chemicals Management Plan Engagement and Outreach Contribution Program
    • Innovative Solutions Canada
    • Radon Outreach Contribution Program
• Gender-Based Analysis Plus
  • Section 1: Institutional GBA Plus Governance and Capacity
  • Section 2: Gender and Diversity Impacts, by Program
    • Core Responsibility 1: Health Care Systems
      • Program Name: Access, Affordability & Appropriate Use of Drugs & 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: Health Care Policies and Strategies Program
      • Program Name: Home, Community & Palliative Care
      • Program Name: Mental Health
      • Program Name: Medical Assistance in Dying
      • Program Name: National Strategy for Drugs for Rare Diseases
      • Program Name: Organs, Tissues, and Blood
      • Program Name: Patient Safety
      • Program Name: Promoting Minority Official Languages in the Health Care Systems
      • Program Name: Territorial Health Investment Fund
      • Program Name: Thalidomide
    • 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 & Nutrition
      • Program Name: Health Canada Specialized Services (Employee Assistance Program)
      • Program Name: Health Canada Specialized Services (Internationally Protected Persons Program)
      • 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: Tobacco Control
      • Program Name: Water Quality
      • Program Name: Workplace Hazardous Products
• Horizontal Initiatives
  • Addressing the Opioid Crisis
  • Canadian Drugs and Substances Strategy
  • Chemicals Management Plan
  • Renewal of the funding for the existing Federal Framework for the Legalization and Regulation of Cannabis in Canada
• Reporting on Green Procurement
  • Context
• 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
• United Nations 2030 Agenda and the Sustainable Development Goals
  • SDG 3 Ensure healthy lives and promote well-being for all at all ages
  • SDG 11 Make cities and human settlements inclusive, safe, resilient and sustainable
  • SDG 12 Responsible Consumption and Production
  • SDG 13 Take urgent action to combat climate change and its impacts
• Up-front multi-year funding
  • Healthcare Excellence Canada
  • Canada Health Infoway

Details on Transfer Payment Programs

Transfer Payment Programs with total actual spending of $5 Million or More

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 2: Healthy People and Communities

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

In 2022-23, Health Canada launched the inaugural calls for proposals for the Program's two distinct streams of funding and selected a total of 20 recipients to receive $11.8 million over two years to address systemic racism in Canada's health systems.

The Program's Project Stream launched its call for proposals from April 6, 2022 to May 25, 2022. The Project Stream's 2022 call for proposals targeted projects specifically addressing anti-Indigenous racism, with priority given to projects that develop and implement cultural safety training, curriculum and/or accreditation requirements for health services providers, as well as projects that integrate culturally safe care in acute care settings and traditional approaches to health. A total of 166 applications were received through the call for proposals, representing $108 million in requested funding. As of March 2023, 15 successful applicants were selected to receive $10.9 million over 2 years, starting in 2022-23, to implement their projects. The 15 recipients are comprised of Indigenous organizations, health system service providers and associations, academic institutions, and incorporated not-for-profit organizations from across the country. The 15 projects respond to one or both of the priority areas, which includes but is not limited to developing and implementing cultural safety training materials, tools, standards, guidelines, resources and other interventions, undertaking meaningful engagement with Indigenous communities and organizations, and fostering knowledge mobilization and partnerships to increase culturally safe, inclusive and appropriate care for Indigenous Peoples. The 15 recipients began receiving funding towards the end of 2022-23, and work is currently underway to implement the projects.

The Program's Engagement Stream also launched a separate targeted solicitation process in August 2022, and selected 5 national Indigenous organizations to receive $900,000 over 2 years, starting in 2022-23. The funding is being used to build the capacity of each of these organizations to meaningfully engage on one of the following health priorities: mental health and substance use; primary care; health human resources; and dental care. The 5 organizations began receiving funding towards the end of 2022-23.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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.

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 the 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

In Budgets 2011, 2016, and 2019, and through a subsequent funding commitment in 2021, the Government of Canada provided a cumulative $200 million, in matched funding with non-federal government donors, for the Canada Brain Research Fund Program "to support the very best Canadian neuroscience" and "to help the medical community better understand the brain and brain health." 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 and then allocates grants to researchers across Canada. The Program's objectives are to: 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

Since the start of the most recent agreement with Brain Canada (2020), Health Canada has provided the organization over $42.7 million in funding. During the same period, Brain Canada has met their matching obligation by raising more than $50 million. In 2022-23, Brain Canada collaborated with institutions, health charities and donors, research networks, provincial agencies, and corporations to raise over $13 million in matched funds to the federal contribution. The overall investment in brain research contributes to discoveries that inform the development of prevention, diagnostic, therapeutic, clinical, technological and health system solutions for brain diseases and disorders. Ultimately, the advances made through this work are expected to improve the health and quality of life of Canadians who are at risk of or affected by brain diseases and disorders.

Brain Canada has invested over $25 million for research grants and awards promoting knowledge mobilization. This allowed the launch of 13 research competitions in 2022-23 which included clinical and translational research. Awards were provided in targeted priority areas including stroke, dementia, and mental health. Among these, several initiatives focused on increasing Equity, Diversity, and Inclusion capacity in the brain research community.

In addition, merit-based awards including the 2022 Research Excellence, Diversity, and Independence Early Career Transition Award and the Personnel Awards for Black Scholars promoted interdisciplinary and collaborative research and increased access to equipment, expertise and data across research networks; with the overall objective to continue developing the next generation of Canadian brain researchers. In addition to research competitions, a total of 86 grants were provided to eligible recipients. Of these, 74% focused on diverse groups including women, men, and gender-diverse people, Indigenous people, visible minorities, and people in various age groups.

Brain Canada funds also supported the launch of the Canadian Youth Mental Health Insight platform, the first-ever of its kind. The platform is geared to improve communication among youth and families, researchers, clinicians, and other service providers using open data and machine learning. It provides access to AI-based services to help users navigate mental health services; and personalized tools that monitor mental health, identify health risks, and recommend services. It also allows service providers and policymakers to use the interactive atlas to gain insight into youth mental health service demand and availability.

A core activity of Brain Canada's work is the convening of research community stakeholders on key brain health priorities. In 2022-23, Brain Canada held 17 stakeholder events (a total of 80 events since 2020) to bolster engagement, support fundraising, and promote knowledge translation in the brain research sphere.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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 the analysis and follow-up of progress, performance and financial reporting.

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 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 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) welcomed three new thalidomide survivors in 2022-23 and supported a total of 125 confirmed survivors as of March 31, 2023.

Ongoing tax-free payments were distributed to all known thalidomide survivors and 100% of payments were made before the end of April 2022, as per the service standard set by the independent third-party program administrator.

The program administrator is responsible for managing an Extraordinary Medical Assistance Fund (EMAF) to assist survivors with costs related to extraordinary health support needs such as specialized surgeries, home or vehicle adaptations and some ongoing costs related to chiropractic care, physiotherapy and attendant services, among others. In 2022-23, 94 EMAF applications were processed, which is more than double the amount from the previous year. Of those, 30% were related to specialized surgeries. The substantial increase in applications can be attributed to a focused outreach the administrator initiated to increase awareness of the EMAF and its benefits to survivors.

In 2022-23, a total of 24 new CTSSP applications were submitted at Step 1 of the 3-step probability based medical assessment process. In August 2022, a judgement issued by the Federal Court, allowed all applicants at Step 2, regardless of the algorithm results, to advance to Step 3. As of March 31, 2023, there were 76 applications at various stages of review at Step 3.

Based on results of the annual survey of survivors for 2022-23, 94% 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 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with the third-party administrator of Canadian Thalidomide Survivors Support Program to discuss 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

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 the 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. In 2016 Infoway received an additional $50 million over two years via a Contribution Agreement to support short-term digital health activities in e-prescribing and telehomecare. This was followed by an additional Contribution Agreement in 2017 for $300 million over five years 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. Budget 2019 further 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 via a Contribution Agreement to support provinces, territories and others to expand virtual health services to Canadians.

In January 2022, F/P/T governments endorsed a digital health action plan. This included tasking Infoway, the Canadian Institute for Health Information and Statistics Canada to advance pan-Canadian standards to ensure health data can securely flow across the health care system while protecting the privacy of Canadians.

In addition to interoperability, Infoway continued to focus on driving digital health adoption by collaborating with stakeholders to improve access to care, addressing challenges, and ensuring that virtual care is a viable and effective option for all. It also continued to advance PrescribeIT and a pan-Canadian data and reporting system for organ donation and transplantation.

Results Achieved

Infoway's work with F/P/T's and stakeholders contributed to the development of a Shared Pan-Canadian Interoperability Roadmap which was endorsed by the Conference of Deputy Ministers of Health on March 30, 2023. This work supports efforts to the modernize the health system through connected care to enable a healthier Canada, laying the groundwork to advance the use of standardized digital health tools and technologies, and the ability of Canadians and health care professionals to access and share patient health information electronically.

Additionally, the launch of Infoway's PrescribeIT e-prescribing service in a 7th province supports the modernization of our health system by enabling prescribers to safely and securely send prescriptions directly to the pharmacy of a patient's choice. While Infoway's collaboration with the Canadian Institute for Health Information, F/P/Ts, and organ donation clinicians and specialists, resulted in a multi-jurisdictional procurement process for a deceased donation management solution, and a project to digitally connect organ donation organizations in British Columbia, Ontario and Quebec.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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 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 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 the 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, forming Healthcare Excellence Canada (HEC). As such, the Department's annual funding to each organization has been combined and is now dispersed directly to HEC via the Contribution to Improve Health Care Quality and Patient Safety Program.

This 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 rapid adoption and spread of quality and safety innovations, build capacities to enable excellence in healthcare and catalyze policy change.

Results Achieved

HEC continued to: spread promising innovations, sustain meaningful relationships with those HEC worked with and assisted in preparing health leaders to lead improvement efforts. HEC also continued to work to improve person-centered care and staff well-being in long-term care homes by supplying seed funding, coaching, creating peer-to-peer networks and offering webinars. This work led to improvements in 93% of homes working to improve person-centered care and 70% of homes working to improve staff well-being. Now approaching the halfway point of its 5-year contribution agreement, HEC is continuing to advance the adoption of quality and safety innovations and implementation of relevant policy change, through events such as its Leader's Forum and programs such as its highly successful Long-Term Care Plus initiative.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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

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 the 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 F/P/Ts 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 contribution agreement provides financial support for CADTH's core business activities, namely, the Common Drug Review, pan-Canadian Oncology Drug Review, Health Technology Assessments and Optimal Use Projects. Through these activities, CADTH is able to create and disseminate evidence-based information about the effectiveness and cost of drugs and non-drug technologies. Provinces and territories use this information to help decide whether or not public health plans should include the particular health products in question.

Results Achieved

In 2022-23, CADTH continued to respond to health system priorities by providing evidence, advice, implementation support, and recommendations for the Canadian healthcare system through its core business activities.

In September 2022, CADTH successfully launched the Post-Market Drug Evaluation Program. The program establishes network of applied researchers, methodologists, and analysts who provide evidence-based responses to questions and concerns raised by F/P/T decision-makers about drugs authorized for use in Canada. The specific focus of this program is on regulated drugs that are broadly available to the Canadian population.

CADTH partnered with Health Canada, the Institut national d'excellence en santé et en services sociaux, and other health system stakeholders to advance the integration of real-world evidence into decision-making. CADTH published a related guidance document in spring 2023 to assist stakeholders in providing real-world evidence for decision-making.

• CADTH continued to work collaboratively with organizations within Canada and abroad. In November 2022, CADTH hosted a roundtable on genetic testing for precision medicine, bringing together stakeholders and experts to discuss a pan-Canadian framework for evaluating, funding, and use of genetic testing for precision medicine. In September 2022, CADTH announced an international collaboration agreement with several health technology assessment organizations (e.g., Australian Government Department of Health and Aged Care and Healthcare Improvement Scotland) to advance work on shared priorities, including COVID-19, future-proofing health technology assessment systems, regulatory collaboration and more.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with CADTH 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 Institute for Health Information

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 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 6: Health Information

Purpose and objectives of transfer payment program

The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization supported by F/P/T that provides essential data and analysis on Canada's health system and the health of Canadians. CIHI was created in 1994 by the F/P/T Ministers of Health to address significant gaps in health information. CIHI provides 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 in total to CIHI through a series of contribution agreements. Over the past 6 years (2017-18 to 2022-23), CIHI received over $475 million under the current agreement, including targeted funding initiatives, such as:

• $140,000 in 2019, to undertake an environmental scan of data gaps for addiction treatment services.
• $500,000 in 2019 to initiate a collaborative pan-Canadian Organ Donation and Transplantation (ODT) Data and Performance Reporting System, in collaboration with Canada Health Infoway.
• A total of $7.1 million in funding to CIHI, in partnership with Infoway, in 2020 and 2021, to advance the activities of the ODT Data and Performance Reporting System project.
• $3.5 million in 2021 to meet priority data needs for public health data management during the pandemic as part of the Safe Restart Agreement.
• $1.7 million in 2022 to address health workforce data gaps and support development of workforce planning data and tools, and expand work on drug data planning.
• $3.7 million to advance pharmaceutical data activities in support of the Budget 2019 - Canadian Drug Agency Transition Office (CDATO).
• $1.7 million to implement new priority data activities under the Budget 2019 - Drugs for Rare Diseases Strategy.
• $1.2 million in support of the Public Health Agency of Canada's Data Pathways for Public Health pilot project.

Results Achieved

CIHI continued to address data gaps in priority areas to improve the collection and reporting of more comprehensive pan-Canadian data in key areas, including but not limited to the health workforce, organ, donation, and transplantation, mental health and addictions, home and long-term care, pharmaceuticals, and the health of Indigenous populations in 2022-23. CIHI continued to provide insights on the COVID-19 pandemic's impacts on Canada's health care systems and updated F/P/T endorsed Shared Health Priority indicators. CIHI published the Health Data and Information Governance & Capability Framework in 2022, a leading standard in getting health organizations started and aligned on data and information governance.

Additionally, in January 2022, F/P/Ts endorsed a digital health action plan and tasked CIHI, Infoway and Statistics Canada to advance pan-Canadian standards to ensure health data can securely flow across the health care system while protecting the privacy of Canadians. In March 2023, Infoway, CIHI and Statistics Canada and P/Ts developed the Shared Pan-Canadian Interoperability Roadmap which was endorsed by all provinces and territories (except Quebec).

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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

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 the departmental result(s)

Core Responsibility 1: Health Care Systems

Result 1: Canada has modern and sustainable health care system

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 arm's-length, not-for-profit organization that was established in 2007 by the Government of Canada. CPAC's mandate is to mobilize partners across the country to reduce the burden of cancer through coordinated, system-level change through the implementation of the Canadian Strategy for Cancer Control (the Strategy).

The Strategy is an overarching framework for a comprehensive Canadian cancer control program. The work of the Strategy spans the spectrum of cancer control, from research, prevention and detection to treatment, survivorship and end-of-life care.

Developed in consultation with Canadians, including cancer experts and stakeholders, the Strategy's objectives include:

• 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.

CPAC is fully funded by the Government of Canada, with Budget 2016 confirming ongoing funding at $47.5 million per year. Health Canada is responsible for managing CPAC's funding which included $250 million for its first five-year term (2007 to 2012), $241 million for its second five-year term (2012 to 2017), and $237.5 million for its third five-year term (2017-2022). Given pandemic related 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. Fiscal year 2022-23 marked CPAC's first year in its new five-year term contribution agreement (2022-23 to 2026-27), with funding of $237.5 million.

Results Achieved

In its final year of its 2017-23 Contribution Agreement, CPAC completed all planned work including activities that were extended into 2022-23 as a result of pandemic delays. All related outcomes have been achieved, notably:

• All 13 provinces and territories have developed or implemented Peoples-specific First Nations, Inuit and/or Métis cancer strategies.
• More than 7,000 paramedics have been trained to assess and treat patients with palliative care needs at home.
• Patient Reported Outcomes tools were made available to more than 110,000 patients to report on the prevalence and severity of symptom burden.

In the first year of its new Contribution Agreement, CPAC focused on implementing its 2022-27 Business Plan. Together with partners, CPAC advanced the priorities and actions of the Strategy, prioritized health equity, supported pandemic recovery and achieved milestones identified for fiscal year 2022-23 such as:

• In collaboration with Canadian Association of Provincial Cancer Agencies, launched an online Models of Care Tool Kit, which provides detailed information on innovative, evidence-informed Models of Care.
• Began developing education and training resources for cancer control agencies/programs, government ministries, and health care professionals to help increase awareness and uptake of the clinical practice guidelines.
• Funded the development and release of Beginning the journey into the spirit world: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada in collaboration with an Indigenous vendor.
• Engaged key partners and stakeholders including patient/family representatives on the development of pan-Canadian Cancer Data Strategy as well as initiated engagement with First Nations, Inuit and Métis partners to recognize Indigenous-led, self-determined efforts toward data sovereignty within this strategy.
• Engaged jurisdictional partners and developed funding approach to enhance analytic capacity to use cancer system data to inform clinical practice and policy decision-making.
• Established agreements with 11 partners (up from nine with the addition of Northwest Territories and Yukon). This work supports ongoing data collection for public reporting of the Strategy indicators in the progress reporting tool, which highlights progress within each jurisdiction.
• Published relevant cancer system performance data and knowledge products such as Road to recovery: Cancer in the COVID-19 era report
• Developed a first-ever geo-mapping tool, OncoLocate, to provide a mapped view of cancer human resources and cancer burden to support health policy decisions in Canada.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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.

COVID-19 Safe Restart Agreements Program

Start date

February 4, 2021

End date

March 31, 2024

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2020-21

Link to the 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

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; and
• 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

These investments are intended to support P/Ts and other recipients' efforts to conduct more testing, perform more contact tracing and improve the sharing of data to slow the transmission of COVID-19. To that end, in 2022-23, Health Canada advanced $22.4 million via Safe Restart Agreement to 30 P/T and non-government organizations to support the implementation and maintenance of wastewater surveillance projects across Canada, rapid test distribution programs, clinical trials on the accuracy and feasibility of rapid tests, cost effectiveness evaluations on the value of rapid test screening programs, and a rapid test implementation and data tracking training program. Health Canada also supported nine data management projects with Indigenous Organizations and P/Ts that have enhanced capacity and infrastructure to support the safe collection of data and First Nations data governance, as well as improved public health data transfer and data analysis.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

Applicants were engaged by making a request for funding through an exchange of letters between Ministers of Health or by submitting a formal proposal using an online 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

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 the 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 time-limited contribution funding for projects that address specific health care systems priorities, 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. The Program's authorities also support budget initiatives related to the Terry Fox Research Initiative, Ovarian Cancer Canada, the Sexual and Reproductive Health Fund, and Medical Assistance in Dying Policy and Practice, and the implementation of the department's Action Plan on Palliative Care.

Results Achieved

Program funding supports a wide range of projects designed to ultimately contribute to improvements in the accessibility, quality, sustainability and accountability of the health care system. These improvements benefit either specific target populations, or all Canadians. For example, projects that produce and transfer knowledge in key areas help improve Canada's health care systems and advance health policy. Other projects identify, develop, implement, assess and promote new or modified tools, approaches and best practices that respond to identified health care system priorities and promote people-centred health care. Another range of projects identify, develop, implement, assess and promote training and skills development, standards, products and technological solutions that will help modernize health care systems delivery.

In 2022-23 the Program launched 7 new projects, in addition to ongoing projects, using its "core" program funding, as well as 6 new projects funded through Budget initiatives related to Medical Assistance in Dying Policy and Practice and the implementation of the department's Action Plan on Palliative Care. The Program's authorities also continued to be used to support Budget initiatives related to the Terry Fox Research Initiative, Ovarian Cancer Canada, and the Sexual and Reproductive Health Fund.

Some selected examples of projects launched in 2022-23 include:

• A project with the Centre for Addiction and Mental Health to develop a national data framework and infrastructure for integrated youth services;
• A project with Pain BC to establish a Pain Canada network and promote improved chronic pain management;
• A project with the Canadian Association of Schools of Nursing to establish a Canadian residency program for new registered nurses;
• A project with Unity Health Toronto to conduct a national survey and engagement on the future of primary care; and
• A project with the University of Alberta and the Canadian Donation and Transplantation Research Program to develop a national research agenda to address the impact of Covid-19 on transplantation patients.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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.

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

2021-22

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 purpose of this Agreement is to expand PEI's public formulary and improve the affordability of its public drug plans to levels more comparable to those of other provinces and territories. This partnership between the Governments of Canada and Prince Edward Island is aimed at increasing access for Prince Edward Island residents to a wider range of prescription medications while also reducing their out-of-pocket costs.

Insights and lessons learned from this contribution agreement may be used to inform the future implementation of national pharmacare.

Results Achieved

PEI has increased coverage of opioid and alcohol dependency medications to provide residents with no-cost access to these addiction treatments and strengthened community mental health services with the addition of second generation long- acting antipsychotic medications. PEI has also changed the requirements for dozens of medications to allow greater ease of access for physicians seeking to provide these medications to PEI residents and expanded access to 61 new medications.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

Health Canada officials continues to engage with PEI representatives via meetings, phone calls, and e-mails. In addition, Health Canada continues to monitor compliance with the funding agreement through regular performance and financial reporting.

Mental Health Commission of Canada Contribution Program

Start date

April 1, 2017

End date

March 31, 2027

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2022-23

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 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 10-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 a $14.25 million per year contribution towards this end. The MHCC also received $10 million over five years (until March 31, 2023) through the Substance Use and Addictions Program to support the improved understanding of the impact of cannabis use on mental health.

Results Achieved

The Mental Health Commission of Canada Contribution Program is expected to contribute to the improved mental health and well-being of Canadians, specifically in the areas of mental health and substance use integration, suicide prevention, and stigma reduction. In 2022-23, notable achievements included:

• Continued to deliver training programs to support mental health and resilience of targeted groups at risk, which included youth, post-secondary students, older adults, veteran community, Indigenous populations and first responders.
• Convened 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.
• Developed an Assessment Framework for Mental Health Apps in Canada in collaboration with the Organisation for the Review of Care and Health Apps, and with the support of over 200 stakeholders. The framework spans across 7 major standards and includes over 450+ criteria.
• Advanced E-Mental Health Toolkit implementation modules, a resource to help mental health providers gain knowledge they need to integrate E-Mental Health into daily practice, in collaboration with the Centre for Addiction and Mental Health.
• In partnership with Stepped Care Solutions, continued supporting a new flexible system of mental health care with open access to a range of resources and services (the Stepped Care (SC) 2.0 model), across Newfoundland and Labrador, Nova Scotia, Northwest Territories and Prince Edward Island. In collaboration with partners, MHCC published the final report on SC 2.0 model implementation in the Northwest Territories titled Partnering Together for Person-and-Family Centric Care. As a result of the SC2.0 model implementation, the Government of the Northwest Territories announced a 79% reduction in average wait times for mental health counseling, along with same-day access to care options.
• Continued championing the National Standard on Mental Health and Wellbeing for Post-Secondary Students by assisting more than 20 post-secondary institutions in tracking their progress with the Standard by using the Campus Mental Health Action Tracker.
• Released a series of policy resources in response to the COVID-19 pandemic, including: Strategies for Post-Secondary Student Mental Health during COVID-19; Examining Two Psychosocial Factors in Long-Term Care During COVID-19 Pandemic; Emerging Evidence on Post-Secondary Student Mental Health During the COVID-19 Pandemic: Guiding Your Work with the National Standard.
• Continued expanding the Roots of Hope community-based suicide prevention initiative by implementing the Early Adopters Program and encouraging the second cohort of new communities to join the program, an estimated impact on more than 3 million Canadians.
• Advanced the work of the National Collaborative for Suicide Prevention, in support of the National Suicide Prevention Action Plan developed by the Public Health Agency of Canada.
• Published Mental Health and Suicide Prevention in Men and Key Takeaways document on men's mental health and suicide in Canada, advancing Collaborative Mental Health Care in Canada's Primary Care Settings: A National Quality Framework with Recommended Measures, Mental Health and Substance Use During COVID: Spotlights on Suicide Ideation and Substance Use and Spotlights on 2SLGBTQ+ Communities in Canada.
• Advanced the work on the evaluation, replication, and scale-up of opioid-related stigma reduction interventions by identifying four new pilot sites to implement the revised Trauma and Resiliency Informed Practice curricula that has been informed by Elders and Indigenous Knowledge Keepers.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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

Start date

June 18, 2003

End date

Ongoing (Contribution)

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

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 12: Promoting Minority Official Languages in Health Care Systems

Purpose and objectives of transfer payment program

The Official Languages Health Program (OLHP) 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 bilingual health services in the language of their choice. Through the implementation of contribution agreements and micro-grants, Health Canada supports investments that improve the active offer of health services for OLMCs, through training and retention of health care providers, networking activities and innovative projects that increase access to health services for OLMCs.

Results Achieved

Program funding supported training and retention of 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 their official language of choice. Key results include:

• For Francophone minority communities, the Association des collèges et universités de la francophonie canadienne (ACUFC)-Consortium national de formation en santé (CNFS) registered 1038 additional enrollments and 838 additional graduates in 108 different health training programs. In addition, according to the results of a survey conducted in June 2022, 95% of newly graduated health professionals surveyed were employed in OLMCs, which made it possible to increase the number of health human resources available to meet the needs of Francophone minority communities. It should also be noted that 97% of respondents reported that they offered services in French in their workplace.
• For English-speaking residents of Quebec, between April 1, 2022 and November 30, 2022, McGill University enrolled over 1,125 health and social services professionals in its English language training program to better serve English-speaking patients in Quebec. A total of 916 healthcare professionals successfully completed their English language training, representing a completion rate of 81%. For courses aimed at improving the French language proficiency of English-speaking health professionals, McGill University registered 103 participants, and of these, 78 completed their training, a completion rate of 76%.
• In addition, as part of the Recruitment and Retention Program for Health and Social Services Professionals, McGill University allocated scholarships and internships to bilingual students pursuing full-time studies in health and who agree to return to or stay in a region of Quebec for a minimum of one year and work in a public health service establishment. Of the 67 scholarship applications, 56 were granted.
• The Société Santé en français continued to support Francophone minority communities (outside Quebec), and the Community Health and Social Services Networks supported English-speaking minority communities (in Quebec) by undertaking networking initiatives that mobilized partners in health to improve access to health services within OLMCs. In 2022-2023, a total of 39 community health networks and 12 satellites across Canada collaborated with various stakeholders to improve OLMCs' access to health services for OLMCs in their official language of choice. These networks provided support, resources, tools, and better practices to inform the planning, development, and implementation of initiatives aimed at meeting the needs of Francophones outside Quebec and Anglophones in Quebec.

OLHP also supported innovative projects to improve access to health services for OLMCs in relation to F/P/T health priorities such as mental health and home care.

• In Quebec, the OLHP supported a "Geodata" project, led by the Jeffery Hale-Saint Brigid hospital to establish a health profile of the English-speaking population to map their health needs.
• In Yukon, the bilingual Constellation Health Centre opened on November 7, 2022, with a team of interdisciplinary health professionals trained on how to use the Interpreter-on-Wheels technology (a mobile device that provides professional voice and video translation). Policies and work standards are in place to address francophone clients' needs and data is being collected to ensure that Francophones in the Province have access to health services in the official language of their choice.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

Action Plan for Official Languages 2018-2023: Investing in our Future.

Summary of Findings:

The evaluation found that the Action Plan:

• Supported access to health and justice services;
• Supported community voices, community culture and gathering spaces, Francophone immigration, second language learning and Statistics Canada's Language Statistics Section
• Maintained English and French as a second language; and,
• Promoted a bilingual Canada through opportunities for youth.

However, the analysis of the Plan's effectiveness was limited since the evaluation was conducted midway through the Plan.

Engagement of applicants and recipients in 2022-23

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

Start date

April 1, 2000

End date

Ongoing

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 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. Health Canada provides $5 million annually to Canadian Blood Services (CBS) (since 2000) to support research and development to improve the safety and supply of the Canadian blood system. Health Canada also provides $3.58 million annually to CBS (since 2008) to support the development of clinical practices and professional/public education materials as they relate to organ and tissue donation and transplantation. CBS is the sole recipient of the Program funding.

Results Achieved

The Program has generated numerous knowledge products and learning events and played a role in public education, engagement and awareness. It also played a significant role in training highly qualified people in important areas such as basic and applied research, developed collaborative arrangements, established partnerships and identified and responded to emerging issues related to organ, tissue and blood systems, in collaboration with P/Ts as appropriate which informed changes to practices and standards.

Organ and Tissue Donation and Transplantation

In 2022-23, the Program continued to support CBS by providing $3.58 million to work with partners and stakeholders to influence and improve system performance through development and dissemination of leading practices, professional and public education, engagement and awareness materials. In 2022-2023, CBS supported the development of 56 knowledge products and 74 learning opportunities for professionals, strengthening the foundations of the system and contributing to overall system performance both now and in the future. Additionally, CBS supported the development of 45 knowledge products and 11 learning opportunities for the public. The public education and awareness activities aim to change donation culture in Canada. Examples include:

• Promoting engagement and collaboration between 2 communities of practice (i.e., the Donation Physician Network and the Donor Coordinator Network) through 2 webinars: "Voices, Rights and Healthcare Equity" and "Organ Donation Following MAID: A Scoping Review." Newsletters were distributed to the Donation Physician Network and to the Donor Coordinator Network.
• Increasing the willingness of Canadians to donate organs and tissue by producing significant knowledge products and learning opportunities for children, youth, students, and teachers, and disseminated through the Education portal, including the creation of a network of champions and a toolkit to promote the education portal, new resource pages for the portal, and toolkits and outreach materials for teachers.
• Supporting annual national activities, such as the National Organ and Tissue Donation Awareness Week Green Shirt Day, and an annual living donation campaign.
  • Planning and preparing the launch of a new national campaign focused on deceased donation which will have its own independent brand ("Leave Well").

The Organs, Tissues, and Blood Program continued to work with stakeholders to improve organ and tissue donation and transplantation through the Organ Donation and Transplantation Collaborative, develop a pan-Canadian governance framework, and acknowledging important developments in redefining brain death; identifying underserved populations; and legislative reforms to organ and tissue donation.

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.

In 2022-23, the Program continued to support CBS by providing $5 million to help maintain and increase the safety, supply and efficiency of the Canadian blood system by advancing innovation and maintaining Canadian capacity in transfusion science and medicine. CBS continued to foster research, facilitated dissemination and application of knowledge, educate the next generation of scientific and health care experts, and engaged with an interdisciplinary network of partners in Canada and beyond. The following activities helped advance innovation and maintained Canadian capacity in transfusion science and medicine:

• Enabling basic research studies on blood products, stem cells, and transfusion medicine helped increase the transfusion medicine and science knowledge base, ensuring safety and sufficiency within the blood system.
• Establishing the scientific basis for changing the blood donor eligibility criteria by asking gender neutral, sexual behaviour-based screening questions of all donors contributed to reducing barriers when donating blood.
• Reducing pathogens in blood components used in Canadians hospitals provided a further safeguard against transfusion-transmitted infections.

CBS 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 and blood and plasma specific to men who have sex with men (MSM), and other individuals impacted by donation deferral policies. The Program provided support to approximately 32 research projects in 2022-2023. Examples of funded research projects include Addressing racial disparity in blood, stem cell, and organ and tissue donor pools, Establishing national best practices for out-of-hospital blood transfusion, Mathematical Modelling – Comparing HIV Risk Between MSM Donation Strategies which published several journal articles in 2022-23, including HIV incidence and compliance with deferral criteria over three progressively shorter time deferrals for men who have sex with men in Canada, and Assessing acceptability, understanding and effectiveness of alternative screening questions for current donors which published Sexual risk behaviour questions: understanding and mitigating donor discomfort.

CBS' research and education network published 198 peer-reviewed and 57 non peer-reviewed publications. Network members delivered 360 conference presentations to local, national and international audiences. The organization led or delivered in partnership more than 79 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. 97% of those stakeholders reported acquiring knowledge and skills by attending these events, an increase over the prior year.

Budget 2021 provided $20 million over 2 years, starting in 2022-23, for the construction by CBS of 6 new plasma collection sites across the country by 2023-2024. In 2022-23, 3 plasma collection sites were constructed in Abbotsford, British Columbia, and Vaughan and St. Catharines, Ontario.

Health Canada provided a further $510,000 over 2 years to CBS starting in 2022-2023 to address create a finalized management plan in the case of immunoglobulin shortages in Canada. In 2022-2023, the literature review was completed to inform the ethical framework and a stakeholder engagement platform developed to allow for future activities.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

Evaluation of Health Canada's Blood Research and Development Program Activities 2017-18 to 2021-22.

Summary of findings:

The evaluation found that the Blood Research and Development Program has supported Canadian Blood Services (CBS) in training many highly qualified personnel in transfusion science and medicine, funding research to enhance the safety and effectiveness in the blood system, establishing research networks to foster collaboration, and developing and maintaining learning opportunities for blood researchers. CBS and their funded researchers have also focused on identifying emerging issues and on designing their research program to address those most pressing for Canadians.

Engagement of applicants and recipients in 2022-23

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) 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

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

2021-22

Link to the 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 the provinces and territories in improving 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 which was jointly agreed to by F/P/T 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; and,
• Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.

Similarly, on home and community care, F/P/T 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; and,
• Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.

Governments also agreed to develop a focused set of common indicators to measure progress on these priority areas. 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 that were implemented over the first years of the Program. CIHI will continue to work with governments across Canada to update and report on these indicators annually.

Following agreement on the Common Statement of Principles for Shared Health Priorities in 2017, the federal government negotiated and signed the first of two sequential bilateral agreements with all 13 provinces and territories which set out details of how each jurisdiction is using federal investments to improve access to home and community care and mental health and addiction services (2018-19 to 2021-22). One-year extensions of the Bilateral Agreements for Home and Community and Mental Health and Addiction Services were implemented for 2022-23.

