Public Health Agency of Canada 2012–13 Departmental Performance Report

Section II: Analysis of Programs and Sub-Programs by Strategic Outcome

Strategic Outcome

Social, economic, environmental, behavioural, and genetic factors have a major impact on the health and overall life expectancy of the population. Standard (or ordinary) life expectancy is the average number of years a person would be expected to live, starting at birth. In comparison, HALE is a summary measure of the average number of years that an individual is expected to live in a healthy state (i.e., it combines both quantity of life and quality of life). As such, HALE provides a better measure of the burden of disease and injury in the population—and how risk factors impact this burden—and can provide insight into the performance of public health efforts and/or where future efforts should be placed. Furthermore, HALE is a promising but relatively new indicator^{Footnote 3} with room for future methodological research and development.

In 2012–13, the Agency published the Health-Adjusted Life Expectancy in Canada: 2012 Report by the Public Health Agency of Canada, which found that chronic diseases and conditions such as diabetes, cancers and hypertension are associated with a significant loss in HALE. The Report also reviewed research evidence that shows Canadians have been experiencing continuing increases in life expectancy and in HALE. While the reasons for this increase are unknown, research suggests that decreases in the rates of cancer and heart disease due to improvements in the health care system and in chronic disease interventions could have played a role.

The Agency’s programs—undertaken in collaboration with F/P/T governments^{Footnote 4}, academia, non-governmental organizations, and international health partners—provide leadership and support in promoting health, reducing health inequalities, enhancing public health capacity, preventing and mitigating injuries and chronic and infectious diseases, providing relevant research support, monitoring health and disease situations and trends, and reducing the risk and consequences of public health events. Better knowledge about the nature and extent of inequalities in health due to socio-economic status and the presence of chronic diseases can help to guide efforts toward reducing those inequalities between corresponding subpopulations. This knowledge is crucial to inform the development and delivery of public health programs and policies that impact the general population, as well as certain vulnerable populations.

Program 1.1: Public Health Infrastructure

Description: This Program strengthens Canada’s public health workforce capability, information exchange, federal/provincial/territorial networks, and scientific capacity. These infrastructure elements are necessary to support effective public health practice and decision-making in Canada. Working with federal, provincial and territorial stakeholders and within existing collaborative mechanisms, the Program supports planning for and building consensus on strategic and targeted investments in public health infrastructure, including training, tools, best practices, standards, and mechanisms to facilitate information exchange and coordinated action. Public health laboratories provide leadership in research, technical innovation and reference laboratory services; surveillance; outbreak response capacity; and national laboratory coordination. Through these capacity-building mechanisms and scientific expertise, the Government of Canada facilitates effective coordination and timely public health interventions which are essential to having an integrated and evidence-based national public health system. Key stakeholders include local, regional, provincial and national public health organizations, practitioners and policy makers, researchers and academics, professional associations and non-governmental organizations.

The variance between Planned and Actual Spending is primarily due to payments required under the International Health Grants Program and assessed contribution to the Pan American Health Organization that were transferred from HC to the Agency.

Performance Analysis and Lessons Learned

In June 2012, Canada met the WHO-recommended Capability Level 2 International Health Regulations (IHR) obligations by attaining basic surveillance and response capacities at designated airports, ports and certain ground-level border crossings. The Agency continued to enhance IHR core capacities by collaborating with F/P/T in developing a Pan-Canadian National Action Plan that could help Canada attain a Capability Level 3.

As the only Canadian public health institution with laboratories accredited to both the ISO 17025 and ISO 15189 standards, the Agency continued to perform to the highest quality standards in laboratory operations in support of its unique federal role to augment national public health capacity and increase Canada’s preparedness to identify and respond to infectious disease threats. For instance, during 2012–13, the Agency provided its partners with positive controls to support Influenza A diagnostic testing; developed advanced analysis methods; and offered laboratory quality management training to international partners.

In addition, the Agency provided ongoing support for a tuberculosis outbreak in Nunavut as well as identified an emerging strain of Cache Valley virus, a pathogen that can be carried and transmitted by mosquitoes. Agency scientists also analyzed genetic traits in a group of sex workers who are resistant to HIV-1 infection. This resulted in the identification of a novel genetic marker which may impact the susceptibility to HIV-1 infection.

The Agency advanced cutting-edge development and use of bioinformatics and genomics for improved pathogen detection, discovery of antimicrobial resistance, and outbreak investigation. This ongoing work led to better understanding of disease transmission, improved timeliness of response, and enhancements in tracking outbreaks.

