Chapter 1: The Chief Public Health Officer's Report on the State of Public Health in Canada 2011 – Introduction

Chapter 1: Introduction

This report, the Chief Public Health Officer's (CPHO) fourth on the state of public health in Canada, examines the state of health and well-being of Canada's youth and young adults while looking at key transitional periods during the lifecourse. It describes persistent or worsening health issues while looking at the specific challenges and successes of these age groups. The report identifies priority areas for action so that Canada can continue to support the transition of young Canadians into healthy and productive adults.

Why a report on the state of public health in Canada?

Canada's CPHO has a legislated responsibility to report annually to the Minister of Health and to Parliament through a report on the state of public health in Canada.^{Footnote 1} The Public Health Agency of Canada (PHAC) and the position of Canada's CPHO were established in 2004 to help protect and improve the health and safety of all Canadians.^{Footnote 1, Footnote 2} In December 2006, the Public Health Agency of Canada Act confirmed the Agency as a legal entity and further clarified the roles of the CPHO and the Agency (see the textbox "The role of Canada's Chief Public Health Officer" and the textbox "The role of the Public Health Agency of Canada").^{Footnote 1, Footnote 3}

The goals of the report

The goals of the CPHO's annual report are to highlight specific public health issues that the CPHO has determined warrant further discussion and action and to inform Canadians about the factors that contribute to improving health. This report does not represent Government of Canada policy and is not limited to reporting on federal or provincial/territorial activities. As such, it is not meant to be a framework for policy but rather a reflection of the CPHO's perspective, based on evidence, on the state of public health across the country. It examines the factors that have influenced the health and well-being of Canada's youth and young adults; it outlines proven and/or promising programs, activities, interventions and policies that can serve as models to inspire action and collaboration among multiple levels of government, jurisdictions, sectors, communities, organizations and individuals; and it identifies priority areas for action so that Canada can foster optimal conditions for health and development.

What is public health?

Public health is about preventing disease and optimizing health. The focus is on promoting and supporting the health of the public, rather than treating the illnesses of individuals. By helping to keep people healthy, the public health system can help to relieve some of the pressures on the hospital and acute health-care system.^{Footnote 4-6}

Public health includes:

• food, water and air quality, including health inspection services;
• promoting health-enhancing opportunities and behaviours (e.g. smoking cessation programs, healthy nutrition, prevention and treatment programs for drug and alcohol use);
• basic sanitation (e.g. sewage treatment);
• disease and injury prevention programs (e.g. vaccinations);
• monitoring, screening, diagnosis and reporting on risks and risk factors (e.g. surveillance of disease to detect outbreaks and identify risk factors for communicable diseases, such as influenza, as they occur in humans); and
• identifying and changing harmful community conditions and promoting safe communities (e.g. impact on health due to the lack of recreational areas, safe housing, education and child care).^{Footnote 5-8}

Public health also includes factors – both inside and outside the health-care system – that affect or determine our health. These include income and socio-economic status, social support networks, education and literacy, early childhood development and healthy workplaces.^{Footnote 9-14} The goal is to ensure everyone enjoys universal and equitable access to the basic conditions that are necessary to achieve health, whether those conditions fall within the public health system or outside of it.

Who is this report about?

Although this report focuses on the health and well-being of youth aged 12 to 19 years and young adults aged 20 to 29 years, it is relevant to all Canadians. Everyone has a role to play and everyone benefits from the creation of healthy environments. Adolescence and young adulthood is generally a time of good health and well-being; however, it is also a time of significant biological, psychological, economic and social transition. It is also a period during which most individuals establish lifelong attitudes and behaviours, setting the stage for their future health and well-being. Interventions that target youth and young adults can have a lasting impact on health, independence and meaningful and productive employment.

The role of Canada's Chief Public Health Officer

The Chief Public Health Officer (CPHO):

• is the deputy head responsible for the Public Health Agency of Canada (PHAC), reporting to the Minister of Health;
• is the federal government's lead public health professional, providing advice to the Minister of Health and the Government of Canada on health issues;
• manages PHAC's day-to-day activities;
• works with other governments, jurisdictions, agencies, organizations and countries on public health matters;
• speaks to Canadians, health professionals and stakeholders about issues affecting the population's health;
• is required by law to report annually to the Government of Canada on the state of public health in Canada; and
• can report on any public health issue as needed.^{Footnote 3}

In a public health emergency, such as an infectious disease outbreak or natural disaster, the CPHO:

• briefs and advises Canada's Minister of Health and others as appropriate;
• works with other departments, jurisdictions and countries, as well as with experts and elected officials, to deliver information to Canadians;
• directs PHAC staff as they plan and respond to the emergency; and
• co-ordinates with federal government scientists and experts, and with Canada's Provincial and Territorial Chief Medical Officers of Health, to share information and plan outbreak responses.^{Footnote 3}