Results Achieved

Through these investments, improvements were made to increase access to home and community care as well as mental health and addictions services. This will lead to better health outcomes and a more sustainable health care system, as care is shifted from expensive hospital care to more patient-centric settings in the home and in the community. For example, enhanced infrastructure through improved digital connectivity, and the use of remote technology, care providers are able to coordinate and plan appropriately for their patients, resulting in more Canadians getting the care they need where they want it. These investments could also have a broader, positive impact on Canada's economy, by making the health care system more sustainable in the long term, and by enhancing workforce productivity and social participation.

The one-year extensions build on progress achieved through the first five years of this federal investment, by:

Improving access to mental health and addictions services through:

• Strengthening capacity of family health services to respond to mental health and addictions;
• Providing culturally informed care services within Indigenous communities; and
• Expanding access to integrated youth services in schools and by using virtual care;
• The agreements are also strengthening home and community care by supporting the delivery of specialized community services programs, including:
  • Increasing access to in-home respite supports;
  • Community-based professional and caregiver supports; and,
  • Improving community-based palliative care services.

The Government of Canada will continue to work closely with provinces and territories to support them in accessing the remaining four years of funding available for home and community care, and mental health and addictions, and to improve health care services across the country.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

Health Canada officials undertook numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with Provinces and Territories 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.

Substance Use and Addictions Program

Start date

December 4, 2014

End date

Ongoing (Contribution)

Type of transfer payment

Contribution

Type of appropriation

Estimates

Fiscal year for terms and conditions

2018-19

Link to the departmental results

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 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 2022-23, Health Canada invested over $140 million towards 310 projects through SUAP. Cumulatively, these projects have delivered a combined total of over 60,200 knowledge products and learning opportunities. In the first 6 months of 2022-23 (April to October 2022), these products/opportunities reached approximately 8.7 million Canadians/Stakeholders. This includes: adults and youth (who use drugs and/or who are at risk, peers, Indigenous Peoples, 2SLGBTQI+, racialized, Fetal Alcohol Spectrum Disorder (FASD), low-income); front-line care teams and healthcare professionals (Physicians/Nurses/Pharmacists); Federal/Provincial/Territorial governments; Regional/Municipal governments; school boards/trustees; community partners (public safety, veterans); non-profit organizations; program designers; policy makers; and the general public. Projects funded include prevention, harm reduction, treatment, or a combination of these.

In addition to providing funding to many community, regional and national organizations, Health Canada also provides SUAP funding to the Canadian Centre on Substance Use and Addictions (CCSA) to fund research on the impact of cannabis legalization and regulation as well as the Mental Health Commission of Canada (MHCC) to inform and advance research on the impacts of cannabis use on the mental health of Canadians.

Tobacco

In support of Canada's Tobacco Strategy, Health Canada funded 8 projects through SUAP 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 512 knowledge products (such as standards/guidelines, tools, toolkits, marketing ads, and reports), delivered 210 learning opportunities (such as training, presentations, workshops, and webinars) over their project lifespans, and were accessed by Canadians over 23,000 times in the first 6 months of 2022-2023 (April to October 2022).

Controlled Substances

282 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. These projects cumulatively delivered over 50,610 knowledge products and learning opportunities, reaching almost 2 million Canadians/stakeholders in the first 6 months of 2022-2023 (April to October 2022).

• Safer Supply – 29 safer supply projects located in British Columbia, Ontario, New Brunswick, and Quebec provided pharmaceutical-grade drugs as an alternative to the contaminated street drug supply to help prevent overdoses and save lives as part of a continuum of care that include other substance use treatment and harm reduction services.
• Pain – 20 projects focused on improving the lives of people living with chronic pain. Projects focused on a variety of measures such as opioid use disorder treatment, capacity building, research, public education, and service delivery.
• Naloxone – 4 national projects, led by St. John's Ambulance, the Advanced Coronary Treatment Foundation of Canada, and the Canadian Red Cross to distribute naloxone kits and provide opioid overdose response training. Since the initial investment in these projects, they have been able to train nearly 1.5 million Canadians in overdose response and have distributed more than 69,000 nasal naloxone kits.

Cannabis

In 2022-23, Health Canada funded 23 projects through SUAP 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, service providers, 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 reported approximately 6.6 million individuals in the first 6 months of 2022-23, through a total of 4,072 cannabis-related knowledge products and learning opportunities, such as posters, videos, campaigns, networks, youth events, webinars, and training sessions.

Canadian Centre on Substance Use and Addictions

Through SUAP, Health Canada also provided $10 million to the Canadian Centre on Substance Use and Addiction (CCSA) to address substance use issues in Canada. With this funding, CCSA advanced work in the substance use sphere while contributing to federal priorities by: informing national stakeholders on substance use trends and emerging issues; creating and disseminating tools and relevant resources targeting specific groups working with partners to develop best practices/innovative approaches to care; and supporting the development of standards and resources to improve workforce capacity. Over the past year, CCSA:

• Advanced national work on reducing alcohol related harms and released Canada's Guidance on Alcohol and Health report
• Mobilized and disseminated knowledge and key information to policy makers across Canada by updating the Canadian Substance Use Costs and Harms Report
• Produced timely information on emerging drug trends and risks through Canadian Community Epidemiology Network on Drug Use Bulletins and released a series of documents on the use, harms and effects of drugs to support sound policy decisions.
• Enhanced and continued to disseminate Competencies for Canada's Substance Use Workforce
• Convened gatherings with more than 3500 participants to share resources/best practices, discuss emerging issues, and provide training.
• Advanced partnerships with key stakeholders (e.g., school boards, universities, hospitals, journalists, People with Lived and Living Experience, and youth) to develop relevant resources. Some examples include Understanding Substance Use – Educator's Guide, Knowing Your Limits with Cannabis, and ED Visits for Alcohol, Cannabis, and Opioid Use Among Youth. In 2022-23, CCSA's resources were downloaded approximately 180,000 times.
• Expanded, and standardized drug-impaired driving data resource by recommending 34 indicators (e.g., data on potential presence and types of drugs in hospitalized drivers) in collaboration with law enforcement, medical, and transportation sectors to address drug-impaired driving issues.
• Provided policy and expert advice to the Government of Canada via the Standing Committee on Health.

Health Canada, through SUAP, provided a final annual funding amount of $2.3 million in fiscal year 2022-23 to CCSA for cannabis research to evaluate the implementation and impact of cannabis legalization to build evidence to inform future policy development. CCSA helped fill knowledge gaps by releasing 5 knowledge products, publishing 3 articles in peer-reviewed journals, and hosting 8 knowledge mobilization events and presentations. Their work covered a wide range of topics including cannabis use and driving, public safety and cannabis, cannabis home cultivation, development of a standard THC unit, cannabis-related poisoning in the pediatric population, and cannabis and mental health. CCSA, with the Canadian Institute of Health Research organized an end-of-grant workshop in June 2023 to share results and discuss future cannabis policies.

Mental Health Commission of Canada

In 2022-23, Health Canada directed $1.6 million in SUAP cannabis funding to the Mental Health Commission of Canada 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. The commission focused its efforts on knowledge mobilization activities such as seminars, panels, virtual and community dialogues to amplify and disseminate previously created resources that contributed to addressing cannabis and mental health of priority populations, above all racialized minority populations, veterans, indigenous communities and youth.

Mental Health Commission of Canada collaborated with CCSA, completing two initiatives and organizing joint knowledge sharing events with grantees and research teams. The two organizations produced user-friendly content and scientific findings which open avenues for future community-based research projects.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

Horizontal Evaluation of the Legalization and Strict Regulation of Cannabis.

Summary of findings:

The evaluation found that a variety of evidence-based information resources and outreach activities had been developed through SUAP funding to support public awareness of risks associated with cannabis use, as well as substance-related harms in priority populations more generally. Stakeholders and partners interviewed were also positive about the work of CCSA and the Mental Health Commission of Canada, which was supported by SUAP funding, to advance cannabis research priorities and provide reliable information.

Engagement of applicants and recipients in 2022-23

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 also explored the development of theme-based Communities of Practice (e.g., peer workers, chronic pain) with partners within and external to the federal government.

Health Canada officials continued to undertake numerous exchanges (meetings, phone calls, e-mails and knowledge transfer activities) with SUAP 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.

Territorial Health Investment Fund

Start date

April 1, 2014

End date

March 31, 2033

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. In 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 supports territorial efforts to innovate and transform their health care systems and help offset costs associated with medical travel. The expected results for Northerners are: improved access to health care services; health care needs being met; and improved health status. Initiatives that launched in 2021-22 and continued into 2022-23 included:

• The Northwest Territories undertook work under its Primary Health Care Reform Initiative, including associated demonstration projects, and continued to implement a System Sustainability Plan, with a goal of strengthening health care service delivery in the territory.
• The Yukon continued to roll out new cultural safety and humility training, worked towards the launch of integrated and collaborative health service delivery models, supported the development of virtual care options to make health care more accessible from Yukoners' homes and communities, and continued to support the implementation of 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 continued to work in priority areas of health human resources and capacity building (such as strengthening and supporting participation of Nunavut Inuit paraprofessionals within the health workforce), continued development of the tuberculosis program, and continued to implement the oral health program.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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

Chemicals Management Plan Engagement and Outreach Contribution Program

Start date

April 1, 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 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 24: Health Impacts of Chemicals

Purpose and objectives of transfer payment program

The purpose of this Program is to support the capacity of people living in Canada, with an emphasis on disproportionately impacted populations and Indigenous peoples, to engage in the Chemicals Management Plan (CMP) and environmental health programs, allowing for a broad range of expertise and opinions to be heard and considered. The Program also supports partnerships to increase outreach to people living in Canada about environmental health issues, using tailored tools and messaging. This will include raising awareness of the impacts of chemicals on human health and how to reduce the risks.

Results Achieved

This Program improved Canadian capacity to participate in the implementation of the CMP and broader environmental health initiatives. It also increased access to information and funding to minimize environmental health risks through funding projects that helped build capacity of Indigenous peoples and other disproportionately impacted populations to participate in the CMP and broader environmental health initiatives. The engagement activities that were carried out as a result of the contribution funding also helped inform Program decisions and activities.

For example, one Indigenous organization supported by the Program provided an opportunity for community members to voice their concerns and needs around water quality and access to clean water. Qualitative data from elders and language holders was collected to answer water quality-related questions.

In another project, an Indigenous organization surveyed First Nations community members (men, women, elders, youth) to better understand exposure to chemicals during domestic and traditional activities carried out by community members. As part of their project, they also hosted forums with government staff where the communities had the opportunity to share their concerns and ask questions on chemical exposures and chemicals management.

As a result of funding provided to a civil society organization, a Toxics Caucus was established. This provided a mechanism to bring the voices of a wider range of Canadians to engage in the CMP. Funding also allowed for civil society to come together in a bilateral meeting with the government and discuss overarching and common chemicals management priorities.

Additionally, the Department funded partnerships with local community organizations to expand the scope of access to information on how to reduce the risk to health from environmental issues for people living in Canada, using customized tools and approved CMP messaging.

For example, Health Canada funded a community organization to develop a range of knowledge products for newcomers, young parents, and Indigenous families. Information on healthy cleaning kits was shared through weekly social media posts. Information was also shared on various topics such as hand washing, lead in drinking water, hazard symbols, storage and disposal of chemicals, parabens, radon gas, carbon monoxide and fire safety and home ventilation. The community organization also provided in-person Healthy Home workshops that were offered with simultaneous interpretation in six languages.

A second project aimed at young parents created a bilingual website on how to reduce chemical exposure at home. The Healthy Habits for Healthy Homes website included information on the cleaning versatility of common household products, non-stick coatings, fragrances and plastics as well as instructions on how to prepare non-toxic cleaning supplies.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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, both formally and informally, and solicited input on engagement activities at key points in the process. Applicant and recipient consultations were structured to support the design of projects that will maximize reach and impact. Health Canada also provided expertise and support throughout project delivery and performance measurement of results achieved, including engagement in the form of partnerships for outreach activities.

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

2023-24

Link to the departmental results

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

Participating companies provided interim reports on their progress developing innovative tools and solutions to Health Canada's challenges launched in 2019. These reports outlined how their prototypes meet the established timelines and benchmarks laid out in their funding agreements. All four showed significant progress and were given their final grant allocation in 2022-23, with expectations that their final report be delivered in 2023-24. This has also demonstrated that the program has successfully created new Canadian Intellectual Property, supported the commercialization of early-stage research and development, and increased the employment of highly skilled workers in the Canadian innovation ecosystem.

Additional results will be reported under Innovation, Science and Economic Development Canada's monitoring and evaluation processes which encompass the entirety of the Innovative Solutions Canada Program, including Health Canada's participation therein.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

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.

Radon Outreach Contribution Program

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 the 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 the Radon Outreach Contribution 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 the radon levels where necessary.

Results Achieved

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, 29 proposals have been funded. They 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 2021 Households and the Environment Survey showed that 69% 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 2023 survey will be available in 2025.

Indicator 2: The 2021 Households and the Environment Survey showed that 9% 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 2023 survey will be available in 2025.

Findings of audits completed in 2022-23

No audit was completed in 2022-23.

Findings of evaluations completed in 2022-23

No evaluation was completed in 2022-23.

Engagement of applicants and recipients in 2022-23

The applicants and recipients of the Radon Outreach Contribution Program were engaged and consulted through face-to-face and virtual meetings at relevant conferences and workshops and by email and telephone. Applicant and recipient consultations were structured to support them in designing programs that maximize reach and impact and provide expertise and support throughout the delivery and evaluation of their programs, with an overarching goal of raising awareness and promoting action to reduce radon-induced lung cancer in Canada.

Gender-Based Analysis Plus

Section 1: Institutional GBA Plus Governance and Capacity

Governance

Health Canada's Sex- and Gender-Based Analysis Plus 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. It provides a framework to strengthen the integration of sex, gender and other intersectional factors^{Footnote 1} in the externally and internally facing work of the Department. In 2022-23, Health Canada made substantial progress in the first year of the renewal of the Sex- and Gender- Based Analysis Plus (SGBA Plus) Action Plan through the following actions:

• Executives across the Department were engaged to increase their awareness about their responsibilities under the new action plan, and to create a cultural shift in valuing the importance of intersectional SGBA Plus.^{Footnote 2}
• Health Canada branches developed and implemented Branch Integration Plans (BIPs) for SGBA Plus, in accordance with the Action Plan. There was overall alignment between the BIPs and the Action Plan strategies so that there was consistency in the objectives and outcomes between the branches and the Department.
• Health Canada established the SGBA Plus Integration Network as a coordinating instrument in advancing the implementation of the SGBA Plus Action Plan through branch integration planning.

Health Canada advanced its work to establish a clear accountability process for SGBA Plus integration in regulatory proposals, through a broad internal consultation process. Health Canada management demonstrated their corporate responsibility to effectively incorporate intersectional SGBA Plus into regulations.

Capacity

In 2022-23, Health Canada made substantial progress in advancing Departmental SGBA Plus capacity through the following actions:

• Implemented a communications plan focused on increasing employee understanding of SGBA Plus and associated concepts (e.g., diversity, intersectionality, inclusion) and how it applies to the work of Health Canada employees.
• Refined and developed communication platforms and materials to increase accessibility and to incorporate diversity and intersectionality awareness, tools and resources.
• Developed and delivered information sessions throughout the year (in town halls, regular learning events, policy, program and regulatory network sessions).

Health Canada strengthened SGBA Plus knowledge and capacity with enhanced learning opportunities, tools and resources to increase SGBA Plus competency. More particularly, the Department advanced the objectives of this strategy in 2022-23 by:

• Delivering 16 information and training sessions to branches, directorates and/or horizontal networks ranging from 25 to 420 participants.
• Organizing and hosting a virtual capacity-building event on disaggregated data with 450 participants.
• Developing and launching a Health Canada SGBA Plus Learning Path. This provided management and employees a framework to guide the development of SGBA Plus capacity within the Department to ensure that SGBA Plus is used in the framing, development and implementation of all Department initiatives. The learning path was developed in collaboration with equity-seeking networks, branch representatives, the accessibility readiness team, and others to ensure an intersectional and diverse perspective.
• Hosting 3 SGBA Plus Network learning events on SGBA Plus best practices to enhance the level of expertise of branch SGBA Plus representatives and communities.
• Developing training presentations to support continual learning, including the design of SGBA Plus 101, 201 and 301 courses. The 101 course is available as a self-paced learning course while the 201 and 301 standards are adapted for each delivered learning session.
• Developing new SGBA Plus tools such as the "Frequently Asked Questions" and SGBA Plus Lexicon.

In 2022-23 Health Canada engaged with equity and inclusion experts, functional committees, Women and Gender Equality Canada, Indigenous Services Canada, and other federal departments on the roll-out of SGBA Plus Action Plan initiatives. As a result of this collaborative work, knowledge and capacity has increased to provide better clarity on messaging and learning and to support the integration of SGBA Plus as an intersectional lens.

Engagement and collaboration activities included the following:

• Collaboration with internal equity-seeking networks to broaden internal understanding on the best terminology to use related to their own reality. Health Canada produced an evergreen lexicon of terminologies in 2022-23, which will be updated as engagement with equity seeking networks and the 2SLGBTQI+ Secretariat at Women and Gender Equality Canada continues.
• Engagement and collaboration with Indigenous Services Canada and Crown-Indigenous Relations Canada on the integration of a culturally relevant lens to SGBA Plus at Health Canada. This work is ongoing and will be continued into 2023-24 as Indigenous organizations develop their frameworks to support this work.
• A survey of Health Canada employees in 2022 indicated that 88% (up 12% from 2020) of employees were aware of the Department's SGBA Plus Policy and that 74% (up 15% from 2020) were aware of specific Health Canada SGBA Plus resources that they can use in their work. Furthermore, 51% of employees consistently applied SGBA Plus to their work, representing an increase of 21% over 2020.

Highlights:

Health Canada surveys Canadians every four years to measure the public impact of its outreach and awareness activities. 2,206 individuals responded in 2023. This sample was weighted to ensure that the final data reflects the proportion of the adult population of Canada by region, age, and gender, according to the census. This survey provided insight into whether variances exist between the key groups regarding outreach and awareness activities and informs future program strategies.

The Department reviewed its privacy-related business practices and tools to ensure that SGBA Plus was incorporated wherever possible and appropriate. This included updates to Privacy Impact Assessment templates (PIA), Privacy Protocol procedures, Privacy Breach Response Products and Preliminary Risk Assessments. In 2022-23, 5 PIAs and 49 privacy risk assessments were completed using these updated tools and Health Canada responded to 119 privacy occurrences (97 of which were determined to be breaches) using updated tools that include SGBA Plus assessments.

In 2022-23, Health Canada expanded its Employee Assistance Program to collect more data on SGBA Plus. Given the increased risk of individuals being identified because of the additional collection of information from SGBA Plus questions, the Department updated the consent requirements, a privacy notice, provided information on the rules and responsibilities around the disclosure of personal information, and provided advice on the data security practices that are applied to all personal information that is collected.

Universal Washrooms

When planning to build Universal Washrooms using a SGBA Plus lens, Health Canada consulted with the departmental equity networks on designs and sought their input on details. In addition, we utilized Public Services and Procurement Canada's standards, best practices and lessons learned on implementation of Universal Washrooms in federal buildings and leased locations. Health Canada is applying a consistent approach with projects and has built Universal Washrooms (defined as single-stall, gender-neutral, with enhanced accessibility features) in Ottawa.

Chemicals Management Plan

The implementation of the new Chemicals Management Plan contribution program has strengthened the capacity of people living in Canada to access environmental health information, and to engage with government officials on chemicals management issues. New voices and diverse perspectives were heard at meetings funded by the contribution program including Indigenous community members and Elders, and organizations representing those disproportionately impacted. Funding also supported community partnerships to develop tailored tools and messaging (in-person and online) for newcomers to Canada, young families, Indigenous families, and others, in order to increase public outreach about harmful chemical exposures.

Section 2: Gender and Diversity Impacts, by Program

Core Responsibility 1: Health Care Systems

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

Program Goals: The policy advice and contribution funding provided by Health Canada is instrumental in advancing the accessibility, affordability and appropriate use of drugs and medical devices. This supports the government's intention to provide an accessible, high-quality, sustainable health system so all Canadians have access to the medications and medical devices they require regardless of income, gender or age.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Second group: somewhat benefits low-income individuals (somewhat progressive)
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• While no group is specifically targeted to benefit from the program more than others, the program's intention to make drugs and medical devices more accessible, affordable and used appropriately may directly or indirectly benefit certain groups. More affordable medications that are used appropriately would reduce the out-of-pocket costs for prescription medications for Canadians and provide greater impact on Canadians with lower income and those with a heavier burden of disease.

Key Program Impacts on Gender and Diversity:

Data gaps are particularly present for racialized 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 racialized communities, who experience higher rates of Cost-Related Nonadherence (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:

A 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 being incorporated to varying degrees. Various health-data initiatives are underway that will seek to improve the collection of disaggregated data with an emphasis on key populations where possible. One such initiative was a survey conducted by Statistics Canada from March 2020 to May 2021 on Access to Health Care and Pharmaceuticals During the Pandemic. The purpose of this survey was to better understand how health care service disruptions affected Canadians during the COVID-19 pandemic. The survey covered topics such as access to pharmaceuticals, impacts of delayed health care, barriers to receiving health care and general health status.

Health Canada is working with the Canadian Agency for Drugs and Technology in Health (CADTH) to improve performance indicators on its products and services as part of the ongoing contribution agreement with CADTH, 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. CADTH's 2022-25 Strategic Plan will also focus on improving its engagement with Indigenous peoples, as well as other marginalized communities, recognizing the history of discrimination and abuse that these groups have faced in the Canadian health care system. As Health Canada and CADTH work to renew its contribution agreement for 2024-25, this will be a key focus of work.

Program Name: Brain Research

Program Goals: The Canada Brain Research Fund program supports Canadian neuroscience by increasing research capacity that strategically advances the prevention, diagnosis and treatment of brain health disorders identified by stakeholders. Specifically, Health Canada provides funding for the Brain Canada Foundation (Brain Canada) which fundraises to match the federal contribution with donations from its range of private, public, and charitable-sector donors and partners.

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

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Percentage of research applicants receiving funding through the Canada Brain Research Fund falling into diverse groups including women, men and gender-diverse people, Indigenous peoples, visible minorities and people with disabilities	Male: 52% Female: 42% Other gender: 0% Prefer not to answer: 4% Person with a disability: 3% Visible minority: 26% Indigenous identity: 2% 2SLGBTQI+: 3%	2022-23 Applications to Brain Canada's research competitions	Of the 86 grant recipients in FY 2022-23, 54 replied to the Self-Identification Questionnaire. The responses were not obtained from all recipients because the questionnaire remained optional considering that it is not implemented across partner-led competitions. Respondents also had the option to skip questions instead of selecting 'prefer not to answer'. Brain Canada is planning to make this a mandatory component of the application process for Brain Canada led competitions and encourage partners to adopt the questionnaire when possible.
Percentage of research projects focused on diverse groups including women, men and gender-diverse people; Indigenous peoples; visible minorities; and people in various age groups	74%	2022-23 Applications to Brain Canada's research competitions	This indicator is calculated by discrete research projects, even though a single project may focus on multiple diverse groups.

Other Key Program Impacts:

Select research projects are specifically geared to examine sex and gender differences, and/or advance knowledge to improve health outcomes for people in diverse population groups. In 2022-23, Brain Canada funded projects targeting specific sub-populations including: youth with mental health disorders, adults aged 50+, and individuals with Amyotrophic lateral sclerosis.

Brain Canada requires its applicants to describe how SGBA Plus considerations will be integrated in their proposed projects and to demonstrate the anticipated impacts of the work. If applicants do not include SGBA Plus considerations, they are required to provide strong justification from scientific literature or preliminary data to support such decision.

In addition to ensuring that SGBA Plus is considered at the proposal and design stages, Brain Canada continues to support applicants from diverse backgrounds. In 2022-23, Brain Canada jointly launched a new competition: the Personnel Awards for Black Scholars. An additional competition targeting Indigenous scholars is planned for 2023-24.

As another way to ensure impacts are benefitting individuals across the country, Brain Canada is in the process of expanding its targeted outreach and communications efforts to geographic areas of interest (including the Maritimes and Prairies). Enhanced visibility in these regions will help Brain Canada attract new donors and partners to support its activities.

GBA Plus Data Collection Plan:

In 2022-23, Health Canada continued to support Brain Canada in their transition to collect a greater scope of disaggregated data. As an outcome of the 2022 program evaluation, a federal stakeholder and funding recipient working group was struck to respond to common challenges of performance measurement and knowledge translation in the brain health sphere. Several of the meetings targeted best practices in SGBA Plus data collection methodologies and advancements to integrate diversity considerations in fundamental research and science activities. Select strategies and principles that resulted from these meetings will be integrated into the program's 2023-24 Performance Measurement Strategy.

In addition, Brain Canada continues to collect demographic data of its applicants using a Self-Identification Questionnaire. In collaboration with an external consulting team, Brain Canada launched a review of the questionnaire in late 2022-23 to support the development of their SGBA Plus and Equity, Diversity and Inclusion Action Plan and ensure that the organizational approaches are aligned with current best practices. The review findings will be shared with Health Canada in 2023-24.

Program Name: Canada Health Act

Program Goals: 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.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

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.

In March 2023, the former Minister of Health announced the intent to issue a new interpretation letter under the Canada Health Act, which will aim to integrate virtual care services and health care providers delivering physician equivalent services into P/T health care plans. This policy aims to make access to these services more universal and equitable for all eligible residents of P/Ts but may also indirectly lead to improved health outcomes for low-income individuals and people living in rural and remote areas. This work is also expected to advance the Poverty Reduction, Health and Well-being pillar of Canada's Gender Results Framework.

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 payments in March 2023, totalling $97,650, as a result of patient charges that occurred in 2020-21.
• Ontario is in the process of implementing a Reimbursement Action Plan with 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 regard to anti-indigenous discrimination and racism in the Canadian health care system.

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

Program Goals: Through the Canadian Partnership Against Cancer (CPAC), 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.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Fourth group: somewhat benefits high-income individuals (somewhat regressive)
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts on Gender and Diversity

Statistics	Observed Results	Data Source	Comment
Percentage of cancer patients satisfied with access to care, by sex and provincial jurisdiction	BC: Male: 70% Female: 70% AB: Male: 74% Female: 74% SK: Male: 74% Female: 73% MB: Male: 74% Female: 74% ON: Male: 72% Female: 70% QC: Male: 70% Female: 66% NS: -- PE: Male: 73% Female: 73% NL: Male: 73% Female: 76% NB: --	Ambulatory Oncology Patient Satisfaction Survey	The Ambulatory Oncology Patient Satisfaction Survey is no longer used in most jurisdictions. CPAC is working with jurisdictions to explore common patient satisfaction measures across various survey tools in use.
Smoking prevalence in cancer patients by household income quintile	Q1: 21.0% Q2: 16.7% Q3: 15.0% Q4: 13.9% Q5: 11.3%	Canadian Community Health Survey (2019)	Q1 represents the lowest income and Q5 the highest income. Data is collected every 2 years. This data is from 2019 and excludes the Territories. New data is anticipated to be available by June 30, 2023.

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 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 (CSCC).

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, which have meant that not all Canadians have benefitted equally from the efforts to implement the CSCC. The first indicator above measures the extent to which patients across Canada are satisfied with access to care. The data are 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 all 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.

GBA Plus Data Collection Plan:

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 Report every June 30th.

The Performance Report is an evergreen package of documents consisting 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 endeavors to maintain its commitment 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 where appropriate. This includes the application of SGBA Plus and strengthening and promoting the collection of sex and gender disaggregated data.

Additionally, CPAC has started publicly reporting on progress made against the priorities of the CSCC. This will be expanded upon in 2023-24 to include functionality to assess P/T progress.

Program Name: Digital Health

Program Goals: Federal funding for Canada Health Infoway (Infoway) supports the organization's work with jurisdictions and other stakeholders in the development and adoption of digital health technologies across Canada. Though surveys commissioned by Infoway and support of digital health technologies that are adopted by P/T health systems, Infoway also works with P/Ts and other partners to consider whether and how sex and gender-based factors could inform their work.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts on Gender and Diversity

Statistics	Observed Results	Data Source	Comment
Number of Infoway databases with the variable Sex	3 annual survey databases with available data Varying topic-based survey databases with available data	Infoway Insights: An interactive data and analytics hub	Infoway conducts some annual surveys along with topic-based surveys that don't always have historical information given their time limited nature.
Number of Infoway databases with the variable Gender	Three annual survey databases with available data Varying topic-based survey databases with available data	Infoway Insights: An interactive data and analytics hub	Infoway conducts some annual surveys along with topic-based surveys that don't always have historical information given their time limited nature

Other Key Program Impacts on Gender and Diversity:

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.

In 2021-22, Infoway received $91.3 million in federal funding to advance digital health innovation, including the continued development of a national e-prescribing system, virtual care initiatives, and the advancement of the organ donation and transplantation data and reporting system. Part of the funding was used to advance pan-Canadian virtual care initiatives in support of P/Ts. In addition, funding supported the adoption, use and linking of electronic medical records and their systems, improving access for providers, institutions and patients.

GBA Plus Data Collection Plan:

Although Infoway had no direct authority over what data is collected via digital health technologies that are adopted by P/T health systems, Infoway worked with P/Ts and other partners to consider whether and how sex and gender-based factors could inform their work. Infoway, through its agreements with third-party recipients of project funding and through the surveys that Infoway commissions directly, supported the collection of user data by sex and/or gender (to the extent practical and as permitted under P/T agreements and other relevant regulations and legislation).

Clinicians, patients, home caregivers and others who have participated in projects funded by Infoway were encouraged to respond to surveys that include questions on sex and gender identity. In an effort to collect resulting data as inputs to future research and analysis that may influence the adoption, use and satisfaction levels of digital health technology, and the benefits derived therefrom.

Furthermore, Infoway continues to make appropriate and relevant data sets from its evaluations available on the University of Victoria's Dataverse network for researchers, policy makers and others across the country to conduct further analysis on topics of interest. As with the existing data sets, sex and gender variables will be included as available and appropriate. These data sets present an increasing opportunity for deeper analysis on sex and gender in digital health and across the health system in general.

Program Name: Health Care Systems Analysis and Policy

Program Goals: This program works to support the federal government's interest in achieving an accessible, high quality, sustainable and accountable health system adaptable to the needs of Canadians.

Health Canada works in close collaboration with 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, 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 and Strategies Program, and Healthcare Excellence Canada (HEC) generates valuable insights that supports the Department's analysis and policy on the health care system.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• Senior Population: direct benefit
• Non-senior population living with health limitations requiring home care services: direct benefit
• Low Socioeconomic Status: indirect benefit
• Women: indirect benefit
• Immigrant: indirect benefit

Key Program Impacts on Gender and Diversity:

Data was collected for the first year of HEC's performance measurement framework in 2022-23 and will be reported when HEC releases its Annual Report covering that period in Q2 2023.

Other Key Program Impacts:

Healthcare Excellence Canada

Through funding provided by Health Canada, HEC implemented initiatives that benefited seniors as a result of its long-term care work, as well as people who experienced homelessness or were vulnerably housed. These included:

• Long-Term Care Quality Improvement Collaborative supported 285 long-term care homes from across Canada to implement quality improvement projects related to improving staff wellbeing and enhancing person-centred care. Based on final report data, HEC's support via seed funding, coaching, peer-to-peer networks, and webinars led to improvements in 93% of homes working to improve person-centred care and 70% of homes working to improve staff well-being.
• Improving Equity in Access to Palliative Care, which worked to help people experiencing homelessness or vulnerable housing receive appropriate care in a timely and safe way without discrimination, reduce emergency department visits and hospital admissions, and allow people to receive palliative care in the environment of their choice.

Common Statement of Principles on Shared Health Priorities and Home and Community Care, Mental Health and Addiction Services Bilateral Agreements:

Acknowledging P/T jurisdiction pertaining to the design and delivery of health services, the federal government has taken actions through bilateral agreements with P/Ts on shared health priorities so that federal health funds benefit all Canadians. This has included priorities for action in the areas such as home and community care and mental health and addiction services. As such, P/Ts were asked to prioritize the use of federal health funds on initiatives that serve the needs of Indigenous people, and address diversity, equity and the needs of underserved and/or disadvantaged populations.

The federal government has taken leadership in engaging with P/Ts to address key health care priorities by providing funding through bilateral agreements. These agreements set out details of how each jurisdiction is investing 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 worked closely with federal, provincial and territorial (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, which are now available in CIHI's Your Health System. These data are disaggregated by sex and/or gender and/or age as appropriate.

Provinces are assisting women, 2SLGBTQI+ and diverse communities in Canada using federal funding under the Home and Community Care, Mental Health and Addictions Services bilateral agreements. One-year extensions of the agreements were implemented for 2022-23. For example:

• Home and community care funding benefits seniors and women, who are overrepresented among the 65+ age group and disproportionately experience the burden of caregiving for loved ones at home. Recognizing the increased burden on women, caregivers in nearly every jurisdiction benefit from increased supports, such as more respite services like enhanced adult day programs, direct financial supports, training, and more support from personal support workers.
• Initiatives seek to increase the number of mental health professionals in communities with high need and increase cultural competency training for mental health professionals, including a culturally appropriate suicide risk assessment tools, and supports for individuals, families and communities affected by suicide.
• Jurisdictions are increasing mother-baby care services. British Columbia is increasing community-based services to reduce risk and enhance protective factors for pregnant and postpartum persons who use substances. Manitoba is implementing a pregnancy and infant loss program improving support to assist women and families experiencing post-partum depression.
• Increasing housing and home-based supports to assist recovery for people with addiction and mental health needs in Alberta, including the addition of housing supports for chronically homeless in the North Zone and women in the sex trade in Edmonton.
• By expanding programs for priority populations, Ontario is enhancing community-based core mental health and addictions services for new Canadians, French-speaking, racialized, immigrant, and 2SLGBTQI+ communities. Additionally, British Columbia's primary care intervention for children and youth will provide mental health and addiction prevention services in school-based settings, recognizing diversity, including Indigenous, 2SLGBTQI+, immigrant, refugee, and newcomer student communities.