In its international role, the Agency provided input and technical expertise for a number of initiatives, including a WHO collaborative study to establish the first international standard for Hepatitis B e Antigen. Agency scientists also provided technical support and advice to the HIV Vaccine Trials Network and the Microbicide Trials Network.

Sub-Program 1.1.1: Public Health Capacity Building

Description: The Public Health Capacity Program contributes to the development and maintenance of a Canadian public health workforce which has the depth and capability to respond to public health issues and requirements at any time. Working with federal, provincial and territorial partners and stakeholders, the Program provides training and support to public health professionals to support this group to carry out core functions and respond effectively and cooperatively to public health events. The Program takes a leadership role in: developing strategies for public health human resources; identifying core competencies required for public health workforce; offering training for public health practitioners to be able to carry out core public health functions; strengthening national capacity to quickly respond to disease outbreaks and public health events; and providing funding to academia to strengthen and advance research and innovative methods in public health.

Performance Analysis and Lessons Learned

Through the hiring and placement of six field epidemiologists and 20 public health officers across Canada, the Agency increased public health capacity, including in the North. Public health host organizations expressed a high level of satisfaction that these placements contributed to their capacity to respond to public health events. Furthermore, the Agency assisted in the management of public health events domestically and internationally by placing and mobilizing its staff to respond to emergency requests for assistance from public health partners. These requests helped the Agency to better understand and build the skills and competencies required when mobilizing public health professionals. This learning will assist the Agency in devising a more comprehensive competency-based strategy and training opportunities to further enhance public health capacity.

The Agency played a key role in enhancing public health partners’ competencies and capabilities by offering 10 facilitated and two non-facilitated modules in public health in both official languages. Over 1,850 public health practitioners, including 70 from the North, enrolled in these modules. Participant feedback highlighted the need for new training modules on International Health Regulations, Introduction to Public Health, Core Competency Toolkit, and Program Evaluation. The Agency also developed and delivered specialized public health training to public health officers, field epidemiologists, partners, and stakeholders across the country. Participant feedback from this training was also very positive.

Sub-Program 1.1.2: Public Health Information and Networks

Description: The Public Health Information and Networks Program facilitates federal, provincial, and territorial coordination and collaboration, and establishes core structures to facilitate access to accurate and reliable information, tools and models required by Canadian public health professionals to perform their public health duties effectively. Working with federal, provincial and territorial partners through the Public Health Network, the Program provides leadership by consulting and undertaking collaborative planning for public health strategies and addressing issues affecting the sharing of information for effective surveillance and action. The Program also invests in tools and processes to allow public health practice and core public health functions to be informed by evidence and applied knowledge; develops scenarios for population and public health research; and prepares models for economic analysis to support effective decision making.

Actual Spending was $8.9M higher than Planned Spending mainly due to payments required under the International Health Grants Program, including an assessed contribution to the Pan American Health Organization (PAHO) that moved from HC to the Agency.

Performance Analysis and Lessons Learned

The Agency continued to work with P/T governments to develop a multi-lateral information sharing agreement to facilitate access to data and information, and is on track to meet its target of four jurisdictions signing by December 2014.

To increase access to public health data and information, the Agency developed the PHAC Surveillance Strategic Plan 2013-2016 to renew the planning, alignment, and delivery of the Agency’s public health surveillance activities. The plan includes concrete actions to address recommendations from the Evaluation of the Surveillance Function at the Public Health Agency of Canada which indicated that the Agency should take a more strategic approach to public health surveillance. The recommendations included: assuming a lead role in developing a shared F/P/T vision for public health surveillance function in Canada; establishing a formal mechanism and criteria to identify relative priorities for surveillance investments; and developing a more strategic approach to the approval and dissemination of surveillance products and information.

The Agency engaged public health organizations through the Public Health Network work plan which provided concrete, prioritized deliverables based on: appropriateness for F/P/T collaboration, rationale, alignment with ministerial and deputy ministerial direction, likelihood of success, and time and resources (required and already invested). Through such prioritization, collaborative initiatives/projects were delivered on time.

To provide access to information, the Agency produced the CPHO’s Report on the State of Public Health in Canada – 2012 which explored the influence of sex (i.e., biological characteristics) and gender (i.e., socio-cultural factors) on public health and the health status of Canadians. An online survey indicated that 87% of respondents reported had used (or were intending to use) the report: to support research papers/articles and presentations; as a reference document for general knowledge about sex and gender; for statistical data in presentations, research papers/articles; and to inform discussions or approaches to policy/programming.

