Introduction: The Chief Public Health Officer's report on the state of public health in Canada 2008


The Public Health Agency of Canada was established in September 2004 to strengthen Canada’s capacity to protect and improve the health of Canadians and to help reduce pressures on the health care system. In 2006, the Public Health Agency of Canada Act confirmed the Agency as a legal entity and the appointment of a Chief Public Health Officer of Canada to speak to Canadians about important public health matters. It also established the legal requirement for the Chief Public Health Officer of Canada to report on the state of public health through an annual report.1

Goals of the report

Health Inequalities 
Health inequalities are differences in health status experienced by various individuals or groups in society. These can be the result of genetic and biological factors, choices made or by chance, but often they are because of unequal access to key factors that influence health like income, education, employment and social supports.

Health inequities refer to inequalities in health that are a result of socially influenceable factors (e.g. poverty, barriers to education or health care). These types of inequalities are deemed to be unfair or unjust.

This report generally uses the term health inequalities, recognizing that the equal distribution of health is an ideal, and that some health inequalities are also health inequities.2

The theme of this first report is health inequalities. It is intended to shed light on public health in Canada, the state of Canadians’ health, as well as the country’s successes and ongoing challenges in reducing health inequalities. It is intended to inform Canadians of the many factors that contribute to good health and what can be done individually and collectively to advance public health in Canada. Most of all, this document is designed to stimulate national discussion about what could be done. Ideally, it will encourage a broad dialogue on how health is viewed in society and how Canada, as a society, can achieve a balance between an effective health care system that meets society’s need for healing and broader public health activities that keep us from becoming sick or getting sicker. These are not competing ideas, but complementary ones.

As much as this report is a mechanism to increase awareness, it is also meant to inspire action to help create opportunities for all Canadians to be as healthy as they can be − mentally, physically and socially. It is hoped that this report will spur increased collaboration among Canada’s leaders, public health practitioners, employers, educators, researchers, community groups, the media and individuals to improve Canadians’ health and overall well-being.

Who this report is about

This report is about all Canadians, regardless of their age, sex, income or heritage. Throughout the report the term ‘Canadian’ is used to speak to all people who reside within the geographic boundaries of the country. In some instances, special terms are used to identify particular groups. The term ‘Aboriginal’ is used to refer collectively to all three constitutionally recognized groups − Indian, Inuit and Métis. Although not constitutionally recognized, the newer term ‘First Nation’ is used to describe Status Indians recognized under the federal Indian Act. When data exists to support discussion about these distinct population groups, specific details are provided for clarity.

What the report covers

As you read the report please take time to consider how you might answer some 
key questions:

Do these examples resonate and/or reflect actions that could be taken in your community (as individuals, politicians, business leaders, etc.)?

How can you participate in reducing health/social inequalities?

Where we have not achieved the best results possible, what are the barriers that remain? What have we, as Canadians, not done?

Who else could you work with to better address the challenges that remain?

What is public health? Chapter 2 provides an overview of the public health approach and the public health system, as well as the role they play in the health of Canadians. This chapter also offers examples of public health success stories and challenges to show the potential for improving the lives of Canadians.

Are Canadians Healthy? Chapter 3 discusses the health of Canadians, including leading causes of death, the prevalence of diseases and the impact of injuries. It also considers worrying trends that might impact Canadians’ future health and well-being. This includes a discussion of health inequalities that clearly underlines the fact that health outcomes and issues are not the same for everyone.

What factors influence our health and what is being done to address inequalities? Chapter 4 highlights how economic, social and personal factors, including income, education, early childhood development, health behaviours, health care and social support influence health. Differences in these factors that are most problematic and that can be influenced through social interventions are discussed. It also offers snapshots of various actions that have been undertaken across Canada to reduce social, economic and behavioural inequalities in order to improve health. These examples provide insight into who is affected, how effective Canada has been at addressing health inequalities as well as where the country may want to concentrate future efforts in this area.

What has been learned? And what are the challenges ahead? In Chapters 5 and 6, the lessons learned from previously discussed public health research, interventions and international and community level practices are discussed. Common elements that are important to addressing health inequalities are outlined. Within these common threads, gaps are identified where more work needs to be done. The report concludes with an invitation from Canada’s Chief Public Health Officer to move forward collaboratively, proactively and inter-sectorally to realize common goals for a healthy Canadian population.


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