GBA Plus Data Collection Plan:

Healthcare Excellence Canada

HEC has developed and implemented its performance measurement framework, aligned with its strategy, to cover its 2021-26 Contribution Agreement. It includes two metrics that will specifically be broken down by sex and/or gender, where data is available: leaders reached by HEC offerings, and leaders reporting increased preparedness (to lead health care improvement efforts) as a result of their engagement with HEC. HEC collected the first year of data for its performance measurement framework in 2022-23, and it will be reported when HEC releases its Annual Report covering that period in Q2 2023.

Common Statement of Principles on Shared Health Priorities and Bilateral Agreements:

CIHI publishes data on the shared health priorities annually through Your Health System. Common indicators are updated and released annually, which include gender-disaggregated data on hospital stays, self-harm, early intervention for mental health and substance use among children and youth, as well as navigation of mental health and substance use services.

Program Name: Health Information

Program Goals: 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 CIHI to allow 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.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Number of CIHI databases with the variable Sex	13 databases with available data 3 databases with partial data availability (i.e., data element has data quality and/or coverage limitations) 17 databases with no, or mixed data availability	CIHI's Equity Stratifier Inventory	It may not be relevant to collect data by sex and/or gender for some of CIHI's databases. For instance, the National Health Expenditures Database is focused exclusively on Financial Information by health care sector.
Number of CIHI databases with the variable Gender	7 databases with available data 4 databases with partial data availability (i.e., data element has significant data quality and/or coverage limitations) 22 databases with no, or mixed data availability	CIHI's Equity Stratifier Inventory	It may not be relevant to collect data by sex and/or gender for some of CIHI's databases. For instance, the National Health Expenditures Database is focused exclusively on Financial Information by health care sector.

Other Key Program Impacts:

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. CIHI's stakeholders use its 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 2022-23, CIHI received over $99 million (about 80% of its total funding) from Health Canada.

Historically, many databases of the CIHI have included data by sex and gender and some have included information on sexual orientation, where applicable. Sex and gender data in the health sector is 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. For many CIHI databases, the data has been collected as a mix of sex and birth and gender (i.e., recorded sex or gender). Sex and gender concepts and collection practices are continuing to evolve in the health care sector, and it may be a number of 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. Using a two-step approach of using assigned sex at birth and gender identity data facilitates the identification of individuals who experience, or express, a different gender identity from their assigned sex at birth (e.g., transgender or gender non-conforming individuals). Measuring inequalities in this group is not possible with sex at birth alone.

CIHI continued to establish common definitions and data standards, and worked 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 were part of a broader program of work under way at CIHI to harmonize and strengthen the measurement of health inequalities in Canada. CIHI supported implementing common coding standards and encouraged their use within P/T health systems, with jurisdictions gradually adopting the proposed standards in their collection systems and voluntarily submitting data to CIHI. CIHI continued to work with jurisdictions on establishing common definitions and data standards in 2022-23 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 has no direct authority over what data is collected, it establishes pan-Canadian standards for data submitted by P/T jurisdictions, actively promoting the use and adoption of standardized identifiers for gender and ethnicity within the data sources. This enables expanded data collection in support of SGBA Plus. It is anticipated that richer data will become available once jurisdictions consistently adopt the proposed standards in their health care data collection systems.

Program Name: Health Care Policies and Strategies Program

Program Goals: The purpose of the Health Care Policies and Strategies Program (HCPSP) is to support the federal government's commitment to maintain a strong and effective publicly funded health care system through investments in emerging and demonstrated innovations in priority areas, such as palliative and end-of-life care, home and community care, mental health care, and other F/P/T and emerging priorities.

The objectives of the Program are to:

1. Increase understanding, and share and generate knowledge and research related to data, policies, best practices, products, technologies and processes, including identification of gaps, needs and trends;
2. Identify, develop, implement, assess and promote new or modified tools, approaches and models that promote people-centred health care systems; and,
3. Identify, develop, implement, assess and promote new learning opportunities, skills development, standards, products and technological solutions. Projects that meet these objectives will contribute to improvements in the accessibility, quality, sustainability and accountability of the health care system.

HCPSP provides funding to a number of projects each year that consider the needs of diverse populations and incorporate in their programming seniors, Indigenous peoples, youth, 2SLGBTQI+ communities, and/or people living in rural/remote areas. This makes sure that SGBA Plus concepts and principles are applied in the activities undertaken and the outcomes and impacts identified.

Target Population: Program stakeholders and target populations include P/T and local governments; non-governmental and non-profit organizations including professional associations, regional health authorities, educational institutions, international organizations, and the public. The Program is responsible for the selection and oversight of recipients, while recipient organizations are responsible for implementing funded projects and reporting back to the Program.

Distribution of Benefits

	Group
By gender	Varies by project
By income level	Varies by project
By age group	Varies by project

Specific Demographic Group Outcomes:

• All Canadians

Other Key Program Impacts:

A number of projects funded by HCPSP considered the needs of diverse populations and incorporated them in programming, specifically seniors, youth, persons with disabilities, Indigenous peoples, cultural communities, 2SLGBTQI+ communities, people from various socio-economic backgrounds, and people living in rural/remote areas.

Some examples of projects that were reported in the 2021-22 DRR SGBA Plus SIT report and that were completed in 2022-23 include:

• Accreditation Canada's project "Peer Support to Help Small Mental Health and Addictions Organizations Develop their Competency in Quality and Accountability", which developed a systematic approach to coaching small public and private mental health and addictions organizations to build their capacity for quality improvement, including culturally relevant content for Indigenous sites. Project leads made sure that the recruitment of advisory committee members, subject matter experts, participating mental health organizations, care providers and caregivers/residents involved in the design, development and testing activities were representative of the population, inclusive of sex and gender.
• The Canadian Standards Association's project "Enhanced engagement and consultation on the development of a national standard for Long Term Care services in Canada" captured the diverse perspectives of residents, families, health service providers, clinicians, and policymakers from across Canada on the needs and gaps in long-term care services — including the voices of First Nations, Inuit, and Métis peoples, people from various socio-economic backgrounds, persons with disabilities, diverse cultural communities, and 2SLGBTQI+ people. This included a series of virtual and on-site visits to long-term care homes across Canada to gather feedback directly from long-term care residents (e.g., deaf, blind, non-English speaking, other residents with cognitive or physical limitations) who may not have been able to engage through completing a Workbook or attending a Town Hall.

Some examples of other projects reported in the 2021-22 DRR SGBA Plus SIT report and continued in 2022-23 included:

• Frayme's "Canada's Youth Mental Health and Substance Use Services and Systems" project continued to build a national scale up of best practices for culturally relevant services. The project focused on building meaningful partnerships with Indigenous, 2SLGBTQI+, rural and remote, Black, newcomer, neurodiverse, homeless, and Francophone youth, families, communities, and organizations. With a focus on amplifying the voices of those whose needs have not been met or those who are doing good work on the ground, Frayme built a network of over 400 partners and over 350 lived experts with diverse identities and matched to research and system transformation opportunities specifically benefiting equity seeking populations.

Some examples of new or amended projects that made a significant effort to address the needs of diverse populations in their programming include:

• McMaster University's "Building Community Paramedicine into the Canadian Healthcare Landscape: An incremental approach to making 'Community Paramedicine at Clinic' (CP@clinic) part of the mainstream health system" project was extended and provided additional funding to expand to additional settings (homeless shelters, patient homes, mobile clinics, Indigenous communities), populations (long-term care patients, palliative care patients, homeless, Indigenous populations), and health issues (palliative care, addictions and mental health). The project aimed to provide pro-active weekly one-on-one community-based health care sessions to older adults to improve their health and quality of life while reducing social isolation and the economic burden on the emergency care system.
• The Association of Faculties of Medicine of Canada's "National Consortium for Indigenous Medical Education" project involved a partnership with the Indigenous Physicians Association of Canada, the College of Family Physicians of Canada, the Medical Council of Canada and the Royal College of Physicians and Surgeons of Canada. The project aimed to provide leadership in areas of common priority and implement Indigenous-led projects that reform and update the education of physicians and create educational contexts, tools and resources that lead to culturally safe health care delivery. The areas of focus included assessment; anti-racism; admissions/transitions; Indigenous faculty recruitment and retention; improving cultural safety in curricula; and Indigenous physician wellness and joy in work.

GBA Plus Data Collection Plan:

As part of HCPSP's performance measurement framework, SGBA Plus is integrated at various stages of the project lifecycle. The process includes: (1) requiring all applicants to describe their approach to SGBA Plus in their proposal package; (2) working closely with funding recipients after the contribution agreement is signed to develop a tailored performance measurement plan that includes the selection of relevant indicators to account for SGBA Plus data, if appropriate to the project; and, (3) collecting, synthesizing, and analyzing the results (outputs and outcomes) reported by the funding recipients at the end of each fiscal year, including the disaggregation of data by SGBA Plus factors where feasible. For instance, all output-level indicators measure some aspect of diversity, including: the identification of underserved groups that resources/activities are targeted to; if a resource is gender-specific; the geographic location of resources, activities, and collaborative arrangements; and the language of products and activities.

The Program conducted case studies of completed projects in 2020-21 and 2021-22 to better understand the impacts of selected initiatives and to illustrate some of the ways in which funding provided to projects supports diversity and inclusion in the health care sector. The Program decided not to continue with the case studies in 2022-23 as the reports did not provide the in-depth analysis and insights expected, and as other demands on the Program were evolving and expected.

The Program also developed post-project questionnaires to be administered to Health Canada program and policy leads at the completion of funded initiatives to gather an additional layer of qualitative data about the success of the HCPSP projects. The questionnaires collect additional information on SGBA Plus best practices and lessons learned, where applicable. This information will be used to strengthen SGBA Plus data collection for HCPSP projects going forward. Implementation of the questionnaires for projects that ended in 2022-23 has begun, but it is still too early to draw any conclusions given the limited data available.

Program Name: Home, Community & Palliative Care

Program Goals: The Government of Canada is committed to supporting P/Ts to enhance access to quality home and community care, long-term care (LTC) and palliative care services so that all Canadians have access to the care they require regardless of income, gender or age.

In January 2023, the Government of Canada welcomed the release of complementary, independent LTC standards from Canadian Standards Association Group and the Health Standards Organization. Together, the standards focus on the delivery of safe, reliable and high-quality long-term care services; safe operating practices; and infection prevention and control measures in long-term care homes.

While Health Canada did not fund the development of the recently released LTC standards, it did provide funding to Canadian Standards Association Group and Health Standards Organization to support enhanced engagement and consultations with Canadians and stakeholders to ensure the diverse perspectives were considered during the development of both standards. This included engagement and consultation with frontline workers, Indigenous communities, Francophone groups, operational staff, and 2SLGBTQI+ community members, and also took into consideration equity and SGBA Plus factors (e.g., racialized identity, Indigenous status, religious minority, sexual orientation, gender identity, ability, etc.).

The standards complement the Government of Canada's collaborative work with P/Ts to help support improvements in long-term care. Budget 2021 announced a $3 billion investment to support P/Ts in their efforts to ensure standards for long-term care are applied and permanent changes are made. This funding will help support workforce stability, including through wage top-ups and improvements to workplace conditions (e.g., staff to patient ratios, hours of work) and strengthened enforcement (e.g., enhanced inspection and enforcement capacity, quality and safety improvements to meet standards), including through accreditation and regular inspections. The federal government will work collaboratively with P/Ts to flow this funding as part of our collective efforts to make sure that seniors and others in care settings live in safe and dignified conditions. Action plans for this funding are still in development by P/Ts.

The Government of Canada is also looking at developing a Safe Long-Term Care Act to help ensure seniors get the care they deserve, while respecting P/T jurisdiction. The Government of Canada will move forward with consultations and engagement with stakeholders and Canadians on a principles-based Safe Long-Term Care Act. This will include representatives of organizations that work with minority groups.

Budget 2023 confirmed the Government's commitment to an increase in health care funding of close to $200 billion over 10 years, including $46.2 billion in new funding for P/Ts. The plan emphasizes the key federal health priorities:

• Access to family health services
• Building a resilient health workforce and addressing backlogs
• Access to mental health and substance use services
• Modernizing the health system through digital health and health data
• Helping Canadians age with dignity

Funding includes $7.8 billion over 5 years that has yet to flow to P/Ts via bilateral agreements for mental health and substance use, home and community care, and long-term care. New funding for health care announced in Budget 2023 included a federal investment of $1.7 billion over five years to support hourly wage increases for personal support workers and related professions, as F/P/T governments work together on how best to support recruitment and retention.

Bilateral agreements to allocate this funding will mutually respect each government's jurisdiction, and be underpinned by key principles, including providing equal access for equity-seeking groups and individuals, including those in official language minority communities to access to health services, including long-term care.

In October 2022, the Government of Canada also announced that the National Seniors Council (NSC) would serve as an expert panel to examine measures, including a potential aging at home benefit, to further support Canadians who wish to age within the comfort of their own homes. The panel is currently working on identifying the health, social and economic factors that prevent seniors from aging at home and provide an assessment of seniors' needs and gaps in existing supports, including defining the vulnerable populations that would benefit most from additional support. Given their extensive knowledge and expertise on issues affecting older adults, as well as their connections to work being led in communities across the country, the NSC members are well positioned to provide advice as well as consult with stakeholders as part of their work on this important issue. Public engagement has been designed in a way to engage a diverse range of key stakeholders to validate the NSC's initial findings and gather views to inform advice on ways to further support Canadians wishing to age at home.

Palliative care helps address the needs of seriously ill people, improving their quality of life and that of their families. In public consultations that informed the development of the Framework on Palliative Care (2018), stakeholders shared population specific challenges in accessing palliative care (such as for people who are children, young adults, homeless, disabled, Indigenous, racialized, 2SLGBTQI+, and/or living in rural/remote areas). Since the release of the Framework, the Government of Canada created the Action Plan on Palliative Care (2019) and has invested $24.7 million in contribution funding (2019-21) from Health Canada's Health Care Policy and Strategies Program and provided an additional $29.8 million over six years from Budget 2021 to implement Action Plan priorities. These include raising awareness of the importance of palliative care; providing public education on grief; improving palliative care skills and supports for health care providers, families, caregivers, and communities; enhancing data collection and research; and improving access to care for underserved populations and to culturally safe palliative and end-of-life care. HCPSP remains the main funding delivery mechanism and as such, recipients are required to provide a sex/gender breakdown of their target populations as part of their performance reports. Where possible, additional disaggregation of data is provided. Some projects have activities specifically focused on populations who experience barriers to accessing palliative care due to the impacts of inequity and inequality.

For example, in 2022-23, Health Care Excellence Canada, in partnership with the Canadian Partnership Against Cancer, launched a national initiative that will see up to 20 communities implement projects to improve access to palliative care for persons experiencing homelessness or vulnerable housing. This marginalized population experiences complex challenges in accessing care resulting from the social determinants of health such as race/ethnicity, housing, gender identity and economic status. The improvement projects will address barriers to accessing culturally appropriate and trauma informed palliative care.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Fourth group: 60% to 79% women
By income level	Second group: somewhat benefits low income individuals (somewhat progressive)
By age group	Third group: primarily benefits seniors or the baby boom generation

Specific Demographic Group Outcomes:

• Senior population: direct benefit
• Non-senior population living with health limitations requiring home care or long-term care services: direct benefit
• Low socioeconomic status: indirect benefit
• Women: indirect benefit
• Immigrant: indirect benefit

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Gender distribution of Canadians (age 18+) who have expressed an unmet need for home care services.	A larger proportion of females (2.1%) than males (1.1%) have unmet home care needs in Canada.	Statistics Canada 2015/2016 Canadian Community Health Survey	N/A
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.	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.	Canadian Institute for Health Information (Updated December 2022)	N/A
Gender distribution of new long-term care residents who potentially could have been cared for at home.	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.	Canadian Institute for Health Information (2021)	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 caregivers reporting distress.	One-third (33%) of senior caregivers reported that their caregiving responsibilities were stressful or very stressful. Among senior caregivers, women reported higher levels of stress than men (39% versus 26%).	Statistics Canada 2018 General Social Survey (Caregiving and Care Receiving)	N/A
Access to palliative care, by sex.	Based on available data, access to palliative care did not appear to differ by sex. 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.	Access to Palliative Care in Canada, 2023 (cihi.ca)	Access to palliative care by gender or other factors was not reported
Caregiving for someone at the end of life.	13% of Canadians 15 years or older reported providing end-of-life care to a friend or family member at some point in their lives. 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.	Statistics Canada, 2012 General Social Survey, Caregiving	N/A

Other Key Program Impacts:

According to CIHI's most recently available data, 62% of assessed home care clients in 2021-2022 were women, and 38% were men. More than 87% of assessed home care clients were aged 65 years and older, and 19% died while receiving home care. (Profile of Clients in Home Care, 2021–2022. Ottawa, ON: CIHI; 2023.).

The unmet needs of caregivers are as follows:

• 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.

To meet the goals of raising awareness of palliative care articulated in the Action Plan, a multi-year national, palliative care awareness campaign is underway. In 2022-23, members of racialized and Disabled communities were consulted for the development of baseline public opinion research materials, participated in public opinion research, and were consulted in support of developing messages for the public. Change in public perception about palliative care is being tracked with data disaggregated by factors including sex/gender and target population (e.g., ethnicity).

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. Over time, 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: Mental Health

Program Goals: 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 mental health services for youth, integrating evidence-based models of care and culturally-appropriate interventions with family health services, and expanding availability of mental health and addiction services for people with complex needs.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Fourth group: 60% to 79% women
By income level	Second group: somewhat benefits low income individuals (somewhat progressive)
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	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)	No link as these data are not currently publicly available. Further, updated data are not available at this time as this question will not be included in the CCHS again until 2024.
Sex distribution of Canadians (aged 12 and over) who reported perceiving their own mental health status as being excellent or very good	Female: 55.1% Male: 63.0%	Statistics Canada (2021-22) Table 13-10-0096-01 Health characteristics, annual estimates	2022-23 data not available at this time.
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: 62.3% Aged 18 to 34: 51.1% Aged 35 to 49: 56.9% Aged 50 to 64: 61.1% Aged 65 and older: 68.2%	Statistics Canada (2021-22) Table 13-10-0096-01 Health characteristics, annual estimates	2022-23 data not available at this time.
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: 54.2% Second quintile: 56.2% Third quintile: 60.6% Fourth quintile: 61.2% Fifth quintile: 62.7%	Statistics Canada (2021-22) Health Characteristics, annual estimates, by household income quintile and highest level of education	Indicator results are positively correlated with income quintile. 2022-23 data not available at this time.
Crude rate of children and youth (ages 5-24) who visited the emergency department for mental disorders by sex	Female: 1,438 crude rate per 100,000 population Male: 1,035 crude rate per 100,000 population	Canadian Institute for Health Information Data tables: Care for Children and Youth With Mental Disorders (XLXS) (2020-2021, pandemic period)	More recent data not available at this time
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: 77% French: 67% The Working Mind – First Responders (TWMFR): English: 52% French: No data available The Working Mind (TWM) Program: English: 70% French: 69%	Mental Health Commission of Canada (MHCC) Core Performance Report (2022-23 fiscal)	Data with less than 20 responses are not reported.
Gender distribution of participants in mental health training programs	Female: 68.0% Male: 27.4% Neither male nor female: 1% Prefer not to answer: 3.7%	MHCC Core performance report (2022-23)	Aggregation of participation across all mental health training programs. Sample size less than 20 is not reported.
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: 92% MHFA French: 86% TWMFR English: 80% TWMFR French: No Data Available TWM English: 91% TWM French: 90%	MHCC Core performance report (2022-23)	Caveat: Not all participants responded to the survey, this number represents a voluntary sample of the participant group.
Approximate sex distribution of Wellness Together Canada site visitors	Female: 60% Male: 40%	Wellness Together Canada Weekly report (data from April 4, 2022 - April 2, 2023)	Note: distribution is approximate, as values are based on Google analytics, and may not be representative of all users.

Other Key Program Impacts:

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.

The Mental Health Commission of Canada (MHCC), one of seven federally funded pan-Canadian health organizations, receives $14.25 million/year from Health Canada to support the mental health and wellness of Canadians in four mandated priority areas: initiatives focusing on key populations, suicide prevention, integration of mental health and substance use, and increasing engagement with Canadians. Budget 2018 also allocated $10 million over five years for the MHCC to assess the impact of cannabis use on the mental health of Canadians.

In 2022-23, the MHCC continued to develop resources with an SGBA Plus lens to address mental health care issues, actively sought out guidance, representation and participation of people with lived and living experience and diverse perspectives, included SGBA Plus considerations in research and policy development, and collected data to support its ability to address the inequality.

The Commission 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 with the purpose 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. The MHCC has also made significant progress internally with the creation of an internal project champion's team that is working to make recommendations on improving equity within the commission.

The Commission continued to use SGBA Plus to identify health and social inequalities for policy and research purposes. For instance, MHCC used SGBA Plus to better understand suicide and suicide risk among men and the need for tailored interventions by developing an evidence brief on Mental Health and Suicide Prevention in Men and a key takeaways document on men's mental health and suicide in Canada. Both resources summarize evidence on factors that lead to increased risk of suicide among men and promote best suicide prevention practices by utilizing the SGBA Plus lens. Additionally, the commission updated the curriculum, materials and evaluation framework of the Trauma and Resiliency Informed Practice program to reflect SGBA Plus principles. This program is an effective intervention for reducing opioid-related stigma among health-care providers developed by Fraser Health Authority. The MHCC also used the SGBA Plus lens in the Stepped Care 2.0 project that improves access to recovery-oriented mental health care by implementing health equity principles in the evaluation indicators.

Additionally, the commission continued to implement SGBA Plus principles in the area of mental health and substance use integration collaborative projects with the Canadian Centre for Substance Use and Addictions. The MHCC used the SGBA Plus lens to identify members of the Advisory Group addressing competencies for integrated mental health and substance use health workforce. It also utilized SGBA Plus principles in the Operational Guidelines for Mental Health and Substance Use Health Service Delivery project by designing gender disaggregated guidelines for women, men, non-binary or transgender people.

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 2022-23, 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, and 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 key populations (e.g., youth, 2SLGBTQI+, racialized people, Indigenous persons).

Health Canada now requires MHCC to describe the SGBA Plus work undertaken in each semi-annual reporting period with the focus on data disaggregation and reporting on impact of their initiatives on diverse stakeholder groups. 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: Medical Assistance in Dying

Program Goals: Health Canada monitors medical assistance in dying (MAID) implementation and undertakes policy work to increase the evidence base about how MAID is being delivered in Canada and to support the consistent implementation of MAID and safe access to MAID for eligible Canadians. Health Canada engages and collaborates with P/Ts, key stakeholders, and health care professionals involved in MAID to facilitate consistent application of the MAID monitoring, regulations and data collection. To foster public trust in the MAID system, the federal government makes data on MAID available to Canadians through federal annual reports. Health Canada also develops regulatory guidance for key stakeholders; funds research to improve understanding of MAID in Canada and to guide policy development and helps improve access to training and knowledge of the application of the MAID law for health care professionals.

Target Population: Adult Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Third group: primarily benefits seniors or the baby boom generation

Specific Demographic Group Outcomes:

• MAID is available to all Canadians who are 18 and over and meet eligibility criteria specified in the Criminal Code. Data is currently collected by Health Canada on the age and gender of those who request and/or receive MAID. The federal MAID monitoring regime will begin collection of information on race, Indigenous identity, and disability starting in 2023. This additional information may help to determine the presence of any individual or systemic disadvantages or inequalities in the context of MAID.

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Distribution of MAID recipients by gender	Total number of MAID recipients for 2021: 10,064 Male: 52.3% Female: 47.7% Non-reasonably foreseeable natural deaths (non-RFND) for 2021: 223 recipients Female 52.5% Male 47.5%	3rd Annual Report on Medical Assistance in Dying in Canada (data collected from calendar year of 2021)	Gender difference is slightly greater than in 2020 (Total number of MAID recipients was 7,595 - 51.9% males and 48.1% females). Findings are consistent across jurisdictions with the exception of Manitoba and Prince Edward Island where the proportion of females receiving MAID was slightly higher. As a result of changes to MAID legislation in March, MAID reporting for part of 2021 (from March to December 2021) included an indication of whether a person's natural death was reasonably foreseeable or not reasonably foreseeable and certain details about non-RFND MAID recipients. New changes to the Regulations for the Monitoring of MAID that took effect January 1, 2023 will allow for more detailed reporting on MAID cases that fall under the non-RFND track.
Distribution of MAID recipients by age and gender	Average age of recipients at the time of MAID: 76.3 Average age of male recipients at the time of MAID: 75.6 Average age of female recipients at the time of MAID: 77.0 Non-RFND deaths: Average age of individuals at the time of MAID: 70.1	3rd Annual Report on Medical Assistance in Dying in Canada (data collected from calendar year of 2021)	The greatest number of MAID deaths occur in the age range of 56 to 90. The majority of MAID recipients (95.1%) were age 56 and up, with 83.3% who were age 65 and older.
Distribution of MAID recipients by main condition	Cancer: 65.6% Cardiovascular conditions: 18.7% Chronic respiratory conditions: 12.4% Neurological conditions: 12.4% Non-RFND deaths: neurological conditions (45.7%) other conditions (37.9%) multiple comorbidities (21.0%)	3rd Annual Report on Medical Assistance in Dying in Canada (data collected from calendar year of 2021)	Cancer was reported as the underlying main condition for 68.4% of men and 62.6% of women that received MAID. The prevalence of these conditions is similar to those seen in 2020 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). New changes to the Regulations for the Monitoring of MAID that took effect January 1, 2023, will allow for more detailed reporting on MAID cases that fall under the non-RFND track.

Other Key Program Impacts:

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 conduct eligibility assessments and deliver MAID and for those who dispense medications for the purpose of MAID, in accordance with the framework. The law also requires the federal government to implement a monitoring regime to collect information from practitioners and pharmacists about persons who request and receive MAID. The Regulations for the Monitoring of MAID support this collection of information and require the Minister of Health to publish a report at least once a year. These reports aim to provide a more fulsome understanding of the characteristics of persons who request MAID and the circumstances under which MAID is sought and administered, and the application of the eligibility criteria and safeguards. Health Canada has produced three Annual Reports on MAID in Canada (2019, 2020, 2021).

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 and meet all eligibility criteria. 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 could potentially broaden MAID to other demographics, such as persons with disabilities and those with complex chronic non-terminal conditions, which may impact current trends. The 2021 legislation requires the collection of additional information related to disability, race and Indigenous identity, in addition to enhanced data related to the new eligibility criterion and safeguards. Collection of this information began January 1, 2023, and Health Canada will report on this broader information in the federal Annual Report to be released in 2024, following a full year of data collection for the 2023 calendar year. 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 the delivery of MAID.

Supplementary Information Sources:

The Regulations for the Monitoring of Medical Assistance in Dying

Third Annual Report on Medical Assistance in Dying in Canada, 2021

GBA Plus Data Collection Plan:

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 recently amended the Regulations for the Monitoring of MAID to reflect these new requirements and published the amended Regulations in Canada Gazette, Part II on November 9, 2022, with a coming into force date of January 1, 2023. Publication of this expanded demographic data for 2023 will occur in mid-2024 with the release of the Fifth Annual Report on MAID in Canada.

Health Canada is also funding research on MAID to improve understanding of MAID delivery and help to inform policy development around MAID implementation. Sex, gender and other diversity information will be part of performance/results reporting with funding recipients, where appropriate.

Program Name: National Strategy for Drugs for Rare Diseases

Program Goals: The first-ever National Strategy for Drugs for Rare Diseases aims to increase access to, and affordability of, promising and effective drugs for rare diseases (DRD) to improve the health of patients across Canada. Launched in March 2023, work will be undertaken via bilateral agreements with P/Ts and funding to the Non-Insured Health Benefits program at Indigenous Services Canada to help P/Ts improve access to new and emerging drugs for Canadians with rare diseases, as well as support enhanced access to existing drugs and early diagnosis and screening. Further funding will be provided to CADTH and CIHI to improve the collection and use of real-world evidence to support decision-making, as well as patient registries. A stakeholder Implementation Advisory Group will be formed to support implementation of the Strategy.

Target Population: People affected by rare diseases

Distribution of Benefits

	Group
By gender	Fourth group: 60% to 79% women
By income level	Second group: somewhat benefits low income individuals (somewhat progressive)
By age group	First group: primarily benefits youth, children or future generations

Specific Demographic Group Outcomes:

• All Canadians

GBA Plus Data Collection Plan:

The establishment of the National Strategy aims to improve access to DRD to help address Canada's current patchwork of DRD coverage, which disproportionately impacts those with rare diseases and those who face challenges accessing health services. By helping to limit barriers for the underinsured, the DRD strategy would support a more cohesive approach to pharmaceuticals management for those impacted by rare diseases and lack of access to related services. This will ultimately provide both patients and clinicians with more information on which to make informed decisions about their care. To ensure inclusion of disadvantaged groups in any scoping decisions and moving forward with Strategy implementation more broadly, Health Canada plans to include diverse patient perspectives in governance and advisory structures in addition to ongoing engagement during implementation of various strategy activities.

There is limited data on rare diseases and on drug coverage status more generally, and what is available is not typically disaggregated by SGBA Plus factors. Proposed infrastructure investments associated with the National Strategy will help to improve use of real-world data and evidence in the evaluation of treatment effectiveness for broader populations than what is typically included in a clinical trial. As part of future funding agreements and investments, Health Canada will also seek agreement from P/Ts to support the measurement and reporting of progress to improve access to DRD, with a focus on SGBA Plus information where possible (i.e., in cases where sample size is sufficient to allow for public reporting).

Program Name: Organs, Tissues, and Blood

Program Goals: The Organs, Tissues, and Blood Program provides funding to support safe, effective, accessible and responsive organ, tissue and blood systems that will improve and extend the quality of the lives of Canadians.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• The Program seeks to improve the environment of all Canadians by providing support for safe, effective, accessible, and responsive organ, tissue and blood systems while respecting F/P/T scopes of authority. With Health Canada support, Canadian Blood Services (CBS) generate numerous knowledge products and learning events and play a role in public education, engagement, and awareness. It also plays a significant role in training highly qualified people in important areas such as basic and applied research. CBS develops collaborative arrangements, establishes partnerships and identifies and responds to emerging issues related to organ, tissue and blood systems, in collaboration with the P/Ts as appropriate. Various stakeholders, including Health Canada, use the knowledge generated by blood research and development projects and organ donation and transplantation projects to inform changes to practices and standards. This will contribute to greater safety, effectiveness, accessibility and responsiveness of the organ, tissue, and blood systems to improve and extend the quality of lives of Canadians.

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Number of organ donors, by sex, 2020	Male: 551 Female: 558	CIHI (2020)	N/A
Percentage of deceased donors, by sex, 2020	Male: 61% Female: 39%	CIHI (2020)	N/A
Percentage of living donors, by sex, 2020	Male: 36% Female: 64%	CIHI (2020)	N/A

Other Key Program Impacts:

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 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 (genetic) 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. Examples are provided as follows:

• CBS worked with partners and external stakeholders to develop community-led strategies to engage with donors and provide thoughtful and inclusive outreach, and to create fully accessible experiences and remove barriers to participation.
• In partnership with clinical researchers and provincial organ donation organizations, CBS is examining existing gaps in national data related to the impact of sex, gender, geography and diversity.
• CBS produced a short documentary, in collaboration with a filmmaker, aimed at diverse and urban audiences.
• CBS developed donor stories to support the Leave Well Campaign also reflect a number of diverse communities.

Additionally, the Blood Research and Development component intersects with issues in gender and diversity. Sex, gender, and ethnic diversity are key considerations for CBS and the research it supports. These considerations are applied whenever a call for applications for any research and training programs is issued. For example, establishing the scientific basis for changing the blood donor eligibility criteria by asking gender neutral, sexual behaviour-based screening questions of all donors contributed to reducing barriers when donating blood. Informed by the research, CBS implemented a sexual-behaviour-based screening donor eligibility policy change for source plasma and whole blood donors in September 2022. CBS is committed to making blood donation as inclusive as possible while maintaining the safety of the blood supply. Héma-Québec made a similar change in December 2022, largely from the same evidence base that informed the CBS change.

Officially launched on September 28, 2023, CBS implemented the Reconciliation Action Plan to serve as a roadmap and living document for how CBS intends to work and collaborate with Indigenous partners, donors, employees and communities.

Supplementary Information Sources:

Organ replacement in Canada: CORR annual statistics | CIHI

GBA Plus Data Collection Plan:

Health Canada will continue to work with CBS to strengthen the collection of SGBA Plus data, as well as to strengthen the diversity and inclusion data.

A modernized and integrated pan-Canadian data and performance system will address current data limitations and facilitate understanding of which population subgroups may be experiencing barriers for accessing high-quality organs. The system is expected to roll out 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

Program Goals: Health Canada and Healthcare Excellence Canada (HEC) work to advance patient safety in health care systems.

Target Population: All Canadians

Specific Demographic Group Outcomes:

• HEC's work to improve the quality and safety of health care is expected to benefit all Canadians, with potential additional benefits to some underserved groups, such as seniors living in long-term care facilities and people experiencing homelessness or vulnerable housing.

Key Program Impacts on Gender and Diversity:

Data was collected for the first year of HEC's performance measurement framework in 2022-23 and will be reported when HEC releases its Annual Report covering that period in Q2 2023.

Other Key Program Impacts:

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

HEC sought out and included the perspectives of patients, seniors, and diverse groups in the design of its programs and projects to improve patient safety. While no quantitative data exists, 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 Quality Improvement Collaborative supported 285 long-term care homes from across Canada to implement quality improvement projects related to improving staff wellbeing and enhancing person-centred care. Based on final report data, HEC's support via seed funding, coaching, peer-to-peer networks, and webinars led to improvements in 93% of homes working to improve person-centred care and 70% of homes working to improve staff well-being.
• Improving Equity in Access to Palliative Care, which worked to help people experiencing homelessness or vulnerable housing receive appropriate care in a timely and safe way without discrimination, reduce emergency department visits and hospital admissions, and allow people to receive palliative care in the environment of their choice.

GBA Plus Data Collection Plan:

HEC's performance management framework includes 2 metrics that will specifically be broken down by sex and/or gender, where data is available: leaders reached by HEC offerings, and leaders reporting increased preparedness (to lead health care improvement efforts) as a result of their engagement with HEC. HEC will also continue to look for ways to go beyond data collection to analysis that may support higher quality, safer care, and better outcomes for diverse populations.