Sub-Program 1.1.3: Public Health Laboratory Systems

Description: The Public Health Laboratory Systems Program is a national resource providing Canada with a wide range of highly specialized scientific and laboratory expertise and access to state of the art technologies. The Program informs public health professionals at all levels of government to enable evidence-based decision making in the management of and response to diseases and their risk factors. The Program conducts public health research; uses innovative approaches to advance laboratory science; performs reference laboratory services; contributes to public health surveillance; provides outbreak response capacity; and leads national public health laboratory coordination. The Program also addresses public health risk factors arising from human, animal and environmental interactions by conducting research, surveillance and population risk analysis. These combined efforts work to inform infectious and chronic disease-specific strategies and prevention initiatives. The knowledge generated and translated by the Program supports the development and implementation of national and international public health policies, guidelines, interventions, decisions and action that contribute to the lifelong health of the population.

The variance between Planned and Actual Spending is primarily due to new funding received for the operating and capital budget carry forward as well as the renewal of funding to enhance the Agency’s ability to prevent, detect and respond to outbreaks of food-borne illness.

Performance Analysis and Lessons Learned

The Agency’s PulseNet Canada team led the national laboratory response to the outbreak of E. coli O157:H7 infections associated with beef products during 2012–13. There were 18 cases identified from four provinces, and the investigation led to the recall of products nationwide. Agency scientists also developed new methods for the detection and isolation of E.coli O157 and non-O157 in agricultural waters.

The Agency developed a comprehensive online training course for laboratory partners, including P/Ts, on DNA fingerprinting for food-borne disease surveillance and outbreak response. The course will provide an efficient complement to one-on-one training for maintaining and further expanding F/P/T laboratories’ on-site capabilities.

As the WHO-designated National Influenza Centre in Canada, the Agency collaborated with the WHO, the United States (U.S.) Centers for Disease Control and Prevention, and provincial partners to conduct national surveillance on seasonal influenza viruses. These surveillance activities included monitoring influenza activities, determining drug susceptibility, and detecting and describing changes to the circulating strains of influenza virus in Canada. Such surveillance information is vital for developing influenza prevention and treatment strategies for annual epidemics as well as pandemics.

Agency scientists continued to play a significant role in supporting research projects through the Genomics Research and Development Initiative (GRDI). As part of the GRDI, the Food and Water Safety Genomic Research and Development Initiative brought together federal expertise to address common concerns regarding two priority foodborne pathogens that represent serious risks to human health and negatively influenced agri-environmental regulations and trade.

Program 1.2: Health Promotion and Disease Prevention

Description: This Program aims to promote better overall health of the population—with additional focus on those that are most vulnerable—by promoting healthy development among children, adults and seniors, reducing health inequalities, and preventing and controlling chronic and infectious diseases. Working in collaboration with provinces and territories, the Program develops and implements federal aspects of frameworks and strategies (e.g., Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights, national approaches to addressing immunization, HIV/AIDS) geared toward promoting health and preventing disease. The Program undertakes common primary public health functions of health promotion, surveillance, science and research on diseases and associated risk and protective factors to inform evidence-based frameworks, strategies, and interventions. It also undertakes health promotion and prevention initiatives, working with stakeholders to prevent and mitigate chronic disease and injury, and to help prevent and control infectious disease.

The variance of $17.5M between Planned and Actual Spending is mainly due to implementation of savings achieved through reduced spending on management and administration, travel, and professional services as well as administrative efficiencies in delivering grants and contributions programs.

Actual FTEs were 56 fewer than Planned mainly due to implementation of savings achieved through reduced spending on management and administration, travel, and professional services as well as administrative efficiencies in delivering grants and contributions programs.

Performance Analysis and Lessons Learned

In collaboration with the National Advisory Committee on Immunization, the Agency launched an evergreen, online edition of the Canadian Immunization Guide that includes 21 new or updated chapters. The Guide has been an authoritative source for health professionals seeking information and recommendations on the use of vaccines since 1979.

Updated information on HIV transmission was published in 2012, and technical support was provided to researchers. Community organizations used the Agency’s Population-Specific HIV/AIDS Status Report: People from Countries where HIV is Endemic to train stakeholders. This document informed discussions at the 2012 International AIDS Conference. The Agency was able to advance disease and population-specific enhanced behavioural surveillance work on a pilot study of Aboriginal Peoples in the Regina area and phase one study focusing on persons originating from HIV endemic countries.

