Introduction: The Chief Public Health Officer's Report on the State of Public Health in Canada 2012


This report, the Chief Public Health Officer’s fifth on the state of public health in Canada, focuses on how sex and gender influence public health and the health status of Canadians.

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

Canada’s Chief Public Health Officer (CPHO) has a legislated responsibility to report annually to the Minister of Health and to Parliament on the state of public health.Footnote 1 (See the textbox “The Chief Public Health Officer’s Report on the State of Public Health in Canada”) 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 3 In 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.Footnote 1 (See the textbox “The role of Canada’s Chief Public Health Officer.”)

Public health is defined as the organized efforts of society to keep people healthy and prevent injury, illness and premature death. It is the combination of programs, services and policies that protect and promote health.Footnote 4

Public health is about optimizing, promoting and supporting the health of all Canadians through programs, services and policies.Footnote 5, Footnote 6 It involves collaborating across many sectors of society to identify and reduce stressors, risk-taking and other threats to health. By helping people have healthier, longer lives, the public health system can relieve some of the pressures on hospitals and the acute health care system.Footnote 5, Footnote 7-Footnote 9

Public health also involves influencing the factors inside and outside the health system that impact our health. Commonly referred to as the determinants of health, these factors include income and social status, social support networks, education and literacy, employment and working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender and culture, all of which affect Canadians throughout their lifecourse.Footnote 10, Footnote 11

The lifecourse model is a way to study the impact of physical and social exposures at various stages in life – from the prenatal period through to later life – on the health of people and the overall population.Footnote 12, Footnote 13

The lifecourse is a path that an individual follows from birth to death.Footnote 14 This path can change or evolve at any life stage (e.g. childhood, adolescence, young adulthood, mid-adulthood and later life) and varies from person to person depending on biological, behavioural, psychological and societal factors that interact to influence health outcomes of men, women, boys and girls.Footnote 14, Footnote 15 Life events, cultural norms and social roles and experiences also interact with different life stages resulting in various effects and outcomes.Footnote 16, Footnote 17 A lifecourse approach helps identify health trends and the links between exposures and outcomes. Applying a sex and gender lens to health can help identify the patterns and gaps in how both sex and gender influence people’s health status.Footnote 18 Interventions, including public policies, can then be targeted to address these trends and links to achieve optimal population health and well-being.Footnote 14, Footnote 19-Footnote 21

The goals of the report

The CPHO’s reports are intended to highlight specific public health issues that the CPHO has determined warrant further discussion and action in Canada. They also inform Canadians about the factors that contribute to improving their health. These reports do not represent Government of Canada policy; nor are they limited to reporting on federal or provincial/territorial activities. As such, they are not intended to be frameworks for policy but rather a reflection of the CPHO’s perspective, based on evidence, on the state of public health across the country. This particular report illustrates how sex and gender interact with each other and with other determinants of health to influence health, health behaviours and outcomes among Canadians; it outlines interventions, programs and policies that have maintained and improved the current and future health and well-being of Canadians; and it identifies priority areas for action where Canada as a society can better incorporate sex- and gender in public health to influence the effectiveness of health promotion and disease prevention efforts.

What this report is about

This report investigates how sex and gender affect the health of Canadians and highlights why they are relevant to all Canadians, regardless of their age, income or cultural background. It also considers the relevance of applying a sex and gender lens to research, programs, initiatives and policies that aim to achieve better health outcomes for all Canadians.

In developing this report, questions arose about whether there should be separate reports for women’s and for men’s health. However, it was felt that separate reports would be divisive and exclusionary. Instead, this report draws attention to sex- and gender-rooted health issues and health inequalities. This report is not meant to be a compendium of all issues related to sex and gender. Rather, the intention is to highlight examples of the progress Canada has made and the challenges that lie ahead in incorporating sex and gender into the development, implementation and evaluation of research, policies and programs in public health.

For the purposes of this report, “sex” refers to the biological characteristics (i.e. anatomy and physiology) that distinguish females and males, and “gender” to socially and culturally constructed roles, relationships, norms, beliefs, attitudes, personality traits, behaviours and values that society ascribes to men, women and gender minority individuals on a differential basis.Footnote 22, Footnote 216 However, it should be noted that there are no universally accepted definitions or easy separation of the terms. The Canadian Institutes of Health Research’s Institute of Gender and Health makes a social/biological distinction between gender and sex with the caveat that they are inter-related and potentially inseparable and that the definitions of sex and gender are evolving.Footnote 23 Readers of the Report should keep in mind that the terms “male,” “female,” “men” and “women” are used interchangeably as appropriate in each section.