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

Program Goals: 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.

Target Population: Official Language Minority Communities (OLMCs).

Distribution of Benefits

	Group
By gender	Fifth group: predominantly women (80% or more women)
By income level	No data is available on the distribution of income level of the Official Languages Health Program (OLHP) target population
By age group	No data is available on the distribution by age group of the OLHP target population

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Number of HC-funded enrollments, additional to provincially-funded places for post-secondary health education in French, outside of Quebec by: Gender (male, female, other/prefer not to answer)	Out of 1038 (100%) students enrolled in post-secondary health education in French, outside of Quebec: 17.5% were male 82% were female 0.5 % were other 0% preferred not to answer	« Consortium National de formation en santé » database (2021-22)	Updated data on this key impact will be available in June 2023, through recipients' performance reports, as required through their funding agreements
Percentage of French-language postsecondary education in health graduates funded outside of Quebec: by: Gender (male, female, other/prefer not to answer)	Out of 838 (100%) French-language postsecondary education in health graduates, outside of Quebec: 18% were male 81.3% were female 0.7% were other 0% preferred not to answer	« Consortium National de formation en santé » database (2021-22)	Updated data on this key impact will be available in June 2023, through recipients' performance reports, as required through their funding agreements
Percentage of funded Language Training Program health professionals /intake staff who have completed the language training (Dialogue McGill) by: Gender (male, female, other / prefer not to answer)	Out of 2180 (100%) of funded Language Training Program health professionals /intake staff who have completed the language training: 10.6% were male 75.8% were female 0.2% were other 13.3% preferred not to answer	McGill University database (2022-23)	N/A
Percentage of recipients of incentives who received financial support through Bursary and Student Internship Support Programs (Dialogue McGill) by: Gender (male, female, other / prefer not to answer)	Out of 88 (100%) recipients of incentives who received financial support through Bursary and Student Internship Support Programs: 11.3% were male 87.5% were female 1.1% were other 0% preferred not to answer	McGill University database (2022-23)	N/A
Percentage of French-language postsecondary education graduates who report having acquired academic and professional knowledge and skills to work in OLMCs by: Gender (male, female, other / prefer not to answer)	Out of the 995 (100%) graduates who reported having acquired the knowledge and skills to work in OLMCs: 11.5% were male 88.1% were female 0.4% were other 0% preferred not to answer	« Consortium National de formation en santé » database (2021-22)	Updated data on this key impact will be available in June 2023, through recipients' performance reports, as required through their funding agreements
Percentage of postsecondary graduates trained in health, who report offering health services to OLMCs 1 year after graduation by: Gender (male, female, other / prefer not to answer)	Out of the 497 (96%) graduates who reported offering health services to OLMCs 1 year after graduation: 12% were male 88% were female 0% were other 0% preferred not to answer	« Consortium National de formation en santé » database (2021-22)	Updated data on this key impact will be available in June 2023, through recipients' performance reports, as required through their funding agreements
Percentage of postsecondary graduates trained in health, who report offering health services to OLMCs 2 years after graduation by: Gender (male, female, other / prefer not to answer)	Out of the 440 (94%) graduates who report offering health services to OLMCs 2 years after graduation: 12% were male 88% were female 0% were other 0 % preferred not to answer	« Consortium National de formation en santé » database (2021-22)	Updated data on this key impact will be available in June 2023, through recipients' performance reports, as required through their funding agreements
Percentage of postsecondary graduates trained in health, who report offering health services in French to Francophone outside Quebec by: Gender (male, female, other / prefer not to answer)	Out of the 954 (97%) postsecondary graduates trained in health, who report offering health services in French to Francophone outside Quebec: 11.5% were male 88.2 % were female 0% were other 0% preferred not to answer	« Consortium National de formation en santé » database (2021-22)	Updated data on this key impact will be available in June 2023, through recipients' performance reports, as required through their funding agreements

Other Key Program Impacts:

Historically, female represented the majority of health human resources. Data highlighted in this report confirms this trend. Male and gender diverse individuals represented a small percentage of students who enrolled in training programs supported by Health Canada's Official Languages Health Program (OLHP), as well as those who graduated from these programs even though particular attention was paid to recruit and attract male students as well as those coming from diversity groups.

GBA Plus Data Collection Plan:

As part of the renewal of the OLHP, the Official Languages Community Development Bureau/OLHP reviewed its performance measurement tools to expand the capacity to measure and assess the impacts of the Program on gender and diversity throughout the next 5-year cycle (2023-28). This review aimed 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 consider SGBA Plus. The revised tools will be used by 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 toward achieving expected results.

Program Name: Territorial Health Investment Fund

Program Goals: The Territorial Health Investment Fund (THIF) supports territorial efforts to innovate and transform their health care systems and ensure Northerners have access to the health care they need. The THIF provides funding for health innovation and supports territories in ensuring the health care needs of all residents in their respective jurisdiction are met, rather than focusing on specific demographics.

Target Population: Individuals in specific regions (Nunavut, Northwest Territories, Yukon), Indigenous peoples

Specific Demographic Group Outcomes:

• THIF projects target territorial residents, including men, women, children, and gender-diverse individuals of all ages. However, there are specific groups who may have higher need for these services, including Indigenous peoples, and territories may use the THIF funding to target the health care needs of specific groups based on need.

Key Program Impacts on Gender and Diversity:

Other Key Program Impacts:

While SGBA Plus data under the THIF is not available, 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 funding delivered through the THIF. Certain projects 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 funding provided through the THIF, Nunavut's TB Program has worked to reduce these disparities through community and mobilizing efforts to better access residents, capacity building and enhancing human resources, and the adoption of new technologies to better treat latent TB, among other things.

As another example, the Yukon has allocated some of 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 has used THIF funding to support primary health care reform initiative and demonstration projects, which include a community-led effort to enhance access, quality and continuity of prenatal, parental/child, and perinatal health care supports for remote communities through proactive virtual outreach. Other demonstration projects focus on mental health and chronic disease management.

Of note, the oral health of children in the territories is below that of other Canadian children. Taking this into account, 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:

The THIF performance measurement strategy that was in place until 2022-23 includes SGBA Plus indicators that 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, territories are reliant on external organizations, such as Statistics Canada, to make these data available. As a new performance measurement strategy is developed in response to the renewal of the THIF that was announced in Budget 2023, 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.

Gender and diversity disaggregated data is a challenge in many cases given that data is challenging to capture at the territorial level and even more so with disaggregation by gender or other characteristics. Territorial efforts will be dependent on available data from, for example, Statistics Canada and CIHI, which is often outside of their control.

Program Name: Thalidomide

Program Goals: The purpose of the Canadian Thalidomide Survivors Support Program (CTSSP) is to contribute to meeting the needs of Thalidomide Survivors for the remainder of their lives so they may age with dignity. Some SGBA Plus considerations are applied by the recipient when making changes to application processes and templates to allow for equitable access to program services by all survivors.

Target Population: A particular demographic group.

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Third group: primarily benefits seniors or the baby boom generation

Specific Demographic Group Outcomes:

• The CTSSP is designed to benefit eligible Canadian thalidomide survivors.

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Clients who reported the ability to age with dignity by gender	Male: 94% Female: 94%	2022-23 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: 78% Female: 73% Prefer not to disclose: 0%	2022-23 Recipient Progress Report (Q3/Q4)	Statistics reported are based on Annual Outreach Survey distributed by the third-party administrator for the CTSSP.

Other Key Program Impacts:

In 2022-23 the CTSSP provided financial support to 125 Canadian thalidomide survivors. Of those, the female population is higher than the male (57% female compared to 43% male). While sex and gender data are collected under the CTSSP, it is a relatively small population of thalidomide survivors and limited data are available. Benefits under the program are equally accessible to all genders.

Thalidomide survivors have access to an Extraordinary Medical Assistance Fund which 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.

Each year, a much lower percentage of men access the Extraordinary Medical Assistance Fund compared to women (36% and 64% respectively in 2021-22). In 2022-23, the CTSSP administrator took steps to encourage more men to apply by reaching out directly to raise awareness of the Fund and how it could help them. This effort significantly increased the proportion of men applying and has created a more even balance (49% men and 51% women).

GBA Plus Data Collection Plan:

The SGBA Plus data collection plan for the CTSSP currently captures data based on sex and gender. Program impacts continue to be assessed and analyzed to better understand survivor needs using an Annual Outreach survey. This allows the CTSSP administrator to build on existing enhancements and 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.

Core Responsibility 2: Health Protection and Promotion

Program Name: Air Quality

Program Goals: The Air Quality Program supports actions to improve air quality and health for all people in Canada. Key activities include research on exposure of people in Canada 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. While the Program benefits all people in Canada by supporting actions to improve air quality and health, program activities have an SGBA Plus focus on protecting sub-populations who may be more susceptible and/or highly exposed to air pollution.

Target Population: All people in Canada

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	First group: primarily benefits youth, children and/or future generations Third group: primarily benefits seniors or the baby boom generation

Specific Demographic Group Outcomes:

• Children or Youth
• Seniors
• Persons with disabilities or health issues or their caregivers
• Women
• Men

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Percentage change in deaths that can be attributed to two major air pollutants: ground-level ozone (O3) and fine particulate matter (PM2.5) by sex, age and region	Ozone (O3) By sex: Male: 3.54%* Female: 2.92%* By age: Seniors (aged ≥ 66): 2.79%* By region: Eastern: 3.86% Central: 1.31% Western: 4.32% Fine particulate matter (PM2.5) By sex: Male: 0.55%* Female: 1.08%* By age: Seniors (aged ≥ 66): 1.00%* By region: Eastern: -0.22% Central: 0.78% Western: -0.02%	Canadian Environmental Sustainability Indicators	The percent change in mortality attributable to variations in short term exposure to air pollution between two periods of seven consecutive years: 1) the reference period, which is 1990-96 for O3 and 2001-07 for PM2.5, and 2) the most recent period, which is 2009-15 for both pollutants. Unit of measurement: % risk of deaths * Indicates statistical significance

To measure these key impacts (i.e., percentage change in deaths compared with the reference period) Health Canada analyzed and tracked the temporal trends in the proportion of non-accidental deaths that can be attributed to O₃ and PM_2.5, by age, sex and region.

Key results showed the following:

• There are downward trends in the adverse health impact (premature deaths) of short-term exposures to O₃ and PM_2.5 on seniors. Although the data that the percentage increase in risk of premature deaths due to air pollution is the same across all adult age groups, the higher baseline deaths among seniors (≥ 66) means that most air pollution related deaths occur in this age group.
• Females show downward trends in deaths attributable to short-term exposure to both O₃ and PM_2.5, while males show no trend for O₃ and a downward trend for PM_2.5. Sex-differences in premature deaths due to air pollution have been inconsistent in previous studies and needs more studies to identify sex-differences.
• Central Canada and Eastern Canada demonstrate downward trends in premature deaths attributable to short-term exposure to O₃, while Western Canada displays an upward trend.
• The risk of premature deaths attributable to short-term exposure to PM_2.5 shows an increasing trend in Eastern Canada. However, no trends were observed for Central Canada and Western Canada.

Other Key Program Impacts:

Health Canada's Air Quality Program benefits all people in Canada 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. The Department has targeted initiatives to better understand and address the needs of these individuals and strives to identify and assess these health risks through its science, research, and assessment work.

For example, Health Canada calculated the health impacts of air quality beyond deaths (e.g., asthma symptom days), set guidelines, and conducted risk assessments. Health risks are communicated to people in Canada, including outreach to sub-populations who may be more susceptible or highly exposed. This includes communicating the Air Quality Health Index (AQHI), which measures the air quality and provides a category that describes the level of health risk associated with the index reading (e.g., Low, Moderate, High, or Very High Health Risk).

The human health science assessments for ambient air pollutants characterize SGBA Plus susceptibility and/or vulnerability to air pollution. In 2022-2023, the Department published a Guide to Addressing Moisture and Mould Indoors to provide practical recommendations to address the health hazard of indoor mould. The Guide notes that some people are considered to be at greater risk of experiencing adverse health effects from mould exposure. These subgroups include infants, children, seniors, pregnant people and those with respiratory conditions such as asthma.

Health Canada conducts research on exposure to, and the health effects of, air pollution which considers 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, in a Health Canada study published in 2022-23, it was identified that exposure to outdoor air pollution increases the risk of asthma and respiratory infections in children. Girls were found to be more susceptible than boys to the influence of air pollution.

Supplementary Information Sources:

Air Health Trends

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. The Department 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 people in Canada 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 the Canadian population and health professionals.

Program Goals: The Program aims to change the state of the biologic and radiopharmaceutical drug landscape in Canada by ensuring that the Canadian population has access to safe, effective and quality biologic and radiopharmaceutical drugs.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	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: 30% Total number of mandatory ADRs for biologics by sex: Male: 161 (51%) Female: 146 (47%) Not Specified: 15 (2%) Total number of mandatory ADRs for radiopharmaceutical drugs by sex: Male: 74 (39%) Female: 112 (59%) Not Specified: 3 (2%)	Canada Vigilance Database (2022-23)	N/A

Other Key Program Impacts:

In 2022-23, the proposed Regulations Amending Certain Regulations Made Under the Food and Drugs Act (Agile Licensing) were published in Canada Gazette, Part I and Health Canada consulted on these proposed Agile regulations as well as guidance for licensing drugs and medical devices. These proposed regulations and guidance will apply to the Biologic and Radiopharmaceutical Drugs Program, the Medical Devices Program, and the Pharmaceutical Drugs Program.

Of note is that the proposed regulatory amendments would compel sponsors to submit disaggregated data when applying for regulatory approval of health products. This would enhance the Department's ability to collect and analyze disaggregated data allowing for improved assessment of safety and efficacy differences between subpopulations in clinical trials. This would also allow Health Canada to be more transparent about the diversity of clinical trial participants for each health product.

The Department's scientific reviewers take 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 continued to implement enhanced post-market surveillance activities for monitoring the safety profile of COVID-19 vaccines that include gender-based analyses. For example, the Department conducted a review of the risk of pregnancy complications and the effects on breastfeeding individuals and breastfed newborns/infants following immunization in pregnancy with monovalent Comirnaty or Spikevax. Health Canada's review of the available information found no evidence that vaccination with monovalent Comirnaty or Spikevax increases the risk of having a miscarriage, preterm birth or other pregnancy complications. In addition, no increased risk for adverse events in breastfeeding individuals and breastfed newborns/infants was observed following immunization in pregnancy with monovalent Comirnaty or Spikevax.

Health Product InfoWatch: October 2022 - see safety brief.

Health Canada is also incorporating SGBA Plus into its Risk Management Plan review process and procedures. The Department also continues to explore how to incorporate SGBA Plus considerations into other post-market surveillance activities. For instance, the Department has launched queries under the Drug Safety and Effectiveness Network to evaluate the post-market safety of hematopoietic stem cell transplantation and the combined use of immune checkpoint inhibitors and tyrosine kinase inhibitors. These queries specifically aim to explore the potential variations in safety outcomes attributed to patient characteristics, such as biological sex, age, and race/ethnicity.

As well, the Scientific Advisory Committee on Health Products for Women (SAC-HPW) continued to provide timely, patient-centered, scientific, technical, and medical advice on current and emerging issues regarding women's health and the regulation of health products for women. In 2022-23, the SAC-HPW provided advice on several relevant topics including:

• Draft guidance document on 'Clinical evidence requirements for medical devices'
• Health Canada's risk assessment of breast implant-associated anaplastic large cell lymphoma
• Applying an SGBA Plus lens to medical devices regulation
• Risk Management Plans and managing the risk of teratogenicity
• Monitoring the safety of COVID-19 vaccines in women

GBA Plus Data Collection Plan:

In the drug and medical device lifecycle, sponsors seek authorization to sell health products on the Canadian market by submitting clinical trial data to Health Canada (and other international health regulators). The Department's scientific reviewers then assess the trial data submissions when considering authorization. However, specific subpopulations continue to be under-represented in drug and medical device 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 in June 2021, which outlines measures that will be taken over a period of 5-10 years. This plan relates to the Department's Biologic and Radiopharmaceutical Drugs Program, the Medical Devices Program and the Pharmaceutical Drugs Program to ensure that the Canadian population have access to information that supports informed decision-making regarding their treatment options, based on the safety and efficacy profiles of diverse kinds of people.

Specifically, Health Canada is looking to work with relevant stakeholders nationally and internationally to 1) improve the SGBA Plus data submitted to the Department; 2) Enhance the way SGBA Plus data is analyzed and reported on by the Department; 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, working collaboratively with international regulators and stakeholder organizations to effect change at a global level.

As part of this work, in October 2022, Health Canada implemented a questionnaire for sponsors of all drug submissions to verify if their submitted clinical evidence has been disaggregated by sex, age, and race/ethnicity. The questionnaire, which became mandatory on December 1, 2022, has allowed the Department to collect baseline data on the proportion of drug submissions it currently receives which include disaggregated data.

Program Name: Cannabis

Program Goals: 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, possession, and research.

The program is intended for all Canadians. More specifically, the program aims to protect the health of young persons by restricting their access to cannabis, while providing adults of legal age with access to regulated products.

Target Population: All Canadians

The program is intended for all Canadians. More specifically, the program aims to protect the health of young persons by restricting their access to cannabis, while providing adults of legal age with access to regulated products.

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Percentage of youth (grade 10-12) who report frequent (daily to weekly) cannabis use in the past 30 days	Overall: 11.1% By sex: Female: 10.6% Male: 11.6% By grade: Grade 10: 9% Grade 11: 11.3% Grade 12: 13.6% By province: Newfoundland and Labrador: 15.3% Prince Edward Island: 11.0% Nova Scotia: 15.9% New Brunswick: n/a Québec: 7.2% Ontario: 12.0% Manitoba: 16.0% Saskatchewan: 14.5% Alberta: 9.4% British Columbia: 10.7%	Canadian Student Alcohol and Drugs Survey (CSTADS) (2021-22) Data is collected biannually. The latest data was collected in 2021-22 and made available publicly in May 2023	Baseline: 2018-19 CSTADS Overall: 9.2% By sex: Female: 7.3% Male:11.0% By grade: Grade 10: 6.0% Grade 11: 9.6% Grade 12: 12.3% By province: Newfoundland and Labrador: 13.9% Prince Edward Island: 10.7% Nova Scotia: 14.8% New Brunswick: 15.2% Québec: 5.8% Ontario: 7.4% Manitoba: 9.7% Saskatchewan: 14.7% Alberta: 11.3% British Columbia: 13%

Other Key Program Impacts:

In 2022-23, Health Canada continued to promote and enable the collection and use of disaggregated data for intersectional analysis of cannabis survey data. The Department conducted the 2022 Canadian Cannabis Survey and released the results in December 2022. This survey collected data on age, P/T, sex assigned at birth, gender, sexual orientation, race, Indigenous identity, community size, education level, and household income.

The Cannabis Program also conducted Public Opinion Research on the state of access to cannabis for medical purposes in Canada, via online surveys with patients aged 16+ and health care practitioners. The patient survey included questions about self-identified sex, gender, age, geography, education, health status, ethnicity, income, and sexual orientation. The health care practitioner survey included questions about gender, age, and geography. Where possible, sex- and gender-based analyses were considered. The report is used to inform future policy and regulatory work.

In March 2023, the Cannabis Program re-launched Pursue Your Passion in schools across Canada (with the exception of Alberta and Quebec) through interactive sessions with virtual ambassadors. This campaign encourages youth (ages 13-15) to pursue their passion without the use of cannabis, and over 123 sessions were completed by March 31, 2023. Pursue Your Passion content was assessed for cultural appropriateness, is available in English and French and has been translated into Cree and Ojibway.

Health Canada continued work to implement strategies aimed at enabling a diverse and competitive cannabis industry comprised of small and large businesses, and increase the participation of Indigenous, Black and other racialized communities. The Department created new webpages and revised current webpages to be more accessible and provide clearer guidance to industry:

• launched a new webpage that provides ongoing cannabis program updates;
• updated the Cannabis Tracking and Licensing System to include responses to frequently asked questions from micro-class licence holders;
• gathered demographic data to better understand the diversity of the cannabis industry;
• leveraged social media campaigns to help disseminate information to a more diverse audience;
• enhanced communication between Health Canada and its stakeholders through its Virtual Learning Series; and
• gathered feedback from industry through the use of surveys to support program improvements and to inform the streamlining of processes.

Health Canada also continued to offer a dedicated Indigenous Navigator Service, whose purpose is to help and support Indigenous-affiliated applicants throughout the federal commercial cannabis licensing process and encourage their participation in the industry. The Department issued an additional 13 licences for cultivating or processing cannabis to Indigenous-owned or affiliated applicants located across Canada, for a total of 56 licensed Indigenous businesses in 2022-23. It also awarded an additional 6 licences to Indigenous-owned or affiliated applicants to cultivate or process industrial hemp, for a total of 27. Health Canada also has a Licensing Advisor Service to assist prospective Indigenous-affiliated applicants who have the support of their local Indigenous government prior to submitting their application.

To improve the Substance Use and Addictions Program's (SUAP) capacity for collecting and reporting on demographic data and to support funding recipients, SUAP undertook the following in 2022-23:

• Collected aggregate project-level data (e.g., diversity and ethnicity demographics) at the front-end of a project's life cycle (current and ongoing).
• Provided a demographic data collection guide to recipients which supports the collection of relevant SGBA Plus data. This guide included examples of quantitative and qualitative demographic data collection tools.
• Provided an information session for funding recipients on collecting performance measurement data, including requirements for demographic data collection.
• Launched an updated progress report template with a dedicated demographic data collection annex.

Supplementary Information Sources:

Sex, Gender and Cannabis Report

Access to cannabis for medical purposes in Canada: gathering information on views and practices of patients and health care practitioners

2022 Canadian Cannabis Survey (CCS)

2019 Canadian Alcohol and Drugs Survey (CADS)

Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS)

GBA Plus Data Collection Plan:

The Cannabis Program applies SGBA Plus to its data collection tools and analysis to help inform policy and regulatory decisions and the development of more targeted public education campaigns. The Program's SGBA Plus data collection plans include the assessment of key aspects of cannabis use through population health surveys, such as the Canadian Cannabis Survey, Canadian Alcohol and Drugs Survey, and the Canadian Student Tobacco, Alcohol, and Drugs Survey.

The Canadian Cannabis Survey (CCS) 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. Health Canada applies a SGBA Plus lens to the analysis of cannabis survey data by including questions on sex, gender, age and other variables.

The Canadian Alcohol and Drugs Survey (CADS) is a biennial general population survey of cannabis, alcohol and drug use among Canadians aged 15 years and older. Indicator data are disaggregated by sex, gender, Indigenous status and age group, where possible. Note that 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 (CSTADS) 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. Indicator data are disaggregated by sex, gender and grouped grade, where possible.

Gender and other demographic data are collected through Performance and Progress Report templates submitted by recipients funded through the Health Canada SUAP on a bi-annual basis and data are aggregated/rolled-up by Health Canada. SUAP requests for indicator data to be disaggregated by demographics such as age, location, gender, and language, and priority populations such as Indigenous, 2SLGBTQI+ and racialized people/communities.

In the future, SUAP will be looking for approaches to improve demographic data collection, including through improved qualitative data collection. SUAP would like to increase the team's access to SGBA Plus training in areas such as reconciliation and Indigenous groups, 2SLGBTQI+, engagement with those with lived and living experience and harm reduction and stigma.

Program Name: Climate Change

Program Goals: The purpose of the Climate Change Program is to increase the knowledge, capacity, and tools on climate change and health risks available to partners across Canada, as well as by increasing the level of awareness of climate change and health risks (e.g., extreme heat health risks) among people in Canada, and ways to protect themselves and reduce heat risks. SGBA Plus considerations are used to gain a more comprehensive understanding of climate change awareness and impacts among disproportionately impacted groups to better target policy and awareness programs.

Target Population: All people in Canada

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Number of heat-related health impacts in Canada (per 100,000 people)	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.

Other Key Program Impacts:

In September 2022, Health Canada published Public Perceptions of the Health Impacts of Climate Change in Canada 2022 on the Library and Archives Canada website. The primary objective of this research was to determine whether, and to what extent, public understanding and perceptions of climate change have evolved over time, based on comparisons to research conducted in 2008 and 2017. Results highlighted the level of awareness of climate change and its health risks and impacts, actions taken to adapt or be more resilient to the health risks or impacts of climate change, trusted sources of media used and other means and opportunities for education and awareness raising, and the public's views on roles of government and non-government organizations. The report included disaggregated results by certain sub-populations (e.g., by gender, level of education, Indigeneity, etc.).

In 2022-23, the Department led the Health and Wellbeing theme of the Government of Canada's first National Adaptation Strategy (NAS), which establishes a shared vision for climate resilience in Canada. Equity and inclusion are at the center of its goals and guiding principles, underscoring the Strategy's support to promote environmental justice and address the factors that make people more vulnerable to climate change.

Supplementary Information Sources:

Public Perceptions of the Health Impacts of Climate Change in Canada 2022

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 public opinion research will be conducted in 2027. 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

Program Goals: 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 people in Canada. SGBA Plus is applied by identifying risks pertaining to certain sub-groups (e.g., infants or children) when assessing health and safety risks of consumer products.

Target Population: All people in Canada

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• Children or Youth

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	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: 62% French: 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 3 years. New data is expected in 2023-24.
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: 34% French: 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 $60K per year: 35% Earn less than $60K 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. Note: The survey is completed every 3 years. New data is expected in 2023-24.
Number of domestic incident reports of a child ingesting an e-liquid	0	Domestic incident reports that the Program received from consumers and industry	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.

Other Key Program Impacts:

Health Canada works to protect all people in Canada from potential risks to human health and safety from consumer products and cosmetics. Planned risk-based compliance verification projects carried out by the Consumer Product Safety Program include products intended for children. In 2022-23 these projects included the sampling and testing of strollers, cribs, and pacifiers. In addition, the Department's consumer outreach often focuses on safety information related to the safe use of products intended for children. For example, in 2022-23 Health Canada partnered with other international regulators for the second annual Safe Sleep Week campaign.

Supplementary Information Sources:

Creating a safe sleep environment for your baby

GBA Plus Data Collection Plan:

In 2022-23, the Department launched an improved version of its consumer product incident reporting form which has increased the percentage of users who complete the gender field to 90%, compared to 81% in the old form. This represents an 11% increase in completion rate of the gender field, which provides the Consumer Product Safety Program with more accurate data for future SGBA Plus analysis related to consumer product and cosmetic incidents.

Health Canada's Consumer Product Safety Program will explore how unconscious bias and systemic racism may have affected program decision-making and design. The project Deconstructing Unconscious Bias will review 5 areas to identify activities where unconscious bias exists. This includes a toxicology project on identifying racial bias in skin pigmentation for assessment of irritation. The Department will continue to explore the potential for additional SGBA Plus data collection opportunities to better assess the Program's impact.

Program Name: Controlled Substances

Program Goals: The Controlled Substances Program authorizes legitimate activities with controlled substances and precursor chemicals, while reducing 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. The Program leads the implementation of the Canadian Drugs and Substances Strategy (CDSS) which outlines the Government of Canada's approach to addressing substance use, including the toxic drug supply and overdose crisis, with the goal of minimizing the harms on individuals, families and communities.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• The Controlled Substances Program directly benefits all Canadians, as the primary target group. There are some program initiatives that address the needs of populations disproportionately impacted by substance related harms. Many factors have an influence over health and well-being, including income, access to safe and affordable housing, trauma and adverse childhood experiences, and race and racism. The renewed CDSS builds on the previous strategy by continuing to take a public health approach to all substances and introduces a new key principle of equity to support targeted actions for most affected populations.

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	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) Due to COVID-19 pandemic, there has been a delay in data collection for the next cycle of CADS. The 2023 CADS is expected to begin in 2023-24 and results are expected to be available in 2024-25.	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 1 occasion, at least once a month in the past year (Heavy Drinking)	Overall: 15.6% By sex: Male: 12.5% Female: 18.7%	Canadian Community Health Survey (2021)	Baseline (2015): Overall: 19.2% Male: 24.1% Female: 14.5%

Other Key Program Impacts:

In 2022-23, Health Canada continued to apply SGBA Plus when reviewing and developing policies and practices to consider equitable access to health and harm reduction services, such as supervised consumption sites and urgent public health need sites, commonly known as overdose prevention sites. The Department has authorized women only supervised consumption sites and applications supported by 2SLGBTQI+ community health organizations. The authorization of peer assistance at supervised consumption sites has helped reduce the risks of harm and overdose faced by women, as higher rates of women and people with disabilities use this service. As well, Health Canada pursued a digital advertising campaign, Ease the Burden, targeted to men working in trades to reduce the stigma of asking for help. Campaign surpassed all set targets resulting in over 17.7 million completed video views and audio hearing and over 142.2 million web visits.

To address identified gaps in data collection, national surveys on substance use are being enhanced to collect better SGBA Plus information including data on official languages. Further, the language in recent cycles of national surveys was revised to better support data and trend analysis going forward. For example, the language regarding sex and gender was revised in the 2023 Canadian Alcohol and Drugs Survey (CADS) and the People with Lived and Living Experiences Survey (data collected between September 2021 to February 2023). In addition, for the first time, data from the 2021-22 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS) was analyzed by gender identity.

SGBA Plus is being applied in the development and implementation of the renewed CDSS, including informing the development of policy and budgetary authorities for the renewed CDSS.

To improve the Substance Use and Addictions Program's (SUAP) capacity for collecting and reporting on demographic data and to support funding recipients, SUAP undertook the following in 2022-23:

• Collected aggregate project-level data (e.g., diversity and ethnicity demographics) at the front-end of a project's life cycle (current and ongoing).
• Provided a demographic data collection guide to recipients which supports the collection of relevant SGBA Plus data. This guide included examples of quantitative and qualitative demographic data collection tools.
• Provided an information session for funding recipients on collecting performance measurement data, including requirements for demographic data collection.
• Launched an updated progress report template with a dedicated demographic data collection annex.

Supplementary Information Sources:

• Canadian Community Health Survey
• Canadian Alcohol and Drugs Survey
• Canadian Student Tobacco, Alcohol and Drugs Survey
• Canadian Postsecondary Education Alcohol and Drug use Survey

GBA Plus Data Collection Plan:

To support the government's tracking and monitoring of the overdose crisis and broader substance use trends, in 2022-23 the program, in collaboration with federal partners, led the development of a new CDSS Data and Evidence Framework. This framework will guide the development of indicators, as well as the collection, analysis, and dissemination of timely and meaningful data and information on the use and impacts of drugs and substances in Canada. These actions will help ensure that equity and SGBA Plus are key considerations when developing or modifying data collection activities and analysis.

In the future, SUAP will be looking for approaches to improve demographic data collection, including through improved qualitative data collection. SUAP would like to increase the team's access to SGBA Plus training in areas such as reconciliation and indigenous groups, 2SLGBTQI+, engagement with those with lived and living experience, harm reduction and stigma.

Program Name: Food & Nutrition

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

Program Goals: The Program aims to change the state of the food and nutrition landscape in Canada by ensuring that the Canadian population is equipped to make safe and healthy eating choices, and that Canada maintains a world-class food safety system.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Percentage of Canadians who report eating fruit and vegetables 5 or more times per day	Total: 21.8% By sex at birth: Male: 17.8% Female: 25.5% By age: 12 to 17: 22.2% 18 to 34: 17.8% 35 to 49: 23.1% 50 to 64: 21.2% ≥ 65r: 25.5% By Region (province) of residence: Atlantic: 15.9% (Newfoundland and Labrador): 12.1% (Prince Edward Island): 17.0% (Nova Scotia): 17.8% (New Brunswick): 15.9% Quebec: 28.5% Ontario: 19.8% Prairies: 19.6% (Manitoba): 19.2% (Saskatchewan): 21.4% (Alberta): 19.3% British Columbia: 21.4% By household Income quintile (national): Lowest: 18.4% Low-Middle: 20.4% Middle: 21.8% High-Middle: 23.2% Highest: 24.4% By highest education: Less than secondary school graduation: 19.1% Secondary school graduation, no post-secondary education: 17.0% Post-secondary certificate, diploma or university degree: 23.9%	2021 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

Other Key Program Impacts:

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 is 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.

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. The Department continued to review and update resources and to develop new resources, tools and initiatives to promote healthy eating as it seeks to broaden the reach of Canada's Food Guide to a more diverse population of people living in Canada and Canadians living abroad.

Another priority for Health Canada is monitoring children and teens' exposure to food marketing. This is an important determinant of healthy eating and may contribute to health disparities affecting youth. In 2022-23, the Department's efforts to monitor food and beverage marketing to children and teens, a study assessing the intersection between persuasive power and exposure of specific platforms on teen audiences was completed. The study reported results based on SGBA Plus identity factors, including age, ethnicity, postal code, and self-identified gender.

The Department also continued to develop targeted healthy eating resources and work with stakeholders to reach the Canadian population across various settings, ages, and population groups. For example, Health Canada partnered with youth organizations to facilitate peer-to-peer engagement on the food guide and enable them to promote healthy eating in their communities. This included engaging youth 12 to 25 years to support peer engagement on healthy eating.

These youth explored issues related to healthy eating promotion and the food guide and developed community interventions that increase knowledge and use of the food guide's healthy eating messages and resources. Youth participants included representation from both official languages, all regions of Canada, as well as a mix of genders and diverse representation including Black, Indigenous, and other racialized youth, as well as youth from rural/remote, low socio-economic status and disability communities, and those who identify as part of 2SLGBTQI+ communities.

In 2022-23, Health Canada continued its development of new regulations that will enable the agri-food industry to conduct clinical trials on innovative foods not yet compliant with the Food Regulations that have been specially processed or formulated to meet the requirements of people with health conditions or for whom it is their sole or primary source of nutrition. As part of a broader Department initiative to modernize the Clinical Trial Regulatory Framework, these Regulations will also allow more complex and innovative trial designs such as decentralized clinical trials. Decentralized trials allow trial participation and thus early access to these new foods for a special dietary purpose by women with young infants, Indigenous and other people living in remote and rural settings with special dietary needs.