In support of disease prevention and mitigation, the Agency participated in the global process that led to the WHO Global Monitoring Framework and the 2013-2020 Global Action Plan for Noncommunicable Diseases. The Action Plan guides efforts to scale up prevention of the four leading non-communicable diseases in order to achieve nine voluntary global targets by 2025.

Aligned with international objectives, the Agency continued collaborating with provinces and territories under Curbing Childhood Obesity: A Federal/Provincial/Territorial Framework to Promote Healthy Weights, including establishing indicators for childhood obesity trends and determinants that will support progress reporting on this significant public health issue. Completion of the Indicator Framework for the Surveillance of Chronic Diseases and Associated Determinants in Canada also contributed to systematic analysis and reporting of trends in risk factors and health outcomes.

The Agency worked with domestic public health stakeholders to develop targeted information including immunization guidance, behavioural and other risk factor research and surveillance, and program evaluations that identify effective interventions, in order to reduce the rates of AIDS/HIV, Tuberculosis (TB) and Hepatitis B and C. Where rates are not declining, and where there are indications of increased risk for disease, additional research and knowledge exchange activities were identified, so future public health efforts can be focussed in areas where the impact on disease rates and risk factors is greatest (e.g., among specific populations; using more integrated approaches; and technical innovation)

Sub-Program 1.2.1: Infectious Disease Prevention and Control

Description: The Infectious Disease Prevention and Control Program is the national focal point for efforts to help prevent, mitigate and control the spread and impact of infectious diseases in Canada. The Program provides leadership for integrating activities related to surveillance, laboratory science, epidemiology, research, promotion, modeling, intervention and prevention, including immunization. Applying an evidence-based approach, the Program informs targeted prevention and control initiatives for many infectious disease threats including acute respiratory and vaccine preventable infections (e.g., influenza, measles), sexually transmitted and bloodborne infections (e.g., Hepatitis B and C, HIV), hospital associated infections (e.g., C. difficile), and human diseases resulting from environmental exposures to food, water, animals and other vectors (e.g., Listeria, E.coli O157, West Nile virus). This Program reinforces efforts to protect the health and well-being of Canada’s population, reduces the economic burden of infectious disease and provides expert advice to federal, provincial and territorial partners and stakeholders. The knowledge generated and translated by this Program influences and enables the development and implementation of public health policies, guidelines, interventions and action—including those required to meet Canada’s International Health Regulations obligations—and helps to guide the population in their decisions regarding their personal health and that of their families.

Actual Spending was $2.0M greater than Planned Spending primarily due to the renewal of funding to enhance the Agency’s ability to prevent, detect and respond to outbreaks of food-borne illness.

Performance Analysis and Lessons Learned

Two emerging pathogens were detected in ticks across in several regions in Canada using new testing methods as part of the Agency’s tick surveillance program. Although the spectrum of disease caused by these bacteria is not fully understood, these discoveries highlight that ticks are transmitters of a variety of disease-causing pathogens in addition to the agent of Lyme disease, and demonstrate the utility of ongoing tick surveillance programs.

In collaboration with P/Ts, the Agency developed Guidance for Tuberculosis Prevention and Control Programs in Canada (PDF document) to provide decision-makers, program planners, public health practitioners, and health care providers with a comprehensive collection of best practices. While the Evaluation of Community Associated Infections Prevention and Control Activities recognized the work of the Agency in supporting efforts to reduce the rates of TB and other infections, further efforts will be required in the future.

The Agency provided leadership to support new approaches to vaccine innovation and development to meet evolving public health needs. This included convening a workshop on vaccine research, development and innovation with federal partners and external stakeholders to assess current capacity to leverage relevant scientific and technical advances.

In addition, the Agency initiated a pilot project to demonstrate and assess potential approaches to common guidance for vaccine use in Canada. Common-vaccine guidance would improve coordination and implementation of program schedules that help ensure timely, consistent and equitable coverage for intended populations nation-wide.

To provide up-to-date information to public health practitioners, the Agency released revised infection prevention and control guidelines and practices for acute care settings and long-term care facilities. In addition, a Web-enabled outbreak communications platform, Outbreak Central, was developed to facilitate the coordination and information sharing during food-borne and other outbreak investigations. The Evaluation of Food-borne Enteric Illness Prevention, Detection and Response Activities found a need for better understanding of the role of activities that aim to predict and prevent bacteria emergence before becoming a risk to humans. The Agency will seek to better align its science and research to inform federal food safety partners in the prevention of food-borne illness.