What does the report cover?

This Report is organized into three distinct sections: The State of Public Health in Canada; Sex, Gender and the Health of Canadians; and A Path Forward.

The first part of the report describes the health and well-being of Canadians. Chapter 1, “The State of Public Health in Canada,” presents a demographic profile of the Canadian population and examines the current physical, mental health and sexual health of Canadians. 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 behaviours and substance use and abuse. Where possible, data is presented to illustrate the similarities and/or differences in health between individuals in Canada. This section is not intended to provide an analysis on how sex and gender impact health outcomes. Instead, it presents a high-level “snapshot” of health and well-being in Canada.

The second part of the report examines sex and gender and how they influence health and well-being of Canadians. Chapter 2, “Sex, Gender and Public Health,” introduces the concepts of sex and gender and how they are linked to health behaviours and outcomes, both directly and through their connection to the determinants of health. It also briefly explores sex- and gender-based analysis as a tool for analyzing how both sex and gender influence health. Chapter 3, “Sex, Gender and Health Outcomes,” uses specific examples in the areas of physical, mental and sexual health to illustrate how sex and gender impact health outcomes, including symptoms, treatment effects and access to care. It also explores the reasons why differences occur. Chapter 4, “Incorporating Sex and Gender into Health Interventions,” examines how sex and gender can be incorporated into the development of research, programs, initiatives and policies that influence health and well-being. The chapter provides examples of interventions, and discusses their efficacy in addressing sex and gender in health.

The third part of the report focuses on how Canada, as a society, can improve the health and well-being of Canadians. Chapter 5, “Sex, Gender and Public Health – A Path Forward,” summarizes the findings from preceding chapters, highlights priority areas for action, proposes recommendations and identifies strategies to better incorporate sex and gender into public health.

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 counterparts in other departments, jurisdictions and countries, as well as with experts and elected officials, to communicate with Canadians about how to protect themselves and their families;
  • delivers public health information to Canadians via media appearances, public statements, updates to the PHAC website, and columns and public advertisements in daily and community newspapers;
  • provides direction to PHAC staff, including medical professionals, scientists and epidemiologists, as they plan and respond to the emergency;
  • leads daily national teleconferences, as appropriate, with federal government scientists and experts to share information and plan outbreak responses; and
  • co-ordinates with jurisdictions through regular teleconferences with Canada's provincial and territorial Chief Medical Officers of Health and others.Footnote 3

The Chief Public Health Officer’s Report on the State of Public Health in Canada

As detailed in the Public Health Agency of Canada Act, the Chief Public Health Officer (CPHO) is required to submit an annual report on the state of public health in Canada to the Minister of Health within six months of the end of each fiscal year. Upon receipt, the Minister shall lay the report before Parliament on any of the first 15 days on which the House is sitting.Footnote 1

The PHAC Act specifies that the CPHO:

  • may prepare and publish reports on any issue related to public health;
  • may, in any report, refer to public health problems and their causes, as well as any measures that may, in his or her opinion, be effective in preventing or resolving those problems; and
  • must set out the source of the data and information used in the preparation of the report and methodology employed to arrive at the report’s findings, conclusions or recommendations.Footnote 1

The inaugural report, The CPHO’s Report on the State of Public Health in Canada, 2008: Addressing Health Inequalities, provided the CPHO with the opportunity to present an overview of public health in Canada, including the health status of Canadians, as well as the country’s successes and ongoing challenges in reducing health inequalities.Footnote 24

The CPHO’s Report on the State of Public Health in Canada, 2009: Growing Up Well – Priorities for a Healthy Future highlighted the health status of children ages 0 to 11 years, and focused on the importance of the early years on the long-term health of individuals and populations.Footnote 15

The CPHO’s Report on the State of Public Health in Canada, 2010: Growing Older – Adding Life to Years focused on the health status of Canada’s seniors ages 65 years and over. The report highlighted the fact that Canada’s seniors are living longer and that many are experiencing good overall health. The report described physical and mental health, economic and social well-being, access to care and services, and abuse and neglect as some of the main areas of seniors’ health and well-being.Footnote 25

The CPHO’s Report on the State of Public Health in Canada, 2011: Youth and Young Adults – Life in Transition focused on the health status of Canada’s youth (12 to 19 years) and young adults (20 to 29 years). The report identified factors that influence their health and how we can create the conditions necessary for young Canadians to transition into adulthood. The report highlighted this period of the lifecourse as it is a time of significant transition, where many life-long attitudes and behaviours are established, setting the stage for future health and well-being.Footnote 20

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