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 works with Statistics Canada on questionnaires that allow for collection of SGBA Plus data to provide information related to food and the Canadian population and future policy development related to healthy eating across diverse groups in the Canadian population. The Canadian Community Health Survey is a key tool for Health Canada to collect data.

As part of its Strategy to monitor food advertising to children in Canada, the Department works with experts to collect data on children's exposure to food advertising in a range of media and settings. Whenever possible, data is collected across diverse groups to assess whether some children are more exposed than others.

Program Name: Health Canada Specialized Services (Employee Assistance Program)

Program Goals: Health Canada Specialized Services consists of 3 specialized services that Health Canada is mandated by legislation, Treasury Board policy, and government direction with the responsibility to deliver.

Employee Assistance Services delivers the Employee Assistance Program (EAP) through a network of contracted mental health professionals, providing access to immediate crisis counselling (by telephone) and referrals to short-term counselling services for federal public servants and their dependents. In 2022-23, EAP continued to apply a SGBA Plus lens to its policies, procedures, and services. EAP has identified groups who typically underutilize their services, such as men, youth and 2SLGBTQI+ communities. Through investment in specialized tools and training, and key activities such as focused communications and recruitment of mental health professionals, EAP is working to ensure equity across its services.

The Public Service Occupational Health Program (PSOHP) provides occupational health evaluations, communicable disease services, advice, and guidance, to federal departments in the core public administration. PSOHP conducts its services considering SGBA Plus-related factors, as relevant to an individual's occupational health, to make equitable, evidence-based recommendations to help client departments protect the occupational health of their employees.

The Internationally Protected Persons Program is described in the next section.

Target Population: Individual eligible federal employees and veterans (and immediate family members)

Distribution of Benefits

	Group
By gender	Fourth group: 60 per cent - 79 per cent women
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

EAP uses an enhanced capacity building approach to invest in efforts, tools, and training to benefit groups underutilizing EAP (such as men, youth and 2SLGBTQI+ communities). Examples of these enhancements in 2022-23 included:

• Leveraging technology, including focused social media communications, real time chat, procurement and promotion of proven digital wellness resources, and availability of virtual face-to-face counselling via secure video;
• Improving capacity to match clients requesting a counsellor with a specific identity, lived experience or other relevant expertise, through ongoing surveys of the counsellor network and associated focused recruitment;
• Continuing the delivery of 2SLGBTQI+ inclusion training to EAP's mental health service providers. To date, the training has been taken by more than 400 EAP mental health professionals; and
• Continuing the promotion of anti-racism, diversity, and inclusion through its suite of services tailored to client departments, including presentations on anti-racism, psycho-emotional support during a Pride workshop event, and workshops on unconscious bias and systemic bias.

PSOHP provides occupational health evaluations, communicable disease services, advice and guidance to federal departments in the core public administration. Individuals accessing PSOHP services are identified by their employing departments as part of their internal HR processes. PSOHP conducts its services considering SGBA Plus-related factors, as relevant to an individual's occupational health, to make equitable, evidence-based recommendations to help client departments protect the occupational health of their employees.

GBA Plus Data Collection Plan:

EAP collects sufficient data to monitor and/or report on service utilization and general client experience (e.g., satisfaction with various stages of the service) by gender and other demographic categories. PSOHP is currently unable to report on program impacts by gender and diversity.

• EAP utilization is disaggregated by gender, age, and various employment categories (e.g., manager, operational, administrative, scientific). EAP also incorporates a GBA Plus lens in a telephonic client survey where data is disaggregated by gender, age, region, language, sexual orientation, and employment equity. Approximately 4,000 clients who had used EAP services initially agreed to participate in the survey. Of those 4,000, 950 responded.
• In 2022-23, PSOHP rolled-out its new National Occupational Health Information System (NOHIS), which will enable the collection of disaggregated data. PSOHP is working to expand the disaggregated data that NOHIS collects and on which it can ultimately report. Health Canada will ensure best practices in SGBA Plus data collection plans, currently used by EAP, are applied to the new information system.

Program Name: Health Canada Specialized Services (Internationally Protected Persons Program)

Program Goals: The Internationally Protected Persons (IPP) Program coordinates the development of health plans for visiting internationally protected persons to Canada. The IPP Program ensures appropriate measures are in place in the event of a medical emergency by developing 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.

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.

Target Population: Internationally protected persons

Distribution of Benefits

	Group
By gender	Fourth group: 60 per cent - 79 per cent women
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• The IPP Program coordinates the development of contingency health plans for visiting IPPs to Canada. As a result of global travel resuming in 2022-23, the IPP Program processed 62 health plans for 28 visits to Canada by IPPs.

GBA Plus Data Collection Plan:

The IPP Program supported the Government of Canada's international obligations under the customary International Law by ensuring the health protection of IPPs visiting Canada. IPPs are Heads of State and/or Heads of Government, and dignitaries from foreign countries visiting Canada for official government purposes or for personal reasons. Official visits by IPPs were at the request of government officials, such as the Prime Minister or Minister of Foreign Affairs. The IPP Program's partners in Global Affairs Canada, Heritage Canada, the RCMP and the Department of National Defence served as hosts for IPP visits and led all planning activities.

Due to the contingent nature of health plans, the limited number of times they were activated and the confidential nature of medical information upon activation, there was insufficient data to measure outcomes. For these reasons, the IPP Program did not collect SGBA Plus data in 2022-23 but will continue to explore ways to incorporate SGBA Plus data collection into its program activities.

Program Name: Health Impacts of Chemicals

Program Goals: The Health Impacts of Chemicals Program aims to protect the health of people in Canada, through the assessment and management of health risks associated with environmental contaminants. The risk assessment process applies SGBA Plus considerations to determine susceptibility and exposure where data are available. SGBA Plus analysis is also used when risk management actions are put in place. The Program's performance measurement activities, intended to assess the extent to which risk management activities have reduced the potential for exposure to harmful substances, include a particular focus on disproportionately impacted sub-groups.

Target Population: All people in Canada

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• Women
• Men
• Children or Youth

Other Key Program Impacts:

Health Canada assesses the extent to which its risk management activities have reduced the potential for exposure to harmful substances. When the Department 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.

The Department 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. For example, since 2007, nationally representative biomonitoring data have been collected through the Canadian Health Measures Survey to inform risk assessment and risk management actions. The levels of environmental chemicals are reported by age group (3-79 years of age) and sex for the Canadian population. In 2022-23 the Survey started collecting information on the gender identity of respondents and a new age group sub-population (1-2 years). Results of this survey are planned to be reported in 2026-27.

In the context of chemicals management, Health Canada recognizes that there are 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 and sex. 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 April 2022, a fact sheet was published describing how the program considers vulnerable populations in risk assessments.

Supplementary Information Sources:

Consideration of vulnerable populations in risk assessment

GBA Plus Data Collection Plan:

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. The Department 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 meet applicable safety, effectiveness and quality requirements through regulatory activities and the provision of relevant information to the Canadian population and health professionals.

Program Goals: The Program aims to change the state of the medical devices landscape in Canada by ensuring that the Canadian population has access to medical devices that meet safety, effectiveness and quality requirements.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Other Key Program Impacts:

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

The Department 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. The Department has published Guidance 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 and includes an SGBA Plus section regarding clinical trial data on sex, gender, under-represented populations, and pediatric populations.

Health Canada also considers SGBA Plus when reviewing medical device licence applications on a case-by-case basis. For example, the review of a patient monitoring system, being amended to include use on pediatric and infant patients, included the review of data on bias among subjects with darker and light skin pigmentation (MDL 103508). The review of a Troponin I test, used as an aid in the diagnosis of myocardial infarction, included the review of female and male specific cut-offs and determination of sex-based sensitivity (MDL 108493).

And as a final example, an application for a dermal filler was rejected because the available clinical data had been collected in a more homogenous population that did not reflect the range of skin tones expected in a Canadian population, and skin tone has been identified as a factor that could potentially affect treatment results for dermal fillers. Furthermore, where data is unavailable to support an indication in specific sub-populations, limitations are included in the indications for use. For example, the licencing of the HIV/Syphilis test did not include an indication for use in pregnant individuals because insufficient data was available to support that use. And this, even though pregnant populations are a group of specific concern for infections with Syphilis.

As noted under the "Biologic and Radiopharmaceutical Drugs" section, the Regulations Amending Certain Regulations Made Under the Food and Drugs Act (Agile Licensing) were published in Canada Gazette, Part 1 and Health Canada consulted on the proposed agile regulations and guidance for licensing drugs and medical devices.

Although the Medical Devices Regulations currently allow the Minister to impose terms and conditions (T&Cs) related to testing on Class II, III or IV medical device licences, under the proposed amendments, T&Cs could be imposed at any point in the device lifecycle and would no longer be restricted to testing. For example, T&Cs could be used to manage risk by restricting the distribution of a medical device to key populations, such as pediatrics or pregnant persons.

The expansion of medical device T&Cs would specifically address uncertainties and risks that only become apparent under real-world use of a device. This could be helpful in identifying the patient populations that would benefit the most from the mitigation of serious health risks. Given that the use of medical devices among individuals experiencing disabilities is disproportionately high as compared to the Canadian population at large, individuals experiencing disability are expected to benefit disproportionately from the proposed amendment to T&Cs for medical devices. The proposed amendments to T&Cs for medical devices should lead to increased levels of confidence in the devices by the diverse populations in Canada who use them.

The Canadian Institutes of Health Research (CIHR) in collaboration with Women and Gender Equality Canada and Health Canada held a virtual Best Brains Exchange (BBE) meeting on March 7, 2023, to explore the development of a Canadian Breast Implant Registry. This BBE provided an opportunity to analyze international best practices and lessons learned, as well as better understand the Canadian landscape. The BBE participants reinforced general support for the development of a breast implant registry, while numerous challenges and considerations were raised, such as those related to privacy, funding and registry management/oversight.

Health Canada continues to investigate important issues at the intersect of medical devices and considerations of sex and gender. In 2022-2023, Health Canada published an updated safety review of Breast Implant Associated – Anaplastic Large Cell Lymphoma and a new surveillance data blog, as well as a safety review of standard synthetic mid-urethral slings (a type of vaginal mesh) that examined the long-term safety and effectiveness.

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 2022-23, the Department implemented 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, a Guidance Document on Clinical Evidence Requirements for medical devices was published. This document provides 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 way's 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.

The Guidance will enhance the way that SGBA Plus data is analysed and reported on by the Department with the goal to better inform the public about medical devices benefits and risks.

Health Canada considers any relevant data that is made available through reporting requirements to support SGBA Plus assessments in the post-market environment. Since 2020 the Medical Device Problem Reporting Form for Health Care Professionals includes optional fields for patient sex.

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 the Canadian population.

Program Goals: The Program aims to change the state of the natural health products landscape in Canada by ensuring that the Canadian population have access to safe, effective and quality natural health products.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Fourth group: 60 per cent - 79 per cent women
By income level	Fourth group: somewhat benefits high income individuals (somewhat regressive)
By age group	Third group: primarily benefits seniors or the baby boom generation

Specific Demographic Group Outcomes:

• All Canadians

Other Key Program Impacts:

In July 2022, final 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 were published. The regulations were informed by the August 2021, Health Canada-CIHR SGBA Plus Health Policy-Research Partnerships where 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.

In this regard 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.

Supplementary Information Sources:

Natural Health Product Tracking Survey 2010 Final Report.

Consumer Health Products Survey 2016

GBA Plus Data Collection Plan:

Health Canada implemented a 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.

The Department considers any relevant data that is made available through reporting requirements to support SGBA Plus assessments in the post-market environment.

Program Name: Pesticides

Program Goals: The objective of the Pesticides Program is to protect the health and safety of Canadians and the environment relating to the use of pesticides. Some SGBA Plus metrics are considered during scientific risk assessment and public opinion research activities for potential impacts to various key populations and to inform future operations if unique findings are observed, respectively.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	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: 50% Female: 50% Prefer not to Disclose: 0% By age: 18-34: 27% 35-54: 34% ≥55: 39% By region: BC: 14% AB: 11% SK/MB: 7% ON: 38% QC: 23% Atlantic: 7% By education level: Less than High School: 4% High School: 23% Registered apprenticeship / other trade certificate: 6% College, CEGEP, or non-university certificate: 26% University below bachelor's level: 6% Bachelor's degree: 25% Post-graduate degree above bachelor's: 9% Prefer not to Answer: 1% By area of residence: Urban: 46% Suburban: 35% Rural: 19% By income: <$40k: 27% $40k - <$60k: 16% $60k - <$100k: 27% >$100k: 22% Prefer not to Answer: 8%	2023 Public Opinion Research	N/A

Other Key Program Impacts:

When a pesticide is being evaluated for its potential risks to human health, the Pest Control Products Act requires Health Canada to consider 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 priority 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 the Department. 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 conducts a Public Opinion Research Survey every four years to measure the impact of outreach and awareness activities on the public. In total, 2,206 respondents completed the survey in 2023, 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 Census. 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. Department 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 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 the Canadian population and health professionals.

Program Goals: The Program aims to change the state of the pharmaceutical drug landscape in Canada by ensuring that the Canadian population have access to safe, effective and quality pharmaceutical drugs.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• All Canadians

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	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: -13% Total number of mandatory ADRs for pharmaceutical drugs By sex: Male: 1,505 (46%) Female: 1,775 (54%) Not Specified: 19 (<1%)	Canada Vigilance Database (2022-23)	N/A

Other Key Program Impacts:

As noted under the "Biologic and Radiopharmaceutical Drugs" and the "Medical Devices" sections, the Regulations Amending Certain Regulations Made Under the Food and Drugs Act (Agile Licensing) were published and Health Canada in Canada Gazette, Part 1. Health Canada consulted on the proposed agile regulations and guidance for licensing drugs and medical devices.

Currently the Minister has the power to impose or amend Terms and Conditions (T&Cs) on opioid drugs and designated COVID-19 drugs in the Food and Drug Regulations. The proposed regulatory amendments would broaden this authority to all drugs. That is, the Minister would be given the authority to impose T&Cs on the drug identification number of any drug, to manage and/or address risks and uncertainties. Manufacturers would be obligated to take the necessary steps to address the identified risks and uncertainties for a given authorized indication of a drug.

For example, T&Cs can be imposed when a certain ethnicity may be under-represented in phase III clinical trials. The Department could require a manufacturer, through T&Cs, to create a patient registry or conduct additional studies to supply this data post authorization. When appropriate, T&Cs may be used to better understand the risks and benefits of drugs in populations that are often excluded from clinical trials due to lower risk tolerance levels, such as pregnant or breastfeeding people.

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 support of the SGBA Plus data strategy, the Department implemented a questionnaire for sponsors of all drug submissions to verify if their submitted clinical evidence has been disaggregated by sex, age, and race/ethnicity. The questionnaire became mandatory on December 1, 2022. Health Canada is undertaking analysis of the questionnaire to be able to report on the proportion of submissions containing clinical data disaggregated by these subgroups.

The Department also 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.

Health Canada is also incorporating SGBA Plus into its Risk Management Plan review process and procedures. For instance, Health Canada has recently submitted a query through the Post-Market Drug Evaluation Program where objectives include assessing patient characteristics (emphasis on SGBA Plus) related to potential risk of developing diverticulitis after exposure to opioids. The Department also continues to explore how to incorporate SGBA Plus considerations into other post-market surveillance activities.

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.

Additionally, Health Canada's SGBA Plus Data Strategy^{Footnote 3} 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.

Health Canada considers any relevant data that is made available through reporting requirements to support SGBA Plus assessments in the post-market environment.

Program Name: Radiation Protection

Program Goals: The objectives of the Radiation Protection Program are to help protect the health and safety of people in Canada from radiation by providing information and advice to individuals, Canadian government departments and stakeholders (P/Ts, health professionals and associations, industry, etc.) about radiation health risks and strategies to manage those risks and by regulating the radiation safety of radiation emitting devices. SGBA Plus considerations are used in research and then applied to support the development and implementation of awareness and outreach activities.

Target Population: All people in Canada

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• Women
• Men
• Seniors
• Children or Youth
• Individuals of particular socio-economic status
• Individuals of particular educational level

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	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: 24% French: 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 $60K per year: 24% Earn less than $60K 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. The next survey will be conducted in 2023-24 and results will be available in 2024-25.

Other Key Program Impacts:

Health Canada's National Radon Program conducts public opinion research approximately every 5 years, to help understand the level of public knowledge about radon and its associated risks. The most recent results (2022) indicate that Canadian householders who are 35 or younger are less likely to have awareness of radon, with people 65 and older being the most likely to be aware. Knowledge of radon testing was generally similar across the country but, when asked where they could get a DIY testing kit, men were more likely than women to mention on-line retailers (33% vs 27%), while people 34 and younger were the most likely to mention a public health office (30%). Households that had already tested for radon correlated with higher income ($80K or more), having a university degree or children under 16, and being a smoker or having been diagnosed with lung cancer. Finally, people aged 65 or older were much more likely (28%) to say that they were not worried about radon. The results will help evaluate and measure the National Radon Program's impact and progress over the last 5 years.

Public opinion research was also conducted in 2022-23 on people's attitudes, knowledge and perceptions about radiation risks from exposure to radiation emitting devices. Results indicated that while most individuals (82%) understood that using a tanning bed did not protect against skin cancer, 1 in 5 people under the age of 35 believed that using a tanning bed protects against skin cancer (21%). Older adults (55+) correctly identified that science has not proven that cell phone use causes cancer (67%), while 2 in 5 people under the age of 35 believe that science has proven that cell phone usage causes cancer (45%). Only 22% of women and 42% of men reported using hearing protection while using noisy products. Results from this public opinion research will further inform Health Canada messaging to address misinformation and to educate people on radiation emitting devices and potential health risks associated with those products.

Supplementary Information Sources:

Final Report Attitudes, Knowledge, and Expectations about Radiation Risk from Exposure to Radiation Emitting Devices

GBA Plus Data Collection Plan:

Health Canada is planning a fact-based survey in 2023-24 to determine 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: Tobacco Control

Program Goals: The objective of the Tobacco Control program is to reduce the prevalence of tobacco use in Canada to less than 5% by 2035 through efforts to prevent the uptake of tobacco use by youth and those who do not smoke and to help those who currently use tobacco to quit. The Tobacco Control Program also addresses the health risks associated with the use of vaping products and works to prevent their use among youth and Canadians who do not smoke.

The Tobacco Control program incorporated SGBA information in the development of policies, programs, and legislation. Data disaggregated by sex, gender, sexual orientation, age, ethnic and socioeconomic status, and other relevant factors is being collected, analysed, and incorporated into our products, including regulations, public education campaigns, policy briefing material, policy position papers, budget proposals, etc.

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• Overall, Tobacco program activities are aimed at all Canadians to decrease the death and disease caused by tobacco use. Tobacco use is not spread equally across the population. To address that, Health Canada implemented policies and interventions that are specifically targeting adults who smoke, youth and/or those who do not smoke. The long-term objective is to reduce tobacco use among all Canadians.

Key Program Impacts on Gender and Diversity:

Key Program Impacts Statistics

Statistics	Observed Results	Data Source	Comment
Percentage of Canadians aged 15 to 19 who have reported using a vaping product (e-cigarettes only) in the past 30 days by sex	Overall: 13% By sex: Male: 15% Female: 12%	2021 Canadian Community Health Survey	Baseline (CSTADS, 2016-17) Overall: 10% Male: 12% Female: 8%
Percentage of Canadians aged 15 to 19 who have reported using any tobacco product (including cigarettes) in the past 30 days by sex	Overall: 5%Table 2.2.2.16 Footnote * By sex: Male: 6%Table 2.2.2.16 Footnote * Female: 3%Table 2.2.2.16 Footnote *	2021 Canadian Community Health Survey	Baseline (CSTADS, 2016-17) Overall: 10% Male: 12% Female: 8%
Prevalence of Canadians (aged 15+) who report current cigarette smoking by sex, age, sexual orientation, educational attainment, socio-economic status and diagnosis of anxiety and/or mood disorder	Overall: 12% By sex: Male: 14% Female: 11% By age: 15-19: 3%Table 2.2.2.16 Footnote * 20-24: 10% 25-44: 13% 45+: 13% By sexual orientation: Heterosexual: 12% Homosexual: 14%Table 2.2.2.16 Footnote * Bisexual or pansexual: 15% By educational attainment: Less than secondary school graduation: 16% Secondary school graduation, no post-secondary education: 16% Post-secondary certificate/diploma: 14% University degree or more: 7% By socio-economic status Income Quintile 1 ($0 to $50,000): 17% Income Quintile 2 ($50,003 to $83,398): 14% Income Quintile 3 ($83,401 to $121,404): 12% Income Quintile 4 ($121,408 to $177,400): 10% Income Quintile 5 ($177,439 to $30M): 8% Respondent reports a mood and/or anxiety disorder: Yes: 19% No: 11%	Canadian Community Health Survey - Annual Share (2021)	Baseline (CCHS, 2016) Overall: 15% Male: 20% Female: 12% 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 2.2.2.16 - Footnote * Moderate sampling variability; interpret with caution. Return to Table 2.2.2.16 Footnote * referrer

Other Key Program Impacts:

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 2022-23, 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. The Department 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 Canadians who do not smoke.

To improve the Substance Use and Additions Program's (SUAP) capacity for collecting and reporting on demographic data and to support funding recipients, SUAP undertook the following in 2022-23:

• Collected aggregate project-level data (e.g., diversity and ethnicity demographics) at the front-end of a project's life cycle (current and ongoing).
• Provided a demographic data collection guide to recipients which supports the collection of relevant SGBA Plus data. This guide included examples of quantitative and qualitative demographic data collection tools.
• Provided an information session for funding recipients on collecting performance measurement data, including requirements for demographic data collection.
• Launched an updated progress report template with a dedicated demographic data collection annex.

Supplementary Information Sources:

Canadian Tobacco and Nicotine Survey 2021 Summary of Results

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.

In 2022-23, Tobacco Control program used 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 Canadian Tobacco and Nicotine Survey 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.

The program changed its analysis plans, primary data sources and projects to collect and report on a variety of equity indicators. These disaggregated data are foundational information enabling initiatives across the directorate to integrate SGBA plus into their work.

In the future, SUAP will be looking for approaches to improve demographic data collection, including through improved qualitative data collection. SUAP would like to increase the team's access to SGBA Plus training in areas such as reconciliation and indigenous groups, 2SLGBTQI+, engagement with those with lived and living experience and harm reduction and stigma.

Program Name: Water Quality

Program Goals: The objective of the Water Quality Program is to help manage potential risks to the health of people in Canada associated with water quality. Specifically, the Program works with other federal government departments and agencies and P/Ts to establish the Guidelines for Canadian Drinking Water Quality. These guidelines are endorsed through a 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. When developing drinking water quality guidelines, the Program considers and often bases maximum acceptable concentrations of contaminants on health endpoints related to SGBA Plus considerations of at-risk populations and sex, when available, most notably the impacts on pregnant persons and birth outcomes, along with other potentially disproportionately impacted populations based on other considerations (e.g., age, geography).

Target Population: All Canadians

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Other Key Program Impacts:

Health Canada's Water Quality Program generally benefits all people in Canada by developing guidelines, including maximum acceptable concentrations or treatment goals, 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 available during the development of a guideline, the Department 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. The Department collects existing and emerging 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

Program Goals: 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 workers in Canada who come into contact with workplace chemicals have the information they need to protect themselves. SGBA Plus considerations are included for regulatory proposals and in the development of educational and compliance promotion activities.

Target Population: A particular demographic group (people in Canada who work with hazardous products)

Distribution of Benefits

	Group
By gender	Third group: broadly gender-balanced
By income level	Third group: no significant distributional impacts
By age group	Second group: no significant intergenerational impacts or impacts on generations between youths and seniors

Specific Demographic Group Outcomes:

• Men
• Women

Other Key Program Impacts:

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.

Supplementary Information Sources:

Precarious Employment and Vulnerable Workers at greater risk of injury

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. In addition, the Department has been considering extending hazard communication requirements to consumer products used in workplaces. As Health Canada continues to explore this issue, SGBA Plus-related information will be included in the analysis.

Health Canada is also exploring the protection of workers at greater risk of injury. In this context, this 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 consider the 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 at-risk sectors. The Department will carry out a fact-based survey to gauge workers' knowledge of the hazard and safety information available to them when using hazardous workplace products. Survey results will be disaggregated by gender, age, region, income and language to identify potential demographic groups that may be at a higher risk of not being informed by their employer on the safe use and storage of workplace chemicals. Results from the survey will be available in 2023-24.

Horizontal Initiatives

Addressing the Opioid Crisis

General information

Name of horizontal initiative

Addressing the Opioid Crisis

Start date

April 1, 2018

End date

March 31, 2023

Lead department

Health Canada

Number of times renewed

Not applicable

Partner departments

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

Other non-federal partners

Not applicable

Expenditures

Total federal funding from 2018-19 to 2022-23^{Footnote 4} (authorities and actual)

Comments on variances^{Footnote 5}

Canada Border Services Agency

The variance between actual spending and authorities is mainly due to previous carry-forwards and reprofiles that were required as a result of delays in procurement and execution due to COVID-19, supply change issues, scope reductions, as well as indirect costs being added to each line item (Employee Benefit Plan, Public Services and Procurement Canada, Shared Services Canada).

Public Safety Canada

The variance between planned and actual spending is due to careful financial management as well as COVID-19 restrictions that directly impacted the Department's ability to host and attend in person events and conferences.

Public Health Agency of Canada

The variance between planned and actual spending is mainly due to delays in staffing, unexpected vacancies, impact of COVID-19 on reduced training, travel and conferences, as well as delays in processing contracts.

Results

Performance indicator(s) and trend data for shared outcome(s)

Brief Explanation of Performance

The substance use landscape in Canada is constantly evolving and changing. While evidence suggests that, by mid-to-late 2019, efforts to reduce the impact of the crisis were having a positive impact as demonstrated by a modest decline in mortality rates, Canada experienced a substantial increase in opioid-related harms and deaths at the beginning of the COVID-19 pandemic and deaths have remained above pre-pandemic levels since this time.

• The number of apparent opioid-related deaths per 100,000 population went from 10.9 apparent opioid-related deaths in 2017 to 18.8 apparent opioid-related deaths per 100,000 population in 2022 (latest data available).
• The number of hospital admissions due to opioid poisoning (including overdoses) per 100,000 population went from 16.4 hospital admissions in 2017 to 17.4 hospital admissions per 100,000 population in 2022 (latest data available).

The federal government is deeply concerned by the number of overdoses and deaths, as each death represents another spouse, sibling, child, family member, or friend lost to this crisis, and will continue to take significant actions in areas of federal jurisdiction to address the crisis. We also recognize that substance use-related harms can extend far beyond overdose deaths ─ including its impacts on people's health, relationships and livelihoods. That is why we need services and interventions that offer a full range of health and social services and supports. The Government of Canada is working with all levels of government to try to reduce stigma, save lives and ensure all people who use drugs have the life-saving substance use services and supports they need through prevention harm reduction, treatment, and recovery and efforts.

The federal government's actions to address the overdose crisis are guided by the Canadian Drugs and Substances Strategy^{Footnote 6} (CDSS), which takes a comprehensive, collaborative, and compassionate approach to substance use issues using a public health lens. In 2017, the Government of Canada funded action through the CDSS to address substance use-related harms, followed by a series of complementary short-term investments through various budget cycles to directly address the overdose crisis. The Addressing the Opioid Crisis initiative was launched in 2018 and received some reallocated funding from the CDSS. In total, between 2019 and 2022, these short-term investments committed approximately $859 million to support a broad range of activities to urgently reduce the number of opioid-related harms and deaths in Canada.

The overdose crisis and substance use, in general, are complex public health issues and there are no one-size-fits-all solutions to preventing or reducing overdose deaths. The overall shared outcome of the Addressing the Opioid Crisis horizontal initiative was to reduce the harms and deaths related to opioid use. 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, treatment and harm reduction interventions through an expansion of the 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).

Key accomplishments through this horizontal initiative (2018-29 to 2022-23) are outlined below:

Health Canada

Health Canada's SUAP provided monitoring and support of 22 opioid-related projects funded through this Horizontal Initiative for the period of 2018-19 to 2022-23 targeting prevention, treatment, and harm reduction interventions. Funded projects were located across the country and included activities such as: developing curricula, tools and supports for safer opioid prescribing; implementing networks and resources that support health and social service professionals to offer addictions services; increasing access to Opioid Agonist Treatment (OAT), including training and performance measurement activities and the development of best practices in OAT. These projects cumulatively created 634 knowledge products that were accessed by over 140,000 Canadians or stakeholders. Projects also delivered 3,322 learning opportunities to over 30,000 Canadians or stakeholders.

Health Canada launched a national multi-year public education campaign to address the stigma surrounding people who use drugs, the growing overdose crisis and to educate people living in Canada on the risks associated with opioids, including the role of stigma as a barrier to treatment in April 2018. This multi-year campaign featured advertising, experiential marketing and marketing partnerships to reach audiences, which included men 20-59, youth and post-secondary students, in addition to the general population.

In April 2018, Health Canada launched the Know More Opioids experiential marketing campaign for youth and young adults to inform them about the harms related to opioids and reduce substance use related stigma. Through this program, Health Canada delivered more than 1,400 in-person and virtual high school sessions, 68 post-secondary school events, 43 events/festivals, and engaged over 175,000 people; and, placed awareness products such as posters and wallet cards, in high-traffic areas of 16 post-secondary institutions between April 2018 and May 2023.

From November 2018 to March 2023, Health Canada ran six phases of a national advertising campaign focusing on various aspects of the overdose crisis. These included advertisements^{Footnote 7} focusing on the impacts of stigma surrounding people who use drugs, as well as raising awareness of the Good Samaritan Drug Overdose Act and how to respond to an opioid overdose. While initial advertising efforts focused on broadly educating Canadians about the improper use of prescription drugs, in light of the latest trends data, the campaign messaging and creatives evolved, as did the approach to targeting those most at risk and those most impacted. Efforts included developing the Men in Trades campaign targeting males aged 20 to 59 in physically demanding jobs who are disproportionately impacted by substance use-related harms.

Health Canada has used several methods to measure the performance of its public education work, including public opinion research (e.g., the 2017 baseline survey and follow-up surveys in 2019 and 2021, Government of Canada Advertising Campaign Evaluation Tools (ACETs)), as well as advertising metrics and web analytics.

Key results achieved included:

• Between fall 2018 and June 2019, unaided ad recall of Government of Canada ads related to opioid use / crisis increased by 8% (i.e., 4% in fall 2018 up to 12% in June 2019); aided recall of Government of Canada opioid ads increased from 26% to 46%; and top-of-mind messages included fentanyl and the opioid crisis, assisting people who are experiencing an overdose, anyone can be affected by opioids, and stigma prevents people from getting help.^{Footnote 8}
• A 6% increase in unaided recall of Government of Canada ads about opioids was found (18% to 24%) in April 2023 compared to before the fall 2022 campaign; 65% recalled seeing the ad after being shown ad creatives; 83% agreed or strongly agreed that the ads talked about an important topic (7% increase over spring 2019); and 71% agreed or strongly agreed that the ads gave them an understanding that support is available to end opioid addiction.^{Footnote 9}
• A reduction in respondents demonstrating stigmatizing views from 28% in 2017 to 24% in 2021.^{Footnote 10}
• A 211.28% increase was also observed in 2022-23 in visits to opioid-related content on Canada.ca/opioids, including content related to seeking help.

Public Safety Canada

During the five-year period (2018-19 to 2022-23), Public Safety Canada developed and administered a range of initiatives that directly supported the Government of Canada's commitment to addressing the opioid crisis and other emerging drug threats. Some successes include the development and deployment of a free online drug stigma awareness training for law enforcement. The training provides tools and reference material to support law enforcement's interactions with people who use substances, to help reduce the stigma they face that prevents them from accessing health and social services. As of March 31, 2023, more than 4,000 frontline law enforcement members have completed the training. The Department remains committed to continuing to work with law enforcement to raise awareness of the training and promote its uptake.

Public Safety Canada also organized and delivered five national roundtables on drugs. Using both in-person and virtual formats, Public Safety Canada provided a forum for law enforcement, academia, Indigenous communities, governmental and non-governmental organizations, Canadian and international experts and individuals with lived and living experience of substance use to share insights, perspectives and challenges in responding to the opioid overdose crisis and other drug threats. As part of this initiative, Public Safety Canada worked with domestic and international partners to identify and address cross-border trafficking issues and enhance sharing of information and best practices that helped to protect Canada's border from the importation of illegal substances and the products used to produce them.

Statistics Canada

During the five-year period, Statistics Canada developed and implemented several initiatives that directly supported the Government of Canada's commitment to addressing the opioid crisis and other emerging threats. As part of Statistics Canada's work on the CCMED, data collection efforts were substantially improved. Data are now received from 12 of the 13 jurisdictions, and coverage issues have been resolved by working individually with the provinces and territories (P/Ts). Furthermore, StatCan addressed timeliness issues by moving from a bi-annual to a quarterly data collection cycle. In conjunction with Statistics Canada's partners at the Public Health Agency of Canada (PHAC) and the provincial and territorial chief coroners and chief medical examiners, Statistics Canada developed a common set of variables for drug-related toxicity deaths to be collected by all jurisdictions. This comparative data has greatly enhanced the ability to analyze and report at the national level.

Funding was also used to develop and apply machine learning techniques on the CCMED data. More specifically, topic modelling and Natural Language Processing were used to automatically classify documents. By using the open text information from the narrative field, it is possible to not only identify opioid related deaths more quickly, but also to identify emerging trends. This is a useful surveillance tool to assist in creating a timelier response to the public health crisis.

Canada Border Services Agency

During the past 5 years, the Canada Border Services Agency (CBSA) has played an active role in supporting the Government of Canada's commitment in addressing the opioid crisis and other emerging drug threats by equipping safe examination areas and regional screening facilities, by augmenting intelligence and risk assessment capacity, and by enhancing the Dog Detector Program.