The Agency supported the FSDS and the implementation of its Departmental Sustainable Development Strategy. The Agency contributed to the FSDS Theme I: Addressing Climate Change and Air Quality through the 2011–2016 Preventative Public Health Systems and Adaptation to Climate Change programs.

Sub-Program 1.2.2: Conditions for Healthy Living

Description: The Conditions for Healthy Living Program improves health outcomes for Canada’s population throughout their lives by promoting positive mental, social, and physical development, and by enabling the development of healthy communities. Population-wide health promotion efforts that respond to the needs of vulnerable and at-risk populations have been shown to improve health outcomes, especially in circumstances where poor social, physical or economic living conditions exist. The Program establishes a positive trajectory for health outcomes in early childhood, sustains healthy living conditions into youth and adolescence and builds individual and community capacity to support healthy transitions into later life. In collaboration with provinces, territories and stakeholders, and individuals directly impacted by a condition or disease the Program advances priorities and initiatives to promote healthy development. It also develops, tests, and implements evidence-based interventions and initiatives that can lead to positive changes in behaviour for those facing socially challenging circumstances (e.g., family violence, poor mental health, injuries, communicable infections, and social isolation). Finally, the Program exchanges evidence-based knowledge to inform public health policies, practices and programs, and helps to build community capacity.

Variance between Planned and Actual Spending is mainly due to implementation of savings achieved through reduced spending on management and administration, travel, and professional services as well as administrative efficiencies in delivering grants and contributions programs.

Performance Analysis and Lessons Learned

The Agency builds on lessons learned from projects funded through the Innovation Strategy. This intervention research program selects the most promising projects and further invests in their implementation, evaluation and knowledge sharing. For example, 20 out of 52 projects from a first phase received funding to continue work in a second phase focused on improving mental well-being and achieving healthier weights.

The 2011 CAPC National Study indicated that CAPC projects are reaching the intended vulnerable population, increasing social support networks, and effectively linking participants to other services. A positive association was found between the CAPC and emotional wellbeing and positive child behaviour.

Results from the Evaluation of the AHSUNC show a significant improvement in participating children’s school readiness skills (i.e., motor skills, language skills, and academic skills). Performance results demonstrated effectiveness in improving cultural literacy and in enhancing exposure to Aboriginal languages and cultures, as well as positive effects on health promoting behaviours such as children’s access to daily physical activity and to health services.

The Agency developed the Age-Friendly Communities in Canada: Community Implementation Guide to help communities start up, implement, and evaluate their own age-friendly initiatives. The Agency also prepared a Mental Health Impact Assessment tool that takes into account the potential effects that a policy or program proposal may have on the mental health of its target population, and tested messages to raise awareness about positive mental health and well-being amongst Canadians aged 16 and older.

To support health promotion and disease prevention in Canada’s territories, a contribution agreement was signed with Nunavut under the Northern Wellness Approach to address sexual health-related priorities identified in Nunavut’s Public Health Strategy and healthy living and disease prevention objectives. All territorial recipients began using a new performance measurement tool, which replaced previous evaluation tools that were found to be time consuming for project staff and duplicative for projects which accessed funds from multiple Agency programs. The new tool addresses these identified issues and the burden on small communities by enabling the collection of information for all programs in one document.

Sub-Program 1.2.3: Chronic (non-communicable) Disease and Injury Prevention

Description: The Chronic (non-communicable) Disease and Injury Prevention Program mobilizes and supports government and non-governmental organizations at national, P/T and local levels, and collaborates with international/national multi-sectoral stakeholders in designing, evaluating and identifying best practices, with the goal that policies and Programs support healthy living, decrease chronic disease rates and reduce the impact of these diseases on Canada’s population. This is necessary because two in five persons in Canada are living with a chronic disease (e.g., diabetes, cancer, cardiovascular disease, lung diseases) and four in five are experiencing at least one risk factor for chronic disease such as physical inactivity, overweight, or obesity. This Program works to track injuries, chronic diseases, their risk factors and related inequalities, and analyses the risks to public health, and determines priorities for action. It also identifies what works in chronic disease prevention and mitigation, according to scientific criteria, and disseminates these approaches widely to increase the use of effective interventions. Finally, it facilitates collaboration among stakeholders to increase the efficiency and effectiveness of chronic disease prevention and mitigation. Program activities are geared toward developing a coherent national approach to chronic disease prevention and mitigation with stakeholders and partners, which will reduce the impact of chronic diseases for persons living in Canada and the health care system.