This report refers to 'Canadians' to denote all people who reside within the geographical boundaries of the country. When data exist to support discussion about distinct population groups, the report uses specific terms to provide clarity, for example, 'Aboriginal,' which includes 'First Nations,' 'Inuit' and 'Métis.'^{Footnote 16} Throughout this report the generic terms 'youth' and 'young adult' are used. While there is no consistent definition for a youth or young adult, the terms are based on available data, health issues and public health activities that involve these age groups. For the purpose of this report, 'youth' will refer to adolescent boys and girls aged 12 to 19 years and 'young adult' to young men and women aged 20 to 29 years. When data are not available for these specific age ranges, it will be stated as being different for clarity.

What does the report cover?

The following identifies the chapters in this report and summarizes the topics covered within each of them.

Setting the stage for healthy life transitions – A public health history.
Chapter 2 introduces the concept of lifecourse and determinants of health as they relate to healthy transitions for youth and young adults. This chapter also explores changes in areas such as public health, education and employment.

The health and well-being of Canadian youth and young adults.
Chapter 3 provides a demographic profile of youth and young adults and examines the current physical and mental health status of this population. It looks at socio-economic determinants of health and their relationship with health status and well-being. It also describes risk-taking behaviours, including risky sexual behaviour and substance use and abuse.

Creating healthy transitions.
Chapter 4 highlights what can be done to maintain and improve the conditions faced by Canada's youth and young adults. It uses examples of interventions, programs and policies that have been proven and/or are promising in Canada and internationally. This chapter examines what is being done to address injuries, risky sexual practices, mental health problems and substance use and abuse for these age groups.

Moving forward – priority areas for action.
Chapter 5 summarizes the findings from preceding chapters, identifies strategies and defines priority areas for action. Based on these priorities, the report proposes recommendations and commitments for a healthy transition into young adulthood.

The role of the Public Health Agency of Canada

The Public Health Agency of Canada's primary goal is to strengthen Canada's capacity to protect and improve the health of Canadians and to help reduce pressures on the health-care system. The role of PHAC is to:

• promote health;
• prevent and control chronic diseases and injuries;
• prevent and control infectious diseases;
• prepare for and respond to public health emergencies;
• Serve as a central point for sharing Canada's expertise with the rest of the world;
• Apply international research and development to Canada's public health programs; and
• Strengthen intergovernmental collaboration on public health and facilitate national approaches to public health policy and planning.

The Agency works in collaboration with various levels of government, health stakeholders and other sectors to promote healthy lifestyle choices and protect Canadians from potential threats to their health.^{Footnote 26, Footnote 27}

Unite and Ignite Conference

This year, PHAC had the opportunity to participate in the 13th annual "Unite and Ignite" youth engagement conference, a partnership between Youth Centres des Jeunes Canada and the Student Commission of Canada, and led by the Centre of Excellence for Youth Engagement.

The conference brought together approximately 400 young people to discuss important issues facing youth in Canada today. The conference attendees were a diverse group of Canadian youth, including representatives from a variety of cultural heritages and different socio-economic backgrounds from urban and rural Canada.

Themes covered at this year's conference included youth homelessness, community youth engagement, community youth retention and attraction, substance use and abuse, action and prevention of youth suicide, bullying and Aboriginal youth perspectives.

The conference also included a session on this report. A presentation provided background information and included key highlights on youth health, focusing on mental health and mental illness, physical health, and health and risk-taking behaviours. These particular areas were discussed with all participants in small groups and youth provided their input and thoughts on the key topics featured in the 2011 Report.

It was important to engage youth in the development of this report as youth make tremendous contributions to the communities in which they live. Youth engagement is about empowering youth, giving them meaningful participation and involvement in decisions that affect their lives.

Participants gave their recommendations and final thoughts on the last day of the conference. Some key points of interest included discussions on the significant influence parents have on their children and the importance of good parenting skills and supports. Also discussed was that Aboriginal and non-Aboriginal people could gain a greater awareness of each other's culture through respect, understanding and communication. Also identified was the need for "honest," non-judgmental and stigma-free solutions-based education concerning substance use and abuse for youth and parents delivered by someone with first-hand experience.

These recommendations as well as the themes from the conference provided valuable input for the 2011 CPHO Report. The conference confirmed the importance of establishing initial good health and resilience as a healthy transition into adulthood. It is clear that for Canada as a society to move forward, building relationships between youth and adults will be about creating opportunities for communication and respect, and listening to young people's perspectives.^{Footnote 29}