The Government of Canada has made investments in providing the equipment necessary to equip 81 of the highest risk/volume ports of entry with Designated Safe Examination Areas. These de-marked separated areas, away from regular employee and public traffic, are equipped with fume hoods, ion scanners, personal protective equipment and other tools that allow CBSA Officers to more safely examine packages suspected of containing opioids and/or synthetic opioids, such as fentanyl, and their associated substances. Three regional screening facilities staffed by full-time field chemists have also been successfully launched one each in Montreal, Toronto and Vancouver. The regions have benefitted from the near-real-time identification of opioids, synthetic opioids, precursor chemicals and other controlled substances, as it allows for higher probability of successful controlled deliveries, immediate officer feedback on indicators and a more efficient examination/release/seizure process. These regional sampling sites have proven to be successful at early identification of new chemicals being used in the manufacturing of designer drugs. In 2022, these regional sampling sites conducted analysis and identification of over 8,000 suspect substances.

Moreover, in support of increasing the intelligence and risk assessment capacity, the CBSA has doubled the number of advanced risk rules it uses to identify and interdict high-risk shipments. In addition, as of 2022-23, CBSA has seen an increase since the beginning of this horizontal initiative (i.e., 2018-19) in the number of intelligence products produced in various areas of the CBSA, which includes predictive analytics in postal and self-serve analytic solutions to integrate opioid threat detection in all commercial work streams. These improvements to intelligence and risk assessment capacity have been directly linked to examination referrals for goods which resulted in seizures and/or law enforcement actions, which kept high-risk shipments, including opioids, out of Canada. This included 60 successful referrals in postal specific to the Vancouver International Mail Centre in 2021-22 as a direct result of this improvement.

Lastly, as part of this initiative, the CBSA added fentanyl detection to the scent profile of six (6) Detector Dog Service (DDS) teams and deployed them to Ports of Entry (POE's) where the risk of opioid smuggling is high. Since their deployment, in March of 2019, these DDS teams have performed over sixteen thousand searches and contributed to more than 8700 enforcement actions (including all drugs & firearms). One of the main challenges the Agency is facing with fentanyl detection and live tools, such as detector dogs, is with obtaining safe, effective and accessible training aids. However, with ongoing support from relevant stakeholders, including members of the Border 5 (B5)^{Footnote 11}, we remain dedicated to finding a solution that allows all drug and firearm DDS teams to safely identify and interdict fentanyl and other emerging drug threats at Canadian borders.

Public Health Agency of Canada

The PHAC continued undertaking its national surveillance and quarterly reporting of opioid- and stimulant-related harms in Canada in order to ensure a strong evidence base is in place to inform program and policy decisions. This work was supported by the deployment of Public Health Officers in P/Ts, who are instrumental in supporting jurisdictions in monitoring, collecting and reporting data to PHAC on fatal and non-fatal overdoses.

PHAC also developed a simulation model of opioid-related deaths to help understand what might happen under certain scenarios, and is undertaking a National Chart Review Study with P/Ts to better understand the characteristics of individuals who have died from drug- and alcohol-related acute toxicities, including the substances involved and circumstances surrounding the death. Memorandums of agreement were put in place with P/Ts to build capacity for data collection, analysis and coordination.

Plans (including timelines) for evaluation and/or audit

A horizontal evaluation of the CDSS, including activities to address the overdose crisis, was undertaken in 2022-23.

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, 2023

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, led by Health Canada and 14 other federal departments and agencies. The CDSS covers a broad range of legal and illegal substances, including cannabis^{Footnote 12}, alcohol, opioids^{Footnote 13} 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.

In 2022-23, the CDSS continued to prioritize action in 4 key areas: prevention, treatment, harm reduction and enforcement.

Moving forward, the Government announced a renewed CDSS October 30, 2023, for which funding was announced in Budget 2023 The renewed CDSS will build on existing approaches and address gaps identified by stakeholders through public consultations and the Expert Advisory Task Force on Substance Use and the Canadian Pain Task Force, to focus on a full continuum of evidence-based health services and supports, from prevention to harm reduction to treatment and recovery. In addition, the renewed CDSS will continue to support efforts to address illegal production and trafficking, with a focus on organized crime, and surveillance and research activities to build the evidence base to support solutions to substance use harms and deaths, including the overdose crisis.

The CDSS recognizes that substance use requires strong collaboration and coordination among 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.

Governance structures

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 an Assistant Deputy Minister (ADM) level Working Group and, to a Deputy Minister (DM) level Task Force.

These DG steering committees reflect and support the CDSS' comprehensive approach to substance use issues and are composed of DGs from federal departments/agencies whose mandates are relevant to substance use across the 4 pillars of prevention, treatment, harm reduction and enforcement, as well as those responsible for contributing to the evidence base (including departments that formally received CDSS funding and those that do not). The Committees meet 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 F/P/T mechanisms, including the F/P/T Committee on Substance Use (CSU), formerly the Committee on Problematic Substance Use and Harms, that is co-chaired by Health Canada and the Province of British Columbia.

Total federal funding allocated from 2017-18 to 2022-23^{Footnote 14} (dollars)

$772,980,012^{Footnote 15}

Total federal funding planned spending to March 31, 2023 (dollars)

$780,889,619

Total federal actual spending to March 31, 2023 (dollars)

$957,272,908

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

2027-28^{Footnote 16}

Performance highlights

In 2022-23, substance use-related harms continued to cause devastating health and social effects on Canadians. The COVID-19 pandemic exacerbated trends 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 to December 2022, apparent opioid toxicity claimed the lives of at least 7,328 Canadians. This is an average of 20 deaths per day, bringing Canada to a total of at least 36,442 apparent opioid-toxicity deaths between January 2016 and December 2022^{Footnote 17}. In comparison, pre-pandemic deaths ranged from 8 (in 2016) to 12 (in 2018) deaths per day^{Footnote 18}. Contributing factors include an increasingly toxic and unpredictable illegal drug supply as well as increased feelings of isolation, stress and anxiety, and limited availability or accessibility of services for people who used drugs during the pandemic.

Indigenous communities across Canada are disproportionately impacted by substance use-related harms and deaths. Recent First Nations-specific data in British Columbia, Alberta, Saskatchewan, and Ontario, have recorded large increases in opioid toxicity deaths during the COVID-19 pandemic, and are overrepresented in instances of opioid-related overdose deaths compared to the general Canadian population. For instance, in British Columbia, the number of First Nations people who died of toxic drugs from January to December 2022 was 5.9 times the rate of other BC residents.. Indigenous Services Canada continues to support First Nations, Inuit and Metis communities to respond to the overdose crisis, including by expanding access to harm reduction measures such as naloxone, and funding wrap-around services at 78 opioid agonist therapy (OAT) sites.

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 and December 2022, 81% involved fentanyl and 79% involved only opioids that were non-pharmaceutical^{Footnote 19}. More than half (56%) of accidental apparent opioid toxicity deaths in 2022 (January to December) also involved a stimulant, reflecting the polysubstance nature of this crisis. Of the accidental apparent stimulant toxicity deaths in 2022 (January to December), 64% involved cocaine, while 53% involved methamphetamines. Contaminants such as benzodiazepines and xylazine, are also in the toxic illegal drug supply.

In 2022-23, Health Canada, working with its other partners under the CDSS, continued to support efforts to: improve access to treatment and harm reduction services; strengthen enforcement to address illegal drug production and trafficking; increase awareness, prevention and stigma reduction activities; and build the evidence base through research and surveillance. As well, Health Canada worked towards a renewed CDSS with its partners, building on recommendations from Health Canada's Expert Task Force on Substance Use and input from 2018 public consultations on the federal drug policy.

In 2022-23, Health Canada's Office of Audit and Evaluation completed a Horizontal Evaluation of the Canadian Drugs and Substance Strategy. The evaluation was conducted in collaboration with funded partners, examining the combined impacts of CDSS activities from 2017-18 to 2021-22 and the Addressing the Opioid Crisis Horizontal Initiative activities from 2018-19 to 2021-22. The final report is expected to be published later in 2023.

In 2022-23, Health Canada, in consultation with CDSS funded partners, revised, retired and developed new outcomes and indicators that are better aligned with the renewed CDSS, new initiatives and areas of focus. Reporting using the new performance measurement framework (logic model and indicators), aligned to the renewed CDSS Horizontal Initiative, will commence with the 2024-25 Departmental Plan.

Health Canada conducted ongoing surveillance and monitoring through its various national and targeted surveys. Data was collected for the 2021-22 cycle of the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS), which ran between September 2021 and June 2022 in 9 Canadian provinces. The survey collected information on tobacco, alcohol, cannabis and drug use among students in grades 7 to 12 (secondary I through V in Quebec). For the first time, this cycle of CSTADS asked students about their gender identity as well as biological sex and the results were analyzed by gender. Between November 2021 and April 2022, data was collected for the second cycle of the Canadian Postsecondary Education Alcohol and Drug Use Survey (CPADS). The objective of CPADS is to examine the prevalence and patterns of substance use and associated harms among postsecondary (college and university) students aged 16 years and older across Canada. For the 2023 Canadian Alcohol and Drugs Survey (CADS), questions and language regarding sex and gender were updated to better support future data and trend analysis. The Public Awareness of Alcohol-related Harms Survey (PAAHS) was launched in February 2023 to establish quantitative baseline evidence of Canadians' views and knowledge related to alcohol and the risks and harms associated with its consumption. PAAHS results will inform any potential future public education efforts and allow for an assessment of the impact of these efforts.

In addition, the People with Lived and Living Experience Survey was conducted from September 2021 to February 2023. This survey was developed to gain a better understanding of the situation of street-involved youth aged 14 to 24 years in Canada who used substances such as alcohol, tobacco, cannabis or other drugs in the past 12 months. The targeted survey consisted of quantitative questions on subjects such as prevalence of drug use, drug harms, and demographics, and qualitative questions so that participants could further describe their experiences with stigma and barriers to accessing to treatment. Furthermore, from July to September 2022, the third and last cycle of the Supervised Consumption Sites COVID Impact Survey was conducted. This survey focused on the impacts of the pandemic on service delivery (including the closure of sites and changing delivery models), the impacts of the pandemic on substance use behaviour among clients, the availability of PPE and other equipment during the pandemic, and the impact of the pandemic on staff. The results of all three cycles of this survey will be released together by the end of 2023.

Other targeted surveys and research, including online surveys to document the demand for and use of new psychoactive substances, as well as data collection from operating supervised consumption sites (SCS) also continued throughout 2022-23. Lastly, in January 2023, quarterly meetings of the CDSS Data and Evidence Partners Table (CDSS DEPT) were initiated to promote the development and improvement of data and surveillance initiatives on substances and their use to address critical gaps. In addition, 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 deaths, hospitalizations and emergency medical service (EMS) responses involving opioids and/or stimulants dating back to January 2016.

In addition to these actions, cross-cutting actions undertaken as part of the CDSS in 2022-23 include the funding of an estimated 275 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, stigma reduction, chronic pain and capacity building. These projects serve as pilots to develop best practices and guidance for evidence-based treatment or proof of concept for a range of service delivery models across Canada.

The Canadian Institutes of Health Research (CIHR) established the Canadian Research Initiative in Substance Misuse (or CRISM) in 2015 as a national research network in substance use research. CRISM is comprised of large multi-disciplinary, integrated teams (also referred to as "Nodes") of substance use researchers, service providers, decision makers and people with lived and living experience, collectively known as the "Network". This Network provides a flexible and expandable platform for accelerating the development and flow of local and pan-Canadian research studies and knowledge mobilization on substance use health including prevention, harm reduction and treatment.

In 2022, the Minister of Mental Health and Addictions and Associate Minister of Health announced $17 million in funding to support CRISM Phase II, including the expansion of the network to add a regional node in the Atlantic, bringing the total number of nodes to 5. The funding will also support a $5 million national controlled trial in the management of methamphetamine use disorder. As of September 2022, a team of CRISM researchers is leading an independent, scientific evaluation of the impacts of the section 56 exemption in British Columbia on people who use drugs, the general population, police forces and the criminal justice system, as well as an evaluation of the economic consequences. The team will be providing CIHR with interim reports at 6-month intervals. CIHR is also supporting the evaluation of program implementation and short-term health impacts of some of Health Canada's SUAP funded safer supply pilot projects. Through this funding opportunity, CIHR also supported 4 projects to assess the public health impact of SCS on people who use SCS services, and on the general population, before, during, and after the immediate COVID-19 crisis. In October 2022, CIHR held an end-of-grant workshop to share research findings related to the evaluation of SCSs, which was attended by the Minister of Mental Health and Addictions. A "What We Heard" report is now available.

In 2022, the Minister of Mental Health and Addictions and Associate Minister of Health announced $2 million for research on alcohol use. in partnership with the Canadian Cancer Society, funded 20 research projects that evaluated policies, programs and practices that regulate alcohol and that have the potential to impact health. The research outcomes provided data and evidence that will increase the knowledge base on alcohol-related harms and how to prevent and treat them and inform future larger-scale research projects.

Additional actions under the CDSS by theme are outlined below:

Prevention

Through the CDSS, the goal of prevention is to prevent, reduce or delay substance use and its associated harms, with a particular focus on youth. In 2022-23, 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 (e.g., resources on safe and effective use of opioids to help manage acute and chronic pain in children and adolescents). Additionally, prevention activities worked to reduce substance use-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. In addition, over the course of its mandate, the Canadian Pain Task Force (CPTF) reflected on the importance of appropriate pain management to prevent higher risk substance use. To this end, Health Canada continues to work with its partners to implement priority actions identified by the Task Force in the Action Plan for Pain in Canada. For instance, in 2022-23 through SUAP, HC has invested more than $11 million in projects that focus on pain related activities to address priorities identified by the CPTF. In February 2023, Health Canada, in partnership with the CIHR, hosted a Best Brains Exchange to further enhance and share knowledge related to best practices and treatment options for people living with chronic pain and concurrent mental health and/or substance use-related conditions.

Treatment

Through the CDSS, the Government of Canada supports evidence-based treatment options and recovery services/systems that are accessible, comprehensive and appropriately tailored to the needs of individuals, including collaboration and knowledge sharing on innovative approaches to treatment and rehabilitation. In 2022-23, 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 included support for a wide range of services, including psychological and behavioural therapies, and medication-assisted treatment options, such as methadone and buprenorphine, which are used to treat opioid use disorder. On February 7, 2023, the Government of Canada announced it will increase health funding to P/T by more than $200 billion over 10 years, in order to improve Canada's health care system. This investment includes $25 billion for shared health priorities, including increasing access to mental health and substance use services and supports. These commitments are in addition to existing bilateral agreements with P/T for health priorities, including mental health and substance use, that were put in place in 2017. These investments will set the foundation for long-term, integrated and sustained health care system change that builds on existing, targeted actions to address mental health and substance use challenges. Over time, this will help reduce the burden on hospitals and other health care supports to help ensure Canadians have access to a full spectrum of mental health and substance use supports and services, regardless of where they are in Canada.

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. In 2022-23, the department continued to facilitate access to medications necessary for OAT (e.g., suboxone and methadone). In addition, the department has supported initiatives 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 2022-23, the Government of Canada supported 78 OAT sites in First Nations, Inuit and Metis 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, 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 (CDSA) (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. In the 2022-23 fiscal year, 87 patients were authorized to use restricted drugs through the Special Access Program.

Harm Reduction

Harm reduction is an evidence-based, public health approach that recognizes that not everyone who uses drugs 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 2022-23, Canada continued to authorize harm reduction services such as SCS, urgent public health needs (UPHN), drug checking, and safer supply programs. As of March 2023, these sites have had over 4.17 million visits, responded to an estimated 47,000 overdoses, and site staff have also made over 239,000 client referrals to health and social services. These sites reduce the risk of overdose death and the transmission of infectious diseases such as hepatitis and HIV. In addition, they provide access to other health and social services for people who use drugs, including opportunities to access treatment.

In July 2022, Health Canada renewed class exemptions to the CDSA to support P/Ts to establish drug checking and supervised consumption services to address urgent public health needs. These exemptions are valid until September 30, 2025. Currently British Columbia, Alberta, Yukon, Quebec, and New Brunswick have established urgent public health need sites (UPHNS) under their P/T class exemptions.

Drug checking is another harm reduction measure and 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. As of March 31, 2023, 25 of the 39 SCS were offering drug checking services. In addition, 7 of the 17 federally authorized UPHNS were offering drug checking, as well as 5 standalone drug checking sites.

Reducing stigma is a key consideration for the response to the overdose crisis as stigma leads to many negative outcomes for people who use drugs. Stigma creates barriers to accessing important health and social services and can reduce the quality of the services received. It leads people to hide their drug use for fear of reprisals and prevents them from getting help if they want or need it. Canada continues to raise international awareness of the drivers, extent of and impacts of substance use stigma on the health and wellbeing of people who use or have used drugs. In October 2022, Canada and the Council of Europe's Pompidou Group, in cooperation with United Nations Office on Drugs and Crime and Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS) organized a symposium on stigma entitled From Stigma to Dignity: Sharing Perspectives, Mobilizing Potential. The event brought together drug policy makers, people with lived/living experience, academics, civil society organizations and other stakeholders to raise awareness of the drivers and impacts of substance use stigma, share resources, and explore promising solutions across sectors including health, law enforcement and criminal justice. In March 2023, at the 66th meeting of the CND, Canada hosted a side event titled "Approaches to Actively Reduce Stigma – Sharing Experiences" which provided an opportunity to build on the discussions following Resolution 61/11 of "Promoting non-stigmatizing attitudes to ensure the availability of access to and delivery of health care and social services for drug uses", with a particular focus on approaches to actively reduce stigma. Panelists from the Community Addictions Peer Support Association (CAPSA), Ghana and Thailand discussed their unique perspectives, approaches and lessons learned for reducing stigma in different settings.

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, 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 2022-23, Health Canada supported 29 safer supply pilot projects with over $32.5 million in funding through SUAP, which included 11 new and 18 existing projects. This includes supporting a range of service delivery projects in British Columbia, Manitoba, Ontario, Quebec and New Brunswick, and a National Safer Supply Community of Practice to help share knowledge amongst stakeholders. interactive map is available illustrating Canada's response to the overdose crisis, including safer supply projects. In fall 2022, Health Canada hosted a three-part Knowledge Exchange on Safer Supply with key stakeholders to discuss and share current evidence and best practices. The What We Heard: Knowledge Exchange Series on Safer Supply summary report is now available.

Actions from the PHAC included efforts through the Harm Reduction Fund to reduce the incidence of HIV and hepatitis C being spread through the sharing of drug use equipment. Through this program, PHAC funded 34 new community-based projects in the 2022-23 fiscal year.

Enforcement

Enforcement priorities under the CDSS focus on addressing trans-national 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 2022-23, Health Canada promoted, monitored, verified and enforced compliance with the CDSA using a risk-based approach to oversee the supply chain and address gaps of potential diversion at licenced dealers and pharmacies. Activities included 220 licensed dealer (LD) inspections completed and 10 compliance verifications where a potential risk of diversion was identified. In addition, 108 pharmacy inspections were completed, and 433 compliance verifications received for follow up with pharmacies. The Department implemented a compliance promotion strategy to expand its reach and promote compliance with requirements, targeted to pharmacy associations, retail chains, and provincial pharmacy regulatory authorities, which included 10 pharmacy compliance promotion sessions to over 800 participants, 2 LD compliance promotion sessions, and 8 meetings held with provincial pharmacy regulatory authorities.

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 for the personal possession of small amounts of controlled substances. On May 31, 2022, the Minister of Mental Health and Addictions and Associate Minister of Health granted a 3-year exemption so that adults in the province of British Columbia will not be subject to criminal charges for the personal possession of small amounts of certain illegal drugs. This exemption is meant to help to divert people who use drugs away from the criminal justice system and towards supportive and trusted relationships in health and social services, and reducing the barriers and stigma that prevent people from accessing life-saving supports and services. The exemption is in effect in British Columbia from January 31, 2023, to January 31, 2026.

Based on evidence that substances chemically related to a known fentanyl precursor (4-AP) are being imported into Canada and used in the illegal production of fentanyl and fentanyl analogues, the Minister of Mental Health and Addictions and Associate Minister of Health made a temporary Ministerial Order controlling these novel fentanyl precursors under Schedule V to the CDSA for a period of 1 year. This action enables law enforcement to act against any illegal importation, distribution, and use of these substances in illegal activities.

Health Canada published updated core structures and guidance documents for 3 substance classes controlled under the CDSA to clarify how these classes of substances are controlled. The web page for the core structures has been updated to improve accessibility and transparency, and includes a newly developed core structure for the benzimidazole class of substances, as well as providing a short overview of the status determination process.

In 2022-23, the Royal Canadian Mounted Police Federal Policing Strategic Engagement and Awareness (FP-SEA) held a Networking Information Session in Ottawa with stakeholders from various partners in law enforcement and various levels of government. The session was a 3-day event attended by 125 partners including international law enforcement. The session was titled "Enhancing Reporting to Police", relating to indicators across various crime types including transnational and serious organized crime, money laundering, and drugs. Additionally, FP-SEA began producing a monthly bulletin relating to crime indicators and crime prevention on topics including transnational and serious organized crime, money laundering, and drugs. This document is shared internally within the RCMP as well as externally to over 3,000 stakeholders.

The Government of Canada has continued to engage with international partners through bilateral and multilateral fora to advance policy and operational responses to various drug threats, including the flow of illegal drugs and their precursor chemicals to Canada. Through the Canada-US Opioids Action Plan, federal partners worked closely with U.S. counterparts to develop new projects and advance implementation of ongoing projects under the law enforcement and border security working groups. For example, Canada has shared more than 275 samples of seized controlled substances with the U.S. Drug Enforcement Agency for supplemental analysis into drug trafficking trends and routes, the Canada Border Services Agency and the Department of Homeland Security's Homeland Security Investigations shared information to improve the targeting of precursor chemicals used in the production of illegal synthetic opioids, and Canada Post and the United States Postal Inspection Service continued to share information and hold joint training workshops on investigations and 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 November 2022, Public Safety Canada hosted the Sixth North American Drug Dialogue. At the meeting, senior officials reviewed progress and adopted a new 3-year strategic framework to continue and enhance joint work to:

• Strengthen public health approaches related to prevention, harm reduction, treatment, and recovery services
• Understand and address the supply chain of illegal synthetic drugs and their precursor chemicals and related equipment
• Address drug trafficking via multiple modes of transport
• Better understand and address the illegal drug-related financing methods and activities that support drug trafficking

Contact information

Health Canada

Carol Anne Chénard
A/Director General
Controlled Substances Directorate
Controlled Substances and Cannabis Branch
carol.anne.chenard@hc-sc.gc.ca
613-410-3793

Horizontal initiative framework: departmental funding by theme (dollars)^{Footnote 20}

Horizontal initiative: Canadian Drugs and Substances Strategy

Shared outcomes:

• SO 1: Problematic substance use^{Footnote 21} is addressed as a health and social issue by governments, communities, stakeholders and Canadian society
• SO 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
• SO 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 variation between planned spending and actuals 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 to address substance use-related harms, including the toxic drug supply and overdose crisis, as well as regulatory actions to authorize supervised consumption sites; urgent public health need sites and other harm reduction activities, such as drug checking services. In collaboration with CDSS partners, HC undertook activities to support the renewal of the CDSS.

Canada Revenue Agency

The variation between planned spend and actuals is mainly due to 2 additional resources required to carry out the CDSS work.

Canadian Institute of Health Research

The variance between actual and planned spending is mainly due to the Agency's pause on strategic funding opportunities in order for CIHR to focus its efforts on supporting the Government of Canada's response to the pandemic. To address the revised funding requirements stemming from the delay of research competitions, CIHR internally redistributed a portion of CDSS funding allocated in 2022-23 to future fiscal years, which will be spent over the life of the initiative.

Correctional Services Canada

The variation between planned spend and actuals is mainly due to the reduction in 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

The variation between planned spend and actuals is mainly due to additional funding was allocated and agreements with P/Ts were amended for fiscal year 2022-23.

Financial Transaction and Reports Analysis Centre of Canada (FINTRAC)

FINTRAC is an unfunded partner within the 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. The variance year-over-year is in relation to the number of FTEs indicated by Intelligence. The number of FTEs within the costing methodology will have a direct impact on the fluctuation of the costs year over year. In addition, the calculated amount related to Internal Services is based on the direct FTEs identified and calculated according to the costing model

Global Affairs Canada

The variation between planned spend and actuals is mainly due to the reallocation of internal resources to support the realization of projects in support of CDSS.

Indigenous Services Canada

The variation between planned spend and actuals is mainly due to regional variations in community needs and priorities.

Parole Board of Canada

The variance between planned and actual spending is due to the estimated number of reviews never materializing.

Public Prosecution Service of Canada

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

Horizontal Initiative Activity codes

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 who intend to use knowledge/skills related to substance use they have acquired through SUAP funded projects.^{Footnote 22}
• PI 1.1.2 Percentage of pharmacies inspected that are deemed to be compliant with the CDSA and its regulations.^{Footnote 23}

Royal Canadian Mounted Police

• PI 1.2.1 Number of awareness products.^{Footnote 24}
• PI 1.2.2 Number of stakeholders reached.^{Footnote 25}
• PI 1.2.3 Percentage of partners and stakeholders who demonstrate an increase in awareness of illegal drugs.^{Footnote 26}
• PI 1.2.4 Number of partnerships and collaborations.^{Footnote 27}
• PI 1.2.5 Number of new engagement opportunities identified.^{Footnote 28}

Targets

Health Canada

• T 1.1.1 65%
• T 1.12 80%

Royal Canadian Mounted Police

• T 1.2.1 5 Illegal drug awareness products will be produced and/or updated
• T 1.2.2 Approximately 1,000 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

Actual Results

Health Canada

• AR 1.1.1 43%
• AR 1.1.2 81%

Royal Canadian Mounted Police

• AR 1.2.1 6^{Footnote 29}
• AR 1.2.2 3000^{Footnote 30}
• AR 1.2.3 55%
• AR 1.2.4 3
• AR 1.2.5 5

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 for non-violent offenders with problematic substance use.
• ER 2.2.2 Increased availability of, and access to, treatment services and programs for youth involved in the justice system.

Indigenous Services Canada

• ER 2.3 Improved access to substance use services.

Performance Indicators

Canadian Institutes of Health Research

• PI 2.1 Percentage of funded research projects with a nature and scope that support CDSS' goals.^{Footnote 31}

Department of Justice Canada

• PI 2.2.1 Drug Treatment Court participant retention rate.^{Footnote 32}
• PI 2.2.2 Percentage of available budget expended to support funded projects under the Youth Justice Fund's Drug Treatment component.^{Footnote 33}

Indigenous Services Canada

• PI 2.3 Number of sites offering opioid agonist therapy (OAT) wraparound services.^{Footnote 34}

Targets

Canadian Institutes of Health Research

• T 2.1 100%

Department of Justice Canada

• T 2.2.1 50% of participants are retained for 6 months in federally funded Drug Treatment Court programs.
• T 2.2.2 100% of the budget allocation is committed to support treatment programming for youth involved in the justice system.

Indigenous Services Canada

• T 2.3 75 sites in First Nations and Inuit communities

Actual Results

Canadian Institutes of Health Research

• AR 2.1 97.7%

Department of Justice Canada

• AR 2.2.1 69.73% of participants were retained for more than six months in federally funded Drug Treatment Court programs during 2022-2023 (based on availability of information in DTCIS).
• AR 2.2.2 Approximately 80% of the budget allocation was committed to support pilot projects under the Youth Justice-Drug Treatment component during fiscal year 2022-23.

Indigenous Services Canada

• AR 2.3 78 OAT sites (2022-23) in First Nations and Inuit communities.

Theme 3: Harm reduction

Expected Results

Health Canada

• ER 3.1 Increased availability of harm reduction services.

Indigenous Services Canada

• ER 3.2 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 from the time the review is complete.^{Footnote 35}

Indigenous Services Canada

• PI 3.2 Number of sites offering opioid agonist therapy (OAT) wraparound services.^{Footnote 36}

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 37}

Targets

Health Canada

• T 3.1 Not applicable

Indigenous Services Canada

• T 3.2 75 sites in First Nations and Inuit communities

Public Health Agency of Canada

• T 3.3 10% decrease

Actual Results

Health Canada

• AR 3.1 Not applicable

Indigenous Services Canada

• AR 3.2 78 OAT sites (2022-23) in First Nations and Inuit communities.

Public Health Agency of Canada

• AR 3.3 Not applicable^{Footnote 38}

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 Service 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 2020-21, GAC will increase capacity of port officials in selected countries in the Americas to intercept and seize illegal drugs smuggled via legal maritime, land, and air containerized cargo. GAC will also work with UNODC and OAS CICAD to build the capacity of law enforcement, forensic laboratories and border control agencies officers to predict, prevent and protect against the challenges posed by synthetic opioids.

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 39}

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.^{Footnote 40}
• PI 4.1.2 Percentage of licensed dealers inspected that are deemed to be compliant with the CDSA and its regulations.^{Footnote 41}
• PI 4.1.3 Percentage of samples analyzed within service standards or by negotiated date.^{Footnote 42}
• PI 4.1.4 Number of drug notifications issued to clients and to provincial and territorial health authorities on newly identified potent illegal drugs in communities.^{Footnote 43}

Canada Border Services Agency

• PI 4.2 Ratio of the average dollar value of drugs and their precursors seized attributed to Intelligence vs. the average dollar value drugs and their precursors seized not attributed to intelligence.^{Footnote 44}

Canada Revenue Agency

• PI 4.3 80% or more of audits resulting in a (re) assessment.^{Footnote 45}

Correctional Service 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.^{Footnote 46}
• 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.^{Footnote 47}
• PI 4.4.3 Total number of case preparation reports (pre- and post-release) completed for all provincial offenders during the year.^{Footnote 48}

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.^{Footnote 49}

Global Affairs Canada

• PI 4.6.1 Number of illegal drug seizures in selected beneficiary countries made possible through GAC capacity-building funding.^{Footnote 50}
• PI 4.6.2 Volume of illegal drugs seized in selected beneficiary countries made possible through GAC capacity-building funding.^{Footnote 51}

Parole Board of Canada

• PI 4.7.1 Number and proportion of provincial offenders convicted of drug offences who successfully complete parole.^{Footnote 52}
• PI 4.7.2 Percentage of individuals (i.e., general public and victims) who are satisfied with the quality of the service.^{Footnote 53}

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.^{Footnote 54}
• PI 4.8.1.2 Number of files for which legal advice was provided by PPSC counsel.^{Footnote 55}
• 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.^{Footnote 56}
• PI 4.8.2.2 Number of files for which legal advice was provided by PPSC counsel where mandatory minimum penalties are applicable.^{Footnote 57}

Public Safety Canada

• PI 4.9 Timely sharing of evidence-based knowledge and intelligence to support law enforcement actions against illegal drugs and substances.^{Footnote 58}

Public Services and Procurement Canada

• PI 4.10.1 Number of active CDSS files where the services of a forensic accountant were required.^{Footnote 59}
• PI 4.10.2 Number of Forensic Accounting Reports produced during the fiscal year.^{Footnote 60}

Royal Canadian Mounted Police

• PI 4.11.1 Number and percentage of Federal Serious and Organized Crime (FSOC) investigations with a transnational nexus.^{Footnote 61}
• PI 4.11.2 Number of drug-related charges laid by FSOC units.^{Footnote 62}
• PI 4.11.3 Number of drug seizures made by FSOC units, including amount of drugs seized.^{Footnote 63}

Targets

Health Canada

• T 4.1.1 90%
• T 4.1.2A target of 80% was established for this indicator on March 31, 2023 to be implemented for fiscal year 2023-24.
• T 4.1.3 95%
• 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 Service Canada

• T 4.4.1 19 (approximately)
• T 4.4.2 10 (approximately)
• T 4.4.3 392 (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 under UNODC and OAS-CICA projects.
• T 4.6.2 At least 20 tons

Parole Board of Canada

• T 4.7.1 99.8% 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. PBC questionnaire was conducted in 2016-17, and the next questionnaire is planned for 2022-23

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 3 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 97%
• AR 4.1.2 85%
• AR 4.1.3 98%^{Footnote 64}
• AR 4.1.4 72^{Footnote 65}

Canada Border Services Agency

• AR 4.2 19:1 ratio – in 2022-2023, the CBSA made 31,693 drug seizures, 679 were intelligence-led. Since the total number 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 19:1

Canada Revenue Agency

• AR 4.3 14 cases resulting in $4.6M in Tax Earned by Audit (TEBA)

Correctional Services Canada

• AR 4.4.1 15 provincial offenders convicted of a drug offence (CDSA Schedule II) supervised by CSC. (Monthly average)
• AR 4.4.2 10 provincial offenders convicted of a drug offence (CDSA Schedule II) with a residency requirement. (Monthly average)
• AR 4.4.3 357 case preparation reports (pre- and post-release) completed for all provincial offenders.

Financial Transactions and Reports Analysis Centre of Canada

• AR 4.5 In 2022-23, 2,085 disclosures of actionable financial intelligence were made to regime partners, including 521 unique disclosures of actionable financial intelligence that relate to at least one drug-related offence. These case disclosures relate to suspicions of money laundering or terrorist financing where the predicate offence is believed to be drug distribution or production.

Global Affairs Canada

• AR 4.6.1 574 seizures
• AR 4.6.2 298.73 tons

Parole Board of Canada

• AR 4.7.1. In 2022-23, 100% of provincial offenders serving sentences for drug offences who are on parole were not convicted of a violent offence during their supervision period. This information was collected by CSC's Offender Management System (OMS) and PBC's Integrated Decision System (IDS) and the data is collected annually.
• AR 4.7.2 81.0% of individuals were satisfied with the quality of the service as per a PBC questionnaire conducted in 2022-23. The last questionnaire was conducted in 2016-17.

Public Prosecution Service of Canada

• AR 4.8.1.1 During the 2022-2023 fiscal year, 6790 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 652 files during the 2022-2023 fiscal year.
• AR 4.8.2.1 During the 2022-2023 fiscal year, 69 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 12 litigation files where mandatory minimum penalties are applicable.

Public Safety Canada

• AR 4.9 100% of planned activities were completed.