Variance between Planned and Actual Spending is mainly due to implementation of savings achieved through reduced spending on management and administration, travel, and professional services as well as administrative efficiencies in delivering grants and contributions programs.

Performance Analysis and Lessons Learned

To better leverage its resources for chronic disease prevention, the Agency established a new funding model to promote innovative, multi-sectoral collaborations and maximize their impact on health outcomes. A collaboration with AIR MILES for Social Change and the YMCA was established to encourage children and their families to get active and stay active over the long term. As well, the Agency supported the expansion of the Get BUSY program which focuses on healthy eating and physical activity among children in the after-school time period with the Boys and Girls Clubs of Canada and Sun Life Financial.

The Agency continued to strengthen the evidence to support chronic disease prevention. Scientific support was provided to the independent Canadian Task Force on Preventive Health Care for the development of clinical practice guidelines on diabetes, hypertension and cervical cancer screening. The Agency also collaborated on the development of the “Prevention in Hand” Web site, which provides health care practitioners with tools to support healthy behaviours among their patients. Furthermore, the Agency completed projects to address information gaps as part of the National Population Health Study of Neurological Conditions and began work on the synthesis report of the results from these projects.

The Agency began working with P/Ts to facilitate data sharing and data quality assessments for the Canadian Congenital Anomalies Surveillance System in addition to working with P/Ts on key aspects of the Autism Spectrum Disorders Surveillance System.

The Agency expanded the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) to two new hospitals, for a total of 17 and started converting CHIRPP to an electronic format to provide timely information on children’s injuries, risk factors, and an early warning system to monitor consumer product hazards. Progress on injury prevention was made through the Lifesaving Society and Canadian Red Cross campaign in 268 communities to prevent drowning in open waters as well as the training of 66 new instructors for the CAN-BIKE safe cycling course.

Program 1.3: Health Security

Description: This Program takes an all hazards approach to the health security of Canada’s population, which provides the GC with the ability to prepare for and respond to public health issues and events. This Program seeks to bolster the resiliency of the population and communities, thereby enhancing the ability to cope and respond. To accomplish this, its main methods of intervention include actions taken through partnerships with key jurisdictions and international partners. These actions are carried out through the implementation and maintenance of International Health Regulations and through the administration and enforcement of legislation, including the Emergency Management Act, the Quarantine Act, the Human Pathogens and Toxins Act and the Human Pathogens Importation Regulations.

The variance of $2.6M between Planned and Actual Spending is mostly due to lower spending for the pandemic vaccine fill-line and lower orders received from provinces and territories for the NAS, offset by additional purchases for the National Emergency Stockpile System (NESS).

Performance Analysis and Lessons Learned

The Agency’s emergency operations infrastructure supported and facilitated emergency/event operations through the 24/7 Watch Office Program and the Global Public Health Intelligence Network. As the IHR’s National Focal Point Office, the Agency links Canada with the WHO/Pan American Health Organization and public health authorities around the world.

The Canada-U.S. cooperation plan under the Health Security Task Force of the Beyond the Border Initiative is in the final stages of negotiation with U.S. partners. Through the Beyond the Border Initiative, Canada is able to reduce the impacts of shared health security risks through expanded bilateral collaboration with the U.S. to advance North American biosecurity and pathogen control.

Collaborative activities with F/P/T and international partners proved to be an important approach to advancing Canada’s health and security agenda, and strengthened the Canada's capacities to detect, assess, notify and respond to public health risks and emergencies of national and international concern as specified in the IHR.

Sub-Program 1.3.1: Emergency Preparedness and Response

Description: The Emergency Preparedness and Response Program is the central coordinating point among federal, provincial, territorial and non-governmental public health partners. The Program is also responsible for strengthening the nation’s capacity to help prevent, mitigate, prepare and respond to public health emergencies. In order to meet these goals, the Program’s interventions include emergency preparedness, emergency planning, training and exercises, ongoing situational awareness and risk assessment, maintenance of a Health Portfolio Emergency Operations Centre, coordination of inter-jurisdictional mutual aid, deployment of surge capacity to provinces and territories, and deployment of Microbiological Emergency Response Teams and associated mobile laboratories. The Program seeks to protect all persons living in Canada and provides surge capacity to provinces and territories and fulfills Canada’s international obligations for outbreak events, such as infectious disease, pandemic influenza and bioterrorism. In addition, it coordinates response to national or manmade disasters and preparedness for mass gathering and high profile events. The Program supports the continued implementation of the Emergency Management Act and International Health Regulations, and it also makes a significant contribution to the Beyond the Border Initiatives and to the North American Plan for Animal and Pandemic Influenza.

Performance Analysis and Lessons Learned

The Agency worked through the Health Portfolio’s Emergency Preparedness Committee to develop and implement a Health Portfolio Public Health Emergency Risk Assessment which forms an appendix to the Health Portfolio Strategic Emergency Management Plan (HP SEMP). This Plan articulates roles and responsibilities related to situational awareness, risk assessment, planning, and training for the advancement of emergency management in Canada. In addition, the Health Portfolio Emergency Response Plan was revised to reflect changes at both the governance and operational levels.

Focusing on potential bioterrorism threats/risks, the Agency developed an all-hazards threat and risk assessment tool with the Health Portfolio that supports the Global Health Security Initiative Threat and Risk Assessment. The assessment tool was shared with key stakeholders and will be discussed as part of Beyond the Border deliverables with the U.S.

The Operational Framework for Mutual Aid Response for use during emergencies was tested and validated through a series of table top exercises. The framework supports the 2009 F/P/T Memorandum of Understanding on the provision of mutual aid in relation to health resources during an emergency affecting the health of the public.

In response to the Evaluation of the National Emergency Stockpile System (NESS) and other reviews, the Agency continued to modernize the NESS through the implementation of an inventory management system, the introduction of risk-informed and evidence-based asset acquisition and disposal processes, and the development of a comprehensive policy management frame.

In collaboration with P/Ts, the Agency prepared the Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector which incorporated a risk management approach and pandemic planning scenarios. This document helps to address the recommendations from the Senate Committee Report on Canada’s Response to the 2009 H1N1 Influenza Pandemic and the Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic to make the CPIP more flexible and responsive.

Sub-Program 1.3.2: Border Health Security

Description: The Border Health Security Program builds and maintains the health security of the Canadian population by implementing public health measures across borders. The Program includes communicable disease control and environmental health services activities to help maintain public health and provide information to international travellers. This is done by helping to prevent the introduction of communicable diseases into or from Canada. This Program administers and enforces the Quarantine Act as it relates to international travelers and conveyances arriving in or departing from Canada. The issuance of Ship Sanitation Certificates to international vessels, the implementation of passenger terminal and passenger transportation inspection Programs (conveyances), and responding to passenger conveyance gastrointestinal disease outbreaks also help to prevent the introduction and spread of communicable diseases. The Border Health Security Program promotes coordinated border health measures by creating linkages between key border departments and agencies, including the Canadian Border Services Agency, Royal Canadian Mounted Police, and the Canadian Food Inspection Agency.

Performance Analysis and Lessons Learned

The Agency maintained 24/7 capacity to respond to potential quarantine events at border sites, supporting Canada’s commitment to IHRs. In addition, the Agency worked with local partners to support education and training on roles and responsibilities under the Quarantine Act to improve clarity about the roles of the Agency, the Canada Border Services Agency, emergency responders, as well as local, provincial and territorial health authorities.

To reduce the risk of communicable disease importation and exportation by humans, conveyances, and cargo, the Agency prepared for the integration of HC’s Travelling Public program with the Agency’s Quarantine program as of April 1, 2013. This integration will enhance Canada’s capacity at the border to detect and respond to health risks through streamlined services for stakeholders.

Sub-Program 1.3.3: Biosecurity

Description: The Biosecurity Program is responsible for administration and enforcement activities related to the use and manipulation of human, terrestrial animal pathogens, and toxins. This Program has specific responsibility under the Human Pathogens and Toxins Act and the Human Pathogens Importation Regulations, and select sections of the Health of Animals Act to promote and enforce safe and secure biosafety practices and laboratory environments. The Program’s main methods of intervention include the issuance of import permits, laboratory inspections, lab certification and verification, education through the provision of knowledge products and training, and compliance and enforcement activities. Researchers, industries, hospitals and laboratories that handle pathogens and toxins are provided with regulatory oversight—including laboratory certification, inspection, guidance and the issue of importation permits. This Program further contributes to the health security of the population by mitigating risks posed by pathogen misuse such as a deliberate release or the intentional production of bioterrorism agents.