Public Services and Procurement Canada

• AR 4.10.1 78 open CDSS investigations in 2022-23 (opened with 78, added 26, closed 9)
• AR 4.10.2 44 CDSS reports issued to clients in 2022-23

Royal Canadian Mounted Police

• AR 4.11.1 283 (7%)^{Footnote 66}
• AR 4.11.2 6,555^{Footnote 67}
• AR 4.11.3 8,080^{Footnote 68}

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 Office on Drug and Crime Annual Report Questionnaire completed with Canadian data.^{Footnote 69}

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.^{Footnote 70}
• PI 5.2.2 Percentage of health research publications related to substance use.^{Footnote 71}

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 not applicable^{Footnote 72}

Canadian Institutes of Health Research

• AR 5.2.1 100%
• AR 5.2.2 92%

Chemicals Management Plan

General information

Name of horizontal initiative

Chemicals Management Plan

Lead department

Health Canada

Federal partner organization(s)

• Environment and Climate Change Canada
• Public Health Agency of Canada

Start Date

2007-08

End Date

2023-24

Description

The objective of the Chemicals Management Plan (CMP or "the Program") is to protect human health and the environment by addressing substances of concern in Canada. It was launched in 2006 and is jointly managed by Health Canada (HC) and Environment and Climate Change Canada (ECCC). The Public Health Agency of Canada (PHAC) also contributes to this Program.

The core functions of the Program are: 1) chemicals risk assessment; 2) chemicals risk management, compliance promotion and enforcement; 3) research, monitoring and surveillance; and 4) collaboration, outreach and engagement.

The CMP addresses both substances currently in commerce ("existing substances") and substances entering the Canadian market ("new substances"). It also takes into consideration various routes of exposure (e.g., from water, air, food, consumer products, cosmetics, pesticides, etc.), and both chronic and acute risks. When identifying and/or managing risks, actions are guided by the Canadian Environmental Protection Act, 1999 (CEPA), the Canada Consumer Product Safety Act (CCPSA), the Food and Drugs Act (F&DA), the Pest Control Products Act (PCPA) and others, as appropriate.

For more information, see the Government of Canada's Chemical Substances Portal.

Governance structures

Health Canada and ECCC share the overall responsibility for delivering the CMP. The Departments fulfill their responsibilities through established internal departmental governance structures, as well as a joint CMP governance structure to address shared responsibilities.

Within the joint structure, there is a CMP Horizontal Initiative Oversight Committee comprised of implicated Assistant Deputy Ministers (ADMs) from the three partner organizations. Meetings of the CMP Horizontal Initiative Oversight Committee are co-chaired by the ADM of the Healthy Environments and Consumer Safety Branch, Health Canada, the ADM of the Environmental Protection Branch, ECCC, and the ADM of the Science and Technology Branch, ECCC. This Committee provides strategic direction and management oversight for the integrated delivery and management of the CMP. This Committee will also resolve any disputes within the Horizontal Initiative. This Committee reports to the Deputy Ministers of Health Canada and of ECCC and is responsible for the overall management of the CMP. It meets approximately four times a year.

The CMP Horizontal Initiative Oversight Committee is supported by the CMP Steering Committee, which consists of all implicated Directors General (DGs) within Health Canada and ECCC. The CMP Steering Committee also meets four times a year, although some DG sub-groups meet monthly. The CMP Steering Committee provides a regular open exchange of information and decisions on a broad range of operational and policy issues for the implementation of CMP.

The CMP Steering Committee is supported by a CMP Working Group, a director-level committee that meets every two weeks to provide oversight of the CMP's implementation and coordination, and seeks to resolve issues that may arise, while developing options and making recommendations to DGs as needed. Overall, this joint CMP governance structure supports integration, co-ordination, decision-making and clear accountabilities within the Horizontal Initiative.

Total federal funding allocated from start to March 31, 2024 (dollars)

$1,785,865,593

Total federal funding planned spending to March 31, 2023 (dollars)

$1,626,636,862

Total federal actual spending to March 31, 2023 (dollars)

$1,576,598,267

Date of last renewal of initiative

June 2021

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

$477,686,192. Budget 2021

Additional federal funding received after last renewal (dollars)

Not applicable.

Total planned spending since last renewal

$318,457,462

Total actual spending since last renewal

$309,893,507

Fiscal year of planned completion of next evaluation

2023-24

Performance highlights

In 2022-23, the Program:

• Conducted science-based assessments and risk management activities, as needed, on both new and existing substances. This included identifying and addressing risks posed by harmful chemicals in foods and food packaging materials, consumer products, cosmetics and drinking water.
• Conducted pesticide re-evaluations and special reviews of existing pesticides on the Canadian market, making science-based decisions that support the safe and sustainable use of pesticides in Canada that are informed by modern science and incident and sales reporting data from industry.
• Conducted research to address priority knowledge gaps related to the risk of exposure and the effects of substances on human health and the environment, in order to inform risk assessments, risk management and international activities.
• Conducted targeted monitoring and surveillance activities related to existing and emerging chemicals of concern to inform risk assessments and risk management activities.
• Undertook performance measurement evaluations to evaluate the effectiveness of risk management measures in reducing the use and release of harmful substances.
• Raised industry's awareness of regulatory and legislative requirements, and conducted risk-based compliance promotion and enforcement activities.
• Increased proactive and diverse communications approaches to the public to raise awareness of the risks and safe use of substances, including greater use of partnerships to expand the reach of messaging, with a focus on disproportionally impacted populations in Canada.
• Participated in a range of international activities that support the sound management of chemicals.
• Identified and addressed human health risks associated with water, food and sanitation on passenger conveyances such as aircraft, trains, cruise ships and ferries, focusing efforts on the areas of greatest risk to public health.

Further details on 2022-23 achievements under the four themes of the CMP are outlined below.

Chemicals Risk Assessment

In 2022-23, assessments for 74 existing substances were published, including 17 Final Screening Assessment Reports (SARs) (representing 69 substances), and one Draft SAR (representing 5 substances). This means that since its inception, the Program has addressed approximately 95% of the 4,363 existing substances that were prioritized for assessment under the CMP.

Regarding new substances, 351 New Substance Notifications were assessed under the New Substances Notification Regulations (308 chemicals and polymers, and 43 animate products of biotechnology).

Thirty-six pesticide post-market reviews were also completed (35 re-evaluations and 1 special review).

Chemicals Risk Management

In 2022-23, ECCC and Health Canada published 20 risk management instruments for existing substances deemed harmful to human health and/or the environment in order to manage the risks they pose (15 proposed instruments and five final risk management instruments). For example, the manufacture and import of lead wheel weights destined for the Canadian market was prohibited in 2022-23, which will reduce the risk of adverse health effects from exposure to lead, while also improving air, water, and soil quality in Canada.

This risk management for existing substances also included three Orders establishing Significant New Activity (SNAc) provisions for six existing substances, and five SNAc Notices of Intent for nine existing substances. SNAc provisions trigger an obligation to provide the Government of Canada with information about a substance prior to a significant new activity.

In addition, two risk management approach documents and one addendum to a risk management scope document were also published. In general, these documents outline the Government's plan for managing the risks from the substance(s), and provide an opportunity for stakeholders to inform the path forward.

Regarding new substances, 15 risk management instruments came into force (four SNAc Notices and 11 Ministerial Conditions) for 15 new substances assessed to be potentially harmful to human health or the environment. By taking these actions early, prior to manufacture or import, only those innovative new substances (i.e., chemicals, polymers or living organisms) that do not cause harm to the environment or human health are introduced into the Canadian marketplace.

Three performance measurement evaluation reports were published, which found that the risk management actions that have been taken for nonylphenol and its ethoxylates (eco-component), dioxins and furans (health component) and dichloromethane (health component) have been successful in achieving their intended objectives of reducing the risks posed to the environment and/or human health.

Health Canada also published seven final guidelines and guidance documents for drinking and recreational water quality, which are used by all jurisdictions in Canada as the basis for their drinking water quality requirements and to inform their recreational water quality requirements.

In-store screening for chemicals in consumer products and cosmetics was undertaken, Health Canada's Product Safety Laboratory also completed the development and validation of a new test method for surface coating materials for toys.

PHAC continued its risk-based public health inspection program to identify and mitigate human health risks associated with water, food and sanitation on board passenger conveyances and their ancillary services to protect the travelling public.

Compliance Promotion and Enforcement

In 2022-23, ECCC's CMP compliance promotion activities focused on pollution, including the release of toxic substances to air, water or land, and the import and export of hazardous waste that presents a risk to the environment and/or human health. These activities aimed to increase voluntary compliance with regulatory and non-regulatory instruments, thereby mitigating consequential enforcement actions. A total of 15,973 known or potential regulatees received compliance promotion awareness materials from ECCC, and 3,322 stakeholders contacted compliance promotion officers for clarification of regulatory requirements and/or additional information. ECCC conducted 626 inspections related to CMP regulations and issued 142 enforcement measures.

Health Canada completed Compliance Verification projects for children's sleepwear, tattoo ink, an existing Cosmetic Ingredient Hotlist entry (Paraphenylenediamine) and for two updated entries on the Hotlist (sodium bromate and Thioglycolic Acid). In addition, Compliance Verification projects were initiated for consumer chemical products, expansion gates and expandable enclosures, cribs, and children's jewellery. Two projects [Tris (2-chloroethyl) phosphate and boric acid in toys] were deferred to 2023-24. In-store screening for chemicals in consumer products and cosmetics was also undertaken.

Research

In 2022-23, Health Canada conducted 25 research projects to address priorities identified by CMP partners. This includes six collaborative research agreement projects, four ongoing projects and the funding of 15 new research proposals to support the following research themes:

1. Environmental Health Research for CMP Priority Chemicals, Mixtures or CEPA substances
2. Monitoring and Surveillance of CMP Priority Chemicals
3. New Approaches and Methodologies for the Assessment of CMP Priority Chemicals, Mixtures or CEPA substances

At ECCC, activities were conducted as part of 19 research projects funded by the CMP. Research topics included the fate, bioaccumulation and effects of CMP priority substances such as flame retardants, perfluoroalkyl substances, rare earth elements, nanomaterials, as well as method development for future monitoring and scoping research on mixtures approaches. The research activities aimed to:

• Fulfil critical knowledge and data gaps in risk assessment and risk management;
• Develop novel methods and approaches to improve priority setting;
• Evaluate the fate and the persistence of toxic substances in the environment;
• Study complex environmental mixtures and other substances of concern on the environment;
• Determine the extent of exposure to contaminants, and;
• Investigate the toxicity of chemicals, including cumulative effects.

Monitoring and Surveillance

The Maternal-Infant Research on Environmental Chemicals (MIREC) Research Platform continued the assessment of prenatal exposure to chemicals and established national estimates of maternal and fetal exposures. In 2022-23, a follow-up study to MIREC called MIREC-ENDO entered Phase 2. MIREC-ENDO is studying the effects of prenatal exposure to environmental chemicals on puberty and metabolic function in children, as well as maternal health.

The Canadian Health Measures Survey (CHMS) resumed data collection for Cycle 7 following the COVID-19 pandemic. This ongoing cycle of collection includes nationally representative biomonitoring data for many new and emerging environmental chemicals and will be used to inform CMP risk assessment and risk management actions. For example, CHMS Cycle 7 includes emerging chemicals such as BPA substitutes, glyphosate, DEET and neonicotinoid pesticides, as well as the first samples collected from children aged 1 to 2 years old for metals in blood.

As part of the Northern Contaminants Program, six human biomonitoring and health project proposals were funded to monitor contaminant levels in wildlife and people in the Canadian North

Annual and Quarterly Surveillance Reports were published online to provide people in Canada with information on the number of reported injuries, hazards and deaths caused by consumer products and cosmetics, including those related to chemicals. The consumer incident reporting form was also adjusted to improve usability, resulting in an increased rate of reporting (including with respect to incidents that involved chemicals).

In 2022-23, there was also significant progress made on data analysis and reporting for many CMP priority substances and/or groups of substances monitored in freshwater, sediments, fish, bird eggs, ambient air, municipal wastewater and biosolids. Data are increasingly made available to the public, following validation, through posting on open data portal. After significant delays and challenges during the pandemic, most monitoring and surveillance activities conducted under the Environmental Monitoring and Surveillance Program at ECCC returned to normal in 2022-23. By year-end, the field work and laboratory activities for monitoring and surveillance had resumed following a progressive return to the laboratory during the year.

Collaboration, Outreach and Engagement

The Department raised public awareness about the health risks of chemicals and pollutants that may be found in and around the home via the Healthy Home Campaign. Healthy Home public outreach activities continued in-person and virtually using a refined approach to reach disproportionately impacted people in Canada, including underserved rural communities, new Canadians, seniors, and students. Ninety-six percent of Healthy Home Learning Sessions participants reported that their knowledge about environmental health risks increased, and 94% intended to take recommended actions.

The Healthy Home campaign aims to empower people living in Canada to take action to protect themselves from the risks of chemical substances and pollutants in and around the home. A mix of both traditional and digital marketing and communication tactics have been utilized. For 2022-23, this included social media (635,455 impressions), web visits (297,706 impressions) and an advertising campaign which saw 23.5 million impressions. The program published and printed four new publications: Healthy Home Guide, Tips for renters, Tips for pregnancy and preparing for baby, and Tips for do-it-yourself projects and renovations.

In 2022-23, Health Canada improved the accessibility of CMP information by refining its approach to communication. This included collaborating with organizations, leaders, and schools on how to better leverage existing technology and develop new educational resources, including reimagined exhibit spaces and materials that supported virtual and in-person participation. Communication materials were also improved to remove barriers to persons with disabilities (e.g., visually impaired and neurodivergent people). These new tools allowed the Department to raise awareness among underserved individuals and households across Canada.

Health Canada also leveraged opportunities to increase the dissemination of CMP messaging through a chemical safety mail-out to rural households in Atlantic Canada, Manitoba, and Saskatchewan.

Finally, Health Canada included disproportionately impacted populations in all its program engagement opportunities and provided support for specific engagement opportunities with Indigenous partners and civil society organizations.

Contact information

Health Canada

Angelika Zidek
A/Director
Healthy Environments and Consumer Safety Branch
angelika.zidek@hc-sc.gc.ca
613-618-0385

Environment and Climate Change Canada

Thomas Kruidenier
A/Executive Director, Program Development and Engagement
Science and Technology Branch
thomas.kruidenier@ec.gc.ca
613-697-4854

Maya Berci
Executive Director, Chemicals Management Division
Environmental Protection Branch
maya.berci@ec.gc.ca
613-852-7302

Horizontal initiative framework: Departmental funding by theme (dollars)

Horizontal initiative: Chemicals Management Plan

Shared outcomes: Risks from harmful chemicals to the environment and to the health of Canadians are reduced.

Performance information

Theme horizontal initiative activities

Horizontal Initiative Activity Codes

Theme 1: Chemical Risk Assessments

Expected Results

Health Canada

• ER 1.1: Risk assessments are conducted in a timely manner to inform risk management decisions
• ER 1.2: Regulated pesticides are deemed to meet current scientific standards with respect to health and the environment

Environment and Climate Change Canada

• ER 1.3: Harmful chemicals are identified through timely risk assessments

Performance Indicators

Health Canada

• PI 1.1.1: % of existing chemicals addressed within targeted timelines
• PI 1.1.2: % of new substances (chemicals, polymers, and animate products of biotechnology) assessed within prescribed timelines
• PI 1.2.1: % of pesticide re-evaluations that are completed within specified timelines
• PI 1.2.2: % of pesticide special reviews that are completed within specified timelines

Environment and Climate Change Canada

• PI 1.3.1: % of new substances (chemicals, polymers, and animate products of biotechnology) assessed within prescribed timelines
• PI 1.3.2: % of existing chemicals addressed within targeted timelines

Targets

Health Canada

• T 1.1.1: 100%
• T 1.1.2: 100%
• T 1.2.1: 90%
• T 1.2.2: 90%

Environment and Climate Change Canada

• T 1.3.1: 100%
• T 1.3.2: 100%

Actual Results

Health Canada

• AR 1.1.1: 100%
• AR 1.1.2: 100%
• AR 1.2.1: 76%
• AR 1.2.2: 0%

Environment and Climate Change Canada

• AR 1.3.1: 81%
• AR 1.3.2: 100%

Theme 2: Chemical Risk Management, Compliance Promotion and Enforcement

Expected Results

Health Canada

• ER 2.1: Regulatees are informed of and comply with legislative and regulatory requirements related to the applicable HC Acts

Environment and Climate Change Canada

• ER 2.2: Regulatees are informed of requirements of regulatory and non-regulatory instruments
• ER 2.3: Non-compliant regulatees become compliant with established risk management obligations

Public Health Agency of Canada

• ER 2.4: Public health risks associated with travel are reduced

Performance Indicators

Health Canada

• PI 2.1: % of planned CMP compliance verifications completed

Environment and Climate Change Canada

• PI 2.2: % of regulatees subject to regulatory and non-regulatory CMP instruments that are contacted through compliance promotion activities
• PI 2.3.1: % of non-compliance addressed by enforcement action
• PI 2.3.2: % of verified compliance for ongoing environmental violations during follow-up inspections

Public Health Agency of Canada

• PI 2.4: % of inspected passenger transportation operators that meet public health requirements

Targets

Health Canada

• T 2.1: 100%

Environment and Climate Change Canada

• T 2.2: 100%
• T 2.3.1: 70%
• T 2.3.2: 60%

Public Health Agency of Canada

• T 2.4: 95%

Actual Results

Health Canada

• AR 2.1: 71%

Environment and Climate Change Canada

• AR 2.2: 100%
• AR 2.3.1: 85%
• AR 2.3.2: 81%

Public Health Agency of Canada

• AR 2.4: 97%

Theme 3: Science-Based Decision-Making

Expected Results

Health Canada

• ER 3.1: Research data is available to inform CMP decisions
• ER 3.2: Monitoring and surveillance data is available to inform CMP decisions

Environment and Climate Change Canada

• ER 3.3: Research data is available to inform CMP decisions
• ER 3.4: Monitoring and surveillance data is available to inform CMP decisions

Performance Indicators

Health Canada

• PI 3.1: % of planned knowledge transfer activities completed related to research on chemicals of concern
• PI 3.2: % of planned knowledge transfer activities completed related to monitoring and surveillance on chemicals of concern

Environment and Climate Change Canada

• PI 3.3: % of research projects that supports priorities for risk assessment and risk management
• PI 3.4: % of monitoring and surveillance projects that supports risk assessment and risk management decisions

Targets

Health Canada

• T 3.1: 100%
• T 3.2: 100%

Environment and Climate Change Canada

• T 3.3: 100%
• T 3.4: 100%

Actual Results

Health Canada

• AR 3.1: 100%
• AR 3.2: 100%

Environment and Climate Change Canada

• AR 3.3: 100%
• AR 3.4: 100%

Theme 4: Collaboration, Outreach and Engagement

Expected Results

Health Canada

• ER 4.1: Canadians and intermediaries have access to information to minimize environmental health risks
• ER 4.2: The Government better understands the interests and concerns of disproportionally impacted populations and Indigenous people regarding the management of chemicals and environmental health risks

Performance Indicators

Health Canada

• PI 4.1.1: % of Canadians who engaged in social media in order to actively learn more about minimizing the health risks of harmful chemicals
• PI 4.1.2: % of outreach participants who report an increase in knowledge about environmental health risks
• PI 4.1.3: % of outreach participants who intend to take recommended actions to minimize the environmental health risks of harmful chemicals
• PI 4.1.4: % of contribution funds committed to selected recipients to communicate evidence-based information about chemicals and health to Canadians
• PI 4.2: % of planned engagement opportunities completed with the participation of disproportionally impacted populations, including Indigenous peoples

Targets

Health Canada

• T 4.1.1: 1%
• T 4.1.2: 80%
• T 4.1.3: 70%
• T 4.1.4: 100%
• T 4.2: 100%

Actual Results

Health Canada

• AR 4.1.1: Average engagement rate 2.45% (*Figure may be higher than usual due to issues with Facebook's analytics platform in 2022)
• AR 4.1.2: 96%
• AR 4.1.3: 94%
• AR 4.1.4: 100%
• AR 4.2: 100%

Renewal of the funding for the existing Federal Framework for the Legalization and Regulation of Cannabis in Canada

General information

Name of horizontal initiative

Renewal of the funding for the existing Federal Framework for the Legalization and Regulation of Cannabis in Canada

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.

Start Date

April 1, 2017

End Date

March 31, 2025

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. This initiative aims to achieve the Government of Canada's objectives of reducing the public health harms associated with cannabis use, particularly among youth and displacing the illegal cannabis market with a strictly regulated legal industry.

Federal partner organizations implement the regulatory framework including licensing; regulatory compliance and enforcement; engagement with partners on public health and public safety; law enforcement; preventing and interdicting the cross-border movement of cannabis; research and surveillance; and public education activities.

Activities are organized by five high-level themes:

1. Implement and enforce the legislative framework;
2. Provide Canadians with information needed to make informed decisions and minimize health and safety harms;
3. Enhance data, knowledge and tools on illegal cannabis and public safety by working with key partners and stakeholders;
4. Provide intelligence, undertake enforcement activities, and support security screenings; and
5. Prevent and interdict prohibited cross-border movement of cannabis while maintaining the flow of legitimate travellers and goods.

Governance structure

The Government of Canada continues to support a robust governance structure to facilitate a whole-of-government coordination in implementing and administering the federal framework to legalize and strictly regulate cannabis. An Assistant Deputy Minister in each partner department is responsible for delivering on planned activities and is accountable for reporting on cannabis results to Health Canada as the lead department for this horizontal initiative. As part of the governance structure, horizontal committees have been established to ensure collaboration and information exchange.

At the federal level, this governance structure includes an Assistant Deputy Minister Cannabis Committee (ADM CC) that serves as a forum for government-wide coordination of policy and activities. It is the main federal government forum to report on progress in the delivery of the program, surface emerging issues or risks and coordinate activities and relay information to responsible Deputy Heads, as appropriate. The ADM CC meetings are held every two months and are chaired by the Assistant Deputy Minister of the Controlled Substances and Cannabis Branch (CSCB), Health Canada. Member departments include Health Canada, Public Health Agency of Canada, Public Safety Canada, the Royal Canadian Mounted Police, Canada Border Services Agency, Privy Council Office, Treasury Board Secretariat, Finance Canada, Justice Canada, Global Affairs Canada, Canada Revenue Agency, Indigenous Services Canada, Statistics Canada, Transport Canada and the Department of National Defence.

The ADM CC is supported by a Directors General-level Committee that meets bi-weekly, as needed, to exchange information necessary to enable timely monitoring and reporting on implementation and risks.

The Government is committed to ongoing collaboration and consultation with provincial and territorial partners. The Federal/Provincial/Territorial (F/P/T) Senior Officials Working Group on Cannabis Legalization and Regulation enables governments to exchange information on important issues about the legalization and regulation of cannabis. Meetings occur every two months and are chaired by Health Canada. Main membership includes representatives from both the policy and health fields at the provincial/territorial-level. Federal departments represented are Health Canada, Public Health Agency of Canada, Public Safety Canada, the Royal Canadian Mounted Police, Canada Border Services Agency, Finance Canada and Justice Canada.

Health Canada assumes the chair and secretariat functions for these committees and working groups and has the central coordinating role in tracking key milestones and in reporting to federal Ministers.

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

$1,047,187,948

Total federal funding planned spending to date (dollars)

$712,252,749

Total federal actual spending to date (dollars)

$652,752,336

Date of last renewal of initiative

2022-23

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

$500,380,492

Additional federal funding received after last renewal (dollars)

Not applicable

Total planned spending since last renewal

$165,445,293

Total actual spending since last renewal

$144,198,240

Fiscal year of planned completion of next evaluation

2027-28

Performance highlights

The federal government continued to support the effective implementation of the cannabis legislative framework in 2022-23, working with provinces and territories (P/Ts), Indigenous governments and communities, municipalities, the regulated industry, public health organizations, non-governmental organizations, academics, federal partners, international partners, and law enforcement 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 2022-23:

Public Health

Evidence-based and innovative public education and awareness is a fundamental component of the government's public health approach to reducing the harms associated with cannabis. As such, in 2022-23, Health Canada:

• Updated and launched the "Pursue Your Passion" experiential marketing campaign as both a virtual-, ambassador-led program in schools and a teacher-led interactive lesson;
• Continued its youth vaping prevention campaign – "Consider the Consequences of Vaping" to include information on cannabis;
• Launched the "Reduce our risk: Choose legal cannabis" campaign designed to provide Canadians with information on the risks of illicit cannabis products and how to recognize the differences between legal and illegal cannabis products;
• Published two additional resources to the Cannabis Resource Series^{footnote 73}; and
• Developed a campaign on accidental poisonings in children from edible cannabis products for parents, caregivers, and guardians of children 14 years and younger in Canada.

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 to co-develop and share targeted public education posters, infographics, social media shareables and other products to prevent and reduce cannabis and substance-related harms among priority populations. Recently published materials include:

• An evaluation guide to support community-based interventions to prevent substance-related harms in youth: Based on the implementation of the Icelandic Prevention Model in Lanark County, Canada;
• An online resource and printable poster to help support older adults in making informed decisions about their substance use, developed in partnership with the Canadian Coalition for Seniors' Mental Health; and
• A first set of social media shareables designed to assist youth in making informed, evidence-based decisions about cannabis vaping, developed in partnership with The Students Commission of Canada.

Through a harm reduction lens, PHAC targeted its efforts and tailored these products in ways to best reach and meet the diverse needs of population groups that are disproportionately impacted by cannabis-related harms. PHAC also continued its efforts on upstream prevention and explored issues such as equity, stigma, mental health and family and gender-based violence. PHAC regularly engaged with a wide range of stakeholders including school communities, provincial, territorial, and national and international partners, to inform its work.

Health Canada also continued its surveillance, monitoring and research activities with respect to cannabis. In 2022-23, Health Canada:

• Published three peer-reviewed research reports^{footnote 74} in collaboration with partners;
• Published results of a public opinion research report that gathered information on views and practices of patients and health care practitioners on access to cannabis for medical purposes;
• Published two annual data reports highlighting adverse reactions involving cannabis products (October 17, 2018 – December 31, 2019 and January 1, 2020 – December 31, 2020);
• Screened 91 instances of adverse reactions associated with cannabis products (24% of which required hospitalization and 4% were reported as life threatening); and
• Conducted scientific assessments to characterize the potential risks associated with certain formulations or ingredients in cannabis products, and responded to over 250 risk-related requests.

Health Canada continued closely monitoring cannabis usage rates. Results from the 2022 Canadian Cannabis Survey found that the number of respondents reporting cannabis use in the previous 12 months remained higher among youth aged 16-19 years and young adults aged 20-24 years compared to those over 25 years old. Since the coming into force of the Cannabis Act in 2018, the prevalence of past 12-month cannabis use in youth aged 16-19 years has remained relatively stable.

Health Canada continued its work towards strengthening the regulatory framework for cannabis by making amendments to the Cannabis Act and its Regulations in December 2022. These amendments foster a stronger cannabis research climate (including research on cannabis for non-therapeutic purposes in humans), facilitate cannabis testing by improving access to testing materials and broadening the educational qualifications for those responsible for testing cannabis at licensed sites, and increase the public possession limit for cannabis beverages to better align with other cannabis products. In March 2023, the department also published a Notice of Intent in the Canada Gazette, Part I, to seek feedback on potential amendments to the Cannabis Regulations with the goal of streamlining and clarifying existing requirements, eliminating duplicative requirements, and reducing burdens, where possible, while continuing to meet the public health and public safety objectives of the Cannabis Act.

The federally-regulated cannabis industry continued to expand and diversify. In 2022-23, Health Canada granted an additional 179 licences for the cultivation, processing and sale of cannabis for medical purposes, 125 licences for research, analytical testing and cannabis drug, and 120 for industrial hemp. The Department also granted 1,805 import and export permits.

Health Canada issued an additional 13 licences for cultivating or processing cannabis to Indigenous-owned or affiliated applicants, for a total of 56 licensed Indigenous businesses in 2022-23. It also awarded an additional 6 licences to Indigenous-owned or affiliated applicants to cultivate or process industrial hemp, for a total of 27 in 2022-23. Health Canada continued to offer a dedicated Indigenous Navigator Service to help and support Indigenous-affiliated applicants throughout the federal commercial cannabis licensing process and encourage participation in the industry.

Health Canada continued work to implement strategies aimed at enabling a diverse and competitive cannabis industry comprised of small and large businesses, with participation from Indigenous, Black and other racialized communities by:

• Updating the Cannabis Tracking and Licensing System to include responses to frequently asked questions from micro-class licence holders;
• Gathering demographic data to better understand the diversity of the cannabis industry;
• Leveraging social media campaigns to help disseminate information to a more diverse audience;
• Enhancing communication between Health Canada and its stakeholders, including through its Virtual Learning Series; and
• Gathering feedback from industry surveys to support program improvements and to inform the streamlining of processes.

Health Canada continued to work to strengthen the integrity of the medical access framework. In April 2022, the Department published the Guidance on Personal Production of Cannabis for Medical Purposes which outlined factors Health Canada may consider when deciding whether to refuse or revoke a registration for personal or designated production of cannabis for medical purposes. This guidance incorporates stakeholder feedback, which is summarized in a What We Heard Report. Further, during the registration process, Health Canada continued to actively seek additional evidence from health care practitioners to substantiate or support authorizations for high daily amounts of cannabis and communicated concerning trends to the appropriate health care practitioner on a regular basis. If a request was not substantiated and represented a risk to public health and safety (including the risk of cannabis being diverted to the illicit market), the Department used its authority to refuse the request.

Health Canada actively supported law enforcement by providing a dedicated 24-7 service to confirm whether specific individuals were authorized to possess or produce cannabis for medical purposes. The Department provided information (where appropriate) to law enforcement and other authorities, such as provincial regulatory medical colleges, to assist with active investigations.

As a means of supporting licence holders achieving and maintaining compliance with the Cannabis Act and its Regulations, Health Canada continues to update its guidance. Examples this year include the Promotion of Cannabis Prohibitions and permissions in the Cannabis Act and Regulations, which was updated in August 2022 and the Guidance on the Classification of edible cannabis, which was updated in March 2023.

Health Canada continued to promote, monitor, verify and enforce compliance with cannabis legislative and regulatory requirements by:

• Undertaking over 779 compliance promotion activities (e.g., emails, webinars, calls, letters);
• Reviewing a total of 23,417 notices of new cannabis products and followed up on 8% (those with potential non-compliance with the regulations);
• Investigating over 1,185 cannabis complaints;
• Making 142 referrals to law enforcement for possible enforcement action;
• Conducting 2 compliance monitoring projects to review industry compliance in areas such as hemp cultivation and cannabis traceability;
• Inspecting 377 cannabis licence holders and found industry complied with Health Canada regulations 96% of the time;
• Actioned 129 compliance verifications, which are conducted to verify compliance in response to information regarding known or suspected non-compliance with the applicable requirements of the Cannabis Act and its Regulations;
• Undertaking 104 cannabis compliance promotion sessions delivered directly by inspectors to promote compliance through educational activities and information sharing with regulated parties;
• Collecting 43 cannabis product samples for laboratory analysis to monitor and enforce compliance with legislative and regulatory requirements; and
• Assessing 41% of current cannabis licence holders through a variety of methods.

The Legislative Review of the Cannabis Act was launched in September 2022. The review is led by an independent Expert Panel that will provide advice on progress made towards achieving the Act's objectives. The Minister of Health is required to table a report setting out the findings of the review in both Houses of Parliament by March 2024.

Public Safety

A tightly-regulated cannabis industry capable of delivering a sufficient supply of quality-controlled products continued to be in place in 2022-23 and Health Canada observed progress towards the displacement of the illegal cannabis market. The proportion of household spending on cannabis in the legal market has grown from 9% in Q3 of calendar year 2018 to 71% in Q4 of 2022. The Department publishes market data on its website each quarter to keep Canadians informed of industry trends. Public Safety Canada (PS) continued to engage with federal, provincial and territorial and law enforcement partners to support the displacement of the illicit cannabis market in Canada. In 2022-23, PS continued to implement the Online Illicit Cannabis Sales Action Plan, including developing information resources in support of enforcement efforts and working closely with subject-matter experts in government and research organizations to strengthen data collection and monitoring of the availability and size of illicit cannabis market, including online.

PS continued to develop and promote public education and awareness activities to assist Canadian consumers in making informed decisions about purchasing cannabis online. In March 2023, PS used a paid content distribution service to help inform Canadians about the harms of illegal cannabis and how to spot the difference between legal and illegal products, which was displayed 11 million times. From July to September 2022, PS led an unpaid social media campaign, featuring a short, animated video, to support Canadian cannabis consumers to choose legal products and raise awareness of the health, safety, legal and financial risks associated with illegal cannabis, including the continued promotion of the Authorized Retailers webpage, which connects people with licenced online and in-store retailers in the province or territory in which they live.

Overall posts from the campaign were displayed more than 9000 times, while the video received nearly 3000 views. To further knowledge mobilization, in February 2023, PS hosted a webinar on emerging issues and trends in illicit cannabis markets, and on best practices in tackling illicit cultivation and financial crimes related to illicit cannabis. This virtual event brought together more than 150 F/P/T representatives from the public safety and law enforcement communities.

In 2022-23, the Royal Canadian Mounted Police's (RCMP) National Youth Services hosted two Youth Officer Training sessions: one in October 2022; and one in February 2023. Participants were asked to complete a survey following each training session in order to assess the impact of the training course. For both training sessions, the participants identified that the presentations, resources and tools were relevant and useful in order to engage with youth effectively. All subjects covered in the training sessions were in line with the RCMP's National Youth Priority Report for 2020-2023.

The RCMP created evidence-based resources to educate youth about the risks associated with cannabis use. These initiatives empower young people to make informed decisions about their health and well-being. Additionally, RCMP worked closely with school resource officers, educators, and other professionals working with youth to promote prevention strategies that address the root causes of substance use among youth.

Furthermore, during 2022-23, the RCMP developed analytical intelligence products that informed RCMP senior management, Health Canada, and Public Safety Canada on the ongoing criminal activities within the cannabis market, despite legalization. These intelligence analyses included identifying trends, assessing organized crime involvement, and describing ongoing challenges for domestic and international police enforcement.