Performance Analysis and Lessons Learned

The programs of the Canadian Food Inspection Agency (CFIA) and the Agency that issue pathogen import permits, certify laboratories handling animal and human pathogens, and provide guidance on biosafety and bio-containment, were consolidated to eliminate regulatory duplication and administrative burden on stakeholders while continuing to protect the health and safety of Canadians. In collaboration with the CFIA, the Agency completed the Canadian Biosafety Standards and Guidelines (CBSG). This document is the first joint human and animal bio-containment standard in the world. The CBSG represents a significant achievement for the Agency as it forms the biosafety foundation for the entire Human Pathogens and Toxins Act (HPTA) initiative and much of the program and regulatory framework.

In keeping with the Agency’s improved service delivery to its regulated parties, Online Smart Forms (PDF document - 810 KB - 3 pages) were launched for import permit applications to reduce the administrative burden, increase the accuracy of submissions, and support improved turnaround times.

The Agency has continued to make significant progress on the design and development of the program and regulatory framework for the HPTA. In March 2013, cross-Canada consultations and engagement were launched to challenge and test specific ideas and options prior to drafting policy instruments and implementing key program elements. The Agency has also made progress in establishing a process for the rigorous analysis of this eventual program and regulatory framework. Notably, a Privacy Impact Assessment of the existing program will be used to address concerns and issues throughout the regulatory design process. Finally, international partners have been engaged with a view to establishing a strong scientific foundation for any proposed containment requirements.

Face-to-face consultations with stakeholders in support of the HPTA Program and Regulatory Framework development generated collateral benefits by enabling the Agency to identify what worked well and what may need improvement to identify evolving trends amongst stakeholder groups and specific needs they may have to address. This information will inform the HPTA Program and Regulatory Framework as well as program delivery.

Program 2.1: Internal Services

Description: This Program supports the Agency’s strategic outcome and all of its Programs. Internal Services are groups of related activities and resources that are administered to support the needs of Programs and other corporate obligations of an organization. These groups are Management and Oversight Services, Communications Services, Legal Services, Human Resources Management Services, Financial Management Services, Information Management Services, Information Technology Services, Real Property Services, Materiel Services, Acquisition Services, and Travel and Other Administrative Services. Internal Services include only those activities and resources that apply across the Agency and not those provided specifically to a Program.

The variance between Planned and Actual Spending is due to the spending of revenues authorities received for the SSP.

The variance between Planned and Actual FTE utilization is mainly due to the transfer of various programs between HC and the Agency as part of the SSP.

Performance Analysis and Lessons Learned

The Agency consistently worked to provide Canadians with information to promote healthy living and to protect from diseases such as diabetes, E. coli infection, and influenza, among others. Working with P/T and international partners and stakeholders to promote public health activities and share information pertaining to emerging events has also been a key focus. Protocols for Health Emergency Risk Communications were revised in concert with the revision of the Health Portfolio Emergency Response Plan.

In 2012–13, due to the large number of total requests (17% increase from the previous year), and the complexity of the files received, the Agency fell short of the 95% access to information and privacy targets. This increased workload is part of a trend that has seen a 65% increase in requests over the past five years. The Agency has undertaken a number of activities to increase its compliance with legislative timelines outlined in the acts, including the establishment of a shared service with HC and procurement of a new case management and imaging system. Communication and information sharing are key to the success of the transition to a shared services model as well as supporting a learning and innovative environment to achieve results in line with organizational goals.

The Agency took a proactive approach on diversity and employment equity by preparing a progress report on the 2011-12 Diversity and Employment Plan and also began consultations for the new 2013-2016 Multi-Year Diversity and Employment Plan for the Agency and HC. Agency employees were also encouraged to join various employee networks to provide a voice and support to Visible Minorities, Aboriginal Peoples, and Persons with Disabilities.

The Agency is a participant in the FSDS and contributes to the Greening Government Operations targets through the Internal Services Program. The Agency contributes to the following target areas of Theme IV of the FSDS:

• Green Buildings;
• Surplus Electronic and Electrical Equipment;
• Printing Unit Reduction;
• Paper Consumption;
• Green Meetings; and
• Green Procurement.

For additional details on the Agency’s Greening Government Operations activities, please refer to Section III: Supplementary Information Tables found on the Agency’s Web site.