The RCMP also built a centrally coordinated intelligence network to track reporting, and to collect and analyze information and intelligence related to this initiative, and directly supported investigations involving cannabis. A national work plan was developed for the next fiscal year for focused collection, analysis, and dissemination of intelligence products within the RCMP and externally with domestic and international partners.

The RCMP worked diligently to process the backlog of Health Canada cannabis referrals for potential enforcement actions to the RCMP and processed requests in a timely matter, despite staffing challenges.

In 2022-23, 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.

The unauthorized movement of cannabis across Canada's borders remains a serious criminal offence under the Cannabis Act. As such, the CBSA continued its efforts to detect and combat the illicit and unauthorized cross-border movement of cannabis in accordance with CBSA program legislation. Despite growing traveller and commercial shipment volumes, the overall number of border interdictions (import and export) remained fairly similar to the previous year. Notably, there was a 2% decrease (from 23,028 interdictions in 2021-22 to 22,566 interdictions in 2022-23) to absolute interdictions and a 4% increase in the quantity of cannabis interdicted (from 16,345 kg in 2021-22 to 16,976 kg in 2022-23).

The CBSA laboratory analyzed 200% more cannabis samples than in fiscal year 2021-22 and cleared all analysis backlogs from previous years, which allowed for the analysis of 30% of suspect cannabis samples received from ports of entry in 2022-23.

A total of 554 monetary penalties were administered to travellers entering Canada with undeclared cannabis in 2022-23, while in 2021-22 there were 278.

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 99% of appeals received within 10 calendar days and decided 80% of the Enforcement and Trusted Traveller appeals within 180 days, exceeding CBSA service standards.

Contact information

Health Canada

John Clare
Director General
Controlled Substances and Cannabis Branch
John.Clare@hc-sc.gc.ca
613-858-8429

Horizontal Initiative : Renewal of the funding for the existing Federal Framework for the Legalization and Regulation of Cannabis in Canada

Shared outcomes:

• SO 1: Cannabis is kept of out of the hands of Canadian children and youth; and
• SO 2: The illegal cannabis market is reduced.

Planning information

Variances Explanation:

Health Canada

Variance due to late receipt of the Cannabis funding in 22-23, program operated at lower level of financial resources. This had a direct impact on planned staffing, O&M expenses for major projects, causing prolonged delays.

Canada Border Services Agency

N/A

Public Safety Canada

The variance was the result of staffing vacancies in the last two quarters of the fiscal year.

Royal Canadian Mounted Police

The variance was due to a ramp-up of operation has been expedited compared to plan.

Public Health Agency of Canada

The variance was a result of management decisions to revise planned operations and maintenance spending in FY 2022-23 due to evolving ministerial priorities and unforeseen delays in procurement.

Theme 1: Implement and enforce the legislative framework

Expected results, Health Canada

• ER 1.1.1 The cannabis industry is federally regulated and licensed
• ER 1.1.2 Canadians authorized to use cannabis for medical purposes have reasonable access to legal cannabis
• ER 1.1.3 The cannabis industry is informed of the regulatory requirements for cannabis
• ER 1.1.4 The cannabis industry is compliant with cannabis-related laws and regulations
• ER 1.1.5 Health Canada has the capacity to identify potential health and safety risks with cannabis products

Performance indicators

Health Canada

• PI 1.1.1.1 Percentage of licence applications processed within service standards
• PI 1.1.1.2 Percentage of cannabis and hemp import and export permit applications processed within service standards
• PI 1.1.2 Percentage of applications for personal/designated production processed within the service standard
• PI 1.1.3 Percentage of targeted federal licence holders who indicate they have access to information to help them understand the regulatory requirements
• PI 1.1.4 Percentage of federally licensed industry that is found to be compliant with regulatory requirements
• PI 1.1.5 Percentage of cannabis-related serious adverse reaction reports reported to Health Canada's Canada Vigilance Program that are investigated

Targets

Health Canada

• T 1.1.1.1 75%
• T 1.1.1.2 85%
• T 1.1.2 85%
• T 1.1.3 80%
• T 1.1.4 80%
• T 1.1.5 100%

Actual results

Health Canada

• AR 1.1.1.1 88.7%
• AR 1.1.1.2 98.4%
• AR 1.1.2 88%
• AR 1.1.3 90%
• AR 1.1.4 96%
• AR 1.1.5 100%

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 have access to enough trustworthy information on cannabis use (including health effects)

Public Health Agency of Canada

• ER 2.2.1 Canadians have access to public health knowledge products on cannabis and polysubstance use
• ER 2.2.2 Stakeholders work with the Public Health Agency of Canada to co-develop knowledge products related to the public health impacts of cannabis and polysubstance use

Public Safety Canada

• ER 2.3.1 Canadians have access to information on illicit cannabis

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 Canadians accessing public health knowledge products developed on cannabis and polysubstance use
• PI 2.2.2 Number of knowledge mobilization projects co-developed with stakeholders on cannabis and polysubstance use

Public Safety Canada

• PI 2.3.1 Percentage increase in web traffic on illicit cannabis pages on relevant GoC and PT websites

Targets

Health Canada

• T 2.1.1 7%
• T 2.1.2 75%

Public Health Agency of Canada

• T 2.2.1 100, 000 or more
• T 2.2.2 10

Public Safety Canada

• T 2.3.1 Baseline will be established in Q1 2023-2024

Actual results

Health Canada

• AR 2.1.1 8.6%
• AR 2.1.2 72%

Public Health Agency of Canada

• AR 2.2.1 41,745
• AR 2.2.2 4

Public Safety Canada

• AR 2.3.1 Not available

Theme 3: Enhance data, knowledge and tools on illegal cannabis and public safety by working with key partners and stakeholders

Expected results

Public Safety Canada

• ER 3.1.1 Governments, law enforcement agencies and private sector stakeholders are aware of policies and practices to reduce illegal cannabis use and availability
• ER 3.2.1 Policy and practice is informed by evidence

Performance indicators

Public Safety Canada

• PI 3.1.1.1 Number of participants reached through knowledge sharing events/meetings on illegal cannabis
• PI 3.1.1.2 Percentage of participants / recipients of knowledge activities / products reporting that they were useful
• PI 3.2.1.1 Number of knowledge products disseminated
• PI 3.2.1.2 Percentage of stakeholders reporting that their policy and practice were informed by data and knowledge tools produced under this program

Targets

Public Safety Canada

• T 3.1.1.1 100
• T 3.1.1.2 75%, starting in year 2
• T 3.2.1.1 6
• T 3.2.1.2 Target will be established in Q3 2023-2024

Actual results

Public Safety Canada

• AR 3.1.1.1 215
• AR 3.1.1.2 N/A
• AR 3.2.1.1 7
• AR 3.2.1.2 N/A

Theme 4: Provide intelligence, undertake enforcement activities, and support security screenings

Expected results

Royal Canadian Mounted Police

• ER 4.1.1 Law Enforcement Records Checks (LERCs) are conducted in support of HC's security clearance decisions
• ER 4.1.2 Canadian law enforcement agencies have access to cannabis-related actionable intelligence products
• ER 4.1.3 Canadian law enforcement agencies are aware of organized crime and the illicit cannabis market
• ER 4.1.4 Canadian law enforcement agencies' information and actionable intelligence are used to inform decision-making
• ER 4.1.5 Canadian law enforcement agencies act against organized crime and the illicit cannabis market
• ER 4.1.6 RCMP prevention and engagement activities support enhanced understanding among targeted partners and stakeholders, including youth and Indigenous communities
• ER 4.1.7 Increased cannabis-specific engagements with Indigenous communities
• ER 4.1.8 Enhanced capacity of target populations, including partners and stakeholders, youth and Indigenous communities, to respond to the cannabis regime

Performance indicators

Royal Canadian Mounted Police

• PI 4.1.1 Percentage of LERCs completed within negotiated service standards
• PI 4.1.2.1 Number of cannabis-related intelligence products
• PI 4.1.2.2 Number of reports on trends and patterns that examine organized crime involvement in the illicit cannabis market
• PI 4.1.3.1 Percentage of cannabis referrals processed within the service standard
• PI 4.1.3.2 Percentage of Policing Partners and Stakeholders who agree that CISC intelligence products inform decision-making and/or priority-setting exercises
• PI 4.1.4 Percentage of internally developed cannabis-related intelligence and information products disseminated to RCMP operational units, non-operational units (e.g. policy units), decision-makers, as well as other stakeholders and external partners/agencies
• PI 4.1.5.1 Percentage increase of cannabis-related occurrences that are tied to organized crime/street gang
• PI 4.1.5.2 Number of cannabis-related tiered projects
• PI 4.1.6 Percentage of targeted federal partners and stakeholders who strongly agree or agree with the statement "RCMP Federal Policing Strategic Engagement and Awareness has increased my understanding specific to the cannabis regime, organized crime, and the illicit cannabis market"
• PI 4.1.7.1 Number of engagements at the leadership level between RCMP detachments/divisions and Indigenous community leadership on cannabis-related issues
• PI 4.1.7.2 Number of RCMP-led community awareness sessions/workshops held with Indigenous communities on cannabis-related issues (e.g. town halls, school presentations, etc.)
• PI 4.1.8.1 Number of information inquiries responded to by the Centre for Youth Crime Prevention
• PI 4.1.8.2 Percentage of targeted partners/stakeholders who strongly agree or agree with the statement "RCMP Federal Policing Strategic Engagement and Awareness has increased my skills/ability to respond to the cannabis regime"
• PI 4.1.8.3 Percentage of youth resource officers who positively assessed the impact of training

Targets

Royal Canadian Mounted Police

• T 4.1.1 75%
• T 4.1.2.1 14 or higher^{footnote 74}
• T 4.1.2.2 6
• T 4.1.3.1 90%
• T 4.1.3.2 80%
• T 4.1.4 80% shared internally (% of total products), 30% shared externally (% of total products)
• T 4.1.5.1 Increase of 10% or more (99 or more)
• T 4.1.5.2 8 (increase of 10% or more)
• T 4.1.6 45%
• T 4.1.7.1 Target/baseline will be established in Q1 2023-24 after the first year of data collection
• T 4.1.7.2 Target/baseline will be established in Q1 2023-24 after the first year of data collection
• T 4.1.8.1 150
• T 4.1.8.2 30%
• T 4.1.8.3 100%

Actual results

Royal Canadian Mounted Police

• AR 4.1.1 100%
• AR 4.1.2.1 19^{footnote 76}
• AR 4.1.2.2 13
• AR 4.1.3.1 81%^{footnote 77}
• AR 4.1.3.2 63%
• AR 4.1.4 89% shared internally; 47% shared externally
• AR 4.1.5.1 54.6% increase (from 1.4% to 2.15%)^{footnote 78}
• AR 4.1.5.2 7^{footnote 79}
• AR 4.1.6 56%
• AR 4.1.7.1 0^{footnote 80}
• AR 4.1.7.2 0^{footnote 80}
• AR 4.1.8.1 174^{footnote 81}
• AR 4.1.8.2 48%
• AR 4.1.8.3 100%

Theme 5: Prevent and interdict prohibited cross-border movement of cannabis while maintaining the flow of legitimate travelers and goods

Expected results

Canada Border Services Agency

• ER 5.1.1 Enhanced capacity to promote compliance and to enforce import and export-related laws
• ER 5.1.2 Capacity to address critical data, research and surveillance gaps that present a barrier to the effective implementation and monitoring of Canada's cannabis framework pre, and at the border
• ER 5.1.3 Prohibited cross border movement of cannabis is detected
• ER 5.1.4 Travellers and the business community have access to timely redress mechanisms CBSA actions and decisions in a timely manner

Performance indicators

Canada Border Services Agency

• PI 5.1.1.1 Percentage decrease in number of traveller cannabis forfeitures at the ports of entry
• PI 5.1.1.2 Percentage decrease in number of traveller cannabis seizures at the ports of entry
• PI 5.1.2.1 Percentage of time cannabis reporting applications were fully functional and available to users
• PI 5.1.2.2 Assessment of the quality of policies, procedures, agreements and research papers to support Canada's cannabis framework pre, and at the border
• PI 5.1.3 Percentage of referred cannabis samples analyzed within 60 days
• PI 5.1.4.1 Percentage of cannabis-related appeals received that are acknowledged within 10 calendar days
• PI 5.1.4.2 Percentage of Enforcement and Trusted Traveller appeals received that are decided within 180 workable days

Targets

Canada Border Services Agency

• T 5.1.1.1 3,995 [5% reduction (+/- 5% variance) to baseline of 4,206]
• T 5.1.1.2 1,393 [5% reduction (+/- 5% variance) to baseline of 1,467]
• T 5.1.2.1 90%
• T 5.1.2.2 Quality is rated as "Excellent," "Average" or "Below Average
• T 5.1.3 90%
• T 5.1.4.1 85%
• T 5.1.4.2 70%

Actual results

Canada Border Services Agency

• AR 5.1.1.1 7,826^{footnote 82} (86% increase to baseline of 4,206)
• AR 5.1.1.2 1,524 (4% increase to baseline of 1,467)
• AR 5.1.2.1 95%
• AR 5.1.2.2 Excellent
• AR 5.1.3 30%^{footnote 83}
• AR 5.1.4.1 99%
• AR 5.1.4.2 80%

Reporting on Green Procurement

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

Context

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 voluntarily developed its corresponding 2022-23 DSDS Report, including applicable reporting on green procurement activities.

Response to parliamentary committees and external audits

Response to parliamentary committees

The Scars that We Carry: Forced and Coerced Sterilization of Persons in Canada - Part II

Brief Summary

Beginning in 2019, the Standing Senate Committee on Human Rights (the Committee) undertook a study on the extent and scope of forced and coerced sterilization of persons in Canada, hearing from experts and civil society groups. In 2022, the Committee heard additional testimony on this issue, including from several survivors who courageously shared their stories.

The practice of forced and coerced sterilization is not confined to our distant past, and law and policy changes are needed to prevent this horrific practice from being inflicted on others. This report highlights the experiences and perspectives of survivors and outlines solutions that the Committee believes are urgently needed to bring an end to this unacceptable practice.

Corrective Actions

The Government of Canada is supporting systemic changes in the health system to improve cultural safety and the awareness and application of informed consent practices.

In June 2021, the Minister of Health wrote the provinces and territories (P/Ts) to remind them of their obligation under the accessibility criterion of the Canada Health Act to ensure all Canadians, including Indigenous people, have universal access to insured health services free of any barriers, including discrimination of any kind. The letter sets out the federal government's commitment to work with P/Ts and Indigenous groups to address anti-Indigenous racism in the health care system, while respecting provincial and territorial jurisdiction in health care delivery.

The Commissioner of the RCMP has publicly committed that any person reporting forced or coerced sterilization to the RCMP will be heard, treated with respect, and informed of available victim support services. The RCMP will fully and professionally investigate any allegations within its jurisdiction.

Public Accounts Report 18 - Natural Health Products Report 2, Natural Health Products — Health Canada, of the Commissioner of the Environment and Sustainable Development

Brief Summary

The Committee concluded that Health Canada was deficient in its oversight of natural health products available to the Canadian market. Although the department approved products on the basis of evidence that they were safe and effective, its oversight of manufacturing sites and monitoring of products once on the market left consumers exposed to potential health and safety risks. Moreover, though it investigated products that were suspected of causing serious health risks and took immediate action to address such risks, Health Canada's approach was reactive and not always successful in having them removed from the market.

To that end, the Committee made six recommendations to help Health Canada improve its administration and oversight of natural health products.

The Committee also acknowledged that during the early stages of the COVID-19 pandemic, Health Canada acted quickly to license alcohol-based hand sanitizers to help address market shortages; and, that it proactively monitored natural health products with claims related to COVID-19 and took action when it identified false claims.

Corrective Actions

Health Canada accepted the totality of recommendations made in the Commissioner's report and in response, prepared a plan to establish a stronger and more robust natural health products program. As part the proposed improvements the Department committed to consider a range of policy, operational and statutory changes, as well as enhanced compliance and enforcement, such as through the greater use of proactive monitoring and a permanent inspection program.

Government Response to the First Report of the Special Joint Committee on Medical Assistance in Dying

Brief Summary

The Special Joint Committee on Medical Assistance in Dying (MAID) was re-created in March 2022 and tasked with reviewing "the provisions of the Criminal Code relating to medical assistance in dying and their application, including but not limited to issues relating to mature minors, advance requests, mental illness, the state of palliative care in Canada and the protection of Canadians with disabilities." While the Committee was initially required to submit its final report by June 23, 2022, that deadline was extended to October 17, 2022. However, the Committee was still required to submit an interim report on mental disorder as a sole underlying medical condition for accessing MAID by June 23, 2022.

The Committee began hearing witnesses on April 13, 2022. However, it postponed hearing from witnesses relating to mental disorder until after the Expert Panel on MAID and Mental Illness tabled its report on May 13, 2022.

Given the need to carry out additional work on this theme, and the importance of allowing sufficient time to consider the many briefs that have been submitted to the Committee in addition to witness testimony, the interim report did not contain final recommendations. Instead, it summarized the testimony presented to the Committee.

Corrective Actions

The Government Response outlines planned/ongoing initiatives that align with/respond directly to the Panel's recommendations, with an emphasis on F/P/T collaborative work underway on practice standards and training in preparation for the March 17, 2023 deadline for the provisions regarding MAID for those whose sole underlying condition is a mental illness. It also takes note of Budget 2021 funding commitments to support safety and consistency in Canada's MAID regime. To address potential concerns with respect to access to mental health services, it also highlights federal work in this area.

Government Response to Public Accounts Committee Report 11 - Securing Personal Protective Equipment and Medical Devices

Brief Summary

In 2021 the Office of the Auditor General of Canada released a performance audit that focused on whether PHAC and Health Canada, "before and during the COVID-19 pandemic, helped to meet the needs of P/Ts for selected PPE (N95 masks and medical gowns) and medical devices (testing swabs and ventilators) " On 10 February 2022, the House of Commons Standing Committee on Public Accounts held a hearing on this audit. The Committee directed one recommendation to Health Canada:

Recommendation 3 – Classification of devices

That, by 31 December 2022, Health Canada provide the House of Commons Standing Committee on Public Accounts with a report regarding the classification of respirators including the justification of whether or not they should remain a Class 1 device.

Corrective Actions

In December 2022, Health Canada provided the House of Commons Standing Committee on Public Accounts with a progress report on the classification of respirators, including the justification for both why and why not the respirators should remain a Class 1 device, while providing further context on classification rules for respirators as set out in the Medical Devices Regulations.

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)

2022 Report 9 of the Auditor General of Canada to the Parliament of Canada

Audit of COVID-19 Vaccines

The Office of the Auditor General (OAG) conducted an audit on COVID-19 vaccines. 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:

• Public Services and Procurement Canada provided adequate procurement support to secure vaccines;
• Public Health Agency of Canada and Health Canada efficiently provided access to COVID-19 vaccines; and
• Public Health Agency of Canada and Health Canada's surveillance of the COVID-19 vaccine was effective and timely.

The audit found that overall Public Health Agency of Canada and Health Canada, supported by Public Services and Procurement Canada, responded to the urgent nature of a rapidly evolving coronavirus pandemic by working together to obtain a sufficient number of COVID-19 vaccine doses for provinces and territories to vaccinate everyone living in Canada.

Recommendation:

The OAG recommended that Health Canada and the Public Health Agency of Canada expedite work with provinces and territories to implement the Pan-Canadian Health Data Strategy.

Health Canada's Response:

Health Canada has accepted the recommendation made by the OAG and has prepared an action plan in response. The Department committed to continuing to collaborate with the Public Health Agency of Canada to advance the development and implementation of the Pan-Canadian Health Data Strategy, working with provinces and territories, such as ensuring:

• Infoway completes a draft pan-Canadian interoperability roadmap, detailing steps for confirmation and adoption of standards;
• Ministers endorse the Pan-Canadian Health Data Strategy as a long-term vision for better health data management guided by the Health Data Charter;
• Ministers affirm support for interoperability standards to enable data access and exchange;
• Ministers agree to common aims for supporting jurisdictional approaches to health data access and exchange, including through policy or legislative approaches; and
• Federal, Provincial, and Territorial officials confirm governance, priorities and implementation plans.

The report was tabled on December 9, 2022.

Environmental Petitions Annual Report

The Annual Report of the Commissioner of the Environment and Sustainable Development indicates that 14 petitions, addressing a wide range of issues, were received between July 1, 2021, and June 30, 2022. One of these petitions was directed to Health Canada. Canadians petitioned Health Canada for information regarding their concerns related to perfluoroalkyl and polyfluoroalkyl substances in water, products and waste.

There were no recommendations in this report for Health Canada.

The report was tabled on October 4, 2022.

Response to audits conducted by the Public Service Commission of Canada or the Office of the Commissioner of Official Languages

• There were no recommendations for Health Canada.
• There were no audits in 2022–23 requiring a response.

United Nations 2030 Agenda and the Sustainable Development Goals

Health Canada

The following provides examples of how Health Canada programming supports the Sustainable Development Goals (SDGs) and supplements the information outlined in Health Canada's Departmental Sustainable Development Strategy and in the SDG overview section of the 2022-23 Departmental Results Report.

SDG 3 Ensure healthy lives and promote well-being for all at all ages

2022-23 Results

In 2022-23, with the support of the Government of Canada, three independent organizations, the Standards Council of Canada, Health Standards Organization, and Canadian Standards Association Group developed a set of two complementary and independent long-term care standards. Together, the standards will promote the delivery of safe, reliable, and high-quality long-term care services, as well as safe operating practices and infection prevention and control measures in long-term care homes.

Through the Shared Health Priorities initiative, one-year extensions of the Bilateral Agreements for Home and Community Care and Mental Health and Addiction Services were implemented for 2022-23. Provinces and territories were asked to prioritize the use of federal health funds on initiatives that serve the needs of Indigenous Peoples, and address diversity, equity and the needs of underserved and/or disadvantaged populations. Through these agreements, Health Canada expanded access to care at home and in the community to support those who need care to remain at home as they age, and to reduce reliance on more expensive facility-based infrastructure. For example:

• In British Columbia, palliative patients will have improved access to 24/7 palliative and end-of-life services.
• Rural Manitobans will have better access to enhanced supports for palliative end-of-life care, including more hospice and after-hours access for clients and families.

These agreements also provided funding for provinces and territories to expand access to community-based mental health and substance use services, with a focus on integrating these services with primary care and expanding services for children and youth and for individuals with complex cases. For example:

• Initiatives have sought to increase the number of mental health professionals supporting communities with high needs, as well as to increase cultural competency training for mental health professionals. This included a culturally appropriate suicide risk assessment tool, and supports for individuals, families and communities affected by suicide.
• Community-based services in many jurisdictions are reducing the need for hospital care, including access to peer support, psychological therapies, and flexible assertive community treatment (FACT) teams.

Several provinces and territories are implementing school-based initiatives for children and youth including better early prevention, detection and treatment. These types of measures seek to improve youth awareness of mental health, substance use health and addiction issues, address the stigma associated with seeking support, and foster a willingness to seek help. For example:

• In New Brunswick, supports were prioritized for children and youth with complex mental health needs to receive a more comprehensive range of services under the province's new Network of Excellence program.
• In Saskatchewan, funding was aimed at physicians and primary care providers to receive extra training on mental health conditions for children and youth, and more facilitators will be trained to deliver Mental Health First Aid to the health, education and social service sectors.
• In Nunavut, additional resources have been allocated for child and youth workers to facilitate peer support networks.

Additionally, as a further enhancement to the bilateral agreements, on February 7, 2023, the Government of Canada outlined the Working Together to Improve Health Care for Canadians Plan. The plan invested close to $200 billion over 10 years to improve health care services for people in Canada. It includes $46.2 billion in new funding to provinces and territories, of which $25 billion over ten years will be invested to strengthen Canada's universal public health care system. Results for 2022-23 include an agreement between Health Canada and the provinces and territories to work together on four shared health priorities to improve health care for people in Canada:

• Expanding access to family health services, including in rural and remote areas
• Supporting health workers and reducing backlogs for health services such as surgeries and diagnostics
• Improving access to quality mental health and substance use services
• Modernizing the health care system with standardized health data and digital tools so providers and patients have access to electronic health information.

The Government of Canada also committed to improving how de-identified health information is collected, shared, used and reported, so Canadians can access their own health information and benefit from it being shared between health workers across health settings and across jurisdictions.

This work contributes to advancing Canadian Indicator Framework (CIF) Ambitions:

• Canada prevents causes of premature death.
• Canadians have healthy and satisfying lives.

While decades of evidence-based action by governments of all levels and civil society have significantly decreased smoking rates, tobacco use remains the leading preventable cause of premature death and disease in Canada. Canada's Tobacco Strategy continued efforts to reduce smoking prevalence, including through prevention of uptake of tobacco use by youth and adults, and through helping people who smoke to quit. Scientific research, surveillance, policy and regulatory development, compliance and enforcement activities, public education and outreach contributed to these efforts. For example:

• In June 2022, Health Canada proposed draft regulations to require health warnings on individual cigarettes and on little cigars with tipping paper and tubes (Regulations amending the Tobacco Products Regulations (Plain and Standardized Appearance), Canada Gazette Part I). Canada is the first country to introduce such measures.
• In December 2022, Health Canada launched a tobacco cessation marketing campaign targeting adults between the ages of 35 to 64 to raise awareness and encourage use of the array of resources and supports available to help them quit smoking. The campaign website is Canada.ca/quit-smoking.

This work contributes to advancing Canadian Indicator Framework (CIF) Ambition:

• Canada prevents causes of premature death.

SDG 11 Make cities and human settlements inclusive, safe, resilient and sustainable

2022-23 Results

Air Quality Program

The Air Quality Program continued to support actions to improve air quality and health for all people in Canada by conducting research on the exposure to air pollution and on the health impacts of air pollution; assessing the health risks from air pollutants and pollutant sources; and analyzing the health benefits from actions to improve air quality. This work enables the Program to also contribute to the updates to the Canadian Ambient Air Quality Standards, which drive the continuous improvement of air quality across the country. For example:

• A collaborative research project conducted with First Nations communities in Northwestern Ontario on the impact of housing conditions on Indigenous children produced two research papers in 2022-23, one relating to respiratory disease and one on skin conditions.
• Mould is a common housing problem, and some people are considered to be at greater risk of experiencing adverse health effects from mould exposure, such as infants, children, seniors, pregnant people and those with respiratory conditions such as asthma. Health Canada has produced a Guide to Addressing Moisture and Mould Indoors which includes practical ways to identify, remediate, and prevent moisture and mould issues.
• In 2022-23, the air health trends indicators included among the Canadian Environmental Sustainability Indicators (CESI) were updated. These indicators present trends in risk of hospitalization and death attributable to short-term exposures to ground-level ozone (O₃) and fine particulate matter (PM_2.5). They estimate the likely risk of death or hospitalization that can be attributed to exposure to concentrations of the pollutants in the air and present the change in that risk over time. The trends vary according to pollutant, age, sex and region.

This contributes to Canadian Indicator Framework Ambition:

• Canadians live in healthy, accessible, and sustainable cities and communities.

SDG 12 Responsible Consumption and Production

2022-23 Results

Chemicals Management Plan (CMP)^{Footnote 84}

The CMP continued efforts to protect human health and the environment by reducing risks related to chemicals and substances in air, water, soil, and consumer and industrial products and processes. Key activities included: chemicals risk assessment; chemicals risk management, compliance promotion and enforcement; research, monitoring and surveillance; and collaboration, outreach and engagement. For example:

• The Maternal-Infant Research on Environmental Chemicals (MIREC) Research Platform continued the assessment of prenatal exposure to chemicals and established national estimates of maternal and fetal exposures. In 2022-23, a follow-up study to MIREC called MIREC-ENDO (short for endocrine) entered Phase 2. MIREC-ENDO is studying the effects of prenatal exposure to environmental chemicals on puberty and metabolic function in the child, as well as maternal health.
• Since 2007, nationally representative biomonitoring data have been collected through the Canadian Health Measures Survey (CHMS). The levels of environmental chemicals are reported by age group (3-79 years of age) and sex (separately for males and females) for the Canadian population. In 2022-23 the CHMS started collecting information on the gender identity of respondents and a new vulnerable sub-population (1-2 years of age).

Health Canada continued to support international engagement on chemicals, including advancing the engagement of the health sector in the global chemicals management initiatives through:

• Leading for the Government of Canada in the Strategic Approach to International Chemicals Management (SAICM), as well as in negotiations towards a new, ambitious voluntary instrument for the global sound management of chemicals and waste; and
• Participating in the World Health Organization (WHO) Chemicals and Health Network to advance health ministry capacity building and engagement for implementing chemicals management systems worldwide to prevent disease and injury and protect human health and safety.

Health Canada also provided technical and policy expertise to strengthen international and intersectoral collaboration on environmental determinants of health (including chemicals, air, water and climate change) by:

• Collaborating with the Organisation for Economic Co-operation and Development on chemical safety and biosafety programs and initiatives; and
• Hosting the WHO Collaborating Centre on Environmental Health, which included leading the Government of Canada's contributions to a World Health Assembly resolution on The Impacts of Chemicals, Waste and Pollution on Human Health, to advance WHO and health sector action on public health crises, particularly among the world's most vulnerable.

This contributes to Canadian Indicator Framework Ambition:

• Canadians consume in a sustainable manner.

SDG 13 Take urgent action to combat climate change and its impacts

2022-23 Results

Climate Change Program

The Climate Change Program continued efforts to increase knowledge, capacity and tools on the human health and health systems impacts and adaptation approaches to climate change available to partners across Canada. The Program also continued work aimed at increasing the level of awareness of climate change and health risks (e.g., extreme heat health risks) among people in Canada, including disproportionately impacted populations, and ways to protect themselves and reduce health risks. For example:

• Health Canada led the Health and Wellbeing theme of the Government of Canada's first National Adaptation Strategy (NAS), which establishes a shared vision for climate resilience in Canada. Equity and inclusion are at the center of its goals and guiding principles, underscoring the Strategy's support to promote environmental justice and address the factors that make people more vulnerable to climate change.
• Health Canada continued to lead international climate change and health efforts by collaborating with the WHO and partners. Health Canada co-chaired the working group on Climate Resilient Health Systems for the Alliance on Transformative Action on Climate and Health. The Working Group has a specific focus on building climate resilience and adaptation to current, emerging and future health impacts and threats of climate change globally.
• Health Canada also supported efforts in building sustainable health systems and strengthening climate resilience through the WHO Collaborating Centre on Environmental Health. Health Canada has provided support to the WHO to inform the development of technical publications to respond to countries' requests for technical support.

This work contributes to advancing Canadian Indicator Framework (CIF) Ambition:

• Canadians are well-equipped and resilient to face the effects of climate change.

Up-front multi-year funding

Healthcare Excellence Canada

General information on up-front multi-year funding to Healthcare Excellence Canada

Recipient information

Healthcare Excellence Canada

Start date

1996-97

End date

In perpetuity

Link to department's Program Inventory

Program 1: Health Care Systems Analysis and Policy

Purpose and objectives of transfer payment

The Canadian Health Services Research Foundation was established as an independent organization in 1996-97. To reflect the evolution of its work, the organization was renamed the Canadian Foundation for Healthcare Improvement in 2012 and subsequently amalgamated with the Canadian Patient Safety Institute in 2020-21 to form Healthcare Excellence Canada (HEC).

In 2022-23, HEC fulfilled the mandate of both of organizations to find and promote innovators and innovations, drive rapid adoption and spread of quality and safety innovations, and build capacities to enable excellence in healthcare and catalyze policy change. HEC focused its efforts on three areas: re-imagining care with - and for - older adults with health and social needs; care closer to home and community with safe transitions; and, pandemic recovery and health system resilience:

• 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 has been delivered through contribution funding rather than upfront, multi-year funding.

Audit findings by the recipient during the reporting year, and future plan

CFHI and now HEC's financial records are reviewed and audited annually by independent external auditors. Independent external auditors will continue to perform audits on an annual basis.

Evaluation findings by the recipient during the reporting year, and future plan

HEC pursues ongoing internal evaluative and measurement work of its activities and reports its results through its website and annual reports. It also undertook an independent 5-year corporate evaluation for the period from 2014 to 2019, in 2019-20 to examine the relevance, effectiveness and efficiency of its work. The results were released in late 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 it 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

HEC's strategy focuses on: finding innovators and promoting, driving rapid, and spread of quality and safe innovations, building capacity to enable excellence in healthcare and catalyzing policy change. It will release an annual report covering 2022-23 in Fall 2023, which will include the first full reporting of its performance management framework, now that baselines have been set.

Similar to its predecessor organizations, HEC has held the remaining up-front multi-year funding in reserve to address potential staffing and pension liability costs. There are no new results associated with the up-front multi-year funding to report for 2022-23.

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 on up-front multi-year funding to Canada Health Infoway

Recipient information

Canada Health Infoway (Infoway)

Start date

March 31, 2001^{Footnote 85}

End date

March 31, 2015^{Footnote 86}

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 (fully expended); and $500 million in 2010 to support continued implementation of EHRs, implementation of electronic medical records in physicians' offices, and integration of points of service with the EHR system (fully expended). 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 the reporting year, and future plan

The annual independent financial and compliance audits were conducted during the year and resulted in unqualified audit reports. There were no other audits scheduled or conducted during the year.

Evaluation findings by the recipient during the reporting year, and future plan

Infoway pursues ongoing internal evaluative and measurement work of its activities and reports its results through its website and annual reports which are typically released in July.

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 advanced initiatives such as procuring national digital health solutions, 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, developing and publishing 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 forum supports knowledge exchange about security, as well as approaches for enabling secure interoperability and data sharing.
• Released the interoperability roadmap in March 2023.

In regard to virtual care and digital health, Infoway:

• Continued support all jurisdictions in advancing their digital health priorities through investments designed to accelerate the implementation of technologies such as virtual care and additional tools to support clinicians; 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.
• Supported jurisdictions by streamlining procurement of digital health solutions 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;
• Collaborated with Healthcare Excellence Canada to develop a Clinician Change Virtual Care Toolkit to support care providers in implementing and using 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.
• Achieved key deliverable under the Working Together to Improve Plan.

Total funding approved (dollars)

2,100,000,000

Total funding received (dollars)

2,093,398,112^{Footnote 87}

Financial Information (dollars)